Clinician Spotlight- Ryan Bailey, PT, DPT.

Meet Ryan Bailey, PT, DPT.

I distinctly heard him say “Central Waters.”

And when a physical therapist gets invited to Amherst, WI to share his expertise, then we’re talking about more than just tapping into the body’s internal mechanisms to relieve pain.

Oooh. Tell me more.

“No, Central Woggers,” he said. “It’s a running group in Amherst. Think the name’s a play on words, a combination of walk and jog.”

Oh, gotcha. I’m guessing this will be more about pain relief than beer.

“Well, those topics aren’t mutually exclusive,” he said.

I like this guy already.

Meet Ryan Bailey, physical therapist at Advanced PT. Recently he was invited to share some of his knowledge with the Central Woggers before they took off for a run.

“So, what topic did they want you to focus on?” I asked.

“Oh, they let me choose,” said Bailey.

Golly, that narrows it down. Bailey’s experience and specialties include working with high-level athletes and orthopedic injuries, foot and ankle dysfunction, pre and post-operative joint replacement and general rehabilitation including ACL reconstruction, sports medicine and biomechanics, just to name a few.

“I decided to give a talk on exercise and pain relief, and why we feel good when we walk and run and exercise,” Bailey said. “More or less about the natural substances within our body to relieve pain that we can tap into instead of relying on medications. Then into anterior knee pain many runners can experience and what the research tells us about strengthening the knee.”

Bailey was under some pressure from the assembled group of several dozen runners to hit the presentation out of the park, as the week prior a nurse and wellness coach named Martha Bailey did just that.

“Yeah, Martha is my wife. She’s pretty good,” said Bailey. “I understand they are inviting her back.”

While he is a frequent runner, Bailey considers running more of a cross training component for some of the many other sports on which he focuses, one of which is surf ski racing. Designed for ocean paddling, surf skis are sit-on top kayaks that are sleek, fast and very tippy. Bailey competed in the sport, a popular pastime with lifeguards, while living in Hawaii and California. Even though it’s tough to find anywhere near the surf ski racing opportunities here in Wisconsin, Bailey still manages to keep his skills sharp.

“There’s actually a very good 17 mile race here called ‘Race the Fox,’ which goes from Berlin to Omro,” he said. “It’s something I’ve done since moving back to Wisconsin.”

Bailey met his Wisconsinite wife in California, where he lived for 30 years, when she went out west for a nursing job. They got married in San Diego and returned to Wisconsin to start their family. They and their three daughters now reside in the house Martha grew up in, located in Fremont. Not surprisingly, their children are into sports and activities just as mom and dad are, and the family takes full advantage of the gamut of outdoor activities Wisconsin has to offer.

And he insists he doesn’t miss the ocean and the beaches.

“I love it here in Wisconsin,” Bailey said. Bailey coaches a number of area teams and is committed to being a resource for youth sports and being there for families after an athlete’s injury. He’s also committed to helping community members stay active and healthy, hence his visit to the Central Woggers.

It seems as if the transplanted Californian has found the perfect place to be.

Learn more here: https://www.advancedptsm.com/ryan-bailey

Does Selecting the Right Running Shoe Help Prevent Injury?

Josh Zilm PT, DPT

Does Selecting the Right Running Shoe Help Prevent Injury?

It’s spring and time to strap on those shoes and get outside.

There has been an entire industry built around providing runners with the best possible shoe.  When answering the question, “Does selecting the right running shoe help prevent injury?” one often has to tread lightly as there are many opinions.  As physical therapists, we like to turn to the scientific literature to answer a question.  Can a running shoe offer a return on energy? Is it better to run barefoot?  Are minimalist shoes better? What about orthotics?  Those are topics for another time.  This post will focus only on the running shoe’s ability to reduce injury and not attempt to answer any of those other questions that can often muddy the waters. 

The industry

The running shoe industry dates back to the mid to late 1800s, but most credit the start of the modern-day training shoe to the founder of a little company called Nike when he started selling shoes out of the back of a van in the 1960s.  Since that time running and shoes have grown into a multi-billion dollar industry.  Did you know that the first New York City Marathon was held in 1970 and had 127 competitors?  That is quite a contrast from 52,812 finishers in 2018.  As the sport has grown so has the market for better shoes with an attempt to meet the needs and demands of the runner.  Research, technology, science, expert opinion, and business has delivered a vast shoe market that boast a variety spanning barefoot the ultimate support and cushion.  So with all the shoes available today, is there a shoe for your foot type that can reduce injury associated with rigors of the sport?

The Amazing Foot

The foot is designed to help our bodies absorb energy as we impact the ground in an action called pronation.  The foot and ankle accomplish these amazing feet through a team effort.  We have muscles from our trunk to our feet that actually fine-tune how the body absorbs shock and then in a split second prepares to propel us forward with each step.  Running injuries are most often associated with the loading phase of running and more specifically the rate at which we load.  Don’t be afraid I won’t get too technical, but it is important to understand that the primary focus on injury reduction regarding the shoe is slowing the rate of loading, that is how fast our bodies have to accept the load with each strike of the foot on the ground. 

Foot Type

The hard part about designing the perfect shoe is that there are 7.66 billion people on the planet with a lot of different foot types (I know they are not all runners).  Thankfully, the orthopedic and running world has been able to classify foot type to offer some order to our attempts to best categorize the variety of feet that walk or run into the clinic.  Foot type does offer some predictive value to the injuries that we typically experience.  Nature(genetics) and nurture(lifestyle) lend way to a spectrum of people have rigid high arched feet, flat feet flexible feet, and everything in between.  The shoe industry has tried to match foot type with the appropriate shoe.  For example, the rigid high arch foot type should consider a softer shoe, while the flat flexible foot could use a more supportive shoe. 

The Shoe Spectrum

The soft shoe would be categorized as a “cushioned” shoe while the more supportive shoe is given the name “motion control”.   It would be intuitive to think that a person with a poor ability to control the position of the foot would benefit from added support and the person with a rigid high arch foot may need a little more cushion because they hit the ground harder.  (funny that studies show that joint reaction forces are actually higher in a cushioned shoe versus minimal support.  The working theory is that runners hit the ground harder with a cushioned heel simply because it’s cushioned.)  This could be a multiday conversation, but my attempt is to explain the basic shoe spectrum that starts with no support(barefoot/running sandal) to motion control(high degree of pronation control).  There are many variations within this spectrum that attempt to meet the needs of the runner, but the question we are trying to answer is can we reduce injury by pairing the runner with the right running shoe?   What does the research say?

Theisen et at 2014 Br J Sport Med completed a study looking at over 200 runners.  They found:

1.      Midsole Hardness and Injury rates: no different.  The amount of cushion had no significant difference in injury rates.

2.      Energy absorption and injury risk have no scientific correlation.  A shoe that absorbs energy does not reduce injury rates.

3.      Shoe wear does not appear to have an effect on biomechanics.  You cannot correct your biomechanics by running with a shoe.

4.      1% increase in metabolic cost for every 3.5 ounces of shoes.  Heavy shoes require more energy.

The recommendation:   Promote light shoes.  Refrain from claiming that shoes reduce injury through cushion or biomechanical changes.

Ryan et al. (2011) Br J Sport Med found;

• Shoe assigned by foot posture index(match the shoe with the foot type).  Static foot type should not be the determining factor for shoe selection.  The highest rate of injury was in runners wearing a motion control shoe that were appropriately matched based on foot type. 

The recommendation: Don't use the algorithm alone in an attempt to match foot type and shoe type to dictate the choice of running shoe.

Nielsen et al. (2014) Br J Sports Med.

• Foot pronation was not associated with increased injury risk in novice runners wearing a neutral shoe.  The “Over pronator” did not experience a greater rate of injury when left unsupported versus supported.

The recommendation: Let comfort dictate.  Give the runner a starting point in shoe selection, but do not feel locked into a shoe, especially motion control. 

Conclusion

Shoe type may offer a good starting point for a new runner when selecting shoes.  Based on the current literature I would recommend starting your search with a shoe that matches your foot type, but don’t feel boxed into a certain type of shoe.  Look for something that is comfortable when you run.  In more recent literature motion control shoes have been associated with higher rates of injury which gives rise to concern for recommending a motion control shoe.

Also, a lighter shoe consumes less energy.  The weight of the shoe does matter.   

One of the questions I often ask in the clinic is, “Do you run to get stronger or get stronger to run” (Dr. Chris Powers, USC).  I see a lot of runners try to compensate for bad mechanics through shoes and more running, but the truth is many people lack the strength to support the activity of running.  A physical therapy running evaluation can be a great tool as you begin or return to running.  Injury reduction comes from improved biomechanics something that we are all capable of with the right instruction.  Like many things in running, there are no short cuts.  Consistent effort = results.  The right running shoe may do a lot of things for the athlete, but with the exception of protecting the bottom of the foot and toes, there does not appear to be evidence supporting the claim that they reduce injury rates in runners.