How To Properly Warm Up Before You Run

Dynamic Running Warm-Up

If you are like some runners you prepare for your run by quickly bending over, touching your toes, then standing up and grabbing your foot behind your low back.  If you are like MOST runners, you don't even do that!  In place of a long-winded stance on why you should warm up and research showing that warming-up before exercise not only prevents injury but improves performance (1), we are just going to cover the bases of a great running warm up through our Bands, Balance, & Bounce Running Warm Up.

BANDS

  • Clamshell
  • Glute Bridge
  • Band Walks
  • Low Row

 

 


BALANCE

  • Plank
  • Dead Bug
  • Bird Dog
  • Single Leg Stance
  • Leg Swing

 


BOUNCE

  • Iron Cross
  • Scorpion
  • Mountain Climbers
  • Plank Twists
  • Butt Kickers
  • High Knees
  • A-Skips
  • Side Shuffle
  • Carioca
  • Reverse Shuffle Butt Kicker
 

Dr. Reheisse is a Board Certified Chiropractic Sports Physician practicing in Cottonwood Heights Utah. Revive Sport & Spine provides evidence-supported chiropractic care and conservative sports injury management.

(1) Fradkin, Zazryn, Smoliga.  Effects of Warming-Up on Physical Performance: A Systematic Review With Meta-analysis.  The Journal of Strength & Conditioning Research. January 2010.  

R.I.C.E may have been A-L.I.E.

If you have ever rolled an ankle, pulled a hamstring, or thrown a ball too hard a few too many times you have probably heard of and used RICE.  You remember...

Rest, Ice, Compression, and Elevation.  

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RICE was coined by Dr. Gabe Mirkin MD back in 1978 when it was first printed in ‘The Sports Medicine Book’.  Since then, it has been the gold standard of care for just about every mild to moderate sports, and non-sports, injury…...despite the mountain of evidence against ice and complete rest.  

Before we dive in, I will state that I am not totally against ice.  In the acute phase of an injury it can aid in inflammation control...note I did not say complete elimination of inflammation, and can also help with pain control.  What I will come out against is complete rest.  We have evidence that continued cardiovascular effort speeds healing, training of the contralateral (other side) decreases recovery time, and continued activity in some way or another keeps our mind positive and focused on recovery.  

Back to the topic of RICE.  While many upon MANY of physicians, chiropractors, physical therapists, and athletic trainers still suggest RICE for an injury to this day, those of us who are progressive in our care methods, who look for safer, more effective ways to speed recovery have been pushing back for years.  But, what does the creator have to say?

When I wrote my best-selling Sportsmedicine Book in 1978, I coined the term RICE (Rest, Ice, Compression,Elevation) for the treatment of athletic injuries. Ice has been a standard treatment for injuries and sore muscles because it helps to relieve pain caused by injured tissue. Coaches have used my “RICE” guideline for decades, but now it appears that both Ice and complete Rest may delay healing, instead of helping.
— Why Ice Delays Recovery - March 20, 2014 by Gabe Mirkin, MD

Before we go on, let's just address inflammation.  Before you start popping NSAIDs day and night, know that inflammation is a natural process of the body to heal damaged tissues.  Within inflammation are cells specifically designed with specific roles to clean up damaged tissue and accelerate repair.  This could be its own LENGTHY post but for our purposes, NSAIDs block the pathway for these cells to do their job and should be used with caution, combine that with too much ice and complete rest and we have a perfect storm for mobility restriction and delayed healing.

So...what do you do with a strain/sprain injury?  Ideally, if you are unsure of the severity, have it checked out.  If we have no breaks, major tears, and have ligament integrity and joint stability, now is the time to stay active...to some extent.  

After years of research, RICE may have been.... A-LIE.    

SUGGESTIONS:

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  • ACTIVE REST:  If you are injured, rest for up to 24 hours is acceptable.  After that, complete rest becomes detrimental.  Under the guidance of a trained sports-medicine professional, activities such as joint range of motion, tissues stretching/flexibility, and tissues LOADing are necessary to speed healing.  While we remain active, the rest component comes from decreased volume and/or intensity.
  • LOAD:  What do we mean by load?  Tissue (muscles, ligaments, tendons) and bone respond to load.  In a less extreme version of ‘what doesn’t kill you makes you stronger’ sort of way, what are you preparing your body for?  If you are a runner, we need to get back to running, in some way, shape, or form...quickly.  This allows your tissues to understand the LOAD it will encounter and that it needs to grow, adapt, and strengthen.  
  • ICE:  Icing an injured area causes the blood vessels to constrict, decreasing the amount of blood that can travel to an area, in turn, decreasing the amount of inflammation and healing cells as well.  While using ice is almost cult-like in a locker-room, it would be wise to limit its use to 10 minutes at a time and, only repeating 2-3 times after an injury.
  • EXERCISE:  Lastly, general exercise helps us stay positive, stay focused, maintain our routine, and most importantly, help speed recovery.  Cardiovascular exercise can help maintain your fitness base, decrease strength loss, and a host of other benefits that keep us on the right track during an injury.  
Dr. Reheisse is a Board Certified Chiropractic Sports Physician practicing in Cottonwood Heights Utah. Revive Sport & Spine provides evidence-supported chiropractic care and conservative sports injury management.

Running Into The Ages

There are many myths about the effects of running on your body as we age, some positive, some negative, many rooted in hearsay.  Most of the negative remarks we hear about running as we age often come from ‘non-runners’ - but do their comments have validity?  I want to take a look at a few concerns and address what current literature has to say, give some suggestion on training, and just help you continue running... because any way you look at it, healthy and safe running is a fantastic way to maintain strength, mobility, and quality of life to age successfully!

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Of the over 25+ million runners, 40% of all fall into the ‘Master’s’ category, or those over 40, with many more over 50 runners taking up running every year.  As we age, our function, flexibility, and ability to withstand stress change and these considerations is where we need to focus our attention to stay healthy and prevent injury. 

 

THE MOST COMMON MYTH

Let me know if you have heard this one... Running is BAD for your knees, don't do it!

We have all had one person or another say to us, ‘oh, running!  That’s is bad for your knees, it will cause arthritis!”  Really?  According to numerous studies published in the American Journal of Sports Medicine and the Journal of Orthopedics and Sports Physical Therapy, running does NOT increase the incidence of osteoarthritis (OA).  On the contrary, we now have evidence of higher rates of knee osteoarthritis in the sedentary population.  Likewise, we have seen recently that long-term (10-20 years) of high mileage running (ambiguous but let's say 50-75, up to 100 miles per week) has been associated with increased ‘wear & tear’ or osteoarthritis...but, BUT, current data is limited in this area.  I will say that this is likely as there is a small population of runners who have been charting high mileage for decades, many of which I have interacted with...some have knee/hip/ankle pain, some do not.  Take it for what it is but running is better than not! 

 

Just with any activity, running has risks related to overtraining, new to training, and accidents.  While we know that running does not necessarily contribute to arthritis progression, we do have more common risks in the aging population.  If you can envision yourself in 20 years, what do you think your mobility, strength, and speed will look like?  If we are honest and familiar with the aging process, they all appear decreased.  This poses a few problems as we run into our later years.  As we age, our muscles and joints stiffen.  This stiffness leads to a more ‘shuffle-like’ gait that has a decreased ability to absorb and attenuate or displace shock forces, basically how the ground fights back as we pound the pavement.  This increased absorption of forces coupled with a mileage or intensity increase can cause a spike in stress fracture risk.  

...Running is not associated with accelerated radiographic OA
— Chakavarte et al (2008)
 

While injuries are a real risk, often inevitable, measures to prevent should be one of the first and last things you do.  Time must be given to the practices of warming up, cooling down, stretching, and strength training.  Here, I want to share 3 very easy items you can add to your routine that can help reduce injury risk while improving your ability and enjoyment of running.  

WARM-UP ROUTINE

Warming up is the best way to prepare your tissues and joints for the rigors of running and protect yourself from injury.

 

 

 

FOAM ROLLING

Foam rolling is a safe, somewhat comfortable, and very effective means to decrease muscle tightness without putting excess tension and stress through the tendon and attachment points. 

 

 

SINGLE LEG WORK & BALANCE

One way to help prevent injury and fall risk is to improve balance and reaction time.  This doesn't just include footwear type, this must include training, focus, core strength, etc.  

 

Just with other runner’s, progression rates must be addressed in the aging runner.  With the decrease in adaptation ability of an older runner, a few items may be different.  We have all been told to increase no more than 10% in volume from week to week, to decrease mileage every 4 weeks by 25% to allow recovery, that we should strength train, cross train, and eat, hydrate, and sleep adequately.  This is all still true...but the one point I want to address and end with is RECOVERY.  Whether it is sleep, cross training, foam rolling, etc.,  recovery needs MORE focus in the aging runner.  I truly believe that we slow down as we age, not mainly because of our ability, but due to our ability and speed of recovery.  Taking your recovery and injury prevention measures seriously can greatly advance your running and racing abilities!  

REVIEW: 

There are risks associated with any sport, running is no different. Current research demonstrates that the cardiovascular, muscle, bone, and joint benefits of running, far outweigh the risks.  

Dr. Reheisse is a Board Certified Chiropractic Sports Physician practicing in Cottonwood Heights Utah. Revive Sport & Spine provides evidence-supported chiropractic care and conservative sports injury management.

How 'The Big 3' Can Decrease Low Back Pain and Make You Stronger & Faster

If you are among the estimated 50% of all athletes who experience recurrent low back pain, don’t stress, there are exercises that can help…and a couple you should probably avoid.

Our ‘core’ is the link between our upper and lower bodies, and mastery of control here is the secret to improved strength, running efficiency, faster speed, and overall health and athleticism. In regards to back pain, our core needs to be solid to not only support a stable spine but provide for proper biomechanics when running, throwing, squatting, swimming, and even just walking.

From an anatomical perspective, our core is made up of the rectus abdominis, transversus abdominis, internal and external obliques, quadratus lumborum, glutes, and internally, the diaphragm and pelvic floor muscle. The goal of these muscles is not only to be strong but to provide a stable platform for our spine through any and all movements. Stability here has a dramatic impact on injury risk and should be a focal point in any sport and health training plan.

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Lets use the example of a runner as the majority of our patient population are runners and almost every sport requires it. A strong core, one with ample endurance, allows for proper movement through our hips, legs, and upper body without excess expenditure of energy. If we are weak here, the late stages of a long run or race become challenging injury risk increase. As the core fatigues, the hips begin to dip, causing extension through the low back, excessive strain on the hamstrings, inward rotation of the femur causing excessive rotation of the tibia that can lead to excessive strain of the ligaments of the knee. This can travel down the chain and lead to poor pronation control causing shin splints, Achilles strains and plantar foot pain…you see where we are going here. Simply put, the core needs to function properly, or the whole system fails.

Most people understand parts of this and that core strength is important, but we still find people who lie on the floor, knock out 100 crunches, call it a day and then wonder why their low back hurts the next day. For this reason, I do not recommend sit-ups or crunches. These two exercises cause undue strain on the low back through repetitive flexion that stresses the discs, joints, and muscles of the lumbar spine.

While many finds these exercises easy to perform, and a staple in their routine, I want to introduce you to a more effective core routine. One that focuses on proper back support and overall functionality as an athlete, regardless of sport. These 3 exercises, termed ‘The Big 3’ were developed by Prof. Stuart McGill, rigorously studied, and proven to protect your back and improve core endurance.

The big 3 are made up of the Modified Curl-Up, Bird Dog, and Side Bridge.

1. Modified Curl-Up

McGill Curl - Up. Low Back Pain Relief Utah.

McGill Curl - Up. Low Back Pain Relief Utah.

Lying on your back, place one leg flat on the floor with the other bent. This position allows for a neutral pelvis during the movement and puts your core muscles in control of the movement without undue strain on the low back. Place your hands under the small of your low back to ensure a normal arch is maintained during the movement. Begin by bearing down to brace your abdomen, continue a normal breathing pattern throughout. If you have difficulty maintaining the brace while breathing, this is where you start. Now, pretend your neck, upper back, and low back are locked together and cannot move independent of one another (straight line from head to pelvis), slowly, lift your shoulders blades off the floor and return to the floor in a smooth pattern, only coming off the ground a couple inches. Take note of your posture, did your chin stick out, did your shoulders round forward from memories of doing endless crunches? Work through 2–3 sets of 10–15, slow and controlled.

2. Bird Dog

Bird Dog Ex. for Low Back Pain

Bird Dog Ex. for Low Back Pain

Begin in a quadruped position with hands under shoulders and knees under hips, both about shoulder-width apart. Brace your abdominals while maintaining a neutral (straight) spine. While maintaining this posture, breath in and out, squeeze your glutes and begin moving your right arm up to a point position while also bringing your left leg to a straight position. Our goal here is to avoid rotation through the spine, maintain our posture and keeping the hips in line. Slowly return to the starting position and then perform with the opposite arm and leg. That is one repetition, perform 3 sets 10–15.

3. Side Bridge

Side Bridge - Core Stability

Side Bridge - Core Stability

Lying on your side, prop yourself up on your elbow, hinge at the hips, and stack your knees on top of each other with a 90 degree bend. Maintaining a solid shoulder directly over the elbow on the ground, lift your hips up and push them forward, bringing your spine to a neutral position. Hold for a 5 count and then slowly return to the starting position. Be aware of head posture and hip extension, maintain a straight line from the head to the pelvis. Perform 3 sets of 10–15 on each side, holding each for a 5 count at the top.

Obviously, there are numerous other exercises that provide stability for the spine while strengthening the core, this is just a starting point. Focus and repetition will bring proficiency, and proficiency will bring improved performance! If you have any questions, please ask, I’m happy to answer what I can.

Until next time, train hard, train smart, and recover well.


Source: McGill, S. (2002). Low Back Disorders: Evidence Based Prevention and Rehabilitation. (2nd Ed).

Dr. Reheisse is a Board Certified Chiropractic Sports Physician practicing in Cottonwood Heights Utah. Revive Sport & Spine provides evidence-supported chiropractic care and conservative sports injury management.

7 Things You Need To Know About Dry Needling

The more we study dry needling, the more we understand its benefit and expand its use in the treatment of musculoskeletal injuries.  Addressing everything from low back pain, migraines, and sports injuries; dry needling proves beneficial in the most common muscle, tendon, ligament, and joint issues seen in a physician's office.  

As more practitioners utilize this technique, it is important to know the basics about dry needling, what to expect from treatment, and what conditions can benefit from this therapy.  Below are seven important items to understand when seeking treatment.  

1. WHAT IS DRY NEEDLING?

Dry needling is a skilled technique performed by trained Chiropractic Physicians and Physical Therapists aimed at managing neuromusculoskeletal injuries and pain while addressing movement dysfunction.  Dry Needling utilizes a thin filiform needle to penetrate the skin, fascia, and muscles to address adhesions, trigger points, and connective tissue.  This speeds healing and relieves pain by decreasing muscle hypertonicity, increasing joint range of motion, and correcting movement dysfunction through releasing a trigger point adhesion.

2. DRY NEEDLING IS NOT ACUPUNCTURE. 

Acupuncture is an ancient traditional Chinese technique that utilizes the knowledge of meridians.  This focus allows an acupuncturist to work on a person's inner balance, energy, qi, and one's life-force.  Work up and exam includes physical, tongue, and pulse examination.  Traditional acupuncture has been widely studied and practiced for thousands of years.

Dry needling relies on the practitioners expanded knowledge of skeletal and neuroanatomy.  This knowledge allows one to identify damaged and sensitive tissues, taut bands, and trigger points as well as injured and overused tissues.  Dry needle practitioners utilize an extensive examination that includes movement analysis, orthopedic evaluation, and a neurological workup that includes myotomal and dermatomal testing.

3.  WHAT IS A TRIGGER POINT?

A trigger point is a spot of muscle/fascia that is hypersensitive, painful when compressed, composed of a taut muscular/fascial bands that restrict oxygenated blood flow, and can refer pain and tenderness while causing motor dysfunction.  According to a recent article in Current Pain and Headache Reports, muscle overtraining or direct trauma to the muscle can lead to the development of trigger points. Trigger points may develop during occupational, recreational or sports activities when muscle use exceeds the muscles capacity to handle stress, disturbing normal recovery.  Dry needling differs from other types of therapy because it focuses on stimulating these trigger points and releasing the tension in order to alleviate pain.

4. WHAT IS A TWITCH RESPONSE

The twitch response is a localized, reflexive response of a dysfunctional area of muscle to palpation, or in our case, a dry needle.  When needling a trigger point, this is one of our goals as it leads to a rapid release of a taut muscle band, decreasing tightness and sensitivity of the surrounding area.  A tight muscle or one with a trigger point will feel an achy discomfort with an occasional twitching or cramping sensation. This twitch response returns the muscle to a normal state by releasing inflammatory chemicals from the trigger point and restoring blood flow to the area.  According to a recent study in the Journal of Orthopaedic & Sports Physical Therapy, The twitch may be a sign that the treatment will be successful.  A local twitch response is a spinal cord reflex that creates an involuntary contraction that can be triggered by a snapping palpitation or penetration with a needle.  When the patient has an involuntary twitch response, that suggests that the needle has hit the right spot.

5. IS DRY NEEDLING THERAPY PAINFUL? 

Dry Needling utilizes a thin filiform needle to penetrate skin, fascia and muscles to address adhesions, trigger points and connective tissue to speed healing and relieve pain.  Often, patients will experience a mild, dull ache during treatment and up to 24 hours post treatment.  Some discomfort is experienced during the rapid ‘twitch response’ but this discomfort is minimal and last only a few seconds.   It is normal to have mild to moderate muscle soreness after dry needling treatment.  Drinking lots of water, stretching, moving your body and heating the sore muscles can reduce the duration of the soreness.  Side effects include mild muscle soreness and bruising in some patients.

6. CONDITIONS COMMON TREATED WITH DRY NEEDLING. 

  • Headaches
  • Neck Pain
  • Low Back Pain
  • Knee Pain (Osteoarthritis)
  • Shoulder Dysfunction (adhesive capsulitis, impingement, rotator cuff strain)
  • Tennis & Thrower's Elbow
  • Carpal Tunnel Syndrome
  • Hip Pain
  • IT Band Syndrome
  • Patellofemoral Pain Syndrome (Runner's Knee)
  • Medial Tibial Stress Syndrome (Shin Splints)
  • Achilles Tendinopathy
  • Plantar Fasciitis
  • Ankle Sprains
  • Muscle Strains

7.  WHAT DOES CURRENT LITERATURE SAY & WHO CAN BENEFIT?

Dry Needling is an extremely effective treatment for acute and chronic pain, decreased flexibility, joint dysfunction, and recovery from physical activity and competition.  Patients who undergo dry needling therapy experience less pain quickly, with most finding relief after their first treatment. According to reports published by the Journal of Orthopaedic & Sports Physical Therapy, patient function is restored much more quickly when dry needling is incorporated as part of the care plan.

Chronic upper-quarter (neck/upper back/shoulder) headaches and spinal movement dysfunction have all been associated with myofascial pain syndrome (trigger points).  Kietrys et. al. published a meta-analysis on the effectiveness of dry needling on this syndrome.  Based on their research and findings, they recommend dry needling as an effective option for treatment of upper quarter myofascial pain syndrome.  They found that pain measures decreased for most patients immediately after treatment and at the four week follow-up meeting.  - Effectiveness of Dry Needling for Upper-Quadrant Myofascial Pain: A Systematic Review and Meta-analysis. http://www.jospt.org/doi/pdf/10.2519/jospt.2013.4668.   

A 2015 study looking at ankle sprain rehabilitation found that adding trigger point dry needling, of the lateral lower leg peroneus muscle, to a rehabilitation plan of proprioceptive/strength exercise the four weeks following an acute lateral ankle sprain, had greater improvements in function and pain than the controlled group of just exercise.  - Trigger Point Dry Needling and Proprioceptive Exercises for the Management of Chronic Ankle Instability: A Randomized Clinical Trial.  http://dx.doi.org/10.1155/2015/790209

It is normal to take several dry needling therapy sessions before the muscle is fully functional again. This is because trigger points are located under deep layers of muscles, so it typically takes several sessions for the changes to take full effect. But patients will usually notice the difference right after each treatment.