 So, you’ve been working hard, training hard, and enjoying life. Your body is a little achy, and dang you’ve been looking forward to a vacation for the last few months. Summer is here! You’ve got your chance to take a break from work and really, truly, relax. Or, maybe you’ve got a move coming and you know you won't be able to train as much. So, the question arises… how little training do I have to do over a longer vacation or during a transition such as a move to a new home to maintain strength levels for my sport? For me it's soccer, but for you it may be running, tennis, basketball, or pickleball! Let's dive into the literature. Luckily, a fantastic review titled “Maintaining Physical Performance: The Minimal Dose of Exercise Needed to Preserve Endurance and Strength Over Time” was just published in 2021 answering this very question. Let’s look at the abstract and I’ll highlight important lines: “Nearly every physically active person encounters periods in which the time available for exercise is limited (e.g., personal, family, or business conflicts). During such periods, the goal of physical training may be to simply maintain (rather than improve) physical performance. Similarly, certain special populations may desire to maintain performance for prolonged periods, namely athletes (during the competitive season and off-season) and military personnel (during deployment). The primary purpose of this brief, narrative review is to identify the minimal dose of exercise (i.e., frequency, volume, and intensity) needed to maintain physical performance over time. In general populations, endurance performance can be maintained for up to 15 weeks when training frequency is reduced to as little as 2 sessions per week or when exercise volume is reduced by 33–66% (as low as 13–26 minutes per session), as long as exercise intensity (exercising heart rate) is maintained. Strength and muscle size (at least in younger populations) can be maintained for up to 32 weeks with as little as 1 session of strength training per week and 1 set per exercise, as long as exercise intensity (relative load) is maintained; whereas, in older populations, maintaining muscle size may require up to 2 sessions per week and 2–3 sets per exercise, while maintaining exercise intensity. Insufficient data exists to make specific recommendations for athletes or military personnel. Our primary conclusion is that exercise intensity seems to be the key variable for maintaining physical performance over time, despite relatively large reductions in exercise frequency and volume.”1 The first time I read this, my jaw hit the floor. What this means is that for most people, endurance can be maintained for over three months and strength can be maintained for over a half a year with relatively few sessions per week. The key metric is INTENSITY. Strength only needs one session per week and just ONE set per exercise, as long as you’re intense and lifting your regular heavy weights. JUST ONE SET. Endurance needs just two sessions per week, and only around 20 minutes of running, as long as you find an intense level of exertion. I’ll keep this blog post short and sweet. Just wanted you guys to know about this amazing article and hopefully gain something from it. If you want to actually read an article this summer, make it this one, as it's pretty straight-forward. Now, go and actually enjoy a break when you need a break! Just a few INTENSE sessions a week is all you need. You’ve earned it. Thanks for reading! Dr. Marcus Rein PT DPT Athletes' Potential 1. Spiering, Barry A.1; Mujika, Iñigo2,3; Sharp, Marilyn A.1; Foulis, Stephen A.1 Maintaining Physical Performance: The Minimal Dose of Exercise Needed to Preserve Endurance and Strength Over Time, Journal of Strength and Conditioning Research: May 2021 - Volume 35 - Issue 5 - p 1449-1458 doi: 10.1519/JSC.0000000000003964
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 As the weather continues to warm up and we begin to look towards the outdoors for a return to running, let's give a quick rundown of what to look for when purchasing running shoes. The shoe is obviously the most important piece of running equipment. Shoes make contact with the ground, provide cushion between our body and the running surface, and affect how we absorb those loads while out for a run. Here are a couple of factors to think about when looking for a running shoe: The Brake Test   Midsole Drop or Offset (see pictures below) The drop in midsole height is the height difference between the heel height and the forefoot height of the shoe. A zero drop shoe refers to a shoe with no difference between the heel and forefoot height. A shoe with a high drop height would have a greater than 8mm height difference between the heel and the forefoot (with the heel being higher). A higher heel to forefoot height drop can lead to a pattern of landing with the heels. The mechanics of heel landing leads to greater loading and force absorption of the knees and hips while running.   Stack Height (see pictures above) The stack height refers to the amount of shoe midsole between your foot and the ground. Barefoot and minimalist style shoes have the lowest stack heights between 3-12 mm in height. The reduced amount of cushion in the midsole allows for more shoe flexibility. The lower the cushion the more likely you are to land on your forefoot or midfoot leading to an increase in loading of the achilles tendon and calf muscles, which will also reduce stress placed on the knees while running. A traditional running shoe will have a stack height around 10-29 mm in height and is what we typically think of when referring to running shoes. This allows for a wide range of flexibility and cushion. Most shoes over 30mm in height are considered maximalist shoes. These will be highly cushioned and are easily spotted on the roads or trails. A maximalist shoe provides just that: maximal cushion with a lot of foam under the foot. The increase in cushion under the heel can lead to great heel striking, which will load the knee and hips more than the foot and calf muscles. Toe Box Width  Looking at a running shoe, we want to have as much room as possible in the front of the shoe for the toes to spread out without feeling blousy or loose. Consider your distance and terrain surface for running. As your feet swell with an increased running distance, you may want a larger toe box if you are running ultramarathons. If you are trail running, a really loose shoe may limit your stability on loose gravel or uneven surfaces. You want ample room for your toes to spread and create a stable base of support for landing while running without creating slippage of the foot in the shoe. Big Toe Mobility    Big toe stiffness can affect comfort and function while running. If you have big toe extension limitations, a large midsole drop height (info above) will create pretension of your big toe into extension. If you already have a limited range of motion, a large drop height can create more problems and pain in the toe as you try to generate toe off while running. Going to a zero drop shoe, or a shoe with more of a forefoot rocker, can allow for more comfortable toe off while running. Neutral vs. Stability/Motion Control Shoe  Neutral shoes have no added bracing or foam density on the instep of the shoe to limit foot and ankle motion while running. Shoes with motion control or stability added to the midsole will have more dense foam or a plastic component added to the inside of the heel and arch area to reduce perceived pronation while landing. However, if you have a good strike pattern or stay on the outside of your foot, a motion control shoe can create more problems by not allowing the normal amount of motion to occur while running. Time to Buy When in doubt go to your local running store and try on different types of shoes. The associates at a good running store will be able to help you distinguish what type of shoe will fit your foot best. Looking at a shoe online to determine if it will work for you can lead to fit and function issues. If you find a pair of shoes that feel great and help you run pain free, stick to them. Shoe molds and uppers can change with a new version, so when in doubt go find a pair at a local store to try them on. I hope this helps, and feel free to reach out with any questions you may have. Happy running!
Thanks for reading, Sam Gillespie PT, DPT, OCS Today we're working on our running mobility issues in our feet and ankles. We all know these can get stiff after miles and miles of running. We're going to work on our big toe, or our first ray. When you toe off in a run position, you have to get about 70 degrees of dorsi-flexion in your big toe. If you do not have that much flexion in your toe, you'll start see problem creep up up stream. To prevent this, grab your favorite lacrosse ball or Yoga Tune Up ball and really warm up your plantar fascia on the bottom of your foot. After that, get into a runners stretch against a wall and focus on stretching your big toe. You can also try toe walking around your house. At Athletes' Potential we help active adults and athletes in the Atlanta area get back to the workouts and sports they love... without surgery, stopping activities, or relying on pain medicine. Life is too short to avoid doing the things that you love. Reach out to us at: www.athletespotential.com info@athletespotential.com 470-355-2106 Let us help you figure out to live your best active life today! Foot strength is super important for runners. Our feet are what propel us forward so in order to generate a lot of power or strength in running, we have to have strong feet. Intrinsic foot strength- simply put, it's the muscles of the foot. Far too often we neglect this part of our body a lot but we need to show it some TLC. To help us gain foot strength, we've got a simple exercise for you to try at home or the office to start building up that strength. It's called the short foot drill. We want to make our foot as short as possible. Go back and forth between squeezing that foot together and relaxing. Do about 15-20 reps at a time. Watch the video for the all tips and get after it. At Athletes' Potential we help active adults and athletes in the Atlanta area get back to the workouts and sports they love... without surgery, stopping activities, or relying on pain medicine. Life is too short to avoid doing the things that you love. Reach out to us at: www.athletespotential.com info@athletespotential.com 470-355-2106 Let us help you figure out to live your best active life today! Today we're covering mobility for foot and ankle issues. If you've been struggling with this or you don't know that you have been, give these exercises a shot.
Massaging and stretching are great but there's one important technique that you might be missing. The first ray needs to be mobile! In order to be an efficient runner, you need about 70% dorsiflexion in your big toe. Any less that that, will cause pain. Try these two foot exercises to improve that mobility. 1) Grab your favorite Yoga Tune Up ball or lacrosse ball and get it under you foot, moving it side to side across your plantar fascia. 2) Do a wall stretch, but lift your heel off the ground to stretch that big toe. 3) Do some toe walks around your house! Hit these for 1-5 minutes. At Athletes' Potential we help active adults and athletes in the Atlanta area get back to the workouts and sports they love... without surgery, stopping activities, or relying on pain medicine. Life is too short to avoid doing the things that you love. Reach out to us at: www.athletespotential.com info@athletespotential.com 470-355-2106  A hot pan - don’t touch it! A wet slippery slope - probably should avoid it. A cactus - definitely avoid it. The experience of pain has taught us these simple rules, and we should be thankful! Burning our hand, slipping on rocks, and getting poked by a cactus’ spines are all three damaging things that we do our best to avoid to ensure our own health. These examples are the easiest way to understand pain, in that it is an alarm system that is designed to protect us from damage by giving us a quick response from which we can learn. Let’s go one level deeper. What happens if you go on a big hike and wake up the next day with your legs in pain? It’s a deep soreness that you haven’t felt before and it’s really bothering your hips and knees. Is this cause for concern? Is this damage? What kind of pain is this? What if you are simply sitting down in the gym after a workout and turn to pick up your water bottle and your back spasms, causing intense discomfort? Is this cause for concern? Is this damage? What kind of pain is this? How about just waking up with shoulder pain for no reason, but it lasts for 10 years? It won’t respond to medication or injections, and resting it just makes it worse. Is this cause for concern? Is this damage? Why the heck is this pain still around? As you can see, the alarm system pain provides is activated in all of these scenarios. This alarm system provides a symphony of sensation that plays its tune and it's up to you (and maybe the assistance of a professional) to decode the symphony. Let me share with you the things I look for in a patient’s presentation to help decode their sensations: 1. Numbness, tingling, or burning? If you are having numbness, tingling, or burning that does not resolve quickly or returns regularly, you likely need an assessment from a professional to determine its root cause. PTs are very skilled in caring for this type of pain! However, if this sensation is with progressive weakness or progressive loss of sensation, you should contact your primary care provider for assessment quickly. If it is rapidly progressive, you should go to the hospital. 2. Pain that's slowly getting better but still around? As long as the pain is getting better overall, healing is occurring. If it's slow, it's still progress, so don’t discount it! If you are frustrated in the pain’s slow speed of improvement, it might be time to come in to see us as we are also very skilled at finding ways to more rapidly accelerate your healing. 3. Pain that is not getting better for over a month? If you’ve been having pain that has not been improving for over a month, it is definitely time to see a professional. PTs are fantastic at diving into the mechanical issues that are causing your pain and improving the painful region’s overall capacity to provide you a higher healing potential. As a final note… there are SO many factors that can affect pain! Here’s a short list of proven secondary factors that have a direct effect on the subjective interpretation of the pain alarm system: Modifiable Factors Proven to Affect Pain*:
Non-modifiable Factors Proven to Affect Pain
As you can see, this complex experience doesn’t just include the local injury but so many other factors! If you would like to read more about the pain experience and its study, I highly recommend "Explain Pain." It is a short read that is well researched and provides a great contextualization of the entirety of the pain experience. So, if you are having pain and want to better understand it, start with contextualizing it as an alarm system that you must learn to interpret. If you’d like to understand your pain further, “Explain Pain” is a great option. And, finally, when you’re ready to have your pain improve, come see us at Athletes’ Potential! Thanks for reading, Dr. Marcus Rein, PT, DPT, CF-L2 * van Hecke O, Torrance N, Smith BH. Chronic pain epidemiology - where do lifestyle factors fit in?. Br J Pain. 2013;7(4):209-217. doi:10.1177/2049463713493264 What does icing do and not do? If you have an injury that needs attention, does icing help? Unfortunately, right now, the evidence is very mixed. Some research shows that immediately following an injury and it the affected area is swollen, icing is not the best thing to do. You want blood to flow to that area and begin the natural healing process.
After a few days, icing works great to numb the pain. But the best bang for your buck is to let that area heal naturally! As always, let us know if you have any questions. We're here to help. Remember, Movement is Medicine! Reach out to us at info@athletsespotential.com or 470-355-2106. Shoulder pain when going overhead? Watch Dr. Marcus walk us through a shoulder assessment so you can get better understanding of how your shoulder should move. Don't forget, there a few cues to make sure you're keeping yourself honest.
If you're still struggling with this movement or experiencing pain or discomfort, give us a call. 470-355-2106 or email us at info@athletespotential.com. We want to help you!  So, let’s talk about the shoulder: It is a very dynamic joint with little surface area between the humeral head and the glenoid fossa. The analogy we often use is a golf ball on a golf tee. There’s a reason why you hear more about shoulder dislocations than hip. We have numerous muscle attachments and ligaments that surround the joint itself. These can be broken down into active (muscles/tendons) and passive stabilizers (ligaments). When we are going through different movements at the shoulder (whether that’s an overhead press, push up, clean, etc.), if we do not have the requisite range of motion, coordination or strength, then our passive stabilizers take on a lot of that stress. As I’ve said before, every single tissue (muscle, tendon, ligament, bone, etc.) in our body has a certain capacity and threshold. Stress is how we build those thresholds up. Stress is also how we break those down. When those thresholds are surpassed significantly or repeatedly, pain and injuries start to pop up. The dosage is the difference in having the poison or the antidote (- quote from someone smarter than me). Now, how can we create more buffer room or bandwidth to withstand these stressors? Smart and well thought-out training. Sure. But, what about creating more freedom and control at the shoulder joint? Then, those tissues are less prone to getting overstressed and everyone is doing their jobs. Today, our focus will be on the overhead archetype – which is an expression of shoulder flexion and external rotation. This can be anything related to pressing, reaching overhead, hanging, or throwing overhead. I see people in the clinic every day that have pain with these movements and when we break these positions and joints down, we tend to see a limitation in one or both flexion and external rotation. Next, we’ll go through a test that you can utilize to see how your overhead position checks out. Wall Test: Common faults we see related to this are:
Try to avoid these mistakes and see where your true baseline overhead position is. After the techniques provided below, come back to this test and re-test the movement. Can you go further? How does the quality of getting there feel? Next, we’ll look at some strategies to improve the mobility aspect of the shoulder joint. Subscapularis Mobilizations: Shoulder Overhead Opener: When discussing the shoulder joint, I would be remiss not to mention the thoracic spine. The shoulder blade and thoracic spine/ribcage are very intimately related which directly impacts shoulder mechanics and position. Next, we’ll go through some techniques to address the thoracic spine. T-Spine Mobilization: Half-Kneeling Wall T-Spine Rotation with Lift Off: Lastly, we will cover my favorite component in the performance process which is the strength and control of the shoulder joint for the overhead position. Supine Eccentric Shoulder Flexion – Dowel or Single Arm with Plate: Dowel Shoulder Flexion PAILS/RAILS: Chaos Overhead Band Carry: Now, you may be thinking, "These are great exercises, but how do I implement them?" Try them as movement prep prior to an overhead workout, accessory work on upper body days or even on recovery days. Do you have to do all of them? Nope. Find the ones that you feel had the best impact on you via the test-retest on the Wall Test and start implementing them in consistently. An active approach tends to work better in the long term compared to the passive approaches and exercises. You’ll be surprised how quickly your overhead position will improve and your overall shoulder health.
If you’re dealing with an injury, reach out with any questions. We design and implement rehab and performance programs to help our athletes, whether you’re someone who doesn’t know where to start or has had an unsuccessful rehab experience. It is our goal for the people we work with to return to their sport or activity performing better than they did before. Cheers, Dr. Ravi Patel, PT, DPT, CSCS  Tennis is a sport that demands an incredible amount of strength, stability, and performance out of one of the most unstable joints in the human body… the shoulder. Not only do you need to drive your shoulder through some truly incredible velocities with something like a serve, but you need to be able to control that power through finely tuned movements in multiple planes of motion with an almost endless list of types of swings. The demands on the shoulder are pervasive in tennis and because of this we have successfully treated endless amount of shoulder related injuries from the tennis players we see at Athletes’ Potential. However, through all these injuries that we’ve worked with, we have started noticing some trends in common strength deficiencies and biomechanical limitations that, when addressed, can have serious impacts on reducing injury risk and improving performance. Trend #1: Inadequate Shoulder External Rotation Range of Motion Arguably the most violent swing in tennis is the serve. To generate the amount of torque required for this swing, you need to have an appropriate amount of external rotation at your shoulders. The video below goes over a quick and easy drill to assess your shoulder external rotation. Essentially you should be able to lay on the ground and get the back of your wrist to the ground while keeping your low back pinned to the floor. Some common mistakes to avoid when doing this assessment include:
If you can’t bring your wrist to the ground, or you have pain when you do or feel like you really have to fight to get there, then try some of my favorite drills to improve shoulder external range of motion. Drill #1: Front Rack Opener Drill #2: Lat Stretch Drill #3: Upper Back Mobilization Trend #2: Upper Back Strength In order to have a strong, effective swing you need to have a strong back. This may seem a little counter-intuitive, but let me explain. Your body is innately intelligent and it’s not going to let you produce more force than it feels it can control. Therefore, to have a better swing, you need to have a strong back to be able to eccentrically control your arm as you go through the swinging motion. Some of my absolute favorite exercises to make sure you have a strong upper back are listed below. Exercise #1: Deadlifts Exercise #2: Pendlay Row Exercise #3: W, Y, Negative Trend #3: Lack of Rotational Core Strength Your power in your swing comes from having a strong core. If you don’t have a strong core, then you have no foundation to deliver a strong swing, and if you are trying to have a strong swing without a solid foundation, well, you’re begging for an injury. Check out my favorite exercise to improve rotational core strength. Exercise #1: Med Ball Rotational Throws Exercise #2: Deadbug Pallof Press Exercise #3: Landmine Twists If you’re a tennis player struggling with shoulder pain (and yes, even elbow pain) or are looking to improve your performance, these drills are a great place to start. They are the three main problem areas that we find ourselves addressing with the tennis athletes who come to us for help. However, If you’re dealing with an injury and want more guidance and help, reach out with any questions. We design and implement rehab and performance programs to help our athletes, whether you’re someone who doesn’t know where to start or has had an unsuccessful rehab experience. It is our goal for the people we work with to return to their sport or activity performing better than they did before. Thanks for reading, Dr. Jake, PT, DPT, CSCS  [https://blogs.bmj.com/bjsm/2019/04/26/soft-tissue-injuries-simply-need-peace-love/] Have you ever pulled a muscle or tweaked something playing a sport? Maybe overdid it in a workout and didn’t notice it till after or the next morning? Every single person has experienced a soft tissue injury before – that can be muscle, tendon, ligament, etc. There’s a lot of mixed information out on the internet about what’s the best approach to hand a soft tissue injury when you experience one. For the longest time, it was RICE – Rest, Ice, Compression, Elevation – while this isn’t completely wrong, it doesn’t meet the full standards of what we know today with science and research. Here’s a handy acronym to help remember the essential components of how to manage injuries better in the future: PEACE & LOVE Immediately after injury, PEACE: PROTECT
ELEVATE
AVOID ANTI-INFLAMMATORIES
COMPRESSION
EDUCATION
  Once some days have passed, it’s good to give it some LOVE:
LOAD
OPTIMISM
VASCULARIZATION
EXERCISE
The thought to keep in mind is to try to play the long game. I see athletes often who come in and get out of pain then go right back to high-level activity without taking appropriate measures to progressively build it back up. What happens? Reinjury. Take the time to put in the work and I promise it’ll be worth it in the long run. If you’re dealing with an injury and want more guidance and help, reach out with any questions. We design and implement rehab and performance programs to help our athletes, whether you’re someone who doesn’t know where to start or has had an unsuccessful rehab experience. It is our goal for the people we work with to return to their sport or activity performing better than they did before. Cheers, Dr. Ravi Patel, PT, DPT, CSCS References: https://blogs.bmj.com/bjsm/2019/04/26/soft-tissue-injuries-simply-need-peace-love/ Axe MJ, et al. Potential Applications of Hyaluronans in Orthopaedics. Sports Medicine. 2005. Last week, we covered the training volume in part 1 of load management. If you missed it, go check it out. Today, we’re going to take a deeper dive into components of load management itself and what you as an athlete, coach or healthcare professional can do about it. I geek out on this stuff so get ready. Any injury ever: FORCE/LOAD > CAPACITY This means any force/load that exceeds the capacity of your tissue’s ability to withstand that force/load. Some examples:
Enter LOAD MANAGEMENT. The goal is simple: to protect you from injury and maximize performance Proper training must be prescribed. Over-training and under-training both increase risk of injury. You want to:
I’d be remiss to not give credit where credit is due: Tim Gabbett and company have been leading the front on this area and are really changing the way teams and athletes are handling training. Now, let’s define LOAD: It is broken down into 2 variables – external load and internal load
We use these two variables to create the: ACUTE: CHRONIC WORKLOAD RATIO (ACWR) This is also commonly referred to as FATIGUE compared to FITNESS. Fatigue being the acute workload and fitness being the chronic workload.
With technology nowadays, we have a number of ways to track this type of data. The most commonly cited method in the research is Session RPE (sRPE), which is time (total number of minutes) multiplied by the RPE for a given training session. The RPE is usually taken after a training session to gauge level of exertion/difficulty. This is measured as “arbitrary units” or “exertional units”. For example, in week 5, let’s say a soccer player practices one day for 60 minutes at an RPE of 8. That gives us: 60 x 8 = 480 units. She practices 4 times during week 5 with a similar intensity. This gives us our ACUTE WORKLOAD (4 x 480 = 1920 units) for week 5. Now we have to look at her CHRONIC WORKLOAD for weeks 1-4.
When we compare the two, you get: 1920/1808 = 1.06 Now what does this number tell us? This ratio helps delineate whether you as the athlete are prepared for the task at hand – what you’ve done compared to what you’re prepared for – that can be a running a marathon, doing a CrossFit Open workout, playing in a professional football game or doing parkour in your living room. In terms of injury risk, acute:chronic workload ratios within the range of 0.8–1.3 is considered the training ‘sweet spot’ where injury risk is at its lowest, while acute:chronic workload ratios ≥1.5 represent the danger zone. If you look at the trend of the curve before 0.80, you should notice the injury risk climbs back up – similar to a “U-shaped” curve. This relationship between workload and injury demonstrates that both inadequate and excessive workloads are associated with injury. Now let’s say from the example above that week 5 workload came out to 3500 arbitrary units. That would make the ratio: 3500/1808 = 1.94 No bueno. This athlete is at an increased risk of injury. When training load is fairly constant (ranging from 5% less to 10% more than the previous week) players had <10% risk of injury based on the study by Gabbett et al. However, when training load was increased by ≥15% above the previous week's load, injury risk escalated to between 21% and 49%. This is commonly represented by ‘spikes’ in acute load relative to chronic load. To minimize the risk of injury, we should limit weekly training load increases to <10%. There’s room to work within this, but a great starting point. Athletes accustomed to high chronic loads have fewer injuries than those accustomed to lower loads, and this supports Gabbett’s assertion that higher chronic loads can act as a protective effect against future injury.  These two graphs give a great depiction of what happens when load is applied appropriately:  Compared to excessive load and/or lack of recovery:  This is something I use every day with my patients and athletes. I’ll look at their training program and see if there is a mismatch in training volume and load management. We start here then look to optimize other components of injury and performance training such as stress management, tissue tolerance, biomechanics, physiology, strength, power, etc. At the end of the day, ask yourself this question: Is your body prepared for the demand of the task?
Cheers, Dr. Ravi Patel, PT, DPT, CSCS References:
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