Ryan Shay Autopsy

Ryan Shay Autopsy: Why the delay?

In the last 4 months, everyone has waited patiently for the autopsy results of US runner Ryan Shay to be released. It was in November last year, during the US Men's Olympic Trials, that Shay collapsed at the 10km mark in Central Park, New York. He was later pronounced dead, and the story shocked the athletics world.

We have now reached March, and still no final report on the cause of death or the results from the autopsy which is performed on all sudden deaths in apparently healthy people. For example, earlier this year, actor Heath Ledger died in mysterious circumstances and an autospy report was released only two weeks later.

So not surprisingly, the voice of those who wanted to know some answers was growing steadily louder or discontented. Apparently, the Medical Director of the race was receiving 25 calls a day from various people. Even here on this site, we've received a number of questions from people asking whether we knew - of course, we are as much in the dark as anyone else. But now, it seems there may be some answers...

Runners World finds some answers

On Thursday this week, Amby Burfoot wrote an article which you can read here, detailing some of the progress made so far.

According to the article (summary for those who don't want to read the whole thing), the Medical Examiner's Office refuses to comment on any case, which is understandable, if not doubly frustrating for those wanting to know. The official word out of the Medical Examiner's office is:

"Every case is individual, and we have to do a complete job on every case that we do. We do the testing that we need until we're satisfied that we can determine the cause of death."

Apparently the four month wait for the report is not completely exceptional - it usually gets released far sooner, but four months still falls inside what the Office considers an acceptable time frame. Final testing is apparently now taking place, and according to the spokesperson, "It should be very soon now."

So within the next week or two, perhaps, we'll have some conclusive (hopefully) answers as to what would cause an apparently healthy and very fit 27 year old to collapse and die during an activity he did just about every day.

But there are some answers, provided by Ryan Shay's father, Joe. In a telephone conversation with Runners World, Shay revealed that:

A toxicology report had been conducted on the supplements Shay was using - he was sponsored by the company EAS, and so any possible contamination was investigated. Apparently, Joe Shay requested that the toxicology report be released before the rest of the results, but the Medical Examiner's Office refused, as policy is to release the report in its entireity. The toxicology report became the focus of attention because at the time, many people wondered whether drug use might have been responsible for Shay's death.

A second part of the investigation was done on tissue samples which were genetically examined. Shay's family specifically requested this to make sure that no other family members were in any danger of a similar cardiac event. Joe Shay revealed to Runners World that this testing showed that Shay DID NOT have hypertrophic cardiomyopathy, which was a widely reported candidate for the cause of death (including here).

So one possible cause has been eliminated, the others remain possibilities. The signs are encouraging that within two weeks, a report will be released, which will hopefully provide some answers. If and when that report is released, we'll do our best to bring to you.

Ross

Sports news interlude

Some news snippets ahead of the weekend

We're taking a break from the series on running shoes today, to look at some sports news that came across the wires in the last couple of days. I'll tackle another post on running shoes over the weekend when there is a little more time to get through some biomechanics articles on the subject - the thing about shoes that it takes you into the field of biomechanics of running, which is highly specialised and vast, so I would want to do justice to the studies.

But for today, some sports news from the last few days, starting with the latest installment in the Oscar Pistorius case.

Oscar Pistorius announces that his own research suggests he has no advantage, and the IAAF were wrong

Well, this is hardly surprising, of course - Oscar Pistorius yesterday announced that he has conducted his own studies in Texas, and they have contradicted many of the results from the IAAF testing performed in Cologne, Germany, last year.

Regular readers will know my take on the situation, and this is simply the latest act in a saga that threatens to be drawn out well beyond Beijing. The IAAF, for their part, have dismissed the research, which is understandable, given that Pistorius and his team went off and had it done all by themselves.

Remember, when Pistorius was tested in Germany last year, he and his team were given opportunities to discuss and consult with the IAAF on the tests. That is, they had input and opportunity to help design the studies, and were of course on-hand when the testing was done, to ensure that it was being done fairly. Pistorius was allowed by the IAAF to have representation in whichever form he chose - lawyers, scientists, podiatrists, coach, family - whatever he wished.

That is the reason why, when the IAAF announced that the testing had found large advantages (25 to 30% for mechanical and energy efficiency), it was strange that Pistorius questioned the completeness and validity of the research. This reaction was tantamount to an admission that his own team had failed to contribute to the research, since they had opportunities to ensure its validity before and while it was conducted.

So now, Pistorius has gone off to an unnamed lab in Texas and done his own work. Work he paid for, consulted on, designed, and was involved in. Not a single IAAF official was present, the IAAF was not consulted in any way, and had no opportunity to view the testing while it took place. The IAAF have therefore dismissed the test result - it is the equivalent of a court case in which the "defendant" is not even invited to the trial.

So what did they find?

I would love to be able to give you a critical analysis of the Pistorius testing, but unfortunately, that is not possible, since Pistorius and his lawyer have refused to say who did the testing, what it consisted of, and what it showed. This is however understandable - one would hardly expect him to reveal the results in the media while a case looms on the horizon. As one reader commented this morning:

"Oscar is playing high stakes poker with the IAAF and the Court for Arbitration in Sport. He and his team would be foolish to show their hand at this point..."

I agree with that, but then it's odd that he chose to announce the test result at all - the great paradox here is that he chose to release a provocative press release. Clearly, the comparison with poker is a good one, because Pistorius may be playing a great game of deception in the media. I don't see that the IAAF are playing the same game - they have flat out dismissed the research, no case of bluff and double-bluff there. Does he have proof? Who knows? Does the result show anything conclusive? Your guess is as good as mine!

One thing I will say is that we have always been big on conflicts of interest here on this website. And I cannot think of a bigger conflict of interests than when you pay for your own research, with the specific intention of proving other work wrong in order to retain a spotlight that must be providing financial rewards. Think for a second about what possible conclusion they could draw - that the blades do in fact give an advantage, and the IAAF were correct?

Can you imagine the headlines: "Pistorius commisions his own tests confirming his advantage over able-bodied athletes", or "Blade runner performs his own research, finds an advantage". Well, of course not - that's a headline that will not seem out of place in a few weeks on April 1! The reality is that Pistorius cannot say anything but that his research proves the IAAF wrong - his entire campaign, and all the spinoffs, depend on it. Similarly, the IAAF cannot at this point apologize for their science being "wrong" and welcome Pistorius into the sport! So we have an impasse, but the circumstances of this latest "research" are so dubious, so suspect, that I find it inconceivable that he would be so presumptious as to even make the claims he has.

What I would love, however, is to see what the "evidence" is. It struck me yesterday that to date, the science of the issue has never been debated - it's been science vs. marketing, no dialogue, only monologues. We've tried to cover the story here, and evaluate the science, and we've received a few emails from people who have blasted it and claimed that it's unfair and untrue. Yet no one has actually presented the counter-argument, either in terms of theory or research results. To date, the rhetoric has been abundant - claims and promises and threats, but nothing concrete. Perhaps Pistorius now has this concrete result, but I'd love to hear how he is going to cancel out a 30% advantage found by the IAAF.

The other thing that is strange is that this testing was done in Texas a month ago - I know for a fact that three weeks ago, Pistorius was investigating the prospect of actually doing the testing here in South Africa. He wanted to have his scientific case prepared from here - so that seems peculiar given that two weeks before this, he had this "exciting" result from Texas. If this is a game of poker, then either someone is bluffing, or perhaps simply ignorant of the science. I've seen little science in the last year, apart from a claim that the human tendon returns 240% of the energy it stores! That "science" was laughable, but perhaps the latest installment will be similar?

Time will tell how this all transpires, and just what testing was done in Texas. To take on the very best scientist in this field in the world (Prof Bruggemann), and the best research facility for this purpose in the world (Cologne), that research must be spectacular.

The IAAF World Indoor Championships

The big sporting event (from a running point of view) this weekend is the IAAF World Indoor Championships from Spain. It's the culmination of the indoor season, and some big names are taking part.

For two informative articles on the weekend, and who to watch, check out the following two articles:

Guide to men's events in Valencia (they don't have a women's guide, unfortunately)
Steve Cram picks his 10 to watch (a bit biased towards British athletes)

If I had to pick two big events to watch, they would be:

• Dwain Chambers in the 60m sprint - only because this is a story we featured here in the last few weeks, and for all the wrong reasons - Chambers is returning to international competition following a break, which followed a forced break caused by his drugs ban. There was huge controversy as to whether he should even be picked for the squad, and he now takes on what is a relatively thin field. If he wins, the story will gather momentum and the headache for the British Athletics (and the world's) fraternity will increase - the spotlight on drugs in sport will only be intensified. Apparently, Chambers is hoping that a medal will help him re-integrate into the sport. Fact is, it's likely to fragment it even further...
  
• Men's 60m hurdles, where the new sensation Dayron Robles will have his first chance to turn up the heat on Liu Xiang ahead of the Beijing Olympics. Robles has been in great form this year, while Liu has hardly raced, so this is the ideal opportunity for Robles to make a statement on what is possibly the most unequal playing field he'll encounter this year. Liu is going to go through 2008 under the most intense pressure perhaps ever placed on an athlete, because he is the face of the Beijing Olympics, and once in Beijing, he'll be carrying the hopes of billions. He's withstood it so far, but Robles can add to it in this race

But, there are some great races in the middle distance events too - the men's 800 and 1500m races, and then Craig Mottram races in the 3000m in a field that's missing Kenenisa Bekele, so he's a good bet for a title there. And in the women, the farewell season of Maria Mutola begins as she runs in the 800m.

Paula Radcliffe to miss London Marathon with injury

Bad news for Paula Radcliffe as she builds up to the Beijing Olympics and the elusive gold medal - she has injured her toe and will not race in London.

The Radcliffe camp are downplaying the significance of the injury, and the reports are that she probably could have raced in London, but would have been below her best, so the wise approach is to rather focus on training for Beijing.

Fortunately, we're far enough away from Beijing that this kind of injury doesn't threaten her big season goal, but it does affect her racing schedule - Radcliffe has always been an athlete who races well and regularly, and of course, given the long layoff she had before New York last year, a few races will be an important part of her Beijing build-up.

However, perhaps this incident will be beneficial - she may now end up racing more at the shorter half-marathon distance, which might ultimately prove to be an advantage, if she can go into Beijing with a little more speed and racing experience in what are likely to be tighter races.

All in all, disappointing for London, but Radcliffe remains on course for Beijing. Time will tell, once again!

She could always try barefoot running - maybe it was her shoes that hurt her big toe!

Join us soon for the third part of the running shoe trilogy!

Have a great weekend!
Ross

Running shoes continued

Running shoes and injuries: Debate continued

Yesterday, we did a short post looking at the debate around running shoes, and whether the shoes which claim to reduce injury risk are in fact part of the problem! Thanks to everyone for the spirited input on the debate - it's been lively and interesting so far. I thought it better to respond in a new post and perhaps lead the discussion based on those comments than bury my response in the Comments section to that post.

Another study on expensive shoes - money doesn't buy you comfort

First, thanks to Clyde for providing the link to the article from BJSM. You can find the article abstract here if you would like to read it. I have a copy of the article as well, and it makes for some interesting reading.

Basically, the researchers set out to evaluate three differently priced running shoes:

• Expensive - priced over 70 Pounds (around $140 or R1100)
• Medium price - around 60 Pounds ($120 or R900)
• Low cost - 40 Pounds ($80 or R600)

The shoes were evaluated primarily on the basis of pressure under the foot and comfort, which is a subjective rating. So they didn't really tackle the issue of motion-control/anti-pronation devices, which is a pity (but more on that later).

Their findings? As you probably might have guessed based on Clyde's comments and the general trend, there were no differences between the shoes for either of these two factors - the cheap shoes produce the same pressure (cushioning), and the same perception of comfort as the expensive shoes. The difference in price of R500, then, results in little difference in terms of cushioning or comfort or pressure distribution.

In a follow up letter to this article, the reasons for this were pointed out - it's simply not feasible to change pressure by shoe-design, because the result would be a dramatic change in biomechanics - the analogy would be to switch from running on tarmac to running on soft, spongy sand. So in effect, the above-mentioned study was "doomed" to find no difference anyway. And of course, this might be true, but then it introduces the obvious question - if shoes can't change the pressure/cushioning, why the enormous price difference? And that's where the debate leads next...

What is missing - research on the 'gadgets'

This study is interesting in that it evaluates one aspect of running shoe design - pressure or cushioning. However, it fails to tackle what I believe is the bigger source of "controversy" around the shoe industry - all the gadgets and gimmicks that are inserted to provide MUCH NEEDED support to runners who over-pronate.

And a good many of the comments to our previous article are from runners who do pronate and have had experience in these shoes. Basically, the premise for these shoes is that upon landing, excessive pronation, which refers to the rolling in motion of the ankle (called eversion of the foot), is responsible for injury, since the pressures and loads placed on the shins and knees is excessively high. Therefore, control the pronation and you control the injury risk...

So shoe companies have all developed their own unique devices to do this. Apart from the devices that are proposed to aid with cushioning (Nike Air, Asics Gel, Adidas Adiprene, and so on), I would dare say that most of the product (and price) differentiation takes place with regards to these motion-control devices. Yet so little research has been done on them. Well, let me qualify that - there is "overwhelming evidence" on all of them, but they're done exclusively by the shoe companies and never published! The funny thing is, I can almost guarantee that one company will have research that proves their device superior, while another, having done almost identical research, will conclude that theirs is the best available!

So it's hardly surprising that Dr Richards and most of you writing into this post are suggesting that anti-pronation shoes are being over-emphasized, and that a well-cushioned shoe is the way to go.

My personal take on the issue - it's the training, not shoes

So let me take that one step further and actually put my head on the block on this one. I fully agree with that assessment - I don't believe that huge, heavy anti-pronation shoes are the solution for running injuries. I stated yesterday that if I were advising an athlete with injury problems, I'd look first, second, and third at their training, and then start to consider their footwear! The point is, training errors are responsible for injury, the rest is detail!

Of course, factors like biomechanics, muscle strength or flexibility imbalances are contributing factors, and so if a runner is "biomechanically correct" (incidentally, that term is thrown around with freedom but without a clear definition of what it actually means! But that's another issue!), they will get away with training that would cause injury to someone who is not so fortunate. Body size and weight are key factors, and then of course, you get leg length discrepancies that throw off alignment, making some people far more susceptible to injury - the result is that one person's ideal programme is another's "boot camp", guaranteed to break them down in a few weeks!

However, I don't believe that simply changing the shoe is the solution - changing the training, and gradually increasing the load is far more likely to resolve the injury.

At the two extremes (high arches or very flat feet), I believe that orthotics may be helpful. I myself have very flat feet (I could probably walk on water if I tried, and certainly on snow!) and I've been in orthotics before. However, I found they caused more problems than they resolved - super rigid, stiff and heavy. So I eventually ditched them, went back to the drawing board as far as training goes (did I mention that I believe training is the key to injury?), and basically started running as a beginner again - I spent a month doing a walk-run programme, consisting of 5 minutes jogging, 2 minutes walking, and eventually managed to phase out the walking part, and the problems are a thing of the past. And all in a pair of very well cushioned, neutral shoes. I certainly lie on the far end of the pronation continuum, but I really am convinced that given the right training, anyone can wear neutral shoes. I don't believe that buying a super-expensive motion control shoe will improve your chances, rather look at orthotics if you feel you have to obtain some support.

To sum up - when you buy your shoes, try them on for comfort and cushioning and fit, and once you find what works, then stick with it. But don't commit to the 'gadgets', well cushioned is sufficient.

The future of the shoe industry

Finally, if I may put on my marketing hat for a moment, I would predict that the heavy motion-control shoe will one day become an extinct species - it may already be on the endangered list! It's difficult to know what stimulated the massive growth in the area, but I suspect what happened was that in the 1970's, when the running "boom" hit, a good many people with "less than perfect" biomechanics took up running. And of course, marketing is all about meeting people's NEEDS. And when the NEED doesn't exist, then you simply create it - "science" is often a big help in this regard!

So the companies recognized that perhaps a million people who never ran before were now running and this represented a huge market to be tapped into. But they needed a selling point, and Point of Differentiation, and the "combat overpronation" campaign was just the ticket!

Now, in 2008, I feel the opposite is happening. More and more people are talking about barefoot running, which is probably a little too extreme, a case of over-compensation, perhaps. But the point is, there is a shift in the market, and I'm sure the companies will respond and try to create a new need - I suppose they already have, with the barefoot shoe concept. But all this adds up to the beginning of the end for the heavy, anti-pronation shoe, which will probably become a relic in the next 20 years. But then again, those may be famous last words!

Thanks again for the debate, keep it coming!

Ross

Running shoes: Solution or the problem?

Running shoes and running injuries: Do the shoes actually cause the injuries?

After a couple of posts on doping, a bit of a change of theme for today, as we look at running shoes and injuries. This post was inspired by a link I was sent by one of our regular readers (thanks John - the link is further down the page, incidentally) and it's a really great article, a real conversation starter, so it follows on nicely from our great discussion after the previous post on lifetime bans for dope cheats. Thanks to everyone for their input on that one, let's see how this one goes.

The other reason to post links is because we've both been incredibly tied down with other work just lately, so in true academic fashion, we'll borrow from the excellent work that already exists and just steer the discussion and the traffic in that direction! Having initially thought that it was Albert Einstein who said that he had "stood on the shoulder of giants", one of our readers pointed out that it was in fact Isaac Newton! To save face, I will however point out that Einstein did quote Newton by saying this later in his own life, which of course only reinforces the idea that in science, don't say something in a new way when someone has already said it perfectly for you! And so we borrow that concept today and refer to a great article on running shoes and injuries...

The running shoe debate: An old topic revisted

To date, we have not really tackled the running shoe subject directly here at The Science of Sport, but it has come up incidentally in previous posts.

For example, it came up in the first post on our series on the Pose Running technique, where it was pointed out that ever since the "boom" in the running shoe industry about 30 years ago, the percentage of runners who get injured each year has remained pretty much the same.

So despite technological advances and developments in the industry, injury incidences have remained largely unchanged. Shoe companies make many promises, such as:

"Anti-pronation devices limit movement of the foot, reducing the risk of injury in overpronators", or "Forefoot and rearfoot cushioning devices reduce impact and the risk of injury"

Yet there's little reason to believe that this is true. The latest studies suggest that anything between 40% and 70% of runners are injured every year. And fascinatingly, in 1989, a study found that runners who ran in shoes costing more than $95 actually were twice as likely to get injured than runners who ran in shoes costing only $40! That was even after correcting for training and racing mileage! Of course, it's impossible to conclude that "expensive shoes CAUSE injury", because there are other factors that can't be accounted for. And one might argue that the typical runner of 2008 is quite different from the runners of the 1970's, who tended to be lightweight, biomechanically very different athletes. So maybe the fact that the injury rates are the same is actually a positive for the shoe industry? But let's pursue it a little further...

Points of differentiation and running shoe research

And what is more, the companies very rarely make their research available for all to see. Even if they did, you can pretty much guarantee that the research (which would be funded by the company, remember) would show "conclusively" that the shoe positively influences biomechanics, cushioning and hence reduces injury risk. The cynics among us would challenge the research on the grounds that they company could hardly spend money on scientific research and conclude that their latest selling point on the new models DOESN'T make a difference!

And in order to understand the full extent of the issue, you have to appreciate what is relatively obvious from a marketing point of view - all shoe makers are doing their utmost to differentiate their shoes and get their "share of wallet" in what is a very competitive, very lucrative (billions of dollars), but very cluttered market. The result of this search for a "point of differentiation" has thrown up a dizzying number of gimmicks and gadgets - every company has their solution, their distinctive features, often with the same function as competitors', yet it's still called "cutting edge technology".

A great article on running shoes

For a great article on the shoe industry, right the way from the Pharoahs of Egypt, through the Middle Ages and then onto the modern shoe industry, here is a great article on running shoes:

Athletic Footwear and Running Injuries

The article is pretty long, but worth the read. For the latest information and some real thought-provoking writing, I'd recommend Part II, about a quarter of the way down the page, which focuses on running injuries and how the shoes have failed to alter the injury rates.

Another site that may well develop into something in the future has been set up by a research in Australia, Dr Craig Richards - it's called "Barefoot versus the shoe"

He actually contacted us recently, in connection with some other articles here (fatigue, Pose), and we discovered the blog then. The posting frequency is relatively low, but it's worth reading simply to see what the shoe companies say in response to Dr Richards when he challenges them for their research. Hopefully in the future, he'll post more regularly and keep exposing the industry where it needs to be exposed.

Is barefoot running the way to go?

On the note of Dr Richards' blog title (Barefoot versus the shoe), the argument is growing that running barefoot is the natural and hence the "correct" way to run. And I know of many podiatrists who are gradually shifting their thinking in this direction - if any of you out there are podiatrists, please feel free to weigh in on the discussion. In fact, even the shoe industry has cottoned onto this idea - think Nike Free, and the other shoes that are now being made to mimic barefoot running.

But, a word of caution here. If you're a runner who has been pounding the pavement for 20 years in a pair of shoes, suddenly switching to barefoot (assuming you can run barefoot - I would never consider it on the tarred roads of Cape Town) may be a risky move for you. Because the change in biomechanics and loading of joints, muscles and tendons threatens injury if you're not careful. So in the article, you'll see advice to run barefoot - what you may miss is the proviso that you start with "small doses", which is really important - be careful about over-compensating and injuring yourself on the other side!

Any shoe experts out there?

I suspect that everyone has an opinion on this one - I have no doubt that many of you reading this will be able to share your experience that a persistent, nagging injury suddenly cleared up when you switched shoes, and perhaps you've never looked back? Those stories are very common, and lend support to the idea that a certain shoe will help with injury risk.

Personally, I'm of the belief that an injured athlete should look at their training as the first port of call after injury. The second port of call is probably training as well, followed by things like muscle strength or flexibility imbalances, and then in fifth, have a look at your training! Seriously though, I think that one consequence of a pre-occupation with shoes and injury prevention is that it takes away the attention that should be given to training - an injury can almost always be traced to a change in training intensity or volume, and that's where I'd begin the detective work, not with shoes.

But, let's hear from anyone who has experience or knowledge. I know we have many readers who are involved in the industry, and have a great deal of technical knowledge, so do fire away!

A look into the future

So that's it as far as "standing on the shoulders of giants" goes - in the next few days, I'll hopefully get that long-awaited post on fatigue up, so join us then!

Ross