Abnormal Forefoot loading creates fatigue ?

How is your medial-lateral foot and ankle stability ? In many injured folks it is an issue and needs to be investigated. Remember, skill, endurance, strength IN THAT ORDER ! Today, Fatigue is the topic du jour !
If you are in a heeled shoe of any degree (greater heels suggests greater risk) , and this likely pertains to increased heel dropped running shoes we would propose, fatigue of the frontal plane is risky business. 
“EMG measurements from habitual high-heeled shoe wearers demonstrated an imbalance of gastrocnemius lateralis versus gastrocnemius medialis activity in fatigue conditions, which correlated with abnormal lateral shifts in the foot-ground or shoe-ground COP of these women.”
Some of this is from the natural foot architecture, a blog post on this very topic is in order we think !
“The results demonstrated accelerated fatigue of the peroneus longus muscle in marching conditions … . EMG analysis further revealed substantial fatigue of the pre-tibial and triceps surae muscles during intensive marching”
Don’t forget to assess fatigue gait brethren ! Motor patterns, skill, strength are all great, but what about fatigue ?! Test for it and you will find it ! 
And, think about this if you are a forefoot strike runner, for obvious reasons, the heels is similarly in a raised posture.

Dr. Shawn Allen

Gait Posture. 2002 Feb;15(1):56-63.
Analysis of muscular fatigue and foot stability during high-heeled gait.
Gefen A

Med Biol Eng Comput. 2002 May;40(3):302-10.
Biomechanical analysis of fatigue-related foot injury mechanisms in athletes and recruits during intensive marching.
Gefen A1.

Podcast 77: Gait analysis, Forefoot Running & more.

Plus, the 5 neurologic gait compensation expressions.

*Show sponsor: www.newbalancechicago.com

A. Link to our server: 

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D. other web based Gait Guys lectures:

www.onlinece.com   type in Dr. Waerlop or Dr. Allen,  ”Biomechanics”

______________

Today’s Show notes:

Google X acquires ‘tremor-canceling spoon’ startup
http://venturebeat.com/2014/09/10/google-x-acquires-tremor-canceling-spoon-startup/

The 5 expressions of neurologic gait decomposition,
Last week we did an online teleseminar … . .
An acoustic startle alters knee joint stiffness and neuromuscular control
http://onlinelibrary.wiley.com/doi/10.1111/sms.12315/abstract
Effectiveness of Off-the-Shelf, Extra-Depth Footwear in Reducing Foot Pain in Older People: A Randomized Controlled Trial
http://biomedgerontology.oxfordjournals.org/content/early/2014/09/08/gerona.glu169.abstract
reader:
I really appreciate learning from you!! I have a bit of a loaded question that I will try to explain clearly to the best of my ability. About 2 years ago, I broke my left shin (hairline-fibula) in a MMA fight. After it healed, a few things have been happening that I assume are connected but can’t quite put my finger on. My ankle mobility on my left ankle is worse than my left. I seem to have permanent turf toe as well. My right glute, ham, and erector are hyperactive.
Additionally, many times when sprinting, pushing a sled, etc, my right quad will become fatigued much more than my left. I believe it’s because I’m not fully extending my left ankle, and relying on my right leg more. Whenever I squat or deadlift, I feel similar too. The right glute and erectors get much more of a “pump” than my left. With all of this, is there anything you would recommend? I truly appreciate it!! It is very frustrating. Thank you again!

Midfoot strike 5 year old running barefoot in grass.

So, heel strike you say ?  Have  a closer look.  This is a near perfect midfoot strike. What you cannot see is his torso progression. As long as the torso has enough forward lean heel strike cannot occur. Heel contact can occur, but not heel strike or impact.

We have talked about this on many occasions here on The Gait Guys Blog. No one else is talking about this fine line difference between heel strike and heel contact.  Everyone still seems hell bent on talking about forefoot strike. Forefoot strike in distance running is not normal, midfoot strike like you see here in this young child is natural and normal. This 5 year old was likely just asked to run barefoot, he was not likely coached. This is because midfoot strike is natural and normal.  As we said, as long as the torso is directly above or in front of the foot contact position there is no way that heel STRIKE can occur, rather heel CONTACT can only occur (unless you have hamstrings like cirque du soleil acrobats and do not mind going into a posterior tilted pelvis at contact). 

We tell our runners to:

  • lift the chest and lean
  • raise the toes and dorsiflex the ankle  (engage the anterior lower leg compartment) so that the arch is maximally prepared
  • a heel KISS of the ground is fine, just no impact
  • you do not need to forefoot strike to run naturally
  • * and, here is one more reason why we like a midfoot strike over a forefoot strike…. because a midfoot strike means that the body continues forward whereas a forefoot strike that then allows into a heel kiss/touchdown means that there is a posterior progression and eccentric lengthening of the posterior chain (hamstrings and calf muscles). This posterior directed motions is not exactly wise when forward progression is the goal of running !

This little fella is doing it right. Largely because he has not been in shoes long enough to corrupt the natural tissues and mechanisms (both the body parts and the natural neuromotor patterns).

* Addendum: after a really productive FAcebook dialogue with some readers we felt we needed to be more clear on some of our unspoken assumptions here.  If the heel hits first, it will be a STRIKE and not a KISS and the load will be high. The only way the heel can kiss the ground like we mention above is if the heel is absolutely contacting at the same time as the forefoot, one could say that there is a more dominant load on the mid-forefoot but the heel can still strike at this same time.  Striking clearly on the forefoot and then touching down the heel is satisfactory but there is still a retrograde movement which we believe is not as economical yet certainly better than heel impact/strike.  To get the perfect midfoot strike with barely a subtle heel CONTACT (not impact or strike) requires greater skill and more mastery as a runner.  And if you are wearing a shoe that is not minimalist or zero drop developing this skill will be a challenge and you will be misleading yourself.    This ammendment added 1 hour post blog post launch.

Shawn and Ivo…….. the Devil is in the Details. 

Biomechanist challenges idea that forefoot strike pattern reduces runners’ injury rate

Cites lack of conclusive evidence

By Jordana Bieze Foster

http://www.lowerextremityreview.com/issues/may/biomechanist-challenges-idea-that-forefoot-strike-pattern-reduces-runners-injury-rate

“UMass researchers have demonstrated that, although forefoot strikers do not experience a vertical ground reaction force “impact peak,” they do experience impacts during running, albeit at lower frequencies than rearfoot strikers. This research, presented last summer at the American College of Sports Medicine meeting in Denver, suggests that because those lower frequencies are attenuated by muscle tissues, while higher frequencies are attenuated by bone, forefoot strikers may actually face a higher risk of muscle injury than rearfoot strikers.

Claims that loading rate is significantly lower in forefoot strikers than rearfoot strikers also may not be entirely accurate, Hamill said. He cited research from Iowa State University, scheduled to be presented in August at the annual meeting of the American Society of Biomechanics, suggesting that when natural forefoot strikers switch to a rearfoot strike pattern, their loading rate actually decreases.

Research, most notably the oft-cited Harvard study published in Nature in 2010, have found higher magnitudes of ground reaction force in rearfoot strikers than in forefoot strikers. However, Hamill noted, the heel is a much less delicate structure than the forefoot and therefore may be better suited to absorb higher forces.”

Dear Dr. Lieberman : Some vital facts on forefoot running are not being discussed.

A clay pot sitting in the sun will always be a clay pot. It has to go through the white heat of the furnace to become porcelain. -Mildred Wite Stouven.

Today’s blog article is likely to bring flames to our feet, but we are not afraid of the heat.  At the very least we will settle for the heat this article may bring so that our work can get the recognition we feel it deserves and so the truth can be brought to light for the good of all mankind.

“Forefoot strike causes less impact force on the body,” says co-author Daniel Lieberman, Ph.D., a professor of human evolutionary biology at Harvard and scribe of a popular barefoot running manifesto in 2010. “People forget that running is a skill, and if you don’t run properly, you’ll get injured.”

Amen to that; we have been saying that for years before this all became popular talk …

We recently read this article in Men’s Health, yet another one supportive of minimalism running. And once again some of the most important facts are being left out. We just cannot sit here and watch the inaccuracies of minimalism and forefoot running continue to root themselves without policing. So, let us once again set foot into the raging battle.

According to the article (LINK) Sturtz says, “Landing on your forefoot, the way humans have run for thousands of years, produces almost zero impact on joints and bones, according to Lieberman’s 2010 study. But 75 percent of us now land heel first—cushioned running shoes made that possible (and comfortable)—which slams up to 3 times the body’s weight in impact force on your knees and legs.”

Our question is, “ Why is no one paying attention to foot types?” In every lecture we do, to clinicians or everyday runners, about “forefoot type” variants (valgus and varus to be precise) we comment that this is something that should be talked about during Running Form Clinics where forefoot landing is promoted. 

“… forefoot running is not the whole answer to injury prevention, just a component”, says Lieberman. “This is not a simple solution to a complex problem—you can’t change one thing and have everything be fine. You can still forefoot strike with poor form.”

And we would add to that quote that “you can get a resultant compensatory running form if you forefoot strike with a forefoot varus or forefoot valgus”. Not everyone has that pristine neutral forefoot bipod architecture that the internet articles are assuming exists in everyone, and thus there is no way that everyone has fully competent pristine forefoot biomechanics that will not eventually trigger injury. This is a fact, not our opinion. 

Dr Lieberman then goes on to say: “ If it ain’t broke, don’t fix it.”

We respectfully disagree. We do this on a daily basis (as do many of you).  If the check engine light on your dashboard is flashing at you every day for a week you would be remiss not to consider the repercussions.  “The car ain’t broken… YET” is a more precise comment. You would be wise not to go on a long distance car trip knowing this fact.  Translating this to forefoot load/strike running, ignoring a potential injury because of flawed forefoot anatomy and biomechanics is a recipe for injury.  Just because it isn’t broken YET doesn’t mean ignoring the issues will make them go away or make you immune. A few hundred or thousand miles on a forefoot variant can be an issue clinically and injury wise.

Just because the body isn’t broken YET doesn’t mean it cannot work better and prevent a problem down the road. Dr Lieberman then goes on to quote, “Remember, almost every distance runner gets injured".  Why is he batting from both sides of the plate here? If “Landing on your forefoot, the way humans have run for thousands of years, produces almost zero impact on joints and bones”, according to Lieberman’s 2010 study then why would he go on to say “Almost every distance runner gets injured”?  There has to be a reason !  Forefoot running is either the answer or it isn’t.  Our valid and ignored proposal above, and our repeated comments throughout our 500+ blog posts on this topic on foot types, is a valid answer to his injury assumption.  It is quite possible that these inevitable injuries occur because people take the advice of “if it ain’t broken, don’t fix it”.  It is also most likely that ignorance of the deeper facts is bliss for most people. .Had they spent the time to find out about their forefoot type and learn to modify subtle biomechanical flaws of forefoot loading strategies of their foot type, perhaps we wouldn’t hear “Remember, almost every distance runner gets injured".   Maybe that is why you SHOULD look into fixing things that are not YET broken and at the very least learn about foot types, particularly which one you have and the potential risks it exposes you to. Our blog here has done this in depth over the last year. 

“An ounce of prevention is worth a pound of cure” -Benjamin Franklin.  Anyone is medicine knows this is true (or should).

We prefer midfoot strike when possible, for many reasons but mainly because it takes into account a tripod contact loading response.  A tripod load is more stable than a rear foot unipod load and more stable than a forefoot bipod load, particularly when there are rear or forefoot variants (rearfoot valgus, rearfoot varus, forefoot valgus, forefoot varus) from the pristine normal that is always assumed in many articles.   A tripod loading response (midfoot strike) can dampen some of the mechanical flaws of either heel or forefoot strike patterns and of the foot type variants that are the norm, not the exception.

We see this stuff everyday in our practices. We are the guys that get the injury cases that are driven by the inaccuracies, or better put “overlooked facts”, of articles on the internet. To be fair, we have also written a fair number of articles for magazines and we know how they can get so chopped down that truth, honesty and full disclosure can be lost for the sake of publication limitations. None the less, our strong opinion, this article could have been far more complete had it talked about the issues we have brought to light here.  We love and respect the work of Lieberman and his colleagues.  He and his colleagues have done a huge service to the runners of the world and we have learned from them. Learning is a lifelong journey for us all and we just think that there is a huge information gap that is being missed and we feel it is time that the runners of the world hear the whole truth. We believe our work is filling that gap.

“First they ignore you, then they laugh at you, then they fight you, then you win.”

- Mahatma Gandhi

For the past year, we have been feeling a bit like Gandhi must have felt. We realize that some of our work is complicated, difficult to understand, and tough to digest. We know we are laughed at by some who prefer to seek the safety of ignorance. And yes, despite 600 blog posts on these very topics (yes, we have one of the most informative blogs and YouTube Channels on the web for runners and athletes looking for answers) we feel somewhat ignored. None the less, we continue to stick our necks out far and long to set the record straight to make sure that everyone knows the facts they deserve to know.   We hope you will forward, link, Facebook and tweet the hell out of our blog post today, for the good of every runner and athlete you know and for the whole of mankind.  We are in this for the long haul. Stick and stones … .       - Drs. Shawn and Ivo …  The Gait Guys

here is the article that spurred our post:

http://news.menshealth.com/fix-your-running-form/2012/01/24/