Monday, June 20, 2011

Physical therapists who always preach "more stability is better"....Are they really helping ALL runners?

I read an article in the magazine ADVANCE for Physical Therapy & Rehab Medicine the other day that had a great premise but was not very inclusive.  The article "Solid Footing" fell short in a few ways.  Read my published commentary below for my thoughts on the article.  I have also attached the link to the article + commentary for your convenience.


Gait analysis with high-speed video equipment is certainly a valuable tool when treating the injured runner.  This article hits that point on the head.  I disagree with a few of the other points presented, however.

First, if the runner is dealing with an injury that is a direct result of poor biomechanics, the first step of action is not always to provide him with the most support possible.  The symptoms associated with some injuries can change very quickly (for the better) when the source of stress is eliminated.  Such sources of stress include, but are not limited to, excessive pronation, heel striking when compared to mid-foot or forefoot striking, and significant peak hip adduction and hip internal rotation in stance.  As the authors stated, some runners may need more support initially, but what they failed to mention is that there are others who may benefit from less support.  For instance, a patient who is struggling with persistent knee pain may need to adjust his footstrike kinematics in order to eliminate the impact transient at initial contact.  Take a close look -- is the patient heel striking, contacting the ground significantly outside his center of gravity aka overstriding?  The proper way to eliminate that impact transient is not to provide him with a more supportive or cushioned shoe but rather to teach him how to contact the ground lightly underneath their center of gravity.  Applying this principle is quite simple.  Within the session, trial test barefoot running on a smooth grass or carpet surface.  If the patient experiences a reduction in symptoms, his injury is most likely related to footstrike kinematics, and a rehab program that involves performing balance activities and other stability exercises barefoot as well as short barefoot strides on grass (50-100m) will promote the development of a mid-foot or forefoot strike.  If the runner does not experience a reduction in symptoms, then maybe the clinician does want to look into stability shoes or even an orthotic….but not until barefoot running has been trial tested.  As physical therapists, we do not want to promote reliance upon external devices if they are not truly necessary.  The human foot and ankle is a marvel and was created to be functional on its own.  Physical therapists can help injured runners develop a healthier, more stable foot and ankle complex through proper exercise prescription.

Which leads me to my second counterpoint…why would the authors attempt to promote a forefoot strike among injured runners while they are wearing heavily cushioned and supportive shoes?  A high heel-forefoot drop, which exists in almost all stability shoes, encourages a heel strike.  The human body will take advantage of what it is given; therefore, if more cushioning is placed in the heel of a shoe, runners will initially contact the ground in that area of high cushioning.  Compare that to barefoot runners or those who run in more minimalist footwear.  They would not dream of heel striking as their calcaneus would be unable to repetitively bear such a load without bony injury.   So, if we try to have runners who are wearing heavily cushioned and supportive shoes forefoot strike, what are we doing?  We are certainly placing an awkward load on the Achilles tendon as it is in a shortened state throughout.  We should be encouraging the Achilles to lengthen through its normal range of motion so that more elastic energy can be stored before push-off in late stance.

These are just some thoughts for discussion and to highlight that there is more than one approach when an injured runner comes to a clinic’s door.  The clinic that considers both approaches is going to be the one that helps that runner return to running more efficiently and effectively.

Thursday, June 2, 2011

Elite Therapy's Couch to 5k Program = Success!

On April 5th, 2011, seven individuals braved the snow showers and 20-degree wind chills to gather at the Mansfield University track for the first training session of Elite Therapy's Couch to 5k Program.  One of them knew what to expect as she had participated in the Fall 2010 program; the other six were about to embark upon a new journey.  I remember telling the participants on that first day that the weather would only get better from there on out.  Boy, could I have been more wrong!  Those readers living in the Northeastern U.S. understand exactly what I mean by that statement.  We had a very rough spring....actually, I hesitate to call it was more like an extended winter with soaking rains.  Nonetheless, every Tuesday evening for eight weeks the Couch to 5k participants met for their weekly workout.

The first workout involved alternating 60 seconds of jogging and 90 seconds of walking for a total of 20 minutes.  Everyone was able to complete this first challenge -- some more easily than others, but they all knew that they had a long way to go before being able to successfully complete the Bridgman 5k on May 30th, 2011.  The Bridgman 5k has a reputation for being the toughest 5k in Mansfield, PA.  Although the first two miles are downhill and flat, the last mile is straight uphill....certainly not the easiest course for someone's first 5k.  But the participants persevered.  They slowly built up to being able to run 15-20 minutes continuously on the track, and that fitness was then taken to the next stratosphere once they began performing 20-30 minute continuous runs and interval workouts on hilly roads (total of three running workouts per week).  Come race day, they were ready to accomplish something that only eight weeks before their bodies and minds would have rejected at the mere thought.

May 30th was something the last two months had not been -- humid.  The participants were properly hydrated, however, and were not going to allow Mother Nature to detain them from reaching their collective goal.  After warming up, they toed the line with a definitive plan in their minds.  They were to pace themselves early in the 5k by relaxing on the downhill, allowing gravity to help take them down the slopes.  My hope was for them to save energy for the uphill last mile.  Knowing that this long hill would be the toughest point of the 5k, I stood along it and encouraged them as they ran by.  Each of the participants followed the plan to a "T" as they all finished between 31 and 45 minutes.  What a tremendous accomplishment for a group of individuals with little to no previous running background!

 Couch to 5k participants and me after the race

Bridgman 5k web site: 

The intent of Elite Therapy's Couch to 5k Program is to promote health and wellness in the Mansfield community free-of-charge.  Couch to 5k programs can be implemented anywhere though -- all you need is hard-working individuals who share a common desire to be healthier.  One of the most important aspects of the program is the team camaraderie that is generated.  The quote "Many hands makes light work" certainly holds true: the participants always found it easier to complete the workouts when they were running together with their teammates on Tuesday evenings.  Many of this spring's participants are already looking forward to Elite Therapy's next offering of the Couch to 5k Program.  Such anticipation to participate in another wellness program is a success in and of itself.  As a physical therapist, I know that I hope to continue helping individuals become healthier and reach their fitness goals!