Physical Therapist offering one-on-one wellness and fitness consultation, as well as group instruction.
Sunday, July 30, 2023
How To Use The Modified Borg Scale of Perceived Exertion
Thursday, July 27, 2023
Predawn Yo-Yo Workout and Perceived Level of Exertion
I recently did a pre-dawn run that I feel is a good example of applying some aspects of exercise physiology to training. I went up a gravel road that forks and then loops around to rejoin itself at the fork. I completed the loop and then did a workout that I call Yo-Yo’s at the fork. With a Yo-Yo workout, I go uphill for a ways before turning around and going back downhill to the low point of the Yo-Yo and then going uphill again. The benefit of a Yo-Yo workout is that it mixes up the level of exertion and type of muscle activity to make the workout more sustainable and decrease the risk of injury: running uphill continuously can subject you to an unhealthy level of exertion, and running downhill continuously can be tough on your joints as the muscles that control your descent become fatigued. Added benefits of doing Yo-Yo’s in a place where a road forks before going uphill in either direction were that I was able to vary the grade, the footing, and my surroundings- different sensory stimulation is helpful to keep from getting bored during a workout. In this case, the distance I chose to go uphill was informed by the desire to limit the intensity of my workout and to avoid waking up the people who lived slightly up the road from my turn-around point by riling up their dogs.
So you might be wondering why I was trying to limit my level of exertion. After all, isn’t the whole point of a workout to exert yourself? The answer to that is yes, but within some limits. The level of exertion you subject yourself to during a workout should be informed by what you hope to accomplish during the workout and can be visualized with something called the Modified Borg Scale of Perceived Exertion. It turns out that your perceived level of exertion can be almost as accurate of a measure of how hard you’re working as a heart rate monitor.
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| Image "borrowed" from http://sterlingwins.com/wp-content/uploads/2017/11/modified-borg.jpg |
In the case of this workout, I wanted to improve my overall endurance with a special emphasis on going up and down the steeper grades that are common while running and hiking in the southern Appalachian mountains where I live. For overall endurance, a low to moderate level of exertion is ideal because it improves the efficiency of the circulatory system while conditioning the muscles for longer duration activities. Of course, when running uphill, it’s tough to keep the level of exertion at a low to moderate level. If you look at my Strava recording, you might notice that I walked intermittently during the uphill portion of the loop, but even with the walking, I was approaching a 9/10 or “Very Hard Activity” level. This isn’t necessarily a bad thing, as “vigorous” activity a few times a week is supposed to cut the risk of stroke among men in my age range, but pushing at this level too often is thought to increase the likelihood of coronary artery disease, so like so many other things in life, moderation is key.
I should also mention that part of the advantage of incorporating hills into a workout is the way the incline can train the musculature of the legs. Generally, muscles develop strength and endurance in the range of motion in which they’re exercised, which means that if you’re always running or walking on flat ground, your legs may be really good at carrying you over flat ground, but your performance will likely suffer if you suddenly try to go up or down a hill. The fact that going uphill forces your knees, hips, and ankles to bend more means that your glute, quadriceps, and calves will be conditioned to contract in a wider range of motion, giving you better performance on a wider range of terrains. Going downhill can have benefits as well because muscles work differently to control the movement during descent than they do generating thrust during ascent. The extra challenge of controlling your speed of descent can help to condition the muscles in ways that will help you avoid injury, particularly while going downhill.
So what does this workout lack? I feel like, from the standpoint of conditioning for running or hiking on a variety of terrain, it’s pretty good. If you look at the Strava recording, you might note that it was fairly short, only 1.94 miles, which is a fair criticism. On the other hand, when you look at the fact that it’s a significant fraction of the distance and elevation gain of the longer hikes I’m trying to stay conditioned for, while investing less than a half-hour in it, this looks like a pretty relevant workout.
If you want a similar degree of insight applied to your exercise routine you should know that I’m preparing to offer one on one fitness and wellness consultation, as well as group instruction. In addition to contacting me through email at everett.stook.pt@gmail.com, you can also follow me on Facebook, Strava, and YouTube. Thanks for reading!
Saturday, July 22, 2023
Bare Your Sole
I have posted this article on other blogs, but I chose to post it here as well because I feel that it's a good representation of my philosophy about running and physical activity in general. It provides a sample of what you can expect if you attend one of my natural running workshops.
In various blog entries you may see me mention barefoot running or minimalist running or a natural running gait pattern, but what do these terms actually mean?
For many of us (myself included before PT school and further self education) there's the tendency to think of running as "pounding the pavement"- putting one foot in front of the other without any real thought about technique. Most of us, at least in western cultures, have been taught by default that running is just a matter of plodding along and hoping that we don't get hurt as the miles add up. If we make adjustments to our approach to running, it's more likely to be changing out our shoes than an adjustment to our technique.Having said that, when it comes to injury prevention, running efficiency, and general enjoyment of the sport; there is strong evidence that technique is more important than footwear. And, surprisingly (at least to those of us who started running in the second half of the twentieth century) less cushioned or supportive the footwear arguably promotes better technique. There is historical, evolutionary, and biomechanical support for this position.
The historical and evolutionary evidence go hand in hand. For the vast majority of human history, we did not have access to synthetic materials used to cushion modern running shoes, yet running predates the emergence of our species. Bram Stoker, Thomas Jefferson, and Philippides are examples of historical figures whose running exploits predated EVA foam, gel, and air cushions
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| Australopithecus afarensis footprint |
From the standpoint biomechanics (my area of expertise) barefoot running makes a lot of sense. First, let's look at conventional running shoes and how they influence running technique. The conventional running shoe, developed over the course of the latter half of the twentieth century, focused on adding cushioning, particularly at the heel. This increased bulk at the heel, promotes an increased heel strike. Running with a heel strike, in turn, means a tendency to impact the ground with the foot ahead of the center of mass of the body and the knee straight. Having the foot impact the ground ahead of the center of mass negates some of the forward motion, thus wasting energy. More significantly, impacting the ground with a straight knee sends the force of the impact through the lower leg, upper leg, through the hip and into the back. With heel impact and straight knee, there isn't a whole lot that the muscles can do to absorb shock.
Running barefoot, or in shoes without a rise from toe to heel, it's easier to land on the forefoot or midfoot, with the foot directly under the center of mass. In addition to being able to move forward without the wasted energy of landing ahead of the center of mass, this makes it easier to land with the knee slightly bent. Landing with a bent knee means that the quadriceps (the muscles on the front of the thigh) and the gluteal muscles (the buttocks) can absorb much of the shock of impact. Also, landing on the forefoot or midfoot means that the ankle has room to dorsiflex (bringing the toes closer to the knee), which gives the calf muscles the opportunity to absorb shock as well. Studies utilizing special plates that can detect the intensity and direction of impact while running have shown that the ability to recruit the above muscle groups is much better at managing the impact of running than any shock absorbing materials that can be built into shoes.
The result of a natural gait pattern is not so much "pounding the pavement" as continually adapting to the running surface to minimize impact. In the book Born To Run, author Christopher McDougal describes highly accomplished distance runners brushing the ground with each step. (I'm paraphrasing since the book isn't right in front of me.) While I haven't developed my technique to the point where I can move with that level of grace, it does allow me to run barefoot on asphalt, concrete, and brick with significantly less knee pain than I would experience after running the same distances on the same surfaces in conventional running shoes with conventional biomechanics.
| Lightweight sandals and a pair of shorts: Minimal equipment required! |
In addition to injury prevention, there's also an aesthetic, almost spiritual, case to be made for natural running. In my case, I like the idea of moving the way people have moved for millions of years. I enjoy the feeling of moving unencumbered by heavy (or any) footwear. I appreciate being able to feel the changes in the ground under my feet. When running naturally, I like to think that I'm running the way humans were designed to run. There's also something very compelling about the simplicity of using a minimal amount of gear to participate in a sport.
So how do you get started with natural/barefoot/minimalist running? First, you should approach it cautiously. After a lifetime of wearing shoes, you likely don't have the foot musculature or the coordination in your legs and hips needed to run the distances you're used to without the footwear you're used to without inviting injury. Instead of throwing away your heavy running shoes, try using the most minimalist footwear that you can get away with when walking, at work, and around the house. If your feet feel pretty good after a week or two of minimalist footwear while walking, you can try running short distances (like a quarter mile) in your minimalist footwear two or three times a week and gradually increase the distance and frequency of your minimalist running from there. You might also try experimenting with landing on your mid-foot with a bent knee and your foot directly below your body while running in your conventional running shoes. (This will be easier with shoes that have less of a rise from toe to heel.) It's probably best not to try to incorporate a forefoot strike into running with conventional running shoes. In my (painfully earned) experience this makes an ankle sprain more likely. Most importantly, back off if you develop new aches and pains.
As you transition to a more minimalist style of footwear, you'll probably find yourself automatically adopting a more natural style of running because landing on your heal without the padding of conventional running shoes will be painful enough to lead you to land on your mid-foot or forefoot. If you want more tips on technique and to see this style of running in action, take a look at the videos on Barefoot Running Center's YouTube channel. Of course, you can also seek out a physical therapist experienced in gait analysis and knowledgeable about natural running. A video gait analysis, that will allow the therapist to watch you run in slow motion and offer you advice at every point of your stride, is helpful as well.
A few words of caution: If you choose to go barefoot, you should only do so on surfaces that you are reasonably sure won't cause abrasions, punctures, or burns (including chemical). Even so, you should be prepared for the possibility of these injuries and any resulting infection. Also, those with diabetes should not go barefoot due to the slower healing and greater likelihood of peripheral neuropathy associated with the condition. (I realize that this may not be a hard and fast rule due to differing levels of progression of diabetes and how well the condition may be controlled on an individual basis, but that was the advice proffered to me as part of my training, so that's the advice I pass along here.)
Having said that, I would encourage anyone with an interest in running to stop "pounding the pavement" and give natural running a try!
Introduction
Hi Everyone! Welcome to my blog! I wanted to use my first post to introduce myself. I am a physical therapist with over a decade of experience in neurological and orthopedic rehabilitation. My experience over that time has led me to believe that much of the pain, suffering, and debility I have addressed could have been prevented, or at least postponed, through improved lifestyle choices earlier in life. Because of this I want to educate and empower people to establish better health habits earlier in life in order to prevent or at least ease the suffering of the aging process.
In addition to my training and experience as a physical therapist, my philosophy about what a healthy lifestyle entails is informed by a lifelong passion for outdoor activity. I have been hiking since I was a small child and also enjoy trail running and mountain biking. I have experience rock climbing, canoing, and kayaking; and completed a through hike of the Colorado Trail. My professional outdoor experience includes guiding a variety of age groups on backpacking, canoe, and dogsled trips.
My business aspiration (still in the planning and development phase) is to offer one-on-one wellness and fitness consultation, as well as group instruction in topics like natural running. My mission is to help people live healthier, more fulfilled lives, by optimizing their well being from the standpoint of physical fitness and general self care.
Please check back often for informative articles about fitness and wellness as well as new information about services I will be offering.
Naturalizing Your Running Style: A Step-by-Step Guide
In recent years,natural running has become more popular as a way to improve the running experience and reduce the risk of injuries. Transiti...
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Soreness in the calf muscles is a common complaint of people who are trying to adopt a natural running technique because of the extra stress...
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I have posted this article on other blogs, but I chose to post it here as well because I feel that it's a good representation of my phil...
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Hi Everyone! Welcome to my blog! I wanted to use my first post to introduce myself. I am a physical therapist with over a decade of experien...

