Everything is Connected

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

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

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

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

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

Dropped Metatarsals

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

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

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

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

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

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

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

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

How to Quickly Raise Your VO2 Max

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

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

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

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

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

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