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Garrett McLaughlin, MS, ATC, CSCS, ART

Functional Training // Injury Rehabilitation // Running Analysis

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Browsing Tags alignment

Assessing Hip Stability with the Lateral Step Down

April 17, 2019 · by Garrett McLaughlin
Article written on April 17h, 2019 at 03:57pm | Follow Garrett on Facebook and Instagram |

Hip stability is super important for runners. But, how do you know if you are proficient in this area without paying a healthcare professional a costly amount of money for an evaluation? Easy! You complete the lateral step down assessment…

The lateral step down is a very simple movement that you can use to build strength, stability, and balance that carries over to running. Or, it can provide insight into how well you are positioning the body on a single leg which relates to the initial foot strike and mid-stance phases of gait.

How to complete the lateral step down assessment…

  1. Find a box or stair that is approximately 4-8 inches in height
  2. While balancing on the platform, lower down until the non-stance leg touches the ground
  3. Make sure to do so slowly and lightly touch the heel to the ground
  4. Rise back up to the starting position
  5. Assess if one or more of the following things happen:
    • Inability to maintain balance and complete the movement for 10 repetitions
    • Shifting or tilting of the body over the stance leg
    • Inability to lower all the way to the ground
    • Noticeable loss of the levelness at your pelvis (drop on the non-stance side)
    • The hip internally rotates and therefore the leg does not stay aligned
    • Inward collapse of the knee and therefore the leg does not stay aligned
    • Collapse of the medial arch and flattening of the foot
  6. Record the results
  7. Complete on the other side

When performing the lateral step down, there are two different positions which could be valuable to assess. The first being more of a hip-dominant position where you slightly sit back into the hip and lower down. The second is with a vertical posture that allows the knee to travel over the toes. Both of these can provide important information on how well you stabilize in a hip versus knee-based strategy.

Want to learn more about hip stability and how to complete the lateral step down assessment? Click the video below to watch the assessment in action before trying it for yourself.

I hope this article helps you determine if more attention needs to be placed on improving lower extremity stability and balance with the lateral step down. For runners, this can shed some light on how efficient you are on one leg.

If you noticed one or several of the positive signs outlined above, make sure to add single leg training into your routine to resolve this weak link. As always, please comment below or reach out directly with questions.

By: Garrett McLaughlin, MS, ATC, CSCS, ART

Tying Together the Core and Hip for Optimal Lower Extremity Kinematics

March 21, 2019 · by Garrett McLaughlin
Article written on March 21st, 2019 at 11:28am | Follow Garrett on Facebook and Instagram |

When we look at proper running form, there is a significant requirement at the hip to stabilize the lower extremity. Stability promotes optimal alignment and greatly improves efficiency during gait. But, the body does not work in isolation and this is especially true while running. Many processes need to happen in a timed out and coordinated fashion in order to create proper movement.

So, how do you create an environment that carries over to better running mechanics and performance? It all comes down to knowing your limitations. exercise selection, progressive overload, and a solid understanding of physiology.

Yes, hip stability is super important. However, a stable hip without control of the spine, pelvis, and ankle is a lost cause. That’s because all of these areas require stability and reflexive control to keep you in an efficient and aligned position while running.

As a starting point, ground-based exercises are an excellent choice. But, it’s important to translate these improvements on the ground into an upright and loaded position that will ultimately carryover to running. This will tie together stability, strength, balance, and neuromuscular control which are all essential for proper movement.

In today’s article, I want to share (3) of the most beneficial core and hip combo exercises for runners. Their benefit comes from targeting the lateral core (obliques and QL) and hip (gluteals, TFL, hip rotators) simultaneously which helps simulate the demand on these areas while running.

The exercises include:

  1. Modified Lateral Elbow Stabilization (Ground-Based: Beginner)
  2. Lateral Elbow Stabilization (Ground-Based: Intermediate/Advanced)
  3. 1-Dumbbell Marching (Upright: All Levels)

As I mentioned previously, this progression teaches hip/core strength and stability on the ground in addition to increasing the demand in an upright position that relates running. I highly recommend this approach for any runner who is serious about seeing big improvements in function and performance.

Take a second and watch this video to learn proper technique on these 3 exercises…

Now that you have learned and hopefully understand the exercises, it’s important to go about this the right way. The modified lateral elbow stabilization and lateral elbow stabilization target the exact same thing but one is very much harder than the other. My recommendation is to select which one you can successfully complete 3 sets of 10 repetitions and start from there. Oftentimes, the lateral elbow stabilization takes approximately 4-6 months to build up to, so don’t rush! It’s more important to hold yourself in the right position and with good technique, rather than choosing the hardest exercise just because.

Since the marching exercise is resisted with a single dumbbell, you can start working on that immediately. Complete the ground-based and marching exercise in the same strength training session to see the benefits from both. This will help build strength, stability and balance in two different positions to impact your running.

Any questions? Comment below or contact me directly so I can provide more individual feedback. Thanks for reading!

By: Garrett McLaughlin, MS, ATC, CSCS, ART

Random Thoughts on Creating Optimal Lower Extremity Alignment for Runners: Installment #8

March 12, 2017 · by Garrett McLaughlin
| Article written on March 12th, 2017 at 1:33pm | Follow Garrett on Facebook and Instagram |

The lower extremity is vital for good running form and performance. We all know that strength and endurance are needed to create movement, especially over long distances. But, they are also essential to withstand the stresses of high mileage. A muscle that is stronger will undoubtedly be more resistant to fatigue.

Within all of that, where does stability fit in? I bring this up because too often people are throwing strengthening interventions at a stability problem. If you have an issue maintaining lower limb alignment and control in the sagittal plane, strengthening the hip abductors won’t cause them to stabilize better.

I’ll be the first to say that strengthening those muscles is not a bad thing and most runners can benefit from this. But, we must put the body in a position to develop a rich neuromuscular connection which relies on constant feedback and response from the nervous system. Not to mention, looking at other areas throughout the kinetic chain for weak links and alignment issues.

Here are some random thoughts on creating optimal lower extremity alignment for runners:

1. Neuromuscular Control and It’s Impact on Stability

Neuromuscular control is a term that signifies the body’s connection between the nervous system and muscles. This system is a two way street which relies on sensory input and motor output. Therefore, muscles, joints, skin, and our own awareness send signals to the nervous system, which then respond with a stimulus to maintain or adjust our position.

When we think about stability, this reflexive scenario is essential. During each contact in the gait and running cycle, our nervous system is flooded with sensory information that it needs to assess and quickly respond to. The question is, does your body have the neuromuscular capacity to respond appropriately?

Despite being strong, we must first possess the ability to connect with specific muscles. Ultimately, this connection needs to happen without us consciously thinking about it. But, creating the framework for unconscious control starts with isolation.

Two of my favorite neuromuscular activation exercises for the hip are:

As you complete these movements, focus on connecting with the body and not about sets and repetitions. Performing isometric holds can be valuable which includes lifting to the end-range and holding the movement for 30-60 seconds. This provides more time to assess and adjust each movement to fire the intended muscles.

2.  Using Isometric Holds for Better Neuromuscular Activation

When it comes to running, the hip (and foot) is responsible for alignment of the leg. When the hip lacks stability and control, you’ll often notice that the femur moves into internal rotation. This can be seen with someone who falls into a “knock knee” position during gait and running.

Isometric holds can provide a situation where the body has time to appreciate it’s position and adjust to create optimal stability. Oftentimes, runners complete functional movements that are throughout the full range of motion. This is important and necessary, but needs to come once a joint can function in static positions.

Recently, I have implemented the loaded single leg stance, split squat isometric hold, and single leg balance with reach drills to provide more time under tension. These drills allow runners to connect with joint stabilizers so they can fire while maintaining a static position. The increased time of holding these positions often makes deficits in stability become more apparent.

I highly recommend you try these movements as an assessment to determine your level of neuromuscular function. See what you feel and if it is truly the area that needs to be firing. Is one side different than the other?

When the stabilizers aren’t functioning properly, we often find that other areas will compensate. The intended movement can actually look identical, but compensation may cause issues down the road.

3.  Train Stability to be Reflexive

Creating “stability” with conscious thought is a common practice. Just because I tell you to hold a split squat and make sure your knee lines up with your second toe doesn’t mean you are more stable. It means you can consciously correct your position.

Stability happens too fast for conscious thought. This is apparent in athletes who have good form and control in the gym, but quickly break down once they get into their training. Unless we create reflexive control in our stabilizers we are still at risk of dysfunctional movement patterns.

How do we teach our body to do this unconsciously?

Over the years, several strategies that have worked best are reactive neuromuscular training (RNT) and various self-limiting exercises. Reactive neuromuscular training is using a stimulus (band, physical touch, etc.) to push a specific joint into the unwanted position. The goal is for the body to autocorrect through reflexive control and re-establish a good joint position. Here is a sample RNT drill using the split squat:

Various self-limiting exercises I have used are in split stance or single leg stance while on a board or some type of balance beam. Why I love to use these structures is because once stability is lost the body loses the ability to remain on the board. Therefore, every loss of control magnifies itself. Creating an environment that rewards quality movement is key. This is the opposite of running and other forms of exercise which allow individuals to move for mile after mile despite poor form and mechanics.

4. Optimal Positions for Developing Stability

It’s important to know which positions create better stability. Yes, single leg stability is the end all be all, but we can use other positions to help bridge the gap to our end goal. I say this because oftentimes people find their balance is poor and continue to work on the hardest balance exercise out there with limited success. Let’s try taking a step back to some of these alternate positions that foster learning and appreciation before progressing ahead.

Two positions that I have in mind are 1/2 kneeling and split stance. Essentially they are the same position, but one is on the ground while the other is elevated. The beauty is you can use them for different reasons, such as: core, upper body, and lower body.

1/2 kneeling and split stance reduces the equal contribution of the core and hip musculature on the pelvis. Instead, it requires the body to maintain a level pelvis while the legs are in opposite positions. This is essential for runners who complete this exact motion in a faster and more repetitive fashion.

You may be wondering, what exact exercises do you mean? Previously I mentioned core, upper body, and lower body, so here are my favorites that fit that criteria:

5.  Is a Joint Mobility/Flexibility Restriction Causing Your Stability Issue?

When trying to improve lower extremity stability and control, it’s common to program stability and balance exercises, right? This would make perfect sense if there were no underlying mobility restrictions. But, if you are lacking optimal mobility or are really tight, what takes precedence?

Several years ago, I was at the Perform Better Summit and heard an interesting concept regarding the impact of mobility on stability. It was said that when a joint lacks range of motion, it tends to reduce the stability output.

Range of motion and joint mobility provide a proprioceptively-rich environment in which sensory input is sent to the nervous system. When a joint lacks movement, the feedback loop is disrupted as there isn’t as much sensory information sent to the nervous system in which to respond to. This lack of mobility can therefore disrupt the subsequent stability.

Ever since I heard this concept taught this way, I always make sure to look at stability from a few different lenses. Essentially, do you have trouble stabilizing? Or, is your lack of range of motion creating poor stability?

6.  Considering the Impact of Other Areas on Alignment

The lower extremity consists of a series of joints from the foot, ankle, knee, and hip. Since the ankle and knee primarily hinge with little rotation (besides just distally of the knee at the tibio-femoral joint), it’s important to look at the foot and hip in terms of alignment. These areas all contribute to alignment of the limb and one always affects the other.

The hip is a common focus in most running programs as it needs to possess adequate mobility, stability, and propulsion. But, excessive pronation of the foot can create a faulty alignment very similar to the hip

One area that need to be assessed is the medial longitudinal arch. The flexor hallucis brevis is an intrinsic foot muscle that spans across the arch and helps provide support to the foot. When lengthened or weak, this muscle fails to provide the control needed to support the arch, thus altering foot and lower extremity biomechanics. This also causes the knee to track medially and the hip will move into internal rotation. So, although it mimics a common hip dysfunction, it’s essential to assess other areas throughout the body.

The lumbar spine and rib cage are also important to lower extremity alignment as they lay the foundation for pelvic position. All of the musculature surrounding the core attach to the lumbar spine, pelvis, and rib cage. When poor alignment and control of these areas are an issue, the lower extremity can often be viewed as dysfunctional.

With how interconnected this region is, I find that the rib cage and lumbar spine can dictate the position for one another. Flared ribs is commonly seen with excessive lordosis and possibly an anterior pelvic tilt. And vice versa. Also, any scoliosis or restriction at the spine can cause altered pelvic positioning such as upshifts/downshifts and rotations.


Anyway, I hope you enjoyed this recent edition of ‘Random Thoughts.’ Feel free to comment below or on Facebook with your questions or insights on the topic.

By: Garrett McLaughlin, MS, ATC, CSCS, ART

Improving Hip Stability and Alignment for Runners

April 14, 2016 · by Garrett McLaughlin
| Article written on April 14th, 2016 at 07:31pm | Follow Garrett on Facebook, Twitter, and Instagram |

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Having proper hip stability is an important characteristic of a successful, and injury-free distance runner. With that being said, I think we are missing the boat on how to train stability properly…

Oftentimes, runners complete the traditional clam shells and straight leg raises before their runs to improve strength surrounding the hip. From a strength/endurance perspective this is adequate. But, what most need is to perform movements upright on a single leg or in split stance to effectively train stability.

Stability is a quality that requires a responsive feedback loop between the muscles and nervous system. You can’t just strengthen a muscle and expect it to automatically stabilize better. But, when we incorporate positions where alignment is disrupted, the nervous sends and receives a flood of signals that respond to correct the positional fault.

All of that sounds good and is the case in an ideal world. What happens when there is inhibition with the pathway?

Neural inhibition is a disruption within the feedback loop that doesn’t allow reflexive control of the stabilizing muscles. In essence, alignment is disrupted AND is not corrected. You have properly seen this before in a runner who has a valgus collapse. Every time their leg strikes the ground, their knee tends to collapse inward into more of a knock-knee position. This isn’t a knee issue, but lack of stability in the foot and/or hip.

knee-valgus1

All I’m trying to get at is, we can’t strengthen a muscle and expect it to stabilize. Instead, we need to restore the neural connection and then re-train stability. You can learn strategies to do so in the following video…

[Question of the day] Have you ever seen a runner who’s knee collapses inward as they run? Please leave a comment in the box below.

By: Garrett McLaughlin, MS, ATC, CSCS, ART

Random Thoughts on Scapula Positioning: Installment #7

January 17, 2016 · by Garrett McLaughlin
| Article written on January 17th, 2016 at 4:08pm | Follow Garrett on Facebook, Twitter, and Instagram |

The scapulae are vital when it comes to upper body function, especially at the shoulder. More often then not, people consider the shoulder only the ball and socket, and not the whole complex. Because the scapula has only one bony attachment, the clavicle, much of it’s function is determined by muscular attachments. We can observe the scapula at rest and throughout motion to determine how surrounding soft-tissue effects it. Here are some random thoughts on scapula positioning…

  1. There are several predictable positioning faults that are more common then others. Often, I find the scapula in a anteriorly tilted and laterally shifted position. This is easy to explain why, poor posture. From prolonged sitting, hunched shoulders, and excess use of technology, we allow shortening of the anterior (pec) muscles, while the upper back (rhomboids) lengthen. A tight pectoralis minor, which attaches to the scapula at the coracoid process, pulls the scapula anteriorly causing a tilt. Tightness in the pectoralis major will round the shoulders forward, causing the scapula to shift laterally away from the spine.
  2. Poor-scapular-positionHow far should the scapula be from the spine? The scapulae normally rest approximately 2 inches from the spine. It is common to see resting positions that do not reflect this. Poor posture can cause an increased distance from the spine. While over-dominant rhomboids and downward rotators of the scapula can cause the scapula to rest more closely. Allowing for proper resting position is essential.
  3. A combined approach to proper re-positioning. As described above, adaptive shortening in specific muscles can cause alterations in scapula position. But, we must also look at muscular weakness as well. To adequately re-position the scapula, we can’t just stretch tight muscles but must also shorten the lengthened and weak musculature. A combined approach will unlock the faulty position and allow for proper position to be restored. Manual therapy is also advantageous in both the shortened and lengthened musculature. Constant tension, regardless of the reason, causes reduced blood flow and fibrotic changes within the tissue. Restoring quality of the tissue may need to be a focus before trying to change length.
  4. upwardrot-300x246Over-emphasizing “shoulder blades back and down” reduces scapula upward rotation. Scapula upward rotation is an important movement which allows for adequate shoulder function when the arms are overhead. Too often, those that train clients will instruct people to “squeeze the shoulders blades back and down.” I have been guilty of this over the years, as well. This is fine when the scapula doesn’t need to upwardly rotate, as in movements under 90 degrees of flexion or abduction (it actually should upwardly rotate when the arm is elevated above 20-30 degrees). But, when we are lifting anything overhead, the shoulder blades need fluid movement to allow for optimal joint positioning. One of the main jobs of the scapula is to provide stability in the shoulder throughout it’s range of motion. Consciously locking down the scapula is NOT creating stability. Stability is a reflexive response from the nervous system to prevent unwanted joint motion. Reflexive means it happens on it own and without conscious thought. Next time you are lifting overhead, let those shoulder blades fly!

I hope you enjoyed this installment of random thoughts. Please go over to Facebook and leave me a comment on what you thought about this article and if you have any insight to share.

By: Garrett McLaughlin, MS, ATC, CSCS, ART

Random Thoughts on Enhancing the Push-Up: Installment #5

October 27, 2015 · by Garrett McLaughlin
| Article written on October 20th, 2015 at 9:27am | Follow Garrett on Facebook, Twitter, and Instagram |

The push-up is often one of those movements that is well-intended, but improperly executed. People are always asked to do push-ups from the floor, when they are not ready for this variation. That is why having a proper push-up progression is key. And, a more thorough knowledge on how to troubleshoot improper form. It’s my goal to provide you with that in this article.

In this month’s, ‘Random Thoughts on Enhancing the Push-Up,’ I want to discuss a few considerations that will ultimately improve your push-up. Instead of dropping to the floor and hammering away at 10, imperfect repetitions, this article will provide some thoughts on how to improve form and see even better results.

1. First, let’s understand proper set-up and positioning. If you don’t start in the right position, how do you expect the sequence of events thereafter to be correct? Begin with the hands on the floor in line with the shoulders, but just outside shoulder width. The toes should be under the ankles. And, the body needs to be in a straight line from the ankles through the head. You’ll see most people jump down and start so incorrectly that you wonder how they will get even a few repetitions in.

2. Is the push-up a full body or upper body exercise? This movement requires maximal stability and engagement in a myriad of muscles from the toes through neck. Therefore, it’s safe to say it’s a full body movement. Because of this, there are many different joints that need to stabilize for proper form.

Let’s start at the knees… The knees need to remain extended and rigid. Oftentimes, poor hip and lumbar positioning occurs because the knees tend to move into flexion. It’s always important to engage the quadriceps before beginning the movement. I always tell people to “lock out” their knees. In most cases, the hips and lower back return to proper alignment.

The lumbar spine and hips… This is a big area to see form breakdown as they often droop towards the ground. The anterior core (abdominals, obliques, and transverse abdominis) are key players to provide the stability necessary to prevent extension. Once we think beyond the simplistic viewpoint that the abs are meant to only crunch the body into flexion, we realize their importance in preventing extension. Cueing “abs tight” can make a difference, but I often find this fault is equally a knee issue as mentioned above. Training anti-extension core stability with exercises like the dead bug, planks, and stir the pot can be helpful.

The thoracic spine… Posture dictates a lot within this movement. Excessive kyphosis (rounding) of the thoracic spine may prevent neutrality. In the younger population, it may be beneficial to teach them to control spine position with the cat/cow before engaging in the push-up. Oftentimes, it’s not that they lack the mobility to get into position, but more so the inability to control it. The cat/cow provides feedback on how to get into neutral and regain proper positioning. In the older, office worker, mobility may need to be addressed first, to offset the negative effects of sitting, before performing this movement effectively.

The head and neck… Text neck has become an epidemic. We are staring at screens so much throughout the day that our head/neck is remaining in a protracted position. If we don’t actively retract the head during the push-up, the nose will make it to the ground before the body. I often find this fault in people who sit at desks, and also those who are trying a push-up variation well beyond their ability. Regressing to an easier variation may actually improve this issue without having to teach proper positioning. But, if that doesn’t do the trick, try incorporating a few of these chin tucks to teach cervical neutral can be helpful.

3. Before beginning the movement, it’s important to “screw” the hands into the ground. This places an external rotation torque through the shoulder and helps centrate the joint. Proper joint centration will allow for better joint motion and stability. The same technique can be used during the squat pattern to provide better centration and engagement of the hip external rotators and gluteals. Notice, as you “screw” the hands in opposite directions (left: counter-clockwise, right: clockwise), the elbows will angle closer to the body. This small adjustment is great for those who keep their elbows high, around shoulder height, or have poor stability in the shoulders.

4. Now that we have discussed all of the things that typically go wrong with the push-up, it’s important to know where to begin. Don’t be worried if you can’t do push-ups from the floor. In reality, most people can’t. You’ll be better off putting your ego aside and trying eccentric or incline variations. Eccentric push-ups are actually regular push-ups, with only focus on the lowering portion. This is valuable while teaching people how to get into proper position and maintain stability throughout the descent. Watch this video for more details…

The incline push-up includes finding a surface where the upper body is inclined, higher then the lower body. At home you can use the kitchen table or counter, and at the gym use a squat rack or bench. Please don’t do kneeling push-ups. I’ve never seen the appeal or importance of these. When you use the knee as your fulcrum, it significantly shortens the lever arm causing much less demand on core stability. Most often, those that do kneeling push-ups still have difficulty progressing to the regular version. Eccentric first, and then Incline is your best bet, while slowly moving the upper body lower until you are able to use the ground. Watch this video for more details…

I hope you found value in this edition of Random Thoughts. Please feel free to leave feedback or comment below. Good luck on those push-ups!

By: Garrett McLaughlin, MS, ATC, CSCS, ART

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