Runners, Stop Making This Mistake in Your Training

According to the research, the chances of having a knee injury increase significantly after running for 1000 hours.

Most serious runners pass the 1000-hour mark within 1 year and end up in performance physical therapy clinics like CHP!

Does this mean that “bad knees” are inevitable once you choose to run? No, but it does mean that you must learn how to take care of them.

Running consists of thousands of strides repeated over and over. As a result, any problems with your running technique will add up, potentially contributing to injury.

Even if you are not a serious runner, you are likely approaching the 1000-hour running mark.

Does this mean that you are a ticking time bomb, ready to explode? Probably not if you are strength training and working on improving your running technique.

Strength Training

Implementing strength training into a consistent exercise routine has been shown to make you a more efficient runner. This means that you use less energy to run a given amount of time and as a result, are less fatigued. Less fatigue=less risk of injury. For this reason, becoming a more efficient runner is an essential part of the sports physical therapy process.

Research also shows that regular strength training improves a runner’s speed and VO2 max. VO2 max is a measure of the amount of oxygen that you can use during exercise. When you can use more oxygen as you run, you will run farther, faster!

Just remember, every runner is unique. Even if you have a running partner with the same routine, you both have unique characteristics and needs to address in a strength training program. Your strength training program must be unique to you. Cookie cutter programs don’t cut it!

Running Technique

Think of the last time that you went out for a run. Were you thinking about every stride you took? Were you aware of your foot strike? I highly doubt it!

Running is an automatic pattern that does not require conscious thought to perform. Most people listen to music or podcasts. We couldn’t do that if we needed to focus on how to run.

Unfortunately, this also means that you may be repeating the same bad pattern over and over without realizing your mistake, until it is too late. One of the most common mistakes occurs with a runners foot strike position. Runners often contact the ground in front of the body which puts more stress on the body.

Foot strike position is dependent on your body dimensions (such as limb length).

We can’t change your anatomy, but we can change the position, aka the posture, of our bodies. This is often the first step of the physical therapy process for a runner!

A “stacked” posture will change your foot strike so that it occurs directly underneath the body. This results in a more efficient stride and less stress to the body. To learn about the stack, check out a previous article that I wrote on Learn to Stack Like a Snowman.

Attempt the drill below to feel what it is like to have a stacked posture while running.

Grab a partner and ask him/her/they to stand behind you (you are also standing)
Have your partner press down on your shoulders with a moderate amount of force and do not let them squish you
As you resist them you should feel your abs engage and feel as if you are standing tall
Next, attempt to shift your weight onto 1 leg and pick up your opposite foot while resisting the force of your partner
Try the other leg

For a video on this drill, click here.

After performing this drill, you should have a better sense of your optimal running posture. Try to replicate this feeling the next time you go on a run!

This Made Me Roll My Eyes

The medical profession, sports physical therapy included, is good at giving out bandaids.

To illustrate this point, let me tell you a story about my best friend. He lives in LA and takes advantage of all it has to offer. The guy can’t sit still. He hops in the ocean to go open water swimming in the morning and goes on hikes or trail runs in the evenings/weekends. 75 degrees and sunny every day must be nice…

On another beautiful, 75-degree day, he was running on a dirt trail to the top of Runyon Canyon and suddenly felt a sharp pain in the inside of his right knee. As he kept running, the pain increased. He decided to turn around, limp down the trail, and make an appointment with his Doctor. He saw his Doctor the next week and was told to take Advil and “take it easy”. This was when he called his favorite performance physical therapist…

My friend has known me since I was 10 years old and could feel me rolling my eyes.

Have you ever been told only to rest as a solution to an injury? This isn’t bad advice but it is a band-aid. It stops the bleeding without solving the reason the bleeding is occurring in the first place!

Pain occurs when the amount of stress placed upon the body exceeds the body’s tolerance of it.

So what is causing this stress to accumulate? It could be over-training, insufficient sleep, poor nutrition or a variety of other factors. Most likely it is a combination of many different things.

The root cause of pain must be addressed if you hope to feel better, stay better, and exercise consistently.

It is essential for your Doctor or Performance Physical Therapist to answer these questions and provide a plan to address them. If you are ready to finally solve the root causes of your pain and injury, contact us now!

For Weekend Warriors Wanting to Avoid Knee Surgery

I probably don’t need to tell you this, but the best surgery is the one that is avoided. Disclaimer, as a sports physical therapist, I am a bit biased!

After knee surgery, your knee is not the same. Tissue may have been removed or artificial parts/pieces may have been put in. Regardless of the procedure, the skin was cut open, scar tissue formed, and time is needed time to heal.

This impacts the function of your knee and your ability to run and exercise as you had previously.

Now, I am not saying that surgery should never happen. What I’m saying is that it should be a last resort.

In my 12+ years working as a sports physical therapist, I have learned that people commonly have knee surgeries when there are things they can do to delay or avoid them altogether.

In many situations, the knee cannot handle the stress required of it for sports or your active lifestyle. As physical therapists, we commonly prescribe exercises that train the knee to handle all of that stress. In other instances, the knees are dealing with too much stress because another area isn’t doing its job. A thorough sports physical therapy assessment will determine what these areas are so that a comprehensive plan can be prescribed to fix it.

Whatever the reason is, a sports physical therapy assessment may be the secret sauce to finally solving your knee pain and avoiding the surgery you have been worried about! To schedule that, contact us today!

What’s the deal with my ankle popping?

When your knuckles pop, your ankle cracks, or your hip makes that strange noise, do you ever wonder, “Is that bad?” Should you see a sports physical therapist or doctor about it?

Well, there’s no need to worry—it’s probably not a big deal if you’re not experiencing any pain when it happens.

I have this quirky habit every morning as soon as I get out of bed. I keep my right heel on the floor and move my knee over my toes until I feel and hear a pop in the back of my heel. It freaks out my wife, Deb, every time.

The cracking or popping in a joint is similar to the sound of pressure being released from a soda bottle. Over time, pressure builds up within a joint, and for some people, it feels good to release it. That’s the noise you’re feeling and hearing.

However, if you experience pain when the pop occurs or if the area feels unstable, it’s important to reach out to us. We can help determine the root cause of these issues and whether any treatment is necessary.

We’ll assess if your pain is related to arthritis, overuse, or another movement-related issue that we can address through physical therapy, with exercises you can do at home.

Here are a few questions to ask yourself. If you answer “yes” to any of these, it might be time to seek help:

1) Is the popping I feel painful?
2) Has there been a recent injury to this area?
3) Does this area feel unstable?
4) Do I have weakness in this area?

You might not even need to visit the office—a phone call could be enough. Check out our homepage here and click on the “free phone consultation” tab!

Stop Standing Straight

“Stand up straight!”

If your parents were anything like mine, you heard that growing up and when I started my career as a physical therapist, I assumed that I would be telling my patients to do the same.

However, that has not been the case.

As a sports physical therapist here in Bethesda, I find this cue to be detrimental to how the body functions. In fact, correcting the need to stand up straight has been one of the most helpful suggestions during physical therapy sessions and throughout the injury rehabilitation process.

Standing up straight causes you to pull your shoulder blades down and back, which limits the amount of movement available to your shoulder blades. The shoulder blades are meant to elevate and abduct (move apart) as the arm is moving away from the body. Just try to keep your shoulder blades down and back as your reach for something!

The cue to stand up straight also commonly causes people to arch their back and tip their pelvis forward. This position places increased strain on the lower back and pelvis, while limiting the amount of motion that is available at the hips.

Correcting this posture is of particular importance for athletes. Every sport has an amount of movement that is necessary to perform it. Golf requires a large amount of rotation at the hips, serving a tennis ball requires a great deal of shoulder flexion, and sprinting requires lot of hip extension.

“Standing up straight” while performing these activities will limit the movements necessary to perform these activities and can often lead to injuries.

This is not to say that this cue is a bad thing. However, it is important to understand when this cue is helpful and when it is not.

Cues like “standing up straight” may work for drills such as deadlifts, rows, and farmers carries, however it is useful to forget this cue for other activities and when attempting to correct your posture!

What Stretch Should You Be Doing?

Ten years ago, flexibility and stretching were all the rage, as well as a large component of the standard course of treatment in sports physical therapy. Many people had stretching in their daily routines, either as an athlete being told to stretch before and after practice from a coach, in a yoga studio by an instructor, or by a physical therapist in order to decrease pain. Now, the phrase “mobility” has been posted everywhere. “How to increase hip mobility to help improve your deadlift”, “Stretching Routines for Runners” and “is your ankle mobility plateauing your squat depth?” headlines can be seen from instagram and tiktok to google ads. But what is the difference between the two? Are they the same thing? What happened to the importance of stretching?

For starters, stretching or flexibility is the ability for a person to get into a position passively keeping one joint in mind. So if you want to bend down, are your hamstrings flexible and stretched out enough for you to touch your toes? To improve your flexibility, you stretch or lengthen your muscles to be able to achieve a goal.

On the other hand, mobility is the amount of active movement you have to reach a goal. For example with the “is your ankle mobility plateauing your squat depth” headline, can your ankle move enough and allow you to achieve a lower squat at your knees and your hips? To improve mobility, you typically need to target the joint itself, rather than the muscle tightness limiting a movement in stretching, in order to create more space for the bones to move on each other.

So how do you know if you cannot touch your toes due to muscle limitations, like in flexibility restrictions, or due to mobility issues? Like most questions in the physical therapy world, the answer is it depends. Physical therapists have a series of tests that can determine if the joint is unable to achieve a desired position due to muscle stiffness, joint tightness or an inability to control the motion that the body already has.

Below is an assessment and exercise that we use for many of our patients experiencing back pain. This helps us to determine the movement capabilities of the spine, including where it may be moving too much and/or not enough.

Once you figure out where your limitations are coming from, it is time to determine if you need to improve them. While these are hard questions to answer in a blog post, this is something that a physical therapist can help you distinguish by using various tests.

If this sounds like something you are interested in learning more about, contact us to receive a customized exercise program to improve either your flexibility or mobility (or both!).