Sunday, February 15, 2009

Lost in Space

Recent research has now confirmed how we process are movements. We have two ways we measure where we are in space without thinking about it. The first way is with something called plate cells. Plate cell are neuron's connected to the hippocampus. If you are in your kitchen and you are navigating to the refrigerator in the dark you are activating the plate cells, Grid cells help place where your body is regardless of context.The cells allow you to triangulate where you are in space.

The ability to tap into practiced movement patterns works a little
differently. While we are learning the movement we are using the conscious
part of the brain known as the I-function. Once we have learned the movement pattern we can access the practiced movements and go on auto pilot. The I-function does not have to be burdened. When we have learned a movement sequence it becomes more difficult to consciously think about the movements versus just doing it. Imagine thinking about each key stroke while you were playing the piano or thinking about
what your arms, torso and feet are doing playing golf or jumping a 360 off a ski jump. Much of coaching performance revolves around not over thinking movements. For some
unbelievable feats of agility copy the following link:

We use this knowledge to retrain our body after injury. A good example is
how we rehab after an ankle sprain. A wobble board stimulates the
vestibular cortex. People adapt quickly. This helps recalibrate your ankle balance after an injury. Diabetes can cause nerve damage that alters the feedback loop with propioception.

Saturday, February 14, 2009

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 to incorporate your workouts into your daily life whether it be your commute to work or at home.

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.

Wednesday, February 11, 2009

Floyd Landis & Santanna Moss Put Steroids Back in the News "Spin, Wash & Repeat"

Floyd Landis & Santanna Moss put Steroids Back in the news "Spin ,Wash & Repeat "

With Floyd Landis's new allegations impicating Lance Armstrong and other big guns a la Jose Canseco plus Santanna Moss's HGH link allegation here is a the low down on the differences between all the acronyms EPO, HGH, & steroids. If the charges stick aging vets like TO may get a second shot for playing time.

The Legacy of Steroids

Do you remember the night before the big fight in Rocky where he visits the Spectrum only to find that the banner of him has the colors on his boxing trunks reversed. The promoter who happens to be there that night responds to Rocky's soft protest with "It doesn't really matter, Rocky, does it. I'm sure you'll put on a good show." The show has taken over pro sports and our
cultures obsession with being the best at any cost is overshadowing the athletes who are training hard a la old school

In 1935 Koch was able to isolate 20 mg of steroid material from 40 pounds of bovine testicles from the Chicago stockyards. In 1935 the first testosterone was synthesized from cholesterol by a scientist named Budenant of Schering. 1 week later Ruzicka working under Ciba announced a patent for the synthesis of testosterone and the two scientists working independently shared the Nobel prize in chemistry.
Between 1948-1954 Ciba and Searl sythesized many analogues of testosterone. In 1954 at the weightlifting world championships, after being invited out to a bar the Soviet team doctor confided in the US team doctor John Ziegler that his team was using testosterone. Ziegler began using them for his team and later began working with Ciba to synthesize diabanol (methandosterone).

The IOC banned the use of Steroids in 1967. Prior to the ban the Germans used and researched steroids extensively. In 1972 the IOC began a full testing program for detecting steroids.

The anabolic steroid act of 1990 made steroids a schedule III drug along with morphine and amphetamines. It is illegal to use schedule III drugs without a doctor's prescription. The sale of steroids on internet is governed by the point of purchase. There are some jurisdictions where the sale of steroids is permitted without a prescription. It is not uncommon for websites to sell steroids and offer advice about how to mask detecting them.

Who is using Steroids in the US?

The Mayo Clinic estimates that 10% of the anabolic steroid users are teens which accounts for about 300,000 . A survey of 12th graders in 2000 showed 2.5% had used steroids while in 2004 the number climbed to 3.4% One survey found that 6.9 % of football players in Indiana had used steroids. Surprisingly, the main motivation for kids as reported by several studies was not scoring touchdowns but looking buff, one of our country's other national obsessions. Another misconception is that children emulate their sports heroes behavior. According to a Sports Illustrated poll 99% of the respondents that they would not use steroids because pro athletes use them. A study in Pediatrics showed that 65 % of teens would consider using steroids if they thought it would make them reach their athletic goals even if they might cause them harm. 57% said they would even if it meant shortening their life.

On the Bubble

Some athletes lose their chance to compete because others are cheating. The pressures to perform begin at an earlier level than ever, just ask any travel league athlete. As sports become more institutional the pressures to perform increase. Parents can add pressure and sometimes provide financial backing for steroids. Some athletes feel compelled to cheat to survive the last cut or to go from bench warmer to starter.

Remember that anabolic steroids build up muscle tissue but pose unique medical risks for children. They can stop the production of testosterone, which will inhibit skeletal growth in teens. There is increased risk of knee and ankle injuries because the ligaments may not be able to withstand the forces generated by the larger steroid enhanced muscles. Also because the kids taking steroids are bigger, stronger and faster there is a greater chance of injuring other player in contact sports. A largely overlooked risk in the mainstream media is that because much of steroid traffic is underground, there is a greater likelihood that the steroids used will be at or below veterinary grade making them more dangerous. The internet appears to be the pharmacy of choice for teens and is widely used for illegal purchase despite the postal sevice’s efforts to crackdown on illegal shipments. Steroids use is linked with a higher early death rate. In a study reported by the National institute of Drug Abuse mice given steroids at levels proportionate to athletes for 1/5 of their lifespan experienced a higher early death rate.

Other Medical Risks

It is important to note that there are important differences within the class of anabolic steroids. The oral 17 alpha forms are the most dangerous. The differences arise because this form of alkylation was developed expressly to allow oral steroids to have significant effects, meaning they will withstand a first pass through the liver thus increasing the liver’s exposure. There is evidence that long-term use of anabolic steroids in the oral form may damage the liver including necrosis of the liver. The injectable form has minimal exposure within the liver. Steroid use can also lead to lower HDL cholesterol and increased LDL levels and triglycerides. The data is scant for a direct causal relationship between cardiovascular disease and steroid use but cohort series suggest a link. Steroids impair glucose tolerance and increase insulin, a state that mimics type 2 diabetes.

What About Roid Rage?

Research on mood swings is still being reported but there are some important statistics. It is estimated by medical experts that 1-2% of steroid users will experience some extreme form of behavior. 3 of 4 studies documented some irritability with steroids giving scientists the hypothesis that some but not all steroids may cause mood changes. One study using testosterone vs. placebo found increased aggressive behavior in the placebo group leading the investigators to the conclusion that a placebo effect may be responsible for these behaviors. Within the individuals variability was noted suggesting a wide range of steroid affects on mood. Anabolic steroid can create withdrawal symptoms when suddenly stopped. This may lead to violent episodes. In addition, sudden cessation of steroids can lead to increased intracranial pressure that can be life threatening. 9.3 % of drug abusers in a drug recovery program reported previous use of anabolic steroids. Many feel this secondary drug use is due to insomnia and irritability associated with steroids.

Signs of Steroid Use

One of the main points that most people do not realize is that because of the masculine changes steroids cause, the upper body muscle development distribution is greater than the lower body. Deepening of the voice, breast reduction, and body hair growth are changes noted in women. Testicular atrophy and development of breasts are changes that can happen to men.

Other Performance Enhancing Drugs

Human growth hormone is another agent that is used to increase lean muscle mass an increase bone density. Like steroids they are banned in sports. Popularity of HGH increased after a 1990 New England Journal of medicine article in which there
was some misinterpretation of the conclusions leading some to view HGH as an anti-aging elixir. The performance benefits if any and side effects are not nearly as dramatic. In theory it can increase the chance of developing diabetes. There is a legal homeopathic inhalent version of HGH which is available. EPO is a genetically engineered version of a natural hormone produced by the kidneys that increases bone marrow activity to make more red blood cells. Dangers of EPO use include heart attack and stroke. Over the counter supplements like creatine canbe harmful and are banned by the NCAA and the Olympics and NFL. Creatine can cause cramping and diarrhea and has been linked to muscle injury and kidney problems.

The Problems with Testing

Although testing has gotten better many feel that the testing can’t keep up with the cheaters. WADA has a budget of about 24 million but it is hard to keep pace with the designer steroids that some elite athletes use to evade detection. That’s the opinion of experts like Dr. Charles Yesalis and Don Catlin who runs a company called Anti-Doping research. Some drugs like epo are hard to test directly and use an indirect test of a hematocrit above 50% before confirmatory testing. One group of high schools randomly tested 500 athletes to yield 1 positive steroid result. At $175 per test a more cost effective way of prevention may be an emphasis on education.

Education on steroid use is largely regulated to posters in wrestling rooms etc. with no formal curriculum. Given the rise in use by teenagers it would make sense to offer some steroid awareness curriculum before major competitive high school sports programs. Steroid awareness can also be raised in local community athletic programs. Positive adult role models can help.

Above and beyond the health risks what kind of message are we sending our children when we have many parents putting pressure on their children for achievement and institutions that have been so slow to embrace a steroid free culture ? It’s ok to cheat as long as you don't get caught? Gary Hall Jr., Olympic gold medal winner in the 50-meter freestyle may have summarized it best when he said that we live in a society where we are innocent until proven guilty-the key word being ‘proven’. We don’t have any way of proving people are cheating.” He points out that many athletes have been implicated in steroid use by scandals such as Balco rather than through testing with the World Anti-Doping Agency (because of the difficulty in getting positive steroid tests.) Bill Moyers wrote that when we give up the fight to ensure an equal playing field we have given up on the bedrock of democracy itself. Athletes and others using steroids is really a reflection of our society rather than a problem unto itself.