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1) "How To Use This Web Site" section complete!
Due to the volume of information on the A-T-A site, I decided it was time to add a formal set of directions on how to put all of the different pieces together. These can be found when using the index tabs. Simply click on the body region that you want to work on and the you will find the "How To" section right at the top (the individual treatment techniques are located below this in each region).
In this section you will find a post that describes all of the massage and mobilization techniques that we've used to date and detailed guidance for how to best use them on the major injury categories (i.e. muscle sprain/strain, tendon injuries, spasm/knot/trigger point, and overuse injuries). There is also a new post on how to incorporate kinesiology taping into your self treatment plan.
2) Kinesiology Taping Series Is in Full Swing
With the help of the folks at Rock Tape, we are currently working our way through the body showing you how to use kinesiology taping as part of your training and recovery plan. If you've never heard of it before, this is a special flexible tape that can be used in multiple ways to speed up your recovery and re-educate your muscles to fire properly when working on form and strength. In short, it is a GREAT tool to have as an athlete.
Here are some links to get you started:
This case study was sent in by an 18 year old female swimmer who has been struggling with persistent pain in the front of her left shoulder for the past two months. Here's a quick rundown of how it started and what has been done to treat it so far:
- Pain started during a high volume phase during preseason. There was no specific incident or "injury" (meaning there was no pop, pull, or "oh no!" moment). Symptoms started initially as pain while swimming at speed or at the end of team practices. They worsened to include pain with normal daily activities and "clicking" with overhead reach. She was unable to complete her competitive season.
- Treatment so far has included ice, ibuprofen, stretching, and decreased swim volume/intensity (HS swim season is over).
What is Impingement Syndrome??
There are three bones and subsequently three joints that make up the shoulder. You have the humerus (upper arm bone) that connects to the scapula (shoulder blade) and both are then connected to the skeleton by the clavicle (collar bone). This gives you three separate joints to help move the shoulder- 1) the glenohumeral (GH) joint, 2) the AC joint (top of the shoulder where the scapula and clavicle join), and 3) the SC joint (where the clavicle attaches to the sternum/breast bone). These joints are then reinforced by muscles that help support them and also work to hold the the scapula against the rib cage. This includes the rotator cuff, Lats, triceps, serratus anterior, pecs, and biceps.
The big take away here should be that the shoulder is an unstable joint that relies on muscles to hold it in proper alignment versus bones. This makes it particularly susceptible to muscle imbalance and injury. For example, overhead movement requires two things: 1) rotation of the scapula
(shoulder blade) and 2) elevation of the humerus (upper arm bone). When
both of these things happen there is plenty of space within the shoulder
joint and all of the tendons and bones are able to move through their full range of motion (ROM) without problem. However, when they do not, this
space is decreased and the larger muscles must force the movement through bad alignment. This can result in the smaller tendons in the front of the
shoulder getting repetitively pinched and inflamed. This is what happens with impingement syndrome. The muscles supporting the joint become tight and over time become less efficient and unable to hold the joint in proper alignment.
Why is it so common in swimmers and triathletes?
The main reason this is so common in swimmers is that all of the muscles that help pull the arm through are also the ones that help hold the joint in position. When they get tight or stiffen up from fatigue, the shoulder blade can get stuck. Once it's stuck, not only is the joint space becomes limited, but you've also lost one of the two components needed for overhead movement. From an injury standpoint, two things can happen: 1) the tendons can get pinched and irritated through repetitive impingement or 2) the muscles/tendons can get injured (i.e. tendinitis, strain/sprain) trying to work around the stuck scapula while continuing to swim.
So how do we treat it?
- Impingement syndrome is the result of muscle imbalances and bad alignment that combine to limit the ability of the shoulder blade and humerus to work together properly. The easiest way to treat it is to focus on the muscles themselves versus the tendons that are being pinched in the front. By restoring mobility to the muscles, you will be able to create slack in the tendons to allow them to heal. This will also help restore normal balance around the joint and create space within it.
- For the shoulder blade you will need to work on: 1) the pectoral muscles, 2) the rotator cuff muscles, 3) the muscles between the shoulder blades, and 4) the serratus anterior.
- For the humerus you will need to work on: 1) latissimus dorsi, 2) triceps, and 3) biceps.
- Ground rules: 1) This is not intended to be a no pain, no gain kind of treatment. You are healing an injury, not trying to beat it up more. 2) These treatments are part of a progression. Only advance through the techniques as you can comfortably. Skipping ahead to the more aggressive techniques to try and rush the process can get you into more trouble. 3) Here is a rundown of the progression we will be following.
- Start with self massage. Use the foam roller first to warm up the muscles and look for deeper problem areas. From here you can break out the tennis ball to use the cross friction and trigger point techniques. Here are the three links you will need (Back of the shoulder, front of the shoulder, upper arm). Each has a video demonstration and pictures with specific spots to work on for the deeper techniques.
- Next up are mobilization techniques. We're looking for 10 reps of each. 1)back of the shoulder, 2) front of the shoulder, 3) rotator cuff, 4) bicep/tricep, and 5) between the shoulder blades.
- Follow up your soft tissue work with stretching. Hold for 20 seconds and repeat 3 times. There are five stretches: 1) mid back, 2) mid back with rotation, 3) tricep, and 4) biceps, and 5) pectoralis muscles.
- Ice 10-15 minutes after soft tissue work and stretching.
- Be realistic. If you can't make progress on this injury or pain increases, get help from a professional. :)
For those of us without an extensive run background, working to improve our form can be a difficult challenge. This isn't due to a lack of training miles or effort. It's simply that we bring varying levels of mobility and strength to the table. The later in life we start running, the more variable this can be. In this multi-part series we're going to approach this challenge from an anatomical and mechanical standpoint. Reaching good run form requires far more than working on cadence and how your foot hits the ground. What are the positions that we need to be able to get into and how do we get past the various muscle and joint restrictions that stand in our way? Once the mobility is there how do we build the necessary strength to use that mobility and then maintain it mile after mile? These are the questions we want to answer.
In the first part of our series on improving your run form we took a look at what normal joint and muscle mobility looks like and more importantly what is needed to get into a good run position. You can review that article here. In this part of our series, we are going to talk about specific work to help restore mobility to these common problem areas.
Step One- Foam Roller
The first thing we are going to work on is muscle mobility using a foam roller. The main goal here is to warm up the area and decrease soft tissue restrictions by stretching out or lengthening the muscles from where they attach to the bones.
There are five specific muscles we will focus on. Click on the links below to review the anatomy and palpation landmarks before beginning. At the end of each post is a video demonstration showing you how to use the foam roller for each.
Anterior Tibialis
Gastrocnemius
Hamstrings
Quadriceps
Hip Flexors
We want to spend two minutes on each muscle. If the muscle is tender, start at the end that is comfortable and use the time to work up to rolling out the full length of the muscle. This may take a few sessions or even weeks depending on how restricted the muscle is and how long it has been that way. You want this to be repeatable, not a "no pain, no gain session" so keep the effort easy and work on what you have (not what you hope it is!).
Key Points
- Keep the muscle as relaxed as you can get it.
- Start at the end that is comfortable and work your way to the other end.
- Start with smaller rolling increments initially and work up to larger, full muscle movements.
- Use these movements to help release general tension but also to look for deeper problem areas. If it hurts to roll over it or you feel a lump or a knot, this means further work is required.
Step Two- Tennis BallOnce you have finished with the foam roller, you can go back to work on the problem areas that you found using a tennis ball. There are two deeper techniques that you can use to further loosen up the muscles. They are cross friction and trigger point release. The key with these techniques is to sink down through the superficial layer you just worked on with the roller to get to the deeper muscle fibers. From here you can work against the muscle in a perpendicular motion (cross friction) or you can apply pressure to a specific sore spot/muscle knot until it releases (trigger point). Click here to read more about these techniques and for a video demonstration on how to perform them. We are going to work on the same five muscle groups as above. Follow the links below for pictures and video guidance for locating common trigger point areas, as well as, specific locations to target with the cross friction technique.
Anterior TibialisGastrocnemiusHamstringsQuadricepsHip Flexors
Key Points - These are deeper muscle techniques and they can cause pain and discomfort. That is not the goal. At no point should it be getting worse. Remember, for most of us it's going to take some time to loosen up the muscle restrictions we've run with and developed over millions of steps and YEARS of training. It doesn't mean it will take forever to change them, but it will take some consistent effort.
- Cross friction works by sinking through the top layer and then working perpendicular to the muscle fibers. This is a very small movement (1-2" max). Sink in and then move. The tennis ball should not be rolling around.
- Trigger point release works by sinking into the sore spot/muscle knot and then maintaining that pressure until the muscle relaxes underneath.
- When starting off with these techniques, start easy. Shoot for 15-30 seconds of cross friction per problem area (no more than 2 problem areas per muscle). For the trigger point technique, start with 1 minute of hold time.
Step Three- Mobilization Techniques
Following your work with the tennis ball we can move onto mobilization techniques. An easy way to think of these is to picture them as massage techniques working specifically on intersection areas. This can mean an intersection where two muscles cross or where two bones meet to form a joint.
The primary goal of a mobilization technique is to anchor down one end and move the other. Unlike the massage techniques these are not held for time. They are performed for 10 repetitions. Click here to read more.Key Points:
- Each mobilization has a start position and a finish position. Place the tennis ball, move into position, and then apply tension. From here you will move to the finish position.
- This is not a traditional stretch. No hold time is required. Go for 10 reps instead and move slowly through the motion.
- If you hit a pain point/strong
stretch, stop there, hold for 1 second, and then repeat for the
remainder of the reps. You don't need to be a tough guy. You want this
stuff to be repeatable. Build through the reps and do what you can do. Never try to force the movement.
Step Four- Stretching
Now that you've learned how to break up adhesions and restrictions within the muscles, you need to stretch so that the body can register that a change has occurred and adapt accordingly. Muscles have what is known as a resting length and tension. This means that at rest, a muscle has an ideal length and tension that allows it to function at full capacity in terms of the force it can generate and the velocity at which it can move the joint it supports. Changes to that resting length and tension, whether it's loss of mobility or increased tension in the form of knots or spasms, will limit the muscle's performance. Think of it this way- the earlier techniques are working to change the things altering that length/tension, but stretching is what will reset and restore how the brain and nervous system use that muscle. The best way to do this is through frequency.
Unlike all of the studies out there debating the effectiveness of stretching, our goals are not to decrease recovery times, decrease injury rates, or even to improve performance. They are much simpler than that. We're trying to restore normal mobility and function so that the affected muscle and those that work with and against it can all work the way that they are supposed to.
Below are some of the basic guidelines to keep in mind while stretching:
- Stretching should never hurt. Once you feel a pull or "stretching sensation" stop there. This way you can build on each stretch without risking injury.
- Shoot for 20-30 second holds and 2-3 repetitions. The key is frequency. Stick to the reps and avoid holding longer to get done faster. It's worth it!
The Routine
Now that we've gone through the different techniques, here is what the final routine looks like. Only progress through the steps when you can complete the first step comfortably and without soreness the next day. The same rule applies when moving up from step two to three.
Step 1
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Step 2 |
Step 3
| | Foam Roller (10 minutes: anterior tib, gastroc, hamstring, quad, hip flexor) |
Foam Roller (10 minutes: anterior tib, gastroc, hamstring, quad, hip flexor) |
Foam Roller (10 minutes: anterior tib, gastroc, hamstring, quad, hip flexor) | | Stretching 2x20 seconds all 5 stretches |
Tennis Ball (Cross friction + trigger point). 15-30 seconds with cross friction (no more than two spots per muscle) and 1 minute hold with trigger point. |
Tennis Ball (Cross friction + trigger point). 15-30 seconds with cross friction (no more than two spots per muscle) and 1 minute hold with trigger point. | | |
Stretching 2x20 seconds all 5 stretches |
Mobilizations (tennis ball + joint)- 10 reps of each | | |
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Stretching 2x20 seconds all 5 stretches |
When is a good time to do this while training with races looming on the calendar?? - Don't worry about squeezing this sort of work in before/after workouts. Choose days that are already easier in intensity or duration. For example- the days after a track session, hill workout, or long run are perfect. These are generally lighter training days or rest days.
- Try to spread these sessions out by 48 hours. Typically you're training schedule will already do this for you. If you're following a schedule that has multiple hard days in a row, wait until all the hard workouts are done and try to do this work the day after when the workout is light or it's a rest day.
- At a minimum, use the foam roller and get the stretches done. Save the rest for when you do have time. The ultimate goal is to do this stuff consistently so find what works for you and stick to it. Better to have shorter weekly sessions than one killer session a month.
- This kind of workout will take some time initially. As you get better at the techniques and more familiar with your muscles and problems areas, you'll be able to focus on those and will become more efficient.
When is a good time when I don't have any races on the calendar?? - If you don't have any specific races coming up or are in your off season, you can increase the frequency of your mobility work.
- That doesn't mean start doing the exercises every day right out of the gates. It means work your way through the steps. Start by using the roller and stretches every other day (3x/week at most). From here you can start alternating days with an easier foam roller/stretch one day and the deeper tennis ball and mobilization work the next day. This will give you 4 days/week and that is plenty.
- You must allow recovery from the deeper muscle work. At a minimum allow 48 hours between these sessions.
- You still want to allow the muscles time to adapt and heal so that you can increase mobility without injury. This means listen to your body. If the 4 days/week is too much and you are sore, back it down. Be consistent with those two sessions.
In the next installment in our run form series, we're going to go back through the joint/muscle evaluation and discuss the common compensation patterns that occur due to prolonged restrictions and help you adjust the above plan accordingly. From there we will move onto specific strengthening techniques and running drills to help reinforce it. In the mean time- get to work!! All the strength in the world won't help you if the muscle can't move. :) |
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