Benefits of injury

Back in high school we had cross country camp at Boyne Mountain, up in the northern part of Michigan.  Now Michigan isn't known for it's mountain ranges, especially the in lower peninsula.  The highest peak in Michigan is Mount Avron, which belongs to the Huron Mountain range that overlooks Lake Superior at 603m or 1,979 feet above sea level.  Boyne's highest peak reaches 1,120 feet.  I don't believe our cross country camp used that specific peak but the fact still stands that my first experience running in what I thought were "mountains" were really just rolling hills when considering the highest point in the Leadville 100 miler is over 12,000 feet.  The elevation in this story isn't necessarily important other than the fact that this is where my first running injury occurred, my junior year of high school.   While charging up the "mountain" during some hill repeats, I felt a pain near my buttocks area and boom, I wasn't able to run for the remaining four days of camp and was stuck to riding bikes behind my friends who were getting in shape for the season.   
After getting back home we scheduled an appointment with the sports medicine doctor at our local clinic and I was told to "rest for two weeks and you're good to go."  Awesome.  To a 16 year old kid who is excited about his first cross country meet, two weeks of rest sounds perfect. Rest up for a few weeks and then use all the energy I saved up for my first meet.  Little did I know what a dumb, dumb I really was.  In the first race of my career had to pull out a mile in from 1) the pain in my right hip was still there, just as severe as it had been at cross country camp, and 2) I wouldn't have been able to finish the race because who would have thought two weeks of no running would make me bad at running?  
Lots of people don't know that this story was the major reason I am in the field of human health and performance.  The interaction with the sports doctor, who basically told me to do one of the biggest no no's in today's rehabilitation world, "rest", had such a profound impact on me that my healthcare paradigm was in part formed there.  When it comes to rehabilitating an injury to the musculoskeletal system rest is rarely the answer.  The doctor recommended something that encourages deconditioning, catastrophizing, pain avoidance behavior, and an increased risk of future injury.  He should have taught me how to modify activity, not avoid it completely.  I realize now that my frustration wasn't with the doctor himself, he was just following standard protocol.  My frustration was with the model of healthcare that encourages rest and medication until surgery is the option, instead of encouraging active rehabilitation as early as tolerable.  This doctor did no functional evaluation, no muscle testing, no recommendations on how to prevent future injury, no recommendations on how to condition the area.  Nothing.  "Rest up and in two weeks you're good to go." 
The hip injury, which to this day I'm still ignorant as to what the diagnosis was, my guess was a simple strain one of my gluteal muscles but that is pure speculation. Together with the early hip injury and all the other bumps and bruises I naturally endured during my years of running led me to where I am today, obsessed with human movement and biomechanics, the biomechanics of gait specifically.  I took a few years off running between my freshman year of college and early into my junior year of college.  After my mother told me I looked like I'm gaining weight (I still remember, mother), I decided it's time to get back into it.  Funny enough, it was myself who looked in the mirror and said "you look like you're gaining weight" that pushed me to start treating my body better last fall.  Anyway, when I decided I was going to start exercising again, I had just started my education in the world of exercise science and biomechanics, and was introduced to the concept of "barefoot or minimalist" running and was determined to focus on stability and efficient movement for the rest of my fitness career. 
Minimalist running can mean a lot of things, from not wearing any electronics while running to running naked (there is a race for anyone).  To me, minimalist running means using the least amount of external support that you need to accomplish the task of running.  This can mean taking the watch off so you are more in tune with your body as opposed to focusing on the seconds and miles slowly pass by.  This can be taking the ear buds out, taking the shirt off, or living in a tiny house.  But it can also mean having your feet do the job they were designed to do after the millions of years of evolution of our species.  Homo Sapien's evolved to bipedality without the external support of a shoe, the firm arches that supprt the medial longitudinal arch.  These are things that are very, very new to humans considering that bipedality is thought to have been introduced to some of homo sapien's ancestors over 7 million years ago.  
Our bodies didn't evolve with supportive and motion restricting shoes that control the amount of pronation (hint: pronation is a good thing and is a useful mechanism in absorbing forces during gait), or encouraging heel striking with extra soft and cushy pillows under the calcaneus.  No, our biomechanical system evolved to support itself with a wonderfully complex interaction of the nervous and musculoskeletal systems.  And it does this with incredible efficiency and energy conservation if done with a little conscious effort.  Our ancestors needed to utilize the least amount of energy we had now because we didn't know when our next meal would be and we might need to use that energy later.  Our ancestors before the agricultural revolution, around 10,000 BC, were hunter gatherers, and had to work a lot harder to catch their food compared to todays humans who have never had food more accessible. A good portion of the time our ancestors had to run down animals by foot, and this wasn't done by a deconditioned, malfunctioning, inefficient body.  They needed to be incredibly fit to do that job.  Not only fit and to have incredible strength and endurance, but their body had to be incredibly efficient from a biochemical and biomechanical perspective, conserving as much energy as possible.  
This means they probably weren't heel striking, as heel striking creates a breaking mechanism with every stride sending shock waves up the ankle, to the knee, to the hip, and up the spine with every. single. stride.  decreasing efficiency and wasting valuable energy.  It's no wonder some people think running is bad for your joints.  The amount of forces absorbed along the biomechanical chain are much higher in runners who heel strike are much higher compared to those who are more inclined to forefoot/midfoot strike.  That means the foot, ankle, knee, and hip are all taking a greater pounding compared to someone who is more forefoot/midfoot strike.  And the more fat mass you have?  Good luck.  The more excess weight you carry the more your joints will feel it.  Those who are both overweight AND overstride, odds are you will eventually be a candidate for knee, hip, or low back pain.  
This doesn't mean the solution is to immediately change your stride to a forefoot/midfoot strike, which is almost as bad of advice as it would be to encourage heel striking and over striding.  The research shows that runners in general are bound to have some bumps and bruises no matter the form you run, like any physical activity there are associated risks.  Changing running form from heel striking to more of a natural stride will move the risks of injury from the knee and hip to more of the bony structures of the foot, the plantar fascia, the achilles tendon,  and a few other areas, but those are the common complaints.  These risks, however, can be addressed by what is done in the in the training program, (cough, cough, in the gym) by strengthening the neuromuscular complex used during the gait cycle.  Taking advantage of what is called the Stretch Shortening Cycle (SSC),  we can strengthen the mechanism we use during every step of gait.  
The stretch shortening cycle is a reflexive contraction of a skeletal muscle in response to a quick lengthening of the musculotendinous unit.  Your nervous system monitors the length and tension of your muscles and has ingrained reflexes that serve to protect the body.  This reflex is seen with stretching of the achilles tendon while the heel is being lowered to the ground during a more of a natural stride.  As the ankle joint goes from more of a plantar-flexed position into dorsiflexion during the gait cycle, the achilles is stretched.  When it is stretched to a point, the nervous system will tell the gastrocnemius muscle to contract, which, with other muscles of course, plays a roll in the plantar flexion of the foot during the push off phase of gait.  When we don't use this mechanism, its efficiency and effectiveness decreases.  The worse the condition of this mechanism, whether it be neurologically or muscularly (in reality its hard to separate the two), the more the passive tissues (the achilles tendon and plantar fascia) will absorb forces and therefor putting runners at the riskf for injuries such as achilles tendonitis and plantar fasciitis.  This SSC can be trained with the intelligent use of plyometric exercises such as jump rope, quick jumping exercises, more advanced exercises such as single leg jumps, depth jumps or many other movements that can mimic the SSC in the ankle joint.  
Other areas that are common complaints for those who are transitioning from a heel strike to a natural stride are stress fractures in the metarsals.  This is another relatively common complaints runners will present with, as the feet are the structures that absorb much of the force during running.  Many opponents of changing the running stride will cite the increase in rates of stress fractures amongst those who have more of a forefoot strike compared to the cushier heel strike.  The increase in rates may be seen, but how many of these runners read the book "Born to Run" and got a newfound sense of endurance, put on some Vibrams and went to pound the pavement for a few miles.  During the initial minimalist boom, many running shoe companies put out their minimalist line and people bought them up and immediately thought they were the Tarahumara.  In reality these people likely didn't take the time to properly transition to a different stride, which is essentially changing the way you've been something you've done thousands of times per day for the majority of your life, and that  likely played a role in the development of injury.  With activity, the risk of injury increases.  You're at a higher risk for rolling your ankle while running in the woods vs sitting on your computer reading this.  These injuries commonly present in areas weak in the biomechanical chain and these areas tend to be where greater forces are absorbed.  People's who feet have acclimated to the cushy home of the shoe (ie anyone who wears shoes) don't have the bone density of those who walk around barefoot, therefor demanding less of the foot/ankle complex.  According to Wolfs Law, the bone will adapt to the load under which it is applied, meaning if you stress bone, it will increase in density in response to better handle the load the subsequent time its applied.  If you aren't stressing a structure, it will adapt to that stimulus (or lack thereof) and decrease its strength (in this case bone mineral density).  The guy who made this law died in the early 20th century.   This information isn't new and it's about time we utilized it in the running world.  The lesson: take the freakin' shoes off and challenge the feet.  Every other aspect of your body gets stronger and more efficient when you train it, why not train your feet?
This does not mean to kick the shoes and go run a few miles in your bare feet.  No.  You'll be injured within a week.  Changing form isn't for everyone and there are plenty of competitive and successful runners who are heel strikers.  If you are a runner who is a historical heel striker, yet you have been relatively healthy and successful, then a transition might not be for you.  Why fix something that is not broken?  But if you're someone who always seems to be hurt, whether in your foot, knee, hip, low back, etc., or have seemed to plateau in your performance you may want to consider changing something.  Making the transition in the proper way, and I'm here to tell you the proper way takes months if not years, could be what you need to make the change you want to see or to kick that nagging pain you've had for a while.  There are plenty of ways to improve the efficiency and performance of running and it all doesn't happen by running.  Starting slow by gradual exposure to barefoot running with graded increases of demand put on the foot/ankle complex over an extended period of time will allow the body to adapt to its stimulus, slowly but effectively.  Spending time in the gym is just as important, as you can't replace the benefits of weight training when it comes to increasing bone mineral density in the lower extremities and nervous input to joints.  Weight training also plays a role in increasing the mechanics and running of running, especially when programs are modeled specifically for runners.  You are malleable.  You are adaptive.  If approached the right way your body will respond and be better prepared for the risks associated with running and other forms of physical activity.  

Lesson learned:  The benefit of an injury is it will commonly highlight a weakness in your biomechanical chain.  My early injury turned out to be one of my greatest blessings as it put me on the path to where I am now.  

Here are some books and articles for further reading on biomechanics and gait


Books:

1) Michaud, T. C. (2012). Human locomotion. New York: Thomas Michaud.
2)  Haff, Greg, and N. Travis Triplett. Essentials of Strength Training and Conditioning. Champaign, IL: Human Kinetics, 2016.
3) McDougall, Christopher. Born to Run: A Hidden Tribe, Superathletes, and the Greatest Race the World Has Never Seen. New York: Alfred A. Knopf, 2016.
4) Page, Phillip, Clare C. Frank, Robert Lardner, and Vladimír Janda. Assessment and Treatment of Muscle Imbalance: The Janda Approach. Champaign: Human Kinetics, 2010.

Journal Articles:

1) Daoud, A. I., Geissler, G. J., Wang, F., Saretsky, J., Daoud, Y. A., & Lieberman, D. E. (2012). Foot Strike and Injury Rates in Endurance Runners. Medicine & Science in Sports & Exercise, 44(7), 1325-1334. doi:10.1249/mss.0b013e3182465115
2) Ache-Dias, Jonathan, Juliano Dal Pupo, Rodolfo A. Dellagrana, Anderson S. Teixeira, Luis Mochizuki, and Antônio R. P. Moro. "Effect of Jump Interval Training on Kinematics of the Lower Limbs and Running Economy." Journal of Strength and Conditioning Research, 2017, 1. doi:10.1519/jsc.0000000000002332.
3) Grier, Tyson L., Michelle Canham-Chervak, Morgan K. Anderson, Timothy T. Bushman, and Bruce H. Jones. "Effects of Physical Training and Fitness on Running Injuries in Physically Active Young Men." Journal of Strength and Conditioning Research31, no. 1 (2017): 207-16. doi:10.1519/jsc.0000000000001487.

Waking up the legs from the long slumber

The Roman poet, Sextus Propertius, wrote "Always toward absent lovers love's tide stronger flows".  It's been a long time since I have dedicated any time to endurance training.  Between four years of chiropractic school and changing my fitness goals towards more of a strength and power oriented program, my fitness has shifted from a strong aerobic foundation into a more rounded training program to form a more functional body.  Tempo runs turned into squats and the mid-week runs were supplanted by push/pull days.  I've seen myself gain nearly 15-20 pounds of weight (some good, some bad) since I last trained for anything endurance and last week those lbs weighed me down as I sloughed through 15 miles of painful and gasping running with a good friend of mine who is making the transition from strength/power training to putting the miles in to eventually run an ultra. 

The point of this post is to hold me accountable and lay out some goals/visions for the next two years.  The first part of making a physical change is putting what is to be changed in front of you so you know what you are about to tackle.  

Fitness Goals:

1) Complete a 100 mile ultra marathon by the time I'm 30 (September 1st, 2020.  Holy crap I'm old)
2) PR in every distance from the 5k to the ultra along the way (long shot but what the heck)
3) Continue to improve my strength in the core lifts of bench press, squat, and deads (bucking the trend that you can't do both)

One of the visions of this blog is to provide interesting content in the world of endurance training, strength, and conditioning.  These next two years will involve my training journey from zero to 100, breakdown of research articles from the fitness world, and hopefully even some content that provides educational value to anyone interested in biomechanics, fitness, running, and strength training.  Another goal is to show the incredible change the human body can undergo within a two year span.  I've lost a lot of fitness in the past two years and it's going to be a very difficult challenge to regain what was lost.  But I firmly believe that the journey from zero to 100 will be more rewarding than any fitness challenge I've undertaken. 

 Sextus proved to be a bright one, although I don't believe he was talking about endurance sport in his original quote.  He knew if you love something enough its absence only makes that love burn stronger.  After only 15 miles last week the fire that burns deep in every runner was lit and it ignited the desire for another endurance check mark of my bucket list.