One of the perks of using UCLA’s (hospital) free web is the access to their library of journals. I downloaded this 2010 article from the NSCA Strength and Conditioning Journal on strength training for distance running. The author Jason R. Karp PhD suggests that conventional hypertrophy-based strength training (10-15 reps at 60-75% 1 Rep Max) is not effective for distance running, especially since it does not improve cardiovascular fitness.
Karp suggests more power and strength based protocols:
3-6 reps at 90-95% of 1 rep max for exercises such as squats, hamstring curls, calf raises, cleans, and deadlifts with 5 minutes of recovery between sets
2×5 reps of plyometric movements such as single-leg hops, bleacher hops, squat jumps, box jumps, and bounding, with full recovery between sets
He adds that such protocols improve running economy by increasing the strength component of power, muscle recruitment, and speed. Karp explains that typical gains from hypertrophy-based training can include unnecessary mass gains resulting in potential loss of speed.
Strength to weight ratio is huge when it comes to running so hypertrophy-based training theoretically may not help one’s running. The author does mention that lower level runners CAN benefit with hypertrophy-based training because in such cases, ANY fitness gains will improve running.
I like the idea of low reps, heavy weight, and full recovery because it doesn’t heavily tax the cardiovascular system that is probably getting enough work from one’s regular running volume. I must admit that I’ve been guilty of doing the conventional style lifting in the gym; I’d do 6 sets of squats for 10-15 reps per set, and going as heavy as possible. I would do the same for deadlifts, knee extensions, and heel raises, all in the same workout. As a lower level runner, I believe that slamming the reps, doing tons of sets, and getting my pump on DID help me become a stronger runner. But I would also burn out, get sick, and injured, so I think the lower reps and full recovery will definitely decrease my chances of over-training and injury.
With muscle hypertrophy in mind, I though about the elite triathletes and marathoners and their body types. I did an online search of their height and weight and the results definitely demonstrate that building muscle and adding mass is low on their list of things to do (form definitely meets function!):
Jan Frodeno, 2x Ironman World Champion: 6’4″, 165 lbs.
While exploring different avenues for future con-ed fulfillment, I stumbled onto a very RECENT research commentary by Karla Franck FAAOMPT in regards to comparing open chain and closed chain exercises post ACL reconstruction. She sums up her article with the following importanttake home messages:
1) Both open kinetic chain (OKC) and closed kinetic chain (CKC) exercises can produce similar stress on the ACL, so PTs must make sure to have consideration for:
a. the surgeons protocol
b. the degree of knee motion and position in range
c. loads applied depending on stage of healing and patient abilities
2) OKC isometric quadriceps contraction from 0-45 degrees of flexion and active knee flexion-extension from 0-50 degrees produce the greatest strain on the ACL.
3) OKC exercise in the ranges of 60-90 degrees of flexion produce no strain on the ACL and are therefore safe on the healing graft.
4) CKC exercise attenuates an increasing external resistance unlike OKC exercise, and therefore can be potentially safer for the healing graft when performing loaded exercise.
5) CKC exercises are more effective at restoring normal knee function with regard to strength and range of motion, and can often reduce pain and enhance knee proprioception. As such, CKC exercises need to be a vital part of a patient’s knee rehabilitation.
The article summary is a great review and some justification for those looking to mix both open and closed chain exercises during ACL reconstruction rehab.
In my older age, I tend to think more about what I can do to make my body a better physical machine rather than simply making my muscles bigger. I’ve gravitated from bench press to to 1-arm push-ups. Unfortunately, I’ve let my upper body go and can’t even generate a 1-arm push-up,…not even a sloppy one.
So in my quest to do one, I’ve added this progression to my exercise regimen:
Why 1-arm push-ups? They are an opportunity to strengthen and promote the co-contraction of both the core and shoulder stabilizers. What’s the use of developing your chest muscles if you can’t coordinate their use with the rest of the body?
A 2003 article from the Journal of Sports Physical Therapy (JOSPT) examined the muscle activation of several body weight closed chain exercises for the shoulder. They found that the 1-arm push-up, while generating resistance of about 60% of one’s body-weight, generated the highest rotator cuff, chest, and shoulder activation when compared to prayer position, quadruped, pointer position, conventional push-ups, and push-ups with legs elevated.
Anyway, I’ll keep you up to date with the progress.
The latest issue of the International Journal of Sports Physical Therapy had several articles on patellofemoral pain (PFP). After reading them, I thought it would be cool to put out some content on the material I found noteworthy and interesting. The following article brought some perspectives I didn’t often consider when treating my patients for PFP.
Current Concepts In Biomechanical Interventions for Patellofemoral Pain by Willy and Meira, The International Journal of Sports Physical Therapy, Vol.11, Number 6, Dec. 2016, pages 877-886
The Patellofemoral Joint (PFJ) is subjected to 4.5-5x one’s bodyweight during running activity and and in excess of 10x their body weight with jumping.
Quad weakness is a risk factor for Patellofemoral pain (PFP) and quad strengthening has been shown to reduce it by 44-90%
Single leg squats performed to at least 65 degrees of knee flexion without added weight yields peak quadriceps forces of approximately 4-5 times body weight.
Open chain knee extensions in the 45-90 deg. range and closed chain squats & leg presses between 0 and 45 deg. range are ideal exercises for strengthening quads; such movement ranges decrease the possibility of further joint irritation
The process of quadriceps strengthening, rather than the actual strength gains, may reduce PFP by improving load tolerance of PFJ structures.
Hip strengthening programs result in moderate to large reductions in PFP, and with moderate to large improvements in function in the short to medium term.
Hip strengthening alone does not appear to alter proximal (hip) mechanics, and non-biomechanical mechanisms may explain the reduction in PFP that is widely reported with rehabilitation programs that employ hip strengthening.
Providing mirror and verbal feedback has been shown to be effective at reducing contralateral pelvic drop, hip adduction and hip internal rotation during a single leg squat.
Some studies suggest that improvements in hip mechanics during single leg squats do not directly transfer to running when applied to runners with PFP.
If frontal and transverse plane hip mechanics are thought to be the main biomechanical factor contributing to a runner’s current PFP, visual feedback to cue reductions in hip internal rotation and adduction are warranted.
If sagittal plane running mechanics are primarily implicated in a runner’s PFP, then cueing an increase in step rate during running may be the most effective gait modification.
Foot orthoses combined with exercise therapy, resulted in improved outcomes over six weeks in individuals with PFP compared with exercise therapy alone.
RETURN TO RUNNING
Running athletes recovering from PFP may have greater success with bouts of moderately fast to fast paced running for a prescribed number of steps rather than focusing on slow jogging for a set amount of time.
Faster running results in decreased stance times and fewer steps to cover a certain distance, resulting in decreased PFJ loads.
My Go-To approach to PFP has always been to address hip strength and mechanics, and I’ve been relatively successful thus far. All it took was a lecture from Dr. Chris Powers in PT school and I was sold. When prepping for the OCS exam, I read that the idea of isolated VMO exercises for PFP was flawed so I kind of put quad strengthening in the back seat of my tool box. This article brought to light the idea that adaptations in the PFJ’s structures (articular surfaces, etc.) rather than the actual strength gains in knee extensors, as the the likely cause for symptom improvement. I completed MedBridge’s online course on Patellofemoral Concepts for Rehabilitation with Terry Malone PT, EdD, ATC, FAPTA and he reiterated the importance of conditioning the joint’s articular surfaces in treating PFP, particularly in cases of OA. I practiced a few years at a Sports Medicine facility where some were still doing VMO targeted protocols but with much success. In hindsight, such success was probably due to PFJ structure conditioning rather than muscle strength gains. After all this, I think I’ll continue to use my original approach to PFP but will definitely supplement it with specific and focused quadriceps strengthening. The aforementioned online course went deep into isometric strengthening protocols so I’ll save that content for another post.
Knowing that the PFJ is subjected to over 10x one’s bodyweight during jumping activity is a pretty good reason to discourage plyometric style training for those carrying excessive weight.
Running faster rather than slower during rehabilitative training was initially counter-intuitive for me but made sense after some thought. That being said, I’m sure that training volumes definitely have to be specific and adjusted according to the patient’s tolerance.
It made sense to me how mechanics involved in the mastery of the single leg squat did not translate directly into running mechanics. The concept of specificity always has to be addressed. I’ve always made it a point to DRILL the mechanics into one’s gait. I progress them from single leg squats, to single leg hops, to alternating hops, to hopping with forward progress (single and alternating), and then into running drills; it’s my part-part-whole progression. I use Gray Cook’s angle of reactive neuromuscular facilitation to promote hip abduction by running next to my patients while holding a sport band around their waist and pulling them laterally towards me as they run forward; the patient’s inside hip has to generate greater abduction forces in order for them to follow a straight line of running.
I could imagine having to do the same intervention on a treadmill with patients I can’t keep up with but that’s yet to happen.
That’s it for now. If you want access to the article, shoot me an email and I could give you some ideas on how to get it if you don’t have a IJSPT subscription.