We had a student, we assessed her running by observing her running. Then we looked at her range of motion, functional strength, and core strength.
Then we started implemented the corrective exercise program.
When we were doing the gastroc stretch, what we found was when we initially did the gastroc stretch she didn’t feel the stretch at all. Even though the results of her assessment showed it was tight.
A lot of times I end up seeing this with clients.
You see this with many people that stretch their calf, especially runners. Many times the toe out is a common compensation strategy in order for the ankle to get greater range of motion in dorsiflexion. With this compensation, the runner avoids the part of the calf that needs to be stretched (the lateral head of the calf).
They’ll do the gastroc stretch that they usually do, and they won’t end up feeling any kind of stretch.
Normal Calf Stretch – with right foot toed out.
The first thing I do to correct them is to make sure that that back foot is pointing straight ahead.
Right Foot Straight Ahead – For many people this will target the calf.
Another way that I can intensify the stretch and focus more on the lateral gastroc is if I get them to bring the heel out. That ends up focusing more on that lateral gastrocs, and they oftentimes will get a better calf stretch. For many people the lateral calf/gastrocs is tight and needs to be stretched.
Toe In – Internally rotating in the hip and focusing more on the lateral part of the calf. For many this will lead to a stronger stretch.
Side View of the Toe In Stretch – No rotation in the back knee and the body is in a straight line.
There you go, give that a go.
The first step is to correct the client and move the foot so the toe is straight ahead. After this correction, you get feedback from you client to see if this changes the stretch. If there still is not a stretch, you can move the foot in by rotating at the hip. That will make the stretch more effective.
A program that I put together to balance out the body to help with running is called Corrective Exercises for Running Injury-free. You can check it out here.
It has been a few weeks and I am starting to get feedback on the program. One person has been having issues with their tennis elbow pain and the program has made it worse. She has asked me if I could help. We have been emailing back and forth. Here are some clips from our email conversation.
“I think my pain has increased a bit so I’m cutting back in intensity but I’m hoping that if I keep at it, it will eventually go away. Bursitis in my shoulder really flared up after starting the program. Not sure if it is related but that is the only thing different that I was doing.”
This brings up a number of points to remember about injuries. They apply to tennis elbow but to all injuries when you are using exercise to help them recover.
4 Key Things to Remember when Exercising for an Injury
Intensity – How aggressively you do the exercises has an effect on your injury recovery. I always suggest to be conservative when staring an exercise program for an injury. Go easy and light. See how things feel after the exercises, a few hours after the exercises and the next day. You should feel like you have done something but your symptoms should not increase.
Resistance – Once again, the resistance you use will determine the stress put on the injured area. We want to stress the injury but not irritate it. It is a fine balance. Once again, start off light and see how it feels.
Cumulative Stress – If you are doing exercises for an injured area, you are adding more stress to that area. If you do not decrease or eliminate other things you are doing that add stress to the injury, this will lead to more irritation and pain. Make sure to look at things that are putting stress on your injured area and decrease or eliminate them.
Pain Techniques – Do the pain techniques in the evening. Doing the ice, stretching and self massage are most effective before you go to bed or a few hours before you go to bed. It relaxes the tissues and then the tissues get a chance to heal while you are sleeping.
Nutrition – Staying hydrated, properly fueled and focusing on inflammation lowering food is important as well. This will help you in your injury recovery.
When it come to tennis elbow pain exercises leading to shoulder pain, I cover this in the video presentation of Tennis Elbow Pain Solution but also Stasinopoulos 2011 says it well:
“If the affected arm is not supported, our experience has
shown that patients complain of pain in other anatomical
areas distant from elbow joint, such as the shoulder, neck,
I would suggest you do the tennis elbow pain exercises with your arms supported. You can look at the exercise descriptions and videos for Exercises 9b and 10b in the program.
“Regarding my bursitis – I took a break this past weekend from exercise and the tennis elbow program and it seemed to be less painful.
I am doing mostly stage 2 exercises but am sticking with a modification of scapular exercises #6.”
It has only been a week or two since you have got the program. You might not be ready for stage 2 exercises.
If you are getting elbow pain from the exercises, look in the exercise descriptions and I give you ideas of what you can do if you get pain from the exercises. Here are a few things to remember:
Conditioning – If you are getting elbow pain from doing the exercises, do exercise #3 for two to three weeks. This will help work on the conditioning of your elbow muscles. By being in stage 2 so early, you are getting pain because of the points that I covered at the top of this article.
Posture – Look at your posture when you are doing the exercise. Make sure it is ideal which is ear-shoulder-hip in a straight line. Being out of alignment puts greater stress on the shoulder.
Technique – If an exercise is irritating, go back and make sure you are doing the exercise correctly. Look at the exercise description and watch the video of the exercise.
“My left elbow and left shoulder are super tight. When I do the tennis elbow program my arm feels worse. Should I work on my shoulder first? Should I stop? Would be happy to have your feedback!”
Follow what I wrote above.
What caused what: What I have seen in many people is a shoulder injury leads to your tennis elbow pain.
I know you have the Shoulder Pain Solved program of mine. Make sure to the pain techniques that I talk about in that program for your shoulder but remember the key points that I talked about above. They are very applicable to all injuries.
“Does my tennis elbow cause my shoulder pain or does my shoulder pain cause my tennis elbow? Is it possible to work on both at the same time or should I focus on one first and then the other? If so, which should I focus on first? Which program would be most helpful – tennis elbow, shoulder, scapula?”
From my experience, one injury often times leads to others.
I feel you can do both but follow what I said above in the article.
If what I said above does not help, go get your diagnosis confirmed by a qualified health professional and have them rule out that there is something else going on. Then take the programs to someone that can help you with the program. You can go to a fitness professional that focuses on injuries or another health professional. The key thing is that they will spend the time with you to go through the exercises.
Remember the points that I said above.
These would be your priorities:
Work on your scapular stabilizing exercises as this will provide stability for your shoulder and decrease the stress on your elbow.
Work on improving your posture as this will decrease the stress on your shoulder and elbow.
Work on the pain techniques in order to relax the muscles around the shoulder and elbows.
Work on strengthening the shoulder and elbow as per the Shoulder Pain Solved and Tennis Elbow Pain Solution program.
Effective Rotator Cuff Exercises was very thorough – I learned a lot. I never completely understood the shoulder joint until I took this course.”
Occupational Therapist / Registered Nurse
El Paso, Texas
“I had Tears Running Down My Face”
Thank you so much for sharing your son’s dance moves with us. I had tears running down my face. How wonderful to be so uninhibited and full of joy.
I was laughing at you laughing.”
Brenda Champagne- Locken
If you missed the video, here it is again:
“I Turn to Rick for Injury Anaswers”
“I meet Rick 2 years ago at a fitness seminar.
I admired his passion and knowledge for helping people with injuries.
As a trainer my goal is to help people maximize their health and fitness.
Once in a while I get a client who gets a nagging injury. When this happens I turn to Rick and he has the answers that help my clients get back to maximizing their health and fitness.
If you want to get maximize your exercise plan and spend less time on the mend.
Check out Ricks injury prevention or rehab tips!”
“To find a Wealth of Knowledge like thins You Usually Have to got to a Fitness Conference”
“If you want to be like a fraction of the greats in this industry and separate yourself from the joe personal trainers. I highly recommend you buy Muscle Imbalances Revealed.
To find a wealth of knowledge like this you usually have to go to a fitness conference somewhere and for a owner/operator like myself this cuts down costs to a minimum because you can watch and learn on your computer!”
Scott Bisbee ACE-PT
Bisbee’s Fitness Experience Inc
“Stop Showing Me the Poppy Uppy Thingy!”
“Stop showing me the poppy uppy thingy!
It just won’t go away.
Rick’s Answer – The Pop-up is a way of giving new people to my website, a piece of my best stuff.
It just takes 1 second to close the pop-up. Just hit the “X” in the top right hand corner. I show you here:
For some people there is no “x” to click. You can try to refresh your web browser or view the page in a different web browser.
“Easily Digestible Product Based Around Current Evidence”
Thanks for the Tennis Elbow Pain Solution (TEPS), as always you’ve delivered an easily digestible product based around current evidence.”
Simon Tydd Physiotherapy
“Impressed with the Wealth of Information Provided”
“Hi Rick, I have viewed the video presentation for the UTG for Cancer Survivors and can honestly say that I am impressed with the wealth of information provided.
Being a cancer survivor of 40 years this summer I can relate to many of the points made by the presenter. I’ve been there, done that, got the t-shirt – as they say! This program definitely affords a personal trainer the opportunity to better understand how a person with cancer would like to be treated and how to put together a suitable exercise program for his/her cancer client.
Also, the information on cancer, types of treatment, side effects, etc., are all very helpful in helping the trainer to better understand and prepare for the cancer client.
Again, great program!”
Pasadena, NL, Canada
Thank you for all the kind words and negative ones. If you ever want to get a hold of me, just email me at support(at)exercisesforinjuries.com .
Males produced greater hip abduction, hip external rotation and quadratus lumborum measures
Athletes who did not sustain an injury were significantly stronger in hip abduction and external rotation
Hip external rotation strength was the only useful predictor of injury status
Often times when we focus on working on the core we think of crunches or bridge variations. It is interesting how this research expands on things further and looks at core function in different planes of movement and different movements. I like the fact that it highlights the importance of looking at hip abduction and hip external rotation strength. Many times this is not mentioned or covered in an exercise program.
Here is an exercise that I give to work on hip movement and strength:
A few comments on the exercise. The exercise can be used for:
Educating the movement of hip movement from the rest of the body.
A dynamic stretching of the hip rotators.
A body weight active hip rotator exercise.
The directions given and the cueing can change the function of the exercise.
Where to get more information – Leetun DT, Ireland ML, Willson JD, Ballantyne BT, Davis IM. (2004). Core stability measures as risk factors for lower extremity injury in athletes. Med Sci Sports Exerc. 2004 Jun;36(6):926-34.
If you are looking for exercises to strengthen the external rotators of the hip, these are what I use:
Easy and Effective Exercises for Tennis Elbow
I am working on this month’s Injury of the Month. It is Tennis Elbow.
I was doing my research on the injury and came across this article, which was interesting. It talks about isometrics for an injury and really highlights the new trend in exercise rehabilitation.
What They Looked At
They wanted to see if isometric exercises were as effective as medication for pain relief in those with lateral epicondylitis (tennis elbow).
They had two groups:
Group 1 – Were shown the exercise and then they did it at home
Group 2 – Began the exercise after 4 weeks of medication
Interesting Points in the Introduction
An increase in symptoms from exercise will decrease the compliance rate to the exercise program
Performing the exercises too aggressively can increase the risk of irritation or injury
The above two points are obvious but nice to see them highlighted in an article
Tennis Elbow Exercise Performed
The researchers only gave one exercise. Here are the details of the exercise:
The subjects did the exercise in a sitting or standing position with the arms flexed to just below shoulder height. Then the wrists were moved in a slow controlled manner into extension with the fingers relaxed. The focus was on moving the middle finger towards the elbow in order to target extensor carpi radialis brevis.
The exercise was performed without pain and in a controlled manner.
Four sets of 50 repetitions with each repetition being held for 10 seconds, done daily.
What they Found
After one month, group 1 had a greater decrease in their pain levels compared to group 2
At 3, 6 and 12 month follow up there was no difference between the groups
Those that did not feel any benefit from the exercise program after one month were referred on to shock wave therapy
Interesting to see the benefits of isometric strengthening on an injury, specifically with lateral epicondylitis. Isometric exercises are not exciting but effective when it is comes to an injury and the safest of the three types of contractions.
A lot of the research out there focuses on eccentric exercises for tennis elbow. This article highlighted the benefits of an isometric exercise which is less stressful on an injured area.
The number of repetitions was a surprise to me. Over a day performing 200 repetitions or about 33 minutes of exercise sounds like a lot. This is a trend that is occurring in exercise rehabilitation. The standard used to be 1 set of 10 repetition but this is fading away and does not correlate well with what many people do during the day (number of movement cycles performed in a day). Performing low load (isometrics) more frequently transfers more over to what one does on a daily basis and assists in recovery.
Just so you know, the tennis elbow exercise program will be coming out at the end of the month.
Where to get more details – Park JY, Park HK, Choi JH, Moon ES, Kim BS, Kim WS, Oh KS. (2011). Prospective evaluation of the effectiveness of a home-based program of isometric strengthening exercises: 12-month follow-up. Clin Orthop Surg. 2010 Sep;2(3):173-8. Epub 2010 Aug 3.
That is it for another edition of the research review. I hope this helps you out when it comes to core stability and injuries, plus a great little tennis elbow exercise.
I got an email from a reader who was looking for some ankle sprain exercises.
I am wondering if you have any ideas for a calf exercise for a person with an ankle injury. They are non- weight bearing and have very little ROM in the ankle (a few degrees of flex/ext). The Dr. would like him to continue strengthening the leg, in particular the gastrocs, however pain levels are quite high.
Thanks! I have really enjoyed your updates and the muscle imbalances revealed.
I have one exercise for Nat.
It focuses on range of motion in the ankle and working the gastroc at a low level.
I have finalized a presentation in Burnaby for later this month.
It is for the Fitness Blitz 28.
There I am along with the other presenters on the flyer:
Here is the description of my session:
Head to Toe Core Fusion Class
When we think of “Core”, we often think of the back, but this is only one of the core areas of the body. As a fitness professional, it is important to address all three core areas in the body. In this hands-on session, weightroom instructors and personal trainers will provide a progressive list of exercises that address all three core ares. You will leave this session with a good understanding of all the core areas of the body and a practical list of exercises that you can use with older adults to young, fit clients.
Discover the three core ares of the body that need to be addresses in order to prevent injuries, improve fitness results, improve health and overcome injuries.
Use common exercise tools found in the fitness center to progress and challenge the core areas of the body
Try out a progressive list of exercises that are safe and challenging for all fitness levels
About the Presenter:
Rick Kaselj, MS, BSc, PK, CEP, CPT, CES
Rick Kaselj is a personal trainer who focuses on designing exercise programs for clients recovering from injuries. He shares his tips, tricks and exercises with thousands of fitness professionals from around the world through his books, courses, presentation and his active blog. Rick recently completed his Masters of Science degree focusing on corrective exercise and therapeutic exercise for the rotator cuff. To learn more about Rick, visit his blog and receive your $299 fitness education gift – http://www.ExercisesForInjuries.com
To download the flyer for the Fitness Blitz 28, CLICK HERE.
If you have fitness education event that you need a presenter for, make sure to think of me. I am working on finalizing some in Surrey.
To see what other fitness education courses that I have coming up, CLICK HERE.
This past weekend, I was in Orange County, California at Fitness Business Summit.
At the conference there were well over 400 fitness professionals from around the world, learning how to improve their fitness business.
I really didn’t know what to expect from the weekend but I wanted to share a few things that happened.
#1 – The Power in Giving
I work hard to keep updating my blog and sending out information on exercises and injuries.
It is amazing to hear from people that read my emails and blog about how much it has helped them and their clients.
Thank you everyone for the kind words and feedback. It just motivates me to give more.
#2 – Are You Rick?
I still feel weird when people recognize me and ask to take a photo with me.
The above photo is with Alex from Florida.
It is nice that I have been able to help so many fitness professionals and then have them help their clients when it relates to exercises and injuries.
I am so happy when I hear that something they read on the blog or in one of my products helped them or their clients.
#3 – The Best Part of a Conference
The best part of the conference was meeting so many of the fitness professionals that were there.
It was great to meet fitness professionals for the first time and reconnect with so many from all over the world.
It is incredible to hear the different work that fitness professionals are doing to help clients reach their goals. I was talking to one fitness professional Saturday night who is helping army vets recover from head injuries in Colorado – very cool.
#4 – Loosen Up and Be More of Who You Are
This guy did a great presentation on letting your personality out:
The guy in the photo is Elliott Hulse. I could not find the video of him dressed up as the Incredible Hulk but it is great.
During his presentation he talked about letting your personality come out. I know, I have got some feedback on being a little dry when it comes to presenting. I need to work on relaxing and letting a little more of who I am come out. Thanks, Elliott, for that reminder. (Sorry, no plans on dressing up as the Incredible Hulk.)
#5 Even Fitness Professionals Have Injuries
When fitness professionals hear that my focus is injuries, they always share their injury story with me.
I enjoy hearing them and am happy to help.
The injuries that I chatted about on the weekend were patellofemoral pain syndrome, lower back pain, tennis elbow, golfers elbow, knee pain and concussions.
#6 Something That May Have Help Me Be a Better Basketball Player
I ran into my friend, Alex Marako, while out in Cali and we got talking about basketball ball handling. I think if I knew this tip, it probably would have helped me be a better basketball player.
I know there is so much more I can say but maybe I will leave that for another post.
All the material within ExercisesForInjuries.com and related sites are provided for information purposes only and is not meant as personal medical advice. Readers should consult the appropriate health professional on any matter related to your health, injury, pain, fitness, well-being, etc. No action should be taken solely based on the information in ExercisesForInjuries.com . The publisher is not a licensed medical care provider and is not engaging in the practice of medicine or any other healthcare profession and is not entering into any kind of practitioner/patient or practitioner/client relationship with its readers. The publisher is not responsible for errors or omissions.