Why MRI Results Don't Always Correlate With Pain

 
 

Injuries are a common occurrence in sports and active living. Whether it's a sprained ankle on the running trail or a nagging back pain that hinders performance, finding an accurate diagnosis often leads to more advanced diagnostic tools. Magnetic Resonance Imaging (MRI) has become a go-to tool for visualizing the body's inner workings, providing detailed images of muscles, ligaments, and bones.

MRI provides a detailed look at muscles, ligaments, and bones, revealing injuries that might not be visible in other diagnostic tools.

But what if an MRI result doesn't tell the whole story?

An MRI can reveal abnormalities that seem to correlate with pain, yet many individuals with similar findings experience no discomfort at all. Conversely, intense pain might exist without any significant MRI findings. This disconnect between what's seen on the screen and what's felt in the body can lead to confusion, misdiagnosis, and even unnecessary treatments.

The Complexity of Pain

A recent research study in Germany investigated the association between lumbar degenerative MRI findings and low back pain (LBP) in a large population-based cohort. The researchers examined 3369 participants, analyzing their lumbar MRI scans and tracking their low back pain status over six years. The study found that 76.4% of participants had at least one MRI finding, and 8.3% had five or more different MRI findings. The study concluded that the MRI degenerative findings examined do not have clinically important associations with low back pain. The effects were almost all less than one unit on a 0 to 10 pain scale, indicating that MRI results may not be as reliable as once thought in predicting or understanding low back pain.

 

Pain is influenced by more than just physical factors; understanding the complete picture is crucial for accurate diagnosis

 

Pain is a multifaceted experience influenced by physical, psychological, and social factors. An MRI only provides a snapshot of the anatomical aspect, ignoring other crucial elements like emotional stress or lifestyle factors that might contribute to the pain. A thorough physical examination and patient history are essential to diagnosis and often provide more insight into the patient's condition than the MRI alone.

At Resilience Physical Therapy, we recognize the complexity of pain and use a comprehensive approach, considering the patient's symptoms, history, goals, and overall condition in our treatments.

  • Our treatments are tailored to the individual's specific needs and goals, ensuring that the care is aligned with their unique situation.

  • We go beyond treating symptoms and work on improving overall function and performance.

  • Besides just treatment, we equip our patients with the knowledge and tools they need to take control of their recovery.

Reference: Kasch R, Truthmann J, Hancock MJ, Maher CG, Otto M, Nell C, Reichwein N, Bülow R, Chenot JF, Hofer A, Wassilew G, Schmidt CO. Association of Lumbar MRI Findings with Current and Future Back Pain in a Population-based Cohort Study. Spine (Phila Pa 1976). 2022 Feb 1;47(3):201-211. doi: 10.1097/BRS.0000000000004198. PMID: 34405825.

The Benefits of Choosing an Out-of-Network Physical Therapy Practice

 
 

Why Are You Out-of-Network With Most Insurances? 

We get asked this question all the time by patients, and we want to help you make a more informed decision about your care. By knowing the benefits of going out-of-network for your physical therapy and the limitations of traditional in-network-based clinics you will have a better understand on why we prefer an Out-of-Network treatment model.

What You Get At An In-Network Based Clinic

In many conventional PT clinics, the scene is all too familiar. Large rooms filled with rows of tables and numerous patients are a common sight. In these settings, it's not unusual for physical therapists to juggle multiple patients at a time due to high patient volumes and insurance reimbursement constraints. 

To manage their busy schedules, many clinics employ support staff who aren't skilled clinicians to assist with your physical therapy treatment. As a result, each patient often receives only a fraction of the physical therapist's attention during their appointment. This could affect the continuity and quality of care, as switching between multiple care providers during a session may not be the most beneficial approach for a patient's recovery process.

Insurance limitations also come into play. For instance, some insurance plans require referrals or authorizations before you can start your treatment. There may also be visit limits, and once you reach them, the insurance will not cover any more sessions, even if you haven't achieved your fitness goals. Additionally, you might have to meet a certain deductible amount before your insurance starts covering your PT sessions, meaning you're paying full price out of pocket until you reach that threshold.

Traditional PT clinics often recommend a frequency of 2-3 visits per week for several weeks to months, which can be time-consuming and interfere with your work schedule, family time, or other obligations. This structure and its limitations often lead to a less personalized, less effective form of care, which might not align with a patient's individual needs and goals.

Why You Should Consider Going Out-Of-Network For Your Physical Therapy Care

One-on-One Time

You are not just another appointment in your physical therapist's schedule. This approach facilitates undivided attention, meaningful communication, and a comprehensive understanding of your needs. With this focused attention, you are likely to require fewer visits, as each session is utilized to its maximum potential.

Direct Access to Skilled Clinicians

You will always work with a physical therapist, ensuring that a skilled clinician administers your treatment. By providing continuous, quality care, your therapist can make on-the-fly adjustments and ensure you gain the most value from your visits.

Independence from Insurance Limitations

Without the constraints of insurance companies, treatment decisions are made entirely based on your specific needs, not what an insurance policy dictates. This means no waiting for authorizations or referrals and no abrupt end to therapy due to visit limits.

Fewer, But More Productive Visits

Since you're receiving focused, one-on-one care, you often need fewer visits than at a traditional PT clinic. This translates into less time commuting to PT, a more efficient recovery process, and getting back to doing what you love faster.

Direct and Open Communication

You will have direct communication with your PT. You can ask questions or express concerns between visits, enhancing your understanding of your treatment and reinforcing your home exercise program.

Active, Targeted Treatment

Unlike traditional PT clinics, which often rely on passive treatments to pass time, you will receive a more active and targeted approach. These include exercises, manual therapy, and education that address the root cause of your problem.

Access to Preventative Care

Insurance companies do not typically cover wellness, maintenance, and injury prevention services. You will have access to preventative care, which can save you time and money in the long run by helping you stay active and healthy.

 
 

While insurance-based physical therapy clinics have their place, they often lack the personalized care and direct therapist-to-patient relationship important to a successful recovery journey.

At Resilience Physical Therapy, we value spending more quality time with each patient, providing personalized and effective treatment plans, fewer visits, and better outcomes. If you are looking for all that in a physical therapy clinic, we may be the right fit for you!

Get Back To Running: Treating Plantar Fasciitis

What is Plantar Fasciitis?

https://www.mayoclinic.org/diseases-conditions/plantar-fasciitis/multimedia/plantar-fasciitis/img-20006161

Plantar fasciitis is an overuse injury that results from the degeneration or thickening of the collagen fibers in the plantar fascia. The plantar fascia is a band of fibrous connective tissue that runs from your heel bone (calcaneus) to the bases of your toes (metatarsals). It plays a vital role in stabilizing your foot's arch while standing, walking, and running.

The repetitive stress placed on the plantar fascia during running can lead to degeneration and breakdown of the tissue, resulting in pain and discomfort. Although the term "plantar fasciitis" implies inflammation, the condition is more about the degeneration of the tissue rather than inflammation.

Causes of Plantar Fasciitis in Runners

Plantar Fasciitis makes up 5-18% of injuries caused by running [1]. As a runner, it's crucial to recognize the factors that can contribute to the development of plantar fasciitis.

Some common risk factors include [2]:

  1. Weakness in the foot/ankle muscles

  2. Wearing worn-out or improper running shoes

  3. Increasing running volume too quickly

  4. Increasing running mileage

  5. Tight calves and Achilles' tendons

  6. Spending excessive time on your feet (e.g., due to a standing job)

  7. Having excessively high or flat arches

  8. Limited ankle dorsiflexion (pointing ankle upwards)

Symptoms of Plantar Fasciitis

If you're experiencing plantar fasciitis, you may notice some common symptoms, such as [3]:

Goff JD, Crawford R. Diagnosis and treatment of plantar fasciitis. Am Fam Physician. 2011 Sep 15;84(6):676-82. PMID: 21916393.

  1. Pain along the arch and sole of the foot, particularly on the inside edge of the heel

  2. Morning pain that's worse when taking the first steps out of bed but gradually fades as you move around

  3. Pain when pressing along the sole of the foot or stretching the fascia

  4. Development of heel spurs in some cases

Foot and Ankle Pain After Running

Different Causes of Heel or Ankle Pain After Running [1]:

  1. Plantar Fasciitis: As previously mentioned, plantar fasciitis is a common cause of heel pain in runners. The degeneration of the plantar fascia tissue can contribute to pain in the heel area.

  2. Achilles Tedonopathy: Achilles tendinopathy presents as aching posterior heel pain. This is caused by irritation of the Achilles tendon, which connects your calf muscles to your heel bone. Most patients with this condition have pain, swelling, and tenderness on the Achilles tendon 2 to 6 cm above its insertion into the calcaneus. 

  3. Ankle Sprain: Lateral ankle sprains are more common in runners. Pain is usually on the outside of the ankle and can be caused by the ankle rolling inwards during an initial foot strike.

Addressing Heel Pain After Running:

  1. Identify the Cause: The first step in addressing heel pain after running is to identify the root cause by having a comprehensive running assessment to evaluate your running technique, gait, and foot mechanics. This assessment may include video analysis to identify any factors contributing to plantar fasciitis, such as overpronation, excessive foot strike force, or inefficient running form. A functional tests may also be performed to assess your lower limb strength, flexibility, and mobility.

  2. Modify Your Running Routine: Reducing your running volume, incorporating rest days, and adjusting your running form can help alleviate heel pain. Additionally, consider incorporating low-impact cross-training activities like swimming or cycling to maintain your aerobic capacity while giving your heel a break.

  3. Choose Proper Footwear: Wearing the right running shoes for your feet can help reduce the impact on your heel and alleviate pain.

  4. Perform Proper Warm-Up and Cool-Down: Implementing a thorough warm-up and cool-down routine that includes dynamic stretches, muscle activations, and mobility drills can help prep your body for running and minimize the risk of heel pain.

  5. Strengthen and Stretch: Incorporate specific exercises and stretches for your feet, calves, and Achilles tendon into your routine. This can help improve your overall foot and lower leg strength, flexibility, and mobility, reducing the risk of injury.

Here are some examples of foot strength and stretches you can add into your training:

Consistency and patience are key when it comes to treating plantar fasciitis. At Resilience Physical Therapy, we can help you develop a individualized treatment plan that addresses the underlying causes of your plantar fasciitis, such as muscle imbalances, bio-mechanical issues, running form etc. so you can increase your chances of getting back to your regular running routine.

References:

  1. Arnold MJ, Moody AL. Common Running Injuries: Evaluation and Management. Am Fam Physician. 2018 Apr 15;97(8):510-516. PMID: 29671490.

  2. Trojian T, Tucker AK. Plantar Fasciitis. Am Fam Physician. 2019 Jun 15;99(12):744-750. PMID: 31194492.

  3. Goff JD, Crawford R. Diagnosis and treatment of plantar fasciitis. Am Fam Physician. 2011 Sep 15;84(6):676-82. PMID: 21916393.

Mistakes To Avoid as a Runner: Running Majority of Your Miles Too Fast

One of the most common mistakes runners make is running too fast for most of their runs. Your body needs time to adjust and recover from faster pace runs, and mixing in slower runs will help you build endurance, improve performance and prevent injury. This article will discuss the significance of easy-pace runs and provide helpful tips on incorporating them into your training, whether you're training for a marathon or just starting out.

Importance of slowing down

Easy pace runs are essential for building a strong aerobic base, improving endurance, and promoting recovery. Constantly pushing your body to its limits is not the most effective way to train. Instead, focusing on maintaining an easy pace during the majority of your training sessions will help you avoid injury, burnout, and underperforming.

The Benefits of Easy Pace Runs

There are several reasons why easy-pace runs are beneficial for training:

  • Developing aerobic base:

    Easy pace runs help improve the efficiency of your cardio, respiratory and muscular systems so that your body can tolerate higher training volumes.

  • Promoting recovery:

    Running at an easy pace helps you recover from more intense workouts by promoting adaptation and blood flow to your muscles.

  • Reducing the risk of injury:

    By providing less workload for your muscles, tendons, and joints, easy pace runs help to minimize the risk of overload.

  • Building mental resilience:

    Practicing patience and discipline during easy pace runs prepares you mentally for challenges on race day.

How to Determine Your Easy Pace

To establish your easy pace, consider the following guidelines:

  • Heart rate-based:

    Maintain a heart rate that is 65-75% of your maximum heart rate (MHR). A quick and nonspecific way to estimate your MHR is subtract your age from 220. Example: if you are 30 years old, 220-30=190, 190 beats per min. is your MHR

  • Perceived effort:

    On a scale of 1 to 10, with 10 being maximum effort, aim for a perceived effort of 3 to 4.

  • Conversational pace:

    You should be able to comfortably hold a conversation while running at your easy pace.

  • Use a pace chart: 

    Here is a sample of Amby Burfoot's RRCA Pace Chart, based on previous race results, to provide a guideline for training pace selection. Highlighted are the easy run-pace suggestions.

RRCA PACE CHARTS DEVELOPED BY AMBY BURFOOT

Tips for Incorporating Easy Pace Runs into Your Training

To effectively integrate easy pace runs into your marathon training, follow these guidelines:

  • Schedule easy pace runs:

    Make easy pace runs a priority by including them in your training plan. Known as the 80/20 rule: 80% of your weekly running mileage should be spent at an easy pace and 20% at a faster pace. For example, if you run 20 miles a week, 80% of 20 miles is 16 miles, and 20% of 20 miles is 4 miles. You should aim to run 16 miles at a low intensity and 4 miles at a higher intensity each week.

  • Listen to your body:

    Adjust your easy pace based on how you feel during each run. If you're feeling fatigued or sore, slow down even more.

  • Run with a partner or group:

    Running with others who share similar goals can help you maintain an appropriate easy pace, as well as provide motivation.

  • Use technology:

    Consider using a GPS watch or heart rate monitor to track your pace and heart rate during your easy runs. This will help you ensure that you're staying within the appropriate range.

  • Avoid overdoing it:

    Resist the urge to push yourself too hard during easy pace runs. Remember, the purpose of these runs is to build a strong aerobic base and promote body adaptation to more mileage.

  • Practice patience:

    It can be challenging to maintain a slower pace, especially if you're used to pushing yourself. However, being patient and disciplined during easy pace runs will pay off in the long run.

Monitoring Your Progress

As your training progresses, it's important to regularly assess your performance to ensure you're on track to achieve your goals. Here are some tips for monitoring your progress:

  • Keep a training log:

    Record your mileage, pace, heart rate, and perceived effort for each run. This will help you track your progress and make adjustments as needed.

  • Listen to your body:

    Pay attention to how you feel during and after your runs. If you're consistently feeling fatigued or sore, consider adjusting your training intensity or volume.

  • Reassess your easy pace:

    As your fitness improves, your easy pace may become faster. Reevaluate your easy pace using the guidelines provided above.

Incorporating easy pace runs into your training is critical for long-term success. By building a strong aerobic base, promoting recovery, and reducing injury risk, you set the foundation for improved performance and a more enjoyable running experience!

Here at Resilience Physical Therapy, we aim to help support athletes by providing the latest techniques and evidence-based practices to achieve their goals and return to doing what they love. Our physical therapists are dedicated to providing personalized, one-on-one care and developing individualized treatment plans to meet each athlete's specific needs. If you want to improve your performance in running or other sports, our team would love to help. Schedule a discovery call to see if we are the right fit for you!

Mistakes to Avoid as a runner: Increasing Your Weekly Mileage Too Fast

The thrill of lacing your sneakers, going out, and feeling the wind in your hair as you run is hard to resist. Whether you're running for the first time or preparing for a marathon, it's essential to ensure you take the necessary precautions to prevent injury and set yourself up for success. This article will explain why it's essential for runners to control their mileage and how to do so.

Mistake to avoid: Increasing your weekly mileage too fast

Running puts significant stress on your body, particularly your joints, bones, and muscles. Increasing your mileage too quickly can increase your risk of injury and limit your progress. Gradually increasing your mileage gives your body time to adjust to the new demands, reducing the risk of injury and improving your performance.

Why You Should Limit Your Weekly Mileage

Injury prevention:

  • Increasing your weekly mileage by more than 30% can put you at risk for overload and the development of repetitive stress injuries such as patellofemoral pain, IT band syndrome, shin splints, etc. [1].

  • By limiting weekly mileage, you decrease the risk of these injuries and ensure that your body has enough time to recover and adapt to the demands of training.

Long-term progress:

  • Consistency is crucial for marathon success. By avoiding overtraining and injury, you're more likely to maintain a consistent training schedule, leading to long-term progress and improvement.

Mental well-being:

  • Overtraining can lead to burnout, both physically and mentally. Limiting weekly mileage allows you to maintain your drive and motivation for your running goals.

How Do I Limit My Weekly Mileage?

Gradual increase in mileage:

  • Increase your weekly mileage by no more than 10% 

  • If you are currently running 20 miles per week, you should aim to increase your mileage by no more than 2 miles the next week (10% of 20 miles)

  • The 10% rule is only a guideline. With proper monitoring, it's possible to safely increase your miles by more than 10% per week

Sample 4 week training schedule with gradual mileage progression for an intermediate runner

Listen to your body:

  • Pay attention to signals from your body, such as constant pain, fatigue, and not running to your expectations.

  • These may be indicators that you need to reduce your weekly mileage or take extra rest days.

Track your progress:

  • Keep a training log to monitor your weekly mileage and how your body responds to the workload. 

  • This data can help you decide when to scale back or increase your mileage.

Work with a running coach:

  • A running coach will develop a customized training plan based on your goals, fitness level, and personal schedule. This will ensure that you follow a training plan specifically designed for your unique needs, balancing your workload.

  • As you progress, your coach can help you set new goals, adjust your training plan, and continue challenging yourself, ensuring that you keep improving and reaching new milestones.

Running Strength and Conditioning Training Session at Resilience Physical Therapy

Here at Resilience Physical Therapy, we aim to help support athletes by providing the latest techniques and evidence-based practices to achieve their goals and return to doing what they love. Our physical therapists are dedicated to providing personalized, one-on-one care and developing individualized treatment plans to meet each athlete's specific needs. If you want to improve your performance in running or other sports, our team would love to help. Schedule a discovery call to see if we are the right fit for you!

1. Nielsen RØ, Parner ET, Nohr EA, Sørensen H, Lind M, Rasmussen S. Excessive progression in weekly running distance and risk of running-related injuries: an association which varies according to type of injury. J Orthop Sports Phys Ther. 2014 Oct;44(10):739-47. doi: 10.2519/jospt.2014.5164. Epub 2014 Aug 25. PMID: 25155475.

2. Winter SC, Gordon S, Brice SM, Lindsay D, Barrs S. A Multifactorial Approach to Overuse Running Injuries: A 1-Year Prospective Study. Sports Health. 2020 May/Jun;12(3):296-303. doi: 10.1177/1941738119888504. Epub 2020 Jan 29. PMID: 31994970; PMCID: PMC7222667.

3. Warden SJ, Edwards WB, Willy RW. Preventing Bone Stress Injuries in Runners with Optimal Workload. Curr Osteoporos Rep. 2021 Jun;19(3):298-307. doi: 10.1007/s11914-021-00666-y. Epub 2021 Feb 26. PMID: 33635519; PMCID: PMC8316280.

Exercises to Restore Knee Mobility and Strength

Knee pain can occur in runners and other athletes who undergo high impact and stress on their joints during training and/or competition. Ignoring symptoms can lead to other injuries and may even force an athlete to miss extended time.

Here are some exercises that can help restore knee range of motion, strength, and stability:

🔸SL Fire Hydrant w/ Wall Support

 
 

🔸Rear Foot Elevated Split Squat Hold

 
 

🔸Single Leg bridge

 
 

🔸Couch Stretch

 
 

Disclaimer: These exercises might not help your condition since every injury is multifactorial. Contact us to see if we can help!

Runners: Landing and Force Production Exercises

Running is a series of single-leg jumps from one leg to the other. Training our muscles and tendons to absorb impact and produce force when our feet hit the ground can help improve running speed and prevent injuries.
_
Here is a progression of landing and force production exercises you can add to your training:


1️⃣ Bilateral Leg Snap Downs

 
 

Cues: Raise both arms over your head while going onto your toes. Perform a small hop and quickly bring your arms down by your side, landing in a knees-bent, hip-hinged position with both legs. Make sure to pause at the bottom. 

2️⃣ Single Leg Snap Downs

 
 

Cues: Raise both arms over your head while going onto your toes. Perform a small hop and quickly bring your arms down by your side, shift your weight onto one leg and go into a knees-bent, hip-hinged position. Make sure to pause at the bottom, keeping the landing feet, knee, and hip aligned.

3️⃣ Double-Leg Drop to Broad Jump

 
 

Cues: Stand on an elevated surface, step off with one foot, and land onto both legs with knees bent and hips hinged. As you land, jump forward as far as you can with both legs.

4️⃣ Single-Leg Drop to Broad Jump

 
 

Cues: Stand on an elevated surface, step off with one foot, and land onto one leg with knees bent and hips hinged. As you land, jump forward as far as you can with that leg. Try to keep your knees aligned with your toes when landing.

If you are experiencing pain or currently dealing with an injury and need help, contact us for a discovery call!

4 Rehab Exercises For Shin Splints

Medial Tibial Stress Syndrome or shin splints is an overuse injury characterized by pain or tenderness on the inner side of the shin bone (tibia) closer to the ankle. This pain is caused by repetitive stress from the muscles/connective tissues surrounding the shin bone (tibia), leading to inflammation around the bone. This is one of the most frequent injuries occurring in runners with a rate of 13.2-17.3%

Here are four exercises that I like to incorporate into an athlete’s treatment plan:

1️⃣Ankle Dorsiflexion Mobilization

 
 

2️⃣Wall Supported Banded Single-leg Fire Hydrants

 
 

3️⃣Single-leg Hip Airplanes

 
 

4️⃣Single-leg Bridge Holds

 
 

If you are currently dealing with shin splints or experiencing pain when running, we can help!

Shin splints: How to reduce injury risk and return to running

What is Medial Tibial Stress Syndrome, aka Shin Splints?

Medial Tibial Stress Syndrome or shin splints is an overuse injury characterized by pain or tenderness on the inner side of the shin bone (tibia) closer to the ankle. This pain is caused by repetitive stress from the muscles/connective tissues surrounding the shin bone (tibia), leading to inflammation around the bone. This is one of the most frequent injuries occurring in runners with a rate of 13.2-17.3%.

What potential factors can put you at risk of developing Shin Splints?

  • Improper running/training plan

  • Compensatory running mechanics during the stance/swing phase such as increased pelvic drop, knee valgus, internal rotation of the hips, and subtalar joint pronation

  • Muscle weakness and/or joint mobility limitations

How can we reduce the risk of Shin Splints and get back to running?

If you are currently dealing with shin splints or experiencing pain when running, we can help!

References:

  • Lopes, A.D.; Hespanhol Junior, L.C.; Yeung, S.S.; Costa, L.O.P.; Hespanhol Junior, L.C.; Yeung, S.S.; Costa, L.O.P. What are the main running-related musculoskeletal injuries? A Systematic Review. Sports Med. 2012, 42, 891–905.

  • Menéndez C, Batalla L, Prieto A, Rodríguez MÁ, Crespo I, Olmedillas H. Medial Tibial Stress Syndrome in Novice and Recreational Runners: A Systematic Review. Int J Environ Res Public Health. 2020 Oct 13;17(20):7457. doi: 10.3390/ijerph17207457. PMID: 33066291; PMCID: PMC7602098.

Improving Rotator Cuff Stability: Shoulder Taps

The shoulder tap exercise targets the rotator cuff muscles and other muscles around the shoulder isometrically. This makes it an excellent entry point to improve shoulder stability, especially if dealing with an injury such as shoulder impingement or rotator cuff strain/tendinopathy

When performing shoulder taps, ensure your chest is positioned over your hands, keep elbows fully extended, and neutral spine. Make sure to keep body sway to a minimum

Here is a shoulder tap exercise progression:

🔸Perform 3 sets of 10-12 reps on each arm

 
 

1️⃣Shoulder Taps on Knees

 
 

2️⃣Shoulder Taps on Elevated Surface

 
 

3️⃣Shoulder Taps in Push-up Position

 
 

4️⃣Shoulder Taps in Bear Crawl Position


If you are experiencing shoulder pain or currently dealing with an injury, we can help!

Training Tips to PR your Next Downhill Marathon

Signing up for a downhill marathon to break your PR? Chasing the elusive Boston Marathon qualification? Or just getting into trail running? Everybody loves a fast marathon and what better way to do it than with a downhill course – let gravity do some of the work, right? Well…not quite. Surprisingly, downhill courses can be more challenging for our bodies compared to running on flats or uphills. First, let's explore why that is, then we'll leave you with some training tips so you can perform your best come race day.

So what makes downhill running challenging?

  1. Higher mechanical strain:

    Running downhill might feel easy for a short time, but your muscles, especially the quads, undergo higher mechanical strain. The repetitive lengthening of your muscles helps decelerate your body's center of mass under load; this strain leads to acute and delayed muscle damage [1].

  2. Strike pattern:

    Most runners adopt a heel-strike pattern when running downhill, which alters the ground reaction forces during initial ground contact. This foot strike pattern leads to significant impact and braking forces on your joints compared to running on flats [2].

These factors cause a significant decrease in running economy and performance during a downhill race, so preparing with a robust training program is essential.

Now here are those training tips we promised:

Tip #1: Add eccentric strength exercises into your training routine

Eccentric exercises mimic the muscle lengthening action we rely on when running downhill. Performing eccentric strength training has been shown to limit the effects of exercise-induced muscle damage caused by downhill running and maximize strength production [3,4,5].

 
 

Click here to see which eccentric strength exercises you should add to your training routine

Tip #2: Exposing your body to downhill running before your race

If you want to get better at running downhill, you need to practice running downhill. Add specific downhill sessions to your training, such as hill repeats or tempo/fartlek runs with downhill portions mixed in. This will allow your body to tolerate downhill runs better and provide a protective adaptation that can reduce exercise-induced muscle damage leading to enhanced performance [6,7,8]. You don't have to be training for a downhill marathon to add this to your workout. Running downhills in training has also been shown to improve running performance and efficiency on flat courses [9].

 
 

Tip #3: Make sure to run in your racing shoes during training

Running downhill puts more stress on the forefoot and toes. Doing some training runs in your racing shoes can help identify any hot spots so you can make proper adjustments come race day. 

 
 

Tip #4: Start small and allow proper recovery time in between downhill running sessions to avoid injury 

When beginning to implement hill runs, start on a lower grade before increasing incrementally to an elevation similar to your upcoming race, if possible. The effects of downhill running on your body, such as increased muscle strain, can lead to delayed onset muscle soreness lasting up to 96 hours. Allow at least 48 hours after a downhill session before scheduling your next high-effort run to avoid overload.

 
 

Click here if you are just getting back into running and want to learn how to do it safely

If you are experiencing pain or currently dealing with an injury and need help, contact us for a discovery call!

  1. Giandolini M, Vernillo G, Samozino P, Horvais N, Edwards WB, Morin JB, et al. Fatigue associated with prolonged graded running. Eur J Appl Physiol. 2016;116(10):1859–73.

  2. Gottschall JS, Kram R. Ground reaction forces during downhill and uphill running. J Biomech. 2005;38(3):445–52.

  3. Douglas J, Pearson S, Ross A, McGuigan M. Chronic adaptations to eccentric training: a systematic review. Sports Med. 2017;47(5):917–41.

  4. Saunders PU, Pyne DB, Telford RD, Hawley JA. Factors affecting running economy in trained distance runners. Sports Med. 2004;34(7):465–85.

  5. Barnes KR, Kilding AE. Strategies to improve running economy. Sports Med. 2015;45(1):37–56.

  6. Schwane JA, Williams JS, Sloan JH. Effects of training on delayed muscle soreness and serum creatine-kinase activity after running. Med Sci Sport Exerc. 1987;19(6):584–90.

  7. Lemire M, Hureau TJ, Favret F, Geny B, Kouassi BYL, Boukhari M, et al. Physiological factors determining downhill vs uphill running endurance performance. J Sci Med Sport. 2020. https:// doi.org/10.1016/j.jsams.2020.06.004.

  8. Byrnes WC, Clarkson PM, White JS, Hsieh SS, Frykman PN, Maughan RJ. Delayed onset muscle soreness following repeated bouts of downhill running. J Appl Physiol (1985). 1985;59(3):710–5.

  9. Toyomura J, Mori H, Tayashiki K, Yamamoto M, Kanehisa H, Maeo S. Efficacy of downhill running training for improving

    muscular and aerobic performances. Appl Physiol Nutr Metab.

    2018;43(4):403–10.

  10. Douglas J, Pearson S, Ross A, McGuigan M. Eccentric exercise: physiological characteristics and acute responses. Sports Med. 2017;47(4):663–75.

  11. Bontemps B, Vercruyssen F, Gruet M, Louis J. Downhill Running: What Are The Effects and How Can We Adapt? A Narrative Review. Sports Med. 2020 Dec;50(12):2083-2110. doi: 10.1007/s40279-020-01355-z. PMID: 33037592; PMCID: PMC7674385.

Training Your Muscles Eccentrically For Downhill Running

Eccentric exercises mimic the muscle lengthening action we rely on when running downhill. Performing eccentric strength training has been shown to limit the effects of exercise-induced muscle damage caused by downhill running and maximizes strength production.

Here are some eccentric exercises to incorporate into your training:
🔸Perform movements slow and controlled, focusing effort on the way down
🔸3 sets of 8-10

1️⃣Eccentric Single-Leg Box Squat

 
 

2️⃣Eccentric Anterior Step-Down with Slant Board

 
 

3️⃣Eccentric Single-Leg Hamstring Curl with Foam Roller

 
 

4️⃣Eccentric Single-Leg Hip Thrust

 
 

5️⃣Eccentric Single-Leg Heel Raises

 
 

6️⃣Eccentric Single-Leg Soleus Heel Raises

 
 

If you are experiencing pain when running or currently dealing with an injury and need help, contact us for a discovery call!

References: Douglas J, Pearson S, Ross A, McGuigan M. Chronic adaptations to eccentric training: a systematic review. Sports Med. 2017;47(5):917–41.
Saunders PU, Pyne DB, Telford RD, Hawley JA. Factors affecting running economy in trained distance runners. Sports Med. 2004;34(7):465–85.
Barnes KR, Kilding AE. Strategies to improve running economy. Sports Med. 2015;45(1):37–56.

Reverse Nordic Curls To Improve Tight Hip Flexors

The Reverse Nordic Curl is a great way to strengthen the hip flexors eccentrically and address hip tightness due to muscle weakness

When performing this exercise, keep your rib cage down when performing this exercise, and engage your core to maintain a neutral spine throughout the motion. Start with band assist and progress to no assistance when you can maintain proper form.


1️⃣Reverse Nordic Curls with Band Assist

🔸Perform 3 sets of 8

 
 

2️⃣Reverse Nordic Curls

🔸Perform 3 sets of 8

 
 

Give these a try! If you are experiencing pain or currently dealing with an injury and need help, contact us for a discovery call!

C-Section Scar Care Management Part 1

C-section is one of the only major surgery that no one refers to physical therapy for post-op rehab. The procedure cuts through at least seven layers of fascias and muscles. Still, OBs only check whether the scar is healed at a 6-week check-up, and does not provide education about scar tissue management, check your core strength, or advise on how to regain core stability. The world needs more education about this issue!

Why is scar tissue management critical?

It prevents tissue adhesion, hypertrophic scars, or keloids from developing, improves the flexibility of the tissues, and decreases the area's sensitivity. You can initiate the process once your scar is healed.

Here are steps for scar tissue management:

Perform 5x once a day
🔸Circling above, below, and on the scar
🔸Pulling different directions above, down, and on the scar

 
 

Do you have any questions about scar tissue management, or are you suffering from numbness around your scar area or pain in your low back/hips/pelvis? We are here to help! Please Schedule a discovery call and see if we’re the right fit!