Pushing the Limits on Performance and Recovery

The cover story in this Sunday's New York Times Magazine has a compelling story about ski jumper Sara Hendrik's bid for the 2014 Winter Olympics. She out jumped the training facility safe zone in Germany soaring one and a half football fields. Her landing was good except she came in too fast and ruptured her ACL,MCL and meniscus. She is now racing the clock to try and get her knee rehabbed in time for the Winter Games putting 35 hour weeks at the gym. If she succeeds this will be one of the more prolific comeback stories in Olympic history considering how recent the injury was. It is inspirational to see that type of perseverance after such a crushing injury. Good luck Sara, hope you can be the 2014 Olympiad come back kid!

Why Don't MEN DO Yoga

This week the health section of the Washington Post posed the question why men shy away from yoga. http://www.washingtonpost.com/posttv/video/thefold/why-dont-men-do-yoga/2013/10/24/faf02a8a-3c2f-11e3-b6a9-da62c264f40e_video.html It is a stigma for some guys but many(including yours truly)have experienced the benefits after injuries. Once the benefits are are know you begin to understand the higher level of yoga to overall health and well being. It is no coincidence that some NFL teams use yoga in their training. It is more widely recognized in Olympic sports development. Both Gary Hall Jr. and Sr. were big early proponents in their dry land swim training and coaching. Recently I bruised a rib after a skateboard injury after a challenge by my daughter that can only be described as more Homer Simpson than Bode Miller. By going to a studio that has smaller numbers you are able to get modifications to help you open up the muscles that are in spasm while protecting against further injury.Sustained practice will also help your ability to limit the extent of injuries and recover more quickly.

Jim my plantar fasciitis is Cured !!!!!

My plantar fasciitis Has finally improved!! I would attribute this to consistent use of my orthotics and FS6 Plantar fasciitis sock. I was able to continue to play soccer and a new pair of cleats helped. I chose not to wear a night splint. I did not inject my heal with a cortisone shot and was on the verge of trying a another laser treatment. I had tried two treatments prior. It's always difficult to say what exactly cured it and I still have an occasional twinge or two. I think that being out of commission with my back for a couple of weeks may have been the final forced rest I needed to get better. You have to have a a self awareness that continuing to do distance running or in my case explosive sports like soccer can cause setbacks but then the alternative is going back to the black and white TV version of your active life versus the color deluxe version.

Washington Nat's Jordan Zimmerman Sidelined with Plantar Fasciitis

Nat's 1st baseman Jordan Zimmerman was recently sidelined with plantar fasciitis.A pro athlete has little time for recovery during the season. Pictured here is an ultrasound of my foot when I had a case of fasciitis last year. What you would like to see the fascia look like strands of spaghetti. Mine has some of that but there is also a dark signal indicating on going plantar fasciitis. If you look at the two lines coming off the white curve that looks like a hill that is where the fascia originates off the heel bone. On top of the fascia about mid way the lines are not as clear indicative of degeneration. Some of my patients have a fusiform or cigar shape which indicates more swelling and degeneration. When I am evaluating athletes that are looking to return to sports I check to see if there is any opening up of the tissue when I punt stress on it suggestive of a tear. It is a great way to monitor there progress of healing. It is the better than an X-Ray study to get to evaluate a sports heel injury that has the classic morning pain and plantar medial heel pain. An X-ray will show the bone structure better but will not show you the fascia composition, tearing, fat degeneration and muscle swelling I ended up hurting my lower back playing soccer which forced me to take a break. . The moment occurred leaning over tie my cleats. What set me up was the soccer games going all out the day before and not unwinding my back with some stabilizing exercises after. The injury has helped my fascia heel because it has forced me to slow down playing and I have only played for an hour or so a couple times. My chiropractor suggested I skip yoga and work on pelvic tilts for my back and stop biking hills for a while. The forced rest will continue to help my fascia heal. I wore an FS6 Fascia Sock and my orthotics in my cleats and shoes. Zimmerman will benefit from this period of rest and is probably getting a lot of physical therapy.

Damn it Jim! I've Got Plantar Fasciitis!

So now I can officially add plantar fasciitis to my laundry list of sports related injuries , most notably being my torn ACL and achilles tendon tear. I am doing just like the rest of many of my patients do and playing thru it, albeit with some caution and I am playing soccer but not running on the road. The next post I put up will show an ultrasound of my partially healed fascia. I got he new F^ sock , have been keeping up with yoga and stretching back my toes. I tried a new running shoe on the treadmill the other day but after 3 minutes I could feel a twinge. I am wearing my orthotics for sports and flip between crocs and sneakers with orthotics at work,, I have tried a l3 laser treatments which temporarily made it feel better. The question Is whether it would have stayed bet err had I stayed away from the Saturday soccer match ritual. In short I am not that far from the rest of you suffering weekend warriors- just armed with a little bit more knowledge on what to do and not willing to go completely idle for the time being...

The Cult of Crossfit

 The crossfit Mantra is to go paleo.  I don't have a problem with invoking paleo mentality to training.  I was inspired when I saw Rocky bust up ribs in the meat packing locker.  I can tell you that the body is designed to take so much stress and then it breaks down. i end up seeing a host of inuries including stress fractures, plantar fasciitis and tendonitis.  Now I know your coach at crossfit is telling you to reject anything supportive for your feet while you are enduring the workouts. Working out with intensity does not mean you ignore the pain. Make sure your body can handle it.

Being In the Moment

I came across an old news clipping from a high school athlete that I knew.  She won the Penn Relays on her last jump and broke the high school record.  When asked how she did it she said she did not focus on how far she had to jump, she just concentrated on correlating what she had to do on her final jump .  I was surprised to see a high school athlete be able to express what was the difference on her final jump that gave her the victory.  I have been involved with athletes on my former biking team who would choke on the exchanges flying off the the bike  decelerating very quickly and I know the difference was not that they could not do it but they were overly concerned about failure and thus were not able to correlate their body movements in those split seconds.  It's all about being in the moment and the great ones figure out a way to do just that.

It's All in The Footwork

Specialist quarterback coach George Whitfield , Jr.  couldn't make it in the NFL and after 2 years in arena football turned to coaching.  He new there was much more to the position than coaches were providing particularly with the footwork.  Much like the what trainers have done with boxing for years and the Hall's have done with swimming like training he has broken the the motion of the sport to fundamental tasks.  The key are the moorings in almost every sport whether it be skiing, soccer, boxing or fencing.  Agility drills that address the unique requirement to a sport and are going to make you a better player and may save you from injury.  RGIII took a pass on Whitfield and may have ended up in the same spot had he employed him but his injury was precipitatate by a misstep.
 Whitfield has his quarterbacks train on the beach in the sand and water as well as timing drills with cues ranging from brooms to  beanbags.  It's not surprising that he has had clients like Cam Newton and Andrew Luck as at the end of the day a smart player and team are going to find what is necessary to make them perform better.  It takes discipline to train this way but it may be the edge you need.

Runner world Article on Pacing and Injuries

http://www.runnersworld.com/injury-prevention-recovery/your-injury-caused-pace-or-distance

The Last Straw

When I saw Kobe's season ending torn achilles  injury in the news this morning something struck me. It was in the playoff run and he was being worked extra hard. Sound familiar RG111/Redskin fans?
He also said he had made a similar move a million times.  It was the proverbial last straw for his achilles.  The achilles tendon looks like a bunch of straws in cross section and when you examine it with diagnostic ultrasound.  The blood supply near the insertion for healing is terrible, hence the proverbial achilles heal. You can tell when the fibers are starting to fray BEFORE there is injury.  So why not take studies of these at a base line if a high level athlete is doing the type of workload these pro and college athletes are faced with? Tools like laser, EPAT and prudent rest might prevent headlines the next day. It may never happen. It is the pros after all.

The Power of Negative Thinking

Bob Knight wrote a book out called "The Power of Negative Thinking"  what he says is that in order to win you must look at the options which will cause you to lose and take corrective action. He took that philosophy to just one play when Keith Smart drained the shot to win the IU the 1987 NCAA  championship in the closing seconds. Daryl Thomas had the ball under the basket but had no shot so he passed the ball out to Smart who created the shot opportunity after he had passed the ball to Thomas. In the world of medicine having a clear eye for what could go wrong can prevent things from getting worse or avoid a disaster.  The thrust of Knight's book is really about the will to prepare rather than being a pessimist.
 Having an appreciation for your deficits can cue you in to what you need to do to make them better whether it be strengthening , stretching or working on agility. I started taking that philosphy to my training. If I'm hurt (for example as I write this I have achilles tendonitis) do something else. I did a boxing /combat class to work on upper body , core and cardiovascular to give my achilles a rest but still advance my fitness. Notice I said advance because there are things you can do to not merely maintain but improve your fitness when you are hurt. In short You identify whats going to continue on a negative trajectory and do something else to get to your end goal a different way.

How to Not Lose Your Head With Cutting Edge

There is a lot of so called "cutting edge" technology that is out there in healthcare and some of it's good and some of it is just industry trying to create a new procedure.  So how does the layman know how to tell good from bad?

Rule number one: If someone uses the term !00% think twice
Rule Number two: Ask Around - not just the folks who are on the internet
Rule Number three: Technology is only part of the puzzle
Rule number four Do your do diligence- from meta-analysis reports like the Cochrane Reviews to asking someone in your running group.

A Man's Got To Know His Limitations

I hit my birthday this month and I got a little taste of aging and athletics.  After hitting the bumps hard skiing on Sunday and getting a little run down I got up the next day feeling a little bit light headed and had to hit the matress or feel like I was about to pass out.  In medical term it's called postural hypotension.  Not enough blood is getting to your head and you feel light headed. Only problem was unlike the past where it was a done deal after the episode this time I felt like I was walking on an unsteady boat at work.  Suddenly I was starting to feel like those sci fi characters in Logan's run that had an expiration date at age 29.  So to make sure nothing else was going on because I have a family history of heart disease I went to get seen by a cardiologist before lunch. The exam revealed what I thought.  I learned a little cold virus I was fighting can also lead to lower blood volume. Just to be sure an EKG was done which showed a mild mitral valve prolapse which can cause a heart sound called a murmer but I have had that as a kid and that has nothing to do with the postural hypotension. The doctor advised me to hydrate and to increase my salt or take an electrolyte replacement drink and use some type of compression on my legs even though I  had no swelling in my legs.  The compression helps the pressure going back up to your head.  By lunch time I was feeling much better.

Well it's a little hard to accept that you are not 29 anymore but dealing with your health is important versus thinking something will just go away on it's own.   Betty Davis once said getting old is not for sissy's and she was right but it's how we deal with things that makes all the difference.

RGIII Bionic Man Or Bust?

So they rebuilt RGIII but they can't make him faster than he was because he was already super fast.
Adidas provides the edgy comeback narrative reminiscent of Nike commercials; "All in for week one".
Chances are he'll be just a little bit slower recovering from his knee surgery but will work to make himself a better overall player in time IF his knee holds up.  By having the pressure of the hype to be good to go in week one he may be setting himself up. Now you would think if anyone can do it RGIII can.  The autograft from his non-injured patellar tendon is stronger than his previous graft and the word is that the surgery went well and he is ahead of schedule.  RGIII is not a comic book hero, however, and is only too human when it comes to vulnerability in his knee as  we saw at the end of last year.  There are some adjustment after knee surgery and sometimes the donor side can have irritation.  Secondary fibrosis  healing can take well over a year even though that is not he main healing.  Let's hope for the sake of his career that Dr. Andrews is not pushed by the franchise, RGIII's own exuberance and the pressure of the hype to play before he is ready.

For more on this and other injury advice check out Sports Talk on News 8 with Glenn Harris and me as his guest 9pm Friday March 1.

Yoga and the Zen Of Ski

Owning a skill is not an easy thing. I taught skiing at Whitetail and  once had a clinic with an instructor named Mark Goodman and he told me that practice does not make perfect, perfect practice does. The thing about yoga with a class is that you get the corrective feedback from the instructor and the energy from practicing with a group.   I had trouble  with standing tall and Mark used a bamboo stick to give me the feedback where I was standing by pacing it underneath the back of my jacket.  That was an excellent self discovery exercise but to really own that posture I had to go to yoga practice to unwind and develop the core and back muscles to stand tall which gives you more leverage skiing.  To really improve once a week does not cut it- particularly if you are not that naturally flexible like me.  You can supplement the classes with your own practice a few times a week .  It is also a great way to relax and   yoga masters don't make it to 100 years by accident.

Hot Foot & Cycling from Bicycling Magazine

Not too Many have circled the spokes like Dr. Saxena & he keeps it simple with his advice In Bicycling:

Painful burning on the ball of the foot (a.k.a. hot foot, or metatarsalgia) is usually a result of hot weather or poorly fitting shoes—or both—on long, hilly rides. "Pressure can pinch nerves in one or both feet and shut down a ride fast," says Amol Saxena, DPM, a time-trial cyclist and podiatrist in the department of sports medicine at the Palo Alto Medical Hospital in California. "If hot foot strikes while you're on a ride, there isn't much you can do other than stop, take off your shoes and let your feet cool down." Saxena takes these precautions to keep his feet cool and comfortable during races.

DO THE SQUISH TEST When shopping for cycling shoes, pull out the insole and hold it up to the bottom of your bare foot (in front of a mirror). "if you can see any part of your foot beyond the borders of the insole, you need a wider shoe," says Saxena. A tip: When you find the perfect shoe, buy another pair for backup.

TAKE A LOAD OFF Move your cleats a few millimeters closer to the heel of the shoe to take pressure off your forefoot. or switch to a larger-platform pedal to more evenly distribute the pressure across your feet.

CUSHION THE BLOW Over time and after many miles on the bike, your feet start to lose their natural padding, which can make riding painful. adding more supportive insoles to your cycling shoes can help. if you're shopping for new shoes, take the insoles along to make sure you get the best fit.

BE A MATERIAL GIRL Choose socks made of high-tech fibers such as Coolmax and Thermax, which wick away sweat. and don't buy a pair right off the rack; try them on with your cycling shoes first.

Benno Nigg PhD: Biomechanics Guru Saying Farewell At Calgary International Running Symposium

The following is an interview I did with Benno Nigg, Phd published in Podiatry Management last year. He will be delivering the keynote lecture at the Calgary International Running Symposium Seminar August 14. http://www.calgaryrunningsymposium2014.com/ Much is written about biomechanics. The breadth information is overwhelming and only some of it is relevant. Many conclusions presented are based on trying to sell a shoe, a book or an opportunity to be in the spotlight. Podiatry can claim partial success in staying current with the literature and leading new research. It is important to have an open mind regarding what is scientific fact in our practices and what is podiatric folklore. Another field that has undergone an overhaul moving from conventional wisdom to applicable science is baseball. Players were rated by scouts on the basis of their looks i.e. solid chin and archaic metrics. Then a former aeronautic engineer named Eric Walker, decided to write a pamphlet that bucked against the conventional wisdom. The pamplet was implemented by the Oakland A's and is the subject of the book and movie "Moneyball". He decided to review how winning teams and was based on statistical criteria that had more relevance to a player and teams success. One example: when baseball was first played players had no baseball gloves and so fielding errors measured as a statistic were an important part of the game. Now errors can actually penalize a gifted player that was fast enough to run to make a play or smart enough to be in the right spot to make a play. The statistic is less relevant to the modern game and this is how we should be viewing what we are applying in our practices. It turns out that in baseball an on base percentage is a more telling statistic of a player's intrinsic value to a team than anything else. In peeling another layer of the onion, a team's aggregate on base percentage was more indicative of success than whether one or two dominant players. Some variables are important but one must look at how the data is applied. As an example, scouts look at foot speed which is based on a timed straight run but that does not always translate precisely to running the bases for example rounding first for a double and the slide into second. In talking with Benno Nigg, Phd, this same philosophy becomes evident. He has been on the investigative side as a hired consultant for shoe companies before he has largely turned his focus to pure research. He is very careful not to draw conclusions that are inferences when he reviews studies. As an example when I asked him recently about a study that Dan Lieberman did on heel vs forefoot injury patterns in shod cross country runners he pointed out that you cannot compare this to barefoot running. He also pointed out that the subjects were cross country runners which does not translate exactly to everyday runners. The following is an interview I conducted with him: If you think the science of biomechanics is static, best to think again according to Benno Nigg and his recent book "Biomechanics of Running shoes: The Disturbing truth about Running shoes, Inserts and Foot Orthotics" Why should a podiatrist buy your book, "Biomechanics of Running shoes, The disturbing truth about Running shoes ,Inserts and Foot Orthotics " Podiatrists that are interested in the actual functioning of the lower extremity and in the reasons for specific intervention may get some help when reading this book.. What do you think the role of podiatry should be with runner's given your view on orthotics? Orthotics can play a major roll in terms of initial recovery from injury. In my view the podiatrist's strategy should be to combine initial orthotic use with recommending strengthening exercises for the small muscles crossing the ankle joint. I also see a role for orthotic in clear structural issues such as an anatomic leg length discrepancy. How have you maintained your objectivity when hired as a consultant for a manufacturer? My primary goal is to help customers understanding their product or intervention. Additionally, I have a standard clause in my contracts that I can publish the results of such studies within 18 months. One particular company I was working with on sport surfaces stopped our consulting relationship after the results did not support their initial claims, however, we went on to publish the results. It is interesting to realize that some companies are interested in more basic science projects, testing models that do not have an immediate financial return but increase the general understanding of a product. What major study or studies caused you to change your views about shoes? There are different aspects where we changed our view substantially. Typically, we had results from a series of studies that did not support our initial speculations. For instance: (1) Impact forces: Initially we thought that impact forces are dangerous and that we have to change shoes and orthotics to reduce external impact forces. A series of studies showed that (a) epidemiologically, impact forces are not a good predictor of running injuries and (b) external impact force peaks are not sensitive to the hardness of the shoe. (2) Excessive pronation: Again, we thought initially that “excessive pronation” would be dangerous and that we should change the shoes to reduce pronation. Again, a series of studies showed that (a) pronation is not a good predictor of injuries. How do you reconcile observation on increased injuries noted such as tendonitis and stress fractures with vibram 5 finger shoes but having no hard evidence to support the observation? How do you think the average clinician should assimilate this? I don’t know how the average clinician should react, except that he/she should functionally analyze every single case and provide functional interventions. Scientific studies should be initiated to assess the actual epidemiology of all these new “footwear solutions” and assess the actual effects of these interventions with respect to epidemiology and biomechanics. What do you see in the future will for running shoes? The future running shoes will have more functional characteristics, they will be lighter and less bulky and some shoes will have sensors to help improving the “ride”. What role do you see for core stability and fatigue in causing injuries and what research do you think substantiates this. There are two major strength centers in the body that are currently associated with injury and reduction of injuries, the core strength and the strength of the muscles around the ankle joint complex. There is initial evidence that both strategies (strengthening these muscles) have a positive effect on reducing injuries. However, the results are initial and need more work. Intuitively, the two concepts seem sound. What should the podiatry schools be emphasizing in the biomechanics classes? I think that major emphasis should be on functional biomechanics and functional solutions. Often, podiatrists want to solve every problem with an orthotic . If the problem is in the Achilles tendon the emphasis for finding a solution should be on reviewing the mechanics of the Achilles tendon. Do you believe that studies will be able to isolate the many variables of runners, running shoes and injuries? Yes, we have developed methods that allow identifying all important variables for running and running injuries. Ben Pearl, DPM References Lewis, Michael ,Moneyball W.W.Norton & Company 2003 Nigg, Benno Phd interview 2012

Spring is just around the corner!

Excited about warmer weather and finally enjoying those vacation days? 

        

        Don't miss out on the

      sun and sand because of

          embarrassing ingrown nails -- 

         visit Dr. Pearl

              and get started with

          personalized laser treatments

            and have the look you want

                                    for spring.

The natural growth cycle of the nail occurs in six months, so starting now means having healthier nails by the time spring and summer roll around.  You can avoid the potential side effects of oral medications and enjoy monthly holistic laser treatments where you can see results after only two or three sessions.

With only a few months left before beach weather, now is the perfect time to call up Dr. Pearl and be ready to join in on the fun!

What We can Take Away from RGIII

It does not take a Monday morning quarterback to say that at some point RG111 should have been giving some sort of reprieve.  The franchise is riding on that wobbly knee.  Of course the problem is the culture of the NFL.   You're supposed to be Superman.  But yo can't ASK Superman if he's ok to stay in the game.  The coach and doctors need to watch him and Tell him when to come out.  When they had the lead they could have taken him out for a series and at least given him a break after the point at which he took off his helmet after a hard hit on the sideline.  A study of runners at Indiana University showed that the point most people get injuries is when they fatigue,  Now magnify this a gazillion times in the pace  and pounding of the NFL and that knee buckle was not if but when.  Now if he had gone back in after a series out maybe he would have had that similar injury but suppose Kurt Cousins put in earlier manages to score some points and just maybe you can rest up your franchise player for another week or another season.

Exposing Myths About Nail Health & Lasers

Here is the real deal on lasers, toenail funs and oral medications:

MYTH 1

If I get a nail fungus infection it must have been from a pedicure.

REALITY:

Most nail infections are from exposure to shoes, locker room  and bathroom.  Some pedicure facilities are substandard in terms of disinfection of instruments but the spores that cause the problem are everywhere and it is more likely you got it in your own house.

MYTH 2

A laser will cure my nail fungus in one treatment and it works 100%.

REALITY:

A laser is a great tool.  Anyone that promises 100% on almost anything  regarding the cure for toenail problems is not giving you  the real deal.

MYTH 3

If I do nothing with a nail fungus it will probably stay the same.

REALITY:

Most of the time it gets worse.

MYTH 4

The cure is permanent.

REALITY:

Whether you use a laser or take oral medications the problem will come back if you are not diligent about disinfection of shoes and applying a topical to prevent early reinfection.

MYTH 5

The oral medications will hurt my liver.

REALITY

Most people are fine as long as their baseline liver enzyme level checks out. There can be side effects with the orals such as headaches, nausea etc.  The trend is that patients are looking for more holistic
healthcare and that is why use of the laser has become more popular.

Focus With Sports Psychologist Scott Goldman Part II

The new year is a time to rededicate our goals:
This applies to giving our best effort in a performance or sustaining an injury prevention fitness program...  

Establish Routines
• This tells your mind and body “it is time to start.” For example, before shooting a free throw, bounce the ball, take a deep breath, find your spot, then release.
Develop Cue Words
• Cue words are specific phrases that remind you of key elements that help successful performances such as “stay low” or “explode from the blocks.” They can also be used to center your attention to the present task. For example, “next

point” and “let it go” can be helpful in refocusing after an unsuccessful attempt.
Practice
• The frontal lobe part of your brain is known for impacting quickness of response and improving your focus. Therefore, engaging in tasks that exercise this part of your brain would improve your focus. Research has shown the following tasks to improve your frontal lobe activity: reading aloud and fast, “Where’s Waldo?” books, Sudoku, crossword puzzles, anagrams, and some video games such as “Brain Age” and “Mind Medley.”