Knee Injury Summary

Over the past week we have been talking about the different kinds of overuse injuries that can occur at the knee. In this blog post, I want to give you a better visual of how they are all related to each other. To do that, let’s break our knee down into three different zones.

Think of zone one as the beginning of problems in the knee. The injuries that occur here are because of mobility restrictions and muscle imbalances in the knee itself. The front of the knee gets overworked and breaks down. By comparison, zones two and three are the continuations of problems in the knee. Instead of the front of the knee breaking down, the body finds a way to compensate around those restrictions and imbalances. This occurs by rotating the the thigh in as shown by the orange arrows. When that rotation is present, new areas become vulnerable to breaking down. When they do, not only do you have to fix the rotation, you also have to go back and fix those underlying problems.

Let’s take a closer look.

Zone 1 (green/front of the leg + knee cap itself)

As you can see in the picture above, zone 1 is the middle strip. It gets top billing for a few reasons. The first is that problems here typically involve less compensation.

Injuries in this area:

  • Quad muscle strain
  • Quad tendonitis (inflammation in tendon above the knee cap)
  • Patellar tendonitis (inflammation in tendon below the knee cap)

Likely cause:

  • Loss of knee extension (your ability to full straighten your knee out)
    • This can be due to tight calf muscles (especially the gastroc), hamstrings/adductors, and glutes.
    • These restrictions can lead to mobility losses in the joints as well (ankle, knee and hip)
  • Strength imbalance between the front and back of the leg resulting in the front of the leg getting overloaded.
  • A combination of both.

Treatment goals:

  • Restore mobility to the joints and muscles.
  • Balance strength out so that the front of the knee is not getting overloaded.

Zone 2 (blue, outside of the leg/knee)

This area of the knee is the outside of the leg and knee where the lateral quads and IT Band are located. Injuries in this area mean that you are compensating by rotating the upper leg in. This can create friction/inflammation between the IT Band and the lateral quad or down along the outside of the knee cap where the band attaches.

Injuries in this area:

  • IT Band Friction Syndrome (either at lower attachment outside of the knee cap or up higher in thigh between the band and lateral quad muscle beneath it)

Likely cause:

  • Whenever there is compensation, you need to think of the causes in layers that need to be addressed one by one.
    • The first restriction is the rotation. The inner thigh muscles (pes anserine, inner hamstrings/adductors) get stuck in a short position while the IT Band and outer hip get stuck in a stretched out/long position.
    • The second restrictions to consider are what that rotation is trying to make up for. Most likely, this means that the knee has lost its ability to fully extend. Sound familiar? These are the same restrictions we talked about above in the front of the knee.

Treatment goals:

  • Get rid of the rotation so that the leg is straight.
  • Restore mobility to the knee itself.
  • Balance out strength so that the whole leg is working.

Zone 3 (purple, inside of the knee)

This area of the knee is along the inside of the knee where the pes anserine is located. Injuries in this area mean that you are compensating by rotating the upper leg in. This can create friction/inflammation between the the muscles stuck in that short/tight position along the inner knee.

Injuries in this area:

  • Patellofemoral Syndrome (PFS)
  • Pes Anserine Bursitis/Tendinopathy

Likely cause:

  • Whenever there is compensation, you need to think of the causes in layers that need to be addressed one by one.
    • The first restriction is the rotation. The inner thigh muscles (pes anserine, inner hamstrings/adductors) get stuck in a short position while the IT Band and outer hip get stuck in a stretched out/long position.
    • The second restrictions to consider are what that rotation is trying to make up for. Most likely, this means that the knee has lost its ability to fully extend. Sound familiar? These are the same restrictions we talked about above in the front of the knee.

Treatment goals:

  • Get rid of the rotation so that the leg is straight.
  • Restore mobility to the knee itself.
  • Balance out strength so that the whole leg is working.

Want to learn more about how to treat these injuries? Log in today and use the body map to access the knee courses.

Pes Anserine + ITB Injuries

Yesterday, we talked about how restrictions behind the knee alter the mechanics of the knee itself. One way to compensate around those restrictions is to shift the workload to the smaller patellofemoral joint. Over time this kind of overuse can lead to patellar tendonitis or patellofemoral syndrome (PFS). In today’s post, we are going to talk about a different type of compensation and how it can create injuries like IT Band Syndrome and Pes Anserine Bursitis/Tendinopathy.

IT Band Syndrome vs Pes Anserine

When the large muscle groups (quads, hamstrings, glutes) are either a) unable to do all of the heavy lifting or b) forced to work around restrictions getting in the way, they will start to rotate in search of help. This means we are moving from big muscles to small muscles that are less equipped to handle the strain. At the knee, this means moving from the patellofemoral joint to the tendons attaching on either side of it. On the outside (in blue in the picture above), we have the IT band. On the inside (in purple), we have the pes anserine insertion. An easy way to think of both is that they help stabilize the knee, one on the outside and one on the inside. Shifting the workload to either requires the whole thigh to rotate so that these structures can be called upon to act as movers versus stabilizers. That may help buy you some time, but that rotation will cause the tendons to rub on the underlying structures creating a friction injury.

What does that mean?

Why is that important?

While there is a normal degree of rotation that happens in the leg, it’s important to realize that the amount of rotation that it would take to cause break down in these tendinous structures is not normal. The rotation here is being used to compensate against something else, giving you two problems instead of one to figure out. Let’s look at each injury one by one:

  • The IT Band is particularly vulnerable when the knee twists in. This could be happening in the last part of your stride (or the bottom of your pedal stroke) when instead of using the glutes, quads, and calves, you are forced to work with the quads, and inner hamstrings/adductors. As those muscles pull and the rotation happens, the IT Band rubs over the underlying lateral quad muscle creating friction. Prolonged friction can lead to inflammation and pain moving the knee. Another example of how this can happen is in weightlifting. As your drop down into squat position, you load the hamstrings and adductors before pushing back up. If there are restrictions there, the knee can rotate in to try and help. That rotation will then create that same friction along the lateral quad.
  • Unlike the IT band which rubs against underlying muscle, Pes Snserine injuries usually mean inflammation in the underlying bursa or in the tendons themselves. The rotation mechanics are the same, except for one thing. The muscles that create the Pes (aka the inner hamstrings and adductors) are pulling versus getting stretched out of position like the IT band. This typically happens in situations where the quads are unable to handle the workload and instead of pushing yourself forward, you are forced to pull yourself forward. In fact, if that pull is strong enough, it can also be why the IT band is getting pulled out of position in the first place. This is why sometimes that knee pain moves around from the inside to the outside of the knee.

So how do I fix it?

The important thing to realize with these injuries is that we need to work backwards through the layers of compensation (normal knee -> knee mobility loss/strength imbalance -> rotation -> injury). Think of it like walking down the wrong road. To fix this, we need to walk it back first and then start moving in the right direction.

  1. To fix the rotation, we need to start by loosening up the muscles along the inner thigh to create slack so that we can rotate the femur back into it’s normal position. Depending on where your symptoms are, this could also include work on the lateral hip/thigh and shin to remove the strain from the IT Band and it’s attachments.
  2. Once the rotation is under control, we then need to go back fix the restrictions and imbalances that are limiting the tibiofemoral joint in the first place. Are the mobility restrictions limited to the muscles behind the knee? Or are the joints on either side of the knee also contributing? Are the muscles on both sides of the knee strong enough to support the activities or has the imbalance started to work against this?
  3. While fixing the underlying mechanical issues to address the compensation, and the cause, we also need to heal the injury itself. In both Pes Anserine and ITB injuries, we need to cure the inflammation that is causing your symptoms.

In both of the courses now available on the ATA site, you will be working to address both of these injuries using self massage, mobilizations, stretching, kinesiology taping and strength work. Head over to the body map and click on the knee to check them out or drop me an email if you have any questions.

Tomorrow we dive into quad and hamstring muscle strains.

PFS + Patellar Tendonitis

Yesterday, we kicked off knee week by talking about some of the common mechanics behind overuse injuries in the knee. In today’s post, we are going to get more specific and start grouping injuries together based on the common mechanical limitations they share. More specifically, today we are going to talk about injuries that arise from mobility restrictions behind the knee.

Jumpers vs Runners Knee

Jumpers and runners knee are the common names for injuries affecting the knee cap. In the case of jumpers knee we are talking about patellar tendonitis where the tendon itself is irritated/inflamed. In the case of runners knee we are talking about patellofemoral syndrome or PFS. In this case, the cartilage under the knee cap is damaged/irritated due to increased strain on how the patellofemoral joint tracks as you bend and straighten your knee. What do both share in common? They start due to a mobility restriction/muscle imbalance in the knee joint itself. These restrictions then shift an increasing workload onto the smaller patellofemoral joint which breaks down over time.

What does that mean?

When we look at anatomy pictures of the knee, it’s easy to to make the assumption that there is one “knee joint”. While this is technically true, it is misleading. There are two components that make up the knee joint. The first and larger component is the tibiofemoral joint which is where the femur (thigh) and tibia (shin) meet. In this joint, movement is achieved by the femoral condyles rolling and sliding atop the tibial plateau. There is also a little bit of rotation allowed at this joint to lock it out straight and then to unlock it as the knee bends again. The second, smaller component, is the patellofemoral joint where the patella moves over these bones to assist with mechanical advantage as a large sesamoid bone. Here is a visual to show you the two joint lines.

Why is that important?

While it’s easy to overlook the tibiofemoral joint and focus on the knee cap where your symptoms are, it is most likely the culprit in both of these injuries. The rolling and sliding of the femur over the tibia (shin bone) is what puts the knee in good position so that the knee cap can track properly to produce the power required for running and jumping. If that joint isn’t moving properly (the femur is unable to move on the tibia), it can increase the strain on the quads and the patellar tendon. This gives you two things to fix: 1) the mechanics behind it, and 2) the symptoms that are a result of those mechanics.

To fix those mechanical problems, we need to look behind the knee. Typically in overuse injuries, mobility restrictions are the trigger that starts it all. This could be from insufficient recovery where muscles stiffen up from training/racing. Over time, those restrictions become more permanent and muscle imbalances develop. In the case of patellar injuries, the hamstrings get stuck in that tight position and become weak. This causes the quads to become the dominant muscle group in terms of workload.

So what causes problems behind the knee?

Let’s go back to the picture above for a moment. The hamstrings get top billing as the problem, but as you can see, the gastroc is also a key player. Both the gastroc and hamstrings actually criss cross behind the knee. This means that both are probably what’s keeping you from full straightening your knee. When one is tight, the other is usually tight as well.

The easiest way to look for this restriction is to test it by sitting on the floor with your knee out straight in front of you. Press the back of your knee flat into the floor and pick your heel up. You should not be able to slide your hand under your knee. You should, however, be able to lift that heel up. The main difference in the pictures below is how well the gastroc moves. On the left, the hamstring is stretched at both the hip and knee. On the right, the gastroc is stretched at both the knee and ankle. We want to get to the one on the right!

So how do I fix it?

The important thing to realize with these injuries is that we need to do two things:

  1. We need to fix the restrictions/imbalances that are limiting the tibiofemoral joint and overloading the patellofemoral joint. Are the mobility restrictions limited to the muscles? Or are the joints on either side of the knee also contributing? Are the muscles on both sides of the knee strong enough to support the activities or has the imbalance started to work against this?
  2. While fixing the underlying mechanical issues to address the cause, we also need to heal the injury itself. In the case of patellar tendonitis, we need to cure the inflammation along the tendon. In the case of PFS, we need stop and heal the inflammation resulting from damage to the cartilage.

In both of the courses now available on the ATA site, you will be working to address both of these things using self massage, mobilizations, stretching, kinesiology taping and strength work. Head over to the body map and click on the knee to check them out or drop me an email if you have any questions.

Tomorrow we dive into what happens when these restrictions start to have a rotational compensation (aka pes anserine and IT band irritation).

Knee Injury Overview

When it comes to overuse injuries of the knee, it is really easy to see them all as unique injuries that are completely unrelated to each other. Some of the most common examples include Chondromalacia/Patellofemoral Syndrome (PFS), Patellar Tendonitis, ITB irritation, Pes anserine pain, and Quad/Hamstring strains. While each has a different name, they all cause pain in and around the knee. They also all result from mechanical problems. This could be mobility loss, decreased strength, or even coordination/muscle imbalances. Whatever the restriction, the injuries that happen are a result of the body compensating and ultimately working in a way it isn’t designed to. Eventually, it will result in something breaking down under the strain produced by that compensation. The only difference is what structure broke down under the strain first.

Let’s Take A Closer Look:

 

 

Your turn! Let’s See How Your Motion Stacks Up:

  1. Hip Extension: Lying flat on your stomach, keep your hips flat, tighten your glutes and lift your leg up straight without using your back or shifting/rolling onto the other leg.

2) Knee Extension: Sitting with your legs out in front of you, push the back of your knee into the floor and lift your heel up.

3a) Ankle Dorsiflexion: With your foot flat on the floor and your heel down, move your knee over your toes.

 

3b) Toe Extension: With the ball of your foot flat on the floor, bring your foot over your toes.

toeext

What’s Next?

As we start talking about the different kinds of injuries in more depth, keep the restrictions you found in mind. Every knee course works to remove strain from the knee by restoring balance to the joints above and below it. Not only does this approach help the knee heal, it also fixes the mechanical problems and prevents them from sneaking back on you.

Toe Deformities + Athletes

In our last blog post we talked about toe deformities and how they can develop from common mobility and range of motion restrictions. What we didn’t talk about was what having bunions, hammer and mallet toes means to an athlete who is training and racing. That’s where this post comes in!

What do you need to worry about?

  • Loss of toe extension (ability to bend your toes back)
  • Progressive loss of ankle mobility (* Remember, those long toe tendons travel up into the calf. The tighter your toes get, the tighter that ankle gets)
  • Less time spent in stance phase (decreased step and stride length)
  • Progressive loss of hip mobility and loss of hip/lumbar relationship (glute shutdown + increased strain on lumbar spine)
  • Progressive compensation upstream in the ankle, knee and hip to work around all of the above

The biggest problem with toe deformities as an athlete is that they reduce the amount of time you are able to spend on that foot. This is time that allows the big muscle groups to share the workload from muscle to muscle, moving you forward in an efficient manner. This time is also important because it allows the transition from shock absorption to stability and propulsion to occur. When you decrease the time on your feet, you are preventing that stabilization from happening. Now, instead of a strong platform to push off of, you get stuck somewhere in between or with no push off at all. This progression also means that the workload never quite reaches the hips as you aren’t on your feet long enough to get there.

With that in mind, let’s talk about which muscle groups get beat up trying to work this way:

  1. The inner calf and peroneals. When there are toe and ankle mobility losses, rotation occurs to keep you from falling over your own feet. This rotation means that instead of using the larger shin and calf muscles, you start to rely more on the smaller peroneals and posterior tib/long toe flexors. These muscle groups are smaller and are not designed to be used for long periods of time. They will require more frequent self care to ensure that they are recovering. Likewise, the calf (gastroc/soleus) and shin will tighten over time because they are not be used like they are supposed to be.
  2. Inner hamstrings/adductors. As your push off is decreased and the hip becomes less active, the quads become the dominant power muscle. This will continue until they become too fatigued to handle the workload. This is when it is common for propulsion to occur through internal rotation of the femur. This allows the inner hamstrings and adductors to pull you forward. The rotation also strains the external hip rotators (piriformis) and smaller glute muscles as they try to stabilize and that excessive rotation. This sometimes can lead to strains and tendonitis developing along the outer quad and IT band as the thigh rotates one way and the lower leg the other way.

So what does all of that actually mean to you as an athlete?

Toe deformities do not mean a life on the sidelines. What they do mean is a reality check- you will have a much smaller margin for error when it comes to self care and recovery versus someone with normal mobility, mechanics, and strength. The good news is that there is a lot you can do to ensure you are recovering between workouts. The better news? You can use the same tools as every one else (foam roller, massage balls, the occasional deep tissue massage, etc). The only change that happens is what muscle groups you are focusing on.

Here is an easy visual:

In an athlete with good mobility and mechanics, the muscles directly along the front and back of the leg take the brunt of the wear and tear. These are the big, power muscles in the legs (gastroc, quads, hamstrings, glutes). While these muscle groups will be affected by compensation for the toe deformity, they will no longer be your primary source of movement. For someone with a toe deformity, we know that your mechanics will be altered. We also know that you will be compensating around the restrictions that led to your toe deformity. For you, the muscles along the inside and outside of the leg will be doing most of the heavy lifting. Since they are not designed for this, they have a much bigger chance of getting cranky and breaking down.

The advice is simple. Make the time to keep an eye on these areas and stay ahead of things instead of waiting for symptoms! Here is a little sample routine to get you started. It will take 15 minutes per foot! Start with the massage and follow with the stretches.

Massage:

Stretching:

Next steps or looking for more?

You have two options. Free users can use the Basics Courses located on the body map. Refer back to our last post for more information on which areas you need. For premium users, head to the Toe Deformities course for a progression of these techniques.

Let’s Talk Toes

When it comes to bunions, hammer, and mallet toes, the most common questions that I get most from athletes are how can I keep training and is surgery really my only option? Both of these are completely understandable questions, especially when you look at the typical article written about toe deformities. They offer a list of potential causes and then talk about surgical options for when “symptoms become unbearable”. Some will talk about toe spacers, pads, and taping, but most solutions are geared at symptom relief versus a long term solution. The good news? This article isn’t one of those. Instead of focusing on a list of causes, we are going to talk about toe deformities and what the different types all have in common from a biomechanics stand point.

Types of Toe Deformities

 

 

 

 

 

 

In normal anatomy, all toes are made up of little bones called phalanges. Every toe except the big toe has three of them (the big toe only has two). These phalanges create three joints called interphalangeal joints or more simply IP joints. The furthest is called the DIP (distal IP joint) and the middle is called the PIP (proximal IP joint). The closest phalange then connects to the metatarsal (long bone of the foot) at the MTP joint. Think of this one like the knuckle in the hand. Why is all of this anatomy important? Toe deformities occur when these three joints (MTP, PIP, DIP) get stuck in a position, creating inflammation and permanent changes to the bone.

Bunions – these can occur on either side of the foot although the big toe is the most common. A bunion occurs when the MTP moves away from the second toe. Over time this forces the phalanges in towards the other toes.

Hammer Toe – these are most common in the second toe (directly next to the big toe) but can happen in any of the smaller toes. This deformity occurs when the PIP joint gets stucked in a bent position. Over time this can grow to include extension at both the MTP and DIP joints.

Mallet Toe- like hammer toes, these can affect any of the smaller toes. The deformity occurs when the DIP gets stuck in a bent/flexed position.

Hallux Limitus/Rigidus (not pictured above) – this deformity affects only the big toe. The MTP joint becomes increasingly limited in motion. In the early stages this is known as hallus limitus. If this loss of motion continues, bone spurs can grow as the result of prolonged inflammation and will make the motion loss rigid as it is now blocked by bone on bone contact.

How Do They Happen?

The most important thing to realize about these types of injuries is that they all result from a progression of changes. You don’t just wake up one day with a bunion or hammer toe. These types of injuries start with a simple loss in mobility that over time results in joint breakdown and permanent bone change. Here’s a visual:

Loss of Motion > Contracture (muscle/tendon/ligaments get stuck short) > Breakdown of cartilage/bone > Bone spur/bunion formation

When you think about the different types of toe deformities in this regard, they become more like an overuse injury. Improper shoes, genetics, and prior injuries can all contribute to this type of injury by creating or exacerbating an underlying mechanical problem. This could be mobility loss in the foot, ankle or hip, decreased strength, or even coordination/muscle imbalances. Whatever the original restriction, the damage to the toes is the result of the body compensating and ultimately working in a way it isn’t designed to. Eventually, it will result in something breaking down under the strain produced by that compensation. In the case of toe deformities, the joints of the toes are what eventually breakdown.

So what can you do about it now?

While the actual changes to the bone and joint are irreversible without surgical correction, it’s important to realize that you still have a lot of control over your feet and the underlying mechanical causes. By improving mobility to the foot and ankle, you can normalize how you walk and run and take pressure off of the toes. This will allow the recurrent inflammation to calm down and help prevent further degenerative changes from happening.

In the video below, we are going to talk about some of the contributing mechanical factors at play and go through a little self test to see how your mobility stacks up:

In the self test at the end, we went through four movements. Here’s a breakdown of the test + next steps:

Self Test Walk through Result How To Fix
Toe Flexion
  1. start seated
  2. keep ankle in neutral position
  3. bend one toe at a time, joint by joint
  4. stop when you feel a pull
Ideally, you want to be able to flex (bend)your toe completely at all three joints.

If you can’t do this, the next test will help determine if the restrictions are above the ankle or below it.

  • If your toe mobility was normal? Nothing to fix!
  • If your toe was limited with just this movement? Start with the foot basics course. If you have a premium account and are looking for more, the toe deformity course will streamline this for you.
Toe Flexion with Ankle Plantarflexed
  1. start seated
  2. point ankle down (plantarflex it)
  3. bend one toe at a time, joint by joint
  4. stop when you feel a pull
How did your toe mobility change? Did it stay the same or did it get worse?

If it got worse, that likely means that you have restrictions both in the foot and up along the shin as well.

  • If your mobility was unchanged and looked normal? Perfect!
  • If your mobility got worse with this test, you will want to add in work on the shin itself where the long toe extensors are located.
  • For free users, check out the foot basics course in addition to the shin basics course. For premium users, the toe deformity course will streamline this for you.
Toe Extension
  1. start seated
  2. keep ankle in neutral
  3. pull one toe back, one joint at a time
  4. stop when you feel a pull
Ideally, you want to be able to extend (bend back) your toe completely at all three joints.

If you can’t do this, the next test will help determine if the restrictions are above the ankle or below it.

  • If your toe mobility was normal? Nothing to fix!
  • If your toe was limited with just this movement? Start with the foot basics course. If you have a premium account and are looking for more, the toe deformity course is the one for you.
Toe Extension with Ankle Dorsiflexed
  1. start seated
  2. pull ankle up (dorsiflex it)
  3. pull one toe back at a time, one joint at a time
  4. stop when you feel a pull
How did your ankle mobility change? Did it get worse with the knee straight or did it stay the same?

If it got worse, that likely means that you have restrictions deeper in the calf where the long toe flexors are located.

  • If your mobility was unchanged and looked normal? Awesome!
  • If your mobility got worse with this test, you will want to add in work on the calf where the long toe flexors.
  • For free users, check out the calf basics course in addition to the foot basics course from above. For premium users, the toe deformity course will streamline this for you.

 

Stay tuned: next week we will dive into what toe deformities mean to you as an athlete in terms of shoe selection, problem areas and recovery!

Ankle Range of Motion

When it comes to overuse injuries it is really easy to see them as an isolated event. The problem, however, is that overuse injuries are not an isolated thing. In fact, overuse injuries are the result of a mechanical problem. This could be mobility loss, decreased strength, or even coordination/muscle imbalance. Whatever the restriction, the injuries that happen are a result of the body compensating and ultimately working in a way it isn’t designed to. Eventually, it will result in something breaking down under the strain produced by that compensation.

The reason I bring all of this up is to point out that a single mechanical problem can actually manifest in a number of ways. Let’s take a look at ankle dorsiflexion for example:

Ankle dorsiflexion is your ability to bring the shin/tibia over the foot. Walking around normally doesn’t doesn’t require that much, but when moving at effort, the demands increase as you load the foot and ankle in prep for more propulsion. Restrictions here will limit that load period and in some cases stop your ability to push off of the foot completely. This means your body has to find a new way to move forward or you will fall over your own two feet. Depending on how your body tries to compensate, a number of injuries are possible.

That is why I wanted to do a blog series about normal mechanics and mobility. There is a reason certain treatments are seen across multiple injuries. It’s because even though what broke is different, the mechanical problems that led to it are likely the same.

With that in mind let’s get started. Up First? The Ankle Joint

In a lot of ways the ankle is the gateway to normal walking, running, etc. Our foot is the first thing to hit the ground and the mobility our ankle provides is what allows us to move over and push off of that foot. Without it, compensation is required to keep you from falling over your own foot. Let’s take a closer look! (note: the last minute is a self test. pause as you need to!)

 

In the self test at the end, we went through three movements. Here’s a breakdown of the test + next steps:

Self Test Walk through Result How To Fix
Dorsiflexion
  1. start in half kneeling position
  2. keep heel perfectly flat on floor
  3. lunge forward so that your knee comes over your toes.
  4. stop when you feel your heel start to come up
Ideally, you want to be able to keep you heel down and move your knee comfortably over the toes.

If you can’t do this, the next two tests will help determine if the restrictions are above the ankle or below it.

  • If your ankle mobility was normal? Nothing to fix!
  • If your ankle was limited with just this movement? Start with the calf basics course.
  • If your ankle was limited in all movements? You will need to address multiple areas. Combine the calf, knee and foot basics courses. If you have a premium account, the chronic tight calves course will streamline this for you.
Dorsiflexion with toes on stretch
  1. place something under the toes. in the video I am using a massage stick. 1-2 inches of height is plenty.
  2. relax the foot and repeat the first test.
How did your ankle mobility change? Did it stay the same or did it get worse?

If it got worse, that likely means that you have restrictions in the foot itself. This can be the small muscles within the foot, the long tendons coming from the deep calf, or a combination of both.

  • If your mobility was unchanged and looked normal? Perfect!
  • If your mobility got worse with this test, you will want to add in work on the foot itself. For free users, check out the foot basics course in addition to the calf basics course from above. For premium users, the chronic tight calves course will streamline this for you.
Dorsiflexion with knee on stretch
  1. keep your heel perfectly flat
  2. straighten the knee so that it is locked straight and repeat the first test
How did your ankle mobility change? Did it get worse with the knee straight or did it stay the same?

If it got worse, that likely means that you have restrictions behind the knee where the gastroc and hamstring tendons criss cross each other.

  • If your mobility was unchanged and looked normal? Awesome!
  • If your mobility got worse with this test, you will want to add in work on the back of the knee. For free users, check out the hamstring basics course in addition to the calf basics course from above. For premium users, the chronic tight calves course will streamline this for you.

 

How To Loosen Up Stubborn Areas

question mark on a sticky note against grained wood

Today we kick off our weekly Q&A session with the most common question I get:

“I have been working on _______ EVERY day and it will not loosen up. What do I do?”

We have all been there on this one. For some of you it may be the calves or hamstrings, and for others maybe it’s a hip or a persistent shoulder issue that just won’t let up. Whatever the area, the problem just won’t go away despite consistent work with the roller or massage ball. So what’s going on and why won’t it go away??

The first thing to realize is that our bodies are not like cars. If something breaks down, we can’t just swap that part out and carry on our merry way like it never happened. This is even more true when it comes to overuse injuries. For most of us, the start of symptoms and the start of the injury are not one and the same. There is a gap between the two and that gap is where we learn how to compensate around the problem so that we can continue training , racing, competing, etc.

This means we need to step back and stop focusing our efforts just on the area that hurts. Instead, we need to think about what other areas are contributing to the problem. Here’s an example:

Shoulder Pain (front of the shoulder to be more specific):

  • You start your self treatment using the Anterior (Front of) Shoulder Basics Course. This will take you through a progression of treatments targeting that area over the course of a few days. You want that time to see what works and to allow recovery between treatment sessions. However, at the end of that program, your shoulder still hurts. Now what?
  • My next step would be to include work on the opposite side of the shoulder. Why? Muscle groups work in pairs. These pairs allow controlled movement of a joint in opposite directions.  If the front side is having problems, then its safe to assume that the back side is as well. Head over to the body map and pull up the back of the shoulder. Add those techniques into your self treatment and reassess how things are feeling.
  • If working both sides doesn’t help, then it’s time to expand the areas we are working on. Why? Most major muscle groups work to move more than one joint. If there are problems at one joint, that muscle group will likely be compromised in how it moves the other joint. This is why the next step is to move up one joint and move down one joint. Using the shoulder as an example, this means that it is time to see how the neck and upper arm (biceps/triceps) are feeling. Back to the body map and pull up those basics courses to learn those techniques.

To put it more simply:

  1. Start with the problem area.
  2. Expand the area you are working on to include the opposite side as well.
  3. Add in the areas directly above and below the problem area.

Sound complicated? It’s not at all! This is where the interactive body map comes in. It doesn’t require you to know muscle groups or names. Simply start with your problem area and then flip the map over to find the area on the other side (this option is on the left hand side of the map). If you are moving up or below, use your mouse to select the areas directly above and directly below.

ATA Turns 6 (and gets a big makeover!)

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It’s hard to believe that this past January the ATA website turned six years old! For those of you who have been along for the ride from the beginning, you have seen a few different versions of the site now. What started as a little clinic wordpress blog has grown into a virtual warehouse of pictures, videos and content. In fact, managing all of that content and keeping it organized, user friendly, and time efficient has been my biggest challenge so far! Thankfully, you have all been a wonderful feedback loop over the years.
That’s why when I sat down to plan out the next phase for ATA, it was with your suggestions and feedback in mind.
  • Problem #1: Site Navigation. Let’s be honest, there is A LOT of information on the site. The body map was a great start in terms of organizing all of it by region, but it still made for large amounts of clicking around to find stuff. Despite my attempts to organize and reorganize, I never really could find a good fix for this until now. The new site is truly an educational site, complete with “courses”. These courses allow me to not only deliver the content in a streamlined way, they allow me to keep everything all in one place, on one screen. The new site is essentially an “app”. It’s simple and incredibly easy to use.
  • Problem #2: Information Overload. The new course setup allows me to keep things short and to the point. Even the videos have a whole new look. There are little timers built in and directions so that you can literally watch and let the video do the rest. Each treatment will take you less than 10 minutes from start to finish.
  • Problem #3: Not mobile device friendly. The new site is more mobile friendly than it is desktop friendly. Why? Because I want you to be able to pull this stuff up on your phone or tablet while you’re on your family room floor using the treatment techniques.

 

Here’s a video to show you how it all works:

So what does all of that mean for you as the user??

To access the courses, you will need to create an account and sign up for a membership plan. 🙂

Here’s what you can expect with your membership:

  • Access to all of the courses. As of today, there are 18 courses currently on the site. This number is only going to grow over the next few weeks as I start loading up the injury specific courses. Once those are done, you can expect 1-2 courses per month on average. My plan is to have three types of courses per region:
    • Basic- these courses are region specific and focus on how to use the different self treatment techniques on that area only.
    • Intermediate- these courses are more in depth and take a more total body approach by working on areas above and below the symptom area.
    • Advanced – these are injury specific courses. Like the intermediate courses, these are more in depth and designed to not only cure your symptoms, but also help you identify the cause behind them.
  • Access to monthly webinars and Q&A’s. These will be announced on the blog and also through member emails. Each will be recorded so if you miss one? No problem. You will be able to download it when you have the time.
  • Access to me for questions, feed back etc. As things get rolling I will be posting “office hours” for you to reach me on skype.

In addition to individual plans, the new site layout also gives me the ability to create custom courses for teams and groups. Coaches? Need an offseason maintenance plan for your athletes or a post workout recovery routine? This is the option for you. Simply use the contact page to tell me what you are looking for!

Sounds pretty good doesn’t it?

 

 

Shoulder Treatment Part 3 (aka elbow and forearm)

Hi everyone! Sorry for the massive m.i.a but it has been a tough few weeks in the Boyle household between an epic battle with the flu and more recently 50 fire ant bites on my hands. Lesson learned the hard way on that one! 🙂 Anyhow..

This week we dive back into the treatment portion of our shoulder series. To recap: in part one we really focused on the large stabilizer muscles to build some slack down into arm, as well as, up into the trunk muscles. In part two, we then added in some more aggressive mobilization techniques to target the busy intersections in the front and back of the shoulder where the biceps and triceps attach.

This week we’re shifting to the other side of the biceps and triceps into the elbow, forearm, and hand. While that may seem far away from where you’re symptoms are, remember- there are four fascial chains of muscles in the arm. The two deep/stabilizing lines run from the biceps and triceps all the way to our hands. On top of them, the superficial lines connect the power muscles of the chest and back to the ones in our forearms. Whichever way you look at it, restrictions here will impact your shoulders ability to function normally. If you’ve been battling shoulder symptoms for any length of time, you can also guarantee that your elbows and wrists have been doing a hefty amount of the compensating.

Here’s the breakdown:

  • Roller: forearm + hand (1 minute each of flexors, extensors, drinking muscles, thumb and pinky finger)
  • Stretches: 30 seconds x 1 of each (flexors, extensors, thumb + hand)
  • Total time = 6-8 minutes

Forearm and wrist massage from Athletes Treating Athletes on Vimeo.