Evan Culbert / December 14, 2021
  • Calf Strain Rehabilitation

    / September 1, 2021
  • Prioritizing your training – what’s most important?

    Evan / July 9, 2021
  • Tips for Picking Running Shoes

    Caitlin / April 13, 2021
  • 5 Signs That Your Pain is Nerve-Related Pain

    Caitlin / December 17, 2020
  • Is running bad for your knees?

    Caitlin / October 9, 2020
  • Mostability – The Secret To Better Running

    Caitlin / October 1, 2020
  • Don’t Skip the Warm-Up and Cool-Down

    Caitlin / April 14, 2020

    By Larry / April 12, 2018
  • When Your Race Is Cancelled

    Caitlin / March 24, 2020
  • Pelvic Proprioception: It’s All In The Hips!

    Caitlin / July 9, 2020
  • Are you intrinsically or extrinsically motivated?

    Caitlin / July 15, 2020

    By Jessica / April 12, 2018
  • Strength Training for Runners

    Strength Training for Runners

    Caitlin / May 6, 2021
  • Calf Strain Rehabilitation

    / September 1, 2021

    Injuries to the calf and lower leg are all too common in runners and field sports athletes. A strain is loosely defined as a muscle tear or damage which can be acute, subacute or chronic. Calf strains are different from other soft tissue/muscle strains because of the structure and function of the calf musculature. There is constant force transmission between muscle fibers and the connective tissue bands between these fibers. Collagen tissue in the calf is also different than what you would find in other muscles.

    When running, 50% of your propulsion comes from below the knee. In steady-state running, the muscles in your calf are loaded up to 12.5 times your body weight. The calf is also fundamental in everything we do from walking, running, etc. It’s difficult to get out of NOT loading it.

    As we age, our muscles atrophy and our tendons become more compliant (see our previous post about tendons!). Research shows that by the time we hit 30 years of age, our calf muscles begin to atrophy. Just because you run does not mean your calves are strong. Most runners I see in the clinic cannot do 25 full single leg calf raises.

    Two Types of Calf Strains

    When it comes to calf strains, we are dealing with two potential injuries - a strain to the gastrocnemius (the major bulk of your calf) or a strain to the soleus (the deeper layer of the calf). Both of these muscles come together to form the Achilles tendon which attaches at the calcaneus, or heel bone. Differentiating strains in the gastroc and soleus is particularly important for an accurate prognosis, appropriate treatment, and successful prevention of recurrent injury.

    Gastroc Strain - the gastroc kicks in at terminal time points during plantar flexion and ramps up as we do things more intensely. It is a powerhouse of a muscle! Gastroc strains have a high speed and intensity component, usually a combined knee extension and ankle dorsiflexion mechanism. The gastrocnemius is considered at high risk for strains because it crosses two joints (the knee and ankle) and has a high density of type two fast twitch muscle fibers.

    Soleus Strain - the soleus is the workhorse of the lower leg and is critical in distance running. Half of soleus strains occur with no clear event. Symptoms include post-activity tightness or tightness during a run that gets worse throughout. Unlike the gastrocnemius the soleus is considered low risk for injury. It crosses only the ankle and is largely comprised of type one, slow twitch muscle fibers. Soleus strains also tend to be less drastic and traumatic when compared to gastroc injuries.


    When it comes to rehabbing these injuries, your timeframe will depend on the grade of the injury or muscle tear. Research shows that injuries that occur more acutely have a significantly longer time to return to play, around 24 days average. Over the first couple of days to a week, stretching and lengthening of the muscle should be limited. If muscle contraction is painful, walking or weight bearing should be limited. Patients may need to wear a boot or use crutches to limit active ankle plantar flexion until pain-free walking can be achieved. Heat and massage are also usually avoided during these early stages.

    Return To Run

    Before returning to run, walking should be pain-free, range of motion restored, and calf strength comparable to the unaffected leg. The calf needs to develop the endurance and load capacity to withstand the demands of running and jumping. Too many runners make the mistake of rushing back to get that first run in and the risk of re-injury is heightened. Over half of the reoccurrences of calf strains occur within he first two months following initial injury. Developing calf resiliency requires a comprehensive rehab program which starts simple and builds in complexity and sport specificity.

    If your calf pain lingers or returns, it might be time to take a look at your biomechanics and anatomy. Are you loading one leg more than the other? Does your foot strike lead to excess force through your plantar flexors? Is your hip, knee and ankle mobility sufficient for gait? Is your tendon elasticity poor? With calf strains that suddenly appear out of nowhere, the low back and spine should always be cleared. If you’ve suffered from a recent calf strain or are dealing with chronic calf issues, consult your PT or other medical professional for rehab guidance.


    Dixon, J. B. (2009). Gastrocnemius vs. soleus strain: how to differentiate and deal with calf muscle injuries. Current reviews in musculoskeletal medicine, 2(2), 74-77.

    Green B, Pizzari T. Calf muscle strain injuries in sport: a systematic review of risk factors for injury. Br J Sports Med. 2017 Aug;51(16):1189-1194. doi: 10.1136/bjsports-2016-097177. Epub 2017 Mar 4. PMID: 28259848.

    Orchard, J. W., Intrinsic and Extrinsic Risk Factors for Muscle Strains in Australian Football. The American Journal of Sports Medicine 2001,29 (3), 300-303.

    Van Middelkoop M, Kolkman J, van Ochten J, Bierma-Zeinstra S, Koes BW (2008) Risk factors for lower extremity injuries among male marathon runners. Scand J Med Sci Sports 18: 691–697. doi: 10. 1111/j.1600-0838.2007.00768.x PMID: 182667

  • Prioritizing your training – what’s most important?

    Evan / July 9, 2021

    Stephen Seiler’s Hierarchy of Endurance Training Needs

     Maslow’s Hierarchy of Needs. If you’ve ever taken a psychology class, this might ring a bell. It theorizes that humans are motivated by a hierarchy of needs – we need to have our basic physiological needs met before we worry about other things like our happiness. In other words, if someone is starving, they aren’t too concerned with their self-realization.

    So why are we talking about a topic from my college psych class in a blog about endurance training? Because sports scientist Stephen Seiler created a “Hierarchy of Endurance Training Needs” that mimics Maslow’s hierarchy that will help you train smarter! Much like Maslow’s hierarchy, Seiler’s model draws upon the evidence to illustrate the most important “needs” that athletes should fulfill before worrying about other “needs,” or aspects of their training.

    Here are Seiler’s eight “needs” of training, beginning with the base of the pyramid, aka training priority #1:


    Total Frequency / Volume of Training

    The most important “endurance training need” in Seiler’s hierarchy is total training volume. His research shows that the first thing you should look at in order to improve your fitness and race performance is to increase you total training load. Now, two crucial things to note when taking this into account:

    • The majority of your training sessions should be low intensity.
    • Increasing volume is only going to help you if it is sustainable and consistent.

    While increasing training volume may make you a better athlete, getting injured from ramping up your volume too quickly or doing a week of super high volume and then crashing from fatigue for a few days following will not work so well. The bottom line here is that increasing training volume and frequency is the most important and beneficial thing you can do as an endurance athlete IF you are able to do so gradually in a manner that will allow you to sustain a higher volume consistently over time without injury.

    High-Intensity Training

    The next “need” to take into account after increased overall training volume is high intensity training. Endurance athletes should include high intensity workouts aiming to hit > 90% of HRmax. Don’t get too caught up in the specific intensity level – Seiler’s research has shown that accumulating more time at a slightly lower intensity is better than less time at a higher intensity. For example, intervals of 4x8 minutes at 90% HRmax would be better than 4x4 minutes at 95% HRmax. For this range of above threshold intervals, 2 minutes has been shown in studies to be the sweet spot for rest intervals. How much of your training should be at this level of intensity? That brings us to the next step on the pyramid.

    Training Intensity Distribution

    The bulk of training (about 80% of sessions) should be low intensity, kept below 80% of your maximum heart rate. The rest of your training sessions (~20%) should include high intensity, above 90% of HR max. Seiler’s research has taught us a lot about polarized training, and has made popular this “80/20” principle of training – keeping roughly 80% of training low intensity and the remaining 20% including high intensity.

    Something worth noting is that the “80/20 rule” is a measure of number of training sessions, not total volume/minutes of training. So if you do 10 training sessions a week, 2 of them should include some high intensity.

     So, to summarize the 3 most important training components: including more, low intensity training volume will increase fitness, and 20% of training sessions should include high intensity intervals. Triathletes, can bump this number up a bit since there are 3 different sports to train (i.e. 1-2 sessions of high intensity intervals per sport during the week).

    General Periodization Details

    Training periodization is a means of breaking a training season into “periods, “blocks,” “cycles,” or whatever you want to call them, and has been a popular method of structuring training since the 1960s. Seiler has found that the details of how you periodize (hope that’s a real word) is “likely overrated.” Not to say that periodization is all a bunch of bologna, but rather that the research is showing various periodization approaches end up with similar results, and the specific method of periodization is not going to make or break your performance. Keep in mind that this is provided that you are fulfilling the first three needs of the pyramid, which are well established in research and should be a priority over what specific periodization plan you have in place.

    Sports-Specific and Micro-Periodization Schemes

    Going a step further in relation to periodization, Seiler describes micro-periodization schemes as having a modest effect on performance. This refers to how you structure your training week, and distribute your higher and lower intensity workouts, along with your rest. There is room for more research here, but listening to your body and spacing workouts appropriately so that you can ensure enough recovery between harder sessions is a good place to start. Multiple high intensity sessions in a row, or going too hard during low intensity training sessions can negatively impact high intensity sessions. Micro-periodization, or how you structure your training week allows you to get the most out of both training and recovery (both important)!

    Training Stimuli Enhancement

    Is it weird to ride the trainer in the bathroom with a space heater and hot water running? Yes. But, it might be a good idea if you are going from a cold environment to a hot climate to race. Seiler’s take based on existing research is that training stimuli enhancement like heat training or altitude training have “potentially important effects, but they are individual and condition specific. It is much more valuable in preparation for a hot race or a race at altitude. Also, keep in mind that it is more important to prioritize the other needs discussed above in order to improve performance.

    Pacing Training

    Pacing training can be “decisive if everything else is done right.” Adding pacing training to learn how and practice proper race pacing can make sure that you maximize your potential and the fitness you have built by following the other “needs” of this pyramid to achieve a good race result.

    Training Taper

    Taper is another potentially decisive component when it comes to race day performance. This is the peak of the pyramid – you have built up fitness by fulfilling the other components of the endurance training hierarchy, and the lead up to your race can ensure that you are in good form take just the right amount of rest to perform your best on race day.


    To see more of Stephen Seiler’s Research, including more on his “Hierarchy of Endurance Training Needs,” you can find him here: https://www.researchgate.net/profile/Stephen_Seiler

    Seiler, Stephen & Sylta, Øystein. (2017). How Does Interval Training Prescription Impact Physiological and Perceptual Responses?. International Journal of Sports Physiology and Performance. 12. 1-22. 10.1123/ijspp.2016-0464.

    Seiler, Stephen. (2016). Seiler's Hierarchy of Endurance Training Needs.. 10.13140/RG.2.2.16667.05924.


    Evan Culbert / December 14, 2021

    What is the Male Athlete Triad?

    Over the past 30 years, research has developed our understanding of the Female Athlete Triad. More recently, research has shed more light on The Male Athlete Triad, a similar condition affecting men. While awareness about the Female Athlete Triad has grown in the endurance community, many are unfamiliar with The Male Athlete Triad.

    Each of these conditions fall under the umbrella of Relative Energy Deficiency in Sport, or RED-S, a broader condition affecting both women and men. These are problems related to prolonged training in an energy deficient state, aka a state of low energy availability in the body.

    Imagine the energy your body uses as money. This money is energy availability. For the sake of the metaphor, let’s call this, “energy dollars.” Eat breakfast? That’s a direct deposit of energy dollars into your body’s energy availability checking account. Going for a run? Time to make a withdrawal.

    This is how our body works (albeit very oversimplified). You wake up and eat a bagel. Boom, 5 energy dollar deposit – you have energy available and are ready to run. Your run costs you 3 energy dollars. Your body makes physiological adaptations and you become a little faster.

    Let’s say after you eat your bagel ($5 deposit), you go for a long run that costs 6 energy dollars and overdraft your checking account. That’s okay, your body can take out an energy dollar from your savings account – energy stored elsewhere in the body. Afterwords, you refuel, and your body builds back stronger. 

    But let’s say you don’t refill your accounts. And you do this day after day. Your checking and savings accounts are running dry, you’ve spent all your energy dollars and you go into energy debt. You are training in a state of low energy availability. Let’s step away from this kooky metaphor for a minute to look at a study:

    In this study, runners reduced energy intake 50% of daily needs and ran 60 minutes on a treadmill every day for 3 days. This caused a 15% decrease in bone formation. In just 3 days! When we continue training in an energy deficient state, with an empty energy availability bank account, our body shuts down other critical processes in our body because there just aren't the funds for it. We have no resources to direct towards building back bone or recovery because in our low energy availability state, everything we have is going towards training. The longer we train with improper fueling, the more these effects are compounded. This is the root of Relative Energy Deficiency Syndrome, or RED-S, and it can manifest in dysfunction of metabolic rate, menstrual function, bone health, immunity, protein synthesis, cardiovascular health, and other bodily systems.

    The Male and Female Athlete Triad’s each involve 3 interrelated conditions secondary to training in an energy deficient state. The Female Athlete Triad was coined prior to RED-S over 30 years ago. It consists of low energy availability, altered bone mineral density, and menstrual dysfunction. Increased research in recent years on the Male Athlete Triad has furthered our understanding of the condition, and like The Female Athlete Triad it is important to know how to recognize and address it.

    What is the Male Athlete Triad?

    3 interconnected conditions make up the triad:

    1) Low energy availability (EA) – put simply, more energy is going out than coming in. To return to our metaphor, the body is operating without energy dollars in the bank and is paying for activity with credit – other bodily functions are suppressed as the athlete continues to train in an energy deficient state. Low EA can be present with or without disordered eating. 

    2) Impaired Bone Health – as illustrated by the study mentioned above, operating in an energy deficit has significant impact on the body’s bone health. Low bone mineral density is present in a bigger proportion of lean-sport athletes like runners, swimmers, jockeys, and cyclists. 

    3) Suppression of hormone function – Specifically, the hypothalamic-pituitary gonadal (HPG) function, resulting in decreased testosterone concentrations and decreased sex drive.

    It is important to note that the male athlete triad is a continuum. There is no exact threshold value of energy availability that once crossed leads to metabolic changes and dysfunction. Instead, we see a spectrum: on one end we see optimal energy availability, bone health, and hormonal function, and on the other severely low energy availability, osteoporosis/possibly bone stress injuries, and Hypogonadaropic Hypogonadism (negative hormonal changes). These changes happen over time when training with low EA. When caloric intake is not enough to fulfil the cost of training load, athletes begin to go into “energy debt.” Initially, athletes may be able to perform well in a state of low EA, but it is not sustainable as they will continue to move towards the unhealthy end of the spectrum. 

    Athletes with or without disordered eating can experience the Male Athlete Triad. 8% of male athletes develop eating disorders, and this number is higher among “leanness sports” like running, swimming, and cycling. Unintentional undereating can also lead to low energy availability. However, it is not always a simple equation of caloric intake equaling energy expended during training to avoid going into energy debt. Oftentimes athletes fail to consider the impact of being a human being and dealing with the daily stressors of life! Life load and the stresses that come along with it can have an impact on our energy availability. Jobs, school, relationships, sleep, stress, quality of food, and difficult life events are all important parts of the equation that demand energy, and are important for any coach, athlete and clinician to remember. 

    Male athletes that continue to train with energy debt, aka in an energy deficient state, begin to demonstrate objective changes that indicate long term energy deficiency. This is as a result of not having energy remaining after the cost of exercise for the body’s basic processes, and includes:

    • Changes in metabolic hormones (i.e., decreased testosterone)
    • Lower resting metabolic rate (RMR) - the body suppresses the energy directed towards basic bodily processes to conserve energy
    • Changes in body weight and composition

    Subjective indicators and symptoms are also important to monitor and can warrant further screening. Examples include:

    • Persistent fatigue and lethargy – this one can be tricky. For many endurance athletes, fatigue is a part of training. We all know the feeling of being in the middle of a training block and feeling tired just walking up a flight of stairs. Fatigue is a part of endurance sports. However, concerning signs may include feeling fatigued after appropriate rest days, when expected to be relatively fresh for intense training sessions, or fatigue that carries through tapering.
    • Decreased libido and the absence of morning erections
    • Decreased beard growth – needing to shave less often
    • Negative performance changes in their sport
    • Mood changes that are unaccounted for
    • Getting sick more often than normal
    • Recurring injuries

    These can occur over weeks to months of training in a depleted state. It is important to evaluate these changes and symptoms in conjunction with one another. Low BMI for example is a common characteristic among runners but alone does not mean an athlete has low energy availability. One indicator is not enough to diagnose RED-S or the Male Athlete Triad; it is a multifactorial condition and should be evaluated and treated as such. Keep an eye out for a part two on this topic with information on how to screen for, evaluate, and manage athletes experiencing The Male Athlete Triad.


    Mountjoy M, Sundgot-Borgen J, Burke L, et al. The IOC consensus statement: beyond the Female Athlete Triad—Relative Energy Deficiency in Sport (RED-S). British Journal of Sports Medicine 2014;48:491-497. 

    Nattiv A, De Souza MJ, Koltun KJ, Misra M, Kussman A, Williams NI, Barrack MT, Kraus E, Joy E, Fredericson M. The Male Athlete Triad-A Consensus Statement From the Female and Male Athlete Triad Coalition Part 1: Definition and Scientific Basis. Clin J Sport Med. 2021 Jul 1;31(4):335-348. doi: 10.1097/JSM.0000000000000946. PMID: 34091537.

    Fredericson M, Kussman A, Misra M, Barrack MT, De Souza MJ, Kraus E, Koltun KJ, Williams NI, Joy E, Nattiv A. The Male Athlete Triad-A Consensus Statement From the Female and Male Athlete Triad Coalition Part II: Diagnosis, Treatment, and Return-To-Play. Clin J Sport Med. 2021 Jul 1;31(4):349-366. doi: 10.1097/JSM.0000000000000948. PMID: 34091538.

    Raj MA, Creech JA, Rogol AD. Female Athlete Triad. 2021 Aug 14. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan–. PMID: 28613538.

  • Tips for Picking Running Shoes

    Caitlin / April 13, 2021

    One of the most common questions we get from our runners is in regard to what kind of running shoe they should wear. This happens to also be the most difficult question to answer straightforward! Running shoes are highly subjective and what works for one person may not necessarily work for another. There are so many different brands and models on the market that it can be a bit overwhelming to know where to start. Below we break down a couple of the important concepts when it comes to running shoe style to help you make the best choice.

    Do you need stability or neutral shoes?

    Stability and motion-control shoes were historically designed to decrease excessive motion at the foot and ankle, such as excessive pronation. Neutral shoes are lighter, a bit nimbler, and allow the foot and ankle to move more naturally. The most important thing to remember when it comes to running shoes is that shoes do not run, PEOPLE do. When a runner is considering what type of shoe he or she needs, controlling motion may not the best approach. Footwear doesn’t necessarily stop or improve any type of foot motion. And often times, people would rather spend money than do the work it takes to improve their bodies and their feet.

    We’ve all been told that pronation is bad, but in reality, pronation is a necessary part of the ankle’s shock absorbing system. The issue arises when that motion is uncontrolled due to poor foot and ankle intrinsic strength. Excessive motion at the foot and ankle can lead to a whole host of issues up the chain including plantar fasciitis, Achilles tendinopathy, knee pain and hip pain. As a physical therapist, my first line of defense is always to train the body to handle the demands of running. It is a much more sustainable, long term approach to healthy running. A stability shoe can be used in the interim to reduce these forces while a runner is working on improving foot and ankle control, but it should not be a permanent, long term solution.

    Lots of cushion vs. minimal cushioning. Which is better and why?

    This is a hot topic in the footwear industry right now, with the current trend towards highly cushioned shoes with carbon plates and large stack heights. Did you know that your running mechanics change based on your shoe’s stiffness and the material it is made out of? Shoes with lots of cushioning and a large stack height bring our feet further off from the ground, and as a result, our body loses its sense of where the ground is (or its proprioception). This sensory information from our environment is important because it tells the foot how to properly load the body when it hits the ground. With so much material between the foot and the ground, highly cushioned shoes can create a disconnect between the feet and the brain, causing weak feet and issues up the kinetic chain.

    We do know that when you run barefoot, you increase your cadence and you have a shorter step length. In shoes, you put greater negative forces through the knee and the hip because you land stiffer. Imagine running on the beach barefoot as the sand moves underneath your feet. Your body naturally stiffens up as a response to that unstable surface. So, is the answer barefoot running? Absolutely not. Yes, our feet are designed to function without the need for shoes or orthotics, but our bodies are not designed to pound miles and miles of pavement and concrete, like we do in our modern world. Unless you’ve been walking around barefoot your whole life, you probably need some protective, shock-absorbing material between your feet and the road.

    Another thing to consider is the heel height of traditional running shoes. A higher heel-to-toe drop (the offset between the height of the back and the height of the front of the shoe) shifts the low back into extension and puts the load through the knees. This moves the body towards a more quad-dominant position and makes it harder to engage your glutes (the backside of the hip, a runner’s powerhouse) when running.

    I always direct my runners towards a shoe in the middle of the spectrum in terms of stack height, cushioning and heel-to-toe drop, unless they already run in minimalist shoes with no problems. If you’re an urban runner and log most of your miles on hard surfaces like pavement and concrete, it might be worthwhile to have a pair of cushioned shoes in your closet to use occasionally for minimizing the harsh impact of those surfaces. I also recommend my runners rotate through a couple different types of shoes, so they aren’t running in the same shoe every day.

    Racing flats vs. everyday trainers.

    Racing flats differ from everyday trainers in that they are designed to be lighter, faster and more minimal than the traditional training shoe. A racing flat has enough cushioning for a distance race, but is essentially a stripped down, faster version of a trainer. And racing flats are proven to be faster than trainers. Racing flats are a great compliment to your training for faster efforts like tempos and threshold intervals, especially if you plan to race in your racing flats. They give you a better feel for the ground and do a better job and teaching your foot and ankle how to act as a shock absorber and propulsive force. However, I wouldn’t recommend using them for a majority of your runs because they are more minimal, especially if you primarily run on harder surfaces. If you already have a dependable pair of trainers and are looking for a secondary shoe, a racing flat or slightly lighter, more minimal trainer can be a great compliment to your training.

    Does brand really matter?

    Prominent biomechanist Benno Nigg published a heavily referenced study about running shoes that found that comfort, above all else, was the best determinant of a shoe’s utility. How well the shoe fits your unique foot and how it feels is more important than any flashy technological advancement. That being said, try on a bunch of different shoes to see what feels and works best for you.

    As a PT, I rarely recommend a particular brand of shoe to my runners. Instead, I give them guidelines for the technical aspects they should be looking for in a shoe (level of cushioning, heel-to-toe drop, stack height, midsole stiffness). Be well informed before you walk into a running store and don’t buy into the hottest, flashiest shoe craze on the market.

    Is it better to go to a store to try on shoes or can I order a bunch online?

    Ideally it is best for you to be able to try different pairs of shoes on if you don’t have a good idea of where to start. Some online retailers will let you return shoes easily if they do not work for you. Some running stores also have lenient return policies that will let you try out the shoe for a bit before deciding to return it or not. Regardless of which outlet you choose, be sure to read all the fine print so you aren’t stuck with a shoe that ends up not working for you!

    Other important things to note

    Most running injuries are repetitive stress injuries that occur from the same stimulus or load applied to a tissue over and over again. Studies show that we can reduce injury risk by switching up your running shoes regularly. You can give your body a different stimulus by wearing a different shoe now and then which will put the foot in a different position and load different tissues.

    When considering switching from one type of shoe to another, depending on how far they are from each other on the spectrum of minimalist-maximalist shoes, allow your body a long period to transition. If you’ve been running in highly cushioned maximalist shoes, do not buy a new pair of neural shoe and start doing all your runs in them. There should be a transition period (anywhere from a couple weeks to a couple months) where you gradually introduce the new shoe to your body and your feet. This method of graded exposure is a much more effective way to get into a different type of shoe without increasing your risk for injury.

  • Strength Training for Runners

    Strength Training for Runners
    Caitlin / May 6, 2021

    Over the last year there has been a huge, and greatly welcomed, increase in those who have decided to lace up and get out the door for some miles, as well as a surge in those willing to conquer high mileage and virtual races, organized or not. Whether it be your first 5K or diving headfirst into the unknown trying to break PRs, there is always a goal ahead, even if it is just to make it out the door for a quick lunch break from zoom.

    Regardless of the running goals set ahead, the approach to running often looks similar - run, stretch (hopefully), and carry on with the day. And while that may be all the time that’s available on most days, it’s important to remember that there is more to running than just the miles.

    Strength training for runners is a necessary piece of the puzzle - it is not in itself inherently specific, but rather strength training that is done by runners to improve their performance.

    Strength training demands for a runner should center around 4 primary factors - increasing the ability to absorb and produce force, maintaining proper posture and mechanics throughout the stride, improving efficiency, and reducing injury and muscle imbalances. The goal of a strength training program is to complement your running, not interfere or set you back. How to properly program a strength training routine is the most challenging component when adding in strength training. Strength training is largely construed as a grueling, 60-90 minute ordeal that finishes in feeling absolutely gassed - and while there are components are meant to be exhausting and require effort, the goal is not to put you out for days on end and leave you questioning if you can still get your miles in.

    There are many ways to approach strength training for runners, depending on goals, needs, and current fitness level, however the one thing every runner has in common is that they will benefit from strength training. Running requires stability, strength, speed, and power, no matter the distance, speed, or level of athlete - strength training works to develop your body to handle these variables without the added mileage. Without any prior introduction to strength training, it can seem like a daunting endeavor to tackle - but with the right mindset, proper guidance and coaching, the idea of strength training as being an equally important component to your training as your running and recovery are will become well known.

    Runners can and will reap the benefits from strength training with just 2 days per week in 30-45 minutes per session. Depending on the stage of your training plan, you may choose to incorporate more or less strength work into your weekly programming, and depending on where you are at in your fitness, you may need to adapt some exercises to fit your current abilities. The bottom line with all strength training is to know that there is no specific right or wrong (unless your form is wrong) exercise, but there are more useful and less useful exercises that one should be doing in an effort to improve your running.

    The goal of strength training is to increase the ability to absorb and produce force, improve muscle recruitment, strengthen primary and accessory muscles required for a more efficient gait, maintain stability through the foot, knee, hip and trunk, and reduce muscle imbalances.

    That said, strength training should feel like you’re working, and it should span the entire spectrum - plyometrics, heavy weights, eccentric contractions, and balance.

    As we enter into the spring and summer, it’s often easier to want to get out the door more and pack on the miles - while running is the primary focus, don’t neglect the other factors that lead to a strong, healthy runner. If you’re new to strength training, or have no clue what you’ve been doing with your strength training, seek out a coach for some guidance or swing on in or reach out and we’ll gladly help you get started!

  • 5 Signs That Your Pain is Nerve-Related Pain

    Caitlin / December 17, 2020

    One of the most challenging aspects of my job as a sports physical therapist is determining what tissue in the body is the source of a patient’s pain. There are a variety of types of tissue sources of pain and sometimes an injury can cause multiple. Because all muscles, tendons and soft tissues in our body are innervated by nerves, a foot problem could very well be manifesting from a nerve-related problem else where in the body. Nerves run from head to toe so any kink or sensitivity long that nerve route can potentially cause pain (think kinks in a long hose).

    Nerve-related pain is a lot more common than most practitioners realize, especially in the athletic population. Probably 20% of injuries I treat in runners, cyclists and triathletes are actually nerve related pains that present as a muscle, tendon or other soft tissue injury.

    What is nerve pain?

    Nerve (or neurogenic) pain can occur any time a nerve is sensitized. This sensitization can happen at any point along a nerve’s trajectory - from the point where it exits the spinal cord in the spine, and along the the nerve’s route to any of our limbs. Once a nerve is irritated, it can be very sensitive to stretch, compression and even chemical changes (hormones, inflammation from another local tissue) in the body.

    Nerve pain can be peripheral (an irritation to the nerve along its route as it goes throughout the body’s limbs), or central (originating from the spine). Central pain can often refer peripherally to various parts of the arms or legs and mimic other orthopedic or musculoskeletal injuries.

    So how do you know if your pain is nerve-related pain? Nerve pain can be tricky to diagnose but there are few patterns that are worth pointing out:

    1. Your Pain Doesn’t Respond to Traditional Treatment - if a patient comes into my clinic with an injury that failed to resolve with other PT, I always look at the spine or for neurogenic symptoms. If you’re treating a distal injury and it is not responding, always look up the chain! I had a patient come in with lower leg pain that wouldn’t resolve with previous massage, dry needling, or soft tissue work. I looked further up into her hip and low back and found that her pain was actually referral pain along the sciatic and common fibular nerves.

    Traditional treatments for musculoskeletal injuries - soft tissue work, stretching, strengthening, dry needling - usually fail to resolve nerve pain if you are being treated peripherally. There is no injured tissue there. Aggressive foam rolling and stretching can also make an irritated nerve more unhappy.

    2. Your Pain is Dull, Diffuse, Hard to Pinpoint, or Moves Around - a soft tissue injury like a muscle strain or tendinopathy is usually pretty easy to pin down. Location and pattern of pain are fairly consistent and localized. Nerve pain can be elusive and difficult to pinpoint where it hurts. And palpating the tissue often does not result in that familiar pain (or any pain at all). If you feel pain in a certain area but touching that tissue does not result in that same pain, it’s likely what you are feeling is referred pain - pain referred to that area from a location further away. Nerve pain can be dull, achy, diffuse, sharp, shooting or accompanied by pins and needles.

    3. Your Pain is Variable and Doesn’t Relate to Activity Level - when patients come in with nerve-related pain, it is difficult for them to find a pattern of pain. It’s not predictable or consistent with their activity level. Sometimes they have pain from the first step of running, sometimes they don’t. Sometimes it gets better throughout a run, sometimes worse. They might also have pain just sitting on the couch. Sometimes the pain moves from one part of the body to another, anywhere along that nerve’s distribution.

    4. You Have Pain at Rest - this is an important one. Random jolts of pain just sitting on the couch or lying down in bed can signal nerve or referred pain. If the nerve pain is a result of nerve entrapment or compression elsewhere, rest will not make it better. Unless you have an acute orthopedic injury, having symptoms at rest can be a red flag for nerve pain.

    5. You Get No Answers From Diagnostic Imaging - nerve pain or an irritated nerve does not present itself on MRI or Xray. When a patient doesn’t respond to traditional PT, imaging is often the next route. So it can be disappointing when an MRI or Xray shows no pathology at all. An even more serious consequence is when the imaging shows pathology that isn’t necessarily related to that patient’s pain. I see this WAY too often and it can be even more psychologically damaging.

    1. Example #1: Patient with low back pain gets MRI and finds he has a herniated disc in his lumbar spine. He comes to me and I find out that his pain is actually referred pain from his glutes - it clears up after a few sessions.
    2. Example #2: Patient with anterior hip pain gets MRI to find she has a labral tear in her hip - she’s told she needs surgery to repair it. She comes to see me and I find out that she has a femoral nerve entrapment in the front of her hip.

    Common areas of pain in endurance athletes and possible nerve culprits:

    Injury/Area Possible Nerve Involvement
    Posterior pelvis, hip (butt) Cluneal, sciatic, obturator nerves
    Anterior and lateral hip and thigh Cluneal, sciatic, lateral femoral cutaneous nerves
    Medial thigh and knee Femoral, obturator nerve
    Lateral shin Superficial fibular nerve
    Medial shin Tibial nerve
    Lateral ankle Sural nerve
    Medial ankle Tibial nerve
    Bottom of the foot Medial and lateral plantar nerves
    Top of the foot and toes Superficial, deep fibular nerves


    All of these above areas of the body are also innervated by specific levels of the spine (L2, L3, L4, etc.). Pain in these regions could also be originating from your back or spine, what we call radicular pain. It's also important to note that every muscle has its own referral pattern. While not necessarily nerve-related, pain can present distally and still be coming from a muscle up the chain. Sound complicated? Not necessarily if you can recognize these patterns!

    So how do you treat nerve pain?

    Remember that water hose analogy above? When considering where to best target your treatment efforts, you need to consider the length of the nerve at play and where is runs. For healthy nerve conduction, the entire length should be uninterrupted and uninhibited. Gentle manual work can help to address any “sticky” areas along the nerve course, including where it originates in the spine.

    Sensitized nerves also respond best to gentle mobility to promote blood flow to the tissues. Functional dry needling with electrical stimulation can also be a fantastic tool for nerve and referred pain, as it can really target the release of tissues impeding the nerves, as well as provide signal input and stimulation to help the nerves properly fire

    So whether you’re a runner, a cyclist or a triathlete, be cognizant of the importance of the nervous system and the role it can play in your pain or injury. If you’re struggling with pain, make an appointment to see a physical therapist today!

  • Is running bad for your knees?

    Caitlin / October 9, 2020

    You’ve probably heard people claim that running is bad for your knees, that all that impact can lead to early development of osteoarthritis. Is there any basis for this traditional claim? Well, truth be told, there isn’t much. In fact, the prevalence of hip and knee osteoarthritis in recreational runners is 300% lower than in sedentary individuals.

    A quick anatomy lesson:

    Osteoarthritis (OA) refers to aging of a joint. It occurs when the protective cartilage in the joint wears down over time. Cartilage is soft tissue that helps to reduce friction between two bones, allowing you to move more easily. OA a COMMON side effect of aging (like graying hair or wrinkles). Symptoms include joint pain, stiffness (especially in the morning), and swelling. There are different grades of OA - Stage 1 refers to minor wear and tear, while Stage 4 is the most severe on imaging, often resulting in a joint replacement surgery.

    Research has shown that 40-50% of people 40 years of age and older have OA changes on X-ray but have NO pain. There’s also a lot of research out there comparing characteristics of these asymptomatic individuals to those with pain. Why do some individuals with OA have pain, and some do not?

    How does running improve knee health?

    In one research study, subjects started a 10-week running program. They had an MRI before and after the program. Researchers noticed that for those who started running, there were actual changes in their cartilage after 10 weeks. They found higher concentrations of glycosaminoglycans (GAGs) in the cartilage, which are important molecules for physiological functions. By attracting water in the cartilage, GAGs can make the cartilage more tolerant to loading. So over the course of 10 weeks, these runners improved the loading capacity of their cartilage, just by stimulating it with impact.

    A 2019 study by Horga et.al found that training for and running a marathon can also improve different features in the knee. Results showed that there was reversibility in the damaged subchondral bone of the tibia and femur in novice runners after training for and running a marathon.

    What does all this mean? 

    Well primarily, running does not wear out the cartilage in your knees! But there’s a slight caveat to that statement. In a study looking at changes on x-ray for hip and knee OA, researchers found that competitive (international or world class) runners had a 13.3% prevalence of OA, which was more than non-runners and sedentary people (10.2% prevalence). Recreational runners had only a 3.5% prevalence. So it appears that too much of a good thing can be, well… not as good. That’s not too surprising. But for recreational runners (even running up to 40-50 miles a week), you can reverse aging effects of the knee joint.

    How to safely run with OA

    We know that running is safe for those who have grade 1 or 2 knee OA. Based on current literature, running does not progress knee OA in people who run. If running isn’t painful, you can continue to run, even if you have OA findings on imaging. For those with mild OA, it is normal to feel something mild in the joint when you run, as long as symptoms return to baseline within the hour after you stop. In addition, there should not be any increase in stiffness or swelling the day after.

    If you are symptomatic, it’s important to consider load when planning your runs. Instead of long duration and less frequency, consider shorter but more frequent runs to reduce peak load and magnitude. It is better to distribute the load across more sessions so there is less load at a given time for the joint.

    For example, instead of 3 x 60-minute runs a week, try running 5-6x a week for 20-30 minutes each run.

    Running twice in the same day can also be helpful. You still get the adaptations but you’re staying under the body’s load threshold.

    Footwear considerations

    The new trend in footwear these days is cushion cushion cushion! Shoes companies claim that these maximally cushioned shoes take lots of force and load off the body. Most of you may also believe that by putting more cushioning under the foot, you decrease the impact forces and load through your joints. HOWEVER, it’s actually the opposite. Impact and loading (particularly at the knees) INCREASES in highly cushioned shoes.

    Consider how your body reacts when running barefoot on concrete vs running on sand or a trampoline (go ahead, try it and compare). We must stiffen up our bodies in response to more unstable surfaces, as opposed to landing softer on harder surfaces (try to land with a stiff leg on concrete… ouch!). Shoes change the way people run. The more cushioning, the higher the stack height, and the farther your foot is off the ground. If you cannot feel the ground under your foot because you have so much cushioning, you will inevitably land with a stiffer, harder leg. You won’t necessarily feel it with each step, but over time the load applied through the knee joint will be much greater than it would be with a neutral shoe.

    In Conclusion

    You can’t afford to NOT run for the health of your joints across your lifespan. Healthy loading stimulates positive adaptations, not only for your musculoskeletal system, but for every system in your body. If you’re running with OA, consider spreading out your runs so each one is shorter, but you’re running more frequently. In terms of what type of footwear is best, it’s also important to consider shoe’s level of cushioning. A highly cushioned shoe may not be the best choice to reduce excessive impact forces through a knee that has limited loading capabilities.

    Alentorn-Geli E, Samuelsson K, Musahl V, et al. The association of recreational and competitive running with hip and knee osteoarthritis: a systematic review and meta-analysis. Journal of Orthopaedic & Sports Physical Therapy.2017;47(6):c373-390.

    Davis IS, Rice HM, Wearing SC. Why forefoot striking in minimal shoes might positively change the course of running injuries. J Sport Health Sci. 2017;6(2):154-161.

    Davis, IS. Shifting paradigms in the approach to footstrikes, footwear and treatment of the foot. J Foot Ankle Res. 2011;4. 1-1. 10.1186/1757-1146-4-S1-A3.

    Horga LM, Henckel J, Fotiadou A, et al. Can marathon running improve knee damage of middle-aged adults? A prospective cohort study. BMJ Open Sport Exerc Med. 2019;5(1):e000586.

    Laskowski ER, Newcomer-Aney K, Smith J. Refining rehabilitation with proprioception training: expediting return to play. The Physician and Sports Medicine. 1997;25(10).

    Riva D, Bianchi R, Rocca F, Mamo C. Proprioceptive Training and Injury Prevention in a Professional Men's Basketball Team: A Six-Year Prospective Study. J Strength Cond Res. 2016;30(2):461-475.

  • Mostability – The Secret To Better Running

    Caitlin / October 1, 2020

    There's a lot of talk these days on the topic of 'mobility' in terms of sports performance and injury prevention. Runners are always looking for ways to improve performance while simultaneously avoiding those annoying overuse injuries. While mobility is one of the most important aspects of sport, it ties heavily into stability. You can't have one without the other. Mobility without stability and vice versa can lead to subpar performances, poor movement patterns and injuries. This leads us to the topic of MOSTABILITY = mobility + stability. Mostability is a term coined by Dr. Gary Gray of the Gray Institute to blend both elements to complete a desired task (i.e. running).

    MOBILITY = the ability of your joints to move through a given range of motion

    STABILITY = the ability of the body to maintain postural equilibrium and support joints during movement

    There’s a reason why we feel tightness in muscles or joints. Our perception of this tightness is not necessarily related to an overworked muscle and does not always mean that we should stretch it. But rather, the body’s nervous system is telling you that there’s instability in that region. Instability signals the brain and nervous system to put the brakes on because it feels threatened. It does this by borrowing stability from somewhere else to provide a sense of security. This is called compensation. This compensation is the tightness that we feel.

    As the Gray Institute says:

    “Just as important, but not as obvious is the 'mostability' of the pelvis when our foot hits the ground in running. At ground contact, the posterior-lateral muscles of the hip have a large role in decelerating the motions of the hip, knee, and foot created by gravity and ground reaction force. These muscles need the pelvis to be a stable base from which to generate force, but the pelvis is moving. So again, both stability and mobility are necessary. During running, the one foot will be in the air when a stable yet mobile pelvis is required. How does the pelvis remain stable while it is moving without the connection to the ground? The mass and momentum of the swinging leg, trunk, and arms all contribute to the ability of the pelvis to have 'mostability'.”

    So how can you incorporate mostability into your routine? Below is an example of an exercise that we use at BUILD to help runners achieve dynamic single leg strength, stability and mobility at the pelvis.


    The hip joint is a dynamic joint that can move in all 3 planes of motion. This exercise is great for runners in that it three dimensionally combines single leg balance, stability and mobility all in one. The focus should be on gaining mobility through the hip joint of the standing leg, so be sure to really open up your trunk, as shown in the video below. Performing the exercise barefoot may be more difficult but will yield better proprioception integration of the foot and ankle. Try it with body weights or with a dumbbell out in front for added trunk and shoulder recruitment.

  • Are you intrinsically or extrinsically motivated?

    Caitlin / July 15, 2020

    This is probably one of the most valuable pieces I’ve written this year. Cancelled races, lack of motivation, decreased compliance to training plans, etc. Those who take personal enjoyment in their activity of choice have been able to persevere throughout this pandemic, while those motivated solely by the finish line, finisher’s medal or the bragging rights have found themselves at a loss for what to do.

    Intrinsic motivation involves doing something because it is personally rewarding to you and brings you satisfaction. You genuinely enjoy and seek the growth of knowledge and personal development it brings you.

    Extrinsic motivation occurs when your behavior is dictated by an external factor pushing you towards a finish line (pun intended). You require a reward OUTSIDE of yourself to be motivated (training for an upcoming race, making the podium, or qualifying for a world championship, etc.).

    But this global pandemic has shaken our system, our normal way of functioning. Those of us who are extrinsically motivated have felt lost and without a sense of purpose. Some have been able to keep their motivation up with small goals, chasing KOMs, doing personal time trials, but not everyone.

    So which form of motivation is the most sustainable? In my experience, the constant high of chasing external finish lines, podiums and KOMs diminishes over time, can lead to burnout, and can actually decrease someone’s intrinsic motivation. Rewards have their uses, but intrinsic motivators hold the real power, satisfaction and longevity.

    If you’re a finish-line chaser who has been struggling with sports being cancelled, maybe take this pandemic to search for some internal factors that bring you enjoyment, motivation and personal fulfillment to your life. Find that internal drive, that biological motivation, that purpose. Learn how to reach your true potential without relying on external sources.

    How? This leads us to the three elements of intrinsic motivation and how to incorporate them into your daily lives:

    Autonomy | If people are in complete control of their experience and outcome, they are more likely to fuel their own motivation. Autonomy also allows for greater creativity and independence from outside sources. To be fully intrinsically motivated, you must be in control of what you do and when you do it. I’ve actually advised some of my athletes who were struggling with motivation to take some time off, not from exercising but from structure, to have them dictate their own schedules to do what they want, when they want.

    Mastery | The desire to improve, to attain the utmost knowledge for a subject, activity or task. Mastery will enable someone to seek their true potential. I have an athlete who is motivated to be a stronger, faster runner. Any finish line or medal is less important than the process of continuous improvement. I’ve given her space and support to aim higher to foster improvement and growth.

    Purpose | Understand WHY you do what you you do. I can’t stress this enough. It’s a known fact that humans are intrinsically motivated by the idea of fulfilling a purpose. Purpose is what gets you out of bed in the morning. Those who believe they are working toward something larger than themselves are often the most hard-working, productive and engaged. Find purpose in your work. Connect it to a larger cause. Volunteer, give back, meditate on compassion, help others. During a crisis, the people who cope the best are those who help others. When we’re motivated by a spirit of generosity or altruism, we benefit as much as those on the receiving end. It’s called the Helper’s High and research shows that it decreases cortisol in the body and predicts better long-term health. With all the excess stress hormones flowing through our body these days, it’s more important now more than ever to be proactive with your health.

  • Pelvic Proprioception: It’s All In The Hips!

    Caitlin / July 9, 2020

    You often hear how important it is to activate the glutes during running, but have you ever tried, simply speaking? It's not as easy as it sounds. But what if you just spend a bunch of hours in the gym doing leg presses, squats and deadlifts to make the hips stronger? Unfortunately, that doesn't translate to running as seamlessly as you think. Research shows that, without neuromuscular retraining, strengthening these muscle groups will not lead to a change in movement patterns.1 You can spend a bunch of time isolating certain muscle groups but that won't help you run any better. You need to train movement patterns, not muscles.

    Jay Dicharry, a physical therapist and author of Running Rewired makes one of my favorite analogies: "You can't make toast if your toaster isn't plugged in". Heavy squats and deadlifts won't fix the problem. It’s just like cramming more bread into the toaster that isn't plugged in. Change requires teaching the brain and body to reprogram movement patterns.

    Running gait is reflexive and habitual. Altering any motor pattern that has become habituated over many years can be difficult, especially considering a runner who runs 20 miles a week. At 1000 steps per mile, this individual can log over 1 million foot strikes per year. But the beautiful thing about the brain is its plasticity. You can modify your form, but you must work on coordinating extra input from the brain into your normal movement patterns. At first, it requires complete, conscious focus on the task. Over time, the new movement pattern can become fully rewired into the brain and reflexive. Altering a motor pattern like this takes both guidance, practice and patience to alter.1

    Pelvic Proprioception

    So this brings us to our topic of the hips and pelvic proprioception. Proprioception is our sense of the body's position and orientation in space. We use this feedback to move all the time. Activating the glutes during running gait initially requires one to be able to sense how the pelvis is moving in space. I think of the hips as both the steering wheel of the lower body and the fulcrum upon which our core is balanced. Pelvic proprioception requires both glute and core input, adequate mobility and stability.

    During running gait, the glutes are supposed to effectively fire concentrically as you extend your hip and push off the ground behind you. In an ideal world, it is reflexive and subconscious (you don’t think about it). But for most of us in our sedentary culture, we require extra input. However, it's not as easy as just 'thinking' about squeezing your glutes. And doing a bunch of single legs squats in the gym will not magically plug them in when you run.

    A runner's ability to effectively activate the posterior hip depends not only on adequate neurons going to the muscle, but also the position of the pelvis. The ability to properly extend the hip at this late stance phase of gait will determine how inhibited or accessible the glutes are. The pelvis moves in three planes of motion when we walk and run. A lot of focus these days involves minimizing pelvic movement in the frontal plane, what we think of as hip drop or pelvic drop (gluteus medius strengthening, anyone?). But we forget that pelvic rotation in the transverse plane is equally as important. A study involving robotic gait assistive devices reduced these pelvis rotations and found that stride length, step length, and gait velocity were significantly reduced while stance phase was increased2. Pelvic rotation is critical for healthy gait and improved performance.

    pelvic rotation Pelvic rotation in the transverse plane – as your knee drives out in front of you, your ipsilateral hip should follow

    So how does this work?

    Proper pelvic rotation requires adequate hip extension and hip internal rotation in this extended position. Think of the body as a dreidel spinning in place. That is essentially how your pelvis should rotate around your spine when you run and walk, back and forth around a vertical axis. If your pelvis doesn't move the way it's supposed to either due to mobility restrictions or motor control issues, your body is going to look for that movement elsewhere (i.e. the hip joints themselves, the lumbar spine, excessive arm swing, etc), which can create overuse injuries over time. A lack of mobility and motor control at the hip and pelvis will also inhibit a runner’s ability to extend the hip properly, thus diminishing the chances of firing the glutes effectively.

    Why is pelvic rotation important? By thinking about the hips moving forward with the knee and the body, you reduce any excessive vertical oscillation (up and down bouncing that takes away from the forward momentum of the body)3. Not only does it allow you to effectively use the glutes during push-off, but by rotating your hip around the vertical axis each time you drive your knee forward, you can actually gain 1-4 inches with each stride. Decreasing risk of injury and improving performance? Now that's a win-win.

    Where do I start?

    The first step? Work on retraining that motor pattern. Below is a three-step running-specific progression to work on controlling your pelvis about that transverse plane. The movements are subtle. I’m not asking you to swing your hips around uncontrollably! Start with the first exercise and when it becomes automatic and reflexive, progress to the next. When you first start these exercises, they may require a lot of cognitive focus on the task at hand. But after adequate repetition and consistency, this should become intuitive. For further guidance and education on gait mechanics and injury prevention, schedule an appointment with us today!

    Single Leg Pelvic Rotation with Knee Drive

    Start off leaning into the wall, as you drive one knee forward, rotate the pelvis to drive that same side hip bone further forward with the knee. The key is to keep that knee moving straight forward (don't let it cross over the center of the body). This slight rotation of the pelvis creates relative internal rotation and extension of the stance leg, consequently turning on the glutes. Remember to keep the core engaged as well throughout.

    Single Leg Pelvic Rotation with Triple Extension

    Start off leaning into the wall, as you drive one knee forward, rotate the pelvis to drive that same side hip bone further forward with the knee. The key is to keep that knee moving straight forward (don't let it cross over the center of the body). This slight rotation of the pelvis creates relative internal rotation and extension of the stance leg, consequently turning on the glutes. Remember to keep the core engaged as well throughout.

    Single Leg Step-Up with Resisted Pelvic Rotation

    The more advanced progression requires single leg stability and balance and core control. With a resistance band around your hips tied behind you, step up onto a box. As you drive your knee forward, your same hip bone should also point and move forward against the resistance of the band. Keep your core engaged!


    1. Davis IS, Futrell E. Gait Retraining: Altering the Fingerprint of Gait. Phys Med Rehabil Clin N Am. 2016;27(1):339-355. doi:10.1016/j.pmr.2015.09.002
    2. Mun KR, Guo Z, Yu H. Restriction of pelvic lateral and rotational motions alters lower limb kinematics and muscle activation pattern during over-ground walking. Med Biol Eng Comput. 2016;54(11):1621-1629. doi:10.1007/s11517-016-1450-8
    3. Saunders JB, Inman VT, Eberhart HD. The major determinants in normal and pathological gait. J Bone Joint Surg Am. 1953;35-A(3):543-558.