How Can I Improve My Hamstring Flexibility?

For so many people tight hamstring muscles are a constant source of frustration. The advice given to them is usually to keep going with stretching, foam rolling, self massage, etc and more often than not the list lengthens but the hamstrings don't. A combination of dynamic stretching and core strengthening helps most people overcome this and can be achieved in a single exercise.

Dynamic Stretching 

Recently there's been more awareness of how this approach rather than static stretching, benefits muscle flexibility. The consensus of much research into hamstring injury has been that to prevent the muscle from tearing, it needs to be able to resist a loaded stretch to end of range. This is effectively what dynamic stretching is designed to do, and as a bonus it also lengthens the structure of the muscle.

Core Strength

Your hamstring muscles attach to your pelvis, which provides a platform for your legs to drive from. If you're lacking in core muscle strength then your pelvic platform will be less balanced, and consequently your hamstrings may stay tight in order to stabilise the pelvis. Try flipping this and getting your core strong and you should feel your hamstrings are able to do their real job which is to get you walking, running and jumping.

Below is an exercise that will lengthen your hamstrings while training the muscles around your hips and core to keep you balanced.

The Inverted Hamstring Stretch



Balance on your right foot with good upright spine posture






Bend at your waist, maintain perfect spine posture and extend your left leg back.





Your body should be in a straight line from head to ankle

Tom Lowes B.Ost MSc (Sports Med)
Registered Osteopath - Sports Injury Rehabilitation

Twitter @SportsMedOsteo    

Runners - improve your stretch shortening cycle

I came across this running drill on YouTube recently and I've been recommending it a lot because it combines balance, coordination and speed. Plus, all my favourite drills are simple.

This exercise will help improve the "spring" needed during the loading and propulsive phases of running. Think of your calf muscles and achilles tendon as a complex spring. When running, these tissues absorb and store energy as your foot contacts the ground, loading up like a spring being squeezed. This loaded spring then releases its energy and pops you up into your next stride. This is called the stretch shortening cycle (SSC). Just imagine an elastic band being stretched and then snapping back (shortening).

With thanks to www.move-ment.net

As you improve make sure you shorten your ground contact time to really develop your stretch shortening cycle and force production.

Watch the video and give it a try, all you need is a step!

Tom Lowes B.Ost MSc (Sports Med)
Registered Osteopath - Sports Injury Rehabilitation

Twitter @SportsMedOsteo    

Reduce Triathlete Injury - Hips, Bricks and Transitions

If you want to try and avoid injury as a triathlete then here’s a stat that’s worth considering: 70% of all injuries to triathletes occur while running. Further to this, recent research has highlighted how in triathlon, the bike-run transition may increase the risk of leg injuries as it affects running posture. 

Before we talk about running off the bike lets think about what your lower body needs to do to achieve good running form. When we run, we need one leg to drive forward and the other to drive back, with each relying on the other to create power through this dynamic flexion/extension pattern. There is a reciprocal relationship between them. Most runners have less of a problem driving forward into hip flexion as the joint naturally allows this, but during hip extension there’s more of a challenge as we’re moving into the end range of the joint. The picture below is a good example of what you’d look for in strong running form. You can see that the athlete in the middle has enormous left hip extension and high right knee drive.

We know that cycling before a run makes it harder to achieve good running form. A recent study looked at a group of triathletes firstly just running, then running off the bike. The results showed that when running after a 30 minute cycle they had a more anteriorly tilted pelvis and reduced hip extension. Clearly we're going to struggle to get good form straight off the bike. Additionally, going into a race after sitting at a desk all week, typically in a flexed hip and spine position, won't help the overall picture either.

My advice to help your day to day tightness that occurs from sitting, is to stretch your hip flexors once or twice a day, using a kneeling lunge with gluteal activation (see video here).

To help the transition try standing for the last few minutes of the cycle. There is research showing that this helps by being more biomechanically similar to running than seated cycling. It opens the hips and spine more which logically you should benefit from. Also familiarise yourself with the transition through BRICK sessions (Bike-Run = ick) as this will create a strong training effect that will carry over to race day.

I hope this gives you some food for thought, and as ever feel free to contact me with any questions.

Happy racing.

Tom Lowes B.Ost MSc (Sports Med)
Registered Osteopath - Sports Injury Rehabilitation

Twitter @SportsMedOsteo    

Will Coffee Help Me Run Further And Faster?

Recently whilst out for a sunday run along the River Thames, I experienced that surge of endorphins familiar to most people who enjoy sport and exercise. I felt like I could have kept going for hours. I'm not a particularly strong runner by any stretch of the imagination, so I was interested in why today I felt like my body was custom built for it. After a little bit of research into this, it seems that it was quite likely to have been the double espresso I drank around an hour before I left.

My pre-run coffee definitely sparks more enjoyment, focus and performance. No real surprises there to any coffee drinkers, but is this just a placebo effect? And can a cup of coffee before a run do any harm?

Like all drugs, there are some negative effects, but many studies have shown that at low doses, caffeine is safe. At high doses you can experience irritability, increased heart rate, headaches, tremors and difficulty sleeping. It can act as a mild diuretic causing increased urine production, but contrary to popular belief, research has shown that it doesn't cause dehydration. 

It is also considered safe by the World Anti-Doping Agency (WADA) and therefore is not on the list of prohibited substances. Olympic athletes certainly seem to love it. A study in 2011 tested for caffeine in the urine of over 20,000 Olympic athletes that competed between 2004 and 2008. The researchers found that 3 out of 4 athletes had consumed caffeine just before or during competition, with endurance sports showing the highest levels of caffeine concentration. This begs the question, is this to enhance performance?

Quite probably. It's effect on athletes is overwhelmingly positive, as borne out by the wealth of research that looks at caffeine and performance gains. In runners, cyclists, rowers, swimmers, tennis players the studies keep demonstrating beneficial effects. A meta-analysis by Doherty and Smith in 2005 reported that when compared to placebo, caffeine improved performance by 11% in well-trained amateur endurance runners. That is a huge gain.

Why does caffeine have such a positive effect on performance? Well there are a number of different opinions on this. Firstly it's likely that caffeine makes calcium more readily available for use by the skeletal muscles. This makes muscles more powerful. Secondly, it increases levels of adrenaline in the blood which stimulates an increase of available fatty acids from fat and muscle. Muscles may use this as an energy source whilst sparing glycogen, which can then be used later on in exercise. Thirdly, and arguably most important of all, is the effect on the central nervous system. It seems that caffeine increases nerve transmission and blunts perceived exertion, which means you can run faster and for longer distances without feeling exhausted.

Okay so if you do decide to take caffeine before you run, how much do you need? It seems perfect for coffee lovers as you only need one cup of strong coffee around an hour before exercise. The research shows that 3mg of caffeine per every kg of body weight (3mg/kg) is enough. For example if you're a 60kg athlete then the optimal dose is 3mg/kg = 180mg caffeine = 1.8 shots of espresso. And if you're thinking more is better and maybe you should drink 2 or 3 of these before a race, well don't. It has no additional benefit on performance and may also bring on some of the negative effects of high doses as mentioned earlier.

In summary, the evidence shows that  a cup of coffee before a run does have a beneficial effect on exercise performance that is not from placebo. All of this being said, the health effects of coffee can differ from person to person, and high doses do have risks. Therefore it's worth consulting with your doctor to make sure it's a good choice for you. Lastly, please choose when you take your "coffee run" carefully. If you train in the evening, then think twice about the benefits, as sleep deprivation has such well-proven negative effects on performance and lifestyle that in the long run you may wish you chose a decaf.

Tom Lowes B.Ost MSc (Sports Med)
Registered Osteopath - Sports Injury Rehabilitation

Twitter @SportsMedOsteo     



Top Tips and Drills To Improve Your Running Form

Are you looking to improve your 5k or 10k performance? Or do you feel that you don't have enough pop in your ankles or kick in your hips? Well take a look at this video from Mark Buckingham, a member of the British Triathlon Team and TriGold squad to kick start some good quality movement patterns and improve your running form. 

Here are some additional tips for the drills:

Posture and the pelvis cues - "Hold your head high and your hips high". This stacks them nicely over each other. To prevent your pelvis tilting and overarching your lower back, imagine you're wearing a belt and focus on the cue "keep your belt buckle up" to keep your pelvis and spine neutral. 

Arms - With all of the drills make sure you're getting the most from your arms. Drive one arm forward whilst the other drives back making sure you combine this with the opposite leg movements to create more power. Keep the elbows bent to around 90degrees, trying not to let them cross over your body as you swing.

High Knees Drill (10 reps, 3-5 sets) - don't just focus on the knee lift but on the downward push of the foot to the ground. Land with a fore-mid foot strike and immediately drive the other foot down. This creates an increased hip extension torque. 

Heel Flicks Drill (10 reps, 3-5 sets) - as you can see in the video, there is a small knee lift so the heel comes from below and up to the buttock. This shouldn't be like a hamstring curl where the heel strikes from behind. 

High Skips Drill (10 reps, 3-5 sets) - focus on good spring through the push off. Combine with a strong opposite knee lift and arm swing. 

Side Skips Drill (5 reps each side, 3-5sets) - start slowly so you don't fall over!

On the hurdle drills it's fine to use mini-hurdles, or even no hurdles, just make sure you achieve good height with your knees. 

These drills are designed to help you develop efficient and effective movement patterns for running and are perfect near the beginning of your training session. If these are new movements to you, make sure you leave a day in between each session to allow adaptation and recovery from fatigue. They can have an effect on your neuromuscular system relatively quickly so aim for 8-10 sessions over 3 weeks and you should get some really positive gains.

I hope you enjoy running through these drills, and that they help you as much as the many other athletes I've had working on them. It would be great to hear how you get on via Twitter @SportsMedOsteo  

Tom Lowes B.Ost MSc (Sports Med)
Registered Osteopath - Sports Injury Rehabilitation

Twitter @SportsMedOsteo     

I've just injured my back - Do I need an MRI scan?

Aside from getting asked this question on a daily basis in clinic, recent press and media attention made me feel the need to give my point of view. 

MRI scans have in many ways revolutionised medicine and enhanced patient care. The newest systems provide detailed images of anatomy that even 5 years ago lacked true clarity. They've also become increasingly affordable to many, and even on Harley street it is now possible to get a scan for £200 if booked off peak. Unlike CT scans and XRays their direct action is safe, as they don't expose the patient to a dose of radiation. However, many respected voices in the medical world are warning that inappropriate use of MRI to get a low back pain diagnosis is actually harming the healthy (1). 

To understand the problem it's important to understand that most acute low back pain resolves within 4-8 weeks if good management advice and reassurance is given by a medical professional.

The guidelines are in essence:

1. Use non-steroidal anti-inflammatory medication

2. Refer to physical therapy/physiotherapy

3. Avoid early MRI unless exceptional cases involving red flags

4. Avoid habit forming medication

5. Avoid early referral for injections or surgery

Ok, so what's the problem? Well, point three of the guidelines isn't being followed and this is leading to "overdiagnosis" of simple back sprains (2). These sprains are given labels like "slipped disc" and "degenerative disc disease" when really the injury is as benign as an ankle sprain. Let me explain further. A recent study (1) showed that in a normal pain free group of people given an MRI scan, 90% had degenerative discs and 30-40% had disc bulges, joint degeneration, and bone spurs. Just to be clear this is the pain free, normal group. The group that had pain related to pathology was tiny at 1-2% of the population. 

So if a medical professional advises an MRI scan and it comes back with "degenerative disc disease" you now have a label, in fact you have just been told you have a disease. This feeds anxiety and fear, creating what's called a nocebo effect. This is the opposite of the placebo effect, and describes any case where putting someone in a negative state of mind has an adverse effect on their health.

This asks the wider question: what are the boundaries that define an illness or pathology? And what is in fact normal and not going to cause longstanding incapacity? If the data tells us that 98% of people with acute low back pain alongside structural changes on MRI have just suffered a sprain, then we clearly need a more careful interpretation of these results. Definitively, low back pain should never be diagnosed from a scan alone.

Overdiagnosis as a concept may sound counterintuitive and many, many peoples lives have benefitted from appropriate use of MRI, but this final statistic delivers the strongest message: In America, people referred for MRI for routine back pain are eight times more likely to have surgery. Now that's a statistic worth changing.

Tom Lowes B.Ost MSc (Sports Med)
Registered Osteopath - Sports Injury Rehabilitation

Twitter @SportsMedOsteo       

 

Here's a great link to a podcast on this subject: Ray Moynihan 

Thanks to Karim Khan @BJSM_BMJ

1. McCullough et al. Lumbar MR imaging and reporting epidemiology: do epidemiologic data in reports affect clinical management? Radiology. 2012 Mar;262(3):941-6. doi: 10.1148/radiol.11110618.

2. Mafi et al. Worsening Trends In The Management and Treatment of Back Pain, AMA Intern Med. 2013;173(17):1573-1581

How Does Mo Farah Keep His Running Form?

Have a look at Mo's core strength routine designed by The Oregon Project 

If you click on the link below you'll be given an insight into some of the running specific core conditioning routines that Mo Farah and Galen Rupp use to achieve their success. Further down is the story of how The Oregon Project revolutionised the American athletic programs' training methods.

The main principles are to improve your spine and hip strength and control in order to give you a better base from which to drive your legs and arms.

Mo Farah's core routine

The Oregon Project was set up in 2001 by athletics coach Alberto Salazar who had a vision of how to resurrect the once dominant elite American distance athletes. It's goal was simple: to enhance performance whilst reducing injury. The strategy was to ensure that their athletes would not only win once, but again and again without breaking down.

Salazar believed that no athlete was perfect and if underlying biomechanics and movement deficiencies were improved, they could create a stronger more powerful and successful group. This revolutionary approach required a rethink of how an athlete was managed, so the project created a team that gelled elite track coaches with elite strength and conditioning coaches. Each athlete would undergo weekly assessment of their biomechanics, allowing any weaknesses and imbalances to be highlighted and then addressed with  newly designed running specific programs.

In more recent years, the project has become a training stable for some of the most celebrated athletes in the sport. An image that clearly encapsulates it's success comes from the closing stages of the mens 10k final at the London 2012 Olympics as Farah is seen clearing the finishing line to take gold with Rupp just a few strides behind him in silver. 

Watch Mo Farah's core routine and try and add all or some elements of it into your training to help you perform better during your runs and reduce your chances of injury.

Tom Lowes B.Ost MSc (Sports Med)
Registered Osteopath - Sports Injury Rehabilitation

Twitter @SportsMedOsteo