Archive for Musings from the Med Tent

050: An Interview With Dr. Tamara Hew-Butler, D.P.M., Ph.D. [Podcast]




Dr. Tamera Hew

Tamera Hew-Butler D.P.M., Ph.D.

Hi Everyone! Today I am honored and pleased to welcome Dr. Tamara Hew-Butler as a guest on our podcast. Let me say this right up front: In my opinion, this is a MUST LISTEN podcast for every endurance athlete who has ever wondered what the science really says about hydration and sodium/salt intake during exercise. What a fitting way to celebrate our 50th episode! 🙂

An award winning assistant professor of Exercise Science in the School of Health Sciences at Oakland University, Dr. Hew is recognized around the world as an expert researcher and scientist. A runner who enjoys training and competing, she has authored 50 scientific papers in such peer-reviewed journals as the Journal of Neuroscience, Medicine and Science in Sports and Exercise, and Sports Medicine, among others.  A bonus for us, is that Dr. Hew is a really nice, down-to-earth science "geek" (her words), who truly enjoys sharing what she knows with others, and as she puts it, "helping her family of runners" around the globe.

I had the pleasure of hearing Dr. Hew present at the "Medicine and Science in Ultra Endurance Sports" conference on June 24th in Squaw Valley, CA., in the week leading up to the Western States 100 Endurance Run. In the conference Dr. Hew presented on the "Spectrum of Exercise Associated Hyponetremia."  

In this podcast, we enjoyed discussing so many things very important to every athlete. Whether you're a runner doing an occasional 5k or marathon, or a triathlete doing multiple ironman distance events, or an ultra runner training for 50mile up to 100mile events, you will WANT TO TUNE in to this podcast to hear what Dr. Hew has to say.

Among the topics and questions we discuss are:

  • Hyponetremia: What is it and what are the risk factors (exercise induced) to be aware of?
  • Dehydration: What does it mean to be dehydrated? What can I do to ensure I don't become either dehydrated or OVER hydrated during exercise?
  • What is the role of antidiuretic hormone (ADH) / arginine vasopressin (AVP) during exericse and how does that impact how much we should drink?
  • Sodium balance and salt intake during extreme exercise: Do you need to take in salt/sodium during long events? If so, how much and how would you know?
  • Some companies looking to sell their products espouse the importance of the perfect electrolyte blend: Does such a thing exist? Do you really need a "balanced spectrum" of electrolyes during extreme exercise or is sodium alone adequate?
  • How reliable are our own body's signals to either drink OR take in salt, when we're training and racing?
  • What does it mean when we feel the desire or need to urinate during exercise? Is peeing a reliable indicator of hydration or electrolyte status?
  • And much more, including briefly touching on protein intake during exercise.

There are so many companies marketing to us and so much anecdotal evidence and personal opinion from internet experts. It is refreshing to hear a true expert share her thoughts on these topics, gleaned from many years of study, research, and experience.

I'd like to convey my sincerest thanks to Dr. Hew for joining me today. I know you will learn a great deal from listening, so tune in and enjoy! Happy Trails!

~Coach Al 

Dr. Kurt Strecker: Can You Cure Your Need for Orthotics?

Dr. Kurt Strecker, Pursuit Athletic Performance

Dr. Kurt Strecker, DC, CCSP

A member of our triathlon team asked if there is any he could "cure" his need for orthotics? It's a great question. I happen to be fairly opinionated on this topic, so I thought it was good to share my thoughts and experience here in the blog.

Functionality of the intrinsic and extrinsic foot muscles is extremely important if you want to run injury-free and perform your best. In fact, at PAP feel it's so important, EVERY athlete we work with gets to do the "small foot" exercise. The small foot (or short foot) exercise was developed, or at least made famous, by Vlad Janda. I believe his aim, originally, was to improve proprioception, a.k.a. the body's awareness of where it is in time and space, by increasing the volume of signals going from the foot to the brain. Additionally, it helps to wake up and strengthen the intrinsic foot muscles.

FOOT FUNCTION: This is something we HAVE the ability to impact positively or negatively. It is neuromuscular in nature. In the Western World, we typically wear shoes from the time we are teeny-tiny people. Both shoes and orthotics decrease intrinsic foot muscle activity (which is why we always prescribe small foot and "high heels"--ESPECIALLY for those wearing orthoses). Proper activation and adequate strength of the intrinsic and extrinsic foot muscles is crucial for preventing plantar fasciitis, preventing bunions, and creating an effective spring to attenuate forces and provide propulsion.

FOOT FORM: Short of surgery or overt trauma, this is something we have NO CONTROL over. The shape of the foot and ankle bones, the curve of the shin--we got what we got. A forefoot varus, for example, is a condition where the bones on the big toe side of the foot don't quite want to get to the ground when the back of the foot is in a neutral position. The problem here is that it can overload the middle or little toe side of the foot and cause too much internal rotation of the leg during the gait cycle. The role of the orthotic in this case is simply to bring the ground up to the foot in the places needed and to disperse the loads properly. Imagine you're walking across the face of a very steep hill. The foot on the uphill side will evert, meaning the pinky toe side will be higher than the big toe side. The downhill side will invert--just the opposite. You can make the foot muscles as strong as you like, but you've still got pronounced asymmetrical loading. While it is true that stronger feet will likely last longer than weaker feet, it is easy to see that the owner of these rides is going to have more problems than someone running on a flat surface.

Put in simplest terms, the shape and function of your feet largely impact the tibia. The shape and function of your hips and core have a greater impact on the femur. If either one is deficient, the knees take a beating. If it's not the knees, something else in the kinetic chain will suffer. The weakest link will break.

Orthotics are NEVER the entire solution. Strength, strength, strength. In case you missed that middle part: strength. If the biomechanics of your feet are such that orthotics are appropriate, then it's strength + orthotics. If you're just going through the motions with small foot and high heels, KNOCK IT OFF and do them right! If you need orthotics, WEAR THEM.

Wearing orthotics doesn't make you an inferior runner. Running shoe advertisements, books and magazines have made people believe that orthotics are "bad" and minimalist shoes are "good." THIS IS COMPLETELY ASININE!! It's a total marketing ploy. Athletes sometimes say, "I don't want orthotics. That's not natural running." For humans, walking is much more 'natural' than flying, but who's gonna walk from New York to Disney Land??

They're your feet and your knees, and it's your athletic career. Get serious!

I hope this was helpful. If not, please holler and we'll talk more.

~Dr. Kurt Strecker


Join today for 20% off and a FREE 30 days on the team! Offer good through January 6, 2013. Click here for more information or on the image below!

Pursuit Athletic Performance Triathlon Team

This Little Piggy Went Running: Techniques for Big Toe Mobility, Part II

Hello Everyone!

big toe, toe pain, foot painDr. Kurt Strecker in the med tent with a follow-up to my earlier post on the importance of mobility in the big toe and its affect on athletic performance.

As you will recall from the previous post, when one part of the body is limited in its movement, some other part will step in to do the work. The problem is, the body part that is picking up the slack is put at greater risk for injury. You might ask, "how much is really affected by a stiff big toe?" The answer: A LOT. Beginning at the plantar fascia, and moving right up the chain to the ankle, the calf, hips, and into the low back--all is at risk for injury just because of lack of mobility in the great toe.

So what can you do about it? Here are some simple exercises you can do at home to create good mobility and get that toe moving well. They say, "the devil is in the details," and paying attention to the movement quality of this small body part can have a great impact on your athletic durability, your ability to get faster, and your risk of injury.

Toe the Line: The Importance of Appropriate Big Toe Mobility, Part I

Hi Everyone!

Dr. Kurt Strecker in the med tent today to talk to you about the importance of mobility in the big toe. It might seem a bit humorous to talk about this unglamorous, oft-forgotten body part, but the big (or great) toe is very important to athletic performance.

In the video below I explain how the issue of limited mobility in the great toe effects everything right up the chain--from the plantar fascia, to the ankle, the calf, hips, low back, directly (believe it or not) to the shoulder. If you have hallux rigidus, or big toe stiffness, it will certainly impede your ability to run long, greatly lessen your ability to run FAST, and will rob you of enjoying a pain-free training regimen.

In the next post coming up later today, I'll show you simple exercises you can do at home that will go a long way to restoring mobility in the metatarsophalangeal or MTP joint, which is at the base of your big toe. Often, taking simple measures can have great impact, and in caring for the mobility of your big toe, this is certainly the case.

Musings from the Med Tent With Dr. Kurt Strecker: The Agony of the Feet–Plantar Fasciitis

Dr. Kurt Strecker, Pursuit Athletic Performance

Dr. Kurt Strecker, DC, CCSP

Dr. Kurt Strecker checking in from the Med Tent to talk to you today about a common, and often debilitating injury, plantar fasciitis. I can almost hear a collective groan from all of you who have endured, or continue to suffer from, this painful affliction. It truly is the agony of the feet.

Plantar Faciitis is an injury that plagues many runners, and a host of other athletes including football, baseball, soccer and basketball players. In this video, I discuss the cause of this misery, which many do not understand. Most importantly, the "small foot exercise" I recommend can go a very long way to helping cure the problem--and PREVENT it from occurring in the first place.

Any questions? Fire away!

~Dr. Kurt Strecker

Musings from the Med Tent With Dr. Kurt Strecker: A (Metaphorical) Pebble in Your Shoe

Hello Everyone!

Dr. Kurt Strecker, Pursuit Athletic Performance

Dr. Kurt Strecker, DC, CCSP

Dr. Kurt Strecker checking in from the Med Tent again today with a few words about how physical movement is impacted and altered when you are injured--particularly when you are dealing with injury over a period of time. Here's some imagery I like to use to bring the point to life.

Have you ever gotten a pebble in your shoe? If you leave it there for a short time--no harm, no foul. If you ignore it during a five-mile road race, your foot will likely be sore for a few days, but no permanent damage will be done. IF, however, you leave the pebble in your shoe for months on end, you will learn to move differently to avoid the pain and discomfort.

Now, what happens if you take that pebble out after a few months? That's right, you will still move differently than you did before the rock was in your shoe. You will continue to have altered movement patterns that negatively affect the tissue around the site, as well as other areas of the body. Compensation and dysfunctional movement is exactly what you create when you are hurt, and it has big implications for your athletic performance, and ongoing risk of injury.

In the video below I go into a bit more detail about all of this, as well as why rehab--GOOD rehab--not only focuses on healing tissue, but works to restore authentic movement. Even subtle changes in how you move due to injury have profound effects on your body, your performance, and overall health.

Be well! Move Strong!

Dr. Kurt Strecker

Musings from the Med Tent With Dr. Kurt Strecker: Pain in the Butt

Dr. Kurt Strecker, Pursuit Athletic Performance

Dr. Kurt Strecker

Hello Everyone!

Dr. Kurt Strecker here with a video series this week, "Musings from the Med Tent." Today, let's talk about pain in the butt--the real, often debilitating pain athletes experience in their derrieres.

Virtually every week we see an athlete complaining, and often shut down, by pain in the piriformis, the gluteus medius, or somewhere else in the backside. Why is it so common, and what can we do about it?

Pain in the butt is, most commonly, due to muscular imbalance. A runner, for instance, moves primarily in one plane of motion. To be healthy athletes, we must have muscular balance in all three planes of motion. When balance is lost and imbalances set in as the miles add up, typically, there is injury.

Our first steps with pain-the-the-butt athletes is to restore mobility and stability in all three planes of motion. This is hugely important to do. In a majority of cases, proper gait analysis and specific prescriptive functional strength exercises can help athletes heal and get back to training and competition.


If balance is restored, and proper mobility and stability is in place, and an athlete continues to have symptoms, then it is time to go look deeper. Lately in our gait analysis lab, we have had a number of runners whose butt pain pointed to more serious hip joint pathology in terms of the labrum. I go into more detail in the video below about why this happens, and what you should do.

As an athlete, you can save yourself from a lot of pain and unnecessary downtime from training and racing if you get yourself functionally strong, muscularly balanced, mobile, and stable. So much of athletic performance depends on the optimal functioning of your butt and all the gluteal muscles--maximus, medius and minimus--in concert with the functional integrity of your hips and pelvis. This is the powerhouse that generates propulsive athletic movement, and when functioning properly, is majorly important in helping to prevent injuries.

Next up in the Med Tent series--What to Do With a Pebble in Your Shoe.