Running For Life

The Boot…….Plus A Cool Quote

2012-01-26T20:08:00.001-07:00

I like to ski. I really like to ski. One of the benefits of skiing (in addition to it being fun all on its own) is that fantastic feeling you get at the end of the day when you take your boots off. Your feet are finally free after a day of being locked up in ski boots.

Well – from a glass half full perspective – I get the pleasure of having that great feeling in my feet every day. Unfortunately it’s not coming with the fun of skiing. The (walking) boot is – well – the boot. After being fixated on minimalist / no shoes for so long walking (clunking) around in this thing is quite the experience. My son came up from the basement after my first day in the thing and said smiling “Well – I’m always going to know exactly where you are in the house.”

I got into this thing 1.5 weeks ago. The plan is for me to be in it 1.5 weeks more. Unfortunately, things don’t feel totally better. I wonder if I’m heading for a cast.

On another note – I received an email today from a guy who had a great quote in his signature. How perfect for those of us that like the minimalist/barefoot mindset:

Fixation is the way to death. Fluidity is the way to life.
-- Miyamoto Musashi

Here is to more fluidity in our lives.

Jim

Hop-Along Cassidy

2012-01-16T21:42:00.001-07:00

Well - since i said I was going in for an MRI - I guess I should report the results.

Calcaneal Stress Reaction. Walking boot for 3 weeks. It could be worse:

If the stress reaction was more severe I'd be in a cast.
At least I can take the boot off and move the foot around.
Moving around isn't too bad.
I can swim. Not being able to do at least that would have been a problem.

One kind of comical outcome: They recommend wearing a shoe with a heel on the non-booted foot to help even out the pelvis. I used to have so many shoes I didn't know what to do with them. Since going more minimal I've pitched almost all of them. I had to dig around in my closet to find my lone remaining pair of "high heeled sneakers".

Lomad (a user on the Runner's World and Barefoot Runner's Society forums) unfortunately has a stress fracture and is in a boot. He recently posted a one-line "product review" of his walking boot which I found appropriate and very hilarious:

"It sucks."

Jim

I’m Not Afraid Of Loud Noises Nor Small Spaces (Fortunately)

2012-01-09T18:56:00.001-07:00

Even though barefooting has significantly improved the heel pain I’ve had, I can’t ignore the fact that it’s still there. And actually – I’m up to running about 2 miles every other day. From a certain perspective……not horrible.

The doc says it’s time for an MRI. He says the heel should have resolved itself by now, and he’s wondering if something is torn.

So it’s time to get on the schedule and “get ‘er done”.

‘Tis shall be interesting.

Jim

Surprised & Disappointed

2011-12-04T21:51:00.001-07:00

For those who have been here before you know my posting rate isn’t particularly predictable. I decided a while ago I wasn’t going to force anything. I write when I realize a topic gives me sufficient energy to put something together. Over the last week I’ve been realizing it has been a while since I put up my last article. I really haven’t felt compelled to put something together – until this morning. I think this will be the first time I haven’t written about the body or injuries or even running.

I like to hang out in running forums. I like it a lot. I like to see what others are doing, their struggles, learn from them, and also hopefully contribute what I’ve learned. And I like to – to the extent possible in a virtual world – understand their personalities. And as is very predictable, some have some very interesting personalities.

ChaserWilliams is one of those guys. I first started encountering Chaser in the Runner’s World Barefooting forum. Chaser is an impressive runner and – as far as being a forum participant is concerned – very very funny. There are a few people in my life who will cause me to literally laugh out loud when I’m reading something they’ve put together. Chaser is one of those people. Chaser is someone who makes forum participation fun. You are never quite sure what you’re going to get when you start reading his stuff, and I like that very much.

A recent surprise (and big disappointment) is that Chaser has been removed from the Runner’s World forums by the moderators. The surprise is two-fold. First, Chaser's stuff is not offensive. It's funny, but not offensive. The additional surprise, though, is what is allowed to remain on the forums (posted by others) that doesn't cause a dismissal. The forum moderators have a tough job. I completely understand the forums exist for the forum owner’s benefit and people participate at the pleasure of the owner. Moderators exist to ensure that the forum, overall, represents what the owner wants it to be. Why they'd choose to remove Chaser while allowing really bad stuff to remain is beyond me.

I’ve been trying to rationalize this dichotomy (banning one and not banning more egregious content) and I can’t. I know it’s not saying much – it’s not like Haselsmasher is a big draw for any given forum where I participate - but as a result of all this I’ve decided to reassess which forums I choose to engage with.

Hello Barefoot Runners Society.

Jim

P.S.: If you’re interested in experiencing Chaser directly have a look at this blog. I recommend it.

Testing The Training

2011-10-29T12:57:00.001-06:00

Virtually 100% of the time when runners talk of testing their training it’s in the context of performing at a race: How well has the race prep done in getting them ready for the race itself. Yesterday I tested my training, only in my case I was testing my form training.

This past week we experienced here in northern CO a pretty classic Fall weather phenomena: On Monday it was almost 80 degrees. On Wednesday morning we awoke to about 8” of heavy, wet snow. The trees (from losing limbs) and the streets (from having tree limbs in them) were pretty much a mess. Yes, being barefoot I’ve learned my feet can handle much more than I thought they could. I’m not ready, however, to go barefoot when it’s in the low 40s and below.

On Wednesday I went to the gym and ran on the treadmill. It was good from the standpoint I was able to exercise but, other than that, it was a disaster. I’ve done a lot of treadmill running in my running career. It doesn’t bother me for the usual reasons people dislike the treadmill. I can put on my tunes and get through it typically with no issues. What I hated this time was that I found it really hard to use the form I’ve been working on. I didn’t go barefoot – I’ve heard too much about feet getting hot and gym management becoming unhappy. I wore the Saucony Bullets I’ve described previously.

Yesterday I ran outside – again in the Sauconys. The streets were clear, it was sunny, and overall it was a beautiful day. The really fun news: My foot, which has had chronic heel pain, handled it extremely well. What didn’t go over very well was my fitness level. The barefoot running I’ve been doing has been slow enough where it really hasn’t been taxing my cardiovascular system. Running with shoes is a different story for me. The level of fitness I need to earn back became quite apparent.

The basic premise of being barefoot the last couple of months has been that 1) I probably need to build up some foot and ankle strength and 2) being really barefoot is the best way to learn how to run in minimalist shoes. As I’ve already reported, form errors have been very apparent over the last few weeks, and fortunately I’ve been successful in doing some slight form changes such that those errors seem to be corrected – or at least I’m more cognizant of them. As a result it was really fun to try the minimal shoes and put that form training to the test. I most definitely found myself being watchful of those things that I was forced to correct when barefoot. What makes me ecstatic, though, is that the foot handled the running so well. There is no doubt that activities that were causing pain prior to doing the barefoot thing (standing for long periods of time, and now apparently running in minimal shoes) now cause virtually no pain.

I’m not writing this as a report that my real barefoot days are over – not even close. I love being barefoot and plan on continuing to do so – as long as it’s not too cold. Hopefully this most recent experience becomes another example of how barefoot activity can be a tool to get running movement optimized. I certainly hope I’ll be able to report again on the results of testing my training – only next time I want to do that as most runners do: Giving a race report.

Jim

No Shoes = Cool Benefits

2011-10-16T09:23:00.001-06:00

At work I used to sit next to a nationally ranked Ironman-distance triathlete. He helped me with various aspects of my running, especially as I was training for my first (and so far only) half marathon. I started having some pains and his response was “Go see my PT.” I’d come back from the doctor lamenting the fact the doctor was stumped. “Go see my PT.” I’d stretch and ice and scratch my head on why it wasn’t getting better: “Go see my PT.” I obviously wasn’t taking his advice. I’d never been to a PT. I mean……COME ON! PTs aren’t doctors. How much could they really help? Well, eventually I took his advice and saw the PT. Five weeks later I was running pain free.

I’ve been working on minimalist running for quite a while – probably 18 months. Things, form-wise, have felt great, but it just wasn’t working. Aches here. Niggles there. I’ve been posting questions in the forums. I’ve been working with my PT. Things just weren’t just getting better. I was running in Saucony Bullet shoes. I bought them because they were on the Pose approved shoe list and were reasonably priced on eBay. They’re great shoes. The soles are very thin and flexible. I figured they were more than minimal enough to give me sufficient ground feel, let my feet move, bring my heel to the ground, etc.

While working on the form and trying to ramp up my mileage (and deal with the various pains) I was hanging out in the Runner’s World Barefoot Running forum, where they discuss not just barefoot but also minimalist running. Many people show up there having heard of the benefits of going to less shoe, wondering how to transition to barefoot. The consistent response of “If you want to run minimalist start by first going completely barefoot.” was ignored by me. “I don’t need to go full barefoot. The experts advocate this to help people get their form correct, but I’ve been working on my form for a while. My form is in good shape.”

Finally, when I posted my own question asking why I couldn’t get this to work, and the answer “Go barefoot.” was given to me, it clicked. “Maybe I should really go barefoot?!” Just like with the PT, whack me 20 times and I eventually get the message. So in late August I started the Lose The Shoes plan that Jason Robillard put together and I began walking barefoot outside. After 2-3 weeks of that I began some running and that has been progressing. Here, in no particular order, are some observations of the last seven weeks:

Walking Barefoot Inside Is Not The Same As Barefoot Outside. Some will say they have reasonable foot strength because they go barefoot in their house. It’s not the same as being outside. There aren’t random pebbles inside our houses. One can walk with a level of “reckless abandon” inside that can’t be done outside. In a certain way I think our houses are “one big shoe” – protecting us from the real world.
Walking Outside Barefoot Is And Is Not Painful. The initial walks weren’t too bad – but they weren’t particularly fun. Part of this very much has to do with the fact our house is on a street that has been chip-sealed – which is quite rough. The “not painful” part occurred after a week or so. The walks became much more comfortable and the real “fun” part started to occur. It feels so good to be out with no shoes.
Sore Hips. Following my first few walks my hips were sore. I think it’s a tangible example of how the gait changes. I’m sure, since my brain knew the foot could encounter almost anything with each footstrike, the hips had to be ready to react. I found this fascinating – being barefoot really does alter the gait.
Ankle Strength. I have a cheap inflatable plastic balance disc. It’s not a Bosu ball – but very roughly the same concept. I haven’t been a consistent user of it – but I get on it occasionally. The other day I gave it a try – the first time using it since I started the barefoot activities. The level of increased stability is amazing. I think barefoot activities have really increased my ankle strength.
Blisters. Even though the running form felt great while in minimal shoes I did get a few blisters when I started running with no shoes. It goes to show that with the shoe things can feel great but, in reality, be off. Blisters actually can be a form diagnostic tool. In my case I developed a blister on the vertical surface of my fourth toe. Thanks to some great information over at Barefoot Running University (Thanks again, Jason R.) I learned this blister location was an indicator of pushing off. I also got a blister (well – almost a blister – it was in development) on the inside edge of the ball of the other foot. That can apparently be an overstriding or pushing off indicator. In yesterday’s run I paid more attention to that foot and I think I had been pushing off. Now it feels great. In both cases I received feedback that something was amiss and the recovery time was so short I didn’t miss a run – and I could try to resolve the issue in the very next run. What a fabulous tool.
Achilles Issues. My previously written about Achilles issue began showing up again. That can be an indicator of pushing off with the calf. The next run I really focused hard on lifting the foot with a relaxed ankle and also making sure I wasn’t running on my toes by having calf tension on landing. That, coupled with some pretty strong calf massage, has helped keep this problem at bay.
Foot Strength. The feet have gotten much MUCH stronger. I’m not saying they’re strong yet – but they’re much stronger. They were in big shoes with totally rigid orthotics for 10+ years – it’s expected they have a lot of muscular development to do. The soles now have this “sheen” on them from getting toughened up. Some people shy away from barefooting because they assume they’ll get massive calluses. It’s just not the case.
ARCHES! My flat feet seem to be getting arches. It doesn’t happen to every barefooter, but some.

If you’re on the fence about going really barefoot – give it a try. One thing that is so cool is that the only thing one has to do is take off their shoes and walk out the door. No shoes to consider. No money to spend. No errands to run. Just go for a walk and see how it goes. Give it a week – at least – and see how it feels. Maybe after that you’ll be convinced it’s not for you. On the other hand, it might be the beginning of a whole new dimension to your running.

Jim

If It Feels Good Is it Good For You?

2011-09-21T22:42:00.001-06:00

It doesn’t happen often but sometimes – on rare occasions – a single action can make both sides of opposing viewpoints happy. Fortunately this happened to me this week. With a single, simple act I’ve improved my life as well as others. What did I do? I deleted the Shoe Forum from my Firefox bookmarks. I typically don’t hang out in the Shoe Forum, but a few weeks back someone reported there was a debate going on over there about orthotics. Being one who not only used to wear orthotics but also has strong feelings about them I trotted on over there to check out what was going on. I added my $.02 (I didn’t raise a ruckus – like certain other folks I know ) and kept going back because I enjoyed the topics and commentary. Over time, however, I started seeing comments that got me riled up. “I’m sorry – no matter what anyone says no amount of strengthening will help my feet.” “You absolutely shouldn’t run in minimalist shoes. You’ll ruin your feet, ankles and knees.” “People who say you should run in neutral shoes are full of crap.” On more than one occasion, upon having a half-written posting, I gave up and threw the text in the trash. They weren’t looking for the kind of input I was about to provide. I was in the Shoe Forum. If someone is there they’re asking for advice in the context of shoes - it’s not particularly polite to jump in and talk about minimalist and barefoot topics. If they wanted non-shoe input they’d have trotted over to the Barefoot Forum.

I was heading over there out of habit. The questions, though, were these: Was it doing me any good? Was I enjoying it? Or was it simply making my blood boil? I’m not out to convince shod runners to take off their shoes. What I dislike, be it in politics or running or business or whatever is closed mindedness. It drives me crazy when people see things as totally black or white. I see the world in shades of gray. Someone who thinks shod running is the only possible option drives me just as crazy as the barefooter who thinks all runners who wear shoes are stupid.

Of the various things that frequently get said when it comes to shoes or form there is one that really gets under my skin: “I heel strike and that’s my natural form. One shouldn’t change from their natural form.” Wow. That’s your natural form? How do you know? Might it be that form is what’s most comfortable? Might it be that particular form, because you’ve been using it for so long, is a habit? Habits feel good because they’re comfortable. We’re used to them. Breaking old habits and establishing new ones can be really hard.

When I learned as a kid to swim freestyle I always breathed on my right side. A few years ago as I was trying to use swimming for cross-training I realized single-side breathing was probably not a good idea. I’d run enough to know that always doing something to one side was inviting problems. I’d read that bilateral breathing was frequently used by lap swimmers, so I set out to learn it. Holy cow it was hard. I had to think. I had to practice. On quite a large number of occasions I’d grab a mouthful of water instead of air and I’d stop mid-way down the lane to stand up and catch my breath. After a while bilateral breathing felt more natural and, now, it is second nature to me. Single side breathing wasn’t my natural style, it was a habit. And habits can be changed.

So some heel strikers and those with other forms justify not changing because they’ve found their “natural form”. I find it even more curious that people claim to have found their natural form while wearing on their feet something that is totally unnatural: a man-made shoe made from man-made materials. I assert their “natural form” is a habit – a habit they’re familiar and comfortable with. And as we all know habits, just because they’re familiar and comfortable, aren’t always good for us. Me visiting the Shoe Forum was a habit - but it wasn’t a good habit. It wasn’t helping me or the Shoe Forum participants. I think people need to look at their running form and assess whether it’s really good for them – or just a comfortable habit.

Jim

Those Weird Barefoot People

2011-09-10T08:59:00.001-06:00

Have you noticed how, literally, there is a growing abuse in the use of the word ‘literally’? I chuckle when people use the word and clearly what they’re saying cannot possibly be true. A quick Google search brought me to this highly entertaining blog. One example from that site: “The cars were literally flying down the road.” Well very recently I’ve been experimenting with barefooting. When I say barefooting I don’t mean minimalist, or barefoot shoes, or aqua socks. I mean being barefoot – literally - skin-to-ground.

Very unfortunately, a few weeks after I wrote that I was running again, my Achilles started getting mad. So, yet again, I stopped. I posted a question in the Runner’s World Barefooting forum asking if some people just can’t do this minimalist thing. The collective wisdom there is that, to make minimalist work, one should start barefoot. And going fully barefoot outside fist requires barefoot walking. I’ve been going barefoot around the house for many months. But even doing that won’t provide sufficient nerve stimulation and reasons for the soles to toughen up. One must venture outside to make that happen. It just so happens that for me that means an almost other extreme: Our house is on a road that has been chip-sealed. If you’re not familiar with chip-seal suffice it to say it’s about the worst road one could choose to get road rash from. Oil is laid down and then a few zillion sharp pebbles are spread on top. Over time the traffic wears the pointy rocks into the surface. Very rough – and stimulating – for tender feet. I have to say the first few walks were pretty tough – but it’s amazing how quickly the feet toughen up. I now look forward to them. And it feels absolutely fantastic. There is no question the feet and ankles are toughening up.

This posting, however, is not intended to go on about the details of my barefooting experiences. Maybe that will happen sometime down the road. What I’ve noticed, as I’ve turned my internet forum attention a bit more to the barefoot community, is some interesting dynamics and perspectives around the barefoot movement.

Zealots!

Getting the feet closer to the ground certainly has been getting a lot of attention. While barefoot running has obviously been around a few years (as in “thousands and thousands of years”) Chris McDougall’s Born To Run has clearly lit a fire. Frequently people will come to the forums stating they’re interested in moving to minimalist or “barefoot” running and they want feedback on their approach. I haven’t, literally, seen the following statement, but it embodies what often happens: “I just closed the back cover of Born To Run and I totally buy into this concept. Fascinating. I am committed to barefoot running and I’d like to go buy the right barefoot shoes for me. Which ones are the best?” That will bring responses along the lines “To really learn minimalist running start really barefoot.” It is then the various forms of “You zealots!” start to occur. Even though people want to “go there” – there is this mental line they seem to have trouble crossing which really “gets them there”. I’m intrigued by this line from minimalist to fully barefoot folks have trouble crossing – both physically (shoe vs no shoe) and mentally (only the hard cores and zealots go truly barefoot). But to take it one step further – I don’t understand why often the reaction seems to be defensive and strong. I can understand “That’s not for me.” but not “You’re a bunch of nuts!”

A Hardcore Zealotor

At the extreme of this category is a guy (I presume) who runs the website Barefoot Running Is Bad. What I find interesting (and entertaining) about this is the amount of proactive energy he expends on his position – and I wonder what is motivating him. I learned once the opposite of love is not hate – it’s indifference. When there is hate (I’m using that word as a handle for the broad concept of putting active effort into something one is against. I’m most definitely not trying to tie it to the very serious issues of hate speech, hate crimes, etc.) there is commitment and engagement. The person responsible for the above website doesn’t not care about barefoot running, he is actively against it. Additionally, the site does not allow comments to be posted. It’s his site – he can do whatever the heck he wants, however not allowing comments speaks volumes to me. Why not allow a dialog? I’d love to learn more about where this guy is coming from. If, by a small chance of fate, the person responsible for that site is reading this, please put up a comment below.

Barefoot Is Unsanitary

This is a long-held belief. I had this perspective as well. Many will often say local health departments have ordinances requiring shoes in public establishments. This, apparently, is an urban legend. Stores can have policies requiring shoes, but that’s a far cry from an ordinance. What strikes me is thinking through why people think of it as unsanitary. Did you wash your feet today? I did. In fact – I scrub my feet with a small brush when I wash them. Have you washed the soles of your shoes today? Have you ever washed them? I haven’t, unless of course, I’ve stepped into an unfortunate substance that smells particularly poorly. (Additionally, I’ve never had to take a toothpick to my feet to get them clean – yet I’ve spent cumulatively hours with a shoe, bad smelling stuff, and a toothpick over a utility sink trying to get that last little piece of foul stuff out of a shoe’s sole.) I think the unsanitary aspect does play into going barefoot when you come home and you don’t wash your feet. Then think about getting into bed with nice clean sheets and unwashed soles that have been outside – disgusting.

The Dreaded Syringe

Many cite road hazards as the reason they could never go barefoot outside. The person taking this stance will inevitably list out the kinds of things one encounters on the road: Rocks. Pieces of metal. Glass. Unsanitary substances I won’t mention. And frequently the list ends with “Syringes”. Syringes? REALLY? Ok, I admit, I don’t live in an urban area, but I’ve never seen a syringe where I’ve run, let alone stepped on it, let alone needed to put in active effort to pull it out of my shoe. I once saw an interview with Chris McDougall and he said something entertaining: “We have two pieces of equipment that help greatly when barefoot running: Our eyeballs. If you see something you don’t want to step on go around it.” Barefoot Ken Bob demonstrates here the very complex process of how to deal with glass.

If you’re interested or intrigued by the concept of taking off your shoes I highly highly HIGHLY encourage you to give it a try. You don’t have to commit to always running sans shoes. You don’t have to commit to ever running sans shoes. Just go out for a walk. Give it a week and see how things feel. The immediate benefit I believe you’ll find is that it’s fun and stimulating. Over a period of just a few days you’ll likely notice some changes in your feet and ankles. However be sure you do this while barefoot – literally.

Jim

I’m Running…………..FINALLY!

2011-07-20T21:49:00.001-06:00

Yep. I’m running. I can’t believe I’m saying this – but I’m running. If you’ve been here before you know I haven’t been talking about running much recently. One motivation for this blog has been to chronicle the move out of orthotics and into minimalist running, however my reports were getting really long-in-the-tooth. I’ve had this lingering heel pain that just would not go away. It most definitely has not been Plantar Fasciitis – that scourge I dealt with for so long. I’m not exactly sure I know what has and is causing it. I believe it is a combination of really bad hip function along with exceedingly tight and weak calves. As I’ve worked those elements the pain has been reduced. It’s not totally gone, but it happens less frequently, with less intensity, and when I get it the recovery time is becoming shorter and shorter.

I’m quite hesitant to write and publish this post. I’m fearful of claiming victory and then having another setback. So I think I need to do some karmic inoculation here. While I’ve obviously seen some huge improvements (over the last three weeks I’ve steadily increased my running and the systems have responded well) I must acknowledge I’m nowhere near a 25+ mpw volume. Lots could still go wrong. I still have bouts of heel pain and I have to treat it gingerly when that happens. But as I said, it’s bouncing back quickly and, I think most importantly, when I’ve increased my running time the foot has stepped up to the task.

This journey started about four years ago. I felt a niggle in my hip. I remember very distinctly thinking that getting over this might not be very easy. I’d had my share of running injuries and this pain wasn’t fitting into the traditional categories. “Might not be very easy” turned out to be prophetic, in a massive understatement sort of way. Resolving that pain has lead to a huge amount of learning, stressing, studying, reading, writing, and poring over articles and anatomy images on the internet. Four years to get cured? Sounds a little crazy, doesn’t it? Yes it does. There were a number of wrong turns, setbacks, etc. Let me tell you: Backpacking is definitely not good for people having foot problems. Two backpacking trips – while a blast while I was on them – wreaked havoc on my feet that took many months to figure out and get over. Bone bruises. Nerve irritations. Etc. All these things added to the time it has taken to get through this stuff.

Before I summarize what I think the keys were to getting better I think it’s most important to acknowledge some folks – quite a significant number of folks. Whether they realize it or not – these folks (and others that I’ve surely missed – apologies in advance) have played a significant role in me overcoming my problems. The famous saying says “It takes a village”. Well – that applies to helping people get through injuries. I participate in three villages. Two of them are virtual – internet running forums. One of them is physical – the local Drs. and medical professionals I actually see. At the Runner’s World Injuries and Barefooting forums hats off to: slowitdown, Suezee, mmrocker13, MeganZe, abbaroodle, KLL0320, John 8:13, SF/John, agelrunner, Barefoot Burt, Last Place Jason, and Packerjohn. At active.com: JamesJohnson, DamienHowell, lenzlaw, marykb, rbird, and a host of others. You may not realize you’ve helped, but you have. By answering my questions as well as responding to other posts you’ve shared information that I’ve learned from. Jeremy Huffman helped me re-engineer my running form and adopt The Pose Method of running. Ozzie Gontang, internet running legend, was very giving of his knowledge and time. From the third and final village: the local medical community: Dr. Stephen Yemm and Dr. Thomas Hecker. Dr. Yemm for his true interest in getting to the root of the problem. Dr. Hecker for approaching podiatry from such a practical perspective it’s highly refreshing. They’ve both provided valuable guidance and insight into the various issues I’ve been dealing with.

The Gold Star award – the “king of the villagers” so to speak – the one that has provided consistently the most insight and interest into my situation - goes to Brad Ott – Physical Therapist extraordinaire. Brad has been extraordinary in working with me. He has been open-minded, curious and very willing to take the time to share his knowledge. His ability to look at the body as an interwoven system is remarkable. I can unequivocally say: If you need a Physical Therapist – Brad and his team at Rebound Sports & Physical Therapy (Loveland and Ft. Collins, CO) are the folks to see. .

So, one might ask: What was the deal? What in the world was going on that required this amount of time to return to the activity of choice? What has been learned?

First – the context. I’ve been running about 15 years. I have really flat feet. Consequently, I figured I needed orthotics. I can’t even remember why I got them. But get them I did and for many years I ran in completely rigid 3/4 length orthotics. In 2007 or 2008 (I’ve lost track) some injuries started. In an effort to get those addressed I started down a path that has resulted in re-engineering certain parts of my body as well as my running form.

The primary items I had to address:

My hips. They were a wreck. Weak. Poor control. Out of alignment.
My feet and calves. Weak. Really weak. Not used to having demands put on them given they were in this “wall-to-wall carpeting” environment of supportive shoes and orthotics. My chronically weak foot (left) was noticably “less buff” than my good foot. And talk about tight calves: Holy smokes.
My balance. Horribly out of practice and low on the skill rating. How critical is balance to running? Well – when you run – you are never on two feet at the same time.
My running form. Classically bad: Long strides. Low cadence. Heel striking.

The critical learnings (in this amateur’s opinion) are these:

The Foot Was Meant To Move. A high percentage of the time orthotics aren’t needed. We need to give the foot a chance to move. Doing so makes them stronger – and reduces the probability of injury.
The Hips Are The Foundation. We think of foundations as being underneath something. In the case of the legs, the hips are the foundation and they’re on top. If you have weak hips then the femur rolls in, which puts pressure on the knee, which then puts pressure on the foot.
Stretching Is Not A Cure-All. “I’ve got this pain. I’ll rest and stretch for a couple of weeks. That should take care of it.” That plan might help in some cases, but not all – not by a long shot.
It’s About Neuromuscular Control In Addition To Strength. It’s one thing for a muscle to be strong, it’s another for your brain and nervous system to control it well. Sometimes getting better involves training the neuromuscular system to control efficiently the muscle.
Changing Your Running May Be Warranted And Can Be Done. Some say one shouldn’t change from their natural form. I say “bunk”. “You shouldn’t change from your natural golf form.” “Jump in the pool and swim however you like. Don’t worry about technique.” Preposterous, in my opinion.
Changing Your Running Form Is A Lot Harder Than It Looks. It’s amazing how you think you’re doing what you need to – but then find out the camera doesn’t lie.
What Appears To Be A Universal Truth May Turn Out To Be False. Orthotics are necessary. Padded shoes are required to protect us from this bad environment. Pronation is bad. In my opinion all of these “universal truths” are in the process of being debunked.
The Person Who Cares The Most About You Getting Better Is You. You can learn more about what is happening medically with your situation than you might realize. Look at anatomy pictures. Understand how things work. Ask questions in the forums. Push your medical professionals for information. If you don’t get answers that satisfy you (which is different than understanding things to the level that they do) go get another opinion. Sometimes you need lots of people to describe their view of the elephant before you can see the elephant for what it really is.

For all you folks out there that are injured and wonder if you’ll run again: Don’t give up. Keep pushing. Keep trying to understand. Many times in this process I wondered if I would ever run again. A number of times I concluded I wouldn’t, however deep down inside I think I knew I’d ultimately resolve the problems. I didn’t know if it would take one, three or seven years, but I figured I’d resolve them. Chances are, with enough patience and perseverance, you will resolve your issues, too.

Jim

Rediscovering The Bike

2011-06-11T21:02:00.001-06:00

I’m always amazed at the feeling of those first few bike rides of the season. It’s the closest I think I’ve ever come to really feeling freedom – at a gut level. It’s so refreshing to feel the road, have the wind in your face, and work your legs into a rhythm.

Over the last couple of weeks I’ve had some fabulous rides. They’ve been simple and short; only 20-25 miles each. The extra pounds and not being particularly fit means I can’t jump into it too quickly. But holy cow have they been fun.

Before I started running I was a biker. My biking was very similar to my running: I didn’t compete. I wasn’t fast. I just loved to go out and roam and see where the roads would take me. I remember one day during the summer when I was in college. I left the house on a Sunday morning not really knowing where I’d end up. After I’d ridden 50 miles and climbed 2,500 ft I stopped for a candy bar, turned around, and rode home. I guess that’s a testament to what a college-aged body can do. There’s quite a difference from 20 to 50.

The next summer two friends and I rode 450 miles through the CO mountains. No sag wagons. We carried everything, including sleeping bags, on our bikes. It was quite the adventure. We slept in school yards, fairgrounds, wherever we could find a place to put down our sleeping bags. All that riding and no shower – in a week. Actually, in the end, I chickened out. I had a minor accident with one of my riding buddies. You know when you push off and you’re trying to get your foot in the pedal and you’re a bit wobbly? Well – we collided – and it potato-chipped my front wheel. We were quite close to a reasonably sized town. I could have gotten it fixed pretty easily. However I’d had it. I’d run out of mental energy. I hitched a ride – and they rode – home.

The riding fell away when the running began (and the kids arrived). I just loved running so much. And given work and young kids, it was just too hard to take the time to ride (which consumes hours) when I could have a good run in in 30 minutes. So the bike was relegated to the role of giving the hooks in the garage a purpose in life – as well as being a great dust collector.

So, since necessity is the mother of invention, I have been getting back into biking. A couple of years ago I bought a new road bike. Up until that point I’d owned two Trek road bikes. The first was a 1979 Trek 514. (If you like old Trek bikes check out this site. There are fabulous pictures and some great information about the vintage Trek bikes.) Then about 10 years later I bought another Trek. This one had Biopace chainrings. Remember those? They were awful. The concept was to make the chainrings slightly oval, to give the rider more leverage at certain points of the stroke. The problem was that with the varying radius the effort required to turn a revolution was not constant – so it felt like they were pulsing. I had to change them out for round. I couldn’t stand them.

I figured a 20 year old bike was worth replacing. This time I broke from the Trek tradition and bought a Specialized Roubaix. Oh my gosh – what a fun bike. Rock solid shifting. Shifting while out of the saddle. Light and a feeling like you’re riding on rails. Bike technology advanced just a little bit in 20 years.

If it has been a while since you’ve ridden - give it a go. I can honestly say, between the swimming and the newly-rediscovered biking, not running isn’t all that bad.

Jim

P.S.: I’m doing tons of hip work. The work involves not only strengthening but also improving neuromuscular control. My ability to do various moves and keep the foot calm is the goal – and things are improving very much. The foot is improving, but very slowly. I know I’ll be running at some point. I’ve decided to not have this place be a blow-by-blow of those activities.

Recommended Health Professionals

2011-05-30T16:09:00.001-06:00

Occasionally on the Runner’s World forums someone will ask “Can someone tell me the name of a good podiatrist in NYC?” – or something along those lines. This page contains a list of forum member recommendations for various healthcare professionals.

Something is here solely because someone took the time to send me the recommendation. There is absolutely no research done by me to validate the recommendation. I do require that the RW forum member be willing to have their user name associated with the recommendation. Therefore, if you have questions about any of these names please PM the recommender (identified in parentheses following each recommendation in the table below) in the Runner’s World forum.

This is a work in process. As people send me recommendations I’ll add them.

Please send recommendations to gbotrr@gmail.com.

Last updated: May 30, 2011

State	Area	Recommendation
CO	Northern CO (Ft. Collins, Loveland, Greeley)	Podiatry: Dr. Thomas Hecker, Orthopedic Center Of The Rockies (Haselsmasher) PT: Brad Ott, Rebound Sports & Physical Therapy – Loveland (Haselsmasher)

Hearing From The Pros

2011-03-24T21:49:00.001-06:00

I’m both envious of and sympathetic to people in the medical professions these days. I’m envious because I bet their work is fascinating – because the human body is fascinating. As I learn more about the body it becomes even more mysterious. How we can do what we do is mind boggling to me. I’m sympathetic to medical professionals because they must lead incredibly hectic lives. I can only imagine what their daily schedules must be like.

It’s because of this last point (how busy they are) that I’m so appreciative of a seminar Rebound Sports & Physical Therapy (Loveland, CO) recently put on about running injuries. (This isn’t an advertisement. I’m a very satisfied patient of Brad Ott – the president of Rebound.) Additionally, the seminar included a great local podiatrist, Dr. Tom Hecker. (This isn’t an advertisement for Dr. Hecker either. I’m a very satisfied patient of his as well.) Both of these folks have gotten me through a variety of issues. How cool was this?! Two medical professionals who know running and running injuries really well, who are both incredibly busy, taking the time to talk to a group of runners for a couple of hours. There are four medical professionals I’d do almost anything for – and two of them were going to be in the room at the same time sharing their knowledge. Suh-WHEET!

As you can imagine – quite a number of things were covered in the 2 hours. These are the things I found most interesting:

Asymmetry In The Body. If we find asymmetry in our bodies that might be an indication of either the cause of an existing injury or an impending injury. The lack of symmetry (comparing a capability on one side of the body to the other) might show itself in a variety of ways. Differences might exist in strength, range of motion, balance, etc. These imbalances can cause compensatory behaviors that, when multiplied over multiple thousands of repetitions, can cause an injury.
Left-side Issues. Frequently when issues do arise it’s on the left side of the body. Why? Our abdominal anatomy is a bit different on the left side. This can encourage the pelvis to be in a sub-optimum position which can impact hip function. Proper hip function is critical because……..
The Hips. The hips, while they’re at the top of the chain physically, are the foundation on which all the leg function is based. So just like in your house – if you have a bad foundation – all sorts of bad things can happen. Knee. Ankle. Foot. They all can get messed up due to bad hips.
Orthotics. In this article I wrote a while ago about orthotics the doctor referenced is Dr. Hecker. He’s one of the few docs I’ve heard of that recommend orthotics as a temporary solution; something to provide support so that the tissues can heal. However once the healing is done – get out of them. Let the limb move and get strong. That’s what is supposed to happen with any body part that is immobilized to help it heal.
Stretching. This one really blew my mind. Part of the event involved bringing a volunteer up to the front of the room and doing some muscle testing. The right side was strong and firing well. The left side – well – not so much. The topic of stretching came up and it was mentioned that stretching can be a muscle inhibitor – something which shuts the muscle down. Brad had the subject hold a gluteal stretch and, after stretching, the strong-sided muscle, which had previously been doing well, had shut down. Amazing. A number of stories were told that described how performance suffered and injury rates increased following stretching.

It’s so cool to see a doctor and PT collaborating closely in their treatment plans. Additionally, these two folks look at us injured folks holistically – and treat the root cause of the injury – not just the symptom itself. If you’re in the Northern CO area I highly recommend them.

Jim

Post Script: The seminar I describe above was recorded and the video for much of it is on YouTube. Have a look if you’re interested:

[Addendum: I said I’d do almost anything for four medical professionals, but I only mentioned two. The other ones? Dr. Stephen Yemm for Sports Medicine and Dr. Tim Podhajsky for a Primary Care physician. Great folks.]

The Doc Continues To Surprise……….

2011-03-03T22:23:00.001-07:00

In January I tried out a local health club to see if I could get into a swimming routine. The trial went well enough I decided to join. I didn’t fully understand the depths of my mental state until I was exercising again. It feels so good to be doing stuff – even if it’s not yet the activity I really love – running. Moving. Getting winded. Feeling tired afterward. Feeling like you weren’t a lazy you-know-what. Looking forward to doing it again. All of these things pulled me from my bad mental state and helped me have a much more positive attitude.

The routine, in addition to helping my mind, has seemed to have helped my heel. Overall the discomfort is improving, although as I describe to my PT, it’s happening at “glacier speed”. As I paid close attention to the pain pattern (When do I get pain? After what activities? What makes it feel better? What seems to make it worse?) I noticed something that seemed very odd: In some situations I would have pain upon contraction of the calf. There were a few times the heel wouldn’t hurt when I got in the pool, but it did hurt when I got out. How weird is that?!?! My very deeply-held mental model has been that the pain is caused by pounding and shock. Swimming is the epitome of non-impact. Why would it hurt as a result of swimming? I concluded it was primarily a weakness and tightness thing – that the calf was pulling on the heel bone and making it hurt. So I focused a lot on stretching and strengthening and just sort of went with the flow. I swam 3-4x/wk. I also started doing spin classes and a little elliptical.

Even though I was doing stuff, my heel was improving, and my mental attitude was phenomenally better, I recently hit my frustration limit. So I call the doc’s office and make an appointment. The only thing that had changed was my frustration level, and I knew I needed to do something. The last time I’d seen him (my podiatrist) was in November. At that time I had a bone bruise and he was recommending a syringe filled with cortisone to help get it calmed down. I did a polite “Thanks but no thanks.” and went on my way. I claimed I didn’t want that chemical in me. Truth be told I was more concerned about the process of delivering the chemical to where it needed to be. (i.e the shot)

So Monday I’m in his office and and pokes and prods and then he lays his diagnosis on me and I about roll out of the chair: “You’ve got an irritated nerve. Some muscles are tense and pinching it. We need to get those muscles relaxed and the nerve calmed down.” Holy smokes – I was figuring I’d need to fend off the cortisone again. Nope – the bone bruise is heeled. He now thinks this is something different. All the calf stretching and massage is just what the doctor ordered. He said sometimes those nerves can get gunked up in the calf, but we feel it in the foot.

So the plan is Voltaren gel (a topical anti-inflammatory cream) for a couple of weeks. If that doesn’t do the trick there is another topical that has muscle relaxers and such in it that we’ll try. If that fails apparently there is an infrared treatment that works well on nerves.

Lastly, as I’m leaving the exam room, I ask if continued elliptical and spinning is OK. He replies “Heck – you can go run if you want.” EXCUSE ME? Did I hear you correctly? It turns out I did hear him correctly. That doesn’t mean running makes my heel feel very good. I certainly don’t feel compelled to go out and run a whole bunch. But I was pleasantly surprised to hear he thinks I can do some running and not make things terribly worse.

Here’s to calm nerves – both in my head and in my foot.

Jim

From Terra Firma To Aqua Softa

2011-01-19T21:55:00.001-07:00

I’ve been procrastinating. I’ve been procrastinating in making the move from running to something different. A few weeks ago it reached the point I knew I had to take action. I was going crazy – obsessing about my foot and also uptight from not getting the stress relief that comes from exercising. My only real options seemed to be swimming and biking. (I love aerobic exercise. My foot could not take a lot of physical pounding.) I love to bike – but not in the winter. In fact, winter biking is over the line for me. I refuse to do it. I just can’t stay warm. That left swimming, which carried with it it’s own set of issues.

Fortunately I was put in swimming lessons at an early age. Therefore I’ve always been comfortable in the water. I could be out in the middle of the ocean, get thrown overboard, and I’d be fine. I wouldn’t panic. I have, however, never been able to become as relaxed and comfortable swimming laps as I could running. You know when you’re out running and your mind seems to disassociate from your body? You’re thinking about various things. You’re enjoying the rhythm. It’s almost as if you forget you’re running. You’re moving along the ground and you’re in total bliss. You’re floating – like you’re in a balloon. Well – suffice it to say I’ve never been able to achieve that swimming. Swimming laps has always involved tremendous amounts of gasping and having the feeling of drowning. Couple that with the prospect of getting into cold water and it’s easy to understand the procrastinating.

I conclude I must have issues with my stroke. That has to be the reason I struggle to swim. Being the analytic I am I decide to get a 30 min private lesson so I can have someone evaluate my stroke, point out my issues, and help me get to that relaxed state in the water. I really dreaded doing this. When I’m learning something I like to be very alone. I have a hang-up about doing things well in front of others. So having an expert swimmer look at me swim – well – this was going to be embarrassing. And it was a lose-lose situation: Either my stroke was bad (lose) or my stroke was ok but I just couldn’t and didn’t enjoy swimming (lose).

I get to the lesson and, of course, the first thing the guy has me do is swim 50 yds while he watches. I finish and he’s chuckling. “I have to say – your stroke looks pretty darn good!” I tell him how I end up gasping all the time. He suggests I swim another lap, but this time he swims behind me to get an idea of my pace. We finish the 50 yds. He stands up in the water and he is gasping and says “You’re going REALLY fast for someone who wants to swim relatively long distances. SLOW DOWN!” We talk some more. He has me do various things. He gives me some pointers and then the 1/2 hr is up. One thing that I realized is that I have done nothing to develop upper body strength in the last few thousand years. I’m a runner for heaven’s sake! What do I need upper body strength for? Well in the water it’s pretty darn important. So the two things I need to focus on are 1) slowing down and 2) developing my upper body.

I found this experience incredibly freeing. My brain could now settle down and focus on learning to swim and building my endurance, just as I learned and built up my endurance when I started running. So for the last few weeks I’ve been swimming. I’m averaging 3-4 times per week. While small the progress is undeniable. I can swim longer now without stopping than I could when I started. Getting into the (sometimes cold) water is now a non-issue. I’m also finding that using the whole body is greatly helping my balance and hip strength.

Finally and possibly most importantly: Swimming makes me feel fantastic. I’m so incredibly relaxed when I’m done. No, it doesn’t compare to running and I’m still very much looking forward to when I can run again. But until that time this is a great alternative which I highly recommend.

Jim

The End Of My Rope

2010-12-19T14:56:00.001-07:00

About three years ago I set off on an effort to fix some running injuries. That’s how this journey of learning about injuries and the body began. A year ago the effort became more focused: Get out of the orthotics and learn the Pose Method of running.

The orthotic weaning and Pose learning were successful. Actually, I’d describe them as highly successful. I also received ASTYM for the Plantar Fasciitis and that, too, was successful. Over the summer I was ramping up the mileage and things were grand. A backpacking trip in August, however, seems to have undone all that progress. I haven’t run in 3 months. And even worse – I and the medical professionals can’t seem to figure out what’s wrong. (Actually, the podiatrist is quite sure it’s a bone bruise. I’m not buying it. I know that’s kind of cocky – but there seems to be too much going on and it moves around to make it bone bruise. And it definitely does not feel like my regular Plantar Fasciitis.) The bottom line is this: My heel hurts. The only way to keep it under control is to have these ridiculously-large arch supports in my shoes. Too much time on my feet makes it worse – even with all this support. Any pounding activity makes it worse – significantly.

We’re doing a variety of stuff to make it better – PT and such. I have to move on from running – at least mentally - at least for now. It’s too frustrating to be thinking “I’m just about there.”, then to wake up one day (literally) and have it hurting all over again. I’ll continue to do those things I’m doing: exercises, resting, icing, etc. I may see if I can get an MRI or something to see if that helps explain something, but while pursuing those things I need to think of myself as a “former runner”. Now it’s time to see if I can turn myself into something else – such as a swimmer.

I guess deep in my soul I believe I’ll get back to running. For my own mental sanity I need to stop worrying about whether that point will be next month or in 5 years.

Jim

Blogger’s Block

2010-10-20T06:01:00.001-06:00

It has been pretty quiet around here. I’ve been fighting Blogger’s Block. Typically I get a flash of an idea for something to blabber about, but recently the idea flow has been all dried up. I’m pretty sure I know why this is the case. I’ve been dealing with a new pain in my foot and it has been really quite depressing. When contemplating giving another update I just didn’t feel the energy. Tiring to write about. I can only imagine how long-in-the-tooth it becomes for the reader.

The results of the ASTYM treatments earlier in the Summer were just phenomenal. I was up to running 3 mi every other day. The Pose Method techniques just feel fantastic. While the rhythmic beat of running has always had an appeal and satisfaction for me, Pose makes it that more enjoyable. It feels great.

I went on a backpacking trip in August (which was a blast) and it must have messed up my foot. Following the trip I couldn’t even come close to running the amount I was prior to the trip. Fortunately it does not seem to be the PF. The doc thought I bruised my heel bone. I took oral steroids to calm down the inflammation. Unfortunately that didn’t do much. Then I did some iontophoresis to help get the inflammation down. That didn’t do much either. The problem is that any reasonable amount of activity (just walking) causes a fairly significant amount of pain. It appears something is injured and just not healing. I decided to take my own advice and use my orthotics to give my feet a chance to rest and heal. So I’m back to wearing them on a daily basis with my old motion control shoes – just to give them some help. So far so good – they’ve greatly reduced the pain. My plan is to give the feet a chance to rest and heal and then gradually get out of them. The PT has gotten me doing even more hip stuff. There are still moderate strength issues. I’m still struggling with a basic issue: When I balance on one leg the bad-foot side just goes crazy – twitching and such. On the good side it’s as solid as a rock and calm.

On another front my wife’s efforts to start running are going really well. She is slowly increasing her running time and, while she had a very brief bout of shin splints at the very beginning, she has no issues now. She is even reporting she is enjoying it more and more – and she is keeping at it. I’m also getting some indicators this disease (running) may be spreading to the rest of the family. Maybe I started something here. It only took 15 years of going out in the sun and rain and wind and snow and……..

Jim

A New Recruit

2010-09-12T10:39:00.001-06:00

If you’ve been here before you know I’ve been running for a while – more than 15 years. My wife (a proud – even defiant – non-runner) has seen the positives and negatives of my involvement in running. On the positive side: When I’m running I’m a calmer, happier person. The frequency of my migraine headaches goes down. In general I have more energy. Those benefits, however, tend to come with a price. Doctor appointments. Physical Therapy appointments. Doing these ballet-like exercises Physical Therapists like to prescribe. Ice bags everywhere and me sitting around using them on some part of my body.

Over the years she and I have worked into this routine where she expresses her amazement that I (and other runners) would proactively choose to participate in a sport that is so hard on the body and results in self-inflicted damage. I then try to defend the sport and convince her that, once I get through this injury, all will be grand and my injury rate will drop substantially. “You really should develop an enjoyment for a different activity because you’re not going to be able to do this forever.”

For many years she has been using a Nordic Track in our basement. She is not one of these people that naturally enjoys exercise, but she is very determined and very persistent in whatever she does. She understands better than anyone I’ve ever met how a small change, implemented consistently over time, can lead to a profound result. After using the Nordic Track for a few months she finished her routine one day and said “You know – I now really see how exercise calms you down and makes you feel good. I can start my routine feeling tired and lethargic and I finish feeling good and energized.” She was hooked. I think it’s fair to say she even looks forward to exercising – or at least looks forward to the satisfaction that comes following exercising.

Yesterday at lunch, following three days of pondering the results of her latest cholesterol test, we were discussing her exercise routine. She said she thought she needed to do something that was more taxing on her body. She looked at me and said “I know exactly what I’m going to do: I’m going to start running.” I about choked on my tuna-on-crackers. She is known to be a bit sarcastic sometimes so naturally I thought she was joking. Nope, she’s serious. Completely serious. She went to a local running store and bought some good shoes and socks. She even bought a watch. (The accessorizing must be complete before run #1 can be completed.) My 5’ 3”, 98 lb. wife, the one who has given me so much grief about running, has begun a running program.

How did her first session go? When she came in the house she said “I think I need to see a Physical Therapist.” Great. Now the joking non-runner has become a joking runner. This is going to be interesting……..

Jim

Running Without Pushing Off

2010-08-17T22:51:00.001-06:00

Periodically quite detailed discussions about different running forms come up in the online forums. Sometimes they degenerate into some pretty intense and detailed interactions – arguing things like falling down vs falling forward, push-off, landing, etc. While it’s easy to get involved in those details, to my mind there is one very basic model that I think these alternate running methods espouse: The primary force that should be used to move us forward is not a motion involving the planted leg driving the body forward. Rather, some sort of leaning or falling mechanism is employed to cause forward movement.

A while ago I discovered this video and I find it fascinating. Dr. Nicholas Romanov, the creator of the Pose Method of running, is running on a sheet of ice. Is there friction between his shoe and the ice? Of course. Is it a lot of friction? Of course not. What better way to show running movement doesn’t require active pushing by the leg. If pushing off with the leg was done – obviously the foot would slip and the runner wouldn’t get very far very fast.

Jim

Flat Feet: Permanent Or Temporary?

2010-07-26T06:53:00.001-06:00

[I’ve never put a postscript before something – but I guess there is a first time for everything. I’m adding this preamble a few days after the article publication date. The photos in the posting below have generated a discussion in the Runner’s World Shoes forum I’ve done some experimenting and determined that two variables contribute to how the footprints look. First, the amount of water on my feet. Second, how deliberately I relax my feet. While I’m highly confident my feet are stronger and the arches have changed, who knows if it’s as dramatic as the photos. Most importantly: I know I can now run more than I have been able to in the last 2-3 years, but with no orthotics and no big clunky shoes. I’ll keep documenting the progress – even if the method of documentation may not be totally repeatable. -- Haselsmasher]

When I was growing up the flat feet in my family were kind of legendary. At least we made them legendary in our minds; and if they weren’t legendary enough – we made them more so. Over-the-top legendary and extreme. I’d hear things like “You think you have flat feet? Well you should see Jim’s! He’s practically walking on his knees his feet are so flat. Imagine the most flat feet possible. Now double that. That’s how flat Jim’s feet are. Doctors have said they’ve never seen such flat feet.” OK. OK. I get it. I have flat feet.

Roughly 15 years ago I started running and, of course, I acquired some of the normal aches and pains that runners experience. Since my feet were so flat I had to deal with this deformity somehow. Certainly someone in my condition couldn’t go out and be a runner without some assistance. Good God! I’ve got flat feet you know! A Podiatrist confirmed the diagnosis which, of course, had already been drilled into my head. A couple of castings, weeks and hundreds of dollars later I had my custom made rigid orthotics and I was off and running – literally and figuratively. I successfully wore those orthotics for many years. Then I acquired the problems I’ve been writing about here.

So I’ve drunk the minimalist shoe / “the feet were meant to move” Kool-Aid and seven months ago I weaned myself off of my orthotics. I wear minimalist shoes every day. I do my hip flexibility and strengthening exercises barefoot. I go barefoot whenever I can, although I don’t venture out in public barefoot (into stores, etc.). I will occasionally go for walks barefoot on the chip-sealed road by our house to stimulate the nerves and muscles. I’ve been asking my feet to do more and overall I can tell they’re much stronger.

I’d heard some reports of people getting arches and, lo and behold, it’s happening to my legendary, horribly flat feet. The first photo was taken June 16, 2010. The second photo was taken July 26, 2010.

I wish I would have photographed my wet-foot profile the day I got out of the orthotics but, unfortunately, I didn’t. I’ve spent enough time around swimming pools to tell you truthfully – no arches whatsoever. Now when I walk on hard surfaces I can feel my foot not contacting the ground.

From what I’ve read creating arches isn’t a requirement for successful barefoot/minimalist running. Some people have this happen and others don’t. I’m finding it fascinating, however, to see that “conditions” such as flat feet that were once thought to be inherently bad and need some form of external assistance may not be permanent and non-changeable. It’s a great example of yet another scenario where the body can and often will adapt to accommodate and do what we ask it to do.

Jim

Increasing Mileage At Your Own Rate

2010-07-09T13:12:00.001-06:00

The other day I happened to be on Ken Schafer’s great site (Your Pose Coach) and Ken provided a link to Jason Fitzgerald’s great site (Strength Running). Jason recently wrote an article about running’s supposedly-“sacrosanct” 10% rule for increasing mileage. This rule states that one should not increase their weekly mileage (or increase their average weekly speed) by more than 10% each week. In the forums a variety of issues come up around this: What is it? After a short-term injury does it need to be followed? If someone is already fit does it need to be followed? Jason lays out some different scenarios and makes the case for why the universal 10% rule may not be so universal.

It’s funny/interesting I found this article now. As I reported earlier my last ASTYM treatment was a few weeks ago. My PT gave me a quite aggressive (very aggressive) ramp-up schedule. He said, as long as I wasn’t in real pain, I could add a minute to my run each and every run. Currently I’m running every-other-day. He was suggesting 9 min, then 10, then 11, etc. I even asked him if that might be too aggressive. He said not to worry about it very much.

Well guess what? I got up to around the 18 min mark and in the morning my heels were hurting. I clearly did too much too soon. So I backed off to 12 minutes. After a few runs the feet felt almost perfect. Now I’ve upped it to 13 min. My plan is to up it one minute at a time – and hold there until I can do a couple of runs with no (or minimal) evening or morning pain. I realized that even the sacred 10% rule might be too aggressive given my delicate Plantar Fascia situation.

So be aware that a rule of thumb is just that – a rule of thumb. And be open enough to realize that it may be too conservative or too aggressive – and that you may just need to throw the “sacrosanct” rules out the window.

Jim

Heeding Advice Much Harder Than Giving It

2010-06-19T06:31:00.001-06:00

Just this morning I read on one of the forums a question from an already-active new runner who was ramping up their running time. “Can I progress more quickly through the program since I’ve been active prior to starting running?” Of course my advice was “Sure you can. But the risk of getting injured goes up.”

I’ve been increasing my running time since the feet are responding so well to the ASTYM treatments and running (finally!) just feels great! My anal-retentive brain has caused me to create for the umpteenth time a training log in Excel so I can look quantitatively at my ramp up and see how fast it is progressing. I so badly want to put bigger numbers in some of those cells – but the equations tell me I’m risking doing TMTS (Too Much Too Soon) if I do so.

Holy smokes it’s hard to hold back…………………

Jim

Body Worlds & The Story of the Heart – Denver

2010-06-13T14:12:00.001-06:00

[Disclaimer: There are no images in this post. There are links to websites with images that some people may prefer not to see. Please be aware of this if you decide to visit any of the links I’ve included.]

Body Worlds & The Story of the Heart is currently visiting the Denver Museum of Nature and Science and when I heard it was close by I knew I “had” to go.

Body Worlds are a set of traveling exhibitions that feature real human bodies and body parts that have been preserved. The preservation process is called Plastination and was developed by Gunther von Hagens when he was working at the University of Heidelberg. There is another Body Worlds exhibit occurring now in North America called Body Worlds & The Brain, in Calgary, Alberta. Canada. There are also exhibitions in Europe and Asia.

Why did I “have” to go? There are two components of my personality that are deeply ingrained: I’m very interested in understanding how things work. (I remember clearly when I was five years old asking my mom if I could take a clock apart. I had to see what was making things move.) I also have a highly addictive personality. (A runner? Addictive? Say it isn’t so!) Put these two things together, in a runner that can’t seem to get over some injuries and you have a guy that has spent HOURS AND HOURS on the internet looking at anatomy images, obsessing about what might be going wrong and why, reading blogs, reading papers, asking questions of my docs and PTs…….. I knew this was an opportunity I might not get again. So with a little trepidation, I decided to go.

I wasn’t totally sure how I was going to react. On the one hand, if I felt so inclined, I wanted to be able to stay a long time. On the other hand, if I got in there and got creeped out, I wanted the flexibility to leave immediately. That challenged a bit the various possibilities on when to go and how to fit it into my schedule. It turns out my wife was leaving on a trip this weekend and I saw the perfect opportunity: I dropped her off at the airport which gave me the rest of the day, sans commitments, to attend the exhibit – for as much or as little as I wanted.

Overall I have to say it was totally fascinating. It was so cool to be able to actually see these structures that we talk about so much as injured runners: The IT Band. The various tendons from the stirrup muscles that wrap around the inside and outside edges of the foot and attach underneath. The menisci of the knee and the ligaments that hold the knee together. The Achilles Tendon and the big space that exists between it and the tibia/fibula.

One really neat thing they did was pose a number of the bodies in real-life activities: Someone throwing a javelin. A woman doing a back somersault on a balance beam. Two hockey players involved in a collision. One really incredible display was of two bodies: A figure skating pair with the man holding up the woman in a one-arm fashion like we see in pairs competition.

There are a couple of other things that really struck me – and it took a while for these to develop in my brain as I went through the exhibit. One is how very small many of these structures are. I have this image of wide open spaces in the body – especially when it comes to the chest. When you see the actual body you get a sense for just how crammed together everything is. Some of the tendons of the lower leg – things that have a mental image in my mind of being not tiny but not huge – look very small and frail. The major branches of the nervous system look like thick string. Surgeons must have quite the difficult job. Second, it was amazing how everything is placed in a pretty small space. They had one display that sounds like it would have been more difficult to observe than it was: The body was standing in a relaxed, neutral pose. Some parts of the limbs had “cylinders” of tissue going all the way out to the skin, while other parts of the limb had significant portions of tissue removed down to the bone . It demonstrated very very well the small space all these structures are contained in. I tend to think of the different sub-systems as occupying the space individually: Skeleton. Blood vessels. Nervous system. Muscular system. Etc. Then when you realize they’re all occupying simultaneously the small volume of space we take up it’s quite incredible.

As I entered the exhibit I became nervous on another level: There happened to be a number of small children in front of me that were very excited, jumping around, making all kinds of noise, etc. I wondered what the tone of the exhibit would be and whether I’d be distracted. (I’m not against kids – nor did I think it inappropriate that they were there. It just made me wonder what it was going to be like inside.) Not only did they quiet down, the whole place was very quiet and very respectful. It was like being in a library. Any talking that was taking place was done in whispers.

Overall it was a fascinating, educational, and humbling exhibit. I’m grateful not only to the people who did the work to perfect the plastination process, create the displays, and make it available in a touring exhibition, but more importantly to the individuals that felt strongly enough about this work to donate their bodies so that, even after they die, thousands could learn from them.

Jim

A Different View On Plantar Fasciitis

2010-06-08T21:42:00.001-06:00

Maybe I’m dating myself – but have you seen the movie Sleeper by Woody Allen? Woody Allen’s character is frozen after he dies and is brought back to life many years in the future. The plot involves him trying to deal with all these things he doesn’t understand. A consistent theme is that what was once thought to be harmful is now considered healthy – such as smoking.

I’ve thought of Sleeper frequently as I’ve gone through the process of resolving my various maladies. I once thought I could run only with orthotics. I once thought I needed padding in my shoes to protect myself from this horrifically harmful environment in which I run. And I thought, because of my very flat feet and overpronation, I needed shoes that were incredibly structured and that controlled the motion of my feet. Now I’m running with no orthotics, in shoes that are so thin I can feel a pebble through the sole and, sometimes, with no shoes at all. Who’d have thunk it.

I think I’m in the process of putting Plantar Fasciitis into this Sleeper category. I wish I could remember where – I think it was in some YouTube video – but I saw a doctor call Plantar Fasciitis a “trash bucket” diagnosis. He asserted that all too frequently almost any foot pain was just labeled Plantar Fasciitis. That term may be encouraging people to pursue remedies that aren’t appropriate and, consequently, aren’t effective.

Plantar Fasciitis (strictly speaking) is an inflammation of the Plantar Fascia; hence the ‘itis’ after Fascia. The same holds true for tendonitis – tendon inflammation. We tend to think inflammation is bad, so the treatment for Plantar Fasciitis is focused on reducing that inflammation: Icing, stretching, cortisone, etc. Obviously, with all of these treatments, the goal is to reduce the inflammation in an effort to reduce the pain, and get us back to doing what we want to do.

What portions of the medical community are now thinking, however, is that the inflammation of Plantar Fasciitis goes away relatively quickly; on the order of a few weeks. At that point the Plantar Fascia starts to degenerate. The interesting and unfortunate part is that the pain continues. So to a certain degree not much has significantly changed from a symptom perspective, but what is happening physiologically is very different. This degenerative state is called Plantar Fasciosis. Where “itis” is inflammation, “osis” is degradation. This degradation scenario supports the stories we hear and have experienced ourselves about taking significant amounts of time off, stretching for weeks, icing for weeks, etc. and seeing no improvement. We’re taking steps to reduce inflammation when there may not be any.

The trick, then, when dealing with Plantar Fasciosis is to rebuild the Plantar Fascia. I’m no scientist so I can’t explain all the science, but what appears to be working for me is ASTYM. ASTYM intentionally injures the tissue on a microscopic level to cause the body to initiate a healing response. If the tissue is actively used while it is rebuilding the body will rebuild it the right way – in a way that enables it to be used as we want it to be used. Graston Technique is, in my amateur opinion, a similar concept. I feel that I’m repeating to a certain degree a point I made when I compared the more efficient running forms: While different they have similarities and it comes down to which one sounds best to you. Some swear by ASTYM and others by Graston. They have their advantages and disadvantages – but I’ll leave it to others to fight that battle.

So, since the tissue is supposed to be used, and the tissues are being stressed and asked to do more, they often feel “uncomfortable” following activity. The really difficult mental model to break is to not stop doing the activity! The sensations being felt are a result of tissue being rebuilt – just as our arms would be sore after doing an intense weight training session. No – those “pains” aren’t coming from inflammation. The body is rebuilding. There may be times where too much has been done, and “pain” really is felt. But by and large, use it and keep using it. Movement and stress is good. The body will adapt.

Three weeks ago, when I started ASTYM, I could run 4 minutes out of a 30 min walk. Today I completed my 6th and final ASTYM treatment. The last two times I ran I ran for 12 minutes both times, and tomorrow I’ll do 13 or 14 minutes. It really is bizarre – not having everything feel perfect but continuing to exercise. I wonder what else in our lives we currently accept as truth will be challenged by some “radical” thinking?

Jim

P.S.: I’m not suggesting one always “runs through the pain”. I hope I’ve been clear that it’s important to work with a professional. I’m relaying my experiences and what I’ve learned from my PT. Your mileage may vary.

Being Unfit Has Never Felt So Good

2010-05-30T18:37:00.001-06:00

As I’ve tried to get back to running the focus has been my foot: What state is it in? How much does it hurt? How much can it handle? Am I doing too much? Will I pay the price later? That darn foot has been the limiting factor in having me do what I want to do. It has caused me to stop running way before I’ve wanted to. It has been an obsession.

As the ASTYM treatments continue to have a positive impact on my foot’s health today a new item popped up as the thing holding me back from running: My lungs. During today’s run I was huffing and puffing and wondering if I was going make my goal time of 11 minutes of continuous running. I did finish. And after I finished I was breathing pretty hard and I had to pause to catch my breath.

As I cooled down I realized how good it felt to be working the lungs. No – the foot isn’t cured, but it has improved to the point that it’s not the weakest link…..at least not now. I realized how excited I was that what’s holding me back now will improve with time (and more huffing and puffing and sweat) and won’t require me to ice my lungs, or worry about whether they’re inflamed, etc. The path to running hopefully becomes a bit more predictable. Given that – I realized I’ve never been so happy to realize how unfit I am.

I’m not sure who gets credit for it but I’m sure many of you have seen it and it’s definitely what has been going through my mind:

“Pain is weakness leaving the body.”

I can’t wait for some pain.

Jim

Pose Method vs Chi Running vs Evolution Running

2010-05-22T10:23:00.001-06:00

As heel striking continues to get a bad name (and in actuality, overstriding may be the really bad culprit) many people are looking for a way to change their running form. Other things can also contribute to a runner’s desire to change their form: shin splints, knee pain, back pain and other ills can be a strong motivator as well. Some runners can “just do it” – change their form on their own. Others look for a program or system to help them adopt a more efficient running form.

For someone looking to study a system to help them change their running form three options come up the most frequently: Pose Method, Chi Running and Evolution Running. While proponents of each program will say each is unique in it’s own way (and that is correct – each program has it’s unique parts) in my opinion there is a core set of principles that are essentially common to all:

Erect body posture
Forward lean and the concept of falling forward (The phrase “gravity pulling you forward” is sometimes used, which is confusing. Gravity pulls you down, not forward. However if a rigid body is not perfectly vertical it falls down. If you fall down and then put your foot down to prevent you from falling to the ground, from a practical standpoint, you’ve taken a step. Repeat that over and over and you’re running.)
Short stride length
Relatively high foot cadence - ~180 bpm minimum
Some sort of non-heel-first footstrike

With this article I’m not purporting that one of these methods is “the best”. The forums have a variety of highly emotional threads arguing this point. I’m a firm believer that each of us are different enough that what might be best for me may not be best for you. My goal is to give an exceptionally high level overview of each and, hopefully, the reader will use this as a launching off point to go learn more about what interests them. That being said, I consider myself a Pose runner and I definitely feel the most comfortable with that program.

Pose Method – http://www.posetech.com/

Pose Method of Running was developed by Dr. Nicholas Romanov. Romanov’s model is centered on the concept that the running gait begins and ends with a body position that is balanced and relaxed – The Pose. The Pose is defined to be a one-legged stance with the head, shoulders and hips aligned over the ball of the foot. The airborne foot is up under the hips. Running becomes a sequence of falling forward from this position, having the airborne leg drop to keep us from falling to the ground, using the hamstring pulling the trailing foot into the airborne position, and then returning to The Pose, but now on the opposite leg. Pose Method advocates the use of a very lightweight, thin soled shoe and not conventional padded running shoes. The belief is that the foot needs to feel the ground if the nervous system is going to fire the right muscles to deal with landing. The website maintains a list of “Pose approved” shoes.

In my opinion Pose Method is the most detailed, specific and exacting of the three methods. In fact, there is a standard which defines whether a runner is actually running Pose or not. I’m not familiar with all of the components of the standard (and 99% of people don’t need to be). An example of one component of this standard: A runner should take no more than two video frames to get from whole foot landing to Pose position. Some people welcome this type of structure and detail. Others find it limiting and frustrating.

The book itself has more content than just information about the running method. There are a large number of drills, strengthening and flexibility exercises. Hip strength is very important in adopting a method like Pose and the book provides some outstanding exercises to build up that strength. The drills are another key component of the method. The running sequence is quite a complex set of movements. The drills exist to help the runner understand and learn to feel the movements so that, when actually moving, it’s easier for the pieces to come together effectively.

Below is a slow-motion video of Jacky, a Pose-certified coach. Notice how the landing foot is directly underneath the hips upon landing. Also notice the complete relaxation of the ankle while the foot is airborne.

Chi Running – http://www.chirunning.com/

Danny Dreyer developed Chi Running with the desire of creating a way to run in a more efficient, less injury-prone manner. He leveraged some core concepts (pun intended) from Thai Chi – a methodology that has been around for thousands of years. He worked with his Thai Chi instructor Master George Xu to take these concepts and apply them to the running motion.

Chi Running focuses a lot on posture and using the core muscles as a key component of movement. It advocates very relaxed extremities while maintaining a solid core. Chi Running believes that the psoas is a key muscle that should be used for hip flexion/knee lift. It also advocates swinging the leg with a bent knee behind the body.

As far as shoes are concerned Chi Running advocates use of a shoe that is less padded than conventional running shoes, but I believe there are shoes that Chi Running would find acceptable that the Pose program would not. (i.e. Pose advocates a more minimal shoe, in general, than Chi Running does) I’m not saying Chi Running is against minimal shoes – not at all. In fact Danny Dreyer talks about the benefits of barefoot running in the book.

Chi Running probably has the best name recognition of the three programs. I’ve seen a number of Chi Running articles in some of the mainstream media. Many runners aren’t yet familiar with this genre of running programs but, if they have, chances are they’ve heard about Chi Running. My guess/sense, both from the program specifics as well as reports in the forums, is that Chi Running is learned more quickly than Pose because it is not as detailed and exact. That doesn’t mean one is better than the other – just different.

This is the best example video I could find of Chi Running. To be clear I think it actually was put together by a Pose advocate to comment on the Chi Running program. The audio does not work so hopefully that enables the viewer to focus on only what the running itself looks like. Pay particular attention to the footstrike. The Chi Running book advocates a midfoot strike, but it sure doesn’t look to be a midfoot strike in these clips. (More on this point later.)

Evolution Running – http://www.evolutionrunning.com/

Of the three programs I know the least about Evolution Running. The program was developed by Ken Mierke. Ken is mentioned in Chris McDougall’s highly successful book Born To Run. Evolution Running advocates glute and hamstring muscles for propulsion. One component that is different from the other programs is that it also advocates beginning the foot’s rearward movement before the foot contacts the ground. Whereas the other two programs tend to target recreational runners, it appears (in my opinion) that Evolution Running is targeting the more serious/competitive athlete and triathlete.

The program is available via DVD. This DVD received very high praise from Last Place Jason (Jason Robillard) on the Runner’s World Barefooting forum. Jason said it’s put together very well and is a great resource for new barefoot/minimalist runners. Jason also did an article on the DVD on his Barefoot Chronicles website. You can find the article here.

Here is a video showing the Evolution Running technique.

Summary

It’s pretty entertaining to watch people argue which of these programs is “the best”. I’ve concluded that choosing which one is for you is a “Coke or Pepsi?” decision. They’re both colas. They’re both carbonated. They’re both sweet and refreshing. At the end of the day it comes down to which one tastes best to you – which one you like the best.

I tried Chi Running and I just didn’t like it. It didn’t click. In the book Dreyer makes frequent refereces to Chi and Thai Chi. Those linkages didn’t work for me. I’m not saying they’re not valid concepts; I think I’m quite open to both Eastern and Western concepts. For example, one aspect of good posture in Chi Running is leveling the pelvis. For most that means having a slight contraction of the lower abdominals to bring the front of the pelvis up. Dreyer describes not doing this results in “spilling Chi”. Well, that’s interesting, but it doesn’t help me and my brain understand why that posture component is important. I also see inconsistency between what I see in the video and an article Dreyer wrote a while ago. In the article Dreyer talks about the evils of dorsiflexion, yet in the video he is dorsiflexing all over the place. The bottom line: When I tried putting the Chi Running pieces together my brain went into overload and it felt like I was trying to do 20 things simultaneously.

When studying Pose Method the drills really helped me focus on the individual movements and components. I worked with a Pose-certified coach to help me with the essential concepts. (Maybe that was my issue with Chi Running – I should have hired a coach.) To help people assess whether they are meeting the Pose standard or not there is a commonly accepted consistent method for getting feedback where the runner makes a video (either drills or running) taken perpendicular to the direction the runner would be or is traveling. This provides a consistent way for the coaches on the forum to provide feedback. Another reason I like Pose Method is because you learn to use a variety of senses to “check in” and see if things are going well. How do your shoes sound hitting and leaving the ground? If it’s different than tap-tap-tap something is wrong. How does your ankle feel as it’s moving through the air? Relaxed? Are you pushing off as the foot leaves the ground? Does the pull while running feel like the drills? At first, like Chi Running, it felt like I was trying to do 20 things at once. The coaches, however, suggested I pick just one or two areas to focus on during a run and forget about everything else. “Focus only on the pull. You can work on other stuff later.” I might do that for a few runs, then I’d focus/learn something else. In a business seminar I took a long time ago the instructor asked “How do you eat an elephant?” The answer was “One elephant hamburger at a time.” By freeing my brain to learn only one skill at a time I chipped away at the running form elephant and then, I realized, I was running Pose (or very close to it).

If you’re really interested in changing your form prepare yourself to work pretty hard. Old habits are hard to break. There will probably be moments you’d like to give up. Sometimes it might appear all too easy to just throw in the towel and go back to the old way. However if you persevere there will likely come a time when it will click and, all of a sudden, you’ll realize you’re running in a new way and it feels amazingly natural and good and free. And hopefully this will be the start of easier, more enjoyable, and more injury-free running.

Jim

Progress With ASTYM!

2010-05-19T21:46:00.001-06:00

ASTYM treatment #2 happened on Monday. While on an absolute scale the progress was miniscule, from a significance standpoint the progress was “Epic!” as my 14-year old son would say.

For the last three months I’ve pretty much had the same routine: Every other day go out for a 30 minute walk. During that walk I run for – I hope you’re sitting down – 4 minutes. That’s it. And even that 4 minute run I’ve been breaking into tiny chunks so as to not stress the foot too much. Even with that minor amount of running, virtually always, my foot is sore by the evening. Frequently it is sore the next day as well.

The day after session #2 I ran 5 continuous minutes per the PT’s instructions. This is the longest continuous block of time I’ve run in the last 7 months. Recall that the treatment itself inflicts micro-trauma on the tissue and a significant part of the program is to use and stress the tissue while it is rebuilding. So he wanted me to give it a reasonably good workout.

That evening following my morning run, when my foot should have been sore, it felt perfectly normal. The next morning – perfectly normal as well. Today was ASTYM session #3. I’ve been told I can increase the running time by one minute if the previous run did not produce significant pain. So tomorrow morning I’m on tap to run 6 minutes.

The treatments themselves, while certainly not pleasant, are not horrible. They’re a bit uncomfortable. I’ve had a tender spot right by the ball of my big toe. I haven’t been sure why. Today I somewhat passively mentioned it to the PT – with the intent of alerting him to be careful when he was running the instruments in that area. He poked and prodded and concluded I have some tendon issues there as well as some range of motion issues that need to be addressed. So in actuality that tenderness was an indicator he needed to get in there with the tools a bit. That’s wasn’t terribly fun.

I’m shocked I increased my running time and the pain level went down. Am I dreaming or something?

Jim

“I’m going to have you increase your running.”

2010-05-12T22:16:00.001-06:00

How many times have we been in the office of a <Doctor/Chriopractor/Physical Therapist> for a running injury and they’ve said those words? Before today the number of times for me was 0. But that is what happened at today’s PT appointment.

A couple of days ago my frustration level with this lingering heel pain reached a point where I decided to go see my Podiatrist. He said the Plantar Fascia on that foot is really tight. (I’d noticed when I massaged it with a tennis ball I could hear it “pop”.) He strongly recommended I see a PT he works with who does ASTYM and dry needling. ASTYM has gotten a lot of positive talk on the forums, so when he mentioned it I was quite enthused. Dry needling I’d heard of – but I was not as familiar with it.

The goal of ASTYM is to break down the problem tissue so the body will rebuild it. This is done by breaking up scar tissue (using plastic tools that are scraped over the skin) and causing the body to go into a healing response. These micro injuries are what cause the body to launch efforts to rebuild and repair the tissue. In between appointments (the “scraping” sessions) the patient is given a regimen of stretching and strengthening exercises. Apparently by using the tissue while the rebuilding is going on the body does it in a way to make it stronger and more effective. This is one of the positive aspects of ASTYM: You’re supposed to be active – at least to some degree; within the scope of what the Physical Therapist recommends.

Dry needling uses Accupuncture needles to (Release? Relax? Break up?) trigger points that can be found in muscles. The similarity between dry needling and Accupuncture is only in the needle. The concepts and premise for the treatments are totally different.

Today was the first appointment. Cocoa butter was put on the skin to aid the tool in gliding over the skin. The PT and I could both feel the things in the foot that needed to be treated. On the lateral side of the foot the Plantar Fascia was nice and smooth. On the medial side it was quite bumpy. He also found two trigger points in the foot and at least one in the calf. He also said the heel pain was not coming from the classic location for PF pain. He thinks there may be a fat pad issue or irritation. Lastly, I have some hip weakness on the side with the bad foot. That, too, could be contributing to the foot issues.

The ASTYM treatment itself was not that difficult to get through. It wasn’t trivial – but it wasn’t as bad as some reports I’d read. (I’d found reports that ranged from “No pain.” to “It really hurts a lot.”) “Intense” would be a good word to use. And it wasn’t intense the whole time – just sometimes.

As we were wrapping up he said the words that about made me fall on the floor: “I’m going to have you increase your running.” Yowsa. This is going to be interesting………………….

Jim

Stretching: Miracle Cure Or Source Of The Pain?

2010-05-06T21:47:00.001-06:00

As I browse the forums there is one concept that seems to be extremely well entrenched in the running community: Stretching is good. And if a little stretching is good, a lot is even better. Often the faith in stretching goes beyond being just “good”, but therapeutic – medicinal even. “I’ve got this pain. I’ve taken a few days off and stretched, but the pain just won’t go away. What could possibly be wrong? If stretching won’t cure this I’m totally stumped.”

Sure – flexibility is important for easy, smooth movement, and stretching helps improve flexibility. However there is evidence that suggests that stretching may not always be the route to eliminating pain. In fact, there may be situations where the pain being felt is a result of the muscle being too lose, and that stretching adds to the pain instead of helping to resolve it.

Damien Howell is a Physical Therapist that frequents the active.com running forums. He has raised this topic in a number of postings and I’ve found the concept/perspective fascinating. Recently a poster (who was dealing with Plantar Fasciitis) was perplexed because, while he’d been executing the mainstream PF regimen for quite a while (calf stretching, Plantar Fascia stretching, wearing a night splint, etc.) he wasn’t seeing progress. He noticed that when he stopped doing these things his pain disappeared. The results the poster experienced flew in the face of mainstream thinking and treatment for Plantar Fasciitis. This certainly was a case that supported Damien’s point: Stretching can sometimes be bad.

The key, clearly, is determining whether a given painful situation is one that requires stretching or, rather, is one that dictates rest and leaving it alone. Sometimes the clue to whether we need to stretch or not can, literally and figuratively, be right in front of us. In the case of the foot, Damien has written an interesting article to get the reader thinking about common foot positions and whether they’re contributing to a contracted or lax state for the Plantar Fascia.

In my own situation, after reading this article, I really thought about some of the ways I spend my day. I sit a lot for my job. My work time is spent either on the phone or on the computer – 100% of the time. I’ve been struggling to get rid of this last bit of Plantar Fasciitis pain, and I wanted to see if the information in Damien’s article could help me figure out some things. I realized I do a few things which really contribute to a plantar-flexed position:

While sitting at my desk I often put my feet out in front of me (feet ahead of the knees) and leave my ankles in a neutral or slightly plantar-flexed position. This position results in the Plantar Fascia being in a chronically contracted position.
Another position I take while sitting is to cross my ankles underneath my chair. This is interesting, additionally, because depending on how it’s done, you may be stretching the Plantar Fascia in one foot (if that foot has the toes and ball of foot on the floor) while contracting the Plantar Fascia of the other foot (if that foot is resting on the opposite ankle and suspended in air).
While sitting at home I’ll often be on the couch with my feet up on the coffee table. Again, feet are in a chronically-tight Plantar Fascia position. (No comments, please, regarding the couch and my back – that’s another program. )

I concluded (guessed) my pain was originating from a scenario where additional stretching could be of help. So the other day I set up a board under my desk and put it on an angle – for a foot rest. For most of the day, while I was at my desk, my feet were on this foot rest that was at a roughly 45 degree angle. As a result my feet were slightly dorsiflexed, which means the Plantar Fascia and calves were stretched, not tight. The positive impact that behavior change had was astonishing. By having a continuous stretch through the day my pain level improved. Damien’s article helped me conclude that tightness might be an issue, therefore stretching could be beneficial. Compare my story with the story told earlier: Both of us have Plantar Fascia pain. The steps to resolve that pain were completely opposite.

In addition to the article already mentioned Damien has assembled a very impressive set of articles on a wide variety of very interesting topics. You can find his library here.

So before quickly concluding or assuming that stretching is the right thing to do, think about that specific muscle and what you do with it: While driving. While walking. While sitting. While standing. While sleeping. If you analyze your daily routine you may get some clues as to whether you should stretch it or not. And don’t forget to adjust your routine accordingly to help that muscle get into some different positions.

Jim

The Old And The New

2010-05-01T20:04:00.001-06:00

I thought it might be time to compare where I’ve been (from a running form perspective) and where I am now. Below you’ll find two videos. In the first video I’m wearing my old motion control shoes and running in the manner I used to run: heel striking. In the second video I’m wearing the Pose-approved Saucony Bullet shoes. While ideally I would have filmed my old style before I attempted any of the Pose transition, it’s quite obvious I filmed both segments on the same day. So the first video is really a representation of how I think I used to run.

Old Running Form – Heel Striking

New Running Form – Pose Method

To be clear – I’m not yet really doing Pose correctly. There are a couple of things I need to fix:

My foot, especially the left foot, is landing a bit too far forward.
My posture still isn’t quite right. It has improved – I’m not bending as much at the waist as I was – but it’s still not where it should be. I need to be more upright.

I need to stay focused on the Pose drills – especially the pulling drills. My theory is if I can do the pull more quickly and also get my posture better I think the foot landing will take care of itself.

It’s really fascinating to me how hard it can be to make these changes. It’s one thing to do what you think needs to be done. It’s yet another to see it done correctly on a video. Before I shot the segment above the last time I’d made a video was probably four weeks ago. During that time I’ve been really focusing on how things feel and just letting my feet drop for landing (i.e. not driving them forward). I was sure I was doing it correctly. Then I look at the video – and realize I still have more work to do.

If you’re thinking of making a form change I highly recommend incorporating video analysis into your program. It’s quite astonishing what it can show you.

Jim

Backslidin’? Not If It’s Temporary

2010-04-21T23:23:00.001-06:00

I have really been struggling lately. I just cannot seem to get rid of the pain in my left heel. Well, I guess I can get rid of it……..if I don’t run. But that, obviously, is not an option. It’s not like I’m running a lot. In fact, I’m hardly running at all: I run 3 or 4 1-min segments out of a 30 minute walk. Almost always everything feels great while I’m running, but later in the day things get painful. It has really been frustrating. I’ve been doing Pose drills to help ensure I’m running Pose correctly. (I don’t know for sure that I am running Pose correctly. I haven’t taken a video of myself in a while.) I’ve also been strengthening my feet through barefoot walks and a little barefoot running. Obviously I’ve been committed to getting into minimalist shoes. I’ve really internalized this concept of getting the feet stronger. It makes so much sense to me.

Today I tried something new: I put a Superfeet insole into my left shoe and went out for my 3 min run. It kind of struck me that maybe my foot needed a little more rest to really get better. I’m viewing this (if it continues to provide relief) as a temporary fix; ala the perspective I espoused when I wrote this article. If wearing a Superfeet insole enables the foot to be pain free, my current thinking is to use it for a while, then go through another weaning process similar to what I did to get out of the big honkin’ orthotics.

So hopefully it’s a temporary fix and not a backslide into the comfort of artificial arch support. It isn’t very much arch support. And the Superfeet are both thin and not padded – so hopefully it will still enable my foot to feel the ground, move, and get stronger.

And maybe, just maybe, I’ll be able to increase from three minutes……to four…….to…….heaven forbid………even more?

Jim

Shin Splints - Revisited

2010-04-04T20:55:00.001-06:00

(Disclaimer: I’m not a doctor or any sort of medical professional. Don’t take any of the following as medical advice. It is my perspective based on my experiences, experiences of others that are on the forums, and internet research I’ve done. You never know – at some point in the future I may be writing something saying I was completely wrong.)

This topic seems to never get old. The Shin Splints blog posting I wrote 12 months ago, other than the blog’s home page, is by far the most accessed page on this site. Recently there seems to be an even greater uptick in interest. I presume because it’s Spring, and folks who haven’t been doing much over the cold months are getting back outside, this common problem is seeing a resurgence.

If you’ve been here before you know that my running world has changed dramatically in the last 12 months. As those changes (philosophy and experiences with running form, the positive way I’ve seen the feet respond by asking them to “step up”, etc.) have occurred my thoughts about how to deal with Shin Splints has evolved.

Before you start trying to make your shins feel better it’s critical you be sure you’re not dealing with a different problem. The big one in this category is a stress fracture. A stress fracture can create some really nasty problems if left untreated too long. From what I understand there are three things that tend to point more to a stress fracture. Stress fractures can be present with all or none of these.

Pain is in one leg. With Shin Splints the pain is often in both legs.
Pain is localized on bone. Stress fracture sufferers will sometimes say they can push on a very specific spot on the bone and feel significant pain. Shin Splint sufferers tend to describe the pain as being over an area of the shin, and tends to be in soft tissue.
Pain increases with activity.

If those symptoms cause you to think you have a stress fracture step away from the computer and call your doctor. Now. Be aware a bone scan or MRI is the way to determine if a stress fracture exists. I’ve read a number of stories where a doctor cleared someone of a stress fracture with an x-ray. X-rays cannot see many stress fractures.

OK, you think you’re dealing with Shin Splints. A quick word on the term. In my opinion there doesn’t seem to be definitive understanding on what exactly occurs and causes the pain. You may have heard the term Anterior Shin Splints and Posterior Shin Splints. Anterior Shin Splints are an issue with the muscles on the front of the shin. Posterior Shin Splints cause pain on the inside (medial side) of the shin. For a while the thought was there was a problem with the Posterior Tibialis muscle which is located in this area, however new thinking is that it’s actually a problem with some other calf muscles that run close by. My point is this: There are lots of theories on exactly what and why is happening but there doesn’t seem to be scientific data on the topic – at least none that I’ve found.

There does seem to be consensus that Shin Splints (whether Anterior or Posterior) is rooted in some sort of imbalance between the calf muscles (plantar flexors) and the muscles on the front of the shins (dorsiflexors). There also seems to be consensus that it is an overuse injury that involves inflammation that contributes to the pain.

In my opinion there are two basic approaches to addressing Shin Splint issues. The mainstream way has the things you’d expect: Resting. Icing. Stretching. Etc. The second approach involves modifying how you run. Since I assume most reading this are interested in the mainstream approach I’ll start there.

Very broadly, the RICE protocol applies to getting over Shin Splint pain. I think, however, a few things can be added to that which help as well. Shoes, massage, strengthening and stretching can play a big role. Maybe it should be RICEMSSS.

Rest. Many interpret this as “Stop running.” I don’t think, necessarily, this is a requirement. If you cut back on your mileage you are resting to a certain degree. That amount of rest may be sufficient. I would start by cutting back some, do the other recommendations described below, and see how things go. If you don’t see improvement, cut back some more.
Ice. When I had Shin Splints I iced my shins a lot. Be careful: The skin on the shins is thin and it’s not very difficult to get an ice burn. Use a thin cloth in between the ice and the skin. Remove the ice every 10-20 min for a while to give them a break.
Compression. Personally – I didn’t do much in this area. You can find compression sleeves in stores and on the internet. Others have said they work well. I don’t have any experiences with them.
Shoes. If you’re not sure you’re in the right shoe it would be worth it to go to your local running store. They can assess what you need and ensure you’re in the right shoe. This is far from a guaranteed fix, but I’ve definitely seen stories of people changing shoes and having things clear up.
Orthotics / Shoe Inserts. Some find relief by putting some sort of insert – either over-the-counter or custom made – into their shoes. I’d tread very very cautiously here. As I described here in a previous blog entry I believe orthotics should be used much more frequently as a temporary rather than long term solution. Yes, there are people who will say that orthotics cured their Shin Splints. That’s great. I think in these situations the gait may have been changed enough to help the muscle imbalance, but inserts will often set up other sets of problems longer term since they will inhibit the feet from moving as they should.
Massage. Getting the blood flowing to the painful areas can help:
- Front of the shins: Get a tennis ball and kneel on the floor at the top of a step. Position your foot so it’s hanging over the edge of the step. Put the tennis ball under the shin and roll it around on those muscles. Also, this is one area where I think The Stick works well.
- Posterior Tibialis. Ozzie Gontang has a fantastic way to massage this muscle. Sit in a chair and put the ankle of the leg to be massaged on the opposite knee. Take one thumb and place it right behind the shin bone, down by the ankle. Wrap the fingers around the front of the shin. Take your other thumb and place it on top of the first, again wrapping the fingers around the front of the shin. Make small circles with the foot and you’ll see and feel the Posterior Tibialis muscle contracting and relaxing. While making circles with the foot push the thumbs firmly into the soft tissue behind the shin and slide the thumbs up along the shin toward the knee. When you first start doing this that muscle may get pretty sore. It’s a muscle that gets forgotten about.
- Calves. A foam roller is an invaluable tool to use for massaging the calves. YouTube has videos on good ways to use it on your calves.
Strengthen
- Front of the shins: Put some sort of weight or resistance on the front of your foot and use the shin muscles to pull your toes toward your knee. This can be done with a resistance band or by hanging some sort of weight (1-2 soup cans in a plastic shopping bag works) from your foot.
- Posterior Tibialis: Stand pigeon-toed (with your toes pointing inwards each other). Using your calves raise up on your toes and return the heels slowly back down to the floor.
Stretch. Standard calf stretches work fine. Google will enable you to find them easily.

I stated that often Shin Splints result from some sort of imbalance in the muscles of the lower leg. In my opinion a heel-strike running form can be a major contributing factor to this imbalance. An alternative approach to getting rid of Shin Splints is to change how you run – and get away from heel striking altogether. This opens a completely different set of options and actions the runner needs to take to resolve the problem. I’ve read stories of people changing only how their foot strikes the ground and their Shin Splints have improved. Others have pursued formally the structured programs in this genre: Pose Method, Chi Running or Evolution Running. The overall goal is to adopt a form that is less stressful on the body. These forms challenge the concept that we need to use muscles to propel us forward and rather we can rely on falling forward to propel us. Then running becomes a continuous series of stopping us from falling to the ground. We’re “simply” catching ourselves when we fall and picking up (not pushing off) the trailing foot that is left behind. I won’t go into the differences between these forms here. The forums are replete with discussions about why someone believes one is better than the other; and vice versa.

This second approach becomes much more of a re-engineering of the running style. As they say, old habits can be hard to break. It takes a good amount of mental commitment to pursue this. It can be frustrating and rewarding. There are many stories of not only Shin Splints being resolved, but Plantar Fasciitis, Achilles Tendonitis, knee pain, etc. Some people call it a fad. I think it’s an acknowledgement that running, like virtually every other sport, has a right way to do it and a wrong way. And almost always the right way must be studied and practiced and learned, just like one does for soccer and golf and skiing and baseball and and football and…………………..

Jim

Barefoot Run #1

2010-03-27T23:21:00.001-06:00

I generally prefer Winter to Summer. I’m not totally sure why, but I think it’s rooted in liking the feeling of being secure and warm in the house when it’s cold and blustery outside. As a result I love Fall; and while Spring is fun, it’s an indicator of Summer – which means hot and uncomfortable.

Given the recent move out of the big shoes and orthotics I’ve been especially looking forward to Spring this year, so I can try a little barefoot running. And wouldn’t you know it – it seems like Spring (or at least a few warm days) seem to be late this year in CO. I know there are people who barefoot in sub-freezing temperatures, but for a beginner like me I just couldn’t fathom that.

This afternoon the weather and my schedule aligned and I was able to do a little barefoot running. I only did a few hundred meters, on a sidewalk.

OH MY GOSH it was fun! It just feels so unusual to feel your bare feet on the cold concrete. I’d run a bit, walk a bit, run some more, walk some more. I didn’t time anything. I didn’t measure anything. I just went out for a while. I’d done enough reading to know one can run into an injury before you realize it. Hopefully I didn’t do too much. I don’t think I did. I think the Pose training really helped. Some people say you can’t run incorrectly when barefoot but I most definitely think that is not the case. Whether shod or not form, I believe, makes a huge difference as to whether you’ll be successful long term.

If you get a chance give it a go. It’s really exhilarating.

Jim

The Beauty Of Running

2010-03-08T06:28:00.001-07:00

Being fit and trim has always been one of the many reasons I like running so much. When I’ve been consistently running I’ve done pretty well on the “fit” part; OK on the “trim” part. To that extent one could say I run for vain reasons.

I’ve never been driven by vanity when it comes to my actual running. All decisions around clothing, shoes, form, etc. have been driven completely by functionality. Over the years I’ve sometimes heard “You’re going to wear that?!?!”

As I’ve been learning The Pose Method of running (motivated, if you’ve been here before, by the need to get over some injuries) I’ve spent a fair amount of time looking at video of people running. Some of this video has been of me, some has been video of others implementing Pose techniques correctly. Much of that time, literally, has been spent advancing frame by frame through a video segment, watching the relative movement of limbs, zooming in on the position of the foot at landing, etc. In essence, I’ve been looking at running very technically.

When I figuratively step back and look at those videos (the good ones – not mine) in a holistic way, however, and watch good runners run I’m struck at how fluid and beautiful the movement can be. You’ll find below some segments I’ve found particularly enjoyable.

I guess I’m adding another dimension of vanity to my running: I hope to look like these people some day – running with an apparent ease that is counter to the mainstream reputation held by many.

Jim

Video of Jacky, a Pose coach in Europe, from various angles, including some barefoot segments:

A comparison of running styles:

This video shows Jeremy Huffman (my Pose coach) demonstrating Pose running at various speeds, including walking.

Declaring Victory

2010-02-18T21:39:00.001-07:00

On October 26, 2009 I initiated here a very deliberate effort to cure my Plantar Fasciitis, get out of orthotics and motion control shoes, and learn The Pose Method of running. I also committed to provide weekly updates on the details of that effort. I did so because when I searched for first-hand experiences for someone doing what I wanted to do I couldn’t really find any. I decided to be “an experiment of one” as they say.

I’ve concluded it’s time to formally close this chapter of my effort to get back to running. The Plantar Fasciitis (PF) is 99% gone. I say 99% because I do have some minor residual pain. If I overdue it I can tell – and it might take 1-2 days of reduced activity to get things back to normal. I’m nowhere near the pain level or mental stress I had 18 months ago. My daily focus is not PF but rather strengthening exercises, Pose drills and plans to increase my running time.

As of January 20, 2010 my orthotics are history. For a number of weeks prior to that time I’d slowly been building up my barefoot time. Then, what started out one morning as an experiment to see how long I could go without them turned into the first day of no-orthotic freedom in 10 years. On February 4, 2010 I wore my motion control shoes for the last time. My Onitsuka Tiger Mexico 66 retro shoes not only enable me to wear a low-heeled, minimally-padded shoe all the time, my 14-year-old thinks Dad is pretty hip because his shoes are “awesome”. I worked with a Pose coach (Jeremy Huffman) to learn the fundamentals of Pose and also learn how to become my own Pose coach and critic. I can’t approach the quality of input the Pose-certified coaches on the Pose forum provide, but the bottom line is I think I know enough to be dangerous and guide myself in my efforts to be a better Pose runner.

The next phase in my effort to get back to a 25-30 mpw running volume is to keep using what I’ve learned, refine my Pose techniques, and increase my body’s ability to handle more and more activity. Watching paint dry would be infinitely more exciting than reading detailed weekly accounts of my efforts to increase my mileage. Therefore, I won’t be providing regular updates on my mileage ramp-up per se. I’ll continue to use this space to offer ramblings about various running topics that grab my fancy. If something interesting occurs in my ramp-up that will get reported on as well.

If you’ve been here before – thanks for reading and also for coming back. My hope is that people who are dealing with foot injuries and/or want to get out of their clunky shoes or orthotics might learn how they can approach the process based on the experiences I’ve had.

If you’re able to run as you want and are injury free – never take for granted the fact that you can. If you’re injured and want to return to running – never give up the fight to accomplish that goal. I think we often forget a concept that I saw written on a bulletin board a long time ago: Running is a privilege.

Jim

P.S.: If you’re reading this posting out of the archives and are interested in understanding some of the details associated with what and how I went through the PF –> minimalist shoe transition the following articles represent the key milestones of the journey.

Orthotics: Temporary Or Long Term Solution?

2010-02-13T23:14:00.000-07:00

(You can read here the article launching and describing the current project.)

Every now and again someone I’m working with (Doctor, Physical Therapist, etc.) says something that really sticks with me; and I end up pondering it for a good long time. My Podiatrist made one of those “Things that make you go ‘Hmmmmmmmm’.” statements a number of months back. “An orthotic is a splint.”

That’s an interesting thing to say. Why would he say that? Why choose that word “splint”? I kicked it around in my brain in the context of other things we’d discussed. I had a pretty decent understanding of his treatment philosophies in general and I wanted to understand why he’d say that. He is a strong believer in the philosophy that the foot was meant to move. He appears to suggest orthotics very reluctantly. Even when he does feel they’re necessary he prescribes flexible orthotics so the feet can move. And he believes that, ultimately, one should try to get out of the orthotic. To be honest, I was having trouble understanding why one would suggest an orthotic if the goal was to get out of it.

That word “splint” kept bouncing around – and then it kind of all came together. I’m an analogy kind of guy. Things become clearer when I can map what I’m thinking through to other situations or models I’m more familiar with.

When we break an arm typically a cast is used to keep it immobilized so it can heal. A sling can also be used to help the healing process. The reasons seems pretty clear: The limb needs some help, support and protection in order to heal effectively. While I’ve never broken my arm I know plenty of people who have. Casts and slings obviously work pretty well. We’ve all seen enough broken arms in our lives to know it’s virtually intuitive to us that treating it this way is the right thing to do.

I now understand my podiatrist prescribed orthotics when my Plantar Fasciitis (PF) was raging because my foot was “broken”. It wasn’t broken in the bone sense, but in the sense that there were tissues that were damaged and needed to heal. In order for that healing to occur the foot needed help and support (a splint) so I didn’t re-injure the foot with each step. (Just as the cast prevents us from re-breaking the arm every time it is moved.)

When the bone in the arm is healed the cast is removed and the arm is free to move again. At this stage the arm isn’t really in a particularly good state. Especially if it has been in a sling it’s likely weak and stiff and somewhat difficult to move. We might and hopefully do go to Physical Therapy to get help in gaining back the range of motion and usefulness the arm had prior to breaking it. Have you ever seen anyone leave their healed arm in a sling permanently? That seems preposterous. We don’t want our arm in a sling the rest of our lives. We need to use it! It’s too important to what we do in our daily lives. That is precisely why we go through the rehabilitation process: So we can have a useful, functioning arm again.

In many cases the feet are no different. Unfortunately there is a very common perception that if a foot needs an orthotic there is something fundamentally and structurally wrong with it and, consequently, the orthotic is needed permanently. Flat feet very much seem to be in this “deformity” category. I’ve seen people write “I’ve been diagnosed with flat feet.” as if it were a disease. To me the term “flat foot” is more akin to describing some fact about any other part of our body; such as weak arms. “I’ve been diagnosed with weak biceps. Get me that sling – I now need to wear it the rest of my life because I have weak arms. Nope. There is nothing I can do about these weak arms. I was born with them. What a shame about me.” A better diagnosis for someone reacting this way might be “Nuts.”

In reading the various running forums I like to frequent people also sometimes conclude orthotics are necessary because they tried to stop using them but failed. They don’t seem to think about the method they used to get out of the orthotics. One recent poster commented “I know for a fact I cannot run without my orthotics. I tried going without them for a week. I ran 22 miles and I got a stress fracture. That proves it.” Sorry – that doesn’t prove it. The only thing it proves is that this person got a stress fracture when she did what she did. That’s a far cry from proving that orthotics are essential to her ability to run. I wonder how different the result would have been had the runner spread that effort to get out of the orthotic over a 4, 8 or even 12 week period. We don’t go bench press 250 lbs right after we’ve removed the arm from the sling. We build up to it slowly and over time. We give the weak arm time to adjust, adapt, and get strong.

While the orthotic can help encourage the right healing environment, don’t forget we control the other aspects of that healing environment. An arm, while casted, probably shouldn’t be used to do push-ups, for example. The orthotic may be necessary, but not sufficient, to get the tissues healed. The long and frustrating trial-and-error process I went through for my PF is a good example. I got the (planned temporary) flexible orthotics, however I continued to try a small amount of running while the PF healed. The only problem was – it wasn’t healing. It’s easy for people to conclude that the orthotics aren’t working if they remain injured after getting the devices. I had to do other things (such as not running at all, wearing highly supportive shoes virtually every waking moment, stretching, etc.) to not undo the positive things the orthotics were doing to help my feet get better.

So how does one get out of the splint (orthotic) once the acute injury is healed? Well, just like the healed arm, very slowly and carefully. Sure, there are stories about people taking them out one day and never having any problems. I think those are the exception. Most of us have to wean ourselves off of them in a controlled way. In my case I started with 15-30 minutes each day. As the feet handled a given level of no-orthotic time well I’d increase it – very slowly. Occasionally I’d notice some issues. If so I’d either hold where I was or even back off a little, just to get things solid again. As my no-orthotic/no-motion-control shoe time got up to the 3-4 hour range I started formally studying and incorporating Pose Method techniques into my daily walking. At this point my feet’s desire to be free just exploded. An experiment one day to see how long past the four hour mark my feet could handle turned into the first day I’ve gone without orthotics in 10 years. And I haven’t had them in since.

Does it really matter if our feet are in orthotics long term? Well, in my opinion, no, as long as you’re pain and injury free. At the end of the day that is the real goal. “If it ain’t broke don’t fix it.” as they say. But if you do have injuries, and you’re struggling to get over them, getting out of orthotics (as well as avoiding heel striking and adopting a less impactful form of movement such as The Pose Method, Chi Running, Evolution Running, etc.) may be an answer. What we view as a necessary solution to our injuries may, ironicially, actually be contributing to them. By letting the foot move, function and adapt as it should we’re creating a healthier system that will be less injury prone. That certainly appears to be the case for me.

Jim

Close To Running? I Hope So.

2010-02-07T21:58:00.000-07:00

(You can read here the article launching and describing the current project.)

Summary: The feet feel very good. I'm kind of stuck on a couple of points in the Pose drills. They're pretty critical - so I need to get them right before I try running any further than 40m or so. If I can get those right I think I’m ready to try some more running.

Details: It was a good and frustrating week. First, the frustrating. My core does not want to stay engaged when I change support legs. My brain is really programmed to push my hips back when I land. I really associate "hips back" with being necessary to find the balance point. My challenge is to get that core and posture rock solid. This is one of the really critical components of the Pose method.

Another critical component I'm struggling with is what Pose calls the “pull". The pull is the action taken when the trailing foot (actually it's the support leg) is pulled off the ground and toward your rear end. The goal is to use the hamstring to do this, not the hips. There are two issues with my pull. One, it's late. I'm leaving my foot on the ground too long. Two, I'm not generating the direction of movement of the foot toward the butt as I should. The late timing will be addressed by counting in my head the cadence the feet should be moving (~180 bpm). The direction of the pull is being addressed by hamstring exercises – quite a number of them.

The good from the week is that I was able to determine these things (with Jeremy’s expertise, of course) through some video I shot of me running. I’ve always been a bit surprised when I watch a video of my running and compare what I see versus what I felt. In this clip I’m happy with the footstrike. I still have a tendency to dorsiflex – which is not good. So seeing I’m not dorsiflexing feels like progress. My foot is landing like it should. The hips should be more underneath the shoulders. I can’t even come close to evaluating a pull when watching a video clip full speed. I can barely assess it when I’m advancing the clip one frame at a time.

It feels unbelievable to run. Yes - it's only 40m or so, but it feels so freeing and easy.

The feet feel very good. I get some heel pain here and there, but nothing major. The odd thing in this department is that I’ve been noticing my heel pain increase when I wear my motion control shoes. That phenomenon is particularly odd because, when the plantar fasciitis was in its acute stage, putting on those shoes reduced the pain. Now that action produces pain. This was putting me in a bit of a bind because I don’t like wearing my Pose shoes (Saucony Bullet) out as casual wear. For activity (the little running I’m doing, as well as walking to practice the Pose methods until I can run more) they’re fantastic. I don’t like, however, the styling. So I looked around for a low heel, thin soled shoe that I felt OK with wearing around casually: running errands, going to work, etc. I settled on the Asics Onitsuka Mexico 66. Hopefully these will fill the bill.

This coming week it’s all about posture and pulling. I think (hope) if I can make progress on those then I can attempt some “extended” running – 100m or so. It’s kind of funny to think of 100m as an extended amount of running, but as I said in a previous post and millions have said before that: The longest journey begins with but a single step

Jim

Pose Learning Continues…And The Barefoot Debate Heats Up

2010-01-31T08:25:00.001-07:00

(You can read here the article launching and describing the current project.)

Summary: The Pose walking continues. Learning to not break posture when moving has been a bit challenging. The feet continue to feel good.

Details: The challenge this week has been to transition from Pose drills that are static/stationary to dynamic/moving. This was surprisingly challenging and frustrating for me. Essentially the issue was, while I had reasonable posture when standing, when doing a simple two-footed hop I would bend at the hips and break the posture. My sense is that I have been running with a bend in the waist for so long I basically don’t know any other position. Jeremy helped a lot and gave me some exercises/drills to help with this. The one that helped the most was attaching a loop of exercise band (not Thera-Band, but tubing) to a stationary object. I climbed inside and put it around my waist and got into the Pose stance while leaning against the tension of the tubing. It helps you get a better feel for the position, the muscles that help keep you in place, etc.

I tried the exercises again and, ultimately, I think I’ve learned to not bend the hips – and more importantly – learn to feel the feeling when I do bend my hips. Actually, while I thought I was doing the static drills well, as a result of working through this challenge, I noticed in one of the static drills I was not keeping the posture. It was slight but I could see it. So by going back to that drill and absolutely nailing it, I think I’m on the road to get the rest of them right. (I’ll put in a little plug here for a some great freeware software called Kinovea. You can take a video file and do single frame advances, draw lines on the frame to check alignment, etc. It’s really great.)

The feet are doing quite well. I need to wear the Superfeet a couple of hours a day. The feet tend to get a bit of an ache at some point in the day. I’ll wear the Superfeet for an hour or two and it goes away. I did do a bit too much yesterday. It’s Sunday morning and my left heel is talking to me the most it ever has since I got out of the orthotics. I did a lot of stuff around the house yesterday – virtually all of it either barefoot or in the Pose shoes. So today will likely be a much heavier-than-normal Superfeet day.

Barefooting: You may have noticed I wrote a very short article mid-week that contained links to a variety of barefoot running information that hit the press. While the information and science has been fascinating to me, how people and companies are reacting is just as interesting. The various internet forums are quite the buzz.

My take is it’s wise to separate the stories that make it to the news shows from practical issues, science and thought for the mainstream running community. The media is out to make money – and they’ll push what draws attention. A few months back I saw a video clip done by a local news station about a guy who runs barefoot 12 months a year – in a climate that gets a reasonable amount of snow. There were shots of him, with nothing on his feet, running in snow that was up to the middle of his shins. The extremes are appealing to report on – because they’re extreme. “My great grandpa ate 6 eggs and 1/2 lb of bacon every morning of his life. And he lived to be 104!” I’m clearly not a barefooter per se (although I’m really looking forward to warmer weather so I can do some) so I can’t speak with authority, but I think a guy running completely barefoot through powder snow is a few sigma out on the bell curve – even in the barefoot running community. Maybe I’m wrong…………………. The business’ reactions are interesting, too. The CEO of Brooks put out an “open letter” expressing people proceed with caution. A letter from the head of RoadRunner Sports is also getting some attention with a letter that expressed his concern for runners’ health and safety.

Within the running community it’s fun to watch how people react. Some barefoot/minimalist proponents appear to be wanting to convert people. It’s understandable. We’re excited about either what we’ve found or what we’re finding. I’ve seen proponents of conventional running wisdom react surprisingly negatively to the science. One person wrote (paraphrase) “It doesn’t take a study to figure out that running barefoot is a completely idiotic idea!” Even a running expert stated in an interview (again, paraphrase) “The idea our shoes are causing our injuries is completely ridiculous.” Apparently the “You could step on a hypodermic needle.” argument is used to convince people they shouldn’t run barefoot. That’s a pretty comical one. One forum poster made a good point: “How many times have shod runners had to pull a hypodermic needle out of their shoes?”

Setting aside the emotion and raw science, I think it’s undeniable that a minimalist or barefoot approach is the only way that some people can run at all. That is the proof point that is important to me. Our collective goal as runners is to run. What does it matter what is on our feet? I think we can all agree on that. And if I’m running in my minimalist shoes, a barefooter is on my left, and a Brooks Beast wearer is on my right, and we’re all pain free, then we’ve all reached the goal.

Jim

Mid-Week Report: Barefooting Grabs The Spotlight(s)

2010-01-27T17:00:00.000-07:00

(You can read here the article launching and describing the current project. You can read here the most recent status report on my move to minimalist running.)

I normally don’t do a mid-week update, however a few things grabbed my attention today so I thought I’d pass them along.

NPR did a couple of segments on barefoot running. One is focused more on the science of barefoot running. The other is focused more on how businesses and others are reacting.

The BBC has a piece on how shoes may have changed how we run.

Here is a fantastic video with Harvard professor Daniel Lieberman. It has excellent slow-motion comparisons of the different foot landings along with force plate and graph analysis.

Also, I recently discovered a very interesting blog called On And Off The Track by Steve Magness. Steve’s current posting is about a study on barefooting. And, just a few days ago, Steve wrote an article about Why Running Shoes Don’t Work.

Happy reading, listening and, hopefully, running!

Jim

“Running is a privilege.”

The Orthotics Are……….GONE!

2010-01-24T14:00:00.000-07:00

(If you're new here you can read the article describing my project.)

Summary: This week has been fantastic. I was able to make major progress in getting out of the orthotics. Lots of focus on Pose walking and trying to ingrain the basic concepts of Pose movement into walking: erect posture, falling, quick foot cadence, relaxed limbs.

Details: I’m old enough to know it’s not good to claim victory too early, but I think this is one of the weeks I’ve been waiting for for a long time. I experimented with not using the orthotics and the feet responded really really well. In actuality I was getting an indication this was going well when I pushed the “Publish” button on last week’s report. I considered putting some of this positive news in that report, but I wanted to let this week unfold and see if it really stuck. It apparently really has - “stuck” that is.

On Wednesday I decided to try an experiment: How long could I go without my orthotics? Over the last few months I think I’ve gotten pretty good at recognizing the little signs through the day when the feet are getting tired, so I wasn’t very worried. I decided, when I started to feel those leading indicators, I would throw the orthotics back in the shoes and be sure things didn’t get out of hand. Well, I went the whole day. No pain whatsoever. I was completely stunned. The next morning (which is when I often feel the impact of the previous day) I still felt 100% pain free. So I kept going…..and I made it completely through that day, too! I was doubly stunned.

A major mental breakthrough this week was the realization that everyday movement, just not running, can contribute a lot more to the foot pain than I realized. I came to this via input from Jeremy (the Pose coach I’m working with) and also the Pose forum. I believe using core Pose techniques during my daily movement contributed to my ability to get out of my orthotics so quickly. The Pose techniques, whether applied to walking or running, enable a form of movement that is much less stressful on the body. It takes advantage of gravity to propel us, which then enables us to not have to do things like use various muscles to push us forward. One of those body areas we often use to push us forward are our calves and feet – toe-off if you will. Pose advocates picking up the foot (since you’re falling forward). Have you ever been walking on a sidewalk and up ahead seen a patch of ice? Most of us alter our gait to walk across the ice patch. That’s because we push off when we walk. A good Pose runner or walker doesn’t need to change their gait when they are on ice, because they’re not pushing off. Walking and running on ice is often used to help people understand the Pose concepts and perceptions.

Progress was also made on the basic drills. I believe I’ve graduated from “Pose Stance Training School”. Below are two pictures. The picture on the left is my first attempt at the basic Pose stance, which is done incorrectly. The picture on the right is the correct stance. The main things to notice in the correct stance are straight posture, slight knee bend and weight over the ball of the foot.

I’ve been doing 30 min walks in the Pose shoes to really focus and practice the Pose techniques. Those seem to be going well.

Actually – that’s about all I have to report for this week. I’m still a bit anxious about what the upcoming no-orthotic week has to bring. I’ve really been looking at those devices with mixed emotions. I view them as the key to helping me cure the immediate injury of PF, by giving my feet rest and support for the healing process. However, they’re also things I wish to get rid of. I keep hearing the words of my Podiatrist from quite a number of months back: An orthotic is really a splint. Splints help us heal, but the real goal is to get rid of the splint. Pose, and patience, I believe, have really enabled me to get rid of them.

Jim

Reference: Stretching & Strengthening

2010-01-22T09:02:00.000-07:00

(Last updated: June 2010)

A collection of stretching and strengthening activities.

	Stretching	Strengthening
Foot	Cross the foot to be stretched over the opposite knee. Pull the toes back to stretch the Plantar Fascia. Stand on a tennis ball. Place the ball right behind the ball of the foot, in the middle of the arch, and right in front of the heel. I do this for 1 minute minimum for each location; 6 minutes to do both feet. Sit on floor. Wrap towel around the foot at the ball of the foot. Pull back on the towel to stretch the calf and the Plantar Fascia.	Towel Curls Marble Pickups Check out this article. It gets a bit technical, but the section titled “IFM Retraining” on pg. 6 is interesting. Try walking on different portions of the feet for small amounts of time: heel, ball, outside, inside. Run barefoot in grass.
Ankle	While sitting in a chair slide your ankle as far forward as possible while keeping the entire sole of the foot on the floor. Stand with your feet reasonably close together, with one foot slightly ahead of the other. Bend at both knees and bring the knee of the back leg as far forward as possible, while keeping the rear ankle stationary. I find it helpful to hold onto a wall or chair while doing this.	Stand on one leg and work on balance. To make more challenging Cross your arms in front of your chest Close your eyes Use a balance board, Bosu Ball, balance disk, etc. Sit in a chair and cross your legs (using the style where one knee is close to the other – not the style where an ankle is placed on the opposite knee). Moving only your ankle, trace out the alphabet in the air. Imagine you have a pencil taped to the sole of your foot and the tip has extended just past the toes.
Calf/ Shin	Foam roller Standard calf stretch against a wall. Sit on the floor. Wrap towel around the foot at the ball of the foot. Pull back on the towel to stretch the calf and the Plantar Fascia. Tennis ball to massage the calf while seated on the floor. Posterior Tibialis: Sit in a chair and cross your legs such that the left ankle is resting on the right knee. You’ll be looking down on the inside of your left shin. Place your right thumb right behind the shin bone (where the bone transitions to soft tissue) down close to your ankle. Your fingers will wrap around the front of the shin. Place your left thumb on top of your right thumb, wrapping those fingers around the shin, too. Make small circles with your left foot. With each rotation you’ll notice/feel Posterior Tibialis contracting and relaxing. While continuing to make circles with your foot, slowly slide your thumbs up the shin, while pressing firmly into the muscle. You’ll massage the muscle and loosen up the fascia that can constrict the muscle. Anterior Tibialis: Kneel on the floor close to a step, such that the foot hangs over the edge of the step. Your shin should be entirely on the floor. Place a tennis ball under your shin. Move the shin so the ball moves along the length of the shin.	Heel raises. Posterior Tibialis: Do heel raises, however at the top of the range of motion supinate your feet. (Move your heels outward.) It will kind of feel like your weight is on your outside toes. Slowly return the heels back down to the floor.
Thigh	Quadriceps: Standard heel-raised-to-butt works well. Concentrate on keeping the knee as close to vertical as possible. It’s easy to abduct the thigh, which I believe reduces the effectiveness of the stretch. Hamstrings: Sit on the floor with your leg extended straight in front of you. Wrap a towel or rope around the sole of your foot. Hold on to the towel/rope and pull your straight torso forward.
Hip	Hip Flexor: Kneel down on the floor like you’re going to propose to someone. Tighten the glute of the leg with the knee on the floor. While keeping the glute contracted, slowly move your torso forward. You’ll feel a stretch in the front of the hip. Gluteus Maximus: Sit on the floor with your legs straight in front of you. Loop a rope or long towel around the sole of one foot. Lean back and lie down completely, while maintaining hold of the towel. Raise your straight leg and use the towel to hold it momentarily in the vertical position. Now lower the leg perpendicular to your torso; e.g. when stretching your right glute bring your right leg to the left and across your body. Piriformis: Here is a great Piriformis stretch.	Gluteus Maximus: Lunges. One-legged squat. Be sure you bend in the hip when you do these and be sure your knee stays roughly over the shoelaces. Do not let your knee go in front of your foot. The pistol squat is a great goal, but in my opinion one does not need to go all the way to the floor to bring significant benefit to running. Check out these hip exercises (video) on the Pose website. Stand on one leg with the knee of the support leg slightly bent. Stand erect – hands can be on hips or out for balance. Rotating only at the hip bend forward. Be careful not to curl the back or slouch the shoulders. Rotate “fairly far” – approaching 90 degrees. You’ll feel your hamstring kick in. Now rotate back to standing up straight. I do a couple of sets of 15. This is great for the hamstring, gluteus Maximus and Gluteus Medius. It’s also great for balance in general.
Core		The Pedestal routine, which can be found here on YouTube. Balance ball exercises.

Week 12: Walk (And Stand) Before You Run

2010-01-17T17:25:00.000-07:00

(If you're new here you can read the article describing my project.)

Summary: The title summarizes my focus this week. This week marked the first week of formal Pose learning and training. The webcam video sessions with the Pose coach (Jeremy Huffman) are really helpful. In just a couple of sessions he has noticed some patterns that need to be addressed. It’s amazing how something (body position, walking, etc.) can look so different from how it feels. In my daily life I’ve been trying to reorient my body from being primarily weight back and on the heels to being more forward and weight over the ball of the foot. Rolfing session #3 was completed.

Details: As I said last week I’ve started working with a Pose coach. We met twice this week via webcams and Skype. It worked really well and I’m really impressed with the information and insight that can be exchanged. He’d step back from the camera and demonstrate various things. I’d step back and do things and he could comment; either confirm I was doing it right or tell me what needed to change. (Additionally, from a raw technology standpoint, I found it quite amazing. I work in high tech so on the one hand it was all pretty mainstream stuff: Skype, webcams, YouTube, etc. On the other hand, however, I was pretty astounded that I could interact so well with someone 1,200 miles away. I’d shoot a video of myself, get it on YouTube, and within an hour had feedback from him.)

Like most new things that are learned there are some foundational concepts that need to be firmly established before moving on to more complex concepts and actions. This week the learning has been focused on:

The Pose stance. It’s a relaxed, two-footed stance with a slight knee bend and erect posture, with the body weight over the ball of the foot. Eliminating as much tension throughout the body while in this stance is really important.
Falling. Transitioning from stationary standing to falling forward. This falling motion is the basis of the forward movement. It’s also important to maintain the erect body posture while falling.
Use of the hamstring (not the hip flexor) to pull the foot off the ground.
Doing nothing to get your foot back on the ground. That sounds kind of odd, but the intent is to not use muscular tension or force to get the airborne foot back on the ground when you need it there because you’re falling. The intent is to let gravity bring the foot back down – and rely on your brain to subconsciously get it where it needs to be to keep you from falling on the ground. Your brain will do it automatically. We don’t need to force it to happen.
Focusing on the sense of how these things feel.

Have I got this stuff mastered? No, but Jeremy has helped a lot in moving me along the road. He also has me doing a variety of hip strengthening and flexibility exercises which are outlined in Dr. Romanov’s Pose Method book. Getting some of these basic concepts incorporated into daily life (walking through the grocery store, walking around the office, standing at the counter doing dishes, etc.) will set a strong foundation for when I start to make it more complicated – by running.

Rolfing: Session #3 was completed. This is one of the “integrative” sessions – designed to tie together the work done in the previous two sessions. Erin worked on the IT Band, the trunk/core, arms, shoulders and neck. Afterward my shoulders and arms felt incredibly loose. We set up a standing every-other-week schedule. Next up: the medial lines of the legs.

Jim

Week 11: Pose Adoption Begins

2010-01-10T08:19:00.000-07:00

(If you're new here you can read the article describing my project.)

Summary: The feet strengthening continues. I’ve been able to do 20 minutes of activity (18 min walking; 2 min running) with no ill effects to the feet. I’m doing this in the low profile shoes with no orthotics! I worked on the Pose drills and did some running. It turned out to be poor running, from a Pose form perspective. I’ve decided to work with a Pose-certified coach to help me effectively adopt the Pose methods.

Feet Strengthening: The feet strengthening seems to be going quite well. It’s now time to ramp up my efforts to learn Pose and, consequently, I’ve started spending time on the forums at the Pose website. A coach there suggested I forego my plan to first transition to the Superfeet insoles (this was the plan I outlined in last week’s report) and instead just go straight to the low profile shoes – with no orthotics. In doing everyday things around the house or office I can wear this configuration for 3-4 hours with no problems. I can most definitely see a decrease in the total time I’m spending in my orthotics, although I’m not being anal retentive about keeping a log or anything like that. I’ve stopped doing the elliptical every-other-day and replaced that with 20 min sessions outside. (A sub-zero cold snap in CO put me on the treadmill and not outside a couple of times. I really enjoy running in the cold. But walking in sub-zero temperatures? No thanks.) I walk for 9 min, run for 1; and then repeat. Again, this is with no orthotics and the low profile shoes. At the end of this workout my feet are quite tired. My plan is to monitor this post-workout feeling very closely and, as they can handle it better, start increasing the time.

The Pose Method: This part of the week has been very interesting to me. I’ve read so much (it seems like it at least), and I’ve watched so much Pose video on YouTube, I thought I was ready and would do pretty well (from a form perspective) actually trying some running. I shot some video of myself, put it on YouTube, and asked the experts on the Pose forum if they would evaluate it. I sat back and waited for the accolades to pour in: “We’ve never seen someone pick it up so easily!”

Well, the input came in, but accolades they weren’t. It turns out I’m not as good at Pose as my mind’s eye imagined I’d be. What a shock! Some extremely helpful folks pointed out a number of issues. I wouldn’t have guessed these were happening, but when I read the input and then looked at my stride frame-by-frame I could very much see their points.

I’m still heel striking. This is especially noticeable with my right foot.
The knee bend is too pronounced.
I’m not pulling my foot off the ground soon enough, resulting in longer contact with the ground than necessary.
I’m “overpulling”, a term used in Pose to describe the situation where one pulls their ankle too high off the ground for whatever speed they’re running. (Pose is about a lot of things, but one of those is efficiency. When one runs faster, in order to have the foot catch up and be ready for the next landing, the ankle ends up being pulled up higher. Doing this too high when running more slowly is unnecessary and wastes energy.)

Given the feedback it was apparent I needed to focus on the basics, which in Pose means becoming proficient in a series of non-running drills to help one understand how the various positions should feel when you’re actually running. This is one of the key reasons why Pose appeals to me. A few years ago I tried one of the Pose “competitors” and I struggled with it. I read all the theory, but translating that theory into movement I found extremely challenging. To perform the Pose drills you get in front of a mirror, get into the right body position, see that it is correct, and then focus on how that body position feels.

The first and most basic Pose drill is the S Stance. The drill simply tries to get the runner to stand a certain way. The stance has a number of characteristics, but I’ll leave it to the Pose book to lay out those details. So I shot some video of me doing the drill and put it on YouTube and, like the previous video clip, I asked the experts for their thoughts. Well, apparently do I not only struggle to run correctly, but I also struggle to stand correctly. While I did accomplish the goal of getting the center of mass over the balls of the feet, the other parts of my body were not in the right places. The knee bend is too pronounced, which puts the bum too far back. I also have some humped shoulders. A stance that has much more subtle knee bend will allow me to stand more erect. (Be aware, if you do watch the S stance video, that I go through some body repositioning in the video. One coach had a great idea: Deliberately position the center of mass in the wrong places – midffoot as well as heel - in order to feel where the body shouldn’t be. I’m making comments in the video while I’m doing this, but the camera had a hard time picking them up.)

Amongst the various input provided on the forum was a recommendation that I work with a Pose certified coach. While videos and time on the forums can get you successfully into the program, individualized help, obviously, is better if it’s possible. That sounded like a good idea. I couldn’t find someone local who was certified. After some inquiries and email exchanges I connected with Jeremy Huffman, a Pose certified coach in Louisiana. He offers online/webcam based coaching. Next week is our first session. Results from those sessions will be another component of my reports here.

Rolfing: Nothing new to report. Session #3 is scheduled for this coming Friday.

The fact I’m able to do some level (any level) of activity with neither motion control shoes or orthotics is extremely motivating. Here’s to hoping the trend continues in the right direction. It’s incredible how good running feels after not doing so for so long – even if it is just for 1 minute at a time.

Jim

“Running is a privilege.”

Secret Page

2010-01-01T12:25:00.000-07:00

This is here just to enable some pictures to be displayed.

Week 10: Sometimes Things Go Well!

2009-12-31T17:30:00.000-07:00

(If you're new here you can read the article describing my project.)

Summary: The last two weeks have been great. The feet feel fantastic. I’ve been doing 30 min of elliptical every-other-day. The hips are engaging and getting stronger. I’ve been able to consistently spend some time out of my orthotics with no issues. Rolfing session #2 has been completed. And my PT has cleared me to experiment with a very very small amount of running.

In the words of that great American George Costanza: “I’m bustin’ Jerry! I’m bustin’!”

Now for some details…………………………

Exercises. I’ve been continuing with the one-legged stance while in a reasonably deep squat position. My PT calls these retro step-ups. I’m not sure if this is his term or a general term. The goal of these has been to make Glute Max take ownership for the balance, and convincing my foot and ankle to calm down. They’ve been going well. One thing I’ve noticed is that I can balance better when my foot has some amount of arch in it. It doesn’t matter whether that arch is there because I have some sort of arch support or I muscularly raise the arch prior to the exercise. The picture to the left is the best image I could find of the position this exercise puts me in. It’s really important to notice that the knee is hardly forward at all. It should be no further forward than the shoelaces.

On another front someone posted on the Runner’s World Forums a link to a great blog – Younger Legs For Older Runners. There is an article specifically on Plantar Fasciitis with some good exercises in it. I’ve been doing those as well.

I tried some of the rope jumping I referenced in my previous blog posting. My first attempts were too much. My feet got aggravated enough where I backed off. I think I just did too much too soon. Fortunately my feet have been in a good enough state for long enough where, by the next day, they were fine.

Physical Therapy. Thanks to a cancellation (I wasn’t scheduled for PT until next week) I saw my PT this week. It was a very encouraging appointment. The next challenge he presented me with is to stand up into a straight-legged position from the one-legged squat position pictured above. Here is the critical piece that just fascinates me for some reason: The motion to raise the torso from the squatting position to standing needs to be done by Glute Max. You don’t want it to be a result of extension of the knee but rather an extension of the hip. Straightening of the knee becomes a secondary result of the extension of the hip. It’s really something. As long as my knee is in the right starting position (no farther forward than the shoelaces) this raising of the torso can be done with the quadriceps reasonably relaxed. I’ve always thought of the quadriceps as having to do this kind of work, but in this position that’s not the case. (One of the things my PT had me do was to get into the wrong starting position – knee more forward than it should be – which causes the quadriceps to do the work of standing you up. He wanted me to understand how it shouldn’t feel. This is one example of why I like the guy so much. He doesn’t just give exercises – but he explains why they’re being done and helps you understand what to look and feel for when you’re home to be sure you’re doing them correctly.)

Weaning Out Of Orthotics. My feet have been feeling so good I thought I might experiment with getting some time out of the orthotics. The feet are getting stronger. I seem to be able to go longer barefoot than before, but I still get an ache when I go too long without shoes (3-4 hours). So I clearly still need to have some amount of arch support.

When my podiatrist first suggested I get out of my old rigid orthotics (not the ones pictured) he suggested I use Superfeet Green inserts. They ended up not providing sufficient support at the time because my feet were so messed up. As a result we ended up going to some flexible orthotics (pictured) and the Superfeets got put in the closet while the acute Plantar Fasciitis symptoms subsided. I thought now they might be a good intermediate step as I try to get out of orthotics and inserts completely.

In my first attempt I went six hours wearing just the Superfeet inserts with no aches or pains whatsoever. Yowsa! I would have never guessed I could have made that kind of progress right out of the chute. So now my plan is to slowly increase that time and see if I can get to wearing only the Superfeets and abandon the orthotics completely.

Rolfing. Rolfing session #2 took place today. This is the one I’ve looked forward to the most: Foundation. This session focused on the feet and shins. There isn’t anything particularly significant to report. There were a few times the pain was pretty intense. I had to ask the Rolfer to ease up a couple of times. It sounds like that is normal. Apparently part of the pain can come from the Rolfer “going in” too fast. If they slow it down it’s easier. Also, she said my left foot (the one I tend to have more trouble with) was pretty stiff and inflexible. The lower legs feel like Jell-O. That’s a good thing. I’m really glad I’m going through this process.

If you have suggestions for what I should be doing I’d love to get them. I want to leverage and report out on as much collective knowledge as I can. Also, if you have any questions about what I’m going through don’t hesitate to email or post a comment.

Jim

gbotrr@gmail.com

Week 8: Doing More, Feet “Stepping Up”

2009-12-21T14:13:00.000-07:00

(If you're new here you can read the article describing my project.)

Summary: PT work (one-legged balancing, strengthening, etc.) continues with no issues. I’m doing 30 min on the elliptical every-other-day. My first attempt at jumping rope at the beginning of the week was too much – had to back off. And a Rolfing ten-series was begun.

The PT exercises are going well. I’m most definitely making progress on keeping my feet calm when I do the one-legged squat/balance described in last week’s report. The most noticeable movement (which I’m trying to eliminate) is Anterior Tibialis. Once I get up on one leg and let things get settled the foot stays quite calm. I’m also still doing the hip strengthening work. As I said in previous posts the Pose book has tons of exercises. The two I’m doing are 1) bending over in the classic toe-touching stance (I know…….I know……it may not be the best for the back – but I’m doing it anyway) and move one leg out to the side (abduction) as high as possible and 2) starting in the same stance but moving the leg straight out behind me. The leg remaining on the floor does all the work. It’s surprisingly difficult, although I can tell I’m building strength because they’re getting easier.

The elliptical work is going great (from the standpoint of my feet handling it well) and horribly (from the standpoint it’s so pitifully boring). (One of the things I do is download podcasts from the Tom Martino radio show. Tom is the host of a local radio talk show that focuses on consumer problems. I’ve been listening to him for years. Having something more than music to occupy the brain helps a lot.) I don’t get it – while I don’t enjoy treadmill running I’d much rather do that than the elliptical. But I’ll put up with the boredom if it means my feet are getting used to moving.

At the beginning of the week I jumped rope for 5 min. (Not continuous – if I missed a jump or was out of breath I’d pause long enough to get my breath back – then I’d start again.) It kind of surprised me how long 5 minutes was. Well, the next day my feet told me that was too much. So on my non-elliptical days I haven’t been doing anything. It took a few days but my feet returned to no pain. Today I did a very little rope jumping. We’ll see how it goes this week.

I also did Session #1 of something I haven’t yet reported on here: Getting Rolfed. I’ve decided to go through the Rolfing ten session series. It sounded fascinating before I started – and the first session alone confirmed that. When I tell people I’m doing this everyone has responded with "That’s really painful! Why would you do that?!” Well – it turns out that reputation of pain, while true in the past, is now not so well deserved. I did some research and found words such as “intense” and “some discomfort”. The bottom line is that the Rolf Institute has developed some new techniques over the years which makes the process less painful.

It was “intense” at times. However the Rolfer I’m seeing (and I’m sure others are similar) encourage frequent feedback and, if it’s too intense, they have ways to make it less so. The first session focuses on some of the superficial fascia that needs releasing. It also focuses on primarily the upper body. I have to say that when I was done I felt:

Very relaxed
My body/chest felt very “free” and “larger”.
My arms and the way they hung from my body felt very relaxed and loose

I’m really looking forward to future sessions. My next appointment (which focuses on the foundation – feet and calves – very apropos given my situation) probably won’t happen until after the first of the year.

Jim

Remember: “Running is a privilege.”

Reference: Most Popular Articles On “Running For Life”

2009-12-20T23:15:00.000-07:00

(Updated: June 12, 2010)

The following articles are accessed most frequently on “Running For Life”:

Shin Splints	http://jimhaselmaier.blogspot.com/2010/04/shin-splints-revisited.html
Comparing The Popular Running Forms	http://jimhaselmaier.blogspot.com/2010/05/pose-method-vs-chi-running-vs-evolution.html
Chronic Plantar Fasciitis	http://jimhaselmaier.blogspot.com/2010/06/different-view-on-plantar-fasciitis.html
Ankle Sprain / Ankle Strengthening	http://jimhaselmaier.blogspot.com/2009/05/make-it-better-than-it-was.html
Ozzie Gontang	http://jimhaselmaier.blogspot.com/2009/04/ozzie-gontang-jedi-master.html
Plantar Fasciitis (re: how the solution may not be in the foot)	http://jimhaselmaier.blogspot.com/2009/06/plantar-fasciitis-look-beyond-foot.html
Stretching	http://jimhaselmaier.blogspot.com/2008/12/stretching.html
Moving To Minimalist Shoes & No Orthotics	http://jimhaselmaier.blogspot.com/2009/10/new-plan-to-dump-orthotics-become-pain.html

Week 7: The Longest Journey Starts…………

2009-12-14T21:12:00.001-07:00

(If you're new here you can read the article describing my project.)

Summary: I was cleared today by my PT to 1) start using the elliptical every-other-day and 2) do some limited amounts of rope jumping. The feet feel fantastic – “perfect” even.

A couple of weeks ago I saw my PT for an assessment of my current situation. His findings were both interesting and humbling. At one point he got down into a semi-squat (feet shoulder width apart, one foot about 12” in front of the other), put all the weight on his back foot, he lifted the front foot off the floor, and then balanced on one leg. While doing this he said “Look at my knee. Look at my foot. Notice they’re steady and nice and calm. Now you do it.” So I get into the position and………..my knee is shaking all over the place…… and the muscles in my shin and foot are twitching like crazy – all in an effort to keep me balanced. If you’ve been to PT you presumably know the feeling: Something looks easy when they do it – and seems impossible when we try.

What my PT has seen is that, if Gluteus Maximus (GM) doesn’t “own” keeping you up and balanced, then the rest of the kinetic chain ends up working overtime. So the last two weeks have been a series of exercises to not only get GM stronger, but to retrain my neuro-muscular system to get GM engaged and tell the lower parts of the chain to relax. Doing these in front of a full-length mirror has been really fascinating. When I started the regimen my feet, especially Anterior Tibialis, were working like crazy. With time they’ve calmed down some, but I still have a ways to go.

I’ve continued with the core work I’ve described in previous postings. The Pedestal is the mainstay. I’ve been able to increase my time in the position from 20 seconds to a full minute. There are also some good exercises in the Pose book. A few of them are focused on hip strengthening and they’re just killers for me.

So, as I said in the Summary above, I’ve been cleared by my PT to start some activity. The elliptical is gentle enough (from a foot pounding standpoint) where I’m hoping that the movement will encourage the Intrinsic Foot Muscles (IFM) to become active and build some strength. I’d also read on the Pose forums a suggestion to jump rope to build foot, ankle, and calf strength. So that, too, got the green light from my PT. I’ll do these in a very limited fashion and see where we are in a couple of weeks. It still feels a bit strange to think of my feet as getting tired, but that really is a good description for how they feel after being on the elliptical or jumping rope.

On the one hand this seems like such a trivial step (some elliptical work and jumping rope) it’s hard to get too excited. On the other hand I know that my next half-marathon, whenever that happens to be, won’t be achieved without starting somewhere.

“The longest journey starts with a single step.” Or maybe in this case: “The journey back to running starts with one rotation on the elliptical machine.”

Jim

Remember: “Running is a privilege.”

Week 5: Not Sure Where This Is Going

2009-11-29T17:40:00.001-07:00

(If you're new here you can read the article describing my project.)

Well, I don’t have much to report. This past week I’ve done the PT exercises I was given. Overall I’ve seen progress – I’m more proficient (strength, skill) now than I was when I first started doing them. On the one hand the feet feel really good. On the other hand, I’m not really testing them in any way. I think I’m ready to “go to the next step”, although I don’t know that that is: More exercises? Some activity? Something else? Since I’m working with my PT I want his input before I figure out what is next on the agenda.

Rather than publishing weekly updates I'm going to now update this space when some meaty progress has been made. I’ll be back when something interesting has happened.

Jim

Week 4: Some Non-Foot Issues…..Apparently

2009-11-22T07:54:00.000-07:00

(If you're new here you can read the article describing my project.)

Summary: Heel pain has been minor-to-non-existent. I’ve “regressed” to wearing the motion control shoes with the orthotics for roughly 14 hours per day, with 1-2 hours of around-the-house barefoot time each day as well. I saw my pain level creeping up as I tried the low profile shoe transition and I realized I need to get back to a very solid, totally pain free state.

Activity Level: Essentially none. Core work continues, but later on I’ll describe some new stuff I’ve been working on. I am going to start walking. I’ve found when I’m injured just walking some of the routes I normally run helps me mentally. We’ve had some nice days in CO and I could look at getting the bike out, but that has been hard mentally because of all this cell phone use when driving. If I was really proactive I’d get to the pool – but getting into water at 6:00AM is just a nightmare for me! (Not from a fear of water perspective, but fear of cold!)

What Happened Last Week: After seeking orthotic transition ideas from my PT we decided it made sense to make an appointment and get some things checked.

It turns out each hip, even though they’re in a lot better shape than they used to be, aren’t in a state to provide the right stability the rest of the leg requires. He had me perform a variety of tests and they all pretty much resulted in the following: When I do some sort of one-legged stance my hip’s ability to stabilize the knee is very poor. His belief (and what he has seen) is that when this occurs you’re creating a less-than-ideal situation for the ankle and foot. Some ankles and feet can handle this, others cannot.

So I’ve been doing a variety of hip strengthening and balancing exercises. The goal is to develop sufficient strength and skill (i.e. train the neuro-muscular system) to enable me to be in these one-legged stances and have my foot be “calm” – not firing all sorts of muscles to keep me balanced. It’s kind of funny doing these in bare feet. I can literally see how my feet work hard – and per the PT, harder than they should – to keep me balanced.

It feels a bit odd trying to solve foot problems by working on something “so far away” (the hips), but it makes sense. (I don’t know if it is the thing that will actually solve it, but it makes sense.)

Everyone have a good week. And if you’re in the US, have a good Thanksgiving.

Jim

“Running is a privilege.”

Week 3: Progress? I Think So………………

2009-11-15T17:28:00.001-07:00

(If you're new here you can read the article describing my project.)

Summary: Heel pain has been minor-to-non-existent.

Activity Level: Essentially none. I’ve been doing the core routine and balancing work.

Commentary: This has been both a frustrating and encouraging week. The frustrating part comes from the fact that I’ve accumulated all this foot gear: Motion control shoes. Superfeet Green inserts with some arch support. And, of course, my custom orthotics which have a ton of arch support. Add to the mix the low profile shoes which I described in last week’s report.

The focus of the week became answering this question: What approach should I use to wean myself off of all this stuff? Do I go straight to the new shoes wearing no arch support and slowly build up my time? Do I stay in my motion control shoes but try to get to wearing Superfeet inserts with less arch support, and then repeat the process to get out of them entirely? Fortunately I have a friend who 1) is very good at thinking things through and 2) is very interested in this project I’ve undertaken. He and I had multiple, detailed conversations on the approach that would be best. We didn’t always agree – but we kept hashing it out.

The encouraging part of the week was that I was able to get to wearing the Superfeet (in the motion control shoes) for 3 hours a day. That, in addition to the 1.5 hours/day of barefoot walking I do, helped me feel that I was making progress.

However what we were both struggling with was the fact that these motion control shoes have a high heel. (That term always makes me think of the line from the Steely Dan song FM: “Kick off your high-heeled sneakers, it’s party time.”) Given the motion control shoe has a high heel it’s really hard to optimize your footstrike, even with plain walking. I found an article on the Pose website about weaning oneself off of orthotics. Their suggestion was to start by wearing the orthotics in the target low profile shoe, and then start the weaning process from there.

My friend and I thought that was a good approach. So my current plan is to first get to a point where I can wear the low profile shoes, with my orthotics, all day long. Once that is in place I’ll begin experimenting with going without the orthotics while wearing the low profile shoes. I just decided on this strategy a couple of days ago. I can currently do 3-4 hours a day in the low profile shoes with orthotics. We’ll see how long it takes to get to doing so all day.

So overall I think it was a positive week (I consistently was able to go without my monster orthotics) although thinking through the combinations and permutations of shoe and arch support hardware got a bit frustrating. Hopefully now I’m on a pretty simple-to-execute plan to ultimately get off of this stuff.

Lastly, I want to give a shout-out to Mr. & Mrs. F (you’ll get the context when you visit there) for their accomplishment this weekend. They’ve completed the C25K program and celebrated that fact with their first 5K run. They’ve done a fabulous job of chronicling their efforts to take up the sport/hobby of running and I find their dedication very motivating. You can find their blog here.

Jim

If you’re able to run now – relish in it. If you can’t – don’t give up on your efforts to get better and get back on the road because………………….Running is a privilege.

Week 2: Getting My Feet Back Down To Earth

2009-11-08T18:00:00.000-07:00

(If you're new here you can read the article describing my project.)

Summary: Heel pain has been a minor roller coaster – because I’ve been taking steps this week to get out of the orthotics. New Pose-endorsed shoes: Arrived. Balance Disk: Arrived.

Activity Level: Some, but very little. Walked for 0.2 mi in the new shoes. Tried a little Pose running – only a few minutes.

Commentary: This week has primarily consisted of experimenting with weaning myself off of the orthotics. Early in the week I had plans to go out for dinner. I decided to take out the orthotics and use my Superfeet Green insoles instead. Things went great! I was without the orthotics for four hours. I had to walk some – not a lot. I got home and the feet felt perfect – fantastic. I thought “Oh man this process is going to be a piece of cake!”

The next day I give it another go. Same setup as the previous evening – Superfeet Green insoles. I think ahead enough to throw my orthotics in my briefcase before I leave the house. I figure, if something goes south during the day, I want to be able to put the orthotics back in. The day goes great! I have a desk job – but I still have to walk a bit. Things went so well I completely forgot that I wasn’t wearing the orthotics. I start packing up to head home and I feel a slight twinge in my heels. Oh no – this can’t be good. The pattern I’ve noticed with my heel pain is akin to what we hear when it comes to staying hydrated: Once you’re thirsty it’s too late. Well, once I start to feel anything in my heels, it’s too late. That doesn’t mean the pain will be bad, but it does mean I’ve taken something too far. So I get home and I immediately put in my orthotics. My feet overall are sore (tired and achy) and my heels hurt a bit. I’m smart enough to bring my orthotics to work, but dumb enough to not actually use them.

Before I go on I need to give a little background because it impacts the results through the rest of the week. I’ll keep it short. When I first got out of my hard orthotics two years ago my podiatrist said I should use Superfeet Green insoles. They have a good amount of arch support, which I clearly needed. When they failed to stop the acute Plantar Fasciitis pain we went to the custom flexible orthotics I have now. My plan with regards to getting out of the orthotics was to first become able to use Superfeet Green full time, and then wean myself off of those. After some reading I decided it wasn’t necessary to take that step – I should just go right to no arch support – but I obviously would need to be very careful as I do it. So after the successful evening out (4 hours) and bad result following the seemingly good work day (10 hours) I figured my “baseline” was 4 hours, and that I would build up my wearing time from there.

The new shoes arrived mid-week. Holy smokes – they’re like slippers! They’re really comfortable. It feels so good to not have all this hardware around my feet. I think it’s kind of funny to compare what I use now (Saucony Grid-Stabil with orthotics) and where I’m trying to get to. The first photo (obviously) is my current setup, including the orthotic. I think when it’s all said and done and the orthotic is in the shoe my arch is over 1” above the foot bed. The second photo (again obviously) is the new shoe. Saucony Bullets – a model Saucony originally had in their lineup in 1985 I believe. (I think they re-introduced them recently – they’re available “new” now – as sort of a retro/nostalgia thing. But that’s just my guess.)

So I have my no-orthotic baseline established (4 hours). The new shoes are here. We are ready to rock-and-roll. The first day I have the new shoes I wear them around the house for four hours. Astute readers will now realize a critical mistake: I’d established the four hour baseline while using the Superfeet inserts. When I wore the new Sauconys I didn’t put the Superfeet in. So I did four hours with no arch support at all. By this time my feet had recovered from the all-day work fiasco, but I essentially re-inured them. Fortunately both of these episodes were minor and, as of this writing, the heels feel normal.

Jeremy from http://barefoot-running.com/ pointed me to his site and referenced some transition information there that is helpful. I think my no-orthotic baseline is 60 min. I’ll start building up my time from there.

On Saturday I went to a track and did a little (very little, about 200m) barefoot running. The track was rougher than I anticipated, so the aggravation to the soles of my feet was more than I expected. All-in-all it felt absolutely fantastic. Unfortunately today (Sunday) I woke up and my heel was a bit sore. I think I have to remember the very first bullet of my plan to make this project work: No running.

The balance disk has been interesting. I can see the skill level improving as I use it. I think I’ve noticed when I use the disk in the Bullets my feet definitely get a workout. I’ve continued the core work and other activities I documented in last week’s report.

This week’s goal: Increase the no-orthotic time. I think I’m going to approach it strictly by time: Monitor very closely exactly how much time in the Bullets my feet can handle.

Jim

Running is a privilege.

Week 1: Getting Out Of Orthotics & Motion Control Shoes

2009-11-01T20:00:00.011-07:00

(If you're new here you can read here the article describing my project.)

Summary: Heel pain almost non-existent: 0-.5. (using a 10 point scale - "10" being excrutiating pain)

Activity Level: None. (No walking or running outside.)

Commentary: The week has consisted of doing my indoor routine. The only outdoor activity I was half-way considering (barefoot walking/running in grass) at the beginning of the week was dashed when 15+" of snow were dumped on us.

My daily indoor routine has consisted of the following:

Core Work: Various exercises on the exercise ball. I've been doing some of these, but not all. I've been doing The Pedestal which you can find here on YouTube.
Glute Strengthening: I've been doing some one-legged squats. I can't go all the way to the floor in a real pistol squat, but I can get down to slightly above knee height. I've actually been doing them for a while - before this project began.
Stretching & Fascia Release: Many thanks to Ozzie Gontang for some advice on this one. I've been focusing on two areas. First, the stirrup muscles - Posterior Tibialis and the Peroneus muscles. Both of these sets of muscles come down around the ankle and connect under the foot - impacting significantly foot dynamics. For Posterior Tibialis I've been using a massage technique that Ozzie has described here (look at the bottom of the page). For the Peroneus muscles I've been using a foam roller. It has also helped to use the edge of something hard - like a wooden step or edge of a table. Second, I've been using a tennis ball on the Plantar Fascia. You can stand/lean on the ball, focusing on three different areas of a the foot: right behind the balll of the foot, the middle of the arch, and right in front of the heel. Another activity has been using the nose of a wooden step to massage the Plantar Fascia. While wearing socks, placing the edge of the step right behind the ball of the foot, while pushing down fairly hard, slowly slide the foot so the step moves toward the heel. It's fairly painful - but I'm hopeful it will be less so as things loosen up.
Foot Movement. I've been going without my orthotics or my motion control running shoes for limited amounts of time - about 1-2 hours each day. During this time I've either worn only socks or a pair of those cheapo (~$6) water shoes. The latter provides a little bit of padding for the large amount of wood flooring I have in my house.

The purchased items described in the article launching this project (my low profile Saucony Bullet shoes and the balance disc) have not yet arrived. I've also ordered Pose Method of Running by Dr. Nicholas Romanov. All items should be here this week, if the FedEx and USPS websites are telling me the truth.

Goal for the coming week: Use the new shoes for my "allow foot movement" time. Incorporate the balance disc as well as Pose drills (using the low profile shoes) into the daily routine. I hope to add some outdoor walking into the mix as well.

Jim

Running is a privilege.

A New Plan To Dump The Orthotics & Become Pain Free

2009-10-26T22:46:00.013-06:00

In the time that I've been writing here I don't believe I've ever written a new article so soon after posting the previous one. Over the weekend I decided to drastically change (relatively speaking) my approach to getting out of my orthotics and free from Plantar Fasciitis (PF). And I've decided to turn this blog from a place that contains various ramblings about running and injuries into a chronicling of my new efforts to get out of all this shoe and orthotic hardware and really be pain free.

For many months the plan I've had with my podiatrist has been to use my current flexible orthotics to keep the PF in check, while allowing my feet to move and increase their strength. The goal has been to, ultimately, be orthotic free. I've been deeply committed to this philosophy as well as frustrated at the time it seems to be taking to make it happen. The doc has asked I be patient, that it will come with time, and he has said that I can continue to run on a limited basis. This has been going on for a year. On the one hand I'm running 3 miles every-other-day, which is light-years ahead of where I was 12 months ago. On the other hand I continue to deal with heel pain that comes and goes, which leads me to believe I'm not really getting better - totally better. In an effort to get over "that last little bit" I've been doing all sorts of things: hip strengthening, adjusting the degree of arch support, stretching, core strengthening, small amounts of barefoot running in grass, starting to change to a midfoot strike, etc. The bottom line is this: I'm not getting over "that last little bit" and I'm not able to determine if any given effort to make things better is really helping or not. Conversely, I'm not really sure if my small amount of running is too much and, consequently, undoing any progress I might be making.

I've been doing a large amount of reading recently that has strongly influenced my decision to approach this differently:

The Pose Running Method. Pose is a running form that focuses on efficiency as well as minimizing the stress running typically places on the body - ultimately resulting in lower injury rates. Dr. Nicholas Romanov created this method quite a number of years ago. It has brought positive results to many. Check out http://www.posetech.com/
Born To Run by Christopher McDougall. Chris searches out the Mexican Tarahumara Indians who are legendary runners. He does this because he has been told by his doctors to stop running due to his age and a variety of foot issues. He learns how the Tarahumara are able to run at levels most runners deem unattainable. When Chris adopts some of their basic principles he not only is able to run pain free, but he completes a 50 mile ultramarathon. If you take nothing else from this or future postings read this book. It's fabulous.

My new project is going to consist of the following plan. Much of this comes from the Pose website. Other components I've added myself.

Stop running. These two words are what the majority of runners least want to hear, however I think I need to take that entire variable out of the equation in order to see if I can make progress on the foot pain and strength and not wonder if I'm undoing progress when I subject my feet to the pounding of running.
Do a small amount of walking/running barefoot in grass. Experiment carefully to be sure it's not causing damage.
Learn and practice the Pose drills. Right now I'm using the Pose website as well as YouTube to learn about them, their purpose, etc.
Wear a Pose-endorsed shoe. The Pose philosophy, when it comes to shoes, is that a very minimalist shoe should be used - to encourage the foot to feel the ground and fire the right foot muscles appropriately. The belief is that the modern padded running shoe prevents this from happening and actually encourages us to run incorrectly.
Consistently execute a core and hip strengthening program. I have an exercise ball and will be using it to work on core strength.
Consistently work a program for improving balance. I think the Bosu Ball is the ideal solution here - but I'm not willing to drop $100 for the privilege. I've purchased a balance "disc" ($20). I'm also going to be doing some work my PT has suggested.
As I get to the point I can consistently do the above with no foot/heel pain, begin some extremely short (Did I say "extremely"? 200m? 400m?) runs on hard surfaces using the Pose method. If well tolerated, increase at an extremely conservative rate.

The first step for my plan is to get a shoe that adheres to the Pose philosophy. This is likely to be the first of a number of odd-feeling steps in this project. I've always run in the high end motion control models (Asics MC-Plus, Brooks Beast, Saucony Grid-Stabil). I like Saucony shoes. I looked on eBay and found a Saucony Bullet for $50. Talk about a shoe that is the exact opposite of a motion control shoe! It should be very interesting to give them a go.

Next Step & Goal: Get the shoes and start doing the Pose drills while wearing them - and see if I can just do them consistently without aggravating the foot pain. I'm not going to attempt any running (besides a very limited amount of barefoot grass running) until I can be sure I can do the basic drills pain free.

I can commit to giving updates here on how things progress. Whether those updates end up being reports of success or failure remains to be seen.

Jim

Running is a privilege.

[Return to the current blog posting.]

Progress - On Multiple Levels

2009-10-22T21:40:00.019-06:00

I’m in an awkward place. On the one hand what I’m about to write makes me extremely nervous. On the other hand I’m also very eager to do so. To set the stage, as I described in my last posting, I’ve been putting effort into adopting a midfoot strike with the hopes of easing the forces on my feet and improving my Plantar Fasciitis. I’m nervous because, as I’ve pursued seemingly hundreds of things to have this get better, many times I thought I’d found the cure – only to be disappointed and realize the feet weren’t getting better as quickly as I thought they would. I’m eager to write because I had a run this morning that was just so over-the-top fun – well – I have to tell somebody. :-)

I’ve only been able to run 3 miles every-other-day. What made this morning especially challenging was that I had a phone call for work at 6:30AM. So I needed to be done and back in the house by 6:15. I go out early by many people's standards, but even by my standards this was early. Additionally, the previous two nights I’d gotten very little sleep. As I lay awake at 4:30, 10 minutes prior to my alarm going off, I was searching for a reason to run some other time. Luckily I failed and got out of bed anyway, figuring I’d feel worse about blowing off the run than having a bad run. All the stars were aligned to have this be a complete disaster.

Before I go into the details of the actual run it’s appropriate to describe a bit about my efforts to adopt a midfoot strike. A few years ago I tried Chi Running. Unfortunately – it just didn’t work well for me. I know it has been fantastic for others, but it just didn’t work for me. It felt a bit like trying to simultaneously rub your stomach and pat your head. There were just a few too many things for my simple mind to keep straight and coordinated. So this time I did some reading about Pose. I probably should get the book. (Sometimes it feels like, in an effort to get to running that is less injury prone, I’m spending as much money on gadgets and books as I would if I just stayed injured and paid all the doctor fees.) A friend told me of Pose drills to help one get the feel of the body movements. I searched YouTube and, of course, I found some videos. I studied them and practiced them myself. It was fascinating. For example one drill is simply lifting up your heel close to your butt and standing on one leg. It appeared, while watching the video, that the value of me doing it was close to zero. It just seemed too simple. But I did it and I started realizing “This is where my knee is.”, “This is how it feels to have a relaxed ankle.”, etc. There were some other drills and I did them as well.

So I’m outside finishing my warmup walk and I break into a run. Immediately it just feels fantastic. The sensations from the drills are translatable to the dynamics of running and it feels great. Even though it felt great, I recognized that by the end it might not feel so great (the fitness level has not returned and, of course, I’m carrying a bit of extra poundage around since I haven’t been running at my normal volume). The run continued to feel great. And it continued to feel great. I didn’t hit that wall of exhaustion. Don’t get me wrong – I got tired. But I noticed something else that was interesting: When I did feel tired I was able to use the drill sensations to remind me what I should be doing. It’s easy to have form break down when you get fatigued, but the drills helped me keep the form.

And best of all – the feet feel fantastic – probably the best they’ve ever felt at the end of a run day. Who knows what they’ll feel like tomorrow. I’ll deal with tomorrow tomorrow. As for today, it was a great run. And remember that, even when a horrific run seems “guaranteed”, you never know what you’re going to find until you actually get out there.

Jim

Running is a privilege.

Cross Training vs. Doing More Damage

2009-08-10T17:23:00.006-06:00

One of the standard “treatments” for Plantar Fasciitis is to lose weight. That makes sense: The less weight you have bearing down on your feet the less stress they’ll be under.

So, as a recovering Plantar Fasciitis sufferer, the prospect of going on an 8-day backpacking trip through the WY mountains scared me a bit. Not only would I be instantly gaining 40 lbs. each time I put on my pack, but the itinerary called for traveling a total of 43 miles and crossing the Continental Divide multiple times. Backing out of the trip was not an option – both because I wanted to go but also because I was part of the adult team leading a group of Boy Scouts on the trip.

Fortunately I was able to see my Podiatrist before I left. I told him my predicament (my recovery had been progressing fine and, were it not for this trip, I wouldn’t even be in his exam room) and asked if there were any “emergency” measures we could take to prevent my feet from becoming hamburger and setting back the months of progress I’d made. He made a simple modification to my orthotics. He placed some piano felt across the arch and created a relatively significant bump to provide even more arch support. He said it would feel really strange (and it did) but it would prevent the plantar fascia from being stressed too much under the additional weight.

The orthotic change seems to have worked really well. While I finished the trip with a few feet issues (a little swelling, a little numbness) I have not acquired any renewed classic Plantar Fasciitis symptoms.

I’m looking forward to running again since I haven’t gone out since I got home. The problem is that I’m just exhausted. I thought I was a relatively fit person, but this trip just totally wiped me out. From a raw strength and endurance standpoint I think it is the hardest thing I’ve ever done. Backpacking doesn’t even come close to providing the level of enjoyment I get from running. But it did open my eyes as being a very viable cross-training option. I think it was great for the hips: With every step Gluteus Medius and the IT Band have to hold up that extra weight. And I can even see that, within reason, it’s a good way to strengthen the feet.

I’d be interested to hear if others have used or viewed backpacking as a cross-training option. I could see donning a pack loaded with deadweight every couple of weeks and going on a hike in order to build strength in key areas. Fortunately this method also enables you to go on an instant diet – lightening yourself by 40 lbs. when you take your pack off. This potentially provides a great way to control not only the extra load, but also how long your body is dealing with it.

I’d be interested in your thoughts and experiences.

Jim

Milestone Achieved

2009-07-06T20:29:00.002-06:00

Well, there it is: Last Saturday's race bib hanging on my garage wall. As I described earlier, my last race (the last time I put a bib on that wall) was July 4, 2006. The time between then and now has been filled with Dr. appointments, Physical Therapy appointments, MRIs, internet research, doing my PT exercises, run/walk combos in an effort to build up endurance, and wondering when I'd be able to run consistently again.

It felt so great to get out with a bunch of runners. The weather was indescribable - just gorgeous. What amazed me was the breadth of people participating. Clearly very experienced, thin, toned runners. Those obviously new to the sport. Kids. People in their 70s.

What a great way to get energized. It's kind of too bad these events are called "races". For me "racing" is a small component of why I do them. Sure, oftentimes I'll go into a race with a specific goal in mind. But other times (like last Saturday) racing had nothing at all to do with it. Participating had everything to do with "being back in the game" and being around people who simply enjoy getting out and moving.

Jim

"Running is a privilege."

The July 4th 5K: A Milestone

2009-06-18T21:01:00.001-06:00

At some point in my running career I starting hanging my race bibs on the wall in the garage. I wanted to have a place where I'd get a frequent reminder of the races I've done and also keep me motivated to enter more.

The last time I hung up a number was July 4, 2006. It was following that race that my injuries really took off and, since then, my running life has been centered on injury diagnosis, doctors, MRIs, physical therapy, grumpiness and about 15 extra pounds.

Yesterday, for the first time in 3 years, I ran 3 miles and my feet handled it really well. The timing couldn't be better. In the next couple of days I'll go register for our town's July 4, 2009 5K. I won't care (at all) about my time. In fact, I'll probably not even bring my watch. Being able to run it will be good enough for me.

Now I've gotta find my staple gun......................

Jim

Plantar Fasciitis: Look Beyond The Foot

2009-06-01T18:00:00.001-06:00

I've written previously about how the presence or location of pain may not be an indicator of where the actual problem is - just a symptom or result of the problem. I believe this is the case with Plantar Fasciitis. After dealing with this condition for quite some time I'm realizing the solution (at least in my case) involves much more than just the foot. Have you ever seen what happens to a car tire when the alignment is out of whack? The tire wears unevenly. No one claims that's a problem with the tire. The ruined tire is just a symptom of something else that needs to be fixed..

The Plantar Fascia is a set of connective tissue on the bottom of the foot that ties together many of the bones in the foot. The term Plantar Fasciitis (PF) gets its name from inflammation and micro-tears that occur when the Plantar Fascia is over-stressed. Additionally, the attach point at the heel bone comes under stress, leading to pain in the middle of the heel. Many websites can be found detailing PF symptoms and suggested treatment. Here is a good one.

Apparently (based on my reading as well as personal experience) one key reason that Plantar Fasciitis develops is because the natural process of pronation (your foot rolling inward when the heel strikes the ground) is too abrupt, rather than it being a controlled movement. Uncontrolled pronation ends up transmitting too much force and rough treatment to the Plantar Fascia - something it was not designed to handle. Controlled pronation is more easily tolerated by the Plantar Fascia than uncontrolled pronation.

So, what can be done to help control pronation?

Arch support. Control pronation from underneath the foot. Help stop if from moving too much. There are two schools of thought in podiatry today on how best to provide this support: rigid or flexible orthotics. I believe in flexible, which will become evident through the rest of this article.

Intrinsic Foot Muscles (IFM). These are muscles in the foot. Two classic exercises for strengthening the IFM are towel curls and marble pickups. Additionally, however, I found this fantastic article that describes another foot exercise. It specficially addresses strengthening the IFM to better assist when the foot is pronating. Check out pg. 6 of the article found here.

Posterior Tibialis. This muscle runs along the inside of the shin bone. The tendon runs around and underneath the inside of the ankle bone and connects to both the top and bottom of the foot. This muscle helps slow down (control) foot pronation. Ozzie Gontang has written a great description for massaging this muscle. (Look at the bottom of the page.) Here is a YouTube video on how to strengthen it.

Gluteus Maximus. Huh? Gluteus Maximus (GM) helping with pronation? Well, it turns out a weak GM allows the femur to rotate too far inward, which means the knee is too far inward, which means there is no way for the rest of the chain (Posterior Tibialis, IFM, etc.) to deal with all that pronation force. If you sit a lot during the day you're especially prone to weak or inactive GM muscles. Here are some ways to strengthen Gluteus Maximus.

And don't forget: The traditional PF treatment, in my opinion, must also be followed. Stretch the calves. Ice the Plantar Fascia. Etc.

My podiatrist says that, when everything is all calmed down and the feet are accustomed to a given level of activity (which can be a multi-month process), then one can "wean" themselves off of the major arch support inserts that may have been used to get through PF. He is a big proponent of the Superfeet Green inserts. Hopefully, given time, that will be the only arch support required.

So........treat where the pain is - the foot itself. Traditional PF treatment is needed. (Even when the car needs alignment the irregularly-worn tire still needs to be replaced.) But don't lose sight of how the other parts of our "suspension" also affect Plantar Fasciitis.

Jim

Make It Better Than It Was (Sprained Ankle)

2009-05-20T07:20:00.002-06:00

Isn't it a horrible feeling when you sprain your ankle? I don't mean just physically, but mentally as well. You take that step, you realize your ankle is on it's side, and three things flash (yell) in your brain, all at the same instant:

"This hurts like hell!"
"Totally collapse all limbs right now! Get weight off that leg as quickly as possible."
"It may be multiple months before I run again!"

Many people think they simply need to give their ankle time to heal, like any other injury. While healing time is important, in my opinion, rehabilitation is equally important. When you roll an ankle all sorts of bad things can and do happen. Tendons and ligaments get stretched, sometimes torn. Nerves can be damaged. And let the swelling begin! Holy cow - sprained ankles can look horrible.

The immediate treatment protocol has been written about ad nauseum: Rest, Ice, Compression, Elevation. (RICE). A good overview of the initial 24-48 hour treatment recommendations can be found here. And don't forget to go to the doctor! You want to be sure nothing is broken, or cracked and about to be broken.

To rehabilitate the ankle my PT had me do the following:

Strength. Stand on one leg. At the beginning you're working on basic strength. It's amazing how quickly it feels fatigued. Try to build up to 2-3 minutes. As it gets stronger do heel raises. Stand with your feet a little bit apart. Raise your heels so you're standing on the balls of your feet.
Flexibility. Do standard calf stretches. Do the calf stretch where feet are shoulder width apart, one a bit in front of the other. Bend at the knees and you can get an extra degree of shin-over-the-foot flexibility. Take care of the opposite movement: While sitting in chair slide your foot (while flat on the floor) as far forward as it will go.
Balance. Balance on one foot. Get those nerves better at firing as they should. When you can do that well make it more challenging. Fold your arms across your chest. Close your eyes. You want to improve proprioception - the body's ability to determine where a limb is in space from the muscles and tendons themselves.

How do you know when you can try running on it? A rule of thumb I've heard is to jump up and down on the injured ankle for 2 minutes. If you feel no pain you can try running. Notice I said "no pain". I didn't say "a little", or "tolerable" or some other weasel word.

I've read that the biggest risk factor for spraining your ankle is having previously sprained your ankle. So get it rehabilitated well and reduce the chances of it happening again.

Jim

If A Tree Falls In The Woods............

2009-05-07T18:10:00.004-06:00

What does it mean to "prove" a diagnosis? These tests our doctors need and like to perform: Do they prove anything? Or do they just offer data to the diagnostician? And what about tests where you actually get an image - something to be seen? Do those tests offer more and/or better information than things like blood tests and such where the results are just numbers?

Wow - lots of questions. How about some answers? (Or, since I'm not a medical professional, a layman's opinion.)

As I surf the Runner's World bulletin boards I've noticed a pattern where people seem to view the imaging tests (specifically CT Scan and MRI) as the "proof" one needs to determine what is going on. Heck, these technologies let the Dr. look inside the body in high degrees of detail. One would think seeing is the best way to determine the actual problem.

I had an experience that challenged this assumption. I started getting a variety of symptoms that pointed to sciatic nerve issues. (Remember that "Sciatica" is a set of symptoms, not a problem per se.) There are a couple of conditions that can cause pain via the sciatic nerve. The two most common (I believe) problems that cause sciatica symptoms are:

Protruding L4/L5 disc which pushes on the sciatic nerve as it exits the spinal canal.
Piriformis Syndrome - where the Piriformis muscle becomes tight and pinches the sciatic nerve deep in the hip.

After having an MRI of my lumbar spine completed the results were apparently conclusive: Bulging L4/L5 disc impinging the sciatic nerve. Case closed, so to speak. I was referred to my Physical Therapist (a really good one) and I began a 3-4 month regimen of McKenzie back exercises and swimming. Although my pain subsided, I'd also virtually eliminated the activities that tended to bring on the pain such as running and long car rides, so I figured I was healing.

Feeling better, I attempted a bike ride. After one 30 minute ride the pain returned - very localized in my hip. That really got me thinking: If a disc in my back was the problem, how could it push on that nerve to make it hurt in just that localized spot? It just didn't make sense to me. I really wondered if the disc diagnosis was correct, however I felt trapped because the MRI had "proven" the disc was the problem.

I decided to see an orthopedist to get another set of eyes on my situation. He reviewed the MRI in detail (technology is great: in the exam room he logged onto the hospital's servers across town and pulled up my MRI) and said something fascinating: "I could pull 100 people off the street with this same MRI and none of them would have back pain. That disc is not your problem."

It turns out it was Piriformis Syndrome that was causing my sciatic nerve symptoms. After some massage and stretching and PT work focused on the hip I was good to go.

Even when you think you have proof, convince yourself that the proof really is proof. It may not be.

Jim

Ozzie Gontang: Jedi Master

2009-04-23T20:44:00.004-06:00

I recently re-discovered an invaluable internet resource for the running community: Ozzie Gontang not only has a tremendous amount of knowledge about the body, how it works, and running, but he has been sharing that knowledge with thousands and thousands for many years.

When I started my running "career" over 10 years ago about the only place (from what I could tell) for runners to congregate on the internet was the rec.running Usenet group. Ozzie not only shared his experiences and knowledge, but he also maintained the rec.running FAQ. While my running continued, I fell away from being active in the internet running community, until recently when I started engaging in the Runner's World forums.

The other day I remembered Ozzie and, thanks to Google, he was easy to find. Check out the Mindful Running information on his website. Ozzie has really assembled some great stuff.

Jim

Shin Splints

2009-04-16T21:18:00.000-06:00

[An updated and more comprehensive Shin Splints article has been written following up on the article below. The updated article can be found here.]

The topic of shin splints comes up a lot on the Runner's World forums. It's a frequent malady for new and experienced runners alike. Frequently shin splints result from advancing your running too quickly (either mileage or speed) and not giving your body a chance to adapt. The shins ache; typically over a portion of the lower leg. (As opposed to having pain in a very specific location, which can be indicative of a stress fracture.) Shin splints can happen in either one or both legs.

While shin splints are quite common, they can be confused with other much more serious injuries. Stress fractures and compartment syndrome can have similar symptoms. Most importantly, see your doctor so you're sure you're not dealing with something really serious.

OK, so you know you have shin splints and they need to be treated. When I've had shin splints I've followed the following regimen and it has worked beautifully:

Rest. Notice I didn't say "Stop running." But you do need to cut back enough to let your shins rest and be not so stressed. Sometimes sufficient rest does equate to not running. But I don't think everyone needs to start there.
Ice. Ice them as much as you can; 3-4 times per day is great. Be really careful when icing your shins. The skin is thin and it can be easy to get an ice burn.
Strengthen. Building stronger shin muscles will help alleviate the condition. Hang a weight from your foot. A plastic grocery bag with 1-2 soup cans in it works great. Now sit on a stool or counter so your foot is off the floor. Moving the foot only at the ankle, raise and lower the weight so you work the muscles on the front of the shin. I do 3 sets of 10 reps; 2 times per day.
Stretch. Keep your calves stretched and loose. A foam roller works well. The standard calf stretches can be found using Google. I recently wrote a blog entry on Active Isolated Stretching, which is another alternative to keep your muscles loose.

You'll find other things on the market for shin splints like compression sleeves, etc. I've heard reports they help, too. I have never tried them.

Doing this for 1-2 weeks should help a lot.

Jim

Stretching

2009-04-09T06:00:00.000-06:00

We've all heard about the importance of stretching and staying loose. The standard approach to getting a muscle to loosen up is to "wrestle it into submission". How many of us have stretched our calves by putting one leg back and leaning up against a wall? I know I have - thousands of times.

The issue is that this method may not be very effective. This form of "passive" stretching can actually cause the muscle to go into a protection mode - actually tightening up in an effort to not stretch too far.

A different method of stretching is becoming popular. This method takes advantage of the fact that, when your brain tells one muscle to contract, it has to tell the opposing muscle to relax. For example, sit on the floor with your leg straight out in front of you and the foot pointing toward the ceiling. Rotate your ankle so your foot/toes come toward you. When you do this you're contracting the muscles on the front of your shin, and the calf is being told to relax.

To make this an effective stretch, the goal is to hold the stretch, for just a couple of seconds, while your brain is telling the muscle to relax. This method is called Active Isolated Stretching (AIS). NPR did a good story on AIS which can be found here. You can find videos on YouTube to see how the techniques are used on specific muscles. Here is a good one for the hamstrings.

I've been using AIS techniques on my calves and hamstrings and I believe I can see (literally) improvement. I had less flexibility in one ankle compared to the other. Using AIS I've been able to improve that range of motion. Not only that, but it's a much more enjoyable way to increase your flexibility.

Jim

Battling The Plantar Fasciitis Beast

2009-03-31T21:05:00.002-06:00

Man - if I could just kick this last bit of Plantar Fasciitis I'd be fully back in the running game. I just can't get this last little bit of heel pain wiped out. If I didn't run things would be grand. No running = no heel pain. But - obviously - the goal is to run!

Through a long boring story my podiatrist suggested I get rid of my rigid orthotics. Doing so, he said, would be better for my feet. However it brought on a raging case of PF that I continue to fight.

As always I remain hopeful. Yesterday they made some modifications to my somewhat-new flexible orthotics. Hopefully that and a little rest will do the trick.

Jim

Dodging A Bullet

2009-03-14T07:51:00.004-06:00

I live in CO and I really like to ski. I don't go crazy over it - heck - I took about a 25 year break from it. But over the last few years I've returned and it's really fun.

Last weekend I took what felt like a pretty minor fall. My binding released. And when I stood up my knee was a little sore. I put my ski back on and away I went. I skied another 3-4 hours and totally forgot the event. That night it was so sore I could hardly get out of a chair. 5 days later I still had trouble getting out of a chair. I was sick - just returning from a multi-year effort to get through some running injuries and now this happens.

I went to the orthopedist yesterday. Man - did I dodge a bullet. The ligaments are tight as a drum and the meniscus is fine. I pulled a small muscle in the back of the knee (popliteus). I should be back to running in another week.

Monday starts a 4 day vacation at a local ski resort with good friends. We've had the reservation since last September. When I asked the doc if I could ski I said "Let me make something perfectly clear: My highest priority is protecting my running." While I want to ski I wanted him to know I was not this downhill animal that would do anything to stay on the slopes, especially not someone that would risk an injury that might sideline me for months.

I think it was easier for him to answer and provide advice once he knew specifically where I was coming from. (BTW, he suggested I "test things out" on some really easy slopes. "Structurally your knee is just fine. However when you've had an injury your nervous system compensates to protect the area. You'll favor it. You'll turn slightly differently. *Those* differences might cause you to behave differently on more difficult slopes. And that can get you into trouble.")

Jim

Non-Runners Advising Runners

2009-01-18T06:30:00.004-07:00

I saw a posting on the Runner's World forums that contained a great quote from "Lore Of Running" by Dr. Timothy Noakes:

"Never accept as a final opinion the advice of a non-runner."

When I first started running (15+ years ago) I developed a pain in my ankle which I later learned was tendonitis. My doctor's recommendation: "Stop running for 3 weeks. If the pain returns when you begin running again you weren't meant to run and you'll need to stop for good." I rested, started again, and the pain returned. I figured the doc was the doc and my short running career was done. Then I started to read about foot types.....and shoe types......and pronation.....and motion control shoes..........

I went to a good running store, bought shoes appropriate for my feet, and I was running pain free! My doc, obviously, knew nothing of these topics.

Jim

Piriformis Syndrome

2008-12-27T17:20:00.000-07:00

This one's a bugger. Oh there are other buggers - Plantar Fasciitis, Achilles Tendonitis, etc. But this is difficult - it's hard to describe, it's hard to stretch, and it's hard to get rid of.

I won't go through the symptoms and diagnosis here. There are lots of places on the web that do this just fine.

The first bugger is getting it diagnosed. From what I know there isn't a specific test for it, so you end up coming to Piriformis Syndrome through a process of elimination. A bulging L4/L5 disc is the most common alternative diagnosis. Some people will claim "I have sciatica." Sciatica is more of a symptom than a cause. Piriformis Syndrome causes sciatica symptoms, but so do other things.

The second bugger is to stretch that baby out and get it calmed down. I've found the following the most helpful:

Check the range of motion for internal and external rotation. Stretch appropriately to improve ROM if not good or symmetrical.
Massage. A tennis ball works great.
Stretching. Here are a couple.
Piriformis is an external rotator. If it's tight and in spasm it may be because the other extneral rotators (such as gluteus maximus) aren't doing what they're supposed to, causing Piriformis to do more work. Check recruitment and strength of other external rotators.

Lastly, pay attention during every-day activities and see if you're doing things which keep the Piriformis chronically contracted. Here are two that are extremely common:

Driving. Do you let your legs stay splayed out against the door or center console?
Sitting. Do you hook your ankles under the seat?

In both of the above situations your thighs are externally rotated and the Piriformis will be chronically contracted.

Jim

Walk Before You Run

2008-12-22T19:43:00.004-07:00

I've had many people tell me they wish they could take up running, however it's just too hard and they end up giving up.

Running is extremely hard on the legs and lungs. Additionally, it takes a while to learn the pace that one should be running. Some first-timers think running means "sprinting".

As in many aspects of life, to begin running you need to walk first. Therefore, here is a simple-to-execute schedule to get you running: (Each week perform the listed activity 3 times.)

Week 1: Walk for 30 minutes
Week 2: Walk for 9 minutes, jog for 1; 3 times
Week 3: Walk for 8 minutes, jog for 2; 3 times
Week 4: Walk for 7 minutes, jog for 3; 3 times
.......
Week 11: Run for 30 minutes!

When you're starting focus on time spent in the activity and not at all on speed. Pay attention to your breathing. If you can't hold a conversation with someone running with you (either literally or figuratively) then you're going too fast. The goal is to get your body accustomed to the routine and pounding of running.

Does 3 months seem like too long of a time to get running? Well, if you're really committed to establishing a long-term running habit, 3 months is no time at all.

Jim

Heal Thyself

2008-12-20T07:30:00.001-07:00

You know who is most concerned with your health? You.

The internet has fundamentally changed the dynamics of how we interact with the healthcare ecosystem. We now have the power to do research ourselves. We can look into a drug that has been prescribed. We can research symptoms and potential causes. We can determine treatment effectiveness.

While us laymen obviously don't have the training of the professionals, we're in a pretty good position to decide whether we agree or not with their recommendations. Make sure you agree with the path your healthcare team is suggesting you take. Challenge them. Question them. Make sure you understand them. Tell them when something isn't working. And if they can't handle this attitude, find someone who will.

Jim

These Aren't The Droids You're Looking For

2008-12-12T20:53:00.005-07:00

What a great Star Wars line.........................................

The pain we feel may not (typically not) be a good indicator of where the problem is. Oftentimes the real problem is opposite the pain - either the opposite side of the limb or the opposite side of the body. A muscle can be stressed because something else isn't doing it's job.

The hip flexors can hurt because they're tight from sitting all day. When sitting Gluteus Maximus (which does the opposite motion of the hip flexors) is stretched. If one sits for long periods of time Gluteus Maximus becomes not only chronically stretched, but the nerves get lazy and it's hard to engage the muscle very much at all. Recruiting and strengthening Gluteus Maximus not only gets this important muscle working, but also loosens up the hip flexors.

These aren't the muscles you're looking to fix.

Jim

Active Rest

2008-12-10T21:48:00.001-07:00

"Can I run?" That's gotta be the most-asked question a healthcare professional gets from a runner when they're injured.

My PT has taught me the concept of Active Rest. "Rest" is relative. Maybe you cut back on your running but still run some. Maybe you quit running for a bit but do something else. Go to the pool. Get out your bike. Go for a walk instead of a run. Or maybe you cut your weekly mileage in half. That's resting. And your fitness level won't deteriorate nearly as fast as you think it will.

Resting is a balancing act. The amount of rest needed is determined by what you're recovering from. You want to ease off to give your body a break and chance to heal. If you listen closely enough you'll know if you're resting appropriately. Interestingly, however, movement promotes healing. So find that level and type of activity that will promote healing but not put you in a deeper hole.

Jim

Physical Therapy - The Magic Pill?

2008-12-09T21:06:00.017-07:00

I studied Mechanical Engineering in college. That gives you an indication of how my brain is wired.

Physical Therapy has been the most fascinating and rewarding aspect of staying on the road. It's so refreshing to have pain eliminated not because of some chemical, but because muscles have been tweaked, nerves gotten retrained, or coordination has been improved.

My first experience with PT was about 5 years ago. I had a pain in my calf and my doctor (not my current doc) concluded I had compartment syndrome. The solution is to cut open the compartment, relieving the pressure and leaving a knee-to-ankle scar. Thanks to Google I determined this is a relatively obscure condition for runners; let alone a 40-ish guy running 9:00 minute miles. The doc was ready to get me into surgery. And the insurance company would have agreed and approved.

I didn't believe him. On the advice of a friend I went to a Physical Therapist. Fortunately my friend recommended a really good one - the one I use today. He discovered some interesting stuff. The big leg muscles (thighs and hips) weren't doing what they were supposed to do, so the little leg muscles (calves and ankles) were "upregulated". They were stressed because, with every foot strike, they had to take on all the responsibility for making sure I didn't fall to the ground.

After about 6 weeks and a few appointments I was back to running completely pain free. By getting those big muscles to do what they were supposed to the strain on the smaller ones was eliminated. Astonishing - go under the knife and not get my issue resolved - or do something completely non-invasive and be back to normal.

Brad Ott @ Rebound Sports and Physical Therapy (Loveland, CO) is the PT who has helped me through these and other issues. Hopefully when you're looking for PT you can find someone like Brad: Someone who knows their stuff unbelievably well and will also take the time to explain what is happening and why. This has made an indescribable difference in helping me understand how the body behaves and reacts.

Jim

2 Years Of Injury Diagnosis, Treatment & Recovery

2008-12-09T17:18:00.007-07:00

I love to run. It began 13 years ago. I told myself if I got up every morning and went for a walk I'd buy myself a Nordic Track. Forget that. After a couple of months the walk evolved into a jog which further evolved into a run. Since that beginning I've participated in countless 5Ks, a number of 10Ks, and 1 half-marathon. I've fought my normal share of running injuries over the years. Then in Dec 2006 "the big one" struck - the one that makes a runner cease all running in order to heal.

I reluctantly went to the doctor - reluctantly because the pain was hard to pinpoint. That was the start of what has turned into a 2 year journey to get back to running again. I'm not totally there but the progress is undeniable. The last 2 months have been the most positive out of the last 24.

Currently (Dec08) I can run 10 minutes out of 30 minutes of total activity. It's pretty small when compared to doing half-marathons, but the vector is in the right direction. I'm currently adding 1-2 minutes/wk to my running time.

My hope is that, by sharing some of my experiences and learnings, others can more quickly get back to what they love to do.

Jim

"A run turns a good day into a great day."