I recently had the privilege to work with a gifted distance runner, who presented with chronic complaints of bilateral, mid-substance, achilles tendon pain that was primarily symptomatic during the morning as well as with her training. She was a pleasant female, who was under no apparent distress with a relatively clean past medical history. After taking her through a battery of tests, which were predominantly unremarkable, I had her run on the treadmill.
After a three minute fitness walking warm up, I instructed her to take up the speed to the point of a comfortable training pace as if she was going out to complete a six to eight mile run. It should be noted that she was running in a pair of Brooks Glycerin (10mm heel to toe differential) that were screened for defects and premature wear. As you will see from the video below, she initially employed a forefoot striking pattern but was not overstriding. After a few minutes of running, I had her stop the treadmill and told her to quiet her feet down before allowing her to resume running at the same pace. Following this cue, she immediately adopted a "full footed strike pattern" while simultaneously reducing the sound of impact.
Within two weeks from the time of the initial consultation and zero follow up visits, she contacted me to relay that she had completed her longest run (11 miles) free of any pain and discomfort in the region of the achilles and was also no longer having any stiffness and pain upon weight bearing during the morning hours. This simple case demonstrates how easy it can be to help runners return to training by applying the biopsychosocial (BPS) model of pain, sound clinical reasoning, understanding treadmill analysis and the performance demands of running, while providing a simple cue related to the sound of contact. In this case the "bio" aspect of the BPS model of pain proved to be the primary factor in addressing her complaints while positioning her to return to her meaningful tasks free of pain. Wishing you STONG, HEALTHY, and MINDFUL Running.
I recently had the pleasure to do a performance coaching consultation with a man who was looking to improve his running. At the time of presentation he was training consistently and running approximately four times per week without any complaints of pain nor dysfunction. When setting up the appointment, I requested that he bring his preferred training shoe, which in this case was a pair of Vibrams. In typical fashion, I made sure to take a look at his footwear and proceeded to ask how he selected the Vibrams as his primary running shoe. He remarked that he enjoyed their comfort and lightweight nature coupled with the fact that they elicit a forefoot strike pattern. Naturally, I started to scratch my head because it was clear that he was relying on a heelstriking strategy based on the wear pattern, particularly on the left side. After taking him through a battery of tests related to the performance demands of running, I had him get on the treadmill to assess his running gait. It should be mentioned that he had run on a treadmill in the past so it was a familiar condition.
Once he settled into his preferred running speed, it was readily apparent and no surprise that he was heelstsriking in the Vibrams. Next, I had him remove the vibrams and get back on the treadmill and resume running at the same speed. Without any cueing, he naturally adopted a different striking pattern more consistent with a midfoot or flat footed stride. After completing this simple treadmill assessment, we discussed the research pertaining to what had just occurred. My goal in highlighting the results of this study from 2012 was not to necessarily change anything related to his running as he was free of injury and training consistently. Rather, I just wanted to ensure that he developed an accurate and refined understanding of the role of footwear as is relates to running and strike pattern to avoid being had by any shoe manufacturer's claims.
Although the authors did not include Vibrams as one of the conditions in this study, they did investigate four running conditions: (1) barefoot; (2) a minimalist shoe (NIKE Free 3.0); (3) a lightweight racing flat (NIKE LunaRacer2) and (4) the shoe in which they were currently using for most of their training. It should be mentioned that in contrast to the Vibrams which have no heel to toe differential, the Nike Free 3.0 does have a 4mm drop, which is important to bear in mind as we discuss the results. Additionally, the subjects in this study were highly trained runners and have therefore most likely grooved consistent running mechanics. Nonetheless, the major differences between running barefoot versus shod based on the results of the study included the following:
1. Stride length and stride frequency were significantly shorter and higher, respectively when barefoot compared with all other shod conditions.
2. Peak knee flexion was significantly decreased compared with all other shod conditions with no difference between shod conditions.
3. There was a 12.6%, 8.4%, and 14.2% reduction in peak knee abduction moment when running barefoot compared with the minimalist shoe, racing flat, and regular shoe, respectively.
4. Peak power generation was reduced at the level of the knee when barefoot compared with minimalist shoes and racing flats while an increase in peak power generation was noted at the ankle while barefoot compared with all shod conditions.
5. Peak power absorption was also greater at the ankle when barefoot compared with minimalist shoes and racing flats.
6. The magnitude of reduction in negative work at the knee joint was similar to the magnitude of increase at the ankle when barefoot versus shod.
In closing, this is just one of several examples of how footwear can influence one's running mechanics. Considering this particular individual was pain free and consistently training, I did not advise him to change his footwear. In the event that he goes on to sustain a running related injury, however, his shoe selection is undoubtedly a topic worth revisiting. This case highlights the fact that running barefoot is minimalist footwear is simply not the same as running barefoot. Wishing you HAPPY, HEALTHY, and STRONG Running!
On June 14, 2015 I traveled to British Columbia by land and by sea to race Victoria 70.3. I really wanted to race this event last year though it coincided with Father’s day and racing always takes a back seat to family. Accompanying us (Mimi and me) on this trip were my parents, who drove cross-country to learn about our new life in Seattle, as well as our good friends Joel and Laura Sattgast and their amazing, well-behaved daughter, Grace.
The week leading up to the race was a whirlwind considering a good chunk of my family was visiting and drove cross-country (Pittsburgh) to see our new digs in Seattle. This meant a lot of running around Seattle while still trying to juggle getting a new business off the ground (Zeren PT) not to mention nailing my taper. While most folks often think of a taper as a short period of time that involves decreasing volume and intensity while coasting into a race, nothing could be further from the truth. All one needs to do is look at the research of Mujika et al. to appreciate a proper taper. Indeed, the volume of training gets slashed by upwards of 60% though the intensity is relatively high, which demands a state of readiness going into each workout. It was also fortuitous to have consumed a bunch of beers during a picnic we hosted on Wed night thanks to having life discussions with my good friend, Will Butler, gracing us with his presence.
To further complicate matters, I was also forced to ride my old and withered Cervelo P2. While this is a solid bike and one that has gotten me to Kona, it felt like I was rolling out an old, dusty car from the barn. The look on the faces of the mechanics at Herriott Sports Performance was priceless when I wheeled my bike into the shop and asked them to wrench it and have it “race ready.” Additionally, the last time that I was fit on this particular bike was over 3 years ago. Fortunately, they made some simple tweaks and David, “The Rocket”, Richter had me dialed in from having worked with me in the past on top of being a genius with all that is performance cycling. In addition to having bike issues, I also managed to rip my wetsuit the Wednesday before the race during a routine open water swim. This mishap would have been problematic though fortunately, my mother and aunt came to the rescue by patching and sewing it just in time to use for the race.
On Friday morning, we packed up the car and headed for Victoria just like the Griswolds. While there are a few ways to get to Victoria, they all involve crossing water so we elected to pick up the ferry at Ana Cortes. The trip proved longer than expected though there was plenty of space on the ship that afforded me the chance to stretch out and catch a short nap.
Upon arriving in Victoria, we were forced to wait in yet another line before arriving at out our local accommodations. After getting settled, Joel and I managed to sneak away for a short bike ride (20 miles). Somehow, after taking a bunch or random turns down what appeared to be cyclist friendly streets, we suddenly found ourselves riding along the coast, which was nothing short of spectacular between the water views and conditions; sunny, high 70s, and no humidity.
The next day was relatively uneventful. We checked in, drove a bit of the bike course, and then did an open water swim while consuming a lot of pretzels. Despite having some mild concerns about potentially cooler water temps, it turned out to nearly be a non-wetsuit legal race because of the unseasonably warm water, which was most likely a function of warmer weather coupled with a shallow body of water. This was perhaps one of the most pleasant lakes for a swim.
Enter race day! In typical fashion, I was up at 3:30am consuming unsweetened applesauce, a banana, plain bagel, Kozy shack rice pudding, and a 22oz Gatorade. After briefly returning to bed and unsuccessfully trying catch a few more Zs, I was out the door and en route to catch a shuttle bus bound for transition. Fortunately, we got there in plenty of time to get things squared away in transition and I made my way down to the start of the swim.
Within a couple minutes and after several bathroom breaks, the race was underway. I felt relatively strong on the swim and had good visibility thanks to finally finding a pair of goggles that do not leak. My wetsuit also held up without issue. After emerging from the water, I was feeling strong and got to T1 while noticing that nearly all of the bikes were still on the racks meaning that I came out of the water ahead of most athletes.
As is typically the case, my legs felt heavy for the first few miles of the bike as my blood was shunted from my swimming to my cycling musculature. I therefore took this time to start dialing in on my fueling by taking in Gatorade and a Powerbar gel with 2x the caffeine. Within 15-20 minutes, I found my legs and started to make moves. After playing yo-yo with a couple of other fast age groupers I managed to pull away and slowly start picking people off. Despite my bike still feeling a bit like a tank, I was locked into aero and was pushing a big gear and fast pace. Fortunately, I did not run into any mechanical issues and finished the bike leg feeling strong and ready to take off on the run. By the time the bike was over I had consumed 5 bottles of Gatorade and 5 gels and finished with an average speed of just over 24mph. I knew I was sitting pretty at this point as I only gain momentum as the race goes on. This was a fast bike for me which I attribute to spending the past several months solely on a road bike, which does wonders for quad strength.
After racking my bike and donning my shoes (Brooks Launch), I took off on the run. I was not sure what to expect on the run leg because I knew that the course was relatively technical as a good portion of it was on trails with lots of roots and rocks not to mention being on narrow paths with traffic going both ways secondary to the sprint race simultaneously taking place. I also knew that a lot of athletes had also taken spills and sprained their ankles the day before while practicing on the course. After settling into a groove, I found my rhythm and started taking over one athlete after the next, most of whom were in the M30-34 age group, which went off ahead of my wave (35-39). After finishing the first loop, I was confident that I had passed everyone else in my AG that may have posed a threat. From here on out it was a matter of just staying persistent without taking a misstep. As I ticked off each mile, I knew that I was going to have a strong finish. Seeing the finish line off in the distance, I mustered one final kick before finally crossing the finish line. My work was finally done for the day and the first race of the season was under my belt. It couldn’t have been more sweet than to celebrate finishing by having my parents and wife witness the end of the race. And with that, my first 70.3 was in the books and I was able to relax while cheering on several other friends and athletes.
Special Thanks: My wife Mimi; my parents Jerry & Kristen; the crew @ Herriott Sports Performance; The Sattgast Family; and all of the volunteers who donated their time to ensuring a solid event.
Overall Time: 4:26
Overall Position: 10th
Age Group Posiiton: 1st
*2nd fastest run of the day
As the debate rages on regarding strike pattern, shoes, and one universally best form to run, how about we first establish consensus regarding common denominators related to running. This past weekend I was fortunate enough to have my uncle, who is visiting Seattle and also happens to be a professional photographer, capture some footage of me running to highlight several key aspects of the running gait that we have to prepare injured runners for as we attempt to return them to daily training and beyond. Ive included three separate pictures to capture three distinct portions of the gait cycle which are as follows and listed from left to right: terminal stance, float phase, and midstance. As you look at these images, it's important to keep in mind that I'm running on level ground at 4:30 pace in the Brooks Launch (10mm heel to toe differential). Below, I've listed some key characteristics and takeaways related to the above images. I've also include footage from a few clips of me running on a treadmill to give you a more thorough perspective of the running gait to compliment the above images.
1. The runner has to progress through the forefoot and ideally the first ray which demands mobility at the first MTP.
2. The knee does not fully extend on the stance leg in the vast majority of cases.
3. Some hip extension is necessary on the stance leg though not nearly as much as some folks lead you to believe.
3. The trunk is erect and the head is held steady.
4. There is a good deal of shoulder extension that occurs on the contralateral side relative to the stance leg.
5. The pelvis and shoulders remain relatively square.
6. A moderate amount of hip flexion is necessary though definitely less than 90 degrees.
1. The brachium (upper arm) never breaks the plane of the torso despite sometimes giving the appearance of doing so.
2. There is a distinct float phase that is inherent to the running gait.
3. A small amount of torso rotation occurs during the running gait.
4. The tibia of the left or more anterior lower extremity is positioned relatively vertical and the foot is positioned close to level with the ground.
5. Although it appears as if I may be overstriding, the foot winds up landing almost underneath my body by the time it contacts the ground (easier to see in the video below).
6. The trunk is erect and the held is held steady.
1. The quadriceps act eccentrically during the stance phase.
2. The leg must progress over the foot thus demanding ankle dorsiflexion
3. There is minimal hip ADDuction that occurs during the stance phase.
4. There is minimal ipsilateral trunk lean towards the stance leg during this phase.
5. The trunk is erect and the head is held steady.
6. The knee of the non-stance leg flexes to ~120 degrees though in most recreational runners this value is ~90 degrees while with world class sprinters it can reach 135+
Based on this information, I thought it would be helpful to list my prerequisites to safely return injured runners to regular training and beyond.
1. No use of NSAIDs or narcotics
2. No signs/Sx of inflammation
3. Ability to fully wt bear through the affected region(s)
4. Adequate toe dexterity (flex-ext of the great toe and lesser toes, splaying, and adduction
5. Ability to balance in a wobble free manner for >30s such that there is no reliance on an arm nor trunk strategy.
6. @ least 35+ degrees of isolated extensions of the 1st MTP extension in a WB position at terminal stance.
7. Ability to progress the leg over the foot (~22 DF)
8. Tolerance to open and closed chain contractions of the lower extremities
9. Good frontal plane stability esp @ hip & trunk
10. Tolerance of fitness walking (3.5mph) in a defect free shoe
11. Tolerance of a progressive walk-run routine
12. Ability to hop in multiple directions on each leg
I recently had the chance to do a Q&A session with Greg Lehman, who is a physical therapist and chiropractor based in Toronto, CA. Greg's voracious reading of the medical and performance literature coupled with his research background and time in Stuart McGill's lab has positioned him as one of the foremost authorities on a variety of topics, which include but are not limited to the following: 1) clinical application of pain science, biomechanics, tendon rehab, running, core strengthening, and clinical decision making. Greg also happens to be one of the most generous clinicians out there as he's provided the online community with a tremendous amount of free resources. To learn more about Greg please visit his website. Without further ado, Greg Lehman folks.
Rarely do you cross paths with someone who is an exceptional clinician and a brilliant researcher. Dr. Richard Willy, who is an assistant professor at East Carolina University, is exactly that! Rich was kind enough to volunteer his time to do a Q&A session with me to highlight some of his research while discussing several hot topics related to running. The work of Rich and his colleagues has definitely had a profound impact on my clinical work and I'm confident that you will learn quite a bit from this short and sweet video. We delve into cueing, shoe prescription, cadence, ankle dorsiflexion, and therapeutic exercise prescription. Without further ado, Dr. Richard Willy folks. #UD, #Fightin' Blue Hens
Last week I had the opportunity and privilege to do a Q&A session with Matt Phillips, who is a sports physio and running injury specialist that works in the UK @ Studio 57. I'd like to first start by congratulating Matt and his wife on the recent birth of their son. Somehow he managed to find time in his busy schedule to have a chat. As you will soon learn, Matt has a great sense of humor and an exceptional command of running and the literature pertaining to it. Without further ado, Matt Phillips!
This past weekend I returned to Portland, OR to share my perspective on running injury management at Pettygrove Physical Therapy and Sports Rehabilitation thanks to Karl and Sasha Kolbeck. Part of this course involves learning how to conduct a simple treadmill analysis. Below you will see footage from a demonstration that I performed with one of the participants during the lab section.
The runner in this video is an experienced female runner and short course triathlete, who has been dealing with pain at the plantar aspect of her right forefoot as well as her right lumbo-pelvic region. Furthermore, she has recently been experiencing left plantar foot pain that is particularly bothersome with ambulation in the morning though her symptoms abate over the course of the day. She is currently running 3x/wk at conversation pace for distances primarily < 6miles per outing in a pair of Brooks trainers that were screened for defects. Lastly, she is running on 0% incline at 6.5mph throughout this analysis.
As you can see from the first clip, she is initiating contact with the ground with her heel while "overstriking" particularly on the right side as evidenced by the sound of her foot. She is also running at a step rate of ~168 steps per minute based on our estimation doing some simple math.
Between the first and second clips, the only instructions she was given were to stay in sync with the metronome, which was set to 184 bpm (~10% increase ala Heiderscheit et al.) and to quiet her feet down. As you can appreciate, these simple cues and feedback had a profound impact on her running gait mechanics in a matter of seconds and led her to adopt a more flat footed/midfoot strike while lessening the impact at initial contact based on the sound of her feet.
This case highlights how easy and effective gait retraining can be when considering strike pattern, sound, and cadence and manipulating these variables through simple cueing and feedback.
Last week, I had the good fortune and distinct privilege to have a discussion with Jeff Moreno, who is a seasoned physical therapist and running performance expert based in California. Jeff is unique in that he has a global understanding of running from injury management to helping running athletes realize the performance potential and beyond. It's obvious that he has invested a tremendous amount of time and energy getting to this point in his career. To learn more about Jeff and his work beyond this Q&A please visit his website move2thrive.com. Thanks again for your time Jeff and keep up the great work!
If there is one assessment that I perform in working with injured runners beyond watching them run, it is undoubtedly the lateral step down (LSD). The LSD is a simple, efficient, moderately reliable, and relevant assessment that yields a wealth of information when considering the performance demands of running. It tells you close to everything a clinician needs to know with the exception of a runner’s tolerance to hopping, cadence, and breathing strategy. Since a good portion of running related injuries (RRIs) tend to occur during the stance phase of running, the LSD gives clinicians, coaches, and trainers with a window into any potential impairments that may negatively impact one’s running while possibly putting them at risk of injury.
Before conducting an LSD assessment of an injured runner, however, it is important to first understand that during the running gait cycle that knee absorption during the stance phase is upwards of 45 degrees of knee flexion. The examiner should therefore set the height of the step to ensure the performer cycles through the 0-45 degree range of knee flexion. Additionally, the performer should also be barefoot to eliminate the potential influence of footwear as a shoe with a heel to toe differential may disguise any dorsiflexion limitation (apologies for demonstrating with shoes in the vid below). From there, I typically demonstrate the movement to provide the runner with a model of performance before having them practice a couple times to get acquainted with the movement. Special attention should be paid to ensure that the foot of the stance leg is straight and at the edge of the platform while the great toe is pointed towards noon on an imaginary clock. The non-stance leg should be held in full knee extension while maintaining the foot in a level position. The hands should also be positioned on the pelvis to ensure that they do not augment the performer’s balance. I typically perform 5 repetitions per side.
1. Clear understanding of how to perform the test
2. Completion of the LSD on the non-involved extremity
3. Ability to fully weight bear through the affected extremity
1. Stepper or platform with adjustability
2. Level surface/ground for the platform for rest on
Information that We Obtain from the LSD Assessment
1. Toe dexterity
2. Single leg postural stability
3. Ability to progress the leg over the foot (ankle dorsiflexion)
4. Tolerance to eccentric and concentric closed chain contractions
5. Adequate hip and lumbopelvic neuromuscular control?
6. Breathing strategy
Possible Compensatory Strategies to Monitor
1. Excessive subtalar pronation
2. Dynamic knee valgus
3. Femoral internal rotation
4. Hip adduction/contralateral pelvic drop
5. Excessive hip flexion
E-BOOK for RUNNERS
MIKE REINOLD & ERIC CRESSEY'S FUNCTIONAL STABILITY PART 4