The Best Way For YOU to Run Hills

Although spring is approaching quickly, it still is winter in West Chester, Pennsylvania.  The mornings are dark, the wind is bitterly cold.  And while some town residents may be awaiting a warmer breeze before trading their comfortable bed or favorite TV show for an invigorating run, the members of local running clubs and other lone runners are pushing through the winter obstacles with dreams of PRs (personal records) in the spring, summer, and fall.

If you are a runner, you may know of some of the workouts they are completing.  Tempo runs, long runs, and fartleks are just a few.  But the one other workout synonymous with winter for runners is hills.  With the possibility of a track being covered with snow and ice, hill workouts on the road are a great way to develop a variety of characteristics vital to the success of a runner.  But how long? how fast? how many? how much recovery?  The questions are numerous.  And yet the answer is very individualized.

First, let's review just a few of the many different types of hill workouts…taking a close look at the purpose and use of each one:

1.)        Hill sprints (alactic = no significant lactate accumulation): 6-12x10-12 seconds at maximal effort on a steep hill with a walk-down recovery (2-3 minutes)

·         PURPOSE: Improve maximal speed and muscular strength by recruiting the highest possible percentage of fibers in the muscles

·         USE: FOR ALL RUNNERS throughout every period of the year….dosage can be adjusted depending upon time of the season

2.)        Hill exercises: 4-6x20-50m of high knees, butt kicks, skipping, and bounding on a moderate grade uphill with a walk-down recovery (1-2 minutes)

·         PURPOSE: Improve elastic reactivity (i.e., agility, quickness) and/or muscular strength

·         USE: For runners lacking strength (early to mid-season) or who are returning from injury [At FLASH Sports Physical Therapy, we utilize hill exercises in the later stages of rehabilitation as a form of running-specific strengthening....think of these hill exercises as squats for the runner!]

3.)        Longer hill repeats at MAXIMAL effort (significant lactate accumulation): 1-10x30 seconds-3 minutes at maximal effort on a fairly steep hill with a walk-down or very slow jog recovery (90 seconds-6 minutes, depending upon length of uphill section)

·         PURPOSE: Improve ability to recruit the greatest number of fibers in the muscles when they are full of lactate while generating the highest amount of power

·         USE: For runners who are preparing specifically for 800m-10k races, need to improve their finishing speed (kick), are preparing for a hilly race, or tend to peak early and need a replacement for early to mid-season high-intensity track work

·         ***Also advised for those returning from injury as one is eliminating the increased impact forces of faster, downhill running.

4.)        Longer hill repeats at SUBMAXIMAL effort (moderate lactate accumulation, sustained work above anaerobic threshold): 6-12x30 seconds-3 minutes at submaximal but strong effort on a fairly steep hill with moderately-paced running recovery (45 seconds-4 minutes, depending upon length of uphill section)

·         PURPOSE: Improve ability to run strongly when fatigued, boosting the anaerobic threshold and aerobic power with an element of strength

·         USE: For runners who are preparing for half-marathon-marathon+ races or are preparing for a hilly race that might involve a series of uphills preceded by some downhill sections

·         ***Not advised for those returning from injury as one is subjected to increased impact forces during the faster, downhill running.  Also, remember not to rush the 180-deg. turns at the top and bottom of the hill; taking these turns too quickly can place a great amount of stress on the knees and other areas and increase your likelihood of injury.  Therefore, although the total time of the workout can be a good measure for quantifying improvement, focusing on the individual times of the uphill and downhill sections may be a better option.  The ultimate emphasis still should be on the uphill portions, however.  Do not improve your downhill time splits at the expense of your uphill time splits; your uphill time splits should be the same to slightly faster from one session to the next while gradually bringing down the time of the downhill splits.

5.)        Uphill tempo runs (moderate lactate accumulation, continuous effort slightly above anaerobic threshold, can be performed on a treadmill for runners who do not live in mountainous areas): 15-45 minutes continuously at an effort slightly above anaerobic threshold on a moderate grade hill

·         PURPOSE: Improve ability to run strongly as one fatigues, boosting the anaerobic threshold and aerobic power with an element of strength

·         USE: For all runners in the early to mid-season (as a replacement for a flat tempo run) and throughout all periods for runners who are preparing for a hilly race; also can be a good replacement for longer hill repeats at submaximal effort with moderately-paced downhill recoveries as the overall stress to the cardiovascular system is similar (perfect for those runners returning from injury but who cannot tolerate the downhills yet!)

As you can see, hills are a gold mine for variety of workouts.  You also can manipulate stride length and frequency depending upon your desired effects and/or strengths and weaknesses.  This idea can be explored further in a future blog post.  So to answer the age-old question: Is there a best way to run hills?  The simple answer is yes while understanding that the best way for YOU today may not be the best way for YOU in 3 weeks or for one of your running partners.  Determine your goals and needs and find the best fit for you.  This same principle applies to the planning of any running workout.  Do not shortchange your running by falling into a rut of staleness; invigorate your workout routine so that YOU can run to the best of your God-given abilities!  

Keeping Your Pockets Fuller with Out-of-Network Physical Therapy

As the owner of FLASH Sports Physical Therapy, LLC, I often am asked by prospective patients if working with an out-of-network physical therapist will cost them more money.  My response: "Typically, no.  And oftentimes, less money in the long run."  But how is this saving remotely possible?  How is shelling out $100 for a 60-minute treatment session less money out-of-pocket than if you work with an in-network physical therapist and pay your traditional co-pay?

Health insurance companies tell us that we will save money by staying in-network.  For many procedures, this statement is true.  For instance, if you undergo ACL reconstruction, you will owe less money out-of-pocket for a surgeon's time if he or she is in-network compared to out-of-network.  Ultimately, these savings occur because the surgery is a one-time procedure on a particular day that is not influenced by the final outcome.  In other words, the health insurance company will pay the surgeon the amount of the previously negotiated fee that is to be covered by them so long as the surgery is completed successfully; your out-of-pocket costs will be whatever your health insurance plan originally designated as your responsibility (may be a co-pay, coinsurance, payment towards a deductible, etc.)

Now, let us take a look at the costs associated with in-network and out-of-network physical therapy care for a minor Achilles tendon issue.  The patient is a male high school runner who has struggled with increased symptoms in his Achilles tendon for a little over a month whenever he attempts to run faster workouts.  He is on his family's health insurance plan, which is a HMO plan.....the Aetna Advantage HMO 30 plan (Pennsylvania) to be specific.  So, what happens if he works with an in-network physical therapist?

$50 co-pay per visit, 2x/week for 8 weeks (16 total visits) = $800 out-of-pocket (after the initial evaluation)

If he is lucky, he will spend 15 minutes working directly with the physical therapist (perhaps manual therapy techniques and patient education)....not because the physical therapist does not want to work longer with him but because he or she has to see two other patients in that same hour.  With whom will the patient work the remaining 45 minutes that he is in the clinic (during which he performs exercises)?  Most likely a physical therapy technician or aide, who is usually a high school or college student interested in the field.  The patient enjoys working with the technician but truly values his time spent with the physical therapist, so if we calculate the amount of money he is paying the physical therapist per hour, we determine that rate to be $200 per hour ($50 for 15 minutes of time = $200 per hour).  **Grand total = $800 dollars out-of-pocket for 240 minutes spent directly with the physical therapist, 720 minutes of exercise with physical therapy technician.

What happens if this same exact patient works with an out-of-network physical therapist?

$90 per visit (10% discount), 1x/week for 4 weeks (4 total visits) = $360 out-of-pocket (after the initial evaluation)

In this case, the patient will spend 60 minutes working directly with the physical therapist.  In my clinic, 50 of these 60 minutes most likely will be spent on performing manual therapy techniques to directly facilitate healing of the Achilles tendon.  The last ten minutes will be spent reviewing the patient's home exercise program (to be performed daily to 3-4 times per week, depending upon the situation) and educating the patient.  Also, if this patient is working with me, he will receive a 10% discount on all services since he is a high school runner.  The physical therapist's rate per hour is exactly what the patient already paid him: $90.  **Grand total = $360 dollars out-of-pocket for 240 minutes with the physical therapist, performing home exercise program on own

***Summary: Discounting confounding variables (possibility of biology of tendon healing requiring 8 weeks of rehabilitation instead of 4 weeks despite concentrated manual therapy time and/or skill level of physical therapist), working with an out-of-network physical therapist could save this patient both time and money.  He could spend less time at a physical therapy clinic for treatment sessions (12 fewer hours!) and could save $440.  And the possibility exists that he may recover more quickly!  (Note: Even in another out-of-network clinic that does not provide this discount, this patient could save $400.)

This cost analysis is based upon actual situations and outcomes with which I have been involved in my career as a physical therapist.  Certainly, it only is one example of what can happen, and not EVERY patient will save money by working with an out-of-network physical therapist, but I have observed that quite a few will do so.  In terms of PPO plans, out-of-network physical therapy benefits may differ from one plan to the next....but in MOST cases, the savings will be even more substantial than that of a HMO plan, particularly if the individual or family has hit the yearly deductible.  So, the next time that you require the services of a physical therapist, take a close look at your health insurance plan and crunch the numbers.  You might be surprised as to what you discover.....and how much fuller your pockets are after successfully completing your course of therapy with an out-of-network physical therapist.

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