 I have recently had quite a few people training for their first full marathon! One of the most common questions I get asked is: What should I eat before and during a marathon? Well, if you are racing soon, stick to eating the same meals you eat before your long training runs. Try to remain consistent with your eating habits throughout the training process once you discover what nutrition works best for your performance. Race nutrition includes fluid intake the days leading up to the race, dinner the night before, breakfast the day of, and supplements during your run. Whatever you do, avoid making any drastic changes in your behavior before or during the race. Dinner: For dinner you want to eat good complex carbs (vegetables and grains), a medium amount of protein (fish or chicken are my go-to choices), with a small amount of high quality fat. Avoid eating high fiber foods and foods with high fat content the night before the race as they are tougher to digest and can lead to GI problems during the race (i.e. beans or lentils). Again, try to remain consistent with your eating habits and don’t try anything too different before your race (common theme). Late Night Snack: If you have a difficult time waking up to eat an early pre-race breakfast, you can try eating a late snack. This also comes in handy if you have traveled or changed time zones for your race. Try to mimic what you would eat for breakfast the day before a race (simple carbs and a little protein). Breakfast: Try eating breakfast at least two hours prior to the start of the race. You do not want to eat too close to the start time or you will have to continue to digest your breakfast during the race. Your breakfast should consist of mostly simple carbs (oatmeal, bagel, toast, rice) and a little protein (protein shake, egg whites, low-fat Greek yogurt), or something like Kodiak cakes (carbs + protein in one!). Again, avoid high fiber cereals and high fat foods, as these foods are harder to digest and can lead to GI problems during the race. Pre-Race Snack: An hour before the race you can eat some simple carbs that can easily convert to energy. Fruit with honey is a good option. Oftentimes I will make a fruit smoothie ahead of time for a pre-race snack. Caffeine: Caffeine is a stimulant that can help with your performance during endurance races and training. If you are used to drinking coffee before your long runs, then go ahead and drink coffee before the race. Be aware that some energy gels and blocks contain caffeine, so test these products out during your long runs prior to race day! Caffeine can also cause GI distress, stimulate the nervous system, and lead to increased heart rate, and, if consumed in excess, can lead to increased urination. All of these issues can create problems for the endurance athlete. If you are not used to consuming caffeine, then the day of the race is not the best time to find out how you will respond. During the race: It is good to know what nutrition will be supplied during the race. Some races are sponsored and will have the nutrition supplements of the race sponsor out on the course. For example if they are supplying GU gels, but you are used to Honey Stinger products, then you should plan on bringing your own nutrition for during the race. A good option is to set an alarm on your watch throughout the race to prompt you to drink and eat small amounts on a regular basis. That way, you are more likely to keep on track for your nutrition goals. One of the biggest issues I see with novice endurance runners is the lack of fluid and energy intake early in the race. It takes time for your body to digest and use the energy you consume. If you wait until you feel thirsty, or start to feel shaky from glycogen storage loss, it’s too late. So, I tell runners to drink and eat early in the race and drink before you feel thirsty. Maintaining hydration throughout the entire race with smaller but consistent amounts is easier on the stomach than trying to play catch-up with large amounts of fluids once you feel thirsty. After the race: You want to make sure you continue to stay hydrated. If it was an especially hot race, you may need to continue replacing your electrolytes throughout the day with a sports drink. Make a plan, stick to the plan, and good luck racing! Thanks for reading,
Sam Gillespie PT, DPT
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 Many people run because it can be done anywhere, is a year round activity, requires minimal equipment, and has excellent cardiovascular benefits. Over half of all runners will sustain a running-related injury while training and around 90% of marathon runners will experience a running-related injury. Reasons to increase your step rate, and reduce your step length, while running:
Small changes in your step rate, or running cadence, can have a major impact on your running resilience. Your step rate refers to how many steps you take in a minute while running. Increasing the step rate while running at a constant speed will decrease your step length. Think about walking across the room vs. jumping across the room. Taking more steps while walking requires less impact forces than hopping the same distance. “Overuse” injuries due to running are often a result of these higher loads of force while landing. Some people can even hear themselves landing with louder steps as they run. Your speed and stride length will influence the impact forces your joints, tendons, and ligaments are required to absorb while running. Increasing step rate has a positive impact on the ankle, knee, and hip joints. The knee joints were most positively affected by increasing step rate, with a 20% reduction in impact forces with only a 5% increase in step rate. This increase in step rate will create a reduction in stride length while maintaining the same running speed. There are many positive benefits of running with a shorter stride and higher step rate. A smaller stride length allows for you to land with your body’s center of mass over the landing foot. This will lead to less impact forces in the knees, hips, and ankles while running. Increased step rate leads to more efficient running mechanics. Improve your running economy with reduction in “up and down” wasted motions while running. You can also reduce the risk of shin splints due to the reduction in shock absorption during landing while running with smaller strides. Things to think about after committing to increasing your step rate and reducing your stride length:
Thanks for reading, Sam Gillespie PT, DPT, OCS Here are my 10 favorite baseline prerequisite screens for runners. These screens test for mobility, strength, and your ability to control your trunk, pelvis and hips. Making sure you are able to pass these screens is a good way to reduce your risk of injury and to enhance your running performance and economy. These tests can also provide an opportunity to assess areas you may need to focus on during your strength and mobility training. 1. Big Toe Extension (see above below): The ability to extend through the big toe is important for progressing your body over your planted foot while running. If you cannot extend your big toe, you will often see compensatory strategies from the leg or lower back above. We would like to attain ~70 degrees of big toe extension. Using a wall or doorway, try stretching your big toe, allowing the ball of your foot to reach the floor.  2. Ankle Dorsiflexion Wall Test: The same concept applies for progressing through your ankle. If you have calf tightness or limited ankle joint mobility, you may struggle to progress your shin forward. You will often see compensations from the leg and back above or from the midfoot below. For running, we would like to attain ~30 degrees of forward mobility (ankle dorsiflexion). 3. Hip Extension: Hip extension is the third aspect of progressing the body forward over the stance leg during running. Since running is mostly a mid range sport for the hip, ~five degrees of hip extension would be adequate, as long as there is no compensation from the lower back muscles. Keeping the front of the pelvis on the floor during this test should help assess hip mobility without compensating from the lower back. 4. Single Leg Heel Raise: Assessing calf strength and endurance is vital for distance running. During this test, perform the heel raise at a tempo of one second up/one second down per heel raise. Set up using a small plate, or step, to achieve a small amount of ankle dorsiflexion. Come up to a complete calf raise for each repetition and stop if you are unable to elevate to the top of your calf raise height. We would like to see ~30 repetitions. 5. Single Leg Hop Test: This test assesses the ability to absorb loads and create tension in the calf complex. We would like to see one-second hops for at least one minute. 6. Lateral Heel Tap: This test assesses your balance, pelvic and hip muscle control, and also assesses the mobility needs at the ankle required for running. Using an eight-inch step, tap the ground with your heel directly to the side. 7. Rear Foot Elevated Split Squat (RFESS): This is another good test for balance and hip control, as well as the ability to generate force through the leg complex. We would like to achieve 10 repetitions without compensation and to maintain good balance throughout each rep. 8. Single Leg Hamstring Bridge: The repeated hamstring bridge is a great way to assess the strength and endurance of the muscles behind the leg. During the test, perform a single leg bridge at a tempo of one second up/one second down per rep. Perform from regular 18” bench/chair height. Try to create a straight line from the knee/hip/shoulder, showing good hip extension each rep. We would like to see 30 repetitions. 9. Single Leg Bridge Hold: During the single leg bridge hold, we are assessing your ability to maintain good hip, pelvis, and lumbar control while engaging the gluteal and hamstring muscles. Hold for 30 seconds without compensating at the hip, pelvis, or lower back. 10. Side Plank This is a good test for assessing muscle endurance of the lateral hip and oblique abdominal muscles. Without proper hip and core muscle endurance, there will likely be compensatory pelvic drop or lower back muscle use to maintain pelvic and hip control. Perform a side plank from the floor with the opposite leg raised. This can be performed on a GHR machine if you have shoulder issues. We would like to see comfortable holds for longer than one minute without dropping the pelvis. You should be looking for any difficulty maintaining these test positions, any loss of balance issues, or any mobility restrictions required during these tests. If you notice any of these deficits, this is a good opportunity to address your needs during your strength and mobility training sessions. If you are unsure of your results, or would like an expert eye for your assessment, feel free to contact us! Thank you and happy running!
Today we're working on our running mobility issues in our feet and ankles. We all know these can get stiff after miles and miles of running. We're going to work on our big toe, or our first ray. When you toe off in a run position, you have to get about 70 degrees of dorsi-flexion in your big toe. If you do not have that much flexion in your toe, you'll start see problem creep up up stream. To prevent this, grab your favorite lacrosse ball or Yoga Tune Up ball and really warm up your plantar fascia on the bottom of your foot. After that, get into a runners stretch against a wall and focus on stretching your big toe. You can also try toe walking around your house. At Athletes' Potential we help active adults and athletes in the Atlanta area get back to the workouts and sports they love... without surgery, stopping activities, or relying on pain medicine. Life is too short to avoid doing the things that you love. Reach out to us at: www.athletespotential.com info@athletespotential.com 470-355-2106 Let us help you figure out to live your best active life today! Foot strength is super important for runners. Our feet are what propel us forward so in order to generate a lot of power or strength in running, we have to have strong feet. Intrinsic foot strength- simply put, it's the muscles of the foot. Far too often we neglect this part of our body a lot but we need to show it some TLC. To help us gain foot strength, we've got a simple exercise for you to try at home or the office to start building up that strength. It's called the short foot drill. We want to make our foot as short as possible. Go back and forth between squeezing that foot together and relaxing. Do about 15-20 reps at a time. Watch the video for the all tips and get after it. At Athletes' Potential we help active adults and athletes in the Atlanta area get back to the workouts and sports they love... without surgery, stopping activities, or relying on pain medicine. Life is too short to avoid doing the things that you love. Reach out to us at: www.athletespotential.com info@athletespotential.com 470-355-2106 Let us help you figure out to live your best active life today! Today we're covering mobility for foot and ankle issues. If you've been struggling with this or you don't know that you have been, give these exercises a shot.
Massaging and stretching are great but there's one important technique that you might be missing. The first ray needs to be mobile! In order to be an efficient runner, you need about 70% dorsiflexion in your big toe. Any less that that, will cause pain. Try these two foot exercises to improve that mobility. 1) Grab your favorite Yoga Tune Up ball or lacrosse ball and get it under you foot, moving it side to side across your plantar fascia. 2) Do a wall stretch, but lift your heel off the ground to stretch that big toe. 3) Do some toe walks around your house! Hit these for 1-5 minutes. At Athletes' Potential we help active adults and athletes in the Atlanta area get back to the workouts and sports they love... without surgery, stopping activities, or relying on pain medicine. Life is too short to avoid doing the things that you love. Reach out to us at: www.athletespotential.com info@athletespotential.com 470-355-2106 Our July Series on Instagram brought you these 4 videos to help runners improve 4 key areas:
Good luck hitting the road (or Beltline or treadmill!) Running has been around for a long, long time… you could even make the argument that it’s been around since the beginning of time. It’s a fundamental movement that humans perform and officially became a sport all the way back in 776 B.C. when a foot face was the FIRST ever event in the FIRST Olympic games. Then, fast forward to 490 B.C when Pheidippides ran roughly 25 miles to deliver news of a victory against the Persians at the Battle of Marathon, which gave way to the marathon race being added to the first-ever international Olympics in Athens, Greece (which only 9 out 25 athletes finished!). This entire blog post could be on the history of running. It’s an integral part of being human. So we should be pretty good at it; right? Well… not really. Running related injuries are some of the most common injuries that we see in the clinic. When you look at the literature, anywhere from 36% to 57% of the running population will experience an injury every year and upwards of 75% of all running injuries can be related to overuse. That’s a lot of people who are getting injured every year. Too many. We see a lot of those people every day at Athletes’ Potential, which has allowed us to pick up on something - something that is criminally absent from running programs: Strength Training.  This. Is. Huge. No matter how you try to look at it, the lack of strength training in the running community is astonishing and unwarranted. Time and time again research is proving the injury reducing and performance boosting benefits of strength training for runners, yet I still hear things like, “I don’t want to get bulky,” or, “it will slow me down,” or, “I’ll get too stiff.” All of these are based on archaic midsets and need to be changed. Nowhere in the literature are these thoughts supported and, in fact, it finds the exact opposite.
However, all that being said, strength training has to be specific to the performance goals of runners. You shouldn’t go out and try to do the exact same training program as a bodybuilder if your goal is to be able to run a marathon. Movements that are going to improve single leg loading and train in multiple planes of motion is the name of the game for runners. Below are some of my favorite exercises to do just that. Bulgarian Split Squats Single Leg Romanian Deadlifts Step Ups with Knee Drive Finish Lateral Lunges Hollow Rock Step Downs Band Resisted Side Steps If you’re dealing with an injury and looking to boost your performance as a runner, reach out with any questions. We design and implement programs to help our athletes, whether you’re someone who doesn’t know where to start or has had an unsuccessful rehab experience. It is our goal for the people we work with to return to their sport or activity performing better than they did before. Thanks for reading, Dr. Jake, PT, DPT, CSCS Strength and flexibility training along with skill practice are usual as we train for marathons, weightlifting competitions, tennis matches and golf tournaments. But have you ever thought about training your diaphragm? What about your pelvic floor? What if I told you there is one major key to training that many folks skip right over? Would you try it? Here is your chance. The diaphragm is a large muscle in the body with direct connections to the lumbar and thoracic spine and ribs. The pelvic floor mirrors the diaphragm- like the younger sibling that mimics the older- and has connections to the pelvis, sacrum and hip rotator musculature. What are the most common injuries and dysfunctions that WE see? Low back, SI joint and hip! “Core strength” is definitely a buzz word in the fitness industry these days. And if you ask 5 people what it means, you are likely to get 5 different answers. So first, let’s talk about the “core.” What is the core? Your core, or the “soda can," is made up of your deep abdominals in the front, back muscles in the back, pelvic floor on the bottom of diaphragm on the top. These muscles work on concert to create pressure on your midline- think a full can of soda that has not been opened. If there is weakness or dysfunction in one of these muscles, then the midline is depressurized- the can has been opened.  So as you run, lift weights, swing a tennis racket or play with your kids, this pressurized can is helping you create torque and move through space with both dynamic stability and mobility. To learn more about this system, check out my blog about pelvic floor anatomy and leaking with exercise. How can I train it? DIAPHRAGM No doubt your diaphragm works; you’re sitting here breathing right? But you can train it to be strong and more effective with your training. A great place to start is the diaphragmatic breath. Not only does this help us work towards full excursion of the diaphragm with a deep breath but it also help relax the pelvic floor. Relaxation of the pelvic floor is just as important and being able to contract it! Try the 90/90 breathing drill and see if you are able to focus on the moving the ribs cage out and up rather than shallow chest breathing. This is essential for control. To add more strength work, try blowing up a balloon in the same position and breathing pattern! PELVIC FLOOR As far as the pelvic floor goes, I am definitely a proponent of seeking assistance from a women’s health PT before starting specific strengthening programs. They can give you a better idea of what YOUR body needs- strength, endurance, relaxation. But a great place to start is imaging creating controlled amounts of tension through your pelvic floor. This can be cued for most folks as avoiding passing gas or gently stopping a stream of urine. (Don’t ever actually stop your stream of urine, this is just a cue for a gentle contraction.) So this contraction should be as intense as the activity that you are performing. Lifting a pencil would be perhaps a 2% contraction, where lifting a heavy couch might be closer to 100%. This sliding scale applies to both pelvic floor and abdominal contractions. Only as much tension as needed for the task! How does posture relate? Going back to the soda can analogy- can you picture how bad posture is equivalent to having dented and bent my soda can? Not idea for keeping that pressurized cylinder! An easy example for this is running. If you have the “grandma lean” from the hips rather than the ankles, your can is bent. These folks tend to have back issues with running, perhaps some leaking and dysfunctional breathing. Straighten up the can and breaths are less challenged and your back feels better! ,
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If you are dealing with back, hip, pelvic pain with activity try some of these strategies. This can also improve your breathing and postures/form with fitness. This merely scratches the surface but may stimulate some ideas about what is holding your training back. After you try these, if you are still having issues or questions, come see us! We love to help people like you get back to doing what they love and living a high functioning, pain-free life. Thanks for reading, Dr. Jackie, PT, DPT Running is a part of the culture in the Army. You wake up early, meet at the PT field and go for a run 3-5x a week. We had formation runs where we’d run a few miles with 100 to thousands of other sounds yelling cadences. We even had runs to celebrate important battles or events in our Brigade’s history. The only problem is, most people in the Army have never actually been taught how to correctly run distance. The statistics on running related injuries are pretty shocking. 75-80% of runners have a running related injury every year. That number bumps up to 90% when you start training for a marathon. With numbers like that you could make the case that we have a running injury epidemic in the US. These numbers carry over to the Army and when I was active, I had an opportunity to try and solve this issue for the Brigade to which I was assigned to at Schofield Barracks. Ironically, for someone that’s tall and skinny, I’ve never really been a naturally good distance runner. This led me to seek out a running coach when I was in Hawaii. The man I found was Ed Bugarin (Google search this guy, he’s no joke). Ed was a retired special operations soldier that trained runners and triathletes on Oahu. I spent a couple spent a couple weekends with him working on drills, cadence and getting stronger in areas I was weak. After a month of running mechanics work, I was running faster for longer and injury-free. In particular I had resolved an issue I’d had since starting in the Army, shin splints. If you’ve never had shin splints before, they suck. It basically feels like someone is sticking a knife in the bone on the front of the lower leg. After working with Ed, I started teaching soldiers in my Brigade how to run. I’d do this in small groups, 10-20 at a time. First, we’d video them running and break it down on an iPad in slow motion. Next we would go out and work on corrective drills and talk about pacing for longer runs. I did this literally with over 1000 soldiers in my Brigade. After all the classes I taught here’s the most important lesson I learned: If your run form with shoes on looks like your barefoot running, you’ll be a very resilient runner. It’s literally that simple. This is something Ed had me do on the road in front of his house until my feet bled. By the way, I do not recommend barefoot running on concrete. Cavemen didn’t run on roads! I’m a much bigger fan of running barefoot on grass. Here’s why I think it’s so effective: When you take your shoe off and run, your foot gets to move naturally. You have 26 bones in the foot, 3 independent segments that articulate with each other and countless ligament/muscle attachments. Imagine if the Golden Gate Bridge could change shape in a split second and then return to it’s normal shape. That’s basically what your foot does. It’s an engineering marvel. Going barefoot allows you to let your foot do it’s job. It also doesn’t give any additional support. That way we can start to rebuild the intrinsic muscles of the foot as well as toughen the skin of the bottom of the foot. Lastly, running barefoot solves the biggest problem for most of the runners I work with- cadence. Cadence is how many steps you take in a minute. You’ve probably been told to just stride it out and try and create as long of a stride as you can. Here’s why. Stride Length+Stride Frequency(cadence)=Run Pace If you increase your stride length you will run faster assuming you maintain the same cadence. You’ll also significantly increase your likelihood of having shin splints, plantar fasciitis and running related knee pain. The better solution is to increase cadence. This would cause us to shorten our stride but increase the number of steps we are taking per minute. Imagine like you’re running on hot coals and pull your feet back off the ground. This also puts the foot landing position under our body instead of way in front of our body. The Principle of Parsimony- It is pointless to do with more what is done with less. This is principle is based off the theory of Occam’s Razor, essentially saying the simplest solution is the best solution. Want to increase your running efficiency, build foot strength and decrease likelihood of injury while running? If so, add in barefoot running once a week to your runs. Here’s how I like to program it: Find a nice, flat grass field or the inside grass area of a track. Perform 4 rounds of this: 50 meter high pull drill on the right (start video at minute 1.26 for drill) 50 meter high pull drill on the left (start video at minute 1.26 for drill) Run 100 meters moderate pace Put your shoes back on and focus on mimicking the feel of the barefoot run strike and cadence while running your intervals.
Run 4-8 400 meter intervals 80-85% effort. Rest until you can perform a 7-second exhale breath before starting the next run. Keep it simple, focus on running as a skill and you’ll be a much happier, injury-resistant runner for years to come. -Dr. Danny, PT, DPT, OCS, CSCS It seems that almost every runner has experienced “plantar fasciitis” at some point. Although there are many stretches and exercises that provide short term relief, it would be best to find out why the bottom of your foot and heel continue to be painful. Sure, there are quite a few factors that could lead to this pain but what if targeting one joint in your body could change your running and decrease your pain for good? Your foot is made up of 26 bones and 33 joints. Proper biomechanics of the foot depends on the appropriate strength and mobility of these joints. The great amount of joints allows the foot to conform to the surface so we can walk in the sand at the beach but also through the grass at home. The feet are our foundation; holding all of our body weight and acting as levers to propel us forward in walking and running. It sounds really complicated- and it is- but there is one joint that tends to be overlooked that can significantly impact your foot function. It is the great toe aka the big toe. The great toe and its mobility are integral in push-off while running. The function is described by the “windlass mechanism”. Essentially, the great toe extends which will tighten the plantar fascia. The tightening of the fascia at the bottom of our foot elevates your arch and keeps the foot from collapsing so that you can effectively push off at each stride.  Without full great toe extension, it will be difficult to allow your weight to advance forward over your foot as you run. Thus, your biomechanics will change. Our body is amazing because it will change and adapt to decrease pain but sometimes these changes are not ideal for long term. Some ways your body will find to get around lack of great toe extension is running with your feet externally rotated (toes out) or taking much shorter stride lengths to decrease the pressure at the toe. Long term changes in running form can begin to effect other joints up the chain- knees, hips, back. The plantar fascia may experience more tension as the toe becomes even more stiff which then can manifest as heel, toe or general foot pain. What does your great toe extension look like? One way to check your great toe extension is in a relaxed position as in the picture below. Your foot may be resting on a surface and push your great toe up gently until you feel resistance or discomfort. Checking great toe extension in a lunge position will be more similar to running and the toe can be pushed back passively by the ground. In the photo below, notice that the left toe extends much further than the right. Ideal range of motion is about 70 degrees of extension, though some people may have more!  If you find that your great toe extension is lacking, try these self-mobilizations at home. Working on these before and/or after a run would be ideal. Spend a few minutes on each mobilization and see how your feet feel: If you have restriction, 2 min each day of this mobilization can start to chip away decreased mobility. Using a lacrosse ball, spend 2-3 min each day on the fascia at the bottom of your foot.
As I mentioned before, great toe limitations can greatly affect your biomechanics. Factors such as stride length, foot contact, hip and knee position through swing can each be altered with foot restrictions and pain. At Athletes’ Potential, we perform Run Form Analysis for our athletes to break down their form individually and change any deviations we may see. Even if you don’t have pain currently, having a professional break down your run form can be eye-opening and help prevent speed bumps in training down the road. We would love to help you stay active and get back to your training throughout the Spring and Summer! Give us a call today to schedule Run Form Analysis or a Physical Therapy appointment to stop your heel and foot pain fast: 770-344-2106. Keep checking in on our blog weekly; May is all about running! Thanks for reading, AP Team  Although your pelvic floor and your feet may seem as though they are different and non-related structures, this is not the case. The connections are fascial, neural and biomechanical. Your feet are your foundation; how they contact the ground dictates all movements at your ankle, knee and hip. Soft tissues and fascia in your feet have vast connections to the legs, hip and back. The feet and pelvic floor, despite the distance from each other, also share neural input! Fascia Fascia is the thin covering of your muscles that looks like a spider web. The posterior fascial line runs from the bottom of your feet, up the back of your legs and torso and to your head. Along the path, the fascia connects to the ischial tuberosities, or the “sit bones”. Muscles from your pelvic floor also attach here! So tension along this fascial line will directly impact your pelvic floor. Essentially, any joint the fascial line crosses and soft tissue in the area can be effected. A great place to start is the feet! Use a lacrosse ball to mobilize the fascia and tissues in the bottom on your foot and around the ankles. Nerves The nerves that are responsible for function around your pelvic floor—sphincters, PF muscles, deep hip rotators—are also responsible for the function of your intrinsic foot musculature. Signs of foot weakness may by indicative of pelvic floor weakness, and vice versa. So, strengthening the foot musculature and stimulating these nerves may help with pelvic floor function. Unfortunately, many athletes wear big, padded shoes which decreases the amount of work the foot musculature must do! Neglecting to walk around on bare feet is robbing your feet of their natural ability to stabilize and form to the surface but also decreases in amount of neural input. We suggest barefoot walking and running to increase the input through your feet and begin to re-strengthen the small foot muscles. The best way is to find a grassy area, about 50-100m in length and run repeats barefooted. Your feet will be challenged much more than when running in squishy shoes, so ease in. You will also notice that your running form is probably different (better). Heel striking when barefoot in quite painful, so the body will automatically shift to more of a midfoot strike—which is good! Biomechanics The ankles drive the movement of the whole kinetic chain- the knee, hip and pelvis and spine. Dysfunction or pain in any of these areas can be stemming from faulty foot mechanics. For example, walking with the toes pointing outwards will cause your ankle joint to perform on a slightly different axis than it was designed. This will be demanding on the ankles and all the way up the kinetic chain. The knee tends to be stuck in the middle and pushed around. The ankle dictates the movement of the lower leg and then influences the upper leg. The knee is just where these two units connect. So you will notice, we do not focus on biomechanics of the knee. The hip has a direction connection with the pelvic floor. One of the deep hip rotators, the obturator internus, connects to the pelvic floor. With this connection, the amount of hip rotation will change (increase or decrease) the tension of the pelvic floor. Putting it all together: Our feet control the movements of the joints above it. If your arch collapses (flat feet), the lower leg will rotate inward and the knee will follow. Up the chain, the thigh will also rotate inwardly which changes the tone of the pelvic floor. The angle of the knee will change with all of this, but remember it is not the driver of the dysfunctional motion, rather the passenger. Living with faulty biomechanics (however slight) can perpetuate back, hip and/or pain and dysfunction. Rather than starting with an MRI for the back or kegals for the pelvic floor, why not see if changing how you move can decrease symptoms? A simple way to put this into practice is a slight change during a body weight squat. Move your feet to a comfortable squat position. Before sending your hips back and down for a squat, screw your feet into the floor. That is, acting as though you are moving your big toes further apart but your feet are not moving. Keep the toes on the ground! This creates torque at the hip. By engaging the external rotators, you are creating tone at the pelvic floor--remember the connection? You may also notice that the arch in your foot becomes more pronounced. Hello intrinsic foot musculature! This motion is also helpful for those with hip pain, especially pinching at the front. In the photos below, my feet are not in a squat stance, but I am showing the subtle external rotation. You can see the largest differences at my knee caps and the direction they are facing. Also, notice my arches after the external rotation (bottom photo). They are higher! You can see a greater difference on my left foot. My whole foot stays in contact with the ground.   Recap: The foot and the pelvic floor have more connections than you may realize. They share fascial connections as well as neural. Taking the time to mobilize tight tissues and allow for more input with bare feet can have positive effects on hip, back and pelvic floor issues. The ankles largely drive the entire kinetic chain from the bottom up. So, taking care of the foundation of movement will be the most beneficial!
Thanks for reading, Dr. Jackie, PT, DPT, OCS, CSCS |
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