Posts tagged: injury

Concussion testing in roller derby

My latest print article is out. Read about concussion testing in roller derby (part 1 of 2) in Issue 10 of Fiveonfive Magazine. For this piece I talked to several people in our league’s safety committee, our main EMT, and two concussion experts based at UPMC.

Earlier this year I knew next-to-nothing about concussions and had never heard of concussion testing. Bottom line: a concussion is a nearly invisible brain injury that can cause trouble down the line if you get another one before the first is fully healed.

Coaches and players in many sports, famously including the NFL, are beginning to take concussion recovery seriously. Tests can help tell if an injured athlete’s brain function is truly back to normal so they can safely return to play. My league, Steel City, is possibly the first roller derby league to formally address this issue.

Expert advice on running shoes may be worse than no advice at all

My Running ShoesIf you want to take up running, you’re supposed to choose a running shoe based on your foot type. If you have low arches, you are an “overpronator” and a good running store will send you home with a motion-control shoe that keeps your foot from rolling toward the inside with each step. If you are a “supinator” with high arches, you’ll get a shoe with lots of cushioning instead. The average non-specialized running shoe is reserved for those with a supposedly neutral gait.

That may be a mistake, say a couple of new studies on injury rates. One found that assigning shoes by foot type didn’t reduce injuries; the other found that specialized shoes, especially the motion-control ones, increased injury rates.

This caught my eye because I’ve been told I’m an overpronator and need motion-control shoes, yet I always had more pain and problems running in them than in flexible shoes like the Nike Free. Once I figured that out, I swore off any shoe with a rigid sole, which includes most running shoes. Motion-control shoes have the stiffest soles of all. According to the nytimes article,

across the board, motion-control shoes were the most injurious for the runners. Many overpronators, who, in theory, should have benefited from motion-control shoes, complained of pain and missed training days after wearing them, as did a number of the runners with normal feet and every single underpronating runner assigned to the motion-control shoes.

Biomechanical studies show that motion-control shoes really do control the motion of your foot, but the author of the Army studies points out that we don’t know whether that motion – the over- or under-pronation – is actually a problem. Barefoot running enthusiasts say that injuries attributed to over- or under-pronation are caused by footwear itself. “Pronation is a natural thing,” says one barefoot runner. “Be happy that it occurs, cause it’s one of our body’s little advantages.”

Can a mouthguard make you faster? Will it at least protect your teeth?

mouthguard comparison

A boil-and-bite mouthguard (top) and a custom molded mouthguard (bottom). Those are my own simulated teeth in the photo!

Mouthguards. Can’t talk with ‘em, not allowed on the track without ‘em. At least that’s how it is in my sport, roller derby. A surprising number of professional contact sports don’t require mouthguards, but these simple gadgets seem to have a lot going for them. They don’t just protect your teeth – their makers say they can prevent concussions, and even give you better cardiovascular endurance. What’s behind these claims?

Do they at least protect your teeth?

When the CDC considered making a recommendation for mouthguards to prevent dental injuries, they concluded there is not enough evidence to issue such a guideline. The American Dental Association, meanwhile, did their own survey of the evidence and came out recommending custom-fitted mouthguards for most sports, contact or otherwise. One study found that half of all football injuries were to the mouth before mouthguards were commonly worn, and only 1% afterwards. A study on NCAA college basketball did find reduced dental injury among players who wore mouthguards.

Really, how can the ADA not push for mouthguards? Their own paper includes a section called “Mouthguard Advocacy” and mentions that they’ve been promoting “properly fitted mouthguards” for over 50 years. The best, they say, are the kind custom-made by a dentist at $200 a pop. The ADA even recommends that you enlist a dentist’s help when you mold your $5 store-bought mouthguard.

Custom mouthguards definitely fit better than the boil-and-bite style, which is a big advantage if they work at all, since you won’t be popping it out of place and chewing on it during games. My own custom-fit guard sticks to my teeth so well I don’t need to take it out to talk to my teammates, or even for water breaks. (The technical name for that feature is “retention”.)

The dentists can hardly be impartial when custom guards are part of their business, but their approach seems to be a common-sense one: wear a mouthguard and maybe it will help.

What about concussions?

Athletes (not to mention our coaches and dentists) are working without enough information. There is no consensus on the optimal thickness of a mouthguard, no clear comparisons of the different types, and no really good large studies on whether mouthguards work at all, to protect our teeth or our brains. A review in the British Medical Journal asks the question Do mouthguards prevent concussion? and finds that all the promising-looking studies are done either by surveying a small number of athletes – too small, say the authors – or simulating impact with skull models. That review concludes that the concussion-preventing aspect of mouthguards is “a myth.”

Jaw-dropping performance?

One curiosity remains – can a mouthguard improve your sports performance by changing how you breathe? a 1991 study with just 17 subjects found that mouthguard users needed less air than non-mouthguard users when they were working hard. These weren’t expensive pieces of equipment, but over-the-counter types that aren’t even molded to the teeth. The authors think the effect is similar to pursed-lip breathing, so you could always try that instead.

Two new types of mouthguards claim to improve performance a different way, by holding the jaw in a relaxed position. Makkar does this with sci-fi looking machinery; UnderArmour skips the face electrodes but puts wedges on the molars of the guard so, they explain, you  don’t clench your teeth. The idea is that when you do, cortisol levels increase in your bloodstream. This dentist explains cortisol as a “solution” [sic] that “makes you weaker, slower, and [gives you] tunnel vision.” The science is still out on this idea. Both of these guards need to be custom-molded by a dentist and cost $500 or more. Want a cheaper fix? Sticking your tongue out helps you relax your jaw too.

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