As I sit here on the 24th of December, 2018, I am extremely happy for how the last year went while also being extremely eager for the year ahead. Because I always ask my clients to reflect back to learn where we can tighten up for better results, I think it’s important that I also do this myself. Without reflection we often overlook the key takeaways that allow us to be better the next time around. Basically, what can we do more of that worked well, while also removing those things which proved to be a waste of time.
Here are some of the most important things I learned in 2018…
1.Don’t make a thing a thing-thing
This past October I went to a Clinical Running Essentials course held by Chris Johnson, PT. One thing that struck me was his line, “Don’t make a thing, a thing-thing.” This line got me thinking of all the aches, pains, and movement issues I see on a daily basis.
Instead of pointing out or dwelling on every single “thing,” it’s important to first consider if it truly matters in the grand scheme of the client’s end goal. Of course it’s important to educate each individual client about their limitations that could be hindering performance or predisposing them to injury. But, it’s not necessary to point these things out in such a way that scares them or excessively highlights their shortcomings. I have seen this a ton from doctors and other local professionals which have left many people paralyzed and living in fear of such extreme consequences.
2. It just takes time
We live in this world of wanting immediate results and gratification. But, that’s just not realistic when it comes to the human body.
The timelines I have provided for new clients looking for specific results have nearly doubled. I learned my lesson that even in an ideal situation things don’t happen quickly or as planned.
When dealing with runners there are so many other variables to consider that you can’t constantly keep your foot on the gas pedal. Mileage needs to be taken into consideration and therefore resistance training has to back down at some point.
This is also true when dealing with chronic overuse injuries. I have worked with countless runners suffering with tendinopathy over the years. Based on the growing research, I have no problem telling them that this could take 6-12 months to resolve.
In the past when I saw quick results from performing Active Release Techniques (ART), I was naive enough to take it one session at a time. Now I’m much more blunt and unwavering when I tell them it’s time to embrace the marathon process of resolving an overuse injury.
This doesn’t necessarily mean that stopping all activity is needed. It’s actually quite the contrary. Instead, let’s manage the stimulus to not consistently overload the tendon while building resilience and tolerance to then ramp up training once again. And, be accepting of a few setbacks along the way. This is just the process!
3. Running-related injuries require a deeper look at running form and mechanics
For years dealing with runners it has always been orthopedic evaluations but no/minimal look at running form. That’s a problem!
When someone is having pain with a specific task, whether that be running or sitting at a desk, it’s 100% necessary to look at their mechanics during that specific activity. Before we go searching for underlying problems, are there any issues from a biomechanics standpoint that need to be cleared up.
I am hesitant to believe that stretching or strengthening a specific muscle or group of muscles will automatically make an ingrained activity suddenly pain-free. Yes, you may need some corrective exercise and re-education, but this should be in addition to fine tuning the activity itself in order to not overload the painful tissue or body area. What if it comes down to performing the activity more efficiently that leads to pain reduction and long-term success? Let’s start there and supplement as needed.
4. Pelvic control in split stance and single leg movements
Because I work in a fitness/performance facility, I am fortunate to watch people move each and every day. This includes my own clients, other trainer’s clients, and those taking group exercise classes. While being observant, the lunge and other split stance movements have really peaked my interest. It’s not that I have a problem with these movements, but how people execute them that often catches my eye.
There is a lot going on biomechanically around the lumbar spine, pelvis and hips. This includes tons of muscles and an interesting assortment of joints that need to be addressed for proper function. What I see regularly is poor control of the pelvis that is often viewed as contralateral pelvic drop.
Wait, what does that mean?!?
Contralateral pelvic drop means that when you are doing a lunge or split squat with your right leg forward, the left side pelvis actually drops when lowering into the bottom of the exercise. Or, vice versa. This drop is often a sign that the current variation of that split stance or single leg exercise is too challenging for that person to control.
For years, rehabilitation and fitness professionals have said that this drop is a sign of gluteus medius weakness. Yes, this may be part of the problem but oftentimes there is an underlying stability problem that needs to be addressed. What I have found is that strengthening the gluteus medius doesn’t always correct the drop without also addressing stability and control in lunge or other split stance movements. Essentially, strengthen the weak links and then put them into a position that demands proper positioning and stability.
This matters not just for the sake of better lunges, but also daily activities where you are predominantly on one leg, such as walking, up and down stairs, and running. Therefore, I recommend you think about this when you are in the gym because it is so easily overlooked. Click here to learn more by watching a video on the topic.
5. Do you really need to stretch?
Aha! Of course stretching would come up.
Just because you “feel tight,” doesn’t mean a muscle needs to be stretched. In fact, stretching might actually have negative effects.
Flexibility and tightness are interesting topics that have their similarities and differences. Everyone feels tight from time to time. That’s a common side effect of life, training, and sport. Then there are those who constantly feel tight in particular muscles regardless of the situation. What we need to take into consideration is “normal” ranges of motion and the flexibility demand during specific activities.
When it comes to hamstring tightness for an avid distance runner. Of course the first instinct would be to reach down and touch the toes or kick the leg up on the couch and lean forward, right? That makes perfect sense.
Because the hamstring is a biarticular muscle (crosses two joints- hip and knee), it’s length doesn’t change a whole lot during running. Therefore, is the feeling of tightness you have actually a limitation within that specific muscle group? Probably not.
Instead of consistently stretching the hamstrings day in and day out to provide relief but no long-term resolution, it may be more advantageous to strengthen these muscles, look at stability around the core/pelvis, and analyze running form. Are one of these an issue?
A muscle that is stronger and has a greater capacity for loading will fatigue less readily. So, if you notice “tightness” that comes on at mile 8 but is no issue throughout the day or before mile 8, consider increasing strength/endurance. What you’ll be surprised to find is that certain muscles that have been tight for years are only being overloaded with the repetitiveness and duration of running rather than being in a shortened position.
Want to learn more on this topic? Click here to watch “3 Reasons You Feel Tight.”
6. Correcting a problem will only do so much without first removing the harmful stressor
Years ago I heard Physical Therapist, Gray Cook, say that sometimes it’s more important to remove the harmful stimulus than to add any corrective strategies. This made complete sense but I didn’t act on that information as much as I should have. Until this past year…
In 2018, I have worked with so many runners suffering from tendinopathy and bursitis. Fortunately, this lends itself to experimentation and seeing what strategies consistency provide positive results. Come to find out, it’s often not adding some magic list of exercises or manual therapy, but rather talking through a thorough history of the pain stimulus that lends itself to the best results.
It all comes down to triggers. A trigger is a specific movement or position that causes or reproduces your symptoms. Instead of quickly brushing this off and diagnosing the problem, how about assessing your individual routine to determine where you are getting into trouble. When those specific triggers are identified, are there other strategies you can adopt to not “trigger” your pain?
For instance, posterior hip pain when running uphill. Continue to run but do so only on flat ground if that doesn’t elicit pain. Restrict uphill running for the time being until the pain stimulus is desensitized.
Lateral hip pain when sleeping. Place a pillow between the knees or adopt a back sleeping strategy while staying away from the trigger at night.
I could go on and on…
What is causing your problem? How can you get yourself out of that position or alter the movement in a healthy way to not create a pain stimulus. Try this first before worrying about adding a list of exercises that may or may not resolve the problem.
7. Less soft-tissue work and more loading to increase capacity
This is a tough pill to swallow for someone like myself who has spent thousands of dollars on continuing education specific to soft-tissue manual therapy. As much as I’ve seen great results using Active Release Techniques (ART), it seems to always come back to movement and re-education that fully resolves many of the issues. This is especially true with the growing research on tendinopathy and tendon loading.
What I hear a lot of is, I had _________________ (ART, dry needling, graston, chiropractic, etc…) done once and it fixed me. I always think to myself, “If you are “fixed,” then why are you back here with the same issue?”
An immediate reduction or elimination of pain never means the underlying pathology has been resolved. There is a some type of neurophysiological stimulus provided by manual therapy that causes pain to improve in many situations. But unless you correct the underlying issues and progressively load the tissue, is the result worth bragging about?
In my opinion, reducing pain is always the primary goal. But, from there, a whole lot of education needs to take place in order to instruct the client about the healing process to ensure this specific injury does not return in the future. This is where a proper and progressive loading program need to be implemented. Essentially, how do we correct the underlying issues which have predisposed this person to pain, while also progressively loading the injured tissue to build tolerance and resilience in the their sport and/or daily activity.
What we have also found through the growing research is that isometrics can be helpful in reducing pain, while slow eccentrics can resolve tendon-related injuries. Let’s start implementing some of these strategies early which are now backed up by research in addition to achieving a short-term reduction in pain from any type of soft-tissue manual therapy.
8. Your warm-up needs to specifically prepare you for the activity ahead
The dynamic warm-up is essential to prepare the body for activity but it is often so quickly and easily overlooked due to eagerness of the activity itself. This is a big problem.
While dealing with runners on a daily basis, you’ll often hear me consistently say that running increases load on the body up to 2-4x. So, how could you go from sitting in the car to this amount of stress and expect long-term success? Yes, I understand you walk slowly, jog slowly, or do some leg swings… This is not as effective as you would think when it comes to preparing for running.
The dynamic warm-up needs to progressively increase tissue/body temperature and be specific to the activity ahead. I also think that specificity has to do with your limitations as well. Basically, how do you prepare the body in a systematic way that sets them up to perform the activity with confidence and success.
A simple outline to follow when preparing for running is:
- Neuromuscular control
- Tissue temperature/joint lubrication
- Shock absorption
These areas are essential and need to individualized to your needs, as well as the needs of the sport. Of course if you are warming up for a different activity, and not running, the system might changed slightly due to the demands of that sport. Regardless, next time you are warming up consider how to progressively load the body in a way that is specific to the sport and your individual needs.
9. Ask for help
For years I tried to do everything myself. What I have found is less success than if I had just asked for help in the first place. That’s easy to realize isn’t it? There are so many people out there that actually specialize in the areas you lack the knowledge in. For me this includes business coaching, graphic design, marketing, etc. Of course I lack in those areas, this is far from the focus on my education which was primarily in orthopedics, fitness, and human physiology.
What I recommend to you as we enter 2019 is finding those 1-3 people who would build up your weaknesses. That way you can continue to work on your strengths while supplementing with people who specialize in the other areas. This will lead to quicker growth, less time spent on areas you don’t fully understand, and likely more long-term and sustainable results.
If you have big fitness goals for yourself in 2019 or you are finally trying to resolve that lingering injury, I’d love to be help you provide you accountability and an easy-to-follow plan for great results. Take a second to fill out this form for a FREE 30-minute Success Session and you’ll be well on your way to make 2019 a year to remember.
Thank you for taking the time to read ‘What I Learned in 2018…’ This was a great year overall and I am eagerly awaiting what 2019 will bring. Since I learned so much this past year, I am happy to say I am much more prepared and ready to perform on my terms. Please comment below with any thoughts or takeaways from the past year.
By: Garrett McLaughlin, MS, ATC, CSCS, ART