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Inquirer Daily News

Archive: May, 2013

POSTED: Friday, May 31, 2013, 5:25 AM
Filed Under: Desirea D. Caucci | Running

Over the past several years there has been a growing trend among the fitness and shoe wear communities to promote barefoot running or running with minimally supportive shoes. This shift has been brought to the forefront with the growing trend of bringing things back to a more “natural” state; let the runners’ bodies control the foot and ankle forces instead of stiff and bulky running shoes.

While some elite athletes have successfully trained and competed barefoot, others have been just as successful with good old fashioned running shoes. More information about the effects of barefoot running and different types of shoe wear on the forces throughout the foot, ankle and rest of the body will be helpful in deciding which method of running is best for you.

Researchers who have spent decades studying the biomechanical forces of runners continue to debate which method is better. One side argues that barefoot running reduces stress and strain by eliminating heel strike during stance. There are proponents growing in number who assert that the most natural gait pattern for runners involves contacting the ground with the mid-foot or forefoot, not the heel; opposite of the natural walking cycle when the heel should hit the ground first. They further theorize that runners begin adapting to shoes by developing a heel strike running pattern because of the design of the running shoes, causing more impact force at contact.    

There is no debate that heel strike running causes a transient impact peak force, but proponents of the heel strike running pattern argue that the rest of the body suffers with the absence of heel strike. In order to land on the mid or forefoot, there is reduced step length and reduced hip and knee flexion, thereby reducing the muscular shock absorption with each step by 50 percent. Subsequently, increased joint stress is transmitted to the knees, hips and lumbar spine. This shifts the loading from the large and strong hip muscles to the smaller muscles of the foot and ankle.  

Like other areas of the body, runners need to have a balanced system of muscles working together to reduce joint stress. In my research, those runners who utilize a mid- or forefoot pattern tend to over-develop their quadriceps and calves while the posterior gluteal muscles remain significantly weaker. A 1:1 balance of the posterior gluteus maximus with the anterior quadriceps muscle groups is ideal. In fact, many lower extremity overuse injuries (most common to for runners include knee and foot/ankle) can be traced back to weak gluteus maximus muscles and a quadriceps-dominant pattern.

So which running style and which type of shoe, if any, is best?  There is not one universal running form that is recommended for all; some body types perform better with heel striking while others perform better with mid- or forefoot gait patterns. But in my experience with patients I favor the heel strike pattern once the gluteal muscles are strengthened appropriately.

The past few months alone, I have treated several patients with running injuries after they consciously shifted their running form from heel to mid- or forefoot patterns. Many patients complained of Achilles tendon pain and plantar fasciitis. In most cases, education on returning to their natural heel strike running form, shoe wear modification, and increased activation of the hip and core muscles yielded pain-free running. However, if you have been a pain-free mid- or forefoot runner, then stay that way. If you are a runner who has pain, then you should be evaluated by a Physical Therapist who can analyze the factors (weakness, imbalance, compensations, inflexibility, shoe wear, etc.) that are contributing to your problem.

As far as shoe wear, new research is confirming that the bulky stability and motion control shoes are actually increasing the stresses on the foot and ankle that they are intended to minimize while the minimalist shoes and barefoot running are increasing joint stress by encouraging the mid to forefoot strike pattern. Therefore, the best advise lies somewhere in the middle. Even if barefoot running was optimal for the body, it simply is not practical or safe for running on surfaces that may be hot, rocky, wet, or covered with pieces of glass or debris.

POSTED: Thursday, May 30, 2013, 9:20 AM
Filed Under: Cycling | Physical Therapy

Editor’s note: Before this weekend’s Philly Cycling Classic, the Bicycling Open will allow Philadelphia amateur riders to preview the course for themselves. Deb Kucera, PT, MSPT from Magee Rehab offers some tips on post-ride recovery.

Recovery from any long ride takes focus. Recovery from a ride that includes the “Manayunk Wall” takes extra focus, especially if you haven’t exactly trained well for it (we’re looking at you, eager amateur riders). 

When should you ideally start to think about recovery?  Ideally, well before you hop on the bicycle. The less prepared your body is for the race, the longer your recovery is going to take. You may be saying to yourself, well, it’s a little late for that. But not to fear—whether you have been training for months on end or signed up on a whim, in a few days, you’re going to have to tackle the infamous Manayunk Wall. And the days to follow may be marked by soreness, pain, and fatigue, but with any luck, no injury. 

POSTED: Thursday, May 30, 2013, 5:20 AM
Filed Under: Cycling | Profiles

To the uninitiated, it’s Levering Street and Lyceum Avenue in the northwest section of Philadelphia.

But to natives and to cyclists, it’s known by a much simpler, yet more foreboding title.

“The Manayunk Wall,” says Sean Petty, COO of USA Cycling. “In a word, it’s iconic.”

POSTED: Tuesday, May 28, 2013, 9:29 AM
Filed Under: Men | Other Sports | Profiles | Running

For years, Channel 6’s anchor and Sports Director Gary Papa was a Philadelphia institution.

But to one colleague, he was so much more.

“Quite simply, Gary Papa is the reason I am here,” says Jamie Apody, Channel 6 sports reporter and anchor who was hired by Papa in 2006.

POSTED: Saturday, May 25, 2013, 1:00 PM
Filed Under: Broad Street Run | Profiles | Running

Several years ago, Carl Ewald found himself slipping out of running shape. So to get motivated, he did what many Philadelphians do—he signed up for the Broad Street Run.

Joining together with some friends, Carl hired a running coach and formed a team. He got back into his desired condition and completed Broad Street. But he still felt unfulfilled.

“Broad Street is such a great experience,” he says. “But every year, after we finished we’d want to do a half-marathon.”

POSTED: Friday, May 24, 2013, 11:44 AM
Filed Under: Baseball
The Phillies' Chase Utley hits a home run in the first inning against the Pirates. (Yong Kim/Staff Photographer)

Last night, the Phillies confirmed what most fans have suspected all week—Chase Utley is indeed heading to the 15-day DL with a mild oblique strain.

The organization quickly stated that the expect the second baseman back after those 15 days—yet on this morning’s television broadcasts, reports indicated Utley could be out for “up to four weeks.”

Research in the January 2012 edition of the American Journal of Sports Medicine looked at Major League Baseball players with oblique strains from 1991-2010. The research, led by Los Angeles Dodgers director of medical services guru Stan Conte, PT, DPT, ATC did not differentiate between first-degree, or mild strains (which Utley has) and second/third-degree strains. It did, however, provide some specific based on player positions and other variables.

  • The average time missed for players with oblique strains from 1991-2010 was 30 days.
  • Position players (non-pitchers) missed an average of 26 days during this time
  • Among position players, switch-hitters tended to miss longer than 26 days on average.
POSTED: Friday, May 24, 2013, 6:00 AM

It is said it often takes a village to raise a child. Quite often, it seems like it takes several members of that village to treat a pediatric or adolescent athlete with a concussion. 

As the scholastic year winds down, I would like to discuss the members of the healthcare team who treat concussion and give some idea what the roles of these clinicians may be, so next year parents may have some idea what to expect if their child is treated for a concussion. This list is by no means complete but will discuss several of the primary players.

The Certified Athletic Trainer (ATC) is often the first responder to a concussion in the sports setting. These practitioners are responsible for the care and treatment of athletes on their team or at the venue in which they are the covering ATC. In the event of a significant concussive event, athletes are often transported to the Emergency Room where an ER physician and his/her team will care for the athlete.  Often, this team has a radiologist as a member who will read the CT or MRI of the brain performed in the ER setting.

POSTED: Thursday, May 23, 2013, 5:00 AM

In an effort to keep even the weariest of travelers refreshed and renewed, Philly’s new Hotel Monaco partnered with local fitness favorite Lithe Method to launch an exclusive “Lithe on Location” weekly fitness class. Every Wednesday at 6:30 a.m. you can get your workout on with Lithe instructors in the fresh air on Hotel Monaco’s Stratus Rooftop Lounge (weather permitting, of course!).
And that’s exactly what I did this Wednesday when I woke up extra early and followed along as Lithe instructor Tiffany Nork led five of us Lithe newbies in a custom-made CCS fitness regimen — that’s Lithe-talk for Cardio-Cheer-Sculpting. CCS is an awesome blend of muscle-shaking cardiovascular, cheerleading-inspired aerobic, and strength training exercises.
If you’re not familiar with Lithe, Lauren Boggi’s workout is widely known for its signature higher power resistance bands that are suspended from the ceiling. Now since this is the first “on location” class Lithe has offered, it’s a twist on the total-body workout using primarily your own body weight and a few innovative props.
“I really have to take into consideration that most people have never taken Lithe before. So we may not do as many reps or as many sequences — it’s just about modifying a lot of the moves,” said Nork (who, by the way, is eight months pregnant and breezing though this workout).
Keeping this in mind, Nork opens every class with a quick lesson on Lithe’s principles: deep breathing, which helps you to incorporate your abs with every move you do, and three spinal positions to help you keep perfect form.
While the CCS regimen features a myriad of different sequences and exercises, Nork lead us through a circuit of high knees, a jog, a high V-low V with a calf pump, a twist, a single jack, a double jack, three jacks with a plyo, the step together touch, the scoop, the clam digger and ended it with the wave to the crowd move that really unleashed my inner cheerleader. Tired yet? Because I was! And that was only a 10-minute sequence.
The rest of our hour workout targeted our arms, core and legs using hand weights (that made 3 lbs. feel a lot harder than it looks), resistance bands to get our legs burning, and a small exercise ball to ensure we were engaging abdominal muscles I didn’t even know I had!
This class is only available to Hotel Monaco guests, local Kimpton Inner Circle and InTouch members, but you can always join one of 25 daily Lithe classes held at four different studios in Rittenhouse, Old City, Northern Liberties, and on the Main Line in Haverford.

Read more Sports Doc for Sports Medicine and Fitness.

About this blog

Whether you are a weekend warrior, an aging baby boomer, a student athlete or just someone who wants to stay active, this blog is for you. Read about our growing list of expert contributors here.

Robert Senior Sports Doc blog Editor
Alfred Atanda, Jr., M.D. Nemours/Alfred I. duPont Hospital for Children.
Robert Cabry, M.D. Drexel Sports Medicine, Team physician - U.S. Figure Skating, Assoc. Team Physician - Drexel
Brian Cammarota, MEd, ATC, CSCS, CES Symetrix Sports Performance, athletic trainer at OAA Orthopaedics
Desirea D. Caucci, PT, DPT, OCS Co-owner of Conshohocken Physical Therapy, Board Certified Orthopedic Clinical Specialist
Michael G. Ciccotti, M.D. Rothman Institute, Head Team Physician for the Phillies & St. Joe's
Julie Coté, PT, MPT, OCS, COMT Magee Rehabilitation Hospital
Peter F. DeLuca, M.D. Rothman Institute, Head Team Physician - Eagles, Head Orthopedic Surgeon - Flyers
Joel H. Fish, Ph.D. Director - The Center For Sport Psychology, Sports Psychology Consultant - 76ers & Flyers
R. Robert Franks, D.O. Rothman Institute, Team Physician - USA Wrestling, Consultant - Philadelphia Phillies
Ashley B. Greenblatt, ACE-CPT Certified Personal Trainer at The Sporting Club at The Bellevue
Cassie Haynes, JD, MPH Co-Founder, Trap Door Athletics, CrossFit LI Certified
Eugene Hong, MD, CAQSM, FAAFP Team Physician - Drexel, Philadelphia University, Saint Joe’s, & U.S. National Women’s Lacrosse
Jim McCrossin, ATC Flyers and Phantoms
Kevin Miller Fitness Coach, Philadelphia Union
Heather Moore, PT, DPT, CKTP Owner of Total Performance Physical Therapy, North Wales, Pa.
David Rubenstein, M.D. Main Line Health Lankenau Medical Center, Team Orthopedist - Philadelphia 76ers
Justin Shaginaw, MPT, ATC Aria 3B Orthopaedic Institute, Athletic Trainer - US Soccer Federation
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