Friday, February 11, 2011

Swimming and Shoulder Pain

It seems like I've been writing about nothing but running lately, so it's past time for a change.

Fortunately, the smart folks at Swim Smooth just posted a great entry in their "Feel for the Water" blog about shoulder pain. They contend that shoulder problems can be caused by having a thumb-first sideways hand entry into the water, due to inward forearm rotation. While this is true in a narrow sense, I believe the sideways hand entry is a symptom, not a cause. Let me explain.

There is far more going on with swim-related shoulder problems than just internal forearm rotation. In particular, if you look at the normal range of motion of the shoulder joint, there is only one point in the freestyle stroke where a hard limit of motion is encountered, and that is during the forward reach, just before/as the arm enters the water, when the arm passes close to the head.

If you keep the shoulder joint open, the upper arm goes wide, meaning the elbow must bend to bring the hand back in front of the shoulder, which makes forearm rotation to a sideways hand entry not only easy, but hard to avoid.  Fixing the hand rotation doesn't fix the underlying cause. That is to say, the hand rotation is a symptom, not a cause: The underlying cause is a lack of arm extension.

However, extending the arm fully can result in impingement of the rotator cuff, which then causes the arm to move away from the head, 'opening up' the shoulder angle to reduce rotator cuff impingement.  So I would say that a sideways hand entry is an indication of avoiding shoulder impingement. That is, there may be damage long before the thumb position becomes evident.

To get the hand to naturally enter flat, and to ensure maximum reach, the elbow must be nearly locked before the arm enters the water. This must be done in a way that prevents shoulder problems.

How is this possible? Aren't they contradictory goals?  Not at all: This is best done by 'throwing' the arm out front, so the associated shoulder rises, combining this motion with a strong final push as the other arm completes its stroke, letting the opposite shoulder drop.  Angling the shoulder upward opens the shoulder joint, freeing the arm to become straighter prior to entry, which in turn encourages the hand to face the water at entry. Try it yourself: Extend your arm straight up over your head as far as possible.  You can't accidentally point your thumb the wrong way when your elbow is locked.

In other words, never swim with both shoulders 'square' to each other in the water, especially as an arm is entering the water. That's not to say that both shoulders are never square to the body: What it means is that when both shoulders are square to the body, one of the shoulders had better be out of the water! The shoulders become square to the body during the middle of the stroke, a situation that should not be present at the end/start of the stroke.

Some swimmers have trouble raising/dropping one or both shoulders, which in turn easily causes shoulder problems during the stroke. This is easily measured: Standing on a hard surface with the back against a wall, extend one arm straight up with palm forward (back of the hand touching the wall), while extending the other arm straight down with palm against the wall (back of the hand against the back of the thigh), with the forearm traveling slightly behind the hip and next to the buttock. Lock both elbows and try hard to get the hands as far from each other as possible (my lats cramp when I hold this position too long), being certain to keep both feet firmly on the floor. Mark the position of the tip of each middle finger on the wall (I use pieces of tape). Repeat for the other side.

Measure the distance from each of the four marks to the floor.  The difference between the heights of the marks for the left arm is the maximum possible swim stroke length for the left side, similarly for the right side.  The difference between the heights of the two upper marks is one measure of lateral asymmetry, as is the height difference between the lower marks.  Asymmetry is not uncommon, and may indicate a mechanical asymmetry (not uncommon, especially for broken bones set poorly).  If there are no known mechanical issues, then asymmetry  can indicate a loose shoulder joint or a latent muscle problem.

If there are no known bone or shoulder issues, then asymmetry likely indicates a lack of flexibility and/or a lack of strength in the muscles used to perform the stretch.  The easiest way to address such issues is simply to repeat the stretch on a regular basis, and also as part of your pre-swim warm-up.

The next opportunity for shoulder trouble comes during the catch, as the hand descends and the elbow bends, which forces the humerus to rotate within the shoulder joint (not a problem for swimmers having a bent arm prior to entry). Swimmers for whom this motion feels awkward or difficult may 'drop the arm', moving the upper arm toward the front of the torso, which can cause the forearm and hand to either go too deep or to cross the center line, depending on the degree of elbow bend.

For me, a good remedy is to focus on getting the elbow bent while the arm is still extended, forcing the elbow out and slightly down, before applying full power with the lats.  I do this using the biceps for a brief moment to pull on the forearm, and the pectorals to pull down the arm, which combine to produce power at the hand and ensure a strong catch. As soon at the upper arm has rotated enough, the full force of the lats can be applied through the mid-stroke.

From its raised position during the entry, the shoulder will naturally drop as the lats contract to provide power through the mid-stroke.  When the lat contraction nears its end, it is time for the arm to 'get long' again. Just as we emphasized 'throwing' the arm out front to open the shoulder angle, we must also emphasize 'pushing' the arm 'long' at the end of the stroke, to pull the associated shoulder down, helping open the angle for the opposite arm.  I do this by giving the lats a reason to stay contracted by continuing to generate power by contracting the triceps to lengthen the arm through the end of the stroke.

There is another opportunity for shoulder-related trouble at the end of the stroke that primarily affects swimmers who under-rotate: If the swimmer is chest-down in the water (not rotated), then the arm must travel behind the plane of the torso to leave the water, which is an awkward (but not harmful) motion. With a good, strong rotation, the arm will rise closer to the lateral plane of the torso, well within the shoulder's normal range of motion.

But doesn't this amount of torso rotation at the end of the stroke force us to do a dreaded scissors kick? It would if the spine were straight, so it is important to twist a bit at the waist to keep the hips closer to level. As the end of the stroke approaches, instead of thinking about 'lifting the arm', I instead momentarily think about 'dropping the hip'. In my stroke, as my triceps do their final strong contraction to straighten the elbow, I'm also thinking about bringing my hip toward my elbow, contracting the associated oblique and QL, which in turn causes the pelvis to twist.

If this is too much to think about during a stroke (which is often the case for me), then I simply don't kick when my hips aren't level.  The cost to levitation and propulsion will be minimal, though the new kick pattern may take some getting used to.

From another perspective, a scissors kick is a good thing! It means you are rotating enough to breathe and make it easy to lift your arm at the end of the stroke. Conversely, the absence of a scissors kick should encourage taking a close look at the rest of the stroke, especially where shoulder limits are involved.

As an ocean swimmer, I don't get a wall push every lap to let my arms and shoulders recover from abuse (or to add abuse by bringing my arms tightly together over my head). It is a wonderful thing to be able to do thousands of sequential strokes without interruption.  In the open water, it quickly becomes clear when your form falters: You go off course. Sometimes very badly so. In the ocean there's no black line to watch to keep yourself on course despite poor form, something I've watched many pool swimmers do.

I often swim with a GPS tucked under my swim cap (a Garmin Forerunner 305), and upon downloading the data after a swim it is amazingly easy to see when my stroke is balanced and consistent, versus when it isn't. Of course, we can look up to do a 'spot' to check our course while swimming in the open water, but the need to do so should be minimized, since, even when done perfectly, it is an extremely inefficient maneuver.

I have a drill I do while swimming straight distances of 1 km or longer: Swim a number of strokes, then do a spot to check my bearing. If I'm on course, increase the number of strokes until the next check. If I'm off course, decrease it by an amount proportional to the error. I'm now always able to swim at least 15 strokes between checks, and have managed 50 when the wind is low and the water is particularly smooth. In ocean triathlons I check every 8 strokes, mainly because of traffic.

In a pool, take away the lane markers, then rapidly swim the length of the pool with your eyes closed. I recommend doing this at night with the pool lights off, to prevent cheating. Will you be inside the lane when you finish? (Put swim noodles or helpers across the water to warn you to stop before hitting the wall.) For bilateral breathers, drifting off course is not only a sign of stroke or strength asymmetry, but it can also indicate subconsciously favoring of one shoulder over the other.

I seldom breathe bilaterally in the ocean. How do I stay on course for so many strokes? I'm afraid my answer is ridiculously simple: I swim as if I will breathe on each side for every stroke! That means I always rotate enough to get one eye clear of the water, even if I'm not breathing on that side.

Over-rotation? I think not.  Why should a breath stroke differ from a non-breath stroke?  Shouldn't a breath stroke be just as efficient as a non-breath stroke?  I believe I'm doing precisely the motion needed to avoid shoulder damage while swimming powerfully and staying on course (an important way to be efficient in open water). When I'm wearing a wetsuit, it is also the motion needed to prevent chafing on the back of my neck. As the torso rotates, so should the head, but not the hips (if possible).

The downside is that so much head motion can lead to motion sickness. For me, this faded with practice, and the benefits have been substantial.  It also works better with a long-distance endurance stroke.  In the pool, the extra head rotation may make it harder to stay in the lane, though this shouldn't be a significant problem if the stroke is truly symmetric.

Bottom line, the motions needed to avoid shoulder injury can simultaneously give you a more powerful and more efficient stroke. Prevention is better than cure. Waiting to see a clear symptom, such as shoulder pain or a mis-pointed thumb, is asking for injury.  A long, forceful reach and good rotation not only limit the risk of shoulder injury, but also maximize stroke length, which lets those of us with shorter arms close the gap with the longer-limbed Phelps and Thorpe clones.

My mantra during my long swims is: REACH! in a stretch, CATCH! using the biceps, PULL! with the lats, then PUSH! with the triceps while twisting the hips. And while the hand is wet, the fingers are pointed straight down. After about 250m my body internalizes the overlapping instances of the mantra, and I get to enjoy the day, returning to active stroke monitoring only when doing a spot, and when fatigue or waves makes my mantra falter.

I didn't come up with either my stroke or my mantra on my own.  The mantra, and the notion of 'throwing' the arm forward, are both due to attending free seminars by elite athlete, exceptionally fast swimmer (Phelps clone) and TrainingBible coach Jim Vance, who dispenses additional wisdom in his blog.  He also has a store where you can buy some of his recorded seminars.  I was taught to swim in late 2008 (at age 52) by Bobbie Solomon, a remarkable person and great coach.

I started studying shoulder motion after I awoke with a sore shoulder the morning after one of my 2-mile ocean swims.  The interactions between joints, muscles, and the demands of sport-related motion are complex, and it took me a while to figure out not only what was going on, but also what I needed to do about it.  Everything fell into place when I attended a second seminar by Coach Vance, after which I was swimming faster than ever, without discomfort (much as I've done with running, but far less difficult).

I'm certainly not a fast swimmer, but I'm able to sustain 1:40/100 yards for hours in a calm water, until I run out of energy to burn.  I do this without any shoulder problems.

Wednesday, February 9, 2011

Finally: Real Foot-Strike Data!

The infamous Runblogger (AKA Peter Larson, PhD) has written some great posts over the past few days about a recent conference on running injuries he attended as an invited panelist.

His posts contain lots of great links, among them links to two posts from the Center for Endurance Sport at the University of Virginia with some hard data about rates of foot force loading:
The conclusions take some of the hot air out of the 'best foot strike' arguments.  Basically, there is no 'compelling' evidence that there is a single all-around 'best' foot strike for all humans:  The 'best' foot strike varies with the individual.  Conversely, you can have problems with force loading no matter which foot strike you use.  Fortunately, the same general remedies apply, independent of foot strike.

The same cannot be said for running shoes:  There is growing evidence that "Less is More" when it comes to shoes.  Changing to a lighter, less structural shoe can reveal latent problems with your stride, which provides the opportunity to improve efficiency and performance while simultaneously reducing the risk of injury.  The underling issue seems to be that the foam and structural elements in heavy running shoes serve to reduce the loading force seen by the foot: Removing that material makes it clear how your stride is actually performing.

This even applies when taken all the way to no shoe at all:  There is also some evidence that those who learn to run well barefoot have fewer problems when they run in shoes, compared to those who don't run barefoot at all.  That is to say, barefoot running may teach skills that are useful when running in shoes.

Here's my take-away question:  Let's say you learn to run barefoot and thoroughly address all stride issues, then you start running in a heavy structural shoe that works well with your new stride (assuming such a shoe exists).  Could this be the perfect combination for life-long minimum-impact running?  Take a proven 'clean' stride, then add as much cushioning as possible?

My own personal experience combined with the Magic 8-Ball says: "Seems Likely".  I suspect the full answer will involve ensuring that the heavy shoe does not add negative factors (such as weight, limited flexibility, and a higher heel) that could cause the stride to change.  I think you'd need to occasionally run barefoot to ensure your stride remains solid.

Interesting stuff.

Monday, February 7, 2011

How to Buy Running Shoes

I'm surprised by how often people ask "What is the best running shoe?" and "Would this shoe be a good one for me?"

Clearly, there are lots of people who don't know how to figure out which shoe is 'best' for their own feet!

I have a very simple system I rely upon:

Rule #1: The 'best' running shoe is the one that feels best when you run in it.

There is no rule #2.

So go shoe shopping with fresh legs. Try on literally dozens of shoes over several trips. Run 1/4 mile in the most promising of them. Some will be obvious losers in just a few strides. The few that are best for you and your feet will soon be clear.

Then, do a 'mixed' comparison: Try one of one shoe on one foot, and one of another shoe on the other foot. Do a short run. Then switch. After doing this with all the final candidates, the best pair should become clear.

Shoe width is an issue for many of us.  Some shoes come in more than one width, and some run narrow or wide.  Be sure to ask about available widths.  Importantly, don't fear the 'gender line': Women with wide feet can do better in men's shoes, and men with narrow feet can do better in women's shoes. It's just a shoe, not a statement of gender identity. It's about your feet.

Color and style don't matter unless there's a tie. Pretty shoes can make for some ugly running. Then again, when the best shoes for your feet are also the best looking, it can sometimes feel as if destiny has intervened. Me, I tend to find that the shoes that make my feet feel wonderful suddenly become better looking.

Remember Rule #1 above! If they don't feel good when you take a short run in them, they aren't the right shoes for you. The stories about needing to 'break-in' running shoes I believe are actually stories of people who bought the wrong shoe and eventually adapted to it. To me, that's bass-ackwards: Buy running shoes that feel great, then replace them when they wear out or don't feel so good.

Sure, listen to the shoe salespeople and try on what they recommend. Nod politely when they describe the latest technology. Let them do whatever measurements they want. Who knows, you may learn something from all of it. But be sure you listen closest of all to your own two feet, and don't stop shopping until they're happy!

There are some other things to keep in mind when trying shoes:

A. If a shoe feels too tight or too loose, be sure it's not the lacing. Take the time to adjust an 'almost OK' shoe once or twice before rejecting it.

B. Socks are also a factor: The best solution may be this sock with that shoe. So bring a variety of your own socks with you, and be willing to try others in the store. With my narrow, flat feet, some of my shoes need thicker socks, some thinner, depending on the width of the shoe. It's about making your feet happy.

C. Replacing the insole can make a difference, especially when NO shoe feels 'best' to you. Years ago I found one pair of shoes that were 'almost right' until I tried some SuperFeet in them, after which they were 'just right'.  For me, this was yet another way to make a wide shoe fit my narrow foot. If you use orthotics, don't assume an orthotic that's good for walking will be good for running: Try shoes with and without your orthotics.

D. While you can test shoes on a treadmill, the final decision should be made only after running outside. Unless, of course, you are buying shoes only for running on treadmills.

Taking the time to do shoe shopping right has several advantages. Not only will you be sure to get the right shoes, but you will also learn one heck of a lot about your own feet, which will make future shoe expeditions faster and easier.

While the above process has proven itself to work for me, it gets much more complex when you are also trying to change your running gait. I have completely overhauled my gait twice in the past two and a half years, and each major change required different shoes to make the new gait work. For me, my problem was pain almost everywhere: I needed to minimize impact to my heels, knees, hips and also the shock transmitted to my spine. Over the past year, as I developed my current gait (forefoot strike with high cadence, shorter stride length, moderate push, and strong arm swing), I have bought five pairs of running shoes!

It was only at the very end of last year that I finally found my 'best-ever' running shoes. They are so comfortable I call them my "Running Slippers". Together with my new gait, these shoes help the miles melt away pain-free.

The odd thing is, this shoe was not carried by any of the 'very best' running shoe stores I visited, including all the TCSD Sponsor shoe stores! I only found it by accident, while shopping in an outlet mall after Christmas. I've heard stories from other runners who found their ideal shoe in WalMart or Target or Big5. I've also had success at Nordstrom Rack.

My current 'best-ever' running shoes cost only $50, including tax! I love my current shoes so much I went back and bought a second pair, just in case they stop making them before I find something better. For comparison, the shoes I bought two and a half years ago cost over $150, for both the shoes and the SuperFeet needed to make them fit.

Try everything you can get your hands on (well, that you can get your feet into): Your ideal road running shoe could be in a high-end store, a discount store, or somewhere in-between. You'll never know until you try.

My legs will tell you it has been well worth the effort! And I haven't stopped shopping yet.

I wanted to mention one other thing about my stride and shoes: When I transitioned to a forefoot strike, suddenly the structure of the shoe didn't matter at all. So the weight of my running shoe has dropped drastically. My Mizuno Wave Creations with the SuperFeet weighed over 16 oz, that's over one pound, per shoe! My 'best-ever' shoes weigh barely 6 ounces each. And my racing flats are only about 4 ounces each.

With all that weight off my feet, I got faster without trying, since I was doing less work with each step.

Your shoes exist to support your stride: Change your stride, you'll probably need to change your shoes too.

Wednesday, February 2, 2011

Learning to Run

For my run clinic, I'm developing a rather basic recipe for getting non-runners running:

1. You don't start running by running. You start running by performing stationary exercises to build leg and core strength, then dynamic exercises to develop/improve the muscle firing patterns needed for running. Simply being able to walk is not enough.

2. The #1 thing that matters in running shoes is how the shoes feel when you run in them! Unless you are an experienced runner, buying shoes without running at least 1/4 mile in them is foolish. It's like buying a car without a test drive at freeway speeds.   Of course, this implicitly requires that you know how to run before buying running shoes! Which by inference means that we should learn to run without running shoes! Huh? What?

3. Learn to run in a manner where the shoe doesn't matter. Let's get some old-school sneakers, like Vans or Converse, or perhaps some flat deck shoes, with a comfy fit that doesn't bind the toes. Next, develop the skills needed to run slowly with a high cadence and short stride by starting with stationary running drills. When the legs are ready, start running slowly on a soft surface, such as a football field or a padded track. Slowly build distance until you can run (not jog) a mile non-stop (however long it takes).

4. Then go shopping for running shoes. With fresh legs. Try out lots of shoes, like 20 pair or so, over several shopping trips. Develop a feel for what shoe features matter, which ones don't matter, and which ones don't work for you at all. Take notes, and keep them with you. Buy the cheapest shoe that feels good when running and has no significant faults.

5. Now we're ready to gradually add both distance and speed, followed by some rolling hills.  Within a month or two, your shoe needs will change: Repeat the prior step.

We don't need no stinkin' diets or cleanses!

There was some recent traffic on the TCSD email list concerning cleanses and other extreme diets.  Here's my $0.02:
I'm no dietitian or nutritionist, but I do have some simple weight-management guidelines I follow:

1. Never Say 'Diet'.  Make normal eating healthy: Don't think that abnormal eating, such as fad diets or 'cleanses', is a substitute or even a useful adjunct for sane normal eating practices.  Conversely, don't eat junk thinking "Oh, I'll just do a cleanse later."

2. Listen To Your Body.  Over time, I've somehow become sensitive to decoding my body's cravings and finding creative ways to satisfy them.  This results in eating habits that contain lots of variety.

3. Energy In = Energy Out.  I don't count calories, but I do watch my bathroom scale.  When I trend high, I simply reduce fats and carbs slightly, and try to find ways to increase my workouts.  It's more about maintaining balance than watching myself like a hawk.

4. Remove temptation.  If you looked in my kitchen right now, you'll find my only "junk food" is peanut butter and honey sandwiches, which ain't all that bad as far as 'bad' snacks go.  You'll also find lots of fresh and frozen fruit and vegetables in my 'fridge, along with low-fat (not non-fat or fat-free) yogurt.  That's the kind of stuff I allow myself to buy, so that's all I have on hand to eat.  I'm not all that strong-willed, so I do sometimes have to go to extremes: I really have trouble not buying the large Costco boxes of Wheat Thins, so much so that I gave up my Costco membership (and it wasn't just the Wheat Thins).

5. Eat to ease hunger, not to become full.  I usually have just two 'sit-down' meals each day (without dessert), and tend to snack 3-4 times during the day.  The meals serve mainly to get protein and fat into me (eggs, cheese, meat, legumes), with fruits and veggies for grazing.  Drinking lots of water while eating also serves to slow me down and fill me up.

6. Moderation in all things, including moderation.  When I'm toward the low end of my ideal range, I permit myself to have lots of fun (called 'beer') getting closer to the top end of my range.  It is important for me to reward myself now and then.

7. Go easy on the supplements.  Dense supplements tend to mess with my sense of physical well-being.  I try to get all my nutrition from 'real' food, with my main 'supplement' being a multivitamin.  This changes during peak training periods, where there aren't enough hours in the day to eat what I'm burning.

8. Have a high resting metabolism.  This somehow feels like cheating; it's the 'anti-diet'.  I carry 5 extra pounds of muscle that do little more than burn calories and make my shirts fit better.  I do full-body circuit/strength training for 2 hours each week using only my own body weight (no weights or machines).  It has benefits beyond muscle development: It also builds reflexes and coordination, which help keep me from doing face-plants when I stumble on a run.

What is your ideal weight range?  Last summer I maxed out my training, ate like a horse, and lost 20 lbs, getting down to 165 lbs (my lowest weight in over 30 years), which I soon found was my 'bonk weight': I had no significant fat metabolism at all, and my endurance performance suffered (though my shorter PRs totally rocked).  By the time I did the Tri Classic last September I had added 5 lbs back and was bonk-free for that event.  My ideal weight range is 170-175 lbs, with 170 lbs being my 'race weight'.

Many of us are time-crunched or injured and have trouble burning all the calories we take in.  If you can do stationary exercise for just 30 minutes every day, even as three 10-minute sessions (morning, noon and night), you'll be amazed at the results.  Without those sessions while my foot was broken (mainly crunches, squats and push-ups) I would have gained MUCH more weight (I only gained 10 lbs over two months).  These short sessions have a triple benefit: They burn calories while you do them, increase your metabolism right after them, and build muscle that burns energy between them.