Doug Bertram: Finishing with Grace

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By Laura Hochnadel

Doug Bertram says he is off the "injured reserve list." The latest proof of this can be found on the Ironman Wisconsin 2010 results website. Considered by RunTri.com to be one of the most difficult Ironman courses in the world, Bertram completed the Wisconsin triathlon on September 12. While his finish time was a couple of hours slower than the race's average time—Bertram admits he's not a fast runner—he doesn't measure success by how fast he finishes a race. Instead, he measures his success by whether or not he is able to finish the race and, come Monday morning, show up to work feeling fine.

Bertram, preparing for Ironman Wisconsin, completes a speed workout at the track. Photographs courtesy of Doug Bertram.

"That's my personal goal," Betram says. "To be able to do these events, train for them, to finish, but finish gracefully so that I don't injure myself."

This is a sound goal for someone who not so long ago measured success by how many feet he walked rather than how many miles he ran.

The Injured Reserve List

Like most active 20-somethings going to college and living in outdoorsy Boulder, Colorado, Bertram says he played hard and sustained his fair share of injuries. However, a particularly devastating string of injuries and accidents eventually had this former mountain biker, back-country skier, rock climber, backpacker, and surfer hobbling around using a cane for support.

It started with a herniated disc in his lower back. Six months into his recovery, Bertram was involved in an automobile accident. The year was 2002. A car ran a stop sign, the driver never hit the brakes, and the car hit Bertram's car at full speed, he recalls. "[The torque of the hit] tore some of the ligaments that support the right side of the sacroiliac (SI) joint..., and that joint is really dependent on ligaments for its stability.... Once I lost the stability in the SI joint, the herniation in the back became a problem again, so I suffered from almost constant blazing pain down my leg, and the only way that I could walk without the shooting pain was to [externally rotate] my right leg to almost a 90-degree angle...so that I could kind of squeeze the muscles in the back of my hip to stabilize the SI joint."

With his walking speed reduced to a third of normal, and his compensatory gait pattern, Bertram says he looked like an 80-year-old man. "This is an unfortunate thing for somebody who is in the medical field," says Bertram, who is a licensed acupuncturist, has a master's degree in traditional Chinese medicine from Five Branches University, Santa Cruz, California, and is a nationally certified diplomat of Oriental medicine (NCCAOM). "You are limping around, and it doesn't look very healthy."

Betram's active life was effectively halted. Even sitting became problematic. At the time of the car accident, he owned 12 surfboards and four mountain bikes. "I got rid of all my surfboards, sold all my bikes," Bertram recalls. "I thought that...my active life was over. I gave away all my climbing gear. I surrendered to that stuff all being in the past."

A Step in the Right Direction

Though he surrendered to the situation at hand, Bertram did not give up. This self-described acupuncture geek sought out different healing modalities: physical therapy, chiropractic care, routine massages, and yoga. The chiropractic care alleviated the acute pain, Bertram says, but it didn't allow him to return to his former active lifestyle, and that was unacceptable to him.

Two events finally set Bertram on the right healing path. First, one of Bertram's acupuncture patients gave him the book ChiRunning. He started to read it, he says, because he had a couple of patients who were using the methodology in the book to try and change their running form in order to run safely. "The book made a lot of sense to me," Bertram says. So much so that he decided to implement some of the principles of the book and see if he could start running or at least start moving his body. "I failed miserably," he says. "As soon as I tried to [straighten] my foot...my SI joint just clunked right back out of place. So that was [when] I started seeking out some guidance and help from Dane." By now it was early 2008.

Bertram rents office space down the hall from Dane LaFontsee, CPed, so the two had become acquainted a couple of years prior. Before meeting LaFontsee, Bertram says he never realized that the benefits of orthotics extended beyond arch support and that a qualified practitioner could modify a foot orthotic to correct biomechanics. "Dane explained to me that instead of having to turn my foot out so far to the side in order to create the pressure to stabilize my hip, he could build up the outside of the orthotic, which would allow me to accomplish that same goal by keeping my foot straight," Bertram says.

LaFontsee, who is also an assistant clinical professor at the Medical College of Wisconsin, Milwaukee, explains this further. "Foot mechanics has a great affect on the knees, hips, and lower back," he says. "Proper footwear and sometimes custom orthotics provides the foundation for the alignment of the entire body." That is why he teaches his medical students and referring doctors about his "look down" approach. With every patient, LaFontsee starts by looking at his or her feet.

LaFontsee originally made Bertram a pair of foot orthotics that "really built up the outside of the right foot," Bertram says, and that built up the inside of the left foot to alleviate the resulting slight pronation. "Almost immediately when I wore [the orthotics], I could feel the muscles in the back of my right hip relax for the first time in a few years. I was getting the resistance I needed from the orthotic. It shifted my hip so that the muscles didn't have to work so hard."

The orthotic support allowed him to slowly start strengthening the back of his injured hip, he says.

With LaFontsee's help, Bertram was able to take the first steps in the right direction. And this was just the beginning.

Try, Try Again

A week after being fit with foot orthotics, Bertram was ready to try running again. "It wasn't a pretty mile," he says. "I was out of shape at that point, and my leg was weak. I did get a bit of inflammation in the SI joint, but I still made it a mile."

After spending more than five years hobbling about, that small success led Bertram to make a bold move: he signed up for the Lakefront Marathon in Milwaukee, Wisconsin. He says that at that point he had never run more than five consecutive miles in his life. "I felt like I needed a goal," he says. "I needed something extreme enough that I was really going to commit to putting in the time to change my body to beat this thing." And beat it, he did.

A focused-looking Bertram starts the run portion of the September 12, 2010, Ironman Wisconsin.

Bertram started paying attention to his running form—foot strike and foot placement, as well as staying relaxed and shortening his stride. He also worked with a personal trainer to strengthen his core. Part of the ChiRunning philosophy, he says, is to never run through pain and to progress to the point where your body is not having a bad experience with running. So that's what he did.

"I still remember my first three-mile run," Bertram says. "I felt like I was breaking the [finish-line] tape at the Olympics, it was such a huge feat. I was sore for a couple of days afterward because it was so new to me, but I kept the mileage progression there and all summer long I followed the Runner's World 16-week training program...."

Eight months after his first attempt at running with foot orthotics, Bertram says he completed the October 2008 Lakefront Marathon in just under four hours, and he felt great the next day. "I didn't have too much soreness, and I definitely didn't have the pain or injury," he says. "Again, with my personality, I thought 'that wasn't so bad. If I can do that, what can I do next?'"

A week later, Bertram signed up for a 50K scheduled for May 2009. "I let the mileage progression go nice and slow but...when I was training for the 50K...I started to get lateral knee pain," he says.

Again, chiropractic adjustments and massages offered relief; however, the pain returned once he started running. Once more, Bertram turned to LaFontsee for help. LaFontsee determined that because the orthotics had been holding the muscles and joint in the correct position, Bertram's sacrum had begun to heal. "The muscles started to realign, and I didn't need all of the build up that was there on the outside of the right orthotic anymore," Bertram says. LaFontsee modified Bertram's orthotics by taking off all the lateral support on the right side while leaving the left medial support in place. Bertram's knee pain disappeared.

Bertram completed the 50K in about six hours, so he decided to sign up for a 50-mile race in October of the same year. "The 50-miler went great, so I ran another one about four months after that," he says. By this time, Bertram was in his second set of orthotics—having worn out the first pair—but the new set had no correction, just longitudinal arch support. Perhaps making up for three years of lost activity time, Bertram says he decided to keep challenging himself, so he signed up for the Ironman Wisconsin. He had a year of Ironman-focused training under his belt before competing in the September 12 event.

"Never in a million years did I picture myself doing a marathon, let alone two of them in a day," Bertram says.

Take Away

Bertram's patients now benefit from his healing experiences. Ever since LaFontsee explained the biomechanics of the foot and how foot problems can result in pain and stress higher up in the body, Bertram says he now follows LaFontsee's "look down" approach as well. With every patient, he starts by looking at their feet. "If patients are out of alignment, that's one of the first things I recommend that they address just because it takes so much longer to get them to start holding adjustments higher up in the body if they walk out of the office and get that same collapse in their feet. So through my own experience it's taught me how to work with my patients as well."

While he's glad he can use his experiences to help others, Bertram says he'd prefer not to have to injure himself to learn in the future. "I'm going to try a different strategy moving forward."

Having successfully reinvented his active self as an endurance athlete and, better yet, not having sustained any sidelining-injuries since, it looks like Bertram's strategy is working: he continues to finish with grace.

Laura Hochnadel can be reached at