neutral shoes with orthotics?

littlebug

Time for new footwear

Any other over-pronators with orthotics? Do you wear neutral or motion control shoes?
Physio (nearly a year ago) suggested I need both but I've never been entirely comfortable with the current shoes (Mizuno) but not sure if it's shoes/ orthotics or combination.
Any suggestions for shoes that work well with orthotics?
Much as I'd like to lose the orthotics I can't deny the difference they've made.

sconhome

A lot to do with the purpose of the orthotic.

Many orthotics are fitted for walking shoes which are generally all neutral. This is to provide correction to over pronation or excessive rolling of the ankle and foot bed.

There are a huge amount of running shoes designed to correct different levels of overpronation and as such they are engineered to take the running load of the body (3-4 times body weight) as opposed to the walking load (1-1.2 times body weight).

Other orthotics are designed to provide postural correction where one leg is shorter than the other for example or to do with back injury, hip alignment etc.

A good designer of orthotics will take into consideration the running loads, a shoe can suffice, and will make the orthotic big enough to fit your running shoe.

Many orthotics are presented for walking shoes and can be too small for a correctly sized running shoe.

HTH

Clearlier

When I'm fit and have good core body strength I wear neutral. When I'm not I need some support.

I would venture to suggest (having gone through a large collection of rubbish ones) that proper orthotics should work in just about any shoes - provided they physically fit. I even wore them in ski boots although I'm somewhat doubtful that they were necessary.

Video gait analysis would be a good idea - that way you can see which shoes work best. Quite a few shops do it now. If you mention where you live I'm sure that people can recommend somewhere.

littlebug

I went with neutral shoe (Brooks glycerin 8) in the end which feel great so far. Have to say the first shop I went to didn't inspire when the person I was dealing with couldn't even figure out the size of shoes he was looking at! Probably first day on the job or something but the advice he was giving me was crazy!

antomagoo

littlebug wrote: »

I went with neutral shoe (Brooks glycerin 8) in the end which feel great so far. Have to say the first shop I went to didn't inspire when the person I was dealing with couldn't even figure out the size of shoes he was looking at! Probably first day on the job or something but the advice he was giving me was crazy!

Just got Brooks Glycerin 8 myself and really like them, the whole area of orthotics seems to promote debate. One physio recommended that I needed orthotics with a neutral shoe, didnt solve the problem. Got a second opinion and that physio found tightness in my neck was causing the problem with my legs, no need for the orthotics

robroy1234

Specialised running shoes, orthotics - the best ever marketing con concieved by shoe and orthotics manufacturers. Majority of people do not need these type of shoes nor orthotics - yet are told that they do by unscrupulous physios and sport shops. Neutral, moderately cushioned, light weight running shoes and a good, well balanced conditioning training programme with a system of injury prevention (stretching, ice-baths, massage) is all that is needed. This route of going to physios and sport shops, getting specialised shoes with orthotics create more problems that means more visits to the physios and more dubious interventions - an ever decreasing circle....these people have no interest in your well-being or progress in running, they are only interested in your continual custom.

gottarun

robroy1234 wrote: »

Specialised running shoes, orthotics - the best ever marketing con concieved by shoe and orthotics manufacturers. Majority of people do not need these type of shoes nor orthotics - yet are told that they do by unscrupulous physios and sport shops. Neutral, moderately cushioned, light weight running shoes and a good, well balanced conditioning training programme with a system of injury prevention (stretching, ice-baths, massage) is all that is needed. This route of going to physios and sport shops, getting specialised shoes with orthotics create more problems that means more visits to the physios and more dubious interventions - an ever decreasing circle....these people have no interest in your well-being or progress in running, they are only interested in your continual custom.

I think you are being overly cynical.

From my own experience when I started running I suffered badly with knee problems which I discovered was down to using the wrong shoe. I didn't know enough to know the difference back then. I was also late in discovering running having played football for years before that.

I was properly fitted for the shoe and have as a result, managed to get the proper conditioning of my body through being able to run. I had been at point of telling myself that I could not run as I was causing myself untold injury which wouold have left me with little drive to achieve the conditioning you suggest.

I choose to repeat my custom with the shop that looked after me in the first place, because I have trust in their ability to look after my interests as a runner. 5 years and I have yet to put a foot wrong with them.

I also subscribe to the train of thought that you lessen the damage on your body by running on a hard surface. This is simply due to the increased proprioceptive feedback you receive from a stable surface. If you are being injured by incorrect shoe, or over training the feedback will inform you before you do too much damage. The danger of highly cushioned shoes and or running on soft surfaces is the extra potential for damage to occur but the feedback process to be dampened to the point of being unaware of injury as it occurs.

This is the basic principle of reverting to barefoot running, proprioceptive feedback = improved running form and overall ability.

robroy1234

Gottarun - how can I be overly cynical. I have been competing in athletics for over 25 years and never had any of the injuries as associated with running shoes/orthotics as now on the increase, only once did I allow someone make me a pair of orthotics and after two days was crippled with anterior tibia syndrome - they went straight into the bin. I first of all always choose the lightest, least techincal shoe - which is always the cheapest, I do plenty of barefoot running on grass, do regular ice-baths, and do not overtrain.
Also I quote from reliable, independently researched studies that are listed on the sportsci.org website - these studies are university researched and not in any influenced or funded by various shoe/orthotics companies. You should note the most "studies" posted on the internet are done and/or financed by these shoes/orthotics companies.

thirstywork2

Im not a big believer in Orthotics myself but I do believe there are certain people who couldn't run without them.
Having tried 3 differn't types of orthotics im now booked in with Michael Davis who makes ''insoles'' which are made from many differn't materials and not hard carbon ones.Time will tell if it works !!!
Rob I think you have had a bad experience working for people who sold orthotics to just about anyone they could and you also had a bad experience yourself but this doesn't mean they don't work for some people.
Lighest cheapest runner might work for you but not everyone.
Regarding injuries you have had more injuries than most runners I know so maybe lighest cheapest ain't working for you:p

Larry Brent

robroy1234 wrote: »

a system of injury prevention (stretching, ice-baths, massage)

no conclusive evidence this helps with injury prevention

robroy1234 wrote: »

a system of injury prevention (stretching, ice-baths, massage)

no conclusive evidence this helps with injury prevention

robroy1234 wrote: »

a system of injury prevention (stretching, ice-baths, massage)

no conclusive evidence this helps with injury prevention

robroy1234

Larry - Cryotherapy is documented to constrict capillaries,
reduce capillary permeability and blood flow (Meeusen
and Lievens, 1986) thereby attenuating swelling and the
inflammatory response (Smith, 1991) which may reduce
the negative effects associated with damaging exercise.
Algafly, A.A. and George, K.P. (2007) The effect of cryotherapy on
nerve conduction velocity, pain threshold and pain tolerance.
British Journal of Sports Medicine 41, 365-369.
Bailey, D.M., Erith, S.J., Griffin, P.J., Dowson, A., Brewer, D.S., Gant,
N. and Williams, C. (2007) Influence of cold water immersion
on indices of muscle damage following prolonged intermittent
shuttle running. Journal of Sports Sciences 25, 1-8.
Barnett, A. (2006) Using recovery modalities between training sessions
in elite athletes. Does it help? Sports Medicine 36, 781-796.
Burke, D.G., MacNeil, S.A., Holt, L.E., MacKinnon, N.C. and Rasmeussen,
R.L. (2000) The effect of hot or cold water immersion
on isometric strength training. Journal of Strength and Conditioning
Research 14, 21-25.
Byrne, C., Twist, C. and Eston, R. (2004) Neuromuscular function after
exercise induced-muscle damage. Theoretical and applied implications.
Sports Medicine 34, 49-69.
Chen, T.C. and Nosaka, K. (2006) Responses of elbow flexors to two
strenuous eccentric exercise bouts separated by three days.
Journal of Strength and Conditioning Research 20, 108-116.
Chesterton, L.S., Foster, N.E. and Ross, L. (2002) Skin temperature
response to cryotherapy. Archives of Physical Medicine and Rehabilitation
83, 543549.
Cheung, K., Hume, P.A. and Maxwell, L. (2003) Delayed onset muscle
soreness – treatment strategies and performance factors. Sports
Medicine 33, 145-164.
Clarkson, P. (1997) Eccentric exercise and muscle damage. International

There is a lot more studies on cyrotherapy. Now all you need to do is fine relevant Independent, University led research that supports the efficacy of orthotic intervention for injury prevention.

Larry Brent

robroy1234 wrote: »

Larry - Cryotherapy is documented to constrict capillaries,
reduce capillary permeability and blood flow (Meeusen
and Lievens, 1986) thereby attenuating swelling and the
inflammatory response (Smith, 1991) which may reduce
the negative effects associated with damaging exercise.
Algafly, A.A. and George, K.P. (2007) The effect of cryotherapy on
nerve conduction velocity, pain threshold and pain tolerance.
British Journal of Sports Medicine 41, 365-369.
Bailey, D.M., Erith, S.J., Griffin, P.J., Dowson, A., Brewer, D.S., Gant,
N. and Williams, C. (2007) Influence of cold water immersion
on indices of muscle damage following prolonged intermittent
shuttle running. Journal of Sports Sciences 25, 1-8.
Barnett, A. (2006) Using recovery modalities between training sessions
in elite athletes. Does it help? Sports Medicine 36, 781-796.
Burke, D.G., MacNeil, S.A., Holt, L.E., MacKinnon, N.C. and Rasmeussen,
R.L. (2000) The effect of hot or cold water immersion
on isometric strength training. Journal of Strength and Conditioning
Research 14, 21-25.
Byrne, C., Twist, C. and Eston, R. (2004) Neuromuscular function after
exercise induced-muscle damage. Theoretical and applied implications.
Sports Medicine 34, 49-69.
Chen, T.C. and Nosaka, K. (2006) Responses of elbow flexors to two
strenuous eccentric exercise bouts separated by three days.
Journal of Strength and Conditioning Research 20, 108-116.
Chesterton, L.S., Foster, N.E. and Ross, L. (2002) Skin temperature
response to cryotherapy. Archives of Physical Medicine and Rehabilitation
83, 543549.
Cheung, K., Hume, P.A. and Maxwell, L. (2003) Delayed onset muscle
soreness – treatment strategies and performance factors. Sports
Medicine 33, 145-164.
Clarkson, P. (1997) Eccentric exercise and muscle damage. International

There is a lot more studies on cyrotherapy. Now all you need to do is fine relevant Independent, University led research that supports the efficacy of orthotic intervention for injury prevention.

Robroy, hence I italicised conclusive evidence. Above is some evidence that cryotherapy may have some effects. But not specifically in relation to injury prevention or improved performance. And a lot of the research wouldn't be of great quality. So nobody can stand up and proclaim stretching, ice or massage to be effective for injury prevention or improved performance.

What you need to look for is a systematic review of the research.

Edit I never mentioned anything in relation to orthotics, only stretching, ice and massage. I am fully aware there is no conclusive evidence that orthotics are effective in reducing injury incidence or improving sports performance.

Micilin Muc

robroy1234, your posting today is worrying me.

You've resurrected a few threads, one of them over 5 years old, to talk about orthotics and your disapproval of them.

I'm a newbie to running and my (sports) physio has mentioned to me that I may need orthotics so I've been reading a few of the threads today.

I'm not saying you're wrong about what your saying, to be honest I haven't a clue if you are or not. But the way you're going about it is definitely making me doubt what you're saying.

Do you have a vested interested in athletes not using orthotics or why are you bringing up these old threads?

Konarider

I am going to simplify this and as someone who works in a clinic with Athletes I feel qualified to speak on it. Here is my simplistic view but one which translates aptly, If you were a carpenter asked to fix a door that was hanging wrong you wouldn't jam a piece of timber underneath it to make it hang right because when you remove the door is back to square one.
Orthotics work on a similar principle in forcing the foot into an optimal position.
My uncle also ran Cross Country for Ireland at world and European Championships and was National Marathon Champion during the 80's and he feels that the chronic knee pain he suffers now is directly attributed to his use of orthotics during his running career.

I don't believe that corrective stretching or cryo treatment can solve the problem either, they can alleviate pain alright but as far as functional rehab goes they would need to be used in conjunction with corrective exercises. Such as pulling a tea towel towards yourself with your toes to build up the muscle and tendons which provide the arch in your foot.

Orthotics are on the rise because more and more people are running, many people may be experiencing issues because it is a new movement for them or they may be overweight causing the sole to flatten out. There are many variables to look at here I myself don't believe in orthotics as they are a temp solution to a long term problem.

Clearlier

Konarider wrote: »

Orthotics work on a similar principle in forcing the foot into an optimal position.

Possibly splitting hairs here but my orthotics don't force my foot into the 'correct' position and the orthotics (several pairs) that I got before my current ones that did try to do that were abject failures. The ones that I have simply prevent my heel from going too far over

Konarider wrote: »

My uncle also ran Cross Country for Ireland at world and European Championships and was National Marathon Champion during the 80's and he feels that the chronic knee pain he suffers now is directly attributed to his use of orthotics during his running career.

Sorry to hear about your uncle's knee. It must be incredibly frustrating for him to have this pain when he used to perform at the highest level.

Konarider wrote: »

Orthotics are on the rise because more and more people are running, many people may be experiencing issues because it is a new movement for them or they may be overweight causing the sole to flatten out. There are many variables to look at here I myself don't believe in orthotics as they are a temp solution to a long term problem.

Even if they are just a temporary solution I think that they can have some value as just that, i.e. to get somebody off the couch and running to help them lose weight possibly to the point that they don't need the orthotics anymore (assuming that it's extra weight that caused the need).

Despite being a user I'm not the worlds greatest fan of orthotics. I don't think that it helps though that the world and his uncle are out there selling total rubbish at professional prices to an unsuspecting public. I must have spent >€1,000 on what I now know to be worthless garbage produced by charlatans who hoodwinked me into thinking that they knew what they were talking about. More fool me perhaps but judging by the amount of people at their stands during expo's etc. I'm far from the only one.

What makes it even harder to get good orthotics is that you have otherwise reputable professionals thinking that they can prescribe them. More than one physio has prescribed for me and others can't understand why mine work (usually think that they're too hard). Orthotists spend 4 years learning how to make orthotics and prosthetics. Physios spend 4 (5?) years studying physiotherapy. Who would you go to see about orthotics?

robroy1234

Larry - I have been in athletics for over 25 years and competed at International level, I also have a Masters in Sport Science and trained and worked in physical therapy and research, so doubt me all you want. The research that I posted previously is only a small section of cyrotherapy, and does consist of ice-baths etc., somehow you suddenly become an expert on these particular research projects and state that cyrotherapy does not use ice-baths. On top of ice-baths, massage, stretching there are foot strengthening exercises that are recommended such as picking up marbles with the toes, toe-towel crunching, bare-foot jogging on grass. I fully concur with Konrider, and that orthotics are a temporary adjustment to be used for cases such as the analogy of propping up the door. The problem here is that physios, orthotists, GPs etc., are prescribing them as a long term, permanant solution without taking heed of long term damage, and without the inclusion of feet strengthening exercises, stretching, massage etc.,

robroy1234

Micilin Muc - Do you have a vested interested in athletes not using orthotics?

So orthotics will cost you €300 - €400 per pair, physio treatment prior to a after orthotics €50 per time, specialised running shoes €100 per pair. Plus the added bonus of Plantar Fascia problems, anterior tibia syndrome, knee problems, hip problems and achilies tendonitis - that all sounds like a great deal...

Whereas the simplicity of running barefeet on grass €0. picking up marbles with the toes €2 (for the marbles) toe-towel crunch - an old towel will do, homemade ice-bath - €20 or so for the bucket - cold water + ice. Light weight, neutral running shoe €40 - €50.
So yeah I have a vested interest - mainly the vested interest is not getting ripped off by those who do more damage to the sport of athletics than anyone else.

gottarun

My comment re being overly cynical is in relation to the general sweeping statement:

these people have no interest in your well-being or progress in running, they are only interested in your continual custom.

And while I agree in principle with a lot that you have to say about proper maintenance of the body through icing, stretching and massage. To say that every body can simply go from being an overpronator to a nice tidy neutral runner through this process is not true and is quite misleading for a lot of inexperienced runners who may be browsing the forums looking for advice.

As most of us are not specialists in biomechanics, physiotherapy of muscloskeletal problems, orthotics are intended for use as a crutch to help the normal person attain the correct foot position for the majority of their daily pursuits. They help position problem feet in the optimum setting to allow correct muscular development of the limbs which will in the future allow the user to wean off the orthotic and maintain their foot in the neutral form.

All to often people become dependent on the orthotic which makes the body lazy and further exasperates their problems as they start to limit the range of natural movement and ability of the feet to self support.

Another sweeping statement which I think is irresponsible of someone with your experience is to use a big brush to apply tar.

robroy1234 wrote: »

mainly the vested interest is not getting ripped off by those who do more damage to the sport of athletics than anyone else.

To whom are your referring? It is the physios? the orthotic designers? running companies? or shoe salepeople that we should be wary off?

Running is suprisingly individual and the method I use to transition to barefoot or minimalist running will not suit others. I want to remain injury free, and so far I have done this through ice, stretch, massage and the correct shoe. I also have a great routine of rolling, all of which I consider normal maintenance. To someone else the cost of going to an NMT every 6 weeks and the hassle of stretching or icing may be an indicator that they are injured. I do it to remain injury free and am happy to do so.

robroy1234

To say that every body can simply go from being an overpronator to a nice tidy neutral runner through this process is not true and is quite misleading for a lot of inexperienced runners who may be browsing the forums looking for advice.

In all my experience at looking at feet, gait analysis and biomechanics of a multitude of people - runners and non-runners I have only ever seen two people who actually have "flat feet" - fallen arches, collapsed Plantar Fascia. All the people that I have seen, who have been told that they have flat feet, over-pronate, etc., on footscan and through gait analysis, and also looking at the wear pattern on their shoes, I have never seen one. The physios that I have once worked for had absolutely no qualms about telling every person that walked into the shop that they needed orthotics, and that they had flat feet, and people with high arches also needed orthotics. Not surprisingly I was appalled at such blatant misinformation in order to profit.

To whom are your referring? It is the physios? the orthotic designers? running companies? or shoe salepeople that we should be wary off?

you should be wary off all these people - especially when they are charging excessively for things that are for most of the time unnecessary and in the long run - damaging. I have no vested interest only to highlight that to spend €300-€400 on orthotics, €120 for corrective shoes, €50 per time physio., one has to look and say that is a lot of money for a pair of orthotics that wholesale at €20, running shoes for less than €50, and simple, quick exercises.

robroy1234

The two people that I saw who had flat feet - were both morbidly obese. A woman in her late 50s and a teenage boy, both were extremely overweight and had a multitude of other problems. The ordinary (non-running) people on the whole have normal, unaffected feet and athletes such as sprinters, hurdlers, jumpers tend to have very high arches whereas the longer the distance, the feet are just as normal.
I know a good number of former top athletes have their running careers cut short by extremely dodgy treatment and information from these unscrupulous people (orthotists, physios, running school experts), one I know very well a 63 minute half-marathoner, who only went to a physio to treat a stiff back after a day of gardening. The physio went on about orthotics, specialised correctional shoes and biomechanical realignment etc., so an expensive pair of orthotics made, sold and placed in his shoes. Not only did the pain in the back got worse, but also pain in the knees, ankles, calves, plantar and anterior tibia. The physio then recommended knee and ankle straps -which restricted movement and therefore put pressure on his hips, and the pain persisted. He was unable to maintain his normal running action and form, and thanks to the intervention strategies needed surgery for anterior tibia syndrome, on his knees and ankles.
A successful running career cut short for good, a rack of injuries and problems, a hefty cost, and physio who made plenty of money later left the country and living in wonderful retirement on the Costa Del Sol.

Larry Brent

robroy1234 wrote: »

The research that I posted previously is only a small section of cyrotherapy, and does consist of ice-baths etc., somehow you suddenly become an expert on these particular research projects and state that cyrotherapy does not use ice-baths.

Rob, of course it is only a small section and there is a lot more out there, but you have to agree, there is no conclusive evidence that cryotherapy is effective. As in multiple, high quality trials.

robroy1234 wrote: »

On top of ice-baths, massage, stretching there are foot strengthening exercises that are recommended such as picking up marbles with the toes, toe-towel crunching, bare-foot jogging on grass.

Again, there is no evidence that these are effective. They may appear logical, but this is not evidence!

I agree with you in principle that orthotics are overprescribed. They may be appropriate in cases of structural flat feet, but the majority of people 'diagnosed' with flat feet have a dynamic rather than a structural problem (in my opinion). In that respect intrinsic foot strengthening may be more appropriate. However I would suggest that the problem is higher up the kinetic chain. Improving muscle recruitment / tone / motor control around the pelvis / hips in particular is likely to improve lower limb alignment and reduce / resolve the dynamic flat foot problem.

Reduced recruitment (and sometimes strength) of the gluteal muscles has been found in runners with knee pain, tibial stress fractures and overpronation issues. Rehabilitation of these hip muscles has led to improvements in these conditions in some cases. There are a number of groups in the US researching this at the moment. So once again I agree with you in principle that 'conditioning' (I'd prefer the term improving motor control) is probably the key to this, but think that looking more proximally may be more beneficial. i.e. strengthening someone's foot may not be that effective if it's 'weak' in the first place due to a problem higher up.

robroy1234

Rob, of course it is only a small section and there is a lot more out there, but you have to agree, there is no conclusive evidence that cryotherapy is effective. As in multiple, high quality trials.

No. I do not agree at all with your premise, and it is more apparant that no matter how many studies that show the efficacy of cryotherapy, you just close your eyes, put hands over your ears and go "na na na na..."
Not, only with studies that are backed, but throughout the US, high schools, colleges and universities have in their athletic departments ice-baths, ice-bins, and in some places cryotherapy chambers - but I suppose you know better than anyone else, and that all these ignorant people don't know what they doing. I suppose that Mo Farah's programme of proper training, diet and cryotherapy is just a fluke, the same way that Kelly Holmes, Seb Coe, Paula Radcliffe use of cryotherapy....

Again, there is no evidence that these are effective. They may appear logical, but this is not evidence!

Wrong - there is plenty of evidence and independent university research into the efficacy of barefoot running, and strengthening exercises for the feet. Even ancedotally the likes of Arthur Lydiard was into the barefoot running and lightweight neutral running shoes.

Clearlier

Larry Brent wrote: »

Rob, of course it is only a small section and there is a lot more out there, but you have to agree, there is no conclusive evidence that cryotherapy is effective. As in multiple, high quality trials.



Again, there is no evidence that these are effective. They may appear logical, but this is not evidence!

I agree with you in principle that orthotics are overprescribed. They may be appropriate in cases of structural flat feet, but the majority of people 'diagnosed' with flat feet have a dynamic rather than a structural problem (in my opinion). In that respect intrinsic foot strengthening may be more appropriate. However I would suggest that the problem is higher up the kinetic chain. Improving muscle recruitment / tone / motor control around the pelvis / hips in particular is likely to improve lower limb alignment and reduce / resolve the dynamic flat foot problem.

Reduced recruitment (and sometimes strength) of the gluteal muscles has been found in runners with knee pain, tibial stress fractures and overpronation issues. Rehabilitation of these hip muscles has led to improvements in these conditions in some cases. There are a number of groups in the US researching this at the moment. So once again I agree with you in principle that 'conditioning' (I'd prefer the term improving motor control) is probably the key to this, but think that looking more proximally may be more beneficial. i.e. strengthening someone's foot may not be that effective if it's 'weak' in the first place due to a problem higher up.

Hi Larry, I don't suppose you have any tips/know of any guides for strengthening/improving motor control of the hip/pelvis area?

robroy1234

Clearlier - the Kinetic Chain theory is that the injury/pain moves up or along the kinetic chain - so from the ankle to the knee, then from the knee to the hips and down again. The only problem is where the origin of the injury lies - is it from the feet or from the hips. Therefore you have a chicken and the egg situation. Is the problem in the hips, or with the length of the leg - I am somewhat astounded by the claims that some people make about one leg being longer than the other - to such an extent that they wouldn't be able to walk properly let alone run. What I am very much disturbed about and the reason I am bringing this subject matter up - is the extent and level of exageration of biomechanical/skeletal structure and injuries that is apparant in the area of sport physiotherapy. People are getting told that they need orthotics, when their feet are absolutely fine. They are getting highly expensive shoes with gimmicks and extras that are mostly unneeded. They are getting fleeced in the manner that shows these "physios" have scant regard for their clients.

As for strengthening the hip/pelvis area - Pilates and core strengthening exercises on the swiss ball. Barefoot jogging on grass, Aqua-jogging, aqua-drills, and aqua-aerobics, and hill running.

BobMac104

Hi robroy, what is your opinion on heel to toe height differential in running shoes. Is there a need for any in your opinion??

Larry Brent

robroy1234 wrote: »

No. I do not agree at all with your premise, and it is more apparant that no matter how many studies that show the efficacy of cryotherapy, you just close your eyes, put hands over your ears and go "na na na na..."

Rob, we'll probably have to agree to disagree. Analysis of research needs to be critical - one can't just take the results at face value. If you don't believe me try typing - ice OR cryotherapy AND rehabilitation - into pubmed. Top article this morning is a 2011 British Journal of Sports Medicine paper by Phil Glasgow and colleagues. The first line of the abstract...'Ice is commonly used after acute muscle strains but there are no clinical studies of its effectiveness.' While there have been loads of studies into ice, few if any could be used to support the general advice re ice in rehabilitation and prehabilitation. That's not to say that it's not effective, just that there is no evidence as to whether it's effective or not.

If you type in - cold water immersion - a systematic review from 2010 begins 'Cold-water immersion (CWI) is a popular recovery intervention after exercise. The scientific rationale is not clear, and there are no clear guidelines for its use. ' It goes on '16 studies were included. Sample size was restricted, and there was a large degree of study heterogeneity. CWI was associated with an increase in heart rate, blood pressure, respiratory minute volume and metabolism. Decreases in end tidal carbon dioxide partial pressure and a decrease in cerebral blood flow were also reported. There was evidence of increases in peripheral catecholamine concentration, oxidative stress and a possible increase in free-radical-species formation.' This shows that it does indeed cause changes or have effects. But who is to know (yet) whether these are beneficial or not? Is reducing blood flow to the brain beneficial? The next step is needed - to determine whether these changes have any meaningful/positive effect in the clinical/sports performance setting. Interestingly they say 'The magnitude of these responses may be attenuated with acclimatisation.' So maybe once we get used to the trauma of getting in the cold bath it's not as effective anyhow. The abstract concludes with the sentence 'The physiological and biochemical rationale for using short periods of CWI in sports recovery still remains unclear.'

All I'm saying is that there is no conclusive evidence. Hence advocating that all sports people use ice (and similarly do stretching or have massage) is no different to prescribing everyone orthotics! It's essentially advocating non-evidence based interventions.

robroy1234 wrote: »

throughout the US, high schools, colleges and universities have in their athletic departments ice-baths, ice-bins, and in some places cryotherapy chambers - but I suppose you know better than anyone else, and that all these ignorant people don't know what they doing.

Once upon a time jumping in the communal hot bath was the thing to do after a top level soccer match. The great Liverpool team of the 70s (arguably the best club side in the world at that time) had 2 secrets to their success. One was not to shower after the game. The theory was that allowing pores to close before showering was better. So they wouldn't shower after away games till they got back to Anfield. The second secret to their success was to stop for fish and chips on the way home for games.

Just because someone else does it, even if their the best doesn't mean it's effective.

robroy1234 wrote: »

I suppose that Mo Farah's programme of proper training, diet and cryotherapy is just a fluke, the same way that Kelly Holmes, Seb Coe, Paula Radcliffe use of cryotherapy....

Sonia made a comment in her book along the lines that she didn't know if ice baths were effective at all but she didn't care - if there was any chance of it having an effect she's use it. And the fact that it was difficult made it better - the harder the better.

robroy1234 wrote: »

Wrong - there is plenty of evidence and independent university research into the efficacy of barefoot running, and strengthening exercises for the feet. Even ancedotally the likes of Arthur Lydiard was into the barefoot running and lightweight neutral running shoes.

I'm not sure if such research would withstand a critical review. A 2011 Cochrane Review into 'Interventions for preventing lower limb soft-tissue running injuries' makes interesting reading, some highlights below...

The interventions tested in the included trials fell into four main preventive strategies: exercises, modification of training schedules, use of orthoses, and footwear and socks. We found no evidence that stretching reduces lower limb soft-tissue injuries (6 trials; 5130 participants; risk ratio [RR] 0.85, 95% confidence interval [95% CI] 0.65 to 1.12). We found no evidence to support a training regimen of conditioning exercises to improve strength, flexibility and coordination (one trial; 1020 participants; RR 1.20, 95% CI 0.77 to 1.87).We found no evidence that a longer, more gradual increase in training reduces injuries in novice runners (one trial; 486 participants; RR 1.02, 95% CI 0.72 to 1.45). There was some evidence from a poor quality trial that additional training resulted in a significant increase in the number of naval recruits with shin splints (one trial; 1670 participants; RR 2.02, 95% CI 1.11 to 3.70). There was limited evidence that injuries were less frequent in prisoners when running duration (one trial; 69 participants; RR 0.41, 95% CI 0.21 to 0.79) or frequency (one trial; 58 participants; RR 0.19, 95% CI 0.06 to 0.66) were reduced.Patellofemoral braces appear to be effective for preventing anterior knee pain (two trials; 227 participants; RR 0.41, 95% CI 0.24 to 0.67).Custom-made biomechanical insoles may be more effective than no insoles for reducing shin splints :eek::eek::eek::eek:(medial tibial stress syndrome) in military recruits (one trial; 146 participants; RR 0.24, 95% CI 0.08 to 0.69).We found no evidence in military recruits that wearing running shoes based on foot shape, rather than standard running shoes, significantly reduced rate of running injuries (2 trials; 5795 participants; Rate Ratio 1.03, 95% CI 0.93 to 1.14).

Larry Brent

Clearlier wrote: »

Hi Larry, I don't suppose you have any tips/know of any guides for strengthening/improving motor control of the hip/pelvis area?

Clearlier, a common presentation in a number of different running related injuries that the hip collapses in a tad. Undetectable by the naked eye in many case, but on foot contact with the ground due to poor eccentric control of some hip muscles, usually the gluteus medius and maximus.

To address this problem you need specific exercises - i.e. you need to exercise the culprit muscles under the conditions in which they are failing, i.e. when the foot contacts the ground, i.e. weight-bearing. And 'core' type exercises that are floor based are unlikely to be helpful. Transfer of training does not typically occur, i.e. specificity of training is crucial.

So squats, lunges and deadlifts (using body-weight is fine) while maintaining form will be best to start off with. You would then need to focus on recruiting these muscles (or more tangibly stop the hip form collapsing in) when actually running. If you send me a PM I could send you pictures.


Rob makes a good point about less people being actually flat footed (structurally) than is often made out. 25% of people will appear to have dropped arches when viewed standing up. When you lie them down not that many will still have fallen arches. So it is a dynamic / weight-bearing issue rather than structural in those cases. I don't think it's an issue of intrinsic foot muscle weakness in many cases at all. Hence foot strengthening exercises are not likely to be effective. More often than not, it's due to poor control / recruitment of hip muscles, which leads to the hip slightly turning in. This brings the centre of gravity of the lower limb more towards the midline of the body and hence the weight of the limb goes through the ground closer to the midline - i.e. more of the inner surface of the sole of your foot will contact the ground than should. Or you will appear to have fallen arches. What Rob may be arguing correctly is that often such people are incorrectly prescribed orthotics. A simple test is to get them to squeeze their buttocks in standing. If this 'raises' their arches, this points you in the direction that they need more tone or recruitment of the buttock muscles. Hope that helps.

robroy1234

Larry - we will have to agree to disagree, as I can draw up as many independent, university led studies to support cryotherapy, as well as a many studies that indicate that barefoot running causes less stress on the body than highly cushioned shoes. Then we can go back and forth in an endless debate on the merits, reliability and validity of each and every study. As for the time immersion cryotherapy treatment which the GAA medical council then based its assessment that the whole system of cryotherapy doesn't work is entirely flawed. One minute in and one minute out - but then again the GAA/soccer lot are not the sharpest tools in the box.
Anecdotally every olympic/international athlete that I know personally do on a consistent basis ice-baths, mainly after training and competition. I have a complete diary of my own progress at college in California with training, treatment, preparation and racing, running 4 miles cross country consistently and going from 20:20 to 19:20 in 12 weeks.

yop

robroy1234 wrote: »

Larry - we will have to agree to disagree, as I can draw up as many independent, university led studies to support cryotherapy, as well as a many studies that indicate that barefoot running causes less stress on the body than highly cushioned shoes. Then we can go back and forth in an endless debate on the merits, reliability and validity of each and every study. As for the time immersion cryotherapy treatment which the GAA medical council then based its assessment that the whole system of cryotherapy doesn't work is entirely flawed. One minute in and one minute out - but then again the GAA/soccer lot are not the sharpest tools in the box.
Anecdotally every olympic/international athlete that I know personally do on a consistent basis ice-baths, mainly after training and competition. I have a complete diary of my own progress at college in California with training, treatment, preparation and racing, running 4 miles cross country consistently and going from 20:20 to 19:20 in 12 weeks.

Based on what? Personally I would take as someone involved in both for near 30 years, as would a hell of a lot more, as a bit of a stupid generalization and portrays a level of ignorance.

As I have found in my line of work, a degree in the discipline gives a person a piece of paper and the ability to regurgitate endless reams of numbers and facts, but ask them to put it into practice and some just crumble into spoofers without the practical ability to do it.

As the saying goes, talk the talk but can they walk the walk

robroy1234

Bobmack - the situation with the Toe - to - heel difference or offset has come on the backfoot of the minimalist shoes. The main theory stems that people are running too heavily on to their heels and then transferring weight over the last and then toeing off. Such heaviness in running is biomechanically unsound and would be like trying to drive your car one foot on the acelerator and the other foot on the break, and alternating between them both. The ideal running pattern is to land mid-foot, and to do this you need to slightly lean forward so your hips are above your knees. You also need to lift your hips up and forward and not "sit in the bucket." The weight of the shoe is important. Certain studies have found that shoes that are heavier and compacted with extras and cushioning actually result in greater levels of stress on the legs therefore negating any desired cushioning.
You are probably looking at running shoes such as the Newtons which have a raised forefoot - I have tried these myself, and raced in them. I found them ok and ran reasonably well, but I do not go overboard into looking at brands of shoes. I go for a running shoe that suits and that I feel comfortable with, which is a shoe that feels as close to barefoot running as possible. The Heel-toe thing - interesting, but will it make you run faster and without injury?

Larry Brent

robroy1234 wrote: »

Larry - we will have to agree to disagree,

Sounds good, we need different opinions to push things forward, get the research done etc.

Best of luck with the training and work.

robroy1234

Yop - What I am referring to with the GAA/Soccer lot was the manner and method in which the GAA medical council decided that cryotherapy didn't work. They based their assumption on a group of intercounty players, did not have a control group, the methodology and protocol was haphazard and unclear. The system of one minute in-one minute out, is not even used anywhere nor have been part of any research. The length of time normally agreed with the collegiate system in the US is 10 - 20 minutes. Some universities in the states have also invested in cryotherapy chambers.

So the GAA medical council threw out cryotherapy and the soccer lot followed suit - based on extremely poor, unverifiable, unreliable, and invalid research methods.

I was referring to those on the council and not your ordinary GAA/ Soccer player.

yop

robroy1234 wrote: »

Yop - What I am referring to with the GAA/Soccer lot was the manner and method in which the GAA medical council decided that cryotherapy didn't work. They based their assumption on a group of intercounty players, did not have a control group, the methodology and protocol was haphazard and unclear. The system of one minute in-one minute out, is not even used anywhere nor have been part of any research. The length of time normally agreed with the collegiate system in the US is 10 - 20 minutes. Some universities in the states have also invested in cryotherapy chambers.

So the GAA medical council threw out cryotherapy and the soccer lot followed suit - based on extremely poor, unverifiable, unreliable, and invalid research methods.

I was referring to those on the council and not your ordinary GAA/ Soccer player.

Fair enough, just sounded like a bit of a generalization

robroy1234

Larry - the whole basis of research is about tweeking out these differences. Thats why when I talk about Sport Psychology I make sure that 1. it is nothing to do with motivational speaking. There are too many fellas going around doing motivational talks and saying that it is sport psychology. 2. That the practice of Academic Sport Psychology and Applied Sport Psychology are well defined and approached.

In relation to research Academic Sport Psychology is highly entrenched in the system, the only problem is that there still is a huge gap between research analysis and actual performance on the track. For example back in 2000, I was in my prime and looking for a spot on the British Olympic team, I was working on my Masters in Sport Science and so I was Physiologically tested on a regular basis. My VO2Max after numerous tests reached the remarkable level of 90.13 ml/kg/min-1 with the treadmill speed 23km/hour gradient 3% and OBLA and heart rate etc., measured and recorded. Yet my performances on the track were getting worse when my performance on the tests improved. What was noted and attributed to the difference were:
1. training effect on running on the treadmill.
2. the competitive environment on the track is vastly different from running on the treadmill - i.e. other runners, weather, running technique.
3. the movement of the body whilst running on the treadmill is vastly different from running on the track. Different level of muscle stimulation and the body's centre of gravity.
4. Competitive running where a fast start brings an athlete into oxygen debt earlier on whereas on the treadmill speed is slowly built up. This runs contrary to how one would actually race on the track - even if you do race in negative splits the amount of effort has to be increased despite the reduction in pace.

robroy1234

Larry - what I found with physiological testing, gait analysis, biomechanic analysis etc., is a huge scope for the error of committing False-Positives. Consider that looking at the numerous East African athletes that have succeeded over the years then fall prey to the "physiologists." One fella Zersenay Tadesse, former World Cross Country Champion and 4 times World Half-Marathon champion going fantastically until he got caught up with the physiological testing crowd. They went wild with excitement over his VO2, and OBLA and Mitchondria density and with that his performances fell apart.

If there is perchance that at the London 2012 games they will have a section for athletes that have orthotics, with specialised straps and taping, with the medals going to those with the highest VO2Max/OBLA in conjunction with the treadmill speed, gradient and environmental conditions - then we as a nation stand a great chance in getting that medal.

Gluteus maximus

After all that, what is the view on orthotics then?

Scam or legitimate?

And if the latter, do you take the insoles out of your shoes before putting in the orthotic? Getting conflicting advice from different people.

Sorry for resurrecting old thread.

robroy1234

Total and utter scam. If you have leg and feet injuries and told you need orthotics, or go into a shop and told that you need motion control/support shoes, then go to a well mowed soccer/football pitch and jog barefoot on grass everyday for three weeks. You will then see that this supposed need for motion control/support/orthotics etc all go out off the window. Then look at what the east Africans wear - light weight, neutral shoes. As the old saying goes "if its not broke, don't fix it."

GKiraly

While im not going to shoot down the non-use of orthotics totally, in fact, another boardie on one of the other threads in Gears & Equipment made a good point about niggles and injuries leading back to structural and functional problems and that orthotics pretty much just sweep the fundamental problem under the carpet, I can only put forward my own positive feedback towards what theyve done for me.
For myself personally, I was years going to physios as I was constantly getting niggles, aches, injuries, then lately I got orthotics - trips to physios gone by wayside, no more injuries, and time and running effort improving all the time.
As I side, thats not to say just cause orthotics appear to have worked for me - in the recent short term anyway - that they are the problem to structural issues with gait and stride. They just happened to have solved my years of problems. Hopefully it will continue. But im open to other theories, that, potentially, could get me out of orthotics in the future if better solutions proved themselves more credible. So if one was to point me in the direction of better sources of info for where I could get to the root of the problem that lead to me getting orthotics in the first place, id be welcome to hear it! I was sceptical for long enough about getting them until I finally gave in as all other avenues of hope were slowly diminishing so im always open to newer and better ideas. For now, its happy running!

dahat

GKiraly wrote: »

While im not going to shoot down the non-use of orthotics totally, in fact, another boardie on one of the other threads in Gears & Equipment made a good point about niggles and injuries leading back to structural and functional problems and that orthotics pretty much just sweep the fundamental problem under the carpet, I can only put forward my own positive feedback towards what theyve done for me.
For myself personally, I was years going to physios as I was constantly getting niggles, aches, injuries, then lately I got orthotics - trips to physios gone by wayside, no more injuries, and time and running effort improving all the time.
As I side, thats not to say just cause orthotics appear to have worked for me - in the recent short term anyway - that they are the problem to structural issues with gait and stride. They just happened to have solved my years of problems. Hopefully it will continue. But im open to other theories, that, potentially, could get me out of orthotics in the future if better solutions proved themselves more credible. So if one was to point me in the direction of better sources of info for where I could get to the root of the problem that lead to me getting orthotics in the first place, id be welcome to hear it! I was sceptical for long enough about getting them until I finally gave in as all other avenues of hope were slowly diminishing so im always open to newer and better ideas. For now, its happy running!

Where did you go for your orthotics?

robroy1234

As a former professional in the orthotics/ shoe industry, plus doing academic research in gait analysis and biomechanics I can pretty state from most academic research is against orthotics and specialized shoes. For people with structural problems with their feet need to have a good look at why their feet are structured in such a way, and paying €300 - €400 for orthotics only delays the inevitable or just exacerbate any existing condition. Since the market explosion in othotics and specialized shoes the level of lower leg injuries have increased, with a strong correlation between orthotics and Anterior Tibia Syndrome.
Simple foot exercises, such as picking up marbles with the toes and toe-towel crunching, strengthens the plantar fascia as well as bare foot running on grass. The idea is to return the feet and legs to its natural way of moving when running. During my time in the industry and looking at thousands of feet on foot scanners, my own findings agree with academic studies that indicate that the vast majority of people do not have flat feet (Pes Planus). That the people who are selling orthotics and specialized shoes are providing misinformation concerning the feet in relation to their products, such as in the case of flat feet the plantar fascia can no longer be strengthened.
Considering that people in Ireland and UK are up in arms over the banks miss-selling products and ripping people off, it appears that certain runners are just as happy to be miss-sold and ripped off by being duped into buying unneeded orthotics and specialized shoes.
It is a lucrative market considering the charges these people have - €125 for gait analysis, €300 for orthotics, €100 for specialized shoes, €50 per time for physio, and as an extra a 6 week training programme for €300.
You will have to ask yourself why athletes in the past didn't suffer lower leg injuries as badly as runners do now and why African athletes also have less incidences of lower leg injuries.

Clearlier

robroy1234 wrote: »

As a former professional in the orthotics/ shoe industry, plus doing academic research in gait analysis and biomechanics I can pretty state from most academic research is against orthotics and specialized shoes. For people with structural problems with their feet need to have a good look at why their feet are structured in such a way, and paying €300 - €400 for orthotics only delays the inevitable or just exacerbate any existing condition. Since the market explosion in othotics and specialized shoes the level of lower leg injuries have increased, with a strong correlation between orthotics and Anterior Tibia Syndrome.
Simple foot exercises, such as picking up marbles with the toes and toe-towel crunching, strengthens the plantar fascia as well as bare foot running on grass. The idea is to return the feet and legs to its natural way of moving when running. During my time in the industry and looking at thousands of feet on foot scanners, my own findings agree with academic studies that indicate that the vast majority of people do not have flat feet (Pes Planus). That the people who are selling orthotics and specialized shoes are providing misinformation concerning the feet in relation to their products, such as in the case of flat feet the plantar fascia can no longer be strengthened.
Considering that people in Ireland and UK are up in arms over the banks miss-selling products and ripping people off, it appears that certain runners are just as happy to be miss-sold and ripped off by being duped into buying unneeded orthotics and specialized shoes.
It is a lucrative market considering the charges these people have - €125 for gait analysis, €300 for orthotics, €100 for specialized shoes, €50 per time for physio, and as an extra a 6 week training programme for €300.
You will have to ask yourself why athletes in the past didn't suffer lower leg injuries as badly as runners do now and why African athletes also have less incidences of lower leg injuries.

Hi Rob, I completely agree that there is a whole heap of misinformation out there regarding orthotics and I've been taken in by more than my fair share of charlatans. I do wonder if the case against orthotics isn't slightly overstated though. In my own case I had been trying to run for 10+ years and couldn't get in two short runs a week without getting a really sore case of shin splints. After a number of false starts I got a pair of orthotics from a qualified orthotist and worked my way up to 50 mpw before I got injured again. I'm doing my best to move away from orthotics but if I didn't have them in the first place I don't know that I would ever have made any progress and I would probably never have managed to run consistently.

Based on my own experiences I like to make the distinction between the professionals - qualified orthotists and podiatrists and the charlatans who sometimes sell them over the counter in places like Boots, Elverys and other retailers and even worse turn up at running expo's and tell you that they're custom making them for you when in reality they're not. I also experienced the physio prescribing them which in some ways is the most misleading because you think that you're dealing with a professional when in reality you're talking to somebody who has a training in a related area and may have done a weekend course and thinks that they're qualified to prescribe orthotics (not all physios are like this).

I think that the professionals have something to offer some people. The rest are pretty useless, can make problems worse and can create new ones.

P.S. I'm not sure that comparable athletes in the past did get fewer lower leg injuries. Comparisons are difficult though because aside from at the elite end we're an awful lot fatter than the guys who ran 30 years ago. I'm not aware of research in the area though so if you are feel free to shoot me down :-)

GKiraly

Totally agree that there is a lot of misinformation out there. I got my orthotics off an orthotist who was recommended to me by a physio, he then in turn had me stand in a foam box which, as far as orthotics goes, opens up another new can of worms, as some will argue that that form of checking for the shape of the foot is wrong methodology and inaccurate. Which I suppose goes to show the amount of subjective opinion out there.


However, in my own case, after 6 / 7 years of running and constant niggles I was faced with the choice of either sticking with the running, constantly getting rubs, or giving orthotics a shot, I chose orthotics as I thought “what have I got to lose at this stage apart from more money with physios”?. It was suggested to me years ago by a fellow runner that I may need orthotics but opted against it at the time as I didn’t think shelling out €300+ just coz some other runner told me would be wisest of things to do until I got advised by a physio or other (hopefully!) reputable source. That’s not to say I’ll still be running in orthotics in years to come, I could be in them for another 6 years before some better option presents itself or, I could be out of them in 6 months. Of course im not happy about shelling out €300 on orthotics, nor do I believe just coz they reduced my injuries and physio visits that they are best thing since brown pasta, on the contrary in fact as I keep an open mind to better options all the time, but at the moment it appears to be the better of the two evils - either I shell out and give plan B a go, aka, orthotics, or id have it spent twice over before the year is out on physios, like the last few years.


I do see the point robroy is making in that there are perhaps other options out there that could rectify the fundamental structural problems. I like to think so as solving the fundamental problem would obviously go one better again in my quest for proper gait structure and cut out the future renewing of orthotics as obviously they don’t come cheap and as some claim, could lead to future foot problems. But until such time as I come across some qualified source within the medical circle who can definitively say that my foot is rolling inwards coz of x, y and z, and instead of orthotics, do this this and this, then Im gonna have to make do with the orthotics!

robroy1234

The problem with orthotics is that even though they start out as a short term fix they end up as a long term problem.