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Triathlon Success: Foot Fitness

Foot and ankle injuries are the number one problem in the sport of triathalon.  The thousands of spins on the bike, impacts on the run, and kicks with the swim can take a toll.  Some preventative training can help speed tissue recovery in your feet and safeguard the ankles.

The foot and ankle are made up of twenty-six bones that are controlled by an elaborate combination of intrinsic and extrinsic foot muscles.  A web of fascia interconnected to the muscles creates a dynamic sling that gives our foot form and acts as a spring to propel   the body through space.  Our feet evolved to guide us over an ever-changing environment of varying surface with minimal support from footwear.  Modern footwear, deconditioning, and prior injuries can all take a toll on the functional mobility and strength of the foot and ankle.  Preventative exercise activities can go a long way to prevent painful injuries in the lower leg and foot.  Watch the video and give these activities a try.

Foot Wave

You can perform this exercise throughout the day and it will help keep your feet healthy and strong.  Point the foot (plantarflex the ankle) and flex all of the toes.  Draw the foot up (dorsiflex the ankle) and keep the toes flexed.  Extend the toes while keeping the foot pulled upward.  Point the foot downward while keeping the toes extended.  Keep the foot pointed and flex the toes.  Move through this exercise in a steady and deliberate fashion.  Take time to feel the muscles activate and stretch in the foot and lower leg.  Repeat the “foot wave” for five to ten repetitions.

Short Foot Drill

The muscles on the bottom of the foot are called the foot intrinsics.  The foot intrinsics function in a manner similar to the core muscles of the torso.  Their job is to brace the foot so it can transfer forces through a stabilized series of boney arches.  Weak or slow to respond foot intrinsic muscles impede the foot’s capacity to decelerate forces.  The short foot drill will improve foot intrinsic muscle performance.

To perform the short foot drill on the right foot, place the right foot flat on the ground and place the left foot back.  Bend the right knee about 20 degrees and lift the left heel off the ground so more weight is on your right foot.  Lift and spread the toes of the right foot.  Lower the toes back to the ground and grip the floor with the big toe.  Contract the muscles on the bottom of the foot.  You should feel a lifting of the foot arches.  Tighten the muscles of the right leg from the calf to the hip and lift the pelvic floor.  Hold this tension in the foot and leg for ten seconds and then release.  Perform five repetitions.

Soft Tissue Mobilization

Treat the soft tissue structures of the ankle and foot with a consistent program of massage.  Three or four times a week, take five minutes and perform some massage stick work to the muscles of the lower leg.  Find a tennis ball and roll out the plantar aspect of the foot.  Deep soft tissue work helps improve circulation, prevents aberrant scar tissue formation, and promotes tissue elasticity.

Cryotherapy

Age brings lower leg arthritic changes and circulatory deficiencies.  These can create pooling of inflammatory byproducts in the feet and ankles created by a week of triathalon training activity.  Cooling the feet and ankles in an ice bath can help break the chemical cycle of inflammation and enhance recovery.  At the end of a training day, fill up a bucket with water and lots of ice.  I like to get most of my lower leg under the water.  Try fifteen to twenty minutes every other day.

Watch our Foot Fitness video for demonstration of these exercises: View Foot Fitness Video

Kat Wood, DPT, ATC

World’s Best Diet Part 7–Paleo

If you google the word diet, you will come up with over 200,000 results.  Every week, month, year, and decade a new study or article comes out claiming certain foods are killing us, or that some other food or nutritional approach will lead us to the promised land.  Unfortunately, articles are written to create traffic, so scientific research is often misreported or spun to sell magazines or generate website traffic.  The truth is, there are many ways to skin a cat.  All of the evidence on nutrition (in regards to weight loss) points to two undeniable truths.  First, that dietary adherence is king.  It doesn’t matter how perfect or evidence based a nutrition plan is, if you can’t follow it, it doesn’t matter.  Before starting any eating plan, you must ask yourself how easy it will be to maintain long term.  Second, you must achieve an energy deficit to lose weight (eat less energy than you expend each day).  Though “calories in, calories out” may be slightly over simplified, it is still the underlying rule to any weight loss success.   For any weight loss plan to work, you must consistently follow the pla, and you must be in a caloric deficit.  This series will highlight the nine most popular current nutrition approaches, and the pros and cons of each.

Paleo

Claims: This approach purports to mimic the way of eating during the paleolithic era.  Also known as the caveman diet, the claim is that with the agricultural revolution over the last 2000 years, our diets have outpaced our evolution.  Proponents claim that that many of our health ills today are due to the fact that we have rapidly introduced too many new foods to the homosapien diet such as grains.  The benefits claimed range from reduced disease, weight loss, more/better muscle, improved performance, no need to track intake, and pretty much everything else under the sun.

Reality: Like everything else that over promises, this meal plan falls short.  Though there is nothing inherently bad or wrong with this diet plan, there is also nothing magical.  The whole premise of the meal plan according to Christina Warinner, who is an expert on ancient diets, is false as seen in this Ted Talk.

Pros: Increases protein intake in many individuals, encourages fruit and vegetable intake.  Often time leads to weight loss due to the fact that it eliminates many foods and thus calories from the diet.

 Cons: Needlessly eliminates grains, dairy, and many starches from one’s diet. This can lead to compliance issues long term and may lead to some nutrient deficiencies.

Jeff Tirrell, CSCS, CFSC, Pn1

Triathlon Success: Movement Prep

Limited mobility is a fairly common finding among recreational runners, bikers, and swimmers.  Very often, the deficits are worse on one side of the body.  A movement asymmetry makes any triathlete more susceptible to injury.  As a group, triathletes benefit greatly from the diligent application of a simple movement preparation program.  Movement preparation drills help prevent and/or train away mobility impairments.

Movement Prep is Superior to Stretching

For athletes, movement preparation drills are more beneficial than static stretching.  Movement prep improves postural reflexes, deceleration skills, standing balance, and coordination.  Any extra mobility you achieve with training must be controlled by your neuromuscular system during varying level of fatigue.  Movement prep develops all aspects of athleticism.  The two exercises I recommend for endurance athletes are the moving posterior lunge and the world’s greatest stretch.

Moving Posterior Lunge

Most runners and bikers have tight hip flexors, weak lateral gluteals, and limited lumbar extension range of motion.  This exercise will improve all of these areas.

Stand tall and step backward with your right leg.  Try to get the right knee close to the ground, stay balanced, and keep the torso tall.  At the same time, bring your arms overhead.  Push up with the left leg, lower the arms, and return to standing.  Repeat with the left leg and move down the track with alternating posterior lunges.  Perform ten repetitions on each leg.  Perform five times on each side.  Common mistakes are allowing the torso to tip forward and caving inward of the front knee.

World’s Greatest Stretch

Running, biking, and swimming are primarily single plane motions.  Runners do little in the way of rotational motion and often have restricted thoracic spines.  The world’s greatest stretch opens up the thoracic spine and will reveal any limitation in movement capacity between the right and left legs.

You need about ten yards of open space.  Stand tall and step forward with the left leg.  Place the hands down on the ground and attempt to lower the pelvis to the ground.  Pause, support the torso with the right hand, and turn toward the left leg.  Reach the left hand to the sky and pause in full rotation.  Return the left hand to the ground outside the left knee and gently attempt to straighten the left knee and then pause.  Bring the right leg up and return to standing.  Repeat the drill with the right leg stepping forward.  Perform five times on each side.  Many mistakes are made with this drill.  Please persevere as it is worthy of your efforts.

View the video here: Movement Prep Video

Michael S. O’Hara, PT, OCS, CSCS

World’s Best Diet Part 6–Vegetarian/Vegan

If you google the word diet, you will come up with over 200,000 results.  Every week, month, year, and decade a new study or article comes out claiming certain foods are killing us, or that some other food or nutritional approach will lead us to the promised land.  Unfortunately, articles are written to create traffic, so scientific research is often misreported or spun to sell magazines or generate website traffic.  The truth is, there are many ways to skin a cat.  All of the evidence on nutrition (in regards to weight loss) points to two undeniable truths.  First, that dietary adherence is king.  It doesn’t matter how perfect or evidence based a nutrition plan is, if you can’t follow it, it doesn’t matter.  Before starting any eating plan, you must ask yourself how easy it will be to maintain long term.  Second, you must achieve an energy deficit to lose weight (eat less energy than you expend each day).  Though “calories in, calories out” may be slightly over simplified, it is still the underlying rule to any weight loss success.   For any weight loss plan to work, you must consistently follow the pla, and you must be in a caloric deficit.  This series will highlight the nine most popular current nutrition approaches, and the pros and cons of each.

Vegetarian/Vegan

Claims: These diets claim to be healthier because they eliminate animal products as a food source.  Claims are vast and include: reducing cancer risk, improved bone health, lower mortality rates, protecting against chronic disease, etc.  Vegetarian diets are those which do not include flesh/meat of animals (though some do include fish) but will typically do include dairy and eggs.  Vegans on the other hand do not consume any products that come from animals (in some cases even excluding honey).

Reality: All of the claims from Vegans and Vegetarians on superiority for health come from correlative studies which do not control for confounding variables.  They simply take a survey and use correlations to draw conclusions.  Correlative research cannot draw conclusions, it can only direct us toward areas that need further study.  Of the 6 studies to ever look at health outcomes among vegetarians and vegans, 3 showed reduced mortality for meat eaters, while 3 showed reduced mortality for non-meat eaters.  The 3 studies that showed advantage to vegetarians all compared religiously motivated groups to general population (who tend not to be overly concerned about their health).

Pros: Tends to encourage the consumption of more whole grains, fruits, and vegetables.

Cons: Often leads to inadequate amounts of protein being consumed.  Anytime entire food groups are removed, there is an increased risk of deficiencies.  In this case, the following nutrients may be compromised: B12, Vitamin D, Calcium, Iron, Zinc, and Iodine.  Protein is the most satiating macronutrient, meaning it tends to fill you up more than fats or carbohydrates.  If protein levels drop, as is often the case in these diets, the chances of over consuming calories rises.  Low muscle mass levels are a risk due to inadequate protein intake.  In my experience, I have only met 2 (out of around 30) vegetarians over the last 20 years who were not either overweight and/or under muscled.

Jeff Tirrell, CSCS, CFSC, Pn1

Triathlon Success: Myofascial Management

Triathlon training is a vigorous and demanding athletic endeavor. The successful triathlete is often the one with the fewest injuries and the best recovery capacity.  Soft tissue mobilization with a roller helps decrease pain, improve mobility, and will speed up recovery between bouts of exercise.  Few of us can afford or dedicate the time to a daily massage.  The roller is the best do-it-yourself method of enhancing myofascial recovery.  Triathletes should begin every training session with five to ten minutes of roller work.

In the book, Anatomy Trains, Thomas Myers describes the interconnected webs of fascia and muscles that move our joints and hold us upright.  The human body is not just isolated muscles, but rather a series of interconnected lines of muscles and fascia that are reliant on one another to produce efficient movement.  The mechanical stress created by a roller keeps the tissue lines sliding and gliding across one another.  It removes neural and mechanical inhibitors of movement and makes exercise easier.

More varieties of rollers have come on the market and whenever we are faced with a lot of choices, it becomes more difficult to make a decision.  In this short presentation, I have some suggestions on the proper roller for the job.

Rollers are available in three foot and one foot lengths.  I find the longer versions easier to use.  Bigger and taller athletes generally do not do well with a short roller.

The best roller for you will depend on your tissue tolerance or how sensitive you are to the compressive forces of the roller.  If you are new to foam rolling, a low density white foam roller is softer and will create less discomfort.  As you develop better tolerance to rolling, you can progress to a firmer black foam roll.  It has been my experience that the white rolls break down faster than the firmer black versions, so be prepared to replace a white roll fairly often.

Hollow, pipe style rollers are newer to the market and I have had good results with two products.  The Grid Trigger Point roller is a cushioned hollow pipe with a grid pattern across the surface of the roller.  Many smaller clients and patients report they like the short version of the Grid roller.  Another hollow pipe version is the Rumble Roller.  This product has a series of projections that extend from the roller surface.  Self-soft tissue mobilization with a Rumble Roller is more uncomfortable than any other roller I have used.   It is a more aggressive treatment, but I have found it works well for individuals with thicker and denser muscles.

So how often should you, a triathlete, use a roller?  I like to stay active, pain free, and maintain my posture, so I use a roller every day.  Physical therapy patients with painful myofascial restrictions may need to foam roll two or three times a day.  Including five to ten minutes of foam rolling prior to a training session is the preventative medicine that will keep you on the road and out of the doctor’s office.  Watch the video that accompanies this article and get going on a roller.

View video here: Roller Video

Michael S. O’Hara, PT, OCS, CSCS

World’s Best Diet Part 5–The South Beach Diet

If you google the word diet, you will come up with over 200,000 results.  Every week, month, year, and decade a new study or article comes out claiming certain foods are killing us, or that some other food or nutritional approach will lead us to the promised land.  Unfortunately, articles are written to create traffic, so scientific research is often misreported or spun to sell magazines or generate website traffic.  The truth is, there are many ways to skin a cat.  All of the evidence on nutrition (in regards to weight loss) points to two undeniable truths.  First, that dietary adherence is king.  It doesn’t matter how perfect or evidence based a nutrition plan is, if you can’t follow it, it doesn’t matter.  Before starting any eating plan, you must ask yourself how easy it will be to maintain long term.  Second, you must achieve an energy deficit to lose weight (eat less energy than you expend each day).  Though “calories in, calories out” may be slightly over simplified, it is still the underlying rule to any weight loss success.   For any weight loss plan to work, you must consistently follow the pla, and you must be in a caloric deficit.  This series will highlight the nine most popular current nutrition approaches, and the pros and cons of each.

The South Beach Diet

Claims: The South Beach Diet says that its balance of good carbs, lean protein, and healthy fats makes it a nutrient-dense, fiber-rich diet that you can follow for a lifetime of healthy eating.  It focuses on eliminating “bad” carbs that are high on the glycemic index scale (meaning these foods increase blood sugar quickly when eaten in isolation).  The diet also encourages the consumption of monounsaturated fats, limiting “unhealthy” fats, and consuming whole grains and other fiber rich foods.  The diet is set up in 3 phases.  Phase 1 eliminates virtually all carbohydrates and is claimed to help eliminate cravings. Phase 2 re-introduces “healthy” carbs and is the weight loss phase.  Phase 3 is the maintenance phase where you continue to use what you learned to do in the first two phases, but other foods can also be eaten in moderation.

Reality: This is another sensible meal plan which allows for eating a balance of lean protein, whole grains, and variety of fat sources.  The only fault with this program is the emphasis on low glycemic carbohydrates.  The Glycemic Index is based on what foods do in isolation.  If other foods are eaten in conjunction with these items, the blood sugar response can be greatly altered.  On top of that, even if a food does rapidly increase blood sugar, it doesn’t inherently make it a poor food choice, and weight loss can still be achieved with these foods assuming portions are monitored.

Pros: Encourages lean protein consumption, fiber rich foods, whole grains, and variety of fat sources.

Cons: Creates an undue fear of certain types of carbohydrates and doesn’t directly advise on portion sizes.

Jeff Tirrell, CSCS, CFSC, Pn1

In the April 2018 issue, Mike O’Hara discusses the benefits of the farmer’s walk exercise. Jeff Tirrell tells you how to reduce injury to your ligaments and tendons, and tips are given for getting back out into the garden.

Download Here

World’s Best Diet Part 4–IIFYM

If you google the word diet, you will come up with over 200,000 results.  Every week, month, year, and decade a new study or article comes out claiming certain foods are killing us, or that some other food or nutritional approach will lead us to the promised land.  Unfortunately, articles are written to create traffic, so scientific research is often misreported or spun to sell magazines or generate website traffic.  The truth is, there are many ways to skin a cat.  All of the evidence on nutrition (in regards to weight loss) points to two undeniable truths.  First, that dietary adherence is king.  It doesn’t matter how perfect or evidence based a nutrition plan is, if you can’t follow it, it doesn’t matter.  Before starting any eating plan, you must ask yourself how easy it will be to maintain long term.  Second, you must achieve an energy deficit to lose weight (eat less energy than you expend each day).  Though “calories in, calories out” may be slightly over simplified, it is still the underlying rule to any weight loss success.   For any weight loss plan to work, you must consistently follow the pla, and you must be in a caloric deficit.  This series will highlight the nine most popular current nutrition approaches, and the pros and cons of each.

IIFYM (If It Fits Your Macros)

 

Claims: The IIFYM diet approach shares many characteristics with Zone and Weight Watchers.  It has its roots from the bodbuilding.com forums back in the 2004-2008 time.  At this time, many forum posters would routinely ask if it was ok to eat a given food while dieting and trying to decrease body fat.  There was a notion (and still is) that certain foods are totally off limits and ignorance of the role of energy balance and protein intake on success.  IIFYM can be different for everyone, but the basic premise is the same.  You have a certain target for total calories, protein, carbohydrates, and fat that you need to hit to be successful with your weight loss goals.  As long as those numbers are hit, then the food quality and micronutrients don’t matter.

Reality: If you hit a given caloric intake target below your maintenance intake needs for long enough, you will absolutely lose weight, regardless of food quality.  If you  hit a certain protein intake this will ensure that you are less likely to lose muscle mass in the process.  Carbohydrate and fat intakes will be dictated by food preference and performance goals.  There have been countless case studies proving that calorie intake is king ( Twinkie Diet , McDonald’s Diet , 100 Day Ice cream Diet ).

Pros: Allows lots of dietary flexibility.  Gives protein minimums.  Encourages accurate tracking of foods and quantity.

Cons: Potentially ignores food quality and micronutrient intake.  Many people have taken this approach as a pass to eat low nutrient foods as long as they are hitting their targets.  Can leave people feeling trapped if they can’t accurately measure or track a food at a social event or restaurant.

Jeff Tirrell, CSCS, CFSC, Pn1

Spring Trap

Preventing Gardener’s Trauma

After a long, snowy Michigan winter, the first warm and sunny day, we charge outside and clean up the yard.  The months snow bound in the house have made the gardeners eager to start the spring clean up and prepare for the summer to come.  Most of us will spend the winter in a fairly sedentary physical state and with no physical preparation to launch into hours of challenging outdoor work activity.  Every year at our clinics, we treat patients with gardening and yard work induced injuries that could have been prevented with some modifications of activity and preventative exercise.  These are my four hints to help safeguard my gardener friends from an unintended trip to the doctor’s office.

#1: Set a Time Limit.

Most of the patients we see with gardener trauma report that they worked “all afternoon” in the yard.  It is not uncommon to hear patients report they were bending, pushing, or pulling for five or six hours.  Use some caution and limit the duration of your weeding, raking, and shoveling.  Set a time limit of two hours and then stop–the garden will be their tomorrow and you will be less likely to have to undergo a springtime MRI.

#2: Use Proper Ergonomics.

Many gardening tasks place your body in challenging positions.  Ergonomic experts go to great lengths to eliminate forward trunk flexion and sustained knee flexion from industrial work settings.  Pulling weeds and cleaning out flowerbeds combines both of these positions and can create mechanical back and knee pain.  Avoid being in the “hands and knees” position for extended periods of time by changing positions frequently.  Use knee pads to reduce compressive forces on the knee joints and purchase gardening tools with extended handles so that you need not bend as far or as often.

#3: Avoid Lifting Heavy Objects.

After a sedentary winter spent indoors watching television and knitting, the last thing you should attempt is to hoist the 40 lb. bag of fertilizer into the back of the wheelbarrow. Lifting injuries increase dramatically with loads greater than 25 pounds.  Lifting any object from the floor to standing is risky, and carrying unstable loads that can shift around increases stress on the body.  Divide heavy loads into smaller portions and avoid lifting directly off the floor.  Get a bigger, stronger, and fitter neighbor or family member to help with heavy lifting tasks.

#4: Prepare For Battle.

Gardening and yard work are challenging tasks that should be met with a degree of preparation.  If you want to work for five hours in the garden and remain pain free, you must train your body for that level of activity.  I have selected three simple exercises you can do to get yourself ready for action in the yard.  Simple modification of ergonomics, limitations on work duration, and preparatory exercise can prevent a summer of pain.

Getting Ready To Toil In The Soil.

These three exercises can help you avoid injury and make your spring gardening safer and more productive.  Ideally you will perform these drills three times a week for two or three weeks before getting outside and working.

Hip Flexor Stretches

This stretch elongates the large muscle that runs across the front of the hip and attaches to the spine.  This region tends to tighten with prolonged sitting and can restrict hip and spinal motion.  Place one knee up on a cushioned chair and the other foot slightly forward on the floor.  Keep the spine tall and bend the front knee to stretch the hip flexor muscles.  Hold for five to ten seconds and repeat five times.  Perform the stretch on the other side.

Four Point Fold Ups

If you are going to spend time on all fours, it is a good idea to train your body for this task.  Assume a four-point position, knees under the hips and hands under the shoulders.  Keep the hands stationary and drop the hips back toward the heels.  Go back to the point you feel a stretch and hold–do not stretch into pain.  You may feel this in your hips, shoulders, lower back, or upper back.  Hold for five to ten seconds and repeat five times.

Bodyweight Squats

Gardening and yard work involves a lot of squatting.  Being able to safely squat allows you to lift with better body mechanics.  Simple bodyweight squats will strengthen the legs and trunk in preparation for these tasks.  Place your feet at least shoulder width apart.  Check the foot width with a full length mirror– most people squat with the feet too close together.   Keep the heels flat on the floor and squat down by pushing the hips back.  Work on maintaining balance and control during the motion.  Practicing this movement pattern will also improve your flexibility.  Perform a series of ten repetitions and then rest and perform another set of ten.

Michael O’Hara, PT, OCS, CSCS

World’s Best Diet Part 3–Weight Watchers

If you google the word diet, you will come up with over 200,000 results.  Every week, month, year, and decade a new study or article comes out claiming certain foods are killing us, or that some other food or nutritional approach will lead us to the promised land.  Unfortunately, articles are written to create traffic, so scientific research is often misreported or spun to sell magazines or generate website traffic.  The truth is, there are many ways to skin a cat.  All of the evidence on nutrition (in regards to weight loss) points to two undeniable truths.  First, that dietary adherence is king.  It doesn’t matter how perfect or evidence based a nutrition plan is, if you can’t follow it, it doesn’t matter.  Before starting any eating plan, you must ask yourself how easy it will be to maintain long term.  Second, you must achieve an energy deficit to lose weight (eat less energy than you expend each day).  Though “calories in, calories out” may be slightly over simplified, it is still the underlying rule to any weight loss success.   For any weight loss plan to work, you must consistently follow the pla, and you must be in a caloric deficit.  This series will highlight the nine most popular current nutrition approaches, and the pros and cons of each.

Weight Watchers

Claims: Weight Watchers markets itself as being flexible and livable.  They assign food points based on their “Smart Points System”.  They encourage the consumption of fruits, vegetables, and lean proteins, and discourage the consumption of sugar and unhealthy fats with this points system.  They even list 200 different foods as being “zero points foods”.  They encourage tracking of food and claim to be successful at helping people achieve long term sustainable weight loss.

Reality: Tracking your food intake in any way is usually helpful when it comes to weight loss–if done accurately.   The points system is really just a complicated marketing scheme similar to simply tracking calories, which anyone can do on their own for free.  There are no zero foods in existence that have no caloric impact, so the notion of “zero points” foods is ludicrous.  Any food eaten in excess can and will slow weight loss and/or lead to weight gain.  Every person I’ve ever met who was a lifelong Weight Watchers client had success with the program, but was 40+ pounds overweight..

Pros: Allows for dietary flexibility which should improve long term adherence.  Requires tracking of food and portion sizes.  If you opt into monthly meetings, there is an accountability factor built into it.

Cons: No minimum requirement given for protein intake.  Allows certain foods to be eaten with no limit.  Not a good long term success rate (think Oprah’s weight swings).

 

Jeff Tirrell, CSCS, CFSC, Pn1

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