Quick Tips To Avoid Over-Training

Who out there is currently training for an endurance race or athletic event? For those of you who are, are you battling any nagging aches and pains? Unfortunately, both competitive and recreational athletes are subject to injury and it is well established that the majority of symptoms related to your training program are most likely the result of over-training. Think of over-training as being synonymous with overuse, and overuse described as repetitive and excessive microtrauma that overloads various musculoskeletal tissues. More simply, tissue breakdown exceeds tissue repair, leading to injury. With respect to endurance sports such as running or cycling, over-training can include excessive mileage, a rapid change in intensity/pace, and/or a sudden increase overall training distance. In other words, too much, too soon, too fast. A recent study reported that approximately one-third of runners with injuries described that they had changed their running routines just prior to their injury development. Another study demonstrated that injured runners had an average progression in weekly distance prior to injury of 31%, whereas the non-injured controls had a progression of 22%.

So what can we do to minimize our risk of injury while progressing through a training program? Here are a few tips:

• Progress slowly

  • As touched on, the majority of overuse injuries follow sudden or significant increases in duration or intensity. When participating in endurance sports, such as running or cycling, we want to follow the 10% rule, which states that we should not increase our weekly training mileage by more than 10% week-to-week. For example, if I run 20 miles this week, next week I should run no more than 22 miles in order to minimize my risk of injury while still adding mileage.

• Listen to your body

  • Think of pain as an alarm system within our body, alerting us of a potential injury to our tissues. Pain experienced in conjunction with your training program could be your body’s way of warning you of an impending injury if you continue to push it. Avoid taking medications like ibuprofen before a training run or workout, as to not impact your body’s ability to alert you of the need to stop.

• Mix it up

  • Many individuals focus on training for their primary sport nearly every day per week. This behavior stresses the same tissues in the same way day-in and day-out, leading to an increased risk of injury. Solution? Try participating in other physical activities or sports one to two days per week. For example, if you are a runner, try going cycling in order to get your cardio for the day. Or if you are a rock climber, take a day off and go to a yoga class. The key is using your body in a different way than you do in your typical training program.

• Take a break

  • While this is somewhat obvious, many of us are guilty of burying our heads in the sand and bucking this recommendation. Rest is important in both injury prevention and performance. Well rested tissues will function better than chronically overused tissues.

• Cool off

  • Applying a cold pack to a region of the body that is hurting after an intense workout can be an effective way to reduce or eliminate discomfort. This is a much safer long-term alternative to popping ibuprofen each and every day.

Happy training!

-Grant Hennington, DPT

Guest Blog: Pain, Stress, & Wildfire

Imagine you are driving through the mountains and spot a small fire in the woods. Your level of concern would probably depend on what you see around you and what is happening around the fire. Is the fire in a fire ring or at a campground? Is it small and contained or is it growing fast and taking over the land? Is it hot and dry out or is the weather cool and damp? How a fire behaves depends on many factors.

The stress we all feel in our lives can act a lot like this fire. On the one hand, stress can be like a good fire. A campfire can keep you warm and can be fun to watch. Even some forest fires are healthy for the environment. Similarly, not all stress is bad. Some stress is actually good for us. It can be motivating, keeps us moving and acting on what is important. But, on the other hand, stress can also be like a bad fire. It can rage out of control, burning faster and hotter than you want.

The environment around a fire matters for how the fire acts. When there is containment and when the weather is cool and humid, the fire stays put. It doesn’t grow fast and, in fact, it might be a little hard to get things to burn. But when things are hot, dry, and windy, the fire can burn out of control.

Consider how the environment of your life impacts your stress. Here are some “environmental factors” that can increase your stress:

• Poor sleep

• Limited social support or isolation

• Few opportunities to feel productive

• Poor self-regard

• Catastrophic or other types of anxious thoughts

To help keep the stress fire contained try to enhance some of these helpful environmental factors in your life:

• Prioritize rest and sleep (7-9 hours each 24 hours).

• Spend time with others who are supportive and enjoyable to be around

• Seek out ways to accomplish something specific each day. Pay attention to your accomplishments, no matter how big or small they are.

• Build your positive self-regard and self-compassion. Evaluate negative thoughts you have about yourself and work to build a supportive relationship with yourself.

• Practice awareness of your thoughts and how those are impacting your reactions and emotions.

-Trevor Davis, Psy.D., ABPP

Improving Your Balance For Ski Season

The season is changing here in the Pacific Northwest, with resorts like Stevens Pass and Snoqualmie Pass getting dustings of snow over the weekend, much to the delight of ski enthusiasts here in Seattle. Sure, ski season is likely several weeks away, but that cannot stop us from getting excited and preparing ourselves for long days of fresh tracks in the backcountry or running laps on groomers inbounds. When it comes to skiing and skiing well, balance is fundamental. However, most people focus solely on strength and flexibility when working out at the gym, with balance exercises getting left behind.

Our sense of balance is dependent on three primary systems in our body: our vision, our vestibular system, and our somatosensory/proprioceptive system. Most individuals understand how our vision impacts our balance, as it allows us to see where we are in space. Try standing on one foot with your eyes open and then continue with your eyes closed. It will nearly always be more difficult for you with your eyes closed, illustrating the importance of vision in respect to our sense of stability. Our vestibular system lies within our inner ear and works like both a bubble level and accelerometer, providing our brain information about where our head is in space and whether or not we are moving or staying still. Think about standing on a train. It is easy to tell that you are moving when the train is speeding up or slowing down, but when the train is moving at a constant speed, it almost feels as if you are not moving at all. This is in part due to the working nature of your vestibular system. Our somatosensory/proprioceptive system involves tiny sensors within the joints, muscles, and tendons of our neuromuscular system, telling our brain about the position of the various tissues at any given time. This system allows you to know whether your elbow is bent or straight without having to look at it. When balancing on one foot, our somatosensory/proprioceptive system sends rapid information to the brain about where our foot, ankle, knee, hip, and trunk are in space so we can make the necessary corrections to keep our center of mass within our base of support, preventing you from falling on to the floor. Collectively, the three systems function together to keep our sense of stability when performing activities requiring high-level stability, such as skiing.

So what are some exercises you can do to improve your balance that are more specific for skiing? Here are a few of my favorites:

Static Single Leg Balance On BOSU

Single Leg Balance With Hip Extension & Rotation On BOSU

Single Leg Balance With Hip Flexion On BOSU

All of the exercises can be performed without a stability trainer, so if you do not have access to one, no need to fret. Performing these balance exercises barefoot on flat ground with eyes closed is often more challenging for individuals. Here is single leg balance routine that can be performed without any equipment that is helpful in preparing for ski season:

Single Leg Stance Progression

Perform all balance exercises for 60 seconds per leg in order to build neuromuscular endurance. Multiple sets can be performed to further fatigue the neuromuscular system. As always, any exercises you attempt should be pain-free and performed in a safe environment. If you have any questions or concerns about balance exercise, it is recommended to contact your physical therapist or primary care provider before initiating a new exercise program.

Let it snow!

-Grant Hennington, DPT

Pain and the Brain

Raise your hand if you are currently dealing with pain. Now, keep your hand raised if you have been battling that pain for longer than 6 months. Is your hand still up? If so, you are dealing with a case of chronic pain. Now, chronic pain needs not to be feared or carried with us like a scarlet letter. The term chronic pain is simply a descriptor of how long someone has been in pain for, with 6 months being the general threshold for the diagnosis. You may have sustained an injury initially or your symptoms may have started more gradually, but in any event, the pain unfortunately seemed to persist longer than hoped or anticipated.

So what is known about chronic pain, or pain in general, that can help us get back to a state of being that we want? First, we know that pain is a normal and essential physiological process, necessary for our survival as human beings. Think about it this way, if you placed your hand on a burning hot stove, wouldn’t you want to know about it? In this scenario, pain alerts us to what is happening so we can remove our hand from the heat source and prevent further damage to the tissues in our hand. Without the ability to feel pain, the damage to the tissues in the hand might be more profound. Or, think about the scenario of having a broken leg. Without the ability to feel pain, we might continue walking around on an active fracture, risking a more serious injury. Pain alerts us to the damaged bone and hopefully leads us to seek medical intervention. With this being said, there needs to be a distinction between feeling occasional pain and living in constant pain. Feeling occasional pain is normal and healthy, while living in constant pain is not.

Second, we know that the longer someone has been dealing with pain, the less likely the pain is associated with their musculoskeletal system (muscles, bones, ligaments, tendons, cartilage, discs) and the more likely the pain is associated with their nervous system (brain, spinal cord, nerves). When we sustain an injury, musculoskeletal tissues become damaged and the nervous system subsequently increases the sensitivity of those damaged tissues in order to protect them while they are healing. Research suggests that most musculoskeletal tissues in the body heal within 12 weeks of injury, at which point the nervous system can return the sensitivity of the area back to a normal level. However, sometimes the nervous system is slow to return the sensitivity of the previously injured area back to normal, instead keeping it at a heightened level of sensitivity even though the tissue is now healed. This can lead to pain with many daily activities and subsequent disability. Pain is all about perceived threat, an output of our brain in place to protect us. As stated earlier, if our tissues have sustained an injury, that is a threat to our survival and our brain will likely produce a pain response in order to protect us from this threat. However, there are scenarios, as with chronic pain, where our nervous system can become extra sensitive and perceive threats at much lower levels, protecting us too much and preventing us (via pain production) from performing activities that are perfectly safe. Think of the brain and nervous system like a home alarm system. When an intruder breaks in (injury), the alarm will sound in order to alert us of the threat and hopefully protect us from further harm. However, what happens if the home alarm system becomes overly sensitive and begins to sound the alarm when a friendly neighbor rings the doorbell? Or when we walk down the staircase? Or when we receive a phone call in the home? In these scenarios, the home alarm system is perceiving threats in the absence of an intruder, making it ineffective in its assigned role. This is analogous to the brain’s role in the pain process and one suspected mechanism for chronic pain.

So what, if anything, can be done about an overactive nervous system and chronic pain? Research suggests a fair amount. For one, education needs to be at the core of the treatment strategy. We now know that teaching people about pain and the nervous system is both a critical and effective way to help reduce disability associated with chronic pain. Simply put, knowing more about pain and how it works has the potential to reduce the pain you experience on a daily basis. Establishing the distinction between pain and injury is an important step in the process of rehabilitation. Pain typically accompanies injury, but we can also experience pain in the absence of an injury or long after an injury has healed. Understanding and accepting this fact is paramount. Second, we need to keep moving. Movement is not the enemy when it comes to chronic pain. While it is true that some forms of physical activity can produce a pain response, physical activity and exercise are not to be feared. The pain we experience with exercise or physical activity are likely the result of an overactive nervous system and not necessarily indicative of injury in cases of chronic pain. With this being said, it is important to practice pacing and graded exposure when returning to exercise and a more physically active lifestyle. Pacing is another term for taking breaks when performing prolonged exercise or physical activities. Think of taking a 20 minute walk, but sitting to rest for 1 minute twice during the walk. Graded exposure refers to the process of gradually increasing your activity level of exposure to typically painful activities. Imagine a scenario where you experience pain when you walk greater than 10 minutes. Graded exposure would suggest walking for 10 minutes and stopping once you experience pain. Then, the next time you walk, you attempt to walk slightly longer than 10 minutes, perhaps 11 or 12 minutes, progressing in a systematic fashion, which provides your nervous system the space to adapt and become less sensitive to the activity of walking over time. Each time you walk slightly longer and nothing significant happens, you are telling your brain that walking is safe and no threat is present. This will bring the alarm system back down to a more normal level and, in turn, reduce the pain experienced. Third, stress management is of great importance when treating chronic pain. We know that stress and anxiety elevate the sensitivity of the nervous system. Think of the link between stress and chronic pain like pouring gasoline on a burning fire. The good news is gentle exercise is an effective way to management stress and anxiety. There are also numerous licensed psychologists and counselors out there to help treat stress and anxiety associated with chronic pain, if you feel you are in need of additional guidance.

If you or anyone you know are battling chronic pain, take the time to learn more about pain under the guidance of a physical therapist or other licensed healthcare provider. And do your best to keep moving!

Grant Hennington, DPT

Pronation: Not Always The Bad Guy

Physical therapists frequently analyze the running mechanics of individuals in a clinical setting, as running is an activity that carries with it a relatively high rate of injury. In fact, per athlete more injuries occur from running than from CrossFit, a sport with a reputation for being injury provoking. Far too often in working with runners, I hear many individuals talk about their tendency to pronate during the running cycle, as if pronation is a 4-letter word and the root cause of all running-related injuries. However, I’m here to tell you today that pronation is a perfectly normal and healthy aspect of the running cycle, allowing us to absorb shock and conform to undulations in the ground, as a pronated foot tends to be more pliable and flexible. Here is a synopsis of the foot position at various points in the running cycle:

• At initial contact (heel strike in approximately 80-90% of individuals), the foot is held in a supinated position, which means the arch of the foot is high and the foot as a whole is more rigid.

• As you transition from initial contact to a foot flat position, the foot transitions from a supinated position to a pronated position in order to quickly dampen the force from striking the ground and conform to the contours of the ground. An inability to pronate during this phase would expose the tissues in your foot to higher amounts of force, making running more uncomfortable. This would be similar to jumping off of a table and landing on locked knees.

• As you transition from a foot flat position to push-off, the foot must quickly transition back to a supinated position from a pronated position in order to efficiently propel you forward. As we mentioned earlier, a supinated foot is more rigid and a pronated foot is more flexible. A greater propulsive force can be generated by pushing off of a rigid foot compared to pushing off of a flexible foot. The inability to re-supinate the foot for push-off would feel similar to running in sand.

So as you can see, pronation is not a bad thing. Too much pronation or at the wrong times in the running cycle could be problematic, but that is true of supination as well. Furthermore, research on the link between pronation and running-related injury is a bit inconclusive. While it is true that some running-related injuries have been correlated with excessive pronation, there is some evidence that it can actually be a compensatory protective strategy in runners.

The foot has been shown to excessively pronate as a result of a lack of stability up the chain, typically at the hip joint. Therefore, it may not always be wise to simply jam an orthotic insert in your running shoes if you have been told you are “over pronating” when you run. A running analysis along with a thorough orthopedic physical therapy examination should precede any decision on the use of orthotic inserts or footwear selection. How we run is determined by more than just the foot and we need not blame all of our running aches and pains on pronation.

-Grant Hennington, DPT