Category: Uncategorized


I managed to upset the Chi Running community…

By Craig Payne,

…I get the impression that they don’t like me!

All because I called them out on the stuff that those that promote it make up and wish it was true (the wishful thinking fallacy). They really do. you only need to read some of the Chi running books and look at their websites and then play a game of ‘spot the fallacies’. I used to do it with my students. I would never bias them, but they soon worked out the problems with no help from me.

Like any cult, they have the same characteristics and are so blinded by their faith that they can not see it.

I have nothing against Chi running. There are aspects of it that are good. The only problem I have are the nonsensical unsubstantiated claims that they make up to support it. I was simply calling them out on that. You see them attack me for what I say and not once address what I calling them put on (that on its own speaks volumes).

It started with this thread on Podiatry Arena, then my review of their manifesto, Chi marathon, and then this post on Running Research Junkie.

Put your critical thinking hat on and read what I say and they say.

Forefoot varus v supinatus

By Craig Payne,

There seems to have been a flurry of publications recently that involved the construct of ‘forefoot varus’ in which a superficial or poor understanding of the concept and confusing it with the construct of ‘forefoot supinatus’ is leading to some flawed conclusion. Even the peer review process of the journals concerned are not picking up on the issue. I have blogged about two of them here:

Is forefoot varus related to patellofemoral osteoarthritis?
The effect of forefoot varus on the hip and knee and the effect of the hip and knee on forefoot supinatus …

It is some thing that comes up with regularity on Podiatry Arena.

This confusion need to stop and not be perpetuated.

Plantar Fasciitis

By Craig Payne,

I find myself writing a lot about this lately and not on the usual run-of-the-mill stuff about it (a good summary of that stuff will be here when its finished). That information is widely known and widely taught. What has been occupying my time has been all the pseudoscience, quackery and snake oil on it, and there is a lot. Not a day goes by in which I do not find something online that need debunking.

There are so many pretend experts out there on plantar fasciitis making all sorts of extraordinary claims as click bait to get traffic to their websites and sell you a product or service.

At the end of the day here are the key points I hammer on about:

  • What is plantar fasciitis? – it occurs when the cumulative load in the plantar fascia exceeds that the tissues can take. This is a mechanical problem that needs a mechanical solution. Generally, in the short to medium term you reduce that load and in the medium to long term you increase the ability of the tissues to take the load. I wrote this: Plantar Fasciitis – how then do you treat it? and this: Strengthening vs Stretching for Plantar Fasciitis about those options and that approach
  • Non-mechanical interventions still have an important role to play as they often help facilitate the healing of the tissues, but I question their long term use if the load issues are not addressed at the same time
  • The natural history of plantar fasciitis is that it does get better on its own. A lot of people do not believe me, especially those who have had it for a long time! But, just look at the placebo or control groups in all the clinical trials on plantar fasciitis. They all get better. But, that may take a long time and it does hurt a lot, so that is no reason not to treat them. The importance of this is that we should only be using treatments that have been shown in clinical trials to do better than that natural history. That is why snake oil approaches get promoted so much. If one was to use one of those approaches just as there is a natural down swing in symptoms as part of that natural history then of course that useless snake oil is going to get the credit. I wrote more about this here: The Problem with the Treatment of Plantar Fasciitis
  • Get the diagnosis right. Plantar fasciitis is extremely common, but there are a lot of things that have similar symptoms. A number of the “snake oil” approaches for plantar fasciitis might work because it was not plantar fasciitis in the first place. But that treatment gets recommended as it “works”.

We really do need to stick to the evidence and be wary of extraordinary claims with extraordinary evidence.

Forefoot striking and anterior compartment syndrome

By Craig Payne,

Anterior compartment syndrome in runners is something that I did not used to like seeing. The conservative treatments were generally and often not satisfactory and many either needed to stop running or opt for surgery. The surgery was not all that bad as it was just soft tissue procedure and usually recovery was easy and uneventful.

In 2011 there was this study which took a small group of runners with anterior compartment syndrome, all facing surgery, and transition them to forefoot striking. All got better and avoided surgery! I blogged about the study here and have been talking about the study at the Clinical Biomechanics Boot Camps.

It makes for an interesting topic of discussion as the study was small and uncontrolled, so not exactly strong evidence. However, the results were dramatic and all subjects ended up not needing surgery. The results are also quite plausible as it is not difficult to see how in forefoot or midfoot striking that there is reduced activity of the tibialis anterior muscle.

The reason for it being an interesting topic for discussion is the wider context of the strength of evidence and how much evidence should be needed to change clinical practice. In a perfect world you do not change clinical practice until there us a meta analysis of all the controlled clinical trials. The above is just one small uncontrolled study.

I always happy to hear feedback from Boot Camp participants who have taken on board what I say and use it and then report back to me that it worked. It does.

Overpronation

By Craig Payne,

Overpronation …. overpronation …. overpronation. One does get tired of it and one does get tired of calling out the loons. There are so many Dunning-Kruger challenged so-called experts on ‘overpronation’ that when you scratch below the surface, there is nothing there and what they are saying about it is clearly flawed and does not stack up to the available evidence. The quack is really strong in some and nonsensical in others and so many myths and misconceptions. Enough said…stick to the evidence.