Name: Liz Makofsky
City/State: Sammamish, WA
Primary sport: Triathlon
How many years in the sport: 5
What Zeren PT and Performance services have you used? I started seeing Chris for physical therapy then hired him as my triathlon coach shortly after being discharged from physical therapy.
Describe your athletic background and how you discovered your current sport? My dad ran competitively throughout my childhood and ultimately got into triathlon, so I was exposed to triathlon at an early age. I ran cross country in high school then ran very intermittently until my mid 30s. At that point, I started to run more regularly, but was sidelined with numerous injuries including knee surgery. I completed a couple of sprint triathlons as a way of incorporating some cross training, but didn’t stick with it. A couple of years later, my husband and I went to Kona to watch a friend compete in the Ironman World Championships. We went back to watch the following year as well. Inspired by all the athletes and curious how the human body can tackle 140.6 miles in one day, I signed up for and completed Ironman Coeur D’alene that following year.
What keeps you training and racing in your current sport? I like to push my body to see how much stronger and faster I can get. I’m motivated by seeing progress, even in training and I actually prefer to train than to race. I’ve met some of my closest friends through training and I love traveling with them and my family to destination races.
What are your go to Zeren PT exercise videos? I do whatever exercises Chris puts on my schedule. I tend to add to his list if I’m feeling a niggle or weakness somewhere. So if my neck or shoulders are bothering me, I do single leg shoulder extensions (sometimes raising onto my toes) and marching with a band (w’s). So I start almost all strength sessions with simple marching. I have discovered that Chris’ hip airplane drill helps me as does the marching matrix and lateral side step with a band above my knees. And, Chris once showed me an exercise that he called the hip thruster. He didn’t know until now, but I like to do that one frequently. I do it at home with my shoulders on a stability ball, black band above my knees and a homemade slosh beam across my low abdomen. It’s a good one!
Do you have kids? Yes, two boys -- 10 ½ and 13...very 13. :)
How does having kids affect your training? How do you balance it all? I feel fortunate to be a stay-at-home mom which affords me the time during the weekdays to get my training done while the boys are at school. The weekends tend to be a little more tricky. My husband, Steve, also trains for triathlons so we frequently trade off. One of us might get up and out the door early on the weekends while the other hangs with the boys. Then we swap in the late morning or early afternoon. I think that Steve and I both are pretty flexible on when and how we get our training done, as long as it happens. Actually, Steve is much more flexible than I am. Somehow, we make it work. Our boys have been incredibly patient and good sports about supporting us, so a lot of credit should go to them as well. They do get bored watching the races, but at least they tend to get cool (and warm!) vacations out of the deal.
What advice do you have for other athletes who struggle to balance training with family? It can be challenging and each family dynamic and schedule is very different. Communication and flexibility with timing workouts to work into a family’s schedule are critical. Sometimes life happens and I have to change my training plan to accommodate my family. I’m not always happy about it, but going with the flow is what enables me to be able to keep training and racing.
How do you balance your training with your partner? Any tips or tricks for keeping your partner happy while you train to reach your personal goals? Steve makes this very easy for me as he is incredibly supportive. As I mentioned above, we trade off workout times on the weekends and try to remain flexible as life happens. Sometimes we both feel selfish taking so much time for ourselves and away from “family time”. I try to make sure to stay on top of my responsibilities, chores, and the little requests that are important to Steve and the boys so they are happy while I am away.
What are your top tips for athletes, as it relates to staying happy, healthy and performing well? Hmmmm. I’m not sure I’m qualified to answer this one as I’m really still learning. For me, remaining consistent with my training seems to keep me strong and injury-free. I try to communicate to Chris ahead of time when I’m traveling or if I have a particularly stressful time. He is able to program shorter workouts that are appropriate to where I am. Even if I don’t want to hit the treadmill on a trip to Disney, I’ve found that I not only maintain my fitness better, but I tend to get less stiff and achey. Even more important, I can pick up my training right where I left off before the trip or modification without missing a beat.
How would you define athletic success as it relates to your personal journey? I constantly set little goals throughout training and racing and meeting each one is a success. That said, I’m constantly setting the bar higher for myself and trying to push for more. I usually acknowledge an accomplishment and have a new goal set almost simultaneously. I’m not sure if that is good or bad. :)
What's your favorite post-race meal, drink or food? Mexican food. I love chips and guacamole!
What key races do you have planned in 2017? Right now I’m only signed up for Santa Rosa 70.3. I’m also eyeing Ohio 70.3 and possibly Los Cabos 70.3 or another fall race.
What are your athletic goals for the next 5 years? I am focusing on half iron distance races and trying to get faster. I would love to qualify for worlds (South Africa?!! Nice?!! Location, location, location!), but have a lot of work to do to make that happen.
This video demonstration provides a simple variation of the mountain climber drill using the Redcord suspension system with a bit of run spin. I like this drill and routinely prescribe it for the following reasons.
When it comes to retraining one's running gait, one of the simplest interventions is to have the runner increase their step rate by 5-10%. Although increasing one's cadence will not necessarily make you a better runner, and is by no means a panacea to address common running related injuries (RRIs), it does yield a myriad of benefits. Increasing one's cadence should be considered in the context of a runner presenting with patellofemoral pain and iliotibial band syndrome, or to reduce moments at the level of the hips in the frontal & transverse planes. Ultimately, if you think a runner's problem stems from overstriding, consider having them turn their feet over faster.
Next time you find yourself at the gym, take a moment to walk by the row of treadmills and make a note of the spectrum of sounds people make when contacting the ground/belt with their feet. Some folks will sound like they are landing on pillows, while others may sound like they are taking part in an elephant stampede. One of the simplest and most effective cues that I often use in addressing one's running gait is to "land like a ninja." We must not forget, however, that the faster you run, the harder you hit the ground. At day's end, however, it's overstriking that gets recreational runners into trouble.
Sometimes, having runners simply take their shoes and socks off can be a great way to enrich the sensory experience of running while reducing the vertical loading rate at impact. Before entertaining such an idea, however, one must take the time to screen the runner's feet to ensure that there are no open wounds that are at risk of becoming infected. Additionally, considering that folks tend to adopt a forefoot strike pattern, which biases the load to the forefoot and calf muscle complex, exercise caution against putting runners barefoot, who have a history of calf strains, metatarsal stress fractures, or dealing with a reactive achilles tendinopathy.
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Perhaps one of the greatest mistakes that we can make as rehab professionals is to treat a runner, who is dealing with a pain problem, as if they have a tissue injury, when in fact they don't. Oftentimes, pain is more about sensitivity than it is true tissue injury. It is therefore critical to distinguish between the two if you hope to engender an optimal outcome. I'd also like to remind you that most runners are not chronic pain patients, but rather, highly motivated individuals, who have been mismanaged and are desperate to return to training to avoid an identity crisis.
In certain cases, runners will present with legitimate tissue injuries. For example, if a runner strains their calf or hamstring, we must honor healing timeframes to avoid over stressing the site of repair while progressively loading them to adequately prepare them to withstand the performance demands of running. Failure to correctly identify and treat a runner presenting with a true tissue will only prolong one's recovery and perhaps worsen their condition.
Understanding how to assess a joint is an important skill to master as a rehab professional. To highlight the importance of joint play, we need to look no further than a lateral ankle sprain, which is a common injury, that routinely goes untreated, and can lead to various sequelae. One of the residual effects of an ankle sprain is joint stiffness at the level of the talocrural joint, which can lead to a loss of ankle dorsiflexion and compensatory motion. Possessing the ability to assess and treat such an impairment is therefore critical to foster improved outcomes among runners.
Never overlook equipment issues. Fortunately, when it comes to running there are relatively few equipment needs beyond shoes, socks, shorts, and a t-shirt or sports bra. Even then, not all of these items are necessary. In the event that you elect to wear shoes, make sure to take the time to screen them for potential defects or premature wear. As you can see from the this pic, the left shoe lacks symmetry. Imagine if a clinician did not correctly identify this defect and started blaming a runner's complaint on some other factor that had no bearing on the situation?
If there is one thing that a recreational runner would benefit from, it's improving their comprehensive capacity. This is most easily accomplished through some basic resistance training, and taking runners out of the sagittal plane. The bottom line is that developing capacity is not only important when it comes to running, but also to get you through the day without issues. And please don't worry that you are going to bulk up from engaging in resistance training, as there is no evidence to suggest that this occurs.
One of the first questions that I ask ALL runners seeking my services is, "What do you understand your problem to be?" I never cease to be amazed by the responses I get. In the vast majority of cases, runners have subscribed to misinformation that only serves to make their situation worse. By no means am I claiming to have all the answers, though there is a lot of credible evidence that we should apply to ensure that runners have the "least wrong" understanding of their situation. Some great examples of misinformation relate to footwear, pronation, and foot strike pattern.
HABITS HABITS HABITS! This is the last and most important aspect to address in working with injured runners. Invariably training errors account for a large percentage of running related injuries. As the saying goes, "We live and die by our habits." The same applies to running. At day's end, adopting good decision making skills and healthy habits, particularly in the context of challenging times, lies at the heart of consistent and healthy running.
Over the past couple days, I have performed a handful of physical therapy consultations with runners, who have "failed" conservative management, yet were desperate to get back to running. In typical fashion, I asked what they were doing as part of their home program. Invariably, it was some combination of foam rolling, stretching, and non-weightbearing progressive resistance exercises (PREs) targeting the hip. It's no wonder that they were struggling to return to healthy running, because all of these programs were not preparing the runner for the performance demands of the sport. So, I thought it was time to go back to the drawing board and review some basic characteristics and fundamentals of running. Hopefully, these will guide you the next time an injured runner walks into your facility. To accomplish this, we need need to look no further than the word R.U.N.
Everyday, I receive an email or message from a recent physical therapy graduate, who is looking for guidance in terms of refining their approach to working with runners, or looking to establish themselves as a running rehab specialist. Although it takes time to master any craft, I thought it would be helpful to share a few pieces of advice/reminders to put you on the right path. By no means is this a comprehensive list, but rather, some simple suggestions that have helped me over the years. Lastly, it's critical to bear in mind that your ability as a runner has relatively little impact on your ability as a therapist, so never confuse the two.
READ ONE JOURNAL ARTICLE PER WEEK
"Everyone is entitled to his own opinion, but not to his own facts." -Daniel Moynihan-
Having spent considerable time in the research lab at the University of Delaware, in addition to working as a research assistant and PT at the Nicholas Institute of Sports Medicine & Athletic Trauma (NISMAT), I had no choice but to immerse myself in the literature. Dr. Malachy McHugh, who is the current Director of Research at NISMAT, used to always remind me that clinical decisions should be driven by evidence rather than belief. So, if you want to be taken seriously, it's important to speak in denominators.
CONNECT WITH A RUNNING COACH
"A coach is someone who tells you what you don't want to hear, who has you see what you don't want to see, so you can be who you have always known you could be."
There are some amazing coaches in the world of running. Chances are that there is even one in your town. Find out who they are and ask to train with their group if they are taking on new members. Otherwise, see if you can get them out for a coffee or a drink. Believe me, they could all use a good PT and will never turn down an opportunity to talk shop.
HANG OUT AT THE LOCAL TRACK
"You can observe a lot by just watching"
One of the best ways to learn more about running is to simply spend time at the local track watching runners train and race. You will see runners of all shapes, sizes, ages, and abilities while getting immersed in the running culture. And please don't be shy! Introduce yourself and tell people what you do from a professional standpoint. Considering the high incidence of running related injuries (RRIs), chances are that you will make some friends ;-)
SPEND TIME WITH STRONG PEOPLE
"If there's one thing that runners should do beyond running, it's strength train." - Gregory Lehman
When looking at the available body of research, it's become readily apparent that strength training plays an invaluable role in safeguarding against injury while improving running economy. Although the vast majority of runners are concerned that they will only put on mass or risk injury, this is a myth. So find the strongest people and the most well respected strength coaches in your area and connect with them. Remember, "you don't earn strength, you learn strength."
INFUSE PAIN SCIENCE & MI
"Innovation is not about tricks, gimmicks, and products. It's about behavior change!" -Al Smith-
The most brilliant clinicians I know possess an uncanny ability to weave pain science and motivational interviewing (MI) into their care. Irrespective of what approach or system you follow, it will be far more effective if you are able to help patients re-conceptualize their situation while facilitating positive behavioral change. That is where the true magic of our profession lies. So, if you are ever looking to take a con ed course, pick one related to pain science and/or MI.
E-BOOK for RUNNERS