Want to avoid running overuse injuries? Don’t lean forward so much, says CU Denver study

Press release:

The ubiquitous overuse injuries that nag runners may stem from an unlikely culprit: how far you lean forward.

Trunk flexion, the angle at which a runner bends forward from the hip, can range wildly–runners have self-reported angles of approximately -2 degrees to upward of 25. A new study from the University of Colorado Denver (CU Denver) found that greater trunk flexion has significant impact on stride length, joint movements, and ground reaction forces. How you lean may be one of the contributors to your knee pain, medial tibial stress syndrome, or back pain.

“This was a pet peeve turned into a study,” said Anna Warrener, PhD, lead author and assistant professor of anthropology at CU Denver. Warrener worked on the initial research during her postdoc fellowship with Daniel Liberman, PhD, in the Department of Human Evolutionary Biology at Harvard University. “When [Lieberman] was out preparing for his marathons, he noticed other people leaning too far forward as they ran, which had so many implications for their lower limbs. Our study was built to find out what they were.”

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Icing muscle injuries may delay recovery

Press release from Kobe University:

A study using a mouse model of eccentric contraction (*1) has revealed that icing injured muscles delays muscle regeneration. The discovery was made by a research group including Associate Professor ARAKAWA Takamitsu and then PhD. Student KAWASHIMA Masato from Kobe University’s Graduate School of Health Sciences, and Chiba Institute of Technology’s Associate Professor KAWANISHI Noriaki et al. In addition, the researchers illuminated that this phenomenon may be related to pro-inflammatory macrophages’ (*2, 3, 4) ability to infiltrate damaged cells. This research raises questions as to whether or not severe muscle injuries (such as torn muscles) should be iced.

These research results were published online as one of the Journal of Applied Physiology‘s Articles in Press on March 25, 2021.

Main points

  • The research results revealed that applying an ice pack to a severe muscle injury resulting from eccentric contraction may prolong the time it takes to heal.
  • The cause of this phenomenon is that icing delays the arrival of pro-inflammatory macrophages, which are responsible for the phagocytosis (*5), or removal, of damaged tissue. Furthermore, this makes difficult for the macrophages to sufficiently infiltrate the damaged muscle cells.

Research Background

Skeletal muscle injuries encompass a range of damage to muscles; from a microcellular level to a severe level. These injuries include not only those that happen during sports or schools’ physical education lessons but also external injuries that occur as a result of accidents and disasters.

‘RICE treatment’ is a common approach for skeletal muscle injuries, regardless of the extent of the injury. This acronym stands for Rest, Ice, Compression and Elevation and is often used in physical education, sports and even medicine. Ice is commonly applied regardless of the type of muscle injury, yet little is known about the long-term effects of icing.

Ice is used to suppress inflammation, however, inflammation in response to tissue injury is one of the body’s healing mechanisms. This has come to be understood as a vital response for tissue regeneration. In other words, suppressing inflammation with ice may also inhibit the body’s attempt to repair itself.

Experiments investigating the effect of icing muscles after injury have produced conflicting results. Some have reported that it delays muscle regeneration while others have stated that it doesn’t inhibit this process. However, none of the research up until now has investigated the effects of icing using an injury model that mimics common sports injuries caused by muscle contraction.

Using a mouse model of eccentric contraction injury, the current research team decided to observe the effects of post-injury icing. In this mouse model, injuries were induced to resemble severe torn muscles.

Research Methodology and Results

Eccentric contraction was induced by electrically stimulating the leg muscles of the mice and then exerting a stronger force during this stimulation to make the leg muscles move in the opposite direction. After this, the muscles were harvested. Icing was performed by placing polyurethane bags of ice on top of the skin over three 30 minute sessions per day, with each session being 2 hours apart. This was continued until two days after the injury. The icing was based on the usual clinically recommended method.

The researchers investigated the regenerated skeletal muscle two weeks after injury, comparing the icing group with the non-icing group. A significantly higher percentage of smaller regenerated muscle fibers were found in cross-sections from the icing group, with a greater number of medium to large fibers in the non-icing group (Figure 1). In other words, this revealed that skeletal muscle regeneration may be delayed as a result of icing.

Next, the researchers periodically took samples of muscle from the icing and non-icing groups of animals in order to investigate what was happening in the regeneration process up until this point.

In the regeneration process, inflammatory cells gather at the site of the injury, remove the debris from the damaged muscle and then begin to build new muscle. However, the results revealed that it is harder for inflammatory cells to enter the injured muscle cells if ice is applied (Figure 2).

Macrophages are typical of the inflammatory cells that enter the injured muscle. These consist of pro-inflammatory macrophages, which phagocyte damaged tissue thus causing inflammation, and anti-inflammatory macrophages (*6), which suppress the inflammatory reaction and promote repair. It is thought that pro-inflammatory macrophages change their characteristics, becoming anti-inflammatory. The results of this research team’s experiments showed that icing delays the arrival of pro-inflammatory macrophages at the site of the injury (Figure 3).

These results indicate the possibility that macrophages are unable to sufficiently phagocyte the damaged muscle when ice is applied after severe muscle injuries caused by eccentric contraction, consequently delaying the formation of new muscle cells.

Comment from Associate Professor Arakawa

In sports, the mantra of immediately applying ice to an injury is commonplace, regardless of the injury’s severity. However, the mechanism that we illuminated through this research suggests that not icing a severe muscle injury may lead to faster recovery. The idea of immediately cooling any type of injury is also entrenched in schools’ physical education classes. I hope that in the future, the alternative option of speeding up recovery by not cooling severe muscle injuries will become known.

However, even though icing may disrupt the recovery process for severe muscle injuries, there is no denying the possibility that there are degrees of mild muscle injuries that can be iced. The next issue is to work out where to draw the line. We are now in the middle of investigating what effect icing has on slight muscle injuries.

Next, we will continue to investigate how icing should be carried out according to the extent of the muscle injury. We aim to contribute guidelines that will enable people in sports and clinical rehabilitation to make accurate judgements about whether or not to ice an injury.

Pink drinks can help you run faster and further, study finds

Press release:

A new study led by the Centre for Nutraceuticals in the University of Westminster shows that pink drinks can help to make you run faster and further compared to clear drinks.

The researchers found that a pink drink can increase exercise performance by 4.4 per cent and can also increase a ‘feel good’ effect which can make exercise seem easier.

The study, published in the journal Frontiers in Nutrition, is the first investigation to assess the effect of drink colour on exercise performance and provides the potential to open a new avenue of future research in the field of sports drinks and exercise.

During the study participants were asked to run on a treadmill for 30 minutes at a self-selected speed ensuring their rate of exertion remained consistent. Throughout the exercise they rinsed their mouths with either a pink artificially sweetened drink that was low in calories or a clear drink which was also artificially sweetened and low in calories.

Both drinks were exactly the same and only differed in appearance – the researchers added food dye to the pink drink to change the colour.

The researchers chose pink as it is associated with perceived sweetness and therefore increases expectations of sugar and carbohydrate intake.

Previous studies have also shown that rinsing the mouth with carbohydrates can improve exercise performance by reducing the perceived intensity of the exercise, so the researchers wanted to assess whether rinsing with a pink drink that had no carbohydrate stimulus could elicit similar benefits through a potential placebo effect.

The results show that the participants ran an average 212 metres further with the pink drink while their mean speed during the exercise test also increased by 4.4 per cent. Feelings of pleasure were also enhanced meaning participants found running more enjoyable.

Future exploratory research is necessary to find out whether the proposed placebo effect causes a similar activation to the reward areas of the brain that are commonly reported when rinsing the mouth with carbohydrates.

Talking about the study, Dr Sanjoy Deb, corresponding author on the paper from the University of Westminster, said: “The influence of colour on athletic performance has received interest previously, from its effect on a sportsperson’s kit to its impact on testosterone and muscular power. Similarly, the role of colour in gastronomy has received widespread interest, with research published on how visual cues or colour can affect subsequent flavour perception when eating and drinking.

“The findings from our study combine the art of gastronomy with performance nutrition, as adding a pink colourant to an artificially sweetened solution not only enhanced the perception of sweetness, but also enhanced feelings of pleasure, self-selected running speed and distance covered during a run.”

Sever’s Disease of the Heel in Child Athletes

The commonest reason for pain in the heel in adults is a condition called plantar fasciitis that make up to 90% of the cases. In regards to children, plantar fasciitis is actually very rare and the most frequent reason for pain in the heel in kids being a condition often called Sever’s Disease. This really is bad vocabulary becasue it is not a disease and the use of that phrase can certainly have pretty undesirable consequences. There’s also a trend away from the using terminology of disorders from getting named after individuals, typically the doctor which first described the problem. The better appropriate name for the problem is calcaneal apophysitis. It is a problem of the growing cartilage area at the back of the heel bone or calcaneus.

When we are born, many of the bones continue to be a delicate and flexible cartilage framework which the bone grows on. With the heel bone growth commences in the center and grows to take up the entire area of that cartilage material framework. Nevertheless, there exists still a cartilage growing region in the back of the calcaneus that development and growth continues to occur at. That small growth growth plate at the back of the calcaneus can be at risk from injury if strains on the heel bone tend to be excessive.

The principle risk factors are a higher bodyweight, those that are taller and having an even more lively lifestyle including playing more sporting activity. Many additionally suggest that tighter calf muscles are a factor, but that’s not absolutely a regular observation. The disorder is far more common in the ages of 8 through 12 years. The growing plate of the heel bone combines with the rest of the bone tissue about the middle of the age of puberty, which means that no matter what happens it’s not possible to have got this issue past that age.

The signs and symptoms of Sever’s disease will usually start off as a slight ache in the back of the heel bone which gets even worse as time passes and it is more painful with a lot more exercise. The condition frequently becomes worse with a lot more exercise levels with soreness amounts definitely not exactly the same every day and differs depending on physical activity or sports participation amounts. A characteristic indication of this problem is pain on the sides in the back of the calcaneus when you press it between your fingers. There aren’t any xrays or any other imaging that can be used to help determine this and the diagnosis is dependant on the clinical findings.

The key approach to treating Sever’s disease will be education of the child and parents about the characteristics of the condition and its self-limiting character. Way of life as well as sport activity levels are going to need to be decreased so the stress on the developing area is lessened to bearable amounts. Cold therapy can be used following sporting activity in cases where the discomfort levels are higher. When the calf muscles are tight, then a stretching program are useful to improve the range of flexibility. A shock absorbing heel pad is frequently also very effective. Usually it is a matter of doing these therapies as well as managing the activity amounts and then wait for the condition to take its natural course and finally recover.

The Richie Brace for a Progressive Flat Foot

A progressing deteriorating of a flat foot or fallen arch of the foot in an adult is oftentimes known as posterior tibial tendon dysfunction as well as adult acquired flatfoot and may have problematic consequences if not detected early and sorted out. This is often more frequent in older in addition to obese adults. The key issue is that the posterior tibial muscles which are the reason for supporting the arch of the feet are not very good at doing that, and so a gradual flattening of the foot occurs. In addition to a falling with the arch of the foot there is typically increasing pain and discomfort in the arch area of the foot and the rearfoot. As the adult acquired flat foot progresses, further walking gets increasingly tougher and it is extremely tireing.

There are actually commonly 4 stages involving posterior tibial tendon dysfunction that this problem progresses through with one being the initial phase and 4 being the final phase that only surgical treatment can deal with. There is certainly some difference of opinion with the classifications of this as their is variability between health professionals plus some reliability concerns. That being said, stage 1 is typically treated with foot supports along with exercises plus some medication for the pain and discomfort. Stage 2 usually needs a lot more aggressive and supportive foot orthoses, carrying on using the exercise routines as well as increasing levels of pain alleviation medicines may be required. Both stage one and two will benefit with high top supporting shoes. Long-term weight loss plans will also be going to be helpful. If this doesn’t stop the development and the foot is heading in the direction of a stage three, then there’s increasing probability that reconstructive foot surgery is likely to be needed. This is the reason it is so crucial that there be more intense conservative treatment of the foot when it’s still at stage 2 to halt the development.

An increasingly frequent treatment for posterior tibial tendon dysfunction while it progresses to stage two is the Richie Brace. This Richie Brace is now being commonly used and it has been demonstrated to be very effective at stopping the progress with this problem and avoiding the requirement for surgical treatment. Surgical interventions tend to be successful, but there is frequently a left over measure of impairment remaining as the surgery usually will require the fusing of some important joints and also the moving of muscles insertions to other parts of the foot. The Richie brace is a combination of an aggressively supportive bespoke foot orthotic plus an ankle foot orthoses with struts to support both sides of the joints at the ankle. The bespoke foot orthoses is made from a plaster cast or optical scan of the foot with the foot kept in a ideal position. The aim of the foot orthotic portion of the Richie Brace would be to try and support the foot in this corrected position. The struts which get included up the side of the ankle are hinged with the ankle joint to allow motion to happen at this joint. These struts are then held on by Velcro on the leg to help support and enhance the benefit of the foot orthotic. Generally if the progress of the problem can be ended making use of this, then surgery is commonly prevented.

The Use of Recovery Footwear

Athletes workout very hard to achieve their goals, usually by increasing the amount and intensity of their workout. On the other hand, what has become clearer lately is that relaxing and not training may perhaps be just as necessary as the specific working out that they perform. The rest or downtime is equally as significant with improving performance and is also an integral strategy to avoid injuries. Overuse injury deterrence is very necessary as if an exercise related injury develops then that affects the ability to exercise to improve overall performance. Every time a training load is applied by a hard workout, you will find some microdamage to the body. The tissues must recover from this damage. The tissues will return from a high intensity workout better if it’s allowed to rest. This microdamage must also recuperate. In case a additional exercising strain is carried out before that small trauma has recuperated, then the damage amasses and an overuse injury sooner or later occurs.

This is exactly why a great deal of research is considering the science of recuperation. Runners have to recover from games and training work outs ahead of the subsequent one. Generally this is as straightforward as only training hard one day and not training as hard the next day. What’s more, it ensures that pro athletes and scientists are looking for tips on how to speed up and facilitate recovery. For instance, costly but not entirely tested concepts such as ice bathing and hyperbaric oxygen chambers. It could imply something as simple as what is known as recovery footwear.

Following a exercise session, professional athletes love to take off their shoes and place on footwear which is comfy and frees the foot from the confines of those shoes. The favourite recovery shoes are frequently flip-flops or sandals which free the foot from the limitations of shoes. They are really commonly soft or well padded plus they typically have some foot support. The intention of these types of shoes are to help provide the feet and leg muscles some rest so that they don’t work as hard. The goal being that this will facilitate recuperation of those worn out feet as well as leg muscles so they are actually better ready for the following workout. A further benefit from those flip flops with an arch support constructed in, is they can be easily made use of by those athletes who are required to wear foot supports within their training shoes. The amount of arch support that may be built in these is usually is similar to that is available in over-the-counter supports that you can buy at retail.

There are many brands of these different kinds of recovery footwear. Among the most well-known in the United States is the Oofos brand name. Their shoes contain a lot of padding which is designed to really provide the foot a rest after having a high intensity exercise session. In Australia, a popular brand name are the Archies. The Archies are a flip flop with an above average amount of arch support and good padding. With these sorts of footwear, a reduced amount of energy is required to move, so that they improve recuperation which help the muscles and joints recuperation from those little discomfort that might come after a very hard workout. This means they are really much more ready for their subsequent workout.

Mueller-Weiss disease of the navicular bone

Mueller Weiss disease is a rare source of pain within the midfoot in adults that has been also known as Brailsford disease. It is a sudden onset osteonecrosis of the navicular bone in the foot. You will find there’s a a lot more well-known problem of the same bone in young childen known as Köhler disease, which is also an osteonecrosis in the tarsal navicular bone, but they are completely different conditions due to the nature with the developing bone tissues in youngsters. The condition was first described by Schmidt in1925. It was W Muller who afterwards proposed how the underlying mechanism of the disorder has been due to an excessive compression force upon the midfoot region. About the same period, K Weiss, noted which the appearances on x-ray were similar to those noticed in a condition known as Kienbock disease, and this is an osteonecrosis. The two of these reviews led to the most commonly used name for this problem, Mueller Weiss syndrome.

Mueller Weiss disease usually affects adults in between forty and sixty years of age (Köhler disease has a common starting point around 5 years of age). It is more prevalent in females. It might have an impact on just one foot, or it can affect both feet. The common symptoms include the gradual oncoming of pain in the mid-foot and hindfoot that may often be localized to the most agonizing area being over the navicular. A flat foot is in addition more common in those with this issue. The easiest way to diagnose Mueller Weiss disorder is via the use of radiology. On x-ray there will probably appear to be a failure of areas of the bone and sclerosis along with comma-shaped deformity on the lateral aspect. A CAT scan may also display similar issues and could be helpful to appraise the stage with the problem in far more detail. A magnetic resonance image can be more sensitive to aid in the diagnosis since it is capable of detect changes in the bone marrow.

Mueller Weiss disease is often progressive and may produce severe pain and become fairly disabling, so treatment should be commenced as early as possible to prevent it from becoming impaired too much. Initial treatment methods are to limit activities, perhaps some pain alleviation medicines and use supportive footwear. Usually foot orthotics are used to help further stabilise the area and support the mid-foot (arch) of the feet. This will keep a lot of stress from the navicular. If that is not really helping, then a even more limitation in weight bearing amounts is essential which means that there is much less pressure around the painful navicular. A moon boot or walking splint is the next phase to help protect and also immobilise the area if the signs and symptoms aren’t improving. If most of these conservative approaches do not help, there are also surgical options that can help with the soreness but can frequently result in some minimal disability, which can be a lot better in comparison to the continual pain of an active disease. The particular surgical treatment might be a decompression of the bone tissue using drilling. Another option in case there are regions of bone destruction would be a operative fusion of the important joints around the bone.

Golf as a contact sport?

Press release:

In the article “Golf: a contact sport. Repetitive traumatic discopathy may be the driver of early lumbar degeneration in modern-era golfers” published today in the Journal of Neurosurgery: Spine, Drs. Corey T. Walker, Juan S. Uribe, and Randall W. Porter from Barrow Neurological Institute describe the biomechanics of modern-era golf and its clinical consequences.

The authors point out that “among professional and amateur golfers, back disorders remain the most common injury, comprising 55% and 35% of injuries in these groups, respectively.” They also note that modern professional golfers are experiencing back problems at far younger ages than the general population. To explain this, they focus on how the golf swing of present-day professionals, such as Tiger Woods, differs from that employed by golf legends Jack Nicklaus and Ben Hogan.

As golf has evolved over the last two decades, the golf swing has become more powerful. To keep up, modern-era professional golf players participate in intensive strength-training sessions. And the techniques of the swing have also changed. During the downswing, greater compressive force is directed toward the spinal disc and facet joints, and this affects these structures asymmetrically. With more than 300 swings per golf-playing day, the golfer repeatedly experiences minor traumatic injuries to the spine, which over time can result in a pathogenic process that the authors have termed “repetitive traumatic discopathy” (RTD).

To illustrate how this can occur, the authors discuss Woods’ years of debilitating spine pain.

In this paper Walker and colleagues discuss modern-day golf swing biomechanics and how they relate to the development of RTD, earlier ages of players exhibiting RTD, and the possibility that golfer’s athletic strength training may contribute to RTD. They also address treatment of patients with this repetitive spinal injury.

When asked about the study, Dr. Walker said, “We believe Tiger Wood’s experience with spinal disease highlights a real and under-recognized issue amongst modern era golfers. Repetitive traumatic discopathy (RTD) results from years of degenerative ‘hits’ or strains on the spine resulting in early onset breakdown, instability, and pain. We hope medical practitioners, and surgeons in particular, will be able to diagnose and treat golfers with RTD in a specialized fashion going forward.”

Young athletes’ ACL injury risk increases with fatigue, new research shows

Press release:

ACL injuries are one of the most common sports injuries affecting adolescent athletes, leading to lost playing time and high healthcare costs. Research presented today at the American Orthopaedic Society for Sports Medicine’s Annual Meeting in San Diego shows athletes who experience fatigue – tested on a standardized assessment -¬ demonstrated increased risk of ACL injury. The study is the first to measure the direct impact of fatigue on injury risk in the adolescent population.

“We studied 85 athletes at an average age of 15.4 years, and found 44.7% showed an increased injury risk after high-intensity aerobic activity,” noted lead author Mohsin S. Fidai, MD, from Henry Ford Health System in Detroit. “Additionally, 68% of those studied were identified as having a medium- or high-risk for injury following the activity, as compared to 44% at baseline.”

The study utilized vertical and drop-jump assessments of each athlete, which were captured on video and reviewed by 11 professional health observers. Participants included track and field, basketball, volleyball, and soccer athletes. Injury risk was also associated with the level of fatigue, as 14 of 22 athletes demonstrating over 20% fatigue showed an increased ACL injury risk. Female athletes and those over age 15 were also more likely to demonstrate an increased injury risk.

“While ACL injury prevention programs are commonly used now, a decrease in injury numbers has not followed suit,” commented Fidai. “We hope this study helps advocate for ACL injury prevention training programs to incorporate fatigue resistance training and awareness by coaches, trainers and physical education teachers.”