Mean Joe Green & Why We Do What We Do

If you look at how a successful company like Coke branded they did it by being everywhere. There was Mean Joe Green drinking a Coke with a kid, Coke on your kids little league baseball scoreboard etc. They established an emotional connection to the product that resulted in a more likely purchase of Coke vs another cola. In Martin Lindstrom’s book, Buyology, he explains how marketers use quantitative research, which involves surveying a large number of people about an idea, concept, or product. They then follow up with qualitative research by surveying smaller focus groups. The basic question they are trying to answer is what makes consumers choose the way they do.
​What may be surprising to discover is that many of these product surveys are not that effective. How people answer a survey is often disconnected from how they behave. One obvious problem can stem from how a survey is worded. A classic example used at Harvard Business School is a survey used to determine who would buy a Ford Edsel. The survey asked whether a potential buyer liked an Edsel, not whether they would buy it. Although most respondents liked the car, very few people actually bought an Edsel, leading to a disastrous loss for Ford.
​Lindstrom contend that we don’t always act on the answers we give on surveys because of unconscious emotions, i.e. previous childhood associations or feelings of improved status. There is a peninsula of unconscious thought that influences the way we behave. Sometimes these unconscious thoughts have a more powerful impact than the conscious answers we give when filling out a survey. ​
​For example, a customer with a foot injury walks into a running store and is met by a young dynamic salesperson who fits the customer with a running shoe selected to help him with his injury. The customer then decides to have a gait evaluation and get information about his stride.
The impulse to get the gait evaluation was borne of both emotion and convenience.  What that customer does not realize is that he may have some condition, such as a leg length discrepancy, that warrants a medical professional’s attention. How we make decisions turns out to be tied to the emotional connections associated with the choices as much as anything else.

What Do Planes, Diabetics and Athletes Have in Common? Shear Force: The Common Dilemma that Diabetics and Athletes Face

For years the biomechanics community has been talking about pressure as a leading cause for ulcers, while its counterpart, shearing, was generally left out of the discussion. It turns out that the same force that causes blisters in runners may be the key to unlocking ulcer prevention.

What Does the Research Show?

Dr. Bijan Najafi at the Center for Lower Extremity ambulatory Research (CLEAR) in Chicago sums it up this way: The most dangerous period for a moving body is during gait initiation and termination because this is when the body is most subject to accelerating and decelerating forces. The same principal holds when considering an airplane taking off and landing. The greatest risk for a crash is during takeoff and landing, during which the plane must endure significant stress from the extreme accelerations and decelerations. Just as a plane reaches a steady state at its cruising altitude, people achieve a steady state during episodes of walking. Individuals with diabetic neuropathy take particularly long to reach a smooth walking gait. It typically takes over 4 steps for a diabetic with moderate neuropathy to reach steady state according to Dr. Najafi, which is in average 25% higher than healthy control subjects. Depending on the type of footwear or insole, this number could be increased or decreased. Although four steps may seem like a small number, when we look at it in the context of daily physical activity it becomes very important. A recent CLEAR study published in Diabetes Care revealed that diabetic patients initiated over 350 episodes of walking per day that are often short (less than 20 steps per episode). The 2010 Diabetes Care study noted that diabetics average 7,800 steps per day, and an average of 10-15 steps per episode of walking.


Various methods have been proposed to decrease shearing in shoes including the use of roller soles, bilayer insoles and orthotics, socks and skin lubricants. Dr. David Armstrong feels that traditional plastizote will eventually become passe in favor of emerging superior biomechanical products.

Brian Davis, PhD, has stated previously that one should not overlook shearing forces when noting the moderate success of therapeutic footwear. While it is likely frictional forces are a key variable, he acknowledges several other reasons for skin breakdown. These factors include alterations in collagen properties, autonomic nervous dysfunction that alters sweating responses, diminished microcirculation and superimposed aging. Hydration also cannot be ignored. Good skin turgor depends on proper hydration.

Dr. Najafi feels that there are some misconceptions regarding research on efficiency and friction. In some lab testing, the emphasis has been on the shoe ground interface instead of the foot shoe interface. But, currently this is a serious challenge, since there is no available technology to measure the shearing inside of shoes. An alternative solution is measuring the effect of reducing shearing on the biomechanics of walking. For example, if we could reduce shear force between the foot/shoe interface but not on the shoe/ground interface, this would allow us to increase the distance between center of pressure (COP) and center of mass (COM) in particular during gait initiation, which in turn would increase gait initiation velocity. Biomechanically, this is similar to a runner who tries to increase his take off velocity by leaning forward. Najafi’s recent study confirmed this hypothesis, in which significant improvement was noted in gait initiation velocity by wearing insoles that reduce shearing compared to sham insoles. He also notes that orthotics reduce the number of steps required to reach steady state. Reducing shear force does not reduce gait velocity.

He notes we should be careful about the balance of our patients, since increasing the distance between COP and COM may trigger falls in those patients with poor muscle performance. Therefore, an assessment of a patient’s balance and risk of falling is of key importance after reducing any shearing on the foot/shoe interface.

In the pipeline, Dr. Najafi is exploring differences in people with diabetic neuropathy versus healthy age matched controls under both shod and barefoot conditions. Gait parameters such as stability and gait fluctuation will be assessed.

How Can We Incorporate These Anti-shearing Methods in Our Practice?

Currently, there are ongoing investigations on various types of innovations in arch supports and orthotics. Lubricant creams are also under current study. Socks that have better wicking properties are something that we should be recommending to both runners and diabetics alike. It remains to be seen whether some of the double layer socks provide any therapeutic benefit over single layer socks. Some running store owners I interviewed related that some runners report bunching with some of the double layered socks.

It appears that a combination of following the research and clinical experience will guide us toward the best solutions for this issue.


References:
David Armstrong, DPM. Personal Communication. 2011.
Davis, Brian. “Can Smart Orthotics Have An Impact in Preventing Diabetic Ulcerations?”. Podiatry Today. Volume 23. Issue 6. June 2010.
Bijan Najafi, PhD MS. Personal Communication. 2011.
Najafi, Bijan. “Importance of Time Spent Standing for Those at Risk of Diabetic Foot Ulceration”. Diabetes Care. Volume 33. Number 11. November 2010.

If You're Not Man Enough To Do It Yourself..I'd be Happy to Oblige

More times than I care to count I have had a patient return to the office frustrated that they are not improving. Well,have you done the excercises I prescribed, have you tried the yoga class I ask? Umm... no doc I didn't have the time might be the reply.It's hard to get better if you are not keeping up with the whole program. Some people want an easy fix. It is a lot easier to pop a pill but this does not lead to sustained improvement.

So I challenge my athlete patients like the opening monologue from "Midnight Cowboy",
"If you're not man (or woman) enough to do it for yourself , I'd be happy to oblige!

Got A Bridge To Sell You In Brooklyn And Some New Fangled Shoes

The rage right now seems to be a new shoe for every occasion. Many companies are jumping on the forefoot running barefoot phenom and pumping out the latest greatest shoe. The companies tout their extensive research and tell you to throw your old running shoes and orthotics into the trash, but is there any substance behind their claims? There are no good studies to substantiate the use of any of these new shoes. Just recently a friend asked me my opinion of the new oesh running shoe. The shoe features a robust forefoot platform and reminds me of the sunglass windshield invention the Steve Martin's character came up with in the movie "The Jerk". One thing they got right is that here is a send aftershock in running hat is more intense than the initial heel strike. Saying that their forefoot platform shoe with a shock absorption system designed to minimize the secondary impact does not mean that it is a better running shoe. Human biomechanics is a complex system with many levers and pulleys. The interactions for each runner are individual and it is not ones size fits all. It is also important to remember that it is the car and the driver that make a racer.

The Skinny on Lasers & Fungal Toenails

People have been fascinated with lasers going all the way back to the iconic image of James Bond being nearly split in two in the movie Goldfinger. Goldfinger was the first blockbuster movie ever. No doubt this brought the idea of lasers as being cutting edge into the American psyche. Lasers have been used in medicine for everything from zapping off warts to whitening teeth and now for treatment of those ugly thick fungal toenails. Another unforgetable scene on the Hollywood silver screen highlightd the social stigma attached to feet that aren't pretty. Eddy Murphy from the movie Boomerang pulls back the covers of his bed to reveal that his sleep over guest has jacked up feet. Lasers are part of a program that can help with the thick fungal nails and are an alternative to oral medication. The should not be thought of as effective as the oral but there are no potential side effects unlike oral aGENTS. Sports like running skiing and soccer increase your risk of getting toenail fungus because you sweat inside a closed shoe or boot and you are subjecting your toenails to repetitive microtrauma. The treatment should be only part of a regiment for a pesky problem.
The laser helps eliminate the fungal spores that lie within and underneath the nail. Just as in fading with laser teeth whitening the nail fungus can come back. It should be used as an adjunct treatment either with an oral or topical treatment. It is also important disinfect the areas the fungal spores reside, so the nail does not get reinfected. There are now ultraviolet lights to do this. Lysol is not a great idea because you are subjecting your skin to strong chemicals but there are other more safe disinfection sprays for shoes available. Health insurance does not cover the cost of this treatment. The treatments are administered once a month over three months and do not require anesthesia. You don't have to hiode your feet. You can flash them like your teeth with or without the teeth whitening!

Barefoot Running & Beyond

The barefoot running movement has spawned a cascade of trends in the running shoe industry. The progression has been towards minimalist shoes the ever since Chris McDougall's seminal book "Born to Run". Prior to the sensation of “Born to Run” Vin Lanana has been using barefoot
running in training his runners at Stanford. He believed that incorporating barefoot running in training resulted in better times. When marketing executives from Nike visited him at the Stanford track they conceptualized a minimalist shoe; a shoe that simulate some of the elements of barefoot running yet provide some protection on the feet. needed to grasp and release on a variety of surfaces such as dirt, grass, road, concrete, and gravel.


Our profession should continue to play a leading role in setting parameters
for the new generation of minimalist shoes. It has become obvious to practitioners dealing with overly zealous runners transitioning to these shoes that they will end up in our offices with injuries. Although there are no injury data banks or studies to support these patterns the anecdotal cases should not be ignored.There seem to be more metatarsal fractures, achilles tendonitis and plantar fasciitis cases. In terms of trying to draw conclusions beyond clinical trends it has a non-polynomial solution. There are simply too many variables to factors to draw a conclusion. There are no current injury logs tracking injury patterns with barefoot and minimalist shoe conditions. This information could be something we as practitioners track.




There appear to be regional trends in terms of new purchases of minimalist shoes. While some mid Atlantic stores are reporting 10% of their sales with strict minimalist another 10% with very little structure some Florida markets are approaching 50% and this is often times based on requests by runners and not recommendations by the store.
Another trend that has fueled the industry is a self discovery desire by runners looking for more efficient techniques or a change to try to help alleviate chronic injuries. The self discovery applies to language that industry taps into. The industry has responded not only by cranking out more minimalist shoes but by scaling back shoes with multiple features. The other incentive for industry is the margins are better with less features and they are lighter to ship. Retailers that have responses later in the game have had to wait almost a full year for the most popular Vibram five finger shoe.

Paradigm Shift: It’s a Trend not a Fad

Declarations have already been made by some that there will be a paradigm shift away from stability shoes and orthotics. It would seem that that is a little early to say but this is certainly the perception by many enthusiasts of barefoot/minimalist shoe runners.
Four factors are driving the trend towards minimalism; function, lifestyle, fashion and price. In this case lifestyle and fashion are very closely related. The shift is a reflection of the market demand for more natural functioning footwear. Footwear specialist, Mel Chrestman points to the hangtag on the Merrrell program as a sign of the times. It emphasizes language such as running in a natural gait. The market is demanding a more raw connection to the earth. This is reflected not only in the running line but the hiking line as well. It is also a slightly edgy statement to be walking around in the gym wearing your Vibram five finger shoes. The shoe has become a nexus of marketing and radical function change akin to the Ronco veg-o-matic device of the 1970’s. In addition, some health club members say that the Vibram shoe helps improve balance and strengthen their leg muscles, particularly the calves, while working out. At a recent training run I saw a five finger runner doing a handstand with his feet backing into a tree in his best simean exhibitionist preen. Where the rubber meets the road, retailers are simply not selling the same amount of rugged hiking boots as the consumption is trending toward more stripped down hiking footwear. Chrestman also adds that at a recent Keen marketing seminar for the trail running and hiking industry the marketing research suggested that the $95 dollar price point was attractive to make the purchase.
There appear to be regional trends in terms of new purchases of minimalist shoes. While some mid Atlantic stores are reporting 10% of their sales with strict minimalist another 10% with very little structure some Florida markets are approaching 50% and this is often times based on requests by runners and not recommendations by the store.
Another trend that has fueled the industry is a self discovery desire by runners looking for more efficient techniques or a change to try to help alleviate chronic injuries. The self discovery applies to language that industry taps into. The industry has responded not only by cranking out more minimalist shoes but by scaling back shoes with multiple features. The other incentive for industry is the margins are better with less features and they are lighter to ship. Retailers that have responses later in the game have had to wait almost a full year for the most popular Vibram five finger shoe. That shoe seems to be the poster child for minimalist shoes. Anecdotally, I talked with several runners whose use of the five finger Vibram shoe, says it helped with their shin splints and IBT syndrome. The second generation Bikila has significant modifications from the original which was hardly more than a one piece boat shoe sole with an upper. A lug pattern was placed on the outsole to give it a true midsole and an achilles notch was placed with a true heel counter to prevent slippage and irritation.

Also entering the market are recovery shoes. Most purists reject the idea of a recovery shoe and it remains to be seen whether this is simply a marketing ploy or a functional piece of recovery equipment.



Also entering the market are recovery shoes. Most purists reject the idea of a recovery shoe and it remains to be seem whether this is simply a marketing ploy or a functional piece of recovery equipment.

Walking in Another Man’s Barefeet

The old adage walking in another man’s shoeapplies to running barefoot because until we try it out we are not experiencing the sensations of barefoot running. Malcolm Gladwell had a pilot put him in a death spiral for a few seconds when he was writing about panic and using the JFK Jr. crash as a case study. It should be no different for us then when we are treating this population. Propriopceptive input is one of the things that purists insist is the thing that prevents them from experiencing the same amount of injuries as in minimalist shoes. Biomechanics guru Benno Nigg Phd has supported the notion that feedback can affect injury rates. Declarations have already been made by some that there will be a paradigm shift away from stability shoes and orthotics Time will tell.

The Underestimated Power of the Legs in Swimming

Gary Hall's race club site has some great info on your swim kick:

http://www.blip.tv/file/4698446

Second Place & The Cost of Being Too Demanding on Yourself

My friend Scott Goldman is a sports psychologist in Arizona. We met recently at a sports medicine conference in Big Sky. This is an interesting piece he wrote on second place.



The costs of being too demanding on yourself: After the 1992 Summer
Olympics, scientists reviewed the emotional reactions of all the medalists.

They discovered some interesting results. It wasn’t a surprise that
the gold medal winners appeared the happiest and most content.
However, they didn’t anticipate that the bronze medal winners appeared happier than the silver medalists.
They concluded the bronze medal winners were happy merely because they medaled. Whereas the silver medalists appeared to feel worse because they saw themselves as “losers” and thought about “what might have been.” It is not uncommon in athletics to hear quotes like “second place
is the first loser” and “no one remembers who finishes second.”



However, these silver medalists forgot one very important point: For their event at that exact moment, they were better than the 6,707,376,502 other people on
this planet. Isn’t it interesting that they had tendency to focus on the one person who was
better that day than all the other people on this planet who they defeated?!
Being demanding on one’s self often leads to training hard, self-discipline and other
qualities for great performance. However, what happens when you are too hard on
yourself? What happens when you begin to demand only perfection? Often, athletes struggle when their system of pursuing perfection mutates into a demand for perfection. Let me clarify: pursuing perfection and trying to achieve greatness is healthy, whereas
demanding it only leads to fear, failure, and suffering. You may ask: “why is demanding so
much of myself such a bad thing when it has gotten me this far?”
Good question.

Allow me to answer the question with a series of questions: What happens when you set
a standard that is unrealistic and fail? What happens when you don’t meet your
perfectionist standards? Do you punish yourself? Are you overly critical? Athletes
“lose” their way when they focus too much on criticizing themselves rather than thinking
about ways to improve. Similarly, athletes will focus too much on what they did wrong rather than what they achieved. Remember, the silver medalists quickly forgot how well
they did and instead focused on the one person who outperformed them.