Tag: running

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Causes of Higher Risk of Stress Fractures in Female Runners

Press Release:

PHILADELPHIA – Running is one of the most popular forms of exercise, enjoyed by a broad range of age groups and skill levels.  More women are running recreationally compared to men; specifically 54% of runners are female as indicated by a 2018 National Runner Survey. Women, however, are at least twice as likely as men to develop stress fractures, an injury that impacts around 20% of runners. However, information is still lacking on how to best prevent and treat stress fractures in women. New pilot research from Jefferson suggests physiological factors that could be included in routine screening for stress fracture risk, as well as changes in training approach to aid in prevention.

The researchers examined physiological differences that might contribute to increased risk of stress fractures in a study published in Sports Healthand also surveyed women’s perception of risk and behaviors that contribute to stress fractures in a separate study published in Physical Therapy in Sport. 

“Most of the literature focuses on elite runners or athletes,” says Therese Johnston, PT, PhD, MBA, Professor in the Department of Physical Therapy and first author of both studies. “It was important for us to capture the regular or average female runner in these studies, and the main goal was to see how we can prevent a first or subsequent fracture.”

Both studies surveyed the same group of 40 female recreational runners, age 18-65 years. 20 women had a history of running-related stress fractures, and they were matched according to age and running abilities with 20 women with no history of stress fractures. The two studies aimed to assess what contributed to risk of stress fractures, from the physiological, such as – bone structure and density, muscle mass, hormonal status, to ones influenced by training routine, such as training intensity, nutrition, insufficient strengthening, and ignoring pain.

“This mixed methods approach provides a richer context and a more detailed picture of the practices and risks that contribute to stress fractures in every-day women runners,” says Jeremy Close, MD, associate professor in family and sports medicine and one of the lead authors on the research. “It also tells us how perceived risk informs physiological risk.”

For the study focused on physiological factors, the subjects underwent a comprehensive blood panel that examined levels of hormones like estradiol and testosterone, vitamins and minerals important for bone health such as vitamin D and calcium, and bone markers. They also underwent dual energy x-ray absorptiometry (DXA) to test for bone mineral density. The researchers found that while there was no difference in estradiol hormone levels between the two groups, women who had a stress fracture history reported menstrual changes or irregular periods as a result of their training, or during peak training times. The blood panel also examined markers for bone formation and resorption, and pointed to increased bone turnover in the group of women with stress fractures. They also found through the DXA testing that women with a history of stress fractures had lower hip bone mineral density compared to women with no history of stress fractures, indicating decreased bone strength that could increase risk of injury.

“DXA for bone density and blood testing for bone markers are not routinely performed in this population – they are usually reserved for post-menopausal women – so we may be missing important clinical indicators for stress fractures in these women,” says Dr. Johnston. “While the link between menstrual changes and bone strength is unclear, our findings also indicate that asking female runners about any menstrual irregularities during heavier training times is important during routine screening.”

For the study investigating women’s self-perception of risk, interviews were conducted with the goals of finding out which factors women thought were associated with stress fractures or maintaining bone health while running. Several themes emerged from these interviews. Specifically, compared to women without stress fractures, women with histories of stress fractures had increased their training load more quickly. Also, while they knew of the importance of nutrition and strengthening exercises, women with a history of stress fracture more often reported not having or making the time for a balanced diet and proper cross-training to complement their running regimen.

Finally, women in this group reported pushing through the pain and running despite an injury more often than those without stress fracture. “In the interviews, it sounded like these women had trouble knowing which pain was normal, and which pain was abnormal. They also reported not always receiving appropriate guidance from healthcare providers on how to progress running safely,” says Dr. Johnston.

“It is clear that there needs to be more guidance from healthcare providers for woman runners on how to prevent stress fractures” says Dr. Close. “It can be very frustrating for these women who are on a path to wellness, but are impeded by an injury that can take several months to heal. If they don’t have the proper guidance on how to return to running safely, they risk a second injury.”

“We hope that our findings will encourage more thorough and routine screening in women runners for bone density and strength,” says Dr. Johnston, “as well as a comprehensive education plan on how to balance running with cross-training, and how to interpret pain cues from the body, to help women differentiate between normal aches and pains and indicators of a serious injury.”

Dr. Johnston plans to continue this research by studying women with acute stress fractures as they start running again, in order to identify factors related to successful or unsuccessful return to running following a stress fracture. The study will include Dr. Close as well as Marc Harwood, MD, service chief in the department of non-operative sports medicine at Rothman Orthopaedic Institute.

The work was funded by the Thomas Jefferson University Office of the Provost. The authors report no conflict of interest

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Global Leader In Recovery Footwear, OOFOS, Accepts The American Podiatric Medical Association Seal Of Acceptance Across All Products

The Seal of Acceptance Further Establishes the Brand as a Leader and Innovator in the Footwear Industry

Press Release:

BRAINTREE, Mass., Aug. 11, 2020 /PRNewswire/ — OOFOS, the global leader in recovery footwear, announces today its full line of products has earned the American Podiatric Medical Association (APMA) Seal of Acceptance, further solidifying them as a pioneer and leader within the recovery footwear category.

The APMA Seal of Acceptance Program recognizes products that have been found to be beneficial to foot health and of significant value when used consistently in a daily foot care program. OOFOS’ full collection is among these products, as all OOFOS styles were found by the committee to promote good foot health, further establishing the therapeutic and health benefits of the brand’s shoes. In receiving the Seal of Acceptance from the APMA, customers and physicians alike are assured that upon purchasing a pair of shoes from OOFOS, they are receiving a product that is of exceptional quality and is manufactured with the consumer’s comfort and well-being in mind.

“This is a huge moment for our brand. It reinforces prior research findings and the benefits of our unique foam technology, which is designed specifically for relief and recovery,” says Steve Gallo, President of OOFOS. “Our mission at OOFOS has always been ‘to make yOO feel better’ and this seal of acceptance by the APMA provides expert validation that our shoes make a difference in the health and wellbeing of our customers day in and day out.”

Made with proprietary OOfoam® technology, OOFOS shoes absorb 37% more impact than traditional foam footwear materials for the perfect blend of cushion and stability, based on a 2018 University of Virginia laboratory study.

The use of the proprietary technology in conjunction with their patented footbed allows the shoes to cradle and support the foot’s arches for more even distribution of pressure across the sole of the foot. The combination has also shown to reduce energy exertion in the ankles by up to 47% when compared to traditional footwear. The APMA committee has further championed this technology through review of the research the brand has done on these footwear components, how the products interact with the human body and the benefits consumers receive compared to traditional footwear.

This seal is just the latest example of how OOFOS is helping yOO recover and feel better with every step. In addition to the APMA Seal of Acceptance, thousands of consumer reviews online rave about the footwear’s positive impact on their lives, including relief of pain due to ailments, bringing comfort to long working hours and maintaining body health for professional athletes. 

“These are the most comfortable slides I’ve ever worn in my life,” says OOFOS brand partner and Pro-Football Hall of Famer, Deion Sanders. This is coming from a dude who is 52, has had three toe surgeries, and is in need of a 4th, these shoes changed the game for me!”

About OOFOS
OOFOS is the global leader in recovery footwear, founded by a team of industry veterans looking to help runners and fitness enthusiasts recover better from their workouts. Made with revolutionary OOfoam™ technology, OOFOS are designed to absorb 37% more impact than traditional footwear. They reduce stress on joints to keep anyone, of any activity level, feeling their best. From professional athletes to casual walkers, OOFOS footwear will make your hard-working feet and body feel better – all you have to do is feel the OO. 

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Running research: Heel-toe or toe-heel?

Press Release:

New research from La Trobe University suggests there is no evidence that changing a runner’s strike pattern will help prevent injuries or give them a speed boost.

In a bid to avoid shin splints, sore knees and other injuries, many runners have adopted a toe-to-heel trend, running on the balls of their feet. This is often encouraged by coaches and health professionals.

However, in research out this week in Sports Medicine, La Trobe injury researcher and physiotherapist Dr Christian Barton found there is no evidence to suggest running on the front of your feet reduces injury risk or improves performance.

“We analysed 53 studies which looked at the impact of forefoot, rearfoot and flatfoot running patterns on injury, running economy and running biomechanics,” senior author of the study, Dr Barton said

“Our comprehensive review suggests that telling someone to run on the ball of their foot instead of their heel may make them less efficient, at least in the short term. Additionally, there is no evidence either way on whether running on the balls of your feet reduces injury.”

Dr Barton said switching your running style shifts the body’s loads but doesn’t make them disappear.

“Running toe-heel might help injuries at the knee, where loads are reduced. However, it may cause injuries to the feet and ankle, where loads are increased,” Dr Barton said.

“Put simply, when it comes to running style: If it ain’t broke, don’t fix it.”

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Would changing gait pattern decrease your likelihood of running injuries?

ROSEMONT, Ill. (April 6, 2016)–Are runners less injury-prone trekking barefoot than in pricey running shoes? Maybe, according to a new literature review in the March issue of the Journal of the American Academy of Orthopaedic Surgeons (JAAOS). Advances in running shoe technology in the last 40 years have not reduced injuries, but racing “barefoot” in shoes with minimal cushioning could help runners change their strides and landing patterns to prevent repetitive heel pain and stress fractures.

Three of four active runners sustain injuries, mostly in the knee and lower leg. Most distance runners who use cushioned running shoes run heel-to-toe, or in a rearfoot strike (RFS) pattern. This action is associated with longer strides and excessive load force–up three times the runner’s body weight–on the lower leg, knee, and hip. This leads to bone and soft-tissue injuries, tibial stress fractures, and severe heel pain, such as plantar fasciitis.

Minimalist, including barefoot running has become popular in recent years. Minimalist running shoes have thinner soles and less cushioning and are more flexible than conventional runners’ footwear. Advocates believe these shoe changes alter running so the front or middle of the foot strikes the ground first–a forefoot or midfoot strike (FFS and MFS)–which reduces load stress on the knee, lower leg, and heel. Flatter foot placement dissipates load impact on the heel.

“Injury patterns among long-distance runners are unacceptably high, and while some research in minimalist running seems promising regarding injury prevention, there still are a lot of unknowns, and the debate continues,” says lead author and orthopaedic surgeon Jonathan Roth, MD, with Fort Belvoir Community Hospital in Virginia. “Evidence to date shows that changing gait patterns, not shoe selection, is the best intervention to lower the injury prevalence in runners. Minimalist shoes may give better feedback to runners and allow them to focus on changing their gait, but not everyone does, and this could lead to more injury.”

Dr. Roth added that increasing acceptance of minimalist running has outpaced medical evidence of its benefits. Orthopaedic literature, however, has demonstrated that with less-cushioned footwear, runners spontaneously transition from the RFS to the FFS gait pattern. Whether FFS running truly can reduce injuries is unknown, but the most compelling data were published in a 2012 study involving a Division I collegiate cross-country team. The results showed:

  • The athletes had a 75 percent injury rate per year, categorized as either traumatic or repetitive;
  • Strike type was characterized for each athlete and showed that 31 percent ran in the FFS pattern and 69 percent demonstrated RFS; and,
  • There was no difference in the traumatic injury rate between FFS and RFS runners; and,
  • FFS runners were 1.7 times less likely to sustain repetitive injuries than RFS runners.

Other findings in the JAAOS literature review include:

  • Barefoot and minimalist running is not injury-proof and poses risk for metatarsal (toe) stress fractures, plantar fasciitis, and puncture wounds;
  • Runners can transition to the FFS pattern in any shoe with appropriate training; and,
  • Barefoot and minimalist running is an emerging phenomenon that requires further exploration of its orthopaedic implications to identify true long-term benefits and risks.

Runners interested in exploring minimalist running shoes to provide more feel and less of a heel-to-toe offset, and to allow easier landing midfoot to forefoot, “should consider themselves as non-runners and start over by walking and gradually adding running distance week to week,” advises Dr. Roth. “This will help assure proper transitioning to build strength, flexibility, stability, and endurance around the foot and ankle.” Transition from a RFS to FFS gait pattern should be a gradual process–over many months. Runners should expect to run minimal mileage when transitioning and always remember the 10 percent rule when increasing in distance. An abrupt switching of gait patterns can lead to an increase in other repetitive stress injuries if not done correctly.