Thursday, November 26, 2015

The Dialogue of a Recovery Log

A patient walks into my office with a problem.  To them it is a medical condition that needs figuring out or solving and it is my job to solve their problem.  It is eerily similar to a criminal investigation.  So I rain the questions down...

What happened?
When did it happen?
Is it getting better, worse, staying the same?
What makes it better or worse?
Once symptoms are aggravated how long do they take to calm down?
Does time of day affect your symptoms?
How do your symptoms change when you ______ ?
At what distance/intensity/weight/repetitions/etc do your symptoms flare up?

It's almost like this brainy crew is waiting to help you.

Now imagine that the "victim" in this scenario could tell me nothing, or next to nothing, about the crime.  In rehabilitation I hear things like, "I'm not sure when or how it started, I just noticed it one day."  This may or may not be true.  Frankly, there is no real way of going back in time and figuring it out.  Some people are great historians and others can't remember what they had for lunch yesterday.

But how much can any of us really remember about a crime scene when we don't realize a crime is occurring?  It's hard to remember tiny details when we don't know that we should be paying attention.  I can't say much for actual crimes but I do have a simple answer for anyone struggling with an injury and it goes a little like this...

Log everything that happens after the incident.

Think of it this way- if you were to watch the behavior of everyone after a crime, you would probably get a reasonable idea of who was guilty. If you aren't paying attention, or if you don't know you are supposed to be paying attention, then you may never notice how the bad characters are giving themselves away.

Einstein said that if he had an hour to solve a problem he would "spend 55 minutes thinking about the problem and 5 minutes thinking about solutions."  What does he mean by this?  You need to understand the problem before coming up with solutions.  It sounds too obvious and yet this is not the way things always work in the world of medicine (or rehabilitation, fitness, health/wellness).  For this reason, one of the first things I ask my patients with a chronic injury to do is start a symptom log.  I want to understand their problem and a symptom log does exactly that.  When completed daily it gives a clear picture of what seems to be helping and/or hurting the patient's healing.  I could come up with a solution on day one, but that does not mean I am dealing with your problem.  I may get lucky and guess correctly.  I may be able to perform enough tests in the clinic that give me a strong suspicion of what your problem might be.  Based on this research, based on the history you provide, based on my experience, based on how your symptoms act in front of me in this given moment, your problem is probably THIS and therefore the solution is THIS.

Understanding the method for problem solving is a key part of Einstein's genius. 

Making educated guesses makes me look smart when I'm right.
But who is right ALL the time?
A symptom log confirms or denies both my and your perceptions about the problem.

When we watch how the characters involved in the crime behave we may find some surprising things.  Many of my perceptions about my injury were crushed by my symptom log.  I thought I needed supportive shoes but it turns out they were making my plantar fasciitis and hip pain worse.  I thought I should do more glute muscle activation/strength exercises, turns out they were making my hip stiffer and hurt more at the time.  I thought I shouldn't run until I was completely pain-free but it turned out barefoot running helped ease my symptoms and heal my body.  I kept a symptom log for about 5 months until I felt I understood my problem well.  I had seen steady progress in the right direction and each time I had a flare up I was able to understand why and quickly manage it.  Over time I had less flare ups while being able to achieve more physically.  At some point I decided I didn't have to log every day; I knew what was good for me and what was not.


Each tab was a week.
For each page I listed the days of the week along the top row.
Each row represented a different component (or character) that I wanted to keep track of...some examples are:

Workout: write down everything you did for exercise, be as specific as possible
Pain/Swelling: write down ALL areas of the body that you have pain, not just your primary injury or area of concern, log intensity 0-10/10 for each location of pain, note any changes to pain before or after activity or based on time of day.
Stiffness/soreness: log the same way you do for pain, location, intensity, and if it changes
Rehab/Therapy/Treatments: any treatment you had (massage, dry needling, manual therapy, etc), any program you are testing (stretching program, specific exercises targeted to your problem).
Shoes worn: if applicable
Medication: if applicable
Other: you can have whatever rows you want.  I kept an "other" section where I sometimes wrote my "perceptions."  For example, one day I wrote that, "minimalist running seems to be the best thing for my foot and hip."  Other days I dug deeper into how my hip was acting, "the clunking is still there when I swing my leg."  You can't be too specific, only too vague.

This is about 4 months into my recovery log.  On Sunday I made a note that I lost good running technique if I "wore too much shoe."  I'd been doing mostly barefoot running prior to the month of April.

I knew by this time that barefoot running felt good to my foot and hip but I was trying to gauge if I could get back in shoes.  Over time I learned I could wear more shoe but I would have to maintain correct technique.  Be careful about judging yourself or your progress, just write the facts down and see what you can change/modify to make things better.  You are basically your own science experiment so keep your emotions in check here.

This was 3 days before when I attempted to run in my shoes and I couldn't do it without pain, so I went back to barefoot.  On 3/6/2015 I was able to run okay with the shoes if I really watched my form.  Remember your progress will not be stagnant and symptoms will change, some days you can get by and some days you can't.

Going back further in time to February 2015 when my mileage was still very low.  Note that I described the trails/terrain.  This could be helpful later because I may run the same distance but feel different on a different trail / elevation change / road / etc.  It may be valuable information later about how terrain affects my symptoms.

Stepping back further in time, by keeping the log for about a month (since late December 2014), I began to realize that just spending time in minimal shoes and not being too stationary were going to be important components in my recovery.

This is an amazing post a few days later (by the way, I had a concussion that month if you're wondering).  I'm basically saying that "based on my recovery log" I feel that I will be able to heal and make progress.  In other words, I'm not better yet, but I'm learning what works and I have more power over my symptoms.  This was a major paradigm shift from a month earlier when I'd had foot pain for a year and hip pain for 6 months and hadn't made progress in all that time.  ONE month of logging changed my mindset completely.

It is a daily commitment to yourself to keep a recovery log.  I am not selling you instant gratification because the body does not heal itself instantaneously.  I am selling you common sense and a way to listen to your body.  This will make you smarter over time which is way better than relying on someone who doesn't live in your body every day and who doesn't have the same level of investment in your health as you do.  Even if you cannot fix yourself and you need a doctor or a therapist, you will make it much easier and more efficient for your doctor or provider to help you.

This is seriously the opposite of success.

With my recovery log I was able to go to my military doctor and ask for a "soft shoe" profile with 100% confidence and 100% evidence of what I needed to heal.  How amazing is that?  He reviewed the evidence and agreed with my unconventional treatment to plantar fasciitis..."well I guess if the boots are clearly hurting and going minimalist has improved your symptoms, we will go with it."  Without the symptom log, I may not have figured out how to heal myself, I would have continued to make the assumption that I needed supportive shoes.  The symptom log also demonstrated to my doctor that I was fully committed to healing, he took me seriously right away and demonstrated he was on my side by offering his help, time out of those darn boots!

These boots are heavy, clunky, and totally mess up my proprioception!

Monday, November 23, 2015

10-min talk on shoe evidence with Dr Irene Davis.

Irene Davis, PhD, PT, FAPTA, FACSM, FASB
Director, Spaulding National Running Center
Department of Physical Medicine and Rehabilitation
Harvard Medical School

Saturday, November 21, 2015

The Basics of Running Form

Today I'm getting away from the "shoe talk" for a moment to discuss a few key principles of good running form.  With research you may find there exists a few consistent tips on how to run better, things like stand tall, keep your knees soft, and don't over-stride.  I need to add this caveat, you shouldn't believe everything you hear out there.  Why?  Because even some residency-trained orthopedic radiologists still believe that running will ruin your knees despite very high-quality evidence to the contrary.  The lack of truth in modern medicine is probably more than most people realize or would feel comfortable knowing about.  As soon as we uncovered the human genome we realized that gene expression (epigenetics) was going to muddle the whole idea that you can predict someone's future health based on their genes.  There are very few cases of disease processes so predictable.

With that disclaimer out of the way, I want you to feel a little warm and fuzzy about this post because there's actually good evidence behind it.  Keep in mind this isn't about perfection but instead about motor learning.  How we accomplish the same task may change over time for a variety of reasons but understanding what constitutes "good fundamentals" gives you a place to start and a way to go about experimenting.

So here goes the story of basic running. 

#1 - Get your posture right.

This is an example of slouched posture.  Neight is loading my back and I'm collapsing under his force.  Mama always told you to sit up straight, she was right of course.  Live your life in good posture and bring it to your workouts as well.

Posture correction.  There are several ways to train this but one of the easiest is to lengthen your spine as though there is a string attached to the back of your head (on top) that's raising you up.  My spine is neither flexed or extended but engaged somewhere comfortably in the middle.  It's easy to do this as a short person, I'm always trying to stand as tall as possible.

When Neight loads my spine I have no issues holding good posture.  My vertebra are stacked like legos and it takes minimal effort to remain upright.

#2 - Know Thy Spring

Before I get too specific regarding the other components of your running form, I'd like a say a few words about "spring" and note some key differences between walking and running.  Speed of movement is not the only way in which they differ.  In walking, you have at least one foot in contact with the ground at all times while in running you have no more than one foot in contact with the ground at any given time.  The implications of this mean that walking and running are very different gaits.

Walking requires active muscle contracts to produce all of the energy needed to move forward while running allows you to load (or store) energy in your muscles and tendons that can be used for the next step (your legs act a little like a pogo stick).  While not all of the energy to move forward is "free" in running, the spring provides a very important and significant contribution.  This is very different than the stiff-knee, heel-to-toe gait we see in walking.  When we walk our leg acts more like an inverted pendulum than a spring.  This is fine mind you; it's great for walking.  With running this gait is inefficient at best and injury-provoking in nature.  It's called "jogging."

This is "jogging" or the "walking gait" that's been transferred to running.  So what we see instead of a spring is a stiff leg and heel-toe gait pattern that's not able to store and release energy.    No one jumps rope with a stiff knee and heel-toe landing and push off strategy but this running style is common.  Why?  I believe it is a lack of proprioception and awareness encouraged by shoes with thick-cushioned heels, stiff midsoles, and toe spring.  Those types of running shoes are "designed" to encourage you to run with this exact form.  More bad news, your spring weakens over time if not used.
I begged my friend to over-stride while running downhill so that I could get a good picture of this.  Many people would look at this photo and not notice much or even give her a kudo for having nice spine posture.  But that said, over-striding downhill is about the worse thing you can do for your joints outside of an accident with a crowbar.  Again this is a walking gait taken to the extreme.  Instead of using her spring to store energy she is braking all the way down the hill using her joints to cushion her landing.  If you run downhill and get a lot of knee pain, you need to assess if you are over-striding.  My friend made a sacrifice for this photo saying, "it hurt so bad to run that way!"

First notice that I have good posture and my head is facing forward, not down towards my feet.  My foot isn't quite ready to land yet but in a few frames prior to this shot my knee was slightly more extended.  This is fine for the flight phase but when I am ready to land I need to be able to engage my spring with a bent knee.

This frame is close to the point at which I've made initial contact with the ground.  Let's employ the KISS principle and just say, "keep the knees soft" and "land quiet like a ninja."  I am in the process of loading my spring in this photo.

#3 - You need excellent single leg stability.

My "spring-leg-pogo-stick" is fully loaded here.  This photo is significant for another reason as well.  Most of you have seen the "pelvic drop" or "hip drop" discussed in running.  You want to see your hips level throughout the loading phase.  At this point in the photo I am placing the most force through my body as all of my weight is on my left leg (key point here, the max force on your legs when running is NOT your landing or contact with the ground but when you are in THIS position).  Anything that compromises this stability (muscle weakness, compensation, foot problems, balance, etc) can negatively affect your alignment.  If you find this is out of whack, try to using different cues to see if it clears up.  Studies show with the right feedback this can often be corrected.  If you're failing to correct a pelvic or hip drop, please get some help.  Left unchecked this can lead to all kinds of overuse injuries (feet, ankles, shins, knees, hips, spine, every kind of tendonitis imaginable).  Finally, your foot should be pointing straight ahead when you are running.  If you cannot self correct this there may be an anatomical reason for it or you may just need some help.  The foot facing straight forward is vital to the actual function of the foot/ankle complex and affects everything upstream.

An example of hip drop.  Your trunk will compensate by leaning the opposite direction just so you can maintain balance.

#4 - Learn to minimize "bounce"

We've talked about "spring" this whole time and now I'm asking you to minimize your bouncing.  A quick lesson in trajectories will clear up any confusion I've created here.  Just imagine that you want to throw a ball as far as possible.  To do this you wouldn't want to throw the ball directly over your head.  The other extreme would be to attempt to throw it perfectly horizontal, like a torpedo; it would fall to the ground in no time.  We all employ roughly the same technique of throwing as far as possible, we estimate a trajectory and try to let go of the ball at just the right time so that we are throwing only as vertical as we need to in order to hit our target.  Now imagine your center of gravity or your body's center of mass as the ball.  Excess bounce means wasted energy but we know that some vertical lift must occur for us to move forward.

How much bounce is too much?  Try to keep your running smooth and allow your springy legs to "spin" under your body.  The more excess motion through your trunk the more energy is diverted away from your forward movement.

#5 - Downhill running usually requires a faster stepping cadence and a deeper knee bend

By keeping your knees "soft" and stepping faster you prevent the "braking" effect of over-striding.  Instead of "pushing off" while running downhill, try to "ease your body down the hill."  This makes for softer steps, quicker steps, and very minimal bounce.  Remember whatever you're thrusting upward has to come down so the higher you push your body upward with a strong "push off" the more force you'll bring to your landing.  Imagine you're taking your body down an escalator (think funny sitcom pretend escalator) and you should get the picture.

Soft knees and quick steps protects your joints.  It's no different than jumping off a high platform and attempting to land softly.  It requires everything from your core to your legs coordinating to control your descent.  This is the essence of eccentric muscle activity, to control the rate of flexion (loading) occurring at your joints.

Lean slightly forward when running downhill.  Leaning back will encourage over-striding and braking (increasing joint stress).  Instead, attempt to lean your trunk perpendicular to whatever grade you are descending.  This takes some getting used to for most people but it's a lot like skiing down a hill.  Pretend you are an awesome skier.
#6 - Running uphill is kinda like running downhill

Lean forward (into the hill) slightly and be sure to avoid the urge to over-stride.  Note that "leaning forward" is not the same as "slouching."  Taking shorter, quicker steps may seem like more work but it's kind of like spinning on a bicycle with the easy gear.  It's less work per step because you aren't trying to cover a lot of ground per step, you're just moving forward a little.  There is a point of diminishing returns when it comes to stepping cadence, most find between 170-180 to work well depending on the terrain.  Downhill running may require that you increase this somewhere between 180-190 in order to maintain good form.  You don't necessarily need to count steps when running, you can just play with how fast you are stepping to find what seems like the least amount of work (and allows you to land quietly and softly).

Depending on the grade of the slope, you may want to try to keep your foot flat when running uphill.  That is to say, if you were moving up a long hill, consider allowing your foot to rest flat for as long as possible during each step to save your calves.  There are times when you will be on your forefoot entirely for a few steps (think of rocky, technical trails and extremely steep slopes) but it's not ideal to do this for long periods of time as you could overuse your calf and achilles tendon.  If you have issues specifically with keeping your foot straight while running uphill (no problem on flat land) you likely have an ankle mobility problem that needs to be addressed.

Running rocky trails at the Air Force Academy in Luna Mono Sandals.  My only critique here is that I am looking down (at the upcoming rocks) instead of forward.  Be flexible in your running understanding that different runs will require different skills of you.  In this case, I need to watch closely where I am stepping but should make sure that I am not slouching because of it...

A great example of a "soft knee" landing.

You can learn to run very fast without over-striding.  The pendulums that are your legs will swing with a larger arc the faster you run.  The key is that when I land my feet are always close to my body and my knee has some bend regardless of speed.  Said another way, I land quietly, softly, and with my feet "under me" not "in front of me."

The arms will follow the legs and the legs will follow the arms.  I don't speak too much about arms because often the arms will compensate for the legs so if the arms are inefficient it may be that we are using them for balance (like the trunk leaning when the hip drops).  That said, on trails or terrain requiring more balance, you may find that your arm carriage widens somewhat.  This is normal.  If you have a habit of over-reaching your arms in front of you when running, you'll want to bring the hands closer to your body.  Extending the hands far forward encourages your foot to move forward as well (over-stride).

Good example of a level pelvis and erect spine (without leaning compensation).   If your pelvis is dropping you may need some help figuring out why it is happening.  I often place runners on a stability program to train them to move properly.  In addition, there may be range of motion deficits that need to be cleared up.

While I have made massive improvements to my own running form I will tell you that it is not a "steady-state" affair.  Hold fast to the principles but allow your body to experiment with the small details.  You will feel different from day to day, season to season, and your mindset, fitness level, energy, and stress level, etc will all play a role in your technique and form.   Listening to your body is the best way to go.

Until next time...

Friday, November 20, 2015

The 3 Mental Mistakes that Limit You

Like learning to throw a ball or spear, swim, shoot a firearm, wakeboard, crotchet, or type 90 words per minute, there are certain basic principles that are helpful to understand.  My last two posts discussed the myth of maximalism and several resources that I used to learn improved running form.  Today I want to briefly go into three common mental mistakes that people make when they face change.  I often see these common slip ups in the world of health, fitness, wellness, and rehabilitation as well.

I believe this to be excellent spear throwing form.
While physical practice will remain an absolutely necessary part of your training or transformation, you may find that you need to drop some emotional baggage before this undertaking.  Maybe you've come to believe that you're not physically built like a runner, like a weight-lifter, like an awesome spear thrower.  Maybe you've tried and made attempts to improve some aspect of your life and have failed again and again.

Welcome to the club my friend.  Grab a name tag and a beverage of your choice while we mingle.

If you were to make a list of everything you believe to be true about your failures or about yourself, why this won't work (or may not work), you would quickly find how damaging carrying those beliefs into your new endeavor would be.  That is to say, how can someone move forward and have trust in their body, faith in their practice, and have hope that they will come out better when they are dragging opposite beliefs along for the ride?

Everyone feel sorry for this donkey.

The bottom line is you can't.  Or maybe you are superhuman and everything will still work out for you, but it's highly likely that instead you will burn out.  You'll give up before you get there if you're trying to move forward in the context of conflicting belief-systems.  Because eventually along the way you will meet a challenge, and if you meet that challenge and you haven't dropped that baggage, you might see it and think, "see, this is what I was saying!  This isn't for me.  I can't do this.  I'm not meant to do this."

When I undertook the hard work to retraining my running form, I first tackled my attitude towards running and the mentality that I held about myself over the past few months and years of failure. I had a lot of baggage from my repeated injuries, missing out on several amazing opportunities to race, missing out on what I thought was my own potential to run in the Olympic Trials some day, missing out on much of my sanity and happy-nature time.  It was actually eerily similar to the baggage someone might have after a failed there something wrong with me?  Why do I still love running so much when it hurts me?  Maybe I should never run again!  And we all know that once we've been hurt, things are never quite the same.  People have different reactions to a breakup and some find ways to better themselves, they learn the lessons without losing love for themselves, and they move forward with new hope.  It isn't easy but the alternative is to live less of our lives because we are afraid.

Prancing across chasms in the sunset.
Make it happen people.

Now to the bread and butter (or bacon and eggs if you prefer).  This is specifically how I changed my thinking before moving forward in training.

#1 - I stopped being fearful of pain.  For example...I did not "judge" or become angry when my body signaled pain, I simply thought, "this is valuable feedback from my body" and "if we work together we will figure this out together."  I thanked my body for the pain signal and believed that the communication would make me a better runner.  So often we run from our emotions, instincts, etc because there is discomfort involved in stopping and admitting that things aren't perfect.  That's totally okay, because for every human being on this earth, there are times and will be times that they experience pain, loneliness, anger, grief, anxiety,'s the fear of these emotions that have the power to stop us.

This could be YOU!

#2 - I turned all my negative self-talk into constructive self-talk.  What made this easier was not placing expectations on the outcome or limitations on how much better I could get or if my body could heal or not.  So this is really like two things I did that I naturally molded into one concept.  Think about it this way, if you are going to place expectations and limitations on yourself, you might as well do something in your favor and say, "it may take time but I am going to recover and be 110% what I was before" (or something like that).  I wanted to put all of my energy in healing, not in debating with myself.  This naturally lead to step #3.

Seriously, let that shit go.  Remember the poor donkey?

#3 - You have to believe that your body can heal (or change, or your situation can change, or you can get smarter, or whatever).  You have to believe that the body can adapt in a positive way over time by doing the right things.  What's interesting is it's not a hocus-pocus belief system.  The human body can adapt and does adapt over time to what we do.  Controlling and dealing with stress has been shown to improve survival in cancer patients.   Brain science has shown neuroplasticity in adults.  So instead of focusing on my failures I wrote down a few truths that I would instead focus on each day.  Things like, the healing process, which I understand well as a therapist, is occurring and will eventually heal my problem IF I do the right things.  By listening to pain, I will learn the right things to do.  If I do everything I must do to heal, I will heal faster (eat right, sleep well, control stress, etc).  Despite months of therapy and professional opinions guys and gals...when I started to think like this I began getting better in a matter of weeks.

After three months I was running 6 miles barefoot at a time without pain.
By month five I ran an ultra-marathon (albeit slowly with walk breaks).
I won a Spartan Beast (12.5 miles) at month six.
Month seven I ran a much faster mountain marathon (Pikes Peak).
I competed in the Spartan World Championships near month ten and performed well (14.5 miles).

But please understand this important key.  No matter how things changed, as success came, I never strayed from the principles that got me there.  If I had pain at month seven I didn't panic.  I remembered my principles and I followed them.  My body responded with a "thank you" and I continued to move in the right direction.  My focus has never been performance, the focus remains on the fundamentals.  Performance will manifest in its own time based on your ability to mentally be where you need to be each day.  It's the proverbial "cart before the horse" scenario.  Don't be afraid of success but always remember what got you there.

This is exactly what happens to every individual that has an injury.
I used simple models like this to remind myself that if I listen to my body
it will guide me through this process appropriately.

I'd failed so many times before because I didn't know any better.  But when you know better, you do better.  Give yourself grace and don't make those three very big mental mistakes.  What else can you think to add to this list?

Wednesday, November 18, 2015


There are many excellent resources online for the average runner looking to improve body awareness and technique.  My goal is to provide you with a place to start because ultimately your journey to finding the most healthy and sustainable way to run for you will look different than my own.  That said, to recap my last entry, here is an excellent educational video on how to chose a running shoe based on evidence, not myth.

Below are a few resources that I studied as I looked at how to improve technique.  Some resources are much better for technique while others do an excellent job of explaining the biomechanics of running and what factors to assess on yourself to see where you need improvement.  I'll try to summarize this for you,

“Anatomy for Runners”by Jay Dicharry is an excellent resource for understanding the biomechanics of running.  It's meant for the runner not the doctor so you can start using what you learn on day one (although it's a great book for sports/orthopedic providers as well).

The Air Force's own Dr. Mark Cucuzella runs the Natural Running Center and opened the first minimalist-only shoe store in America (Two Rivers Treads) to provide runners with not only "alternative footwear" but with proper education on running technique and training as well.

Dr Cucuzella, US Air Force Reservist

If you have a little hippie in you like I do, Michael Sandler and wife Jessica Lee wrote an excellent "how to" book called "Barefoot Running."  Michael's story is especially compelling as he went from a traumatic accident which led to a titanium left hip/femur as well as a very banged up left knee (he has no ACL), along with nearly a 1" leg-length discrepancy back to running.  His book explains how he did it, the exercises, the technique, the progression.  This is a great book if you're looking for a step-by-step guide and you want to avoid injury.

Michael Sandler overcame tremendous injuries to run again.  He has dedicated his life after the accident to teaching other runners what he has learned.

I personally like a guy known as "Barefoot Ken Bob" as well.  He has some great tips to help people learn how to run lighter, softer, and smoother.

Barefoot Ken Bob has been a barefoot runner for many decades, long before the minimalist movement ever started.  He says he ran barefoot precisely because he doesn't like pain - being barefoot allows him to adapt his stride to promote the softest landing possible.

With all of the "resources" I've mentioned you'll notice there is a very big theme of barefoot running.  What is important to realize is that I am not advocating people just take their shoes off and go for a normal run.  You can get hurt on day one doing that.  What I do advocate is that people become aware of what they are doing when they run.  In my own personal experience, I actually had to go completely barefoot because my technique was so far gone - it's what 14 years of competitive running can do (when you are fast people generally don't say anything about your over-striding).  Because I had run 14 years and 20,000+ miles the wrong way, changing was a monumental feat.  The resources I used allowed me to re-learn a better movement pattern.  I typically do one short barefoot run a week to encourage and remind my body the right way to run.  The rest of my runs I wear only the amount of shoe I need to tackle the terrain and no more.  As far as I can tell in all of the scientific literature, this is the way to go for healthy and sustainable running.

On that note, if you have pain or an injury it's important to see a physical therapist who knows something about running.  Everyone's body is unique and why we do what we do is also unique.  A running technique evaluation only gives a little bit of information, I might see that your hip drops and you lose alignment, but this doesn't tell me why...for that there is likely more digging in an evaluation that has to take place.  It could be hip weakness but just as likely it could be a timing issue or that your gluteus medius is over-worked because it's compensating for something else that isn't working.  That's why I don't recommend treating yourself if you have an injury and just working on technique doesn't always address the other problems.

But if it is simply a technique issue, then practice will be the most important factor.  It isn't easy and that it why I believe that so many people have failed.  That doesn't make it impossible either.  But it's the same reason so many people try to lose weight and don''s hard to change.  I literally just used the exact resources I mentioned above and by taking off my shoes was able to teach myself better form and technique, my feet were my coach.  If you are as determined as I was it is highly probable that you can improve technique without spending a lot of money on someone to coach you.  There are people who train running form for a fee but I can't speak to their abilities or to what exactly they are teaching, I only know what I teach when I coach running technique.  Pose and Chi running are popular programs but they promote a very rigid way of doing things and it's the primary reason why I do not promote their programs.  Instead I promote body awareness and learning how to move so that you are soft, smooth, quiet, and efficient.  The exact movement will look different between people and even on yourself as you vary your terrain, distance, speed, etc.

It took me a few weeks of focused practice but the light went off and as long as I didn't do too much too soon my body adapted.  I went from being unable to walk without pain to running a mountain marathon, a mountain ultra-marathon, and in the Spartan World Championships, placing 12th Elite female in 11 months of working on my running form and not worrying a lick about my speed.  No running shoe could ever give me that.  That my friends was a crap-ton of hard work...

Completing the Pikes Peak marathon in Aug 2015.  I ran in sandals for 25.5 miles and took them off when I started to slip in the rain.  The final 3/4 mile I ran barefoot down the street and into the finish.  Nine months before I literally couldn't walk without foot and hip pain.  I never gave up and worked on my technique like it was my job.  Now running is no longer a "high impact" activity because I know how to run correctly.

Tuesday, November 17, 2015


Today's runners have encountered the entire gamete of footwear choices (and all of the cumbersome baggage) not available to runners 50+ years ago.  When I examine what has happened over the past half-century, it becomes a story of corporate strategies, marketing, and mass myth more than an evidence-based conversation.

The first mass-produced running shoes were made by Adidas, Asics, and Puma in the 1940's and 1950's.  They were little more than a rubber sole and leather upper.  They had minimal cushioning and a minimal heel stack height if any.  These were the days when most runners were athletes competing in races for prizes and records, the running boom had not yet hit America and so there wasn't a ton of recreational jogging.  The running boom developed in the 1970's as a way for many people to become more fit, lose weight, or to enjoy running for social reasons.  The problem is that running is actually a skill and if done poorly (or if the person is not prepared) can quickly lead to injury.

Typical 1940's runner

Early Adidas - many of these shoes were hand-made for olympians.

So along came the running shoe industry to the rescue, or so many thought.  The conventional running shoe as we know it began to take shape to "prevent harmful shock" and "improve pronation mechanics" and "cushion your joints."  The premise of this is actually quite literally ridiculous.  The underlying message here that no one in the running shoe store will say is that running in today's world is inherently harmful and you must protect yourself with the technology of a shoe.  If this were true, you shouldn't be running at all.  You shouldn't be using a shoe to do something that is inherently unnatural.  But it's not really true anyway, it's not supported by any science.  So why are so many still convinced they need a certain kind of shoe to fix their problem?  It is still to this day all too easy to find a medical person who agrees with that sort of logic. 
The Nike Cortez - adding some heel height

And what about the other "logic" that says, "ok maybe there are some runners who do not need the support and cushion because they are biomechanically perfect, but I do because I weight a lot (or I'm not efficient, or I'm not a real runner, or whatever else people say).

Let's take that same premise for a moment to the sport of swimming.  If you were to throw a small child into a pool and watch him/her unsuccessfully flounder around, you wouldn't say the child is hopeless, that he or she can never learn to swim and must always wear floaties because they are not "biomechanically gifted."  You would teach the child a proper stroke.  The child would learn to swim because they learned to move properly.  The same goes for learning to roll, climb, lift, squat, jump, land, throw, catch...these are motor skills that can be learned and improved with practice.

If you need these floaties to swim you aren't swimming right.

The premise that you would need a special protective device in order to be safe during running makes the assumption that the problem is the activity itself and NOT your technique and skill-level.  It's clear that this is not the case.  In the 1970's achilles injuries began to explode due to many people who did not have proper movement undertaking a new exercise program.  The industry responded with a higher and more cushioned heel.  This did not address the real problem but unfortunately created a new one.  The more cushion you place in a shoe, the stiffer you make it, and the higher the heel, the more you promote over-striding.  Wearing such a shoe takes away all of your foot-sense and now you are no longer fully aware of how awful your form has become.

What happens when our brain is missing information?  A lot of bad things...
Imagine yourself piloting an aircraft in poor visibility conditions and you are relying on an air traffic control tower to get you steadied for landing.  The information they give you is obviously critical in your ability to land properly...if they are degrees off or do not understand your location or speed of travel or if their instructions are muffled by a bad radio connection, you will not have a very happy landing.  And yet this is exactly what we do with too much shoe, we muffle our connection, we change the information.

If you need this shoe to run you aren't running right.

Imagine you want to send a message to a friend via email using a keyboard.  Wearing thickly cushioned shoes is like trying to type a message wearing a thick set of gloves.  I have practiced typing enough that I can close my eyes and type well with few mistakes.  But if I close my eyes wearing thick gloves and try to type it will be a disaster.  Whatever message I wanted to send will be completely distorted and useless to the intended recipient.  Thickly cushioned shoes are a lot like playing the "telephone game" with your sensory input.  What gets to the brain isn't exactly the real message, it's distorted.  Your brain will do its best to understand the input, but with bad information it will not be able to make a good decision.  Your brain cannot adequately protect your body from pain, inefficient movement, excessive stress, etc with inaccurate information.

This cycle occurs with every kind of sensory input in the body (sight, smell, taste, hearing, and touch).  Affecting the sensory input affects your processing (brain) and will change the output.  Maybe the muscles you recruit or the speed of recruitment changes, maybe you under or over-correct.  This can change something as basic as reflexes.

The incidence and severity of running-related injuries will remain the same until culturally we are ready to acknowledge that it isn't the shoe we should have corrected in the 1970's, it's the skill of running for the average person.  What many do not realize is that the current support for maximalist cushioned shoes is faith-based; it's a belief that if we just add more protection we won't jar our joints and we will save ourselves from injury and wear-and-tear.  Most running shoe stores will embrace cushioning or stability components of shoes as a way to protect the body and keep people running.  There again lies the assumption that running isn't safe in the modern world and you must buy this product to protect you from such a dangerous activity.  Meanwhile there is no support for this assumption in scientific literature...

Will we transition back to minimalism soon?  Unlikely.  Many running shoe companies dumped their promotion and inventory of their minimalist shoes a few years ago due to the high number of injuries being reported.  Of course we know it was not the fault of the shoe but rather poor technique and implementation of a major change in training.  But that doesn't make it any more appealing to running shoe companies to change tune.  They need to sell shoes to stay in business so most will do what is popular versus what is scientifically supported.  Let's also remember that the majority of runners are still wearing the middle of the road supportive shoes that were popular in the late 90's, so they never changed to minimalism or maximalism in the first place.

I don't see this issue much differently than I see the issue of obesity (at the individual level). It takes great responsibility for a person to take matters into their own hands and find a solution.  In running, this means relying on learning the right motor patterns and giving the body time to adapt, not simply saying a shoe (or a specific diet) is the answer.  It's a lifestyle, it's a new belief system, and it's a new way of doing things.