Sunday, July 25, 2010

feet revisited - shoes, no shoes or the right shoes

the issue of running shod or barefoot still crops up in a variety of formats. but a most interesting article in the NY Times yesterday brought up a whole different way of considering the issue: special shoes for special feet vs no special shoes.

this is prompted by the long-held belief that motion-control shoes prevent overpronators (flat-footed people) from excessive rotation of the ankle, lower leg, and knee, and thus prevents problems up the kinetic chain. obversely, supinators- those with high arches - tend to not be able to absorb shock upon foot strike, so cushioned shoes were deemed appropriate for this population. however, as the studies referred to in the article suggest, maybe the degree of shock absorption is not the cause of knee problems in runners. this is novel.

whenever a client comes in to ask my advice re an injury or ache, i sometimes garner a guess. but if it's painful and chronic, i more often refer to a sports med doc who's better capable of making a diagnosis based not only on his best guess but on proper evaluation of the patient. even if the client has seen an alternative doc - chiropractor, massage therapist, etc - or even if he's seen an orthopedist (many of whom are better at diagnosing surgically-necessary problems but not necessarily causes), i refer to a diagnostician who is not a surgeon. why? because he is more apt to consider the entire person, not just the injury site itself. if he can find a cause that does not need surgical repair, he will refer back to me or to a physical therapist if the injury warrants it. but he will also quickly refer to surgery if necessary.

the point is, without an accurate diagnosis of the cause, no matter the repair, it is likely to crop back up if the same activities resume. (on a personal note, i went yesterday to a Muscle Activation Therapist (MAT) to see if i could get some help on a problem. he did a thorough review of my whole body, not just my hip, and found some 'weak' areas of segments of muscles, and even whole muscles, that were not firing well. he treated them, sent me some exercises for them, and we'll have to see how it goes. but, despite my capacity to do many exercises for the muscles he identified as problematic, the neurological firing patterns were dysfunctional. hence, problems await.)

so, if you are a runner, and you are experiencing problems, yes, sure, please do look at the feet first. they hit the ground with lots of force many times. a podiatrist, esp a sports podiatrist, is a good first measure - tho my sports med doc is not a believer in orthotics, the ones i had made for me in 1976 still work - but don't stop there. skip the shoes- like the many articles on barefoot suggest, shoes may only hide the problem, and like this article suggests, shoes may actually create the problem - but then see a sports med specialist - and some personal trainers and p.t.'s are good sources for this kind of info. but first, and foremost, take time off the perpetrating activity. otherwise, compensations take over and new problems will arise.

http://well.blogs.nytimes.com/2010/07/21/phys-ed-do-certain-types-of-sneakers-prevent-injuries/

Monday, July 19, 2010

core exercise

so, i've been traveling a lot lately, some pleasure - like to panama city beach with my girlfriend during the july fourth weekend, some paternal -like to los angeles and seattle with my daughter checking out colleges, some work - like to kansas city to teach other trainers for exercise etc, and most recently, some pure play - to crested butte, colorado with six of my old philadelphia neighborhood. seven old men - all of us now over 56, up to 58 yrs of age, who've known each other for over 50 years. pretty amazing. what's also amazing is how healthy and fit we all were - we did a 10 mile hike at over 11,000 ft climbing 2200 ft and no one had to stop for medical reasons; even our knees held up pretty well. the next day we ventured forth on a 4 mile trek around the top of a mountain at 11,600 ft, but the trail was covered with scree, fallen rocks, that sometimes narrowed to 1.5 ft in width with a near vertical drop of hundreds of feet. three of us chose to forgo this trek - two for knees (me included) and one for vertigo. we had a nice time just hanging out at the trail head in the sun, with the breeze and a small, very warm for a high-altitude lake lake where we dipped our not-so-tired feet....because we could.

but the reason for the blog is not my personal life. one of my buddies, an avid exerciser, very knowledgeable for a layperson, asked about the TRX, suspended training system. he contended that it was the 'best' core exercise his friend has ever had and was wondering about getting involved in it. my response was characteristically....me. you see, i'm skeptical. i'm not so sure it's all it's cracked up to be. here's why.

first, many of the exercises are suspended by arms to allow large lower body movements such as squats, lunges, lateral lunges, cross over lunges, etc. these are hi rep exercises with load essentially reduced by arm suspension and thus become a form of cardiovascular exercise. with added resistance you could get more muscle building with less time investment.

second, many of the core exercises, tho creative and dynamic, are in prone or supine positions. while good semi-isolating exercises, they are less than functional. after all, they are prone or supine. core exercise, by definition, is an exercise that engages many of the trunk-lumbar spine-pelvic-upper thigh musculature. these can be done in any position....but we really live in an upright state, even if sitting. so i emphasize - except for those with spine issues - core exercises in sitting or standing positions. while not as isolating, they allow for the core to be engaged in ways it will have to stabilize the spine during sport, recreation, or ADL. as such, i would argue that the best core exercises are those that apply to life. however, i do appreciate the development of core strength and endurance via more isolating exercises, esp the planks and bridges. TRX moves can enhance said isolating exercises. but, i would still say these are not the best core exercises simply because they are isolated in non-functional positions.

finally, TRX and other toys of the trade- Bosu balls, stability balls, etc - may or may not be better than the traditional tools of the trade - free weights - until otherwise tested. like a said earlier, a squat with added load will engage more core muscles in more functional patterns of movement than the TRX. and it will help build bone density! in other words, for the time, and the effort, you'll get more bang from your buck using traditional tools.

remember, the TRX was designed to allow Navy SEALS to train where equipment did not exist. it served its purpose. but what do SEALS actually do to get in shape to do their job: run, swim, climb, jump, carry, push ups, sit ups, and other equipment-less activities. add some resistance to these and you have a much more beneficial and less taxing program....for life.