Thursday, December 29, 2011

Overpronation in Runners

“Overpronation” has been some sort of buzz word in the running community for a long time, but is generally a meaningless term. It is widely used to wrongly prescribe a specific running shoe (ie motion control). The real problem with the term is that it is a substantial oversimplification of what is actually happening to the foot and the use of the term seems to have made experts in it by some health professionals, running shoe sales people, coaches and even runners who have no sort of medical or related qualification. The blogosphere is also full of non-experts pontificating on myths of overpronation. It is easy to see that they have no real understanding of biomechanics and foot function and what they write is easy to deconstruct. There are numerous reasons why a foot may overpronate, so to advocate one method to treat overpronation over another is just plain ignorance of what the causes of it are. Muscle strengthening will only correct overpronation if a muscle weakness is the cause. Muscle stretching will only correct overpronation if a tight muscle is the cause. Gait retraining will only correction overpronation if there is an abnormality in the gait amenable to gait retraining. Foot orthotics will only correct overpronation is there is an alignment issue with the bones. If you have overpronation, do yourself a favor and see someone who actually understands what it is, rather than listen to the unscientific pontifications of self-proclaimed gurus who just happen to have a blog. For more detail on this, I blogged about it here. There are so many overpronation myths to bust and so little times to deal with them!

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Wednesday, December 21, 2011

Navicular Stress Fracture

Navicular stress fractures are a diagnostic challenge and the existence of the so called “N spot” over the navicular is an important diagnostic suspicion. X-rays are not always helpful with a significant number of false positives. There are no short cuts with a navicular stress fracture, the time non-weightbearing away from sport is a minimum of 5-6 weeks. There is no way around this. I have recently spoken to a couple of colleagues who had to deal with athlete with this and they were looking for ways to avoid that. There is no way. The outcomes and success rates and the return to sport for a navicular stress fracture, regardless if it is a surgical or conservative management plan seem to be about the same. The athlete has to be told: no weightbearing for 5-6 weeks. Find a non-weightbearing activity for them to keep going.

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Tuesday, December 13, 2011

Running With a Cadence of 180 Steps a Minute

The concept of runners shortening the stride length and increasing the cadence to 180 steps a minute has been coming up as a concept a lot me recently. I am not sure what to make of it. Some prominent coaches and running form experts are advocating it to reduce the risk of injury. At the same time a number of sports scientists are dismissing it as not valid. Most runners tend to naturally adopt a running form that is the most metabolically efficient for them. Any change to that tends to come with a metabolic cost. Those that advocate it are very passionate abut it, but as we know that the more passion there is in defending a theory, the less likely there is to be any evidence that supports it (Paynes First Law). I am certainly seeing injuries in those runners who use a 180 cadence, so I going to wait until the science tells me which is the better way to go on this one.

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