Swelling helps healing, so are ice and NSAIDs bad?

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As of September 2017, new Sweat Science columns are being published at www.outsideonline.com/sweatscience. Check out my bestselling new book on the science of endurance, ENDURE: Mind, Body, and the Curiously Elastic Limits of Human Performance, published in February 2018 with a foreword by Malcolm Gladwell.

- Alex Hutchinson (@sweatscience)

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Lots more to come from the sports nutrition conference in Canberra, but first I just wanted to quickly put up a link to my article in today’s Globe about new research suggesting that swelling may help injuries heal faster:

Every weekend athlete knows the RICE rule for dealing with minor sprains and strains: rest, ice, compression and elevation, with the latter three tactics aimed at minimizing inflammation.

But a study published last month by researchers at the Cleveland Clinic adds to growing evidence that swelling actually plays a key role in healing soft-tissue injuries. The result is a classic tradeoff between short-term and long-term benefits: reducing swelling with ice or anti-inflammatory drugs may ease your pain now, but slow down your ultimate return to full strength.

“This whole discovery has really thrown into question all of our traditional approaches to treating injuries,” says Greg Wells, a University of Toronto exercise physiologist who works with national-team athletes at the Canadian Sport Centre. [READ THE WHOLE ARTICLE…]

Another blood spinning study finds no improvement in Achilles tendons

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As of September 2017, new Sweat Science columns are being published at www.outsideonline.com/sweatscience. Check out my bestselling new book on the science of endurance, ENDURE: Mind, Body, and the Curiously Elastic Limits of Human Performance, published in February 2018 with a foreword by Malcolm Gladwell.

- Alex Hutchinson (@sweatscience)

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Actually, the title isn’t quite true — this is a just new wrinkle on the same Dutch study reported earlier this year that found no difference between platelet-rich plasma injections and placebo (saline) injections for 54 patients with chronic Achilles tendinopathy. The new paper, just published online at the British Journal of Sports Medicine, presents further data from this experiment: in addition to the previously reported pain scores (which, admittedly, are a bit wishy-washy and subjective), they used “ultrasonographic tissue characterization, a novel technique which quantifies tendon structure.”

Basically, they used ultrasonic imaging combined with computer image recognition to get an automatic (i.e. objective) measure of tendon health. The results: scores improved for both PRP and placebo (note that the subjects were also doing a rehab regime involving eccentric exercises during the study), but there was no significant difference between the groups.

Given the results presented earlier, this isn’t a big surprise — and of course, certainly isn’t proof that PRP doesn’t work in any context. But it’s another reason for skepticism. As the authors conclude, “these data argue against clinical use of this form of PRP in present clinical practice.”

Biomechanics for performance and injuries

THANK YOU FOR VISITING SWEATSCIENCE.COM!

As of September 2017, new Sweat Science columns are being published at www.outsideonline.com/sweatscience. Check out my bestselling new book on the science of endurance, ENDURE: Mind, Body, and the Curiously Elastic Limits of Human Performance, published in February 2018 with a foreword by Malcolm Gladwell.

- Alex Hutchinson (@sweatscience)

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My Jockology column in today’s Globe and Mail takes a look at the growing use of biomechanics technology by elite and recreational athletes, both to enhance performance and address injury problems. The two guys I spoke to were Dana Way, the Winnipeg-based biomechanics expert who travels with the Canadian track team, and Reed Ferber, who runs the University of Calgary’s Running Injury Clinic and has been rolling out a 3-D gait analysis system at clinics in western Canada.

[…] In typical laboratory “motion-capture” systems, small reflective markers are affixed to the athlete’s body at key points such as joints and extremities. Video cameras connected to a computer record the motion of these markers, and use the data to draw a stick-figure that duplicates the essential features of the athlete’s motion.

While traditional systems used a single camera to capture motion in two dimensions, the latest systems use multiple cameras to create a three-dimensional model. Major League Baseball’s Boston Red Sox, for example, are using a 20-camera system to analyze the throwing motion of their pitchers.

At the University of Calgary’s Running Injury Clinic, biomechanist Reed Ferber has been using an eight-camera system with 20 reflective markers to analyze the running gait of his patients and research subjects. But he’s found that for the 3-D gait analysis systems he’s started installing at sports clinics across the country, three specially designed cameras are sufficient. [READ THE WHOLE ARTICLE…]

The accompanying graphic, by the Globe‘s Trish McAlaster, does a nice job of showing how the 3-D gait analysis works:

lf-jockology-biomechanics-graphic

Achilles tendons, platelet-rich plasma and Megan Wright

THANK YOU FOR VISITING SWEATSCIENCE.COM!

As of September 2017, new Sweat Science columns are being published at www.outsideonline.com/sweatscience. Check out my bestselling new book on the science of endurance, ENDURE: Mind, Body, and the Curiously Elastic Limits of Human Performance, published in February 2018 with a foreword by Malcolm Gladwell.

- Alex Hutchinson (@sweatscience)

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Today’s Globe has my article on new approaches to treating and preventing Achilles tendinopathy, including platelet-rich plasma therapy, a.k.a. blood spinning. Since I’m in Delhi, I had a chance to speak to the experts here with the Canadian team, and to Megan Wright (2008 Olympic 5,000-metre finalist who missed most of 2009 with Achilles tendon problems):

… In some cases, though, tendinopathy doesn’t respond to conservative treatment. In the months before and after the Olympics, Ms. Wright tried icing, acupuncture, sleeping in a “night splint” and “kinesio taping” – applying special tape along the length of the calf to relieve strain on the tendon. She even tried intramuscular stimulation, sometimes called “deep needling,” in her calves – a procedure that, as the name suggests, involves sticking needles deep into the calf muscle.

Finally, she turned to platelet-rich plasma. Since tendons have a very poor blood supply (unlike muscles), minor tears and inflammation tend to heal slowly. PRP therapy involves drawing a small amount of the patient’s own blood, spinning it in a centrifuge to concentrate the most useful components (the platelets) and reinjecting this concentrated plasma at the injury site. The platelets then release various “growth factors” that stimulate the body’s natural healing response… [READ THE REST OF THE ARTICLE]

Wright races tomorrow night against a tough field, including the inevitable trio of Kenyans. I’ll be live-tweeting the race, which is scheduled to start at 11:20 a.m. Eastern time, at @sweatscience.

Inflammation is needed to repair injured muscle

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As of September 2017, new Sweat Science columns are being published at www.outsideonline.com/sweatscience. Check out my bestselling new book on the science of endurance, ENDURE: Mind, Body, and the Curiously Elastic Limits of Human Performance, published in February 2018 with a foreword by Malcolm Gladwell.

- Alex Hutchinson (@sweatscience)

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There’s growing recognition that anti-inflammatory drugs aren’t always the best response to muscle soreness or injury. In that light, the press release accompanying a new study in the FASEB Journal is overstating things when it says “the study shows for the first time that inflammation actually helps to heal damaged muscle tissue, turning conventional wisdom on its head.” Still, the results are interesting:

The research report shows that muscle inflammatory cells produce the highest levels of IGF-1 [insulin-like growth factor-1], which improves muscle injury repair. To reach this conclusion, the researchers studied two groups of mice. The first group of mice was genetically altered so they could not mount inflammatory responses to acute injury. The second group of mice was normal. Each group experienced muscle injury induced by barium chloride. The muscle injury in the first group of mice did not heal, but in the second group, their bodies repaired the injury.

The paper itself makes it clear that researchers already knew that inflammation was important to muscle repair, but the mechanism (i.e. the role of macrophages in producing IGF-1) was unclear. So does this mean that anti-inflammatories are a bad idea after muscle injury? Not necessarily — too much inflammation can still cause problems (for reasons that aren’t entirely clear to me). What the authors propose is that, when a muscle injury is being treated with anti-inflammatories, it may make sense to also administer supplemental IGF-1 to compensate for what the anti-inflammatories are blocking.