Picture attribution/credit: Schneelocke/Wikimedia Commons LicenseFollowing a recent study published on-line by the journal Medicine and Science in Sports and Exercise titled “Foot Bone Marrow Edema after 10-Week Transition to Minimalist Running Shoes”, several headlines raised alarm about the safety of Vibram Fivefingers (VFF) shoes. “Barefoot Running Can Cause Injuries, Too” stated the New York Times. “Whoa there! Quick switch to 'barefoot' shoes can be bad to the bone” was the Sciencedaily.com headline. Well, don’t chuck your minimal shoes without first putting on your research hat. Let’s dig deeper: The study concluded that switching from “regular” running shoes to VFF caused increased bone marrow edema of bones in the feet. Sure, bone marrow edema doesn’t sound pleasant, but is some swelling and tissue change in response to a change in conditions really such an aberrant and worrisome response? Muscles adapt to stress by forming micro-tears before they grows stronger. Think of lifting weights at the gym. It’s not the lifting the weight that strengthens the muscle. It’s the micro-tears that form in the muscle, followed by repair and remodeling of the muscles that makes them stronger. This remodeling in response to stress is called Davis law. There exists a similar law for the stress response in bone…Wolf’s law describes how bone adapts to stress in order to better withstand future stress. The researchers found no differences in soft tissue response amongst the two groups of runners, putting worries about possible Achilles tendon and plantar fascia damage to rest. It’s the difference in bone response that is under consideration. About two thirds of the runners in the VFF group experienced an amount of bone edema (swelling) that would classify them as suffering from a “stress injury”. Two of these people even developed stress fractures. It takes longer for bone to change than muscle. Bones remodel upon micro-damage, thanks to osteoclasts and osteoblasts, which travel around and chew up damaged bone and replace it with fresh new bone. Since this process occurs sequentially, bones can actually get weaker before they get stronger. If a new stress is introduced more quickly than the bone can repair itself, the bone can become micro-damaged and form a stress-fracture. Edema in bone is one sign of remodeling! As Peter Larson at Runblogger.com points out in his analysis of this study, any change that causes stress may cause bone edema. He cites evidence that changing from walking to running, adding a metatarsal arch pad, or increasing training intensity can all cause bone edema. A fundamental design flaw threatens the validity of this study. It is missing a CONTROL GROUP! We have no way of knowing whether it is switching to VFF, or switching to ANY different running shoe that is causing the bone edema. Run far away from this study! But make sure you do it with slow, controlled increments of added stress, to ensure maximum health of your bones and soft tissues. References: 1. Foot Bone Marrow Edema after 10-week Transition to Minimalist Running Shoes Ridge, Sarah T. et. al, Feb 22, 2013 2. http://www.runblogger.com/2013/04/do-vibram-fivefingers-increase-risk-of.html
Picture attribution: lululemon athletica via flikr, wikimedia creative commons license.Power yoga is an athletic, fast-paced, challenging class that is usually performed in a warm room. The poses are linked together in a flowing manner, and the practitioner connects his or her breath to the movements in and out of poses, as a way to build-up internal heat. It was developed in the 1990’s and has gained recent popularity in the Bay Area. The two American teachers that are credited with the invention of power yoga are Beryl Bender Birch and Baron Baptiste. They developed their styles almost simultaneously, which isn’t surprising considering that they both studied under Ashtanga yoga master Sri K. Pattabhi Jois. Power yoga is a good complement to a serious running training plan. Beryl Bender Birch, the wellness director of the New York Road Runners since 1981, introduced this type of yoga to the traditional athletic community. It is touted as a great therapy to rehabilitate an injury. There are eight axioms of power yoga, which bear remarkable similarity to the theories behind the cumulative injury cycle and general principles of athletic performance. Axiom 1: You have to be hot to stretch. This goes hand in hand with the recent research articles that provide evidence that static stretching before a workout may actually decrease the power output of muscles and leave them more vulnerable to injury. Save the static stretching for after a run, while you are still warming down. Axiom 2: Strength, not gravity determines flexibility. Without the strength work, the heat is not there, and thus the stretch work is not effective. Axiom 3: Sports do not get us in shape. In fact, sports get us out of shape. Athletes develop tight muscles and sports create imbalances because of repetitive training and uneven use of muscle groups, or the uneven use of one side of the body. Overuse of a certain muscle group creates an inflammatory process in which adhesions are laid down. These sticky adhesions (scar tissue) limit range of motion and cause pain and spasm. This causes decreased circulation and further tightness, which leads to further tissue trauma, and the whole cycle continues. Sports chiropractors use Active Release Techniques (ART) and Graston Technique to breakdown the adhesions from the bound-up soft tissues, so that the imbalances may be lessened, and range of motion may be restored. This results in more functional movement and less pain. Axiom 4: All injury in sports is caused by a structural and muscular imbalance. Except for accidents like falling off a mountain bike or getting kicked in a soccer game, structural imbalance is the #2 risk factor for determining risk of injury. Guess what #1 is? It’s previous history of injury! Axiom 5: Muscular imbalances and structural irregularities don’t fix themselves. We see this all the time in the clinic. You can stop running for two weeks and your knee pain may lessen, but unless you correct the underlying problem with muscle work, joint re-alignment, and rehabilitation exercises, the issue will come roaring back next time you run. Axiom 6: Even iron will bend if you heat it up. As connective tissue heats up, it becomes less “solid” and more “liquid”. In both bodywork and power yoga, it becomes more pliable for shaping when it is warmed. With movement and the specific pressure of manual therapies, old clumps of gnarly scar tissue can get broken apart and remodel into healthy tissue. Axiom 7: Stopping training doesn’t correct an imbalance. Pressing pause on our activities may give the tissues time to heal, but if any misalignment or imbalance is present, the same biomechanical relationship will be in place once we return to activity. Axiom 8: No matter how fit you are at what you do, when you start something new you have to ease into it. We all are familiar with this. From picking up a new sport, to making the switch to minimal running shoes, to changing surfaces from track to trail, our bones and soft tissues need time to adapt to the stress of a new activity. Power yoga is a great complement to running, cycling, or any other sport. Connecting to your breath, moving mindfully, and easing slowly into new types of yoga are keys for enjoying a safe and beneficial yoga practice. Check out local power yoga classes at CorePower Yoga and Groove Yoga in Berkeley, and Flying Yoga Shala in Oakland.
Selina Shah, MD, FACP is a board certified sports medicine physician at the Center for Sports Medicine in San Francisco, CA and Walnut Creek, CA. She has several years of experience caring for athletes of all ages and abilities from weekend warriors to Olympians. She often utilizes musculoskeletal ultrasound for diagnoses which has several advantages over MRI: it can be done in the office, it is cheaper, it has better distinction of tendon pathology, and it allows for dynamic imaging. She is also managing concussions and utilizing ImPACT for neuropsychological testing.
She is a team physician for USA Weightlifting and USA Figure Skating and travels with the athletes internationally and nationally. She has done a volunteer rotation at the US Olympic Training Center in Colorado Springs. She is a member of the USA Gymnastics Referral Network. She has worked with USA Track and Field, Ironman USA, the Senior Olympic Games, World Gymnastics Championships, and Nashville Predators Ice Hockey. She is also a team physician for Northgate High School in Walnut Creek, CA.
She is the dance company physician for the San Francisco Ballet School, Liss Fain Dance Company and Diablo Ballet. She is a physician for Berkeley Repertory Theater, Mill’s College, St. Mary’s College, and Northgate High School. She takes care of the performers for Cirque du Soleil when they come to the San Francisco Bay Area. She has taken care of several Broadway performers including those from American Idiot, South Pacific, and Lion King, and the Book of Mormon.
Dr. Shah has been an athlete all of her life. She was a competitive artistic and rhythmic gymnast and swimmer. She has over 20 years experience as a dancer. She has danced professionally with a Bollywood Company and salsa dance company. She remains active in dance, running, yoga, and strength training.
Where: Innersport 1250 Addison St. Suite 102, Berkeley, CA 94702
When: May 15, 2013 7:15PM
What: Presentation on current research on diagnosis and treatment of Tendonitis
For: All athletes, injured or not. Repetitive Stress Injuries (RSI), repetitive work injuries.
RSVP: firstname.lastname@example.org We'd love to see you there!