When it isn’t going too swimmingly…


SwimmingThe most common complaint from swimmers is shoulder pain.

But sometimes it isn’t coming from the shoulder.

When a swimmer has slight pain at end of range shoulder movements but no loss of shoulder strength it is always best to examine the cervical spine (neck) and ensure there is no involvement coming from there – and if that is clear, we move on a little further down the body.

Key assessment point for swimmers with shoulder pain:

Upon examination, if there is some tightness in thoracic spine extension (backwards) movement, which can be demonstrated in a reduced combined elevation test.

If there is a reduction in thoracic range, the mild sub-acromial shoulder impingement we are being presented with can be possibly brought on by tightness in the swimmer’s abdominal muscles – that in turn are reducing thoracic extension…. are you still with me?

When there is tightness limited his thoracic spine movement, there is some extra difficulty in achieving full shoulder range of movement.

In swimming, the streamlined body position underwater is crucial for good efficient swimming. Obtaining an ideal body position reduces the drag forces applied on the body, as they will slow the swimmer and force them to work much harder to generate enough force to propel their body through the water and get to the end. The extra work to overcome these drag forces is a large contributing factor to overload injuries, especially in shoulders;

A good streamline body position has a number of key components:

Upper body: sufficient shoulder flexibility, thoracic spine extension / mobility / strength, adequate abdominal muscle length
Lower Body: enough hip extension (ability to move hip / thigh backwards), ankle plantar flexion (pointing toes like a ballerina) and core control – hello abs!

Here is an exploration of the upper body components:

Adequate Arm & Shoulder Flexibility
The ability to get your arms into an extreme position above your head with ease is essential for a good streamlined position. Tightness through your shoulder muscles, especially your latisssimus dorsi, pectorals (major and minor) and the rotator cuff (shoulder blade) muscles will make this difficult. So get stretching

Adequate Thoracic Spine Extension / Mobility / Strength
This describes the ability of the portion of the spine near the shoulder blades to straighten up. This allows the spine to get longer and the shoulders to achieve their maximum position overhead more easily. Thoracic spine mobility is often comprimised by habitual poor sitting postures (school, work desks).

Adequate Abdominal Muscle Length

But aren’t we just meant to have abs of steel? Not quite!

Strength and control is also very important but often in our attempts to achieve improved strength (eg. hundreds of crunches), we actually tighten these muscles and compromise their length.

This can lead to the rib cage being pulled down / forwards and difficulty expanding the chest when breathing. This makes it difficult for the swimmer to obtain thoracic spine extension and thus, a streamlined body position.


If you think some of these characteristics may apply to you and your swimming and / or you would like further information, please feel free to contact me





Top running apps for 2013

Top Running AppsWith proper training and carefully planned workouts, finishing a race can be easy.

Smartphone users are in luck. With the accurate tracking and real-time statistics that dozens of apps provide, you’ll receive performance-enhancing advice that will not only get you through today’s run, but help improve your time for the next one – reducing the chance of injury that can occur through incorrect preparation

For people who enjoy running, there’s nothing like lacing up the Nikes, heading out the door and hitting that stride. But every runner hits a wall at one point or another and day after day, run after run can soon become monotonous. Sometimes a little jolt to the routine is welcomed.

Whether you want to try out new routes, strive to be that little bit more speedy, have better endurance or even prepare for that fun-run, runners (and want-to-be runners) can turn to the following 10 iPhone apps for a little more variety in their training regimens:

1. RunKeeper Pro

RunKeeper Pro is probably the most well-known of the running apps on this list. This is a feature-rich app that enables GPS tracking, distance, speed monitoring, caloric output and activity history for any number of activities you partake in including sports such as running, cycling, hiking, skiing and swimming. You can also sync all the data to RunKeeper’s website to monitor progress and share publicly. RunKeeper also offers a simplified version of the app for free.

Cost: $9.99


2. Ghost Race

Sometimes, the best motivation is competition and who better to compete with than yourself? Ghost Race enables you to track your times on various routes and compare your performance from day to day. The app’s audio function also keeps you updated on your progress against your ‘Ghost’ in real-time.

Cost: $0.99


3. Endomondo

This app turns your smartphone into a trainer. By tracking your workouts, it gives you feedback as you run and analyzes your performance based on time or calorie-related goals set by you before the run. Extra perks include heart rate tracking, split times and speed. Its social aspect allows you to share your runs online with its personal online community and via Facebook and Twitter.

Cost: Free


4. Get Running (Couch to 5K)

Targeted more for beginner runners, Get Running provides users with a specific training regimen over the course of nine weeks, with the end goal of being able to run for 30 minutes. Audio prompts guide users through each workout and even provide encouragement along the way.

Cost: $1.99


5. iRace

iRace is a comprehensive app for locating road races near you or in any city that you choose to search. The app also enables you to preview the race route (if available) and send “challenges” to contacts, inviting them to run the race with you.

Cost: $0.99


6. Fitnio

Fitnio is another GPS-based tracking and monitoring app for walking, running and cycling. The app records your activity and then displays distance, pace, caloric burn and also keeps an ongoing log of all workouts and also syncs with its website. Fitnio also provides an emergency contact option in the event that immediate help is needed during a workout.

Cost: $1.99


7. Run Coach

Run Coach is a good app for both seasoned and novice runners who desire a little more motivation for running success. With a variety of training plans to choose from, a 5k, 10k, half marathon, marathon, etc., Run Coach provides personalized plans and enables you to track your progress along the way. Running and nutritional tips are also offered for quick reference.

Cost: $0.99


8. iMapMyRun

If you want a GPS-based route tracker and activity log, but don’t want to pay for one, iMapMyRun is a good alternative. Similar to some of the other tracking apps, this also enables you to save your data to the app’s website where you can monitor progress and share publicly, even via Twitter. For more features like iPod integration and photo geo-tagging, there’s a more comprehensive version available called iMapMyRun+ that costs $4.99.

Cost: FREE (woohoo)


9. Interval Run

For runners who like to mix it up with interval training, this app is a good way to integrate a little variety into your workout. With training plans including Tabata, Couch to 5K, Gateway to 8K and a One Hour Program, the recorded voice tells you what to do and when to do it.

Cost: $1.99


10. UltraTimer

UltraTimer is a great app to have on hand for use as a precise timer, whether it is for circuit training, sprints or just for general use. The app comes with a couple example training plans, but any desired timing schedule can be inputted and multiple timers can be run simultaneously as well.

Cost: $1.99



but wait, I found more!



For Beginners


Couch to 5K (C25K) was designed for the couch potato or beginning runner. It features a step-by-step program that allows users to build strength and stamina during an eight-week time period. The app only requires you to dedicate three days per week to pounding the pavement, giving you alerts when to walk, run and cool down.


As an alternative, use the 5K101 podcast training program (also eight weeks) to download weekly workouts and get tips and advice, mixed with upbeat music while you run, to help you pace yourself and run with ease.


For Coaching

MiCoach is the closest form to a virtual personal trainer you can get. By inputting your height, weight and average speed, the app gives you a customized training plan — complete with exercises and videos — that helps you gain speed and endurance. Plus, access input on distance, pace and the burned calories, as well as at least 400 strength and flexibility exercises. Seasoned runners may enjoy the shoe tracker, which monitors your shoe-wear usage, so you’ll know when it’s time to retire your current pair.



For Camaraderie


Whether you prefer to run by yourself or with motivational friends, try Running Club, a virtual experience to schedule live runs or races with friends, family or even strangers from across the county. All you need to do is join a live race and wait for the start. You can track your location with its real-time map feature and compare your times with others you run against.

Once you’re done practicing, Race Finder will help you find more than 40,000 races — from marathons to 10Ks, 5Ks and fun runs across the nation.

Because who doesn’t want that free race t-shirt?


For Long Distance

When running long distances, it’s important to use GPS tracking. That way, you can map exactly where you ran and how long (or short!) it took you to get there. Nike+ Running does just that. In addition to recording your distance, pace and time, it gives audio feedback on your time per mile and offers a motivational cheer function that you can set at certain times and goals. Plus, share the GPS map of your route with friends so they can see where you ran.

Alternatively, RunKeeper notifies you when you hit PRs and helps manage your goals and target times. Best of all, it allows you to view your split times per mile and lets your supporters watch live maps of your runs.


For Stamina

Many times we stumble across a song we love while running, but it’s just too darn slow. The Upbeat Workouts for Runners app takes your current running pace and matches it with a song in your library of a similar tempo. The faster you run, the quicker the song; and if you start to walk, the music slows down. It also includes free workout plans to guide you while you run.


In order to build stamina, it’s important to stay injury-free and safe before, during and after races. With RunInjuryFree, you can pinpoint areas on your body that hurt or that you want to work on, and diagnose certain symptoms. It offers preventative measures and stretches to cure your ailing pains (music to a physio’s ears!)



Happy running! (and don’t ignore any niggles)


Love, TOA

Barefoot Bandits


During the past year, more and more runners and readers have asked for my opinion regarding the increasingly popular barefoot running styles of shoes.  I was recently interviewed about my thoughts about the trend of changing over to barefoot style running

Have you seen your patients change their regular running shoe to as style of shoe to simulate barefoot running?

I have, over the past year been asked questions about barefoot running seem to parallel the influx of new barefoot running shoes available. The most common I’ve seen in my practice include NikeFree, Vibram Five Fingers and Newton Running shoes.

The NikeFree was the first introduced in 2004. During that time, Nike who was sponsoring Stanford University’s track team discovered that some of their training had been done barefoot. Stanford’s athletic coach at the time, Vin Lananna felt that barefoot training reduced athletic induced injuries and improved ankle strength. Nike saw an opportunity and then the NikeFree was developed. Basically it has a soft, non-supportive cloth upper with a wide, cushioned midsole having deep grooves to enhance flexibility.

A little later on the scene was the Vibram Five Fingers, which were introduced in 2005. Vibram originally designed these to be worn while yachting and was surprised initially that anyone would want to run in them. Once this was realised, the Vibram with individual toes became mainstream.

Newton Running was developed in 2007 and is similar to the NikeFree in appearance. The main difference between these two is that this little guy provides more forefoot cushion. It was designed by Runners and is heavily endorsed by runners.

In regard to shoes that simulate barefoot running, what in your clinical opinion are the biomechanical strengths and weaknesses of these shoes in comparison to the basic and conventional running shoes?

Barefoot running shoes are designed to promote forefoot contact over heel contact – in other words, a lighter strike to the ground.

This does two things.

1)   it reduces the impact of heel strike, improving shock absorption throughout the midfoot and forefoot.

2)   it alters the centre of gravity forward with the feet being better centred below the hip, which is a much more stable alignment.

My concern with barefoot running shoes isn’t with the biomechanics of the design but rather the concern that runners will see this as this new, sexy fluoro shoe and train without proper conditioning or assessment.

It doesn’t matter whether you are wearing NikeFree 5.0 or Nike Zoom Structure Triax +12. If the running shoe isn’t a match to your type of foot and running biomechanics, injuries will occur.

I also think in addition to shoes, too many runners have not been adequately coached in proper form.

The best running shoe design in the world coupled with poor running form has little chance of benefiting a runner.

ChiRunning, Pose Tech Training and Evolution running are all running methods that simulate barefoot running form and are often helpful in reducing or eliminating injury.

Are there other considerations Physiotherapists should keep in mind when asked for recommendations of these shoes by patients? Are there certain foot types that would prohibit use of these shoes?

When asked by patients about barefoot running I say it may have a place in an overall training strategy, but based on most of the patient’s pathology I see coming through the door, few would benefit from this as a primary treatment. In fact I have taken quite a few runners out of these styles of shoes because they caused injury.

It amazes me that so many experienced runners (triathletes, marathoners, ultrarunners) who presumably know everything about their running are oftentimes clueless when it comes to their shoes.  Then it is my time to shine! J

They are sponsored by a particular shoe company consequently have to wear that company’s shoe and no one has really ever analysed whether it’s right for them or not. Or, they have run in the same shoe for the past 10 years but never realized that the shoe design has changed so dramatically during a version change, that in spite of the name being the same it’s not the same shoe.

In your experience in treating athletes, are there any particular brands of these shoes that simulate barefoot running that you have found to be effective?

The few patients I have who use these types of shoes as well as readers of my blog find that Vibram Five Fingers are really the only shoe that simulate the true feel and biomechanics of barefoot running. NikeFree and Newton Running seem to be losing ground in the battle of barefoot running shoes. However, I’m sure as time goes on, more and more shoe companies will jump on the barefoot running bandwagon and incorporate even more designs and styles into their manufacturing lines.


So in other words, keep it simple and use what works for your own running style…



The Office Athlete