Gary’s Fitness Blog

In our book, Strength Training for Runners, Nikki and I included the single leg squat.  It is an exercise that I like to add into a runners program for several reasons:

1.  It requires you to use a single leg to produce force; this translates well into running which requites this movement to be repeated 1000’s of times.

2.  It helps develop stability in the hips and knees.  One of the premises that we have discussed in our book is that when a runner begins running more miles and increasing the intensity of their runs, if they have poor stability (primarily hip abduction and external rotation strength) they will be more prone to injury.  The research we share in the book supports this theory.

The NASM training that Nikki and I attended back in June also used the single let squat as an assessment for specific movement patterns, muscle imbalances and range of motion (just another use that a trainer may have for this exercise).

As I continue to build the list of exercises that I do on the TRX Suspension Trainer, I have found the single leg squat to be one that I find very effective.  I like how the TRX allows the non-power leg to follow a more natural “running” motion.  It allows this motion, but it doesn’t interfer with the stability aspect of the exercise - the exercise still requires a person to maintain good stability through the entire motion of the downward and upward phase of the movement.  By adding pauses at the bottom and top of the movement, you can add aditional stability challenges. 

Here’s a picture from the Fitness Anywhere site that displays this exercise at the bottom of the exercise movement:

 Hope you are staying injury free!

In the personal training studio I use a TRX Suspension Trainer everyday to provide some supplemental exercises.  For example, I use it to do chest presses (push ups), rows, assisted squats, one-leg squats and what they call the “power pull”.  I like to do many of these exercises as warm up exercises because it uses bodyweight as the resistance and it is easy to incorporate stability aspects to the workout.

Yesterday, I decided to do a complete workout on the system and start to experiment with some more advanced exercises.  Specifically I really wanted to challenge my core and see if I could get a complete workout.  We’ve been using it so long as an accessory I wanted to test it out as a primary piece of equipment.

I’m a little sore today, but that is expected as I still haven’t recovered from the EndureChallenge and any lower body work makes me sore.  My abs and triceps have also been a little sore today.  Does being sore mean that it is a good workout?  NO.  But I was able to challenge some stabilizing muscles in my upper body in uncoventional ways and the core work is pretty challenging.  There are still some core exercises that I’ve seen done that I wasn’t able to do.. maybe soon?

I’m going to try and incorporate one workout a week done completely on the TRX for a while and see how it works out.  I’ll let you know.

In full disclosure, I have signed onto their affiliate program.  Which means they give me a commission if you follow my links to their site and decide to purchase a system.  I have used the system in the studio everyday for over a year and really like it, so I feel good promoting the equipment.  I’m just excited to see how I can use it as a complete system.  It could be a great piece of equipment to own for some of my more mobile clients, if I can create complete programs with the system.

Here’s a youtube video to motivate you a little (I’ll see about adding some videos of my own in the near future).  The exercises around 1:42 into the video are the one’s that I have not been able to do yet?

Workout:

• Type: Strength Training
• Date: 05/15/2008
• Total Time: 00:45:00.00

Workout:

• Type: Strength Training
• Date: 05/12/2008
• Total Time: 00:45:00.00

I have now watched the NOVA - Marathon Challenge program twice.  My personal opinion is that the documentary is way better than the Spirit of the Marathon Documentary that was done about the Chicago Marathon trainees.

That may be due to the face that I’m a little bit of a science freak when it comes to the training involved in  marathon training.  The NOVA special doesn’t go into a lot of detail, but they do address certain training issues:  injuries, VO2 Max, Body Composition and a little about nutrition during long runs.

Here are some key take home messages that I’d like to point out and my view:

1.  Long Runs

I’ve discussed this many times in the past.  I recently wrote an article that I called, “A look at the long run and marathon training.”  And my first podcast, “The long run in a marathon program.  The double long strategy,” addresses my thoughts on how to approach a long run.

One of the interesting discussions was when the exercise physiologist and nutritionist from Tufts said that by the time you get to the “long” runs you have already developed the physiological changes and the soft tissue changes, the long runs are primarily beneficial for the psychological outcomes.

That is a point that I like to make and my point-of-view is that the downside of injury (for most runners) is greater than the psychological uplift a person may generate.

Just a reminder that there is no magic to a 20 mile run.

2.  Weight Loss / Body Composition

They analyzed the body composition of the runners before and after their marathon training programs.  What they found was that only one of the runners changed their body weight or body composition during the program.

This is hard to believe for many people, especially when you consider the amount of exercise they added to their lifestyles.  The take home message (which they made) is that we often over-estimate the caloric expenditure of the activity we participate in.

Thus, if we want to get into a weight management situation or lose some weight, nutrition is a very important (if not the most important) variable in that program.  This can be hard for an exercise physiologist and personal trainer to admit because I want to believe that exercise is the most important key to any lifestyle… but there are limitations.

A better message is that there needs to be a combination of exercise and non-disordered-eating.  One thing that I see often (and see in myself), is a belief that with all the exercise that comes with running a marathon or training for an Ironman, a person can eat whatever they want.  That mentality leads to disordered eating.

Exercise Session –> Eat what mind wants –> Non-Optimal Food Choices

This is one thing that I am currently working on.  I know that when I’m in full capacity training I have little mental energy and strength to combat poor nutritional habits.  Last summer it got a little crazy as I trained for Ironman Wisconsin.  Now that I’m not in full capacity training, I see myself being able to change some of those habits.  Still more changes that need be made.

3.  The other side of body composition.
The other side to their body composition discovery was that the one person that did have changes also included a bootcamp training program in addition to their marathon program.

This is a good lesson because it helps us realize that even within an exercise program, there needs to be a balance between strength training, flexibility training, and cardiovascular training.  Many endurance athletes can become addicted to the “runner’s high” and neglect other aspects that would benefit their health (again, I am as guilty as anyone).

4.  The injury issues:

There seemed to be a lot of injury issues that the runners were dealing with.  One of the most important lessons that I’m continually learning is the value of specific strength training and flexibility training as a hedge against injury in a beginner / novice marathon program.

You can go back and read the posts I’ve had on strength training and patellofemoral pain.  Many lessons learned there.

If you have read some of my blog posts lately than you have seen that I have been digesting some research articles related to patellofemoral pain and strength training.

One question that could be asked is; Why patellofemoral pain? Here are two answers:

1. If you read my review of the article that discussed the benefits of physical therapy then you would know that patellofemoral pain is also known by many other names, such as, chondromalacia patellae, anterior knee pain, patellar malalignment, and patellofemoral arthralgia. Therefore it may seem that the name is a very narrow issue, but it is not.

2. These issues seem to be very common set backs that runners deal with from my experience. While I used to believe that these knee issues (runner’s knee even) were more prevalent with new runners, I am not sure that I can make that general observation anymore. I feel like I get these questions all the time lately, from all sizes, shapes, gender and experience of runners.

The previous two articles have been a review of: a - suggestions to sports physicians on how to address and manage pfp and b - the role that physical therapy interventions have, especially strength exercises.

The article that I reviewed today discussed the question from another angle, Is there a difference in hip strength in females that have patellofemoral pain versus those that don’t?

Here’s the article source:

Ireland ML, Wilson JD, Ballantyne BT and Davis IM. (2003). Hip strength in females with and without patellofemoral pain. Journal of Orthopaedic and Sports Physical Therapy. Vol. 33, No. 11, Pgs. 671 - 676.

The basics of the study is that they matched 15 females subjects with patellofemoral pain to 15 female subjects without patellofemoral pain. They then tested both hip abduction (moving your leg away from your body) and external rotation (rotating your foot in).

They had some interesting findings:

1. isometric hip abduction was 26% weaker in the females with patellofemoral pain
2. external rotation was 36% weaker in females with patellofemoral pain

They do point out in their discussion that b/c of the study design it is not possible to determine a cause/effect relationship, but they do make some observations that I felt were worth mentioning:

1. the results of this study, along with previous studies show that proximal stabilization programs (this means proximal to the knee… thus the stabilization at the hip) may be beneficial for those with patellofemoral pain.

2. strengthening of the hip abduction and external rotators may benefit those with patellofemoral pain (they mention other studies that have focused on strengthening the gluteus medius)

My thoughts:

This observation is essential to my understanding of the patellofemoral pain issue and helping runners. Why? Because most of the articles that I’ve read and found deal with the issue of patellofemoral pain treatment. Which is not what I would ultimately like to do. The desire is to find characteristics of the problem and correct them before they become an injury that needs treatment.

Again, this article does not show a cause / effect relationship. I could not promise someone that if they increased their strength for hip abduction and external rotation, they would not ever develop knee pain. The injury is multifactoral, therefore that idea is too simplistic in my point-of-view.

But it does point to a possible factor that we can control by including some appropriate strength training exercises.

One of the biggest revelations that I’ve had lately is just how oblivious I have been to this issue in the past. I have always had personal training clients strengthen their hips in the different planes, but I have seen the hip abduction weakness and hip stability (glut med) weakness a lot recently. Even in my own hips, which has created other problems (tight psoas muscle and back pain).

Does this mean that doing a hip strengthening routine is appropriate for everyone? I am not sure I can answer that, but I will say that my belief now is that it can’t hurt (while knee pain can), especially for those who are beginning a running/cycling program or are in a period where they are increasing their activity levels by a large percentage.

Hopefully I can find an article that discusses these weakness issues and interventions related to prevention. If I can, that will be the next patellofemoral pain article I review.

Until then… happy abductions.

In my last post I discussed the topic of Patellofemoral Pain and Tendionopathy. Specifically, I mentioned the special communication that was put out in the November, 2007 issue of Medicine and Science in Sports and Exercise.

Over the past year, I have been collecting articles, reading and researching this topic of injury prevention for runners and strength training. The special communication has once again peaked my interest and I thought I’d share a brief synopsis of a few articles that I have reviewed lately.

The next few posts will all be short reviews of articles discussing Patellofemoral Pain. Here’s the first article:

Source:

Crossley, K, Bennell, K, Green, S, et. al. (2002). Physical therapy for patellofemoral pain. A randomized, double-blinded, placebo-controlled trial. The American Journal of Sports Medicine, Vol. 30, No. 6. Pgs 857-865.

1. One of the first things I found interesting was that in the introduction they say that patellofemoral pain is the most common diagnosis cited by many authors. And that while it is a common issue to be seen and treated, the “pathologic origin of this disorder is not clearly understood.”

2. The jargon is wide ranging describing this issue. Patellofemoral Pain, Chondromalacia Patellae, Anterior Knee Pain, Patellar Malalignment, and Patellofemoral Arthralgia have all been used synonymously.

3. “The rationale behind the use of physical therapy for alleviation of patellofemoral pain includes restoration of patellar alignment through active or passive interventions, including quadriceps muscle-strengthening exercises, stretching, patellar taping or bracing, biofeedback, and use of corrective foot orthoses.”

4. The purpose of the trial was to find out if physical therapy was effective in managing and treating patellofemoral pain in comparison to a placebo group.

5. The physcial therapy used consisted of: patellar taping, biofeedback of vastus medialis oblique (VMO, which is the quad muscle on the inside of your leg), gluteal muscle strengthening exercises and stretching.

The exercises that they uses were the following:

• isometric VMO contraction at 90 degrees — basically a leg extension done isometrically at 90 degrees
• squats to 40 degrees with isometric gluteal muscle contraction (4 sets of 10 reps)
• isometic hip abduction standing against a wall (4 sets of 15 seconds)

added exercise after 2 weeks:

• step downs — stand on step and slowly lower leg in front (3 sets of 5 or 10)
• increase the hip abduction to 30 seconds.

6. They were instructed to do these exercises 2x a day while in the program.

7. They concluded that there was a significant difference between the two groups in three measurements: worst pain, usual pain and anterior knee pain scale. But there was no difference between groups in the functional index questionnaire.

My thoughts:

As many of the articles that I find, this article discusses the rehabilitation of knee pain not the prevention of knee pain. But there are some interesting insights that I feel I can pull from this article:

The exercises that they chose strengthened the gluts and hip abduction. This is a common theme that I have seen in runners that end up developing the worst knee issues - they have weak glut and hip abduction.

One easy way to see how stong and stable your hips are (those two mucles groups involved) is to stand on one leg and try to do a 2 or 3 inch squat. Make sure you are not holding onto any table, chair or wall for balance. Can you do it? Does your knee try to cave in towards your other leg or push out away from you midline?

If it appears that you can’t balance or do the squat, it might be that you are a little weak.

Now relate this to running. Each gait cycle you have to do a very small version of the single leg squat. You flex and extend at the hip, your knee flexes and extends, your foot dorsiflexes and then you plantar flex to toe off. What happens if each time you go through this cycle your leg isn’t strong enough to carry through the movement and your hip or knee has to adapt?

Let’s do a quick calculation: Let’s say each leg goes through this cycle 90 times a minute (the 90 rpm cycle many coaches suggest today), you run for 1 hour (60 minutes). That equals 5,400 times each leg will make that movement. Now go run a marathon!

My thoughts are obviously an attempt to make a somewhat educated discussion based upon my experience and the knowledge gained from this article. As I continue to be aware of the issue of injury in runners, I continue to be more convinced that some runners will benefit by including strength training in there regular programs. For no other reason then they will be able to handle more miles without injury.

One of the biggest questions becomes, What exercises should I do? One place to start would be with a post I wrote some time ago called, Improve Muscle Imbalances with Strength Training - Hip Stabilizers. I plan to update that post soon, but I still believe it is a good starting place.

Next Post:

I plan on looking at an article called “Hip Strength in Females With and Without Patellofemoral Pain.”

** Below is a copy of an email I sent to a few runners I’m currently coaching**

I was reading through the latest issue of the Medicine and Science in Sports and Exercise yesterday and found a special communications from the organization (American College of Sports Medicine) to team physicians. In that communication they gave suggestions to physicians about “selected issues in injury and illness prevention”.

The one injury area that I thought was relevant to us runners was their thoughts around Patellofemoral Pain and Tendinopathy.

Risk Factors they associated with this are:

1. muscle weakness and imbalance and inflexibility including quadriceps shortening
2. trauma, overuse, training errors or previous injury
3. patellar hypermobility
4. hip muscle weakness

Prevention Interventions Include:

1. implement sport / activity conditioning program with periodization emphasizing the proven interventions of quadriceps strengthening and increasing hamstring flexibility

2. other interventions may include core / lower extremity strengthening, hip abductor and external rotator strengthening, improving motor control.

My thoughts:

I come across a lot of issues in runners and general population with weak hip stabilizors and pelvic mobility/control. Incorporating some adductor exercises / abductor exercises have seem beneficial (I’ve especially seen this in a cyclist that I’ve worked 2 years with). The other thing that they talk about is “motor control” … I’ve recently seen a need to incorporate some balance training (single leg balance exercises) to help develop the hips / lower leg stability so that it can properly move through the gait cycle.

Some beginning exercises that can help in these two areas can be found at this link: http://familydoctor.org/online/famdocen/home/healthy/physical/injuries/479.html

One thing to remember is that when running your body can’t rely on a machine for stability or movement patterns, so when incorporating a strength, stability and balance program… don’t use machines.

Last thought:

Everytime you run, your body has to work to strengthen itself and adapt to the workout. If the first law of training is “specificity” (which it is one of the first four by the way) then we should appreciate that regular running is likely the best way to strengthen our body to run. In other words…

… if you are not running regularly, it doesn’t matter how many single leg squats you do on a balance pad, your long run is going to likely cause injury…..

…. But if you have been running regularly, these exercises are a great addition to help boost your body’s ability to handle your runs…

…. In other words - these exercises are In Addition To, not In Place Of your running …

…. unless you are already dealing with an injury, which changes the entire ball game …

**** End of Email ****

Those are some thoughts that I felt were worth sharing with everyone. Since that email, I’ve come across a couple situations that have driven home the importance of these injury prevention interventions even more.

When motivation is high, which often is the case in an individual taking on a marathon for the first time, there can often be a disconnect between what is “optimal” and what is “practical”.

I put “optimal” in quotes because there are a lot of people out there willing to give advice about the proper way to train for a marathon. But the question we always have to ask ourselves is this: Is it the proper way to train for me? The truth is that there are many ways to get to the finish line of a marathon (or triathlon), choosing the best path for you is the key.

Someone who has run 10 (or 50) marathons may have a program that works well for them, but may not necessarily be proper for you. Do they have the same biomechanics as you? What was their history with running before they began?

There are so many variables. The interventions listed above are a good starting place if you are starting to see some patellofemoral pain during or post running workouts. They are also a good hedge against injury development if you have poor biomechanics or running form.

If you feel like you need more individual guidance, look me up and I’ll try to help if I can. My email is garyditsch at gmail dot com.