Flexibility 101: Static vs. Dynamic Stretching

Have you ever wondered when you should be stretching with respect to your running program? More specifically, have you ever wondered what type of stretching you should be doing? While the research on stretching is a bit of a mixed bag, there are some tried-and-true principles to follow in book-ending your training runs, no matter your experience level within the sport.

Prior to running, we want to avoid static stretching, focusing rather on dynamic movements/stretches to warm up and prepare our muscles for the rigors of running. Static stretching has been shown to temporarily reduce the power output of our muscles, something we do not want to do prior to a run, as a reduced power output may make us slower. In contrast, a dynamic warm-up activates key muscle groups utilized during the running cycle in order to prepare those very muscles for sustained work. It is important that the dynamic warm-up closely mirror the physical demands of running in order to prepare the most appropriate muscles and tissues. In other words, performing walking lunges and skipping motions would be more appropriate than hitting a heavy bag. Finally, the dynamic warm-up should be simple and concise, requiring no greater than 5-10 minutes to complete. If longer or more complex, it is more likely you will skip it! Here is a sample dynamic warm-up routine:

Dynamic Running Warm-Up

Following your run, it is safe and appropriate to perform a static stretching routine, targeting the muscles and joints you stressed during your training run. Static stretching should be gentle and prolonged, holding each position for approximately 60 seconds. More aggressive stretching is not more effective, as it can more easily activate the stretch receptors in our muscles and tendons, limiting the ability for the muscles to relax and let go. Aggressive stretching also increases our risk of over-stretching and subsequently injuring our soft tissues. So keep it light! Key muscle groups to stretch following a run are the calves, hamstrings, quadriceps, and gluteals, all of which are primary movers during the running cycle. Here is a sample static stretching routine:

Static Stretching Cool-Down

Both routines should be easy and pain free. If you are experiencing discomfort with any of the positions, stop and move on. If possible, consult with a physical therapist or other medical professional if you have any questions or concerns regarding your specific stretching routine.

RUN ON!

-Grant Hennington, DPT

Tips For Training For Ski Season

With back-to-school just around the corner and summer coming to a close, here in the Pacific Northwest it’s time to start thinking about training for the upcoming ski season. As my inbox is flooded with emails about discounts on season passes and lodging at the local ski resorts, I cannot help but feel inspired to prepare for those long days in the backcountry or skiing laps on powder days inbounds. But what are some of the more important areas to focus on when building a ski conditioning program? While skiing can be a lifelong sport, it also carries with it high physical demands and risk of injury. Therefore, as with most sports-specific training programs, the key is including exercises that promote both injury prevention and performance enhancement. When it comes to skiing, exercises that improve strength, stability, and mobility are paramount. Here are a few examples:

• A retro floating lunge improves functional gluteal and quadriceps strength, while also promoting improved stability at the hip and knee joints, two prominent areas that can frequently be injured when skiing.

• Band-resisted side-stepping strengthens the gluteus medius, a muscle integral in controlling excessive rotation at the knee joint. Training this muscle is important in reducing the risk of ACL tears, an unfortunately common injury among skiers.

• Ankle dorsiflexion lunges help increase mobility at the ankle joint, allowing you sufficient range of motion to avoid back seat skiing.

• Lateral bounding facilitates improved stability at the hip and knee joints, while also strengthening the gluteals and quadriceps, helping you better hold your edge on more challenging terrain.

As with any training program, a slow and systematic progression is key to avoiding overuse injuries. Performing strengthening exercises such as these 2-3 days per week is enough to make improvements and more is not always better. Your program should be at least 8 weeks in length in order to provide adequate time for adaptive changes to take place to your musculoskeletal and cardiovascular systems. It takes time and consistency to make your muscles stronger and your joints more mobile! Finally, seek clearance from your physical therapist or primary care provider before initiating any new exercise program and stop if you find yourself limited by unrelenting aches and pains.

Fingers crossed for a big snow year. Hope to see you out there!

-Grant Hennington, DPT

Getting Back To The Basics For Health & Wellness

Raise your hand if you think you get enough exercise per week. Now raise your other hand if you think you get enough sleep per night. Are both your hands up? If yes, kudos to you, as statistically you are in the minority among adults in the United States. If no, where do you think you are lacking? According to the Centers for Disease Control and Prevention (CDC) adults need at least 150 minutes of moderate-intensity exercise per week and at least 7 hours of sleep per night. For those of you with both hands up, are you meeting these recommendations or do you need to put a hand down? The health benefits of regular physical activity are numerous and well documented, with exercise being linked with reduced risks of cardiovascular disease, diabetes, and several types of cancer. And we also know insufficient sleep has been linked with many chronic diseases, such as diabetes, heart disease, obesity and depression. Getting the picture? If you were to think of exercise and sleep as prescription drugs, they would be some of the most safe, effective, and affordable drugs in history, without the significant side effects of common pharmaceuticals. Exercise and sleep also appear to be equal opportunity interventions, as the health benefits apply to both men and women of all ages, races, and ethnicities, according to the CDC. Unfortunately, approximately one-half of adults in the United States do not get enough exercise per week and one-third of adults do not get enough sleep per night. This could partially explain why nearly two-thirds of adults in the United States are overweight or obese.

So why do we have such an inactive and sleep deprived population? Most of us could carve out 30 minutes per day for 5 days each week and tuck ourselves in 30-60 minutes earlier each night. So what’s the hold up? For one, starting to exercise regularly and sleep more requires behavior change, which can be difficult to initiate and stick with. Beginning an exercise program is often uncomfortable and unpleasant, especially if you are typically sedentary. The good news is there are several gentle forms of physical activity that fall in to the “moderate-intensity” category, according to the CDC:

• Walking

• Swimming

• Going for a bike ride

• Yoga

• Dancing

• Yard work

• Water aerobics

As you can see, there is no need to take up running or team sports if you want to get fit. It should also be noted that each form of exercise does not need to be performed all at once, as three separate bouts of walking for 10 minutes per day would count for 30 minutes and carries with it similar health benefits. An added perk is that regular physical activity has been linked with improved quality of sleep so you can be working on both aspects of health and wellness with one deed. What a deal!

So, if you find yourself not feeling well as of late, check in to see if you are meeting your basic physical activity and sleep recommendations first and foremost. If you are not, try to work up to it and see if it helps before turning to sophisticated and expensive tests, treatments, and/or procedures. If you are getting 150 minutes of exercise per week and sleeping 7+ hours per night, but are still not feeling well, then it may be appropriate to seek out an evaluation by a medical professional.

For more information regarding physical activity and sleep from the Centers for Disease Control and Prevention, click on the following links:

CDC Physical Activity Basics

CDC Basics About Sleep

-Grant Hennington, DPT

An Ounce of Prevention: Reducing the Risk of Ankle Sprains

A running joke in Seattle is that summer doesn’t start until July 5th, which therefore means prime hiking season is now upon us. Exploring the mountains and alpine lakes of the Pacific Northwest can be an excellent form of exercise, bringing with it numerous benefits to your musculoskeletal and cardiovascular systems. But with those benefits also comes the risk of injury, with ankle sprains being a common culprit. In fact, ankle sprains make up approximately 45% of all sports-related injuries in the United States. While most ankle sprains will heal over the course of 2-8 weeks, 73% of individuals who have sustained an ankle sprain once are likely to sustain another ankle sprain in the future. Fortunately, the risk of ankle sprains can be reduced via injury prevention programs. In fact, those who have sustained an ankle sprain in the past benefit even more from these injury prevention programs, experiencing a greater reduction in risk than those who have never sprained an ankle. However, the overall risk of ankle sprains is still higher in individuals who have a history of an ankle sprain. The best predictor of a future injury is a past injury. We cannot change the past, but we can alter the future by performing targeted exercises at the ankle joint.

So what do these injury prevention programs look like? The primary goal is to improve ankle stability via balance/proprioceptive exercises, which are the gold standard for reducing the risk of ankle sprains. Standing on one foot with your eyes open on flat ground is a solid baseline, for which you should be able to balance for 60 seconds without having to catch yourself. If you can do this without much of a challenge, a simple progression is to close your eyes, which will make the exercise significantly more difficult. Our vision is one of three systems to contribute to our sense of balance and typically the one we rely on most. So, when we close our eyes we are down to two systems and are therefore less efficient at maintaining our balance. Once this is mastered, one could advance to performing single leg balance with motion on the opposite side of our body, further challenging our limits of stability. Here is an example:

Single Leg Balance Progression Video

Balance exercises like these can be performed every day in order to reduce the risk of ankle sprains when hiking, backpacking, or trail running. Perform balance exercises barefoot in order to make them more challenging. As always, all exercises should be pain free and you should get approval from a healthcare provider before beginning a new exercise program following an injury. Once cleared, find a safe and quiet place to stand on one leg and test your limits of stability.

-Grant Hennington, DPT

Common Myths About Back Pain

Raise your hand if you have had or currently have back pain. Is your hand up? Studies suggest that approximately 80% of individuals will experience back pain at some point in their life and about 40% of individuals at a large gathering will currently be suffering from back pain. Translation: back pain seems to affect us all. In fact, back pain is the second most common reason individuals will see their doctor, trailing only the common cold. Unfortunately, we think about and treat back pain very differently than the common cold, with significantly more fear and anxiety surrounding the condition of back pain, when in all actuality, it is no more severe of a diagnosis. Like the common cold, the vast majority of cases of back pain will improve over time and do not require sophisticated or complex medical interventions. So why then do we worry if our back pain will get better or not when we do not seem to carry this same worry with respect to the common cold? The answer is we have not always taken the best approach to educating the population about back pain, leading to various misconceptions and myths that perpetuate unhelpful beliefs and behaviors. So let’s address some of the common myths about back pain.

Myth: If my back hurts, I need an x-ray or an MRI in order to find out what is wrong so I can fix the problem.

Incorrect. It is very unlikely that the findings of an x-ray or MRI study will change the treatment strategy, unless the decision is whether or not to undergo surgery. In fact, x-ray and MRI findings have been shown to be poorly correlated with back pain. A deeper dive shows that approximately 40% of individuals WITHOUT back pain will demonstrate abnormal findings in x-ray and MRI studies. There is even some recent evidence that suggests individuals who receive x-ray or MRI studies early on in their recovery have worse outcomes than those who do not receive early x-ray or MRI studies. The fact is most cases of back pain will improve without expensive scans or complicated procedures. Education and exercise seem to be the keys to success.

Myth: My back hurts because I am old and have arthritis so there is nothing I can do about it.

False. Old age has not been linked with back pain. In fact, individuals between the ages of 30 and 50 have the highest rates of back pain. After the age of 50 your risk of back pain is actually slightly lower. Furthermore, most studies suggest that degenerative changes (i.e. arthritis) begin after the age of 30 and progress throughout our life span. So if arthritis always resulted in pain, why do individuals in their 30’s not have higher rates of back pain than individuals in their 70’s? The answer is because arthritis and back pain are not strongly linked and therefore not a scarlet letter one needs to carry with them or be fearful of.

Myth: I injured my back 10 years ago and I don’t think it ever quite healed.

Unlikely. Tissues heal. Most of the evidence suggests that bones, muscles, tendons, and ligaments completely heal after approximately 3-6 months. While the pain people experience can persist long after 3-6 months, that is not indicative that the injured tissue did not heal. Pain and injury are not one in the same. While it is true that most injuries carry with them pain, many individuals experience ongoing pain beyond the healing time of the injury they sustained. Why is this? Pain is an output of the brain and can be the result of an overactive nervous system. Pain functions to protect us from danger or potential threats in our environment. If we touch a burning hot stove, pain results in us removing our hand to avoid further injury to our skin. However, sometimes our nervous system protects us TOO much, sounding the alarm in the absence of something truly dangerous or threatening. Think of experiencing back pain from sitting or standing for 5-10 minutes. There are few cases where this is dangerous or inciting injury to tissues, but people often experience back pain with as little activity as this. This is most likely the result of an overactive or extra-sensitive nervous system, not an injury that never healed. So what can we do about this? Studies suggest education is the first line of defense. The more we know and understand about the science of pain, the less pain we tend to experience. Gentle exercise, activity modification, graded exposure, and pacing are also effective tools, all of which can be implemented by your physical therapist.

The take home message is if your back hurts there is usually something you can do to make it feel better without expensive scans or complex surgical procedures. There is good evidence for education, exercise, activity modification, ice, ergonomic adjustments, massage. The key is to take an active approach and to be patient, which is easier said than done. But the good news is the majority of cases of back pain will improve with time.

-Grant Hennington, DPT