All About Feet

Anyone who’s read this blog much at all knows I’m way into feet–or I should say I’m way into foot function. Lately I’ve been investigating the diabolical effects of Morton’s Toe. I seem to have a touch of this dysfunction and I think it brought on the major foot pain I had during the trail race I did recently. (And to expand on the issue of injuries, I seem to have had every single running injury known to man. There is an upside. I’ve learned how to defeat these various strange villains of movement.)

Because the feet are so intricate and so extremely important to every single thing we do all the time, I want to present some relevant information on how to fix some potential problems many people may have. So here are some videos from some experts in the field of movement impairment and movement improvement: Dr. Kelly Starrett at MobilityWOD.com and Drs. Shawn Allen and Ivo Waerlop aka the Gait Guys. I’ve found these instructionals to be extremely valuable. If you’re having Achilles issues, plantar fasciitis, knee pain, hip pain–who-knows-what-kind of pain then this information may be very helpful.

Training Update: I’m Running Well.

My training–particularly my running–is improving very nicely. I’m getting faster and I’m able to run without pain far more than I’ve been able to in roughly a decade. I think several factors are at work here:

1) I’m using my glutes: I’ve mentioned recently (here and here) that I’ve learned a tremendous amount of how to use my glutes to both stabilize my knees and propel me forward. This has been a huge bit of progress for me.

2) I’m aware of my arches: I recently stood on a device called a pedobarograph. Quite interesting. It showed me pressure was distributed through my feet as I stood on it. Turns out my arches were a bit collapsed. It wasn’t anything terrible but something worth working on.

I’m an advocate of minimal shoe running so I didn’t want to turn to an orthotic insert. I did a bit of research and found a tremendously helpful article about the three different arches of the feet–not just the one arch most of us think of. The article described where each arch is on the feet and how to move and perceive the arches. Unfortunately, the article and the site it came from seem to have vanished from the universe. I plan to do a video demonstrating where these arches are and how to move them. The video in the next paragraph should be helpful as well.

3) I’m toeing off: Along with using my arches, I’m also focusing on using my big toe to help propel me forward. It’s the last thing I feel on the ground as I drive forward. I’ve realized that in past years I haven’t been doing a very good job of this. This is a complex thing. Here’s a video from the Gait Guys that touches on the muscles and the actions that are responsible for good toe and arch mechanics. (BTW, the Gait Guys put out a lot of detailed info on all things pertaining to gait. They can also be found at Youtube. If you’re having problems with your feet, knees, hips, etc. you may find their information very helpful.)

The video is a bit technical but the long and the short of it informs me that the exercise known as the calf raise or heel raise should benefit me. Specifically the heel raise should help condition the muscles that maintain the arches in my feet (the flexor hallucis brevis, the abductor hallucis, and the tibialis posterior) I’m doing a lot of these daily in the 15-20 rep range. I’m also jumping rope.

4) I’m lighter and stronger: I’m under 200 lbs. for the first time in about 10 years. Less of me always makes running easier. It’s also a big help in mountainbiking. Not only am I lighter but my numbers in the gym are pretty decent being that I’m running and biking a lot. I power cleaned 175 lbs. recently. My squat is around 225 lbs. for 2 reps (I’d really like to get that number up…. some day). My deadlift is about 335 lbs. for 2-3 reps. My pistol squats are improving in terms of range of motion, reps, and technique. Stronger + lighter = better.

5) The FIRST plan is working: I “first” used a Furman Institute of Running and Scientific Training (FIRST) run plan for the Cherry Blossom 10-Miler several years ago. It was the best race I’ve ever run so I figured I’d use the FIRST half-marathon and marathon plan for my two upcoming races.I like these plans because they have me running only three days per week. I’m doing a speed workout on the track, middle distance “tempo” run, and a long run. I’m doing other things on other days of the week, typically lifting and/or cycling or just resting. Three runs per week is quite a bit less running than is advocated by other plans. For an explanation of the plan, have a look at Training Science.com.

6) Beet juice(?): I’ve mentioned the benefits of beet juice. Now, I never attribute one outcome to only one factor, but every time I drink beet juice before a run I feel really good. I go (for me) fast and I’m able to cover (for me) long distances while feeling quite decent.Perhaps this is a nonsensical placebo effect, it’s all in my head and purely psychological. Guess what: Who cares? If I think it makes me a better runner then it’s probably making me a better runner. Hooray for me and my brain. We shall choose to be happy.

Essential Hip Health Drills

I’ve recently mentioned California-based physical therapist Kelly Starrett, and his very interesting blog MobilityWOD.com. (I’m doing his Mobility Course in Denver at the end of April.) One of his posts discusses why sitting is poison for your ability to move. (Also, check out Why sitting all day is slowly killing you for more details on this evil activity.) He’s on to something. Sitting is bad and we need to do something about it.

You sit too much.

By the way, if you’re saying, “But I don’t sit that much,” I have several questions for you:

1) Are you a non-Amish/non-lumberjack American in the modern world? If you say “yes” then you sit too much.

2) Do you own a car? If you say “yes” then you sit too much.

3) Is there a desk and/or a computer involved in your life? Clearly your answer is “yes” because you’re reading this.

4) Are you a cyclist? If it’s “yes” then you sit too much.

5) You sit too much.

Deep posterior hip muscles

Effects of sitting

So what does sitting do to us? First, we get restrictions in a bunch of our muscles and tissues. Particularly we see restrictions in our posterior hip capsule. This type of restriction can contribute to a condition called anterior femoral glide syndrome, which can cause pain at the front of the hip and generally bad movement. Further, the various

muscles in this region can become impaired, tight and weak. Sitting shuts down these muscles and our brain literally forgets how to use these extremely important movers and stabilizers. All of this can result in various aches and pains, poor balance, difficulty sitting and standing, poor running form, poor lifting form–it’s all bad!! What’s the solution?

Mobilize & strengthen

Superficial posterior hip muscles

The best way to address these restrictions is to move. We’ve got to move the tight tissues and we have to re-learn how to operate these muscles that have likely gone dormant. What follows are three drills borrowed and adapted from Shirley Sahrmann and Nick Tumminello.

Simply doing these movements and feeling a stretch in the hip will help loosen tight tissue, but we want to go beyond that. Again, we need to re-learn how to use these muscles and in order to do that you must contract them as you’re doing these drills. Think of adjusting the tension of your glutes in much the same way as you’d adjust the tension of your bicep during a bicep curl. You’ll maintain tension throughout the movement even as the muscle become stretched. You’ll probably

find it difficult to maintain a perceptible contraction as the glute stretch. Work on it. It’s a skill that you should develop in order to overcome pain and perform better. It’ll take practice but the payoff will be tremendous.

Running News

The New York Times Phys-Ed section discusses a recent Harvard study on running form. The study examined injury rates among heel strikers vs forefoot strikers. The subjects were 52 runners on the Harvard cross-country team. Researchers looked at four years worth of data on injured runners. The pertinent finding is this:

“About two-thirds of the group wound up hurt seriously enough each year to miss two or more training days. But the heel strikers were much more prone to injury, with a twofold greater risk than the forefoot strikers. (Emphasis is mine.)”

Be careful though. This finding doesn’t necessarily mean that everyone should immediately change their running form. The article quotes says:

“Does this mean that those of us who habitually heel-strike, as I do, should change our form? “If you’re not getting hurt,” Dr. Daniel Lieberman says, “then absolutely not. If it’s not broke, don’t fix it.”

But, says researcher Adam I. Daoud, who was himself an oft-injured heel-striker during his cross-country racing days, “if you have experienced injury after injury and you’re a heel-striker, it might be worth considering a change.”

For further discussion and analysis on these findings, have a look at Runblogger’s post (and how these findings are being misused in advertising) and the post at Sweat Science. Both of these guys do a great job of telling us what the data does and does not show.

“With it went my belief, naïve in retrospect, that yoga was a source only of healing and never harm.”
– William J Broad, NY Times

If you haven’t read or heard about it, the New York Times recently ran an article titled How Yoga Can Wreck Your Body. It’s far from the perfect article. For one, it’s full of anecdotal evidence. Second, many of the examples given of yoga causing injury consist of people doing rather extreme versions of a pose or movement. I think the article does bring up valid questions: Can yoga cause harm? Is it always safe for everyone?

I’ve had a couple of harsh experiences with yoga. Once I had a teacher that thought since I looked big and strong I could do some sort of headstand. I figured I would follow the teacher’s lead and give it a shot. Without question I was not ready for this pose. I left the class with a very painful shoulder. This instructor had been teaching for years and was very highly sought after at the gym where I worked. I was in another class where an instructor all but insisted that I move deeper into a pose and I simply couldn’t do it. My nervous system was trying to protect me by preventing further movement into this position and she had me trying to force my way into a deeper range of motion. Again, by the end of class, I was in a bit of pain. This is not what I was after.

My observation is that yoga is often championed as a panacea cure-all for any number of ailments: back pain, knee pain, mental stress, possibly even digestive issues. I can’t say everyone says this type of thing but in every gym setting where I’ve worked yoga is discussed and presented in this glowing fashion. But is yoga really any different from any other type of exercise? Might there be a few risks?

First and foremost, yoga is movement. So is running a 100 m sprint. Driving a golf ball is also movement. The power lifts are movements. Typing on a keyboard and watercolor painting? Also movement. Guess what: Movement can cause injury! (By the way, try NOT moving and see how healthy you become.) Further, yoga is a lot of very different movements. One may be quite safe, another quite unsafe. All parts of yoga can’t be viewed fairly as the same thing.

We can probably agree that movement is essentially necessary and usually healthy. We can probably agree that walking is typically safe and healthy. But what if we have a sprained ankle? Or a damaged vestibular system such that we can’t tell which way is up? Then even walking might be quite harmful. Lifting weights is similarly healthy in most cases. If we have a herniated disk or if we use bad technique then lifting may be very unhealthy. Why would we view yoga as any different? If we have poor kinesthetic sense then moving into any number of poses could cause pain and/or injury.

Further, we as Americans often have the view of “If a little bit is good then a BIG WHOLE LOT must be great!” More is better in other words. I’ve heard some yoga people speak proudly of not only how deep they can move into a pose but also how quickly they can move from one pose to another. Sounds a lot like the talk in any weight room. Just substitute weight and reps for poses and depth of motion.

Glenn Black is an experienced yoga teacher who’s interviewed for the Times article. He speaks to other yoga teachers and practitioners on the issue of injuries. He talks about ego. (I think the popular image of yoga is that it is an ego-less type of thing. But what human activity is free of ego?) Black says, “My message was that ‘Asana is not a panacea or a cure-all. In fact, if you do it with ego or obsession, you’ll end up causing problems.’” This seems a very wise statement, and I’m pleased that this article may start to shed light on the idea that yoga should be evaluated the same way as any other type of exercise.

Chronic Pain Lecture at Cherry Creek Athletic Club, Denver

For anyone who’s interested in learning more about chronic pain and how to use the Z-Health Performance System to start overcoming chronic pain, I’m giving two lectures next week at the Cherry Creek Athletic Club in Denver. Both members and non-members are welcome. The lecture is free. Dates and times are:

5:45 pm, Tuesday, December 6th
9:30 am, Thursday, December 8th

This is an interactive lecture so you will be moving around. It’s not a full-on workout by any means but please wear clothing that will allow you to move comfortably.

For more information call the Cherry Creek Club at 303-399-3050 or you may email me at DenverFitnessJournal@Gmail.com.

The pitchers were not injured and had no pain. But the M.R.I.’s found abnormal shoulder cartilage in 90 percent of them and abnormal rotator cuff tendons in 87 percent. “If you want an excuse to operate on a pitcher’s throwing shoulder, just get an M.R.I.,” Dr. James Andrews, sports medicine orthopedist from Gulf Breeze Florida says.

Sports Medicine Said to Overuse M.R.I.s is a very valuable article from the New York Times Health section. It deals with the widespread use and misuse of magnetic resonance imaging (MRI). As you may know, these images can reveal all sorts of interesting information from inside our bodies. Fractures, frayed tendons, fluid around a joint and tumors are just a few things that can we can see via an MRI scan. The thing is, these images don’t always tell us why we’re in pain.

The quote at the top is from a study by Dr. Andrews in which he scanned the shoulders of a bunch of uninjured baseball pitchers. Though they weren’t in pain, nearly all the scans revealed “abnormalities.” The results are similar to a similar study of hockey players in which MRIs showed that 70% of the subjects show “abnormalities” in their hips. The thing is none of the hockey players were injured or in pain.

The Times article discusses the profit motive behind both MRI scans:

“The price, which medical facilities are reluctant to reveal, depends on where the scan is done and what is being scanned. One academic medical center charges $1,721 for an M.R.I. of the knee to look for a torn ligament. The doctor who interprets the scan gets $244. Doctors who own their own M.R.I. machines — and many do — can pocket both fees. Insurers pay less than the charges — an average of $150 to the doctor and $960 to the facility.”

The article goes on to discuss a skier who was prescribed surgery for a torn knee ligament. This prescription was based on an MRI and the tear was confirmed by a second opinion. It was a third opinion and MRI however that showed that the ligament was not torn and surgery was not needed. In this case, the third doctor noticed that the first and second assessments of the torn ligament did not match the symptoms of the man’s injury. It seems the prior opinions relied only on what the MRI showed and not on a carefully considered history of the injury.

The overall message here is that MRIs can give us a lot of information but they may not tell us the whole story. An MRI is not a perfect, magic tool that tells us exactly how to address our pain. It seems the best doctors recognize this and are very careful to order MRIs only when truly needed. Don’t be afraid to get multiple opinions on your injury. If your doctor seems to be relying only on an MRI, keep looking around for more help.

It’s the Cycling Stupid?

Despite what I said in my last post about feeling great, a number of my years-old aches and pains have returned–and it frustrates the hell out of me!! I can spend several weeks feeling great. I can run, lift and bike however much I want and everything feels top-notch. Then the symptoms come back. My left heel and Achilles starts to ache. My left glute feels weak. Parts of my left hamstring often hurt. (Maybe I should amputate my left side?) And I’m right back where I’ve been for way too long. It’s all of these things that have led me to continue to investigate pain, injury, nervous system dysfunction, and how to overcome these issues.

Giving up is not an option!

Cycling-related issues

Bicycling has been one of the constants over the course of my pain. It’s been one activity that I’ve largely been able to do pain free. But now I’m wondering if the bicycling is setting me up for the pain and dysfunction I’ve been experiencing. Beyond that, it may be sitting in general that’s an issue for me.

It’s probably no surprise to you that spending a lot of time on a bike saddle isn’t always the healthiest thing a man can do. Various nerves and blood vessels can be mashed which can result in a variety of problems including erectile dysfunction, numbness, prostate issues. Here’s a decent rundown of potential men’s health issues related to cycling.

Cycling may also have implications beyond that most sensitive of areas. If we look at the hip flexion and extension in cycling vs. hip flexion/extension in running, then we see that that cycling keeps the hips in a very closed type of position. We go from lots of flexion to slightly less flexion as we pedal. We never get full hip extension. Thus we may create glutes that are overly stretched out and weak while simultaneously restricting various other nerves in the low back and pelvis. Add this to the fact that we all wind up sitting a lot during the day no matter how active we are, and you might see how we can quickly create problems in the hips that may filter out to other areas of the body.

Nerve flossing

This is your wiring.

Something else I’ve started recently is a bit of nerve flossing. “What?!” you say? If you look at the chart on right, you’ll notice that the nerves run out from the spinal cord and out through the limbs all the way out to the fingers and toes. Along the way they travel through various passages. As we move our nerves must move too–at least they should move. They should slide back and forth smoothly as we bend, reach, sit, stand, twist, etc. But sometimes these nerves sort of become stuck. As you might guess, nerves are somewhat sensitive. They don’t much like being stuck, squished, pinched or otherwise messed with. We can end up with what’s known as nerve impingement or nerve entrapment. Nerve entrapment can cause pain, numbness, weakness and/or pins-and-needles in any number of places. Someone can have an entrapped nerve for instance in their knee and they may feel symptoms down in the ankle or up in the hip. Fortunately we can mobilize these nerves though and un-stick them. Watch the nerve flossing videos to see how.

(These are drills which we’re taught in Z-Health T-Phase. I haven’t attended T-Phase yet but I’m dying to go. Nerve flossing isn’t exclusive to Z-Health. It comes from the world of neurodynamics. Good resources for neurodynamics are the NOI Group and Neurodynamic Solutions.)

I started doing some of these last week and felt better immediately. I’m doing a lot of them every day and I’m sort of playing around with different angles and different amounts of tension as I do them. My theory is that if I free up the nerves several good things should happen. First, I expect reduced pain right off the bat. Second, I expect better movement as the nerves should conduct impulses from the brain out to my working parts and back again. Better movement should help resolve any deformities in soft or hard tissue. (For more on this concept read about Wolff’s Law and Davis’ Law. These laws describe how tissue remodels along the lines of stress. Further, these laws govern such things such as bone density, arthritis, and callouses. Arthritis is reversible by the way! Don’t let a doctor tell you otherwise.)

So the plan is this: As much as it “pains” me, I’m laying off the bike for several weeks. How long? I’m not sure. It’s the one part of the equation that I really haven’t changed so I need to investigate it. Further, I’m going to continue with the nerve flossing and lots of to see what happens.

Further, my idea is that running is something humans have done since before the start of forever. Bicycling meanwhile is quite a different activity from anything our ancient ancestors did, and it’s a very new activity relative to how long homo sapiens have been on earth. Thus it may be the sort of activity that causes some weird stuff to happen to us–or me specifically. So my hope and my expectation is by reducing the cycling I’ll resolve some of these issues, and this will allow me to run. I will eventually return to cycling and see how I feel. This whole process, should it work, should enhance my cycling ability as well.

Recognition of Chronic Pain as a Disease

If you’re suffering from chronic pain, then understanding how pain works is key to overcoming it. The New York Times has a pertinent article regarding this very strange issue from which so many suffer. Giving Chronic Pain a Medical Platform of Its Own highlights a growing understanding of chronic pain by some medical professionals (and a misunderstanding by many more medical pros). The main points are these:

“Among the important findings in the Institute of Medicine report is that chronic pain often outlasts the original illness or injury, causing changes in the nervous system that worsen over time. Doctors often cannot find an underlying cause because there isn’t one. Chronic pain becomes its own disease.

“When pain becomes chronic, when it becomes persistent even after the tissue and injury have healed, then people are suffering from chronic pain,” Dr. Sean Mackey, chief of pain management at the Stanford School of Medicine said. “We’re finding that there are significant changes in the central nervous system and spinal cord that cause pain to become amplified and persistent even after the injury has gone away.”

We see now that in many many cases, pain DOES NOT equal injury. (If you fall and bang your knee, cut your finger, or touch a hot stove then yes, the pain is quite indicative of an injury. These are acute injuries, not chronic pain issues.) Read the rest of the article for some of the latest ideas on pain science. If you want more excellent information on the very strange subject of pain, check out Body In Mind, a blog by pain researchers based at the The Sansom Institute for Health Research at the University of New South Wales in Australia.

“Runners who continue running when they are exhausted unknowingly change their running form, which could be related to an increased risk for injury.”

Runners get injured. I’m a runner and I’ve been injured–a lot. If you’re a runner then you either have been, are or are going to be injured. According to one source, 60-65% of all runners are injured during an average year (by definition, an ‘injury’ is a physical problem severe enough to force a reduction in training).

If you’ve encountered a running injury then you probably know that it’s rarely a simple solution to fix what ails you. From shoe changes to barefoot running to stretching to foam rolling to foot strengthening exercises, to physical therapy to acupuncture to chiropractic to massage and on and on… This is a huge hassle and it would be wonderful to avoid this kind of aggravation! So with some particle of optimism, I present an article from Science Daily that may help us avoid injury: When to End a Run to Avoid Injury: Runners Change Form When Running Exhausted.

The article discusses a study from Indiana University published in the Journal of Biomechanics in November 2010. Researchers observed that subjects demonstrated biomechanical changes as they fatigued during a run. Runners tended to display excessive motion at the hips, knees and ankles.

The study had subjects run on treadmills until they either reached 85 percent of the subject’s heart rate maximum or a score of 17 (out of 20) on the rating of perceived exertion (RPE). By the end of their runs, all of the runners reported an RPE of at least 15 — studies have shown that RPEs between 13-15 indicate fatigue. Here’s what you need to pay attention to. The article states, “Runners’ RPEs could provide some answers, with RPEs of 15-17 indicating runners’ have reached a point where their mechanics have likely begun to change in an undesirable way.”

The RPE scale is shown below.

What does this mean to you the runner? Don’t run to the point of exhaustion. Stop when you’re feeling good and strong, not when you feel beaten to hunched-over death.

I’m going to go out on a limb and suggest that we might take this advice for any type of exercise: lifting weights, cycling, martial arts–whatever. This isn’t to say we should avoid tough workouts but most of our workouts should be comfortably challenging, not torture. (I’ve mentioned this concept in previous posts; look here and here.)

Facial expressions can be very useful in gauging our exertion levels. When I’m working with clients I watch their faces. When a grimace starts to show we stop the set. The “scary face” is a transmission from one human to the other humans that something isn’t going all that well. (Next time you’re in the gym, have a look around and see how many people have a look on their face like they’re being stabbed. Don’t be that person.) It means we’re butting up against certain physiological limitations. If we spend enough time doing this we’ll likely end up in some type of pain. Heed your body’s warnings and you can stop injuries before they start.

Denver Fitness Journal

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

Injury Rehabilitation