Episode 3 – Dr. Kasey Hill- Stay Curious

Dr. Kasey Hill is a Sports Medicine Doctor in Baton Rouge, LA, who has been helping Runners, Triathletes, and a variety of other athletes get stronger, fitter, and healthier with his 12 week group training classes targeted towards running called “Power Running”.

From which shoes may be best for you and why shoes don’t prevent injuries, to “Toe Yoga”, what the heck is the “Rotisserie Chicken Exercise” (Hint: it does NOT involve KFC, Chick-Fil-A, or Popeyes) and why it may be a valuable addition to YOUR strength training program, this episode is packed full of great expert insights and tips to help you see a boost in your running power.

Show Notes:

In this Episode:

• Dr. Kasey Hill
• Dunning-Kruger Effect
• Relaunching Running Strong – Power Running
  • Why start the class?
  • Do the same people come back or are there new groups that come in?
  • How to program/organize the class?
• Definition of Core Control
• Stiffness to Control Motion and Stretching
• Pelvic and Core Positioning, Breathing, and Posture
• Class Strengthening and Exercises
• Focus on Small vs. Gross Muscles
• Easy Take Home Exercises
• Conclusion

0:52 – 

Dr. Kasey Hill

• From Baton Rouge, LA
• Works in sports medicine at the Ochsner Medical Center
• “I think we have very similar philosophies” – Dr. Hill to Menachem
• One of his mentors is Jay Dicharry who he worked with at UVA – Charlottesville at the Gait Lab
  • Dr. Hill reached out to Jay and said, “I’m feeling kinda comfortable with biomechanics, but I wanna learn more about just training”.
  • Jay responded, “read everyone, and make up your own mind because whenever you start thinking you know it all, then you’re in a dangerous place and you’re not willing to learn and grow at that point”
• Dr. McGill has mentioned as well in his presentations that It’s become almost dogmatic to think you know everything
  • The true experts say the answer is it “it depends”

5:08 – 

Dunning-Kruger Effect

• Graph that shows the willingness of an individual to discuss something/their confidence in it vs. their actual knowledge of it
• “I think it’s one of the truest graphs I’ve seen… and part of the tricky part is knowing where you might fall on that graph” – Dr. Hill

• Realizing how often we don’t know the answer is such a big part of medicine and sports science right now
• It really depends on the individual, so when it comes to different shoes for running Dr. Hill sometimes says, “try on a lot of different shoes and whichever one feels best – go with that one”
  • But, you also don’t want to look like you don’t know what you’re talking about, so runners have responded to Dr. Hill in different ways depending on the person. Most people are reasonable and if you take the time to explain to them what’s going on and what the research shows, then they tend to understand
• “Shoes for runners are kinda like bikes for cyclists” – Menachem

8:58 –

Relaunching Running Strong – Power Running

• “Strength training can be one of the best supplements for endurance sports”
• There’s a lot of research to support this, but not a lot of people have caught on to it yet
  • Strength training increases efficiency and decreases the shortening of the stride later in races
  • There is also a ton of overlap on what you might do for a cyclist vs. a runner, which can be seen in Triathlon Science
• The class has helped to convince the runners that they need to do strength train and continue strength training
• 3 month (12 week) program

12:17 –

Why start the class?

• • He would do a clinical gait analysis, which is unique for an MD to do, and is typically done by a PT
  • If a runner is having a problem Dr. Hill would say, “hey, let’s hop on the treadmill and take a look”. He’d then watch them run, get a history, and do a physical exam. After, he’d give a list of stretches, mobilizations, exercises, and drills
    • The problem was that a lot of people don’t do it on their own at home, so people would ask if they could do it weekly or have a class
  • Dr. Hill also heard his mentor Jay speak about a class he had at his new job and it was very similar
  • From a business perspective, he doesn’t make much money from the class, but it’s better marketing, and it’s real preventative care. It also helps people see that strength training for runners can be beneficial

14:47 –

Do the same people come back or are there new groups that come in?

• Mostly new groups who have heard about it or seen online marketing
• The same people started to come in and say, “I still don’t feel comfortable doing it on my own”, so he started an advanced class. This way, once people have gone through the intro then they can join the advanced group
  • Around 6-10 people per class
• “If you run for a year, you might get pretty good at running, but if you stop running for 6 months, you’re not gonna be able to pick up right where you left off, and it’s the same for strength training. If you wanna get the most benefit from it, you gotta keep it going to some degree at least” – Dr. Hill
• General principles of class are always working on power, strength, and stability

16:55 –

How to program/organize the class?

• • Done through the lens of sports performance as well as MD, so part of his goal is to make sure no one gets injured
  • Week one of class is posture, which ties in with core control/stability. They also address the question of what is core bracing?
    • Essentially, it’s spine neutral because that’s what we want in running, using more of the transversus abdominis to hold position
  • Also, teaches them to feel their muscles and use them, specifically the gluteus maximus and medius
  • Usually start class with a biomechanics lesson and then take them through a workout
  • First couple of weeks can look like therapy exercises because they are very focused and specific on form
    • This cues people to fire the right muscles and stay in the right position
  • Each week builds on the last week and gets to harder body weight exercises and slowly starts introducing strength exercises
  • Week two of class is hip hinging, specifically with spine neutral position, and they’ll work on it for 6 weeks before introducing a barbell
    • This way they can work on motor patterning first, and then slowly add resistance and load to it to build on strength

20:50 –

Definition of Core Control

• Core stability: “the ability to keep the spine in a pretty stable position while we can move our limbs back and forth” – Dr. Hill
• Dr. Hill’s shared a popular saying from UVA, which was, “you don’t wanna fire a cannon from a canoe”. In this case, the canoe is the core, which is the base of all movement because the hip attaches at the pelvis which attaches to the spine
  • The cannon needs a stable base to work from
• Strength training helps with efficiency
  • A lack of core stability makes you less efficient in your movements because you’ll wind up wasting more energy

23:46

Stiffness to Control Motion and Stretching

• Force creates motion, but you need that stiffness to control the motion
• Stretching hamstrings only releases neural tension, which returns after 20 minutes
• Loss of internal and external hip rotation is a direct correlation to lower back pain and discomfort because you lose the ability to have that stiffness and control the motion
• Not a lot of Dr. Hill’s patients have back problems, but he does have a lot of people with a chronic hamstring, for which he usually looks more at the hip flexor
  • “Almost everybody (especially cyclists) has a tight hip flexor” – Dr. Hill
  • Stretching the hip flexor will help with some of the hamstring pain

• • “Specifically with runners, these muscles – the deep 6 of the hip – are often so neglected” – Menachem
    • This led him to get into postpartum corrective exercise, which is focused on breathing
• Hip flexor stretch half-kneeling: the stretching sensation is the capsule of the hip because your hip flexor is locked and you’re getting that hinge
• Static stretching is a dogma
• Dr. Hill’s way of doing it: have people get in typical kneeling position, but instead of worrying about moving forward and getting the hip behind them, they stay nice and tall, and will do a posterior pelvic tilt – draw the abs in, squeeze the glut (to pull the pelvis down and give reciprocal inhibition to the hip flexor) and hold the stretch
• The elite guys usually can’t touch their toes because they have such tight hamstrings
• Inchworms are a really good exercise to show cyclists and triathletes that they need to really get their hips down
• Internal obliques are the largest of the abdominal muscles
  • Internal obliques are in stretched position in anterior pelvic tilt, so they won’t be able to really stabilize and produce pressure, leading to hamstring tightness

34:23

Pelvic and Core Positioning, Breathing, and Posture

• Vern Gambetta on his podcast the GAINcast, said something along the lines of “as long as you’re breathing you’re good enough”
  • “As long as you’re not holding your breathing and passing out, I’m generally good with it” – Dr. Hill
    • He wants to learn more about it down the road
• How he teaches it is in the hook lying position: on back, knees bent, feet on the ground, like you’re about to do a bridge
  • Feel front of hip bones, slide finger inward ~1 inch and separating firing the transversus abdominis vs. not really crunching down
  • Might have them put one hand under their low back so they can feel if they’re pressing down into the ground doing too much of a posterior tilt and find what feels neutral with cuing
    • “Like you’re putting on your really tight skinny jeans” – Dr. Hill
• It’s learning the position and then strengthening into it, so they do lots of planking and side planking to work the lateral chain
  • “A plank is a very static exercise and running is never a static sport” – Dr. Hill
  • As soon as they can do a certain amount of time planking (~40 seconds), we back off to 20 or 30 seconds and add movement
    • Donkey kick plank, spiderman plank, or running man side plank
• Just by simply changing the lever arm, the length of how long you have to work, as well as angle that the gravity is affecting, can have a significant positive effect on your training and ability to execute a movement
• The obliques have those 4 components: lateral – medial and upper – lower, and to get the full training effect, you need to get all 4 compartments

40:39

Class Strengthening and Exercises

• Dr. Hill teaches squats, specifically chair of death squats, in which the knees stay behind the toes, and you sit into it with more of a hip hinge pattern. This teaches you to use glutes more than quads
• Eccentric calf raises, which tune up the Achilles and calves
• Most of the rest of the exercises are laying down, but he wants to progress to upright, closed-chain, more functional stuff
• Dr. Hill does versions of pallof press with the advanced class
• Double-leg bridge → bridge march → single-leg bridging (increases with difficulty)
  • Big focus is to not let rotation happen
• “Rotisserie chicken”: single-leg bridge in which the foot on ground is the spit through rotisserie; drop pelvis down and raise up; rotate ~20º
  • Check it out on Facebook! @DrKaseyHill
• Once we get used to doing these exercises without spinal rotation, we start to introduce rotation exercises because there’s a lot of it in both running and swimming
• Stand and put hands across the chest on shoulders and work on rotating shoulders side to side without letting the pelvis move. Then, hold shoulders still and see if they can rotate pelvis right and left without jutting out to the side or arching their back
  • Looking for pure rotation without extension
• Tippy twist: single-leg deadlift with same rotation as “rotisserie chicken”; down position with hips level; hips down → hips up → back to level → stand back up
• Tons of balance work with foot and ankle needing to control you (happens week ~10-12)
• “There’s a recipe and ingredients” – Dr. Hill
  • Recipe = gait analysis and how someone runs
  • Ingredients = what needs to be improved upon

50:23

Focus on Small vs. Gross Muscles

• According to Dr. Kathy Dooley, the gluteus medius is like the rotator cuff for the hip, which helps pull it and center the femoral head and acetabulum. They are both ball and socket joints – except in the hip we’re much more bulky and have bigger muscles
• All of the small muscles have to work together for the system to run smoothly

• Dr. Hill definitely focuses on small muscles with his runners
• Toe Yoga: slightly different version of short foot or foot doming
  • Main goal: hold little toes up in the air while driving big toe straight down
  • It is also important to avoid curling, which typically happens from muscles in the leg. It’s more focused on working intrinsic muscles of the foot and bracing the arch – similar to bracing the core
  • Usually, they can separate little toe movement from big toe movement
    • Work on strengthening flexor hallucis brevis 
    • Dr. Hill works on toe control, foot control, and strength not in shoes
• Progressively working on balance and learning to separate and control hind foot on forefoot motion
• If you practice standing on a pillow and a squishy bosu, you’ll get really good balance standing on those things, but it won’t necessarily translate to a different environment
  • If you’re running on a solid surface, Dr. Hill would then prefer to do foot and balance work on a solid surface

57:38

Easy Take Home Exercises

• Menachem’s is the Kill Bill exercise – “wiggle your big toe”
  • Go buy spacers for in between your toes that women use for pedicures and wear them for about 15 minutes a night and feel the bones moving
• Dr. Hill’s Toe Yoga
  • Barefoot – sitting down in a chair – one foot at a time, unless two feet are easier
  • Working on separating big toes separate from little toes, and once they’re good at it, they can try it with shoes on, even while at work
  • This should help with coordination and movement
  • Sitting → standing → standing on one leg
    • Short foot/foot bracing

1:03:04

Conclusion

• Takeaways/gems for the listeners:
  • “I wanna say it depends” – Dr. Hill
  • Don’t neglect stability. It’s really important, especially for not getting injured
    • Pay attention to how you practice stability and get some good resources if you don’t know the proper technique of how to do it
  • Get in the gym, lift heavy weights, and develop power
    • This will translate to running and cycling, and don’t worry, you won’t turn into a muscle head!

• “I gotta stay curious” – Dr. Hill
  • Those that are making a difference are those that are asking questions
• Where can we find you?
  • Instagram: @drkaseyhill
  • Facebook: Dr. Kasey Hill