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Summer 2019 Newsletter

Training with the 80/20 Principle

Sara Boughner, DPT

As summer days truly begin to get warmer and the snow is melting quickly from the mountains, it is easy to spend more time outside, training harder and longer. Multiple invites from friends for long adventures can add up, and it is easy to see large jumps in time, distance, and effort in your training and activity levels. Everyone recognizes that rest and recovery are an important part of training, but modifying your levels of intensity throughout the week can additionally help you recover while staying consistent and advance your fitness while reaching your summer activity goals.1

The 80/20 rule, or the Pareto principle, is a common concept that applies to many fields of practice, and states that 80% of the effects of an event come from 20% of the causes.2 The endurance training world has its own 80/20 rule, though the premise is different. It proposes that 80% of endurance training should be done at a lower intensity, while 20% should be higher intensity. This means that if you like to run five days per week, only one of your runs should be hard, while the rest should feel easy.

Training - image of runners on top of mountain

photo credit: Seth Orme

In his podcast, The Science of Ultra, Shawn Bearden, PhD proposes that “If you wonder whether you’re at an easy pace, then it’s probably too fast. You know when it’s easy.”3 The science behind the 80/20 rule supports the efficacy of the principle, but it does not yet claim to know exactly why it works. One hypothesis claims that low intensity training is more beneficial than previously thought, while another proposes that high-intensity training is more effective when the rest of one’s training is spent keeping it easy. A third hypothesis is that high-intensity training places too much stress on the body to be done in large amounts, and even moderate-intensity training does not allow you enough time to recover between workouts.1

While a combination of these theories may be the answer, the takeaway is that it is beneficial to back off of the intensity of your typical training days, especially in the long days of summer. Of course everyone responds slightly differently to training, and fitness is a complex balance of chronic training load, overall stress, sleep, nutrition, genetics, etc.1 However, to prevent burnout, overtraining, and reduce the risk of overuse injuries from a summer of activity, know that it is favorable to employ a form of active recovery and take some (or most) of those days easy. Depending on how you train and what equipment you use, you might do this by monitoring heart rate, cueing-in to how hard you feel like you are working, or setting a pace and staying above it.

The flip side is, of course, that one of your training days each week should feel hard. Based on your sport, this can be achieved in many ways. It might look like a pre-designed workout, pushing your effort level or pace, or getting your heart rate into a higher zone. However you choose to do it, make sure you are working hard with the knowledge that your other days will be easy. This can help you get to the Rut, or another Fall goal, feeling strong and ready.

References:
1. Fitzgerald, Matt. 80/20 Running: Run Stronger and Race Faster by Training Slower. Penguin Books, 2015.
2. “Pareto Principle.” Wikipedia, Wikimedia Foundation, 30 June 2019, en.wikipedia.org/wiki/Pareto principle.
3. Bearden, Shawn. “Stamina=Endurance Economy.” Science of Ultra Podcast, www.scienceofultra.com/podcasts/93.


Tips for a Healthy Hiking Season

Sarah Menhennett, PT, DPT, SCS

Many do not consider hiking to be a “sport” in the same way that running is, but it’s important to recognize the high demands that exploring the mountains on foot places on your body, especially if you’re planning on covering a lot of terrain, doing some serious climbing, or going on a multi-day trip with a heavy pack. While traumatic injuries do occur with hiking, many injuries are a result of overuse. Taking training and the importance of good equipment seriously may make your experience more enjoyable and help prevent injuries.

beautiful image of mountain and lake

Gradually increase your mileage
Build up to that 20+ mile hike. If there’s a particular long hike that you have your sights set on but haven’t been getting much cardio in over the winter/springtime, plan out your hiking season to have the longer ones later in the season to give your body a chance to build the appropriate strength and cardiovascular adaptations to adequately handle longer, more strenuous excursions. Another way to build up the mileage is having multiple shorter hikes planned in the same area. That way you can get the miles in, but won’t be caught 10 miles away from your car if you or others in your party decide to call it a day early.

Elevation change
A steep hike puts much more stress and strain on your body than an even trail. This is another component that should be a part of your training. Gradually increasing your elevation gain and the grade of your hikes will give your muscles and tissues a chance to adapt to the higher demand.

Balance training for foot and ankle stability
A trail with uneven terrain, rocks, and roots can be a recipe for a sprained ankle. While a good pair of hiking boots may help with providing ankle stability, it can be very beneficial to work on your balance in a controlled environment (off the mountain), especially if you are prone to ankle sprains. Working on balancing on one leg is a good place to start. You can start on the floor then work up to standing on a foam pad or pillow. To increase the difficulty, try balancing with your eyes closed. ***Make sure you have something sturdy within reach to grab on to in case you lose your balance.

Shoes
A good pair of hiking shoes is important for ankle stability, protection from rocks, and traction. Comfort and the right fit are of the utmost importance. Shoes that are too tight can put pressure on the Achilles tendon or your metatarsals (foot bones). Shoes that are too loose may result in blisters. Recognize that you may have to adjust your laces during your hike as your feet may swell. You may need to tighten your laces when you descend to prevent your foot from sliding forward into the front of the shoe.

Backpack
Make sure your pack fits appropriately to take stress off your shoulders and back. Experts at local outdoors shops may be able to help you find the right size pack and check your adjustment. Here’s a link to a basic “how to” for making appropriate adjustments at home: https://www.outsideonline.com/2312101/how-properly-fit-your-backpack 1
Breaking in your pack on shorter hikes is always a good idea to make sure you get the fit right and to allow the hip belt to conform to your shape.

Train with load
While having your pack adjusted properly will do wonders for comfort, weight is still weight. If you are planning on doing some hikes with heavy load (multi-day backpacking, having to pack in your water, or hiking out with game), do some training hikes/walks with a gradual increase in pack weight.

Trekking poles
The use of trekking poles has been shown to take stress off joints with downhill walking. This benefit has been shown to be the case with or without carrying a heavy pack. While covering uneven terrain, they may also assist with balance.2 To maintain a proper trekking pole fit, your elbows should be at about a 90 degree angle with your arms at your sides. Shorten the poles for uphill hiking, and lengthen them as you descend.

hiker in meadow with beautiful moutain range behind

References:
1. Online website. Accessed July 7, 2019. https://www.outsideonline.com/2312101/how-properly-fit-your-backpack
2. Bohne, M., & Abendroth-Smith, J. (2007). Effects of hiking downhill using trekking poles while carrying external loads. Medicine and science in sports and exercise, 39(1), 177-183.


Summer Miles and Plantar Fasciitis

John Fiore, PT

Summer is in full swing and long days on the trail and off the trail can take a toll on our feet. The human foot is an engineering marvel. It is easy to take the foot for granted until foot pain occurs. The human foot is comprised of 28 bones and their associated ligaments, tendons, and muscles. While human feet have evolved to support upright walking (bipedal gait), they often object to the abuse we subject them to. Plantar fasciopathy is a prevalent injury in the summer months as most of us pack way too many runs and hikes into our brief summer months. This article will focus on the plantar fascia which plays a large role in the Windlass Mechanism which improves intrinsic foot support and contributes to our ability to run and hike efficiently.

The plantar fascia is a thick fibrous band of connective tissue which runs from the front of the calcaneus (heel bone) to the base of the toes. It acts as a last resort to stabilize the longitudinal arch of the foot. Characterized by pain in the heel region of the arch of the foot, plantar fasciitis is the the most common cause of heel pain requiring medical care. It is estimated that 1 in 10 people will develop plantar fasciitis in their lifetime, resulting in one million medical visit annually.ii Because plantar fasciitis often becomes a chronic condition, understanding the causes and proven treatment options will lead to effective resolution.

Plantar fasciopathy is a more accurate term to describe heel and arch pain as it includes the inflammatory condition (plantar fasciitis), and degenerative condition (plantar fasciosis) of the plantar fascia. Plantar fasciitis occurs when the thick, fibrous plantar fascia becomes inflamed due to trauma, poor foot strength, repetitive arch strain, or faulty foot-ankle biomechanics. Plantar fasciosis describes the non-inflamed degenerative state of the plantar fascia due to repetitive stress and chronic soreness.

Diagram of Plantar Fascia

Diagnosing plantar fasciitis involves palpating its attachment on the front of the calcaneus (heel bone). Pain is experienced during prolonged standing, running, descending stairs, and most notably upon rising and walking across the floor first thing in the morning. Additional causes of heel and plantar pain to be ruled out by your physician or physical therapist include bone stress reaction, stress fracture, localized nerve entrapment, and lumbar S1 radiculopathy. Predisposing factors to plantar fasciitis include repetitive impact (distance running, jumping sports), rapid increase in activity level or mileage, poor intrinsic foot-ankle support, poor running biomechanics, and obesity (BMI >30).

Effective treatment of plantar fasciopathy takes place over four phases:

Acute Pain Phase: During the acute pain phase, pain must be reduced by avoiding running, hopping, and prolonged standing. Providing additional support through taping, use of anti-inflammatories (if inflammation is present), and reducing impact through gel heel cups and comfortable footwear may be part of the acute pain phase of rehabilitation. Isometric toe flexor exercises, active stretching techniques for the plantar fasciaiii and gastroc-soleus muscle group will improve foot and ankle mobility and function.

Gradual Loading Phase: Manual physical therapy, progressive lower leg and ankle resisted exercises are added during the gradual loading phase. Underlying hip, glut, and core weaknesses must be addressed as well. Gradual plantar fascia loading exercises begin with double leg heel raises followed by single leg heel raises as tolerated. Proper technique is crucial to begin to build loading and weight bearing tolerance.

Heavy Loading Phase: Once single leg heel raises are tolerated pain-free, a barefoot modified (towel roll beneath toes) single leg calf raise progression is commenced. The Rathleff loading program (Rathleff et al 2014) continues to add resistance to single leg heel raise progressions over four weeks, building eccentric strength and tension tolerance.iv Running and hiking are reintroduced upon successful completion of the Rathleff program. For runners, a 2D video running analysis is vital to insure proper running biomechanics to reduce re-injury.

Plantar fascia exercises

photo credit: www.semanticscholar.org

Successful long-term return to distance running requires regular plantar fascia release, foot intrinsic strength, and lower leg mobility and strengthening exercises. Proper footwear, adequate recovery following exercise, and gradual increases in training load will help keep plantar fasciitis-fasciopathy and other foot issues from returning. The experts at Sapphire Physical Therapy can evaluate your running gait, detect any form or strength issues, and develop a foot injury prevention and treatment program to meet your individual needs. Call Sapphire Physical Therapy or learn more at www.sapphirept.com and don’t let your feet keep you from meeting your summer running and hiking goals.

References:
i Riddle DL, Pulisic M, Pidcoe P, Johnson RE. Risk factors for plantar fasciitis: a matched case-control study. J Bone Joint Surg Am. 2003:85-A:872-7
ii. Riddle DL, Schappert SM. Volume of ambulatory care visits and patterns of care for patients diagnosed with plantar fasciitis: a national study of medical doctors. Foot Ankle Int. 2004 May. 25(5):303-10
iii DiGiovanni BF, Nawoczenski DA, Lintal ME, et al. Tissue-specific plantar fascia stretching exercise enhances outcomes in patients with chronic heel pain. J Bone Joint Surg Am 2003:85-A(7):1270-7
iv Rathleff MS, Molgaard CM, Fredberg U, et al. High-load strength training improves outcome in patients with plantar fasciitis. Scand J Med Sci Spor 2014