tag:blogger.com,1999:blog-31837182307115012482024-03-13T12:46:20.135-04:00The Sports DocJamie Raymond, D.C.http://www.blogger.com/profile/11212629079920430101noreply@blogger.comBlogger26125tag:blogger.com,1999:blog-3183718230711501248.post-12885318371396481042013-09-19T15:05:00.003-04:002013-09-19T16:06:58.979-04:00Medial Knee Pain - Pes Anserine Bursitis<br />
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In this blog we’ll talk about knee pain, one of the more
common injuries we see, especially as marathon season rolls around. We have previously discussed Iliotibial Band
Friction Syndrome (which creates pain on the outside of the knee), so today we’ll
look at the inside of the knee and specifically the Pes Anserine (P.A.) Tendon. </div>
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This tendon, which means ‘goose foot’ in
Latin, is actually the connection of three hip muscles onto the inside of the
knee: the Sartorius, Gracilis, and
Semi-Tendinosis (the inside hamstring.) (In the photo above the tendon is where the blue and brown lines converge at the knee.) Pain
and inflammation of the P.A. Tendon is called Pes Anserine Tendinitis or Bursitis.</div>
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Pes Anserine pain is felt distinctly on the inside of the
knee potentially during and after running, jumping, climbing stairs, and other activities. The pain may or may not respond to ice and
NSAID’s, does respond the rest, but can become quite severe if training
continues. This is one of those injuries
that athletes may self-manage for long periods with stretching, foam rolling,
icing, and reducing training but without ever getting it truly solved. </div>
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Another structure nearby that can also create inside knee
pain is the medial meniscus. It’s
important to differentiate the two as a medial meniscus tear won’t necessarily
respond to conservative care and can require surgery. Two symptoms that point to a P.A. injury are
medial knee pain after prolonged sitting and also pain in the <i>rear</i> leg with a lunge type motion. Meniscus pain is generally better with rest
and would likely be worse in the <i>front</i>
leg with a lunge. An upper tibial stress
fracture could also cause pain in this area.
An accurate diagnosis is essential as the treatments for these three injuries
are very different.</div>
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<span style="color: windowtext; font-size: 11pt; line-height: 17px;">Note: As always when we write about injuries you’ll see references to the concept of ‘muscle inhibition’, where-by muscles become not just weak but overtly ‘turned-off’ and unable to fire. This concept is often not fully appreciated and yet can be critical to really getting to the root cause of how injuries develop. Inhibition usually stems from issues with the joint(s) that the affected muscle attaches to or near.<o:p></o:p></span></div>
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There is a great saying about knees, one that we believe: ‘The
knee has the unfortunate circumstance of being located between the hip and the
ankle.’ Outside of overt trauma, most
repetitive knee injuries start with biomechanical issues in the hip joint above
and/or the foot below. The P.A. is no exception;
pain here usually stems from problems in the hip or foot, causing the Sartorius
and/or Gracilis to tighten as they try to over-compensate. We have not seen many cases of P.A. directly
attributable to the Semi-Tendinosis, despite the bad rap that tight hamstrings
receive. The common scenarios we do see
leading to Pes pain are:</div>
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<li><span style="text-indent: -0.25in;">Imbalances between the hip flexors and the
gluteus maximus causing compensation in the Sartorius.</span><span style="text-indent: -0.25in;"> </span><span style="text-indent: -0.25in;">Especially when the hip flexor is overtly
inhibited, the Sartorius (being partially a hip flexor itself) will be </span><span style="text-indent: -0.25in;">forced
to work excessively.</span></li>
<li><span style="text-indent: -0.25in;">Weakness and especially inhibition of the
adductor muscle group, causing the Gracilis to compensate. </span><span style="text-indent: -0.25in;">This scenario may or may not have accompanying
gluteus medius weakness.</span></li>
<li><span style="font-family: Symbol; text-indent: -0.25in;"><span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><span style="text-indent: -0.25in;">Foot weakness, especially if accompanied by a
toed-out, over-pronating gait, causing the Gracilis (and </span><span style="text-indent: -0.25in;">adductors) to work too
hard in helping to control the resulting extra lower leg motion.</span></li>
</ul>
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In any of these scenarios the compensating muscle(s) become
tight with time, causing the P.A. tendon and sometimes its under-lying bursae
to become inflamed.</div>
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Treatment of P.A. Tendinitis involves not only releasing the
tight, compensating Sartorius and/or Gracilis (or, if involved, the
Semi-Tendinosis,) but also ascertaining why the muscle is tight in the first
place (i.e. what is it compensating for?)
Active Release Technique works especially well in freeing up what is
tight. Typically much of this work is
directed at the upper end of the muscles near the hip where the tightness
usually first develops. In fact trying
to do too much work to the P.A. tendon itself at the lower end without first
releasing the upper end can just irritate it further.<br />
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As with many injuries, releasing the tight muscles is fairly
straight-forward, while figuring out the under-lying biomechanical cause is
more complicated. Some real-world
examples we’ve seen include:</div>
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<ul>
<li>Several cases of former soccer players who subsequently took
up running. The Sartorius is used more in soccer than most sports (think of
trying to hit a hacky-sack with the inside of the foot and you get the idea of its action.) However in
each of these cases it wasn’t simply tightness to blame but also accompanying
gluteal weakness.</li>
<li>A prior low back (pelvic) injury causing adductor inhibition
and therefore Gracilis tightness.</li>
<li>A prior low back (lumbar spine) injury causing gluteus maximus
and psoas inhibition and then subsequent Sartorius over-compensation.</li>
<li>An old groin pull (which usually occur in one of the upper
adductor muscles,) in which the adhesions (scar tissue) present in the
adductors bound up the Gracilis creating P.A. tension.</li>
<li>Old ankle injuries leaving athletes with residual weakness
and a characteristic toed-out gait causing Gracilis compensation.</li>
</ul>
Full resolution of this injury requires taking into account
these types of factors and helping the athlete rehab the under-lying
imbalances. Assuming there are no
accompanying orthopedic factors like a meniscus tear, Pes Anerine issues are
usually fully fixable. Hence our moto: ‘If
it <i>ain’t</i> broke, we can fix it!’Jamie Raymond, D.C.http://www.blogger.com/profile/11212629079920430101noreply@blogger.comtag:blogger.com,1999:blog-3183718230711501248.post-83812936635801830102012-04-28T07:03:00.000-04:002012-04-28T07:03:13.249-04:00Gluteus Medius: The Forgotten MuscleOn my last blog I related how I had discovered that my right gluteus medius (GM) wasn't firing while snow-shoeing up a mountain. Since then I've made it my mission to figure out why and to fix it. I think I've succeeded and thought I would share, since so many injuries seem to have this muscle imbalance as a root cause. In fact I would say that out of the past ten new injured runners I've seen, eight of them had a weak or 'turned-off' GM as a causative factor. These injuries range from ITBand Syndrome, other knee injuries, Piriformis Syndrome, recurring calf pulls, and low back and hip pain. The common theme here is that when the GM turns off other muscles over-compensate and sooner or later an injury manifests.<br />
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I've had a right hip issue on and off for at least 15 years. Early on I realized that keeping my hip abductors strong (including GM) kept the pain at bay. I mainly did side steps with a resistance band around the ankles, but tried various other things as well. It wasn't until snowshoeing however, that it dawned on me that my right GM still wasn't working. This would explain why my hip pain had been worsening in recent years.<br />
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After I got over feeling sorry for myself, the phrase 'Physician, Health Thyself' came to mind, and I went back to the drawing board. Basically I resurrected an old simple GM exercise: the lowly Clamshell. However I now do (and teach) it with a new intent, specifically holding onto the GM and willing it to fire. In the beginning this was quite frustrating because it just wasn't there. What I've observed is that for people like myself, with long-standing weakness, the body becomes so skilled at over-compensating that the GM becomes neurologically by-passed. Other neighboring muscles, like the gluteus minimus, TFL, piriformis, and/ or quadratus lumborum take up the slack. It takes a deliberately simple exercise to find it and get it reconnected to the brain. Any exercise that's the least bit complicated will only perpetuate the imbalance. <br />
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It took at least 2-3 weeks of this before I could reliable get the GM to respond. However I was downright stoked when, after the 3rd week, I went out for a longer-than-expected long run and had virtually no hip pain for probably the first time in a year (beware when a friend says, "I want to try linking up some of the newer Portland trails I've found- shouldn't take more than two hours.") Interestingly, the next week I wasn't quite as diligent with the clamshells, and when I went to do a warm up set before that weekend's long run I could tell the GM wasn't quite there, and correspondingly had more pain on that run even though it was shorter.<br />
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Thus confirmed, I've been working on it since with good results so far. I've also been doing Kettle-bell swings, and I swear my but has gotten about an inch bigger (which, when you have 'white-guy' butt isn't a bad thing.)<br />
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I'll post my full "Glut Rehabilitation Program" shortly.Jamie Raymond, D.C.http://www.blogger.com/profile/11212629079920430101noreply@blogger.comtag:blogger.com,1999:blog-3183718230711501248.post-86432558323131405182012-02-25T16:58:00.004-05:002012-02-25T17:25:44.365-05:00Snow-shoeing for the Gluteals<div>It seems like I begin every post with an apology for not keeping up to date on this blog better, so here it is: sorry.</div><div><br /></div>It took a little driving last weekend, but I was able to find some snow. Although it's been a disappointing winter (if you like snow that is), there is winter to be found in the White Mountains. I went snow-shoeing up East Royce Mtn- beautiful day and great views from the top. <div><br /></div><div>Learned a few interesting things: For starters, to the uninitiated, tracks in deep snow that veer on and off the trail might look like they belong to a lost hiker in need of rescuing, upon closer inspection, likely belong to a deer who presumably does not need rescuing. Also, snow-shoeing down a steep powdery trail is wicked fun. And finally- my right gluteus medius isn't firing! About half way up I could feel my left butt-cheek burning as I climbed through foot deep powder, but I realized at some point, Houston- we have a problem- the right one was no where to be found.<div><br /></div><div>This was distressing to me for a few reasons:</div><div><br /></div><div>1. A weak or 'turned-off' glut is probably the single most common muscle imbalance that leads to injury for athletes, especially runners.</div><div><br /></div><div>2. Knowing this, I always try to maintain strength there (even though it may look like I still have a classic white-guy butt, I do work at it.)</div><div><br /></div><div>3. Despite this, it's still weak- or more in my case: 'inhibited', meaning something is happening mechanically (or not happening) that is preventing this important hip stabilizer from engaging. </div><div><span style="font-size: 100%; ">Usually this relates to an issue in the ankle and/or the antagonist muscle groups, the hip flexors and adductors.</span></div><div><span style="font-size: 100%; "><br /></span></div><div><span style="font-size: 100%; ">4. I have recognized this for myself and sought help, and thought I had it all worked out.</span></div><div><span style="font-size: 100%; "><br /></span></div><div><span style="font-size: 100%; ">Not a good way to enter into training for Pineland which is a few short months away. Does anyone know a good sport chiropractor?</span></div><div><span style="font-size: 100%; "><br /></span></div><div><span style="font-size: 100%; ">In any case, for the rest of you with uninhibited but maybe just weak gluts, I would highly recommend snow-shoeing up a mountain a few times as a great way to strengthen the back-side. Much more fun than bridges and clam-shells!</span></div><div><br /></div><div><br /></div></div>Jamie Raymond, D.C.http://www.blogger.com/profile/11212629079920430101noreply@blogger.comtag:blogger.com,1999:blog-3183718230711501248.post-58861988274913824242011-03-22T06:52:00.002-04:002011-03-22T06:59:54.744-04:00Natural Running ClinicThere's a couple inches of snow on the ground this morning- it must be spring!<br /><br />Myself and Kirsten Buchanan will be at Maine Running Company this weekend hosting a 'Natural Running Clinic.' I understand that this one is sold out but there will be another one is April..... tried to post a link but I'm not too good at that kind of thing- but it's on Maine Running's website.<br /><br />Apparently another thing I'm not too good at is keeping up with this blog, as I think the last post was about last year's Boston, and here we are coming up on Boston again. This has more to do with a lack of time than a lack of content- have some new news, events, and thoughts to share hopefully more regularly coming soon.Jamie Raymond, D.C.http://www.blogger.com/profile/11212629079920430101noreply@blogger.comtag:blogger.com,1999:blog-3183718230711501248.post-36252526341203000482010-10-20T07:09:00.003-04:002010-10-20T07:16:56.793-04:00Maine Running Company TalkThanks 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.<br /><br />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.<br />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.<br /><br />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.<br /><br />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.<br /><br />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.<br /><br />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.<br /><br />Good luck!Jamie Raymond, D.C.http://www.blogger.com/profile/11212629079920430101noreply@blogger.comtag:blogger.com,1999:blog-3183718230711501248.post-66198002171862939692010-05-21T05:23:00.008-04:002010-06-07T20:25:53.163-04:00The Boston MassacreI 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!<br /><br />So the 'Boston Effect' from the last post has turned into what we're calling the 'Boston Massacre."<br /><br /><br />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.<br /><br />Staying healthy is all about balance. Training balanced with rest. Athletic goals balanced with family and work. Gluts balanced with hip <span class="blsp-spelling-error" id="SPELLING_ERROR_0">flexors</span>. Balancing the checkbook in such a way that justifies yet another new pair of shoes.... you get the idea.<br /><br />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 <span class="blsp-spelling-error" id="SPELLING_ERROR_1">pre</span> and post zoo, and the stress this all creates, is more challenging than most.<br /><br />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 <span class="blsp-spelling-corrected" id="SPELLING_ERROR_2">sports</span> chiropractor,<span style="font-size:78%;"> </span>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.<br /><br />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:<br /><br />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.<br /><br />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 <span class="blsp-spelling-corrected" id="SPELLING_ERROR_3">nuisance</span> 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.<br /><br />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.<br /><br />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.Jamie Raymond, D.C.http://www.blogger.com/profile/11212629079920430101noreply@blogger.comtag:blogger.com,1999:blog-3183718230711501248.post-29749801996884626552010-04-10T08:53:00.002-04:002010-04-10T11:20:56.950-04:00The Pendulum EffectSo 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.)<br /><br />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.<br /><br />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.<br /><br />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.<br /><br />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.Jamie Raymond, D.C.http://www.blogger.com/profile/11212629079920430101noreply@blogger.comtag:blogger.com,1999:blog-3183718230711501248.post-19150146515354390752010-03-19T06:08:00.002-04:002010-03-19T06:15:26.832-04:00Bullet-Proof Runner: General Principles of Running InjuriesHere 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!):<br /><br /><br /><strong>In general most non-traumatic distance running injuries reflect a body that is out of balance.</strong><br /><br />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.<br /><br /><strong>Musculoskeletal imbalances are inherent in most individuals, whether they run or not.</strong><br /><br />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.<br /><br />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.<br /><br />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.<br /><br />It finally dawned on me that: <em>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.<br /></em><br /><br /><strong>Sources of Imbalance</strong><br /><br />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.’<br /><br />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.<br /><br />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.<br /><br />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?Jamie Raymond, D.C.http://www.blogger.com/profile/11212629079920430101noreply@blogger.comtag:blogger.com,1999:blog-3183718230711501248.post-15552654292856128172010-02-22T05:57:00.003-05:002010-02-22T06:51:14.905-05:00The Bullet-Proof RunnerAs 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. <br /><br />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.<br /><br />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. <br /><br />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:<br /><br />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.<br /><br />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.<br /><br />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.<br /> <br />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.<br /><br />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.<br /><br />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. <br /><br />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.<br /><br />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.Jamie Raymond, D.C.http://www.blogger.com/profile/11212629079920430101noreply@blogger.comtag:blogger.com,1999:blog-3183718230711501248.post-25099521861621319762010-01-24T20:44:00.004-05:002010-01-24T20:58:21.336-05:00We've Moved!We are now up and running at our new location at 611 Brighton:<br /><br /><a href="http://3.bp.blogspot.com/_7InJvS9jAO4/S1z6aVh30KI/AAAAAAAAAC4/0CYioZP79UY/s1600-h/Office+Pic.jpg"><img style="display:block; margin:0px auto 10px; text-align:center;cursor:pointer; cursor:hand;width: 400px; height: 354px;" src="http://3.bp.blogspot.com/_7InJvS9jAO4/S1z6aVh30KI/AAAAAAAAAC4/0CYioZP79UY/s400/Office+Pic.jpg" border="0" alt=""id="BLOGGER_PHOTO_ID_5430490581064732834" /></a><br /><br />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. <br /><br />Hope everyone is off to a good New Year!Jamie Raymond, D.C.http://www.blogger.com/profile/11212629079920430101noreply@blogger.comtag:blogger.com,1999:blog-3183718230711501248.post-18310826130505114862009-11-16T20:11:00.004-05:002009-11-16T20:28:22.003-05:00Upcoming TalkI will be giving a <a href="http://www.mainerunning.com/component/option,com_events/Itemid,41/agid,203/day,19/month,11/task,view_detail/year,2009/">talk at Maine Running Company </a>this Thurs., Nov. 19 at 7:00 p.m. on the topic of minimalist running.<br /><br />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!Jamie Raymond, D.C.http://www.blogger.com/profile/11212629079920430101noreply@blogger.comtag:blogger.com,1999:blog-3183718230711501248.post-90405723668072070642009-10-28T19:50:00.004-04:002009-11-05T20:08:17.994-05:00What I've Learned About Stress FracturesI'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.<br /><br />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:<br /><br />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.<br /><br />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.<br /><br />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. <br /><br />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.Jamie Raymond, D.C.http://www.blogger.com/profile/11212629079920430101noreply@blogger.comtag:blogger.com,1999:blog-3183718230711501248.post-11233081984071345842009-10-16T05:30:00.001-04:002014-01-20T06:07:05.832-05:00Proximal Hamstring SyndromeI 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.<br />
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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.<br />
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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.<br />
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<a href="http://1.bp.blogspot.com/_7InJvS9jAO4/St0PYI29vPI/AAAAAAAAACg/Zo_rIZBibwc/s1600-h/Post+Hip-+edited.jpg" style="margin-left: 1em; margin-right: 1em;"><img alt="" border="0" src="http://1.bp.blogspot.com/_7InJvS9jAO4/St0PYI29vPI/AAAAAAAAACg/Zo_rIZBibwc/s400/Post+Hip-+edited.jpg" height="544" id="BLOGGER_PHOTO_ID_5394484836029021426" style="display: block; margin: 0px auto 10px; text-align: center;" width="640" /></a></div>
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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. <br />
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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.<br />
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<a href="http://1.bp.blogspot.com/_7InJvS9jAO4/St0FZ1lWn_I/AAAAAAAAACA/TsZ1yIG5hhg/s1600-h/lower_cross.jpg"><img alt="" border="0" src="http://1.bp.blogspot.com/_7InJvS9jAO4/St0FZ1lWn_I/AAAAAAAAACA/TsZ1yIG5hhg/s400/lower_cross.jpg" id="BLOGGER_PHOTO_ID_5394473870098341874" style="cursor: hand; cursor: pointer; display: block; height: 234px; margin: 0px auto 10px; text-align: center; width: 132px;" /></a><br />
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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:<br />
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-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.<br />
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-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.<br />
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-In some cases, the piriformis muscle also becomes involved, causing sciatic nerve irritation and more pronounced pain, sometimes further down the leg. <br />
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-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. <br />
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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.<br />
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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.<br />
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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!<br />
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<a href="http://3.bp.blogspot.com/_7InJvS9jAO4/St0WN1w8BgI/AAAAAAAAACo/j0qj8rVuhD0/s1600-h/BridgeHeel.jpg"><img alt="" border="0" src="http://3.bp.blogspot.com/_7InJvS9jAO4/St0WN1w8BgI/AAAAAAAAACo/j0qj8rVuhD0/s400/BridgeHeel.jpg" id="BLOGGER_PHOTO_ID_5394492355686172162" style="cursor: hand; cursor: pointer; float: right; height: 244px; margin: 0 0 10px 10px; width: 400px;" /></a>Jamie Raymond, D.C.http://www.blogger.com/profile/11212629079920430101noreply@blogger.comtag:blogger.com,1999:blog-3183718230711501248.post-48998274640979273872009-10-05T19:26:00.000-04:002009-10-05T20:51:02.884-04:00Stress FractureSo 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.)<br /><br />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.<br /><br />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.)<br /><br />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:<br /><br />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.<br /><br />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.<br /><br />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.<br /><br />(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.)<br /><br />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.<br /><br /><br />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.Jamie Raymond, D.C.http://www.blogger.com/profile/11212629079920430101noreply@blogger.comtag:blogger.com,1999:blog-3183718230711501248.post-55087212585828098812009-09-29T23:45:00.000-04:002009-09-29T20:45:09.667-04:00Vermont 50K Race ReportSo 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!<br /><br /><a href="http://4.bp.blogspot.com/_7InJvS9jAO4/SsHm2gtOtoI/AAAAAAAAABo/cXymdjaiVSA/s1600-h/linda.JPG"><img style="display:block; margin:0px auto 10px; text-align:center;cursor:pointer; cursor:hand;width: 320px; height: 240px;" src="http://4.bp.blogspot.com/_7InJvS9jAO4/SsHm2gtOtoI/AAAAAAAAABo/cXymdjaiVSA/s320/linda.JPG" border="0" alt=""id="BLOGGER_PHOTO_ID_5386840453478790786" /></a><br /><br />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. <br /><br />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. <br /><br />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!!! <br /><br />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! <br /><br />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. <br /><br />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. <br /><br />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!Jamie Raymond, D.C.http://www.blogger.com/profile/11212629079920430101noreply@blogger.comtag:blogger.com,1999:blog-3183718230711501248.post-58467522481113434252009-09-14T19:30:00.000-04:002009-09-16T14:05:13.032-04:00Plantar 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.<br /><br />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. <br /><br />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.)<br /><br />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. <br /><br />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.<br /><br />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.<br /><br />So what did we learn?<br /><br />1. Everything is connected.<br />2. Address your imbalances before training for distance (or speed.)<br />3. Watch out for long drives in the car, especially right before or after a long run.<br />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.)<br />5. A marriage apparently can survive both training for a 50K at the same time, so long as that foot gets fixed!Jamie Raymond, D.C.http://www.blogger.com/profile/11212629079920430101noreply@blogger.comtag:blogger.com,1999:blog-3183718230711501248.post-63289056970633403732009-08-26T19:55:00.000-04:002009-08-26T20:37:08.418-04:00Everything is ConnectedSorry 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.<br /><br />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.<br /><br />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.<br /><br />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.<br /><br />So, moral of the story: keep your butt moving! By the way, does anyone know a good sport chiropractor?Jamie Raymond, D.C.http://www.blogger.com/profile/11212629079920430101noreply@blogger.comtag:blogger.com,1999:blog-3183718230711501248.post-67731011615185262622009-07-20T20:42:00.000-04:002009-07-20T21:57:00.888-04:00Dropped MetatarsalsDid 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.<br /><br />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.<br /><br />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."<br /><br /><br /><img id="BLOGGER_PHOTO_ID_5360710891507402946" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 326px; CURSOR: hand; HEIGHT: 190px; TEXT-ALIGN: center" alt="" src="http://4.bp.blogspot.com/_7InJvS9jAO4/SmUSJ0_dyMI/AAAAAAAAABY/_YqxRogh_50/s320/Leo+foot+labelled.jpg" border="0" /><br /><p>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. </p><p>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.</p><p>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.</p><p>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.</p>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.Jamie Raymond, D.C.http://www.blogger.com/profile/11212629079920430101noreply@blogger.comtag:blogger.com,1999:blog-3183718230711501248.post-47954185460768717322009-07-14T06:04:00.000-04:002009-07-14T06:24:59.321-04:00How to Quickly Raise Your VO2 MaxHere is a belated follow up to my entry (see First Post) regarding a radical intensity training plan:<br /><br />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:<br /><br />-Find max heart rate (you may already know it)<br />-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.<br />-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).<br />-Do this workout M-W-F<br />-Workouts on T-Th-Sa take the form of a 30 minute sustained threshold interval. Basically aiming for 85% of max HR.<br />[Sun was a rest day. Repeat this for four weeks.]<br /><br />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.<br /><br />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.<br /><br />OK enough about my middle of the pack struggles. I'll get back to injury prevention topics in subsequent posts.Jamie Raymond, D.C.http://www.blogger.com/profile/11212629079920430101noreply@blogger.comtag:blogger.com,1999:blog-3183718230711501248.post-46282994665291208572009-07-08T07:16:00.000-04:002009-07-08T07:44:26.834-04:00Vermont 50KSo 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.<br /><br />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. <br /><br />Once I decided and ran it by the boss, she said, "Well you better get on the horn." <br />"You mean get on the ball, and start training?" I said (with typical spousal sarcasm.)<br />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."<br /><br />So, thought I would put my goal on the blog. I'm sure training for this race will provide some good blog-fodder.<br /><br />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.<br /><br />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.Jamie Raymond, D.C.http://www.blogger.com/profile/11212629079920430101noreply@blogger.comtag:blogger.com,1999:blog-3183718230711501248.post-29020319448702020082009-07-05T08:54:00.000-04:002009-07-05T10:16:57.608-04:00FeetOK 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.<br /><br />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.<br /><br />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:<br /><br /><br /><br /><br /><br /><br /><img id="BLOGGER_PHOTO_ID_5354975952451511314" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 300px; CURSOR: hand; HEIGHT: 142px; TEXT-ALIGN: center" alt="" src="http://1.bp.blogspot.com/_7InJvS9jAO4/SlCyQcKhpBI/AAAAAAAAAAw/-IQPFCRSUxA/s320/tribal-feet.jpg" border="0" /><br /><br /><p> </p><p> </p><p>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!<br /></p><p>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.</p>Jamie Raymond, D.C.http://www.blogger.com/profile/11212629079920430101noreply@blogger.comtag:blogger.com,1999:blog-3183718230711501248.post-38881343312683634262009-07-04T03:21:00.000-04:002009-07-04T04:08:02.143-04:00Barefoot Running Part 2I 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!<br /><br />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!<br /><br />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.<br /><br />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...<br /><br />... 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.<br /><br />I have read, written, and explained to others this concept, but that morning I really FELT it.<br /><br />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.<br /><br />Happy 4th!Jamie Raymond, D.C.http://www.blogger.com/profile/11212629079920430101noreply@blogger.comtag:blogger.com,1999:blog-3183718230711501248.post-10838035303606157822009-06-25T07:12:00.000-04:002009-06-25T07:35:52.332-04:00Western States 100Over the past few months I've been priveleged to meet Maine's only two entrants into this weekend's Western States 100 (<a href="http://www.ws100.com/home.html">http://www.ws100.com/home.html</a>) 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.<br /><br />Jamie <a href="http://mainerunner.blogspot.com/">http://mainerunner.blogspot.com/</a> and Dr. Jim <a href="http://www.creatingwellness4me.com/">http://www.creatingwellness4me.com/</a> (a fellow chiropractor) are Maine's two runners crazy enough..... I mean, good enough to qualify for this year's race.<br /><br />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.<br /><br />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!Jamie Raymond, D.C.http://www.blogger.com/profile/11212629079920430101noreply@blogger.comtag:blogger.com,1999:blog-3183718230711501248.post-13068292042556996972009-06-25T07:08:00.000-04:002009-06-25T07:12:29.398-04:00The $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!”<br /><br />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.<br /><br />My response essentially was, “Run barefoot.”<br /><br />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.<br />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.<br /><br />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.<br /><br />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.<br /><br />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.<br /><br />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.Jamie Raymond, D.C.http://www.blogger.com/profile/11212629079920430101noreply@blogger.comtag:blogger.com,1999:blog-3183718230711501248.post-57303591561221788972009-06-10T07:09:00.000-04:002009-06-10T07:28:27.303-04:00Barefoot Running Part ISo 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:<br /><br />"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! "<br /><br />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.<br /><br />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.<br /><br />Running in Vibrams (to abbreviate I'll start calling it "Varefooting") gives you the same benefits with an extra layer to protect your skin.<br /><br />There will be many more posts on this topic.....Jamie Raymond, D.C.http://www.blogger.com/profile/11212629079920430101noreply@blogger.com