Tag Archives: reflections

Calm and strong along the runner’s trail

Effortlessly, air diffuses into the body, filling the belly with the purest form of fuel. Oxygen floods the bloodstream, penetrating every cell. The mitochondria, the cellular children, devour the oxygen like candy, returning a surge of ATP in gratitude for the treat.

Pacifying the mind yet empowering the muscles, this air expands the belly to transform the core into a powerhouse of stability. Tranquilized, the jaw becomes jello. The shoulders relax into a rhythmic swing that guides the gait cycle. The torso calcifies into a concrete cylinder, resilient and reinforced by a combustion of internal energy. Gently supported by the core, the hips float without strain above the terrain. The pelvis glides directly forward, immobile in all other planes. The earth below transforms into a still sea, unperturbed as the weightless feet barely graze its glistening surface.

Despite this calm, despite this buoyancy, the body is impenetrably strong. The torso comprises an iron rod, elongating and bracing the spine from tail to tip. Two other rods, parallel to the first, extend from each hip to the ground. The heel slides with ease up this rod to kiss the buttock before gracefully returning to brush the earth.

From this calm the body learns balance. From this strength the soul discovers life.

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Running the Minimalist Road: Worth the Risk?

Alcohol. Politics. Relatives. Ice cream. The common thread? All are best enjoyed in moderation (just kidding, family … I love you all dearly!). Running, on the other hand, is one activity we should feel free to indulge in to the extreme. Maybe not in terms of mileage, speed or intensity, but in terms of foot support – or more precisely – lack of support. Just a year or two ago I would have argued defiantly with the me of today, having been skeptical of both barefoot zealots and advocates of cushy, motion control shoes. It was from this conservative, middle-of-the-road stance that I launched my minimalist experiment, gradually transitioning to lighter, less supportive running shoes, ranging from huaraches to racing flats.

Readers and friends will attest to the fact that this past year has been undoubtedly the most challenging of my fifteen-year running history, strewn with an unwelcome and unprecedented chain of frequent, relentless running injuries. As recent as a month ago, I began to seriously reconsider the tradeoff between the risks and benefits of my attempted transition to minimalism. Sidelined once again, this time from intense calf strain, I picked up Barefoot Ken Bob Saxton‘s book Barefoot Running Step by Step for some inspiration. While I typically avoid promoting specific products or gear, this man is not only the father of barefoot running and a running guru, but also a witty, endearing writer. Reading this book at the nadir of my frustrating recovery generated the perfect storm. Running should be easy, fun and painless; if it is anything else, you’re doing it wrong. My recent runs, in contrast, were filled with with aches, tension and anxiety. While I noticed a definite improvement in my form, some lingering bad habits in conjunction with reduced protection from less shoe left my bones, tendons and muscles dangerously vulnerable. Clearly something had to change.

Desperate, but willing to experiment as always, I ditched the fear that my feet were still weak from injury, ditched my goals of rebuilding my pre-injury marathon-level mileage, and ditched my shoes … my flats, my vibrams, my sandals. Starting at just half a mile, my feet were laden with blisters and my spirit was humbled by my evidently horrible footstrike. Despite having transitioned fully to an otherwise barefoot lifestyle, the layer of foot protection I consistently relied on while running was blocking a source of sensory feedback essential to reap the full benefits of barefoot running.

Although I’ve run bare – or nearly bare – countless times before, these previous efforts had been lacking two critical ingredients: 1) Awareness of my form and 2) Mentality of a novice runner complete with a willingness to progress SLOWLY. With a touch of restraint and patience, lots of intentional relaxation and a boatload of mindfulness, over one month I’ve developed the ability to run four miles completely bare, blister-free and often with an obnoxious grin plastered across my ecstatic face. Once I abandoned the preconception that my feet still weren’t strong or tough enough, the transition was remarkably easy. The secret, I quickly discovered, is first and foremost to relax and run however feels fun and easy. This revelation was aided by several indespensible tips from Ken Bob’s “cheat sheet”, such as bending the knees, landing first on the forefoot followed by the heel and toes, a forward lean that propels you into a falling motion, and steps so light the feet barely kiss the ground. The greatest challenge hasn’t been mastering the technique or covering the mileage; rather, it’s been fighting the inevitable “barefoot running exuberance syndrome”. I’ve addressed this by adhering to the following super-conservative plan (of course, this isn’t ideal for everyone, but is working great for me!):

1. Run at most every other day.
2. Start at 0.5 miles, increasing by no more than 0.2 miles per run.
3. Stop at the first sign of pain, and don’t even think of increasing mileage if the last run wasn’t awesome.

Having followed steps one and two religiously, I have yet to worry about step three.

By venturing beyond the comfort zone of minimalist running, I’m finally seeing the logic behind many of the claims from other barefooters that I had previously dismissed as radical propaganda. Running barefoot doesn’t guarantee correct form or injury-free running, but it does make it a heck of a lot easier. The chronic hip and calf tightness I’ve felt for years literally melts away when my shoes are off.

The sidewalk greeted my feet with this message after my most recent barefoot run.

And best of all, the skills I’m learning bare are translating into easier, healthier, more fun shod running as well. This past month of supplementing my longer shod runs with short barefoot runs has facilitated a successful recovery from months of injury, as I’m learning to run in shoes with the same ease as without them.

So if you’re thinking of exploring minimalist running but are afraid to bare your soles, I urge you to consider … is moderation really worth the risk?

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Back to basics

In the long run, coping with life’s challenges and hardships can provide unforeseen benefits such as a more grounded perspective and sense of empowerment. Similar strengthening can also occur during a runner’s battle with injuries. For instance, I’ve emerged from prior injuries having learned critical lessons in patience and adaptability. Yet this growth has often also been accompanied by an awareness of concomitant physical losses, including reduced strength and stamina, missed races and training setbacks. My most recent injury, however, has demonstrated that when the injury is severe enough and the struggle to recover is sufficiently trying and lasting, even these physical losses can be converted into gains. How, you ask, could a five-month hiatus from running, ignited by a metatarsal stress reaction followed by a lateral foot injury and then severe calf pain, turn one into a stronger runner? By radically transforming their technique and definition of running.

Too often we address injuries with a patch; we treat the pain and inflammation with drugs, ice, orthotics, creams and bandages, until the symptoms disappear, without ever understanding how they originated in the first place. A frustratingly stubborn recovery, for which these quick fixes are ineffective, can force a deeper understanding of the biomechanical imbalances that frequently lay at the source. While each runner is unique and must listen closely to their own body to learn such lessons, let me share a few personal experiences that may strike a chord with some readers.

As the cause of my injuries was not immediately apparent, I initially tried to treat them while adhering to my ingrained, unhealthy running habits. Only when I finally realized this old routine would no longer cut it, I launched a new approach to my recovery with a clean slate. I abandoned my goal to rebuild mileage and became determined to simply learn to run again – correctly and painlessly – which I’ve approached by incorporating frequent short, easy and mindful barefoot runs. This simple tool not only teaches proper running biomechanics, but has also revealed subtle differences between my shod and barefoot running form that have likely been the culprit of injurious, inefficient running.

Metatarsal stress reaction

The ignition to my train of injuries, a stress reaction in my left metatarsals, was assumed to be a classic result of too many miles in too little shoe, before my feet were strong enough. Yet this explanation seemed at odds with my intentionally very gradual, cautious transition to a minimal shoe and foot strengthening efforts through barefoot walking. A recent barefoot run confirmed that the culprit may not have been the miles and weakness, but rather, poor running form transferring undue stress to the forefoot. During this particular run along a harsh urban route – my only unpleasant barefoot run to date – I adopted a rigid, tense and sloppy foot strike as I traversed uneven, rough terrain. The consequence was an aching, swollen top of foot, disturbingly remniscent of my old injury.

Lateral foot tightness

Just as my stress reaction was healing and I resumed gentle running, I became plagued with a nagging ache along the lateral foot (presumably the flexor digiti minimi brevis / abductor digiti minimi muscles), from the cuboid to the base of the fifth metatarsal. To no avail, I tried massage, ice, heat and running on every imaginable surface, from concrete, dirt and grass to an Anti-gravity treadmill. It wasn’t until replacing my already minimal shoes with an even lighter, less cushioned and less supportive shoe that I found relief. The subtle arch support of my prior pair had evidently been encouraging excessive supination, placing undue strain along my lateral lower leg and foot.

Calf strain

Finally recovered from my foot ailments after months of rest, I launched back into running cautiously but soon discovered my calves were not up to the task. A month of running with tight calves culminated in intense pain and swelling that spread throughout my calf, ankle and foot, forcing me into another two-week running hiatus. Despite common logic that weak, strained calves would benefit from cushion, support and soft surfaces, I discovered a peculiar phenomenon that the calf pain appeared instantly when running in shoes, but I could run painlessly barefoot … on concrete.

Could it be that each of these injuries did not in fact result from too many miles, aggressive training or insufficient support, but instead stemmed from running with unnecessary tension and improper biomechanics? 

Admittedly I’m eagerly awaiting the days when I can enjoy endless miles with full strength and endurance; but for now I’ve discovered a new source of joy from running. Rather than progressing in terms of mileage or speed, I’m gaining satification from my gradual improvements in form which allow me to run free of pain, tension and injury. These lessons have spawned a new era of growth in my evolution as a runner, one marked not just by improved biomechanics and strength, but also by a rekindled appreciation for the pure joy of running.

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Barefoot birthday

A year ago yesterday I took off my shoes, and *mostly* haven’t looked back. Envisioning this post months ago, I projected an enthusiastic account of how a barefoot lifestyle can radically improve foot health and transform your running. While the year-long journey has certainly been enlightening, it has more specifically revealed the detrimental impact of a lifetime of shoe-wearing, the dangers of demanding too much from the body, and the complexity of the “barefoot vs. shod” debate.

Before expounding upon my personal experiences, let me clarify what I mean by the term “barefoot”. I do not wear shoes unless absolutely necessary. That means bare sole to dirt, concrete, pavement or snow, walking around campus, at lab, through my neighborhood or hiking a mountain. I’ll slip on a pair of flip-plops in professional situations or at restaurants or stores that request shoes, since I may not understand others’ distaste for feet, but hey – I’ll respect our difference of opinion. The other main exception is when I run. Although my feet rapidly adapted to walking bare, the demands of running bare are considerably greater and require a more cautious transition. For this reason, depending on the distance, my running footwear ranges from a lightweight shoe to a sandal to fully bare.

As my original motivation for this experiment was to personally assess the effects of a barefoot lifestyle, the critical question is how has shoe-free living changed my life and health? As a scientist, you’d think I would have conducted a properly controlled experiment. But as an overzealous extremophile, I of course changed too much at once, and now have a mess of uninterpretable anecdotes. Over the past year I not only started walking barefoot, but concurrently started using a standing desk and running in minimalist shoes, making it essentially impossible to dissociate their impact on my well-being. With that caveat, let me share the benefits, frustrations and painful lessons of this adventure.

By far the most entertaining aspect of my barefoot experiment has been the often ludicrous, hilarious and sadly misinformed comments I receive from strangers. I’ve been repeatedly advised to put on shoes because my feet “need” the arch support, I’ll cut myself on all the glass and needles that are everywhere, I’ll contract diseases from all the spit on the ground, and my favorite (from a plumber) – “there’s shit everywhere”. Either these are unwarranted concerns or I’m blessed with super-human resistance, since I have yet to experience any of these complications. In fact, the greatest danger I’ve encountered has been one easily removable splinter. I’ve even proudly developed enough resilience to walk over glass without injury.

Feet at the start of my barefoot experiment (left) and one year later (right). Excuse the poor quality of the 2011 photos, taken from my iPhone!

Perhaps most astounding is that such a seemingly minor change as taking off your shoes leads to such a dramatic physical transformation. The visible changes have been surprisingly subtle, including slight thickening of the skin on the soles and a slight expansion of the metatarsals. Although I originally intended to document the physical changes with periodic photographs, the differences from day 1 to day 365 are just barely apparent. Rather, the predominant changes have been in terms of internal structure and strength. My feet have appropriately adapted to the demands of supporting themselves, instead of relying on the artificial support of a shoe, by gradually developing stronger muscles, bones, tendons and ligaments. The difference has been dramatic enough that others, including my massage therapist and acupuncturist, have commented on my remarkably high arches and increased strength in my feet and lower legs.

In an ideal world, the story would end here. Hypothesis confirmed … returning my feet to their natural state led to improved foot health and function. But I am an athlete – a stubborn, sometimes irrational, too often fanatic – runner. As such, I of course sought the thrill of pushing my boundaries, expediting my progress towards minimalist running and only half-heartedly heeded the warnings of an overly aggressive transition. I ran contently in a safe transition zone for several months before making the error of incorporating marathon training into my bare and minimalist experiment. Predictably, at the peak of my training I over-ran myself into a metatarsal stress reaction which, due to a combination of a poor self-diagnosis and improper treatment, evolved into an excruciating 4 month hiatus from running. A slow bone recovery was followed by soft-tissue irritation as my foot is re-awakening to the demands of running.

That said, one could justifiably consider this a failed experiment in barefoot living. The anti-barefoot community can now happily add me to their stats of runners who sustain transitioning-to-barefoot-running injuries (although, some research suggests these stats may be inflated). Call me crazy, but instead of convincing me to protect my vulnerable feet with shoes, the journey has opened my eyes to the many joys of a barefoot lifestyle and minimalist running. Walking bare is an essentially risk-free way to improve foot health while inviting in a flood of wonderful, novel sensory experiences. My trials with minimalist running have foremost underscored the dangers of 1) weakening our feet through a lifetime of unnecessary, artificial support, and 2) over-stressing the thus-weakened bones and soft tissue of the foot by demanding too much, too soon. While dangerously high mileage in a minimal shoe pushed my feet beyond their present strength, this is by no means evidence that a lighter – or absent – shoe is inherently dangerous. Running bare with poor form or insufficient strength can lead to injury; conversely, there’s no risk of running in traditional shoes with correct form. While the runner, not the shoe, is the critical factor (for example, see Daoud et al, 2012), the benefit of less shoe comes from the natural tendency to run with improved form – including faster cadence, lighter steps and a midfoot / forefoot strike – with reduced interference from a bulky shoe.

Year one has been filled with surprises, frustrations, and continued physical and mental development. As is true for science in general, our findings may not always confirm our predictions, but we can trust that they’ll reveal the truth. I’m looking forward to a second year of growth and discovery, but can’t help wonder … do bare feet experience the terrible two’s?

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Altered runiverse

I’m not one for elaborate running gear or gadgets. It’s my personal preference not to run with music, a watch or GPS device, and in all honesty, I find the gimmicky marketing for schmancy running clothes and overpriced shoes quite disturbing. However, I recently discovered one running gadget worthy of shameless promotion. It is a genuine godsend to injured running addicts, such as yours truly.

Alter-G anti-gravity treadmill

The wonder-device to which I refer is the Alter-G anti-gravity treadmill. Yes, you heard me … anti-gravity ... as in, reduces the gravitational force on your lower body to allow you to run or walk with forces equal to a fraction of your full body weight. The mechanism is downright ingenious: the runner wears rubber shorts that zip into an inflatable “capsule” attached to the treadmill. The treadmill calibrates to the runner’s weight and pumps air into the region surrounding the legs, providing a subtle supportive uplift. The amount of inflation, and thus the degree of support, can be controlled to allow the user to run at 20-100% of their body weight in 1% increments. This allows runners battling injuries that prohibit weight-bearing activity, such as tendonitis or bone fractures, to run without pain or risk of further injury. The price tag isn’t cheap, ranging from $30,000 -$75,000 depending on the model. But Alter-G’s are continuing to pop up at gyms and medical facilities across the country, many of which offer pay-per-use options (usually also pretty pricey!) to the public.

My first indulgent Alter-G run was at M2 Revolution, a cycling gym in San Francisco. More than a month into a foot injury (metatarsal stress reaction) and in the throes of deep running withdrawal, the experience served as both reassurance that my body was still capable of running and an exhilarating reminder of why I love to run. Incredibly, despite its highly effective external support system, the treadmill allows you to run unrestricted, maintain a normal gait and foot-strike, and actually get a decent cardiovascular workout. In fact, my weakened quads and calves felt fantastically sore the next day!

Progression from 36% to 73% body weight

Thanks to the wonderful staff at the office of Dr. Ian Purcell in San Diego, who personalized a discounted pay-per-use package deal, I’ve been able to continue feeding my running addiction while successfully rehabilitating my foot. I’ve run on the Alter-G 6 times over the past few weeks and find it a great way to objectively monitor my recovery. For example, I was able to comfortably complete my first run at 36% body weight. My most recent run, 18 days later, was at 73% bodyweight, equivalent to an average gain of 2% body weight per day. Beyond providing my much-needed running-endorphin fix, the consistent progress I’ve measured with this tracking system has also shone a light at the end of the tunnel, keeping me sane and optimistic through this otherwise unpredictable recovery process.

Now who has an extra $30k they’re dying to spend?

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Adventures in healing

Today marks the 8 week anniversary of my perplexingly stubborn foot injury. Had I known back in February that I would still be unable to run today, I likely would have resigned myself to a period of springtime hibernation. But every day brings new reasons for optimism and I can now confidently report having entered a stage of progressive recovery. In retrospect, the unpredictable ups, downs and surprises of this frustrating period have also been immensely character-building.

Like many runners, I tend to have an inflated sense of how in touch I am with my body; I am thus continually humbled by how poorly I sometimes interpret its messages! If you read my last post, you’ll recall that I initially self-diagnosed my top-of-foot pain as extensor digitorum longus tendonitis. However, after 6 looooong weeks of unsuccessfully treating for tendonitis, I began to suspect a more serious injury … could it be a dreaded metatarsal stress fracture? An MRI revealed no clear fracture line, but showed “abnormal signal intensity” throughout the foot, reflecting edema in the bone marrow, consistent with a diffuse stress reaction (for a great review of stress fractures and reactions in athletes, see Fullem, 2012). Oddly enough, this finding came as a huge relief, finally providing an explanation for my excruciatingly slow healing. No surprise that treating weakened bones for tendonitis would be completely ineffective!

At the same time, this diagnosis taught me a critical lesson. Equally important as listening to your body and heeding signs of incipient injury is accepting you don’t always have the answer, and remaining open to all potential causes of a problem. My symptoms appeared perfectly consistent with tendonitis, and perfectly inconsistent with a fracture: aching that moved around along the path of the tendon from shin to ankle to top of foot, but no swelling or pain upon pressing the metatarsals. With an athletic history void of fractures yet scattered with tendon issues, I was convinced this was just more of the same. But to my surprise, under the combined stressors of marathon training and aggressive transitioning to minimalist running, my metatarsals gave out before my tendons.

Over the last 2 weeks I’ve conducted extensive research which has led me to incorporate several new treatments. Although it’s impossible to attribute improvements to any one intervention, together the following appear to have been highly effective at promoting healing in my stressed metatarsals:

Supplements
During injury recovery, the body requires additional nutritional support beyond the demands of normal maintenance to ensure active repair of damaged tissue. For bones, this support includes excess calcium, with vitamin D, magnesium and vitamin K, all of which are essential for building strong bones. Silica has also been shown to promote bone health (Carlisle, 1981Jugdaohsingh et al, 2004; Seaborn & Nielsen, 2002) and as a nice side effect, purportedly also improves hair, nails and skin (although I have yet to notice newly lush locks or a vibrant complexion!). In addition, I’ve been supplementing with glucosamine-chondroitin and omega-3’s for joint support and inflammation control, respectively. I’ve also become rather obsessive about maintaining a balanced diet rich in vitamins, minerals and protein.

Bone stimulation
There’s considerable evidence that stimulating fractures with ultrasound can accelerate bone healing (Heckman et al, 1994; Nolte et al, 2001). I purchased a bone stimulator (Exogen 4000) a week ago and – coincidentally or not – have experienced the most marked improvement yet over this past week. Such devices are relatively pricey and not easy to track down (I found mine on Ebay), but are user-friendly, FDA approved and scientifically validated.

Homeopathy
Comfrey, or Symphytum officinale, is commonly referred to as “knitbone” due to reports of its phenomenal ability to heal bone fractures. I have been applying a comfrey salve topically to the foot as well as taking a homeopathic dose of symphytum multiple times a day.

Activity
The traditional prescription for stress fractures or reactions is complete rest from all forms of weight-bearing activity, often including a boot for walking. For later stages of recovery I’ve seen conflicting advice, with some therapists suggesting the incorporation of pain-free weight-bearing exercise to encourage strength building. As a firm believer that our bodies are more resilient than we’re often aware and under some circumstances are most nourished by active healing, I have opted for the less conservative course. Granted, during the first 6 weeks, my decision to use the elliptical machine, walk and hike (barefoot of course!) was based entirely on a misdiagnosis of tendonitis. Now knowing the state of my bones at this early post-injury stage, I suspect this excessive activity almost certainly delayed my healing. Since my foot has advanced beyond its original highly vulnerable state, I currently follow a simple guideline: engage in any activity that does not cause discomfort. Given my high pain tolerance, I set my threshold at discomfort rather than pain. Running through “discomfort” is what triggered this injury in the first place! This approach currently permits me to walk, do the elliptical and one other secret indulgence to be shared in a coming post (intrigued, aren’t you?)!

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PriTSD: Post-running-injury Traumatic Stress Disorder

For a while now, I’ve been intending to write on every runner’s favorite topic – injuries. I’m certainly no sports medicine specialist, but let’s face it – my share of close encounters over the past several years makes me almost as qualified. Having stayed remarkably healthy over the recent months, my original vision for this post was to highlight my invaluable (ehem) insights into injury prevention. Had I written that post and adhered to my own advice, maybe I would not presently be discussing post-injury recovery and running withdrawal.

December 26, 2011. House-bound by the bitter cold and snow but needing to release some pent-up holiday energy, I resorted to a treadmill run and treated myself to running the final 4 miles barefoot. A subtle ache appeared on the top of my left foot which, given my surging endorphins, I of course ignored. Over the ensuing two months, this foot issue re-emerged several times without progressing beyond mild discomfort. Assuming myself invincible, I continued to push my limits, simultaneously training for my next marathon and increasing my mileage in minimalist footwear.

Lateral ankle

February 18, 2012. While on my weekly long run, the foot ache re-appeared, but this time worsened from mild annoyance to a cautionary, progressive ache. Of course, I convinced myself it was nothing and completed the 22 miles. The extent of the damage was only evident while attempting to run two days later, each step coupled with a shooting pain along the top of my left foot and ankle. I had run myself into a full-blow case of extensor digitorum longus tendonitis.

Today. Three weeks later and still unable to run. It may appear ludicrous that runners voluntarily run themselves into such debilitating conditions. Yet I’m convinced the very qualities that make us so vulnerable to overuse injuries are also what make us so well-suited for distance running. We persevere, adhere religiously to our goals and tend to have remarkably high pain tolerances. Running is a phenomenal way to heighten bodily, mental and environmental awareness; however, when those sensations are overwhelmingly positive and rewarding it can be exceedingly difficult to detect subtle messages of injury or imbalance. It is therefore crucial to heed those quiet warnings which we too often acknowledge only in retrospect.

These past three weeks have been a genuine physical and emotional rollercoaster. At the risk of sounding melodramatic, for a runner the post-injury period can remarkably parallel the aftermath of other major traumatic experiences. The process begins with denial, during which you stubbornly insist the condition is minor, fleeting and can be run through. This is followed by acceptance of the injury’s severity but also shock and irrational fears that you will never run again. This can also coincide with veritable physical withdrawal, making this the most difficult stage. For me, going from running 60-70 miles/week to zero sends me into a physical and mental downward spiral. The crash is characterized by a paradoxical combination of lethargy and anxious restlessness. During my first post-injury week I essentially shut down, my motivation and productivity in lab and school plummeting.

Eventually, healthier coping mechanisms take hold, allowing you to start taking proactive steps towards recovery. In week two I replaced the couch with cross-training, forcing myself to go to the dreaded … gym. With no apparent improvement from the standard RICE (rest, ice, compress, elevate) approach, during week three I began to seek alternative methods to expedite the healing process. I’ve begun acupuncture, homeopathy (ruta graveolens) and K-laser therapy and have since noticed marked improvement – namely increased range of motion, reduced inflammation and the ability to walk pain-free! I can only speculate whether this change is attributable to any one of these treatments, a placebo effect or simply reflects the natural time-course of my body’s recovery process. Regardless of their source, such improvements are a comforting reminder of the body’s innate healing powers and the critical importance of a positive and proactive approach towards recovery.

I won’t lie. Three weeks and counting of no running is driving me crazy. But I suspect these periods may be invaluable for an endurance athlete’s long-term growth, complementing our physical stamina with invaluable training in psychological endurance. Stay tuned for progress reports … I foresee a strong tendon and lots of running in the near future!

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Active-state functional connectivity

Task-positive and task-negative brain networks (Fox et al, 2005)

I’m currently preparing for a talk on a recent paper (Powers et al, 2011) using resting-state functional connectivity MRI to study large-scale networks in the human brain. (Okay, actually I’m procrastinating working on the talk by writing this post.) Different brain regions are anatomically connected via projections from one area to the next, allowing long-range communication across the brain. This functional connectivity can be observed as synchronized BOLD signal in connected regions while a person is at rest or performing a task, and such correlated areas have been found to correspond with functional sub-networks within the brain. For instance, an extensive “task-positive” network (shown in warm colors at right, from Fox et al, 2005) is thought to comprise multiple sub-networks including, for example, a task control system composed of the dorsal anterior cingulate and frontal operculum, and a dorsal attention system involving areas of superior frontal and parietal cortex.

While out for a run yesterday I was struck by the remarkable parallel between such integrated brain systems and our non-brain “networks” of muscle, fascia, tendons and ligaments that coordinate distinct yet complementary functions while we run. Unfortunately but necessarily, this appreciation was triggered by the heightened bodily awareness that accompanies injury. About a month ago during a particularly intense and hilly run, I noticed a nagging tension in both hip flexors. I followed this the next day with a short, easy barefoot run during which a dull ache appeared on the top of my foot. Simply a classic case of the novice barefooter’s too-much-too-soon, right? Over the subsequent weeks, I’ve dealt with recurring minor flare-ups of both these top-of-foot and hip issues and assumed they were unrelated and exacerbated by distinct factors – my continued increase in barefoot / minimalist mileage and hill running, respectively.

But it wasn’t until my monthly sports massage this week that I learned just how connected – possibly causally related – these problems were. As my therapist applied pressure just lateral to my hip flexor a subtle burning appeared in my extensor tendon along the shin and foot. Release of hip pressure … relief of extensor ache. Application of hip pressure … return of extensor pain. And so on. I was astounded by the consistency of this pattern to the point that I even questioned my own sensations. There was an undeniable connection between my hip flexor and extensor, such that tension in one translated into pain and impaired function in the other. Although I’m not happy to report that my “anterior leg network” hasn’t fully recovered, its continued dysfunction has further highlighted the strong connectivity I suspected during the massage. While running a moderate uphill climb yesterday, my hip flexor predictably tightened up. Moments later, an ache appeared along the top of my foot and ankle. Then – just to mix things up, my knee began to burn as I felt my knee cap riding out of alignment. While certainly not a pleasant finale to the run, this sudden cascade of pains clearly demonstrated a deeply integrated anterior chain, from foot to knee to hip – and likely beyond.

Tom Meyers' Anatomy Trains

A clear picture of functional brain organization requires understanding not only the role of single units – a neuron or isolated region, but also the critical interactions between such elements. Similarly, effective communication within and across our musculoskeletal sub-systems, along with an integration of mind with body, is essential to properly function as a runner. The springy tendons of the foot cannot propel us along without power from our quads and gluts, stability from our core, and motor commands from and sensory feedback to the brain, together coordinating a smooth, fluid ride.

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ebb and flow

A decade ago a wise older friend reminded me that we are no different from a molecule of water in the ocean. Over the course of our lives we are carried with the waves along an unpredictable and uncontrollable journey. Although our instincts prompt us to rejoice as we crest the peaks and agonize as we struggle through the troughs, it is futile resist the current. Her words echoed through my mind as I ran today, noticing the peaks and troughs of the day’s run as well as those of my running evolution over the years. Each foot strike imparted a novel experience … in one moment I was floating – the next, feeling strongly connected with a passing runner – the next, anxiously aware of a nagging weakness in my ankle – the next, disengaged from my body, engrossed in composing a paper for my most recent research study. It is natural to notice both the positive and negative of every run, but the danger arises when we expect either to persist. Sometimes we are blessed with a run composed entirely of euphoric moments … and sometimes those moments are filled with fatigue, discouragement or pain. But dwelling in the bad will only intensify the misery and dwelling in the good will make the fall all the harder.

Just as we are carried along the current of a given run, so do we ebb and flow through our days, weeks and years of running. Upon my first significant running injury two years ago, I was struck with anxiety and terror that I would be permanently incapacitated and my running days were over. Although deeply distressed at the time, I now see that those fears were no more than irrational fabrications of my overactive mind. Over the years, most runners will inevitably experience challenging periods that we’d like to wish away. Whether they involve a disappointing race performance, a week of sluggishness or a year battling injury, these hurdles are fleeting. Although I admittedly continue to struggle through such troughs, I have discovered that they can sometimes be as valuable as the peaks. They can serve as humbling triggers that force me to re-evaluate my personal goals and reasons for running, as well as enhance my awareness of both my own body and surroundings. I have begun to embrace these challenges as opportunities to learn from the possible structural, functional or even psychological imbalances that may underlie a problem. By remaining open to these periods of exploration they can become phenomenally informative and provide invaluable insight into the interactions between my body, mind and environment.

To conclude, some inner ramblings from the day’s run – a personal reminder of my alter-ego, H2O:

The present is static but existence is dynamic. Embrace this moment as it is all that you have or all that exists. You cannot retrieve the past and you cannot yet access the future. Now is your only reality so appreciate all that it may offer. But do not cling to it, since in a moment it will dissolve. However pleasurable now is, no effort can make this experience persist. However painful now may be, in a flash it will be replaced by a distinct set of sensations, thoughts and emotions … by an entirely novel, fresh reality.

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To wear or to bare?

A runner’s choice of footwear can be confusing and downright overwhelming. We’re fed mixed messages from shoe manufacturers that their latest motion-control, cushioned stability shoe with custom orthotics on the one hand – or maybe their lightweight minimalist shoe on the other – will guarantee our feet a smooth, fast ride. For years I believed that finding the right running shoe was like finding one’s life partner … we all have a perfect match out there somewhere, but it might take years of dating around to discover our sole-mate (sorry – couldn’t resist). Over the past several months I began to both test and question this idea in a recent personal experiment. But before sharing my discoveries, let me offer a bit of context …

I had been blessed with 14 years of essentially injury-free running. That is, until a fateful day in February 2010 when, while training for the Boston marathon, I returned home from my evening run with a torn achilles tendon. Needless to say, I did not make it to the starting line that April. The ensuing year was filled with a flurry of peroneal tendonitis, femoral-patella syndrome and trochanter bursitis (ie ankle, knee and hip injuries). Was my body just not designed to run this many miles (as my doctor informed me!) or was I doing something wrong?

Given many runners’ reports that going barefoot helped resolve their injuries, I began to look into the possibility that my shoes might be contributing to my own problems. Although initially skeptical of these seemingly radical claims, the more I researched, the more I found them intuitively appealing and scientifically sound. The logic was simple: the human body evolved to walk, run and jump perfectly fine without the need of external crutches like arch support or heel cushioning. It’s doubtful that our hunter ancestors had to slip on their Nikes before pursuing their next meal. Modern man has changed little from our predecessors, with one notable exception: for most of us a lifetime of shoe-wearing has fostered an epidemic of shoe-dependence. Held captive in footwear, our feet become weak, inflexible and ridden with bunions, fallen arches or crooked toes. We in turn attempt to correct these imbalances with more cushioned, structured and protective footwear, only perpetuating the cycle. The truth is, our feet are quite well suited to sustain the physical impact of these activities with their elegant support system of 26 bones, 33 joints and over 100 muscles, tendons and ligaments. Introducing an artificial support system like footwear transfers the impact burden from foot to shoe, which over time can 1) weaken our feet and lower legs, 2) alter our natural walking or running gait and 3) redistribute impact forces to place excessive stress on areas like knees and hips. While there is nothing inherently dangerous about shoes themselves (with maybe a few exceptions), the associated consequences of long-term foot support such as weakness and unhealthy gait are concerning. I’ll limit my explanation to this, in the hope of being minimally redundant with the countless articles already written on the topic. But I will refer the interested reader to a stellar investigation into the effects of shoes on foot-strike patterns and their associated impact forces, published last year by Daniel Lieberman and colleagues.

Thus, curious and excited yet still skeptical, five months ago I began to experiment with the natural potential of my own feet. This has not been a quest to become a barefoot runner per se, and I do not intend to provide a “how-to guide” for such a goal. Rather, it has been an exploration of my body’s response to removing my feet from artificial sources of support and protection. Heeding cautions that my feet would be weaker than expected, I began slowly … exceedingly slowly since I was concurrently training for another marathon and of course, stubbornly refused to compromise my mileage. My experiment involved the following core elements:

Walk barefoot. Babies aren’t born with the capacity to run without first developing the strength to crawl, then walk and finally run. Similarly, why would I expect to be able to run bare if I couldn’t first walk bare? On day one of my barefoot journey I lasted only a few blocks before my sensitive skin and tired feet screamed for shoes. But within just a few weeks I built up the strength and resilience to walk essentially everywhere and anywhere.

Run minimally. Various features of your typical running shoe can influence gait including cushioning, arch support and heel-to-toe drop, all of which were characteristic of my own standard running shoe. I therefore experimented with various shoes that minimize these factors to different degrees. Practically, this involved running most of my mileage in my standard shoe, while gradually increasing the percentage of miles run in a more minimal shoe. For instance, I began by running about 20% of my weekly mileage in a light-weight racing shoe and ramped up this mileage by approximately 10% each week. I also supplement my daily longer runs with one or two weekly short runs (1-3 miles) in minimal protection (huaraches or vibram five-fingers).

Listen and adapt. This has been critical for both the success and evaluation of my experiment. I’ve become increasingly aware of my body’s response to each new change and continue to adapt as necessary. When feeling strong I allow myself to increase my “minimal shoe” mileage. If I feel weakness or strain in my feet or calves, I introduce extra support until the issue resolves. For instance, I recently completed a marathon in a lightweight shoe but ran exclusively in a higher-support shoe for the entire post-race week to allow my strained feet and ankles to recover.

So what has come of the early stages of my experiment? I now exclusively walk barefoot, as I’ve grown to love the sensation of my foot contacting the earth as well as a heightened awareness of my environment. In fact, I find it rather awkward to walk in shoes and can’t imagine going back. While I won’t go so far as to claim that discarding my shoes has been a panacea, I’ve discovered that footwear significantly affects my lower leg strength, running form and overall running experience. Perhaps most remarkable has been the transformation in my gait. Trained as both a dancer and sprinter before taking up distance running, I developed an unusual tendency to excessively forefoot strike and supinate. But in zero-drop footwear I find myself engaging my entire foot – from ball to heel – and striking with better lateral balance. As my form corrected, the demands on my upper leg shifted lower, resulting in remarkably stronger feet, calves and shins as well as reduced tightness in my hips, quads and IT band. Generally, the less support and cushion under my feet, the lighter, smoother and more balanced I find my gait. That said, I appreciate some form of protection from rough terrain, as this frees my mind from worrying about rocks, sticks, or other potential dangers so I can simply enjoy the ride. Yet I still find value in a traditional shoe, particularly in providing extra support to keep me running through periods of soft-tissue weakness or strain. As conservatively as I tried to pace myself, my progression was just aggressive enough to ensure my share of achy feet, stressed tendons and tight calves. These past months have debunked the myth that any one shoe – or lack of shoe – is ideal. In fact, I currently alternate among 5 different models of footwear, depending on my support needs …

My embarrassingly large array of running shoes, from handmade huaraches (so fun!) at left to classic supportive sneakers at right.*

My barefoot / minimal journey is still in its infancy and I’m excited to witness its continued evolution over the coming years. These preliminary “data” indicate that for me, less is indeed more. Less shoe equals increased strength, a more balanced foot-strike and an overall more liberating running experience. However, the heterogeneous reports from others suggest that this is not a universal experience and that the runner, rather than the shoe, is the critical ingredient. So whatever you choose to – or not to – wear, if you’re healthy and happy then you’re probably doing something right.

* Although I try not to promote any particular product, I will gladly share my opinions if you contact me directly.
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