You might want to think twice before strapping on those traditional clunky sneakers and running around your neighborhood. Every year millions of Americans take up running as a way of getting off the couch and trim the mid-section only to find themselves right back where they started - but this time with back, knee and foot pain!
Learn how incorporating barefoot training prior to your next fitness adventure will have your feet singing a much happier tune.
Passage taken from Barefoot in Boston, by Art Horne
"Looks like mom was right – the cheaper shoes do work just as well, and in fact, might just be safer for you too.
If you are starting to feel like I am picking on traditional shoes and their parent companies well, that is because I am and it is about to get a whole lot worse. In a study conducted by Marti (1989) in which he provided a questionnaire to over 5000 runners of a popular 16-km race, he discovered that expensive shoes accounted for 123% greater injury frequency than the lowest cost models. In fact, the incidence of injury while the subjects were wearing shoes over $95 were twice as high as for those subjects wearing shoes costing less than $40. There may be a number of other factors associated with injury other than just shoe cost but these results included correction for these other influencing factors such as training mileage and history of previous injury! Marti also notes that injuries were not significantly related to race running, speed, training surface, characteristics of running shoes or relative weight. In other words, the fancier the shoe, the more injuries you can expect from them!
So what do “fancy” shoes have that ordinary shoes do not?
The answer may be found in a 2001 study by McKay. Although McKay’s group did not set out to determine the manufacturing differences between lower end and high end shoes, their findings did point to one feature within many athletic shoes that may very well be to blame. In this study researchers sat courtside and watched over 10,000 recreational basketball participants as they played to determine the rate of ankle injury and examine risk factors of ankle injuries in recreational basketball players. Each participant completed a questionnaire which included questions related to: age, sex, height, weight, protective equipment (ankle brace, mouth guard, etc), shoe type (cut low, med, high), age of shoes, whether the participant performed a warm-up prior to playing, and of course questions identifying their injury history.
After analyzing the data, three risk factors emerged: 1. Previous ankle sprain – those athletes with a previous sprain were almost 5 times more likely to sprain again. 2. Players who did not stretch prior to games were 2.6 times more likely to injure their ankles then those that did. 3. Players wearing air cells in the heels were 4.3 times more likely to injure an ankle compared to those with no air cells in their heels."
BSMPG wishes the over 20,000 runners participating in the 2013 Boston Marathon the very best of luck!!
Register for the 2013 BSMPG Summer Seminar - May 17 & 18th
Early Bird Prices end April 15th so run to a computer after finishing the marathon and sign up to enjoy the discounted prices!
I recently attended the BSMPG Summer 2012 conference, and over the course of two days I realised how little I know. I got the opportunity to hear a number of really smart people speak (including Bill Knowles, Craig Liebenson, Dr John DiMuro, Mark Toomey, Art Horne, Dr Pete Viteritti, Keith D’Amelio, Chris Powers, Irving Schrexnayder and Alan Grodin).
It was awesome.
Firstly, a huge thanks to Art Horne and the rest of the people who made the conference possible. Fingers crossed I’ll be able to make the trip across the pond for it next year.
Here’s a snapshot of my notes which I scribbled down throughout the conference.
“Injury is an opportunity to become a better athlete”.
We shouldn’t be talking about return to play, we should be talking about a return to competition.
Are any of your athletes load compromised, or joint compromised?
The return to competitive strategy should be months or years long, not weeks.
“It’s easy to get an athlete back to sport, it’s hard to keep them back”
This past weekend I had the pleasure of heading to Boston for my third Boston Sports Medicine and Performance Group (BSMPG) Summer Seminar. I wasn’t sure how it was going to top last year’s line-up and I can’t say for sure that it did, but it was at least on par. I was able to hear some very informative presentations from Bill Knowles, Craig Liebenson, Sean Skahan, Dan Boothby, Pete Friesen, Boo Schexnayder, Joel Jamieson, Cal Dietz, Chris Powers and Alan Grodin. The following are the three things that I am going to implement into my program at Michigan Tech as soon as I get back to Houghton tomorrow (I am writing this on the plane trip home).
1. Subjective Athlete Monitoring
Joel Jamieson spoke about allostasis and the training process. According to Joel, Allostasis is “the varying integrated adaptive responses taken by the body in order to maintain homeostasis at all times and in all circumstances as necessary to keep the body alive.” We only have a certain amount of energy (called the allostatic reserve) to accomplish these adaptations. Training is obviously one of the stressors that can disrupt homeostasis, causing allostasis to occur. However, if the training is too much in terms of volume, intensity, or both, then that allostatic reserve can be drained and we won’t get the training adaptations that we are looking for.
Therefore, it is essential to monitor the recovery levels of our athletes and quantify their training load to maintain that allostatic reserve and ensure readiness for training. Unfortunately, at Michigan Tech we don’t have the resources for an Omega Wave or even other heart rate variability technology. I also don’t have the time to measure everyone’s vertical jump or grip strength on a regular basis. However we can use subjective measures to tell how an athlete is feeling and how they perceive their training. We will now have the athletes rate on a scale of one to ten on how ready they feel to train that day after the warm-up (it’s best to do it after the warm-up because athletes rarely feel ready before, sometimes I don’t feel fully ready until after the warm-up) and they will rate their perceived difficulty and intensity after the training session. This will allow me to quantify how they are responding to training and make adjustments as needed.
2. Lowering Hurdle Height for Plyometrics
In our second, third and fourth phases of plyometric training we use hurdles to jump over and in the past we have allowed our athletes to bring their knees up, sometimes all the way to their chest in order to clear the hurdle. During Boo Schexnayder’s presentation, he repeatedly discussed the importance of posture while jumping and that the set should be stopped if posture is lost at any point.
The fusion of sports and medicine becomes a more potent mixture each day. Using tools that gauge performance with a high degree of accuracy allows us to quantify our results in almost any fashion imaginable. Tracking minute changes in the body such as heart rate, function, mobility and mechanics provides us information on our athletes that we can rely on to develop customized programs for each athlete. Real-time reporting functions provided by today’s latest technology make it simple and efficient to make evidenced based decisions in any setting.
Doctors, physicians and trainers are all working closely with one another to bring the most comprehensive care an athlete can hope for. Student athletes are among the top demographic to benefit from this union of sports and medicine where coaches and trainers regularly evaluate hundreds of students regularly. Coordinated care breeches team practices in addition to advising on lifestyle choices and curriculum.
Outside of institutions, merging is evident in private facilities where athletic development is the number one priority. Through the eyes of Dr. Thomas Lam, Director of Athletic Development at FITS Toronto, an environment focused on sports-science and coordinated care is a premier destination for training and therapy. Located in the hub of Canada, Dr. Lam’s two Toronto locations service every level of athlete, each equipped with a sports science lab. Tracking manipulations to the nervous system by evaluating the results in through changes to the biomechanical system, Evan Chait of Kinetic PT brings his discussion to OptoSource’s Fusion Track workshop.
For attendees of the Boston Sports Medicine & Performance Group, the Fusion Track will be the ideal chance to learn about incorporating data collection into sports performance planning and get a look at the best tools for managing all of the streams of information sports performance programs rely on today.
Speakers for this presentation include:
Dr. Thomas Lam of FITS Toronto on integrating objective analysis into an existing sports performance and medicine program.
Evan Chait of Kinetic PT will discuss The Chait Neuropathic Release Technique (CNRT), a multidisciplinary diagnostic and treatment process that focuses on 3 tiers of health. The 3 Tiers include the nervous system, biomechanical system, and the movement pattern system.
What to expect:
Using the cloud to safely and efficiently manage data.
Incorporating multiple streams of objective analysis into existing programs.
Tracking and trending change for coordinating care.
Take a sneak peek into Bruce Williams' presentation, New Concepts in Foot Function & Gait Analysis Assessments & Treatments, at the 2012 BSMPG Summer Seminar.
Space is still available - Register today before the last seats are gone!
Most athletes and coaches think podiatrist means someone who makes orthotics, could you dispel that myth and talk about the holistic approach with foot care and how you even work with injuries in the low back? Many don't understand your profession deals with biomechanics, surgery, and even manual therapy.
Podiatry is a very interesting profession. Surgery is really the highlight of what Podiatrists do and are trained to do at the present time. All Podiatrists receive about a year of biomechanics while in school. They are all trained to cast for orthotics and write prescriptions as well. Some podiatrists utilize manual therapy in their practice, but probably less than 5%.
In my practice I figured out very quickly my orthotic outcomes were not what I wanted them to be. I set out to understand how I could do a better job for my patients and that lead me down a very interesting path of self- education. I found a mentor to assist me in the use of in-shoe pressure and video capture technology. He also happened to expose me to the use of manual therapy in the foot and ankle. The use of the technology and the therapy really opened my eyes to what I was missing in practice. The use of the quantitative data from the in-shoe pressure really exposed me to the way the foot will function and react to a shoe and to an OTC or custom foot orthosis. This has helped me to realize my limitations in practice while also allowing me to move past most of my peers in the understanding of the foot’s importance in walking, and athletic gait.
Most of my sports medicine podiatry peers are great collaborators with physical therapists, strength and conditioning coaches, athletic trainers and massage therapists. We all realize that we are just a piece of the puzzle in the process of enabling our athletes to compete at their highest levels.
Barefoot training and minimalist shoes seem all the rage right now, can you share some objective pros and cons to what athletes may benefit and risk wise when diving into this territory?
Barefoot is the thing right now, just as toning / rocker bottom shoes were a few years back. In moderation and in certain specific situations I see benefit for patients and athletes from both types of shoes. The biggest problem I have with the minimalist / barefoot shoe debate is that there is very little proof that doing workouts barefoot will have the amazing results that so many people say they have had.
I use a lot of technology to quantitate my outcomes, good or bad. I would appreciate it if others would utilize similar technology to do the same. Enthusiasm is wonderful, but there is a need to realize when something is not working the way we hoped it would and realize a different take is needed to get a successful outcome. I have seen a lot of people chasing rainbows the last few years and it confuses me. I appreciate the capacity of strength and conditioning to improve outcomes for athletes, but, there are limitations to what can be achieved and maintained. I see the limitations daily with what I do and I try to refer to P.T. and strength coaches to assist my patients and athletes to achieve an overall better outcome.
I am regularly amazed that so many in the sports industry seem very anti-foot. I’m not really sure why this is, but my suspicion is that every podiatrist and many P.T.’s will put patients and athletes in an orthotic and often they do not work. Podiatrists are very bad about this and often don’t have a specific reasoning or a plan for why they chose to use their devices. I have a very specific reasoning pattern and evaluation process for doing what I do for my patients. I really try to have a method to my madness. I have a very good success rate, but not perfect by any means. I am always looking for a new way to improve my outcomes whether it is through a new modification to a device, a new mobilization technique or through partnering with a better team of sports minded individuals so that we can all work together to benefit our athletes.
When the foot hits the ground a complex reaction of joints, muscles, and neurological responses happen. Could you share your approach with both technology and experience when working with athletes?
I use F-Scan in-shoe pressure and Dartfish as well as another older video capture technology. I am starting to experiment with wireless emg and a nodular motion capture technology. In-shoe pressure can give you a tremendous amount of insight into how an athlete’s foot and lower extremity functions. There are however limitations to what the data can indicate. This is why I use video capture and why I’m experimenting with the nodular motion capture. It is important to know what the position of the hips, knees and lower extremity in general are doing for each step. Relating this to the trunk position can give you insight as well. Once you have enough gait data from the trunk on down, then you can really start to incorporate a plan for the athlete from the ground up. As you track going forward you should see what is working and what is not.
Wearable technology is being used now and will be utilized even more in the near future. It is important to start to work with this technology or to partner with those who do use it regularly. There are great benefits to quantifying evaluations and using wearable tech to validate plans of interventions is going to become the gold standard as we move forward.
You are familiar with different screens such as the FMS and traditional orthopedic assessments. Could you share your perspective on how some additional information from your methodology can help athletes reduce injuries?
FMS is a great screening tool and can give you quite a bit of information to help practitioners to formulate a plan for an athlete’s rehab or for their regular conditioning.
I have a basic screening tool that can assist or expand on the FMS as far as for evaluating the foot, ankle and lower extremity. If you can gain a better understanding of how the foot is structured and functions then you can start to get a much better understanding of how your interventional plans will work and whether you can expect realistic improvement.
I like to use a basic scale to discern the structure and stiffness of the foot along the medial and lateral columns. It is good to know the standing heel position of the foot, if there is any limb length difference left to right, and also the available range of motion of the big toe joints and the ankle joint. Just having these few basic points of information can start to give insight to why an athlete may be prone to stress fractures of the metatarsals, chronic ankle sprains, and even if they may be prone to knee injuries. Adding ranges of motion of the hips, and knees in static and walking gait can multiply your available knowledge base even more.
There are reasons and patterns for why some athletes get injured and why some do not. Quantifying as much of the structural components of the foot and lower extremity function is the best way to start to identify those patterns.
But for all the things and subject matter they disagree about, there is one thing that every coach certainly would agree on.
It's not sets or reps.
It's not the use of Olympic lifts, or periodization method, or even conditioning protocols.
The one thing that all coaches agree on is the struggle to program and plan for large number numbers of athletes in a consistent and easy manner.
It's the one thing that ALL strength coaches would agree upon.
And now, thanks to Cal Dietz and XL Athlete, coaches can spend more time on the floor coaching and less time plugging numbers into excel files or adjusting programs because of an athlete's injury or because a sport coach changed training times.
Click HERE to learn more about the XL Strength Program Developer.
See Cal Dietz along with more of the nation's top hockey strength coaches and keynote speakers including Craig Liebenson and Chris Powers at the 2012 BSMPG Summer Seminar this May 19th and 20th.
See Highlights from Coach Dietz's talk at the 2011 BSMPG summer seminar below.
In a follow up from a previous post (Up The Chain It Goes), additional evidence supporting the relationship within the kinetic chain has emerged from south of the equator. In a study out of South Africa examining the link between available dorsiflexion and mechanical low back pain researchers found a statistically significant decrease in ankle dorsiflexion ROM and associated reporting of low back pain (Brantingham, 2006). With the vast majority of adults suffering from low back pain at some time in their life, (some reports are up to 85%) and 80% of people reporting foot problems during their lifespan, it’s not a surprise to see that these two conditions may very well be related.
Let’s take a closer look:
Methods: “ The study was a blinded, 2-arm, non-randomized clinical study involving 100 subjects with chronic or recurrent mechanical low back pain (intervention group) and 104 subjects without chronic mechanical low back pain (control group) between the ages of 18 and 45. A blind assessor performed weight-bearing goniometry of the ankle and big toe and the navicular drop test on all subjects in both groups.”
Results: “An independent t-test (inter-group) revealed a statistically significant decrease in ankle dorsiflexion range of motion in individuals with chronic mechanical low back pain.”
Conclusions: “This study’s data found that a statistically significant decrease in ankle dorsiflexion ROM, but not flatter feet, was associated with subject report of chronic mechanical low back pain disorders.”
Discussion: “The findings of this blinded study support previous reports suggesting that decreased ankle dorsiflexion may be a factor in chronic mechanical low-back pain. There was no clear association found between decreased hallux ROM and mechanical low back pain in this study. If these findings are confirmed through additional studies, exercise and manipulation therapy to increase ankle range of motion could become an important consideration in the treatment of some patients with mechanical low back pain disorders.”
Hmmm, if only we had some additional studies….
Perhaps this will help.
During a routine exit physical, 60 division one athletes were assessed for available weight bearing dorsiflexion bilaterally as described by Bennell et al in 1998 (inclinometer was replace by Clinometer app for ITouch) to examine limitations in this movement. Ten athletes with limited weight bearing dorsiflexion (less than 4 inches from knee to wall) volunteered for follow up evaluation and manual treatment. Out of the initial 120 measured ankles, 47 ankles (21 right, 26 left) demonstrated limited weight bearing dorsiflexion range of motion.
Athletes were then asked to walk normally in their athletic shoes while wearing an in-shoe pressure sensor (Tekscan) and through an optical measurement system (Optojump). Each athlete then underwent a general manual therapy intervention aimed to improve ankle dorsiflexion, followed again by the same gait analysis and pressure mapping data capture.
Gait Cliff Notes: optimal gait should have two mountains with a trough between them. The first mountain represents heel strike to midstance, the trough representing the mid-stance phase, and the second mountain being propulsion from full foot contact to toe-off.
Easy right? Good.
Note: The second mountain should almost always be higher than the first.
Case Study 1:
Notice how the first mountain is slightly higher than the second – this is BAD!
Remember from our cliff notes: the second mountain should be higher.
Notice change in toe off from pre- to post-treatment which specifically targeted patient's limited dorsiflexion? The second mountain is now higher than the first. That’s a GOOD thing!
Better yet – athlete was measured 3 days post treatment and improvement in Dorsiflexion range of motion stuck! Try doing that with a slant board stretch.
Bennell KL, Talbot RC, Wajswelner H, Techovanich W, Kelly DH and Hall AJ. Intra-rater and inter-rater reliability of a weight-bearing lunge measure of ankle dorsiflexion. Australian Journal of Physiotherapy. 44;175-180.
Brantingham JW, Gilbert JL, Shaik J, Globe G. Sagittal plane blockage of the foot, ankle and hallux and foot alignment-prevalence and association with low back pain. J of Chiropractic Medicine. 2006; 4(5); 123-127.
“The residents who live here, according to the parable, began noticing increasing numbers of drowning people caught in the river’s swift current and so went to work inventing ever more elaborate technologies to resuscitate them. So preoccupied were these heroic villagers with rescue and treatment that they never thought to look UPSTREAM to see who was pushing the victims in.”
Learn what is hurting your feet and your performance, and how to finally train your feet the way they were meant to be.