“It’s Gotta be the Shoes…”

In 1989, Spike Lee created a marketing phenomenon with the “It’s gotta be the shoes” campaign featuring Michael Jordan and Nike’s Air Jordan’s.  I was only nine-years-old at the time, but pleaded with and begged my parents for a pair of these shoes that would cost a small fortune for my parents.  If only I could acquire a pair of these shoes, then surely I would be the top basketball draft pick of the playground selection committee.  In the end, I did not get my wish with the shoes, but I never seemed to lose my desire for finding the right shoe to “lead me to the promised land” in terms of athletic performance.

In 2011 I was increasing my running mileage and was getting occasional aches and pains which I attributed to my poor running shoes.  At around the same time I read a book, like millions of other Americans, entitled Born to Run.  In the book, the author Christopher McDougall tells the very entertaining story of the Tarahumara Indians and “Caballo Blanco” who all run in minimalist footwear. Intrigued by the information presented in the book, I decided to invest in a pair of Vibram Five Fingers.  As soon as I put the shoes on my feet, my running form was dramatically altered.  After running in the Five Fingers shoes for about 1.5 miles, my calf muscles were exhausted. The next day, I could barely walk due to muscle soreness.  As the weeks went by, my running form continued to change and my legs became stronger in different ways in order to adapt to the new form.  For me, this discovery was pivotal.

At the same time that I was experimenting with minimalist footwear, millions of other Americans were doing the same thing.  Some runners were acquiring a changed running form which resulted in improved athletic performance, others simply acquired injuries.  The minimalist footwear market was said to have peaked in 2012 at roughly $400 million.  In its “heyday” minimalist footwear was not only the topic of conversation in the running shoe industry, but also in the medical community.  Once again, a question was being raised about a shoe’s ability to improve athletic performance or to help avoid injury.

Today the pendulum has swung far from minimalist footwear, but the end goal remains the same.  Now the question is, “Can maximum cushioning on a shoe prevent injury or improve athletic performance?”.  This new fad, which began approximately two years ago, was to go to maximal cushioning in footwear.  Brands such as the Hoka One One are an example of a maximalist shoe yet surprisingly light weight.


One of the theories behind maximal footwear is that it allows your body to take on greater workloads (such as greater miles) while keeping the amount of stress placed on joints to a minimum.  Some athletes have switched over to this type of footwear and found the results to be beneficial to their training capabilities.  One such athlete is Leo Manzano, an American Olympic medalist in the 1,500 meters.  Leo is now sponsored by Hoka and he claims that by wearing Hoka’s his legs now feel “fresh after long runs” in a recent article with the NY Times.  Other runners are less enthusiastic about the maximalist footwear.  Long time local runner Dan Nephin tried out the Hoka’s after the Boston Marathon in 2014.  At first, Dan said “The debut run was amazingly cushy. Almost spongy.” but after several hundred miles he reports “After a while, the super cushy sensation and platform sensation went away”.

As the performance shoe pendulum swings from minimal cushion to maximal cushion, I feel that one constant remains the same, the need to address other muscle imbalances that may impact running form.  No matter what type of shoe you are putting on your feet, without good mechanics, running will likely result in an injury at some point in time.  Jay Dicharry, a leading physical therapist who works with multiple top endurance athletes states in the same NY times article, “There is a lot of evidence to show that people who spend more time improving their bodies, as opposed to shopping for shoes, are the ones who are going to run better”.

As stated in a previous post, the average runner purchases 2.2 pairs of shoes prior to seeking medical attention.  If you are struggling with pain after increased activity, consider contacting your local physical therapy practice or family physician about possible muscle imbalances that could be causing your pain.  Frequently we find that people who focus on improving their pelvic and mechanics not only feel better but also perform better than those putting more value and confidence in the performance of the shoes they are wearing.


Spring is here! Sort of…

As with the rest of the world, Spring is scheduled to begin at 6pm on March 20th.  Unfortunately, here on the east coast, the weather is far from Spring-like with up to 6″ of snow forecasted to come down on the first day of spring.  But even with the snowfall, winter will still lose.  Spring is coming.

With spring comes gardening and with gardening comes the potential for low back pain.  As you prepare your beautiful beds for the beautiful bulbs about to burst forward, consider these tips/techniques to protect yourself from injury:

LIFTING: Think about and try to incorporate efficient posture throughout the body while lifting. Pay particular attention to the spine (i.e. prevent prolonged bending at the waist while lifting, instead use a hip-hinge). Pictured: Proper lifting from ground (initiation of lift through terminal lift)


  • MORE ON LIFTING: Even when lifting lighter objects from moderate heights, one should still use proper body mechanics. It is often the repetitive stress that causes pain. Pictured: Improper lift (top), proper lift (bottom)side bend liftproper lift
    • CARRYING: Be sure to maintain neutral posture at your spine while carrying an object. Prevent backward “shearing” of the lower back. Pictured: Improper form (top), proper form (bottom)

    carrying poorlycarrying properly

    • PULLING: Try not to use your back and neck. Maintain a slight hip-hinge, use a staggered stance and shift your body from front to back to use momentum to pull.  This same technique also works great for pulling weeds and those deep roots that require so much force to remove. Pictured: Improper form (top), proper form (bottom)reachreach 2

    A lot of these techniques may not come naturally but with guidance, training and practice you will be able to garden with these proper techniques without pain.

Running Medicine 2015 conference Highlights

Immediately following last week’s winter storm Thor, was the annual Running Medicine Conference on the campus of UVA in Charlottesville, VA.  While there were multiple great lectures presented by various leaders in their fields of study, here are a few highlights I found particularly interesting:

1.  Vegans and Vegetarians really can exercise.

Jim Morris

Dr. Martin Katz, MD of Revolution Health Care in Scottsville, VA gave a very intriguing lecture about the benefits of a “plant strong” diet.  Apparently in the late 1800’s and early 1900’s there was a common belief that vegans and vegetarians are unable to exercise due to lack of protein and therefore not enough strength to perform.  Not only was this theory proven wrong, but in recent years, studies are beginning to show how beneficial plants can be for everyone including athletes.  The man pictured above is Jim Morris, a 77 year-old body-building vegan.  That’s right, 77 years-old and a vegan.  Jim is just one example of athletes excelling in their sport while maintaining a vegetable based diet. During the lecture, Dr. Katz was not promoting that everyone be vegetarian but rather everyone attempt to maintain what he considers “plant strong” diets.  To back up his plea, Dr. Katz listed out study after study showing the varying beneficial affects of various foods on the body.  One study in particular showed that plant based foods are 100 times stronger than animal based foods in terms of antioxidants.  Another showed that tart cherry juice concentrate can be effective in preventing muscle tissue damage and decrease pain.  Legumes appear to be another wonder food in their ability to block free radicals in the body which can lead to chronic diseases.  The list of studies was seemingly endless but the simple takeaway was increase the amount of plants you incorporate in your diet.

2. 50 % of runners will experience an injury this year.

Dr. Reed Ferber, PhD, ATC from the University of Calgary analyzes data concerning walking and running mechanics from all over the world.  Since 1990, the injury rate in running remains the same at 50%.  The average injured runner also then buys 2.2 pairs of shoes prior to seeking medical treatment.  Dr. Ferber’s goal is to reduce that rate by 5% which would result in an estimated savings of $2.2 billion dollars in fees associated with treating running related injuries.  While he has not found a magic cure or preventative measure to decrease the injury rate, one bit of information that he continues to focus on is that instability in the pelvis leads to increased variability in running form which can then result in injury.  Future blog posts will delve deeper into some of Dr. Ferber’s findings but one simple take away is the addition of “daily positive stress” in our lives.  Instead of overloading our system with negative stress which may result from poor posture in sitting or running with bad mechanics, we need to add a positive stressor such as squats with correct form or climbing stairs to build proper strength.

3. Strong force levers require stable surfaces


As usual, Jay Dicharry, PT of REP lab in Bend OR gave a tremendous presentation about the importance of pelvic stability in healthy running.  Our legs are very strong levers that apply a lot of force to our body while running.  It is paramount that our bodies be able to accept these forces, otherwise injures occur.  Future blog posts will discuss this in further detail.  For now, here is a visual to better understand this principle.  We all need to build strong foundations for great bridges to be better runners.

falling bridge

Posture…YOU have a choice to stress OR strengthen all day!

A few months ago, the Washington Post researched and published a diagram which listed out the potential health risks associated with poor posture.


While the picture seems to unfairly stereotype a more aged female, people of all ages fall victim to health problems associated w/poor posture.  At Prana, we frequently treat patients of all ages who have multiple theories (many of which they have “Googled”) on why they are experiencing pain yet they never consider posture as a potential contributor.

Of course, we recognize that there can be other factors contributing to pain other than poor posture, but imagine how painful certain activities may be when performed for long durations with poor posture that creates stress points in the body other than being stable like a statue. One example is to think of the classic image of a woman carrying a heavy vase of water on top of her head. posture vase

Now imagine performing the laborious task above, but instead of keeping your body well-aligned with efficient core muscles recruited, you have one hip stuck way out (like parents do sometimes to hold a toddler on their hip) and with a significant forward head (as many individuals do while using a smart-phone or at a computer).  Imagine the stress and strain that would be added to joints, muscles, bones and ligaments.

Lucky for most Americans, we don’t have to carry heavy vases of water long distances.  What we do have to contend with is carrying heavy loads of office work in front of a computer.

standing desk pictureDoes this look familiar?  If its not a mirror image of you, maybe it is someone in your office.  Let’s examine this picture for a second.  What complaints do you think someone with this type of posture might experience?  Symptoms resulting from this posture might include headaches, neck pain, shoulder pain, numbness/tingling throughout the arms/hands, lower back pain that feels like “pulling”.  If symptoms progress without effective conservative intervention (like skilled physical therapy), more serious problems could develop may include carpal- tunnel syndrome, cervical spine degenerative disc disease, migraine headaches, shoulder rotator cuff tendinitis and perhaps a partial tear….which could lead to the need of surgery.

In recent months, many people (including those at Prana’s front-desk) have invested in standing desks and I applaud them for their change.  But applying poor posture to standing could be just as detrimental to your health as poor posture in sitting.  Here is an example of someone making good use of their standing desk investment.  efficient standingLook at her posture!  Because of her proper alignment and base of support with her legs, she automatically gets a core response and therefore is ready to conquer her e-mails like she would conquer the gym….achieving strength gains to her body…not repetitive stress.  She is on a mission to get work done while maintaining a healthy spine and glutes.

Good posture does not come naturally and needs to be coached and trained like a sport. And, posture is becoming more and more popular in the media.  A few months ago Runner’s World published an article titled “Is Sitting the New Smoking.”  Just the other week, the reputable news source, The Onion, presented an article about NBA great Tim Dunkin and his desire to instate a standing bench policy on the sideline.

Remember…you can take control of your sedentary job.  YOU have a choice to strengthen instead of stress/strain all day despite being tied to a computer.

Resuscitation for the Dead Butt

Last time we brought to light the issue of “dead-butt syndrome”.  Most of you likely excelled at the bridge test and had no difficulty or pain.  For the more advanced patient, a more sensitive way to test for gluteal strength is to perform a squat.  At first, everyone may say that squatting is easy and therefore their glutes are fine.  Now, to add a bit of a twist, attempt to perform a squat with a coffee table or chair in front of your knees.  Renowned Physical Therapist Jay Dicharry refers to this as “chair of death” squats due to the increased difficulty.  By placing an object like a chair in front of your knees, it causes your form to change and place more strain on your quads and gluteal muscles while removing strain from your low back.

chair of death

Enough about testing, lets discuss treatment!  There could be any number of reasons why your gluteal muscles may not be working including tight hip flexors, nerve tension or even a restricted hip capsule.  While in the clinic we may focus on releasing tightness in soft tissues, for the purposes of this blog post, lets talk about exercise.  Here are 3 simple exercises to perform to improve the neuromuscular control of your gluteal muscles:

1. Simply walking backward on a treadmill.  Be the first at your gym to look ridiculous. By walking backward, you are forcing your hips to extend and therefore causing greater contraction of your gluteal muscles.  While this exercise may not put much strain on your gluteal muscles due to the lack of resistance, it will certainly build neuromuscular junctions due to the high repetition of having to walk backward for several minutes.

2.  Deep Squats.  (as pictured above) I once attended a medical conference where one of the presenters stressed the importance in your ability to perform deep squats.  In an effort to maintain efficient strength in this presenter’s children, he had his kids eat breakfast every day while in the deep squat position.  I’m not saying that we all need to go to that extreme but simply getting up out of a chair with appropriate form or performing 12 squats in your kitchen while your coffee is brewing could be a great start.

3. Take the stairs! I know it seems simple but how often do you avoid the stairs and elect to take the elevator or escalator.  Stairs are a simple way to gain improved gluteal strength.  For those of you who are more athletically gifted and therefore bored with stairs, we could call them vertical single leg lunges.  Still not challenged?  Take 2 or three at a time.

It is essential for people of all walks of life to maintain healthy working gluteal muscles.  Not only can healthy glutes provide power but (no pun intended) they can also prevent back pain.  New research is beginning to highlight the importance of gluteal strength to prevent knee pain.  This is especially important for you runners reading this blog. climb stairs

Tiger lost his glutes…. but he’s not alone.

This week, golf great Tiger Woods got a lot of publicity for a comment he made after withdrawing from a recent golf tournament.  Tiger stated that his glutes were “deactivated” and resulted in him experiencing increased low back pain which led to his eventual withdraw from competition.  Many sports talk shows laughed about his “deactivated” glutes and even Business Insider published an article about the seemingly weak excuse.  But what if perhaps he has a valid complaint?  Maybe he’s not alone?

The gluteal muscles are arguably the most important muscle in your body.  The gluteal muscles allow us to do hundreds of activities from getting up out of a chair to running upright.  Think about that for a second, what other animal on earth is able to run upright with 2 legs?  In the context of golf, the gluteal muscles are king.  They provide postural stability for our body which allows efficient transfer of power from the ground to the golf club head.  Monkeys do not have well activated glutes.  Picture for a second a monkey trying to swing a golf club.  That is a hilarious thought.  Monkey’s have no glutes and therefore do not have the ability to swing a club well.

Though not particularly well researched, “Dead-butt syndrome” (DBS for short) is an epidemic that is sweeping across the nation.  Every day, millions of Americans spend multiple hours simply sitting on one of the most important muscles in their body, the glutes.  Unfortunately, many Americans don’t even realize that there is a potential powerhouse of strength available to them, if only they were to use their butt for more than just a seat.

Are you one of the millions of Americans suffering from DBS?  If you are unsure, here is a potential way to self diagnose

For starters, Titleist Performance Institute issues a simple test to determine how well your glutes are working or “activated”.  The simple bridge test is a way to determine if your glutes are “activated” or if they are lacking and therefore resulting in increased hamstring activity.  If glutes are underutilized the result may be that low back extensor muscles or hamstrings have to compensate.

Now, how do we treat dead-butt syndrome?  Do you have any ideas?  Can I take a pill or is there an app for that?  We’ll talk more about that next time.