Barefoot Running

Who doesn’t want to run like a Kenyan? The speed, endurance, and efficiency of these elite distance runners is the stuff of legend, and those in the running community have tried to glean some insight as to what makes these African runners such a powerful force in marathon running. One of the obvious starting points is to analyze the biomechanics of the running stride and see if there are efficiencies inherent to the Kenyan athlete.

Of course, this has been done with more than one researcher noting one glaring observation: Kenyan runners do not wear shoes. They grow up, play, and often train barefoot. Could this be the secret to running faster? Certainly, some people think that it is. The barefoot running trend has gained a steady following over the past few years. But as the barefoot running contingent has grown, so have its detractors. Let’s take a closer look.

Barefoot Running

Advantages of Barefoot Running

First of all, most barefoot runners do not run in their bare feet. Even the fanatics realize that the roads and trails contain many hazards such as broken glass, nails and rocks that could cause potential injury or discomfort to the feet.

Instead, they use minimalist running shoes, a type of sneaker designed to mimic the barefoot condition in terms of biomechanics. Typically, these shoes are lightweight and feature a thin sole without the large heel cushion found in traditional running shoes.

Biomechanically, the research has shown that barefoot running eliminates or minimizes the heel strike during running. The runner attempts to absorb the impact of body weight by landing with the foot flat or slightly on the ball of the foot. This allows the lower leg and foot to distribute the body weight over a larger surface area. The heel strike found in those wearing traditional running shoes, called shod runners, creates a condition where the full force of impact is driven through the heel, and ultimately the heel cushion of the shoe.

Proponents of barefoot running claim reduced injuries as a result of this change, although there is not much research available to support this claim. One claim that does seem to be supported in the medical literature however, is that of reduced energy consumption while running barefoot.

Simply put, barefoot runners should not fatigue as quickly as shod runners. This would be a great advantage to distance runners and racers who want to attain peak performance or even achieve a personal best during local road races.

The finding is interesting as stride frequency and mechanical work were higher in barefoot runners, indicators which would lead one to believe that the runner would consume more energy. However, the cushioning material in a running shoe absorbs a considerable amount of energy in the shod runner. Energy that would otherwise be used to propel the runner forward is lost in the sneaker. Think of the traditional running shoe like a Cadillac. It gives a smooth ride, but not too efficient.

Disadvantages of Barefoot Running

The obvious risks associated with barefoot running such as puncture wounds can be mitigated with the use of a minimalist running shoe. With this type of footwear, much of the biomechanical adaptations which proponents claim as advantageous are maintained, i.e. reduced heel strike and improved efficiency.

However, there are other reasons why someone may not want to run barefoot. Without a traditional running shoe, the runner lands with a flat foot instead of the traditional heel strike seen in shod runners. This increases the pressure on the bones of the forefoot, which are quite a bit more fragile than the heel.

Over time and with high mileage, a runner could develop a stress fracture, a small break in one of the forefoot bones. This would sideline a runner for several weeks at best, and could become more severe if ignored. Proponents claim that barefoot running is more natural and that we as humans evolved in a way that makes the barefoot method more efficient. But cavemen rarely put in thirty plus miles per week.

The bottom line is that there has not been enough research performed to advocate one method or the other. More studies need to be conducted, and we need to be open-minded about the results. With the barefoot trend steadily gaining a following, the research is sure to follow.

In the meantime, let’s go back to our elite Kenyan marathoners. In an environment where every conceivable advantage is sought and analyzed, these athletes all wear running shoes in competition. Maybe shod running is biomechanically advantageous, or maybe the cumulative effect of pavement on flesh for 26.2 miles eliminates the inherent advantage of running barefoot.

Dr. Mark Reed is an orthopedic surgeon specializing in foot and ankle surgery in the Seattle metro area. He can address all of your questions regarding barefoot running as well as any other foot and ankle conditions.

barefoot running photo

5 Common Hockey Injuries

Hockey photo

The regular NHL season is well underway and the Seattle Thunderbirds are respectively improving their stats with their recent win over the Vancouver Giants at ShoWare Center.

In the regular season as well as the off season, players experience a variety of sports-related injuries as a result. Ice hockey is a contact sport where the players and the puck move at high speeds, so when players run into each other or objects, great force is used. This is why hockey is considered a collision sport. Injuries are fairly common, but efforts can be made to avoid them with training and proper equipment. Listed below are five common injuries that can occur while playing hockey.

AC Joint Injury

The acromioclavicular joint, or AC joint, is one of the joints in the shoulder responsible for motion and stability. The ligaments that hold the AC joint together can be torn through sudden impact to the shoulder, which can cause separation to occur in the AC joint. This sudden impact can happen in hockey when players skating at high speeds collide with one another or into a rigid surface. Swelling, bruising, pain, and motion range loss are all symptoms of AC joint separation. There may also be visible bumps on the shoulder if the bones separate.

Shoulder Dislocation

Shoulder dislocation generally refers to a dislocation in the glenohumeral joint in the shoulder. This happens when the top of the humerus, or upper arm bone, is forced out of the glenoid, the socket in the shoulder joint it usually nestles in. If a player falls or receives a heavy blow or sudden impact on the shoulder, it can cause dislocation if the upper arm is forced to move in an abnormal way. Symptoms of shoulder dislocation include pain, weakness, and mobility issues. The arm may also appear to hang incorrectly off the shoulder.

Muscle Strain

Muscle strain occurs when a muscle is pushed past its limit. This can happen if a player’s muscle is suddenly presented with a heavy load or stretched beyond its normal ability. If a player’s muscles are tight but not warmed up or not conditioned well, tearing or straining is a risk. Symptoms of a muscle tear include pain at rest or when the muscle is used, and weakness or inability to use the muscle.

Meniscus Injury

The meniscus is a C-shaped piece of cartilage in the knee. There are two menisci in each knee joint, and if they are torn they can affect stability in the knee. This tearing can happen if the cartilage is worn down or through the quick movements and stress put on the knees by ice skating. Symptoms vary depending on how and where the meniscus is torn, but symptoms can include pain, instability or feeling the knee “giving,” stiffness, swelling, and an impaired range of motion. Sliding, popping, or locking may occur if the tear is left untreated because loose fragments from the meniscus tear will drift into the joint.

Gamekeeper’s Thumb

The ulnar collateral ligament, or UCL, connects the bones at the base of the thumb, which prevents the thumb from moving too far from the hand. When an acute sprain or tear of the UCL occurs, it is called a UCL injury. When the injury is chronic and develops over time from repeated UCL stretching, it’s called gamekeeper’s thumb. UCL injuries are commonly caused by injury or trauma in which the thumb is bent away from the hand at the MCP joint. This can happen in sports hockey, or in any situation in which a fall is landed on an outstretched hand.

This injury might also be sustained when a person is gripping something that is suddenly moving, like a hockey stick during a fall. Swelling, pain, and tenderness on the ulnar side of the thumb are all symptoms of UCL injury. You may also have difficulty pinching and gripping with the thumb, and you may have limitations in your range of movement. In severe cases, a bump under the skin, called a Stener lesion, may form due to the ends of the torn ligament being held apart by a nearby tendon.

If you believe you are suffering from a sports injury and need specialized orthopedic care, Orthopedic Specialists of Seattle has excellent treatment options available for you. Please feel free to contact Orthopedic Specialists of Seattle at (206) 633-8100 to schedule an appointment.

Rotator Cuff Tears and Repairs

Rotator Cuff Tears and Repairs

In the world of orthopedic surgery, there are few body parts as notorious as the rotator cuff. It’s one of those medical terms that has become a household name, and usually comes with a wince and a sympathetic nod when we hear it. Most people know of someone, a friend or family member, who has injured this particular part of the shoulder. We also see it in the sports news quite often.

In fact, now that football season is in full swing, we may hear more about Seattle Seahawks defensive lineman Michael Bennett who was diagnosed with a rotator cuff tear earlier this year. He played through the injury last season and plans to do it again this year, although he will likely need surgery in the off-season.

The rotator cuff is a group of four small muscles and tendons that surround the head of the shoulder. Their job is not so much to move the arm through space, but to provide dynamic stability to the shoulder. This means that as the larger muscles of the chest and shoulder create arm movement, the smaller rotator cuff muscles pull the upper arm into the shoulder socket. This design allows the ligaments of the shoulder to be relatively loose so that we can enjoy a vast degree of mobility, being able to reach in a near three hundred and sixty degree range of motion.

Tearing of the rotator cuff can happen in two ways. An acute tear happens suddenly, such as when you fall on an outstretched hand, or lifting a heavy object. There is generally the sudden onset of pain and a corresponding loss of function of the arm, to varying degrees.Tears can also happen slowly over time. As we age, the tendons of the rotator cuff become weaker and gradually fray. This is particularly so with the supraspinatous tendon, located on the top of the shoulder blade.

This muscle and tendon tends to get pinched between the shoulder blade and the arm bone, especially if theother rotator cuff muscles are weak. The supraspinatous also has poor blood supply, sotears often do not heal on their own, making surgical repair necessary to restore function.-1

Symptoms of a Rotator Cuff Tear

Symptoms of a rotator cuff tear include pain with movement of the shoulder and tenderness to touch. Inability to lift even household objects out to the side or overhead is also typical. Sometimes a person will not be able to actively lift the arm overhead due to abnormal movement within the joint itself.

Another indicator is a prior history of shoulder tendonitis or bursitis as this would point to excessive stress on the rotator cuff over time.

Treatment can be conservative for some tears, including physical therapy to improve shoulder mobility and progressively strengthen the cuff muscles. However, the majority of tears will likely require surgery if function of the shoulder is to be restored. Rotator cuff surgery has come a long ways in recent years, with many surgeries being arthroscopic.

This is a minimally invasive technique where the surgeon inserts a camera and surgical tools through small incisions in the shoulder. The instruments are only about a centimeter in diameter and can burrow through layers of muscle on top of the rotator cuff, whereas in past years these muscles had to be cut, making for longer recovery times.

During thesurgery, the torn rotator cuff tendon will be sutured together. The surgeon will also clean away any bone spurs that may have contributed to a degenerative tear.

If the tear is complex or involves additional procedures such as tendon transfers due to excessive degeneration of the rotator cuff tendon, then the surgeon may need to open the shoulder with a slightly longer incision. It involves more cutting of shoulder musculature and may slightly lengthen recovery time; however, from time to time it is necessary.

Fortunately, most repairs will not require this technique.Recovery is generally a four to six month process, involving four phases:

  • Phase 1 (protection): Lasting from day one to four weeks, this stage of healing involves protecting the surgery. You will be required to wear a sling during most parts of the day. Gentle mobility exercises may be prescribed.
  • Phase 2 (passive motion): Lasting until the sixth week, you will be prescribed physical therapy and begin moving the shoulder with assistance within a prescribed range of motion.
  • Phase 3 (active motion): From weeks six through twelve, the focus will be on moving the arm and shoulder on your own, increasing the active range of motion.
  • Phase 4 (strengthening): You should have improved mobility at this time, allowing you to focus on building full strength and function of the arm.

Undergoing a rotator cuff repair can be a lengthy process. The amount of time that you will be required to be away from work will vary depending on the physical demands of your job. This will all be discussed in depth during pre-operative visits so that you may plan accordingly.

However, if surgery is recommended, you should not delay for long, as the torn tissue becomes weak and shortened over time, making a successful repair more difficult.If you are experiencing persistent shoulder pain, please feel free to contact my office to arrange a consultation.