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!
Tuesday, September 27, 2011
Tuesday, September 6, 2011
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.
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.
Tuesday, August 30, 2011
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.
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.
Sunday, August 28, 2011
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.
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.
Thursday, August 18, 2011
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...
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...
Wednesday, August 3, 2011
Running and Music
I can't count how often I hear someone complain about earphones that don't stay put while running, often due to motion and/or sweat. They will then ask: "What is the best kind of earphones to use while running?"
The correct answer is none.
The vast majority of runners do at least some running on or near roads. Anywhere moving vehicles and people mix, collisions are sure to happen. Runners are seldom hit from the front, since the eyes can provide enough warning to avoid a collision.
Most runners get hit from the back or side, where the ears are the main warning source. Intentionally reducing ear sensitivity while running anywhere near traffic is literally suicidal. Many communities understand this, and have passed laws restricting the use of earphones and music players near roads.
I have personal experience with this: Just over 25 years ago a runner wearing earphones was waiting for the light to change at an intersection, then proceeded to run across the wrong side of the intersection. I was just entering the intersection on my motorcycle, having timed the light perfectly, only to suddenly find that runner in front of me.
I hit the brakes and horn and veered to miss the runner, but she kept going, never hearing the huge amount of noise my horn and tires were making. I was unable to avoid slamming into her. I had a very rough landing, was knocked unconscious, and nearly slid into oncoming traffic.
When I woke in the hospital, two police officers were standing at the foot of my bed. They asked if I knew what had happened, and I told them everything I could remember. My memory abruptly ended an instant before the impact. I didn't remember the collision itself or anything after.
They next told me she was declared dead at the scene. My blood pressure crashed and I passed out for a few moments. When I came to again, they said something that's been burned into my memory ever since: "It was not your fault. The witnesses and the evidence at the scene make it clear you did everything possible to prevent the collision. The earphones she was wearing and the volume setting of her music player combined to make her completely unaware the danger she was in. She was negligent to the point that she essentially committed suicide, and used your motorcycle to do so." They said more after that, but my mind had locked up trying to process that last sentence.
Even now, a quarter of a century later, this memory still wakes me, my heart thumping and my hands shaking.
There is no safe way to combine music and traffic with running or bicycling. Just being a runner or bicyclist on a road is hazardous enough without making it worse by adding music.
The music a road runner hears is often their own requiem.
I'm enough of a personal libertarian to believe that we each have the right to determine when and how we leave this world. I also believe in personal and social responsibility, and we should not inflict needless trauma on others.
Wearing earphones while running or biking anywhere near a road is equivalent to intentionally making yourself a candidate for a Darwin Award. But as you exit the gene pool, you should try to do so with minimal pain to loved ones and strangers alike.
Wearing only one earphone or keeping the volume down is not a viable solution: Your attention will still be on the music, instead of on the hazards present in the world around you.
The same applies to using a phone while running.
If you must run with music, please stay well away from traffic, and consider these alternatives to roads and sidewalks:
Update, 16 August: I've received a fair amount of feedback about this post. Some said they rely on music to keep their pace regular. In that case, consider running with a metronome such as the inexpensive Seiko DM50. The beep of the metronome will not prevent you from hearing approaching traffic. I seldom run without mine!
The correct answer is none.
The vast majority of runners do at least some running on or near roads. Anywhere moving vehicles and people mix, collisions are sure to happen. Runners are seldom hit from the front, since the eyes can provide enough warning to avoid a collision.
Most runners get hit from the back or side, where the ears are the main warning source. Intentionally reducing ear sensitivity while running anywhere near traffic is literally suicidal. Many communities understand this, and have passed laws restricting the use of earphones and music players near roads.
I have personal experience with this: Just over 25 years ago a runner wearing earphones was waiting for the light to change at an intersection, then proceeded to run across the wrong side of the intersection. I was just entering the intersection on my motorcycle, having timed the light perfectly, only to suddenly find that runner in front of me.
I hit the brakes and horn and veered to miss the runner, but she kept going, never hearing the huge amount of noise my horn and tires were making. I was unable to avoid slamming into her. I had a very rough landing, was knocked unconscious, and nearly slid into oncoming traffic.
When I woke in the hospital, two police officers were standing at the foot of my bed. They asked if I knew what had happened, and I told them everything I could remember. My memory abruptly ended an instant before the impact. I didn't remember the collision itself or anything after.
They next told me she was declared dead at the scene. My blood pressure crashed and I passed out for a few moments. When I came to again, they said something that's been burned into my memory ever since: "It was not your fault. The witnesses and the evidence at the scene make it clear you did everything possible to prevent the collision. The earphones she was wearing and the volume setting of her music player combined to make her completely unaware the danger she was in. She was negligent to the point that she essentially committed suicide, and used your motorcycle to do so." They said more after that, but my mind had locked up trying to process that last sentence.
Even now, a quarter of a century later, this memory still wakes me, my heart thumping and my hands shaking.
There is no safe way to combine music and traffic with running or bicycling. Just being a runner or bicyclist on a road is hazardous enough without making it worse by adding music.
The music a road runner hears is often their own requiem.
I'm enough of a personal libertarian to believe that we each have the right to determine when and how we leave this world. I also believe in personal and social responsibility, and we should not inflict needless trauma on others.
Wearing earphones while running or biking anywhere near a road is equivalent to intentionally making yourself a candidate for a Darwin Award. But as you exit the gene pool, you should try to do so with minimal pain to loved ones and strangers alike.
Wearing only one earphone or keeping the volume down is not a viable solution: Your attention will still be on the music, instead of on the hazards present in the world around you.
The same applies to using a phone while running.
If you must run with music, please stay well away from traffic, and consider these alternatives to roads and sidewalks:
- Treadmills
- Oval tracks
- Paved paths
- Trails
Update, 16 August: I've received a fair amount of feedback about this post. Some said they rely on music to keep their pace regular. In that case, consider running with a metronome such as the inexpensive Seiko DM50. The beep of the metronome will not prevent you from hearing approaching traffic. I seldom run without mine!
Friday, July 29, 2011
(Nearly) Barefoot Running: Why?
There is lots of online discussion about barefoot running, including running in very thin shoes such as Vibram Five Fingers (VFFs). There are many aspects to the discussions, including topics such as benefits, risks, how to transition, how to train, and many more.
My favorite running information source is RunBlogger Pete Larson, who has had many interesting recent posts on this and related topics. His coverage tends to be observation-driven, with occasional guest posts by true experts and highly respected authorities (most with PhDs). And his readers post some great comments and links.
His blog, along with my own research, convinced me to incorporate VFFs into my own training regimen.
My goal has not been to give up my "running slippers" or my racing flats, since I'm too much of a committed road runner for that. Plus, I've already had one metatarsal stress fracture and I'm not looking for another, so I like the idea of having some padding between my feet and the ground. Finally, I've looked at the soles of barefoot runners (generally thick, cracked leather), and talked with them about their experiences (frequent discomfort, especially on gravel and hot asphalt), and I'm not inspired to emulate their dedication.
Given the above, why should I do any VFF running at all? My reasoning is simple but not obvious, so please bear with me.
The online discussions tend to center on two primary tenets: Barefoot running is more "natural", and traditional running shoes can damage some runners. My personal experience emphatically supports that last point, but I'm a "broken" runner, so my case isn't typical.
So what about that "more natural" claim? The arguments for it are passionate, with some interesting evidence I found to be persuasive but not conclusive. However, my curiosity was spiked: What would change if I tried running in VFFs? How would they affect my comfort and performance?
I got my VFFs right after Christmas, while I was still recovering from my stress fracture, though I didn't start running in them until early this spring. When I did start with them, I ran only on soft surfaces (sand, turf, padded track), and only for 5 minutes at a time. I slowly built up to 20 minutes running, about 2 easy miles, then stopped adding both distance and speed. These days, I run in them only twice a month.
Why so little use? Because I immediately learned what was most important to me: Running in VFFs reveals where my gait can improve, and provides instantaneous feedback as I find and incorporate the needed improvements.
From my perspective, having less between my feet and the ground gives me much more sensitivity and input from my feet, and I become much more aware of irregularities and imbalances in my stride. Conversely, swaddling my feet in socks and shoes (even minimalist shoes) is equivalent to making my feet slightly numb. Occasionally experiencing the "direct" sensations from running in my VFFs also helps me be more aware of what my feet are doing while wearing shoes.
I use my VFFs as a way to check that my shod stride is OK, since the first 100 yards in VFFs will let me know if there is any discomfort or awkwardness I should address. Rather than thinking of my VFFs as running shoes, I view them as another training tool that provides important information, right up there with my Garmin Forerunner 305. Somewhat similar to how I sometimes ride a spin bike instead of my road bike: Doing a given activity with different equipment and/or in a different environment permits subtle aspects of the activity to be sensed and focused upon.
I believe many of us can benefit by becoming "more natural" runners. A good way to do this is to run barefoot or in VFFs. But I do not believe we need to completely give up our regular running shoes and socks to achieve the desired results. I suggest the following three-phase process:
My favorite running information source is RunBlogger Pete Larson, who has had many interesting recent posts on this and related topics. His coverage tends to be observation-driven, with occasional guest posts by true experts and highly respected authorities (most with PhDs). And his readers post some great comments and links.
His blog, along with my own research, convinced me to incorporate VFFs into my own training regimen.
My goal has not been to give up my "running slippers" or my racing flats, since I'm too much of a committed road runner for that. Plus, I've already had one metatarsal stress fracture and I'm not looking for another, so I like the idea of having some padding between my feet and the ground. Finally, I've looked at the soles of barefoot runners (generally thick, cracked leather), and talked with them about their experiences (frequent discomfort, especially on gravel and hot asphalt), and I'm not inspired to emulate their dedication.
Given the above, why should I do any VFF running at all? My reasoning is simple but not obvious, so please bear with me.
The online discussions tend to center on two primary tenets: Barefoot running is more "natural", and traditional running shoes can damage some runners. My personal experience emphatically supports that last point, but I'm a "broken" runner, so my case isn't typical.
So what about that "more natural" claim? The arguments for it are passionate, with some interesting evidence I found to be persuasive but not conclusive. However, my curiosity was spiked: What would change if I tried running in VFFs? How would they affect my comfort and performance?
I got my VFFs right after Christmas, while I was still recovering from my stress fracture, though I didn't start running in them until early this spring. When I did start with them, I ran only on soft surfaces (sand, turf, padded track), and only for 5 minutes at a time. I slowly built up to 20 minutes running, about 2 easy miles, then stopped adding both distance and speed. These days, I run in them only twice a month.
Why so little use? Because I immediately learned what was most important to me: Running in VFFs reveals where my gait can improve, and provides instantaneous feedback as I find and incorporate the needed improvements.
From my perspective, having less between my feet and the ground gives me much more sensitivity and input from my feet, and I become much more aware of irregularities and imbalances in my stride. Conversely, swaddling my feet in socks and shoes (even minimalist shoes) is equivalent to making my feet slightly numb. Occasionally experiencing the "direct" sensations from running in my VFFs also helps me be more aware of what my feet are doing while wearing shoes.
I use my VFFs as a way to check that my shod stride is OK, since the first 100 yards in VFFs will let me know if there is any discomfort or awkwardness I should address. Rather than thinking of my VFFs as running shoes, I view them as another training tool that provides important information, right up there with my Garmin Forerunner 305. Somewhat similar to how I sometimes ride a spin bike instead of my road bike: Doing a given activity with different equipment and/or in a different environment permits subtle aspects of the activity to be sensed and focused upon.
I believe many of us can benefit by becoming "more natural" runners. A good way to do this is to run barefoot or in VFFs. But I do not believe we need to completely give up our regular running shoes and socks to achieve the desired results. I suggest the following three-phase process:
- Starting out, do lots of short and easy barefoot/VFF runs to let your stride stabilize and find a comfort zone. This may take 1 to 3 weeks. If possible, try to limit regular running shoe use during this time: For example, do this in the off-season.
- Continue light/easy running for the next 1 to 2 weeks. During each run, frequently switch back and forth between shoes and barefoot/VFFs until the transition between them is smooth and effortless.
- Return to normal training in shoes, and periodically do some short/easy barefoot/VFF runs to ensure the stride is still OK.
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