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The Great Debate:  Heel Striking vs. Mid/Forefoot Striking

Over the past 10 years there has been a shift in the minds of some coaches, trainers, and runners in regard to the “best” way to run.  Some say heel striking is the preferred method while others claim elite runners use a midfoot or forefoot strike. 

Runners, like all athletes, are prone to becoming a part of the latest trends and fads.  It is the nature of athletics and competition.  We want what other people say is “the best,” or what the professionals are using.  You see this in basketball with the armbands, baseball with the eyeliner, and recently in runners with technique (heel strike vs mid/forefoot) and philosophy (barefoot).

The problem with jumping on the bandwagon with a new trend is simply stated.  It is a trend.   There is no scientific evidence supporting the claim that forefoot running will reduce injury, that it is more efficient, or that it is the preferred method.   So what does the science say?   Let’s take a look.

Hasegawa et al., J Strength & Cond., 2007, (21), 888-893

This study was performed at the Sapporro International Half Marathon in Japan.  They used a high speed camera to capture foot strike at the 15 km mark.  In total they were able to capture the foot strike of 248 men and 35 women.

Results:  An overwhelming 75% of the elite runners were heel strikers, 24% were midfoot, and 1% forefoot strikers.

So where did these ideas come from? 

1)  Marketing and Advertising of Shoe Companies.  This stems from shoe stores pushing their new shoes, and also how they train part-time help to fit athletes for shoes (supplying them with basic info in regard to pronation and supination).  Just because someone can define the word pronation and supination, does not mean they can properly address shoe and running issues.  I mean come on, the same people who are pushing these new shoes pushed Nike Shox when they came out.  These were the worst shoes ever made…they actually had less shock absorption.  They were cool though.

2)   You Tube.  Non-experts are making claims on blogs and YouTube videos and showing elite runners that are mid and forefoot striking.  This is done by inadequate home equipment or, in some cases, someone attempting to pause a video at foot strike. The heel strike to midfoot moment is too fast for anything other than a high speed video camera to comprehend.

So what about Haile Gebrselassie? 

He is obviously running on his forefoot.  Here is something to go home and test.  Try running a 1/10^th of a mile at his world record pace.  That is about 4 minutes 45 sec /mile pace.   What are you doing to keep this pace?  Sprinting.  Most people cannot even sprint at this pace.  Sprinters run on their forefoot because their weight is in front.  This is normal.  The faster you run the more you run on your forefoot.

Arendse et al., Medicine & Science in Sports & Exercise: Volume 36(2) February 2004 pp 272-277 

This research evaluated how heel strike compares to the Pose method of running, concerning load across the ankle, knee and hip joints. 

Results:  When running on the forefoot or Pose method there was a statistically significant decrease in load through the knee and hip.  However, there was a statistically significant increase in load through the ankle.

What to gather from this research is simple.

If you have problems with your back, hip, or knees when heel striking and you have no other known biomechanical problems, dysfunctions or weakness, then changing to a forefoot strike may be beneficial.   If you run on your fore or midfoot and you have shin splints, Achilles tendinitis, or other calf issues then you should consider heel strike.  If you do not have any problems then don’t even consider switching because there is no evidence to support it. 

Knowledge is power.  Stay up to date with credible sources when evaluating these issues.  Things will change in the future with more research.  In the mean time, stay away from the blogs and YouTube videos.

Wes Creech, D.C., ART, CSCS

Performance Spine and Sports Center

Meniscus Injury Prevention – ART and the Denver Broncos

See this interesting article relating to meniscus injuries:

http://kinetichealthcalgary.blogspot.com/2011/01/treating-and-preventing-meniscus_30.html

Soft Tissue Treatment and Management

Wes Creech, D.C., ART, CSCS

Professional education geared toward the manual treatment of soft tissues has been severely neglected among all clinical groups.  Soft tissue refers to muscle, tendon, fascia, ligaments and nerves.  Although medical doctors, osteopaths, chiropractors and physical therapists have all been educated on specific soft tissue injuries, the manual treatment of those injuries have long been overlooked. 

In many cases, medical and osteopathic clinicians prescribe drugs like muscle relaxers, anti-inflammatory drugs and pain medications without addressing the actual trauma to the soft tissue.  Many chiropractors and physical therapists utilize different types of stretching, massage, and hot/cold therapy.  While these are great for relaxation and to control inflammation, they do not delve into the biomechanical relationship of muscle and nerve function.  Again, the actual cause of the soft tissue dysfunction is rarely addressed.

Each soft tissue has a separate and distinguishable function, every muscle and nerve moving relative to one another.  Some muscles and tendons slide in opposite directions on movement while others slide and move in the same direction.  A comprehensive knowledge of anatomy and biomechanics are needed to effectively evaluate changes in this motion.

In the past, soft tissue treatment has been a broad shotgun approach.  I propose that specificity is the key to effective treatment.  To be specific and to have a high success rate there are four areas of soft tissue distortion which need to be thoroughly evaluated.

1)      Tissue Texture

2)      Tissue Tension

3)      Tissue Movement

4)      Tissue Function

If these are used in combination, a very specific location of dysfunction will be evident.  For example, a patient came to our clinic with a two-year history of knee pain.  He had two meniscus surgeries, and underwent six months of physical therapy.  Therapy included strengthening of quads, hamstrings, glutes, etc.  His quads were also stretched and massaged.  After six months of therapy, he was still unable to go up and down stairs without pain.  The therapist told him that his quads were weak and to strengthen them more.   He came to our clinic in desperation.  After evaluating his knee for all four of the aforementioned distortions, a small adhesion was found between his rectus femoris and vastus lateralis (two of the four quad muscles) and just above the patella (knee cap).  After two treatments addressing this thumbnail sized lesion, he was walking up and down steps with only a minor ache.  After five treatments he was pain free.  This is just one example of how a small problem can be overlooked and have far reaching effects.

These same principals can be applied to all areas of the body and 95 percent of all musculo-skeletal injuries.  At Performance Spine & Sports Center we specialize in the treatment of repetitive use/soft tissue dysfunctions from occupational workers to professional athletes.  All of our treatments are individualized and tailored to each person’s SPECIFIC dysfunction.  Some common symptoms that are related to soft tissue are listed below.

1)      Neck and Back Pain

2)      Shoulder Impingement

3)      Tennis Elbow

4)      Achilles Tendonitis

5)      Plantar Fasciitis

6)      Sciatica

7)      Carpal/Tarsal Tunnel

8)      Numbness and Tingling

If you have any questions on how Performance Spine & Sports Center can help your musculo-skeletal pains, please visit our office or call 217.222.5800.

Carpal Tunnel Syndrome: Is it as common as it seems to be?

Over the past 20 years the diagnosis of carpal tunnel syndrome has sky-rocketed. Whether self- or professionally-diagnosed, the term “carpal tunnel” gets thrown around every time someone has numbness or tingling in their hands. Although carpal tunnel syndrome does cause these symptoms, it is typically not the culprit. Carpal Tunnel Syndrome is considered a nerve entrapment and these types of soft tissue injuries are not well understood by any profession. The purpose of this article is to shed new light on this diagnosis and help everyone - patients to professionals - understand what carpal tunnel is, how it can be prevented and, if necessary, be treated.

So what is the carpal tunnel? 

The carpal tunnel is formed by the carpals (wrist bones) below and the transverse carpal ligament from above. These structures create a “tunnel” for the flexor tendons and the median nerve.  True carpal tunnel syndrome occurs when the median nerve is compressed at this site. This nerve entrapment or compression causes pain, numbness and tingling in the thumb, index finger, middle finger and half of the ring finger.

True carpal tunnel syndrome is caused by repetitive use of the flexor tendons accompanied by sustained wrist flexion or extension. This environment will likely cause the tendons to become irritated and swollen which reduces the size of the tunnel and causes the median nerve to be compressed. So, the first lesson one must understand about carpal tunnel is this: the said distribution of pain and numbness must be present.  If it is not present, it is not carpal tunnel.  If your entire hand is numb, it’s not carpal tunnel. If the back of your hand is numb, it’s not carpal tunnel. And if your small finger is numb, astonishingly enough, it is not carpal tunnel. Commit Lesson 1 to memory.  If you learn anything from this article – learn this. 

Lesson #1:  Symptoms must be located in the thumb, index finger, middle finger and half of the ring finger and thumb pad.

Now things get a little tricky. Just because these symptoms are present does not automatically mean we are dealing with carpal tunnel syndrome. It does mean that the median nerve is compressed, but not necessarily at the carpal tunnel. An entrapment of the median nerve anywhere from the armpit to the carpal tunnel will cause the exact same symptoms. This is where carpal tunnel goes misdiagnosed. There are seven sites from the wrist to the armpit which commonly cause entrapment of the median nerve.  The most common site for median nerve entrapment is at the pronator teres muscle.  This is even more common than the carpal tunnel!

In 80% of patients, the median nerve passes directly underneath this muscle, and in 20% the median nerve passes directly through the pronator teres. When this muscle is overused by repetitive twisting of the forearm or sustained pronation (palm down), then nerve entrapment is most likely coming from this site.

Lesson #2:  Don’t assume that the median nerve is entrapped at the carpal tunnel.

So you may be wondering how the actual spot of entrapment is best diagnosed?  This is very hard to do.  Most of the diagnoses will come from the history, onset of symptoms and occupational/recreational examination.  A lot of authorities on the subject use NCV (Nerve Conduction Velocity) tests or EMG (electromyography) to diagnose the problem. This form of diagnosis is expensive and not very conclusive. These tests that pick up median nerve entrapment are inconclusive on where the entrapment site is. While they do a great job of ruling out cervical (neck) involvement, they are poor at distinguishing between the carpal tunnel and various sites throughout the forearm. Sometimes a skilled practitioner can find where the nerve is entrapped by feeling relative motion between the nerve and surrounding tissue. This is always the best way to diagnose the condition.

Lesson #3:  Don’t rely solely on expensive tests to determine the diagnosis.

The best way to prevent and self-treat carpal tunnel is to recognize the risk factors and avoid repetitive motion as much as possible.  If your job requires repetitive wrist, finger or elbow movement, you are at a higher risk of injury.  Proper stretching before, during and after work will be the most beneficial in preventing and resolving cases of carpal tunnel or carpal tunnel-like symptoms. Stretching of the wrist flexors is the best way to relieve and prevent carpal tunnel. This stretch should be performed every hour (10-12x/day) when repetitive motion is performed. These stretches accomplish two goals:  1) Stretch the wrist flexors to keep them from getting tight and irritated.  2) Pull the median nerve through the muscles to keep them from sticking or adhering to them.  If there is normal muscle tissue and normal nerve glide, carpal tunnel symptoms will not be present.

Lesson #4:  Perform stretches 10-12x/day.

When these stretches fail to resolve symptoms or numbness and tingling become more frequent, it is time to seek medical advice/ treatment.  Common forms of treatment include rest, ice, medication, cortisone injections, physical therapy and surgery. 

A new method of treating these conditions is Active Release Technique (ART).  This is a patented soft tissue and diagnostic treatment aimed at releasing nerve entrapments and restoring the muscles to normal function.  At Performance Spine & Sports Center, we specialize in this technique and combine it with strength and rehabilitation of the muscles to bring the Quincy-area the best, most effective way of conservatively treating nerve disorders.  Sure, some of our patients have to be referred for surgical consults, as it is the nature of the disorder, but most find relief through our treatment regimens.  If you have any questions about carpal tunnel or carpal tunnel like symptoms, do not hesitate to call our office at 217.222.5800.

Lesson #5:  If pain and numbness persist seek medical advice.

Understanding Shin Splints 

Wes Creech, D.C., ART, CSCS

Performance Spine & Sports Center

Quincy, IL  62301

What are shin splints?  Shin splints are known in the medical field as medial-tibial stress syndrome (MTSS), which is a generic term to describe lower leg pain. Shin splints are most prevalent in runners (13%), but can affect any athlete or individual who has a sudden increase in training. Shin Splints are considered a repetitive stress injury because they occur after repeated stress or jarring of the bones, muscles and joints without proper conditioning or recovery between workouts. Shin splints can be felt along the inside or outside of the tibia, but are most commonly felt on the inside.

What causes them?  Shin splints are commonly caused by muscle imbalances, over-pronation, insufficient shock absorption (worn out shoes), and toe running (no heel strike).  When these problems occur, the muscles of the lower leg tear away from the periosteal (outer surface of the bone) surface. This sets off a cascade of events leading to an increase in inflammation and fibrotic (scar) tissue. Without proper treatment, more fibrotic tissue is formed leading to added faulty mechanics and additional pain.

Causes include: 

• Improper stretching
• Overtraining
• Increase in training frequency
• Running or jumping on hard surfaces
• Muscle imbalance between the posterior and anterior leg
• Worn out shoes that do not have enough support
• Running on tilted or slanted surfaces
• Other biomechanical issues

Symptoms: 

• Pain on the inside/outside of lower leg
• Pain is worse in weight-bearing exercise
• Pain that lingers after stopping activity
• Tightness in calf muscles

Treatment: The treatment of shin splints is often very frustrating for the athlete.  Most facilities prescribe rest, ice, and anti-inflammatories as treatment. Although these are necessary steps to take for pain relief, they are far from the gold standard of care. Going down this road often leads to deconditioning and cessation of activity only for the athlete to return to the same problem. Gold standard of care for the treatment of shin splints is considering and treating all aspects and biomechanical faults that lead to the development of the condition. 

Treatment at Performance Spine & Sports Center:  At Performance Spine & Sports Center, we evaluate running shoes, training regimen, foot and hip mechanics, gait and, most importantly, soft tissue mechanics.  Without evaluating all causes, there is no way to properly apply treatment and expect a full, long lasting recovery.

Performance Spine & Sports Center utilizes Active Release Techniques (ART), a patented, state of the art diagnostic and soft tissue treatment system, aimed at breaking down scar tissue and restoring normal mechanics. By utilizing this treatment, we rarely have to remove the athlete from their training regimen, and significant results are seen after just a few treatments.

Don’t let shin splints get in the way of your training.  There are treatment options available.  Visit our website performancespinecenter.com for more information on ART.  To schedule an appointment call our office at 217.222.5800.

 

The Art Of Healing

 

Active Release Techniques, a new trend in body repair, helps injured athletes get back in action fast.

By Robin Rinaldi From the August 2004 issue of Runner's World

When you're a veteran of 15 half-marathons and six marathons, running through discomfort is familiar territory. So when Shirley Cornelius, 43, of Spokane, Washington, developed a painful tightness in her glutes, she didn't stop training--even when her stride began to shorten, her knees started to hurt, and her right leg felt numb. New shoes and orthotics didn't help, nor did six months of physical therapy. Desperate to get better, Cornelius turned to Active Release Techniques (ART), a rigorous and interactive form of massage therapy in which a practitioner applies pressure to the affected area while moving the surrounding muscles through a full range of motion.

Cornelius's breakthrough came when Kelli Pearson, an ART practitioner and chiropractor in Spokane, discovered that both of the runner's sacroiliac joints (which lie between the spine and the pelvis) were "locked up," meaning their range of motion was very restricted. She used her hands to search the muscles for "adhesions"--places where injury, repetitive motion, and inflammation had left dense, tight scar tissue. Pearson pressed into the scar tissue, and ran her hand along it in one direction as she instructed Cornelius to move her legs through a proscribed set of motions, including moving each leg forward and back. The next day, Cornelius was sore. The day after that, she felt better. And by the time her next half-marathon rolled around, the pain was gone. "After three months of weekly sessions, I'm 100 percent better," she says. "The difference is amazing."

While ART, which Colorado chiropractor Michael Leahy patented in 1988, remains virtually unknown to the general public, many elite athletes rely on it to heal their soft-tissue injuries. The NFL, NHL, and Major League Baseball have begun contracting ART practitioners to keep players healthy; ART booths are popping up at marathons and triathlons; and Olympic runners, such as Marla Runyon, credit ART for helping them recover from injuries such as plantar fasciitis.

At first glance, ART might appear similar to a standard massage. A key difference is the direction of the rubdown, says Bill Ross, M.D., a sports medicine specialist at St. Francis Memorial Hospital in San Francisco. "Other kinds of deep-tissue massage move in any direction," Dr. Ross says. "ART lengthens the tissue in the same direction as muscle fibers naturally move. That's what stretches out the adhesions and causes healing."

Being "active" also sets ART apart. You participate in an ART session by moving your limbs to help release tension. Unlike most forms of massage therapy and chiropractic care, ART isn't designed to be an ongoing treatment or preventive tool?it's done to heal a specific injury. The average recovery requires six to 10 sessions, though some patients feel an immediate change.

A key to ART's apparent success might lie in Leahy himself, a triathlete who has completed 31 Ironmans. His background as a chiropractor and an aeronautical engineer gives Leahy a unique understanding of the complexity of the soft-tissue system of muscles, tendons, ligaments, and fascia (overlying sheets of connective tissue). "You need to make the layers of tissue slide over one another in order to function correctly," says Leahy. "They all have to slide directionally or the runner feels weakness and tightness. ART has 500 specific protocols to address the ways these tissues slide across each other."

Learning these protocols takes three days of hands-on training and about $2,000. ART certification is open to all licensed healthcare providers, including physical therapists, massage therapists, and trainers. There are about 3,500 certified practitioners worldwide. If performed by a chiropractor or physical therapist, insurance will often cover the cost of treatment, which ranges from $50 to $100 a session.

Before you start looking for an ART therapist near you, know that so far, there's been only one published study on the method's efficacy. The research, published in 1998, was done at the University of California at San Diego, and found that 71 percent of patients reported improvement after four weeks of ART treatment. But only seven percent said their pain was completely gone, and the study wasn't randomized, nor did it use a control group--two precursors for scientific proof.

A random, controlled study with patients reporting their pain and functional levels would help scientifically back up what the anecdotal evidence on ART is suggesting. Such a study is planned for late this year at UC San Diego.

But seeing is believing, even for an M.D. like Dr. Ross. "I know that it works," he says. "ART is more effective for chronic inflammation than any other treatment available--and often a complete cure. I've been treating these problems for 25 years, and now I finally have something to recommend to my patients that works."

http://www.runnersworld.com/article/0,7120,s6-241-286--6951-0,00.html