Category Archives: rehab

Does barefoot running really impact injury or performance? Evidence for the peanut gallery

Screen Shot 2014-05-16 at 2.34.30 AMOK…..most of you are going to have a field day with this blog post, so let’s just get it out there. Barefoot running came in a BIG way. And like most BIG things that come quickly, its fading at a rapid rate. A lot of people think barefoot runners are nuts, and begging for injury. And others think that the injury risk is the same as those who wear shoes, but the location of injury in the body will just move from one to another. Well, I’m not really a fan of speculation.

Some years ago, I put out a survey to barefoot runners with some simple questions. How much to you run barefoot? Why did you go down this path? Did barefoot running impact your injury risk or performance? Over 500  runners responded. Thank you interweb.

To be 100% forthcoming, the study is biased towards runners who have actually tried barefoot running (not minimal footwear, but true barefoot). Duh, you had to have experience running barefoot to answer the questions! Barefoot runners are a passionate bunch, but we made the default assumption that people tell the truth. And yes, its just a survey. But it provides an interesting slant. Instead of wondering if barefoot running works, why not just ask people who do it?

This study, “Barefoot Running: Evidence from the Field” was just published in the Journal of Sport and Health Science, and you can get a full download right here. And for those of you who just want the simple version, the abstract is below.

Now I’m not saying that all of you should ditch your shoes for 100% of your mileage. But this idea of barefoot running supports a very critical concept. Feet are capable of some pretty good work. Barefoot running, when done in the right volume and circumstances, can be a great training tool to help you build a better body. And no matter what side of the barefoot debate you stand on, putting better bodies into running is a concept we can all get behind.

Abstract

Background

Running is becoming an increasingly popular activity among Americans with over 50 million participants. Running shoe research and technology has continued to advance with no decrease in overall running injury rates. A growing group of runners are making the choice to try the minimal or barefoot running styles of the pre-modern running shoe era. There is some evidence of decreased forces and torques on the lower extremities with barefoot running, but no clear data regarding how this corresponds with injuries. The purpose of this survey study was to examine factors related to performance and injury in runners who have tried barefoot running.

Methods

The University of Virginia Center for Endurance Sport created a 10-question survey regarding barefoot running that was posted on a variety of running blogs and FaceBook pages. Percentages were calculated for each question across all surveys. Five hundred and nine participants responded with over 93% of them incorporating some type of barefoot running into their weekly mileage.

Results

A majority of the participants (53%) viewed barefoot running as a training tool to improve specific aspects of their running. However, close to half (46%) viewed barefoot training as a viable alternative to shoes for logging their miles. A large portion of runners initially tried barefoot running due to the promise of improved efficiency (60%), an attempt to get past injury (53%) and/or the recent media hype around the practice (52%).

A large majority (68%) of runners participating in the study experienced no new injuries after starting barefoot running. In fact, most respondents (69%) actually had their previous injuries go away after starting barefoot running. Runners responded that their previous knee (46%), foot (19%), ankle (17%), hip (14%), and low back (14%) injuries all proceeded to improve after starting barefoot running.

Conclusion

Prior studies have found that barefoot running often changes biomechanics compared to shod running with a hypothesized relationship of decreased injuries. This paper reports the result of a survey of 509 runners. The results suggest that a large percentage of this sample of runners experienced benefits or no serious harm from transitioning to barefoot or minimal shoe running.

Win. Or Don’t. Life lessons learned from losing at individual sports.

Screen Shot 2014-04-21 at 11.37.03 PMMy kids are the best. They are awesome. They are perfect! Let me tell them how wonderful they are 24/7!

If you are a parent, there is no doubt how you FEEL.

But, now we are hearing different messages from psychologists that all this praise isn’t really best for our kids. We are hearing a new message: praise the work, not the kid.

Experts tell how this plays out. When you tell your kid “you are an awesome bagpipe player!” twenty times a day, your child begins to believe it. They begin to link “awesome” with themselves. But they don’t build a framework of why they are awesome, or what it takes to achieve awesome. Anyone ever heard of Justin Bieber? My 2-yr old makes better life decisions than this guy. While he’s been swooned by millions of adolescent girls, he’s completely lost the ability to discriminate feedback between from fans, and who he really is.  Perhaps this is an extreme example, or maybe its not. Experts tell us too much praise breeds a sense of false sense of security. Kids begin to believe what they are told, but they don’t associate the praise with the action required to achieve this praise.

Apparently, what we should be saying is “I’m so proud of all the hard work you put into playing bagpipes.” While some people may view this as trivial, kids appear to get a different message. They hear that you are proud of the WORK they put each day. They associate hard work with  success. And since everyone likes praise, they focus their efforts on the work to earn more praise.

The world of sport is pretty cool: we can learn complex life lessons while doing fun things that we actually enjoy. But team sports and individual sports give us uniquely different experiences.

Think about it. Its the finals. Your team scores the winning touchdown, 3-pointer, or homerun. The crowd rallies. Fans on on their feet. Cheers. Coach gets doused with the water cooler. In fact a lot of people confuse the vibe that these Norman Rockwell images convey with the actual   achievement of winning.

I love team sports (if you are an LSU fan and have seen a home game at Tiger Stadium, its a whole different state of mind) but they can be confusing for young minds. If you win, great. Why did your team win? Did every player on the team carry out each play perfectly? Did you win because 3 starting players are so incredible they made up for deficiencies on the rest of the team?  Or did you win because the other team made error after error, or had 2 of their best players hurt?

Because each of the three scenarios would convey a completely different sense of accomplishment. If YOU or your kid nailed the game – awesome! “I’m so proud of that key penalty kick you blocked” you may say. But maybe your kid didn’t play their best. In fact, maybe they screwed up big time, but the team still won. What kind of lesson does that convey to an 8 yr old? Is everyone on the team still a winner even if some of the kids blew their position that day? Or maybe the opposing team just couldn’t get their act together. does that make your kid a winner? Does being a “winner” really breed positive feedback for individual skill and inner drive?

I’m a firm believer that team sports can teach you a major lesson: sometimes things happen that are beyond your control (other players, other teams, bad calls from the ref). Team sports offer an immersive environment to build relationships and develop trust with others to help work around unique problems you encounter.

But kids can be overwhelmed with the desire to WIN, and lose focus of the process it takes to have a great performance. Individual sports offer the ability to look uniquely at yourself.  And from a developmental standpoint, this is big. The legendary coach Joe Vigil often says “there are few sports more nobel than track and field. Its you a fixed course and a watch. And there is no hiding.”

Let’s think about this. I’m twelve, swimming the 100 meter butterfly at the state meet. I’ve put in tons of work, and show up prepared. The gun fires, and I’m soaring off the block, stroking as hard as I can, only to show up at the finish one tenth of a second out of first. Next up is the 200 fly. Again, I showed up a few hundredths, or maybe a few tenths of a second off the big win. I have no idea how many times I didn’t win, but it was a LOT!

And in these individual events, the hard truth was obvious. The only reason I didn’t win was because I didn’t perform. Maybe I blew my start. Maybe I blew my race strategy. Maybe I showed up less fit than I needed to be. I was 12, and certainly didn’t have a lot of life experience to make sense of all this. But my coaches over the years were beyond incredible. Each and everytime I didn’t win, they helped me reflect on my limits, which motivated me to overcome these limits, and praised me for what I had done to perform. I learned specific lessons – and won – through losing. But each time, they were things I had control over. And when you have control over the situation, you can improve.

The take home from all this? All these “life lessons” obviously didn’t turn me into Michael Phelps. But they helped me grow as a person. I begin to understand what I was good at, and what areas of my training / life I need to work on. As a 12-yr old, I needed direction, and individual sports gave this to me. I learned to look at myself objectively. Oddly, things still happen to me now, that I can compare to experiences and challenges I learned from competing as a young athlete. And guess what? I still screw up in life, and I’m still trying to be a better person.

We all love our kids unconditionally, and win, lose, or tie, they need to know that. But as for lessons learned from the world of sport, Its up to us to help channel these wins and losses within our kids to help them grow.

Because there was another time I dove into the pool. And that time, things clicked. And a state record fell. And so did a spot on the national rankings. And I understood all the work I put in to make that moment come true. I was pretty pumped. Not only did I win, I grew. And I want my kids to know this feeling too.

The Dynasty of Running Medicine Continues

photo 1-11The University of Virginia Running Medicine Conference continues to be the premier source of training and applied knowledge for clinicians across the country. I’ve been lucky enough to co-direct this course with my colleagues Dr. Robert Wilder and Eric Magrum for the past twelve years. We assembled an entourage of experts to bring us up to speed on the latest research, and how this applies to our patients.  And this year, we had requests to expand into talks on performance planning and progression, and we delivered.

From the clinical side:
Dr. Fran O’Connor described findings of “Exertional Rhabdomyolysis”. Its great that the endurance community is embracing strength training. However, going to big too soon can lead to some serious health implications. Dr. O’Connor described how to identify these signs and symptoms when people go a little too aggressively in CrossFit and other competitive environments, and how to ensure that you are progressing training appropriately.

Dr. Wilder described “The Runner With Heel Pain.” Sure your plantar fascia can be the driver of your nagging pain, but there are other structures in this area that drive symptoms, and other areas that can refer to the heal. He reviewed what these are, and how to manage them for success. And on Saturday, Dr. Wilder led a water running lab to discuss tips to ensure high physiologic training stress to maintain fitness while placing the body in a reduced training load.

“The Great Toe” was presented by Eric Magrum. Conservative clinical management of the big toe is essential to proper foot stability. We reviewed normal foot function, problematic scenarios, and how to address each. The one-two punch was saturday’s lab session with hands on evaluation and treatment.

But sometimes, the great toe isn’t so great. Dr Joe Park presented “The Not-So-Great Toe” and discussed the skilled surgical management of the foot and lower leg when conservative care hasn’t worked. Dr Park presented the current state of care for foot management, how this impacts the entire lower quarter, presented some case studies to offer real world application, and innovative, outside the box solutions for correction of serious disorders.

Dr. Siobhan Statuta wasn’t stressed out when she presented “You’re Stressing Me Out! – a review of foot stress fractures.” We reviewed the identification, management, and return to play criteria to ensure successful care.

Dr. John McKnight had some great content (and great pictures) of “common skin conditions of the foot” – we discussed everything from blisters to foot fungus to serious infections, and how to treat these from a clinical as well as a practical approach. Yes, make that one more use for duct tape.

Have you ever wondered what happens “inside” the muscle, and why some tissues sustain strain injuries (tears) more than others? Dr. Silvia Blemker presented the engineering side of the equation. She showed her innovative work with real-time MRI and how the shape of the aponeurosis affects the stress and strain of muscular forces, and how we can learn more in the future in our efforts to prevent injury. In short, muscle architecture matters.

Now, we’ve discussed how to get runner’s healthy, let’s look beyond into the world of performance.

Have you ever wondered what type of cutting edge training principles are employed by Olympic athletes? and why this works? Our keynote speaker Dr. Brad DeWesse identified what constitutes successful athletic performance, and how to cycle your training to achieve it. Sure there’s an “art” to coaching, but is’t it nice when you can make things objective? Brad was able to present data points on values they assess on all their athletes, how they implement training for targeted improvements in the lab, and what kind of outcome this has in the real world. Impact? The US has won more medals in the sports Brad is working with. Its the stuff of genius.

With a formula for successful training in front of us, yours truly provided an overview talk called “Run Better: Clinical, Strength, and Power Prep for Strength and Endurance Athletes.” We identified how to put a better body into your overall plan: how to screen for muscle imbalances that restrict optimal physical development, how to fix them, and most importantly, how to integrate these skills into running mechanics. Following this, I presented real world case scenarios (with data) to show how this impacts both quantitive lab values and race times. Result? Pain free runners that are setting good numbers in the lab and PR’s on the course.

I’d like to thank over 230 physicians and therapists who attended, and about 100 of you who return each and every year. This course almost seems like a small family at this point, and we greatly appreciate your support, enthusiasm, ad feedback each year. Dr Wilder, Eric, and myself wish you success in implementing these concepts with your patients and athletes!

 

“How to Train Like an Olympian” – NBC finds out!

If you want pull a 1080 Japan air in the half pipe, launch yourself 100 yards on downhill skis, or accelerate a bobsled to peak speed before jumping in, science can help you do what you do, better.

NBC came by our lab for a little demo, you can check it out here. (updated with the video link)

Note:  Just don’t ask me anything about curling…….

NPR asked: do smarter shoes make smarter runners?

Brace yourself. You thought heart rate and GPS was cool? The tech revolution is coming to running in a major way. Sure, it’s got some hurdles, but its likely going to be easier than signing up for health care insurance online.

So what if your shoe could tell you about your foot strike ? would it matter? what if you had gear that could tell you about more than foot strike?  What can Tech do for you as an athlete?

Check out this link to listen to the NPR interview for some answers.
And if the merging of tech and athletics intrigues you, check out this article I wrote for Spark/Qualcomm.

Cool technology + smart people to make sense of it = some pretty cool times for you as an athlete.

 

Running around from USATF Nationals to USATF Nationals

Last week, I had the privilege of jumping on a plane and traveling to speak at the USA Track and Field National Conference in Indianapolis. It was a great melding of the minds, with the focus on “rebuilding” the athlete pool. I was asked to speak about injury and trying to reduce injury. My talk was titled: “Solving the mystery of running: practices for sustaining an injury free career.” Given that over half of runners get hurt every year, its a pretty important concept to take a step back and try to STOP this madness. In this presentation we talked about how and why mobility, stability, strength, and power are all unique traits that runners must have, and how these attributes directly transfer to gait. And most importantly, how to improve deficits you’ll find in your runners. So after a day of great discussion, meetings, and networking,  I jumped on a plane back home to Bend, OR.

USATF Nationals to NationalsAnd nationals followed me back home!- This weekend is the USATF National Cross Country Club Championships.  About a thousand runners are converging here in Bend to see which XC Club can take the cake. Local stud, Max King, has organized a challenging course for Saturday. On Friday, I’ll be hosting an all-star athlete panel Q&A featuring: Lauren Fleshman, Besty Flood, Mario Mendosa, Stephanie Howe, and Max King. If anyone wants to ask the best what makes them the best, and gain some scientific insight as to why and how these concepts may make sense for you, come on by – we’ll see you at 4 PM PST at the event expo.  And on Saturday (raceday!), we’ll see you starting at 9 AM for the community run. The REP Lab tents  will have fire pits, hot chocolate, a propane heater, and most importantly – we’ll be hosting a holiday cookie swap!  -that’s right – bake some cookies, trade em out, and eat up. And yes, yours truly will be awarding bragging rights for the best cookie at nationals. Sugar cookies are cute, but don’t stand a chance. To all the potential bakers out there, I’ll give you a hint – don’t bother bringing an entry without chocolate if you really do want to win. And while you are munching, you’ll be cheering as MC’s Jesse Thomas and Matt Lieto calling the races from 10 until 2. And rumor has it there are some after-parties happening ’round town……come see us at the tent and we’ll give you the scoop.

And if you can’t make it to Bend this weekend, Make sure to check out the Runner’s World Google Hangout with Oiselle’s Project Little Wing. The REP Lab is proud that these elite women  call our clinic home for their performance and injury prevention needs.

So this weekend: listen to the experts, eat cookies, and run…..that about sums it up!

Why is stability important for long term athletic success?

Success as an athletes depends on an intact joint, strong muscular support, and specific control from our brain to use the right amount of force for the job. But what happens when our joint is chronically damaged? Is your career over? Let’s take a detailed look at how the body adapts, and even improves with stability training.

Warning: I shot this quickly between patients…..there is some fast talking going on at times…….

Treadmill Running: What’s different? What’s the same?

Well, its that time of year again. The sun sinks below the horizon early, and with that my phone rings with reporters wanting to know what tips they should give to their readers about running successfully on a treadmill. Rather than risking this info getting watered down, I figured I’d give you the straight scoop.

  • Fact vs Fiction: A lot of coaches preach the message “you push yourself over the ground outside, and your pull yourself overground on a treadmill”…..this is 100% false. If you look at the fancy stuff we measure called “ground reactions forces” you’ll see very very similar patterns when running on either surface. The overall mechanics are very much the same.
  • Think about it as a different surface, not a different way to run: despite the fact that the treadmill is very similar to running over ground, there are some differences, and some are actually what qualify as “statistically significant.” But if you look at the clinical impact this has, and if you deal with this type of data every day like I do, the differences are really small. There is a difference in body mechanics running on grass, trail, asphalt, and concrete. But again, these differences are small. As long as you slowly adapt your mileage to treadmill, you’ll be OK. No one runs 100% of their miles on trail and then jumps 100% onto the road. This goes for transitioning miles to the treadmill. Allow a few weeks to transition your mileage over, and your body will adapt to these slight changes.
  • Run correctly on your treadmill: Here’s the most important one. Everyone has a friend who ran on their treadmill and then got hurt. Or maybe it was you. They “blame it on the treadmill” – what happened? First, you need time to acclimate (re-read previous paragraph).  But most importantly, its not running on the treadmill that’s typically the issue. More often than not its running differently on the treadmill. Example. If running outside, you are free to make small fluctuations in speed. On the treadmill, the belt speed is held constant. So if you decide to try to slow down 1%, you can’t. As you get tired, your speed changes, but your cadence slows, which forces a longer stride than you are used to. Your body’s soft tissues are in a completely different position (longer) than you’ve trained them in your previous miles. This longer position can create strains on soft tissues and increase the lever arm on your joints and cause pain. But this really isn’t a treadmill issue – its a running form issue.
  • To incline or not to incline? We often hear to increase the incline on the treadmill to 1-2% to make up for the lack of wind resistance. Here’s the deal. Raising the incline slightly increases the physiological stress level compared to flat, and it doesn’t really change the loads much on the body. In fact, running with a slight incline is actually a bit “safer” for the body since it makes it tougher to over-stride. So no harm here.

What’s a safe way to run on the treadmill?

  1. gradually increase the % of miles you are doing on the treadmill
  2. run the same. Be honest with youself. Are you really running 6:45’s on the road? or are you really running 7:15’s? Aim to keep paces realistic. And aim to keep your stride pretty close to what you typically do. An easy way to do this is by counting your cadence (number of foot contacts per minute). Next time you are running 7 min pace, count your strides. If you are consistently hitting 88 per minute (single side), then aim to maintain the same cadence on the treadmill at 7 min pace. This way you avoid overstriding and the stresses it can place on your body.
  3. Novices: don’t go crazy on speed work. Doing intervals makes you tired. Running faster than 800 meter pace on the treadmill can make it much more likely that you’ll run with compensated form.  In general, I recommend tempo intervals on the treadmill, but speedwork is best done outside. If you must do speedwork on the treadmill, make sure your cadence is similar to what you’d maintain outside.

For those of you who like the fine print, feel free to read more below. And of note, all the information in this article pertains to steady state distance running. Sprint training on treadmills is a different concept entirely. My UVA lab group wrote one, and Irene Davis’ team wrote another. No matter on treadmill or outside – enjoy your run!

References:

Riley PO, Dicharry J, Franz J, Della Croce U, Wilder RP, Kerrigan DC. A kinematics and kinetic comparison of overground and treadmill running.Med Sci Sports Exerc. 2008 Jun;40(6):1093-100

Fellin, R.E.,  Manal, K, Davis, I. Comparison of Lower Extremity Kinematic Curves During Overground and Treadmill Running. J Appl Biomech. 2010 November; 26(4): 407–414.

 

Lesson of the day: don’t hold back

A nice reminder to keep your eye on the big picture, but remember to enjoy yourself….
“The idea is to become an old wizard; to live a long and fruitful life and have a family and be healthy and enjoy the ride. And speaking of the ride, why not let it rip? At least just a little bit. Everyone I know who’s really stoked about getting out of bed in the morning does that to some extent.”
–Laird Hamilton

Road vs. Cyclocross Bike Fit: what’s the difference?

A lot of hype concerning the difference between fitting a road bike and a cyclocross bike could be cleared up if we all agree on two simple things: put the engine in the right place, and then adjust for handling and comfort. Let’s break this down.

Saddle position

Your pedals are driven by large muscles surrounding the trunk, hips and knees. In fact, about 98.8% of the force you deliver to the pedals comes from your hips and knees. That’s right, the ankle only produces a very small percentage of your total power. So it makes sense to have the saddle height and setback (also called for-aft position) the same between your road and cross bikes to maximize power production. Why would you select a saddle position that compromises power output? Keep it simple. If you like your current saddle placement on your road bike, there is zero reason to change it on your ‘cross bike.

Handling and comfort

Good bar position allows you to move around while properly weighting the front end for corners and technical terrain | Photo © Jill Rosell Photography

Good bar position allows you to move around while properly weighting the front end for corners and technical terrain | Photo © Jill Rosell Photography

Okay, now here’s where things are a bit different. Instead of rolling your slick tire down fresh asphalt, you’ve got to contend with dusty pumice, wet grass, rocks, roots, and the nutrient ‘crossers crave: mud! In short, it’s critical to have a good handling front end. This means that you want to have a little less weight on the front so that you can lift your front end over obstacles easier. Careful though, too little weight on the front end will bring your torso too upright make it hard for your front tire to bite and send you skittering wide towards the outside of the turn. Let’s see how this all plays out in fit.

  • ‘Cross bikes typically have a higher bottom bracket. If you were smart, you’d kept your saddle in the same place as your (properly fitted) road bike.  This means that your saddle is higher in the air than your road bike. Since your saddle is higher, your handlebars also need to be higher.
  • Hand-grip placement for optimal handling: A lot of people rarely use their drops on their road bike. Then when on the ‘cross course, they find that they are forced into the drops on steep downhills to brake and get a better grip on the front end. Most riders find the bike is much more stable when conditions get squirrely if they use the drops. So if you are going to be in the drops, make sure you are comfortable.

So what’s the secret recipe to make sense of it all?

It’s simple really; the goal is to get the bars a bit “closer” to you. And you can do this in three different ways. You can run a shorter stem to move the bars closer, you can run your bars higher (by putting a few spacers under the stem or by using a stem with more rise), or a combination of both. I typically recommend that riders start by raising their bars first (because this usually only means moving spacers or flipping a stem). Setting up the bars with some combination of “up and back” will allow you comfortable access to the drops for good grip and handling, and while still allowing you to have optimal engine placement so you don’t lose any precious watts.

Powerful, sketchy, and somewhat comfortable. Yeap; sounds just like ‘cross racing!