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Endurance Athlete Consulting covers a broad range of topics regarding human performance in sport, sport related injuries, and rehabilitation. If there is something specific you would like to inquire about, please feel free to email me at:

I am available for speaking engagements and in services regarding aspects about injury, injury prevention, training for specific competitive events, injury treatment protocols, and workplace ergonomic assessments for a healthier work environment.

Saturday, March 30, 2013

Running After A Lumbar Spine Fusion Part II

Just to summarize some of what was stated in the previous post regarding running after a spinal fusion:

  • Pay attention to your level of pain, 
  • Symptoms that were present prior to your fusion (you don't want to be experiencing these same symptoms), 
  • The maturity of your fusion, and how your body responds after you've gone out for a run.  Don't start running too soon!  What I mean by this last statement is, 
  • Pay attention to symptoms that are consistent with inflammation.  If there is too much inflammation, you'll experience a sharp spike in pain, swelling, and prolonged soreness.  Because of the excess swelling following a run or series of runs, this can cause pre-existing leg and back pain.  This is what you absolutely do not want!  So, to counter this, reduce the time or distance of your running, switch from running outside to running on a treadmill where the surface is more forgiving.
This last statement is an excellent segue into what is the most important:
  • Pay attention to the way you are running!  
When returning to running after a spine fusion the mechanics of your running are going to have to go through an overhaul.  Here is a list of specific aspects of your running mechanics that you will have to change, modify, or pay close attention to:

  1. Shorten your stride and slightly increase your leg turnover
  2. Minimize as much as possible the amount of up and down motion that is present in your running stride
  3. Maintain a "neutral spine" position during running.  You must not let your back extend in a aggressive or ballistic manner such as often happens when sprinting or performing speed work.  If you are familiar with the term anterior pelvic tilt, then limit the anterior tilt and perform a modest stable posterior pelvic tilt.  This means you'll have to put some time into keeping your abdominal muscles strong.
  4. If you are used to using a firm stable shoe and striking hard through your heel, this will most likely not work for you anymore.  Switch to a more cushioned neutral shoe and retrain yourself so that you have a lighter heel strike and more of a mid foot or "bare foot" style of running mechanics
  5. Finally, do not rush in to running too soon.  Make sure your trunk muscles are strong, your fusion has matured, and that you have performed a good thorough pre-conditioning protocol such as a course of physical therapy prior to resuming running!

Some of the above statements might not make sense to you or be confusing.  So, here are the explanations why you'll want to pay attention to each one.  Not all of these may need to be changed. 

Much of the above and below depends on the overall health of your spine following surgery, the reason for surgery, and the number of levels in your lumbar spine that were fused.  The more levels fused, then the more attention you'll have to pay with regards to using the best mechanics possible to maintain a healthy spine and ensure longevity of your running.  So, here are the explanations why you'll want to pay attention to each of the above mentioned:

1.  Typically, a longer stride means that there is an increased vertical component in your running stride. This equals out to a harder heel strike.  A longer stride also means that your back will be extending more and a stronger pull will be on your hip flexors.  Both of these add stress to your fusion.

2.  Even if your stride length is already shortened, you'll still want to make sure you've taken out as much vertical component out of your running as possible to limit a hard heel strike and often violent impact with especially newbie and heavy runners.

3.  With runners, the muscles along the spine become quite conditioned from just the running that you do.  Typically there is a large imbalance between your muscle along your spine and the abdominal muscles unless purposeful training of the abdominal muscles are being performed. Therefore, if the spine muscles are developed to an extent that this is adding increased pressure on your lower back through resting muscle tension alone, then keeping your abdominal muscles strong would be most logical in order to counteract the strength of the muscles along the spine.  When running, it will be very important to purposefully keep mild to moderate tension in your abdominal muscles to assist with avoiding excessive extension in your lower back and to avoid excessive pull from the hip flexors.  This is where maintaining a "Neutral Spine" or mild to moderate "Posterior Pelvic Tilt" comes in very handy.  The posterior pelvic tilt evens out load or impact absorption through the lumbar spine.

4.  Firm stable shoes were intended to be used for larger runners who have not developed or learned the necessary running mechanics specific to them.  The firm and stable shoe makes up, only in part, for the poor running mechanics, sloppy foot placement on the ground, and for at times violent impact by poor running mechanics.  By shortening your stride, your foot strike changes significantly and your running stride becomes much more cushioned.  There is more forward translation occurring when your foot strikes the ground with a shorter stride.  There is much less impact through the heel because the angle of dorsiflexion or the amount that your foot is pulled up is significantly less with a shorter stride.  This alone softens the heel/foot strike on the ground.  Vertical movement is significantly reduced, and much of the foot pronation that is meant to be controlled by a firm and stable shoe is not nearly as pronounced with a shorter stride.  In addition, through a shorter stride, there is less time between heel/foot strike and toe off.  There is more energy for forward translation with less effort!  Your running becomes more efficient, more muscles are used, and there is less incident of injury due to better running mechanics.  That being said, and with improved running mechanics, it just makes sense to move in to a lighter and more cushioned shoe to allow your foot to do what it is meant do and to enjoy your runs in.

5.  Finally, be patient.  It doesn't matter who you are, you still need time to heal!  For a spine fusion to be considered safe enough to resume short and easy runs, it will take a minimum of six months.  During this six month period, aerobically condition yourself on a stationary bike or swimming in a pool.  The aerobic conditioning will also help significantly with persistent pain symptoms.  Perform strengthening exercises for your legs and trunk while maintaining a neutral spine position.  When you do get back to running, I believe you'll be surprised at how well you'll do just from the cross training during this six month time frame. 

If you have any questions, concerns, or comments feel free to email me!

Happy Bipeding!

Brad Senska, PT, DPT, BS, ASTYM.

Saturday, March 9, 2013

Getting Back To Running Following A Spine Fusion

Since I left this blog more or less wide open for discussing nearly any aspect of sports injury and non-related sports injury but are trying to get back your prior level of physical fitness and or activity, I’ve a topic I believe that may be relevant to many of you and is absolutely relevant to myself.

I’ve never mentioned in any of my posts the injuries that I have sustained through sport and injuries that were not related to sports.  With regards to dynamic activities such as running, jumping, team sports etc. following a spinal fusion, you will hear a very broad spectrum of opinions whether it is a smart or good idea to resume your usual fitness activities following a fusion.  There is a lot to be taken in to consideration after a fusion.  The following are several aspects to consider and then I’ll talk about how to make an informed decision as to whether or not it’s a good idea with regards to you:

·      Consider the trauma of which was sustained that led you to having a fusion.  Was the need of your fusion due to hereditary traits and age, were you involved in a severe traumatic accident, OR, was the fusion a product of repetitive use or an overuse injury?

·      How many levels were fused and in which part of your spine?  For example, did you have a fusion in your lumbar spine, thoracic spine (which is not very common), or in your cervical spine?

·      Was or is there any permanent nerve damage resulting in muscle wasting or atrophy?

·      Are your pain symptoms currently managed or do you still have acute pain?

·      And, what are your expectations regarding the level of fitness you want to acquire or re-acquire?

Since January 2005, I have had 5 surgeries on my lower back.  My lumbar spine is fused from the 3rd lumbar vertebra to the sacrum.  Three of these surgeries were to perform fusions in order to stabilize my lumbar spine, take pressure off of nerves, restore strength, and to resolve acute pain symptoms.  Two of the surgeries were to remove bothersome hardware and for debridement of scar tissue.  The injuries I sustained in my back were from two specific issues.  The first reason leading to surgery was trauma from cycling accidents and acrobatics, the second and what I believe caused the damage to my spine worse than the damage that should have been done is due to genetics or hereditary issues.  Yes, my family has a history of spine degeneration.  I believe I was spared a much worse outcome from the hereditary issues due to staying fit through my sports and strength training as well as strict adherence to using the best biomechanics possible on the bike and when running as well as with work activities.

So, to answer the question, can you go back to running following a spine fusion?  Absolutely!  I also resumed cycling and in 2008 won 2 Arizona state championships in the Cat. 3 division.  These were in the 40km individual time trial and the hill climb road race. 

Introduction back into cycling and running were done methodically.  Here is where my advice to everyone begins.

First, you need to make sure that your fusion has matured.  Like healing of the plantar fascia, beginning ballistic and dynamic type of activity cannot be rushed!  You also need to make sure that no other parts of your body will suffer injury or insult if you do resume running.  And something that is extremely important, make this decision with your doctor.  But here’s the catch.  Do not let your doctor make the decision for you!  I’m not saying this to undermine your doctor.  I’m saying this because you know your body the best.  You are the best advocator for yourself!  Also, your doctor may not have any kind of sports, biomechanical, kinesiology, or athletic background and not have a clue about the forces caused or not caused through running.  Yes, he may be a surgeon, but this only means he knows how to do surgery and does not know how to help the patient recover from the surgery!  That’s why there are physical therapists!  

Most information about getting back to running following a lumbar spinal fusion says to not go back to running.  Most of the information that this is based on is nothing but myth, old wives tales, and is based on hypothetical information.  I know many weekend warrior types, amateurs, and professional triathletes that have undergone lumbar spine fusion at one and two levels.  Right around 6 - 10 months later, they’re racing at their prior level and are symptom free.

When doctors and healthcare providers think of running, the first thing that comes to mind is IMPACT!! (Notice how I used the “impact font”.  Clever huh?).  If your mechanics of running are proper, then impact is not an issue.  Running is a forward motion and not an up and down motion.  To really see this in action, view a video of sprinters or marathoners.  You’ll notice that there is virtually no up or down motion.  Up and down motion when running indicates an inefficient and harsh running gait!  This is precisely why using a good mid-foot strike is so important (as should be used when running).  The midfoot strike takes away the axial pounding through your lower extremity and hips and in return minimizes the axial pressure through your spine.

There is a very large population of physical therapists and other healthcare providers that will tell you to absolutely refrain from running following a spine fusion.  And, if you are going to cycle, then you’ll have to cycle on an upright bike.  Then there are the physical therapists and doctors that have an athletic and sports background with a much larger knowledge base in the mechanics of sport, the tolerance of forces, and the dispersion of these forces when the said activity is performed with in the proper manner.  These are the therapists that will put you back into your running shoes and back in to an aero position on your time trial bike or road bike without compromise to your body.

So, in summary, you can get back to running following a spine fusion.  You’ll have to be patient, start in a gradual and methodical manner, make sure there are no secondary complications or injuries occurring, and make sure you’re running in the most efficient manner.  I could go on for quite some time giving you a lot more information regarding this topic.  But I’m preparing for a cervical spine fusion on March 26, 2013 (a hereditary issue).  But you can count on me getting back to running at the right time and in the right manner.

Watch for Part Two of this post.  I’ll talk about specific aspects to focus on following a spine fusion and what to do to make the proper adjustments regarding your gait during running.  These adjustments will significantly reduce excess stress on the spine other than what would be caused by impact.  Just to get you thinking, these forces are in the axial (rotational) plane and sagittal (forward/backward) plane and the way the muscles tug on your spine during running.

I’m already tingling from the excitement of it!!

Happy Bipeding!

Brad Senska, PT, DPT, BS, ASTYM.

Wednesday, March 6, 2013

Strengthening the Plantar Fascia...This Post Makes More Sense!

I think I need to clarify a previous post on my blog.  I kind of went haywire when writing Can You Strengthen the Plantar Fascia??  So right from the beginning, no you can not strengthen the plantar fascia!  The plantar fascia no matter how you look at it is made up of connective tissue and not contractile tissue as is the tissue that our muscle are made up of.  In the prior mentioned post, I treat the plantar fascia as if it is a tendon because of it's properties and characteristics and the way it responds to proper treatment.  But as stated in peer reviewed literature and the medical field, it is considered a ligament.  I do believe there will be a closer look though at it's classification.

What you can do however is to strengthen the specific muscles in the foot and leg that will relieve the abnormal tension on the plantar fascia.   The plantar fascia does respond to forces and stress on it.  This is seen in imaging studies.  The plantar fascia will thicken under heavy loads and abnormal tension.  This is one method that is used to diagnose plantar fasciitis.  When the load on the plantar fascia reduces, the thickness of the plantar fascia reduces as well.  Ligaments do not have such a responsive property but tendons do!

Here in lies a problem though.  The plantar fascia can thicken but it doesn't necessarily mean that the pain in your foot is that of plantar fasciitis.  The problem is that a doctor will look at the thickness alone and use this one diagnostic finding and then automatically assume that a person has plantar fasciitis.

So, let's take for example the connective tissue at your wrist of which often causes symptoms of carpal tunnel syndrome.  The connective tissue or retinaculum that makes up one side of the carpal tunnel thickens.  This then puts pressure on the underlying vessels and nerves going in to the hand.  It's this pressure on the underlying tissue that causes the pain.  It is not the thickening of the retinaculum.  This retinaculum is for the most part nocioceptor free.  But if this retinaculum were a tendon, it would be extremely painful at rest or when active.

In my book, I give specific directions with performing what is called "eccentric" strengthening exercises.  This type of strengthening is great for strength gains but also increases the integrity and strength of the involved tendons.  One particular tendon that responds very well to eccentric strengthening is the patella tendon.  Eccentric strengthening is also used for achilles tendonitis or recovering from a ruptured achilles tendon repair.  Therefore, assuming the plantar fascia is a tendon and even after reading this post you still are hung up on "strengthening the plantar fascia", then these are the exercises for you.

So you see, the pain in your foot can easily be the tibialis posterior tendon or the intrinsic muscles in your foot.  As seen in the image below, the pain that you feel in the heel of your foot is usually from the  periosteum (the outer covering of your bone or the "skin" of your bone.  This skin on our bones is nerve dense with pain receptors).  The periosteum can become quite painful from the pulling and tugging of the tissue attachment that is under abnormal stress, i.e. the plantar fascia.  It's this very reason that when you press on the bottom of your heel when you are experiencing symptoms that your heel is very sore and painful.  The pain is coming from the inflammation at the bone and tissue attachment site on your calcaneus or heel bone.

Image is property of David Wooster Middle School...Thank You!

Again, it takes a methodical and meticulous examination of the leg, ankle, and foot prior to determining exactly what you have - plantar fasciitis, tibialis posterior tendonitis, or some other injury to your foot or leg.

Any questions, feel free to email me!

Happy Bipeding!

Brad Senska, PT, DPT, BS, ASTYM