Tag Archives: running

The shoulder-hip rotation equation

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

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

She noted three main issues:

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

Left shoulder rotates excessively

Left shoulder rotates excessively

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

Right leg lifts lower than left

Right leg lifts lower than left

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

Right foot rotates outward

Right foot rotates outward

Mental trick FAIL

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

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

Mental trick SUCCESS!

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

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

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Return to racing, bare and proud!

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

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Running rebirth

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

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

Racing: The missing piece

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

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

Taper despair

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

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

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

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

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

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

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

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

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

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

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PRP: A shot full of miracles

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

Platelet-rich plasma: The nitty-gritty

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

So, did it work, you ask?

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

Welcome back, Gumby!

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

Return of strength

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

Goodbye pain!

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

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2014 in running: Patience, growth and healing

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

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

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

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

2012-14_Mileage

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

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

Happy, healthy trails ahead to all my wonderful readers!

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PRP. It’s a real pain in the butt

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

THE VERDICT

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

THE PROCEDURE

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

Platelet_Rich_Plasma_PRP-Therapy-IMAGE

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

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

THE AFTERMATH

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

ACTIVITY

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

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

MY BOTTOM’S BOTTOM LINE

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

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

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Navigating the niggles

You’re midway through an otherwise phenomenal run. You’re feeling strong, just tackled that dreaded hill and have fully entered the zone. Suddenly, your heart sinks a bit as you feel a niggle coming on. Whether it’s an ache in your foot, a twinge in your knee, or tightness in your hip, these minor discomforts can be majorly disconcerting. Maybe it will dissipate in a minute … or maybe it will evolve into a serious injury. Sure, a smart runner will listen to their body. That’s easy enough when your body is screaming adamantly “Your foot is broken, dummy!” But how do you respond when your body mumbles incoherently “Yeah, I’m not feeling so hot. The ankle feels kinda blah … you might want to check it out … or not … I don’t care”. In these situations, neither intense trepidation nor denial of the warning signs are ideal approaches. But don’t fret, runner. There is in fact a middle ground on which you can cautiously and safely test the injury waters.

1. SLOW DOWN, SWITCH IT UP, SHAKE IT OUT

Sometimes a simple correction is all you need. If that niggle arose from pushing too hard, just slowing your pace could reset you back to normal.

We often think of over-use injuries as emerging after many days or weeks of too much running. But sometimes monotonous motion – even over the course of several minutes – can trigger over-use symptoms. If you’ve been running on the road, find some grass or trail. If the terrain’s been rough or uneven – for instance, a rocky path or canted road – switch to something more stable. The slight change in muscle engagement might be all you need.

If these quick fixes don’t fix, stop and shake it out for just a moment. Sadly, many of us have been taught that running breaks are a sign of weakness. Believe me, running yourself into a broken bone or torn tendon will leave you much weaker than had you taken a brief pause. Even a 30-second rest might allow an overworked muscle to recuperate, leaving you refreshed for the rest of your run.

2. FOCUS ON FORM

The onset of a niggle is the perfect time to check back in with your body. Often, a slight form correction can nip the problem in the bud. It’s not always obvious where the imbalance is coming from, so scanning the body – from tip to toe – will cover your bases.

Good running form, courtesy of the Mark Cucuzzella and the Natural Running Center.

Good running form, courtesy of the Mark Cucuzzella and the Natural Running Center.

Head. Starting with your head, assess your posture. Imagine a string pulling your head up from your shoulders, elongating your neck and spine into a tall, straight line. Keep the shoulders relaxed but don’t forget to keep the arms bent and active. The rhythm of your arm swing can have a powerful impact on your running cadence – which we all know is a critical element to strong, healthy running.

Core. Moving down, evaluate your hips and core. Stability in these regions are perhaps the most essential component of good running form, and – as the term implies – comprise the core of a runner’s stride. Imagine your hips on an even horizontal plane, the right and left hip bones perfectly aligned, neither dipping nor rotating with your stride. Keep a slight lean in the upper body, visualizing a straight planE from head to toe angled forward, being mindful not to bend at the hips.

Legs. Next come the legs. Bend the knees, and keep the gluts and hamstrings active. Check where your feet are landing. They should contact the ground directly under the hip, not in front (this is ovestriding – an all-too-common source of many problems!), nor at the midline (this is a cross-over gait, which can be the source of many lateral injuries). Sometimes mentally exaggerating these features can help achieve them – for instance, aim to make foot contact behind and to the outside (laterally) of your hips. You’ll likely end up striking right under the hips.

Feet. Lastly, check in with your feet. Keep them relaxed – your foot muscles are not “power muscles” as are your quads, gluts and abs, and thus should not be relied on to propel you through your stride. Especially if you are running barefoot or minimalist, there can be a tendency to unnecessarily over-engage the feet. Imagine landing as lightly as possible, lifting the foot at the moment it touches the ground, rather than pounding or slapping. And of course, keep your cadence high. Aim for a balanced foot strike that’s neither excessively fore-foot nor rear-foot. I find that focusing on a “pancake-flat” foot-strike (forefoot and heel striking simultaneously) works best for me, but play with this to find your comfort zone.

3. UNEARTH THE ROOT OF THE PROBLEM

Modifying your speed, terrain or form are great quick fixes for mid-run niggles. But the critical question for preventing a recurrent, or long-term injury, is what caused the problem in the first place? This is some great food for thought for the remainder of your run … reflect on what you were doing leading up to the onset of the problem. Revisit not only the moments before, but also the days and weeks before. Did you just summit a monster hill? Maybe you’ve incorporated more speed work than normal this week, or have been pushing your mileage recently. Subtle changes, even those unrelated to your training, can impact your running health. Sleep deprivation, poor diet or stress can all work against a runner, impeding recovery, promoting inflammation or increasing fatigue. Chances are, you might be battling several of these aggravators, making it challenging to pinpoint one root cause. So go ahead, take an extra rest day, treat yourself to a deep-tissue massage and indulge in an extra hour of sleep.

And remember, a niggle’s nothing more, unless you let it be. Embrace these moments as learning tools and you’ll only grow stronger and healthier!

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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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