💥FOOT PRONATION and RUNNING INJURIES💥
✅Foot pronation is NOT an Injury Risk Factor for Novice Runners 🏃🏼 wearing a neutral shoe! We always hear patients in Clinic say ‘I think I have really flat feet’. But if there is no foot pain, does it matter?
Great post by @rehabscience reminding me of a great study a couple years ago:
▫️N = 927 novice runners (1854 feet)
▫️Baseline: foot posture on each foot was evaluated using the foot-posture index and categorised into:
1) highly supinated (n=53)
2) supinated (n=369)
3) neutral (n=1292)
4) pronated (n=122)
5) highly pronated (n=18)
▫️Participants then ran in a neutral running shoe without replacing the insole they were provided and used GPS to track running distances over a 1-year period.
✨ NO DIFFERENCE IN INJURY RATES BETWEEN ALL FOOT POSTURE TYPES!
✔️This study really questions the notion and importance of foot pronation as a strong predictor of injury among novice runners in a neutral shoe.
👟 Having a comfortable shoe may be a more relevant factor for healthy persons trying to choose a running shoe.
📚Nielsen RO, et al. Foot pronation is not associated with increased injury risk in novice runners. Br J Sports Med. 2014.
⛹️♂️Knee Pain in Jumping Sports
🗣’I think I have Jumper’s Knee Doc’...a common phrase I hear in clinic. Especially with the high-profile Kawhi Leonard Injury in basketball, everyone is more aware of this overuse type of knee pain. But did you know there are different types? :
🔻Quadriceps Tendon Pain
🔻Patellar Tendon Pain
🌌Quad Tendon pain is generally less common, but typically presents above the knee-cap after a lot of exercise, after a long period of rest (like the off-season). It’s frustrating to clients and teams because it won’t hurt at rest, but then will flare-up mid-activity 💢and be unbearable
🌠We’ll see the quad tendon variant more with:
🔹Sports needing a lot of knee flexion (basketball, skiing)
🔹Patients with diabetes or metabolic problems
➡️ Rest and Ice rarely solves the problem,
It takes a lot to be successful in a health practice. We believe in the 3️⃣A's. I think it applies to a lot of health careers:
🔴Ability - this is obvious. You need to always strive for the highest level of skill and service in your profession. Never be complacent, always be learning
🔴Affability - aka 'Like-ability'. This is frequently lost with professionals. It doesn't mean being a 'friend', but being respectful, empathetic, and generally in a good mood. Clients can divulge a lot of crucial information on their case if they feel more open to communication. If you bring your own personal problems to the job no one will want your service.
🔴Availability - the most underrated. We all want vacations, normal working hours. But if you can't make small sacrifices: working a Saturday once in a while, working late once per week...you're under-serving the clients who can't make it 'normal times'.
♨️ LOW BACK REHAB - Dead-Bug Exercise Variations
⚠️The ‘Dead bug’ exercise is one of my favourite foundational exercises for core control and stability. The whole idea is to maintain a neutral spine (maintain contact between back and floor) while moving your arms and legs at the same time. The basic version can get easy so try these tougher variations….
1️⃣Banded Dead-Bug (attached to rig or sturdy object)
2️⃣Weighted Dead-Bug (10lbs overhead)
3️⃣Single Arm Weight Dead-Bug (Challenges Oblique Sling)
4️⃣CLX Band Resisted Dead-Bug
➡️Some of these variations challenge your rotational control, and others challenge you with more weight into extension. Try them out, as always consult someone first if you have low back pain!
🏃🏽♀️FIX YOUR RUNNING TECHNIQUE (Shin Angle)
📽Recently had an awesome time helping out my friend with her Youtube VLOG ‘How to Start Running’. Check this out ASAP on ‘Abby Pollock Youtube’. In the interview we go over some of the top technique tips if you want to take up running. Video is complete with biomechanics and drone footage 😵,
☝️One of the most important technique cues is the angle of shin(tibia) on impact with the ground 💥
When we run it's all about an efficient conversion ↔️of energy from each step to the next, with our muscles and tissues acting as springs.
❌When we land with an Angled ↙️Tibia, like the left picture, our shin bone and anterior leg muscles have to dissipate up to 3x our body weight. EVERY STEP.
✅When we land with a more vertical ⬇️Tibia like on the right. We more efficiently convert this energy to our posterior leg muscles, thus propelling us ⚡️forward.
💡This simple change will likely decrease Shin Splints and anterior compartment syndrome. It also can decrease your run times. Personally I've found this more clinically significant than the age old debate 'heel vs forefoot strike'
To Help Cue this change:
🔻Increase your running cadence
🔻Run like you are 'falling forward'
🔻Don't 'over-stride' each step
♨️ LOW BACK PAIN BASICS
To give you an idea of how to think of low back pain (LBP)..when someone comes into clinic we go through a basic process:
1️⃣Red Flags - is it actually LBP (not kidney stones, etc.)
2️⃣Is it Disc/Nerve related - are there signs of muscle shrink, weakness, tingling
3️⃣What direction of movement are they intolerant? (Flexion, extension, rotation)?
✅After 5 years of practice I found the EXACT source of pain doesn’t always matter. As long as it’s nothing major like fracture, severe neurological deficit, etc.
❇️What’s more important is their functional deficit. Ex: they can’t lift (flexion based), it hurts to swing a baseball bat (rotation), it hurts after tying their shoe (extension).
⏩From here we can now plan our attack of rehab 😏
📝If you’ve had low back pain, and we know 90% of you have….what direction sets it off?
🏋SQUATS and DEADLIFT Differences
If you're a workout junkie, can you answer this in 5 seconds? 🕑 To clearly answer is harder than you think 🤔. If you do these exercises all the time, you simply know how to do them. But what's the REAL difference?
Only a few years ago we would say, that's easy: a deadlift is with weight in hand 👋, and squats are with weight on shoulders 👤. But now it's complicated with gyms having equipment like:
For example, if you're doing a 'split squat' holding a kettle bell off the ground, isn't that a 'deadlift'?? 😏Tricky I know.
Now in recent times I like to move away from those 2 terms to the following:
🔴KNEE DOMINANT PATTERN (deep movement of knees AND hips)
🔵HIP DOMINANT PATTERN (deep hip movement with minimal ⬇️ knee bend)
✅So in simple terms: traditionally defined its 'weight off ground vs weight held high'. Newer definition it's 'hip vs knee dominant'. As always it's not about what an exercise is called, but the intent of the individual doing it.
🏋How Bar Placement Affects Your Squat
It's all about ✅ pros and ❌cons. There is no right or wrong place for the barbell when you squat. Just as there is no 'ideal' human body. Where you hold the barbell in a squat will load joints differently. Are you weightlifting for competition 🏋️♀️, or do you just want to squat with limited pain after an injury? These questions dictate where you hold the bar.
🔴High Bar - this has you place the barbell above the 'spine' of the scapula. It uses part of the traps to cushion the bar. You can see the torso angle from hips to bar is more vertical. This will give less leverage to the hips (yellow line) so it can be a better lifters with: 🔺Low back pain
✳️Low Bar - this has you slightly retract your shoulder blades to provide a shelf for the barbell around the spine of the scapula. Notice the torso angle is a lot less. The knees have a lot less leverage (blue line). And the bar won't put as much weight near the neck. This can be better for lifters with
🔺Poor Ankle Mobility
As my colleague described yesterday at our lifting workshop, the better leverage through your hips with low-bar technique allows you to lift heavier (as the hip as more powerful surrounding muscles). But for certain body types high-bar technique may feel better👍
🔷SHOULDER BLADE Breakdown
Ok so the title is misleading, the scapula doesn't function as an 'anchor' ⚓️. But its crucial to healthy glenohumeral joint motion, especially in throwing ⚾️⚡️ activities. It needs to have a balance of mobility and control due to its over SEVENTEEN muscle attachments.
It's such an important hub for the upper-extremity, because imbalances ⚖️can affect joints farther away. For example imbalance of neck muscles attaching to the scapula can affect farther down to shoulder and elbow 😵
The main movements of the scapula are:
Because of sedentary lifestyle, the last 3 functions are usually in overdrive ⚡️. This has big consequences for the rotator cuff. In overhead motions the scapula should be able to upwardly rotate ⤴️and clear space for the supraspinatus muscle. For a lot of people it doesn't, hence commons activities can irritate the rotator cuff long term:
🔻Overhead Bar Press
✊How Grip Width Changes Your Bench Press
Earlier this week I was getting some bench press tips because of some ongoing wrist pain I have (yes I get pain too 😅). I thought some of these tips were good to pass along ➡️
Like my posts about squats, there's no right ✅ or wrong ❌width for your bench press. But it depends on your goals, and it depends on past history of pain ♨️. So what changes when you bench with wide grip vs narrow grip?
🔷Wide Grip: Anterior Deltoids, Serratus Anterior, Coracobrachialis are all very active. More activity of the the clavicular (upper) fibers of Pec Major are found. If you have a past history of wrist pain💥this grip may be more comfortable, as it prevents excess Ulnar deviation of the wrist ⤵️
🔶Close Grip: Pectoralis Major is more active in its Sternocostal (middle) and Lower fibers. Triceps activity is higher, especially if the elbows flare out from the body. If you have past injuries to the AC Joint (shoulder separations) this grip will be more comfortable. This is because the lever ⚖️of the barbell is closer to the body, applying less shearing force to the AC joint.
Ref1: Strength and Conditioning Research
Ref2: Journal of Strength and Conditioning
Milner Chiropractic and Sports Injury Clinic