Cadence: It is a Big Deal

Knee pain, “shin splints”, and stress fractures are one of the most common running injuries. Below is a typical conversation that I have with a runner at 3D Wellness with one of these problems:

Me: “What do you know about cadence?”

Runner: “It’s the number of steps that you take in a minute.” (Sometimes even adding “It should be somewhere around 180 steps per minute”)

Me: Do you know what YOUR cadence typically is?

Runner: “No, but I know it is supposed to be around 180” OR “Yes, it somewhere around (insert number significantly <180)”

Me: Is it something you have worked on before?

Runner: “No” OR “Yes, I took a running form class that talked about it, but I did not really focus on it.”

The reason why I took the time to give you a glimpse into a patient interaction is because runners often DO know about cadence, but the importance has not been stressed enough. What if I told you that over half of patients that come in with knee pain or previous stress reactions had their problems completely if not mostly resolved by simply increasing their cadence? What if I told you that if you just increase your cadence by 5% that you will reduce the impact through your lower leg by 20%? Yes! That’s right. A 5% increase gives you 20% less stress!! Would you put more emphasis into training with a higher cadence? Most would say a resounding, “YES!”

If you are a runner that wants to avoid knee pain or a stress reaction,  be proactive and start working on that cadence! Here are the steps:

  1. Find out where you are starting. What is your current cadence?
  2. Add 5%. Download a metronome app or check out the RunCadence app.  Hit the ground softly with every beat and aim for a rate 5% greater than your baseline.  It should feel weird and make your lungs work a little harder at first.
  3. When it stops feeling weird, add another 5% until you land comfortably somewhere around 180 steps per minute.


Femoroacetabular Impingement (FAI)

What is an Femoroacetabular Impingement (FAI)?

  • A structural adaptation found in hockey players
  • Abnormal contact between the ball and rim/socket during activity
  • Results from a ball that is not perfectly round (CAM) or a socket that is too deep (PINCER)
  • Repetitive impingement leads to “pinching” of the labrum between the ball and socket
  • Labral tears are common and often do not cause pain
  • Important to recognize and treat the underlying impingement
  • FAI presents as decreased hip flexion and internal rotation range of motion


A Recent Study

FAI research is in progress.  The study looked at youth hockey players from 10-18 years of age, and compared their age to prevalence of FAI and labral tears.  The results are eye opening. The table below summarizes the findings.


Age FAI Prevalence Labral Tear Prevalence
10-12 37% 48%
13-15 63% 63%
16-19 93% 93%

Signs and Symptoms

  • Deep sharp groin pain
  • Worse with quick turns
  • Limited hip rotation/flexibility/stiffness
  • Unable to sit for prolonged periods
  • Groin / Front of the hip pain after activity

PT’s Can Rule Out 

  • Rule out muscle and tendon strains, contusions, fractures, Athletic pubalgia (sports hernia)
  • The study did not report if these athletes were symptomatic. Since FAI’s are bony abnormalities it is not possible to “stretch” someone into new ranges if they have FAI because those ranges will not be available. Develop appropriate exercise accommodations and individualized programming to ensure that the athlete does not approach end range during training sessions

Upper and Lower Cross Syndrome In Athletes

Muscular imbalances in our athletes can lead to major injuries. Hockey is a fast pace, aggressive game that requires specific skills and physiological attributes. These postures and structural adaptations may result in subsequent injury. Being aware of the importance of injury prevention can lead to a better, healthier skater.

Posture and high force skate production require certain techniques that can cause adaptations such as upper and lower cross syndrome. Hockey players are in the athletic crouched “ready position” for long periods during their games and practices. Shifts last 30-45 seconds, 60-180 “hockey game minutes”, and sit on the bench resting in the same flexed hips, forward head and rounded shoulders posture. These postures are called Upper Crossed Syndrome and Lower Crossed Syndrome.

Upper Crossed Syndrome posture has rounded shoulders, forward head, increased rounded back (thoracic kyphosis). Lower Crossed Syndrome posture has an anterior tilted pelvis, weak gluteus, and arched low back (lumbar lordosis). The muscle imbalances that occur in this posture can cause pain, decreased muscle activation and muscle overuse. A comprehensive assessment should be utilized to develop an individualized program to help hockey players train at their maximum potential and diminish injury risk.

Skating Balance and Stability Training

Skating is a technique that is learned and practiced starting at a very young age. As you progress through your hockey career, don’t forget off ice training. To become a better skater you must train your bodies 3 feedback systems: vestibular, proprioception, and visual.

Vestibular System:

The vestibular system is made up of 3 semi-circular canals inside you ears that are filled with fluid. The combination of fluid movement is what keeps us feeling “level”.  After a concussion this system is usually compromised and typically requires appropriate intervention to return to normal.


Our body has receptors in our muscles, tendons, ligaments and joints. These receptors give us feedback of where our body is in space.

Visual System:

The visual systems plays a LARGE role in our stability and balance and we rely on it heavily with all daily activities and during sports. For example, stand on one leg…..EASY. Now, perform that same task with your eyes closed. Not as easy! Ours eyes constantly track and respond to our ever-changing environment.  When training, the more we challenge this system the more adaptable it can be when we need it during quick direction changes during sports.  This is the system we typically over-rely on.

Put it all together:
All 3 of our systems (vestibular, proprioception, visual system) work in a delicate balance to keep us balanced and stable.

If you would like a balance assessment to improve your daily life or sports performance contact me at

Whole Body Mindset in Hockey

Building overall fitness enhances hockey-specific training gains. Fitness can be improved with increased flexibility, proper nutrition, decreased body fat, increased strength and muscle mass, and elevated aerobic power. Hockey season is long! Performing well in all of these categories is important to success.

Athleticism builds on fitness. Putting the athlete more in tune with their body will help develop better movement. Just as power-skating coaches modify body mechanics on ice, a focus on athleticism improves body function off the ice. The best athletes make the best hockey players. The higher their fitness and athleticism, the more they can capitalize on hockey-specific training (Peter Twist). This thought process then leads to the question: What can a Physical Therapist can do to help enhance your hockey skills and performance?

A Physical Therapist (PT) is educated to look at the body as a whole with focus on flexibility, strength, range of motion and gait. PTs observe how the body moves and look for dysfunction to help prevent injury. It is a misconception that physical therapy is only utilized after an injury. The best rehabilitation happens prior to an injury to prevent it from happening in the first place. An assessment of the whole body will allow a PT to be able to develop a plan for an athlete to help reduce injury and enhance their sport performance. We plan ahead for retirement with a 401K, why not plan ahead to keep your body healthy all season long by preventing injury and investing in your overall fitness through a physical therapy assessment.

Concussions 101

What is a concussion? According to the Center for Disease Control (CDC) a concussion is a type of traumatic brain injury (TBI). They are caused by a bump, blow, or jolt to the head or by a hit to the body that causes the head and brain to move rapidly. This movement can cause the brain to bounce around or twist in the skull, stretching and damaging the brain cells and creating chemical changes in the brain. The best way to visualize what happens to the brain is like shaking a bouncy ball inside of a jar. This injury can cause numerous problems.

CT Scan and MRIs do NOT show concussions 99% of the time. These tests are only used on occasion to rule out more severe brain injury (subdural hematoma, epidural hematoma). The take home message is that a clean scan does not mean the athlete does not have a concussion, so we need to know what symptoms to look for.

Symptom List:

  • Physical signs- headache, loss of consciousness, amnesia, nausea, vomiting, balance problems, dizziness, visual problems, fatigue, sensitivity to light/noise, numbness/tingling
  • Cognitive impairment- slowed reaction times, difficulty concentrating or remembering, feeling slowed down, feeling mentally foggy
  • Emotional impairments: irritability, sadness, more emotional, nervousness, anxiety
  • Sleep disturbance- drowsiness, sleeping more/less, troubles falling asleep

1.6-3.8 million people sustain concussions each year in the US (56.4 per 100,000). Concussion testing preseason is so important for our athletes! If an athlete sustains a concussion these baseline tests can be used to find the athletes deficits and better treat the injury to get the athlete back on the field as fast as possible.


Contact Dr. Katie Varga, PT, DPT at for questions regarding concussion testing for individual athletes and teams!

The Rotator Cuff Revealed

Rotator Cuff ComicThe rotator cuff tear is one of the most common shoulder injuries. Here are some FAQs from patients newly diagnosed with a tear or who suspect a tear.

Q: What is the rotator cuff?!
A:  It is a group of four muscles: the supraspinatus, infraspinatus, teres minor, and subscapularis. The supraspinatus muscle tendon is the most commonly torn.

Q: What is a muscle tendon?
A: It’s what connects the muscle to your bone.
Q: What does the rotator cuff do? 
A: Each muscle in the group plays its own role, but basically the rotator cuff helps to raise your arm, rotate your shoulder, and maintain the ball of your shoulder joint in the proper position.
Q: What causes rotator cuff tears?

Read more