Tag Archives: stretching

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

Announcing the REP Triathlon Camp! – immerse yourself with the best, and achieve the best

Its just like the summer camp you went to as a kid. Except that……
Instead of eating hot dogs, we’ve got fully catered meals.
Instead of “being prepared” like a good Scout, we’ve got full sag on every workout.
Instead of dodgeball, we start each day with body work, strength training, or yoga. 
Instead of “trying harder” to make it through the obstacle course, we’ll coach you to “move smarter” through the most efficient mechanics for your sports.
Instead of a councilor that reads comic books, your camp leaders wrote the book on training, and teach nationally.
Instead of cheesy sing-alongs, we’ll show you all the secrets to training, equipment, and recovery for you are fully prepared for every race scenario.
Instead of fruit punch, you’ll be surrounded by the most thriving microbrew scene around. 
And we’ve even got a campfire for nightime chats with professional athletes and experts. 
So like we said, its just like summer camp when you were a kid.
 
 
The REP tri camp was born out of a simple idea. Build the best possible experience for our athletes. Period. 
Knowledge. Tools. Decades of and coaching and clinical experience. Passion. 
Thus summer, take your body to a whole different level. 

The Bat-signal has been lit: time for a PARTY!

 

Want to see what we are up to @ Rebound? Come grab a beer, some eats, and join us for our open house this Thursday! (superhero dress optional)

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Coffee Talk: TrailRunner Nation Podcast

The guys at Trail Runner Nation podcast gave me a call, and asked a few questions. If you’d like to hear some inside scoop on what you can do to keep healthy and happy on the way to your next PR, grab some of your favorite brew, and tune in here.

We’ll debunk some myths, babble about footwear, talk about why we don’t treat injuries by treating symptoms, and discuss some cutting-edge approaches on strength training for endurance athletes. Its a long hour of conversation, but all this talk is aimed at ways to help make running fun. Because that why we do this stuff. And more fun is, well,  just more fun.

Elevator Up? The Mindset Behind a Champion

A few weeks ago, I got to present along side Dr. Joe Vigil at a USA Track and Field conference in LA. For those of you who have to ask “who is Joe Vigil?”…..this man is to coaches as Rolex is to watches: the best.

Dr Vigil always has the uncanny ability to break down complex tasks and ask you the “right” introspective questions to help you reach your next milestone. We don’t just train the body in isolation. We’ve always heard that the body can handle more than the mind wants to give. So with that, I’m going to leave you with the following picture. Is it time to take the elevator up the “achievement triangle?” – What’s holding you back from reaching your goals? Change all starts with the desire to change.

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In fact, lets move beyond kumbaya and start this process in motion right now. Turn the computer off. Get out a sheet of paper and make 3 columns. Write down your goals in column 1. Then write down the obstacles that stand in the way of each of your goals. Then make a 3rd column of exactly what you are going to do to beat each of those obstacles.  Stick it on your fridge and remember your passion. When one of those obstacles seems like its standing in your way, make your tiger face and beat it down. Mental Tough = Body Tough.

And if you need help with your plan, give me a ring – I’ll help you find your tiger face.

Reminder: webinar on running form, mobility, and strength -Feb 26th!

Hey gang – Just got back from speaking at a great USATF Level 3 conference in Costa Mesa, CA, this weekend. I’ll have some highlights to post from that event later on. But for today, I  wanted to send out a reminder about the USA Triathlon webinar I’ll be conducting tomorrow, Tuesday Feb 26th.

If you’d like to register, please see this link. And yes, we’ll have some Q and A time.

Hope to see you on the web!

Want a free copy of my book? School’s in session at a local running retailer.

There is a store called “Daddy Ultra Runs” down in Cocoa Beach, FL, and the owner, Hernan Garcia, is giving away my book with every shoe purchase from October through December…..at his own expense. Is this crazy? I don’t even know this guy. Why would a shop owner do something like this?

Let’s look at the reality here. 82% of runners sustain a running injury during their lifetime. Stats show that 42-62% of runners get hurt each and every year. Those numbers aren’t good! In fact some people would look at those numbers and say “running is dangerous – stay away!”

However, my experience treating runners daily for over a decade, and collecting objective information on their running stride in my lab has shown me that running isn’t really the problem. The problem has more to do with a) your body, or b) the way in which you run. While I spend my “day job” doing individual running assessments in my lab, I realize that I can’t see everyone, which is why I wrote the book, Anatomy for Runners. While its no substitute for a full one-on-one evaluation, its the best I can do until I’m able to successfully clone myself.

Let’s be honest, Your local running retailer is the first point of contact for runners. They see way more runners in a day than any local clinician does, and can take advantage of their exposure as educators. They can spread better information to both new and experienced runners, and together, we can work collectively to change those injury stats, and keep you running healthy into the future.

Thanks Hernan, and thanks to all of you who are spreading the word on the book!

What can you learn from a frustrated bird?

Here at UVA, I teach a course called Neuro-muscular Basis of Human Movement, and today we are speaking of all things running mechanics. One of my students made an analogy that actually tells us a lot about running. Well, the analogy doesn’t really tell us that much, but a host of really angry and pissed off birds will….. Yes–> those angry birds!

Angry Birds is a simple game ( if it’s so simple, why has our country’s gross national product dropped since its launch????) that forces us to abide by the laws physics. Your goal, of course, is to knock out those smirky smiling pigs at various locations. You learn very quickly that aiming too high blasts your bird up to the clouds, at the expense of sacrificing distance. Aiming too low also compromises distance. Aiming just right produces the greatest distance covered with a pull of the slingshot….. The fancy name for this would be the optimum trajectory

While you don’t have to land on a pig when running, you do try to cover a given amount of distance per stride. In fact, the definition of running economy would be to cover a given distance with as little energy as possible. Too much up and down motion while running wastes a lot of energy. Actually about 80% of the energy required to run comes from raising and lowering the body against gravity. So “aiming too high”- too much vertical rise an fall- is not a smart move.

A lot of people get this. The problem is that they take it to the opposite extreme. They tell us that we need to minimize the rise and fall of our body. Does this play out? Go play angry birds again, and aim your bird dead flat. Pull back all the way and watch your bird take flight….. It won’t go very far. Limiting the up and down motion of the body when running not only ensures you won’t go far with each stride, it also costs a lot of energy! Go for a run and try to keep your head as still as possible- you won’t be able to do this for long- its tough!

So what is best? If you try to get maximum distance per fire on angry birds, you’ll find that about 45 degrees gives you the greatest distance. So does this mean that you should aim for this when running? Well, not exactly. The body isn’t a bird, a cannon ball, or any other type of projectile. It’s an actively controlled spring that actually stores and releases elastic energy to help you move forward. Some amount of vertical rise and fall is actually beneficial to “load the slingshot” and store and release this elastic energy. Exactly how much depends on your body weight, your leg length, and your pace, and your contact time. A sort of nice number is around 4-6 cm of vertical rise and fall of the body typically produces optimal results. In labs like ours at UVA, we study this kind of stuff to tweak your economy.

The take home message is that some rise and fall is necessary, even advantageous, when running.* So when someone tells you that a runner is efficient because their head stays perfectly still when running, maybe you should hand them your smartphone and tell them to play a little game.

* note- excessive rise and fall of your phone, as in when you throw it against the wall after not beating a level for the 37th time, isn’t recommended.

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Less From Your Shoes, More From Your Feet

There has been a lot of interest lately in the transition to minimal footwear. Am I going to get hurt? How long does this transition take? Is this really better for me? Will my old shoes take it personally? Last year at this time, there were 6 minimal shoes on the market. This year there are 64. It’s a hot market, and folks are taking notice. While shoes are nice to talk about, let’s not forget that it’s the runner in the shoe that plays an active role in this equation. Shoes don’t run by themselves!

The recent article by Giuliani et. al. has raised some concerns.2 They highlight 2 cases of stress fractures in 2 different runners who transition to minimal footwear. The switch to minimal footwear can be dramatic. You get more “feel” since the squishy midsole is reduced or gone. You get a lower differential from your rear foot to your forefoot. These 2 factors change a) the position of the foot (Heel isn’t higher than the forefoot in full contact) and, b) the demand of the runner to stabilize the foot inside the shoe. In short, with less “stuff” in between you and the ground, you need your body to do a bit more, and get accommodate to a bit more as well.

Ever hear about the experiment with pre-K kids with the cookies? They put a kid in a room with cookie on the table and tell him/her that they can eat the cookie and they’ll get one cookie. BUT, if they don’t eat the cookie, they’ll get 2 cookies later (yea!). The tester walks out of the room and the kids go into panic mode when sitting in front of this stellar, delicious cookie. Most eat the single cookie for instant gratification.  They fail to see the merits of waiting patiently for a better result.

What in the world do cookies have to do with running shoes? A lot. The switch to minimal footwear can pay off in the long run, but you need ensure you’ve got what it takes for a successful transition. Obviously any time you make a change to your body, there is an adaptation period that needs to occur.  A lot of “experts” say that it will take 6 months to a year to fully transition to a minimal shoe. I’d like to think that this is overly cautious, and like to discuss why using the anatomy. We’ve found great success using the following 3 criteria for runners looking to run with “less”.

1. Mobility: Traditional running shoes have about a 10-13mm drop from the heel to the forefoot. This creates a “rocker” effect in the shoe. Take a look at a shoe from the side and you’ll see that the curve from the ball of the foot to the tip of the toe rises up. Since your foot is flat, you need to ensure that you have enough mobility (called dorsiflexion) of the big toe to allow the foot to roll over. Additionally, since the heel is higher in a traditional running shoe (think a small high heel) the heel chords are used to operating in a shortened position. You need to ensure that you’ve got the mobility needed to allow the heel chords to operate form their slightly lengthened position. So what to you test?

    • Ankle mobility (heel chords) – you need to be able to dorsiflex (cock the foot up towards the shin) about 25 degrees. Lack of mobility here means you’ll need to stretch the calf and Achilles.
    • Plantar facsia mobility – with the ankle in about 5 degrees of dorsiflexion, you need to have 30 degrees of dorsiflexion at the big toe. If you don’t have this, you can’t roll over the toes, and will be forced to spin off of the forefoot.

2. Single-leg Standing Balance: normal balance has been identified as standing on single leg for 30 seconds
with a still upper body and full foot contact. Since the midstance phase of running is essentially a single leg squat, it is essential that the runner is able to maintain the foot in contact. A triangle between the inside ball of the foot (1st MTP), end of the big toe (distal phalanx of the 1st ray), and outside ball of the foot (5th MTP) should be seen. When in single leg stance, the muscles in the foot need to be “pro-active” not “re-active”. If you are wobbling your foot back and forth when standing on one foot, you’ve got some room to improve your “proprioception” – or sense of where and what you’re your foot is doing during contact. The most successful way to improve single leg balance is to perform it frequently (15-20 times a day) for small doses (30 seconds each).

3. Ability to isolate the Flexor Hallucis Brevis: a key factor that distinguishes humans from primates is our medial longitudinal arch. This arch is actively stabilized by the flexor hallicus brevius (FHB). While standing, try to drive the big toe (1st MTP) into the ground (plantar flexion) while slightly elevating (dorsiflexing) the lesser toes. Make sure not to roll the ankle in or out. This test enables screening of muscles inside the foot that stabilize the arch. The FHB can be easily distinguished from the longus (FHL), as the FHL crosses another joint in your big toe (1st IP joint), resulting in your big toe curling. Spend some time getting to know your foot. Aim to drive the big toe down while lifting the little toes (without curling the big toe!), and lift the big toe up while driving the little toes down. It’s the best way to work on coordination of muscles that actively stabilize the foot in stance. It’s your foot – control it! If you can do this, it’s a sign that you can keep the rear foot stable on the forefoot when the body sees the greatest amount of pronation (which is just slightly after midstance and AFTER the heel is off of the ground by the way.)1 Midstance is when forces are highest throughout the body- about 2.5x’s your body weight. You need the internal strength to be able to respond to these forces to keep things in alignment.

When your foot “works” it can actively stabilize the transfer of forces through the foot. If you don’t pass these 3 tests, no worry  -get to work on improving your limitations. Pay a visit to your local PT if you need help with specific exercises and stretches to improve.  If you lack mobility, research shows it takes 10-12 weeks to gain significant improvements. So stretching for 2 weeks likely won’t be enough for most folks. Improving tissue length can take some time. If your limitations are in the balance aspect, you’ll be amazed how quickly this improves if you simply practice practice practice. Typically, about 2 weeks yields a significant improvement. Finally, strength gains take about 6-8 weeks to achieve. So if you really have trouble isolating your foot muscles, this could take a bit to get them stronger – but you can always improve the strength of your muscles!  Passing these 3 tests doesn’t mean that you should go run a marathon in your new minimal shoes on day 1, but we’ve seen that folks who master these have little to no problem making the transition. I’ll note here that these tests are not new in my mind. I’d like all runners  – even those who run in traditional shoes – to pass these tests. Its that when the “stuff” under your foot is less, these traits are that much more important.

So invest some time to improve your foot – Because it’s always better to have 2 cookies instead of one!  Shoes make a difference, but it’s the runner in the shoe that you’ve got control over.

References:

Dicharry, JM., Franz, JR., Della Croce, U., Wilder, RP., O’Riley, P., Kerrigan, DC. Differences in Static and Dynamic Measures in Evaluation of Talonavicular Mobility in Gait. J Orthop Sport Phys Ther 2009;39(8):628-634

Giuliani J, Masini B, Alitz C, Owens BD. Barefoot-simulating Footwear Associated With Metatarsal Stress Injury in 2 Runners. Orthopedics. 2011 Jul 7;34(7)