Tuesday, June 16, 2009

Do any of us know what we're talking about?

First, a link to a recent Gina Kolata article on "bad advice" from sport health professionals. The problem is more insidious than bad advice. It's that the empirical evidence behind the efficacy of most everything in sport performance, health, injury, and recovery is, at best, weaker than than a 30c homoepathic dilution*. I was searching the letsrun.com forum the other day to read people's experiences with piriformis pain. I wasn't looking for solutions, I just wanted to know if people had run through the injury successfully. But reading people's solutions to the injury was a microcosm of the problem outlined in Kolata's article.

• Do these stretches (link to stretches) because the muscle needs to be loose and flexible to recovery and remain healthy. Definitely don't do strength exercises becaus tight, inflexible muscles are what's causing the pain in the first place
• Do these strength exercises (link to strength exercises). You need a strong core to allow the weakened muscle to recover and reduce future injury. Definitely do not stretch it because you will tear scar tissue in the weakened muscle.

More generally, there is a huge industry of health care professionals and gadget makers throwing advice at us on how to reduce the probability of injury. Stretch! Orthotics! Core Strength! Pose (or Chi) running! Barefoot! Nike Free! Medial Posting! 300-500 Miles! Compression Shorts! The list is endless.

Let me compare the sports medical advice with something like the advice to take vaccines. The flu vaccine has an efficacy of 50-75%. The polio vaccine has reduced the rate of polio cases from >100,000 year to ~1000/year. The smallpox vaccine has reduced smallpox from >50,000,000/year to ZERO.

So my question to M.D.s, chiropractors, yoga gurus, podiatrists, sport shoe companies, physical therapists, and CW-X, is, if your advice reduces running injuries, how come we're not seeing fewer injured runners?**

Finally, Kolata's article goes well with my post yesterday. Too few of us really challenge our own beliefs with hard data.

*a 30C dilution is a solution that has been diluted 1/100, thirty times. The probability that a single molecule of the solute remains in the water is fantastically small. Now that is a weak solution!

*There is good evidence that running less reduces the rate of injuries.

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