Boston Sports Medicine and Performance Group, LLC Blog

Are Your Feet Ready? The Boston Marathon Is Back

Posted by Boston Sports Medicine and Performance Group on Fri, Apr 12, 2013 @ 08:04 AM

Are your feet ready for running this summer?

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.

 

Barefoot in Boston Barefoot in Boston

 

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!!

 

athletic training

 

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!

 

Register for the 2013 BSMPG  Summer Seminar Today

Topics: acute pain, boston marathon, Christopher McDougall, Marathon Monday, BSMPG Summer Seminar, Chris Powers, achilles pain, barefoot training

The Plantar Fascia - Look Beyond The Point of Pain

Posted by Boston Sports Medicine and Performance Group on Mon, Dec 17, 2012 @ 09:12 AM

 

Plantar Fascia PainBSMPG Summer Seminar

 

"The plantar fascia, essentially a continuation of the Achilles tendon, attaches from the base of the calcaneus, covers the bottom of the foot, and inserts into all five digits of the foot. This band acts as both a support of the underlying muscles, thereby assisting stabilization of the foot, and a shock absorber for the body.  It has been referred to as a prime stabilizer in that it helps prevent collapsing of the mid-foot during the midstance phase of gait as the person's body weight passes over the supporting structure of the foot. Through its connections to the Achilles tendon, gastrocnemius, hamstring complex, sacrotuberous ligaments, erector spinea, and epicranial fascia, the plantar fascia has essentially direct communication with the entire body.  Inhibition of the intrinsic foot musculature can often lead to losses of structural integrity within the plantar fascia, which contributes to increased pronatroy stresses at the hip, knee, and ankle/foot complexes, and resultant stabilization issues of the lumbopelvic region. Likewise, poor proximal control of the Thoracopelvic Canister and/or lower extremity pronation tends to overload the plantar fascia, creating many of the common lower extremity compartment and overuse syndromes."

pg. 43

Corrective Exercise Solutions to Common Hip and Shoulder Dysfunction by Evan Osar

 

Give the gift of health and wellness from BSMPG this holiday season - Choose stocking stuffers such as a previous conference DVD or Barefoot in Boston, the book that has people thinking twice about todays modern shoes!  

Looking for a larger present to give? Try giving the gift of registration to the 2013 BSMPG Summer Seminar featuring the world's top Sports Medicine and Performance Training professionals including Dr. Stuart McGill.  Discounted rates appy until December 31st!

 

Register for the 2013 BSMPG  Summer Seminar Today

 


Topics: BSMPG Summer Seminar, achilles pain

Up the Chain it Goes...

Posted by Boston Sports Medicine and Performance Group on Sun, Apr 29, 2012 @ 15:04 PM

By Art Horne

 

 

derrick rose torn acl

 

 

With recent season ending ACL injuries to New York Knicks Iman Shumpert, and Chicago Bull’s point guard Derrick Rose coming on the same day, (not to mention Eric Maynor from the Thunder and Spanish Star Ricky Rubio earlier this season) discussion has arisen as to how these terrible injuries could have been avoided.  Although the possible contributing factors are endless, ranging from previous injury to simply fatigue, one area worth shedding more light on, especially in the case of young Rose, is the implication of the kinetic chain as a whole.

Let’s start at the ground and work our way up.

I think we’d all agree that the big toe is a big deal.   But how closely are we looking at this “pivotal” body-ground juncture?

In a study by Munuera et al, researchers found that “Hallux interphalangeal joint dorsiflexion was greater in feet with hallux limitus than in normal feet.  There was a strong inverse correlation between first metatarsophalangeal joint dorsiflexion and hallux interphalangeal joint dorsiflexion.” (Munuera et al, 2012). 

TRANSLATION: People with abnormally stiff or limited motion at the great toe had excessive motion at the joint just distal.

If you don’t have mobility where you need it, you’ll surely get it somewhere else.

Let’s move up the chain shall we?

In a study by Van Gheluwe and his group,  researchers looked at how a stiff or limited great toe joint changes the way we walk.  In their study, “two populations of 19 subjects each, one with hallux limitus and the other free of functional abnormalities, were asked to walk at their preferred speed while plantar foot pressures were recorded along with three-dimensional foot kinematics.  The presence of hallux limitus, structural or functional, caused peak plantar pressure under the hallux to build up significantly more and at a faster rate than under the first metatarsal head.  Additional discriminators for hallux limitus were peak dorsiflexion of the first metatarsophalangeal joint, time to this peak value, peak pressure ratios of the first metatarsal head and the more lateral metatarsal heads, and time to maximal pressure under the fourth and fifth metatarsal heads.  Finally, in approximately 20% of the subjects, with and without hallux limitus, midtarsal pronation occurred after heel lift, validating the claim that retrograde midtarsal pronation does occur.”

TRANSLATION: if you have a limited motion in your great toe, pressure changes will occur – increase pressure changes will cause pain over time (think blister on your foot).

And pain changes the way we move – period.

Let’s take a look at the ankle.

In an article  by Denegar et al, the authors outline the importance of regaining normal talocrural joint arthrokinematics following an ankle injury.   The authors note,

 “All of the athletes we studied had completed a rehabilitation program as directed by their physician under the supervision of a certified athletic trainer, and had returned to sports participation.  Furthermore, all had performed some form of heel-cord stretching. None, however, had received joint mobilization of the talocrural complex.  Despite the return to sports and evidence of restoration in dorsiflexion range of motion, there was restriction of posterior talar mobility in most of the injured ankles.  Posterior talar mobilization shortens the time required to restore dorsiflexion range and a normal gait.  Without proper talar mobilization, dorsiflexion range of motion may be restored through excessive stretching of the plantar flexors, excessive motion at surrounding joints, or forced to occur through an abnormal axis of rotation at the talocrural joint.” (pg. 172)

TRANSLATION: I repeat, Without proper talar mobilization, dorsiflexion range of motion may be restored through excessive stretching of the plantar flexors, excessive motion at surrounding joints, or forced to occur through an abnormal axis of rotation at the talocrural joint.” (pg. 172)

If you don’t have normal ankle motion, and specifically at the talus, your ankle motion (although appearing normal) is probably coming from other joints and/or in a combination with foot pronation.

 

Foot Pronation = Tibial Internal Rotation

Tibial Internal Rotation = Femoral Internal Rotation

Tibia and Femur Internal Rotation  =  Knee Valgus (or knee collapse)

Knee Valgus = BAD

 

But just because you have some extra motion doesn’t mean you’re doomed right?

No.

But, excessive motion without the ability to control that motion certainly does.  So where does knee control come from? The Hip!

But hip strength, control, and neuromuscular timing is seldom appreciated, and in the case of the basketball athlete it is certainly poorly measured, especially after ankle injury.

In a study by Bullock-Saxton, researchers investigated muscle activation during hip extension after ankle sprain and showed a changes in timing of muscle activation in the ankle sprain grouped compared to the non-injured group.

 “the results highlight the importance of the clinician’s paying attention to function of muscles around the joints separated from the site of injury.  Significant delay of entry of the gluteus maximus muscle into the hip extension pattern is of special concern, as it has been proposed by Janda that the early activation of this muscle provides appropriate stability to the pelvis in such functional activities as gait.” (pg. 333)

 

In another study examining ipsilateral hip strength/weakness after the classic ankle sprain, researchers demonstrated that subjects with unilateral chronic ankle sprains had weaker hip abduction strength and less plantar flexion range of motion on the involved sides (Friel et al., 2006)

“Our findings of weaker hip abductors in the involved limb of people with chronic ankle sprains supports this view of a potential chronic loss of stability throughout the kinetic chain or compensations by the involved limb, thus contributing to repeat injury at the ankle.” (pg. 76)


“If the firing, recruitment, and strength of the hip abductor muscles in people with ankle sprains have been altered because of the distal injury, the frontal-plane stability normally supplied by this muscle is lacking, and the risk for repeat injury increases.  Weak hip abductors are unable to counteract the lateral sway, and an injury to the ankle may ensue.”

TRANSLATION: Ankle sprains cause neuromuscular changes up the chain and specifically in the hip.  If this weakness is not addressed after an ankle injury,” frontal-plane stability normally supplied by this muscle is lacking.” 

 

Lack of frontal-plane stability + Knee Valgus = Injury

 

Of course suggesting that the above points are exactly the reason for which Rose suffered his injury is certainly a stretch and not the intention of this post, nor is it to question the treatment that he or any other NBA player received prior to their devastating injury (for the record, the Chicago Bulls Sports Medicine and Strength Staff are regarded as one of the very best in the league).  What I am suggesting however is that examining athletes and patients with the use of advanced technology to determine a state of readiness to participate, and/or examine more closely changes in gait and neuromuscular firing is certainly worth pursuing, especially in light of the ever-rising salaries within professional sports.  A quick look is certainly worth the small investment.

One thing is for sure, ACL injury is not limited to teenage females or only seen on the soccer pitch.

 

Previous Posts:

The NBA Should Have Learned From The NFL - Injuries On The Rise

Did The NBA Lock-out Ultimately End Chauncey Billups' Career?

 

See lectures directly related to gait, injury prevention, and performance at the 2012 BSMPG Summer Seminar:

1. Dr. Bruce Williams: Hit the ground running: Appreciating the importance of foot strike in NBA injuries

2. Dr. Bruce Williams: Breakout Session: Restoring Gait with evidence based medicine

3. Art Horne and Dr. Pete Viteritti: Improving Health & Performance - Restoring ankle dorsiflexion utilizing a manual therapy approach

4. Dr. Tim Morgan: Biomechanics and Theories of Human Gait: Therpeutic and Training Considerations

5. Jose Fernandez: Advanced Player Monitoring for Injury Reduction

 

 

See the most advanced player monitoring equipment currently available at the 2012 BSMPG Summer Seminar:

 

 zeo affectiva  ithlete

BioSensics  Zflo insideTracker

 

Dartfish  freelap timing   Tekscanoptosource

Click me

 

 


References:

Munuera PV, Trujillo P, Guiza L, Guiza I. Hallux Interphalangeal Joint Range of Motion in Feet with and Without Limited First Metatarsophalangeal Joint Dorsiflexion. J Am Podiatr Med Assoc. 102(1): 47-53, 2012.

Denegar, C., Hertel, J., Fonesca, J.  The Effect of Lateral Ankle Sprain on Dorsiflexion Range of Motion, Posterior Talar Glide, and Joint Laxity.  J Orthop Sports Phys Ther. 2002; 32(4):166-173.

 

Van Gheluwe B, Dananberg HJ, Hagman F, Vanstaen K. Effects of Hallux Limitus on Plantar Foot Pressure and Foot Kinematics During Walking. J Am Podiatr Med Assoc. 96(5): 428-436, 2006.

Bullock-Saxton, J. E., Janda, V., & Bullock, M. I. (1994) The Influence of Ankle Sprain Injury on Muscle
Activation during Hip Extension. Int. J. Sports Med. Vol. 15 No. 6, 330-334.

Friel, K., McLean, N., Myers, C., & Caceres, M. (2006). Ipsilateral Hip Abductor Weakness After Inversion
Ankle Sprain. Journal of Athletic Training. Vol. 41 No.1, 74-78

Smith RW, Reischl SF. Treatment of ankle sprains in young athletes. Am J Sports Med. 1986;14:465-471.

Topics: Art Horne, basketball performance, basketball training programs, BSMPG, athletic training conference, Charlie Weingroff, boston hockey conference, barefoot strength training, Andrea Hudy, Bruce Williams, Cal Dietz, Alan Grodin, Barefoot in Boston, Dr. DiMuro, Dan Boothby, Chris Powers, achilles pain, Dorsiflexion, ankle problems

Christopher McDougall talks Running Barefoot and if we were BORN TO RUN

Posted by Boston Sports Medicine and Performance Group on Sun, Apr 15, 2012 @ 07:04 AM

Christopher McDougall Talks Barefoot and Why Humans Were Born to Run

 
 
Are you wondering why your running shoes resemble high heels? Ever think about why your big toe overlaps your second and why your arch really isn’t an arch anymore and resembles more of a pancake? Thinking about baring your sole? Barefoot training has recently become popularized as a potential benefit in injury prevention and rehabilitation programs. It is also purported to serve as an additional means to enhance athletic performance and running economy. However, limited clinical research is currently available to justify this practice and even less information is available describing how one may go about safely implementing a barefoot training program. This book explores the scientific and theoretical benefits concerning the merits of forgoing the modern running shoe for a simpler approach and offers real life solutions to all the obstacles standing between your feet and mother earth. Although it’s true that Americans love their shoes, what you learn about the merits of stuffing your feet and toes into these modern day casts might just have you singing a different tune – a tune your feet will certainly be much happier moving to. Welcome to Barefoot in Boston!
 
 
Enjoy Born to Run author, Christopher McDougall's TED presentation below!
 
 

 

Learn how you too can enjoy the benefits of being barefoot by reading BAREFOOT IN BOSTON, available now in both paperwork and kindle.

barefoot in boston

Topics: athletic training conference, athletic training, Irene Davis, Christopher McDougall, athletic training books, barefoot strength training, achilles pain, barefoot running, barefoot training

Barefoot Invades Boston!

Posted by Boston Sports Medicine and Performance Group on Fri, Apr 13, 2012 @ 19:04 PM

Boston Marathon meet Barefoot in Boston

 

The Barefoot Running Symposium is presented by the New England Barefoot Runners. This symposium is available to the general public at no charge on a first come, first serve basis.

This FREE event occurs during (and is part of) the 1st Annual Boston Barefoot Running Festival. This event showcases well known international speakers who have been studying running biomechanics for years. It includes pioneers of the barefoot running movement who have written books, who have previously shared their experiences through speaking engagements and barefoot running workshops.

Additional speakers are well established barefoot runners with stories of how this change in running has taken them to higher levels.

Boston Public Library
Rabb Lecture Hall
700 Boylston Street
Boston, MA 02216

Saturday, April 14, 2012
1PM – 4PM

 

Click HERE to read more about this exciting event and the speakers that will be there including the leader in Barefoot research - Irene Davis!

Watch Irene Davis lecture in the video below as she describes the challenges with the traditional heel strike during running and how going with less on your feet might just be the answer to your injury woes.

 

 

Not sure if baring your sole is a good idea?  Read BAREFOOT IN BOSTON, and learn how the shoes on your feet are doing more harm than good.

barefoot in boston

 

Topics: Art Horne, boston marathon, Irene Davis, barefoot strength training, Barefoot in Boston, achilles pain, ankle problems, barefoot training

Art Horne Interviews with Joe Heiler on SportsRehabExpert.com

Posted by Boston Sports Medicine and Performance Group on Wed, Sep 7, 2011 @ 07:09 AM

 

sportsrehabexpert

 

Click HERE to listen to this interview.

In this interview, Art discusses his new book, "Barefoot in Boston: A Practical Guide to Achieving Injury Resolution and Enhancing Performance", as well as discussing some research on barefoot walking and training versus wearing shoes, what to look for in minimalist shoes, how he has incorporated barefoot training with his basketball team, and much more..(including how to take a hack saw to a basketball shoe!)

Topics: Basketball Related, Art Horne, BSMPG, functional movement screen, boston marathon, foot pain, foot fracture, barefoot strength training, Barefoot in Boston, achilles pain, barefoot running, barefoot training

Barefoot In Boston now available on Kindle

Posted by Boston Sports Medicine and Performance Group on Wed, Aug 10, 2011 @ 16:08 PM

 

barefoot in boston

You know those fancy, air-filled, arch-cushioned, expensive-as-hell sneakers that you buy to enhance your performance? Well, what if we told you they were most likely not only decreasing your performance, but increasing your likelihood of injury? You would probably call us crazy, but people thought Galileo was crazy once too.  Are we comparing ourselves to Galileo? No, great guy though.  What we are saying is that we are proponents of an idea which is growing in popularity and for some very good reasons.  Barefoot training has recently become popularized as a potential benefit in injury rehabilitation programs. It is also purported to serve as an additional means of injury prevention and to enhance athletic performance.  However, limited clinical research is currently available to justify this practice and even less information is available describing how one may go about safely implementing a barefoot training program.  This book explores the scientific and theoretical benefits concerning the merits of barefoot training and offers real life solutions and alternatives to all the things separating you and your feet from mother earth, including examples of specific programs and training progressions.  By the time you are through with this book, you will be part of the movement and your feet will be on their way to a happier, healthier version of their formerly miserable selves.

Topics: reduce injury risk, foot pain, foot fracture, barefoot strength training, Barefoot in Boston, achilles pain, barefoot running, barefoot training