Running. Less evil than you thought.

Running as an exercise seems to divide people, either you are for or against it, there seems to be no middle way. Yet it is the one physical activity that even the most sedentary of us would be hard pushed to admit that we have never tried and as a child it seems a natural state of motion. Breaking into a run comes instinctively for many years until we find the bicycle or the car will do the job just as well.

There have been regular bouts of interest in running in the West and in 1977 it was Jim Fixx’s “The Complete Book of Running” that ignited a running revolution, particularly in America. Then, in 1984, Jim dropped dead while jogging, the victim of a heart attack and suddenly everyone had an excuse not to buy those jogging shoes after all. Jim’s family history of heart disease and his once heavy smoking habit were conveniently ignored in the rush to the gym for the new craze of aerobics.

Now another book has flared interest in running. Chris McDougall’s “Born to Run” is a riposte to those who feel we shouldn’t run because if we were meant to why does it hurt so much and why do we get told by our osteopaths that it is hard on our joints and stressful on our ligaments?

This book challenges this assumption in the same way that we should challenge assumptions we as practitioners and patients make about a number of long held beliefs when it comes to our bodies and how to use them. I came away from this book with the thought that there are probably many other areas that have never had the same kind of thinking applied, particularly in the field of osteopathy where we can make the mistake of developing fixed ideas about the treatment and management of injuries.

Chis McDougall, a 6’4”, 105 kilo non-runner headed off to find a tribe of the world’s greatest distance runners and learn their secrets, and in the process shows us that everything we thought we knew about running is wrong. For centuries the reclusive Tarahumara Indians of Mexico have practiced techniques that allow them to run hundreds of kilometers without rest and chase down anything from a deer to an Olympic marathoner while enjoying every minute of it. Chris was also to find his own inner ultra-athlete, as he trained for the challenge of a lifetime: an eighty-kilometer race through the heart of Tarahumara country.

Many of the ideas that appear in the book have been surfacing in one form or another for quite some time. There have long been questions as to why it is, in the face of ever more exotic footwear, that we seem to have just as many ankle injuries to manage? And why is it for the small group that choose to run without shoes at all that their incidence of shin splints and lower limb pain is so low? Chris McDougall’s answer is that far from being a poor exercise choice we are in fact well designed to run. The short hairs covering our body, which allow the movement of air, coupled with our ability to sweat are ideal in helping keep us cool. You might not like ending up drenched at the end of a run but just imagine how a thickly matted animal, that only cools itself by panting, feels after a turn around the block. Our short toes and the positioning of our muscles and ligaments also makes running easy for us to manage and the combination of these and other features allow humans to achieve something quite remarkable, something that may well have allowed us to leap our way up the food chain. You can still see in Africa today where bushman can catch large antelope simply by running them down.

It may take them hours or days but eventually the prey will fall to the ground exhausted by heat stroke. It’s thought that this may have been the first way man was able to successfully hunt for meat, giving us an great evolutional boost. So why do we have so many problems with our weekly jog and why do so many of our patients steer clear of this the most basic of exercise choices?

The trouble is we just don’t know how to run properly any more and the heavily padded shoes that we’ve been told will save us from injury often do just the opposite. Our feet, narrowed by constrictive shoes have robbed us of the wide stable base an unfettered foot provides. We also spend years not running which leads us to develop poor running styles and bodies carrying too much weight. The result is heavy joggers catching their full body weight on the heel of their shock absorbent shoes. Although this is probably reducing the impact on joints and muscles they are only encouraging the runner to over stress joints, ligaments and muscles. Every time your foot hits the ground proprioceptor nerves send details to your brain about your foot’s position in space. Start rolling your ankle while barefoot and your nervous system will correct your posture before you get into trouble. With a heavily padded shoe the message may get through too late resulting in a sprain. The weekend jogger often makes the mistake of running at a slower pace, thinking it has to better for them but watch a child or a professional runner and you’ll notice a striking difference. They’ll land on their fore-foot allowing the anatomy of their and legs to catch them before they hit the ground resulting in little or no impact on the heel itself.

They don’t need the shock absorption around their heel and can afford to use lighter shoes and still avoid shin splints, heel spurs and all manner of other stress related injuries. There has been a trend for some runners to even run barefoot to help accentuate this effect. Not something I’d recommend when there are plenty of lightweight shoes now available but a barefoot runner is 4% more efficient then their soled companions and in the last kilometer of a marathon that could be as useful as a downhill slope to the finish line.

Well trained runners will also run at a rate where their right foot hits the ground about ninety times a minute. When I tried this I found I had to take what felt like baby steps. I worked furiously to get my rate up to this level but when I did I noticed several things. Instead of heaving myself into the air and then having to catch my body weight I was instead barely leaving the ground and catching myself was now trivial, even if it was happening much more often. The front of my thighs were sore from the effort I had to make in flicking my legs forward but I didn’t have that deep ache in my legs that usually got to me before the end of a run.

Although I’ll remain a part-time runner I’m changing my running style. I’ve bought a lightweight pair of shoes, my shoulders are slightly rounded forward as I concentrate on landing on my mid-foot rather than my heel and my iPod is loaded with ninety beats per minute music to stop me from dropping back to the plodding style that I once thought sensible. I’m not going to be found taking eighty-kilometer fun runs but I’ve changed my thinking about running. It’s not for everyone and I think some time needs to be spent planning on your approach but it’s certainly not to be written off. It’s also changed my thinking about the treatment of lower limb injuries.

Every now and then it’s great to have your assumptions upended. Rather than steering patients clear of running if they have obvious impact injuries I’m going to reprise the way they run and never rule out the option that running could be part of their weekly exercise. I’m also looking forward to having my assumptions about other treatment approaches challenged. I don’t know where the new ideas will come from but I am sure they’ll offer new hope for patients and practitioners alike in the treatment and management of all sorts of injuries.

As Osteopaths we like nothing better then to adapt to new ideas and treatment management approaches. With our aim in getting people to get the best from their bodies we are only too happy to go to new places and try new ideas.                                                                                  

Simon Clement, January 2010