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R.U.N. as an Acronym to Better Understand Running

11/17/2015

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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. 
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"R"

Running is a repetitive, rhythmic activity. 
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"U"
 
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Running involves unilateral  loading & 
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being
upright.
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"N"

Runners are never in contact with both feet at the same time so they need to tolerate unilateral, plyometric activities.
​
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5 Pieces of Advice for New PT Grads Looking to Work with Injured Runners

11/13/2015

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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
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"Everyone is entitled to his own opinion, but not to his own facts." -Daniel Moynihan-
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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
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"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."
-Tom Landry-

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

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 "You can observe a lot by just watching" 
-Yogi Berra-

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
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"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 
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"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. 
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Five Frontal Plane Exercises for Runners to Master

11/10/2015

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When it comes to running related injuries (RRIs), the frontal plane receives considerable attention, especially among recreational female distance runners. A good chunk of research over the past several years has particularly focused on peak hip adduction and contralateral pelvic drop (CPD) during the stance phase of running. So, I thought it would be helpful to share a group of exercises that I routinely use to challenge runners in the frontal plane. My primary goal in prescribing these exercises is to simply challenge runners outside of the sagittal plane while building capacity and exposing them to more variable loads. It should also be mentioned that these exercises are used in combination with other interventions such as mirror gait training and step rate manipulation to address impairments related to the frontal plane. At day's end, we must never forget that running is a tri-planar activity!



​This is hands down one of my favorite exercises to challenge a runner's postural stability in single leg stance as well as their transverse and frontal plane control. I never cease to be amazed by how challenging this drill is for people.


​If there is one exercise that I would have runners perform outside of running, it would be lateral toe taps. This drill directly challenges ankle dorsiflexion as well as strength of the quadriceps, hip abductors and external rotators. Add a mini band to further challenge the exercise



​Once you have mastered the lateral toe tap drill, you can easily progress this exercise by simply crossing midline. This also serves to provide a nice eccentric load to the lateral hip musculature.


​One of the mantras that I always recite to clients is that "running is about rhythm and timing." Once the lateral and cross body toe taps have been mastered, look to incorporate quick crab walks. They are deceptively challenging and great for runners in terms of getting their feet off the ground quick.

I developed this simple drill sequence after spending some time training with a world class speed skater. Needless to say, he owned the frontal plane. Aim to master each individual drill before progressing to the next. Id strongly encourage using a cross training shoe rather than a running shoe for this particular drill to safeguard against rolling your ankle.  
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Simple Suggestions for Finding An Appropriate Running Shoe

11/6/2015

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Selecting an appropriate running shoe has never been more confusing and difficult. This should come as no surprise considering the misinformation that exists related to arch height, pronation, and cushioning to name a few. We must also contend with experts from various fields and disciplines making grandiose statements regarding footwear without ever having evaluated or observed the runner, who clings to such advice as gospel. At day's end, how you run, and the decisions you make related to your running, far outweigh what's on your feet, provided that the shoe is 

​appropriately fit and free of defects. So, find a pair of shoes that feel comfortable, and don't get caught up in the hype of the purported benefits of various shoe features. As I always remind runners, treat buying shoes similar to shopping for jeans. First, check to see if the right size (length and width) is in stock. From there, it's only natural to try on a few different pairs to see what feels best. Perhaps you walk (or run) around the store a bit to see how they fit/wear. Inspecting the jeans for possible holes or sloppy stitching would also be indicated to ensure that you don't walk out with a lemon. In contrast to shopping for jeans, however, don't be so concerned with how the shoes look. This is where runners often get into trouble :-) 



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​SCREEN FOR MANUFACTURING DEFECTS
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​RUN IN MORE THAN ONE PAIR OF SHOES
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​ACCOMMODATE THE FOREFOOT
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​SIZE SHOES TO THE LONGEST TOE OF THE LONGEST FOOT & SOMETIMES YOU MAY NEED TWO DIFFERENT SHOES

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​DON'T FALL PREY TO THE UPSELL OF ORTHOTICS
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​STICK WITH WHAT FEELS COMFORTABLE ON YOUR FEET
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Below is a list of reminders that I put together and send out to my clients as postcards. Thought you may find them helpful...
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I also wanted to share this video by Dr. Kevin Maggs, D.C., who did an excellent job highlighting key research while challenging several routine practices related to prescribing and selecting footwear for running. Enjoy!

Prescribing Running Shoes from RunningReform on Vimeo.

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Return to Running Rules of Thumb - Are You Ready?

11/3/2015

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I recently shared a simple return to running program for medical and fitness professionals to help injured runners return to consistent training. Before initiating such a program, however, a runner should meet certain prerequisites or milestones to ensure that it is appropriate to advance their activity level while avoiding a potential relapse in their condition. In the event a runner does not meet the items on this checklist, and prematurely attempts to return to training, they are playing with fire and will most likely prolong their recovery. So before transitioning a runner back to training, take the time to ensure that they meet the prerequisites outlined below. ​



​NO SIGNS OR SX OF INFLAMMATION
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PILLS & INJECTABLES OUT OF YOUR SYSTEM 
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​ABILITY TO FULLY WEIGHT BEAR THROUGH THE AFFECTED EXTREMITY 
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​ABILITY TO PROGRESS THE LEG OVER THE FOOT 
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​TOLERANCE OF OPEN CHAIN LOWER EXTREMITY EXERCISES


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​TOLERANCE OF CLOSED CHAIN LOWER EXTREMITY EXERCISES
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​GOOD FRONTAL PLANE CONTROL
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​TOLERANCE OF 45-60' OF FITNESS WALKING
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​TOLERANCE OF REPETITIVE SINGLE LEG HOPPING IN MULTIPLE DIRECTIONS
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10 Phrases to Teach a Parrot to Recite to Injured Runners

10/29/2015

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​I’m strongly considering buying a parrot. Not only would a parrot be fun to have as a pet, but it would also prove invaluable in assisting me in helping runners seeking my physical therapy services. Considering that I often sound like a broken record when speaking to runners, I figured that it may be easier to train a parrot to recite several common phrases and mantras that I often use in the clinic. Ten key phrases that I would specifically teach the parrot, in no particular order, are as follows...
 
1. FIVE WILL GIVE YOU 20 – Heiderscheit and colleagues demonstrated that a five percent increase in step rate, relative to one's preferred cadence, leads to a 20% reduction in energy absorption at the level of the knee.
 
2. IF YOU CAN SKIP, YOU CAN RUN – I never cease to be amazed by a runner's inability to skip. The performance demands of skipping are very similar to running. Skipping is also a plyometric activity that demands rhythm, timing, and reciprocity.
 
3. ALL FOOT STRIKE PATTERNS WORK UNTIL THEY DON’T – All foot strikes are viable options when it comes to running, yet possess unique characteristics. One strike pattern is not necessarily superior to others in most cases. At day's end, wouldn't it be nice to be able to perform all three?
 
4. IF THERE’S ONE THING YOU SHOULD DO BEYOND RUNNING, IT’S STRENGTH TRAIN – At this point, the research has clearly demonstrated the benefits of strength training when it comes to safeguarding against overuse injuries. Strength training serves to build a runner's capacity while eliciting neuromuscular adaptations and improved economy. Running and strength training is a winning combination. So don't worry about putting on unnecessary muscle mass and go pick up some weights. I promise it will benefit you!
 
5. NEVER FORGET THAT RUNNING IS A TRI-PLANAR ACTIVITY – Although running is primarily a sagittal plane activity, we must never ignore the frontal and transverse planes when it comes to training. This is oftentimes where runners, especially females, require the most attention.
 
6. YOU MUST BE ABLE TO WALK BEFORE YOU RUN – If you are not able to tolerate walking, then chances are you are asking for trouble to attempt running. So, if you are rebounding from an injury, make sure that you are first able to tolerate walking, unless you want to prolong your recovery.  
 
7. NEVER BE THE VICTIM OF DEFECTIVE SHOES – Simply because a shoe makes it into a store by no means guarantees that it is free of defects. Manufacturers will readily admit that defective shoes are a reality. It is therefore critical to screen for defects, particularly if you are rebounding from an injury.
 
8. THE TERM, “RECOVERY RUN,” IS AN OXYMORON FOR RECREATIONAL & SUB-ELITE RUNNERS – How can a plyometric activity be used as a means to foster recovery? For most recreational runners, a recovery run is what I call a walk.
 
9. NOTHING GOOD IS HAPPENING THE LONGER YOUR FOOT IS IN CONTACT WITH THE GROUND – The longer your foot is in contact with the ground, the more range of motion and control you need. Unfortunately, most recreational runners are lacking in both of these departments. So get those feet turning over a bit faster. 
 
10. WHEN IN DOUBT TAKE A REST DAY – Anytime a world class runner or endurance athlete is interviewed at the end of their career, and asked “What would you do differently if you could go back in time?" the response is invariably, “I would’ve rested more." Up to this point in my career, I've never witnessed a runner get injured from taking a rest day. So when in doubt, leave it out.
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Simple Return to Running Program for Injured Runners

10/27/2015

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Access Now
One of the first research projects that I worked on during my undergraduate studies at the University of Delaware (UD) was a return to throwing program for baseball players. After tennis practice, I used to sit at the home UD baseball games while recording pitch counts before handing the data over to one of the PhD students for analysis. This information was then used to develop a data-based interval throwing program to help injured pitchers return to the mound by gradually exposing them to the performance demands of throwing. Mike Reinold and colleagues also published a nice manuscript in JOSPT related to Interval Sport Programs (ISPs) that covered baseball, tennis, and golf. Surprisingly, however, there is no well accepted return to running program for medical and fitness professionals to apply to runners rebounding from injury. I therefore developed this simple return to running program, which couples an injury grading system with soreness rules, to foster improved decision-making as we prepare runners for a safe return to running. Please download and share it if you find it helpful. As always, any and all feedback welcome. Wishing you HAPPY, HEALTHY, and STRONG Running!
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Running Injury Evaluation Form for Rehabilitation Professionals

10/20/2015

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Download Here

​Here is the evaluation form that I currently use in working with injured runners. Considering that I have a tough time keeping secrets, and enjoy helping others, I wanted this document to be available to my viewers as well as the online community. It blends the current body of medical literature with my clinical experience. I'm confident that it will prove helpful in laying the groundwork to develop a plan to help get runners back to consistent training. We welcome any feedback, and wish you HAPPY, HEALTHY, and STRONG Running!
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Seated Isometric Row | Chris Johnson PT

10/19/2015

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Purpose: To strengthen the scapular stabilizers and posterior rotator cuff while focusing on vertical alignment

Equipment: Medium resistance tubing, chair or platform, and anchor point for tubing

Success: Perform one, 30s second hold

Mastery: Performing five, one-minute holds

Common Errors: Drawing the bands past the plane of the body, flaring the ribs
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A Simple and Practical E-book for Recreational Distance Runners

10/15/2015

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GET NOW
Our goal in writing this e-book was to best prepare recreational, distance runners for the performance demands of the sport. Running is a skill that involves bounding from one leg to the next in a balanced manner. Although we all arrive at our own unique strategy to deal with the repetitive, multi-planar forces associated with running, there are several common denominators to healthy running. These include possessing adequate strength, flexibility, economy, rhythm, and timing. Additionally, it also important for runners to develop a basic understanding of equipment needs as well as modern pain science in an effort to mitigate injury and foster sound decision making. This e-book marks the first in a series of e-books, which are designed to provide runners with essential skills and information necessary to enjoy a life of running happy, healthy, and strong. We hope that you enjoy it! 
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DISCLAIMER: This site is oriented to my opinions and thoughts regarding various performance and rehabilitation subject matter. Please keep in mind that application of this material is a personal choice, and in no way is the author responsible for those choices. Readers are encouraged to only operate within their scope of practice. Examination, treatment, intervention, and rehabilitation for athletes should only be performed by a licensed medical professional.