Migraines and other types of headache -- such as tension headache and sinus headache -- are painful and can rob you of quality of life. Migraine symptoms include a pounding headache, nausea, vomiting, and light sensitivity.
Research has shown that most migraines originate in the spine, often because of misalignment of the vertebra which can then irritate the nerves that travel the length of the spine to the brain. This misalignment makes individual more prone to chemical imbalances in the brain. Some studies have shown that manipulating the vertebrae—a chiropractor’s specialty—relieves the pressure against inflamed nerves and can in turn relieve the headaches, this is certainly true for the hundreds of migraine sufferers who swear by their chiropractor’s treatment of their own personal migraines. Chiropractic treatment also deals with many of the causative factors in regards to migraines such as relieving the restriction in movement in the neck, muscle tension in the neck, as well as muscle tension in the upper back and shoulders which when it is not corrected can lead to posture problems that may influence migraine occurrences and severity. If correctly used as a form of preventative migraine treatment, periodic chiropractor adjustments (or spinal manipulations) can keep the spine and cervical bones aligned more properly in order to help avoid the onset of migraines in the first place. Studies have even shown that individuals who receive normal and periodic adjustments can actually begin to feel when their spine and cervical bones begin to get out of line and can know when a simple visit to the chiropractor’s office is needed so that they can schedule for and adjustment and can ward off the onset of migraine pain and they symptoms that are associated with an attack.
If you are suffering from a migraine, come see Dr. Tom Fletcher in Murray, Utah, who
Which is more important to focus on? It all depends on your unique body and goals.
As an athlete, is it better to have mobile joints or flexible muscles? Well, it depends. Ultimately, like any training or recovery method, all athletes have specific goals and their bodies are unique. Hence the one-size-fits-all approach does not apply. Without getting into the heated and never-ending stretching debate, let's first discuss the difference between joint mobility and muscle flexibility, and who can benefit from each.
Ever wonder why someone can't fully straighten or bend their elbow after being in a cast for four weeks? Most people think that the muscles are shortened and tight, but it's actually the joint itself becoming stiff and restricted due to a hypomobile joint capsule.
Joint mobility refers to a joint's ability to move freely through a given motion. A joint can be stiff and thus hypomobile or it may be loose and thus hypermobile. The amount of mobility in a joint is primarily determined by the pliability and length of the ligaments and joint capsule. The length and ability of the ligaments and joint capsule to control the joint is determined by genetics, posture, activity, and injury history. The quality of movement in a joint will determine how well a muscle can lengthen or activate. A joint can be stretched beyond its "natural" limits unintentionally via a sprain or intentionally to achieve greater motion (i.e. when swimmers stretch shoulders and ankles beyond natural motion). What is normal or natural joint mobility for a given joint is debatable, although it is generally accepted that a stiff or hypomobile joint should be mobilized to allow for improved motion and muscle activation, while a loose or hypermobile joint should be stabilized through strengthening.
Muscle Flexibility refers to the muscle's ability to lengthen over one or two joints. A muscle is connected to a bone via tendons at two different points on the bone. Muscles will contract and relax in response to to signals from our brain and nervous systems. As a muscle reaches its maximum length, tension increases at its attachment points, causing a stretching sensation. While there are ideal muscle lengths for each muscle, they are more theoretical and must be based on an athlete's unique anatomy, injury history, and goals.
Examples of which athletes need what:
More than half of all runners will overdo it at least once in their running career. Overtraining is a result of not properly recovering between workouts on a repeated basis. Some types of workouts and training will make you more susceptible to overtraining, but the underlying cause is always a lack of recovery. While all driven athletes are prone to pushing too hard without properly recovering, researchers have identified a few training situations that make runners more vulnerable to overtraining.
1. Reaching too far in one training cycle.
Perhaps the most common cause of overtraining I encounter as a coach is by athletes who attempt to break their personal bests by too much in one training segment. While it can be especially difficult for a beginner runner or someone who is rapidly improving to assess what their potential might be, it’s important that every runner approach improving on a step-by-step basis. Skipping a step or trying to make the jump from a 3:20 marathon to a 3:05 to qualify for Boston in one fell swoop will often lead to overtraining.
2. Not taking a break between training segments.
Another common cause of overtraining is not giving your body enough rest between training cycles. I work with many runners who want to jump from one training cycle to the next with little or no rest between. Many runners tend to finish a tough training segment where they pushed their bodies to new limits and raced well and immediately jump back into hard training toward the next goal. In doing so, these runners never give their bodies a chance to fully recover and absorb all the training from the last segment. They carry that fatigue with them and drastically increase the chance of overtraining.
3. Too many intense speed workouts.
Finally, performing too many speed workouts or VO2max training sessions in one training cycle has been proven to increase the risk of overtraining symptoms. From a physiological perspective, researchers have hypothesized that the increase in overtraining symptoms by runners who performed 8 weeks or more of speed work is the result of a rise in pH levels (too be effective, speed work should actually bring your pH levels down) and a stagnation in blood lactate levels.
Symptoms Of Overtraining
It can be difficult to accurately determine if you are overtrained without a lab coat and fancy equipment. However, here are some clues you can use to help you determine if you’re recovering properly.
During overtraining, you may have a higher than normal heart rate while resting and while sleeping. Record your heart rate each morning as soon as you wake up and before you get out of bed. Keep a small notebook by your night stand where you can record the data each day. If you find an extended period of time where your heart rate increases in the morning, you could be suffering the effects of overtraining.
Overtraining can lead to a decrease in hormone production, specifically the hormone catecholamine, which can influence the sympathetic nervous system. This can lead to increased feelings of stress and moodiness. If you’re feeling increasingly irritable or stressed, it might be a sign that you’re training too hard.
Susceptibility To Sickness
Overtraining impairs the immune system, which leaves you more susceptible to contracting colds, the flu, and other viruses. If you find yourself getting sick more than usual, especially repeated bouts of the same virus, it could be a sign of overtraining.
Disturbed Sleeping Patterns
Finally, overtraining interferes with the bodies circadian rhythms, which can cause you to have trouble sleeping. Symptoms include waking up much earlier than normal or trouble getting or staying asleep.
Digging Yourself Out
While I’ve spent a good amount of time discussing the causes and symptoms of overtraining, the treatment will be much shorter. You’ve probably even guessed it already–rest. If you’re overtrained, you need to focus on rest and recovery.
Congratulations to all of those who raced Ironman St. George last weekend. There were lots of friends and family at the event and it seems everyone had a good day.
Remember that you aren't going to bounce back the day after the race like nothing happened. Recovery is essential to all athletes. Below is a list of some tips from the pros:
Cliff English: The best “poor man’s” recovery tools? Water, salt and an ice bath.
Meredith Kessler: People tend to concentrate on days off, tapering and sleep. But you need to practice recovery after every workout … so you can be fresh for your next workout. I use a steady diet of protein drinks within the fueling window, as well as cooling wraps and recovery boots after workouts or at night.
Andy Potts: As much as the experts tout sleep, I still think it is underrated. Sleep should be your No. 1 form of recovery.
Ben Hoffman: There are no magic bullets for bouncing back fresh as a daisy, but if you do all the little things, they make a huge difference. I use compression boots with cooling pads, foam rollers, golf balls underfoot, The Stick roller, regular massage, eating a good balance of carbs and protein immediately following workouts and getting plenty of rest each night.
Tim O’Donnell: Recovery is more important than fluff workouts. If it comes down to a 60-minute aerobic ride that is on your training schedule versus getting a massage when your body is beaten up, or getting an extra hour of sleep when you are exhausted, treat yourself!
Terenzo Bozzone: The faster you recover from training, the more key workouts you’ll be able to do along the way. I use compression socks and sleeves after all workouts. When I get home, I elevate my legs and use compression boots.
As far as compression boots go, remember that Dr. Tom has a pair of Normatex
After three years of hosting what many believed to be the most difficult Ironman in North America, St. George is shifting gears for 2013. With fewer and fewer athletes signing up for the endurance event each year, Ironman announced in 2012 it would cut the race distance in half to a 70.3 for 2013 and beyond. The difficult (and somewhat controversial) move looks like it will pay off for Ironman and the Southern Utah community.
“The main reason behind the decision was the fact that registration numbers weren’t as high as they’d hoped,” explains Ironman 70.3 St. George race director Jeff Gardner. “St. George is a great partner and a great community for a race. They thought this would be a way to keep the race here, and it looks like, based on the response, that it appeals more to a broader base. It seems like it’s been well received.”
The combination of the reduction in distance and the race’s designation as the Ironman 70.3 U.S. Pro Championship means that more age-groupers and professionals will be headed to St. George for the race, set for this Saturday, May 4. As the U.S. championship, the race will hand out a prize purse of $75,000 and will give athletes the opportunity to earn a large number of points that will help them qualify for the 70.3 and Ironman World Championships. Only the 70.3 World Championship in Henderson, Nev., offers more points at this distance. Comparing the 2012 pro start list to the one for this weekend’s race gives an idea of the impact of those points and prize money. Only 24 professionals (male and female) started the full-distance race last year, while nearly 80, including several past and current world champions, are expected to make the start in 2013.
The race will also welcome approximately 1,000 more age-groupers than it did in 2012, and a big part of that is the appeal of the shorter distance to the surrounding community.
“There are a lot more local athletes that have signed up because it’s a half,” Gardner tells us. “More people that live here that have been training and that adds to the overall excitement of the race.”
The reduction in distance has brought increased attention and excitement, but Gardner emphasizes that this will one of the hardest 70.3s in the world. The swim and run courses (with the exception of the run course in 2012, which had to be changed due to construction) will be very similar to the Ironman course and have simply been reduced for the distance. The point-to-point bike course will see a dramatic change with 25 miles of uncharted territory for this event making up part of the 56-mile bike.
That bike course features 2,552 feet of elevation gain, while the half-marathon will send runners up 709 feet. The hills (many of which are fairly steep) aren’t the only factors that make this course difficult, though. Weather conditions in Southern Utah during this time of year can shift dramatically from day to day, and that lack of predictability has been evident over the past three years of the Ironman.
“I would say it’s going to be really nice weather this year,” Gardner says. “Every year we’ve had something different. The first year we had a cold front come through that week so we had cold water. The second year it was 95 degrees and it was really hot. Last year we had 30-40 mph winds. Because it’s in the spring you have that chance of weather changing and being unpredictable.”
Right now the weather forecast calls for a high of 85 degrees and winds at 10 miles per hour. But again, that can change quickly. The water temperature is also drastically improving each day. Just one week ago it sat at 50 degrees and it’s already climbed to 62 degrees.
Regardless of conditions, St. George’s enthusiastic community will no doubt be out in full force on Saturday. Age-groupers and professionals have raved about the local support after each Ironman—last year’s champion Meredith Kessler event went as far as to call it "a magical place." As a local to the area, Gardner says he is biased but believes there is nowhere else like it.
“I’ve worked at other Ironman races and I’ve raced,” he says. “I’m from St. George so I’m partial, but I think there isn’t a community that receives it better than St. George does. They come out and support us. This year we’ll have over 2,500 volunteers. They appreciate what it does for the community, the opportunity that it is for those that are here, the lifestyle and the economic impact.”
Remember to visit Dr. Tom Fletcher at the Ironman Expo at the ART tent in St George this coming weekend.
For all those racing Ironman St. George 70.3 this coming weekend, you may all be wondering the same thing.... How hard should I push myself in a race?
Q: How do I know how hard to push during a race? I want to give everything I have but still make it to the finish line in one piece.
A: That is the million-dollar question and a tough one to answer. It takes athletes years of racing to find the balance between leaving it all out on the course and going so hard that they blow up before the finish. The short answer is experience. Consider that a pro might race 10 to 20 times per year for 10 years; that’s a lot of chances to get it right or wrong. And everyone gets it wrong at one point. If you race long enough, you will have a day that gets ugly and ends with a long walk home, or worse, a trip to the med tent. Those races definitely make for tough days, but they can be valuable learning experiences. So how to learn where the edge is without wasting a key race? Try it out in training or at a low-key, shorter race. Go out a little harder than you think is wise and try to pinpoint your personal limits.
A test set in training can act as an indicator of fitness and give some good guidelines for where your effort should be in a race. Go to the track and run 10x1K at goal pace for Olympic-distance race training or head out for a timed 20-miler to see if that marathon pace is possible. (The goal is to reach failure, so if you don’t make it through the set it just means you did it right.) Now you have an indicator of what is realistic. On the bike, wattage can be a very helpful tool. I train with an SRM to give me constant feedback of what kind of power I can sustain over different distances. Get used to the feel of each effort during training and you can be a good judge of pace and power in races.
On race day you should be rested and fueled properly, so ideally you should be able to sustain a slightly higher maximal effort than in training. This is where a time trial or a low-key road race in your training can be helpful. Compete in a local 10K or 40K bike TT and be prepared to go a little harder than you think is wise. Push yourself to sustain the pace as long as possible and note where the wheels come off. These barrier-breaking workouts will help you discover where your absolute limit is—it is probably higher than you might have thought. They can also help you identify what type of athlete you are: speed- or endurance-oriented. Typically, men seem to have higher power and speed and need to work on endurance; they may find they go out too hard early on and have to slow down considerably. Women tend to be more naturally suited to endurance events and maintain a more even pace, but they often find they reach the finish line with energy to spare. By using these smaller races and test sets we can figure out our strengths and what we need to work on, whether it is starting off more moderately and saving some juice for the second half, or getting on it right away and pushing hard throughout the whole event. I fall into the second category: I need to go as hard as I can straight from the gun otherwise I naturally settle into a pace that is too slow. In my best races I have hit a point where I think the effort is way too hard and I won’t be able to sustain it. Then I just keep hanging on (and it hurts like hell) but surprise myself at the end with a new PR.
The goal in a race should be to measure your energy throughout so you cross the finish line using the absolute last drop of gas in the tank. This takes time, experience and practice. And just remember: No true athletic career is complete without one epic blowup story to tell around the campfire.
Wishing all of our patients good luck racing St. George this weekend, from Dr. Tom Fletcher's office in Murray, Utah.
Don’t let training take its toll on your body—four things to do after every workout so you’re ready to take on your next tough effort. Rub It
As if you needed another excuse to get a massage, here’s one more: Experts say that rubbing down muscles after exercise is as effective in preventing soreness than aspirin or other pain medicine. In a recent report in the journal Science Translational Medicine, researchers from the Buck Institute for Research on Aging in Novato, Calif., write that massage slows production of chemicals in the body linked to swelling, soreness and inflammation. Not only that, a good rub down increases blood flow and promotes the formation of mitochondria, which our body needs to create energy. So go ahead, book some time on the table after your next hard effort (or just grab your foam roller and self-massage). Your muscles will thank you.
New marketing has launched coconut water into to the mainstream, but it’s actually been around for ages as a way to rehydrate rapidly. “In World War II, they used coconut water instead when they ran out of IV fluids,” says Alan Kipping-Ruane, a USAT coach and official. Reaching for this thirst-quencher post-workout can restore electrolytes, potassium, and sodium lost through sweating. Zico Coconut water—which packs more potassium than a banana in every bottle; 15 times more than the average sports drink—has recently started sponsoring triathletes including Greg Bennett, and Laurel and Rebeccah Wassner. Not crazy about coconuts? Chocolate milk is another idea recovery drink.
Dipping yourself into a tub full of frigid water may be the last thing you want to do after a chilly run or ride, but an ice bath is a proven method of preventing injury. In fact, one new study says cold therapy can reduce soreness by up to 20 percent when compared with passive post-exercise rest. Just can’t do the dip? Have hope: The cryosauna may be coming soon to a spa or PT office near you. Currently used by elite athletes like distance runner Dathan Ritzenhein, this is a chamber that works to reduce the skin’s surface temperature to 30°F in just seconds, which then sends a message to the brain to increase blood and oxygen flow to your core. When you step back into normal temperatures, blood vessels expand, resulting in an instant energy boost, skin rejuvenation and quick muscle recovery—without the pain of an ice bath.
Active recovery is as important as your hard workouts. So even if you wake up completely spent from that interval session the day before, peel yourself off the couch and hit the gym. “I’ll do some very light movement to help speed recovery,” says pro triathlete Ryan Bates. “A five-minute spin on the bike, or a few laps of breast-stroke in the pool just to get the joints moving.” Agrees Kipping-Ruane, “I recommend doing a spinning workout or walking on a treadmill at a high incline (like 15 percent grade at 3-4 mph) for 10 to 20 minutes. It’s tough, but it gets the legs going.”
The single most important head to toe exercise for triathletes is arguably the deadlift. The deadlift is second to none for enhancing performance and becoming a bulletproof triathlete. The deadlift strengthens the posterior chain, requires adequate flexibility and joint mobility, demands proper spinal mechanics, and augments shoulder blade strength and stability. If you are not currently deadlifting, it’s time to make a change. I am confident that by the time you are done reading this piece, you will better understand why the deadlift should be a mainstay in every triathlete’s training program beyond the swim, bike,
The benefits of the deadlift became readily apparent to me after focusing on this exercise in preparation for the 2011 triathlon season. I managed to add 30 watts to my one-hour time trial effort without making any other drastic changes in my program. Keep in mind that I was not using inordinate amounts of weight either. While I always knew the deadlift was an important compound movement, I never fully appreciated that adding this one exercise would have such profound effects. Given the fact that most triathletes are wary of the deadlift for fear of low back injury and/or putting on excessive mass, I’m here to tell you that it could be the missing link in your training and what stands between you and a PR or even the podium.
Before simply going to the gym and hammering out a bunch of deadlifts, there are several key considerations worthy of discussion relating to equipment and technique. Let’s first discuss equipment needs associated with the deadlift. The first piece of equipment you’ll need is a thin-soled pair of shoes with a minimal (<6-8mm) heel to toe differential, if one at all. Some strength and conditioning specialists even suggest going barefoot to enhance proprioception since the sole of the foot is heavily populated with mechanoreceptors. Needless to say, however, extreme caution should be exercised to avoid dropping the bar or weights on your feet. Other options include racing flats, wrestling shoes, and Chuck Taylors. The second piece of equipment is a trap bar (AKA hex bar). This bar is important when first learning the deadlift, as it’s more forgiving relative to a straight bar, used during a conventional deadlift. This is particularly relevant for middle aged and older triathletes, who often lack ankle dorsiflexion (ability to progress the leg over the foot) from years of running. The trap bar is also ideal for those with limited flexibility and longer femurs because it helps to minimize unwanted and potentially injurious compensatory motions such as spinal shearing.
Once the necessary equipment has been secured, the deadlift, like any compound movement, is all about technique. It has been my experience that most triathletes shy away from deadlifting as part of their strength and conditioning program for fear of injury or because they have never received proper instruction on deadlift technique. In an effort to avoid embarrassment in a public gym setting, most triathletes consequently stick to what they know while excluding the deadlift altogether.
Let’s work from the ground up. Once you step into the trap bar or hex bar during the initial setup, you should position your feet roughly shoulder width apart while keeping them straight. Avoid going too wide because otherwise your knees will contact the bar during the lift. By assuming the proper stance width, you’ll be able to adopt the appropriate “knees out” position during the lift, thereby creating greater torque and stability at the hips. Now that you’re in a good position, you’re ready to descend to grasp the bar. During the descent, your hips should flex such that your bottom moves in a backward direction or towards an imaginary wall about a foot behind you. (This is one of the most important cues in coaching the deadlift because it is imperative to realize that the deadlift is not a squat, but rather a pulling exercise.) You should think about your hips moving back and forth rather than up and down. During the early part of the descent, anchor your knees outward as your hips flex and your bottom moves back. Take in a big gasp of air before or during the descent to pressurize the lower abdominal region and increase spinal stability. Once you secures the bar in your hands while maintaining a neutral spine with your elbows locked out, you’re almost ready to draw the weight off the floor. One way to ensure that the elbows are taut, facilitating a “chest up” position, is to think of someone asking you to show them the logo on your shirt. During the ascent, don’t simply think of pulling the weight but also about putting force into the ground. The hips and knees should both extend at the same time. As you approach the top of the range you should think of fully extending your hips while avoiding overarching the low back. One of the most common cues is to think about pinching something between your butt cheeks. Don’t forget to not forget to firmly draw the shoulders into a down and back position to maximize recruitment of the scapular stabilizers.
In terms of frequency, load, sets, and reps, everyone will have different needs based on a slew of factors. Rather than elaborate on this topic, triathletes are encouraged to seek out the help of a certified strength and conditioning specialist, who has experience in working with endurance athletes. It should be mentioned, however, that I am deadlifting throughout the year to varying degrees. I also incorporate “speed deadlifts” into my routine as I approach the competitive season rather than focus on heavier loads.
In closing, triathletes who take the time to understand and master the deadlift will reap great benefits from this compound movement. The deadlift is arguably one of the most important exercises to enhance athletic performance despite being perceived as an inappropriate exercise for endurance athletes. Always strive to emphasize form and technique over resistance to avoid unnecessary injury. I am confident that this exercise in and of itself will allow you to find that extra gear, which you always knew you had but were previously unable to harness. As always, wishing you purposeful and mindful training. See you on the road.
Symptoms - Pain in the back of the heel, the tendon just above it, or possibly up to where the calf muscles form a "V" on the back of the leg. The pain can be mild to debilitating.
What is Happening - The Achilles is a thick, ropelike tendon about four inches long connecting muscles in the lower leg to their insertion points at the heel bone. The most common injury location is the muscle-tendon junction, where the muscles converge into the tendon. The most serious Achilles injury is to the tendon itself. Inflammation of the tendon, called tendinitis, and chronic inflammation with fluid build up, called tendinosis, are the most common of this type.
Prevention - The best way to prevent Achilles Tendinitis in the first place is by building limber lower legs. This involves flexibility and strength. An underlying lack of flexibility, especially in your calf muscles, can be a primary cause of Achilles injuries.
Employ dynamic rest - With Achilles injuries, swimming and biking are good options, if the exercise is pain free. Running is likely to aggravate the injury and slow recovery.
Ice it - Applying ice to the area for 15 minutes four to six times a day can help reduce inflammation and swelling.
Stretch it - If you can stretch without pain, stretch the area and your other muscles in your legs.
Strengthen it - A tendon like the Achilles starts to hurt because of the load put on it. If you want to reduce the loading force, build up the muscles affecting the load, so they can take the brunt of it. Exercises like calf raises, squats, lunges, and so on are good exercises.
Another treatment option is Active Release Technique or ART by Dr. Tom Fletcher in Murray, Utah. ART can get you back on your training schedule fast
Shin splints are among the most frustrating injuries because they make a basic act, running, impossible. The term "shin splint" denotes more than one lower-leg ailment, but let's focus on the more common bone-related shin pain.
Symptoms - Pain in the bony part of the shin, along the tibia, during and after exercise. It can also be a tightening pain in the soft, outside, muscular part of the shin, usually bad enough that running becomes impossible, and then subsides when you stop running.
What is Happening - Bone-related shin pain, can range from a stress injury, irritation of the bone, to a stress fracture, which is an actual crack in the bone. It is generally the result of body mechanics, amount of activity, activity intensity, and bone density.
Treatment - See a doctor for proper diagnosis. Stress injuries can become stress fractures, which can sideline you for a long time. Dr. Tom Fletcher at Wasatch Health Solutions can diagnose and treat shin splints. You can also employ dynamic rest. Find another activity that doesn't load your legs, swimming and cycling are good choices.
Try switching to a shoe that limits pronation, gives arch support, and/or gives some cushion from the impact.
If bone density is a problem, try upping your calcium and vitamin D intake, about 1300 milligrams of calcium and 400 micrograms of D per day.
When increasing running mileage, follow the 10 percent rule. Never up your weekly running mileage by more than 10 percent of what you have been running.
Strengthening your hips and core will improve stability while running. This will help you improve body mechanics and foot strike. You could also attend a run clinic to help improve running form and body mechanics.
Remember that Dr. Tom is an ART specialist in Murray, Utah. Athletes are a
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