Podcast #140: Running, hallux amputation, building deeper gait concepts.

Topics:

hallux amputation, achilles tendon, achilles tendinopathy, rehab achilles, bursae, marathons, vapourfly, shoes, shoe fit, gait, gait problems, gait correction, gait retraining, running, foot strike, heel strike, midfoot strike, rearfoot strike, heel strike, loading responses, gait rehab, muscle strength, isotonics

Links to find the podcast:

Look for us on iTunes, Google Play, Podbean, PlayerFM and more.

Just Google "the gait guys podcast".

Our Websites:
www.thegaitguys.com

doctorallen.co

summitchiroandrehab.com

shawnallen.net

Our website is all you need to remember. Everything you want, need and wish for is right there on the site.
Interested in our stuff ? Want to buy some of our lectures or our National Shoe Fit program? Click here (thegaitguys.com or thegaitguys.tumblr.com) and you will come to our websites. In the tabs, you will find tabs for STORE, SEMINARS, BOOK etc. We also lecture every 3rd Wednesday of the month on onlineCE.com. We have an extensive catalogued library of our courses there, you can take them any time for a nominal fee (~$20).

Our podcast is on iTunes and just about every other podcast harbor site, just google "the gait guys podcast", you will find us.

Where to find us, the podcast Links:

iTunes page:

https://itunes.apple.com/us/podcast/the-gait-guys-podcast/id559864138?mt=2

Google Play:

https://play.google.com/music/m/Icdfyphojzy3drj2tsxaxuadiue?t=The_Gait_Guys_Podcast

Direct download URL: http://traffic.libsyn.com/thegaitguys/pod_140real_-_10618_9.18_AM.mp3

Permalink URL: http://thegaitguys.libsyn.com/podcast-140-running-hallux-amputation-building-running-concepts

Libsyn Directory URL:http://directory.libsyn.com/episode/index/id/7135745

Topics and links:

The tendinopathic Achilles tendon does not remain iso-volumetric upon repeated loading: insights from 3D ultrasound. Nuri L, et al. J Exp Biol. 2017.

https://www.ncbi.nlm.nih.gov/m/pubmed/28620014/

Good tip to decrease loading and help decrease injury risk in runners: See study by Chan et al.:
http://journals.sagepub.com/doi/abs/10.1177/0363546517736277?url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&rfr_dat=cr_pub%3Dpubmed&

Vapourfly shoe
https://www.nytimes.com/interactive/2018/07/18/upshot/nike-vaporfly-shoe-strava.html

Men’s marathon:
https://twitter.com/chrisbramah/status/1019481750039343104/photo/1

fun facts:

Foot strike patterns of the World Championships Marathon:
Women’s race:
73% rearfoot, 24% midfoot, 3% forefoot
Men’s race:
67% rearfoot, 30% midfoot, 3% forefoot
pic.twitter.com/iWRzjImQBZ
https://www.iaaf.org/about-iaaf/documents/research#biomechanical-research-projects

Foot structure and stiffness is critical
https://www.nature.com/articles/srep29870

Tendons can change
Progressive calf strength training led to increased achilles stiffness @ 4 weeks & increased tendon cross sectional area @ 8 weeks
https://link.springer.com/article/10.1007/s00421-018-3904-1

Bursae can thicken painlessly as a normal adaption to activity... just like skin calluses!
https://www.ncbi.nlm.nih.gov/pubmed/24907190

Between 63-72% of participants were wearing incorrectly sized footwear. review of the literature here from @LTPodiatry team:
https://jfootankleres.biomedcentral.com/articles/10.1186/s13047-018-0284-z

How Neuroscientists Explain the Mind-Clearing Magic of Running -- from the Science of Us
https://www.huffingtonpost.com/science-of-us/how-neuroscientists-expla_b_9787466.html

Fatiguing your way to your injury? Endurance Injuries, Part 2

Yesterday we wrote about the importance of endurance acquisition in preventing injuries. It is not a coincidence that many injuries sneak up on athletes in the later part of a game or event. Fatigue can predispose us to the variables that sent up compensation and injury, not always of course, but often.  

We felt it would be worthy work to look into a few other journal articles to make our case, not that it truly needed to be hammered out further, but we like to hammer.

We discovered that novice runner's (1) trunk inclination increased and ankle eversion increased with fatigue. Furthermore, as fatigue increased, it was noted to be prominent in the hip external rotators and hip abductors (2). We have discussed this ad nauseam over the years. Failure in these areas impact one's ability to hold sufficient limb rotation to ensure clean sagittal knee mechanics.  Challenges in these motions also lead to faults in foot targeting.  When these abductors and external rotators fatigue or weaken, hip adduction can often occur leading to undesirable medial foot targeting, hence narrow step width and our favorite soap box topic, the cross over gait. These issues become pronounced at the end of the run according to the Dierks study. However, in the 2nd Dierks (3) study these findings were challenged, "uninjured runners normally experience small alterations in kinematics when running with typical levels of exertion". Similarly, in the García-Pinillos study, (5) no major form failures were noted in endurance athletes that pushed their limits in another type of failure test, the HIIT (high intensity interval) workout. Dierks (3) remarked that "It remains unknown how higher levels of exertion influence kinematics with joint timing and the association with running injuries, or how populations with running injuries respond to typical levels of exertion.". 

None the less, these are just two studies, and there are others to refute it. We do however, challenge this. But, this is easy to do, because all day long in our clinics we see and hear the cases where there is correlation, because the people seeking us out are in fact "symptomatic" patients and not uninjured runners, so it is easy to lean in one biased direction from our end. Though, it bodes the bigger question off of this following statement, "uninjured runners normally experience small alterations in kinematics when running with typical levels of exertion", as to whether in time, these small alterations might lead to a symptomatic state. One can easily theorize that it is in fact this time variable that eventually leads these small alterations towards bigger ones that might become symptomatic. After all, every avalanche starts with a single snowflake, no offense to the snowflakes out there.

Shawn Allen, the gait guys

References:

1.  J Sci Med Sport. 2014 Jul;17(4):419-24. doi: 10.1016/j.jsams.2013.05.013. Epub 2013 Jun 19.
Kinematic changes during running-induced fatigue and relations with core endurance in novice runners. Koblbauer IF1, van Schooten KS2, Verhagen EA3, van Dieën JH2.

2. J Orthop Sports Phys Ther. 2008 Aug;38(8):448-56. doi: 10.2519/jospt.2008.2490. Epub 2008 Aug 1.
Proximal and distal influences on hip and knee kinematics in runners with patellofemoral pain during a prolonged run. Dierks TA1, Manal KT, Hamill J, Davis IS.

3. J Biomech. 2010 Nov 16;43(15):2993-8. doi: 10.1016/j.jbiomech.2010.07.001. 
The effects of running in an exerted state on lower extremity kinematics and joint timing. Dierks TA1, Davis IS, Hamill J.

4. Gait Posture. 2014;40(1):82-6. doi: 10.1016/j.gaitpost.2014.02.014. Epub 2014 Mar 4. 
Do novice runners have weak hips and bad running form? Schmitz A1, Russo K1, Edwards L1, Noehren B2.

5. J Strength Cond Res. 2016 Oct;30(10):2907-17. Do Running Kinematic Characteristics Change over a Typical HIIT for Endurance Runners?
García-Pinillos F1, Soto-Hermoso VM, Latorre-Román PÁ.

Podcast 128: Usain Bolt, Plantaris Tears, Arm Swing

Podcast links:

http://traffic.libsyn.com/thegaitguys/pod_128final.mp3

http://thegaitguys.libsyn.com/podcast-128-usain-bolt-plantaris-tears-arm-swing

https://www.thegaitguys.com/podcasts/

Key Tagwords:

usain bolt, plantaris tear, plantaris, sole lifts, heel lift, leg length, short leg, heel drop, shoeque, symmetry, asymmetry, sprinters, scoliosis, tendinopathy, achilles, runners, marathons, running injuries, arm swing

Our Websites:
www.thegaitguys.com
summitchiroandrehab.com   doctorallen.co     shawnallen.net

Our website is all you need to remember. Everything you want, need and wish for is right there on the site.
Interested in our stuff ? Want to buy some of our lectures or our National Shoe Fit program? Click here (thegaitguys.com or thegaitguys.tumblr.com) and you will come to our websites. In the tabs, you will find tabs for STORE, SEMINARS, BOOK etc. We also lecture every 3rd Wednesday of the month on onlineCE.com. We have an extensive catalogued library of our courses there, you can take them any time for a nominal fee (~$20).
 
Our podcast is on iTunes, Soundcloud, and just about every other podcast harbor site, just google "the gait guys podcast", you will find us.
 
Show Notes:

Superficial plantar cutaneous sensation does not trigger barefoot running adaptations.

https://www.ncbi.nlm.nih.gov/pubmed/28728130

Arm swing
http://www.medicalnewstoday.com/articles/173680.php

Usain bolt
https://mobile.nytimes.com/2017/07/20/sports/olympics/usain-bolt-stride-speed.html?referer=

Plantaris tears
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1978447/

Caveat Emptor: Foot placement is a complex thing.

"Understanding why we place a foot where we do can be a choice, eventually a habit, of perceived stability, of compensation and we like to say "it is a sliding scale between liabilities and economy". If you want more running economy, go for a narrow step width, but realize you are wrestling with its underlying liabilities.  The key is, one must have enough durability on the loading response of a narrow step width (cross over gait) to fend off the liabilities to reap the rewards of the improved economy. Forgo this principle, and it is caveat emptor."- Dr. Shawn Allen

Today we wanted to revisit a few topics and start to tie them together so that readers can perhaps more deeply bring the study discussed here today, into a deeper thought process.

We have discussed the topic of gluteal pain in chronic low back pain clients previously, when the 2015 Cooper article was published ahead of print. Well, it came out in print (Euro Spine J) in 2016 so we wanted to revisit it with some more global thoughts. Those links are below. 
Basically, the article said that people with low back pain often have “Gluteus medius weakness and gluteal muscle tenderness are common symptoms in people with chronic non-specific LBP.”  
 

As we mentioned in our blog post last year, commenting on the "ahead of print" article, "it is often more on the side of pelvic frontal plane drift. The abdominals and spinal stabilizers also often test weak on this same side. We often see compromise of hip rotation stability as well because , since the hip is relatively adducting (because the pelvis is undergoing repeated frontal plane drift, hence no hip abduction) there is often a component of cross over gait phenomenon which can threaten rotation stability of the lower limb (type “cross over gait” into the search box of our tumblr blog for a landslide of work we have written on that phenomenon)."

This brings to mind this brief (14minute excerpt) from an old podcast we did (#109b, link below) on foot targeting, pelvis frontal plane drift, glute weakness and cross over gait. We brought together several concepts in that 14 minute span and it was on the topic from the Rankin article (link below).

If one is treating clients one must put all these concepts together (one should also have a deep grasp of the principles in this video ). One cannot have tunnel vision, one must embrace the entire picture neuromechanically. Foot targeting, gluteus medius activity, frontal plane pelvis drift or sway, cross over gait parameters, limb torsional issues, foot types and many more must all come into play if you are to truly get to the bottom of your clients problems. The approach must look at the loading and movement patterns at the very least, from foot to pelvis.  We would argue one should not stop there however, take your evaluation all the way into arm swing, thoracopelvic canister stability and more.  
We have pounded sand on the cross over gait and arm swing and the like for almost a decade now. As far as we know, we introduced, and if not, at the very least were the ones that dove deep into the cross over gait and its issues, and all of the attributes and functional pathologic pieces that go with it. We feel that if you fully understand the 40+ articles we have written on the cross over gait and arm and leg swing you will take your client and athlete evaluation to another level.  Understanding unconscious foot targeting is key in our opinion. "Understanding why we place a foot where we do can be a choice, eventually a habit, of perceived stability, of compensation and we like to say "it is a sliding scale between liabilities and economy". If you want more running economy, go for a narrow step width, but realize you are wrestling with its underlying liabilities.  The key is, one must have enough durability on the loading response of a narrow step width (cross over gait) to fend off the liabilities to reap the rewards of the improved economy. Forgo this principle, and it is caveat emptor. "

Shawn & Ivo, the gait guys

https://thegaitguys.tumblr.com/post/149177564774/podcast-109b-shorts-the-gluteus-medius-during

A neuromechanical strategy for mediolateral foot placement in walking humans. Rankin BL
J Neurophysiol. 2014 Jul 15;112(2):374-83. doi: 10.1152/jn.00138.2014. Epub 2014 Apr 30. 

Eur Spine J. 2016 Apr;25(4):1258-65. doi: 10.1007/s00586-015-4027-6. Epub 2015 May 26.
Prevalence of gluteus medius weakness in people with chronic low back pain compared to healthy controls.
Cooper NA1,2, Scavo KM3, Strickland KJ3, Tipayamongkol N3, Nicholson JD4, Bewyer DC4, Sluka KA3.

http://www.ncbi.nlm.nih.gov/pubmed/26006705

Podcast 127: Tendinopathies, Tendon Pain & more.

Key Tagwords:

neuroscience, hip pain, tendonopathy, DNA, running, injuries, achilles, tendonitis, gait, shoecue

Show Links:

http://traffic.libsyn.com/thegaitguys/pod_127f.mp3

http://thegaitguys.libsyn.com/podcast-127-tendinopathies-tendon-pain-more

Our Websites:

www.thegaitguys.com

summitchiroandrehab.com   doctorallen.co     shawnallen.net

Our website is all you need to remember. Everything you want, need and wish for is right there on the site.
Interested in our stuff ? Want to buy some of our lectures or our National Shoe Fit program? Click here (thegaitguys.com or thegaitguys.tumblr.com) and you will come to our websites. In the tabs, you will find tabs for STORE, SEMINARS, BOOK etc. We also lecture every 3rd Wednesday of the month on onlineCE.com. We have an extensive catalogued library of our courses there, you can take them any time for a nominal fee (~$20).
 
Our podcast is on iTunes, Soundcloud, and just about every other podcast harbor site, just google "the gait guys podcast", you will find us.
 
Show Notes:

New neuron science
http://trendintech.com/2017/04/05/groundbreaking-study-reveals-neurons-communicate-in-a-way-we-never-imagined/

Exercise strengthens you DNA
http://www.mensfitness.com/training/build-muscle/exercise-strengthens-your-dna

Development of overuse tendinopathy: A new descriptive model for the initiation of tendon damage during cyclic loading
Tyler W. Herod, Samuel P. Veres
https://twitter.com/stijnbog/status/875270547562692608

The neuromechanical adaptations to Achilles tendinosis.
J Physiol. 2015 Aug 1;593(15):3373-87. doi: 10.1113/JP270220. Epub 2015 Jun 30.
Chang YJ1, Kulig K1.

Hip muscle strength is decreased in middle-aged recreational male athletes with midportion Achillestendinopathy: A cross-sectional study.
Phys Ther Sport. 2017 May;25:55-61. doi: 10.1016/j.ptsp.2016.09.008. Epub 2016 Sep 13.
Habets B1, Smits HW2, Backx FJG3, van Cingel REH4, Huisstede BMA5.

Changes of gait parameters and lower limb dynamics in recreational runners with achilles tendinopathy. Kim S1, Yu J2.
J Sports Sci Med. 2015 May 8;14(2):284-9. eCollection 2015 Jun.

Vibrations and strides
http://www.popsci.com/measuring-vibrations-runners-strides-could-prevent-muscle-injuries

ShoeCue product:
https://www.shoecue.com/?gclid=CKL1mI_e8tQCFZi4wAodgXMPJA

RULES of tendonopathies:
https://pbs.twimg.com/media/C3BbmWlXgAAg-ZA.png:large

Roger Enoka
http://www.humankinetics.com/products/all-products/neuromechanics-of-human-movement-5th-edition

http://onlinelibrary.wiley.com/doi/10.1002/jor.23629/abstract?campaign=wolacceptedarticle

Does asymmetry matter ?

Does asymmetry matter ?

There has been some brilliant talk in the socialverse as of late that asymmetry doesn't matter. We believe these dialogues may be contextual for dialogue purposes (perhaps?) and we have no problem with that. I am sure we may approach our patients differently, though restoring pain free function is the goal. We have a problem layering more endurance, strength and power on asymmetry. Sure the client may feel better, but that is just because the threshold of the system is better, maybe. They have better armor, they are more durable, and thus further from the pain line, but the problem is undeniably still there, it is just protected. 
So, why not try to move closer to symmetry, if that gives pain relief, and then build strength, power, and endurance on those cleaner patterns ? Doesn't that make more sense ? One question we have, that science cannot prove (or disprove) is whether greater strength on asymmetry increases risk for injury ? Well, we think so, and we think that if for a given client, that strength and endurance built on a more symmetrical frame is likely to have less risk for injury. But, the verdict will always be out on that until we can clone folks.

We believe that driving toward symmetry much of the time does in fact matter. Is it going to happen 100%?, no, asymmetry is the rule in the human frame. We are talking about not driving deeper strength, power, endurance into an asymmetrical pattern that further puts strain into tissues not designed or apt to be favorable to the organism/joint/limb etc. We are putting together a written piece expressing some of our points of view further. We have found that when we drive our clients towards symmetry we often, not always, have to drive less strength and load into our clients to dampen the pain beast.

Stay tuned . . . .

https://youtu.be/0Jn2CESZ6jw

Podcast 126: Running, Athletes & MTSS (Medial Tibial Stress Syndrome)

Key tag words:
running, gait, injuries, achilles tendon, CRIPSR, swearing, limbic system, MTSS, stress fractures, tibial stress fracture, medial tibial stress syndrome, shoe drop, treadmill running, treadmills, barefoot, cortisone, cartilage loss, runners, marathons

Plus a plethora of other great running geeky stuff, clinical pearls, swearing, why not to use cortisone injections and more !

Podcast location links:

http://traffic.libsyn.com/thegaitguys/pod_126fmp3.mp3

http://thegaitguys.libsyn.com/podcast-126-running-athletes-mtss-medial-tibial-stress-syndrome

http://directory.libsyn.com/episode/index/id/5563258

Our Websites:
www.thegaitguys.com

summitchiroandrehab.com   doctorallen.co     shawnallen.net


Our website is all you need to remember. Everything you want, need and wish for is right there on the site.
Interested in our stuff ? Want to buy some of our lectures or our National Shoe Fit program? Click here (thegaitguys.com or thegaitguys.tumblr.com) and you will come to our websites. In the tabs, you will find tabs for STORE, SEMINARS, BOOK etc. We also lecture every 3rd Wednesday of the month on onlineCE.com. We have an extensive catalogued library of our courses there, you can take them any time for a nominal fee (~$20).
 
Our podcast is on iTunes, Soundcloud, and just about every other podcast harbor site, just google "the gait guys podcast", you will find us.
 
Show Notes:

Implantable computer chips will control your body’s movement
http://nypost.com/2017/05/16/implantable-computer-chips-will-control-your-bodys-movement/?utm_campaign=partnerfeed&utm_medium=syndicated&utm_source=flipboard

ANU researchers grow brain cells on a chip that can be used for neural implants
http://tech.firstpost.com/news-analysis/anu-researchers-grow-brain-cells-on-a-chip-that-can-be-used-for-neural-implants-376218.html

How Scientists Think CRISPR Will Change Medicine
http://time.com/4764488/crispr-genomic-technology/

'Exercise-in-a-pill' steps closer with new study
http://www.medicalnewstoday.com/articles/317263.php

Swearing can boost muscle strength and stamina, scientists claim
http://www.mirror.co.uk/lifestyle/health/swearing-can-boost-muscle-strength-10358340

MTTS: medial tibial stress syndrome
https://www.thegaitguys.com/thedailyblog/2017/5/2/medial-tibial-stress-syndrome-mtss-and-the-long-flexor-of-the-big-toe

Corticosteriod coffin
Effect of Intra-articular Triamcinolone vs Saline on Knee Cartilage Volume and Pain in Patients With Knee OsteoarthritisA Randomized Clinical Trial

Timothy E. McAlindon, DM, MPH1; Michael P. LaValley, PhD2; William F. Harvey, MD1; et al

https://twitter.com/JAMA_current/status/864631934483345408

http://jamanetwork.com/journals/jama/fullarticle/2626573?utm_source=TWITTER&utm_medium=social_jn&utm_term=901304561&utm_content=content_engagement|article_engagement&utm_campaign=article_alert&linkId=37665463

Achilles Tendon Load is Progressively Increased with Reductions in Walking Speed.
http://journals.lww.com/acsm-msse/Abstract/publishahead/Achilles_Tendon_Load_is_Progressively_Increased.97204.aspx

Shoe drop has opposite influence on running pattern when running overground or on a treadmill.   Nicolas Chambon et al
https://link.springer.com/article/10.1007%2Fs00421-014-3072-x

Forefoot strike running: Do you have enough calf muscle endurance to do it without a cost ?

Below you will find an article on footwear and running. Rice et al concluded that 

“ When running in a standard shoe, peak resultant and component instantaneous loadrates were similar between footstrike patterns. However, loadrates were lower when running in minimal shoes with a FFS (forefoot strike), compared with running in standard shoes with either foot strike. Therefore, it appears that footwear alters the loadrates during running, even with similar foot strike patterns.

They concluded that footwear alters the load rates during running. No brain surgery here. But that is not the point I want to discuss today. Foot strike matters. Shoes matter. And pairing the foot type and your strike patterns of mental choice, or out of natural choice, is critical. For example, you are not likely (hopefully) to choose a HOKA shoe if you are a forefoot striker. The problem is, novice runners are not likely to have a clue about this, especially if they are fashonistas about their reasoning behind shoe purchases. Most serious runners do not care about the look/color of the shoe. This is serious business to them and they know it is just a 2-3 months in the shoe, depending on their mileage. But, pairing the foot type, foot strike pattern and shoe anatomy is a bit of a science and an art. I will just mention our National Shoe Fit Certification program here if you want to get deeper into that science and art. (Beware, this is not a course for the feint of heart.)

However, I just wanted to approach a theoretical topic today, playing off of the “Forefoot strike” methodology mentioned in the article today.  I see this often in my practice, I know Ivo does as well. The issue can be one of insufficient endurance and top end strength (top end ankle plantar flexion) of the posterior mechanism, the gastrocsoleus-achilles complex. If your calf complex starts to fatigue and you are forefoot striker, the heel will begin to drop, and sometimes abruptly right after forefoot load. The posterior compartment is a great spring loading mechanism and can be used effectively in many runners, the question is, if you fatigue your’s beyond what is safe and effective are you going to pay a price ? This heel drop can put a sudden unexpected and possibly excessive load into the posterior compartment and achilles. This act will move you into more relative dorsiflexion, this will also likely start abrupt loading the calf-achilles eccentrically. IF you have not trained this compartment for eccentric loads, your achilles may begin to call you out angrily. Can you control the heel decent sufficiently to use the stored energy efficiently and effectively? Or will you be a casualty?  This drop if uncontrolled or excessive may also start to cause some heel counter slippage at the back of the shoe, friction is never a good thing between skin and shoe. This may cause some insertional tendonitis or achilles proper hypertrophy or adaptive thickening. This may cause some knee extension when the knee should not be extending. This may cause some pelvis drop, a lateral foot weight bear shift and supination tendencies, some patellofemoral compression, anterior meniscofemoral compression/impingement, altered arm swing etc.  You catch my drift. Simply put, an endurance challenged posterior compartment, one that may not express its problem until the latter miles, is something to be aware of. 

Imagine being a forefoot striker and 6 miles into a run your calf starts to fatigue. That forefoot strike now becomes a potential liability. We like, when possible, a mid foot strike. This avoids heel strike, avoids the problems above, and is still a highly effective running strike pattern. Think about this, if you are a forefoot striker and yet you still feel your heel touch down each step after the forefoot load, you may be experiencing some of the things I mentioned above on a low level. And, you momentarily moved backwards when you are trying to run forwards. Why not just make a subtle change towards mid foot strike, when that heel touches down after your forefoot strike, you are essentially there anyways. Think about it.

Shawn Allen, one of The Gait Guys

Footwear Matters: Influence of Footwear and Foot Strike on Loadrates During Running. Medicine & Science in Sports & Exercise:
Rice, Hannah M.; Jamison, Steve T.; Davis, Irene S.

http://journals.lww.com/acsm-msse/Abstract/publishahead/Footwear_Matters___Influence_of_Footwear_and_Foot.97456.aspx

“ I had explosive diarrhea in the middle of a good long run.”

We have always wanted to start a blog post with something dirty like that, but it never seemed like the right thing to do. So, we figured we would save it for on or around the day of our 1000th blog post. We started The Gait Guys blog in 2011 with our first blog post and just a few days ago the trumpets sounded at the 1000th post. How did this happen ? Well, it happened little by little, 3-5 post a week, month after month. It happened just as the gentleman described in the video above on how to make a dry wall, stone after stone.  Our writing has managed to reach into 74 countries with the additional help of our podcasts, teleseminars and social media.  Thus, we wanted to just voice a little thanks to you all for following us, week after week, month after month.  So far this has been a pretty great journey for us and we are happy you have come along for the ride. 

Now back to sphincters and running. 

“ I had explosive diarrhea in the middle of a good long run.”

Think it can’t happen to you ? Here is a true medical literature case study. “A 20-year-old female running the Marine Corps Marathon developed diarrhea at mile 12. After finishing the race she noted that she was covered in bloody stool. A local emergency department suspected ischemic colitis.” This was straight from the Grames study found below. 

Maintenance of the basal tone in the internal anal sphincter is critical for rectoanal continence. Effective evacuation requires a fully functional rectoanal inhibitory reflex-mediated relaxation of the internal anal sphincter via inhibitory neurotransmission.

Ok, What !!!!????

Basically, all that means is that the tone of the anus is pretty complicated and when it works right, we don’t think about it much, and when it shows us signs of things hitting the fan, it prompts an immediate hierarchy of our attention.  However, diarrhea is so much more than what is violently erupting from the opening at the other end of our alimentary tract.

Lower GI complaints such as urgency and diarrhea are not all that uncommon in runners.  Sometimes it is pre-race jitters/nerves, sometimes is too many donuts and coffee before the big sunday team run, sometimes it is electrolyte imbalances or too much beer or Wild Turkey the night before, sometimes it’s aberrant autonomic nervous system stimulation, and in the initial case above sometimes it is ischemia (impaired blood perfusion to the colon).

Possible mechanisms of ischemia in distance runners and others participating in intense exercise may include a combination of splanchnic vasoconstriction, dehydration, and hyperthermia, combined with the mechanical jostling of organs via intense activity. Most of the unfortunate presenting with marathon-running-induced ischemic colitis respond favorably to conservative treatment, but awareness is the first step. However, as in the Cohen et al case referenced below, sometimes the unlucky collapse at the finish line and have other results …  whereafter “computed tomography scanning revealed ischemic colitis of the cecum and ascending colon, which progressed to the development of clinical peritonism after 48 hours. This patient subsequently underwent a laparotomy and right hemicolectomy, with ileostomy formation, on the third day after admission. Operative and histologic findings confirmed ischemic colitis of the cecum and proximal colon.”  

So, there is some anxiety-inducing stuff to think about right before your long run this week ! But lets be realistic. Be smart, watch your diet with a good food diary, think hard about your fluid levels and what those fluids are, be smart about pushing hard during high temperature days, know your usual stool habits, and most of all do not ignore the subtle or obvious signs that things could be going wrong in a race or in training. Unexpected bowel problems in a race may not be only a mere embarrassment, they could be telling you something is seriously wrong. 

In closing, thanks for following our writings for the past 3.5 years, writings amounting to 1000 articles. It has been a fun journey and we have learned right along side of you.  In relation to the video above, our body of work is clearly no novel, but our journey in itself is a story of sorts. A story that has been piecing together all the little nuances of the human frame and its biomechanics, bit by bit. 

(Oh, and for those who feel we should apologize for the video not being about, well, erupting diarrhea in a runner, well, we wanted to make today’s post more about the writing process. If you want THAT video, that is what youtube might be for. Just don’t too much of your day looking for it, try writing a book instead.)

Shawn and Ivo,

Two Gait Guys trying to avoid what sometimes hits the fan.

References:

1) Am Fam Physician. 1993 Sep 15;48(4):623-7. Runner’s diarrhea and other intestingal problems of athletes. Butcher JD.

2) Am J Emerg Med. 2009 Feb;27(2):255.e5-7. Marathon-induced ishemic colitis: Why running is not always good for you.  Cohen DC1, Winstanley A, Engledow A, Windsor AC, Skipworth JR.

3) Case Rep Gastrointest Med. 2012;2012:356895. Ischemic Colitis in an endurance runner.  Grames C1, Berry-Cabán CS.