Running Injuries: Prevention From The Ground Up Part 1

By Kirsten Carmichael DPT, CSCS, SFG I, MFDc

I frequently get to work with runners and one common complaint is with foot/ankle discomfort or pain.  I decided it would be great to provide some preventive tips and tricks starting at the feet and working my way from the ground up.  These are also great tips for other athletes who may be experiencing similar problems.  Give them a try! 

First, many problems up and down the leg can occur from a limitation in ankle mobility.  To test this you can stand with your toes about 5 inches away from the wall in a lunge position.  Keeping your heel on the ground, bend your knee and reach it as close to the wall as possible.  If your knee easily touches the wall your mobility is looking good.  If you can't reach the wall without your heel lifting or feel stiffness in your ankle then this is an area to work on.  In the same position as the test (see video below) you can perform some active glides.  We recommend performing 10 repetitions on each side. 

Next, there are some great tools to keep your soft tissue mobility looking good.  One awesome tool for plantar fascia health is rolling on a lacrosse ball.  Simply place your foot on top of the ball and roll along the ball of your foot, the inner arch, and along your heel.  If you feel any tight or "crunchy" areas then give these spots a little extra love.  

You also want to make sure the soft tissues in your calves stay loosened up.  Sometimes using a foam roller for this area can be a bit awkward so I prefer to use a stick.  If you get in a half kneeling position as shown you can also get a little extra stretch on the calf as you roll.  If you find any "bumps" in the road you can move the stick (as shown) side to side to create a cross sectional release.  I usually recommend 10 rolls up and down on each side again spending a little extra time on any trouble spots. 

Now that you've mobilized your ankle joint and soft tissues you want to stretch in that newly found range of motion.  A good gastroc stretch is first on the list as shown.  Make sure you keep that toe pointed straight ahead and your heel on the ground. 

Deep to that gastroc muscle is the often neglected soleus muscle.  As shown below move the back foot in just a bit and give the knee a bend to stretch this guy as well. 

Finally, after all of this mobilization and stretching it is great to reinforce those deep muscles that support your arches.  A great way to get this started is called "arch doming". In standing you will focus on grounding your big toe and making an arch along the inside of your foot (see video below).  I usually recommend 20 repetitions. 

Definitely give all of these a try pre-run or work out to make sure your mobility and stability are in check before you load the system.  Performing some of the soft tissue release and stretching after can also be beneficial if anything has tightened up along the way.  Over time you will develop a beautifully balanced foot and ankle and prevent any future issues! 

Hope you found these tips useful!  If you are still experiencing any pain or discomfort contact us!  We love nothing more than to help athletes perform pain-free and at their best! 

Follow our blog, Instagram, and Facebook (@gonextlevelpt) for upcoming posts with more tips and tricks and all things sports releated! 

Is there a higher risk of lower extremity injury after a concussion?

By Kirsten Carmichael DPT, CSCS, SFG I, MFDc

I always have my eye out for the latest research in the world of concussions and some very interesting studies have been emerging lately. The question being asked is do athletes have an increased risk of sustaining a lower extremity injury following a concussion?

One study by Lynall et al in 2015 retrospectively looked at injury data in Division I collegiate athletes.  They found these athletes were almost twice as likely to experience lower extremity musculoskeletal injury after concussion when compared with controls.

Another more recent study in May 2017 found similar findings with collegiate athletes.  Herman et al reported that the odds of sustaining a musculoskeletal injury were 3.39 times higher in the concussion athletes.

Yet another recent study by Lynall et all published in November 2017 looked at high school athletes. This study found that for every previous concussion, the odds of sustaining a subsequent time-loss lower extremity injury increased 34%.

So, what gives with all this increased injury risk?  It is suspected that lingering deficits in gait and dynamic balance may have something to do with it.  Lynall et al has proposed there may be reduced cortical excitability impairing the brain’s ability to effectively control and coordinate movement after concussion.  Further, this may have something to do with delayed reaction and movement time.  If we think about this in relation to the high physical and cognitive demands of athletics it is easy to see where the potential for injury may occur.

With this information how do we make a change to help lower the risk?  Currently many concussion protocols primarily utilize neurocognitive testing, static balance tests, and symptom reporting.  It is proposed that utilizing more functional balance assessments would be beneficial (especially using sport specific tasks such as cutting and jumping).  This sounds a lot like what I do at Next Level in my exertion assessments.  During an exertion evaluation the athlete completes multiple dynamic tasks testing the vestibular system at high levels and elevating the athlete’s heart rate.   We consider the specific nature of each sport and look to progress all aspects before return to play including cutting, changing direction, accelerating/decelerating, jumping, running, throwing, coordination, reaction time, and cognition.  The goal of future research will be to take a deeper look at functional movement after concussion and come up with a dynamic assessment that is easy to implement in our concussion protocols across all levels of athletics.

Exertion Physical Therapy-where we jump, cut, change direction, and get sport specific :)

My take home message from this research is that concussions are something that should be taken seriously for many reasons.  If you have a concussion it is important to get evaluated to make sure everything clears (including those dynamic balance and sport specific tasks) before returning to sport to avoid the risk of musculoskeletal injury.  Hopefully soon everyone in athletics will have more detailed assessment tools and we can see the incidence of these injuries go down.

References

Lynall RC, Mauntel TC, Padua DA, Mihalik JP. Acute lower extremity injury rates increase after concussion in college athletes. Med Sci Sports Exerc. 2015;47(12):2487-2492.

Herman DC, Jones D, Harrison A, et al. Concussion may increase the risk of subsequent lower extremity musculoskeletal injury in collegiate athletes. Sports Med. 2017;47(5):1003-1010.

Lynall RC, Mauntel TC, Pohlig RT, et al. Lower extremity musculoskeletal injury risk after concussion recovery in high school athletes. J Athl Train. 2017;52(11):1028-1034.

Post Concussion Physical Therapy

By Kirsten Carmichael DPT, CSCS, SFG I, MFDc

How does a Physical Therapist help someone post-concussion?

Most concussions (80-90%) will resolve within a 7-10 day time period.  For a small percentage of people symptoms last beyond 2-3 weeks and in these cases a Physical Therapist may be able to help.

The vestibular system located in the inner ear senses motion of the head and helps stabilize your eyes while you are in motion.  If the vestibular system is disrupted you may continue to experience dizziness, sensitivity to motion, difficulty balancing, etc. 

Testing eye movement during an evaluation

A Vestibular Physical Therapist can provide a detailed assessment to determine the nature of your symptoms and begin exercises to help the system adapt and heal. 

Training convergence with a Brock String

Balancing on an unstable surface and getting in some rotational work

A Physical Therapist can also address any underlying issues with the neck that may present with a concussion.  It is always important to assess if dizziness and headaches are actually coming from the cervical spine.  We also initiate cervical strengthening exercises as early as possible.  Strengthening the neck has been found to reduce the odds of concussion which is important when returning to sport.

Working the scapular muscles and strengthening the neck wearing a special cervical weight

 Research has also found that getting moving as soon as possible after a concussion is important.  With exertion therapy we monitor you through a progressive and sport specific return to play program. We work with your doctor to make sure you are ready to return to sport. Additionally, we make sure you have regained your strength, agility, plyometric, and reaction time to prevent any future musculoskeletal injury.

Heart rate monitor on and ready to get moving on the Airdyne bike

Working on some dynamic stability training

  Higher level training challenging the vestibular and cardiac systems in multiple                                    planes

If you are experiencing lingering concussion symptoms contact us and see what we can do to help you get back in the game!

Lessons Learned in the Land of Kettlebells

By Kirsten Carmichael DPT, CSCS, SFG I, MFDc

I distinctly remember having a conversation about kettlebell training with a patient a year and a half ago.  He asked if I had considered going for the Strong First certification and my initial reply was I just didn’t know if my shoulder was up for that.  I have been dealing with a labral tear from my years of volleyball and completing the snatch test (100 snatches with a 16 kg/35 pound bell in under 5 minutes) and overhead pressing with the same weight seemed like a daunting task.  However, the leaders in my Physical Therapy and Strength and Conditioning world (Cook, McGill, Liebenson, and of course Brett Jones, etc) reference kettlebell training and the work of Pavel frequently.  Naturally the next step in furthering my education was to sign up, buckle down, and see how things went.

                I have been using kettlebells for years with my patients as they are one of the most versatile tools for training functional movements.  I have never trained with the level of intent and focus as when I first met with my kettlebell coach (Craig Valentine, Loomis Kettlebell).  Fast forward through months of training (and special love to my shoulder with lots of arm bars, carries, and heavy get ups) and I passed my certification last weekend in Denver, Co.  There were a few shoulder hiccups along the way, but my awesome Strong First leaders helped me manage through all the high-volume work.  I wanted to share a few of the things I learned through this experience. It was one of the best and most rewarding events I have ever been through.

Sweaty and starving after completing the SFG certification

1.)    Kettlebell training has made me stronger than ever before.  The focus on stabilizing and strengthening my shoulder lead to some heavy get ups that I would never have thought possible.  I also can press a 44 pound kettlebell overhead without any shoulder pain. My training program was not fancy but man has it been effective in making me strong.  

2.)    You don’t need fancy equipment for an awesome work out.  Kettlebells are a simple piece of equipment that allows you to work your entire body.  Build strength, build endurance, train your stability…you can do it all.  Plus, they are portable.  Mine came on the road with me many times.

Tucker and my traveling bells 

Camping kettlebell

3.)    Kettlebell training reinforces seeing the big picture and looking at movement as a whole.  This has reinforced all that I have learned in the land of FMS (Functional Movement Screen).  As I was assessing a team member's dead lift at the course my instructor advised me to literally take a big step back and look at her, and the problem area jumped right out at me.

4.)    Kettlebell training transferred power to other areas.  I watched my vertical jump improve.  When I was home for Thanksgiving I decided to do some interval hill runs and felt like I was flying.  Even though I hadn’t been specifically training these things my kettlebell training improved them.

5.)    There is nothing more functional than kettlebell training and it is a tool that can be utilized by everyone.  The movements can always be progressed or regressed.  There is truly nothing more functional than getting up from the floor, squatting, picking something up from the floor, and carrying heavy things.  

Overall, I had a wonderful experience and am so excited to start incorporating all of the new things I learned into my physical therapy and coaching (as well as my own training).  Good thing there is no shortage of kettlebells over here!