Monday, October 31, 2016


Scottsdale Sports Medicine


Scottsdale Sports Medicine


Scottsdale Sports Medicine

Sunday, October 30, 2016

What is Femoral Acetabular Impingement (FAI)?

Femoral acetabular impingement (FAI) is the Cara Delevingne of running injuries. Fret not, this hip injury has nothing to do with a strong eyebrow game, but like Cara, it is very en vogue at the moment. FAI is very much a diagnosis of the modern age. Its birth has dovetailed with the improvement and sensitivity of our imaging techniques like X-rays and MRIs. But what is femoral acetabular impingement, anyway? Let’s look deeper at this diagnosis, and explore FAI symptoms…

What is Femoral Acetabular Impingement - FAI Symptoms - Hip Pain - Symptoms of Femoral Acetabular ImpingementWhat is Femoral Acetabular Impingement?

Simplifying Femoral Acetabular Impingement

In short, it means the hip bones are misshapen. Because of that, they rub against each other and can damage the joint.

For symptoms of femoral acetabular impingement to become problematic you really need a few things happening:

  1. A misshapen hip joint
  2. Excessive loading of the joint
  3. Perceived threat

What is Femoral Acetabular Impingement?

Pincer lesions

A pincer lesion relates to the acetabulum (the socket of the ball and socket joint). If you have a pincer lesion it means that the socket is a bit deeper in some parts so the femoral head (which is the ball, of the ball and socket joint) is deeper into the socket.

The only real consequence of this is that you will run out of range of motion more quickly than if you had a normal-shaped acetabulum.

Visualisation helps us understand what is femoral acetabular impingement; think of it like this: Imagine your acetabulum is like your breakfast bowl and your femur is like the thin end of a baseball bat. If you place the thin end of the baseball bat in the centre of the bowl and, holding the end of the bat in the centre, moved the bat as far as possible in all directions you will eventually get to a place where the shaft of the bat hits the rim of the bowl. That is your end of range.

If, however, you swapped the breakfast bowl for a mug or cup and did the same thing, you would hit the rim of the cup much sooner. This is what a pincer lesion is like.

Cam lesions

A cam lesion relates to the ball (the head of the femur). In a cam lesion, the ball is aspherical, instead of being relatively round, it has a bit of a hump on one side.

The consequences of this are the same as with a pincer lesion, but for slightly different reasons. In this scenario, if you kept your breakfast bowl as the acetabulum but this time turned the baseball bat upside down, so you now have the thick end of the bat in the bowl, you would still run out of range, hitting the rim of the bowl sooner because you have a bigger ball.

Now, this is important. Is having a cam or pincer lesion enough to cause FAI hip pain?

No. 100% No. You can have both cams and pincers — or combinations of both — and have absolutely no issue with your hips. You can continue living your life without any worry.

That is because you need other ingredients in the pot to cause FAI hip pain.

Unfortunately, I feel, we tend to obsess over issues in our body’s structure. The problem here is, if you believe that the structure of the hip is the only issue that could cause FAI symptoms, it means the only solution is to surgically change that structure.

That is grossly oversimplifying the problem and using a sledgehammer treatment when a miniature hammer will do.

So, what causes Symptoms of Femoral Acetabular Impingement?

To get to a place where symptoms of femoral acetabular impingement become problematic you also need excessive loading and/or increased perceived threat.

Excessive loading is where you take the misshapen hip that does not have a huge range of motion, and continuously and repetitively load it at its end of range.

Traditionally the impingement is on the anterior and superior part of the hip joint (front and top). The movements that tend to load this area are hip flexion and internal rotation. This causes excessive antero-superior impingement of the ball on the socket and does not give the joint enough time to recover, get stronger and adapt to the load.

This, in turn, causes the tissues in this area to break down. Your brain will sense this threat to your bodily tissues and protect you by sending you pain signals, your FAI hip pain.

This is why athletes in sports that require repetitive end of range hip flexion and internal rotation FAI more often. Think dancers and cyclists. The hip joint itself is not the problem, it’s the excessive end of range loading of a small part of that hip joint that’s causing the issue.

The third ingredient is not always present, but it’s important to look out for. This is perceived threat. Basically, we are looking for any fear, anxiety, stress, catastrophization (fearing the worst) around the injury or in life in general.

If these thoughts are present, your brain is listening. These thought patterns are telling the brain something is wrong with you or in your life. The brain will perceive this as a threatening state and move to protect you with more FAI hip pain.

So, if we know that all of these three elements can play a part in femoral acetabular impingement, we do not have to look to change the morphology of the hip, we can just look at changing load or threat.

Load & Threat Management in FAI

You could decrease activities that need lots of hip flexion/internal rotation. It could be something as simple as raising your bicycle seat. You can look at movement patterns and change the way you move to offload that part of the hip.

Similarly, if you feel there are wider threats making you stressed or anxious, you can address these by simple education to lower threat levels and provide yourself an environment of perceived safety.

So take a hip with a lesser range of motion, add repetitive end-of-range loading/impingement and sprinkle on some fear or life stress and you have the perfect recipe for hip pain, symptoms of femoral acetabular impingement.

Now we’ve hopefully better answered the question ‘What is Femoral Acetabular Impingement?’, let’s step away from the scalpel and look at the simple things first. Options that do not include cutting through my lovely healthy tissue and shaving away my bone, thank you very much!

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Scottsdale Sports Medicine


Scottsdale Sports Medicine


Scottsdale Sports Medicine


Scottsdale Sports Medicine


Scottsdale Sports Medicine

Tuesday, October 25, 2016


Scottsdale Sports Medicine


Scottsdale Sports Medicine


Scottsdale Sports Medicine

Can You Cure Runner’s Knee [Part 3]

I hope you’ve been enjoying the first two parts of our series on understanding and treating runner’s knee. In this section of our series, I’ll be discussing gait re-training. Read on to learn how changes in running form can be used to help runners who suffer with patellofemoral pain.

Haven’t been following along? You can check out the previous instalments here:

Gait Re-Training in Patellofemoral Pain Rehab

Let’s talk about gait re-training. Put simply, it’s the process of making targeted changes to your running form to overcome injury.

running gait re-training for patellofemoral pain runners knee

Gait Re-training: Who is it best for?

Research tells us that females are likely to respond to gait re-training than males. But guys, don’t worry, that’s likely because runner’s knee is more common among women. Clinically, I see lots of males who respond well to gait re-training.

Male or female, if you have a poor running style, you are also more likely to benefit from gait re-training. By poor running style, what we mean is a running style that means that you may look similar to the images and video below:

Trendelenburg Gait (aka Hip Drop)

Knee Valgus“Knock Kneed” Valgus Position

How can we apply gait re-training?

Working with simple, achievable cues will help you improve your running form . As a start, working with a digital metronome will help you elevate your running cadence, also known as step rate.

It is easy to calculate your cadence for a given pace: Simply count the number of steps that you take when running for 60 seconds. Alternatively, if you run with any wearable technology such as a Garmin watch, it will probably record your cadence.

For some context, the most common step rate that I see in the clinic is 160. There is some evidence that if we increase this by a given percentage (the typical choice being 5-7.5%), that we may achieve some positive changes to your running technique.

Based on this, if I see a runner who has a step rate of less than 172 at an easy conversational pace, I usually look to increase their cadence while maintaining a constant speed on the treadmill, or running at a consistent pace outdoors.

There is no magic number for everyone, so you’ll have to calculate your own and make incremental adjustments.

Runner’s Knee Rehab Resources

Pay attention to your foot strike

Biomechanically speaking if you switch from heel striking to run with a forefoot strike pattern, it will generally reduce the impact on your knee.

However, be aware: It is impossible to remove net impact from the body, changing your foot strike simply moves that impact around. You’ll go from loading one joint to another. A foot strike cue is probably the biggest example of where one technique change will benefit body part A (the knee), but upset body part B (the ankle/calf complex). Particularly if you’re suffering from Patellofemoral Pain, this kind of trade off can be very much worth while.

I would caution all runners from changing your foot strike drastically without paying attention to the resulting impact on the rest of your body.

The cues described above are certainly not your only options. When working with a runner, James and I will often cue changes in trunk position, abdominal activity, foot strike/position, contact times and swing path, to name but a few…

It is unlikely that one magical cue will work well for all runners, so be patient and seek the advice of a qualified medical professional with a specialist interest in running form if you are not finding relief.

Remember to take it slowly and consider using our return to running program to give you some structure. It is essential to remember that few treatments work well in isolation, do not forget about the role of exercise!

Further Reading on Running Gait Re-training and Running Form

If any clinicians are reading this, I would direct you to two academic papers that our group has written if you wish to know more about gait re-training.

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Monday, October 24, 2016


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Scottsdale Sports Medicine

Sunday, October 23, 2016


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Scottsdale Sports Medicine

Saturday, October 22, 2016


Scottsdale Sports Medicine

How Does Alcohol Affect Fitness & Running Performance?

Put that beer down! OK, you don’t have to toss your beer. Enjoy it. But don’t forget to consider the effect of alcohol on the body. How does alcohol affect fitness after all?

I’m sorry to report that the late night G&Ts don’t do your performance any good at all. In fact, the research suggests that consuming alcohol is detrimental to performance and recovery.

Believe it or not though, for a time it was believed that alcohol in small amounts could help improve athletic performance!

Since then, many studies, including this one, titled Alcohol And It’s Effects On Sprint & Middle Distance Running found that alcohol is detrimental. Even if you usually drink moderately, but go wild to celebrate once in a while. That binge drinking makes a difference — and not a positive one.

How Does Alcohol Affect Fitness & Running? Effect of Alcohol on the Body - Running after Drinking Alcohol

The effect of alcohol on the body

A 2006 paper by Susan M. Shirreffs, PhD at Loughborough University, found that small amounts of alcohol added to an athlete’s diet limited the the ability of the athlete’s liver and muscles to retain glycogen (an important energy store for your body) by almost 50% after eight hours.

That’s pretty significant.

So no matter what sport you do, this presents a significant problem. Other negative effects of alcohol consumption on the body include:

  • Reduced reaction time
  • Motor control impairment
  • Impaired judgement
  • Impaired memory
  • Disruption to sleep patterns
  • Liver function damage
  • Hypoglycemia
  • Raised blood pressure
  • Dehydration
  • Restricted ability for the heart’s to contract during exercise
  • Impaired body temperature regulation

The list goes on.

The effects of alcohol on recovery

Consuming large amounts of alcohol after an event — like when we celebrate a marathon with a few beers — can negatively affect our ability to recover.

You’re probably familiar with the marathon stairs test” right? You know the one. Your legs are so stiff and sore it’s like you’ve got two short planks down the legs of your pants making it impossible to climb the stairs. Forget about going down stairs in the normal fashion. Many a marathon runner has had to resort to sleeping on the living room couch for three days until they could bend their knees again! The effect of alcohol on the body will only make this worse.

Drinking your head off after the race might feel good in the moment, but it won’t aid your recovery one little bit.

One study observed that the alcohol actually causes additional inflammation, reducing the athlete’s ability to adequately recover from strenuous exercise.

To further explain, the folks at Boston University suggest that alcohol can affect the body’s ability to recover in the following ways:

  • Limits the body’s ability to absorb essential nutrients like B1, B12, Folic Acid and Zinc
  • Constricts aerobic metabolism
  • Alcohol sugars are converted into fatty acids (not good for recovery)
  • Lowers oxygen-carrying capacity in the blood
  • Alcohol causes dehydration which can exacerbate muscle strains and niggles

What About Non-Alcoholic Beer?

The folks at James’s Gate brewery in Dublin, home of Guinness and one the world’s most infamous drinking cultures (it’s OK, I’m Irish, I can slag myself off) have told us for years that “Guinness Is Good For You”.

Maybe they were right — to a degree anyway.

Research from 2011 suggests that non-alcoholic beer is good for reducing inflammation and upper respiratory tract infections in marathon runners.

A research team led by Johannes Scherr, M.D. studied 277 healthy male marathon runners participating in the Munich Marathon. They set out to determine whether non-alcoholic beer would show antioxidant, anti-pathogenic and anti-inflammatory properties in their study participants.

The study found that consuming a modest amount of non-alcoholic beer for three weeks before and two weeks after a marathon actually reduces post-race inflammation and the incidence of upper respiratory tract infections. “The naturally occurring polyphenolic compounds of non-alcoholic beer are responsible for fighting these common ailments in distance runners,” the researchers wrote.

Running after Drinking Alcohol

And if you’re worried about your health and performance, don’t even think about running a Beer Mile — that’s when runners race a mile, chugging a beer between each lap of the track. It’s all fun and games until someone has a cardiac arrest.

In the same study mentioned above, the researchers state that “alcohol consumption before exercise decreases myocardial contractility”. In other words, alcohol limits the ability of your heart to contract.

Now I don’t know about you, but that’s enough for me to decide that running after drinking alcohol, specifically downing a can of beer every 400 meters in an hard-run mile, is just a bad idea.

So… should you crack open another beer?

Hopefully I’ve answered the question ‘how does alcohol affect fitness?’. It seems there’s no doubt that alcohol negatively affects you fitness and running performance. I hope this post has gone some way to helping you understand the effect of alcohol on the body.

If you want to perform to your best and live a healthy and active life, there’s no place for over-indulgence in alcohol. Everything in moderation!

The post How Does Alcohol Affect Fitness & Running Performance? appeared first on Run Coaching, Ironman and Triathlon Specialists - Kinetic Revolution.

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Scottsdale Sports Medicine

Thursday, October 20, 2016

Are You at Risk of Stress Fractures? [Video]

In on stress fractures, I talked about some of the possible contributing factors to this frustrating type of running injury.

These risk factors include decreased shock absorption, mobility restrictions, strength imbalances/limitations, and insufficient recovery.

As endurance athletes, the important thing to realize is that all of these problems can of course be solved. The biggest challenge is learning how to recognize what ‘normal’ looks like, so that you can identify problems that could end up developing to stress fractures early before they gain momentum.

Think of it like running down the wrong road. The further you get down that road, the more work you have to get back to where you were.

So let’s do a little self-evaluation…

1. Shock Absorption

Have you ever been to a professional track event or road race? One of biggest things you will notice is how quiet the athletes are on their feet. Whether it’s in the warm up or flat-out down the home stretch, they are almost silent on their feet.

Now leave the earbuds and music at home and compare that to your own running.

How loud are your footsteps?

Does that sound change as your speed goes up? Does it stay the same? If there are problems on how you are striking the ground, you will be able to hear them. You’re shooting for quiet steps.

2. Mobility Restrictions

When it comes to mobility, we are looking at four joints in particular: toes, ankles, knees and hips. Restrictions in any of these are going to force you to change how you move forward.

Typically, this compensation occurs through rotation.

For example, instead of pushing off of your leg to propel yourself forward, you might twist off of your foot or hip to work around the restriction.

These little corrections can be sneaky and they don’t always show symptons. So, how do we spot them before stress fractures become a problem? One of the first things I like to do is get a visual.

I start by having my athletes lay flat on their stomach with their feet hanging off something like the picture below.

prone hang

Do your feet point straight down towards the floor like in the first picture or do they twist in or out like the second two pictures?

This is a great way to get an idea if you have some extra rotation going on. If you do, then you can start looking closer to see where the restrictions might be.

3. Strength Imbalances & Limitations

When it comes to strength, runners love to talk core workouts and planks. I like to look at their squat as it will tell me far more about their ability to use the big muscle groups together in a coordinated, functional movement.

A good squat requires good mobility at the ankles, knees and hips, as well as strength, postural control and core stability. In other words, everything needs to work together, much like running.

Here’s the overhead squat test:

  • Stand tall with your feet shoulder-width apart and toes pointed forward.
  • Lift your arms so that your elbows are straight and your arms are directly above your head.
  • While maintaining that arm position, descend into a squat as deeply as possible with your weight on your heels.
  • Hold the bottom position for a count of one, and then return to the starting position by pushing up through your heels.

4. Insufficient Recovery

When it comes to recovery, the first step is to realize that our sport only takes up part of our day. The rest of that day is spent running back and forth to work, family events, kids games, chores and errands.

All of these things, in addition to our actual training and racing, require recovery as they place stress on the body. In fact, one might even argue that life places more stress on our bodies than all of our training and racing combined. So how can we tell if we are doing too much?

  • Poor sleep quality (inability to fall or stay asleep, increased tossing and turning, cramps at night.)
  • Elevated resting heart rate
  • Muscle fatigue/soreness (it’s one thing to be sore after a hard race or run, but after every run? That’s not the goal.)
  • Overall health (frequent colds or worsening allergies.)

After running these tests, do you think you’re at risk for stress fractures?

Get ahead of it and take care of these issues before they progress.

The post Are You at Risk of Stress Fractures? [Video] appeared first on Run Coaching, Ironman and Triathlon Specialists - Kinetic Revolution.

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Scottsdale Sports Medicine

Best Speed Book in Decades

This is the best book I have read on speed since The Charlie Francis Training System. It’s rare that something like this comes out. To order, click the link below.


from Michael Boyle's Blog
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Wednesday, October 19, 2016

Amazing Review of New Functional Training for Sports

This review made my day. The reviewer said that I had written ” the best book on sports training published to date”.

Here’s the entire text:

This could just be the very best book I have ever read on strength training and conditioning for sports (and fitness). Page after page, I found myself utterly impressed by Boyle’s wisdom and sensible viewpoints on virtually every topic. In an industry dominated by arrogance and bravado, Boyle’s humility and ability to recognize weaknesses in his method and to change his mind on several concepts, acts a model for all in our field.

The text is divided into 11 chapters. It’s well worth the investment of time reading every word and the book from cover to cover, as there are tips and ‘take home’ messages on every page. The book begins by a discussion on making training more functional. Here, Boyle covers the latest science on the topic and puts to bed some of the silly circus-style training that is mistakenly thought to be functional training. In this chapter, I appreciated the simplicity of his approach to strength conditioning: stability for the stabilizers, strength for the muscles involved in the sport, emphasize unilateral strength development, high emphasis on free weights, protect from injury.

The next chapter covers the analysis of the various demands of the sport. An understanding of these components allows us to see how Boyle selects the exercise, loading and programs covered later in the book.

The next chapter is about assessing functional strength. Again, I appreciated the simplicity of his approach: assessing strength in what matters – chin-ups, rows, push- ups, and split squats. Of the seemly endless battery of tests available to a trainer, Boyle cuts to the heart of the matter by simply assessing upper and unilateral lower body strength which gives the trainer clear directions as to the future exercise emphasis for their clients.

The real strength of this book lies in the next several chapters: program design, foam rollers, stretching and strength training for the lower and upper body, core, plyometrics and Olympic lifting. This is perhaps the best writings on these topics currently available anywhere. Clear explanations of why Boyle choses the exercises that he does and why he avoids other ways or exercise selections. His rationale for his progressions and regressions are ‘must reads’ for all trainers. You may not see eye to eye with every point, but you will certainly appreciate the wisdom and Boyle’s argumentation of why he recommends what he does.

The book concludes with a chapter on program design, where Boyle outlines the key program components, as he sees them, and then provides several sample strength programs (both for two, three and four day per week). The chapter finishes with some sample recommendations for sports specific conditioning.

Mike Boyle has written, in my opinion, the best book on sports training published to date. His wisdom, simplicity of approach, scientific foundations and over 30 years in the coaching game has produced the new standard in the field and a book that will remain a ‘must-read’ for a long time to come.

Reviewer: Tony Boutagy,


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Monday, October 17, 2016


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Scottsdale Sports Medicine


Scottsdale Sports Medicine


Scottsdale Sports Medicine