Tag Archives: foot

My new book: bedtime story for the new royal baby?

It seems the Brits have been busy. A few weeks ago, a new Royal baby greeted the world, and it seems my collection of bedtime stories to Prince George was released just in time!

photo-14Anatomy for Runners has made quite an impact. Since its release almost one year ago, its been one of the top selling running books, and achieved significant accolades with runners, coaches, clinicians, and the industry. In fact the book has done so well, that it was picked up by a UK-based Lotus Publishing Group. The overseas edition, re-titled “Run Like an Athlete” is available now to anyone on the other side of the pond. I’m quite happy with this title – its actually hat I wanted to call the US book in the first place. It features all the same excellent content, although its been translated from English to well, English……

Yes…..The Queen’s prose is quite different from our countrymen’s linguistics. Going through the editing process with the publisher, I’m shocked at how much it was altered for the european audience: “Soccer mom = football mum” are among thousands of edits.

Note: this version of the book is best utilized with hot tea, crumpets, ascots, and a Hugh Grant movie playing in the background. 

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my copy arrives by none other than the Royal Mail

Do you sprain your ankles? if so read this!

Screen Shot 2013-06-25 at 3.31.53 AMThere’s a good chance that you heard a friend say ” I sprain my ankles all the time”….or maybe you are the one saying this! Why do some people sprain, and then keep spraining their ankles over and over? Well, we recently published a study examining just this. This study was first-authored by one of our former grad students, Lisa Chinn, PhD,  as part of her dissertation at the University of Virginia. While Lisa has moved on to a faculty position @ Kent State,  she spearheaded this project. So, I thought I’d play “7 Questions with Dr. Chinn.

I’ll briefly set the stage here. People with chronic ankle instability sprain, and keep spraining their ankles. There has been lots of attention paid to this area of research lately, because lots of sprains can cause lots of long term problems, and lead to lots of down time in training. Most of the research comparing the folks who keep spraining their ankles is done comparing walking and running barefoot. Yes, I know the barefoot movement is strong, but let’s face it – most people are wearing shoes, and despite what you’d like to think, barefoot gait is quite different than your gait in shoes (and it’s NOT just rearfoot vs forefoot folks….) Given the following, we thought that we’d examine the different ways people walk and run when they have healthy ankles, “single-sprain” ankles, or “chronic ankle instability” ankles.  This got slightly technical at times, but I tried to summarize things towards the end. Since about 30-60% of you will have this issue, let’s ask Dr Chinn some Q’s:

1. What is chronic ankle instability, and how does this differ from people who have only had one sprain?

Chronic ankle instability (CAI), interestingly enough, is a very difficult (sometimes frustrating) syndrome to define. There is an ongoing discussion for a common description of CAI; however as of now, there is not a universally accepted definition. Some researchers rely purely on subjective reporting of symptoms by patients, while others, require some type of mechanical dysfunction to be present at the ankle joint, while still others desire a history of multiple ankle sprains. And of course, there are some who use any combination of the three. The majority of researchers (myself included) will described CAI as the long-term feelings of your ankle giving way or weakness following an initial ankle sprain. This can occur as a result of a single ankle sprain or from an accumulation of multiple sprains. Many subjects/patients claim to “tweak” their ankles all the time. It is estimated that about 30-60% of individuals that sustain an initial lateral ankle sprain will develop CAI.

There is a group of individuals who sprain their ankle once and who do not go on to develop CAI; researchers are currently using the term “coper” to describe these individuals. Research is relatively new on this population. What about them results in a full recovery from their ankle sprain? Was the sprain different or was something regarding their rehabilitation different? Are there other characteristics of these individuals that reduce their feeling of instability? Or, have they changed their lifestyle to not put themselves at risk for “tweaking” their ankle? This is a very exciting area of research because, our goal as a clinician is to prevent CAI from occurring and since we probably won’t ever figure out how to actually prevent ankle sprains from happening; we would like to determine how to get all ankle sprainers to become copers.

2. Why did you choose this topic to research?

I am an Athletic Trainer by profession. While working with various sports, at various levels, and multiple age groups one injury I always encountered were ankle sprains. No matter who you are, there is a risk of suffering an ankle sprain. With my background in athletic training and my exposure to the injury, when I decided to go to the University of Virginia for my doctorate I decided that I wanted to focus my research on ankle sprains and ankle instability. Being at UVA gave me access to prominent ankle researchers and an unbelievable motion analysis laboratory which I took advantage of.

This particular study was developed as a progression from a previous study conducted at the lab. A couple of years prior to my arrival to UVA, Lindsay Drewes (now Lindsay Sauer) and Patrick McKeon, conducted a similar study in CAI subjects, however, their data was collected while subjects were barefoot (Drewes et al., 2009; Drewes, McKeon, Kerrigan, & Hertel, 2009). Their studies reported some interesting findings; however asking individuals to perform barefoot tasks is novel, so I wanted to replicate the study while subjects were shod (shod means in shoes), a more common/comfortable condition.

3. What did you find?

The short answer: we found that while shod, gait kinematics are different between those with and without CAI. (note: kinematics is a fancy word for range of motion)

Interestingly, unlike previous gait research on CAI subjects, we did not find kinematic differences just prior to, at, or immediately following initial contact. I think adding shoes to our methods has revealed altered kinematics that barefoot methods had not previously done. Our kinematic differences occurred towards terminal stance as well as during swing. One thing to note is; no one really understands when ankle sprains occur, it has been hypothesized that they may occur either at initial contact OR terminal stance (Konradsen & Voigt 2002). However the majority of research has only focused on initial contact. Our study actually evaluated the entire gait cycle finding difference at terminal stance is very new and original. Hopefully this will encourage more researchers to evaluate the later stages of gait in the future.

4. Given that the previous research was using people walking/running barefoot, what do you think adding shoes into the equation helps?

Adding shoes to the research has added a piece to the mysterious CAI puzzle. Before I discuss what shoes added, let me explain a little about the shoes we used. We were able to obtain multiple pairs (both men and women sizes) of Brook Defyance shoes. Collaborating closely with Brooks, we were able to remove various aspects of the shoe to enable us to place anatomical markers on a subject’s skin without disrupting the integrity of the shoe. Placing markers on the skin allowed us to better observe joint kinematics. Placing markers on top of shoes (which has been done in the past) only allows researchers to observe what the shoe is doing. Shoes may slip or move differently than the joint. Our goal was to see what each individual’s limb was doing, which with this custom shoe we were able to do.

So, getting back to your question, I believe incorporating shoes, specifically our custom shoes, has significantly contributed the CAI literature. Previous research has shown that there are kinematic differences and muscle activation differences between running barefoot and shod (Kerr et al 2009, De Wit et al 2000, Burkett et al 1985). If anyone has ever tried to go and run barefoot (outside or on a treadmill) without weeks of acclimation, your feet hurt and your gait naturally changes in order to adequately absorb forces. The majority of previous CAI literature asked their subjects to perform this novel task of running barefoot. Knowing that gait changes, we are unsure if their findings are due to the task or due to CAI or both. Allowing our subjects to wear shoes, we were able to capture a more natural gait stride. Secondly, plantar stimulation has been shown to affect CAI subjects differently than healthy controls. Placing shoes on our subjects may have provided some stimulation that barefoot gait does not. Plus, being an athletic trainer, I always want to try to mimic what athletes do and there are not many sports that train or compete barefoot.

5. Can you make any recommendations based on this study?

I think the most important recommendation I have for clinicians and athletes is not to shrug an ankle sprain off as “just” an ankle sprain. This study as well as the majority of CAI literature shows that individuals with CAI have both local and global alterations compared to healthy controls. We also know that CAI has been linked to osteoarthritis. This study specifically shows that gait changes can be observed. After suffering from an ankle sprain and those who have CAI should evaluate their rehabilitation and not hurry back to activity. Therapists can incorporate gait re-training exercises into rehabilitation.

6. What questions remain unanswered about the effects of CAI on athletes?

Oh so many! As any researcher will tell you, as we answer one question it seems like 10 more pop up. I touched upon this previously, but I think the three most important unanswered questions pertaining to CAI are, 1) What causes it? 2) Can we prevent it? and, 3) How do we best treat it? I know these are three very broad questions, but it’s what all CAI researchers are striving to determine.

7. Describe your new career/research interest for us?

Since leaving UVA about a year ago and starting here at Kent State University, my overall research focus has not changed; I still want to better understand CAI and determine how to prevent CAI. However, because I do not have access to a state-of-the-art motion analysis lab my methods are shifting a bit. Neuromuscular control, balance, and proprioception are, in my opinion, the keys to ankle sprain rehabilitation. I am implementing various interventions on individuals with CAI in hopes to determine the most effective way to treat this syndrome.

So…..for those of you wanting a simple summary. Here it is. People who keep spraining their ankles walk and run different from those who don’t sprain frequently. While some of you may say “who cares”  - this is pretty important stuff. You see, all the gait research out there says something pretty simple. Variability is good. Its good to have slightly different ways to move. This way, when you get into “interesting situations” (like when you plant your foot slightly wrong) you have a skill set in place to correct your ankle position and save your body from injury. But this study shows that the pattern of people with CAI is different. And since these people keep spraining, one could say this compensated pattern really isn’t working….and is likely a big contributing factor to their ongoing issues.

From the clinical side, its a good idea to improve the stability of your foot and ankle. Strong muscles inside the feet means less stress to the joint and better proprioception for faster stability, which both reduce injury risk. Want some more? Check out foot some specific foot strengthening exercises in my book, and on this video below (right about 3:22).

Lastly, I’d like to say thanks to Lisa for all her work on this project, and thanks to Brooks for supplying shoes, and helping to ensure that the modifications we made to the study shoes to get 3D markers on the foot did not alter the function of the shoe during walking and running. If you’d like to contact Dr Chinn for additional questions, feel free to contact her below.

Lisa Chinn, PhD, AT. Assistant Professor in Athletic Training, Kent State University, Room 266D MACC Annex,Kent, OH 44242  - lchinn@kent.edu

More free books on the east coast, from Two Rivers Treads

The good folks at Two Rivers Treads are stepping up to help you this holiday season, with a free copy of my book, Anatomy for Runners. So if you need a pair of shoes, why not help those who are making an effort to help you as well. Here’s their email below.

Community Runners,
My friend Jay Dicharry is considered by most in the running world to be THE guru on gait mechanics and running injuries. He spent the better part of 2 years writing a book “Anatomy for Runners”. Jay and I have collaborated on many projects and much of what I have discovered I have Jay to thank for.

So our gift to you is his book with any shoe purchase or 50 dollar gift certificate. This includes closeout or current models. This special extends while our book supply lasts….we have enough books to hopefully get us through the holidays.

Dr Mark Cucuzzella
Two Rivers Treads

Chevy Tahoe or a Mini Cooper? A tip on running shoe selection.

You are about to leave your house and have the keys to both your cars in your hand. Which do you take?

Today, you have to drive through town town to get some groceries, and then to the mall. Its a slow drive on neighborhood streets to the freeway. Your SUV is comfortable, affords a good view of the road, and has lots of room for the stuff you are going to buy. Given the fact that SUV’s account for huge number of sales in the US, the public agrees this is a logical choice.

OK – its the weekend. You are going to flee the city and head up to the cabin. Its a really twisty backcountry mountain road. Turn after turn, its hard to even maintain the posted speed limit. Do you select the SUV that ensures you need to slow down due to body roll, or do you take the sports car? The sports car is lighter, lower, and has a firmer suspension. It was designed for these very conditions. While a stiffer suspension may be less comfortable driving through the burbs, the improved “road feel” you get with the sports car helps you drive better at speed through more challenging roads.

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Time to go shoe shopping! You ask the salesman to pull two pairs of shoes for you. The first feels like a cloud at first step. It feels like you could stand around in them for hours. Your quick run test on the sidewalk in front the shop confirms that same cushy marshmallow feel during your run. Going back inside, you slip on shoe #2. It feels comfortable, but is much firmer. It didn’t grab you at first step as you walked around the store, but when you repeated your short demo run outside, it felt pretty much like the shoe wasn’t even there. The firmer feel felt a bit more responsive.

What running shoe should you buy?

Well, the marketing research is clear. People buy shoes b/c of 1) color, and 2) “first feel”. First feel is that first step you take. You know that sense of walking on a cloud…..the same feeling that made you think you could stand around in them for hours? Well, that doesn’t have anything to do with running shoe selection. Running is not standing. When you stand, you have half your body weight split between each foot. The total load on each each leg is about half your body weight. When you walk, sometimes you have two feet on the ground, and sometimes you have one foot down on the ground. So at the most, you’d have your full body weight on one leg, and at the least, it would be split between both legs. And when you are walking, your feet are on the ground for a long time. If you need to “micro-correct” your muscles to stabilize your body, you’ve got time to do so.

Running isn’t standing. And its not walking. During running, your foot is only on the ground for a very short time: The average runner moving at 7.2 mph is on the ground for only .17 seconds. Decisions on stability need to happen very very quickly, faster than you can actually think about them. And when running, there is no double leg contact. You are either sailing through the air, or in contact with a single leg. That single leg must not only support your full body weight, but about 2.5x’s your body weight.

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So what “car” do you pick? Well, lets look at hundreds of research articles on foot and ankle balance. Almost every single article says that you have a harder time balancing and stabilizing when on a cushioned surface. On marshmallow-cushy surfaces, the muscles that control your foot and ankle kick on too late and not enough to keep things under control. So if you are going to rally around a twisty mountain mountain road, the stiffer suspension on the Mini Cooper gives you better traction and feel. When running, a firmer feeling shoe provides a stiffer surface for the muscles in your foot and ankle to support your body. Said very simply: the foot works better when on a firmer surface.

So do yourself a favor. Go to the store. Try on your shoes. Obviously you’ll stand, and then walk outside or over to the treadmill. But resist the urge to make an impression on the shoe until you are actually running. Of course you should buy a pair that feels comfortable! But most of us are in shoes too soft and squishy to be running fast. Pick the right car for your drive, and the right shoe for your run. Running comfort, not walking comfort, should be key.

Baby needs a new pair of shoes

It’s pretty tough for a lot of runners to make sense of all the changes in footwear these days. One key message is that shoes don’t run on their own. You are profoundly more important than the shoes on your feet. This being said, footwear construction can and does make a difference. And when we talk about kids shoes, it affects not only how they walk and run, but more importantly, how they develop.
Want to learn a bit more? Check out the “Shoes for Small Fry” article I wrote for Running Times. As a parent, we all try to give our kids an advantage. I’m well aware that there are a lot of things coming up in my kids life that I can’t control. But giving my kids the gift of strong feet is one I can control. Those little feet just might be passing you up on the race course sooner than you think!

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My 4yr old’s feet: excellent alignment and strong for her scooter, soccer, and the playground. The right footwear will ensure they look this way as she ages through the big game of life.

any pearls for the aging runner?

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Runner’s World asked for some key points to think about as we edge-up in years. It happens to all of us at some point right?

Check it out here

Disclaimer: the advice mentioned in this article is not meant to replace Botox