The Running Conundrum: To shoe or not to shoe? – Part II

Date: September 2017

Last time (August 2017 blog – The Running Conundrum: Part 1) we discussed the terminology associated with running shoes and how the latest research suggest that we should think of this as a continuum on which all running shoes fit. To recap the terms we discussed were minimalist and maximalist shoes and the 5 key factors (based on the research) that should be considered when looking at the characteristics of that shoe (weight, flexibility, stack height, heel-toe drop and motion control technology). We finished that blog with the questions around:

  1. What is the best shoe for me to be wearing?
  2. I have been fitted for this shoe so it must be right…Right?

Well the answer to that is…

When looking at running shoes and how appropriate they are for your body you need to ask yourself a few key questions:

  1. Do I have (or have I had) and injury to my foot, ankle, knee, hip or back?
  2. How old am I?
  3. What are my previous footwear habits?
  4. What is my running experience?
  5. Do I care about my performance or am I happy with where I am at?
  6. Am I currently at the start, middle or end oy my training for the season?
  7. Do I like the feel of my shoes?
  8. Do I like the colour? (the latter not being that important but to be honest it is a little 🙂 )

I can appreciate that this is a lot to think about when choosing a shoe! But, if I put it to you this way, if you were to run with what is considered the optimal cadence (number of times your feet hit the ground in 1 minute) then each foot would hit the ground 90 times in 1 minute. Over a 20 minute run each foot would hit the ground 1800 times! That’s a lot of repetitions! When thinking of it this way, suddenly choosing the most appropriate shoe is definitely something to think about! Upwards of 70% of running injuries occur in the lower limb and some studies report up to 50% of these occur at the knee (van Gent et.al, 2007). This is why putting time and knowledge into correctly choosing your running shoes are paramount.

This is also one of the reasons why when looking at changing a running shoe the transition to doing so should be very gradual and controlled. The best way that I could think to try and make this as user friendly as possible is to show you the wee flow chart below.

It is extremely important to stress that when looking at changing (or moving to a more minimal) running shoes that this is done in consultation with a health professional and the process is done gradually, because if done to fast the mechanical load will be too high and injury will ensue. The rule of thumb is for every 10 percent change in minimalism this should be done over a 1-2 month period.

So what is the take home message…if you run in traditional shoes and have no injuries and do not want to increase your performance and efficiency – stay in your normal shoes. If you have an injury or want to improve your technique, efficiency and performance then you will need to consider what is between you and the trail and get a professional to guide/assist your decision making 🙂

Keep Safe and Happy Running 

Joel

Physiotherapist & Exercise Scientist

Certified Professional with “The Running Clinic”


Lindsay celebrates 30 years in the business

Monday the 14th of August was a day of celebration at Accelerate Physiotherapy. Lindsay Stephenson began her business with Anne Allen in 1987, called the Esk Street Physio clinic. Over the years, there has been three name changes (Stephenson Allen, Stephenson Murray, and now Accelerate Physiotherapy), and three different locations around Invercargill. A wee morning tea was put on, with some past faces of the clinic joining us. Plus some lovely messages from past staff were sent through, from those who weren’t able to make it. We wish Lindsay congratulations on her amazing achievement with the practice.

  


The Running Conundrum: To shoe or not to shoe?

Date: August 2017

This will be a two part series on the running shoe conundrum; we will stack” up the knowledge and research, have flexibility” in our ideas and drop” the hammer on what is recommended via the research! (All puns entirely intended, hands up who has a healthy fetish with running shoes – guilty as charged!)

Over the past few years there has been discussion, research, marketing and objection towards reducing the supportive nature of shoes and getting back to basics – “The Minimalist Movement or The Barefoot Running Movement”. If you are involved in the running community, enjoy reading fitness blogs or magazines and/or have a healthy obsession/fetish with running shoes then you may have heard about this. However a large part of the community hasn’t. So together we will delve further into the black hole that is “running shoes” and hopefully come out the other side refreshed with a newfound knowledge (or strengthening existing knowledge) you can use for yourself, family and friends. It is important to note that I have no vested interests in any shoe company and unfortunately 🙂 get no gratuities from any shoe brand.

In the beginning there was terminology…broadly there are two main terms/groups that most people talk about with running shoes, those being “minimalist” in nature and by virtue of opposing forces…you guessed it maximalist shoes. The way I like to think of the running shoe “groups” is more of a continuum by which there are varying degrees of minimalism – this is called the “Minimalist Index”.

You might be asking: Well Joel, how do I tell what is what? And what is best for me or my child? Great Questions! As with all my blogs my goal is to promote thought and understanding and I will hopefully answer those questions in the coming series.

The “Minimalist Index” was created by a group of Researches to allow a standardized measurement of minimalism within a running shoe. The research consisted of 42 experts from 11 countries and agreement was met on the classification (Esculier, et.al 2015). The index is characterized by 5 main measures of a shoe:

Simply put, the lower the stack height, lighter the weight, lower the heel-toe drop, less motion control (pronation control) technologies and the more flexible the shoe is, the higher the “Minimalist Index”. Now more questions are likely to be popping into your head … like what is the best? What should I be wearing? I have been fitted for my shoes so they are the best right? I could imagine you’re sitting at home (or work) thinking about the next awesome run and now wondering are my shoes the most appropriate and efficient I could be wearing..? All great questions!

If the shoe fits do I wear it? Well…it depends! This is what we will start to discuss next time 🙂

Until then,

Keep Safe and Happy Running 

Joel

Physiotherapist & Exercise Scientist

Certified Professional with “The Running Clinic”


Does running reduce your risk of death?

Simply…YES! Running reduces your risk of all-cause mortality (cause of death) by 63%! Is it Worth Doing? The whole idea of this blog is not to get you running marathons in 2 weeks or breaking world records (however this is great if you wish! 🙂 ) the idea is to get thought provocation and question your exercise ideas and promote discussion around healthy living. Let us start with some simple questions that you can ask yourself and your kin:

  1. How active are you?
  2. What level of activity am I/are we doing currently?
  3. Does running directly relate to reduced risk of death?
  4. What is the required exercise for healthy living?                        

As you may have discussed with friends and family (as I have had this discussion multiple times with clients throughout the years), if there was a magic pill that could be taken to reduce your risk of all-cause mortality (death by any cause) including cardiovascular disease, obesity, diabetes and cancer then given the nature of our current society, the quick fix, the majority of us would say… YES sign me up!

I’m sorry to say this is not the option (although it may be one day) and is not the ideal solution on our journey to optimal health. A recent study by Artelo et.al., 2012 concluded that running will reduced your risk of all-cause mortality (especially cardiovascular disease) by 63%. This is crazy when you think about it…63%! I will discuss more on this later, firstly let’s try and clear up some misconceptions with running and related injuries.

There is the thought out there that running will cause increased wear and tear on your knees and cartilage and that this will lead to early osteoarthritis and result in early potential joint replacement.  A recent review of the research by Timmins et.al, 2016 suggest that this is not the case and running cannot be directly correlated to the development of osteoarthritis. In fact the evidence also suggests that subjecting your cartilage to load (in a controlled and gradual manner – progressively loading through running) actually increases the thickening of the knee cartilage over time. So, what does this tell us, running isn’t linked to the development of osteoarthritis and running has been suggested to increase cartilage thickness in your knees over time (Mosher, Liu & Torok, 2010).

The body will adapt as long as the stress placed on the body is less than the body’s ability to adapt!

What about the idea that running reduces the height of your discs in your back and leads to increased wear and tear? Recent research suggests that this too is not the case. Belavy et al, 2017 has shown that in long distance runner and joggers that their disc heights were greater with improved hydration leading to improved strength! The way to approach these topics, or the way that I like to think about them, is that the body adapts! The human body is best not to be thought of as a manufacturing machine that over time wears out, the human body adapts to the loads (exercise) that it is subjected to…as long as the loading is at a rate that the body can adapt! Often I see (and have been very guilty of the same) of doing too much too soon leading to injury 🙂 . Just remember, one size doesn’t fit all and a good program is always recommended!

So what are the recommendations? How should we approach this?

The American Heart Association (2010) has coined the phrase “Ideal Cardiovascular Health”. This is broken up into two main areas that equate to optimal cardiovascular health and should be simultaneously present. They are – Risk behaviours and Risk Factors. The two main areas need to be in the absence of clinical cardiovascular disease – heart failure, stroke, coronary heart disease.

Risk behaviours

  1. Abstinence of smoking within the last year
  2. Ideal body mass index (BMI)
  3. Physical activity at goal levels – described as 150 mins of moderate intensity exercise per week or 75 mins of vigorous exercise per week
  4. A diet that promotes good cardiovascular health

Risk Factors

  1. Normal Cholesterol levels
  2. Blood Pressure < 120/80 mmHg ( not on medication for same)
  3. No Diabetes

The idea is based on meeting the 7 mentioned points above. The study mentioned preciously by Artelo et.al., 2012 has shown that someone that meets 3-4 of the above points has a 55% reduced risk of death from cardiovascular disease compared to someone who only meets 1-2 of the points, and someone who meets 5-7 of the above points has a 63% reduced risk of death (cardiovascular cause) compared to someone who meets 1-2 of the points above.

So…putting it all together…what is the take home message?

Running is a great form of exercise that produces endorphins and ‘feel good’ hormones, if transitioned and loaded properly can improve cartilage health and when combined with a healthy lifestyle can reduce your risk of death from cardiovascular causes by up to 63%. The Body adapts to the training load that is applied to it and when mechanical load is sufficient for tissue adaption then health and performance improves. Everyone is different and a personalised program is recommended 🙂

 

Keep Safe and Happy Running 

Joel

Physiotherapist & Exercise Scientist

Certified Professional with “The Running Clinic”


Runity Running Course

runningBeing a runner, when Polestar Pilates were hosting a Runity Painless Running Coaching Course in Auckland this year I was really interested personally and professionally.  It was a fantastic course!! I learnt a lot for myself but also for clients. There has been a lot of work to do since to work towards gaining the Coaching Certificate and another course next year to go!

To summarise a whole 3 days

  • Everyone should be able to run and keep running. Humans are the only animals that are designed to run for long distances like marathons and ultras (not saying we all have to) as we evolved running after our prey and outlasting them so we could catch them.
  • There is a huge variance in running styles but, there is an optimum style where you are a low risk of injury due to the repetitive nature of running.
  • It is worth getting checked out to see what you need to improve to run for years bypassing the injuries. It often comes down to poor flexibility in some areas – not always the areas you think but may be back, hips and ankles.

Check the runity.run website for more information.

Happy running

Andrea


Off on OE

They say all good things must come to an end and it is true. My last day working for Accelerate Physiotherapy is on the 13th May 2016 after working here for the past 4 years 2 months and 8 days.

It will be a bittersweet moment as I leave the clinic, my wonderful colleagues, my friends, family and New Zealand; as my Husband and I head off on an adventure overseas. We are heading over to the UK to start exploring and working around the world and we are unsure exactly when we will be back.

Over the past 4 years I have made many happy memories with the girls at Accelerate and I feel very privileged to have been able to play a part in the recovery and rehabilitation of the clients that I have seen over the years.

Everybody who walks though the clinic doors has a story and as a physiotherapist I enjoy hearing their story and finding a way that I will be able to help them get back to narrating and participating in their own story; as opposed to “sitting on the side lines” as is often the case when an injury is involved.

For the past 2 years I have been lucky enough to operate our satellite clinic in Tuatapere every Tuesday and Thursday and it has been great. The staff at the Tuatapere Medical Centre are wonderful and the community seems to enjoy having the physio service close by (unless they are receiving trigger point release, they don’t seem to enjoy that so much!).

So when I leave the clinic on Friday it will be with feelings of excitement, sadness, nervousness, anticipation, exhilaration, but most of all I will feel thankful. Thankful of the great times I have had, the wonderful people I have met and thankful that I have an amazing opportunity to spread my wings and fly.

So this good thing must come to an end but I cannot wait to see what good thing is coming next.

Until next time…and I shall leave my final words up to Arnie…”I’ll be back”

 Lucy Scurr

 


One Step Forward

My involvement with cancer rehabilitation began after having family members diagnosed with cancer and thinking I’d like to help but I have no idea what I could offer them.

I had just finished my Pilates certification in 2011, when I saw an advertisement asking for physiotherapists to complete specialised training in order to offer rehabilitation for cancer survivors. The programme offered back then was known as PINK Pilates. This sounded like the perfect opportunity to combine my Pilates training with cancer rehabilitation.

After completing the course in 2012, I quickly learned that there was far more treatments to offer cancer survivors than just Pilates. Other services can include massage, joint mobility, sleep hygiene, relaxation, and breathing techniques as well as Pilates, strength training, or just a sounding board. The PINC programme aims to optimise physical and functional recovery; ease pain and muscular tension; help regain strength and mobility; increase energy levels; improve posture and core stability; maintain independence; shift focus from illness to wellness; and reclaim body confidence and control.

Research has shown that remaining physically active is a very important component in cancer recovery and effects of its treatment, so I do try to encourage some form of exercise for each person dependent on the individual’s interests. However, everyone’s situation is different. Running a marathon maybe more doable for someone who was highly active prior to their diagnosis, whereas walking a block maybe achievable for someone else. The PINK Pilates programme recognised that there was a greater range of treatments for cancer survivors that could be offered than just Pilates, so the founders rebranded the programme to the PINC programme.

Over the last five years, Accelerate Physiotherapy has grown its cancer rehabilitation therapies to include the Steel programme, which is a similar programme for males run by Lindsay Stephenson; a 365 survive to thrive journal; and the PINC Next Steps programme, which is a group exercise programme for women who have finished their main cancer treatments. The Next Steps programme combines Pilates, Yoga, relaxation, and cardiovascular exercise. Also this year, I will be completing my Lymphoedema training, to enable people with any Lymphoedema issues to be treated in the same clinic.

There are now 120 certified PINC and Steel cancer rehab physiotherapists working in 35 regions in New Zealand, Australia, and the UK. Accelerate Physiotherapy is the only practice to offer the cancer rehab programmes in the Southland region.

If you would like more information regarding any of the programmes or cancer rehabilitation, you can go to www.pincandsteel.com or ring Accelerate Physiotherapy on 2186583.

Alana Malcolm.

 

 


Dizziness

 

There are many different causes of dizziness some of which can be helped with Physiotherapy treatment.

Some common problems that I would see are:

  • Dizziness that has resulted after a head injury or more mild concussion. Physiotherapy treatment for this usually consists of exercises to improve the head and eye co-ordination and balance.
  • BPPV which is Benign Paroxysmal Positional Vertigo. Clients with this usually complain of a short duration spinning sensation which occurs when they change position suddenly such as lying down or rolling over. It is cause by crystals in the ear falling off and floating around in the ear canal. This can usually be resolved following one treatment where the crystals are moved out of the canals by preforming a specific manoeuvre.
  • Cervical Dizziness. This is dizziness that is a result of problems with the neck joints or muscles. Treatment is generally mobilisation and massage.
  • Vestibular neuritis. This is where the nerve to one ear has been affected and isn’t working properly. This leads to one ear sending different messages to the brain than the other and dizziness results. Specific exercises are given to treat this problem.

 

There are some other problems such as Meniere’s disease which have dizziness that physiotherapy does not help.

The initial assessment for dizziness lasts an hour so we can be thorough and identify what the underlying cause of the dizziness is, and then proceed to appropriate treatment.

 

 


Did you know that over 1.1 million New Zealanders are affected by incontinence? Unfortunately, many of these individuals will also not seek any help even though the common contributing factor of pelvic floor dysfunction can be treated. 

What is incontinence?

The unintentional loss of urine or faeces. 

What are the common symptoms of pelvic floor dysfunction?

– Leakage with exertion, coughing, sneezing or laughing

– Urgency to reach the toilet with leaking or a fear of leaking

– Pain in the buttock, pelvic or groin region

– A heaviness, bulging or dragging feeling internally

– Increased frequency of urination

– Waking one or more times a night to pass urine 

What are some of the risk factors for incontinence?

– Older age

– Pregnancy

– Childbirth

– Obesity

– Smoking

– Bladder infections 

Can physiotherapy help?

Yes. Pelvic floor training is an internationally recognised treatment option for incontinence and prolapse. Women’s health physiotherapists are trained to complete thorough assessments in order to assist you in regaining adequate control of your bladder and bowel. Treatments could include the following:

– Education regarding how to effectively activate and strengthen the pelvic floor muscles

– Techniques for bracing during coughing or sneezing

– Strategies to manage urgency

– Education on correct toiletting techniques

– Retaining an overactive bladder which may include the use of bladder diaries

 


Office Workers Advice

Office Workers Advice: returning to work following the holidays

Have you started to experience discomfort in your neck, arms or back with returning to work following the holiday period?

Now is a great time to take a look at your work habits and address this discomfort before it becomes a bigger problem.

Our bodies are not designed to sit for long periods of time, hold our arms in one position for too long or complete repetitive tasks such as typing or mouse work for prolonged periods.

So what can you do to avoid this occurring:

  • Task variation: where possible vary your tasks as often as you can as this can alter your work position e.g. vary between hand written work, typing, mouse work, phone calls and meetings where possible
  • Regular rest breaks: Ensure that you take all standard rest breaks and don’t get into the habit of eating at your desk. Time away from your desk and computer work station gives your muscles time to recover from the work that they have been doing.
  • Micropauses: it is recommended that at least once every hour (ideally every 15 minutes) for 5-10 seconds you should STOP what you are doing, DROP your arms down by your side and gently SHAKE them to relax your muscles and help restore normal circulation
  • Postural variation: take any opportunity to get up from your desk such as walk to the printer to collect your own printing, or go next door to discuss matters with your colleague rather than phoning or emailing
  • Stretches: completing neck, arm and back stretches prior to your day starting and regularly throughout the day helps to prevent or reduce any muscle tension that may cause discomfort. Refer to www.habitatwork.co.nz for a range of appropriate exercises.

It is also important to ensure that your workstation is set up to suit your individual needs. Even the slightest adjustment to your chair, screen height, or desk layout can make a difference to your posture and any discomfort. If you require any assistance don’t hesitate to contact the team at Accelerate Physiotherapy to discuss the situation or arrange for an onsite ergonomic workstation assessment with your Physiotherapist.