A PT talks about alignment (was: Things to consider when starting BFR)

orlyg1521

Barefooters
Apr 24, 2011
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(Moderator's note: this thread has gotten all off track. If you just want to talk about starting BFR, find or start a different thread. If you want to actually talk about the OP's proposal concerning "alignment" and such, stay here. Thanks -- stomper.)



It has been interesting to me (being new to the minimalist/barefoot running craze and being a PT) that in every website I have found, the advice has been to start slow and wean into running "barefoot". Good advice for many people taking on this endeavor.

I believe that one thing that should be addressed is a person's skeletal alignment and muscular balance. Starting slow is excellent advice but to HOPE that a person's body will adjust is a gamble. So many of the described injury issues I am reading can be attributed to misalignment of the hips or ,as your example shows, an upper body issue.

The most common issues linked to hip misalignment are: plantar fasciitis, achilles tendonitis, patellar tendonitis, IT band syndrome, hip flexor tendonitis. The issue starts with our society's general lack of activity and most of our time spent sitting (either work/school/video games). 40 hours or more of sitting versus 20 minutes x 3-4/week, which do you think wins? And consider that many people started running for health reasons after years of mostly being sitting/relatively inactive. Also consider how much the majority of people spend time working on flexibility countering the negative effects of "the chair".

The human body has an amazing ability to adapt to the demand placed in it. If "The Chair" is what our bodies are exposed to for years and years for hours upon hours then it will adapt to the chair position. The result is shortened or tight hip flexors, tight hamstrings, external rotation of the hips and ,depending on the type of work, rounded shoulders with a forward head. Unless the "char" is addressed and taken out of the body it (the body) will compensate for the issues I described. This leads to stress in structures in ways that are not natural. Like a car that is out of alignment, the signs are subltle and get worse with increased demand. Tendonitis , where ever is might be felt, is a sign that something is not aligned/functioning properly. The question is what is the cause not just treating the symptom.

Tight hip flexors prevent the hip from extending leading to stress in the low back. External rotaion of the hips can lead to landing too much on the outside of the heel/foot and loading onto the outer knee and loading onto the IT band. Inversely an internally rotated hip leads to loading onto the inside of the foot/ arch (plantar fasciitis), loading onto the inside of the knee.

These issues can be addressed through progressive and directed exercise routines. This along with a gradual weaning into minimal/barefoot running can decrease the amount of injury being seen "Due to barefoot running" as many nay sayers are quick to point out in their efforts to discredit the natural way we were meant to ambulate.

More later on the effects of modern footware and the upper body connection

Orlando Gomez PT

www.adapttraining.com
 
You would think. My PT spent

You would think. ;)

My PT spent a lot of time looking at alignment when I was having issues with my shins, back and knees. She was also vehemently opposed to my wearing orthotics and my Doc demanded she make me a pair. Another PT I worked with had me do all workouts in the gym with him Barefoot so the muscles could do the work and not the shoes. That was in 2007 and when I started shedding the shoes and bought my first pair of VFF's.

If you have information about adjusting alignment, that might me valuable to many. I had some hip issues and she tought me some adjustment techniques to align before running, frankly, I didn't keep up with them after 6 months and forgot which side to do them on. Once, when evaluated by a trainer, he said that I had some alignment issues that became apparent when I did squats, my feet turned out. He said he could correct that it I signed up for the $400 / month plan :O

Go figure
 
I'm sure I have a lot of

I'm sure I have a lot of alignment issues, which is probably why I do better running barefoot than running in shoes. If I had better structural alignment, I would probably be able to run better in shoes than I do.

I don't think barefoot running is a cure-all, but I think it does help some when alignment and form aren't perfect.
 
I will definitely hit this

I will definitely hit this thread up for some input after my chiropractor appointment on thursday. Not sure if the guy is any good, but he was offering initial consultation sessions for only $35 at the end of my race sunday. I have known for a while my alignment is screwed up and figured might as well check it out.



He did a quick assessment at the race site (he had a frame with strings to check out your symmetry) and apparently there is a 10 lb differential in the force supported by each foot. I also had a raised right hip (think that leg is longer) and a raised left shoulder - it seems that those two wouldnt go together without some major scoliosis but I don't think that is a problem. He also said my spine was lacking the natural curvature...
 
Okay, Orly, you wanted some

Okay, Orly, you wanted some discussion, here is some. You have presented your ideas in a relatively formal way, so I'll respond in kind.

I think you have an important thing to say, but I also think much of your statement relies on overloaded premises.

I note your post presents a solution (directed, progressive exercise routines to improve alighnment, to supplement gradual weaning into minimal/barefoot running) before it comes out and states the practical problem that requires fixing ...

orlyg1521 said:
This... can decrease the amount of injury being seen "Due to barefoot running" ...

You are referring to a problem that may not exist. The scientific literature doesn't describe ANY level of injury (high or low) "due to barefoot running." It hasn't been studied beyond the level of anecdote.

Of course more people are trying barefoot running these days, so more injuries will be observed among certain medical practictioners (perhaps these are the anecdotes you refer to), but that doesn't indicate anything about the rate of injury associated with the activity, which is what all of us are really interested in.

Now I understand you are saying that these "barefoot running injuries" (which, caveat, may not exist) are really due to "misalignment of hips" or "an upper body issue." But the way you state things makes me wonder about the difference between logic and faith.

orlyg1521 said:
So many of the described injury issues I am reading can be attributed to misalignment of the hips or ,as your example shows, an upper body issue. ... The most common issues linked to hip misalignment are: plantar fasciitis, achilles tendonitis, patellar tendonitis, IT band syndrome, hip flexor tendonitis...

If you are really saying that MORE OR LESS EVERYTHING can be treated by improving "skeletal alignment" or restoring "muscular balance" or treating "an upper body issue" then you are simply stating an article of faith, since all these terms sound like general concepts whose meanings might change from one patient or practictioner to the next. Such vague terms lead to nonscientific arguments since they prevent the possibility for alternative explanations.

All that being said, I do agree that it is rather incredible how little people in our society tend use their body's capabilities. The body can do amazing things and most people never get close. If people are experiencing discomfort and injury at an activity, perhaps it is because their bodies are simply not accustomed to doing anything. At all.

I guess the question is how to help people express those capabilites and feel more comfortable. My personal nonscientific observation has been that people need a challenge to help wake them up and become more aware of what's possible. Of course a PT provides that, in a formal way. But I also suspect that any kind of challenge involving both muscles and balance and thinking (martial arts and yoga are obvious ones, but there's also carpentry, drumming, barefoot running, ballroom dancing, and so on) will do a lot.

It would be interesting to know (for unfit people without really dire problems) if a formal program of PT works better than some less "medical" activity. Is there any formal literature on that?
 
Oops, perhaps what I wrote

Oops, perhaps what I wrote above can be disregarded. I responded earnestly to orlyg, but he has posted the exact same text several other times on this site. So it's probably spam from someone trying to sell their services. Guess I'm just a sucker.
 
stomper wrote:Oops, perhaps

stomper said:
Oops, perhaps what I wrote above can be disregarded. I responded earnestly to orlyg, but he has posted the exact same text several other times on this site. So it's probably spam from someone trying to sell their services. Guess I'm just a sucker.
You know barefoot running has become popular when the spammers show up.
 
Orlyg is not a spammer. 

Orlyg is not a spammer. After reading that a couple of people thought he was spamming the site after his initial postings of the same text to a few different threads, he wrote to me (a few days ago) and apologized and asked if it would be more appropriate to start this separate thread instead. I told him that was just fine.
 
I just want to

I just want to add...
orlyg1521 wrote:
This... can decrease the amount of injury being seen "Due to barefoot running" ...



Let's make sure we are actually talking about people who run b a r e f o o t and not in something like VFFs and calling it barefoot when it's not. The problem we are finding over and over again is that people who are getting injured while running in minimalist footwear end up telling their doctor they were running barefoot when in fact they were running with something on their feet, something in which even being minimal can throw off their biomechanics and cause them some sort of injury or lead them to believe they can run as far and as fast as they could when they were running in traditional boat anchors. Barefoot running gets the bad rap, and it's got to stop!
 
Stomper, Just came in to

Stomper,



Just came in to take a look at what might have transpired. I am excited to have some responses. A bit late to reply to your first reply, I will in the next few days.

As far as your snippy remark about my being a spammer...not going to waste my time.

TJ, thanks for the backup.
 
You're welcome, Orly.  I'm

You're welcome, Orly. I'm glad we're all clear now. Stomper's just trying to do his job as one of the mods. You can see how that first impression came off as a little spammy. I'm sure he doesn't mean any harm. Please forgive.
 
I think that BF Ken Bob, in

I think that BF Ken Bob, in his non-scientific genius, has it just right. Start slow, even to the point of just standing around BF, if that's how slow you need. And, Barefoot Means Barefoot. The full range of feedback from Really Bare Feet is what will keep the injuries at bay and allows the vastly adaptable body to adapt vastly, in it's own time.
 
Barefoot is barefoot?What

Barefoot is barefoot?

What are you trying to do? Label people? Why do you purists go so far out of your way to EXCLUDE everyone?

SHEESH!
 
JosephTree wrote:I think that

JosephTree said:
I think that BF Ken Bob, in his non-scientific genius, has it just right. Start slow, even to the point of just standing around BF, if that's how slow you need. And, Barefoot Means Barefoot. The full range of feedback from Really Bare Feet is what will keep the injuries at bay and allows the vastly adaptable body to adapt vastly, in it's own time.
I second that. The thing that undermines most people beginning the journey of barefoot running is lack of patience. You'll find quite soon that running barefoot feels great, so it'll be hard to hold back ease into it gradually.
 
There is nothing that is more

There is nothing that is more educating than direct and immediate feedback. Pain is one of the (if not the) most effective feedback methods.

When running with shoes and overdoing it the result will be pain and/or temporary disfunction which comes with delay of more than a day. Seldom to never there is immediate feedback.

With minimalist shoes there is dampened and slightly less delayed feedback. While you can run for example on your heel in VFFs without immediate pain you can also overload tendons and ligaments pretty quickly because nothing stops you from doing too much.

Going the full way of skin to ground barefoot when you do to much to soon there will be immediate pain for almost everything you do wrong. Heel running on gravel or concrete just hurts. Too much too soon just hurts quickly because the skin on the soles can not take it. Exception here is that if you have a nice, soft surface like grass or sand nothing keeps you from overdoing and the overload on tendons and ligaments applies as in the feeling-damening minimalist shoes.

Yes, many of us are sub-optimal in their bio-functions (at least I definetly am) due to age, wrongdoings in the past or alike. It certainly helps to be aware of the issue and pay special attention to the own body. But I cannot come up with something that keeps me more effective from overdoing than barefoot running on not nice surfaces.

Definetly it helps to make people aware on what they need to do in order to have a positive learning experience and not be frustrated or even injured. This should be done in a way that the hurdle that is being presented to the new-to-be barefoot runner is not too high to keep from trying.





Just my $0.02

Jörn
 
Matt wrote:JosephTree

Matt said:
JosephTree said:
I think that BF Ken Bob, in his non-scientific genius, has it just right. Start slow, even to the point of just standing around BF, if that's how slow you need. And, Barefoot Means Barefoot. The full range of feedback from Really Bare Feet is what will keep the injuries at bay and allows the vastly adaptable body to adapt vastly, in it's own time.
I second that. The thing that undermines most people beginning the journey of barefoot running is lack of patience. You'll find quite soon that running barefoot feels great, so it'll be hard to hold back ease into it gradually.

At the risk of restating the obvious, I'll add to this that I belive ego, jealousy and competitiveness are also major components of an injurious experience (bare or shod.)
  • It's easy to think we should be able to run long distances (right away) barefoot because it's natural.
  • It's easy to think I should be able to run long distances barefoot because that guy my same age can.
  • It's easy to think that if we persevere and just push through the pain, the way I grew up understanding (especially) endurance sports, we can succeed at running barefoot the same way.
I believe we all have our limits, and the refusal to accept them (sometimes!) is what leads to injury. It's very well possible that you, (yes you) may never, ever, ever be able to run a marathon (in shoes, barefoot, or ice skates) because of some inherent limitation in your particular biomechanics that at this point, you're unaware of because you haven't pushed yourself to that point. Yet.

I had to ask myself what my limit was. Start adding miles until I'm hurt? Again? I had to let off the gas and stick to a reduced mileage as I build up slower than my ego drives me to. It's hard to do.

That's why I suggest ego, jealousy of 'better runners,' and a lifetime of misinformation about running are additional causes of injury. Don't think that I'm against pushing one's limits either, because that's not at all what I mean. I mean pushing one's limits irresponsibly, irrationally or unrealistically, within the scope of this discussion about injury/imbalance.
 
I'm confused...so this is NOT

I'm confused...so this is NOT a thread about tips, do's and don't's for new BFRs??? Sneaky title! Did I take a wrong turn and end up in "Ask the Docs"?? I've read it 3 times and I'm still cratching my head. Will there, or will there NOT be a test on this information later? What are we supposed to discuss? Our hips, our shoulders or if I am personally "Biomechanically suited for running" ("...but to HOPE that a person's body will adjust is a gamble.) I'm not trying to be a smart-ass, but I don't get it. I use to hurt when I ran, I changed my shoes for gloves and the pain went away. Suppose my body adapted pretty quick??? (shrug)



I don't get it. I'm going running.



-Jonny
 
It's not that simple for

It's not that simple for everyone, Jonny. Some people adapt quite easily, some people take longer. Sometimes, I think I'm still learning as I go, and I've been at this for a little while. It would be nice if all we had to do was take our boat anchors off, have the pain go away, and be normal again. But that's not always the case. Some of us have been damaged (developed bad habits that are difficult to shed), some of us have nagging injuries, and some of us have ankles and feet that have atrophied that need to be strengthened before we can just go out and run any distance or speed we want. It takes time to adapt to the new way of running, whether that be musculoskeletal or with our plantar skin.

I hope I misundertood your meaning because there's a lot of good advice and information in this thread provided by a lot of experienced people, some of them who have learned the most common lesson...TMTS.
 

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