Tag: Matt Phillips

Strength, Flexibility & Injury Risk

How to Measure Your Strength and Flexibility to Assess Your Injury Risk

Guest blog by Matt Phillips (RunnersConnect)

injury assessment and treatmentWhen you see the word “couch” in the title of an article about running, you can generally assume it is referring to the one in your living room in front of the television.

Well, as someone always keen to keep you on your toes (metaphorically speaking – please do not start trying to run on your toes), I am in this article actually talking about the couch you lie down on when you visit a physiotherapist, sports therapist, osteopath, etc.

Though our natural tendency and expectation when seeing a manual therapist is to lie back and let him/her “fix” us, the aim of this article is to consider whether having us lie down on a couch is the most effective way for a therapist to be able to assess our injury and in doing so reach conclusions as to how to treat us.

Assessing range of movement: static vs dynamic

Any runner who has been to see a manual therapist will be familiar with the basic protocol. The therapist asks you about your medical history, previous injuries, the circumstances surrounding the current injury and then embarks on a physical assessment of your body in order to see what, when, why, how – all important questions that will help creation him/her create an appropriate treatment plan and recovery programme.  One of the most common indicators used to assess an injury is range of motion (ROM).

We are all familiar with the fact that when we hurt ourselves, we typically lose some degree of mobility in that area of the body.

  • To assess the hamstrings (back of leg), the therapist will typically ask you to lie on your back on the couch and raise a straight leg
  • To assess the quadriceps (front of legs), you lie face down and bend the heel back towards the bottom, and so on.

These tests can give the therapist a lot of information, but the problems start if an assumption is then made, as is often the case, that the ROM seen lying down on the couch (static) is a predictor of the ROM exhibited when you are on your feet and moving (dynamic).

An example: I have treated runners who when lying face down on the couch and bending a leg back cannot get the heel anywhere near their bottom. If I help by pushing on their bent leg, the heel gets a little closer but not a lot. And yet, when I watch the same clients running at a high enough pace (outside or on in the gait lab on a treadmill), their heels are more or less touching their bottom every stride.

In other words, the static ROM they showed when lying on the couch was not a predictor of their dynamic ROM when running, and therefore any assumptions I make based on the couch ROM with regards to the mechanics of the injury, how I best treat it, how I could improve their running performance, etc. become unfounded.

Static range of movement is not an accurate indicator of dynamic range of movement.

The Thomas Test

My personal experiences are not conclusive. For that we need to have a look at the research. Runners who have ever seen a manual therapist for pain in the hip, front of thigh or the knee will probably be familiar with The Thomas Test.

It is commonly used as a way of assessing range of hip extension “permitted” by the hip flexors (front of the hip), and thought to be an indicator of how much hip extension is available when the runner’s body travels over the weight bearing stance leg during forward propulsion.

As can be seen in the image below, the test involves the runner lying back on the couch, clutching one leg close to the chest and allowing the other to relax and move down towards the end of the couch.

RC17_ThomasTest

  • The back of the runner’s right leg can be seen to be making contact with the end of the couch.
  • Hip extension on the right leg is therefore recorded as satisfactory.
  • If a gap had existed between the back of the right leg and the couch, limited right hip extension would have been recorded.
  • The angle of the knee is also used as an indicator of restriction, specifically for the rectus femoris, one of the quadriceps muscles that as well as extending the knee also flexes the hip.

In the image, the runner’s relaxed right knee has an angle of 900, which again is typically regarded as satisfactory. If the angle were less than 900 (it is not uncommon to see a near enough straight leg), a limited ROM would have been recorded.

Now, it is important to stress that I am not saying this test is a total waste of time.  As a therapist I still find a place for it during some assessments. However, hopefully some of you are already looking at the image and thinking “But he’s lying down – this only tests static hip extension!”  Well, recent research would agree with you.

In a 2009 study, Schache et al. set out to compare the degree of hip extension during running to the hip extension flexibility measured in the clinic using a Thomas Test. Their results were such that they concluded:

Static hip extension flexibility, measured using the Thomas test, was not found to be reflective of these dynamic movements (running)… It is advised that clinicians need to be extremely cautious about making predictions about the dynamic sagittal plane movements of the pelvis and hips based on the outcomes of the Thomas Test.

If we accept that the degree of effectiveness of a treatment depends on the accuracy of the assessment and diagnosis, this could well be a problem for therapists who base decisions solely on static assessment. Using it in combination with dynamic tests is another matter.  The question is, why are static tests so popular, and why has no one talked about this much before?

Your muscles don’t decide how you move

Part of the reason that assessment by manual therapists has to date largely ignored the differences between static and dynamic movement is the way we have been taught to view the human body. Movement is typically presented to us as the product of individual structures like muscle, ligaments, tendons and bones.

For example, if you are unable to touch your toes you are told that your hamstrings are “too tight” or “too short”; if you find it difficult to lift something heavy, you are told a particular muscle/s is “too weak”; if you get tired too quickly your muscles are said to lack endurance; go over on your ankle a few times and you are told certain ligaments are too loose, and so on.

Modern research suggests that movement is not a product of how short, long, weak or strong a muscle, ligament or tendon is. Just as bones would be nothing without muscles pulling them, muscles would be nothing without the brain communicating with them; it is the brain that decides how and to what extent we move by comparing sensory feedback at that moment (using a multitude of systems in the body) with a stored memory bank of every movement you have ever performed in your life.

Quite a powerful little hard drive when you think about it. The feedback systems used are proprioceptive, visual, vestibular, and include visual horizon, orientation against gravity, joint compression, angle and torque, tissue tension and length. The feedback is obviously very different when you are lying static on a couch, compared to the dynamic movement of running. We have obviously removed the need for balance, acceleration, deceleration, etc.

Range of motion itself is traditionally seen as a skill. Flexibility is seen as a skill. We are commonly labelled as either inflexible or flexible depending on whether we can touch our toes or do the splits, neither of which our body requires when running. In reality, flexibility and range of movement is very much movement specific.  Ben Cormack of movement specialistsCor-Kinetic summarizes this as follows:

Flexibility is a component of successful movement. We need to be able to achieve the right amount at the right time in the right movement.

With that in mind, the effectiveness of lying a runner down on a couch in order to assess whether they can achieve the required range of movement needed at the various stages of the running cycle does seem to be less than we may have once imagined.

How should movement be assessed?

The obvious answer is how we started this article, i.e. get off the couch!  Again, I am not suggesting there is no place for a couch in a clinic, but I am suggesting that to assess a movement required for an activity, we need to recreate as much as possible the motor patterns needed for that activity. So for a runner, standing up is pretty much a must. We need to see how much hip extension is achieved on a weight bearing leg, whilst body weight is being transferred, with an element of acceleration or deceleration, throw a rotation in. Not easily done if the subject is lying down on a couch.

Modern research into the role of the brain in governing movement, as opposed to the muscle itself, has also brought with it a departure from the traditional method of pursuing “norms”, i.e. the idea that there is an optimum way for everyone’s body to move. We have talked about this a lot on Runners Connect with regards to there being no one optimum running style that will suit everybody.

If the brain and nervous system are responsible for how we move, comparing sensory feedback from multiple systems with a stored memory bank of movements that an individual has performed in his or her unique life, we should expect and welcome a great deal of variety in the way individuals move.

Taking a median of a sample population and setting that as a per-requisite or goal for efficient movement is simply not backed up by research. Injuries do not always correlate with deviation from such medians.

Pronation

A good example of this is the way in which a “normal” level of pronation has traditionally been preached as a way to fix and avoid injury. A median point was created and suddenly a huge percentage of the runners in the world were labelled as “overpronators”.

Research has shown that trying to “fix” such runners by enforcing a certain type of running shoe or orthodic does not always work, and can in fact sometimes make things worse.

So, instead of comparing ourselves to others, maybe an assessment should involve spending more time comparing what is going on in our own body, e.g. the left side to the right side. I am not talking about striving to achieve perfect symmetry – the idea that symmetry promotes good health and asymmetry leads to pain has been weakened by a lot of research, along with the common and sometimes obsessive goals of “fixing” a tilted pelvis, leg length discrepancy, fallen arches, etc. What I am referring to comparing the capability of the left and right to produce the dynamic movement necessary in running.

Movement variation

Asymmetry is normal and should be accepted as part of nature, but the question is when does our personal variation in movement become a limitation? Ben Cormack explains:

At Cor-Kinetic, we look more at the comparison of the system against itself, e.g. left vs. right. The variation between segmental capabilities, especially in cyclical activities such as running, in an integrated system may provide more clues to increased workload and avoidance strategies of the brain and body than objective comparisons of a median ROM from the subject.

In a future article, we will look at some more modern and potentially appropriate ways that a runner can be assessed when seeking injury treatment. For now, what I hope you see is that even though lying down and “getting fixed” is what we expect and often hope to receive when seeing a manual therapist, the road to recovery in future may well involve us standing up and becoming more involved in the both the assessment and treatment process.

In the meantime, if you are a runner who has experienced less couch use during a physical assessment or indeed a manual therapist who has made a move to using the couch less in assessments and/or treatments, do please feel free to share your thoughts in the comments section. below.

Recommended courses for therapists

Therapists in the UK: If this article has made sense to you and stimulated an interest in learning how to integrate 21st century knowledge, skills and techniques into your practice, I can personally recommend you contact Ben Cormack and his team at Cor-Kinetic.

Therapists in the United States: In terms of focus on brain, neuroscience and modern pain science, I am yet to discover any other education provider who delivers the same training as Cor-Kinetic. (If you are aware of anybody in the States, do let me know!) That said, with regards to learning to see movement in a context based and integrated fashion, The Gray Institute stands out as an international leader in delivery of Applied Functional Science, so they may well be a valuable first point of call.

Happy running!

Matt Phillips is a Run Conditioning Coach, Video Gait Analyst & Sports Massage Therapist with over 20 years experience working within the Health & Fitness Industry. Follow Matt on Twitter. For more great training, injury prevention and nutrition advice, be sure to check out the RunnersConnect blog. If you’re in the market for a personal coach then it’d be worth checking out their coaching service as well.

Improving Your Speed

Step Frequency and Step Length

Guest blog by Matt Phillips (RunnersConnect)

how to improve running speed

RUN (rŭn) - to go steadily by springing steps so that both feet leave the ground for an instant in each step

Competitive running, be it against yourself or against others, is essentially about getting from A to B in as short a time as possible. Looking at the definition above, logic suggests there are two ways you can cover a specified distance in less time:

  1. Move your legs faster, i.e. increase step frequency
  2. Travel further with each step, i.e. increase step length.

At this point, shorter runners will probably be looking at option 1 and thinking, “Yep, that’s where I can shine!” whilst the taller of you will smile at option 2 in the thought that being lanky does have its advantages! And yet, in reality, research suggests that the secret of covering more ground in less time boils down to an ability to excel in both options.

Step vs. stride

Before we continue, I feel it may be useful to point out a little clarification regarding terminology. Though in practice you will see the words “step” and “stride” used interchangeably (e.g. stride frequency and stride length), technically speaking they are different.

A stride incorporates two steps, the left and the right. Stride length is therefore actually double the step length (assuming the left step is more or less the same as the right step). In other words, stride length is the distance covered between initial contact (IC) of one foot and the consecutive IC of that same foot. Step length, on the other hand, is the distance covered between IC of one foot and IC of the opposite foot, i.e. half.

By the same reasoning, you will take twice as many steps per minute as strides, so stride frequency will be half that of step frequency. It’s not a biggie as in literature you will commonly see the two words used interchangeably, but next time you do see Usain Bolt being quoted as running the 100m in 41 strides with a stride length (SL) of 2.44m and a stride frequency (SF) of 256spm, you will now know the “strides” they refer to are actually “steps”.

Step frequency

“Move your legs faster” sounds an obvious way of increasing speed but it is in fact a skill that requires not only increased aerobic capacity but also progressive neuromuscular training and more often than not modifications to your running form.

The speed your legs move is measured in number of steps per minute (spm), often referred to as cadence. The average recreational runner has a cadence of about 150-170spm, with variance due to factors such as individual height, level of general fitness, hip strength, running form, speed, etc.

As we saw in the article Heel Striking, Overstriding and Cadence, research shows that elite runners at race pace also vary in their cadence, but they are always in excess of 180spm. Though this does not mean you should directly go out and try running in excess of 180spm, being aware of your current cadence and experimenting with runs at a 5% increase may well be worth considering.

To determine your own cadence, simply count the number of times your left foot hits the ground whilst running for 30 seconds. Let’s imagine yours turned out to be 40. Double that to get the total for 60 seconds (80); then double it again to get the total for both feet (160). Your cadence (for that particular running speed) is therefore 160spm. For more information on such, see the aforementioned article.

Step length

When one suggests increasing step length, the immediate thought is to try and reach further in front of you. After all, that is what you would do if you were walking. The problem with doing this when running is two fold.

Firstly, landing your foot way out in front of your body (centre of mass) can in effect act as a brake with every step you take, especially if you are landing on a locked knee and heel. This is where all the fuss about heel striking stems from, even though the issue is not that you are landing on your heel but the fact you are jamming your leg out in front of you and decelerating each step.

Given that we are looking at ways to help you run faster, this is obviously not a great idea.

The second problem is to do with injury. Though the exact mechanism is as yet unknown, there does seem to be a correlation with the above and picking up lower limb injury. It may be something to with efficiency of load absorption and transference, and is very likely dependent on the individual, but if you are over striding and suffering from injury it may well be an area to address.

So, if reaching out in front of you is not the best way to increase step length, how about increasing the distance your leg travels behind you before leaving the ground? How far your leg gets behind you is a product of hip extension, which we looked at in the article, The Importance of Hip Extension.

Though inflexibility in the hip flexors (front of the hip) is often blamed for limiting hip extension in running, in actual fact the maximum angle of 10-12o is not that hard to achieve, so it could be argued that for most runners, limited hip extension is not an issue. Greg Lehman, a specialist in Running Injury/Biomechanics, has a detailed look in his article here.

In practice, elite athletes do not have greater hip extension. Their incredible step length comes from the ground they manage to cover whilst both feet are off the floor, also known as flight time. This is a product of the power they manage to generate pre-take off, bearing in mind we are talking about forward propulsion and not vertical propulsion.

In future articles we shall take a look at where this power comes from and what we can do to increase it, but for now we will turn our attention to how elite runners use both step length and step frequency to win races!

A study of step length and step frequency

In his excellent article Understanding Stride Rate and Stride Length, coach Steve Magness considers a study done by Enomoto et al. in 2008 which included a look at the stride (step) length and stride (step) frequency of the 3 medallists in the 10,000m at the  2007 World Championships of Athletics. The runners were Kenenisa Bekele (1st), Sileshi Sihine (2nd) and Martin Mathathi (3rd).

In summary, analysis of the 10,000m race revealed the following:

For the first 9km of the 10k race (approximately 23 laps of 25), all three athletes ran at more or less the same speed. However, the step frequency and step stride used by each of them to maintain that speed did vary:

  • Bekele, out of the three athletes, had the lowest step frequency (190spm) but the longest step length (despite being 7-11cm shorter than the other two athletes!)
  • Sihine’s had a higher step frequency than Bekele but a lower step length.
  • Mathathi had the highest step frequency of all three runners, but the shortest stride length.

During the final km, all three athletes managed to increase their speed, but using different modifications to their step frequency and length:

  • Bekele went from having the lowest stride frequency (190spm) to having the highest at 216spm, and did not lose hardly any step length whatsoever. The resulting increase in speed won him the race.
  • Sihine managed to increase his moderate step frequency, and in the last lap also managed to significantly increase his step length. The overall increase in speed was enough to bring him 2nd place.
  • Mathathi managed to increase his shorter step length but in doing so lost some of his high step frequency. As a result his speed stayed more or less the same and for that reason he came in 3rd.

Points to take away from the study

As Magness points out, the most important thing to take away from this study is that all three medallists sustained and increased their speed using distinct, individual methods. At Runners Connect we cannot stress enough how important it is to recognise that all runners are individuals with unique strengths and weaknesses, physical and mental attributes, physiological response to exercise, etc.

The elites succeed by developing a running form that suits their unique characteristics, and so should we. Make a note of what works for others and how they got they got there, by all means try it yourself, but never expect a one-size-fits all solution based on the success of another runner/s.

For mere mortals like ourselves, the study serves as a reminder of the relevance of both step rate and step length in maintaining and increasing speed.

Being aware of our performance for each may open the door to pin pointing where we should be directing our efforts. If we discover that our step length is low, that could be a sign that we need to do more strength/power work. If we notice our step frequency (cadence) is low, maybe some cadence/neuromuscular work are called for.

Bekele excels in being able to sustain an impressive stride length, but when the moment comes he can also increase his step rate by some 16spm. The implications for running coaches could be many.

In a future article we will look at greater detail on how to improve both step frequency and step length. We will see that in fact the two are very related. For many runners, increasing step rate is in itself one way to develop the power that is needed for increased step length.

As always, changes to running form including step length and step frequency are typically best addressed via ancillary exercise and drills.

Trying to continuously modify either whilst running is never a good idea as any changes you do achieve will remain the isolated product of conscious effort, as opposed to learning, practicing, drilling and being cued outside of your normal runs, so that the modifications take place unconsciously whilst running, which is how it needs to be.

And as always, the goal is to gradually optimize your unique step length and step frequency, not imitate someone else’s. And do not expect any magic formulas. If you make a sufficient effort at doing the hill work, interval training and strength conditioning (including plyometric exercise) that are recommended for so many aspects of running performance, both your step length and step frequency will naturally develop. Stretching those hip flexors may be less work, but when has less work ever paid off?

Do you have any experience of working on your step (or stride!) length or frequency? As always we are keen to hear about any experiences you care to share. There is so much we can learn from each other, so do please feel free to leave comments!

Happy running!

Matt Phillips is a Run Conditioning Coach, Video Gait Analyst & Sports Massage Therapist with over 20 years experience working within the Health & Fitness Industry. Follow Matt on Twitter. For more great training, injury prevention and nutrition advice, be sure to check out the RunnersConnect blog. If you’re in the market for a personal coach then it’d be worth checking out their coaching service as well.

Dynamic Stretching

A Warm-up Routine to Reduce Injury and Improve Performance

Guest blog by Matt Phillips (RunnersConnect)

stretching warm-up for runnersThe Romans had a neat trick for knowing how far their troops had traveled. They would have a soldier count each time his left foot hit the ground. When he’d reached 1000, they knew they had traveled a mile. Some 2000 years later, researchers at Boise State University confirmed this with data determining the total number of steps to run a 12-minute-mile as 1,951 (compared to 1,064 steps for a 6-minute-mile).

So, why the history lesson?

Well, if I asked you to go and hop 1,951 times you would probably show some initial reservations as to whether your legs are up to the task. And yet, running is pretty much that – an extended series of hopping from one leg to the other whilst trying to minimise ground contact time (with some help from gravity, depending on the efficiency of your running form), and dealing with forces of around 2.5 times your body weight each time your foot hits the ground.

Seeing running as a series of hops can be a useful way to open your mind to the fact that in order to run without suffering injury, you ultimately have a decision to make: either reduce how far you run (i.e. say goodbye to races over a certain distance) or prepare your body for longer distances by adding strength & conditioning exercises to your weekly routine.

Through this new series of weekly articles, my aim will be to help you avoid becoming one of the 30- 70% of runners who get injured every year. We will start by looking at one of the most important and yet commonly overlooked ways of preparing for your run: the warm up.

Is stretching before a run bad for you?

Let’s face it, most runners will welcome any excuse to avoid a 5-10 minute warm-up before a run. We just want to run!

So when research from New South Wales, Australia first suggested over 10 years ago that static stretching (long-hold stretching) did not reduce injury,  traditional warm up routines before running were soon ditched in favour of just jogging the first five minutes.

The case against static stretching before a run was further weakened by recent research that suggests it reduces the natural leg stiffness that is required for running efficiency. As the foot makes contact with the ground, this stiffness is said to absorb energy and use it to spring forwards.

Researchers at Florida State University in 2010 showed that trained distance runners became about 5% less efficient and covered 3% less distance in a time trial if they did static stretching before the run.

However, and this is the crunch, all of the above concerns static stretching, i.e. long-hold stretching (like touching your toes for 40 seconds). It is important to differentiate this from dynamic stretching, which involves controlled, repetitive sports-specific movements that mimic the way your muscles and connective tissues will need to stretch during your chosen activity, e.g. swinging your leg forwards 15 times.

A follow up study by Florida State University stated that there is no evidence that dynamic stretching before a run inhibits performance.

Dynamic stretching as a warm-up

Let’s look at an example: one of the major components of an efficient running stride is having enough range of movement in the hip flexor to allow your leg to travel back behind you before your toe leaves the ground. A dynamic stretch that mimics this hip extension, e.g. a lunge, will reduce internal resistance whilst running and improve the efficiency of your stride.

Given that many of us have tight hip flexors due to sitting down all day, a controlled dynamic stretch that progressively increases range of movement in the hip before we start running can help us run more efficiently with better form.

Although there is no evidence that one particular “running style” will reduce injury rate (no one-size-fits-all remedy), certain biomechanical inefficiencies associated with poor running form can be linked to reoccurring injury (more on that next week).

Preparation for efficient running form cannot be achieved by simply preceding your run with a five minute jog.

In being active and challenging, dynamic stretching will also promote the other well documented physical and mental benefits associated with a warm up.

What dynamic stretching should I do?

Which and how much dynamic stretching you do in your warm up will depend on your fitness level and the type of running you plan to do.

You will find many examples online but as always we suggest you consult a professional before embarking on a new exercise routine. The main message I want you to get from this article is that you do something!

I personally am a huge fan of progressive lunges before embarking on a run. Elite running coach Jay Johnson demonstrates physical therapist Gary Gray’s “Lunge Matrix” in the link below, describing it as “quintessential, elemental and fundamental to staying healthy as a runner.” He stresses that “you do this the FIRST thing when you get out of the car.”

Here is a summary of the “Lunge Matrix” seen on the video. You can also purchase the Lunge Matrix as part of Jay’s excellent Building a Better Runner DVD series.

For each version, Coach Jay recommends five lunges are performed on each leg (10 in total).

1. Front Lunge

stretching for runners_front lunge

In this lunge, you are preparing for forwards & backwards movement (the sagittal plane). The front knee needs to stay in alignment with the front foot (same goes for back knee & back foot), but there is often debate as to whether the front knee should pass the toes. Personally, I see stopping the front knee from passing the toes as a way of helping quad dominant runners from using the posterior muscles more, discouraging excessive arching of the lower back and getting a better stretch in the all too often tight hip flexors.

2. Front lunge with a twist

stretching for runners_lunge with twist

The action of twisting over the front leg (moving your body through the transverse plane) increases the stretch in the hip flexor of the back leg. By challenging your balance it engages the core (including the glutes) and increases proprioception (your body’s ability to sense movement within joints and joint position). It will take some practice so break it down into stages.

3. Side lunge

stretching for runners_lateral lunge

This lunge moves your body through the frontal plane and in doing so targets the abductors and hip-stabilizing muscles. Aim to keep the fixed leg straight. Personally, I recommend rotating the lifted foot out to 45 degrees so that the knee moves in line with the foot.

4. Back and to the side Lunge

stretching for runners_side lunge

With this lunge, the traveling back foot turns 90 degrees to the side, again allowing the knee to move in alignment. By traveling in a combination of the frontal plane and sagittal plane, you are preparing for the often forgotten rotational demands of running.

5. Backward lunge

stretching for runners_backward lunge

The backwards lunge is more challenging than the others but in essence involves the same muscle movement sequencing that is needed in running. It demands more core stability, hip extension and glute recruitment than the other lunges, decreasing hip and ankle stiffness. Or as Coach Jay says “…a great way to explain to your butt that you’re about to use it.”

Where do we go from here?

Like I say, there are plenty of sources for dynamic stretching on the internet: ankle rolls, toe pumps, leg swings, single leg deadlifts, etc. Sourcing is not the issue.

The issue is ensuring you avoid the massive temptation to miss it out before you run. You will come up with every excuse under the sun: “It’s too cold,” “I don’t have time,” “I’ll do extra tomorrow to make up for it.” It’s just five minutes people!  Believe me, it will create focus, readiness, and mark the beginning of fewer injuries & improved running performance.

I look forward to hearing which dynamic stretching exercises you add to your warm up. If you are struggling to source links, ask in the comments section and either I or another reader will be happy to help. Happy running!

Matt PhilipsMatt Phillips is a Run Conditioning Coach, Video Gait Analyst & Sports Massage Therapist with over 20 years experience working within the Health & Fitness Industry. Follow Matt on Twitter. For more great training, injury prevention and nutrition advice, be sure to check out the RunnersConnect blog. If you’re in the market for a personal coach then it’d be worth checking out their coaching service as well.

Choosing the Right Running Shoes

A Look at How Trainers Affect Training and Running Performance

Guest blog by Matt PhillipsRunnersConnect

running shoesFollowing last week’s article “Foot Types & Foot Wear,” I have had quite a few runners ask me the same question, with words to the effect of: “Ok, if the whole overpronation shoe model thing has no evidence, what the hell do I run in!?”

A very good question! But first things first…

Why do we need running shoes at all?

Relax, I’m not going to start preaching about barefoot running (although I’m not going to dismiss it either). But in order to discuss how we decide which trainers are suitable for us, it is useful to re-evaluate exactly what we are buying them for.

With that in mind, over the last couple of days I have been asking the runners I meet what they are looking for when they buy trainers. Collectively, the majority of them produced the following three reasons: protection,supportcushioning.

Protection

If by protection we are referring to avoiding glass & syringes, then wearing something on our feet obviously makes sense. This may well be the main contributing factor as to why, at least in my experience, it is rare to see runners training or racing in no shoes on at all.

Many of us could probably find less hazardous routes on which to entertain the theoretical benefits of barefoot running, but until clearer evidence supports such theories, most of us will probably pass.  However, if we’re talking about protection from running on hard surfaces then we are essentially looking at cushioning (more on that shortly).

Support

By support, most people are referring to stopping the medial arch of the foot “collapsing,” which brings us back to the whole supination/neutral/pronation paradigm used by most running shops to prescribe you a “suitable” trainer after watching you walk or run for a couple of minutes (or in some cases just standing you on a pressure pad, which in itself has no connection to how your foot acts whilst running). I am sure you are already familiar with the process:

  • If the arch of your supporting foot drops “too much” you are labelled an “overpronator” and assigned a motion-control shoe that will in theory reduce the “overpronation”.
  • If your arch does not drop “enough”, you are said to be an underpronator (or supinator), and assigned a flexible, cushioned shoe to absorb some of the shock that underpronator is said to cause.
  • If you are somewhere in the middle, you are said to have normal pronation and are recommended a “neutral” shoe that in theory provides just the right amount of stability and cushioning.

As we saw last week, this model is heavily flawed and unsupported to date by any evidence. It is important not to let fear of injury or promises of recovery persuade you to be herded into one of the three pens (motion control, stability or neutral) however persuasive the sheepdog/sales person may be!

Cushioning

If you regularly run on hard surfaces like pavements, tracks and treadmills, you would think cushioning makes sense. Running shops can be very quick to stress this point if they “see” you as a heel striker. And yet, studies show (Scott, 1990) that peak loads at typical sites of injury for runners (Achilles, knees, etc.) actually occur during midstance (when your bodyweight passes over the supporting leg) and toe off (when your back leg pushes away from the ground).

These studies suggest that impact force at heel contact has no effect on the peak force seen at typical injury sites.

There is also growing evidence that when faced with higher impact forces from a harder running surface, your body makes natural adjustments to deal with the change in impact force – changes in joint stiffness, changes in the way the foot strikes the ground, and also via a concept called “muscle tuning” (pre-activation of muscles prior to impact).

Based on information received visually and from the previous foot strike, the body adjusts how strongly the muscles in your leg contract before the foot hits the ground again. Imagine jumping on a trampoline – your legs naturally stiffen in preparation for the soft landing.

Now imagine yourself jumping onto concrete – your legs naturally become less stiff in preparation for the hard landing. This natural adjustment is the result of sensory feedback from not only the eyes but also from the feet. In other words, the theory is that sensory feedback from the feet following one foot strike helps prepares the body for the next foot strike. If this is indeed the case, could excessive cushioning at the bottom of a trainer inhibit this natural sensory feedback?

Cushioning & injury prevention

The role that impact actually plays in running injuries is not at all clear. Studies by two highly respected biomechanics researchers, Dr. Irene Davis (Director of the Running Injury Lab, University of Delaware) and Dr. Benno Nigg (Co-Director of the Human Performance Laboratory, University of Calgary) have produced contrasting results.

Whilst Dr. Davis’ research links high impact loading rates with plantar fasciitis and tibia stress fractures, Dr. Nigg has found that overall injury rates are slightly lower among runners with high impact loading rates.

One possible interpretation of the above is that leg stiffness, as we considered earlier, is an important factor with certain injuries. Dr. Davis’ research linked runners who had suffered tibia stress fractures with higher impact forces and higher leg stiffness.

If tibia stress fractures are a consequence of high leg stiffness (for which I hasten to add there is as yet no evidence) then maybe runners susceptible to them should try wearing a less cushioned shoe and run on harder surfaces.

Just as we saw in our “landing on concrete” example earlier, in preparation for the harder surface, the body will reduce leg stiffness, which if the theory is correct could reduce susceptibility to tibia stress fractures.

At this stage it is all theory, and I draw particular attention to the words “maybe” and “try”. Always introduce changes slowly and gradually! Give your body a chance to tell you how it feels about the change before you do any harm to yourself!

So what trainers should I buy?

For those of you still clinging onto the hope that I or indeed anyone is going to be able to give you a structured model for trainer selection, I should probably put you out of your misery. There is no model. But do not despair. See it as liberation as opposed to a hindrance.

Yes, some people are recommended trainers and their injury disappears, but plenty are given the same advice and the injury continues. The journey to injury free running is best started with acceptance & application of the following mantra, as used by running coach James Dunne of Kinetic RevolutionForm Before Footwear.

As far as trainer selection goes, Pete Larson, anatomy professor, writer & runner with self diagnosed shoe obsession sums it up nicely: “I can run in just about anything as long as I’m careful to take things slowly and listen to my body.”

This is what I mean by “liberation.

Part of Pete’s Running Shoe Collection, 2010. (Photo Courtesy of P. Larson)

Part of Pete’s Running Shoe Collection, 2010. (Photo Courtesy of P. Larson)

In my opinion, one of the best things to so far emerge from the barefoot debate is the much larger variety of designs of shoe you can now choose from.

Having seen that heavy cushioning is not necessarily helpful to everybody, you should now hopefully be more confident to test, for example, some lighter trainers. Again, the secret is experimenting to see what feels comfortable for you. Bear in mind that a trainer that suits you for one distance, terrain or speed may not work as well for another.

You could also try trainers with a slightly lower Heel-Toe Drop than you are used to (the difference in height between the heel and the forefoot).

Traditional running shoes have a heel-toe drop of about 12mm. Vibram Fivefingers have pretty much a drop of 0mm. Going straight from 12mm to 0mm is not taking things slowly or listening to your body! There are plenty of 6-10mm transitional trainers on the market which will allow you to experiment more gently.

Though there is as yet no direct evidence for benefits of a lower drop, I personally see much logic in the argument that exposing your feet and legs to varying forces (in a controlled, sensible manner) could potentially make you a stronger runner and reduce injury.

Remember to listen to your body

If you run too far, too often, or too fast in a new pair of trainers, your body will let you know. Many of the running injuries we see in clinic are linked to a runner buying a new pair of trainers and thinking they can pick up their training program from where they left off. It’s more than that. Most runners actually run faster or further the first time they put on their new trainers (we all love new toys!).

  • It is vital to respect the fact that your body will often need time to adjust to a new style of trainer. Put on a minimalistic shoe for the first time and run too far and your calves will soon let you know about it! It’s all about taking it slowly and listening to your body.
  • If you experience a slight discomfort, treat it as a thoughtful message from your body that you need to break the new trainers in a little more gently. Put them away for a while. Go back to your favourite trainers then re-test the new ones with reduced time or intensity.
  • Obviously, if the pain is persistent and affects your running whilst wearing other footwear then get it checked out by a professional, but in my experience most running injuries are the result of either ignoring a warning sign (not listening to the body) or too quick an escalation in frequency, intensity or time.

It may be the shoes, but it’s more likely to be you pushing yourself too much, too soon. Which brings me to my next point…

Use more than one pair of trainers

In order to break in new trainers, you will need to have your all time favorites at hand to wear in between. Your body will warn you if you are doing too much in your new trainers. Listen to it. Put them away for a week, continue with your regular trainers, then go back to the new ones.

Many runners I work with report that exposing their legs & feet to different forces via rotating the trainers they run in leads to (or at least coincides with) less injury. Given that the majority of running injuries are the result of repetitive strain, mixing it up kind of makes sense (and that goes for running surfaces as well). Invest in a few pairs of different style trainers – the chances are you will get your money back by less need for injury treatment!

Have you experienced success by changing to a new style of trainer? Maybe you already rotate different style trainers as part of your running program? We are always keen to hear from you and look forward to reading your comments.

Happy running!

Matt Phillips is a Run Conditioning Coach, Video Gait Analyst & Sports Massage Therapist with over 20 years experience working within the Health & Fitness Industry. Follow Matt on TwitterAnd for more great training, nutrition, maintenance info, check out the RunnersConnect blog.

Injury Prevention: Footwear & Foot Type

The Impact of Footwear and Foot Type on Injury Prevention

Guest blog by Matt Phillips, RunnersConnect

footwearAlways Evolve” – one of my favourite valedictions used by esteemed physical therapist and blogger Mike Scott, DPT at the end of posts in his weekly series “Educainment.

Running has certainly seen some evolution of thought over the last few years, much of it following the publication in May 2009 of Christopher McDougal’s best seller Born To Run, bringing with it bold claims that running barefoot (or wearing something as close as possible to barefoot while protecting you from environmental elements) can strengthen your feet, reduce running injuries, encourage proper running form, and improve performance.

Until then, the only experience many of us had of barefoot running was seeing the South African teenager Zola Budd on our television sets, running barefoot in the women’s 3000 meter race at the 1984 Los Angeles Olympics.

Barefoot running

Whilst some runners have praised a transition to barefoot running (along with the typical shift to forefoot striking that barefoot running encourages) as a cure for an injury they were suffering, others have not been so fortunate and have seen it bring the onset of new injury, despite religiously following a slow, progressive transition period.

Clinical tests to date have also produced conflicting results. Barefoot running has been seen to reduce the risk of certain running related injuries, but increase the risk of others. It’s as if what works for some does not necessarily work for others. Sound familiar?

Regardless of personal experience, production of conclusive evidence for the benefits of barefoot running is still an ongoing project.

Minimalistic footwear

The increased profile and interest in barefoot running brought with it demand for less restrictive, less cushioned footwear, with the idea of allowing the foot to move and work in a more natural fashion whilst still providing a certain amount of protection.

As a result, today there is a wide spectrum of minimalistic footwear that, though not as extreme as barefoot style shoes like the Vibram FiveFingers, typically aim to provide less drop (difference between heel height and toe height), less cushioning, a wider toe box (more room for the toes) and more flexibility.

Like barefoot running, conclusive evidence for the benefits of minimalistic footwear is still a work in practice. A 2012 review in the Journal of Strength & Conditioning titled: “Running Barefoot or in Minimalist Shoes: Evidence or Conjecture?” concluded:

Running barefoot or in minimalist footwear has become a popular trend. Whether this trend is supported by the evidence or conjecture has yet to be determined.

Traditional footwear

Before any of you take “lack of conclusive evidence” as a reason to dismiss the possible benefits of barefoot running or minimalist shoes, I should point out – and this may come as a shock to you – that there is no evidence either that traditional running shoes can reduce injury or improve running performance.

Yes, you read that right. Though you were maybe told in the sports shop that your cushioned, stability or motion control trainer will help prevent injury, there is no evidence to support it. The problem is, the model that has been used for the last sixty years and more often than not is still used to help you select which trainers suit you is based on, well… not a lot.

Foot types

If you have ever been to a sports shop to buy a pair of running shoes (or have received an “ankle-down” gait analysis), chances are you are familiar with the diagram below, or something very similar. It links three “foot types” (based on the height of the medial arch) with three corresponding types of recommended running shoe:

RC6_FootTypes

The origin of the idea to group feet according to the height of the medial arch is not clear. Ian Griffiths, Director of Sports Podiatry Info Ltd suggests it may stem from a method of assessing footprints devised in 1947 by Colonel Harris and Major Beath as part of an Army foot survey. The first time an image associating medial arch height with shoe type actually appeared in print could have been the 1980 “The Running Shoe Book” by Peter R Cavanagh.

RC6_RunningShoeBook

What we do know is that since 1980, running shoes all over the world have been recommended and sold using the Foot Type model. Selection typically follows an “assessment” (often involving the subject stepping onto a pressure pad or being filmed from the ankle down whilst running) of how much the medial arch drops (referred to in the diagram as “pronation”) or doesn’t drop (“supination”), along with the idea that somewhere in the middle (“neutral”) is normal, healthy and necessary for injury prevention (more on that later).

  • If the arch of your supporting leg drops “too much”, you are labelled an “overpronator” and assigned a motion-control shoe that will in theory reduce the “overpronation”. If your arch does not drop “enough”, you are said to be an underpronator (or supinator), and assigned a flexible, cushioned shoe to absorb some of the shock thatunderpronator is said to cause.
  • If you are somewhere in the middle, you are said to have normal pronation and are recommended a “neutral” shoe that in theory provides just the right amount of stability and cushioning. Leaving aside the question of who decides “how much” dropping is normal, it is important at this stage to remind ourselves that both pronation and supination are naturalintegral parts of foot biomechanics.

Dr Shawn Allen, Diplomate of American Board of Chiropractic Orthopaedists explains:

The foot is a biomechanical marvel. 26 bones and 31 joints, working together in concert to provide balance, stability, and locomotion. As we walk or run, the foot is supposed to go through a series of biomechanical changes, so that it can either adapt to the environment or become a rigid lever for propulsion. When these mechanisms fail, problems usually arise. When the heel hits the ground, the arch of the foot is supposed to partially collapse (pronation), so that the foot can adapt to the ground; in this position, it is flexible and “unlocked”. After the weight of the body passes over the foot, the arch is supposed to retract, and the foot becomes more rigid or “locked” (supination), so that you can use it to propel yourself forward. If the foot remains in pronation for too long, or does not supinate correctly, problems will develop over time.

Problems with assigning shoes according to degree of pronation

So, the running shoe recommendation model is based on the idea that at midstance, just before the full weight of the body passes over the foot, the best position of the subtalar jointis “neutral”, i.e. the foot perpendicular to the horizontal ground.

The argument is that this “neutral” position signifies optimum functioning of the foot, optimum pronation and supination. One problem with this is the fact that the subtalar joint has variable anatomy. In other words, function will vary from person to person, so the ‘optimum’ position to be in will also vary. Ian Griffiths explains:

Studies have shown that the structural anatomy of the human subtalar joint varies from person to person and it has also been shown that the location of the axis of the joint can and does vary from person to person; this will of course directly influence the magnitude of pronation and supination seen.  In light of this sort of evidence it seems odd that there would be an expectation that all individuals could or should function similarly or identically.”

Taking the above into consideration, it should come as no surprise that there is no data or evidence that suggests “neutral” STJ alignment is linked with injury and/or pain free running. One study examined 120 healthy individuals both non weight-bearing and weight-bearing. Not one subject conformed to the criteria of “neutral” alignment.

Is there any evidence that “over-pronation” increases injury?

Almost all studies to date on “over-pronation” have found no evidence that it increases the risk of injury. A 2010 study concluded that the prescription of shoes with elevated cushioned heels and pronation control systems tailored to an individual’s foot type was not evidence based.

Another piece of research suggested the running shoe model was overly simplistic and potentially injurious. In fact, in this research, every ‘overpronated’ runner put into a motion control shoe during a 13 week half marathon training programme reported an injury.

Craig Payne, DipPod MPH, University lecturer and famed Running Research Junkie points out that lack of evidence for linking overpronation to injury may well be down to the methods used to measure pronation:

The weakness of many of those studies is how they measured “pronation”; for example, some measure calcaneal eversion; some measure navicular drop; some do a footprint analysis; and some use a dynamic 3D kinematic analysis. The problem with that is that someone may be ‘overpronated’ on the measurement of one parameter and not ‘overpronated’ on another parameter.”

A study published this month by Teyhen DS. titled “Impact of Foot Type on Cost of Lower Extremity Injury” set out to determine the relationship between foot type and medical costs associated with lower extremity musculoskeletal injury, using a population of 668 healthy U.S. military healthcare beneficiaries in active military service for at least 18 months of the 31 month study.

It quantified level of pronation using the Foot Posture Index, a measurement of static foot posture that takes into account not one but multiple components that go into “overpronation”, devised by Dr Anthony Redmond, Arthritis Research Campaign Lecturer at the University of Leeds.

Whether static foot posture has much to do with foot posture whilst moving (e.g. running) is a discussion for another day. What the study did show is that of the 336 participants (out of the total 668) who sought medical care for lower extremity musculoskeletal injuries, a high percentage (no exact value available at this time) were those who had been listed as “extreme pronated feet” via the Foot Posture Index.

Future research will be needed to help see if degree of pronation via multiple component assessment (e.g. the Foot Posture Index) can be linked to injury. In the meantime, using just one component of “over-pronation” (e.g. medial arch height) to assign suitable footwear will continue to be a game of hit and miss.

Concluding considerations

  • Is the whole running shoe recommendation model based on misconception?
  • If it is, what model should be used, if any?
  • There are certifications out there teaching shop staff how to sell running shoes. What are they based on?
  • As a result of this debate, some are suggesting that runners should buy trainers based on “comfort” alone. Hard to imagine?

As I see it, just because an injury is present on someone with an “excessive” level of pronation (whatever that is…), it does necessarily mean that the level of pronation is the cause of the injury (correlation vs. causation).

It is imperative to consider and understand the biomechanics of the rest of the body (as well as foot posture) before reaching any conclusions. And even with all of that knowledge, it will still be a daunting task to be able to say “this is the running shoe you need!”

So, what should we base trainer recommendation on? A tricky question that we will consider next week. In the meantime, I am keen to know of your personal experience. What you are currently running in? What made you buy them? Have you managed to reduce injury via a change in footwear? Maybe a change in your footwear has led to an increase in injury? As always, I look forward to your comments!

Happy running!

Matt Phillips is a Run Conditioning Coach, Video Gait Analyst & Sports Massage Therapist with over 20 years experience working within the Health & Fitness Industry. Follow Matt on Twitter. And for more great training, nutrition, maintenance info, check out the RunnersConnect blog.

****UPDATE****

As luck would have it, Colbert interviewed Daniel Lieberman on the subject of barefoot running on last night’s show:

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