by Russ Ebbets
In healthcare a clinical pearl is a tidbit of information that helps one arrive at a decision in a shorter period of time. In a sense a clinical pearl is a mental shortcut, maybe a “rule of thumb” that one has learned through observation, trial and error or experience. It could also be some institutional knowledge passed along by a Yoda-type before there was an institution.
The problem that some have with clinical pearls is that they are often experience-based and not evidence-based. Clinical pearls might not be the result of clinical trials or rigorous scientific scrutiny but rather the result of paying attention to disease patterns and disease processes that present on a regular basis.
The lack of scientific scrutiny may be due to the fact that clinical pearls often deal with the mundane, day-to-day decisions one must make that don’t register on the radar of prestigious peer-reviewed healthcare journals. Clinical pearls seldom fall into the “weird and wonderful” category and generate the glamor of institutional funding or grab a headline on the evening news.
So, what is the value of a clinical pearl? Remember, traditional healthcare is usually about pain and suffering. Anything that can reduce the time of pain and suffering is a worthwhile endeavor. Diagnosis precedes action, and time is of the essence in diagnosis. For a healthcare provider clinical pearls offer a means to make a quick decision.
Are clinical pearls always right? Probably not, but they always offer some direction, some place to start from which the efficacy of conclusions can be ruled-in or ruled-out to chart a future course of care that can be planned and enacted.
These 30 training pearls detailed below are similar to clinical pearls in many ways. They are concise observations that lead to conclusions that are the result of years and years of involvement and observations in the sport. Will they always be right? Probably not, but they offer at the very least a hint of direction from which an evaluation and decision can be made.
The training pearls are divided loosely into three general categories: anatomy and physiology, overtraining and training theory. Some of the training pearls may be taken with the proverbial grain of salt. I am confident one will find more wheat than chaff here. At the very least they will prove to be a rich source of topics for discussion on your next training session.
Anatomy and Physiology
- The human body consists of about 50-75% water. Water always takes the easiest course. If your motivation is running low one day, think about this.
- When one feels compelled to put the hands on the knees the heart rate is over 150 bpm.
- Once the heartrate reaches 170 beats per minute the intensity of the activity can be maintained for about 30 seconds.
- One loses the ability to talk fluently when the heartrate is greater than 120 beats per minute.
- When charting morning awakening heart rate, if the heartrate shows a 10% increase over one’s “average,” this is a sign of being overtrained and not recovered from the previous day’s workout.
- Pathologic pronation can be measured by noting how much the navicular tubercle (the second most prominent “bump” on the inside of the foot) drops from a seated to standing position. Movement of greater than 1 centimeter is seen as a positive sign for pathologic pronation.
- Isometric contractions strengthen the soft tissue holding elements of the body (ligaments, joint capsules, tendons, fascia) that are responsible for joint stability and play a role in the dynamic stretch reflex.
- Running economy (RE) is a measure of movement efficiency. RE is measured in mL of oxygen consumed/kilogram of body weight/kilometer run (mL/kg/km). RE can be affected by one’s symmetry of motion, balance, strength, velocity, VO2 max and such environmental factors as wind, terrain, incline or ambient temperature.
- The foot loses its ability to dorsiflex as we age. This is one of the reasons why Achilles and plantar fascia problems develop in the 30’s and 40’s. Compounding this problem is that we sleep with the foot in a plantar flexed position for hours on end. This allows the calf muscles to “rest” and heal in a short and tightened position.
- Scientists are finding that the health of one’s intestinal flora aids endurance qualities. This is one of the justifications for the controversial use of fecal transplants.
- Heat injuries (heat exhaustion, heat stroke) appear to be cumulative. Long term thermoregulation problems can result due to brain injury from the excessive internal core temperature.
- The normal foot naturally supinates at heel strike and toe-off. Supination “locks” the bones of the foot creating a rigid lever that makes the propulsion of the gastroc-soleus (at toe-off) more effective or the shock transfer and shock absorption by the hamstring/gluts (at heel strike) more efficient.
- Children tolerate internal heat generated by endurance events more poorly than adults. This is due to the child’s disproportionate head size (1/5th body height) compared to an adult (1/8th body height) and the decreased surface area for evaporative cooling.
- When it takes as much effort to put your training shoes on as it does to actually start training taking a day or two off might be the better option.
- Overtraining is usually divided into two categories. Neural overtraining is the result of too much speed/power training and is an exhaustion of the sympathetic nervous system. Metabolic overtraining takes longer to occur and is an exhaustion of the parasympathetic nervous system and seen more in endurance athletes.
- Asymmetric stride patterns from right to left and left to right are a primary cause of overuse injuries. Optojump studies have shown that an abnormal gait pattern needs to be greater than 17% asymmetric before the “limp” is obvious to the naked eye.
- Injuries are problematic because replacement scar tissue does not have the elastic qualities of healthy tissue. The problem can repeat and repeat until the original injury turns into a chronic or career limiting problem.
- It takes about 20 minutes of continuous activity to elevate the body’s core temperature. This is a point to consider when planning one’s “warm-up.”
- The large muscles of the body take the longest to awaken and become fully activated. A pre-breakfast morning jog can help accelerate this process for an early morning race.
- Coordination is a sign of intelligence.
- Stretching the adductor magnus (groin stretch) before the hamstring group will yield a 10 degree greater range of motion in forward trunk flexion. In terms of “touching one’s toes” this stretch sequence will give a 3-4” increase in range of motion.
- The best test of athletic ability is the vertical jump test.
- Losing 10# of body weight can decrease one’s 10K time by 60 seconds. This “law” has diminishing returns as with too great a weight loss one loses muscle weight and therefore propulsive abilities. One also loses the protective layers of fat within the body that cushion organs (specifically the kidneys) and mitigate the shock of ground contact (the heel’s calcaneal fat pad).
- Superlative efforts or personal bests invoke the 10-Day Rule. The 10-Day Rule dictates one actively rest the body 10 days following a superlative effort to allow the nervous system to recover and adapt. It takes the nervous system 7x as long as the muscular system to normalize.
- The ability to rise quickly from the ground is a sign of core stability.
- Training age is the point in an athlete’s career when they begin to specialize in one event or sport. For most athletes that time corresponds with the end of high school but could be as young as 11-12 years old for a female gymnast.
- Spinal manipulation increases one’s ease of motion, increases neural drive from the brain and enhances the expression of the five biomotor skills (speed, strength, flexibility, endurance and the ABC’s of agility, balance, coordination and skill).
- There are only five ways the spine or a joint can move – flexion, extension, lateral bending, shearing or sliding and rotation. Not all joints can actively move in all directions but there should be some passive movement or joint play in all directions. Excessive movements in any of these directions can lead to injury.
- Some say pain is “weakness leaving the body.” Pain is actually a defense mechanism of the body. Pushing through pain is a requirement of superlative effort. The callousing work of interval training, resistance work or an increased work capacity can all help one better manage pain. When does pain shift from a nagging nuisance to a wise counselor? If there is technical breakdown with an uneven, poorly coordinated or non-productive asymmetric body movements – listen up.
- Modern training theory is based on the application of stress to the body. This thought evolved from the pioneering work of Hans Selye and his classic book, The Stress of Life. Remember, stress represents a cumulative, multi-factorial assault to the body that may include changes to the physical (fatigue of a workout), sensory (decreased awareness of the 5 senses or the “analyzers”), emotional (temperament, attitude, motivation, fear confrontation) and intellectual (thought, reason, decisiveness) facets of the athlete.
There you have it. Food for thought. Have a Happy New Year!
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Russ Ebbets, DC is a USATF Level 3 Coach and lectures nationally on sport and health related topics. He serves as editor of Track Coach, the technical journal for USATF. He is author of the novel Supernova on the famed running program at Villanova University and the sequel Time and Chance. His most recent book, A Runner’s Guide, a collection of training tips and running articles was a 2019 Track and Field Writers of America Book of the Year finalist. He can be contacted at firstname.lastname@example.org.