Tennis Elbow

Tennis elbow, or what we call in the biz “lateral epicondylitis,” is characterized by pain on the outside portion of the elbow.  Although it’s common in tennis players anyone can get tennis elbow especially people who use their hands a lot, i.e. golfers, rock climbers, handymen (and women), etc.  It’s essentially a type of tendinitis that is the result of overuse.

Traditional treatment approaches involve supportive bands or sleeves, NSAIDs, corticosteroid injections, physical therapy, and sometimes surgery.  

A couple things can lead to the development of tennis elbow.  As mentioned above overuse is a big one. One less addressed issue that is equally if not more important is mechanics.  How are you swinging the tennis racket or golf club? Is your form good? Is your shoulder weak and putting excess stress on your elbow?  What about your wrist? If any of the traditional treatment approaches are successful at reducing pain but mechanics are not addressed there is a good chance the pain will return.  

It’s important to put out the fire (pain), but we must fix what caused the fire (mechanics).  

Below is a video of an exercise we use to restore proper shoulder function to take stress off the elbow.  

Our approach:

  1. Put out the fire aka reduce pain.   We do this with cold laser, acupuncture/dry needling, soft tissue work, kinesiology tape, and/or joint mobilizations.  

  2. Fix what caused the fire:

    a.  Strengthen the tendon.  Tendon pain happens because the strength of the tendon cannot match the stress being put on it. This is why the "rest and wait" method does not work.   

    b.  Improve mechanics.  This will be different for everyone.  Areas that can affect the elbow are the hips, core, shoulder, neck, and wrist.

  3. Modify activity.  Rarely do we have to tell someone to completely stop what they're doing.  There is a sweet spot between complete rest and going all-out where recovery can happen but where you can continue doing the things you love.  We work together to find that sweet spot. 

Not all elbow pain is the same.  Treatment should involve an individualized approach that addresses the root cause of the complaint.  Don't let pain hold you back from what you love doing. 
Let us help you bounce back pain free!

Pregnancy and Postpartum Back Pain

Pregnancy is a wonderful process, but throw some nausea and back pain in the mix and it can be a long 9 months.  As I'm writing this my wife is in her second trimester with our first child. The first trimester was filled with nausea.  As she creeps through her second tri the nausea is replaced with a growing belly and an aching back.

Like wearing a heavy book bag on the front of your torso your body will begin to compensate for the additional weight.  Your low back muscles may tighten to support your baby weight. Additionally, your abdominal muscles, which usually help brace your spine, are being stretched and are less effective at doing so.  Upper back tightness is also very common during pregnancy due to increased breast size and low back stress. As your body prepares for birth it will release a hormone called relaxin, which loosens the ligaments around the pelvis. This can lead to further instability and increased difficulty controlling the spine.

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These issues can be lessened, or avoided altogether, with the proper care.  Specific core exercises are great for keeping the abdominal muscles active, the pelvic floor strong, and body position optimized.

Specific exercises are used during pregnancy to:
-Reduce pain
-Strengthen the abdominals and pelvic floor musculature
-Improve movement quality
-Prepare the body for the birthing process

The last bullet point is key.  The birthing process is a trauma to the body, especially the pelvis. The stretching of the pelvic floor muscles can cause them to stop working efficiently leading to low back pain, exertional incontinence (peeing a little when you exercise), and pelvic floor pain even after you've given birth.  

As mentioned above, the abdominal muscles stretch during pregnancy. Ideally, after birth the muscles return (structurally and functionally) to as they were before pregnancy.  Sometimes the two halves of the rectus abdominis (6-pack muscle) don’t come back together as they should causing diastasis recti.  It can be a problem aesthetically and functionally. Certain exercises that work the rectus abdominis have been found to reduce and even correct instances of diastasis recti.  

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Below are some examples of the exercises we give to our pregnant and postpartum women to help strengthen the core and alleviate back pain.

Is Chiropractic Care Safe During Pregnancy?

The number one priority for any expectant mother is the health and safety of her baby.  We make every necessary accommodation for pregnant women. Special treatment tables break away at the abdomen allowing the patient to lay safely and comfortably on her stomach. Treatments are kept gentle and communication is key.  A heavy focus is placed on gentle exercises tailored to the individual meant to take stress off the painful area while strengthening the core and pelvic floor.

Complaints we address with our pregnant patients:
-Low back pain and tightness
-Upper back pain and tightness
-Tightness in the neck and shoulders
-Pelvic floor pain
-Sciatica-like symptoms
-Foot pain

How we address these complaints:
-Soft tissue work in the low back
-Adjustments in the upper back and sometimes lower back
-Nerve flossing to reduce sciatica symptoms
-Acupuncture to manage pain and tightness
-Stretching
-Corrective exercise
-Education

In summary, pregnancy has an AMAZING outcome.  Unfortunately, back pain during and after pregnancy is common but can be managed.  

If you or someone you know is experiencing back and/or pelvic pain during pregnancy or the postpartum period we would be happy to help.  Your first appointment will include a chat to discuss your current complaints and goals, a comprehensive exam to find the route cause of your problem, and treatment. 

DISCLAIMER: There can be a range complications that arise from pregnancy that cause pain.  For the purpose of this article we focused on the biomechanical causes of discomfort.  Always discuss any concerns you may have with your OBGYN.

 

How Pain Works

Ever wonder why a broken bone doesn't hurt right away? How about why the sign of a heart attack is pain in the left arm?  Pain is more than being pinched and saying "OW!"  It's complex and will present differently for different people at different times, even in the same injury.  By understanding how pain works, we can better manage it with less stress.  

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Pain is a Warning Signal

Did you know that we don’t actually have pain receptors? What we do have are called nociceptors. Unlike other regular touch receptors, nociceptors require a much higher stimulus to send signals to the brain. The nociceptors job is to yell up to the brain, “Hey, check this out! Is this okay?” Once our brain receives a signal from nociceptors, it decides whether or not the signal is threatening. If the brain thinks the signal is a threat, pain is produced. If the brain thinks the signal is not threatening, pain is not produced.

 
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Pain Does Not Equal Tissue Damage

"Pain is an alarm, not a damage indicator." (Lehman)  A great example of this is sudden low back pain.  You may have experienced this.  You go down to pick something up (maybe it’s something small like a pencil), and WHOOPS! Your back “goes out,” and it’s excruciating to straighten up.  Did you rupture a disc or pull a muscle doing such a simple task?  Not likely.  Your spine is an important structure. For some reason your brain perceived that movement as threatening, and tightened up the muscles in your back to protect you.

 

Pain is Context Dependent and Multi-factorial

At airports they say to report suspicious packages.  It's up to airport security to determine how to respond.  Before 9/11 a suspicions package would probably be treated as less of a threat. Nowadays, something like that is taken extremely serious, because our context is different.  Pain works in the same way.  A previous injury may lower your threshold for having pain.

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When deciding whether to send a pain signal, your brain takes in all pertinent information.  The amount of sleep you're running on, your level of stress, your history of pain will all contribute to your current pain state.  This also means that pain can change from day to day without any more or less tissue damage. This should be reassuring.  People dealing with an injury will often get discouraged when they feel worse than the day before.  This is not necessarily a set-back.  Perhaps that person got less sleep, is less hydrated, or more stressed than they were yesterday.  Since pain is multi-factorial, it's important to consider more than just the health of the painful tissue.  

It's important to recognize that pain is a request for change, but it's just as important not to let it stress you out.

 
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Pain Can Be Learned and Unlearned

The good news is the brain is plastic, meaning it can change. It can unlearn pain by performing once threatening movements in a safe environment.  That is why we find movement so valuable at TruMotion. We are training the brain!

 

 

 

Pain is Not All In Your Head

Don't let the above info make you think pain is imagined.  Pain is all in your head the same way hunger is all in your head.  Sure signals from your stomach will trigger the feeling of hunger, but the site of rotten trash will quickly block those signals. Pain works in the same way. It’s physical AND psychological.

"You Are Not Your MRI or X-Ray" -Lehman  
MRI and x-ray have bad track records of identifying pain.  It's common to have rotator cuff tears or bulging discs show up on imaging in people who don't have any pain.  These types of imaging are great for identifying serious pathology like cancer, but pain is not something that can be be reduced to an image.  Remember, it's multi-factorial!

 

Management Strategies

  • Pain is a warning signal meant to protect you, not an indication that you're damaged.
  • Pain is context dependent, so changing your context can help provide relief.

    • Get 8 hours of sleep.

    • Do things you enjoy to balance out things that may stress you out.

    • Hydrate.

    • Eat clean and avoid inflammatory foods.

  • A skilled chiropractor can help you find ways to move around your pain so your brain can unlearn it.

  • For the most part, don't sweat MRI or x-ray findings.  

This is a massive topic that is not done justice in a single blog post.  If you are struggling with pain, give us a call and check out these two excellent (free) resources you should check out:

Pain Fundamentals Workbook
Better Movement

3 Easy Running Stride Fixes

Running seems like a simple enough task, but like any movement in athletics, it’s a skill. Unfortunately, most people don’t view running as a skill, so attention is not given to ensure people are doing it efficiently.  There are subtle nuances in the running stride that can lead to an excess loss of energy, something I call an “energy leak.”  We want to minimize these energy leaks by making our running stride as efficient as possible.  

As a chiropractor that works frequently with runners, I see a lot of different running styles. Your running style is like your fingerprint. Everyone’s will be a little bit different, but when there are big variations from the norm (energy leaks) a runner may be more likely to get injured.  Below I have listed 3 of the most common running stride faults and strategies for how you can fix them.  


The Overstrider

The Problem:  This is one of the most common running stride faults.  When runners overstride they strike the ground with their foot too far in front of their body.  Running this way is like putting on the brakes with each step.  It also sends more ground reaction forces up the leg, which may lead to injury.  In distance runners a shorter, quicker stride is more energy efficient than a long laborious stride.

The Fix:
-Running is essentially a controlled fall.  If you stand straight then allow your body to lean forward at some point you are going to need to catch yourself with your foot.  Do this over and over, and you’re running!  You want your foot to land under your center of mass.

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-Have a slight forward lean when you run.  Let gravity be your friend.  Land your foot close to under your body. 
-Running to a metronome can help train a quicker, shorter stride.  Apps like RunCadence make this easy to do.  


The Bouncer

The Problem: So we want to move forward (horizontal) when we run, right…? There will be some bounce in a good stride, but too much vertical oscillation is an energy leak!

The Fix: Try to keep your eyes level with the horizon, and think “soft feet.”  Use the drill below to help drive this home. 


The Twister

The Problem:  This is common in younger runners who haven’t learned to control their body yet.  The core is used to resist rotation when running.  If the core is weak, we get “The Twister.”

The Fix:  Anti-rotation core work is a great form of exercise for all runners.  Below are some video examples.  


For a full running stride evaluation or for treatment of a running injury schedule an appointment with us!  I (Dr. Sankey) will take you through a gait analysis and a running-specific functional movement screen.  We will discuss your previous and/or current injuries as well as your goals as a runner.  Just click the button below.  

Your Hamstrings Probably Aren't Tight, But If They Are, Who Cares?

Patients tell me everyday how tight their hamstrings are.  There are several reasons someone may feel tight but may not actually be tight. Additionally, if someone has been labeled as "tight" does it really matter?

This post will focus on runners, because we (yeah I'll include myself in this) love to talk about how tight our hamstrings are.  However, there's something here for everyone. 

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The feeling of tightness is just that- a feeling.  There are several things that can cause this feeling beyond actual tight muscles. One common culprit is called neural tension.  We have nerves that run the length of all our muscles (the sciatic nerve follows the hamstrings down the leg). Nerves are meant to glide freely when we move.  When they don't (several things can cause this) we will feel tight even when the muscles themselves are not tight. 

Tightness is a protective mechanism.  When the brain senses that the body is in a threatening situation it will contract muscles to brace the body.  Think about any time you were startled, in a car accident, shoved, or even stressed. We can't help but tighten up.  When the body feels unstable or uncomfortable with a movement, the hamstrings may contract a bit giving the feeling of tightness.  

Maybe your hamstrings are tight, but does it matter?  Watch anybody run and you'll see how little hamstring flexibility is actually needed.  In fact, having "loose" hamstrings may hinder performance. The true function of these muscles while running is to store and release energy. Runners need springy hamstrings, not wet noodles.  

The runner pictured below is British distance runner, Mo Farah.  On the left you see him mid-stride with his right leg as far as it will go forward.  The next picture shows Mo on his back.  Imagine he's doing a hamstring stretch. Not much flexibility needed, eh?

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With this in mind, is stretching like the image below really necessary?

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Take Home Message:
If you like stretching your hamstrings keep doing it, just don't feel like you have to.  As I said, having springy, tight hamstrings can actually be beneficial to running.  This does not mean that stretching will make you slower, however.  Holding a static stretch for more than 60 seconds right before activity may lead to a slight decrease in performance, but it's negligible. There are sports where lots of flexibility is needed, but distance running is not one of them. 

People worry too much about the mobility they don't have and not enough about controlling the mobility they do have.  Things like slow heal lowers for the calves or RDLs for the hamstrings will strengthen the muscles and tendons and work the end ranges of the muscles.  I'll take a strong runner over a flexible one any day. 

The feeling of tightness is a symptom.  The actual cause of the tightness will vary greatly between individuals.  If you feel uncomfortably tight, let us help you figure out why.  Give us a call (980) 819-5818, or schedule online by clicking below.

Patient-Focused. Results-Driven.

Chiropractic | Movement | Dry Needling | Acupuncture | Laser Therapy

Run Away from Plantar Fasciitis

My Embarrassing History

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At the beginning of my junior year of collegiate cross country, besides having a questionable hairstyle, I began noticing a pain in my heel.  At first I would only feel it when I was running.  Soon my first few steps each morning felt like walking on broken glass. It quickly began hurting all the time. Like a typical thick-skulled male athlete I didn't tell my coach or athletic trainers fearing they would tell me not to run.  I figured I had a stress fracture in my heel, and if I could just get through the season I’d have time between cross country and track to let it heal.  The pain got to the point where I could no longer ignore it.  I would wince with each foot strike and limp with each stride.  

 

What Is It?

Fortunately, I did not have a stress fracture.  What I did have was plantar fasciitis.  The plantar fascia is a thick band of connective tissue running from the ball of the foot to the heel. Overuse can cause the point where the fascia attaches to the heel to become irritated.  

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In some cases the fascia pulls so hard at the heel that a heel spur can develop.  When the fascia pulls at your heel it creates a little gap.  Your body responds by filling that gap with bone. Unless you have the spur surgically removed, it’s not going anywhere.  Fortunately, with the right treatment you can be completely free of plantar fasciitis pain even with a spur.

 

How Do You Fix It?

Even if two people receive the same diagnosis it doesn’t mean their treatment should be the same.  Each person has their own unique anatomy, biomechanics, and injury history, and those factors need to be accounted for when creating a game plan for treatment.  

Most people coming to see us with plantar fasciitis receive cold laser therapy.  This is typically used over dry needling because… well… needles in the feet?  No, thanks.  Cold laser is a painless treatment that involves using light energy to stimulate tissue healing.  This is typically followed by some light soft tissue work on the calf and bottom of the foot.

The meat and potatoes of our treatment lies in taking our patients through specific exercise to strengthen the fascia.  Strengthening the fascia fixes the cause of the problem and ensures it doesn’t come back.  The level and intensity of the exercise will vary depending on the person.

Additionally, depending on the foot type, the patient may receive taping to support the bottom of the foot.  

 

What Can I Do Now?

PF can be very stubborn, but there are things you can do to prevent it from getting worse.

  • Flip flops:  Have you ever tried running in flip flops?  It’s quite difficult.  In fact it’s impossible to walk normally in flip flops without them falling off.  They’re not good for your feet, so definitely avoid them if you have PF.
  • Wearing cushioned, supportive shoes will help relieve the stress on the plantar fascia.
  • Night splints that pull your foot back have not been shown to be very helpful.  They’re often recommended by podiatrists, physical therapists, and chiropractors, but the research behind them is lacking.
  • Get it taken care of!  Plantar fasciitis can be fixed.  Start conservative (chiropractic) before trying something more invasive (cortisone or surgery).  Find a medical professional you trust. We have helped many people with plantar fasciitis become pain free, and we would love to help you as well!

To learn more about your options or to schedule an appointment, click the button below.

 

 

Beating Shin Splints

There are several things that can cause pain in the shin and several areas of the shin that can hurt. For the purpose of this post, I am going to be discussing pain on the inside portion of the shin.   The large bone in your lower leg is called the tibia.  It's the inner, lower two-thirds of this bone that tends to hurt with "typical" shin splints, aka Medial Tibial Stress Syndrome.  Go ahead, impress your friends with your new words. 

It is as the name implies.  Medial tibial stress syndrome occurs when the amount of stress to the medial tibia area (bone, muscles, tendons) is greater than the structures can handle.  It does not imply fracture. 

Who Gets Shin Splints?
One of the most common running injuries, shin splints tend to occur in those who run higher weekly milage at quicker paces.  Sorry ladies, but it's more common among females. One study found those with smaller lower leg circumference were significantly more likely to develop shin splints and stress fractures.  With every foot strike the tibia actually vibrates a little.  Having more muscle helps attenuate the vibration lessening the stress in the tibia.  

What Can I Do To Prevent Shine Splints? 
Lift something heavy!  Seriously though, muscle attenuates shock, and strength training develops muscle in a way running does not.  Additionally, strength training increases the density of our bones making us more resilient to shin splints and stress fractures.  

Make sure you are in the right shoes.  This seems obvious, but it's very important.  If you've been dealing with reocurring injuries, have tried every pill and potion, but still get hurt, it's time to get fitted for a fresh pair of kicks.  Go to a running specific store.  Charlotte, where we are proudly located, has a handful.  

I Think I Already Have It.  What Can I do?
If you currently have pain, it's important to get it checked by a professional to rule out anything serious.  A good doc will uncover things you may not have thought of on your own. 

In addition to , some good recommendations are as follows:

1.  Decrease weekly milage and pace

2.  Compression calf sleaves  

3.  Run on soft surfaces

4.  Ask your doctor about supplementing with vitamin D, calcium, magnesium, and a protein shake.

5.  Avoid anti inflammatory drugs.  They significantly reduce tendon-to-bone healing.  

6.  Deep Tissue Laser Therapy.  Painless, safe, and effective for speeding tissue healing. Learn More. 

Since shin splints occur because the body cannot repair itself as quickly as it's being stressed, taking time off of running may be necessary.  Low impact forms of cross training like swimming and cycling are great for staying in shape while recovering.  

Rehab Drills
A key muscle that needs to be targetted when working through shin splints is the flexor digitorum longus. The video below shows an easy way to do that.  Perform 8 sets of 40 repetitions throughout the day. 

Another important muscle is the tibialis posterior.  Hit that one with the exercises below.  Perform 8 sets of 20 reps throughout the day. 

Sources:
Michaud, T.C. (2011) Human locomotion: The conservative management of gait-related disorders. Newton, MA: Newton Biomechanics.

Moen, M.H., Tol, J.L., Weir, A., Steunebrink, M. and De Winter, T.C. (2009) “Medial Tibial stress syndrome,” Sports Medicine, 39(7), pp. 523–546. doi: 10.2165/00007256-200939070-00002.

Cohen, D., Kawamura, S., Ehteshami, J. and Rodeo, S. (2005) “Indomethacin and celecoxib impair rotator cuff tendon-to-bone healing,” The American journal of sports medicine., 34(3), pp. 362–9.

TMJ Pain: Answers You Need

TMJ stands for temporal mandibular joint.  It's essentially the hinge that allows your jaw to open.  If you put your fingers just in front of your ears and open your mouth, you will feel your TMJ move.  Pain in this area is often called TMD (temporal mandibular disorder) or TMJ syndrome. 

Dentists tend to be the first line of defense when dealing with TMD. Poor occlusion and recent dental work can all be causes or aggravating factors of TMD, but there can be more to it.

Although you may be experiencing pain around your TMJ, that doesn't mean the root of the problem is at the TMJ.  There is an intimate connection between the jaw and the neck.  Whenever there is TMJ pain the neck will be involved in some capacity and vice versa. Therefore, any treatment of TMD that does not address the neck is incomplete.  Put your fingers on the back of your neck just under the base of your skull.  Now open your mouth as wide as you can, and notice how you feel those muscle contract. Quick biomechanics lesson: whenever you open your jaw, your neck extends (bends back) slightly.

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Muscle knots called trigger points (represented by the "x" in the picture) will send pain to predictable areas (represented by the blue ovals).  There may be nothing physically wrong with the jaw, but a trigger point in the neck can cause it to hurt. Fun fact: a less common trigger point all the way in the calf can also refer pain to the jaw.  

The jaw is a highly innervated area, meaning it has a huge nerve supply. This is one of the reasons why problems in other areas can manifest at the jaw and problems at the jaw can maifest in other places. Even psycological symptoms like anxiety can result in clenching of the jaw.  

Signs that you may have a problem in these areas include but are not limited to headache, jaw pain, jaw clicking, uneven jaw opening or protrusion, neck pain, ear pain, and tooth pain.

One very common fault in neck function is weak deep neck flexors. When these muscles aren't working properly other muscles are forced to take up the slack and tighten up. These muscles include the traps and jaw muscles.  Tightness in these muscles can lead to headaches, neck pain, and... you guessed it, TMD!

Use this exercise to work the deep neck flexors:

It's extremely important to avoid clenching your teeth.  Long-time clenchers wont even know they are doing so until someone points it out.  The best way to break this habit is by practicing the jaw relief position. This teaches you to keep the muscles around your jaw and neck relaxed.  

  1. Teeth slightly apart
  2. Tongue resting lightly on the roof of your mouth

  3. Lips closed

  4. This should be performed at all times when not chewing, talking, or exercising

How do we address TMD in our office?

  • Thorough exam of the neck, shoulders, upper back, and jaw to find the root of the problem and develop a baseline. 

  • Decrease pain.  We use cold laser, acupuncture, and soft tissue work around the neck and jaw to accomplish this.

  • Improve mobility.  Dry needling, soft tissue work, and adjustments are our go-to for un-sticking those stiff areas.

  • Improve stability and motor control.  Exercises like the one in the video above help retrain your brain how to use your muscles and move properly.  

  • Educate.  We help teach you the things you should be doing on your own to help further your care.  This is our most powerful tool, because it gives you the ability to take control of your situation!

If you are dealing with TMD, neck pain, or headaches, give us a call! (980) 819-5818

Beating IT Band Pain

I have a love-hate relationship with the IT band.  It was my first injury as a runner.  As a high school freshman, I had to stop and walk on several runs because the pain on the outside of my knee was so bad. On one occasion it hurt too much to walk.  Fortunately, this brought me to see a chiropractor for the first time, and here we are! 

First thing's first, what is the IT band?  It's a super thick band of fascia that runs from the hip to the knee.  IT stands for iliotibial.  The 'ilio' part comes from 'ilium,' which is the bone that forms the rim in your pelvis.  'Tibial' comes from tibia, which is your shin bone.  The IT band originates from 3 muscles on your ilum (gluteus maximus, gluteus medius, and TFL) and makes its way down across your knee to your tibia.  Classic IT band syndrome involves pain on the outside of the knee and sometimes up into the outside of the thigh made worse by running.  

The term 'IT band' is often demonized by runners because of the pain it can cause.  Believe it or not, the IT band actually serves a purpose. It helps stabilize your hip and leg when you move and even keeps your femur from bending!  Yes, the strongest bone in your body would bend if it weren't for your IT band.  

The IT band is very tough.  In fact, its strength has been likened to that of Kevlar, the material used in bullet proof vests.  Scientists have found that when stretched to maximal force the IT band only lengthens 0.2%.  Whomp whomp.  As runners, our first inclination is to stretch or foam roll anything that is hurting.  With the IT band, our time could be better spent.  

When working through ITBS, shift your focus from the Kevlar-like IT band to the more responsive muscles in the hip that connect to it.  If you have ITBS, you are likely to find tender areas in the hip muscles on the side of discomfort. Use a lacrosse ball ( or the Super Nova I'm using in the video) to roll them out, and pause on the tender spots until the tenderness calms down.  

I am not saying foam rolling the IT band is pointless.  It may improve blood flow to the area and can even help relieve some local discomfort.  But keep in mind you are not actually lengthening the tissue, so a few minutes spent on the foam is probably plenty.  

Your core muscles and the hip muscles that attach to your IT band, help stabilize the body from excessive side-to-side movement when running.  When these muscles aren't doing their job it puts stress on the IT band.  This stress is usually felt as pain around the knee.  Take care of the tender muscles as described above, but it's just as important to stabilize the system.  Great stability drill videos can be found on previous blog posts, 4 Drills to Rehab Your Running and 6 Exercises to Bullet Proof Your Running. 

Source: Michaud, Thomas.  Injury-Free Running; How to Build Strength, Improve Form, and Treat/Prevent Injuries

How Laser Therapy Eases Pain

Our goal at TruMotion Therapy is to provide our patients with the most cutting edge, evidence-based treatments to get you out of pain and moving better.  Deep tissue laser therapy is the new addition to our line-up of therapies that already includes chiropractic care, myofascial release, dry needling, and functional movement training.

Is Laser Therapy for Me?
If you are experiencing any of the following laser therapy may help.

  • Low back pain

  • Headaches

  • Tennis/Golfers Elbow

  • Achilles Tendinitis

  • Fibromyalgia

  • Shoulder pain

  • Knee Pain

  • Shin splints

  • Disc problems

  • Sprain/strain

  • And more!

 

Besides TruMotion and Dr. Evil, who else uses lasers?
Veterinarians commonly use laser therapy on injured animals and to help expedite scar healing following surgery.  Podiatrists use lasers for everything from plantar fasciitis to toe fungus!

Duke University athletic department sees its benefits with their athletes.  "Deep tissue laser therapy is one technology that has exceeded expectations and given our team a valuable modality we can count on for treating the wide range of musculoskeletal conditions we encounter." 

#Science
Laser therapy is essentially light that makes its way deep beneath the skin.  Photons, one main component of laser light, penetrates to the cellular level targeting mitochondria. Mitochondria are the power house of your cells.  They are responsible for creating energy (ATP).  When photons are absorbed by the mitochondria your cells rapidly kick out energy, which speeds up the cells' the normal healing processes.  Laser therapy is like hooking jumper cables to your cells.  

Your cells also respond by releasing chemicals (NO and O) that improve blood flow to the area being treated.  Improved blood flow and increased energy lead to repair of damaged cells and creation of new cells.  This essentially speeds up the healing process. So, laser does more than just block pain.  It actually helps improve tissue function.

Nerd out to a video that explains this whole process.

ATP sounds cool.  I'm in.  What's a treatment like?
Laser therapy is safe and pain free.  A single treatment takes about 3 minutes. Depending on your complaint, you may require 6-8 treatments for complete relief.  Laser is a powerful tool when it comes to healing, but it's made even more effective when combined with other therapies. Laser treatments are almost always paired with a chiropractic adjustment or myofascial release techniques.

  

About Chiropractic

Chiropractic involves adjusting the joints of the spine and extremities.   Adjustments improve motion and neurologic function.  

 

Benefits of Chiropractic

  • Chiropractic seeks to treat the root cause of your complaint, not just put a bandage on the symptoms. This ensures lasting results.
  • Chiropractic is a safe, evidence-based treatment option for back pain, headaches, neck pain, and more!
  • Dr. Sankey combines chiropractic care with dry needling, functional movement training, acupuncture, laser therapy, and myofascial release to provide relief from a wide range of complaints.  
  • Lower cost and great satisfaction.  "Spinal, hip, and shoulder pain patients had clinically similar pain relief, greater satisfaction levels, and lower overall cost if they initiated care with [chiropractors]."  Source 

 

A Different Approach

We are different from your typical chiropractor.  At TruMotion we combine chiropractic care with dry needling, laser therapy, myofascial release, and movement to provide lasting relief from pain.  

 

Chiropractic Myths

"The bones in my back are out of place, and I need to get re-aligned." 
Joints are supposed to move and be exposed to various positions.  The bones in your spine will never be perfectly aligned, because your spine is dynamic.  Sometimes those joints are not moving enough, and that is where chiropractic adjustments come to play.  It's like putting grease on a stuck door hinge 

"Chiropractic is dangerous."
Chiropractic is one of the safest, drug-free, non-invasive therapies for neuromusculoskeletal complaints. Soreness following an adjustment happens occasionally but is not long lasting.  Serious complications are extremely rare and can usually be avoided by a thorough consultation and exam.   At TruMotion Therapy, Dr. Sankey spends an hour with each new patient to ensure that person is a good fit for chiropractic care. Each treatment is tailored to the specific needs of each patient. 

"I'm going to get put on a long treatment plan."
Our goal is to get you out of pain and give you the tools you need to remain that way.  As much as we love to see your smiling face everyday, we like to get you better and on your way as quickly as possible. That being said, health is a process.  It takes time and commitment to achieve.  From the moment you walk in the door for the first time, we are a team working together! Once out of pain and moving properly, many patients chose to come in for occasional tune-ups.  We love that kind of motivation!

What is Dry Needling? How is it Different Than Acupuncture?

Found in the mountains of Austria, Otzi “The Iceman” was well preserved for a 5,300 year old corpse.  What set Otzi apart from other ice-preserved bodies were the tattoos he had inked all over his body.

Those studying The Iceman found the tattoos corresponded to traditional Chinese acupuncture points.  An autopsy of the body revealed Otzi probably suffered from arthritis in the knees and low back, and the acupuncture points sketched onto his skin would have been used to treat those conditions.  Interestingly, Otzi was found 2000 years before and thousands of miles from when and where acupuncture was thought to be developed.

ACUPUNCTURE

Acupuncture, invented by the ancient Chinese, is one of the oldest forms of healthcare.  It is based on the idea that the body contains a vital life force call Qi (pronounced ch-ee), and any imbalance in Qi is the root of illness and ailments.  An acupuncture treatment seeks to restore a balance in Qi by inserting thin microfilament needles into specific points on the body.  These points are called acupuncture points and they are thought to contain higher concentrations of Qi than anywhere else.  Meridians, channels that run throughout the body connecting acupuncture points, direct the flow of Qi. 

Think of meridians like the plumbing in your house.  If there is a blockage in a pipe under your garage you may not get water in your bathroom sink until you address the point of blockage.  Acupuncture works in a similar way by addressing acupuncture points far from the area of complaint.  Treating a headache may involve inserting needles in the leg for instance. 

DRY NEEDLING

From its origin to its use in the clinic today, dry needling follows a different path than acupuncture.  There are various methods of dry needling, but I will limit our discussion to that of trigger point dry needling.  Trigger points are taught bands of muscle fibers that can cause muscle soreness.  In an attempt to eliminate trigger points in their patients, doctors in the 1950s injected these taught bands with saline solution using a hypodermic needle.  You could call this “wet needling.” This seemed to work quite well, but doctors soon realized inserting the needle without injecting saline solution worked to relax the muscle all the same.  By substituting hypodermic needles for acupuncture needles dry needling was born.

The Difference

Acupuncturists claim to treat a variety of issues ranging from internal disorders like irritable bowel syndrome to musculoskeletal problems like low back pain by balancing Qi.  Dry needling practitioners tend to limit their treatments to musculoskeletal disorders by reducing muscular tension and influencing neurological function.  These are generalizations that certainly do not apply to all acupuncturists or dry needle practitioners.  

Depending on the state, there are several professions that can be licensed in acupuncture and dry needling including chiropractors, physical therapists, and medical doctors.  None of these professions can call themselves acupuncturists.  That titled is designated for individuals who have been to acupuncture school.  

A needle inserted in the body has the same physiologic affect whether it's done by an acupuncturist or a dry needle practitioner.  The effectiveness of the treatment is determined by the competency of the clinician.  As the western understanding of acupuncture increases, new methods of needling are developed and a fusion of the two schools of thought is developing.  This fusion involves appreciating the connectedness of the body via neurology and fascial chains as apposed to a vital life force.  That is a rabbit hole that goes beyond the scope of this post, but it is pretty cool stuff that deserves its own article in the future. 

To experience the benefits of acupuncture or dry needling first hand, schedule a visit and we will see if it's the right fit for you!  (980) 819-5818.

The Perfect Sleep Position

Waking up with aches and pains is not normal, especially if you didn't fall asleep feeling that way.  You should feel refreshed when rolling out of bed.  If the mornings are rough your sleep position may be to blame.  

When choosing the best sleep position it's important to look at a couple factors: 

  • Does the position put the least amount of stress on the muscles and joints as possible?

  • Is this position ideal for you as an individual? Do you have back pain? Do you snore? Do you have sleep apnea? 

  • Most importantly, can you actually sleep in this position?

The best sleep position is one that will allow you to sleep best.  Sleep is incredibly important and the vast majority of Americans are not getting enough of it.  If you find a sleep position (even if it's not totally ideal) that provides you with quality slumber, sleep-on young grasshopper.  Adequate sleep in a "bad" position is better than too little sleep in a "good" position.  

That being said, there are modifications that can be made to your sleep position of choice to allow you to sleep better and with fewer aches and pains when you wake up.  

 

Side:
The most popular sleep position.  Common variations involve having the legs straight or tucking into the fetal position.  Side sleeping is great for those who snore or have sleep apnea, because it keeps the airways wide open.  If you snooze on your side you'll want:

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  • A firm pillow with thick cushion to support your neck and prevent shoulder-smushage.  If you find yourself putting a hand under your pillow or head you likely need a thicker pillow.

  • A softer mattress to ease pressure on your shoulder and hip.  

  • A leg pillow to support your pelvis and prevent the low back from torquing out.  

 

Back:
Sleeping on your back is usually the best option for those with back or neck pain.  If back sleeping is your thing you'll want:

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  • A thinner pillow to keep your neck in a neutral position.  There are pillows that are made with a thicker neck support and a depressed head cradle, which are great options for back sleepers.
  • A firmer mattress.

  • An additional pillow or two to place under your knees.  This helps take some stress off the low back.   

 

Stomach:
This is the least ideal option of the three due to the stress it places on your neck and low back.  In order to breathe (unless you can do so through your ears) your neck has to be cranked to the side.  Hold this position for 7-9 hours and yeah... your neck will be stiff.  If you don't have to sleep on your stomach, don't.  Like I mentioned above, if that's what it takes to get a good night's sleep there are some modifications that can be made to set you up a little better.  If you sleep like you're straight out of a Vicks Nyquil commercial you'll want:

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  • No pillow under your head.  It will push your neck into too much extension

  • A pillow under your chest and arm to prop yourself into a little rotation.  This will make it so your neck doesn't have to be as rotated.  Another pillow under your knee will help keep your back in a happy neutral position.

Sleep position is not everything, however.  Mattress type, pillow type, bedtime routines, and so much more can impact how you sleep and feel when you wake up.  For additional tips on getting better sleep check out a previous blog posted called Tips For Better Sleep.

*Mattress firmness recommendations are just guidelines.  It's totally fine to sleep on a soft mattress if you're a back sleeper if that's what you prefer. 

The Truth About Back Pain

Back Facts

  • Low back pain (LBP) is the leading cause of disability worldwide. 

  • It's estimated that around 80% of people will experience back pain at least once in their lives.

  • Most instances of LBP are mechanical and do not require drugs or surgery.  

X-Ray Vision
Having advanced diagnostic imaging has benefited the medical community tremendously, but  It can have unintended consequences. Let's take a look at some numbers...

  • 40% of 35 year-olds will have degenerative joint disease (DJD) on x-ray but will not have any pain. 

  • 30% of 30 year-olds will have a herniated disc on MRI but will not have pain. 

Why do these numbers matter?  Let's say a 30 year old with LBP goes to a doctor and gets an MRI. The MRI shows a disc herniation, and her LBP is blamed on the herniated disc.  However, the above statistics show that disc herniations frequently don't cause pain.  Perhaps her back pain is being caused by tight hips that are putting stress on her back.  If she were to get surgery to repair the herniation, she would likely still be in pain, because the thing ACTUALLY causing her back pain was not addressed.  

Imaging is great for ruling out serious pathology (cancer, fractures, etc.), but research (1) shows a skilled clinician can do the same by taking a thorough history.  

What Causes Back Pain?
The causes of back pain are widespread.  To keep things simple I like to break up the causes into 3 categories:

  • Functional: poor movements habits, i.e. rounding your back when lifting something heavy; poor lifestyle habits, i.e. obesity

  • Structural: arthritis, disc bulge/herniation

  • Pathological: cancer, kidney stones, inflammatory bowel disease

Most cases of LBP are functional.  If functional issues, like lifting heavy objects with a rounded back, are not addressed they can lead to structural issues down the road (arthritis and disc herniations). Only about 1.4% of back pain cases are pathological.  These are very simplified categories, and there is certainly spill-over between groups.  

So what happens when someone "throws out their back?"  We have all heard of people going down to pick something up, it can be a barbell or a even a pencil, and throwing out their back.  There are several things that can cause that excruciating pain and accompanied stooped posture.  

  • A herniated disc or sprained ligament.  In this case there was likely repetitive actions that slowly irritated the disc or ligament until the final injury occurred.  The straw that broke the camels back if you will.  Conservative care has been found to be effective at managing these cases. 

  • Alarm signal.  Our bony spine houses a very important structure: the spinal cord.  Because this bit of anatomy is so important to us our spine has an incredible alarm system.  It will sound the alarm if it senses danger before something tears or breaks.  That alarm signal is pain, and it's there to protect us.  This is likely the most common cause of acute back pain.  

 

Setting the Record Straight!
There is a lot of misunderstanding around functional and structural causes of back pain. Common structural issues many people think cause back pain include a short leg, being out of alignment, and scoliotic curves.   

  • Short leg: A true short leg is where one leg bone is physically shorter than its partner on the other leg.  Leg length differences up to 1 cm are common and have not been shown to contribute to back pain.  A difference larger than that is very rare.  

  • Misalignment: Unfortunately a lot of chiropractors will still tell you the bones in your spine are out of place and need to be realigned.  Not the case.  Your spine is dynamic and meant to move. There are many things that can give the impression of misalignment like tight muscles or "sticky" joints.

  • Scoliosis: When looking straight on at someones back, a perfectly straight spine is dubbed as "normal."  The fact is, many people have slight curves to the right or left in their spine and don't have any problems.  As soon as pain arises, however, it's easy to blame the pain on the curve. Even people with extreme scoliosis, upwards of a 50 degree curve, can live pain free lives.  

 

Tips and Tricks

Mobility

There are key areas that tend to lack mobility on most people and can lead to LBP.  These are the upper back and hips.  When you go about your daily activities (walking, running, lifting, turning, etc.) you need a certain amount of mobility to perform these tasks.  If you lack the requisite mobility in one spot your body is smart and will "steal" it from somewhere else.  For example, when running your hip needs to be able to extend a bit behind your body.  If you have stiff hips, that motion will come from the next closest spot, which is the low back.  If you are torquing your low back with each stride, it's no surprise you have pain! 

Mobilize the upper back with this drill:

  • Knees and hips bent to 90 degrees.

  • Keep your knees together.

  • The band not completely necessary.

 

Mobilize the hips with this drill:

  •  Keep a neutral spine throughout the movements.

 

Stability

Just like the upper back and hips need to be mobile, the low back needs to be stable, meaning it should resist excess motion.  Your low back should be stable enough to keep from: bending when you're lifting something heavy, twisting too much while running, etc.  A stable spine comes from a stable core.  You will notice the core exercise below doesn't involve a lot of movement.  For those with back pain, traditional sit-ups may put too much stress on the spine and not challenge the abdominals enough.  This exercise is proven to be safe on the spine and work the abs appropriately. 

Stabilize the core with this exercise:

Breathing

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You take around 20,000 breaths each day! The main muscle used in respiration is the diaphragm, but it also plays an important role in posture.  In the image to the right the diaphragm is highlighted orange. Notice its intimate connection with the low back.  

Many people fail to use their diaphragm properly when breathing, which can result in instability and pain in the low back.  If the diaphragm isn't being used for breathing we will recruit other muscles like those in the neck and upper back to take up the slack.  These muscles are not meant to be used for breathing and end up getting tight and sore. Sound like you?

  • Sit with your shirt off in front of a mirror.

  • Wrap your hands around the side of your stomach so your thumbs are near your back and finger tips are in front.

  • Focus on feeling your breath in your hands.  This is not just belly breathing, because your breath should be felt 360 degrees around your lower torso.

  • While doing this make sure your shoulders aren't raising up and down with each breath.

  • Try to use this method of breathing throughout the day.

 

The Big Picture
Although we have been focusing a lot on movement, there are many other things you can do to help manage or avoid back pain.  

  • Diet is key.  Since the gut is physically, neurological, and chemically close to the spine, it's important to eat clean.  A good source for which foods to eat can be found HERE and which foods to avoid HERE.  

  • Quite smoking.  It's not good for you or those around you.  

  • Hydrate!  The discs in your spine are 70% water.  Get a 32oz water bottle.  Fill it up at breakfast, and have it finished by lunch.  Fill it up again at lunch, and have it finished by dinner.  

  • Walking and running are therapeutic for the spine and recommended for those with back pain.

  • Avoid staying in one position for too long.  This goes for sitting AND standing.  

  • If your low back is hurting make sure you're moving through your hips to spare your spine.  This movement is called a hip hinge.  

Back pain can be extremely debilitating and frustrating. The info provided here should be reassuring, however.  Most forms of back pain are functional and not due to any structural abnormality like a short leg, scoliosis, degeneration, etc.  That means you have control. Altering the way you move can have a tremendous effect on the pain you feel.  Sometimes all you need is a nudge in the right direction, and that's where a chiropractor comes in.  With proper care you will be given the tools you need to get out of pain and stay that way without having to commit yourself to 3 office visits a week for the rest of your life!  

 

Sources: 

1.  McGuirk B, King W, Govind J, Lowry, J, Bogduk N. Safety, efficacy and cost-effectiveness of evidence-based guidelines for the management of acute low back pain in primary care. Spine 2001; 26:2615-2622

2.  Liebenson, C. (2006) Rehabilitation of the spine: A practitioner’s manual. 2nd edn. Baltimore, Mar.: Lippincott Williams and Wilkins.

Mobility Drills For Runners

Everyone should have a basic physical maintenance routine to ensure longevity.  The goal of this routine should be to prevent injuries from happening and not as a treatment for once they've occurred.  The hard part is knowing where to start.  I've included 7 videos of mobility drills aimed at helping the running athlete, but they can be used by anyone.   

You don't have to do all of these everyday.  Maybe you did speed work today so you want to focus on the feet and lower legs. Perhaps a longer run has your hips feeling tight so you focus on the hip drills. The idea is to become more aware of your body and to have a road map so you're not aimlessly stretching.  

Foot
Your foot has 26 bones, 33 joints, and over 100 tendons and ligaments all of which are crammed into a shoe and pounded on with each stride. Why not show your foot some love?  This drill helps open up all those crammed structures in the feet.
 

Calf, Achilles, and Plantar Fascia
This drill is money for those who prefer a forefoot strike when running.  

Tibialis Anterior and Peroneals
Some of the most overlooked muscles by runners are the ones on the front and outside of the shin. Trail runners should be especially mindful of these muscles due to the varied terrain they run on.  

Posterior Chain
I wrote an entire blog post on the myths of hamstring flexibility, so I wont harp on it here.  I will say that you likely don't need to be stretching the life out of your hammies.  General mobility and movement through the posterior chain (calves, hamstrings, gluts, and back) is important, however. The sequence in the video below is great for that. 

Hip Flexor
Healthy hips are extremely important for runners.  Tight hips can limit stride length putting stress on other areas possibly causing low back and knee pain.  The drills in the video below will help mobilize your hip flexors so you can get the most out of each stride without stressing the back. 

General Hip and Ankle
Although great for the hip, this next drill also works the ankle nicely. Be sure to keep your foot flat. On the 2nd and 3rd variations use your elbow to push your knee out as you drive it forward. Try to look more excited than I do while your doing it!

Thoracic Spine
When you think of stretching after a run you probably don't think about your upper back.  Proper mobility in this area will assist you in keeping a neutral upright posture during long distance runs.  

Foods That Fight Inflammation

A couple weeks back I put out a blog post on Foods to Avoid.  The food listed in that post promote inflammation, which is a major component of disease and injury.  So now that you know which foods to avoid, you may be asking what should I be eating?  Great question. Below are the foods that should make up that LARGE majority of your diet. 

Grass-fed meat

Wild caught fish: Salmon and sardines are especially nutrient rich.

Free range chicken and eggs

Vegetables

Leafy greens: Don't limit yourself here.  There are many different types with various flavors and nutrients, including: spinach, kale, arugula, Swiss chard, and dandelion greens.

Fruit: Be sure to eat fruit in its full form.  Juices contain all the sugar and none of the fiber.  The fiber in the fruit allows the sugar to be absorbed slowly so your blood glucose levels don't spike.  Even fresh-pressed fruit and vegetable juices can have as much sugar as a soda, and your body will respond to it as such.  If you want to drink your fruit, throw it in a blender.  

Nuts: I've been on a macadamia kick lately.

Omega-3 seeds: Flax, chia, and hemp.  These are best purchased in their full form and blended or soaked immediately before eating.  This way you get the full nutrient benefit.  

Dark chocolate

Spices: The best spices for fighting inflammation are cinnamon, turmeric, and ginger.

Coconut, avocado, and olive oil.

Coffee and green tea

You may notice all of these foods are in their full form.  You could essentially find each one of these items in nature without much alteration.  This is a good way to approach eating.  If you can't find it in nature, or if it did not exist 150 years ago you probably shouldn't be eating it.  As much as I wish there was a Pop-Tart tree, overly processed junk foods like this are products of artificial engineering and do not belong in our diet.

I have never been a fan of food pyramids, but this one from Arthur De Vany's book The New Evolution Diet gives a good perspective as to how we should be eating. 

Eating properly and moving frequently will turn your body into a healthy, efficient machine! You will be able to fight colds and avoid aches and pains better than before.  When you do want the occasional Pop-Tart, your body will be able to handle it.  Going cold turkey on junk food is not sustainable for most people.  Commit yourself to an 80/20 rule.  80% of the time you will eat a balanced variety of the foods listed above, and 20% of the time you can indulge.

Seaman, D. (2016) The Deflame diet: Deflame your diet, body, and mind. United States: Createspace Independent Publishing Platform.

De Vany, A., Taleb, N.N. and Fooled (2011) The new evolution diet: What our paleolithic ancestors can teach us about weight loss, fitness, and aging. New York, NY, United States: Rodale Press.

Managing Achilles Tendon Pain

The Achilles tendon is the strongest tendon in the body.  It begins in the calf muscle and attaches to the heel bone.  The tendon twists 90 degrees between the muscle and bone giving it the ability to act as a spring while running. Having a tendon that can store and release energy is one of the advantages humans have when it comes to covering great distances.  As strong as it is Achilles tendinopathy is one of the more common running injuries. 

What is Tendinopathy?
You may have never heard that term before.  You're probably more familiar with tendinitis.  The suffix -titis implies inflammation.  Most tendon issues don't involve a significant amount of inflammation, so saying tendinitis is incorrect.  Tendinopathies can be broken into early and late stages.  The early stage may involve some swelling.  This is due to build up of water in the tendon, not inflammation.  If the proper measures are not taken to manage the painful tendon things will progress to the later stages.  Here we begin to see collagen build-up in the tendon giving it a thicker, perhaps nodular, appearance.  Same as the early stage, late stage tendinopathy does not involve inflammation.  These changes happen because the tendon is under stress.  The body does what it can to "thicken" the tendon to keep it strong.  

Why Do People Get Achilles Tendon Pain?
It's pretty simple.  Tendon issues happen when load exceeds capacity. Using running as an example, tendon issues occur when the amount of miles run exceeds the ability of the tendon to recover.  We can think or our capacity to handle load (strength) as a cup and the load (running) as water.  If you run more than the cup can handle it will overflow causing injury.  To prevent injury you can either use less water (run less) or get a bigger cup (strengthen your tendon).  If you're like most runners, you'll likely prefer the latter.  Keep in mind load can be the distance you run and/or the pace in which you run.  

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Barefoot running became popular after the book Born to Run was released.  Supporters of barefoot running claim running unshod encourages a more natural foot strike thus reducing injury risk.  It does encourage most people to run with a more midfoot/forefoot strike.  The problem lies in the claim that running this way reduces injury risk. Running with a forefoot/midfoot strike, running in a minimalist shoe, and running barefoot simply redistributes force to the lower leg (plantar foot, Achilles, and calf). It's not necessarily better or worse than running shod or with a heel strike.  If you plan on making the switch to a more minimalist shoe or to a different foot strike do so gradually so your body has time to adapt.

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Soft Tissue Massage:
We have already determined there are two ways to manage tendinopathies: reduce load and increase capacity.  Soft tissue massage feels nice, but it does not contribute to either one of these goals.  Rubbing the surface of the skin does very little (if anything) to effect the structure of the tendon.  

 

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Stretching:
Stretching puts compression on most tendons.  It's best to avoid directly stretching the tendon in the painful stages of tendinopathy.  You will get much more bang for your buck with strengthening exercises.

 

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Ibuprofen:
Ibuprofen is an anti-inflammatory and pain relieving medication.  In the early stage of tendinopathy ibuprofen may help reduce swelling. Since late stage tendinopathy does not involve inflammation there is likely no reason to take ibuprofen.  If the pain interferes with your life or ability to perform necessary tasks occasional use is probably not a problem.  Always consult with your general practitioner before taking any medication.

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Ice and Heat:
Keep in mind that neither are a solution.  Ice will numb the senses, which will help relieve discomfort. Heat will make the tissues feel loose.  Don't feel like you need to do either, but if one feels good go for it!  Just don't overdo it.  

 

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Rest:
In the early stages of tendinopathy reducing training volume is important, however completely shutting things down is not ideal.  As mentioned above it's important to encourage adaptation of the tendon, and continuing to train at an appropriate level can facilitate this.  A good therapist will assist you in finding the sweet spot in your training: enough to help strengthen but not too much as to overdo it.   

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Strengthening:
Strengthening is the only way to encourage adaptation of the tendon to ensure recovery from a current injury and prevention of future injuries. Strength exercises for tendinopathy are highly individualized.  Choosing the right type of exercise and dosage depends on the stage of the injury and baseline fitness of the individual.  If you have a nagging tendon injury, let us help you work through it with a custom plan that fits you.  

The typical protocol of rest, ice, and massage for Achilles tendon pain is no longer thought to be the best form of treatment.  Modifying activity and direct strengthening of the muscle/tendon is the current gold standard of treatment for tendinopathy.  At TruMotion we talk constantly about the importance of adequate sleep, hydration, and an anti-inflammatory diet.  Although not directly mentioned in this blog post, the importance of those 3 things cannot be overstated when dealing with any injury.  

If you're dealing with tendon pain (or any type of pain for that matter) let us create a custom action plan with you.  

Do Runners Need To Stretch?

I see that sheepish look all the time from my runner patients when they tell me, "I definitely don't stretch enough..."  Let's take a step back for a moment and ask the question, do runners really need to stretch?

First off, does stretching even do what we think it does?  Does stretching make our muscle tissue longer? 

  • Short term stretching, like reaching for your toes for a minute or two, DOES NOT make our muscle tissue longer.  It simply increases our tolerance to stretch.  These changes are temporary.
  • Long term stretching, like years and years of yoga, can make our muscle tissue slightly longer.

Is this something runners need to be concerned with, however?  The typical distance runner's stride is fairly compact, and does not require a lot of range of motion from the involved muscles or joints.  Additionally, runners benefit more from having muscles that resemble short springs as apposed to long, wet noodles. 

Instead of aimlessly stretching before and after you run, have a plan.  

Before You Run:

  • You simply want to make your muscles warm.  You can do this with an easy spin on a bike or a light jog.  Follow this up with some dynamic warm-up drills like leg swings. 

After You Run:

  • Replicate the dynamic drills you did before your run.

Do I Give My Patients Stretches?

I do give many of my runner patients stretches to do, but they typically have some dynamic component.  Dynamic mobility drills will give you the best bang for your buck.  They involve the nervous system more than your typical static stretches, thus ensuring more lasting results.  

 

Do runners need to stretch? No. 

 

Can targeted, individualized, dynamic mobility drills be beneficial for runners? YES! You can check out our YouTube channel for mobility drill ideas, or schedule an appointment with Dr. Sankey for a personalized plan.  

 

Related Articles:
Your Hamstrings Probably Aren't Tight, But If They Are, Who Cares?
Mobility Drill For Runners

Original Video: