Working out with a purpose. As I have continued my personal quest to enjoy an active life. My exercise routine has evolved from a punishing 6-7 days a week everyday feeling sore to the point of pain to a maintenance program with the goal of getting functionally stronger & improving my poor posture.
One of the first things I learned & I would like to share is foam rolling. Foam rolling is best done before exercise. The roller is used to break up adhesions, bring blood flow to the muscles. Foam rolling is one of the best things you can do for self maintenance.
My last few visits to Dr. Todd have been focused on developing posture, engaging lazy muscles, and trying to open up my shoulders. We've made a couple changes to my daily routine including using a stand-up desk at work. This has been such a huge change. I don't slouch at my desk and I'm not tired during the day. Standing opens up my hips which keeps my hip flexors from getting tight throughout the day and it also keeps my shoulders from creeping up throughout the day.
I've felt the benefits in running and swimming. My shoulders stay lower and properly engaged during running as opposed to rising up towards my ears. This leaves the core engaged and my body more relaxed to focus on running. During swimming, the open shoulders allow me to rotate and extend more freely and pull water with less effort. Although I thought I had pretty good posture during non-training hours, there was quite a lot of junk to break up in my shoulders. After a bit of graston (check out the handiwork in the picture), my shoulders roll back and my chest is wider.
Posture is so important at all times. There are small fixes that can make such a big difference. Many times, simply standing and focusing on stretching out instead of scrunching up will be noticeable improvements. Coupled with a little mental discipline, I'm looking forward to continuing to engage muscles properly and seeing the long term benefit translate to training.
The seemingly endless debate of "nature vs nurture" is brought one step closer to resolution (which leaves us with only a bazillion more steps to go) by David Epstein in his book The Sports Gene and it's been on my mind since I finished listening to the book over a week ago. Not only are the scientific studies and anecdotes Epstein highlights thought-provoking, they have implications for all of us as athletes. Here are some questions we might all ask ourselves after reading this book:
How good can I get?
Is there a limit set on my ability because of my genetics?
Am I not as good as Billy Bob Joe from lane 4 because he works harder than me, or because his genetic makeup is superior to mine?
Here are some additional questions specific to me that I've been asking:
How much of my success so far is due to genetics and how much due to hard work?
If I decide to compete as a professional triathlete, will I get trounced because my genetic makeup isn't like Jan Frodeno's?
Or is it?
Do I have to give it a shot to know if I can be the best, or can something like VO2 max or genetic testing give me my answer?
If one of my motivations is to see how good I can get, but testing tells me "not very good" then are my other motivations strong enough to keep me in the sport?
These are all pretty powerful questions that can have a profound impact on our lives. Epstein presents evidence that it is most certainly a mix of both genetics (nature) and hard work (nurture), and attempts to discern what percentage of each is responsible for extraordinary performance in an array of sports from baseball to chess to Ironman triathlon to sprinting. He explores the warrior-slave theory of Jamaican sprinting, the Kenyan and Ethiopian domination of marathoning, and how rare gene variants have been found to be not-so-rare at the highest levels of sports like dog racing or track running.
A few things that I've been able to conclude from the book:
1.) Ironman triathlon racing is probably a larger percentage of nurture than other things like singing that are largely genetic. There are so many factors that influence Ironman racing like experience, training infrastructure and luck that genetic predisposition is partially overridden. Have any of us ever met someone who popped out of the womb going sub-9 in an Ironman? I know I haven't. Have any of us seen someone who at the age of 10 could sing better than almost anyone you know? They're rare, but yes!
2.) It's not only your physical ability that is partly determined by your genes, but your mental ability. Epstein's chapter on Alaskan huskies in the Iditarod is an amazing example. They were actually bred not only for their physical talent, but for their eagerness to run and mental toughness over a grueling 8 day race. We may not be willing to breed humans to be tough or fast, but the husky anecdote is one that suggests our genes partly determine our willingness to suffer.
3.) Though many people have told me that I must have talent and that's why I'm as fast as I am, I've never thought of myself as particularly gifted. I admit that I do have more talent than most, but compared to some of the elites out there, I didn't have a high starting point - I ran an 8min mile in middle school, unlike the 5:20 that Meb Keflezighi ran. I believe my gifts of mental toughness and some degree of physical talent have overcome some of the disadvantages I face.
Let's each find what we are well-suited for and passionate about in life, and then go after it!
P.S. Feel free to leave comments if you have a stance on the nature vs nurture debate
Hello All-Pro Patients! I am excited to be able to share my thoughts and experiences on the All-Pro Health blog, and to be working with Dr Todd in some of the many areas he is an expert in. I came to Todd initially for help with my Achilles, but Todd's work also yielded a pleasant surprise. Read on.
I met Dr Todd in Kona, Hawaii, where I was to take on the most grueling one-day event in sport, swimming 2.4 miles in the Pacific Ocean amidst a sea of thrashing bodies, cycling 112 miles through the lava fields and infamous Mumuku winds, and running 26.2 miles in temperatures exceeding 100º. My preparation for the Ironman World Championship had gone tremendously well but I had a nagging Achilles injury that prompted me to visit Todd who, as I learned from John Bye of the Mapso Tri Club, was visiting Kona to witness the event and help some of the best athletes in the world. After my first visit with Todd four days before the race, it was clear that he is a very knowledgeable and skilled practioner of ART, Graston, kinesiotaping and biomechanics and after two visits my Achilles was feeling much better. I placed 72nd overall in a time of 9:23 (if you'd like to read my full race report, email me at email@example.com)
Since I'm constantly trying to improve, when I returned to NJ (after some much needed R&R in Kauai!), I went back to Todd to see what else he would be able to help me with, now with access to the full array of equipment at his office. Todd's ability to identify areas of weakness and construct a plan to correct them is impressive, and his borderline giddy passion for athletics (as a triathlete himself) is important to me. He gets it!
After a few more visits, including a chiropractic adjustment, we were convinced that we should work together. Our initial targets:
1.) Finish healing my angry Achilles after the terror I put it through by racing an Ironman
2.) Correct my terrible posture
Take a look at the picture comparison in this blog - the first one is how I used to stand. My shoulders are hunched, and my neck is craned forward like I'm a chicken. Fast-forward through four weeks of working with Todd on mid and lower trapezius strength, and bringing flexibility back to my chest, and you have picture number 2. My shoulders are back and down, chin is tucked, and my neck is properly aligned with my spine. Do I look better? HECK YES! And here's what's more...
Ever have headaches from sitting at a desk for hours straight at work? I've had migraine headaches, often beginning midday on Mondays, for most weeks for the past several years. I could never figure out why I got them, and the only relief I found was from taking Excedrin (I hate taking medicine). Since working with Todd, I haven't had a single headache in 5 weeks! Magic? No! Posture!
I'm sold, and drinking the postural Kool-aid.
P.S. Take a look at my Bio on the website to learn more about me! Feel free to email me questions at firstname.lastname@example.org
Rollers can be great to help work out kinks during training. An achy muscle, tight back, or sore ligament can definitely be addressed through some targeted rolling. But, that's not it. I've come to find that the roller can actually help pre-workout as well. Rather than spending time on a slow warm-up, I've started to roll out my legs before rides and runs and it's been a huge help. I can start my workouts with clear legs and a focus in the body to be more effecient and effective.
Several years ago, I wrecked on my bike and banged up my shoulder. It still causes me some problems. Dr. Todd listened to this, watched my movement, and gave some pointers on using the roller to stretch out the shoulder area and break up the scar tissue. This is particularly important based on the swimming stress put on the shoulder as well as the core development we're focusing on during the off-season. By pairing the roller both before and after workouts, I'm looser, a bit more flexible, and more effectively ready to go for workouts. It's been great to utilize a training tool in a more productive manner and add to recovery.
I remember the date clearly - February 14, 2015. I was in the middle of a long run when I suddenly fell to the ground from a shooting pain in my left foot. I attempted to get back up and continue running, but quickly realized that I was not able to put any pressure on my foot. I got up to walk but couldn’t put any pressure on my foot. As I was driven back to the starting point of our long run, all I could think about was that I only finished 11 miles of our 20 mile run. I thought, tomorrow I’ll have to make this up. The next day, I went to the urgent care center and got an x-ray, which negative for any fracture, but I still couldn't walk without immense pain. Scheduling an appointment with the orthopedist took days – days that seemed like months. Once I finally saw the doctor, he gave me crutches and simply said I could run whenever it felt better. The marathon I was training for was one month away. So for the first month of my injury, I ran a few times, thinking I could still race the marathon, even if I had to crawl. But the date of the marathon came and I still could barely walk. I knew I had to abandon my hopes of keeping my fitness, in terms of running. I made an appointment to get a DEXA scan to measure my bone density and the results shocked me. My bone density was two standard deviations below the norm. I knew I had to make some changes to get healthier and just do what I should have done in the first place – do nothing, let it heal. Fastforward to May – I thought I would be able to run by the time graduation rolled around but there was a pressure in my foot that persisted. I saw a different orthopedist who now told me that my stress fracture looked healed; however, the extra bone formed might be causing a neuroma (inflammation of the nerve), which is why I still felt pressure. Just what I needed, I thought. The weeks prior I started using an underwater treadmill to introduce my foot slowly to impact. Before I left to go home for a week after graduation, I made a plan with my physical therapist to start alternating between walking and running. If I felt pressure, it was okay but any pain and I was instructed to stop immediately. The two minute jog/one minute walk routine was awful. Worse than any track workout or long run. But it was necessary. After about two weeks, I was ready. Three miles straight. The first continuous run back was overwhelmed me with emotions. I felt so grateful and appreciative that I could run again and almost hated myself for taking advantage of it before. During that run, I vowed I would train smarter. I’ll strength train this time; I’ll cross-train this time; I’ll take my easy runs easy – I swear. Fast forward again – June 10th, four months post-diagnosis. My foot has slight pain but thankfully not from the stress fracture. The orthopedist said the flexor on the next toe is inflamed but that with some ice and ibuprofen it should take care of itself. Although, now when I run I feel overcautious – guess that’s not exactly a bad thing. I was able to get some speed work in for the first time and ran the Durham Parkrun 5K in 18:10.
Two weeks later, toward the end of June, I experienced that same initial pain on a long run. Again, I couldn't put any pressure on my foot. I was so fed up with everything. I resorted back to strictly swimming and at the end of July, received an MRI. All of the doctors were wrong. The problem was in fact a rare disease called Freiberg's disease, avascular necrosis of the second metatarsal. In addition, I had three other stress fractures, probably as a result of the joint pain. This was not something that was going away quicly or easily. All of my plans went out the door and I prepared to move back home to New Jersey.
When I came back to Whippany, I was extremely fortunate to meet Dr. Todd. I started treatment in late October and, using the alter g, am able to run at 75% of my body weight. My foot is looking much better, and I am feeling healthy and positive. I am looking forward to being completely healed and coming back faster than ever!
My recent trip to Kona was an unforgettable experience. Not only was I privileged to be at one of the greatest sport events in the world, I had the opportunity to work with the best of the best athletes! Here’s what I took away from the Ironman experience: As you can imagine, the pro athletes all different body types - short, tall, muscular, and lean. What they did have in common was flawless running bio-mechanics. I did not see the common gait deficiencies we generally see in most amateurs and age groupers. There was no excessive foot pronation, hip hiking, arms crossing midline, excessive trunk rotation or rounded shoulders. I came to realize that if I can change these inefficiencies and poor running habits of our athletes at APH, not only will it prevent injury, it will also give them the opportunity to perform stronger and faster. Using a combination of chiropractic care and physical therapy, we will correct our athletes inefficiencies through gait training and functional strengthening. This off-season, it is our goal at APH to prepare our athletes to be their best come March 2016!
Deep Squat Lift:
- Get as close as possible to the object being lifted.
- Place your feet nice and wide to keep you stable as you lift.
- Initiate squatting down to the object by bringing your hips back and bending your knees. Make sure you are hinging (folding) at the hip crease and that you are maintaining a straight back. Do not round your spine.
- When you get to the bottom of your squat, pick up the object and bring it as close to your body as possible.
- Push through your legs to come up to a standing position, again maintaining a straight back and keeping the object close to your body.
Half Kneel Left:
- Get as close as possible to the object being lifted.
- Place your feet one foot in front of the other nice and wide to keep you stable as you lift.
- Bend your front and back knee to get down to the floor so that your back knee rests on the floor. Make sure are hinging (folding) at the hip crease and that you are maintaining and straight back. Do not round your spine.
- When you get to the bottom of your kneel, pick up the object and bring it as close to your body as possible.
- Push through your legs to come up to a standing position, again maintaining a straight back and keeping the object close to your body.
If you have any pain or discomfort, do not continue the exercise and speak to a medical professional.
The majority of patients undergoing physical therapy treatment at All-Pro Health will at some point receive Trigger Point Dry Needling (TDN) as part of their treatment. Being a non-traditional and scarcely utilized therapeutic modality in the physical therapy world, patients tend to have many questions. The purpose of this blog post is to educate you on this procedure and it's benefits.
1. What is TDN?
TDN involves multiple advances of a thin non-medicated filament needle (similar to an acupuncture needle) into the muscle in the area of the body which produces pain and typically contains a 'Trigger Point’. Trigger points, often referred to as muscle or myofascial ‘knots’, are hyperirritable areas in a taut band of muscle which can contribute to dysfunctional movement patters.
2. Is it the same as acupuncture?
The only similarity between acupuncture and dry needling are the needles themselves. TDN is based on anatomy and aims to cause change in dysfunctional soft tissue with the goal of normalizing it’s neurophysiological state. Acupuncture involves the insertion of extremely thin needles through your skin. Traditional Chinese medicine uses acupuncture to balance flow of energy (also known as qi or chi) which are believed to flow through meridians, or pathways, in the body.
3. How does it work?
Based on research studies performed by Dr. Jay Shah at the National Institutes of Health, inserting a needle into the trigger points will elicit a local twitch response", which allows the muscle to release and a positive biochemical change to happen. pH levels are returned to baseline and pain levels are reduced.
4. What is the procedure?
The skin is cleaned with alcohol. Your therapist will be wearing gloves and hand sanitizer will be used in addition. The trigger point is localized by the therapist's fingers while the needle is inserted into it. The needle is 'pistoned' through the trigger point for 4-5 repetitions.
5. Is it painful?
The insertion of the needle itself is not painful. The local twitch that is elicited will trigger a few seconds of discomfort which patients describe as spasming, cramping, or an electrical shock. The pain is short-lived and benefits are long lasting in combination with all other physical therapy treatments.
6. What are the side effects?
A common side effect that patients experience is soreness lasting from a few hours to 2 days.
7. Are there any precautions I should take after the treatment?
Avoid strenuous activity and training. Light activity is encourage after treatment to help with the soreness. This can include gentle walking or stretching. Ice or heat may also be applied over the area that is sore.
Trigger point dry needling is a therapeutic modality that is invaluable in the rehabilitation process and can be used on any part of the body no matter where you injury is. Whether your injury is chronic or acute, traumatic or non-traumatic, dry needling can help. Below is a video demonstrating the procedure: