Runners Be Smart when Going to Minimalist Shoes

This article clearly shows it is the transition process from one thing to another in runners that causes injuries, not the thing itself (whether it is hill running, speed work, minimalist shoes, long distances, etc.)

http://www.runresearchjunkie.com/impacts-and-injury-and-the-transition-to-minimalist-running-shoes/

Ideal Running Form

Ideal Running Form: Slight Forward Lean of Trunk, Powerful Swing of the Arms, Foot not too far in front of body, and very little bounce up and down of the head

If you never have walked a Labyrinth you should. It is a mirror of our spiritual journeys. At times, we are so close to our Center, only to feel miles away minutes later. The correlaries to our own paths are worth reflecting on.

Plyometrics for the Distance Runner: Fitness Tips from Personal Trainer Lisa Tonra

PLYOMETRICS for the Distance Runner - JUMP for Faster Race Times and More Energizing Runs!

5K, 10K and half-marathon runners! Looking for faster race times, a greater sense of 'ease' with your run and greater running efficiency? It's time to step (or hop) it up with plyometric training!

Plyometric training helps runners recruit muscle fibers in the most efficient way. Plyometrics are based on the principle that a muscle's Stretch-Shortening Cycle (defined as an active stretch, or eccentric contraction of a muscle, followed by an immediate shortening, or concentric contraction of that same muscle) can create much more power than a normal muscle contraction. This is because the muscles are able to store the tension from a stretch for a short period of time - causing the muscle to react like a rubber band. The better your muscles are at producing force against the ground quickly, the less time you spend on the ground. Plyometrics help the hip and lower extremity muscles transition from their eccentric to concentric contraction more quickly, thus producing more force against the ground. Now we're moving fast!

As a rule, distance runners tend to recruit and use more Type I (aerobic, slow twitch) fibers. But when speed work is incorporated into your routines, more of the anaerobic, Type II fast-twitch fibers are recruited. Part of improving your ability to run is maximizing muscle recruitment. The more muscles recruited, the more ability you have to produce force against the ground and the faster you’ll go! However, the goal is ALSO to recruit as few muscle fibers for the task as possible. It sounds contradictory, but the more muscles you recruit, the more oxygen they require, and this can lead to decreased running economy. So we have to be picky with our fiber selection! Running economy is all about using oxygen efficiently. Our goal is thus greater recruitment of those explosive fast-twitch fibers, which use less oxygen. More bang for the buck from a muscle perspective!

NOTE! In addition to good overall strength in the major muscles of the hips (gluteals and hamstrings) and thighs (quadriceps), it is CRITICAL that you have adequate strength in your calf muscles and flexibility in your ankles for the plyometric drills. The biggest calf muscle (gastrocnemius) usually contains a larger proportion of Type II fast-twitch muscle fibers, and responds well to traditional strength training. 

Beginners should start with calf training basics: 

1. Heel raises: holding onto a counter top, squat rack or other sturdy surface, raise and slowly lower your heels until you reach fatigue. Use a weight amount such that you are completely fatigued by 10-15 repetitions. This weight can be simply your body weight, or you may hold small dumbbells of equal weight in each hand. You may also try lifting one heel at a time, with or without added weight. More advanced exercisers may use the same exercise but increase the weight amount used, such that fatigue is reached by 6-10 repetitions. Everyone should complete 2-3 sets with a 1-minute rest interval between sets.

This basic exercise is well worth the time invested: more Type II fiber recruitment  in your calves equals better ground force reaction time, less overall body fatigue and a better race time!

Once you've achieved good basic strength in the calves, it'll be time to move on to some basic Plyometric drills.

Beginning runners can start with stair climbing (two stairs at a time if you're able), two-footed hopping in place, or short bursts of running uphill. Each activity should be performed for 45-60 seconds per bout.

More advanced runners can try the following:

2. Ankle hops: With feet hip-width apart and heels elevated, balance on the balls of your feet. Bend your knees, place hands on hips, and repeatedly hop forward, pushing off and landing only on the balls of both feet. Stay on the ground as little time as possible between hops and never let your heels touch the ground. For variety, you can try hopping backward. Reps: Start by hopping 10 yards, building up to 20 yards. When you're ready add a second and third bout of 20-yard hops with 1-minute rests between them. This drill will strengthen EVERYTHING below the knee, but especially the Achilles Tendon, shin muscles, calves (see above), and the flexor muscles that support the ankles.

2. Squat Jumps: Stand with both feet hip-width apart and place your hands on your hips. Tilt your hips back and bend your knees, leaping straight up as high as possible. Land softly with both feet  in the same spot. Bend your knees to absorb the impact. Reps: Begin with one set of 10 jumps in rapid succession. As you get stronger, build up to three sets, each set separated by a 1-minute rest. This drill will strengthen all of the muscles, tendons, and ligaments from the waist down. Efficient!

In a nutshell: plyometrics work primarily because they strengthen everything related to your feet and ankles. They make all of the muscles, tendons and ligaments acting on your ankles stronger and more powerful, helping you to become "stiffer" (a good thing!)

How tired should you feel with this type of workout? In general you should finish any plyometric workout just as fresh as when you started. If you feel unduly fatigued you likely did too much. Keep the repetitions low enough so that each rep is a quality rep. With regard to rest intervals, rest at LEAST one minute or long enough to be at 100% for your next attempt. 

As with ANY athletic program, make sure you check with Dr. Blake about proper footwear and the need for corrective orthotics. Bring any new (or existing) foot and ankle injuries, or muscle/joint pain to his immediate attention.

Best of luck! And here's to your next personal BEST race time!

About Lisa: 

Lisa Tonra, a twenty-year veteran of the fitness/wellness business, holds credentials from ACSM, NASM, and BASI Pilates and is currently a Physical Therapy graduate student. She specializes in injury 'pre-habilitation,' prevention and recovery for all sports-related and overuse conditions. Lisa can also design, implement, coach and monitor fitness routines for all recreational athletes, fitness enthusiasts and beginning exercisers. Her philosophy is a simple one: "There is a (sometimes hidden) fitness enthusiast in all of us! It’s good to set a short-term fitness, health or lifestyle goal to get yourself up and moving, but challenge yourself to take the longer view of 'training for life.' What are Your Body Goals? I can help you achieve and maintain them, and do it injury-free!" 

Visit Lisa's personal website here: http://yourbodygoals.com

Posemethod of Running: For some softer and gentler method which can reduce symptoms

     I love watching good runners run. The style and grace of powerful motion is not only appealing, but I can almost remember when I could do something like that. Most of us can not hit a golf ball like Phil Michelson, nor kick a soccer ball like David Beckham, nor dunk the ball like Blake Griffin, but we can run with the same powerful forms of the running greats. If you love to run, study running. Study the shoes and the various running styles. Find out if your running style is efficient or not, smooth or injury prone. Many running clubs exist that offer advice. Running shoe stores also can be helpful. Podiatrists and physical therapists that specialize in running injuries can be found. The American Academy of Podiatric Sports Medicine is a good place to look for a referral (www.aapsm.org) in your area. Definitely if you can run smoother, you should have a longer running career.

     It is very hard to change your running style and it can give you problems. So, who should change? And, is there something in your running style that can be changed? I have always told my patients when we want to make changes in running style to start with each run or workout from one telephone to another and then forget about it. The next workout 2 telephone poles, and the next 3. With this technique, you begin to practice and you begin slow. You also really focus when you have a short distance. When you want to change heel strike like in the video above, and also arm swing, etc, make one change at a time. Give yourself 6 months to make a major change. It should take longer if you have run for 15 years vs 6 months.

     Running is a gift to Homo Sapiens. It is built into our DNA, in contrast to basketball, tennis, football, etc. We are all natural runners, although some more than others. Being a natural runner does not mean you are a natural athlete. Sweating or exercising may not be what you like. But, you still could, with relatively minor training in the grand scheme of things, run a marathon safely. The first steps may be to get the right shoes for your biomechanics and then have your running style evaluated. See if some minor changes may help. Start Slow and Go Slow.
   

   

Running: The First Year is Critical Just to Survive

CA Podiatrist Discusses Common Injuries in New Runners The most common running injuries are shin splints, runner's knee, plantar fasciitis, Achilles tendonitis, and some type of foot fracture, according to Dr. John Pagliano, a Long Beach sports medicine podiatrist. And there's more bad news - they'll probably keep popping up for the first year for new runners. Dr. John Pagliano Pagliano recommends strength workouts three times a week on alternate days, which should include upper body strengthening. And if the pain lingers for more than two weeks, that's when you should go see someone. Source: C J Lin, San Gabriel Valley Tribune [12/11/11]

Join Marathon Matt for Inspiring Training Sessions Year Round

http://myemail.constantcontact.com/The-Rundown-The-Long-Green-Line--Skip-a-latte---join-Touchdown-13-1--and-more-.html?soid=1101336190191&aid=2daLu3iD67A




Marathon Matt inspires people to run, and helps them train safely. Even if you have run 1/2 or full marathons before, you can learn alot from him. Dr Rich Blake   If you need more motivation to run that first step, see this video entitled "Spirit of the Marathon". I have completed 4 marathons, it does change your conscious of who you are.

Running with Knee Pain: The Cause May be the Hip or Foot

Runners, given enough time, may develop some form of knee pain. This short article below makes the point to look for the cause above or below since treatment may be greatly influenced by what is found.

http://www.bcm.edu/news/item.cfm?newsID=4369

Knee Pain With Runner: Possible Ilio-Tibial Band Syndrome

Hi Dr. Blake,

I am a runner (no more than 10k races) and have had a pain on the side of knee for the past month or so.  I was told that it could be my IT band and to do stretches to help recover from the pain.  I run in the City so I thought the pain might also be from running downhill. 

Dr Blake's Note: The Ilio Tibial Band runs down the lateral or outside aspect of the leg from the pelvis to the tibia. It most commonly causes symptoms on the outside of the hip or the outside of the knee. 

Can you recommend the most efficient stretches and any other suggestions for a quick recovery? 

Dr Blake's Note: IT Band Syndrome is almost a pure runners problem. Rarely ever see it in other sports. Here are some common IT Band stretches.

 Should I be icing my knee after every run?

Dr Blake's Note: IT Band Syndrome is a form of tendinitis. All the common treatments of Tendinitis should be employed to help. Please see the link on BRISS for tendinitis treatment. 

http://www.drblakeshealingsole.com/2010/06/briss-principle-of-tendinitis-treatment.html

  Is it possible that it could be something else?

Dr Blake's Note: Definitely, it is uncommon for women to get IT Band tendinitis around the knee, but not rare. If there is any swelling, it is not IT Band Syndrome. If it does not feel better with stretching during a run (I love the lateral wall lean stretch while running), it is not IT Band Syndrome. It could be lateral knee joint pain, lateral collateral ligament, lateral hamstring, etc to name a few. If the pain is on both knees in roughly the same spot, it is most definitely IT Band. 

  Would a knee brace be unnecessary if it really is my IT band?

Dr Blake's Note: If it is IT Band, knee braces should not help, and may hurt. If you experiment with a simple knee brace while running, and you feel somewhat better, continue to wear. 

It take me a few days to recover from the pain after a run.  I have my longest race coming up in September and don't know if it's safe to run because the pain is still bothersome.

Thank you,

Lesley

Lesley, Thanks for the email. Definitely do not run through pain that starts in the middle of a run.You will definitely make it worse.  Stop, try to stretch out the IT Band, and then continue to run only if the pain subsides. If you can get PT for it with the upcoming race, go for it. They can normally calm it down quite well. For a race in September, it is too late to change you biomechanics too much, but is would be okay to make a shoe change if your shoes are too worn down (usually over 500 miles). Hope this helps. 

Good Running Shoe for Supinators: Consider Saucony Triumph 8

Here is a view of the Saucony Triumph 8 from the side. The shoe is a neutral shoe, which for supinators can be too soft and unstable, but this one seems to work well. As the video says it has some good qualities that make it stable. One of my patients EB brought this shoe to my attention. It works very well for her and she is a significant supinator.

Here is EB in the Saucony Triumph 8 left shoe from the back view. You can see how vertical it holds her foot, although she has an insert to stop some of her supination.

     Running shoe stores can tend to use to many generalizations and one of them which has always bothered me is that supinators need neutral cushioned shoes. Many supinators, with orthotic devices to correct some or all of that supination, due the best in stability shoes. I am always fighting these neutral shoes when trying to stablize an unstable foot. So, I hope this Saucony Triumph 8 stands the test of time.

Marathon Training: Marathon Matt's Website

Running is a nature activity for the human body. This blog will have many posts on tips to keep you running. I highly recommend you subscribe to Marathon Matt's website, and if you live in the San Francisco Bay Area, perhaps check out his programs. Besides, he is a great guy!!!

http://www.marathonmatt.com/

http://www.dreamstime.com/stock-images-girls-running-to-play-rimagefree780301-resi2565486

Running Biomechanics: General Principles

The way that you run is called your "running style" or "running gait". Your running gait pattern should be smooth without excessive motions (mechanically efficient). Having your running gait style evaluated by a sports podiatrist, physical therapist or trainer may be very helpful, especially in the following four instances:

1. 
   
   You have never run before and have no idea how to start.
2. 
   
   People who see you run say that you run different in some way (ie. limp, lean to one side, turn ankles in, etc).
3. 
   
   Running itself for you has always produced a variety of running-related problems.
4. 
   
   If you look at your shoe wear and shoe insole wear after 300 to 400 miles and find that the wear is very unequal between the two feet.

Here are 7 general principles that define a smooth, efficient running style. Some of these you can definitely learn yourself. They are:

1. Lean forward slightly at the waist. The straighter you run, the more bouncing up and down you do, and the more excessive jarring on your legs and low back. This moves your center of mass slightly forward to the body, much less stress to the skeletal system.
2. The length of your stride (measured from right heel contact to left heel contact) should be equal to or less than your height. It takes a friend and some trials to measure this of the sidewalk. Try to time right heel contact at one place and have your friend focus on where you land your left heel. A common error is to "overstride" as you try to run faster. Seventeen different running-related injuries are associated with this problem. As you attempt to run faster, focus more on faster leg speed (stride rate) than straight longer strides. You will have to move your hip muscles faster for sure.
3. Your foot should contact the outside of the  heel or full-foot first (little toe side). There are some schools of thought that toe running may prove to be better, but I find the foot biomechanics harder to stabilize with toe runners and presently do not recommend it's use. However, if you are a natural toe runner, I would not try to change what comes natural to you.
4. Don't slap or pound your feet along the path. Concentrate on slight gait changes that lessen the jarring. This problem may require better shock absorbing shoes or special inserts made to absorb shock.
5. Relax your fingers, hands, arms, shoulders, neck, and jaw. Relaxing the upper body promotes total relaxation and running efficiency.
6. Carry your arms at a right angle (90 degrees) at the elbows. Make sure both arms are swinging equal (unequal arm swing could indicate a structural problem with your legs). Don't let your arms cross in front of your body or, at least, minimize this action. Running is a straight line progression movement, and side to side motions are counter productive. Relax your wrists, but carry your hands straight with your thumbs up.
7. Take the "Talk Test". If you can talk while jogging, you are running at a comfortable speed.

Shin Splints Part II: An Anatomy Lesson

As I discussed in Part I of Shin Splints, the pain is from below the knee to above the ankle. It is a large area with many possible structures involved. In most cases the pain is self-limiting, but with some use of the 10 basic treatments (see Part I)  you are guaranteed that the rehab will be quicker than with just REST.



Let us review the anatomy of Shin Splints. The 4 basic types of shin splints are Medial (most common), Anterior (2nd), Lateral (3rd), and Posterior (4th). The medial group of muscles (function) are the posterior tibial (controls over pronation), flexor hallucis longus (stabilizes the big toe), and the flexor digitorum longus (stabilizes toes 2 to 5). Photo below shows where medial shin splints occur. Since over pronation, bunions (unstable big toes), and hammertoes (unstable lesser toes) are all common problems, this type of shin splint is the most common. More specific treatments of these problems include various methods in controlling pronation (there will be a series of posts on this topic), stablizing the big toe area or stablizing the lesser toes.These include toe separators/spreaders, shoe inserts with Morton’s extensions, and big toe spica taping to stabilize the big toe area, and toe crests, toe taping, reverse Morton’s extensions all to stabilize the lesser 4 toes.

Many patients purchase shoes too wide in the toe box leading to marked instability, especially when they have bunions. Too much room with resultant sliding around is just as bad on bunions and hammertoes as having too little room with resultant crowding.

The 2nd most common form of shin splints is anterior shin splints (see photo above). The muscles (functions) involved all help to control foot slap after heel strike, and then to help lift the foot off of the ground at toe off. Overuse situations can easily occur with hill running and increases in the speed of workouts. The muscle/tendons involved are the anterior tibial (controls over pronation and stabilizes the first metatarsal), extensor hallucis longus (stabilizes big toe and lifts toe up at toe off), extensor digitorum longus (stabilizes lesser toes and lifts these toes up at toe off), and the peroneus tertius (stabilizes the outside of the foot including the cuboid , 4th metatarsal and 5th metatarsal).



This muscle group is normally the weakest of the 4 groups and has to constantly pull against the more powerful Achilles tendon. As the calf/Achilles gets too tight/too strong with vigorous exercise, it is hard for the anterior group to keep up. These muscles will strain under the added stress of working against the tight Achilles. Hopefully, you can see, when someone has anterior tibial shin splints, treatment should be directed towards:
• Stretching of the calf

• Decreasing hills/speed for awhile

• Stabilizing pronation (medial support) or stabilizing supination (lateral/cuboid area support)

• Stabilizing any digit appearing unstable (with toe separators, taping, toe crests, etc.)

The 3rd most common form of shin splints is lateral shin splints (see photo). The muscle/tendons (functions) involved are the peroneus longus (stabilizes the lateral ankle against excessive supination and stabilizes the cuboid and the first metatarsal), and the peroneus brevis (stabilizes the lateral ankle against supination and stabilizes the cuboid and fifth metatarsal). So they stabilize the lateral ankle, and both sides of the midfoot area. Ankle braces, ankle proprioceptive exercises (see post on flat footed balancing), power lacing, and stable shoes if you pronate or supinate too much can all be part of the treatment.

The 4th common form of shin splints is posterior shin splints (see photo). The upper 2/3 of the calf is considered a shin splint if the pain is deep. This is normally a stress fracture on the posterior aspect of the tibia (very common in runners) and often misdiagnosed as calf muscle strain. It may also be a strain of the soleus muscle (deep part of the calf) where it originates on the tibia. The gastrocnemius (or gastroc) is the bigger, more superficial, muscle of the calf. The soleus muscle starts deep to the gastroc and becomes the other ½ of the Achilles tendon below. Therefore, the soleus functions to lift the heel. It also attempts to slow down pronation at heel contact, so over pronators may strain the muscle. It is harder to strengthen the soleus then the gastroc, so weaknesses may develop and muscle strains can occur with relatively minor overuse situations.



A further post will discuss various ways to strengthen the gastroc versus the soleus. In general, soleus strengthening is done with the knee bent 45 to 90 degrees and the ankle is then plantarflexed with resistance (pointed downward like a ballerina on her pointe shoes). Treatment of this type of shin splints must initially rule out tibial stress fracture which requires more modifications. Once tibial stress fractures are ruled out, functional changes include decreasing ankle plantarflexion (extension) and stabilizing pronation. Also, avoiding activities that produce a negative heel effect (see separate post), like getting off your seat in cycling. A slight biomechanical change in activities to minimize heel lift (ie. walking more flatfooted even when going up hills, or lowering the seat on your bike) can greatly speed up treatment.

Shoe Evaluation: Shoe Flexion Test

The Shoe Flexion Test checks flexibility of the front of the shoe. You are testing whether the shoe bends correctly or in the wrong place. As you walk or run, you need to bend your foot in the metatarsal or ball of the foot area as the heel lifts off the ground. This easy motion is called propulsion or push-off. It should occur only at the right place or injuries may occur. Grab the shoe again (like the post of Shoe Torsion Test) firmly at the heel. Then, grab the toe area and simulate toe bend by bending the toes upwards. The second photo demonstrates the shoe easily bending, not at the ball of the foot, but at the arch. This is how injuries to the arch, or plantar fascia, can occur. The shoe actually forces the foot to bend at the wrong place. Ouch!!! Combine the Shoe Flexion Test with the Shoe Torsion Test with Heel Verticality Test from other posts and you are beginning to have a clear understanding on how evaluate the safety of the shoes you buy. Good Luck!

Shoe Torsion Test for Stability

One of the best tests you can do at the shoe store when looking for a stable shoe is the Shoe Torsion Test. The photo above shows a shoe from the side. Grab the heel firmly. Grab the front of the shoe and attempt to twist the shoe as demonstrated in the photo next to this text. If the shoe twists easily, it fails the stability test, and you should not buy it. After you do this test on 5 different shoes, you will have a good understanding of the range of stability offered in the current market. Golden Rule of Foot: Avoid Shoes that fail the Shoe Torsion Test.

Hill Running Tips

San Francisco: A Runner’s Paradise (with a hilly twist)


Those of you who live in the San Francisco Bay Area know the true beauty and allure of San Francisco. Once you move here, why would you ever leave willingly? I work in the only downtown hospital in San Francisco, Saint Francis Memorial Hospital. Millions of people work in the downtown daily. People from all over the world travel to this area on vacation and business trips. It is truly an exciting place to live, or even experience briefly. Runners can train year round so they love the great climate.

When runners move to San Francisco, they are immediately faced with potential danger---the San Francisco Hills. There are 7 of them. Finding a flat running routine can be challenging. The 7 miles 5 days a week they were running in flat Dallas can not be transferred into hilly runs in San Francisco without danger lurking. Hill runs can be great in moderation, but must be gradually incorporated in your running program.

     This photo does not do justice to one of the steepest hills in San Francisco called Lansdale Avenue. The hiking area to the left is Mount Davidson Park and the incline is intense. As a high school runner at Archbishop Riordan High School here in San Francisco we would do twice weekly interval training up this hill to the base of the huge Cross at the top of the hill. Probably why we won the league championship on a yearly basis.

     When you are training for some event and increasing the intensity of your workouts, think about these key points. Never increase the 3 main variables at the same time---distance, speed, and hills. First, build up your distance to where you would like/want it. Then stabilize the distance at that same amount, and add two speed workouts or two hill workouts per week, not both. These two workouts per week are normally in the middle of the week, like Tues/Thurs, with an easy run on Wednesday. Speed and Hill Workouts provide different stresses to the body and will make you faster and stronger. Just do not increase both at the same time. Give yourself 3 weeks at hills or speed, level off that variable, then add the 3rd variable. Try 3 weeks with one speed and one hill workout per week, then try 3 weeks just adding the 3rd variable. Do you see how safe, albeit slow, this procedure is? Since this is a medical blog, I am going to emphasize safety.

     One way to safely add hills is in the middle 1/2 of a run. So, during a 6 miler, run 1 and 1/2 miles flat, 3 miles in a hilly area, and the last 1 and 1/2 miles flat. Do the math! Charge up as many hills as you feel up to, pumping extra hard with your arms to help pull you up, but go easy down hills. Down Hill Running is one of the biggest dangers for injuries, especially during the last 1/4 of the workout when the muscles are fatigued. There is only damage to your joints as a benefit of down hill running, other than mortgage payments for orthopedists. But if you run up, you must run down, so go easy. The stresses to your body running down hill can be up to 10 times body weight as you land on each foot. Go easy with down hill running and last much longer as a runner. The occasional race where you need to fly down a hill to win a prize or something is just fine, but avoid the pounding of down hill running during your normal training runs.

    

Running: Develop A Base when starting running

Running is one of the safest activities out there. Running seems natural for the human body and can be done relatively safely. Many athletes need great shoes and orthotics, especially if their mechanics are somewhat off, but the average runner can actually run a marathon. This implies good training, but the human body seems to withstand the stresses of marathon training (a truly incredible task) with relative ease. There is really no other feat this impressive that thousands upon thousands of athletes accomplish each year.

But the first year of running is what separates the men from the boys, the women from the girls. In my 30 years of practice, I have found that the first year of running is the crucial survival year. Getting through this first year with its ups and downs, injuries, and discomforts, is very challenging. It is in itself a huge accomplishment. Learning about training, proper shoe selection, pace, what pains to ignore or take seriously, is all part of developing a BASE. Developing a stable base is one of the most important keys to a long running career.