Saturday, June 9, 2012

Rehabilitation of Common Running Injuries

Basically, the subject of running injuries comes down to static versus dynamic runners. Static runners get hurt, dynamic runners do not. Have you ever watched a world class track meet and said to yourself “boy she runs so smooth, that’s what a runner looks like.”  Running injuries are simple to assess but difficult to treat because how do I make a “regular” runner look like a world class runner?  The truth is, you cannot make a mule into a miler.  But what you can do is teach the principles of efficient running.  Lets begin with a vocabulary lesson.
Ground Reaction Force: the reaction to the force the body exerts on the ground. In other words, this is the pounding a body takes while running. Running ground reaction force has been shown to measure about 3-5 times the persons body weight during easy to moderate running and as much as 7-9 times with sprinting.
Vertical Displacement: the shifting of the center of mass in a vertical direction, resulting in a change in elevation.  Or, how much your body bounces during running.
Running Efficiency or Running economy: the measure of how efficiently a person uses oxygen while running at a given pace.  Or, the ease in which a person runs.
To sum up these terms, the more economical a person runs the more he/she controls the amount of ground reaction force by minimizing vertical displacement.  The more fluid the force moves through the body the more dynamic the runner runs.  If a person is bouncing too much–maximizing ground reaction force–the less economy, and  the more pain a person will experience.
Now lets get back to injuries.  Running injuries can be treated palliatively with fancy equipment like foam rollers or “sticks” ( a popular massage device). Rubbing/massaging makes for short-lived relief but at the end of the day the running gait must become more economical.  The force must be minimized.  Here are principles of efficient running:
Proper Foot strike: Studies cannot say that forefoot or midfoot is the best way to go.  The reason is that whether your forefoot or midfoot hit first only matters where the foot hits in relationship to your center of gravity, which is where the ground reaction settles.  If you reach out the leg to strike with the heel, your leg is working way to hard.  Moving the foot strike to underneath the center of gravity makes for less vertical displacement and more efficiency.
Proper Strength: If it comes down to force transmission and you are unable to decrease the ground reaction force, the body must increase the strength to dissipate ground reaction force.  The muscles most commonly requiring more attention are glutes, quads, calves, and toe flexors/extensors.  The glutes control the hip and knee position while the quads support the shock absorbing knee.  Calves/toe muscles work to use the foot as a force “dampener.”  When they all work together they function like a symphony to run more economically.
Proper Pacing: What if you are going too slow?  What if you are going too fast?  There are plenty of tools available online to assess your proper pacing by using various race results.  Here are a few, mcmillan or Vdot.
Proper footwear: Not too much shoe or not enough shoe.  See “You mean I cannot wear the cute ones?”
When you report to physical therapy, make sure you do your homework.  Not every PT knows about running.  We get very minimal run training in school.  Ask around. Find out who is performing one on one care and knows about running.  Interview the PT. Ask them how many running-specific continuing education courses they have attended. As you can see there are many factors influencing healthy running. If you run dynamically you are running economically.  Finding a balance between lowering ground reaction force and increasing muscle strength is the difference between running pain-free and economically and running poorly with pain.

    Sunday, June 3, 2012

    “You Mean I Can’t Wear the Cute Ones?”

    While you can go a lot of ways with women and shoes, I am going to stay away from the obvious.  No Laura (Rubeli), this is not a fashion discussion nor is a lesson on how to organize shoes Renee (Ursem).  My wife will be happy we are not discussing how many of them we have.  It is about functional footwear for running.  As a health care provider prescribing footwear for runners, I am not so concerned about style or whether or not the colors match.  (Although it is a bonus when the colors DO match.) I am concerned about footwear that is functional.  How do I know what footwear is functional for my running?
    Shoe companies love to dazzle you with claims of “weight loss,” “shaping,”"no injuries,” or “promise of performance.” There are no studies to support such claims.  Ultra engineered footwear can lead to more injuries or difficulties.  Our feet are designed to move.  Our knees and hips are designed to withstand force.  The body is very efficient at the transfer of force.   If you try to control motion or force with plastic another compensation will occur.  These gimmicks may become a crutch for lack of foot strength.  Every day you wear them your foot and body are not learning to function effectively.  The barefoot runners are doing better than the over engineered runners.  Barefooters rely on the body to rise to the occasion. There are many factors influencing proper shoe selection and may require a professional evaluation to be accurate.
    The running store. When you arrive at your average everyday running shoe store your shoe selection can be overwhelming.  We place shoes into categories with increasing levels of support in the way of engineering.  Here is the progression from least support to most support:  Minimalistic, neutral, stability, stability plus, and motion control.  Now, what is the first thing your handy salesman will have you do?  ”Lets see you walk.”  The response, “OH NO…YOU ARE A PRONATOR.”  Pronation is a very complicated motion your foot undergoes when the arch is flattened.  Flat feet are sometimes referred to as: over-pronated feet.  There are plenty of runners with no arch that run perfectly healthy.  The salesman will say “You need these shoes. ” “These” shoes are over prescribed, over posted hunks of plastic to stop your pronation in the form of a motion control shoe.  Pronation is perfectly normal and not a death sentence.  Your feet absolutely have to pronate to dissipate force.  The effect of a motion control shoe is muscle weakness due to the unnatural support the plastic is providing.  The shoe is doing the job of some muscle or even muscle groups.  The salesman may not know how much pronation to protect for.  At best he guesses.  Injury history, previous footwear, current fitness, current running goals, current strength, and gait analysis contribute to proper footwear selection.
    So what shoes are good for me? The shoe for you is the shoe that feels right.  You must love them.  If you think they are going to grow on you, your making a mistake.  The shoe must be comfortable out of the box.  If not the shoe will break you before you break it in.  LOVE THEM.
    • Shoe selection example #1: Sara is a twenty something, recreational runner who walks/runs about 4 days a week, her goal is to lose 30 pounds by the beginning of the summer. Lately she has been experiencing “foot pain.”  She has been exercising is a big name brand motion control shoe.  In the last few months she has added more miles and more days a week of exercising.  Her strength program is getting stronger and stronger.  Gait analysis shows a moderate pronator.  SELECTION=Stability or stability plus.  Which ever shoe she loves the most in those categories.  The foot pain is a result of the plastic wearing out and now not supporting her feet.  If the motion control shoe is refreshed then the muscle go right back to not working.  Lets allow the foot to move, give the foot less help, and ask the body to do more work so it is not dependent on outside force.   The result of the foot getting stronger is more efficient, happier running.  The foot will be tired but will progress with time.  If by 3 weeks you are not happy about that, the shoe you selected is not appropriate.  Consult the shoe provider for return policy.
    • Shoe selection example #2: 50 year old male, Mark.  Training for his 4th marathon but has not run one in several years.  Mark runs about 60 miles a week on a build and 40 miles on a recovery week.  He has an annoying shin splint issue that is not changing one way or the other.  His pain occurs especially on long runs toward the end.  His strength program is non-existent since he is busy with 2 jobs and running.  He has no abnormal running biomechanics.  He has been running is a very popular neutral shoe.   SELECTION=STABILITY.  He is not strong enough at the end of his runs to support his foot and is asking the achilles to overwork.  Maybe he requires more shoe and stability will help over time.  He could add more strength work or add more shoe.
    A few tips: Do not move 2 or more shoe classification up or down the list.  Too little or too much shoe too soon will be hard to overcome.  Do not be suckered by too good to be true marketing.  Put your faith in your body: it is resilient.  Be an informed consumer.  Running a few marathons does not qualify you to prescribe shoes.  Understand your needs, ask questions, and gather good information. Try to buy well known, reputable brands and models to be consistent on your choices.  The off shoot (like Sports Authority) shoe store gets an exclusive contract with the shoe company and may not be consistent.  Healthy running is a combination of a multitude of factors.  Do not let footwear be a reason you are not running healthy.  Have a good run!

    Monday, April 30, 2012

    The Truth About Barefoot Running

    After recently reading one of the most popular running magazines around I had a good laugh.  I am noticing tons and tons of hoopla surrounding the barefoot running craze.  I am amazed at how people just jump on bandwagons without asking appropriate details.  
    Here is the scoop.  There is no easier way to run.  Running is hard.  That is actually why it is so beneficial.  Barefoot running is not the unknown that unlocks a pain-free, super fast running experience.  Barefoot running is a lateral move. Remember happy running comes down to force.  There is a scale; one side the force produced by the ground (ground reaction force) and on the other side is the force your body can produce (strength/connective tissue tolerance etc).  When the scale is tipped to the ground reaction force you get injured, when it is tipped the other way you run without injury.  Barefoot running CHANGES both sides of the scale.  It does not increase or decrease the force, it makes it move laterally.   You need more strength to run barefoot; strength in the form as stability.  The demand for Core, hip, knee, ankle, and foot stability is higher.  That CAN be a good thing.
    If you can get your body acclimated to barefooting and the necessary stability is achieved then you CAN run barefoot, but should you?  The injury rates are the same.  The injuries that barefooters get, runners with shoes do not get.  Broken glass?  Didnt see that rock or bump?  Stub a toe?  It is easier to get a stress fracture without shoes.  How long can you run barefoot without something like this happening?  The other traditional running injuries are basically the same.  If you can learn to run efficiently with shoes, wouldn’t that allow for longer, healthier running?  Wouldn’t the long term, cumulative effects of years of healthy running outweigh a short term, eye popping barefoot running career?
    Can barefoot running contribute to healthy running?  Sure!  Barefoot drills, maybe some strides in the grass barefoot, or strengthening with no shoes on help you develop some of that stability.  Common sense prevails.  160 bucks for “barefoot” shoes? Spend that money on quality coaching or a gait analysis and trust your body.  Your body knows how to be efficient, it just might need a push in the right direction.  Lets make a lifestyle change, learn to handle force appropriately, and let that cumulative effect take place!!