Wednesday, May 30, 2012

Danny Abshire author of Natural Running, I have some questions for you!

This has the potential to be a lengthy post. I will try to keep it short, but there are three parts to it. One, an accounting of where I am in my running or lack of running (not having updated that in about a month), some current thinking I have been doing, and most important of all, it will include some questions (at the bottom and in red type) that maybe just maybe I can get Danny Abshire (Runner's World article here) author of Natural Running: The Simple Path to Stronger, Healthier Running to review and answer.

I have yet to make that great recovery from the labral tear surgery on my left hip last summer. Sure, I got back to running within a month of the surgery and did an 8 miler within two months. I got some slower 5k racing in over the winter while doing the Freeze Your Buns race series and I got my mileage over 30 and then over 40 miles in a week back in February, but then I hit a standstill and I am not sure I am making the progress I want or should be making. I basically stopped the drive to get back to my former running self at the end of February, piddled around until I got a new PT person and stopped running per his suggestion prior to the Boston Marathon last April.

I decided to listen and slow down with the hopes of getting things right with this PT even if I am not sure if stopping was that great of an idea. As of now, I think I just wasted a bunch of time doing nothing. The PT focuses in on strengthening my hip. I could do that till the cows come home, but it hasn't changed my imbalances or mechanics in the way I expected and at times my muscles or nerves still hurt with no rhyme or reason. I think that with all the strengthening I have been doing that I would see a progression of things getting better and I don't see that happening. The PT does do some good hip mobilizations that I couldn't do on my own, but that only takes up about 5 minutes/week of my PT time. The rest is standard PT and I could do that at home.

Last week, after about 5 weeks completely off from running, I started up running on my own initiative again. I wanted to stick somewhat with the idea that Ian Adamson gave me at the Boston Marathon in April of running one minute the first day and add one minute each day after that. I didn't quite limit myself to that, as I ran around the block (about 1/2 mile) for 3 days and then started doing two loops for 4 days now. I will keep it at that and just add an extra lap every once and awhile. While it is good to run, boy do I feel out of shape. I am sure I could go 8 miles any day I if I wanted to and would find my breathing ease up along the way, but this small amount of running doesn't allow for getting warmed up or in a groove at all and I can't tell if anything has really changed with my running after all the PT and time away.

As I started to run and even before during the layoff, I still don't feel stable on my left side. I started thinking about my feet again. I always have that question. Is it my feet that cause the hip problem or my hip that caused the problems down to my feet? I saw this quote on a kettlebell message board last week from Mark Reifkind (His wife Tracy has some kettlebell swing DVDs. I used one last year to inspire myself to do 10000 swings in one month. Mark wrote:
"Gray Cook taks about how the foot has to be stable so the ankle can be mobile so the knee can be stable, ect. I now believe the TOES have to be mobile so the foot can be stable, ect."
My toes are stiff, not mobile, making my foot unstable and my ankle stiff. This is all opposite of the way it should be. My knee is not stable and to go further up the chain joint by joint, my hips are stiff when they should be mobile and my lower back is mobile (flexible) when I think it should be stiff. If I am seeing things properly, my toes are leading to a chain of opposite joint expectations and outcomes and possibly a precursor to all the problems I have been having. Could the toes be the culprit after all?

Along with my PT, I have been doing a lot of foot and toe mobilizations based on Somatic exercises the past month with a lot of inspiration and encouragement from Sue B. up in Canada. Despite doing all that, there is still something not normal about the way my left foot interacts with the ground. I have explored this in years past and never have gotten anywhere with my questions. Basically my big toe and big toe joint don't really touch the ground when I stand in my best position. My weight is balanced between the joint of my smallest toe and the joint of  my 2nd toe. If I want to get the first MTP joint on the ground, I have to pronate my foot down on the inside.Of course when I do this my knee caves in, my foot everts out and my hip rotates in. That is the running and moving posture that I hate! In the past I have tried posture control insoles for Morton's foot and self-made cutouts on my insoles to try to fix this. Of course this was all before my hip surgery, so I hoped that things might resolve all the way down the chain from my hip, but they haven't.

I had ditched my orthotics when I stopped running in April. My orthotics where primarily made for functional hallux limitus, so there is a cutout under the first MTP joint to preload my big toe for running. On reflection this just means my big toe has to drop down further to make contact with the ground, but maybe the arch is made to keep the foot level?

Last week, as I was thinking about all this again, I stood tip-toe on each foot. I noticed when I do that with my right foot, that this foot is stable and solid when flexed. On my bad left side, however I noticed that the 2nd toe joint is the joint that connects with the ground (like it is too big) and this gives my foot two options, roll to the outside to let the little toe joint touch the ground or roll to the side of the big toe joint. I would guess that means when I run, walk, or stand, my foot has to roll either left or right. It never goes straight ahead. I find it hard to believe that I was born with this, plus the tibial torsion on only that left side, as well as the femoral anteversion on that side too! Really? They have to be all connected in some way. Can I find that way and straighten things out?

I tried cutting out under 2nd toe joint on an old insole and used that for a couple of days this week. I have never seen anything like that before so I don't know if that is a good strategy or not. It didn't hurt anything, it just felt a little weird, but I didn't want to create a new problem, so I put the experiment away.

Then I started reading the book Natural Running by Danny Abshire and I got super excited just by reading the forward.  I saw this book at the Newton Running booth while I was at the Boston Marathon, but then spent time talking with Ian Adamson and forgot to go back and buy it, so I remembered it and ordered it from Amazon a couple of weeks ago.  Danny Abshire is one of the founders of Newton Running Shoes. I remember getting real excited about the Newton shoes when I first heard about them years ago. After reading about them, I knew I had to try them as soon as they allowed mail orders. I  am sure I was one of the first to order when their online ordering went live back then with their first model. The thing that excited me about these shoes were the pods on the forefeet of the shoe. I remember thinking even back then, that these shoes might solve the problem I had with the 1st MTP joint not hitting the ground. I thought the pod under the 2nd toe might depress more giving my big toe a chance to work. They didn't work that way for me. I used them only a few times and put them away. I now know I should have broke them in more slowly. I went our for 5-8 milers right off the bat with them and noticed I didn't have the strength to keep up on the  forefeet beyond the first few miles. Plus my left foot rolled to over to that big toe again still trying to get it to the ground, so they didn't work out as I had hoped.

This is what I read triathlete great Paula Newby-Fraser's forward to Natural Running: I read that she developed a problem in the middle of her string of Ironman race wins in the early 1990s. She thought it was the end of her career until she visited with Danny Abshire. Danny noticed something that no one else had before with Paula's feet. She had an unbalanced forefoot alignment. Danny made orthotics for her that got Paula back and winning in Hawaii just two months later. Reading later in the book, I found out what Paula's forefoot imbalance really was. The first metatarsal of her right foot was not touching the ground (sound familiar?) and and her feet faced or "toed out" (sounds like what others have called tibial torsion with my left foot). Danny built a light foot support for Paula to go under her first metatarsal and the rest is history. Now I know that all runners are built differently and that I am no Paula Newby-Fraser, but I was doing Ironman distance races before Paula ever did and anyone that knows my story, know that it was my five years of triathloning in the 1980s that started making my biomechanical problems interrupt my daily and athletic life.  According to Danny even a small bit of imbalance in the forefoot can cause problems for athletes. I decided to play again with my shoes and taped some moleskin under the first metatarsal of an old insole as described here except I did it all the way down from under the joint to the end of the toe. I dusted off my old Newton shoes and did my last two training miles like this. I don't know if it is good to do or not. My left foot felt more stable, but it is hard to tell over only a mile of running. I did notice that I used my left glute more (or at least it was sore) and the tight pain (or pinching) in my adductors had moved a bit further down so it wasn't as much of a pinch as a tight muscle.

Today I had physical therapy again and although my PT is good with the mobilizations, he is not too good at listening or responding to my questions and observations. He doesn't want me to think or talk about what I have read in a book. I don't dare tell him I have a blog and have been reading and writing about this stuff for years. I have learned to be quiet about my thoughts, but today I wanted to go over some of what I wrote here. He didn't really want to hear it, I guess because I wasn't trusting his judgment or expertise, but as I have learned from visiting so many specialists, none of them have yet seen the whole picture. He didn't quite "see" the toe thing, but basically said to let my foot and leg do what they wanted to. So I am supposed to stand, walk, and run and let my left foot pronate down to get the toe on the ground and let me knee knock in, and my hip rotate in. Even though when doing the exercises, I am to keep my knee and foot straight. Heck, this guy with similar problems as mine seems to have fixed them himself.

As I explained to him that didn't make sense. If I am to train to keep things straight, why let them do their own thing when in real life and not think about it? As I was doing a one legged reach: the opposite leg goes back as I bend forward and reach my hands forward, I again remarked that it is hard as my foot wants to roll to one or the other side. I can't keep it flat on floor. If I am exercising this way, trying to keep the knee straight, what is the benefit to let the knee collapse in at all other times? He put a thickness of towel under my big toe and said that it might be easier to do the exercise this way if I wanted to. Well, isn't that what I was asking about putting something under my big toe and joint while running? He didn't want to really get into it or discuss what I read and have been noting for years about my foot. I don't see why instability has to be the answer if there is a way to stabilize things.

So, I am curious about the custom forefoot orthotics that Danny Abshire makes at his running store called Active Imprints. I don't see much about them online, but if Danny is such a master of biomechanics, I would certainly love to know more. One thing that bugs me about the orthotics that I have is that my Podiatrist (who is world reknowned) has never watched me run in them. He has also never watched me run at all and he knows I am a runner. I don't know how he can be sure they are the best for me, when he has never seen the mechanics of my running!

So here are my questions for Danny Abshire that I would be thrilled if he (or someone else knowledgeable could answer).

1) Does a forefoot imbalance and instability (like Ironman champions Paula Newby-Fraser and Craig Alexander have and quite possibly Kirani James) present themselves in a similar fashion with most athletes? What would it look like when someone with an elevated 1st metatarsal runs? Paula also toes out. Is this commonly associated with problems with an elevated 1st MTP joint?

2) Have you seen other athletes with this problem who also seem to have developed the toed-out position (or tibial torsion), knock-knees, and an inwardly twisting femur (femoral anteversion). If so could the elevated big toe cause the other problems or be an effect of the other problems higher up the chain? Is the elevated big toe related to Morton's foot? I bought a book Why You Really Hurt: It All Starts in the Foot a couple of years ago that makes the case for this.

3) Can using a layer of moleskin (or do you use something more rigid) under the 1st metatarsal be a good way to try to fix the problem? or does the lift need to be done with a full foot orthotic? Would adding moleskin to another orthotic mess up the way the orthotic was intended to work. My orthotics have cut-outs under the 1st MTP joint for FHL. That seems to be the main purpose of the orthotic except for some rearfoot contol. That is a lot of stuff in my shoe just for cut-out under that joint.

4) Is the only place that makes these forefoot orthotics your store in Boulder, Colorado? Are there any Active Imprint trained orthotic makers in the Boston area? If not, are there any times when specialists bring their work to other locations, like during the Boston Marathon Expo or does someone have to live in the Boulder area to get these orthotics? If I can't get to Boulder, what could I try to do on my own?

5) Of course, I would be open to any suggestions and advice that you might have. I am continuing to read your book and will try the drills in there as well as keep with the limited amounts of running and the slow build up to mileage as Ian Adamson advised me at the Boston Marathon Expo.

Basically, I am frustrated that almost one year post surgery on my hip, I am not a regular runner. While my hip feels better and the surgery was a success, my body if still full of compensations and idiosyncrasies  that do not allow me to get out there and put in the mileage that lets me be and feel healthy. I really miss running, being fit, and feeling healthy. The last two years leave me feeling bloated and feeling at a great loss for not being the active and healthy person that I have been my whole life. I just want to be able to move through life without feeling like a worn out old man.


Anonymous said...

Hey Jim,

I can definitely relate to your post. I posted on one of your entries a few months ago about suffering from the same problem you do. I woul love to talk to you about what I think is working and what isn't. It is too much to post as a comment though. Please send me an email if you are interested in discussing.
Mike (tommysnark at hotmail dot com)

Jim Hansen said...

Mike, I will definitely get in touch. I finish teaching this week, so it will be a couple of days.

Anonymous said...

The more I think about this post, the more I think you are right. I think the issue starts to arise as a movement pattern to protect the big toe. Either the big toe refuses to bend, or is painful to bend, so instead of pushing off the big toe, the entire foot (and leg) rotates out so you can roll off to the side. After some googling, I believe this is called by some people as heel whip.

I think once this problem arises, in addition to fixing the problem with a big toe, you have to train all the other muscles of the leg which have been compensating with faulty movement patterns. For example, building the calf back up in the correct position like your friend discusses in the video. Also strengthening the hip rotators which are forced to be weak to allow the entire leg to rotate.


Jim Hansen said...

I completely agree, Mike. I have more for you later. My podiatrist is known for his work with functional hallux limitis. Have you seen this post? It explains a lot, however I don't like the orthotics he made for me. I am working on the big toe now with an interesting post coming when I have some time next week.