https://www.marathontrainingacademy.com/calf-strain-pull
Marathon Training Academy
April 20, 2021
In this guest post for Marathon Training Academy, I address the factors that increase your risk of developing a calf strain/pull. You will learn how to recognize the symptoms and how to self-treat this condition so you don’t lose too much time with your training. Continue Reading
We all know the importance of exercise, fitness, and generally staying active in order to age well. For many, exercise and fitness is a way to have fun and stay in shape. Others use activity to manage stress or chronic illnesses (such as diabetes, osteoporosis or heart disease). The benefit of consistent exercise has a positive effect on our physical, mental, and social well-being. It can be very disappointing when low back or sciatic pain prevents you from reaching your exercise goals.
Low back pain (LBP) or sciatic pain is the most common injury/pain complaint for those in the western world. LBP is estimated to affect nearly 80% of the U.S. population at one time or another. Worse yet, once you have experienced an episode of LBP you have a 90% chance of having a reoccurrence.
How can you address your back or sciatic pain in order to get back to doing the activity that you love (whether that is walking, running, or hitting the gym)? First, you need to assess your risk factors.
Some of the specific risk factors for LBP are also risk factors for other types of injury. Lack of adequate core strength (particularly, strength in the outer core and pelvic/hip musculature) can contribute to other types of injuries, so it’s an important to address the weakness sooner rather than later.
Consider the amount of repetitive force your body must absorb even with walking (not to mention during sports or exercise). The outer core muscles are responsible for movement of the trunk and spine as well as aiding in stability. (Although critical for stability, the inner core muscles don’t actually produce any trunk or spine movement.)
The outer core muscles consists of the following muscles: lumbar paraspinal muscles; the quadratus lumborm; the internal and external obliques; and the psoas major and minor (hip flexors). Some may also include the glutes (buttocks muscles), hamstrings, and quadriceps as part of the outer core muscles.
Imbalances or a lack of strength within the core musculature often will manifest in altered lower body mechanics and an inability for the body to properly absorb and distribute forces. Over time, the body’s tissues eventually break down and can lead to a repetitive use injury in the lower extremity.
As a physical therapist, I always assess the core and hip musculature and look for imbalances in strength when determining the root cause of low back or sciatic pain. In the majority of cases, I find that a component of hip and core muscle weakness has led to the pain.
The good news is that this is a completely preventable problem. Most of us already know that we need to cross train and that proper core strength is important. However, too many of us either don’t dedicate enough time to the process or we aren’t performing the correct exercises. Performing proper core exercises and particularly, lumbar stabilization exercises are the primary treatment modality for low back pain (LBP).
Proper core and lumbar extensor strength is the key to preventing an episode of LBP and is also a critical step in avoiding other types of injuries affected by weakness in the core and pelvic/hip muscles. The most important factor in meeting your exercise goals is to be consistent. Don’t let low back or sciatic pain prevent you from staying active and enjoying your favorite activities.
Treatment for back or sciatic pain doesn’t have to include addicting medications, scary injections, surgery or high medical bills. For the approximate price of just one co-pay to see a doctor, you will receive my easy to read book with step-by-step instructions and a complete video package designed to help you prevent and self-treat reoccurring low back pain episodes.
AVAILABLE NOW ON AMAZON!
Treating Low Back Pain during Exercise and Athletics eBook
In this eBook, you’ll learn why it is critically important to prevent the first episode of low back pain. LBP has reoccurrence rates as high as 90%. If you have already experienced an episode of LBP, you’ll learn why exercise is an important component to long term management. Most importantly, you will understand how to avoid pain and injury in order to take your training to the next level. Topics include:
7-part Series of Instructional Videos
Nearly 60 minutes of actionable advice to prevent and treat LBP as it relates to active individuals, sports, and athletics. An in-depth look at treating LBP with a 7-part series of instructional videos in which I address the following:
Save 15% with discount code LBP
“As a long time back pain sufferer I can honestly say I’ve tried it all. True LBP will make you desperate enough to try anything. Long story short – Ben Shatto truly rescued me from this vicious pain cycle. Ben’s methods of physical therapy whether it’s hands on treatment or this amazing video packet, his methods prove to be cutting edge and highly effective. Healing takes work and this video package is a fantastic foundation for the healing process to ignite!” –Sandy
“When can I return to my normal activity after experiencing an episode of severe low back or sciatic pain?” is a question I am often asked as a physical therapist. Low back pain (LBP) and sciatic pain can be so severe and debilitating that it can completely derailing your training and lifestyle! It’s hard to run, exercise or even move if your back, buttocks or leg hurts.
Believe it or not, in spite of what your back or sciatic pain is telling you, initial activity and exercise are a critical component to treatment and recovery and is backed by extensive scientific research.
Everyone’s experience with low back or sciatic pain is different. The severity of pain can widely vary. For some, even walking normally can be difficult. A guide for which exercises and movements to perform is critical in order to successfully return to activity.
One crucial indicator that you’re ready to taper back into more regular activity (as you progress your rehabilitation-based exercise) is whether or not you can walk with a normal gait. In particular, can you walk normally with a longer stride length during your normal gait cycle?
The ability to walk normally (notice that I didn’t say without discomfort) is an important milestone. It means that the spine is being stabilized well enough from the core musculature and that the nerves in the leg are not too tight or inflamed to tolerate and accommodate for the stretch that will occur from other activities.
If you are unable to walk normally, then the emphasis should be on regaining lumbar and lower extremity range of motion in addition to performing core and lumbar stabilization exercises. Limit your sitting, but do not try to taper back into other activities (at least not yet).
It’s critical to remember that everyone’s recovery will be different. Recovery and tapering back into your normal activities should be entirely symptom dependent. Listen to your body on what it can handle. The pain will tell you if you need to stop.
Follow the rule of thumb for movement: If the pain worsens by spreading peripherally down the buttock and into the leg and/or foot, then the condition is worsening. You must stop that activity. If the pain centralizes and returns back toward the spine (even if the pain worsens slightly), then keep moving as the condition is actually improving.
Prior to returning to your full and normal training activities, insure the following:
With proper treatment, low back or sciatic pain should resolve in as quickly as two weeks. Severe episodes can take 4-6 weeks or longer. Continue with your rehabilitation protocol until you’re performing all exercises normally.
Treatment for back or sciatic pain doesn’t have to include addicting medications, scary injections, surgery or high medical bills. For the approximate price of just one co-pay to see a doctor, you will receive my easy to read book with step-by-step instructions and a complete video package designed to help you prevent and self-treat reoccurring low back pain episodes.
AVAILABLE NOW ON AMAZON!
In this eBook, you’ll learn why it is critically important to prevent the first episode of low back pain. LBP has reoccurrence rates as high as 90%. If you have already experienced an episode of LBP, you’ll learn why exercise is an important component to long term management. Most importantly, you will understand how to avoid pain and injury in order to take your training to the next level. Topics include:
Nearly 60 minutes of actionable advice to prevent and treat LBP as it relates to active individuals, sports, and athletics. An in-depth look at treating LBP with a 7-part series of instructional videos in which I address the following:
Save 15% with discount code LBP
“As a long time back pain sufferer I can honestly say I’ve tried it all. True LBP will make you desperate enough to try anything. Long story short – Ben Shatto truly rescued me from this vicious pain cycle. Ben’s methods of physical therapy whether it’s hands on treatment or this amazing video packet, his methods prove to be cutting edge and highly effective. Healing takes work and this video package is a fantastic foundation for the healing process to ignite!” –Sandy
As low back pain sufferers already know, it’s very difficult to exercise and train at a high level when you are experiencing low back pain (LBP). Nothing will derail your best laid training plans and routines faster than a severe episode of low back pain. LBP is the most common injury and pain complaint for athletes and non-exercisers alike. It’s estimated to affect nearly 80% of the U.S. population at one time or another, and it’s one of the top reasons for physician visits.
Fortunately, most LBP is mechanical–meaning it’s from a physical or structural cause not related to conditions such as cancer or infections. The problem with this type of LBP is that it usually comes back. People who have had an episode of mechanical LBP are 90% more likely to experience it again.
If you want to train hard and compete at a high level or even just enjoy the weekend’s events, then avoiding LBP is critical. Avoiding the following three most common mistakes can save you from costly medical visits, prescriptions, chiropractic visits, and physical therapy services. More importantly, avoiding injury and LBP insures that you can keep training to your heart’s content!
Prolonged sitting (and especially, prolonged sitting on a vibrating surface) is one of the biggest risk factors for LBP. Sitting (slouched in particular) causes excessive strain on the lumbar discs and ligaments. Even if you exercise regularly, many of us still work in an office setting which forces us to sit more than we should. This excessive and prolonged sitting not only impacts our spine, but it also leads to tight hamstrings and hip flexors and generally tends to inhibit proper gluteal muscle function.
Even if you are running, exercising, and training during most days of the week, we all spend too much time sitting. To make this worse, many of us are sitting with chronically poor posture.
Everyone has heard about the benefits of core training. However, most people aren’t doing it correctly. This isn’t about sit ups or crunches. Proper core strength involves training your abdominal muscles and back extensors to produce a rigid cylinder when exercising and moving. The core muscles are not prime movers, but stabilizers. They must be trained this way. The strength needs to be proportional front to back to insure this rigid cylinder for proper spinal stabilization. In general, most of us don’t spend enough time strengthening a key core muscle in back known as the multifidus (shown below) nor do we spend enough time strengthening the back extensors in general.
The core muscles are part of the body’s natural method of stabilizing the spine. The core muscles, along with intra-abdominal pressure, help to form a round rigid cylinder that is utilized to support the spine. Ligaments and boney articulations are also important in spinal stabilization. Most people don’t realize that the core actually consists of two separate groups of muscles, the inner and outer core muscles, and neither group involve the rectus femoris muscles (the six pack).
Those who work on core strength may not be performing the correct exercises. Performing proper core exercises and particularly, lumbar stabilization exercises are the primary treatment modality for LBP.
To learn how to effectively exercise and work the core muscles in order to prevent or self-treat LBP, be sure to check out my Treating Low Back Pain (LBP) during Exercise and Athletics Book and Video Package. USE DISCOUNT CODE LBP AT CHECKOUT FOR 15% OFF!
An adequate warm up should always be performed to help minimize the risk of injury and maximize your ability to perform at an optimal level. A proper warm up should include: a cardiovascular warm up; a dynamic warm up; a specific spine warm up; and when indicated, a sport specific warm up.
Cardiovascular Warm Up
To properly prepare the body for activity, the first stage of the warm up is to increase blood flow throughout the body, but in particular, to the core muscles and spine. I recommend approximately 10 minutes as this allows for better mobility in the joints and tissues of the body. It starts to prime the nervous system for activity. It also promotes healing as movement is necessary to bring in the nutrients necessary to heal (if there is already damage or an injury). The cardiovascular warm up will vary and is dependent on your activity or sport.
Dynamic Warm Up
After the initial cardiovascular warm up, progress into a dynamic warm up series. This will typically involve warming up the muscles and joints of the spine, pelvis, and lower legs.
The purpose of the dynamic warm up (specifically in the lower extremity) is to insure adequate mobility in the areas that will be involved in the activity. This will almost always include the hamstrings, hips, and pelvis. Adequate lower leg mobility is important in order to perform your specific exercise or activity. The more motion that can occur through the pelvis and legs, the more force can then be generated and passed through the pelvis.
More mobility in the lower legs and pelvis means less need for mobility in the spine. This means less stress during motion will be placed on the spine—therefore, decreasing your risk of injury. The point is to maximize spinal stability and encourage movement through the hips, pelvis, and upper thoracic.
One example of this is to mobilize your hamstrings by using the foam roller (as demonstrated below).
Spine Specific Warm Up
I am a big proponent to performing a very specific spinal muscle warm up upon completion of the cardiovascular and dynamic warm ups. Since you may have already experienced an episode of LBP, a very specific and thorough warm up is important for prevention. Priming the specific muscles of the core (particularly, the multifidus and lumbar extensors) is a critical step to avoiding re-injury. The multifidus is a critical muscle in preventing LBP and must be active to properly stabilize the spine. It helps to prevent shearing forces from affecting the spine which is critical to avoiding LBP.
Examples of a spine specific warm up may include performing press-ups and the superman exercise (as demonstrated below).
Sport Specific Warm Up
This warm up will vary significantly depending on the type of endeavor you are about to participate in. For example, a sprinter will need a very different warm up compared to an ultramarathon runner or someone performing in a CrossFit competition. For runners, the warm up varies. Are you racing on a flat course or are you heading out for a very hilly trail run?
It’s important to evaluate the requirements for the event and be ready to perform the actual movements required to compete at a high level. A proper warm up allows your body to immediately perform at its peak and reduces the risk of injury. Regardless of the sport or event, this is also the perfect time to make sure all of your equipment is appropriate for the conditions of the event.
Don’t skip the warm up regardless of your training or event time and/or location! You may be the only one performing a thorough warm up, but it’s because you understand the importance of one in order to prevent LBP and to improve your performance.
It’s important to identify the common mistakes that can cause LBP. By implementing these prevention strategies, you can avoid injury and keep training. Fitness is a lifelong pursuit. If you are injured or just not having fun, then you will not stay engaged and motivated in the long term. Don’t let LBP affect your ability to stay active and keep enjoying your favorite activities!
AVAILABLE NOW ON AMAZON!
In my book, Treating Low Back Pain during Exercise and Athletics, you will learn how to address specific causes of LBP as well as the best practices on how to prevent and self-treat when you experience an episode of LBP. In this step-by-step LBP rehabilitation guide (complete with photos and detailed exercise descriptions), you will discover how to implement prevention and rehabilitation strategies to eliminate pain and get back to training and exercise sooner.
Learn how to prevent, self-treat, and manage LBP so you can get back to your daily life and exercise goals more quickly without additional unnecessary and costly medical bills!
I must warn you that this is not the typical post from me. All of the information is true and sadly, not exaggerated in any way. My hope in documenting this true account of events is that it will help others know how to better avoid injury. If you do develop an injury, then maybe some of my self-treatment strategies could be helpful.
What most people don’t know about me is that I have struggled with low back pain (LBP) for over 20 years. Early on, I had years of constant and chronic LBP. This pain helped drive me to seek out different self-treatment methods. I began to understand LBP along with the best practices on how to self-manage and most importantly, avoid future flare-ups. This has personally helped me manage my own pain while helping thousands of others either directly with physical therapy or by sharing my book, Treating Low Back Pain during Exercise and Athletics.
Even with all my diligent efforts (most of the time), the occasional LBP flare-up occurs. Unfortunately, the last incident was due to poor judgement on my part. In early November of last year, I had been sitting a lot while working on a few projects, and my back started to ache. It was mild at first. However, by mid-month, I could hardly get out of a chair and walk.
As a physical therapist (PT) that specializes in treating LBP, I should have known better, but I chose to do what most people do. I ignored it, and pressed on. I reminded myself that I’ve had this pain before, and it typically goes away. Right then, I didn’t have time to address it.
Monday morning rolled around, and I was scheduled for my 5 mile tempo run. As any runner or exercise enthusiast knows, if it’s scheduled, then it must be done (no matter what, right?). I was sure my back would loosen up as I ran. Often times, a warm up prior to running makes it feel better. (If I was being honest, the pain was pretty bad that particular morning. It was preventing me from sitting, getting out of my car, and even walking straight. Was that a good enough reason to cancel a run?)
I managed a short walking warm up since that was all I could muster and proceeded into a slow jog. About 2 miles into my jog, my right calf started to hurt. Why stop? I was sure it would all shake loose soon…
As mile 3 approached, I was falling apart. My back hurt to the point I couldn’t stand up straight. My right calf was completely locked up. It was giving me a sharp pain with every step. The bottom of my left foot started aching. I finally shut it down and limped home.
Later that day, my calf wasn’t any better (neither was my back), and now I had full on plantar fasciitis. Pretty good start to the week, but I got that run in. By the end of the day Monday (post run), I was miserable, but I didn’t dare tell anyone.
As a PT, I should have known better. I started to analyze exactly what was going on. For some reason, my disc bulges (a pre-existing problem at L4/L5 and L5/S1) had flared up for no apparent reason and were hurting terribly. My back pain had caused a left lateral shift in my spine, which meant I couldn’t stand normally. The nerve tightness down my left leg affected my walk, so I could not fully stride out.
In hindsight, my sad attempt at a run early that morning was actually a terrible idea! I had obviously been running with a poor gait pattern. This altered gait pattern with poor running mechanics resulted in a right calf strain and the development of plantar fasciitis in my left foot. (And this all started in 3 miles!)
My initial treatment was to determine my directional preference for my lumbar spine pain:
A directional preference is a way to identify a pattern to the pain. Does the pain get worse when you bend over or does it improve? What happens when you repeat this movement? Determine how your pain responds. If it spreads away from the spine and down into the leg, beware that you are moving in the wrong direction. Stop that particular movement, and instead try moving in the opposite direction. If you were moving into flexion, try extension. If you had trialed extension biased movements, try flexion. Find the movement pattern that helps the pain improve and that has a positive effect on any other symptoms you may be having.
I determined my directional preference. As I performed my series of movements, my symptoms were peripheralizing (returning back to the middle of my back to the point I could stand straight and walk normal).
After a series of 10 side glides followed by 10 press-ups (as demonstrated below), I could eliminate 75% of my LBP and symptoms as long as I didn’t sit. Sitting would immediately bring the pain back on. For the next several weeks, I avoided sitting at all costs including during dinner.
I also started back extensions over an exercise ball (3 sets of 15 repetitions as demonstrated below) every morning as part of a lumbar strengthening program. I chose back extensions to insure that I was working my lumbar extensor muscles. I kept my movement patterns within my directional preference. This was preceded by and followed by side glides and press-ups as well as continuing to avoiding sitting. I stopped running since I couldn’t fully walk or jog without an altered gait pattern.
For my calf, I started foam rolling and stretching regularly. I used a mobility band (as demonstrated below) as a way to provide compression while I performed heel raises (typically a set of 20-30 repetitions). Thankfully, I had the opportunity to trial a product that not only utilized the compression from the mobility band, but added a way to self-mobilize the calf. The CTM Band worked exceedingly well for this. (“CTM” stands for compression, tension, and movement.) Use code MTA15 for a 15% discount. (If you suffer from any form of blood clotting disorder or are on blood thinning medications, I would advise against utilizing mobility bands for any type of deep compression.)
For my plantar fasciitis, I also performed calf stretches as well as used a small ball (as demonstrated below on the left) to mobilize the bottom of my foot. Pain in the morning seemed to be the biggest issue, so I would sit up and stretch before getting out of bed (as demonstrated below on the right). By the end of the day, my foot would really start to hurt. Since I was unable to sit due to my back, I used a padded stool to kneel on whenever possible.
I continued this treatment plan for over 3 weeks. For the first 2 weeks, I was unable to run, so I concentrated on rehabilitation exercises only. During this time, I utilized a self-prescribed course of over-the-counter Ibuprofen (anti-inflammatory). I didn’t have any medical issues with taking this medication. Please consult your physician before taking any medications or supplements.
I also initiated a supplementation protocol consisting of adding collagen hydrolysate to my daily smoothie as well as taking CapraFlex by Mt. Capra. (It combines an organic glucosamine and chondroitin supplement with other natural herbs and enzymes which are designed to reduce inflammation, promote bone and joint healing, and wellness.)
This continued for approximately 4 weeks. The rationale behind the supplementation was to insure that my body had the necessary building blocks to heal and to provide additional anti-inflammatory support to my body during my recovery.
After 3 weeks, I returned to running for only shorter distances (under 5 miles). I was tapering back into other exercise routines with appropriate modifications which included increasing my warm up and cool down times and avoiding bending forward since I wasn’t 100% better.
The reason I chose to share my most recent LBP episode with you is because I have heard versions of this story over and over again from other runners, weekend warriors, and patients. We really can be our own worst enemy!
As a PT, I should have known better than to run that day. As a runner and weekend warrior, the feeling that it may be a “mortal” sin to miss a scheduled run or work out can be a powerful temptation to do it even though your body may be telling you to reconsider.
As any frequent exerciser knows, a few aches and pains is par for the course. In fact, it’s pretty normal! Oddly, I will have just as many if not more, aches and pains when I stop running and exercising as when I’m regularly training.
The moral of my story is a reminder to be very self-discerning and self-aware to understand what is a typical ache and pain versus something more serious. In my case, not being able to walk normally due to pain should have been a clue not to run abnormally either. My abnormal running pattern that day is what led to the overuse injuries in both my calf and foot. What was surprising even to me was how fast the pain developed and turned into a true overuse injury in only the course of 3 miles!
If you’re not sure how to effectively and safely exercise your back or if you’re already experiencing low back pain, be sure to check out my Treating Low Back Pain (LBP) during Exercise and Athletics Book and Video Package.
Treating low back pain does not need to be difficult or expensive. For the approximate price of just one co-pay to see a doctor, you will receive my easy to read book with step-by-step instructions and a complete video package designed to help you prevent and self-treat reoccurring low back pain episodes.
USE DISCOUNT CODE LBP AT CHECKOUT FOR 15% OFF!
If you have a question that you would like featured in an upcoming video or blog post, please comment below or submit your question to contact@thePhysicalTherapyAdvisor.com. In case you haven’t already, be sure to subscribe to my e-mail list and YouTube channel as well as join our community on Facebook by liking The Physical Therapy Advisor!
Runners are accustomed to a certain amount discomfort. Training can be hard and uncomfortable at times which is exactly why it’s so rewarding and addicting. It can get a bit confusing when it comes to physical injuries and pain. Most runners have experienced that out of nowhere pain in a foot, knee or hip that had us wondering if we should really keep running. Then just as suddenly as it appeared, it faded away. How about the all too common sentiment: “It takes me 2-3 miles just to feel warmed up from all my aches and pains.”
It can be difficult to answer these questions at times. It can be difficult to self-diagnose the aches and pains we all feel (particularly, for newer runners). Even more experienced runners may question when to push and when to rest. Injuries can be confusing, and it can be surprisingly difficult to tell if we’re really injured and even where the injury really is located.
Although sometimes a challenge, knowing why you’re in pain is actually the most valuable knowledge there is for treating the root cause of the problem. The most important thing to understand is that getting to the bottom of your pain is the key in relieving it….permanently.
For example, treating your knee may not help to eliminate the pain if it’s actually your hip or low back that is the real source of the pain. Just to make things even more confusing, your pain might not even point to an injury in the first place! Often, we may experience pain that is fleeting and that disappears on its own or is referred from an entirely different part of the body.
Understanding the difference between a one-off pain and a chronic debilitating type of pain is absolutely crucial. If you don’t pay attention to the pain and it really is pointing to an injury, then you might end up exacerbating the injury and/or injuring your body even worse. This can lead to an extended time away from training with a prolonged rehabilitation and recovery.
Understanding injuries and pain can be tricky. It may seem impossible to identify either the cause of the pain or its location, but one thing is certain: it cannot be ignored! Listen to your body and make a decision to get the help you need. Take action. Analyze your activities, stop doing those that you think may be detrimental, and seek professional help if you need it. (If you are unable to determine the reason for the injury, please seek a professional physical therapist in order to establish the exact cause and potential treatment needed.)
Given the complexities of the human body, it can be difficult to determine the root cause of the injury. However, most overuse injuries have very common patterns of dysfunction. Treating according to well documented patterns is often all one needs to recover and get back to running pain free and safely. Formal medical intervention is not always needed or feasible.
Angie Spencer (RN and Certified Running Coach), Trevor Spencer (co-host of the Marathon Training Academy Podcast), and I created the Resilient Runner Program to help you manage and self-treat many of the most common running related injuries and painful areas. This program uses common patterns of dysfunction as a guide to help you self-treat most running related issues.
More specific strategies to help you determine the cause of your injury along with more thorough treatment and prevention strategies for those suffering from overuse injuries are covered in the program, which is designed to help YOU meet YOUR training goals by insuring you have the tools to avoid injury, recover quickly, and train at a peak level.
What’s Inside the Resilient Runner Program:
If you’re tired of ongoing aches, pains, and injuries, learn how to become a resilient runner so that you can continue to train and compete in order to meet your goals!
https://www.marathontrainingacademy.com/becoming-resistant-to-running-injuries
Marathon Training Academy
November 14, 2020
In this podcast interview with Angie Spencer (RN and Certified Running Coach) and Trevor Spencer (co-host of the Marathon Training Academy Podcast), we discuss how you can become more resistant to running injuries. Topics include: key ways that people can prevent injuries from occurring in the first place; what type of strength training runners should be doing; and how to differentiate between discomfort and pain and when to seek help. Listen to the podcast
Disclaimer: This blog post and podcast are not meant to replace the advice of your doctor/health care provider, or speak to the condition of one particular person but rather give general advice.
Weakness in the deep external rotation muscles and poor lower extremity single leg balance are commonly associated with many lower extremity overuse injuries. A simple and effective exercise to improve strength, balance, and general stability of the deep hip external rotator muscles is the clock exercise (also called the star drill).
The important points to remember in this exercise are to keep the stance knee unlocked (the leg you are standing on) with the patella (knee cap) slightly externally rotated (usually pointing towards the 3rd or 4th toe). The rotation must come from the hip, NOT the ankle. The stability of the hip and activation of the deep hip external rotators needs to be the primary focus.
Slowly touch the ground very gently with the opposite leg. The amount of pressure touching the ground should be so slight that if there were a package of crackers taped to the bottom of the foot the crackers would not break. Performing the drill on a balance pad will significantly increase the difficulty level of the exercise.
In the following video, I demonstrate how to use a balance pad to perform the clock exercise, a key lower leg stability exercise for treating knee pain, hip pain, and foot and ankle related issues as well as balance.
For additional videos on my recommended exercises to increase hip strength and stability, be sure to check out:
For prevention strategies and to learn more about on how to self-treat the most common lower extremity overuse injuries, be sure to check out the Resilient Runner Program, which is designed to help YOU meet YOUR training goals by insuring you have the tools to avoid injury, recover quickly, and train at a peak level.
Have you performed the clock exercise before? If so, what was your experience like? Please leave your comments below.
If you have a question that you would like featured in an upcoming blog post, please comment below or submit your question to contact@thePhysicalTherapyAdvisor.com. In case you haven’t already, be sure to subscribe to my e-mail list and YouTube channel as well as join our community on Facebook by liking The Physical Therapy Advisor!
Hip pain, knee pain, and even foot pain (such as plantar fasciitis or posterior tibialis syndrome) can have an associated hip external rotation weakness. An important yet often overlooked component to proper lower extremity stability is how the deep hip external rotator muscles need to work along with other hip external rotators and hip abductors, such as the gluteus medius, to insure proper lower extremity positioning when the leg is in full weight bearing. Particularly, in a single leg stance position during walking, running, skipping or landing from a jump as the leg accepts full weight bearing while the opposite leg is in swing phase.
The deep hip rotators, also known as the short external hip rotators, are a group of muscles consisting of the superior and inferior gemelli, obturator internus, quadratus femoris, and the piriformis. This group of muscles is extremely important for stability of the body, pelvis, and leg as the leg/foot initiates full ground contact.
Weakness in these muscles is often associated with many of the more common lower extremity overuse injuries:
A simple and effective exercise to improve strength of these muscles is the standing hip 3-way exercise. The important points to remember in this exercise are to keep the stance knee unlocked and in a “soft” stance with the patella (knee cap) slightly externally (laterally) rotated (usually pointing toward the 3rd or 4th toe). The rotation must come from the hip, NOT the ankle. The stability of the hip and activation of the deep hip external rotators should be the primary focus.
In the following video, I demonstrate how to use an exercise band to perform the standing hip 3-way exercise, a key hip stability exercise for treating hip pain, knee pain, and foot and ankle related injuries.
For additional videos on my recommended exercises to increase hip strength and stability, be sure to check out:
For prevention strategies and to learn more about on how to self-treat the most common lower extremity overuse injuries, be sure to check out the Resilient Runner Program, which is designed to help YOU meet YOUR training goals by insuring you have the tools to avoid injury, recover quickly, and train at a peak level.
Do you suffer from hip, knee or foot pain? If so, hip external rotation weakness may be part of the reason for the ongoing pain as you overload and overuse other structures trying to gain extra lower leg support. Additional discussion can help others to manage this condition more effectively. Please leave your comments below.
If you have a question that you would like featured in an upcoming blog post, please comment below or submit your question to contact@thePhysicalTherapyAdvisor.com. In case you haven’t already, be sure to subscribe to my e-mail list and YouTube channel as well as join our community on Facebook by liking The Physical Therapy Advisor!
New Year…New You! With the beginning of a new year comes the drive to want to do something different and better than the previous year. Resolutions, new changes, new outlooks, and new workout routines are on the top of many people’s resolution list for the new year.
Getting in shape is important for your physical and mental health, but as with everything, you can do too much. As we get into our new routines with fresh motivation, we push ourselves harder–we run faster, swim further, and lift more. Yet while our new workouts may seem outwardly healthy, we may actually be doing ourselves harm in the long run.
Why? For some of us, the exercise routines we have been inspired to take on have turned from ‘healthy’ to ‘unbalanced’. It may be that we progressed too fast or our volume or intensity of training is too high for our present conditioning.
More commonly, there was not enough attention put into the recovery portion of training. In other words, as we’ve pushed ourselves on the court, in the pool or on the bike, we’ve lost track of our personal limits. We’ve fallen prey to what is generally called Overuse Training Syndrome (OTS). It’s also referred to as Overtraining Syndrome.
Overuse Training Syndrome is pretty much exactly what it sounds like: it occurs when the body is pushed too far during exercise and/or training–over and above its limits for too long–thereby causing it to lose its ability to recover in a sustainable and safe way. For obvious reasons, this wreaks havoc on both your health and your training routine, not to mention to your mental endurance. The training cycle should consist of a balance of training, recovery, and then adaptation. Too much training and not enough recovery means no adaptation and in the case of OTS, a regression of health and training status.
Overtraining typically leads to worsening performance and results. Unfortunately, the most common reaction to OTS is an even greater commitment to training harder, faster, and more often. The effects typically end in disaster.
So, what can you do? You love training, your routine is magnificent, and you’ve finally mastered the art of waking up early enough to get the right amount of activity in before work. How could you possibly change anything at this point?
It’s time to start being very honest with yourself. Exercise is wonderful for you, but too much of it may actually be putting you at a disadvantage. The key is–as with so much in life–balance. It’s very important to balance the duration, type, and pace of your routines in order to make sure that no one part of your body is constantly under fire.
Although it may be difficult to accept at first, rest is just as important as exercise. It’s absolutely crucial that you give your body time off to recover and rest. This will allow your muscles to repair themselves, your joints to heal, and your endurance to be prolonged. The training cycle should consist of the right balance of training, recovery, and then adaptation.
Working out is as much about the ability to listen to your body as it is to push it to be its best. Adding a rest day (or two) to your week will actually be more beneficial to your workout than skipping them. As an extra bonus, you can sleep a bit later on those days! Balancing exercise and rest is the most effective way of staving off the risks associated with Overuse Training Syndrome. Knowing how to do this is, however, tricky for many of us.
For more information on overtraining, be sure to check out my 12 Tips to Prevent Overtraining Syndrome and 10 Tips to Self-Treat Overtraining Syndrome. In addition, you can find more recovery tips in Muscle Cramping & Spasms – Treatment Options.
AVAILABLE NOW ON AMAZON!
If you are interested in a more thorough look at Overtraining Syndrome and how to use overreaching as an effective training tool, be sure to check out my book on Amazon, Preventing and Treating Overtraining Syndrome. I show you how to recognize the risk factors and symptoms of OTS. You’ll learn how to utilize prevention strategies to help you develop a personal training strategy that will allow you to push past your limits and prior plateau points in order to reach a state of what is known as overreaching (your body’s ability to “supercompensate”). This will speed up your results, so that you can train harder and more effectively than ever before! In addition, learn how to use the foam roller (complete with photos and detailed exercise descriptions) as part of a health optimization program, recovery program, rest day or treatment modality.
Nothing can derail your best laid training plans and goals like an injury or suffering from OTS! If you develop OTS, you will need to take specific steps to speed up your recovery in order to prevent injury and return to a normal training schedule. Be sure to check out my book today in either paperback or on Kindle!