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Ask the Practitioner:  Barefoot Running - Why (or Why Not), What, How?


For this edition of Ask the Practitioner, we connected with Adam Daoud, an experienced runner and medical student, who while at Harvard worked extensively on research in the Skeletal Biology Lab.  His website states, "My current research interest lies in investigating the ways in which the human body is suited particularly well for endurance running and determining why Homo sapiens possess such incredible endurance running capabilities."  As a co-author of the studies cited below as well as work published in the journal Nature, Adam has narrowly focused in on the plusses, minuses, and implications of a growing trend among running enthusiasts, barefoot and / or minimally shod running.  Have you ever wondered if barefoot running would be good for you?  Read on for Adam's perspective......




rc: What are the potential benefits of barefoot running or running in minimalist shoes?

 

AD: I think that the biggest potential benefit of the barefoot style of running is reduced injury. The barefoot style of running that habitually barefoot and minimalist runners tend to use is a forefoot strike, landing on the outside ball of the foot before easing the heel down under the control of the calf muscles. This style of running minimizes the forces experienced at impact, which may help to avoid injury. Notice that this focuses less on what is under a runners’ feet and instead considers how footwear affects how runners use their feet and how this changes their style of running. My recent work looking at foot strike and injuries in collegiate runners found a nearly two-fold reduction in running injuries among forefoot strikers, none of whom were barefoot runners (Daoud AI et al. Foot Strike and Injury Rates in Endurance Runners: a retrospective studyMSSE, 2012.). This was a study about running form, more work especially prospective work needs to be done to look at the interplay between footwear, running form and injury. A singular focus on what runners strap to their feet can easily lead a runner into danger.

Another potential benefit would be financial savings. Since forefoot strike runners do not use the cushioning of a shoe to reduce the impact, shoes can be worn for many more miles before being replaced. As a forefoot strike runner, I usually wait until the upper is pulling off the lower before tossing shoes.

Studies on running efficiency have gone both ways. Our lab recently found that running in minimal shoes is more efficient regardless of foot strike and that there was no difference between heel striking and forefoot striking in terms of running efficiency (Perl DP et al. Effects of Footwear and Strike Type on Running EconomyMSSE, 2012.). While Rodger Kram’s lab has found that barefoot running is less efficient than running in lightweight, cushioned shoes (Franz JR et al. Metabolic Cost of Running Barefoot versus Shod: Is Lighter Better? MSSE, 2012.). But in general, a less injured runner is a better-trained, fitter runner so even if forefoot striking is not more efficient there may be performance gains by avoiding time off due to injury.

rc: What are the risks?

AD: While the major benefit of the forefoot strike running is injury reduction, the greatest risk is increased chance of injury during a runner’s transition from their current running form to forefoot strike running and possibly doing so in a more minimal shoe. Forefoot strike running puts very different stresses on the lower limb compared to heel striking. The muscles of the calf and foot have to do more work each time the foot strikes the ground while the bones of the foot incur impact and bending forces that are different than those experienced in heel striking. In addition, running barefoot or in a more minimal shoe will require increased muscle force to stiffen the arch of the foot and the bones of the foot may be subjected to less evenly distributed forces. Recent case reports have described instances of metatarsal injury in runners transitioning to barefoot running. Though if case reports were written up for all of the injuries sustained by “normal” runners, sports medicine journals wouldn’t have room for anything else.

Other risks are quite obvious such as injury to the sole of the foot due to surface conditions if a runner chooses to run completely barefoot. Though these risks can be greatly reduced by using your eyes and choosing smooth surfaces that are free of jagged debris. A hard surface such as a road or sidewalk can be a good surface.

 

rc: What are some sensible ways to experiment with barefoot / minimalist running to explore whether it is appropriate for you?

AD: The first thing to do is to decide whether or not your current form is working for you. If in your years, possibly decades of running you’ve found shoes that fit your running form and you’re not plagued by injuries then why change? But if you’ve struggled with injury as a heel strike runner then you might want to consider trying out forefoot striking. Unless they ask, my running friends don’t hear a word from me about running form until they get injured. This not only gives me a chance to figure out how much they’ve been injured in the past, but also transitioning to forefoot strike running can line up perfectly with returning from injury since you’re already running at a reduced volume and intensity. Transitioning should be done slowly and in accordance with what your body is telling you, just as you would any other new training technique such as weightlifting or plyometric exercises.

Concerning form, jump straight up in the air. Where on your foot did you just land? You should do the same when you run. Try out running completely barefoot on a track or smooth paved surface to try to get a feel for what it should feel like. Your bare feet will encourage you to run correctly as it will hurt to do otherwise. Don’t run barefoot on overly soft ground to learn good technique since the cushioning of the ground will allow you to run without good form. You can find more information including videos of forefoot strike running in various footwear on my past lab’s website.

The biggest mistake a runner could make would be to buy the newest, coolest pair of minimalist shoes and then go out and continue running in the same way they always have – heel striking – in their new minimal shoes. The heel cushioning of a standard running shoe will no longer attenuate the large impact forces of heel striking. Another mistake would be to consider the barefoot style as a panacea and to suddenly switch 100% of your running to forefoot striking. Your muscles need time to grow stronger and to learn the new firing pattern of a new gait pattern. And your bones need time to strengthen and remodel to adequately deal with the new loading patterns of forefoot strike running.



Our philosophy is to train at current fitness level to race at peak performance.  For that reason, we don't use goal times.  Instead, we use your past race performances to generate your pace chart and training schedule.  This is the safest way to progress to the next level. 

With that said, we encourage you to consider running a shorter distance race prior to your goal race (for example, a 5K or 10K).  We expect that as you start to condition, you will run an equivalent faster non-goal race.  The system will then update all your training to match your new fitness level.

To enter your new race time, follow the steps below:



ACS_croppedParticipating in a race for a personal cause or organized charitable organization has become an extremely popular way to experience race day.  Some of the largest marathons can boast of millions of dollars raised per year for great causes in this manner. Charities in almost every segment of the non-profit world have found their way into the action, offering race numbers for a variety of challenging endurance events.

If you are an experienced racer looking to try your next goal race with this additional motivation, or if you are seeking your first long endurance effort and wonder if the charitable piece would help you get to the finish line, here are a few things to consider when making the commitment.



imgresAsk the Practitioner:  Blisters!

For this installment of Ask the Practitioner, we connected with Michelle Toy, Assistant Athletic Trainer at Santa Clara University.  Michelle has worked with the cross country teams at Santa Clara, as well as high school athletes as the Strength and Conditioning Coach at Woodside Priory school.  This summer, Michelle will again serve as a trainer for the Bay Area Running Camp.  In short - she's seen some blisters!


RC: Why do runners typically get blisters?

MT: The most common reasons that runners get blisters are: their shoes don't fit right, they aren't wearing thick enough socks, they are running with improper mechanics, they are running on uneven surfaces, or they are running in new shoes that haven't been broken in long enough.



RC: What can you do if you develop a blister, but still need to get out there and run?

MT: If you have a blister, you can help protect it by wearing a band-aid over it or wearing a gel pad called second skin or skin lube.


RC:  What are some good ways to prevent blisters before they occur?

MT:  Good ways to help prevent blisters are to wear shoes that fit properly, wear thicker socks, run on even ground, break new shoes in over the period of a week, or wear skin lube over hot spots.



marathon-de-Paris

I admit it.  I love the big races.  Tens of thousands of runners, festival atmosphere, spectators all along the way - that is my type of marathon. I have checked a few of the biggest US marathons off the list over the past several years, but traveling abroad for a marathon was not anywhere near the top of my to do list.

 

Somehow, a wide-ranging conversation with a long time coaching client last fall coincided with a time when we both needed new goals and the narrow window for Paris Marathon registration was open.  Next thing I knew, I was headed to the City of Lights for a running adventure.

 

Most of my weekends include coaching or participation in sort of running competition, but with all the quirks of the American running culture baked in.  Many of these details I had taken for granted and had expected Paris to conform.  To my surprise, I had the opportunity to wean myself out of the comfort zone, and experience a few things I look forward to having inform my running and coaching.


1. These people are serious!

In the United States, the growth of running as a participatory (vs. competitive) sport has been well documented, and the expansion of the field has generally widened the spectrum of finishing times. In Paris, however, the very last corral offered at the Paris Marathon by finishing time was 4:30! My two traveling companions found that aid stations were being packed up as they arrived not too far behind that pace.   At six hours, little remained of the finishing area, and the police presence had been lifted, leaving the last remaining few to navigate their own version of the final half mile around traffic.  Amazing for a race of over 30,000 finishers.


2. Women’s running has plenty of room for growth

In the wake of the explosive growth of  women’s only events, women’s running has grown by leaps and bounds in the United States.  While the Paris Marathon had a ton of men running 3-4 hours, a yawning gap of depth remained after the elite field on the women’s side.  For myself, that was a plus – I’ll freely admit that a cool spot in the results was a draw.  However, it spoke volumes of how much we take for granted the middle class American women’s fitness culture taking root in our neighborhoods.  That “casually serious” athlete population remains a much smaller sisterhood in other parts of the world.


3. Who needs waves?

With a stroke of good fortune to find lodging between the start and finish, our little group had the opportunity to head to the race directly from our place.  45 minutes before, we set out, my companions to their end of the corrals, me to my end.  So much for 4:30 am wakeups and long bus rides to the start!  In a situation that I will likely never enjoy again and haven’t enjoyed before, I actually returned to our hotel to use the facilities in comfort, and had plenty of time to spare.  A miracle.  As the race time counted down, the handcycles were started early, but beyond that, each corral was just let through sequentially after the starting horn sounded.  Nearly 35,000 people in one wave on a single street.

Myriad traffic islands, various bumps and signs loomed unmarked in the center of the road, with a few pretty rough 90 degree turns early on.  Only the goodwill of the person pointing to it in front of you spared you from disaster.  Merely the hint of the insurance liability involved in just these factors would have caused change and precautions in American races of this size.  Here?  No problem.  Just watch your step.

 

4. Sports drink every mile?  Pshaw.

In the US, many of our bigger marathons provide water and sports drink every mile or two miles.  At this race, we received only water and fruit every 5K, and many times on what felt like variable sides of the road, causing some harrowing navigational challenges.  Interestingly, the water was served in small bottles and returned in small dumpsters (great for bank shots)!  With each water bottle, I grabbed a huge handful of oranges with my gloved hands (it was chilly) and stuffed my face into each for the next several hundred meters.  Very messy, but these and gel packets got me to mile 18, where the sole Powerade station waited.  Once, I would have laughed at myself for caring so much about sports drink, but by accustoming myself so much to it over the years, it tasted like liquid gold.  Flourescent blue gold, but gold just the same.


5. No barricades?  No problem!

Perhaps one of the most enjoyable, yet jarring elements of the race were the lack of barricades during much of the course.  Having watched the Tour de France on television, where cyclists climb narrow roads with crazy crowds just barely stepping back in time as the bicycles part the sea of people, It was slightly surreal to be barely avoiding people who had spilled on to the streets, off the curbs, cheering and stepping back milliseconds before the outermost person crashed into them.

Around mile 8, a boy on a scooter, accompanied by what appeared to be his father, also on a scooter, pushed along side us for at least a mile, on the street, until a fellow runner started yelling at him in French to get out of the way. Sunday long runners showed the minimal interest in making way, sometimes running the opposite direction along the route or leaving the tiniest fraction of a second while crossing the course.  Absolutely, most marathons do not have barricades along the majority of the course, but if you have ever run down 1st avenue in the New York City Marathon and can picture that scene with no barricades or controlling police presence, then you can imagine the crazy vibe at a few points.

 

Will my Paris Marathon experience help me run faster next time out?  Successful adaptation to the unexpected does breed confidence.  The low key approach to many of the things American race directors might stress about definitely contributed to my own relaxed approach as a runner, and I believe that helped. More importantly, I gained a new appreciation for all of the little things we take for granted – what race directors do to ensure our safety, increase the chance we’ll have an enjoyable time, and have the ability to do our best.  I learned I can survive without them, but I’m glad I usually don’t have to!



kinesio_foot

Adam Kemist, C.Ped and his wife Michelline own the On Your Mark running and walking store in Los Altos, California.  A long time health and wellness professional, Adam is a Board-certified Pedorthist with biomechanics expertise and also has several years of experience as an FNF member.  This month in Ask the Practitioner, Adam answers a few questions about Kinesio tape, which has become an increasingly popular tool among professional and recreational athletes.

FNF: What is the Kinesio Taping Method and how did it come about?

AK: In the mid-1970s, Dr. Kenzo Kase was a well-known Japanese practitioner licensed in chiropractic medicine and acupuncture.  He could not find a tape to give him the results that he desired for himself and his patients. So he developed Kinesio Tape.

The Kinesio Taping Method is designed to facilitate the body’s natural healing process while allowing support and stability to muscles and joints without restricting the body’s range of motion. It is used to successfully treat a variety of orthopedic, neuromuscular, neurological and medical conditions. Both Kinesio® Tex Tape and the training protocol have shown results that would have been unheard of using older methods and materials.



This month, we touch on a question that comes up over and over with brand new and experienced runners alike.

Form Tip:  Arms

Q:  What should I do with my arms when I run?



Ask the Practitioner - Sciatica

Written by Dena Evans January 30, 2012
sciatica_pointThis month, we sat down with Dr. Michael Fredericson, Director of the Physical Medicine and Rehabilitation Sports Medicine Service at Stanford Medical Center.  Dr. Fredericson has spent a career addressing the needs of athletes at all ages and ability levels, and here, he provides some insight on sciatica, one of the most common ailments for adult athletes.

 

FNF: What is sciatica and what are signs you might be suffering from it?

MF: For most people, it relates to a bulging or herniated disc in your low back that is pressing on a nerve.  You feel it through the sciatic nerve.  That nerve goes all the way down your leg, so you’ll feel it there as well.  Sometimes your back is fine, and the problem is pirformis syndrome.  Your sciatic nerve goes through the pirformis, one of your smaller backside muscles that helps rotate your hip. That muscle can get tight and it can compress your sciatic nerve.  The biggest reason to see a physician is that you want to make sure it is not a bulging disc pressing on your nerve, as this requires more aggressive treatment.

 

FNF: How do you typically treat sciatica?

MF: First, we try to figure out if there was something that got them into this situation.  A lot of people don’t realize that it isn’t from their activity, but from their work.  Maybe they sit too much or drive a lot, which can put increased pressure on their discs.   The piriformis muscle can also get tight from driving too much.  So a lot of it is getting them out of the activity, and then calming down the inflammation.  We’ll advise over-the-counter products like Aleve or ibuprofen, and then prescription anti-inflammatories and so forth, in combination with physical therapy.   If it is a bulging or herniated disc in the back, sometimes we recommend an epidural corticosteroid injection and very rarely, surgery.

 

FNF: What can we do to prevent sciatica?

MF: Everyone is typically given core exercises as a part of their physical therapy, so that is something we should do prophylactically as well.  It takes pressure away from the disc.  We also should take care with our back mechanics.  People don’t think about simple things throughout the day such as how you lift, or how you sit and stand. You should.   Also, it is wise to be careful with the downhill running.  It is easy to get out of control downhill running and put too much stress on the low back.  Likewise, overstriding [landing with your foot too far in front of your body] can lead to overstress on the back. 

 

 



Breathing on the Run

January 30, 2012

breathing

This month, we return to one of the basic types of questions we get on a regular basis - how to breathe while running.

 

We know breathing is important because we feel awful when it is ragged and shallow and we feel better when we are running easily enough that we hardly notice it at all.

 

The faster we run, the quicker we will reach a point where we will have to concentrate on our breathing in order to continue at that pace.  That is because the additional strain of the pace over time has caused our muscles to demand more oxygen on a quicker schedule.  All of sudden, you need more air and breathing begins to require your attention.

 

Usually when you get at the point where you must concentrate on your breathing, recalling long complicated lists of multi-step tasks is not something to which you are looking forward.   As such, we offer the following simple tips to remember when the going gets tough.

 

Straighten up

When we are tired, our running posture can often fall apart – our shoulders hunched over or bunched up to our earlobes, much more tense than is desirable.  When you need to get more air and right away, remind yourself to draw your shoulders away from your ears, but straighten up nice and tall.  This allows for your lungs to have the maximum room to pack in more air, and may be able to help ease symptoms of a side stitch by stretching out the afflicted area.

 

Breathe deeply

Often, whether it is the pure physical strain of the task at hand or the stress created by that strain, we tend to pant and take shallow breaths at the time we need to bring in the most air.  In the moment, it seems like the quickest way to gather as much oxygen as possible.  In reality, it is much more efficient to take a slower, deeper breath.  Imagine you are filling your stomach/ diaphragm first, from your bellybutton up to the tops of your lungs, rather than take a shallow breath.  Panting is like splashing some water over the mouth of your water bottle.  Some of what you want gets in, but the effort yields much less than the desired result.  A deeper breath is like sticking your water bottle directly under the faucet stream.  Fill up those lungs so they can do what they do best – get air to your screaming muscles!

 

Begin a slow and rhythmic breathing pattern

Breathing deeply almost certainly means you are slowing your inhaling and exhaling rhythm without necessarily focusing on doing so.  However, concentrating on your breathing rhythm can do two things:  distract your mind from the stressful running task you are continuing to pursue, and ensure you are taking in enough on each inhale.  When you are running or walking at relative ease, your breathing pattern may be 2-2 or 3-3, that is, it takes two footfalls (one landing of either foot) to inhale and two footfalls to exhale, etc.  However, when you are tired and air is at a premium, try to spend a bit more time on each inhale than you do on each exhale, for what might end up as a 3-2 rhythm or a 4-3 rhythm.  The most important thing you can do is to fill your lungs with each inhale, and it is harder to do that quite as quickly and as forcibly as you can exhale.  Take your time, try to relax yourself generally by the almost meditative counting of your breathing rhythm, and / or let a favorite song guide your brain through the pattern.  All of a sudden, you’ll be at the next mile marker or water station.

 

Everyone is a bit different, and all of us, from novice to experienced runners, need to practice techniques in low stress situations before taking them to the streets in the big race.   Listen to your breathing on easy runs to find out what your natural patterns are.  Try to maintain a tall posture and open your chest when the running is easy before forcing yourself to find that position when the running is tough.  Test out a 3-2 pattern or a 4-3 pattern on your next interval or tough workout and see what feels right.  With practice and the confidence of a few counteraction measures in your pocket for the next tough racing patch, hopefully the finish line will find its way to your feet just that much more quickly.



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