Toes or Heels?  Revisiting The Runner’s Debate

Dev Mishra, M.D. President, Sideline Sports Doc Medical Director, Apeiron Life Fellow, American Academy of Orthopaedic Surgeons Institute For Joint Restoration, Menlo Park, CA   October 27, 2020 Key Points: Forefoot strike running can reduce impact forces on the leg, leading to a reduced risk of some types of running injuries However, the transition from…

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Relative Energy Deficiency in Sport (RED-S): An Under-Recognized Sports Health Disorder

We previously wrote about the Female Athlete Triad, and provide below an update. While most commonly found in female athletes, it’s been discovered that male athletes can also have a form of this problem. So a broader term has been in use recently, Relative Energy Deficiency in Sport (RED-S).

RED-S is a serious health condition typically affecting teenage athletes. It’s made up of three key components (“the triad” for female athletes):

Low energy availability, sometimes associated with an eating disorder (females and males)
Abnormalities in the menstrual cycle (females)
Low bone mineral density, sometimes leading to stress fractures or osteoporosis (females and males)

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A Simple Way To Reduce Kneecap Pain

Pain in the front of the knee with running is extremely common in all age groups, but particularly so in teenagers and women in their 20s and 30s. Physicians often use the vague and generally unhelpful phrase “patellofemoral pain” when describing this condition.

A recently published study shows that a simple 10% increase in the step rate (i.e. cadence) is an effective way to improve pain symptoms and improve running mechanics. The beauty of the method is that it took only a single 10-minute session, can be done by the individual runner, and results lasted at least 3 months.

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Toes or Heels?  The Runner’s Debate

As an orthopedic surgeon I generally see folks in my clinical practice once something has gone wrong. Either they’ve been injured already or there is some ongoing reason that affects pain, performance, or quality of life. But in our role as team physicians we get a chance to interact with athletes before a problem has occurred.

I’ll often see athletes with Achilles tendinitis or shin splint syndrome and discover that they recently changed their running style from heel strike to forefoot strike. It’s easy for me to jump to the conclusion that forefoot running is somehow bad for runners. Or am I seeing a skewed population? I recently spoke with my Stanford colleague Michael Fredericson M.D., an internationally recognized running expert to find some answers.

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Are Calf Compression Socks Helpful Or Just A Fashion Statement?

Calf compression socks are reported to improve leg endurance during running, speed recovery after a long distance run, and possibly lead to better performance. Do they actually do these things or is something else happening?

A recent scientific study evaluated the pain levels, performance, and muscle architecture during a six-week training period prior to an ultramarathon and in the immediate period after the race. In this group of healthy experienced runners with no prior issues of leg pain, the study authors found no improvements in the compression sock group. In fact, their runners with compression socks actually reported more pain than the runners who trained and competed without the socks.

The conclusion in this well-performed study of healthy runners is that there is no benefit to wearing the compression socks. Still, I find there are good reasons to wear them, especially if you’re recovering from an injury.

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Strong Hips Are Key To Healthy Running

The repetitive nature of running means that runners are unfortunately at risk for a number of overuse running injuries. The most common injuries include patellofemoral pain (PFP), iliotibial band syndrome (ITBS), shin splints or medial tibial stress syndrome (MTSS), Achilles tendonitis (AT), plantar fasciitis, stress fractures, and muscle strains.

 A high percentage of runners with these injuries will unfortunately stop running permanently due to the injuries. While there are many factors that may contribute to the development of an overuse injury, a recently published biomechanical study supports the idea that strong hips- especially the hip abductors/glutes- are keys to pain free running.

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Risk Factors For Adolescent Stress Fractures

Stress fractures in adolescent athletes are unfortunately fairly common. Here’s an interesting recently published scientific study that aims to identify risk factors for stress fractures in adolescent athletes. The authors found several characteristics associated with stress fracture risk: lower than normal body mass index, four weeks or more history of shin splints, minimal involvement in weight training, decreased amount of sleep, daily stress, and low dairy intake.

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When Can I Play Again: Tibia Stress Fracture

A stress fracture is an overuse injury that occurs when muscles become fatigued and eventually are unable to absorb the shock from a sport or fitness activity. Rather than being absorbed by the muscle, the stresses are instead transferred to the bone causing an injury to the bone itself. The bone injury is called a stress fracture. It can range from deep bruising within the bone to more severe type of injury where the outer surface of the bone is cracked. The most common site for a stress fracture is in the lower extremities in the tibia or in the foot but can also occur in other areas such as the spine. In this post will cover stress fractures to the tibia and typical return to play times.

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Long Distance Running Won’t Kill Your Knees

I see a lot of folks in my clinical practice with hip and knee arthritis and many of them have extensive running histories. Most of these folks believe that it’s the long term running that eventually led to the arthritis, but the belief that running causes knee arthritis is probably a myth. The idea that running can lead to arthritis makes sense. You run on a hard surface for long distances and over many years the impact leads to wear and tear. Seems pretty logical, right? Well the available evidence points us in a different direction.

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The Runner’s High

By Dev Mishra, M.D. President, Sideline Sports Doc Clinical Assistant Professor of Orthopedic Surgery, Stanford University Key Points: When your body comes under stress or experiences pain, neurochemicals called endorphins and endocannabinoids are produced in the brain. This happens in all age groups. Endorphins and endocannabinoids are considered natural painkillers because they activate receptors in…

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