Sports Wellness Center

by Natalie Wong, PT, OCS

 

CPMC Physical Therapy and Sports Wellness Center

 

In 2007, California Pacific Medical Center (CPMC) Physical Therapy Department started the Sports Wellness Program to bridge the gap between medically necessary therapy services and community based wellness and fitness programs.   With the growing number of active individuals in the Bay Area, life spans expanding, and the desire to make a more lasting change with our patients, the PT department began offering a range of wellness programs taught by therapists that are available to employees and the public.  With the medical and fitness expertise of the physical therapy team, we keep you fit in the safest way possible.

 

Below are brief descriptions of what we have to offer.

  • Total Body Fitness – An effective 60-minute cardio and strength workout for those trying to prevent injuries and stay healthy.  We provide a Level I and II class.

 

  • Fit for Life – A class designed for people 60 years or older to help them increase strength and flexibility, improving their balance and reducing their risk of falls. This overwhelmingly successful class helps keep participants healthy and independent.

 

  • Pilates – Our Pilates Mat Class and Private Pilates Reformer sessions are taught by Physical Therapists with Pilates certifications.

 

  • Bike Fit –Are you fit to ride?  Our Fit to Ride Program offers two bike-fit options.
  1. Option 1: A musculoskeletal assessment with a bike-fit evaluation with you seated on your bike that is secured to the bike-fit trainer.
  2. Option 2: In addition to the bike-fit evaluation and musculoskeletal assessment, this option includes an interactive cycling video analysis to optimize your comfort, efficiency, speed and overall cycling performance.

 

  • Running – CPMC’s Running Clinic will help you improve running mechanics to optimize biomechanical efficiency and endurance; improve posture, flexibility, strength, and balance; minimize repetitive joint stress and prevent injury; identify common running training errors; and provide skilled exercise program instruction and feedback.

 

  • Alter G Treadmill – Do you want to return to running or start a running or walking program but afraid you are too overweight or injury prone? The anti-gravity treadmill is a technology that unloads you so you can walk/run with an adjusted body weight.

 

  • Golf Conditioning – Are you ready to get back on the golf course or improve your game? Private sessions are with physical therapists who are (Titleist) TPI certified.

 

  • Fitness Training – What are your fitness goals? To prevent injury? Stay healthy? Lost weight? Exercise during pregnancy? Our private sessions with a Physical Therapist will tailor an exercise program to meet your needs. CPMC employee discount available.

 

For more information about the Wellness staff or see a list of our programs, please check out our website at www.cpmc.org/sportswellness.

 

We are located at:

Outpatient Physical Therapy – Pacific Campus

2360 Clay Street

San Francisco, CA 94115

Advertisements

CADENCE: HOW YOUR RHYTHM CAN AFFECT YOUR RUNNING

by Jonathan Ide-Don, PT, DPT, OCS

WHAT IS CADENCE?

Cadence is the number of steps (or strides) a runner takes in a set amount of time.  It is often expressed in steps per minute (each foot hitting the ground counts as one step) or strides per minute (one cycle of right foot then left foot hitting the ground counts as one stride).  Other names for cadence include step rate, step frequency, and turnover.  Cadence is also one component that determines running speed:

Cadence  X  Step Length  =  Speed

WHY IS IT IMPORTANT?

Cadence is one of the key factors affecting running mechanics.  If a runner maintains a constant speed, but increases their cadence, their step length will shorten as well.  A shorter step length and faster cadence can have effects on muscle activation patterns, joint loading, and the overall movement patterns.

Cadence is one factor that is under conscious control of the runner, and short-term changes can be seen immediately with easily accessible tools or cues.  Making long-term changes stick will require practice over a period of weeks to months.

WHAT DOES THE RESEARCH SAY ABOUT CADENCE?

Key points from the research:

Running with a quicker cadence results in the following:

  1. Shorter step length (Fletcher 2010)
  2. Less vertical displacement
  3. Shorter stance time
  4. Better shock attenuation (Hamill 1995)
  5. Less energy absorption at knee (Heiderscheit 2011)
  6. Less energy absorption at hip
  7. Less braking as the foot hits the ground
  8. Increased gluteal activation (Chumanov 2012)

WHAT DO THE COACHES SAY?

There appears to be a general consensus that a minimum of 170 to 180 steps per minute is a good cadence to shoot for.  Pose running teaches at least 180 steps per minute, but faster if the athlete is able to perform the proper technique.  Chi running also teaches an ideal cadence of 180 steps per minute.  Blaise Dubois, a physiotherapist based in Quebec City, also advocates a cadence of at least 170 steps per minute.  He recommends increasing the cadence to 180-185+ steps per minute for faster workouts.

WHAT DOES THIS ALL MEAN?

  1. Increasing cadence lessens forces at the knee and hip joints
  2. Increasing  cadence lessens risk of stress fractures associated with repeated, excessive loading of the bone
  3. Increasing  cadence increases gluteal activation, which may positively affect alignment of your knees, ankles, and feet during running

If you are looking to prevent future injuries, or to return to running following an overuse injury, increasing your cadence 10% over your preferred cadence may be beneficial.

A specific target for your cadence is largely dependent upon the individual.  However, shooting for at least 170-180 steps per minute may be a good place to start.

HOW DO YOU DO IT?

1. Running intervals with a metronome

If you have a smartphone, you can download free or really cheap metronome apps onto your phone.  As part of your warm up, run for 30 to 60 seconds with the metronome matching your footsteps to the metronome beat, rest for 1 minute, and repeat 3 to 5 times.  Then shut off the metronome, and go out for your run and try to maintain your goal cadence.  My personal favorite is the Steinway & Sons free app for the iPhone:

https://itunes.apple.com/us/app/steinway-metronome/id393021343

2.      Running with music with specific beats per minute

Build a playlist!  Running with music can make some runners feel like they are working less hard to maintain a certain speed (Bood 2013).  Even better, the music can serve as your metronome.  Check out the websites below to search and find songs to build a playlist at different cadences:

http://www.cs.ubc.ca/~davet/music/bpm/

http://www.bpmdatabase.com/search.php

http://runningplaylist.net/category/bpm-2/page/2/

3.      Running drills with a metronome

These drills are excellent technique drills as part of your warm up.  Using a metronome while practicing the drills is a great way to practice the rhythm of running at a faster cadence.  Try each drill 3 times each for 30 seconds, matching your footsteps to the metronome beat.

https://ptsportswellness.wordpress.com/2013/12/04/running-drills-the-quick-switch/

https://ptsportswellness.wordpress.com/2013/12/04/running-drills-modified-butt-kicks/

https://ptsportswellness.wordpress.com/2013/12/04/running-drills-modified-butt-kicks-moving-forward/

4.      Jump rope

Practice jumping rope with both feet hitting the ground with a quick, light hop.  Jump rope is a great way to teach your body how to quickly get your feet on and off the ground.  Progress from 2 feet jumps to alternating right foot / left foot jumps.  Focus on quickly picking the heel straight up toward your sit bone, hopping just high enough off the ground to clear the rope.   30-60 seconds of jumping with 30-60 seconds of rest for 5-10 rounds is a great way to start.

5.      Use mental imagery

For those runners who work best with a mental image, some of my favorite cues I have heard are “run like you are running on hot coals,” “Hot feet,” or “run like you are running on thin ice.”  Try different mental cues, and find the one that works for you the best.

SOME CAVEATS

1.      Keep your speed constant.

Some runners who have tried to increase their cadence told me that their tendency is to just want to run faster.  This point is valid, because as running speed increases, running cadence tends to increase as well.  The challenge is can you run at a constant speed, but increase your cadence?  Running on a track, treadmill, or straight flat pathway with distances marked can help you control your pace while learning the faster cadence.

2.      Practice, practice, practice… and be patient!

A running course I recently attended recommended 6 weeks of running homework with drills 3 days per week, which included a lot of metronome drills.  It takes a long time to make permanent changes in your running cadence, as your body likely has “overlearned” its preferred cadence.

REFERENCES

Fletcher et al.  Biomechanical performance factors in pose running and heel-toe running.  International quarterly of sport science 2010/2012.

Chumanov et al.  Changes in muscle activation patterns when running step rate is increased.  Gait and posture.   (36): 231-235, 2011.

Bood et al.  The power of auditory-motor synchronization in sports:  enhancing running performance by coupling cadence with the right beats.  PLOS ONE.   8(8): 1-8, 2013.

Heiderscheit et al.  Effects of step rate manipulation on joint mechanics during running.  Medicine and science in sports and exercise.  43(2): 296-302, 2011.

Hamill et al.  Shock attenuation and stride frequency during running.  Human Movement Science.  14(1): 45-60, 1995.

Romanov, N. (2004).  Pose Method of Running.  USA: Pose Tech Press.

Running Drills: Forward Fall into Run

by Jonathan Ide-Don, PT, DPT, OCS

The primary goals for this drill:

  1. Learn how to fall forward while placing your foot underneath your body

  2. Learn how to take short, quick strides

How:

This drill will train your body how to transition from standing still, to leaning forward, to running forward while maintaining short, quick strides. 

Start by standing with both feet on the ground in tall posture with both knees slightly bent.  Pull one heel straight up to the buttock, and balance on one foot with arms in running position.  Shift your weight forward and lean forward gradually.  Once you feel at the edge of your balance, quickly switch your feet by pulling the heel of your other foot straight up to your buttock.  Continue leaning forward as you run, focusing on keeping your strides short and quick with your foot landing softly underneath your hips.

COMMON MISTAKES

  1. Reaching your foot out in front of your body as you fall forward rather than quickly pulling the heel up to your buttock behind you
  2. Landing hard on your heel , rather than softly landing with your foot underneath your hips
  3. Losing your forward lean as you start to run

Running Drills: The Quick Switch

by Jonathan Ide-Don, PT, DPT, OCS

The primary goals of this exercise:

  1. Teach how to lean forward while quickly switching support between feet

  2. Teach how to maintain a tight core and forward lean

How:

Start by standing just further than arms distance away from a wall.  Lean forward and place both hands on the wall.  Keep a straight line from your ear down to your shoulder, to your hip, your knee, and to your midfoot.  Gently bend both knees.  Pull one heel straight up to your buttock.  QUICKLY switch support by pulling your other heel straight up to your buttocks, and letting your first foot fall to the ground relaxed.  Alternate pulling one foot and then the other off of the ground.

Start switching between feet with a short pause between switches to learn the movement.  As you get comfortable with switching, shorten the pause between switches until you are essentially running in place.

This exercise can be performed for time.  Start with 20-30 seconds and gradually increase until you can perform the drill successfully for 60 seconds.

COMMON MISTAKES

  1. Driving knee too far forward in front of the body rather than lifting the foot straight up to the buttock
  2. Flicking foot too far out behind you rather than lifting the foot straight up to the buttock
  3. Rounding at the mid or low back as you lift your foot rather than keeping a straight spine
  4. Stomping the ground loud and hard rather than landing softly and quietly
  5. Jumping up off ground when switching between feet rather than minimizing air time

 

Running Drills: Modified Butt Kicks Moving Forward

by Jonathan Ide-Don, PT, DPT, OCS

The primary goals of this exercise:

  1. Teaching runner how to change speed of running by changing the angle of their forward lean

  2. Combining proper running posture, proper pulling, and a proper forward lean

This drill is a progression from the stationary, modified butt kicks.  This drill is more challenging to the stability of running posture, as it adds one layer of instability:  a forward lean.  Once you have mastered the stationary modified butt kick drill, give this drill a try!

How:

This drill starts by performing stationary modified butt kicks.  Lean forward slightly from the midsection while maintaining proper tall posture and pulling technique.  As you lean forward just a couple of degrees, you will start to move forward.  As you lean forward at a greater angle, you will move forward even faster.

Start with a slight forward lean covering 10 meters distance.  Progress by increasing your angle of forward lean and increasing the distance covered to 20-40 meters at a time.

COMMON MISTAKES

  1. Breaking  at the hips rather than leaning forward as one unit
  2. Leading with your chin rather than leaning forward as one unit
  3. Reaching your foot forward in front of your body rather than keeping your footstrike underneath your hip as you lean forward

Running Drills: Modified Butt Kicks

by Jonathan Ide-Don, PT, DPT, OCS

The primary goals of this exercise:

  1. Reinforce proper running posture dynamically as you switch from one foot to the other

  2. Teach proper pulling technique of the heel straight up to the ischial tuberosity (sit bone)

  3. Improve endurance, strength, and speed of hamstring contraction in the context of running

This exercise is a slight modification of the traditional butt kick exercise.  The primary modification of this exercise is the cue of how the runner pulls the foot up off the ground.  In traditional butt kick exercise, the runner focuses on keeping both thighs vertical, and firing the hamstrings to lift the foot up in an arc behind them to kick their buttocks.  In the modified butt kicker, the runner focuses on firing the hamstring and lifting the heel of the foot straight up in a vertical line to their ischial tuberosity (ie. sit bone).

Notice in the video how the knee comes slightly forward relative to the body, rather than keeping the thigh vertical and the knee pointing straight down at the ground.

How:

Start by standing in tall posture with feet hip width apart, knees soft and pushed out to the side, elbows bent 90 degrees, and eyes straight ahead.  Imagine there is a rubber band connecting from the heel of your foot straight up to your ischial tuberosity (your sit bone).  Fire your hamstring and quickly pull your heel in a straight line vertically up to your sit bone.  Then, fire the hamstring on your other leg to quickly pull your other heel up to your other sit bone.

When you lift your other heel, let your other foot fall passively to the ground and land soft and relaxed on the ground.

Start with a slow rhythm, quickly pulling one heel up, pausing briefly, finding your balance, then quickly lifting your other heel up.  Once you feel comfortable with the quick pulling of the heel, then you can speed up the rhythm.  Eventually the rhythm should match your running rhythm with a quick turnover.  The exercise eventually turns into running in place.

COMMON MISTAKES

  1. Keeping thighs vertical to ground and kicking heel up in an arc behind you
  2. Jumping off the ground when switching feet
  3. Flexing the low back and mid back forward as you pull the heel up
  4. Landing loudly, stomping your foot on the ground when switching feet

Running Drills: Falling Forward

by Jonathan Ide-Don, PT, DPT, OCS

The primary goals of this exercise:

  1. Teach how to maintain proper posture

  2. Teach how to fall forward

Running can be viewed as controlled forward falling.  Maintaining proper posture from head to toe as you fall forward will ensure that you maintain proper alignment of all of your joints as you run.  Proper posture also facilitates proper muscle activation patterns and stability of your spine, which will decrease risk of injury. Leaning forward slightly while running encourages proper alignment and assists in preventing over-striding.

How:

Start by facing a wall, standing arm’s distance away

Key point #1 Find proper posture in the running position. 
Stand tall with your feet hip width apart.  Imagine there is a string pulling up from the top of your head to lengthen your body from head to toe.  Soften both knees while simultaneously pushing knees outward.  Bend both elbows to 90 degrees (right angle) with hands and shoulders relaxed.  Eyes should be focused straight ahead on the wall.

Key point #2:  Pull your heel up to your sit bone. 
Imagine there is a rubber band connecting the heel of your foot to your sit bone, and lift one heel straight up to your buttock.  Hold this position for a few seconds finding your balance.

Key point #3:  Lean forward. 
Lean forward slowly, feeling as you shift the weight from the heel of your foot forward onto the ball of your foot.  Fall forward maintaining tall posture and catch yourself on your hands.  Push yourself back up to the start position.  Fall forward again, maintaining tall posture.

Repeat for 1-2 minutes on each leg

COMMON MISTAKES

  1. Letting your knees dive in toward each other instead of pushing out as you soften your knees
  2. Leading with your head, jutting your chin forward as you fall forward
  3. Bending at the hips instead of keeping tall posture as you fall forward
  4. Letting your back hyperextend as you catch your hands on the wall