Skechers GOtrail 2 Review

Skechers GOtrail 2 Review

Saucony Type A8 Initial Review

   After a little lull, the Saucony Type A series has finally received a major update.  After the Type A6, the shoe did not change and instead of the A7 was titled the Type A.  The Type A7 was for the most part only an upper change, thus I elected to review the A6 (HERE) and pass on the A7/Type A.  The lack of name change initially was concerning for the future of the Type A series, but the A8 was more than worth the wait.  This shoe has received significant updates that improve on almost every aspect of the shoe.  How so?  Let's talk. 

The Running DPT Injury Prevention: The Achilles and Calf

The Running DPT Injury Prevention: The Achilles and Calf

    The Achilles and calf are both important sources of performance as well as sources of frustration.  Various research has demonstrated an incidence rate of 10 to 20 % for Achilles tendinopathy depending on race distance (Lopes et al., 2012; Middlelkoop et al., 2007).  Many runners will not need research to tell you how irritating injuries in this area can be, including 5k and 10k world record holder Kenenisa Bekele who struggled with this issue for quite some time.

Image from Physio Brisbane

    The Achilles and calf complex are actually made of multiple muscles that connect into the Achilles tendon.  Everyone knows the gastrocnemius as the big calf muscle, which is actually made of two somewhat separate medial and lateral heads.  This muscle crosses both the ankle and knee joints, so it functions to both plantarflex the ankle and flex the knee.  Thus it tends to be most active later in stance phase as the knee straightens and assists during terminal stance to both push off via the ankle and start swing phase with knee flexion (although there are many other muscles that do a far better job of knee flexion than that). The soleus is the deeper muscle of the calf complex that is often overlooked (but should not be).  This muscle only crosses the ankle joint and thus is a primary ankle plantarflexor.  The soleus is active far earlier in stance phase than the gastrocnemius and is especially active when the knee is flexed (as opposed to straight with the gastroc).  Finally we have the plantaris (not pictured above) which is a tiny thin muscle that weakly contributes to the gastrocsoleus muscle complex.  Other than potentially being there for proprioception, little is known about the true function of the plantaris (other than being a pain trying to differentially diagnose from other injuries in that area).   All these muscles connect in some manner into the Achilles tendon, which happens to be one of the thickest tendons in the body.  The tendon inserts into the middle posterior calcaneus (heel bone) and has several bursae close to it to reduce friction between the many structures in that area.

Image from WebMD

   Now how does all this apply to runners?  Well as we know the calf complex is important to help with propelling the body forward during the propulsive phase of gait.  What most do not seem to realize is that the calf muscles are also very important for shock absorption.  For those that land on their forefoot or midfoot, there is a higher loading rate not just during initial contact (as that is the main shock absorbing muscle with that type of footstrike) but also overall through midstance as the body passes over the foot (Almonroeder et al., 2013).  So a forefoot/midfoot striker has a prolonged eccentric loading phase for the achilles complex.  This is not a bad thing, just something to be aware of.  Different footstrikes load different areas and have different risks associated with them.  Regardless of initial contact, the calf complex also begins to be heavily loaded eccentrically during midstance as it resists further dorsiflexion then gives a quick concentric contraction as the foot passes under the body to assist with forward propulsion. 

    So what does that mean?  That means regardless of where you land first, the soleus is being loaded eccentrically during midstance and the gastrocnemius functions more during terminal stance and toe-off.  Additionally if you forefoot strike, the eccentric loading phase for the soleus begins at initial contact instead of midstance.  So that poor soleus takes quite a beating, especially since the most muscle damage and the highest risk of muscle tears occur with eccentric exercise.

EXERCISES

Eccentric Heel Drops

    These are some of the best we have for tendinosis and tendinitis (after the immediate acute phase) especially of the Achilles.  Eccentric exercise has the highest load compared to isometrics or concentrics.  So it is a great way to prep the soleus for the job it has to do.  I personally prefer bent leg heel drops rather than traditional straight leg heel drops as they isolate the soleus muscle better (although the soleus will also be active during straight leg calf work).  I tend to find more soleus based issues than gastrocnemius in the longer distance running crowd.  Per clinical practice guidelines and quite a bit of research out there, eccentric training is one of the best ways to manage achilles tendinosis as eccentric exercise seems to help with tendon remodeling and healing (Carcia et al., 2010).  Tendinosis is the chronic version of tendinitis, whereby the tendon becomes chronically injured and the normal phases of healing go awry due to continued load and the inability of the tendon to fully heal. Eccentric training seems to help reset that due to the extremely high controlled load (the research is still out on the exact mechanisms).

(Disclaimer: When rehabbing an Achilles tendon, anecdotally I have found it best to utilize both straight and bent knee heel drops despite preferring bent knee).

Straight Leg Calf Raises

    Given that the gastrocnemius is most active as a plantarflexor during terminal stance with the knee straight, this muscle can be trained best with straight leg calf raises.  If this is the source of your issue, eccentric straight leg drops are great.  If you are just trying to strengthen, focus on normal straight leg heel raises to help train this important terminal stance muscle.

Ankle Strengthening

      

    The gastrocsoleus complex works best on a stable surface like any large muscle group.  If you are running on an unstable and weak ankle, instead of focusing on propulsion, the calf will spend extra time loading AND trying to stabilize.  The gastrocsoleus is supposed to be a sagittal plane muscle, not frontal or transverse plane.  Many injuries occur when muscle groups have to compensate in ways they are not supposed to.  Thus if your calf has to compensate because you have a weak posterior tibialis (which is a weak plantarflexor but supposed to be stronger invertor) or fibular muscles, your calf is doing extra work on top of what it needs to be doing.  This is a great way to burn out a muscle, or in clinical terms lead to a tendinitis, tendinosis/opathy (long term) or muscle tears.  So make sure the base is stable.  That includes strengthening the posterior tibialis, anterior tibialis, fibularis longus, brevis and tertius and the intrinsic foot muscles.  I have previously written a post on the ankle stabilizers that can be found HERE.

Gluteal Strengthening

    Given that the gluteal muscles are also loading and propulsive muscles during the stance phases of gait, it is important to have those strong to prevent Achilles or calf issues.  Why?  The gluteal muscles are especially active during the loading phase of gait and midstance to help first absorb forces then begin the transition into the propulsive phase of midstance (Noakes 2003; Perry 1992).  If the gluteals are weak, the calves are one of the many muscle groups that will take up the extra shock absorption and propulsion generation duties.  As I have stated many times, injury prevention is about balance (sometimes literally as I mention briefly in the next section) in the body.  Every muscle group has a purpose and when they fail to perform that, something else has to work twice as hard to overcompensate.  That overcompensation and thus overworking of a muscle is a great way to injure it.  I have written a post on gluteal and hip strengthening and it can be found HERE.

Balance Training

    As I mentioned with in the ankle stabilizer section, the calf works best on a stable base.  While strength of the stabilizers is important, so is working on the neuromuscular component of balance.  That involves both practicing coordinating the muscles of the ankle and foot to stabilize this area, but also your proprioceptive sense.  Proprioception is the fancy term for how the body knows where each part is in space relative to everything else.  Having a better idea of that means your body picks up where you are or are about to land on the ground, thus can neurologically kick on your ankle stabilizers faster or better.  Thus I recommend people practice single leg balance both with eyes open (all senses are active) and eyes closed.  With eyes closed, your somatosensory sense (direct sense from the nerves in your joints and muscles regarding where your foot is) is emphasized.  This sense is particularly important when your vestibular and visual senses are preoccupied (the other two major proprioceptive senses), like when you are on a windy trail run.  Your eyes are figuring out where that next tree is, your inner ear is dealing with the undulating changes in the terrain and thus the position of your head.  So that leaves one last sense to help you land with each foot step!  Now you might understand what may have contributed to that rolled ankle on the trail run last week!  Plus running is a series of single leg balance.  So you should practice that!  (I will have a future post on balance).

    Achilles injuries can be both simple and extremely complicated.  Further issues that should also be addressed include training volume (balance is important, not too much and not too little), cross training, worn out footwear and stretching.  So while the above are important exercise and strength considerations for prevention, you have to think about the larger picture as to why these occur.  Your achilles and calf muscles are powerful friends if utilized correctly, so make sure to take care of them.  Prevention here is key and in addition to performing the above calf exercises, balancing your body and ensuring that everything is working properly is a great way to work towards keeping yourself healthy.

Thanks for reading and don't forget to tack on!  

As always, my views are my own.  My blog should not and does not serve as a replacement for seeking professional medical care.  I have not evaluated you in person, am not aware of your injury history and personal biomechanics, thus am not responsible for any injury that you may incur from the performance of the above.  I have not prescribed any of the above exercises to you and thus again am not responsible for any injury that may occur from the performance of the above.  This blog is meant for educational purposes only.  If you are currently injured or concerned about an injury, please see your local physical therapist.  However, if you are in the LA area, I am currently taking clients for running evaluations. 

Dr. Matthew Klein, PT, DPT, 
Orthopedic Resident - Casa Colina

References

Almonroeder, T., Willson, J., Kernozer, T. (2013).  The Effect of Foot Strike Pattern on Achilles Tendon Load During Running.  Journal of Biomechanical Engineering, 41(8): 1758-1766.  doi: 10.1007/s10439-013-0819-1

Carcia, C., Martin, R., Houck, J., Wukich, D. Achilles Pain, Stiffness, and Muscle Power Deficits: Achilles Tendinitis.  Clinical Practice Guidelines to the International Classification of Functioning, Disability, and Health from the Orthopaedic Section of the American Physical Therapy Association.  J Orthop Sports Phys Ther. 40(9): A1-A26.  doi: 10.2519/jospt.2010.0305

Lopes, A., Hespanhol, L., Yeung, S., Costa, L. (2012).  What are the main Running-Related Musculoskeletal Injuries? Sports Medicine, 42(10): 891-905.  doi: 10.1007/BF03262301

Middlekoop, M., Kolkman, J., Ochten, J., Bierma-Zenstra, S., Koes, B. (2007).  Prevalence and incidence of lower extremity injuries in male marathon runners.  Scandinavian Journal of Medicine and Science in Sports.  doi: 10.1111/j1600-0838.2007.00683.x

Noakes, T. (2003). Lore of Running - Fourth Edition. Champaign, Il: Human Kinetics

Perry, J. (1992). Gait Analysis: Normal and Pathological Function. Thorafare, NJ: SLACK Incorporated.

Nike Zoom Fly Initial Review

Nike Zoom Fly Initial Review

Footwear Science: Outsole Wear Patterns

Footwear Science: Outsole Wear Patterns

Shoe wear patterns are the predominant question I get about shoe prescription.  Patients frequently ask about wearing out certain parts of the shoe, what that means, if the shoe is right for them and so on.  Long ago when I was working in running stores in college, I was confused that so much emphasis was put wear patterns telling people if the shoe was right for them.  As I advanced in my understanding of biomechanics, then into a doctorate in physical therapy and further discussing this with clinicians all over the world, I realized that we have almost no evidence regarding wear patterns and shoe prescription.  The internet is full of blog posts, articles and links describing shoe wear patterns telling you all these intricate things.  Here's the problem: there's almost no research on this.  Almost all (if not all) of those posts are simply anecdotal evidence.  If you look at almost all of the articles out there, they do not cite any research. This includes posts BY CLINICIANS.

Footwear Science: Sole Flare

Footwear Science: Sole Flare

I have discussed previously on this blog how many different ways you can add stability to a shoe.  This goes beyond the traditional methods of utilizing second density foam or posting more commonly on the medial side of the shoe (there are very few shoes that have lateral posting, namely the New Balance 990 series and in a minor fashion the Brooks Asteria).  Stability can come from many different footwear factors: firmness, sole width, heel counters, posterior lateral heel bevel and more.  What I want to discuss today is medial and lateral sole flare.  This is defined as the protrusion laterally or medially of the sole beyond the upper.  This can happen at any point along the sole of the shoe.  What this is supposed to accomplish is by extending the midsole beyond the upper, there is more material to resist the roll of the foot in that direction.  

Image from footmarkcped.weebly.com

I have discussed an aspect of this previously in regards to posterior heel flare (LINK) and some degree of the physics behind this are similar.  However, the lateral and medial sole flare influence on the frontal plane mechanics have more variability depending on placement.  

Traditional or more narrow heel of the Adidas Adios 1 Haile.  Sole is fairly in line with upper

Flare can be placed at any point along the medial or lateral sides of the sole.  When placed in the heel, it serves to moderate pronation or supination depending on the side.  Medial sole flare in the heel is generally utilized for pronation.  Given that there is extra material on the medial side of the foot, there is more resistance to the inward roll of the foot.  For those that tend to pronate more immediately at the heel or have excessive calcaneal eversion, medial heel flare is a good way to stabilize upon initial contact.  For those that collapse more at the midfoot, this can provide minor resistance, but midfoot posting or a wider sole will likely do a better job.  

Medial and minor lateral heel flare in the Saucony Ride 10

Lateral sole flare in the heel is one of the few ways to resist supination at heel contact.  Supination generally involves the laterally directed roll of the foot upon contact and loading response.  Like medial sole flare, lateral sole flare creates more material on outside of the shoe that serves to resist the outward role of the foot.  With the exceptions of the shoes mentioned above, there are not really any running shoes specifically made for excessive supination of the foot.  This may be due to the fact that supination tends to be a much more rare biomechanical feature.  A great many individuals assume they supinate, but what usually happens is that they land in an inverted foot position causing them to land on the outside of their foot and then they pronate (which is fairly normal).  Just because you wear out the lateral side of you shoe does not necessarily mean you supinate.  Supination is named for actual ankle motion, not shoe wear, which is poorly correlated with little to no research on outsole wear patterns.  Given that it is rare to find actual second density foam or posting for supination, lateral sole flare tends to be a more common shoe feature that can help with this.  However, individuals that land laterally and pronate naturally need to be careful of excessive lateral heel flare.  The reason being is that lateral heel flare with normal mechanics causes an early initial contact with normal landing in a slightly inverted foot position.  It is normal to land at the posterior lateral heel (not the posterior medial).  Early initial contact however is not good because your muscles are not ready to absorb impact and it increases amount of distance your foot has to pronate.  So for those with posterior tibialis issues, lateral heel flare is something to avoid because it means the posterior tibialis has to work over a greater distance AND you land when your muscles are not ready to absorb shock.  Your muscles should optimally be activated before you land to prepare for shock absorption.  An early contact means they are not fully ready and thus your shock absorption has to be compensated for (usually by joint loading).  

More pointed sole flare in the Salming Speed 5

Given that most shoes with sole flare tend to have it both medially and laterally, you may have one side you need and another you don't.  As I always tell my patients, don't be afraid to edit your shoes.  If it is really necessary, find a shoe with a certain flare and carefully shave down the side you do not need to a more straight edge.  I would not suggest doing this on a new pair of shoes, but try it on some older pairs first for practice and comparison.  For those with general instability, bilateral flare may help but most would benefit more from internal stabilization (straps, tape, orthotics, etc).  

Zoomed out comparison (harder to see from afar).

Stability features in the forefoot are rare.  The current iterations of the the Adidas Tempo Boost are one of the few shoes with forefoot based posting.  The Nike Odyssey has full length posting that includes the forefoot.  However posting up that far is not common.  Forefoot sole flare is a bit more common and Saucony is one company that tends to do this frequently.

Medial and lateral forefoot flare in the Saucony Ride 10

Like the heel, the forefoot of a shoe can have lateral, medial or both kinds of flare.  Forefoot lateral flare generally resists excessive late stage supination or more accurately excessive forefoot inversion at late stance phase.  Excessive inversion of the forefoot at late stance or toe off may cause excessive loading of 4th and 5th metatarsals and usually I find there is weakness of the fibularis longus.  Weakness of this muscle causes an inability to hold 1st metatarsal down and propel off of it, so people avoid loading it.  Your big toe joint is a very important place for you to lever off of during toe off.  It generally is a much more robust joint that can take a great deal of force if applied in the correct plane of motion (sagittal).  The 4th and 5th metatarsals are not so tough and given the lack of muscular stabilization at those joints means you are either setting yourself up to overuse the lateral structures of the foot, waste energy as you cannot propel yourself as well off these joints or potentially place yourself at risk for stress fractures (that last one is anecdotal.  I do not have a study to cite on that). 

Image from www.runningshoesadvice.com

For those that forefoot strike on the lateral edge of the forefoot, forefoot flare may not be a good thing.  Similar to the lateral heel flare, lateral forefoot flare can cause early initial contact during a forefoot strike.  Early initial contact is again not usually a good thing because you are hitting the ground before your muscles and body are ready to properly absorb force.  This can lead to excessive joint loading and a little extra muscle strain potentially in the peroneus longus or posterior tibialis, as both have a longer direction to fall and attempt to eccentrically control.  Most individuals however wear this down fairly quickly in shoes with minor forefoot flare and then don't notice it.  For shoes with a great deal of lateral forefoot flare, many forefoot strikers need to be wary or at least understand why they may or may not be having some initial discomfort (sometimes iliotibial band issues from my experience with a few patients).  Some people may never have a problem however and it depends on the resiliency of the person. 

Forefoot medial flare is a favorite of mine as it tends to resist forefoot pronation or collapse.  Rolling off a collapsed first ray is not a good thing.  That is normally where you can pivot and power off as long as you have strong calves to propel you forward, a strong fibularis longus to hold the first metarasophalangeal joint down and decent abductor hallucis strength to keep the first toe straight.  Collapse of the forefoot or more accurately the transverse metatarsal arch (yes, you have three arches in the foot) is not good in general.  As pronation is actually three motions (dorsiflexion, abduction, eversion), as the forefoot everts, this places the medial aspect of the first metatarsophalangeal joint on the ground.  Add abduction to that and you have further pressure on that medial side.  Rolling or toeing off that point over years can cause the bone to respond to those abnormal forces and grow out to resist them.  That and this force pushes the 1st toe laterally, lengthening out the abductor hallucis muscle (a very interesting muscle that is commonly weak, but is one of the many important medial longitudinal arch muscles).  This weakness along with the above are what can contribute to the formation of bunions (excessive pressure on the medial aspect of that joint and pushing the big toe lateral... sounds familiar?).  So that medial support in the forefoot sounds pretty good right?  Always my big question as to why that is so rare in footwear when bunions and collapsed forefoot or transverse metatarsal arches are so common.  

Image via www.bodiempowerment.com

In terms of footwear prescription, people collapse in far more places than traditional posting takes into account.  So if you are one of those lucky ones, this guide may help you find a shoe that does this.  If you supinate excessively at the heel, look for a shoe with lateral heel flare (not posterior lateral if possible).  If you pronate excessively at the heel (rather than the midfoot from calcaneal mobility), look for medial heel flare.  If you pronate at the forefoot, find a shoe with medial forefoot flare (Saucony commonly does this).  If you supinate excessively at the forefoot, find a shoe with lateral forefoot flare.  These do not have to be extreme as I have found subtle changes generally cause fewer issues than extreme ones.  

The current paradigm of stability shoes needs to be changed. As I have said previously, there are many different ways to create or find stability in a shoe.  For those with more interesting issues, hopefully this post serves as a guide to help you find a shoe that better suits your stability needs.  As always, your number one priority should be strengthening, stability and mobility work of your own body before looking at a shoe, but footwear definitely plays a large roll and is very important to consider.

Thanks for reading.

*As always, my views are my own.  My blog should not and does not serve as a replacement for seeking professional medical care.  I have not evaluated you in person, am not aware of your injury history and personal biomechanics, thus am not responsible for any injury that you may incur from the performance of the exercises on this blog.  This blog is meant for educational purposes only.  If you are currently injured or concerned about an injury, please see your local physical therapist.

Dr. Matthew Klein, PT, DPT

Casa Colina Orthopedic Resident

Doctor of Physical Therapy

References

Neumann, D. (2012).  Kinesiology of the Musculoskeletal System: Foundations for Rehabilitation - Second Edition.  St. Louis, MI: Mosby Elsevier

Noakes, T. (2003). Lore of Running - Fourth Edition. Champaign, Il: Human Kinetics

Perry, J. (1992). Gait Analysis: Normal and Pathological Function. Thorafare, NJ: SLACK Incorporated.

Powers, C. (2017, February): Implications for Movement Dysfunction and Musculoskeletal Injury. Functional Biomechanics of the Lower Quarter.  Lecture conducted from the Movement Performance Institute, Los Angeles, CA.