“If nothing changes, nothing changes. If you keep doing what you’re doing, you’re going to keep getting what you’re getting.” – Courtney C. Stevens

The Gist: 

Knee pain from cycling often stems from repetitive movement patterns that become ingrained over time. As we age, these compensations—developed with each pedal stroke or stride—can alter our body’s natural mechanics. Over time, they overload some structures while underloading others, leading to inefficient movement and, eventually, pain. Addressing these neuromuscular habits is key to resolving and preventing knee pain from cycling.

The Who:

Passionate cyclists typically realize the value of a bike fit, especially if (i.e. when) a niggle or pain arises. However, many riders still struggle with pain despite best efforts with a bike fit and general strengthening programs. 

The What:

“Squats for watts” is the saying but this is merely the cycling version of “no pain, no gain”.  Without awareness of our own compensation patterns, weaknesses, asymmetries, mobility, flexibility, and joint restrictions, more loading will serve to reinforce our neuromuscular ruts. Plus, bilateral loading (such as squats) is not specific to many (any?) sports and should be low(er) on the hierarchy of sport-specific exercises for cyclists.

No pain? Remote programming and the infinite cycling-targeted accounts on Instagram can have some value (mostly just overly dramatic movements with the title like “MTB Training”). And if there isn’t a mountain bike in the background it doesn’t apply – see below. 

For those with an actual loitering physical ailment, the limited benefit to a subjective and arbitrarily assembled group of exercises is soon realized. However, I do understand the natural psychological need for most people is trialing at least a couple dead-end band-aid approaches before seeking help.  

The How:

See a performance physical therapist with expertise in cycling. Ideally a PT that performs bike fits as well. A perspective and assessment outside of our own consciousness is the best (only) way to know and understand our own movement and strength inadequacies. Then, an individualized movement training program can be applied as we begin to unravel years of moving into the path of least resistance. From there you can layer in “squats for watts”. 

In the days leading up to your appointment, try these things: 

1. https://www.youtube.com/watch?v=9LpNul1D8dE
2. Cycling-Specific Hip Hinge – YouTube 
   

Summary:

Your bike fit, load tolerance, and neuromuscular patterning must all be harmonized for cycling longevity. Off bike movement dysfunction does not evaporate when seated atop a bicycle. 

We must function well off the bike to maximize our performance and activity capacity.  Cookie cutter approach to bike fit and strengthening doesn’t ensure good movement patterns or muscle recruitment. A good bike fit will mitigate the effect of a significant imbalance, however function and self awareness will be compromised without a holistic approach that includes refined muscle recruitment and movement patterns.  

Written by Dr. Tim Tracy – PT, DPT, OCS| Physio Room

The post Knee pain from Cycling: The Neuromuscular Rut appeared first on Physio Room.

Building Strength for Endurance Athletes: Master Control, Then Unleash Power

The gist: 

When it comes to building strength for endurance athletes, the priority is clear: first build control and integrity. Increase usable range of motion. Then build output.

Strength on top of compensation compromises sport longevity. Endurance athletes need to address postural and stabilization deficits early on. If you are simply looking to improve sprint performance, sorry. But if you want to ride, run, and perform for years to come, read on.

Pain too often becomes an unfortunate byproduct of hard training. However, this pain is not always the result of overtraining; often, it stems from poor body awareness and mobility restrictions. The good news? These issues can be mitigated by focusing on improving control, developing better movement patterns, and addressing strength imbalances. By honing in on these essentials, endurance athletes can build true strength, enhance performance, reduce injury risk, and achieve sustainable, long-term gains.

The Role of Body Awareness in Training

Body awareness, or proprioception, refers to an individual’s ability to sense the position and movement of their body parts in space. It plays a crucial role in any athletic endeavor, from lifting weights to running or performing complex sports maneuvers. When body awareness is lacking, athletes may inadvertently use improper mechanics, leading to compensations that increase stress on certain joints or muscle groups. Over time, these compensations can result in pain and, eventually, injury.

The first step in mitigating these issues is developing a strong foundation of body control. This means teaching the body to move efficiently through its full range of motion without unnecessary tension or restriction. In other words, before you start building power or strength, you need to improve your ability to control your movements and maintain proper form. This is where mobility exercises and controlled movements come into play.

Mobility Restrictions and How They Impact Performance

Mobility restrictions are often at the root of many training-related issues. These restrictions can be caused by tight muscles, joint stiffness, or even imbalances between the left and right sides of the body. When one side of the body is significantly stronger or more mobile than the other, it can lead to asymmetrical movement patterns, further exacerbating pain and increasing the likelihood of injury.

For example, imagine a runner or cyclist who has a more mobile right hip but a stiff left hip. This imbalance can lead to compensatory movement patterns that place more stress on the left side of the body, potentially causing joint discomfort, muscle strain, or even injury over time. By working to correct these imbalances and improve overall mobility, athletes can achieve more symmetrical, efficient movement patterns that enhance performance and reduce pain.

Mitigating Left vs. Right Differences in Strength and Control

One of the key goals when addressing mobility restrictions is to reduce the differences in strength, control, and joint stiffness between the left and right sides of the body. Often, athletes may be unaware of these discrepancies until they begin to pay closer attention to their movement patterns.

To address this, challenge both sides of the body equally via unilateral exercises. Single-leg squats, hip hinge and lunge variations are excellent tools for improving awareness, then symmetry, then overall function and strength. Then, we can be confident both sides of the body are developing at the same rate. These exercises not only help reduce imbalances but also promote better control and coordination, which are critical for both everyday activities and athletic performance.

Additionally, mobility drills that target specific joint restrictions, such as hip internal rotation or thoracic spine mobility exercises, can help restore the body’s natural range of motion. By focusing on areas that are often tight or restricted, athletes can improve their overall movement efficiency and reduce the risk of pain or injury.

Building Power and Resilience

Once an athlete has established a solid foundation of body awareness, control, and mobility, they can begin to build strength and power. The key to this process is to develop resilience through progressive overload. By gradually increasing the intensity of training while maintaining proper form and movement patterns, athletes can build the physical and mental toughness required for peak performance.

However, it’s essential to remember that building power and resilience should never come at the expense of mobility or body awareness. Athletes should continue to prioritize controlled movements, dynamic mobility, and unilateral exercises to maintain balance and reduce the risk of injury as they progress in their training.

Conclusion

Pain and discomfort are often seen as inevitable parts of hard training, but they don’t have to be. By improving body awareness, addressing mobility restrictions, and correcting left vs. right imbalances in strength and control, athletes can enhance their movement patterns and perform at their best while minimizing the risk of pain or injury. Remember, control is the foundation upon which power and resilience are built. Focus on improving your body’s awareness and mobility, and you’ll be better prepared to take on even the toughest training challenges.

Written by Dr. Tim Tracy – PT, DPT, OCS| Physio Room

The post Strength for Endurance: Control First, Power Second appeared first on Physio Room.

Win a $750 Visa Giftcard or a pair of Normatec Boots

We’re feeling the gratitude this season, so we’re giving back to YOU with our Thankful Thanksgiving Giveaway! Enter for a chance to win some amazing prizes that’ll keep you motivated and moving through the holiday season. Whether you’re looking to level up your recovery game or just treat yourself, we’ve got something special lined up!

Look below for full rules and guidelines, and make sure to enter by December 6th! Winners will be announced on December 11th. Let’s make this Thanksgiving one to remember—good luck!

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How Does Hip Pain Happen for Runners?

Hip pain in runners can often be linked to tight or weak hip flexors or issues with running form. If you’re experiencing pain in the front of your hip or near your groin or lateral hip, it could be related to how your foot strikes the ground.

Check if the foot on the affected side is turning outward (external rotation). This might be due to increased tension or weakness in your glutes or because your body is trying to avoid hip flexion pain by altering your movement. When the glutes aren’t doing their job properly, the TFL (a muscle on the side of your hip) might take over during the running stride, which can lead to pain on the lateral or posterior hip, as well as with hip flexion.

How Do We Fix It?

Hip flexion pain can occur when the posterior capsule of the hip tightens, with glute tendinopathies or a true hip impingement (FAI). All of these diagnoses can cause the hip flexor muscles to feel pinched because the head of the femur can’t move freely in the hip joint. 

To address this, we need to strengthen and coordinate all the muscles around the hip joint, not just the glutes or hip extensors. This includes the adductors, hip flexors, abductors, extensors, and the glutes responsible for internal and external rotation.

Exercises to Consider:

• Eccentric banded hip flexion
• Yoga block hip internal rotation (IR)
• Copenhagens
• Romanian Deadlifts (RDLs)
• Squats
• Bulgarian split squats

These exercises help improve strength and coordination in the hip area, which can alleviate pain and improve running form.

Strength Training for Runners with Hip Pain

• How does this happen?
  • Hip pain can occur for many reasons, but for runners it can be due to tight/weak hip flexors or impaired running form. 
  • If you’re a runner and you start to notice hip pain in the front of your hip or near your groin, take a look at your foot strike. You might notice that the foot on the affected side is turned into external rotation. This can be from increased tension/weakness in the glute muscles or because the body has sensed weakness or pain with hip flexion and is trying to find a way to avoid moving in that plane of motion. In order to fix this problem the body might start relying on the TFL muscle (lateral hip) to assist more with bringing the leg forward during the eccentric phase of the gait cycle. This can cause pain at the lateral/posterior hip in addition to pain with hip flexion. 
• How do we fix this?
  • Hip flexion becomes painful when the posterior capsule of the hip becomes tight, causing the hip flexor muscles to feel “pinched” because the head of the femur cannot move far enough back in the capsule to allow pain free range of motion when bringing the leg forward.  
  • Like any other joint in the body, when a muscle becomes weak/tight other muscles need to work harder to stabilize or move the joint. 
  • In traditional PT a practitioner might only focus on strengthening the glutes, or hip extensors, because this is the opposing muscle group for the hip flexors. 
  • However in order to truly fix a hip impingement we need to strengthen and improve the coordination for all of the muscles surrounding the hip joint: adductors, flexors, abductors, extensions, and the glute muscles that manage internal and external rotation. 
    • eccentric banded hip flexion 
    • yoga block hip IR 
    • Copenhagens 
    • RDL’s 
    • Squats 
    • Bulgarian split squats 

Targeted strength training can be a game-changer for runners with hip pain. By strengthening and coordinating the muscles around the hip joint—flexors, extensors, adductors, abductors, and rotators—you can reduce discomfort, restore proper movement, and improve performance.

Incorporate exercises like eccentric banded hip flexion, yoga block hip IR, Copenhagens, RDLs, squats, and Bulgarian split squats to build strength and move pain-free. Need help? Our team is here to guide you to stronger, healthier running!

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Will lifting heavy help you PR at your next race?

The goal of every good strength and conditioning coach is to enhance the physical preparedness of athletes for their sport. This kind of  training is done outside of working with a technical coach, in this example – a running coach. S&C coaches have three primary goals for their endurance athletes: improve performance, improve capacity for training, and lower the risk of injury. 

Myths about strength training for runners: 

• Will adding heavy lifts to my training program cause more soreness, and affect my ability to complete longer runs? No. An effective S&C program will focus on intensity over volume through selecting exercises that are pertinent to improving strength and coordination of movements that are specific to runners. There will not be a lot of time wasted on “junk volume,” and adequate recovery time will be built into the program. 
• Will lifting heavy add unwanted muscle bulk that will slow me down? No. A well designed S&C program for endurance runners would focus on power production, strength, and functional exercises to improve performance without increasing bulk. 

How does strength and conditioning benefit running performance? S&C programs are designed to cause several adaptations to the neuromuscular system. They will improve your body’s ability to generate force, more effectively use elastic energy from tendons, and help you run with more efficiency which will help you run farther by preventing muscle fatigue. 

All of this is to say – If you are an athlete, you should train like an athlete. Here is how you can incorporate S&C into your endurance training program:

If you want to run farther… 

Plyometrics/Power: Plyometrics: 3x/week @ 50 reps per session// Power: 30-70% of 1RM performed @ high velocity for 3-5 reps per set. 

Plyometrics are exercises that are used to make you more explosive in your movements – like pushing off the ground more forcefully as you’re running, and accepting the force through your tendons as you land. When you teach your body to rely on the elastic properties of tendons to repeatedly create force off the ground, your muscles will fatigue at a slower rate and you can run farther. 

Power exercises should focus on lifting a lighter weight fast. Because of the focus on speed you should reduce weight to 30-70% of your 1RM and focus on patterns that include “triple extension” (more on that later). Including plyometrics and power in your training benefits your feet, achilles/calves, hips, knees, and ankles which are all common sites of injury for endurance runners. 

If you want to run faster… 

Strength training: 2-3x/week @ 80% or more of your 1RM for 3-6 reps/set

Strength is required for muscle groups to produce force during coordinated movements. If you want to run faster, you need to be able to produce a high level of force rapidly. Running speed is directly related to the amount of force your body is able to produce against the ground. Also, it is no surprise that runners tend to suffer from common overuse injuries, known as tendinopathies. These occur due to the high volume and repetitive loading on the body (joints and lower limbs in particular for runners). When you strength train you are strategically placing load through a muscle with the goal of increasing its tolerance to repetitive stress. Training in this way helps reduce the risk of injury. 

My advice is to focus on one major lift, that you will perform heavy, per training block (4 week period). If you are training for strength you should focus on 80% or more of your 1RM for 3-6 reps/set. A heavy stimulus and fewer reps per set are required to create these adaptations. 

If you want to focus on running mechanics to make your body more resilient… 

Dynamic warm up/functional exercises: 3x/week @ 15-30 minute sessions. These can be performed after a short duration/high intensity training run. 

As discussed above, we want to focus on selecting exercises specifically for runners so we don’t waste time/effort on “junk volume.” For runners, a dynamic warm up should include hip mobility, single leg stability, hamstring activation, calf strength, and trunk control. Strength that you acquire in the gym does not always translate to activity unless you train it to do so. We want to make sure the strength you are acquiring from heavy lifting can be used to express force well during running. 

So for endurance runners it is important to choose exercises that will develop force to improve running and should involve the lower body producing “triple extension,” which is the action of the ankles, knees, and hips straightening in a coordinated pattern. Think of jumping straight up to create this movement. This type of training allows your body to accelerate at a high level of force similar to a running stride.  

In conclusion… 

No one falls in love with strength training by doing bridges or core work. Lifting heavy, training for powerful movements, and teaching our bodies to absorb and use high forces is vital to causing adaptations that will benefit your running performance. So will lifting heavy help you PR? If you follow a well designed S&C program, progressively increase your lifts, and provide plenty of recovery time… then yes, it will. 

P.S. Don’t forget to check out the Runner’s Checklist for a complete guide to running.

Sources: “Strength and Conditioning for Endurance Runners,” (Blagrove)

The post Endurance Athletes: The Common Disconnect With Strength Training.  appeared first on Physio Room.

Before picking up a kettlebell to complement your endurance training, the first step is often to unravel suboptimal movement patterns. 

What causes these patterns? 

The human body’s desire for efficiency (when cycling and running) tend to enhance movement patterns unique to each person, a.k.a a neuromuscular rut. 

Challenging and changing default patterns is the hardest part of any rehab or performance program. It only gets harder with age. 

Are weak muscles to blame? 

Unlikely. For cyclists, poor awareness with the sport’s primary movements, hip hinge and lunge, are often the root cause of knee or low back pain. Layering weights on top of bad movement patterns exacerbates issues, or at best, performance and wellness benefits are mitigated. 

Most that struggle with low back pain don’t realize that “the core” includes our gluteal muscles. The hip hinge for cyclists is a key comment to more fun on the bike with less pain. 

The first step, which is common even among elite athletes, is for clients to proficiently recruit and identify well with the left and right side glute complex. Then have the glute be the primary sensation during functional movement patterns such as hip hinge, squat and lunge. 

Mentally and physically reorganizing how we move is often the most powerful, and most challenging, component towards resolving long standing low back pain. 

Learning to move better is a skill. This is where a great physical therapist can use their expertise in identifying detrimental movement patterns to help you move more efficiently and maximize your athletic performance. 

Check out this article by Training Peak for the best strength exercises for cyclists.

The post Endurance Athletes: The Common Disconnect With Strength Training.  appeared first on Physio Room.

Do you have low back and/or knee tightness when riding? 

The gist: There are 6 primal functional movements of the human body. Of those, the hinge and lunge are the two primary movements for mountain biking. Mastery of these two movements off the bike provides numerous riding advantages, but ultimately leads to more fun and less back pain on the bike. 

Squat vs Hip Hinge:

The What: Squat biases the knee and quads whereas the hinge biases the hips and glutes. 

The Why: Joint angle influences muscle function = Put your body in a position that takes advantage of our workhorse gluteal muscles to reduce back pain on the bike. .

Part 1:(Hip hinge vs squat) 

Part 2:(cycling specific hip hinge)  

Lunge Pattern:

The What: Pedaling is essentially a lunge pattern performed over and over. And over. 

The Why: Large left vs right lunge asymmetries and poor dynamic control are also present during the pedal stroke, leaving untapped performance and comfort on the table. 

Part 1: (click here and watch the pedaling dynamics self assessment)  

Bike Fit for High School Riders

Why are bike fits important for all ages and levels of riders?

The latest and greatest bike doesn’t mean much if the rider is not set up to take full advantage.

Comprehensive bike fitting not only involves adjustments of the bike itself (biomechanical), but also teaches riders about their compensatory movements (proprioception) and how to move well (neuromuscular) on the bike once it has been fit. 

Physio Room Bike Fitting: Biomechanical changes + Neuromuscular Awareness 

How a rider pedals, functions, and feels on the bike are often overlooked components during a bike fit. As a physio and experienced bike fitter I can help ensure form and function meet.  

How a bike fit can improve performance

• Reduced injury risk allows training consistency without unwanted time off 
• Improved posture and body position aids breathing pattern and oxygen delivery 
• Improved efficiency via improved muscle recruitment and load distribution through muscles and joints
• Less overall energy waste 

Rundown

Ultimately,  preparation and recovery and optimizing riding comfort and efficiency equates to performance and fun for any rider. 

Tim Tracy, DPT, OCS, CSCS: Physical Therapist, Bike Fitter

The post #1 way to prevent low back pain on the bike appeared first on Physio Room.