Sapphire PT Presentation at RE November 15th

Join Sapphire Physical Therapy on Wednesday, November 15 at 6:30 pm in the Runners Edge basement for an informative presentation. The presentation will focus on how impact loading rates during running relate to injury risk and discuss ways to reduce loading through simple running tips and targeted exercises. Handouts and presentation information will be provided along with refreshments and snacks.

The evening talks will be followed by an interactive demonstration using an accelerometer, which is a tool used to measure and track impact loads as well as foot strike pattern and limb asymmetries during running. The accelerometer is a great addition to Sapphire PT as it collects real-time data while individuals are running in their everyday environment including Missoula’s awesome trails. An outline of the evening’s speakers
and topics include:

– Dr. Willy, Ph.D., PT, a professor at the University of Montana School of Physical Therapy, is an expert in his field and in running injury research will define what impact loading is and discuss how it relates to running injury risk.

– Holly Warner, DPT, physical therapist at Sapphire PT who specializes in running gait analysis and in treating running injuries, will discuss practical ways to reduce impact.

– John Fiore, PT, owner of Sapphire PT and who specializes in running gait analysis and in treating running injuries will provide off-season training ideas to improve strength and running efficiency.

Join us to learn how to incorporate exercise and technology this winter to help you meet your goals and stay on track for 2018.

The Drive Behind Achieving Goals: What Motivates us through Success and Failures

by John Fiore, PT
Sapphire Physical Therapy

November is a good month to reflect on the past year. As runners, this season reminds us how important it is to be thankful for our experiences and challenges in 2017. In order to set realistic running goals for 2018, it is appropriate to look within for the driving force(s) for why we run.

Understanding the forces behind our motivation to succeed is a complex topic which is relevant to individuals and athletes of all ages and abilities.  Our reasons to set and achieve goals are directly related to our past experiences, childhood upbringing, and the challenges we have faced along the way.  Whether you are a world class athlete or recovering from a recent knee surgery, success depends on your ability to motivate yourself in the face of adversity.  So why do some athletes push themselves to the level of extreme sports?  Is it the success of crossing the finish line, or the struggles endured along the way?  Consider the possible contributing factors below to better understand your unique reasons for pushing yourself to be healthier, stronger, faster, and more fulfilled as a person.

Bridger Ridge Run 2017


Personality Traits:

A March 7, 2016 article by Bradley Stulberg (Outside.com) described biological and personality traits shared by some world class athletes.  Growing up in a goal-oriented household often leads to a goal-oriented adult.  For some, the hard work required to reach an athletic goal fuels the fire to compete. Familiarity with struggle (both physical and/or emotional) at an early age may also motivate a person to challenge themselves through physical pursuits later in life.  The road map of our life steers us over paths which may be a chaotic and rough as the ones we have left behind.  

Biochemical Needs:

The feeling of well-being after achieving a goal is second to none.  Our brain releases neurotransmitters such as Dopamine and Serotonin which provide us with a feeling of contentment and satisfaction associated with physical exercise.  The brain depends on these neurotransmitters for health and balance of moods and our outlook on life.  It is thought that the brains of extreme sport and ultra endurance athletes’ brains require more neurotransmitters to maintain homeostasis. This is often manifested in the frequency and intensity of one’s athletic goals.  Once a goal has been achieved, a more challenging goal is established.  In sports such as mountaineering, climbing, and ultra running, a more challenging goal implies a higher risk of injury or consequence.  Balancing risk and success becomes a grey area for many athletes and must be factored into a healthy, long-term training plan.

Ouray 50 mile, 2017


Social Network:

Missoula is a prime example of a community held together by a love for the outdoors and endless recreational opportunities.  The running, cycling, and skiing communities are vibrant in Missoula, providing a social network of camaraderie and support. Living by example is convenient in Missoula whether you are an aspiring athlete or a world class competitor.

Past Success and Failure:

For many athletes, standing on the podium is not the clearest memory, but rather the vulnerability experienced in failure.  Whether failure was the result of poor training or an injury, the rawness of failure motivates like few other factors.  Fear of failure, therefore, should not impact your ability to set a goal.  Remember, failure can be a stronger predictor of future greatness than present or past success.  Find your own motivational reasons and use them to fuel your passions in life.  Through well planned goal setting, your unique personality needs can be met while allowing yourself to be present for your family, friends, loved ones, and even a stranger or two in need along the way.  


John Fiore, PT
Sapphire Physical Therapy
1705 Bow Street
Missoula, MT 59801

Offseason Training for Runners: Why gluteal exercise are not enough.

October marks the beginning of the running offseason. While some lament the cooler temperatures and frozen precipitation, many of us are dreaming of skiing through deep powder over the next several months. The offseason, however, is the time period during which the foundation of your 2018 running season is built. Offseason cross training, mixed with selective running, represents a therapeutic physical and mental break from long miles and needed preparation for the coming year.

Western Montana provides ample outdoor cross training opportunities. If your 2018 running goals include a 10k PR, then short interval running, track workouts, and alpine skiing will meet your needs. If your goals include achieving success in an ultra distance trail run, then Nordic skiing and ski mountaineering will compliment your winter running program. While the intensity and duration will vary based on one’s goals and abilities, below are a few areas an effective offseason running program should include:

Injury Risk Reduction:

The best predictor of future running injury is the presence of a past running injury. The most obvious cause of running overuse injuries is too much volume or load to the system too quickly. Simple solution: gradually increase running mileage and intensity and allow for adequate recovery. Running training programs and racing goals, however, complicate the simplicity of injury preventions. Understanding a few facts regarding how our bodies move is an important first step in understanding and avoiding injuries due to compensatory movement imbalances we may not realize we have.  

Skeletal muscle can be divided into two groups representing their primary function: Stabilizers and Mobilizers.  Stabilizing muscles allow us to maintain the posture necessary for movement. Diminished stabilizing muscle activation leads to movement imbalances and overuse injuries in the lower extremities. Stabilizing muscles (which all runners should work to strengthen) include the gluteus medius, transversus abdominus (lower abs), obliques, lower trapezius, serratus anterior, multifidus (deep low back muscles), rotator cuff, and deep neck flexors.  Mobilizing muscles are more familiar to us as they are responsible for moving our extremities: Quadriceps, hamstrings, gastrocnemius, hip flexors, adductors, rectus abdominus (six pack muscle), erector spinae, and latissimus dorsi. In the presence of muscle shortening (secondary to frequent sitting, postural tightness), prior injury, weakness, or repetitive motion activities (involved in single-sport training such as running) stabilizing muscles are inhibited unbeknownst to the individual. For example, in the lower extremities, the stabilizing glutes and abdominals are often inhibited and overpowered by the hamstrings, hip flexors and quadriceps.   

A movement imbalance example common in both recreational and competitive athletes is that of hip extension.  The ideal muscle firing pattern for proper hip extension is stabilization of the low back with the multifidus and transversus abdominus, extension of the leg with the gluteus maximus, and secondary assistance with the hamstring. A common compensatory movement imbalance for hip extension is contraction of the erector spinae and hip flexors, extension of the leg with the hamstring, and little or no contraction of the gluteus maximus. If such a compensatory hip extension movement pattern is not changed through training, even the most progressive strengthening program will not protect a person from injury or allow him or her to return to running following an injury.  

Aerobic Engine:

Cardiovascular fitness requires consistent work. Experience has taught me that maintaining a base level of cardiovascular fitness in the offseason reduces the need to play “fitness catch-up” in preparation for spring running races. Building your aerobic engine to carry you up climbs both short and long requires specified training. High intensity intervals are never fun, but mixing up the means by which you subject yourself to intervals reduces burn-out. Nordic skiing intervals, skinning (backcountry or ski mountaineering set-up) intervals, power hiking intervals, and cyclocross racing are great ways to disguise intervals in a fun and novel activity. One to two running or snow hiking interval workouts can also be implemented during the offseason if you prefer to stick with running.


Consider joint and tissue (muscle, tendon, fascia) mobility as the key to reduce some of the compensatory movement patterns discussed above. Flexibility is often synonymous with extreme stretching. While many of us are inherently “tight,” it is important to distinguish between tight muscles and stiff joints. Joints which lack the necessary mobility (range of motion) for healthy movement are subjected to increased impact loading while running. The offseason is a great time to have your stiff knee, hip, or ankle evaluated by a physician and by a physical therapist to improve joint function. Be proactive with joint stiffness now to avoid cartilage damage and chronic joint-related issues later. Running through joint pain is never a good idea.


While offseason cross training and exercise should be fun, intensity should be added on a weekly basis to build strength and power. As athletes age, the importance of workout intensity increases. Most athletes over age forty gravitate towards long, ultra endurance sports and races. While it is true that longer events suit our highly trained endurance engines well, training with intensity will build muscle strength and muscle performance. Regularly-scheduled (2-3 times per week) plyometric and interval workouts will build some speed in your legs for whatever cross training activity you choose. Short hills will seem easier to run up in the spring as well.

Fun Meter:  

Enjoy your off season! Branch out and try new activities. Missoula is fortunate to be a mecca for outdoor winter recreation and a hub for excellent fitness establishments and gyms. Consult a professional for assistance in setting up a balanced off season program to suit your 2018 goals AND to recover-rebuild from your 2017 running season.

Don’t waste your off season training time by strengthening compensatory movement patterns which lead to a decline in performance and possible injury.  Get the most out of your training through an effective physical therapy consultation. The physical therapy staff understand compensatory movement patterns which lead to movement imbalances and injury. For more information, call or email the Sapphire Physical Therapy staff. Make 2018 the year you run, train, and compete without pain or limitations.  

John Fiore, PT



How Sitting Can Increase Injury Risk

by John Fiore, PT

Runners are well aware of the importance of strength training to reduce injury risk. Even the most specific strengthening program will fail to produce results, however, if compensatory movement patterns are not addressed. Our modern lifestyle is filled with sitting. We sit at work, sit while driving, sit for relaxation, yet expect our hips, pelvis, and spine to function normally. Hip flexor tightness is synonymous with prolonged sitting. The psoas is in important hip flexor muscle which warrants further discussion to understand the challenge of running injury treatment and prevention.

The psoas is an important core muscle which stabilizes and moves both the lumbar spine and the lower extremity.  Collectively, the psoas and iliacus muscles are referred to as the iliopsoas muscle group. The psoas works in conjunction with the iliacus muscle.  While both the psoas and iliacus insert on the lesser trochanter of the femur (groin area), the iliacus originates in the iliac fossa and iliac crest of the pelvis and sacrum, whereas the psoas originates along the transverse processes of the lumbar spine. The primary function of the psoas muscle is to flex the hip. Secondary actions which are very important for proper lumbar spine and lower extremity function and symmetry include femoral lateral rotation, lumbar extension, and lumbar side bending. In addition, the iliacus tilts the pelvis anteriorly. Both the psoas and iliacus muscles activate unilaterally or bilaterally. Asymmetry between the right and left psoas muscles due to tightness or weakness, therefore, is an important source of one-sided low back and leg pain.  While psoas asymmetry is often overlooked, proper, targeted clinical testing must be included when thoroughly evaluating low back and extremity pain and overuse injuries.

The psoas muscle lifts the hip and leg forward when we walk, run, and climb. Overutilization of the iliopsoas can lead to postural and mechanical issues.  Without the necessary strength in the abdominals, hips, gluteal and small stabilizing lumbar (multifidi) musculature, the psoas becomes shortened, over-active, and irritated.  Gait and postural deviations may present as a laterally-rotated hip, an anteriorly tilted pelvis (unilaterally or bilaterally), or a sway back posture.  An iliopsoas-dominant athlete may develop a myriad of overuse injuries including:  psoas or groin pain, sacroiliac and low back pain, iliotibial band pain, and even knee and foot overuse injuries.

Once a psoas imbalance or overutilization issue is diagnosed, the resulting mechanical asymmetry must be addressed through manual physical therapy techniques. Targeted active release stretching, dry needling, deep tissue release, and muscle energy techniques are effective ways to restore symmetry and proper function to the right and left psoas musculature. Manual therapy alone, however will not “fix” the problem. Strengthening the antagonist musculature will allow the body to maximize efficiency of movement.

Strengthening the weak links in the modern day athlete can be difficult due to ingrained movement patterns.  Strengthening the lower abdominal and gluteal musculature, for example, reduces our reliance on the psoas to “pick up the slack” in lumbar and pelvic stabilization. Functional core strengthening involves the gluteal and abdominal musculature stabilizing in conjunction with sport-specific upper and lower extremity motions.  Sit-ups and crunches alone, however, may exacerbate the problem of tight or dominant psoas  musculature.  It is important, therefore, to include planks (prone and side positions) and single leg weight bearing core exercises to reduce habitual psoas use. Finding your lower abdominals (transversus abdominis) muscles when lifting is key to prevent the anterior pelvic tilt associated with iliacus activation as well as the lumbar sway back associate with psoas activation.  

Our modern day lifestyle of prolonged sitting and very little physical activity other than our “workouts” predisposes us to psoas muscle shortening and dominance.  Sitting inherently shortens the psoas while the antagonist muscle (gluteus maximus) is unable to function the lengthened position of sitting.  The most common area of weakness in present day athletes (based upon my empirical evidence of 24 years in practice) are the gluteus medius and gluteus maximus.  No wonder we have difficulty contracting our gluts when much of our day is spent sitting!  In addition to a physical therapy strength and postural evaluation, a video gait or running analysis will reveal muscle imbalances to address to effectively prevent and treat injuries related to a hip flexor or psoas domain state.  

Finally, for an aging athlete or individual, hip joint compression due to excessive sitting and associated psoas tightness can accelerate osteoarthritis.  Balancing proper muscle flexibility with core stabilization and strength will decrease the impacts of prolonged sitting to permit a healthy, active lifestyle for years to come.  

(John Fiore is the owner of Sapphire Physical Therapy in Missoula. You can reach him at john@sapphirept.com or 406-549-5283)


  1. McGill,S.(2007) Low Back Disorders: evidence-based prevention and rehabilitation. 2nd ed. Human Kinetics. Champaign, IL. P 60-61, 214-217.
  2. Jones,S. Rivett,D. (2004) Clinical Reasoning for Manual Therapists. Elseier Butterworth Hinemann. New York, NY. P 261-274,
    3. Greives. Grieve’s Modern Manual Therapy. Harcourt Publishers Ltd. 19943
  3. http://www.serola.net/research-entry/iliopsoas/

Uphill Running Technique and Training for Efficiency and Stress

by John Fiore, PT

With The Rut only four weeks away, now is the time to add a some climbing specific runs to
your training plan. Understanding which uphill running techniques work best for your body type, fitness, and experience will pay off greatly on race day.

Aerobic Fitness and Hill Interval Training:

Not everyone is a natural uphill runner, but natural ability is a small part of the uphill running puzzle. Aerobic fitness and high strength-to- weight ratio result in faster uphill times. Uphill interval training is necessary to build both aerobic and anaerobic fitness. Following a variety of uphill interval durations (from 30 seconds to 5, 10, 15 minutes) based on your running or racing goals will teach you how to effectively pace your efforts based on the terrain you are climbing. Uphill interval repeats will train your body to recover more efficiently at the top of a climb in preparation for the descent and the next hill. Uphill interval workouts are easy to find online, but Forrest at Runners Edge is a great local resource as well. He provides excellent uphill interval workouts during the current Rut Training Class. Basically, uphill intervals are not fun, they hurt, but you will hurt a lot more on race day if you have not done weekly uphill intervals, period.

Uphill Running Technique:

Body composition, aerobic fitness, and terrain dictate the most efficient uphill running technique. Below are examples of four uphill running techniques with some advantages and disadvantages of each.

Running every climb is obviously what every runner aspires to be able to do. When the grade kicks up for prolonged periods, however, energy conservation becomes important. A runner with a high strength-to- weight ratio (light but strong) and a high level of aerobic fitness may be able to run and leave the pack in the dust. Running posture should include an elongated trunk for breathing, slight forward lean to counter-balance gravity, short, quick, tall uphill strides, and rhythmical upper body arm swing. The energy cost of such superhuman efforts repeatedly during a run or a race can be huge, and slower but more efficient climbers may catch the fatiguing uphill runner. Again, know your limits by practicing your uphill running threshold during interval

Power hiking with hands on thighs is the go-to technique for long, sustained climbs during long runs or races. Hiking uphill results in a lower heart rate which means you can sustain the effort for a longer duration. Gradient also dictates when a runner must resort to power hiking. Again, the gradient which requires hiking varies from runner to runner based on aerobic fitness and strength-to- weight ration. If you are being passed by power hikers and you are still slogging uphill in a run, then consider hiking. Using your hands on your thighs as you push off provides extra power, supports your upper body and spine, and allows for good breathing. Practice short, quick and longer, slower power hiking steps to see which technique suits your fitness and body type (leg length, strength) best. When you crest the top of the climb, transition back to running, breathe, and recover.

Power hiking with poles is similar to power hiking with hands on thighs, except the poles allow for longer stride length. Poles also aid in providing balance, and spread the muscle demand over four extremities rather than just two. Using trekking poles requires practice. Try an uphill interval workout with poles and practice pole placement. Poles provide great assistance while descending as well, and running-specific poles are light and can be easily stowed in your pack when not in use.

Uphill Terrain Running Agility:

It is important not to stare at your feet when running uphill. Look slightly ahead to plan your route and practice bounding uphill to increase your uphill running agility. Short, rocky, steep climbs are ideal for uphill bounding practice. Recover by jogging slowly back down the same hill. Feeling at home on varied uphill terrain (loose dirt, rocky trails, scree fields, and ridge lines) will insure confidence and efficiency on race day.

Upper and Lower Body Strength:

I may sound like a broken record, but strength is vital for efficient uphill running. Upper body strength will insure a rhythmical ascent and provide the counter balance for climbing legs. Using poles or hands-on- thighs both require upper body strength as well. A strong core will reduce the likelihood of low back stiffness or pain during prolonged climbs. Finally, moving your body weight uphill against gravity as quickly as possible requires strong quadriceps, hips, and gluteal musculature. For any specific questions related to uphill running technique-training, or injury treatment-
prevention, contact me at Sapphire Physical Therapy.

John Fiore, PT



Downhill Running Form and Training Techniques

Downhill Running Form and Training Techniques
John Fiore, PT

The challenges of running uphill are addressed through uphill interval training and techniques specific to climbing. Downhill running, however, is often a forgotten aspect of training. While it is true that many races are won on the unrelenting climbs, races are more often lost on the long, technical descents due to blown quads and poor technique. I do not claim to be a stellar downhill runner, but I will pass on useful training techniques founded in running biomechanics which may help you make the Swift Current cutoff time or even soar to victory at The Rut this September.

Regardless of body type or speed, the following seven training tips will improve your downhill running form and efficiency and reduce post-running soreness and injury risk.

Commit to running downhill: When the climb is over and the gradient tips downward, shift gears in your mind and body and commit to descending. Your leg musculature must now function in the lengthened position referred to as an eccentric contraction. In a lengthened position, your muscles are prone to soreness which is minimized through specified training.

Lean forward and use gravity: A common mistake many runners make is to lean back on the while descending. This “back seat” descending techniques results in higher impact loading through the heel, a shift of the center of gravity behind the body, and a higher incidence of blown quads or sliding feet. Lean forward slightly through the pelvis and trunk, using gravity to your advantage. Downhill running is often viewed as controlled free-falling and can actually be as fun as it sounds.

Descending at the Chuckanut 50k

Move your feet quickly: Cadence plays a crucial role in increasing running efficiency by reducing joint impact loading and conserving energy. Increasing your cadence (160-180 foot strikes per minute) will decrease joint impact forces, reduce muscle fatigue, and reduce the incidence of tripping on a stray rock. Try seeking out rocks to land on rather than navigating around rocks as if you are crossing a stream.

Look down the mountain and anticipate your next move: When running uphill, it is best to look a step or two ahead rather than face the entire climb head-on. In contrast, when descending, keep your eyes five to ten feet ahead of your feet and anticipate your next two steps in your mind and your legs will follow. Practice this technique on a rocky familiar descent and train your proprioception (non-visual sense of foot-leg position in space).

Relax your arms and utilize your entire body for balance: Balance becomes more of an issue running downhill at speed. Utilize your arms for balance and allow them to flail wildly while maintaining stable, strong trunk and hip musculature. Core strength and joint stabilization will pay off on the descents and it is important to utilize a regular program to achieve functional running strength.

Simulate race terrain in training: If your upcoming race includes downhill running or technical, rocky terrain, it is imperative to practice on similar terrain. Missoulians are fortunate to have a choice of rocky, steep terrain less than one hour away in any direction from town. Rocky trails abound in the Bitterroot, Rattlesnake, and Mission Mountains. Practice downhill intervals, climbing back up, and practicing a different line and varying your cadence and foot placement strategies.

Emphasize eccentric single leg training: Runners tend to focus on step ups, squats, and non-weight bearing gluteal exercises, but the secret to confident downhill running lies in eccentric single leg strengthening. Utilize single leg plyo-hops, box jumps, and even single leg box jumps onto an uneven surface such as a pad or Bosu Ball to train your body to fly down the scree and talus slopes of your favorite mountain race. For more specific questions related to downhill running training, injury treatment or prevention, call or email me at Sapphire Physical Therapy.


John Fiore, PT