Dr. Richey – 001

Posted on February 9, 2010 by CoachJay

Welcome to a new series where Dr. Richard Hansen – “Richey” – helps you and I understand what’s going on during running. From muscle activation to biomechanics, from DIY home therapies to preventive exercises, Richey is obsessed with figuring out the how and why as it relates to the human body running. You can follow him on twitter @ARTSportsChiro.

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  • Cara Campbell

    Can you go into more specifics about single leg i.e.. specific exercises, examples, what to concentrate on

  • http://coachjayjohnson.com CoachJay

    Great question and I'll leave this for the good doctor, but please know this is exactly the type of question we're looking for. Richey and I will work on a video response in the coming days – hope to have it in a week or two.

  • http://coachjayjohnson.com CoachJay

    Also, the Lateral Lunge (LL) warm-up includes one exercise, the single leg squat, that is something all runners should be able to accomplish. Another resource is the General Strength (GS) progression on the Running Times website. While most of this exercises in the leg circuit (see the second video) are not single leg, Sara demonstrates the same single leg lunge and shows two different ways you can do it.

    Bottom line is these videos just scratch the surface, yet I will go out on a limb (no pun intended) and say that the LL and the GS progression are as important as working on single leg/single support for the runner who has done little or no ancillary work.

    Thanks for your question Cara and we'll come up with a video response soon.

  • JP

    Do you have any suggested home therapy or exercises for a sore/fatigued hip flexor. It has been feeling weak and is inflamed after 3 or 4 days of running, so I take a few days off. Doesn't affect stride, or at least that I notice. It has been suggested that I work on strengthening my glutes and hams, but wasn't given any specifics. So any stretches, therapy, or exercises would be great.

  • PeytonH

    I would love to see what Dr. Richie has to say and, more importantly, DO for the treatment of chronic plantar fasciitis!

  • Glennrjames

    Coach, can you talk about some stretching and preventive exercises for some of the deeper and harder to reach areas of the hips like the piriformas. I am having some problems with piriformas syndrome and find that treatment is more difficult than other muscle groups such as the hamstrings, quads, and calves.

  • tkemp

    Jay:
    Could you please have Dr. Richey provide his insights on the question posed in the video? How would he approach the the combination of Gluteus Medius/maximus weakness and QL involvement we see so frequently in athletes? What kind of proactive exercises can we put in place with our teams that might reduce the Q angle (which he is hinting at)? Since these factors have such a high correlation to injuries, his advice would be greatly appreciated. Many thanks for the timely discussion.

  • Rhymenocerous

    This of course depends on what you mean when you say 'hip flexors' as a few of the muscles that flex the hip are actually quite deep (i.e. the interior surface of your ilium aka 'hip bone' – not the one that you hip check with [because that's not really your 'hip' but your 'leg' ... I digress] but the one that sticks out above your trousers). I'm going to go out on an extremity and assume it's some of the relatively superficial ones that are giving you trouble and suggest a method that has worked for me in the past:

    Get a bottle of wine. Or a 40 if you're into that.
    Drink it (for the, um, vasodilatory effects).
    Roll on the bottle (not the neck though) like you would a foam roller. Cover the entire length of the dodgy muscle. I suppose the area in and around the pelvis tends to be heavily populated with bones, so it takes talent not to roll over anything crunchy, but I find this method works very well for the hamstrings, quadriceps, even the TFL. For the nooks and crannies, try the same thing with a baseball.
    Even if it isn't bothering you, the s-s-s-sartorius! is technically a hip flexor, so you should listen to this song: http://www.youtube.com/watch?v=unnbZReh4_U

    When it comes to exercises, I find the Myrtl routine really gets after my gluteals (aka ass) and TFL. For the hamstrings and the aforementioned ass, I like the supine plank (umbilicus to the heavens), lifting and holding alternating legs.

    Hopefully that addresses your problem.

  • marcluko

    I would like to hear his take on overpronating and people with flat feet or leg length discrepancies.Is it really the cause of lower extremity issues? and are orthotics honestly better than just strengthening the foot muscles and Achilles?

  • coach w

    I second the PF request…many of the athletes I coach seem to be developing PF this winter, and barefoot exercises seem to aggravate it.

  • Coach Q

    I coach cross country. This season we had about 3 of our female athletes experience hamstring strains/pain. We are flatlanders, most of training is on flat courses. What might be the cause of this issue? Poor biomechanics, overstriding, muscle weakness???? Any suggestions would be appreciated.

  • http://www.highaltitudehealth.com/ drrichardhansen

    Great posts and great questions everyone. Keep them coming as they serve as inspiration for what you would like Jay and I to discuss and perhaps do a video on! I'll do my best to answer each question as detailed as I can to the best of my knowledge. So please don't get frustrated if I don't answer it the way you were hoping or as fast as you were hoping and let me know if what I post is helpful or not as it will help me learn to be more general or specific as I respond in the future. To start, I'll address the specifics of what I talked about in the video with regard to biomechanics and then I'll talk about some exercises that I recommend for any abnormalities. In the video, I mentioned the importance of glut med function in relation to single leg stance during running. Why is it important? The gluteus medius muscle is the most important lateral stabilizer of the hip and pelvis during stance phase of running. The force produced by this muscle (as it has the highest EMG activity of any lateral stabilizer) creates most of the compressive force on the hip to balance the pelvis over the femur during single limb support. So its role is a significant one, especially when running speeds increase. Many runners, however have a weakened or inhibited glut med., especially if their running style promotes hamstring over-activity. Weakness in the gluteus medius can result in a drop of the pelvis on the opposite side during stance phase, known as a Trendelenberg sign. Why is this drop significant? If the gluteus medius is weak or inhibited, and that drop occurs, then lateral pelvic stability falls on the smaller tensor fascia latae muscle (the muscular portion that leads into the more fibrotic IT Band). This can create an overactivity and eventual fatiguing/tightening in the IT band, leading to the lateral knee pain common in IT Band syndrome. Additionally, to maintain the balance on the opposite side, the QL muscle (which I alluded to in the video) on that opposite side kicks in to keep the pelvis level. This also can cause over-activity in the QL which is now being relied upon to do both pelvis, hip, and lumbar spine stability (its normal function). These are just a couple effects that can result from glut med weakness or inhibition. SO how do you know if the glut med is weak or inhibited? First, have the athlete perform single leg balance with the elevated knee at the same level as the hip for about 30 sec.. If the elevated hip starts to drop, then the glut med is involved, whether it being weak or inhibited. Then have them walk while holding a 8-12lb med ball overhead. If their hip continues to drop while walking, or they have a lateral sway, then the glut med is probably weak. If the hip drop or pelvic stability actually improves compared to normal walking, then the glut med is probably inhibited, not necessarily weak. So how do you correct a weakness or inhibition? If it is a weakness, then side-lying hip abduction exercises, side lunging, wall-ball hip hiking, and single leg reaches will help. If the muscle is inhibited, then Jay's lateral lunge warm-up incorporates most of the exercises I would recommend (side-lunging, side skipping, and single leg squatting). But, I would also include single leg bridges and lateral box step-ups.

    I hope this answers your Question Cara, as well as a few aspects of some of the other posts below.

  • http://www.highaltitudehealth.com/ drrichardhansen

    So it would definitely depend if it actually is your hip flexor (meaning Psoas and Iliacus muscle) or one of the relative synergist muscles, like the rectus femoris, sartorius, any of the vastus group muscles, or a combination of any of these. To know that would depend on an accurate functional clinical assessment. Assuming it is your hip flexor, most likely it is not inflamed or a tendonitis per se, but more of a tendinosis. That is not to say that there is not inflammation in the area around the tissue, as that is a common reaction from injury. But it is actually rare to have inflammation in the actual tissue as part of an over-use injury. On a microscopic level, injured tissue from overuse conditions have an increase in tendon repair cells with no indication that classic inflammatory cells are present. I agree with rhymenocerous that foam rolling may help a little, but I wouldn't necessarily do that right now. Why? Because when things hurt, we want them to feel better now. So when it comes to foam rolling, injured athletes tend to overdo it. (Acu)Pressure is good on injured tissue to help the muscle relax, but too much pressure is bad and can stimulate the muscle to contract back up as a response, known as reflex muscle splinting, in order to protect the relative joint that the muscle influences. With regards to exercises to help strengthen the hip flexor, I am a fan of dynamic leg lowering. This means you like on your back, place your hands under your lower back, start with your legs elevated at 90 degrees, and slowly lower your legs to the ground while maintaining lumbar spine contact with your hands. The Myrtl routine, as mentioned, is awesome at working the Psoas (in the first two exercises), and gluts in the latter two exercises. Additional glut/hamstring exercises I like are hip extension movement patterns, where you start on your hands and knees and slowly extend your leg behind you while keeping the pelvis and lumbar spine neutral. Do this with both leg straight and knee bent. Also, Cook Hip Lifts are great at isolating the glut. Lie on your back and hold one knee into your chest while the other knee is bent. Then, slowly lift your hips off the ground into a modified plank pose. To strengthen your hamstrings, I like hamstring curls on a physio ball. Lie on your back, placing one ankle on the ball and the other foot on the floor. Perform a plank while curling the ball towards your butt. These are just a few exercises to help strengthen the gluts/hamstrings that I like if they are an issue for you. But again, determining if the hip flexor is actually involved first is the key. Soft tissue release of the anterior chain muscles will also allow those muscles to lengthen helping to facilitate the hip extension/posterior chain muscles without being inhibited. Hope this helps.

  • http://www.highaltitudehealth.com/ drrichardhansen

    I forgot to mention what I meant by tendonosis. A tendonosis is more likely because it is the accumulation of multiple microtears occurring in the tissue resulting from repetitive loads (running, cycling, sitting for a long time, pitching, swimming, etc.). Without cessation of the activity, abnormal healing patterns can occur causing a deformation in the collagen fibers of the tendon. This creates a biochemical response stimulating the pain receptors, as opposed to the pain response caused by inflammatory pressure on the tissue. Where as, a tendinitis is typically the result following an immediate acute injury, such rolling your ankle or falling on an outstretched arm in football, tendonosis occurs over a period of time without having the inflammatory repsonse always present. Hope that helps to clarify what I meant.

  • Rhymenocerous

    I've always thought of tendonosis as degeneration of the tendon (and thus much more sinister), while tendonitis is just inflammation (a temporary nuisance but not really a huge deal). Is this essentially correct?
    For example, many people think they have 'just a spot of Achilles tendonitis' when in fact it is tendonosis and treating the symptoms without addressing the underlying cause so often leads to a recurring cycle of injury and eventually permanent deficit in probably the most important structure in running.

  • selfcoach

    My question has to do with upper back pain at the end of a long run. I used to get lower back pain at the end of long runs and running downhills hard. Ever since ive been doing jays Lunge Matrix and leg circuit 1 3 days a week followed by myrtle and ped, my lower back pain is gone.

    I just ran 16 miles and my upper back was killing me miles 10 or so to finish. Its near base of the neck and down a few inches. Im guessing its my traps. Would Jays Back Routine be a good way to go with this problem.

    Im guessing it has something to do with forward lean or just my big head is fatiguing those muscles.

  • Rhymenocerous

    Spot on with the trapezius guess.
    However it has nothing to do with leaning forward (as that comes from much lower in the back) or your giant head (it's like Sputnik: spherical, but quite pointy in parts [ http://www.youtube.com/watch?v=lI_0-kz4lR0 ]).
    A big job of the trapezius is to retract the scapulae (shoulderblades). Imagine the scene in 'Naked Gun' when they are sitting in the car eating pistachios. Imagine placing an unshelled pistachio on one of your thoracic vertebrae and trying to crack it with your shoulderblades – that is scapular retraction. Now imagine the scene in 'Naked Gun' when OJ's fro is too big to fit through the door – it has naught to do with scapular retraction but it's a cheap laugh, for several reasons.
    I'd bet your issue is mostly down to arm carriage. Just being too tense in the shoulders, etc. and putting (relatively) weak muscles in a position where they become fatigued before the completion of a 16M run. Seated rowing in the weight room, or even really focusing on the down segment of a pushup (home remedy) might address things.

  • selfcoach

    Would this make even more sense? My college coach always told me to relax that i ran too tense, also doing push ups i suck at. Even worse, i hated down and hold em push ups. Id rather be vomiting on the track then doing down and hold em pushups. So what you said above makes sense.

  • bgoldsmith

    Great video. I'm new to running and some of this stuff is over my head. I feel like right now I'm just concentrating on going out and running. However, I feel like I should be aware of things, like weak glute stuff. What signs would point to needing to do the work outs described above more? Also, it would help if you put a dumbed down description of medical terms in parenthesis for example gluteus medium (upper butt cheek muscle – I made that up, not sure if that is right).

    Keep doing the great videos.

    PS. Dr. Hansen are you single?

  • http://www.highaltitudehealth.com/ drrichardhansen

    I completely agree, tendinosis definitely takes longer to treat, yet is more common than a true tendinitis. It is, as you suggested, a degeneration of the tissue caused by overuse mechanisms leading to a fraying in the microfibrils of the tendon seen microscopically as a collagen separation. I tend to stay away from the term degeneration, as the connotation of the word is often associated with aging joint and bone pathology, but it is for sure a form of degeneration.

  • http://www.highaltitudehealth.com/ drrichardhansen

    So plantar fasciitis (which is an overgeneralized term for most plantar foot injuries) is a tricky one, because there are so many different factors that can contribute to it. The term plantar fasciitis is a bit misleading as well, because it is not always the plantar fascia that is effected. Barefoot exercises will definitely help prevent the occurrence of the condition, but if someone has already developed it, then certain barefoot work can aggravate it. It's kind of like giving curls to a strained bicep. The cause would obviously influence the type of treatment, so having a proper evaluation will help in trying to pinpoint what specifically is going on. But for hypothetical purposes, here are some things I would recommend for a few of the more common predisposing factors. One cause is inefficient foot intrinsics (such as the flexor digitorum brevis, lumbricals, interossei, quad. plantae, flexor hallucis brevis, and digiti minimi muscles) and posterior tibialis firing (the muscles of the foot responsible for proprioceptive input to stabilize the ankle) for the activity being placed on it. This means the muscles of the foot don't activate as effectively as they should so they are ill-prepared to handle a sudden change in the exercise intensity or duration being placed on them. This causes the muscles to fatigue out and tighten up. Tenderness in the plantar fascia can also be referral from other lower leg muscles. These include active trigger points or tightness in the gastroc, soleus, posterior tib, flexor digitorum, and flexor hallucis muscles. Keeping the foot intrinsics loose and dealing with the active trigger points or tightness in the associated muscles will for sure help, even if the cause is from trigger point referral. Rolling the foot out after running with either a tennis ball, lacrosse ball, golf ball (although this can feel a little too tender with how hard the ball is), or frozen water bottle will help address this. Strengthening the foot intrinsics is best done by performing small foot (pushing the ends of the toes into the ground causing the arch to contract up) and single leg balance simultaneously. Once balance can be maintained for 1 min while activating the foot intrinsics, perturbations can be added (such as eyes closed, instability boards, tossing a ball against a wall, etc.) Research shows other commonly prescribed exercises, such as towel crunchers or picking up things with the toes, don't activate the foot intrinsics as well as the small foot contraction with balance. To manage a weak posterior tib, performing calf raises starting from a neutral position and going upwards while maintaining inward rotation of the feet. For calf tightness (gastroc and soleus), I recommend eccentric calf lowering exercises. Start from a neutral position off a box or curb and let gravity pull you down, hold 3-5 sec and raise back up to a neutral position. Weight can gradually be added as the muscles become adapted to the stretch. These are just a few exercises that help, but like I said, proper evaluation and treatment by someone that is knowledgeable in the various biomechanical influences and experienced at differentiating specifically which tissue is involved and releasing any adhesions is essential to effectively managing “plantar fasciitis” like symptoms.

  • Jon

    Jay,
    I know this seems trivial, but please don't refer to him as a physio. Two entirely different professions with different backgrounds, history, education, treatment philosophies, and professional oversight.

  • http://coachjayjohnson.com CoachJay

    Jon -

    Doesn't sound trivial at all. I was going out of my by calling him a physio to not call him a chiropractor as for many Americans that term is loaded. Most American's (the majority of the readership thus far) have not heard the term and since I've never had an athlete or coach explain exactly what a physio is then I used to when describing Dr. Richard Hansen to keep people's mind's open.

    In sincerely appreciate your comment and by no means is it trivial. I'm currently calling exercises General Strength that aren't really that, yet it's something people on this site are familiar with and I don't want the semantics to get in the way. So your comment was quite helpful – thanks – and I'll need to work on a post about the importance of semantics and how I've been lazy with semantics as of late (though a few years ago I was quite strict).

  • Jon

    Jay,
    A physio is simply what physical therapists are referred to as outside the United States. Can't give a solid answer as to why there is a different name in the states, but it wouldn't make much sense to change it now. The reason I bring it up is that it is technically a violation of ethics and some practice acts to refer to chiropractic treatment as physical therapy and vice versa.

    All that said, keep up the great work on the website. This is a good resource, especially the quality of the videos.

  • http://www.foamrollerguide.com/ Zac of Foam Rollers Guide

    I suggest foam rolling both before and after a workout ,it loosen up muscles and after to remove any toxins. At first, foam rolling may feel uncomfortable or even slightly painful; however, over time pain and discomfort decline as your muscles and tissue are loosened.