Falling Down Stairs

A couple of day’s ago, one of my mentors, Dr Kathy Dooley, posted this on her page. In it she writes:


“Your workout should never break you.

All of us need to sit down and assess what we want out of our workout.

If you want sore muscles, you can fall down the stairs. You’ll be sore and hurt. Is that a workout?

You completed the 15 mile run, but you hobbled out of bed the next day. Did you build fitness on a dysfunctional platform?

I assumed the workout was in place to make one healthier. There is nothing healthy about beating oneself up.

Eustress – positive micro stresses – can have huge medicinal benefits. We are adaptive beings. But the workout making us hobble is not eustress.

If your goal is to deadlift 500 pounds, then earn it – safely. Put the time in. Get a good coach. Or get a new goal.

If your goal is to be “healthy,” I’m here to tell you that no one knows what that means but you. What does health mean to YOU?

Seriously, sit down and contemplate what you want from your workout.

Time is valuable. You can spend it beating yourself up, or you can spend it BUILDING yourself up.

As always, it’s your call.”

drawing of someone falling down stairs.

 

Falling Down Stairs

I reposted it onto my facebook page and it garnered some great discussion. There is one line in this post that has really resonated with me.

“If you want sore muscles, falling down the stairs will work. You’ll be sore and hurt. Is that a workout?”

This quote sums up really well why so many people get caught up in the cycle of injury. They are essentially throwing their bodies down the stairs through every set and repetition of their workouts, whether it’s running, weight training, sports, or even Yoga.

Running, squatting, and lunging are controlled falls. If you lack the ability to stabilize your feet, hips, low back, and/or core, then you have movement dysfunction. Your body lacks the ability to absorb, stabilize, and respond safely to your environment. In this circumstance, every step is the equivalent of falling down stairs. Your joints, connective tissue, and other supportive structures do not know the difference. How many flights of stairs can you fall down before something breaks down?

Warning sign of the danger of falling down stairs.Rest and recovery are important for your tissues to heal. But once they are healed, if you return to an exercise program without addressing an underlying movement dysfunction, you will be once again throwing your body down the stairs.

This is where you may need help. If you cannot fix these things alone, you need the help of a movement therapist who can assess and treat the root causes of movement dysfunction. I recommend finding a movement therapist who practices NeuroKinetic Therapy™ (NKT). This is the work that I do.

When your workouts hurt you, it’s time to take a hard look inside at how you value yourself, your body; and your life. It is not fitness or a workout when it hurts you. It is self destruction. As Dr. Dooley said, “Time is valuable. You can spend it beating yourself up, or you can spend it BUILDING yourself up.”

If you are tired of falling down stairs and are ready to break the injury cycle I strongly encourage you to reach out to an experienced Movement Therapist in your area. I highly recommend someone certified in NeuroKinetic Therapy™, gait assessment, and natural movement. If you’re in the Austin, TX area, then click here to schedule a free consultation.

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Don't Chase Pain, Break Free!

Thinking man statue. What is Neurokinetic Therapy.What is NeuroKinetic Therapy?

A little more than fifteen years ago, I found myself sitting on a bench in a gym thinking about what I was going to do with the rest of my life. I was recovering and rehabbing from a second knee reconstruction and just a few months away from being discharged from the Navy. I had no idea what I wanted to do. Then it hit me like a brick: I wanted to help people feel better, move better. I wanted to help people live better.

Over the years, this key moment has remained present with me as I re-educate and re-invent what I do, in a continual process of re-investing myself in my passion. How can I best serve? How can I provide the best possible support to my clients?

These questions still continue to shape me as a movement therapist, and shape my practice as it evolves to best meet the needs of each individual client. I have graduated from being simply a massage therapist or personal trainer primarily focused on the short term physical fitness goals of my clients. I am now also concerned with helping them heal and recover from the chronic pain and injury while improving their long term movement quality. A massage therapy license has allowed me to do hands on massage therapy targeted treatments, and I am a strong advocate for self-massage with a foam roller. However, I have noticed that hands on massage therapy is frequently not enough. Some people experience short term relief from pain, but a few days later, it returns. Massage then often becomes a tool for pain relief, rather than for actual healing, and clients accept that pain and discomfort are a normal part of a life well lived. Have you ever said “My hip/shoulder/back/neck/foot is aching again, but I can deal with it for a few more days. Time to schedule another massage”?

I was looking for a more profound modality to help my clients truly heal. This is when I began to read the work of some of the top coaches and therapists in the world. (Charlie Weingroff, Dr Perry Nickelston of Stop Chasing Pain, and David Weinstock) Advice such as “don’t chase pain” and “pain is telling you there is a problem, not where the problem is coming from” was followed by discussion on how to assess compensation patterns through hands on manual muscle testing and movement assessment, which tells a therapist where and how to treat the root cause of the pain, rather than the pain itself. I was directed to the page What is NeuroKinetic Therapy, and I knew immediately that this was the work I had been seeking–the work that will best help my clients recover.

When it comes to pain and discomfort, there is no longer any need to “deal with it.

With that said, I will do my best to explain the function and application of NeuroKinetic Therapy.  However, words do not do it justice. If you ever experience pain or discomfort, perhaps caused by an acute injury or perhaps from simply living life, I encourage you to call and schedule a free consultation. We will work together to craft an individualized set of treatments for you, so that you can feel better, move better, live better.

What is NeuroKinetic Therapy™ (NKT)

Manual muscle test on client's elbow. What is Neurokinetic Therapy.NeuroKinetic Therapy™ is a sophisticated form of movement therapy that goes beyond the treatment of symptoms and instead focuses on the root causes of pain and dysfunction. It can be used as both an assessment tool and rehabilitative technique for chronic pain and injury. It is very effective for treatment of pain in the low back, neck, shoulders, knees, hips, and feet; NKT is also used for improving walking/running gait, correcting poor posture, preventing injury, and enhancing athletic performance. For many, treatment can result in nearly instantaneous relief from pain and discomfort.

Through a series of hands-on muscle tests, a certified NKT professional can assess movement systems to determine the specific patterns of imbalance, dysfunction, and compensation. This problem-solving technique can quickly zero in on the muscle(s) responsible for pain and injury. The therapist can then utilize massage therapy, foam roller therapy, stretching, or other therapy modality to release the appropriate muscles tissues; and corrective exercises to strengthen imbalances.  The result is quick, long lasting relief from pain, stiffness and dysfunction, and overall improved movement quality and performance.

NKT bypasses treatment of symptoms and is instead used to identify and correct the root cause of dysfunctional motor patterns through direct assessment of the relationship between your nervous and musculoskeletal systems. This relationship takes place through the Motor Control Center (MCC), which is crucial for interacting with the world by determining movement as well as for establishing balance and stability.

Old school switchboard operator. What is Neurokinetic Therapy.The MCC in action

Think of the MCC as a switchboard operator. Except instead of a person on the other end of the line, you get a movement action from your muscles–your body’s engines. The MCC receives a call to move and determines the appropriate combination of muscles and forces to generate the desired action. This process requires the synchronized and choreographed interaction of the nervous system (the phone lines) and the muscle system (the movement engine).

Say you want to perform a movement such as getting out of a chair. This message passes through the switchboard operator (MCC) which relays the message through the phone lines (your nervous system) to the engine (your muscles). In this message the MCC command directs which muscles to fire and which to relax, or brace. It determines the sequencing, speed, and power needed from each muscle in order to complete the desired action.

Illustration of man in pain in front of the computer. What is Neurokinetic Therapy.When you have trauma caused by an accident, injury, repetitive use, over-training, or poor ergonomics, the pain and/or instability disrupts natural movement patterns, causing temporary dysfunction. The MCC responds to the dysfunction by rerouting the signal to other muscles and shutting down the injured muscle, thus creating a compensation pattern. Muscles that normally perform other uses are now facilitated to make up for the injured, inhibited muscle(s). In the short term, this helps protect your body from further injury and allows the injured tissue time to heal.

However, problems arise when the compensation remains well after the injured tissue has healed. Over time, the compensation becomes hard-wired into the nervous system, which can lead to persistent muscular soreness and stiffness, loss of strength and function, and eventually to more serious bio-mechanical issues.

This is bad. Beyond the fact that it causes pain and discomfort, why is it bad? Because the muscle that is now compensating (the facilitated muscle) already had a job responsibility–now it has two. This is akin to you having to do your job and your coworker’s job. You would be working twice as hard, wouldn’t be as effective at either job, and most likely you’d also be a little (or a lot!) cranky. This is what happens to your muscles. When a muscle becomes cranky, it affects movement quality and often causes pain.

Southpark image. What is Neurokinetic Therapy.Things get even worse when you apply a strength and conditioning program to a dysfunctional movement pattern. When you add load and repetition, the movement patterns you train become stronger over time. Add load and repetition to a dysfunctional movement pattern, and you strengthen the dysfunction. When it comes to moving without pain and injury, practicing high quality movement is fundamental. Practice doesn’t make perfect–practice makes permanent! Perfect practice will help you own high movement quality. When you are dealing with a motor control injury, a strength training program by itself probably won’t correct it. If anything, you risk hard-wiring the dysfunction even more deeply into your motor control system. Unfortunately, this is a cycle I see many athletes repeating: coming off an injury, slowly adding load and intensity back into their training program, and–boom!–another injury setback. It is a vicious cycle, and can be frustrating and depressing.

There is an option to break free of this cycle.

NKT can be a powerful tool to help heal from an acute injury, reduce your risk of pain and injury, break from the injury cycle, and get you moving and feeling better. NKT is quick, cost effective treatment for both rehabilitation and prevention of injuries.

Will NeuroKinetic Therapy be helpful for you? Every case is different and every person responds differently to therapy. NKT is far and away the most profound therapy I have come across. The only true way to understand this work is to experience it.

Ready to ask what is NeuroKinetic Therapy and learn how NKT can help you? Leave a comment below. If you’re in Austin, Texas you can schedule a consultation online here.

Who can benefit from NKT?

  • Runners
  • Triathletes
  • Weight Lifters

Those who enjoy:

  • Tennis
  • Golf
  • Football
  • Baseball
  • Basketball
  • Dancing
  • Body Building
  • Volleyball
  • Soccer
  • Swimming
  • Rock Climbing
  • Biking
  • And so on…

Jesse James Retherford of The Art of Fitness is a Movement Therapist who offers NeuroKinetic Therapy, movement assessment, hands on massage therapy, personal training and coaching, and personalized exercise programs to help his clients eliminate pain, create a pain and injury prevention plan, move better, and tackle all of their life goals. Click here to learn more about What is NeuroKinetic Therapy.

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Plantar Fasciitis – What is it and Finding Relief

I frequently get questions about specific injuries. Many of these are about plantar fasciitis. Here is a breakdown of one of the more common causes of plantar fasciitis.

Picture of the achilles tendon wrapping around the calcaneus and blending into the plantar fascia. Plantar fasciitis.Plantar fasciitis is a pain symptom located at the heel or plantar fascia of the foot–the thick connective tissue which supports the arch of the foot. It is often most painful in the morning with the first steps out of bed, and may be aggravated by standing, walking, or running.

Here’s the deal about plantar fasciitis

It is the diagnosis of symptoms. It is not the diagnosis of the problem. The pain may be in your foot–but the problem is not. What you will not often find in definitions or explanations of plantar fasciitis on the web is that there is a deeper issue at play. The pain in your foot diagnosed as plantar fasciitis can often be traced back up to your gluteus maximus–your butt. These days, we sit too much and our butts muscles wind up not doing much. So they basically shut down or go to sleep–they become inhibited. This is not a good thing.

Your gluteal muscles have some very important functions. They are some of the most powerful muscles in the body and are the primary reason we stand upright. The gluteus maximus is a pelvic stabilizer and powerful hip extensor. The gluteus maximus provides power when we are going upstairs, rising from a sitting position, and climbing or running.

When gluteus maximus isn't functioning well, it get's very angry like the Hulk. This can lead to plantar fasciitis pain.Hip extension is your ability to stand upright. If you look at our primate cousins who still use their hands to walk, you’ll notice they have tiny butts. They also lack the ability to extend their hips into a fully upright standing position. Pelvic stability is hugely important. It provides the ability to stabilize the pelvis to our upper body, support the low back, and provide a solid powerful core. This point where your pelvis stabilizes with your upper body is where most coordinated movement is generated. If you lack pelvic stability, your entire movement system will be negatively affected. Your body demands stability. Without it, your body will find compensation elsewhere, by utilizing other muscles to do the job of those that are “sleeping,” i.e. inhibited. With plantar fasciitis, the calves are recruited to help stabilize the pelvis. This is not the work the calves are functioned to do. They don’t like it. Move like this long enough, and your calves will turn into The Incredible Hulk–they will get very angry and start to smash, i.e. tighten up and cause big hurt.

How this translates into pain in the foot

The two muscles that we call the calves (Gastrocnemius and Soleus) attach to the heel via the Achilles Tendon. The Achilles Tendon wraps over the heel bone where it then becomes the Plantar Fascia. The Plantar fascia stretches across the bottom of the foot to the base of your toes. While we may think of these muscles and tendons as separate plantar fasciitis is pain on the heel or plantar fascia of the foottissue structures, you can see by the picture that these structures are not separate. They are one continuous fascial tissue structure. So you can imagine that tension in one will affect each of the others. If your calves are working overtime–doing not only their job but also the job of your glutes–they may get distressed. With this distress, inflammation and pain will eventually set in. That pain can then show up anywhere in this continuous tissue chain. When the pain appears at the heel or plantar fascia, we call it plantar fasciitis. If it happens above the heel, it is called Achilles Tendonitis or tendonosis. The irony of all this is that the calves are not the issue! If anything, they are the most functional muscle in the group–they’re working overtime, after all. It’s their relationship with the asleep at the wheel Gluteals which need to be addressed. This is where the pain in your foot is literally a pain in the butt.

Relieving plantar fasciitis pain

GRIDXside
The Grid Foam Roller by Trigger Point Therapy

When treating any kind of painful dysfunction, my first goal as a movement specialist is to help my clients find relief from the pain. The method I’ve found most beneficial for this is self massage using The Grid foam roller to release the tension built up in the calves. Here are some simple exercises to help relieve the discomfort in your foot by working with The Grid.

Now once the pain is gone, this does not mean you are fixed. Pain is a communicator–it alerts us to an underlying problem. But it is not the problem itself. This is why the “treatments” often found online (such as this one) will only provide temporary relief; they target the symptom (pain) rather than the core underlying issue.

There is still movement dysfunction that needs to be assessed and addressed, and as detailed above, it likely originates in the hips. Strengthening and balancing movement patterns associated with the glutes is the next step in treating plantar fasciitis, and can best be done by making an appointment with a qualified movement specialist. To ignore this step places you at risk of an even more painful and serious injury at some point in the future. Finding help is hugely important in the long run for continued recovery and pain free movement.

Here are some simple quick tips for quick temporary relief. Or check out this older article with more exercises to help with plantar fasciitis pain.

Place foam roller beneath calves. Slowly roll from the ankles to the knees. Plantar fasciitis
Place The Grid foam roller beneath calves. Slowly roll from the ankles to the knees.
Using a foam wedge, press heel into the ground and actively straighten your knee. Stretch to slight discomfort, NOT pain. Hold for 1-3 minutes each stretch for plantar fasciitis
Using a foam wedge, press heel into the ground and actively straighten your knee. Stretch to slight discomfort, NOT pain. Hold for 1-3 minutes each stretch
The Grid foam roller by Trigger Point Therapy. Self treatment for plantar fasciitis.
The Grid foam roller by Trigger Point Therapy.

 This is the foam roller I recommend: The Grid by Trigger Point Therapy

Knee Pain and Running

Running and Knee Pain

There is a conversation taking place on facebook in a runner’s forum about knee pain and running.  What you are about to read is the exchange I had with the author of the original post.  Check it out below.  And will you do something?  If you know someone with knee pain that you think this would speak to, will you pass the link along?

The Question:

Ok fellow runners…ever since I took a week off post 1/2 marathon I can’t run more than 2.5 miles without excruciating knee pain. Never once happened before. This is bullshit! Help!!!

My Response:

Knee pain is a postural issue. It has less to do with a problem at the knee and more to do with mobility and stability dysfunction at the hips, feet, upper back, core, and shoulders. For any adjustment to be effective, the entire biomechanical chain must be addressed.  Not just the knees.

No Pain sign. Knee Pain Running.I work on postural dysfunction in four (4) stages:

Knee Pain Running

1. Pain: Your range of motion must be, first and foremost, PAIN FREE! This means, if it hurts to do… DON’T DO IT!!! If your knee hurts to run, squat, or lunge, etc… hold off on these exercises until you can do them without pain.  What to do about the pain?  I address the pain through movement assessment, hands on massage therapy, and a personalized exercise program. I recommend finding a highly movement therapist who uses walking and running gait assessment and has experience successfully treating these types of injuries. I typically see a significant reduction in pain within 2-4 treatments.

Practicing some full body self massage using a foam roller may also provide some temporary relief from the pain.

2. Mobility: Once the pain is reduced, you will need to work on improving your functional range of motion, such as the ability to perform a functional deep squat or lunge. IN MY OPINION, IF YOU CANNOT PERFORM A FUNCTIONAL DEEP SQUAT OR LUNGE, YOU SHOULD NOT BE RUNNING! PERIOD!!! These are progressive movement patterns that lead up to running. Babies learn to squat-ass-to-the-grass BEFORE they learn to walk and run.  You must do the same.  So do it.  And on top of training for functional lower body mobility, you will need to work on upper body mobility as well. When your thoracic spine, scapula, and neck are restricted, your hips will not function properly.

3. Stability: Now that you have improved Range-of-Motion (ROM), you will need to train your body for stabilization with this renewed ROM. This is the basic definition of posture. The ability of your body to stabilize throughout your entire ROM. For more on posture, read:

What is Posture

Here are some super basic corrective exercises to get you started.

The Foundation of your Posture – Injury Prevention Begins at your Foot

Corrective Exercises for the Hips

Corrective Exercises for the Scapula

4. Conditioning: Running is a very basic movement pattern. It is also a very small percentage of our overall functional movement pattern. If the only form of exercise you are doing is running… you are running directly into a potential injury. Your body needs to be conditioned throughout it’s entire movement ability. Full body functional movement is vital to overall health and vitality, as well as running ability. Another way to think about this is: How do you want to feel when you’re 70, 80, 90, or 100? Do you want to run comfortably in advanced age? Conditioning your body through full functional movement patterns, which includes running, is the key to both of these questions.

I encourage you to hire an expert team to help you through this process. The investment now will save you thousands in your long term pain and health. I suggest hiring a therapist to help with the pain; a movement coach to help improve your posture; and a running coach to teach you how to run (years and years of sitting on our butts means that we don’t know how to do this very basic movement pattern – even if we run frequently). Here is a link with tips on finding a quality therapist and coach:

Five Steps to Choosing a Professional Therapist

Good luck.

The Response:

Jesse, in a perfect world I would LOVE to be able to hire all of those folks to help me out. I have contacted an ART (Active Release Therapy) doctor in hopes they’ll be able to help me a little bit. As for the rest I’m going to have to go it alone or go through my HMO (which everyone knows could take years) to get to a physical therapist. My knees don’t actually hurt unless I’m running. I can do squats and everything w/o knee pain…it’s when my glutes get tight about mile 2 that everything goes to pot. So I’m sure some of it’s my form and some of it is that I’m just too tight. I will continue to work on it and stop running for the time being. Perhaps yoga is in my future…

My response:

I completely understand the issue of cost. At the bare minimum, I encourage you to invest in a foam roller, softball, lacrosse ball, and golf ball. This will allow you to do a great amount of the massage work on your own. The foam roller alone should make a huge difference with your pain during running. It may take a few weeks. Here is another article on foam roller therapy that has a bit more detail to it.

How to Treat and Prevent Injury and Become a Better Runner

Finding a good teacher, Part II

When looking into a PT, I recommend really vetting them out. You want the most educated, experienced, passionate, top of their game professional available. You are looking for a highly skilled therapist, preferably one who includes manual therapy; as well as multiple other modalities; and looks at the entire movement system, not just your knees. If they treat the knees in isolation, find another therapist! Hopefully, it won’t take too long, but you are better off taking your time searching for a high quality therapist who is the best fit than to settle on someone who isn’t.

Can you really do a functional squat?

The majority of clients that I see, at the time they come in, say that they can do a squat. The fact is they cannot do a “functional” squat. This is what I consider a functional squat:

This Is A Functional Squat

Baby squatting with perform form. Knee Pain Running.
If you can’t do this from standing to sitting to standing keeping your shoulders down and back, without your heels coming up, your feet rolling out, or without pain then you can’t do a functional squat.

Here is a great little video from Barefoot AngieBee describing squatting

Understanding Pain

Understanding Pain

How is your understanding pain? Have you been told by a medical professional that the pain you’re experiencing is all in your head? Yes, it’s true. But it’s also much more complicated than that. It does not mean you’re crazy. It’s possible that that particular professional is not fully suited to help you through the healing and recovery that you need. There are active steps you can take to fully heal, and there are amazing professionals that can help you through this process.

Understanding Pain: What to do about it in less than five minutes?


Do you have a story of pain you’d like to share? Please share in the comments.

Jesse James Retherford is a Movement Therapist and owner of The Art of Fitness in Austin, Texas. We offer professional movement assessment, hands on massage therapypersonal training and coaching, and a personalized exercise program to help you move better, feel better, and live a pain free life.

The Art of Fitness
6512 Lancret Hill Drive
Austin, TX 78745
Phone: 512.587.2283

Jesse James has been understanding pain for years. You can read My Story of Pain here.

The Importance of Good Form running and Interval Training

A couple of weeks ago I touched upon the subject of the need to train good form running, not conditioning in Injury: Recovery & The Grand Return. In today’s post, I want to dive a little deeper into the subject of Form.

What is Good Form Running?
Picture of toddler performing a perfect squat. Good form running.When it comes to movement patterns, including – but certainly not limited to – squatting, lunging, running, jumping, throwing, etc, form is paramount. Break down in form is what breaks the body.

Poor form is one of, if not the primary cause of, chronic pain and injury.  This goes whether you are an elite level athlete, weekend warrior, or even a sedentary couch potato. The way you move has a direct and definite impact on how you feel.  It has everything to do with your form, good or bad.

Form is the applied combination of technique and skill. Form is a learned behavior.  It is built through repetition (aka practice), and is embedded in the nervous system. When you learn a new movement pattern, your nervous system creates a specific neural pathway for this new skill (the connection of one part of your nervous system with another).

At first this pathway is weak; the connection is poor. But the more often you repeat the movement pattern, the stronger the neural pathway becomes.  Sustained consistency goes farther than sheer force of effort.   It’s kind of like building a road.  Over time, as more and more traffic uses the road, it is expanded.  Over time, with enough use (i.e. traffic in this example), the road is slowly transformed into a highway.

Proper form takes the right movements and deeply hard wires them into a specialized skill through perfect repetition of movement patterns.

Poor form takes the wrong movements and deeply hard wires them into bad habits through the repetition of imperfect movement patterns.

Poor form

Is inefficient, leaks energy, and makes tasks harder and more exhausting to perform.
Wears down the soft tissue of joints, leading to inflammation and damage.
Creates dysfunctional pain patterns throughout the body.
Increases your short and long term medical costs, by way of…
-visits to doctors and physical therapy
-pain medications
-surgeries
-hospital stays
Poor form, in short, shortens your life!

Good form running

Increases efficiency – You move smoother and faster, jump higher, squat more weight, etc., all with less effort and strain.
Minimizes wear and tear on joints, ligaments, tendons, cartilage.
Allows you to do more with your body and your life.
Speeds recovery time.
Is preventative medicine.
Reduces short and long term health care costs.
Prevents living a life of pain and injury.
Increases productivity.
Proper form, in short, lengthens your life!

Good form running must come first

This is important. Proper form and poor form are both developed through repetition.  The difference lies in the quality of the movement being repeated.

Why does this matter?

Because you cannot train form and conditioning at the same time.

You cannot learn a new movement pattern (form), and – at the same time – use that movement pattern to train for endurance, strength, power, or speed (conditioning).

For example, say you are recovering from a running injury.  If you are training to improve your running gait (form), you cannot use running to improve your conditioning. The two – on a fundamental level – don’t work together!

Training to improve your form and training to improve conditioning are fundamentally incompatible.

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To improve form, you need practice… perfect practice. You need to practice your good form running perfectly in order for it to stick.  When you train for form you are allowing your neurological system to develop new bio-mechanical habits. Because it is so important to have flawless form, you must repeat the movement pattern flawlessly with every repetition.

At the beginning of form training, perfect form breaks down at the first sign of fatigue. Once fatigued, you will no longer be able to maintain good form running.

Training with imperfect form reinforces the poor movement patterns that will ultimately lead to injury.

At the same time, you cannot improve your conditioning without fatigue.  Fatigue is a core component to training endurance, strength, power, and speed. You will not achieve significant improvements in your conditioning without training into some levels of fatigue.

Perfect Practice Makes Perfect! Good form running.
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Case Study. An example from real life:
Susan had not had the time to run in over three months.  On Saturday she decided to try one mile for her first run.  One mile is a pretty short distance, and a perfect place to start to get back into good running condition, right? She ran at a 10 minute mile pace.

Here’s the problem: because of her level of conditioning, she is only able to run with proper form for about 1-2 minutes before fatigue sets in.  Once fatigued, it is impossible to maintain proper running form without rest. Each and every step she takes after her form breaks down is a step down the path of a poor neural pathway.  

If she decides to push through and complete the mile without rest, she will actually spend 80% of her running time practicing poor form. That is 80% of her training time building upon a highway system of dysfunction and future pain and injury!

Is that what she wants?  Is that what you want?

The same example can be used for all forms of movement.  Fatigue affects your form in all activities, like swimming, cycling, tennis, resistance training, etc.

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If you want to improve your form, if you want to reduce the recurrence of pain and injury, then you must train with patience.  You must limit how much you perform the desired movement until you have fully developed your new and improved form.

You need perfect practice until you have perfect form.

Then, and only then, can you use that movement to train conditioning.  It may take a few months or longer, depending on your age, conditioning level, injury history, and a few other factors.

It is very likely that you will be able to work on your conditioning in some way.  However, it must come from activities in which you already have a high level of skill and technique.

In any specific movement pattern, you cannot train form and conditioning at the same time.  Perfect form first.  Train conditioning later.

Interval Training
One of the best training methods for improving form is interval training.  Interval training maximizes the benefits of repetition and minimizes the instance of fatigue.   It involves a series of low to high intensity exercises followed by periods of rest or recovery. Interval training includes in the vital rest and recovery your body needs to maintain proper form.

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Case Study. An example from real life, Part 2:
Let’s take another look at Susan’s run.  Instead of running a mile nonstop, she can do a series of one minute runs followed by one minute recovery up to ten times, or really as long as she can maintain proper form, whichever comes first. Not only will she be able to get in the distance that she wanted to run, but she will do it using proper form during a much greater percentage of her workout.

Over the course of several weeks, she can slowly add more time to each running interval and decrease the time of each recovery interval. This helps improve form, increase mileage, and prevent injury. Within a couple months, she will be able to run nonstop for the desired distance while maintaining great form.

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Barefoot Running
Person running barefoot. Good form running. If you have been thinking about making the switch to a barefoot lifestyle, this interval training is an ideal time to incorporate barefoot running into your training. By adding barefoot running into your training you get immediate feedback in your running form.  Basically, bad form will hurt immediately, allowing you to make immediate adjustments in your form.

It is also a great way to force yourself to limit the total amount of training time each day. Your feet will be far too sensitive to train beyond fatigue and poor form. A proper barefoot running transition needs to be done slowly.

It is important with barefoot running that you do not attempt to Push Through The Pain. (Here is more reading on how to make a smooth, safe, injury free transition into a barefoot lifestyle.)

12 Week Interval Running Program

This is the same interval training that I included in the article about Injury and the Grand Return.  It is an excellent interval training program and is a solid way to get back into proper running form.  Jump back over to the bottom of the “Injury” article to have a look or click here to download it as a PDF.

Foam Roller on the IT Band – Waste of Time?

Hi Jesse,

The tensor fascia latae and gluteus maximus muscles feed into the IT band.I wanted to get your opinion about using the foam roller on the IT band with a firm roller. My understanding is that you can certainly massage and gently stretch the IT band, but it is supposed to be taut because it helps to support the lateral leg muscles. People feel a difference between the IT band and the quad muscles. They assume they need to loosen this up. So maybe there are no adhesions, but what they are feeling is the normal tension of the tissue. I think it is ok to roll it out gently, but not to push it. What do you think?

Thanks,

My Response

Thanks for the email. This is a great question. I’ve had it in mind to address this question for a few weeks now.

In the past few weeks a couple of different articles on using a foam roller on the IT Band have been posted online with different opinions on the benefits of foam roller self massage therapy.

Foam Roller on The IT BandIn the first article, Stop foam rolling your IT Band, the author, Greg Lehman, is a bit critical of using the foam roller on the IT Band. He makes a good argument that there is very little benefit to rolling the IT band due to the fact that it is dense connective tissue with limited ability to be lengthened or change.

In the second article, Is Foam Rolling Bad for You?, Michael Boyle defends the use of a foam roller on the IT Band and makes an excellent case of the benefits on foam roller massage therapy.

I agree with completely with Michael Boyle’s article. I find foam roller massage therapy to be hugely beneficial to healing, recovery, and injury prevention. I also agree a little bit with Greg Lehman about the futility of using a foam roller on the IT Band.

Here is my take:

Most people spend way to much time with a foam roller on the IT Band at the neglect of the other and more beneficial areas of their legs, hips, and shoulders.

The IT Band is white, tendinous fascial tissue, which means it receives less blood flow and has less ability to “release” compared to muscle tissue such as the glutes. The IT Band is also incredibly strong. I’ve heard awesome anatomist and movement therapist, Kathy Dooley, say that if you connected the IT Band behind two trucks moving in opposite directions, it wouldn’t stretch or tear. If the power of two trucks won’t change this tissue, a foam roller on the IT Band probably won’t change it much either.

The IT Band attaches directly to the gluteals and tensor fascia latae (TFL), the tension in the gluteals and TFL pull through the IT Band down to the knee and ankle. Most pain that is felt in the IT Band, outside of knee (runner’s knee), and ankle is more than likely caused by dysfunction in the muslces located in the gluteals, TFL, and adductors. Adhesions do form in the IT Band, especially closer to the knee. However, in my experience as a movement therapist, I find the majority of adhesions which affect the IT Band are located in the dense tissue of the gluteals and TFL. Most people have minimal adhesions directly within the IT Band itself.

How this translates with using a foam roller on the IT Band

When you roll the IT Band and neglect the adductors, glutes, and TFL, you will only get temporary relief, not lasting change. As soon as you stand up, the restrictions in the adductors, glutes and TFL will once again pull through the IT Band.

Trigger point referral patterns down leg due to dysfunction in the hip muscles.You will get greater change in the IT Band tissue, increases in range of motion of the hips, and  reduction of pain and discomfort by breaking down adhesions in the TFL, gluteals, and adductors. This is especially helpful for people new to using a foam roller, since rolling the IT Band can be very painful. If you spend a few minutes working through the gluteals and TFL first, when you roll on the IT Band it will be significantly less painful.

I believe that if you only roll out the IT Band and neglect other areas of your body, you could be asking for trouble. By loosening up just one side of the hips and knee, the opposing sides tighten to take up the slack. This could create imbalances in your movement patterns, as well as your body’s ability to stabilize the knee and hip joints. This is the big reason why I recommend to clients that they spend equal time addressing their entire body. The goal is to bring balance to the tissue, not to only work what feels good.

Personally, I do occasionally use a foam roller on the IT Band. It feels good and I can feel the benefit. But it is an area that I spend a minimal amount of time on. If I only have a short amount of time to roll, I roll the adductors, TFL, glutes, and calves. I won’t hit the IT Band at all.

Something to note: If you are using a foam roller on your IT Band to treat a painful condition, but you get only temporary relief and the pain continues to come back, then the IT Band is not the problem. In this case, I highly recommend seeking the help of a highly skilled movement therapist who can assess movement dysfunction and develop a personalized exercise program specific to your needs.

On another note, when I perform deep tissue massage therapy on a client, I rarely focus any time directly on the IT Band for the same reasons listed above.

 

The Grid foam roller by Trigger Point Therapy - for self massage therapy
This is the foam roller I recommend most: The Grid by Trigger Point Therapy

 

Here are some articles with examples of how to perform foam roller therapy.

Foam Roller Massage Therapy For Beginners

Plantar Fasciitis Self Treatment for Fast Relief 

Sciatic Pain Tips for Low Back Pain Relief 

 

What is Posture and How to Improve Your Posture

Anatomy chart side view of good posture.When I think about posture, the first thing that comes to mind are the words I’ve heard, and still hear, in childhood and adulthood: “stand up straight and pull your shoulders back.”  Or I get an image of the skeletal and muscular anatomy posters in a doctor’s office with a plumb line that goes directly through the center of the head, shoulder, hip, knees, and through arches of the feet. This is what many of us are taught is “good” or “perfect” posture. There is a problem with these pictures and instructions: they do not represent the entire story of what posture truly is, nor do they effectively teach you how to maintain it.

 

What is posture?

Posture is not a concept. Neither is it an “ideal or static position.” Posture IS position.  It is the stable position of your body as it moves in gravity right now. Posture is the shape of YOU – moment by moment, movement by movement. What provides that shape is a highly complex system of bones, muscles, tendons, ligaments, and fascia that provides stability, strength and coordination to the body.

Postural muscles [or core muscles] stabilize the joints within the skeletal system through movement, against gravity. In terms of posture, stabilization means to slow down joint movement.  In essence, postural muscles are a high-tech braking system. When it comes to movement and injury prevention, stability is king. It is more important – for long term joint and movement health – to be capable of slowing or stopping joint movement than it is to speed it up, and your body inherently knows this.

It is from stability that all healthy movement is derived.

Movement Muscles
Movement muscles [called phasic muscles] are the muscles that provide mobility. These muscles are primarily responsible for movement. Your phasic muscles are what make you go. They are the gas pedal.
What causes poor posture and pain?
X-ray picture of person sitting in front of the computer in a very poor posture position.When postural muscles are not engaged, such as from sitting for long hours every day, or lack of functional exercise, they go to sleep.  If you do not use them, your postural muscles literally lose the ability to stabilize the joints of the body. Since stability is so important to movement, when your postural muscles lose their ability to function, your body MUST do something about it.
What does this look like? A great example of this is the lower core. It is primarily responsible for stabilizing the hip and the lower back. Sitting shuts off the lower core muscles. If you sit for long hours every day, over time you lose the ability to turn your lower core on. You can no longer fully engage them. Do this long enough and you will lose the functional ability to stabilize the hip and lower back with your core muscles. The muscles are there, but they are no longer doing their job.What happens…
You have your postural muscles, the brakes. You have your movement muscles, the gas pedal. When the postural muscles shut down, the movement muscles are left with the responsibility of providing stability as well as mobility. This is the equivalent of having your foot on the gas pedal and on the brake at the exact same time.What does this look like?
Picture of someone with hip pain due to poor posture habits. Let’s think again about your lower core. Once the lower core muscles have shut down, the pelvis is left unstable. Remember, stability is king! Your body will recruit stability from somewhere else when needed. In this instance the stability will come from the hip flexors and gluteals – both mobile muscles. The hip flexors and gluteals take over stability control of the pelvis. In doing so, they lose some functional ability as mobile muscles placing greater stress on the hamstrings and low back, leading to significant reductions in the range of motion of the hips and secondarily to the shoulders, knees, and feet. Reduced range of motion causes imbalances throughout the body, which ultimately lead to dysfunction, pain, and injury.
What is the lesson here?
For your body it is posture, aka stability, that trumps movement.  If your postural muscles have lost their ability to function, your body will automatically trade in movement to achieve stability.  There is no movement that does not begin without stability.To improve posture, you must improve your body’s ability to stabilize itself within every range of motion available. This means creating a fundamental shift in how you move and how you train movement. The program I recommend to my clients includes self-myofascial release using a foam roller, deep tissue massage therapy, full body flexibility, corrective exercise, functional strength training, and being barefoot.

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Free Your Feet

Feet are the foundation of posture.  A strong foot creates the base support structure for a strong healthy body. A weak foot creates an unstable foundation affecting the posture from head to toe. You cannot build a strong stable structure over an unstable foundation. It would be like attempting to build a house on top of sand. Sooner than later the entire structure will collapse.

As a movement therapist, one of the things I specialize in is helping clients heal from chronic pain and injury. In the majority of clients that I treat, I have seen a connection between their chronic pain and the health of their feet, including the shoes they wear.  Painful conditions of the knees, hips, low back, shoulders, and neck can all be traced down to the feet. I believe that foot health is one of, if not the biggest, determining factor of pain, injury, disease, overall health, wellness, and vitality. To have healthy feet, you must free your feet.

Happy Feet - Free your feet.Your feet are your connection to the Earth.

The sole of your foot is one of the most sensory nerve-rich parts of your body, comparable with the palms of your hands, mouth, and genitals. Sensory nerves receive stimuli from the environment, such as texture, temperature, and traction. Let that sink in a bit. Imagine spending 10-12 hours a day with thick padding on your hands. How well would you be able to interact with the environment?

“Sensory information from the foot is used to protect the foot itself from injury, but it’s also used by the brain to make subtle adjustments in your gait to protect bones and joints all the way up your body and to maximize the efficiency of your movements.”Dr. Daniel Howell, the barefoot professor

Imagine that, from the moment you start to crawl and explore the world, thick cushioned gloves were placed on your hands for eight to 16 hours each day. How would the world look and feel now? You would lose finger dexterity and the ability to grip.  Without grip strength, your body would look much different. The muscles of your chest, back, shoulders, and arms would be dysfunctional, weak and atrophied, affecting functional movement of your entire body.  Your life also would look considerably different. More than likely you would feel a physical, emotional, and spiritual disconnect from friends, family, and environment. This is what has already happened with your feet. Instead of saying “free your feet”, I’d be promoting “free your hands.”

Feet in high heels. These are not happy feet. Free your feet.
They may look happy
X-Ray of foot in high heels. Free your feet.
But they really are not happy
Hokka Running shoes make not happy feet. Free your feet.
Great marketing, but definitely not happy feet

Free Your Feet!

For most of us, shoes are on our feet from the time we take our first baby steps — shoes with hard, thick rubber soles. These shoes lift your foot an inch or more off the ground and block the sensory nerves from receiving external stimuli. This weakens the intrinsic muscles that make up the arch of the foot, changing the way you walk and run and undermining the development of the core muscles that make up your posture. After decades of wearing shoes, many peoples’ arches have partially or fully collapsed, creating muscular and postural dysfunction, wreaking havoc, and causing considerable pain throughout the body.

So where does foot health begin? It begins with your next step and the shoes you choose to wear.I am an advocate of minimalist shoes. The least amount of shoe on your foot that you can manage pain-free, the stronger your body will be.Here is the best definition of minimalism and minimalist shoes I have found. It is borrowed from Dr. Mark Cucuzzelas.Barefoot in grass. Free your feet.

What is minimalism?
• free your feet to develop naturally
• looks for the least amount of shoe you can safely wear now
• works toward reducing the amount of shoe necessary through strengthening the foot and improving your stride
• practices running as a natural movement of the body, rather than an unnatural act requiring artificial support to perform safely
• embraces the notion that the beefier the shoe, the more a runner’s natural stride is inhibitedWhat is a minimalist shoe?
• complements natural foot function
• has very low heel-to-toe drop
• is constructed with thin material under the foot, allowing maximum ground feel
• has a soft and flexible upper
• is light and flexible

Nike Shox. They look cool and all, but they are not happy feet. Free your feet.
Not minimalist shoes and very unhappy feet

The most common question I hear about minimalist shoes and my response

Don’t I need arch support?
You have the most advanced arch support design system in the history of bipedal locomotion, and it is already built into your foot. There is nothing that man can create that will be superior to God.

The structure of an arch is a phenomenal piece of engineering. The Romans perfected the use of arches in their architecture. Why? The arch is the strongest shape in natural architecture and becomes more structurally stable with more weight pushing down.  Your arches actually get stronger with weight on them. If you were to apply upward pressure from underneath, you would collapse the arch, which is exactly what arch supports in your shoes do, whether they are built into the shoe or insertable orthotics.

Arch supports are designed to immobilize or limit the motion of your arches. While immobilizing may be appropriate to aid the healing process of a broken bone or a torn ligament, permanently immobilizing any part of the body will lead to loss of function.

Barefoot skiing. Free your feet.
Yeah happy feet!

The foot is not only the foundation of your postural body, it is your connection to the planet. Every step you make in life begins with the foot. If you utilize the natural engineering and design of your foot, you will build a solid support structure that will be more capable to carry you pain and injury free throughout life. The more contact between the earth and your foot, the better you will feel physically, emotionally, and spiritually. It is time to Free Your Feet!

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Sciatica Pain tips for Low Back Pain Relief

As a licensed massage therapist, I specialize in chronic pain and injury management using deep tissue massage therapy. Most of my clients come in with a common complaint: pain in the low back, hips (primarily on one side), and/or shooting pain or numbness down the back of the leg commonly referred to as sciatica pain. More than two million Americans suffer either from back pain or a form of sciatica that is often misdiagnosed and improperly treated.   Many suffer from pain for months or years without a proper diagnosis.  I work with these symptoms so frequently that I have noticed some common characteristics with this all-too-common pain complaint.

Pelvis with sciatic nerve and piriformis
Hip joint. Red: Piriformis muscle. Blue: Sciatic nerve.

The most common characteristics I find are aggravated myofascial trigger points (TrPs) in the piriformis muscle.  Piriformis trigger points are often confused for a herniated disc, sciatica, or other back issues, and many sufferers undergo unnecessary and costly tests, injections, and surgeries.

What is the piriformis?

The piriformis muscle is a small external rotator of the hip whose function primarily is to turn the knee and foot outward. It lies deep within the gluteal muscles, originates from the sacral spine, and attaches to the greater trochanter of the femur — the big bony “bump” on the outside top of the thigh.  The sciatic nerve passes beneath through an opening called the sciatic notch.

 

Hip abduction

Function

In non-weight bearing activities, foot unloaded and hip extended, the piriformis rotates the thigh outward. When the hip is flexed at 90 degrees it aids in hip abduction. Hip Abduction. In weight-bearing activities, foot loaded, the piriformis is often needed to control the rapid medial rotation of the thigh — for example, as the foot strikes the ground during walking or running, the knee turns inward.
Trigger point referral pain pattern from sciatica nerve impingement due to piriformis
Piriformis trigger points and referral pain pattern

 

Piriformis Trigger Points Symptoms

The myofascial sciatica pain component includes pain in the low back, groin, buttock, and hip.  A trigger point may cause the muscle to compress and irritate the sciatic nerve, causing the pain to travel along the course of the nerve. The pain may radiate down the back of the leg and into the hamstrings, the calf muscles, and possibly the foot. The pain may initially be confused with a hamstring strain or diagnosed as true sciatica. Weakness, stiffness and a general restriction of movement are also quite common. Tingling, numbness, or shooting pains down the leg can also be experienced.  Symptoms tend to be aggravated by prolonged sitting or by intense activity.

Causes
Piriformis trigger points are predominantly caused by a shortening or tightening of the piriformis muscle.  Piriformis trigger points are commonly associated with sports that require a lot of running, change of direction, or weight-bearing activity.  Piriformis trigger points can result from acute overload (as when catching oneself from a fall), from repetitive overload (as with the rapid internal rotation of the weight bearing experienced by walkers and runners with poor biomechanics),  or from sustained overload (as when holding the leg bent and turned outward for prolonged periods while driving a car or working at a desk).  Sciatica pain from piriformis trigger points is also a common complaint during pregnancy.
Pic of inflamed sciatic nerve due to piriformis impingement
Impingement of sciatic nerve from piriformis TrP

The piriformis muscle is responsible for the symptoms of pain by projecting pain from activation of the trigger points and by nerve entrapment upon the sciatic nerve.  Once trigger points are activated, the piriformis muscle begins to put pressure on the sciatic nerve.  The sciatic nerve runs under (and sometimes through) the piriformis muscle on its way out of the pelvis. The piriformis muscle can squeeze and irritate the sciatic nerve in this area, leading to the symptoms of sciatica.

Treatment and Prevention

The first two steps in treating piriformis trigger points can provide the most significant and immediate relief: deep tissue massage with stretching of the external rotators of the hip.  Deep tissue massage techniques such as myofascial release and trigger point therapy are highly effective at reducing active trigger points. Once the trigger point is released, there will be a significant reduction in pain.

GRIDXside
The Grid Foam Roller by Trigger Point Therapy

Following up the massage with flexibility training will help loosen the muscle and help prevent a return of the trigger point and sciatica.  I have found that it takes between four and ten massage sessions to move out of the acute pain phase from piriformis trigger points.  It may be shorter or longer depending on the cause and severity of the initial injury.

For long-term prevention of piriformis TrPs, self-myofascial release and flexibility will be your most invaluable tools.  Below are some pictures of how to relieve piriformis TrPs using a ball (preferably a tennis ball for beginners) and how to stretch the piriformis muscle and other external rotators of the hip.  With each stretch, it is important to breathe into the stretch and only stretch to slight discomfort … NOT PAIN.

Using a soft ball to release the piriformis muscle and gain relief from sciatic pain patterns.
Self-trigger point therapy using a ball. Find a painful spot in the glutes, relax your body into the ball, hold the position for 30-60 seconds or until you notice a significant reduction in pain. Move to the next painful spot. 5-10 minutes total.
Stretching the piriformis muscle in a supine figure four stretch.
Lying piriformis stretch. Place the leg you are stretching mid-calf on opposite knee. Pull opposite knee towards chest while at the same time pulling the knee of stretching leg towards opposite shoulder. Hold 30-60 seconds.
Seated gluteal stretch. Cross the leg being stretched over opposite leg. Wrap opposite elbow around the knee and pull towards opposite leg. Keep your back straight. Hold 30-60 seconds.
Seated gluteal stretch. Place ankle of the leg being stretched on opposite knee. Throw both hands over your leg, take a deep breath, and, as you exhale, allow your chest to drop toward the floor. Hold 30-60 seconds.
Modified pigeon pose. Place leg being stretched on a table, couch, or bed with knee bent and opposite leg resting on the floor. Drop your chest toward to table. Hold 30-60 seconds.

Other suggestions to prevent Piriformis TrPs

Get assessed by a qualified movement therapist. The exercises shown here are a guide to provide temporary relief. They are not a permanent fix. The underlying movement issues that are causing your piriformis to impinge your sciatica nerve need to be addressed. Find a highly skilled movement therapist in your area who can assess muscle function and gait mechanics.

Our bodies were designed to move.  It is important to keep moving.  Try not to sit down for more than an hour at a time. Stand up, take breaks, go for a walk, and move your body throughout the day. Lack of movement causes muscle dysfunction. Proper movement is key to an active healthy life. With an exercise program that focuses on functional movement patterns with core strength and stabilization, regular full body massage (self-massage or professional), and full body flexibility you will reduce your chances for chronic pain and injuries.

Running/walking

Change the way you walk and run. Heel strike is the most common dysfunction in running/walking gait. As soon as the heel strikes the ground, the knee rapidly moves into external rotation followed by rapid inward rotation. This places repetitive trauma on the piriformis muscle and leads to TrP formation and activation. I suggest hiring a coach who instructs forefoot or midfoot strike running form.

Replace your shoes. Modern running shoes promote heel strike. I advocate shoes with as little cushion and arch support as your body can handle.

Be smart with a shoe and form transition. Your body has adapted to how you walk and the shoes you wear.  A fast transition without proper instruction and training raises your risk of significant injury.  Below is a great article about what is wrong with your running/walking shoes.

What Happens to Our Foot When We Wear Traditional Running Shoes

This is the foam roller I recommend: The Grid by Trigger Point Therapy. This is an affiliate link. If you click it and make a purchase, The Art of Fitness will receive a small commission. These commissions help support TAO-Fit to continue producing life-changing content. Thank you for your support.