Monday, November 16, 2009

Upcoming Talk

I will be giving a talk at Maine Running Company this Thurs., Nov. 19 at 7:00 p.m. on the topic of minimalist running.

I know, I know... talking about barefoot running at a running shoe store?! Seems a little crazy. But there is more to it than just barefoot running (especially given that we live in Maine with winter approaching), it's a fun and new topic, and one that generates a lot of questions. This is a free talk and open to anyone. Hope to see you there!

Wednesday, October 28, 2009

What I've Learned About Stress Fractures

I've been fortunate enough in my years running to have experienced numerous mild injuries, that were enough to gain some personal insight but not so bad that I missed much time running. As they say experience is the best teacher. It is one thing to read about an injury, another to treat numerous people with that injury, and quite another to actually have the injury yourself. When someone comes in with a tight back, sore hip, strained hamstring, or plantar fascitis, I can feel their pain.

Now that I am back running (hallelujah!), and having seemingly fully recovered from my stress fracture, I thought I would share a few new things I have learned:

1. I debated getting a pneumatic boot when the injury first happened. Even though they seem to be the standard of care, the only studies I could find said that they didn't make any difference in healing time (although this was for tibial stress fractures and mine was a metatarsal fracture.) Wanting to avoid any additional muscular atrophy, I decided to just listen to my body and go with what allowed me to get around without pain, which turned out to be a built-up, motion control running shoe I dug out of the closet. I wore these daily for 1-2 weeks until I could transition out of them.

2. In surfing around for stress fracture related info, I came across a product called the Exogen Bone Healing System, "the only bone healing device approved to accelerate fracture healing of indicated fresh fractures." I had heard of using electric currents to facilitate fracture healing, but was surprised to learn that the Exogen uses ultrasound. Ultrasound is basically a vibrational frequency, meaning that the healing effect in this case is thought to come from the mechanical stress induced by the shockwave created. When I learned this it kind of confirmed my decision not to use the boot. My thinking was that if daily ultrasound application (mechanical stress) helped bone healing, then immobilizing it in a boot would almost have the opposite effect. So long as I was putting some stress on the area by continuing to walk on it with shoes that allowed me to do so without pain, I thought I would be accomplishing relatively the same effect. The key I felt was really heeding the pain signal and resting and icing when it felt appropriate.

3. I started taking a calcium supplement (Metagenics Cal Apatite) right from the beginning. This is a higher grade form of calcium called MCHC. I remember seeing a study showing decreased healing fracture times with large doses of MCHC. Most calcium supplements consist of calcium carbonate (the same as TUMS) which don't absorb all that well. I've seen x-rays where calcium carbonate pills are floating through the intestines, undigested.

I don't know if these factors made a huge difference, but I can say that my particular fracture healed to where I could run again within 4-5 weeks, which seemed like a pretty quick turn-around time.

Friday, October 16, 2009

Proximal Hamstring Syndrome

I thought I would talk about a running injury that I have seen a lot of over this past summer and fall. There is a very specific type of hamstring injury that can occur in runners that, once present, can be hard to shake. The official diagnosis is 'Proximal Hamstring Syndrome' or 'High Hamstring Tendonitis' (or Tendinopathy), although, as we shall see, this injury has more to do with the pelvis as a whole rather than just being confined to the hamstrings.

This injury is fairly unique to runners, more often in woman, and especially in woman that have had kids.  (A joke in our office is that our number one patient is the running mom with butt pain.)  Runners with this injury typically feel the pain right up at the crease of the butt, somewhere near the ischial tuberosity (or the "sit bone"), which is the proximal attachment of the hamstrings. Sometimes the pain will radiate down further, leading runners to identify it as a hamstring injury. For other runners the pain is a little higher and will be labelled a gluteal or piriformis problem. When asked to point to where it hurts, the runner will often have a hard time locating the exact spot where the pain originates.

Other relevant structures in the area include the sacro-tuberous (ST) ligament, which merges with the hamstgrings at the ischial tuberosity, the gluteals, the sciatic nerve and the over-lying piriformis muscle. One interesting bit of anatomical trivia is that the hamstrings and ST ligament (along with the back muscles above and the calf muscles and even plantar fascia below) are literally connected by fascia (connective tissue), making them one continuous functional unit. A consequence of this is that tightness anywhere in that chain can pull on other parts of the chain.

The symptoms can range from chronic mild tightness in the area to more severe pain, especially during prolonged driving. In many cases it doesn't hurt to actually run, but more afterwards. The injury may relate to one specific muscle pull, especially during speed work, or just as commonly develops gradually over time with lesser intensities of running.

The tricky part of this injury is that it almost always represents a problem of the hip as a whole, and not just the hamstring. Classically the runner will have weak gluteals and/or tight hip flexors that tilt the pelvis, effectively pulling the ischial tuberosity upwards, pre-tensing the ST ligament and hamstrings. The picture below demonstrates a common postural dysfunction called "Lower Cross Syndrome", where in addition to the weak gluts and tight hip flexors the individual has weak abs and tight back muscles, contributing to a forward pelvic tilt.

My take on Proximal Hamstring Syndrome is that quite often it occurs in runners who demonstrate some or all aspects of the lower cross syndrome; maybe not enough to cause the normal accompanying symptom of lower back pain, but enough to distort the pelvis and preload the hamstrings and pelvic ligaments. Subsequently these structures then become more susceptible to injury. Starting from this basic template, there are different scenarios that can occur:

-The hamstring and/or ligaments can be overtly strained, or torn. This might happen with speed work, or with a forceful, unanticipated stretch, such as getting pulled forward while on water-skis.

-Just as commonly there isn't one specific tear but just continued tension and inflammation that causes adhesions (scar tissue) to become layed down along the upper hamstring and/ or the ST ligament itself. The longer this injury persists the more adhesions form.

-In some cases, the piriformis muscle also becomes involved, causing sciatic nerve irritation and more pronounced pain, sometimes further down the leg.

-I've even had some cases recently of runners where the only symptom was recurring calf muscle pulls. We were able to trace things back to the sciatic nerve involvement which was apparently causing subtle weakness of the calf, making it susceptible to strain.

Many runners self-manage this injury with hamstring stretching, foam roll work, and ice, but find that these remedies don't really make much long-term difference. As a matter of fact excessive hamstring stretching can actually make things feel worse, because you are just further aggravating a pre-tensed muscle. Rest may improve things short-term but the symptoms usually return when running resumes.

As far as treating this injury, most of the underlying factors must be addressed for true long-term resolution of the problem. A lot depends on how long the issue has been present. I've had cases when the runner seeks treatment soon after the pain has developed (before adhesions have developed) where simply releasing the hip flexor and having them strengthen the gluts resolved the problem. More commonly we have to add some cross-friction massage and Active Release Technique to the adhesed ligaments and hamstrings to fully alleviate the pain.

The biggest factor in preventing this type of injury (and many others) is to keep your core muscles strong, especially the gluts. This topic is worth its own blog, but essentially, for runners, I use the single-leg bridge as a benchmark. Being able to hold this position for 5-10 seconds solidly, without wobbling or hamstring spasm, indicates adequate strength for running. If you can't hold this position, do bridges with both legs on the ground, working your way to the single-leg version over time. Long story short, keeping your butt strong help will prevent one less pain in your butt!

Monday, October 5, 2009

Stress Fracture

So as I mentioned last time I believe I have a stress fracture. It happened on a Vibram Five Finger run on the road about four days prior to the Vermont 50K. I started to feel pain which then quickly progressed to where I had to hobble home. Initially I was hopeful that it was along the lines of a mechanical metatarsal issue (see the post Dropped Metatarsal.) I had my friend and colleague Garret Llewlyn, D.C. work on it several times, which alleviated some of the pain, but the remaining pain was on top of the 4th metatarsal and persisted. Pain on the top is quite often indicative of a stress fracture (while pain on the bottom is usually mechanical in nature.)

I haven't gotten an X-ray yet as stress fractures are notorious for not showing up initially. Out of the dozen or so stress fractures we saw this past summer I can only think of 1-2 that actually showed up on the first X-ray (by the way most of these occured wearing conventional shoes.) I'll proabably get one in a week or so just to confirm, and what you would typically see more than a fracture line is the fluffy white evidence of new bone being layed down.

I want to thank everyone for their best wishes. I didn't feel like I was doing anything outlandish with my running, so therefore just have to accept it and move on (what else can you do?) I'll treat this as a learning experience. Fortunately it's not so bad that I can't do some biking so I'm not going completely nuts. (Running up a hill with a cyclocross bike on my shoulder did prove unwise. I'm trying to picture the look I would give to someone in my situation who did that. Physician, heal thyself.)

Anyways the intent of this post was to provide a cautionary tale to those interested in the whole minimalist movement. I still believe whole-heartedly that ultimately that is the way to go. However I can pick out some mistakes I made that led to this, that might help others avoid a similar fate:

1. First and foremost, I realize that a Tarahumara Indian I am not! Meaning that just because I integrated barefoot and Vibram running into my training throughout the summer, I spent most of the rest of my time (not to mention life) in shoes. It takes time for most of us Westerners to adapt the foot and calf strength, and apparently bone density, required to do this safely. When someone suffers a stress fracture, I often use the phrase, "Too much, too soon." This applies here as well.

2. Be extra cautious on the road. This wouldn't have happened had I stayed on the grass. I honestly have never felt better than the barefoot runs I did on grass this summer. There were times where my form felt perfect and I felt like I could have run forever.

3. Additionally, be cautious of using Vibrams on the road. Vibrams take away the skin sensitivity factor of running barefoot, allowing you to open up your stride more, which is something I initially liked about them. On the other hand, they don't really provide any more cushioning that being barefoot. The net effect is that there can be more impact to your foot in Vibrams than when barefoot. I noticed this phenomenon leading up to the injury. Running on a mostly soft surface such as Pineland, Vibrams were perfect, to minimize the ouch of stepping on small rocks, acorns, etc. However on a nice smooth road free of debris my feet were actually more comfortable when barefoot, once I had built up enough calluses.

(This same effect has been observed in conventional, cushioned running shoes. Most of the feedback from your foot is dampened, which can lead to alterations in your gait, such as heel striking, that can actually produce more force than if you were barefoot.)

4. Lastly, I don't think that it was random that it happened where it did. Having Dr. Llewlyn work on the foot right after it happened made me realize the joints nearby were fairly locked-up, which placed more stress on the spot that fractured. Also, I had been sick for about a week leading up to this, and had done a lot of laying around trying to recover. I could feel my gait was off, and in particular that my left foot wasn't springing off the ground like my right (which I associate with the tibialis posterior muscle, which supports the arch.) This is something I had noticed before but had improved as my calves had gotten stronger. I think being sick, and also being barefoot less overall due to colder weather had weakened my left calf just enough to contribute to the injury.

We've all heard stories about people having near-death experiences realizing the preciousness of life. Not to over-dramatize, but it's really hit home for me over the past two weeks what a gift it is to be able to run.

Tuesday, September 29, 2009

Vermont 50K Race Report

So we just got back form Vermont for the 50K trail run. Unfortunately I wasn't able to run as I have what I believe is a stress fracture in my foot. More on that in the next post, but wanted to give Linda a chance to relate her amazing experience. She did an awesome job in really bad conditions, and we're really proud of her!

Jamie has asked me to do a debriefing of the VT 50K since sadly he was unable to participate:( I am two days past the event and emotionally and physically wasted. A lot of physical, mental and time management (having three kiddo's under 7) went into this event.

I have never considered myself an athlete. I ran a mile for the first time back in college: to the 1/2 mile marker at the Blvd. and back Yipeee!!! From there went on to do a couple 5k's, 10k's and eventually a Marathon in 2000. In your 20's it's amazing how easy this is, as your body can take a ton of abuse and still keep going with very little injury.

Fast forward nine years and three kids later. I had no core strength to hold my pelvis together. Between that and hormones everything would just clunk out of place. I went to a great physical therapist to learn how to strengthen my core, and with the help from my wonderful husband I was able to get my body back into balance. Last year I had dabbled in triathlons, doing two sprints, one olympic and two half marathons. Still was having left hip /knee issues- I felt fit not stellar- lower middle of the pack finisher -that's okay still breast-feeding. Over the winter Jamie and I started to hear more and more about trail running and we became intrigued. We signed up for the Pineland 25K-loved it!!!

These events are perfect for me: endurance, mother nature, and cookies at the aid stations. However my whole left lower side of my body wasn't so happy. Hello ITB-you suck! So began my further education into the world of single-legged bridges, planks of all shapes and sizes, CORE, hip flexor stretches and barefoot running. I'm not saying my body is perfect (nope) or super strong (it helps that I am married to sports chiropractor) but she done good in Vermont!

Whenever we test ourselves or dare to climb out of our boxes, we journey and grow. This was my Odyssey! The self-doubt I had going into this plagued me for two weeks with insomnia, irritability and irritable bowel right up to packet pick-up when I thought I was still a fake and some how these people can tell. I slept well Sunday night, thanks to the Harpoon Brewery and a great talk with Jamie that boiled down to: It is my choice to do this. It's my choice to be here and participate. So buck up; be present and do it. And that is what I chose to do.

We woke up to rain and temp's in the low 50's. Six hundred mountain bikers and about 100 50 milers had hit the trails before we started. The mud was so deep you were in danger of losing your shoe. Many times we had to walk because running was too dangerous. A smart-aleck friend had told me prior to the race not to worry, that Vermont is mostly all downhill (I'm not going to say much more on that topic.) Between the rain, mud, and cold, I didn't get warm until mile 27.

And guess what... I loved every minute- actually all 8hrs and 42 minutes of it. My body was strong and she held up for me. By choosing to be there and be present today I am an athlete....... Until that next darn box comes!

Monday, September 14, 2009

Plantar Fascitis: In the Beginning...

Had an interesting experience observing the beginnings of a potential case of plantar fascitis. Since it happened to Linda I know all the details and she doesn't mind if relay the story.

When we first started training for our upcoming 50K, she was coming off of a left hip injury that essentially boiled down to having had three kids in five years with resultant pelvic instability. Hard work on her part in getting her core strong had for the most part put that issue to rest.

The one residual issue from that injury was some remaining weakness of her left foot (specifically tibialis posterior, one of the main arch supporters.) She had been working on strengthening the foot, and even listened to her wacky husband and done some barefoot running. Unfortunately not enough to get the foot where it needed to be relative to the miles she was logging. Consequently she developed some shin splints on that left side (irritation of the flexor digitorum muscle, which in my mind compensates for the weak tibialis posterior.) Fortunately this seemed to settle down fairly quickly with some aggressive treatments (anyone receiving an elbow massage to their shin splints can thank Linda for being the guinea pig on that one... she said if she were a patient of mine she would have kicked me and never have come back... but hey what can I say- it worked.)

The next thing to happen a week later was pain on the bottom of her (you guessed it: left) heel. She described it to me as this sequence: after doing a longer run while we were on vacation, she hopped in the car for a several hour drive home. She could feel things locking up (see the last post, 'Everything is Connected.') Subsequently some of her old pelvic issues resurfaced, and she could feel her entire left side down through the hip, hamstring, and calf tighten up. Some of this feeling remained on her next run, and then bingo: the next morning she had heel pain in the classic plantar fascitis location.

At that point we decided that now wasn't the time for her to be transitioning to minimal, less supportive shoes, that she just needed to do what she had to do to get through to the race. So she found some Saucony trail shoes that were more supportive. These couple with getting things rebalanced and the calf opened up seem to be doing the trick.

For me it was interesting seeing all this play out. Usually seeing someone once a week I wouldn't quite get every....single.....teeny.....weeny....itty.....bitty.... last detail of an injury like this, on a moment by moment basis. But hey, if we can all learn from this, then its all good.

So what did we learn?

1. Everything is connected.
2. Address your imbalances before training for distance (or speed.)
3. Watch out for long drives in the car, especially right before or after a long run.
4. Make sure that if you are making changes to your gait and/ or level of support from your shoes, you did it over a long, gradual period. (Just because your husband may have freakishly strong feet doesn't mean yours necessarily are.)
5. A marriage apparently can survive both training for a 50K at the same time, so long as that foot gets fixed!

Wednesday, August 26, 2009

Everything is Connected

Sorry for anyone who has been checking for any recent posts. Meant to keep this more fresh but with summer waning haven't been on the computer as much. The longer I waited I felt like I needed to come back with something monumental but I'll just go with what's on my mind right now; gotta start somewhere.

I have an axiom that, "Everything is connected." It never ceases to amaze me how often this proves true in the human body, and the past week has been no exception. Work on someone's foot and it affects their pelvis. Work on the pelvis and it goes to the shoulder. Work on the shoulder and it goes to the neck.

Despite seeing this every day in the office it always hits closer to home when one of these connections affect me. I'm sitting here now with a balled up hamstring that makes it hard to even bend over. However the issue didn't start in the hamstring. Last weekend we drove 4 hours to my folks' house. Between the drive, sitting around more than I usually do, and having any motivation to stretch being zapped from being around extended family, I felt pretty tight heading into the next morning's long run. I was unable to open up my stride, but had to get in some miles so I kept going. So consequently my right hamstring totally seized up the next day.

When sitting for long periods, more than what is normal for you, your hip flexors tend to tighten up and your gluts tend to shut off. This contributes to a pelvic tilt that preloads the hamstrings and also makes them over-compensate for the inhibited glutes. If you then go and run in that state the hamstring is more likely to have issues. This can range from an overt "pull" with speed-work to an abnormal tightness that won't leg go after the run, especially with longer distances. If you don't correct the underlying issues and continue running you can actually develop adhesions in the hamstring and even the sacro-tuberous ligament, which connects the hamstring to the pelvis. This ligament is the source of a lot of butt or "piriformis" pain in runners, particulary when they drive after running.

So, moral of the story: keep your butt moving! By the way, does anyone know a good sport chiropractor?

Monday, July 20, 2009

Dropped Metatarsals

Did a long run this weekend in my Vibram FF's. I've been doing these mainly at Pineland of late but didn't have the time to drive up there so just went locally, which means I ran about 1/3 of it on asphalt. The harder surface caused a tender spot on the bottom of my foot I'd been neglecting the past week to get a little worse. This isn't something I'd felt much running in shoes but the lack of cushion made it worse. I was able to stop and snap a few things loose in my foot, which made the pain go away for the most part, but if I weren't a sports chiropractor with an affection for feet, this probably would have cut my run short and had me looking for new shoes.

The pain I felt was from a Dropped Metatarsal. I can't remember if this is an official diagnosis but that's what I call it.

The metatarsal is the bone that connects the toe to the arch of the foot. The cuneiforms and the cuboid (of 'Born to Run' fame) are the row of bones comprising the arch where the metatarsals attach. The illustration below is provided by none other than Leonardo DaVinci, who, when he wasn't too busy painting the Mona Lisa or inventing flying machines, studied the human foot and called it, "A masterpiece of engineering and a work of art."

The individual bones of the foot are connected by joints. Just like any other joint, they are succeptible to becoming restricted, inflamed, and tender. The second and third cuneiforms, because they comprise the apex of the arch of the foot, are especially prone to becoming fixated. When this happens, pain can develop on the underside of the foot, often right in the middle where the cuneiform abuts the metatarsal. It is especially pronounced when going barefoot on hard surfaces (which I can attest to.) It can also affect the ball of the foot where the metatarsal attached to the toe, which often creates a pain similar to stepping on something sharp.

Typically a fixated metatarsal is stuck in a pushed down position, requiring me to literally push it back up to free up the joint. This is why I call it a "dropped" metatarsal.

The best remedy for this issue is to have the foot manipulated to restore motion to the affected joints. In simple cases the pain will often immediately improve. I recently treated a severe case of this that required 5-6 visits on my part to finally get the stuck joints released. However even in that case the pain improved immediately once we succeeded.

This is a condition that I find frequently accompanies other foot issues such as plantar fascitis or neuromas. It is not uncommon to have a runner who has been diagnosed with these other conditions, when in fact the most tender spot on their foot is the restricted cuneiform/ metatarsal. In some of these cases once we free up the joint issue the remaining plantar fascia or neuroma pain turns out to be less than what was thought, if at all. The severe case I mentioned above had been diagnosed with both of these conditions, and, having had no luck with conventional treatments was facing surgery.

Ultimately the key to preventing this from happening again is to better support the arch. This is done by either increasing the amount of arch support with shoes and/ or orthotics, or by strengthening the muscles that provide internal support. If you've seen me or read any of my other posts you can probably guess which approach I favor.

Tuesday, July 14, 2009

How to Quickly Raise Your VO2 Max

Here is a belated follow up to my entry (see First Post) regarding a radical intensity training plan:

So after following this plan for one month, the biathlete I described raised his VO2 max by 10 points! (Not 10% but 10 points, as measured in a lab.) He described the plan for me for anyone interested:

-Find max heart rate (you may already know it)
-Want to be working at 90-95% of max HR during intervals. It's easiest to achieve this consistently on the treadmill where you can account for all the variables except yourself. I have chosen 15% grade and starting speed of 6mph because this brings it closer to skiing. You may choose a lesser grade, but will likely have to compensate by increasing the speed. Once you accomplish the same protocol twice in a row, increase the speed 0.1mph. Repeat.
-Interval structure is 5 by 5 minutes at chosen speed and grade, with 2 minutes recovery in between. Recovery should be active, with reduced speed and grade (a brisk walk or slow jog).
-Do this workout M-W-F
-Workouts on T-Th-Sa take the form of a 30 minute sustained threshold interval. Basically aiming for 85% of max HR.
[Sun was a rest day. Repeat this for four weeks.]

One amazing thing about the results here are that this is an already highly conditioned athlete. You could take a couch potato and put them through a training program and get stellar results, but it is much harder to make big gains in such a short periof of time in a fit person. He actually has two more cycles of these to go through heading into this ski season.

I plan on trying this using a treadmill this winter. Hard to incorporate it when right in the middle of training for a distance event, but I would love to get faster. I've been running some of the weekly Boulevard 5K's and then this past weekend did the Bradbury 6 mile trail race. Find that I am getting almost the exact same times as last year, which is a little frustrating. Plan on trying a mini "crash" week this week where you increase the intensity of training for 1-2 weeks (as described by Joe Frield in 'The Triathletes Training Bible.') Hopefully this will make me a little faster heading into Beach to Beacon.

OK enough about my middle of the pack struggles. I'll get back to injury prevention topics in subsequent posts.

Wednesday, July 8, 2009

Vermont 50K

So Linda and I have signed up for the Vermont 50K trail race in September. This will be the longest distance either of us has run on or off road. I had decided to focus on running this summer and skimp on the triathlon training. Then mother nature reinforced my plans by raining out the entire month of June and the biking and swimming have fallen by the wayside.

I was looking to do a trail marathon. Reading Born to Run and meeting some of the local ultra people around has inspired me to try my first ultra. I've done two road marathons in the past but just can't stomach the thought of running that far on the road theses days. There aren't many trail marathons around so I settled on the Vermont 50K. I'd honestly rather run an extra 4 miles on trail than 26 on the road.

Once I decided and ran it by the boss, she said, "Well you better get on the horn."
"You mean get on the ball, and start training?" I said (with typical spousal sarcasm.)
Thinking quickly on her feet, she came back with, "No jack***, get on the horn and start telling some people. That way you'll have to follow through."

So, thought I would put my goal on the blog. I'm sure training for this race will provide some good blog-fodder.

Linda had planned on doing the Maine marathon this year, but she's been enjoying her trail running so much this year she decided to join me in Vermont. We had to sit down one night with a calendar and literally spent an hour coming up with a schedule where we could both run four days week and maintain family homeostasis. Basically we decided that if we went to bed one hour earlier each night (essentially giving up one hour of TV) and got up earlier, it could work. After following the schedule for one week to make sure it worked we signed up for the race.

I'm resisting the urge to attach any time expectation to the race. My goal is to find a pair of trail shoes that allow me to maintain my barefoot/Vibram form on a rocky 50K trail, and to just enjoy the experience.

Sunday, July 5, 2009


OK so the great Pineland barefoot experiment lasted all of 4 minutes. Two minutes to realize that the trails there weren't quite as soft as I remembered, then two more to get back to the car to retrieve the Vibrams. Somehow I was remembering lush grass paths, which there are a few of, but it doesn't take much gravel to ruin the experience. I was more concerned with being able to open up my stride and get in a good long run than tip-toeing over rocks.

I did finish off the run with a half hour of barefoot running around the grass of the campus proper, which I've done in the past. I will say that the Pineland campus is a great place to get in some barefoot running. The fields at Twin Brook in Cumberland are another good place to get in a little distance sans shoes.

I actually spent most of the rest of the day barefoot, taking the kids to the beach and then some backyard wiffleball. By the end of the day my feet felt swollen and sore. Linda took a picture:

Just kidding- this is a picture I found online taken of a tribal villager who had never worn shoes a day in his life. I can't imagine this guy ever suffered from bunions or heel spurs!

A quick reiteration here: I'm not advocating that runners throw away their shoes. But barefoot running, as a form of training, promotes good form and strengthens your feet and legs. It's a great way to help prevent injury or as part of rehabing from an existing injury.

Saturday, July 4, 2009

Barefoot Running Part 2

I received an email from a holistically minded friend recently with a link to some information about the concept of grounding. It is known that as we live and breathe, and particularly exercise for long periods, we build up a net positive charge and free radicals, which are atoms in need of an electron. This is known to be bad for your health, and the reason anti-oxidants are talked about so much these days. The surface of the earth has a net negative charge, meaning a surplus of electrons. Therefore the theory of grounding holds that if you are in skin contact with the earth, particularly outdoors in the grass, dirt, rock, etc. you ground yourself and tap into the earth's unlimited supply of electrons to dissipate your positive charge and free radicals. (I apologize if the details aren't quite right but it's been many years since I took physics.) I had heard of this before, that Lance Armstrong's former chiropractor on US Postal recommended athletes lay out in the grass after a hard workout to ground themselves. For anyone who has seen me sprawled out in the grass after a race, fatigue, nausea, and pain were only half the reason!

The theory continues that one consequence of being inside most of the time and then wearing rubber soled shoes when you do go outside diminishes your ability to be grounded and is harmful to your health. I was describing this to a scientifically inclinced friend who made a comment about crossing over from physics into metaphysics. However even if grounding isn't true, I don't mind passing along advice if the end result is that people reading this would feel inclinced to go outside and take their shoes off!

I will be doing more reading up on this topic myself. As with many health topics, it seems intuitive to return to something that our ancestors spent a lot of time doing.

In any case after hearing of grounding I was inspired to do my next morning's speed workout barefoot in the grass at some ball fields, something I had done in the past but not so much recently since getting (rubber-soled) Vibrams. I don't know if it was the grounding effect but the workout felt much better than I was anticipating. So good that on my next run, as I was going through Evergreen cemetary, I decided to kick off the shoes again and tromp around the grass there for the next 45 minutes or so. Again, the run felt awesome. However, being in the cemetary there was a lot more paved, dirt, and gravel road crossings to contend with and by the end my feet felt pretty raw. I put my shoes back on (light-weight trainers) to run the paved road home, and suddenly had an epiphany, bringing me to the original inspiration for this post...

... after running barefoot for 45 minutes over all sorts of surfaces, I realized that the only reason I needed shoes was to protect the skin of my feet. I didn't need them for cushioning. I didn't need them for stability. I didn't need them for pronation control. My feet, conditioned through many months of Vibrams running, did just fine on their own. I basically just needed a little protection from the elements. These particular shoes were light enough to allow me to continue the high cadence, mid-foot striking groove I had gotten into running barefoot moments ago. But had they been any heavier I know they would have interfered rather than helped my form.

I have read, written, and explained to others this concept, but that morning I really FELT it.

I'm due for a long run at Pineland this morning, and plan on staying in contact with Mother Earth for as long as my little feet will hold out.

Happy 4th!

Thursday, June 25, 2009

Western States 100

Over the past few months I've been priveleged to meet Maine's only two entrants into this weekend's Western States 100 ( a 100 mile trail race in California. The WS100 is the Boston of ultra's, attracting enough applicants to require a qualifying system and lottery.

Jamie and Dr. Jim (a fellow chiropractor) are Maine's two runners crazy enough..... I mean, good enough to qualify for this year's race.

I never even considered the possibility of doing an ultra until meeting these two guys. I was fortunate to join Jamie and one of his pacers on a night-time trail run, with the intent of practicing using headlamps on technical terrain. I've been so focused on technique in my running lately that it was a joy to tap into that timeless feeling of running. I was focused more on just making sure not to trip over roots and fall into puddles in the dark, that two hours went by in a flash. I gained some appreciation for the mental state I presume one needs to enter to complete something like WS. I can't say I'm entering the lottery for next year but I think I can see how its possible at least.

So join me in wishing these two guys the best. As you go to bed Saturday night send them some positive mental energy as they don headlamps to finish out their journey!

The $900 Foot

“I’ve spent $900 on this foot so far. If it gets injured again I think my husband is going to divorce me!”

Words spoken recently by a plantar fascitis sufferer. She had been dealing with this issue for at least a year. Between seeing her podiatrist for orthotics and cortisone injections, me, and then most recently a rolfer, the foot pain had finally resolved. Now she was looking for guidance on getting back into running safely.

My response essentially was, “Run barefoot.”

I’ve finally reached the point where I can look a person in this situation in the eye and make this recommendation. This is in large part to reading the new book ‘Born to Run’ recently. I’ve been leaning in the minimalist shoe direction for about three years now in my own running. During this time I’ve discussed the benefits of getting away from orthotics and bulky stability shoes with only a few runners who seemed open-minded and good candidates for this approach.
Reading ‘Born to Run’ however, has caused a paradigm shift in my approach to running injuries, particularly to the feet. I realized that there are many other people, who are much more qualified than I, who believe that modern running shoes sometimes cause more problems than they help.

Think about the fact that in regions of the world where people don’t wear shoes, plantar fascitis is almost non-existent. So if we reverse engineer the problem, we can assume that there is something about shoes that actually promotes increased stress to the heel. So why do we then recommend to plantar fascitis sufferers that they need more cushioning or support in the form of heavier shoes or orthotics. Have you heard the definition of insanity? To continue doing the same thing and expecting different results.

Now I’m not saying you need to eschew running shoes altogether. But understand what they do. The main function of all the various motion control features is to decrease the amount of muscle contraction required to stabilize your foot. The flip side to this is that by only running in shoes, your feet become weaker with time. Imagine if you put on a nice soft neck brace. It would probably feel good for a while. You could totally relax your neck muscles and allow the brace to carry the weight of your head. Now imagine how you would feel upon removing it if you had left it on for two weeks. You would have experienced so much muscle atrophy that you could barely hold your head up. I see runners and other athletes everyday who are in otherwise great shape but who have weak feet. We forget that our feet are supported by muscles and other soft tissues that respond to appropriate conditioning by becoming stronger.

I’ve come to question if many if not most foot injuries, and even many knee injuries, would have happened in the first place had the person done regular training barefoot or in something like Vibram Five Fingers to experience what running shoeless feels like. Running this way, you experience constant feedback from your feet and adjust your gait accordingly. Your lower extremities become stronger with time, instead of weaker.

So, for our friend with the expensive foot, I honestly thought that running barefoot or in Vibrams on soft grass would be the safest means of getting back into running.

Wednesday, June 10, 2009

Barefoot Running Part I

So I received an email from a runner I've worked with in the past for various issues. She's taken my rants to heart and has started some barefoot running. It really surprised me, as I tend to think of barefooters as a fringe bunch, and she is a pretty straight-laced mom. But there is no denying the sheer pleasure of running without shoes. Her only complant is:

"My problem is that I run to [the trail] in my Sauconies and then run barefoot and put my shoes back on to run home and I feel awkward trying to run in my shoes after running barefoot. It just feels wrong! "

I've felt the same way since starting to wear my Vibram Five Fingers. As I've grown accustomed to them I always find they are what go on my feet as I head out the door. The biggest surprise for me so far is how easy its gotten to run even on the road in the Vibrams, which have absolutely no cushioning. I run often in Evergreen cemetary, and usually by default wind up in the grass or dirt roads, even when wearing shoes. The other morning while running there in the Virbrams, having been lost in thought for a while, I realized I was on the asphalt, but hadn't even recognized the difference.

Studies have shown that when your run barefoot, you automatically adjust your gait to soak up the impact with your muscles and tendons. There is even an observed paradox, when measuring Ground Reaction Forces, that barefooters actually are landing with less force. The cushioning of the shoe attenuates some of the pain signal to your brain, so essentially it allows you to land harder.

Running in Vibrams (to abbreviate I'll start calling it "Varefooting") gives you the same benefits with an extra layer to protect your skin.

There will be many more posts on this topic.....

Monday, June 8, 2009

First Post

So here goes with my first blog entry. Funnily enough, this inaugural post goes against my stated intent of sticking with injury prevention topics vs. aspects of training. However this is a good example of "blog-quality" material and why I started this in the first place.

I heard of a crazy training plan today that I had to share. I've been working with an Olympic caliber biathlete (skate skiing and shooting) for the past several months. He is working with a coach named Jay T. Kearney, Ph.D., a former Olympian himself and who also works with Carmichael Training. He has devised a plan that could purportedly raise one's max VO2 by 50%. If true, this is an astounding number!

The plan basically entails several week blocks of six days a week of intensity training. I am being deliberately vague because: 1. I don't know the exact details yet myself 2. This is a pretty new concept that goes against conventional wisdom, and 3. This is probably not appropriate for most of us.

The point I wanted to make is that apparently your max VO2 isn't as set in stone as we've been told. This makes sense to me. Over the years I've come to realize that there are other physical (and mental) attributes that are more malleable than we've been led to believe. I've spent the past three years working to change my running form, culminating in running the Pineland Farms Trail Challenge in Vibrams (essentially bare-foot- more on this later.) I had an awesome time at the race and have finally reached the point where running has become a real joy again.

However when the after-glow of the race subsided and I was looking at my (slightly below) MOP time, I decided that my next goal is to get faster. I'm tired of being passed by people with horrible form! So today's info came at just the right time for me: can't say that I'll be doing six days a week of intensity training, but its nice to know there is hope of getting faster.