Elliptigo Review: Running Without Impact

Good lord I can't believe I actually made it to Spring Break.

    The last two weeks have been very quiet blog-wise due to multiple reasons.  I just survived two weeks of hell, ie DPT school midterms.  It has been a whirlwind of caffeine, no sleep and stress.  I am now laughing at my past self who just 6 months ago thought the first semester was hard.  In addition to that, I injured my foot about a week ago during a uptempo run in the Skechers GoRun Ride 3.  My hypothesis is that I jumped into a very neutral shoe with a higher heel-toe drop than I was used to (the GRR 3 has a 8-9mm drop whereas the Purecadence 1 that I was previously training in had a 4-5mm drop with support) may have exacerbated the amount of pronation I was experiencing.  My assistant professor and I took a look at my foot and after some manual muscle testing, gait analysis and a tuning fork test (testing for stress fractures.  Thankfully it was negative) we began to realize just how bad my pronation issue is and one of the connections of my Posterior Tibialis was seriously pissed off.  The Post Tib functions in plantarflexion and inversion of the foot.  It also plays a huge part in maintaining the arch as well as eccentrically and concentrically controlling the subtalar joint motion during foot strike going through the contact phase, stance phases with pronation, supination and terminal stance phases.  I have always been a huge pronator, but have been a bad DPT student and not addressed the issue/ignored it.  I'm wondering if some of my Achilles issues stemmed from this.... because I've mostly trained in neutral shoes for a long time.  Particularly during my super-minimalist phase.

    Not that pronation is the end all diagnosis.  I'll say this over and over again: when it comes to the mechanics of gait in walking or running, the whole kinetic chain is involved.  Something that happens at the foot is usually a result of something happening at the hip.  And it translates the other way as well.  I'm reevaluating my hip mechanics to see if I've missed anything, other than the fact that I have still have mild imbalances.  Example: my right gluteus medius is a little weak, which is why my right hip drops a bit.  Running mechanics are a constant work in progress because little things will always pop up and the body will compensate for them in amazing and irritating ways.

   Thankfully during this injury I was still able to get some good workouts in thanks to my Elliptigo 8C.  I mentioned this briefly in some previous posts, but I am fortunate enough to have won an Elliptigo from the 2014 Las Vegas CSM physical therapy conference.  I just filled out a little survey after trying one of these things for the first time at the expo and then a week later I got a very special call.  

Yep.  I got the green one.

   Needless to say I was pretty excited, but also a little apprehensive.

   To be honest I've made fun of people who use the Elliptigo for a long time.  I fully admit that.  I think this stems from being a hardcore "Run-Only" type of training guy.  I viewed cross training as needed only during injuries to keep yourself from going insane.  In addition, I had very little success with ellipticals during past injuries in college.  I've found them to not replicate running mechanics very well and never felt like I was getting a good aerobic stimulus from them.  

First Elliptigo Ride (Thanks Rachel  for the video!!)

    Upon receiving my Elliptigo 8C, all those fears were quickly quelled.  The great people at Elliptigo have really done their homework and created a wonderful tool for runners.  Above is my first ride on the Elliptigo and I immediately noticed how different it felt from a normal elliptical.  

    The biomechanics are very similar to running without the impact.  This is achieved with a much greater hip range of motion allowed by the Elliptigo, particularly through really good hip extension.  If anything having one of these might help your running form (Not confirmed.  Just a thought).  I immediately noticed that my glutes were really working, as opposed to the normal quad tightness I've experienced with ellipticals.  I attribute this to the hip extension allowed.  My inner physical therapist was quite aroused (in a good way, not a weird way).  Stimulating the glutes to work over the quads is almost always a good thing! 

   As excited as I was about my new cross training tool, I didn't use it much after that first ride until a few weeks later.  Why you ask?  Because Pomona has NOTHING in the way of bike lanes and the streets are horrendous.  I'm pretty sure if I tried to take my Elliptigo out for an actual workout, I would get hit by a car or shot.  Or both.  

Enter an example of the Stationary Trainer.  This is not mine.  I have the Kinetic Road Trainer 2.0

    This is when I decided to get my hands on the Kinetic Road Trainer 2.0 with an adapter for the Elliptigo. And I can say it was well worth the investment (especially since I got the Elliptigo for free).  Once I got my hands on the stationary trainer, the Elliptigo started getting used a great deal more.

    I have to say I am very impressed with how much of an aerobic stimulus I get from using this awesome tool.  Every time I've used the Elliptigo (time ranging from 30 to 60 minutes) I've come away with sweat pouring off me (even with a fan, which I put up later) and fatigued in a good way.  It really provides a good stimulus that is CLEARLY above and beyond what an elliptical provides (even with the stationary trainer).

    What makes the stationary trainer and Elliptigo combo even better is that I can study while using it!  I've been using a large binder clip and attaching my class notes to the handlebars to get studying and a second "workout" in.  As DPT school has continued on, I've realize that I have less and less time to do things outside of school.  Adding the Ellptigo into my routine has allowed me to get some really good aerobic work in while still preparing for class and exams.  Plus without as much impact, I can still run at a high level due to the high level of work I can put in.  I've found myself recovering faster due to replacing that second run with a non-impact form of exercise.  My normal runs have been increasing in pace due to both my increasing aerobic capacity and possibly my glutes firing better.  Those are the major muscles that are sore after using the Elliptigo, which is perfect.  Those are the muscles you really want to be using during running if you want to run fast!

Just posing with my new Elliptigo.  And no.  I don't wear jeans while I use it.  

    The Elliptigo was especially handy with my foot injury last week during the harder of the two weeks of 2nd semester midterms.  Luckily it didn't aggravate my posterior tib at all and I could still hammer away.  It allowed me to study without going completely insane from a lack of physical activity.  And I got a lot of studying done on that thing.  Although I was probably driving my neighbors nuts from working out on the Elliptigo in my apartment (with the stationary trainer) at 6am most mornings before class and again at 8 or 9 pm in the evenings.  For their sake I'll hopefully heal up quickly and get back to running in the morning and Elliptigoing (Is that a word?  If not, it is now) in the evening for 30-45 minutes.  

    I feel very fortunate to have one of these tools that is and will continue to be a integral part of my training.  I am very excited to see where the Elliptigo helps take my training.  I cannot recommend it highly enough.  This product has changed my view of cross training because it does such a good job of stimulating your aerobic system with impact.  Do I still hate ellipticals?  Yes.  Is the Elliptigo the same as an elliptical?  Hell no.  Like I said before, the people at Elliptigo have done their homework and created a wonderful thing.  Do I love the Elliptigo?  Hell yes.  Go check one out.  

Thanks for reading!

As always, my opinions are my own!

Tack On!

-Matthew Klein, SPT 

*I won the Elliptigo 8C from the 2014 Las Vegas CSM physical therapy conference and it was provided free of charge.  This did not change my view of the product.  However I would like to thank the kind people at Elliptigo for giving me the opportunity to try the Elliptigo.

Please go check out the Elliptigo website.  They have some really great products that I highly recommend.  Elliptigo is an awesome company with a bright future.

Training/Life Update and New Training Ideas 2/28/14

My brain hurts, but I'm alive.

    It's that time of the semester.  DPT school is ramping way up (or I just realized that I need to bump myself back up to that level) and a crazy schedule of midterms is continuing.

    But things are going well!  This last week I have recovered well from the Brea 8k, which turned into a great workout rather than a good race (Brea 8k Race Report).  I learned some good things from it and am ready to start implementing some new ideas that I'll get into in a bit.

    On some not so great news, Saucony began sending out their offers to athletes for their sponsored 2014 Saucony Hurricane Team last week.  I kept checking Twitter with various hashtags (#sauconyhurricane, #sauconyhurricaneteam, #findyourstrong) to see who was announcing their spot on the team.  After a week I have heard nothing, which based on who I saw sponsored is not totally surprising.  Some very fast people are on this team, particularly those with fast half marathon times.  My 1:11:11, despite being my first half marathon, is fairly slow for a sub-elite runner.  If I ran in the 1:06:00-1:07:00 range that would be different.  Unfortunately I don't think I have the time or money right now to adequately train for a fast half marathon.  Post DPT school is definitely a time when I will focus on that distance.  For now though I will be racing it sparingly.  Although we'll see where my Elliptigo training goes as I have a stationary trainer adapter coming for it that I'm hoping to use while studying so I can get more aerobic training in (more on that later).

    So yeah.  I don't think my application to the Hurricane program was accepted.  It is a little strange that I saw a few other people comment on the fact that they actually received nice rejection e-mails that still wished them the best.  I have received nothing in the way of communication from Brian Mahoney (marketing director at Saucony), who I originally sent my application to.  To which he replied confirming that he had received them.  I even e-mailed him earlier this week when I did not receive a rejection letter wondering what the status of my application was.  Still have not received any response.  

    That is not going to keep me down though!  I will continue looking to the future and continue to train as a member of the Cal Coast Track Club.  I'm hoping if I get fast enough this will mean some seeding of gear from Asics, but we'll see.  I already received really nice short and long sleeved shirts from the team, so things seem to be going well.  It's nice to be on a team again!

And those new training ideas.

So here's what I've been doing.

    I have incorporated a great deal of plyometric exercises into my post-run drills.  These started Sunday after the Brea 8k and I will definitely keep them in my arsenal.  I've started with just doing variations of single leg hops up on a step and down.  I do forward single step hops, side step hops (both directions, laterally hopping and medially hopping) and then diagonally hopping up and down in both a medial and lateral diagonal direction.  This seems to really be helping my ability to push-off from the ground, along with continued step-ups on the stairs of my apartment.  The step-ups have been really good for my glute max strength and stride length as I have seen a decent increase in running speed since I added it to my routine.  Mostly because the glute max is one of the main hip extensors.  Why do you think fast (good) sprinters have such huge butts?  Because that's the main propulsion muscle.  I learned about this exercise's effectiveness on the glute max at the recent CSM 2014 Physical Therapy conference in Las Vegas.  I have not found the article the talk referenced (Running Injuries: From Youth to Collegiate), although I have found several articles discussing how much the single limb squat activates the glute max and medius and how much the side leg abduction exercise activates the glute medius (Distefano, Blackbun, Marshall & Padua, 2009 & Lubahn et al., 2011).  Both of these exercises have been very important to my core/strengthening routine, particularly the single leg squat.  The side leg abduction has been in my routine for a while now, but it wasn't until recently that I added some medial and lateral limb rotation during that motion to stimulate the glute medius and minimus more (this was something I just learned in my Kinesiology in DPT school).  Doing external rotation with the hip slightly extended during a side leg abduction will really hit the glute medius and doing internal rotation will hit the glute minimus a bit more.  That and clamshells with my trunk stabilized has allowed me to continue working on my glute medius strength.  When I am satisfied with my strength level, I will start adding therabands and leg weights into these exercises to make them harder.  For the single leg squat I need to start holding light dumbbells to work on strength once I am ready to move up difficulty-wise.  

   Obviously for core I am still doing exercises focused on good core control via firing the transverse abdominals.  Two exercises I'm doing for that are a bridging exercise with alternating single limb hip flexion and the transverse abs engaged to stabilize the trunk and pelvis as well as the bird-dog exercise, also with the transverse abdominals engaged to stabilize the trunk and pelvis.  The bird-dog exercise is more focused on the multifidi and other deep muscles of the back, but pulling in the transverse abdominals helps those fire.

    Just this morning I started adding power skips for height and distance into my post run drills just to work on more pop from my push-off.  It's not a good idea to try starting new things right before a race (I'm running the Dairy Aire 5k tomorrow, which is part of the group of 3 races called the Triple Crown that I am trying to triple win), but I'm training through it anyway.  No report yet on how these have effected me but I'm interested to see where I can go with more plyometrics.  I've done a ton of drills throughout the last few years, but I'm beginning to see some discussion in the physical therapy and athletic world as to whether those drills actually do anything for motor patterns.  I still think drills are important before hard workouts in the sense of doing a dynamic warm-up.   But like how static range of motion may not relate to actual moving range of motion (dynamic ROM), I wonder how drills actually affect running form.  So as always, I am my own subject for this experiment.  Let's see where this goes.

    What I probably need to do is do my "drills"  (high knees, butt kicks, etc) before every run and plyometrics after.  I've done drills after runs for the last several years with the belief that I am solidifying motor patterns when my body is fatigued.  I have not seen peer-reviewed evidence regarding this idea, but I have continued to do it.  Maybe it's time for a change just to see what happens.  The only issue is motivating myself to do that before the run as usually I just want to get started.  I'll try any type of training once, so let's see where this goes.  

    Oh yeah.  And the Elliptigo?

   So I have a stationary trainer on the way right now so I can actually start using the Elliptigo.  Pomona has nothing in the way of bike lanes.  I have tried seriously riding it on the streets for 10 minutes before I realized I was going to get hit by a car.  Plus I don't have the time anymore to be doing a second workout during the day unless it involves studying.  In the last few days I've actually had some success using the elliptical machine in my apartment for 35-45 minutes hard while studying.  The material I have studied has stuck in my head and I feel like aerobically I gained something from the elliptical without any additional pounding.  I'm beginning to see why many elite athletes use the Elliptigo to get additional training in without putting them at risk for stress-related injuries.  The mechanics of the Elliptigo are much more similar to those of running than a traditional elliptical.  This is achieved through the athlete being taken through greater hip extension and hip flexion, as opposed to the limited mechanics allowed by a normal elliptical.

    So my goal is to try studying on the Elliptigo with the stationary adapter in my apartment to get my work for school in while getting aerobic work in for running without the pounding.  I'll still be running 10-11 miles in the morning for training with 20ish miels on Sunday for a long run so I can hit my +80 miles for training, but now I'll have this additional training that doesn't put me at risk for injury (I hope).  So in a way I'll be able to train like I'm running +110 miles a week again (I hope to work up to using the Elliptigo for an hour a day in the evening while studying), but with studying for a bunch of it.  We'll see what happens and what school allows.

    So that's what I've been doing recently.  I'm hoping for good things tomorrow at the Dairy Aire 5k, but it is raining pretty hard.  So I'll just be going for the win.  Then it's back to studying my rear end off.

Let's see where all of this takes me.  I'm excited for the future.

Thanks for reading!

As always, my thoughts are my own.

Tack On!!

-Matthew Klein, SPT

Citations:

Distefano, L, Blackburn, J, Marshall, S & Padua, D.  (2009).  Gluteal muscle activation during common therapeutic exercises.  Journal of Orthopedic Sports Physical Therapy, 39(7), 532-540.  

   

Lubahn, A., Kernozek, T., Tyson, T., Merkitch, K., Reutemann, P. & Chestnut, J.  (2011).  Hip muscle activation and knee frontal plane motion during weight bearing therapeutic exercises.  International Journal of Sports Physical Therapy, 6(2), 92-103.  

Why Hips Don't Lie: Thoughts On Knee/IT Band Pain

Being an obsessed runner who loves running as much as possible, you can imagine how many people ask me if I'm worried about my knees.  Knees knees knees.  That's all people think about.

I used to respond with, "Oh, I'm a minimalist runner!  I run on my forefoot and midfoot and will thus never have knee pain!!"  I have moved past that stage, realizing that a little support and cushioning go a long away, especially when I pronate/evert like crazy.  Which led to a nagging peroneal injury.  Not that I think pronation control is the cure all.  That's for another post.

The point is, I'm back in traditional shoes (Brooks Adrenaline/Brooks Ghost) at the moment for my normal training.  It feels easy to maintain my form with a decent midfoot strike, but I know I'm a heelstriker.  So we'll call it a midfoot/heel strike because I switch between the two depending on my fatigue level or how paranoid I'm being about my form.  Another follow up post will be about footstrike and why it's not as big a deal as we think.  So I started to worry about my knees.  Yet they didn't hurt.  My quads got wrecked after my half marathon last week at the Southern California Half Marathon where I took second in 1:11:11.  That's 5:26 pace.  That's the longest I've ever raced and the only training I did for that was a couple 10-11 mile tempos runs pacing a friend of mine the month before.  That and my crazy high mileage from college(+110 miles per week).  So here I am thinking that I'm putting myself at risk.  One of the main reasons I got interested in physical therapy was long term injury prevention so I can run until the end of my days (whenever that happens to be).

But wait.....

Those of you who know me well know I struggled with constant IT band issues during the beginning of my competitive running career.  When I started competing my senior year of high school, I made it only briefly into each season of cross country and track before I succumbed to Iliotibial band syndrome (once on each side).  This continued into my freshman year of college, where again I was injured during cross country and  two weeks before the 10,000m NWC championship in track.  That 10k was a horrible race.

So finally I took things into my own hands and started researching what the hell was going on.

And here's what I found:

The IT Band is a thick band of fascia attached to the Tensor Fascia Latae and the Glute muscles.  You may hear DPTs and others talk about how the population has weak glutes because we spend so much time sitting.  Well, it's kinda true.  So what happens when those glutes aren't firing?  The Tensor Fascia Latae takes over.  And that muscle is tiny.  So eventually it fatigues, then the IT Band gets tight as hell and pulls on its attachment at the knee.  Then BOOM.  IT Band syndrome.

So how do you fix it?  By strengthening your glutes!!  Particularly your glute medius!  Which is responsible for much of the lateral stabilization of the hip and knee.  It's a hip abductor, so it's one of the muscles that prevents the knee from going inwards during standing or running!

I'll refer you to another DPT, Dr. David McHenry from PACE in Portland, Oregon for the best exercises on that.  The clamshells, reverse clamshells and Jane Fondas demonstrated here:

http://www.therapeuticassociates.com/sports-medicine/stability-routine/

are awesome.  Go check those exercises out.

Once I started doing those, I stopped having any IT band problems.  I've even stopped doing my special exercises for a week just to test it and then it comes back.  So obviously I need to keep doing them.

Back to knee pain!

I've never had any.

Being a heelstriker/midfoot striker made me wonder why I hadn't, because it's such a stereotypical thing to have happen.  The only thing I could think of was the fact that my core exercises have so much to do with strengthening my hips (another post coming up on why "core" doesn't just mean abs).  So I began to look into this.

Article after article seems to point to the fact that various types of knee pain may come from weak glutes.  I would guess that it has to do with how the knee is tracking through the gait cycle (ie does it stay in a neutral straight position or is it subject to valgus/varum forces, going inward or outward?) or maybe that the individual is using their quads primarily for propulsion rather than their glutes!  The quadriceps muscle attaches right below the knee on the upper Tibia (tibial tuberosity).

Here's a couple examples:

Robinson and Nee (Robinson & Nee, 2007) examined female subjects with unilateral patellofemoral pain.  ALL of the subjects with patellofemoral pain tested positive for weak hip strength (it's a cross sectional study, so there were only 10 subjects w/ pain compared to 10 without.  So "ALL" is relative).  They looked at hip abduction, extension and external rotation.  All of these motions had strength impairments in those with knee pain.

Cichanowski, Schmitt, Johnson and Niemuth (Cichanowski, Schmitt, Johnson & Niemuth, 2007) analyzed   female collegiate athletes with unilateral knee pain in regards to hip strength.  They compared the subjects to themselves and found that the hip abductors and external rotators were much weaker on the injured side than the non-injured side.

I can keep spouting off more of these because they keep going on and on.  Just look up "Glutes" and "Patellofemoral Pain" and you'll find enough articles to last you until the end of days.

Like I mentioned early, my thoughts (as a student, not a dpt yet.  I have nothing to cite on this so take it with a grain of salt) on this are that patellofemoral pain can be due to instability of the knee and/or overuse of the quads instead of the glutes for propulsion during a running or walking gait.  I think excess lateral/medial movement of the knee puts pressure on all the tendons and ligaments surrounding and excess use of the quads puts pressure on their connection point just inferior to the patella.

Solution?  Strengthen your hip abductors with the stereotypical Physical Therapy exercises (Clamshells and lateral leg raises or Jane Fondas at minimum) and your hip extensors.  Why the hip extensors?  Ask any DPT, PT, strength and conditioning specialist, etc about the glute muscles and sports performance.  THEY'RE REALLY IMPORTANT!!  Why do you think elite sprinters have big butts?   But in most people they end up weak, and the quads take over for propulsion.  Which can (there will always be exceptions thanks to human variability) lead you down the path we've been talking about!

So Shakira had it right.  She just didn't realize that her song was applicable to injury prevention and rehab.

Now if hip strength/kinematics affects the knee joint, what about the other joints in that chain?  The human body is REALLY good at compensating for a weakness, even to the point of another injury.  Trust me.  It's what a majority of my job as a doctor of physical therapy will be involved in correcting.   I'm assuming you can guess that it may involve injuries in the ankle and the hip areas.  It probably involves attempting to get more propulsion from the calves (achilles injuries), foot (Plantar fascities), hamstrings (hamstring injuries) and more to compensate for those weak hip extensors.

So strengthen those hips.  They'll help you run faster and may protect you from various injuries.

If nothing else, the exercises will make your butt look better.  Think of it as a two for one deal.

Hope you enjoyed my first real blog post.

As always, my thoughts are my own unless cited.

Thanks for reading.

-Matt Klein, SPT

Citations:

Cichanowski, H., Schmitt, J., Johnson, R., & Niemuth.  (2007).  Hip Strength in Collegiate Female Athletes With Patellofemoral Pain.  Medicine & Science In Sports & Exercise.  39(8): 1227-1232

Robinson, R., Nee, R.  (2007).  Analysis of Hip Strength in Females Seeking Physical Therapy Treatmet for Unilateral Patellofemoral Pain Syndrome.  The Journal of Orthopedic Sports Physical Therapy, 37(5): 232-238