Sunday, November 30, 2008


Recently, a New York Times article summarized some research by the University of Nevada that concluded that static stretching for 30 seconds decreased muscular power of the leg muscles of those that stretched versus those that did not. Vertical jumping and torque was unchanged.Power is the application of work within a finite time. Torque is the application of force and does not require movement unlike work. It is important to remember that athletes have different requirements depending on the sport and stretching should be sport specific."Athletes typically include static stretching as a part of the warm-up, but the evidence is clear that this practice will decrease performance in sports that require explosive movements," said UNLV kinesiology professor and study co-author Bill Holcomb, who directs the university's Sports Injury Research Center. He concludes stretching should be done after sports activity. When I asked Bill Holcomb to elaborate on his conclusions he said “The type of stretching to warmup should be dynamic rather than static to prevent a reduction of power. Then, after activity and during the cool down, static stretching can be used to improve range of motion/flexibility for later performance. “ Warming up is also something that can be overdone at the expense of performance.
“There is a neuromuscular inhibitory response to static stretching,” says Malachy McHugh, the director of research at the Nicholas Institute of Sports Medicine and Athletic Trauma at Lenox Hill Hospital in New York City. The straining muscle becomes less responsive and stays weakened for up to 30 minutes after stretching, which is not how an athlete wants to begin a workout. Another support to the idea of the inhibitory response is that the other side of the stretched leg has been shown to have less power.Stretching muscles while moving, on the other hand, a technique known as dynamic stretching or dynamic warm-ups, increases power, flexibility and range of motion. Muscles in motion don’t experience that insidious inhibitory response. They instead get what McHugh calls “an excitatory message” to perform.
Citing earlier studies, Stacy Ingraham, an exercise physiologist at the University of Minnesota, Twin Cities, says that, "When you stretch, you lengthen muscle fibers. It then takes longer for messages from the brain to travel through them. Stretched muscles also seem to be more sluggish than un-stretched ones. They don't spring back as readily. And every time you stretch, you may be tearing your muscle fibers a tiny bit." Flexibility is speed specific. There are two kinds of stretch receptors, one reacts to magnitude and speed and the other reacts to magnitude only. This also explains why it doesn’t make sense to static stretch prior to dynamic activity.
These receptors are also responsible for the stretch reflex which counters in the opposite direction to the part being stretched.
I have talked with athletes and yoga instructors about overstretching before explosive sports such as soccer and the possibility of too much laxity creating instability and a setup for injury. Clearly there is a balance between how much stretching is done.
This puts into new light the concept of devices such as night splints that use static stretching for structures like the plantar fascia that are already injured. The difference here being that the part is injured and immobilization, a time honored strategy is part of the treatment and the fascia is put at physiologic tension which is not as forceful as a true static stretch. The athletes that use a night splint are also more likley to have a flexibility deficit in the achilles tendon.

Wednesday, November 26, 2008

Efficient Use of Recovey

Words of wisddom by cycling coach BJ Basham on elliminating what we can do without.

Cycling is all about efficiency. It is easy to find stuff we can buy for our bikes that are supposed to make them faster, but the benefits of an efficient training schedule far outweigh any gains that a new set of wheels or carbon bars can provide. A well thought out training plan involves the 2 main components required to improve performance: Overload and Recovery. Your coach can give you specific workouts and there are several tools such as power meters and software to provide you with the most efficient means of getting the right amount of overload, but it is really up to you to make sure you make the most efficient use of the time provided for recovery. It is important to remember that just because you are not on the bike or in the gym, that doesn’t mean you are getting the rest you need to recover from the overload of your last training session.
So what can you do to make the most efficient use of the recovery time built into your training plan. The first step is to look at all the activities in your day-to-day life that might affect your ability to recover. For most of us, this includes going to work and taking care of our houses and families. Then think about what you can do to make the most efficient use of the time you have each day. For example: Could you change your work schedule so that you are not sitting in rush hour traffic each day? Could you work from home? What activities around the house can you change to make more efficient use of your time? Are there elements that add to the level of stress in your life? What can you do to reduce the level of stress? Do you get enough sleep? Are you staying up watching TV when you could be sleeping and recovering?
How about the efficient use of your money to help you recover. As cyclists, we all love to have the latest and lightest equipment, but once your bike is setup to be safe, and a reasonable weight, a lot of thought should go into the next component you buy with the idea that it will make “it” faster. Remember that without the rider, the bike just leans against the wall not going anywhere. You should think about if your money could be better spent in someway to make “you” faster. Since we are discussing recovery, what can you spend your money on to make your recovery time more effective. Most cyclists do not realize that the bike shop is not the only place they should be shopping. For example, a lawn tractor could have a much greater affect on my racing career than a 15 lb bike ever could because the tractor might cut my mowing time down from three hours to only one and also eliminate three hours of walking around in the heat on tired legs. The new expensive gadgets may look cool at the races, but could your money have been better spent to make you faster by helping you to be recovered and ready for the next workout or race.
Always remember that there are two parts to the training formula and that recovery is just as important as overload. You can use your training tools such as your heart rate monitor or power meter to make sure you do not ride too hard on your recovery days, but it takes some personal initiative and self control to make sure that the time spent off the bike also provides the greatest amount of recovery. I read an interview with Chris Horner where he explained that his training program consisted of five to six hour rides followed by the rest of the day spent on the couch. That kind of schedule is not realistic for most cyclists, but it does emphasize the importance of recovery. In order to get the most out of a prescribed workout, it is important that you are fresh and ready to put forth the effort required, which means that you must be recovered from your last workout.
In the old days (1980s) the rule of thumb for cyclists was “Don’t stand if you can sit and don’t sit if you can lay down” . This may be a bit extreme, but the spirit of the rule still holds true. Anything that you can do to improve your recovery can help your performance. And since everything in your life has affect on your recovery, everything can potentially modified to help you recover better

Sunday, November 23, 2008

Running Shoe Cushioning: Perception and Reality

The running shoe industry has built much of its platform on cushioning. In studies by Benno Nigg ,very soft shoes will bottom out when loaded, producing higher impact forces than firmer shoes that do not bottom out. Yet for any of us who have run downhill on concrete the more cushioned shoes seem to be less jarring so how do we reconcile this? I interviewed Benno Nigg, one of the foremost biomechanics gurus on running shoes and he was able to provide a new paradigm which he has published on. He started by telling me that there is no article in the literature which supports the notion that peak force transmission will be altered with varied levels of cushioning. In fact peak force transmission does not occur during heel contact as we might intuit but in midstance where the internal forces in joints muscles and tendons are 4 to 5 times greater than during impact There is something else that accounts for the perception that we are more comfortable in a certain level of cushioning. That something else is explained in Benno' Nigg's vibration model. When we impact the ground our soft tissue compartments (e.g. calf, hamstrings etc.) start to vibrate. However the human body does not like vibrations. Consequently, muscles are activated to dampen these vibrations. The degree of dampening that occurs in various types of shoes is what leads to our perception of comfort in the shoe. Cushioning is better represented by examining the vibrations that travel up the lower extremity according to Dr. Nigg. So we have an innate sense of what works for our bodies that is probably more accurate than any test could demonstrate for us. We must also consider the fatigue that occurs within the muscles that are working to distribute the vibrations. We know from other studies that fatigue can lead to injuries and this may be part of the answer we seek.

Friday, November 21, 2008

Does your Bike Fit You?

I spoke to BJ Basham, a cycling coach out of Fairfax,VA, at length about this and I like his approach of tailoring thingsto the individual as opposed to one set of hard fast rules regarding bike fit. This submission summarizes his views.
Does your bike fit you or do you fit your bike? In other words, is your position on the bike based on the length of your limbs and range of motion about your joints and your riding style, or is it based on the equipment you have chosen or what came with your bike from the shop. Too often, I have found that the latter is the case. Many riders try to adapt the way they ride and the way they sit on a bike to the what the bike allows them to do, as opposed to adjusting the parts on the bike to allow them to ride in a position that is efficient, aerodynamic and allows them to avoid many overuse injuries related to long hours in the saddle. The other mistakes many riders make is worrying about the “look” of their bike or trying to match the position of their favorite pro.
The fact of the matter is that the human body is very adaptable and will learn to work in even the worst riding position over time. There have even been some very successful cyclists who have ridden in very unorthodox positions (check out old photos of Sean Kelly). Another fact is that the damage done by a bad riding position or misaligned pedal stroke may not be noticeable for quite a long time. How often have you noticed a pain in your knee or hips that only comes on when you put in some extra miles?
The goal of a good bike fit is to set the saddle, handle bars and cleats in a position that allows you to turn the pedals efficiently and with no damage to your joints or bones and to avoid undue fatigue. When your riding position fits you, your bones can carry more of the stress of applying power to the pedals and supporting your body, and your joints can work and track within their normal range of motion.
A precision bike fit is one that is based on the length of the bones and the position of the joints that are involved in the process of pedaling your bike. In order to get a precision bike fit, each segment of the limbs involved in the pedaling motion needs to be accurately measured. Short of using an x-ray machine, the best way of getting accurate measurements is by locating and marking anatomical landmarks that can be used to identify the position and shape of the rider’s bones and joints. Using these landmarks, the rider’s ideal position can be determined based on the size and shape of the bones and joints in the rider’s legs, hips, torso, shoulders, arms and feet, and how all these body parts can work together to pedal the bike.
Another challenge cyclists with more than one bike may face is how to make sure they are riding in the same position on whichever bike they choose to ride. It is important to avoid changing your riding position frequently because muscle memory is a very big component of a smooth and powerful pedal stroke. If your saddle height changes up and down and back an forth every time you ride, your muscles will be trying to pull up before your reach the bottom of the pedal stroke or push down while your foot is still on its way up. This lack of coordination can lead to injuries to the joints, muscles and other connective tissue as well as impaired performance. A good bike fit is one that can be transferred from one bike to the next while maintaining accuracy and precision. Remember that your position is your position no matter which bike you ride. What this means is that frame geometry should not have an affect on your riding position. Your butt should still be in the same place relative to your feet and hands.
The type of riding you are planning to do should also be considered when determining your riding position. The requirements of road, mountain and time trial/triathlon riding will result in a different riding position for each style. Aerodynamics, bike handling, sprinting and climbing requirements all have an affect on your riding position.
There are many good fitting systems that use different landmarks and biomechanical measurements and calculations in order to determine the riders ideal saddle, handle bar and cleat position. When shopping around for someone to fit your bike to you, the more precision there is, and the more factors that are included in determining your position, the better. I will admit that there are probably one or two gurus in the world that could look at you and tell you exactly what needs to be changed, but the rest of us need to do some measuring to get it right.
I would recommend that you look for a system that determines your ideal riding position independent of the bike or equipment being used and look for a bike fit professional who will take into consideration other factors including riding style, biomechanical imbalances, physical differences from one limb to the next and neuromuscular issues that may not be fixed by even the most precise setup.
Something to keep in mind if you are planning on having a professional bike fitting done is that the equipment that you currently have may not allow you to achieve your ideal riding position. The seat post or saddle may not allow for the amount of adjustment required or the top tube on your frame may not allow you to get to the ideal reach to the handlebars. The bike fitter will aim to get you in the best riding position, but it will be up to you to take their advice and make the recommended changes.
Also remember that it may take a bit of time for you to adapt to the new riding position. A period of low intensity riding should always be planned for after making any changes to your riding position, especially if the changes are big. Never change your position right before an important event.
Riders at every level have a good reason for having a precision bike fitting done. Riders who only get out once or twice a week will want to be sure they are getting all they can from the time they spend in the saddle and riders who compete or put in a lot of time on the road will want to be sure they are as riding as efficiently as possible while at the same time avoiding overuse injuries from even the slightest misalignment or imbalance.
Remember, your bike should fit you, not the other way around.

BJ Basham is a USA-Cycling Expert coach and an experienced Wobble Naught bike fit professional. For any questions about coaching, bike fitting he can be reached at 703-803-4621 or by email at

Thursday, November 13, 2008

Iliotibial (IT) Band Syndrome In Cyclists

This is a submission from Paul Glodzik, DC
An injury that often plagues cyclists as well as long distance runners is IT band syndrome. The symptom most commonly reported is severe pain just above the lateral aspect (outside) of the knee. This usually occurs when there is a sudden increase in training volume or improper bike fit. To fully understand how this occurs I will need to explain the anatomy and the biomechanics of the knee. The IT band is a tough thickened piece of fascia that starts at the lateral aspect of the iliac crest of the hip and extends down to the patella (knee cap), tibia (shin bone) and biceps femoris tendon (part of the hamstrings). Fascia is a type of connective tissue that surrounds muscles and tendons and allows the muscles to glide over each other more easily.
The IT band functions to stabilize the lateral aspect of the knee. It was believed that the IT band would rub against the lateral condyle of the femur (outside edge of the thigh bone) or a bursa (fluid filled sac) and cause pain. Newer research has shown that this is not the case. Most individuals do not actually have a bursa at this location.(1) There is a highly vascular fat pad that is located beneath the IT band at this location. When the knee is flexed (bent) the tibia rotates internally (inward) if there is no compensating external rotation of the femur (hip bone) the IT band increases compressive forces on the lateral aspect of the knee. The increased compressive forces prevent blood flow from passing through the above mentioned fat pad. With the decreased blood flow inflammation occurs within the fat pad causing pain. The pain is usually at its highest intensity when the knee is flexed at 30 degrees.
IT band syndrome is usually treated conservatively with rest, ice, anti-inflammatories (try Bromelain it is a proteolytic enzyme that has the same effect as aspirin or ibuprofen without the side effects of gastric bleeding and increased stress on your liver), stretching and rehabilitative exercise. In a small percentage of patients that have recurrent IT band syndrome surgery is performed to release the posterior aspect of the band.
If you notice that you are starting to experience pain in your knee that is similar to this the best thing to do is to take time off your bike. Now I understand that is not something most cyclists want to hear. It however may be a necessary step to reduce the pain. To aid in the reduction of pain stretching and rehabilitative exercises need to be completed. A recent study on IT Band problems suggests this stretch. Start by standing on the right leg and place your left leg behind and across the right leg. Make sure that you are close to a wall for balance with the right side closer to the wall. Now lean your left hip away from the wall and reach toward the left foot. You should feel a stretch in the outside of your left leg and hip. It is also important to have proper therapy performed on the IT band. There are soft tissue techniques, such as ART (Active Release Techniques) and Graston Technique, which are designed to help break up any adhesions that are present in the IT band.
More important than stretching is dealing with the cause in most cases. The gluteus medius (one of the deep buttocks muscles) is usually very weak in patients that have this syndrome. The gluteus medius is one of the external rotators of the hip and the muscle that is most active when attempting to stabilize the pelvis on one leg.. When your hip is flexed to 90 degrees the gluteus medius helps externally rotate your femur (thigh bone). When you are at the top of your pedal stroke both your hip and knee are flexed. This means that the femur should be externally rotated with the tibia internally rotated. With a weakened gluteus medius the femur stays internally rotated. This causes the fat pad at the lateral aspect of the knee to be exposed to the increased compressive forces from the IT band. The gluteus medius can be strengthened by performing exercises on one leg. By performing these activities the majority of patients who suffer from IT band syndrome receive relief of their symptoms. A good exercise to strengthen your gluteus medius is a one leg step down. Start with your right leg on the edge of a step and the left leg off of it. Now begin to lower yourself onto your left foot (make sure to land on your heel and not the toes). This is accomplished by sitting back and bending your right knee until the left heel touches the ground. Once you have touched the ground push back up. Do not let your right knee collapsing inward. Make sure to keep your knee over your foot. If you have any questions contact
1) Khaund, R and Flynn, S Iliotibial Band Syndrome: A Common Source of Knee Pain American Family Physician 2005 Apr 15;71(8):1545-50

Thursday, November 6, 2008

Straight Talk on Steroids

Thursday, October 23, 2008

Eddy Van Guyse 35 Years after "Breaking Away"

Some of you may not know Eddy Van Guyse by name but you will remember the hit out of nowhere that he played in;"Breaking Away". Eddy played the Italian villain that put a bike pump into the spokes of the young Italian bike racer wannabe Dave Stohler and shattered his view of the way the world really works. The movie had a great script and Peter Yates directing of "Bullitt" and "The French Connection" fame but it needed someone with racing experience to breathe authenticity into it. That someone was a young Belgian bike racer who grew up in Chicago 3 blocks from Wrigley Field, named Eddy Van Guyse. Eddy told me he won the part with his swarthy Italian "look" and wore a shirt with the top buttons undone chest hair and all. I saw the film when I was in high school and after getting goose bumps watching the bike racing scenes decided I.U. was the place for me. I've gotten to know Eddy through our mutual continued interest in cycling through the CSC bike race in Arlington and the bond from riding in the Little 500 at IU in different eras. I've had the conversation since, that had he not lent his technical expertise to the film it probably would not have rung true even though it was great story and I never would have ended up going to Indiana.

Ben: Eddy do you think kids today will relate to "Breaking Away" the way that my generation did in the late 70's?

Eddy: I think humans have not changed at the core. We all have brains, hearts and blood pumping through them.
Kids today may have a stronger index finger from punching the buttons on video games and computers but they still relate to a good story. One thing I find is that kids have more trouble making eye contact and connecting in general. The best teachers i had growing up were also able to articulate a good story.

Ben: You've told me in the past that Peter Yates pulled you aside for technical advice on the movie "Breaking Away".
You put the kabash on the bikes with reflectors and coaster brakes that were going to be used for the movie.

Eddy:When I met Peter Yates I asked him if he wanted to make a movie that had bike rides featured or did he want to make a movie about bike racing.
There were some things on the bikes that they gathered that not give the look of a bike racing movie. He said "Eddy we need to talk to you more about this "

Ben: You mentioned that you were a pretty good baseball player and being 3 blocks away from Wrigley field, what made you choose bike racing over baseball?

Eddy: We played makeshift baseball with a rubber ball against a wall in an alley painted with a square. This was the era of free range kids. My mother called us alley cats and would say things like "Come inside you alley cats!" as it approached 9 o clock at night. My family took me to the velodrome races in Konshen and Northbrook in Chicago and I could see that they admired the racers as I did and I decided I wanted to become a bike racer. The decision was of my own free will. My parents encouraged me to make my own choices.

Ben: You told me your father was a big influence in your life and that he was a people person and that's where you got that gift.

Eddy: My father survived three months in a concentration camp during World War 11 and almost a year after he was deported to a work camp. When we came to Chicago he was very good at reading people. He could smell a rat and one thing I remember was how he was very outspoken aabout Fidel Castro being a dictator when he rose to power before it became apparent to everyone. The Belgian community in Chicago was important to my father.

Ben:What would you tell someone who wants to be a bike racer.

Eddy: Are you ready to deal with pain. People also don't realize how lonely the training can be to be. A champion is able to ignore the pain

Ben: How did you develop as a bike racer?

Eddy: I was 5'6" my freshman year at !U. When I was an intermediate racer I could not crunch down the big gears like the big boys in the sprints on the track but I had endurance. I finished my freshman year at 6 foot. Now I was able to add
more power to my racing but my strength was as a road racer.

Ben: You've said before that the "Little 500" race felt like a gladiator entering the arena...

Eddy You have no other intramural event like it with a stadium built for 30,000 people for a bike race. The other thing about the "Little 500" is that it is a team race. I've done Madison races and other amateur team events but this was a more defined team event. The racers that have been through the Little 5 at I.U. become like your brothers.

Ben: What are your views on professional sports in America.

Eddy: I have a 4 letter word for what pro athletes do: P-L-A-Y while the rest of us
W-O-R-K. Athletes should keep this in perspective.

Monday, October 6, 2008

Imaging Sports Injuries

Many athletes tend to “push through the pain,” continuing to work out even when it hurts. There are times when you may just be fighting through muscle fatigue, and continuing your workouts makes sense. If you are having severe pain or other physical symptoms, such as limitations in motion or giving way, these are more likely to send you to see a health care professional. Athletes often continue to train through chronic or lower grade pain, however. Unfortunately, continued stress of an injury or abnormality say lead to serious consequences. Continued ligament or cartilage damage may lead to the need for corrective surgery. How do you know if you are one of the athletes who could develop serious consequences from continued workouts without treatment?

The first step in evaluating a sports injury is seeing a health professional. They will do a physical exam, and will probably order xrays. Xrays will pick up bone changes, and may suggest a soft tissue injury. Many subtle abnormalities are not visible on xray, however, and CT or MRI is needed as the next step in evaluation. CT is best at looking at the cortex of bone- the hard shell around the softer inner marrow. This is good for looking for a fracture, stress thickening of bone cortex (early stress changes before a fracture), and degenerative bone changes. Newer “multi-slice” CT scanners can now image your leg or arm in just a few seconds, with crystal clear pictures of the bone. Software allows the reconstruction of the 2 dimensional CT images into 3D pictures which improve diagnostic accuracy.

MRI is best suited to looking at the marrow core inside the bone cortex and for evaluating all the many soft tissues that you use in sports (muscle, tendon, ligament, and cartilage). There are many injuries an MRI can demonstrate that would be missed on xrays. A meniscus tear in the knee of a runner, a rotator cuff tear in a tennis player, or a ligament tear in the wrist of a golfer, for example. These could be repaired surgically. Ignoring the pain from one of these injuries may lead to degenerative changes in the bone that could not be repaired easily, and could curtail your continued sports activity. Milder injuries seen on MRI can often be successfully treated by medication, an injection, or physical therapy, getting you back to pain-free training or competition. Newer MRI advances include higher strength magnets, including a 3T closed magnet and 1.2-1.5T open magnets. These are sort of like having higher pixels on your digital camera, giving sharper and better pictures.

CT or MRI imaging may also show that you have no significant abnormality. This could free you to continue training as tolerated, without the worry of having bone or soft tissue damage. Treatment of your pain or injury, or the peace of mind from knowing there is no significant soft tissue or bone injury, is a great reason to talk to a health professional if you are having pain. This can help you keep reaching for your personal athletic best for years to come.

This is an editorial submitted by Dr M. Kraut, MD. Dr. Kraut is a board-certified musculoskeletal fellowship-trained radiologist who also trained first as an orthopedic surgeon. Dr. Kraut has competed in swimming and track, and also completed several triathlons. Dr. Kraut works at MRI of Richmond, and reads musculoskeletal cases for Tyson’s Corner Diagnostic Imaging and Vienna Diagnostic Imaging in northern Virginia. Website

plantar fasciitis

Wednesday, October 1, 2008

Paul Newman

Not a sports medicine post per se but this video of Paul Newman's charitable foundation reminds us that giving is sometimes better than recieving and something we can all strive to emulate.

Saturday, September 20, 2008

Cross Training

OK, so we all have heard of cross training but do we know what it means. The beauty of cross training is that it gives our muscles a different set of instructions and that will give certain overused muscle a break and enable others to develop. We see this with all sports now. Pro football players doing yoga. Swimmers like Gary Hall Jr. using boxing training as part of their dryland routine. And who could forget the prototype for cross training, Bo Jackson?
I think that many times people develop overuse injuries because they fail to give their bodies a change of routine and intensity.
It is also good for the psychology of training .More later... You know I read this book that said that it takes reaching about a hundred people to find one person thats willing to contribute an idea. Well here's hoping that this finds that one. Let me know your ideas.

Sunday, September 14, 2008

Power Yoga: For better balance and strength

Power yoga is one mode of training that creates strength along with flexibility and balance. Although yoga videos are useful, the optimum environment to learn yoga is in a studio or class. The difference between yoga and stretching is that yoga is more dynamic and is a closer simulation of athletic activity. You are moving through the poses in many positions and transitioning between the positions. In the coming months I will put together a visual article of 4 yoga stretches with the assistance of my yoga instructor that can be used as a supplement for a yoga class when time does permit attending one. Until then many classes will offer introductory sessions so that you can find the right pace and intensity that is right for you. For me, yoga has helped me avoid a second surgery on my knee, eliminated my previous back pain, and helped me with better balance and strength with skiing and soccer in particular. Many of my patients have exhibited dramatic improvements after attending yoga classes. So go do it! Take a yoga class! For info on power poses here is a link:

Fatigue and Injury

We all know the effects of individual muscle fatigue on injuries, your leg muscles get tired and all of a sudden you injure your knee. EMG studies have shown that the anterior shin muscles fire 85 % over their fatigue threshold in running. Hence it is no surprise that many runners develop shin splints. It turns out that over all fatigue plays an important role just as localized muscular failure to an area. No one has been able to prove decisively why this happens but it is probably multifactorial. As our
form degrades we are in a less stable position to prevent injury. It is also reasonable to assume that as you fatigue the brain's ability to execute precise movement patterns also degrades. What to do? Develop the core and support muscles. Heighten the body's spatial awarenes with agility drills. This is why track work deconstructs the running stride and uses drills to help perform more efficiently.

Monday, September 8, 2008

Balance, Injuries and Tom Brady

I watched the replay of Tom Brady's ACL injury on his left knee and it struck me that he was somewhat tentative before he through the pass. Was it because he didn't take reps with no exhibition games under his belt or was he still favoring his injured right foot from last year. Even he may not fully know. We make a lot of small adjustments in athletics subconsciously. One thing is for sure is that he has a steep road to recovery in the NFL with that type of injury. He is a professional and you can't second guess starting a star like Brady in the season opener. Most of us do sports for fun and the lesson here is that one injury can impact another injury even when you don't realize it. I did not scream when I tore my acl and had a bucket handle tear when I hurt my knee playing soccer so I can only imagine the other structures that were damaged with his injury. Many pro skiers continue after a torn acl because their leg muscles are so strong but with football there will be no choice but a full reconstruction.

Thursday, September 4, 2008

Remembering 9-11 and St. Paul's Chapel

Standing on the viewing platform of the World Trade Center site, I was not fully prepared for the deep emotions I experienced nearly six months after the devastation. In March of 2002, I spent a weekend volunteering at the medical clinic located in St.Paul's Chapel, which was spared by the September 11 blast and served as the immediate triage station after the disaster. I still get chills when I think about the time I spent at the chapel and ground zero. The chapel continued to serve as a medical clinic and source of refuge for the firefighters, police officers and recovery workers. Before my shift began, I went to the excavation site. Around the perimeter,the heat-seared midsection of a skyscraper served as a painful reminder of the lives lost. Huge banners lined Broadway, honoring the firefighters and police officers for their heroic acts. Shrines set up by the victims' friends and families surrounded the chapel.
Inside the chapel, the clinic coordinator explained that the workers sought relief not only for their feet; they needed someone to talk to. The chapel also served as community where workers could pray, rest on cots, or have a warm meal served by volunteers. The spirit of the police officers there spanned all emotions. Many officers shared jokes. Others, more solemn, sat reading children's letters of encouragement. One officer was stoic until a group of children sang and then hugged each of the civil servants in the chapel. I'll never forget how he let go of some of the pain if only for a few moments as he closed his eyes and smiled in their embraces.
The people I treated appreciated the convenience of having care available at a moment's notice. Most of my patients worked grueling 12-hour shifts. Some workers improvised their own podiatric supports: one construction worker came in limping with a makeshift splint made out of tape slung from behind her heel to the base of her toes, holding them upright.

Near the end of the shift, a protocol officer asked me if a calling had brought me to the clinic. I told him I considered it a privilege to help make his fellow officers more comfortable. While reflecting on the conversation on the drive back to D.C. I thought about my friend Jimmy from college who made it out of one of the towers on the march down the stairs and a doctor from Arlington I knew with a young family on a west bound plane who did not. I thought about my cousins who I stayed with across the river in Brooklyn who were living with the traces of the aftermath in the faces of their friends and neighbors. It occurred to me that the "calling" he was talking about is the reason most of us in healthcare embark on a career in medicine. Sometimes it takes an experience like this to remind us why we started the journey in the first place.

Tuesday, August 26, 2008

Aqua Velo, Its not an aftershave!

Well after my wife catching the triathlon bug after doing the bike leg of the Columbia Iron girl I decided I better step up to the plate. Great thing to train for as a couple and I saw my wife Laura morph from non-athlete to triathlete. I was proud of her. Its only taken 10 years of marriage for me to rub off on her! Because I have a chunk of cartilage in my left knee gone on my femoral condyle after a second ACL/medial meniscus knee injury doing excessive plyometrics I have opted for an Aqua Velo. I am still deciding which one and was tempted by the Chesapeake Man which features a 2.3 mile swim but it has been over 10 years since my Olympic distance triathlon and priority number one is not to drown and I think I should start with a shorter open water swim.
I am open for suggestions. For those not familiar an aqua velo is a stand alone event but more frequently part of an organized
triathlon in which you only complete the bike and swim segments. A way for the 40 something set with bad knees to get back in competition and put off the appointment with your friendly neighborhood orthopedist for a knee replacement!

Friday, August 22, 2008

No Bolt from the Blue

Usain Bolt broke three world record while gathering 3 gold medals in the mens' 100 meters and 200 meters and 4x100 meter relays in this years Olympics. Never been done. The New York times recently raised speculation as to whether or not his performance was clean. The issue was also raised as to the improved performance of the whole Jamaican track team. Usain was beating older athletes at 15 in Jamaica so he is no bolt from the blue. I'm a podiatrist and make my living watching movement patterns. There is no wasted energy with Bolt (other than his celebratory arm waving just before the finish). If thats the way he can do it more poer to him! At 6'5" his head does not move up and down and he is tight getting out of the blocks (little lateral movement). Having said that I choose to embrace his accomplishment with the recognition that there is uncertainty with respect to PED use in modern sports. To acknowledge some uncertainty is not bashing the performance of an athlete like Bolt. It is living in reality.

Tuesday, August 12, 2008

Newton: Function vs. Hype

The Newton running shoe is part of the forefoot running craze. The concept was put together by 2 guys that got the thumbs down from Saucony on their idea. The premise is that forefoot running is more efficient and that the nature of the design is
more suited for forefoot running The concept of energy efficiency is especially attractive to the triathlete community as they are all about energy efficiency on that third leg. It has an energy return system on the forefoot hence the name Newton which is supposed to provide energy return. As I am a podiatrist, I tend to see only the folks that are having problems and this is what prompted me to write this piece. I had a patient that was not a competitive runner that developed shin splints after switching to running with the Newton shoe. The trouble with making the switch to the Newton is that many runners do not have the level of conditioning or the efficiency in their forefoot running to make the transition. My patient had both these problems. There is another subset of runners/trend setters that are simply caught up in the boutique aspect of the shoes at $175 a pop. If John Mayer is wearing them on that you-tube snippet in West Hollywood I must get a pair. The reviews from the running shoe stores have been mixed as well. One running shoe specialist I spoke with reiterated the concern that if you are not a forefoot runner to begin with there may be some breaking in soreness. Others have reported calf and achilles pain. A japanese study reports that elite marathon runners fared better with a forefoot/midfoot striking pattern but is this correlation or causation. the answer remains to be seen.

Saturday, August 2, 2008

Gary Hall Jr. Covering the Olympics

Gary Hall Jr. covered the Olympics and sharing his insights on the competition. His last blog entry is a reflection on what it means to be an Olympian. You will need to cut and past a couple of these into the browser.

Hall's in the house

Walking the Plank

The 2000 US 4 x 400 meter relay track team had the gold medal revoked because of doping by one of the team members. I treated one of the alternate relay members and I wonder what course his Olympic career would have taken had some of his teammates not cheated.

Wednesday, July 30, 2008

VO2 MAX:Know What You're Paying For

SImon Bartlett at Quest Sports Science is My Guest Post:
Considerations for Athletes Prior to Physiological/Metabolic Testing

With the advent of inexpensive, easy-to-use metabolic assessment systems on the market today, the availability of metabolic testing (VO2 max) has grown considerably. Today’s athletes have an array of testing services available to them because of these less costly systems. However, questions remain:

1. How reliable are these cheaper devices for accurately assessing and measuring changes in the cardiorespiratory performance of an athlete?
2. What legitimate scientific research is available demonstrating the accuracy, validity and reliability of such systems?
3. Can the user interpret the data correctly?

Quest Sports Science Center uses one of the most trusted systems on the market today- the ParvoMedics TrueOne metabolic cart. The TrueOne cart is currently used worldwide by many universities in addition to NASA, the NIH and US Olympic Training Centers—a true testament to the system’s reputation! Operation of the TrueOne cart requires extensive knowledge, experience and training to calibrate, maintain and assess outcomes.

Recent scientific studies compared the TrueOne Metabolic Cart with two other popular systems: the CardioCoach (KORR Medical Technologies) 1 and the New Leaf (MedGraphicsVO2000)2. The studies unequivocally concluded that the TrueOne metabolic cart proved to be the most accurate and reliable system for measuring cardiorespiratory fitness. Conversely, the CardioCoach and New Leaf metabolic carts were significantly less reliable demonstrating an overestimation in VO2 capacity at most work rates and the CardioCoach’s inability to measure changes in VO2 resulting from 14 weeks of physical training. Implications for the athlete? Caveat Emptor---Buyer Beware! Results from unreliable systems can produce erroneous data that could be used to establish incorrect training volumes and intensities.

In conclusion, Quest Sports Science Center recommends that an accurate, unbiased measurement of VO2 max by qualified* fitness professionals (exercise physiologists, trainers and qualified coaches) is utilized for a valid and reliable assessment of cardiorespiratory fitness. The data extrapolated can then be effectively applied to the development and implementation of an appropriate exercise program to help the athlete reach their goals.

* American College of Sports Medicine (ACSM) Certified Exercise Specialist and/or National Strength and Conditioning (NSCA) Certified Strength and Conditioning Specialist (CSCS).
* Registered Dietitian (RD) and licensed in the state (LD/LDN).

1. Monitoring VO2 Max During Fourteen Weeks of Endurance Training Using the CardioCoach: Journal of Strength and Conditioning Research, 2007, 21(1), 62-66

2. Accuracy and Reliability of the ParvoMedics 2400 and MedGraphics VO2000 Metabolic Systems: Eur J Appl Physiol, 2006 Aug 3; 16896734 (P,S,E,B)

Quest Sports Science Center, Annapolis, MD, 410-626-1566,

Wednesday, June 18, 2008

my sports medicine blog

I've been a board-certified podiatrist since 1992. I ran track and cross country in high school followed by a short-lived track stint at Indiana University as a walk-on. When I injured my achilles tendon, I switched over to bike racing and tried my hand at IU's Little 500 Bike Race popularized in the 1970's hit movie "Breaking Away."

Years later, I tore my ACL playing soccer just before turning 40. I realized that I would need to take my conditioning much more seriously to avoid further injuries. So I sought out the best rehab protocols and programs out there today. Now I do my best to integrate everything I've learned into my state-of-the-art sports-medicine practice. I try to maintain an active lifestyle: a decade as a snow-ski instructor, road biking, conditioning, and yoga, all of which has allowed me to stay injury free for the past eight years. Part of the key to remaining healthy is ti incorporate your workouts into your daily commute.

I'll be sharing knowledge from my medical practice and my experience with athletes, information that will be useful for both the weekend warrior and more serious athlete: for training and living injury free. Stayed tuned in for special guests--friends and athletes with their own stories to tell. I welcome your feedback.

Evolution Running (Ken Mierke)

Evolution Running, a method developed by Ken Mierke, looks at the optimal biomechanics for the generation of horizontal propulsion,;the placement and foot position of foot-strike, as well as the timing of the propulsive movements, follow through and leg recovery.

10 Commandments of Evolution Running:
1st Commandment: Land with your foot directly beneath your center of mass.
2nd Commandment: Never let your foot extend forward beyond the knee.
3rd Commandment: Land on the balls of your feet and keep the heel unweighted throughout footstrike.
4th Commandment: Minimize contact time between your feet and the ground.
5th Commandment: At any running speed, maintain the same high turnover rate (180 – 182 steps per minute or higher).
6th Commandment: Maintain a straight line from the toes, through the hips, to the shoulders, but lean slightly forward with the hips and ribcage.
7th Commandment: Maintain a constant, slightly-bent, knee angle from just before to just after footstrike. Do not bend or straighten knee for propulsion.
8th Commandment: Begin to pull leg back, from the hip with a constant knee angle, before footstrike.
9th Commandment: Use quick, light movements, not forceful ones, to propel forward
10th Commandment: Immediately after the follow-through is completed, begin to drive the knee forward powerfully. As the knee drives forward, allow the foot to lag well behind during leg-recovery, using momentum, not muscular contractions, to raise the heel.
Like the other methods, Evolution Running teaches runners that the foot should land directly beneath the hips, not out in front. Evolution Running teaches a similar foot-strike to the Pose method, but focuses more heavily on placing the weight on the forefoot at foot-strike, without as much concern with heel contact. Many runners experience severe muscle soreness and injuries when adopting a foot-strike which keeps the heel entirely off the ground. Ken feels that the real issue is where the weight lands. He agrees that the perfect stride has the heel slightly off the ground, but he is not sure that every runner should strive for that perfection, especially immediately upon adjusting technique. He believes that adjusting the technique of a heel striker to a heels-off runner should be a gradual, two-step process. Ken teaches that a runner first needs to learn to land with almost all his weight on the forefoot with very little weight on the heel. After mastering this foot-strike, some may work toward keeping the heel entirely off the ground.
Evolution Running directly addresses propulsion - how and when which muscles contract to move the runner forward. Ken says “Minimizing braking by positioning the foot-strike and the torso optimally is critical to sustained fast running, but ultimately the muscles of the hips and thighs propel a runner forward. Except running downhill, gravity does not propel. The muscles contract to move us forward and there are more efficient ways and less efficient ways to accomplish this movement.
The Pose method's teaching is all in the vertical plane. Ken does not assume, as Romanov does, that if a runner gets everything right in the vertical plane that he/she will automatically generate horizontal propulsion correctly. “The Pose Method provides some excellent insights, but it never instructs how to develop propulsion. The Pose Method simply teaches us to run in place and then lean forward. That, by itself, won’t produce sustained fast running.”
While Ken agrees that the most efficient position from which to generate propulsion is forward leaning, the legs do have to propel us. Evolution Running specifically analyzes the biomechanics of the leg and hip, describes the two incorrect paradigms most runners use, and explains how to correct them. Most runners use knee extension or knee flexion as primary propulsion producers. Ken believes that knee extension produces mostly vertical displacement, with the amount of horizontal propulsion generated not worth the quadriceps fatigue or the time wasted moving up and down. He has found that knee flexion produces efficient horizontal propulsion, but places most of the workload on a relatively small muscle group which fatigues relatively quickly.
Evolution Running teaches that hip extension, rotating the leg backward around the hip, provides horizontal propulsion with minimal vertical displacement and uses larger muscle groups (the gluteus maximus along with the hamstring muscles) to accomplish it. This hip extension keeps the energy cost of generating propulsion lower and spreads the work among greater muscle mass, improving energy efficiency and reducing peripheral fatigue.
Efficient runners begin the propulsive movements before foot-strike, pulling the leg and foot backward before they are weight bearing. This minimizes braking and pre-stretches the elastic tissues to generate propulsion in a forward, rather than just in an upward direction. Pose and Chi runners wait for gravity to pull them down to the ground; Evolution runners proactively pull the foot and leg backward into the ground.
While other methods emphasize a bent-knee leg recovery, Evolution Running teaches runners to use the angular momentum of the leg to “swing” the heel up, rather than hamstring contractions. By overlapping the follow through of the lower leg with recovery of the upper leg, the hamstring muscles can relax, increasing their endurance and reducing fatigue. Evolution Running teaches that the hamstring muscles are propulsive, so runners should relax them during leg recovery, using the hip flexor muscles instead, to initiate leg recovery and relying on momentum to swing the heel up.
Maintain turnover up hills, using extremely short strides. When running uphill, runners will extend the knee, using this movement for the necessary vertical displacement and hip extension for forward propulsion. He also teaches runners to lean exaggeratedly downhill, coasting and allowing gravity to propel.
More information is available at

chi running

A strong mind is important to direct strong muscles, so says the power of Chi.
Dreyer adheres to the Pose Method’s idea that gravity propels. Certainly effective running is largely about technique smoothness and relaxation, but ultimately it is the muscles that create the movement.
However efficient your stride and however strong your concentration and will, every runner needs to develop the muscles with hard training and nurture these muscles with protein. A strong mind is important to direct strong muscles, but the mind cannot perform the movements.
Chi Running points out the basics of several major technique errors that plague most runners and offers the basics of improving biomechanics. It also focuses heavily on attitude and the spirituality of running, which may be useful and important to some runners. Positive thinking and relaxation are important components of efficient running.
Dreyer guesses that using his techniques a runner can probably run their normal pace at about thirty percent of the energy expenditure required using their current technique (though he has never tested this notion). Claiming a seventy percent improvement in running economy is ridiculous. No running technique will enable a runner to almost triple his speed without increasing energy expenditure.
Dreyer describes the use of the core muscles to generate propulsion, instead of the muscles of the hips and thighs. Strong core muscles are critical to any sports activity, but in running the hips and thighs must do most of the work to generate propulsion. He describes increasing hip rotation as a means of increasing stride length, but efficient runners do not demonstrate greater hip rotation, and this technique brings up injury concerns.
In summary, Chi Running provides valuable insight on keeping a strong, healthy attitude about running, and it provides some excellent insight into the most basic aspects of running biomechanics. For athletes interested in tuning in to the spiritual aspects of running, Chi Running is the way to go.

Tuesday, June 10, 2008


Glucosamine sulfate is being uses for athletes with osteoarthritis in the knees. Glucosamine received a grade of A on health line,which gets input from the NIH for its benefit in this area. Most of the evidence suggests that it provides a low anti inflammatory component along with increased flexibility. A study published in the Journal Archives of Internal Medicine examined people with osteoarthritis over three years. People in the glucosamine group had a significant reduction in pain and stiffness. On x-ray, there was no average change or narrowing of joint spaces in the knees (a sign of deterioration) of the glucosamine group. In contrast, joint spaces of participants taking the placebo narrowed over the three years. I usually have my patients try a 3 month course to see if it works for them.

Saturday, June 7, 2008

Massage and Recovery in Sports

It is no secret that people feel better after a massage but not everyone realizes the benefits of massage for sports recovery and
injury healing. Massage loosens up tight muscles which in turn helps circulation because tight muscles will constrict the blood
vessels diminishing the blood flow which provides nutrients, healing cells and warmth for optimum muscle contraction. This is why every pro bike team employs a soigneur for their athletes. The soigneur takes care of the massage and nutrition for the cyclists and they select balms before and after competition to keep the muscles warm and loose. Many sports medicine clinics including my own employ a sports massage therapist.

It has been said that the calf is the bodies second heart and it is no surprise that the calf can cramp up during athletics particularly when the temperature is cold or hydration is inadequate . The calf muscle needs such an extensive network of blood vessels because of the demands we place on it in sports as well as every day activity. When there is inadequate blood flow the
muscles can cramp and individuals with peripheral arterial disease may even develop life threatening clots in the legs.

If you have trouble getting to a professional massage therapist which is the best option there is information in books and the internet on self massage. Stretching, especially the achilles tendon is often done in conjunction with massage.

Friday, May 23, 2008

diagnostic ultrasound

About 10 years ago imaging with diagnostic ultrasound became available for identifying muscle and tendon and ligament tears, soft tissue lesions such as cysts and general review of anatomy. Unlike an MRI it is a real time study much like an ultrasound study to visualize the heartbeat of a baby. You can actually see a tear in a tendon when you stretch the tissue. One common injury we see is plantar fasciitis. The thickness of the fascia can be measured which can help to tack swelling and progress. When the achilles tendon is scanned you can see the cross section of the tendon and find out if there is damage inside the tendon sheath. The benefit of the study is determined by the experience of the sonographer. You can see some examples at

Wednesday, May 21, 2008


Arnica has bee used to treat arthritis,muscle soreness and inflammatory conditions in Europe and is now gaining more wide spread use in the US. A 2007 study by Widrig out of Switzerland compared arnica favorably to NSAIDS for osteoarthritis. By contrast on healthline arnica has a grade of C for pain associated with osteoarthritis. The NIH did not find any difference with respect to bruising versus placebo. I found one study on arnica taken by mouth from a double blinded placebo controlled trial from the Oslo Marathon which demonstrated decreased soreness but no measurable changes in enzymes.
I have not used the oral version for my patients but have had anecdotal success with the topical gel. The oral version at certain
levels can have side effects. Currently the oral is not approved for use by the FDA. I carry a 12% version of the gel made in Germany in my practice and have seen 7% available at drugstores.

Friday, May 16, 2008

Power Yoga: For better balance and strength

Power yoga is one mode of training that creates strength along with flexibility and balance. Although yoga videos are useful, the optimum environment to learn yoga is in a studio or class. The difference between yoga and stretching is that yoga is more dynamic and is a closer simulation of athletic activity. You are moving through the poses in many positions and transitioning between the positions. In the coming months I will put together a visual article of 4 yoga stretches with the assistance of my yoga instructor that can be used as a supplement for a yoga class when time does permit attending one. Until then many classes will offer introductory sessions so that you can find the right pace and intensity that is right for you. For me, yoga has helped me avoid a second surgery on my knee, eliminated my previous back pain, and helped me with better balance and strength with skiing and soccer in particular. Many of my patients have exhibited dramatic improvements after attending yoga classes. So go do it! Take a yoga class! For info on power poses here is a link: