Saturday, December 8, 2012
V-Core instructor training and why runners should do things barefoot
Last week, I had the privilege of taking a V-Core certification class with Dr. Emily Splichal. Dr. Emily is a podiatrist in NY who introduced me to the golf ball technique I discussed here and whose guest blog can be found here. She advocates barefoot training as a way to improve foot stability, mobility, and integrate hip and foot function. She believes in an evidence based approach to programming and selects exercises based on their proven effectiveness, rather than simply because it "looks" cool. She is an excellent teacher and a thorough lecturer. By the end of the 6 hour workshop when we were reviewing anatomy, I found myself thinking, "of course the gastrocnemius and the peroneals concentrically evert and plantarflex while the soleus and its best friend the posterior tibialis plantar flex and invert and it only makes sense that at initial contact the foot is rigid, becomes flexible (pronates) and then becomes rigid ago for toe off. Why didn't anyone else ever explain it this way?" The workout was challenging, and by the second workout, I noticed some other participants fighting fatigue (lack of gluteus medius control during dynamic balance exercises, difficulty balancing as effectively), but that's to be expected at the end of a long day. The sequencing was well thought out. I found myself repeatedly thinking how good this style of training would be for runners. Not only was the workout performed barefoot without socks to optimize feedback from the ground, the movements are sequenced so that there is a gradual build in difficulty without some of the masochism often found in a group exercise setting (the "we will do this until we are all dying" approach). If I were teaching this to runners, I would integrate diaphragmatic breath with an emphasis on neutral pelvic alignment to bring a little more awareness to the LPHC, but this was a foot workshop focusing on foot mechanics, so that is simply a personal preference.
There is this fascinating thing that runners do when they take up exercise programs. They exercise with shoes on and they often choose exercises that are done in a seated position or on 2 legs. Running, of course, is an activity that takes place entirely while standing and on one leg; as a result, I have always felt it is important for runners to incorporate single leg training into their routines. An interesting journal article by Barr and Harrast (2005) points out 40-50% of all running injuries take place below the knee and foot problems are the most common injuries reported by marathon runners. What this says to me is that runners need to strengthen the foot and ankle complex as part of their movement regimen. Performing exercises while maintaining a short foot, for example, is a great way to begin to re-establish the neuromuscular control necessary for proper gait mechanics. This, along with improving ankle dorsiflexion, can begin to combat the risk of plantar fasciitis; Barr and Harrast state runners with ankle dorsiflexion of 6-10 degrees have a 2.9 odds ratio of developing plantar fasciitis while runners who had 0 degrees or less of ankle dorsiflexion have an odds ratio of 23.3. This is a substantial difference, and one that should be considered when developing strength and mobility programs for runners. Further up the kinetic chain, these factors can contribute to anterior pelvic tilt, lack of hip control, and excessive knee movement in the frontal plane. Runners need to perform movements that integrate foot and hip function and emphasize proper mechanics all of the way up into the pelvis and lumbar spine. Another point Dr. Emily made during the V-Core workshop which also applies to running gait is there needs to be a focus on eccentric control, rather than simply focusing on concentric contraction. Functionally, decelerating motion is critical for proper stabilization patterns during gait mechanics. This is why things such as hopping can be so good for runners- proper landing technique requires eccentric control of the lower limb muscles. She integrated some single leg hops and plie hops that were low impact and felt safe, even in a group setting. Runners would benefit greatly from integrating some of these gentle plyometrics into their programs.
I would highly recommend taking one of Dr. Emily's workshops if you are at all interested in gait mechanics, integrated barefoot training, and understanding the impact of the foot on the rest of the kinetic chain. If you are a runner and there is a V-Core class near you, it would be highly worth your time to incorporate this into your training program. I strongly believe that runners need to do more than just run (especially if they are sitting most of the day) to maintain joint mobility and prevent injury. If there isn't a V-Core class near you, take your shoes off and, if you are without an arch, try to activate the muscles that lift the arch of the foot away from the floor. Try to perform some exercises in this position, such as lunging, single leg squats, single leg deadlifts, etc. Notice how this makes your hips feel and focus on using perfect form with each repetition. Your running stride will thank you for it.
Yours in health and wellness,
Barr, K. P., & Harrast, M.A., (2005). Evidence-based treatment of foot and ankle injuries in runners. Physical Medicine and and Rehabilitation Clinics in North America, 16, pp. 779-799.