“If you screw-up toe-off, the rest of the movement is compensation.”
—The Gait Guys

Just when you thought the running gods had grown tired of tormenting us with new and ever more exasperating running injuries, I’m saddened to report they’re still at it and as sadistic as ever. This latest one— functional hallux limitus (FHL)—which, like all the other injuries, has a flashy Latin name, translates to “this really sucks” . . . well, not to that exactly, but if you’ve got it, it certainly does. That you’ve likely never heard of FHL isn’t a surprise; few have. That’s because FHL—a pint-sized affliction with big consequences for runners— keeps a low profile, literally and figuratively.

For something so ruinous, FHL doesn’t make its entrance with the drama of a sprained ankle or torn hamstring. Instead it infiltrates our body with a Ninja’s stealth, then conceals itself in the most inconspicuous of places: the big toe joint. From there, FHL sows the seeds of dysfunction throughout the body by creating the illusion that the joint operates perfectly, even as its mobility is seriously compromised. FHL’s deception leaves its victims oblivious and clinicians flummoxed, making it one of the most insidious, least-known, and shockingly underdiagnosed conditions in running.

Before venturing further into this dark place, it’s important to know what we’re dealing with, so I’ve parsed FHL’s three components:

functional—using something (in this case, our body, and more specifically the big toe and foot) to do something weight-bearing (running)

hallux—the medical/scientific/Latin name for the big toe

limitus—limited; in this case, referring to the big toe joint’s limited bendability

Translation complete, we now understand that FHL is a condition occurring only when the foot is used for its designed purpose: locomotion (and as a consequence of locomotion, bearing weight). It’s as a result of weight bearing that the big toe’s bendability becomes limited to 30 degrees, usually less. Capiche?

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FHL’s Deception Revealed: The Left Image Shows the Hallux Bending Nicely with the Foot Unloaded; The Right Image Shows a Thumb Applying Load Under the First Metatarsal Head and the Hallux’s Range of Motion Disappearing Almost Completely

You should also know that there are two other, much worse conditions that are part of the hallux trilogy which I won’t talk about because they’re just too damned depressing, but I’ll give them a brief mention anyway. They are structural hallux limitus, where the mobility of the hallux is disrupted during both weight-bearing and non-weight-bearing activities, and the ultra-nasty hallux rigidus, where an unbendable big toe is accompanied by significant degeneration of the big toe joint. These baddies can substantially disrupt, even end, your running.

In a nutshell, what happens to those hapless souls who cross paths with FHL is that the big toe joint, known to those in the trade as the metatarsophalangeal joint (in short MTP joint or sometimes MPJ), loses its bendability when the foot is weight bearing. The more dynamic the type of locomotion we’re engaged in—for us it’s running, which is very dynamic—the more important a mobile MTP joint is. As mentioned, it must bend, or dorsiflex, a bare minimum of 30 degrees, but ideally between 65 and 75 degrees, as we run to ensure a proper and powerful toe-off. I define a proper toe-off as a high heel with the sole of the foot close to, or at, vertical, and the heel neither abducting or adducting (tipping in or tipping out). Check out these guys . . .

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Finland’s Pekka Vasala and Kenya’s Kip Keino Display Awesome Form – With Perfect Toe-Off – In the 1972 Olympic 1500 Metre Final. Whether We’re Olympians or Casual Runners, Hallux Range of Motion Plays a Huge Role in Our Ability to Run Fast and Pain Free

Most runners with FHL are aware of blocked movement and pain in their MTP joint, so they use a simple and somewhat effective strategy to deal with it: they lessen the bending of the joint by moving around the restriction. And voilà, the pain is gone . . . or reduced. Brilliant, no? At first it is, but in the long run it’s terrible. Why’s that? Because as clever as runners think they are, they’re oblivious to the mayhem compensations like this can create.

Assuming that all our bodily systems are in perfect working order (that’s a really big assumption, but I won’t address the many variables now), here’s a very simple way of looking at how the body gets things done: think of your body as a home computer, consisting of two essential components, the operating system (OS) and the hardware (the physical parts of the computer). Your nervous system is the OS; your body (in this case, your musculoskeletal system) is the hardware. When given orders from the nervous system, the musculoskeletal system (the bones, skeletal muscles, fascia, ligaments and tendons) has one goal: task completion. It doesn’t think about movement economy or efficiency, or about the implications of lifting heavy things with bad form. The orders sent by the nervous system to the musculoskeletal system are starkly unambiguous: it doesn’t have to be pretty, just get the job done.

And movement for many isn’t pretty: if we’re dealing with injuries, pain, advanced age, poor body awareness, excess weight, or an array of pathologies/diseases (take your pick), the way we’ll move might be downright ugly. It’s against this backdrop that the musculoskeletal system “gets the job done” by moving in a way that’s not only unhealthy, but which perpetuates continued poor movement by grooving an aberrant pattern in the nervous system. And once that pattern has been established, it’s damned hard to correct.

Compensation—automatically shifting movement/load away from the “natural” or “best” path for a particular movement to an alternate route—begins a process of musculoskeletal overload, eventually leading to syndromes and inefficiencies, imbalances and pain. Is it really that bad? Yes, it usually is. Compounding the problem is that we’re usually not even aware we’re compensating; the body simply defaults to a path that’s free of restriction or pain. Even if we know we’re compensating, we’re probably okay with it simply because it allows us to run, or move, unencumbered, or at least with less pain.

One consequence of FHL, gluteal amnesia, shows how a particular structure (in this case, the gluteus maximus muscles) far from the source of the problem (the MTP joint) can be adversely affected. Gluteal amnesia occurs when an immobile MTP joint prevents full hip extension in late mid-stance, otherwise known as the hip extension phase of gait. Because the gluteus maximus is the primary extender of the hip, it won’t contract properly when hip extension is compromised, and as a result becomes partially deactivated and weaker. It then is less effective at doing its job, which is to extend, abduct and externally rotate the hip/leg when we run.

Another problem associated with FHL is a low gear push-off. When the bendability of the MTP joint is comprised during gait, the foot will move around the block and the heel, in turn, will abduct (tip to the outside). Because of this, the plantar fascia can’t tension or load energy (an essential step for loading strain energy by tensioning the plantar fascia is known as the windlass mechanism), and the propulsive force that must happen with toe-off is lost, hence the term “low-gear push-off.”

The million-dollar question is, of course, how does a person get FHL? Without question, certain foot types are at risk for FHL, the over-pronated foot in particular, but the current thinking on its cause(s) is not definitive. As is often the case, conditions or pathologies like FHL manifest when an inherited predisposition meets the right circumstances, commonly known as the interaction of nature and nurture. The website of the Mayo Clinic (mayoclinic.org) notes that “wearing tight, narrow shoes might cause bunions or make them worse” and, in the next sentence, that “bunions also can develop as a result of an inherited structural defect.” Others assert that FHL is entirely self-inflicted, created by the habitual use of toe-constricting footwear.

For those hoping to avoid the horrors of MTP joint dysfunction, here are some recommendations:

1. All footwear (this means anything you put on your feet) must have a wide toe box—no exceptions.

2. Go barefoot whenever possible.

3. Use toe spacers.

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Toe Spacers Can Help Reverse the Inward Migration of the Big Toe (Hallux Valgus)

4. Do lots of yoga, with postures that focus on mobilizing the ankles and big toe joints.

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A Great Posture for Mobilizing Our Feet, the Big Toe in Particular

As a yoga teacher, movement coach, and runner, I see the consequences of limited or rigid halluces (“ha loo sees”: more than one hallux) every day: bunions, bouncy strides when walking or running, an inward migration or abduction, of the big toe toward the second toe, and unexplained pain in the knee, hip or low back.

FHL is frequently overlooked by health care professionals as a cause of dysfunction and pain elsewhere in the body. Those who should catch FHL are medical doctors with training in orthopedics or sports medicine, as well as doctors of chiropractic and podiatry, and physical therapists, all of whom possess an excellent understanding of the musculoskeletal system and the consequences of limited mobility in the MTP joint.

An important final point (and repeating what I mentioned earlier): the test for FHL is dynamic, meaning the foot must be in a fully weight-bearing, closed kinetic chain position when the MTP joint is assessed. Remember, the name for this condition is functional hallux limitus; it appears only when the foot is functioning, not when you’re kickin’ back and the foot’s propped up on an ottoman. Clinicians, if they consider the big toe at all, miss FHL because their assessment is passive, not dynamic. If the leg is supported and your friend bends your big toe back 80 degrees without pain or restriction, that’s great, but it only means you don’t have either of the two more severe manifestations of the hallux trilogy. You can, however, still have FHL.

I’d be interested in hearing from readers about your experiences with FHL, structural hallux limitus, or hallux rigidus and how it affects your running. Send your story to info@yogamadeforrunners.com

Thanks.

Here’s a question: who are these people who find yoga fun and relaxing? I see them on magazine covers or in ads smiling and laughing while they do their poses and pretend that yoga is just so damned lovely it makes them incontinent of joy and probably incontinent with joy as well. I’ve got to tell you that those images of yoga good times make me feel like I’ve really gotten it wrong, as if there was something they forgot to tell me to do, recite a mantra maybe or visualize puppies, when I showed up for class.

I mean really, what do fresh yoga models know of life? The reality for most people doing yoga is that it’s neither fun nor relaxing. Try yoga after enduring any of the traumas visited on our bodies by life’s cold calculus, of which the following is only a tiny sampling: ACL replacements and hamstring tears, herniated discs, sprained ankles, angry SI joints, dislocated elbows, whiplash, broken kneecaps, inflamed bursas or frozen shoulders. Then show me the smiles and laughter as you try to persuade your body to bend, twist or balance.

What I’m certain is happening is the weeping, agonized faces of these models are being photo-shopped into oblivion, replaced by a sort of Stepford Yogis look intended to convince the doubters that “despite your dilapidation, yoga will permeate your soul causing unrestrained giddiness and laughter”. The yoga ads remind me of the demented grinning you see in photos from North Korea, where Kim Jong Un is surrounded by uniformed flunkies whose only hope is that if they smile harder than the next guy their Supreme Leader won’t annihilate them with an anti-aircraft gun or a pack of starving dogs.

leader

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It was Saturday afternoon, Thanksgiving weekend, when an e-mail landed with a joyless clunk, rousing me from my post-run stupor. A friend wrote that he had just attended a presentation at the Victoria Marathon expo entitled “Running Sport Science: 35 Years of Progress – The New and the Tried and True.” In his message, my friend reported that the seminar’s guest speaker responded to a question from the audience with “Why would any runner want to do yoga?” The speaker explained his position by citing the need for “stiffness” in a runner’s muscles and claiming that yoga made the muscles “loosey-goosey.” Yes, he actually said “loosey-goosey.” This is progress?

Sigh. Just when I thought we’d seen the last of these nitwits, another yoga basher rises from the muck, this one conjuring the insightful “loosey-goosey” to describe the hellish reckoning that awaits runners who do yoga. As a bonus, the condescending snark of “why would any runner want to do yoga?” saves us rubes from getting conned into buying a worthless yoga membership by some smooth talkin’ hustler. We should all be grateful.

If you follow this type of thing, and it seems that in my role as a teacher of yoga to runners I have to, then you know it’s fashionable in certain circles to trash yoga. Some strength and conditioning experts, running coaches, and other athletic types believe that yoga for runners/athletes (I will toggle between the two throughout this piece) is stupid, for want of a better word, mainly because it ruins “athleticism”, a word whose meaning has evolved well beyond the quaint “displaying the attributes of an athlete” found in musty dictionaries.


Athleticism!

Nowadays, “athleticism” is that quality of being a superbly trained, finely-tuned athletic machine, possessing the exquisite neuromuscular skills needed to nail a triple axel or curve a penalty shot past a human wall into the last six inches of net. Athleticism is also the capacity to generate the explosive biomechanical force needed for rocket-sled starts from blocks or the blue line, as well as the enormous oppositional forces for hit-the-brakes decelerations and full stops and turn-on-a-dime changes in direction.

Yoga, some contend, is decidedly un- or even anti-athletic, because the stretching part “deadens the muscle” and reduces “peak strength and power” (the words of a different expert), thereby impairing the body’s ability to perform these astoundingly complex neuromuscular actions.

Adding to the shaming of yoga, those who have swallowed the Crossfit Kool-Aid know that Crossfit’s fundamentalist faction, the group that hews to the strictest interpretation of its doctrine, ranks yoga one notch below pedophilia in their hierarchy of reprehensible activities (a list that also includes long, slow running). So before I go on, a bit of advice: if you join Crossfit, best not to mention your love of downward dog and leisurely two-hour runs or you’ll be frog marched onto the next bus to Camp Dumbbell, their “re-education” centre. There, with your eyes clamped open like Malcolm McDowell in A Clockwork Orange, you’ll be forced to watch box-jumping videos until you’re a weeping puddle of flesh.

malcolm_mcdowell_being_made_to_look_in_Clockwork_OrangeNooo! Not another box jumping video!

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When, on January 17, 1977, Gary Gilmore took the long walk to the death house at the Utah State Penitentiary, it would have been impossible for him, or anyone else, to know how profoundly his last utterances would affect popular culture. Gilmore, sentenced to death by firing squad for heinous crimes, was asked moments before his execution for any final words. His reply: “Let’s do it.” Those words penetrated deeply into the American psyche, and in 1988 Nike’s advertising agency, influenced by Gilmore’s terse bravado, morphed his words into the now iconic “Just Do It.” The “Just Do It” tag line has been stratospherically successful for Nike, and is used in their advertising to this day, 26 years after its introduction.

 

nike-just-do-it

 

Just Do It was a hit because it was a perfectly shaped kick in the butt: with three one-pulse words, eight letters in total, it was brevity writ large (or small), yet it brimmed with a get-off-your-ass, no excuses, quit your whining and get it done imperative. It wasn’t pretentious or elitist. It didn’t care if you were Michael Jordan or Jane Bag-of-Donuts. More than anything, Just Do It was empowering: lift your meek and downtrodden self from the swamp of self-pity, it said, and find your salvation in the church of athletic endeavor. Thus did Just Do It become a cri de coeur for a generation of sports enthusiasts, runners in particular, and it continues to percolate through sports culture in ways unimaginable when first introduced. Who could have predicted that the concluding words of a condemned man would form the foundation of one of the greatest advertising slogans of all time?

 

It’s 2014, and empowerment is what sells in the fitness biz. Flip through the pages of any running magazine and the mutant spawn of Just Do It are everywhere: barely coherent tag lines and slogans littering the advertising copy of companies hoping to catch lightning in a bottle, just as Nike did back in ’88. The problem, of course, is that creating the perfect slogan for your sneakers, energy bars, compressive underwear, or whatever it is you’re selling, is a daunting proposition. When handled poorly, as it typically is, Just Do It wannabes stumble down a path that leads not to fame and fortune from their products’ success, but to a clumsy borrowed creativity.

 

Success breeds imitators, but fantastic, over-the-top success breeds desperation, and Nike’s competitors, or those who just wanted some of the Nike mojo for their own product, felt pressured to capture that same cool and hip athletic ethic. The shoe companies Saucony, New Balance, and Brooks; the food products chocolate milk and Pure Protein bars; and the clothing company Under Armour have all adopted the Just Do It attitude in their slogans. But by attempting to distill their corporate message into a lean and mean Just Do It-like package, bursting with meaning and oozing inspiration, they end up with an awkward mess of pseudo-English that dishonors the master and fails utterly to capture the crispness of the original.

 

MY AFTER_IRONMAN_01.25.2012_Page_1

 

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The past, despite our fervent desire that it leave us alone, has an awful tendency to reach out with withered hands and grab us by the throat. So it was one recent, rainy afternoon that an artifact I had buried, both emotionally and physically, clambered out of a shoebox of running mementos and back into my life.

The item in question: a photograph of a youthful me, moving with anguished purpose along a rocky path two and a half miles above sea level, toward the finish of the Pike’s Peak half marathon. I examined the image as if it were a crime scene photograph, looking for evidence of . . . hmm, well, I’m not exactly sure what I was looking for. Perhaps a clue to what possessed me to race to the top of a 14,115 ft mountain.

Unlike many race photographs, this one displays no hint of triumph or celebration, none of the colour and energy (GO MOM!! YOU CAN DO IT!!!) that propels exhausted runners in the stretch run. There are no cheering masses, only scattered individuals staring piteously at the trickle of survivors making their way to the end of that dreadful haul. The spectators, their solemnity mirroring the bleak mountain terrain, look down as if in mourning, bundled in winter attire despite the mid-August date. Erase everyone from the photo and you could be looking at the surface of Mars.

When Zebulon Montgomery Pike decided to climb the unnamed mountain back in 1806, he was on a mission. Pike, a captain in the U.S. Army, had been ordered by U.S. President Thomas Jefferson to explore the southwestern reaches of the land acquired in the Louisiana Purchase. During his journey, he found himself at the bottom of a mountain in a territory that in another 70 years would become the state of Colorado. And so, with his men, he attempted to climb the peak but failed, driven back by deep snow. Seven years later, Pike, now a general, would be killed in the War of 1812. Nevertheless, the mountain became known as Pike’s Peak, immortalizing Zebulon Pike for his actions as a soldier and explorer, and in particular for attempting to reach the summit of that mountain.

Fast-forward 181 years to August 22, 1987. I’m standing on the main street of Manitou Springs, at the base of Captain Pike’s mountain, at the starting line of the Pike’s Peak half-marathon. Of all the events I could have chosen, why I chose this one is a bit of a mystery. What I remember with certainty is that in the spring of 1987 I wrote away for and received an entry form, and somehow convinced a friend to join me. I also remember filling out the entry, and in the box where it asked for my projected finishing time, I confidently wrote “two hours”. The problem was that the course record at the time was 2:05. This was a rather important reference point, but at the time I had no clue, and my two-hour estimate seemed quite reasonable (at least to me).

emperorfull

The author, hamming it up for the camera, nears the summit

The fact was I had absolutely no capacity to break, or even threaten, this record, held by a whippet-lean, perfectly built mountain runner from New Mexico named Al Waquie. It was his record that I had, with my deluded two-hour prediction, declared my own. Despite all that, I was in sterling shape, having just run a decent half in 1:11 (on an absolutely flat course, on a smooth, paved road, in abundant sea level air, in nice weather), and I was feeling confident, even with the high altitude, the 7800 or so feet of vertical gain, capricious weather, and the rocky, uneven terrain (see photo) factored in.

A bit of an aside here: for those of you who follow this type of thing, you might be interested to know that the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) calls this a Delusional Disorder, or more colloquially, a personal delusional system. And mine was functioning exceptionally well.

To make matters worse, in the weeks leading up to the race the significance of my reckless prediction percolated into my subconscious, and I was gripped by a vivid paranoia. I imagined an official at race headquarters processing my entry form, reading my projected time, doing a double-take, then becoming slowly incapacitated by a deep, scornful laughter. Compelled to share my madness with others, he passed the form to his colleagues, pointing at the box where “two hours” was printed neatly, after which the entire office collapsed into hysteria. Driving the knife of humiliation even deeper, they would assign me race number “1”, with a mocking “GOOD LUCK!” scrawled on the back.

Other than rampant paranoia, my Achilles heel was, of course, the altitude (hell, it was everyone’s Achilles heel) and by declaring two hours as my hoped-for time, I boldly announced my utter lack of understanding not only of the effects of high altitude on exercise performance, but what this mountain could do to people. To someone born and bred breathing the rich, moist air of Vancouver, and with zero experience running at altitude, I walked blissfully into the belly of the beast.

The week of the race we flew to Denver, then drove to Colorado Springs, an hour south. The start of the race was in the village of Manitou Springs, just west of Colorado Springs at an altitude of about 6300 ft. In retrospect, calling this event a “race” was, for me, a joke, because I certainly wasn’t racing. Any pretense of that had been obliterated the moment I stepped off the plane in Denver, situated at a puny 5280 ft, and found that even walking up a flight of stairs left me short of breath. No, this would be survival, pure and simple.

Race day! The weather was benign, not hot, but stable. Weather in the mountains is unpredictable, even in summer (the 2008 race had a blizzard) and the temperature can easily drop 40 degrees (F) from the start to the finish, so I dressed appropriately: long sleeve thermal top under a short sleeve mesh t-shirt. Also, gloves and a warm hat wrapped up in a windbreaker tied around my waist. If the weather deteriorated, I was somewhat prepared. I felt good.

The gun sounded and we were off. The wild sprint typical of many race starts was absent; we knew what lay ahead, so most proceeded at a relaxed jog. I remember forcing myself to run slowly and found that easy to do simply because it would have been suicide to run fast, so I just ambled along. We traversed some paved streets and after a short time found Barr trail, our path to the top.

The course doesn’t provide a gentle welcome. The first few miles are among the steepest of the race (see course profile), and after just 45 minutes I was already at about 8,000 feet. For most of its length, the trail is narrow, allowing only single file running. I was jogging steadily, passing people when possible but also being passed by others as the field sorted itself out; I noticed after a while the grade becoming a bit less onerous.

As mountains go, Pike’s Peak is not remarkable, especially in Colorado, where it is one of 54 “Fourteeners”, or peaks of at least 14,000 feet. But it is well known, and not just for the two foot races (a full marathon, from the bottom to the top and back again is held the day after the half). There’s also an auto race up the mountain, the famous Pike’s Peak Hill Climb, as well as a cog railroad that takes tourists (those with enough sense not to walk or run to the top) to the summit and back. It’s also popular with hikers, with abundant trails offering many opportunities for high altitude trekking.

Ninety minutes (six miles?) gone. I noticed how altitude fatigue was different than what I felt at sea level: my legs were heavy and every step required effort. The higher I went, the worse it got. My breathing was deep and my lungs were stinging, and despite my best intentions it slowly became almost impossible to run; even fast walking was an effort.

ppgraph

Small things began to eat at me. For example, I found the absence of normal mile markers upsetting. Without those there was no way to gauge my progress, no way to play the mental game of putting one foot in front of the other until the next mile marker, and then the next, until the end. If I’d been running something more civilized and things weren’t going well, I could at least do that. There are, however, critical landmarks along the way, structures, signs, and geographical points that give an idea of where you are and what remains, but those seem to resonate only with Peak veterans (or those who took the time to study the course map, which I hadn’t). With names like French Creek, A-frame, The Bottomless Pit sign, Barr Camp, they offer a way to measure the effort, and reassure participants that despite the slowness, you are moving upward.

Higher now, and things weren’t going well; people began to stream by me in increasing numbers. Trying desperately to keep up I alternated walking with jogging, which soon became mostly walking. My mood was swinging wildly between abject humiliation and despair. I looked at my watch: two hours gone; I’m nowhere near the finish. To save face I began limping; someone asked if I was okay. I stopped limping. I was truly pathetic.

Then, like a flicked switch, an incredible weariness hit me, and the last drops of my youthful vigour evaporated in the thin, dry air. I tried to keep walking, but even that was beyond me. Just ahead, at a wide spot on the trail, was a comfortable looking rock. And that is where I sat and hung my head. I breathed deeply and slowly, and after a few minutes the fatigue lessened. I stood and re-took my place in the stream of bodies going up.

We continued to move higher, but became more strung out. Someone near me said: “We’re comin’ up to the A-Frame.” The what? Did you say A-Frame? What the hell is that? “We’re getting closer, about 12,000 ft.” “Closer” to me meant nothing; for all I knew the finish was in Denver. A while later I masked my growing agitation and asked nonchalantly “Much further?” “Not far now.” I’m sorry, did you say not far now? If a baseball bat had been handy, and if in my feeble state I’d been able to lift and swing it, I . . . well, never mind.

I was alone on the trail. Even though I was above the tree line, the person ahead of me was out of sight, and I didn’t dare look back. I saw something up the trail . . . a marker, or perhaps a sign? My faculties were so badly eroded that I assumed it was a mirage. I looked down and kept walking; when I looked up again the sign was still there, and as I drew near it read two miles to the summit. I processed this information, but could do nothing with it, because at this point the thought of running was absurd; now it was just one foot in front of the other.

Compounding my agony was the fact that even when I knew the finish line was near, it just never seemed to appear. I could clearly hear the announcer on the peak exhorting finishers, his amplified voice flying through the thin air, ricocheting off the rocks and down the barren mountain. It was maddening. The finish was always just over the ridge, around the next corner. I would look up and see nothing, just more mountain. I asked spectators “Am I close to the finish?” and the answer would be “You sure are, it’s just up there,” gesturing to some invisible place higher up on the mountain. Every time I surmounted a ridge, there would be yet another ridge, another switchback. Where’s the f&$#@ing finish??? I was disintegrating, any sense of civility ripped out of me. I longed for The Bottomless Pit, which I would hurl myself into to end this madness. They would find my crumpled body–along with many other shattered souls I’m sure–for whom a different finish line was ordained.

The office worker pops into my mind again, now even more deranged than his previous visits, his face contorted into a grotesque red mask of derision. He jabbed a fat finger into my chest saying “Two hours, two hours,” while laughing hysterically. I was on the brink.

I staggered over the line in 3:53:26. Of the 1270 ascent participants I was 514th; the men’s winner did 2:09, the women’s 2:39 (I report this with such accuracy only because I looked it up). For me, there was no dramatic finish line scene; I just stood there, emotionally numb. Otherwise, and rather oddly, I felt okay. I was used to the searing exhaustion that typically accompanies racing, but that sensation was strangely absent, probably because I had walked at least half the distance.

I recall wandering around like some sort of refugee, feeling displaced and dispossessed, wondering what had just happened and not exactly knowing what I should do next. Perhaps it was the lack of oxygen. I put on warm clothing and found my friend; he had finished well ahead of me.

Then we got on the bus and they drove us back down the mountain.

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If we are to truly visit yoga and plumb its depths, and if, as runners, we hope to benefit from a practice that can help us become healthy and fit in mind and body, then we must become aware of bodily sensation, the subtle but tangible quality that is the language of our body. Sensation speaks to those with a quiet mind and a patient ear, revealing the body’s secret intrigues and loud complaints. Being guided by sensation in running and in yoga means we have accepted that sensation is a phenomenon worthy of our trust and full attention.

Our willingness to listen to our body’s voice begins a dialogue between mind and body, and is the first step in creating a deep and enduring quality of embodiment. But this path is littered with obstacles that will test our resolve, and the ideal state of complete embodiment may seem at times to be beyond our reach. But ultimately our striving to be grounded and whole will be realized, and the universe of the body offered to us.

To understand and appreciate the importance of connecting more deeply to the body, and to understand the barriers to that connection, let’s consider this statement from yoga teacher Richard Freeman: “yoga begins with listening.” At the start of most yoga classes, the participants, their minds a plague of thoughts and anxieties, are perhaps anticipating how their recalcitrant bodies will respond to the raw intensity of the postures. Their attention is typically directed outward to the instructor or their neighbor, not inward to the body. So the suggestion that students listen to the body may be perplexing or disappointing, perhaps enticing, or even novel, but it’s not what some of us might typically associate with yoga.

As runners, we’re first attracted to yoga not just for how it can benefit our running, but for the sheer physicality and challenge of the postures. For many their requirements seem daunting, if not impossible, but runners seem innately drawn to formidable obstacles. So we bring that goal-oriented mindset with us as we set out on the path of yoga. But as we begin our journey, Freeman asks us to adjust our natural inclination toward the manifestly physical nature of the practice, and instead of proceeding with the focus and vigor typical of runners, he asks us first to “listen.” True listening requires patience, concentration, and openness, and is decidedly un-physical, but with listening as the guide, the physical practice blossoms. It is then that the body’s story is told to us in its own language, sensation, to which we listen attentively and with enthusiasm as the narrative plays out.

Sensation is a purely present moment experience; it is neither past nor future. But connecting to sensation requires empathy for the body and for ourselves, and implies a willingness to experience our own suffering. So we tune in to the endless stream of sensation flowing past our field of awareness, and follow it from moment to moment. Because the creation of a “present mind” is one of the desired outcomes of yoga, focusing the mind on sensation (and the breath) helps to ensure that the mind is anchored firmly not only in a place (the body), but in time (the present moment). When we connect to sensation we climb inside our body and experience it with total commitment.

Sports psychologist Stan Beecham talks about the significance of this for runners: “Overuse injuries have a lot to do with not paying attention to your body, not being in tune with your body, not being able to trust what your body is telling you. Injury is not a physical event. It’s the mind-body complex working together.”

When Beecham says our lack of attention to the body contributes significantly to injuries, he’s articulating one of the key messages of runner’s yoga, and at the same time shifts much of the responsibility for injuries squarely onto the runner. Rather than being at the mercy of barely understood forces that act indiscriminately on our bodies, Beecham (and Freeman) want us to pay attention to and recognize the significance of what the body is telling us every second, whether we are runners or not. In other words, embrace the body with the mind.

Mark Johnson offers this summation:

“We can think and imagine only through our bodies.”

Photo credit: Greg Herringer photo


Please, have a seat. Comfortable?  Good. Would you like some water? No? Okay, let’s begin. I’d like you to close your eyes; now breathe deeply and allow your mind to drift off to some place warm and happy.    Walmart?  Um . . . sure, why not.  I’m going to say two words, when I say those words I want you to stay calm and relaxed.  Ready?  Plantar Fasciitis.  Wait, don’t get up, where are you going? Come back!

Hmm, you seem a bit sensitive. Maybe you’ve had a bad experience with the PF thing. On the other hand, it’s possible you have no clue what I’m talking about, and if that’s the case then consider yourself lucky. After all, why trouble your mind with negative stuff: ignorance is bliss, baby. That is until you’re mid-way through a build-up for your next half marathon, logging big miles, and your first steps out of bed the morning after a hard run that was maybe a little too hard feel like you’re stepping on broken glass. Then six months on, you’re still dealing with the same &%$# problem, you’re “cross-training” (oh yeah, who doesn’t love pool running???), your racing plans are a smoldering ruin, and you realize that given the option you’d have gladly stepped on broken glass so this nightmare would have ended about the same time they removed the stitches from your foot.

I’m here to offer what help I can, but be forewarned, this article will not present the cure for PF simply because it’s not a condition that favors its victims with specific causes and certain cures. I’ll merely explain what is currently known about its origins, and then offer some therapies that might give succor to the afflicted. So don’t expect a miracle; there’ll be no tossing of crutches, canes or night splints into a bonfire, no spontaneous healings. Sorry. As a yoga teacher I’m biased, naturally, toward “stretching” tissue, because I believe, and the evidence suggests, that poor flexibility has a causative role in PF. But it’s just that, a contributing factor, and not the smoking gun that sufferers are desperately seeking. Anecdotally, reports from my students suffering from PF tell me that stretching has been effective in alleviating symptoms, and some have reported their pain disappears completely.  Hallelujah!  Send your donations to my PayPal account, all major credit cards accepted. 

What is the Plantar Fascia?

It’s a sheet of connective tissue (fascia) that runs along the sole of each foot (the plantar), from the heel to the toes. Like all fascia, the plantar fascia is made of extremely tough and resilient tissue. It is this durability that allows it to absorb and withstand the huge mechanical forces that act on it when we walk, run, or jump. But it’s that same toughness that can make it very challenging to fix when injured.  

One impediment to fast healing is that the fascia, unlike muscle, has limited blood flow. The vital nutrients in blood play a critical role in the health and healing of tissue, and if there isn’t much of it, the process of repair and regeneration won’t happen as quickly.

Yet another problem is that the plantar fascia is in an awkward location. If you’re interested in moving from place to place during the course of your day and you’re not using any type of mechanical conveyance, then you need your feet. So when you stand, walk, or run, the plantar fascia is being stressed, and unless you’re off our feet it won’t get a break. But even resting the plantar fascia can be a problem because it can tighten up, especially during sleep, resulting in those painful first steps every morning.

What is Plantar Fasciitis?

Plantar fasciitis is a degenerative condition of the plantar fascia that causes pain on the bottom of the foot. The plantar fascia usually begins to hurt due to overuse or trauma, and it shows up commonly in runners because they tend to overuse things. The typical locations for PF pain are the heel, just in front of the heel, or the arch. So if you have chronic pain in those places, you probably have PF. But it could be something else, like a heel spur or flat feet.

The pain from PF can range from very debilitating and life altering, to low-grade, annoying and something that its sufferers can live with. It’s common for runners or other athletes with PF to continue with their sport, albeit in a modified fashion.  But as we’ll see, this approach is self-defeating.

Plantar fasciitis has a murky provenance. A good description comes from Lemont et al. (2003): “Plantar fasciitis is widely described . . . as having a multi-factorial and widely disputed etiology.” Translation: many potential causes with little agreement on an actual cause. In an influential 1965 study, “Painful Heel”, Lapidus and Guidotti wrote that “the name ‘Painful Heel’ is used deliberately in preference to any other more precise . . . diagnosis, since the cause . . . remains unknown.” Fast-forward to 2003, Lemont and company commented on the previous quotation from the “Painful Heel” study, writing “Now, 40 years later, this statement can still be considered accurate.” So in the space of nearly four decades, little progress has been made on discovering a cause of PF. The one exception is that now it’s now considered a degenerative condition, not an inflammatory one.  But this just describes the nature of the condition rather than identifying a cause.

What Causes The Pain: Inflammation Or Degeneration? 

Over the last few decades, there’s been a significant shift in the medical-scientific community’s thinking about the nature of overuse injuries in connective tissue (in particular tendons and fascia). According to Khan et al (2000), “Advances in the understanding of tendon pathology indicate that the conditions that have been traditionally labeled as Achilles tendonitis, patellar tendonitis . . . are in fact tendinosis.” Three years later Lemont, writing about plantar fasciitis, presented findings that strongly suggest that PF “is a degenerative fasciosis without inflammation.”

Hmm, tendonitis or tendinosis; fasciosis or fasciitis: what’s the difference other than four letters tacked on to the end?  As it turns out, a great deal. In essence, this discovery has shown that the pain in your plantar fascia is not due to inflammation (signified by the suffix “itis”, Latin for inflammation, stuck to the end of tendon, fascia, etc.), but instead results from degeneration of the tissue (signified by “osis”, short for “necrosis”, or tissue death). In other words the tissue that makes up your plantar fascia is not inflamed, it’s degenerating, or worse, dying.

Our continued misunderstanding of PF results from the persistence of its description as fasciitis, rather than fasciosis. The medical community, either through habit or misunderstanding, continues to refer to it as an inflammatory condition. This is important, because at a minimum the absence of inflammation and the presence of necrosis in tendon and fascia overuse injuries change the treatment protocol for the injury. In the not-too-distant past the thinking was that if you were a runner and you hurt your plantar fascia, then the pain was from inflammation. The treatment for this was familiar to many runners: rest, ice, anti-inflammatory medication, and visits to the physiotherapist, who, among other things, would do stuff to the injured area with strange machines. During my days as a hard-core runner, I ingested fistfuls of anti-inflammatories and spent countless hours icing for a variety of running-related overuse injuries.

We never questioned this approach, or should I say that most people never questioned it. That is of course until someone realized that the accepted thinking on the matter was flawed. Again, Khan et al write that “an increasing body of evidence supports the notion that these overuse tendon conditions do not involve inflammation” and “tendonitis is a rather rare condition.” What researchers have discovered is that inflammatory cells were not present in the injured tissue of tendon or fascia; what they found instead was collagen breakdown, a key indicator for necrosis. You don’t treat tissue degeneration the same way you treat inflammation. Nowadays the accepted treatment for tendinosis or fasciosis includes plenty of icing (so glad that all the time I spent icing my Achilles tendon wasn’t wasted) and the “encouragement of collagen-synthesis,” in other words building the strength of the tissue by developing collagen.

Will this shift in our understanding of connective tissue reduce the recovery time for those with PF? Well, yes and no. First, time won’t be wasted with treatment methods that have little or no effect. On the other hand, the recovery from “osis” is generally much longer than from “itis”, something those of you with PF already know.

When a girl in a bikini promises “to cure your plan-TAR fasciitis in just a few days” as she kicks and punches a heavy bag, my advice is to be a bit skeptical.

Looking For A Cure

The PF I’m currently dealing with was the result of trauma, not overuse. While taking out the trash in my slippers last summer I stepped on a sharp rock directly under my heel. For two months I barely noticed it, and was able to walk and run free of pain. Then in December it suddenly got worse, and it’s been a problem ever since. Why did it happen this way?  I have no idea and my doctors offer only vague explanations. Like most runners with PF I continued to run, thinking that because my case was the result of trauma and not overuse then somehow it would be different. Ah . . . no.  I’ve just completed three weeks of no running and minimal walking and my foot is feeling pretty good. I’ve been maintaining my fitness and strength with indoor cycling and I’ll start back soon with a walk/run program.

After talking with other runners who have PF, most, at least initially, don’t rest. Considering the rather obsessive nature of most runners, this shouldn’t be a surprise. Two recent conversations with students of mine provide examples. Both are avid runners who injured their plantar fasciae and continued to run despite (tolerable) pain. So they kept at it, but not in a way that was enjoyable or that would allow them to train productively. Stopping completely to rest the injury was something they weren’t prepared to do, but it was a necessary step toward resolving the issue. In fact, the refusal-to-accept-reality mindset of most runners with PF is probably the reason that it has a reputation for being persistent, and one of the main reasons it takes so long for it to heal: runners just don’t want to stop running!

Some advice: when PF is diagnosed, stop running. Trust me, it will keep hurting unless you stop, and the longer you continue to run, the longer it will take to heal. The sad fact is that tendonosis takes substantially longer to heal than tendonitis.

In his excellent, in-depth review of the literature on PF, Paul Ingraham provides a synopsis of the most viable treatments.

 

1) Arch support (with inserts or supportive shoes)

2) Calf stretches

3) Plantar fascia stretches

4) Night splints (devices that hold the plantar fascia in a constant stretch, or traction, as you sleep)

5) Icing*

6) Rest

7) Massage

* Icing, popular as an anti-inflammatory, is also effective in treating tendonosis. I now ice my plantar fasciosis frequently and it definitely helps.

 

Note that of Ingraham’s seven recommendations, three involve stretching tissue, either the plantar fascia itself or the calf (really all the muscles on the back of the lower leg). Also, #3 and #4 are essentially the same: while #4 uses a device to hold the foot dorsi-flexed for a prolonged time, usually overnight, #3 would be short duration yoga-type stretching.

In my yoga classes and workshops, I teach specific postures that create a deep stretch on the front and back of the lower leg, and the top and bottom of the foot. While in Virasana (see photo), students plantar-flex (point toes and feet) and dorsi-flex (curl toes under) their feet. The structures most affected by this routine are the calf, soleus, Achilles tendon, and posterior tibialis on the back of the lower leg; the anterior tibialis on the front of the lower leg; the plantar fascia on the bottom of the foot; and the peroneals on the lateral side of the lower leg.

To those of you suffering from PF, I can only say good luck and don’t give up hope. Investigate your options, do the work, and be optimistic. The vast majority of those afflicted are completely cured or a have a substantial reduction in their symptoms.  If you are proactive, diligent, and patient, you’ll be part of that majority.

When examining the architecture of the foot we see that it is, in fact, a tripod. The three “feet” that make up the tripod are the heel bone (calcaneus), the head of the first metatarsal (the big toe mound), and the head of the fifth metatarsal (the little toe mound). Connecting each of the three feet are three myofascial slings, or arches. These are the medial longitudinal arch that runs along the medial side of the foot; the lateral longitudinal arch that runs along the lateral side of the foot; and the transverse arch that spans the foot from the head of the first metatarsal to the head of the fifth metatarsal. When the three feet of the tripod bear weight equally, then the foot is in a stable position. If one of the feet is not bearing load our nervous system will sense instability and turn off or inhibit some of the muscles responsible for whichever action we’re trying to produce.

Plantar sensory feedback, primarily from the proprioceptors, plays a central role in safe and effective locomotion and in stabilizing the stationary body. When we are upright and supported by our feet the nervous system measures the fluctuation of pressure from receptors on the sole of the foot. From that proprioceptive feedback, we unconsciously put our body in the right place, balanced over that foot. When the body responds properly to feedback from the feet, the positive response feedback turns on, and in turn it switches on the anti-gravity muscles of the leg.

The problem is that many runners have lost connection with their feet. Most runners have either non-responsive, floppy feet, or they have functionally rigid feet, which is the complete opposite of the listening foot. This is a foot that hangs on like grim death by grabbing the floor, trying to maintain some semblance of equilibrium or balance so the body doesn’t topple. Suddenly, all of the athlete’s control and tension is from the knee down. This is a common sight in yoga classes: when stability is tested, as with a balancing posture for example, the student’s toes curl under and grip the floor, the foot shrinks, and the muscles of the lower leg twitch and quiver in an attempt to stabilize the body. So if the practitioner lacks balance, stability, or control, peripheral tension is created and the listening foot is doing anything but listening. Now it’s not able to relay high quality proprioceptive information, which is essential to the body’s ability to orientate itself in space and maintain equilibrium.

What we want is for the information from our feet to flow freely and orient our body with perfect alignment, balance, and control. So if the emotional, neuromuscular, and cognitive connection with our feet is dysfunctional, this will be reflected in the quality of the sensory information flowing through the body, with predictable consequences. Yoga is a method of integration that requires the practitioner to bring awareness to all regions of the body, without regard to how challenging that process may be.

Whenever I think of ankles, I think of Misery.  It was 1990, and the movie based on Stephen King’s novel Misery had just been released. It starred James Caan as an acclaimed novelist and Kathy Bates as a nurse who cares for him after he is seriously injured in a car crash near her isolated, snowbound house.

As the bedridden Caan recuperates in her house, he (along with the audience) begins to realize that Bates is kind of . . . um . . . off.  Well, not just kind of off, very off. Despite the fact that Bates’s nurse character is a huge fan of Caan’s writer character, she takes issue with the plot line in his new novel, and, well, at that point things pretty much go south for Caan. Sensing that something is amiss with Bates, he uses her absence from the house to leave his sick bed and roam the house in a wheelchair, plotting an escape. Oops, bad move. Bates returns, cottons on to his unauthorized wandering, and decides a preventative measure is warranted to ensure this behavior is not repeated. So she does what any demented caregiver would do: with Caan now tied to the bed, she grabs a sledgehammer and breaks his ankles. Yes, both ankles . . . with a sledgehammer. Need I emphasize that these are not light taps she administers, but a full wind-up?  I think you get the picture.

There’s little doubt that in the annals of movie sadism Bates’s “hobbling” of Caan ranks near the top of any list of non-gratuitous, ghastly acts. As to the audience’s reaction, 23 years has done little to diminish the freshness of my memory of that moment. The collective gasp, muffled screams, and “oh my Gods” still ring clearly today.

But as macabre a story as Misery was, I like to think of Nurse Bates less as a destroying angel and more as a symbol of what awaits runners if they lose the range of motion (ROM) in their ankles. The demon image of Bates looming over us haunts our sleep like a perpetual nightmare. There she stands, smiling grotesquely, sledgehammer slung over her shoulder, preparing to dispense her own brand of therapy as you lie tied to your bed, mouth open but unable to scream.

When we consider the ankle joint, we see that an important requirement for its proper functioning is a high degree of mobility in the sagittal (forward and back) plane. This mobility is demonstrated by the ability to dorsi-flex (bring the top of the foot, or dorsum, closer to the shin bone, or tibia) and plantar-flex (point the foot and toes) the foot. With the bare foot flat on the floor and the heel grounded, we should be able to move the knee forward over the toes, reducing the 90-degree angle between the tibia and foot by at least 20 degrees. But runners with poor ankle mobility can barely dorsi-flex their foot/ankle, almost as if the shinbone and top of the foot are frozen into a right angle.

Unless it’s the ankle itself that’s been injured, it’s usually starved for attention. Unlike the knee, with its diva-like needs and neuroses, and the depressive foot, with its fallen arches and calloused skin, the ankle tends to linger in obscurity, unloved and easily overlooked as we rush our attention back and forth between the knee and the foot.  Part of the problem is that most runners are clueless as to the true source of their pain and dysfunction. This is because pain can be a terrible liar, and has a way of manifesting where the real problem isn’t. The compensatory tricks the body employs to move around the ankle’s limited mobility are devilishly effective, but the results of that compensation are pernicious.

This is because the body plays a kind of zero-sum game, and at some point the ankle will reclaim its lost range of motion from elsewhere in the body. When we walk or run with tight ankles the body searches for the lost mobility by initiating a series of compensatory actions, and this is where the problems really begin. What’s so perplexing is that runners won’t necessarily feel this limited mobility. Instead, they’ll experience the effects of the compensations: collapsed arches, bunions or hyper-pronation in the feet, anterior knee pain, various problems in the hips, or low back pain.  

There are several ways mobility in the ankle joint can be compromised. The first is as a result of injury. If the ankle has been sprained or broken, scar tissue or impingements can impair its ability to move freely, reducing range of motion.

Ankle mobility can also be reduced if the tissue in the back of the lower leg is tight. The structures that can become very short and tight, thereby reducing mobility, include the Achilles tendon, gastrocnemius (calf), soleus, and posterior tibialis.

Finally, choice of footwear can affect the ankle’s ROM. Our favorite sport (or sports) may require footwear that allows the ankle little or no movement. Downhill ski boots, hockey skates, and high-top basketball sneakers are examples of footwear that can limit ankle mobility. Also, habitually wearing shoes with high or stacked heels will shorten the tissue in the back of the lower leg, limiting dorsi-flexion.

That I stress the importance of ankle mobility in my runner’s yoga classes and workshops shouldn’t be a surprise. In class, people with tight ankles are easy to spot. As they sit in any posture that requires substantial plantar flexion of the foot (Virasana, for example: see photo), they’re the ones who have difficulty keeping their ankles and feet straight. One of the body’s tricks is that it will try to move around areas of stiffness, so if the ankles are tight they will crescent outwards to avoid the restriction and find room to move. When I see “bowed” ankles, I reposition them to be sure they’re straight. This way they’re moving into the stiffness and not around it.

MIke Dennison 

Weird looking dude in Supported Virasana (Hero) pose, with feet and ankles plantar-flexed

Outside of yoga class, another tight ankle “tell” is a bouncy stride. As we run, the main direction of movement should be forward, with slight up and down motion. But the runner with ankle mobility issues avoids the restriction by lifting their heel of the ground prematurely at the end of the stance phase. This action sends them “up” instead of forward, wasting substantial energy and shifting the mobility emphasis from the ankle to the forefoot. The calves and other posterior structures of the lower leg are now being used to push them through the gait cycle. Runners with this type of gait pattern are referred to as “quad dominant”, because rather than using the powerful gluteus maximus (buttock) muscles, they extend through the quads and calves. 

If there’s any lesson to be learned from Misery, it’s to keep your ankles mobile and avoid the problems that poor ROM creates. For added incentive, rent the movie. Think of it as Nurse Bates making a house call.

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If you laughed yourself sick when you read this, then you’ll get sick again if you miss my intensives in Halifax and Vancouver.  Check the schedule and sign up soon!

This cautionary tale, dear reader, is shocking but true. I ask only that you gather your loved ones and hold them close as you read my anguished words. And after, as you dab at wet eyes, you will nod with agreement that it would be impossible for all but the most depraved mind to fabricate such a frightful event. This sad case involves one dearer to me than any other, a person of such character and standing that . . . ah, what is the use of this charade, for I am the hapless victim. For me to claim that this episode was an impulsive escapade springing from youthful folly would be nothing but a bald lie. Because, as you well know, I am firmly ensconced in mid-life, even though I regularly feign an adolescent energy by singing along with Lady Gaga and driving like Justin Bieber.

But enough of this; on to my story . . .

One glorious summer day a few years back, I was headed to Vancouver’s North Shore to run the trails and slopes around Grouse Mountain, Mecca for local trail runners. I avoided the mob of Lulufied awesomeness on the Grouse Grind and instead headed east along the Baden-Powell trail, eventually running up the rather cruel “Cut” ski slope to the top of the mountain. But once there, I saw that hordes of tourists and “Grinders” had created a long wait for the gondola ride to the bottom of the mountain. I decided to run down.

So down and down I went, retracing my path up. Arriving back at the parking lot my legs were tired and sore, but nothing I hadn’t experienced before. The next morning, however, I awoke to something quite peculiar: as I rolled out of bed and took to my feet, my legs, painful and tender, nearly buckled as they tried to support me. Alarmed by this feebleness I returned to my bed, where a thousand bleak scenarios ricocheted around my mind. I was gripped by the kind of dread one feels when they realize their body is under attack by those ghastly, multi-word afflictions that, seemingly overnight, ambush the hale and hearty. In my mind’s eye a dark future beckoned, and all that was visible down life’s narrow and ever-shortening corridor was a wasteland of respirators, 24-hour care, and specialists who shake their heads grimly as they speak in whispers to everyone but you.

But after several minutes my rational mind elbowed its way back and the hysteria abated. It was then that I recalled the previous day’s misadventure and realized, blessedly, that my present condition was not going to be one of those things. What this was, in comparison, was really quite prosaic: it was my introduction, rather my re-introduction, to the world of eccentric muscle contractions and delayed onset muscle soreness, a painful world that all athletes, runners in particular, inhabit. I’ve been a visitor to this place many times in the past, as no doubt have you, but it’s always jarring to return and have our bodies remind us, in their own way, that none of us are exempt from the sometimes harsh rules of physiology and bio-mechanics.

We certainly don’t need to run down a mountain, throw a javelin, or fast-pitch a softball to discover eccentric contractions. They occur routinely in everyone, athlete or not. But because of the demands that athletes place on their bodies, eccentric contractions can be more frequent and intense, and their after-effects far more debilitating. So what are eccentric muscle contractions and what can be done, if anything, to lessen their after-effects?

Acting on orders from the nervous system, the body uses three types of skeletal muscle contraction to achieve its goals: isometric, concentric, eccentric. The concentric contraction, where the muscle shortens or contracts, is how we typically think our muscles work all the time, but this is not the case. Have a look . . .

Isometric: muscle does not change length as it fires
Concentric: muscle shortens as it fires
Eccentric: muscle lengthens as it fires

To wrap your minds around this it might be helpful to think of muscles functioning much like the gas pedal and brakes on a car. The concentric contraction (muscle shortens) is like stepping on the gas pedal; it creates force to move or accelerate the musculoskeletal system. The eccentric contraction (muscle lengthens) does the opposite: it acts as a brake to slow and stabilize the body and store elastic energy. Remember, the essence of an eccentric contraction is that the muscle lengthens as it fires. And, as Shakespeare wrote, there’s the rub . . . or in our case, the pain.

The problem is that the biomechanical process at the heart of an eccentric contraction is quite violent. Enormous negative, or oppositional, forces are applied to the working muscles to slow (or brake) them, causing them to pull apart with every stride. There is substantial evidence that eccentric contractions cause damage to the muscle, which is why they increase the risk of muscle and tendon injuries and inflammation, and cause pain for the athlete who hasn’t specifically prepared for them.

The “day after” pain we feel is called delayed onset muscle soreness, or DOMS. The symptoms of DOMS can range from muscle tenderness to intense, debilitating pain that peaks 24 to 48 hours after the exercise and usually subsides within 96 hours. DOMS is common after a race or when runners initiate new, unfamiliar types of training, or even when re-introducing specific training that our muscles have “forgotten.” This could include faster interval or speed training, long runs, and yes, even downhill running. All can be painful if done for the first time or for the first time in a while.

To add insult to injury, the pain from DOMS is also accompanied by an acute loss of strength that can continue for several days after the exercise, even outlasting the soreness from DOMS. This loss of strength is substantially greater than that found in other types of muscle contractions and takes longer to recuperate from.

A side note: For those who hope to run the Boston Marathon someday, prepare well. Boston’s insidious nature reveals itself in the first 4 miles, during which the course loses about 310 feet of elevation; by 16 miles, the course loses another 120 feet, for a total to that point of 430 feet. “So what’s wrong with that?” you may ask. Well, maybe nothing, or possibly a great deal. Because of the strength-sapping nature of eccentric contractions, runners whose legs are not “calloused” for downhill running can feel substantially weakened by the time they reach the Newton hills, beginning at about 16 miles, and the notorious Heartbreak Hill at roughly 20 miles. Their legs, feeling wobbly due to the substantial downhill running in the first half of the course, not to mention the exhaustion of running that far, can often feel exceedingly fatigued in the race’s later stages, much more than on a flatter course.

But fear not, a solution is at hand. Researchers have shown that “muscle damage need not be an obligatory response following high-force eccentric contractions” (LaStayo et al). In other words, if we prepare the body for eccentric work, we can do a great deal to substantially diminish or eliminate their nasty side effects. Even better, “inoculation” to eccentric contractions occurs rapidly.

The irony is that the original cause of the damage and pain is what we use to inoculate against further pain and suffering. This is no different than getting a flu shot, where a watered-down version of the virus itself is used to build an immunity to the specific strain of flu. We introduce the “new,” more specific eccentric work, whether it’s faster interval training, downhill running, or long runs, and build immunity by applying the eccentric stimulus progressively and repeatedly. The protective adaptation occurs quickly, with the effects being felt within 24 to 48 hours of the initial exposure to the damaging eccentric bout (Lindstedt et al).

What’s important to remember is that it doesn’t matter how long you’ve been running or how much experience you have, if you’re new to a specific type of training, or you haven’t done that type of training in a while, progress slowly. If you’re training for a hilly trail race, don’t run down the side of a mountain the first time out.

Armed with this information, we can train with a better understanding of why running hurts, and what we need to do to reduce the effect eccentric contractions have on our body.


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