Waterloo Chiropractor, Waterloo Physiotherapist, and Massage Therapist (RMT)

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Here at Delanghe Chiropractic & Health we are really excited to be leading our first beginner run program!

Date: Starts Sept 4th, 2018

Price: FREE

SIGN UP NOW

The idea is simple:

Every week, you will tackle a progressive plan that will take you from zero all the way to 5K in 6 weeks!

Each week will also include an information session from trained medical professionals.  Your coaching team includes:

Together, we will be tackling the VERY fast and fun course at the Run Waterloo Fall 5K Classic.   

Afraid you won’t be able to do it?  Don’t be!  Both Karen (mom of 4, new to running) AND Amanda (Olympic medalist, but now busy mom of two) of Delanghe Chiropractic will be starting from scratch and going through the plan with you!

Oh, and did we mention it is FREE?  Join us, have some fun, and reach your fall fitness goals! You can register HERE or by e-mailing info@drdelanghe.com or calling (519)885-4930

learn2run5K

We’ve all heard of DOMS (delayed onset muscle soreness) and the majority of us have experienced it at least once.

It’s that muscle pain and weakness that we feel a day or two after some exercise. It can be caused by any type of muscle contraction but it is most commonly caused by an eccentric exercise such as downhill running and resistance training. (Reminder: an eccentric exercise is a movement where the muscle is under load as it lengthens. For example, a raising part of a bicep curl is a concentric exercise but the lowering part of a bicep curl is the eccentric part)

The typical symptoms include strength loss, pain, muscle tenderness, stiffness and swelling. Symptoms typically peak 24-48 hours after exercise and fade within 96 hours. The severity of DOMS depends on several factors but in general, more damage occurs with higher intensity and unfamiliar actions.

Physiologists do not have clear understanding of the mechanism behind DOMS, however the proposed theory involves a mechanical disruption to the sarcomeres (the fundamental unit of a muscle structure) which then sets off an inflammatory response. The swelling is caused from the movement of cells and fluid from the blood stream to the muscle, where it contributes to the sensation of pain.

I’ve often been asked if it’s okay to continue exercising and/or what can someone do to help reduce the feeling of DOMS. A recent meta-analysis looked to compare the effects of the most commonly used recovery techniques on muscle damage, DOMS, inflammation and the feeling of fatigue from physical exercise. The authors looked at the effects of 1 session of several different types of recovery techniques after physical exercise on:

  • DOMS
  • Perceived fatigue (ie: how much someone feels tired)
  • Inflammatory markers (IL-6, CRP)
  • Muscle damage markers (CK – creatine kinase)

Let’s have a look at the evidence!

Massage

Based on this meta-analysis, massage was the most effective for DOMS and perceived fatigue! The authors reported that a 20-30 min massage performed immediately after or up to 2 hours after exercise has been shown to help reduce DOMS for 24-96 hours after exercise. Elite athletes (in this case ultra-marathon runners) reported a significant improvement in lower perceived pain after massage. Not only does a massage feel good, but it has also been shown to reduce CK and IL-6 in the blood after exercise which may help towards a faster recovery.

Rationale:

Massage seems to help the symptoms of exercise-induced muscle damage by increasing blood and lymph flow which can stop the CK response and clear it from the blood. It’s assumed that massage flushes out neutrophils (an immune cell that responds to inflammation) from the damaged area which would otherwise cause more CK in the area.

Compression Garments

Compression garments have a significant and positive impact on DOMS up to 96 hours after exercise. It has been shown that wearing a whole-body compression garment over a 24-h period after intense heavy resistance training significantly reduces perceived fatigue. That might not be realistic for us but other compression garments such as leggings and socks can be used.36391146502_1bd4d6090e_k (2)

Rationale:

The beneficial effect of compression garments might be explained by:

  • A reduction in the space available for swelling and edema
  • Better venous return (blood flow back to the hear)

Cold Water Immersion

Cold water immersion (CWI), aka: ice baths, showed a significant effect on DOMS and perceived fatigue after training and competitions/tournaments as well as after strenuous exercise in both trained athletes and recreational subjects.

Ice baths in water at 11-15⁰C for 11-15 minutes is considered the optimal dose to have a positive impact and reduce DOMS.

Rationale:

CWI seems to help reduce exercise-induced inflammation, edema, pain sensation, and muscle damage through these ways:

  • The hydrostatic pressure from being immersed in water may help transport fluids from the muscle to the blood and therefore eliminate inflammatory products
  • Narrowing of blood vessels from the cold temperature may reduce fluid diffusion into space in the muscle and reduce the inflammatory reaction

Contrast Water Therapy

Contrast Water Therapy (CWT) which is bathing alternately in warm and cold water seems to have a small effect on DOMS but not perceived fatigue. CWT has been able to reduce the perception of pain at 24, 48, and 72 hours post-eccentric exercise. CWT also reduced CK concentrations in the blood.

Rationale:

CWT promotes the opening and narrowing opening of blood vessels which may reduce the formation of edema, inflammatory pathways and decrease feeling of pain.

Active Recovery

Active recovery also has a significant effect on DOMS, but not effect on perceived fatigue however, the impact of active recovery is only significant during a short period after exercise. There seems to be no influence of active recovery on CK, IL-6 and CRP concentrations in the blood.

Rationale:

Active recovery seems to help DOMS by enhancing blood flow in muscle tissue, which helps to remove metabolic waste and therefore reduce muscle pain.

Cryotherapy

Cryotherapy is the exposure to a cold chamber and appears to be effective in reducing DOMS after exercise. The authors found that cryotherapy had an effect on DOMS but only for about up to 6 hours after exercise and any cryotherapy done 24 hours after the end of exercise is ineffective in alleviating DOMS.

Stretching/Electrostimulation

The meta-analysis did not find any significant influence of stretching or electrostimulation on DOMS and fatigue. In fact, results showed that stretching less than 6 hours after exercise might even produce DOMS.

Take Home Points!

At some point we will experience DOMS and with time, it will go away on its own but there are some ways to help reduce the feeling and possibly recover faster. Massage seems to be the most effective in relieving DOMS and fatigue. Ice baths and compression garments can also help but are less effective.

Keep in mind that the outcomes from this meta-analysis looked at many studies with different protocols and the results can vary depending on many things such as the type of exercise, level of immersion in water, and amount of pressure from compression garments to name a few.

One final note is that while research shows that these post-workout techniques can make us feel better faster, over time we might we lose some of the benefit from that hard workout or training session since the signal to adapt to the training is blunted from using these recovery methods. So, it is important to use them strategically (ie: after a race where you went too hard or leading into a big race) and to avoid using them during base training and instead just give yourself more time to recover.

Hope this helps with your recovery!  If you have any other questions, or would like to learn more about me, check out my profile HERE.

References:

Dupay et al. An evidence-based approach for choosing post-exercise recovery techniques to reduce markers of muscle damage, soreness, fatigue, and inflammation: a systematic review with meta-analysis. Frontiers in Physiology. 2018

 Connolly et al. Treatment and prevention of delayed onset muscle soreness. Journal of Strength and Conditioning Research. 2003

Are you a constant sufferer of stress related bone injuries? An endurance athlete? Female?

There are many different contributing factors of stress fractures in endurance athletes. Overcoming these challenges and working toward the prevention of these injuries is so important in order to continue with our training and competition schedule. In this article ,I will discuss why female endurance runners are more susceptible to these injuries along with some modifiable risk factors (i.e. nutrition interventions) that can be manipulated to reduce your risk of suffering one!

(Men, I did not forget about you. Stay tuned for an article on stress fractures in male endurance athletes!)

Possible Reasons for Stress Fractures

There are many endurance athlete-specific reasons why stress fractures may occur. One reason for this is the fact that distance running has a high metabolic demand. It costs a lot of energy to run fast for long periods of time and thus increases our need for a higher caloric intake. This can put us at risk if we are inadvertently under consuming calories. Inadequate food intake including both overall energy and micronutrient intake, can play a role in increasing our risk of fractures.

Excessive negative energy balance aside, runners seem to be especially at risk compared to other endurance athletes who also consume lots of calories. Although running does indeed increase bone mineral density (bone strength) with the proper balance of training and recovery, the repetitive nature of high-volume running often leads to the athletes not taking adequate rest days and/or programming in periodized reduced training weeks. This can lead to insufficient recovery and healing of the bone in between bouts of stress and therefore not enough time for the bone to adapt and become stronger. I would refer you to my colleagues, Dr. Sean and Kayla Ng, at the clinic to find out more about how to structure your training schedule.

Version 3 On top of inadvertent negative energy balances and insufficient recovery, some endurance athletes neglect the inclusion of a strength program into their training schedule. Lifting will act as a stimulus to increase bone mineral density. Not only this, but strength training can also aid in enhancing hours muscles ability to direct forces optimally through bones (i.e. compressive vs. sheer forces). For more on this, again I would encourage you to discuss this with my colleagues Dr. Sean and Kayla Ng.

Another risk factor is related to how in some circles, runners are often pressured to fit into the very thin and light body category. First off, low BMI or low weight in itself can be correlated with low bone mineral density. In addition, if that low weight is combined with weight loss efforts and low energy intake, this can wreak havoc on your bone health due to hormonal changes (i.e. decreased estrogen production) and resulting menstrual dysfunction (which can act as an early sign that your are consuming insufficient calories).

BUT, all is not lost!  There is a lot we can do to overcome our bone health challenges. Nutrition, for one, is an easily modifiable risk factor that can have positive outcomes for our bone health.

Nutrition & Bone Related Injuries

To put the need for proper nutrition in maintaining bone health in perspective, here are the results of 3 interesting and very applicable studies on the topic:

  1. Negative energy balance and estrogen: Low energy availability, which is the amount of energy left over after exercise for normal physiological function expressed in calories/kg fat free mass, decreases estrogen levels. This results in a 4x greater risk of bone injury compared to those who have adequate energy availability.
  2. Insufficient calcium: Low calcium intake (800mg) resulted in 6x more risk for bone injury compared to high calcium (1500mg).
  3. NFL players and Vitamin D: In NFL male players, players with 1+ fractures had higher rates of inadequate levels of circulating Vitamin D.

Practical Applications:

So, here’s what you can do:

  1. Make sure nutrition intake closely matches energy demand of sport & daily life.
  2. Consume enough bone building materials (i.e. calcium, vitamin D, and magnesium)
  3. Weight loss tactics should be introduced at appropriate times (likely in the low training/off season) to reduce risk of injury close to race season.

I hope these statistics and general tips reinforce how important nutrition planning is for endurance female athletes. If you still have questions or need guidance on planning for your race season, come visit me at the clinic!  You can check out more about me on my profile HERE.

References:

Tenforde AS et al., 2016. Association of the female athlete triad risk assessment stratification to the development of bone stress injuries in collegiate athletes. The American Journal od Sports Medicine 45(2), 302-310.

Heikura IA, Uuitalo ALT, Stellingwerff T, Bergland D, Mero AA, Burke LM. 2017. Low energy availability is difficult to assess but outcomes have a large impact on bone injury rates in elite distance athletes. International Journal of Sport Nutrition and Exercise Metabolism.

Barrack et al., 2014. Higher incidences of bone stress injuries with increasing female athlete triad-related risk factors. The American Journal of Sports Medicine. 42(4). 949-958.

Papageorgiu M, Dolan E, Elliot-Sale KJ, Sale C. 2018. Reduced energy availability: implications for bone health in physically active populations. Eur J Nutr. 57:847-859.

Maroon JC, Mathyssek CM, Bost JW, Amos A, Winkelman R, Yates AP, Duca MA, Norwig. 2015. Vitamin D profile in National Football League players.

Welcome to part 2 of the my exploration of very low carb diets for endurance athletes.  My last article provided the basis for understanding this article as it explored how and when our body choses to use fat vs. carbs.  Check it out here.

In this article, I will now explore (1) do low carb diets actually enhance fat metabolism and (2) does that actually makes us faster.

Does VLCD increase fat burning capacity?

Short answer, yes, the body is forced to increase fat use to support the energy needs during exercise. Research clearly shows that after adapting to a keto diet for as little as 3 weeks results in significantly elevated rates of fat oxidation (0.6g/min to 1.5g/min) during exercise. Fat oxidation at moderate intensities (65% VO2max) in elite ultra-endurance athletes on a keto diet contributed 88% of the fuel for exercise verses 56% in athletes consuming high carbohydrate diets. Now, if we remember what we discussed in the last article, we learned that as we increase intensity we increase the amount of carbohydrates burned. This begs the question “will those high fat oxidation rates continue at intense ecercise (80% VO2max)?”. Another study investigated the fuel usage of elite race walkers at 80% VO2max, and they too found that fat oxidation was elevated to the same levels as previous research (1.5g/min).

low carb

Research Outcomes of VLCD and Performance:

The more important question in my mind (and likely yours as well) is “well that is fine and dandy- my body will burn more fat, but what will happen to my performance?!”. We will review some key research studies that have looked at fat adaption diets (high fat diets for 3-7days), keto diets and their effect on performance. The majority of high fat diet adaptation and keto diets find that performance decreased and a handful found they had no-statistically significant effect. Only two articles find a performance benefit.

Keto, Training and Performance

Louise Burke et al. (2017) conducted a large study investigating the effects of a keto diet, chronically high carbohydrate diet or periodised carbohydrate diet on race performance of elite race walkers after a 3 week intervention and training camp. Athletes on the keto diet perceived the training to be significantly more difficult and experienced an inability to complete the exercise training sessions planned. This is a very important point because if an athlete cannot train as hard as they could they won’t see much improvement in their sport.

After the 3 weeks of intense training, the keto group had higher fat oxidation compared to the two high carbohydrate groups. All groups had significant increases in their maximal oxygen uptake (VO2max) as a result of the training. As we discussed in the previous article, burning fat is less efficient and this study clearly demonstrated that at all competition race speeds there was significantly more oxygen used in the keto group and there was no change in the fraction of VO2max at various speeds. The high carbohydrate and periodised carbohydrate groups used less oxygen and were able to keep the same pace at lower fraction of VO2max. In plain English, the two carbohydrate groups improved their running economy and efficiency with the training where the keto group did not reap the benefits of the training because the cost of burning fat is so high.

Lastly, this study compared pre and post training performance walk times in a real 10km race. They found that both carbohydrate groups had a reduction in their time by 5-6% (on average 190s and 124s faster for high carbohydrate and periodised carbohydrate group). There was no improvement in the keto group and on average their times were 23s slower. There was a wide variability in performance for the keto group, ranging from 162s faster to 208s slower, meaning that keto worked for some individuals but not others.

High Fat Diet With Carbohydrate Loading

What if we don’t go into ketosis and we use a fat adaptation strategy + carbohydrate load, best of both worlds right? Havemann et al. (2006) showed that when elite cyclists consumed a high fat diet (68%) for 6 days with 1 day of carbohydrate loading that there was no significant difference in time to complete a 100km simulated bike race compared to a traditional high carbohydrate diet. However, if we look at the time to completion, we find that the high carbohydrate trial was completed on average 3 minutes 44 seconds faster (likely significant in the real world), leading us to believe that on average high carbohydrate diet may be superior to high fat diets. Again, 3 out of 8 racers on the high fat diet did improve their time compared to high carbohydrate diet, demonstrating that there may be some athletes who may respond well to a high fat diet.

More importantly, this research included 1km sprints throughout the ride to simulate a race like situation and found that the power output was significantly lower in the high fat diet group which lead to slower sprint times. Despite having lower power output in the high fat trial, they perceived they were working as hard as they were in the high carbohydrate trial. There was no difference in muscle recruitment during the sprints, meaning the high fat trial worked just as hard as the carbohydrate trial but did not achieve the same results in the sprint performance. The researchers thought that the high fat diet + a carbohydrate loading period would result in glycogen sparing due to increased reliance on fat for fuel, thus improving sprint times as sprinting relies on glucose to provide fuel. This was not the case and it is possible that high fat/fat adaptation diets reduce the ability to effectively burn carbohydrates.

Summary

  • VLCD do result in higher rates of fat oxidation during exercise
  • VLCD may reduce response to training
  • VLCD decreases economy in elite athletes
  • VLCD decreases ability to work at maximal effort which is important when there is change in work intensity- ie running up a hill, breaking away from the pack
  • Most studies show that on average VLCD negatively affect performance in endurance athletes, however there are some that may respond well
  • Remember that VLCD are not the same as training fasted or temporarily low carb diets to train your body to use fat more effectively, as this is an effective training method

In my final article in this series, I will explore the roll of supplements, the keto diet, and how that relates to athletic performance.

References:

Volek JS, Noakes T, Phinney SD. Rethinking fat as a fuel for endurance exercise. Eur J Sport Sci. 2015;15(1):13- 20.

Volek JS, Freidenreich DJ, Saenz C, Kunces LJ, Creighton BC, Bartley JM, Davitt PM, Munoz CX, Anderson JM, Maresh CM, Lee EC, Schuenke MD, Aerni G, Kraemer WJ, Phinney SD. Metabolic Characteristics of keto-adapted ultra –endurance runners. Metabolism. 2016;65(3):100-10.

Burke LM, Ross ML, Garvican-Lewis LA, Welvaert M, Heikura IA, Forbes SG, Mirtschin JG, Cato LE, Strobel N, Sharma AP, Hawley JA. Low carbohydrate, high fat diet impairs exercise economy and negates the performance benefit from intensified training in elite race walkers. J. Physiol. 2017;595(9):2785-2807.

Havemann L, West SJ, Goedecke JH, Macdonald IA, Gobson ASC, Noakes TD, Lambert EV. Fat adaptation followed by carbohydrate loading compromises high intensity sprint performance. J. Appl. Physiol. 2006;100: 194-202.

Leckey JJ, Ross ML, Quod M, Hawley JA, Burke LM. Ketone diester ingestion impairs time-trial performance in professional cyclists. Front. Physiol. 2017;8(806).

What is Acupuncture?

Modern acupuncture is defined as a therapeutic technique in which sharp, thin needles are inserted into specific points on the body. Mechanical, electrical or physical stimulation is sometimes added to the needle to increase the effect. Needles are inserted into acupuncture points, aka: acupoints which were first established in traditional Chinese medicine.

Classical vs. Anatomical Acupuncture: What’s the difference?

Classical acupuncture is based on Tradition Chinese Medicine (TCM). Ancient Chinese believed that everything in the universe was energy. The philosophy that emerged from this thinking is called Taoism which translates to the energy of the universe. The energy is also referred to as Qi (chi).

Qi consists of two equal and opposing energies, Yin and Yang and is commonly represented by the picture above. The curved line represents movement and dynamic fluid between the 2 energies. They are mutually supportive and interdependent.

It was believed that Qi flows through the body along energy channels (referred to as meridians) and could flow into specific sites aka: acupoints. If Qi was deficient, blocked, or out of balance, symptoms such as pain would appear. Needling these sites relieved the symptoms by unblocking and restoring flow of Qi and re-establishing energy balance in the body.

Anatomical acupuncture was originated by Dr. Joseph Wong in the mid 1970s and bridges the gap between TCM and Western medicine. The acupoints are chosen based on anatomy and physiology.

The main difference between classical and anatomical acupuncture is the paradigm used in the selection of points.

The Points

Early studies show most acupoints are located on or near peripheral nerves. There is no evidence to support the existence of new or special structures under these acupoints, however, histological studies (ie: looking under a microscope) have shown a higher concentration of neural tissue and neuroactive components at acupoints compared to non-acupoints.

Neural tissues are the actual tissues themselves and include nerve endings and sensory receptors. Neuraoactive components are cells that release chemical mediators that can excite or inhibit signals to the brain.

The Neural Acupuncture Unit (NAU)

The NAU is a collection of the neural and neuroactive components surrounding the needle. In the diagram, the NAU is the area within the dotted lines. These tissues would be stimulated by the needle.

What Happens When the Needle is Inserted?

Local Effects

When a needle is inserted, it causes some damage to the issue near the insertion point, which stimulates a chain of biochemical reactions in your body. As a result, your body produces various inflammatory and immune response in the NAU. Basically, it is a micro-injury which does negligible harm to the body while creating a therapeutic response.acu2

Non-local Effects

Without getting too in-depth, the non-local effects involve altering pain signals through receptors in the spinal cord and how they relay messages to the brain. The nerve signals from the local tissue travel to the spinal cord and through complex mechanisms, block the original pain signals from getting to the brain.

Another area of the brain is also involved. The hypothalamus-pituitary complex (don’t have to remember this name!) is also stimulated when a needle is inserted and releases anti-inflammatory chemicals into the bloodstream that can help to reduce pain.

These local and systemic responses help to explain the pain-relieving effects of acupuncture.

In my next article, we’ll look at the effects that acupuncture can have for different injuries!

REFERENCES:

Wang, Kain, White. Acupuncture analgesia: I. The scientific basis. Pain Medicine. 2008

Zhang, Wang, McAlonan. Neural acupuncture unit: A new concept for interpreting effects and mechanisms of acupuncture. Evidence-Based Complementary and Alternative Medicine. 2012

Welcome back to another protein-focused edition of Training & Performance! My last article looked at the evidence in support of avoiding protein while you run. Today, I will discuss one of the more common questions I hear at my practice: does protein timing and distribution matter? And should you be consuming protein directly after a workout?

iron sources

Muscle/Protein Physiology

Our muscles are in a constant state of breakdown and renewal. For the average person (depending on factors such as age and level of activity), muscles are broken down and rebuilt at a rate of 1-2%/ day. To help support this renewal, the building blocks of muscle (amino acids) need to be taken in on a regular basis.

While the amino acids we ingest provide the raw material to support that 1-2% renewal rate, that is not all they do. The act of ingesting amino acids also triggers a physiological cascade that signals more muscle growth. So, when the body is being fed amino acids, not only does it have the material for muscle growth, but an anabolic muscle-building state is also put into action!

So it’s no surprise that ingesting protein is important to muscle growth. Now the question is, how much and how frequently do we need to ingest protein to optimize both of these benefits and maximize our gains?

Click HERE to read the rest in the Run Waterloo Magazine.

I have written many times(1234)  about the importance of ingesting carbohydrates during a race (if it’s long enough).

I’ve also discussed how taking in other sources of fuel, like protein, is not the best move due to it triggering an increased risk of GI distress. The reason: in part, protein is not absorbed and metabolized as quickly as carbohydrates. Delayed gastric emptying results in water diffusing into your guts and increasing the odds of needing to take a PB-killing washroom break! iron sources

One thing I have heard in response to this tip from patients and athletes at H+P is that IF one is able to handle protein from a GI standpoint, is it worth experimenting with on top of carbohydrates as a fuel source? Is there an additional benefit to taking in protein during a race if it doesn’t bother your stomach? That is what we’ll be looking at with this article.

CLICK HERE to read the rest in the RunWaterloo magazine!

What is it?!

Overuse injury associated with pain on the outside (lateral) part of the knee

Anatomy

The ITB is a band or sheath of fibrous connective tissue that surrounds the muscles on the outside of the thigh and crosses both the hip and knee joint. It originates from the tensor fascia latae (TFL) and gluteus maximus muscles and then continues down the femur (thigh bone) where it attaches to both the femur and tibia (shin bone) on several bony landmarks.

The function of the IT band is to stabilize the hip and knee as well as limit hip adduction (leg moving towards the midline) and internal rotation of the knee.

Epidemiology and Risk Factors

The knee is the most commonly injured area in runners – accounting for 25-42% of all running injuries. ITBs is the second most common knee injury for runners with patellofemoral pain syndrome being first.

ITBSigns/Symptoms

Runners usually have no exact history of trauma and find that the pain comes on gradually over the outside of the knee during a run. The pain usually appears within a few km of a run and increases in intensity. That same area can also be tender to touch.

Pathophysiology/Etiology

There are a couple theories on the pathophysiology of ITBs.

Some researchers believe that ITB inflammation is a result of excessive friction between the ITB and the boney prominences which occur when the ITB slides over the boney structure and causing inflammation during repetitive movements such as running. Others have argued that rather than the ITB band causing excessive friction, the inflammation is caused by the ITB compressing an area of highly innervated fatty tissue between the IT band and boney prominence

Contributing Factors to Developing ITB Syndrome

The most common factor in developing ITBs is an increase in exercise intensity through mileage, hill training or speed work.

Other reported possible causes which may increase tension in the ITB by altering hip and knee angles include:

  • Downhill running
  • Wearing old shoes
  • Always running on same side of road
  • Leg length discrepancies
  • Excessive pronation of the foot (foot rolling inward)
  • Tight ITB
  • Weakness of glute medius muscle

ITBs and Running Biomechanics

It has been suggested that injuries can manifest as a result of an increase in exercise intensity beyond a threshold level, combined with certain intrinsic factors in athletes.

A recent systematic review looked at biomechanical variables and investigated whether distance runners who suffer from or develop ITBs have different biomechanics than runners who do not develop ITBs.

The evidence shows that it is unlikely that abnormal biomechanics at the foot or shin bone can contribute to increasing tension of the ITB.

The results suggest more is happening at the hip and knee. Runners who eventually develop ITBs have more internal rotation at the knee and greater glut medhip adduction angles during the stance phase of running (when the foot is in contact with the ground) compared to healthy controls.

Some researchers have found that this internal rotation of the knee is due more to an externally rotated femur (thigh bone rotated outside) and suggests this may be due to insufficient activity in the medial rotators of the hip (gluteus medius, gluteus minimus, TFL).

As for muscle strength and endurance, there is currently no evidence to suggest that reduced muscle strength plays a role in ITBs. However, the research is limited because many of the trials give inaccurate impressions of a muscle’s functional strength. Future research is needed to look at the timing of muscle action rather than the magnitude of strength.

Research also suggests that runners with current ITBs tend to have more trunk flexion than healthy controls. It is uncertain whether the increased trunk flexion is due to a tight ITB or if the ITB becomes tight as a consequence of the flexed trunk (aka: the torso leaning forward)

How do we treat it!?

Stay tuned to my next article on the latest evidence for treating and managing ITBs!

References:

Foch et la. Associations b/n IT band injury status and running biomechanics in women. Gait & Posture. 2014.

Louw & Deary. The biomechanical variables involved in the aetiology of iliotibial band syndrome in distance runners – a SR. Physical Therapy in Sport. 2014

When it comes to performance, there’s no doubt that nutrition plays a significant role. In the past, I’ve really focused on acute nutrition: what you can do directly before or during your run to be faster (i.e. here).

training and performance

An area I have neglected to focus on is what you should be doing from a nutritional standpoint on an on-going basis to stay healthy and perform at your best. One key area that I see as a recurring problem in my practice and athletes around me is iron deficiency anemia.

Iron has a number of roles in the human body. The most important function is how it is incorporated into hemoglobin and myglobin to facilitate oxygen transportation. If these proteins decline, our ability to transport oxygen to our working muscles also drops, and performance plummets along with it (such as here and here).

CLICK HERE to read more in the RW Magazine

Well, it’s safe to say that the hot summer days of running are here! With many big races on the horizon, including the Waterloo Classic, it’s important make sure we do our best to prepare for the additional challenge heat provides.

gregIt’s a topic I wrote about briefly in the past, but this week I wanted to take a closer look at things. Two strategies I discussed before were (1) getting acclimated to the heat and (2) pre-cooling.

Both of these strategies make sense logically.  If you practice running in the heat, your body will be better equipped to handle it. In the case of pre-cooling, if you start with a cooler body temperature, then there is more wiggle room before your body really has to make the push to cool off. But what does the research show, and how well does each strategy work?

Click HERE to read the rest in the RW Magazine.

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