The following is some feedback from barefoot runner Ken Bob:
I enjoyed reading your post. Though it doesn't have any new information, it is a good round-up of the general issue.
I would add, that in the book, "Barefoot Runner"
http://runningbarefoot.org/?p=85
One of the reasons (may have been speculation on the part of the author) given for Abebe Bikila wearing shoes in the Tokyo Olympic Marathon, was so as not to dishonor his hosts, who presented him with the new shoes. I will be among the first to admit, that Abebe Bikila comes off as a bit naive in this account of his life.
As far as the arguments for support, or feedback - in engineering, any system that benefits from feedback, will be more stable than one that cannot sense it's own outcome. The problem I see with Robbin's and other's writings, is that they are written by doctors for doctors. Running barefoot is very simple. It provides precise feedback, via the thousands of nerve endings in our soles, that help us learn (if we take the time to listen) how to run more gently, and more efficiently.
As for runners who wear shoes because they have problems running barefoot... I suspect the opposite is more likely true, as many of the folks on my email group, have started running barefoot because they could no longer run with shoes. In our society, I suspect there are only a few who would give running barefoot a fair chance, until just these past few months, thanks to Christopher McDougall's book. The problem is, most of us have learned to run, without the benefit of the precise feedback from our soles, and so, if we simply step out of our shoes, and attempt to run the way we ran with shoes, which has in many folks, become a very strong habit, we will say, "Running barefoot hurts!" What we don't realize is that pain is trying to teach us to change the way we run. But, old habits are difficult to break, and few folks want to make changes in their lives, when they can simply pop a pill to kill the chronic pains they suffer from years of poor running technique. And most won't even try running barefoot, especially if it already hurts to run with shoes. So, I suspect, there are a great number of would-be runners, who have given up running, simply because the idea of running barefoot had not occurred to them, or they cannot imagine how it could possibly be better than with shoes.
While many of those who have given it a fair chance, like Barefoot Ted, who could not run more than a few miles with shoes, without severe pains in his knees, back, etc... Now, since he took the time to relearn HOW to run, while barefoot, has successfully completed, not just a few marathons, but also several ultra-marathons, up to 100 miles!
And Ted is not a rare exception, except for his interest in ultra-running and an eagerness to talk, both of which has given him some fame.
Some ten years earlier, there was another runner, who wanted to run, but had all sorts of knee and back pains whenever he tried any significant distance with shoes - and he had tried all sorts of shoes that were supposed to solve these problems. He found my web site, and being a registered nurse, was not only skeptical, but made it his mission to prove me wrong. Now we call him, "Barefoot Larry" and he has completed dozens of marathons, all barefoot.
Well, I could go on and on, but I think you might be better served by asking some specific questions, and I would like to express my gratitude that you, as a DPM, are actually showing an interest in this issue, for as a wise person once wrote, "Some will experience cognitive dissonance when their point of view is challenged." And for a long time, this has been our experience with foot doctors.
I am just another runner, who finding it difficult to run any significant distances in shoes, without ending up with bleeding feet ( I am a rarity in our society - one who never really adapted to running with shoes ), started the Running Barefoot web site, as a means of answering the many questions folks were asking me, anytime they saw, or heard about me running barefoot. I never intended to take on the shoe industry. But, I am happy if a few folks have begun questioning the accepted wisdom of seeking solutions from those whose business is to profit from the same solution. Now, I'm not opposed to making profit, after all, I too work for a living. However, I do believe we, as a society, need to be much more critical of marketing strategies, particularly, in realizing that they ARE marketing strategies, not necessarily gospel truth!
Have fun,
-barefoot ken bob
Tuesday, June 23, 2009
Friday, June 19, 2009
New Concepts In Stretching
Recently, a New York Times article summarized some research by the University of Nevada that concluded that static stretching for 30 seconds decreased muscular power of the hamstring and quadricep muscles of those that stretched before activity versus those that did not.1 The decrease was about 3%, minimal but not insignificant, particularly when fractions of a second can count in sprinting events. Vertical jumping height and torque were unchanged. Power is the application of work within a finite time. Torque is the application of force and does not require movement unlike work. Torque is the force you apply to a jam jar that is stuck. Work is what happens once you get the lid moving.. Similar reductions were found in the Achilles tendon in a previous study.2 Two other studies reported that strength was reduced up to one hour after static stretching.3
It is important to remember that athletes have different requirements depending on the sport and stretching should be sport specific. "Athletes typically include static stretching as a part of the warm-up, but the evidence is clear that this practice will decrease performance in sports that require explosive movements," said UNLV kinesiology professor and study co-author Bill Holcomb, who directs the university's Sports Injury Research Center. When I asked Bill Holcomb to elaborate on his conclusions he said “The type of stretching to warmup should be dynamic rather than static to prevent a reduction of power. Then, after activity and during the cool down, static stretching can be used to improve range of motion/flexibility for later performance.“ Warming up is also something that can be overdone at the expense of performance.
“There is a neuromuscular inhibitory response to static stretching,” says Malachy McHugh, the director of research at the Nicholas Institute of Sports Medicine and Athletic Trauma at Lenox Hill Hospital in New York City. The straining muscle becomes less responsive and stays weakened for up to 30 minutes after stretching. Another support to the idea of the inhibitory response is that the other side of the stretched leg has been shown to have less power. Stretching muscles while moving, on the other hand, a technique known as dynamic stretching or dynamic warm-ups, increases power, flexibility and range of motion. Muscles in motion don’t experience the inhibitory response. They instead get what McHugh calls “an excitatory message” to perform.
Much has been written about problems with ballistic stretching but dynamic stretching is different. Dynamic stretching consists of controlled leg and arm movements that extend to the limits of your range of motion. Ballistic stretches involve trying to force a part of the body beyond its range of motion. In dynamic stretches, there is no bouncing.
Flexibility is speed specific. There are two kinds of stretch receptors, one measures magnitude and speed and the other measures magnitude only. These receptors are also responsible for the stretch reflex, our body’s protective mechanism, which counters in the opposite direction to the part being stretched. This also explains why it doesn’t make sense to static stretch prior to dynamic activity. There is considerable but not complete transfer of static stretching to dynamic stretching.4 In another study that looked at static stretching done not in close proximity to testing, on groups that were doing no other training regimen, the stretching group performed better. The author concluded that stretching in this manner could help bridge to a regular training regimen.5
Citing earlier studies, Stacy Ingraham, an exercise physiologist at the University of Minnesota, Twin Cities, says that, "When you stretch, you lengthen muscle fibers. It then takes longer for messages from the brain to travel through them. Stretched muscles also seem to be more sluggish than un-stretched ones. They don't spring back as readily. And every time you stretch, you may be tearing your muscle fibers a tiny bit."
The epidemiology program office at the Centers for Disease Control and Prevention conducted a study that reviewed 361 research studies on stretching. The results indicated that stretching increased flexibility but this did not decrease injury rates. Injury rates were higher for both the most flexible and least flexible study participants than for those in the mean.6 I have talked with athletes and yoga instructors about overstretching before explosive sports such as soccer and the possibility of too much laxity creating instability and a setup for injury. This would likely hinge on the flexibility of the athlete at baseline. Witvrouw et al believe that part of these contradictions in injury rates of studies can be explained by considering the type of sports activity in which an individual is participating. “Sports involving bouncing and jumping activities with a high intensity of stretch-shortening cycles (SSCs)(e.g. soccer) require a muscle-tendon unit that is compliant enough to store and release the high amount of elastic energy that benefits performance in such sports. If the participants of these sports have an insufficient compliant muscle-tendon unit, the demands in energy absorption and release may rapidly exceed the capacity of the muscle-tendon unit. This may lead to an increased risk for injury of this structure.” They add that recent studies have shown that stretching programs can significantly influence the viscosity of the tendon and make it significantly more compliant for the rigors of high intensity sports.7
How do these findings relate to some of our concepts of treatment? In 2002, Lance Barry, DPM reviewed static gastrocnemius-soleus stretching versus night splints in the treatment of plantar fasciitis. He found that the night splint group had a significantly reduced recovery time. The idea of putting the fascia at physiologic tension versus stretching the gastrocnemius had more of an impact on improving plantar fasciitis. Immobilization, a time honored strategy is part of the treatment with night splints. The splints that extended the toes, in this case the Strausberg Sock, had better results than the other splints although this variable was not part of the study design.8The parallel between these studies is that muscle static stretching just prior to activity does not promote better sports performance and runner's style static standing stretching for plantar fasciitis may damage the fascia and delay healing.
Naturally, there are many variables to consider when determining the best options for athletes and our patients regarding stretching. The evidence leans towards more dynamic stretching as part of a warm up routine in lieu of static stretching immediately prior to activity.
1.Samuel, MN, Holcomb, WR, Guadagnoli, MA, Rubley, MD, and Wallmann, H. Acute effects of static and ballistic stretching on measures of strength and power. J Strength Cond Res 22(5): 1422-1428, 2008
2.Rosenbaum, D. and E. M. Hennig. 1995. The influence of stretching and warm-up exercises on Achilles tendon reflex activity. Journal of Sport Sciences vol. 13, no. 6, pp. 481–90.
3. Fowles, JR DG Sale, JD MacDougall - Journal of Applied Physiology, 2000 - Am Physiological Soc. Vol. 89, Issue 3, 1179-1188, September 2000 Reduced strength after passive stretch of the human plantarflexors
Kokkonen et al. (1998) Research Quarterly for Exercise and Sport
4.Kurz, Tomas, Science of Sports Training, page 236
5.Kokkonen AG Nelson,C Eldredge, JB WInchester - Medicine & Science in Sports & Exercise , 2007 1831. Chronic Static Stretching Improves Exercise Performance.
6.Pope, RP, Herbert, RD, Kirwan JD, Graham, BJ A randomized trial of preexercise stretching for prevention of lower- limb injury. Medicine and Science in Sports and Exercise. 2000; 32:271-277.
7.Witvrouw E, Mahieu N, Danneels L, et al. Stretching and injury prevention: an obscure relationship. Sports Med 2004;34:443-449
8. Barry, Lance D. DPM et al. "A Retrospective Study of Standing Gastrocnemius Soleus Stretching versus Night Splinting in the Treatment of Plantar Fasciitis," The Journal of Foot and Ankle Surgery, Volume 41, Number 4, July/August 2002.
It is important to remember that athletes have different requirements depending on the sport and stretching should be sport specific. "Athletes typically include static stretching as a part of the warm-up, but the evidence is clear that this practice will decrease performance in sports that require explosive movements," said UNLV kinesiology professor and study co-author Bill Holcomb, who directs the university's Sports Injury Research Center. When I asked Bill Holcomb to elaborate on his conclusions he said “The type of stretching to warmup should be dynamic rather than static to prevent a reduction of power. Then, after activity and during the cool down, static stretching can be used to improve range of motion/flexibility for later performance.“ Warming up is also something that can be overdone at the expense of performance.
“There is a neuromuscular inhibitory response to static stretching,” says Malachy McHugh, the director of research at the Nicholas Institute of Sports Medicine and Athletic Trauma at Lenox Hill Hospital in New York City. The straining muscle becomes less responsive and stays weakened for up to 30 minutes after stretching. Another support to the idea of the inhibitory response is that the other side of the stretched leg has been shown to have less power. Stretching muscles while moving, on the other hand, a technique known as dynamic stretching or dynamic warm-ups, increases power, flexibility and range of motion. Muscles in motion don’t experience the inhibitory response. They instead get what McHugh calls “an excitatory message” to perform.
Much has been written about problems with ballistic stretching but dynamic stretching is different. Dynamic stretching consists of controlled leg and arm movements that extend to the limits of your range of motion. Ballistic stretches involve trying to force a part of the body beyond its range of motion. In dynamic stretches, there is no bouncing.
Flexibility is speed specific. There are two kinds of stretch receptors, one measures magnitude and speed and the other measures magnitude only. These receptors are also responsible for the stretch reflex, our body’s protective mechanism, which counters in the opposite direction to the part being stretched. This also explains why it doesn’t make sense to static stretch prior to dynamic activity. There is considerable but not complete transfer of static stretching to dynamic stretching.4 In another study that looked at static stretching done not in close proximity to testing, on groups that were doing no other training regimen, the stretching group performed better. The author concluded that stretching in this manner could help bridge to a regular training regimen.5
Citing earlier studies, Stacy Ingraham, an exercise physiologist at the University of Minnesota, Twin Cities, says that, "When you stretch, you lengthen muscle fibers. It then takes longer for messages from the brain to travel through them. Stretched muscles also seem to be more sluggish than un-stretched ones. They don't spring back as readily. And every time you stretch, you may be tearing your muscle fibers a tiny bit."
The epidemiology program office at the Centers for Disease Control and Prevention conducted a study that reviewed 361 research studies on stretching. The results indicated that stretching increased flexibility but this did not decrease injury rates. Injury rates were higher for both the most flexible and least flexible study participants than for those in the mean.6 I have talked with athletes and yoga instructors about overstretching before explosive sports such as soccer and the possibility of too much laxity creating instability and a setup for injury. This would likely hinge on the flexibility of the athlete at baseline. Witvrouw et al believe that part of these contradictions in injury rates of studies can be explained by considering the type of sports activity in which an individual is participating. “Sports involving bouncing and jumping activities with a high intensity of stretch-shortening cycles (SSCs)(e.g. soccer) require a muscle-tendon unit that is compliant enough to store and release the high amount of elastic energy that benefits performance in such sports. If the participants of these sports have an insufficient compliant muscle-tendon unit, the demands in energy absorption and release may rapidly exceed the capacity of the muscle-tendon unit. This may lead to an increased risk for injury of this structure.” They add that recent studies have shown that stretching programs can significantly influence the viscosity of the tendon and make it significantly more compliant for the rigors of high intensity sports.7
How do these findings relate to some of our concepts of treatment? In 2002, Lance Barry, DPM reviewed static gastrocnemius-soleus stretching versus night splints in the treatment of plantar fasciitis. He found that the night splint group had a significantly reduced recovery time. The idea of putting the fascia at physiologic tension versus stretching the gastrocnemius had more of an impact on improving plantar fasciitis. Immobilization, a time honored strategy is part of the treatment with night splints. The splints that extended the toes, in this case the Strausberg Sock, had better results than the other splints although this variable was not part of the study design.8The parallel between these studies is that muscle static stretching just prior to activity does not promote better sports performance and runner's style static standing stretching for plantar fasciitis may damage the fascia and delay healing.
Naturally, there are many variables to consider when determining the best options for athletes and our patients regarding stretching. The evidence leans towards more dynamic stretching as part of a warm up routine in lieu of static stretching immediately prior to activity.
1.Samuel, MN, Holcomb, WR, Guadagnoli, MA, Rubley, MD, and Wallmann, H. Acute effects of static and ballistic stretching on measures of strength and power. J Strength Cond Res 22(5): 1422-1428, 2008
2.Rosenbaum, D. and E. M. Hennig. 1995. The influence of stretching and warm-up exercises on Achilles tendon reflex activity. Journal of Sport Sciences vol. 13, no. 6, pp. 481–90.
3. Fowles, JR DG Sale, JD MacDougall - Journal of Applied Physiology, 2000 - Am Physiological Soc. Vol. 89, Issue 3, 1179-1188, September 2000 Reduced strength after passive stretch of the human plantarflexors
Kokkonen et al. (1998) Research Quarterly for Exercise and Sport
4.Kurz, Tomas, Science of Sports Training, page 236
5.Kokkonen AG Nelson,C Eldredge, JB WInchester - Medicine & Science in Sports & Exercise , 2007 1831. Chronic Static Stretching Improves Exercise Performance.
6.Pope, RP, Herbert, RD, Kirwan JD, Graham, BJ A randomized trial of preexercise stretching for prevention of lower- limb injury. Medicine and Science in Sports and Exercise. 2000; 32:271-277.
7.Witvrouw E, Mahieu N, Danneels L, et al. Stretching and injury prevention: an obscure relationship. Sports Med 2004;34:443-449
8. Barry, Lance D. DPM et al. "A Retrospective Study of Standing Gastrocnemius Soleus Stretching versus Night Splinting in the Treatment of Plantar Fasciitis," The Journal of Foot and Ankle Surgery, Volume 41, Number 4, July/August 2002.
Monday, June 8, 2009
Saul Raisin: Coma to Comeback Road to Ironman
I met Saul at the Clarendon Cup Bike Race this year and how could you not get drawn in by his story. I'm half way through his book and wanted to share some of his thoughts moving forward. Forget Tony Stark, Saul; you're the real Ironman, brother.
A little over three years ago I lay comatose in a French hospital. I almost lost my life. My massive brain injuries were the result of a high-speed bicycle crash. My parents stood at my bedside, trying to comprehend the prognosis. They were told by doctors that I could be possibly brain dead, if I was to live they needed to find a nursing home to put me in because I would need special health care assistance the rest of my life. At the time I am told that I was the youngest team leader ever in the Sport of Cycling. At the age of 23 my future in cycling could not have been brighter. In the blink of an eye my world changed. In that same instant, though I couldn’t possibly comprehend it at the time, my life gained real purpose.
Doctors have called my recovery miraculous. Within the last three years I’ve raced in the US Pro Cycling Championship, run the New York City Marathon,Married and Divorced within 8 months, and competed in several Triathlons. I told my friends and family when I was in the hospital if I ever lived a normal life again that I wanted to give back and help people like me. Now I have started the Raisin Hope foundation and I’ve written a book to let others know that they are not alone. If I am not giving motivational speeches to crowds numbering in the thousands, or competing in Triathlons, I plan on spending time with our Wounded Soldiers from the war. In short, my experiences have gone beyond the impossible. This year my goal is to be the first person to come back from a Brain Injury as severe as mine and complete the Ironman in Hawaii.
To find out more about Saul's story check out :
www.raisinhope.org = my foundation
What advice do you have for someone who has suffered an injury taking them of the bike a while in terms of building back up stamina & strength?
Take time and do not panic to get back into good form. Good condition is not something you can rush. I find that it is best to accept the condition you are in and use that to learn about yourself and improve as a person.
Where are you currently in your training for the Ironman
Georgia and Philadelphia
What sort of diet did you have which helped you recover?
I do not think my Diet helped in my recovery. I was 125lbs after my coma and I gained 50lbs in the hospital. My resting metabolic rate they calculated at 13,000 calories a day because of high temperatures and my brain trying to heal it's self. . I was eating 3 times a day put snack in-between.
What do you like about what Lance has done for the sport. Is there anything you would do differently that you are comfortable to say?
He has given millions of people hope. His comeback from cancer is inspiring and shows others that you can over come obstacles in life no matter how big they are. The only thing I would have done different is won the Tour de France on a French team.
Do you feel the sport has cleaned up the way it should?
It is getting better. Because of the longitudinal testing of the French riders and blood passports where they look for changes in blood chemistry it is impossible to take performance enhancing drugs in the sport. As a spectator you can rest assured that in the Tour de France is 100% clean and guys that try to cheat will get caught.
What is your view of North American bike racing today?
Cycling is growing and I hope is going to continue to grow.
What do you eat and drink while racing during event?
Gu H20, Gu Roctane gel(best gel in the market), GU Chomps Energy Chews
What is your back strengthening regimen?
Sit-ups, push-ups, very light weights.
How are you getting the message out on our Vets from Iraq.
As far a our vets. The deal is this is the first war were we are able to save the lives
of our VETS from injuries in all previous wars would have killed them. Because of this
it is creating tens of thousands of them with TBI and other disabilities that they
will take with them their whole lives. The disabilities are so sever the government is
over whelmed and is doing every thing in its power to get them the care they need.
The thing is that the Government is trying to build state of the art brain injury rehab centers
but there are not really in place much less can handle the needs of the thousands already with
brain injuries. It is sad to say that it has taken this war to get the governments attention on how
sever a brain injury it. As far as the American public, they pick up my book and
read the book jacket about a kid who came back from a life treating brain injury. But yet
they do not know how substantial that it. I believe it will be five years after the war when it
hits America how severe a brain injury is and the devastation we have done. This war will affect the lives of hundreds
of thousands of people. I am in a state of panic trying to raise awareness for brain injury and our wounded
warriors.
A little over three years ago I lay comatose in a French hospital. I almost lost my life. My massive brain injuries were the result of a high-speed bicycle crash. My parents stood at my bedside, trying to comprehend the prognosis. They were told by doctors that I could be possibly brain dead, if I was to live they needed to find a nursing home to put me in because I would need special health care assistance the rest of my life. At the time I am told that I was the youngest team leader ever in the Sport of Cycling. At the age of 23 my future in cycling could not have been brighter. In the blink of an eye my world changed. In that same instant, though I couldn’t possibly comprehend it at the time, my life gained real purpose.
Doctors have called my recovery miraculous. Within the last three years I’ve raced in the US Pro Cycling Championship, run the New York City Marathon,Married and Divorced within 8 months, and competed in several Triathlons. I told my friends and family when I was in the hospital if I ever lived a normal life again that I wanted to give back and help people like me. Now I have started the Raisin Hope foundation and I’ve written a book to let others know that they are not alone. If I am not giving motivational speeches to crowds numbering in the thousands, or competing in Triathlons, I plan on spending time with our Wounded Soldiers from the war. In short, my experiences have gone beyond the impossible. This year my goal is to be the first person to come back from a Brain Injury as severe as mine and complete the Ironman in Hawaii.
To find out more about Saul's story check out :
www.raisinhope.org = my foundation
What advice do you have for someone who has suffered an injury taking them of the bike a while in terms of building back up stamina & strength?
Take time and do not panic to get back into good form. Good condition is not something you can rush. I find that it is best to accept the condition you are in and use that to learn about yourself and improve as a person.
Where are you currently in your training for the Ironman
Georgia and Philadelphia
What sort of diet did you have which helped you recover?
I do not think my Diet helped in my recovery. I was 125lbs after my coma and I gained 50lbs in the hospital. My resting metabolic rate they calculated at 13,000 calories a day because of high temperatures and my brain trying to heal it's self. . I was eating 3 times a day put snack in-between.
What do you like about what Lance has done for the sport. Is there anything you would do differently that you are comfortable to say?
He has given millions of people hope. His comeback from cancer is inspiring and shows others that you can over come obstacles in life no matter how big they are. The only thing I would have done different is won the Tour de France on a French team.
Do you feel the sport has cleaned up the way it should?
It is getting better. Because of the longitudinal testing of the French riders and blood passports where they look for changes in blood chemistry it is impossible to take performance enhancing drugs in the sport. As a spectator you can rest assured that in the Tour de France is 100% clean and guys that try to cheat will get caught.
What is your view of North American bike racing today?
Cycling is growing and I hope is going to continue to grow.
What do you eat and drink while racing during event?
Gu H20, Gu Roctane gel(best gel in the market), GU Chomps Energy Chews
What is your back strengthening regimen?
Sit-ups, push-ups, very light weights.
How are you getting the message out on our Vets from Iraq.
As far a our vets. The deal is this is the first war were we are able to save the lives
of our VETS from injuries in all previous wars would have killed them. Because of this
it is creating tens of thousands of them with TBI and other disabilities that they
will take with them their whole lives. The disabilities are so sever the government is
over whelmed and is doing every thing in its power to get them the care they need.
The thing is that the Government is trying to build state of the art brain injury rehab centers
but there are not really in place much less can handle the needs of the thousands already with
brain injuries. It is sad to say that it has taken this war to get the governments attention on how
sever a brain injury it. As far as the American public, they pick up my book and
read the book jacket about a kid who came back from a life treating brain injury. But yet
they do not know how substantial that it. I believe it will be five years after the war when it
hits America how severe a brain injury is and the devastation we have done. This war will affect the lives of hundreds
of thousands of people. I am in a state of panic trying to raise awareness for brain injury and our wounded
warriors.
Saturday, May 16, 2009
Knee Pain and Cycling
You ride your bike and and expect your knees to hold up - until they don't.
Knee pain for cyclists, previous injury notwithstanding, is usually not an isolated event; it is a process. We lose our health, knee joint included, one sand at a time until the point where we begin to notice it and do something to try and change the downward trajectory. Knee pain has truncated training rides, spoiled centuries and even ended cycling careers. But it doesn't have to - learn how to diagnose and prevent knee pain to keep cycling a part of your life for years to come.
What types of knee pain are common to cyclists?
Anterior knee pain which includes patellofemoral (also known as chondromalacia) is the most frequent type. Patellofemoral stress syndrome is an overuse injury that involves cartilage breakdown underneath the kneecap. Have you ever wondered why your knee makes crunching or popping noises going up or down steps? Often times this is a symptom of patellofemoral stress syndrome, because of an imbalance occurring above or below the knee. Some of this imbalance is caused by posture on the bike. Cycling positioning involves hunching forward and flexing your hips while in the saddle for long periods. If you are not fit to the bike properly this can exacerbate the problem. Other factors are muscle development distribution or a muscle strength deficit which can throw things off.
What causes knee pain in cyclists?
The knee can be affected by weakness of the gluteal external rotators which can lead to increased internal rotation of the leg and increase patellofemoral stress due to altered bony alignment. Cyclists typically have more developed calf and quadricep muscles than the average person. The vastus medialis is the tear drop shaped muscle that bulges out just above the inside of the knee and is usually well developed in cyclists, but if you have let riding go for a while or are new to the sport you can strengthen it with straight leg raises, lunges and dips or step downs with one leg going lower than the other while the other leg is on a block or stair. Other problems include muscle imbalances, excess motion in one or more joints, and leg length discrepancies. As we age a phenomena called cross linking occurs. This results in our tendons and ligaments being less flexible making them more susceptible to injury. Massage yoga and proper stretching can help minimize this. The body has a memory regarding injuries and sometimes it takes only a little more stress to setup for another injury episode.
Solution 1: Cycling Orthotics
A cycling orthotic can be made to compensate for problems that stem from too much motion occurring at the foot pedal junction.Not only can an orthotic decrease injuries but it can improve performance. This is accomplished by filling the dead space between your arch and the insole of your shoe so that energy is transferred directly to your pedal and not lost inside the cleat. An example of an imbalance which may be corrected is building lift on one side of an orthotic if there is leg length discrepancy. As a general rule, I usually compensate for half the difference of the discrepancy. Larger differences have to be adjusted in the crank arms or with shims. Another problem that can be addressed is excess motion, which can cause knee or arch pain. By placing a cant into a prescription for an orthotic, this force can be decreased. In cases where there are only minor issues over the counter insoles can sometimes be used.
Solution 2: Professional Bike Fitting
Bike fit issues and pedal selection may be the primary source or exacerbate existing knee problems. A saddle that is too high can lead to stress on the ITB, and patellofemoral loading can occur. If it is too low stress on the patella or quadriceps tendon can occur. If the seat is pitched too far forward stress on the anterior knee occurs because of too much flexion. If the saddle is too far back the ITB can be stretched because of the increased length. If the inside of your knee is bothering you and your clipless pedals have too little or no float, consider changing to a pedal with more float. If initial measures do not solve your problem a professional bike fit is in order. With this many moving - and connected - pieces, getting a professional opinion can not only increase your comfort and power, but also help ensure you can hammer for years to come.
Solution 3: Avoid the need for a Solution in the first place
Finally, try to control what you can. Keeping the knee warm in cooler weather is critical if you have any knee stiffness. Consider joining a yoga class or check out some yoga DVD's. Some people swear by glucosamine supplements to mininmize cartillage breakdown. Make sure you have no allergies to any of the components before you try glucosamine. If you have chronic swelling after exercise this may be a sign of more specific damage such as a meniscus defect or tear or internal ligament damage and a visit with your friendly neighborhood orthopedist is advised.
Remember that knee health is a process, not an event. Maintain your body more care than you put into your bike, because you probably use it more frequently and replacement parts aren't as easy to come by.
Knee pain for cyclists, previous injury notwithstanding, is usually not an isolated event; it is a process. We lose our health, knee joint included, one sand at a time until the point where we begin to notice it and do something to try and change the downward trajectory. Knee pain has truncated training rides, spoiled centuries and even ended cycling careers. But it doesn't have to - learn how to diagnose and prevent knee pain to keep cycling a part of your life for years to come.
What types of knee pain are common to cyclists?
Anterior knee pain which includes patellofemoral (also known as chondromalacia) is the most frequent type. Patellofemoral stress syndrome is an overuse injury that involves cartilage breakdown underneath the kneecap. Have you ever wondered why your knee makes crunching or popping noises going up or down steps? Often times this is a symptom of patellofemoral stress syndrome, because of an imbalance occurring above or below the knee. Some of this imbalance is caused by posture on the bike. Cycling positioning involves hunching forward and flexing your hips while in the saddle for long periods. If you are not fit to the bike properly this can exacerbate the problem. Other factors are muscle development distribution or a muscle strength deficit which can throw things off.
What causes knee pain in cyclists?
The knee can be affected by weakness of the gluteal external rotators which can lead to increased internal rotation of the leg and increase patellofemoral stress due to altered bony alignment. Cyclists typically have more developed calf and quadricep muscles than the average person. The vastus medialis is the tear drop shaped muscle that bulges out just above the inside of the knee and is usually well developed in cyclists, but if you have let riding go for a while or are new to the sport you can strengthen it with straight leg raises, lunges and dips or step downs with one leg going lower than the other while the other leg is on a block or stair. Other problems include muscle imbalances, excess motion in one or more joints, and leg length discrepancies. As we age a phenomena called cross linking occurs. This results in our tendons and ligaments being less flexible making them more susceptible to injury. Massage yoga and proper stretching can help minimize this. The body has a memory regarding injuries and sometimes it takes only a little more stress to setup for another injury episode.
Solution 1: Cycling Orthotics
A cycling orthotic can be made to compensate for problems that stem from too much motion occurring at the foot pedal junction.Not only can an orthotic decrease injuries but it can improve performance. This is accomplished by filling the dead space between your arch and the insole of your shoe so that energy is transferred directly to your pedal and not lost inside the cleat. An example of an imbalance which may be corrected is building lift on one side of an orthotic if there is leg length discrepancy. As a general rule, I usually compensate for half the difference of the discrepancy. Larger differences have to be adjusted in the crank arms or with shims. Another problem that can be addressed is excess motion, which can cause knee or arch pain. By placing a cant into a prescription for an orthotic, this force can be decreased. In cases where there are only minor issues over the counter insoles can sometimes be used.
Solution 2: Professional Bike Fitting
Bike fit issues and pedal selection may be the primary source or exacerbate existing knee problems. A saddle that is too high can lead to stress on the ITB, and patellofemoral loading can occur. If it is too low stress on the patella or quadriceps tendon can occur. If the seat is pitched too far forward stress on the anterior knee occurs because of too much flexion. If the saddle is too far back the ITB can be stretched because of the increased length. If the inside of your knee is bothering you and your clipless pedals have too little or no float, consider changing to a pedal with more float. If initial measures do not solve your problem a professional bike fit is in order. With this many moving - and connected - pieces, getting a professional opinion can not only increase your comfort and power, but also help ensure you can hammer for years to come.
Solution 3: Avoid the need for a Solution in the first place
Finally, try to control what you can. Keeping the knee warm in cooler weather is critical if you have any knee stiffness. Consider joining a yoga class or check out some yoga DVD's. Some people swear by glucosamine supplements to mininmize cartillage breakdown. Make sure you have no allergies to any of the components before you try glucosamine. If you have chronic swelling after exercise this may be a sign of more specific damage such as a meniscus defect or tear or internal ligament damage and a visit with your friendly neighborhood orthopedist is advised.
Remember that knee health is a process, not an event. Maintain your body more care than you put into your bike, because you probably use it more frequently and replacement parts aren't as easy to come by.
Saturday, March 28, 2009
Diagnosticc ultrasound is becoming an immediate way to evaluate injuries without having to be scheduled for an MRI in many cases
Saturday, March 14, 2009
Yoga for Cyclists
Cycling next to swimming, is one of the least damaging high
aerobic sports. Nevertheless, there are a few chronic injury syndromes that can occur while riding. Many of these problems can be avoided if you warm up properly and take a few minutes after you ride with an appropriate stretching regimen. This is critical if you are undergoing a fast-paced workout or hammering the hills.
The reason you warm up is to get blood moving to your extremities so that they can contract more efficiently. The muscles I recommend that cyclists stretch include the calves (gastrocnemius), the front upper leg muscles (quadriceps), the back upper leg muscles (hamstrings), and outer hip muscles (tensor fascia latae) and core work.
There are many cycling, running and fitness books and websites that have excellent diagrams of the proper stretches. Remember that some info may be dated and that dynamic stretching is currently supported by research. Gone are the days of holding a stretch for 20 seconds. The progressions today are focused on gaining stability as well as on stretching. Stretching after a workout is important because of the shortening, which occurs after a muscle has been vigorously contracted in physical activity. An even better solution is to take a yoga class.
Think of your core as the linchpin that is necessary for muscles to work efficiently that are rotating around it. When it is weak you will feel it particularly in your back and hamstrings. Boat pose (Paripurna Navasana) with extension and flexion of your legs is helpful along with Superman or Locust pose (Salambhasana)with opposite leg and arm extended. You can create sequences that will also help protect your knees such as going from chair pose to warrior 3 . Hip openers such as squatting with feet flat are great hip openers after the compression that occurs on long bike rides. Different sequences to stretch the illiotibial band such as making a figure 4 with your legs while on your back are essential.
Muscle imbalances are a potential problem area that can plague your cycling. This happens commonly with the bigger front thigh muscles (quadriceps) overpowering the hamstrings or the calf muscles overpowering the front muscles in the lower leg. A muscle strength and flexibility evaluation can identify these problems. Consult a sports medicine specialist if these initial steps do not resolve your discomfort.
aerobic sports. Nevertheless, there are a few chronic injury syndromes that can occur while riding. Many of these problems can be avoided if you warm up properly and take a few minutes after you ride with an appropriate stretching regimen. This is critical if you are undergoing a fast-paced workout or hammering the hills.
The reason you warm up is to get blood moving to your extremities so that they can contract more efficiently. The muscles I recommend that cyclists stretch include the calves (gastrocnemius), the front upper leg muscles (quadriceps), the back upper leg muscles (hamstrings), and outer hip muscles (tensor fascia latae) and core work.
There are many cycling, running and fitness books and websites that have excellent diagrams of the proper stretches. Remember that some info may be dated and that dynamic stretching is currently supported by research. Gone are the days of holding a stretch for 20 seconds. The progressions today are focused on gaining stability as well as on stretching. Stretching after a workout is important because of the shortening, which occurs after a muscle has been vigorously contracted in physical activity. An even better solution is to take a yoga class.
Think of your core as the linchpin that is necessary for muscles to work efficiently that are rotating around it. When it is weak you will feel it particularly in your back and hamstrings. Boat pose (Paripurna Navasana) with extension and flexion of your legs is helpful along with Superman or Locust pose (Salambhasana)with opposite leg and arm extended. You can create sequences that will also help protect your knees such as going from chair pose to warrior 3 . Hip openers such as squatting with feet flat are great hip openers after the compression that occurs on long bike rides. Different sequences to stretch the illiotibial band such as making a figure 4 with your legs while on your back are essential.
Muscle imbalances are a potential problem area that can plague your cycling. This happens commonly with the bigger front thigh muscles (quadriceps) overpowering the hamstrings or the calf muscles overpowering the front muscles in the lower leg. A muscle strength and flexibility evaluation can identify these problems. Consult a sports medicine specialist if these initial steps do not resolve your discomfort.
Tuesday, March 10, 2009
Barefoot Running
Mention barefoot runners and most people's first association is probably the legendary 1960 Rome marathon victory by Abebe Bikilla. To some advocates the conversation can get heated up quickly as if you were talking about politics. The fundamental question that has yet to be fully answered is whether one can accurately track a population of runners who are barefoot vs.shod.
Abebe Bikilla : Barefoot Icon
The story goes that Adidas who was the shoe sponsor for the games did not have any shoes that fit Bikilla by the time he trried on the shoes that were left. Bikilla decided to run the race barefoot as he had trained and won. Of his race he is quoted as saying that “I wanted the world to know that my country, Ethiopia, has always won with determination and heroism." . He did not repeat a barefoot run in 1964 in Tokyo. Part of this decision was attributed to the more industrialized roads in Tokyo. He also was recovering from an appendectomy 40 days prior and still managed to pull off a world record running this time in a pair of Asics.
Barefoot Running from the Savanna to the Track
Anthropologists such as Daniel Lieberman believe that the human foot developed to run barefoot. His hypothesis is that we were built for endurance running. He is doing a study with Vibram Shoes and is currently looking for barefoot runners. Prospective studies and randomized controlled trials of barefoot and shod running are difficult to achieve for obvious reasons. Robbins and Gouw argued that plantar sensation induces a plantar surface protective response whereby runners alter their behavior to reduce shock. The less-cushioned shoe permitted increases in plantar discomfort,a phenomenon that they termed "shock setting" Coaches such as Brooks Johnson and Vin Lananna have used barefoot running as part of an overall program to train the body to run long distances fast. In their opinion, to run properly, the foot needed to grasp and release on a variety of surfaces such as dirt, grass, road, concrete, and gravel.
The Shoe Industry Steps In
Several companies have weighed in with their versions of a running shoe which simulates barefoot running. Adidas approach was to try and copy the shape of the foot. In theory this will produce smaller lever arms which can react faster.The idea for the Nike Free was born out of a visit by a couple researchers to Stanford where Lananna was having athletes running barefoot as part of their training regimen. Many competitive runners I spoke to use barefoot running or shoes like the Nike Free as part of their training. Nike had students test it for 6 months and those using the the Free for 6 months had greater flexibility and strength in the foot. I interviewed Tobie Hatfield from Nike's Innovation Kitchen and Jeff Pisciotta from the Nike Sports Research Lab to find out how the shoe industry has incorporated the concept of barefoot training into their shoe design. They seem to be spearheading the shift back to their spirited roots to the old Bill Bauerman days when they made prototype soles on waffle irons. They studied 20 competitive runners on grass and kinematics analysis demonstrated a general trend towards full foot contact. If you watch the footage of Abebe Bikilla's Rome Marathon you will notice the same thing. The perception of some of the runners tested was that they were landing more towards the forefoot than they actually were. . Many believe that racing barefoot is difficult unless you have been running without shoes all your life. Many recreational runners are also starting to try barefoot running in an effort to prevent injuries and improve technique. The problem with this is that some of them will not have the conditioning to handle the transition to barefoot running. Experts in the field agree that any transition to barefoot running be done slowly.
The running shoe industry has built much of its platform on cushioning. In studies by Benno Nigg ,very soft shoes will bottom out when loaded, producing higher impact forces than firmer shoes that do not bottom out. Yet for any of us who have run downhill on concrete the more cushioned shoes seem to be less jarring so how do we reconcile this? I interviewed Benno Nigg, one of the foremost biomechanics gurus on running shoes and he was able to provide a new paradigm which he has published on. He started by telling me that there is no article in the literature which supports the notion that peak force transmission will be altered with varied levels of cushioning. In fact peak force transmission does not occur during heel contact as we might intuit but in midstance where the internal forces in joints muscles and tendons are 4 to 5 times greater than during impact There is something else that accounts for the perception that we are more comfortable in a certain level of cushioning. That something else is explained in Benno' Nigg's vibration model. When we impact the ground our soft tissue compartments (e.g. calf, hamstrings etc.) start to vibrate. However the human body does not like vibrations. Consequently, muscles are activated to dampen these vibrations. The degree of dampening that occurs in various types of shoes is what leads to our perception of comfort in the shoe. So we have an innate sense of what works for our bodies that is probably more accurate than any test could demonstrate for us. We must also consider the fatigue that occurs within the muscles that are working to distribute the vibrations. We know from other studies that fatigue can lead to injuries and this may be part of the answer we seek.
For runners such as Dave Watts,the director of the American Running Association things have come full circle. He relates that some of the early Tiger shoes he ran in in the 70's were not very beefed up in terms of cushioning. They resembled the more fashionable running shoes you see in boutiques in Brooklyn and West Hollywood. At one point he was running in orthotics prescribed for plantar fasciitis and a conventional running shoe. Now he gravitates towards shoes like the Free. The trend in the shoe industry seems to be toward offering more shoes with more minimalist designs. Keep in mind that for most runners barefoot training is good to train the small muscles that are not trained in stable running shoes.
It is hard to isolate all the force vectors because of the complex arrangement of the joints of the lower extremity. Robbins association between injury and wearing shoes has the possibility that wearing shoes increases the risk of injury, but other explanations are possible; for example, in developing countries barefoot runners may be too poor to seek medical attention, shod runners may wear shoes because they have problems running barefoot.
There appears to be a continuum of preference for barefoot running related to a runner's efficiency and abilities. Certainly runners that have grown up running barefoot in areas where it is more prevalent, like Kenya, have been conditioned to run more efficiently barefoot than more industrialized countries. Beyond that elite athletes are exceptional in their foot musculature and would have an easier time in general running barefoot than others.
A word about zealots on both sides of running barefoot vs shod. Some will experience cognitive dissonance when their point of view is challenged. This means that when presented with evidence contrary to their point of view they will tend to deny it or reframe the evidence as if it was part of their argument all along. We should remember this, otherwise we are no better than the iconic Dr. Zaius who held both the posts of both minister of science and defender of the faith, a conflict of interest that does not seek out answers, only support for our own preconceived views. It turns out for the answers are very individual and may not be what we expect.
Judah Tim, Bikila: Ethiopia's Barefoot Olympian
Barry Block DPM personal communication
Tobie Hatfield Jeff Pisciotta,personal communication
Benno Nigg Phd personal communication citations
Nigg, B. M. and Wakeling, J. M. Impact forces and muscle tuning - a new paradigm ESSR Exercise and Sport Sciences Review (29) 1 37-41, 2001
Nigg, Benno New Ideas and Concepts in sport shoe development
(Robbins and Hanna, 1987). ,
Robbins SE, Hanna AM (1987). Running-related injury prevention through barefoot adaptations. Medicine and Science in Sports and Exercise 19, 148-156
Robbins SE, Gouw GJ (1990). Athletic footwear and chronic overloading: a brief review. Sports Medicine 9, 76-85
Abebe Bikilla : Barefoot Icon
The story goes that Adidas who was the shoe sponsor for the games did not have any shoes that fit Bikilla by the time he trried on the shoes that were left. Bikilla decided to run the race barefoot as he had trained and won. Of his race he is quoted as saying that “I wanted the world to know that my country, Ethiopia, has always won with determination and heroism." . He did not repeat a barefoot run in 1964 in Tokyo. Part of this decision was attributed to the more industrialized roads in Tokyo. He also was recovering from an appendectomy 40 days prior and still managed to pull off a world record running this time in a pair of Asics.
Barefoot Running from the Savanna to the Track
Anthropologists such as Daniel Lieberman believe that the human foot developed to run barefoot. His hypothesis is that we were built for endurance running. He is doing a study with Vibram Shoes and is currently looking for barefoot runners. Prospective studies and randomized controlled trials of barefoot and shod running are difficult to achieve for obvious reasons. Robbins and Gouw argued that plantar sensation induces a plantar surface protective response whereby runners alter their behavior to reduce shock. The less-cushioned shoe permitted increases in plantar discomfort,a phenomenon that they termed "shock setting" Coaches such as Brooks Johnson and Vin Lananna have used barefoot running as part of an overall program to train the body to run long distances fast. In their opinion, to run properly, the foot needed to grasp and release on a variety of surfaces such as dirt, grass, road, concrete, and gravel.
The Shoe Industry Steps In
Several companies have weighed in with their versions of a running shoe which simulates barefoot running. Adidas approach was to try and copy the shape of the foot. In theory this will produce smaller lever arms which can react faster.The idea for the Nike Free was born out of a visit by a couple researchers to Stanford where Lananna was having athletes running barefoot as part of their training regimen. Many competitive runners I spoke to use barefoot running or shoes like the Nike Free as part of their training. Nike had students test it for 6 months and those using the the Free for 6 months had greater flexibility and strength in the foot. I interviewed Tobie Hatfield from Nike's Innovation Kitchen and Jeff Pisciotta from the Nike Sports Research Lab to find out how the shoe industry has incorporated the concept of barefoot training into their shoe design. They seem to be spearheading the shift back to their spirited roots to the old Bill Bauerman days when they made prototype soles on waffle irons. They studied 20 competitive runners on grass and kinematics analysis demonstrated a general trend towards full foot contact. If you watch the footage of Abebe Bikilla's Rome Marathon you will notice the same thing. The perception of some of the runners tested was that they were landing more towards the forefoot than they actually were. . Many believe that racing barefoot is difficult unless you have been running without shoes all your life. Many recreational runners are also starting to try barefoot running in an effort to prevent injuries and improve technique. The problem with this is that some of them will not have the conditioning to handle the transition to barefoot running. Experts in the field agree that any transition to barefoot running be done slowly.
The running shoe industry has built much of its platform on cushioning. In studies by Benno Nigg ,very soft shoes will bottom out when loaded, producing higher impact forces than firmer shoes that do not bottom out. Yet for any of us who have run downhill on concrete the more cushioned shoes seem to be less jarring so how do we reconcile this? I interviewed Benno Nigg, one of the foremost biomechanics gurus on running shoes and he was able to provide a new paradigm which he has published on. He started by telling me that there is no article in the literature which supports the notion that peak force transmission will be altered with varied levels of cushioning. In fact peak force transmission does not occur during heel contact as we might intuit but in midstance where the internal forces in joints muscles and tendons are 4 to 5 times greater than during impact There is something else that accounts for the perception that we are more comfortable in a certain level of cushioning. That something else is explained in Benno' Nigg's vibration model. When we impact the ground our soft tissue compartments (e.g. calf, hamstrings etc.) start to vibrate. However the human body does not like vibrations. Consequently, muscles are activated to dampen these vibrations. The degree of dampening that occurs in various types of shoes is what leads to our perception of comfort in the shoe. So we have an innate sense of what works for our bodies that is probably more accurate than any test could demonstrate for us. We must also consider the fatigue that occurs within the muscles that are working to distribute the vibrations. We know from other studies that fatigue can lead to injuries and this may be part of the answer we seek.
For runners such as Dave Watts,the director of the American Running Association things have come full circle. He relates that some of the early Tiger shoes he ran in in the 70's were not very beefed up in terms of cushioning. They resembled the more fashionable running shoes you see in boutiques in Brooklyn and West Hollywood. At one point he was running in orthotics prescribed for plantar fasciitis and a conventional running shoe. Now he gravitates towards shoes like the Free. The trend in the shoe industry seems to be toward offering more shoes with more minimalist designs. Keep in mind that for most runners barefoot training is good to train the small muscles that are not trained in stable running shoes.
It is hard to isolate all the force vectors because of the complex arrangement of the joints of the lower extremity. Robbins association between injury and wearing shoes has the possibility that wearing shoes increases the risk of injury, but other explanations are possible; for example, in developing countries barefoot runners may be too poor to seek medical attention, shod runners may wear shoes because they have problems running barefoot.
There appears to be a continuum of preference for barefoot running related to a runner's efficiency and abilities. Certainly runners that have grown up running barefoot in areas where it is more prevalent, like Kenya, have been conditioned to run more efficiently barefoot than more industrialized countries. Beyond that elite athletes are exceptional in their foot musculature and would have an easier time in general running barefoot than others.
A word about zealots on both sides of running barefoot vs shod. Some will experience cognitive dissonance when their point of view is challenged. This means that when presented with evidence contrary to their point of view they will tend to deny it or reframe the evidence as if it was part of their argument all along. We should remember this, otherwise we are no better than the iconic Dr. Zaius who held both the posts of both minister of science and defender of the faith, a conflict of interest that does not seek out answers, only support for our own preconceived views. It turns out for the answers are very individual and may not be what we expect.
Judah Tim, Bikila: Ethiopia's Barefoot Olympian
Barry Block DPM personal communication
Tobie Hatfield Jeff Pisciotta,personal communication
Benno Nigg Phd personal communication citations
Nigg, B. M. and Wakeling, J. M. Impact forces and muscle tuning - a new paradigm ESSR Exercise and Sport Sciences Review (29) 1 37-41, 2001
Nigg, Benno New Ideas and Concepts in sport shoe development
(Robbins and Hanna, 1987). ,
Robbins SE, Hanna AM (1987). Running-related injury prevention through barefoot adaptations. Medicine and Science in Sports and Exercise 19, 148-156
Robbins SE, Gouw GJ (1990). Athletic footwear and chronic overloading: a brief review. Sports Medicine 9, 76-85
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