I'm not sure if I've mentioned this before, but I work in the orthopaedics department at a major hospital. I mainly do basic research in the development of implantable devices, but the clinical half of our lab works directly with patients and is expanding to a number of gait studies. This is really exciting for me, since the majority of my work has been engineering-based, which makes sense since I'm an engineer. But I've always wanted to work on the clinical side - the point where I've debated returning to nursing school or getting a certificate in clinical research so I can shift gears.
Now I was chatting casually with one of our clinical research staff/PTs at the coffee machine last week. She was asking about how my IT band issues were coming along, and I, in turn, brought up the fact that they were great compared to the stress fracture. I dicussed my visit to Sports Medicine the week before, and how I wasn't sure if I was going to return to my traditional running shoes or the Vibrams.
Now my doctor has worked with the clinical labs in our department over the years, thus my coworker was familiar with him and his experience. She started to tell me about the new offsite gait/sports medicine facility they're currently getting set up along with a number of new biomechanics studies that I might be interested in -- and ultimately a new sports medicine PT that arrived last year. This PT apparently has extensive experience in running gait analysis. I perked right up at that. She said she would talk to him for me, see if he could help me get back running again. She also said that they'd be thrilled to have me help them out with the gait studies they'll be starting later this year.
So wait, let me parse this down for you, since I'm ramling:
(1) I get to work with an accomplished PT to determine weaknesses in my biomechanics and ultimately how to fix them to run healthy.
(2) I have been invited to participate in running gait analysis research, which will ultimately be cutting edge research in the sports medicine/orthopaedic field and help answer all of the questions that have arisen in the wake of the minimalist running fad (it's now my word too).
Showing posts with label barefoot running. Show all posts
Showing posts with label barefoot running. Show all posts
PT and Biomechanics Analysis
Tuesday, May 10, 2011 barefoot running, biomechanis, injury, physical therapy, stress fracture
What happened with the podiatrist
Wednesday, April 27, 2011 barefoot running, doctor visit, injury, minimalist running, stress fracture, vibram
I had my visit with the orthopaedic podiatrist this morning. It was uneventful and confusing. Now I really liked the doctor. He was friendly, had a sense of humor and amicable to asking all of my questions. He even said I had good questions - score!
Perhaps it was the excellent conversation that left me pleased with the visit in spite of the lack of answers.
When I explain how I went about injuring my foot, I could already see the rueful shake of his head. I later learned that give the "fad" (his word, not mine) of minimalist running, that people were arriving at his doorstep in epic numbers with injuries such as mine. I was, in fact, a statistic. He and some collaborators at Harvard are currently writing a paper on this very observation, to be submitted in the near future to JBJS or JSM.
Now he specifically stated that he neither supports nor discourages minimalist running. However, he did spend quite a bit of time pointing out some rather glaring holes in the few papers published on barefoot running - notably the sample population in the Nature article (all Kenyans who had never worn shoes and grew up running on grass compared to shod American runners who ran on urban surfaces). Or that fact that they measured impact force on the ground as opposed between the heel and shoe. And the obvious lingering question - even if you can steadily show that barefoot runners land with 20% of the force of a shod runner, does this actually lead to lower rates of injury? Even Dr. Lieberman wasn't able to conclusively say that barefoot running resulted in lower risk of injury. The research simply hasn't been done at this stage. Adequate controls and sample populations weren't in place in the published studies.
Beyond the few studies themselves, becomes the most relevant question - one that I asked him: As a heel-striking, shod runner, how can I safely transition to a minimalist, forefoot-landing running style? There is no proven or certified method of doing so at this stage. Current research compares lifetime barefoot runners and lifetime shod runners. As someone who spent the first 30 years of their life wearing shoes, running in shoes with an elevated heel, will I not only be able to transition to a healthy, safe barefoot stride that equals the same efficiency? My body has adapted and is "efficient at running inefficiently" - to quote Danny Abshire. The bottom line: Will this transition reduce my risk of injury? The answer is that no one knows right now. The research hasn't been done.
So after spending 30 minutes talking intently to the orthopaedist about this, we did come to several conclusions.
I have a fairly uncommon foot type where my heels are set inward when I stand with my feet facing straight forward. So if you look at my feet head-on, you can see the insides of my heels. This results in a mild supination of my foot, where my foot settles off to the sides and I land harder on the outside of my foot. This is something that could be corrected with a couple millimeter heel wedge. He said that if I continue to have ITBS problems, to give him a call and we'll look into the heel wedge.
If I stick to a minimalist stride, the ITBS may not be a problem, since it is primarily an overuse injury that is a result of the heel-striking gait and compensations associated with it. Therefore, if I continue to land on my forefoot, I will likely curtail the ITBS.
This sounded great to me. My entire reason to swap to the VFFs and natural running stride was to get rid of the ITBS that was plaguing me with mileage above 6-8 miles. So upon having this route confirmed, I asked, "So how do I safely return to the forefoot striking gait without reinjuring myself?"
That's the million dollar question.
For one thing, the stress fracture repairs itself stronger and healthier than it was originally - so the likelihood of refracturing that exact spot is unlikely. That doesn't mean I won't just fracture at another location. I asked if there was a set program or recommended transition. He laughs in a good natured way "You mean, is there running school or programs that safely transitions runners from shod to barefoot running safely? No. That would be handy. I'm sure you can find some guy claiming to be able to do just that, but its not routed in research or proven safe practices. There is no certified program to transition you. Our PTs wouldn't be able to help with that, and I don't know of any place off hand that offers such a program."
So pretty much, I'm on my own. He did confirm that weak calves were the primary problem. I suggested calf strengthening exercises - something I already do - and slowly easing into running. On grass - not pavement. He didn't really confirm or deny. But I can certainly continue my non-impact weightlifting and cardio.
He did tell me that I can go onto the treadmill tonight for a trial run. I am to run 1/2 to 1 mile. If I feel any pain, I should stop. Pain indicates that the fracture isn't healed. I can "only run when there is no pain." This can take any numbers of days or weeks, depending on my day to day activity levels. Every time I feel pain though, I should consider the fact that I'm taking a little away from the healing process.
I asked if I should wear the VFFs or my Landreths for the treadmill trial. He said that was up to me. But suggested if I was going to go the minimalist route in the future, that I should consider alternating in the beginning. That is a wise idea.
So...that's that. You're probably as confused as I am. But I'm not more confused than I was going in. I've just had the confusion over this transition to minimalist running confirmed by one of the leading doctors in the nation. Sweet.
On a side note, I gave myself a mini-pedicure in anticipation of the visit today. My toes are sparkling with fluorescent pink polish. I get giddy just looking at them.
Perhaps it was the excellent conversation that left me pleased with the visit in spite of the lack of answers.
When I explain how I went about injuring my foot, I could already see the rueful shake of his head. I later learned that give the "fad" (his word, not mine) of minimalist running, that people were arriving at his doorstep in epic numbers with injuries such as mine. I was, in fact, a statistic. He and some collaborators at Harvard are currently writing a paper on this very observation, to be submitted in the near future to JBJS or JSM.
Now he specifically stated that he neither supports nor discourages minimalist running. However, he did spend quite a bit of time pointing out some rather glaring holes in the few papers published on barefoot running - notably the sample population in the Nature article (all Kenyans who had never worn shoes and grew up running on grass compared to shod American runners who ran on urban surfaces). Or that fact that they measured impact force on the ground as opposed between the heel and shoe. And the obvious lingering question - even if you can steadily show that barefoot runners land with 20% of the force of a shod runner, does this actually lead to lower rates of injury? Even Dr. Lieberman wasn't able to conclusively say that barefoot running resulted in lower risk of injury. The research simply hasn't been done at this stage. Adequate controls and sample populations weren't in place in the published studies.
Beyond the few studies themselves, becomes the most relevant question - one that I asked him: As a heel-striking, shod runner, how can I safely transition to a minimalist, forefoot-landing running style? There is no proven or certified method of doing so at this stage. Current research compares lifetime barefoot runners and lifetime shod runners. As someone who spent the first 30 years of their life wearing shoes, running in shoes with an elevated heel, will I not only be able to transition to a healthy, safe barefoot stride that equals the same efficiency? My body has adapted and is "efficient at running inefficiently" - to quote Danny Abshire. The bottom line: Will this transition reduce my risk of injury? The answer is that no one knows right now. The research hasn't been done.
So after spending 30 minutes talking intently to the orthopaedist about this, we did come to several conclusions.
I have a fairly uncommon foot type where my heels are set inward when I stand with my feet facing straight forward. So if you look at my feet head-on, you can see the insides of my heels. This results in a mild supination of my foot, where my foot settles off to the sides and I land harder on the outside of my foot. This is something that could be corrected with a couple millimeter heel wedge. He said that if I continue to have ITBS problems, to give him a call and we'll look into the heel wedge.
If I stick to a minimalist stride, the ITBS may not be a problem, since it is primarily an overuse injury that is a result of the heel-striking gait and compensations associated with it. Therefore, if I continue to land on my forefoot, I will likely curtail the ITBS.
This sounded great to me. My entire reason to swap to the VFFs and natural running stride was to get rid of the ITBS that was plaguing me with mileage above 6-8 miles. So upon having this route confirmed, I asked, "So how do I safely return to the forefoot striking gait without reinjuring myself?"
That's the million dollar question.
For one thing, the stress fracture repairs itself stronger and healthier than it was originally - so the likelihood of refracturing that exact spot is unlikely. That doesn't mean I won't just fracture at another location. I asked if there was a set program or recommended transition. He laughs in a good natured way "You mean, is there running school or programs that safely transitions runners from shod to barefoot running safely? No. That would be handy. I'm sure you can find some guy claiming to be able to do just that, but its not routed in research or proven safe practices. There is no certified program to transition you. Our PTs wouldn't be able to help with that, and I don't know of any place off hand that offers such a program."
So pretty much, I'm on my own. He did confirm that weak calves were the primary problem. I suggested calf strengthening exercises - something I already do - and slowly easing into running. On grass - not pavement. He didn't really confirm or deny. But I can certainly continue my non-impact weightlifting and cardio.
He did tell me that I can go onto the treadmill tonight for a trial run. I am to run 1/2 to 1 mile. If I feel any pain, I should stop. Pain indicates that the fracture isn't healed. I can "only run when there is no pain." This can take any numbers of days or weeks, depending on my day to day activity levels. Every time I feel pain though, I should consider the fact that I'm taking a little away from the healing process.
I asked if I should wear the VFFs or my Landreths for the treadmill trial. He said that was up to me. But suggested if I was going to go the minimalist route in the future, that I should consider alternating in the beginning. That is a wise idea.
So...that's that. You're probably as confused as I am. But I'm not more confused than I was going in. I've just had the confusion over this transition to minimalist running confirmed by one of the leading doctors in the nation. Sweet.
On a side note, I gave myself a mini-pedicure in anticipation of the visit today. My toes are sparkling with fluorescent pink polish. I get giddy just looking at them.
Wednesday, March 2, 2011
barefoot running,
extensor tendinitis,
stress fracture,
top of foot pain
0
I had a sad realization today that perhaps it wasn't my ballet flats, but the forefoot running had led to what feels like a broken foot (<-- melodramatic, not broken). I was reading several barefoot running blogs that discuss how top of the foot pain is fairly common due to overuse, tight calves, etc.
From Go Barefooting:
I had diagnosed it correctly, it seems. I feel reassured, however, that this is both common and I can address it through stretching my calves more. Which apparently IS, in fact, possible. Even last fall when I did the TRX training with Janet, she told me my calves were impossibly tight. I can't imagine how much worse it has gotten since I began forefoot running, even with my careful stretching.
I had recently noticed that while I could run anywhere from 3-5 miles in the vibrams, that my calves ached considerable just after 1 1/2-2 miles still. That I could still physically run, but my calves were definitely maintaining a dull ache for the run. I also noticed some uncomfortable sharp pain through my left foot at times. I always slowed or stopped when it happened, and it immediately went away, but there could be some cumulative effect.
I'm still icing 2-3 times per day, taking ibuprofin and trying to be as gentle as possible. My plan is to not leave my couch this weekend. It sounds insanely boring, but its all I can do. Okay, I might leave to do laundry but that's it! Besides I ant to do that at 7am on Saturday morning. For workouts I'll do non-foot-loading strength training and P90X. I can do the pushups and stuff as long as I balance on my right foot or do them on my knees.
I have a plan. That always makes me feel better.
On a side note, I signed up for the B.A.A. 5k this morning. I'm excited to celebrate Marathon Weekend with a race, even if it's not 26 miles. And I talked my best friend into doing the Warrior Dash in June. It will be my last hurrah - as in, I turn 30 on Sunday. Saturday, however, we will be Warriors! Woohoo!
This is a shot of my swollen left foot today:
From Go Barefooting:
The typical runner making the switch will usually complain of sore and tight calves after the initial barefoot runs. This is because the calf muscles are now being tightened and flexed. After that initial shock is gone and the calves begin to adapt, the same runners typically complain of pains in the tops of their feet. These pains are usually coming from two muscles and/or three tendons that run the length of the top of the foot, one of which actually starts along the tibia.
....
All of you who started out with calf pain transitioned to top-of-the-foot pain for that very reason. Your calves got extremely tight and sore. A lack of proper stretching and relaxing caused a counter balance problem, which manifested itself in the connective tissues in the top of the foot. Remember that every joint in the body is a balancing act between muscles, and the pain you feel is rarely coming from the spot you are feeling where you feel it.
With top-of-the-foot pain you should stretch the calves and arches as well as taking anti-inflammatory meds. Getting the calves to relax and loosen up should be the main focus, as this will allow the release of the muscles and tendons in the top of the foot. Icing the top of the affected foot will also help in the recovery process. As with any injury the main prescription is rest. This may be the toughest of all pills to swallow, especially for someone who has just learned the pure joy of running bare, but rest and time, stretching, and ice will heal this issue, allowing you to get back out there and do what you love.
I had diagnosed it correctly, it seems. I feel reassured, however, that this is both common and I can address it through stretching my calves more. Which apparently IS, in fact, possible. Even last fall when I did the TRX training with Janet, she told me my calves were impossibly tight. I can't imagine how much worse it has gotten since I began forefoot running, even with my careful stretching.
I had recently noticed that while I could run anywhere from 3-5 miles in the vibrams, that my calves ached considerable just after 1 1/2-2 miles still. That I could still physically run, but my calves were definitely maintaining a dull ache for the run. I also noticed some uncomfortable sharp pain through my left foot at times. I always slowed or stopped when it happened, and it immediately went away, but there could be some cumulative effect.
I'm still icing 2-3 times per day, taking ibuprofin and trying to be as gentle as possible. My plan is to not leave my couch this weekend. It sounds insanely boring, but its all I can do. Okay, I might leave to do laundry but that's it! Besides I ant to do that at 7am on Saturday morning. For workouts I'll do non-foot-loading strength training and P90X. I can do the pushups and stuff as long as I balance on my right foot or do them on my knees.
I have a plan. That always makes me feel better.
On a side note, I signed up for the B.A.A. 5k this morning. I'm excited to celebrate Marathon Weekend with a race, even if it's not 26 miles. And I talked my best friend into doing the Warrior Dash in June. It will be my last hurrah - as in, I turn 30 on Sunday. Saturday, however, we will be Warriors! Woohoo!
This is a shot of my swollen left foot today:
Only run 1/4 mile to start.
Tuesday, December 21, 2010 barefoot running, bikilas, shoes, vibram
This is my fervent warning if you buy a pair of these shoes. Only run 1/4 mile the first time you go out in them. Do not try to run further even if you think you can. Literally, run around the block, go into the house and take them off immediately.
That said, I ran 1.7 miles in them the first time. Three days later I am still incapable of walking like a normal human being. The DOMS is so bad. I think its still getting worse. I'm the broken, mangled Terminator. And I'm not sure that I'll be back, haha.
So these are my jazzy new Vibram Five Finger running shoes. I bought the Bikilas, which are specifically made for running (vs hiking, watersports, etc.). Very lightweight. 2mm sole with 1 mm of traction padding that you can see on the bottoms. They have no cushioning and therefore I can literally run them into the ground - until my feet come up bloody, haha.
They are incredibly comfortable. But you have to run on your forefoot, so if your current gait involves your heel hitting the ground at any point, this is going to be totally different for you. And that is why you can't run more than 1/4 mile the first few times out. Trust me.
That said, I ran 1.7 miles in them the first time. Three days later I am still incapable of walking like a normal human being. The DOMS is so bad. I think its still getting worse. I'm the broken, mangled Terminator. And I'm not sure that I'll be back, haha.
So these are my jazzy new Vibram Five Finger running shoes. I bought the Bikilas, which are specifically made for running (vs hiking, watersports, etc.). Very lightweight. 2mm sole with 1 mm of traction padding that you can see on the bottoms. They have no cushioning and therefore I can literally run them into the ground - until my feet come up bloody, haha.
They are incredibly comfortable. But you have to run on your forefoot, so if your current gait involves your heel hitting the ground at any point, this is going to be totally different for you. And that is why you can't run more than 1/4 mile the first few times out. Trust me.
The New Shoes
Saturday, December 18, 2010 barefoot running, bikilas, shoes, vibram
I went into Marathon Sports after work today to pick up my bib for the upcoming Jingle Bell 5K in Somerville. And somehow I walked out with a brand new pair of aqua-and-white Vibram Five Finger Bikilas.
I am resting some kind of sad and sorry hope on these shoes that they will fix all of my IT band problems and vault me back into the world of endurance running. See how inspirational they look?
I am resting some kind of sad and sorry hope on these shoes that they will fix all of my IT band problems and vault me back into the world of endurance running. See how inspirational they look?
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