Movie Monday: The Vertical Compression Test

Howdy Readers! Today is Monday and hopefully the beginning of a new tradition here at Eat.Run.Rehabilitate.! I hope to continue to upload and post videos weekly and sometimes even biweekly if I get overly ambitious. I have been trying to take some time and pre-record some videos so that way when I do have time to do some editing and posting it will allow me to be more caught up on everything.

Anyways, today's video is going to be about the Vertical Compression Test. This is another test that I learned from Jay Dicharry's Anatomy for Runners book. I've said it before and I'll say it again...not a bad book to have around for reference! This is a great way to go about assessing a person's overal posture on their postural stability and its effect on the entire kinetic chain. Check out my video below!

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Three Non-Negotiables for Running

Running a half-marathon indoors is as boring as it sounds.

Howdy Folks! Howdy? Why do I say that? I don't know but here in Miami everything keeps on thinking that I am saying "How ya doing", so perhaps I need to find a new greeting. Nevertheless, lets get back on track. Speaking of track...Do you run, work with runners, or want to run? I wrote today's post to share with you all some concepts that I learned from Jay Dicharry and Mark Cucuzzella at the Healthy Running seminar.

So guess what...? There is a lot more to running that going in circles around a track or bombing down trails in the woods. How about we break it down and discuss three critical components to running?These are critical for running "better" without taking a hit to your economy or risk of injury. I didn't say these three concepts will make you the best runner or prevent 100% of injuries. However, if you don't have these three things then you my friend are missing a few pieces of the puzzle.

1. Runners Need Mobility. Not More but Not Less.

What the heck does that mean? It means you need just enough mobility to move what needs to be moved without creating a compensatory movement pattern. It also means that going above and beyond that threshold may not be beneficial. We are talking Goldilocks here, not too tight and not too loose. We need you to be just right. The good thing here is that "just-right" probably fluctuates between body type, activity type (sprinter vs. distance vs. hurdlers), and running form. However, there are some minimums. We need enough mobility to allow our legs to extend behind us. This requires adequate hip extension, ankle dorsiflexion, and first ray dorsiflexion. We need other joints to be mobile as well but these are the essentials. How much? We are looking for 15-20 degrees of hip extension, 30 degrees of ankle dorsiflexion and another (ankle is already dorsiflexed to 30 degrees before measuring great toe mobility) 30 degrees of metatarsophalangeal (MTP) dorsiflexion of the first ray on top of that. These are not "normal" ranges of motion for these joints but these are the amount needed for running.

2. Runners Need Stability.

If you try to drive a car with poor alignment very far then you are in for a hard a time. The human body is no different. You need a stable and properly aligned "chassis" for efficient energy transfer. This means you need enough "core" control or stability to maintain your alignment while running, for the entire run. You need to be stable from stride 1 through mile x/the finish. This requires stability in all three planes and not just the sagittal plane where many of us tend to hangout. I see poor stability as a common fault for many of us. It is challenging to have proper motor control, especially for long periods of time. We do not want unstable levers to interact with and try to control high/rapid forces.

You need to be stable from beginning to end.

3. Runners Need Strength & Power.

You're a runner, right? The prime example of an "endurance" athlete. Pure cardio, pure aerobic metabolism, purely about getting in the miles or minutes. Wrong. Runners need proper levels of strength and power as well. There is plenty of evidence to show that weight training can be very beneficial to endurance athletes and runners! Your hips (glutes) need to be able to propel your entire body up and forward...very very quickly, many many times. In addition, vertical ground reaction forces (vGRF) in running peak at about 2.5x body weight! Think about that for a second...That would be the equivalent of a 150lb runner doing a single leg back squat with 225lbs on the bar for a total of 375lbs through one leg!

What about plyometrics? Economic running is very plyometric in nature...it is all about how well you can store and release elastic energy! If we are going to have stable levers from non-negotiable #2 then lets take advantage of that and apply some large forces through them!

Gravity is relentless. You need to be strong because we are always fighting it.

In Conclusion

Take these three concepts in isolation and they make sense. Look at them in combination and they make even more sense! Hey wait a minute! How do these things even help runners? Well, overall these are needed to better our running economy and that is done by addressing two key concepts of economic running form.

• Better Storage and Release of Elastic Energy
• Minimized Loading Rates

Now we just need to take these conceptual ideas and put them into practice, right? Stay tuned for future posts where we will discuss how to evaluate and address these issues.

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Healthy Running Course Review

Hold on a second guys....Okay, there. Sorry. I had to come down from what I imagine being on cloud 9 feels like. I have had one crazy, jam-packed, and exciting month so far. The month concluded with two pretty big events. First of all, I finally got around to popping the question...and thankfully she said yes.

On top of that I had the opportunity to travel to Portland, Oregon to attend one of the newly established Healthy Running Courses. In addition to being a course participant I was invited to present the findings of my research on Correct Toes and Lems during one of the lunch breaks! So I wanted to write up a post with my thoughts and feelings regarding this new continuing education course that is geared toward medical professionals, running coaches, and fitness professionals that deal with endurance athletes. There was even a few purely recreational runners in attendance as well!

I was pretty nervous in this photo but not as nervous as I was for the next one...

This was a pretty nerve wracking moment.

Additionally, in about a week I will begin a road trip with my new fiance in order to move to Miami. There we will reside for the next 4 years or so while I begin work on my PhD from the University of Miami. A lot of culture and geography shock in my life lately...

Pretty Sweet geography around Portland. I am very jealous of everyone that lives here.

So where do I actually begin with this course review? Initially, before the course actually began I had wanted to create a large, and detailed write-up about this course. I wanted to share a lot of the information that was discussed, reviewed and learned throughout the weekend. However, at the time I didn't realize just how vast, over-reaching, and yet enjoyably specific the content would be. I could actually write or should I say it would require me to write MANY blog posts to cover everything. Instead, I figured that I would share with you all my general thoughts and feelings.

I arrived on Friday afternoon in Portland and was given a tour of the Correct Toes' office and the clinic (Northwest Foot and Ankle) of Correct Toe's creator, Dr. Ray McClanahan, DPM. Northwest Foot and Ankle/Correct Toes was the host for this conference and boy were they ever a hospitable group of people.

This group went above and beyond and I think this added to the overall open and friendly feeling that existed at this course. This wasn't one of those CEU courses where people sit next to each other and only talk the bare minimum, ignore each other in the halls, and bust ass to leave at the end of the day. I felt like this course, it's instructors, and the participants all fostered a very open, inviting, and collaborative format. On Friday evening, there was a dinner and drinks at a local restaurant to work as an ice breaker before the next morning's festivities.

A family physician, massage therapist, podiatrist, athletic trainer, chiropractic student, certified athletic trainer, and a physician from Canada all at one table the night before the conference. Talk about collaboration...Talk about stories...Talk about Passion.

The next morning I woke up early before the conference to enjoy some local coffee while watching the last couple stages of Le Tour de France. Talk about the type of weather that makes you fall in love with a place.

Portland at 6:30AM...Peaceful at worse.

I was probably the first course participant to arrive on Friday morning but the food and beverages that were catered for breakfast beat me (lunches were also provided and catered, the second day we had Chipotle for lunch!).

Upon arrival to my seat I found some sweet swag in my goodie bag...I was very delighted when I began to rifle through the contents. Actually, I am sure everyone enjoys free stuff.

Pieces of swag included: Free Newton Energy Running Shoes, Almond Butter sample, and an item by a company called "Back Joy" that is supposed to be used for periods of long sitting to promote better posture. On top of that, Correct Toes included a tank top, a pint glass, a small ball for self myofascial work on the foot, and a couple pens and pads of paper for taking notes. I love free pens.

The blue thing is the Back Joy device. I am still in the process of testing it out but so far I think I like it.

On top of all of the above swag, this course is taught using Jay Dicharry's book as the course text, Anatomy for Runners, and as a result we were all provided a free copy of it. This didn't bother me because I already own the book and I was a huge fan (Check out my previous review here.) of it. Therefore, I won't mind sharing this book with somebody else to help pay-the-knowledge-forward.

So what about the actual course? How does a person even begin to delve into a two day, sixteen hours continuous hours of knowledge bombs, and information into one post? The first things that come to my mind is stuff like: amazing, engaging, Broad without being skimpy on details, and specific without being needlessly detailed.

The names behind putting on this course are very notable and respected in the running community: Dr. Mark Cuccuzzella, Jay Dicharry, Ian Adamson. We also had Kevin Rausch, PT of Rausch PT show up on the second day to help out during labs and to answer any participant questions. If you are familiar with the world of running injuries, research, gait analysis and running footwear then you probably know who they are. If you don't recognize their names then you NEED to get familiar with them and their work. Especially if you consider yourself somebody that works with runners, endurance athletes, or anybody that runs in their respective sports. Period.

Dr. Mark. "1 second, here is another knowledge bomb for you all."

I love listening to Dr. Mark Cucuzzella talk whether it is on podcasts or videos and in person was no exception. This guy knows so many people, is educated on so many different topics, and is very open minded. I was very happy to be able to finally meet him and if you ever get the chance to hear him speak you will learn how captivating he can be with his knowledge of research, running history, personal anecdotes, and funny stories.

On top of having a passion for running it seems he has a bigger passion for just helping people...including kids too! Oh and if you're going to go for an "easy" group run with these guys after course then you better have some regular mileage under your belt. I am just starting to get back to running now after a long period of time off and I got dropped really quickly! A little sad considering I was probably the youngest person at the conference and easily the youngest person on the group run.

Jay's devilish grin before dropping some knowledge bombs himself.

Jay Dicharry is a physical therapist that now practices in Bend, Oregon at Rebound Physical therapy. Jay used to be the head of the running research/gait analysis lab at the University of Virginia. Jay's name is stamped all over the world of research for gait analysis and running related studies. At one point during the course Jay showed us a quote that he once wrote for a text book. He then went on to bash it to highlight the need (and his ability) to critically think, remain open-minded, and the importance to stay current with research.

Jay claims to talk fast but he uses tons of analogies and metaphors to help convey long and arduous ideas or topics into concise and easy to understand statements. To me this means he understands what he is talking about inside and out. On top of this, Jay isn't a frilly clinician. What does that mean? To me Jay is the straight to the point, knows what we do and don't know, and isn't looking to find the "coolest" or most "flavor of the moment" treatment approach. He just goes with what he knows and with what works to provide favorable outcomes. Jay provided us the information on what we need to know, what we need to look at, and how we can be the most effective clinicians without the use of his expensive and fancy equipment.

So what did we actually learn? A lot. I've read Jay's book at least 3 times previously and I still learned a ton from this conference. Just check out this list of learning objectives that are listed for this course:

• Discuss the pathophysiological process behind running injuries and the new treatment concepts relating to these pathologies. 
• Improve his\her clinical efficiency through a better knowledge of objective diagnostic assessments and their place in the clinical exam of an injured runner. 
• Discuss the new theories behind tissue stress, adaptation and preventive stress.  
• Recognize the relationship between running biomechanics and the risk of injuries. 
• Build a program to help an injured runner return to running using the theoretical principles relating to different energy systems, cross-training and warm-up.
• Discuss the science behind running shoe technology, plantar orthoses, flexibility and strengthening in the prevention and treatment of running injuries. 
• Discuss the science and practical application of aerobic development, speed training, and periodization. 
• Describe the principles and be able to teach efficient running form including supplemental drills. 
• Evaluate a patient for movement dysfunction during a clinical visit and provide simple corrective measures.              
• Discuss clinical Injury assessment and exam and specific corrective exercises. 
• Describe practical gait analysis, cues, and corrections. 
• Discuss Nutrition for health and performance.
• Prescribe footwear to complement the patient’s current movement pattern and how to safely transition them to more functional footwear

Dang. That is a lot of information...and they really did deliver but obviously some points were more in depth and detailed than others...As Doctor Cucuzzella put it, It was enough information for us as clinicians to apply but left more for us to learn about. It was entry level exposure on some topics while others were definitely advanced. Enough for us to think about a trip down the rabbit hole if curious. Here is a better Day 1 vs. Day 2 Split of what was discussed. I took this stuff right from their website...

Day 1:

Anthropologic Basis of Running

Training Principals
Aerobic development
The role of intensity
Recovery principals, practice and overtraining syndrome
​Coordination and peaking
Warm up and cool down
Nutrition for performance

Footwear
Performing for ultra-endurance, movie and Q&A
Evolution, Design and Technology of footwear
Influence of footwear on gait
Relationship of footwear to injury
Fitting Issues and adaptive devices

Efficient Running Workshop
Stability / Mobility / Strength
Movement patterns for efficiency and injury reduction
​Form drills to re-enforce motor skills

Day 2:

Assessing the Injured Runner
    Triad of Running Injuries
    Tissue specificity – micro-anatomy
    Baby biomechanics
    Building the perfect runner: how strength and mobility impacts form
​    Identifying and fixing problems
    Optimizing the runner: building a paradigm from distance to sprinting
Medical Issues in Endurance Sports
    Heat and Hydration for the Athlete
    Cardiac Issues 
Assessing the Injured Runner Workshop
​    Clinical running analysis: the Visual Gait Tool in case studies & hands on practice
    Clinical mobility and stability assessment lab
​    Evaluation and treatment workshops - physical exam and exercise prescription

In conclusion, this was a great course. I learned a lot and it definitely left me feeling more confident in my ability to evaluate, and treat running injuries. Additionally, I feel like I took my visual gait analysis skills to a whole different level. I learned things that I may have been thinking or doing previously may have been flawed and reaffirmed a lot of other stuff that I was already doing. It was amazing to get some insight into the "information" that people try to tweeze out of a gait analysis and to find out what you really CAN and CANNOT derive from watching somebody run.

Dr. Ray McClanahan, DPM, myself, and Jay Dicharry, MPT, SCS.
These two guys combined have 4000x the brain power that I do. 

One other point that I loved during the conference was the focus on or the overlap of injury reduction/prevention versus enhancing running performance. Sometimes certain issues held these two ideas under the same umbrella and for other areas they had a direct inverse relationship. This helped when thinking about an individual's goals...and when you start with the finish you can provide a more focused plan. I really do recommend this course.

There is still way too much garbage information out there regarding running form, running footwear, running injuries and endurance training. I urge any interested medical professional, running coach or even motivated runners to see if one of these courses are being hosted near you. If you can't do that then your next best starting spot is probably with Jay's book, Anatomy for Runners. 

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Minimalist or Zero Drop Shoes Are NOT a Cure-All.

My old running shoes

Today's post is kind of half personal story/half conjecture/half observation(wait, that doesn't add up!). To begin, I have now been wearing a minimalist/zero drop type shoe everyday for both casual use and exercise/running. The only time I wear a shoe that is not completely flat is when I wear my dress shoes with my suit for basketball games.

One of my current favorites

I am a huge proponent of wearing zero drop shoes with a wide toe box and the absence of a "toe spring". I feel this shoe design interferes the least with proprioception, normal foot mechanics, and proper tissue length. Think of non-zero drop shoes as being like a mini-high heel.

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Is It Time to Replace Your Running Shoes...or Time To Get an Evaluation?

Today's blog post is a tiny rant inspired by overhearing this conversation time and time again between runners...

"Yeah its about time for me to replace my shoes, my 'insert body part here'  has been acting up lately and 'insert symptoms here'. I definitely just need to get some new shoes."

While I concede the fact that slowly overtime the properties of your shoe will change and that will affect the kinetics or forces acting upon your body during activity. However, it is inane to think the real problem is your shoes. More likely is the fact that you probably have an underlying dysfunction that becomes sub-clinical with rapid change in kinetics (new shoes) that can allow the symptoms to alleviate.

Some people may argue that if this system isn't broke then don't fix it. If you have the money to constantly spend on shoes for every fabled 300-500 miles then maybe this is your thought process. On the other hand, what about the possibility that this potential dysfunction or running form issue could be detrimental in terms of potential performance. Even worse, this true dysfunction could eventually manifest into a much larger problem that isn't easily fixed with a new pair of shoes.

Want to know what the better solution is in my mind? Find yourself a clinician (athletic trainer, physical therapist, chiropractor, or doctor) that is experienced with runners, running biomechanics and assessing the entire body. We don't want to find somebody that is going to point out that your shoulder blades are dysfunctional (maybe...we do!?) but perhaps you have a dysfunctional hip or back issue that is manifesting itself as pain or injury at the foot or ankle? There is also the potential for somebody to suffer from a general medical issue that is not musculoskeletal related or potentially related to nutrition/lifestyle choices.

Do yourself, your running performance and your wallet a favor and refrain from buying tons of shoes and save up to get yourself a consultation with an expert clinician.  Don't just settle for anyone but ask around and find somebody that has some of the aforementioned qualifications.  That is my rant of the day!

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My Top Friday Finds!

The weekend is finally here and that means you might have some more free time on your hands. If that is the case then here are some recent and interesting reads for you all. They are split up by genre! ;)

Eat.

Paul Jaminet of the Perfect Health Diet gives his take on the recent supplementation/vitamin debate.

To go along with the supplements here is a lengthy review of the literature related most supplements you will find on the market.

Run.

Pete Larson of Runblogger wrote a post that reminds us not to overlook the small things. For example, could your running shoes be too small?

Steve Magness shared this article on twitter related to a study looking at how much power Usain Bolt needed to generate to set his records.

Rehabilitate.

Sports Medicine Research Blog dissects some research on modifiable risk factors for osteoarthritis!

If you haven't started reading TheManualTherapist's weekly Friday "5" series then you are missing out. Here is his latest edition!

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Sunday Funday: Runner's exercise of the day.

Here is a quick video highlighting a great exercise for runners. This is an exercise that I like using with athletes that are struggling with overcoming issues with glute inhibition and proper core stabilization. Keeping your pelvis level and equal is very challenging and can be great as a corrective exercise for something like the rotary stability test on the FMS. You don't a TRX do to this either...any suspension trainer, sturdy rope, a plyobox, or a chair can work as well! Enjoy!

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The 10% Rule of Running: My Experience and Thoughts

Ah, the 10% rule of running for increasing mileage or run time. A very specific and objective piece of conventional wisdom handed down from each running generation to the next. Many have voiced both praise and disdain for the rule and it has even been used in some research studies.

I am currently in the process of rebuilding my running base after letting it dwindle to near zero over a 4-5 month span. I wanted to avoid doing too much too soon when I returned to running regularly and I like to experiment with ideas so I figured I would put the 10% rule to the test.

My rules for this were to run no more than 10% longer per longest run of the week or per week total. I was allowed to run less if needed and would only be running 3-4x a week. So far, after following this rule for several months I have been able to increase my total time very easily in terms of both aerobic and musculoskeletal comfort. There have been times of slight soreness but the kind you embrace or expect from a workout plan that gradually imposes increased demands or loads.

I must say that so far this base building has gone far easier than previous base building efforts. Previous attempts were plagued with issues like chronic compartment syndrome, plantar fasciosis, Achilles tendinopathy, Medial Tibial Stress Syndrome, and other common but nagging running injuries. My girlfriend has also been rebuilding her base alongside me. In the past she had a history of IT Band Syndrome/Patellofemoral Pain Syndrome issues and repeat stress fractures in high school. So far she has not had any problems arise either.

That is me in the white shirt and shorts on the far left, when I first started running. I definitely used to over-stride!

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Two Exercises I Do Before Every Run: My First Video Post!

Hey everyone, I was about to go for a run today and I thought of the idea of highlighting some of repeated-end range exercises that I have mentioned in some of my recent posts. Today I will show you two of them that I do try to do before every one of my runs. I learned these from Dr. Erson of TheManualTherapist.com so I can't take credit for thinking of them! I must say that incorporating these two exercises has helped me resolve any lingering heel stiffness/pain that I previously had.

It is very easy to find out if these will do anything for you by giving them a try and checking your mobility to see if benefit from them. If you do, great! If not, you might want to try some soft tissue to assist you reach your true end range or maybe just find something that does work for you!

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Book Review: Anatomy for Runners: Unlocking Your Athletic Potential for Health, Speed, and Injury Prevention

Title:
Anatomy for Runners: Unlocking Your Athletic Potential for Health, Speed, and Injury Prevention
Author: Jay Dicharry, MPT, SCS
Publisher: Skyhorse Publishing; 1 edition (August 1, 2012)
Pages: 290
Price: $10.67 (Paperback) or $7.99 (Kindle)
ISBN: 1620871599

Well, I've never formally written a review before let alone published one for people to read on a blog. The only reviewing I have done is given my opinion to others that would listen (or pretend to). However, I decided that this book was a great place to start. The quality of information and the way it was delivered has given me the motivation to make an attempt at writing this review. So...where do I begin?

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Videos for Running Assessment, Correction and Form Drills.

I was perusing the internet today when I came across a couple of videos produced by Dr. Mark Cucuzzella. Dr. Cucuzzella is the director of the Natural Running Center, Professor of Family Medicine at West Virginia University and the owner of Two Rivers Treads in Shepherdstown, West Virginia. Dr. Cucuzzella is a running guru that has been at the front of the natural running movement for many years now.  He also brought us this previously mentioned video that highlights the principles of natural running form.

Must see video for runners.

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