Our hamstrings take the brunt of a lot of stress we put on them daily. Not only from training and working out but also we spend a lot of time sitting on these muscle and the attachment sites. We also have to take into account the nerves that are running through the muscle coming from our lower back. All this makes for a complex combination of dealing with pain. This video does a great job breaking it all down.
What It Helps:
>Hamstring pain/tightness
>Low back pain
>Relieving nerve pain
Dr. Douglas Casa came to UWL a couple weeks ago and shared with us how to prevent sudden death in athletes with a focus on heat illness. The main problem we discussed is heat stroke. Before we get into the recommendations I want to make sure that I reference that all this information is from Dr. Casa and the Korey Stringer Institute. It was just too important not to share.
Through Dr. Casa's research and his own interventions when covering events they have found a 100% survivability in a heat stroke event. The goal for anyone dealing with a heat event is get the person under 104degF in the first 30 minutes. So far that has produced 100% survivability.
There are four elements of surviving heat stroke:
Recognize
Rectal Temperature
Rapid Cooling (Cold water immersion is best)
Cool First, Transport Second
When all four of these steps are followed and we can get core body temperature down we can help everyone who suffered from heat stroke survive. With summer coming right around the corner and more road races and other events occurring these steps need to be implemented. Check out more resources below.
Hinging is a skill that we often overlook when it comes to basic movements that we use in the weight room but also in everyday life. This video gives a great breakdown of why you should hinge and really focus on doing things correctly. It may seem simple but getting it correct is going to make a huge difference in your quality of movement.
Things It Helps:
+Preventing Low Back Pain
+Engaging Posterior Chain
+Helping to lift heavier things
So many good things and you can adjust as you need to (like drop the feta if you're dairy free, I don't personally recommend it). It changes up salads and can make it so you get some more greens in your life along with other solid vegetables. If you're growing cucumbers this summer it can be really hard to keep up with their production, use this salad as an option.
Ingredients:
3 tomatoes, cut into wedges
1 medium red onion, sliced into rings
1 cucumber, pilled and sliced into thick half moons
1 green pepper, sliced
16 black olives (get the Greek ones)
7 oz of feta (block or crumble)
1 tbsp red wine vinegar
1/4 cup extra virgin olive oil
1 tsp dried oregano
sea salt
Game Plan:
As said before, the secret to make a delicious Greek salad is in the ingredients: juicy tomatoes, crisp cucumber, creamy feta cheese, good quality extra virgin olive oil and some tangy black olives will really make a difference.
To make this Greek salad recipe, start by preparing your vegetables. Wash thoroughly and strain the vegetables. Cut the tomatoes into wedges, slice the onion into thin rings, cut the cucumber in thick slices and place everything in a large bowl. Don't forget to add the olives as well.
Season with salt and pour over the extra virgin olive oil and vinegar. Toss everything together so that the flavors mix. Be careful not to add too much salt, as the feta cheese and the olives are salty enough.
Greek salad is always served with feta cheese on top, a drizzle of olive oil and dried oregano.
Trigger points can be extremely painful and the world we live in and how we position ourselves on a daily basis predisposes us to getting them in our upper traps. If you've had them there before you know can attest how much they can hurt and cause a lot of other problems. This Study Spotlight takes a look at a couple treatment options in the treatment of these trigger points and how they might help.
What They Did:
Researchers in this study looked at a comparison of utilizing Kinesio taping techniques (space correction) vs. trigger point dry needling and their effectiveness on treating myofascial pain in the upper trap. Groups were assigned at random and evaluated for trigger points and myofascial pain and then assigned to a treatment group.
What They Found:
After comparing results the results showed that both treatments had comparable positive effects on pain perception and the pain pressure threshold. There was questionable effects on the cervical range of motion.
What It All Means:
There are always multiple ways to treat an injury or pain that a patient is experiencing. Trigger point dry needling can be extremely effective as a treatment but is highly invasive due to inserting single or multiple needles through the skin and into the tight tissue. For some people they tolerate it extremely well but for others, especially with needle phobia it can be near impossible to go through a treatment.
The use of Kinesio taping is much less invasive and you only have to worry about potential skin irritation. It is also one that can last for up to 3-5 days depending on the application. This can allow for much less stress when it comes to treatment and removing any issues with needles.
This means there is a good option for the use of multiple treatments to get the same positive effects on myofascial pain in the upper trap. It also brings up the possibility of combining treatments in order to try create a more positive outcome.
Source: Dogan, Nesibe. Kinesio taping versus dry needling in the treatment of myofascial pain of the upper trapezius muscle: A randomized, single blind (evaluator), prospective study. Journal of back and musculoskeletal rehabilitation.
Prepping your body for the activity you are about to undertake is a huge key to maintaining success and keeping your body moving pain free. This video is a great guide to get you started on planning ahead on what you need to do to prep your body for your desired activity. This helps set you up for success not only for injury prevention but also to increase your ability to perform. Check it out.
Things It Helps:
-Preventing Injury
-Increasing/Enhancing Performance
-Generally Feeling Better
Sometimes simple does just fine when it comes to eating. This is a simple yet unique combination of some favorites to give you a high protein snack that you can have access too about anytime you want. Easy to travel along with and have at work or if you stop home quick Give it a try.
For the shoulder being an extremely mobile joint it is unfortunate how quickly it can lose that mobility. While you can lose mobility in external rotation it is often a lot more common to lose it in internal rotation. That can lead to all kinds of problems with shoulder impingement issues, nerve issues and all kinds of other problems in the anterior shoulder. If you can get more movement and mobility here it can unlock all kinds of motion to relieve pain and increase your ability to perform.
Things It Helps:
-Tight and sore shoulders
-Restricted ROM
-Better overhead movement
Embarking in more learning about leadership and all the different thoughts on philosophies have brought up a lot of different ideas about how those things might be applied to health and wellness. There have been a lot of theories on leadership throughout the past one hundred years and recently the focus has been on being more transformational. A transformational leader is one who's focus is on the follow. Motivating followers, helping them fulfill their dreams and potentials are some of the major focuses of a transformational leader. An ability to be and remain intrinsically motivated is also a key trait of transformational leadership.
How does this apply to health and fitness?
I believe for people to be effective in the health, fitness, and medical professions you have to be remain transformational. Information is being generated too quickly to be stuck in old ways that no longer seem to have the effect they were once thought to. In order to remain at the top of your game (which I believe all practitioners should) you have to be intrinsically motivated in order to go comb through all the research and find what the next thing is that can benefit your patients. Failure to do can present major costs. Not only will you potentially fall behind, how you are able to care for and service your patients will decline. Obviously this isn't a good thing.
Leaders within these areas also must be transformational and encourage their employees to go out and challenge themselves. Depending on the situation, a leader may not want others to pass them up in terms of knowledge and skills. This is short sighted and will hold the employees and the organization back from achieving its potential. A leader must embrace the paths their employees want to go and actively help them achieve their goals within the framework of the organization or department.
How can this be accomplished?
Go out and challenge yourself. Don't settle for what your comfort is but seek out disconfirming information. Doing so can provide benefits from two ends. One, it can reconfirm what you do if the information/evidence isn't enough to change your mind. Two, it can help set you on a new path to something that could be better or at least enhance your current practice. A person can accomplish this through multiple avenues. Continuing education outside of comfort zones or just going deep in the literature and finding out if what you've been told is truly the best option for what you are trying to accomplish.
Keep transforming. Don't change for changes sake but don't sit idle because you might be worried what you find on the other side.
Neural flossing is a technique that can be extremely beneficial for your body. After you've been stretching for quite some time and maybe not quite getting the response that you fully want this would be a great option to throw into the mix to help get things free'd up and feeling better. Be careful not to overkill these exercises as they can go too far. Try them out.
Things It Helps:
-Tight Hamstrings
-Low Back Pain
-Sore Groin (adductor) Muscles
Loaded question and one that is not simply answered. They do say that "money is the root of all evil" and unfortunately the more I learn about healthcare and the insurance industry, it appears that is the case. If you know a doctor you may think they make pretty good money and you're not wrong in that assumption, but are they overpaid?
I would argue that your general physician is not. The CEO of some of the top medical clinics in the world, yes the world make somewhere between $2.8 and $4.8 million dollars a year (isn't much when you look at $30+ million a year for a quarterback...). For most people those numbers seem high but when you look at what a physician can do for you, I would argue they are justified.
Here is where I struggle though. What about the insurance companies. In 2017 health insurance CEOs earned $342.6 million dollars in salary. These individual salaries could go all they way up to $83 million dollar a year....for what? How has your premium been lately? Has your deductible gone down?
I would argue this could be the root of a lot of the problems in healthcare. Everyone deserves to make a living but for companies that in theory their business model is to help people with health insurance how much sense does it make for them to make 10's of millions of dollars and that doesn't trickle down to help the everyday insurance holder. While insurance can help you in the really bad times does it offer everything it could?
The healthcare system as we know it will be bound to collapse under the weight of increasing rates and hospitals billing more for services in order to cover their expenses it has to burst at some point. There isn't a simple solution but being proactive in your own health and potentially looking at other practitioners might be the next best step. We will try and do our part to get everyone there.
The 'Back Knobber' is a very common tool that a lot of people will use to help relieve tight areas all over your back. Is there a best way to utilize this tool though? We often see people trying to use it but not maximizing the power that it can provide you. This video gives you a great intro on how to maximize the effect of the tool to relieve the pain and tightness in your back.
Things It Helps:
-Upper back tightness
-Mid thoracic trigger points
-Tight QLs
Stir fry is an easy way to add some health macros to you diet. Filled with your favorite protein and vegetables you can customize what you want your wok to take a look at. You could throw this over a bed of rice (white or brown, your call) or if you're really looking to clean it all up try it over cauliflower rice.
Ingredients:
2 tbsp avocado or coconut oil
1 pound beef sirloin, cut into 2-inch strips
1 1/2 cups fresh broccoli florets
1 red bell pepper, cut into matchsticks
2 carrots, thinly sliced
1 green onion, chopped
1 tsp minced garlic
2 tbsp soy sauce or coconut aminos
2 tbsp sesame seeds, toasted
The Game Plan:
Heat oil in a large wok or skillet over medium-high heat; cook and stir beef until browned, 3 to 4 minutes. Move beef to the side of the wok and add broccoli, bell pepper, carrots, green onion, and garlic to the center of the wok. Cook and stir vegetables for 2 minutes.
Stir beef into vegetables and season with soy sauce and sesame seeds. Continue to cook and stir until vegetables are tender, about 2 more minutes.
"You could have a rock in your shoe and in current medicine you could take an ibuprofen and feel a little better and feel less pain. Or you could stop, remove your shoe and dump the rock out."
-Chris Kresser
This quote summed up so many things we see in not only medicine but also in performance and just life in general. All too often we are looking for the quick fix. The pain reliever. The supplement. That one piece of equipment that should put us up and over the top. Is that thing we are looking for though really getting to the source of the issue though?
Being as guilty of this as anyone it has been an eye opener. There is a lot of things you can change in your lifestyle to get more health benefits:
Staying hydrated
Getting enough QUALITY sleep
Eating Whole Foods
Limiting things on the ingredients label you can't pronounce
Basic activity (walks are a great start)
Simple mobility work
As mush as you can try not to add to the continuation of dulling the pain or looking for the quick fix to get you to the next phase of whatever your goal might be. Stop, consult a professional if you need to, and figure out why that issue is occurring. Take the rock out of your shoe and be all the better for it.
This is not a fun one to do but you'll thank the barbell later. These areas are chronically tight on most of us for having to be at a desk and on a computer all day. Digging in deep to these areas and releasing that tissue will be huge for your shoulder health in the long run and allowing some of the stress of your back musculature. Give it a try.
What It Helps:
-Tight anterior shoulders
-Rounded forward posture
Sometimes you have to just start with a region of the body and not a specific body part. In our world that we spend too much time sedentary and in a chair our tissues can start to get locked down and prevent us from moving how we want. This video gives you the basics on where you can get your start to help get your upper body moving more freely and reducing pain and tightness.
Things It Helps:
-Shoulder Mobility
-Upper Back Stiffness
-Lat Mobility
It is understandable that a business owner needs to find products and services that people not only want but that offer good enough margins to help the business grow. As people I can understand that in the world we live in it’s hard to make the ‘right’ choices all the time when it comes to our health and nutrition. But can’t we do better?
The Individual:
This is not the focus of this post but I feel I would be doing disservice if it wasn’t addressed. I will be the first one to admit that my diet is not perfect. I will opt for pizza and beer if I can and not think twice about it. Does that make me a hypocrite? That is for you to decide. I’d argue it makes me human and I can live with that. Ultimately at the end of the day we get to decide what we are going to put in our bodies and we vote with our dollars when we buy all the things people are selling us.
It is our decisions that ultimately determine our health. Own those decisions and do what you can to make the best ones. While I haven’t counted out the percentages the 80/20 principle of doing it right 80% of the time and letting loose a little on the 20% is generally a good place to start.
The Entity
I am not in a place to tell people how to run their business and make a profit to support themselves and their employees. I feel like I can make the ask though that do we have to do it on the back of low cost, low nutrition, high calorie, "junk" food. It seems like a great business move but also a trap for everyone heading to the check out counter. So many things that are easy to grab that most people had no intention of getting in the first place. This could be the business goal, but at what cost.
I believe these are the things that our the overall health of our community. While people still maintain the right to choose...can't we do better in providing the best options available? We don't have to do away with everything that is sweet, salty or savory but can we at least tone down how much we are bombarding people with it? I believe this would lead to not only healthier customers to keep them coming back but to healthier employees which reduces insurance cost and benefits the business overall (the numbers are staggering and we'll try and do a post on that).
For everyone, until a shift changes in how places do business selling calorie dense nutrition deprived food you'll have to turn your will power on full force. Moderation is the key to almost everything. Find that happy medium and do it for your health.
Warm ups are easy to bypass. As we get busier and hurry form one thing to the other trying to get a workout in is hard enough, but to warm up as well? Now we are just talking crazy. This video talks about the importance of not leaving that 'warm up' or in the case movement prep out of your routine and explains why it can be so beneficial for your body.
Things It Helps:
-Preparing for a workout
-Priming main movers (hips/shoulders)
We tried a version of this at our house and while nothing quite beats the crunch of a good egg roll this one was a lot more guilt free. All the great flavoring of an egg roll without the deep frying of the shell that can throw your nutrition off. Give it a shot and customize it to how you prefer your favorite egg roll.
Ingredients:
2 tbsp sesame oil
3 cloves garlic, minced
1/2 cup onion, diced
5 green onions, sliced on a bias (white and green parts)
1 pound ground pork
1/2 tsp ground ginger
Sea salt and black pepper to taste
1 tbsp Sriracha, more to taste.
14 oz bag coleslaw mix
3 tbsp Coconut Aminos
1 tbsp rice vinegar
2 tbsp toasted sesame seeds
The Game Plan:
Heat sesame oil in a large skillet over medium high heat.
Creatine has been long been known for its ergogenic aid when it comes to performance. Whether it comes from enhanced recovery or from helping add some muscle through higher intensity training, the studies are out there. There has been some research coming out about cognitive benefits of supplementing creatine and the potential benefit of utilizing creatine for post concussive recovery could be significant. This article does a great job breaking down ideas of where creatine and cognitive function can go.
What They Did:
This was a review article of the potential effect of creatine on cognitive function. Not only in long term cognitive health but potentially in the recovery from different types of traumatic brain injury.
What They Found:
Authors believe that a high creatine content may theoretically enhance brain function, through facilitation rapid energy provision during times of accelerated ATP turnover. Theoretically, supplementing creatine could provide this benefit.
What It All Means:
The authors have concluded that higher levels of creatine supplementation may be the way to go when it comes to trying to optimize outcomes for health. This could potentially look like supplementing at a "loading" rate of 20g/day as you might do in the early phases of supplementation for the first week of using creatine for muscle concentration. The authors realized that that creatine could exert its influence in situations whereby cognitive processes are stressed, in particular acutely.
The long term effects of supplementation could show promise with traumatic brain injury and other cognitive issues. There is hope that the potential for supplementing creatine could help in the recovery from injuries like concussion. Not only is it easy to supplement and get proper dosages but it is also fairly inexpensive. The research to follow is going to be big and could really help people be in a better spot in their recovery process.
Limitations:
This study did a pretty good job overall going though the literature and trying to figure out what the best way is to supplement creatine is for the best cognitive function.
Reference: Dolan, E. Beyond muscle: the effects of creatine supplementation on brain creatine, cognitive processing, and traumatic brain injury. European Journal of Sports Science. 19: 1. 2019. 1-14
A lot of jobs require time behind a desk on a computer. There have been many attempts at making computers more ergonomic to help prevent aches and pains that come along with being at them for extended periods of time. This video gives some ideas you can try to implement if you are stuck using a laptop that can help save you from neck strain, shoulder pain and a whole host of other things that can be just plain annoying.
Check it out.
Things It Helps:
-Neck Strain
-Anterior Shoulder Problems (rounded shoulder)
-Helping Wrist Pain
When you hurt your should via contact it often occurs at or near end ranges of motion. When we are focusing on determine return to play and contact there are several things we take a look at to ensure that it is done safely. We look at strength and the ability to try and use that force in 'functional' movement. Are we doing the best job we can though when we test people out? This article takes a
look at some new ideas.
What They Did:
This was an editorial article discussing new ideas for testing shoulder strength and max ranges of motion. The data collected and referenced is a small sample size of athletes that they testing strength on. Researchers tested force production with a plyometric push up as well as isometric contraction at end ranges of motion in flexion, scaption and abduction.
What They Found:
So far the testers are finding the the PPU and ASH test are reliable. Finding reliability means that the test is getting consistent results in finding differences in strength in affected sides vs. non-affected sides. In specific cases the ASH test and PPU test have proven very beneficial in determining if an athlete is ready to return to full participation.
What It All Means:
This is a unique way in looking at shoulder strength and how it is applied not only plyometrically but at end ranges of motion. Utilizing this information can help determine if an athlete with an injured shoulder is completely ready to return. Testing at end ranges of motion isn't something that we normally incorporate into the functional testing to determine return. Often shoulder injuries occur at the extreme end ranges of motion and without having strength and stability. Utilizing both a plyometric test and strength at the end ranges can help bring more evidence to ensure safety.
Limitations:
The authors reference this during the article but this testing is just at the beginning. They do mention the test being reliable which is great but more testing and outcome measures will be needed in order to make it a potential 'standard' in shoulder testing.
Reference:
Ashworth, B. Force awakens: a new hope for athletic shoulder testing. Br J Sports Med, 0:0.
Author Greg McKeown says the most fitting defintion of essentialism is "less but better." Basic Value Proposition: "Only once you give yourself the permission to stop trying to do it all, to stop saying yes to everyone, can you make your highest contribution towards the things that really matter."
This was an extremely interesting topic and while the episode I took it from was focused on cleaning out your life from 'to-do' lists and things that don't help propel you forward. I wanted to try and take this concept and bring it into the world of health and improving what you're looking to do moving forward.
There is one thing I'd change about the line above. "Only once you give yourself the permission to stop trying to do it all, stop stop saying yes to everyone and EVERYTHING, can you make your highest contribution towards the things that really matter." The world has too much information that and that can make it near impossible to know where to start (we realize it is iron ic as we run a blog of health information but we digress).
I think the best option when it comes to trying to focus on essentialism in your health is making sure you don't bypass the basics. A few examples:
Nutrition: Don't leap to the detoxes, energy producing vitamins, fat burning teas, etc. While these tools might have their time and place know basic caloric needs can trump all. Find a resource that allows you predict your energy expenditure (see below) so you can get an idea where you need to be on a daily basis and then begin to track what you use during the day. Wait until you start here before you add more things to remember in your day, keep it essential.
Aches and Pains: Disclaimer-if you are in that much pain you need to someone. These ideas are not for medical conditions or emergencies, more so the everyday soreness we might experience. That being said we don't know it is always necessary to rush off to the chiropractor, physical therapist or physician. Often times things like general low back soreness can be something more than soreness but the evidence doesn't support that getting a MRI is always beneficial. Often there are findings on those results that can make it seems things are extremely bad when keeping things basics can help. Start basic, start essential with mobility and soft tissue work and some rehab and see where you can get.
Find the essentials in what you need to do for health. Keep things as simple as possible for as long as possible to find the things that are most effective and don't cloud what is going on related to your health.
I've often tried to use the excuse that I just lifted too much and therefore I would never have the ability to have full shoulder range of motion. While that may be true for some individuals, I am not one of them and yet I still lack some shoulder range of motion that you never know when could come in handy. This group of exercises is a great way to get out and get an increase in your shoulder range
of motion. Try it out.
Things It Helps:
-Limited shoulder range of motion
-Anterior shoulder pain
-Tight lats.
Something to change it up and one that we tried a different version of at our house. A great flavor and based on the fact it came from 'My Fussy Eater' it appears to be kid approved and one that they won't shy away from.
Ingredients:
1/2 tbsp oil
1 medium onion, finely chopped
1 clove garlic, crushed or finely chopped
1 tsp cumin
1 tsp ground coriander
1 tsp smoked paprika
1/2 tsp mild chili powder
1 can (chopped tinned tomatoes)
800 ml vegetable or chicken stock
250g chopped cooked pork
1 can cooked kidney beans, drained
130g frozen chopped vegetables
1/2 red pepper, chopped
The Game Plan:
Heat the oil in a large saucepan and add the onions. Cook for 2-3 minutes until soft.
Add the garlic and the spices and cook for a further 1 minutes, stirring constantly.
Add the chopped tomatoes and stock. Bring to the boil and simmer for 5 minutes.
Use a stick blender to blitz the soup to make it smooth.
Add in the cooked pork, kidney beans, frozen vegetables and red pepper and simmer for 5 minutes.
Serve immediately with some grated cheddar cheese and tortilla chips for dipping.
Achilles tendinopathy is an extremely frustrating injury and one that can drag on for much longer than it needs to. There are lot of ideas on what the best treatment plan is for helping to expedite the healing process and those range from specific exercises to a full range of interventions. Platelet rich plasma (PRP) injections have been gaining popularity recently along with the utilizing trigger point dry needling (TpDN) to help stimulate healing. This study takes a look at comparing those two interventions
What They Did:
In this study researchers compared PRP injections to TpDN in the treatment of Achilles tendinopathy. The treatments were once a week for three weeks. Satisfactory outcomes at baseline, three months and six months.
What They Found:
It appears that it depends on the patient on whether PRP or TpDN helps the outcome of Achilles tendinopathy. In this study it was observed that it only works in a percentage of subjects but not everyone. When looking at satisfactory scores PRP showed slight superiority against TpDN, mainly
in younger participants.
What It All Means:
There are big time ranges when it comes to expense for getting either of theses interventions done. Typically PRP is going to be more expensive but it is hard to say with PRP due to no insurance billing codes that are currently available. Some practitioners are more expensive than others.
That being said, with the interventions not working for all patients it isn't something you have to jump to immediately to try and treat this injury. There are a lot of other things you could try to help in healing your Achilles issues. Rehab and self soft tissue work can be effective and is something worth giving a try to see if that gets you the effects that you need for improvement. We also would highly recommend at dorsal night splint. It's like 8 hours of healing while you sleep and sets you up to not have the initial shock of pain in the morning. If you aren't getting the results you want (or as fast as you want) you could definitely look into PRP and TpDN and see which ones works better for you.
Limitations:
This study was pretty good overall when looking directly at comparing these two. The rehab interventions after the second injection allowed the opportunity for more healing to occur. It is really hard to do a complete intervention as there are many other options you could use to help in the healing process but that could bring too many factors into the study.
Resource:
Abate, M. Platelet rich plasma compared to dry needling in the treatment of non-insertional Achilles tendinopathy. The Physician and Sports Medicine.
Hip mobility is something that is extremely important to us and it is what we believe a keystone to helping so many other things in the body. That could be due to pain or just to increase performance but if you regain mobility and control of your hip to add strength to it there are so many things that will improve.
Both of these guys know a thing or two about mobility as one has amazing mobility and teaches it to the masses. The other is an extremely strong guy that has gone through his share of injuries and come out for the better.
Things It Helps:
-Hip Mobility (pretty obvious)
-Low Back Pain
-Knee Pain (better mechanics)
Thursday, January 10, 2019
Ankle Mobility Background & Importance
Chances are if you're reading this you've sprained your ankle once or twice (or a "bajillion" times), so let's talk about how to assess if those previous injuries are still limiting your performance. Overall ankle mobility and stability is important (see countless athletes out every day for sprained ankles). This article will primarily focus on ankle dorsiflexion, the deemed "most functionally important" of the ankle's planes of motion. Ankle dorsiflexion (DF) or the "pulling your toes to your nose" motion is something many take for granted. In an open-chain movement, it occurs as the talus slides and rolls on the superior tibia/fibula complex. Conversely, when the foot in contacting the ground (closed-chain), DF occurs as tibia and fibula "mortise" slides anterior on the proximal talus placing stretch on the syndesmosis and high ankle ligaments that connect the tibia and fibula. Multiple injuries to these structures is 1) not uncommon and 2) can lead to a build up of scar tissue leading to a gradual decrease in joint mobility (DF). Those limited in DF may see deficits in their ability to squat deeply or properly, walk or run with a normal gait pattern, or see decreased performance in their respective activities. It may be difficult to realize that your ankle DF is decreasing while it happens, but this blog intends to help you assess your DF and treat (if needed).
Compensations:
As you may know, the ankle is part of what we call the "kinetic chain" meaning ankle movement affects motion of the hip and knee and vice versa. Therefore, the reason many don't realize their DF is limited is because of the slightest compensations through the kinetic chain. The following is a list of common compensations you should watch for: decreased knee flexion (ski-boot walking), increased foot pronation (medial foot falls in), increased forward trunk lean during squats, anterior pelvic tilt, and early heel lift during gait. Remember, the body is a complex structure with a lot of moving parts so if someone (or yourself) walks into a clinic and has increased anterior pelvic tilt, for example, it doesn't necessarily mean they, or you, have decreased ankle DF.
Measurement
To test and re-test your DF, let's work through a method that's extremely easy to do yourself:
Tools needed: a wall/vertical surface and piece of paper, tape measure/ruler, and pen OR inclinometer/iPhone
Instructions for Ruler Method:
Set up in a half-kneeling lunge with 2nd toe of front foot touching the wall (Place paper under front foot against edge of wall)
Reach your front knee towards the wall trying to not allow your front foot to pronate (or collapse) and keeping heel touching the paper/ground
Progressively move your front foot away from the wall (cm's at a time) until you can just barely reach your knee to the wall with your heel still intact with the ground (right)
Mark where your 2nd toe is on the paper and measure that distance (cm) from edge of paper
Interpretation: it is thought that <9-10 cm distance indicates limited DF, or a side-to-side difference >10% if measuring for unilateral limitations
Instructions for Inclinometer/iPhone Method:
Utilizing the same set-up as above, place inclinometer or iPhone (using the measure/level app) on the midpoint between knee cap and ankle on the bony ridge of the front of your shin
Interpretation: <35-40 degrees indicates limited DF, or side-to-side difference >10% if measuring for unilateral limitations.
So, you measure and find that you have limitations, now what?
Interventions: Stretch, Mobilize, Load
I recommend utilizing the following interventions prior to squat or lower body emphasis days during your warm-up, or if there are profound deficits 1-2x/day minimum. This routine will commonly facilitate within-session changes in DF as well as allow you to then load the joint in its newly found range of motion. These interventions will most likely benefit most if performed without shoes. Stretch: Standing Gastroc/Soleus Stretch
Perform a classic "runner's stretch" with the target ankle behind and knee straight (it may be helpful to put the toes up on a 1" platform, plate, or rolled up towel to facilitate the motion coming from the ankle- not shown in video).
Bring the target ankle closer to the body center and bend the back knee slightly to facilitate a soleus stretch (again keeping the toes on a platform- not shown in video)
I don't necessarily hold these stretches for 30 seconds, I like to do 2-3 sets of 3 contract-relax series: 5 second contraction (actively DF ankle), 10 second deep stretch, repeat 3x ea. leg
Mobilize A: Foam Roll Gastrocnemius/Soleus
I recommend spending NO MORE than 1-2 minutes per gastrocnemius/soleus complex and plantar fascia per leg. Be efficient.
I'll leave the rest to a video by Dr. Mike Reinold to show a nice little series of self-myofasical release techniques:
Mobilize B: 1/2 Kneeling Self-Mobilization with Movement:
Anchor a 1/2"-1" band behind you and assume a 1/2 kneeling lunge position with the target ankle in front.
Loop the band just below the 2 large ankle bones (malleoli) such that it stabilizes the talus. Stretch the band such that it is tight when in the 1/2 kneeling position to provide a posterior force on the ankle joint.
Maintaining heel contact and a stable foot (don't let arch collapse), drive your front knee forward in line or just outside of the foot. Avoid your knee caving in. Push the knee as far forward as possible without losing heel contact with the ground.
Perform this about 2-3 sets x 10 reps with a 2-3 second pause at end range
Notes: this may be performed with the front foot on level ground or on a 6-12" box/platform to increase the angle of pull of the band or placing a weight on the front knee to add a compressive load to the ankle (shown in videos above). If at anytime you feel a pinching sensation at the front of the ankle, make sure to back off the range of motion; i.e. don't try to push through this pain as it may indicate an anterior impingement injury. If struggling to maintain correct foot posture, here's a link to a video that Dr. John Rusin has provided to help:
Load: Goblet Squat Self-Mobilization with Movement
Keeping the band anchored behind you and looped below the two malleolin of the target ankle, step away such that the band is tight and your feet are even and shoulder width apart
Hold a moderately heavy dumbbell or kettlebell in the goblet position and perform squats with a good upright posture
Perform this about 2-3 sets x 8-10 reps
Putting It To Use:
I like to perform this circuit prior to squat or lower body lifting days in an Every Minute On the Minute (EMOM) style so that I am consistent, efficient, and don't take too much time during my warm up. What this means is that at the start of the 4 or 8 minute time period I'll do the stretches, start of the 2nd minute I'll foam roll, 3rd minute is 1/2 kneeling mobilization, 4th minute is loading and then repeat if I'm feeling extra tight for a second set. Rest during the time between an exercise ending and prior to the next minute starting.
Test-Retest: Be sure to use the measurement test before and after this mobility routine and track these changes over time. You should see immediate changes after completing these exercises as well as gradual long-term changes over time if you consistently perform this circuit.
Other Resources:
Here is a video from Squat University that does a nice job of putting this together with a few different twists of their own:
If you're looking to change up your style for dinner this weekend or having something different for lunch this could be what you're looking for. A Greek inspired dish with spaghetti squash to fill you up along with a great combination of vegetables and peas to help fill you up and fuel your day. Check it out.
Ingredients:
1 tsp olive oil
1/4 cup thinly sliced red onion
1/2 tsp minced garlic
1/3 cup unsalted chickpeas, rinsed and drained
1/2 tsp chopped fresh thyme
6 cherry tomatoes, halved
1 1/2 cups Easy Baked Spaghetti Squash
1 cup baby spinach, torn
Dash of salt
2 tbsp crumbled feta cheese
The Game Plan:
Heat oil in a medium skillet over medium-high. Add onion and garlic; sauce 4 minutes.
Add chickpeas, thyme, and tomatoes; cook 1 minute.
Add spaghetti squash, spinach, and salt; toss gently to combine.
"If you see fraud and do not say fraud, you are a fraud.”-Nassim Taleb
Now that is how you start an article. I'm not going to go so far as to just sit down and list out some suspect, even questionable practices...but we are going to talk about some ways to avoid falling victim to them.
Things that could make someone a "fraud":
Their thing is the ONLY thing. No need for anything else.
Only selling 'stuff' and you HAVE to buy certain things.
They can fix ANYTHING
Nothing to back it up (education, research, or continued learning)
Even people in the health and fitness industry have to make a living so at some point you are going to have to pay them some money. There isn't anything inherently wrong with this but there are some things to look out for. If all they are doing is selling you on something you have to have and if you don't add it to your life you won't have success. HUGE Red Flag. Anything that is only financially incentivized is something you need to stay away from.
Also be leery of someone can fix any and every problem with a specific type of treatment or specialized technique. If that were truly the case they would be world famous, see 6 people a week and you and I probably wouldn't have access to them. There are a lot of great practitioners out there but no one can treat everybody and fix everything. Things are too complex and people are too individual. If they follow it up with you HAVE to come back over and over to keep the progress, be careful on just looking for a quick fix.
With all of these things you have to find people that have the information and knowledge to back it up. While traditionally that comes with college and higher education it doesn't have to. Years of experience, research and knowledge gathering along with critical thinking can be sufficient but you have to do your due diligence. Ask a lot of question, get informed on your own and you can always ask them what they would do if they were in your situation to get a better feel.
Be careful out there for frauds, while I don't want to start throwing around names (yet) I am happy to give input if you have questions (free of charge of course).
While shoulder pain while you're sleeping and/or lifting doesn't seem like it would have a lot in common you'd be surprised at how much the differing mechanisms can cause the same amount of pain. This video gives you a break down of what you can do in order to help relieve some shoulder tightness and pain. Give them a try.
We don't feature seafood often enough in our Friday Food so we wanted to make sure we got back to it. Here is a simple shrimp recipe that would taste great with you favorite greens to accompany it or with a fluffy bed of rice. Enjoy this one.
Ingredients:
1 tbsp olive oil
1 pound large shrimp (peeled and deveined)
1 tsp minced garlic
1/4 - 1/2 tsp red pepper flakes depends on your heat preference
1 tsp lemon zest
1 tbsp lemon juice
2 tbsp parsley or cilantro chopped
Salt and pepper to taste
The Game Plan:
Heat the olive oil in a large skillet over high heat.
Season the shrimp with salt and pepper to taste.
Add the shrimp and cook for 3 minutes or until shrimp are pink and opaque.
Stir in the garlic, red pepper flakes and lemon zest; cook for 1-2 minutes more.
Hamstring injuries are tough to deal with and the rehab process can be very frustrating. Anytime an intervention appears to have a positive effect on the rehabilitation outcome it is worth taking a look at and seeing if there are any areas you could apply it to your treatment and rehabilitation plan.
What They Did:
Researchers randomly assigned 37 elite athletes with an acute grade I or II hamstring strain to either a cryotherapy group or a cryostretching group. Each group received 5 sessions of supervised treatment pulse home-based intervention.
What They Found:
The objectives that the researchers looked at with the treatments were changes in pain, active and passive knee extension range of motion, along with functional status. What the researchers found was that compared to cryotherapy, cryostretching (cryotherapy followed by stretching) resulted in larger improvement of function and passive knee extension range of motion. They also found that active knee extension and pain severity were not significantly different between the two groups.
What It All Means:
Before we get into our personal take on everything this study does show that adding some stretching into the rehab protocol can help improve functional outcomes and passive knee range of motion.
We agree with adding some stretching into the rehab protocol when it comes to hamstring injury is a good idea but the hard part is trying to figure out when to add it in. We generally don't agree with adding cryotherapy to the injury process, outside of some contusion injuries, as we can't figure out when and how it makes a big difference when it comes to aiding the healing process. Movement we believe is key to start off the rehabilitation process. You need movement that is pain free but this helps you jump start your bodies process of healing.
Limitations:
There aren't a lot of limitations with this one because it is a direct comparison of two interventions. Really the biggest things figuring out where this fits in your treatment and rehabilitation plan. Again we think movement is key early and often and figuring out where to add stretching in.
Resource: Sefidashti, L. The effects of cryotherapy vs cryostretching on clinical and functional outcomes in athletes with acute hamstring strain. Journal of Bodywork & Movement Therapies.
Ingredients:
of motion. Try it out.
Chances are if you're reading this you've sprained your ankle once or twice (or a "bajillion" times), so let's talk about how to assess if those previous injuries are still limiting your performance. Overall ankle mobility and stability is important (see countless athletes out every day for sprained ankles). This article will primarily focus on ankle dorsiflexion, the deemed "most functionally important" of the ankle's planes of motion. Ankle dorsiflexion (DF) or the "pulling your toes to your nose" motion is something many take for granted. In an open-chain movement, it occurs as the talus slides and rolls on the superior tibia/fibula complex. Conversely, when the foot in contacting the ground (closed-chain), DF occurs as tibia and fibula "mortise" slides anterior on the proximal talus placing stretch on the syndesmosis and high ankle ligaments that connect the tibia and fibula. Multiple injuries to these structures is 1) not uncommon and 2) can lead to a build up of scar tissue leading to a gradual decrease in joint mobility (DF). Those limited in DF may see deficits in their ability to squat deeply or properly, walk or run with a normal gait pattern, or see decreased performance in their respective activities. It may be difficult to realize that your ankle DF is decreasing while it happens, but this blog intends to help you assess your DF and treat (if needed).
