Shoe Review: Brooks Adrenaline GTS 20

Sponsored by Zappos Running. All Opinions are my own.

Stability, cushioning, responsiveness…it all sounds like the best way to describe a good running shoe, but what do these terms really mean? Do all running shoes really have the right amount of everything to protect us from injury and help us run our best? The answer is no. All shoes are made differently and it takes time and patience to find the right pair. If you ask a hardcore runner what they want in a shoe, most likely they will say “fast” is their priority. The problem is shoes that help with speed, are not the most comfortable. You pretty much have to give and take when it comes to deciding on the right pair. The most important feature to look for in running shoes is support. After all, that’s what shoes are made for—to support our feet.

In comes Brooks Adrenaline GTS 20. I was lucky enough to snag a pair from Zappos, where I regularly buy all of my running clothes and gear. Their extremely large selection of products guarantees that you’ll find what you need every single time. As a Rewards Member you get free expedited shipping and free returns for a year, so there is no reason to shop elsewhere! I’ve heard great things about the Adrenaline GTS 20 so I wanted to try out a pair myself. It was a hard choice out of about two-dozen color options. I selected the peacoat/light blue/copper, which looks even better in person!

Chain Reaction

Did you know any problems that arise in the feet could lead to issues and injury in higher joints in the body? For example, if you overpronate, this causes the foot to buckle inwards, which causes the knee to rotate and pressure to get unevenly distributed even up to as high as the lower back joints. Ankle and foot problems are frequently the initial cause of knee pain in runners. This is one reason why I love the Brooks Adrenaline GTS 20. It is actually made with a system that controls motion in the foot to minimize this chain of reactions. Stabilizing the foot with GuideRails, you can count on the Adrenaline GTS 20 to provide you with much more comfortable and pain free runs.

Dual Cushioning

Cushioning is cushioning, right? Yes and no. The term makes runners think of soft, plush materials that hug your feet, but the cushioning in the Adrenaline GTS 20 does much more than that. DNA LOFT is the softest of Brooks’ cushioning and is what adapts to your foot’s shape, positioning, as well as your bodyweight. I felt a good amount of that pillow-like support when running in this pair, yet with a springiness that I normally get in a lightweight racing shoe. This is what the second layer of cushioning is responsible for. The BioMoGo DNA was created to give a shoe that’s part of a “cushioned” line a speedy element. Don’t worry—having this extra layer does not add any bulk.

I took my Brooks on a few different runs—8 mile easy run, 12 miles with 3 miles at tempo pace in the middle, and an 18-miler long run at aerobic pace. They felt extremely comfortable and well-cushioned, but I was surprised at the stability I felt given they weren’t too stiff like most motion control shoes. This must be the GuideRails technology mentioned earlier. I was hesitant about the 18-miler since the shoes felt extremely lightweight for a long run given I have significant instability in my foot and ankle joints. Thankfully they felt supportive enough and did not give me any pain or soreness in my feet as I usually get after using lightweight shoes for longer sessions.

As for my speed session, I was pleasantly surprised! Since I already knew about the two layers of cushioning and the stability technology, I was anticipating a less than ideal assist for my fast miles. It turns out the addition of the BioMoGo DNA that is supposed to help with responsiveness, really does provide the spring you want when trying to run faster. I’m still waiting to try these out for an even faster workout on the track to really test this technology!

If you are looking for a sleek, lightweight, and cushioned shoe, the Brooks Adrenaline GTS 20 is a good option, especially for every day runs. This line is made with durable materials, so you can count on this pair to last you longer than many other brands. Don’t forget—Zappos has a full stock of over two dozen color options, so you can be sure to find a print that matches your style!

Awkward Tightness in the Legs? It May Be Compartment Syndrome

The most common area of the body in which runners complain of pain is the lower leg. Of course when you think about the mechanics of running, the lower leg receives the majority of the impact since it carries the most weight throughout the running cycle. This is why conditions such as knee pain, and more commonly plantar fasciitis are frequent. One of the more misdiagnosed conditions seen in recreational runners and elite athletes is chronic exertional compartment syndrome (CECS). During exercise blood flow increases and muscles expand. The pain from CECS is felt when the lower leg areas become swollen during exercise, if the fascia, which is basically a sheath that wraps around the muscles, does not expand with the muscles.

Symptoms

The type of pain usually felt with CECS is aching or burning in a specific area of the lower leg that begins at a certain time after beginning activity. Most commonly, the pain occurs in both legs and either in the posterior compartment (calves) or anterior compartment (shins). Along with pain, numbness or tingling, as well as tightness can be felt that worsens as you continue the exercise. These symptoms usually subside within 10 to 20 minutes after stopping the activity.

Differential Diagnosis

The reason this condition is misdiagnosed is because it resembles other more common conditions such as shin splints and tibial stress fractures. Shin splints are caused by overuse of the muscles connected to the shin bone, causing small tears which result in the muscle being “pulled” off the bone. The pain from shin splints is felt along most of the shin bone, whereas a tibial stress fracture is felt at a localized point in the bone. Both of these conditions, along with CECS, result in pain in similar areas and are usually caused by either improper biomechanics or overuse from adding mileage or intensity too soon during training.

If you are experiencing pain during exertion, especially if it begins within the first 10 to 20 minutes of a run and relieves within 10 to 20 minutes after stopping, get evaluated by a professional. If along with the pain is a sensation of significant tightness in the lower legs, CECS is most likely expected. An MRI will help rule out specific muscular issues. There are newer, more advanced MRI exams that can assess how much fluid accumulation there is in the compartments of the lower leg during activity, which has been found to be accurate in diagnosing CECS. It may limit the need to use the more invasive approach of diagnosing which is compartment pressure testing where needles are inserted into the muscles to evaluate the amount of pressure present.

Treatment

The goal of treating CECS is to relieve the pressure in the affected compartment during exertion. Unfortunately, the first step in treatment is avoiding aggravating activities, such as running. Doctors may prescribe NSAIDs and an icing regimen to help decrease the inflammation. During this rest time from activity, it is effective to include techniques to keep the muscles and fascia flexible such as massage and stretching. Once the symptoms are more controlled, it is important to ease back into running VERY gradually to be able to monitor returning symptoms. As you do this, strengthening all lower leg muscles, including the feet, should be incorporated.

Calf stretching should include performing with the knee straight, to stretch the outer muscles, and bent to stretch the deep soleus muscle.

The simplest way to keep the anterior dorsiflexors (along the shin) loose, is to use the foam roller or other deep tissue massager.

The first exercise most athletes include for the lower leg are basic heel raises. As mentioned above, the calves also include a deeper muscle called the Soleus, that often lacks sufficient strength. You can target these muscles by performing the heel raise exercise with a bent knee, or sitting adding weight to your lap.

Weakness in the ankle and foot may also contribute to lower leg issues. To target these ankle and foot stabilizers, using a resistance band is effective. Other exercises include single leg standing on a stable and unstable surface such as a foam mat or balance disc.

Unfortunately, in the majority of the more severe cases, a surgical procedure, called a fasciotomy, is required. Basically the fascia itself is cut open to relieve the tension in order to allow normal blood flow and muscle expansion to cause less pressure during activity. The recovery time after this procedure is quite short and allows athletes to return to their sport within 6 to 12 weeks. Post-surgical rehabilitation requires the same treatment as the conservative approach mentioned above.

Prevention & Maintenance

Biomechanics, or running form, is commonly blamed for lower leg dysfunction, such as CECS. Research has been done on evaluating foot strike patterns in runners and how these patterns may cause mechanical issues in joints from the lower leg to the hip and spine. When one uses the heel strike for landing during running, the anterior compartment muscles, the dorsiflexors, must act eccentrically to control the foot from slapping onto the ground with every step. This causes overuse and inflammation in the area. Many studies have evaluated the outcome of changing this foot strike pattern to a mid-foot or forefoot landing, and have concluded that this may help control and even resolve CECS. This is a change that should be done gradually, such as beginning with 5 minutes of forefoot strike in a single run and adding 5 minutes every few runs.

Another prevention option is running with shoes and/or orthotics that limit pronation of the foot. Overpronating requires even more work for the dorsiflexor muscles and causes increased tightness to the entire lower leg compartment muscles.

The exercises mentioned above should be incorporated to help prevent CECS and other lower leg dysfunction, as many times weakness and inflexibility are the cause. If you have been diagnosed with CECS or are experiencing symptoms, make sure to back off of the aggravating activities and always ease back into it during recovery. Seek medical advice if symptoms do not resolve or become severe. Remember, the quicker you take care of your pain, the quicker you will be back to doing what you love.

Sources

Tucker, Alicia K, Chronic Exertional Compartment Syndrome of the Leg, Current Reviews in Musculoskeletal Medicine, April 2, 2020.

Gallo, Robert A., Michael Plakke, and Matthew L. Silvis, Common Leg Injuries of Long-Distance Runners: Anatomical and Biomechanical Approach, Sports Health, April 2, 2020.

Gibson, Alexander, Chronic Exertional Compartment Syndrome and Forefoot Striking: A Case Study, International Journal of Athletic Therapy & Training, April 2, 2020.

Mobility Exercises Every Runner Should Be Doing

If you are a runner, then you have probably been told about how important it is to warm up before heading out for your workout. Some of us get a few stretches in and go straight to the run and others are usually short on time so skip it all together. You have probably heard static stretching, such as a prolonged quad pull, is not a good idea before running. This usually elongates and relaxes your muscles, which is something you do not want when you are getting ready to run fast. Instead, we are told to incorporate dynamic stretching, which is actually a mobility exercise rather than a flexibility exercise.

Having good flexibility means you can passively move your joints and muscles through a wide range of motion—passively meaning ‘in a relaxed state’. Having good mobility, on the other hand, means you can actively move your muscles and joints through a normal range of motion, but with proper form and strength. Many runners incorporate stretching before or after runs to treat or prevent tightness in the muscles, which is common in the hamstrings, hip flexors, and calves for the most part. Although tightness can relieve, the actual joint can remain stiff, causing poor running mechanics, which affects stride length, push-off, and torso rotation. All of these outcomes will create inefficient running limiting you from reaching faster paces, as well as increasing the risk of injury.

Ankle Mobility

It is best to include a 10 to 15-minute mobility warm-up routine before every run. This will assure you are properly warm and ready to hit the road (or trails or track). A good plan is to begin with the lower, smaller joints and work your way up. The following ankle mobility drills will get you ready to push off the ground with your full range of motion and keep your calves from overworking.

Rocking

Forward and backward ankle rocking involves the dorsiflexors and plantarflexors of the ankle. While standing, lift the forefoot and toes as high as you can and rock forward to lift the heels. Continue rocking forward and backward for 15 reps or 30 seconds. Rocking with lateral movements will involve the invertors and evertors of the ankle/foot joint. Lift the inner part of the foot while weight bearing on the outer edge and rock the ankles to switch and weight bear on the inner foot.

Rolling

In a seated or lying position with feet unsupported, roll the ankles making circles in both directions—clockwise and counterclockwise. This is a great exercise to do before getting out of bed in the morning, especially if you have issues such as plantar fasciitis. Besides making circles, you can also try writing out the alphabet with your ankles and toes.

Knee Mobility

Circles

Stiffness in the knees is a common complaint from runners. Mobility exercises can help ease this stiffness and create more efficient running mechanics so that the knees do not bear too much pressure during the run. While standing bend your upper body forward and place your hands on your knees. Rock the knees in small circles in both directions for a maximum of 30 seconds.

Quad Pulls

Just like a regular static quad pull stretch in standing, you can incorporate a dynamic version for mobility. Grab your right foot with your right hand behind your back and hold for two to three seconds. Alternate legs until you reach 30 seconds.

Hip Mobility

Glute Pulls

The hips are probably the biggest problem area for runners when it comes to proper mobility. Hip Stiffness and lack of mobility is the cause of short strides, decreased upward knee drive after push-off, and limited torso rotation. Glute pulls, similar to the quad pulls for the knees, will help mobilize the back side of the hips. While standing, lift your knee to your chest and hug tightly for two to three seconds. Alternates sides for 30 seconds total.

Military March

Tightness in the hamstrings’ connections to the hip and knee joint can cause stiffness that limits stride length and upward knee drive as well. Kick up the right leg as high as you can and reach your left hand to the right foot. Switch kicks for 30 seconds.

The Rest of the Body

The legs aren’t the only parts that need to move while running. The arms and trunk need their proper mobility, as they help propel the body forward and stabilize the hips, respectively. Arm swings are easy to do during your walk towards your starting point. Standing upper trunk rotations for a few seconds mobilizes your hips and spine. Lastly, neck mobility can be incorporated for a few seconds as well such as with clockwise and counterclockwise circles. As mentioned, these warm-up exercises will take 10 to 15 minutes and can also be done at other times during the day. After just a few weeks of consistent mobility work, you will notice the improvements in not only your stiffness but also your running form!

Injury Prevention 101

We all know that runners have a higher risk of injury than non-runners, just as do athletes of any other sport. Obviously this is true, as simply being more active means you are on your feet more often with a greater availability to trip over an object and fall, step on uneven surface and roll an ankle, or just overuse weak body parts. In my opinion this risk is better than being inactive and risking developing heart disease, diabetes, and other health issues that come from lack of exercise. Besides being cautious to avoid tripping and bumping into something, runners, and all other endurance athletes, should follow other steps to decrease their injury risk on a daily basis.

SLEEP & Rest

The first and most important method to help prevent injury is to make sure you are getting enough sleep. You may feel like your 4 or 5 hours of sleep every night is just fine to keep you going, but sleep does much more than help us get through our day. Most, if not all, of the muscle damage repair and growth occurs during sleep. Human growth hormone is released during certain stages of sleep that increase blood flow to our muscles so that they can repair from our workouts. Another stage of sleep, REM, is responsible for relaxing our muscles and reducing symptoms of chronic pain. Runners should aim for at least 7 hours of sleep each night, but research shows 9 or more hours gives the most benefit to competitive athletes.

Strength Training

A well-rounded exercise plan is always best when it comes to lowering your risk of overuse injuries. You’ve probably read that triathletes, even those who participate in Iron Man competitions, have a lower risk of injury than marathoners. That’s because triathletes train with a balanced mix of running, cycling, and swimming. As a distance runner, if all you are doing is running, then you are inching your way closer and closer to an injury every day. The best formula for runners is to incorporate a mix of running, weight lifting, and other cross training cardio exercises. Lack of time may be the reason most runners skip strength training, but you can highly benefit from a quick 20 to 30 minute session a few days per week. This should be a priority if your goal is to improve your performance and not get injured.

Pack on the Miles GRADUALLY

One of the quickest ways to get injured as a runner is to increase weekly mileage by a substantial amount—even if you’re feeling great. The rule of thumb is to never increase by more than 10% each week. This may even be too much for some runners. A safe method is to increase by a handful of miles each week for 3 to 4 weeks and then have one week as “recovery” where you drop your mileage by 20% to let your body rest. After this recovery week, you can safely start back from where you left off.

Rotate Your Shoes

Since the feet carry your entire body weight during all activities, it is beneficial to give this part of the body a break. One way to do this is to switch your shoes throughout the week. Most brands make running shoes for different types of workouts. Save your well-cushioned shoes for long runs and recovery runs, and your lighter pairs for speed and track sessions. The style of each shoe is different which means your foot muscles will work differently in each pair. Everything that happens down in the feet has an effect on the rest of the body—so shoe rotation lets different muscles all over the body work and rest all at different times. 

Focus on Good Form

The constant pounding on the ground from running has an impact on the entire body. The ideal running form is one that lessens this impact and keeps all parts in sync and balanced. It is beneficial to add strides once or twice a week to focus on this. Run 5 sets of 20 to 30 seconds at a hard pace where you practice holding an upright posture with relaxed shoulders, taking quick steps, landing on the mid-foot, and a having a slightly forward lean—all aspects of proper form. Once you master good running mechanics, you will lower your risk of overusing any part of your body.

Stretch & Foam Roll

Just like weak muscles are prone to overuse injuries, tight muscles are more prone to tearing—which is an injury that can put you out for months! Runners can get tight all over, but hamstrings and calves/Achilles are the common areas that get torn. My advice is to make it a habit to stretch after EVERY SINGLE RUN for 10 minutes. A few sets of 20 second holds for the glutes, hamstrings, quads, and calves is enough. Foam rolling can be more tedious but is useful to tackle much deeper muscular tightness. It may also help improve range of motion that is limited by chronic muscle inflammation.

These steps may seem like a large load added onto your regular running routine, but they are necessary if you want to run for years without worrying about easily getting injured. These components will also help you become a more efficient and faster runner over time, so it’s a win-win if you ask me!

Sources

How Sleep Adds Muscle. The National Sleep Foundation. www.sleep.org. Nov 15, 2019.

Running with Arthritis? Here's All You Need to Know to Stay Healthy

One of the most common complaints of pain for most adults is caused by arthritis. This condition can become extremely debilitating and limit the ability to enjoy even the simplest activities. It has been a common thought that running is harmful to joints and causes arthritis. Recent research has shown the opposite results. Running can actually help control the symptoms of arthritis. Early signs are often ignored as they are usually short-lived and infrequent and can mimic other conditions such as overuse symptoms and muscle soreness. If you are a runner or partake in other activities, it is beneficial to understand the causes, symptoms, and management options available in order to avoid requiring invasive treatment.

What is Arthritis?

According to the Arthritis Foundation, the condition is just a term used to described joint disease and includes over 100 different types. It is most common in adults, but many of these types of arthritis can be found in children, as well. The cartilage located in between bones, which acts as a “cushion”, is lost creating constant pressure during activities. The earliest symptoms include joint stiffness, pain, and swelling. As mentioned, these can last a short time and occur infrequently. Stiffness is usually felt the most after prolonged positioning such as sitting or when getting out of bed in the morning. When in motion, the stiffness is usually relieved. In more advanced stages of arthritis, significantly prolonged activities can make the pain worse. Over time, arthritis can cause visible joint changes such as enlarged knuckles. Other joint deformities are only visible with X-rays.

Unfortunately, arthritis cannot be cured, but there are several management strategies available that can allow you to live comfortably without sacrificing your desired activities. The most important treatment approach, especially in the early stages, is balancing aggravating activities with rest. The key is to control the buildup of inflammation in order to avoid extreme pain to the point where you must take too much time off. For runners, this means if you are beginning to feel symptoms during or after a 10-mile run or longer, than you should be cutting back to shorter runs and adding in other cross-training activities, including strength training.

Strength Training is a Must

The constant grinding of bones with arthritis is what naturally causes pain and swelling. Getting the surrounding muscles stronger can help relieve this pressure. Stronger muscles also mean you can tolerate activities for a longer period of time, such as getting back to those 10-mile runs and racing marathons. Yes, this is possible, but runners must understand that strength training needs to become part of their regular training regimen. It is also the best way for non-runners to help control their symptoms and possibly avoid worsening arthritis and requiring surgery.

For hip and knee arthritis, which is one of the most common areas affected, especially in runners, it is important to alternate between bodyweight and resistance exercises. Both offer strength gains but give the joints a break from too much impact. Exercises should incorporate the larger muscle groups such as the quads, hamstrings, glutes, and calves, as well as smaller muscles that play a role in hip and knee stabilization. These smaller groups are the hip abductors and adductors, internal and external rotators, and the core muscles. Besides squats, lunges, heel raises, and step-ups, which all target the larger muscle groups, floor exercises for the lower body are an easy way to get in strength training at any time. Bridges, clamshells, and hip extensions are all great exercises that can be done with or without a resistance band. Core exercises such as planks and leg raises are also good additions.

Management for Runners

Besides alternating runs with lower impact cross training, there are several other strategies to help relieve symptoms. Using hot packs before activities can help ease pain and stiffness and the use of ice afterward can help control inflammatory buildup from your workout. Over-the-counter anti-inflammatory medications can also help manage symptoms. Below are other methods specifically for runners with arthritis.

• Use a run-walk method during most runs

• Eat a low-inflammatory diet. Examples of foods that help lower inflammation in the body include fruits, vegetables, whole grains, nuts, beans, and fish. Foods that can increase inflammation include fried foods, high gluten foods, processed and high-fat meats, dairy products, and foods with trans fats.

• Run on softer surfaces. Consistent road running causes repetitive pounding on joints. Try alternating running on trails, grass, and the treadmill.

• Warm-up properly. Getting right into running on stiff joints can exacerbate symptoms. Incorporate dynamic stretches such as leg swings, lunges, hamstring and quad pulls, and ankle rolls before every run.

• Exercise consistently. Avoid taking long breaks in between workouts. Even if you do not have time for your training runs due to a busy work and family schedule, you can increase the amount of walking during the day by parking further from your destination, stretching while cooking dinner, or waking up 15 minutes earlier to add in a few exercises before starting your day.

Sources

Paul T. Williams, Effects of Running and Walking on Osteoarthritis and Hip Replacement Risk, Journal, Sep 2019

Ponzio DY, Syed UAM, Purcell K, Cooper AM, Maltenfort M, Shaner J, Chen AF, Low Prevalence of Hip and Knee Arthritis in Active Marathon Runners, Journal , Sep 2019

Arthritis Foundation, What is Arthritis?, Website, Sep 2019

Finding the Right Running Shoe for You

Finding the right running shoe can get tricky. We all want to go for the most stylish pair with attractive colors and designs, but many times these nice-looking kicks end up destroying our feet. As a runner and physical therapist I have learned along the way that the single most important gear to be picky about for running (or really any activity that has you standing or walking for long periods of time) are shoes. If you are an occasional runner who gets in a few miles every week just to stay active, one pair at a time is sufficient. But runners training for a distance event, especially those who incorporate different types of runs require a couple of pairs to rotate through. And it involves more than just “cushioned” or “light” when shopping around. 

Know Your Foot Type

The first thing every runner should do when selecting shoes is figure out their foot type. Are you a pronator? Do you excessively supinate when you land? Do you have high arches? What does this all mean anyway?!

Pronator: This is when you land on the inner part of your foot when running. Most of the time runners initially land on the outer border of the foot, but quickly roll inward excessively. Those with low arches usually fall in this category.

Supinator: This is when you land on the outer border of the foot and remain with the majority of the pressure on this area throughout the midstance and even into the push-off phase of running. Those with high arches will fall into this category.

There are several running shoe stores that offer a gait analysis that can give you an idea of your foot type, but the best analysis would be by a podiatrist or sports medicine professional that specializes in gait and has access to the technology. A great way to analyze your foot type that can be done at home is checking the wear on your current or an old pair of running shoes. If you notice the wearing is excessive on the outer border, you can assume you are a supinator and you underpronate when you land. A pronator would have excessive wear on the inner border. If your shoes have even wear, you most likely have a neutral arch and pronate a normal amount.

Next Step: Shoe Type

Cushioned: Supinators should opt for cushioned shoes (at least for the majority of their runs). They provide optimal comfort (cushioning) with the least amount of firmness in order to promote a bit more pronation when landing. Cushioned shoes are made to be more flexible, but not all flexible shoes are cushioned! Some cushioned shoe examples are New Balance Fresh Foam, Brooks Adrenaline, and Saucony Omni.

Motion Control: This shoe type is made with more rigid materials in order to control the foot from rolling inward too much. Overpronators or runners with flat feet will benefit from motion control shoes since they include a more dense midsole, which helps raise the arch of the foot. Saucony Kinvara, New Balance 1540, and Brooks Ravena are all great shoes for low arches.

Stability: If you are a neutral runner, then stability shoes are your go-to. Most will have a firm rear and flexible forefoot with a moderate amount of cushioning. Some examples are the Saucony Guide Iso 2 (one of my favorites!), Adidas Ultraboost, and Nike Air Zoom Pegasus. 

Shoe Rotation

If you are an everyday runner, alternating between faster paced running, track sessions, and easy runs, it is best to rotate between two or three pairs. Opting for lightweight, flexible shoes are best for speed sessions. Shoes made for the track or even most “racing” shoes such as the Nike Vaporfly 4%, generally do not have much cushioning. As long as you limit the use of this type of shoe to short track repeats and racing, your feet won’t be affected too much. For the majority of your weekly runs (which should be at a conversational/easy pace), it is ideal to use the shoes that are best for your foot type as explained above.

Everyone has different feet and running form varies greatly, so what works for one person may not work for another. Just because you see a “fast” runner using a pair of the brand new Nikes does not mean you should go out and spend the money to use the same style. Well, first of all, a shoe does not necessarily make you faster. If you find you run faster in a given pair of shoes it is your better foot mechanics that are making you faster, not the actual shoe. The best advice if you are having any foot, knee, hip, or back pain during or after running, is to definitely evaluate your running mechanics and foot type. Switching to the right shoe for you can be a simple fix to a nagging problem.