Running is a pain!

79% of runners are injured annually.  

If you or any of your friends are runners, chances are that you’ve found yourself talking about your injuries at some point.  These injuries aren’t caused purely by running, rather they are caused by running with faulty mechanics.  In our last post, we went over self-tests to see if you're have the fundamental mobility and stability to run. In this post, we're giving you an overview of some of the most infamous injuries associated with running.

Patellofemoral Pain Syndrome

Also known as “PFPS,” Patellofemoral Pain Syndrome results in pain around the kneecap, or patella.  The patella and femur have a specific tracking pattern as the knee moves through flexion and extension, and PFPS occurs when that tracking becomes faulty.  PFPS is typically a product of hip and/or calf weakness or poor tissue flexibility.  

Iliotibial Band Syndrome

Also known as “ITBS”  or “IT Band Syndrome,” Iliotibial Band Syndrome results in lateral knee pain and inflammation.  It occurs due to friction of the IT band rubbing against the lateral femoral condyle as the knee moves throughout the running gait cycle.  The friction of the band increases with poor flexibility and hip weakness.

Plantar Fasciitis

Plantar Fasciitis is inflammation of the plantar fascia; the tissue that runs along the bottom of the foot; resulting in heel and arch pain.  This is caused by poor ankle mobility resulting in improper mechanics.  It can occur with a “high” OR a “low” arch.  Runners typically feel less pain during their run, and an increase in pain at the end or after the run.

Achilles Tendinopathy

Achilles tendonitis is an overuse of the Achilles Tendon; the tissue that joins your calf muscles to your heel.  This occurs due to poor tissue compliancy (either too compliant or not compliant enough) during the propulsion phase of gait.  Achilles Tendinopathy increases in individuals > 35 years of age due to changes in tissue compliancy.  

Low Back Pain

Low Back Pain can occur in runners for a multitude of reasons.  For example, poor hip extension can result in excess anterior pelvic tilt or pelvic rotation, and weak hip muscles can result in unilateral stress on intervertebral joints.  It is most frequently associated with improper posture and/or a lateral trunk lean.

All of these injuries and more can not only be resolved, but prevented with a proper analysis and evaluation done by one of our Doctors of Physical Therapy.  Click here to schedule your first appointment!

Are you ready to run?

So you’re ready to hit the ground running, literally.  Before you do, there are a few things you should check to make sure your risk for injury is as low as it can be.  Of course, getting a running analysis done by a qualified professional is the gold standard to determine your readiness to run.  However, here are a few simple tests you could do on your own, too:

1)   Ankle dorsiflexion

Ankle dorsiflexion is the ability to raise your forefoot from the ankle joint.  From footstrike to midstance during running, your foot goes through an average of 15 degrees of dorsiflexion.  Without sufficient dorsiflexion range of motion, one might demonstrate decreased stance time and excessive flexion at other joints while running.

Photo 1

Photo 1

Photo 2

Photo 2

Sit on a chair with your knees bent to 90 degrees and your feet flat on the ground.  Keeping your feet flat on the ground, scoot forward in the chair until your knees are directly over your toes (Photo 1).  If you are unable to keep your heels down in this position (Photo 2), you have insufficient ankle dorsiflexion.

2) Hip flexor mobility

The “hip flexor” is made up from 2 muscles, the Iliacus and Psoas, coming together to join the spine/pelvis to the femur.  Since the job of these muscles is to flex your hip, tightness of them will result in limited hip extension.  This could result in over striding or excessive pelvic rotation.

Photo 3

Photo 3

Photo 4

Photo 4

Sit with your butt at the very edge of your bed.  Hug in one leg as you lie onto your back, allowing one leg to hang off the edge.  If the knee of your hanging leg is higher than your hip (Photo 4), your hip flexors are limiting your hip extension.  Repeat with the other leg to determine symmetry.  

3)   Glute strength

Consider your Glutes as the powerhouse of your running.  They are a massive muscle group and should be used to propel you forward.  Unfortunately due to faulty movement patterns or insufficient hip extension range of motion, many runners have weak glutes; forcing them to rely on other, smaller muscles to move forward. 

Photo 5

Photo 5

Photo 6

Photo 6

Lie on your back with your knees bent and feet flat on the ground.  Place a pen across your pelvis.  Kick one knee straight so that only one foot is making contact with the floor.  Try to lift your hips off of the floor with one leg, without allowing the pen to slide off (Photo 5).  If the pen slides off (Photo 6), you feel back pain, or you are unable to lift yourself off the ground, you have inadequate glute strength.

4) Dynamic hip stability

Adequate hip stability is necessary to safely absorb shock and efficiently propel you forward.  Consider running a series of repetitive single leg hops.   With approximately 1000 footstrikes per mile of running, that is a lot of single leg hops.  Inefficient hip stability could result in inward collapse of the leg, causing forces to be distributed in a way that puts you at risk for injury.

Stand on one leg and hop in place 15 times.  You should be able to do so without collapse of your ankle and/or knee, excessive drop of your pelvis, or a loss of balance.  If you experience any of the above, it is likely that your hips are not strong enough to stabilize you through a run.

5)   Dynamic core stability

Your core is responsible for holding your body together with every step you take.  Your core stability must be adequate enough to maintain your spinal and pelvic alignment with every foot strike and push off.  Inadequate core stability could result in an abnormal arm swing, excessive pelvic movement, and a posterior trunk lean.

Starting on your hands and knees with something balancing on your lower back, reach your right arm and left leg away from you at the same time.  Repeat with opposite sides.  You should experience minimal movement of the spine, resulting in the ability to keep an item on your back without it falling off.   If you are unable to balance something on your back, or unable to remove your arm and leg off of the ground at the same time, you likely do not have the appropriate core stability required to run.

If you have failed any of these tests, or have any other questions about running, our Doctors of Physical Therapy are ready to help! Click here to schedule your 60 minute evaluation or email info@fitclubny.com!

We Run New York!

As the weather warms up, more New Yorkers are leaving the gym and hitting the pavement.  Whether you are an expert, recreational, or new runner, there are a few things you should know before you start to rack up the miles.  

You may be familiar with the phrase “be fit to run, don’t run to get fit.” This phrase should resound in runners of all levels, but especially in those just getting started. When done correctly (and safely), running has exponential cardiovascular and physical benefits; and surely will help you look beach ready.  However, faulty mechanics derived from muscle imbalances, poor flexibility, insufficient strength, etc. could result in more detriments than benefits.

Unfortunately, most people are unaware of faulty mechanics until they are faced with an injury.  At that time, they are forced to either decrease or stop their running program until their injury is resolved.  This occurs so frequently that 79% of runners are injured annually.  Common injuries from poor mechanics include Patellofemoral Pain Syndrome, Iliotibial Band (IT band) Syndrome, Plantar fasciitis, Achilles Tendonitis, and more.  Rather than wait until something breaks to fix it, why not prevent anything from breaking in the first place?  

A simple running analysis performed by a qualified Physical Therapist could reveal any potential risks for injury you may have.  You may wonder:  Well, I run outside so if someone watches me run on a treadmill, how accurate will it be?  Research shows minimal differences in running gait between treadmill and outdoor running; therefore, a treadmill provides an easy and valid gait analysis.  With the help of modern technology, running analyses enable practitioners to identify areas for improvement to enable runners to achieve their peak performance while minimizing risk of injury.

Dr. Rena Eleázar analyzes Dr. Britt Gunsser's running pattern to help her train for the Brooklyn Half Marathon.

Dr. Rena Eleázar analyzes Dr. Britt Gunsser's running pattern to help her train for the Brooklyn Half Marathon.

If you want to take your running to the next (or first!) level, click here to schedule your one-on-one gait analysis and evaluation.

Stay tuned for our next series of blog posts addressing injury prevention, common injuries, running form, footwear, and more!

Core and Glute Activation - Accessory Exercises for Lower Body

We see a lot of athletes who are considered "quad-dominant" - that is, they have HUGE thighs that do a ton of work, but if you isolate the strength of their posterior chain (specifically glutes!), you'll often find that they have a lot of trouble using them!

"But I squat all the time!" we hear them say. All it takes is a weak core to cause your weight to shift a certain way (usually forward), then all the work of squatting goes to the quads instead. Over time, this movement pattern may lead to overuse injuries of the lower back, hip, or knee. The following are great core and hip activation exercises to wake these muscles up before squatting, running, jumping...basically any lower body activity!

1. Posterior Pelvic Tilt Progression

These exercises target your Transversus Abdominis (TA), your deep core muscle, that helps stabilize your lower back. Many times, we see athletes lock out their lower backs in hyperextension, which compresses your spine and may cause pressure on the nerves that supply your legs. In hyperextension, this muscle cannot work efficiently, so you end up using other muscles to compensate for your lack of stability. Over time, your muscles may give out, causing muscular strains or unwanted damage to the ligaments and discs in your back.

The progression moves from pelvic tilting on your back to pelvic tilting with your legs moving. It challenges your stability by making it harder to maintain a flat lower back as you are forced to support the weight of your legs.

2. Glute Bridge Progression

These exercises target - you guessed it - your glutes! They build on the pelvic tilt to make sure that you continue to engage that TA muscle as you use your glutes. Note that Rena in the video doesn't push her hips all the way up - she is avoiding hyperextension of her lower back, and keeping the work of the exercises in the glutes and core. The progression moves from a double-leg bridge, to a single-leg bridge, to a bridge hold with alternating leg lifts. The last exercise further challenges TA activation in a new position - the goal is to not let the hips drop or let your body fall over to one side. You are trying to remain centered with minimal weight shifting.

3. Lateral Band Walks

This exercise targets your hip abductors, which are also part of the gluteal group of muscles. Your hip abductors are responsible for maintaining your knee alignment in relationship to your hip. If your knees collapse inwards when you squat, deadlift, or land from a jump, you could use these exercises. That "knock-knees" position puts you at a high risk for knee injuries (think: ACL tear - yikes!). Again, you want to build on what the other exercises did - keep your TA engaged throughout, and maintain your alignment with minimal weight shifting. As the band moves farther away from the center of your body, the harder it becomes to maintain alignment. If having the band around the arches of your feet is too easy, you can always use a heavier resistance!

If your lower body pain persists after incorporating these exercises into your warm-up routine, you will highly benefit from a formal evaluation by one of our Doctors of Physical Therapy. Click here to schedule your appointment today!

Getting Overhead - Accessory Exercises for The Upper Body

We are going to take a look at a few upper extremity (UE) accessory exercises that should be used by all CrossFit athletes, and overhead athletes in general. I can’t tell you how many athletes we have treated who are super strong in certain planes of motion (dysfunctional positions) and super weak in others. We see this A LOT with posterior chain muscles of the UE, or muscles located on your back. How many times have you worked on scapula stabilizer endurance during a WOD? How much activation are you getting from your low trap during HSPU? If you haven't been thinking this way or working on these muscles, you need to.

Many times we find that athletes who have shoulder pain with overhead lifts often have a muscle imbalance. The muscles in the front of the body are strong and tight and the muscles in the back are long and weak. Complete recipe for disaster! What we need is balance and symmetry between these opposing muscle groups. Here are two exercises we make sure are part of our CrossFit athletes programs to help improve this balance and reduce pain.

The first accessory exercise is the bent-over row. This exercise involves horizontal pulling which is a key for Crossfit. Many boxes don’t adequately focus on strength in this plane. We are looking to perform this exercise with your middle and lower traps engaged.

  1. Start with the bar on the ground with your hips hinged, back flat.
  2. Pull your shoulder blades down and back, away from your ears.
  3. Pull bar from the floor while keeping shoulder blades down and back. Do not arch your back.
  4. Perform 2 sets of 8-10 reps at a light/medium weight.

Another exercise that should be part of every routine is the prone Y. This exercise also targets those lower and middle trap muscles that are so important in reducing shoulder impingement and labral tears. This exercise is great because it also effectively gets you in an overhead position with much lower load on your rotator cuff muscles.

  1. Start with your arms in a Y position, like you're doing the YMCA dance.
  2. Squeeze your shoulder blades down and back, away from your ears.
  3. Raise your arms off the floor (it could be 1-2 inches!) while keeping your shoulder blades down and back. Do not arch your back.
  4. Perform 2 sets of 8-10 reps.

Those of you who have pain with these motions or have tried these and still have pain need a full evaluation by one of our Doctors of Physical Therapy. Pain limits your movement/motion and limiting movement/motion directly affects your lifts. Get back to PR’s and pain free lifting with Fit Club.  Don’t wait for the pain to get better on its own, It Won't! Call us at 646-875-8348 or email info@fitclubny.com to schedule your evaluation today.

Accessory Work - Everyone Needs It, But Nobody Wants To Do It

Here at FitClub, we see a lot of people who are doing their best to work out and get healthy. They run, do CrossFit, take classes, or try to do their own thing at the gym. They come in with a variety of injuries, but there is a common denominator with all of them - they are mostly, if not all, overuse injuries.

What does this mean?

Let’s take CrossFit, for example. CrossFit trains a lot of complex movements - squats, presses, everyone’s favorite burpees, and everything in between. These movements require a fair amount of strength and coordination between muscle groups. Many times, bigger or more dominant muscle groups will take over all the action, and the smaller or weaker muscle groups will be left hanging out to dry. This creates a big imbalance between the larger and smaller muscle groups. This phenomenon isn’t limited to CrossFit, though. It can happen with any repetitive motion, like running, jumping or swimming.

If you only use the more dominant muscle groups during these movements (at high repetition, high weight, or both), at some point, they are going to call “it quits.” When this happens, you will end up with a strain, such as in your back when you pull a heavy deadlift (or a lot of light deadlifts) with bad form, or at the worst, a tear (such as in the muscles of your shoulder after doing high repetition pull-ups with poor shoulder stability).

The thing is, your body will start giving you warning signs (PAIN) very early on that something needs to change. This could be a painful clicking in your shoulder, sharp pain in your knees after a squat day, or soreness in your back that lasts a few days (read: do not take back pain as “normal!”). Most people try to “work through it” instead of addressing the issue, which often leads to a more serious injury that usually requires more recovery time.

This totally sounds like me - what can I do?

Two words: ACCESSORY WORK. Everyone needs it, but nobody wants to do it. Accessory work wakes up those weaker muscle groups so that they can contribute to the movements your body is trying to perform and balance out the work. In this blog series we will be going over a few of our favorite accessory exercises for different regions of the body to help you reduce your imbalance and avoid overuse injuries! In the long run, this doesn’t apply to just CrossFitters; it applies to anyone who is trying to get healthy through movement and exercise!


If you think you may have an overuse injury and want a more guided and individualized approach to recovery, our Doctors of Physical Therapy are here to help! Click here to schedule your first appointment or call 646-875-8FIT.

Going Down in the DM

Every day I ride the R train into Manhattan, and I cringe as I watch everyone’s posture with their cell phones. The amount of patients we treat with neck pain has increased steadily over the last few years, and I believe cell phones have played a huge part in this problem. I use a cell phone daily as well, however, you have to be careful about HOW you use your device.

There is an old syndrome that has gotten a new name because of the use of these high tech devices. What was once called “forward head posture” is now being coined “tech neck!” Tech neck is an overuse injury that occurs as a result of looking down at your phone or laptop for extended periods of time. It is categorized as a posture/position in which your ear drum sits forward, in front of your shoulders. Many times this posture is associated with lower neck and upper back pain, rounded shoulders, and reduced neck and arm range of motion.

The muscles and joints in your neck are designed to hold the weight of your head -  about 11lbs. As your head moves forward the weight of the head in effect changes due to gravity (think of holding a gallon of milk close to your body versus holding it with a straight arm out in front of you). This increase in weight of the head causes strain on the muscles designed to hold the head up. After a while, these muscles and tissues fail because too much is being asked of them over too long of a period of time. At this point pain and dysfunction set in and you come in to see us (Your AMAZING Physical Therapist!).

Prevent Tech neck from occurring by making a few simple changes in your day

  1. Try setting time limits. For every 15 mins on your device take a 3 min break to look up and adjust your posture.

  2. Try using a tablet or phone holder to reduce the amount of forward bending that takes place in your neck. Try to sit or stand all the way upright, and in this position keep the device as close to eye level as possible.

If you still are experiencing pain into the neck when using your device your muscles may have already quit on you. Call us today to help you correct your posture and wake up those sleeping neck muscles!

I can't sleep!

An age-old question - what is the best position for sleeping?

According to the National Sleep Foundation, the best sleeping position is on your back because it allows your spine to rest in a neutral position. However, there are often barriers that limit people from comfortably maintaining a neutral posture while on their back. Some are external, such as a non-supportive pillow or mattress, and some are internal, such as tight muscles or joints that affect a person’s resting posture. Because of this, people may feel more comfortable sleeping on their side or stomach. Of all sleeping positions, the National Sleep Foundation names stomach-sleeping as the worst, since it places the most stress on the lower back and neck.

Whatever your favorite sleeping position is (mine is on my side), here are some things to consider and/or try:

  1. Keep your spine as aligned as possible. That pillow-top mattress seemed like a good idea at the time, but if you’re sinking so far into it that you’re lying like a banana for 8 hours a night, it might not be the right mattress for you. Choose a mattress that will support you in a neutral position with your body straight. Same goes for pillows - the thick “neck contoured” memory foam pillow may not be the best for you, depending on how you like to sleep.
  2. Sleep with a pillow between your knees (if you sleep on your side) or under your knees (if you sleep on your back). If you lie flat on your back, you will probably find that your lower back arches to the point where you can fit your hands/arms underneath. This arch places a lot of stress on the joints and muscles in your back, so you want to make it slightly flatter. An easy way to do this is by supporting your knees. Additionally, especially in women, your hips tend to be wider than your waist, and sometimes even wider than your shoulders! If you sleep on your side with your knees together, that places a lot of strain on the hip, especially the one that faces the ceiling. Sleeping with a pillow between your knees can help keep the hips in a better alignment throughout the night.

  3. Try to keep your arms below shoulder level. You probably tend to toss and turn and end up in all kinds of positions throughout the night, but keeping the arms below shoulder level can decrease compression on your brachial plexus, a nerve bundle that travels near your armpit and is responsible for the sensation and control of your muscles in your arms. If you experience numbness or tingling in your fingers that wake you up at night, try adjusting your position to one where your arms stay near your sides.

If any of these methods work to decrease your pain while you sleep, it suggests that you may have some of those internal limitations that affect your resting posture. An evaluation by a physical therapist will help to determine those specific limitations and define ways to correct them!

Our Doctors of Physical Therapy are ready to help you sleep pain-free - schedule your initial evaluation now by clicking here.