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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

Loading Strategies to Resolve Patellar Tendinopathy

March 7, 2020 · by Garrett McLaughlin

| Article written on March 7th, 2020 at 1:17pm | Follow Garrett on Facebook and Instagram |

Anterior knee pain is common amongst runners, athletes, and the general population. In this article, I will attempt to explore different considerations regarding patellar tendinopathy specifically and provide various loading strategies for rehabilitating the knee back to full function.

Click here to connect with Garrett directly about your knee pain.

The patellar tendon is located directly at the front of the knee and connects the quadriceps, patella, and proximal tibia. Pain is usually localized to the inferior pole of the patella and during movements that load the quadriceps. Cook et al reports that approximately 1/3 of athletes who presented with patellar tendinopathy were unable to return to sport for more than 6-months. Therefore, early detection in less severe stages is crucial, as well as the acceptance that resolution of symptoms could take an extended period of time.

Anterior view of the knee joint and patellar tendon.

What’s important to realize about an injury to the patellar tendon is that we are dealing with a dense fibrous connective tissue that connects muscle to bone. According to Thorpe et al, the main function of tendons is to “transfer muscle generated force to the bony skeleton, facilitating movement around a joint, and as such they are relatively passive, inelastic structures, able to resist high forces.” Despite being able to resist against high forces, as in running, jumping, and many sporting activities, tendons are susceptible to injury based on various scenarios…

The force placed upon the tendon exceeds the tissue’s load capacity
A series of small and repetitive forces are applied for a duration long enough to cause tissue breakdown
Other biomechanical factors are creating compensation elsewhere throughout the kinetic chain which ultimately increases load on the tendon

Regardless of which scenario proves to be true, the end goal of any tendon rehabilitation program is not the absence of pain, but return to full, pain-free function. Like with most injuries, rest is important and will allow the injury to calm down temporarily. However, tendon pain will likely resume when load is re-introduced to the area if the capacity of the tissue is not restored.

In the research article, ‘Current Concepts in Biomechanical Interventions for Patellofemoral Pain,’ Willy et al describe a homeostasis model first created by Scott Dye in 2005. This model suggests that the injury process can be stimulated in response to sudden bouts of increased training loads or stressors. For example, a runner or athlete that is conditioned for a specific distance or intensity but decides to increase one or both of these factors before the tendon is ready to handle the increased workload. That’s why I recommend all runners follow a structured and progressive training program which increases mileage in a safe and effective manner to build tissue tolerance.

Willy et al states that once homeostasis of the tissue is disrupted, sudden increases in training loads may no longer be able to be tolerated even if these are routine daily activities. Therefore, once the tissue is in a pathologic state, the ability to load without pain decreases significantly. The goal now becomes to re-establish this homeostatic relationship to stabilize the tissue, then progressively restore the loading capacity to be more tolerant to the forces it will encounter. Basically, excessive loading created this situation but it will also be a key factor in resolving it for long-term success.

Now, before we cover the loading strategies to resolve patellar tendinopathy, it’s important to touch on cadence, aka step rate, and it’s impact on the knee while running. Overstriding (image B below) is a term that refers to the foot landing too far in front of the body’s center of mass at initial contact. What this does is create a braking mechanism and thus increases energy absorbed at the knee.

Progressively loading the quadriceps and patellar tendon will certainly make the area more tolerant to the forces of running. At the same time, increasing cadence by just 5-10% has been shown to decrease energy absorbed at the knee by 20-34%.

Running at a higher cadence reduces stride length, disperses the amount of force over more steps, and allows the foot to land closer underneath the body’s center of mass. A combination of both approaches is important to consider in order to reduce the likelihood of injury and/or return to running following patellar tendinopathy. Click here to read a more in-depth article that I wrote on the topic called, ‘The Impact of Cadence on Running Mechanics.’

When incorporating the following loading strategies, it’s important to keep in mind the 24-hour rule. Basically, you want to stress the patellar tendon in a healthy way that limits pain to nothing above a 3 out of 10. And if pain lingers, 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, and position might be warranted.

Decline Squat Progression

The Decline Squat is a fantastic exercise that utilizes a slant board or elevated heel position to increase demand on the knee. Like with all of these progressions to rehabilitate patellar tendinopathy, it’s important to understand the dose and response relationship before increasing the intensity in anyway. What I mean is, start simple and progress slowly after seeing how the tendon responds to the added load, tempo, and number of repetitions. The different variations of this movement allow you to gradually increase load on the knee joint in a progressive manner. In this video, I demonstrate the bodyweight, goblet, and 2-dumbbell Decline Squat progression.

Spanish Squat Progression

The Spanish Squat is a somewhat newer exercise that I’ve only used for the past 2-years or so. Like with all of these progressions to rehabilitate patellar tendinopathy, it’s important to understand the dose and response relationship before increasing the intensity in anyway. What I mean is, start simple and progress slowly after seeing how the tendon responds to the added load, tempo, and number of repetitions. The different variations of this movement allow you to gradually increase load on the knee joint in a progressive manner. In this video, I demonstrate the bodyweight, goblet, and 2-dumbbell Spanish Squat progression.

Lateral Step-Up with Counterbalance

Since the knee is largely influenced by stability at the foot, ankle, and hip, it’s important to successfully complete one of the bilateral exercises mentioned above and then move on to a single leg variation. The Lateral Step-Up with Counterbalance allows the body to be held in a position that loads directly into the knee joint. Like with all of these progressions to rehabilitate patellar tendinopathy, it’s important to understand the dose and response relationship before increasing the intensity in anyway. What I mean is, start simple and progress slowly after seeing how the tendon responds to the single leg position, load, tempo, and depth of the step. This exercise is usually recommended after laying the foundation with the two bilateral progressions demonstrated above.

Despite showing you two different loading progressions to properly rehabilitate patellar tendinopathy, it’s not my intention for you to complete both of these. I would start by determining which is the best starting point for you and following that path to create a more tolerant and pain-free knee. Once that’s achieved, the Lateral Step-Up with Counterbalance is a suitable next step to incorporate single leg loading and stability. This is especially important if your goal is to return to running or a change of direction sport.

I hope this article has helped you better understand patellar 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 knee pain once and for all.

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

Considerations for Maintaining Optimal Knee Health

March 27, 2019 · by Garrett McLaughlin

Article written on March 27th, 2019 at 03:55pm | Follow Garrett on Facebook and Instagram |

The knees endure tons of stress during running, athletics, lifting weights, and other daily activities. That’s why it’s important to implement the correct approach to optimizing knee health within your strength training and movement program.

In many instances, runners strengthen the muscles surrounding the knee joint in an attempt to resolve a knee injury and/or prevent a future one from occurring. Building strength and resilience is always welcomed since it creates somewhat of a protective shield around the joint. However, from a biomechanics standpoint, the knee joint is greatly influenced by the hip and medial longitudinal arch. Therefore, solely increasing strength is a short sighted approach to reducing pain and improving function.

Like I mentioned previously, the hip and medial longitudinal arch are key players when it comes to proper knee health. Stability and control at these joints ultimately dictate how the knee will be positioned during movement. This is especially true with running and single leg stance.

Poor stabilization at the hip and arch cause what’s commonly known as, valgus collapse. This means the knee joint is tracking inwards and the alignment of the entire lower limb is no longer in a vertical position. The greater the degree of this collapse, the more stress placed on the patellofemoral joint and knee as a whole. It’s important to realize that this is not a knee strength issue but rather a positional issue.

So, what’s the solution?

Assuming structural issues have been ruled out, implement a thorough and progressive corrective/loading program to build stability, control, and alignment in the lower extremity. This should include exercises that target hip/foot activation AND stability and alignment.

Next, improving the knee joint’s ability to withstand higher loads and ground reaction forces with landing-based plyometrics is a must. Teaching proper jumping, landing, and positioning of the joint during loaded activities will build the resilience needed to return to running with better long-term success and less incidence of future injury.

The following video will reinforce several key considerations when targeting optimal knee health…

I hope this article has helped shine some light on the “other” areas which contribute to proper knee health. I highly recommend seeking an evaluation from a qualified healthcare professional so you can be properly diagnosed and put on a daily corrective program. If improving your knee health is a priority, click here to contact me directly so you can work towards achieving a pain-free and healthy lifestyle.

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

In the Spotlight: Michelle Martelle

October 15, 2018 · by Garrett McLaughlin

In this edition of ‘In the Spotlight,’ let’s talk with Michelle Martelle. Michelle was enrolled in the Integrative Approach to Movement program for the past 6-months which includes an orthopedic approach to movement training. Due to the long-term nature of these chronic injuries, a patient and progressive approach needs to be taken in order to respect the body’s healing process. Luckily for me, Michelle was awesome to work with and I enjoyed every session!!

I started working with Michelle because she was suffering from a challenging case of plantar fasciitis and patellofemoral pain. When aches and pains linger for years, it’s an uphill battle getting to the point where things are manageable again. And in the case of overuse injuries, it may actually take 6-12 months for that to happen. Luckily, despite many frustrations throughout our time together, Michelle was able to prevail by working hard and being patient.

We regularly spoke about the rollercoaster ride she was on and how looking at improvements from a wider lens allows us to view those details which are impossible to see day to day or even week to week. It was also important to re-evaluate the baseline testing protocol to provide a more objective look at progress.

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

Michelle Martelle

Q: Where are you from?

A: “Charlotte, NC”

Q: What are some of your favorite hobbies?

A: “I love boating and being on the lake. I also love hiking, especially around waterfalls.”

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

A: “First and foremost, I would always want to live close to my children. I would hope that would be in a place that is warm all year round near crystal blue water.”

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

A: “I was referred to Garrett when I was buying new tennis shoes. I was having terrible knee pain and had plantar fasciitis. I thought that new shoes would help. I was telling the salesperson that I used to love to run but haven’t been able to for the past four years. I also told her that I was starting PT for my knees and foot. She recommended Garrett because he had helped her work through an injury and get back to running. She said he would be able to help me too. So, I went to see Garrett for a consultation. He was so impressive and had all the confidence in the world that he could help me with my physical issues. So, I chose to work with Garrett versus a conventional physical therapist. It was one of the best decisions I have ever made! My first and most important goal was to get rid of my knee pain and foot pain with the ultimate goal of being able to run again without pain.”

Q: How long have you been experiencing pain and were there any strategies in the past that provided relief?

A: “I have been dealing with plantar fasciitis from mild pain to severe pain for at least eight years. I have spent a lot of time stretching and rubbing my foot to get rid of the pain. It would go away slightly, but never healed completely. I had been dealing with knee pain for three months prior to working with Garrett. My knees have always had a small amount of pain, but not the extreme pain that I had been dealing with over the three previous months. I could barely get up the stairs at my house. Nothing I was doing was making it better.”

Q: What are the most noticeable improvements you’ve seen so far?

A: “Since working with Garrett, my foot pain is almost completely gone. It only hurts very mildly if at all and that is typically only right when I wake up. I am so excited about this progress! And my knees are so much better! I can go up and down the stairs with no problem. I can even run up and down the stairs now! I can sit on the floor Indian style and get up without my knees buckling on me!”

Q: Were these improvements easy to achieve? And, tell us a little bit about any struggles along the way.

A: “It took six months of working with Garrett to get to the point where I am now. It definitely wasn’t easy. I have always worked out, but I basically had to start over with certain exercises to build up the strength in my legs. It was very humbling. From the beginning through around four months, I was always in pain for a day after working with Garrett. I was having to learn new exercises and re-learn some of the exercises that I had been doing forever. I didn’t realize that the way I was doing some of the exercises before working with Garrett was incorrect and probably creating some of the issues. There were days that I didn’t want to go meet with Garrett because I was in so much pain and that made me super grumpy! He wouldn’t let me give up though. He made me push through and after six months, I feel so much better! I actually feel better than I have in years!”

Q: If you were having a conversation with someone who was experiencing the same aches/pains as you were, what would you tell them?

A: “I talk to people all of the time that are dealing with the same pains that I have had. I always say the same thing – go see Garrett! He has been great! I tell them all about my struggles with the pain, my training with Garrett for the past six months, and how much better I feel because of working with him.”

Q: What was your favorite part about the corrective exercise sessions?

A: “My favorite part about the corrective exercise sessions was seeing the improvements that I made and the strength I was building. I will be the first to say that I didn’t love all of the exercises because they were hard for me. But seeing where I am now versus six months ago makes it all worth it. I would do the exact same thing again if I had another injury. And honestly, working with Garrett was my favorite part! He was always so positive and upbeat! He has a great attitude and outlook on life! It’s hard not to leave smiling after training with Garrett!”

Q: What is that one thing you dislike the most (exercise, stretch, etc.) but continue to work on because you know it will help?

A: “What I have learned along the way is that my hamstrings are my achilles heel. They are the cause of a lot of my issues because they are super tight, especially my left one. I REALLY don’t like the supine ball curls! My hamstrings cramp up almost immediately. But Garrett has taught me that I need to focus on using my glutes, not my hamstrings. Maybe it is actually a weak gluteus maximus that is the cause of all of my issues! 😛 I still do the daily exercises he gives me and try to do the weight training he taught me twice a week.”

Q: If there is one piece of advice that you could provide to yourself when you first started this program, what would that be?

A: “At the beginning of my time working with Garrett, I would have told myself to be patient and that there will be times that you will feel like giving up. I would have told myself to remember that I would need to work through it slowly. Thankfully, Garrett reminded me of that!”

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

A: “Garrett is the first trainer I have ever worked with. He is very educated in what he does. While I was training with him, he attended several continuing education seminars. Also, he works with a lot of people to rehabilitate them after injuries. I had sought help in many different ways for the pains I was dealing with and Garrett has been the only one who was able to “fix” my physical issues. I believe that his ART certification makes him stand out among his peer group.”

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

A: “I am working hard towards running again. I am not a marathon runner, just a simple 5k runner. I really enjoy it and would love to be able to run without having any pain or injuries. Also, I would really like to do a mud run again. They are so much fun!”

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

Using Frontal Plane Movements to Promote Optimal Knee Health

March 15, 2018 · by Garrett McLaughlin

Article written on March 15th, 2018 at 8:04am | Follow Garrett on Facebook and Instagram |

The knee joint is very simple in it’s design. A hinged joint that primarily moves in flexion and extension. There is also some motion that occurs just below at the tibiofemoral joint (internal and external rotation) that needs to taken into consideration during lateral and rotational movements.

Even though the motion at the knee is relatively simple, it is greatly influenced by the joints above and below. This includes the foot/ankle and hip. Because ultimately, function at those joints largely dictate positioning of the knee.

As someone who has formerly dealt with knee pain, I know how debilitating it can be. Just because pain is experienced at the knee doesn’t mean the knee joint needs to be the sole focus of your intervention. And doing so would be a shortsighted approach to resolving knee pain.

When progressing through a corrective exercise program to restore function and resolve pain at the knee, incorporating sagittal plane movements are a good starting point. This includes any movement where the body utilizes flexion and extension, and never moves laterally or rotates. For example: squat, split squat, deadlift, reverse lunge, etc. From a knee standpoint, it’s main job is to flex and extend with little rotational demand at the joint.

Sagittal plane movements, although basic on the knee joint, require stability and optimal control from the foot and hip. Because these joints have the capability of multi-planar movement, they must now stabilize to ensure the knee is tracking properly. That’s exactly why programs created to improve knee health need to take into consideration the joints above and below.

But, what’s the next step? Oftentimes, people stop with sagittal plane movements because they are unsure how to progress and continually challenge the knee.

The frontal plane can be a suitable next step and often needs to be executed with care for those with previous history of knee pain. With the addition of lateral-based movements, the knee joint has a tendency now to move from it’s safe, aligned position, to a position that can surely place more stress upon it. This includes into internal and external rotation at the tibiofemoral joint which increases stressed inside of the joint.

Several exercises that are a great starting point in the frontal plane are lateral step ups and lateral squats. Both require contribution from the foot and hip and add a new stress on the knee with the lateral-based movement. But, care must be placed on where the knee is positioned, especially early on. Deviations from pure flexion and extension can cause internal rotation and subsequent valgus at the joint. This is where caution needs to be taken to promote optimal positioning of the knee.

In the following video, let me walk you through how the lateral step up can be used as a progression to promote optimal knee health…

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

What I Learned In 2017…

December 30, 2017 · by Garrett McLaughlin

Article written on December 30th, 2017 at 10:34am | Follow Garrett on Facebook and Instagram |

Overall, 2017 was a year to remember. To be able to work with clients who are enjoyable and motivated on a daily basis is a blessing. Oftentimes, I find myself driving home from a long day and wondering how I get paid to do what I do. That is in no way downgrading the service I provide, but to magnify the grateful feeling I have to work in a profession that is constantly evolving, active, and fulfilling.

In addition to thoroughly enjoying what I do, this year I had the opportunity to learn a lot. Here are the top things I took from 2017:

[Consistency trumps all]

Several of my clients achieved big results this past year. Even though I’d love to take all the credit and say that it was the “perfect” program and what have you, I’d have to lean more towards them consistently putting in the effort, and that they were solely responsible for their success.

Yes, I am the tour guide throughout all of this. I can show you how and where to spend your time/effort, but unless you actually do it on a regular basis it really doesn’t matter. And, on a regular basis I mean most days of the week for month after month.

Fortunately, I changed my offerings from smaller commitments to, “If we are going to do this, you’ll need to invest the next 6-months,” kind of thing. That’s because many of us possess the mindset that a few weeks or a single month is enough. To be honest, that’s barely scratching the surface.

So, if there’s one piece of advice I can give you looking ahead to 2018, it’s be consistent for the long haul and you will undoubtedly be rewarded.

[Stress the body as little as possible to create the adaptation for runners]

As I work with more and more endurance athletes, the need to train to exhaustion drastically reduces. This approach is fine for the general population, but when it comes to athletes who consistently and progressively stress the body, overuse is quick to follow. That is why I often find some group exercise classes can be more detrimental than helpful for runners.

Instead, it’s important to be respectful of your mileage and add just enough of a stimulus to see improvement. Anything more than the minimum effective dose is a step closer to overtraining.

With this approach, a lot of education is often needed to teach and get buy-in for this concept. Quality of movement must be held to a higher regard than quantity. Endurance athletes are already getting quantity within their training plan, so let’s emphasize good movement to stay healthy and pain-free.

I often compare this concept to taking painkillers. If one Advil eliminates your symptoms, do you necessarily need two? Let’s apply that same thought process to functional training for endurance athletes and I think you will be surprised with the positive results.

[Stop foam rolling so much and start moving to end-range more]

Foam rolling and other forms of self-myofascial release (SMR) have become more of an afterthought in many of my programs this past year. Even though research does indicate there are some positives to SMR, it seems like we have been placing it on a pedestal that is far too high.

Does it break up scar tissue? Probably not. Does it re-align muscle fibers? Doubtful.

But, it does create a reflexive response from the nervous system to down-regulate or temporarily reduce tone in a tissue. This means we can take advantage of it’s short-term benefit and use SMR to facilitate better flexibility, movement, and recovery. However, alone it’s long-term benefits are very few and far between.

Instead of rolling around and hoping for the best, how about teaching your body how to get into certain positions with better awareness and control. Your hamstrings are tight? You may be more quickly rewarded by addressing mobility and movements that lengthen the hamstring throughout the full range of motion. This approach has been more productive and creates sustainable, long-term results.

Ultimately, what we have to realize that there is more to range of motion that just one specific muscle that appears to be tight. I know your hamstrings always feel like they limit motion and are achey. But, is that due to poor gluteal firing, inability to appreciate end-range of motion so the hamstrings are protecting, or lack of stability elsewhere? All of the above mentioned issues will NOT be corrected with the foam roller. Yes, a foam roller may allow you to temporarily feel less tight. However, it will not correct the underlying issue when completed in isolation.

What I’m trying to get at is you must incorporate daily doses of good quality of movement. Stop rolling around on a foam roller or trigger point ball for 10, 20, or 30-minutes and start teaching your body how to get in the right positions. We are so efficient as humans that I’m confident this approach will provide you better long-term and more sustainable results.

[Movement prep versus dynamic warm-up]

The dynamic warm-up is a topic that I’ve held several seminars on this past year. It was also something that I devoted plenty of content to on social media. To say I love this topic is an understatement.

The problem is, we often take warming up too literally. Yes, increasing tissue temperature and lubricating the joints is important before a workout or run. But, there are so many other aspects of a good dynamic warm-up that go overlooked.

Let’s put the term ‘dynamic warm-up’ on the back burner for just one second… How about we call anything we do before running and exercise ‘movement preparation.’ Movement prep is a term that is more synonymous with quality and function, than solely tissue and body temperature.

Movement preparation can include strategies, such as: foam rolling and self-myofascial release, flexibility and mobility drills, balance and stability exercises, full range of motion movements, power and plyometrics, and locomotion. All of these should be targeted at the specific areas your body needs addressed to move more efficiently, prepare for the activity that is soon to follow, and “warm-up” the body.

This is why I feel replacing the dynamic warm-up with a movement preparation routine would greatly impact you moving forward. Let’s stop using a general approach and hoping for individual benefits. Instead, learn which areas of your body need to be targeted in order to become a A+ mover. Then, hammer down day after day before each activity to address these. I think you’ll notice that movement quality improves, your workout and runs become more effortless, and automatically you end up “warm” and ready to rock and roll. Who would’ve thought?!?

[Slow eccentric step ups are gold (shout out to Chris Wolfe of WolfePT)]

When you are hungry to learn, surround yourself with really smart people. This past year, I was fortunate enough to team up wth local physical therapist, Chris Wolfe, on various seminars and smaller pieces of educational content.

To say the only thing I learned was this small tweak on the traditional step up would be an understatement. It’s one of those exercises that I’ve been programming for years with success, and his small adjustment made it even more valuable.

Because I deal with a lot of runners, single leg stability is at the forefront of what we focus on. That means the step up is a perfect exercise choice to impact this.

For years, I have taught a more upright position on the step up which doesn’t necessarily provide as much control on the descent. After learning from Chris, if you reinforce a more hip-dominant position and forward lean, the ability for the hip to control the descent drastically increases. This can be good for some people and VERY challenging for others who lack the control and appreciation of getting the hips involved. In the end, it allows a more hip-focused, eccentric control during a fantastic single leg movement. This is something everyone, especially runners, can benefit from.

[Regressions aren’t a step back but a deviation from the fastest route]

Regressions are such a valuable part of any exercise and rehabilitation program. That’s because you don’t always progress in a linear fashion. Whether that be due to pain or poor movement, there’s a time and place for plan B.

Years ago I was very particular about my programming because I liked to sequence exercises a certain way. With this approach you’ll quickly realize that there are some people who just don’t progress the same as others, and you may need to make additional modifications. There is no need to be embarrassed or discouraged by this. To be completely honest, I’ve had to regress more exercises than I can remember this past year due to knee pain.

Let’s think about this scenario because we’ve all been there… Know when you are driving in a new neighborhood and you have your GPS set to find your destination? Well, there are times when you are either not paying attention and miss your turn or the sound on the GPS is turned off and you drive right past the street.

What happens?

The GPS re-calculates the route and finds you an alternative way to get there. Yes, this might take you a few more minutes and cause you to drive a more scenic route. But, it’s just a small modification to the original plan that ultimately provides you the same end result.

This is how I feel about regressions. Even though I’m trying to get you to achieve your goal is the shortest and safest time frame possible. There comes a time and place when we have to detour. Our eyes are still set on the end-goal, but our path is no longer linear.

Don’t get frustrated when you have to detour along the way. Movement is often complicated with many detours and additional turns. It’s those people who accept the alternate route with an open mind and respect the process who quickly find themselves back on track and potentially better than before.

This is exactly what happened to me… I was frustrated at a recent flare up in my right knee that I pretty much threw in the towel. Why exercise if I can’t do what I wanted? If you know me you know I can be stubborn like that.

Instead I went back to the drawing board. I know I couldn’t do any lunges or split squats so I opted for a sumo squat. What happened? Doing this for 6-8 weeks put my knee in a very low stress position that didn’t cause pain. I was still able to work towards my health and fitness goals while minimizing stress on the knee. With patience and consistency I soon found that I gained more options. Now pain was minimal/non-existent with split squats so I started with light weight and worked up. This was the trend that I followed throughout the entire year.

Fast forward a year later and I have no limitations, very minimal knee pain, and have actually made tremendous improvements in my health/fitness. With that being said, I highly recommend you put your ego aside from time to time and be open to taking a step back. It may not be the fastest route but if you keep your eyes on the end goal there are other ways to get there. The GPS, despite frustrating at times, always gets you to your end destination.

[If you need better results, ask for help]

I mentioned before that I was stubborn, right? For years, I have been working, and very motivated to improve myself and my business. As we all know, that can be very challenging when you have no business background. I mean, I went to school to help people, NOT for marketing, sales, and other administrative tasks. And the best part is, I preach on a daily basis that if you need help with your fitness, an injury, or anything movement-related that I am your guy.

Then why did it take me so long to accept my own advice and find someone who was more qualified to save me time, money, and energy?

In October of 2017, I hired a business coach. My goal was to simplify my processes to only the most reliable and least time consuming that provide results. I know it’s only been 2+ months now, but having someone to help me along the way has been tremendous. Instead of getting opinions from friends and loved ones on what they “think” might be a good idea. I have the backing from a business owner who has been through all of this herself and has the resources to facilitate long-term and sustainable growth.

What I’m trying to get at is, it’s time to take a honest look at yourself in the mirror. Has it been months, years, or decades that you have been struggling to see the results you deserve? Start to realize that you are great at some things but not everything, and that’s okay. That’s why I recommend putting your ego aside and asking for help in those areas where you struggle. Ultimately, you are making the best investment of all time. The investment in YOU.

Thank you for taking the time to read this article. I would love to hear what key things you learned this past year. And, I wish you nothing less than HUGE results in 2018.

If there is anything I can do to help you see faster and more reliable results with your health/fitness, please click the link below to schedule your FREE 30-minute Success Session.

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

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