Lift heavy weights to improve your endurance.

If reading detailed research isn’t your cup of tea, here’s the executive summary:  If you strength train with very heavy resistance (>85% of your one rep max – (1RM)) along with your endurance training, you can improve your long-term endurance without any increase in muscle mass.  Yes, I know that may be contrary to intuition, but there you have it.  Other studies show that weight training with <80% of your 1RM just doesn’t cut it.  So, you have to lift heavy!  However, please don’t sue me when you herniate a disc trying to squat 532 pounds. Utilize a personal trainer if you want to go >85% of your 1RM – that’s what they’re there for.

OK, here are the details…

This study just came out in March of this year:  Effects of resistance training on endurance capacity and muscle fiber composition in young top-level cyclists. The gist of the relatively small study was that they had two groups of highly trained cyclists – one group continued with Endurance training alone (E group) while the other group added high resistance Strength training to their Endurance routine (SE group). For the SE group, they weight trained 2-3X/week and progressively increased the weight. They progressed over a period of a couple weeks to 4-6 reps of ≥85% of their 1RM. After 16 weeks of training, both the E and the SE groups improved their short term (5 min) cycling performance, but when it came to a 45 minute cycling, the endurance capacity increased only in the SE group (by 8%). Interestingly, the muscle fiber area and capillarization (# of blood vessels) was no different.

Take home message…

Combining strength training with endurance has shown equivocal results in different studies. However, when you dissect the studies, it turns out that long term endurance performance has not shown gains in the SE group when the subjects did low volume (<8 weeks duration) and/or low-intensity (<80% 1RM) strength training (found here, here and here). However, when the volume is high and the intensity is high (≥85% 1RM) there is significant improvements in long-term endurance capacity (found here, here, here and here)

Pretty much all of these studies concur that there is no change in muscle size because the normal increase in size that you would see is blunted because of the continued endurance training which is catabolic.

OK, so if there is no change in Vo2max, muscle size or capillarization, why do they get better at endurance capacity? The answer there is still unknown, but the theories are numerous. The one that makes the most sense to me is a change in economy of movement because of improved neuromuscular recruitment. Simply put, when you lift heavy, you learn how to utilize more muscle fibers and you become more coordinated in firing the muscles. Therefore, if you run or cycle at 70% of your Vo2 max, but your are recruiting more power with the same effort, you will go faster and use less oxygen.

Beet Juice Better Than Aero Wheels?

Ergogenic aids come and go and what is usually thought of as a breakthrough turns out to be another disappointment.  The idea of nitric oxide as an ergogenic aid is absolutely huge right now in the research.  I thought it was time to finally talk about it – even if it turns out to be a total flop, there is no harm in discussing it.

OK, I’m going to keep this as unscientific as possible. Partly because I don’t want to bore you, but mostly because I barely know what I’m talking about…;)

The big news in the science of sports supplementation in the past year involves – beet juice. More specifically, the high nitrate concentration in beet juice. Nitrate is abundant in vegetables and is converted in the body to nitric oxide. A flurry of studies lately have demonstrated that dietary nitrate reduces oxygen cost during exercise and thus, boost performance.  I have listed two studies below, but there are more.

Study 1: In a double-blind, placebo (PL)-controlled, crossover study, subjects consumed 500 ml/day of either beetroot juice (BRJ) or placebo for 6 consecutive days and completed a series of “step” moderate-intensity and severe-intensity exercise tests on the last 3 days. The oxygen consumption following the onset of moderate exercise was reduced by 19% in the BRJ condition. During severe exercise, oxygen consumption was reduced and the time-to-exhaustion was extended (BRJ 675 sec vs. 583 sec for placebo)

Study 2 (an important one released April 5, 2011): Researchers found a way to take the nitrates out of the beet juice, so they gave the athletes beet juice with nitrates and beet juice without nitrates as a placebo. Drinking 500 mL of beet juice with nitrates 2.5 hours before a cycling time trial improved 4 km TT time by 2.8% and 10 mile TT time by 2.7% vs beet juice without nitrates. In other words, the 4K time trial was 6.26 vs 6.45 min and the 16K dropped as well – 26.9 vs 27.7 min. Some of you may say “one minute for a 16K time trial? That’s not much!) OK, let’s put it in perspective…cyclists pay a couple thousand dollars for aero wheels. As shown on the Zipp wheels data, for a 1080 front and a sub9 disc wheel (total cost about $3200) you can expect to save 108 seconds…over a 40K race! That’s equivalent to 43 seconds over a 16K race, while the beet juice saved people 48 seconds over a 16K race. $3200 for wheels, or down some beetjuice. Hmmmm…….

The effects of nitric oxide have been known for years. There are some effects that we are not quite clear on, such as increasing mitochondrial action in the cells. We do know, however, that it causes vasodilation , or dilating blood vessels. Researchers think that this is how it helps get oxygen to the working muscles more efficiently.

Ironically, that is the same mechanism of action as Viagra. Indeed, pro athletes have already though of this. Roger Clemens was known to have Viagra in his locker, but only for “athletic” performance…not for “other” types of performance. BALCO founder Victor Conte was quoted as saying ” “It’s bigger than creatine. It’s the biggest product in nutritional supplements.” Also, at the Giro d’Italia, Italian police found 82 Viagra pills and syringes in the car of top cyclist Andrea Moletta.

Before you run out and buy beet juice, are there any side effects? Too early to tell, but possibly…you can read more about it here. Also, take it easy on the mouthwash. Yes, you read that correctly – take it easy on the mouthwash. In order for your body to benefit from the nitrates in the beetjuice, you first have to convert the nitrates to nitrites, then to nitric oxide. You need these little critters in your mouth called bacteria to do the conversion. Mouthwash kills the bacteria, hence no conversion. Yes, they’ve actually done studies on this. Read more here.

Cadence and Joint Loading

For the purposes of this post, we are referring to a steady state run (not accelerating) on flat ground…

During a standard running gait evaluation, there are many factors to analyze.  Without listing all of them, today I would like to talk about one that is high on the list.  That is the step frequency, or cadence.  We are referring to the number of times your feet hit the ground in a given time frame – usually measured as steps per minute.

We know that a higher cadence results in:

  1. Less horizontal braking force
  2. Less vertical displacement of your center of mass
  3. Less joint forces at the knee and hip
  4. Initial foot contact closer to the center of mass (Less overstriding)
  5. A flatter foot position at initial contact (less heel strike)
  6. Less peak ground reaction forces (how much force you hit the ground with)

There are implications that have potential to reduce injury for all 5 of those factors, but #3 is the one that I will focus on in this post: Less joint forces at the knee and hip.

A recent study done at the University of Wisconsin took 45 runners and had them run at their preferred pace (average of 9:15/mile).  The runners had an average of 172.6 steps per minute (± 8.8 steps per minute).  The researchers then had the runners run at the same pace, but under five step rate conditions: preferred, ±5%, and ±10% of preferred. In other words, the same pace, but the number of steps per minute were increased or decreased by 5% and 10%. The runners were able to change their step frequency by listening to a metronome and matching their steps to the beat of the metronome.

The results confirmed all of the 6 factors that I listed above.  However, as I said earlier, this article will focus on the mechanical energy at the hip and knee.  The table below outlines the changes:

.                                                          -10%        -5%        Preferred       +5%         +10%
Energy absorbed @ Hip (J/kg)             1.2           0.9                0.7            0.5            0.3
Energy absorbed @ Knee (J/kg)          13.5         11.1              9.2            7.4            6.1

As you can see, the amount of energy absorbed at the hip was 57% less when going from preferred step rate to +10% step rate and a whopping 75% less when going from -10% step rate to +10% step rate.  At the knee, it was 33% less for the +10% condition compared to preferred and 55% less in +10% compared to -10%.

This is an amazing finding.  Is it enough to reduce injury?  We don’t know, but if I had knee pain and could decrease the load on the knee by 1/3 just by increasing my step rate by 10%, I think that would be good.

So, who should adopt a faster cadence?  Well, for this post, we are looking at this from an injury perspective.  So, if you’re not injured and don’t usually get injured, I would ignore this post.  Also, if you are injured, but have a relatively good cadence I wouldn’t change (I usually don’t change people if they are >170 or 175 steps per minute, although other factors weigh into it).  However if you are injured, or frequently injured, AND have a low cadence you would probably benefit by changing to a faster cadence.

The easiest way to accomplish increasing you step rate is to listen to a metronome and match your steps with the metronome while on a treadmill.  If people do it outside, they tend to run at a faster pace.  By doing it on a treadmill, your pace is kept constant.

I have given this type of gait changes to a number of patients, but the one problem I constantly hear is “I’ve looked on the web but I can’t find a metronome sound for my iPod.”.  Well, here you go.  Simply right click on these mp3’s and then “save link as”:

165

170

175

180

OK, here are the arguments against increasing step frequency and studies that counter those arguments:

1. “Even if the magnitude of the load is less, I’m taking more steps, so the benefit is offset”

This study suggests that reducing the magnitude of the load outweighs the increased number of steps.

2. “That’s great while I listen to a metronome, but once I stop listening, I will revert back to my old ways”.

    This study says that most people can maintain gait changes for at least one month follow up, with no other intervention.

    3. “I have longer legs, so my step length is longer and my step rate is slower”

      This study showed that people with leg length or height of the runner is not strongly associated with stride length or frequency

      4. “If I change my stride frequency, I will be working harder”

        This study showed that if you change your cadence by less than 10%, the oxygen consumption doesn’t change much.  Once you change by more than 10% of your preferred cadence, oxygen consumption goes up significantly.

        Alter-G

        So…we took a leap of faith and got ourselves an Alter-G. What the heck is an Alter-G you ask? Watch the video below and you’ll find out.

        In the D.C. area, the Redskins have one, D.C. United has one and the Veterans Affairs hospital has one. That makes us the ONLY publicly accessible Alter-G in the DC area

        Alter-G a treadmill that unloads the weight from you as you run. You can run with 100% to 20% of your body weight. Perfect for anyone with shin splints, ITB syndrome, knee pain, hip pain, recovery from stress fractures and the list goes on and on.

        Simply put on the shorts, step in the machine, zip in and run. You calibrate the machine to de-weight you in 1% increments. Afraid you won’t get the workout you would normally? They’ve accounted for that – they did a study on cardiovascular effort and found that for every 10% reduction in weight, you simply speed up the treadmill 0.6 mph. This results in the same cardiovascular effort, but your musculoskeletal system is spared.

        So, let’s say you’re training for a race and start to get some tweaks of pain. First, obviously, you get treatment a great ART/chiro/acupuncture office, but you also keep up your training on the Alter-G

        Even for non-injured runners, you can de-weight yourself a little and run at much faster speeds than normal. This helps to improve your turnover rate as well as do longer runs with much less risk of overuse injury.

        This is an amazing device for people coming off hip replacements, knee replacements, ACL surgery or any other lower extremity or back surgery. Most patients take a long time to get up and start walking. The Alter-G can allow you to get walking without your full body weight.

        We will be having an open house for people to try it out for about 10 minutes at no charge on Tuesday March 8th at 5:30 and Saturday the 12th at 3:00 for a couple hours each day.

        Check out the video here:

        barefoot/minimalistic running

        Greetings!

        Yes, I know these newsletters have been sparse lately, however I’m hoping to get back to a more regular routine. We have officially and legally (God, please forgive the lawyers) sold the Arlington office, become official US citizens, the NFL season is over (Go Pack Go!) and I am officially in Ironman training. Hopefully these factors will allow me to get more focused on running and give me thoughts for the newsletters.

        New Trends In the Prevention of Running Injuries

        Or…

        A Barefoot Running Orgy

        The weekend of January 28th-30th, I spent at the National Conservation Training Center in Shepherdstown, WV for a 3 day conference “New Trends in the Prevention of Running Injuries.” and in the eyes of TheRunningClinic.ca, I am officially a “Running Specialist.” So, in the words of Carl Spackler, “I’ve got that going for me, which is nice.” This was a great conference and I’m happy I attended.

        This conference was lead by Blaise Duboise, a Canadian Physiotherapist who works for the Canadian National Track and Field team and is an accomplished runner himself. The audience was limited to 40 of us (mostly PT’s, orthopedic surgeons, and one chiropractor ;)) but also in attendance in the audience were:

        Danny Dreyer (author of Chi Running)

        Ian Adamson (Director of Research and Education for Newton Running and World Champ in a ridiculous number of endurance races)

        Jay Dicharry (from UVA’s SPEED lab – possibly the nation’s premier gait analysis lab and recently featured in Running Times)

        Peter Vigneron (Runners World)

        Jeff Horowitz (Competitor Magazine and personal friend)

        Peter Larson (RunBlogger.com)

        There were many knowledgeable people there with a number of diverse viewpoints. Overwhelmingly though, it was people who were pro barefoot/minimalistic running. This was a bit of a surprise to me, because I was just expecting a biomechanics and treatment conference without any agenda. When you get a bunch of people in the room who all share the same viewpoints, they feed off each other and opinion unfortunately becomes perceived as fact. There were a few voices in the crowd who debated which was nice. However, imagine going to an Obama rally and shouting out that national healthcare is a really bad idea…in your opinion. Do you really want to do that?

        This newsletter will ruffle the feathers of some of you. Sorry. Some of you are ardent Vibram, barefoot runners, while other are the opposite. Please keep an open mind – sometimes it’s good to stretch your brain. It’s also tough for me to summarize 3 days of class work and evening conversations during group runs and unofficial presentations, but here’s what I got out of it:

        1) Research is lacking: On both sides of the fence – barefoot/minimalist and high tech shoes have very little concrete evidence to say one or the other is better for injury prevention. Even the whole concept of running for health can be debated when you are critical of the research. For example, the presenters were reporting on studies showing that runners have a reduced risk of annual death compared to non-runners. Seems straightforward enough, but was it due to running? Maybe it’s because runners generally choose a healthier lifestyle including other exercise, not smoking, better diets etc. We just don’t know, and to say it’s due to running is a leap of faith. Personally, I think it’s mostly the running, but in the research community, the words “personally” and “I think” probably aren’t great terms to throw around.

        2) Barefoot Running is Different: Essentially that’s all you can say right now. There are abundant studies showing that barefoot running increases cadence, reduces ground reaction forces, impact rates, changes joint torques and muscle loading strategies, reduces vertical displacement of the center of mass and a slew of other factors that we “think” would reduce injuries. However…is that definitely going to reduce injuries? Not necessarily, or at least, not yet proven. I think that’s where the barefoot running community has gone astray…they criticize the running shoe industry for no concrete research, and imply that running shoes are bad for you. Yet there are not any good studies showing that barefoot running reduces injuries either. Even if some hypothetical person switches to barefoot running and feels better, is it the barefoot running or something else? In other words, is it the barefoot running or is it the increased cadence that you typically see with barefoot running. Maybe it’s the change from heel strike to midfoot or forefoot strike that makes the difference. Maybe it’s less bouncing because you don’t have the cushioning of the shoe. All we can say is barefoot running is different, not necessarily better.

        3) Most injuries are due to too much, too soon, too often. In other words – overuse injuries. Our bodies have an amazing capacity to adapt. As such, we can apply a mechanical load to a muscle, ligament, tendon or bone and if done with the right frequency, the right duration and the right force, the body will make that tissue stronger. Too little force, frequency or duration will result in not enough tissue adaptation and it won’t get stronger. Too much of any of those will result in injury, because the tissue hasn’t had time to adapt. If my newsletter doesn’t bore you to death, here’s a great paper from 2004 on overuse injuries in runners.

        4) Measuring someone’s anatomical variations will give you no information about injury prevention. In other words, if I measure your leg length, foot arch, body weight heel valgus, knee valgus hip inversion/eversion or the color of your eyes, these factors will tell me nothing about your injury potential. There is one exception to this and that is a study that found leg length differences can correlate to more injuries, however, these are only if the difference in leg lengths are more than 2cm. That is huge!

        Unfortunately, health care providers are taught to measure the body while lying down or standing. This is non-functional (i.e. static, not dynamic). However, things change while moving; what the foot does standing still is different than what it does with forward momentum, the opposite arm swinging, the torso rotating and the knee bending. How many people developed shin splints while laying on a table, or standing still? We need to see how the body moves when you perform your functional activity.

        Essentially, we can’t take one factor and say – that’s why you’re injured, or this is why you will get injured. There was a lot of biomechanical evaluations and research presented at the conference that definitely made me better equipped (and I thought I knew it all!)

        What I can say with a great deal of certainty is that most people could benefit from doing some barefoot running training. Since we know that barefoot running generally increases cadence, reduces ground reaction forces and impact rates, reduces excessive pronation and all sorts of other things, I think it’s a good idea to do some training barefoot. This has to be done very gradually!!! However, to switch to being a barefoot runner…I’m not convinced. At least not yet. More and more studies are being done. We’ll see what happens. If it ain’t broke, don’t fix it.

        There is so much more to discuss, but it gets very technical and thus, boring for a newsletter. Hooray for you if you’ve read it this far! I don’t want to lose anyone else, so I’ll end it here and maybe talk more about this another time.

        Reducing Inflammation: A catch 22?

        RICE – Rest Ice Compression and Elevation. It’s the term many people know when they suffer from an injury. It’s the standard protocol and its purpose is to reduce swelling and inflammation which should reduce pain. Throw in some anti-inflammatory pills (Non-Steroidal Anti-Inflammatory Drugs – NSAID’s) like Aspirin. Ibuprofen or naproxen and you’ve really stunted the inflammatory process.

        This treatment protocol has been followed for decades, however, more clinicians and researchers are questioning this protocol. The question is, do you really want to stop the inflammation? Do you want to take NSAID’s, apply ice or get a steroid injection. Do you really want to put an end to the swelling?
        The answer is appearing to be yes…and no. If you really need a short term solution, then go ahead and reduce the inflammation. If you are concerned about long term implications, you may be better off to let the inflammation run it’s course. In other words, there appears to be a trade off: reduce inflammation now and benefit – just understand that you are sacrificing the health of the tissue in the long run.
        Confused yet? Let’s break it all down:

        Inflammation is a complicated process involving not only the physical appearance of redness and swelling, but a whole host of cellular processes designed to lay down the building blocks of healing. While sometimes painful, it’s also a necessary process needed to heal tissue. Do you really want to blunt that course of action? Let’s see what happens when you do:

        Two new studies in the past couple months have strengthened the notion that, contrary to popular belief, swelling and inflammation are very beneficial to the healing process.
        The first study found that mice that were genetically altered so that they could not produce swelling were unable to heal from muscle injuries. This isn’t exactly my favorite study since first of all, it was done on mice and secondly, genetically altering something doesn’t really reflect real world scenarios. The point of the study however: no swelling=no healing.
        The second study was published last month the British medical journal – The Lancet. Here, they found that injections of cortisone (a powerful anti-inflammatory steroid) brought initial relief for tendon injuries such as tennis elbow, but produced significantly worse outcomes 6 and 12 months later compared with patients who did nothing or performed exercises.
        Results seem to be a trade-off between short-term and long-term benefits: reducing swelling with ice or anti-inflammatory drugs may ease your pain now, but slow down your ultimate return to full strength.
        Ultimately, the best advice may be to treat any injury as much as you need to – but not more.

        That is the end of this newsletter for those of you who want to go with what is written above and don’t want to be bored with more research studies. For those who want more evidence, I have listed a few more studies below.

        1) This report reviewed 25 other clinical trials involving athletic injuries with cortisone injections. In their conclusion, they report, “Tendon and fascial ruptures are often reported complications of injected corticosteroids”

        2) Another article which reviewed the past 50 years of published literature reports ” Several reports from animal and in vitro studies have demonstrated impaired bone healing in the presence of conventional NSAIDs, as measured by a variety of different parameters.”
        3) There are many many studies done on rats where the researchers break the legs of the rats, feed them varying doses of NSAID’s and see which ones heal the fastest. Invariably, the rats given the most NSAID’s heal the slowest. There aren’t many human studies because, let’s be honest, who wants to volunteer to have their bones broken? However, there are some studies on humans. This study looked at the healing rate of patients who underwent spinal fusions. Of the 288 cases that were randomly given NSAID’s, it was found that nonunion occurred in 5 of 121 (4%) of patients not taking NSAID’s and 29 of 167 (17%) patients receiving NSAID’s. The rate of non union went up as the dose of NSAID’s went up.

        Tidbit#1:

        Sitting will kill you!

        OK, maybe the title is a bit melodramatic. After all, if you listen to the news, it’s always something that will kill you, right? I found this study interesting and wanted to put it in here, because many people who exercise believe that as long as they work out, they are totally evading the effects of other negative lifestyle habits. This study looked at 123,000 men and women between 1993 and 2006 and they found “Women who reported more than six hours per day of sitting were 37 percent more likely to die during the time period studied than those who sat fewer than 3 hours a day. Men who sat more than 6 hours a day were 18 percent more likely to die than those who sat fewer than 3 hours per day. The association remained virtually unchanged after adjusting for physical activity level.”
        So, was this study an aberration? Unfortunately not. A similar study in May 2010 found that men who spent more than 23 hours a week watching TV and sitting in their cars had a 64 percent greater chance of dying from heart disease than those who sat for 11 hours a week or less. Again, being physically active did not counter the detrimental effects of being sedentary the rest of the week.
        I believe this goes back to today’s lifestyle. Instead of walking, we tend to drive a few blocks to go to the store; instead of walking down the hall, people send an emails to coworkers; we use computers, televisions and video games constantly.
        What to do? Get up and walk to go to the store, pace around the office, next time you’re watching Amazing Race, do some push ups or stretching. For Pete’s sake, stop the Roomba and pick up the vacuum!

        Tidbit#2:

        Water water everywhere
        OK, so the source of this tidbit isn’t exactly a peer reviewed journal, but the information is important nonetheless.
        Ironman now has it’s own magazine – Lava. In the Oct/Nov issue, there was an article that I thought was fascinating. In the 2008 Louisville Ironman, the temperatures were in the 90’s and humidity up around 80%. All participants were required to step on a Tanita body scale prior to the race. While not as revealing as a TSA body scan at the airport, this device is good for measuring a few different things, including body weight and water percentage (hydration levels). Here’s what they found:
        • In men who tested with a hydration level above 65 percent, 97.78 percent finished the race. Men who tested with a hydration level below 55% either finished in the bottom 18% or did not finish
        • In women who tested with a hydration level above 60 percent, 92.5 percent finished the race. Women who tested with a hydration level below 50% either finished in the bottom 13% or did not finish
        Perhaps in another article I will go further into the strategies of race day hydration and pre-race hydration. For now, stay hydrated!

        TidBit#3:

        Band on the Run: Music makes you faster…sort of.
        Great, now I’m going to have that song in my head the rest of the day. This study was published in Sept 2009 and found that listening to music while you exercise can make you faster…if you do it right.
        The researchers chose a program of six songs, then played them either at regular speed, 10 per cent faster, or 10 per cent slower while the subjects rode exercise bikes. The subjects were unaware of the speed changes. Speeding up the music program increased 1) distance covered/unit time, 2) power and 3) pedal cadence by 2.1%, 3.5% and 0.7%, respectively; slowing the program produced falls of 3.8%, 9.8% and 5.9%.
        However, perceived exertion was also higher with the fast music. That means that while the subjects sped up with faster music, they also felt that they were working harder. Apparently they were actually willing to suffer more as long as the music was pushing them along.
        My legal department has advised me that I should also include this disclaimer: Listening to music through earphones may be hazardous while running or biking on populated streets with vehicles weighing more than you. Please be cautious.

        Hip weakness and knee pain

        Greetings!

        So I was treating a novice female bodybuilder a couple days ago who wants to start running. The problem is that when she gets over 5 miles, her knees start to hurt. After an evaluation we learned that the outside muscles (abductors) of her hips were weak. “How can that be, I work out with weights all the time?” she asked.
        Well, when all you do is forward lunges, squats, leg press, leg extensions, leg curls and dead lifts, that is all forward and backward – no lateral strength. As we see below, life is more than forward and backward movements. Side to side and rotational strength is also very important.

        Title Article:

        Hip abductor weakness in distance runners with iliotibial band syndrome.

        or…

        Do weak hips cause knee pain in runners?

        * Hip “abductors” are the muscles that move the thigh out to the side (away from midline)

        Knee pain is one of the most common pains seen in runners New evidence has been coming out in the past few years indicating that we need to look more at the hips for the cause of knee pain.

        This new study was small (just five runners and four control subjects), but found that twice weekly hip strengthening exercises for 6 weeks was able to reduce knee pain significantly in runners. The injured runners began the six-week trial registering pain of 7 when they ran on a treadmill and finished the study period registering pain levels of 2 or lower; i.e. no onset of pain.

        This 2000 study found that not only did runners with Iliotibial band syndrome have weak hips, but by strengthening the hips, the ITB pain went away…

        · 24 distance runners with ITBS and control group of 30 non-injured distance runners
        · Females: 21% weaker abductors in the injured leg compared to their non-injured limb and 24% weaker than control group
        · Males: 21% weaker abductors injured leg compared to their non-injured limb and 30% weaker than control group
        · 6-weeks of rehabilitation of strengthening the hips
        · The females increased hip abductor torque by 34.9% in the injured limb. Males an average increase of 51.4%.
        · 22 of 24 runners were pain free and still after 6 months follow up

        This 2008 study looked at the changes that occur in the entire lower extremity mechanics if hip strengthening exercises were employed. They found that after a 6 week program of hip strengthening,

        · Hip abduction and external rotation strength was improved by 13% and 23% respectively
        · the rearfoot inversion (the runners heels collapsing inward) was reduced by 57%
        · knee abduction moment (the knee collapsing inward) was reduced by 10%

        While this doesn’t necessarily say that hip strengthening will reduce knee pain, is certainly confirms that hip strengthening has a major influence on the mechanics of the knee and feet.

        I am a big fan of doing core strength work if you’re a runner. While most people wouldn’t consider hip strengthening as “core work”, it absolutely is. Unfortunately, “the core” has become synonymous with doing sit ups, but core muscles are technically any muscle that attaches to the pelvis. The hip muscles would be at the heart of the core.

        I am also a big fan of coach Jay Johnson. One of his latest blog posts speaks of how we develop quicker metabolically than we do structurally. In other words, most runners develop strong cardiovascular systems, yet we are very weak in our muscles, tendons and ligaments. A great intro program to strengthening the hips is the Myrtl routine. While this won’t be the cure all, it is a good start to waking up your hip muscles in a variety of directions.

        If we break down running into it’s very, very (I can’t emphasize the “very” enough) basic form, it is a one legged squat followed by another one legged squat, followed by another and another. Unlike walking, there is never a point in running when we are on two feet (if you ever find yourself with two feet on the ground in a race, that’s called walking, and you’ve bonked). This makes it important to train on one foot. I have seen many people who are more than capable of doing a heavy squat with two legs, but completely lack the muscular control and balance to do a one legged squat. This is due to weakness in the hips. Check out this video. Right knee one leg squat is good..left one is not so good. Since her left knee caves inward during the squat, it causes major stress on the knee and the ITB. This is from hip weakness and we can assume that during her running gait, there is a certain amount of this inward collapsing of the knee going on every time she plants her foot on the ground…especially when she’s fatigued later in the race.

        So to summarize, knee pain in runners isn’t always what it seems. By treating the knees, we may be able to make some headway, but gait analysis and hip strengthening go a long way to treating knee pain.

        Which is the harder workout: Elliptical or Treadmill?

        The motivation for this edition’s topic was originally for my own research, but I thought I may as well make a newsletter out of it. Since we are in the heart of the marathon season right now, many runners have been doing their long runs and coming up gimpy to say the least. If the pain prohibits running, or risks further damage, I usually encourage some amount of substituting an elliptical workout instead of the regular running. Since the motions are similar to running without the impact, it’s a good substitute for running for some injuries. However, some brazen patient actually had the gall to actually ask a question: “Will I get the same workout on an elliptical vs. running?”. After I fired them as a patient, I thought I’d look it up…

        Cardiometabolic Comparison Of Elliptical And Treadmill Exercise Responses

        or…

        Which is the harder workout: Elliptical or Treadmill?

        There is enough research to show that if you take time off from running, your quickly lose much the cardiovascular and musculoskeletal fitness that you had so diligently gained. There is also enough research to show that if you take time off running but substitute elliptical, water jogging, stair master etc., the loss of fitness is minimized. Depending on the injury, ellipticalling (yes, I just made that a verb) is probably the best substitute since it most closely mimics running. How does it compare in terms of the cardiovascular workout though?

        · 2005 study: 16 subjects had their vO2 max tested and then on subsequent sessions were put on a treadmill or elliptical and asked to exercise at a “heavy” perceived exertion (RPE). During each exercise session (10 minutes in duration) at the prescribed RPE, oxygen consumption and heart rate (HR) were measured continuously. In the end, they concluded that “energy expenditure is greater during treadmill compared to elliptical exercise at the same perceived exertion level.”. In other words, you get a better workout on a treadmill

        · 2004 study: 24 subjects in a setup similar to the last study found that “Treadmill produces greater exercise expenditure than elliptical training with less strain or feeling of exertion. Despite energy expenditure differences, elliptical training provides a respectable, low-impact exercise alternative to treadmill running.

        In contrast…

        · 2004 study: Researchers tested 18 subjects again in a similar research setup an found “elliptical machine exercise appears to be equivalent to treadmill exercise for maximizing energy expenditure at the same self-selected moderate intensity.” They also found that all subjects elicited a significantly higher heart rate on the elliptical compared to the treadmill even though perceived exertion was not significantly different.

        · 2004 study: OK, 2004 was apparently a popular time for researching this topic. This study had 24 women do either treadmill, elliptical or stair-climber machine with similar intensities and durations and found that “similar physiological improvements were observed using stair-climber, elliptical trainer and treadmill running when training volume and intensity were equivalent.”

        In the end, it appears that with the same perceived effort, some studies show that treadmill is a better workout physiologically than an elliptical, while other studies show no difference. Whatever difference there is, it’s safe to assume that it is such a small difference that it’s not worth worrying about.

        Obviously if you’re training for a race, there is no substitute for actual running. The biomechanical load placed on the muscles and the joints in running are vastly different than a elliptical trainer. That being said, an elliptical is about as close to the real thing as you’ll get and at least there is some comfort in knowing that you can replace some of your runs with sessions on an elliptical machine and get close to the same cardiovascular workout.