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Browsing Tags pain

Cadence: How to Manipulate Your Step Rate to Reduce Pain and Improve Performance (FREE Webinar Replay)

August 17, 2020 · by Garrett McLaughlin

Cadence is an important metric to track with your running. That’s because it can help reduce load into sensitive and painful tissues, address common faults with your running mechanics, and even improve running economy. Hence why it’s also called the “low hanging fruit” in the running world! But, cadence has to be approached the right way to create the results you are after.

Recently, I held a 60-minute webinar to talk about the topic of cadence exclusively. It’s my experience from working with countless runners that many are not familiar with cadence and, even if they are, it’s not being manipulated properly to improve running performance and/or reduce pain.

In this FREE webinar replay, what you’ll learn is…

What is cadence?
The research behind cadence as it relates to…
- Running mechanics
- Running economy
- Injury-specific
Methods to calculate your cadence
Tips & drills to manipulate your cadence
Q&A

–> Click here to receive instant access to the FREE webinar replay.

I hope you enjoy this webinar! Comment below or contact me directly if you have any questions or comments regarding this content. And, if you want to implement the best strategies to improve your running, click here to learn more about the Healthy Running Program.

Achilles Tendinopathy: Loading Strategies to Restore Pain-Free Function

April 7, 2020 · by Garrett McLaughlin

| Article written on April 7th, 2020 at 12:37pm | Follow Garrett on Facebook and Instagram |

Achilles tendinopathy is a general term used to signify pain, tenderness, and chronic changes to the tendon. On a regular basis, I see a lot of new running clients who enter the Healthy Running Program that display lingering symptoms which have not been fully addressed to resolve the injury process. Symptoms are most commonly seen at the mid-portion of the tendon, although insertional tendinopathy where the tendon and calcaneus meet is also possible. Pathology is often caused by degeneration as opposed to inflammation, and can be developed even before the onset of symptoms. That’s why a progressive and structured strength training program for runners can be valuable to maintain the integrity of this tissue as an injury prevention strategy.

Click here to connect with Garrett about your achilles pain.

Numerous studies have looked at exercise, therapeutic modalities, soft-tissue therapy, braces and splints, and injections as a way to resolve achilles tendinopathy. Exercise consisting of isometrics, eccentric, eccentric-concentric, and heavy slow resistance loading have been popular and continue to be highly regarded and debated as strategies to address overuse tendon injuries. The debate comes from mixed research showing people who respond favorably while others who may not respond quite as well. However, as a form of conservative management, loading the affected tissue should be a priority early within the rehabilitation process before considering other options.

Let’s define the four types of loading strategies…

Isometric loading is when the calf complex is contracting but the achilles is held in a position where it’s length remains constant. This can vary from shortened, mid-length, or lengthened positions depending on your specific needs and presentation.
Eccentric loading consists of an isolated and slow lengthening of the tissue. Do not confuse this with static stretching, as the calf muscle and achilles tendon are shortened and then actively lengthened through their range of motion. Think of assisting yourself up to the top of a calf raise and then emphasizing a slow and controlled contraction on the way down.
Eccentric-concentric loading consists of actively shortening and lengthening of the tissue. During a calf raise, the achilles and calf are used to actively raise up and lower down. This requires equal parts eccentric and concentric contraction.
Heavy slow resistance (HSR) more replicates a strength training type exercise where a greater degree of load is placed on the tissue. Instead of performing a bodyweight only movement, HSR utilizes external resistance to load the calf raise with a barbell or dumbbells.

With each of these types of loading to directly address the achilles tendon, repetitions, sets, rest periods, duration of movement, duration of time held in the lengthened position, and external load are all factors which need to be considered for the best results. In addition, Alfredson et al recommends stressing the tendon to the point where pain is evoked. Therefore, an aggressive approach that takes into consideration the “24-Hour Rule” might be necessary in resolving overuse tendon injuries.

The “24-Hour Rule” is a general rule of thumb we use to determine the appropriate amount of stress to place on an injured tendon. Basically, you want to stress the achilles tendon in a way that evokes pain but does not exceed a 3/4 out of 10 on the pain scale. If pain continues after you finish the exercise, it should resolve completely within 24-hours. This is an important concept to understand with tendon pain. A certain degree of pain is acceptable and might be needed to elicit the desired response from the tendon. However, if your pain exceeds these parameters then modifying certain variables, such as the exercise, tempo, load, rest period, and position might be warranted.

With all of this talk about pathology of the achilles tendon, it’s important to also understand how running biomechanics can be linked with injury. In research articles by Azevedo et al and McCrory et al, the factors which were shown in runners suffering from achilles tendinopathy compared to a healthy control group were…

Decreased range of knee flexion between the foot strike and midstance phases
Decrease in pre-foot strike muscle activity of the transverse abdominis
Decrease in post-foot strike muscle activity of the rectus femoris and gluteus medius
Muscular weakness of the plantar flexors while eccentrically controlling dorsiflexion
Larger inversion angle at foot strike and increased rate of pronation
High and inflexible arches

Therefore, in addition to incorporating specific exercises to improve the tendon’s ability to tolerate load, modifying running biomechanics is often warranted. If pain is manageable while running and doesn’t last more than 24-hours after, I usually recommend continuing to run or implementing a run/walk interval so running mechanics can be addressed. Despite overloading the tendon being a main reason which contributed to the injury in the first place, resting often leads to less than desirable results unless compensation and disability result from activity.

If you’re interested in scheduling a virtual or in-person running analysis click here to contact me directly.

In the following section, let’s cover a progressive loading protocol that I often use when rehabilitating achilles tendinopathy. Of course, there are multiple ways to load the achilles as shown in the research. But, I often find starting with isometrics and progressing to eccentric-concentric and then heavy slow resistance or plyometrics is reliable since it provides multiple options depending on the response from the tendon. Use the “24-Hour Rule” as your guide to determine where to start and progress as tolerated from there.

Isometric Calf Raise

The Isometric Calf Raise is usually a safe starting point if you are suffering from a reactive achilles tendinopathy or hesitant to load the tendon. What this does is place the tendon under load for a given duration to begin stressing the area very conservatively. The variables that can be modified are duration, position of the ankle, and double leg vs. single leg. Complete this exercise for 2-3 sets of 20-60sec.

Calf Raise

The Calf Raise is the entry point into isotonic achilles loading. Isotonics is a term that refers to the muscle/tendon moving from a shortened to lengthened position. When incorporating this exercise, the variables to take into consideration are sets, repetitions, tempo, and range of motion. Complete this exercise for 2-3 sets of 10-20 repetitions.

2-to-1 Calf Raise

The 2-to-1 Calf Raise is used within this progression to segue from bilateral to unilateral loading. Since the achilles needs to withstand a great degree of stress during running and different sporting activities, it’s important to utilize single leg variations to replicate that and introduce a higher degree of load. Simply, raise up on both legs and then isolate the lengthening of the injured achilles tendon with a slow and controlled eccentric contraction. The variables to modify depending on how you respond to this exercise are sets, repetitions, tempo, and range of motion. Complete this exercise for 2-3 sets of 10-20 repetitions.

Single Leg Calf Raise

The Single Leg Calf Raise is essential to help resolve an achilles tendinopathy. One big problem I see is that runners stop with Calf Raises or 2-to-1 Calf Raises since pain begins to stabilize allowing them to return to activity. Unfortunately, the absence of pain does not equate to a fully healed tendon and, therefore, more loading with harder variations is recommended. The variables to modify depending on how you respond to this exercise are sets, repetitions, tempo, and range of motion. Complete this exercise for 2-3 sets of 10-20 repetitions.

Ankle Hops

With any tendon, the end goal needs to improve it’s ability to store and release energy. If you stop short of achieving this, you will have a situation where the capacity to be loaded has been improved but not with rapid and explosive movements. That’s a main reason why most runners suffer from recurrent tendon issues year after year. Ankle Hops is a very simple and important low level plyometric movement. Essentially, it is an explosive Calf Raise that improves the elasticity and shock absorption capability of the tendon and calf complex. Complete 2-3 sets of 5-10 repetitions while increasing intensity.

Now that you have a better understanding about achilles tendinopathy with different exercises to address the injury, it’s important to start simple and determine your starting point. Reflecting back on the “24-Hour Rule,” try to find the most challenging exercise above which creates a mild degree of pain but resolves within 24-hours. Continue to progress in terms of exercise, sets, repetitions, tempo, and range of motion, while being mindful of how you respond.

I hope this article has helped you better understand achilles tendinopathy, as well as recommended strategies to reduce pain and increase function. As always, it’s important to consult with a trained healthcare professional to be properly diagnosed and understand the underlying factors which may be contributing to your injury. Please take a second to click here so we can create a structured plan to resolve your achilles pain once and for all.

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

Sources:

Etiologic Factors Associated with Achilles Tendinitis in Runners by McCrory et al
A Treatment Algorithm for Managing Achilles Tendinopathy: New Treatment Options by Alfredson et al
Achilles and Patellar Tendinopathy Loading Programmes : A Systematic Review Comparing Clinical Outcomes and Identifying Potential Mechanisms for Effectiveness by Malliaris et al
Chronic Achilles Tendinopathy Treated with Eccentric Stretching Program by Verrall et al
Biomechanical Variables Associated with Achilles Tendinopathy in Runners by Azevedo et al
Achilles Pain, Stiffness, and Muscle Power Deficits: Mid-Portion Achilles Tendinopathy Revision 2018 by Martin et al
Achilles Tendinopathy: Current Concepts about the Basic Science and Clinical Treatments by Li et al

The Secret Behind Injury Prevention: Can You Run Your Next Race Pain-Free?

November 2, 2019 · by Garrett McLaughlin

| Article written on November 1st, 2019 at 4:45pm | Follow Garrett on Facebook and Instagram |

Have you struggled with persistent aches, pains, and various running-related injuries throughout the years? Are you at the point where you are ready to try something different in hopes of seeing better results? If so, this article should provide you with the guidance necessary to reduce your likelihood of injury once a for all.

I hate to mislead you with some attention grabbing title. But, the truth is… Running is a painful sport. In fact, the research shows that up to 70% of runners get injured each and every year. Therefore, the real goal should be how to reduce your risk of injury since it cannot be prevented altogether. This can be done by increasing your tolerance to the demands of running and functioning in a more efficient way.

In the following sections, I will present a few key points for you to consider when emphasizing injury reduction…

Perform a Running Analysis

Since you’ll usually spend anywhere from 3-6 days per week running, the first step is to run more efficiently. How do you go about that? Spend the time and a little money on the front end by paying a trained professional to conduct a running analysis. This can be done in simple ways such as slow-motion treadmill analysis or with wearable technology like the DorsiVii.

Too often do we pay for the best Garmins, self-myofascial release tools, and training programs. In reality, your money is best spent on improving the quality of your movement within the sport. More efficient running form will cause less wear and tear on the body, as well as improve performance.

Complete a Movement Assessment

In addition to analyzing your running form and implementing the corrections which will make you more successful on the road, it’s important to assess general and specific movement patterns. What’s important to realize is that the body is really good at compensating. This means that a movement might appear normal even though the strategy to achieve that position has been altered due to a mobility, stability, or motor control problem.

During an assessment, you will complete a series of movements that can be analyzed by a trained professional. These movements provide a good glimpse into how the body functions in various positions. And, these naturally play a big role in how well you run.

Most movement assessments consist of the squat, lunge, single leg stance, step down, and other relevant drills. They can also be broken down to a greater degree when a discrepancy is found by evaluating one or several of the joints involved. In the end, you can determine your overall movement competency, if there are any imbalances or asymmetries from side to side, and which weak links need to be addressed to reduce your risk of injury.

Correct Your Weak Links

With the running analysis and movement assessment completed, you will have a very good idea of which areas require your attention. What’s important to realize is that there might be several things which are not “optimal,” in regards to your movement. The good thing is, you don’t have to be perfect to be a successful runner. And, by no means do you have to correct everything. Instead, work closely with your healthcare provider to determine what are the low hanging fruit or most important priorities to target first. Start there!

When implementing a corrective plan, patience and consistency are the two key ingredients. You can’t work on your specific exercises once a week and expect it to have any impact. Many of these underlying issues may have been present for months or even years before uncovering them. Therefore, address them daily, progress your program when able, and stay committed for the long haul.

Incorporate a Structured and Progressive Strength Training Program

Runners either have a love or hate relationship with strength training. However, one thing we can’t deny is that a higher level of strength or endurance only increases your tolerance to the demands of running. And, the great thing about that is, you are able to improve your foundation without running more miles. This is crucial as we age.

In my opinion, strength training is not the best term for it. Of course, it’s helpful to be stronger and more resilient. But, there are other characteristics which could better reduce your risk of injury, including: mobility, stability, neuromuscular control, timing, coordination, stiffness, and shock absorption. All of these play a vital role while running and should be addressed within your strength training program.

The big question usually becomes, how do you implement a strength training program alongside your running? Of course, running needs to be your priority. With that being said, there are weeks or months throughout the year where you can be more aggressive in the gym. This is usually following your goal race as you take some time to recover or even early in your running plan while you are still establishing a base. Then, as mileage builds, strength training can back down into more of a maintenance phase. As long as your body is able to adequately recover between runs, strength training should play a role in some way. Anywhere from 1-4 days per week is recommended depending on the time of year.

Understand Intensity, Volume, & the Importance of Recovery

Three of the most important variables in running are intensity, volume, and recovery. These have a very special relationship with each other that undoubtedly play into your likelihood of enduring a running-related injury. Plain and simple, the higher the intensity or greater the volume, the more recovery is needed. When recovery is overlooked for the sake of running faster or more miles, tissue breakdown will likely exceed tissue repair.

Running is infamous for chronic overuse injuries such as tendinopathies and stress fractures. How do these occur? A repetitive load is applied for too long or with too much magnitude for positive remodeling to occur. That’s why it’s very important to listen to your body and reduce intensity or volume when you are excessively tired, not sleeping well, experiencing high levels of stress, during certain times of your menstrual cycle, and/or not hitting your normal paces.

In the end, it’s important to be smart with your training. If you start to notice any of the warning signs listed above, consider what modifications you might have to make to stay healthy. That’s why I always recommend following a structured and progressive plan that builds you up for your goal race, while prioritizing recovery. Not to mention utilizing an experienced running coach to help you make smart decisions.

Like I mentioned upfront, running is hard on the body and there is no way to prevent running-related injuries from occurring altogether. Being smart, listening to your body, and applying some of the strategies I mentioned can help alleviate the risk so you can continue running on your terms for years to come.

Thank you for reading this article. If you personally need help reducing your risk of injury and think some of the strategies I outlined in this article could be helpful, click here to learn more about the Healthy Running Program. This program is designed for runners and will be 100% individualized to your needs. In-person and remote options available!

In the Spotlight (September): Brooke Kocher

September 15, 2017 · by Garrett McLaughlin

We are back at it with our second edition of ‘In the Spotlight!’ This month I have a recent client who’s diligence and attention to detail has been the best I’ve seen. And, it’s really no surprise she saw great results.

After the first session/evaluation, each one of my clients receive specific instructions on exercises and drills to perform daily. This is an area many of them could be more consistent to see better results. That was not the case with Brooke.

Brooke was always eager to learn and apply the strategies I recommended on a daily basis. This allowed her to see great improvements with her lower back/hip pain and begin slowly returning back to the activities which she loved so dearly.

Without further ado, let’s shine the spotlight on…

Brooke Kocher

Brooke and her daughter at the Disney 5k in 2016

Q: First, tell us a little bit about yourself and where you are from?

A: “I am from Chattanooga, TN and have lived in Nashville with my family for four years. My husband, Ryan, and I have three children who are 9, 5, and 3. I am a full time mom and have loved the gift of staying home with them while also being involved in fitness, church activities and volunteering in the community.”

Q: If you could live anywhere in the world where would that be? Why?

A: “This is a very difficult question because I love to travel and would be very happy living in many places. I was fortunate to travel abroad several times in high school and college and each trip I felt like it only increased my desire to live abroad for longer periods of time. One of my favorite spots was Edinburgh, Scotland. The history, rural and coastal beauty and cultural dances and music were all amazing.”

Q: Other the years, what forms of exercise have you been into?

A: “Early on I participated in gymnastics, diving, track, soccer, running and modern dance. Since having children, I have mostly enjoyed running longer distances and then I started doing CrossFit four years ago.”

Q: What are the top reasons you enjoy CrossFit and staying active?

A: “CrossFit was the perfect combination of gymnastic movements, running, introducing barbell movements (which was new for me) and the sheer competitive drive that I missed from organized sports. Plus I could compare my results to my husband. We are both competitive and push each other to improve as we age. I want to stay active to enjoy activities with my husband and children for as long as possible. Physical activity is my stress release, my creative outlet and my time to recharge in nature.”

Q: When you first started working with Garrett, what were the goals you wanted to achieve?

A: “I researched Active Release Therapy (ART) and wanted to know if Garrett could address sciatic nerve pain with ART that physical therapy had not improved. I didn’t want to lose hope that I could be asymptomatic from a herniated disc, but I was starting to accept that maybe I would never fully recover. I didn’t know what goals to have other than moving without pain.”

Q: What was the catalyst that made you reach out to Garrett in the first place?

A: “I had been working with a massage therapist for several months and she recommended Garrett to me. She has been a fantastic resource so I trusted her judgment and she was hopeful that Garrett could address my problems better than past physical therapists had. And most of all I had prayed daily for God to order my steps and direct me to the next step in my treatment. I am thankful God knows what He’s doing!”

Q: What are the some of the improvements you’ve seen so far?

A: “I have seen countless improvements in my activities of daily living as a mom. I can pick up my 3 year old son without pain. He used to say, “hug me up” which means pick him up and hug him. I couldn’t do that without pain and it broke my heart. I can now bend down to tie my shoes, change clothes, get in and out of a car, carry groceries, race my children and participate in pilates/yoga classes that I thought would never be possible.”

Q: An individualized corrective exercise program that includes mobility, activation, strength, and movement was a big part of your success… Why do you think this was the case?

A: “I had to train my body to awaken and activate certain muscles that were not responding properly and therefore were putting undue stress on smaller muscle groups. As a gymnast and runner, I had always taken my endurance, strength, and flexibility for granted, but none of that mattered anymore if my muscle imbalance and poor activation sequences were putting me at risk for injury.”

Q: Do you think you would’ve seen positive results without the corrective program or if you only completed your exercises sparingly?

A: “I do not think I would have improved had I not trusted Garrett’s expertise and followed the corrective program as it was prescribed. Before meeting Garrett, I had been in physical therapy for 6 months under several different therapists, and did not see the improvement I hoped for. After working on Garrett’s program, I saw significant improvement. The specific movements and sequences made all the difference!”

Q: What is that one thing you dislike the most but continue to work on because you know it will help?

A: “I dislike the restriction on movements that I know will lead to sciatic nerve pain. I wish I could resume all of the activities I once enjoyed, like running, but I know being patient and following Garrett’s guidance on which movements to avoid until my muscle balance and mobility have improved will be worth it.”

Q: Do you have any advice for others who are going through the same situation as you?

A: “The daily commitment to follow through on exercises at home will be the small and steady steps that eventually lead to long-term gains. Some nights the last thing I feel like doing is my stretches, but it is worth it.”

Q: How do you feel Garrett’s services may differ from other professionals in his field?

A: “I knew immediately that Garrett’s initial, thorough evaluation of my condition and attention to detail of my medical history, current pain levels, etc. showed his commitment to getting the proper diagnosis and corrective exercise program. Knowing that he expected me to do my part and was confident that I could improve gave me the hope and encouragement that change was possible.”

Q: Looking ahead, do you have any new goals you are working towards?

A: “I want to pursue swimming and potentially resume running. My favorite activity with my 9 year old daughter was racing 5Ks, so I must keep improving in my corrective exercises in order to run without pain. But I trust that is possible with Garrett’s help!”

Thank you for reading the ‘In the Spotlight’ segment. And, a big shout out to Brooke Kocher!! Please feel free to comment below with any questions or feedback.

Exercise of the Month: Band Wide Pull

November 5, 2015 · by Garrett McLaughlin

| Article written on November 5th, 2015 at 10:19am | Follow Garrett on Facebook, Twitter, and Instagram |

Posture is important. And, in the human race it is declining rapidly. Not only is gravity one of our best friends and worst enemies, but technology is playing a huge role as well. Most of what we do on a daily basis is in front of us. We type on the computer (like I am now), we sit in the car, and we overall endure postures that are pretty lousy. So, having a go-to exercise to combat forward shoulder posture is essential.

The band wide pull is basic. But, while being basic, it is very easily done incorrectly. It’s primary goal is to strengthen the muscles between the shoulder blades, which promotes good posture and optimal shoulder health.

The muscles between the shoulder blades and the spine include the rhomboids and trapezius. When we are in a position where our shoulders round forward, we place these muscles in a lengthened/stretched position.

As you read this, what position are your shoulders in?

Constant tension is a gateway into the cumulative injury cycle. We need balance between musculature tension and relaxation. In the case of good posture, our soft-tissue is held in a balanced position where it is in optimal length. Here, blood flow is restricted within the tension positioned, but restored with relaxation. Therefore, muscles are able to be fueled with oxygen and function optimally.

When we adapt to the everyday postural stresses and now maintain a forward shoulder posture, tension in this musculature is constant. Constant tension means limited blood flow and lack of oxygen. Our tissues become fibrotic and lose their supple and elastic properties. This often exhibits as pain or “tightness” between the shoulder blades.

What I’m trying to say is that you should do the band wide pull to offset this problem. Some stretching will also be a good supplement to open up the tight pec major.

How to properly execute this exercise

Hold a very light/light resistance band in your hands
Start with your elbows by your side and palms up, facing the ceiling
Ensure the upper trapezius/shoulders are relaxed and without shrugging
Squeeze the shoulder blades together and stretch the band in opposite directions
As the arms straighten next to the body, make sure the pinch between the shoulder blades is the focus
Relax and return to the starting position
Repeat for the desired repetitions

Note: The focus of this exercise is motion at the scapulothoracic joint and not at the shoulder. This means that we don’t want to excessively extend the shoulder, but focus on squeezing the shoulder blades together. Begin with a light band, anything too challenging will cause compensation and limited success.

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

10 Exercises to Offset the Negative Effects of Sitting

October 18, 2015 · by Garrett McLaughlin

| Article written on October 18th, 2015 at 7:15pm | Follow Garrett on Facebook, Twitter, and Instagram |

We have all heard the claim, “sitting is the new smoking of this generation.” That definitely rings true and hits close to home.

We have already seen the damaging effects of smoking, but are only in the midst of the sitting epidemic.

Hindset is 20/20, and many people won’t understand it’s impact until it’s too late. This holds true for office workers, truck drivers, and those who sit for extended periods of time.

And, that is just from an occupational standpoint. Studies show an increased number of people are sitting for extended periods at home as well, while also living sedentary lifestyles.

This is a problem.

What can YOU do to offset the negative effects of sitting?

Making movement a priority is in the forefront of fixing this epidemic.

That doesn’t mean we need to spend countless hours in the gym each and every day to see a benefit. Try standing up and moving your joints 2-3 times every hour. That’s a good place to start.

If you want to get more specific and your workplace provides ample space to move, below is a guide to overcoming the negative effects of sitting. Take just 5 minutes every hour and complete the following list of stretches, mobility drills, and strengthening exercises.

Pelvic Tilts x10
Dead Bug x10 each
Brettzel 2.0 x 5 breaths each
Quadruped Thoracic Spine Rotation x10 each
Bird Dog x10 each
1/2 Kneeling Hip Flexor Stretch x30 seconds each
Wall Pec Stretch x30 seconds each
Bent Over T x10
Wall Ankle Mobility x10 each
Squats x10

How do you feel?

The list of exercises above are designed to accomplish the following:

Mobilize joints restricted from being in the seated position
Stretch tight/shortened muscles
Strengthen weak/lengthened muscles
Increase joint lubrication
Get you out of your chair and utilize the body’s range of motion
Provide a positive stimulus to prevent postural decline

Try incorporating those exercises into your daily routine. Whether you are sitting at work, or sitting at home, they can be invaluable in providing your body the movement needed to offset the negative effects of sitting.

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

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