Tagged Sports Injuries

Meet the Ultra-Fat, Super-Cushioned Running Shoe

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Credit Hoka One One

Can fat-soled shoes that appear to have been constructed in part from marshmallows help you run better? The first study of a new kind of thickly cushioned running shoe suggests that this type of footwear may not make running any easier. But it probably also will not make it harder. And nobody knows yet whether these maximalist running shoes, as they’re called, are the answer to preventing the painful injuries that sideline as many as 90 percent of runners at some point.

Anyone who hangs out with distance runners has doubtless noticed the sudden popularity of these shoes, which provide two or three times as much foam padding between the foot and the pavement as most running shoes. The voluptuous Hoka One One shoes are perhaps the most recognizable of the new maximalist footwear, but almost every athletic shoe company offers models now with similarly extreme padding.

Maximalist shoes would seem to be a fervent reaction to and rebuke of the other recent fad in running-related footwear, which consisted of minimalist or barefoot-style shoes that provide little if any cushioning.

But according to John Mercer, a professor of biomechanics at the University of Nevada in Las Vegas, and senior author of the new study, both types of footwear were developed in response to the same concern: the desire to prevent running injuries.

Many hoped that barefoot-style shoes, by removing most padding, would change how people run in beneficial ways. Researchers had noted that people who grow up running barefoot (which means, mostly, young Kenyan runners) typically strike the ground near the middle or front of their foot and tend to have relatively few injuries. Perhaps, the researchers speculated, that style of running would result in fewer injuries for the rest of us.

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The Clifton 2 is a thick-soled running shoe made by Hoka One One.

The Clifton 2 is a thick-soled running shoe made by Hoka One One.Credit Hoka One One

So some runners began wearing flat, minimalist shoes that mimic running barefoot.

But the results were not altogether salutary. No agency collects data about running injuries, but anecdotal reports suggest that quite a few barefoot-style runners wound up getting hurt, in part because their feet and legs were unused to the new patterns of pounding that occur when shoes provide little or no cushioning.

Human nature being what it is, people then turned to shoes with far more cushioning than had been used in running shoes before.

“I first saw these extremely cushioned shoes being worn by ultra-runners and trail runners” covering long distances, Dr. Mercer said. More recently, less intense runners have begun wearing the maximalist shoes, he said.

These shoes promise plush comfort without a decrease in athletic performance, Dr. Mercer said. Rather surprising (to me), most maximalist shoes weigh about the same as thinner models, Dr. Mercer said, because the foam used for cushioning has a cotton-candy airiness.

However, these shoes are still so new that scientists had not yet examined their effects on how people run.

So for the new study, which was presented last week at the annual meeting of the American College of Sports Medicine in Boston, Dr. Mercer and his colleagues asked 10 experienced runners to eschew their usual shoes for a few days.

At the university’s human performance lab, the runners donned alternately an average pair of running shoes and a pair of maximally cushioned shoes. They ran in each type of shoe at three different speeds and two different inclines on a treadmill, while wearing a mask that measured precisely how much oxygen the runner was taking in. Each run lasted eight to 10 minutes.

If shoes make it more or less difficult to run, Dr. Mercer said, the amount of oxygen that a runner wearing those shoes breathes in should commensurately rise or fall.

As expected, the runners all gasped in far more oxygen when they ran at higher speeds and increased slopes. But their footwear did not affect their oxygen intake. The runners required about the same amount of oxygen at the various paces and inclines whether they wore super-fat or average shoes.

In other words, the maximalist shoes did not make running more tiring. But they also did not make it easier.

The results might encourage some comfort-loving runners, like me, to consider trying the fat-soled shoes.

But this study was quite small-scale and did not address the pressing issue of injuries. No one knows at this point whether wearing maximalist shoes will keep people from getting hurt, Dr. Mercer said. The shoes might, for example, turn out to contribute to certain injuries if their added height makes runners less stable or less able to feel and respond to changes in the ground beneath them.

Dr. Mercer and his colleagues hope to study injury patterns from these shoes in the future.

For now, the broader import of the study’s findings could be that shoes may matter less for running ease than many of us might expect. So if you like your current shoes, stick with them. If, however, you do wish to try maximally — or minimally — cushioned shoes, visit your local running specialty store and wear a pair for a jog around the block to judge whether you enjoy how they feel.

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School Athletes Often Lack Adequate Protection

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Credit Paul Rogers

With all the attention on national rules to prevent and properly treat injuries to professional and college athletes, it may surprise you to learn that there are no nationwide guidelines to protect high school athletes from crippling or fatal injuries.

Instead, it is up to individual states and the schools within them to adopt policies and practices that help to assure the safety of children who play organized school or league sports. But most states and schools have yet to enact needed safety measures, according to data from the National Athletic Trainers’ Association.

“Each state has its own high school athletic association, and each policy has to be individually approved,” said Douglas Casa, an athletic trainer and chief executive of the University of Connecticut’s Korey Stringer Institute, named for the former National Football League player who died from complications related to heatstroke in 2001.

“It’s a burdensome, grueling process,” Dr. Casa said, that he and others hope will yield to the efforts of a new program, the Collaborative Solutions for Safety in Sport created by the athletic trainers’ association and theAmerican Medical Society for Sports Medicine.

The program held its second meeting last month, attended by two high school representatives from each state, to provide them with road maps to establish safety rules and policies or laws for high school athletics.

Last year alone, about 50 high school athletes died, according to the association, and thousands suffered long-term complications from sports-related injuries, most of which could have been avoided had well-established safety practices been in place and observed.

The leading causes of sports-related deaths among high school students are sudden cardiac arrest, head and neck injuries, and exertion-induced heatstroke or sickling, which occurs in athletes who carry the sickle cell trait. Fatalities occur primarily because most schools lack four critical ingredients to assure sports safety: emergency action plans, policies for proper conditioning and safe exercise in high heat and humidity, the presence of trained health professionals at all practices and games, and immediate availability of automated external defibrillators, or A.E.D.s, to reset a stilled or erratically beating heart.

In July 2004, Laura Friend of Fort Worth, lost her 12-year-old daughter Sarah during a junior lifeguarding class because nobody recognized the child was in cardiac arrest and no one initiated CPR or used the A.E.D. on the premises. Not until after Sarah died was it known that she had been born with an enlarged heart.

Ms. Friend, who now coordinates a Texas cardiac emergency project, created a nonprofit foundation in her daughter’s memory that has donated 59 A.E.D.s and provided CPR and A.E.D. training for hundreds of youth and adults in Texas.

However, despite a 2007 law requiring an A.E.D. in every school in Texas, “many are locked up in an office and not accessible, or only the school nurse knows how to use it,” Ms. Friend said.

Knowing that sudden cardiac arrest is by far the leading cause of death among student- athletes, Dr. Casa owns an A.E.D. and takes it to every practice and game of soccer, lacrosse and swimming involving his three school-age children.

The Mallon family of Del Mar, Calif., knows all too well the importance of having a medically trained professional on hand during practices and games. Tommy Mallon owes his life and well-being to an athletic trainer and a quick-thinking teammate who refused to help him up when he landed hard after colliding with another lacrosse player when he was 17. Instead, a trainer was summoned who, noticing subtle neurological signs that suggested a catastrophic, potentially fatal injury, called immediately for an ambulance.

Tommy, 23, now a global risk analyst in Austin, Tex., had sustained a fractured vertebra in his neck and torn artery to the brain. Had he been moved incorrectly, he could have died or been paralyzed.

In the years since, Tommy’s mother, Beth Mallon, has been a relentless advocate for teaching athletes how to recognize basic signs and symptoms of trouble on the field or court. Some 5,000 students have already been through the program she developed, Athletes Saving Athletes, taught by athletic trainers.

“In just two hours, the kids learn all they need to know: This could be serious, when and how to get help,” Ms. Mallon said. “We’ve had three success stories so far: one involving a heatstroke, one with cardiac arrest and a third with a neck injury and concussion.”

“High schools spend tons of money on referees, but almost nothing on safety,” she said. “I’d like to see every high school in the country adopt a sports safety curriculum. You never think a catastrophic injury will happen to your kid, but if it does, you’d be so grateful that someone is there who knows what to do.”

Dr. Jonathan Drezner, director of the Center for Sports Cardiology at the University of Washington, outlined the key practices the collaborative project is trying to get every high school that sponsors athletic activities to adopt:

■ An athletic trainer at every practice and game;

■ An emergency action plan to respond appropriately to an athlete in distress;

■ A publicly accessible A.E.D. and school-based program in its use;

■ Climatization policies to prevent heat injury and heatstroke.

Although having a medically trained person readily available can be too costly for many schools, an A.E.D. costs only about $1,000 and can be used to save anyone — coaches, refs and spectators as well as athletes.

“I can’t believe we don’t have universal access to A.E.D.s in schools; they should be like fire extinguishers,” Dr. Drezner said. “There are 7.5 million high school athletes in this country. During the academic school year 2014-2015, there were 55 cases of cardiac arrest among them, and 57 percent died.”

Parents whose children want to play school sports often focus more on uniforms than on measures to protect them from serious or fatal injuries. Experts say that a pre-participation medical exam is critical and should include an EKG if there is any family history of heart trouble.

Coaches should know CPR, the location and use of an A.E.D., the signs of a possible concussion, and when to keep a player on the sidelines. Coaches should also monitor climate conditions and know when to postpone or suspend a practice or competitive event to avoid heat injuries. During hot weather and high humidity, a cooling tub should always be available. If school money is tight, parents might hold a fund-raiser to assure that an athletic trainer or sports medicine doctor attends every practice and game.

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An Easy Way to Prevent Blisters? Try Tape

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Credit Getty Images

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Paper tape, the kind you can find in a first-aid kit, can help prevent blisters.

Paper tape, the kind you can find in a first-aid kit, can help prevent blisters.Credit Grant S. Lipman, M.D.

Exercise science today is exploring countless mysterious, exciting and poetic aspects of human physiology and performance. But sometimes you just wish that someone would tell you how to keep your feet from hurting. A wonderfully practical new study obliges, providing the first reliable, field-tested evidence about how to prevent blisters during prolonged exercise. Anyone running next week’s Boston Marathon, you’re welcome.

Blisters are one of the most common bugaboos of physical activity. Almost everyone who regularly trains or competes in any sport has experienced blisters. They reportedly afflict about 40 percent or more of marathon runners and frequently cause racers to drop out of the event.

“Blisters happen to just about everyone,” said Dr. Grant S. Lipman, a clinical associate professor of medicine at Stanford University, who led the new study.

Blisters develop when something rubs repeatedly against a patch of skin. The resulting friction causes the top layers of the skin to begin separating from one another, producing a feeling of heat. This is a hot spot, a warning sign of an incipient blister. If the friction continues, fluid fills the spaces between the skin layers, and you have a blister.

Blisters hurt, as most of us know from experience. So active people have tried many methods to avoid them. Past studies in the small field of blister science have found that, by and large, none of these methods work. Applying petroleum jelly to the feet, for instance, increases friction and the incidence of blisters, according to a 1995 study. Ditto for wearing cotton socks, using lotion combined with antiperspirant, or sticking a bandage, Moleskin or other specialized protective patch onto the foot.

But Dr. Lipman, who is the director of the Wilderness Medicine program at Stanford and the medical director for several ultramarathons around the world, had heard from ultramarathon runners that wrapping parts of their feet in paper tape helped them to stave off blisters.

Paper tape is exactly what its name suggests, a thin, inexpensive tape made of paper. You can find it at virtually any drugstore, sold as surgical or medical tape, and it is a common component of first-aid kits. It is thinner than bandages, and breathable.

But anecdotes from happy racers do not constitute scientific evidence, Dr. Lipman knew.

So for the new study, which was published this week in the Clinical Journal of Sport Medicine, he turned to a group for whom blisters are almost inevitable: ultra-ultramarathoners and, specifically, the participants in an annual, grueling multistage ultramarathon run across parts of Jordan, Madagascar and the Gobi and Atacama deserts.

Dr. Lipman and his colleagues asked all of the runners signed up for the 2014 event if they would wear paper tape on their feet to determine if doing so actually prevented blisters. Almost 130 men and women agreed.

Immediately before the first stage began, those racers visited Dr. Lipman’s medical tent and had their feet wrapped. Runners with a history of blisters, which was most of the runners, showed the researchers where they had been prone to develop the sores in the past. Those areas — usually the toes — were then covered with the thin tape. If someone had not experienced blisters before, the researchers wrapped parts of their feet at random.

The uncovered portions of each runner’s affected foot would serve as a control, the scientists had decided. If a runner developed no blisters or blisters only where his or her foot had remained unprotected, then the tape could be considered to have worked.

Six stages and more than 200 miles later, most of the runners had developed at least one blister. But an overwhelming majority of those blisters, about 70 percent, had occurred on the unprotected parts of the foot. Very few blisters had developed beneath the tape.

Over all, the scientists concluded, the tape had reduced the incidence of blisters by at least 40 percent, a very “robust effect,” they wrote.

But there were quibbles. Paper tape is not very sticky and typically will peel away as feet sweat. Most runners had to reapply the tape multiple times throughout the race stages, meaning they had to carry a roll with them, stop, uncover their feet, retape and resume running. Whether participants in shorter, single-stage events, such as a marathon, would need to retape their feet is not known

(On the plus side, Dr. Lipman said, paper tape won’t stick to a blister and tear away skin or tissue when removed, as bandages will.)

Most of the racers involved in the study, however, said afterward that they planned to use the tape in future events, Dr. Lipman said.

For those at home considering likewise taping their feet to avoid blisters, the process is simple, he said. Cut or tear a single narrow strip of the paper tape and wrap it over whichever part of your foot has been prone to blisters. (See photo.) For most people, the toes and ankle are the spots most vulnerable to blisters.

Also, he said, use common sense. Make sure that your shoes fit and don’t rub against your skin. Never wear brand-new shoes in a race, as you won’t know whether they rub. And don’t wear cotton socks or coat your feet in petroleum jelly.

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Why We Get Running Injuries (and How to Prevent Them)

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Credit Getty Images

Warm weather is on its way across the country — really, it is, I promise— and so are spring marathons, meaning that many people soon will begin a new or augmented running program. Many also will wind up sidelined by injury. But a new study suggests that being light on your feet could keep most runners healthy.

Running injuries are extremely common, with some statistics estimating that as many as 90 percent of runners miss training time every year due to injury.

But the underlying cause of many of these injuries remains in question. Past studies and popular opinion have blamed increased mileage, excess body weight, over-striding, modern running shoes, going barefoot, weak hips, diet, and rough pavement or trails. But most often, studies have found that the best indicator of a future injury is a past one, which, frankly, is not a helpful conclusion for runners hoping not to get hurt.

So for the new study, which was published in December in the British Journal of Sports Medicine, researchers at Harvard Medical School and other universities decided to look at running injuries, one of the more obvious but surprisingly understudied aspects of running, and to focus their attention, in part, on those rare long-time runners who have never been hurt.

Specifically, they set out to look at pounding, or impact loading, which means the amount of force that we create when we strike the ground. Pounding is, of course, inevitable during a run. But runners with similar body types and running styles can experience wildly different amounts of impact loading, and it hasn’t been clear to what extent these differences directly contribute to injuries.

The researchers recruited 249 experienced female recreational runners, who were chosen in part because they all struck the ground with their heels when they ran. Most runners are heel strikers, and heel striking is believed by many running experts to cause higher impacts than landing near the middle or front of the foot, possibly contributing to an increased risk of injuries. (The scientists focused on a single sex so that they would not have to control for gender in the results.)

The volunteers reported to the biomechanics lab at the Spaulding National Running Center, which is affiliated with Harvard Medical School, where they completed questionnaires about their injury history and then strode along a track equipped with force monitors to determine their impact loads.

Afterward, the scientists asked each volunteer to complete an ongoing, online running diary and injury log.

The researchers tracked the runners for two years.

During that time, more than 100 of the runners reported sustaining an injury that was serious enough to require medical attention. Another 40 or so reported minor injuries, while the rest remained uninjured.

More remarkably, in the minds of the researchers, 21 of the runners not only did not become injured during the two-year study but also had not had a prior injury. They remained long-term running-injury virgins, the athletic equivalent of unicorns.

Intrigued, the scientists decided to compare that small group’s impact loading with the pounding experienced by the seriously injured runners, since, the researchers theorized, the contrast between these groups should provide the most telling data about whether how hard you land affects your risk of being hurt.

The answer was that it does. The never-injured runners, as a group, landed far more lightly than those who had been seriously hurt, the scientists found, even when the researchers controlled for running mileage, body weight and other variables.

That finding refutes the widely held belief that a runner cannot land lightly on her heels.

“One of the runners we studied, a woman who has run multiple marathons and never been hurt, had some of the lowest rates of loading that we’ve ever seen,” said Irene Davis, a Harvard professor and director of the Spaulding center, who led the study. She pounded far less than many runners who land near the front of their feet, Dr. Davis said. “When you watched her run, it was like seeing an insect running across water. It was beautiful.”

The data also, however, contain a more general message for those of us who are not as wispy and whippy in our landings. Consciously think about “a soft landing,” Dr. Davis said. Some runners, especially those with a long history of injuries, might want to experiment with landing closer to the midfoot, she said, since many — but not all — runners naturally land more lightly when they don’t lead with the heel.

Consider, too, slightly increasing your cadence, she said, which is the number of steps you take per minute, a change that also tends to reduce the pounding from each stride. Or you might, as I plan to do, imagine that you are running over eggshells or, even more evocatively, are a water strider, moving gracefully and weightlessly across the pond.

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