Rules To Run By | Running Physical Therapy

Rebuilding Your Body Post-Marathon and Post-Injury

2013-10-12T17:46:00.001-04:00

Wilson Kipsang set a world record in the marathon of 2:03:23 in Berlin on September 29, 2013. Here is your opportunity to learn from the fastest marathoner the world has ever seen! His philosophy to rebuilding after the marathon applies to both running training and recovery from injury:

"After every marathon, Wilson spends about 2 months going in the gym of Lornah Kiplagat, for rebuilding the level of strength lost during the specific training for long distances, and maintaining high level of flexibility and reactivity. This is something other athletes don’t do, preferring to rest waiting [until] their body can again be able to work at its best. Specifically, we can see the difference of mentality between Wilson and other top runners in the behavior after some injury: the most part await [most of them believe that] the time can solve the problem, totally resting and looking for some business, while Wilson has in his mind the priority to attack the injury, giving [it] great importance."

- Renato Canova, coach of many elite runners around the world

When you train for a marathon, you lose muscular strength in the final training period if most of the marathon-pace long runs are performed over flat terrain. Of course, fast long runs on the flat are exactly what you need to achieve a peak performance in a flat marathon. Specificity rules! But, after finishing the marathon (hopefully with a PR!), you are not only extremely fatigued, but also at your lowest level of muscular strength. The flat long runs and the marathon itself have brought you to this state. What can you do to make sure that your next race is successful? Rebuild your strength while slowly increasing the volume of easy running in your routine. Participating in some cross-training activities (cycling, swimming, rowing, etc.) in replacement of easy running in the first week or two back can be helpful as well. DO NOT perform fast long runs, intense tempo runs, or any other strenuous running workout that will push you further into the hole. Your #1 priority needs to be rebuilding your running-specific strength (see Hill Workouts #1 and #2)!

Canova's last line is one of his best. Remember, resting a running-related injury can only do so much. We must "attack the injury" through focused interventions to achieve functional, pain-free running. At FLASH Sports Physical Therapy, we take this approach very seriously. Even if our patients are taking a brief rest from running, they are performing tolerated cross-training activities and running-specific therapeutic exercises and activities in the interim. This method enables them to return-to-running even better than before! Stronger, more stable, and more knowledgeable regarding preventing injury recurrence = consistent, smart training = FASTER TIMES!

The Best Way For YOU to Run Hills

2013-02-16T13:35:00.000-05:00

Although spring is approaching quickly, it still is winter in West Chester, Pennsylvania. The mornings are dark, the wind is bitterly cold. And while some town residents may be awaiting a warmer breeze before trading their comfortable bed or favorite TV show for an invigorating run, the members of local running clubs and other lone runners are pushing through the winter obstacles with dreams of PRs (personal records) in the spring, summer, and fall.

If you are a runner, you may know of some of the workouts they are completing. Tempo runs, long runs, and fartleks are just a few. But the one other workout synonymous with winter for runners is hills. With the possibility of a track being covered with snow and ice, hill workouts on the road are a great way to develop a variety of characteristics vital to the success of a runner. But how long? how fast? how many? how much recovery? The questions are numerous. And yet the answer is very individualized.

First, let's review just a few of the many different types of hill workouts…taking a close look at the purpose and use of each one:

1.) Hill sprints (alactic = no significant lactate accumulation): 6-12x10-12 seconds at maximal effort on a steep hill with a walk-down recovery (2-3 minutes)

· PURPOSE: Improve maximal speed and muscular strength by recruiting the highest possible percentage of fibers in the muscles

· USE: FOR ALL RUNNERS throughout every period of the year….dosage can be adjusted depending upon time of the season

2.) Hill exercises: 4-6x20-50m of high knees, butt kicks, skipping, and bounding on a moderate grade uphill with a walk-down recovery (1-2 minutes)

· PURPOSE: Improve elastic reactivity (i.e., agility, quickness) and/or muscular strength

· USE: For runners lacking strength (early to mid-season) or who are returning from injury [At FLASH Sports Physical Therapy, we utilize hill exercises in the later stages of rehabilitation as a form of running-specific strengthening....think of these hill exercises as squats for the runner!]

3.) Longer hill repeats at MAXIMAL effort (significant lactate accumulation): 1-10x30 seconds-3 minutes at maximal effort on a fairly steep hill with a walk-down or very slow jog recovery (90 seconds-6 minutes, depending upon length of uphill section)

· PURPOSE: Improve ability to recruit the greatest number of fibers in the muscles when they are full of lactate while generating the highest amount of power

· USE: For runners who are preparing specifically for 800m-10k races, need to improve their finishing speed (kick), are preparing for a hilly race, or tend to peak early and need a replacement for early to mid-season high-intensity track work

· ***Also advised for those returning from injury as one is eliminating the increased impact forces of faster, downhill running.

4.) Longer hill repeats at SUBMAXIMAL effort (moderate lactate accumulation, sustained work above anaerobic threshold): 6-12x30 seconds-3 minutes at submaximal but strong effort on a fairly steep hill with moderately-paced running recovery (45 seconds-4 minutes, depending upon length of uphill section)

· PURPOSE: Improve ability to run strongly when fatigued, boosting the anaerobic threshold and aerobic power with an element of strength

· USE: For runners who are preparing for half-marathon-marathon+ races or are preparing for a hilly race that might involve a series of uphills preceded by some downhill sections

· ***Not advised for those returning from injury as one is subjected to increased impact forces during the faster, downhill running. Also, remember not to rush the 180-deg. turns at the top and bottom of the hill; taking these turns too quickly can place a great amount of stress on the knees and other areas and increase your likelihood of injury. Therefore, although the total time of the workout can be a good measure for quantifying improvement, focusing on the individual times of the uphill and downhill sections may be a better option. The ultimate emphasis still should be on the uphill portions, however. Do not improve your downhill time splits at the expense of your uphill time splits; your uphill time splits should be the same to slightly faster from one session to the next while gradually bringing down the time of the downhill splits.

5.) Uphill tempo runs (moderate lactate accumulation, continuous effort slightly above anaerobic threshold, can be performed on a treadmill for runners who do not live in mountainous areas): 15-45 minutes continuously at an effort slightly above anaerobic threshold on a moderate grade hill

· PURPOSE: Improve ability to run strongly as one fatigues, boosting the anaerobic threshold and aerobic power with an element of strength

· USE: For all runners in the early to mid-season (as a replacement for a flat tempo run) and throughout all periods for runners who are preparing for a hilly race; also can be a good replacement for longer hill repeats at submaximal effort with moderately-paced downhill recoveries as the overall stress to the cardiovascular system is similar (perfect for those runners returning from injury but who cannot tolerate the downhills yet!)

As you can see, hills are a gold mine for variety of workouts. You also can manipulate stride length and frequency depending upon your desired effects and/or strengths and weaknesses. This idea can be explored further in a future blog post. So to answer the age-old question: Is there a best way to run hills? The simple answer is yes while understanding that the best way for YOU today may not be the best way for YOU in 3 weeks or for one of your running partners. Determine your goals and needs and find the best fit for you. This same principle applies to the planning of any running workout. Do not shortchange your running by falling into a rut of staleness; invigorate your workout routine so that YOU can run to the best of your God-given abilities!

Keeping Your Pockets Fuller with Out-of-Network Physical Therapy

2012-09-21T11:52:00.000-04:00

As the owner of FLASH Sports Physical Therapy, LLC, I often am asked by prospective patients if working with an out-of-network physical therapist will cost them more money. My response: "Typically, no. And oftentimes, less money in the long run." But how is this saving remotely possible? How is shelling out $100 for a 60-minute treatment session less money out-of-pocket than if you work with an in-network physical therapist and pay your traditional co-pay?

Health insurance companies tell us that we will save money by staying in-network. For many procedures, this statement is true. For instance, if you undergo ACL reconstruction, you will owe less money out-of-pocket for a surgeon's time if he or she is in-network compared to out-of-network. Ultimately, these savings occur because the surgery is a one-time procedure on a particular day that is not influenced by the final outcome. In other words, the health insurance company will pay the surgeon the amount of the previously negotiated fee that is to be covered by them so long as the surgery is completed successfully; your out-of-pocket costs will be whatever your health insurance plan originally designated as your responsibility (may be a co-pay, coinsurance, payment towards a deductible, etc.)

Now, let us take a look at the costs associated with in-network and out-of-network physical therapy care for a minor Achilles tendon issue. The patient is a male high school runner who has struggled with increased symptoms in his Achilles tendon for a little over a month whenever he attempts to run faster workouts. He is on his family's health insurance plan, which is a HMO plan.....the Aetna Advantage HMO 30 plan (Pennsylvania) to be specific. So, what happens if he works with an in-network physical therapist?

$50 co-pay per visit, 2x/week for 8 weeks (16 total visits) = $800 out-of-pocket (after the initial evaluation)

If he is lucky, he will spend 15 minutes working directly with the physical therapist (perhaps manual therapy techniques and patient education)....not because the physical therapist does not want to work longer with him but because he or she has to see two other patients in that same hour. With whom will the patient work the remaining 45 minutes that he is in the clinic (during which he performs exercises)? Most likely a physical therapy technician or aide, who is usually a high school or college student interested in the field. The patient enjoys working with the technician but truly values his time spent with the physical therapist, so if we calculate the amount of money he is paying the physical therapist per hour, we determine that rate to be $200 per hour ($50 for 15 minutes of time = $200 per hour). **Grand total = $800 dollars out-of-pocket for 240 minutes spent directly with the physical therapist, 720 minutes of exercise with physical therapy technician.

What happens if this same exact patient works with an out-of-network physical therapist?

$90 per visit (10% discount), 1x/week for 4 weeks (4 total visits) = $360 out-of-pocket (after the initial evaluation)

In this case, the patient will spend 60 minutes working directly with the physical therapist. In my clinic, 50 of these 60 minutes most likely will be spent on performing manual therapy techniques to directly facilitate healing of the Achilles tendon. The last ten minutes will be spent reviewing the patient's home exercise program (to be performed daily to 3-4 times per week, depending upon the situation) and educating the patient. Also, if this patient is working with me, he will receive a 10% discount on all services since he is a high school runner. The physical therapist's rate per hour is exactly what the patient already paid him: $90. **Grand total = $360 dollars out-of-pocket for 240 minutes with the physical therapist, performing home exercise program on own

***Summary: Discounting confounding variables (possibility of biology of tendon healing requiring 8 weeks of rehabilitation instead of 4 weeks despite concentrated manual therapy time and/or skill level of physical therapist), working with an out-of-network physical therapist could save this patient both time and money. He could spend less time at a physical therapy clinic for treatment sessions (12 fewer hours!) and could save $440. And the possibility exists that he may recover more quickly! (Note: Even in another out-of-network clinic that does not provide this discount, this patient could save $400.)

This cost analysis is based upon actual situations and outcomes with which I have been involved in my career as a physical therapist. Certainly, it only is one example of what can happen, and not EVERY patient will save money by working with an out-of-network physical therapist, but I have observed that quite a few will do so. In terms of PPO plans, out-of-network physical therapy benefits may differ from one plan to the next....but in MOST cases, the savings will be even more substantial than that of a HMO plan, particularly if the individual or family has hit the yearly deductible. So, the next time that you require the services of a physical therapist, take a close look at your health insurance plan and crunch the numbers. You might be surprised as to what you discover.....and how much fuller your pockets are after successfully completing your course of therapy with an out-of-network physical therapist.

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How would a limited edition framed photo from the 2012 London Olympics look on your wall at home? Call FLASH PT today at (610) 696-5076 to schedule your FLASH Running Clinic to be entered in a random drawing for this prized memorabilia!

For more info: http://flash-pt.com/Documents/RunningClinic.pdf

BOLT: Retire Smarty Jones-Style.

2012-08-20T10:11:00.000-04:00

As the dust from the 2012 Olympic Games in London begins to settle, we finally have an opportunity to reflect on the many incredible performances by athletes of all nationalities. Jessica Ennis winning the heptathlon for Great Britain. The U.S. women's soccer team winning gold over Japan. Michael Phelps capping off his career with a record 22 medals. Mo Farah of Great Britain becoming a double Olympic gold medalist in the 5,000 and 10,000 meters, with his training partner Galen Rupp of the U.S. snagging the silver medal in the latter. And last but not least, the unforgettable performances of Jamaican Usain Bolt in the 100 and 200 meters. What a remarkable display of dominance!

Silencing the naysayers, Bolt became the only man in Olympic history to successfully defend his 100 and 200 meter titles. Despite his typically less-than-explosive start, Bolt powered away in the closing stages of the 100 meters to win over a stacked field. Reports indicate that Bolt took only 41 strides to cover the distance compared to runner-up Yohan Blake's 43 strides. What do these numbers tell us? In short, gone are the days of record-breaking short, bulky sprinters who at any moment looked like they wanted to show you "their guns." We now have the opportunity to savor the results of long, powerful limbs that seemingly swallow the track with each stride. I know I am not complaining....9.63 seconds for an Olympic Record!

High-speed video of the start of the 2012 Olympic Men's 100m Final:

Bolt towers above the rest of the field.

The word is that Bolt enjoyed the eve of his first win with some Swedish handball girls. As he should. And more recently, that Bolt's coach removed him from London as he was too easily distracted by the "sexy British girls." After the 2012 track and field season is in the books, Bolt has a choice, however; continue to run and risk being beaten at his own game, or retire at the very top as the greatest sprinter of all time. Bolt, take a lesson from racehorses. A few incredible races and they are pulled to live a life of leisure and fun with the mares; they are STUDS after all. So, Bolt, play some ball, try your hand at cricket, but do not take another step on the track. You already are a legend and have nothing more to prove. Except to that high jumper in the corner with the long, elegant legs. She may be your perfect pick for Bolt baby #1.

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In the spirit of the London Olympics, do not miss out on our EXCLUSIVE OFFER!

How would one of these limited edition framed photos from the 2012 London Olympics look on your wall at home? Call FLASH PT today at (610) 696-5076 to schedule your FLASH Running Clinic to be entered in a random drawing for this prized memorabilia!

For more info: http://flash-pt.com/Documents/RunningClinic.pdf

Should Runners Learn to Dance? Physical Therapy and Performance Implications (Part 2)

2011-07-27T10:12:00.000-04:00

In Part 1, we discussed several observations involving the sports of running and dancing. These observations lay the groundwork for this post, so if you have not read Part 1 yet, I suggest you at least skim it.

Now....some of you may be asking yourselves, "What do these observations mean to me as a runner!?" Today I'd like to delve deeper into one of my methods for developing functional single-leg stance (adapted for runners from the Selective Functional Movement Assessment). Remember, this method also applies to the early rehabilitation of dancers, so if you run by day and dance by night, listen closely!

First, let's take a look at dysfunctional single-leg stance:

Front view Back view

Do you see how this runner is leaning away from the leg on which he is balancing? He is unable to stabilize his body through his trunk and lower extremity. So, if you exhibit dysfunctional single-leg stance like the runner above, how should you go about developing a functional one?

As a sports physical therapist, my first goal is to help teach my patient the feeling of functional single-leg stance. In other words, I use inexpensive tools to encourage the body to activate the required stabilizing muscles. Check out the picture below.

Single-leg stance with trunk musculature activation**

**Take note of the 90-degree angle at the L hip and knee as well as the upright trunk position....think of trying to stay pencil-straight from your stabilizing (planted) leg to your head. Proper positioning of the band involves hanging it around an object like a weight machine or a tree and pulling it towards your body with palms down. Make sure that you have enough tension in the band.

I am having the patient use a band (can be a piece of Theraband or other stretch-like material) to facilitate activation of the trunk musculature. One of the main reasons runners display dysfunctional single-leg stance is because they are not able to engage the trunk in concert with pelvic stabilizing muscles and the respective lower extremity. If you utilize a band as illustrated above, you will notice that you can more easily maintain the single-leg stance position. At that point, you are beginning to teach your body proper muscle activation patterns, which are extremely important for injury-free running. How long should you maintain this position? Enough time to challenge yourself. Build up to 4-5 sets of 45-second bouts. When you can maintain functional single-leg stance with the band for 45-seconds at a time repeatedly, retest yourself. I'll bet that your once-dysfunctional single-leg stance is now functional = minimum of 10-seconds maintaining proper form without losing your balance. Obviously, additional progressions for this functional movement exist, but the exercise illustrated above is the BASE for more advanced sequences.

Following development of functional single-leg stance, a series of low-level plyometrics is often initiated, beginning with double-leg hops and progressing to single-leg hops. This portion of the exercise prescription following a running-related injury can be quite tricky and is best completed under the guidance and supervision of a physical therapist who specializes in treating runners.

If you have any questions or comments regarding the information just presented or a personal running-related injury question, feel free to contact me at jrbst2@mail.francis.edu or via DoctorJunes on Twitter. I would be happy to help you in any way that I can. And please, don't be like one of the dance accidents in the YouTube video below!

Should Runners Learn to Dance? Physical Therapy and Performance Implications (Part 1)

2011-07-06T15:43:00.006-04:00

Runners and dancers -- two completely different types of athletes, right? Think again. Although formal dancing often occurs in an upstairs studio and running is performed anywhere from treadmills to trails, the two disciplines share some startling similarities. Personally, I do not have any formal dance training unless you count the 5th grade ballroom dance lessons...thanks Mom and Dad! I have much more experience working with and treating runners. But as a physical therapist, I have worked with several dancers over the course of my career thus far, and I have made the following observations involving both sports:

1.) Dancing is a form of exaggerated running. Running is an activity in which an individual is always in single-leg stance (one leg on the ground at a time) on one extremity. In other words, one leg is on the ground while the other is in the air. Dancing commonly involves leaping from one foot to the next; therefore, like in running, development of functional single-leg stance (see pictures below) is an extremely important element of a physical therapy plan of care for a dancer.

Front View Back View

2.) Development of the foot and ankle musculature and proprioceptors is vital to success. A dancer who is weak in her foot and ankle complex will not be able to safely land while leaping. Sports physical therapists see a fair amount of dancers with ankle sprains as a result. The same principle applies to runners, particularly those who compete in off-road/track events like cross country and trail running. Those readers who regularly run on trails can identify with this statement...strong and agile ankles can mean the difference between navigating that rock on the trail or sitting down on it afterwards with a bum ankle.

3.) From a performance standpoint, runners and dancers are always attempting to develop more powerful strides or leaps, respectively. For runners, a powerful stride combined with an effective metabolic system is a deadly weapon. Have you ever seen a professional dancer leap across the stage? What a graceful display of true athletic power. Should you be performing exaggerated running aka bounding as a part of your comprehensive training program?

Just a few casual observations to consider. Runners can learn from dancers and vice versa. Actually, I have known a few individuals who have excelled at both disciplines throughout adolescence. In addition, I will go one step further and state that a common paradigm exists for treating running and dancing injuries. Will the final stages of rehabilitation be different? Absolutely. But many similarities will exist in the earlier stages in terms of functional exercise. In my next post (Part 2), we will explore how some of these observations and concepts relate to the treatment of running and dancing injuries. These implications will be useful for all runners who desire to decrease their incidence of future injuries. Check back for more!

Physical therapists who always preach "more stability is better"....Are they really helping ALL runners?

2011-06-20T12:34:00.000-04:00

I read an article in the magazine ADVANCE for Physical Therapy & Rehab Medicine the other day that had a great premise but was not very inclusive. The article "Solid Footing" fell short in a few ways. Read my published commentary below for my thoughts on the article. I have also attached the link to the article + commentary for your convenience.

http://physical-therapy.advanceweb.com/Archives/Article-Archives/Solid-Footing.aspx

Commentary:

Gait analysis with high-speed video equipment is certainly a valuable tool when treating the injured runner. This article hits that point on the head. I disagree with a few of the other points presented, however.

First, if the runner is dealing with an injury that is a direct result of poor biomechanics, the first step of action is not always to provide him with the most support possible. The symptoms associated with some injuries can change very quickly (for the better) when the source of stress is eliminated. Such sources of stress include, but are not limited to, excessive pronation, heel striking when compared to mid-foot or forefoot striking, and significant peak hip adduction and hip internal rotation in stance. As the authors stated, some runners may need more support initially, but what they failed to mention is that there are others who may benefit from less support. For instance, a patient who is struggling with persistent knee pain may need to adjust his footstrike kinematics in order to eliminate the impact transient at initial contact. Take a close look -- is the patient heel striking, contacting the ground significantly outside his center of gravity aka overstriding? The proper way to eliminate that impact transient is not to provide him with a more supportive or cushioned shoe but rather to teach him how to contact the ground lightly underneath their center of gravity. Applying this principle is quite simple. Within the session, trial test barefoot running on a smooth grass or carpet surface. If the patient experiences a reduction in symptoms, his injury is most likely related to footstrike kinematics, and a rehab program that involves performing balance activities and other stability exercises barefoot as well as short barefoot strides on grass (50-100m) will promote the development of a mid-foot or forefoot strike. If the runner does not experience a reduction in symptoms, then maybe the clinician does want to look into stability shoes or even an orthotic….but not until barefoot running has been trial tested. As physical therapists, we do not want to promote reliance upon external devices if they are not truly necessary. The human foot and ankle is a marvel and was created to be functional on its own. Physical therapists can help injured runners develop a healthier, more stable foot and ankle complex through proper exercise prescription.

Which leads me to my second counterpoint…why would the authors attempt to promote a forefoot strike among injured runners while they are wearing heavily cushioned and supportive shoes? A high heel-forefoot drop, which exists in almost all stability shoes, encourages a heel strike. The human body will take advantage of what it is given; therefore, if more cushioning is placed in the heel of a shoe, runners will initially contact the ground in that area of high cushioning. Compare that to barefoot runners or those who run in more minimalist footwear. They would not dream of heel striking as their calcaneus would be unable to repetitively bear such a load without bony injury. So, if we try to have runners who are wearing heavily cushioned and supportive shoes forefoot strike, what are we doing? We are certainly placing an awkward load on the Achilles tendon as it is in a shortened state throughout. We should be encouraging the Achilles to lengthen through its normal range of motion so that more elastic energy can be stored before push-off in late stance.

These are just some thoughts for discussion and to highlight that there is more than one approach when an injured runner comes to a clinic’s door. The clinic that considers both approaches is going to be the one that helps that runner return to running more efficiently and effectively.

Elite Therapy's Couch to 5k Program = Success!

2011-06-02T22:07:00.004-04:00

On April 5th, 2011, seven individuals braved the snow showers and 20-degree wind chills to gather at the Mansfield University track for the first training session of Elite Therapy's Couch to 5k Program. One of them knew what to expect as she had participated in the Fall 2010 program; the other six were about to embark upon a new journey. I remember telling the participants on that first day that the weather would only get better from there on out. Boy, could I have been more wrong! Those readers living in the Northeastern U.S. understand exactly what I mean by that statement. We had a very rough spring....actually, I hesitate to call it spring....it was more like an extended winter with soaking rains. Nonetheless, every Tuesday evening for eight weeks the Couch to 5k participants met for their weekly workout.

The first workout involved alternating 60 seconds of jogging and 90 seconds of walking for a total of 20 minutes. Everyone was able to complete this first challenge -- some more easily than others, but they all knew that they had a long way to go before being able to successfully complete the Bridgman 5k on May 30th, 2011. The Bridgman 5k has a reputation for being the toughest 5k in Mansfield, PA. Although the first two miles are downhill and flat, the last mile is straight uphill....certainly not the easiest course for someone's first 5k. But the participants persevered. They slowly built up to being able to run 15-20 minutes continuously on the track, and that fitness was then taken to the next stratosphere once they began performing 20-30 minute continuous runs and interval workouts on hilly roads (total of three running workouts per week). Come race day, they were ready to accomplish something that only eight weeks before their bodies and minds would have rejected at the mere thought.

May 30th was something the last two months had not been -- humid. The participants were properly hydrated, however, and were not going to allow Mother Nature to detain them from reaching their collective goal. After warming up, they toed the line with a definitive plan in their minds. They were to pace themselves early in the 5k by relaxing on the downhill, allowing gravity to help take them down the slopes. My hope was for them to save energy for the uphill last mile. Knowing that this long hill would be the toughest point of the 5k, I stood along it and encouraged them as they ran by. Each of the participants followed the plan to a "T" as they all finished between 31 and 45 minutes. What a tremendous accomplishment for a group of individuals with little to no previous running background!

Couch to 5k participants and me after the race

Bridgman 5k web site: http://www.jeffbridgman.com/5k/

The intent of Elite Therapy's Couch to 5k Program is to promote health and wellness in the Mansfield community free-of-charge. Couch to 5k programs can be implemented anywhere though -- all you need is hard-working individuals who share a common desire to be healthier. One of the most important aspects of the program is the team camaraderie that is generated. The quote "Many hands makes light work" certainly holds true: the participants always found it easier to complete the workouts when they were running together with their teammates on Tuesday evenings. Many of this spring's participants are already looking forward to Elite Therapy's next offering of the Couch to 5k Program. Such anticipation to participate in another wellness program is a success in and of itself. As a physical therapist, I know that I hope to continue helping individuals become healthier and reach their fitness goals!

Should ALL runners stop heel striking? Delving beyond footstrike....

2011-05-18T23:32:00.002-04:00

In my last post, we discussed some of the underlying causes of running injuries -- poor biomechanics being one of them. Today I'd like to delve a bit deeper into running biomechanics.

First, several different running footstrikes exist: heel striking, mid-foot striking, and forefoot striking. If you went to your local 5k and observed the footstrikes of all the runners, you would quickly notice that almost everyone is heel striking. Most recreational runners in the USA are heel strikers, which is likely a result of wearing cushioned shoes all their lives (with significant amounts of cushioning in the heels of the shoes). Besides having poorly developed muscles within the foot, these runners might also overstride when they are running. In many third-world countries where shoes are not as plentiful, individuals tend to be mid-foot or forefoot strikers while running. Adoption of a mid-foot or forefoot strike is absolutely necessary because a barefoot calcaneus (heel) cannot repeatedly bear the load of our body at the point of initial contact; a healthy arch, on the other hand, is more than capable of bearing this load, which is what occurs during barefoot running. Therefore, the availability and our choice of footwear certainly impact how we run.

Now, let's take a look at the differences between a heel strike and a mid-foot strike. I've taken high-speed video using Dartfish software to provide you with a visual representation of each footstrike. You'll notice in the top video (shod) that the runner contacts the ground first with the heel....and then rolls through onto his toes, at which point he pushes-off. Conversely, in the bottom video (barefoot), the runner contacts the ground on the outside of his mid-foot....before flattening the foot and then rolling towards his toes to push-off. Also, take note of where the runner's foot is landing in relation to his center of gravity (location of his pelvis) in each video. A mid-foot strike forces the runner to strike more under his center of gravity than does a heel strike. Why is center of gravity important in running? Just like when we lift a heavy object from the floor, the point at which we initially contact the ground while running should be only slightly in front of our center of gravity (otherwise we are overstriding). If it is not, we subject our lower extremities to significantly greater impact forces. However, you can heel strike while still landing optimally under your center of gravity. In this case, heel striking does not appear to be as bad as many make it out to be. Unfortunately, very few runners are truly capable of heel striking without overstriding, which may be a result of our footwear. On the other hand, it is nearly impossible to mid-foot or forefoot strike and overstride...hence the reason why many encourage a switch from heel striking to mid-foot or forefoot striking. [Note: the current literature has determined that heel striking generates greater impact forces than mid-foot or forefoot striking even if you are wearing a well-cushioned shoe.]

Whew. That is a lot for anyone to absorb all at once. Contemplating these points though, many runners ask me whether they should switch from heel striking to mid-foot or forefoot striking. My answer -- it depends. It depends upon whether you are currently injured or running pain-free. It depends upon your running goals. It depends upon whether you are actually overstriding. There are too many factors to consider to make a blanket statement for everyone. What I will say is that many runners could benefit from including barefoot strides and drills on a smooth, grass field (excluding diabetics!). This barefoot running will reinforce your "natural" biomechanics and help develop the many muscles in the ankle and foot. You should use it as a SUPPLEMENT to your regular training regimen....just like you might supplement your training with strength training or core work. Remember, build up slowly. Start with one 50-100 meter barefoot stride and increase by one each week until you are running 8-10 barefoot strides total following a run.

Let me know your thoughts on the footstrike debate. I'd be interested in hearing your experiences or stories regarding barefoot running.

Always injured on one side? Think asymmetries.

2011-04-14T10:01:00.006-04:00

First, your right achilles begins bothering you after a long run. A few weeks later, your right hamstring starts nagging you in the middle of a faster track workout. Three months pass, and then you begin having some pain on the front of your right knee a few miles into each run. "What is going on?" you ask yourself. "Why do I develop injuries only on my right side?"

Runners who ask themselves this question likely have gross or specific asymmetries. In other words, one side of the body is stronger or more flexible than the other side....not necessarily at the site of the injury. For instance, the runner in the above scenario might have weaker gluteal muscles and a slightly tighter calf on the right side when compared to the left. Think of the human body as a kinetic chain: one chink in the chain can lead to a multitude of overuse injuries. As a result, when a runner becomes injured, he or she (or the health care professional) needs to consider the significant effect an asymmetry can have on the body when it is subjected to a high training load. I will even go one step further by saying that we should address asymmetries before an injury even surfaces.

Now, are asymmetries only tight or weak muscles? Absolutely not. We need to think about the way we move, sit, and perform basic tasks in everyday life. Let's say that you squat to the floor to pick a piece of paper off the ground. Do you notice that you bear more of your body weight on one side versus the other? Does one heel come off the floor while the other remains flat? How about the position of your knees -- are they both over your toes, or is one of them collapsing in? Being able to perform a basic, yet complex movement like a squat with proper technique and body symmetry is an important factor for keeping injuries at bay.

Asymmetries are not the only factors that contribute to running injuries, however. Training error (aka too much, too soon), poor running biomechanics, and symmetrical muscular imbalances (aka inactive or weak gluteal muscles) can all lead to a gradual onset of pain in one or more locations. Therefore, the key to running injury prevention and recovery is identifying such deficiencies so that they can be addressed earlier rather than later.

Another great minimalist shoe - Merrell Trail Glove!

2011-03-14T16:42:00.003-04:00

Recently, I decided to purchase a pair of the Merrell Trail Gloves. I have worn a variety of minimalistic, "low-profile" shoes since December 2004 and continue to run by the mantra "less is more". Although I recognize that such minimalist shoes are not for everyone, many runners could certainly benefit from supplementing their training with barefoot and/or minimalist running. One of the key benefits of running barefoot or in minimalist shoes is the lack of (or very little) heel to forefoot drop. Regular trainers have a greater amount of cushioning in the heel of the shoe than in the forefoot; as a result, the Achilles tendon is constantly in a shortened state throughout the gait cycle. Why is this bad?? The same reason that high heels are terrible for a woman's feet. A chronically shortened Achilles tendon does not produce the same amount of propulsion as does one of normal length. Also, transitioning from high-heeled trainers to flats or spikes sans injury is much more difficult. Training exclusively in more minimal shoes or including them in your training shoe rotation a few times a week can help you avoid these pitfalls. Remember, as with everything, a VERY GRADUAL transition is necessary to avoid injury, however.

Anyways........the reason the Merrell Trail Glove is so special is because it has a zero heel-forefoot drop! In other words, 12 mm of cushioning exists in both the heel and forefoot of the shoe = a flat shoe. The 12 mm of cushioning provides sufficient protection from debris and rocks without taking away the ability to "feel" the ground. Merrell also designed the shoe in such a way that runners could go sockless if they so desired.....they fit like a glove. If you decide to go sockless, please make sure you wash them occasionally for your family's and friends' sakes! Those runners currently wearing Vibrams will be happy to know that the forefoot of the Trail Glove is splayed to accommodate the toes. This feature allows the runner to push-off the ground just as if he was running barefoot on a grass field. Overall, the Trail Glove appears to be the first actual "shoe" that embodies the principles of Vibrams without the hippy flare. A great minimalist shoe for any off-road surface!

Check them out, and let me know what you think!
http://www.merrell.com/US/en-US/Product.mvc.aspx/22875M/50390/Mens/Barefoot-Trail-Glove