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RunSafe: The Longer Version 
14th-Mar-2012 09:02 pm
running, shoes
So, I thought I'd write up a slightly longer post about the running evaluation that I had done over at the UCSF RunSafe clinic.

The clinic runs in the evenings up at UCSF's Mission Bay campus. I was told to wear dark-colored form-fitting running gear. Runners are evaluated in groups of 4. I was, unsurprisingly, the least experienced runner in the group. I was joined by two experienced marathoners/triathletes and a guy who was getting back into running after having fairly serious leg surgery.

There are four stations involved in the assessment: a physical therapist, a podiatrist, body composition analysis and treadmill assessment, and a nutritionist. Each runner starts at a different station and they rotate everybody through all four.

I started out being evaluated by the physical therapist and one of her students. This was a really interesting part of the assessment - a lot of what I learned was stuff that I already knew or suspected, but some of it was new. The physical therapist had me do a variety of things like balancing on one foot, twisting from side to side, lunging, etc. Then I lay on a table and she had me hold my leg up in the air in various configurations and try to resist as she tried to push my leg down. Then she did some flexibility assessments, which mostly involved her telling me not to resist as she moved my leg around.

A few of the more interesting findings:

  • My calf strength and gluteus maximus strength are good. (The physical therapy student actually did a bit of a double-take at my gluteus maximus test result. Most runners have weak butts.)

  • My gluteus medius strength is pretty pathetic, and is worse on the left than on the right. I'd pretty much surmised this as the cause of my bout of trochanteric bursitis this past summer, but it was nice to have this confirmed. On the other hand, it was a bit disappointing to find that even after a couple of months of working on strengthening that muscle, it's still a weak spot. The RunSafe folks have given me a slightly different repertoire of exercises to try out, so we'll see if that makes a difference.

  • My flexibility pretty much sucks. My hamstrings, hip flexors, and quadriceps are all tight. Must get more consistent about stretching.

From there I went to the podiatrist, who had me remove my shoes and socks and walk back and forth a bunch. She did some flexibility and strength tests on my feet. Basically, my feet are really normal. My gait is normal, my arches are normal, strength is normal. My ankle dorsiflexion (the ability to pull the foot upwards rotating at the ankle) is kind of on the sucky end of normal, but not really a concern. In short, the podiatrist told me that I have perfect feet for running, and I'm wearing the right shoes, and I shouldn't change anything.

She did tease me a bit about my Injinji toe socks, saying, "Whenever I see a runner in those, it's someone who's dying to get into a pair of Vibram FiveFingers." She made it clear that she's sort of amusedly skeptical of the minimalist shoe trend - I think she's seen a lot of people hurt themselves by trying to make the switch to barefoot or minimalist running too intensely. She told me to feel free to try a less structured shoe than what I currently wear (Brooks Dyad 6 - a neutral cushioned shoe), but to take it slow and cut back on my running or switch back to a more supportive shoe the moment I felt any foot or shin pain.

On from there to body composition analysis. I have to say that I was pleased that this segment of the assessment was a) the only time weight was mentioned without my bringing it up first and b) that I was given the option of skipping it. I won't say that the folks at the RunSafe clinic are Health At Every Size practitioners, but they do recognize that weight is not the perfect indicator of health and that it's a sensitive subject for some people. (I was a bit disappointed that the PDF report they emailed me later, which was clearly generated from a standard form, leads off with "Your body mass index is ..." and a bit of canned text about weight loss.)

They used one of those bioimpedance scale thingies to measure my body composition. It put my body fat percentage at 42%, a full 7% above what the hydrostatic analysis I had done a while back put it at. Dr. Luke, the fellow doing the analysis, said I should trust the hydrostatic measurement.

Then, the fun part: treadmill test. They stuck dots of fluorescent-colored pink tape to all my joints, and filmed me from the back and the side as I ran on a treadmill. Maybe 5 minutes warmup and 5 minutes of running.

Then I chatted with the nutritionist while I peeled all the pink dots off myself. My biggest question was about eating and drinking on longer runs (assuming that eventually I will work my way up to longer runs), especially given that I run on an empty stomach because running too soon after I've eaten gives me nausea and/or side stitches. Her advice was just to keep experimenting with different things - most people eventually find something they can tolerate.

Then they sent all of us runners to hang out in the lobby with the nutritionist, and swap marathon stories and eat trail mix while they analyzed our treadmill videos. Then they brought us back in and we watched all the videos and got to hear everyone's analysis.

My own treadmill analysis (which they've sent me on DVD so I can review it) really illustrated the performance consequences of the strength and flexibility deficits the physical therapist found. You can very clearly see on the video that my right hip drops downward every time I pick my right foot up off the ground, because my weaker left gluteus medius isn't doing enough to stabilize my pelvis. I'm also slightly knock-kneed when I run - again because the gluteus medius isn't doing enough to pull my thigh outward. And I have a short stride, probably because of the lack of quadriceps and hamstring flexiblilty, although that's not an unmixed curse - the short stride slows me down, but it also keeps my feet under my center of gravity and protects against some kinds of injury.

I was a bit surprised to see from the video that I'm definitely a heel striker. Surprised only because I don't feel the impact in my heels when I run - I feel my midfoot hit the ground. I kind of wish I'd thought to ask more questions about foot strike patterns, but we'd been going for two hours at that point, and my brain was kind of tired.

Seeing the other videos was quite interesting. There were commonalities (I think three of the four of us had visible hip drop on at least one side) and some differences (one runner was very distinctively an overpronator). We were also wearing all sorts of different shoes, and one guy had himself filmed both in shoes and running in bare feet.

The day after the assessment, they emailed me a PDF with all the analysis results, plus a boatload of corrective exercises for the various problems they identified. I'm currently working on regularly incorporating one of the gluteus medius exercises (the clam shell) and some of the stretches they gave me, and I'll see how things go from there.
15th-Mar-2012 09:21 am (UTC)
Those socks look awesome. I just wish I could get a left one with teflon on it.
15th-Mar-2012 02:06 pm (UTC)
Well, that'd make your toes curl!

I keep thinking that I must know someone clever enough to teflon coat a sock as an aftermarket modification, but I can't think who.
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