Wednesday, June 18, 2008

my sports medicine blog

I've been a board-certified podiatrist since 1992. I ran track and cross country in high school followed by a short-lived track stint at Indiana University as a walk-on. When I injured my achilles tendon, I switched over to bike racing and tried my hand at IU's Little 500 Bike Race popularized in the 1970's hit movie "Breaking Away."

Years later, I tore my ACL playing soccer just before turning 40. I realized that I would need to take my conditioning much more seriously to avoid further injuries. So I sought out the best rehab protocols and programs out there today. Now I do my best to integrate everything I've learned into my state-of-the-art sports-medicine practice. I try to maintain an active lifestyle: a decade as a snow-ski instructor, road biking, conditioning, and yoga, all of which has allowed me to stay injury free for the past eight years. Part of the key to remaining healthy is ti incorporate your workouts into your daily commute.

I'll be sharing knowledge from my medical practice and my experience with athletes, information that will be useful for both the weekend warrior and more serious athlete: for training and living injury free. Stayed tuned in for special guests--friends and athletes with their own stories to tell. I welcome your feedback.

Evolution Running (Ken Mierke)

Evolution Running, a method developed by Ken Mierke, looks at the optimal biomechanics for the generation of horizontal propulsion,;the placement and foot position of foot-strike, as well as the timing of the propulsive movements, follow through and leg recovery.

10 Commandments of Evolution Running:
1st Commandment: Land with your foot directly beneath your center of mass.
2nd Commandment: Never let your foot extend forward beyond the knee.
3rd Commandment: Land on the balls of your feet and keep the heel unweighted throughout footstrike.
4th Commandment: Minimize contact time between your feet and the ground.
5th Commandment: At any running speed, maintain the same high turnover rate (180 – 182 steps per minute or higher).
6th Commandment: Maintain a straight line from the toes, through the hips, to the shoulders, but lean slightly forward with the hips and ribcage.
7th Commandment: Maintain a constant, slightly-bent, knee angle from just before to just after footstrike. Do not bend or straighten knee for propulsion.
8th Commandment: Begin to pull leg back, from the hip with a constant knee angle, before footstrike.
9th Commandment: Use quick, light movements, not forceful ones, to propel forward
10th Commandment: Immediately after the follow-through is completed, begin to drive the knee forward powerfully. As the knee drives forward, allow the foot to lag well behind during leg-recovery, using momentum, not muscular contractions, to raise the heel.
Like the other methods, Evolution Running teaches runners that the foot should land directly beneath the hips, not out in front. Evolution Running teaches a similar foot-strike to the Pose method, but focuses more heavily on placing the weight on the forefoot at foot-strike, without as much concern with heel contact. Many runners experience severe muscle soreness and injuries when adopting a foot-strike which keeps the heel entirely off the ground. Ken feels that the real issue is where the weight lands. He agrees that the perfect stride has the heel slightly off the ground, but he is not sure that every runner should strive for that perfection, especially immediately upon adjusting technique. He believes that adjusting the technique of a heel striker to a heels-off runner should be a gradual, two-step process. Ken teaches that a runner first needs to learn to land with almost all his weight on the forefoot with very little weight on the heel. After mastering this foot-strike, some may work toward keeping the heel entirely off the ground.
Evolution Running directly addresses propulsion - how and when which muscles contract to move the runner forward. Ken says “Minimizing braking by positioning the foot-strike and the torso optimally is critical to sustained fast running, but ultimately the muscles of the hips and thighs propel a runner forward. Except running downhill, gravity does not propel. The muscles contract to move us forward and there are more efficient ways and less efficient ways to accomplish this movement.
The Pose method's teaching is all in the vertical plane. Ken does not assume, as Romanov does, that if a runner gets everything right in the vertical plane that he/she will automatically generate horizontal propulsion correctly. “The Pose Method provides some excellent insights, but it never instructs how to develop propulsion. The Pose Method simply teaches us to run in place and then lean forward. That, by itself, won’t produce sustained fast running.”
While Ken agrees that the most efficient position from which to generate propulsion is forward leaning, the legs do have to propel us. Evolution Running specifically analyzes the biomechanics of the leg and hip, describes the two incorrect paradigms most runners use, and explains how to correct them. Most runners use knee extension or knee flexion as primary propulsion producers. Ken believes that knee extension produces mostly vertical displacement, with the amount of horizontal propulsion generated not worth the quadriceps fatigue or the time wasted moving up and down. He has found that knee flexion produces efficient horizontal propulsion, but places most of the workload on a relatively small muscle group which fatigues relatively quickly.
Evolution Running teaches that hip extension, rotating the leg backward around the hip, provides horizontal propulsion with minimal vertical displacement and uses larger muscle groups (the gluteus maximus along with the hamstring muscles) to accomplish it. This hip extension keeps the energy cost of generating propulsion lower and spreads the work among greater muscle mass, improving energy efficiency and reducing peripheral fatigue.
Efficient runners begin the propulsive movements before foot-strike, pulling the leg and foot backward before they are weight bearing. This minimizes braking and pre-stretches the elastic tissues to generate propulsion in a forward, rather than just in an upward direction. Pose and Chi runners wait for gravity to pull them down to the ground; Evolution runners proactively pull the foot and leg backward into the ground.
While other methods emphasize a bent-knee leg recovery, Evolution Running teaches runners to use the angular momentum of the leg to “swing” the heel up, rather than hamstring contractions. By overlapping the follow through of the lower leg with recovery of the upper leg, the hamstring muscles can relax, increasing their endurance and reducing fatigue. Evolution Running teaches that the hamstring muscles are propulsive, so runners should relax them during leg recovery, using the hip flexor muscles instead, to initiate leg recovery and relying on momentum to swing the heel up.
Maintain turnover up hills, using extremely short strides. When running uphill, runners will extend the knee, using this movement for the necessary vertical displacement and hip extension for forward propulsion. He also teaches runners to lean exaggeratedly downhill, coasting and allowing gravity to propel.
More information is available at

chi running

A strong mind is important to direct strong muscles, so says the power of Chi.
Dreyer adheres to the Pose Method’s idea that gravity propels. Certainly effective running is largely about technique smoothness and relaxation, but ultimately it is the muscles that create the movement.
However efficient your stride and however strong your concentration and will, every runner needs to develop the muscles with hard training and nurture these muscles with protein. A strong mind is important to direct strong muscles, but the mind cannot perform the movements.
Chi Running points out the basics of several major technique errors that plague most runners and offers the basics of improving biomechanics. It also focuses heavily on attitude and the spirituality of running, which may be useful and important to some runners. Positive thinking and relaxation are important components of efficient running.
Dreyer guesses that using his techniques a runner can probably run their normal pace at about thirty percent of the energy expenditure required using their current technique (though he has never tested this notion). Claiming a seventy percent improvement in running economy is ridiculous. No running technique will enable a runner to almost triple his speed without increasing energy expenditure.
Dreyer describes the use of the core muscles to generate propulsion, instead of the muscles of the hips and thighs. Strong core muscles are critical to any sports activity, but in running the hips and thighs must do most of the work to generate propulsion. He describes increasing hip rotation as a means of increasing stride length, but efficient runners do not demonstrate greater hip rotation, and this technique brings up injury concerns.
In summary, Chi Running provides valuable insight on keeping a strong, healthy attitude about running, and it provides some excellent insight into the most basic aspects of running biomechanics. For athletes interested in tuning in to the spiritual aspects of running, Chi Running is the way to go.

Tuesday, June 10, 2008


Glucosamine sulfate is being uses for athletes with osteoarthritis in the knees. Glucosamine received a grade of A on health line,which gets input from the NIH for its benefit in this area. Most of the evidence suggests that it provides a low anti inflammatory component along with increased flexibility. A study published in the Journal Archives of Internal Medicine examined people with osteoarthritis over three years. People in the glucosamine group had a significant reduction in pain and stiffness. On x-ray, there was no average change or narrowing of joint spaces in the knees (a sign of deterioration) of the glucosamine group. In contrast, joint spaces of participants taking the placebo narrowed over the three years. I usually have my patients try a 3 month course to see if it works for them.

Saturday, June 7, 2008

Massage and Recovery in Sports

It is no secret that people feel better after a massage but not everyone realizes the benefits of massage for sports recovery and
injury healing. Massage loosens up tight muscles which in turn helps circulation because tight muscles will constrict the blood
vessels diminishing the blood flow which provides nutrients, healing cells and warmth for optimum muscle contraction. This is why every pro bike team employs a soigneur for their athletes. The soigneur takes care of the massage and nutrition for the cyclists and they select balms before and after competition to keep the muscles warm and loose. Many sports medicine clinics including my own employ a sports massage therapist.

It has been said that the calf is the bodies second heart and it is no surprise that the calf can cramp up during athletics particularly when the temperature is cold or hydration is inadequate . The calf muscle needs such an extensive network of blood vessels because of the demands we place on it in sports as well as every day activity. When there is inadequate blood flow the
muscles can cramp and individuals with peripheral arterial disease may even develop life threatening clots in the legs.

If you have trouble getting to a professional massage therapist which is the best option there is information in books and the internet on self massage. Stretching, especially the achilles tendon is often done in conjunction with massage.