It's been a while...

Wow. My last post was in August 2014. Here we are a whole year and some later.
To update my readers (mostly my mom, who am I kidding) here is what has happened since:

• September 2014: Child #2 was born
• July 2015: Accepted into a PhD program (why not right? two kids under 4..)
• August 2015: Moved my clinic hours back to Duke and now am a full time Duke employee (my opinions and advice are my own however :) 

The aim of the blog: I hope to cover mostly physical therapy related stuff like best exercises for pathologies, simple running related tips etc. I may throw in a few things like how to manage this work life balance act (spoiler alert: there is no such thing as a balance) and then other stuff that my postpartum running moms would geek over, i.e. stroller reviews, planner reviews... I am obsessed with planners.

I want this to be a 2 min read... because that's how long I have before some one yells "mom." I hope to provide my readers with a Skimm style version of what they are trying to read (succinct, humorous and something you tell your girlfriends about).

Ok I think this is a good step towards 2016. Maybe this will help my rid my social media addiction.

Thanks cyber world!!
xoxo

Feet 101:

It seems to me that when people get injured i see a slew of the same type of injury or body part. This summer I have been lucky enough to have a bunch of feet to see at work! I am happy to report that my pregnancy nose has survived most of the stinky ones!

Feet are often injured because they have to compensate for the weak or tight hips, dysfunctional knees and tight IT bands. It’s common for someone with foot pain to find the cause further up the chain, but you can still do a lot to keep your feet healthy and pain-free. Here are some tips:

Stretch: The gastroc and soleus muscles in the back of your leg often try and do everyone’s job. Keep them quiet and happy. See the runner stretches below. They're so easy, you can even do them in line at the grocery store. 

Get your roll on: The plantar fascia at the bottom of your foot may get tight. Rolling on a tennis ball can often relieve tension and you get a free foot massage at the same time.

Learn a party trick: Then wow your friends by picking up bottle caps with your feet and dropping them in a jar. Strengthening the feet can help fix common problems like flat arches and heel pain. Next time you have to pick up after your kids do it with your toes!

Hide your Achilles heel: Strong calves can help prevent tendinopathies. If you cannot do 25 calf raises with no issues on one foot, it is probably time to work on that. To challenge the range of motion, you can always hang off a step.

Stretching 101: Making the warm up and cool down easy!

All too often runners are perplexed when they try to design their own warm up and cool down. We all face the difficult task of fitting our long run around the family's schedule or sneaking in a short one at lunch break. To add a 10 minute warm up and adequate cool down after can be a daunting task, but it can help prevent overuse injuries. Here are some tips to minimize the thinking and motivate you to do it:

Dynamic warm up:

1. Count it in your mileage. As you do your knee ups and butt kicks, keep moving forward. This will help you get warm and not worry about "adding" more to your already busy day.

2. Walking doesn't count. Hip swings, side stepping and lunges hit a variety of muscles that walking alone may not warm up. Get your body ready for the ballistic nature of running.

3. Warm up before you head out. If rolling on the ground at the track or in front of the neighbors is embarrassing, do it in your living room before you head out. After you drive to your local running spot, be sure to do a few minutes of warm up when you get there.

4. Make it a priority. Warming up and cooling down may save you some money that you would usually spend at the chiropractor, massage therapist or physical therapist! One trip to a PT or chiro could cost as much as a new pair of shoes!

5. Still lost? Try this. One of the best dynamic warm ups that I like to give my patients is Lesley Paterson's 10-minute dynamic warm up. There is also a group of high level runners using Meb Keflezighi's active isolated flexibility routine as a dynamic warm up. Coach Jay Johnson also has some tips here.


Cool Down:

1. Get back to normal length. After using your muscles for a certain number of miles where they are contracting extensively to help you move, it is important to restore the length. This can prevent injury, as muscles are not staying shortened over the course of time and pulling on tendons/bone.

2. Do it whenever. My husband regularly performs his stretching routine after brushing his teeth. It is part of the routine and he claims that it relaxes his muscles and helps him sleep better. Whether you read or watch TV at night, make it a part of you daily routine. Whenever you have 10 free minutes post work out, be it before you have to get the kids, before you step in the shower or while you wait for your pasta to cook, do it then.

3. Don't stretch a cold muscle. If you have been walking around the house then you can stretch. If you have been sitting, ease into the stretches gently. Remember - we're trying to prevent injuries, not cause them.

4. Enjoy it. Use this time to do some relaxation exercises, visualization or reflection in your head. Sports psychologists encourage the relaxation technique where you concentrate on the muscles relaxing completely by thinking about the tension leaving each muscle (start at your foot and move up your leg).

5. Still lost? Try this. If you are a very tight person, static stretching that involves holding a stretch for a long period of time may be a good idea. Some ideas of what can be found here. If you are the type who could do all the obnoxious moves in your very first yoga class (i.e. naturally flexible), then foam rolling to target just the tight muscles may be the way to go. Proaxis Therapy has a great foam rolling handout that walks you through the process. For specific tight knots and trigger points tennis balls, lacrosse balls and baseballs can also be used instead of a foam roll. Stay away from bones or anything that feels like a nerve (burning, stabbing, shooting pain).

Core exercises with the swiss ball

Last month we targeted exercises for the weak hips (glute maximus and minimus). This month we focus on the core muscles, as they are another important muscle group to target. For starters, pulling your belly button in and tightening all your abs (lower and upper) is a sure way to make sure they are on. Make sure your pelvis is not rotated forward or back, and is leveled, while you are tightening your core.

Below are some swiss ball exercises that have been seen to have great upper and lower abdominus activation compared to other exercises out there.

1. Swiss ball pike: 

Starting position (make sure tummy is pulled in pelvis is neutral)

Ending position

 2. Swiss ball roll out

Starting Position (Pull in belly button)

Roll out the ball with your abs controlling the ball and pull back in to starting position!

Start with 2-3 sets of 6- 8 reps and build to 2-3 sets of 15-20. Make sure you feel your abs getting tired and not your back. These exercises have been seen to be better than crunches, side sit ups etc in a research study 

Enjoy!! 

(Escamilla RF, Lewis C, Bell D, Bramblet G, Daffron J, Lambert S, Pecson A,Imamura R, Paulos L, Andrews JR. Core muscle activation during Swiss ball and traditional abdominal exercises. J Orthop Sports Phys Ther. 2010 May;40(5):265-76)

Best bang for your buck...or should i say butt

Strength exercises have often been prescribed to help runners with speed and power as well as injury prevention. There are many exercises out there but not many with the best “bang for your buck”. This month I highlight 3 exercises that will help you get stronger. These exercises have been seen to have the best glute firing (under EMG).

1    1. Single Leg Squat - Running is nothing but doing and plyometric squat on one leg and then switching to the other, therefore this exercise is highly recommended. 

-    

•     Stand on one leg 
•     Sit back like you are going to sit on the toilet, you can let your chest come forward (just make sure your are not arching your back- suck in that belly)
•     Make sure your hip, knee and foot are in line. If your muscles can't do it hold on to the door frame 
•     As you lower yourself sit back into your hip and squeeze the glutes on the way up
•     Start with 3x 8 and build to 3x 15-20 as you get stronger (make sure your glutes are doing the work not the quads) 

    2. Single Leg Dead lift: The single leg dead lift is similar to the squat however your are reaching down and squeezing your glutes up with less to no knee bend in the knee 

•     Stand on one leg 
•     Keeping your back in neutral core tight bend forward at your hips (not waist) 
•     Squeeze your glutes as you come up 
•     If you are too unstable or cannot maintain hip knee and foot alignment hold on to something 
•     Make sure your feel the glutes more than the hamstrings/ quads
•     Start with 3x 8 and build to 3x 15-20 as you get stronger (make sure your glutes are doing the work not the quads)    

3.  Transverse Lunge: Is like a regular lunge but your foot reaches diagonally backwards to purposely stick out your hip needing you to squeeze the glutes to bring it back to neutral 

•     Stand on both legs
•     Reach diagonally back with the leg you are not working, sit back into your hips
•     Squeeze your glutes and bring the other leg back to neutral
•     Start with 3x 8 and build to 3x 15-20 as you get stronger (make sure your glutes are doing the work not the quads)  

Searching for Booty

I write a column for a local magazine, Endurance Magazine, that targets an Endurance athlete readership. It is a great magazine where you can always find useful articles. Below is an article on strengthening. Make sure your MD is okay with you doing these exercises especially if you are pre or post partum!

 

Dear Doc,

Training takes a lot of time. I want to be stronger & more efficient, but still have time to swim, bike and run. What couple of exercises can you recommend that will give me the most bang for my buck for improving form & preventing injury?
Sincerely,
FJ, Wilmington NC

 

Dear FJ,

We could fill up the entire magazine with pages answering this question, but the single best advice is glute strengthening. The glutes play a critical role in maintaining hip stability in multiple planes. I consider them an essential and often overlooked part of the core. Due to a lack of awareness and inability to activate, many people have weak glutes. You should definitely activate and strengthen your glutes this offseason!

The two exercises we recommend are the single leg bridge and the running man. The bridge focuses on single leg strengthening and stability on the mat while the running man is performed in a weight bearing position specific to running. Before you start either exercise, you must know how to contract the correct muscles. Otherwise you could compensate with other muscles that are already overworked.

Single leg Bridge

1.       Lay on your back, knees bent, one leg in the air

2.       Pull in your lower abs and squeeze your glutes

3.       Then, push your hips towards ceiling.

4.       When your hips are elevated, the foot, knee and hip of the working leg should remain in a straight line. This ensures the glutes are on and active through the movement.

5.       If you feel this in your back, hamstrings, calfs or quadriceps you may be compensating incorrectly. In that case, perform the movement with both feet on the floor and progress to the single-leg version once you can really isolate the glutes.

6.       Start with 3 sets of 8 reps for each leg and build to 3 sets of 20.

Feel the burn!

 

Running Man

1.       Begin with your right foot forward and your left foot back. Your left toes should be in line with the right heel.

2.       Squeeze glutes and pull in abs

3.       Bring the left knee up 45 degrees, just like you would when you run, and return.

4.       When your knee is elevated, the foot, knee and hip of the opposite (working) leg should remain in a straight line. This ensures the glutes are on and active through the movement. If possible, perform the exercise in front of a mirror.

5.       Start with 3 sets of 8 reps for each leg and build to 3 sets of 20.

 

Shefali Christopher PT, DPT, SCS, LAT, ATC  works for Proaxis Therapy at Southpoint and Carrboro. She is an endurance athlete and ironman finisher who recently dressed up like a pirate for Halloween to illustrate her love for booty. In her spare time, she can be found analyzing her one-year-old son’s running gait.

Screen yourself!

After you have a baby in Germany, the new mom gets 4 visits with the physical therapist! New Zealand also has similar care. New moms should see a PT that works with women's health or sports. Blogger Kate Hall writes the PT "can help with diastasis (abdominal separation), posture, and pelvic floor strength and suggests appropriate exercises.  These interventions often result in reduced incontinence, back pain and diastasis, and provide a faster return to normal posture and body mechanics, including sexual intercourse". There are definitely valuable tips they can give you. If you are looking for someone close to you visit the APTA site.

My biggest tip is give an injury no more than 2 weeks to heal on its own. If you can't run/exercise without pain after 2 weeks, it's time to see a medical professional. In my biased opinion, you should see your physical therapist because we are the musculoskeletal expert.

If you are not injured and  just want to screen yourself, you can test yourself. Physical therapists use tests like 'single leg squat' to see what a patient's overall strength and flexibility look like.

• Give your cell phone on video mode to someone
•  do 5 squats on just the right leg (just small baby squats- if they hurt STOP).
• Now do the same on the left. Stop reading till you have the video on-hand because if you know what it's suppose to look like, you might cheat.
  
  Look at your video, freeze the frame, and see if your hip, knee and foot are alingned. Watch for any rolling in or out (pronation/ supination) at your feet or any leaning at your trunk (shoulder in line with foot?). Basically, things should line up and if they don't, you might want to further investigate why
  

Good..shoulder, hip, knee and foot in line

Not so good..this is how your left foot lands during your run!

(knee rotating in, pronating foot, hip out, shoulder out)

Not so good..foot out, knee rotating out, hip in, shoulder in

Did the test generate more questions than answers? Is it weakness or tightness? Most women are flexible and the poor alignment happens due to weakness, especially post-baby. The posts to follow will walk you through my recommendations.

Got questions? email me ShefaliChristopher at gmail dot com :)