A study published in the Journal of the American Medical Association, Jan. 13, 2010 gave disappointing results in using plasma rich protein to treat non-insertional Achilles tendinopathy. It showed no difference between using a sham injection of saline and combining it with a painful eccentric stretching protocol  in comparison with an injection of plasma rich protein injection along with the standard painful eccentric stretching protocol.

The authors note that previous studies did not have good control groups. In this small study, 27 patients were in the placebo group and 27 in the treatment group. The VISA-A score was used to assess improvement. Both groups improved somewhat without a significant difference between the two groups.

The study was called a “preliminary communication” which is often done with small studies. Other studies on similar topics with fewer than 30 individuals studies have also been billed as “preliminary studies”, but when they are talked up afterward, the “preliminary study” status is usually forgotten. As far as study design goes, the design, blinding, and performance of the study seems just right. I am not entirely convinced of the efficacy of the painful eccentric stretching protocol and would have not minded another study group omitting that treatment. Apparently it is not a panacea (or there would not be studies looking to add to the results), although the initial preliminary study made it sound as though it would be. Follow up journal articles by the primary author of the first study have been positive and are referenced below. Others have expressed reservations on the methodology. (see Woodley et. al. 2007 and Kingma et. al. 2006) Eccentric stretching and overload for tendinopathy has mixed results at best in other body areas.

Note: VISA-A is the Victorian Institute of Sports Assessment-Achilles

References:

Platelet-Rich Plasma Injection for Chronic Achilles Tendinopathy: A Randomized Controlled Trial
Robert J. de Vos; Adam Weir; Hans T. M. van Schie; et al. JAMA. 2010;303(2):144-149 (doi:10.1001/jama.2009.1986)

Alfredson H. Chronic midportion Achilles tendinopathy: an update on research and treatment. Clin Sports Med. 2003;22(4):727-741.

Alfredson H and Cook J (2007), A treatment algorithm for managing Achilles tendinopathy, new treatment options, British Journal of Sports Medicine, 41, 4, 211.

J J Kingma, R de Knikker, H M Wittink, T Takken. Eccentric overload training in patients with chronic Achilles tendinopathy: a systematic review. Br J Sports Med 2007;41:e3 (http://www.bjsportmed.com/cgi/content/full/41/6/e3). doi: 10.1136/bjsm.2006.030916 (concludes: Studies on the effectiveness of eccentric overload training in patients with Achilles tendinopathy show many methodological shortcomings)

Woodley, B.L., R.J. Newsham- West, and D.B. Baxter, Chronic tendinopathy: effectiveness of eccentric exercise. Br J Sports Med, 2007. 41: p. 188-199.

Additional Information:

Pribut, S.M.,  Top 5 Running Injuries. Podiatry Management, 2008

Blog on: Heel Lifts and Achilles Tendinitis

Dr. Pribut on Achilles Tendinopathy

Dr. Pribut on The Science of Tendinopathy

An article written for the January, 2010 issue of Podiatry Management Magazine entitled “Challenging Running Injuries: Be Knowledgeable, Be Prepared” is available in PDF format. It is at the PM site along with a quiz for continuing medical education credit. The target audience is health care professionals. Much of the information has been or will be incorporated at the running injuries site. All are welcome to download and read the article.

PDF Version at PM Magazine

Best Meme: Exercise is Medicine. Trademarked and owned by the American College of Sports Medicine

Best Public Domain Meme: Exercise is good for what ails you. It’s mine and probably someone else’s too. You can have it for free as an open source code for life.

Best Runner of The Year: Usain Bolt

Best Marathon Victory of The Year: Meb Keflezighi bringing it home at the New York Marathon.

Best Running Magazine: Runner’s World. (with Runner and Marathon & Beyond close by)

Best Secret of Success: Avoid over training and the terrible too’s. Too much, too soon, too fast,  too often, with too little rest. Khalid Khannouchi, says that rest is the secret ingredient for success for the aging runner. Of course, I’d guess good genetics, and a lot of hard work helps too! This past summer Khalid received the Golden Foot Award of the American Academy of Podiatric Sports Medicine. He is also deserves to be known as one of the nicest people of the year.

Best Running Politician: And controversial in this slot would is Sarah Palin. But as a marathoner, and one who isn’t sure what papers she reads daily, she did know that George Sheehan is one of her favorite authors and philosophers. Bonus points for that put her over the top.

Best Basketball Playing Politician: Barack Obama. Now, Barack needs to publicly announce he has given up cigarettes and taken up running and he has a chance at the position above this one.

Best Book: Born To Run, by Chris McDougall. Best running read for a long time and  clearly dominated in the running world.

Best Fitness Book For Nonrunners: The Body Fat Solution, by Tom Venuto. While I’m more of a fan of cardio, and cardio out of your comfort zone more than HIIT, Tom Venuto has much advice for those trying to lose weight. Motivation, often a weak point, is well covered here.

Best Quick Workout Book I Haven’t Read Yet: Cardio Strength Training by Robert Dos Remedios. It’s new and it’s on order. I’m sometimes forced to get a workout in with only 20-40 minutes available. Coach dos Remedios has written up a bunch of short plans including some 15 minute plans. That may be a bit short, but I like to see what others are thinking of and I’m sure there are plenty of fine ideas here for those who like to mix in strength training. His text on “Power Training” is incredibly thorough.

Best Humor Running Book: The Runner’s Rule Book by Mark Remy

Best Out of Print Running Book: Running and Being by George Sheehan

Best Vacation Spot: Hawaii. Clearly the choice on both the right, left, and center. Pick an island, any island. You can’t go wrong.

Best Publisher: Rodale Press. Rodale publishes Runner’s World, Runner Magazine, and tons of books on fitness and health topics.

Best Game To Quit: World of Warcraft. How many games could keep so many people playing for so many hours? 5 year anniversary just passed, time for a change and the rest of life. Besides, sitting still for 5 hours in front of a TV screen or computer monitor has serious adverse health effects.

Best Revealed Wisdom: Hip strength and core strength is important. Abductors help ITB syndrome and gluteal muscles can help Patellar tendinitis (tendinopathy) and resistant patellofemoral pain sydnrome.

Best New Thought On Exercise: Exercise isn’t only good for what ails you, but sustained movement may have driven evolution of the hominid brain.

Best Sports Medicine Publication: Medicine and Science in Sports and Exercise. Official publication of the ACSM

Best Science Magazine: Science Magazine. (Nature is right up there too.)

Best Must Read Running Humor Blog: Mark Remy’s Daily Views Mark occasionally takes some hits on his blog, but he is consistently funny and occasionally controversial. And this summer, he pointed out a new member of the running community: Eminem, seen on the Jonathan Ross show. Jonathan is occasionally involved in controversies himself.

Best Running Blogs: Runner’s World Blogs. There are others, but overall the blogs at runner’s world are a great assortment and worth reading. Read them all and pick your own favorites, if you haven’t already. There is something for everyone. If you’ve missed Amby Bufoot’s two blogs, put them on your list: Foot Loose and Peak Performance. General fitness blogs: Leigh Peele’s Diet, Fitness, Life is also worth a look. Leigh tells the truth about diet, fitness, and trends at her new and likely permanent domain.

Best Music Video of The Year: Ima let you finish, but Beyoncé’s “Put A Ring On It” is it. This, it should be noted, was also selected by that exemplar of fine taste, Kanye West.

Best New Music Act: Florence and the Machine.

Best Commitment: Work on fitness and health. Made by many, kept by many, and in line to be the best commitment for next year too!

Best Thing Avoided: The Tiger Woods/ Mark Sanford life style. Thanks to those who helped with this one. More reasons why working out, running, and staying home is better than golf and politics.

Best Connector: The Internet. Intertubes, interwebs and all!

Happy New Year, everyone. I hope your year gets off on the right foot! Make your plans and commitments and get off to a good start!

Merry Christmas and Happy Holidays to all!

Tendinitis is often used incorrectly as a generic term for overuse tendon injuries. The term that should be used is tendinopathy. Tendinitis and tendinosis both refer to microscopic changes that are seen on biopsy. Even spelled as “tendonitis”, it is still incorrect. The current view is that long term overuse tendon injuries display little to no inflammation. While the original meaning of the word inflamation refers to something feeling like it is “on fire”, the medical term refers to histopathology and microscopic examination. While it may still hurt and in a sense feel as bad as if it were on fire, we need to start calling the injury tendinopathy. Of course the biggest problem is that when a doctor tells you that your problem is “tendinopathy” it will take a 20 minutes of discussion to define what is meant by that.

The running injuries website has been updated to include an overview on the science of tendinopathy. We’ll update this page as new information and research appears.

Holiday wishes and Happy Thanksgiving to everyone. This is just a quick note.

I’ve added some new material and updated some older material. The topics and pages are:

Injuries To the Hallucal Sesamoid Bones: Sesamoidopathy and Sesamoiditis

Hallux Rigidus and Hallux Limitus

Turf Toe

These can all be challenging problems for athletes. They are less common than certain other problems, but they still occur very often. Hallux rigidus, sesamoid area pain and sesamoid injury, hallux limitus and turf toe are inter-related problems. The articles review the conditions, classification, and treatment. The tone of the articles is fairly hardcore science, but hopefully they are still accessible enough for everyone to understand.

Meb Brings It On Home!

The winners are in for the 2009 New York Marathon. Another exciting and great race with some surprises. Paula Radcliffe placed 4th in the race and suffered from ongoing injuries. Derartu Tulu of Ethiopia finished in first place. Meb Keflezighi, wearing a USA singlet, 34 years old, set a PR (2:09:15) and came in first. He finished strongly pulling away from Kenya’s Robert Cheruiyot, 4 time winner of the Boston Marathon, over the last few miles. He became the first American to win the race in 27 years, since Alberto Salazar did so in 1982. Ryan Hall came in 4th. Six of the top ten men’s finishers were American. This is the first time that has happened since 1979, when Bill Rogers won.  Joan Benoit Samuelson, the first woman’s Olympic Gold medalist (1984), set a New York Marathon, over 50 women’s record, finishing in 2:49:09.
Congratulations to all of the many other competitors and runners today. For those of you looking forward to the 2010 New York Marathon, you can start signing up for the lottery on November 2, 2009.

Women’s Results

Men’s Results

News Updates:

Keflezighi’s  Breaks the Tape First

Tulu Wins Women’s Marathon

Pre-race Chat With Meb (At Runner’s World)

Bring It On Home: Led Zeppelin

I wish good luck and a strong finish to everyone running tomorrow in the New York Marathon and to the runners participating in other marathons coming up the rest of this fall!

As the media frenzy leads up to the New York Marathon, there is more than one story to pay attention to. There is history, current competition, excellent runners, ordinary runners, and a whole city gearing up for a big day. For most runners, today is a rest day and for the evening, a bit of pasta. I recall watching the New York Marathon all the way  back when Bill Rogers and Alberto Salazar each won it multiple times. The first year Salazar won, I watched along first avenue and wondered who was this guy in the bright yellow shorts running so upright and far ahead of everyone else. I then jogged over to Central Park to see the early finishers. Then at the end of the race, I’d be out for my run and watch the “slow runners” coming in at over 4 hours. Of course, no fussing or teasing about a 4 hour finish now! Back then it was also wonderful to watch Greta Waitz win consistently year after year. The New York Marathon continues to be exciting. Paula Radcliffe has an amazing string of victories. And the race itself going through all the boroughs with so many people watching and cheering, and crossing so many (difficult) bridges is a tremendous event.

The New York Times joined in the media frenzy. After a “run-up” of articles the last few months that have been quite good and resulted in a lot of participation at their forums, the marathon made it to their OP-ED page today. Unfortunately the article on the op-ed page lamented our missing champions and the fact that an American hasn’t won the men’s division in 27 years since Alberto Salazar won. The author deems this failure a lack of “narrative”. The piece concluded by making fun of runner’s world for having general articles on improving muscular fitness and articles for beginners.

In actuality, I’m going to recommend the Runner’s World New York Marathon coverage as the best place to read about what is coming up and for fine overall stories and profiles of the runners participating. Runner’s World both profiles world class runners and offers excellent information on the sport of running to lesser mortals. Running is a participatory sport. At a time in which 65% of U.S. adults are overweight, a magazine offering tips about starting running without feeling bad because you are slow, how to improve, what shoes might be best for you, nutritional recommendations, recipes, motivation tips, and even advanced training, can not be a bad thing.

With Runner’s World publishing excellent articles on stretching, overall fitness, strength training, nutrition, along with articles on the best and the fastest, it can only help the overall health and fitness of their readers. I’d encourage all runners to both visit their web site and get a copy to read. There is much inside for every runner, and the articles go deeper than the newstand cover may suggest. Other fine magazines geared to runners include: Running Times, and Marathon and Beyond.

There are a few things we can consider doing to improve our runners. At the same time we need to work on the overall fitness and health of everyone. Runner’s World encourages everyone, and has always done so. While there were many exciting past races, many are still excited to be out running and doing the best they can. To improve the sport (and our health) we have done a disservice to everyone by requiring only one year of gym in high school. Childhood obesity is at an all time high and this does not help. Encouraging more athletic participation and demonstrating team, carry over sports,  and individual sports and making it school centric would be helpful.

Better coverage of track and field and running events  in national news and sports shows would be helpful. Live coverage of major races and track events on television would be a good thing. And how can we not have live coverage of the Olympic events? With a million cable stations available why was there not a package for sale that included multiple channels along with many different events for those few weeks. Years back this was done, and it would have been quite successful the last few Olympics.

We have no failure of narrative, publishing, or research. The American College of Sports Medicine is the most respected organization of professionals in the world. Their journals (especially Medicine and Science in Sports and Exercise) are eagerly awaited by researchers and clinicians working in the field of sports medicine. We have the tales of Dean Karnazes. This year has seen one of the most enjoyable reads on running in Born to Run: A Hidden Tribe, Superathletes, and the Greatest Race the World Has Never Seen, by Christopher McDougall.  We have research, topical magazines, participants, web sites, bloggers, and as much narrative as we could hope for.

The media could certainly do a better job in presenting running events, and the benefits of the sport and helping to publicize  appropriate goals and how they can be established. Complaining that not enough Americans have won lately doesn’t give adequate credit to those who have both talent and have worked hard for their success. And we need to remember that we are all a part of the human race. Going beyond sport is a book published earlier this year by Johns Hopkins Professor David Calleo, Follies of Power: America’s Unipolar Fantasy which points out the reality and significance of  a multipolar world. The international lessons here extend beyond politics, trade and international affairs and into sports. If one pays attention, you may yet find yourself bringing back accolades to your country perhaps even in the form of a Nobel prize.

The United States has a fine and growing group of excellent men and women runners, yet New York is open enough over the years to have welcomed and been joyful for all of the marathons winners and their participants from wherever they come from. (Even those from Boston during the world series. )

Runner’s World NY Marathon Coverage

New York Times Marathon Coverage

Related:
Running In Central Park: Interactive Map

Frank Sinatra: New York, New York

24 Hours To See New York: Gene Kelley, Frank Sinatra

Empire State of Mind (Jay Z, Alicia Keyes)

After unusually persistent aches and pains during training or after your race, you may decide it’s time for a visit to your sports doc. Of course, we hope you’ve increased your training slowly, checked your shoes and done your best to  learn how to avoid the doctor’s office.

Now that you’ve decided it is time for a visit, how can you make that visit work in the best way possible for you?  What should you bring? Of course bringing yourself in is the most important thing.  The following items are helpful. And the running shoes are often contributors to the injury and it can be very helpful to examine them.

Try to bring in the following items:

Notes on your injury:

• When did it start?
• Where does it hurt?
• When does it hurt?
• What has changed in your training?
• What speedwork or harder than normal running have you been doing?
• What shoes did you wear before you were injured, when injured and what are you wearing now?
• What surfaces have you been running on?
• What have you tried to make things feel better?

Things to bring:

• Current running shoes ( the newest running shoes you have used)
• Previous running shoes (recent ones which may have contributed to your injury)
• Orthotics (if you use them)
• Running/Exercise Log (if you have one)

• Look for a sport specific shoe.
• Go to a specialty store. Runners should visit a specialty running store.
• Take injury history into account.
• Measure feet each time shoes are fit.
• Wear the customary socks for to be worn for sport participation. Sock thickness affects the sizing and fit of shoes.
• Bring orthotics to fit shoes, if you wear them.
• Fit shoes later in the day since feet expand slightly by then.
• Leave a finger’s width in front of the longest toe.
• Make sure both the heel to ball fit and the shoe length are both matches for your foot.
• Make certain the shoe feels comfortable. It won’t be feeling better in a week, if it doesn’t feel good right away.
• Check the shoe for manufactured defects. It should line up perpendicular to the ground and not wobble.
• Replace your athletic shoes regularly. Runners should replace the shoes every 350-450 miles.
• Remember to forget about the size and focus on the fit
• Don’t wear a new shoe in a race or in a long distance competitive event.

For more information see:

Dr. Pribut’s Running Shoe List

Dr. Pribut on Fitting and Selecting Running Shoes

Elvis: Put On Your High Heeled Sneakers (Master Out-take)