Episode 1764 - What does vertical add to the equation?

Dr. Jason Lunden // #FitnessAthleteFriday // www.ptonice.com In today's episode of the PT on ICE Daily Show, Endurance Athlete division leader Jason Lunden discusses uphill & downhill running, the differences between flat running, and how to progress into vertical running with patients & athletes. Take a listen to the episode or check out the full show notes on our blog at www.ptonice.com/blog If you're looking to learn from our Endurance Athlete division, check out our live physical therapy courses or our online physical therapy courses. Check out our entire list of continuing education courses for physical therapy including our physical therapy certifications by checking out our website. Don't forget about all of our FREE eBooks, prebuilt workshops, free CEUs, and other physical therapy continuing education on our Resources tab. EPISODE TRANSCRIPTION INTRODUCTIONAll right. Welcome everyone. Happy Friday. Welcome to another episode of PT on ice daily show. Uh, hope everyone had a wonderful 4th of July holiday and have a great weekend ahead. My name is Jason Lunden. I am the lead for the endurance athlete division. Uh, so teach rehabilitation injured runner live and online as well as a professional bike fitting course. And what I'm going to cover today is. what vertical adds to the equation. So talking about uphill and downhill running, both hills and in the mountains, and what the differences are compared to level running, why that matters, and then how to safely progress that training for yourselves and your patients. So uphill and so Adding vertical to one's training obviously means adding some uphill and downhill running, and those are obviously different than running on level ground. So uphill running is characterized by a lot more mechanical work, meaning there's a huge increase in the load on the muscles, as well as changing the biomechanics of running so that one is landing in more of a flexed position at the hip and the knee as well as more dorsiflexion at the ankle and that the amount of hip flexion, knee flexion, and ankle dorsiflexion is much higher in uphill running than level running and or certainly downhill running as well. Stance times are longer, the amount of time in flight is lessened, and impacts are overall less. As far as contrasting that with downhill running, downhill running is characterized by landing with a lot more, the knee in a lot more extension, a lot less hip flexion. And then depending on the experience of the runner for running downhill, If it's more of a novice runner, they're going to be characterized by striking with a rear foot strike pattern or heel strike pattern. If it's a more experienced downhill runner or trail runner, it's going to be characterized by more of a mid-foot strike pattern. Here, downhill running is basically characterized by negative work, so it's all eccentric work. So a lot of more impact to the runner and a lot less load specifically on the muscles, just more of an eccentric load. And so why does this matter? So, you know, thinking about your patients that you might be working with, if you have someone with a high hamstring tendinopathy, that's likely going to be loaded a lot more and potentially irritated more. with uphill running, right? Because that hip is going to be in more flexion. There's going to be more muscle work, particularly on the posterior chain with that uphill running. And that repeated high hip flexion angle is going to also cause some compression at that hamstring insertion. Whereas if someone is dealing with patel femoral pain or maybe medial tibial stress syndrome, Downhill running is going to really increase the stress on those areas with that increased impact and eccentric load and definitely irritate those symptoms. And so you want to be thoughtful when prescribing or getting those runners back into dealing with a vertical that, you know, if it's a high hamstring tendinopathy, you may want that runner to be hiking the uphills and then running the downhills. And then conversely, if it's someone with patel femoral pain, you'll want them to be running the uphills and hiking or walking the downhills. And in addition, If someone is running, whether it be on the road or on the trail, and they have a race that has a vertical profile with some elevation gain and loss, you definitely want them to be implementing hill workouts or running in varied terrain. early on in their training so that they have the time to adapt to those new loads on the muscles and on the joints, as well as, you know, adapt their running mechanics appropriately too. So typically, you know, if it's someone who's new to trail running and, you know, they're going to be running their first trail race and there's, you know, 5,000 vertical elevation gain and loss, they're going to be wanting to implement that training far out in their training. So months ahead of time, again, because of the differences in the mechanics and the loads on the muscles with uphill and downhill running. As far as ways to, you know, implement this safely, there really isn't any scientific evidence on this. It's mainly anecdotal, you know, a lot of kind of looking at a lot of the advice that coaches will give is really based on the 10% rule or the literature that we have on progressing training volume in running. So, you know, no more than 10% increase in vertical per week or certainly no more than 15% over the course of two weeks is a common piece of advice that you'll hear. So what does that look like? You know, if someone is running 10,000, or sorry, 1,000, vertical in the first week, uh, you wouldn't want to increase by more than another, um, a hundred the following week, if you're doing that 10% rule. And that's going to be really more for your novice runners. Um, and generally for your, your novice trail runners or novice runners that are, or novice runners running hills, um, it's going to be looking like, you know, probably being able to add a thousand feet of vertical. in their first week and then progressing from there with that 10% per week or no more than 15% for two weeks. If it's a more experienced trail runner that you're working with who has had a lot of experience of doing a lot of vertical, start at approximately 50% of what their vertical was prior to dealing with their injury. And then the last thing to consider is, okay, so we're talking about vertical, but how are we progressing that in the space of also progressing just running volume as well as intensity? And so a good rule of thumb here is to not, ideally, the safest way is to not progress all three of those elements in the same week, but realistically that's probably going to have to happen. And so the best place to start out is not increasing all of them combined by more than 15% per week. So what that would look like is, you know, I am running, you know, 50 miles a week. I'm doing a thousand foot of vertical a week. And then also within that week, probably, you know, adding in a speed workout as well. And so for the next week, I would want to not increase my weekly volume by more than 10%. So we keep that at, you know, 10% and then not increasing the combined vertical and amount of intensity work by more than 5%. So that would get us our 15% total there. So again, just to recap, you know, adding vertical or dealing with vertical with endurance athletes, uh, is going to be very common. Um, especially if, for those of you living in more mountainous regions, um, where trail racing is, is King. Um, but even for your, your road racers too, if they're going to be running a race with, you know, a vertical profile, so not Chicago marathon, but, um, you know, maybe Boston marathon. where there are some hills, you really need to be thoughtful of how to, one, implement that training, as well as how to progress that training, and how running uphill is going to stress their body differently. how it's going to change your mechanics. So again, uphill running is going to be a lot more load concentric on the muscles, especially on the Achilles, the glute, the hamstrings. And it's going to be characterized by a lot more, a much deeper angle of flexion at the hip, knee and ankle. Whereas downhill running is going to be characterized by a much larger eccentric load with potentially being at a rear foot strike versus a mid foot strike and adding a lot of impact. To progress that, we want to kind of draw on the information and experience we have from both coaching and the literature, which is going to be drawing on just level running. So not increasing vertical by more than 10% per week, or not increasing vertical volume and intensity for a sum of more than 15% per week. And wanting to implement this early on in their training so they have time to adapt to the stresses of training. I'll leave you with just one really cool article that came out more recently, which was looking at downhill running and adaptation to that. And really as little as one bout of 30 minutes of downhill running on a 20% grade results in what they call the bout effect, or it's really a protective effect on eccentric muscle damage and delayed onset muscle soreness. So after that one bout, the next time the runner runs downhill, they're going to have less eccentric muscle damage and therefore less delayed onset muscle soreness. So that's pretty cool. So definitely wanting to implement that downhill running as soon as you can into their training so they start getting those adaptive effects. SUMMARY All right. Well, thank you everyone for listening. We do have some endurance athlete courses coming up. of coming up right around the corner on July 8th is when our next cohort of rehabilitation injured runner online starts. So that is the last one for the summer. So we'd love to see you online for that. Our next professional bike fitting course is going to be in Denver at the end of July. And then our next rehabilitation injured runner live is going to be in Sparks Glencoe, Maryland. in September. So we'd love to see you at those courses. Reach out if you have any questions. Have a great weekend. Get outside. Do something fun. See y'all. OUTRO Hey, thanks for tuning in to the PT on ICE daily show. If you enjoyed this content, head on over to iTunes and leave us a review, and be sure to check us out on Facebook and Instagram at the Institute of Clinical Excellence. If you're interested in getting plugged into more ice content on a weekly basis while earning CEUs from home, check out our virtual ice online mentorship program at ptonice.com. While you're there, sign up for our Hump Day Hustling newsletter for a free email every Wednesday morning with our top five research articles and social media posts that we think are worth reading. Head over to ptonice.com and scroll to the bottom of the page to sign up.