Heel Toe


  Hanging around ultra-marathon runners has caused me to notice a couple of things. First, these people are crazy. The iconic 26.2 mile marathon distance is hardly considered a warm-up, with races going as long as 50 or even 100 miles. The second thing I noticed is that ultra-runners tend to have a different stride than most, landing each step on the front of their foot instead of their heel.

As a doctor who treats all kinds of runners, I have realized that forefoot strikers tend to have different types of injuries than heel strikers. Here’s how it breaks down: forefoot striking (FFS) tends to result in more pain in and around the ankle and calf but less injury overall, while heel strikers tend to have more knee, hip, and low back issues.

This year I signed up for the Whidbey Island Marathon and for the first time in my life, had to miss an event due to injury. Longer training runs were impossible because of significant right hip pain with each heel strike. This was about the same time that I discovered the correlation between running style and injury type, and about the time I had a conversation with a running friend of mine who told me that he got rid of his hip pain by “running faster” which caused him to land on his forefoot.

The connection between heel striking and impact injuries of the knee and hip was becoming clear, so I decided to change my gait and stop heel striking. If you are going to try this, a word of caution: start slow! Your calves are going to get really really sore. Try short distances to start with, followed by plenty of calf stretching and vitamin C for tissue repair. Running barefoot on turf is a good way to get the feel for it. Start with quick sprints the width of a soccer field (it’s impossible to heel strike when you’re sprinting), then slow down as much as you can while still forefoot striking. It’s going to take some time for your new gait to feel comfortable so don’t get discouraged; it doesn’t look as awkward as it feels! Shoes with a lower drop from the heel to toe will facilitate forefoot striking. Somewhere in the 4mm range is better than the typical 10-12mm common to most running shoes.  After I switched to forefoot striking, my hip pain went away and I am able to run longer distances again. My next event is going to be the Bellingham trail marathon with over 5000 feet of elevation climb during the race. Who’s with me?!!

It’s always nice when research backs up clinical observation. In October of 2007 the International Journal of Sports Physical Therapy published a study that looked at the amount of impact (or “power absorption”) at the ankle, knee, and hip joints during rearfoot striking (RFS), forefoot striking (FFS), and running barefoot. The study found that runners can slash the amount of impact on knees and hips by more than half by simply switching from rearfoot to forefoot striking. FFS with shoes on was very comparable with barefoot running in terms of diminishing impact through the knee and hip.

My clinical recommendation is that people with hip or knee pain, or people who want to run far or often should consider forefoot striking. People with calf strains, achilles tendon problems, or plantar fasciitis should approach transition to FFS with caution, but may experience long term benefit as calf muscles and tendons become stronger. Remember, calf muscles form tendons that wrap underneath your feet and support your arches. Strong calves make for healthy feet. Trail running is another way to decrease joint impact from running. Good thing Discovery Park is right around the corner! 



Dr. Penner completes 1st Half Ironman!


When I tell people that I just ran my first Half IronMan triathlon (a 70.3 mile swim-bike-run) the response is varied. Other triathletes are instantly excited and we share a connection which sparks a conversation that could last for hours if we’re not careful. Those who have never run a race of that magnitude often give me a puzzled look and ask "why would you ever want to do something like that?"

 Well... let me tell you; First of all, I feel a deep sense that something profoundly good is happening when I move my body. Mind, body, and soul are connected and I feel that when I use my body, especially when I use it a lot (like 5 hours and 11 minutes in a row for example).

Triathlons are particularly appealing to me because it’s such a good full body workout. Swimming developsupper body strength primarily while cycling and running are great lower body workouts with less impact than running ultra long distances. Spread the stress around as I always say. 

Secondly, I ran a half IronMan because it was hard. I want to be a person who intentionally faces hard things head on. I want to get used to doing hard things instead of shying away from them. Starting a business from scratch is hard, being a good dad is hard, denying my own selfishness is hard, life is hard! I want to work hard and play hard because this is where the good life is lived, this is where we find out all that we can be. You won’t find the same level of joy, success, or have the same sense of accomplishment in your life if you don’t tackle the hard things.

 So pick something you know you should do that’s hard, and do it. You’ll be better off for it and so will those around you. If you can’t think of anything, maybe try a triathlon. I have yet to meet an ironman triathlete who regrets owning that title. 




Running and Chiropractic (according to Christye)

We only had one take for this shot, because my legs were too tired to jump twice!I don’t normally get to take the reins of the MCM blog, so this is a special treat for me!


As some of you know (because I am chatty), last month I competed in the Kirkland Half-Marathon.  And I wasn’t the only one—several other MCM patients hit the pavement that day: a special shout-out to Michael Miller and Craig Beck for pulling down some blazing fast times on that 13.1-mile course!  Woot woot!  It was an incredible event: the day was warm and sunny, the course was beautiful (albeit a tad hillier than I’d expected…), and I smashed my previous personal record by 4 minutes.  Plus they gave us free Jamba Juice at the finish line!  FREE JAMBA JUICE!  And while I didn’t quite beat Josh’s time (insert eye roll here), this race was still an important milestone for me in my journey from injury to fitness.


In 2009, I injured my knee while training for a full marathon.  I rehabbed it all winter and trained for the same marathon in 2010—only to re-injure both knees halfway through the actual race.  It was my own darn fault—I overtrained for both events—but I kept thinking, “Hey, I’m young, I’ll bounce right back.”  And then I didn’t bounce back.  To say I was frustrated would have been the understatement of the century.  When I came to work for Magnolia Chiropractic & Massage in 2011, I had been to see a physical therapist, two personal trainers, and a sports medicine doc to try and fix my knee problem once and for all—but to no avail.  And what I’m going to say next will make me sound like the biggest brown-noser on the face of the earth, but I truly believe that chiropractic and massage has helped me reach “pre-injury status”  (as Josh would say), and turned my running career around.


Don’t stop reading!  I’m not just kissing up to my boss here!  Since last year, I’ve successfully completed a 12k, three 5ks, and three half-marathons—and all without injury.  The way I see it, chiropractic has helped me recover from my injury in two important ways: 1) It addressed the structural issues that impeded my performance, and 2) It emphasized that there was no “quick fix” for my problem.


I am a lucky duck because the perks of my job at MCM include free massage and chiropractic adjustments.  I have been getting routinely adjusted—usually once a week, but as frequently as three times a week when I was working through a back issue—for the past 12 months, and it has made A HUGE DIFFERNCE in how I feel while running.  Dr. Penner is a veritable textbook of knowledge on the musculoskeletal system, and has helped confirm the diagnosis I got from my sports doctor, recommend rehab exercises and stretches, and address the issues surrounding my isolated injury (e.g., adjusting my low-back helped my knees feel better).  And there aren’t enough positive adjectives to describe how incredible Tai and Allison are at their jobs. 


But adjustments and massage alone were not enough to take care of my injury.  This is something I’ve learned from sitting behind the front desk, watching patients come and go: the people who actually do their “homework” exercises get better faster than those who don’t.  Simple.  I’ve seen the data in our appointment tallies!  I realized that all the sports doctors and physical therapists in the world couldn’t help fix my knee if I didn’t do my part.  It’s not their fault that I didn’t do the rehab exercises at the frequency or intensity they prescribed—it was mine!  Every time I went out for a long run instead of listening to my body and resting, I made my injury worse.  Every time I skipped my exercises altogether, I made my injury worse.  What I wanted was a magic Band-Aid fix—and what I got was disappointment.


Chiropractic has increased my awareness of my body—and when you pay more attention to what’s going on in your body, I think you naturally take better care of it.  So as much as I wanted Dr. Penner to just Snap-Crackle-Pop my knee out of pain, I’m actually glad it’s been a long road to recovery.  Because it’s taught me that I can take an active role in taking charge of my health.  My body is my body, and no one else’s: I can become aware of it, I can listen to it, and I can discern (within limits) what it needs.  Even if it needs me to slow down.


So, thanks to my crack medical team here at MCM, and some very careful and conservative training plans on my part, this past year has been the most fun and successful year of running I’ve had yet.  Culminating in my 1:40 time at the Kirkland Half, and a 1:39 P.R. a few weeks later (just 3 minutes shy of Josh’s best time, so he better watch his back!). 


Now my biggest problem is just figuring out how the race folks lost track of my bib number and didn’t record my time…but one thing at a time.


New Golf Certification for Dr. Penner


Dr. Penner is a proud member of ProSport Chiropractic, a nationwide network of highly skilled chiropractic doctors who provide on-site treatment and support for professional athletes.  ProSport Chiropractic is a leader in chiropractic sports education, and Dr. Penner is extremely excited to be participating in a three-part certification process on the treatment of common golf injuries taught by the renowned Dr. Jeff Blanchard, founder of


The first seminar will be held in early June, and in addition to world-class instruction on the diagnosis and treatment of common golf injuries, teaching will be presented by Dr. Dan Murphy on the history, symptoms, signs, diagnostic tests, special imaging (MRI, CT scan, etc.) and management of patients who have sustained dramatic brain injury.  Dr. Mark Charette will also be presenting on lower extremity adjusting (the concept of "the noisy joint," and adjusting protocols that achieve excellent results with feet, knees, and hips).

Here at Magnolia Chiropractic & Massage, we are constantly striving to grow and improve.  Dr. Penner sees this series of seminars as an excellent opportunity to hone his clinical skills in order to be of better service to his patients.  And when asked how he felt about honing his clinical skills, Dr. Penner said, "Oooooo I'm giddy with excitement!!!"


Dr. Penner Places 27th, Eats Large Cake

Dr. Penner's wife made this spectacular (and delicious!) gold medal cake in celebration of Josh's successful race.

As I rounded a bend near mile 8 of the Whidbey Half Marathon, the city of Oak Harbor came into full view.  The sun glistened on the water, and the smooth arc of coastline led my eyes up to the wooded hills of Whidbey Island, and the Olympic Mountains standing majestically beyond.  My breath caught for a moment, then I exhaled deeply.  There was more in that breath than just oxygen and carbon dioxide.  I was breathing out stress.  I was unwinding, and I could feel balance being restored in my mind and body. 


How often do you give yourself a chance to do that?  When you get wound up tighter and tighter by your busy city life, what unwinds you? 


I have an idea.  Get out of your man-made environment (especially concrete) and get into nature.  Swim in it, run in it, climb on it!  


You don't even have to do anything if you don't want to: studies show that if you simply look at nature you will begin to relax.  Scientists at Essex university showed that spending as little as five minutes in a green space cuts stress.  Other studies have shown that those with access to countryside are less likely to have heart disease or strokes.


One of the most stress inducing things you can look at is concrete.
One of the most relaxing things you can look at are trees. 


If you live in the city you might want to consider getting out of your concrete surroundings every once in a while.  Find some trees, water, and mountains to enjoy.  


And if you don't want to hike, swim, or run, you can just look.  That's OK, too. 


In health,
Josh Penner, D.C.