Wednesday, October 20, 2010

Maine Running Company Talk

Thanks to all those who came to the talk last Thursday night at Maine Running Company on ‘Natural Running,’ and thanks to John Rogers for hosting us. It felt a little surreal to be up there speaking. A year ago I was that wacky sports chiropractor telling people to try some barefoot running and now I’m an ‘expert’ (or ‘noted expert’ as I tell my wife.). I learned a lot from my fellow presenters, and they helped to explain the ‘how’ and ‘why’ of this new movement. Danny A. from Newton really has the form piece down, and I realized how much thought and experience goes into Newton shoes. Kirsten Buchanan has a great perspective, coming from a more conventional background but now being able to shed light on the emerging science behind minimalism. She showed me a stack of recent studies that are demonstrating how running barefoot and in minimalist footwear leads to lower impact forces and is associated with a decreased risk of things like runners’ knee and plantar fascitis. I wish we had had the time to hear more from them.

I thought I would post a few follow-up thoughts of my own, things I woke up the next morning thinking, ‘Why didn’t I say this?!’ As you may have seen from prior posts I was very zealous about minimalist running last year. To be honest I haven’t been thinking about it as much lately. I’ve just accepted it now with my own running and feel fully acclimated. Also this time of year in the office is more about trying to patch up runners getting ready for the fall marathons and halfs, and discussing changing gait isn’t what someone needs to hear weeks before their race.
At a minimum, barefoot running on grass is the easiest way to find your best form and also ensures that your feet and ankles are strong enough. The form piece comes easiest on grass; since it’s immediately comfortable, you can open up your stride without the skin sensitivity factor. Many of the elements of good form, including an upright posture and shorter strides tend to happen more naturally and intuitively when running without shoes. As far as injury prevention, it makes sense (to me at least) that any given runner should be able to do their longest run barefoot on grass. This implies that your muscles, tendons, and ligaments are strong enough to support you, regardless of what shoe you wear.

From this starting point it then becomes more about your goals. If ‘Born to Run’ was a religious experience for you and you are intent on running like the Tarahumara, then it’s a matter of finding the right covering for your feet when conditions prevent going sans shoes. In this case Vibram Five Fingers are probably your best bet.

For me, after spending last season finding my best form and rehabbing weak ankles with a lot of barefoot and Vibram running, I started this season looking to train harder to go faster. By springtime all my hard earned calluses from last year were gone and I was back to being a tender-foot. My natural progression, and the direction that I think most runners would follow, was to find shoes that didn’t interfere with my new stride. On the road this meant racing flats or Newtons, and on trails New Balance 100’s and Inov-8’s. Due to my experience with a stress fracture Vibrams have become mainly my Pineland shoe (soft surface without many roots or rocks), although at some point I’ll probably use them more often again. I still utilize barefoot running on grass for speedwork or if I just feel the need to get back in touch with my best form.

To be honest, I didn’t wind up running much this season. One thing that I found, and have seen repeatedly in the office, is that when you improve upon one area of the body (in this case my form and foot strength) whatever your next tight or weak link is will be revealed as your training increases. For me it was a balky hip that started to manifest in the knee. Right around that time I was lucky to score a sweet used bike, so I took all that as a sign to bike more this summer and work on rehabbing the hip before the knee became a true injury. However, putting aside my own sob story, I have worked with a number of injury-prone runners who have utilized the minimalist approach to great success.

If you are thinking about trying the minimalist approach, this is a good time of year to start. It takes time to change your form and to acclimate your body, and is not something you want to attempt in the midst of race training. Obviously the barefoot season is rapidly waning, but, depending on your starting point, injury status and goals, there are many options to get started. The most important thing is to take it slow.

Good luck!

Friday, May 21, 2010

The Boston Massacre

I started this one a few weeks back and then forgot to finish it.... I've been made aware that people are actually reading this blog, so I'll try to be more timely!

So the 'Boston Effect' from the last post has turned into what we're calling the 'Boston Massacre."

It seems that just about every runner we worked with leading up to the Boston Marathon has had a new issue pop up since the race. In talking with one of the survivors yesterday, we came up with some reasons that I thought I would share, especially since I know thoughts of fall marathons are on many people's minds.

Staying healthy is all about balance. Training balanced with rest. Athletic goals balanced with family and work. Gluts balanced with hip flexors. Balancing the checkbook in such a way that justifies yet another new pair of shoes.... you get the idea.

Training for and running a marathon on the road is probably one of the most challenging things that most runners can take on (no offense to the trail runners out there!) Boston in particular, due to the time of year it's run, the qualifying standard, the course, the pre and post zoo, and the stress this all creates, is more challenging than most.

Training for a marathon is hard enough, but to maintain balance through the process is especially tough. I know one guy getting ready to do Burlington this weekend, who sold his business about a month ago and is otherwise unencumbered, and is still feeling the pressure. Keeping up with appropriate strength training, stretching, seeing your sports chiropractor, and getting enough rest becomes tough particularly when you're training volume gets high in the run up to the race. Quite often something has to give, and then you go and race 26 miles on pavement, creating the perfect storm for injury.

I think there are lessons here for anyone considering training for and running their first marathon, or doing that distance with a PR time goal in mind:

1. There is a certain amount of strength training, particularly core work, necessary to prevent injury when training for distance. My unscientific observation is that a minimum of twice per week of this type of cross-training, coupled with somewhat consistent stretching, helps to keep people out of trouble. Ensure that you factor in the time/energy required to keep up with this non-running work when planning your training.

2. Even when you do appropriate cross-training, any lurking imbalances that you have are more likely to manifest when you take on training for distance. If you have small nuisance type of injury that you've been able to manage with the foam roller, don't be surprised if it gets worse when you increase your volume of training. It's always easier to address something early on than waiting a few weeks before your race when the pain threatens to shut you down.

3. Factor in increased rest time. If you already have a busy life and sleep less than 8 hours per night, your body might not hold up to this type of training if you can't carve out the appropriate recovery time.

I'm all for marathon training (my kids need braces after all), but just be sure to take into account the big picture before signing up. For me, my initial enthusiasm for another marathon in the months leading up to Boston have been reduced to trying to set a new 5K PR this year.

Saturday, April 10, 2010

The Pendulum Effect

So life has been laughing at my attempts at writing a book lately, so I'll let that go for now. However I do have some new thoughts to share, as I increase my own training, and with an influx of runners lately (I call it the 'Boston Effect'- which fortunately coincides with tax time.)

Last running season for me was all about the minimalist movement. Reading 'Born to Run' capped three years of experimentation with barefoot and minimal shoe running, and made me a believer. I was able to finally find my true natural running form, something I had spent years looking for. Having previously been dependent on stability shoes to run, the pendulum had swung all the way in the other direction. Running was fun and life was good again..... right up until getting a stress fracture running in Vibram FF's on the road.

This season the pendulum has come back to a happy medium. I have been more focused on increasing my pace, hoping to improve upon some of last year's MOP results. I have still been incorporating barefoot running, doing my speed workouts on grass soccer fields near my house. If I had the time or inclination to build up sufficient skin toughness, I would probably do a lot more barefoot running. But I'm just a gringo living in a place with cold winters, so for most other runs I've been using very flat road (NB rc230's) and trail (NB 790's and just got some NB MT 100's). I still like Vibram's but will not wear them on the road anymore, and they don't provide enough protection to go fast on trails I run on anywhere but Pineland.

This morning's long run has really helped put things in perspective. I drove to Baxter Blvd. (something I hate doing, but oh well), hoping to run in Vibrams to get the best of both worlds: skin protection to run at pace, but still the barefoot feeling. After two laps however, I thought I started to feel pain on the top of my left foot, triggering stress fracture flashbacks from last year, and I thought, "Screw this!" and immediately took off the Vibrams (of course just in time for a bunch of unavoidable gravel and the bridge, all at 38 degrees.) As I had hoped, the skin sensitivity factor made me land a lot lighter and I did my last lap with no foot pain. It was fun, especially the looks you get (ranging from smiles to incredulity to outright disgust.) However, I had to slow way down, which kind of defeated the purpose of the run.

People develop certain views of the world based on their occupation. EMT's wear seat belts, E.R. nurses don't drive motorcycles, and insurance agents know that stuff happens. Based on my experiences I've come up with a new philisophy about my running. I'm training for Boston, for Western States, for Lake Placid...... 20 years from now. My point being, I still want to be healthy and in the game then, doing the things I love.

Friday, March 19, 2010

Bullet-Proof Runner: General Principles of Running Injuries

Here is the second installment of "The Bullet-Proof Runner." This is tenatively Chapter 2, although this is still a pretty rough draft (but hey, its free!):

In general most non-traumatic distance running injuries reflect a body that is out of balance.

Many running injuries tend to follow a consistent pattern. Often they are the end result of a chain of events that begins with a musculoskeletal imbalance of the core and hips. (In this context the “core” includes the lower half of the spine, pelvis and supporting muscles.) During running, this imbalance leads to the generation of asymmetric and/or excessive loading of the lower extremities. The body can withstand or compensate for these forces up to a point. Eventually however a threshold of soft tissue inflammation and damage and sometimes joint restriction is exceeded and pain ensues. If training continues from this point a true injury can develop that hampers or makes it impossible to run at all.

Musculoskeletal imbalances are inherent in most individuals, whether they run or not.

Being a chiropractor I have seen my share of back pain. Over the years I began to recognize common “patterns” of core and hip muscle and joint imbalance that were present in those with back pain. For example, in individuals with lower lumbar spine pain, the right hip flexor seemed weaker than the left the majority of the time. These types of findings were so ubiquitous that it seemed logical they must stem from fundamental issues such as posture, hand-dominance, one’s occupation; essentially the net effect of what a person has (or hasn’t) done with their body.

From the beginning of my career I have always been drawn to the sports medicine side of things. However in the beginning I found working with runners frustrating. Their injuries quite often seemed resistant to what I had to offer. Over the years as I continued my education and learned new treatment methods my success rate improved. I practiced the holistic truism of always looking at the joint above and below the injured area. I did again learn to recognize particular commonalities in injured runners, such as the fact that lower extremity injuries tended to affect the left side greater than fifty percent of the time. However I still never felt like I could quite wrap my mind around why certain injuries happened in the first place. Consequently I continued to have cases in which my treatment wasn’t as successful as I (or the patient) would have liked.

For many years my patternistic approach to back pain and my treatment of running injuries remained somewhat separate concepts in my mind. However one day, after performing a gait analysis on a runner with lower back pain, I had one of those light-bulb moments where these two ideas suddenly synapsed together. This person had no issues with her lower extremities (or so she thought,) just her back. I was able to look at her gait though and explain not only why her right lower back hurt, but also to predict issues in her left lower extremity. On exam we found overtly painful spots in her left knee and heel that I knew were the beginnings of adductor tendinits and plantar fascitis.

It finally dawned on me that: We all have the same basic body design. Injured runners are just people with the same types of imbalances as anyone else, only they run. Running is very physically demanding, particularly to the lower extremities. Consequently these imbalances, even when subtle, become magnified and are quite often the underlying cause of running injuries.

Sources of Imbalance

Body composition, muscle tone, and flexibility are a function of genetics and lifestyle (nature and nurture.) Your body is a reflection of your genes, but just as importantly what you do with it. Not only is it true that ‘You are what you eat,’ but also ‘You are what you do.’

In my opinion the biggest source of musculoskeletal imbalance derives from the fact that we are using our pre-historic body design to function in today’s modern world. Most of us sit too much, and move our bodies too little. Our daily tasks have become much less physically demanding than they used to be, but on the other hand much more repetitive. In the case of the average runner, when they do move it’s usually on an unvarying, unyielding surface, in thick-soled shoes that don’t allow their feet to feel and respond to the ground.

Due to our modern lifestyle our hips tighten, our postural muscles weaken, and it becomes an effort to stand up straight with a level pelvis. Our dominant side tightens up to the point where muscles start shutting off and it actually becomes our weak side. Our feet become weak and can no longer support our weight without the support of the same shoes that made them weak in the first place. When we do run our cushioned shoes dampen the pain signal to our feet, allowing us to run in a style we could never sustain if barefooted.

Now you take an individual who lacks the core strength or endurance to support their frame, whose pelvis is twisted, whose feet are weak, and you ask them to run. You ask them to perform an activity that requires perfect synchronization and coordination of the entire musculoskeletal system. You make it socially awkward (and even medically inadvisable) for them to run without shoes so that they can find their own form, but on the other hand give them no advice on how to go about this activity. Is it any wonder virtually every runner is guaranteed a significant injury at some point?

Monday, February 22, 2010

The Bullet-Proof Runner

As spring inches closer and our thoughts turn to the upcoming running season, I thought I would post a series of entries excerpting an injury prevention book that I've been working on.

The phrase "Bullet-Proof Runner" popped into my head about two years ago on a winter long run. I had inadverdently taken a wrong turn and wound up running about 2-3 miles more than I had intended. In the past that would have unquestionably led to me crawling home at a much slower pace with various body pains. However I was pleasantly surprised that I was able to hold things together and in fact have a great run all the way through. I had really been focusing that winter on a core, lifting, and stretching routine to address my known imbalances. On that run I really felt the positive effects of all of this work coming together: I felt bullet-proof.

Thereafter I worked on solififying these exercises into a routine for the injured runners I saw at the office. What started as just exercise handouts evoloved into aspirations of a full-fledged book, the rough draft of which has been sitting in my word processor for at least a year now. I stopped working on it right after reading "Born to Run," thinking all of the answers had been revealed by the Tarahumara Indians. Having had the opportunity to work with dozens of more runners and other athletes since then (many of whom have read the book), and pushing things further in my own running has just solidified the basic premise of my book.

I thought posting this in blog form would allow some of my work to see the light of day, and maybe even prompt me to finish the darn thing! So without further ado, here is the Introduction:

Running is a great endeavor. It works on many different levels: it’s a great work-out, doesn’t take much time, doesn’t require much gear. Running provides time to think, or not to think. Running helps us get in touch with a very primal, fundamental means of using our bodies that as adults we don’t often experience otherwise. Nothing else quite captures the feeling of a good run. I run. I get it.

Unfortunately, for a lot of people the blessing of running comes with the curse of pain, injury, or, in the worst-case scenario, the inability to run at all. No other group of endurance athletes suffers more injuries than distance runners. The more miles you run the greater the chance you will become injured.

Some people seem to have “it” and some don’t. I need only to watch my daughter’s gymnastics class running around barefoot to realize that some people are born with that right combination of body type, feet, and intuitive form to run without worry. Combine that with a high VO2 max and the right mindset and you have a great distance runner in the making. However most of us aren’t so blessed.

For the rest of us, there is hope. You don’t have to resign yourself to running in pain. Just because you may not look like a Kenyan doesn’t mean you can’t enjoy the benefits of running. You may have to work a little harder on preparing your body to run, but it is possible.

So why is it that some people can run as much as they want while others are plagued with problems? What separates the injured from the uninjured? I asked myself that question many times over the years as I sought to recapture the ease and joy of running I once had. My personal journey, combined with the experience of working with many injured runnerss, has given me some insight as to what it takes to run without injury.

If there is one thing I’ve learned about the human body it is that everything is connected. Knee pain usually results from an issue in the hip or foot. Foot pain may be due to worn-out shoes or it might relate more to what’ve happening at the hip. Hip pain usually relates to the pelvis and core. To truly understand a running injury you must utilize the holistic approach of taking into account the entire body.

Most non-traumatic musculo-skeletal pain starts with an imbalanced body. Distance running injuries are no exception; in fact running more than any other sport will uncover your underlying biomechanical issues and turn them into injury. As a runner you may work around your imbalances with various compensations. You might stay off the asphalt or limit your mileage. You might stick with the one sneaker that keeps you out of trouble, or stretch religiously. However if you have an underlying musculoskeletal imbalance, chances are it will catch up with you. It might linger silently or nag you only occasionally for years, only to manifest as a true injury when you try to increase your mileage, push the pace in a race, or allow your shoes to become a little too worn. Whatever recently changed is usually blamed for the injury, when in fact the true culprit was there all along.

Many running injuries that I have seen could have been prevented had the runner known to identify their imbalances ahead of time and also the appropriate steps to remedy them. This is what the ‘Bullet-Proof Runner’ concept is all about: empowering runners to take a more pro-active role in addressing the causes of injury as opposed to just being reactive and dealing with the effects.

Sunday, January 24, 2010

We've Moved!

We are now up and running at our new location at 611 Brighton:

We are excited to be here, and I would like to give a big thanks to everyone who helped to make this happen for us.

Hope everyone is off to a good New Year!