It’s All Connected:
Reverse Engineering Injury Mechanism
Andrew Charniga, Jr.
“If you find from your own experience that something is a fact and it contradicts what some authority has written down, then you must abandon the authority and base your reasoning on your own findings.” Leonardo da Vinci (1452 – 1519)
(quoted from “Seeing the Body: The Divergence of Ancient Chinese and Western Medical Illustration”, Camillia Matuk, Journal of Biocommunication, VOl. 32, No. 1, 2006)
The considerable research into the problem of female ACL injury in sports such as volleyball, soccer, basketball and even softball is terribly flawed. It is based on bias stemming from false assumptions:
/ the widely accepted bias that peculiarities of female biomechanics and distinguishing features in gender physiology, perceived as biological shortcomings; are principal mechanisms predisposing women to disproportionate rates of injury;
/ ligaments stretched or otherwise stressed by movements of the lower extremities outside arbitrarily established parameters of motion are to be avoided and controlled by special exercises and techniques;
/ the focus of research on exercises and techniques to correct the female defects, this despite the differences in female biomechanics remain unchanged;
/ the ultimate confusion, a blurring of lines, distinguishing science from commerce; created by an infrastructure of commercial products which is an inevitable consequence of academic speculation and questionable research.
The ankle is for bending the knee
A list examples of purportedly safe exercise techniques for knee bends, lunge exercises and so forth would be too long to present here. Unequivocally, with the overwhelming majority of these safe techniques one can find a connection to the academic community, physical therapy, or personal training business. Most advocate movement at the knee and hip as if the person exercising had no muscles, tendons and ligaments situated in calf and foot which would be of any use to perform a simple knee bend. And, of course, one is left to assume they would not be of any use in take – off in jumping, landing, changing directions, amortizing and dissipating forces on the lower extremities and so forth.
For instance, consider these instructions to perform knee bends from the National Strength and Conditioning Association; an organization which certifies strength and conditioning coaches.
“Avoid bending the knees to initiate the movement.”
“Allow the hips and knees to slowly flex…Continue flexing the hips and knees until the thighs are parallel to the floor.
“Keep the heels on the floor and the knees aligned over the feet… ensure that the knee does not move beyond the toes..” (Brown, L., 2007; Baechle, T., 2000)
Of these instructions of how to perform knee bends, is it oxymoronic, that one should “avoid bending the knees to initiate the movement”? The underlying assumptions about tight ligaments presented in part II that one should bend in such a way as to minimize stretching ligaments and maintain a linear stress on the knee joint are obvious from these instructions.
As already noted, the technique instructions would seem to exclude participation of the foot, ankle joint and musculature of the shin in performing this natural, simple exercise.
Which of course begs the question what are the roles of the ankle joints, muscles, tendons and ligaments in bending and straightening the lower extremities?
Figure 1. Illustrations of training techniques (from upper left) featuring ideas fostered by a fear of stretching of ligaments; of bending too far. In both half squat exercises depicted, feet are in a straight line, thigh and shin bones are moving linearly, with minimal movement at the ankle joint. Unfortunately, few attempt to make a connection between these training techniques and a predisposition for injury (post surgery injured knee pictured) under the natural conditions an athlete can encounter on the court, athletic field, skiing and so forth. On the other hand, weightlifters (upper right and lower right) subject the lower extremities to high speed, massive loading with un-choreographed, unrestricted joint movements and footwear sans artificial support; yet experience low injury rates of lower extremities.
Consider the following from a Kinesiology textbook which has been widely utilized in American universities:
“the long tendons cross the ankle in a way that makes for lack of bulkiness and for good leverage but contributes little to stabilization (Arnheim and Prentice, 1998) cited by Luttgens, 2002 “Consequently, this joint is unusually susceptible to strains, sprains, dislocations and fractures”. Luttgens, 2002
This single idea, the human ankle joint has evolved over tens of thousands of years in such a way as to make it “unusually susceptible” to injury is not a fact based on some proven functional insufficiency; but a conclusion based on observation of anatomy.
Figure 2. Despite the massive forces on the ankle and foot in weightlifting, ankle injuries are rare. The weightlifting shoe provides no support for the ankle; nor are taping and braces used to support this joint. Charniga photo.
The central idea from the textbook cited, conveys, tendons contribute little to stabilization. And, it is that single word “stabilization” which creates the backdrop for confusion and ultimately misinformation. The pervasiveness of this term is the foundation of both an academic and commercial infrastructure built around a conservative approach to the problem of ankle injuries in sport.
Although not intentional, an idea like this in the context from where and whence it originates in academia can spawn an entire commercial infrastructure.
For instance, the practice of taping ankles to prevent and/or support the joints from injury in sports like football, basketball, volleyball and others is so commonplace the term athletic trainer and ankle taping (and knees) are practically synonymous. Annually, thousands upon thousands of miles of athletic tape for taping joints are sold in the USA. Moreover, the US market for ankle and knee braces is more than $1 billion annually.
It is pretty obvious that the conservative nature of ankle taping practitioners and use of braces to protect the ankle joints from injury is elicited by a fear of stretching ligaments, a fear of bending; especially as it pertains to what are perceived to be acceptable movements of the ankle joint.
Consider a position paper by the National Athletic trainers Association:
In sport, ankle injuries are the most common injury, with some estimates attributing upward of 45% of all athletic injuries to ankle sprains.
In their systematic review, Fong et al2 noted that the incidence rates of ankle injury and sprain are highest in field hockey, followed by volleyball, football, basketball, cheerleading, ice hockey, lacrosse, soccer, rugby, track and field, gymnastics, and softball…… Managing these injuries appropriately is clearly problematic for sports health care professionals”. (T. Kaminski, et al, 2013)
The question that must be asked is why the high rate of ankle injuries in sports which do not involve maximum strain (track and field excluded)? And, can reverse engineering to weightlifting shed light on this problem where stresses on the ankle are extremely high, prophylactic taping and bracing non – existent, yet injury rates extremely low?
Figure 3. The photo in upper left corner illustrates anticipated consequences of turning the ankle on a football field, volleyball court, basketball court etc; while in many instances with ankle joints taped or even wearing ankle braces. The female weightlifters twisting ankles, knees and hips; while holding (from left to right) 130 kg (206% of bdwt) and 127 kg (169% of bdwt); free of injury, returned to lift the same weight minutes later.
Luttgen’s statement that the tendons crossing the ankle joint “lack bulkiness and for good leverage but contributes little to stabilization” is a bias which serves as the foundation for the entire approach to the ubiquitous ankle injury in American sports. This bias stems from a single idea that the ankle joint is inherently unstable because this joint does not have “bulky” tendons.
For example, the term “ankle stability” appears no less than 48 times in the National Athletic Trainers Association position paper; the title of which is “Conservative management and prevention of ankle injuries”.
Clearly, this group’s approach to care and prevention of ankle injuries is focused on this idea of ankle stability; regardless of how arbitrary and vague as to just what would constitute ankle “instability”. In one form or another, the management and prevention of ankle injuries is focused on taping the joint or bracing for practice and competitions; and, balance exercises for conditioning the joint to resist movement outside a relatively narrow range of motion.
Against this backdrop consider the following:
“The Achilles tendon is much thinner in proportion to the strength of its muscles, than most other tendons. If it were thicker it would stretch less and be less effective as a spring.”
“When humans and other mammals run, the body’s complex system of muscle, tendon and ligament springs behaves like a single linear spring (‘leg spring’). (Alexander, R. McN., 1992)
Now we have contrasting conceptualizations of one and the same thing. On the one hand from the viewpoint of Luttgens and ultimately the athletic training/medical disciplines, the ankle tendons are lacking in bulk which makes the joint unstable. This idea, in its turn, is the centerpiece of an academic discipline and commercial enterprise where the focus is to address this poorly designed joint.
These ideas persist, despite the fact that the human ankle joints and of course feet have evolved over tens of thousands of years, adapting to walking on two legs, instead of four.
However, according zoologist Alexander, there is nothing wrong with the tendons or other structures of the ankle. The body’s tendons and ligaments are biological springs; the form of which are in harmony with function. The tendons and ligaments of the ankle are biological springs connected to the biological springs of the foot. All of which, are connected to spring mechanisms of the knee, thigh and hip. Hence the notion that spring mechanisms arranged in series, i.e., muscles, tendons and ligaments connected by bones and joints can considered a single spring; a ‘leg spring’ (Alexander, 1992; McMahon, 1990; Farley, 1996).
It is this idea which explains how humans and animals adjust to greater stride frequencies in order to run faster: the leg spring, consisting of the muscles, tendons, and ligaments from hip to foot, stiffens to abbreviate ground contact time. Consequently, shortening a sprinter’s contact time with the track translates into a longer period of time with both feet off the ground, i.e., the sprinter who is “flying” down the track spends a longer time, literally, flying (Novachek, 1998).
The important idea to be inferred from the concept of a leg spring, is this: if the leg spring can stiffen as a single spring it can also release tension as a single spring; and, in turn function as a reactive protective mechanism.
So, here are two antithetical concepts applied to one and the same anatomy:
/ One, which believes the ankle joint is poorly constructed for stability; joint movement needs to be supported (fear of stretching ligaments) taping and/or bracing; and, which is bolstered by a profession and commercial infrastructure which has developed around the concept of supporting the joints with taping and braces;
/ the other, which believes the form of the ankle is in harmony with its function as a biological spring mechanism and of course is interconnected with other springs from hip to toes.
“The body is filled with springs that are just as good (as the artificial feet of Oscar Pisitoris). They are called ligaments. They are called tendons. In addition the body has muscles which can do far greater things than just springs.” Hugh Herr MIT, NBC evening news 8/6/12
Consider the following photos.
Figures 4-8. Charniga photos.
The young female lifter in these photos is lifting a 127 kg barbell. She rearranges her feet to scissor her legs in order to drop under the weight. The rear (left) foot returns to the platform first followed by the front foot. Her right ankle proceeds to roll under the pressure of the athlete’s bodyweight and the weight as she struggles to balance the barbell and her body as a single unit, called the athlete – barbell system.
This certain injury in the making was a non – event. Tension released from hip, knee and ankle joints reflexively, as one; elastic tendons and ligaments, stretched and recoiled. Both leg springs having stiffened to raise the barbell, released tension as well: muscles from hip to foot relaxed. The release of tension and the lifter’s, in the words of Moroz, “extensibility reserve”, redistributed and dissipated the force of the falling barbell and body. She simply got up, walked away; returned 1.5 minutes later to successfully lift that weight; and, three minutes after that to raise 133 kg.
Curiously, an antithetical evolution in philosophy can be observed between the design of footwear for weightlifting and sports like American football, volleyball, basketball and others; as it relates to problems with the ankle, knee injuries; and, consequently, convoluted solutions such as taping/bracing ankle joints, and so forth.
The design of weightlifting shoes have evolved from supporting to exposing the ankle joint, i.e., sans support. The basic idea driving this evolution in philosophy, reflected in the design of the footwear was to permit and facilitate bending the ankle to lift bigger weights (A. Charniga, “Why weightlifting shoes”?). Moreover, weightlifting has a relatively low injury rate for knees and an almost non – existent injury rate for the ankle.
Figure 9. Soviet made weightlifting shoes of the late 1950s with high top design covering the ankle joint; contrasted with modern weightlifting shoe of the female lifter on the right. The evolution of the design of the shoes conforms to the idea that freedom of movement in the ankle joint is desirable and most importantly: the ankle joint does not require artificial support under the high loading conditions of weightlifting. The Russian lifter on the left has laced the shoes only half way to permit ankle bend. Also, the lifter has fashioned a tarsal strap by wrapping the laces around the mid – foot area of the shoes. In contrast, the modern weightlifting shoe with exposed ankle joints and tendons which in this example, sans socks, are clearly visible. (Kono and Charniga photos)
For instance, the footwear of American football, volleyball and basketball, in contrast to weightlifting, at the very least, preserved the design of a high top shoe for ankle support; even though this design has been discarded by manufacturers of the shoes for some of these sports. See photos.
Figure 10. Contrast in design between modern low cut with ankle joint exposed, weightlifting shoes; a military boot featuring high ankle lacing, restricting movement; female volleyball players with similar “military” footwear: low cut shoes with ankle braces similar to the one depicted in far upper right corner and “spattaping” the shoe to the ankle to play football.
The American philosophy, reflected in the contrasting evolution in design of shoes with weightlifting, still centers around minimizing and supporting ankle movement through taping/bracing of ankle joints. Essentially this philosophy stipulates support and /or minimal movement of the ankle joint is safe. This of course is in stark contrast to the design of the modern weightlifting shoe which pretty much permits unrestricted, unsupported ankle movement. A philosophy of taping and bracing ankles to play sport reflects a fear of stretching ligaments, a fear of bending knee and especially ankle joints while in engaging in sport. It is a disaster in the making.
Consider the set of photos below:
Figure 11. Three examples of preparing the ankle for sport; relative to radically differing philosophies of ankle stability. Upper left female volleyball player on the court wearing low cut volleyball shoes with braces to support ankle joints. Lower left photo of a football player with ankles heavily taped to shoes forming a unified bond from lower portion of shin across the arch of the foot to the heel. Unlike literature emanating from the American medical and athletic training communities, the weightlifting literature is devoid the term ‘ankle stability’ (Vorobeyev, 1972;1988). Hence, photo on lower right of Olympic champion David Rigert (Kono photo) playing around in the gym snatching 130 kg in bare feet.
Two of the above photos of a volleyball player with rigid ankle supports and professional football player with ankles taped to shoes illustrate two underlying assumptions, unsubstantiated bias’: a fear of stretching ligaments and that the ankle joint is inherently unstable. On the other hand, in the weightlifting community; for the barefoot weightlifter pictured, these ideas don’t exist.
It is a logical assumption that the links in the body’s kinetic chain have evolved such they are designed to work together; movements of any link inter-conditional with movement of all the rest, and vice versa. Consequently, one can logically assume taping and or bracing one set of joints relative to another would at the very least alter the harmony between form and function which nature has so tediously crafted.
Consider the following:
“An additional issue that needs to be evaluated is whether bracing or taping the ankle has any negative effect on other joints in the lower extremity, specifically the knee. To date, bracing or taping the ankle does not seem to increase prevalence of knee injuries. However, most studies included a very small number of people who had sustained knee injuries, so definitive conclusions are difficult to make. ” (T. Kaminski, et al, 2013)
From this statement it is obvious the vagaries of science, bias and commerce collide; conspiring to cloud the issue.
Were sufficient objective evidence allowed to emerge; proving taping and or bracing ankles “increase the prevalence of knee injuries”, what then? What of all those graduates of university athletic training programs who have acquired ankle taping skills; only to learn how to cause more harm than good? Likewise, what about the credibility of those institutions and the staffs?
Moreover, further muddying the water is the influence of commerce.
If ankle taping can cause knee injuries what about the companies who annually sell thousands upon thousands of miles athletic tape purchased to address ‘ankle stability’? Furthermore, how would more harm than good research affect the 1 billion dollar a year bracing market?
Reverse engineering a conclusion
Reverse engineering can help explain the extremely low rate of ankle injury in weightlifting and why weightlifters who have fallen or otherwise experienced a “black swan” event without injury. The following theory appears to fit.
Weightlifters have to switch instantaneously from raising a barbell to receiving it on the chest or overhead on straight arms. In effect, it is analogous to switching from throwing a heavy object to instantaneously catching it. The weightlifter “throws” the barbell by forcefully straightening the trunk and lower extremities; in the process stiffening the leg spring, i.e., the muscles, tendons and ligaments from the hip to foot. The weightlifter has to relax the very same muscles used to straighten up in order to switch to dropping down. Tension is released in the leg spring.
Figure 12. The ability to release tension in the leg spring extremely fast allows a highly skilled weightlifter’s body to exceed the acceleration of gravity while dropping into a low squat. Soviet sport scientist I. Zhekov (1976), theorized the possibility of a weightlifter dropping under a barbell with an acceleration of 2Gs. However, it is only possible to outstrip the acceleration of a free falling body by holding onto something, which in this case is the very slow moving barbell. Charniga photos.
A lifter can suddenly experience some problem with balance or coordination in the process of receiving the barbell. The tension which has returned to the leg spring once the athlete’s feet return to the platform in the process of descending can be released (as in the examples shown) such that the mechanical energy of the athlete’s descending body and the barbell can be redistributed and/or otherwise dissipated; preventing injury.
For instance, the example of the female lifter twisting her ankle and falling to the floor. In the first two photos she is rearranging her legs after thrusting the barbell, i.e., the leg spring stiffened by a half squat to thrust the barbell, releases tension from hip to foot when the lifter switched to scissoring the legs. The athlete’s leg springs stiffen as the feet are returned to the platform to fix the barbell.
Subsequently, the lifter turns her ankle struggling to balance the barbell overhead. At one and the same instant, both of the athlete’s legs from foot to hip relax, i.e., the stiffening process is reversed.
The high speed relaxation of the leg spring, both a skill and a special quality cultivated by the high class weightlifter, to switch from lifting to receiving the barbell; in this situation, becomes a reactive protective mechanism. The release of tension coupled with the weightlifter’s flexibility prevent injury.
Now, consider the following:
“A 2009 study published in the “International Journal of Exercise Science” studied 17 subjects during warm-ups and 60 minutes of touch football and found spatting to be more effective than taping at limiting range of motion.” A 2011 study from researchers at Drake University published in the same journal found spatting and taping together to be as stable as bracing.” R. Axon 2013
It is unlikely a reactive protective mechanism designed to release tension in the leg spring will work in the desired manner if one or more of the joints in the spring is artificially stiffened with tape or bracing designed specifically to limit range of motion.
Inhibiting or otherwise tampering with this natural, reactive protective mechanism can create conditions, for a probable outcome; where taped feet, ankles and knees and/or otherwise trained to restrict range of motion, suffer disproportionate injury rates in sports with less stress on the joints than a maximum strain sport like weightlifting.
So, to return the question as to how a basketball player suffers a skin protruding shin bone fracture, (raised in part I) from falling on a basketball court. An explanation with a high degree of probability can be deduced when several of the factors presented here are taken into account. The general fear of stretching ligaments and fear of bending the lower extremities only in a certain way, embraced by the athletic training/physical therapy/personal training communities means these fears are incorporated into the supplementary training of athletes.
In all probability the ankles both basketball players whom suffered shin bone fractures, were taped, braced or otherwise artificially supported. These athletes typically would not practice large range of motion exercises like deep knee bends, lunges, vertical jumping from a low squat, etc where knee, hip and ankle joints are subjected to stretching tendons and ligaments through a large amplitude of motion.
Consequently, reactive protective reflexes, designed to release tension in the entire leg spring upon landing or falling; would at very least be inhibited by taping and the internal resistance of the athletes’ muscles, tendons and ligaments, i.e., a general lack of unencumbered freedom of movement.
Unlike weightlifting; the knee, hip and ankle joints of the basketball players taught to bend a certain way by conditioning coaches, personal trainers, physical therapists and so forth, would likely direct the forces acting on the body to go somewhere other than soft tissues, to the shin bones for instance.
Figure 13. When weightlifters preform a ½ knee bend to jerk the barbell a significant portion of the force is generated by calf muscles. These muscles straighten the tilting shins in what can be described as a reverse origin insertion contraction of the soleus muscle.
The shortening soleus straightens the knee because shin bones are connected to thigh bones by a coupling called the knee joint. The soleus pulls the tilting shin towards the vertical (yellow arrows), which in turn pulls the thigh towards the vertical (white arrows) along with the quadriceps muscles, by a process called inertia coupling . The shin and thigh bones are interconnected via the knee joint; so the movement of one affects the another: the movements of the long bones of the lower extremity are interconnected, interdependent and inter-conditional.
The muscles tendons and ligaments of the thigh, shin and foot arranged in series act as a single spring, sometimes referred to as a leg spring. Consequently, the forces generated to raise a barbell are produced from the ground up and the stress is distributed from foot to hip and not concentrated in the knee joint, regardless if the knees bow inward or not. Compare this sudden jolt at the instant the athlete switches from bending to straightening with such power as to bend the barbell to the forces experienced by American female athletes in events with body weight only, such as basketball, soccer, volleyball where ACL injuries are common. Charniga photos.
References (continued from parts I and II)
43/ Kaminski, T., et al, “National Athletic Trainers Association Position Statement: Conservative Management and Prevention of Ankle Sprains in Athletes”, J. of Athletic Training, 48(4):528-545:2013
44/ Vorobeyev, A.N., Weightlifting, Textbook for the Institutes of Sport, FiS, Moscow, 1988. Translated by: Andrew Charniga, Jr.
45/ Vorobeyev, A.N., Weightlifting, Textbook for the Institutes of Sport, FiS, Moscow, 1972. Translated by: Andrew Charniga, Jr.
46/ Charniga, A., “Why Weightlifting Shoes”, www.sportivnypress.com
47/ Axon, R., “Ankle tape can be sticky situation in college football”,
“The ankle bracing and supports market includes rigid ankle braces such as ankle stirrups and trainer braces; and ankle supports including semi-rigid supports, lace-ups, and elastic and neoprene supports. Growth will be driven by the increasing use of ankle braces for prophylaxis to treat injuries and for postoperative support. The increasing prevalence of sports injuries and obesity will have a positive effect on this market.”