Sunday, December 30, 2012
In November, I had the opportunity to take the second part of the DNS sport course. I reviewed DNS I in an earlier post, and was thrilled to have the opportunity to not only learn from Zuzana again, but to take a private with her. I was coming off of a self imposed 30 days of yoga, 1/2 marathon training, with some biking and weight training thrown in for good measure. An old hamstring injury flared up in the midst of all of this and I was hoping Zuzana could provide some insight into changing my mechanics. I, of course, thought I was in pretty good shape with perhaps some minor tweaking needed. During our private session, my tendency towards an inspiratory breathing pattern became quite apparent, along with my lack of lateral hip stability. Both of these things were negatively affecting my spinal position during physical activity. Over the course of the weekend, proper breathing patterns were continually emphasized during higher level positions, as well as eccentrically working the gluteus medius and integrating it with proper foot function (i.e. maintaining a short foot). A video of Zuzana explaining proper breathing technique can be found here: http://www.youtube.com/watch?v=-7UJPm1hBEo
The fascinating thing about all of this was how much an inspiratory breathing position can affect spinal position and how much that affects pelvic position during movement. Not only is spinal position impacted by breathing, the muscles of respiration, including the serratus anterior and transverse abdominis, are also important spinal stabilizers. Blandine Calais-Germain points out in her book "Anatomy of Breathing" the serratus anterior is a powerful inspiratory muscle that does not involve the neck. Rather, it has a strong rib cage posture which serves as the base for the neck region. It is also an extremely important stabilizer of the scapula. One of the rationales behind maintaining a good breathing position is this allows proper shoulder blade positioning and therefore proper shoulder stabilization. Another important aspect of proper breathing which has strongly influenced how I move is the relationship between the diaphragm and the psoas. In a review by Buchholz (1995), Elsa Gindler's work on the function of the diaphragm is discussed, including the fact that the diaphragm properly lowers only if both the psoas major and minor and the hip joints allow free leg-movement and low back flexibility. Additionally, Page, Frank, and Lardnor (2010) point out spinal stabilization occurs if the transverse abdomens, multifidus, diaphragm, and pelvic floor co-activate for both trunk stability and force transmission. Weakness in the pelvic chain can lead to dysfunction elsewhere, including low back pain, IT band syndrome, anterior knee pain, ACL tears, and ankle sprains.
So what does this all have to do with running gait and hamstring injuries? By using primarily a chest breathing pattern, I was not properly stabilizing my pelvis. To compensate for my lack of spinal stability, I learned to accomplish hip extension by anteriorly tilting my pelvis. This, of course, shortened my psoas, turned off my poor gluteus maximus, and caused the rest of my posterior chain (calves and hamstrings) to go into overdrive leading to the appearance of the old hamstring injury. Two fascinating things have happened since I have adopted a better breathing strategy. The first is that my running stride has improved. When I catch sight of myself in windows, I am no longer arching my back. I am able to breathe into my belly as I run and my posture is much better. The combination of better breathing, improved spine position, and active release therapy on my hamstring has resulted in no more hamstring pain. The second thing that has happened is I no longer feel any lumbar spine compression when I practice yoga. I have always had too much mobility in my lumbar spine. My solution has always been to draw my belly button in to activate my transverse abdominis. It turns out drawing in the naval doesn't activate the TrA, but breathing diaphragmatically does. This has made a huge difference in how my back bends feel and I suddenly understand why the inhale always happens while moving away from the earth- to stabilize the spine. Mark Stephens wrote a really interesting blog that discusses engagement of Uddiyana Bandha which can be found here: http://www.markstephensyoga.com/blog/mula-bandha-uddiyana-bandha. He essentially says we want a relaxed belly during practice, not a contracted one. While it has been really hard for me to throw out years of "engage Uddiyana Bandha. Pull the navel towards the spine," the elimination of discomfort in the lower back and the improvement in my thoracic extension has been rather extraordinary.
One last note is much of the positioning of the spine and ribcage comes not from a pelvic tilt, but from a dropping of the ribcage. This can be difficult to understand at first and, while it is a subtle distinction, it is an important one. Dropping the ribs flattens the lumbar curve by using thoracic mobility, not lumbar mobility. This allows spinal stabilization to occur and does not compress the lumbar vertebrae. I do think this is what has made a huge difference in how my backbends feel and present themselves. It is also what I focus on while running to maintain a proper pelvic positioning. Years ago, when I read Chi Running by Danny Dryer, I couldn't figure out why he wanted people to pretend like they were hugging a big ball before they began running. In retrospect, I see it accomplishes the same spinal position in a different way.
If you are interested in more reading on this topic, "Anatomy of Breathing" does a really nice job explaining the breath in a not overly technical way. Sue Falsone's Movement Lecture on the thoracic spine also does an excellent job explaining the role of breathing in spinal stability.
Yours in health and wellness,
Calais-Germain, B., (2006). Anatomy of Breathing, Eastland Press: Seattle.
Buccholz, I., (1994). Breathing, voice, and movement therapy: applications to breathing disorders. Biofeedback Self Regulation, 19(2), pp. 141-153.
Page, P., Frank, C.C., & Lardner, R., (2010). Assessment and Treatment of Muscle Imbalance. Human Kinetics: Illinois.
Saturday, December 8, 2012
Last week, I had the privilege of taking a V-Core certification class with Dr. Emily Splichal. Dr. Emily is a podiatrist in NY who introduced me to the golf ball technique I discussed here and whose guest blog can be found here. She advocates barefoot training as a way to improve foot stability, mobility, and integrate hip and foot function. She believes in an evidence based approach to programming and selects exercises based on their proven effectiveness, rather than simply because it "looks" cool. She is an excellent teacher and a thorough lecturer. By the end of the 6 hour workshop when we were reviewing anatomy, I found myself thinking, "of course the gastrocnemius and the peroneals concentrically evert and plantarflex while the soleus and its best friend the posterior tibialis plantar flex and invert and it only makes sense that at initial contact the foot is rigid, becomes flexible (pronates) and then becomes rigid ago for toe off. Why didn't anyone else ever explain it this way?" The workout was challenging, and by the second workout, I noticed some other participants fighting fatigue (lack of gluteus medius control during dynamic balance exercises, difficulty balancing as effectively), but that's to be expected at the end of a long day. The sequencing was well thought out. I found myself repeatedly thinking how good this style of training would be for runners. Not only was the workout performed barefoot without socks to optimize feedback from the ground, the movements are sequenced so that there is a gradual build in difficulty without some of the masochism often found in a group exercise setting (the "we will do this until we are all dying" approach). If I were teaching this to runners, I would integrate diaphragmatic breath with an emphasis on neutral pelvic alignment to bring a little more awareness to the LPHC, but this was a foot workshop focusing on foot mechanics, so that is simply a personal preference.
There is this fascinating thing that runners do when they take up exercise programs. They exercise with shoes on and they often choose exercises that are done in a seated position or on 2 legs. Running, of course, is an activity that takes place entirely while standing and on one leg; as a result, I have always felt it is important for runners to incorporate single leg training into their routines. An interesting journal article by Barr and Harrast (2005) points out 40-50% of all running injuries take place below the knee and foot problems are the most common injuries reported by marathon runners. What this says to me is that runners need to strengthen the foot and ankle complex as part of their movement regimen. Performing exercises while maintaining a short foot, for example, is a great way to begin to re-establish the neuromuscular control necessary for proper gait mechanics. This, along with improving ankle dorsiflexion, can begin to combat the risk of plantar fasciitis; Barr and Harrast state runners with ankle dorsiflexion of 6-10 degrees have a 2.9 odds ratio of developing plantar fasciitis while runners who had 0 degrees or less of ankle dorsiflexion have an odds ratio of 23.3. This is a substantial difference, and one that should be considered when developing strength and mobility programs for runners. Further up the kinetic chain, these factors can contribute to anterior pelvic tilt, lack of hip control, and excessive knee movement in the frontal plane. Runners need to perform movements that integrate foot and hip function and emphasize proper mechanics all of the way up into the pelvis and lumbar spine. Another point Dr. Emily made during the V-Core workshop which also applies to running gait is there needs to be a focus on eccentric control, rather than simply focusing on concentric contraction. Functionally, decelerating motion is critical for proper stabilization patterns during gait mechanics. This is why things such as hopping can be so good for runners- proper landing technique requires eccentric control of the lower limb muscles. She integrated some single leg hops and plie hops that were low impact and felt safe, even in a group setting. Runners would benefit greatly from integrating some of these gentle plyometrics into their programs.
I would highly recommend taking one of Dr. Emily's workshops if you are at all interested in gait mechanics, integrated barefoot training, and understanding the impact of the foot on the rest of the kinetic chain. If you are a runner and there is a V-Core class near you, it would be highly worth your time to incorporate this into your training program. I strongly believe that runners need to do more than just run (especially if they are sitting most of the day) to maintain joint mobility and prevent injury. If there isn't a V-Core class near you, take your shoes off and, if you are without an arch, try to activate the muscles that lift the arch of the foot away from the floor. Try to perform some exercises in this position, such as lunging, single leg squats, single leg deadlifts, etc. Notice how this makes your hips feel and focus on using perfect form with each repetition. Your running stride will thank you for it.
Yours in health and wellness,
Barr, K. P., & Harrast, M.A., (2005). Evidence-based treatment of foot and ankle injuries in runners. Physical Medicine and and Rehabilitation Clinics in North America, 16, pp. 779-799.