Core training for runners: Focus on axial positional neutrality first.

Core training is a term often referring to abdominal exercises that are generally good for everybody including runners to perform for injury prevention and performance. The understanding of the public is shifting beyond just abdominal exercises, thankfully. The goal for this post is to broaden the frame on what core training is and its purpose.

(Axial) Spine, thorax (rib cage) with shoulder girdle, hip girdle

Let’s talk about muscles. So, what are your core muscles? Keep it simple. Just think of the muscles connecting your head to the neck, elbows and knees to your trunk, and all that are in between. In my view, essentially any muscles attaching to your axial skeleton, shoulder girdle, and hip girdle make up your core muscles.

Many professionals specializing in movement performance prefer to use the term “core control” versus “core training” as control implies actively aligning (positioning, orienting, or posturing) the axial system for movement. This could be from any position such as sitting, standing, lying down, et cetera. However, control does not necessarily imply improving the ability to generate force. So “core strengthening” may be used to describe making muscles stronger and/or fatigue resistant. Let’s consider core training as a blend of core control (timing and orientation) and core strength (the ability to produce force). For physics nerds, it may be better understood as kinematics and kinetics.

To enhance one’s understanding of core training, the concept of positional neutrality must be understood. Let’s define positional neutrality as the orientation of the axial skeleton, including pelvis and shoulder girdle, for maximum movement variability of the rib cage, spine, pelvis, arms, and legs relative to the individual. It’s the balance of muscle tension that establishes your starting alignment. In theory, the inability to position the axial skeleton in “neutral” results in either symmetrical and equal suboptimal 3-dimensional range of motion and/or asymmetric equal-and-opposite joint range of motion right versus left and/or skewed rotation observable in the trunk, shoulder, and hip joints unless there is compensation in the movement system. (I know. That’s confusing.) If only the body were this simple, though. One must also consider that there is a degree of asymmetry in the human body that is normal. Traumatic injuries, the parent’s you chose, Wolff’s law / physical stress theory, will also impact an individual’s positional neutrality. The fact is, determining positional neutrality is really difficult for a person to determine without assistance from someone else who knows what he/she is doing.
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Here is a contrived example of why establishing positional neutrality of the axial system is important: I want to run up a steep hill fast. When I push off my left leg, I need my right hip socket to be oriented in a way for me lift or pull my right knee high while still allowing my left leg to push me up the hill. If the start position of my pelvis is skewed in one direction and I go up the hill, the movement will be suboptimal on both sides for different reasons. I would be too good on one side, and not good enough on the other.  If you know Goldilocks, she likes the one in the middle that’s “juuuuusssst right.” Which is to say, if my pelvis is more optimally oriented from the start (positional neutrality) I may be just as good at pushing and pulling on my right leg and my left leg. In theory, this implies improved load distribution on muscles-tendon and joints. I like the sound of that from the perspective of joint health, muscle and tendon recovery time, longevity, and performance.

One of the blessings and curses of being human is an incredible ability to compensate or workaround non-optimal conditions, which is the argument against the need for establishing positional neutrality. But things start to get out of whack when loss of positional neutrality reaches a “not-so-well-defined” threshold that begins to push the available range of motion of joints in one direction. Let’s use another example.

Imagine your shoulder joint as a golf ball (humerus) on a perfectly vertical golf tee (scapula). Gravity is pulling the ball down onto the tee and air pressure is holding it evenly in place on all sides. There is no shear force on the figurative joint and it is happy. Now imagine a strong wind (hypertonic infraspinatus muscle) starts to push the golf ball forward onto the lip of the tee (labrum). The golf ball is no longer aligned in a comfortable resting position through the vertical axis of golf tee unless an equal and opposite force pushes it back onto the tee. Ease the pressure on the figurative labrum, and push the ball back on the tee with your index finger and thumb (subscapularis and supraspinatus). Now tip the golf tee sideways (alter the position of the shoulder socket resting position) so the ball almost falls off. Something has to hold it there, constantly, or it’s going to fall! Again, now there is constant shear stress on figurative joint and lengthening pressure on the labrum and tissues that lengthen over time with sustained stretch.  Is this a good start position?

This scenario in the human body has been described by Shirley Sahrmann as the loss of the PICR (path of instantant center of rotation) of a joint. Ligaments, cartilage, labral tissues, and muscles/tendons begin to adapt as an individual moves further from this ideal position of relative neutrality. The nervous system reorganizes into a new understanding of the body’s neutrality, which may not really be a healthy neutral like the golf tee not aligned with gravity. When ligaments, tendons, and muscle adapt to accommodate new joint position at the shoulder or hip, for example, a degree of instability or impingement toward one direction arises. You may or may not experience pain, but it depends on how much force through a specific range of motion you try to move through and how many times you do it. It just depends on how much it takes to sensitize the tissues.   I can’t tell you how much it will take, but your brain will. “Ouch!”

So what is the biomechanical goal of core training? From an injury prevention perspective, one might say that it is exercise designed for the purpose of restoring or maintaining positional neutrality of axial skeleton. That is to say, it is exercise designed to avoid the positions of instability or impingement defined as moving the extensibility of mostly passive structures (i.e. ligaments, cartilage, labrum) away from the neutral zone of a joint. Some very flexible individuals may have large ranges of motion in all directions (large neutral zone) requiring more control, while others may be very stiff in all directions (small neutral zone). Think of stretchy yoga girl versus 70 year-old stiff guy. So, static stretching may be a form of core training for very stiff individuals if the goal is to improve range of motion. However, pushing into instability where it is not needed through repetitive asymmetrical loading is UNWISE CORE TRAINING!

From a performance optimization perspective, there are two primary goals of core training for runners. 1.) optimizing muscle tension for fatigue-resistant powerful linear motion and 2.) maximizing gas exchange. In other words, core training should complement translation of forces from pushing on the ground into forward linear movement and pumping air into and out of the lungs by twisting the body back and forth repeatedly (A.K.A. running). Right and left alternating

IMG_3664exercise incorporating focused breathing, challenging the thighs-hips, upper arms-shoulders, and thorax is advanced exercise that an be modified in terms of degree of control, speed of movement, and resistance. Body weight exercises on all fours, planking exercises while holding static positions train core muscles. Supported postures on the floor either facedown or on one’s back may be the easiest to feel if the goal is to maintain a static core position. Establishing positional neutrality is where one should start. I believe this requires physical assessment by a professional to specifically determine areas of focus. But, an individual will learn to feel this position and may be able to achieve it while running without exercise before running. With only anecdotal evidence to support the statement, this is what FLOW feels like.

So what is core training? It is performing a movement that challenges the axial skeleton to maintain optimal position for movement of the extremities relevant to the desired task to be performed. It is a blend of control and strength. It is restoring or maintaining positional neutrality first of the axial aspect of the movement system. Its purpose is to maintain the PICR of joints of axial skeleton, shoulder, and hip joints. The abdominals are a big part of the equation, but so are many other muscles. For runners, I will generalize and say that the oblique abdominals, transversus abdominis, breathing diaphragm(s), pelvic diaphragm(s), Latissismus dorsi, multifidi, iliocostalis lumborum, serratus anterior, gluteus maximus, iliacus, gluteus medius, adductors, hamstrings, quadriceps, triceps brachii, et cetera, etc. etc. … are really important. My point is, all muscles are important and play a role in core training.  Ask yourself: What is going to get you to position yourself for the most movement variability from the start position?

In my opinion, exercise fads and programs today revolve too much around ‘mobility’ through aggressive stretching AND strengthening into extension and external rotation (opening up in front) because you don’t spend enough time there all day (sarcasm). For example, imagine sitting or standing all day with what your mother told you was “good posture” (in extension of your spine, perched on the edge of your seat), then going to the gym and doing more extension exercises like back squats, lunges, good mornings or straight leg deadlifts, pull-ups, bench press, Lat pulldown, snatch squats, stretching your hip flexors, gluteals, and avoiding a real curl up where your spine flexes because “it’s bad for your back.” Where is the logic? I am not saying any of those exercises are bad. They have a purpose, but you must look holistically at movement. If you want to make orange juice and all you have are lemons, good luck.

The key takeaways of core training:

  • Core muscles are those that are attached up from the elbows and knees to the axial skeleton, shoulder girdle and hip girdle. Don’t forget the diaphragm right in the middle of it all. Yes, breathing matters!
  • Core training begins with establishing a healthy start position first – Are you oriented appropriately for optimal movement of your arms and legs. Can you achieve positional neutrality?
  • Positional neutrality is the orientation of the axial skeleton, including pelvis and shoulder girdle, for maximum movement variability of the rib cage, spine, pelvis arms, and legs relative to the individual. It is the static observation of a dynamic system.
  • Core training is a blend of timing and body positioning (coordination) and force production.
  • Stretching can be considered core training if it safely enhances the ability to orient / position the body.
  • Learn exercises from an expert that optimize your start position for maximized movement variability without stretching or strengthening into instability or impingement.
  • Add challenge and variability to maintaining neutrality through the axial system during movement. The more specific to the intended task, the better the performance of that task will be. Don’t just do more extension based exercises or planking.

Where resistance training, task specific training, and core training begin and end is a gray area. Be fit, be strong, be coordinated, and keep moving!

 Head for the hills,

-Erik

Post script –

I am a firm believer that being thoroughly assessed by a physical therapist is the best first step to getting serious about exercise, which is why it is mentioned in the post. Assessment should involve a thorough, in-person, one-on-one evaluation ending with relevant patient education. How you move and understanding why you are doing an exercise or modifying a movement habit is important. That said, the goal is not to create fear of moving. The purpose is to empower all humans to move with the precision that maximizes the benefit of exercise and minimizes risk of acute injury or gradual onset of injury. It is far better to keep moving than the alternative.

Mental hurdles for new runners

1) Creating the habit. The first big hurdle is the mental and behavioral aspect of starting something new and sticking to it. Let’s face it, running is an absurd activity. But so is anything that is challenging. Like anything though, the more you practice the activity, the easier it gets. Creating the habit requires mental toughness and a plan. There are no shortcuts, but you can make a new habit stick by cueing yourself through a variety of strategies: 1) sleep in your running clothes 2) leave running shoes in front of your bedroom door 3) buy yourself a running gadget, so you are committed to using it 4) reward yourself if you must 5) set a goal(s) 6) Train with a buddy to create accountability.  Screen Shot 2015-12-03 at 6.45.49 AM

2) FEAR of discomfort (pain). Running can be painful, but it does not have to be! If you take nothing else away from this article remember this: Learning to run relaxed at any speed is the key to unlocking all that is positive about running. Unfortunately, the thought of running can create fear. The perfect example is how “ball sport” coaches ‘unintelligently’ use running as punishment rather than positively reinforcing the behavior of running through slight discomfort. Running should be viewed positively and science proves its benefit when running at any level. The pain gets less and less with practice, and the sense of reward increases. The greater one’s fitness, the more one craves harder efforts. Pushing your level of discomfort and adapting to it is a positive experience.

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3) Patience: Can you delay gratification? Are you a spender or saver? Are you Veruca Salt or Charlie Bucket (see Charlie and the Chocolate Factory)? Running success comes to those who are patient. This is the reality. Aerobic development takes time. Skill acquisition takes time. Impact-proofing your body, specifically to running, takes time. Regularly running too hard or routinely testing your limits increases your risk for injury.  My advice to new runners is to treat running like saving money. View each run as a small investment… “money in the bank,” or “hay in the barn.” Focus on running for time, not pace or distance. Maximizing ones potential takes years. Enjoy the experience celebrating the short-term goal achievements and milestones, but expect there will be setbacks. It will take time to run further, and to run faster.

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4) Making comparisons: Humans naturally compare things. It’s how we make sense of our world. “It’s all relative,” they say. Well, it is hard not to compare oneself to others and oneself to oneself. New runners must learn what comparisons are relevant and when they are relevant. This requires experience. The experienced runner has a good sense of body awareness and can compare a given effort to an expected performance. The new runner wants to compare every run by time or by pace. This is a mistake. Training is non-linear, and focusing on performance of each run can lead to overtraining.

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5) Bending the rules and adapting training: Novices like to follow rules and stay well within the lines. Everyone wants a plan because it is easy to believe, “If I do X, then I will achieve Y performance.” When it comes to training, there is a lot of gray area. Finding one’s training rhythm requires trust in adapting training. Trust comes from experience. This is where having a knowledgeable coach or running mentor can make a difference in your running experience. Based upon one’s personality, he/she may end up overtraining or undertraining. The best training rhythm is individualized based on basic principles, but the rules can be bent. It is an art, and perfecting it is what makes running constantly challenging and rewarding.

To sum up:   Patience and consistency are paramount.   Measure progress in months and years, not weeks.  Allow the power of cumulative efforts to build fitness over time, and avoid constantly comparing one run to the next. Be willing to deal with some short-term discomfort for longer terms gains.   Cultivate the ability to feel relaxed and in control at any level of effort.  Remember, running is a positive experience, not punishment!  Don’t overcook your goose.  Be flexible when following “a plan.”  Adapt your training to keep yourself going.    JUST GET STARTED and experiment to find the rhythm of harder work and recovery that works for you.  Learn from an experienced runner if you need guidance.

 

The Truth About IT band Syndrome

IT band

It’s NOT a FRICTION SYNDROME

The purpose of this article is to inform readers that commonly held beliefs regarding ITBS (iliotibial band syndrome) lack evidence and miss the target on treatment. As dedicated exercisers and competitors doing your part to maintain your health, longevity, and push the limits of human performance, you deserve better knowledge and empowerment to keep going. Gaining control over your pain starts with understanding why.

Point 1. Make sure your pain is not caused by something else. Anybody can point to a body part that is painful and give it a name (i.e. runner’s knee and ITBS). The cause of your symptoms is what is valuable to know, and in order understand the cause, the entire movement system (the human body) should be assessed. Lateral thigh and knee pain has potential pain referral from other structures such as the back or hip, not to mention the myriad movement impairments that can occur from the great toe through the spine. Listing differential diagnoses and explaining the relevance of impairments exceeds the scope of this article, but beware, IT band syndrome can be a wolf in sheep clothing. Seeing your physical therapist is an inexpensive first step to establish the factors giving rise to your pain, and ruling out other sources of pain referral.

Point 2. Despite the ‘word on the street,’ IT band syndrome is NOT a friction syndrome or a bursitis. Anatomic research shows there is not even a bursa there!1,2 And, despite the common belief that the IT band tendon slides and rubs back and forth over a bone in the knee, the functional anatomy debunks this phenomenon. Anatomical research has revealed that two slips of tendon with different bony attachments are tensioned at different ranges of knee motion giving the appearance of a band of tissue sliding back and forth. 2  What can occur is compression of a highly vascularized fat pad in that outside part of the knee, which may or may not be the anatomical source of pain.1,2

Well, what about stretching? IT band syndrome is caused by a tight IT band, right?

Point 3. It’s highly unlikely your IT band is too short. Research shows that clinically identified “tight IT bands” are not predictive of IT band pain anyway.3 What’s more, the typical static stretching does not actually lengthen the iliotibial fascia, so why is everybody stretching so much? Let’s review functional anatomy again. Under your skin, your thigh muscles are circumferentially wrapped in a Saran wrap-like tissue called fascia. That fascia is connected all the way down to the back of your thigh bone, running nearly the entire length of the thigh bone. The IT band is simply a thickening of that tissue, and it is not moving anywhere. Consider that a maximal muscle contraction of the TFL causes a 0.2% change in IT band length.1 Furthermore, research shows you are much more likely to be relaxing and lengthening the supportive hip muscles…you know, the muscles you are supposed to be strengthening (see point 4).   Therefore, stretching can actually be counter-productive despite how good it feels while doing it.

Point 4. Strengthening hip girdle muscles has scientific support.4,5 But there is a caveat. It is really easy to strengthen muscles that are already strong, and it is really difficult to strengthen muscles that are relatively weak. It is import to first reeducate your nervous system to recruit specific muscles before strengthening. My mentor always says, “Just because you wear your muscles, does not mean you use them.” So as long as you are recruiting specifically weak muscles, have at it, Jane Fonda. Though not a cure-all, strength and endurance of the hip and pelvic girdle contributes to improved alignment of the lower limb joints while running. What is often the missing component, however, is functional coordination of these muscles while running.

Point 5. Sorry, there is no secret formula for treating IT band syndrome. Passive modalities such as ice, heat, or massage may confuse your nervous system long enough to experience short-lived relief, but the pain will return unless you take a holistic approach to correcting movement patterns. About the foam roller, my professional opinion is that it can help mobilize adhered tissue layers and relieve painful myofascial trigger points (small painful bundles of muscle and connective tissue). However, if the impaired movement is not remedied, those bundles of joy will return.

Point 6. Please, do not give up without a fight. If foam rolling, stretching, icing and general strengthening have been unsuccessful, you now have a better understanding why. So the next time someone proclaimes, “Oh, you just have a tight IT band!” you know better.

My challenge to those who accept that pain is part of who you are as a runner, make time for yourself to learn about how you move. Subtle tweaks can make big changes. Movement is vital to your health, and the precision of your movement is vital to the health of your movement system. Remember, you only have one.

Citations

  1. Falvey EC, Clark, RA, Franklyn-Miller A, Bryant AL, Briggs C, & McCrory PR. Iliotibial band syndrome: an examination of the evidence behind a number of treatment options. Scand J Med Sci Sports 2010; 20:580-587.
  2. Fairclough J, Hayashi K, Toumi H, Lyons K, Bydder G, Phillips N, Best TM, Benjamin M. Is iliotibial band syndrome really a friction syndrome? J Sci Med Sport 2007; 10: 74–76.
  3. Devan MR, Pescatello LS, Faghir P, Anderson J. A Prospective Study of Overuse Knee Injuries Among Female Athletes with Muscle Imbalances and Structural Abnormalities. Journal of Athletic Training 2004; 39:263-267.
  4. Nohren B, Davis I, Hamill J. Prospective study of the biomechanical factors associated with iliotibial band syndrome. Clin Biomech 2007; 22:951-956.

Article Published in March 2014 issue of Northwest Runner Magazine

Check out Frank Netter’s Atlas of Human Anatomy and related website

Femur on Acetabulum (hip) Anterior Glide: A risky mobilization

I recently came across this video, and I immediately felt compassion for the young man going along with the exercise.   Although the intentions are for the good of this young athlete, the potential harm far outweighs the benefit of this exercise when applied blindly.  The instructor may be excellent at applying this on an individual basis, but I must politely disagree on this one being “mass marketed.”

This mobilization has a high potential to cause structural damage to the labrum and lengthen the anterior hip capsule that may or may not need more length/compliance.  Prior to performing a mobilization of this nature, a client MUST BE ASSESSED by a qualified and licensed professional.  I would estimate that <1% of patients/clients seen in our clinic would benefit from this mobilization.

Blindly applying a forceful anterior glide to the hip without assessment on a routine basis will more likely create INSTABILITY than do anything to “warm up” for exercises that that require a posterior glide of the hip.

Proper function of the anterior capsule should limit or “check” hip hyper-extension.  Kelly may not literally mean “tearing,” at least I hope not, but you should never feel “tearing” while performing a stretch.

If the goal is to “stretch” or inhibit the TFL, far less force is required.

If you are a healthcare professional you may want to read the following clinical practice guidelines.

 

1.  Lewis
 CL
 & 
Sahrmann
SA. 
Acetabular 
labral
 tears.
 Phys
Ther.
 2006;
86:110‐121.

2.  Lewis 
CL, 
Sahrmann
 SA,
Moran
 DW.

 Effect
 of
 hip 
angle 
on
 anterior 
hip 
joint
 force 
during
 gait.

 Gait
and
Posture.
 2010;
32:603‐607.

3.  Enseki K, Harris-Hayes M, White DM, et al.  Nonarthritic hip joint pain: Clinical practice guidelines linked to the international classification of functioning, disability and health from the orthopedic section of the American Physical Therapy Association. J Orthop Sports Phys Ther. 2014;44(6):A1-A32.