Entry strength and mobility for lower limbs for young athletes

Recently Performance Podiatry Geelong spoke to an elite group of young footballers participating at the V-Line Cup in Geelong.  Following are the strength and mobility exercises suggested:

  1.  Table Top
  2. Decline board ankle mobility and lower limb strength

decline-3

3. Squat

squat-form

NB.  This exercise is to be performed using body weight only to start with.
4. Nordic Hamstring curls

nordic

For specific information regarding repetitions/ sets please do not hesitate the clinic.

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How to choose the best running shoes

Selecting the best running shoe for you can be a daunting process.  The following relates to technical guidelines that may help the process.  However, there is not a “one size fits all approach.”  Some people may well follow the complete opposite to what is proposed here.  For those individuals, they may well be adaptive to their footwear and quite resilient to loading forces (pressure from the ground when running) and injury in general.

  1. Comfort: Above all factors, footwear must be comfortable.  Research suggests that if an individual picks a shoe based on their perceived comfort, they are less likely to get injured.  There are many factors (some of which will be discussed in further detail) that can impact comfort.  One of the most important factors is “fit.” A good running shoe store can help you to ensure your heel is held firmly in the shoe and your forefoot is not too compressed.  Ensuring adequate depth, width and length of your footwear is vital.  If your runners are too tight, you may lose the ability to properly move your toes and contract the associated musculature.  This can have a detrimental effect on your load capacity (your ability to withstand running forces) and running efficiency in general.  When your toes have space and can move without impediment, deep musculature of your legs and feet are able to work more efficiently than if your toes are constricted.
  1. Alternating footwearAlternating footwear has been shown to decrease injury rates. By using footwear with different features, weight bearing load is varied to the body. For example, increasing the pitch of footwear (higher heel), you may decrease loading through the forefoot and distal leg. Conversely, a lower pitch runner (flatter pitch) may increase the loading of the forefoot. An example of alternating footwear could be: An experienced runner of around 80-100km mileage per week alternates three different types of athletic footwear:
    1. Standard 10-12 mm pitch runner chosen based on comfort to perform easy runs on a daily basis
    2. Refined footwear of lower pitch and bulk in general- used for key speed sessions
    3. Maximalist footwear- cushioned footwear (e.g., Hoka) used for recovery sessions

    3. Footwear selection based on age

    All things being equal, the older you are (very generally speaking!), the less resilient you may be from weight bearing exercise. Good training may counter advancing years.
    For older athletes, they are more likely to have adapted to wearing positive heeled (heel elevated in relation to the forefoot) footwear over their lifetime. Additionally, older individuals are more likely to experience stiffness of all components of the musculoskeletal system (calf muscles, achilles tendon etc). This is further exacerbated by a lifetime spent excessively in a flexed position (sitting at work, working on computers).

    With these factors in mind, it will generally be safer for older athletes to wear footwear with higher pitch (or maximalist footwear). Stiffness and footwear adaption is not set in concrete. Mobility can be improved and footwear options may change based on an individual’s range of motion and resilience to loading.

    Younger athletes generally have less history of injury and better mobility. As a result, their musculoskeletal system is able to cope with a greater variation of footwear features. From a personal perspective, I like the concept of more minimalistic footwear to prevent footwear from generating contracture in soft tissue. However, I am very aware of the natural fallacy (the concept that natural technique like barefoot running or minimalistic footwear is best). This approach is flawed as there is not a one size fits all approach.

    4. Footwear selection based on mobility

    Leg stiffness- If someone has excessive leg stiffness, it is generally excepted (but not necessarily supported by research…. yet!) to wear footwear with higher pitch.

    5.  Footwear selection based on History of injury

    Achilles injury- use higher pitch footwear or footwear with forefoot rocker (e.g. Hoka)

    Plantar fascial injury- higher pitch footwear

    Forefoot pain-higher pitch or maximalist footwear

    knee pain- minimalistic footwear. Minimalistic can help a runner strike beneath their centre of mass which can decrease loading forces through the knee. However, in this case, running assessment is key. It is vital to ensure running cadence and sagittal biomechanics are assessed to ensure decreased knee forces. Low pitch, minimalistic footwear can help but guidance may be required.  For example, a runner with degenerative knee issues may also have history of Achilles pain.  In this case, the individual may have to choose footwear features which are not entirely assistive of one of the pathologies.  Reverting back to perceived comfort may help decide what footwear features the runner ultimately decides on.

6.  Footwear selection based on history

Footwear history is an important consideration in deciding what shoe is best for an individual.  For instance, if someone has been wearing a shoe with a particular feature like rearfoot support`** for a prolonged period of time (e.g., 10 years) without any injury, it may be unwise to change the type of shoe.

7. Footwear selection based features such as support

Medial support is footwear feature often used to control foot pronation (“rolling in”).  Most research does not support the notion of such features reducing injury risk.  However, in certain cases, it is accepted that shoes stronger on the medial ( midline side) are vital.  For example, in  those with tibialis posterior dysfunction, a serious foot and leg pathology, it would be recommended to wear footwear with such supportive features.

 

One final note.  Good footwear alone will not prevent injury.  Good training principles focussing on gradual overload, strength and resilience and optimal health are vital.

 

** Footwear features such as medial support do not always equate to changes in body biomechanics (kinematic and kinetic changes).

 

Luke Madeley

Knee Pain

Knee pain is an all too common complaint in runners. There are many causes for this knee pain but one of the most common injuries is called Anterior Knee Pain (AKP) or patellofemoral pain syndrome (PFPS). This makes up to around 25% of all identified knee injuries in runners. The interesting problem with AKP is that it is a diagnosis made from its only symptom of pain which is usually located around or under the knee cap. This condition is rarely associated with any structural damage.

Historically we used to think that one of the primary causes of AKP was due to the misalignment of the patella during running. Clearly there is an association between tight and overactive structures around the knee that can influence the position of the patella through its movement. Addressing these through a structured stretching program and a course of manual therapy can help. However, more recent research is shedding new light on the most common cause of AKP. Hip weakness and early fatigue during the stance phase of running leads to a valgus or ‘knock knee’ posture and this has shown to be a leading cause of AKP. Simply put, as your foot comes in to contact with the ground the muscles on the outside of your hip must become active to stabilise the pelvis girdle and to stop it tipping forward on the opposite side. If the muscles do not do this then your knee will turn in slightly (genu valgum) to compensate causing a change in the biomechanics and probable pain around your patellar! Studies have shown that by incorporating specific hip abductor strengthening exercises in to a rehabilitation program, not only does the peak hip abduction strength improve but stride-to-stride knee joint variability improves, a reduction in genu valgum is observed during stance phase and most importantly pain is reduced!!!

So what is a good exercise to improve your lateral hip muscles? Well my 2 favourites include the resistance band walk and the lateral shuffle. All you will need to do these exercises is a loop of resistance band and a bit of space. Loop the band around your lower leg or ankles and stand in a half squat position with your feet wide enough apart to feel some strong tension in the band.

  1. To do the resistance band walk all you do now is walk forward in the half squat position keeping the tension in the band by making sure your feet stay wide apart. Take around 20 steps forward and then 20 steps backwards.
  2. To do the lateral shuffle, instead of walking forward in the half squat you take a step to the right keeping the half squat and after planting your right foot you move your left foot equal distance to the right. Take around 20 steps in each direction.

There are many more exercises that can help improve your function and running form and so if you would like a comprehensive assessment and rehabilitation program developed using the latest in evidenced based research then please do not hesitate to contact us for an appointment.

 

Nick Williams

Running Cadence

Recently there has been a shift in focus away from particular foot strike patterns relating to running injuries toward alterations in cadence.  While this has been a positive initiative for many runners, foot strike patterns may still have relevance in treating specific injuries.  However, altering cadence is something almost anyone can attempt and adapt to.  Shifting foot strike patterns can be more difficult.

Cadence refers to a runner’s stride rate.  Combining stride rate with stride length gives you your running speed.  It has been suggested that a cadence of 180 strides per minute is optimum.  However, in practical terms this is not relevant as cadence changes with running speed.  For example an elite runner may do an easy run at a cadence of 170 and race a 10 k with a cadence over 200.

10689830_758602744178513_8401221313807836078_nNovice runners tend to run at much lower cadences.  Coupled with lower cadences is the tendency to overstride.  Overstriding occurs when your foot contacts the ground in front of your centre of mass.  This often coincides with heel striking.

So what are the benefits of running with a higher cadence?  Research has indicated an increase in cadence can result in a decrease in force applied to the knee (patellofemoral joint) and hip when running.  Most agree this is do the foot contacting he ground beneath the body’s centre of mass.  The potential downside of this is an increase load to hamstrings and rectus femoris (quadricep) musculature.

To calculate steps/minute, count the number of times one foot strikes the ground for 30 seconds and then multiply this number by 4.  Re-test number of times in various situations.  If your cadence is consistently low (e.g., less than 160), try increasing your stride rate by 5-10%.

Remember, don’t get caught up in the absolute number relating to cadence.  If you are struggling with injury or a novice, it may be worth altering your cadence by a small percentage and see whether it helps.

Polarised Training

Having just finished reading 80/20 Running by Matt Fitzgerald as well as a recent post by Joe Friel on his blog, I thought it would be worthwhile posting a summary on polarised training.  I would certainly recommend reading 80/20 Running as it is an intriguing yet easy read and has some nice training plans relevant to different distances.  Joe Friel’s books and blog are always a great reference for the novice to elite athlete.

Polarised Training.  What is it?

Polarised training refers to an exercise plan involving predominantly very low intensity exercise interspersed with a small amount of very high intensity training.  Advocates of such programs like Matt Fitzgerald recommend, on average, 80% of training performed at low intensity and 20% at a higher intensity.

Why would you want to train in this way?

Because it makes you fit!  Research has shown that polarised training is an extremely effective form of training in enhancing your VO2 max (your maximum oxygen consumption during exercise and common measure of level of fitness).  It is superior to regular moderate intensity exercise (which is how most people train) and high volume low intensity training.

How is intensity defined?

Athletes and coaches use various different tools to determine intensity including pace (running), heart rate, power output (cycling) and perceived effort.  If you are interested in the specifics of these measures I direct you to the above-mentioned resources.

But I want to start it NOW?

Whoa cool it!!  Most people embarking on fitness programs are fairly impatient.  “Too much too soon” is the most common cause of injury seen at our clinic and is far more relevant than most biomechanics factors.  Before considering any form of intensity, I would recommend working on some form of fitness base incorporating consistent easy exercise.  This is especially important for activities such as running involving repetitive loading to the lower limbs.  For semi-weightbearing activities such as cycling, intensity can be added earlier.  For those who have been exercising consistently for many months (or preferably years) and have a reasonable level of base fitness and have not suffered from injury over that period, some intensity can be added into their program.

How to get started…

If you want to start polarised training, and don’t want to use training tools such as heart rate and power, then you will need to rely on perceived effort and pace/speed.   A GPS training App is a handy addition and can easily be downloaded for your phone (e.g., cyclometer, strava).  When performing your easy training, you should be able to hold a conversation with a training partner.  Often the effort feels “too easy.”  Once finishing an easy session, you should feel that you could continue to exercise for longer.  By performing most of your training at low intensity, when it comes time to do your high intensity sessions, you really have the energy to put a lot into it.  Hard sessions are very difficult and involve extremely heavy breathing, lots of perspiration, burning muscles and high heart rates.  As these sessions are stressful on the body, an emphasis on quality rather than quantity is important.  If you feel like you cannot give a scheduled hard session everything then it may be better to replace it with another easy session.  Easy exercise helps athletes to recover from the hard sessions whilst also improving components of cardiovascular fitness.

Is polarised training everything?

No.  Specificity is.  Your training needs to be specific to whatever event/ race you are training for.  For example, if you are are training for an ultra marathon, low intensity volume will be more important than intensity when compared to shorter events such as a 10 km race.

Furthermore, the concept of periodisation is relevant.  This term refers to planning training over a period of time with an emphasis on building fitness by manipulating volume intensity for a specific race/ event goal.

Julian Spence on his recent marathon, health and nutrition

By Luke Madeley


Julian Spence is an amazing running talent that has achieved a lot in a very short space of time.  Coming onto the scene fairly late after pursuing football and surfing interests, over the last 6 years Julian has had success with ultra-running, marathons, cross country, as well as on the track. Julian has taken the role of Geelong Regional Cross Country manager and is also the store manager for The Running  Company.  I caught up with Julian after the recent Melbourne marathon to discuss his run, his future and his thoughts on nutrition, performance and health.

Congratulations Julian on a great effort.  I sense from your Strava post (Julian titled his recent marathon run as ‘the wrong way to run 2:27’) you are not happy with your Melbourne Marathon, despite finishing 15th.
I was unhappy with the time, but content with the way I went about the run.  The first half went pretty well as I was running consistent splits and I felt good.  However, I couldn’t maintain the pace and in the latter part of the race I could have easily pulled out.   Overall I was satisfied that I was able to get the finish line. 
 
Leading into the race, you were in great form.  Why do you think you ran slower than you expected?
I was aiming for sub 2:20 and I was definately fitter than 2:27.   There was a chance that I wasn’t in 2:20 shape and that may have been the problem.  However, I still went for it, and when you’re on such a fine line, things can fall apart pretty quickly.  I probably could have gone out there and ran conservatively with the aim to run 2:24.  However,  I pushed myself to run 2:20 which exceeded my threshold on the day and I basically cooked myself!
 
You also experienced an injury a few weeks before the race?
I was doing a long training run around marathon pace and ran 16 kms into a shocking head wind.  I must have changed the way I was running a little bit.  I think I just started to lean forward as I was fighting into the wind which may have changed the way my hammy and glutes were working.  After that run, I pulled up sore around my hip.
 
The injury significantly messed with my head. I was stressing about it which led to poor sleep and I started to second guess myself.  Also, the legs didn’t get as much time in them for the last 2 weeks prior to the marathon and they were used to running twice a day every day.  And all of a sudden I was not running at all.
 
How is your recovering going?
I haven’t ran in a week and I’m going to have another week off and then start to re-build.  I played golf today.  I will ride the bike while Bri (Julian’s girlfriend) runs and walk the dog twice a day.   I also enjoy just sitting, and not really doing a whole lot.   I’m already starting to get motivated to start running again now that the soreness has gone and I’m seeing Bri out running.
 
What are your short-term goals in running?
The best bit about this experience is the fitness block I got out of it.  My immediate goal is a marathon in Japan in February next year, which will give me a chance of running the distance again. I would also consider running the Gold Coast marathon next year where there will be more guys running at the pace I am aiming for.   I might do some trail running over summer and  I will also jump on the track for some races.   But mainly my focus is Japan.
 
What are your long-term goals in running?
I want to break 2:20 and I want to run at the Zatopek 10 k.m.  However  I don’t really think about goals like that.  Because once I’ve run 2:20,  I’ll want to improve on that.  I don’t want to put a ceiling on my expectations.    That’s why short-term goals are more relevant to me.  There will always be another level to get to.
 
What are your thoughts on running for health benefits?
I don’t see a lot of people losing weight when they run. Most people complain when they start running that they don’t lose weight.  And then people are fighting with it (running) all the time and it’s battle to get out all the time.  So in those cases, I don’t think that is something you should be doing. Something that is good for your health should still be enjoyable.  If you’re forcing yourself to run, it’s not healthy.
 
I run because I enjoy it.  But it’s not necessarily always healthy.  I’m always sore, I have no power what so ever, I am stiff and inflexible.  I really eat whatever I want so my diet is not awesome.  I’m probably under the weight range, my immune system is constantly on edge all the time.  So I wouldn’t say what I do is all together healthy.  But what I do is at an extreme.  And I enjoy it.
 
You can be healthy and run ok but you’re not going to do as well as if you run 150 kms a week.
 
What are your thoughts on nutrition and do you feel nutritional requirements for an elite athlete should be different to the average active person?
A lot of it is input vs output.  If I run 15 kms in the morning, I think it is 500-600 calories that I burn.  In the evening I run 7 kms, maybe I burn 300 calories.    I need to get that (calories) from somewhere, otherwise I will waste away.    I won’t recover well, I’ll be tired all the time and sore. I find that it is hard to get all of those calories by eating really clean.  I try to keep foods wholesome but sometimes you just need to pack it in.  So often before bed I will drink a sustagen (energy drink) milkshake so I don’t wake up in the middle of the night hungry.
 
For average person, if you consume 300 calories before bed and you’re not doing the work then it will just go straight into your fat stores.  You don’t need as many calories if you’re not expending a lot of energy.
What’s your philosophy on injuries?
 Every runner gets injuries.     And sometimes you need to work out the mistake in your training, whether it’s training load, too much intensity, too much volume or too much intensity in close proximity to volume.     Sometimes it is the surfaces you run on, like if it is heavily cambered.     Footwear features are also important and I know I get tibialis posterior tendon pain when the shoe is too soft.
 
I started changing the way I ran after sustaining a knee injury.  An MRI has shown I have cartilage damage but I was able to cope with this by running with a higher cadence and landing more on the forefoot (and landing under centre of gravity).  Using a lower (flatter heeled) pitch shoe, I found it easier to do learn this and it allowed me to absorb the load of running.  I started in barefoot shoes such as Vibrams doing walk/runs on fairly hard surfaces.  From doing this, patterns changed and all of a sudden landing on the heel felt really unnatural with increased jarring and force.  It is good to have some cushion under there (foot) so you can run the next day without being really sore but the best learning technique is to not wear a shoe at all.
 
What are the necessary components of a successful running  program with reference to long steady, tempo and interval workouts?
A program can have all three of these components and can do really well.  I don’t pidgeon hole one of these components as the answer.  I think all three can help.
 
Could you give me an example of  each type of workout?
Long steady runs have the lowest risk (of injury) and are a good way for me to start re-build fitness.     An example of a long steady run for me would be running on a trail for two and half hours at an easy pace (4.30-5.00mins/ km).
A marathon specific tempo session would be 16 k ms  at 3.15-3.20mins/km.
Interval training in reference to marathon training would involve 10 repetitions of one km on the track with 90 seconds recovery.  This would be usually be  performed at 3 min/ km pace.
 
What additional training tools do you use besides the traditional?
That’s a good question.  I take Sustagen before I go to bed so I sleep better.  I take inner health plus to help settle the gut.  But really I just run…

Healthy Food. Are we too busy to care?

By Luke Madeley

There is no doubt that nutrition has a huge impact on health and sports performance.  Recently, fitness coach extraordinaire, Joe Friel tweeted that: “The greatest advance in the next 10 years for endurance sports won’t be in equipment or training; it will be in nutrition.” At present, there are experts arguing over potential benefits of low fat/ high carbohydrate vs low carbohydrate/ high fat diets.  Prominent basketballer’s Kobe Bryant and Lebron James have captured headlines for adopting low carbohydrate diets.  Cricketer’s Shane Watson and David Warner have also adopted a similar nutrition plan.    Advocates for such diets suggest benefits including weight loss, better sustained energy and better overall health. 

Lebron James029444-pete-evans

The paleo (caveman) diet is also gaining popularity.  This diet, adopted by celebrity chef, Pete Evans is characterised by whole foods and excludes refined carbohydrates, including grains, processed foods, legumes and dairy products.  Critics of the paleo diet suggest that whole grains are the basis for a healthy, nutritious diet (based on the current food pyramid). Many believe, we have become victims of convenience.  For example, when we purchase food at a supermarket, do we question the origin of the food?  Is the meat we purchase from healthy animals from natural environments?  Is the fruit we eat chemical and hormone free?  Whilst remaining contentious, the prominence of the above-mentioned diets and the celebrities that follow them have allowed us to question the food we commonly consume.

Recently I had the pleasure of being shown around Geelong Institution, Siketa Meats  by owner, Bruno Siketa.  When asked about the key to his success, Bruno simply replied, “quality.”  He believes in sourcing meat from best, healthy animals.   It stands to reason that if you want health benefits from food, the source must also be healthy.  A simple concept, yes.  But has it been lost in the modern world? So what is the perfect diet?  This topic will be argued for many years to come (and we will endeavour to provide some insight into the current trends).  However, regardless of whether you believe in high/ low fat versus low carbohydrate diets, it is hard to argue against high quality, locally sourced whole foods.