Achilles' Ankle

My running plan for 2010 was to join the New York Road Runners, run nine races and volunteer for one, and qualify for the New York Marathon for 2011. 

I'd had miscellaneous issues with my right ankle and my knees over the course of getting into barefoot-style running in 2009 and early 2010, but I thought I had sorted all that out.

Then I ran the Brooklyn Half Marathon: I finished, and started limping.  I'd done a 20k prior to this race, and my foot was fine, although I had runner's knee from running in my MT100s prior to and during the race.  But running the half in my new Bikilas left me with an injured metatarsal-cuboid joint, a joint I wasn't aware I'd possessed.  After attempting a few more runs, including a 5k race the following weekend, I realized that I had a problem.  The New York Marathon was obviously not a reasonable goal if I couldn't even finish a half-marathon without a six-week recovery window.  I'll note that this injury felt far better when walking around barefoot than it did even in Vibrams.

So I started analyzing the situation.  I recalled that when I started running in Vibrams, I'd had a number of issues with my right ankle, but through form adaptations I'd managed to make the acute pain disappear.  But I continued to have issues at longer distances, and when trail running over rocky terrain.  I began to realize that I had been compensating for the injury, but that this compensation fell apart at longer distances and rougher terrain.  I also recalled that 3-4 months before reading Born to Run and recommitting to running in Vibrams I had severely sprained my ankle while mountain biking.  The ankle didn't bother me while wearing shoes, though.  Apparently I just didn't use those muscles while wearing shoes.  I was able to compensate by holding the ankle rigid while running: this worked, but put stress on the metatarsal-cuboid joint (hence the pain in the Brooklyn Half), and stressed the Achilles' tendon on rough surfaces (hence the pain while trail running).

So I decided to attempt to resolve the issue in two ways:  First, since the metatarsal-cuboid joint pain basically went away when barefoot, so I started running barefoot and not just in Vibrams.  After getting nasty blisters on the 4th and 5th metatarsal heads (just before the toes) on the second run, this seemed to work pretty well.  The supination that lead to those blisters was also the motion that was causing the metatarsal cuboid pain (putting weight on that joint in the wrong way).  But the movement was too subtle to be conciously apparent.  I needed a mechanism to auto-correct the movement, and barefoot running provided the feedback.

Second, I noticed that when doing the potty squat (or Asian squat) my right ankle was less mobile, and my right foot over-pronated compared to the left.  So I commenced doing regular potty squats to try to improve this.  I also made a conscious effort to keep from holding my right ankle rigid using my Achilles' tendon.  This was problematic, as I kept reverting back when I stopped thinking about it, but it did improve things.

My reward from these efforts was shooting pains on the inside of my ankle.  I regard this as a good thing: I was now bypassing my compensations, and was actually stressing the weakened and injured parts of my ankle. The metatarsal-cuboid joint pain disappeared, and the Achilles' tendinosis improved when running on rough surfaces.  The ankle did get stronger, and while I had these pains running in Colorado and when running the Reach the Beach Relay, they didn't seriously impede me. 

I managed a 20-mile round-trip run/walk up Pikes Peak, did another 7.2-mile run up Waldo Canyon, and did 16 miles in 24 hours during the relay, and so figured I had slain the beast.

So with high expectations I entered the Paine to Pain Half Marathon.  I decided to wear my New Balance MT100s, and then when they came out, the very similar MT101s.  Unfortunately, around the 5-mile mark for the training run, and the 6-mile mark for the actual race, I started getting IT band pains.  Serious IT band pains.  While I was able to manage a somewhat decent time (for a guy who limped the second half of the race) it was not fun and left me with a six-week recovery window.

And unfortunately, unlike my prior injuries which went away almost immediately when I reverted to Vibrams or barefoot, this was a real injury, apparently, and I had to wait it out.

So I continued to work on my ankle, do the potty squats, and try to use both feet in a symmetrical fashion.  The ankle seemed to improve.  Then "the jerm" posted this on Barefoot Ted's Google group:

"and the winner is! Posterial Tibial Tendonitis/ dysfuntion. x rays showed no signs of fracture or bone degeneration or abnormalities. ultra sound is next week sometime to check for inflammation and/or edema. the doctor complemented me on my complete lack or arch, and really thinks i need orthotics, i will give him some props he did mention the study on custom vs. store bought and how they showed no difference, but then said each persons foot is different and need them made to fit properly. sooooo i guess i'll be cross training and p90xing for a a while and elipticaling and swimming. any other suggestions to keep my cardio up and impact down?"

I replied:

"Cool! That sounds very similar to the issue I'm having!
http://orthopedics.about.com/cs/footproblems/a/posteriortibial.htm

"Especially the bit about the sprain, the flattening arch (especially obvious when doing the potty squat), and being unable to stand on the tip-toes on the affected foot. My right foot also points out more than my left, just as described.

"Thanks for posting!"

As I noted in my that thread, the treatments they prescribed at about.com for that problem were absurd.  I did the rest part inadvertently, but wearing sneakers.  But I had clearly had no improvement in function, the initial injury was 1 year, 9 months ago, at today's date.

I started doing some exercises to strain the affected area: sort of like doing eccentric heel drops for Achilles' tendinosis, if it hurt me, I figured it was doing some good.  And things seemed to be improving, albeit slowly.  I was able to do nine-mile trail runs in my favorite local park with little pain, and the Achilles was doing much better than before.

When ski season started, I also noticed that I was using my right ankle and foot differently.  I was getting ankle pains, but was also jamming my right big toe against the front of the  ski boot.

I mentioned all this to my trainer, who's been hugely helpful to my progress through this, and he stated that he didn't think the problem was the in the ankle at all.  He thought that the problem was likely in the hip, and the ankle was just showing strain as a result of a problem elsewhere in the system.  I scoffed, but agreed to do the exercises that he said would demonstrate the weakness.  Well damned if he wasn't right.  By having me lie on my side and lift my legs, and then attempt to resist his downward pressure on my legs, he conclusively demonstrated that my gluteus medius and minimus (more bits I wasn't aware I had) were much weaker in the right leg than in the left.  He also had me attempt to balance on a bent knee (you know, the way you do when you're running) on both legs, and while I was rock-stable on the left leg, I wasn't able to do it well on the the right.  The gluteus muscles terminate in the IT band, and this would explain why I had the IT band issues while running the Paine to Pain race.  The combination of the cushioned shoes and a leg that was too weak to stabilize itself effectively on the cushioned shoe was a double-whammy. 

I'd managed to improve my ankle enough to get to the next weakest point in the chain.

So the next time I went skiing, I worked on the right leg, forcing myself to use both legs evenly.  I hadn't even realized how asymetrically I had been skiing, especially in the moguls.  I noticed that my right foot had changed quite a bit from the prior season. (Nothing like stuffing your feet into a block of hard plastic to draw your attention to how your feet have changed!) A bunch of settings that I had done to my right foot needed to be undone, as my right foot seemed to be becoming more like my left. This was on a six-year old pair of boots, btw.  So clearly, as my trainer sugested, the issue was a preexisting one.  He thought that the sprain 18 months ago was probably due to the weakness of the leg, not the other way around. 

I was explaining all this to my wife with my eight-year-old daughter listening, and she piped in and showed me an exercise that her dance teacher had taught her.  The exercise was specific to all the muscles I was discussing (and hurt me like heck to do in my right foot!).  My daughter explained to me that most people have one leg weaker than the other, and that this exercise was specifically designed to address that.  From the mouths of babes!  I'm adding this exercise in, it was more effective at hitting the weak area than anything my trainer showed me!

I also noticed that the attachment point of my posterior tibial tendon (under the arch) was bothering me a bit after the latest bout of skiing.  I want to stress it, but I need to be careful about not over-doing it.  I also had a fair bit of itchiness there, inside my foot.  A weird feeling, but not a bad one.  Perhaps this indicates healing, as itchiness generally does, or maybe some scar tissue breaking free?  A short run on the treadmill in Vibrams cleared this up.

So between skiing evenly and doing a bunch of new exercises to address the weak gluteal muscles, I think I'm well on the way to defeating this.  I can already start to feel the strain in my knees as the next-weakest part of the link becomes stressed.

One other thing that I noticed was that when I stood at rest, I bear most of the weight on my left leg.  As my trainer observed, "That'll do it.  20 years of standing primarily on one leg and you're left with a big imbalance."  So I now try to balance on both legs, and this is part of the exercises I'm doing.

For 2011 I'm back to the plan for 2010, hopefully this time the legs are both strong enough to get me through it.

None of this would have been possible without barefoot-style running.  I never even realized that my ankle didn't heal properly after the sprain.  In sneakers I used the muscles in my foot and ankle so little that it didn't matter that they were injured and weak!  No doubt I was set up for worse sprains and injuries in the right ankle as time went on.

I hope that this is useful for you folks.  Unravelling this took a lot of patience, a lot of attention to minute signs from my body (some of which, like the initial ankle pain upon running in Vibrams I should have been more attentive to), and being very open-minded.  I thought my trainer was nuts when he told me the problem was likely, at least in part, in my hip, but sure enough, he was right.

P.S. One other useful tidbit of information that helped me figure out what was going on was from Robb Wolf's interview of Tim Ferriss.  Tim Ferriss mentioned that one of the things that helped him deal with some of his niggling little problem was to divide his body into quarters, and address the weakest quarter, to equalize the strength, and therefore the stress, on the body.  He mentioned that this alone caused a lot of annoying aches and pains to go away.  It makes perfect sense, and as I was already doing this with my right arm versus my left (I'm left-handed), opened me up to the same idea concerning my legs.

P.P.S. Exercises here and here.

P.P.P.S. Achilles' Ankle and Lee Saxby, a follow-up post.

Paine to Pain Trail Half Marathon Report

First, let me say what a great, well-run race this was.  The course was terrific and well-marked, the volunteers were enthusiastic and numerous, and they even had cheerleaders at the start and the finish.  Race Director Eric Turkewitz and his team deserve a ton of credit for putting this race together.  I really can't think of one thing wrong with the race today, they even arranged for perfect weather.

The course starts next to Thomas Paine's cottage, in New Rochelle, NY, heads up a hill, and then follows the Colonial Greenway trail, ending on the track at the high school near to the start.  The first mile or so gets you up and over a ridge between one drainage and another on roads, and then you hit the Leatherstocking trail, a windy, rocky single-track through Westchester County.  From there the balance of the trail is on bridle paths that wind near the Hutchinson Parkway back to New Rochelle.  It's a nice course, and, as the RD put it: "Hilly, for Westchester.  This isn't the mountains."
Most of my report on this is about my personal progress, with some race details thrown in, so bear with me if you're still reading. ;)

My last (and first) half marathon was the Brooklyn Half Marathon this spring. That went well in that I finished in under 2 hours (1:56), not as fast as I had hoped, but a decent time.  (I ran that race in a brand-new pair of Bikilas.  Not wise.  Never run a race in new shoes...) Unfortunately I discovered that an old sprained ankle from a year earlier was hurting my form.  I finished the race with a strained metatarsal-cuboid joint, a joint I wasn't aware I possessed up until this race.  I limped off the course in a good deal of pain, and limped around for a few weeks afterward, although I was able to run without pain.

So most of my training since then has been focused on figuring out what was wrong with my ankle, and how to fix it.

I had run the course with the RD and a bunch of others last weekend.  They had two groups running, the fast group, and the slow group.  I was planning on running with the slow group, but went out fast and wound up easily keeping up with the fast group for the first 5 miles or so.  I've been focusing on relaxing my injured right ankle to stress the injured parts, so that hopefully they'll get stronger, and this has been working, but around mile 6 or so I began to feel tightness in my IT band, combined with a strain in the weak part of my ankle.  I promptly tripped, landing on the tight IT band.  Naturally. ;)  So at this point I began to struggle keeping up with the group.  Ultimately I wound up finishing 10-15 minutes behind the group, in about 2:11.  Not what I was hoping to do, but a decent performance given my weak ankle.  I ran in my New Balance MT100s, since my pinkie-toe which I dislocated running in Treks in Colorado is still sensitive, and I didn't want to kick any more rocks with it.

Yes, I'm a mess, and I get injured way too often.

So a week later and I'm back.  My goals for the actual race were pretty modest at this point.  I was just hoping to exceed my performance from a week earlier, and to not injure myself any further.  I tried to take it easy in the early miles, and wound up running strong into mile seven.  I tripped, but did not fall, in almost the same spot as last week, amusingly.  (My friend also tripped and rolled in nearly the same spot.  Must be jinxed.)  But then the IT band began to get tight, and I could feel the weakness in the right ankle.  Oh well.

The race at this point was much easier than the training run the week before.  I felt much stronger, and did not get my tingly-scalp "bonk" at all during this run.  That has occurred during both of my prior runs at 13.1 miles, so that was a definite improvement.  I ate an apple and had a large cup of coffee with whipping cream prior to the race, and suffered no hunger during the race, or after, so that worked well.

But given the state of the ankle and knee, finishing was my major priority. 

And I did, in about 2:06, I would estimate.  I forgot to stop my Garmin when crossing the finish line, and as the race was not chipped, the full results haven't been compiled yet.

So I had a great run in a great race, and improved my performance, and hopefully continued to strengthen my injured ankle.  A nice way to spend a beautiful October morning.

The modified MT100s performed flawlessly during the training run, and the MT101s I ran in today were even better.  Yes, I ran my second half marathon in a pair of shoes I'd never run in before.  I'll post a comparison of the two with some pictures later on.  I saw a bunch of runners in Bikilas and Treks running the race, and I kind of regret not using my Treks, as I didn't stub a toe in either run on this course.  But I'm happy with "better safe than sorry" for this.

UPDATE: As promised: New Balance MT100 versus MT101

UPDATE: Results released.  As I reported, I finished. ;)  In 2:06:26.  I guess I was paying better attention than I thought at the finish line.  Considering I limped for most of the second half of the race, I guess that was pretty decent.  At one point I figured I'd done a 13-minute mile, and when I looked down and saw I'd actually run mile 12 in 11 minutes, I was stoked.  Oh, how our standards can slip. ;)

Is R.I.C.E. Paleo?

OK, pretty facetious title there, but a serious topic. R.I.C.E. stands for Rest, Ice, Compression, Elevation (sometimes Protection is prepended to the acronym, as you'll see).

If you've ever gotten a sprained ankle or similar soft-tissue injury, you've no doubt been advised to do RICE on the affected part. It's nearly a religious ritual for athletes. What I've learned about medicine in the last few years of my barefoot-style running and Paleo/Primal diet experiment is that practices will persist in medicine for decades, if not longer, which not only have no basis based on the medical and scientific literature but which have often been contradicted by that literature, again, often for decades.

So whenever you hear "everyone" telling you that you should do something, you should be skeptical.

In this case, there's good reason to be skeptical, as RICE has been tested extensively, and found lacking:

"The Use of Ice in the Treatment of Acute Soft-Tissue Injury: A Systematic Review of Randomized Controlled Trials

"Results: Twenty-two trials met the inclusion criteria. There was a mean PEDro score of 3.4 out of of 10. There was marginal evidence that ice plus exercise is most effective, after ankle sprain and postsurgery. There was little evidence to suggest that the addition of ice to compression had any significant effect, but this was restricted to treatment of hospital inpatients. Few studies assessed the effectiveness of ice on closed soft-tissue injury, and there was no evidence of an optimal mode or duration of treatment.

"Conclusion: Many more high-quality trials are needed to provide evidence-based guidelines in the treatment of acute soft-tissue injuries."

So the evidence that we have offers little to no validation of RICE. Recognizing this, this study was proposed:

The PRICE study (Protection Rest Ice Compression Elevation): design of a randomised controlled trial comparing standard versus cryokinetic ice applications in the management of acute ankle sprain.

"...Given these findings, it seems a logical progression to examine if the analgesic effects of intermittent ice application can facilitate earlier therapeutic exercise, and subsequently improve clinical outcome following acute ankle sprain. The safety and effectiveness of incorporating therapeutic exercise with periods of intermittent ice application has not previously been examined in patients with acute soft tissue injury...."

(Unfortunately, I can't find the completed study: I have no idea if it was or was not completed.)

Now, you might find this hard to believe, but devising a treatment and then never bothering to test it in a scientific fashion is par for the course in the medical profession, as is continuing to use the treatment after it's been shown to have no suporting science behind it and to be of questionable efficacy. People would rather "do something", than do nothing, even if doing nothing is the correct course of action. The PRICE study notes this, as well as noting some of the potential issues with the treatment:

"...Recent evidence has suggested that the addition of exercise to ice application is more effective than ice application alone after various soft tissue injuries, including acute ankle sprain [19]. However, by reducing the conduction velocity of other, non-nociceptive fibres, cold application may also have a number of deleterious effects, including reduced muscle torque [20]. This is of particular relevance if ice is to be applied in combination with therapeutic exercise in the early stages after an acute soft tissue injury. Such effects could lead to the development of altered neuromuscular control patterns and potentially, to an increased risk of re-injury...."

The "logic" behind this treatment is the same as that of the use of anti-inflammatory medications: inflammation is associated with pain, and despite the fact that "correlation does not equal causation", the inflammation is treated as if it is the cause of the pain (link to PDF):

"Treating soft tissue injuries with protection, rest, ice, compression and elevation has been the mantra of physiotherapists for many years. Commonly shortened by the acronym ‘PRICE’, this approach is also widely accepted by layman as an essential component of first aid practice....

"...For many clinicians, their rationale for using modalities such as ice and compression after an injury is simply that it controls the clinical signs of inflammation. Applying a cold compress on an injury that is hot, red and swollen is commonsensical; but it clearly overlooks other potentially important physiological, cellular and molecular events. We use the term inflammation constantly in the clinic when referring to acute injuries however few can define what they mean by it. There is continued confusion as to whether inflammation is a ‘bad’ process, or, whether it is in fact fundamental for optimal repair.3 With major advances in our understanding of the inflammatory response in recent years, we can now begin to put these questions into context and consider the clinical implications and pathophysiological rationale for common interventions such as ice...."

"...It is clear that physiotherapists cannot recommend an optimal protocol for ice application beyond conjecture. Similarly, deciding on the most effective compression bandage or quantifying how much rest to advice, is also challenging. O’Sullivan and Keane’s1 study provides further evidence that developing clearer evidence based guidelines for PRICE is an important aim for the future. However, given the complexity of contemporary models of inflammation, we must also consider if is still realistic to produce one set of definitive guidelines to suit every type of soft tissue injury? Furthermore, we must consider that by recommending PRICE, we are recommending a combination of different treatment modalities each with their own unique molecular, cellular, physiological and clinical effects."

The evidence with NSAIDS, a common class of anti-inflammatory medicines, is that by blocking inflammation, they can permanently impair the body's healing process. Inflammation is, of course, the initial response of the body to some injury, and if inflammation is prevented the body does not have a plan B to heal.

From an evolutionary perspective, this "logic" for RICE is nonsense, of course: the body has a healing protocol that, ignoring animal precedents, was honed over millions of years of evolution in Africa, where ice is a rarity. The notion that ice is therefore necessary, or anything more than a distraction, therefore deserves great skepticism. Most likely, by impairing the body's proper function (inflammation), the healing process is impaired, as suggested by higher rates of re-injury.

Your body has evolved a protocol for healing which involves inflammation and pain (to reduce use of the injured part). I think the wisest course is to let the body's protocol operate: it has far more development time behind it than RICE does. (Even the Rest part of the protocol is of dubious value: for many injuries the medical profession now recognizes that immediate activity is essential for proper healing. If this is true for an injury as severe as a colon resection, broken hip, or a hip replacement, why shouldn't it be true for a simple sprained ankle?

My own view of RICE is that its value is in the fact that it simply distracts the injured from thinking about the injury. The discomfort of the ice against the skin gives you something else to think about. There are other means of distracting the injured party: when I had my wisdom teeth pulled, the dentist used music instead of general anaesthesia to keep my mind off what was happening. This was surprisingly effective, without any of the downsides of general anaesthesia.

And without any concern about impacting the healing process.

"Surprise: Scientists discover that inflammation helps to heal wounds

"...Zhou and colleagues found that the presence of inflammatory cells (macrophages) in acute muscle injury produce a high level of a growth factor called insulin-like growth factor-1 (IGF-1) which significantly increases the rate of muscle regeneration. The research report shows that muscle inflammatory cells produce the highest levels of IGF-1, which improves muscle injury repair. To reach this conclusion, the researchers studied two groups of mice. The first group of mice was genetically altered so they could not mount inflammatory responses to acute injury. The second group of mice was normal. Each group experienced muscle injury induced by barium chloride. The muscle injury in the first group of mice did not heal, but in the second group, their bodies repaired the injury. Further analysis showed that macrophages within injured muscles in the second group of mice produced a high level of IGF-1, leading to significantly improved muscle repair...."

P.S. Mark Sisson covers this as well.

P.P.S. Follow-up. The doctor who coined the acryonym R.I.C.E has come around.

Dr. Phil Maffetone's "Big Book of Endurance Training and Racing" Review

Thanks to some of the participants on Barefoot Ted's Google group, I recently became aware of the work of Dr. Phil Maffetone.  We spend a good bit of discussing a various topics on that group, but a most of it concerns barefoot and barefoot-style running, and peripheral topics to running.  Diet comes up very often, because runners are either concerned with increasing performance or losing weight. A good diet is obviously important on either front.

Given my personal history, diet is of particular concern, and over the last 2+ years, researching diet and barefoot-style running have become my intellectual hobby.  So I've spent quite a bit of time learning about the science behind barefoot-style running and the paleo diet, since, respectively, reading Born to Run and discovering that I'm acutely wheat-intolerant.
So with that background, and my skeptical nature, I'm pretty impressed with Dr. Phil's book.  (As he's known in his online posts.)

The cons of this book are: Dr. Phil's credentials.  He's not a medical doctor, and he comes from an "alternative" medicine background [update: see the P.P.S. below].  That said, based on the reading I've done, he's pretty spot on for almost all of his suggestions.  And for whatever strange reason, most of the "alternative" doctors seem to be more open to diet as a cause for common medical maladies.  Examining the reasons behind that fact are fodder for another long post, but I will say that if the suggestions seem scientifically sound, you shouldn't discard them just because they come from a chiropractor.  That said, I'd recommend this book to anyone, with the following caveat (and the second con):

It's not well-sourced.  One of the compelling aspects of the Jaminet's Perfect Health Diet is that there book is well-footnoted with online resources that you can look up to learn more about why they make a specific recommendation.  Dr. Phil's book is not well footnoted.  You've got to take him on faith if you're not familiar with the research behind it.  The fact that the foreword is written by Mark Allen, the famed triathlete, and the afterword is written by Dr. Timothy Noakes, the famed exercise physiologist, should give you skeptical types some comfort.  For myself, I've already done enough reading to realize that Dr. Phil's work is well-founded, and don't have to rely solely on the testimonials.  But it would be good if he presented better evidence, as some of his ideas are pretty out there; while being correct, in my view.

The pros of the book are pretty simple.  You can save yourself my two years of diligent reading to achieve a much healthier approach to fitness and health just by following the recommendations of this book. 

I've been following most of the recommendations on diet and barefoot-style running for long enough (and before reading the book) that I'm a big fan.  The one part the book added for me was a detailed explanation of Dr. Phil's 180-formula for training intensity.  I'm now using this as my guide, and have definitely noticed benefits so far.  It's not magic, but it's definitely improved my training in the few months I've been using it.  I hope to continue through the winter, and start seeing the benefits of this approach come spring.

In a nutshell, Dr. Phil argues that you should train for most of your miles by keeping your heart rate low enough that you're primarily burning fat, and not carbohydrates, as fuel.  Dr. Noakes observes that following this approach helped Mark Allen to become one of the most fit and successful athletes in the world.  It's a pretty well-tested, if counter-intuitive, approach.  The formula is simply 180 - your age = the heart rate at which you should do most of your training.  (There are some complications based on fitness and injury status, but that's the basics.)  In my opinion, this is a training program for broken humans, who've been following the bad diet advice of the modern era, and not getting the sort of vigorous exercise that our bodies evolved to expect.

So I would highly recommend this book to anyone looking to get a better and comprehensive view of how to be fitter and healthier.  Or if you don't feel like poking around on this or any other blog that covers healthy diets and barefoot-style running, you can just buy Dr. Phil's book and be done with it.  I've already loaned my copy out to a good friend, along with Mark Sisson's The Primal Blueprint and the afore-mentioned The Perfect Health Diet.  (Happily I also got the Kindle version.)

Here are a bunch of segments that I highlighted in my Kindle and manually typed in here, since the Kindle doesn't allow copying [update: see the P.S.].  Sigh.

"Aspirin, ibuprofen (such as Advil), naproxen (such as Aleve), and other non-steroidal anti-inflammatory drugs (NSAIDSs) are commonly used for pain relief. If taking NSAIDs lessens your pain, it probably indicates your fats are not balanced."

Makes a lot of sense to me.  Excess omega-6 intake and insufficient omega-3 are pretty obivously indicated in a lot of maladies, most especially joint pain and weak cartilage.

"The most popular shoe in this category is the basketball sneaker.  Plain high-top sneakers were popular for many years, but today they have become fancy over-supported, overpriced high-top shoes. Supposedly, the added ankle support, the key feature of this shoe, protects against ankle sprain and other injuries. But studies don't verify this. Actually, these shoes can do just the opposite, as basketball players may have the highest rates of ankle sprains of any sport. When the ankle, or any area of the body, is supported, we run the risk of weakening that area. This is the result of muscles that sense the support and no longer have to work as much; the result is loss of some of their strength."

Again, makes perfect sense to me.  I think basketball players, and most other athletes, have been sold a bill of goods by the sneaker companies.  There's no evidence for any of the sneaker-company claims, except lots of injuries.

"Perhaps the first published scientific evidence describing the harm from shoes came in 1954 when researchers Basmajian and Bentzon measured the electrical activity in foot muscles using an electromyographic (EMG) device. This study showed that when shoes were placed on the feet, certain muscles lost significant function."

Well, Dr. Munson predates this by quite a stretch, as The Soldier's Foot and the Military Shoe was published in 1912, and tested on millions of feet by 1954.

"This is because shock absorption in the feet occurs at the same level of intensity whether we wear shoes or not."

It's even worse than that: shock absorption is worse when wearing shoes, not better, or even equal.

"For acute foot problems - recent injuries such as a fall, twisted ankle, or stubbed toe - the traditional RICE remedy of rest, ice (or cold), compression, and elevation can be very effective."

I'm not a big fan of RICE.  It's been tested, and found to be ineffective.  But if it makes you happy, or keeps your mind off your pain, go for it.  I never take pain killers or use RICE for my frequent falls and stubbed toes.  And I don't miss it.  (Twisted ankles are a thing of the past since going barefoot-style.)

"Other important factors included balancing fats, eating ten servings of vegetables and fruits each day, and controlling stress."

OK, sorry.  Ten servings of fruit and vegetables a day?  I think this is ridiculous.  I generally eat three meals a day, and may have a snack.  I think that if you eat more frequently you're probably doing something wrong.  This is one area where Dr. Phil is conveying ill-considered conventional wisdom.
He also has a chapter on oral pH, which is interesting, but about which I know very little...  But given the solid character of the rest of the book, something I will take into consideration.

So I have a couple of quibbles with Dr. Phil.  Big deal. I highly recommend this book.

P.S. Sean points out that one can access highlights via the Kindle web site.  I was using the Kindle for PC software to try to copy the text.  Live and learn.  This will make my next review a lot easier, as I love using the Kindle highlight functionality.

P.P.S. Luis notes this page where Dr. Phil describes himself thusly:

"While Tim’s essay seemed to focus on so-called alternative medicine, my practice style was not alternative. Instead, it was a physiologically based approach of evaluating and treating an athlete in an individual way rather than a cookbook style that is still common today. Properly stated, I practiced complementary sports medicine. Alternative medicine is an alternative to this approach, and especially one departing from more traditional or conventional medicine. (Many in the alternative medicine community say that I’m too scientific.)"

I like this description, and think it's 100% accurate.  Lots of reasonable practices are decribed as "alternative", complementary is a much better term for what Dr. Phil does.

P.P.P.S.  Sean has some additional thoughts.

P.P.P.P.S. Here's an update. Pretty remarkable improvements, IMHO. In addition, I did a regular warmup at the gym. I found a speed on the treadmill that would reliably keep my HR under the MAF rate (137 at the time), and then did my warmup run at that speed. I initially had trouble keeping it below 137. Now, I don't even get close to 137, and have finished my warmup run with HRs as low as 121. Pretty incredible. The treadmill warmup is a part of my gym routine that I've been doing for about 4 years prior, but I would also try to run fast. So this recent improvement in HR is not simply because I've started doing a warmup run, my routine was pretty consistent for years prior to starting Maffetone.

Exercise For A Weak Ankle

In my ankle post I mentioned that one of the signs that something was wrong was when I ran across rough surfaces and had an Achilles' tendon pain.  Well, thanks to my trainer, I've found an exercise that replicates that pain in a few short minutes.  Hopefully this will allow me to strengthen the ankle...

The exercise is pretty simple: procure a step box, about 4 inches high, and starting on the left side, using one foot, jump up on the box, then down on the right side, then back up on the box, and then down on the left side.  Continue until you're unable to, or whatever. ;)

What I found really fascinating about this exercise is that when I did it with my strong left leg, I landed almost silently.  My weaker right leg made a loud sound each time I landed on the box. 

One of my principles of barefoot-style running is that if you're doing it right, you're doing it quietly. 

Clearly my right leg is in bad shape.

Achilles' Ankle and Lee Saxby

As part of their sponsorship of the NYC Barefoot Run Weekend, VivoBarefoot offered injured runners a chance to have a training session with Lee Saxby, who leads the VivoBarefoot running education program, and trained as a Pose coach with Nicholas Romanov.  I've heard excellent things about Lee's training sessions, so I entered the lottery for a session.

Much to my surprise, since I never win anything, I won.

I had the chance to speak to him prior to the session, and it was quite amusing, since the last time I'd spoken to him (at the VivoBarefoot store in NYC), I'd told him that I think coaches are unnecessary if the "Born to Run" hypothesis is true.  He was curious why I wanted a coaching session with him.

I wanted Lee to give me an independent assessment of what's going on with my weak leg.  To that end, I tried to tell Lee as little as possible of what was going on with my bad leg.  Armed with an uncooperative patient, he gamely started off with a video assessment of my barefoot running form.

What's the worst he could say, I wondered?  "Your form is horrible: give up on running", was one of the possibilities I imagined...

Happily, he told me I had pretty decent form.  He noted that I leaned back a touch, and videoed me again standing in a pose that I thought was proper running form, and showed me the contrast between that and how I actually run.  That was an interesting datum, one that I will work on.  But he complemented me on my foot strike.  A compliment only a barefoot-style runner could appreciate.

Then he videoed me running in my Merrell Trail Gloves.  Form was indeed different, and sloppier in those, which was hardly a surprise to either of us.  As we'd agreed the night before, adding anything to your foot is going to alter the way you run, and the less you add the better your form should remain.

And he didn't notice any difference in my running form between my two legs, which was a good thing, I suppose.  I've put a lot of effort into getting them to work in the same way, and I've made a lot of progress. I still notice differences, but it seems I've ironed out the gross inefficiencies.

Next he addressed the issues with the bad foot.

 Lee asked me to do what he referred to as a hunter-gatherer squat, but which I refer to as a potty squat.  It's also known as the Asian squat.  This is a movement that most modern Americans can't do easily or correctly, but it's a basic movement pattern that we all ought to be able to do.  He noted that, no surprise, my mobility in my right ankle was worse than my left.  Next he had me lie on my back with my feet in the air, so he could, basically, yank my foot away from my body to help stretch out the ankle.  Then he bent my toes down to look at where the "knuckles" in my feet were.  Bingo!

His conclusion was that I've got Morton's Foot*, but only in the "bad" foot.  The good foot has adapted.  Morton's Foot is essentially a high arch condition where the first metatarsal head is pulled behind the second metatarsal head.  This is something that should correct itself with continued barefoot running, and he explained that he had Morton's Foot, and was able to correct it.  This explains my observation that for most of my life, my "bad" foot has been the longer foot, but now the good one is.  The arch has come down in the good foot, lengthening the foot, and allowing the first met. head to be equal to the second, as it should be.

Then he described to me the various issues one would experience with Morton's Foot: 

• Over-Supination in foot-strike; check, had that, resolved (after some blistering) though barefoot running instead of Vibrams, allowing for more feed back.
• Ilio-tibial Band Syndrome: check, got that, during this race.  Too much cushion under the weak leg.
• Sore Metatarsal-Cuboid Joint: check, got that; that was my first running injury, during the Brooklyn Half Marathon.

To that list I'd add Runner's Knee, (Patello-Femoral Syndrome), which was in the strong leg from compensating for the weak leg when running down hill.  I've also developed a clicking in the first meta-tarsal-cuboid joint.  I'll often wake up with that joint locked, and only a deep potty squat will free it up, often with a large pop like a cracked knuckle.

The stretch he suggested to help improve the ankle mobility was a variation of the potty squat: I should squat down while holding on to something ahead of me, so I don't fall over backward, and bounce gently up and down while on the balls of my feet.  This is supposed to help stretch out the tendons in the foot, and keep them loose enough for proper movement.  He also recommended barefoot jump rope, to dial in the proper landing pattern.  And, of course, continued barefoot running.

One other important ability Lee mentioned was being able to do exercise 3 in this post: to isolate the Flexor Hallucis Brevis. Lee got this from Jay Dicharry, who wrote that post.**  Lee is able to stretch his big toe far away from his second toe, an capability I refer to as monkey-toe.  Even another barefoot runner we spoke to who has run a few marathons couldn't do that trick. 

Along with isolating the FHB is pressing down on the ground with the big toe when running.  This trick made a big difference to me in the latter stages of the 8-mile barefoot run I did this weekend.  When the weak foot started getting sloppy round about mile 7 (my longest previous barefoot run was 6 miles), I made a point of pressing down, and it helped correct the foot.  It also gave me a whole range of exciting new sore muscles in my weak leg.

I ran a total of 11.5 miles on two days after working with Lee, and his suggestions definitely made a difference to my running, an immediate difference.

Back to the question of "barefoot running coaches" that I discussed with Lee when I first met him: I still don't think they're necessary.  As Peter Larson said during our time with Merrell, if people were raised wearing well-designed shoes, no form coaching would be necessary.  Children naturally run with perfect barefoot-style form, they don't need to be taught.  This is perfectly consistent with the "Born to Run" hypothesis, and good evidence that's it's true.  Even an adult with no legacy injuries or bad movement patterns should be able to transition injury-free, if he takes his time.

But, there are lots of people like me.  I was able to get to good form, but still have legacy issues from my shod days.  As Lee likes to say, he fixes broken runners.  And he's got a lot of experience doing it, a lot more than I do.  Which was why my time with him was valuable.  Hopefully some of the things he showed me, while building on my own deductions, will speed up my transition time.  Lee said it took him five years to fix his own Morton's Foot.  I'm impatient, I'd like to do it faster.  And I feel no need to re-invent the wheel to do it.

Transient aches and pains while transitioning are normal, but they shouldn't prevent you from running, or last more than a run or two.  If you start getting aches and pains that do prevent you from running, or consistenly bother you for days, getting some advice is a good idea, and Lee is very good at what he does.  I was quite impressed by how accurately he described all the the injuries I've already had, without telling him them beforehand.

And my running definitely felt better afterward.

* Lee explained that Morton's Foot is different from Morton's Toe (which is usually used interchangeably with Morton's Foot).  Morton's Toe, or Greek Toe, is a longer second toe than first.  Morton's Foot is when the arch is too high, basically, pulling the first metatarsal back into the first.  Greek Toe is something you're born with.  Morton's Foot is correctable.

** The post implies that you should wait until you can do those three exercises before starting barefoot-style running. I think that's overly cautious. Happily I had the opportunity to discuss this with Jay last weekend. He thinks that a person who can do those three exercises should be able to transition to barefoot-style running without injury. I think that's 100% correct. I'm pretty much the perfect example, as I couldn't do any of those exercises in my weak leg, even after several years of barefoot-style running. But barefoot-style running is a benefit all it's own, and I've resolved other running injuries. So don't wait until you can do those exercises, but get on them while you're running.

P.S. Jay Dicharry has a video out on foot self-evaluation for barefoot-style runners.

New Balance MT100 versus MT101

When New Balance released the MT100 last year, minimalist runners were quite excited.  The good news about this shoe was that it was designed for famed (in the ultra-running community) minimalist runner Anton Krupicka.  Minimalist features included: a flexible sole (except for the rock plate), a breathable design geared to be worn without socks, and light weight. 

Side view, 101 on top

The problem is that the shoe features a whopping big drop from the heel to the forefoot: 10mm.  Due to the construction of the shoe, this was easily resolved, however.  Heel-less MT100s are quite a nice option to have, especially in colder weather, or while racing.

MT100 original ankle collar

 But nothing is ever perfect in the first draft. There were a few relatively minor issues with this shoe: it was a bit narrow across the front of the toe, and the tongue and the achilles thingy tended to bother some people. (If you look closely at the Side View picture, you'll note that the part of the 100 that rides up the achilles is missing, while it's present on the 101. It's missing because I cut it off with a razor knife after attempting to run sockless in the 100s one summer day. This only took a moment, and significantly improved the shoe.)

I will note that the soles on both shoes are functionally identical.  The toe area on the 101 may be a smidge wider, but this seemed to have no effect other than to avoid feeling like the soles were a tad narrow, which did occur sometimes in the 100, especially when running down hill.

Rear view, 101 on right

Unfortunately one feature carried over is the 10mm differential with the heel.  In the side view photo you'll notice that both shoes have had the heel zeroed (reduced to a similar height, approximately 8mm).  The 10mm heel differential is gone.  The 101 and 100 were done by two different cobblers, and since this is a manual process, they're slightly different, but after a few minutes of running feel the same.
 
The 101 is indeed wider across the toes, although upon trying them on they felt like they were crowding my big toe a bit.  This may be a function of the fact that I've been wearing my 100s without the insole.  To give my toes enough room I bought the 101s in a size 10, versus the 9.5 in the 100, so I have a comfortable fit even with the insole.  This allows for a bit more protection in the heel area when racing.  There is enough room in the toe to splay my toes when running down hill, and that, along with wearing the insole, allowed me to bomb down hills heedless of the rocks.

Front view, 101 on left

New Balance also slightly changed the tongue; although I never had any problems with the prior tongue, but if you did, rejoice.
 
They also significantly redid the overlays on the top, and the material seems to breathe much better than the 100 did.  The laces are either the same, or are so similar that I can't tell the difference.
 
The one welcome improvement is that the achilles-tendon slicer at the top of the heel is much reduced, and the soft liner material (light green in the picture) curves over the plastic material which was formerly so effective at gashing your leg.
 
I've not tried running sockless in the 101 yet, but hope to have a pleasant time of it.
 
To test the old and the new, I ran the same course twice, as detailed in my Paine to Pain Race Report.  I won't recap that here, except to note that the modified 100 performed well in the practice run of that course. 
 
I had only worn the 101 around for about half an hour prior to sending it to the cobbler for a heel-ectomy.  I picked them up Saturday afternoon for a race on Sunday.  Yes, like a fool I took a shoe that I had never even run in once to a trail half-marathon.  It occurred to me while in the parking lot at the race start that I was doing this, and that I had sworn I would never do it again after making this mistake with my Bikilas.  But I had no other shoes, so I really had no choice at that point.
 
Happily, they performed perfectly.  I wore the exact same pair of socks with the 100 and the 101, and I did not experience any discomfort whatsoever with the 101.  Not a blister, not a hot-spot, no break-in at all.  Kudos to New Balance for that.  I did stop at about mile 11 and adjust the tongue on one shoe, but that was precautionary. 
 
So I like both of these a lot.  If you can find the 100 on clearance and make the modifications I did, I think you'll be quite happy with them, while saving some money.  Or buy the 101 and, after removing the heel, wear as is. 
 
My only caveat about these two shoes is that they do have excessive cushioning.  Yes, even 8mm is too much for me nowadays.  The only knee pain I've ever had in my running career has been from the 100s last winter (runners' knee), and two Sundays ago (IT band stiffness).  The IT band stiffness repeated the second Sunday in the 101.  I don't know if this is the result of the 101s or of my weakened ankle (detailed in the race report), so I will withhold judgement.  Ideally I'll do the Paine to Pain course again in the next few weeks in my Treks, and see how the knee and ankle do.

P.S.  Here's my summary of my New Balance MT100 and 101 posts. 

Here's my follow-up post on the knee issues I had running in the MT100 and 101s.  In a nutshell, the two New Balance sneakers exacerbated an existing condition, but they did not cause it.  I avoid cushioned shoes, and avoid problems.

A Couple Of Recent Runs

[Just came across this post from 11/9/2009]

I've had a few interesting run recently.  I thought I'd share some details of them and what I'd learned hoping it might be of some use to others.

10/24: Nike+ Human Race 10K.  Ran in KSOs with no socks.  Had a problem w/ nausea before, during, and after the race.  I'm pretty sure that this was due to really wanting to put in a good time.  My friends said afterward that I was "Running to win" (finished six minutes ahead of them).  Ran at a 7:41 pace [actual result was 7:40], which is much better than my previous best effort at this distance.  Tapered for a few days beforehand, and pushed it during the race.  Calves hurt after the race (good hurt), had a few minor abrasions from the KSOs, but nothing else.  Followed the "relax, relax" mantra during the race, which meant that the sticks and nuts that were on the course just really weren't an issue for my feet.  Stopped worrying about them after a little while and just let my feet deal with them.  Have to take a few days off after the race to let my calves recover.  Feet felt great.  Do a few three and five milers during the week.

11/1: Run with "The Runner". 8.6 miles, 4.6 road, 4 trail.  We all must have a friend like this (if you aren't yourself one of these people).  He's a real runner.  Puts in creditable performances in all his races, has been running for years, and almost never suffers running injuries.  In this case, he also read Born to Run this summer, and ditched his big sneakers for some racing flats.  Not worried about his form, because obviously what he's doing is working for him, except for his bunions.  He's not been interested in barefoot/Vibrams since he's sure he never heel strikes.

So we run, in the rain.  I'm wearing my Treks with injinji crew socks.  He's got the racing flats on.  I listen to his running, "thwap, thwap, thwap".  "Hey, you know you're heel-striking?" Thwapping stops, he's corrected his form. "I am not."  We have an discussion about how to tell if he's heel striking, to listen to the feet.  About half way up the big hill that makes up the meat of this run my calves start to ache. 

Thinking back on the many posts on this group, I think I've got a choice.  Take it easy, or push through and risk injury.  Well, I'm running with The Runner, for the first time since I started running in Vibrams.  There's no way I'm bailing... the only thing bothering me is the calves: Push on.  On the downhill stretch, I pass him in his racing flats and bomb down the slope.  Thank you, Vibram!  As we approach the end of the race, The Runner comments on how much quicker I'm running now.  Finish the run in pretty strong form.  This is my longest run in Vibrams.

Calves are hurting mightily that afternoon.  I go home and crash on the couch for a few hours and watch some TV.  I'm a little worried. Next morning, go for a slow three miler and then for a four-mile hike with the kids.  Calves aren't doing that badly, actually, they're improving with the exercise, but the right Achilles has taken to aching and throbbing.  Take a couple days off, then do a few more three milers.  Setting me up for the next run:

11/8: Trail run w/ 3 new runners I don't know.  Wearing the Treks with Injini mini socks. I invite The Runner along, since it always helps to have the fastest runner be one of your friends. :)  Achilles is still aching a bit, so I'm a little nervous about this. We all show up and chat for a few minutes.  One of the other guys says, "Look at his feet!"  They all ask about the Vibrams, they think I'm nuts.

The area we're running in is rocky in the way that only Connecticut is rocky.  If you think you live somewhere that's rocky, imagine this: take a mountain range higher than the Himalayas.  Crush it down to rubble over several Ice Ages, and then spread that rubble around with a thin topping of dirt and newly-fallen leaves.  Welcome to CT.  They can't believe that the Treks are going to be OK in the rubble...

Fortunately I've done most of my Vibram hiking and trail running in this area and in Baxter State Park in Maine, which may be the only spot on Earth that's rockier than CT, so I'm pretty confident.  Off we go!  Legs, feet, most importantly, that sore Achilles are all feeling just dandy, and more importantly, I'm having no trouble keeping up.

We continue for maybe 3 miles.  The only spots that are giving me trouble are the downhills, since the rocks are all covered with leaves, I'm taking it easy. But I'm catching back up on the flat bits (that wonderful feeling that you're being rushed along). We all stop, and the three guys I don't know look at me and comment that my feet must be killing me. Thanks to the relax, relax (and a little bit of EVA midsole), I can honestly say that they feel great. My feet seem to be finding their way to the ground through the leaves. They all shake their heads. At this point I take off the Injinjis, as they're binding between my toes.

Unfortunately shortly after this, the unthinkable happens: running down a fast, clean slope, at full speed, I stub my right pinky toe.

It nearly takes me off my feet, but I manage to get my feet back under me and recover. I'm convinced that if I'd been wearing sneakers I would have gone down hard here; my body was on auto-pilot and recovered. It felt like my feet flew back up to catch my falling body, sort of like Hermes, the Greek god with wings on his feet. The fellow behind me complimented my on the recovery, and asked if I'd sprained my ankle (he was running with an ankle-brace). I don't miss a step, but clearly the toe is a problem. So I keep going. After about another mile and a half, we stop to wait for the guy in the ankle brace, and the toe siezes up. I'm running, but limping, all the way back to the parking lot, about half a mile.  Afterward, the toe swells up (it looks like a grape the morning after) but all the rest of the aches and pains are gone. Calves, perfect; Achilles, perfect; feet, perfect. 6.2 miles, my longest trail run to date, over rocky, nasty terrain, and aside from a stubbed toe, I feel better at the end of the run than I did at the beginning.

The couple of days off was key, I think, between the days where I was pushing it. And your body does love the beating, so I guess that's in favor of "active recovery" days too, as I was feeling better at the end of the last run than I was before the first in the series.

But what's great, is that each run is more fun than the one before it. How long can this keep up?

BTW, the stubbed toe is the first injury I've had from minimalist running. I have been taking it easy, and not pushing runs, and I think it's been paying off.

[A few thoughts: I can't remember the last time my calves hurt.

Kicking rocks, or any other immovable object with your toes is a bad idea, and hurts. That said, it's one of the least significant injuries, I've now done it a number of times and never failed to finish the run. If you do it, as I learned above, don't stop running! 

I've not done another road 10k race since the Nike race.  It's a great distance, I really need to do another...

Oh yeah, the runs are still great. The newbie glow has worn off, though.]

P.S. That was more than a stubbed toe. It was quite broken. I wound up having to wear some New Balance MT100s in order to run on it: the rock plate in the shoe helped to stabilize the toe when running. Pretty amazing that you can break a toe and keep running, but I guess from an evolutionary perspective it's a good feature.

Minimalist Mountain Biking Shoe

Sometimes, you have to wear a shoe.  When I mountain bike, three pieces of safety equipment are mandatory: shoes, gloves, and helmet.

My first pair of mountain biking shoes were cross-country racing shoes, with a narrow, deep sole.  They may be great for cross-country racing, but for the rocky, gnarly trails I ride in Connecticut, they were a ticket to a sprained ankle.  I'm still trying to get over the last sprained ankle...

My most recent pair of mountain biking shoes were some platform-style free riding shoes, which did great, and were similar in shape to a Munson last.  But the sole delaminated after my last ride.

I wound up getting the Specialized Tahoe as a replacement shoe.  They also have a Munson-last shape (why is it mountain biking shoe companies get it?), and they have a reasonably wide footbed for stable landings.  I think I got last year's model, which has a velcro bit across the top of the laces.  They fit great, and didn't make me hate the fact that I was wearing shoes for a several-hour ride.  On a side note, the last two mountain biking shoes I got were 9s, these were a 10.  Part of that is that I want more room, part is that my feet are definitely bigger now.

I don't know if they're zero-drop or not, for a biking shoe it's not all that important, IMHO. If you're running up a hill, you don't notice the heel, and if you're running down a hill... You're mountain biking;  why are you running down a hill?

P.S. Here's a link to the new version of the Tahoe.



404

The link to the old version leads to one of the funniest 404 errors I've ever seen...

Bosu Balls And Other Unstable Surfaces

Just came across this post by Steve Magness again.  It's a classic:

"[Unstable Surface Training] can lead to improper recruitment patterns and ruin motor skills, so it certainly should not be combined with anyone trying to improve a sports skill on a stable surface (Willardson, 2004)."

Well, well.

As I posted in the conversation that caused me to rediscover this post:

"We have a bosu ball in our gym. As I ski, I was a diligent user of it prior to starting barefoot-style running and hiking. What I found was I had such an enormous increase in strength and balance from going around in Vibrams (which I also wear in the gym on the Bosu ball, of course), that it dwarfed whatever little gain I was getting from the bosu ball. It made a huge difference to skiing, which observation I've had confirmed by one of my converts who's also a skiier.

"So I don't use the bosu ball anymore. Whatever incremental improvement it might offer me just really isn't worth the time, IMHO. I'd rather be running. ;) Even on the dreadmill.

"I have been doing ankle-strengthening exercising, including balancing on one foot on the floor. As said in that link, it really does hit the soleus muscles, which seem to be the ones I injured when I sprained my ankle."

I will note that lots of top skiiers and snowboarders use bosu balls as part of their training; but they are often operating on an unstable surface, so bosu balls may offer some value.

Barefoot At The New York Marathon

Good luck, guys.

"...That’s right. Wood, a 35-year-old programmer, is running the entire 26.2 miles completely barefoot.

“I’ve been running through a lot of back streets where sometimes it’s all rubble and glass,” says Wood, whose long training runs take him through Brooklyn, over the Manhattan Bridge and up the West Side of Manhattan. 

"Wood isn’t participating in some sort of monastic self-flagellation.
"Rather, he’s part of a growing number of New Yorkers who’ve said bon voyage to their sneakers and embraced the idea that running barefoot promotes proper form, thereby preventing most injuries that plague long-distance runners.

"“I think a lot of people are under the impression that someone has stolen my shoes, and I’m running after them,” quips the second-time marathoner who ditched his running shoes about a year ago because his knees began to bother him.

"He began his barefoot odyssey with funky “five-finger” wetsuit shoes that are made by Vibram, then went the full monty.

"After a recent 19-mile barefoot run through the city, Wood didn’t need to ice his body or stretch out thoroughly. “The knees feel great. I feel a complete difference,” he swears...."

Good luck to all the folks running the marathon shod, also.

Back from a long hiatus, this story features the popular Obligatory Ding-Bat Podiatrist quote!

"...Though running barefoot is increasingly popular in the running community, there are experts who say sole-to-pavement jogging is playing with fire.
"“Some people say the caveman is a perfect example of how walking barefoot is safe and not harmful to the body,” says Dr. Rock Positano, director of non-surgical foot and ankle service at the Hospital for Special Surgery.
"“What they don’t mention is that the average caveman didn’t live past age 20. It’s not a very good comparison.”
"Running a marathon barefoot is a “nightmare in the making,” he says. “The feet will be screaming for mercy — [as will] the shins, knees, hips and back.”..."

Thanks Doc!  Another podiatrist ignorantly spreading fear, uncertainty, and doubt.  Gotta love that.  Read the literature, Doc. We do.

Podiatry Today: "Tackling The 10 Myths Of Barefoot Running"

It's Podiatrist Day here at Yelling Stop:

Barefoot running, minimalist running and natural running are all terms that describe running in a manner that allows our foot to function the way it was designed (or has evolved). This happens through the use of little or no shoe at all. Many runners suffering from chronic injuries are adopting this way of running and are experiencing relief of symptoms to find themselves running with enjoyment and a more relaxing form.

I too have been cured of a running injury, which I suffered from for over eight years after transitioning my gait to that of a “barefoot” runner. Without further ado, here are the 10 myths of barefoot running.

Who is this radical?

Dr. Campitelli is a Fellow of the American College of Foot and Ankle Surgeons. He is board-certified by the American Board of Podiatric Surgery. Dr. Campitelli is in private practice at Northeast Ohio Medical Associates with various offices in Ohio. He is an Adjunct professor at Ohio College of Podiatric Medicine and is a medical Advisor for Vibram USA.

He's been posting on Vibram's Facebook page for a while now...

P.S.  My two other podiatrist-related posts on "Podiatrist Day":

"Dr. Nirenberg Reviews The Altra Adam"

"Fierce Feet!  Get Your Feet STILETTO READY!"

The last post is by my new favorite barefoot-friendly podiatrist.

Feet and Vascularity

After I started wearing minimalist shoes, I started reading everything I could find about barefooting.  One of the more interesting accounts came from Samuel B. Shulman (yes, he would be known today as a podiatrist):

"...All of them, however, gave a history of much pain and swelling of the foot and ankle during the first few days of work as a rickshaw puller. But after either a rest of two days or a week's more work on their feet, the pain and swelling passed away and never returned again."

After I climbed The Owl and then Mt. Katahdin, I sat in my family room and my wife said, "Oh my goodness, look at your feet!"  Actually, it was mostly my ankles.  They'd swollen up to quite a bit larger than their normal size.  Her next question: "Don't they hurt?"  Well, actually, no, they didn't hurt.  Although they were alarmingly large.  Having already read Dr. Shulman's account above, I was fairly blase about the swelling, especially since there was no pain at all.  I wouldn't even have noticed, if my wife hadn't pointed it out to me.  And yes, it never occurred again.

Some time after, she noticed that my feet had gotten much more vascular.  This makes sense.  The swelling was likely the result of lymph filling the tissues in my feet, and my body responded by growing new blood vessels, and enlarging existing vessels, in my feet.

Today, I pulled my ski boots off after a day of hard skiing, and saw this:

Yikes.

As you can see, my feet are very vascular.  I didn't capture it in this picture, but my lower legs were also similarly vascular.

I'll do a post at some point about my experimenting with barefoot-style skiing, but it's been largely successful, and I've found some boots that allow my feet to function pretty well.  A side effect of this is that I no longer have cold feet while skiing, regardless of the temperature.

Now, if you have a condition like diabetes that adversely impacts the circulation in your feet, a program like Dr. Bernstein's and some minimalist shoes could allow you to radically improve the circulation in your feet.

Plus, you'll never have cold feet again.  After getting back from skiing, I went out to dinner, in sub-freezing temps, in my flip-flops.  As did my daughter.  We both had toasty feet.

"...The Very Latest Fitness Trends"

"Barefoot training

"Exercising with bare feet is expected to get even bigger in 2011. 'Off the back of some research done into running with bare feet and the benefits of it, there's a lot of buzz about barefoot training at the moment,' says Alan Holl, head of commercial fitness at Virgin Active. 'It's the natural way to run, and means you usually land on the front of your foot, which reduces impact. If you wear trainers, you tend to land on the heel, the impact of which is not good for your legs and can even lead to knee and shin problems.' Exercising barefoot helps to develop ankle, knee and hip stabilisation, promoting good movement and preventing injury.

"Virgin Active gyms are offering the group exercise willPower & Grace [sic], a barefoot training programme that aids the functionality of the entire body. Originating in New York, it is a cardio-meets-body-and-mind exercise class. A new book on barefoot running, The Complete Idiot's Guide to Barefoot Running by Dr Craig Richards, is published on 1 February, and Vibram FiveFingers, a company that manufactures a type of shoe that acts like a glove for the foot, allowing you to mimic exercising barefoot, while actually wearing some protection, is growing in popularity...."

Unfortunately those ridiculous toning shoes also get a nod.

Minimalist Runners In The Army Get Hurt Less

"Relationships Among Self-reported Shoe Type, Footstrike Pattern, and Injury Incidence":

OBJECTIVE:

To assess the association of self-reported shoe selection with reported foot strike patterns, compare overall injury incidence associated with different shoe conditions, and identify differences in injury location between different shoe conditions....

RESULTS:

Shoe selection was significantly associated with reported footstrike (χ² (4df) =143.4, P<.001). Barefoot and minimalist runners reported a more anterior footstrike than traditionally shod runners. Traditionally shod runners were 3.41 times more likely to report injuries than experienced minimalist shoe wearers (46.7% shod vs 13.7% minimalist, χ² (1df) =77.4, P<.001, n=888). Minimalist shoe wearers also reported fewer injuries at the hip, knee, lower leg, ankle, and foot than traditionally shod runners.

Duh, no kidding. This must be part of that unfair advantage that led the Army to ban minimalist running. Idiots.

From Runblogger on Facebook.

Follow-up to "Happy Feet"

So an update to the Happy Feet post: it's not so happy now. I drove home from work today, planning on a barefoot run (with the dog) when I got home. just thinking about it was enough to bring on that strange feeling.

Two runs ago I got some nasty blisters on my right foot, from my ankle injury causing it to land incorrectly. Last run polished the blisters off.  This run polished the skin off.  I've got a nice, dime-sized raw spot on my problem right foot.  The left foot is flawless, like it was pedicured. (From my wife's descriptions of pedicures, anyway...)

So I'm limping around now, and I have happy foot. :) Hopefully this'll learn that right foot to behave better, as they say down on the farm.

I posted this over at Barefoot Ted's group, and got some amusing responses.

Latest Barefoot Run

So after polishing my right foot down just shy of the muscle a few weeks ago, I decided to take some time off barefoot running.  Both to give my skin a chance to grow back, and so as not to blow up my race.

Having finished the race Saturday afternoon, and feeling in pretty good shape by Sunday afternoon, I decided to go out.

I will note that I had stepped on a thorn at the race finish at Hampton Beach, NH.  I immediately sat down and tried to get it out, but I immediately had a full-body cramp that left me lying on my back in the sand, with people running over to make sure I wasn't having a seizure, or a heart attack.

Oh well, so I guess my foot was too far away from my arms...  Sunday afternoon I reexamined the thorn, and got it out fairly easily.

So I ran for 3 miles at an easy (10 min/mile) pace, with a hole in my foot.  The hole wasn't an issue at all, and my form felt much improved from my last foray out.  (I did not put a band-aid or anything on the hole, btw.) 

I think I've finally figured out what was causing problems in my right ankle, and while it's not fixed, it's getting there.

I am definitely going to put a lot more effort into running barefoot going forward.

"Running in a minimalist and lightweight shoe is not the same as running barefoot: a biomechanical study"

Yep. Now it's official!

"Experimental conditions
"The protocol involved four experimental 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 completing the most training mileage (herein called regular shoe)....

"Conclusions
"Barefoot running was different to all shod conditions. Barefoot running changes the amount of work done at the knee and ankle joints and this may have therapeutic and performance implications for runners."

Full-text at the link.

Reach The Beach Relay Race

Right about now, the Rank and Vile team of which I'm a member should be starting off. 

I'll be wearing my Vibram Speeds for my 3 legs, with my cut-down New Balance MT100s as a fall back (primarily in case of cold weather).

It's a 200-mile relay race.  I've been wanting to run this race for 5 years, since my good friends (and better runners) started doing it.

1st year: laser eye surgery (discretionary).

2nd year: diverticulitis surgery.
3rd year (last year): kicked a suitcase and bruised my ankle bone. Was on the team and had to drop.
4th year (this year): BETTER NOT HAVE ANYTHING HAPPEN! ;)

It's a 12-person 11-person team (oops), and we each run three most of us will be running 3 legs.  I've got a 3-mile leg and 2 6-mile legs.

All I need to to is finish with an 8-handle on my time, and I've met expectations, so anything better than that is gravy. :)  God willing.

Posterior Tibial Tendonitis Exercise

Popular demand after the last post led me to request a session with my trainer, er, my daughter, to share her dance instructor's exercise with the world.

P.S. Hope goes barefoot outside and does gym at school in her Vibrams.



Thanks to Miss Amy at Art of Dance.

P.S.  Next time I try to find this post by searching for "ankle" I'll be able to.