The Best Injury Treatment is Prevention

...and "Balance" is the best form of prevention.  Let me explain.

Chance are, you have heard maxim that is the title of this article before, along with pearls of wisdom like, "An apple a day keeps the doctor away!" and "An ounce of prevention is worth a pound of treatment!"  It is likely that all of us, on some level, know that preventing something bad (or injurious) from happening is far, far better than dealing with the aftermath.  This is why there are seatbelts, airbags and auto insurance, but we still require everyone to attend driving school and take a test to obtain a license.

Intuitively, we get this.  So why am I talking about it?  Because most of us are very, very bad at it when it comes to our own bodies.  This is especially true if we don't like something that is good for us, like healthy food or exercise.  We become very choosy about what we will and will not do in order to maintain health or improve performance.  This is why I know people who won't eat certain foods because they are bad for them, but are in the bars every weekend.  It's not that they're misinformed, it's just that they are willing to compromise on only so many things.  Think you don't know someone who does that?  Look in the mirror - we all do, in some fashion, and I will be the first to raise my hand and say I am guilty of drinking Diet Coke (lower calories, no high fructose corn syrup) but scarfing down far too much ice cream.

But it's not just diet (which is only one part of healthy living).  When I speak about prevention, I'm talking about the things we can do to maintain an active, healthy lifestyle.  Here are a few things that will all help us be better, healthier, active adults.

*  Do the things you don't like.
    Most workouts will include some aspect of the following, with one probably being a main focus: mobility, stability, strength, and conditioning.  It is likely that you hate one of these things, or at least part of one of these things.  For me, it's the dynamic warm-up.  I'll foam roll all day, but after that I just want to get under the bar or out on my run or bike route.  So, why not just skip it?  PREVENTION!!  (Remember??)  If I skip the dynamic warm-up, my program is lacking a vital component.  The warm-up is what allows me to lift as well as I do or run without being injured, as I wrote about last week.  So, while I find it irritating, I know that it actually makes me a better lifter, runner and cyclist.

*  Do things that are hard.
    We do easy things all the time.  We do hard things a lot, too - I will not take that away from you.  But, when it comes to the gym, we need to make a commitment to the hard stuff.  I struggle with rotational stability.  I can hang clean with the best of them, but ask me to chop and lift and suddenly I'm a new fawn, all wobbly and soft.  Because it is hard for me to do, it's easy to skip it - but it being hard is precisely the reason I need to work on rotational strength more, not less.  It's hard because it is my weak spot, which means I am susceptible to energy leaks and injury.  Find what is hard for you and become a master at it.

*  Once in awhile, do something when you don't want to.
    This is a tough one.  If we are lucky, we are doing what we want to do for the majority of our waking hours, making the occasional push to do something unpleasant (but beneficial) a little easier.  If we aren't so lucky, we spend a lot of time (perhaps at work or in school) doing something we don't really want to be doing.  I am always reminded of the dad from the Calvin & Hobbes cartoon, who is constantly trying to get Calvin to do something he doesn't want to because, "...it builds character."  At the risk of sounding like a parent, that guy was onto something.  In fitness, we tend to do the things we enjoy doing.  I became a runner basically because I hated running.  Yes, that's counterintuitive.  I've been athletic and active my entire life, but I wanted a new challenge that fit into my current lifestyle - running fit the bill.  Sandwich one thing you don't like (say, Mountain Climbers) between some things you do like (front squats and Turkish Get-Ups, obviously) - you get the idea.  You will find there is a special satisfaction in completing something you're not thrilled about doing in the first place.

       Source.

*  Once in awhile, don't do something when you do want to.
    I put this in here as a reminder that recovery is important.  While for some of us the issue is not moving enough, for others the issue is slowing down.  Running through injury, lifting when sick, or just plain working out every day of the week without a break will only lead to breakdown in the end.  Go have fun!  Yes, working out can be fun.  Go do something else that is fun (Dear Red Sox, Please feel free to help me avoid injury by giving me tickets to a game a week so I have something fun to do other than working out.  Love, Me).  Speaking of fun...

*  Make a commitment... to doing something FUN.
    In reading through my list of the first four, it sounded a bit like a manifesto on how not to enjoy life!  Nobody wants to be forced to do something they don't like or that is hard all the time.  Likewise, we don't want to take away the things we enjoy.  That's why working activity into your life in ways that bring other forms of enjoyment is important.  I could run just to run - for the health benefits or whatever.  But, I run road races because I get further enjoyment out of the inner (and occasional outer) competition, the camaraderie of "we're all in this together" and the social aspect of having a post-race pint.  Beyond running, this activity brings me joy.  Do exercise and fun coexist in your life?

I opened the blog saying that balance is the best form of prevention.  Living a balanced life will enable you to stay healthy and realize your full potential.  Work and play.  Activity and rest.  Flexibility and strength.  Mobility and stability.  We need all of these things to be complete.

On a personal note, the last few weeks have been a bit of a roller-coaster in the lives of people I know.  Two untimely deaths have been met with a birth and a wedding - and with these events I have witnessed utter despair and unbounded joy.  In this moment I am thankful for the people I love and who love me, for the opportunities I have and create, and for the ability and drive to be better and move forward, however incrementally.  As my RoadID says, "Momentum trumps inertia."

I thought I'd leave you with another Calvin and Hobbes strip!

"Grown-ups play by justifying it as exercise and keep tabs by quantifying performance."  Source.

How My Warm-Up Saves My Ass (Literally)

A little while ago, I was browsing the interwebs, and I stumbled on this article: "When the Diagnosis is 'Dead-Butt Syndrome'".  After the obligatory giggle, I read through author Jen Miller's account of being diagnosed with gluteus medius tendinosis, sometimes referred to as "dead-butt syndrome."  With or without the -osis (indicating an inflammation of the tendon sheath) attached to it, gluteus medius weakness is absurdly common in endurance athletes - particularly those who do only one sport, and especially in runners.  The third paragraph nails it: "It's a symptom related to what running experts hammer at: the need for cross-training and strength training."

Which brings me back to the Hyannis races that went on last weekend.  Prior to the race, I was doing a dynamic warm-up.  I find that I am always the only person doing this, and I get a lot of funny looks (it's okay, I'm used to that).  Some people "warm-up," of course, by static stretching and running around a bunch to get the blood flowing and practice their stride.  As far as neuromuscular facilitation, or movement preparation, or functional movement warm-ups, though, it is non-existent.  One experienced runner commented, "Um... you make me feel like I should be doing something.  I don't warm up.  I just run."  Another wandered by while I was doing body-weight squats and said, "The real challenge is to see if you can still do those after the race!" (Result: I could, though not without some grimacing).

There has been increasing coverage in the general media about the dangers of specialization, especially in children, and how doing one thing all the time can lead to very serious injuries.  Runners for some reason think they are immune to this, and I have yet to understand why because they are plagued with injuries. Now, I am new to this whole "being a runner" thing, so maybe I just haven't drank the Kool-Aid yet.  However, my background is in athletics, injury, biomechanics and sport training.  I would never assume to know everything about anything, but I've had a pretty solid success rate at both preventing and treating injuries in many clients. The ultimate test, though, is with myself.  How many self-proclaimed experts do we know who don't actually practice what they preach?  Heck, I'm guilty from time-to-time (Ice cream before bed?  Yes please!)!  But, on this front, I'm one of the best - the only injuries I've ever sustained were spraining each ankle once, and both were because I fell down a flight of stairs (yes, each ankle once, fell down stairs on two separate occasions... because you can't strength-train the "klutzy" out of your DNA).  I have never sustained a major competition- or training-related injury (though I *have* sustained a "lack of training" injury in my two bulging lumbar discs... more on that some other time).

How do I do it?  What magic elixir am I taking??  It must be L-glutamine, right?  Or glucosamine?  Or protein shakes?  Or maybe I just don't train that hard - that must be it, right?

Wrong!  Though I may not be running marathons right now, guess what?  You don't have to be training for a marathon to get hurt... but you knew that.

The best part is, it's simple - and I'll give it to you right here.  I am currently training for both running and cycling events.  I run three days a week at steady mileage to maintain the gains I've made, but I don't need to increase right now because I am not training for a farther distance than I've yet achieved.  I bike three days a week at varying, progressively longer distances.  These activities overlap on one day, so I train 5 days a week with two for "rest," but that is an active rest - these are days when I am working both jobs and just don't have time to get a run or bike in, but since one job is at a gym, I am able to do a few basic movements for recovery.

With all that time for training, it sounds like there's not a lot of time for that all-important cross-training I've been harping about, right?  And that's where the warm-up comes in.  One part Renegade Training, another part Mike Boyle Strength and Conditioning, I spend between 15 and 40 minutes (depending on the day and the activity) getting my body ready for what I'm about to do.  The major takeaway here: nearly all these exercises emphasize hamstring development and the "turning on" of the gluteal muscle group.  Why does this matter?  I'll tell you in another blog.  For now, the components of my warm-up:

*  Foam Roller - Don't leave home without it!!  I spend between 20-30 seconds each on my glutes, hamstrings, thoracic spine, IT bands, hip flexors/quads and adductors.

*  Posterior chain activation and core strength - Variations of bridges, tables, planks and Supermans (with a few push-ups thrown in) to get my core activated and ready to stabilize my hips, pelvis and back during my bike/run.

*  Dynamic ROM (range of motion) - Split squats, lateral and transverse lunges, as well as single-leg body-weight Romanian deadlifts and body-weight sumo squat "stretches."

*  Movement Prep - Walking lunge progressions, skips, butt-kicks.

For more specific info, hit me up with questions.  Happy Training!!

Winter Lightning

I've lived in the Northeast for all but 4 total years of my life, and this is the first time I can remember a thunder-and-lightning storm in the middle of February. I am sitting here in the dark, watching the storm out my back windows - admittedly, jumping out of my skin with every flash that lights up the night sky (I have an irrational fear of lightning, and I would prefer to be hanging out with my cat right now, who has sought refuge from the storm under my bed).  There is something brilliant about such a powerful display of energy in the form of weather.  The lightning and thunder have retreated now, and - as always - the emergency sirens rise in the distance.

This seasonal anomaly had me pondering other things that don't make sense.  For instance, the preposterous amount of injuries sustained in non-contact situations by runners.  OK, the storm didn't directly lead me to think about hurt runners - this article did.

The author, John Converse Townsend (a somewhat ironic name, given who he is upset with), takes aim at the footwear industry, joining the growing legions of voices who place blame for poor running technique and the host of injuries that accompanies it square on the shoulders those who design and manufacture athletic shoes.  I do not wish to echo his sentiments here - you can read what he has to say, as he put it quite succinctly.  However, I would like to highlight one aspect of his article.

Townsend discusses running form during basketball games.  This is an important, and significant, departure from the current conversation about running that is entirely about, well, runners.  But what about the millions of athletes who run as a part of their sport?  Basketball, soccer, lacrosse, field hockey, rugby, American football - these are just a few of the sports in which running is required for success, but is not the actually the primary goal of the athletic event.

So, what if we're (mostly) all doing it wrong?  Shoes may play a role in this.  Townsend's article quotes a colleague of mine, Dr. Irene Davis, who gamely states, "We've seen tremendous innovations in motion control and cushioning.  And yet the remedies don't seem to defeat the ailments."  Does this mean the shoes are actually the problem?  While I am convinced that the footwear industry has not lived up to the hype in terms of providing the promised benefits of shoes that cost half my weekly salary, I am not yet convinced that said shoes are actually the culprit - or, at the very least, the *only* culprit.

That said, this idea of improper biomechanics strikes a chord with me.  In an era where most business is conducted from a seated position and activity is not the norm, it is not surprising that something about our gait may have changed.  In the interest of brevity (and the fact that I am still fighting the flu and would like to go lay down now), I will explore this issue more in another post.

Until then, have fun doing something active!

Confessions of a Reluctant Runner

I am a runner.

I wince at the sight of that sentence.  A fitness professional I know asked me recently about sports I used to do. He followed it with, "And now you're... a runner?"  The hesitation, and the slight trace of a smirk that played at the side of his mouth gave away his feelings on "runners."

I am a runner.

Truth is, I was once probably worse than he was about "runners."  I still harbor many of the feelings I did previously, and with good reason.  I have dealt with self-proclaimed runners, of both the competitive and casual collection, in various settings for years.  Here is what I have learned: They are nearly always hurt.  Runners, as a group, seem to have the highest incidence rate for chronic, nagging injuries.  Maybe this makes intuitive sense - they engage in exercise that is of a chronic, nagging variety (you can see how thrilling I think running is).  But something about runners, and the injuries they sustain, is different.  No athlete who is serious about his or her sport is going to want to take a day off, even if it means the chance to be better, longer.  Nearly all athletes are hard-wired to want to go, push, practice, participate - this is one of the greatest challenges of working with athletes.  But runners... they are another animal entirely.  I once asked a runner to please, please take the day off from running to let some Achilles inflammation calm down.  He proceeded to run 3 miles, only to return and tell me that he DID take the day off.  And you know what?  He truly believed that running 3 miles was "a day off."

I am a runner?

Okay, I am not *that* kind of runner, and let's be honest, I'm never going to be.  For the first 29 years of my life, running was something you did out of necessity, as a part of something else.  You ran to first base.  You ran the length of a soccer field.  You ran to catch the T.  Thus, my running was mostly of the sprinting variety. I scoffed at distance runners.  Who the heck wants to pound pavement for hours on end, only to end up injured?  What's the point?  Where is the goal-scoring?  Where is the team you are benefiting?  I smirked at athletes who used jogging as a training mechanism.  I couldn't wait to show them how they were training themselves to be slower.

But, now I am a runner.

Nearly every sport I've ever participated in, from soccer to softball to pick-up dodgeball games, has had an explosive component to it.  Thus, I have always trained for explosive power and speed.  I am at home under an Olympic bar.  I live to single-leg box jump.  I find joy in repeated sprints, pushing myself to be faster every time.  About a year ago, though, I realized that it had been quite some time since I had actively participated on a sports team.  What, exactly, was I training for?  I was becoming the gym-rat I abhor - the person who is in the gym, and is "fit," but for what purpose, exactly?  To be better at being in the gym?  Ugh.  I needed a goal.

Enter: cycling.  (Gotcha.  You thought I was going to say running).  When someone very close to me was diagnosed with Multiple Sclerosis, I did the only thing that felt like helping - I bought a bike, organized a team, and did the MS 150 Ride in South Florida.  I actually fell in love with cycling.  It was the first time I experienced any sort of joy while doing an endurance-type sport.  Eventually, I figured that if I could transition into cycling with such enthusiasm, maybe it was time to give running another chance.  After all, I'd never run with a purpose (apart from not keeling over while slogging through some pre-determined distance that would be considered a successful "workout" for the day in the years before I knew better).

So, here I am.  I have signed up for several races (mostly 5Ks and one 4-miler) over the past few months.  It's been... interesting.  I don't love it - not yet.  But I'm giving it a chance.  I'm doing my first 10K in a week and a half.  I plan to do a half marathon this year - two weeks before my 30th birthday.  That's the plan.  I needed to have goals again, and now I do.  The thing is, it's not a competition - the only "competition" is with myself, something I've never really found that motivating.  Where's the team you don't want to let down?  Where are the fans you want to do well for?  This purpose of this blog is two-fold: First, put this experience out there.  My "team" will be the people who read this and relate, or at least feel like they come away with something new.  Second, say it with me now, accountability.  I've worked in the fields of rehabilitation and fitness long enough to know that without accountability, every goal is harder to attain.  So, I put this out into the interwebs as my way of saying, "I will do what I say I will do."  Half-marathon, here I come.

Because I am a runner.