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The science of a sports injury

On Wednesday I met physical therapy clinical professor David Nolan, who recently presented research at the American Physical Therapy Association’s annual conference. Nolan has a joint appointment at Massachusetts General Hospital, which just opened the Orthopaedics Sports Performance Center. This place is the definition of cool.

It’s a huge room with force plates embedded in the floor floor and twenty or so video cameras hanging from the ceiling. Sports injury patients and research subjects don little UV lights at different points of their body and when they run around the room or do jumping jacks or whatever, the cameras see the lights. If your heel hits the floor before your toes, the cameras can tell. Together with the pressure data  from the force plates, this makes for a digital picture of a person’s physical motion.

Clinicians and researchers can use this room for a variety of applications, from diagnosing the underlying cause of a sports injury to analyzing the mechanics of a person’s gait. Nolan is using it to analyze running related injuries in his clinical practice but he will use the data he collects to answer a host of research questions.

One in particular has to do with barefoot running. In case you haven’t heard, word on the street lately is that running shoeless provides a lower impact exercise option than your standard sneakered job. In a way, the logic makes sense. It’s supposed to be more “natural.” Sneakers allow us to strike the ground with the heels of our feet because they have synthetic padding. But without sneakers, the heel strike sends a spike of pressure shooting through our joints. Since we evolved with no Nike to speak of, we should be naturally inclined to strike at the balls of our feet instead of our heels.

So why then do so many people suffer from sports injuries soon after starting up a barefoot running regimen? The answer also makes sense: because they’re not used to it. If you’ve spent your whole life walking around in shoes, then suddenly running a mile without them could quickly wreak havoc on your body. That’s because your calves and Achilles tendons aren’t strong enough to absorb the new level of impact — the sneaks have been taking care of that this whole time.

Nolan said he sees injured barefoot runners who claim that they’ve completely changed thier gait from a “heel strike” to a “midfoot strike” but when they hook ’em up in the lab, the data tells a different story. Nolan says it can take as long as six months before a full transition has been made, and that even if we’re marathoners, we can’t expect to run as far and as long right away without shoes. “If you don’t do it thoughtfully, you’re setting yourself up for injury,” he said. “It’s too much of a good thing too fast.”

The sports performance center at MGH, which officially opened its doors in June and is expected to have a formal opening in the fall, provides augmented physical exams and can allow researchers to tease out the mechanics of movement that can’t be seen with the naked eye, said Nolan. He’s looking forward to bringing co-op and graduate students into the lab and to forge new collaborations with other sports medicine teams, he said. The new facility will enable a host of previously inaccessible research questions.

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