The structure-function paradox: Thoughts from a barefoot-curious reader

One perk I’ve enjoyed since starting this blog has been connecting with like-minded readers … runners, barefooters and scientists. Occasionally readers will reach out with their personal stories or questions (which I love!) The other day I received an email from a reader curious about the importance of toe and metatarsal alignment for foot health. His insights into foot biomechanics, enthusiasm for optimizing his own barefoot experience, and curiosity for the best path to do so – were striking. As he raised some interesting questions that are relevant for anyone considering transitioning to a barefoot lifestyle, I’m sharing his message, along with my response, below (note that I’ve removed his name for privacy and have trimmed the email for brevity).

I’d like to say thank you so much for documenting your experience, it is an invaluable source of information. I have great investment in this movement for myself (patellar tendonitis, fallen arches), and my family (bunion sufferers). I’m going to cut right to the chase. You seem very knowledgeable about the biomechanics of the foot, and I feel there is a significant sliver in the venn— diagram between our two philosophies. What about our toes alignment with our metatarsal shafts?

This is an idea that I see very rarely addressed among barefoot runners. I’m not sure how much of this information you’re familiar with, probably all of it but just in case I’m going to breeze through it. The shod VS the unshod life, a developed condition. I feel like this is so often ignored. In my rehabilitation from conventional footwear, I’ve been made aware of the deformation that has taken place in my bones and tendons that has bent my big toe inward, bent my small toes outward, and given me hammertoe. Why do I see so few barefoot runners addressing this? I work everyday to stretch and re-align my great toe into its natural place, a continuation of the metatarsal shaft, so that it can once again be in its place of maximum support.

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I even invested in a product that re-alignes my toes back to the way they were, so as to, over time, affect the bone and tendon structure, pushing them back into alignment. But seeing your story, how you came through without the use of these, and how your toe alignment between 2011 and 2012 didn’t seem to change much. In your recent pictures it’s hard to discern the alignment of your toes, have you seen a difference since 2012?

Does this idea hold water to you at all or do you consider something else entirely more important than alignment. I would love to know, I’ve been trying to make sense of going completely barefoot, but with my great toe alignment (about the same as yours in 2012) it just doesn’t make sense to me, I feel like I’d be putting weight on a delicate system that no longer is in the proper alignment to do its job properly. Am I completely off the mark? Any thoughts would be extremely appreciated.

I love this last picture, and it is the most profound and affirming to me, a (mostly) un-contacted tribe within the amazon. Their toes are my every day goal. I know little biomechanics, but this has philosophy has resonated with me. Am I wasting my time with this? Is this new information to you? What made you feel your path was best?

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MY RESPONSE:

Thanks for your email. I love hearing from others with a shared interest in natural, barefoot living. Indeed, I’m aware of the deformations shoes make on our feet, and that toe separators can help reverse this (I actually have some myself).

I think the answer to most of your questions lies in your goal. If your main aim is simply to realign your bone structure, then sure, work on this just the way you are. For me, better toe/metatarsal alignment has been an incidental consequence of pursuing my other goals – overall healthier, stronger feet that allow me to move the way my body is meant to. So there are two, albeit related, issues here: structure and function. You seem very focused on changing your foot structure, but for what purpose? If it’s so that your foot (and body) will also move better, the best way to achieve that is simply to use your feet the way they’re meant to be used. By going barefoot as much as possible you will quickly build muscle, tendon and bone strength and as a consequence, your foot shape will also change.

I gave up shoes four years ago and have indeed noticed major changes since then. The toe splay hasn’t been dramatic, but my arches have become strong and high and my feet and ankles have gone from soft and dainty looking, to thick, toned and defined. This sounds odd, but my feet have become my favorite physical asset – I’m proud of their transformation into powerful, beautiful structures. At this point, I could care less how my toes splay, since my feet are functioning magnificently, allowing me to walk and run for miles on end, pain-free and carefree!

You’re concerned that you could injure yourself by going barefoot if your bone alignment isn’t perfect. This is a slight possibility, but easily avoided by simply listening to your body. I would be concerned less about proper alignment than general foot weakness. The risks of walking or running barefoot excessively before you’re ready come from inadequate strength, and the only way to strengthen your feet is to use them! Sure, going out and sprinting a 5k for your first barefoot run will injure you. Instead, go for a short walk until your feet start to fatigue. Then call it a day. Or run around the block for 2 minutes. Give yourself enough rest to allow your feet to recover and rebuild before you try again. Over time, you’ll be able to walk further, run longer and start noticing remarkable changes in how your feet feel, look and function. When I gave up shoes in 2011 I couldn’t walk barefoot more than a few minutes before my feet hurt. I walked barefoot for a couple years to build up base strength, then began running barefoot – literally starting by running one block. I now regularly run 40-45 miles a week barefoot.

I seem to have written a novel, but this is an important and interesting topic for me! My last tidbit of advice is to not over-think it … just enjoy the improved sensory experience and awareness your feet give you and savor the growth, however gradual it may be. Happy barefooting!

What are your thoughts on the relative importance of foot structure and function, and how they influence one another?

I love hearing my readers’ experiences and questions, so please don’t hesitate to reach out!

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The shoulder-hip rotation equation

Stabiliity. Mobility. Activation. Relaxation. Each of these features has its place in a strong, efficient running stride. Yet, an excess or lack of one at the wrong place in the gait cycle can seriously throw off a runner’s biomechanics. Through some recent trials and experimentation of my own, I’ve learned how profoundly true this is for a proper kinematic balance throughout the core, extending from the pelvis up through the abs, back and shoulders.

Those who’ve been following my blog will be aware of my history of hamstring and foot injuries. I’ve struggled with disproportionate left hip/hamstring tension and tendinopathy for years, and have sustained beyond my fair share of right foot fractures and tendinoses. While these issues are more or less under control due to gradually improving biomechanics, more mindful training and frequent self-care (massage, ART and physical therapy), they continue to linger as minor annoyances on most runs. A couple weeks ago, my physical therapist performed a gait analysis to get to the source of these longstanding imbalances.

She noted three main issues:

1) Excessive left shoulder rotation. I tend to pull my left shoulder back too much right before left foot-strike. The arms should swing in the sagittal plane, but there should be minimal rotation at the shoulders.

Left shoulder rotates excessively

Left shoulder rotates excessively

2) Insufficient right leg drive. Compared to my left leg, my right leg does not come up as high during the swing phase. I can feel this while running, as if the leg is dragging behind me instead of driving back powerfully. In fact, I have a tendency to occasionally stub my right big toe due to my inability to lift.

Right leg lifts lower than left

Right leg lifts lower than left

3) Externally rotated right foot. When the foot strikes, it tends to land with the toes pointed outward. I am also keenly aware of this error, as it feels like the entire right leg is uncontrollably turned out.

Right foot rotates outward

Right foot rotates outward

Mental trick FAIL

For the past week, I’ve attempted to consciously correct each of these biomechanical errors in turn … without success. Efforts to stabilize my shoulders left me with excess tension from the neck down, through the shoulder and back. Empowering my right leg drive felt unnatural and exhausting, and turning my right foot inward was even more awkward and resulted in lateral ankle pain. Form correction FAIL.

My physical therapist prescribed some drills to ingrain proper shoulder and foot motor-memory; yet these changes will take time and I wanted a quick fix. I knew something major was off with my gait, so I launched my own investigation. I came across an article discussing the balance between shoulder and pelvic rotation (which I can no longer track down) that struck a chord. Excessive amounts of shoulder rotation, they explained, may signal insufficient hip rotation. If the hips are too rigid, the upper body compensates. Prior to my long run this week, I practiced this simple exercise to reinforce what proper pelvic rotation should feel like … and to no surprise, this was a novel sensation for my typically rigid running hips.

Mental trick SUCCESS!

Throughout my long run, I repeatedly checked in with my form, this time drawing on some new tools in my belt. Rather than forcefully immobilizing my upper body, I focused on relaxing the shoulders, keeping the neck extended, and leading with the chest. I increased my forward full-body lean and was cautious not to overstride. Most critically, I experimented – for the first time – with exaggerating my pelvic rotation. As my left leg began to swing back, I let the hip pull back with it … this was a remarkably new sensation, but felt fluid and right. I was suddenly able to attain much greater leg extension that usual, without force or effort. Further exploring the movement, I discovered that emphasizing rotation on the left compared to the right seemed to balance and better align my hips. The pattern of tension that typically evolves over my long runs – extending from my lower back down through the left glutes and hamstring – was oddly absent. Not only was my left leg moving with new-found fluidity, but my right leg had inadvertently gained strength and alignment as well. By increasing my left pelvic rotation, my right leg and foot were now freed to glide naturally through their stride. Without effort, the right foot was now striking straight and both legs were driving back with equal strength.

So how does a runner know how to balance stability with mobility? When during the gait cycle to relax and when to engage? It’s truly a delicate balance, and one that doesn’t always come naturally. Injuries that cause compensatory movement, or years of running with even slight dysfunction can further exacerbate and ingrain poor motor patterns. Critically, as each runner is unique in terms of structure and function, there is no one-size-fits-all biomechanical prescription. Even running experts agree there’s no “perfect” form, and it can be risky to change your form unnecessarily. My advice to you, runner, is to experiment with your gait if there’s a preexisting problem. Then, play with various adjustments and assess your body’s response until you hone in on changes that benefit you.

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Return to racing, bare and proud!

As I crossed the finish line of the San Diego Half Marathon this past Sunday, I choked back the tears as a powerful flood of emotion overcame me. Two years ago at this time, I was recovering from my second metatarsal stress fracture, just one of a series of severe injuries that kept me sidelined from racing – and nearly from running at all. Over the previous two years, I had tried – and failed – to treat my torn achilles, peroneal and extensor tendonitis, hip bursitis, metatarsal stress reaction and two fractures, by experimenting with every therapy in the books and every shoe available (seriously, you should have seen my shoe rack). My running accomplishments had rapidly diminished from regular marathons to hobbling a few painful miles at best. Each successive injury was followed by yet another, sending me faster into a downward spiral of intensifying hopelessness, as it appeared that my running days were nearing their end.

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Running rebirth

There was a deeper imbalance that was untreatable by rest, physical therapy or new shoes. It was time to hit the reset button and retrain myself to run … from scratch. When I vowed to give up shoes a year and a half ago (September 7, 2013 to be exact) I was terrified. This meant intentionally reducing my mileage to frustratingly low levels and risking more broken bones or worse (as the media promised, with headlines to the tune of “Barefoot Running Can Cause Injuries, Too” and “Barefoot Running Injuries: Doctors See Health Problems Ranging From Stress Fractures To Pulled Calf Muscles“). Although I had been dabbling in running barefoot for a year or so prior, I had approached it as a casual occasional training tool to improve my form, not to mention have a little childlike fun on the side! It seemed unsustainable for the distances and regularity I had been logging and longed to return to. Yet, as every conventional option had failed me, the novelty and craziness of barefoot running offered just the glimmer of hope I needed.

As I progressed through my barefoot journey, the initial apprehension quickly wore off. The requisite patience was offset both by the thrill of running painlessly and freely, as well as by the small, victorious milestones along the way. I vividly remember the satisfaction of completing my first barefoot mile, the giddiness after my first 5-miler and the astonishment after finishing my first 10-miler. The experiment was working!

Racing: The missing piece

Yet, although I had overcome the chronic injuries and – most importantly – had regained my love for running, there was still a missing piece to my inner runner. Due to the incessant injuries, followed by the gradual transition to barefoot running, I hadn’t seriously raced since my last marathon over three years ago. I knew from others’ experiences that returning to full performance (in terms of distance and speed) after switching from shod to barefoot running can take years – around a decade by some estimates. While I dreamed of returning to racing, I was admittedly terrified. Foremost, my barefoot training required a new level of control and precaution, forcing me to limit my terrain mostly to smooth pavement and concrete, and to abandon speed and distance goals. But further, racing for me has always been a chance to explore and test my physical and mental limits. Barefoot racing was uncharted territory and I feared the disappointment if I were to fail that test.

Soon, this race anxiety was overpowered by annoyance with the anxiety, and fed up with my complacency, I took the plunge. My body may never be “perfectly” barefoot-race-ready, but my mind was itching to race. With more excitement than perhaps for any past race, I spontaneously registered for the San Diego Half Marathon, just a couple weeks out. I had been warned by a fellow barefoot runner of some rough spots, but refused to check out the course in advance. Ignorance can indeed be bliss. I was anxious enough, and preferred to bask in blind eagerness than further worry myself.

Taper despair

To my despair, a week from race day as I began to taper, I developed an odd forefoot issue: tight, burning metatarsal heads and painful, tingly first and second toes (I suspect this was related to clumsily wacking my foot on a curb weeks prior, but we’ll never know). The two days before the race, the ‘injury’ peaked and I was hobbling in pain. The mental battle raged, as I weighed the risks and benefits of showing up at the starting line – a painful, miserable, slow run, versus intense disappointment and regret.

Race morning, my foot still ached. But I had to try. The buzz at the starting line reaffirmed my decision, as the shared anticipation amongst the running community flooded me with excitement.

Mile 1: My big toe ached. “Already? Ugh. Why I am I here again?” By mile 2 the pain was gone.

Mile 3: A rough stretch of nasty road. What would have typically ripped up my feet now barely fazed me as I focused intently on light, relaxed form.

Mile 5: Drained and anxious. My foot had been acting up around mile 4-5 in my training runs, and I anticipated the end of my race was near. “This race was such an idiotic decision. I’m injured and tired … there’s just no way this will end well. I’ll most certainly end up more severely hurt, and for what? To prove that I can race barefoot?” But the energy of the runners and spectators propelled me forward, and the constant stream of “Barefoot … thats awesome!” and “Look, she’s barefoot!” reminded me that not only could I do it, I was doing it.

Mile 6.5: Half way already? The foot still felt fine.

Mile 9: After an ugly stretch of not-so-well maintained pavement crossing the 5 freeway, “the hill” appeared. As the 300-foot ascent began and runners around me began to walk, I savored the smooth concrete under my feet as I climbed steadily. But as I peaked to flat ground, I felt a painful ‘pebble’ under my big toe. After a couple of minutes I pulled aside to wipe it away, but there was no pebble. My already finicky flexor tendon had apparently been irritated by the hill, but with only 3 miles to go, I had to push through.

Mile 11: The course weaved through my neighborhood, and as I passed by the cheering onlookers at my typical weekend coffee spot, the pride hit me. I could have been one of those spectators myself, sipping my tea with regret. But not today.

To the finish: Perhaps the most frustrating stretch of the race was the downhill finish. I felt exceptionally strong, but had put on some slight breaks to avoid tearing up the quads, calves and of course, feet.

13.1: I crossed the finish line with deeper gratitude than at perhaps any other race. Compared to my shod days, I hadn’t run particularly fast, and the distance was nothing remarkable, but I had broken another type of PR. After years of being sidelined by injury, I was back in the game. That missing piece to my inner runner was finally found. I was no longer transitioning to barefoot running … I was there. I was a real runner once again … strong, healthy and basking in the post-race passion of the running community that I so missed.

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PRP: A shot full of miracles

Four and a half weeks ago I couldn’t bend over, extend my leg in front of me or sit for more than a few minutes without a deep pain in the butt. Four and a half weeks ago I got my first injection of platelet-rich plasma (PRP) to treat a chronic hamstring tendinopathy. I was desperate and eager, but also very skeptical. “You’re a perfect candidate for the treatment,” my doctor encouraged me. “We’ve had incredible success with cases just like yours.” I wanted so badly to believe him, but didn’t want to face the disappointment if it didn’t work. This was my last resort. I had tried every other treatment in the books – ART, physical therapy, massage, dry needling, you name it – none of it helped. So why would PRP? What would I do if it didn’t work?

Platelet-rich plasma: The nitty-gritty

I covered the procedure in detail previously, but to summarize, I received three injections into the injured hamstring, each spaced a week apart. The first was intensely painful, but each subsequent shot was noticeably more tolerable. Despite my doctor’s advice to avoid running completely, I continued running throughout the treatment and recovery, albeit at a slightly reduced mileage (I’ve been logging roughly 25-35 miles/week, compared to my typical 40-45 miles/week). At no point did I feel the running set me back, and if anything, I suspect the gentle activity may have helped stimulate healing.

So, did it work, you ask?

Fast forward to today, and I can confidently say I’ve experienced a medical miracle. I’m by no means 100%, but in just a month I’ve witnessed dramatic, objective improvement and continue to improve daily. For the first couple of weeks, I really wanted to feel an effect and at points convinced myself I felt something. In retrospect, these early notions were most certainly a placebo effect. However, right around two weeks – after my final treatment  – the wishful thinking turned into an undeniable reality. Since then I’ve developed 1) increased range of motion, 2) remarkable strength, and 3) essentially no pain running. Even my ART and massage therapists were astounded at how different … healthier … my tissue felt. So I guess it’s really not just in my head?

Welcome back, Gumby!

I’ve always been flexible … almost too flexible for a runner. But that range of motion disappeared with my recent hamstring flare-up, and I haven’t been able to bend over without intense pain in seven months. Today, I can easily touch my toes (pain-free and without fear of ripping my hamstring!) and can almost do the splits, just like my typically Gumby-esque self.

Return of strength

The tearing in my hamstring left me not only tight and inflexible, but also weak. I’ve been unable to do simple exercises that engage the hamstring, like reverse planks and hamstring curls. Today, my bad leg is still weaker than my good, but I can hold a single-legged reverse plank without collapsing in pain. Now that‘s progress!

Goodbye pain!

The last tidbit of evidence that I’m legitimately improving is the joyous absence of pain while running! Sure, I still feel tight. My stride occasionally shortens, especially with fatigue or during the last couple miles of a long run. But I no longer have to stop mid-run to jam my fist into my cramping butt. Perhaps the most wondrous perk of the this miraculous healing process has been regaining those blissful miles of meditative escape. Instead of cringing in anxious anticipation of when my hamstring will throw a tantrum, or of when my hip will lock up and my feet will refuse to turn over, I can once again float along, physically fluid and mentally free.

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2014 in running: Patience, growth and healing

I never run with gadgets of any sort – no watches, GPS or music for me. Yet, as a scientist, I’m a sucker for crunching numbers and plotting data, both in the lab and to evaluate my running progress. It should be no surprise, then, that I track my mileage rigorously. There’s something deeply satisfying about visualizing those tranquil, meditative hours on the road as fluid points on a graph. Please indulge me, therefore, as I open this review of my past year in running with some data fun!

I ran a total of 1760 miles this year, 93% (1628) of which were barefoot … that is, skin to earth … bringing me to a total of 2632 lifetime barefoot miles. Given the rule of changing your running shoes every 300-500 miles, I’d say I’m well overdue for a new pair of feet. The remaining 132 miles were traversed in socks, Sockwas, chainmail Paleo Barefoots, huaraches or Skoras. I reached peak mileage in November with a 45 mile week, also my highest weekly mileage since transitioning to barefoot running. Compared to my shod-running days, these stats are underwhelming. Back in my marathon training years, I regularly logged 60-70+ mile weeks, typically including a 20-ish mile weekend long run. However, I’m more proud of these recent miles than any before.

After a couple years of unsuccessfully dabbling in minimalist (and a touch of barefoot) running, on September 7, 2013 I committed to abandon my shoes for good. I was frustrated with chronic injuries and had come to dread and resent running; the one activity that had formerly fueled and impassioned me was only leaving me injured and depressed. The past 15+ months have offered their own series of challenges, testing my patience as I essentially relearned to run, retraining my body to move with proper biomechanics, and to listen attentively to my body’s warnings of overtaining or incipient injury. Over the course of the year, this transition developed into a transformation; as I lost my addiction to shoes I also lost the chronic injuries and rediscovered that fresh, genuine joy to running that first hooked me as a runner. My total mileage is now lower, and my “long” runs are now shorter – currently on the order of 10-14 miles. However, these have been some of the most liberating, fun and insightful miles of my running career.

Perhaps most importantly, they’ve also been the healthiest miles in many years. In contrast to 2012 and 2013, during which I respectively lost five months and five weeks to metatarsal stress reactions and fractures, I took no time off from a running injury in 2014. Compare the erratic green and blue lines in the below graph to the stable, steady red line of this year. Not only have I found freedom from injury, but in just a year, I’ve built up to running comparable volumes as the year prior (1781 total miles in 2013), when I only logged half of my miles barefoot, and am running 65% higher volume than 2012 (1063 total miles), when I squeaked out only 10% of my miles barefoot. In fairness, 2014 included periods of voluntary reduced mileage while babying the occasional niggle, along with a few days of forced rest to recover from a foot infection and PRP injections for a chronic hamstring issue.

2012-14_Mileage

I haven’t raced once this year, and honestly, I couldn’t care less. Despite an absence of race medals and PRs, I’ve accomplished – no, exceeded – each of my running goals this year. I no longer train to race, or to reach arbitrary distance or speed milestones. I run because it fills me with life. I run to feel the essence of existence fully and intensely – sometimes while soaring, floating or flying – other times while cursing through the struggle between body and mind to quit or to push through one more step. In the end, the patience and growth have all been worth it, to feel my body, mind and spirit soaring together in unison, an effect unparalleled by any drug.

This review may be filled with numbers, but I write it to remind myself and my runner readers that running is about so much more than time and distance. There are always new ways to grow, new trails to explore and new power to discover within yourself. On the eve of a new year, I wish you all a rewarding running journey in 2015 replete with your own evolution and adventures.

Happy, healthy trails ahead to all my wonderful readers!

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PRP. It’s a real pain in the butt

Seventeen years now. It’s been roughly 17 years that I’ve struggled with intermittent hip pain / hamstring tightness / sciatica, blah-ba-de-blah, etc. It comes and goes, and while it has never stopped me from running, it has stopped me from running well. My latest flare-up, which began about six months ago, has been the worst – and most stubborn – yet.

THE VERDICT

Having completely run out of patience babying my achy butt, moderating my speed and gingerly prancing up hills to avoid overstretching my immobile hamstring, I finally saw an orthopedist and pushed for an MRI. Verdict: chronic partial tearing, scarring and tissue thickening along the hamstring, most severe at its origin near the ischial tuberosity; essentially high-hamstring tendinopathy. It’s anyone’s guess when the degeneration began, but the tendon clearly isn’t healing itself. After an unwelcome lecture pointing out that my aging body is only going to further weaken (I’m 32 for god’s sake!), that my vegetarian diet is not suited for athletes (curious how he’d explain these ultra-runner and ultra-athlete veggie legends), that my bare feet need “support” and that I should really just stop running so much, my doctor finally offered a rational alternative: PRP, or Platelet Rich Plasma. I eagerly agreed, desperate to try anything that might nip this butt-pain in the bud and finally restore strength and functionality to my weakened tendon.

THE PROCEDURE

As a relatively new technique, PRP protocols vary considerably across practices. My doctor advised a series of three injections, spaced 7-10 days apart, although he reported the number of necessary treatments can range anywhere from one to five, depending on the injury and patient. And in some cases, the treatment isn’t effective at all. The procedure is actually quite simple and takes under an hour. They first draw blood which is then centrifuged and processed for several minutes to yield a solution rich in platelets. This provides a concentrated source of factors that support healing, like growth factors and cytokines. The goal is to induce an inflammatory response to promote tissue repair. Next, the doctor identifies the target site by manually probing around until he hits the “hot spot” of pain. After preparing the skin with some disinfectant (and a mysterious cooling liquid), he inserts the needle, guided by ultrasound, and injects the platelet-rich plasma. In my case, the pain was relatively diffuse, so he injected at several different locations of my hamstring origin, to cover all bases.

Platelet_Rich_Plasma_PRP-Therapy-IMAGE

I will not lie, the procedure isn’t fun. There were some painful moments, although never intolerable. I’ve read that many physicians will use local anesthetics during the procedure and prescribe pain-killers for pain management, although mine did neither. I guess I just look that tough. ;)

As a relatively novel, borderline experimental treatment, PRP isn’t covered by all insurance plans. Mine fortunately covered it fully. Otherwise, each injection may put you back $1000 or more.

THE AFTERMATH

The doctor indicated that I’d be fine to drive afterwards, which was far from true. For the next couple of days, sitting – especially on hard surfaces or while driving – was extremely uncomfortable. There was a constant deep, dull ache and the sensation of a severe bruise at the injection site. Since the therapy relies on a strong inflammatory response, ice and anti-inflammatory medications (which I avoid anyway) are not allowed. Each day the pain subsides slightly, and today, four days post-injection, I feel 90% normal (not healed, just 90% of my pre-PRP state).

ACTIVITY

My doctor gave very limited guidelines for my activity levels during the recovery period. He in fact skirted the issue, indicating that my activity depended on my “need” to run, and my healing goals. On one hand, he said, he’s had athletes compete hard just a few days after the treatment and manage a full, successful recovery. On the other hand, any amount of irritation to the tissue could delay healing and set me back. A confusing, unsatisfactory response. Being both a strong believer in active recovery, and one who spirals rapidly downwards when I can’t run, I opted for the more aggressive recovery trajectory.

After two days of near total rest (excepting some very light yoga), I ventured out on a test run. I set a mental limit of three miles, acknowledging that attempting a run so soon was pushing the envelope already. So of course, I accidentally ran six instead. To my great surprise, my hamstring felt no worse than pre-PRP. Sure, it was tight. Yes, it was achy. But the discomfort level was the same as while resting or walking, and did not progress throughout the run. Today – the day after this test run – the hamstring continues to improve. So I’m treating myself to another easy run, of no more than 4 miles. I promise.

MY BOTTOM’S BOTTOM LINE

So what’s the verdict on PRP? It’s far too early to tell. For one, it’s admittedly painful. And at only four days into the therapy, it’s far too early to tell whether it’s working. Purportedly, symptoms may start to improve anywhere between several days to months after treatment. But the underlying science is logical, and the immediate resulting deep ache confirms that an inflammatory response is indeed underway. This is enough to give me hope, and hope is enough to keep fueling my runs.

Have you gotten PRP or are you considering it? I’d love to hear your experiences and questions!

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Sweet talking the pain way

Sure, we’ve all heard about the importance of the mind-body connection for improving our running performance, but how many of us actually give credence to the idea? Many of us have experienced the strong influence of our mental state on our physical performance, though we may not always be aware of its impact. You’re probably familiar with one of these scenarios … a bad day at work is topped off with an equally miserable run, or a celebratory run after hearing some good news sends you soaring into that runner’s high. Well, just the other day, my run highlighted exactly how powerful our mental landscape can be at assuaging or preventing injuries.

hamstring-origin-tendinopatFor the past five months (or more accurately, 17 years if you consider the repeated flare-ups since I began running) I’ve been battling chronic, relentless hamstring / glute / hip tightness and pain. Call it what you will … the various docs I’ve seen have attributed it to anything and everything, from sciatica to piriformis syndrome to hamstring tendinopathy to good old-fashioned overuse and weakness. Regardless of these meaningless diagnoses, I’ve found no relief, despite my desperate treatment attempts with massage, foam-rolling, ART and acupuncture. And despite this failed therapy, I’ve continued to run through the pain, as any typically irrational running addict would do.

A twitter discussion, following a particularly traumatic (to the hamstring) 12-miler, got me thinking. @skorarunning pointed out “I’ve even read that rolling could cause tightness, as it’s a stress to the muscles & they could tighten as a safety mechanism”. @rickmerriam corroborated “Muscles tighten up to prevent joints from going into positions of vulnerability. #BuiltInProtectiveMechanism”.

As I started my run the next day and my hammie/glute/hip immediately tightened up (per usual), I thought back to these comments. Why was it cramping? What was it trying to protect itself against? For whatever reason, it was vulnerable, and – sensing the need to shield itself against some mysterious stressor – locked up in defense. The vision of an anxious child came to mind: unnecessarily frightened of a harmless, imaginary threat. ‘If only I could just convince my hamstring that the threat is not real … there’s no reason to ‘fear’ the run,’ I wished. And so I did. I had a chat with my leg and encouraged it to clam the heck down. To stop overreacting. There was no real danger. It was safe and strong and protected. At the slightest hint of tension, I sweet-talked the muscle into soft, loose submission. And to my complete astonishment, the muscle listened, sending me sailing comfortably and strongly through 8 pain-free miles.

Was it merely a coincidence? Would my hamstring have behaved had I not whispered soothing lullabies into into its, um, hammie-ears? This was but another experiment of one, and I will never know. But I do know our muscles activate in a beautifully orchestrated neuromuscular symphony, which is intimately connected with our central nervous system. It would not surprise me if the the cognitive superstar of the human nervous system – the brain – is charismatic enough to use its mental coercion to sway its fellow motor neurons into passive compliance.

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It finally happened

Ever since I went barefoot over three years ago, I’ve scoffed at the “Aren’t you afraid you’ll catch a disease or infection?” comments. Ridiculous, I thought. I don’t walk around with open foot wounds, and my feet aren’t a bacterial highway to my orifices. After this past week, however, I’m realizing that maybe a little fear would have served me well.

Here’s an abbreviated version of my real-life horror-story to scare a little caution into the barefooting community.

Saturday: Post-dinner stomach rumbles evolved into suspected food poisoning. I’ll spare you the details, but any food sent me an immediate angry message that kept me miserable and sleep-deprived for three days.

Tuesday morning: Stomach turned a corner for the better, so despite my fatigue and weakness, I attempted a run. Managed 8 miles but noticed a mild heel ache. Did I bruise it without noticing? Was it a hint of plantar fasciitis? I had sustained a minuscule cut on that heel a week ago, but that had healed. Not overly concerned, I did some gentle self-massage and slathered some DMSO – a controversial chemical thought to promote soft-tissue healing – over the heel and ankle. I then went about my day, walking barefoot and pleased that I was back up and running again.

Tuesday evening: Foot had gotten progressively worse and I’m feeling notably drained. Must have overdone it with the run. Right before bed, my groin region begins to hurt and I’m feeling chilled and achy. 101.5° fever. A little internet research educates me that swollen lymph nodes in the groin indicate injury to the foot or leg. The pieces of the puzzle are starting to fit together.

Infected foot. The doctor's outline shows the extent of the infection.

Infected foot. The doctor’s outline shows the extent of the infection.

Wednesday: I awaken to some rapidly spreading and intensifying foot pain, leading to a trip to the ER. It’s an infection, the doc confirms, and gently suggests I run in shoes. I respectfully tell him I’ll opt for this over chronic fractures and tendonitis. He accepts my decision, prescribes an antibiotic and tells me I’ll be feeling better by the morning.

Drip. Drip. Two hours of antibiotics directly into the bloodstream.

Drip. Drip. Two hours of antibiotics directly into the bloodstream.

Thursday: I awaken to a throbbing foot and the terrifying sight of deep red streaks climbing up my ankle. Back to the ER it is, hopping on one foot most of the way. They give me an IV of vancomycin (an antibiotic) and release me six hours later with prescriptions for two more antibiotics. So. Many. Drugs.

Fast forward two days later, and I can almost walk normally. The infection’s under control and the swelling has mostly subsided, though there’s an ugly patch of broken blood vessels and bruising that’s tight and tender to the touch. Thank god for modern medicine. The alternative of losing a limb (or worse) to a simple infection – a reality that our ancestors and many less fortunate populations around the world today still deal with – is humbling and sobering. That’s a topic for another day.

So what caused the infection? The docs didn’t really care to look into it, but assumed it was the old cut on my heel. I suspect otherwise, as the infection never actually extended to the cut itself. The other possibility, that admittedly creeps me out, is that the DMSO – a “universal solvent” – absorbed some nastiness from the outside world directly into my skin and bloodstream. The chemical is not approved for medical use on humans, apparently for good reason. I’ll never know the exact cause, but my DMSO is enjoying its new home in the trash.

“I told you so!” I can hear you all crying in anti-barefoot triumph. Not so fast. Incidentally, I sustained a similarly serious foot infection a decade ago from a blister caused by … poorly fitting shoes. Life happens, unpredictably and uncontrollably, shod or barefoot. As abandoning my shoes and rediscovering the power of my feet has introduced so much strength, health and joy into my running and everyday life, re-embracing shoes is nowhere on the horizon. Sure, barefoot running carries its unique set of risks. But I’ll take the occasional bruise and fluke infection over repeated broken bones and torn tendons any day.

Stay safe and run happy!

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Global similarity signals of recognition strength

The below article was recently rejected from the Journal of Neuroscience as a ‘Journal Club’ commentary on Davis et al., 2014, ‘Global neural pattern similarity as a common basis for categorization and recognition memory’. Hoping that my efforts will not go to waste, I’d like to give the piece an alternate home here. Please read, comment and share, all free of paywalls!

Theories of long-term memory have linked an item’s memory strength to its “global similarity” (Clark and Gronlund, 1996). The greater the conceptual overlap between a target item and other items stored in memory, the more familiar the item will seem. While psychological models have consistently supported the theory that across-item similarity contributes to recognition memory, it is unclear how neural computations give rise to this relationship between representational similarity and memory strength. Neuroimaging studies have shown that activity in the brain’s medial temporal lobe tracks memory strength as well as the representational overlap between stimuli in memory, establishing this region as a likely host for a global similarity signal that confers accuracy and confidence to recognition judgments.

Model of the multivoxel pattern similarity analysis. A) The multivoxel activation pattern within a region is extracted for each stimulus (S1, S2, etc.). B) The correlation between the activation pattern for each stimulus and that of all other stimuli is computed. Across-item correlations are expected to be higher for stimuli that are strongly remembered than those that are poorly remembered. Adapted from Xue et al., 2010.

Model of the multivoxel pattern similarity analysis. A) The multivoxel activation pattern within a region is extracted for each stimulus (S1, S2, etc.). B) The correlation between the activation pattern for each stimulus and that of all other stimuli is computed. Across-item correlations are expected to be higher for stimuli that are strongly remembered than those that are poorly remembered. Adapted from Xue et al., 2010.

In their study recently published in the Journal of Neuroscience, Davis and colleagues (2014) tested whether the similarity between blood oxygen level dependent (BOLD) activation patterns elicited by an item and other encoded items predicted how confidently the item would later be recognized (see figure). Participants underwent functional magnetic resonance imaging while performing an incidental encoding task of repeated Chinese words. They were later administered a surprise recall task, in which they freely reported any recalled words from the encoding task, as well as a surprise recognition task, in which they reported their confidence in having previously seen a word. The authors then computed a neural similarity score for each word, which measured the correlation between the multivoxel activity pattern for that word and the activity pattern for all other words (Davis et al., Figure 1). This global similarity metric was compared to recognition confidence ratings to assess the relationship between neural representational overlap and memory strength.

Consistent with their prediction, the extent of global similarity between the multivoxel activation pattern of a word and that of all other words correlated with the word’s subsequent recognition confidence ratings (Davis et al., Figure 3A). Within their medial temporal lobe region of interest, the effect was localized to clusters in both the parahippocampal gyrus and hippocampus. This link between neural global similarity and recognition strength held even after controlling for within-item similarity, which the authors previously showed to correlate with memory strength (Xue et al., 2010). Furthermore, medial temporal lobe pattern similarity also correlated with the semantic relatedness between words (Davis et al., Figure 6). This demonstrated, for the first time, that medial temporal lobe substrates of between-item similarity mirror psychological metrics of memory strength and semantic relatedness. The stronger an item is represented in memory, the more highly its semantic content, and its representation in the medial temporal lobe, overlaps with that of other stimuli.

While these initial results speak to the mechanisms by which an item is perceived as familiar, considerable debate exists over whether recognition is mediated by a single neural system. For instance, some neuroimaging and lesion studies have reported functional segregation of familiarity and recollection signals within the medial temporal lobe (Eichenbaum et al., 2007), while others indicate that the medial temporal lobe collectively supports all forms of recognition memory (Squire et al., 2007). Furthermore, there is evidence that successful recall can be mediated by global similarity (Gillund and Shiffrin, 1984), but also by pattern separation of an item from other items (O’Reilly and Norman, 2002). Thus, to dissociate between effects of global similarity on recognition strength and on recall, pattern similarity analyses were additionally performed on non-recalled words alone, and also on recalled versus non-recalled words. Global similarity of medial temporal lobe activation patterns both correlated with the memory strength of non-recalled words and predicted recall success. Thus, both recognition and recall may rely on the degree of neural representational overlap across items in memory.

Finally, the authors investigated whether the association between memory strength and neural similarity extends beyond long-term memory. Given prior evidence that learning categorical rules increases the psychological similarity of learned items and activates the medial temporal lobe, they tested whether global similarity of medial temporal lobe representations reflected category learning. Indeed, global similarity of medial temporal lobe activity patterns correlated with the psychological similarity between an item and others in its category (Davis et al., Figure 3B, C). Notably, these regions overlapped considerably with those from the long-term memory pattern similarity analysis (Davis et al., Figure 4). Thus, global similarity computations in the medial temporal lobe may not selectively subserve episodic memory formation, but might support a range of learning processes.
These findings suggest a universal mechanism of coding memory strength within the medial temporal lobe that generalizes across domains, beyond just recognition memory. This bridge across cognitive domains aligns well with our understanding that acquiring both episodic memories and categorization rules involves learning new information, a process fundamentally supported by memory encoding. However, the breadth of such a medial temporal lobe code, which extends beyond recognition to encompass recall and categorization, raises important considerations regarding the heterogeneity versus homogeneity of medial temporal lobe memory functions.

Some theories of medial temporal lobe function propose distinct roles for the hippocampus and parahippocampal gyrus in long-term memory. A recent study examined whether these regions also functionally dissociate according to memory-related global similarity computations. LaRocque et al. (2013) reported a correlation between across-item neural similarity and recognition strength in the parahippocampal gyrus, but an inverse correlation in the hippocampus. This dissociation contrasts with the parallel representations in the hippocampus and parahippocampal gyrus observed by Davis et al. (2014). Thus, hippocampal representations of global similarity and distinctiveness may both contribute to recognition memory. These seemingly contradictory findings in fact align with computational models of hippocampal function suggesting that the structure performs both pattern completion and separation in the service of long-term memory (Yassa and Stark, 2011). These operations are likely computed by separate hippocampal subregions and support distinct memory functions. Specifically, pattern separation may be mediated by the dentate gyrus and promote discriminative processes that aid encoding and recollection, whereas pattern completion may be mediated by CA3 and generalize across inputs to signal familiarity. It is therefore possible that hippocampal signals of representational overlap and distinctiveness coexist in complex tasks like those employed in these studies (LaRocque et al., 2013; Davis et al., 2014), which may dynamically engage concurrent memory encoding and retrieval processes. Follow-up studies will help to resolve why a pattern completion or separation signal would dominate depending on the task condition or memory manipulation.

Furthermore, given the inherent ambiguity of multivoxel signal content, it is unclear what particular information is carried in overlapping activation patters. Here, BOLD patterns correlated with both memory strength and semantic content; yet, multiple additional variables may covary with these cognitive measures and hence contribute to the similarity across multivoxel space. As the authors acknowledge, an infinite number of factors, which can be challenging to detect or control, may increase the similarity between BOLD activation patterns (Todd et al., 2013). Further research will be important to more completely characterize how variance in factors such as stimulus features, cognitive sub-processes, BOLD dynamics, or analysis procedures, may additionally drive the overlap in BOLD patterns of neural representations.

The findings of Davis and colleagues provide novel insight into medial temporal lobe coding mechanisms of memory strength, linking computational models that implicate psychological similarity in recognition strength with representational similarity of memory-related brain activation patterns. Together, these results solidify a base upon which to more thoroughly examine the breadth of this medial temporal lobe similarity signal across cognitive processes. Such findings will serve as critical steps towards clarifying the extent to which overlapping neural representations in the hippocampus and parahippocampal gyrus contribute to a range of learning processes – including both those within and beyond the domain of episodic memory.

References

1. Clark SE, Gronlund SD. 1996. Global matching models of recognition memory: How the models match the data. Psychon Bull Rev 3:37-60.
2. Davis T, Xue G, Love BC, Preston AR, Poldrack RA. 2014. Global neural pattern similarity as a common basis for categorization and recognition memory. J Neurosci 34:7472-84.
3. Eichenbaum H, Yonelinas AP, Ranganath C. 2007. The medial temporal lobe and recognition memory. Annu Rev Neurosci 30:123-52.
4. Gillund G, Shiffrin RM. 1984. A retrieval model for both recognition and recall. Psychol Rev 91:1-67.
5. LaRocque KF, Smith ME, Carr VA, Witthoft N, Grill-Spector K, Wagner AD. 2013. Global similarity and pattern separation in the human medial temporal lobe predict subsequent memory. J Neurosci 33:5466-74.
6. O’Reilly RC, Norman KA. 2002. Hippocampal and neocortical contributions to memory: advances in the complementary learning systems framework. Trends Cogn Sci 6:505-10.
7. Squire LR, Wixted JT, Clark RE. 2007. Recognition memory and the medial temporal lobe: a new perspective. Nat Rev Neurosci 8:872-83.
8. Todd MT, Nystrom LE, Cohen JD. 2013. Confounds in multivariate pattern analysis: Theory and rule representation case study. Neuroimage 77:157-65.
9. Xue G, Dong Q, Chen C, Lu Z, Mumford JA, Poldrack RA. 2010. Greater neural pattern similarity across repetitions is associated with better memory. Science 330:97-101.
10. Yassa MA, Stark CE. 2011. Pattern separation in the hippocampus. Trends Neurosci. 34:515-25.

ResearchBlogging.org
Davis T, Xue G, Love BC, Preston AR, & Poldrack RA (2014). Global neural pattern similarity as a common basis for categorization and recognition memory. The Journal of neuroscience : the official journal of the Society for Neuroscience, 34 (22), 7472-84 PMID: 24872552

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Feet in shining armor: Paleo Barefoots review

CHAINMAIL. Quick … what comes to mind? Medieval warriors? Knights in shining armor? Running shoes? (Okay, maybe not so much shoes.) Given traditional recommendations for cushioned, supportive running shoes, the thought of metal chains against naked feet might not elicit a strong sense of comfort or safety.

THE CONCEPT

Indeed, even I – a barefoot runner – was skeptical when I first heard of the Paleo Barefoots, a minimalist footwear constructed entirely of chainmail. Being a sucker for functionally and aesthetically innovative advances in minimalist running, I became immediately intrigued. Like most minimalist shoes on the market, the Paleos are designed to allow the foot move as freely and naturally as possible, with just enough protection against the elements. But what sets the Paleos apart is their unique design that, theoretically, will let them last a lifetime. Even the most minimal shoes – including the more popular “toe” shoes or huaraches – require a rubber-like sole at least several millimeters thick to confer durability and protection. In contrast, the Paleos’ construction from metal – yes, literally minuscule steel links – eliminates the need for a thicker sole. This design yields a sock-like slipper, only 1.4 mm thick, with ultimate flexibility and ground feel.

My Paleos@Ultra with green paws

However, while chainmail will win the battle against dirt, sand, twigs and grass, the victor of a metal-versus-concrete war is anyone’s call. Thus, Paleos are intended only for use on ‘natural’ surfaces, and aren’t recommended for running through the concrete jungle. Such a product sounds like a dream come true for any barefoot runner looking to venture into more challenging terrain. But the unfortunate reality is, dreams aren’t fulfilled for free. In fact, the Paleos carry perhaps the heftiest price tag on the minimalist shoe market – on the order of two- to three-hundred U.S. dollars, depending on the style and options.

THE PRODUCT

After reading several glowing reviews, I became curious – okay, no … obsessed – with trying the Paleos. I rationalized the sacrifice to my bank account with the reassurance that it would be a one-time cost, as the Paleos should last forever if cared for. After much deliberation, I bit the bullet and purchased my very own Paleos@Ultra. Considering the high price tag and the shipping time from Germany, I was nervous about their fit and my chosen options. To my relief, their customer service promptly evaluated my foot tracing and confidently offered a size recommendation.

My Paleos fit perfectly right out of the box.

When they arrived, I was first struck by the quality of not only the shoe, but also the thoughtful packaging, informative care guide and personal touches. My Paleos arrived packaged carefully in an exquisite metal box, along with instructions and a complementary chainmail key chain. My personalized Paleos were equipped with engraved metal plates, black elastic laces, mesh lining socks and ankle wraps, and green “paws”, designed for extra grip on rough rocky or urban terrain. Right out of the box, this was clearly a quality product.

PERFORMANCE

In all honesty, it took me three attempts to fully appreciate the Paleo experience. As they’re unlike any other footwear I’ve tried, it took me some time to refine my fit and preferences. When I first put them on, they felt loose and heavy on my foot as I walked around my apartment. I couldn’t imagine them performing well while running. My first test run was a brief trot on a sandy trail cut short by skin irritation at the back of my ankle. Feeling that my Paleos were too loose, I had tightened the laces too snuggly, to the point where they dug into my achilles. Discouraged but not defeated, I tried another day, loosening the fit and wearing the sock liners. This first mini test-mile was a success and I was ready for a real trial run.

Paleos with sock liners

As I am far from an experienced trail runner, I sought out a gentle trail for my test run. The terrain was mostly packed sand, but also included several unavoidable rocky patches and stretches of rough gravel. I had only previously attempted this trail in full shoes or Luna sandals, and would never consider tackling it barefoot. In fact, convinced the Paleos would not hold up against the gravel and rocks, I stashed my Lunas as back-up. To my great surprise, the Paleos handled even the roughest segments with ease. The fine gravel and stones, which would typically abrade my bare feet, didn’t phase me. Although I could feel the larger rocks, not once did I get a foot bruise, which I’ve become notorious for sustaining. About two miles in, I did feel some irritation around my achilles (and later discovered a small blister as a result), which was easily remedied after a quick adjustment to loosen the laces. As the run progressed, the experience became almost surreal, as I soon forgot I was even wearing footwear, yet still felt well protected from the rough earth under foot. I found myself sprinting the end of my five-mile test run, carefree and thrilled with the Paleos’ exceptional performance.

THE SERVICE

This review wouldn’t be complete without mentioning the great folks behind the product. From start to finish, the owner himself made it a priority to respond to my questions and concerns via email and social media. They shipped my Paleos faster than promised, and they arrived in the U.S. remarkably quick. When they got stuck in customs, the owner looked into the issue and sent me shipping updates along with his apologies for the delay.

Sure, it may take some time for the mainstream running community and shoe market to embrace a metal sock as an acceptable option for running footwear. I don’t predict the PaleoBarefoots will soon be ranked among Runner’s World’s most popular shoes for comfort, style or affordability. But based on my initial impressions, I suspect there’s a niche of selective athletes who would be thrilled to discover this treasure. What barefoot runner isn’t looking for foot protection that not only embodies minimalism and functionality, but also the bonus perks of quality, creativity and beauty?

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