The science of a sports injury

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

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

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

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

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

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

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