October 16, 2012 | 3
With a single bad step as he ran untouched across a field this September, one of the best cornerbacks in the National Football League removed himself from the game for a whole season. New York Jets fans who saw Darrelle Revis’s left knee buckle under him that day may have pled with their televisions: not the ACL. But it was too late for Revis and his anterior cruciate ligament, which will undergo surgery this week.
Football fans are all too familiar with the ways in which a knee or ankle can fail a person. But athletes, like other humans, are simply doing the best that an ape running around on two legs can.
Before we lived and walked on the ground, our ancestors inhabited the tree branches. They didn’t look quite like chimpanzees or any other modern animal, but they were large apes built for climbing. They had big, grasping toes and extremely flexible feet and ankles. “These things were just brilliantly adapted for living in the trees,” says Boston University anthropologist Jeremy DeSilva. He studies the evolution of ape and human locomotion by looking at both ancient fossils and modern-day animals in motion.
When our ancestors descended from the trees and began walking upright, they faced some major mechanical challenges. “Being on two limbs is just a real problem,” DeSilva says. “If you were taking shop class and your assignment was to build a chair, and you built a chair with two legs, you’d fail the class because it would fall over all the time.” Simply balancing an animal upright is a feat of evolutionary engineering—and that’s before the animal starts moving around.
To walk on two limbs, our ancestors had to make several modifications to the feet they’d inherited from tree-climbing apes. Flexible, grasping appendages with 26 individual bones had to become stable surfaces that we could push off of with each step. “We’ve stiffened things up by patching these bones together with a bunch of ligaments that make up the arch,” DeSilva says. And muscles that were once used for grasping branches now support the foot’s arch. “But boy,” he says, “these are just a bunch of band-aids.”
Though these new two-legged bodies worked well enough to keep our lineage alive, bipedalism may not be the best idea evolution has ever had. “If you look across the animal world,” DeSilva says, “good ways of moving evolved multiple times.” Flight, for example, has evolved many times. So has a streamlined body in swimming animals. But striding on two legs evolved just once in mammals.
The only other animals that walk like we do are birds. And with a couple hundred million years to work on the problem, rather than the mere 5 million or so that we’ve had, birds have come up with what DeSilva thinks is a tidy solution: they’ve fused several bones together to create rigid, immobile feet.
In humans, DeSilva says, “I find the foot to be incredibly problematic.” He thinks a lifetime of walking and running on feet held together by evolutionary band-aids is bound to lead to the kinds of problems people frequently experience: plantar fasciitis, collapsed arches, shin splints, Achilles pain.
What’s more, DeSilva says, “We have evidence that these things are not just modern problems.” In the ancient hominins whose fossils he studies, there are many who suffered from the same injuries that plague us. There are broken ankles in individuals 1.9 and 3.4 million years old (both healed). There’s osteoarthritis in a creature that may have been Homo habilis. An Australopithecus has what looks like a compression fracture in its heel. Another individual sustained, and healed from, a severe high ankle sprain 1.8 million years ago.
Modern-day humans know a thing or two about twisted ankles. The most commonly sprained ligament in the whole human body is a tiny one in the ankle called the anterior talofibular ligament. What’s notable about this ligament, DeSilva says, is that almost none of our living ape relatives has it.
DeSilva’s opinion is that humans evolved this ligament to keep the ankle stable. An upright human is like a balanced stack of blocks, he says. Our ankle bones have flattened surfaces that sit on top of each other, unlike the curved and snugly fitted ankle bones of a chimp. When a human steps on an unexpected rock, this extra ligament in the ankle might be necessary to keep the whole stack of blocks from slipping off its foundation. We don’t dislocate a foot entirely when we trip on a curb—but we might be benched for a couple of months.
Like our ankles, our knees have wide, flattened surfaces that spread out the weight we’re carrying on two limbs instead of four. And they’re large, compared to our body size. “The whole bed-of-nails idea is at work here,” DeSilva says. “Human joints tend to be very puffy.” Structurally, though, our knees are similar to those of our climbing relatives; they have all the same components that a modern chimp’s knee does.
But chimps don’t ever land funny after a layup shot, or change direction too sharply while cutting upfield. That kind of sudden sideways motion is the knee’s downfall, and can rip or snap the ligaments that stabilize the joint.
The infamous ACL sits inside the front of the knee joint, holding the thigh bone in place on top of the shin bone. Its counterpart at the back of the knee is the posterior cruciate ligament. The MCL and LCL, or medial and lateral collateral ligaments, cradle the knee joint on either side and are especially vulnerable to sideways jarring. Too much twisting in the knee can tear the menisci, pads of cartilage tucked inside the knee socket.
Our knees have no problem with the normal folding and straightening of our legs. “When you go too far out of range in the other directions, that’s when you get in trouble,” says Irene Davis.
Davis is a physical therapist and biomechanics researcher at the Spaulding National Running Center at Harvard University Medical School. Despite how often we suffer injuries, Davis says, “I think we’re designed really well for both walking and running.”
Davis cites the theory, promoted by Harvard anthropologist Daniel Lieberman and others, that early humans evolved as so-called persistence hunters. Before they developed effective spears, the theory goes, our ancestors obtained meat by separating an animal from its herd and simply chasing it on foot until it couldn’t run any farther. Researchers point to various skeletal features and cooling mechanisms—and the fact that some people seem to enjoy it so much—as evidence that our species is built for long-distance running.
Of course, early humans would have done it without Reeboks on. In the clinic, Davis advocates what she calls a more natural style of running. She teaches people to land gently on the front of their foot with each step, as barefoot runners do, rather than hard on their heels as people with cushioned running shoes tend to.
Davis believes that wearing structured, arch-supporting shoes makes feet weak and lazy, and that this weakness leads to common foot injuries such as plantar fasciitis. Yet feet are largely ignored until they give us trouble. “You don’t see people at the gym strengthening their feet,” she says, but you should. “Strong feet are healthy feet.”
Despite what DeSilva sees as evolutionary patchwork, Davis thinks the human foot is “just a fantastic structure.” Each time the foot hits the ground, it must be both flexible enough to absorb shock and adjust to uneven terrain and rigid enough to push off of again. Davis thinks the problems come when we don’t use our feet and legs as evolution intended.
When treating patients with overuse injuries, Davis teaches them to run with better mechanics so they avoid getting the same injury in the future. Runners receive feedback on their motion from tools such as accelerometers or mirrors, then practice carrying their bodies in better alignment.
Davis says people can also be taught to prevent future acute injuries such as ACL tears. Most ACL injuries are non-contact; as Darrelle Revis knows, one awkward step is all it takes. So there are programs that teach athletes to land their jumps more gently, or aim to strengthen stabilizing muscles around the knee to protect its ligaments. Though some people will still choose to put themselves in the paths of linebackers, they can at least learn ways to run and jump that put less strain on their vulnerable ligaments to start with.
Having recovered from recent injuries of his own, Jeremy DeSilva will be lacing up his minimalist Nike Free sneakers to run a marathon this weekend. Influenced by the research on barefoot running, he’s left cushioned sneakers behind and is now propelling himself more like his Australopithecus subjects did. “I guess I take my work home with me,” he says.
Davis runs completely barefoot, though in the winter or when she needs more protection for her feet she’ll wear a minimal covering such as water shoes. She also rollerblades.
One sport Davis doesn’t enjoy is football. “I don’t like watching the injuries,” she says. “I see a big pile of people with someone underneath it and it just drives me crazy.”
Image: Cpl. Michelle M. Dickson
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