Category Archives: Run

Skora Core: A sh*e review?!

Fare warning, barefoot runners … the following post contains sensitive content. It is, indeed, a SHOE review.
“Has she turned to the dark side?” you might ask.
“Hypocrite!” you may holler.
Don’t fret, barefooters. I still run exclusively barefoot, strongly advocate free feet, and don’t foresee changing my ways any time soon.

That said, I am not anti-shoe, but rather, view shoes as tools that can be immensely beneficial when used in the right context. I’m writing this review not because I’m swapping my feet for SKORAs, nor do I suggest you do, if you’ve already discovered the joys of naked soles. Instead, I’m writing this as a former shod runner who understands the value (and rarity) of a quality running shoe and believes that SKORA is about as good as a shoe gets. During my roughly two year transition to minimalist – and later barefoot – running, I experimented with shoe after shoe after shoe. Many failed miserably while others were unimpressively acceptable. Through these many trials and errors I vowed to never become a brand evangelist. That is, until I put on my SKORA Cores.

When I bought my pair of SKORAs last year I took a huge gamble. I had never purchased a running shoe without first trying it on, but was so intrigued by others’ glowing reviews that I just had to try them. With a hefty price tag of $110-195 depending on the model (as of Winter 2014), this isn’t a cheap gamble to make. But when I took them out for their first spin, I had no regrets.

STRUCTURE

Skora_CoresThe Core is constructed of a Goatskin leather upper and an injection blown rubber sole. Because of this composition, and its lack of cushioning, the shoe can allegedly sustain 1000+ miles, compared to the measly 300-500 mile lifespan of typical running shoes. It is zero-drop (no heel-toe differential) and has an 11-mm stack height, making for a truly minimalist ride. Like all of SKORA’s aesthetically pleasing models, the Core comes in a range of color options, including my chosen charcoal / cyan / purple combo. You can find all of the other juicy details in SKORA’s product description.

FIT

When SKORA says they fit true to size, believe them. I didn’t, and it took three orders (which they gladly exchanged) to finally find my correct size. For reference, I usually wear an 8-8.5 (Women’s US) in everyday shoes, and a 9 in running shoes, and my SKORA size was an unambiguous 8. Once I finally settled on the right size, I discovered just how comfortable they are. Out of the box (which, by the way, is nearly as beautiful as the shoe) they almost molded to my feet. After a few more runs, they further softened and fit the foot like a glove. The toe box was comfortably roomy, although my feet are admittedly on the narrow side, so I can’t speak for those with a wider forefoot. The Core weighs in at a mere 6.7 ounces, but I might have guessed even less. Unlike many of the minimalist shoes I’ve tried, they make it easy to forget you’re in a shoe.

RIDE

The Core may be light and comfortable, but how does it perform? As a diehard barefooter, nothing will ever compare to my own two feet. But if you’re looking for a bit of protection from the elements while minimizing the bulk and interference from a standard shoe, the Core’s a great choice. When I first tried the Core I immediately noticed how engaged my feet were compared to the other minimalist shoes in which I had been running. I could feel my foot landing, rolling through the arch and toes, and could detect variations in ground surface that were blocked by other shoes. That said, they performed well on a range of surfaces, including some pretty rough trails.

Back when I was a shod runner, I so loved my Cores that I applied to be a SKORA ambassador. Since going full bare, I have only rarely worn my SKORAs, but this does not discredit my accolades for their shoes. From their philosophy of “running real” to their exceptional product quality to their fun social media, the company is one even a barefoot runner can stand behind. So, for those of you who do enjoy wearing a shoe, this one’s worth checking out.

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Blisters, bruises and other bumps along the barefoot road

Your average runner has much to consider before heading out for a run. Do you try to stay cool and dry in your moisture-wicking tank, or bundle up in a hat and gloves? What socks are best for preventing blisters? Have your shoes surpassed their mileage limit? How much water and fuel should you tote during your long run?

Running barefoot eliminates many of these concerns, as the fit, cost and lifespan of socks and shoes become irrelevant. But barefoot running carries its own unique set of considerations that the typically shod runner may not anticipate. Since ditching my shoes I’ve encountered several new challenges, some of which are easily addressed, while others I have yet to conquer. Below I discuss the issues with which I’ve most frequently struggled, along with whatever solutions (if any!) that I’ve discovered.

Terrain

The beauty of going bare lies in the rainbow of sensory input from the earth to the feet. But sometimes these sensations can verge on intense, especially to the novice runner. With time, the trained barefooter should be able to run lightly enough that even the roughest gravel doesn’t phase them … or so I’ve heard. But for the rest of us who are still growing, challenging terrain can be the greatest limiting factor to enjoyable running. When I first began running barefoot, I restricted myself to the smoothest concrete and paved surfaces, still my favorite terrain. As I’ve become more adventurous, I’ve discovered the pleasures and benefits of diverse surfaces, and now incorporate as many different types as possible into my runs.

Smooth, flat, hard surfaces permit greater stability in the ankles and other joints, and can be an excellent way to reinforce proper form. However, miles of concrete can rapidly tire the feet. Veteran barefooters will attest that rough gravel is ideal for learning how to run lightly and softly. Even the slightest friction between foot and ground will tear up the feet, encouraging you to “place” and “lift” the foot, rather than skid, shuffle or push off. Even if you despise gravel running as much as myself, there is absolutely truth behind these claims, and it can be highly beneficial to incorporate brief rough stretches into your runs. Perhaps the most fun terrain, as any child will readily tell you, is grass or soft dirt. Besides just feeling magnificent on the soles, the natural variability of the surface is a great tool to strengthen the feet and ankles, and train the body to rapidly adapt to uncertain terrain. However, all that instability can also fatigue the legs if you’re not well adapted. And while that soft green grass may look inviting, it’s also a great hiding spot for twigs, stones and bugs! I’ve had one too many carefree grassy sprints abruptly disrupted by bruises, thorns and bee stings.

Blisters, abrasions and callouses

I lump these issues together as they often share both common causes and common fixes. The first discovery a new barefooter will likely make is the pain of blisters on the soles of the feet. Over my first couple weeks of running barefoot, my feet developed multiple small blisters on my toes and balls of my feet. As blisters are a direct result of friction, their location can inform about what you’re doing wrong, and help to easily correct your form. Blisters on your big toe? You might be gripping or pushing off aggressively during foot lift. As you self-correct, the blisters will quickly disappear. In fact, I can’t even recall my last blister. That said, I do still struggle with mild abrasions and callouses, both on the ball of my left foot, which too reflect improper form. Gait analysis confirmed that reduced mobility in this foot causes mild sheering at foot contact. Clearly, I still have work to do.

First Aid

photo credit @reasra

The best treatment for these form-related skin problems is, of course, to identify the problem and correct it! In fact, this is the only sustainable solution. That said, there are a few tricks to help you deal with – and dare I say, keep running through – these issues. Obviously, keep any open blisters or abrasions clean and protected. I’ve also found that applying vitamin E oil, or using finger and toe blister Bandaids, can expedite skin healing. For callouses, moisten the skin and then carefully file down the callous (don’t break the skin!) using a nail file. If you need to run with such an “injury”, a bandaid won’t last a quarter mile. However, covering the bandaid with a layer or two of strong athletic tape works wonders (I love leucotape). Be sure to to include the bandaid over the wound, to avoid irritation from direct contact with the tape adhesive. Using this application, the tape has remained intact for me over distances up to half marathons. I’ve had limited success with liquid bandages and super glue for short runs, but find that they wear off much faster than tape.

Bruises

Unless you run exclusively on treadmills or tracks, bruises – from rocks, acorns, uneven sidewalk, you name it – will be unavoidable. Usually, these are pretty benign. I often get them on my metatarsal heads or heel, and can easily run through them without pain. Gentle massage can help initially, and mild bruises typically clear up within 24 hours. However, in rare situations, a severe bruise can lead to more debilitating trauma. Just a few weeks ago, I trod on a rock at mile 2 of a 14-miler. I finished the run, only to notice the dull bruise after finishing (endorphins are both miraculous and dangerous!). I’ve been suffering intermittent burning, aching and numbness in that heel ever since, which I only just recently connected to that bone bruise sustained weeks ago. Oddly, I’ve been able to continue easy running, as it’s most aggravated by walking or downhill running. There’s not much one can do to treat a bone bruise, besides wait the natural course of healing, although I’ve found some mild relief from taping and cold/hot contrast water therapy to flush out the inflammation.

Cuts

“Don’t you cut yourself on broken glass?” asks everyone, all the time. I have yet to discover this planet laden with broken glass which shod runners apparently inhabit. However, if you’re running through a rough part town, a construction zone, or the Las Vegas strip (as I just recently attempted!), you just might encounter some glass. While this may be the greatest fear of many new barefooters, it actually poses much less risk than imagined. The skin rapidly adapts to barefooting by thickening, becoming remarkably resilient. I have indeed stepped on broken glass – probably way more often than I’m even aware – but have only been cut once. This, due to my own stupidity. I jumped full force into a deep puddle, only to discover a shattered bottle lurking within. The sole of my foot was covered in shards of glass, but only one managed a tiny puncture. I removed it, cleaned it, and was out running the next day. So runner, fear not the broken glass.

As I’m still admittedly a barefoot noob, there’s certainly much more I have yet to learn. So please, share your thoughts! What are your favorite ways of dealing with rough terrain, blisters, bruises and cuts? What other challenges have you encountered in your barefoot journey that I may soon discover?

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When barefoot novelty becomes a bare necessity

When I began running barefoot over a year ago, each barefoot run was a thrill. My feet experienced a world of exciting new sensations, I was running smoother and lighter than ever before, and running was simply fun! Over the ensuing several months, some of novelty, but none of the pleasure, wore off. My strength increased and I was able to run about half of my mileage barefoot. After following this system for some time, a distinct trend appeared. I deeply looked forward to those barefoot runs and approached them fearlessly, confident – no, certain – I would feel great. Coincidentally, a subtle dread for my shod runs began to grow. When I laced up my shoes, I could sometimes squeak out a good run, but just as often would slog through, tired, sloppy and achy. I hesitated to give up my shoes for fear of reducing my mileage, but began to resent those miserable junk miles. Finally, I became fed up with the frustration and – just over two months ago – took off my shoes for good. I had reached a turning point where I was no longer running barefoot just for fun, but because I found myself unable to run shod without significant discomfort. Bare feet had become a bare necessity.

The switch did not come without its sacrifices, however. Given that I was still adjusting to the unique demands of barefoot running, I had to cut my weekly mileage in half. This is no easy feat for a running junkie. Yet the patience required to start from scratch, in essence relearning to run, has proven beyond worth the challenge. I’ve learned more about proper biomechanics, my body’s strengths and weaknesses, and the delicate relationship between form and function, over the past ten weeks than over my entire 17 years of running.

Shod running forces one to perceive their form as if through a frosted window. In contrast, barefoot running allows you to perceive it in high resolution, as if through a microscope. Any structural imbalance or mechanical error is immediately apparent, as your feet afford the most exquisite and accurate sensory feedback. This feature builds the framework for a foolproof system to rapidly correct and optimize one’s running form. A few examples from my own training adaptations illustrate these benefits.

Overstriding > ankle pain

Slight overstriding on my right leg contributed to ankle pain. (Gait analysis courtesy Jennifer Reiner, DC)

Slight overstriding on my right leg contributed to ankle pain. (Gait analysis courtesy Jennifer Reiner, DC)

A major impetus for going bare was perpetual instability and strain in my ankles. I felt chronic fatigue in my posterior tibialis, Achilles and peroneal tendon, before and during the first few weeks of my switch. Playing with my form, I noted that the strain was alleviated when I landed with my feet under – not in front of – my center of mass. I had been … (gasp!) overstriding. It’s quite likely I’ve been doing so for many years, probably contributing to prior injuries, but it only became apparent barefoot. It’s not only visibly obvious, but also audibly detectable, as I hear a distinct slapping sound when my form gets sloppy and I return to my overstriding tendencies.

Heel-striking > shin stress

As my ankle issues resolved, the stress moved up my lateral shins and I acquired mild symptoms of anterior compartment syndrome. A bit of research suggested that shin pain can result from heel-striking, which can easily be resolved by adopting a forefoot strike. Within just a few days of consciously landing forward on the ball of my foot, my shin pain had cleared up. Intriguingly, though I was running barefoot and (mostly) avoiding overstriding, which are often associated with forefoot striking, I had still retained a subtle rearfoot strike.

Forefoot striking > forefoot ache

No gait change comes without some cost. With my forefoot shift, I experienced some moderate tightness and bruised sensations under the ball of the foot. Cautious not to overstress my feet with these new changes, I’ve been focusing on modifying my form according to my body’s current needs. If I feel excessive tension in my shins, I’ll emphasize a forefoot strike; when the forefoot acts up, I relax back into a rearfoot strike. When barefoot, these rapid shifts – and their immediate benefits – are easy and effective.

Foot immobility > abrasions

Immobility in my left big toe joint caused ankle rotation and shearing.

Immobility in my left big toe joint caused ankle rotation and shearing.

While I haven’t suffered a blister or cut in many, many months, my left ball of foot (under the base of the big toe) tends to get disproportionately tender compared to the left. With my increasing mileage, this had become increasingly problematic, and recently became coupled with a growing callous under the neighboring second metatarsal. This was a clear sign, that would otherwise have been masked by shoes, that there are still some lingering mechanical issues. My insightful physical therapist, who noted immobility in my big toe, prescribed some exercises to increase flexibility and mobility in the big toe joint. After only a few days, I’ve already noticed much less abrasive shearing. Yet again, another simple fix.

Personally, this recent barefoot journey has been immensely successful, enabling me to retrain myself to run well and consequently resolve chronic injuries, all the while restoring hope that most running problems can be overcome by simple training modifications. Yet despite the fact that I had to take off my shoes to discover this, I’m not convinced that it’s purely an issue of footwear. Rather, successful running fundamentally comes from proper form. Some can achieve this regardless of footwear. Others, such as myself, will need more help from tools that encourage mechanical corrections. For me, one of simplest, not to mention liberating, ways to do so has been to break down the barriers between body and environment and let my feet directly sense and respond to its rich surroundings.

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Why sweeping generalizations aren’t best for most runners

Barefoot is bad!Every movement has a counter-movement. Barefoot running is no exception, having recently been met with its share of backlash from skeptics and naysayers. While open discussion and objective critique are healthy responses to any fad, a recently published article – Why barefoot isn’t best for most runners – went a step too far with its distorted claims, never mind snarky attitude, to leave untouched.

Let’s walk through (shod or bare, I don’t care) some of the article’s most shining moments.

Seasoned members of staff can normally categorise runners at first glance … people looking for Vibrams are usually already wearing Vibrams, which is something of a giveaway. They also tend to look disgusted when you tell them that the shop doesn’t stock them, as though the sale of more traditional running shoes was some sort of conspiracy.

I’d like to start by commending the author for admitting that he and the other shoe store employees outright judge their customers based solely on appearance. I’ll be sure to avoid your store. On the other hand, they’ve sparked my curiosity with their mind-reading powers that enable them to detect paranoia over shoe conspiracy from just a facial expression. Of course, every shop should be free to stock only their chosen products. But if they decide to exclude an entire shoe category, they should be willing to accept that some customers will be disappointed by the limited options.

The problem is that we also didn’t evolve to run on roads. Or if we did, the evolutionary process that built the roads was the same one that designed the cushioned running shoe.

We can argue the evolution argument until we’re blue in the face, but for now there is no clear answer. Yes, it’s true neither modern shoes nor concrete existed until relatively recently. Sure, our bodies haven’t yet perfectly adapted to either. However, we also certainly haven’t evolved to remain sedentary 60% of our waking hours, rely on machines for transportation, stare at electronic screens or consume highly processed, packaged foods. But we’re an innovative and adaptable species and are surviving fine (for now) in the face of these rapid changes. The more immediate question, rather than how our ancestors ran, is what’s best for the modern runner. There’s no evidence (correct me if you can find some!) that 1) roads are worse for runners than dirt or grass, or 2) cushioned running shoes actually protect against the alleged “dangers” of modern running surfaces. Researchers have just begun to study the relationship between footwear and injuries, and the jury is still out. Thus far, there has been a lot of conflicting evidence, depending on the particular study methods and population, suggesting that the answer isn’t as simple as modeling our running after Grok.

When people were following the “Paleo diet” from necessity rather than whimsy, their life expectancy was probably in the 20s, if they were lucky.

How is the paleo diet relevant? The author appears to be critiquing barefoot running by debunking a completely independent lifestyle choice. I’m unaware of any correlation between footwear preference and dietary habits. In fact, I know several barefoot runners (@caitymccardell, @KenBobSaxton, myself) who are vegetarian or vegan, which one could argue is the antithesis of paleo.

For those who are planning to spend £100 or more on barefoot shoes to emulate Bannister, it should be noted that you can buy plimsolls for £4 on eBay.

Agreed. Spending $100+ on shoes is absurd. All the more reason to go barefoot. It’s free.

When I see people out running in barefoot shoes, they never look as if they’re having a particularly good time … Most people who use barefoot shoes admit to having to run less because of the pressure on their joints. For someone who enjoys running long distances and the feeling of having a bit of a spring in their step, the choice of barefoot shoes is therefore a bit baffling.

Sure, maybe those runners are miserable. Sure, maybe it’s because of their shoes, or maybe it’s because of the judgmental grimace on a certain gawker’s face. We’ll never know. But rather than speculate about another runner’s experience, why not just ask them? As one who actually runs barefoot and knows other barefoot runners, I can attest that my barefoot runs are often far more freeing and exhilarating than my shod runs. The spring in our step is precisely why we prefer to go bare. When running barefoot you literally feel that spring, conferred by the awakened, elastic arch and tendons of the foot. As for the relationship between barefoot running and joint pain (or lack thereof), look no further than some actual research.

A recent study published in Medicine and Science in Sports and Exercise, however, supports what I’ve learned from talking to customers who have experimented with barefoot shoes … Half of them (study participants) began running in Vibram FiveFingers shoes gradually, following the guidelines set out on Vibram’s website, while the control group continued to run as normal. After 10 weeks, the control group had remained the same, but 10 out of the 19 runners who had transitioned to Vibram FiveFingers showed raised levels of bone marrow edema (a buildup of fluid similar to bruising) in their feet. The worry is that the barefoot running trend is a fairly recent one, and most of the study’s runners with raised levels of bone marrow edema wouldn’t actually have noticed an injury yet – many of the injuries caused by barefoot shoes may be lurking just around the corner.

This – the only piece of solid evidence presented – is once again misconstrued to support the “barefoot is bad” argument. Just a few of the flaws to this interpretation, which have been thoroughly detailed elsewhere, include:

1. The study used a transition protocol that was far more aggressive than experts recommend (Vibram has since changed their guidelines).

2. Many of the subjects didn’t even follow protocol, increasing their mileage more rapidly than advised.

3. Some edema can be part of a healthy response that leads to bone strengthening, indicating that the bone is appropriately adapting to a new stressor. The MRIs could not distinguish between normal edema and signs of injury.

Most running shops will now offer gait analysis, with the aim of selecting the type of shoes most suitable to the individual’s running style, body type and the surface they are planning to run on.

Note the term “aim”. Regardless of the intention, such recommendations are meaningless if their underlying assumptions are flawed (see herehere and here for why).

One final editorial note: By definition, barefoot running requires bare feet. Any individual’s beef with minimalist shoes bears little weight on the “goodness” or “badness” of barefoot running.

Rather than make a convincing argument for the author’s footwear preference, commentaries like this exemplify the absurdity of the growing barefoot versus shod derision. Get ready to defend yourselves, runners. Next up is the great headband versus hat debate!

A special shout-out to @akiraoc for bringing this article to my attention!

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So you think you can run?

Of course you know how to run. It’s as natural and instinctive a behavior as walking, breathing or eating. Through years of diligent training you’ve developed into a serious runner with exceptional running form of which you are proud. Yet, not matter how close we are to the “ideal” form, there is always room for improvement. Even the most minor imbalance will become alarmingly apparent when we push our training beyond our norm, whether by increasing mileage, speed or experimenting with new terrain or footwear.

Over the past couple of weeks, a combination of increased mileage and footwear play (alright, when am I not exploring my barefoot and minimalist limits?) culminated in a cautionary threat of incipient tendonitis in my ankles. Although this may simply have been a classic case of too-much-too-soon, I’m convinced it was also a case of too-much-with-poor-form. Two patterns tipped me off to a likely biomechanical problem. First, the pain consistently appeared while running shod, during which I reliably get sloppy with my form, and subsided running barefoot. Second, the sites of tightness and weakness were asymmetrical, manifesting as left lateral and right medial ankle pain – an obvious warning of left-right imbalance.

Frustrated and terrified of a developing injury, I made an uncharacteristic and desperate move: I contacted a local running guru for a gait analysis and training session. I love my running community, but I have a bizarre aversion to running with others. And I hate taking running advice, adamant to tackle any obstacle through my own research and hard work. But in a rare flash of run-humility, I put my stubbornness aside and sought expert advice.

The session began with a video playback of myself running. I cringed as my mental image of my idyllic form was shattered. I bounced along, my legs reaching just in front of my body, feet landing somewhere between heel and midfoot. Oh the horror! I was over-striding and heel-striking! For over an hour I ran, marched, played with my posture, visualized butterflies and analyzed my footprints. I felt like a baby learning to walk and left both humbled and overwhelmed by the wealth of invaluable information.

In the hopes that I’ll retain these insights and that you, dear reader, might also reap their benefits, I’ve outlined below the five most valuable lessons from my training session. The featured video that follows illustrates a runner who beautifully integrates each of these elements into his impeccable form. I encourage you to watch along as you read.

1. High cadence. Although they are in fact unrelated, it’s easy to confuse cadence with speed. Cadence refers to your step frequency, which is independent of your speed. For example, you could run at the same speed with long, slow strides (low cadence) or fast, short strides (high cadence). Elite runners typically run with a cadence well over 180 steps per minute, which has become the standard  recommended minimum. Not only can a high cadence prevent over-striding, but emerging research suggests that it also reduces forces on muscles and joints, and hence minimizes injury risk.

2. No jumping! Try running in place. Now let me guess – are you hopping in place, jumping from one leg to the other? Running is essentially lifting your legs while moving forward (we’ll get to the forward motion part soon), so there’s actually no need to jump in order to run. Simply lift your knees up without jumping, and remember to keep that cadence high. As you march, note how your foot lands, the ball contacting the ground first, followed by the heel.

3. Ankle to shin. Now that you’re marching in place with a soft ball-to-heel landing, it’s time to think about the placement of your knees, ankles and feet. Focus on lifting your knees high, but be careful not to drive your foot out in front of you. Instead, as you lift and lower your right leg, imagine your right ankle sliding along the inside of your left shin, as a roller bearing glides along a rail. Your foot should remain directly under your hips throughout the cycle, not in front. This is key to preventing over striding, which we know makes us vulnerable to a range of injuries.

4. Up, up and away. So you’re marching away, knees high, fast cadence, feet beneath you. What do you hear? The sound of your feet smacking the ground? Aim for silence, your feet not striking, but rather, lifting off, the ground. Imagine your favorite bird, flying insect or aircraft (take your pick) hoisting you up from the top of your head. Your body elongates and elevates above the earth, your feet barely able to graze the ground. Each step makes you lighter and takes you higher.

5. Lean. You’re off and running with a light, quick, stride, legs cycling beneath you at 190 steps per minute … you’ve perfected your running form, except for one minor detail … you’re running at zero miles per hour. How do you move forward? Yes, your stride needs to lengthen, but you shouldn’t lengthen it. Let gravity do the work for you. As you march in place, lean forward ever so slightly. Don’t bend at the waist, but let yourself “fall” forward while maintaining an erect posture. As your center of mass shifts in front of you, gravity will propel you forward and suddenly, without trying, you’re running!


Video credit to Dr. Mark Cucuzzella of the Natural Running Center.

On your next run, I challenge you to focus on these tenets of mindful running. Don’t worry if it doesn’t come to you immediately, and definitely do not let it detract from the joy of your run. Stay relaxed and note any change that ensues as you make minor adjustments. Then report back. Is there one guideline that you find particularly beneficial? Do you have your own running form secrets to share? Please do! We may hate to admit it, but there’s always more to learn.

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Pavlov’s runner: conditioned to fear the run

What’s your running nemesis? Do you bonk without regular energy gels or struggle to regulate your hydration? Do hills make you crawl? Or do long hours on the road bore you to tears? I know you have one … we all do. In fact, I have several, depending on the run, my health and mood. But I’ve come to realize that they all stem from one phantom nemesis – a fabrication of my overactive mind: anxiety over the uncertain.

The longer the run, the greater potential for disaster. It’s not that I dislike running; au contraire, it’s my oxygen, my water, my heroin. Yet still, I often dwell on innumerable, unlikely scenarios of possible running catastrophes. Will this be the run where that nagging tension in my achilles develops into a tendon rupture? Will this be the run that I finally puncture my foot and find myself stranded barefoot and bloody, miles from home? Of course, these fears are irrational and have yet to come true. Every run has its highs and lows, and in reality the highs almost always outweigh the lows. fearconditioningYet, just as a mouse can be easily conditioned to fear a neutral tone, just one or two particularly traumatic running experiences can make us unnecessarily fear a run. Since my recent metatarsal stress fracture, I’ve repeatedly convinced myself – sometimes to the point of tears – that I refractured my foot. In reality, a world apart from my hyper-paranoid thoughts, my feet remain strong and healthy and have carried me through countless glorious miles.

We’re all familiar with the purported mind-body connection, but few of us consider the power of our attitude on our running performance. Reflect back and you just might notice an intriguing association between your mental state and the quality of your runs. Thinking back to my most distressing injuries – an achilles tendon tear, stress fracture, peroneal tendonitis – they’ve all occurred during periods of excessive stress, anxiety or exhaustion. The body most certainly struggles to properly recover and repair itself during times of fatigue or physical trauma, but we shouldn’t overlook the concomitant influence of our psychological state. Sure. This may sound like psycho-BS. But there’s evidence that the relationship between mental and physical is real and biologically founded. Indeed, stress hormones such as cortisol are known to do real bodily harm, such as impair bone and collagen formation, increase blood pressure and weaken the immune system. Within a given run, simply focusing on the joy of the present moment and appreciating each lone step can minimize stress and counteract its negative effects, by calming an anxious mind, relaxing tense muscles and allowing the body to move fluidly and naturally.

runninginfearOf course, bad runs and injuries occasionally happen and a touch of apprehension might be warranted … but ultimately, it can only work against you. If you’re going to fracture your foot, worrying about it will not prevent it. Approaching a run with fear can only accomplish two things: 1) alter your physiology or biomechanics in ways that may actually exacerbate a bad run, or 2) so strongly grip you that you do not even attempt the run. I have experienced both.

Rather than dreading the pain you might feel from an incipient injury, or running through fatigue, embrace each step and be mindful of the distinct sensations they carry. If pain arises, it will likely dissipate. If it persists, allow yourself to end the run and be content that you didn’t allow your fear to prevent you from at least trying. If you feel great, bask in the endorphins, but acknowledge that they too are fleeting. Running is a journey with both infinite opportunities and challenges to conquer. You can fear the obstacles or indulge in the adventure – the choice is yours.

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Spice! The secret running ingredient

Perhaps you know the type. Maybe you are the type. Every morning, she laces up her trusty worn-out sneakers, heads out along the same neighborhood route at the same sluggish pace. She’s satisfied to have gotten in her daily run, but for some curious reason, she witnesses no improvement, is developing nagging knee pain, and is bored to death!

ground-spices

Time to spice up your routine, runners!

This was me a decade ago. I’ve gradually learned that this obsessive adherence to routine is a recipe for stagnation and injury. So what is the key ingredient to maintaining a healthy and impassioned relationship with running? SPICE!

Overuse injuries, the kind that plague so many runners, such as tendonitis or stress fractures, arise from excessively repeating the same movement patterns. This problem is inherent to endurance running, which demands identical motions for hours at a time, day after day. But spicing up your runs with minor day-to-day variations can minimize the trauma associated with repetitive, high mileage. And by variety, I’m not suggesting going to such drastic measures as diversifying with (gasp!) cross-training. If you’re anything like me, as long as I’m physically capable of running, nothing can get me into the pool or onto the bike. Even sprint training and hill repeats turn running into work, which I will not tolerate. Of course, if you have the patience for such things, more power to you!

Rather, incorporating even small differences between runs can offer great returns. This has been a primary focus of my training over the past few months, through which I’ve discovered several easy ways to make each run feel fresh and exhilarating:

Distance. You may love that four-mile route, but doing it day after day mounts only to junk mileage. By mixing up the daily mileage, you’ll find that both the long hard runs and the short easy runs become indulgent treats. For example, on a given week I’ll often log one solid long run to fuel my endurance (25-30% of total weekly mileage), a couple of moderate distance runs to maintain my mileage (30-50%), and a couple of short, easy recovery runs (25-30%). Most importantly, listen to your body. If you had a ten-miler on tap, but are dragging by mile six, it’ll serve you better in the long term to call it quits. Likewise, if you feel like tacking on a couple extra miles or bursting into a sprint – even if your training plan didn’t call for it – go for it!

fall_pic

Trails aren’t dangerous. Clumsy trail runners are.

Terrain. Concrete will wreak havoc on your joints … The cant of a road will imbalance your stride … Grass and trails will make you trip or roll your ankle … We’ve heard it all. It appears there’s no ideal – or even safe – running terrain. Yet luckily, this is just one more fallacy with no scientific support. Rather, research has shown that although distinct surfaces alter our biomechanics (Tessutti et al., 2012), they are not differentially associated with injury risk (van Gent et al., 2007). (Okay, trails can sometimes be dangerous – but only for the exceptionally uncoordinated. See obligatory humiliating pic as proof.) So feel free to explore, venturing onto road, sidewalk, trail or grass and noting how your body adapts to each surface. For instance, I’ve found that running barefoot on even, smooth hard surfaces is wonderful for developing proper form. When I feel myself fatiguing during a long road run, switching over to grass or trail for even a few minutes can do wonders to rejuvenate my tired legs. Becoming an all-terrain-runner can open up a new world of running possibilities.

Footwear. I’m a firm believer that there’s no ideal running shoe, but there is ideal running footwear: none. As much as I embrace and encourage running barefoot, there’s absolutely a time and a place for shoes (burning pavement and sharp rocks aren’t fun, no matter what people say). The principal problem with shoes, however, is how they alter your gait in even the most subtle ways. We’ve all experienced the slight discomfort of running in a new pair of shoes to which we haven’t adapted. For this reason, most runners search for their “perfect” shoe and run religiously in nothing else. But running is all about adaptation. Minor challenges and stressors are what impart incremental strength and endurance gains over time. Alternating between various shoes (to the extent that your wallet can bear) forces you to work different muscle groups and prevents excessively stressing one particular area. For instance, my ankles tire easily when running barefoot, but my calves or hips tighten up in different shoes, depending on the support level. Therefore, I allow several days between runs in the same shoes, to ensure sufficient recovery from any shoe-induced aches or pains.

So is there one secret ingredient to running happy and injury-free? No, there are many! Go out and explore them all. Then share with me all the fun ways (that I’ve most certainly overlooked) that you spice up your runs.

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DIY: Minimalist running socks

So you run barefoot. Your feet have toughened up, you’ve perfected your light, quick foot-strike and you pride yourself on having become so bad-ass. But c’mon, admit it … Every once in a while it’s just too cold, that gravel’s a bit too rough and you just might need to protect your feet. So what’s a barefooter to do? Dish out $100 for a pair of shmancy “barefoot” shoes that you’ll wear twice a year? Fret no more! There’s a much simpler, cheaper (and way more bad-ass, since really – that’s what matters) way to protect your feet while maintaining that barefoot feel. Make your own running socks!

What you’ll need:

  • Socks
  • Plasti Dip
  • Paintbrush
  • Paint tray

How to make your running socks:

1. Socks. Choose a good pair of socks. The ideal pair will be new, since you want them to last as many miles as possible. They should fit snugly, with sufficient elasticity so they don’t slip off or slide around while running. But make sure they’re not too small, since the Plasti Dip can make the fabric contract a bit. I use socks with separated toes in this example, as I prefer how they allow greater toe mobility compared to standard socks, but any good pair – toed or toeless – will do.

Plasti_Dip2. Plasti Dip. Get some Plasti Dip in your favorite color. Plasti Dip comes in a rainbow of colors (18 to be exact), so you can tailor your socks to be as flashy or inconspicuous as desired. It’s available in either the standard liquid or aerosol spray cans. Here we’ll use the standard pourable form, but I’ve heard the spray works as well.

pour3. Prepare. First, get comfy. Wear some old clothing and find a chair away from valuable furniture, as there will likely be some stray Plasti Dip spatter. You’ll probably want to protect the floor with some newspaper. Get a book or a friend to keep you entertained while the socks dry. Next, put your socks on and pour a generous amount of Plasti Dip into the paint tray.

paint4. Paint. Now you’re ready to start! Carefully paint the Plasti Dip onto the bottom of your foot with the paintbrush. Ensure that the layer is relatively even but thick enough to actually provide some durability. Avoid the sides and top of the socks, and make sure the ball, heel and toes are fully covered, as these areas will sustain the most wear and tear while running.

dry5. Dry. Prop your feet up and wait at least 30 minutes for the socks to dry (longer is always better). It’s critical that they are on your feet during this initial drying period, as the Plasti Dip will mold to the shape of your feet. Once you’re sufficiently bored, carefully remove the socks and let them finish drying, soles face up. They won’t completely dry for several hours, and I’d suggest waiting a full day before running in them just to be safe.

6. Try them out! Here’s the fun part. Take your socks for a spin. The first several steps might feel strange, but the sock should quickly adjust to your foot and feel almost as wonderful as fully bare. My first run in my Plasti Dip socks was 5 miles, in the frigid New England weather along a debris-strewn highway. The socks held up remarkably well while keeping my feet surprisingly warm and adequately protected against the elements.

Since these guidelines are based on my first experiment, I’d love to hear others’ tips and tricks for improving my future running socks. As always, please share your thoughts and experiences!

Update 4/20/13: I performed a touch-up using the spray can and it was considerably easier and less messy. I highly recommend it over the pourable Plasti Dip!

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Fracture recovery: Running to rebuild

Of the many running injuries I’ve endured, my metatarsal stress fracture has been the most mentally challenging from which to recover. The internet is repleat with advice on how to treat a fracture: rest, supplements, bone stimulators … everyone has their two cents to offer. Yet there’s a perplexingly disproportionate dearth of information about how to return to running once healing has begun. What’s a safe distance to start with? How quickly can you ramp back up? How do you know if you’re pushing too far? Over the past six weeks, my struggle to answer these questions and ensure a safe return to running has incidentally proven to be an exceptional opportunity to retrain myself to run with greater balance, awareness and pleasure. While this has been a rewarding journey in retrospect, I certainly wouldn’t wish this anxiety-inducing learning process on anyone else. In the hopes of sparing others the same nerve-wracking self-experimentation, let me share a few of the lessons I’ve learned along the way.

When am I ready to run?

Running on a fracture before it’s sufficiently healed can delay recovery, or worse – result in a refracture. So how do you know when you’re in the clear to resume running? A good rule of thumb is to wait until you can hop on the fractured foot / leg without pain … and then wait another week. Everyone recovers at different rates, but for me, this would have been around six weeks post-fracture. However, I developed some uncomfortable nerve stimulation in my neighboring toes that delayed my first run to week seven.

How much is too much?

When returning to running from a muscle, tendon or ligament injury, the rule is simple: if it feels uncomfortable, stop – you’re pushing too hard. Not so with a stress fracture. That ache that first emerged at fracture onset will linger to haunt you throughout your recovery, whispering deceptive messages that you’re exacerbating the injury by running on it. But in fact, a certain amount of moderate physical stress is beneficial – and necessary – to stimulate ongoing bone growth and remodeling. The site will certainly ache, as the bone has not regained its full strength, and the surrounding soft-tissue may be aggravated, but this will gradually dissipate with regular, gentle weight-bearing stress. The key, however, is to be able to discriminate between that lingering harmless ache, and the emergence of a novel injury. While I hear claims that “you never refracture the same site”, there are also countless stories of runners who proceed to fracture neighboring bones or develop compensatory soft-tissue injuries. So while that familiar dull ache may be benign, you should probably take heed of new pain in neighboring metatarsals or that worsening tendon strain.

How should I train differently to prevent another fracture?

A bone becomes susceptible to fracture when the amount of stress to which it’s exposed exceeds its capacity to rebuild and recover. Such imbalances might occur for a variety of reasons, including an aggressive increase in training mileage or intensity, or poor biomechanics that incorrectly redistribute impact forces, for example from improper footwear or compenstation for weakness elsewhere. Whatever the cause, the critical step in preventing future fractures is identifying and correcting the original problem.

Leading up to my fracture, I had recently incorporated regular barefoot running into my already minimalist routine. Upon experiencing some mild achiness along the top of my foot, I made the mistake of giving up barefoot running entirely for a week while increasing my overall shod mileage. Granted, this certainly allowed me to continue running with relative comfort … temporarily. But unbeknownst to me, those shoes were not actually protecting my foot from injury, but rather, most likely permitting me to run with sloppy form while masking the sensory warning signs of an incipient fracture. Since my return to running, I’ve adopted the philospohy that if I can’t safely run barefoot, I shouldn’t be running at all. The beauty of running “naked” is two-fold: 1) You quickly learn to run with optimal form, or you pay for it with blisters, sore calves and strained achilles tendons. 2) Any functional imbalance will become immediately apparent as bare foot kisses bare earth, sending you an invaluable warning of the impending injury.

Barefoot running, Iron MountainI’ve kept my barefoot mileage at approximately a third of my total mileage, incrementally increasing both shod and barefoot mileage weekly (see training log below). Sure, this has kept me in check, restraining me from indulging in long shod runs for which my metatarsal is not yet strong enough. But the real perk is the fun of it. The muscle soreness, tension and anxiety I sometimes feel during my shod runs literally melts away once the shoes come off.

How quickly should I progress?

There are training plans available for every imaginable combination of race and runner, for novices and elites, from your first 5k to 100-milers and beyond. But how much and how hard should you run when recovering from a fracture? Although this is possibly the most critical consideration for a safe recovery, it’s also one of the least frequently addressed. To remedy this, I’ve shared below the ad-hoc routine I’ve followed, which has ensured a happy and (thus-far) healthy return to running.

But please take heed of a few cautions before launching into your first run. First, as every runner will recover at different rates, it’s impossible to set a one-size-fits-all recovery plan. For reference, before injury I would regularly log 60-70 miles per week. If your norm is well above or below this, you’ll obviously want to tailor your progression accordingly. Second, I’ve taken advantage of this fresh start to concurrently learn to run with heightened awareness and improved form. To this end, a significant amount of my mileage is fully barefoot, while the rest is run in minimalist shoes (3-6 ounces; 0-7 mm heel-toe drop). How this affects my progression I can only speculate; intuitively one would assume it would require more conservative training, yet in fact, I suspect the benefits of improved biomechanics might actually outweigh any risks. As a final caveat, note that these past six weeks haven’t been without considerable “growing pains”. Almost every run has been accompanied by some degree of achiness near the fracture site, along with mild aggravation in the surrounding muscles and nerves. These symptoms, if mild, are typical and should improve as the injury continues to heal.

Unlike with other injuries, when it might be optimal to couple longer distances with more rest days, I found consistency ciritical for fracture recovery, and therefore opted for higher frequency, but shorter runs. The table below shares these essential measures:

Run frequency: how many days run per week.

Longest run: distance of my longest single run each week, separately for shod and barefoot runs, and combined, since I often finish my shod runs with some barefoot miles.

Total mileage: weekly mileage separately for shod, barefoot and combined (shod + barefoot).

Fracture_recovery_log

And just because I love graphs …

Mileage_graph
These are just the thoughts of one runner … one still experimenting, still learning, and crossing her fingers that these words will be validated by a lasting triumphant return as a stronger, smarter, healthier runner. A runner still looking for all the help she can get, and curious about your own experiences recovering from fractures – your successes, frustrations, tips and concerns – so please share!

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Fracture fears: A nightmare comes true!

Irrational fears. We all have them: snakes, heights, public speaking … stress fractures. Runners tend to be a fearless breed, that is until it comes to debilitating injuries we just cannot run through. For me, the dreaded stress fracture has always been at the top of my list of deep, gut-wrenching fears. And considering how my thin, caucasian, female frame and my thousands of miles logged each year put me at an elevated risk, I’ve been pleasantly surprised at how well I’ve avoided this terrifying injury. That is, until six weeks ago. Having survived and mostly emerged from the obligatory stages of post-injury traumatic stress, I now feel relatively well equipped to share my experiences with this runner’s nightmare come true.

CAUSES

So what was the straw that ultimately broke the camel’s, uh … metatarsal? Two-months into a transition back from a perplexing injury in my left foot, I had been slowly increasing mileage and experimenting with a variety of footwear, terrain and barefoot running. Was it the barefoot running? Unlikely. Ironically, given some mild strain along my first metatarsal, I had decided to “play it safe” and take a hiatus from barefoot running the week leading up to the fracture. Ignoring my own advice, I instead switched to running full-time in racing flats.

Was it too much too soon? Possibly, although I had been mindfully transitioning very gradually and cautiously. Despite roughly following the 10% rule (no weekly mileage increase greater than 10%), I had unintentionally completed a particularly taxing week of training. On my first back-to-back run since returning to running I got lost, extending my planned “easy” six-mile trail run into an hour and a half adventure through a canyon. With only subtle warning signs, the fracture appeared just a few days later during an otherwise normal run.

As the term implies, a stress fracture is the result of too much stress to a bone, from any of a variety of causes. In my case I suspect a number of factors were at play. I’m an odd case of an oversupinator and underpronator, failing to complete the normal lateral to medial rolling of the foot during the stance period. Coupled with an unusually tight flexor hallucis longus tendon, my second metatarsal was undoubtedly under excess stress that would otherwise be supported by the stronger first metatarsal. My stressed bones were all the more vulnerable in a minimalist shoe that provided less protection than a standard shoe, yet less sensory feedback than bare feet to warn me of the impending fracture.

SYMPTOMS

X-ray 12 days post-injury showing fracture at the head of the 2nd metatarsal.

I’ve always expected the onset of a fracture to be signaled by a definite aha moment – a sudden, stabbing unmistakable pain. Not so. Rather, the presumed onset of my fracture was accompanied by a gradually increasing numbness in the second toe and a subtle tightness along the top of the second metatarsal, neither of which qualified as painful. A tender, pea-sized lump soon appeared over the metatarsal, which I dismissed as an irritated extensor tendon. The next day, a gentle “recovery hike” sent me to the ER with electricity-like pain and an inflamed, swollen foot. Unable to walk without searing pain, I still vehemently denied the possibility of a fracture, instead self-diagnosing a case of capsulitis. Two-weeks post-injury, an X-ray confirmed the dreaded presence of a full, but non-displaced fracture across the head of the second metatarsal.

TREATMENT

Considering the abundance of confusing and often conflicting medical and anecdotal advice, what is the best treatment approach for a rapid, healthy return to running? After researching and experimenting with numerous alternatives, the following proved most effective for my personal recovery.

Avoid:

1. NSAIDs and ice. You should control the unbearable pain and swelling with non-steroidal anti-inflammatories (NSAIDs) and ice, right? Wrong. While they may provide temporary relief, they will likely impair the body’s beneficial inflammatory response critical to healing the damaged tissue. There is now abundant evidence that NSAIDs actually delay fracture healing (Burd et al., 2003Butcher & March, 1996; Giannoudis et al., 2000) and can often exaccerbate inflammation.

2. The boot. I wore the boot a total of just a few hours, and saw little benefit. While it did alleviate a bit of foot pain while walking, it also misaligned my legs hips and back, making it quite uncomfortable and exhausting to walk at length.

Do:

Exogen bone stimulator

1. Bone stimulation. If I were to attribute my rapid healing to any single factor, it would be low-intensity ultrasound bone stimulation. FDA-approved for treating fractures, bone stimulation is supported by research demonstrating singificantly faster bone healing. I’ve been using an Exogen bone stimulator since week two, for 20 minutes twice daily. They’re not cheap, and if you purchase one from eBay, be sure to follow these guidelines to prevent getting ripped off.

2. Supplement. Bone production requires adequate calcium, vitamin D and magnesium. Even if you think you’re getting enough from your diet, it’s a good idea to supplement for added security. Silica is also important for bone development, with the added perks of promoting hair and nail growth. Anecdotally, since I’ve started taking silica I’ve had to cut my nails twice as often as usual! To reduce inflammation naturally, without the potentially detrimental effects of NSAIDs, try turmeric, ginger or omega-3 fatty acids.

3. Rest and activity. Both are critical for the healing process and it can be challenging to determine the optimal balance. In the early stages when the bone is most fragile, immobilization is critical to prevent displacing the bone or otherwise exaccerbating the fracture. But once the critical stage has passed and the site is less vulnerable to reinjury, gentle movement and mild stress are essential to rebuild strength. An overly conservative rest period may actually delay healing and leave the bone and soft tissue weaker than pre-fracture. Non- or light-weightbearing activities will encourage circulation, increase flexibility and maintain strength while minimizing dangerous impact forces. I’ve maintained some degree of sanity with water jogging, the elliptical and running on an anti-gravity treadmill. Of course, these may not be safe for all fractures; beneficial and detrimental activity may be hard to discriminate and only you can determine your safety threshold. For those with a high pain tolerance like myself (which probably includes most injured runners … isn’t that how we got here in the first place?), a good guideline is to stop any activity that increases your level of discomfort. Note the use of the term discomfort rather than pain. Discomfort indicates you are aggravating the injury, whereas pain is a good sign that some damage has already been done.

RECOVERY

As with any injury, the first question we runners ask is When I can run again? Although having just passed week six I’m still not running, my progress has been steady and encouraging, with several landmark transition stages.

0-2 weeks: During the acute post-injury phase I was essentially unable to walk without intense, diffuse pain throughout the foot, extending across the top and ball of the foot and through my first, second and third toes. The foot was hideously swollen and I could easily induce pain by pressing on the fracture site, bending the toe, or under vibration testing. This is by far the most difficult stage, during which you will most certainly want to crawl into a hole and hibernate until it passes. But take comfort – it will pass.

2-4 weeks: The swelling reduced somewhat and I was able to walk for short distances (< 10 minutes). Light exercise like the elliptical and anti-gravity treadmill became feasible. This stage likely corresponded with the formation of a soft callus around the fracture.

X-ray at 5 weeks shows a hazy “ghost” indicative of a hard callus.

4-6 weeks: My most significant recovery occurred at approximately four weeks. I suddenly found myself able to walk for longer periods (up to an hour), and perform forefoot-loading exercises like downward facing dog without pain. I suspect this breakthrough was coincident with the development of the hard callus. A follow-up X-ray at five weeks confirmed the presence of this hard callous, visible in the image as a hazy “ghost” around the fracture location and palpable as a firm lump. But take heed; this sudden improvement can provide a false sense of strength. This callus is in essence a bone-like patch that will be gradually remodeled over several months into permanent, stronger bone, so running on a young hard callus still carries high risk of reinjury. For me, the presence of the callus has been sufficient to preclude running, as the physical deformation from the enlargement has introduced additional strain and even bizarre nerve stimulation in the neighboring metatarsals and toes. While the fracture feels ready to run, the surrounding region is sending a cautious message that all is not yet back to normal.

Irrational by definition, ungrounded fears like sustaining a stress fracture may best be overcome by tackling them head on. Having dealt with frustratingly stubborn soft tissue injuries (achilles and peroneal tendonitis, trochanter bursitis, piriformis syndrome … the list goes on), I’ve found odd comfort in the predictable timecourse of bone healing and the straightforward, logical treatment. With every day of healing, my fracture fear slowly dissolves. The (maybe not so scary after all?) nightmare is gradually morphing into a waiting game, as I count down the final days to my official return to running – free and fearless.

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