Monday, July 27, 2009
3 minutes of icing to let you play again? Really?
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Would you be surprised to learn that if you apply an icebag to 
your hamstrings for ten minutes, and then go to do a vertical jump, you'll jump less high than if you didn't have an icebag on your leg for ten minutes? Ah but what about 3mins of icing? and why should you care about the difference? Consider this recent article in the Journal of Strength and Conditioning Research:
This is a little better unpacked in the article. Icing is used a lot for dealing with injuries. It's one of the famous parts in RICE, rest, ice, compression and elevation.
Aside: why ice? Turns out that RICE is being debated. While lots of good things have been claimed about icing, and there's literature that says, even though we don't know why, icing works better with compression, (er, maybe it's just the compression) some folks have been wondering if compression and ice are really great ideas rather than not interfering with the body's natural injury healing mechanisms. What about heat instead? what about no restriction on the area? what about compression rather than cold? what about letting the body just do it's thing?
A recent summary in 2007 by JL McDonald called Fire and Ice (pdf) states:
No wonder researchers are worried about someone being iced up going back into play: they aren't feeling their limbs properly and spatial awareness would go south. The authors only hint at this being their concern:
But wait. Aren't you hurt if you're icing?
What is interesting to me anyway, here, is that we're dealing with an athlete who has an injury, or they wouldn't be getting iced, and the question is what effect will icing have on their vertical jump? Ok, we're testing with un-injured participants, that's one (ethics and all but who's to say the effects are the same with someone with an injury), but isn't there a sort of fundamental ethical conundrum about asking someone who is so f'd up that they need to be icing in the first place then to go back into the game? The authors write in their Discussion section
What the others do note in practical applications is
What are the authors saying? 10 mins may impact their performance so ten minutes is too long? But while three mins doesn't that's ok, send them back in? The authors leave the question hanging as to whether three mins. of icing, has that had a good effect, though, at all.
Or *maybe* the whole idea is stupid?
Here's my question: why does the athlete need to be iced? - assuming icing is in any way a good idea.
Here's the follow up questions:
If someone has such a degree of pain or inflammation that they need to be iced, what evidence is there to suggest that a three minute shot of ice has made the tissue situation sufficiently ok to enable a full re-introduction back into play in the first place?
Now maybe there is super evidence to support this: that staying moving is a good idea. There's tons of work in pain that pain does not equal injury, but let's say there is an injury, what are we doing here with the ice bag? Where is the work that shows in cases such as these - the athlete keen to get back in the game - that that's been a Wise Move in and of itself?
As said, there may be, and maybe that literature is so well known the authors haven't felt the need to site it, but that that issue doesn't even get a mention makes me think, maybe not. Tweet Follow @begin2dig
your hamstrings for ten minutes, and then go to do a vertical jump, you'll jump less high than if you didn't have an icebag on your leg for ten minutes? Ah but what about 3mins of icing? and why should you care about the difference? Consider this recent article in the Journal of Strength and Conditioning Research:Functional Performance Following an Ice Bag Application to the Hamstrings
The Journal of Strength & Conditioning Research. 23(1):44-50, January 2009.
doi: 10.1519/JSC.0b013e3181839e97
This study examined the immediate and short-term (20 minute) effects of 3- and 10-minute ice bag applications to the hamstrings on functional performance as measured by the cocontraction test, shuttle run, and single-leg vertical jump. Forty-two (25 women, 17 men) recreational or collegiate athletes who were free of injury in the lower extremity 6 months before testing and who did not suffer from allergy to cryotherapy were included. Time to completion was measured in seconds for the cocontraction and the shuttle run test. Single-leg vertical jump was measured on the Vertec (Sports Imports, Columbus, Ohio) in centimeters. The 10-minute ice bag application reduced immediate postapplication vertical jump performance and increased immediate post and 20-minute post shuttle run time (p <= 0.05). A decrease in cocontraction time was observed at 20 minutes post compared with preapplication during the control condition in which no ice bag was applied. Power and functional performance are affected by short-term cryotherapy application. Power and functional performance was impaired immediately and 20 minutes after 10-minute ice bag application to the hamstrings, whereas a shorter duration of ice application had no effect on these tasks.
Right. Really, this result can't be seen as much of a surprise, so why did this study get published - publication of work generally means there's deemed to be a "significant contribution" to the field by the work presented
Aside: why ice? Turns out that RICE is being debated. While lots of good things have been claimed about icing, and there's literature that says, even though we don't know why, icing works better with compression, (er, maybe it's just the compression) some folks have been wondering if compression and ice are really great ideas rather than not interfering with the body's natural injury healing mechanisms. What about heat instead? what about no restriction on the area? what about compression rather than cold? what about letting the body just do it's thing?
A recent summary in 2007 by JL McDonald called Fire and Ice (pdf) states:
When the evidence to support the use of ice in musculoskeletal disorders is separated out from the commonly used context of the RICE (Rest, Ice, Compression, Elevation) protocol, it has been claimed that ice alone is effective in relieving pain, reducing oedema and relieving muscle spasm.I mean, folks make it sound so obvious: use ice (and elevation and compression) to bring down swelling, not heat because
• The evidence suggests that ice alone has a local anaesthetic [cuts off sensation -mc] rather than analgesic effect [actually acts on pain signals -mc].
• There is contradictory evidence for whether or not ice alone can reduce oedema [tissue swelling - mc] , but it may be that compression is the most effective component of the RICE protocol for oedema, given that, while compression is effective in reducing oedema, the addition of ice to compression shows no additional benefit.
• No evidence was found in the reviewed literature to support the assertion that ice can relieve muscle spasm, although there is consensus in the research that local heat can.
Heat is not your friend at first, because it increases circulation, which puts painful pressure on nerve endings. The warmth stimulates the flow of inflammatory chemicals, too, which make pain worse.Ok, pain is not necessarily a good thing, but if stimulating the flow of inflammatory chemicals is bad (is it? isn't inflammation an essential first part of healing? but ok, more is not always better) - what's the deal with trying to cut off that process with ice? what's ice doing in this kind of tissue condition where only ice is used? It doesn't bring down swelling - that's compression, apparently; it doesn't mitigate pain chemistry; it doesn't calm down spasaming muscles. What's left is that it anesthetizes the pain response so the sensation in the area goes numb.
No wonder researchers are worried about someone being iced up going back into play: they aren't feeling their limbs properly and spatial awareness would go south. The authors only hint at this being their concern:
In addition to the potential risk of injury [?? is it proprioception/senstation being deadened? -mc], the effect of cryotherapy on functional performance is a relevant concern, especially if the athlete plans to return to practice or competition immediately after the treatment.These authors are not the first to be concerned with the effects of icing prior to athletic endeavor. They site over a dozen studies that have come up with conflicting results about its impact on performance.
But wait. Aren't you hurt if you're icing?
What is interesting to me anyway, here, is that we're dealing with an athlete who has an injury, or they wouldn't be getting iced, and the question is what effect will icing have on their vertical jump? Ok, we're testing with un-injured participants, that's one (ethics and all but who's to say the effects are the same with someone with an injury), but isn't there a sort of fundamental ethical conundrum about asking someone who is so f'd up that they need to be icing in the first place then to go back into the game? The authors write in their Discussion section
Our study provides additional insight regarding the effect of cryotherapy on a major muscle group while performing functional activities. We wanted to provide clinical relevance to practicing certified athletic trainers; hence, we chose ice bag application because it is the most widely available form of cryotherapy. The time of application also coincides with the clinical relevance of the study. Our rationale for this includes circumstances in which the athlete will be returned to play after ice treatment of short durations. In some instances, an athlete will remove the ice bag early (within 10 minutes) and return him- or herself to play without clearance by a certified athletic trainer. We also examined the effect of these ice treatments after 20 minutes of time had elapsed; we found that as little as 10 minutes of ice can still detrimentally affect functional performance, as shown by the shuttle run in our study.I guess other questions would be, so what? We now know that three minutes has no impact on power, but ten minutes does. But isn't the question about the status of the injury? not about the overall minimal effect on power? What's the likelihood that with that slowed down effect that they'll reinjure themselves or be better protected? That doesn't get discussed.
What the others do note in practical applications is
Certified athletic trainers, athletes, coaches, and practitioners often apply ice to an injured athlete during practice or games. There are often times when athletes feel that they are ready to go back into competition, and they do not complete the total application time for the cryotherapy session. Our findings suggest that a 3-minute application does not affect the functional test measures, but a 10-minute application affects vertical jump and shuttle run times. An athlete may not be able to perform at his or her optimal level after a 10-minute application of cryotherapy even though the cryotherapy was applied to a secondary muscle group; therefore, we should use caution in returning the individual back into competition because there may be other deficits that have not yet been identified. Further research is warranted on primary muscle groups and on the use of short-term cryotherapy applications.
What are the authors saying? 10 mins may impact their performance so ten minutes is too long? But while three mins doesn't that's ok, send them back in? The authors leave the question hanging as to whether three mins. of icing, has that had a good effect, though, at all.
Or *maybe* the whole idea is stupid?
Here's my question: why does the athlete need to be iced? - assuming icing is in any way a good idea.
Here's the follow up questions:
If someone has such a degree of pain or inflammation that they need to be iced, what evidence is there to suggest that a three minute shot of ice has made the tissue situation sufficiently ok to enable a full re-introduction back into play in the first place?
Now maybe there is super evidence to support this: that staying moving is a good idea. There's tons of work in pain that pain does not equal injury, but let's say there is an injury, what are we doing here with the ice bag? Where is the work that shows in cases such as these - the athlete keen to get back in the game - that that's been a Wise Move in and of itself?
As said, there may be, and maybe that literature is so well known the authors haven't felt the need to site it, but that that issue doesn't even get a mention makes me think, maybe not. Tweet Follow @begin2dig
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Saturday, July 25, 2009
Is what's on the label really in your supplement?
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Most of us into health and nutrition dabble in supplements. Some whey protein here; a vitamin D capsule, maybe some fish oil, there. We do this because we believe what we've read about these things being a good idea. But what if what's on the label isn't what's in the tin? How do we really know we're getting what's promised by the label?
At the recent Z-Health 9S:sustenance course, overviewed here, we talked a lot about supplements: about what ones are worth taking, yes, but also about where to source them, once you've made the decision to use them. Based on that discussion, i did some further digging. It's not a story with a happy ending. Sorta more like left who's on stage at the end of Richard III: oh goodie the exciting, poetic, smart villain is dead, while this cheating asshole is left to run the kingdom but at least no one will be fighting anymore. hoo frickin' rah.
So this post presents a brief overview of legislation in the US around dietary supplements, problems with supplement quality and contamination, what good manufacturing practice (aka cGMP is) what third party certification like Consumer Labs or USP does with GMP (overivewed, anyway), a glimpse at the EU situation, and why June2010 is not the end of the War of the Roses.
History and Current Unregulated Practice. In the US, since 1994, there's been no requirement to have the Food and Drug Administration (FDA) assess either what goes into supplements or how they're made. Indeed, the FDA explicitly does NOT certify supplements (the way it does drugs and biologics). As its own web site says:
There are in the US alone about 4 various standards groups that certify supplements against the Good Manufacturing Process. These are Consumer Labs, mentioned above, the NSF, NPA and USP (we'll come back to these in a second). According to Wikipedia's entry on cGMP, this means,
In contrast, with GMP, the process of how a supplement is made is submitted to the certification body, assessed against the certification group's standards, and then audited in practice. The specific details of each group's auditing process are detailed on their sites, but here are the types of things they consider for certification:
USP (US Pharmacopia)
"Will break down and release into the body" is a pretty important thing, isn't it? Seems obvious, but some supplements in those ConsumerLabs.com random tests have been shown to be inert - they don't break down at all even in acid, never mind water, like ever.
NSF
Why so many certification labs? It's a business. NSF also tests tools. ConsumerLabs tests everything. USP and NPA don't. Why might a company choose one cert over another? Good question. Certifications cost money. One might also believe that the auditing practices of one group seem more amenable than another. It's worth digging into each program to see what you would find most comforting.
Natural Products? For instance, some of us like to privilege "natural" products in our supplements over synthetics. Whether there is a clear difference in terms of absorption or not can be debated, and indeed the vitamin D2 vs D3 debate is a great example of such a discussion (though vitamn D2 is from natural products that are vegetarian sourced and then irradiated rather than from squished fish and animal parts, but i digress).
For that preference, there is a GMP certification group focusing on standards for naturals. Called, naturally enough, the Natural Products Association. Their guidelines for GMP spec are quite detailed, too. They have a considerable list of companies on their listings as well, and it's great that these can be checked.
UK/EU
In the EU, the standards seem to be incredibly weak. Ya have to demonstrate that in quantity and quality, they are safe. Placebo is safe: having nothing in the supplement including what's on the label, is safe. Despite this breadth, the UK fought them: why pay money to say what you've been selling for years is safe, went the argument - at least in part. Gosh, sport, i dunno. Maybe it's NOT. That said, some folks think the legislation is protecting law makers rather than conusmers. But then what IS a consumer to do who wants to make sure what's on the label is what's in the tin?
In the UK, some companies do send their products to be tested. But that's product testing, not product process auditing. When they want to prove their goodness in terms of GMP, they can go the ISO (international standards) route and get ISO 9001:2008 accreditation.
Becuase i say so? Another company that makes natural products in the UK and claims to use Good Manufacturing Practice, for made-in-uk supplements, however, doesn't say how that claim is verified.
Another supplement shop suggests that GMP in the UK is self-regulated: it's GMP compliant if we say it is:
June 2010: Law comes back to the Supplement Wild West - sort of. Back in the states, apparently by June 2010, supplement companies will have to be compliant with minimum GMP to sell their wares (pdf of whole rule here). Hoorah. Sounds wonderful, doesn't it. Here's the irony. Remember, this law/ruling is for Dietary Supplement makers. So watch this exception:
GMP - better than a kick in the head. There's something to be said, perhaps, for companies who have taken it upon themselves to pick up the cost of quality assurance third-party certification. There can be corruption everywhere, to be sure. Inspectors paid off, etc etc, but for the most part, why bother with the certification then? There seem to be a thriving fleet of businesses making money on supplements without any breath of certification.
So, take away: the above may help explain why some products cost a *little* more than others. Certification is not the big cost, but production mechanisms, practices and oversight for compliance DO cost more.
If the result of that process is both a safe-from-contaminent and quality product such that what's on the tin is *in* the tin, then that is value for money.
If you're not sure if your favorite supplement shop is GMP certified by a third-party, why not ask them? If enough people do ask, they might up their game. They may say no, they can't afford to raise prices. Likewise, you may decide it's too great a risk of potentially wasting your money *not* to get your sups from a GMP certified source.
ps - supplements that are likely *worth* investing in, based on the best of what we know?
whey protein, creatine, b complex - the research on these guys is so long standing now and so repeated in terms of results, it's hard to argue. THough i would say pea protein and rice protein are also great alternatives - as algae oil seems to be for fish oil.
So for the few things that have been shown to add real benefit, may be worth chasing down the ones with the highest certified potency/quality/purity?
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At the recent Z-Health 9S:sustenance course, overviewed here, we talked a lot about supplements: about what ones are worth taking, yes, but also about where to source them, once you've made the decision to use them. Based on that discussion, i did some further digging. It's not a story with a happy ending. Sorta more like left who's on stage at the end of Richard III: oh goodie the exciting, poetic, smart villain is dead, while this cheating asshole is left to run the kingdom but at least no one will be fighting anymore. hoo frickin' rah.So this post presents a brief overview of legislation in the US around dietary supplements, problems with supplement quality and contamination, what good manufacturing practice (aka cGMP is) what third party certification like Consumer Labs or USP does with GMP (overivewed, anyway), a glimpse at the EU situation, and why June2010 is not the end of the War of the Roses.
History and Current Unregulated Practice. In the US, since 1994, there's been no requirement to have the Food and Drug Administration (FDA) assess either what goes into supplements or how they're made. Indeed, the FDA explicitly does NOT certify supplements (the way it does drugs and biologics). As its own web site says:
FDA does not approve dietary supplements.Why might such oversight at the level of the FDA be important? Well, our fave sup companies might not be delivering the goods. Consider this story from June this year on a consumerlabs.com test of various supplements:
Unlike new drugs, dietary supplements are not reviewed and approved by FDA based on their safety and effectiveness. Most dietary supplements that contain a new dietary ingredient (a dietary ingredient not marketed in the United States before October 15, 1994) require a notification to FDA 75 days before marketing.
The notification must include the information that was the manufacturer or distributor's basis for concluding that the dietary supplement will reasonably be expected to be safe. After dietary supplements are on the market, FDA evaluates their safety through research and adverse event monitoring.
Potency problemsIn ConsumerLab.com testing last November, four out of seven supplements contained less ginkgo than claimed on their labels, and one failed to break apart properly to release its ingredients. Seven out of nine failed in tests in 2003, as did six out of 13 in 2005."It is now believed that ginkgo is among the most adulterated herbs," the company reports.Tests by California scientists of two dozen ginseng supplements, reported in a nutrition journal in 2001, found that many differed from their labels. The concentrations of some ginseng compounds varied by up to 200-fold from product to product.In ConsumerLab.com tests, six out of nine chondroitin supplements failed testing in April 2007. One had only 8 percent of what it claimed to contain, and one "maximum strength" product had none.
Vitamins and minerals had problems, too. A "high potency" iron supplement contained less than half the amount claimed. Of 23 top-selling vitamin C pills, one provided less than half the amount promised; the suggested dosages of some others were beyond recommended safe levels. Of 10 vitamin A supplements, one provided twice its stated amount, raising concern about toxic side effects.
Ok they above sounds like a rip off: claiming to have something in it that just isn't there. But the problems don't stop there. What about putting crap into the supplement that isn't on the label and may be a banned substance or just some crap drug? This too has apparently happened:Last year, nearly 200 people were sickened by supplements containing up to 200 times the amount of selenium stated on the label. Symptoms included hair loss, discolored and painful fingernails, muscle cramps, joint pain, diarrhea and fatigue.
So what is a consumer to do?Spiking Your Shake"Random batch spiking" has a long history in the supplement business. It works like this: "The manufacturer sprinkles an illegal substance into an over-the-counter dietary supplement," says Feliciano. "The legal ingredients are claimed on the label, but they don't disclose the drug."
Chris Lockwood, formerly the senior category director of diet, energy, food, and beverage at the supplement retailer GNC and now a doctoral candidate in exercise physiology at the University of Oklahoma, recalls taking a popular protein powder in the early 1990s: "When I first took it, I got great gains. I felt great. I got strong. I got lean. But then something happened to it." Years later, he related his experiences to one of the product's formulators who confirmed for him that the powder had been spiked with Clenbuterol, an asthma drug that supercharges your metabolism.
There are in the US alone about 4 various standards groups that certify supplements against the Good Manufacturing Process. These are Consumer Labs, mentioned above, the NSF, NPA and USP (we'll come back to these in a second). According to Wikipedia's entry on cGMP, this means,
Since sampling product will statistically only ensure that the samples themselves (and perhaps the areas adjacent to where the samples were taken) are suitable for use, and end-point testing relies on sampling, GMP takes the holistic approach of regulating the manufacturing and laboratory testing environment itself. An extremely important part of GMP is documentation of every aspect of the process, activities, and operations involved with drug and medical device manufacture. If the documentation showing how the product was made and tested (which enables traceability and, in the event of future problems, recall from the market) is not correct and in order, then the product does not meet the required specification and is considered contaminated (adulterated in the US). Additionally, GMP requires that all manufacturing and testing equipment has been qualified as suitable for use, and that all operational methodologies and procedures (such as manufacturing, cleaning, and analytical testing) utilized in the drug manufacturing process have been validated (according to predetermined specifications), to demonstrate that they can perform their purported function(s).Process Check vs Spot Check. In other words how the stuff is made is checked, not just a given batch "randomly" selected to be tested by a lab. On some bulk supplement sites, they will post batch "certificates of purity" as a kind of quality control - and a person then has to take it on faith that that certificate matches up with the batch actually in the holder's control and that is then being parceled out from that batch (in another process, introducing another opportunity for contamination) into smaller tins.
In contrast, with GMP, the process of how a supplement is made is submitted to the certification body, assessed against the certification group's standards, and then audited in practice. The specific details of each group's auditing process are detailed on their sites, but here are the types of things they consider for certification:
USP (US Pharmacopia)
The USP Verified Mark helps assure consumers of a manufacturer's commitment to quality and helps them easily identify and choose a product thatA list of USP cert'd supplement companies can also be found on their web site.
- contains the ingredients listed on the label, in the declared potency and amount
- does not contain harmful levels of specified contaminants
- will break down and release into the body in a specified amount of time
- and has been made according to the FDA's Good Manufacturing Processes
"Will break down and release into the body" is a pretty important thing, isn't it? Seems obvious, but some supplements in those ConsumerLabs.com random tests have been shown to be inert - they don't break down at all even in acid, never mind water, like ever.
NSF
What does NSF certification of a dietary supplement mean to consumers?They seem to be missing that disolvability eh? But you can also check if your brand uses the NSF for their certification. Likewise if you're concerned about banned substances, NSF makes a business of certifying for this compliance, too.
NSF International was one of the first organizations to develop an independent product evaluation program to address the rapidly growing dietary supplements industry.
The purpose of our voluntary program is to test and certify dietary supplements products to
- verify the identify and quantity of dietary ingredients listed on the product label;
- ensure the product does not contain undeclared ingredients or unacceptable levels of contaminants; and
- demonstrate conformance to currently recommended industry Good Manufacturing Practices (GMPs) for dietary supplements.
Why so many certification labs? It's a business. NSF also tests tools. ConsumerLabs tests everything. USP and NPA don't. Why might a company choose one cert over another? Good question. Certifications cost money. One might also believe that the auditing practices of one group seem more amenable than another. It's worth digging into each program to see what you would find most comforting.
Natural Products? For instance, some of us like to privilege "natural" products in our supplements over synthetics. Whether there is a clear difference in terms of absorption or not can be debated, and indeed the vitamin D2 vs D3 debate is a great example of such a discussion (though vitamn D2 is from natural products that are vegetarian sourced and then irradiated rather than from squished fish and animal parts, but i digress).
For that preference, there is a GMP certification group focusing on standards for naturals. Called, naturally enough, the Natural Products Association. Their guidelines for GMP spec are quite detailed, too. They have a considerable list of companies on their listings as well, and it's great that these can be checked.
UK/EU
In the EU, the standards seem to be incredibly weak. Ya have to demonstrate that in quantity and quality, they are safe. Placebo is safe: having nothing in the supplement including what's on the label, is safe. Despite this breadth, the UK fought them: why pay money to say what you've been selling for years is safe, went the argument - at least in part. Gosh, sport, i dunno. Maybe it's NOT. That said, some folks think the legislation is protecting law makers rather than conusmers. But then what IS a consumer to do who wants to make sure what's on the label is what's in the tin?
In the UK, some companies do send their products to be tested. But that's product testing, not product process auditing. When they want to prove their goodness in terms of GMP, they can go the ISO (international standards) route and get ISO 9001:2008 accreditation.
ISO 9001:2008 specifies requirements for a quality management system where an organizationSo far, myprotein.co.uk, claims to be the sole UK supplement maker with the 9001:2000 certification, never mind the ultra recent 2008 version (it takes the better part of a year or more to get to that certified process so no wonder myprotein has just been able to announce the slightly earlier standard).
All requirements of ISO 9001:2008 are generic and are intended to be applicable to all organizations, regardless of type, size and product provided.
- needs to demonstrate its ability to consistently provide product that meets customer and applicable statutory and regulatory requirements, and
- aims to enhance customer satisfaction through the effective application of the system, including processes for continual improvement of the system and the assurance of conformity to customer and applicable statutory and regulatory requirements.
Becuase i say so? Another company that makes natural products in the UK and claims to use Good Manufacturing Practice, for made-in-uk supplements, however, doesn't say how that claim is verified.
Another supplement shop suggests that GMP in the UK is self-regulated: it's GMP compliant if we say it is:
What is GMP?I have not been able to find anything to show either that there is anything other than a shop claiming that their supplements follow GMP protocols in order to claim GMP "certified." That said, it seems like the only real EU-wide objective approach is the ISO 9001:2000/2008 certification. As in the states, there are a variety of groups set up to help organizations meet these criteria and get their practices assessed by accredited labs.
Good Manufacturing Practice (GMP) offers quality assurance; it is a set of strict pharmaceutical regulations, codes, and guidelines that ensure that food supplements are constantly manufactured and controlled to a high standard which is suitable for use. Within the UK it is only legally applicable to medicines and veterinary medicines, however, GMP is a self-regulatory code within the supplements industry which is used alongside the regulations that are set out within the Food Supplements Directive.
Simply Supplements’ purchasing team ensure that all of our supplements comply with the Food Supplements Directive and that countless products are GMP certified.
June 2010: Law comes back to the Supplement Wild West - sort of. Back in the states, apparently by June 2010, supplement companies will have to be compliant with minimum GMP to sell their wares (pdf of whole rule here). Hoorah. Sounds wonderful, doesn't it. Here's the irony. Remember, this law/ruling is for Dietary Supplement makers. So watch this exception:
The most important and obvious change is that the final rule does not apply to dietary ingredient suppliers and manufacturers. The burden of compliance with cGMPs fully lies with the dietary supplement’s manufacturer and requires dietary supplement manufacturers to test 100% of the incoming dietary ingredients.Excuse me? So this sort of means that while manufactures have to be able to say what their processes are and list that their processes follow GMP, and that will take some cost and effort, who's to say what's on paper is what they do? Who is going to police this? The FDA itself is woefully understaffed. And while it can carry out random inspections, is the cost of a fine cheaper than the cost of changing manufacturing practice?
GMP - better than a kick in the head. There's something to be said, perhaps, for companies who have taken it upon themselves to pick up the cost of quality assurance third-party certification. There can be corruption everywhere, to be sure. Inspectors paid off, etc etc, but for the most part, why bother with the certification then? There seem to be a thriving fleet of businesses making money on supplements without any breath of certification.
So, take away: the above may help explain why some products cost a *little* more than others. Certification is not the big cost, but production mechanisms, practices and oversight for compliance DO cost more.
If the result of that process is both a safe-from-contaminent and quality product such that what's on the tin is *in* the tin, then that is value for money.
If you're not sure if your favorite supplement shop is GMP certified by a third-party, why not ask them? If enough people do ask, they might up their game. They may say no, they can't afford to raise prices. Likewise, you may decide it's too great a risk of potentially wasting your money *not* to get your sups from a GMP certified source.
ps - supplements that are likely *worth* investing in, based on the best of what we know?
- fish oil or equivalent broad spec fatty acids
- vitamin d
- coq10
- protein/bcaa
- creatine
- a multi
- some e
- some magnesium
whey protein, creatine, b complex - the research on these guys is so long standing now and so repeated in terms of results, it's hard to argue. THough i would say pea protein and rice protein are also great alternatives - as algae oil seems to be for fish oil.
So for the few things that have been shown to add real benefit, may be worth chasing down the ones with the highest certified potency/quality/purity?
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Friday, July 24, 2009
Occlusion training: Sparking Muscle Growth when Injured or Just Sick of Heavy Loads
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When we hear the words "muscle hypertrophy" most of us think of body building and super duper muscle mass.
But hypertrophy itself is a natural and indeed necessary part of strength development. And it can be hard to induce hypertrophy when coming back from an injury or just when pooped of dealing with heavy weig Occlusion training (restricting venus return for very short periods) has intriguingly been associated with muscle hypertrophy. This recent review shows that its combined use with low loads can be great for rehab of ACL injuries as well as general athletic prep.
Great scott. Do you see capitol letters as shouting? this authors must be really excited about the research.
The part that is exciting is that if you can give a population a way to train their muscles and build their muscles at loads that are much lighter that what would be needed otherwise, you can imagine that the opportunities to get repair happening or growth happening could be, er, huge. Hypertrophy huge.
So let's take a quick peek at what hypertrophy is understood to be, and then at how occlusion training is generally applied.
Hypertrophy. Well, we know that if bodybuilders talk about hypertrophy they're talking about building muscle mass. But as said, anyone developing strength will get some hypertrophy happening. Why? How do we get stronger? That's complicated, but a simplified model would be: in the first instance, we are learning simply how to fire the muscles we have to do some new task, like lifting something heavy. So for someone who's never lifted, when starting a lifting program, say, they make big leaps in their strength in the first 8-12 weeks. A lot of that is neurological.
The other part of muscle building is laying down new muscle fibers to deal with trauma. When we train, we break down muscle tissue often deliberately in order to create an adaptation/growth. SO muscle literally gets pulled apart from time to time. Ironically, that is not what causes delayed onset muscle soreness (or DOMS). DOMS hits 24 - 48 hours after working out muscles (hence the delay part) and some theories are that it's the result of new muscle fibers butting up against each other and settling in - so it's the repair process rather than the damage process that is painful. Neat.
Which brings us to hypertrophy, in particular myofibrillated hypertrophy, which is the laying down of new actual muscle fibers or myofibrils. These are tiny fibers and not where the body builders' bulk comes from. That's generally sarcoplasmic - also important to protect the myofibrils and usually goes hand in hand with myofibrillated hypertrophy. We'll come back to that another time. Suffice it to say, what kind of growth is where sets, reps and REOCVERY come into play in terms of this balance and which kind of hypertrophy a program is privileging.
So let's say we're looking at getting the muscles around a knee injury built back up. The person is at a place where they can body squat, maybe do some light weight work, but (a) it may not be desireable for the person to do TONS of reps, but unless they do tons of reps with a light weight, desired hypertrophy - new muscle tissue growth - is not going to happen. Enter this really cool aspect of hypertrophy training, Occlusion training.
Likewise, OT *may* be useful to give athletes a break from high load work. Note, this does not mean do OT during a back off weak: the whole point of a back off weak is to let the body recover, not push it to adapt further.
Occlusion Training. Occlusion is a beautiful sounding word, isn't it? It's usually seen in visual contexts - to occlude something is to block it from view. If you put your mother's picture in front of that ugly stone someone gave you from their holiday in Crete, you have occluded the view of the offensive object that your loved ones won't let you chuck.
In occlusion training, we're talking about another kind of block. In this case, blocking the flow of blood - a bit, and for intervals. So what? How can that be good?
Well, an idea is, restricting blood flow causes fast twitch fibers to get involved in the process sooner than they otherwise would. Likewise a biggie in the effect is the production of blood by-products, and ones that trigger significant increases in GH. (i have visions now of Mike Mahler tying up his quads while doing lightweight kettlebell swings).
Caveats of Application. SO when we talk about restricting blood flow, what are we really talking about? IF we cut it off, don't our limbs drop off? Well, yes. So here, we're talking about restriction as opposed to total constriction, and also for particular intervals. And for light loads.
Ok what does that mean in practice? There are a variety of approaches described in the article that involve walking and the effects on strength. Pretty cool stuff. The authors, however, offer a sample protocol for strength:
from the article: note binding for knee work is at the top of the thigh - the proximal end of the vastus
The above is not encouragement to go try tying off your friend's legs and asking them to jump around :) As the authors state about future work:
Loenneke, J., & Pujol, T. (2009). The Use of Occlusion Training to Produce Muscle Hypertrophy Strength and Conditioning Journal, 31 (3), 77-84 DOI: 10.1519/SSC.0b013e3181a5a352 Tweet Follow @begin2dig
When we hear the words "muscle hypertrophy" most of us think of body building and super duper muscle mass.But hypertrophy itself is a natural and indeed necessary part of strength development. And it can be hard to induce hypertrophy when coming back from an injury or just when pooped of dealing with heavy weig Occlusion training (restricting venus return for very short periods) has intriguingly been associated with muscle hypertrophy. This recent review shows that its combined use with low loads can be great for rehab of ACL injuries as well as general athletic prep.
The Use of Occlusion Training to Produce Muscle Hypertrophy
Loenneke, Jeremy Paul BS; Pujol, Thomas Joseph EdD, CSCS
Strength and Conditioning Journal:
June 2009 - Volume 31 - Issue 3 - pp 77-84
doi: 10.1519/SSC.0b013e3181a5a352
Articles
LOW-INTENSITY OCCLUSION (50-100 MM HG) TRAINING PROVIDES A UNIQUE BENEFICIAL TRAINING MODE FOR PROMOTING MUSCLE HYPERTROPHY. TRAINING AT INTENSITIES AS LOW AS 20% 1 REPETITION MAXIMUM WITH MODERATE VASCULAR OCCLUSION RESULTS IN MUSCLE HYPERTROPHY IN AS LITTLE AS 3 WEEKS. A TYPICAL EXERCISE PRESCRIPTION CALLS FOR 3 TO 5 SETS TO VOLITIONAL FATIGUE WITH SHORT REST PERIODS. THE METABOLIC BUILDUP CAUSES POSITIVE PHYSIOLOGIC REACTIONS, SPECIFICALLY A RISE IN GROWTH HORMONE THAT IS HIGHER THAN LEVELS FOUND WITH HIGHER INTENSITIES. OCCLUSION TRAINING IS APPLICABLE FOR THOSE WHO ARE UNABLE TO SUSTAIN HIGH LOADS DUE TO JOINT PAIN, POSTOPERATIVE PATIENTS, CARDIAC REHABILITATION, ATHLETES WHO ARE UNLOADING, AND ASTRONAUTS.
Great scott. Do you see capitol letters as shouting? this authors must be really excited about the research.
The part that is exciting is that if you can give a population a way to train their muscles and build their muscles at loads that are much lighter that what would be needed otherwise, you can imagine that the opportunities to get repair happening or growth happening could be, er, huge. Hypertrophy huge.
So let's take a quick peek at what hypertrophy is understood to be, and then at how occlusion training is generally applied.
Hypertrophy. Well, we know that if bodybuilders talk about hypertrophy they're talking about building muscle mass. But as said, anyone developing strength will get some hypertrophy happening. Why? How do we get stronger? That's complicated, but a simplified model would be: in the first instance, we are learning simply how to fire the muscles we have to do some new task, like lifting something heavy. So for someone who's never lifted, when starting a lifting program, say, they make big leaps in their strength in the first 8-12 weeks. A lot of that is neurological.
The other part of muscle building is laying down new muscle fibers to deal with trauma. When we train, we break down muscle tissue often deliberately in order to create an adaptation/growth. SO muscle literally gets pulled apart from time to time. Ironically, that is not what causes delayed onset muscle soreness (or DOMS). DOMS hits 24 - 48 hours after working out muscles (hence the delay part) and some theories are that it's the result of new muscle fibers butting up against each other and settling in - so it's the repair process rather than the damage process that is painful. Neat.
Which brings us to hypertrophy, in particular myofibrillated hypertrophy, which is the laying down of new actual muscle fibers or myofibrils. These are tiny fibers and not where the body builders' bulk comes from. That's generally sarcoplasmic - also important to protect the myofibrils and usually goes hand in hand with myofibrillated hypertrophy. We'll come back to that another time. Suffice it to say, what kind of growth is where sets, reps and REOCVERY come into play in terms of this balance and which kind of hypertrophy a program is privileging.So let's say we're looking at getting the muscles around a knee injury built back up. The person is at a place where they can body squat, maybe do some light weight work, but (a) it may not be desireable for the person to do TONS of reps, but unless they do tons of reps with a light weight, desired hypertrophy - new muscle tissue growth - is not going to happen. Enter this really cool aspect of hypertrophy training, Occlusion training.
Likewise, OT *may* be useful to give athletes a break from high load work. Note, this does not mean do OT during a back off weak: the whole point of a back off weak is to let the body recover, not push it to adapt further.
Occlusion Training. Occlusion is a beautiful sounding word, isn't it? It's usually seen in visual contexts - to occlude something is to block it from view. If you put your mother's picture in front of that ugly stone someone gave you from their holiday in Crete, you have occluded the view of the offensive object that your loved ones won't let you chuck.
In occlusion training, we're talking about another kind of block. In this case, blocking the flow of blood - a bit, and for intervals. So what? How can that be good?
Well, an idea is, restricting blood flow causes fast twitch fibers to get involved in the process sooner than they otherwise would. Likewise a biggie in the effect is the production of blood by-products, and ones that trigger significant increases in GH. (i have visions now of Mike Mahler tying up his quads while doing lightweight kettlebell swings).
Caveats of Application. SO when we talk about restricting blood flow, what are we really talking about? IF we cut it off, don't our limbs drop off? Well, yes. So here, we're talking about restriction as opposed to total constriction, and also for particular intervals. And for light loads.
Ok what does that mean in practice? There are a variety of approaches described in the article that involve walking and the effects on strength. Pretty cool stuff. The authors, however, offer a sample protocol for strength:
A typical low-intensity prescription would involve an intensity of 20-50% of 1RM with a 2-second cadence for both the concentric and eccentric actions. The 1RM is calculated from the maximum amount of weight you can lift once under normal blood flow conditions. Three to five sets of each exercise are completed to volitional fatigue. This is done to ensure that there is a high metabolic buildup. The rest periods are 30 seconds to 1 minute in length and occur between every set, with the occlusion still being applied (5,6,27,35,36,39). At the conclusion of the last set, blood flow is restored to the muscle.Again, the important take away here is LIGHT loads for a few sets. Likewise the PROXIMAL end of the targetted muscle is what gets bound, as shown in the image below.
Cook et al. (6) compared different protocols of occlusion using percent maximal voluntary contraction (%MVC) and found that 20% MVC with continuous partial occlusion was the only protocol that elicited significantly more fatigue than the higher intensity protocol.
from the article: note binding for knee work is at the top of the thigh - the proximal end of the vastusThe above is not encouragement to go try tying off your friend's legs and asking them to jump around :) As the authors state about future work:
Future research on occlusion training should focus on studying the health risks associated with long-term use and determine populations in which this type of training may be contraindicated (6). Although the research has yet to define populations in which occlusion training is dangerous, we postulate that those with endothelial dysfunction should not use occlusion training because of the reduction in blood flow. Research should also further study the microdamage to blood vessels and subtle changes in blood flow, both of which may stimulate thrombosis (38). Also, one should seek to evaluate the gene expression at later stages of postexercise recovery after occlusion and in response to occlusion training (7). Finally, studies should begin to focus on the local regulators of muscular growth, such as growth factors and reactive oxygen species, to elucidate the mechanism for the present cooperative effects of exercise and occlusive stimuli (39).Take away: if you're looking to build up strength especially after an injury, short term use of occlusion training may be a good way to get back in the game. Likewise, if you're getting fatigued by heavy lifting or jus the thought of having to pick up a really heavy bar to make a difference is getting you down, doing some short term occulsion sets because of their effective LOW reps and LIGHT weight, may be just the thing to keep you training and provide the mental break necessary to get back at it.
Loenneke, J., & Pujol, T. (2009). The Use of Occlusion Training to Produce Muscle Hypertrophy Strength and Conditioning Journal, 31 (3), 77-84 DOI: 10.1519/SSC.0b013e3181a5a352 Tweet Follow @begin2dig
Thursday, July 23, 2009
Smart SMALL Dosing of Caffeine can be Super Performance Booster
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There is a FABULOUS survey article on caffeine use in sports performance from May 2009. Big Take away: caffeine, yes, does have a performance enhancement effect on a whole lot of stuff BUT there are also down sides. BUT BUT it seems that dose and timing have an effect PLUS small doses are JUST AS effective as larger ones. isn't that frickin' cool?
Sökmen, Bülent; Armstrong, Lawrence E; Kraemer, William J; Casa, Douglas J; Dias, Joao C; Judelson, Daniel A; Maresh, Carl M
Now the big contribution of this article for practical applications in coaching is that it looks at a bunch of effects that need to be considered to build an appropriate "dosing strategy"
Power/Speed Very Fast. The article begins its consideration by looking at caffeine's effects on power. Main hit: peak power in 6 secs of the wingate test. So benefit to phosphagen system dominant activities. Caffeien also seems to lower pain perception. hmm. IF you've ever done a wingate test that could be a Good Thing. Not so clear (yet) there's any big boost to glycolytic-heavy events.
Cognitive Function and Skill. Intriguingly in sports like Tennis, the paper shows, hitting accuracy has gone up. Now is that because of its mental altertness effects? or the CA++ happening? The authors really emphasize that caffeine use has to be thought of not as a single factor effect, but look at the range of ways it acts on physiologic as well as cognitive function. And habituation. A biggie on figuring out dosing is how habituated to it a person already is.
Withdrawl. Likewise, the inverse of being on caffeine is going off it. So if there's a desire to increase the effectiveness by getting off it for awhile before a competition, then the authors recommend being sure to do so at least a week before, since reactions to withdrawl are individual but generally peak 24-48 hours after stopping. From personal experience, these can be harsh. The authors actually suggest tapering off rather than cold turkey to reduce training impact.
The key thing in the study is not being a big caffeine head already so that one is not tolerant of it.
Dosing. And what do we mean by caffeine head? Apparently not necessarily a coffee drinker. Coffee it seems can actually blunt the effects of caffeine, so for performance, we're talking capsules.
THen the question is how much and when? low level doses during the day (75mg) improved cognitive function over the day. Costs? sleep gets screwed up, which has its own negative effects on other aspects of performance. SO how use the fact that caffeine effects peak about 75mins post ingestion and are cleared from the body in about 6-7 hours post ingestion?
Again, super cool that a dose as small as 5mg (that's it; just 5mg) can have a huge effect on someone not habituated to caffeine. And that in men, 10mg (and that's it) significantly reduced the experience of leg pain in a cycling experiment. What about the habituated? The authors say that recent work has shown that there's no bigger ergogenic effect in taking anything greater than 9 mg·kg.
SO considering that the usually size of a caffeine pill is 200mg, are we perhaps overdosing?? The authors might say "that depends." What's your dosing strategy??
HYDRATION AND CAFFEINE. And did you know, the authors point out, that it's a big misconception that caffeine leads to dehydration. As to the popular use of blending caffeine with everything else? dunno - yet "The effects of ingesting caffeine with a carbohydrate solution, with an amino acid solution, and during creatine loading require further study."
Bottom line: caffeine use can be great for certain types of sports performance stuff; low dosing with as little as 5-10 mg (that's nothing - but it's super something) can be hugely significant.Key thing: figuring out a dosing strategy is "multi-factorial" - it's not well i gotta run all day tomorrow so i'll amp up caffeine in the morning with my double espresso." Dam.
DOSING STRATEGY: small. The above is a great example of what makes a survey article super: it's able to look at a wealth of data on a topic over years and see where the consensus lies, if there's consensus. Here, it's pretty clearly, happily, less is more, and can be a whole lot of more, when dosed smart.
Citation:
There is a FABULOUS survey article on caffeine use in sports performance from May 2009. Big Take away: caffeine, yes, does have a performance enhancement effect on a whole lot of stuff BUT there are also down sides. BUT BUT it seems that dose and timing have an effect PLUS small doses are JUST AS effective as larger ones. isn't that frickin' cool?
Journal of Strength and Conditioning Research:
May 2008 - Volume 22 - Issue 3 - pp 978-986
doi: 10.1519/JSC.0b013e3181660cec
Caffeine Use in Sports: Considerations for the AthleteSökmen, Bülent; Armstrong, Lawrence E; Kraemer, William J; Casa, Douglas J; Dias, Joao C; Judelson, Daniel A; Maresh, Carl M
Cool. What the study suggests is that well hmm, all the use of taurine or (my fave) tyrosine to boost hard workouts etc may be set aside for a low dose snort for a few days leading up to that "intense training."Abstract
The ergogenic effects of caffeine on athletic performance have been shown in many studies, and its broad range of metabolic, hormonal, and physiologic effects has been recorded, as this review of the literature shows. However, few caffeine studies have been published to include cognitive and physiologic considerations for the athlete. The following practical recommendations consider the global effects of caffeine on the body: Lower doses can be as effective as higher doses during exercise performance without any negative coincidence; after a period of cessation, restarting caffeine intake at a low amount before performance can provide the same ergogenic effects as acute intake; caffeine can be taken gradually at low doses to avoid tolerance during the course of 3 or 4 days, just before intense training to sustain exercise intensity; and caffeine can improve cognitive aspects of performance, such as concentration, when an athlete has not slept well. Athletes and coaches also must consider how a person's body size, age, gender, previous use, level of tolerance, and the dose itself all influence the ergogenic effects of caffeine on sports performance.
Now the big contribution of this article for practical applications in coaching is that it looks at a bunch of effects that need to be considered to build an appropriate "dosing strategy"
Power/Speed Very Fast. The article begins its consideration by looking at caffeine's effects on power. Main hit: peak power in 6 secs of the wingate test. So benefit to phosphagen system dominant activities. Caffeien also seems to lower pain perception. hmm. IF you've ever done a wingate test that could be a Good Thing. Not so clear (yet) there's any big boost to glycolytic-heavy events.
Cognitive Function and Skill. Intriguingly in sports like Tennis, the paper shows, hitting accuracy has gone up. Now is that because of its mental altertness effects? or the CA++ happening? The authors really emphasize that caffeine use has to be thought of not as a single factor effect, but look at the range of ways it acts on physiologic as well as cognitive function. And habituation. A biggie on figuring out dosing is how habituated to it a person already is.
Withdrawl. Likewise, the inverse of being on caffeine is going off it. So if there's a desire to increase the effectiveness by getting off it for awhile before a competition, then the authors recommend being sure to do so at least a week before, since reactions to withdrawl are individual but generally peak 24-48 hours after stopping. From personal experience, these can be harsh. The authors actually suggest tapering off rather than cold turkey to reduce training impact.
The key thing in the study is not being a big caffeine head already so that one is not tolerant of it.
Dosing. And what do we mean by caffeine head? Apparently not necessarily a coffee drinker. Coffee it seems can actually blunt the effects of caffeine, so for performance, we're talking capsules.
THen the question is how much and when? low level doses during the day (75mg) improved cognitive function over the day. Costs? sleep gets screwed up, which has its own negative effects on other aspects of performance. SO how use the fact that caffeine effects peak about 75mins post ingestion and are cleared from the body in about 6-7 hours post ingestion?
Again, super cool that a dose as small as 5mg (that's it; just 5mg) can have a huge effect on someone not habituated to caffeine. And that in men, 10mg (and that's it) significantly reduced the experience of leg pain in a cycling experiment. What about the habituated? The authors say that recent work has shown that there's no bigger ergogenic effect in taking anything greater than 9 mg·kg.SO considering that the usually size of a caffeine pill is 200mg, are we perhaps overdosing?? The authors might say "that depends." What's your dosing strategy??
HYDRATION AND CAFFEINE. And did you know, the authors point out, that it's a big misconception that caffeine leads to dehydration. As to the popular use of blending caffeine with everything else? dunno - yet "The effects of ingesting caffeine with a carbohydrate solution, with an amino acid solution, and during creatine loading require further study."
Bottom line: caffeine use can be great for certain types of sports performance stuff; low dosing with as little as 5-10 mg (that's nothing - but it's super something) can be hugely significant.Key thing: figuring out a dosing strategy is "multi-factorial" - it's not well i gotta run all day tomorrow so i'll amp up caffeine in the morning with my double espresso." Dam.
DOSING STRATEGY: small. The above is a great example of what makes a survey article super: it's able to look at a wealth of data on a topic over years and see where the consensus lies, if there's consensus. Here, it's pretty clearly, happily, less is more, and can be a whole lot of more, when dosed smart.
Citation:
Sökmen B, Armstrong LE, Kraemer WJ, Casa DJ, Dias JC, Judelson DA, & Maresh CM (2008). Caffeine use in sports: considerations for the athlete. Journal of strength and conditioning research / National Strength & Conditioning Association, 22 (3), 978-86 PMID: 18438212Tweet Follow @begin2dig
Do Running Shoe Types Reduce Injury? How about No. But what about No Sneakers?
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Ok, in a sort of inverse correlation here as to one more reasons why running shoes suck, and that freeing your feet is a Good Idea - and that thin soled shoes like vibram five fingers may be much better for improving your resistance to injury, this relatively just in.
A new prospective study shows that when a running shoe store recommends a specific type of trainer for you, based on your foot type (you may stand on a type of light box or do a "wet test" for foot print, to be told based on your arch the kind of shoe you need), that is supposed to be more helpful to your stride etc etc, injury levels do not seem to be decreased.
What was found to influence injury? Suprise surprise: general fitness.
Indeed, what this study did not look at, intriguingly, is what would happen if INSTEAD of using sneakers of any kind, thin soled shoes like tiger Tai Chi's or similar were used. In other words, all other things being equal, would the promises of proprioceptive joy offered by the less is more approach to foot wear, where the twist test of a shoe means more joint mobilization in the foot, more proprioceptive signals shot out to the brain to judge where we are in space, could actually improve injury reduction? My *guess* would be, based on folks's reports of feeling better in less foot wear, that going the other way - out of cushy soles of any kind - just might.
Related Posts
A new prospective study shows that when a running shoe store recommends a specific type of trainer for you, based on your foot type (you may stand on a type of light box or do a "wet test" for foot print, to be told based on your arch the kind of shoe you need), that is supposed to be more helpful to your stride etc etc, injury levels do not seem to be decreased.
The cool thing in the study is that it had a high no. of participants and a goodly fix of stats and it was able to look at stats for a standard set of tasks, Basic Combat Training (BCT).Journal of Strength and Conditioning Research:May 2009 - Volume 23 - Issue 3 - pp 685-697doi: 10.1519/JSC.0b013e3181a0fc63Original ResearchInjury Reduction Effectiveness of Selecting Running Shoes Based on Plantar Shape
Knapik, Joseph J; Swedler, David I; Grier, Tyson L; Hauret, Keith G; Bullock, Steven H; Williams, Kelly W; Darakjy, Salima S; Lester, Mark E; Tobler, Steven K; Jones, Bruce H
Abstract
Knapik, JJ, Swedler, DI, Grier, TL, Hauret, KG, Bullock, SH, Williams, KW, Darakjy, SS, Lester, ME, Tobler, SK, and Jones, BH. Injury reduction effectiveness of selecting running shoes based on plantar shape. J Strength Cond Res 23(3): 685-697, 2009-Popular running magazines and running shoe companies suggest that imprints of the bottom of the feet (plantar shape) can be used as an indication of the height of the medial longitudinal foot arch and that this can be used to select individually appropriate types of running shoes. This study examined whether or not this selection technique influenced injury risk during United States Army Basic Combat Training (BCT). After foot examinations, BCT recruits in an experimental group (E: n = 1,079 men and 451 women) selected motion control, stability, or cushioned shoes for plantar shapes judged to represent low, medium, or high foot arches, respectively. A control group (C: n = 1,068 men and 464 women) received a stability shoe regardless of plantar shape. Injuries during BCT were determined from outpatient medical records. Other previously known injury risk factors (e.g., age, fitness, and smoking) were obtained from a questionnaire and existing databases. Multivariate Cox regression controlling for other injury risk factors showed little difference in injury risk between the E and C groups among men (risk ratio (E/C) = 1.01; 95% confidence interval = 0.88-1.16; p = 0.87) or women (risk ratio (E/C) = 1.07; 95% confidence interval = 0.91-1.25; p = 0.44). In practical application, this prospective study demonstrated that selecting shoes based on plantar shape had little influence on injury risk in BCT. Thus, if the goal is injury prevention, this selection technique is not necessary in BCT.
What was found to influence injury? Suprise surprise: general fitness.
The present study found a number of risk factors thatSo next time a buddy says they're getting a particular kind of "stabilization" shoe to help so they don't ankle roll or whatever, they may want to consider these results.
confirmed previous work in BCT. Higher injury risk pro-
gressively increased with progressively lower aerobic fitness,
lower muscular endurance, older age, less physical activity,
and more cigarette smoking, similar to results in much of the
BCT literature (1,9,14,16,22,28,29,37,41,43).
Indeed, what this study did not look at, intriguingly, is what would happen if INSTEAD of using sneakers of any kind, thin soled shoes like tiger Tai Chi's or similar were used. In other words, all other things being equal, would the promises of proprioceptive joy offered by the less is more approach to foot wear, where the twist test of a shoe means more joint mobilization in the foot, more proprioceptive signals shot out to the brain to judge where we are in space, could actually improve injury reduction? My *guess* would be, based on folks's reports of feeling better in less foot wear, that going the other way - out of cushy soles of any kind - just might.
Related Posts
- VFF b2d index - the many wonderful effects of foot freedom
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