Crutches suck, and somebody finally did something about it:

The lower leg is completely unloaded, your thigh bears all that weight, and you can keep your hands free and your armpits unchafed.

What if the expression is really “time heals awl wounds”? The common interpretation outscores it on Google 132,000 to one (really, just one?), but I think my version has the significant advantage of not being blatantly wrong. So the next time somebody tries to console you with the cliché, gently remind them that you are suffering from more than a mere puncture wound.

T-Nation has an excellent article up, Joint-Friendly Training. It provides a bunch of exercises that work around joint injuries, so you can keep training and getting stronger. Definitely useful for me!

NSCA reports on an interesting study suggesting you can greatly reduce ankle sprain risk with stability pad training (PDF), especially if you're in the high risk groups (overweight, and/or previous sprains).

Awhile ago I sung the praises of ice baths. Turns out it might just be all in my head. Or maybe it's even counterproductive. Hard to say. As noted, pain is hard to measure, and even if it is a placebo effect, if it's a placebo effect that works, that's what really matters.

It's all in the hips, which makes these two pieces by Keith Scott particularly important reads: Healthy Hips Part I - Self Assessment and Healthy Hips Part II (remediation).

Personally, it looks like my lazy-ass glutes (ha ha) are perfectly happy to let my hamstrings carry the load. Dang. Can the fixes really be as simple as they sound?

This is devolving into a link blog. That's okay though, as I feel like I've covered most of what I want to cover (check the guide and the archives). As I try new stuff I'll post it, but until then...

• Gregg's favorite exercise is one of my favorites too. The difference between us is that he uses kettlebells instead of DBs, and he includes pictures.
• There are some great ideas (and workout names) in this Crossfit thread, Hardest Metcon Workouts ("metabolic conditioning").
• With the outdoor season right around the corner here in the NE, it might be worth having a look at this article on preventing quad soreness.
• Patrick Beith: Summer Training for Speed (and Part II).
• Finally, Dispelling The Top 10 Nutrition Myths (update: this guy slams this piece; update 2: see discussion below).

At Pinnacle Fitness, The effect of NSAIDs such as aspirin, ibuprofen, and acetaminophen on muscle growth:

A group in 2001, however, using eccentric contractions in human subjects to induce muscle damage, showed that post-exercise NSAID use drastically reduced the increase in protein synthesis normally seen in response to muscle damage. This study is relevant to real workouts because the researchers used a model for muscle damage that is very similar to what what happens during a normal weight training workout and the doses of NSAIDs used in the study were normal therapeutic doses, not unlike those that most people would take for a headache or after a tough workout for soreness

Also read the piece at Again Faster, via which I found the link above.

First off, I was never actually diagnosed with achilles tendinitis. They hurt like hell though, and now, after a lot of work, they're better. I think my self-diagnosis was correct, but what do I know? Anyway, here's what happened and what I did:

I played Easterns in early June with no problems, but afterwards had some achilles pain in one ankle. Pickup over the subsequent weeks made it quite a bit worse, and it ended up in both ankles. Some days were worse than others. On a good day I was aware of my achilles but could play fine, and on a bad day my first step was very painful and I probably could only manage 75% of my top speed, if that. I stayed in denial for two to four weeks (can't remember), then decided I had to take steps. So I did what I always do, which is read a lot about the problem. If you don't feel like doing all the same reading, here's what I took away from it:

In most cases it's not an inflammation problem. Instead, the tendon fibers are being damaged, and the tendon is becoming less tendon-like. There were scary MRIs somewhere of healthy tendon vs. deteriorating, and they certainly helped spur me to action. Anyway, there was a study where one group did your typical anti-inflammatory treatments (ice, ibuprofen, cortizone) while another group did strengthening exercises. At the end of the 12 weeks, the whole (I think) anti-inflammatory group was still miserable, while the whole (I think) strengthening group was much improved or cured. Sounds great, right? Unfortunately, the strengthening protocol is a bit of a pain in the ass. You do the following twice per day (!), seven days a week (!) for twelve (!!) weeks:

• 3 sets of 15 straight-leg, weighted, eccentric calf drops per leg (45/leg, 90 total).
• 3 sets of 15 bent-leg, weighted, eccentric calf drops per leg (45/leg, 90 total).
• (so that's 180 in the morning, then another 180 in the evening.)

An eccentric calf drop works like this: Stand with the balls of your feet on the edge of a step, and your heels hanging off the edge. With both feet, raise yourself up on your toes. Now stand on one foot and lower your heel as far as it will go. Put your other foot back down to raise yourself up again. The point is you are trying to NOT work the raise (concentric contraction of the calf), and are trying to super-work the lower (eccentric contraction).

The study said you should work your way up to decent extra weight. I started off with bodyweight just to try it, jumped up to 20 pounds almost immediately, and finished the 12 weeks at 60 pounds (attached to a dip belt). The study also said the participants generally pushed through pain, but what does that mean, really? Personally, I found my achilles might start off sore in a given session, but would usually improve over the course of the session. The study didn't say anything about whether you should lay off other activity, so I chose not too. Kept playing pickup twice a week (at times quite painful), doing other workouts, etc. Not sure if this was the right thing to do or not.

The other thing I did was borrow a night splint (I've never ordered from them before, so can't vouch for them) and wear it overnight on whichever achilles felt worse (wish I had two!). I feel like this helped, but it's hard to be sure. There is no doubt the splinted achilles was less stiff and sore first thing in the morning. Anyway, if I were buying new I'd probably try a couple of the sock-like variety (another vendor I've never tried) as the bulky ones are, well, bulky, and more expensive.

Finally, the last thing I did was work the calf stretch I described in my My Key Stretches as often as possible. I can now get my hips to the wall, which is a pretty big improvement from where I started 12 weeks ago.

Anyway, the bottom line is that in the first four weeks I wasn't sure if it was helping. I suspected it might be, but still had painful days. In the second four weeks I was sure it was helping, but I wasn't all better yet. By the third four weeks I was basically pain-free. At this point I'm all done with the program and the achilles don't affect my play at all. I'm doing maintenance sets every other day or so, and we'll see how that goes. I still get stiffness in the achilles from time to time, but so far no more pain. We'll see if maintenance workouts keep the problem in check.

I recently realized I never followed up on my ankle brace delibrations. It came to my attention when reader N. Trout sent me this e-mail:

Hi, Jim. I stumbled upon your site while doing some research. I have a remarkably similar experience with ankle braces. I'm 38 years old and fairly active. I had chronic ankle sprains up through college, at which time (about 1989) the school's training department gave me the McDavid brace. I've been wearing that ever since and have never fully sprained my ankle ("tweaked" it a few times but never rolled it over completely)...until two nights ago. Coincidently, I had just bought a new McDavid ankle brace for my right ankle and the night I sprained it was the first night I wore the new brace. Maybe it wasn't sufficiently tight and/or broken in, or maybe it was just that I came down just right (or wrong) on someone else's foot and nothing could have prevented the roll and subsequent sprain. I do believe, however, that the brace probably limited the extent of the sprain. Anyways, it has incredibly been 17 years for me as well without a sprain. Some of the other guys I play basketball with swear by the Active Ankle brace but I didn't want to make a change (until two nights ago) because the McDavid had seemed to suit me so well all these years. I did end up going to the doctor yesterday. I figured that maybe there had been some new technological advancements in ankle protection technology over the past 17 years. Sadly, he said not much has changed, but he did recommend Active Ankle.

So, I'm wondering what you ultimately did. Did you make the switch or did you stick with McDavid? What's happened since your last post on this topic (or did I miss an update somewhere on your site?)?

Here's my reply, which will do double-duty as follow-up for this site:

Hi Noel,

Sorry to hear about the ankle! Also sorry about the lack of follow-up, it just didn't end up being all that interesting. The bottom line is that I tried the Active Ankle braces, but didn't like the way they felt, so went back to McDavids. I'm fairly comfortable with this for a few reasons:

[1] I figured one sprain in seventeen years wasn't too bad a record.

[2] I read in one of the studies that no ankle brace solution provides enough support to resist the torque of a bad roll.

[3] Another study suggested increased proprioception and/or assisting in returning the foot to a neutral position is how ankle braces and taping conferred their benefits.

From this I inferred that the Active Ankles would be better at resisting torque but not as good in providing proprioceptive benefits, while the McDavids would provide the converse. No idea if that's true, but it seemed to make sense to me, at least.

Then again, I know guys that swear by the AAs, and say stuff like, "I can't imagine spraining my ankle while wearing this."

Sorry I don't have a more conclusive answer. If you stick with the McDavids, make sure you tighten them up after the first 10 minutes or so. I never realized how slack they get (one of those studies mentioned that tape jobs and lace-ups basically provide no support after the first 10 minutes because of loosening). Of course, I had to stop doing this because the added pressure exacerbated my achilles pain. If it's not one damn thing it's another... :-)

Good luck!

Jim

I've taken a couple ice baths now, both between tourney days, and I think the only way to describe them is "excruciatingly good." Immersion sucks, but it does wonders for next-day soreness. While still painful, my last approach for getting in worked well enough that I think I'll stick with it from now on:

• Put a little ice in the empty tub and sit in it. Position the rest of the ice within reach of the tub.
• Start filling the tub with cold water and let it cover you gradually. I know this sounds awful, but it beats the hell out of filling the tub with ice water and jumping in. I'm not sure why, but I think it's because with my approach it's more like something that's happening to you rather than something you're doing to yourself.
• After you've filled the tub, grab the rest of the ice and pour it in. The temperature will drop significantly, and it's no fun, but by this point the worst is already over.
• Soak. I go for about 10 minutes but I have no idea what the optimal time is.

After the first three minutes of agony the last seven are relatively okay, I guess. A teammate brings reading material, but I don't really feel like I ever get to a level of comfort where I'd be able to concentrate or enjoy whatever I'm reading. Maybe after a few more and I'm better acclimated to the practice.

Anyway, definitely worth it. It's like having a new set of legs.

UPDATE: Or maybe it's just a placebo effect.

I'm not a fan of these injury posts. On the one side, I do like sharing the information. On the other side, lots of what I post is first-hand information, and all that implies...

Anyway, ever since the ankle sprain last year, my achilles on that foot has been threatening to go all tendinitisy on me. I was going to do piles of research and share it with you, but my teammate Jon has had chronic problems with his achilles for years, and is a wealth of information. So I have the luxury of not writing this post myself, but instead can cobble it together from our e-mail dialog (edited lightly, emphasis added):

Jim said:

I am now on the IR (hopefully just for a week) with tendinitis in my Achilles. I have been flirting with it ever since the ankle sprain, and Easterns finally brought it on for real. Played pickup yesterday, but it was unpleasant. I'm hoping a good ice, rest, and ibu regimen will get me back on track pronto.

Jon replied:

Bummer. Take it from me, achilles problems can last forever, but hopefully this isn't the case with you. Rest is key, I think. Hopefully that will take care of it. In any event, I've attached an article and also included a link below that I thought were pretty informative with regards to the achilles tendons. Turns out there's no such thing as achilles tendonitis -- it's really a tendonosis (tendinitis implies inflamation, but there's no evidence that inflamation is part of the problem in achilles injury -- hence ice and ibuprofen aren't really helpful in this case). [from my super-quick research I think both conditions exist, but certainly where chronic injury is concerned it sounds like tendonosis is the correct term.] According to the medical literature, the only treatments with good clinical evidence of effectiveness are rest and "heavy-load eccentric calf-muscle training":

Sports Injury Bulletin - Achilles Tendinitis

I've been doing something similar to the Walt Reynolds exercise for a long time (recommended by my physical therapist), and am 4 weeks into the program from the Swedish study. It makes things worse before it makes them better, but it does seem that it's starting to having positive effects now. My physical therapist also gave me a a variety of strength and balance exercises, particularly ones to work on leg muscles that are important to stabilization, but I think these are actually pretty similar to some of the stuff you are already doing.

Jim replied:

Wow, thanks Jon! Great article. I'll have to post that on my fitness blog (which is more and more looking suspiciously like an injury blog).

So you do the Walt and Swedish exercises, and you also play? I guess what I'm asking is, you've just been playing through the pain for years, don't take rest, and have added these exercises into the mix, right?

I ask because I'm trying to figure out if I should just stop stressing the achilles (i.e. no playing) until I'm pain-free, or if I should do rehab and play simultaneously. The pickle is not wanting to fall behind on conditioning.

Jon replied:

Since it sounds like you're going to do some of these rehab exercises, and wonder whether you need to take off time from ultimate, I'll give you some more detail on how I manage the achilles problems, since it's kind of complicated.

First, back about the time when I broke my collarbone in 2001, I was struggling with a lot of pain in the achilles, and I got an appointment with a physical therapist. He made me rest completely for a few weeks, until all pain from the achilles was gone, and in the mean time made me an orthotic to control my overpronation. I think there would not be any problem with doing exercise that doesn't stress the achilles during this time (e.g. burpees, weights, maybe biking), but since I had a broken collarbone there wasn't much else I could do anyway. After the rest, he started me on an exercise that's roughly similar to the Walt exercise. The way I do the exercise is the following. I stand on, say, my right leg on the bottom step of the stairs, facing the floor (as opposed to the higher steps), and I keep my left leg straight and suspended in the air, and then I lower my left leg down slowly, keeping it straight, until the heel of my left leg touches the ground, and then lift it back up again. I repeat this for 30 reps, and then do the other leg. This works the calf muscle eccentrically, and also gets the rest of the leg involved and improves balance. Once I got good at this, I switched to a stable stool that is a bit higher than my first step, so I can get a deeper knee bend going.

After doing this for a few weeks, my PT gave me bunch of other exercises to do in addition, mostly with dumbells, for strengthening the legs and for overall body fitness. Most of these are very similar to the dumbell exercises described in Ross Enamait's book. A lot of lunges and shoulder presses and so forth. Sounds similar to what you are doing already. These exercises especially worked the hamstrings, glutes, hips, and groin.

Another exercise he gave me that is more achilles-specific is the following: Get on a treadmill and set it to maximum incline at a very low (walking) speed. Then run / hop sideways (not crossing over legs) for four minutes on each side. Kind of like how you would run sideways while positioning yourself to play defense in ultimate. This really works the calf muscles, and also works the feet and ankles in a different plane than most typical exercises. I find this one to be quite helpful, but you'd need a treadmill. You could also just do it out on the street or on a grassy field, although I think it works a lot better if you can do it uphill. I find this exercise makes a noticeable difference when I do it regularly.

After doing these routines religiously 2-3 times per week for a couple of months, I started playing ultimate again in the spring of 2002, and my achilles were completely pain free for months. But at some point in the summer, when the ground got hard and I played in a tough 2-day tournament, my achilles eventually started bothering me again. I then took a little time off from ultimate, maybe a week or two, but in the mean time continued to stick with all the rehab exercises along with interval workouts on a bike and, after a little while, light jogging. Then I came back and things were manageable. This pattern essentially repeats itself every year, and is not so bad. But it would be better if I could be pain free throughout the season.

This year, after feeling a bit of achilles soreness after WMO, I decided to get more aggressive with the rehab exercises. I've been doing the Walt-like exercise almost every day, and started doing the Swedish exercises almost twice-daily as well, and I've made sure that I do the sideways-running about 3 times a week (I often stop doing that when I switch from treadmill to outdoor running with the nice weather). I had never done the Swedish exercises before. They feel easy while you're doing them, but then I found that my calves were incredibly sore for about two weeks. I started this about 4 weeks ago, and continued to play ultimate once a week throughout. This is part of the reason I sucked at pickup a couple of weeks ago, as my calves were so sore I felt like they were going to collapse the whole time. After about a couple of weeks, the calf soreness has been gradually subsiding. My achilles were pretty sore after Saturday at Easterns, but have been rock solid and pain-free otherwise (I played Sunday with no pain). So in short, I have been playing through it while doing the rehab exercises, and I think it's working OK. We'll see what happens when the ground gets hard.

The link below from the Carleton University sports medicine department provides the details of a Swedish-style program for the achilles. In their program, you're supposed to avoid sports for two weeks while you start the calf exercises, but then you resume sports after two weeks.

Rehab for Chronic Achilles Tendinitis

It's also worth noting that in the Swedish study, they did not wait for the achilles pain to go away before starting people on the eccentric calf exercises.

Jon then followed up with this:

Ah, one crucial thing I forgot to mention in my description of the "Walt-like" exercise that I do on the bottom step. When you are standing on your right leg, and lowering your left heel to the ground, you lower the left heel by bending your right leg at the knee. And vice-versa when you stand on your left leg.

Jim asked for clarification:

You keep the foot on the step flat on the ground, right? As in, your heel stays down and your Achilles stretches as your knee flexes?

Jon replied:

That's right, you've got it exactly right. The foot on the step stays flat, and you bend the knee on that leg. You keep your other leg straight. The heel of the straight leg eventually touches the ground below the step as you bend the knee of the leg that's on the step.

There, that does it! About the only thing I found independently of Jon was a note (with no medical backup) that wearing a night split (commonly prescribed for plantar fasciitis) can also be helpful. The splint holds your foot angle at 90-degrees (or even a touch higher) keeping your achilles stretched throughout the night. Without the splint, in a relaxed state your foot hangs away from the shin, keeping the achilles in a shortened position all night. I borrowed my dad's splint (which was the thing that finally allowed him to gain ground on his plantar fasciitis after months of frustration), and I seemed to improve, but have no idea how much the splint contributed, if at all. Could have just been the rest.

Damn, the "injuries" section of this site is getting long! I should call it "Limping & Whining Fitness". Anyway, in the interest of sharing every little thing, I am quite prone to pain behind the kneecaps, a condition that worsens the more often and vigorously I exercise. I've generally been able to control it with diligent icing, but lately it's been getting worse. Doing that thing I do, some quick Googling turned up a likely candidate "Patellofemoral Pain Syndrome". I realize this is a fancy way of saying "it hurts behind the kneecap" so wasn't too optimistic about finding a cut-and-dried cure. This review by Mark S. Juhn for the American Academy of Family Physicians was very interesting nonetheless. I'm going to choose to believe it's this rather than chondromalacia ("actual fraying and damage to the underlying patellar cartilage"). Still a bummer though, as it's impossible to get a good lower-body workout without lots of knee flexion.

Ah yes, the vaguely defined condition and treatment. Just like my other bugaboo, shin splints. It's probably the same biomechanical problem (whatever it is) hitting me two different ways.

WMO was my first tournament since a bad ankle sprain suffered at the end of the 2005 season. With my current set of braces splitting at the seams, I need to take stock...

I sprained each ankle pretty badly numerous times playing high school basketball. High tops provide ZERO support, in my experience. I've probably done each ankle six times unbraced. However, when wearing McDavid lace-up braces I made it through 17 years of Ultimate without a sprain (until my first Nationals - wouldn't you know it?). So now I have to decide if I should buy another pair of McDavids, or if I should switch to Active Ankle braces. I hesitate to give up my McDavid's as they served me so well for 17 years, but I don't want rare ankle sprains, I want zero ankle sprains. Theoretically the Active Ankle braces provide more support, or so says "a major university." But which major university? What study? And what of all the anecdotal stories you hear about ankle sprains and bracing? Some examples:

• Braces don't prevent sprains (false, if my experience has anything to say about it. Give me a few months braceless and I'll give you a sprain the size of a goose egg. With braces, one sprain in 17 years).
• Braces will make your ankles weak and dependant, so you can never go braceless again (seems like hogwash to me, provided your brace allows a normal range of motion while preventing an abnormal range of motion).
• Braces will slow you down (not sure).
• Braces transfer the stress further up your leg, making you more prone to knee injury (this one just seems silly, unless the brace is seriously compromising your normal range of motion).
• Braces are not the answer, proper rehab is (maybe, but again, not in my experience. Sprain 'em enough, and no amount of rehab is going to tighten them all the way up again. Interestingly, a NMT friend of mine recently told me that there are lots of proprioceptors in the ligaments themselves, so when you sprain an ankle and damage the ligaments, it is not only the ligament looseness that makes you more prone to sprains, but the decreased proprioception down there as well).

Anyway, I went a huntin' for some studies. My initial Google search (university study "active ankle" inversion tape) turned up a few things, but clicking through on the Scholarly articles for university study "active ankle" inversion tape gets you the good stuff. Without further ado, various sources with interesting excerpts (note that I'm not qualified to judge the validity of these studies):

The Prevention of Ankle Sprains in Sports - A Systematic Review of the Literature by Stephen B. Thacker, MD, MSc, Donna F. Stroup, PhD, MSc, Christine M. Branche, PhD, Julie Gilchrist, MD, Richard A. Goodman, MD, MPH, and Elyse A. Weitman

To assess the published evidence on the effectiveness of various approaches to the prevention of ankle sprains in athletes, we used textbooks, journals, and experts in the field of sports medicine to identify citations. We identified 113 studies reporting the risk of ankle sprains in sports, methods to provide support, the effect of these interventions on performance, and comparison of prevention efforts. The most common risk factor for ankle sprain in sports is history of a previous sprain. [emphasis added]

How incredibly awesome. If someone could arrange for a team of experts to summarize available literature whenever I set out to research something, that'd be grand.

Using a variety of tools, these investigators have demonstrated that inversion of the ankle is substantially restricted with these interventions. Slowing the speed of inversion, however, does not provide the peroneal muscles time to contract to prevent injury, and the torque generated by braces will not counteract the inversion movement that typically leads to injury. Moreover, such restriction is reduced after exercise, especially in persons using tape or cloth wrapping. Although the effectiveness of orthoses is reduced by exercise, these devices can be tightened easily to provide effective deterrents to extreme inversion, and may also protect the ankle by preventing inversion movement by preloading and maintaining the ankle in proper anatomic position at impact. [Tighten those braces after you've been exercising a bit!]

Although the majority of studies indicate that appropriately braced or taped ankles do not adversely affect performance, several studies report a small, but statistically significant, decrease in performance.

a randomized controlled trial of 2562 U.S. intramural basketball players observed for 2 years demonstrated a protective effect of high-top shoes. This study also demonstrated the protective effect of taping, reporting a reduction from 32.8 sprains per 1000 participant-games to 14.7 sprains per 1000 participant-games. Indeed, the protective effect of shoes was due primarily to taping, although the use of high-top shoes enhanced that protective effect. [emphasis added]

In a randomized controlled trial of 1601 U.S., male, college-aged intramural basketball players with no history of recent ankle sprain, a semirigid orthosis had a significant protective effect compared with the unprotected ankle (1.6 ankle sprains per 1000 athlete-exposures versus 5.2 sprains per 1000 athlete-exposures).

The trial of soccer players in Sweden suggests that training that focuses both on agility and flexibility decreases the risk for ankle injury. Similar results are seen in a study of knee injuries among soccer players in Italy.

For decades, taping the ankle has been the preventive method of choice for coaches and trainers in many sports. Data from one randomized controlled trial indicate that taping can prevent ankle sprains, despite the fact that tape loosens in approximately 10 minutes and provides little or no measurable support to the inverting ankle within 30 minutes. [interesting paradox - click through for more]

Despite these research needs and unanswered questions, on the basis of this review, we can make one clear recommendation to coaches, trainers, and athletes: athletes with a sprained ankle should complete supervised rehabilitation before returning to practice or competition, and those athletes suffering a moderate or severe sprain should wear an appropriate orthosis for at least 6 months. Research suggests that the benefit of the orthosis persists up to 1 year after injury.

The influence of foot positioning on ankle sprains by I.C. Wright, R.R. Neptune, A.J. van den Bogert, and B.M. Nigg

First of all, the entire introduction is fascinating. Go read it. On to the excerpts:

This meant that the more plantarflexed the foot was at touchdown, the greater the incidence of excessive supination. This result was further supported by the findings presented in the literature. Inversion sprains often occur when the foot is plantarflexed (Leonard, 1949; Renstrom and Kontradsen, 1997), and the ATF ligament, which is loaded when the foot is plantarflexed and supinated, is the most frequently sprained ligament of the ankle (Leonard, 1949; Saunders, 1980). Therefore, it appears that susceptibility to sprains is increased by initial plantar flexion.

Ankle taping and bracing may influence the position of the unloaded foot, decreasing the tendency of the foot to be plantarflexed. Taping and bracing stiffen the ankle in dorsi/plantar flexion as well as supination/pronation (Bruns et al., 1996; Siegler et al., 1997). Siegler et al. suggested that `the largest effects of the ankle braces on the passive flexibility of the ankle complex occurred near the neutral position of the ankle. Therefore the braces not only limit the range of motion, but may return the unloaded ankle to a neutral position. Since the foot was initially plantarflexed an average of 10° at touchdown during the simulated side-shuffle movements (Neptune et al., 1999), returning the foot to a neutral (zero dorsiflexion position) would tend to decrease the sprain frequency. Both ankle taping and bracing have been shown to improve foot position awareness in the unloaded foot (Heit et al., 1996). Therefore, in addition to passive ankle repositioning, taping and bracing may improve active ankle repositioning (by the muscles) in response to proprioceptive signals, thereby reducing the occurrence of excessive plantar flexion at touchdown. The findings of the current study would therefore suggest that repositioning of the foot prior to touchdown may be the means by which taping and bracing reduce ankle sprain frequency.

Very interesting. I wonder if that's how my McDavid's served me so well for 17 years? Clearly, since I sprained my ankle while wearing them, they don't provide enough support to prevent sprains Although, who knows how much worse the sprain would have been without them (it was bad enough). Also, I wasn't in the habit of tightening the braces after 10 minutes or so.

The Effects of Kinesio™ Taping on Proprioception at the Ankle by Travis Halseth, John W. McChesney, Mark DeBeliso, Ross Vaughn and Jeff Lien

I've written about Kinesio tape before. I imagine the Kinesio folks weren't too happy with the findings:

The application of Kinesio™ tape does not appear to enhance proprioception (in terms of reproduction of joint position sense (RJPS)) in healthy individuals as determined by our measures of RJPS at the ankle in the motions of plantar flexion and 20° of plantar flexion with inversion.

Although...

It is important to note, however, since the present study did not specifically measure changes in cutaneous sense, that kinesio™ tape cannot be ruled out as a contributor to increasing cutaneous sense. We can only speculate on the role cutaneous sense may or may not play in RJPS. It may be that kinesio™ tape does contribute to increasing cutaneous feedback, however it appears that it plays only a minimal role in RJPS.

Peroneus Longus Stretch Reflex Amplitude Increases After Ankle Brace Application by ML Cordova and CD Ingersoll

Wow! Here's a study that speaks directly to the two products I'm considering:

A 3 X 3 X 2 factorial design guided this study. The first independent variable (within-subjects factor) was the test condition with three levels: control (no brace), semi-rigid (Active Ankle training brace; Active Ankle Systems, Inc, Louisville, Kentucky, USA), and lace up (McDavid 199; McDavid Knee Guard, Chicago, Illinois, USA).

Figures this study would be the hardest to understand. Is it desireable that the peroneus longus amplitude increase? It sounds like it is. Thank goodness for the one-line "take home message":

External ankle support may enhance the sensorimotor response of the peroneus longus muscle.

More...

We attempted to investigate the effects of long term use of ankle braces on the amplitude of the peroneus longus stretch reflex. The neuromuscular function of this muscle is critical to the dynamic support of the ankle/foot complex and the prevention of inversion injuries. As a result, peroneus longus reaction time (latency) during a simulated ankle sprain has been predominantly studied comparing normal and chronically unstable ankles,7 9-13 whereas the effect of ankle support on peroneus longus function has not been as thoroughly investigated.

There is no question that the semi-rigid style is more restrictive than the lace up style because of its inherent construction. The restrictive properties of the ankle braces play a role as the physiological limit of joint motion is reached. However, the peroneus longus muscle is firing well before the physiological limit is reached. This may provide more evidence that the external ankle support offered may enhance cutaneous feedback in addition to the mechanical properties of the devices.

Another important finding of this study is that, after acute application, the lace up brace resulted in greater stretch reflex amplitude of the peroneus longus than the semi-rigid and control conditions. We hypothesise that this is due to increased afferent information provided to the central nervous system primarily by cutaneous mechanoreceptors, and perhaps other joint mechanoreceptors, although no other data exist on the influence of ankle bracing on peroneus longus reflex amplitude. Because the lace up brace covers more area than the semi-rigid brace, more receptors may be being stimulated.

So the lace up (McDavid) provides for improved proprioception as soon as you put it on, but the semi-rigid (Active Ankle) doesn't improve proprioception until eight weeks go by? Not sure I'm interpreting that right, but that's what it sounds like. Here's the conclusion:

This study was designed to determine if long term ankle bracing affects peroneus longus neuromuscular response. The data provide evidence that peroneus longus amplitude in response to sudden inversion perturbation immediately after the application of a lace up style ankle brace is facilitated. It was also observed that peroneus longus amplitude was increased after an eight week application of a semi-rigid style ankle brace. The increased reflex response with an immediate application and extended use of external ankle support is a positive finding, as the neuromotor response from the primary musculature dynamically stabilising against lateral ankle sprain is enhanced. Although these results are encouraging, more studies are needed to understand the mechanisms by which these neurophysiological characteristics of the peroneus longus stretch reflex are effected. These results provide support for clinicians who advocate the use of prophylactic ankle support for extended periods of time, perhaps over the course of a sport season, in healthy subjects and in subjects who suffer from chronic ankle instability.

All very interesting stuff, but it doesn't bring me any closer to a decision! Damn.

According to a Lifehacker write-in tip, you can make an ice pack using Dawn dishwashing detergent (and a zip lock bag). I just did a quick test with a small amount of whatever detergent we have upstairs (it's not in the original bottle) and it congeals to a cloudy gel when frozen. Perfect! Being a big fan of post-workout icing (regardless of injury), I'm going to buy me like a gallon of Dawn and dump it into one of those huge freezer zip lock bags.

A teammate of mine recently had knee surgery, and was given a DonJoy Iceman to aid his recovery. He loaned it to me for my sprained ankle, and it's great! Just fill it with ice water, wrap the pad around the body part you want to chill, and relax. You can just leave the thing on for hours (although you can set the dial cold enough to be dangerous at such durations, I think). The unit appears to cost around $200 new, but happily seems to be well-represented on eBay. With some luck you could score one in the $50-70 range. This is very expensive when compared to the normal cost ($0) of icing an injury, but would definitely be worth it for major rehab projects, trainers, or teams. And my ankle is very, very happy to have a loaner unit.

A bit off the beaten path for this blog, but fascinating enough to post. Mirror therapy:

[Complex regional pain syndrome] occurs in about one-third of people who fracture their wrists: they suffer unexplained persistent pain in their hand, arm or shoulder once the supportive plaster cast is removed. The pain can be so bad that some patients beg for their arm to be amputated, says Candy McCabe, who developed the novel mirror therapy at the University of Bath in the UK.

In the study, eight CRPS patients sat in front long mirrors. These were placed so that each person could see only the healthy half of their body, along with another reflection of the same half.

The result was that the side of the body with the painful arm was hidden from their view and it appeared to the patients as if they had two healthy arms. They were told to concentrate hard on the image and try to believe that what they saw was a true depiction of themselves.

"Three of them were cured instantly; the others took a little longer," says McCabe. "But once the mirror was removed, the pain returned." However, with continued mirror therapy, six people were completely cured. The two exceptions had conditions complicated by limb ulcers and actual physical distortions.

Be sure to click through to find out what happens to healthy folks subjected to the treatment.

A buddy of mine has been struggling with Achilles tendonitis, and I noticed at Regionals that he had this single strip of tape running down his calf and into his cleat. Reportedly, this was helpful. I just learned tonight that this wasn't any ordinary old athletic tape, but was instead Kinesio Tex tape. Sounds pretty nifty:

KINESIO TEX® TAPE is a very thin (about the same thickness as skin), porous cotton fabric with a medical grade acrylic adhesive. A special method of adhesive application and porous nature of the fabric allows the skin to breathe and showering cleans part of the skin under the TAPE. The TAPE is designed for a 30 to 40% longitudinal only stretch and when applied lifts the skin and provides support for surrounding soft tissue.

This TAPE is LATEX FREE and NON-MEDICATED.

KINESIO TEX(r) TAPE was designed to be worn for multiple days ( 3 to 4 ); and an hour after application it will withstand athletic activity and showering without coming off. [snip]

Theoretically, KINESIO TEX® TAPE will lift the skin to increase the space between the skin and muscle. This reduced localized pressure help promote circulation, lymphatic drainage and lessens the irritation on the subcutaneous neural pain receptors. As an end result, the Kinesio Taping Technique reduces pain, swelling and muscle spasm; and subsequently promotes the body's natural healing processes. Additionally, the built-in stretch of the TAPE supports fatigued, weakened and/or strained muscles.

There are books and videos for learning techniques for using this magical tape. Who knew?

Custom orthodics can help with all kinds of foot problems, but usually involve a pricey visit to a health professional. Outside just plugged SOLE Custom Footbeds, which you bake in your oven, stick in your shoes, then lace up and mold to your feet. A quick testimonial from the author:

I've always been bothered by high arches, weak ankles, and bad knees. Using the Calgary, Alberta, company's inserts, I trained for and ran a marathon without any foot, ankle, or knee pain. Want more proof that these things work? Consider that Nike's ACG Adventure Racing Team uses them—instead of a Swoosh option—in their shoes.

$40. I'm always leery when something sounds too good to be true, but it sure beats the cost of having an orthopedist mold me a set. Tempting, especially given my history.

On the one hand, I hate discovering my weaknesses because I really don't want to have any. On the other hand, when I find them I can work to eliminate them. I have the shins under control, and am working actively on my back so I can hopefully keep it from going out every other year. Up next? My rotator cuff. I haven't torn it or anything, but I have nagging soreness that is starting to get in the way of my pushups, pullups, and will certainly be an obstacle in some of the more advanced skills I'd like to tackle. So here's what I've learned:

From the March 2002 issue of Men's Fitness, Big-League Shoulder Protection by Roy M. Wallack:

The most common injuries in sports are to the shoulder. The overhead (military) press and deep dips both put huge amounts of stress on the shoulder (see tip No. 2). So does throwing a baseball, swimming, rowing, or swinging a racquet--anything that repeatedly puts your arm over your head, or raises it out to the side or pulls it in, exerting lots of extra force on the shoulder joint.

The problem is that the shoulder isn't as strong as it looks. The humerus (upper-arm bone) has a large range of motion only because it dangles precariously off the edge of the body. The humeral head is pulled sideways against the socket of the scapula (the shoulder blade) by a series of four small upper-back muscles collectively called the rotator cuff. These muscles are the foundation, the unsung heroes, the glue that holds the shoulder joint together. When they ate weak or overpowered, the humerus gets out of line and undue stress is placed on tendons and ligaments. And you feel pain.

It's easy to strengthen the rotator cuff muscles—if you can remember to work them, that is. Since these so-called "precision" muscles (which precisely center the humeral head) are invisible from the outside, they're easy to overlook. Big mistake.

We love to build up the glamorous "outside" muscles, the triceps, biceps, delts, lats. "Ironically," says Jobe, "the stronger these get relative to the rotator cuff, the more at risk you are of pulling the humerus out of its tenuous socket, injuring the AC joint (the juncture of the clavicle and the acromion, the front of the shoulder blade) and even tearing some tendons." The latter is the dreaded "torn" rotator cuff. Bottom line: Ignore the rotator cuff at your own peril.

That article also includes a laundry list of dangerous exercises, which includes pushups! Basically, it includes anything that puts your elbow behind your body. Sigh. I am unwilling, however, to give up dips and so thoroughly compromise the range-of-motion on my pushups. So hopefully strengthening my poor neglected rotator cuff muscles will do the trick. The article above has the exercise illustrations stripped, so here are some from The American Academy of Family Physicians and some more from Body Results.

Encouragingly, this happens not only to people like me, who are climbing the fitness ladder, but also to guys like Matt Furey, who stand on a pretty high rung:

What I have to tell you is something you can etch in stone right now. And that is ... There are muscles all over your body that cannot be adequately trained with weights or with body weight calisthenics.

You may wonder, how do I know this? Good question. I'll answer by telling you about the shoulder injury I sustained from a combination of:

a. wrestling
b. the gymnastic rings
c. throwing whip-like backhands

The injury sort of crept up on me. Thinking it was just a nagging annoyance, I kept on. Then, in December of 1999, a day after giving a seminar in Philadelphia, I could barely lift my right arm. In fact, the only way I COULD move it was by grabbing beneath the elbow with my left hand and pushing it where I wanted it to go.

I gave it a rest for a week and it felt a bit better, and so, even though I couldn't use the arm too well, I kept on wrestling, thinking I would eventually get over it. A month later, I stopped wrestling for two months to let it heal. Sure, it got better during that time - but it was still weak.

Whenever I thought I was much better, I would try some Hindu pushups. It would feel okay for awhile, but then, after a couple days, I was back to agony again. Through a combination of deep tissue massage and herbs, the shoulder would feel much better - but because the pain came back when I trained, I feared that my Hindu pushup days were over.

He then goes on to sing the praises of the Lifeline Chest Expander. I think I'm going to stick with the aforementioned exercises and stretches for now, but he does a quite a job of making it sound like the greatest thing since sliced bread.

My second post in a row on injuries. I should have named this weblog "InjuredAndWastingAway.com", as I put my back out playing pickup about two weeks ago. Fer cryin' out loud, such a Masters-division injury. Actually, trusty Mr. Kim was right on hand to make me feel a bit better on that score:

Some athletes feel immune to back injuries, associating back pain with people who are older or out of shape. Contrary to that perception, back pain is the number one cause of "limited activity" for adults under age forty-five. In fact, after the common cold, back pain is the most common medical complaint in the United States. No one is immune, particularly not those who put increased stress on their back by engaging in demanding movements like high kicks, falls or throws [like whatever it is that I did to myself].

Anyway, I don't know what precipitated it, it just started siezing up until play was no longer possible. It was bad enough over the next three days that it would take me a good 30 seconds to get up off the floor, for example. On the fourth day it loosened up considerably, and I was able to start doing pseudo-workouts again, but even half-assed efforts would set me back on the sieze-up scale. And that's basically where I've been for two weeks. The lack of walking-around pain is nice, but losing conditioning as we approach the critical juncture of the season was plunging me into despair, especially with improvement in my back plateaued. On Tuesday I started prescription muscle relaxants and anti-inflammatories, but they were making no difference at all (the anti-inflammatories can take awhile, I understand). So last night I went to watch pickup, got a tip for something to try, and today I feel much better! I have hope again. But before I describe the miracle cure, let me describe the exact nature of the pain:

After the initial sieze-up subsided, the pain was sharp and pretty much centered where my spine and belt intersect. If I locked my knee mostly straight and swung my right leg from the hip, I could get full range of motion, forward swing parallel to the floor, no problem. But with my left leg the forward swing produced sharp pain at that spot in my back maybe 25 degrees into the swing. Like my hamstring was pulling something very specific in my back, or was pinching a nerve that ran up there, who knows?

So here was the tip from my holistic-posture-breathing-alignment-healer-type teammate (I really should get an official title from him). Paraphrasing:

Try rolling up a washcloth into a small cylinder. You don't want it to be too big. Then lie on your back, knees bent, feet on the floor. Put your head on a couple books for comfortable neck alignment. Lie on the rolled up washcloth such that it runs along your spine under your lower back. Visualize your back flowing and relaxing over the cylinder formed by the washcloth.

Twenty minutes later, my range of motion on the left-leg swing had at least doubled. Amazing! Your mileage may vary, of course. Get a proper diagnosis before trying this. Backs are nothing to screw around with. I'll leave you with more immortal words from Mr. Kim on that score:

Back pain, if left untreated, can lead to other nagging aches and pains. If you try to compensate for back pain by favoring or "babying" the offending area, you may find yourself deveoping sharp shooting pains in your leg or tense knotted muscles in your shoulders. Back pain should be addressed at your earliest opportunity, wiht a visit to your doctor or a physical therapist.

I struggled with chronic shin splints for at least a dozen years before finally getting them under control around three years ago. Here is everything I know about shin splints, and what I did to fix (or at least suppress) mine...

(Usual disclaimers apply: I'm not a doctor, trainer, etc. Follow at your own risk. This is just what I've read (probably with poor comprehension) and what I've done for my own shin splints.)

Definition

"Shin splints" is a garbage term that pretty much covers any form of recurring shin pain. Such pain can be caused by any of the following:

• Overuse or overpronation can cause tendinitis in your shins.
• Repeated jarring (like from running :-) can cause the lower-leg bone sheath (periosteum) to become inflamed.
• Nerve irritation can develop from friction with the surrounding muscles.
• Stress fractures, although in my experience you get the other problems first, and then this develops, laying you up for awhile.
• Finally, compartment syndrome. Very bad. All the stuff in your leg (muscles, veins, nerves, etc.) run through four different compartments, each wrapped in a sheath. If the stuff swells and is constricted by it's compartment, your blood flow can get cut off (and I hear it hurts like hell). Relatively rare, but very serious. Seek medical attention immediately. Now. Yes, you can lose your foot if the circulation is cut off for too long. Cold or blue feet are two giveaways, although I don't know if they will always happen.

Prevention

Obviously, the best thing to do is figure out the cause of your shin splints and eliminate it. Here are some ideas:

• See a good orthopedist who works with athletes (he/she should watch you run, not just look at how you stand) to determine the cause or your shin pain. If you overpronate, you'll want to wear proper shoes, and possibly have said orthopedist make you custom orthodics. I've never actually performed this step personally, but probably should, even though I now have a system that keeps my shin pain in check (more on that shortly).
• Increase your running distance and/or speedwork gradually. Your body has to grow tolerant of the impact.
• Run on softer surfaces (although I believe this can possibly be counterproductive for shin splints caused by overpronation rather than impact stress, as it introduces even greater undesirable motion in your foot).
• Lose weight, if you're carrying extra baggage. Every pound you lose reduces impact stress on your shins.
• Do stretching and strengthening exercises for the front of your lower legs. Running strengthens your calves out of proportion with your shins, so you want to try to keep them balanced. I actually don't have a source for this, so might very well be making it up. Pretty sure I heard that somewhere though.
• Ice after workouts. Even if you're not in pain, ice will help prevent inflammation.

Treatment

If you're already in pain, here are things you can try to get relief:

• Rest until you aren't in pain any more, and then build up more slowly.
• Ice.
• Ibuprofin or some other anti-inflammatory.
• Some folks try wraps or tape, but these have never worked for me. In fact, for me the compression sleeves you can buy made them worse. Your mileage may vary.
• ...and pretty much everything under "Prevention" above.

Many of you will want to play through your shin splints. I know I have. In the dozen or so seasons I strugged with shin splints, I probably successfully played through them twice. The other 10 times they kept getting worse and worse until they were unplayable. Based on those stats (and conventional wisdom), I don't recommend playing through them. Notice, though, that I tried to play through them all 12 seasons, and did so mostly by consuming far more Ibuprofin than I should have. I'm not the sharpest stick in the eye. So do as I say, not as I do.

My Shin Splints Experience

My struggles with shin splints began in college, playing Ultimate Frisbee on a field that was so hard it may as well have been a parking lot. Even though I was in good shape at the time, the pounding was just too much for me. Ibuprofin and stupidity got me through all my college seasons. After college I continued to be dogged by shin splints. Notice I keep using the garbage term as I never really had them properly diagnosed, although I do know that I overpronate. As I settled into adulthood and declining fitness, my yearly cycle would look something like this:

1. Basically take the winter off from exercising.
2. Start playing Ultimate two or three times a week around April. Lament the dismal state of my fitness, but enjoy pain-free shins.
3. June. Fitness improves. Shin pain begins. Start Ibuprofin diet.
4. Around July. My pain/performance peak.
5. August through the end of the season. Watch my pain curve increase, and beat down my performance curve.
6. Rinse. Repeat.

Then, finally, around three years ago I tried playing a couple games of indoor Ultimate over the winter. Within two sessions I started experiencing June-level shin pain. I knew something had to change. And besides, as I mentioned elsewhere, I was tired of sucking. So it was time to get in shape and fix my shins once and for all. Here's what I did:

1. Hopped on the NordicTrack. I've written elsewhere what a great machine this is, but for my purposes in particular is was perfect. I needed to get some exercise outside the high-impact context of Ultimate, I needed to lose some weight, and I needed to work out my lower legs. Even jogging brought on shin pain for me, so easing into running slowly wasn't an option. The NordicTrack was a good, full-body, aerobic workout, and the balance component of the exercise really worked my lower legs well. In fact, for my first several weeks of my workouts on that machine, most of my soreness (the good kind) was in my lower legs and shins.
2. Lost 20 pounds. Then another 20 pounds. The first 20 was enough to make a big difference for my shins though.
3. Started icing religiously after each and every workout that had any kind of an impact component (jogging, running, rope jumping, competing, etc.). Note that this means I am icing healthy shins! I am not waiting for the pain to start. For icing anything, but especially shins, I can't recommend Cryopak Flexible Ice Blankets highly enough. They are cheap, five or six fit nicely in a small personal cooler, and you can wrap your entire lower leg with one or two (depending on what size you buy and how tall you are). Man, it gets you good and cold. I just put them right on my skin and wrap them down with a snug Ace bandage. I'm not recommending direct ice-to-skin contact in case you get frostbite or nerve damage or something, but I've never had any problem with it personally.

That's it. Less weight, better fitness, and regular ice. I'm not sure which of those factors had the biggest influence, but I've been shin splintless for three years now, and I thought I was always going to be stuck with those bastards.

I still overpronate though, and I just learned that might account for my high number of ankle sprains, random foot pain the day after Ultimate, and inclination towards calf cramps. I really should do the right thing and get that checked out. And so should you, if you're anything like me.