So It’s Time for Cross-Training

For years the term “cross-training” has been tossed around in athletic and sports communities, in regards to off-season or winter fitness planning. “Cross-training” is touted as a way to decrease injury risk, build an aerobic base, improve strength and flexibility and to stave off boredom. That all sounds fantastic…but what do I actually DO when I “cross-train”?

According to Wikipedia, “Cross-training refers to an athlete training in sports other than the one that athlete competes in with a goal of improving overall performance. It takes advantage of the particular effectiveness of each training method, while at the same time attempting to negate the shortcomings of that method by combining it with other methods that address its weaknesses.”

OK, so that is also nice to know, but other than doing something besides my main sport, I’m still at a loss as to what I’m going to be doing while I’m “cross-training.”

Runners World magazine’s web site recommends a wide variety of activities. Cycling, swimming, strength training/fitness classes, Yoga, Pilates, etc.

Runners World is a magazine for runners, and none of those activities involve running, so that must mean I can do ANYTHING other than my main sport. Yes, and NO.

It is true, doing an activity other than your primary sport can be beneficial, and for many people it is enough to keep winter gym boredom at bay and even possibly improve your overall fitness.

However, I propose going a step further. Take this time to concentrate on areas of weakness or neglect that result after a full season of focused training on a particular sport. As Malcolm Gladwell and David Epstein have both described in their books Outliers, and The Sports Gene respectively, it is “purposeful practice” that takes athletes to the next level, not just simply trudging on with uninspired routines.

I have created a few guidelines to help with planning your own cross-training program. At first look they are very general, but only in title. In application they can be far more specific.

Change Direction

Many of us, myself included, participate in sports that involve one particular movement repeated over and over. Runners, cyclists and hikers do just that. They run, cycle, or hike. This leads to glaring muscular imbalances that not only can limit performance or enjoyability of your activity, but can even lead to over-use injuries in the long term. Each of these sports are uni-directional, meaning that you constantly are moving in one direction, forward (for the most part). Cross-training for these individuals should involve activities involving lateral movements.

Strengthening the hip muscles and core with side to side activities (hopping, grapevine runs, playing sports involving cutting, etc.) can go a long way in preventing over-use injuries. There are numerous research studies in both Physical Therapy and Exercise Science fields supporting the benefits of strengthening these areas. Not only will this help prevent injury, but a 2006 sports physiology study found that “horizontal whole body movement” is directly linked to improved speed and acceleration.

Changing direction is not only for unidirectional athletes. For athletes in overhead sports strengthening the hips and core in this manner is also essential. Biomechanical studies of tennis players found that 63-74% of the total power generated came from this region. Not from the shoulder girdle or elbow. In fact, when treating elbow or shoulder injuries in athletes in the clinic it is standard care to address hip and core weaknesses/imbalances as well. In doing so on your own during the off-season you can possibly prevent these injuries from ever occurring.

Strength, Strength, Strength

This is the best time to build a foundation of strength. Unless your sport involves a barbell, weight training can be intimidating at first, but do your best to stay off of the machines if you can help it. Research says that squats and lunges can improve balance, overall strength, and vertical jump nearly 3x greater than the knee extension or hamstring curl machines. In fact, these machines have zero effect on both squat strength and balance. There are concepts of intermuscular coordination and neuromuscular education at work when you have to lift free weights against gravity in unsupported positions. Though they are beyond the scope of this article, essentially you are educating your muscles to contract more efficiently to complete a given task. More efficiency translates into improved speed, endurance, and injury prevention come Spring.

Prevent Further Over-use

Winter can be a painful divorce from our favorite activity/sport. Just ask any runner. Runners are notorious for their dedicated addiction to their sport, often to a fault. But don’t let the love you have for your sport be the ultimate reason why injuries set you back come competition time. This is especially true for endurance junkies. It would be foolish for me to recommend avoiding running to a runner, or skipping spin class to a cyclist. However, a strong aerobic base can still be built without having to log long miles the same old way. This is where Runners World Magazine’s recommendation comes into play. Changing activity can provide a great mental break. plus, if you can keep your high heart rate up (approximately 70%x (220-your age), it can be a valuable way to build endurance. Personally, I am a big proponent of swimming in the off-season, despite the fact that I am quite terrible at it (according to my wife, the former collegiate swimmer). It is incredibly cardiovascularly taxing and zero impact on my joints, plus afterwards the hot tub is always welcome before hitting the cold winter air back to the car.

So don’t waste your time this winter wallowing in worthless workout misery. Take initiative and turn your sweat into time well spent. Finish this winter, and start next season, more explosive, balanced, and bomb proof.

Article also found at

By Steve Stockhausen PT, DPT

Runners Knee – the long but successful road to recovery

Exactly one year ago I underwent a surgical procedure to alleviate a long standing, and rather severe case, of Illiotibial Band Syndrome, or runners knee. This is a very common injury involving a pathologic tightening of the illiotibial band (ITB) causing sharp pain in the outside of the effected knee, likely due to a hip weakness. The uncommon part of my particular injury was its lack of progress with physical therapy. Ninety five to ninety seven percent of ITB related problems can be solved by conservative measures (skilled physical therapy and/or injections). Being a physical therapist myself, the lack of progress was particularly distressing, and was preventing me from doing the one thing I moved to Durango to do, which was run on the beautiful mountain trails. After nearly 4-1/2 yrs of hard work, I opted to have a procedure called a Z-plasty, performed by one of our local orthopedic surgeons.

Initially after surgery my knee was very stiff and painful, but I was able to walk the next day with only the support of one crutch. Within four days I returned to work at the clinic with only a slight limp, icing between patients and staying late to do my own rehabilitation.

Rehabilitation for this type of procedure is fairly straight forward. In the beginning days/weeks, a priority is placed on knee range of motion (ROM), especially for straightening. From there, making sure the muscles of the quadriceps are firing correctly and improving my walking form were emphasized. Shortly thereafter (2-4 weeks), gentle hip strengthening began, with the focus being placed on the gluteus medius.

The gluteus medius is responsible for abducting the leg, or swinging the leg out sideways. Also, when standing on one leg, it is the muscle responsible for keeping your pelvis level over the standing leg, preventing the hip from kicking out sideways. If this muscle does not work correctly, or is weak for some reason, an assortment of injuries can result. Some research has linked this muscle to injuries of the ankle, knee, hip, and even lumbar spine (low back). It was going to be essential for me to get my gluteus medius as strong as possible if I was going to be able to run again pain free.

By 6 weeks I was permitted to begin jogging again, which was incredibly encouraging for me. It was by no means pain free, but I never had the stabbing pain in the outside of my knee that I had become so accustomed to after 2-3 miles.

With the nearly constant help of Dave, Ellen and my wife (who is also a physical therapist), I made good progress. The greatest challenge, as it is with our patients, is in fact being patient. The body has specific healing times that must be respected in the rehabilitation process. Knowing the appropriate timing and progression during recovery can mean the difference between running for fun a few miles a week, and being able to compete at a high level again. It was with the guidance of other therapists who have the advantage of perspective (It is very difficult to be realistic in expectations when it is your own body in recovery. Even for a PT).

I spent much of the winter and spring of 2013 in the clinic and the Durango Recreation Center weight room strengthening my legs, and most specifically my glutes. By the time June came around I was running pain free and with improved form. I continued to work hard on my therapy, even though I was 7 months post op. All of my hard work began to pay off in big ways. Not only was I running pain free, but I was able to challenge my self again, running my first marathon, then a week later doing the Pikes Peak Ascent and setting a PR. However, these were only stepping stones to my ultimate goal that I have had for nearly 10 years.

Runners Knee in Durango CO | Tomsic Physical Therapy

On September 28, nearly 11 months after my surgery, I finished my first Ultra-Marathon. Not only did I finish the Devil Mountain 50K, but beat my goal time, and in the process finished 5th overall, which was a completely unexpected result.

It was only with a tremendous amount of hard work and good guided therapy that I was able to finally achieve a goal that I had nearly given up on a year prior. Through this experience I have grown an even greater appreciation for the efforts that our patients give towards their own rehabilitation and training. These are scary times after surgery, but with hard work and the advice of trusted clinicians, a 110% recovery truly is possible.

Physical Therapy In The National News

Nice to see some recognition for physical therapy in the national media. US News discusses the benefits of physical therapy before injections or surgery. The physical therapist is highly skilled in all musculoskeletal conditions, and is ready to get athletes (especially runners) back in action.

Read the article here:

Be proactive and get a movement screening before starting a new training regimen to prevent problems before they start!

Stephen Stockhausen PT DPT, @SStockPT

Common Cause of Heel Pain Shown to Improve More with Manual Physical Therapy than Traditional Therapy

Ever have a stabbing feeling in your heel with your first step out of bed the morning after a long hike down the Colorado Trail? The stabbing pain is the call sign of a condition commonly called plantar fasciitis.

The plantar fascia is a strong fan-like band of stiff connective tissue that stretches from the base of the heel towards the toes. This band supports the bottom of the foot and is essential for transitioning the foot from a “shock absorbing state” (pronation), when the foot initially touches the ground, to a “force producing state” (supination) for final push off when walking or running. Intrinsic muscles within the foot also assist in providing muscular support. When these structures become over worked or stressed they cause a sharp pain usually felt in middle of the heel. Occasionally there may also be a component of heel pain stemming from a low back problem.

This condition has been referred to as an “itis,” meaning inflammation, but recent research has reported little evidence of true inflammation. Physical changes in the tissues of the plantar fascia are found instead.

Patients are often treated with orthotic devices, corticosteroid injections, night splints, stretching, and a referral to physical therapy.

Traditional physical therapy interventions have included stretching the Achilles tendon and plantar fascia, ultrasound, iontophoresis, and orthotic devices. However, these interventions are often only effective for short term.

A recent study by Cleland et al. in the Journal of Orthopaedic and Sports Physical Therapy showed manual, or ‘hands-on’, physical therapy, in which specific techniques were applied to mobilize the joints of the foot, ankle, knee and hip, as well as to the soft tissue of the plantar fascia to be more effective than a traditional physical therapy approach for the treatment of plantar fasciitis. Not only was manual physical therapy shown to have excellent short-term effects, but the benefits lasted at least 5 months after the final treatment was completed.

When you first feel the symptom of Plantar Fasciitis, you should begin self-treatment. A simple and effective technique to do at home is to massage along the bottom of the foot. Push deep and firmly into the soft tissues of the foot, gliding back towards the heel, feeling for any lumps or bumps along the way. These bumps may be painful, but working them out will be worth a few minutes of discomfort. Rolling your foot on a tennis ball or a frozen water bottle are also other ways to do this. Then begin stretching your calf and your hamstring.

So, next time you find yourself limping your way to work Monday morning after a long weekend out on the trails, be sure to give these techniques a try. If symptoms are not resolving, make your way to the nearest manual physical therapist for faster and more permanent results.