A behind the scenes look into the approach taken at Radiance Physiofit to the assessment and treatment of an Olympic level runner.
Like most runners, Triyaningsih wants to get better, stronger, and faster. However, unlike most runners, her goals include an Olympic medal. For Triyaningsih (Triya for short), this is not out of the question – she holds the current SE Asian Games record for the 10,000m (34min 32seconds, in 2013). She also won the SEA Games 5,000m race and marathon in the same year. In 2012, she competed in the London 2012 Olympic games, finishing 84th with a respectable time of 2 hours and 41 minutes. Now, though, her sights are on Rio, and she is determined to get closer.
Unfortunately however, Triya, like a lot of runners, ran into the trap of many athletes who over-train and under recover, and ended up with a stress fracture of her right metatarsal. This led to a period off her feet while being treated by her podiatrist, the excellent Rob Ashton, based here in Singapore. Rob diagnosed that Triya’s chronic issues were in part based on an increased loading of one side as she ran, leading to her long term chronic issues, and thought that she would benefit from seeing Declan Halpin, the head physiotherapist here at Radiance Physiofit.
Declan explains: “Rob Ashton initiated the process, and referred Triya to see me so we could spend some time together and I could do a biomechanical assessment on her and screen her for any injury-potential predispositions. Based on those findings, I created for Triya a resistance-training protocol and more significantly, a movement-strategy that she can incorporate daily into her training to addresses her muscle imbalances, and target specific areas of weakness. This should not only avoid future chronic injury issues, but actually improve her performance as she builds towards Rio.”
Screening at Radiance PhysioFit:
So what exactly does the assessment process and screening entail?
Declan, with degrees in both Sport and Exercise Science, and Physiotherapy is adamant about the importance of a thorough movement assessment. “Without a full movement assessment, how can you design anyone’s conditioning program? It would be like a builder trying to build a house without any knowledge of the foundations! You could be doing more harm than good!” So what exactly is involved in the assessment process? “Whilst most good physiotherapists should be able to provide a pretty thorough muscular length and strength assessment, they very often forget to test the athlete through function, and they definitely don’t challenge the athlete’s movement systems enough. I like to use the Functional Movement Screening (FMS) system as a starting point, or a framework for my own assessments. It may not be the most sensitive tool available, but it because it provides an objective marker to work towards for the athlete, and enables me to communicate better with sports trainers and coaches who are also working with the athlete.”
FMS is a screening tool designed by American physiotherapist Grey Cook used to identify limitations or asymmetries in athletes when performing seven different fundamental movement patterns that are key to functional movement quality in individuals. All the physiotherapists and trainers at Radiance Physiofit are ceritified to provide the screening accurately, which allows them to refer clients to each other, and discuss their progress and improvements accurately and objectively.
With the use of both the FMS and Declan’s own functional tests (single leg squat, power hopping, and treadmill running), Triya was fully assessed. The results were surprising. Whilst Triya is obviously an excellent runner, she showed significant functional weakness between her left and right side. Indeed, when performing certain tests, Triya showed significantly less stability through movement in certain tests on her left hand side, leading to a medial collapse of her left knee, and a dropping of her hips on her left hand side.
Treatment Strategy at Radiance PhysioFit
Triya spent a month training with us at Radiance Physiofit, under the watchful eye of both the Head of Physiotherapy, Declan Halpin, and Seishen Ratnagopal, our Athletic Trainer. With Triya spending over an hour at Radiance everyday, there was plenty of time and opportunity to implement a completely individualised, holistic plan. The goal was to create a stronger, more stable athlete in Triya, and eradicate the discrepancy between her left and right side. The challenges facing the team were to maintain a degree of aerobic fitness in this marathon runner, whilst at the same time providing a strength program designed to activate her areas of weakness, and give her a rock-solid base of stability.
The first step of Triya’s program was to build strength in her glutes, specifically her glute medius, as well as other hip abductors and external rotators. Without this muscle firing adequately and consistently, it would be impossible for Triya to maintain a stable running gait, particularly as she fatigues. These were strengthened through isolation hip abduction exercises such as the banded clam and the cable hip abduction. (See videos).
Cable Hip Abduction:
However, the focus of her treatment was to create stability through movement, and thus we graduated as quickly as possible to exercises which reflected this. By introducing instability (using a wobble board) into movements such as lunges and squats, we forced Triya to engage the targeted muscles to maintain hip stability and avoid knee deviation. (See videos).
Wobble Board Lunge:
In other exercises, we created and challenging movement pattern by doing unilateral weighted exercise (single arm kettlebell cleans), forcing Triya to engage the correct muscles on one side. Also, by presenting a pull/push to Triya as she moved, she was forced to counteract the forces throughout the movements (banded reverse lunge) by engaging the correct muscles. (See videos). In order to maintain Triya’s aerobic fitness we had her doing long distance cycling sessions, high intensity rowing sprints, and sessions in the swimming pool.
Single Arm KettleBell Clean:
Reverse Lunge with Palof Press:
Reverse Lunge with Single Arm Shoulder Press:
Unfortunately, due to the enforced rest period prescribed for Triya’s stress fracture, we could never progress her exercises beyond this level with the introduction of explosive, plyometric movements. Adding speed to the movements is another stress which challenges the body to maintain form and function – and an area where many athletes fail. Very often athletes can be observed performing a perfect single leg squat, but when asked to perform five maximal repetitions they lose stability and display a malformed movement pattern.
Upon re-examination, Triya was found to be much stronger and stable, and scored an almost perfect score on her FMS – as expected by an elite athlete. Triya has been provided with a maintenance program to keep her new found strength levels high. However, time will tell whether this new stability translates into improved running form, improved performance, and reduced injuries. We are looking forward to having Triya back in Radiance once she is cleared to train at 100%.
The advantages of having a skilled and experienced assessor are clear, as they are able to really pinpoint your areas of weakness which might be hampering your performance, or leading you down the path to injury. As Declan points out himself, “Our rehabilitation programs are not designed to treat one small problem until you are pain free. Our goal is to return you to the track or the field performing at a higher level than before, with a much lower chance of reinjuring yourself.”
For those interested in having a full functional assessment at Radiance Physiofit, please contact us at firstname.lastname@example.org