Neurology, Psychology and Pedagogy: Running on your Brain

In working with the folks in my Miserable Runners Group (MRG), and in the additional studying I've been doing, I've come to realize that there are only a few fundamental things a body must do to run comfortably. Remember, I'm talking about comfortable running here, with a stride that is merely effective, not necessarily fast or efficient.

But if you look around at all the "learn to run" methods out there, you'd think there were hundreds of different ways to run, with each one claiming the others are wrong or misguided!

Sure, there are differences, but mainly in style or order or emphasis, not, I now believe, in principal content (allowing for minor variations and additions/omissions between them).

Why then are there all these different approaches, if they all boil down to essentially the same thing? And why does each have its 'to the death' proponents and detractors?

I believe a big part of it comes down to psychology (how we think) and pedagogy (how we can be taught), both of which combine to determine how we, as individuals, will learn best. The study of learning has resulted in the description of several "Learning Modalities" ("LMs" from here on).

Depending on who you talk to, and in what context, there are up to 8 different LMs humans use to acquire skills and knowledge (just ask Google). Since running is a physical skill, we'll focus only on the LMs related to learning a physical skill, which include:

1. Linguistic/Logical/Verbal/Auditory: "Tell me what to do."
   This would be either Oral (a lecture or audio recording) or Reading (a book without pictures).
2. Visual: "Show me what to do. Let me watch someone do it right."
   Live demo, or video, or detailed images in a book or website.
3. Tactile/Proprioceptive/Kinesthetic: "Walk me through the motions."
   Literally taking the student by the hand, with continual hints and corrections.
4. Naturalist/Experimentalist/Intrapersonal: "I'll figure it out on my own."
5. Intrapersonal/Social/Observational: "Let me watch others learn it."

You'll notice I used lots of synonyms above: Each of the various communities involved with the study of learning (psychology, cognitive science, educators, etc.) has evolved its own specialized lingo, and splits hairs in different ways (mainly on how others do or don't participate in the learning process). Most groups do agree on a basic trio: Visual, Auditory, and Tactile. However, I find these three to be too simplistic to be useful in actual learning environments.

We each use all of the above LMs, but seldom all at once. We each tend to have one or more dominant or preferred LMs. However, the LMs used in any specific situation will generally depend on the task at hand, the environment, and the available resources.

If you look at the content of the various running instruction and coaching systems, you will see many of the differences between them boil down to different levels of emphasis placed among the various LMs. It can be almost comical to watch authors attempt to invoke other LMs within the context of a book: Way too often it can fail miserably (which is why there are so many DVDs and YouTube videos out there). Quite often, the author's own least-favored LMs can limit or restrict what can be taught and how well it can be taught.

When the student's dominant LMs align with the instructor's, Magic Happens! It can feel like the instructor or author or coach has climbed into our minds and bodies to directly and rapidly implant knowledge and skills. But it would be silly to have to wait for such magic before we can learn: We must be adaptable, both as students and instructors, and try to make the best possible use of all available LMs. When it comes to learning, the integrated use of multiple LMs is always greater than the sum of using individual LMs.


So then, do variations in the use of LMs account for the differences between, say, "Chi Running" and "The POSE Method"? Combined with, perhaps, a different ordering of the chapters?

To a significant extent, yes, but not completely: The LMs are mainly concerned with getting knowledge into our brains. Getting our bodies to do what our brains want them to do is a whole 'nother ball of wax.

It turns out, not only do we each use a different range and combination of LMs, but each of us has different ways of using our minds to control complex body motion. For example, if I want to encourage you to use a short, quick stride, I could say any of the following, some of which may work better for you than for others:

• Put your foot down sooner.
• Lift your foot sooner.
• Take smaller steps.
• Don't put as much weight on your heel.
• Be light on your feet.
• Swing your arms faster.

Each of the above may sound like a very different thing, since each describes a different portion of the stride. I used to think they were different things. To an elite athlete, perhaps they are. For a beginner, in reality they are different views or perspectives (not parts), of the same thing.

When watching various coaches in action, I'd occasionally see them get frustrated when advice that works for one beginner fails miserably for another with the same problem. They'd spend time teaching it using all available LMs, but the athlete would still prove unable to put that specific piece of advice into action.

I've been through it myself, while trying to help beginner open-water swimmers include key motions in their stroke. For example, if I wanted you to increase the amount of body roll in each stroke, I could say any of the following:

• Breathe by turning your body to get your face to the side, not your neck.
• Get a shoulder out of the water with each stroke.
• Get an eye above the water even on the non-breathing side.
• Roll your hips more.
• Swim "skinny" in the water, more on your side.

Some swimmers would 'get it' from one description, while other swimmers would 'get it' from another. I'd go through the sequence until finding the one (or combination) that worked best. Quite often, it seems we are searching for a 'trick' that suddenly makes the desired motion 'make sense' and 'just happen'.

What's going on here? Why do we often need to use different descriptions (within the same LM) to achieve a given result?

My first thought was that it had something to do with differences in how we each process language. But that can't be it: Neither the language being used, nor the concept being described, are complex enough to be affected by differences in language use or comprehension. Not even by those for whom English is a second or third language. I rarely have had anyone appear to be confused by what I meant by the phrases I used. They just didn't know how to make their bodies do what the words meant!

I did some reading about how our conscious thoughts are turned into physical action. It turns out, we have direct conscious control over only limited parts of our musculature. For example, if I tell you to wiggle just your little finger, it is easy. But if I tell you to wiggle just your little toe, it may well be impossible for you to do.

We have significant conscious control over our hands. Commands to the rest of the body get processed in unconscious ways before the relevant muscles get activated. While it is easy to blink both eyes on command, it is much harder to blink just one eye. And we barely have control over our arms: Try patting your stomach with one hand while rubbing the top of your head with the other. Then switch. Even such simple motions have a large degree of unconscious processing involved, and overcoming that processing can be very difficult.

This is why we often need to do repetitive drills to teach our bodies to perform new motions, such as playing a complex Bach piece on the piano. Such training processes actually lay down new neural pathways within the conscious brain, and between the brain and the muscles involved.

Repetition is not always needed: In many instances an appropriate pathway already exists, but we lack direct conscious access to it. But if we think about a thing in different ways, then different pathways get activated, and we may find that one way of thinking suddenly produces the desired action when other ways of thinking failed.

This is what I believe happens in many beginner athletes, but the extent to which this can happen appears to diminish as athletic performance improves. Simply put, as experience builds, then if a desired pathway exists, at some point it would already have been accessed. So as you become more proficient, you may find that repetitive drills are more often needed to implement even a minor technique change.

I believe beginners are poised to make immense gains from the outset, mainly because thinking a different thought can have a rapid and direct physical response.

It is almost as if the nerves to our muscles comprehend only a subset of the language we think with, and we need to keep trying different thoughts, using different wordings, until we stumble upon a conscious thought the motor neurons 'understand'. And if we fail to stumble upon one, then we need to create it through repetitive drills.

There is lots of literature about how repetitive drills work. One important aspect is that much of the processing that controls our muscles happens far outside of our conscious brains. The spine performs a massive amount of processing: If we stub our toe, our leg muscles start to pull the foot back long before we consciously feel the pain. If we touch a hot pan with our hand, the same thing happens. Much 'reflex' action occurs in the spine, not the brain.

Reflexes are, by definition, involuntary actions. We are presently concerned with voluntary actions. These, too, require significant processing in the spine and 'lower' parts of the brain in order to happen. When we walk, we aren't consciously thinking about our balance, or how we will move our feet to react to changes in balance. We do control our walking to the extent that we set the speed and direction, yet we have no conscious involvement in making the individual muscles fire, or in integrating balance signals from the inner ear with muscular actions.

This processing occurs in parts of the brain and spine that are only mildly affected by conscious thought. Many repetitions are needed before the conscious thought will be able to cause the desired physical action on command. Or, conversely, to replace one automatic motion pattern with another.

When trying something completely new, when not trying to make only a tiny refinement in an existing motion, it is worth applying the effort needed to try thinking differently about the desired motion from every possible perspective, to see if we can stumble upon an existing pathway we can use to aid our efforts.

I believe this is why you will find that some beginner running technique books contain advice that 'just works' for you, while other equally well-written books do little or nothing for you. Part of it may be due to how the LMs are used. But a significant part of it is not about how the book teaches something, but it may instead be more about how the phrases the author has chosen interact with your specific brain-body connections.

The books that work best for the most people seem to do lots of repetition, not only to employ multiple LMs, but also to say the same thing in as many different ways as possible. The more advanced a book gets, the less often repetition is used for any purpose: Elite athletes and coaches are expected to do the work of using the appropriate LMs and finding the best ways to describe the concepts.

Beginners, on the other hand, have different needs, and can respond to methods of coaching that would be inapplicable to an advanced athlete. I believe many coaches have not yet learned this, and will often try to use elite techniques (and expect elite responses) when they interact with beginners.

Elites seem to need to break things down to their smallest components before changes can be made. When optimized performance is desired, the changes have to be customized to the athlete. The elite athlete typically learns less and less as they go on: They have mastered the fundamentals, and everything else is details. They have developed highly optimized neural pathways, and repetition is needed to change them. So it may take increased effort for an elite to learn the next 'detail'. More and more work for ever tinier improvements.

Beginners need to learn only a very small number of relatively simple things. Beginner triathletes can get along extremely well with a 'one size fits all' freestyle swim stroke, and a 'one size fits all' comfortable running gait. For the beginner to find that common stroke and gait, they will need to use their bodies in ways that have little resemblance to what they've done before. Everything is big changes: Nothing is details. But sometimes the beginner can 'get lucky' and make use of an existing pathway to rapidly learn large chunks of technique. The problem is finding those pathways.

I feel very fortunate that I started helping out with coaching while I was still very much a beginner: The instinctive way I coached was very close to how I learned, and it has only been recently that I've tried to figure out what's really been happening with the beginners I've worked with, including myself.

The key, sometimes, is just finding the right words. It's not about learning different parts of a technique (no beginner needs that), but learning a single technique by focusing on various parts until one of them gets results. The end result is the same, no matter which part 'works'!

Put another way, it is pointless to get caught up in what the 'ideal' gait for a specific beginner runner should be: There is no such thing. Only elites and experienced amateurs get to search for a personal 'ideal' gait. Beginners should seek only a 'comfortable' gait, and there is a common gait for that. The terminology and phrases used in both beginner and elite books may sound very similar, though I now understand the goals are different: For an elite, there may be one phrase that best describes a needed gait adjustment. For a beginner, there may be one phrase that can make the entire gait happen almost as a whole.

That's why I said at the beginning of this rather long post that there are only a very few things the body has to learn to become able to run comfortably. It's just a single, common, simple gait. The beginner doesn't need to be taught individual pieces and details, the beginner needs only to find the right description, which can often sound just like going through a list of details.

In other words: If you want to learn from a book, be prepared to get all the beginner books! I believe they all wind up at about the same place, despite taking paths that look very different.


I'll conclude with a few side notes, each of which should probably become its own future blog post:

Side Note #1: Based on my own experience as a patient, I believe much of Physical Therapy involves not just restoring physical range, speed or force of bodily motion, but more importantly on establishing conscious and unconscious control over that motion. All Physical Therapists will focus on improving the measurable aspects of strength and mobility: Only the best Physical Therapists will go beyond this to establish new activities and new levels of comfortable performance, even beyond what was present before the injury occurred! I believe this may be a significant factor in why some PT results 'stick' and others 'fade'.

Side Note #2: When an experienced athlete is recovering from a significant injury requiring a prolonged absence from running, rather than trying to return to a prior 'ideal' gait, it may be better to become a beginner again, to quickly learn (or re-learn) a simple 'comfortable' gait, and then evolve that gait to become a new 'ideal' gait. I suspect it will permit a faster return to running with a reduced risk of repeated injury. And it may even lead to a new performance peak, rather than trying to force a changed body to perform using an unchanged gait.

Side Note #3: I believe each of us should always keep a 'comfortable beginner's gait' in our running arsenal, even as we learn advanced techniques and build ever greater speed and endurance. I call it my 'Git Her Home' gait, which I will use whenever I suddenly find myself spent before the end of the run, and stopping or walking is not (yet) an option. This has happened to me with annoying frequency as I continually attempt to maximize my performance: I will bonk by making a nutrition mistake, or I will take a hill too hard and need to recover at the top, or I get sucked into running on the shoulder of someone who is much faster than I am, or I discover in the middle of a run that I actually do have a cold, or I stumble and have trouble getting all the pieces working smoothly together again, or I realize my new shoes aren't as comfortable as I had hoped. My Beginner's Gait let's me keep running at faster than a jogging pace while simultaneously letting my body recover and sort itself out.

I am always disappointed to see top athletes suddenly go from all-out running to walking: It seems they have just two running speeds: All and Nothing, Win and Lose, with lots of suffering and little room for recovery while running. Perhaps that's what's needed to ascend to the top. I think the rest of us should have more usable gears. For us, the first goal should always be to enjoy the experience and finish without pain or injury, the second goal should be to maintain good form and avoid walking, and only the third goal should be to win or set a new PR.

SwimSmooth: "Stroke Technique Is Even More Important In Open Water"

The wise, friendly and communicative folks at SwimSmooth have a recent blog post with the above title.  The main point they make is that bilateral breathing leads to a straighter open water stroke.  I'd say something more fundamental is also involved: Symmetric body rotation, independent of breathing, leads to a straighter stroke.

Though I'm a relative beginner myself, with just over 3 years in the open water and no freestyle swimming at all before that, I've spent the past two years helping beginners in the open water.  Basically, I started in, and never left, TCSD's (the Triathlon Club of San Diego's) beginner open-water swim clinic.  I first stayed around as a helper, and now (amazingly) as an assistant coach.

I work with a rotating group of 20-50 beginner swimmers every week.  Along with the leaders and senior coaches in our clinic, I suspect there aren't too many people around who regularly coach more true open-water beginners.

Our primary approach is to make open water swimming fun and enjoyable.  We've found that if a swimmer is comfortable in the water, then speed and distance will come simply because they will want to practice.  We don't get technical in our clinic, we don't focus at all on speed, and we focus on distance sufficient only to prepare them to survive and enjoy their first sprint triathlon.

"It is not possible to win a triathlon during the swim, but it is easy to lose one there."  - Common triathlon proverb

We focus primarily on 'functional form', and we teach a one-size-fits-all freestyle stroke that anyone can learn, a stroke that is optimized to get any beginner comfortably through the open water.  We don't explicitly target efficiency, and instead focus on teaching beginners to monitor themselves with every stroke and stay within their limits.

While I won't go into all the details of the stroke we teach, a primary component is to minimize all twisting of the neck.  We ask them to imagine trapping a small ball between the chin and upper chest.  That means in order to breathe, you must rotate your body!

Since we generally wear wetsuits in San Diego (the air is warm, but the ocean is cool), one of the greatest afflictions for new open water swimmers are neck rashes, more popularly known as 'wetsuit hickies'.  The cause isn't the fit or design of the wetsuit:  Eliminating neck rotation completely eliminates this problem at its source.

Surprisingly, we don't focus at all on bilateral breathing, other than to mention the reasons why it is a Good Thing.  What we do emphasize is having fully symmetric body rotation on every stroke, so that you always get one eye out of the water, even on the non-breathing side.  When a beginner later chooses to try bilateral breathing, their head will already be in the right position for it.

Yes, this may seem to be quite a lot of head and body rotation, and some folks do indeed experience dizziness or mild nausea while adjusting to it over the course of a few hours practice.  When this occurs, we suggest swimming with an extremely low stroke rate, about one arm per second.

We find that a low stroke rate not only makes the rotation more tolerable during the adaptation phase, but it also helps the swimmer focus on their whole body, especially the core, back and legs, instead of focusing only on using their arms to make progress through the water.  Many beginners twist and contort their bodies as they swim, and slowing things down helps them observe and correct this behavior on their own.

Many beginners lack upper body strength and endurance.  Here again, a very slow stroke rate has immense benefits, helping beginners avoid exhaustion and anxiety or panic (and the subsequent perception of wetsuit tightness we call 'neoprene smothering').  We focus on 'slow form' because, quite often, that's all the beginner swimmer can handle!

If you first find form and fun, fitness and fastness follow!

Another benefit of our 'no neck rotation' form element is that when the swimmer leaves sheltered water and encounters chop, surge and swells in the open ocean, they will then be able to easily add some neck rotation to get their mouth further away from the turbulent surface and thus make breathing more successful.

I've seen several fast open water swimmers with minimal shoulder rotation who experience nausea whenever they encounter even mildly unsettled conditions, claiming it was due to the 'rough water'.  I would tend to disagree: I believe it may have more to do with their having to add unaccustomed rotation to their stroke in order to breathe.  It seems best to address motion sensitivity while still a beginner.

Full, symmetric rotation not only supports a straight stroke, but also prepares the beginner for bilateral breathing and rougher conditions.

Another advantage of always getting an eye out of the water on the non-breathing side is that it vastly improves 'situational awareness' during a race.  We teach our beginners to draft to make the swim leg of a triathlon faster and easier.  When swimmers pass close by, it is tough to draft them if you never see them!

Proficient pool swimmers making the transition to open water often have the greatest difficulty learning 'full rotation'.  It seems they are so used to staring down at that black line that they often have great difficulty not only with rotation, but also with spotting/sighting in the open water.  They also tend to get the most wetsuit hickies.

Another complicating factor for pool swimmers is their insistence on kicking.  In a wetsuit, kicking provides little or no benefit, unless you have such a large motor that you have the energy to spare.  So another component of our beginner open-water stroke is minimizing kicking.  Most are able to eliminate it entirely, though a few folks need one kick per stroke to aid rotation.

The immediate benefit of eliminating kicking is that the body's energy stores are reserved for use by the arms.  For our beginners, it is important their energy lasts for the full session, and isn't exhausted too soon.

Since beginners tend to spend a long time in the water during their first few races, we do teach them to kick during the last 50 meters of the swim in order to get their legs warmed up and ready for exiting the water: This tends to eliminate the all too common "stand-up-then-face-plant" event at the end of the swim.  It is also useful for everyone at the end of an Ironman swim.

One more thing about pool swimmers transitioning to the open water: I've seen proficient pool swimmers be surprised and panicked after their first 100 meters in the open water due to unexpected exhaustion.  Removing the pool wall removes the flip-turn which in turn removes the long recovery glide their bodies are accustomed to having at the start of each length of the pool.  If they want to become good open water swimmers, I suggest they 1) don't let their feet touch the wall, 2) sight on the lane dividers instead of the black line, and 3) practice with a pull-buoy.

Back to the topic at hand: The stroke I've described is taught to beginners to help them become comfortable swimming in the open water and to ensure success in their first sprint triathlon.  After that, we encourage our 'graduates' to get lots of practice and to start attending the more advanced swim workouts and clinics our club offers several times each week.

I hope this hasn't sounded too heretical, but all I can say is that I've seen it consistently work well for many open water beginners.  We don't try to turn them into competitive swimmers, nor do we even try to help them find their personal, ideal stroke.  We try only to give them a basic foundation that works well, is easy to learn, and doesn't get in the way of having fun.

What may be a bit more heretical is that we also teach our beginners to glide.  We found that simply doing a slow-motion stroke is often not the best way to swim with a low stroke rate.  It is often better to combine a powerful stroke with a glide. This not only provides a brief recovery period during each stroke, but also builds strength and muscle memory while simultaneously helping the beginner become acutely aware of the overall shape and position of their body in the water.  If your body isn't straight, you will see yourself head off-course during the glide.  And, importantly, a short glide also momentarily halts rotation, further helping limit dizziness and nausea while learning 'full rotation'.

STROKE, glide, look-to-the-side, STROKE, glide, look-to-the-side.

The best thing about beginners learning with a glide in their stroke is that as fitness and conditioning improve, it is easy to reduce then eliminate the glide.  Conversely, if an intermediate swimmer becomes over-tired during a swim, briefly restoring a familiar glide can permit them to recover without stopping.  A glide is a Good Thing for an open water beginner to learn.

Though I've not discussed all aspects of the basic stroke we teach, some of the parts I have described may in some ways seem counter-intuitive or even wrong.  All I can say is that it absolutely helps beginners swim straight and far, then permits them to smoothly progress toward improved conditioning and higher speed.

Most importantly, it creates open water swimmers who have a blast in the water and race really well, staying on-course in the midst of a crowded field, even in unsheltered open water.

The Miserable Runners Group

Hi,

I'm Bob, and I'm a Miserable Runner.

My goal is to use this Fall and Winter to become Less Miserable, and to run my first-ever half-marathon next Spring.

We all know the saying: "Misery Enjoys Company."  If that's not a great reason to start a running group, I don't know what is!

If you've been reading my blog you already know my story, but here's the short version:  For my entire adult life, running has never been easy for me, especially past the first mile.  I briefly ran 10Ks in my early 30's, but soon quit due to joint and foot pain that didn't go away for days.  Triathlon found me just over 3 years ago, just before I turned 52, and just as my body started falling apart.

My love of triathlon has not permitted me to quit running, and with each new (and old) running problem, I have kept studying the available resources, kept asking questions of doctors, physical therapists, coaches, academic researchers and fellow athletes, and kept learning and trying new techniques to improve my run despite my limitations.

I believe I finally have learned enough to pursue serious distance running with a greatly reduced risk of future injury.  However, I seem to lack some of the discipline needed to consistently apply what I've learned to myself.  I believe I will do much better as part of a group that meets 2-3 times per week.

I'd like this group to focus not on speed, but on comfort over distance.  To be able to eventually run long distances without stopping, and without injury.  Yes, we'll want to go as fast as possible, but speed will always be a minor concern, with comfort and safety always coming first.

I first want to focus on preparing our bodies for running, rather than simply strapping on our running shoes and making the same old mistakes over and over again.  This will involve basic muscle strengthening, improving balance and mobility, and (re)learning the motions and muscle use patterns needed to run comfortably.

In chats with other miserable runners, one common situation I've seen is that many people have no idea what a proper running shoe fit feels like!  While I can't fit a shoe to anyone's foot, I do believe I've learned quite a bit about how you can learn to go shoe shopping and find the best available shoe for your foot.  This is something that must be addressed before doing any serious mileage.

I want our group to be about running, not run-walk or jogging.  I'm talking about non-stop running, where we learn to manage our breath and energy so we don't have to stop due to overexertion.  Where we become able to continuously monitor our running form, and learn to stop running when our form starts to fall apart, long before we cause any injury or pain.  I want each of us to become able to do long distances at a 10 minute per mile pace, and shorter distances at a somewhat quicker pace.

Being allergic to pain (it makes me cry), I plan to do all the above without misery, but with lots of determination.  I think the phrase "No Pain, No Gain" does not and should not apply to age-group athletes.  Let the elites go down that path.  My goal is to find that place where "I Run Because It's Fun".

Also, I'm not a running coach.  I'm just a guy who has been frustrated by some major problems with his own running, and who has studied and tried lots of things to get past them. I still have questions, and I'm still learning, and I'd much rather do it as part of a group.

Most importantly, I'm done with injuries!  I want our group to be all about injury prevention and avoidance.  Safety and comfort must always come first.

So, would you like to join me? Please let me know!

Reading Your Own X-Rays

As triathletes, we often sustain injuries requiring some form of medical imaging to arrive at a diagnosis and a treatment plan.  The images will most often start with X-Rays, which if inconclusive may be followed by an MRI or CAT-scan, or on rare occasions a bone scan.  We then get a diagnostic pronouncement from our doctor, complete with hand-waving and finger-pointing in the general direction of the medical images.

The sad fact is, doctors are occasionally wrong, or at least not "completely correct".  I have personal experience with this.  Most often, they simply leap to a logical conclusion, a natural by-product of having only a 15 minute appointment to work with.  Other times they are "almost-right" or "right enough", and the prescribed care is adequate for the actual injury.  But sometimes "close" is not good enough, and much time can be lost pursuing ineffective treatments.

You should view your doctor as being an educated and dedicated professional, though one who is operating under lots of time pressure, who also is only human. The best way to improve your outcome is to be able to help your doctor as much as possible, to be able to help gather symptoms, to help analyze them, and to help find the best remedy.  A second way, of course, is to always get a second opinion before doing anything major like harsh drugs or surgery, or after an initial treatment fails.

If you had an extra 8-10 years, you could become a doctor yourself.  Well, for at least one specialty, if not for all the specialties involved with athletic injuries.  However, just because the knowledge mountain is truly huge, that does not mean there isn't lots of valuable and useful medical knowledge each of us can and should learn and learn to use.

The best place to start is with "A&P": Anatomy and Physiology.  Being able to name the parts of your body, know what they do, and know how they fit together.  While it may be interesting and fun to learn the whole body, the easiest and most useful way to start is with the specific areas of recent injuries.  And most of our pain and injuries tend to be in the legs and feet.

When studying a portion of the body, it is good to start from the inside and proceed outwards, starting with the bones and cartilage, then the ligaments, then the muscles and tendons, and finally the nerves.  But even that is a large amount of information.

So, rather than learn everything about even a single body region or subsystem, we can start by taking advantage of a fundamental property of our bodies: We have bilateral symmetry.  If we hurt on one side, the other side will likely be an excellent reference for comparison.  Instead of learning all about the injury area, we can start by looking for things that differ between the two sides.

When making comparisons, our eyes are our best sensors.  When looking inside our bodies, X-Rays give our eyes lots to work with.

A possible first step in this direction is to learn what your doctor is doing when ordering X-Rays.  A typical order includes the name of the body part and descriptions of the desired views.  But this is also quite a lot to learn: Most doctors don't remember the names of all the possible views, and tend to work from multiple choice lists.

What I do instead is simply request that the same exposures be taken on both sides of the body. This way, no matter what the exposures are, I will be able to compare the same views for two body parts: One injured, and one (presumably) healthy.
 
Many doctors will automatically order X-Rays for both sides, or will gladly do so if asked.  If the doctor won't order the duplicate exposures (citing issues of necessity, cost or radiation exposure), I've sometimes been able to convince the X-Ray tech to image both sides at once on a single plate (same number of shots).  The doctor may not need the additional images, but I sure do!

After the appointment, get a copy of the X-Ray images downloaded onto CD or DVD (a minor charge, if any, though there may be some paperwork).  I recommend waiting until after a radiologist reads the X-Rays, since his report will typically be included with the X-Ray data.

Next, you get to play Home Radiologist!  There are several free/open programs available to help you examine your X-Ray images (opening DICOM files, zooming, contrast stretching, pseudo-color enhancement, etc.).  You may need to try several programs before finding one that you are comfortable learning and using.

Before looking for any specific conditions, start with getting used to playing with X-Rays.  Most of the above programs include tutorials to help you learn your way around X-Ray images.  There are also several tutorials online that will teach you about what you can find by examining an X-Ray, though most of these tutorials are aimed at medical students, and are thus written in 'medglish' (Medical English: English with lots of Latin and Greek thrown in).

Next, learn the anatomy imaged by the X-Rays.  Much can be learned while viewing an X-Ray alongside a good anatomical reference (I use the images in Wikipedia and WebMD).  There are also many online sources for reference X-Ray images, such as MedPix.  Use these for practice until you get your own images.

Another great resource is your dentist.  Most of us get dental X-Rays taken twice each year, so there is lots of history, redundancy and variety to work with.  Most dentists are more than happy to share how they examine your images, and explain what they find.  My dentist and I have an ongoing contest to see if I can spot everything that's going on before she reads my images.

It can take many hours to 'train our eyes' (train our visual perception system) to 'see' (search for and find) subtle variations in X-Ray images.  Having lots of images to examine really helps, especially multiple views of the same part on both sides of the body.

I have well over a decade of my own X-Ray data for my back, knees, ankles and feet.  (Yeah, I'm getting older, and my X-Rays prove it.)  These images get more valuable not only with each passing year, but also with each new injury.

Three years ago I had knee pain that was diagnosed as being caused by ITB Syndrome, and a stretching regimen was prescribed.  My Sports MD also took X-Rays of my knees to ensure there was no other damage.  The nurse pulled the images up on a display, and while I waited for the doctor to return I correctly identified my own chondromalacia.

I didn't know that was what it was called at the time, nor what caused it, but I knew enough about X-Rays and basic knee anatomy to able to quickly spot the differences between the X-Ray images of my two knee caps, and to associate that with both my pain and the range of motion over which the pain occurred.

This skill really paid off for me very recently.  I had initially injured my foot last October, and everyone I talked to, including my MD, said it appeared to be a stress fracture of the second metatarsal.  X-Rays showed nothing, which is not unusual for first-time stress fractures.  And, sure enough, 6-8 weeks later I was able to gently return to running.

In a recent triathlon I again experienced sudden pain in the same place, but with less than half the intensity I had in October.  I decided to finish the race, with the commitment to immediately quit if the pain increased to its prior level.

Two days later I was back with my MD, who ordered more X-Rays.  To our mutual surprise, not only was no new break visible, but I immediately saw there was no hint of the bone thickening expected from the healing of the prior stress fracture.  We had a bona-fide mystery on our hands, and we decided to call in a specialist.

My MD gave me a referral to a podiatrist, who then diagnosed a problem with my transverse metatarsal ligaments (the ligaments that cross the foot connecting the heads of the metatarsals).  He confirmed that I had never had any significant stress fractures in either foot.  Fortunately, the treatment and recovery for both injuries is nearly identical (don't run, avoid causing pain, wait 6-8 weeks).  I'm in another recovery phase now.

The lesson here is that many physical ailments don't show up on X-Rays, so it is important to know not only how to look for damage, but also to know to look for expected characteristics that are missing.  Either way, learning your way around an X-Ray is valuable.

While few will likely want to get this involved in analyzing their own medical data (yes, I am an engineer), I do highly recommend everyone become comfortable viewing their own X-Rays, and not be afraid to say "Show me!" whenever a diagnosis is made from the X-Ray data, to typically be followed by asking "Where?", "Why?", "How?" and so on.

If you do get involved with reading your own X-Rays and decide to look at an MRI, you should know that MRI images are at least 10 times harder to analyze and interpret.  Even specialists have trouble with them, and recent studies have shown MRI to sometimes be a relatively poor primary diagnostic tool, and it has been shown to be almost useless for correctly diagnosing sources of back pain (leading to needless surgery that harms or fails to help the patient).  So be very wary when your orthopedist uses an MRI to justify a surgical remedy!  Ask if the same recommendation would be made without the MRI images, and insist that additional imaging be performed (X-Ray, CAT-scan, bone scan, ultrasound, etc.) before consenting to surgery or other risky or costly treatments.  And, of course, always get a second opinion.

You are the one who has to sign your treatment consent forms.  You have to go through the treatment.  You have to deal with the after-effects.  You are fully responsible for what is done to your body!  It is important that you learn as much as possible about the entire diagnosis and treatment process, and never blindly trust doctors (or anyone else).  The more serious the injury and/or the more drastic the treatment, the more vital detailed knowledge becomes.

X-Rays are a nearly universal diagnostic tool for finding and identifying structural damage.  Your doctor will order them either to confirm a specific diagnosis, and/or to exclude other possible problems.  Either way, the more you know, the sooner you will start the correct treatment.


I have not included any of my own X-Rays here, nor have I described the specific things I do to examine them.  This is intentional:  I want to avoid giving the false impression that I am any kind of an expert when it comes to interpreting medical X-Rays.

I am not a medical radiologist, though I do have extensive experience with industrial radiographic imaging.  I have developed several industrial imaging systems, and have trained operators in their use.

I am more than willing to list the tools I use and how I use them, but a blog post is not the best forum.  If you'd like a demo, please say so in the comments or contact me directly.  If you are local, I'll put together a small seminar.  If not, I'll try to learn how to make a YouTube video.

Shoe Salespeople

Even the most expert salesperson can't possibly sell you your ideal shoe if the store doesn't carry it!  And no store carries every shoe.  Every salesperson knows this.  Unfortunately, not all customers do.  Salespeople know this as well, and the lesser ones take advantage of it.

One way to tell the best and very best salespeople from the second-best:  Only the best will tell you when no shoe they carry will work for you.  And only the VERY best will recommend you try specific shoes they don't carry, and will refer you to competitor's stores that do (though you may need to ask).

A lazy salesperson will initially bring out only one pair of running shoes for you to try.  A good salesperson will bring out 3-4 pairs, and a better one will bring out 6-7.  A truly dedicated (but non-expert) salesperson will keep bringing out shoes until you either buy a pair or leave (or they run out of shoes).  An expert will have a process for shoe fitting that will quickly find the best shoe in stock for your foot.  But only the best and the very best will know when to stop bringing out shoes, will know when no shoe they have will work for you, and will pass on the sale.

Specialty running store owners and managers will often have this level of insight, since they have to examine and consider lots of shoes before selecting the brands and models they will carry.  The typical running shoe salesperson will not.

Then there are the truly bad salespeople, the ones who will say anything to sell a pair of shoes.  The worst among them may mention giving running shoes "time to break-in".  This is a lie, a blatant attempt to persuade you to buy a shoe that doesn't fit.  Taking this bad advice means it will be your foot that 'breaks' (blisters and bleeds), not the shoe.

Long ago, when running shoe uppers were made of cotton canvas and/or leather, the shoe shape would change very noticeably during the first several hours of use, so you would buy them allowing for this behavior.  The upside was that every shoe would soon become custom-fit to the wearer's foot. 

Modern running shoes use synthetic materials that are much more stable:  It used to be that you discarded racing shoes if they got soaked:  Now we toss our shoes in the washer!

Modern shoe designs are a much closer match to the actual shape of the foot, so a better fit 'out-of-the-box' is possible, and should be expected.  The downside is that a modern shoe won't, can't, change shape much (not until it wears out), so it is more important now than it has ever been that the shoe be as perfect a fit as possible on the day you buy it.

Unfortunately, too many runners have no clue what their 'perfect' fit feels like, having never had one in their lives.  Even the most expert salesperson can only do so much in the face of such ignorance.  The best way forward is simply to try on and test-run lots of shoes at lots of stores, learning every step of the way.

While it is useful and instructive to listen to shoe salespeople, and it is worth your time to find the true experts, nothing can replace knowing for yourself when a shoe is best for you.  When you do buy a pair of running shoes, you must trust yourself above all others, and take full responsibility for the results.

Podiatrist: "No, Bob, you didn't break your foot."

What?  When my podiatrist told me the above last week, I was very surprised, to say the least.

When I did the Camp Pendleton Sprint Triathlon three weeks ago, I re-injured my foot during the run from the surf to transition.  It felt just like my incident last October, only half as painful.  After promising myself I'd quit if it got worse, I completed the race anyway.  Being unable to push with my right foot, my left leg was cramping by the time I finished the 5K run, but my run was only 90 seconds slower than my goal!

I saw my primary physician two days later, and when nothing showed on the X-Rays (again), he gave me a podiatry referral. Since there aren't many podiatrists in my system, I had to wait two weeks for an appointment.

One thing about my X-Rays:  I was not surprised that my injury last October did not show up on my X-Rays, because stress fractures often don't.  But with a repeat injury at the same location, both my primary physician and I were puzzled to see no bone thickening associated with the healing of the prior stress fracture.  And the reduced pain level of the new injury did not fit with any kind bone fracture diagnosis.  Hence the podiatrist.

The podiatrist instantly saw I had never had any significant trauma to the bones of my foot, and he then proceeded to lecture me on the fine anatomy of the foot (unsurprisingly, it seemed to be a well-practiced topic for him).  Basically, the foot is criss-crossed by a large maze of muscles, tendons and ligaments.  And unlike most other parts of the body, where a single degree of motion involves only a single primary tendon and/or ligament, the foot has multiple layers of interlocking support.

The thing that confused me is that tendon and ligament damage I've had in other parts of my body still generally hurt after the load was removed: For my foot, both times the pain was completely eliminated when I simply lifted my foot from the ground.  I also have had a long history of ankle sprains, so I though I knew what a sprain felt like.

Not so, said my podiatrist:  When a tendon or ligament is dislodged from its place in the maze, intense pain is often the immediate result.  And since the tendon or ligament itself may have experienced minor or no damage, there will be little or no pain after the load is removed.  And so long as activity is limited, there will often be no visible swelling.

That diagnosis perfectly fit my symptoms.  It also explained why the re-injury hurt less than the original.  And, not surprisingly, the time needed to completely heal a sprain is about the same as to heal a stress fracture.

It also explains one other thing that puzzled me during my healing process: My foot always felt better in snugly laced shoes than it did in sandals, slippers or barefoot.  While compression is not generally helpful in healing fractures, it is often helpful in healing sprains (by limiting incidental loads).

And since my foot was more comfortable shod, I had been strictly limiting my barefoot activities to the absolute minimum.  Which meant my foot became easier to injure while unshod, which is exactly what happened during my swim exit at the triathlon!

What does that mean for my future in running? First, to help my current healing process, I will continue to limit my barefoot time.  But the moment my foot is healed, I plan to gradually increase my time spent out of shoes (in sandals and/or barefoot).

My current injury was primarily caused by the spreading of my unshod foot while under load, combined with the twisting associated with exaggerated barefoot pronation, plus running on an irregular surface.  My initial injury last October was more due to the pronation alone while wearing flimsy racing flats.  Over time, I need my foot to become better accustomed to and more tolerant of these motions, and greater activity without shoes is the only way to do so.

Toward the end of my visit with the podiatrist, I asked him: "Which ligaments or tendons were affected?"  His answer?  "I haven't a clue.  There are way too many of them to know for sure!"  (I think he did know, but didn't want to take the time to explain, since he had a bunch of appointments stacked up after mine.)

The identity of the culprits doesn't really matter: The recovery process will be the same.

I've been doing lots of research on foot sprains, and I'll summarize what I'm learning in a future post.

Arm Swing

I've been tinkering with all aspects of my stride for three years now, and if I were to pick the single most critical aspect of my stride, the part that both consumed the most time to develop and yielded the best results, it would be my arm swing.

I am convinced that arm swing is one of the most complex stride components to work on.  The length of the arm bones matters (both in an absolute sense, and relative to the leg and torso lengths).  The amount of arm muscle matters, as does the weight distribution between the upper and lower torso.  The arm swing that works best for one runner may not work at all for another runner, even if their body builds were nearly identical.

I have several very different arm swings I use, depending on the terrain (flat, uphill and downhill), the shoes I'm wearing (shoe weight has a great effect on the stride), and my fatigue level (my best speed under the conditions).

It took me about 6 months of experimentation to not only try many arm swing variations (range, symmetry, rate, forcefulness, elbow angle, etc.), but also to keep working with the 'best' ones until they became 'natural' to me.  I found it essential to record all my test runs on my Garmin Forerunner 305 so I could later compare apples-to-apples, independent of what or how I felt (except for joint discomfort).  Every new arm swing variation always felt worse, or at least strange, at the start.  But the numbers do not lie.

The most surprising thing I learned is that I run with my arms!  When using a metronome to train my turnover rate to a higher level (I train at 190 bpm), I found it was my arm swing I had to force to match the metronome, not my legs.  Whatever my arms do, my legs will follow (if they can).  The reverse did not work at all for me:  Trying to make my legs turn over faster was a pointless endeavor.  I've recently begun looking at my leg swing, and seeing if I can use my arms to help improve it, rather than focusing only on the legs.

I also had to incorporate stretching and some light strength training to help my arms become better at doing the swings that worked best for me.  In particular, my rearward swing increased quite a bit (especially uphill), and I had to increase my strength and range of motion to make it effective, comfortable and sustainable.

Right now, my best arm swing on level ground with fresh legs looks like this:
- Elbows at about 95 degrees (slightly open)
- Hands open and flat (making a fist ruins my arm swing)
- Arm swing does not cross the body (no torso twist)
- Rearward swing is slightly exaggerated (it helps me maintain my best forward lean and also helps me use my hamstrings better)
- Downward arm swing is forceful, return swing is relaxed (it basically matches what the opposite leg is doing)

Having minimal torso twist has proven to be a key component toward helping me go faster.  YMMV: Many runners require some torso twist to help obtain full leg extension.  I have long arms relative to my leg length (great for swimming) which seems to make torso twist unnecessary for me.  (I did try bending my arms more and adding torso twist, but it slowed me down.)

The thing is, this is beginning to feel like a never-ending cycle:  Every time I get faster, my stride lengthens (I keep a near-constant turnover rate), and I need to adapt my arm swing to work better with the increased range of leg motion.  If you already have great cardio conditioning and good speed, you may reach your potential sooner, with less experimentation and adaptation.

I'm still trying to work my way down to an 8 minute pace, one step at a time...