October 2009

Out on a limb: Ahead of the curve

Jordana Second Headshot LERIt isn’t often discussed in the medical literature or in scientific sessions, nor is it mentioned in this month’s cover story on bracing and athletic performance. But the extent to which an athlete can benefit from orthotic management depends at least in part on his or her skill level.

Skateboading is a case in point, according to E.C. “Ned” Frederick, PhD, editor of the new journal Footwear Science and one of the few people who has actually quantified the biomechanics of skateboarding. At the Prescription Foot Orthotic Laboratory Association’s annual conference on foot biomechanics and orthotic therapy in October, Frederick explained that one of the most important skateboarding terms for a lower extremity practitioner is “bail out,” which refers to an aborted attempt at completing a trick.

Bailing out typically results in a skateboarder landing on his or her feet rather than on the board. Because a skateboard is designed to absorb shock, this type of failure can be as tough on the lower extremity bones and joints as on the athlete’s ego. Skateboarders in the steepest part of a skill’s learning curve are those most likely to be bailing out—again and again, sometimes hundreds of times a week—and therefore are also those most likely to benefit from orthoses or shoe modifications that can help offset those forces and protect the athlete from injury.

Volleyball is another example, and the one most often a topic of discussion in my own home.

My husband Dan is in his third year in a local volleyball league, practicing or competing at least three times a week. Not long after he started playing, he invested in a pair of hinged AFOs and wore them religiously despite having no previous history of ankle instability. The devices’ primary indication was essentially to serve as battle gear, to protect the ankles from collisions under the net. (Somewhat surprisingly, when one player’s entire weight comes down on the foot of another, either player’s ankle can end up paying the price.)

These days, Dan almost never wears the braces. But that’s not because he thinks they adversely affect his jump height or his timing. It’s because he no longer needs the protection. His skills have improved to the point where he now regularly plays with the “big boys”—more experienced, more talented players—who have the body control to come down from a block or a hit with both feet on the correct side of the net.

Few of the athletes you treat will have perfected their sport. Some will be learning new techniques, others will be at the point where they are still learning the rules. Learning is a necessary part of sports, but it also can make an athlete vulnerable.

So make a point of finding out if your patient has recently decided to introduce the rail slide to his skateboarding repertoire, or if he’s working his way up to playing volleyball with the big boys. Because that athlete’s learning curve will be a lot steeper in a hurry if he or she is sidelined with an injury. You can make sure that doesn’t happen.

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