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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
Quote:
Running-related stress fractures have been associated with the overall impact intensity, which has recently been described through the loading rate (LR). Our purpose was to evaluate the effects of four acute interventions with specific focus on LR: wearing racing shoes (RACE), increasing step frequency by 10 % (FREQ), adopting a midfoot strike pattern (MIDFOOT) and combining these three interventions (COMBI). Nine rearfoot-strike subjects performed five 5-min trials during which running kinetics, kinematics and spring-mass behavior were measured for ten consecutive steps on an instrumented treadmill. Electromyographic activity of gastrocnemius lateralis, tibialis anterior, biceps femoris and vastus lateralis muscles was quantified over different phases of the stride cycle. LR was significantly and similarly reduced in MIDFOOT (37.4 ± 7.20 BW s(-1), -56.9 ± 50.0 %) and COMBI (36.8 ± 7.15 BW s(-1), -55.6 ± 29.2 %) conditions compared to NORM (56.3 ± 11.5 BW s(-1), both P < 0.001). RACE (51.1 ± 9.81 BW s(-1)) and FREQ (52.7 ± 11.0 BW s(-1)) conditions had no significant effects on LR. Running with a midfoot strike pattern resulted in a significant increase in gastrocnemius lateralis pre-activation (208 ± 97.4 %, P < 0.05) and in a significant decrease in tibialis anterior EMG activity (56.2 ± 15.5 %, P < 0.05) averaged over the entire stride cycle. The acute attenuation of foot-ground impact seems to be mostly related to the use of a midfoot strike pattern and to a higher pre-activation of the gastrocnemius lateralis. Further studies are needed to test these results in prolonged running exercises and in the long term.
...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?
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
__________________ Craig Payne
__________________________________________________ ___________________________________ Follow me on Twitter | Run Junkie God put me on this earth to accomplish a certain number of things - right now I am so far behind, I will never die.
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...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?
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
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.
Juste to start, can you explain your reference to tell that stress fracture of the tibia represent just 1% of the sport injuries.
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.
__________________ Craig Payne
__________________________________________________ ___________________________________ Follow me on Twitter | Run Junkie God put me on this earth to accomplish a certain number of things - right now I am so far behind, I will never die.
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.
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
The practice of running has consistently increased worldwide, and with it, related lower limb injuries. The type of running surface has been associated with running injury etiology, in addition other factors, such as the relationship between the amount and intensity of training. There is still controversy in the literature regarding the biomechanical effects of different types of running surfaces on foot-floor interaction. The aim of this study was to investigate the influence of running on asphalt, concrete, natural grass, and rubber on in-shoe pressure patterns in adult recreational runners. Forty-seven adult recreational runners ran twice for 40 m on all four different surfaces at 12 ± 5% km · h(-1). Peak pressure, pressure-time integral, and contact time were recorded by Pedar X insoles. Asphalt and concrete were similar for all plantar variables and pressure zones. Running on grass produced peak pressures 9.3% to 16.6% lower (P < 0.001) than the other surfaces in the rearfoot and 4.7% to 12.3% (P < 0.05) lower in the forefoot. The contact time on rubber was greater than on concrete for the rearfoot and midfoot. The behaviour of rubber was similar to that obtained for the rigid surfaces - concrete and asphalt - possibly because of its time of usage (five years). Running on natural grass attenuates in-shoe plantar pressures in recreational runners. If a runner controls the amount and intensity of practice, running on grass may reduce the total stress on the musculoskeletal system compared with the total musculoskeletal stress when running on more rigid surfaces, such as asphalt and concrete.
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
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.
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
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.
__________________
Sincerely,
Kevin
**************************************************
Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College
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
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.
Quote:
Originally Posted by Craig Payne
...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?
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
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?
__________________ Craig Payne
__________________________________________________ ___________________________________ Follow me on Twitter | Run Junkie God put me on this earth to accomplish a certain number of things - right now I am so far behind, I will never die.
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:
Quote:
six of one and half a dozen of the other
Fig. about the same one way or another. It doesn't matter to me which way you do it. It's six of one and half a dozen of the other. What difference does it make? They're both the same—six of one and half a dozen of the other.
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.
__________________ Craig Payne
__________________________________________________ ___________________________________ Follow me on Twitter | Run Junkie God put me on this earth to accomplish a certain number of things - right now I am so far behind, I will never die.
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Military stress fracture occurrence do not really count here (due to boots worn, load carriage and asymmetric gait from rifle carriage).
Agree when we look specifically the incidence.
Quote:
Originally Posted by Craig Payne
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 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.
Quote:
Originally Posted by Craig Payne
--> 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.
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
Quote:
Originally Posted by Craig Payne
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.
Agree. And there is maybe many other scientific "posters / Abstracts" that we don't know because never published... showing a link ... or not.
Quote:
Originally Posted by Craig Payne
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).
Thanks to precise
Quote:
Originally Posted by Craig Payne
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?
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)
Quote:
Originally Posted by Craig Payne
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?
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?)
Quote:
Originally Posted by Craig Payne
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.
Agree. but I will say that it's more "Its 8 of one, half a dozen of the other"
Quote:
Originally Posted by Craig Payne
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?
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?
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[quote=Blaise Dubois;274805]Agree when we look specifically the incidence.
Blaise.. are you able to post the full text of your paper here, or if that is not appropriate, can you privately email it to me?
It is always difficult to get a feel for the research from just an abstract.
cheers
simon
3. Why the incidence of Achilles tendinopathy seems to increase? (heel lift? too much protection? misadaptation?)
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.
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
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?
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?
Hi Blaise
Do you have a reference that you base this on? Or is this your personal opinion?
__________________
Craig Tanner
Podiatrist ASPETAR-
Qatar Orthopaedic and Sports Medicine Hospital
Doha
QATAR http://www.aspetar.com/
Hi Blaise
Do you have a reference that you base this on? Or is this your personal opinion?
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)
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.
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
__________________
Craig Tanner
Podiatrist ASPETAR-
Qatar Orthopaedic and Sports Medicine Hospital
Doha
QATAR http://www.aspetar.com/
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
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 :)
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
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.
__________________
Craig Tanner
Podiatrist ASPETAR-
Qatar Orthopaedic and Sports Medicine Hospital
Doha
QATAR http://www.aspetar.com/
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.
Or indeed, just this planets population change over this time.
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.
Hmmm... not sure too. Not sure we can choice the 3 studies we want and forget all the others. 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...)
Hmmm... not sure too. Not sure we can choice the 3 studies we want and forget all the others. I think we call this cherry picking
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...
__________________
Craig Tanner
Podiatrist ASPETAR-
Qatar Orthopaedic and Sports Medicine Hospital
Doha
QATAR http://www.aspetar.com/
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...
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
Impact reduction during running
I think we call this cherry picking
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