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Welcome to The Dr. JJ Thomas Podcast! Here I'll be talking all things physical therapy, raw and unplugged, giving you the unfiltered insights you've been searching for in your cash-based physical therapy business. If you're caught in the grind of the traditional model, swamped with paperwork, or feeling like you're not reaching your full potential as a physical therapist, this podcast was created just for you.
Went through the runners readiness assessment, which is a series of 13 movements, 5 movement based, 4 strength and stability based, and then 4 based on foot control and structure. When we assess runners, we kind of view runners as a race car, and we're the mechanics. So our job is to take a look under the hood and make sure all the components are there and what components may or may not be there is gonna influence our decision making when we look at how his running form presents. For the knee drive component, we're just gonna do a simple a skip, skip, which I know you're really familiar with. But the reason I want you to get back into this before your training runs is so that your brain and your body are prepared to get that knee height.
Dr. Eric Abramowitz:It's something you're very familiar with and you already do, but leading into track practice and jumping, you're doing it for more explosive reasons. Now that we're getting into these more steady state training runs, your brain doesn't really feel like it needs to do that, but clearly we we saw on the data that that's a major issue that we're running into with your running efficiency. Right. That's looking a lot better, Chris. Welcome to the Doctor.
Dr. Eric Abramowitz:JJ Thomas
Dr. JJ Thomas:podcast. Hey. Welcome to doctor JJ Thomas podcast. I'm JJ Thomas. Today, we have very special guest.
Dr. JJ Thomas:Doctor. Erica Abramowitz, who you know from our social media. And just, if you followed us at all, you know Eric's a critical part of our company here at Primal Physical Therapy. He's opening his own office very soon. He does some incredible things with gait analysis, 3 d gait analysis.
Dr. JJ Thomas:So I thought it'd be really cool to share that with you guys today on the podcast. Eric has a lot of, fun things in store, and especially because we have a special guest, Chris Sims, who is a all time favorite athlete of mine. We've been working with Chris for many years. All the way he's a rising senior at Bucknell. Double sport athlete.
Dr. JJ Thomas:But we've been working with Chris on and off, since he was in high school. So, you're in for a treat. Enjoy.
Dr. Eric Abramowitz:Alright. Thanks, JJ. Appreciate it. Yeah. Like JJ said, Chris is a 2 sport athlete at Bucknell, football player, defensive back, and a triple jumper for the track team.
Dr. Eric Abramowitz:So, this running gait assessment is really to help him optimize some of his conditioning work when he's just going out for runs. The data we're gonna collect here isn't necessarily gonna be that pertinent for his, his triple jump technique, but it's gonna be more for his ability to condition and stay healthy and fit, throughout the off season and during during the season. So Run DNA, Doug Adams of Run DNA created this amazing piece of equipment. It's the Helix 3 d camera system. We have 3 different cameras that collect data from 3 different angles.
Dr. Eric Abramowitz:We've got 18 sensors on Chris, 4 on the pelvis and then the rest on the legs. The the camera does a really great job collecting all this data and then imprinting it into a program where we're gonna be able to see a three-dimensional view of Chris's structure and followed by that will be on the right hand side. You'll end up collecting a lot of data that gives us the information that we're gonna use to make some tweaks and adjustments to his running form. So Chris and I have worked together for a little while, 3 weeks ago Chris came in for his first assessment which was part of this program and we went through the Runner's Readiness Assessment which is, which is a series of 13 movements, 5 movement based, 4 strength and stability based, and then 4 based on foot control and structure. That's basically giving us a look under the hood.
Dr. Eric Abramowitz:So when we assess runners, we kind of view runners as a race car, and we're the mechanics. So our job is to take a look under the hood and make sure all the components are there and what components may or may not be there. We wanna make sure that what we see on the camera and the 3 d capture is not just a technique driven issue. If there's a mobility or strength or stability issue, we wanna know that so that when we look at the modifications and the treatment plan for him, that we're addressing the right, the right root cause of the problems here. So it's really important to look under the hood before we get him on the treadmill, and now we're here to get them running.
Dr. Eric Abramowitz:So, Chris, are you ready? So we kinda wanna go at what we call like a zone 2, zone 1, zone 2 running pace, which would be a running speed that you could feel comfortable having a conversation. Okay. Right? So not if we're not trying to get out to like a fast run and check out your running and sprinting form.
Dr. Eric Abramowitz:Right. Running form, not sprinting. But we want you at a comfortable pace where you can have a conversation. Okay. So whatever you think that would be, say for, like, 2, 3 miles Okay.
Dr. Eric Abramowitz:Is it is it good enough pace? Okay. I want it to be specific to you because if you're gonna go off for a run, what this looks like if you're running a lot faster is gonna be different than when you're running at a slower pace. And our cues and changes and our suggestions might change. Okay.
Dr. Eric Abramowitz:So whatever pace you would go out for like a regular comfortable run, that's where I want you running. Okay. Okay. So I'll let you so hit turn the treadmill on. I'm gonna let you run for like 20, 30 seconds before I do anything.
Dr. Eric Abramowitz:Ready? Okay. K. Go for it. Alright.
Dr. Eric Abramowitz:Go ahead and hit pause, Chris. Awesome. It's perfect, thanks. Okay. So so after that data collection, the system is gonna create a ton of angles and measurements that are related to what you're doing throughout the running phase.
Dr. Eric Abramowitz:The top section here, it's gonna show just some general parameters. It classifies you in a certain category. It gives us your cadence, your vertical oscillation, some other some other variables. Then we get into your initial contact phase. So what's your what are your feet doing the moment you hit the treadmill?
Dr. Eric Abramowitz:Then we look at the mid mid stance phase. So at mid stance on the foot, what are your body angles looking like? At terminal stance, we're looking at hip and ankle positioning. And then during the swing phase, what's your hip doing? Okay.
Dr. Eric Abramowitz:So those are those are the key components that are gonna help us identify where we can improve your running efficiency. Right? When we're doing these running gait assessments, what we're really trying to do is not necessarily maximize your horsepower, but improve your miles per gallon. Right? We wanna make you efficient so that you can go for longer per gallon.
Dr. Eric Abramowitz:Yeah. Right? We wanna make you efficient so that you can go for longer and reduce the risk of your body breaking down because the more stress on the body, the lower the tissue capacity. And our job is to make sure that your body is absorbing and utilizing the force that you hit the ground with and the ground hits you back with. Okay.
Dr. Eric Abramowitz:And that's the reason behind why we're making we're gonna make some adjustments to this. So when we look at when we look at the system, what's what's nice about this is that we can actually replay your running form from various angles, Side view, we can spin this around and take a look at you from the front. Right? Take a look at what your knees are doing, what your feet are doing, are you crossing over, what's your pelvis doing, are we getting some contralateral pelvic drop. Okay.
Dr. Eric Abramowitz:And we can pause this, freeze frame, whatever we want. So some of the the important facts here that are gonna guide us on on what exercises and what cues we're gonna look at starts with the running category. So the running category that all your numbers are showing is that your Overstrider with low knee drive. The Overstrider is not that you're taking too long of a step, but it's the the relationship of where you make contact with the ground relative to your center of mass. Okay.
Dr. Eric Abramowitz:Okay. So essentially what what that's saying is we need you to hit the ground closer to underneath your body. Okay. Okay? And the knee drive component just tells us that the hip flexion angle during the swing isn't getting up high enough.
Dr. Eric Abramowitz:Okay. K? If we can get that knee up higher, we can drive and strike the ground a little bit more vertically and and behind us, so that we can use that force to propel us forward. Okay. When we start landing with our foot too far out in front, we end up increasing the braking force.
Dr. Eric Abramowitz:Right? The the ground hits us back with equal and opposite forces. So if my foot lands too far forward, that force is gonna hit me back in too much of a horizontal plane. Okay. So I'm basically overcoming braking forces every time I hit the treadmill Okay.
Dr. Eric Abramowitz:Or the ground. Ideally, if we can get that landing position more midfoot, forefoot, and underneath us, we're more equipped to overcome that initial contact force and use that energy to help propel us forward. Okay. Therefore, just just purely making the initial contact position, improving efficiency. Okay.
Dr. Eric Abramowitz:Right? So the the other thing that we're seeing is your cadence at is about 163. There isn't there isn't a perfect cadence number. Every body type and size is a little different, but I would say you're definitely on the lower side. Okay.
Dr. Eric Abramowitz:Okay. We often see overstriders coupled with this low cadence. Mhmm. The low cadence, we have fewer steps per minute, which means we're spending too much time in the air. Okay.
Dr. Eric Abramowitz:Right? My foot is taking longer to get down. Right? If I can take more steps per minute, right, then my feet are spending less time in the air. Right.
Dr. Eric Abramowitz:K. What we're seeing at initial contact here is that your tibial inclination angle, especially on the right side at 9 degrees is significantly higher than the standard norm that we want of of 3. Right? So let's play this just so you can see what's happening. So on that right side, boom.
Dr. Eric Abramowitz:K. So treadmill lit up, which means that's initial contact. In this position, we have a we have your heel, or essentially your lateral malleolus, your ankle, out in front of the knee, and we have a very straight leg. You're essentially landing on a 2 by 4. Right?
Dr. Eric Abramowitz:Yeah. We've got no spring shock absorbing ability in this position. Right. The arch of the foot, the Achilles, the calf, those are the main spring loaded components of this initial contact phase, and you're not accessing that immediately. You're actually loading straight through.
Dr. Eric Abramowitz:This is a pretty straight line, straight through bone. Mhmm. Right? So we'll end up getting a lot of stress through the ankle, through the shin, into the knee. You can end up with knee pain, hip pain, a lot of other things when we're just considering this two dimensional view looking at the side view.
Dr. Eric Abramowitz:So we have a heel strike position, and your ankle and heel are getting way too far out in front of your knee. What we wanna do is bring that landing position closer to the heel being underneath your knee. So if this were where your land where you were landing, this would be perfect. Right? And this is one of this is one of our targets here.
Dr. Eric Abramowitz:Okay. I don't want you necessarily thinking about landing shorter. Right. We're gonna influence your cadence, which should and hip flexion, so the knee drive. Those two things should start to bring your foot closer to underneath your center of mass.
Dr. Eric Abramowitz:Okay. I wanna make sure I can give you 1 or 2 cues that make the biggest change. Okay. Right? That's the goal.
Dr. Eric Abramowitz:I can show you 7 or 8 different things here that are outside of the norms. 8 or 9 7 or 8 queues is just not gonna work well. Right. But there's a lot of things we can manipulate individually that'll make a massive influence on on all of these things. Okay?
Dr. Eric Abramowitz:The other main things that are standing out to me is your peak hip adduction angle. So whether that thigh is angled in during mid stance or not, usually talks a little bit about core trunk and hip control. Okay. Okay. And on your left side, you're more than double the angle that we want.
Dr. Eric Abramowitz:Okay. Right. So when we looked at some of your strength testing, there was a hip weakness that we were identifying. Right. That's probably why that's happening.
Dr. Eric Abramowitz:Okay. Right? This is most likely a little more result of a strength and stability issue than it is like running form and technique. Okay. So we'll address that with some exercises after we get to get through the running form stuff.
Dr. Eric Abramowitz:So our job right now is to help you get your heel and your foot landing underneath you more. I want you to try to land under like the mid foot and arch of your foot rather than the heel. So when we start running, we're gonna get the treble back on. You're gonna go back to that same speed. Mhmm.
Dr. Eric Abramowitz:The first thought is gonna be increase my turnover. Okay. Right? I want you to feel like you're almost running on ice. You wouldn't take these big long strides and steps because you know your foot would slip out from underneath you.
Dr. Eric Abramowitz:Right. If we can pick our knees up and and attack the ground with shorter steps, which is gonna increase our cadence, we should see that initial contact position get closer to us, and it'll feel easier to land on the mid foot and forefoot. Okay. Okay. So let's start with those two thoughts Okay.
Dr. Eric Abramowitz:And let's see what we got. Cool. K. Go for it. Yep.
Dr. Eric Abramowitz:So I wanna see you try to get your knees up a little higher in front of you. And let's focus on, like mind to body connection, the front side of your body. Don't worry about what's happening on the back side. Start getting those knees to drive up, and land more on the toe mid foot. Okay.
Dr. Eric Abramowitz:Yeah. That looks great. Now think about that ice analogy. Right? I wanna see that turnover increase.
Dr. Eric Abramowitz:If you were running on ice, you have to pick up those feet a little more? Yep. Awesome. Let's see what we got. That's looking a lot better, Chris.
Dr. Eric Abramowitz:How's it feel? Feels better. Awesome. Go ahead and hit pause. Alright, so let's see.
Dr. Eric Abramowitz:So we're we're actually doing a lot better. So your strike from center of mass, right, we have 18 centimeters out in front of you. Our goal is to keep that under 29. Right, that's on the left, and on the right we're at 21. Your cadence didn't necessarily go up a ton, it went up 2 points, but we can tell that the the foot inclination angle, so how how dorsey flexed your foot is at that initial contact phase once significantly down, which means you're landing on the mid foot, forefoot component that we're trying to get.
Dr. Eric Abramowitz:So the the last piece that we talked about was hip flexion. Right? You were below 7. You're around you're below 10. You were you were at 7.
Dr. Eric Abramowitz:You more than doubled those things. You did a great job. And I think that's that's a huge influence on that foot strike position and your strike from center of mass coming in big time. Right. K?
Dr. Eric Abramowitz:So the only thing that we would like, the only thing I would necessarily change or ask you to continue to work on would be to increase your cadence. Okay. Some things you can do on your own to do that is if you listen to music while you run, a lot of these music apps have running playlists that run at beats per minute. So you can come up with, like, a rock or hip hop or something, a 170 beats per minute Mhmm. And play that.
Dr. Eric Abramowitz:And your goal is to just run to that beat. Yeah. If you're not somebody that runs a music, you can there are metronome apps, but then all you're listening to is It's a metronome. Beeping is a metronome, and that might drive me crazy. Yeah.
Dr. Eric Abramowitz:But there's a lot of different music options that'll keep you running at if you just run to the beat, it's gonna keep it within a set range. Okay. And I think that'll help you a lot with this with this cadence. But otherwise, you made some really awesome changes that I think will definitely decrease some of the strain and stress you're imposing on your body, especially at an initial contact. Right.
Dr. Eric Abramowitz:The only thing that now we're looking at, right, that peak hip adduction angle is still high. Mhmm. But again, that's more likely coming from some of the strength and stability assessments that we saw initially rather than this. So this is something that can create some some torsional forces around the the entire limb, shin splints, knee pain, hip pain, some of that stuff. So we're gonna get into some exercises that I think can help you out with that.
Dr. Eric Abramowitz:Other than that, continue focus on that knee drive and we'll go over a drill there and keeping that cadence up. Okay. Okay? Awesome. Good job.
Dr. Eric Abramowitz:So let's go to some exercises and running drills. Cool. Alright. So you did a great job on the treadmill. We're gonna get into some of the exercises now that are gonna address those 3 main components, that we saw with the running form.
Dr. Eric Abramowitz:The first one's gonna be your knee drive. So, getting that hip flexion angle higher in the swing phase. The second is gonna be cadence, which we'll also incorporate into the exercise for your knee drive. And the third one is that hip adduction angle, which is gonna relate to that hip strength test that we did before we got you on the treadmill. Okay?
Dr. Eric Abramowitz:Okay. So for the knee drive component, we're just gonna do a simple a skip, which I know you're really familiar with. But the reason I want you to get back into this before your training runs is so that your brain and your body are prepared to get that knee height. Okay? Okay.
Dr. Eric Abramowitz:It's something you're very familiar with and you already do, but leading into track practice and jumping, you're doing it for more explosive reasons. Now that we're getting into these more steady state training runs, your brain doesn't really feel like it needs to do that, but clearly, we we saw on the data that that's a a major issue that we're running into with your running efficiency. Right. So, simple a skip. We're gonna start with 1 leg at a time, and I want you to get that knee up excessively high because I think when we exaggerate the movement, it starts to we start to regress to the mean, so to speak, when we're actually performing.
Dr. Eric Abramowitz:So really focus on getting that knee pretty high. As the knee comes up, be really present to what your rib cage is doing. As the knee gets higher, the tendency is for us to lose our posture and shift backwards with our ribs flaring up. Try to keep those ribs down, stay strong through the stomach, and drive that knee high. Okay?
Dr. Eric Abramowitz:So let's see what you got. Yeah. Great job. Ribs stay down. Knees coming up high.
Dr. Eric Abramowitz:Right? And, again, this is really just to tell your brain, hey. We're ready to go for a training run. That knee drive position is still really, really important. Okay?
Dr. Eric Abramowitz:Now, to help with the cadence, I just wanna see you hit that a little faster. Okay. Right? Again, we're exaggerating the feel. So if you can get that knee drive happening really quickly, then when you go out to your training runs, you can try to find that tempo a little bit better.
Dr. Eric Abramowitz:So let's hit that one a little faster now. Yeah. Great. Again, when you go out to run, your brain's gonna recall a little bit of that tempo, and it'll help you get back into the cadence we're looking for. K?
Dr. Eric Abramowitz:One exercise I really like for glute strength and connecting the glute to the core and trunk is a is a is the DNS star plank. So it's a side plank we're gonna work where we're anchoring from the knee and the forearm. Okay? So I'll demonstrate first. We're gonna go I apologize for you jiu jitsu athletes.
Dr. Eric Abramowitz:I have shoes on the mat. I'm gonna clean this. I promise. So we're gonna start with the elbow stacked directly under the shoulder, and we're gonna we're gonna get into a little bit of a hip flexion position to start. Again, the knee and the forearm are anchoring points.
Dr. Eric Abramowitz:At the bottom of this plank, the hip's gonna be floating. The top leg is gonna be reaching back behind me, and the and the top arm is gonna reach out in front. There will be a hinge at the top. So I'm gonna come up, get into some hip extension at the top. On the way down, hip is still floating.
Dr. Eric Abramowitz:I'm gonna extend that right leg back and right arm up and forward and come back up. K? We're accessing some hip rotation and hip extension along with some abduction here. So it's a really great glute activation exercise. Let's see what you got.
Dr. Eric Abramowitz:Yep. So bring that elbow in more underneath your shoulder. Perfect. Good. So on the bottom, that's gonna be the bottom.
Dr. Eric Abramowitz:The only difference is your hip won't be touching the mat. Okay. Okay? So come up to the top. So it's a traditional top of the side plank.
Dr. Eric Abramowitz:Alright. Drop back down. So right there, you anchored from your feet. I want the anchor point to be at the knee. Okay.
Dr. Eric Abramowitz:So when you come up, the bottom knee is the only thing that's really driving through the mat. Don't think about the foot at this point. Just drive through that that left knee and come up into the top of your side plank. So bring your hips to me. Come up full up higher.
Dr. Eric Abramowitz:Awesome. Now as you lower, extend that right leg back up that right leg back and the right arm out in front of you. Drop the hip and then come back up. Good. Drop the hip, reach and rotate.
Dr. Eric Abramowitz:Good. Come back up. Awesome. Come back down and back up. Good.
Dr. Eric Abramowitz:K. Relax. So in this same position, we're still being mindful of the rib cage, so really keep that rib cage depressed. Engage the anterior chain. And if you bend your bottom knee a little bit more, you might feel more comfortable anchoring from that knee.
Dr. Eric Abramowitz:Okay. So, let's get a little more knee bend. Perfect. Yep. Yep.
Dr. Eric Abramowitz:So just come up to what the side the top of a traditional side plank would feel like. Good. Bring your hips to me more like you're finishing the the dead lift. Perfect. Now as you drop down, the right leg's gonna go backwards, the left arm's gonna go up and forwards.
Dr. Eric Abramowitz:Go ahead. Down, hinge, come back up. Good. Down, extend, come back up. Send that right foot behind you a little bit more.
Dr. Eric Abramowitz:There you go. Come back up. Now do one without your hip tap in the floor. Hover at the bottom and come back up. Awesome.
Dr. Eric Abramowitz:Relax. Yeah. So you can kinda tell at the top, you're actually missing a piece of that at the top. It's hard for you to finish that movement. Right.
Dr. Eric Abramowitz:So, again, that adduction issue is more likely coming from the strength component of this than it is form related. Okay? Yep. The last piece of this is being able to tap into that glute while the foot's grounded. So that does a nice job of activating and recruiting the core and hip at the same time, but I wanna make sure you're getting that same recruitment while the foot is actually grounded.
Dr. Eric Abramowitz:And this one's pretty simple. We're gonna do what looks like a traditional split squat, but I'm gonna give you some banded resistance at the knee. The band's forcing that knee into that adduction position. Okay. So now we have some more tactile feedback that's trying to pull us into the angle that we're trying to avoid, which makes us engage that hip, engage the foot, feel like we're really grabbing the floor and rotating that thigh out.
Dr. Eric Abramowitz:And your job is to maintain the position of the knee over top of that ankle throughout the entire movement. Okay. What we don't want is the knee to cave in and we start to tip over, right, and you can get more tension by a thicker band or just moving out, But let's get real heavy on the lead leg, knee stays over the foot, hip stays in line with the knee, lower, drive through the leg. Lower down, drive through the leg. Let's test that out.
Dr. Eric Abramowitz:Good. So set that left foot. Awesome. I want you to bring that left knee a little more forward. Awesome.
Dr. Eric Abramowitz:Good. And you're you're already set up in a great position. The thigh is in line with the foot. Go ahead and lower down. Don't let that knee move a millimeter in.
Dr. Eric Abramowitz:Hold, drive up and forward. Good. Yep. Come down. Pause.
Dr. Eric Abramowitz:Drive through that foot. Engage the toes. Great. Drive up. Awesome.
Dr. Eric Abramowitz:Good job. So we'll start with those 3 movements. Try to do a few of those before every run. You can either set it for time. There's no magic number.
Dr. Eric Abramowitz:I just want you to feel like you're getting those muscles firing. You should feel like the glutes are warm, they're working, and then go out for those runs. Sounds good. Cool? Yeah.
Dr. Eric Abramowitz:Awesome. Okay. Yeah. Anytime.