Goodbye Plantar Fasciitis???

This is a quick update to my recent plantar fasciitis posts (Part I and Part II.) I met recently with Denver-area Z-Health movement specialist Brain Copeland and it seems he may have helped me find a titanic breakthrough in my PF! Briefly, he assessed whether or not my arms and legs were coordinated properly during gait. He used muscle testing as part of this assessment. Turns out I had really only been cheating at walking and chewing gum. My gait looked normal enough but I was weak in certain positions where I should’ve been strong, and I was strong in some positions where I should’ve been weak. He then introduced cross-crawl patterns to me. Since then, my PF pain has decreased significantly and it has stayed that way. (I saw him on Saturday and this is Wednesday.) In some circles, this is known as a “WTF?” moment.

“Imagine you hire three people to work at a company to perform three separate jobs. But two of the employees are trying to do the same job and the third job is getting neglected. This is how I envision neurological disorganization.” Brian Copeland, Z-Health Movement Specialist

Goofy? Yes. Effective? Also yes!

The Cross-Crawl

Cross-crawl patterns are, as the name implies, movement patterns that resemble crawling. That is, the right arm and left leg converge and vice versa for the left arm and right leg. These are remarkably easy patterns and they can be created while standing, seated, prone or supine. Some of this stuff resembles some goofy old-school “aerobics” class movements (‘Knee to elbow everyone!!”) The supine cross-crawl looks like the “dead bug” ab exercise while the prone cross-crawl is essentially the same as the “bird-dog” low-back rehab exercise. Still another version looks like some sort of Irish jig. Fun stuff right?! (The good news is these moves are really easy and at least in my case, very powerful.) I’ll post video of cross-crawls soon.

What’s at Work Here?

I asked Brian Copleand several questions:

Q: Who might benefit from cross-crawl patterns?

A: “Everyone can benefit from cross-crawling patterns as the movement helps strengthen certain neural pathways in the brain that are beneficial. For instance, when you run, jog or walk and you step forward with your right leg which arm swings forward? It better be your left or you are a toy soldier. This cross lateral pattern of movement is key in both athletes and non-athletes. If you ever see a martial artist throw a very powerful kick with their right leg you will see their right arm go back and left arm come forward. This has to do both with rotational force and rotary stability in the trunk to maintain balance. So cross crawling movements are basically a part of our everyday lives. When the movement patterns become switched then we see all number of strange neurological issues arising such as unexplained pain that has no pathological explanation, clumsiness, troubles with memory and other cognitive issues depending on the severity of the neurological switching.”

Q: How do we identify those who may have this neurological switching?

A: “There are some specific tests that a Level 4 Z-Health Exercise Therapist can give to ascertain if someone has neurological disorganization and no one should self diagnose, but having said that people can get an idea if they have this by looking for the following things. Typically someone will have had some head trauma at one point in their life, even if it was as a child. People might be socially awkward and not know why. People may have a hard time remembering things and have to be shown something over and over again. People will often say things like, ‘things always work different for me than other people,’ and they don’t know why. Frequent clumsiness is a possible indicator as well.”

Q: What do cross-crawls achieve? Can you describe what these patterns do for our brains?

A: “Well that is the $64,000 question. Researchers are still discovering the how and why but for now we know that it does work. As I’ve been told before, science is the observation of repeatable phenomenon. So even if we don’t have the full picture yet we know that it works. But if I may hypothesize just a little… It is classically understood that the left hemisphere of the brain controls the right side of the body and vice versa, there is some variance in there but as a general rule it is true. We also know that many of the natural movement patterns that we have are cross-lateral in nature, in other words right leg, left arm and vice versa. These patterns help to stabilize our torso and provide balance and efficiency of movement. Now imagine if all of a sudden the right hemisphere of your brain decided that it would control the left side of your body, except it would also control the right thumb but not the fingers. Now the left side of the brain is having signal feedbacks or misfires as it tries to control your right thumb. Now the pre-cognitive brain (the automatic part that controls the behind the scenes stuff) encounters confusion and we reach what Z-Health founder Dr. Eric Cobb, D.C. calls a threat response. I can already tell that I am about to open a whole can of worms so I’ll digress a little. Imagine you hire three people to work at a company to perform three separate jobs. But two of the employees are trying to do the same job and the third job is getting neglected. This is how I envision neurological disorganization.”

Q: What else should we know about cross-crawl patterns?

A: “Well there is always more to know but it can become quite complex. I would just say make them a part of your daily warm up for your exercise routine, 20 or so should suffice as preventative medicine. If you have neurological disorganization you may need to do more reps than that. And ultimately each person will respond uniquely different, the amazing and frustrating thing about the human body.”

“Folks can learn a little more about Z-Health and how the human nervous system has an impact on both the pain we feel and our potential for athletic ability by checking out these articles: What is Z-Health and Why It Works and How to Eliminate Pain, Stiffness and Weakness Forever.”

So that’s a fairly thorough discussion on cross-crawling and why it may work. I don’t want to promote cross-crawling as a magic cure-all panacea for everyone. That said, these are very easy movements to execute and they may very much be worth a try. If you have lingering pain that isn’t responding very well to treatment, give cross-crawling a shot. In my case I’ve had tremendous results. (Now of course the challenge is to remain conservative as I add back in running, biking, etc. The temptation is to ramp up to 1000 mph. Not a good idea.)

Further information on cross-crawl patterns can be found at the following sites: Head Back to Health, Natural Health Techniques.

Hello Plantar Fasciitis :-( Part II

Part I of this post ended mid-way through my explanation of various strategies to combat plantar fasciitis (PF). Here are more treatment methods.

Taping

Various taping strategies may be used to help alleviate PF symptoms. Tape should help support the arch of the foot and help shoulder some of the burden borne by the plantar fascia. There are two options. First is the traditional white athletic tape. This stuff can be rigid and uncomfortable but possibly effective. Here’s a video on how to apply athletic tape in order to relieve PF. And here is a slightly different method.

The other taping option is elastic therapeutic tape, (aka Kinesio tape.) Elastic therapeutic tape became popular during the 2008 Beijing Olympics where many athletes were seen wearing the strange, multi-colored blotchy looking stuff on their legs, shoulders and other body parts. Kinesio tape supposedly goes beyond simply providing support to injured areas but also may influence the healing process. Here’s resource on how to apply this stuff.

Night Splints & Socks

For anyone interested in a more medieval approach to PF, you may enjoy the night splint. Similar to the night splint is this specialized sock. Both items are designed to provide a prolonged stretch to the plantar fascia and Achilles tendon while you sleep. I recently spoke to an employee at a local running shoe store and she said these things are fairly uncomfortable. Still, several posts I’ve read on various forums proclaim these things as useful.

Other methods

This guy swears by walking on gravel in his sock feet. I think it must be the same principle as using a golf ball to break up the scar tissue associated with PF. Other sources suggest freezing a can of coke and rolling it underneath the foot. Here’s an example of a specific plantar fascia stretch from which some folks have had success.

I would suggest staying away from cortisone injections. Cortisone is a powerful steroid that can provide very quick relief from PF pain. The big drawbacks are 1) it’s a symptom treatment; it doesn’t fix anything, and 2) too much cortisone weakens connective tissue thus creating a risk of a rupture.

Nor can I see much benefit to plantar fascia release surgery. This again doesn’t solve a problem but may create more problems. Part of this surgery includes cutting the plantar fascia in order to release tension. Problem is the plantar fascia is a major shock absorbing part of the body. Altering that structure doesn’t seem wise to me.

My Strategy:

As I’ve thought about my own PF, I realize a couple of things: 1) I changed my gait and therefore changed how my tissues were being stressed. 2) I simply didn’t give myself enough time to adapt to this change. 3) I believe my PF is part of a larger puzzle involving faulty movement patterns. Here’s my plan.

Rest

The one common theme I’ve seen and heard from those who’ve overcome PF is that rest is necessary. Damaged tissues must be allowed to heal. Therefore, I’ve greatly reduced my running and biking. There seems to be no way around it.

Joint Mobility

If, as I believe, I have faulty biomechanics (i.e. I don’t move well) then no matter how much I rest and treat my injury, I can expect it and/or other similar symptoms to return once I start running again. Thus I must search out those resources that will help correct my movement problems. Z-Health is my chosen rehab system. Why Z-Health? Because the Z-Health methodology recognizes that there is probably more to my PF than simply heel pain. My whole body–especially my nervous system–must be addressed in order to move better.

Z-Health has helped tremendously with my back and shoulder pain, and I’ve seen numerous others improve their performance through Z-Health. I’m a certified Z-Health trainer but I recognize that I can’t solve all my problems on my own. Twice recently I’ve visited with certified Z-Health practitioner Brian Copeland of Core Fitness in Aurora, CO. I’ve been very impressed with my results thus far–especially after yesterday. We did further testing on my neurological system and found that certain fundamental aspects of my movement coordination aren’t functioning quite correctly. Among several exercises, we recently implemented cross-crawl patterns into my process. All I can say is I’m stunned at how much better my heel feels! In 24 hours the pain has subsided very significantly. I believe correcting my movement patterns is the most significant and most complex part of my plan.

Structural Integration

I haven’t experimented much with massage though I’m aware of its role in many athletes’ lives. Structural integration (Rolfing is a type of SI) involves manipulating connective tissue including the fascia. In this way, my body should interact better with gravity. Posture should improve, pain should diminish and I should move better. Donielle Saxton is the Denver-area massage therapist with whom I’ll be working. The details and principles behind this process is really fascinating. For further information check out Anatomy Trains and KMI (Kinesis Myofascial Integration).

Cold Laser

Finally, I’m getting a bit of cold laser therapy at Mederi Health in Denver. This is pure symptom treatment–and I’m OK with that. Reducing the pain should help calm my nervous system and speed my return to normal function.

Shoe Insert and Taping

I recognize that my arch may need some help. Therefore I’m going to bolster the area by way of a grocery store-bought arch support and Kinesio tape.

We shall see what happens.

Ouch...

Here is a major drag in my life. I’ve run into injuries off an on over the past few years. Just as I get healthy a new one seems to crop up: back pain, shoulder pain, Achilles tendon pain… The latest and greatest issue is heel pain aka plantar fasciitis. (I’m going to call it PF.)

Minor symptoms showed up a few months ago but they sort of came and went. Pain on the outside of my heel wasn’t severe and it faded out rapidly. (I associated plantar fasciitis with pain along the inside of the arch of the foot.) I’d been running some and biking a lot. I’d changed my gait and I was running a good bit in my Vibrams–and I was feeling really good!! (Interestingly, my new gait pattern had helped my Achilles tendon pain. Seems I shifted the stress elsewhere.)

I’ve read up on the issue. What have I found? It seems that one person’s PF is very different from another’s PF. Some runners insist that once they went barefoot, their PF went away. Other runners swear by the opposite end of the spectrum and that orthotics were the cure. Still many many other runners have tried many different treatments but with limited success. Some people suffer with PF for a few weeks or months. Others deal with it for a decade. Much of PF is a big mystery. What’s important here?

Causes of plantar fasciitis:

This is hard to figure out. Like most things involving bodily pain, there’s likely more than one cause. “Improper footwear” is one culprit. Biomechanical glitches such as leg-length discrepancy or tight calves also get blamed, as do high arches, low arches, leg length discrepancy, poor glute firing patterns, tight illiotibital bands. Some sources suggest that PF is due to trigger points, or knots in the muscles. There are many potential culprits for this crime, and most likely some of them are working together.

(I’ll go a little further and suggest that all these issues have causes. If we’re not asking WHY the arches/glutes/IT bands/trigger points are tight/slack/dysfunctional then we’re definitely not getting to the true cause(s) of PF.)

Improper footwear is an interesting issue. Much of the conventional wisdom says we should run in well cushioned shoes that fit our foot type, support our arches and guide our feet properly. Funny thing is military studies such as those discussed in the previous post show that footwear matched to foot type does nothing to decrease running related injuries. Ask barefoot runners and they’ll tell you that any footwear is improper footwear. So what is improper footwear? Seems it’s dependent on the eye of the beholder.

Treatment of Plantar Fasciitis:

Conventional treatment includes rest, ice, anti-inflamatory medication. Orthotics are often prescribed as are calf and foot stretches. Further pharmacological treatment may include a steroid shot. That’s the conventional stuff. What else is there? Well, there are a multitude of therapies and strategies. As I mentioned, it seems that every case of PF is different from every other case. Therefore there are many variations on treatments.

Massage

Rolling a golf ball, lacrosse ball or similar ball along the bottom of the foot helps many PF victims. This is supposed to help break up scar tissue and keep the plantar fascia supple. A similar strategy involves using a foam roller to massage the calf, hamstring, illiotibial (IT) band, glutes, etc. These are forms of self-massage. More formalized massage methods may proove beneficial. Myofascial release, Active Release Therapy (ART), deep tissue massage, trigger point therapy, Structural Integration (aka Rolfing) are examples of massage-type techniques that may prove beneficial in addressing PF.

Shoes

Lots of options here! From barefoot to orthotics and all points in between, what you put on your feet (or possibly take off of your feet) may strongly influence PF. This series of posts on the Runner’s World Forum encapsulates the issue very well. One poster emphasizes wearing orthotics ALL THE TIME, while another poster says, “I think the thing that finally was a breakthrough for me was walking barefoot in the sand.” I’ve found very similar statements throughout my reading. So while there doesn’t seem to be any one shoe-based solution for everyone, consider the idea of changing footwear.

Orthotics are usually expensive. Cheaper options include grocery-store bought arch supports and heel cups. Superfeet and Sole Supports are similar to orthotics but also less expensive.

Joint Mobility/Strengthening

Weakness of the foot muscles may be causing your PF. Therefore, strengthening the foot and lower leg and improving mobility/stability is vital. We may not spend much time thinking about strong feet but hey, we only have to use them all the time every single day right? Maybe it’s actually important! I look to Z-Health R-Phase and I-Phase drills to enhance neural communication and awareness in feet and lower legs. I’ll give some examples.

Start by simply moving the foot and ankle in all available directions. Make circles with your feet. Turn the sole in and out. Flex and extend the toes along with the rest of the foot (make foot waves). Ball-of-foot circles, toe pulls, and knee circles may help as well. You must concentrate and try to make the movements as smooth and refined as possible. Stay relaxed and breathe. Single-leg balance drills may be beneficial too.

My personal opinion is that at some point, barefoot or minimal shoe work should improve foot strength. (Again, some people insist this is the key to their overcoming PF.) It may be too much though if your foot is injured. The plantar fascia may be further damaged if you overload the region. So it may be a progression similar to adding weight to a strength program or mileage to a running program. Start with a small amount of barefoot balance work while still wearing whatever supportive footwear you’ve got. You may gradually add in more barefoot work if the pain decreases. Back off if the pain increases.

Ultrasound, Cold Laser, Shockwave Therapies

Physical therapists and chiropractors often use ultrasound therapy on soft-tissue injuries. The idea is to bring heat to the area and facilitate healing. Research is mixed on effectiveness.

Cold laser therapy is a somewhat new therapy that may aid healing of PF. The evidence is unclear though. Research continues as to what wattage laser is ideal, what wavelength should be used, and how often one should receive treatment. A Runner’s World article profiles one runner’s positive experience with laser therapy.

Extracorporeal shockwave is yet another electromagnetic method of addressing soft-tissue injuries. Similar to ultrasound and cold laser, research is mixed, which shouldn’t be surprising. If we’re dealing with a problem that may have multiple and varied causes it makes sense that one or another type of therapy may or may not be effective. Further, ultrasound, laser and shockwave therapies deal with focused energy. That energy can vary in terms of power and wavelength. An injury may be exposed to varying amounts of energy for varying amounts of time. Thus there are numerous factors that may or may not lead to healing of PF. Lots of choices….

I’ll continue this post with a look at night splints, walking on gravel, magical ceremonies and everything else used to drive out the evil spirit that is Plantar Fasciitis (plus my own strategy in overcoming this issue.)

Feldenkrais

I’ve been suffering with back pain and other symptoms (Achilles pain most recently) of something since about 2002. I’ve gone through a lot of types of therapy from physical therapy to chiropractic, to Muscle Activation Techniques to Active Release Therapy, acupuncture, massage, prolotherapy and lots of different corrective exercise protocols. My issue seems to be a movement issue. That is, as I move the sequence of events–muscle contractions, feedback from muscles and joints, etc.–that should be happening aren’t happening in an ideal way. I’ve gotten better especially with my introduction to Z-Health but nothing has quite yet resolved my issues. I’ve been aware of Feldenkrais for a while and it’s been on my list of modalities to investigate. I recently emailed Seattle-area Rolfer and Z-Health practitioner Todd Hargrove (Todd writes an excellent blog) to ask him his opinion and he suggested I search out a Feldenkrais practitioner, so I did. Yesterday was my first experience and it was quite interesting.

I met with local Denver Feldenkrais practitioner Ray Little for two hours and I became quite a bit more aware of how I move–and how I should move. Without any technical terminology or complicated instructions, he helped me feel how to walk properly. The most powerful thing he showed me was where on my foot to feel the impact of walking (right in front of the heel) and then how to effectively push myself forward. We discussed the idea of lengthening into stride, taking the impact of the foot strike and smoothly rebounding into forward motion. All and all it was a very enlightening experience and I very much look forward to meeting with him again next week.

As I’m about to post this, I’ve gone on two runs since Monday and I’ve felt better than I have literally in years. I think I’m back on the horse!!

MRIs & Docs May Not Have All the Answers

We’d like to think that our modern medical technology and treatment methods can diagnose and heal any problem. PET scans, CAT scans, MRIs and X-Rays allow us to peer inside the body and examine tissues and organs. Our MDs and surgeons are the beneficiaries of hundreds of years of evolving medical education. But guess what! Not every ache and pain has an obvious cause and many docs are as mystified by our ailments as we are.

New Study Finds 70 Percent of Able-Bodied Hockey Players Have Abnormal Hip and Pelvis MRIs comes from Science Daily. The piece explains the findings of a study conducted by the American Orthopedic Society for Sports Medicine. The study used the MRIs of the pelvis and hips of 39 collegiate and professional hockey players. Seventy percent of the images showed abnormalities yet only two players reported pain. In other words, most of the players had what we might identify as “injuries” yet only two of them were “hurt.” So this goes to the issue of just how valuable are these sorts of diagnostic tools.

Matthew Silvis, MD, Assistant Professor, Department of Family Medicine and Orthopedics at Hershey Medical Center at Penn State University College of Medicine stated,

“Unexpectedly, the majority of players had some abnormality in their MRI, but it didn’t limit their playing ability. The study raises many questions, but its value to surgeons is to recognize that imaging doesn’t replace good clinical judgment, which includes a detailed history and complete physical exam. This study might make you hesitate to read too much into an MRI.”

A lot of us probably assume the MRI is very precise and can show us exactly why our back, knee or shoulder is in pain. Yet we may need to think about whether or not we’re looking at chickens or eggs here. Do these abnormalities cause pain, or are they simply coincidental to pain?

Obviously the only reason anyone gets an MRI outside of a study like this is because we’re in pain and we need to know why. (I have yet to meet anyone who had an MRI simply out of curiosity about what they look like on the inside.) So automatically we have a self-selected group to study. If this study is any indication then in fact it’s entirely likely that people who feel healthy may indeed appear to be injured according to their MRI. Thus what is seen on an MRI and attributed to our pain–bone spurs, a torn labrum, or a herniated disks for instance–may or may not be the cause of our pain. Perhaps the source of our pain is something else entirely. The point is the MRI is not always as precise as we’d like to believe.

I’ve had personal experience with this sort of situation. Several years ago I was performing a barbell snatch and I felt a pop followed by very sharp pain in my left shoulder. A cortisone shot helped only temporarily. I underwent an MRI and according to the image there was no serious injury. It wasn’t until a surgeon had a look inside my shoulder and saw that my supraspinatus tendon was about 90% detached. After he reattached the tendon he later explained how MRIs can be helpful but they’re not always very precise.

On a simiar theme, a recent New York Times story examines to what degree doctors sought medical attention for their aches and pains. You might be surprised to learn that docs who were interviewed rarely visted other docs when they’re hurting. (The Times story also references the MRI story mentioned above.) Doctor-athlete, Paul D. Thompson, a marathon runner and a cardiologist at Hartford Hospital in Hartford said the following:

“I think most folks should not go, because most general doctors don’t know a lot about running injuries,” he said, adding, “Most docs, often even the good sports docs, then will just tell you to stop running anyway, so the first thing is to stop running yourself.”

So all-and-all, as much as we’d love to believe that the modern mainstream medical profession has all the answers–or at least the tools to find all the answers, it simply ain’t so in a lot of cases. The fact of the matter is most MDs don’t fully understand human movement and how all the parts of the body–bones, muscles, organs, and most importantly the nervous system–act together in a 3-D world governed by gravity. Just look at how many specialists there are around us. There are podiatrists for the feet, spine specialists, knee specialists, shoulder specialists, low-back doctors, etc. There are surgeons that specialize in opening us up and tinkering about. There are docs to analyze blood, the eyes, reproductive organs, the heart, our minds…. But guess what, we’re all one big system! If we or the people who are assessing us believe that we’re just a bunch of separate parts then we’re way off the mark. And if your doc just wants to feed you pain medicine–definitely go get another opinion. (As one acquaintance put it, “Your pain wasn’t caused by an ibuprofen deficiency.”)

(BTW, please don’t take this as my hating on the entire medical profession. If I’m in a car crash and I’ve got a piece of steel stuck in me, please go get me a surgeon and not a massage therapist or chiro.)

Recognize that the arms and neck are highly affected by the feet. Weak eye muscles can cause bad posture and thus neck pain. Medication for our high cholesterol may cause low-back pain. Shoulder pain may be rooted in poor wrist and hand mechanics. Even if the tissue of a years-old injury has healed, the ability to move and control the limb may not have been restored–and that may be causing pain in any number of areas. The bad mood you’re in may be driving that aggravating hip pain.

The body and the nervous system is tremendously complex and all its parts are highly interactive at all times. Always keep this in mind if you’re in pain and looking for relief.

When will this end?!

Anyone who’s experienced chronic pain knows it can be a very mysterious issue. Chronic pain presents very different characteristics and patterns when compared to acute pain such as a skinned knee or a sprained joint. It may start for no clear reason and progress with no clear pattern. A long-ago healed injury may continue to hurt even though the tissue is no longer damaged. Oddly enough even amputees and paraplegics may experience pain emanating from missing or non-working limbs. Chronic pain seems as if it’s driven by a very mysterious force.

The issue of hope–or hopelessness–can be a truly crushing burden in the quest to resolve long-term pain. Typical methods in addressing chronic pain may include drugs (ibuprofin, steroid shots, muscle relaxers), heat, ice, physical therapy, chiropractic adjustments, massage (Active Release Therapy, myofascial release, Rolfing, and others) and acupuncture, and then if none of the above works then we often resort to what certainly must be the final sure cure: surgery. These methods often provide temporary relief at best.

This past weekend I attended the first half of the Z-Health R-Phase certification. Pain and resolving pain was the overarching theme. I learned a tremendous amount about the issue. As many people have observed, pain doesn’t always equal an injury. Pain sometimes feels better with movement: someone with a slightly sore shoulder may feel better as he or she moves the arm around. In contrast, pain often does indicate an injury. If I break my leg and I continue to walk, then the pain will increase with every step.

A key issue we discussed is that the site of pain is rarely the site of the problem. Pain is often a symptom of dysfunction elsewhere in the body (Or sometimes even outside the body. More on that in a moment.) For instance, absent a blow or violent twist of the knee, knee pain is rarely a knee problem. Knee pain is often rooted in hip or foot dysfunction. Similarly, shoulder pain is often rooted in poor spine or hand movement. As the renowned neurologist Karel Lewitt said, “He who treats the site of pain is lost.”

Emotions are often overlooked when we deal with pain. Again we often think of pain as strictly a bodily thing. Still a lot of us have noticed that our pain increases during times of stress. This is an indication that we must consider our mind and our emotions when we’re trying to resolve long-term pain. It may be that our “physical” pain is rooted in the conditions that surround us. In fact what happens in many cases is that the pain itself causes us such distress that it becomes a self-perpetuating situation in which our fear of pain drives only more pain. It’s an enormously complex matter when we start to look inside our head in order to address pain; but if we’re not considering the inside of our skull then we’re probably missing the mark by a long shot.

One of the books Z-Health creator Eric Cobb suggested we read is David Butler’s Explain Pain. Butler is an Australian neurologist who specializes in pain research and treatment. His blog on pain is called Explain Pain. If you’re currently in pain or if you’re in the business of treating pain I highly suggest you look into it. Pain treatment professionals should also look into the Neuro Orthopedic Institute. The NOI site describes their mission as such:

“The nervous system is our prime focus, integrating neuroscience, neurodynamics and manual therapy into patient management. NOI’s core philosophy is to provide progressive, current material, always challenging existing management protocols, to promote professional reinvestment, and to ensure that course participants benefit from the most recent research in a fun way.”

Z-Health Day 1

Yesterday was the first day of the Z-Health R-Phase certification here in Denver and I found it very informative and enjoyable. We learned a tremendous amount about the nervous system and why doing joint mobility drills can relieve pain. (I started the day with some low back pain. We progressed through only a few drills: foot/ankle drills and knee drills. Soon after there was no back pain and I still am pain free this morning as I type this.) It sounds strange I know, but the ways of the body and nervous system are often less than obviously logical.

The class of about 20 students is the most diverse class I’ve seen at any sort of exercise course. In addition to personal trainers there’s a physical therapist and a PT school student in attendance, a yoga instructor, a school teacher, and a nurse. One man is a client of a Z-Health trainer who’s simply been impressed enough by the results that he wants to learn more. One woman has seen her elderly mother go through hip and knee surgeries with poor results. She said she didn’t want to get old in the same fashion.

I don’t want this to sound like some sort of a weird cult thing or blind devotion to some oddball system. Z-Health creator Eric Cobb has drawn on a wide variety of sources in developing the system. Much of what informs Z-Health is neurological research and an understanding of what pain is, how the brain views pain and they myriad ways we can address pain. Cobb urges students and Z-Health trainers to read a lot and learn as much as possible about these issues.

One criticism of Z-Health is that it’s hard to explain. People ask “What is Z-Health?” and those of us who’ve been exposed to it often can’t give as succinct an answer as we wish we could. I think the Z-Health web site should give a better explanation of what Z-Health is and how it works. The course I’m taking is called R-Phase. “R” stands for restore, rehab, and re-educate. There are other phases but R-Phase forms the basis for the other phases. I’ll do my best to give an explanation.

The driving concept is that the nervous system is the key driver of of every facet of the body. Absent an acute injury like a broken bone, cut or dislocation our pain is a movement problem. For example “My knee hurts when I climb stairs,” or “My shoulder hurts when I reach overhead.” Those are movement problems. The nervous system drives movement, not the muscles, not the bones, not connective tissue but the nervous system. Thus is if we want to eliminate pain then we must address the nervous system in order to improve movement. (Interestingly, if any movement pattern is compromised–ankle movement for example–then it may create pain and/or weakness in other regions such as the neck or a shoulder. It’s sort of similar to the way a storm in Seattle may impair air traffic in Miami.) The way we do this is by moving each joint one at a time through its full, pain-free range of motion. We do this very precisely under strict control. In this way we improve the brain’s map of the body (the homunculus). We increase the nervous system’s recognition of these joints and limbs thus we improve movement and control of the body.

That’s the brief, non-technical explanation! I wish I could put it more briefly. Medical and body work professionals may still prefer a more thorough explanation. Z-Health looks somewhat like tai chi. In fact Z-Health draws on martial arts, tai chi and dance for various mobility drills.

For anyone wanting more information I suggest you call the Z-Health offices. The people who work there are very much willing to discuss Z-Health and answer any questions. They’re a very helpful and well informed staff.

Achilles Tendon Issues: Help from Dr. Ivo at Summit Chiropractic

My wife and I just recently enjoyed a long weekend in the mountains full of skiing/snowboarding, sleeping in, and wishing we had a condo near the slopes. Part of that weekend included a visit with Dr. Ivo Waerlop at Summit Chiropractic in Dillon, CO. I went in hopes of 1) getting help with my sore left Achilles tendon that’s been bothering me for months, and 2) get some of his thoughts on barefoot running. The visit was very helpful and enlightening.

Dr. Waerlop was featured in a Denver Post article on barefoot running. My wife looked up his web site and it grabbed my interest. Dr. Waerlop is involved in the biomechanics of cycling, running and skiing (three things I love), and he’s involved in barefoot running. In fact, he’s a biomechanics advisor for Vibram. He’s also an accupunturist.

I won’t go into every detail but his asessment of my gait was very precise and his explanations very thorough. He assessed my feet, legs and trunk; observed my gait; and presecribed several exercises for me plus a sole lift for my shoe.

Most importantly we focused on attending to the causes of my problems (faulty biomechanics in the feet and toes) rather than the symptoms (pain in the Achilles–oh yeah, and my low back and my left shoulder).

He also advised me on barefoot running. I probably won’t ever be a full-on barefooter but I likely will be doing some barefoot running in the near future. (Gotta take it slow!)

There’s more. Dr. Waerlop is part of the Homonculus Group. (What is the homonculus? Excellent question. Click on the word to find out.) This is a group of physicians and sports performance/injury rehab professionals who are “committed and driven to better understand the problems of pain and movement impairment in this world (basically the aches and pains that ail individuals.)” The Homonculus site is rich with podcasts, articles and discussion threads (though it appears their discussion board has received a lot of spam which should be removed. Go to page 1 of the discussion board for legitimate information.) Finally, Dr. Waerlop is one of the Gait Guys whose lectures on gait assessment are found at Youtube.

I am very excited to dig into the articles and podcasts. If you’re a trainer, coach, or injury rehab professional–or if you’re just a fitness geek with some spare time, I highly recommend you investigate some of this material. I can’t get enough of this stuff!!!

Counterpoints to Barefoot Running

I think it’s important to analyze any trend or issue from several viewpoints. In the world of fitness and nutrition we see all sorts of fads come and go. Today barefoot running is gaining in popularity. I’ve posted recently on some of the research that suggests barefoot running may be healthier for the joints than shod running. So, I believe it’s worth considering doing some barefoot work whether it be gym work such as weight training or agility work; or perhaps very short runs on a soft surface such as grass. It may in fact be beneficial to work toward a full transition from shod running to barefoot running. That said, it’s vital to consider other views.

First, the Science of Sport gives us Barefoot running – new evidence, same debate. One notable point the writers make is this:

“I guarantee that the media are going to be all over this and they are going to tell you that you should be running barefoot or in Vibrams. You will hear how science has proven that being barefoot will prevent injuries, and that those of you who are injured should blame your shoes as you lob them into the garbage bin.

(This sort of observation can go for just about every new study that’s reported in the press.) I think it’s entirely likely that runners may latch on to barefoot running thinking that it’s an instant magic cure for whatever is bothering them and the results may be disastrous. (Then what will the press, physical therapists, and podiatrists say? “Barefoot running is the worst thing in the world! No one should do it ever! Then we’ll have discarded a potentially helpful tool from our toolbox.)

The article goes on to give an example of what happens when the pendulum swings too far and runners adopt something very new and very different into their training:

“And I will illustrate this with our own insight into footstrike and injury. When the Pose research was done in Cape Town, athletes basically had their footstrike patterns changed through 2 weeks of training in the new method. The biomechanical analysis found lower impact forces (sound familiar? Same as the Nature paper), and even less work on the knee joint. This was hailed as a breakthrough against running injuries, because lower impact plus lower work on the knee meant less chance of injury. Jump ahead 2 weeks, and 19 out of 20 runners had broken down injured. Why? Because their calves and ankles were murdered by the sudden change. And the science showed this – the work on the ANKLE was significantly INCREASED during the forefoot landing.”

Thus we get the very clear point that barefoot work must be added gradually into your routine. A rapid switch in running technique is probably a very bad idea. DO NOT move rapidly to replace all your shod miles with barefoot miles.

Over at the Running World According to Dean you can read Another Barefoot Running Story. He seems a bit skeptical on the issue of barefoot running. Owen Anderson at Educated Runner has presented two posts on barefoot running: Barefoot, Nearly Barefoot and Bearfoot Running; and Barefoot Running: What the Harvard Study Really Said. Both articles are again somewhat skeptical of barefoot running and running in Vibrams. Anderson’s second post is most valuable I believe in that he points out some of the limitations of the study “Foot Strike Patterns and Collision Forces in Habitually Barefoot versus Shod Runners” that appeared recently in the journal Nature.

Anderson makes this point: “The Nature investigation did disclose some interesting information about the effective mass of the foot and shank (which we won’t discuss here), but it offered no other information about the potential links between barefoot running and either injury or performance.”

He’s correct. This study was not a long term study. The study indeed showed lower impact forces at the ankle, knee and hip during barefoot running when compared to shod running, however the runners were not observed over the long term. Thus we only know what happened during the short duration of the study. This situation is indicative of most barefoot running studies. Nor did the study investigate which method–barefoot or shod–results in the fastest performances.

Further studies should be conduced looking at several points. First, long-term studies should look at injury rates of shod runners compared to barefoot or minimally shod runners. Second, we need to move beyond injury issues and look at racing performance. In other words can we run faster barefoot/minimally shod or in shoes? Third, it might be interesting to see how many people have tried to convert from running shoes to barefoot running but were unsucessful. What happened to these people?

From my point of view, none of these other posts or viewpoints have changed my thinking that some degree of barefoot work is very likely healthy for a fair number of people. It’s not necessary for anyone to permanently discard their running shoes for bare feet, but perhaps it would be valuable to consider taking the shoes off from time to time and letting the feet behave like feet.

News on Barefoot Running: Part III

To this point we’ve looked a couple of aspects of the human foot and running. In Part I we looked at research showing the unshod or minimally shod foot worked quite well at running for the vast majority of human history. In Part II we looked at the following: 1) research linking knee osteoarthritis to high loading forces on the knees, 2) higher loading forces were associated with stability shoes, and 3) lower loading forces were associated with shoes such as flip-flops that allow a more natural foot movement. Thus we can conclude that in order to avoid ailments such as knee osteoarthritis (and I might guess the same for hip, ankle, and low back arthritis) we should do whatever we can to allow our feet to move unencumbered.

[Researchers] concluded that running shoes exerted more stress on these joints compared to running barefoot or walking in high-heeled shoes.

So here are the lastest findings on this issue. Running Shoes May Cause Damage to Hips, Knees and Ankles, New Study Suggests details the findings of a study published in the December 2009 PM & R, the journal of the American Academy of Physical Medicine and Rehabilitation. (Here’s the abstract, and the full text.) Researchers studied 68 healthy adult runners as they ran on a treadmill both in modern running shoes and while barefoot. Significantly higher torque forces were observed in the subjects when they were in running shoes. The study reports “An average 54% increase in the hip internal rotation torque, a 36% increase in knee flexion torque, and a 38% increase in knee varus (inward) torque were measured when running in running shoes compared with barefoot.”

Those are significant forces! And why do most people wear running shoes? To protect the feet, provide stability, to be comfortable… Very interesting that these shoes actually increase the forces which we’re looking to minimize. In closing, the researchers say,

“Reducing joint torques with footwear completely to that of barefoot running, while providing meaningful footwear functions, especially compliance, should be the goal of new footwear designs.”

So with that statement in mind, I’ve recently purchased a pair of Vibram 5-Fingers model KSO. I’ve worn them the past couple of days at work and they’re quite interesting. I plan on wearing them exclusively when I weight train, and I plan on running in them fairly soon. (There’s a little too much snow on the ground here in Denver right now.) I’ll probably try some running on the grass first and then try short runs on pavement. We’ll see what happens…

Denver Fitness Journal

All Things Health and Fitness by Kyle Norman, MS, CSCS, FMS, RRCA Running Coach

Injury Rehabilitation