THOUGHTS ON:
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5 Areas To Develop Great Habits That Will Improve Your Health
With the continuation and exacerbated condition of the COVID-19 pandemic, this might be a challenging question to answer. You may feel physically well. Heck, you may even be one of the strong ones, unphased by the "stay home" orders and are socially and mentally doing well also.
Regardless of how you respond to the initial question, I have one response for you.
It is April 5th, 2020, and I have one question for you.
How are you?
With the continuation and exacerbated condition of the COVID-19 pandemic, this might be a challenging question to answer. You may feel physically well. Heck, you may even be one of the strong ones, unphased by the "stay home" orders and are socially and mentally doing well also.
Regardless of how you respond to the initial question, I have one response for you.
Developing healthy habits I hope!
Like every other email, letter, and news article I have read lately, let me start by saying that I genuinely hope that you are safe, well, and maintaining some sort of routine that allows some hint of normalcy.
Now that we have handled the essential "well-being" statement, I hope that you are using this time wisely.
If you think as I do, this will relate… I've always wondered how much I could get done if I were granted an unlimited amount of time. Could I get all of those projects done? Spend more time with my family? Learn a new skill? Improve my health and fitness? Grow stronger in the ways I see myself when not restricted by the finite resource of time?
That request has been granted, and I'm going to test the limits of my productivity. I urge you to do the same.
Below are the most important five areas in my life right now. I want to discuss ways we can improve in these areas, and I will share what I am individually working on during our 'down-time.' Until next time, stay safe, protect your family, and let's all come out of this with improved habits and as a better version of ourselves.
PHYSICAL HEALTH
The number one hurdle to improving your physical health is TIME. Since you have it, start a routine. Walk once per day. Make it fun and have challenges within your home or online. Commit to doing one thing each day that is positive for your physical health.
Our family's goal is to do something active after each meal. It may be a walk, basketball game, playing catch, or having a wall-sit/push-up/plank challenge.
I'm working up to running 5-6 days per week, typically in the morning, and strength training 3-4 times per week, usually at night. With the extra time, having 90-120 minutes each day to exercise is doable. Remember, once fitness is obtained, it is easier to maintain. Meaning, when we have to go back to the usual grind of work and life, exercising a few times each week will keep what you earn during this downtime.
FAMILY HEALTH
What has your kid's been begging you to do? Unless it is going to Disneyland, you have the time to do it. Take time each day to do what one of your kids wants to do, minimal restrictions. Their imagination might prove to be a refreshing break from our turbulent times.
We have committed to playing a family game every day. Right now, we are really into Ticket To Ride and Cover Your Assets.
PROFESSIONAL HEALTH
What work project, or side hustle, have you been dreaming about getting started, or finished, but just haven't had the time. Commit to it, and DO IT!
My big three to accomplish during this downtime are 1. Catch up on all of our blog posts and exercise videos. 2. Automate many of the technical processes in our office. 3. Update our website. Bonus: LEARN - Currently, I'm working through a strength and conditioning certification and a golf-specific stretch program.
MENTAL HEALTH
Improvements in mental health are hard and take chunks of time. Which is why many people don't work in this area of their well-being. We can meditate, read, journal, pray, explore nature, etc. What helps you be at ease? Do that!
I have committed to journaling 15-minutes each morning and ending my day with 30-minutes of reading something inspirational. Right now, I'm reading 'The Courage To Be Disliked.'
As a bonus, I'm learning the piano, but that may hinder my mental health progress. Ha!
SOCIAL HEALTH
Since we are supposed to be social distancing, though I will argue it is physical distancing, this area needs attention. We are human, and the only way we have survived this long and will continue to do so is by social interaction. We have unlimited technology, so find one person each day and call them, write to them, spend all day texting with them, just be sociable.
Outside of spending time with my family, I have committed to calling one friend each day. Using my journal as inspiration, which starts with gratitude, I'm writing one or two people each day. Maybe you will get a letter from me?
In times of challenge, the robust and adaptable will prosper. Inside our clinic, we deal with the physically afflicted, but there is so much more to your overall health. Physical limitations can have an impact on each of these areas, but when the physical restriction is remedied, you still have to work on these other areas.
Wishing you all the very best in health and safety! We look forward to seeing you, talking with you, and helping you in the future.
-Dr. Reheisse
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.
New Year - New Goals: Setting & Achieving Your Goals This Year.
If you are like me, you love to set goals, spend hours on action plans to achieve those goals, and ponder on the impact and improvements you can make to yourself, your company, your family, your health, and everything else around you.
Fast forward from when we originally posted this blog, it is now 2020! Wow!
If you are like me, you love to set goals, spend hours on action plans to achieve those goals, and ponder on the impact and improvements you can make to yourself, your company, your family, your health, and everything else around you.
While you will not find a shortage of articles telling you how to set goals. Or how by February 1st, over 80% of people will have already abandoned their resolutions, let’s just keep this short and to the point in hopes that you are aiming to be part of the 20% who holds on, pushes through, and progresses not just your life, but your family’s, and everyone you interact with.
When gearing up for the new year, or getting back on track, set your aim high and work these 3 steps.
BE SMART
We have all heard of the ‘SMART’ acronym about goal setting.
Specific: Be as specific as possible with your goals, they are easier to break up and achieve if they are clearly defined.
Measurable: This is usually the easiest part. How will you know when you have achieved your goal? When you hit your mark. 1000 miles running - $100K in growth - 2 full weeks of vacation time with your family. Put a number to it!
Attainable: Don’t make your goals too easy. Set your goals just at the end of your reach. Goals that make you work and dig down deep create the best feelings of accomplishment when completed.
Relevant: Is this goal important to you? Does it help you become a better person? Can accomplishing this goal help and serve others?
Time-Based: Every goal must have a deadline, or it is just a thought; a dream; an everyday task.
Break down each goal you have set into smaller, workable, SMART pieces.
THE ONE THING - BUILD YOUR FOUNDATION
Studies have shown that we are incapable of multi-tasking! Don’t believe me, just try to do three things at once and see how well they are completed, if at all. The new year brings about much excitement about the possibilities and opportunities ahead, but if our focus shifts to too many things at once, it will all quickly fall apart. Start by reading ‘The One Thing’ by Gary Keller and focus all of your attention on one goal at a time. See it through to completion and then move on to the next.
When I sit down to plan out my year, quarter, or week, I review my One Thing, that big goal for the year. But, it has to be broken down further than that. Humans simply can’t focus on one thing for an entire year! You know the saying, ‘The way to eat an elephant is one bite at a time,’ it’s true. If you want to reach your BIG goal, break it down.
I have shifted my life, personal and professional, to ROCKS. This isn’t a fancy acronym, but I do like to think of these rock as the material needed to build the foundation of what I hope to achieve and provide to the world during my life. ROCKS are 2-3 small steps that can be taken each 90 days that move you a step closer to your ONE BIG THING. Science has shown us that the extent of our ability to focus on a task is 90 days, so this method works perfectly. Break your big goal down into 10-12 steps and put all your focus into 2 or 3 of them every quarter.
This works the same in business as it does running—every quarter, you have to change cycles. You may want to run a 3:30 marathon this year. You have four macrocycles of training to complete this year, each composed of 2-3 microcycles. Just going out and haphazardly running will not get you to your goal, you have to plan and focus.
10X EVERYTHING
Look at your goals. Look at the energy, time, commitment, and focus it will require, and 10 X it! In Grant Cardone’s ‘The 10X Rule’, he discusses that anything worth accomplishing will require ten times more time, energy, and resources than you initially thought. How do you attack this, with massive action.
In summary, take an hour this week, work through your goals and develop an action plan. Assure they are SMART, begin by focusing on just one, and TAKE MASSIVE ACTION!
- Happy New Year -
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. If you have an injury that is preventing you from doing the things you enjoy, call or schedule now.
Tendinopathy Injuries - 7 Things You Need To Know About Tendinitis and Tendinosis
Tendinopathies are a pain. If you have ever experienced this type of injury, you know this! While we treat these conditions often, these patients often become great friends of ours. Not only because we get them back to running, but because these injuries take time and constant attention.
Tendinopathies are a pain. If you have ever experienced this type of injury, you know this! While we treat these conditions often, these patients often become great friends of ours. Not only because we get them back to running, but because these injuries take time and constant attention.
We see an abundance of ‘failed’ tendinopathy cases, either from conservative care or those who have received injections and other interventions. A big misunderstanding we see it this...a patient comes in, states they have had it scrapped, injected, and have rested...and IT DIDN’T WORK! While frustrating, I have to explain to this person how they were misinformed. An injection will only help with pain, resting will only help with pain...but those two ‘treatment’ options didn’t do anything to fix the problem. Confused yet?
To help with understanding, below are 7 things you need to understand about tendon injuries to help you recover correctly and return to sport better than before.
I will start with the statement that I'm no magician, I don’t have a magic wand to fix these injuries. The one thing these cases need, that no one wants to give, is TIME and PATIENCE. Chronic tendinopathies require progressive loading and TIME. Progressive loading takes TIME. Most good protocols for chronic tendinopathies are 4-12 MONTHS long.
1. Treat This Injury Like Good Barbecue, Cook It SLOW.
Consistent daily loading of 10-15 reps over weeks to months is encouraged. We typically recommend 1 set of 10-15 reps done slowly 4-6x daily.
2. ‘No More Than’ 1,2,3,4, ‘I Hate When We Get To 6,7,8!
Pain during loading should be tolerable; a 1-4 out of 10 pain is just fine! When you push into the 6-8 out of 10 pain, you have done too much. Pay close attention to the 5/10 pain. If it is trending up from 5/10, then stop and modify. If the pain is trending down from 5/10, continue. Pain is an excellent indicator of progress and failure. Listen to your body!
3. Produce & No Worse.
Loading tendinopathies can produce pain, but later (minutes to hours later), the pain should return to baseline, where it was before the exercise. This is important because many patients and most exercise prescription should not produce pain, but tendinopathies are DIFFERENT! Pain (tolerable pain) is very likely with loading, and loading is REQUIRED for management and a successful outcome in many cases.
4. Watching Paint Dry.
The paint will dry. It will just take TIME. The rehab isn't sexy. It's 1-2 exercises several times daily for months. Your tendinopathy, if we assessed correctly, will get better, it just will take TIME. Most protocols are 4-12 months long. I typically will say initial results can begin at 2-3 months, but we won’t abandon the protocol until at least a 4-month trial has been completed. Think about that for a moment! If you have an actual tendinopathy issue, anyone who tells you they can fix it in a few weeks either doesn’t understand anatomy and physiology, or they are unfit to manage your case.
5. Progressive Overload Is Required To Make The Tendon "Bigger, Faster, Stronger And Harder To Put Down."
We start simple and progress as allowed. Isometrics -> Concentrics -> Eccentrics -> Functional Tasks, it’s the process, and most of the time, you can not skip a step. Throughout this process, we may need to back up periodically or adjust and step on the gas depending on how your body responds.
6. Tendon Injury Management.
We typically start by addressing the soft tissue and joint mobility involved to help treat pain and get you on the right track; this usually takes 2-4 weeks. We will then take the in-office exercises and emphasize progressive home loading and exercise progression. Once we start moving the needle, we move to ‘check-ins every 3-4 weeks in the office to evaluate progress, address sticking points, and progress exercises.
7. Slow Healing Tendinopathies.
It is often more than just the tissue and load, what other factors are going on in your life?
Metabolic Concerns -> Function Medicine Workup
Psychological Concerns -> Believe it or not; some people become very attached to their pain. Working through this and realizing that you WILL GET BETTER, it a huge part of the battle with chronic pain. It’s no longer taboo to talk with someone about this!
Long-Standing Tendinopathies that have improved but plateaued must consider additional loading or regenerative medicine referral.
Knowledge is power; what you do with it is your choice. I will end with the most significant issue we see when dealing with these cases, REST. Many believe that rest will heal a tendon injury. We know so much more about Achilles injuries, plantar fasciitis, high hamstring tendinopathy, and other tendinopathies, we KNOW that rest does not help. It will help with pain, but it does not address the problem. Once you return to the activity that causes the problem, it will come right back.
Are you unable to run, hike, ski, or exercise because of a nagging tendon issue that shuts you down in the first few steps? Have you been resting, icing, are have even had an injection or two with little results? It’s time to step-it up...it’s time to load it...it’s time to push it. Schedule an appointment today, and let’s get started getting you back to the things you enjoy.
- - -
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. Special mention and credit to Dr. Dino Pappas for the article outline.
Hamstring Injury - Part 1: Anatomy & Runner's Risk
It’s the start of a beautiful day. You were able to get to the track around 6:00 am for a solid speed workout, your favorite. You warm-up, go through your stretching and dynamic movement routine, and besides a little early morning stiffness, you feel great. Then it happens, you are on number 5 or 12 200 meter repeats, and the back of your leg cramps up something fierce! You stop, stretch, massage, but nothing helps…now you can’t run - workout over.
It’s the start of a beautiful day. You were able to get to the track around 6:00 am for a solid speed workout, your favorite. You warm-up, go through your stretching and dynamic movement routine, and besides a little early morning stiffness, you feel great. Then it happens, you are on number 5 or 12 200 meter repeats, and the back of your leg cramps up something fierce! You stop, stretch, massage, but nothing helps…now you can’t run - workout over.
If this sounds familiar, you know that hamstring injuries are terrible. They are hard to predict, difficult to treat, and can sideline a running longer than a stress fracture. As distance runners, this is a less common injury when compared to Runner’s Knee, Shin Splints, and IT Band Syndrome…but they can be much more complicated and stubborn to bounce back from.
As a Salt Lake City-based runner myself, I have had a few minor (luckily) hamstring injuries back in my hurdling days. Now, as a primarily distance runner, spending more time on the trails of the Wasatch Mountains, my hamstrings have felt strong and resistant to stress. But as we will discuss in this series, that doesn’t mean it can’t all go south tomorrow.
If you have ever watched a runner IMMEDIATELY pull-up in a race and can see the grimace on their face; you can almost feel their pain. If you have been unfortunate enough to experience this yourself, you don’t want to ever think about that moment again…so let’s move on!
We are here to take a deep look at and discuss hamstring injuries. What they are, how they happen, the different types of hamstring injuries we experience as runners, what you can do about them, how to rehab a hamstring injury, what the return to running process looks like, and eventually how we can prevent a dreaded hamstring injury.
Hamstring Anatomy & Function
Hamstring Anatomy Review
Before we dive in to the function of the hamstring, how it responds during the running gait, and the injuries common among the running group, lets have an anatomy review, shall we?
The hamstring group is made up of 3 muscles, one of which has two heads, meaning we have 4 areas to concern ourselves with. The muscles and their actions are as follow:
Semitendinosis: The semitendinosis mucles originates from the ischial tuberosity (sit bone) and inserts below the knee on the medial side of the tibia. This orientation causes it to act on two joints meaning it is both a Knee Flexor and Hip Extender. Due to its insertion on the inside of the tibia bone, it can internally/medially rotate the tibia when the knee is bent and also internally rotate the femur when the knee is extended.
Semimembranosis: The semimenbranosis muscle originates and inserts very closely to the semitendinosis and acts similarly as a knee flexor and (poor) hip extender. There are subtle differences in the two ‘semi muscles’ but it’s claim to fame is more along the lines that is may play a role in knee stability given it is suspected to have a functional relationship with the popliteus muscle on the back of the knee and a few fibers supporting the MCL. We learn more about the body everyday, so this may change.
Biceps Femoris: The Biceps Femoris has a similar function as the ‘Semi muscles’ in that it assists in knee flexion, and lower leg deceleration during the runners gain cycle, but it is somewhat special. The biceps femoris muscle has two heads that attach to two different places. The long head comes all the way from ischial tuberosity like the ‘semi brothers’, crossing the hip joint, making it a hip extender. But the short head, it comes off the back of the femur at a spot called the linea aspera. The short head does not cross the hip joint so it does not extend the hip, but it does have a special power. If you are unfortunate enough to experience an avulsion of the hamstring origin off the ischial tuberosity, the short head is still attached and allows you to, albeit weakly, flex the knee. This allows you to maintain some ability of ambulation. Our bodies are smart!
Basic Function Of The Hamstrings In Running
The hamstrings have a very important role in the running gait cycle, but it may not be what you think. As distance runners, our hamstrings are not as strongly used as in our sprinting counterparts, but as we all know after a good speed work session, they are back there serving ther purpose.
To keep this simple. The hamstrings job is to ‘slow’ down the leg as it swings forward. WHAT? SLOW DOWN? Yes! And the faster you run, the harder it works to slow down the leg.
It does this in what is called an eccentric contraction. Simply put, the hamstring fires as the leg swings forward so that your foot and lower leg do not go flying out, causing the knee to fully extend, and then you land on a locked knee. This would cause many injuries, and runners with a lack of control here often have knee and hamstring injuries.
Okay, so lets go a little deeper…nerd-out if you will.
For a great review of the gait cycle, check out the Biomechanic.
When the leg is planted in the stance phase, the hamstring contracts with the quads and adductors to create a stable platform inwhich we can use our momentum to continue to propel forward.
As the leg moves into the toe off phase, the hamstring supports by contracting more concentrically aiding in the push-off that propels us forward..but here is where it gets fun.
During the mid part of the swing phase, the hamstring is passive as the quads and adductors do most of the work bringing the leg foward. The hamstring does work to pull the heel toward the butt in good form, but they do more stretch than anything as studies suggest the hamstring stretches from 50% length to 90% length during this time.
Once we start moving from mid swing to heel contact, the hamstring kicks in eccentrically, and puts the brakes on the lower leg, allowing for a stable platform to land and maintain during the new stance phase.
What Do The Hamstring Do For Distance Runners?
As distance runners, we work through all of theses running phases, just less draumatically than our explosvie sprinter friends. The hamstrings act more in the stability and concentric role during our long outings, which leads way to one theory as to why distance runners deal with more tendinopathy injuries (generally overuse) than strains and avulsion injuries (dynamic and powerful contractions).
What Types Of Hamstring Injuries Do Runners Experience?
Acute Hamstring Strains In Runners:
This is one of the most common overall injuries to plague athletes, for running, it is usually a problem for the sprinter of the group. A muscle strain, or pulled muscle, occurs when a muscle is suddenly overstretched, resulting in the tearing of some of the fibers within the fascicles that make up the larger muscle as a whole. This can be a very small percentage which only causes mild tightness, to a more prominent injury that can range from mild swelling, to complete immobility with bruising and severe swelling.
As a runner, if you are to experience a hamstring injury, a mild strain is preferable. Typically, we can get back out and perform modified running in 2-4 weeks with full healing and return to play in 4-8 weeks.
Hamstring Tendinopathy In Runners:
This is what we see most. As distance runners, we typically run far, make us prone to overuse injuries. Those injuries typically start with a little tightness that goes unaddressed because we are able to continue running. Over time, that muscle tightness begins to place an overload on the tendon, and that tendon begins to get irritated. In can inflame, dehydrate, become sensitive, and eventually make it difficult to run, walk, or sit for long periods.
There are two places this can occur, the lower tendon insertion, which we typically see acutely after a race, fall, or a big downhill effort. This area is often where we see a rupture in sprinters. If you have ever watched a 100m or 200m race and seen a running pull up very quickly and then fall or start hopping, this is what they experienced, and it can be career-ending at the highest level of the sport.
Now, for the upper tendon origin. High hamstring tendinopathy is so common and so frustrating, it has been listed in the runner’s guide of forbidden phrases. High hamstring injuries suck…there is no way around it. These injuries take TIME and often require some time off from running. I told you it was a forbidden term.
High hamstring tendinopathy typically takes 3-6 months for a full recovery and complete release to high volume and high intensity running. Care involves a strict plan for in-office and home care…and even with that, we still send out a good percentage for co-management with an orthopedist.
To summarize this injury. Don’t ignore your hamstring tightness or an injury you believe to be a mild strain. Give it attention, seek help, and rest if necessary. Unfortunately, some runners will press on, and the outcome is very unfortunate.
Hamstring Avulsion Injuries In Runners.
This is a tough one that typically requires surgical intervention. An avulsion injury is when the hamstring tendon pulls away from its attachment on the bone and takes part of the bone with it. These are uncommon without a significant mechanism of injury, we don’t typically see this from just running, but it has happened. This injury will cause severe pain, swelling, and bruising and should be examined by an orthopedist as soon as possible as the muscle can begin to ‘roll-up’ and atrophy shortly after the 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.
If you are in the greater Salt Lake City, Utah area and are a runner dealing with a nagging hamstring injury, we are here to help. Click the link below to schedule a consultation appointment and lets get you back out and running.
Youth Running: Benefits, Risks, & Considerations
Running is one of the best (coming from a runner) and easiest sports to take up in the world. Running is a major part of nearly every sport on the planet, making it an excellent option for our school-aged athletes. In 2017, almost 500,000 runners ran XC, and over 1 million athletes ran track. With the ease of access and a million different training techniques and training theories comes the risk of adverse effects. Over the last 10 years, we have seen a 34% increase in injuries incidence among runners.
Running is one of the best (coming from a runner) and easiest sports to take up in the world. Running is a major part of nearly every sport on the planet, making it an excellent option for our school-aged athletes. In 2017, almost 500,000 runners ran XC, and over 1 million athletes ran track. With the ease of access and a million different training techniques and training theories comes the risk of adverse effects. Over the last 10 years, we have seen a 34% increase in injuries incidence among runners.
Shin splints can be an precursor to stress fractures in young runners. Check out our MTSS Blog Series to prevent and rehab this common injury.
It is estimated that 20-80% of runners will experience an injury in a given year. Random range, right? You try to find two studies that can agree on this! However, we do know that more than 50% of all pediatric sports injuries are due to overuse. We also know that overuse has is signs and symptoms and can be prevented.
What do we know about youth running? A lot actually. Let’s look at the facts and discuss how we can prevent future injuries so our young runners can enjoy a life-long relationship with this wonderful sport.
BENEFITS OF RUNNING FOR YOUTH ATHLETES
Great Cardiovascular Health.
Improved Cognitive Development.
Exercise increases metacognition, behavior regulation, and accelerates behavioral and emotional engagement.
Bone Health - Increased Bone Density
Positive Self Image & Emotional Wellbeing
Aids in Development of Total Athleticism.
Running injuries are common in youth-aged runners, but the benefits from frequent exercise, competition, and camaraderie far outweigh the risks. Learn more about beginning running for health and fitness here.
CURRENT TRENDS IN YOUTH RUNNING: INJURY RISKS
Accelerated Growth.
Peak height velocity (when children grow fastest, resulting in bones lengthen faster than muscles and tendons can keep up with) occurs around 12 for females and 14 for males.
Just before this rapid growth, bone mineral content is at its lowest, making bones and growth plates vulnerable to the load and stress of running.
Low Bone Mass For Age.
Affects 39% of female youth runners.
Might be the more likely cause of stress fractures than training load.
Low Energy Availability, Relative Energy Deficiency in Sports
Adolescence is a time of rapid growth with unmet energy demands…inadequate calorie intake with increased running demand can lead to abnormal menstrual function in females, bone mass depletion, and high risk of musculoskeletal injuries and stress fractures.
Males Commonly Suffer From Low Bone Mineral Density As Well.
Risk factors include being less than 85% weight for height, running over 30 miles per week, a history of stress fractures, and having a diet lacking in calcium-rich foods.
Answering ‘YES’ To The Following:
‘do you believe that being thinner leads to faster running performances?’
BIG RED FLAG
Increased Anxiety or Avoidant Coping Strategies Such As Denial.
Perfectionism-related thoughts are associated with higher rates of depression, anxiety disorders, obsessive-compulsive disorders, and eating disorders.
History Of Previous Running Injuries.
Strong indicators for in-season injuries are injuries during summer training (female) and history of previous running injury (males).
HOW CAN WE PREVENT INJURY IN YOUTH RUNNERS:
To prevent injury, cross training is necessary. Recent data suggest that shorter intense bouts of activity like sprinting, other sports, and neuromuscular training are better for developing motor skills compared with endurance running. Remember, though they grow, they are still kids and need time to play. Play outside, play other sports, rest from play. Don’t forget that.
Strength Training #1 - Improved Core And Pelvic Strength Led To Faster Race Times.
A 6 week strength program aimed at pelvic and core strength led to improved race times. Strength training also leads to better weight control, improved motor performance skills, improved cardiovascular health, and enhanced psychosocial well-being…oh, and less sports-related injuries.
Strength Training #2 - Spine & Hip Strengthening.
Exercises aimed at the spine and hip muscles helped injured youth runners rehab from injury faster and prevented future occurrences of common running injuries such as Achilles tendinosis, iliotibial band syndrome, runner’s knee, plantar fasciitis, and shin splints.
Strength Training #3 - Strength Training For Runners Program.
We have developed an instructional series around some of the best strength exercises for runners. You can check those out here.
Set Realistic Expectations - Know Age & Developmental Stage Capabilities.
Unrealistic expectations lead to athlete frustration, low self-esteem, burnout, and injury! This can lead to reclusiveness, depression, and loss of enjoyment.
Monitor Youth Runners For Signs Of Burnout.
Students athletes who withdraw from activities they previously enjoyed may be experiencing chronic stress and burnout from their sport. This leads to more complicated issues if unaddressed, like depression, obsessive-compulsiveness, and eating disorders.
If an athlete becomes more irritable, anxious, or struggles with perfectionism, they are demonstrating signs of burnout. They need time off or decreased self, coach, and or parental pressures related to their sports.
Coordination Of Care For An Athlete.
Extrinsic risk factors for injury include improper training volume, intensity, or progression, early sports specialization, poor footwear, and inefficient running form. These factors are better addressed when the athlete, parent, coach, and healthcare provider have open communication with the athletes BEST INTEREST at the forefront.
Modify Training Program To Allow Rest Periods
Injury can be reduced by developing a training plan that limits weekly and yearly participation time to reduce repetitive movements and increase scheduled rest periods within each week, season, and annual training cycle.
Suggested rest is at least 1 day per week, 1-2 weeks every 3 months, and participation limited to 9-10 months per year.
Avoid Early Sports Specialization (Bolded Based on IMPORTANCE)
Highly specialized youth athletes (those participating in one sport more than 8 months of the year) report more injuries than their peers, independent of age, sex, or training volume.
Early Sport Specialization is associated with unidimensional identity with the sport leading to the athlete feeling as like they lack control with their participation in that sport. This leads to burnout.
All Credit To The Authors & AJSM. No Copyright Violation Intended. Click Here To Access Full Article.
When To Seek Treatment
Now that we are aware of injury risks, YOU have to take preventive measures. For some, this means a little time off before training ramps up again. For others, it’s time to hit the gym, toss a ball around, shoot some hoops, and spend some time at the pool.
Early Care Is Crucial To Retruning To Running In a Resonable Time-Frame. Schedule Today.
Shin Splint Pain Relief -> CLICK HERE
IT Band Pain Relief -> CLICK HERE
Runner’s Knee Pain Relief -> CLICK HERE
When it comes to injuries, we know two things.
(1) Rest is rarely beneficial for sports injury recovery. Rehab needs to be active!
(2) The sooner you seek care with an injury, the sooner you will be back out and running.
If you or your child has been training for the upcoming cross country season but are continually being sidelined by injury and illness, it’s time to find help and get back on track. If you are a runner in the Salt Lake City area, Revive Sport & Spine is your go-to clinic to get you back up and running quickly, giving you the tools to help you run faster, farther, and more efficient than before.
Krabak et al. Youth Distance Running: Strategies for Training and Injury Reduction. American College of Sports Medicine. 2019. Current Sports Medicine Reports. www.acsm-csmr.org.
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 for the great people and adventurers of the Salt Lake City Valley.
Medial Tibial Stress Syndrome Part 3 - Treatment and Rehabilitation
So we have made it to this point. You have been rolling, stretching, warming up before your runs, but your nagging shin splint pain will not go away. Maybe it has improved 50%, but as you continue to train for your upcoming event, the pain has plateaued. Sound familiar?
So we have made it to this point. You have been rolling, stretching, warming up before your runs, but your nagging shin splint pain will not go away. Maybe it has improved 50%, but as you continue to train for your upcoming event, the pain has plateaued. Sound familiar?
I know it has for me. As we discuss treatment options here in part three of our Medial Tibial Stress Syndrome series, a few of the techniques we show that are commonly used here in the office were used to help me overcome my battle with shin splints when I was working toward my first marathon.
Just with any other injury, if you are truly doing everything you can (allowing ample time to warm-up before exercise, training within your limits and not hanging too long in the upper limits as you progress, you are stretching, rolling, and giving constant attention to recovery and rest) and you can not shake the pain after 10-14 days, YOU NEED HELP! Our goal with this series is to give you options, ideas, and a direct path of the things you should be doing, but if they don’t get you to where you need to be, or out of pain…that is why we are here!
Below are a few of the treatment options we typically utilize when caring for medial tibial stress syndrome, as well as a basic return to running rehab protocol that not only provides strength in needed areas but is aimed at preventing future injuries.
NOTE: The care we provide is adapted to each individual person and their presenting condition. What works for one athlete may not work for another. This is where the exam and functional analysis come in. If any of these exercises cause pain, STOP, and seek care from licensed professionals. (Like Us!)
SHIN SPLINTS: IN OFFICE TREATMENT
MYOFASCIAL RELEASE
IASTM - Instrument Assisted Soft Tissue Mobilization
DYNAMIC CUPPING THERAPY
DRY NEEDLING THERAPY
KINESIO TAPING
SHIN SPLINT REHABILITATION PROTOCOLS
Medial Tibial Stress Syndrome - Rehabilitation Exercises - Phase 1
Medial Tibial Stress Syndrome - Rehabilitation Exercises - Phase 2
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.
Medial Tibial Stress Syndrome Part 2 - Self-Care For Shin Splints
In PART 1 of our Shin Splints series, we took a look at the anatomy associated with medial tibial stress syndrome as well as the factors that make runners especially susceptible to them, namely the repetitive nature of running compounded by most cases typically doing too much too soon. Here in PART 2, we are going to look at self-care options as well as some considerations for preventing repeate episodes of shin splints so that you can keep running and training for your goal races.
In PART 1 of our Shin Splints series, we took a look at the anatomy associated with medial tibial stress syndrome as well as the factors that make runners especially susceptible to them, namely the repetitive nature of running compounded by most cases typically doing too much too soon.
Here in PART 2, we are going to look at self-care options as well as some considerations for preventing repeate episodes of shin splints so that you can keep running and training for your goal races.
SELF CARE OPTIONS FOR MTSS-SHIN SPLINTS
Self Myofacial Release - 4 Ways To Care For Your Shin Splint Pain
Pre-Running Warm-Up For Shin Splints
Training Modifications, Gear Suggestions, & Other Prevention Considerations
Form, Cadence, & Ground Contact Time:
This is a tricky subject, honestly I’m not sure why I even mentioned it. One can go miles down the form training rabbit hole and come out the other side worse they they were before. However, I do want to mention three things that must be considered and worked into your training plan to help prevent shin splints and make you a more efficient and faster runner.
The ground fights back! The more time we spend in contact with the ground, the harder this battle will be. I’m not here to talk about heel-striking, forefoot running, etc., but I will mention cadence. The higher your cadence, the less time your foot spends on the ground. Meaning, the less ground reactive forces you absorb and the less stress on your body.
Again, I’m not here to correct form. But I do believe we can all be more efficient. Strength training helps us become more efficient for those later stages of the race. Please add strength training to your program, it is extremely useful.
Alter your surfaces. Don’t always pound the pavement. The track and trails are your friend…and your feet will thank you for it.
Shoes:
Shoes are something I get asked about frequently. My honest answer is this, ‘We have more shoe technology and selection than ever…we also have more injuries than ever.’ Take that for what it is worth but I do believe shoes should be rotated and changed frequently. I suggest a 2-3 pair rotation, avoid running in the same pair two days in a row, and switching out for a new pair every 200-300 miles depending on the shoe.
Warm-Up & Cool-Down:
This is SO BIG. In every injury we encounter and talk about, how you warm-up (if at all) and cool-down has a direct impact on your injury risk, and recovery speed from injury. Warming up prepares your body for the task ahead, giving it the best chance to avoid injury. Colling down helps work out those tight spots after training while encouraging faster recovery.
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.
Medial Tibial Stress Syndrome Part 1 - What Are Shin Splints and Why Runners?
Springtime is here! The weather is warming up, the sun is starting to shine on those early morning runs, and we can finally shed many of those heavy layers of clothes for our preferred running shorts and singlet top!
But…spring time also means something else for runners.
Springtime is here! The weather is warming up, the sun is starting to shine on those early morning runs, and we can finally shed many of those heavy layers of clothes for our preferred running shorts and singlet top!
But…spring time also means something else for runners.
For most runners, it means it is time to come out of the pain cave, get off the globogym cardio theater dreadmill, and start hitting the roads again. For some, it means it is time to come out of hibernation and begin training again. While this all seems well and good, the road can cause some aches and pains that the somewhat forgiving treadmill or cushy couch hid from you all winter long.
You know what I am talking about. That all too familiar pain down the inside of shin bone that can also sometimes radiate into the foot and seems to intensify with every run. Road running in the spring can be wonderful, but it can also be painful. The road is an unforgiving surface (part of the reason our treatment plans include running on a track or trail) that can bring even a veteran runner to their knees in frustrating agony with each run.
Yes, I’m talking about Shin Splints!
Today we are beginning our Shin Splint Relief & Prevention series by discussing what ‘shin splints’ are, how they occur, who is more likely to experience shin splints, as well as a few other complicating factors. We will follow this up with self-care in Part 2, and Treatment & Rehabilitation options in Part 3.
WHAT ARE SHIN SPLINTS: MEDIAL TIBIAL STRESS SYNDROME
From an anatomical perspective, shin splints are a condition where there is pain, tenderness, and sometimes swelling along the middle, inside of the tibia (shin) bone. While the cause is debated as to whether this pain comes from a muscle and tendon response to doing too much too soon, the tibia bones inability to handle the stress and pounding from running, or damage to the connective tissue that wraps and supports all of these structures in the lower leg and foot.
The hallmark sign of Shin Splints is the extreme tenderness along the inside of the shin that seems to improve as a runner warms up, but begins to worsen, last longer, and eventually prevent running as time passes without care. From this, this condition is more aptly named Medial Tibial Stress Syndrome.
Before we discuss why this condition plagues runners, and what we in the medical community think is actually happening, let’s look at the important anatomy involved.
WHY RUNNERS & WHAT FACTORS LEAD TO SHIN SPLINTS
Running injury statistics are horrifying, with studies estimating that anywhere from 40-80% of runners experience an injury EVERY YEAR. I am not going to bother trying to track down the actual number because it changes montlhy as new research comes out, but the fact is that as runners, we run a high risk of injury. From that, it is estimated that 1 in 5 are dealing with shin splints. Since this is such great news, let’s look at some reasons why this injury is so common and who could be at higher risk.
New Runners - If you are truly new to running, Shin Splints are almost a right of passage. In the process of your body adapting to this new stress, figuring out your form, and slowly increasing your mileage, your body will get to the point where it starts to scream…’why are you doing this to me’. As we progress through this series, you will find ways to build up your body, more specifically your legs, so that it can handle this new stress of running.
Running Biomechanics - The Tibia bone is believed to absorb 2-3x’s your body weight with each step. Take into account that the average runner has a cadence (steps per minute) of 140-180, it is no wonder we begin breaking down at the tibia.
Higher BMI/Body Weight - Looking at the last statement, if you have higher body weight, and you are new to running, forcing your tibia to withstand the pounding from running should be a slow process with ample recovery.
Training Volume - Just like new runners, if you are a veteran with a solid training base of 30-35 miles per week and you sharply bump up to 55-60 miles per week, you are essentially treating your body like a newbie with a very unfamiliar stress.
SIMILAR PROBLEM: Too Much Too Soon & Classic Overtraining
Form - Forefoot, Midfoot, or Heel Striker, you efficiency within that form and allowance for adaptation to stress is what either prevents or causes injury. I have seen all forms present with shin splints, and it is usually a combination of the above causes.
WHAT ACTUALLY CAUSES SHIN SPLINTS
While the cause of Medial Tibial Stress Syndrome is still debated, with research naming a different cause. It is likely a combination of the factors we are going to cover. This is why, if you have been suffering from shin splints for a month or so and are just trying to run through them, it is important to get an evaluation, a structured plan around your goals, and some treatment to get you over the hump.
Weak Ankle Dorsiflexion - Loss of eccentric control.
One issue that many believe to be a cause, or at least a contributor to shin splints is poor control of the anterior leg muscles, or weakness of the Tibialis Anterior muscle. This one stands out in newer runners because it is responsible for the slapping sound one makes when their foot hits the ground. This comes from weak eccentric control of the muscle, or the ability to slowly let it down to the ground. Our bodies are amazing, so when one area fails, another area takes the load…
Poor Pronation Control & Tight Posterior Tibialis Muscle
Lets first start by reminding everyone that pronation is a normal part of the gait cycle, but poor control of the speed of pronation can cause problems. If we have excessive tightness through the posterior tibialis muscles, either due to overuse or poor adaptation to load, it is unable to respond well enough when the foot hits the ground, causing the foot to crash in during pronation. If this is the case, we see each step pulling on this already tightened muscle, as well as the facia that wraps it and attached to the inside of the tibia bone (that spot where you are tender), inflaming the area, damaging the muscle, and leading to poor mechanics while running.
Bowing of the Tibia Bone
To further the case of this mid-shin bone pain where the posterior tibial muscle lies, we have data that shows the Tibia bone actually bowing during running. While our bodies are adaptive and resilient, we believe this bowing to be minimal, undetectable without fancy equipment, but a natural part of our body handling the forces the road gives back with each step. Where this comes in to play is with a young or new-to-running runner who decides to run through their pain. If this goes on long enough, and the runner overtrains, this can lead to a stress fracture injury.
Over Training - Too Much Too Soon
This is probably the most common reason runners experience shin splints, and most other injuries for that matter. Over-training is the common factor of the 3 potential causes we mentioned above. As a new runner or an experienced one looking to increase mileage, a plan that not only includes a structured running plan, but strength training, cross training, and rest must be considered.
SUMMARY
Shins Splints are most known to cause pain along the inner edge of the tibia bone that is tender to the touch. Swelling may or may not be present.
While many causes are debated, one thing holds true. Whether you are a new runner or a veteran. Doing too much too soon will likely lead injury.
Runners are most at risk due to the repetitive nature of running. Add in volume changes, the pounding of the road, lack of self-care and warming up before each run..it all adds up.
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.
Spinal Manipulation - Who Benefits Best From This Effective Treatment Option
Spinal manipulation, or the chiropractic adjustment, is the hallmark of Chiropractic Medicine, but what population of patients benefit from this safe and effective treatment option?
Spinal manipulation, the hallmark of Chiropractic Medicine….
First -> Let’s address the elephant in the room! Spinal Manipulation has been touted to help or heal everything from low back pain to the common earache and yearly influenza epidemic. While many practitioners, and patients alike, claim that a chiropractic ‘adjustment’ cured all their ills, current research does not support those claims. We are not here to call those cases out as some people honestly did find an improvement to their conditions through spinal manipulation, we just can not provide consistent results to a large number of subject to clearly understand the mechanism.
However; Low Back Pain, Neck Pain, Muscle and Joint Injuries, Strain/Sprain Injuries…we have mounds of data to support the effectiveness of manipulation and manual therapy in these cases. So much, that we can now predict who will benefit best from this type of care.
What Does Spinal Manipulation Look Like?
Before we jump into what we call ‘Clinical Prediction Rules’ regarding joint manipulation, please realize that each person is an individual, and each condition is as unique as the person who presents with it. Utilizing these rules is not the end all be all; there will be outliers. Some people have tried joint manipulation, or exercise, or dry needling, or a myriad of other therapies with little to no results. Sometimes their condition is passed this type of intervention and needs to bypass conservative care for more invasive options. Moreover, many of these patients either receive ONLY ONE therapy or had the wrong ‘concoction’ of care for their condition, or the phase of healing they were in when the therapy was used was incorrect causing poor timing to be the culprit of poor outcomes. So…if you have tried a few of these, don’t give up and completely write them off. Get a second or third option, look at it with a set of fresh eyes and try a new direction, a new order of care and see how your condition improves.
Now, back to the predictions. Below are what we consider to be the characteristics of patients who research predicts will have the best and fastest outcomes from spinal manipulation.
The Number Of Days With Your Current Low Back Complaint is LESS THAN 16 Days.
Pain & Radiation Of Symptoms (Pain, Numbness, Tingling) Does Not Go Farther Than The Knee.
Fear Avoidance Behavior Assessment. You Do Not Fear That Your Back Pain Will Last Forever and Will Not Keep You From Enjoying Life In The Future.
Through Examination, Movement Assessment, and Provider Palpation, At Least 1 Spinal Segment of the Lumbar Spine is Restricted/Hypomobile.
At Lease 1 Hip Has More Than 35 Degrees of Internal Rotation.
So What Does This Mean?
If you present to an office like ours with ACUTE LOW BACK PAIN that is RADIATING PAIN TO THE GLUTES, RESTRICTED LUMBAR SPINE ROM, and ONE HIP HAS RESTRICTED INTERNAL ROTATION ROM…
YOU ARE A GOOD CANDIDATE FOR SPINAL MANIPULATION
&
WE SHOULD ANTICIPATE GREAT RESULTS.
Two studies on spinal manipulation, utilizing these Clinical Prediction Rules found:
Patients who presented with less than 4 of the 5 above rules, had a 45% likelihood for a positive response from spinal manipulation.
Positive Response means that after 2-3 treatments with spinal manipulation, patients saw a 50% reduction in symptoms and pain.
A patient who presented WITH at least 4 of the 5 rules, increased their likelihood of a positive outcome to 95%.
Another study, utilizing a side-lying lumbar manipulation technique along with ROM exercises, found a 50% reduction in symptoms in 11 of 12 participants. The one participant who did not respond still found a reduction in symptoms, but did not reach the 50% reduction mark the study considered as a ‘positive outcome.’
In summary, Spinal Manipulation is an effective and safe tool for low back pain. But it is just that, a tool! Care that relies on only one treatment modality will only be somewhat useful to a specific, and small, population. Care that focuses on the patients' individual presentation and goals, and adapts a variety of therapies for that particular condition will typically yield the best results. If you have tried manipulation, PT, massage, dry needling, or any other therapy as a stand-alone treatment option, I invite you to give us a call to see how we can develop a better treatment plan around your personal goals.
Resources:
Cleland, JA et al. The Use of a Lumbar Spine Manipulation Technique by Physical Therapists in Patients Who Satisfy a Clinical Prediction Rule: A Case Series. JOSPT 2006.
Flynn, T et al. A Clinical Prediction Rule For Classifying Patients With Low Back Pain Who Demonstrate Short-Term Improvement With Spinal Manipulation. Spine 2002.
Childs, JD et al. A Clinical Prediction Rule To Identify Patients With Low Back Pain Most Likely To Benefit From Spinal Manipulation: A Validation Study. Annals of Internal Medicine 2004.
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.
Sciatica Pain Relief Part 4: Treatment & Rehabilitation
As we gather to close out this series on Sciatica, talking this time on what care looks like in our office when someone presents with Sciatic Nerve pain, you will recognize some similarities from the previous Sciatica-related articles. That is because rehabilitation for Sciatica is similar to the self-care and prevention exercises we shared previously. So…if you haven’t taken a look at our Sciatica Pain Relief series parts 1-3, click the links below and check them out. Our goal is to have you work through those modules before seeking care. You will often find that spending a week on the exercises we shared, might relieve your pain, and if maintained with some frequency, may prevent future occurrences. Nevertheless, if you are here, are located in Salt Lake City and the surrounding area, we are here to help.
As we gather to close out this series on Sciatica, talking this time on what care looks like in our office when someone presents with Sciatic Nerve pain, you will recognize some similarities from the previous Sciatica-related articles. That is because rehabilitation for Sciatica is similar to the self-care and prevention exercises we shared previously. So…if you haven’t taken a look at our Sciatica Pain Relief series parts 1-3, click the links below and check them out. Our goal is to have you work through those modules before seeking care. You will often find that spending a week on the exercises we shared, might relieve your pain, and if maintained with some frequency, may prevent future occurrences. Nevertheless, if you are here, are located in Salt Lake City and the surrounding area, we are here to help.
Treatment surrounding Sciatica takes on two parts: (1) Addressing the low back, regardless if low back pain is present and (2) Addressing the posterior hip, associated musculature, and its interaction with the sciatic nerve. One of these (#2) we can affect directly and often provide immediate relief. The other (#1) can be addressed by focused and modified daily action, joint mobility, decreased muscle tension, and…TIME.
Let's start with the low hanging fruit here. We have already discussed the association of the Sciatic Nerve and the muscles of the posterior hip. When it comes to treatment, our goal is to enact a change as fast as possible. We hope that patients come in having already tried stretching rolling, and increased movement to decrease the tightness and tension of the muscles in the back of the hip. From there, our job is to change the tissue in ways most can not do themselves.
Our typical treatment here is a combination or assisted progressive stretching, active and passive myofascial release movement, and dry needling…almost always dry needling.
To help understand what these treatments look like, check out these video demonstrations. These treatments have proven extremely effective in assisting patients to recover quickly from sciatica and sciatic nerve issues.
When it comes to rehabilitation, it is essential to understand that for the majority of people, even though the sciatic nerve radiating pain down the leg may have come on suddenly, it most likely took months to get to that point, leaving us with a bit of chronic muscle tension to address. THIS TAKES TIME.
When helping patients with their home care exercise plans, we look to address two areas, (#1) The Lumbar Spine, (#2) The Posterior Hip Muscles. If your problem is primarily in the hip/thigh region, exercise and daily life modification (usually sitting less) will bring quick and lasting relief. If your problem is primarily in the lumbar spine, our goal is to keep you as mobile and active as possible while the injury heals. Again…TIME.
POSTERIOR HIP MOBILITY
NERVE FLOSSING: Sciatic Nerve
LUMBAR SPINE MOBILITY & STABILITY
Sciatica is a common complaint, with a wide variety of causes. If you worked through our Sciatica Relief Series here and are still dealing with radiating leg and low back pain, please reach out to us with questions or come in for a consultation to further discuss your condition. If we can help you, we will let you know; if we can’t, we will get you to the best provider for your case.
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.
