Mar 28, 2013

Looking back to look forward: My own running.

I took a moment this morning to look at my training log from this week last year and compared it with this week. My new numbers are sad when compared to last year.
3/25/2012-3/31/2012 – Last YearTime:
3:25:31 h:m:s
3/25/2013-3/31/2013 – This Year
0:35:03 h:m:s
If we look back one more week my time would have been a big fat zero. What happened to my running? Well I will tell you what happened. I let myself make excuses for myself. My running peaked around May of last year when I ran the Madison Half-Marathon with my girlfriend.

Since that time I slowly let my training decline until it flat lined in October or September. There are a few of reasons of why I did this to myself.

Youth Sports Safety and Injury Prevention Pt. 1

I have recently had people ask me some questions regarding injury prevention, especially for youth and adolescent athletes. Coincidentally, the National Athletic Trainers' Association hosted the 4th annual Youth Sports Safety Summit in Washington, D.C. in early February. The major focus of this summit was on concussions which is related to but different than what I want to discuss today. More specifically, recently published an article about youth injuries with commentary by famous orthopaedic surgeon, Dr. James Andrews.

The safety and well-being of the youth has always been a hot topic in American politics and media outlets. However, it wasn't until recently that a long-running and beneficial activity for the younger populations, sport and exercise, has been looked at with scrutiny. I would attribute this to the changing culture and philosophies related to sport and exercise.
Dr. Andrews notes…"I started seeing a sharp increase in youth sports injuries, particularly baseball, beginning around 2000,"…"I started tracking and researching, and what we've seen is a five- to sevenfold increase in injury rates in youth sports across the board.”
More specifically, a lot of kids/parents/coaches are treating or training youth athletes as if they are currently a professional or collegiate athlete and they expect that doing this will turn them into the next all-star or elite level athlete. Instead of kids playing a fall sport and then changing it up with a season off or another sport all together we are seeing a rise of off-season and club sport leagues. It is also not uncommon for a 15 year old boy playing soccer in the fall at school, then move to directly to indoor club soccer and then move right into outdoor club soccer in the spring and summer. Rinse and Repeat. Sometimes these athletes will do this at the same time as other sports which equals out to them playing multiple sports at the same time.
I am happy to see these kids being active but that is exactly what they are…kids. Some of these youth athletes have a busier schedule than the collegiate athletes that I treat. There are some major issues that I see with this.

1) Lack of Rest & Overtraining
This is pretty self-explanatory but if you have such a hectic and busy schedule how can you expect to have any rest to recover? It seems like 2/3rds of the population is having an inactivity issue while another part of the population struggles with the other extreme of being over-active.

2) No “cross-training”

Ch-Ch-Changes…Cueing my David Bowie here but adolescence is the second biggest time for growth next to infancy. As muscles, bones, and connective tissue are lengthened and changed therefore our motor control (brain-muscle control) behavior need to change. The human body learns from input. If you stick to just one sport you are only getting one set of movement patterns as an input to learn from. If you are a football player that wrestles and runs track you are getting a much more dynamic and varied input movement patterns.
The human body is a dynamic piece of equipment. I have seen basketball players with a poor ability to use their own body for leverage while playing in the post or boxing out but what is baffling is that they have played basketball all of their life. However, I often find out that these athletes only focused on basketball and didn’t participate in other sports.
Cross-training in different sports also exposes your body to different movements and forces that act upon your body. You are more likely to injure your shoulder if you throw a ball all year round versus taking a few months off after a throwing season. Even professional baseball players take several months off after their season is over.

3) Increased exposure to injury
Increased in-season playing time equates to an increased risk of being injured by pure chance. More hours on the field or court is going to increase the chance you will roll your ankle on somebody else's foot, sustain a concussion or any other sort of contact injury. This might not apply if you play a sport like golf but it will still definitely increase your chance at suffering a chronic injury if you have inappropriate mobility, stability or motor control behaviors that are left untreated.
Additionally, one of the biggest predictors for injury is a history of previous injuries. This means suffering additional injuries in out of season club sports may potentially put an athlete at risk for suffering injuries during in-season sports. I’m not saying spraining your ankle in club sports will cause you tear your ACL in-season because nobody knows that. I can say that spraining your ankle may cause muscle imbalances, compensatory movement patterns, and altered sensory input that could affect your risk for an ACL injury.

4) Training like a pro doesn’t make you a pro
If I want to work on becoming an Olympic marathon runner like Ryan Hall I should just copy his training program right? Wrong. Ryan has spent decades of his life devoted to training for the marathon and has progressed his training plans as he has advanced as an athlete. Most of us would probably break down after a week or two on his program if we could even finish one of his workouts. The same thing goes for anyone wanting to be the next NFL quarterback or NBA all-star.
Dr. Andrews labels these phenomenon into two categories, Specialization and Professionalism.
“Specialization leads to playing the sport year-round. That means not only an increase in risk factors for traumatic injuries but a sky-high increase in overuse injuries. Almost half of sports injuries in adolescents stem from overuse.
Professionalism is taking these kids at a young age and trying to work them as if they are pro athletes, in terms of training and year-round activity. Some can do it, like Tiger Woods. He was treated like a professional golfer when he was 4, 5, 6 years old. But you've got to realize that Tiger Woods is a special case. A lot of these kids don't have the ability to withstand that type of training and that type of parental/coach pressure.
Now parents are hiring ex-pro baseball players as hitting and pitching instructors when their kid is 12. They're thinking, 'What's more is better,' and they're ending up getting the kids hurt.”

He also gives this advice to the parents of young athletes…
“The first thing I would tell them is, their kid needs at least two months off each year to recover from a specific sport. Preferably, three to four months. Example: youth baseball. For at least two months, preferably three to four months, they don't need to do any kind of overhead throwing, any kind of overhead sport, and let the body recover in order to avoid overuse situations. That's why we're seeing so many Tommy John procedures, which is an adult operation designed for professionals. In my practice now, 30 to 40 percent of the ones I'm doing are on high-schoolers, even down to ages 12 or 13. They're already coming in with torn ligaments.
Give them time off to recover. Please. Give them time to recover.
I said in the book, I want parents and coaches to realize the implications of putting a 12- or 13-year-old through the type of athletic work done by a 25-year-old. Parents and coaches, though they mean well, need to understand what the long-term effects of overuse can be.”

In part 2 of this topic I will discuss a few items that I think can be used to help prevent injuries in not just youth athletes but active people of all ages. The number one thing that we may need to look at though is our current sport culture and questioning if you are advocating Specialization and Professionalism to your athletes(if you are a coach) or your own children.

Mar 20, 2013

No Way! I actually won a giveaway!

Winner, Winner. Chicken Dinner.

I won something. This was a great way to wake up on the first day of spring and the only way it could have gone better was with some chocolate chip, gluten-free pancakes. Miraculously, my girlfriend made me some delicious ones for breakfast(I probably won't need to eat until supper now).

So what did I win and how did I do it?

Well I was lucky enough to win the newest model of huaraches(sandals) El Mono, produced by Luna Sandals. Luna Sandals was founded by Barefoot Ted whom some of you may know from the book, Born to Run. Barefoot Ted learned how to make huaraches from the Tarahumara of Mexico's Copper Canyons and has taken this knowledge to create a line of premium huaraches.

I won these sandals because I read a review of El Mono at The Running Lunatic Blog written by Patrick Sweeney, a Luna Sandals sponsored runner. At the end of his review Pat set up a giveaway using I'm not a stranger to Luna Sandals and I love my Luna Originals(now the Venado) and my Leadvilles w/ ATS Laces so I figured I would jump at the chance to own another pair of Luna's.

My current Luna's are my current favorite go-anywhere do-anything shoe to wear when the whether is permitting. I even wear them when the weather isn't permitting (sub-freezing temperatures with snow and ice) without much of an issue but that's just because I am kind of an idiot.

I have horrible balance. Good thing I was wearing my Luna's.
 I introduced my girlfriend to her Luna Sandals. When I first got them she made fun of me for them but after running in her own pair she fell in love. She fell in love so much that she wore them for a half marathon last May and a full marathon last October. Her first half and full marathons, actually.

She ran a sub 4-hr marathon in Luna's for her first marathon ever, not bad.

We use our Luna Sandals for hiking, running, and relaxing.

I even wear my Luna's to look out windows. Very brave of me.
I can't thank Pat Sweeney of The Running Lunatic as well his more infamous blog Bourbonfeet and all of the lunatics at Luna Sandals enough for this opportunity. I can't wait to try them out and I will definitely post a review of them here on this blog for all to read.

Mar 12, 2013

Ankle Dorsiflexion: The What, Why, and How.

Dorsiflexion. This important motion occurs at the ankle and is seen when the dorsal(top) aspect of the foot and the anterior(front) aspect of the tibia(shin) move closer together. This motion is seen with and is necessary for proper execution of many basic human movements including squatting, running, walking, jumping and more. This motion is a vital part of most functional movements and proper function up and down the entire kinetic chain. Even minor tasks such as sitting and standing from a chair or walking up and down stairs requires adequate dorsiflexion of the ankle.

There are many issues related to inadequate dorsiflexion including many lower extremity injuries and and foot deformities. Evidence exists that problems here can be related to falls in the elderly, patellar tendinopathy, ACL injuries, lower extremity kinematic changes, and patellofemoral pain syndrome to name a few. This motion could be limited by several different problems such as soft tissue mobility(muscles and fascia), bony abnormalities, joint capsule restrictions(belongs with soft tissue mobility), and impingement of these structures.

The human foot and ankle are masterpieces of complexity and natural engineering.

When a person is deficient in dorsiflexion they are not automatically limited in the aforementioned movements(besides dorsiflexion, duh) or tasks such as a squat. The human body is great at incorporating compensatory movements to allow a continuance of motion to increase our ability to survive but at the cost of our ability to thrive. 

For example, lets say I have a patient named Jim Shorts who comes to me with complaints of knee and low back pain as well as a history of chronic plantar fasciosis. Jim loves going jogging, playing basketball, and working in the garden with his wife. 

These are very common symptoms and could be caused by a variety of issues but for the sake of this post lets discuss how they could be related to dorsiflexion of the ankle. Before we even begin to evaluate Mr. Shorts lets think about how dorsiflexion might be needed during each these activities. 


  • The ankle plantar flexors(think calf muscles) and plantar fascia may be eccentrically (resistively stretched) loaded at initial foot strike depending on landing type (heel strike vs mid-forefoot landings).

Initial Contact

  • As the gait cycle changes from initial contact to mid-stance, the ankle moves into a more dorsiflexed position. At this moment, vertical ground reaction forces are at their highest(Active Peak on the graph below) and loading of the achilles tendon is reaching its maximum peak. To allow proper dispersal of these forces and to allow some of this energy to be stored and then reused the achilles must act as a spring.  Dr. Mark Cuccuzzella has made a video that highlights these principles of running mechanics and he does a much better job of visually and audibly explaining it than I can in writing.
  • Steve Magness, writer of the blog Science of Running, and Head Cross Country coach at the University of Houston wrote a great post on the most vital components of running here as well.


  • The ankle plantar flexors are now on maximum stretch(maximum dorsiflexion) and are maximally loaded now must assist the posterior chain(gluteus muscles and hamstrings) to propel the body forward and slightly upward(propulsion phase & toe-off).

These components involving the ankle and its ability to dorsiflex are vital to running and any sports that involve running. If motion is impaired we should not expect to be efficient or safe from injury. Would you expect a car to have maximum performance or to be safe from harm if you had improperly sized or damaged shocks? 

I like the analogy of the ankle plantar flexors to be a group of rubber bands. If you have soft tissue problems then these rubber bands may be tied full of knots or could be thought of as dried out and having lost their snap. If you have bony or joint capsule restrictions then you may not have the ability properly stretch out a healthy rubber band to allow maximum performance or perhaps this inability caused a degradation in the health of the rubber band itself. Double Jeopardy.

Basketball & Gardening
  • Requires the ability to run(discussed previously)
  • Requires the ability to jump
    • You need to be able to shoot a jump-shot, lay-up, dunk or to go up for a rebound.
  • Requires the ability to land after jumping
    • You need to safely come down after jumping and be able to dissipate the forces from impacting the ground.
  • The above can be summarized by the ability to squat. (*Only the squat applies to gardening, unless you are into some extreme gardening stuff that i've never heard of before.)
    • You also need to be able to properly squat to get into sport-specific positions of basketball such as a defensive stance and you don't want to bend at the waist to work in your garden(some people still will). 

Looking at Mr. Shorts
So we begin to evaluate Mr. Shorts and we have him perform some functional movements to evaluate his movement behavior. For example, we ask Jim Shorts to do a deep squat like he would while gardening and we notice that his heels can not touch the ground and he excessively flexes his trunk forward to allow his arms to work at ground level.

Next, I have Jim show me his defensive basketball stance. We immediately notice that his knees extend past  his toes and that he has that same forwardly flexed trunk position as before. He also complains that this position immediately exacerbates the pain in his knees and low back.

At this point I decide to try something. I take either a heel lift and place it into Jim's shoes or place his heels onto a 2in. board and have him repeat his deep squat. This time Mr. Shorts is able to squat down with his heels flush to the ground (or board) and his back appears to be parallel with his shins from a side view. The only difference here is that we eliminated the demand for proper dorsiflexion. Technically, this might not be the only reason for his limitations but I wanted to show how improper dorsiflexion could change a functional movement. 

This example shows us how problems with movement at the ankle can increase forces and perhaps damage tissues further up the kinetic chain. The next step for us would be to decipher what type of dorsiflexion restriction Jim Shorts actually has but that post is for another day so lets move on to figuring out how to evaluate your own ankle dorsiflexion.

Self Evaluation
Lets discuss how you can evaluate your own ability to dorsiflexion at home. Here are a few links to some of my favorite techniques and how-tos for evaluating ankle mobility.
  1. This first link is credited to Mike Reinold's blog and is an all-encompassing post that is very concise and does a great job of saying everything that I am trying to say with this post. He even has many great videos for working on improving your own mobility.
  2. This link is to a blog post by Jay Dicharry, MPT, CSCS...Author of the book, Anatomy for Runners. Jay is probably one of the premier clinicians and researchers out there today when it comes to running mechanics, research and injuries. This post discusses more than just ankle dorsiflexion and is definitely recommended.
  3. This next link is actually to a video made by Jay Dicharry. This video will show you a quick and easy list of self-evaluation techniques and fixes for somebody looking to transition to minimal running shoes. However, I feel that these are vital to athletes and runners regardless if they are barefoot or wearing Hoka one-ones.
  4. How much dorsiflexion do you actually need? Jay Dicharry recommends at least 25 degrees of dorsiflexion at the ankle and 30 degrees of dorsiflexion of the big toe(measured at 5 degrees of ankle dorsiflexion). Mike Reinold and the minds of the Functional Movement System, such as Gray Cook sponsor the idea of the knee reaching about 5 inches past the toes while in a half kneeling stance. One study found that athletes with less than 36.5 degrees of dorsiflexion had an..."18.5 to 29.4% risk of developing patellar tendinopathy compared to a 1.8 to 2.1% risk for athletes with dorsiflexion greater than 36.5 degrees." I believe most of these values to be too similar to chose one set of thought over the other and suggest them as mere guidelines and not cut points.
How do I fix this?
I had originally planned on writing an entire section on my favorite joint mobilization, static stretching, and soft tissue mobilization techniques but the links I provided in the self-evaluation section have some great techniques included with them already. I feel like I can not top those techniques and I highly recommend them. However, I do want to summarize some thoughts about trying to increase dorsiflexion.
  1. I believe that a vast majority of us living in 1st world countries that grew up with or have been wearing shoes for decades with an elevated heel have limitations in ankle dorsiflexion. There are exceptions to this but I have provided you with information to check for yourself.
  2. I admit that going barefoot or  utilizing a more minimal shoe during training may not be feasible for everyone. However, I do feel that incorporating and wearing a shoe with less heel-to-toe drop or less of an elevated heel during everyday activities such as at work, around the house or out on the town can be very beneficial for restoring proper ankle dorsiflexion. What you wear on your feet 90% of the time probably has a more profound effect on your tissues than the shoes you wear 5-10% of time you spend training each week.
  3. When it comes to increasing the actual mobility with manual work I believe a multi-faceted approach is best. A combination of joint mobilizations, static stretching(post exercise), foam rolling, etc is probably going to be more effective for you unless you or a manual therapist has determined that only one specific issue is limiting you. It would not be uncommon for several of these issues to be a limiting factor for a person.
  4. Do not ignore above and below, tibial internal & external rotation as well as plantar fascia mobility influence movement at the ankle as well.
  5. DO NOT try to treat the symptom by eliminating the need for proper dorsiflexion. Utilization of heel lifts, immobilization, restrictive tape jobs, new shoes and etc. are only treating your symptoms. These MAY be appropriate for short-term relief but they do NOT fix your problem. If you try to take the easy way out and try to eliminate this motion then you are setting yourself up for a different set of problems up and down your entire kinetic chain.
In conclusion, this is going to be an issue with a majority of people. This problem exists in both the physically active and inactive populations. Only the minority of people that I've tested have had adequate ankle dorsiflexion. I would love to see how this compares with a third world country where people have not had the "luxury" of wearing shoes with elevated heels since birth. I bet you can find plenty of pictures in a national geographic magazine where the indigenous tribespeople have perfect squat form and can hold it comfortably with ease.


Here are a few related videos that I have made that should be of value to this topic as well! Enjoy!

Mar 8, 2013

My Blood Tests & a Preview of what's next: Ankle Dorsiflexion

Howdy folks,

I am going to be traveling out of town with the basketball team that I work with in attempt for them to make the sweet 16 in NCAA Division III basketball so I don't have time to finish next week's blog post just yet but I thought I'd give a little preview of what is to come. Next week we will begin a discussion of ankle dorsiflexion. We will discuss the importance of this motion, the prevalence and research related to a lack of dorsiflexion and how to do a self-evaluation to check your own dorsiflexion at home. We will also talk about different ways of working on regaining or maintaining this motion including some of my favorite joint and soft tissue mobilization techniques, trigger point therapy, as well as mobility exercises and stretching. This won't be a post just for runners but for anyone who wants to live an active lifestyle. It doesn't matter if you are a power walker, weight lifter, martial artist, ballet dancer, mountaineer or grandmother that enjoys gardening.

In other news, I received my blood test results back today including a blood lipid panel and thyroid stimulating hormone levels. I went into the doctor for a wellness appointment earlier this week and wanted to get some blood tests done so that I could have a baseline for my health as it is related to diet. I wish that I had thought of this idea before I began eating an ancestral health/paleo/high fat type diet about a year ago so that I could see how I have changed since then. Although this is a cross-sectional look at my health it still shows that here and now that my values are within  healthy and normal ranges. I would like to point out that my hematocrit level is considered low but that can be misleading and thrown off my individuals that are well hydrated.

Here are my results below:

It doesn't look like I am at risk for developing any health problems with this diet that is high in saturated fat and lower in overall carbohydrates. As I said though, with just this one test we have no way to know what direction these bio-markers are moving...they could be improving or getting worse but for this current moment in time I am quite alright (not that I wouldn't like to tweak a few values, like seeing my HDL rise up to around 70 and to see my LDL numbers broken down further).

Have a great weekend!

Mar 1, 2013

A rant about Gorillas, a Chick Flick, and Diet.

Last weekend my girlfriend brought me to the latest chick flick that was written by the same guy that brought us The Notebook. The movie was titled Safe Haven and it's safe to say that it won't ever rival The Notebook in popularity.  However, that won't stop lonely ladies from renting it after purchasing a bottle of wine and a pint of Ben and Jerry's or using it as a way to punish their boyfriends(jk sweetie).

Your skin smells like skin.
Now it is time to get down to my actual rant. During the movie, the main character starts reading The China Study after finding it in a tourist shop's lost and found book pile.  The China Study is book written by T. Collin Campbell about a study done with T. Collin Campbell as one of its investigators. This seems like a unrelated plot point, because it is but it also becomes the basis for me to start ranting to myself and my girlfriend during the film.
The bible of vegans and vegetarians.

The China Study itself is actually a very interesting study and is probably one of the largest studies on human diet and health ever performed to date. However, there are some problems associated with this book/study. My first problem is the poor data analysis and statistics that was done for this study.  T. Colin Campbell did great things by helping conduct this study but there are flaws with his data and the implications that he has derived from it.  Denise Minger of became one of the first big viral critics of The China Study and a lot of her information/critiques about the China Study can be found here. Stan the Heretic, a physicist with interests in nutritional biochemistry also expands upon these analyses.

So you think you've got guts? Check out the comparison.
Continuing on, later in the film the main character is conversing with the co-star about The China Study and they go on a tangent about the health and musculature of gorillas as a result of their diet versus the common diet of us humans. The conversation between the two implicates that we should eat just like gorillas (vegetarian raw food diet). This might seem like a good inference for some people seeing that we are both primates, mammals, and that we humans struggle with diet and health.

There is a problem with this line of thinking...we are NOT gorillas. We are humans. Different anatomy and physiology people. I'm not trying to make the case that we shouldn't eat fruits and vegetables but I am trying to highlight the idiocy in thinking that we should copy another creature's diet. I am also not trying to claim that we have substantially different nutrient requirements compared to gorillas but we do have much different food requirements as a result of our biological differences. You might ask what science do I substantiate this with?

If you look at the above picture you will notice a big difference in the midsection of gorillas vs humans. The guts of a gorilla account for 2.9% of its body weight versus 1.7% of body weight for humans. This means that a humans gut is 40% smaller than that of a gorilla. What does this mean? Well the average western lowland gorilla obtains 57.4% of its energy from dietary fiber. All of this fiber is not directly digested by the gorilla but rather by its gut bacteria via fermentation which is then delivered to the gorilla in the form of short-chain fatty acids. These fatty acids can then be turned into saturated and monounsaturated fats by the gorilla's body. Humans on the other hand can only obtain about 7% of energy from fiber due to our decreased length of large intestines which is the sight of fiber digestion in primates like gorillas and humans. The large intestines make up 60% of the gorillas gut where it only comprises 17% of the human gut. This is obviously a problem if you want to start eating like a gorilla and has profound implications on how foods are digested and converted to different nutrients in the body. Lets compare at the macro-nutrient composition as % of total energy of the gorillas diet before and after digestion.

Before Digestion                                   After Digestion
Fat:2.3%                                                 Polyunsaturated Fats:<2%
                                                              Monounsatured/Saturated Fats:58%
Protein: 24.4%                                         Protein: 24.4%
Carbohydrate(ex fiber): 15.9%                   Carbohydrate: 15.9%
Fiber: 57.4%                                            Fiber: Converted

Source: Jaminet, Paul; Jaminet, Shou-Ching (2012-12-11). Perfect Health Diet (Kindle Locations 812-831). Simon & Schuster, Inc.. Kindle Edition.

By looking at the before and after picture here we are able to see how a gorilla eats a low fat, high fiber, moderate protein and low carbohydrate diet by look at just food sources. When we look at the biological picture we see that the gorillas body is actually producing a high fat, low carbohydrate, moderate protein diet that is similar to the macro-nutrient ratios found in sources like mammalian breast milk and the proportions touted by paleolithic inspired diet advocates.

In conclusion, I don't think it is wise to try to eat what other mammals eat. I do however think that eating the nutrient composition of other mammals may be a wise model considering that we share similar cellular structures and cellular demands. I do not understand why this aside was thrown into the movie...I do not know if the writer is secretly trying to promote The China Study, or if they are trying to appeal to the vegan and vegetarian crowds? Maybe it was just a silly fact that they threw into the movie to act as a conversation piece or for levity but all I know is that it made me want to rant. So I did.


Disclaimer: Please note that some of the links on this blog are affiliate links and I will earn a commission if you purchase through those links. I have used all of these products listed and recommend them because they are helpful and are products from companies that I trust, not because of the commissions that I may earn from you using these products.


All content on this blog is meant as instructional and educational. The author and guest authors of this blog are not responsible for any harm or injury that may result. Always consult a physician or another proper medical professional for medical advice. Registered & Protected