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Impact reduction during running

Discussion in 'Biomechanics, Sports and Foot orthoses' started by NewsBot, Aug 10, 2012.

  1. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
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    Impact reduction during running: efficiency of simple acute interventions in recreational runners.
    Giandolini M, Arnal PJ, Millet GY, Peyrot N, Samozino P, Dubois B, Morin JB.
    Eur J Appl Physiol. 2012 Aug 9
     
  2. Craig Payne

    Craig Payne Moderator

    Articles:
    6
    ...same old .. same old ..... heel impacts have only been linked to one running injury (tibial stress fractures that make up less than 1% of running injuries!) and somehow its the root of all evil and has to be eliminated.

    Of course you can reduce impacts by midfoot or forefoot striking, but at the cost of increased muscle activity and increases in various joint moments --> those changes increase the risk for injury in those tissues! Why do studies like the one above not acknowledge that risk? ... is it because they have an agenda to promote?

    ...its six of one, half a dozen of the other! ... injury rates between forefoot/midfoot and rearfoot striking are the same (except in one small study of almost elite runners)

    And we now know that if you reduce the impact in the tibia, the actual total strain in the tibia increases due to the increased muscle activity needed to reduce the heel impact: Increased Tibial Strain in Forefoot Striking
     
  3. Admin2

    Admin2 Administrator Staff Member

  4. Blaise Dubois

    Blaise Dubois Active Member

    Craig, it will be a pleasure to try to find time (soon as I can) to comment this one... I'm co-author... but after you read the entire article.
    Juste to start, can you explain your reference to tell that stress fracture of the tibia represent just 1% of the sport injuries.
     
  5. Craig Payne

    Craig Payne Moderator

    Articles:
    6
    No specific reference, but if you look at many of the epidemiological studies on running injuries, tibial stress fractures usually do not appear in the data --> assumption that they must be <1% to not appear; ie they are that infrequent.
     
  6. Blaise Dubois

    Blaise Dubois Active Member

    According to epidemiological studies, stress fractures represent up to 20% of all sports medicine consultations. The incidence of stress fractures, especially high in running-related sports, could be as high as 30% in military populations. Tibial stress fractures are the most frequent and represent from 30 to 50% of all stress fractures.

    2012-Dubois, Cochrane Review Protocol
    2006-Warden, Stress Fractures: Pathophysiology, Epidemiology, and Risk Factors
    2006-Snyder, Epidemiology of Stress Fractures*
    2008-Fiestone, How Stress Fracture Incidence Was Lowered in the Israeli Army: A 25-yr Struggle
     
  7. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Tessutti V, Ribeiro AP, Trombini-Souza F, Sacco IC.
    J Sports Sci. 2012 Aug 17.
    Abstract
     
  8. Bruce Williams

    Bruce Williams Well-Known Member

    Blaise;
    That would still only represent 7% of all injuries. That is of course if what was classified in the literature were actually a stress fracture and not periostitis or a "stress reaction" of the tibia. These two are not the same at all and yet are classified the same by most practitioners'.

    So that might lower the actual number again another 30-50%. Should we all change the way we run to mitigate something that happens less than 5% of the time? I would not advocate that to any athlete unless they specifically had the issue and it was very likely that that would be one of the only ways to treat the issue.

    Further, who is to say that those who strike midfoot or forefoot are less likely to get a tibial stress fracture. Did your references cover that specifically? I would contend that landing midfoot and getting lateral gastroc and likely the peroneals to fire more is not a good thing in many instances. Just because the muscle fires more does not mean it is doing so affectively. Indeed it may be doing so purely because it realizes that the hallux must be stabilized at midfoot strike and because that landing pattern is usually more plantarflexed than a heel strike pattern. The tension on the achilles, the more the peroneals will not function as effectively. They may still fire to try to make up the difference but that does not mean they will function effectively to do what they normall would need to do.

    Ineffective peroneals often lead to overly active posterior tibial tendons. That will often lead to perisotitis of the tibia or stress reaction or as some would classify it, a stress fracture!

    I don't deny that midfoot striking in faster running is likely beneficial for many athletes, just not all of them.

    sincerely;

    Bruce Williams
     
  9. Blaise:

    If you want to do a fair analysis of the frequency of sports injuries, you need to include the studies by Taunton et al.

    Two years of study, n = 2,002

    Tibial stress fractures were the 9th most common injury: 67/2002=3.3%

    Femoral stress fractures were the 19th most common injury: 19/2002=0.9%

    Therefore, in Taunton's 2 year study of 2,002 sports injuries, only 4.3% of the injuries were stress fractures.

    I believe Taunton's numbers much more than your "20%" number that you claim since Taunton's numbers much more closely align with what I have seen in my practice over the past 27+ years.

    Taunton JE, Ryan MB, Clement DB,McKenzie DC, Lloyd-Smith DR, Zumbo BD.
    A retrospective case-control analysis of 2002 running injuries. Br J Sports Med 2002;36:95-101.
     
  10. Blaise Dubois

    Blaise Dubois Active Member

    UP TO 20% is not the same that 20%

    1% is the magic numbers that podiatrist promote to minimize the reality

    My reality is probably more around 5 %... but tibial SF are more frequent that MTT SF (I see almost essentially runners)

    Now that there is a trend to minimalist shoes and some runners switch too quickly on that trend, the incidence of MTT SF increase

    The incidence on others sports or populations (ex: military) is for some higher

    Taunton study is one out of 10 others... even included in the systematic review of Snyder it will be deluded

    There is probably other pathologies link to VLR (according to a unpublished study of Davis, it's link to overall pathologies, especially PFPS)
     
  11. Craig Payne

    Craig Payne Moderator

    Articles:
    6
    Sorry about the delayed reponse (you know how it goes!). Military stress fracture occurrence do not really count here (due to boots worn, load carriage and asymmetric gait from rifle carriage). If you look at the systematic review by Lopes et al 2012, most of the running injury studies they included did not even report tibial stress fractures as occurring at all in runners (its prevalence was so low). However, a couple (if I recall correctly as I no have paper handy) did report it at high number, leading Lopes et al to conclude tibial stress fractures at a overall 4.5% prevalence in runners and 0% prevalence in ultramarathon runners. I not sure how they got to 4.5%. The rationale of how they got to that figure if some studies reported 0 is not clear (suspect it was based on inclusion criteria of papers that were included/excluded in the systematic review; they also managed to conclude that patellofemoral pain syndrome was 5.5% prevalence which has raised a lot of eyebrows! - I always thought it was around ~25%!)

    --> hence my comment of 1% ... Whatever it is, it is uncommon. My point is that a lot of effort is going into reducing what is not really a very common running injury.

    I know Irene's study did report more injuries linked to impact loads, but as you noted its still in abstract form and we do not know the details.

    My point here was that why in almost all publications on how bad heel strike is and how it forefoot/midfoot striking can reduce the impact at heel strike is there NO mention of the tissues that are loaded more in order to midfoot/forefoot strike and the potential injury risk associated with the increase load in those tissues (ie post tib tendonitis; Achilles tendonitis; DMICS; etc). eg why did Liebermann et al not mention this in their flawed study in Nature? (I know in your paper above there were cautionary comments). Why, do you rarely see it mentioned that in order to contact the ground lightly, you need an increase in muscular effort that increases in the strain in the tibia and put tendons of those muscles at increased risk for injury?

    Lopes et al reported the incidence of achilles tendonitis at 6.2-9.5% - based on that (and I don't agree with this, but making a point), should not everyone heel strike to prevent that problem as it is more common that tibial stress fractures?

    Its 6 of one, half a dozen of the other - different running forms load different tissues --> each is associated with a different injury risk profile. My main point above is that why those who promote one form as being better than another only focus on the injury risk profile of the form that frying to bag and not mention the risk profile of what they are promoting?
     
  12. Craig Payne

    Craig Payne Moderator

    Articles:
    6
    I just got an email about what I mean by that; thought it easier to respond here. Its an idiom and according to the Free Dictionary:
    In the context of above:
    Rearfoot striking --> greater risk for tibial stress fractures; Forefoot striking --> greater risk for metatarsal stress fractures (six of one and half a dozen of the other)
    Rearfoot striking --> greater risk for anterior tibial muscle/tendon problems; Forefoot striking --> greater risk for posterior tibial muscle/tendon problems (six of one and half a dozen of the other)

    Hopefully that makes it clearer.
     
  13. Blaise Dubois

    Blaise Dubois Active Member

    Agree when we look specifically the incidence.

    I think the incidence/prevalence of stress fracture are under estimate one these studies. We do a diagnostic of stress fracture with a XR or MRI or CTscan or Bone scan... not clinically like a MTSS. A percentage of Stress fracture are probably include in the MTSS category... not the opposite.

    My thought : MTSF = close to 5% (it's not rare!) and I don't included here all the other pathologies possibly link with increase VLR

    Agree. And there is maybe many other scientific "posters / Abstracts" that we don't know because never published... showing a link ... or not.

    Thanks to precise

    Maybe because the speed of the adaptation process (and the risk of non-adaptation and persistent pathology) are not the same between "hight metabolism tissue" like muscle and tendon AND "low metabolism tissue" like bone and cartilage? (I play the evil advocate... but I think that, this is a part of the answer)

    1. Heel strike happen unconsciously for many runners with this problem!
    2. After a certain time (persistent condition)... tell them to stop to rear foot strike is one of the thing to include in the treatment plan... like eccentric exercises.
    3. Why the incidence of Achilles tendinopathy seems to increase? (heel lift? too much protection? misadaptation?)


    Agree. but I will say that it's more "Its 8 of one, half a dozen of the other"


    Agree.
    Maybe because one come from 2 million years of evolution and find in barefoot population and the other present from 40 years and find principally on shod runners?
    Maybe because one is more frequent on efficient runners and the other one more on "a lot less" efficient runners?
     
  14. toomoon

    toomoon Well-Known Member

     
  15. Blaise Dubois

    Blaise Dubois Active Member

     
  16. efuller

    efuller MVP

    Blaise,

    Are you asking why forefoot strikers get more Achilles tendonitis? If you are: It's part of the mechanism that reduces forces at impact. Forefoot strikers will, at contact, dorsiflex their ankles with a plantar flexion moment. This will reduce peak forces of ground contact, but there will be much higher forces in the Achilles tendon at contact.

    Eric
     
  17. Blaise Dubois

    Blaise Dubois Active Member

    It was not my question... I understand this concept ;)
    My question was more : Why the incidence of Achilles tendinopathies are more frequent now than 30 years ago?
     
  18. CraigT

    CraigT Well-Known Member

    Hi Blaise
    Do you have a reference that you base this on? Or is this your personal opinion?
     
  19. Blaise Dubois

    Blaise Dubois Active Member

    Just by looking the last SR of Lopes compare to holder one (also read the book of Peter Larson... interesting stuff on that topic... evolution on stats in 1970 to 1980)

    MTSS and Achilles Tendinopathies seem increase...

    Maybe the numbers don't represent the reality?

    In my practice, my reality, the population that have the most of those 2 pathologies are (in order)
    1. Those moving too fast from minimalism to maximalism shoes (n=4)
    2. Those moving too fast from maximalism to minimalism shoes (n=+)
    3. Those use to run with maximalist shoes (n=++++)
    4. Those use to run in minimalist shoes (n=+++)
    5. Barefoot runers (n=3)

    ...but that just clinic and experience.
     
  20. CraigT

    CraigT Well-Known Member


    Hi Blaise
    It may be just a typographic error- do you mean the OLDER one rather than the holder one?? Can you give a specific reference?
    Also- can you explain your n= abbreviation?? the numbers and +++ do not make sense to me... or is this just me?
    Thanks
     
  21. Blaise Dubois

    Blaise Dubois Active Member

    Older... not Holder

    Cavanagh 1979 (stats from The Runners Clinic)

    Running injuries. A review of the epidemiological literature
    Willem van Mechelen
    Sport Medicine 1992

    A retrospective case-control analysis of 2002 running injuries
    J E Taunton, M B Ryan, D B Clement, D C McKenzie, D R Lloyd-Smith, B D Zumbo
    Br J Sports Med 2002;36:95–101

    A prospective study of running injuries: the Vancouver Sun Run “In Training” clinics
    J E Taunton, M B Ryan, D B Clement, D C McKenzie, D R Lloyd-Smith, B D Zumbo
    Br J Sports Med 2003;37:239–244

    on my practice, n=1 means 1 patient
    n = ++++ means a lot :)
     
  22. CraigT

    CraigT Well-Known Member

    Hmmm... not sure it is really valid to compare the data from Lopes to the data from 'older' studies. It is a review of literature and the data was from 8 studies ranging from 1984 through to 2011. There were 3500 pooled subjects, and of these nearly 2900 came from one study.

    I would think it is more useful to compare the 3 studies from Clement, Taunton et al(1981),Mcintyre, Taunton et all (1991), Taunton, Ryan et al (2002) which show that if anything Achilles injuries have decreased (though slightly). In fact in 1991 they speculate that perhaps better footwear may be a reason for this.

    The injury that has apparently increased increased is ITB syndrome, and they suggest that is possibly due to the overuse of shoes which have excessive support- i tend to agree with this. It may also have something to do with the increased popularity of cycling along with running...

    I think you also need to consider the running population now compared with 30 years ago- possibly the reason why the total number of injuries have apparently not decreased.
     
  23. Or indeed, just this planets population change over this time.

    http://en.wikipedia.org/wiki/World_population
     
  24. Blaise Dubois

    Blaise Dubois Active Member

    Hmmm... not sure too. Not sure we can choice the 3 studies we want and forget all the others.:confused: I think we call this cherry picking

    What do you think of that

    1970 hight incidence of AT (read stats report on Pete larson's book) - because people start running more... and too much
    1980-1990 réduction of the incidence of AT but increase of PFPS - because we stat to use heel lift, larger/supportive shoes and more bulky shoes... that decrease the stress on the AT but change the biomechanics and increase the stress on the knee
    2000-2010 incidence of AT increase again - the AT tissue are 'de-conditioned' (runners are walking in their life and running only in shoe with heel lift, they grow-up in bulky shoes, they are more and more sedentary)
    2010-2014 More increase of AT - same reason (200-2010) but with the trend of minimalism
    2020-2030 less injuries in général, less AT, less PFPS - people are use to think more, stop to listen pseudo-advices of over-medicalisation from health professionals. Most of healthy people run in minimalist shoes that don't interfere with biomechanics and tissue adaptation

    just my thought. (I need to see all study together to be sure of that...)
     
  25. Blaise Dubois

    Blaise Dubois Active Member

    Agree...
    But don't tell me that big bulky shoes decrease the incidence of injuries
     
  26. Don't tell me that minimalist shoes and or forefoot striking do either.
     
  27. Blaise Dubois

    Blaise Dubois Active Member

    We just finish a pilot study on that (minimalist vs maximalist)... soon the results
     
  28. CraigT

    CraigT Well-Known Member

    Really?
    The 3 studies are from the same group of practitioners, done over a 20 year period, done withe the aim of comparing injury demographics over that period...
    Are you not tryinig to say that you think that the types of injury seen is changing???
    If so, then this is probably the study that would show it...
    (I am looking forward to the 2012 release...)

    Actually I can't believe the ITB figures are not of more interest to you.

    Cherry picking is taking one piece of data and then suggesting it is a good representation of an overall picture while ignoring conflicting data.
    An example would be citing that stress fractures make up 20% of all sports medicine consultations, but ignoring that this figure is from a study where all subjects were track and field athletes and is also in conflict with other figures from a more general running population...
     
  29. Blaise Dubois

    Blaise Dubois Active Member

    In french, when we say "Up to 20%" (jusqu'à 20%), it's mean that studies show different result between 0 and 20%.

    When we say that tibial stress fractures represent less than 1% it means that it's between 0 and 1%... that's probably true for recreational runners, in a specific area, assess by a specific professional... NOT the reality of different area, different type of physical activity, assess by different professional
     
  30. Griff

    Griff Moderator

    I presume this study has a prospective design and you used monozygotic twins Blaise?
     
  31. Blaise Dubois

    Blaise Dubois Active Member

    Close to... see some point of our study. I'm waiting your critics... that I will transmit to the coauthors for improvement of the next study :boxing:

    Also you can send me the clinical study you produce to improve practice of clinicians (I want to learn)

    Comparison of two types of running shoes for preventing injuries in recreational runners: a pilot study.

    - Prospective
    - Randomized control
    - Population: Recreational runners subscribing to a structured 16-weeks training program towards a half-marathon.
    - Inclusion criteria are the following: (1) Age between 18 and 45, (2) no past medical history of injury during the 6 months preceding the start of the 16-weeks training program, (3) be able to run at least 20 minutes continuously.
    - Exclusion criteria are (1) the presence of an underlying or suspected degenerative musculoskeletal pathology in the lower limbs such as osteoarthritis, (2) a past medical history of lower limb injury or surgery potentially altering running biomechanics, (3) use of foot orthotics in the last 6 months, (4) the presence of any neuromusculoskeletal symptomatic problem in a lower limb or in the lumbo-pelvic region.
    - Intervention. One group will wear modern absorbing running shoes with or without stabilization technologies (TS group) and another group will wear minimalist shoes (MS group). Subjects will go to a pre-determined specialized running shoes store where an expert in shoes fitting will propose a choice of 6 pre-determined shoe models from different brands for each group. Personal preference among the 6 models proposed and optimal fitting for every subject will determine the final choice by each participant.
    - The individualized training program will be sent and running sessions will be recorded by subjects using the online system TotalCoaching.com. This online tool will enable the research team to follow every subject’s training via their running log. If a subject
    modifies a run, he can write the change and the reason. An automated alert will be sent to the research team when subjects will miss a training session. We will also be able to see if subjects felt any pain during or after their activity using visual analog scales (VAS), which will be completed for every training. The number of missed training sessions will be recorded as well as trainings that were reduced by 50% or more because of pain limitation.
    - Subjects will be contacted by phone or email if their log shows irregularities or recurrent pain to orientate them towards a sports physician (PF). This doctor will be blinded to the type of shoes used and his role will be to establish a diagnostic, pain sites and affectation levels by filling out a pre-conceived evaluation sheet and to recommend appropriate actions to the subject
     
  32. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Impact reduction through long-term intervention in recreational runners: midfoot strike pattern versus low-drop/low-heel height footwear
    Marlène Giandolini, Nicolas Horvais, Yohann Farges, Pierre Samozino, Jean-Benoît Morin
    European Journal of Applied Physiology; April 2013
     
  33. Is impact really that important of a factor for running injuries. May want to look at Benno Nigg's study!
     
  34. Craig Payne

    Craig Payne Moderator

    Articles:
    6
  35. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    A Comparison of Negative Joint Work and Vertical Ground Reaction Force Loading Rates between Chi Runners and Rearfoot Striking Runners
    Donald Lee Goss & Michael T. Gross
    J Orthop Sports Phys Ther, Epub 9 September 2013
     
  36. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Shear cushions reduce the impact loading rate during walking and running
    Ming-Sheng Chan, Shu-Ling Huang, Yo Shih, Chia-Hsiang Chen & Tzyy-Yuang Shiang
    Sports Biomechanics Published online: 11 Oct 2013
     
  37. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    The influence of lower extremity coronal plane movements on the passive regulation of instantaneous loading mechanics during running
    Jonathan Kenneth Sinclair, Paul John Taylor, Sarah Jane Hobbs
    Baltic Journal of Health and Physical Activity. Volume 5, Issue 3, Pages 167–175, ISSN (Online) 2080-9999, ISSN (Print) 2080-1297, DOI: 10.2478/bjha-2013-0015, October 2013
     
  38. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Variables during swing associated with decreased impact peak and loading rate in running
    Anne Schmitz, Michael B. Pohl, Kaitlin Woods, Brian Noehren
    Journal of Biomechanics; Available online 22 October 2013
     
  39. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Rearfoot and Midfoot/Forefoot Impacts in Habitually Shod Runners
    Boyer, Elizabeth R.; Rooney, Brandon D.; Derrick, Timothy R.
    Medicine & Science in Sports & Exercise: 2 December 2013
     
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