Thinking Outside the Box

Thinking outside the box is thinking outside traditional boundaries. . Management guru Mike Vance has claimed that the use of the nine-dot puzzle in consultancy circles stems from the corporate culture of Walt Disney . The phrase relates to a traditional management problem called the nine dot puzzle. The object is to connect the nine dots with only four lines. (solution at end of post)

Houston, We Have a Problem

Remember the movie Apollo 13, where the survival of the crew literally depended on fitting the square central module carbon dioxide scrubber canisters into the round holes of the lunar module unit and unless a way could be found to use the square ones the carbon dioxide levels would reach poisonous levels before the crew could get home. The solution came in the form of jerry-rigged duct tape, suit hoses and cardboard to make the connection. Their problems still were not over as they had to shorten the trajectory back to the earth with damaged navigational equipment and had to use the sun and crescent of the earth as reference points for their second rocket burn back.


In the world of sports John Madden redefined how people relate to football with his X's and O's on the telestrator. He made the technical aspects of the game more accesssible to the average viewer. He made the viewer more connected with the humor he injected in his telestrator such as steam vent lines off a bald player on the sidelines and circling old school barbeque at the cities he visited on the road. Known for his zingers on the air, perhaps his most profound quote was:"Coaches have to watch for what they don't want to see and listen to what they don't want to hear".

Olympian Gary Hall Jr. took the monotony of training laps in a pool outside the box devising his own training schedule which included spear fishing,boxing yoga and racing with swimmers from other countries at his base camp. Bucking the traditional Olympic development training model, he brought the training to his home on terms that worked for him so that he was able to compete successfully at an elite level while navigating through the meticulous monitoring needed with managing his diabetes.

In football, Redskin coach Jim Zorn has a reputation for being outside the box with unusual training methods such as the use of both Slip 'n Slides and Dodge Ball drills in his football practices. He once bought in a baseball player to teach his quarterback how to slide. He has manged to continue to earn the respect of outside of the box players such as Chris Cooley. He took a very unorthodox approach to the NFL code of private critique and public praise when he called out some players that were not playing up to snuff. Being candid about his players' performance level is something that is important for a unit to respect its leader in high risk situations according to Thomas Kolditz head of the psychologic testing
at West Point. In an office setting calling out staff is in public is not constructive. The critical difference is that shared risk mandates that decisions made on the football or battlefield have to happen in a very narrow time frame and the physical well being of your teammates and fellow soldiers depends on tight integration and performance of the unit. The Redskins record this year is not a
reflection on the coaching as much as the influence of upper management and injuries. An organization is ultimately only as good as its top brass.

Swimsuit Technology The Car & the Driver

Its the car and the driver these days in swimming with the advent of super buoyant suits.
http://www.nytimes.com/2009/07/29/sports/29swim.html

Stretching Revisited

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.

More Barefoot Running Info

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