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Author Topic: Stress fracture and the barefoot transition  (Read 1447 times)
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Chilli
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« on: March 07, 2012, 01:12:04 PM »

Hi all,

Bit of background first, please bear with me....

I am a rower/crew boy of over 20 years having competed at the highest level possible in my prime. I am currently 36 years of age and after suffering some nagging lower back pains over the last 9 months decided to take a year out from rowing and give this marathon running thing a try (signed up for one in November). Barring a little cross-training, I have mostly avoided running for much of my life due to concerns over the long-term damage impact sports like running do to oneís body (mostly the knee joints). Of course, if Iím going to do a marathon then I obviously cannot avoid running anymore.

Approximately 9 weeks ago I began low intensity 30 minutes runs wearing a standard running shoe, I was covering nearly 4 miles per session, I did this for a couple of weeks. I cannot remember which session it was, this injury snuck up on me very stealthily but I felt a pain in my right knee sometime during those early sessions. It was quite bearable though, I thought nothing of it and just carried on doing my runs each week, it didnít feel like it was getting any worse so I figured it was some sort of tendon strain that would heal itself after a while.

A couple of weeks later my VFF shoes finally arrive (went with a Komodo Sport and a Bikila). I did my first couple of sessions in them and they felt great, almost liberating. I could feel my technique automatically snap into the fabled front foot strike that I had read so much about, I was quite conscious of the change and really enjoyed it. The muscular wear during the session was extreme and the pain the next day considerable, but it was a good pain, the kind of muscular pain you have when working long since used muscles. Two days later that pain had completely dissipated, however, that knee pain remained. Everything that I have just described happened over a 3-4 week period.

I had previous earmarked Monday 30th January as the date I would begin the first of 2 and a half 18 week relatively aggressive marathon training programs (I decided on the Higdon intermediate 2 for the first one). Week one went fine, the runs were comfortable, cardiovascular, respiratory and muscular functions were 100%. It helps that I was coming from this tremendous platform built up from rowing, I would almost arrogantly describe the running as easy, however, the knee pain, whilst not getting any worse, was worryingly not getting any better either.

Super Bowl Sunday and DISASTER STRIKES!

The Hal Higdon Intermediate 2 program calls for its first long run at the end of week 1, a 10 mile run. Me being the typically macho arrogant crew boy decided I would make that a 2hour run at a sustainable 7.5mph (15 miles). In rowing we generally train for set periods of time rather than distance, this is to ensure that no matter how fast we become weíre always getting a solid 45, 60, 90 minutes in the UT1 or UT2 training zones. Once again my system coped very easily with the respiratory, cardiovascular and muscular demands of the piece, however, down that final 30-45 minutes that knee was starting to hurt quite a bit. At the end of the run I could put no weight on the knee at all, the pain was too great. I sought immediate professional consultation which led to an MRI scan which showed that I have a stress fracture of my right medial tibia.

Iím nearly 5 weeks past that fateful Sunday and the knee feels 100% fully healed (although recovery calls for me to take at least further 1-2 weeks of full rest, which I will do). Looking back on this, it is clear that the initial injury was done in those first few weeks (maybe even very first week/session) of running in a standard running shoe whilst possibly (probably) heel striking. So I cannot blame this on VFF, however, the injury certainly went from minor to serious as a result of that 15 mile barefoot run on Super Bowl Sunday, and as much as I hate to admit this, I suspect I may have engaged in a bit of heel striking in the middle section of that run due to indiscipline/concentration lapse/mild muscular fatigue (which I know is VERY bad if youíre running barefoot).

I know that youíre meant to transition gradually from standard running shoes to VFF, switching between the two shoes over say a 4-6 week period gradually increasing your usage of the VFF over that period.

Here is my question: Assuming perfect front foot striking running technique, is there any need to transition at all?

My injury was done heal striking in a traditional cushioned shoe over short distances, my contention is that had I switched over to VFF right from the off I would never have done the injury in the first place.

Thank you for reading all of this and I welcome all comments and thoughts.
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« on: March 07, 2012, 01:12:04 PM »

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JustinB
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« Reply #1 on: March 07, 2012, 01:35:09 PM »

Assuming perfect front foot striking running technique, is there any need to transition at all?

In short.  Yes.  No matter what you need to transition slowly.  Your feet, your calves, and the rest of your muscles are not used to the kind of strain you get when you begin barefoot running with a forefoot strike.

You have to put your ego on hold and start slow.  I have been an athlete my entire life, playing baseball at nearly every level.  I used to run track and still work out 5-6 days a week.  My first run in VFF's was 1/4 mile and my legs felt like they were going to fall off.  It took me a month to reach a mile and even then I ramped it up a little quick and developed very slight top of foot pain.

You are essentially relearning how to run so you have to start over.  There are long distance runners that literally ran 100yards as their first VFF/Barefoot run. 
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« Reply #2 on: March 07, 2012, 01:44:19 PM »

I second that entirely, running properly won't compensate for the fact that your feet (arches) are not trained to support themselves and your weight (they were supported by your shoes previously), and your legs are not trained to sustain forefoot strikes (different muscles entirely). All those muscles, tendons and ligaments will undergo extreme transformations during the transition (transition meaning from unused structures to used structures, not from heel strike to forefoot strike) and these transformations can only happen pain free if they are extremely gradual. Less than a mile to start, then increases of about 10% each time on non consecutive days... I know it'll set you back a lot, but less than a metatarsal stress fracture or a tendinitis....
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Chilli
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« Reply #3 on: March 07, 2012, 01:57:15 PM »

Thanks guys. Another question: Does it matter any that I have done virtually no running at all for the last 8 years? (in other words, there's no transition to make because I'm not coming from an existing running platform to transition from). Remember, my stress fracture was obtained wearing a standard cushioned running shoe, not VFFs.

For me barefoot running seems to be the way the human body was naturally designed to work.
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« Reply #3 on: March 07, 2012, 01:57:15 PM »

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« Reply #4 on: March 07, 2012, 02:03:10 PM »

Chili, doesn't matter... because you are transitioning.  Transitioning from no running to running.
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« Reply #5 on: March 07, 2012, 02:10:06 PM »

Chili, doesn't matter... because you are transitioning.  Transitioning from no running to running.

And you are also transition from being shod to minimalist footwear.  Even if you were not at all planning on running, you will experience minor pains transitioning to minimalist footwear, because as Horse Rider pointed out you are using different muscles entirely.  There are reasons why this site is riddled with stories about TMTF and TOFP.  Heed the warnings so you do not serve as another example of what not to do.
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« Reply #6 on: March 07, 2012, 02:59:04 PM »

Ok, I will heed these warnings. I have another question: I lost a lot of time with this stress fracture, I need to go straight into that Hal Higdon Intermediate 2 once my Dr gives me the ok to return to training. Can I integrate the transition into the program?

http://www.halhigdon.com/training/51140/Marathon-Intermediate-2-Training-Program
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« Reply #7 on: March 08, 2012, 10:15:08 PM »

At 3, 5 miles immediately, I would say absolutely not.  I understand wanting to stay on schedule, etc, but from experience I can tell you to screw the schedule and just go slow.   There will always be a marathon to run - jumping immediately into something like that immediately will likely spell disaster.

In addition to using your muscles and joints differently, barefoot/minimalist running, etc will also help build bone density over time.  A lot of folks get injured from jumping into too much mileage and not only can the muscles not handle it, they suffer stress fractures in the metatarsal bones.  Lack of bone density from years in boots/shoes is a factor.  I would advise against that training program, and spend at least a month, if not two, walking and doing short (ie 1/2 mile) runs and SLOWLY working your way up.  Retrain your muscles, strengthen your bones.  Lay that foundation.

And spend time running barefoot to jump start your return.  It never hurts to try that for a month or so, fix any form issues, etc.  Being bare keeps you from doing too much distance in addition to teaching you the best mechanics for you.
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« Reply #8 on: March 14, 2012, 01:46:16 PM »

Thanks guys. Another question: Does it matter any that I have done virtually no running at all for the last 8 years? (in other words, there's no transition to make because I'm not coming from an existing running platform to transition from). Remember, my stress fracture was obtained wearing a standard cushioned running shoe, not VFFs.

For me barefoot running seems to be the way the human body was naturally designed to work.

Actually, not running for the last 8 years puts you in a worse position because you probably have lower than average bone density Ė thus the tibia stress fracture. It doesn't matter whether you where in normal running shoes, Fivefingers, or swimming flippers. The human body is a frugal machine and will not allocate resources to something that is not being used. It doesn't matter what type of shoe you start your running program in, you'll still have to start from square one. You should also start from square one after such a significant injury like a stress fracture. Like so many on this forum you have fallen victim to doing too much too soon (TMTS). You can do a search for TMTS or TOFP - top of foot pain. You will get lots of hits on the search. There will other marathons to run. Take your recovery slowly and do it in a very disciplined manner. Listen to your body back off if it protests to what youíre doing. I went through a long recovery in 2010 from multiple metatarsal fractures from a hiking accident. I know how mentally challenging the recovery phase can be. Just remember it is much faster to recover correctly once than it is to recover twice.
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