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Airmen learn to run strategically with online instruction

By Air Force News Service | Aug. 15, 2012

FORT GEORGE G. MEADE, Md. (AFNS) — Beginning Sept. 1, Air Force medical officials will take new strides to get Airmen running safely.

The Air Force Telehealth Office will conduct a six-month study to investigate the outcome and efficiency of online running instruction.

The study will examine the effectiveness of a newly developed set of computer-based training modules currently in the final stages of testing and expected to be available to Airmen soon, officials said.

One year ago, Army leadership banned the use of "toe shoes" during in-uniform physical training sessions after encountering a change in Soldiers' clothing habits.

Air Force policies have taken a slightly different turn. While no running technique is officially endorsed or any style of running or running shoe mandated, officials said they recognize that wear of minimalist shoes, with flat, flexible soles that lack traditional cushioning, has increased among Airmen. To prevent injuries among those who make the transition on their own accord, an education program will offer basic instructions so service members can transition safely and effectively.

Separated into three distinct parts, the Web-based training will have one Airmen-oriented module, one "train the trainer" module and one that will "educate the educator." Each module will offer information tailored to the needs of their respective target groups.

Running injuries happen regularly in the Air Force, Lt. Col. Mark Cucuzella, Air Force Reserve physician and coach of the Air Force running team, said. Second only to basketball, running is one of the leading causes of injury while on duty. The direct costs of medical treatment for running injuries, and indirect costs such as missed work days and decreased job performance, are considerable.

"While running seems like a natural thing, many people do not know much about proper running technique," Cucuzella said.

Air Force officials have considered running training since the re-establishment of the run portion of the Air Force physical fitness test, however, the need for injury prevention among the new "minimalists" may have accelerated that development. Therefore, proper transitioning to this form of running is at the heart of the modules.

"Humans have run in bare feet since the beginning of time," Lt. Col. Antonio Eppolito, Air Force Telemedicine chief, said. "The paradox is that while there are many indicators minimalist running can benefit Airmen in the long term, they run the risk of experiencing injuries by transitioning too quickly."

These injuries can be prevented, Dan Kulund, former Air Force Medical Support Agency chief of health promotions, said.

"Aircraft maintenance maintains aircraft with preventive care," Kulund said. "We took that idea and formed runner maintenance. We want to apply preventive care rather than wait for problems to develop."

Because many runners have experienced injury or discomfort during training, Cucuzella recommends approaching the Web-based training gradually. People need to approach the training from their starting point - from experienced runners to novices, he said.

"During running, you experience approximately three times your body weight upon impact," Kulund said. "So if there are any deficiencies in the mechanics, they are exaggerated. What we try to do is to optimize the approach to running for each Airman and enable them to either validate their technique or discover problems."

To understand where some of these problems lie, the training aims to educate runners about basic ergonomics of the foot and physics of running.

"The arch of our feet collapse when we run, sort of like a 'spring' - that is normal," Cucuzella said, stressing the importance of landing with a mid-foot strike. The spring-like motion of feet and knees, combined with smaller, quicker steps absorbs the energy of the impact.

"What happened in our culture is that we now wear shoes that brace the foot and changes movement pattern and foot structure early in foot development," Cucuzella said. "It's like an aircraft during landing: If everything is locked out, then all the impact energy is going to be absorbed by areas of the body that are not designed to do so."

This changes running form and prevents many runners from running softly without impact protection from soft-soled shoes. The development of large shoes may have seemed like a good idea to prevent harsh impacts, Cucuzella said. The increased padding was supposed to enable runners to extend their stride, but ultimately reduces the body's natural spring-like movement.

However, the development of running shoes has followed a pendulum motion, Kulund said. While sportive running started natural with old-fashioned racing flats that offered little support and allowed natural foot movement, shoe companies started adding little nuances ending up with bulky shoes that have been in use until recently.

"It's just a matter of the pendulum swinging back," Kulund said.

Many runners want to know why running with "less shoe" is more effective and some are apprehensive.

"The burden of proof should be on the athletic shoe manufacturers," Eppolito said. "There has not been a single study which proves that cushioned running shoes significantly improve performance or prevent injury in runners."

But buying different shoes may not be necessary right away. Kulund developed the Basic Aerobic Training Tool as a memory aid to train Airmen in natural running, before changing footwear.

"If Airmen wear a shoe with a lower heel, they automatically improve their running form," Kulund said. "But not every Airman will necessarily want to change shoes right away. The Basic Aerobic Training Tool helps them find a natural form even when not wearing lower-heeled shoes."

The feedback from Airmen using the BATT method has been positive, Kulund said, who hopes once they memorize the technique, Airmen will pass the figurative "baton" and inspire others to improve their running.

Some Airmen are already espousing the benefits of the training.

Before the development of the online training, the three experts travelled to bases across the nation to conduct running clinics - helping Airmen, face-to-face, understand the basics of proper running.

"Cucuzella had a unique perspective because he was both a medical professional and a long distance runner," Tech. Sgt. Carl Lund, 29th Intelligence Squadron language analyst, who attended a training session with Cucuzella, said. "We took our shoes off and went through some activities of posture and movement. Running without shoes was a new concept."

Lund said he was initially surprised, but once Cucuzella explained the physics of minimal running, it made sense to him. He now thinks differently about his running technique.

"It's definitely something I'm cognizant of now," Lund said. "It's hard to get out of bad habits, but I think I made progress toward better technique."

Lund has purchased different shoes after the class, but he said he doesn't use them much yet. "It's definitely a different style of running and you have to acclimate to it," Lund said.

While the training aims to improve Airmen's running and prevent injuries, the efforts also intend to educate the professional health staff on minimalist running.

"Minimalistic running has actually been well established," Eppolito said. "It's been around for a long time, but has only now regained popularity in the last few years. That may make it seem like a faddish occurrence. The fact is sports medicine has done a lot of research on the subject."

Medical professionals tend to follow conventional wisdom, Cucuzella said. But when properly trained, they too can learn how to better advise their patients in preventing rather than treating injuries.

"We have the science and proof on the side of exercise physiology that this is the proper way to train and to become healthy, fit and a better endurance runner," Cucuzella said. "It's not about running faster, but about going back to a natural movement pattern that was lost."

To ensure that both Airmen and health professionals get the most out of this training, data gathering on its effectiveness is a priority for the near future, Cucuzella said.

"Ideally we would like to see Airmen improving by simply learning from the computer-based-training," Cucuzella said. "But if that doesn't work, we will need to find out how else we can standardize the training process."

While it is still unclear whether the CBT will have the desired effect, Cucuzella is optimistic.

"We hope it can help people," he said. "It's a lot of new information. But like any skill, if Airmen have patience, practice and become their own coaches, they're going to intuitively feel which changes work and are ultimately going to feel better while running safer."