Tuesday, January 15, 2013

Benno Nigg PhD: Biomechanics Guru Saying Farewell At Calgary International Running Symposium

The following is an interview I did with Benno Nigg, Phd published in Podiatry Management last year. He will be delivering the keynote lecture at the Calgary International Running Symposium Seminar August 14. http://www.calgaryrunningsymposium2014.com/ Much is written about biomechanics. The breadth information is overwhelming and only some of it is relevant. Many conclusions presented are based on trying to sell a shoe, a book or an opportunity to be in the spotlight. Podiatry can claim partial success in staying current with the literature and leading new research. It is important to have an open mind regarding what is scientific fact in our practices and what is podiatric folklore. Another field that has undergone an overhaul moving from conventional wisdom to applicable science is baseball. Players were rated by scouts on the basis of their looks i.e. solid chin and archaic metrics. Then a former aeronautic engineer named Eric Walker, decided to write a pamphlet that bucked against the conventional wisdom. The pamplet was implemented by the Oakland A's and is the subject of the book and movie "Moneyball". He decided to review how winning teams and was based on statistical criteria that had more relevance to a player and teams success. One example: when baseball was first played players had no baseball gloves and so fielding errors measured as a statistic were an important part of the game. Now errors can actually penalize a gifted player that was fast enough to run to make a play or smart enough to be in the right spot to make a play. The statistic is less relevant to the modern game and this is how we should be viewing what we are applying in our practices. It turns out that in baseball an on base percentage is a more telling statistic of a player's intrinsic value to a team than anything else. In peeling another layer of the onion, a team's aggregate on base percentage was more indicative of success than whether one or two dominant players. Some variables are important but one must look at how the data is applied. As an example, scouts look at foot speed which is based on a timed straight run but that does not always translate precisely to running the bases for example rounding first for a double and the slide into second. In talking with Benno Nigg, Phd, this same philosophy becomes evident. He has been on the investigative side as a hired consultant for shoe companies before he has largely turned his focus to pure research. He is very careful not to draw conclusions that are inferences when he reviews studies. As an example when I asked him recently about a study that Dan Lieberman did on heel vs forefoot injury patterns in shod cross country runners he pointed out that you cannot compare this to barefoot running. He also pointed out that the subjects were cross country runners which does not translate exactly to everyday runners. The following is an interview I conducted with him: If you think the science of biomechanics is static, best to think again according to Benno Nigg and his recent book "Biomechanics of Running shoes: The Disturbing truth about Running shoes, Inserts and Foot Orthotics" Why should a podiatrist buy your book, "Biomechanics of Running shoes, The disturbing truth about Running shoes ,Inserts and Foot Orthotics " Podiatrists that are interested in the actual functioning of the lower extremity and in the reasons for specific intervention may get some help when reading this book.. What do you think the role of podiatry should be with runner's given your view on orthotics? Orthotics can play a major roll in terms of initial recovery from injury. In my view the podiatrist's strategy should be to combine initial orthotic use with recommending strengthening exercises for the small muscles crossing the ankle joint. I also see a role for orthotic in clear structural issues such as an anatomic leg length discrepancy. How have you maintained your objectivity when hired as a consultant for a manufacturer? My primary goal is to help customers understanding their product or intervention. Additionally, I have a standard clause in my contracts that I can publish the results of such studies within 18 months. One particular company I was working with on sport surfaces stopped our consulting relationship after the results did not support their initial claims, however, we went on to publish the results. It is interesting to realize that some companies are interested in more basic science projects, testing models that do not have an immediate financial return but increase the general understanding of a product. What major study or studies caused you to change your views about shoes? There are different aspects where we changed our view substantially. Typically, we had results from a series of studies that did not support our initial speculations. For instance: (1) Impact forces: Initially we thought that impact forces are dangerous and that we have to change shoes and orthotics to reduce external impact forces. A series of studies showed that (a) epidemiologically, impact forces are not a good predictor of running injuries and (b) external impact force peaks are not sensitive to the hardness of the shoe. (2) Excessive pronation: Again, we thought initially that “excessive pronation” would be dangerous and that we should change the shoes to reduce pronation. Again, a series of studies showed that (a) pronation is not a good predictor of injuries. How do you reconcile observation on increased injuries noted such as tendonitis and stress fractures with vibram 5 finger shoes but having no hard evidence to support the observation? How do you think the average clinician should assimilate this? I don’t know how the average clinician should react, except that he/she should functionally analyze every single case and provide functional interventions. Scientific studies should be initiated to assess the actual epidemiology of all these new “footwear solutions” and assess the actual effects of these interventions with respect to epidemiology and biomechanics. What do you see in the future will for running shoes? The future running shoes will have more functional characteristics, they will be lighter and less bulky and some shoes will have sensors to help improving the “ride”. What role do you see for core stability and fatigue in causing injuries and what research do you think substantiates this. There are two major strength centers in the body that are currently associated with injury and reduction of injuries, the core strength and the strength of the muscles around the ankle joint complex. There is initial evidence that both strategies (strengthening these muscles) have a positive effect on reducing injuries. However, the results are initial and need more work. Intuitively, the two concepts seem sound. What should the podiatry schools be emphasizing in the biomechanics classes? I think that major emphasis should be on functional biomechanics and functional solutions. Often, podiatrists want to solve every problem with an orthotic . If the problem is in the Achilles tendon the emphasis for finding a solution should be on reviewing the mechanics of the Achilles tendon. Do you believe that studies will be able to isolate the many variables of runners, running shoes and injuries? Yes, we have developed methods that allow identifying all important variables for running and running injuries. Ben Pearl, DPM References Lewis, Michael ,Moneyball W.W.Norton & Company 2003 Nigg, Benno Phd interview 2012

No comments: