JF: TFL, Deep Hip ER, and Proximal Hamstring Pain in a Runner along with Neck Related Symptoms (11-5-17) Week 7

Highlights from email
- Ran 10 mile race that went pretty well
- After, significant hamstring pain, left fingers tingling, R hip burning
- Otherwise fairly good week with bilateral hamstring tightness, hips and butt mild discomfort, L arm and shoulder pain continue with reduced pain at times
- Updates in bold

Organization of the week should look something like the list below
- Monday: Daily Sequence + Circuit 1 and 2
- Tuesday: Daily sequence
- Wednesday: Daily Sequence + Circuits 3 and 4
- Thursday: Daily Sequence
- Friday: Daily Sequence + Circuit 5
- Saturday and Sunday: Daily Sequence
Daily Sequence
- BELOW ARE A FEW MOVEMENTS YOU CAN TRY THROUGHOUT THE WORK DAY TO POSSIBLY DECREASE THE ARM PAIN…LET ME KNOW HOW THEY FEEL
  - Seated/Standing Self GH traction Extension VIDEO
  - Posterior Shoulder Stretch Door Pull VIDEO
- Try for one set of each movement 10-15reps
- This sequence is meant to be a warm up prior to running or simply a sequence to do end of the day or first thing in the morning
- It should not take long
- It should be attempted when you have pain to possibly reduce symptoms
  - Number One: Self Myofascial Release
    - I know you mentioned you have done some of this already
    - I encourage you to try some of the techniques below, you do not need to hit every point but try to establish areas tht feel significantly different on your problematic side as points to focus on
    - Self MFR Quad/Hip Flexor VIDEO
    - Side Lying IT Band VIDEO
    - Self MFR Ball Glute/Piriformis VIDEO
    - Self MFR Hamstring VIDEO NEW OPTION
  - Number Two
    - Shoulder Extension/Internal Rotation Bridge VIDEO
      - This combines shoulder mobility, quad stretch, light glute activation
      - 8-20 reps slow and controlled
      - SUBSTITUITION OPTION
        
        Tall Kneel Cane Behind Thighs VIDEO
  - Number Three
    - Deep Neck Flexor with Thoracic Extension Seated and Foam Roll VIDEO
      - Can be done seated or lying on a foam roll as depicted
      - In place of a foam roll, a yoga mat or thick towel roll will work
      - 8-20 reps
      - The chin tuck can be awkward, see video below for more instruction
        
        Deep Neck Flexor Activation Head Supported Chin Tuck VIDEO
    - SUBSTITUTION
      - 18.1) Hands Elevated CHILDS POSE Variation VIDEO
      - 8-20 REPS
  - Number Four (OPTIONS)
    - Cross Leg Contract Relax Posterior Hip VIDEO OR Cross Leg Contract Relax Seated VIDEO
    - The feeling has to be in the butt and not the groin or anterior hip
    - Sidelying Thoracolumbar Rotation Stretch VIDEO
      - Try this and let me know if one side feels much tighter then the other
      - If you find one side to be tighter, do an extra set on the tighter side
    - NEW OPTION:
      - Cross Leg at Table/Bed Isometric VIDEO
        
        This should give you a stringer stretch in the hip/glute
      - Side Sit with Rotation and Glute Isometric VIDEO
  - Number Five
    - Try this position as an alternate to the ones below
      - 1/2 Kneel Post Isometric with Hip Flexor Stretch VIDEO
    - Hip Extension Options: Choose one or both
      - 21) Band Resisted Hip Extension Mobilization VIDEO
      - 22) 1/2 Kneel Anterior Lunge Single Arm Overhead Reach VIDEO
Strength Circuits: 3 days a week we will start to build a strengthening routine
- Goal is 8-20 reps or 30-90sec for each movement
- Go through the 3 movements to fatigue in the parameters above
- Go through a second set but half as many reps for each movement as the first set, EXCEPT FOR FRIDAY YOU WILL DO ONE SET OF EACH BECAUSE YOU ARE DOING ALL 4 CIRCUITS
- NOTICE BELOW MANY MOVEMENTS WILL HAVE A PHASE 2 OPTION IF YOU FEEL THE PREVIOUS OPTION HAS BECOME TOO EASY…..ONLY IF THE PREVIOUS OPTION IS TOO EASY
- Do this for each circuit listed below
- Circuit#1
  - Quadruped with Physio Ball Hip Extension VIDEO
    - May progress to straight leg lift, hold each for 5 sec and then lower back to toe touching floor
    - 8-20 reps slow, each leg
    - PHASE 2 OPTION:
      - Quadruped Hip Extension progression VIDEO
        
        SAME MOVEMENT WITHOUT BALL
        
        CAN ADD ARM LIFT AS DISCUSSED IN VIDEO
        
        8-20 REPS
  - Basics of Pelvic Control Pre- Bear Position VIDEO
    - Incorporate this concept in the bear with the leg lift, holding each leg lift 5 sec, alternating legs, 30-90sec, video below
      - Basics of Bear with Leg Lift VIDEO
  - Step Knee Flexion Intro VIDEO
    - Exaggerates the running stride
    - Make sure foot on the ground is straight and you maintain some lower abdominal tension
    - 8-20reps each leg
    - SUBSTITUTION
      - Step with Ankle Dorsiflexion VIDEO
      - Similar position but includes self ankle mobilization
- Circuit#2
  - Laying on Back Weight Pull Over and Band Pull Over VIDEO
    - Start with light weight and a slow and controlled movement over head
    - Stick with the lying down version with dumbbells
    - Start light 3-5lbs each hand
  - SUBSTITUTION
    - Side Plank with Lateral Shift Progression VIDEO
      - Start at a higher surface and try for 30-90sec
      - Sometimes the hip thrust can cause you to tense low back and I want to see if this is more difficult on one side compared to the other
  - Sidelying Leg Raise Progression to a Stretch VIDEO
    - Pay attention to the details on this one
    - Don’t lift the leg too high
    - Even if you are on the floor, keep it to a small amount of motion
    - PHASE 2:
      - Side Step Band Progression VIDEO
        
        DO THIS SLOW WITH A LIGHT RESISTANCE BAND
        
        SHOULD FEEL THIS MORE SO IN THE WEIGHT BEARING LEG
        
        8-20REPS
- Circuit #3
  - Counter Push Phase 1 VIDEO
    - Try sticking with one side at a time
    - Slowly bring one knee up towards counter or hands against wall and then straighten leg behind
    - Goal 30sec-2 min
    - make sure you keep shoulders down and don’t tense your neck as your arms get tired
    - You may want to do one leg, then do the movement below, then come back to do the other leg so your arms get a break
    - PHASE 2:
      - Wall Bird Dog VIDEO
        
        30SEC – 2 MIN EACH SIDE
  - Double Leg Bridge Phase 3 VIDEO
    - UPDATE:
      - Typically the hamstring is loaded more so with the knees bent. You can play around with the amount of knee bend to feel tension in the back of the thighs
      - Make sure you keep toes straight up towards ceiling
      - This really loads the hamstring and if done too aggressively can irritate it
      - The straighter your knees, the less pressure on the hamstring but the more likely you are to tense the low back. Try to bend your knees a little less but really focus on abdominal tension and not going too high to where the low back arches
    - This can be done with feet up on the edge of chair or couch if you don’t have a ball
    - If this causes pain at the top of the hamstring, straighten the knees more and it will be less stress on the hamstring
    - Don’t worry about going up too high
    - Goal is to feel tension in the hamstring but not pain
    - 8-20 reps slow
    - PHASE 2
      - Single Leg Bridge Phase 5 VIDEO
        
        MAY WANT TO TRY 5 REPS SINGLE LEG AND THE REST DOUBLE LEG TO START
  - Squat Pulses In Short Range VIDEO
    - May use a light band around the knees of there is knee pain or significant grinding around the knee
    - Stay in the deepest range possible and do small pulses for 30sec-2 minutes
    - This should be pretty challenging, but make sure you have no joint pain
- CIRCUIT #4
  - SUBSTITUTION
    - 1/2 Kneel Band horizontal Abduction with Progression to Rotation VIDEO
      - updated video, if you get more out of this motion stick with it
    - Band Extension Deadlift VIDEO
      - Focus on this movement instead of the pull out to the side which may be irritating the arm symptoms
      - Let me know how it feels in comparison to the band pull out to the side
  - Reverse Lunge Towel Slide VIDEO
    - This one will load the hamstring and hip flexor into a stretch
    - Be careful not to go too deep into the motion too fast
    - This one also really loads the hamstring so be careful that it is not irritating it
    - 8-20reps
  - Pre Run/Walk Single Leg Balance Drill VIDEO
    - Emphasis on balance and stability when moving through the gait/running cycle
    - PHASE2:
      - Pre Run/Walk Band Resisted Stride Drill VIDEO
        
        same movement with a band on the ankle
        
        8-20 reps slow
- CIRCUIT #5
  - Single Leg Deadlift VIDEO
    - This movement is going to allow for progressive loading of the hamstring and glute
    - Make sure you go down into very slow 4-5sec on the way down
    - Keep back straight and standing leg just slightly bent
    - You should feel a pull into the stance leg hamstring
    - start with light weight…5-10lbs
    - 8-15reps goal each leg
  - Down Dog to Up Dog Floor VIDEO
    - Move through it very slowly
    - Do your best not to over stretch the hamstring, pushing too hard into a stretch can commonly increase hamstring pain
    - 8-15reps slow
  - Lying on Back External Rotation Phase 1 VIDEO
    - Pay attention to not creating any increase in tension in your neck
    - This is more of a higher rep low resistance movement, so goal should be either for time (30sec-2min) or high reps (20-30) but don’t do the movement fast
    - Let me know if you notice a difference in the problematic arm