Exercise Spotlight: The PUSH-UP!

Push-ups can be a great full body exercise that is easy for anyone to perform anywhere. All you need is a floor. You may think of the push-up as being predominantly an arm strengthening exercise (pecs and triceps), but if you perform it properly, you will also provide your core, and scapular stabilizers (serratus anterior) a great workout as well. If you are not using these muscles and properly aligning your body, you may be placing excess sheering, compressive, or torsional loads to the shoulder or spine. Below, Tara and Anya outline some key points to think about the next time you do a push up and provide a great example of good technique vs. poor technique with the push-up exercise. 

Avoid Training Error, Avoid Injury

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By: Anya Gue, PT, DPT

Many runners have taken the winter moths to take a little break from running and embrace the snow and, for some, the gym. As the temperatures rise, the snow melts, and the birds start chirping, its hard not to lace up those shoes and hit the trail. Especially if you've maintained some decent fitness over the winter, it can be easy to ramp up those miles rather quickly... a quick jog down the river path, a huff up to the "M,"and what's that I hear..., Jumbo's open? Got to hit that! If you're not careful, you may find that you are increasing your running mileage too quickly. How quickly is too quickly? As you may guess, the answer is very dependent on the person as well as underlying fitness, running intensity, ability to recover, and previous running injury history. When a runner increases running volume and/or intensity too rapidly, it is referred to as "training error." While there are so many articles, blogs, and social media posts outlining various stretches and exercises to perform in order to prevent injury, the topic of training and recovery tactics is often overshadowed and underemphasized. I can't tell you how often I have runners come into the clinic saying, "I was doing so well until..." Running related injuries are often due to a relative overuse (tissue overload) due to the repetitive nature of the activity, so you can see why management of your training loads and learning to listen to your body is an essential skill in injury prevention. 

In this post, I will outline and discuss some principles and tactics you may want to consider and practice in order to avoid injury due to training error and follow up with a few examples. In a series of following posts, I will dive a little deeper into some tools you may use to monitor composite training loads, how to manage cross training in the "on" season, and how psychological factors may contribute to training error. 

For now, lets dive into some tips to get you started:

1) Record your training It only takes a few minutes to jot down your distance, time, and effort for a particular run or cross training activity. This doesn't have to turn into an obsession of paces and perfect distances/times, but you can think of it as simply gathering data. By tracking your workouts, you can have a way to see if you have any rapid jumps in quantity or intensity. If you develop a seemingly random ache/pain or unwanted fatigue, it helps to be able to look at the training history to find a possible cause. Often, people find that they either significantly underestimate or overestimate how much they are training. Either of these can lead to injury or sub-optimal performance.

2) Follow the "10% rule"- or at least something close to it. Yes, it feels painfully slow in the beginning, but there have been multiple studies indicating a significant increased injury risk when running mileage is increased by >10% over consecutive weeks. This "rule" does not have to be followed strictly, and should vary a little depending on experience, time taken off from running, etc. I tend to use a 10%-30% rule, allowing for a little higher jumps on occasion when a runner has either maintained a good base, or has not had a reduced volume for a very long time, and/or has been cross-training appropriately. However, to have the lowest risk of injury, you would want to stick to 10%. You can find a link to a summary of an article published in JOSPT that discusses some evidence behind the 10% rule Here. If you participate in activities other than running on a regular basis, you do have to account for the stress of these activities as well. I will talk about how to account for the cumulative stress of all of these activities in the a future blog post.

3) Keep long run distance increase between 0.5-2 miles/week. It makes sense that your body may not respond well to a jump in a long run of 6 miles one week straight to 10 miles the next (if it's been months since you've run that far), even if you still manage to adhere to the "10% rule." When weekly mileage is relatively low (10-30 miles/week), your long run should not increase by more than 1 mile. If you are a veteran runner, or you've managed to get your weekly mileage up to 40-50 miles/week, you may be able to safely increase that long run by 1-2 miles at a time as long as you were able to complete your previous long run without any negative outcomes. 

4) Plan your training! For some, this may be a weekly outline of the approximate total weekly mileage and where it's distributed. For others, it may be a 3-6 month periodized training schedule with hopes to peak for goal races. In order to follow the previous suggestion of gradual progressive increase in mileage, you have to plan a little so you don't find yourself nearing end of your week with an already 15% increase in weekly mileage only to be tempted by an invite on a social 10 miler that jacks up that increase into the >30%. Planning your training progression may also help you avoid rapid jumps in training volume that occur out of necessity when you realize you have a big race in 1 month that you had to sign up for 6 months ago (because that's how things tend to be now), and realize that your volume is no where near where it should be in order to be adequately prepared.  Making at least a loose outline of where you want to spend your miles can be very helpful in giving you an idea of the reality of what your running week should look like. You don't have to stick to it to the exact 10th of a mile and you can always alter as you go depending on outside life influences, and fatigue levels.

 5) Plan your recovery! Even more important than planned training is planned recovery.  Even the best training plan is only as effective as the recovery. While high training loads are essential for improving physical and psychological fitness for improved performance, there has been ample evidence suggesting that performance will decline if adequate recovery is not allowed. Recovery does not only include rest from physical activity, it also includes obtaining adequate sleep, and nutrition. Fatigue occurs when training demands are high, and recovery is low. Of course fatigue is  to be expected with any training plan, but know that your performance will decline and your injury risk will increase if your recovery is consistently inadequate and your fatigue levels continue to increase over a prolonged period of time.

6) Listen to your body! This can be difficult if you have made a training plan and are determined to stick to it no matter what. Even the best laid plans for training and recovery do not always align with what your body needs when you are in the midst of training. Remember that your ability to recover is highly dependent on many extrinsic factors that can change from day to day. It's impossible to know how you will respond to a given training load. Learning how to listen to your body and respect when it may need an extra rest day or when you might be better off skipping a track workout can be very tricky, but so important! So I say, have a plan, but be ready to deviate from it and modify as you go.

Now, consider this equation:

Fitness - Fatigue = Performance

Usually, the end-goal of training is to increase your performance ability. Lets use this equation in a hypothetical case of  a runner who decided to start training for  marathon after a winter of mild-moderate activity. Let's look at how his equation may look (relative to his running fitness and performance specifically) throughout his training cycle and where he could go wrong if adequate rest is not observed (rating on 1-10 scale with 1 associated with low, and 10 associated with high):

He has maintained some fitness through the winter with his skiing and gym workouts and begins to run more consistently. He feels a bit slower than he has been, but his legs are fresh:

Fitness (4) - fatigue (2) = Performance (2)

As he continues to progressively increase training loads, his equation shifts:

Fitness (7) - fatigue (4) = Performance (3)

He listens to his body, plans a easier week:

Fitness (7) - fatigue (1) = Performance (6)

*He's getting faster!

But lets say, he decides, "wow, I'm really starting to see some improvements, I'm gonna really train hard, because I might just be able to crush this race!" He chooses not to rest, even though his body is tired:

Fitness (7) - fatigue (6) = Performance (1) 

*Even though he has not lost fitness, his performance level drops

He is upset to see a drop in his tempo run pace, and decides he is not training hard enough, so he continues to ramp up the effort:

 Fitness (7) - fatigue (8) = Performance (-1)

*Uh-oh. Thing's are not looking good. I don't even know what a negative performance means since these numbers are arbitrary, but it seems like it would be associated with increased injury risk, or perhaps a product of "overtraining" 

In this example,  you can see how recovery can effect your ability to progress your performance and how psychological factors may inhibit your ability to properly practice rest and recovery

Here are a few more examples that tie together all of the above tips.

A) Image of an individual's training log who demonstrates several issues in her training progression (this is not a real person, but it is very similar to many that I have seen):

Experienced runner who has been running very little over the winter. She is signed up for a 50k at the end of June.

Experienced runner who has been running very little over the winter. She is signed up for a 50k at the end of June.

Although it appears that this individual was fairly conservative with the increased mileage by starting out with relatively short runs, you can see several places where she demonstrates "training error": 1) She is inconsistent and demonstrates several very large jumps in weekly mileage; 2) she was a bit too aggressive, I would say, with her relatively large increase in long run mileage (orange); 3) She has NO rest days in the weeks of May 5th-June 4th (yellow). Unfortunately, she was not able to participate in her race due to development of knee pain. BUMMER!

B) Image of an individual's training log who demonstrates wise training progression

Moderately experienced runner who did not run much at all for the past 4 months...should have started a little sooner if he had hoped to be up at 50 mile weeks back in June...

Moderately experienced runner who did not run much at all for the past 4 months...should have started a little sooner if he had hoped to be up at 50 mile weeks back in June...

This individual followed the 10%-15% rule. But, you can see that he was not running a 50 mile week until the end of July. You can also see how slow the progress was in the initial 4-5 weeks. It's great to take a period of time during the year where you run less or not at all, but know that if you have hopes to be running high mileage weeks or long races over the summer, you need to plan your progression carefully and start building your base back up at an appropriate rate, and you need to give yourself adequate time to get to your goal weekly mileage or long-run mileage. 

Unfortunately, there is no cookie-cutter way to train. Everyone is different in baseline fitness levels, ability to recover, and susceptibility to "over-doing it." Another huge factor in how well an individual may tolerate progressive increase in training load is underlying tissue strength and tolerance to load. Additionally, we have not even discussed how training intensity and cross training fit into a training plan or how phycological factors can lead to training error. Stay tuned for more discussion regarding these issues on this in the next post!

Please feel free to comment or contact me at endurancephysioanya@gmail.com with any comments or questions. 

Thanks for reading! Happy spring running

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Pelvic Health Physical Therapy Following Abdominal or Pelvic Surgery

The months after a major abdominal or pelvic surgery can leave you feeling discouraged, lost, and unsure about how to begin feeling like your former self again. Never fear, pelvic health physical therapy is here! Endurance Physio’s Tara Mund is passionate about helping patients navigate their post surgical recovery and safely return to a healthy active lifestyle.

Whether you had a C-section delivery, hysterectomy, prostatectomy or hernia repair surgery, it is undeniable that the pelvic floor and core muscle function is altered post operatively. Taking the time to re-establish correct pelvic floor and core muscle activation can make all the difference between a successful recovery and a frustrating injury prone journey.

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In addition to training pelvic floor and core muscle function, scar tissue is also a common concern following surgery. Physical therapy can help manage this with scar tissue mobilization to keep you moving well. Diaphragmatic breathing, stretching and self scar mobilization are all tools you can use to maximize your recovery with your home exercise program.

Finally, once you have re-trained your pelvic floor and core muscles and are managing scar tissue, it’s time to learn how to gradually resume activity. Walking is often a good place to start, but for how long, how often, and when to progress can be unclear. Even if you have been cleared by your doctor, your body may not feel ready to get back into running or your old weight lifting routine just yet. This is where individualized attention from a professional can be an invaluable tool to help guide this process. Endurance Physio will give you step by step instruction on how to gradually progress, focusing on your specific target areas of weakness while learning excellent form and body mechanics. We will teach you how to take care of your new body and potentially make it even better than it was before!

For those of you who may be a bit more competitive in your sport, did you know that at Endurance Physio we have both a biking and a running specialist? Jamie Terry, DPT and Anya Gue, DPT are able to perform specialized bike fitting as well as video running analysis. No matter what your goals are, at Endurance Physio we are here and ready to help guide you as far as you can dream to take it.

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Exercise Spotlight: The Basic Clamshell

If you're gonna do 'em, do 'em RIGHT!

So you're lying on your living room floor going through the motions of a clamshell because you read in Runner's World that it would make your knee feel better, or keep you from getting injured during your marathon training (or because your physical therapist said you should;-). You finally decide you've done enough because you kind of feel like you could lay there and do them all day and you're antsy to get on to your run or ride, or ski etc. You feel some sense of gratification because you at least tried to do something good for yourself, but you're still a little confused as to what the exercise did for you. If this sounds familiar, then you are either doin' it wrong, or you don't need to be doin' it at all!

Refer to the following videos and explanation of when the clamshell exercise may be an appropriate exercise to incorporate into a strength or rehabilitation routine

Although it is not very functional, requires only a relatively small amount of actual movement, and, quite frankly, looks a little silly, the clamshell has it's time and place for being an effective exercise to incorporate into a rehab, prehab, or general strength routine.  

Inappropriate use of the clamshell:

  • Performing with poor technique (see the video)
    • Allowing pelvis to rotate towards the ceiling as you lift the knee
    • Anteriorly tilting pelvis as you lift the knee
  • Performing without sufficient loading or functional application 
    • If you are trying to actually build strength and muscle hypertrophy and it takes 20 or even 50 reps to begin to fatigue the muscle, you are not going to effectively build strength or hypertrophy the muscle. Instead, you will need to add load with the use of a resistance band around the knees and create fatigue within 10-15 repetitions
    • If you are working on using the muscles during biking and running, you had better also be performing some kind of exercise that will fatigue the muscle in a more functional motion such as single leg squatting, lunging, and plyometrics. 

Appropriate use of the clamshell:

  • For "neuromuscular awakening": Perform as a warm-up prior to higher level exercises in order to improve the central nervous system recruitment of the muscle so you are able to use them during higher loading, more complex functional exercises, or even prior to participating in your sport of choice. 
  • For isolated hypertrophy and strengthening: You may add a resistance band in order to around the knees in order to increase load and fatigue with fewer reps (perform 3sets of 10-15). When I say fatigue, I mean, you can't do any more without breaking technique and your butt is burning!
  • To build muscular endurance of the hip abductors/lateral rotators You may use it as a part of a side lying series  that will work on improving the neuromuscular connection, and building endurance in the most important hip stabilizing muscles (Refer to additional videos for ideas here)
  • For strengthening when weight bearing exercise is not an option due to injury or post-operative status

EMG studies have shown that, when performed against gravity, the clamshell exercise requires a relatively small amount of gluteus maximus (GMax) and gluteus medius (GMed) compared to some other exercises (single leg squats, side plank with hip abduction, lunges etc). However, many folks who would benefit from gluteal strengthening need to do so because of an imbalance in their hip musculature. They tend to  overdevelop the large powerful muscles such as flexors (TFL, rectus femoris)  and the muscles that are meant to stabilize the hip and pelvis become underdeveloped and subsequently weak. In order to restore a proper strength ratio of these muscles, it is essential that one chooses an exercise that will work the weaker muscles more than the already overly developed ones. Otherwise, your imbalance will only continue to exists and potentially become even more pronounced. In order to strengthen the gluteals without those larger muscles taking over, one must first isolate and activate them to assure they can find them and utilize them in more functional and higher load exercises. The clamshell is a great place to start. 

In order to get the most out of this exercise, it must be performed with excellent technique. If you perform clamshells and are unable to feel significant muscular fatigue,

then you are probably not performing it appropriately! 

Thanks for reading! 

Anya Gue, DPT

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Clamshells...They are so glamorous! 

Fixing the Leak

Urinary incontinence is something that is very common among women and men in the United States. It is a problem that is often ignored and accepted as a normal part of aging, or something that all moms deal with after childbirth. Incontinence can be embarrassing to talk about, and since there is an entire aisle dedicated to this in the stores, it must just be part of life right? Actually, many people are not aware that there are simple things that can be done to address urinary leakage and pelvic health physical therapy can help.

The specific type of treatment for incontinence is very individual and dependent on your symptoms and muscle function. That is why it is important to seek care from a professional instead of googling “how to do a Kegel” or even following a generic handout in an attempt to strengthen your pelvic floor muscles. Depending upon whether you are experiencing urge urinary incontinence, stress urinary incontinence, or a mix of both, your treatment could include strengthening, muscle re-training, bladder training, fluid intake modification or a combination of these.

Tara Mund, DPT, is Endurance Physio’s pelvic health specialist and she has been helping women and men address urinary incontinence in Missoula for the past 10 years. Tara understands the importance of a customized treatment approach to meet your individual needs and goals. Whether that means running a marathon or just playing with your kids, Endurance Physio wants to see you get back to being the best version of yourself!

Contact Endurance Physio to make an appointment (926-2150), or email Tara with any questions at Endurancephysiotara@gmail.com.

Endurance Physio is Taking Care of Missoula Moms

Tara Mund, DPT, Endurance Physio’s pelvic health specialist, is committed to helping moms get back to doing the activities they love. Pregnancy and childbirth can pose many challenges for a women’s body. When it’s time to get back to being physically active, many moms are left confused as to what to do and when to start. There are also other common factors such as C-section delivery, diastasis rectus abdominus, and urinary incontinence that further complicate this decision. Although tempting, putting on your old running shoes and heading straight out for a jog is not your best plan for safely getting back into shape.

Tara emphasizes the importance of first building foundational strength with focus on pelvic floor, core, hip, and postural muscles. Pelvic health physical therapy can provide you with a systematic, individualized plan to get back to all of your previous activities feeling strong and confident.

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Tara hiking with her two kids this summer

Tara hiking with her two kids this summer

 

Contact Endurance Physio to make an appointment (926-2150), or email Tara with any questions at Endurancephysiotara@gmail.com.

Exercise Spotlight: Hip Hinge

The concept of a hip hinge movement pattern is essential for anyone that moves.

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What do I mean by "hip hinge"? Hip hinge is a sagittal plane movement where the hips are the axis of rotation between a neutral lumbopelvic segment and a femur (your thigh). (**See below for further discussion regarding hip hinge definition)

This sounds simple, but it can actually be quite difficult to know were your body is in space and to isolate movement to one joint while stabilizing at another joint- especially when you are trying to stabilize a column of many joints (the spine), while only moving at the hip joint.  The ability to control a hip hinge movement is extremely important for optimal mechanics during weight training, yoga, running, cycling, daily activities (lifting, bending), and much more.  It requires coordination between your core stabilizers and your gluteal musculature, as well as a high level of body awareness and motor control. The inability to dissociate hip movement from spine movement can lead to decreased performance and increased risk for injury. At Endurance Physio, we often teach our athletes/patients this concept before we progress to higher level exercises.

Below, are 2 videos that demonstrate how to practice a hip hinge movement (1st video) and how to apply it to a squatting motion (second video).

Once you are able to perform the movement without the cuing of a dowel or mirror, you may apply it to many other movements. To name a few:

  • Running/hiking (especially uphill)

  • Unloading the dishwasher (that's right:)

  • Downward Dog (yoga pose)

  • Raking leaves, shoveling snow

  • Bending down to pick up your 2 year old child

  • Any strength training that involves lunging, squatting, single leg squatting...

I think you get the gist

More on the definition of a hip hinge...

**In the world of olympic weight lifting, the "hip hinge" exercise is generally defined as an exercise where you bend forward with maximal motion at the hip and minimal motion at the knees. This is often also referred to as a deadlift. This is often contrasted by a  traditional "squat," which is more focused on maximizing knee flexion and minimizing hip flexion by keeping the chest upright. The main difference between a hip hinge and a traditional squat is where the the primary torque occurs. In a hip hinge, the torque is focused at the hip, resulting in the majority of the load at the gluteal and hamstring musculature (posterior chain) as opposed to the quadriceps. In the traditional squat, the torque is primarily at the knee joint with the majority of the load in the quadriceps as opposed to the gluteals. Based on my definition of a hip hinge stated above,"a saggittal plane movement where the hips are the axis of rotation between a neutral lumbopelvic segment and a femur (your thigh)," the concept of hinging at the hip can be applied to either exercise. The idea is that you move at the hip joint without flexing or extending in your spinal segments.

More on squats...

A squat can fall on a continuum of the 2 extremes listed above and become more of a hip-dominant exercise that will load the glutes, or a knee dominant exercise that will load the quads. 

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So is one way better than the other? IT DEPENDS! From the point of a physical therapist and injury management/prevention, either way can be more beneficial depending on the individual, the injury, and the goal. For example, if you are cyclist with anterior knee pain and an imbalance where your quads are disproportionately stronger than your glutes and hamstrings, I would recommend working on the hip/glute dominant squat pattern in order to load and strengthen the glutes and decrease load to the knee and quads. However, if you are a skier with relatively weak quads and/or patellar tendinosis, I may recommend a more knee/quad dominant squat in order to progressively load and strengthen the quad muscle and tendon. That said, I more commonly see an issue with quad dominance and posterior chain weakness, so it is more common that I work with individuals on mastering a more glute dominant pattern in order to uptrain the glutes and downtrain the quads. In my opinion, if there does not appear to be an imbalance, a squat should be somewhere in between the 2 extremes so that both the gluteals and the quads are loaded and fatigued.

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If you have any questions or additional comments regarding this discussion, please feel free to contact me at endurancephysioanya@gmail.com or comment below. Thanks for reading!

Plantar Fasciosis- Why is it happening to me, and why isn't it easier to get rid of?

By Anya Gue, DPT

https://www.consultant360.com/content/plantar-fasciitis-office-management

https://www.consultant360.com/content/plantar-fasciitis-office-management

Plantar heel pain, most often diagnosed as plantar fasciitis or plantar fasciosis, affects approximately 10% of the population. So if you happen to develop this issue, what should you do? Stretch your calves? Buy some supportive orthotics? Strengthen your feet? Unfortunately, there is no one magic treatment that works for all individuals, but I am hopeful that this article will provide a little guidance to help you better understand the next step you need to take in order to get on the right track to rehabilitation.

Most often, the development of plantar fasciopathy can be attributed to one or more of the following musculoskeletal impairments:

  • Stiff calf musculature or ankle joint restriction leading to limited ankle dorsiflexion mobility
  • Excessively low and overly compliant medial longitudinal arch (pes planus) 
  • Excessively high and ridged medial longitudinal arch (pes cavus)
  • General foot and ankle muscle weakness
  • Poor motor control and proprioception of the foot ankle
  • Poor proximal strength of the hip and core leading to impaired mechanics at the foot 
  • Significant increase in load to the foot muscles and ligaments over a short period of time. For example: increase in running mileage or intensity; increase in time on feet during the day in general; abrupt change in footwear from supportive shoe to less supportive shoe

Once the overload and acute damage to the plantar fascia tissue has occurred, the best action for treatment should include several different steps:

1. Protect the overloaded tissue to allow for healing and pain reduction to occur (reduce stress to the plantar fascia by reducing time on feet, use of a heel lift and/or orthotic (more on this in the discussion below), and activity modification

2. Address any underlying impairments- this may mean aggressive calf stretching, use of night splint, foot strengthening, and/or movement retraining. You may want to consult with a physical therapist to determine what these are for you as an individual.

3. Address any extrinsic loading issues such as managing training volume, poor footwear, or excess time on feet

4. Progressively re-load the tissue without overloading and causing more damage. This part can be tricky and must be very patient specific. Often the pain that results from plantar fascia injuries is correlated with microtearing and change in composition of the structural collagen fibers. If the tissue is completely unloaded and allowed to "rest," it will likely continue to remain in this state. It must be stimulated to remodel back to its functional form. Most recent research has revealed that this can best be achieved through a loading program that is progressed based on symptom presentation and pain provocation.

Is it worth buying orthotics?

Collapse of the medial longitudinal arch places excess stress on the plantar fascia

Collapse of the medial longitudinal arch places excess stress on the plantar fascia

It would be nice if treatment was as simple as buying the right orthotic, putting it in your shoe, and BAM...pain is gone. Shoe inserts, or foot orthoses are one of the most commonly prescribed treatments for plantar heel pain, but the evidence to support this as an effective treatment is outdated and conflicting. However, in September 2017  a systematic review and meta-analysis was published in the British Journal of Sports Medicine with some useful results:

A foot orthosis is meant to provide support for the medial longitudinal arch and decrease the stress on the plantar fascia

A foot orthosis is meant to provide support for the medial longitudinal arch and decrease the stress on the plantar fascia

Do foot orthoses reduce pain? In the short term of 0-6 weeks, there was no significant reduction in pain. There was a moderate reduction on pain in the medium term of 7-12 weeks, and there was no conclusive reduction in pain in the long term of 13 to 52 weeks. 

Are custom orthotics any better at reducing pain than prefabricated? Not necessarily! The results of this study indicated no difference in pain reduction between the custom orthotics (often very expensive) than the prefabricated orthotics.

In conclusion, treatment of plantar fascia pain needs to be individualized depending on the causative factors. Shoe inserts may be an effective way to reduce symptoms, but custom orthotics are generally not necessary. 

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If you have any questions or comments regarding this post, please feel free to contact the me at endurancephysioanya@gmail.com or comment on blog post below. Thanks for reading!

 

Reference:

Whittaker GA, Munteanu SE, Menz HB, et al. Foot orthoses for plantar heel pain: a systematic review and meta-analysis. Br J Sports Med Published Online First: 21 September 2017. doi: 10.1136/bjsports-2016-097355

Welcome, Tara!

We are excited to announce that Tara Mund, DPT has joined Endurance Physio! She started with us September 21st and is currently accepting new patients.

Tara has worked in Missoula as a Physical Therapist for the past 10 years specializing in treatment of pelvic health conditions. She has completed extensive post-graduate training in this area including a Certificate of Achievement in Pelvic Physical Therapy (CAPP), and currently is the only therapist in Montana who has completed this training. Treatment of urinary incontinence, pelvic pain, pelvic organ prolapse, and post abdominal/pelvic surgery care, are among the diagnoses that she specializes in treating. 

At Endurance Physio, we are committed to helping patients get back to doing what they love. We are happy to be able to offer Tara's expertise in helping patients achieve this. 

Tara can be reached by calling us at 406-926-2150 or by email at endurancephysiotara@gmail.com.

Please join us in welcoming Tara to the Endurance Physio team!

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Taper Tips from Endurance Physio

Tom Robertson Photography

Tom Robertson Photography

The final weeks leading up to a big race can feel exciting, yet nerve-wracking . After so many weeks of hard training, the time has come to back off and let the body rebuild, refuel, and recover in preparation for the big race. Although the physical demands are are lessened during a taper period, the mental demands are high. Supposedly at this point "the hard work is done," but I find the taper to be particularly difficult to execute properly.

Often, you feel quite ready for such a break from the high volume, but it is not uncommon to experience feelings of anxiety and distrust in the taper process.  You are probably not alone. Here are some common feelings that are experienced during a taper and some tips to ease anxiety and help you make the most out of your taper:

  • Feeling like you might be losing fitness with the reduced training volume This is understandable, but remember that you can not fully benefit from the hard training you have put in if you don't allow your body to recover. Resist the temptation to add extra mileage or hard workouts to your training. You are not going to create fitness in the last week before your marathon and adding in "junk miles" or an extra tempo run will probably only tire you out. If you want to make sure you keep your legs ready to run fast, integrate a mile of race pace into your easy run or finish up with a few strides.

  • Noticing aches and pains that you didn't have while in the thick of training Now this is nerve-wracking! By nature, a hard training plan will put you on the edge of injury as you purposefully stress your body in order to crease an adaptive response to increase speed, strength, and endurance. The stresses of training can accumulate and your body may fall behind in tissue repair and energy reserves just as you begin to taper. If you are noticing new pain during running during the final week of training, don't be afraid to skip out on a few of your short easy runs. Missing a few of these in the last week of training is not going to make or break you race, but it might give your body just enough time to repair the broken down tissues.

  • Feeling abnormally fatigued If you back off on mileage and intensity, you should start to feel fresh and energetic, right? On the contrary, runners will often find they feel extra fatigued during their taper with "heavy legs" when walking up a flight of stairs, or on their easy runs. I can't clearly explain why this happens, but I believe a lot of this is mental: you know you are about to undertake a significant physical challenge and want to be well rested, so any sense of fatigue can be magnified in your brain. You are likely in a form or subconscious conservation mode. When in the middle of your training, you may have been willing to put out every bit of effort possible to make it through your long tempo run. Your body and brain know better at this point and something inside says "whoa there, hold back and save it for the race."Also, although you have reduced training volume and intensity, your body is still working herd to recover from the previous hard weeks of training. This takes energy! Try not to let these feelings mess with your head. Embrace the fatigue and trust that your body will be ready to roll come race day, especially if you visualize and expect it to.

  • Slashing calories because you aren't running as much True, you may not need quite as many as with your highest volume weeks, but remember that you still need adequate fuel to rebuild and repair your tissues, as well as to fill those glycogen stores. Now is not the time to try to drop a pound or two before race day. Being in a calorie deficit is the last thing you need at this point.

  • "Carb loading" the day before the race You should be filling your glycogen stores throughout the week prior to the race, not just the day before. The best advice I can give here is not to change your diet the week and day prior to the race. For example, if you don't usually eat pasta, don't feel like you should load up on it the night before. This can lead to a belly ache and many unwelcome pit stops during the run.

  • Feeling antsy to run more because you simply just love running It makes sense that most people training for a running race love to run. Often runners who don't get to run as much as they want can get grumpy or antsy to run. Inherently, you should be running less than you are used to during a taper. Try to be proactive with this and make a list of things you want to get done in place of running. Mentally prep yourself for swapping a little of your running time for something else. With the amount of time that you have likely put into training, there is surly something out there that you have fallen behind on- garden, laundry, a good book... Enjoy every second of your shortened workouts and know that soon enough, you will get your fill.

  • Your physical therapist, doctor, or coach told you to take 4-5 days off to let one of those aches/pains calm down for the race Luckily, as previously discussed, you won't lose your fitness in a few days of no running. The biggest problem here is that you may begin to doubt your body and lose confidence that you can achieve your personal race goals. Best thing to do is let your body rest and rebuild for these 4-5 days (or sometimes longer if needed/possible). During this time, you can visualize yourself running the race and hitting your time goals with no pain. It sounds cheesy, but it really is better than sitting there worried that all of your goals should be forgotten. The day before the race, go for a short test run with some strides (50-100m of faster paced running). If you are still feeling significant pain, then the race will likely not feel much better the following day. If you feel good, then it can give you that mental boost that you may be needing-"maybe I didn't lose it all." While I encourage a positive attitude in this type of situation, it's still a good idea to also mentally prepare for the possibility that the injury may rear it's head half way through, leaving you with the potential choice of dropping out or limping it in. This is always a possibility with racing.

Tom Robertson Photography

Tom Robertson Photography

  • Use your non-running time to visualize your race Just because the hard training is done, doesn't mean you can let up on your mental efforts for success. See yourself at the start and in the first few miles feeling good but not going out too fast. Imagine how you will likely feel in the last 1/3 of the race- tired and like you want to slow down but pushing through and staying strong, relaxed, calm and confident. Visualize yourself catching that second wind and kicking it into the finish line with your goal time displayed overhead. At this point, your physical training is pretty much over, but it is the crucial time for mental preparation.

I hope some of these thoughts help you be as ready as you can be for race day.  

GOOD LUCK MISSOULA MARATHON PARTICIPANTS!!!

Anya Gue, DPT

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