Over the past few months I have been corresponding via e-mail with Dr. Mark Cucuzzella on the topics of running form and running shoes. Mark has a very interesting background in that he is a family physician at Harpers Ferry Family Medicine in WV, an Associate Professor at West Virginia University School of Medicine, and the owner of Two Rivers (TR) Treads, the nation’s first minimalist-only running store. If the above wasn’t enough to keep Mark busy, he’s also a highly accomplished runner, having completed over 60 marathons and ultras. Mark’s marathon PR is 2:24, and according to his bio on the TR Treads website, he has “run under 2:35 for a marathon 22 of the last 24 years including a 2:34 in the 2010 Boston Marathon at age 43.” Pretty impressive resume to say the least!
I asked Mark if he would be willing to answer a few questions about his background, his store, and his running life here on Runblogger, and he graciously agreed. Hopefully you’ll find what he has to say both informative and insightful.
You have a long and accomplished history as a runner. What are some of the moments in your running history that mean the most to you?
What gives me the most meaning is being able to teach basic principles through my own running performance now that I am in my 40’s. Still running marathons at under 2:35 with a crazy busy life is a testament to what we teach at our store- good form, aerobic development, functional strength, and above all fun. Moving into the ultra distances and accepting new challenges and learning new things is what it is all about. Edmund Hillary once said “”If you set out on an adventure, and you are absolutely convinced you’re going to be successful, why bother starting.“.
Having run under 2:35 for 22 of last 24 years (including 2010) is a something I feel good about. I’ve run under this time in 4 decades. Missed during my medical intern year and in 2009 when I ran 2:37.
What prompted your move to a more minimalist style of running shoe?
I had surgery on my feet in 2000 and needed to develop a low impact running style. At that time I knew little about shoes, but always felt better when I trained in racing flats. I could run with a quick, light cadence with more minimal footwear. My work with an innovator in the shoe design industry, Trip Allen, led me to discover the benefits of a zero drop shoe (i.e., no heel lift). I sawed off a centimeter of heel to level my training shoes. This was an epiphany…my body felt the efficiency and comfort immediately.
I subsequently evolved into doing education work with Newton Running, who are all about zero drop shoes and barefoot function. I have also learned a ton from Danny and Katherine Dreyer of ChiRunning. They are great teachers and everyone can learn from their methods. We have done 2 research trials on their methods too: http://www.chirunning.com/shop/pages.php?pageid=63.
What are the key design flaws that you most commonly observe in most modern running shoes?
Our website is loaded with information on the footwear education page titled “The World is Flat….if You are a Foot.”
There are several design flaws but the most important are:
• heel elevation: almost every shoe available today has some sort of heel lift – this affects posture, natural gait, and eleastic recoil.
• too much soft foam: the paradox of cushion is that foam interferes with proprioception and increase impact forces in the upstream joints, especially if you heel strike.
• toe spring: shoes curve upwards from the ball of the foot to the toes, incorrectly lifting the toes off the ground. This denies the foot use of the windlass mechanism.
• tapered toebox: (narrow toe area) nearly every shoe narrows from the ball of the foot to the toes. However, the shape of the foot is widest at the toes and tapering can lead to a deformed and inwardly turning large toe. This affects support of the arch in a critical way.
• curved last with cutout under 5th ray: the midfoot area of the sole is often cutout denying use of the 5th metatarsal ray, which is naturally a weight-bearing bone.
• Children’s shoes: any child shoe exhibiting the above defects and employing support and heavy cushion interferes with natural foot function and development.
Which shoes do you currently use in your own training?
I have 2 primary shoes for 2 different purposes. Both with zero to 2mm drop.
For fast runs on the roads where performance is focus the Newton Distance (see below) is a great shoe for employing barefoot running mechanics with some give back to natural elastic recoil. One can really feel this at the end of a marathon when the legs are pretty toasted and you move forward by relaxing. This shoe works with you if you employ the strong core and relaxed limb approach to running. With the insole removed (no foam needed) and some heel counter cut out (also not needed for barefoot style) the shoe weighs in at a mere 7oz. This is NOT a soft foam shoe. A firm TPU top plate and firm rebound chambers in the forefoot make this shoe a completely different feel from most and an addictive one when you start to use it.
For trail and mixed surfaces I run in the Terra Plana EVO. I take the soft insoles out of all my shoes and with this shoe it is 3mm of tough Duratex between my foot and the Earth. I run up and down mountains in this shoe which forces one to use very good barefoot running style.
Do you see a strong link between running shoes and proper running form?
Yes and no. You can run with really bad form in any shoe. Good form must come first (check out Mark’s running form in the video below from the 2010 Boston Marathon). Running true barefoot on hard surfaces will reinforce better form, as only then will you experience the immediate and negative feedback of a heel strike. Elevated heels feel horrible when you have learned good form. You cannot get natural elastic recoil from the Achilles and Plantar Fascia with your heels elevated.
Video clip of Mark Cucuzzella (blue shirt/white hat) near mile 17.5 in the 2010 Boston Marathon. Filmed at 300 fps with a Casio Exilim EX-F1 digital camera. Video courtesy of runblogger.com from Runblogger on Vimeo.
People often debate the relative merits of heel, midfoot and forefoot striking – based on your combined medical and running experience, do you see one of these as superior to the others?
I think people are really talking about a similar thing. The important point is landing gently under your center of mass. Eliminate the word strike from the vocabulary. A runner is not striking anything. Picture the lunar lander coming onto the moon surface….something will touch first but the entire platform settles down. This is the key to landing…let your full foot settle down under your center of mass, trigger/load the elastic recoil, and lift back off quickly.
How does your medical background influence your thoughts on footwear?
I take a basic science approach to anatomy, biomechanics, evidence based practice, and research. Although none of this has given definitive proof that there is a perfect shoe, there is great validity to the concept that your foot is the smartest design and that elevating the heels with crash pad cushioning will not prevent injury or lead to better foot function.
We have an extensive reference section on our site for some deeper reading.
Like almost everything in health, from nutrition to all aspects of longevity, the best interventions are the least. Natural food, healthy daily activity, and letting the body function as it is designed always come back to being the best answer.
You already have a successful career as a doctor, what prompted you to open a running store?
Runners come to running stores to get opinions on injury. Doctors get no training in running injury prevention. Most running store employees are not highly trained in this either. So what better place to educate and help runners stay healthy? Plus we eliminate the waste of unneeded medical costs and tests. We have free injury clinics in our store. My desire is to teach.
The other important reason is we are a band of volunteers hosting large races here and we needed a headquarters. Freedom’s Run will be the largest event in out state in only its second year www.freedomsrun.org . This is an amazing run through 4 National Parks and the outcome is building trails and gardens at local schools. We are also a model for Park Prescriptions. See the video on this link…we are 5 minutes in http://www.parksconservancy.org/our-work/igg/events/park-prescriptions.html. Come join us for Freedom’s Run on October 2!
What makes TR Treads unique?
We are the first store to completely abandon elevated heel running and walking shoes. Our focus is to educate first and then see if a shoe can help you get into better function. We encourage folks to be barefoot as much as possible. We give back in a huge way to the community through sponsorship and literally 1000’s of volunteer hours from our lead staff Tom Shantz and James Munnis, both of whom are reformed heel strikers.
Is there any thing else you’d like to add?
Our goal is nothing short of being the first town to eliminate running injuries….we are getting there. Shoot for the big goals and you can achieve them. We also want to see every child learn to run for fun, mostly in their bare feet, and stay in soft functional footwear for life. We need to un-teach parents and clinicians that children need stiff supportive shoes.