Most people spend a lot of time building capacity – very few train expression.

The post Why Performance Fails appeared first on RunTeach.

In this article you are going to find out a bit more about some of the chemistry involved in breathing, why it’s important for your breathing in general, but specifically how it can help you improve your running.

You may already know that when you breathe in you inhale oxygen (O2) and when you breathe out you exhale carbon dioxide (CO2). But how does this relate to efficient and functional breathing?

Well, the basic process is that when you inhale oxygen it eventually ends up in the small air sacs deep in the lungs called alveoli. The alveoli actually share a membrane with your capillaries, allowing the oxygen to diffuse across into the blood. From there it is pumped around the body to all of the tissues where it is used to help each cell survive and thrive. In terms of your running, the more oxygen that can be supplied to your working muscles and other tissues, the easier your running will be; also faster and longer. But that’s not the whole story as you’ll discover very soon, but first let’s briefly look at the exhalation process.

As the blood comes back around to the alveoli from being pumped around your body by your heart, it contains carbon dioxide that has been generated by your cells as part of their normal function of metabolism and put out into your blood. As the blood passes through those capillaries next to the alveoli, the carbon dioxide is diffused back across from the blood to the lungs. You then breathe it out as you exhale.

Energy Systems

When you run, irrespective of the intensity that you are running at, you are utilising three primary energy systems:

1. Your aerobic system.
2. Your lactate system, also known as your anaerobic system.
3. Your alactic system, sometimes known as your phosphocreatine system.

Your aerobic system uses oxygen and both glucose and fat to help your body’s muscles and other tissues keep you running. It becomes the dominant energy system when you are on your easy runs and the intensity is below your lactate threshold 1 level. The other two systems are still active, but much less so.

As your intensity increases, you begin to transition across your energy systems and your lactate system becomes more active. This system still uses glucose as fuel, but doesn’t use oxygen and doesn’t really use fat (it can but it’s so minor that common teaching is that it doesn’t). This transition zone that includes some upper aerobic system activity and some lactate system activity is where you are usually operating in when you are running a hard 5k and 10k, and in certain places during longer distances as the intensity increases at times. The skill with this transition zone, between lactate threshold 1 and lactate threshold 2 is balancing your effort so that you almost ‘surf the wave’ by keeping enough oxygen and fuel being supplied to your working muscles and the waste products of the cells from energy creation (lactate, CO2 etc) being removed and cleared (or reused in the case of lactate), with pushing hard enough to get the performance you want. This is a zone I like to refer to as the speed endurance zone.

The harder you push, the closer you get to lactate threshold 2 and the less oxygen is available for your working muscles. The waste products from the cells also can’t be cleared efficiently because your blood cannot move around your body fast enough. This basically puts you on a timer before your cells are unable to function as needed. For well trained runners, this timer is around 3 to 5 minutes. For the rest of us it can be a lot less.

For completeness, the energy system that is dominant when you are at your highest level of intensity (think of a 10 second all out, max intensity sprint) is your alactic system. This doesn’t need oxygen, glucose or fat, instead relying on an internal energy source. However, this internal energy source is like a flashbang in that it burns very brightly, but only for a few seconds. Typically, your alactic system can only function well for between 5 to 10 seconds depending on how well trained you are. If you are ever at a running track and watch sprinters training high intensity short sprints, you’ll notice that they take very long recoveries (sometimes 5+ minutes) between each rep. This is to allow that alactic system to fully recharge, otherwise the sprint will be done in the lactate system or even in the threshold or aerobic systems if the recovery is very short. While you will use your alactic system in your normal running (think of finish line sprints, overtaking etc), and you do need to train it, you won’t need to put as much emphasis on it as the other two systems.

So how does all of this relate to breathing? Let’s find out…

Running, O2 and CO2

As you’ve just learned, the higher the intensity of your running, the less efficient your system becomes at both getting oxygen to your body’s cells, and at removing the waste products such as carbon dioxide from your cells. In both cases, this will force you to slow down at the very least.

But for many runners this leads to panic and breathing difficulties. As you discovered in article 3, carbon dioxide is the chemical trigger for you to take a breath in. Because carbon dioxide builds up as your intensity increases, the trigger to breathe can get very strong very quickly. This can cause that feeling of panic and you start to gasp. Unfortunately, this more often than not will result in either hyperventilation or paradoxical breathing (where your breathing muscles are doing the opposite of what they should be). Neither situation is good and can result in your predictive brain learning that running hard is unsafe.

Now, you may think that taking in larger breaths, particularly through your mouth, will lead to more oxygen getting into your blood and out to your cells. Unfortunately it doesn’t really work like that. We’ll look at this more in the next article which is on nose breathing, but for now you just need to know that due to things like respiratory rate, dead space and a simple formula, more air and quicker breaths don’t equal more oxygen. For that, you need to learn to breathe more efficiently to get more oxygen exchanged, and to not react when you get those triggers to breathe in the way that you are currently doing.

One of the first steps of doing that is to increase your tolerance, or reduce your sensitivity, to the build up of carbon dioxide as the intensity of your running increases. In turn, this reduces the panic response, and while you may still have to slow down a bit, it is more controlled and you’ll be able to hold a higher intensity for longer. This is the hypercapnia training that I mentioned in article 3, and is all about training your system to tolerate lower levels of oxygen (hypoxia) and higher levels of carbon dioxide. To begin with this, let’s start with a simple exercise (this is the one from the ebook):

1. Take a slow breath in through your nose for a 4-count.
2. Exhale slowly for a 4-count and hold for a 4-count.
3. You may start to feel a small amount of air hunger near the end of the breath hold, but don’t worry if not.
4. Progress to holding that out-breath for a count of 5 then 6 then 7 to start to experience the feeling of air hunger. You may find it induces panic, in which case just dial it back.

There are many ways of progressing this exercise, and also several variations that I often use with my clients. The first one I start with is to do rounds of these breath holds like this:

1. Take a normal breath in through your nose and then a normal breath out through your nose and hold your nose.
2. Count to 5 and then take a normal breath in through your nose, trying not to gasp the air in, and then out through your nose.
3. Take another normal breath in through your nose and then a normal breath out through your nose and hold your nose.
4. Again, count to 5 and then take a normal breath in through your nose, trying not to gasp the air in, and then out through your nose.
5. Repeat this for a total of 5 breath holds.
6. Continue breathing through your nose for another 30 seconds to 1 minute depending on how much recovery you feel you need.
7. Complete three sets of the above.
8. Aim to do this several times a day for the next week until it becomes easy to do. Then reduce the two breaths between breath holds to just one breath.

With continued practice of all the exercises you’ve learned on the ebook and articles, you will be well on your way to reaping the rewards of more efficient and functional breathing.

In the next article you’ll learn about nose breathing and why it’s important in your life in general, but also why it’s vital to start building it into some of your running.

The post The Biochemistry Of Breathing appeared first on RunTeach.

You can find the first supporting article on the Muscles of Inhalation here.

As a reminder, we look at the biomechanics of breathing, we really need to be looking at:

1. The muscles of inhalation
2. The muscles of exhalation
3. The skeletal components such as your rib cage
4. The integration and control of all of the above, and you ability to effectively use them under different conditions

This article takes a brief look at the muscles of exhalation.

Exhalation

Exhalation, or breathing out, involves a number of muscles including:

Some of the muscles of exhalation

As with inhalation, exhalation involves a lot of muscles that need to contract to help change the size and shape of the breathing cylinder. As important though, and often overlooked, is the ability of all of these muscles to relax.

For the rib cage to expand up and outwards during inhalation, the muscles of exhalation need to be in a relaxed state to allow this to happen. Equally, for your rib cage to come down and in, the muscles of inhalation need to relax.

It is this coordination of tense/release that allows fluid movement of the breathing cylinder, helping to form the foundation of efficient and functional breathing. It is always my starting point when working on improving someone’s breathing, as even if they don’t get some of the other techniques right away, I know they will have good quality movement in this area.

High quality movement is amazing for reducing the overall threat that your brain experiences in every moment of every day. And given that you can only handle a certain amount of threat before you begin to experience undesirable outputs such as pain, panic, anxiety, fatigue and a whole host of other stuff, deliberately practising high quality movement throughout your body is an essential element of achieving and maintaining a high level of health and wellbeing.

To experience the muscles of exhalation, you can use the same exercise from the first article (see below) as it is a fantastic awareness exercise. Just shift your focus to the exhalation aspect, making relaxation a deliberate action. This can seem a bit strange at first as focussing internally can result in more tension in your muscles. One way to get around this is to close your eyes and imagine the contraction of some of the muscles of exhalation while also allowing a smooth relaxation to occur. This takes a bit of practice but is worth doing. 

This is also a fantastic mindfulness exercise that can help calm and settle you.

1. Stand or sit with your back straight, shoulders relaxed.
2. You may find that lying on your back can be a useful position for this version of the exercise.
3. Place your hands around the base of your ribs.
4. Inhale slowly through your nose.
5. Exhale slowly, feeling your ribs come down and in, reducing the size and shape of your breathing cylinder. 
6. Repeat the exercise a number of times to get a good idea of how well you are activating and relaxing the muscles that help your rib cage to change shape and position.
7. Do you notice a difference between your right side and your left?

Now change the position of your hands so that they are half way up your rib cage and repeat the deep, slow exhalations. Do you feel your rib cage moving at this level?

Now move your hands to your upper ribs, just below your collar bones. Repeat the inhalations and observe how well your rib cage is moving.

What’s Next?

Take some time to practise both versions of the awareness exercise: inhalation and exhalation. Doing this daily is a great way to add some mindfulness while at the same time bringing in body awareness. It’s absolutely fine if you can’t move smoothly at the moment as it takes some deliberate practice and good coordination between relaxation and contraction.

And this coordination skill is the subject of the next article as we look at the role of neuromechanics and your brain in helping you to breathe better and more efficiently.

The post The Biomechanics Of Breathing – Muscles Of Exhalation appeared first on RunTeach.

Do you love going to the gym? Or perhaps you’re like me and just don’t enjoy it at all; it seems way too much hassle carving out the time for a strength routine when you could be out running. Sound familiar?

The problem is, whatever we hear and read about reducing injury risk, injury prevention, prehab and rehab, getting stronger is something that almost always tops the list. And in many ways the phrase…

…is absolutely correct. We do tend to be more robust and more resilient when we are stronger. We are also able to develop more power and have greater stability – two things that go hand in hand in helping us run faster. Furthermore, if you are a runner over the age of 40, research implies that we should pay even more attention to staying strong in order to improve our performance and reduce our injury risk.

So essentially, you’ve got to get stronger! But hang on a minute… What does that actually mean? Does it mean you need to make time for two or three weight training sessions per week? Does it mean you need to drop one run per week to focus on strength work?

If the very thought of it is making you anxious, the good news is that you may not have to do this at all. There are ways to help you get stronger without lugging giant weights about, or spending numerous hours per month doing resistance training. Actually, some of that might still be necessary, but as it will be super targeted it will be shorter in duration and you’ll see results far quicker and they’ll last far longer.

What Is Strength?

Before we get into that though, we need to look at what strength actually is. Here are some dictionary definitions:

The ability to do things that need a lot of physical or mental effort

Cambridge Dictionary

The Merriam Webster dictionary has these definitions:

Looking through each of those, I can apply them in my mind to running. But is that what most of us really think of when considering doing strength work in connection with running? Although it seems logical that we need to be strong to run, do we really think “I’m going to make myself impregnable, solid and tough!” Or do we just think “I wish I could run faster and longer without my knee hurting! I better make sure it’s strong enough”.

So dictionary definitions of strength don’t actually help us at all in a practical sense. And I’m pretty sure most of us think we’re robust enough already, until we aren’t of course.

Be honest here, how many of us would skip strength work if we didn’t really need to do it? What’s that – you are already skipping it?… Yeah, I hear that all the time from runners.

But that’s OK. To me, strength is like fitness. It changes in the different areas of your life. If your goal is to sit on the couch all day and watch TV, and you can achieve that goal, then you are both fit and strong enough to do that. Equally, if your goal is to run a 20 minute 5k, but you’re currently running a 25 minute 5k, then you are neither fit enough nor strong enough to achieve that goal. We can split this down a bit further to be more helpful.

If we leave fitness to one side for now – mainly because I view strength as just one aspect of fitness and this could get very complicated – and just focus on strength. We can view strength in a similar way in which I view resilience:

The ability for your body’s tissues to withstand the forces applied to them, in the intensity, duration and frequency which your activity demands.

So basically, you are strong enough if your body’s tissues can handle all the forces you chuck at them without either giving up (injury) or forcing your nervous system to introduce some red flags such as fatigue, niggles and the warning experience of pain.

To complicate it slightly, strength is also linked to your ability to produce power, which in turn helps you run faster. But let’s just keep this simple for now, as your nervous system won’t let you express high levels of power without first having a powerful expression of strength. If you just went “uh?”, then let me explain:

Strength can be expressed in two different ways:

When you run, your feet will typically only be in contact with the ground for between 220 milliseconds and 350 milliseconds. At the more elite end of running, the number is lower as the foot turnover (cadence) tends to be a little higher. And I know, we are all told to improve our cadence.

But the trick with improving cadence is also keeping good form and not just turning what may have been a half-decent heel lift at a slower cadence into something that resembles a fast shuffle, just to get your feet turning over faster. There is also the challenge of being able to put down enough power in a shorter amount of time, but I’m kind of moving away from the point here and these are topics for different articles. Back to strength…

With your feet being on the ground for such a short period with every step, you don’t have enough time to voluntarily think about keeping your joints stable in your feet, ankles, knees, hips, pelvis, back, shoulders and neck. This all needs to happen automatically or reflexively. It also needs to be coordinated across the different areas for improved movement efficiency. And while you may think that only being on the ground for a fraction of a second means that there isn’t enough time to even bother with joint stability because you essentially hop or lunge from one foot to the other continuously, the forces of running are such (up to 3 times bodyweight – possibly more depending on what you read) that stability in each step is critical. 

Many of us get away with less than ideal reflexive stability over short distances and when we are not tired, but ramp it all up and suddenly the impacts are amplified and before long we certainly know about it. The same is true if you start to push the pace. More pace generally means more force both into the ground and back up from the ground (ground reaction force), so your body’s tissues need to be able to handle the greater demands and the need for even better reflexive stability.

One great example that we can all observe is the classic hip drop. The next time you are running behind someone, look at the movement of their pelvis. If their hip drops down to the opposite side of their stance leg, then they are likely to have some reflexive stability issues. Ordinarily, if you have hip drop, you will be told to do lots of glute (maximus and medius) and core strengthening and integration exercises (hopefully), but if your reflexive stability is poor, you are still unlikely to be able to build or use that strength properly.

Mastering the skill of reflexive stability is, in my opinion, a relatively quick and highly efficient way to improve your overall expression of strength for running – far better than just lifting weights and hoping it will all work. You will feel more stable, be able to put more power into your running, and run longer distances more comfortably than you’ve been able to before. 

You will also be teaching your nervous system how to identify, activate and control your muscles (these are all individual skills by the way). This then forms a fantastic foundation for you to carry on with any other strength work you may enjoy doing, and it will have much more of a positive impact and the benefits are likely to stick around for longer.

For clarity, to improve your reflexive stability, you do need to do voluntary neural drive exercises (i.e. resistance training), but they need to be well designed so they stimulate and upregulate the parts of your brain and nervous system that control reflexive stability.

Summary

To summarise then, first think about reflexive stability when you think about strength in running. Once you have mastered this through well designed and personalised exercises, you may or may not need more strength work of the normal “just lift weights” kind. You may find that your running sessions already provide you with enough stimulus to keep improving your resilience and neural drive strength. Of course that does depend on your goals, but that’s a topic for another article…

The post What Is Strength In Running? appeared first on RunTeach.

I’ll present one case study here, and follow up with more over the coming weeks.

Firstly though, for the avoidance of doubt, tissue issues are real things. Strains, sprains, tears, breaks – they are very real and just because they may not always be associated with pain (but in most cases they are for the reasons mentioned in Part 1), if you are in any doubt whether you have a physical injury or not, then you need to get seen by a medically trained professional – ideally someone who has experience of dealing with active people and specifically runners.

OK, now we have established that, let’s start looking at some case studies where runners have come to me with painful knees, hamstrings, ankles, IT Band etc. In many cases they have had this pain for months and months, and a few of them have had the pain for years and have seen a wide variety of very well meaning professionals that have helped somewhat but not quite got to the source of the issue. I want to give you a high-level overview of how they presented, some of the things I tried; what didn’t work and then what did work (with varying degrees of success).

Runner 1: Outside of right knee very painful for the last three years.

Introduction

Runner 1, we’ll call him Jim as that’s not his name, came to me for a running assessment as he had been getting pain in the outside of his right knee for the past three years. The only way he could run without pain was with a knee brace. He had a number of different types of knee brace from simple thin neoprene ones to more sturdy neoprene ones with built in hinges. This last type was the one he used most often as it gave the best relief, although it was quite cumbersome and very hot to wear.

Over the previous three years he had seen different practitioners, and at one point saw a physio once per week for three months. Unfortunately, nothing worked and the end result was always the same – he had to go back to running with a knee brace.

He eventually came to me on a recommendation. Jim’s thoughts were that something about his biomechanics (running technique) was leading to the knee pain and if he could improve his technique the pain would go away. Jim was also very concerned that if he ran with the knee pain (i.e. without the brace), he would be doing himself damage and severely injure the tissues.

The assessment

I always start my assessments with some basic pain and neuro education. After listening to Jim’s background and discussing his pre-submitted health forms, I explained how pain and movement works through an applied neurology lens. I often begin this education piece with the information in Post 1 of this mini series and expand from there as necessary. I find this helps to relieve some of the fear that you may have over damaging tissue when you run in pain. Let’s be clear though, running through pain is never a good idea, but the reframing of pain Vs injury helps you to take a step back and look at your situation more objectively.

Following this discussion, I stuck a load of dots on Jim and observed him walking up and down my office; taking video for discussion later in the assessment. How you walk gives me a wealth of information about how well your brain and nervous system is integrating with your muscles, and how well you unconsciously control certain movements. Jim then walked on the treadmill as it gives me slightly different data, and then he did a very small amount of running (both barefoot and in shoes) so I could capture the most important movement patterns as he ran. Now onto the really fun bit.

The rest of the assessment was made up of lots of brain-based tests and drills designed to look at Jim’s movement patterns specific to running. So in this section, I’m looking for things like coordination, agility, stability (both conscious and reflexive), balance, and your ability to express and control strength in certain movements. In Jim’s case, I also wanted to look at his sensory system in depth. From Jim’s pre-submitted forms, I had designed some tests to specifically assess how his sensory input may be contributing and impacting his knee pain.

Sensory Mapping

You may not be able to fully appreciate why this is important, so let’s take a very brief detour into the world of sensory mapping…

Without wanting to go into any complicated explanations, science has revealed to us that you have a number of virtual maps of your body that sit in various areas of your brain. These maps detail parts of your body with particular reference to controlling movement. The only way these maps can be kept to date is through the sensory input that comes in from those areas. If the maps go out of date or get blurry, your brain cannot accurately identify where that body part is so cannot move and control it well.

If the brain doesn’t feel ‘safe’ in knowing where a body part is, you won’t be able to be strong in that area and you may well be inaccurate when trying to move. Let’s just say that the body part in question is your knee. If this map is blurry, then your brain cannot identify where your knee is, so it can’t move it well. In addition, this inability to move well spills over into not being able to stabilise your knee joint.

As I’m sure you can imagine, when you are running your ability to stabilise your knees is very important. If you aren’t able to do this, your brain doesn’t feel ‘safe’ and predicts that this could lead to a physical injury. In order to get you to do something about it (initially, to stop this threatening activity of running), it gives you the experience of pain. But get this, it may not be the map of your knee that’s blurry. It could be your ankle or your hip and your brain is using pain in the knee because it knows you’ll pay attention to it.

Updating Jim’s Brain Based GPS

Through the sensory testing, I discovered that Jim’s right leg had a much lower sensitivity to vibration, heat and cold. This was most pronounced around his right knee and right ankle. The maps of these areas, therefore, were not being properly updated as there were significant sensory mapping data missing. So the first part of my mission to help Jim run without knee pain was to begin updating those brain maps.

To help update the maps and to also start to improve Jim’s right sided reflexive stability, we spent a couple of sessions where we combined cold sensory input around his right leg with loaded coordination and accuracy drills. This involved exercises such as accuracy shoulder circles, banded punch outs using my reaction lights, and mobilising the nerves around his right side pelvis and right leg.

As we started to make changes, Jim started to feel better about his running and was doing a bit more – and he had ran twice the preceding week without the knee brace. We then started to see the impact of not having the required level of skill to stabilise his joints to the degree needed for an increase in his running. Over the past months, Jim had also had left heel pain but this had been secondary to his right knee pain so wasn’t an initial priority. Now, however, it started to feel worse. Jim had changed running shoes which may also have been a factor, but the main challenge was that he still hadn’t developed the necessary stability skill, and clear brain maps, that he needed in order to increase his running. Determined as ever, Jim was due to run a trail half marathon in a couple of days.

Although that race went well, it was clear that Jim’s left heel pain was now the priority. We shifted focus slightly to deal with that while Jim was still doing the brain mapping exercises for his knee. After a few weeks of doing the exercises, Jim’s heel pain had improved and we put our focus back onto his right knee.

We spent some more time clearing up Jim’s brain maps with a variety of exercises designed specifically to challenge his brain and nervous system to clear the maps up.

The Big Breakthrough

Jim could do a few runs a week now without the brace, and even went for a period of a couple of weeks where he didn’t wear it at all. However, he had become somewhat reliant on it from a comfort perspective. Jim had used his knee brace for so long that his entire belief system about his knee pain was firmly attached to his use of the knee: with the brace, he had no pain and felt fully confident in running up 13 miles. Without the brace he could run without pain, but was always on edge about the possibility of impending tissue damage because he didn’t have the knee brace supporting him.

So now I had the added challenge of changing Jim’s belief system so we could reduce his anxiety around running without a knee brace. As part of this process, we also looked together in some detail at what the knee brace was actually doing for him.

The first thing I did was to demonstrate that his knee brace wasn’t giving any real support to his knee joint at all. It was just a neoprene brace with some plastic hinges built in. Although it was a bit weighty and felt the part, the truth was that Jim could move his knee into every angle very easily and the brace didn’t stop him. If it truly was providing any kind of positional or rigid joint support, he shouldn’t have been able to do that. So if it wasn’t providing significant joint support, what was it doing that was making his running completely pain free when he wore it?

We looked next at whether the heat being generated by the brace was making up for the lack of cold sensory input that Jim had in his knee, and therefore helping to update his map on the fly. There was good logic around this, and if the brace was heating the skin then this would help clear up the map as he was running. This in turn would help his brain activate the muscles better and stabilise the joint: no threat, no pain.

Then Jim told me that at the times when he wasn’t wearing the brace, if his knee hurt he would massage it in the painful area and this often allowed him to continue running for a bit longer. So I decided to get Jim to do some safe exercises that nevertheless irritated his knee, so I could do some testing. Jim started doing single leg squats and sure enough his knee pain came back. So I checked the skin mobility around the relevant area and discovered that it didn’t move very well. Skin stretch and fascial stretch (the deeper layers of tissue) are important sensory inputs that also help to map out your joints, and for Jim the skin stretch sensitivity in that area was poor.

I had Jim squat again but this time I made contact with his skin in the relevant area around his knee at an appropriate firmness and depth, and his knee pain simply vanished. I learned from this experiment that Jim’s knee brace was giving him firm pressure and pushing layers of his skin together which was providing the necessary sensory input to complete the brain map and allow his brain to control and stabilise his knee.

After some more experimentation, I came up with a personalised taping strategy that provided the same pushing together of Jim’s skin and fascial layers. So I managed to replicate the benefits the knee brace was giving him with a simple single piece of kinesiology tape strategically applied, that was both more comfortable and more practical than lugging a hinged knee brace around. Jim found he could complete all of his runs totally free of any knee pain as long as he had used the taping strategy before he ran.

So the big lesson here is that Jim’s lack of sensory input from his skin and deeper layers of tissue in a small area near his right knee, was confusing his brain and stopping the brain maps of his knee from being correctly updated. Combine this with the other sensory deficits and the brain maps were constantly out of date. Because the maps were blurry, his brain couldn’t properly control his knee when he was running. This meant he wasn’t handling the forces correctly which was creating a large threat level for his brain. His brain interpreted this as being unsafe and produced a pain experience to get Jim to stop what he was doing.

Was Jim’s issue fully resolved? No, he still needs to use the tape until such a point where the sensory deficit has been improved. This is going to take time and dedication, and Jim may decide it’s easier just to use a small piece of tape on his knee each time he runs.

So No Strength Work Then?

It’s very common in cases of knee pain for you to be given a load of strength work to improve the activation and strength of the knee and surrounding areas. While this can work in some people at some times, I often find that this doesn’t address the source of the issue. Is strength the ultimate output we want? Yes, but how you go about achieving it is the key.

Jim, like you, already has an abundance of strength in his muscles without doing additional lifting. The goal wasn’t to add more strength. Jim simply wasn’t able to access the existing strength available to him. The goal then, was finding a way for Jim’s nervous system to effectively activate his current strength and help his brain in stabilising his ankle, knee and hips.

Through all of the mapping exercises we did, and then finally with the specialist taping, we were able to do just that. We did use resistance bands at times, but I used these to stimulate stability with light and moving resistance rather than direct lifting work.

As an added benefit, Jim had always had very tight hamstrings – so much so that he couldn’t forward bend towards his toes very far at all. In problem solving his knee and heel pain, we also hugely improved his hamstring flexibility and strength without ever directly working on his hamstrings. Things like that happen a lot when I work at the level of the nervous system.

Main Takeaway

If you’ve had knee pain (or ankle, hamstring, hip pain etc) for more than six to twelve weeks, maybe you need to be looking wider than just some calf raises, clams, squats and lunges. Perhaps your sensory system needs testing to see if there are reasons why your brain won’t allow you to access your current strength. My motto, learned directly from two of the experts I’ve been following for many years, The Gait Guys, is:

1. Develop the skill first.

2. Add endurance to that skill.

3. Finally, add more strength to that skill if it’s needed.

In Jim’s case, he had to develop a joint stability skill that was currently beyond what he had. We achieved this through mapping exercises, sensory therapy and taping. He is currently adding endurance to this skill through his running and other exercises, and a natural part of this process is accessing more of the strength you already have.

The post Why Does My Knee Hurt? Case Study 1 appeared first on RunTeach.

Earning The Injury – A Bigger Problem Than Just Knees

Along with the monumental growth of recreational running over the past 10 years or so, there has also been a huge increase in the number of runners getting injured. You may think that’s logical and it does make sense that if the total number of runners increases, so does the total number of injuries. So far so obvious.

But I think the ratio of injuries to runners has got all skewed and the same runners are getting more and more injuries in a shorter and shorter time. In fact, I think that running related injuries in some sectors of recreational running are so common that they are almost worn as a badge of honour! Injuries almost seem to be an inevitable part of being a runner.

This may be common, but it’s NOT NORMAL!

When is it alright to just accept that we get injured? Never! But that’s what seems to be happening and I get disheartened whenever I read about runners getting injured over and over again and often ask myself the question “why?”.

Back To Knees

OK, mini rant over.

So, why does your knee hurt? To answer this question we need to put injuries into two distinct camps:

1. Acute injuries that have just happened. For example, you’ve slipped off a curb (or stepped off the promenade which I witnessed an unfortunate gentleman do the other day on the beach) and twisted your knee and ankle. Or, two days ago you banged your knee really hard on the table leg and it’s swollen right up. Or, you’ve unfortunately tripped on a tree root and face planted like a good’un.
   
   I used to split the above type of injuries from the more common running injuries that tend to sneak up on you over time. But in this context it’s more useful to keep them together as ultimately if there are tissue issues, it’s a single point in time where the threshold has been breached and led to those issues – even if it’s been a slow burn to get to that point.
   
   All these are examples of an acute injury that may or may not have resulted in some tissue related issues (strains, tears, breaks etc). In all these cases, your brain thinks you’re pretty stupid and in order to punish you releases huge amounts of pain… No, not really – but your brain does think the behaviour that led to the acute injury was a bit uncalled for and creates a small packet of data called a Neurotag that it can push in front of you next time, just to remind you that doing it again may be a little silly and this can trigger caution – a good thing.
   
   What actually happens at the brain level is that the area that received the physical injury goes on heightened alert and special threat sensors in the tissues send signals to your brain alerting it that there’s either an issue or a possibility of an issue.
   
   If your brain thinks the situation is important enough (based on a lot of past and current data), it will produce an output to get you to change your behaviour. In the case of acute injuries it’s normally quite a bit of pain so you pay attention to not using the injured area until it’s had time to heal.
   
   The threat sensors, called nociceptors, stay at a high sensitivity until such a time that the tissue has recovered enough that you can go back to using it. Essentially, the nociceptors create a buffer zone around the injured area that if you try to access (i.e. move, put weight on, put force through, etc) the brain’s response is to create an experience of pain to remind you to back off.
   
   Under normal circumstances, most injuries will have recovered to a state where the sensitivity of the nociceptors has gone almost back to normal within six weeks. Under certain conditions this can take longer, but rarely more than 12 weeks for most of the common injuries. Of course, there are always exceptions so it’s always a good idea to get things checked out by medically trained bods if you are in any doubt at all.
   
   So, in summary: acute injuries, whether they actually result in tissue issues or not, are injuries that have happened somewhere in the last 6 weeks. They usually cause an increase in sensitivity in your threat receptors (nociceptors) that in turn triggers the creation of a buffer zone. This buffer zone is closely monitored by the nociceptors and they inform the brain if you try to breach it. In response, your brain creates the experience of pain to remind you to reign it in. Usually, but not always, this buffer zone shrinks as the tissues recover and the sensitivity of the nociceptors returns to normal.
2. “But I’ve had my pain for months!” I hear you cry. I know, I know, we’re coming to that now. The second category or injury was what used to be called chronic injury. This is the pain and apparent injuries that just go on and on and on. So what’s happening here?
   
   At this point it’s really useful to separate out injuries from pain. You may have gathered from the acute injuries section that injuries and pain aren’t necessarily linked. “Whoa!!! Wait, what???!”. That’s right, injuries and pain don’t need to be bed buddies – you can have one without the other. I know, mind-blowing isn’t it. But you actually already knew that. Here are some examples:
   1. Military personnel injured on a battlefield that don’t feel any pain until they are in a hospital.
   2. The guy in Australia who walked down the high street with an axe in his head, even stopping to buy a sandwich from a convenience store on his way to the hospital – didn’t feel a thing.
   3. That cut you just noticed on your finger and now hurts because you’ve seen the blood.
   4. Phantom limb pain where the pain is somewhere in the limb that’s no longer there.
   5. And countless other examples, both major and minor.
      

So what we are really talking about in this section is chronic pain rather than injury, now often referred to as long-term pain. This will make more sense in a minute, I promise.

Remember in the acute injury section I mentioned that usually, the buffer zone reduces within six weeks? Well, sometimes the system just doesn’t work very well for one reason or another. This means the buffer zone stays put and the sensitivity stays high. In fact, the sensitivity can even increase and this can become a real problem. The key thing here is that while the buffer zone stays where it is and the nociceptive sensitivity stays high, the actual tissues themselves are recovering exactly as they should. This results in…dun, dun, dun…..

Pain without injury.

So it is completely feasible, and actually very, very common, that if you’ve had pain for more than at least six weeks, your are moving into a chronic pain state where the injury (if there even was one at all – don’t worry, that’s for a different day) is recovering well but the system isn’t resetting. This results in your brain being tricked into thinking it needs to keep giving you the experience of pain so you avoid using the now non-injured area. 

Does that mean you should just push through the pain if you’ve had it longer than six weeks? NO! STOP! DON’T EVER DO THAT!

Pain MUST Be Paid Attention To

Even if you’ve had the same pain for many weeks, months or years, you should always pay attention to it. Pain is an output from your brain to let you know something isn’t right and you need to take action. Even if your nociceptive sensitivity and buffer system hasn’t reset properly, you still need to pay attention to the pain experience.

There are many things that could be triggering the threat levels in your nociceptors and stopping the system from resetting. Often, I find this is connected with a poor sensory or motor map of a joint at one side (or both sides) of the painful area.

If, as part of the original injury (even if it was years ago) some of your sensory ability may have been affected, the joint maps may be incomplete. Your brain uses this sensory input to help determine where a joint is, and how to activate and control the muscles and connective tissue in supporting the functioning of that joint.

This can also impact your ability to stabilise your joints when running, and you can probably guess that this itself presents a huge threat to the brain. In turn, your brain produces a pain experience to get you to stop doing the actions leading to the threat, and you get in a cycle of threat-pain-threat-pain etc.

This can be hard to break, particularly with traditional strength-type training and rehab as they almost completely miss the mark of how your system needs to be treated for those sensory systems to be up-regulated and stimulated.

Paying attention to your pain experience can give many clues as to the underlying cause(s) and is often not directly related to the painful area at all. Ignoring your pain experience can lead to unhelpful compensations that can then lead to other acute injuries, whether of the immediate kind or the slow burn kind.

So, Why Does My Knee Hurt?

Hopefully, this article has helped you to understand that injury and pain aren’t necessarily linked, and you can have one without the other. You will also appreciate that sometimes your system doesn’t reset correctly following an injury (or perceived injury), and this can lead to long-term pain because something is still causing a threat to your brain and until you deal with that something, it can be a very long road back. This is often the reason why you may get recurring pain in the same or a similar area.

So the real answer to “Why Does My Knee Hurt? AKA Runner’s Knee” is:

It Depends…

Over the next few weeks I’m going to write up some of the case studies of runners that I’ve worked with where we’ve approached their knee pain, as well as other “injuries”, at the level of the nervous system rather than just always going for “strengthen, strengthen, strengthen” in the traditional way.

This means that I’ve assessed how and why their nociceptive system isn’t resetting as it should, and we’ve designed specific drills and exercises, as well as things like specific taping strategies, to make incredible progress – even when they have already seen everyone else and done everything else.

I hope you’ve found this article interesting and it’s raised some questions about how you currently approach your running injuries and pain. As for the answers… you’ll need to open your mind and stay tuned for more articles.

The post Why Does My Knee Hurt? AKA Runner’s Knee appeared first on RunTeach.

Getting confused?

With up to 80% of runners being struck down by a running related injury in every 12 month period, it’s about time you took action to reduce your own injury risk.

All over the Internet you can find many ways to do this from Yoga for runners, a million different ways to stretch, mobility for runners, and of course everyone’s favourite, strength for runners.

Do you really have to do all of these? If not, which is best? How can you decide where to invest your time and money? Do you even need to invest any money because there are literally thousands of free posts and videos in all of the categories I mention above. Where do you start?

Stripping it back

Let me help by peeling it right back to bare bones – well, hopefully not literally, but you get my point. Let’s strip this thing down!

There is only one reason you get injured – your body’s tissues cannot handle the forces being applied to them. It actually is as simple as that… and as complicated as that!

Let me elaborate with a little more detail. Your physical tissues don’t know about miles or kilometres. They don’t know about trail runs, road runs or track sessions. They don’t even know about running. You could be swimming, cycling, rock climbing, digging out your allotment, skiing or rock climbing. All your physical tissues know about is mechanical force.

Mechanical force is simply the load that’s applied to your tissues (bone, muscle, connective tissue, skin, etc) at any given time. They can either withstand the force, or they can’t. If they can’t, they fail and injury occurs – simple.

When looking at mechanical force, we need to look at the three primary elements:

1. Intensity
2. Frequency
3. Duration

Intensity

Intensity is the amount of force; it’s the level of loading or impact. For example, if you whack yourself on the thumb with a hammer (don’t do this by the way), there is a higher intensity than if you poke your thumb with your finger (unless you are mega strong of course).

When running, the level of intensity tends to be influenced by how efficient a runner you are, your bodyweight (although you’d be surprised on this one), the speed you are running at, and the surface you are running on including the incline/decline, your ability to control how you land and your reflexive stability (joint stability).

Frequency

Frequency is the number of times the force is applied in any given period.

When running, you can look at frequency at both a micro and macro level. At a micro level, frequency is the number of steps you take in a minute. This is commonly known as your cadence, and most running watches will give you this number. Contrary to popular belief, there is no ideal cadence.

It was commonly thought that 180 beats per minute (or steps per minute to be more accurate) was the ideal, but this was misinterpreted from some track sessions of a very few elite athletes quite a few years ago. These days, most professionals and coaches accept that we find our own cadence to a certain extent, but under certain circumstances there is a range that appears to be more efficient in terms of performance and injury prevention. 

Personally, I like to help people achieve between 176 spm and 186 spm as I’ve found that to be a good range to encourage efficient form while also encouraging good performance. Current research isn’t conclusive in terms of injury prevention and cadence, but this is often because the research itself is flawed. There is some evidence that if runners with a slower cadence, who are also experiencing pain in certain areas, increase their cadence they can reduce their pain. But higher quality research is required to provide us with the data we need in order to make better decisions around cadence and injury risk.

Anyway, back to the point. If you have a cadence of 176 spm, your tissues are exposed to the forces of running 176 times per minute. You may think then, that a lower cadence is good, but it’s a bit more complex than that as with a lower cadence your feet are on the ground for longer – see Duration for more on this. As a side note, this is why some evidence points to a higher cadence – feet are on the ground for less time.

When viewed at a macro level, frequency becomes about the number of runs per week, month, year etc. Not paying attention to this is a leading cause of overtraining that in turn can result in your tissues not being able to handle the forces involved.

Duration

Duration is over how long the forces are being applied – it’s a period of time. Like Frequency, duration can be viewed at both a micro and macro level.

At a micro level we need to consider how long your feet are on the ground with every step, known as ground contact time and is measured in milliseconds. Most efficient runners have a ground contact time of 220 ms or less, whereas most recreational runners tend to trend from 250 ms to 350 ms or higher. Now, this is still a fraction of a second, but that small difference in time exposes your tissues to the forces of running for that little bit longer, and it makes a difference to both injury risk and performance.

At a macro level, you can view duration as the time you are out on each run, and your overall time running in a week, month, year etc. 

Why tissue fails

As you’ve just learned, mechanical force is applied to your tissues every time you go for a run. In fact, it’s applied all of the time in every moment of your life. It is present in an almost infinite combination of the three elements mentioned above, and how well your tissues are adapted to each combination determines whether they handle it or fail – or breach the threshold for your nervous system to be happy, and this then results in niggles and pain.

To reduce your injury risk you need to train your tissues to adapt to these forces – again, it’s as simple as that. There are ways to reduce the forces through improved efficiency (elements of technique for example), but there will always be forces your tissues need to handle.

To adapt, your tissues need two critical components. If these aren’t present, your injury risk  increases. These are:

1. Load: you need to overload your tissues for them to adapt
   
   
2. Recovery: I always say that “the magic happens in the recovery”. During recovery, your tissues are rebuilding and reorganising so they can better handle the same overload of forces the next time they are exposed to them

It is crucial to understand though, that:

1. If the overload is too much (any excessive combination of the elements of mechanical force), your injury risk increases
   
   
2. If the overload is too little, no or minimal adaptation is forced

The skill is finding the balance between these two, combined with appropriate recovery, and in line with your goals.

How to use this info

Now you have a simple overview of why injuries occur, let’s have a brief look at how you can use this knowledge to reduce your own injury risk. Again, at a foundation level there are some easy things you can do:

1. Frequency: This is probably one of the easiest areas to address, although not all runners actually want to take action here. When looking at frequency you need to look beyond just running. You need to look at what else you are doing in your life that’s exposing your tissues to overload. Remember, your tissues don’t have any concept of running, going to the gym or any other activity – all they know is mechanical force.
   
   Increasing the number of runs per week increases your frequency of loading while also reducing potential recovery time.
   
   Reviewing your overall loading activity, both running and non-running, and the amount and quality of your recovery can highlight areas where you are doing too much and not giving yourself appropriate time to adapt.
   
   
2. Duration: Another area that’s relatively easy to review if you are allowing your tissues to adapt or not. Look at the length of your runs and the length of your recovery periods. Similar to above, the longer your runs, the less time you have for recovery and the more you expose your tissues to the mechanical forces of running.

It’s very common when building up to longer distance events that we increase our mileage. While your body has no physical sense of distance, increasing your mileage will generally result in an increase in the duration of your runs. This exposes your tissues to potential overloading for more time before they get some recovery.

Paying attention to any sudden increases, as well as looking at your overall duration of both running and non-running loading activities can help you identify if you are allowing your tissues to adapt or gradually wearing them down.

I have deliberately missed out Intensity here as it’s more complex to address. This is where we need to look at efficiency which brings with it a whole bunch of skills training and skill endurance – my main passion and the focus of most of what I teach.

For now, making sure you are reviewing both Frequency and Duration will help you to reduce your injury risk and improve your overall running performance.

The post Injury Prevention – Simplified appeared first on RunTeach.

Stiff, achy muscles is a common complaint among runners. Whether it’s your hamstrings, calves, shoulders, hips, thighs or back, I’m sure you know exactly what I’m talking about. So you do what we all do these days: you do an online search and find all manner of stretches that promise almost instant relief. But how effective are these stretches, and should we include them in our warm ups to avoid getting stiff muscles in the first place?

Stretching is one of those things that has been hotly debated for quite a few years now, and to be honest, the available research is inconclusive about the benefits that stretching promises to deliver. Having said that, there is overwhelming agreement that static stretching as part of a warm up can reduce your running performance. Further to this, here are some words from Eyal Ledermen in his book Therapeutic Stretching, Churchill Livingstone Elsevier, 2014, referring to stretching as part of a warm up before and after exercise: 

Wow, that’s some statement and you may be thinking “what the heck do I do with that? Do I just not do a warm up any more?”. Firstly, let’s keep our focus on stretching. An effective warm up should never have been just about stretching anyway, so removing the stretching part of it does not mean removing the warm up completely. See this short article to discover why a warm up is important and what it is aiming to do.

Secondly, all we’ve done here is basically said that stretching isn’t very effective and isn’t a necessary part of a pre and post workout routine. By the way, Lederman isn’t the only expert to say this. Jay Dicharry, MPT, SCS, who is recognised as an authority in biomechanics, says something very similar in his books, and there are plenty of other specialists in this field that agree. But what about stretching in a wider context? What about using stretching to recover your range of movement (ROM) from your stiff muscles?

Fixing The Wrong Thing

Here is where it all goes a bit murky, and we need to look at the different types of stretching, what our goals are, and what the underlying cause of our stiff muscles or restricted ROM is. Too often we attempt to fix the output or outcome rather than the source of the issue. For example, restricted ROM around your hip is an output. Is the cause stiff hip flexors, glutes, quads etc? No, because they are also outputs. It is true that the stiff muscles are likely to be holding a restricted ROM, but what’s causing the stiff muscles in the first place?

Also, attempting to stretch a stiff muscle is more often than not, the complete opposite of what you actually want to do. If the muscle is already stiff, attempting to stretch it may trigger more contraction and more stiffness. Stiffness (a partial contraction) is a protection mechanism from the underlying nervous system, so trying to pull apart a protected muscle by stretching it is just plain daft. What then are you supposed to do?

The easy answer is to find out why your nervous system is holding the stiffness in place. Have you overworked the muscle and your system wants you to stop using it until it’s recovered? Does your system feel unsafe when you use that muscle, perhaps because you have faulty mechanics and can’t use it properly and are prone to injury? Do you have stability issues that are causing your system to stiffen up certain areas in order to create compensatory stability? Do you have sensory mismatching or miscommunication across different areas of your nervous system?

A good example of this sensory mismatch leading to muscle stiffness is a difference in signals coming from your visual system and your internal balance system (vestibular). If your brain is receiving different information from each and it can’t match it up correctly, it will stiffen your neck to keep your head still to avoid you falling over, feeling sick and other motion/balance-related issues. Simply trying to stretch your neck out won’t help. It may feel good at the time, but until you address the underlying sensory mismatch, that stiffness will come right back.

Thinking It Through

This same type of thing is happening all over your body. So the next time you think that stretching out stiff muscles is the only way to get relief, just ponder a bit longer. What may be causing the stiffness in the first place, and how can you address that issue? Of course, stretching can feel great and it does have a “mapping” effect where it helps your brain to identify where parts of your body are, so I would never say don’t stretch. It’s more about being aware that stretching probably isn’t doing what you think it’s doing, and there are far more effective ways to reduce muscle stiffness, regain ROM and improve performance.

The post Should You Stretch? appeared first on RunTeach.

With the number of people lacing up their shoes and getting out running continually on the increase, so is the number of running injuries. Three years ago, the available literature told us that up to 75% of runners will get a running related injury in every 12 month period. Today, that figure is now 85%!

If, like me, you think that figure is way too high and you want to know more about how you can lower your injury risk, read on…

Running injuries fall into two categories:

• Traumatic, one-off incidents such as falling off a curb or falling over on the trail.
• Progressive overloading that can happen over weeks, months or years.

Overuse injury

Progressive overloading is the cause by far of the vast majority of running injuries. And the thing about it is that it sneaks up on you in stealth mode. What starts out as a niggle, an annoyance, something you ask your running buddies about and get a variety of advice on – slowly works away in the background. It weakens muscle, bone and connective tissue until one day it just gives way – snap! This is a classic overuse injury. 

It could be a hamstring, Achilles, or other muscular or connective tissue injury. In some cases in can be a bone injury such as small fracture in your foot, ankle, shin, knee or hip. Often, you do get some pain but it commonly presents in a different area and this can confuse any self (or indeed professional) diagnosis should you seek it.

Spooked

All this sounds pretty scary, and maybe that’s appropriate as Halloween is just around the corner. And at the rate runners get injured, chances are that every one of us has some overuse injury lurking around waiting for it’s chance to snap.

But, the good news is that most of these overuse injuries can be prevented. All those missed running hours, wasted race fees and hundreds of pounds spent on physios and rehabilitation could have been saved. But how?

Tolerance to injury

The only reason we get injured is that our muscles, bones and connective tissue cannot handle the load we are applying to it. In one-off traumatic incidents, excessive load is applied very quickly and our systems can’t react in time to reduce the impact. With overuse injuries, we aren’t providing the tissue with the correct ratio of load and recovery to allow it to adapt to the amount and frequency of loading we are expecting it to handle.

When we break it down like that, it sounds pretty simple. And the truth is – it is pretty simple. But simple isn’t the same as easy, and there are lots of ways we distort that ratio of load Vs recovery. Perhaps the one we all hear the most is “too much too soon”. What does that really mean? 

Reading between the lines, you probably realise that to reduce your risk of injury you need your muscle, bone and connective tissue to be able to tolerate the loads you are subjecting it to. And this should be your mission as a runner. To keep enjoying your running you need to be more resilient.

It is certainly our mission. We care about you enjoying your running and we hate running injuries. That’s why we are on a quest to do what we can to reduce the rate of running injuries within the running community.

On a mission to reduce injury

For the past year this has been through our in-depth running analysis, personalised coaching and educational workshops.

Yes, you can find so much information online about running injuries and how to reduce your risk. But how do you know what’s good, effective information and what’s just regurgutated content for someone’s blog? Having said that, there are some amazing resources out there.

I would definitely encourage you to learn about tissue tolerance, prehab strategies and other ways of reducing injury – even if you are not that interested in injuries or think “it will never happen to me”. If you give it some thought, the less time you are injured means more time running which means better consistency which usually results in more PBs.

A good starting point is my blog, the main page is here.

I’ll keep adding to the exercises and info so that you can work on your own injury prevention plan.

If you want to experience a fun and interactive live session, then come along to my Resilient Runner Workshop. The whole aim is to help you reduce your injury risk and transform into the runner you want to be.

Details of the workshop can be found here.

The post Niggle and snap appeared first on RunTeach.

The muscles that we are particularly interested in are the tibialis anterior muscles. However, a couple of others are also important here…

Extensor digitorum longus and Peroneus longus

All you really need to know though, is that we are talking about the muscles down the front of your shins. In most recreational runners, these muscles are weak and underused. As such, we tend not to be able to get the range of motion at the ankle that we need for running. This is turn can lead to lots of compensations such as over pronation as well as knee and hip pain.

The movement where your toes and shins come closer together by your foot moving upwards is called dorsiflexion, and this is crucial to running from both a injury prevention perspective and a performance perspective.

Essentially, to run fast and to reduce injuries, your ankles need to move properly. We also talked about it in the following posts:

1.  You are the weakest link

2. Shin Splints – Causes of shin pain in runners

3. Ankle testing for runners

So, how can you get strong shins and improve how your ankles move? Fortunately, it’s really simple and only takes a few minutes each day to do.

This exercise may be the only one you need. It comes from those experts in all things gait Shawn and Ivo, AKA The Gait Guys. Unfortunately their own video is a little old and difficult to view properly, so we’ve created our own.

Doing this simple exercise for two minutes every day, or at least three times per week, for a few weeks, will result in huge gains in shin strength.

Combine strong shins with increased ankle range of motion, and you will reduce your injury risk and get faster!

The post Shin strength exercises for runners appeared first on RunTeach.