I have recently had quite a few people training for their first full marathon! One of the most common questions I get asked is: What should I eat before and during a marathon? Well, if you are racing soon, stick to eating the same meals you eat before your long training runs. Try to remain consistent with your eating habits throughout the training process once you discover what nutrition works best for your performance. Race nutrition includes fluid intake the days leading up to the race, dinner the night before, breakfast the day of, and supplements during your run.
Whatever you do, avoid making any drastic changes in your behavior before or during the race.
Dinner: For dinner you want to eat good complex carbs (vegetables and grains), a medium amount of protein (fish or chicken are my go-to choices), with a small amount of high quality fat. Avoid eating high fiber foods and foods with high fat content the night before the race as they are tougher to digest and can lead to GI problems during the race (i.e. beans or lentils). Again, try to remain consistent with your eating habits and don’t try anything too different before your race (common theme).
Late Night Snack: If you have a difficult time waking up to eat an early pre-race breakfast, you can try eating a late snack. This also comes in handy if you have traveled or changed time zones for your race. Try to mimic what you would eat for breakfast the day before a race (simple carbs and a little protein).
Breakfast: Try eating breakfast at least two hours prior to the start of the race. You do not want to eat too close to the start time or you will have to continue to digest your breakfast during the race. Your breakfast should consist of mostly simple carbs (oatmeal, bagel, toast, rice) and a little protein (protein shake, egg whites, low-fat Greek yogurt), or something like Kodiak cakes (carbs + protein in one!). Again, avoid high fiber cereals and high fat foods, as these foods are harder to digest and can lead to GI problems during the race.
Pre-Race Snack: An hour before the race you can eat some simple carbs that can easily convert to energy. Fruit with honey is a good option. Oftentimes I will make a fruit smoothie ahead of time for a pre-race snack.
Caffeine: Caffeine is a stimulant that can help with your performance during endurance races and training. If you are used to drinking coffee before your long runs, then go ahead and drink coffee before the race. Be aware that some energy gels and blocks contain caffeine, so test these products out during your long runs prior to race day!
Caffeine can also cause GI distress, stimulate the nervous system, and lead to increased heart rate, and, if consumed in excess, can lead to increased urination. All of these issues can create problems for the endurance athlete. If you are not used to consuming caffeine, then the day of the race is not the best time to find out how you will respond.
During the race: It is good to know what nutrition will be supplied during the race. Some races are sponsored and will have the nutrition supplements of the race sponsor out on the course. For example if they are supplying GU gels, but you are used to Honey Stinger products, then you should plan on bringing your own nutrition for during the race. A good option is to set an alarm on your watch throughout the race to prompt you to drink and eat small amounts on a regular basis. That way, you are more likely to keep on track for your nutrition goals.
One of the biggest issues I see with novice endurance runners is the lack of fluid and energy intake early in the race. It takes time for your body to digest and use the energy you consume. If you wait until you feel thirsty, or start to feel shaky from glycogen storage loss, it’s too late. So, I tell runners to drink and eat early in the race and drink before you feel thirsty. Maintaining hydration throughout the entire race with smaller but consistent amounts is easier on the stomach than trying to play catch-up with large amounts of fluids once you feel thirsty.
After the race: You want to make sure you continue to stay hydrated. If it was an especially hot race, you may need to continue replacing your electrolytes throughout the day with a sports drink.
Make a plan, stick to the plan, and good luck racing!
Thanks for reading,
Sam Gillespie PT, DPT
Countless times, I have been asked if it is safe for youth athletes to start strength training. “Aren’t there risks to their growth plates?” and “Won’t it stunt their growth?” are common concerns. It is the purpose of this article to face these questions head on and go to the research.
Growth Plate Damage Causing Stunted Growth?
The epiphyseal plate, also known as the growth plate, is a critical part of a child’s development. A properly growing epiphyseal plate ensures that the child will grow taller! So what does the evidence say about strength training and growth plate damage causing stunted growth? The American College of Sports Medicine (ACSM) concludes in a review that “...there is no evidence to suggest that resistance training has a negative impact on a youth’s growth potential.” Further studies by Dr. Avery Faigenbaum have even shown that there are possible positive effects to the growth plates from a strength training program.
Strength training injuries are typically found in youth athletes to be strains and sprains, with occasionally a fracture. While these are unfortunate, the statistics are clear: the rate of injury with sports such as soccer, basketball, and football are much higher than the rate of injuries with strength training or weightlifting. I would strongly argue that the actual benefits of strength training for youth athletes far outweigh the risks.
So What Are The Benefits?
A 2019 review of eight studies concluded that strength programs that were properly executed and supervised actually decreased injuries for youth athletes. Not only were these programs safe for athletes, but they experienced fewer injuries after the strength and conditioning programs were completed.
A 2016 review of 43 studies concluded that significant performance increases can be achieved through strength and conditioning for youth athletes. Increased muscle strength, vertical jump performance, linear sprint performance, agility, and sport specific performance in team sport athletes, endurance athletes, and individual athletes were all seen in youth athletes aged from 6-18. The strength and conditioning programs varied greatly according to the ages, sex, and development of the athletes, each tailored to the development capacity of the youth athlete.
With the right coaching, a strength and conditioning program is safe, effective at decreasing injuries, and effective at increasing performance. The fears of stunted growth need to be put to rest! If you have more thoughts about youth athletes performing appropriate strength and conditioning, check out the citations below! If you’d like to discuss this further, feel free to reach out!
Marcus Rein, PT DPT
Halloween is this weekend, which means there are going to be a lot of tricksters out there (and maybe one giant treat...I’m looking at you Braves!). While harmless pranks and scary decorations are all fun in games, there is no place for scaring people with bad, dated medical information. Our bodies are incredibly resilient and some of the common “scary” comments our patients have heard from other providers, or seen on imaging, really aren’t anything to be afraid of at all.
Okay, I know we’re all busy getting costumes and candy ready, so let’s jump right in.
“Worst case of bone on bone I’ve ever seen!”
If I’ve heard this once, I’ve heard it a thousand times. “The doctor said I’m bone on bone!” “Worst case of arthritis he has ever seen!” Most often your physician or other healthcare provider is referring to something called osteoarthritis (also called Degenerative Joint Disease or DJD) in situations like this, and guess what… It is totally normal to have arthritis! More and more studies are coming out that show many active adults have some form of DJD and that calling this a “disease” is incredibly misleading.
While DJD cannot be reversed, it’s often not the main pain generator and can be easily managed with education on symptoms, appropriately prescribed exercise, and just good ol’ fashion exercise. Walking the dog, playing with your kids, gardening… all great examples of non-exercise based movement that keep your joints moving. As cheesy as it may sound, the old adage of “motion is lotion” is spot on and is the reason that “worst case of arthritis I’ve seen” shouldn’t get you weak in the knees.
This one hits close to home. At the young age of 14, I actually had two knee surgeries. One to attempt to repair my meniscus and one to remove it once the repair failed. Looking back on it and relating the symptoms I was having to what the research is now showing, I had no business getting either of those surgeries and you most likely don’t need one either. Once again, a torn or frayed meniscus is a normal sign of aging and is often found on imaging with people who have knee pain at all.
Even in an acute situation where a tear is found on an image after injuring your knee, as long as you don’t have a physical “block” in your knee, where that meniscus has essentially turned into a door stopper and impeds normal motion at the knee, you will be absolutely fine without surgery. In fact, research consistently shows that conservative treatment will have equal to (or better) results as surgery AND you won’t be setting yourself up for future complications associated with missing portions of your meniscus.
I’ll keep this one short. Simply put, in most situations, herniated discs do not require surgery. In fact, multiple studies have demonstrated that you can take 10 random people off the street with no back pain, give them an MRI, and an average of 7 out of 10 people’s images will come back with some variation of a herniated disc. In fact, “large low-risk-of-bias trial between surgery and usual conservative care found no statistically significant differences on any of the primary outcome measures after 1 and 2 years” (Jacobs et al). Our bodies are incredibly resilient and, in most cases, will heal just fine with appropriate treatment.
“You’ll never be able to do ‘X’ again.”
This is the most frustrating thing for me and the rest of the staff here at Athletes’ Potential. We are constantly hearing people come in and say something like, “My doctor said I’ll never be able to deadlift again,” or, “My physical therapist said I shouldn’t do CrossFit.” This is absurd and is a fallacy you shouldn’t fall for. We constantly get people coming into our office and we are constantly getting them back to the activities they love. A provider quickly dismissing an activity you do without any context is lazy, myopic, and an easy sign that you need to get a second opinion.
So, in review, there are a lot of scary phrases out there that, in reality, have no right to be scary. New research is being pumped out every day that our bodies are readily adaptable. If you’re in the Atlanta area and you’ve heard one of these phrases before, give us a call or fill out the contact request form by clicking the button below. We’d love nothing more than to help you get back to what you enjoy.
Thanks for reading,
Dr. Jacob, PT, DPT, CSCS
Waking up from a wonderful full-night’s rest is one of the greatest things one might enjoy. As I’ve been getting older, I’m much more appreciative of a full night’s rest. However, there’s one thing that has affected me and my patients from time to time that has taken what could be a great sleep and turned it into a painful event.
It’s the infamous “crick in the neck” that you feel when you just didn’t sleep right.
You didn’t bang your neck on something. You didn’t headbang to a great heavy metal song. No… you just slept wrong.
So what is that “crick” in your neck? And, more importantly, what can you do about it?
1. Muscle Spasm
The most common type of “crick” we see from a sleeping injury is a muscle spasm. Whenever the body is in a unique position for an extended period, such as when recovering from a surgery or after limping for weeks after a bad knee injury, the body develops compensations to accommodate those changes. The compensations are primarily muscles tightening up in areas that are both guarding and balancing the body to accommodate for this new way of moving.
The neck is no different.
By sleeping with your neck in a strange position for a full night, you are changing the way your muscles are typically set to a great degree over a long period of time! Soon enough, the brain says “Hey! This is feeling like a unique position I've held for a very long time! It’s time to tighten up some muscles to get us ready to hold this position for a much longer time!”
Bang. The muscle spasm crick has formed. This typically feels like a large cord of muscle that is just locked into a certain position.
Let’s move onto the next type of “crick."
2. Facet Irritation
Facet irritation is when a joint in your neck (a joint is where two bones meet) gets pressed too tightly together. If this joint is pressed too tightly overnight, irritation can form and a “crick” can form. This can also trigger a muscle spasm, so you can have this facet irritation as well as muscle spasm!
Typically this is felt as a single local point of irritation on your neck, maybe about the size of a quarter. If this combines with a muscle spasm, you’ll have that small quarter-sized spot of irritation with the whole area feeling like a big tight cord.
So you have this neck pain after sleeping wrong… what do you do?!
One of the easiest things you can do to quickly loosen up muscles in that area is to massage the upper trapezius muscle using this technique:
Find a small ball and a doorway. Place the ball on the doorway and press the meaty part of your upper shoulder into that ball. Hold for 1-5 minutes, or until the muscle tension and tenderness decreases significantly.
Another great technique is to use that same small ball and lean up against the wall targeting this spot on that same shoulder. Also massage here for 1-5min.
Doing these two things 3-5x/day should begin releasing some tension you’re feeling in your neck region. Other things you can do is use a heating pad and avoid positions of irritation in your bed, such as sleeping face down or using too many pillows.
If you’re still having pain from poor sleeping positions, please reach out! We’re more than happy to help you resolve this neck pain!
Thanks for reading,
Dr. Marcus Rein, PT, DPT
Our past couple blogs have revolved around neck pain. Why? Because it’s 2021 and we are a year and a half into our “new normal” caused by the global pandemic, which means more time working from home, which means increased time spent behind a computer screen, which means more neck pain and more headaches. Throw on the added stress that people are experiencing and it’s starting to feel like there’s a different kind of pandemic going around with all the neck pain and headaches we’ve been treating at Athletes’ Potential.
In our previous blogs this month, we’ve given a ton of great information about how your neck is the source of your headaches and why looking down at your phone all day may not be the best idea. (If you missed those, you can find them here.) While all that may be great, there’s one area that frequently gets missed when people get their necks looked at by a medical professional, and that area is their back.
While there are certainly fasial lines, misaligned joints, and muscle tensions in the low back that can cause changes “up the chain” that lead to neck pain, those situations are a little fewer and farther between and aren't necessarily the part of your back that I’m talking about. Instead, we’re talking specifically about your thoracic spine, or your upper back.
A little anatomy lesson for you to make sure we are all on the same page. Your spine is divided into three separate segments: cervical (neck), thoracic (mid back), and lumbar (low back)... in other words, your thoracic spine connects your neck to your low back. Now, there are a couple of things that are pretty cool when we’re talking about your thoracic spine:
Going back to that first fun fact: The upper portion of your thoracic spine has to be able to move along with your neck. Hypomobility leads to pain. In other words, if one joint isn’t moving properly, then that causes other joints (above or below the stiff joint) to have to move in an excessive range of motion (hypermobility), which leads to pain in those joints. That is exactly what we see when it comes to the upper thoracic spine and its ability to cause neck pain. If your upper back has excessive stiffness, then that causes your neck to have to rotate, extend, etc., in excessive ranges of motions to do simple tasks (think looking over your shoulder to check a blind spot), which will inevitably lead to pain.
Luckily, there a ton of drills you can do to help improve your thoracic spine mobility and two of my all time favorites are listed below:
Thoracic Spine Self Release:
Open Book Exercise:
The second way your thoracic spine can cause neck pain actually has more to do with that second fun fact. One of the most important functions of your rib cage is to protect some very important structures such as your heart, lungs, liver, diaphragm, etc. Your lungs and diaphragm in particular are what we want to focus on here. You see, when people sit at a desk for prolonged periods of time or are experiencing high amounts of stress, what tends to happen is people start taking shorter breaths and use the accessory muscles found in the neck when they breath instead of the more appropriate muscle being their diaphragm. When this happens, we’ll start seeing muscles like the scalenes, sternocleidomastoid (SCM), and subclavius start to develop too much tension, which will lead to neck pain and even referred pain causing headaches.
Lucky for you, we have some favorite drills that can help with that too, and a lot of them focus on proper breathing. Now, before you roll your eyes and think, “proper breathing?! Breathing is breathing,” that’s what I used to think too, but thanks to our good friends over at Shift, in addition to the thousands of people we’ve helped to improve their breathing, I can promise you, that thought process couldn’t be further from the truth. Give these drills a shot and see for yourself. You’ll be amazed at how effective cleaning up your breathing patterns can be.
90/90 Diaphragmatic Breathing:
In review, improving your upper thoracic mobility and appropriate breathing patterns could be effective treatment options for you if you’re dealing with neck pain and, at a minimum, will help you live a healthier life. However, these treatment options are just pieces of the ever elusive puzzle that make up neck pain. If you’re dealing with neck pain, reach out with any questions. We design and implement programs to help people just like you, whether you’re someone who doesn’t know where to start or has had an unsuccessful rehab experience. It is our goal at Athletes’ Potential for the people we work with to get out of pain and return to their sport or activity, performing better than they did before.
Thanks for reading,
Dr. Jake, PT, DPT, CSCS
Every day, all day, you are carrying a bowling ball with you.
Not literally of course. Hear me out.
You wake up, you go to work, you care for your kids, and the entire time you have this massive ten pound object sitting on your shoulders for which you are responsible! It’s propped up by a few supportive structures, each of which are organized and arranged to be wonderfully supportive of this object.
You can probably guess by now, I am talking about your head and neck. Your head being the bowling ball and the neck being the structures that support it!
Now if I was to tell you to arrange this head and neck in an ideal way, you would likely put the head perched nicely on top of the neck without much lean. Intuitively as well as seen in the research, if you see a neck that’s leaning, you know that neck is likely working harder than a neck that is more upright.
We are living in a world that is more phone-focused than ever, and in the world of physical therapy, we are seeing a HUGE uptick in phone and screen related pain. So what are a few things you can do to help alleviate this “text neck” that we see so often at Athletes’ Potential? Try a few of these things and see how you feel after a week:
1. Foam roll your upper back 1-5 minutes 1-2x/day. These will help relieve tension in your upper back that can throw your neck and head forward. Enjoy these!
2. Chin tucks 3x10-15 with light effort 1-2x/day. These will help align and exercise your neck by putting it in the right position. Be gentle! Feel the deep muscles lightly working to pull your chin down and back. Aim for a “double chin!"
Moral of the story: care for your bowling ball. Over time, you will lose strength, coordination, and mobility if you don’t work on them occasionally. These two simple exercises can help start to get you out of your text neck positioning. If you are still having problems, feel free to reach out to us at any time to help you improve your neck issues.
Thanks for reading,
Dr. Marcus Rein, PT, DPT, CF-L2
About ⅔ of the population will suffer from neck pain and headaches at some point in their lifetime. Stress, posture, and muscle tension can all lead to headaches. Some common causes that can predispose you to headaches are: staring at a computer screen all day, lifting heavy weights overhead at the gym, or limited mobility of the neck, upper back or shoulders.
Tension headaches refer to headaches related to muscle or fascial tension, and the postural changes that accompany the muscle tension. This increase in tension might be from stress, a physically demanding job, or poor posture and muscle fatigue at the end of the day. Tension and stress can lead to trigger points and tightness in your postural muscles. This muscle tightness can directly refer pain into the head and face creating headaches on one or both sides of the head.
Muscle tension in the neck can result in compression and squeezing of the nerves going into the base of your head. Compression of these nerves can lead to pain behind the head, along the temples, as well as behind the eyes. Usually this compression is felt directly below the base of the head in the upper neck region, and is associated with a more forward head posture.
You can also get headaches from dysfunctional jaw mechanics (TMJ) associated with upper neck stiffness. The upper neck region can tilt the head and jaw creating abnormal muscle tension in the neck, jaw and face. If you have headaches associated with eating, notice your jaw clicking this may be an indication of neck and jaw dysfunction, also termed TMD.
Incomplete mechanics of the joints of the neck and upper back, as well as shoulder stiffness can create additional stress on the muscles of the head and neck. What steps can you take to relieve or reduce your chances of getting headaches caused by incomplete mechanics?
If you have tried these methods of headache relief, but continue to have symptoms contact us below to see if physical therapy is a good option for you.
Thanks for reading.
Dr. Sam Gillespie
Part 2: The Hip’s Role in Low Back Function
A car needs a good road to function at its best. A house needs a good foundation to stay strong. A tree needs solid roots to stand tall.
By only focusing on the low back you are having low back pain, you are missing the big picture!
The hips play an absolutely crucial role in low back pain. If they are weak or stiff (or both!), the foundation of your house has major issues in providing your low back what it needs to function pain-free.
This is very much supported by the literature. Two major reviews found that in patients with low back pain, there was a high prevalence of weak hips (1) and that by strengthening those weak hips, you can improve your back pain (2)! Furthermore, a lack of hip internal rotation has been found to be correlated with low back pain as well (3).
So, if hip strength is found to be directly associated with low back pain, we’ve gotta strengthen our hips! If I were to choose two exercises for you to try for hip strength that can help with low back pain, here’s the two I would choose to target these potential impairments.
Single Leg Hip Thrust:
Keeping your core tight, squeeze your butt as you push your hips up to the sky. Try to not let your spine move. Let your hips do all the movement (no arching your back!). Try 2-3 sets to moderate levels of fatigue. If this is too hard or too uncomfortable, regress to trying these on the ground without your back elevated.
Clamshells and/or Side Plank Clamshells:
Clamshells are often looked down on as easy basic exercises (which they can be). However, if you know how to progress them, they can be downright challenging! These are two variations I enjoy in the clinic and both involve a band. Try 2-3 sets on each side to mild to moderate levels of fatigue.
Both exercises should have discomfort levels below 2/10. More is not better with these!
By combining a healthy lumbar spine and hip complex, you have the best chance to improve your low back pain for the long run. If you still feel like you’re getting stuck, feel free to reach out to us and we can get you the care you need to get your back to the place you want it to be!
Thanks for reading,
Dr. Marcus, PT, DPT, CF-L2
Part 1: The Lumbar Spine’s Fundamentals
If you are reading this blog post, you likely are having back pain or have had back pain in the past. You understand how debilitating it can be. You understand how much it can take away from you. You are not alone.
Eight percent of all adults experience chronic back pain. Back pain is the sixth most costly condition in the United States. Back pain accounts for over 12 billion dollars of medical expenses every year. So yes, lots and lots of people have back pain!
It is rare that a day goes by in my practice that I do not see a client with some sort of low back pain. So, in this short two-part series, I’m going to go over some quick things you can do to consider if you are having low back pain and are continuing to want to exercise or play sports.
Fundamental 1: Resume activities as tolerated
One of the biggest factors to accelerate recovery in low back pain is to resume functional activities as tolerated. It’s not bed rest. It’s not stretching. It’s using your back and body as tolerated.
This tells us three things:
First and foremost, we are resilient! Even with pain and dysfunction, if we are able to do things as tolerated, we will recover faster!
Second, it tells us that despite the pain and dysfunction, we need to look at ways we can improve our mechanics in order to return to functional activities faster. Resting for too long is not the best option to regain our activities that we’ve lost due to the pain.
And third, it tells us that we need to figure out a way to still respect the pain while not being fearful of it. Simply listening to your pain, being brave, and trying things out gently is a key part in progressing as tolerated.
Fundamental 2: Coordinated Movements
This is where my expertise as a doctor of physical therapy comes into play. I am an expert at understanding movement. Both functional and dysfunctional movement patterns come into my clinic every day, and it is my job to ensure that even with the pain that your back is experiencing, you are still able to do things as tolerated to best get you back on your feet.
So how do I do that?
I ensure that your coordination at remaining in neutral spine position is solid before anything else.
Try the “bird dog” or “dead bug” exercises to see if you have reasonable spine coordination. If your spine moves significantly from its normal resting position during these movements, you definitely have a coordination deficit.
Of course there are many more tests I use to assess for appropriate lumbar coordination; however, these are just two that are tried-and-true in my practice.
Fundamental 3: Strength
Once you have gained a reasonable amount of coordination in keeping in neutral, we add some intensity. Longer holds, more variance, more load… all are options depending on the goals of the client.
Aim for two minutes of great coordination with dead bugs and bird dogs to understand what a strength requirement standard should feel like.
The key variable is the coordination. Once coordination falters, you have to work harder or regress to something easier.
Once these three fundamentals are working at a reasonable level, your function should definitely be improving. If you’re still having difficulty after working on your day to day activities, your coordination, and your strength, you may need more guidance from a physical therapist.
My job is to guide you through low back pain that isn’t responding to basic exercises. If you think that you’ve tried all you can, feel free to reach out to receive some more specific guidance to you and your situation. We’re here to help!
Look out for Part 2: The Hip’s Role in Low Back Function - coming soon!
Thanks for reading,
Dr. Marcus Rein, PT, DPT, CF-L2
Many people run because it can be done anywhere, is a year round activity, requires minimal equipment, and has excellent cardiovascular benefits. Over half of all runners will sustain a running-related injury while training and around 90% of marathon runners will experience a running-related injury.
Reasons to increase your step rate, and reduce your step length, while running:
Small changes in your step rate, or running cadence, can have a major impact on your running resilience. Your step rate refers to how many steps you take in a minute while running. Increasing the step rate while running at a constant speed will decrease your step length. Think about walking across the room vs. jumping across the room. Taking more steps while walking requires less impact forces than hopping the same distance.
“Overuse” injuries due to running are often a result of these higher loads of force while landing. Some people can even hear themselves landing with louder steps as they run. Your speed and stride length will influence the impact forces your joints, tendons, and ligaments are required to absorb while running.
Increasing step rate has a positive impact on the ankle, knee, and hip joints. The knee joints were most positively affected by increasing step rate, with a 20% reduction in impact forces with only a 5% increase in step rate. This increase in step rate will create a reduction in stride length while maintaining the same running speed.
There are many positive benefits of running with a shorter stride and higher step rate. A smaller stride length allows for you to land with your body’s center of mass over the landing foot. This will lead to less impact forces in the knees, hips, and ankles while running. Increased step rate leads to more efficient running mechanics. Improve your running economy with reduction in “up and down” wasted motions while running. You can also reduce the risk of shin splints due to the reduction in shock absorption during landing while running with smaller strides.
Things to think about after committing to increasing your step rate and reducing your stride length:
Thanks for reading,
Sam Gillespie PT, DPT, OCS
Dr. Danny and staff's views on performance improvement, injury prevention, and sometimes other random thoughts.