training – moirahoran

May 7, 2015May 7, 2015

A Few Of My (LEAST) Favorite Things

A guest post from my friend and fellow Jersey Girls StayStrong Multisport Club member and a physical therapist, Laura Fucci.

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The Jersey Girls Facebook page is often studded with posts regarding injury issues and discussions. The year since I joined you impressive, inspiring women I haves culled a few of the most frequently debated topics. I have been a PT for 23 years, specializing in orthopedics and sports medicine as well as a full body certified Master Active Release Technique practitioner. I worked the Lake Placid Ironman the last 4 years where I treated countless Iron folk and met many of you Jersey Girls! A mediocre runner and triathlete since 2003, I also competed in regional and national level powerlifting back in the 80s and 90s.

Moira asked if I would address some common injuries and hopefully dispel some misconceptions.

Let’s start with my least favorite thing: ITB Syndrome

ANATOMY:

The Iliotibial Band is a tough fibrous piece of connective tissue. It originates along the iliac crest (the boney lip of the side of your hip) It splits into a superficial and deep layer. The ITB encloses the Tensor fascia Latae and connects with tendons of the the gluteus maximus.

It then inserts laterally on the knee on the femoral epicondyle and crossing the knee joint onto the tibia.

FUNCTION:

Supplies lateral stability to the knee.

WHY DOES IT HURT?

The ITB gets the blame for causing pain in runners and cyclists as well as other athletes. The ITB is wrongfully accused. It merely does the bidding of the muscles with which it attaches. Dysfunction in your gluteus, TFL hip flexors or even your foot can cause the ITB to be pulled such that it compresses on the richly innervated and vascularized fat underneath the strands anchoring it to the end of the femur. There is even debate in the research community that no “bursitis” exists in ITB syndrome as evidence shows lack of bursa in cadavers studys

This leads us to my LEAST FAVORITE THING about ITB Syndrome.

I have patients and athletes who are forever rolling ,grinding and in general punishing their ITB. The ITB is not composed of contractile tissue, therefore IT CANNOT BE STRETCHED. Stop rolling your ITBs. It wont help. If you happen to get your TFL, gluteues maximus and vastus lateralis/ITB junction in there -then you’re achieving a stretch which trickles down to some relief.

HOW DID THIS HAPPEN AND HOW CAN I GET RID OF IT?

In PT we have a saying about the cause of pain: “It is where it ain’t”. A good evaluation will uncover where the muscle dysfunction might be. PTs and Chiros can go on for hours discussing all the possible causes of ITB syndrome. In the interest of time and space here are just a few:

Lateral muscle tightness of the TFL, gluteus medius or even the quadratus lumborum (along your side attaching to the top of the hip) can cause a pulling on the ITB which in turns pulls lower down the chain to the insertion on the knee. Think of a rope caught in between a tug of war. The losing side here is at the knee.

Hip lateral rotator weakness: Gluteus Maximus as well as some shorter hip rotators. PTs are big on getting patients to activate and strengthen their glutes to normalize functional movement and decrease pain.

Hip flexor tightness: In particular is a muscle called the rectus femoris that crosses the hip and inserts on the knee and can contribute to a painful dysfunction

Pes planus or flat foot: Be careful here as not to mistake a stable flat foot with one that really pronates. This over pronation and pull the tibia into internal rotation and cause pressure on the lateral knee. A good assessment can judge if there is a need for a new running shoes or orthotic

February 26, 2015February 27, 2015

Just How Should We Feel When We Run?

I’m not going to mention any names, but here is a message I got from one of my Club members, a friend, and also an athlete I coach one-on-one:

” I feel really slow and . . . . I just always hurt whether I’m running a lot or not. I get through it, but not sure why I feel like that.”

I’ve been thinking a lot about what she said, and about how she feels.

I can relate to the “feeling slow” part — I ran yesterday on the beach, around 11AM. It was sunny, hot and humid. It was close to low tide, so there was lots of shells along the shore line and lots of people collecting them. I also know, because I do like to go shelling myself, that lots of those shells still house living sea life. So I try not to run on the shells. The crunching sound bothers me and I feel like I’m killing something important. So, I spent a lot of time dodging people and dodging shells — all of which meant I spent a lot of time running in soft sand and running on a sloped surface. Of course, this is all just a bunch of excuses to answer for the Garmin data that I kept seeing — I was running around 11 minute pace. And I thought about my athlete’s comments about her running. “I feel so slow, things hurt.”

I do need to say that mid-way through my run I spotted a pile of shells that I just couldn’t pass by. (And I’m grateful for the awesome pockets in my Coeur Sports little black tri top so I could carry my treasures with me!)

Here’s what I was wondering, just how are we supposed to feel when we are running? I know I was tired yesterday, I ran 15 on Sunday, and biked 68 on Tuesday. My legs were obviously tired, and I’d guess (as a coach) that I wasn’t fully recovered. I also couldn’t get my heart rate or pace up so I know what that means. And yes, I keep making more excuses!

I still feel good about yesterday’s run. I ran and I walked 7 miles yesterday, and averaged for the run portion around 11 minutes per mile. I enjoyed the sites — the Gulf of Mexico, the wildlife preserves, the people out making the best of the day. I ran 8:30 pace comfortably the day before, and a half marathon at just under 9 minute pace last weekend. And yesterday my run averaged 11 minute pace. So, just how are we supposed to feel running anyway? Running is hard. Sometimes we feel great, and sometimes we don’t.

I have an idea. For me, for my athlete, for all of us. Let’s just take the pressure off ourselves. Maybe sometimes we just need to take the watch off, the heart rate monitor off, and run because we can. Forget about the pace. Forget about the distance. Just run, and enjoy it because we can. What’s the alternative? Those options make me really sad.

October 22, 2014October 22, 2014

Just What Do All Those Letters and Certifications Mean, Anyway?

I’ve spent a lot of time, money and energy to earn the certifications that I have (USAT Level One Certified Triathlon Coach, Total Immersion Level Two Certified Coach). While certifications do not make you an “expert”, education and experience certainly do. I see lots of people promoting themselves as certified experts in various and sundry fields that are hot topics these days, not the least of which is nutrition.

Since I can only speak to nutrition from the standpoint of what has worked for me, I thought it best for me to ask an expert. I’d like to thank one of my athletes, Club members and friends for agreeing to be a guest blogger, and I’d like to introduce you to Aimee Crant-Oksa, MS, RDN and the Clinical Nutrition Manager at Centrastate Medical Center.

In an effort to help us all get the best advice and guidance we can, I thought I’d ask Aimee to explain just what “nutrition” is all about.

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“Would you go to an non-credentialed doctor or nurse for medical advice or care? Why would you do that for nutrition . . . isn’t what you put into your body important? Think about that the next time you see the word nutritionist . . . where were they trained or what is their background/knowledge base?

There are three distinct nutrition credentials that require scientific training, an internship and college degrees, either bachelor’s (BS) or master’s (MS).

1. Individuals with the RD or RDN (Registered Dietitian or Registered Dietitian Nutritionist) credential have fulfilled specific requirements, including having earned at least a bachelor’s degree (BS), (about half of RDs hold advanced degrees – MS or PhD), completed a supervised practice program of 900-1200 hours and passed a registration examination — in addition to maintaining continuing education requirements for recertification.

2. The CNS (certified nutrition specialist) credential involves passing an exam, completing a 1,000 hour internship and obtaining an advanced nutrition degree – MS or higher.

3. The CCN (certified clinical nutritionist) must obtain a 4 year degree, complete a 900 hour internship, have 50 hours post-graduate study in clinical nutrition, and pass an exam.

There are many less intensive paths ranging from the CNC (certified nutrition consultant) which requires completing only one course and the certified nutritionist (CN) credential which requires a six week course program.

RD/RDN’s learn to translate the science of nutrition into practical tips for your every day healthy living. Registered dietitians draw on their experience to develop a personalized nutrition plan for individuals of all ages. They are able to separate facts from fads and translate nutritional science into information you can use. A registered dietitian can put you on the path to a healthy weight, eating healthfully and reduce your risk of chronic disease.

Some RDNs may call themselves “nutritionists,” but not all nutritionists are registered dietitian nutritionists. The “RDN” credential is a legally protected title that can only be used by practitioners who are authorized by the Commission on Dietetic Registration of the Academy of Nutrition and Dietetics. The definition and requirements for the term “nutritionist” vary. Some states have licensure laws that define the range of practice for someone using the designation “nutritionist,” but in other states, virtually anyone can call him- or herself a “nutritionist” regardless of education or training.

So remember the next time you see the term “nutritionist”, don’t forget to ask just what their credentials are.”