 Often times, patients that have trouble or pain with squatting can chalk it up to mobility issues. Ankles and hips seem to be the major culprits. But what if mobility isn’t YOUR problem? Even if you have an ATG (deep) squat you may still experience: Back and/or hip pain Hamstrings and glutes not getting stronger Increased soreness in the inner thigh (adductors) Plateau of performance in squat based activities Does this sound like you? Keep reading. Motor control is the process of using the neurological system to coordinate your muscles and limbs as you perform a skill. Without motor control, we will have trouble controlling our body in space. This can lead to undesirable positions while we are under a weighted barbell. Unfortunately, many of us do not have ideal motor control—particularly as we add fatigue to the system. Fatigue can come in the form of heavier weight or multiple reps. How do we judge motor control from the outside? Technique. Form. So we know you have an ATG back squat with the chest upright and feet flat. If you add weight and that changes, you need to practice motor control. This is rewiring the system so that as we move our extremities or add weight to lifts, the form looks the same as squat without weight. Many times this has to do with the initiation of the squat. It should always start with a hip hinge. Now, some athletes who think they are hinging are simply over-extending their back. This means they send their hips “back” by poking the pelvis back and allowing the ribs to flare up. Rather, the space between your ribs and hip bones shouldn’t change as you hinge your hips back. The same pop of the pelvis back can be a problem as you get close to the bottom of the squat or start to drive back to extension. A great drill to test out your squat is using a PVC for 3 points on contact. Holding the PVC against your back, you should have contact with the back of your head, midback and pelvis. Keeping this alignment, hinge your hips back then drop into a squat.  Some faults that are common with squatting will be demonstrated when the PVC pipe leaves one of the points of contact. Below, the left picture shows a rounding of the midback that causes the PVC to leave the pelvis. This often happens at the bottom of the squat too. The fault on the right demonstrates over-extending the hips and changing pelvic position rather than hinging the hips. I find this to be more common on initiation of the squat, particularly for those complaining of back pain. If you noticed that the PVC left your body at some point, try filming yourself as you practice!  Improving motor control takes reps and practice. The PVC drill is great as a warm up for squats. You could also perform tempo goblet squats (see video below). Holding the weight in front will help you engage your deep core and stabilize your ribs and pelvis to keep the torso in the ideal position. Moving at a slow tempo is more challenging to the neurological system and will help engrain that movement pattern. The same rules from the PVC pipe drill still apply!  Inside of thighs really sore after squatting? The large muscles running along the inside of your thighs are the adductors. They function to bring your leg closer to midline, stabilize the hip and knee, and work synergistically with glutes and external rotators (squats?!). Going along the lines of motor control, be aware of the speed of your descent and “bouncing” out of the hole. The squat should not be a fall to the bottom and a bounce off the calves. You want a controlled descent; taking advantage of the stretch-shortening cycle at the bottom can be helpful but the torso alignment should still be maintained. If you are a free-faller or a bouncer, try to slow it down and control the movement. Similar to the goblet squat, this will improve control but also strength!  If you look like the woman squatting above, this is your starter plan for improving motor control and strength. Take the time to assess your alignment and control through the movement. Cleaning this up will decrease pain and improve your performance drastically.
At Athletes’ Potential, we work with athletes like you every day-- those who just want to move better and those that are in pain. If you are finally ready to feel better and improve at the gym, give us a call. We would love to help! Thanks for reading, Dr. Jackie, PT, DPT, OCS, CSCS
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 Running is a part of the culture in the Army. You wake up early, meet at the PT field and go for a run 3-5x a week. We had formation runs where we’d run a few miles with 100 to thousands of other sounds yelling cadences. We even had runs to celebrate important battles or events in our Brigade’s history. The only problem is, most people in the Army have never actually been taught how to correctly run distance. The statistics on running related injuries are pretty shocking. 75-80% of runners have a running related injury every year. That number bumps up to 90% when you start training for a marathon. With numbers like that you could make the case that we have a running injury epidemic in the US. These numbers carry over to the Army and when I was active, I had an opportunity to try and solve this issue for the Brigade to which I was assigned to at Schofield Barracks. Ironically, for someone that’s tall and skinny, I’ve never really been a naturally good distance runner. This led me to seek out a running coach when I was in Hawaii. The man I found was Ed Bugarin (Google search this guy, he’s no joke). Ed was a retired special operations soldier that trained runners and triathletes on Oahu. I spent a couple spent a couple weekends with him working on drills, cadence and getting stronger in areas I was weak. After a month of running mechanics work, I was running faster for longer and injury-free. In particular I had resolved an issue I’d had since starting in the Army, shin splints. If you’ve never had shin splints before, they suck. It basically feels like someone is sticking a knife in the bone on the front of the lower leg. After working with Ed, I started teaching soldiers in my Brigade how to run. I’d do this in small groups, 10-20 at a time. First, we’d video them running and break it down on an iPad in slow motion. Next we would go out and work on corrective drills and talk about pacing for longer runs. I did this literally with over 1000 soldiers in my Brigade. After all the classes I taught here’s the most important lesson I learned: If your run form with shoes on looks like your barefoot running, you’ll be a very resilient runner. It’s literally that simple. This is something Ed had me do on the road in front of his house until my feet bled. By the way, I do not recommend barefoot running on concrete. Cavemen didn’t run on roads! I’m a much bigger fan of running barefoot on grass. Here’s why I think it’s so effective: When you take your shoe off and run, your foot gets to move naturally. You have 26 bones in the foot, 3 independent segments that articulate with each other and countless ligament/muscle attachments. Imagine if the Golden Gate Bridge could change shape in a split second and then return to it’s normal shape. That’s basically what your foot does. It’s an engineering marvel. Going barefoot allows you to let your foot do it’s job. It also doesn’t give any additional support. That way we can start to rebuild the intrinsic muscles of the foot as well as toughen the skin of the bottom of the foot. Lastly, running barefoot solves the biggest problem for most of the runners I work with- cadence. Cadence is how many steps you take in a minute. You’ve probably been told to just stride it out and try and create as long of a stride as you can. Here’s why. Stride Length+Stride Frequency(cadence)=Run Pace If you increase your stride length you will run faster assuming you maintain the same cadence. You’ll also significantly increase your likelihood of having shin splints, plantar fasciitis and running related knee pain. The better solution is to increase cadence. This would cause us to shorten our stride but increase the number of steps we are taking per minute. Imagine like you’re running on hot coals and pull your feet back off the ground. This also puts the foot landing position under our body instead of way in front of our body. The Principle of Parsimony- It is pointless to do with more what is done with less. This is principle is based off the theory of Occam’s Razor, essentially saying the simplest solution is the best solution. Want to increase your running efficiency, build foot strength and decrease likelihood of injury while running? If so, add in barefoot running once a week to your runs. Here’s how I like to program it: Find a nice, flat grass field or the inside grass area of a track. Perform 4 rounds of this: 50 meter high pull drill on the right (start video at minute 1.26 for drill) 50 meter high pull drill on the left (start video at minute 1.26 for drill) Run 100 meters moderate pace Put your shoes back on and focus on mimicking the feel of the barefoot run strike and cadence while running your intervals.
Run 4-8 400 meter intervals 80-85% effort. Rest until you can perform a 7-second exhale breath before starting the next run. Keep it simple, focus on running as a skill and you’ll be a much happier, injury-resistant runner for years to come. -Dr. Danny, PT, DPT, OCS, CSCS  It seems that almost every runner has experienced “plantar fasciitis” at some point. Although there are many stretches and exercises that provide short term relief, it would be best to find out why the bottom of your foot and heel continue to be painful. Sure, there are quite a few factors that could lead to this pain but what if targeting one joint in your body could change your running and decrease your pain for good?  Your foot is made up of 26 bones and 33 joints. Proper biomechanics of the foot depends on the appropriate strength and mobility of these joints. The great amount of joints allows the foot to conform to the surface so we can walk in the sand at the beach but also through the grass at home. The feet are our foundation; holding all of our body weight and acting as levers to propel us forward in walking and running. It sounds really complicated- and it is- but there is one joint that tends to be overlooked that can significantly impact your foot function. It is the great toe aka the big toe. The great toe and its mobility are integral in push-off while running. The function is described by the “windlass mechanism”. Essentially, the great toe extends which will tighten the plantar fascia. The tightening of the fascia at the bottom of our foot elevates your arch and keeps the foot from collapsing so that you can effectively push off at each stride.  Without full great toe extension, it will be difficult to allow your weight to advance forward over your foot as you run. Thus, your biomechanics will change. Our body is amazing because it will change and adapt to decrease pain but sometimes these changes are not ideal for long term. Some ways your body will find to get around lack of great toe extension is running with your feet externally rotated (toes out) or taking much shorter stride lengths to decrease the pressure at the toe. Long term changes in running form can begin to effect other joints up the chain- knees, hips, back. The plantar fascia may experience more tension as the toe becomes even more stiff which then can manifest as heel, toe or general foot pain. What does your great toe extension look like? One way to check your great toe extension is in a relaxed position as in the picture below. Your foot may be resting on a surface and push your great toe up gently until you feel resistance or discomfort.  Checking great toe extension in a lunge position will be more similar to running and the toe can be pushed back passively by the ground. In the photo below, notice that the left toe extends much further than the right. Ideal range of motion is about 70 degrees of extension, though some people may have more!  If you find that your great toe extension is lacking, try these self-mobilizations at home. Working on these before and/or after a run would be ideal. Spend a few minutes on each mobilization and see how your feet feel: If you have restriction, 2 min each day of this mobilization can start to chip away decreased mobility. Using a lacrosse ball, spend 2-3 min each day on the fascia at the bottom of your foot.
As I mentioned before, great toe limitations can greatly affect your biomechanics. Factors such as stride length, foot contact, hip and knee position through swing can each be altered with foot restrictions and pain. At Athletes’ Potential, we perform Run Form Analysis for our athletes to break down their form individually and change any deviations we may see. Even if you don’t have pain currently, having a professional break down your run form can be eye-opening and help prevent speed bumps in training down the road. We would love to help you stay active and get back to your training throughout the Spring and Summer! Give us a call today to schedule Run Form Analysis or a Physical Therapy appointment to stop your heel and foot pain fast: 470-355-2106. Keep checking in on our blog weekly; May is all about running! Thanks for reading, Dr. Jackie, PT, DPT, OCS, CSCS |
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