Doc for Jocks

FIELD OF DREAMS VS. HARD SCIENCE

2012-01-25T14:23:00.000-08:00

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 and what is 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 did 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 a 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 regularly interviewed in magazines like Runner's World. 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. Be careful not to jump to conclusions when the next web browser update or magazine exclaims a new finding as it may not be relevasnt.

Boimechanics:Field of Dreams Vs Hard Science

2012-01-24T11:53:00.000-08:00

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 and what is 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 did 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 a 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 regularly interviewed in magazines like Runner's World. 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.Be careful not to jump to conclusions when the next web browser update or magazine exclaims a new finding as it may not be relevasnt.

Mean Joe Green & Why We Do What We Do

2011-12-11T15:45:00.000-08:00

If you look at how a successful company like Coke branded they did it by being everywhere. There was Mean Joe Green drinking a Coke with a kid, Coke on your kids little league baseball scoreboard etc. They established an emotional connection to the product that resulted in a more likely purchase of Coke vs another cola. In Martin Lindstrom’s book, Buyology, he explains how marketers use quantitative research, which involves surveying a large number of people about an idea, concept, or product. They then follow up with qualitative research by surveying smaller focus groups. The basic question they are trying to answer is what makes consumers choose the way they do.
What may be surprising to discover is that many of these product surveys are not that effective. How people answer a survey is often disconnected from how they behave. One obvious problem can stem from how a survey is worded. A classic example used at Harvard Business School is a survey used to determine who would buy a Ford Edsel. The survey asked whether a potential buyer liked an Edsel, not whether they would buy it. Although most respondents liked the car, very few people actually bought an Edsel, leading to a disastrous loss for Ford.
Lindstrom contend that we don’t always act on the answers we give on surveys because of unconscious emotions, i.e. previous childhood associations or feelings of improved status. There is a peninsula of unconscious thought that influences the way we behave. Sometimes these unconscious thoughts have a more powerful impact than the conscious answers we give when filling out a survey.
For example, a customer with a foot injury walks into a running store and is met by a young dynamic salesperson who fits the customer with a running shoe selected to help him with his injury. The customer then decides to have a gait evaluation and get information about his stride.
The impulse to get the gait evaluation was borne of both emotion and convenience. What that customer does not realize is that he may have some condition, such as a leg length discrepancy, that warrants a medical professional’s attention. How we make decisions turns out to be tied to the emotional connections associated with the choices as much as anything else.

What Do Planes, Diabetics and Athletes Have in Common? Shear Force: The Common Dilemma that Diabetics and Athletes Face

2011-11-02T10:42:00.000-07:00

For years the biomechanics community has been talking about pressure as a leading cause for ulcers, while its counterpart, shearing, was generally left out of the discussion. It turns out that the same force that causes blisters in runners may be the key to unlocking ulcer prevention.

What Does the Research Show?

Dr. Bijan Najafi at the Center for Lower Extremity ambulatory Research (CLEAR) in Chicago sums it up this way: The most dangerous period for a moving body is during gait initiation and termination because this is when the body is most subject to accelerating and decelerating forces. The same principal holds when considering an airplane taking off and landing. The greatest risk for a crash is during takeoff and landing, during which the plane must endure significant stress from the extreme accelerations and decelerations. Just as a plane reaches a steady state at its cruising altitude, people achieve a steady state during episodes of walking. Individuals with diabetic neuropathy take particularly long to reach a smooth walking gait. It typically takes over 4 steps for a diabetic with moderate neuropathy to reach steady state according to Dr. Najafi, which is in average 25% higher than healthy control subjects. Depending on the type of footwear or insole, this number could be increased or decreased. Although four steps may seem like a small number, when we look at it in the context of daily physical activity it becomes very important. A recent CLEAR study published in Diabetes Care revealed that diabetic patients initiated over 350 episodes of walking per day that are often short (less than 20 steps per episode). The 2010 Diabetes Care study noted that diabetics average 7,800 steps per day, and an average of 10-15 steps per episode of walking.

Various methods have been proposed to decrease shearing in shoes including the use of roller soles, bilayer insoles and orthotics, socks and skin lubricants. Dr. David Armstrong feels that traditional plastizote will eventually become passe in favor of emerging superior biomechanical products.

Brian Davis, PhD, has stated previously that one should not overlook shearing forces when noting the moderate success of therapeutic footwear. While it is likely frictional forces are a key variable, he acknowledges several other reasons for skin breakdown. These factors include alterations in collagen properties, autonomic nervous dysfunction that alters sweating responses, diminished microcirculation and superimposed aging. Hydration also cannot be ignored. Good skin turgor depends on proper hydration.

Dr. Najafi feels that there are some misconceptions regarding research on efficiency and friction. In some lab testing, the emphasis has been on the shoe ground interface instead of the foot shoe interface. But, currently this is a serious challenge, since there is no available technology to measure the shearing inside of shoes. An alternative solution is measuring the effect of reducing shearing on the biomechanics of walking. For example, if we could reduce shear force between the foot/shoe interface but not on the shoe/ground interface, this would allow us to increase the distance between center of pressure (COP) and center of mass (COM) in particular during gait initiation, which in turn would increase gait initiation velocity. Biomechanically, this is similar to a runner who tries to increase his take off velocity by leaning forward. Najafi’s recent study confirmed this hypothesis, in which significant improvement was noted in gait initiation velocity by wearing insoles that reduce shearing compared to sham insoles. He also notes that orthotics reduce the number of steps required to reach steady state. Reducing shear force does not reduce gait velocity.

He notes we should be careful about the balance of our patients, since increasing the distance between COP and COM may trigger falls in those patients with poor muscle performance. Therefore, an assessment of a patient’s balance and risk of falling is of key importance after reducing any shearing on the foot/shoe interface.

In the pipeline, Dr. Najafi is exploring differences in people with diabetic neuropathy versus healthy age matched controls under both shod and barefoot conditions. Gait parameters such as stability and gait fluctuation will be assessed.

How Can We Incorporate These Anti-shearing Methods in Our Practice?

Currently, there are ongoing investigations on various types of innovations in arch supports and orthotics. Lubricant creams are also under current study. Socks that have better wicking properties are something that we should be recommending to both runners and diabetics alike. It remains to be seen whether some of the double layer socks provide any therapeutic benefit over single layer socks. Some running store owners I interviewed related that some runners report bunching with some of the double layered socks.

It appears that a combination of following the research and clinical experience will guide us toward the best solutions for this issue.

References:
David Armstrong, DPM. Personal Communication. 2011.
Davis, Brian. “Can Smart Orthotics Have An Impact in Preventing Diabetic Ulcerations?”. Podiatry Today. Volume 23. Issue 6. June 2010.
Bijan Najafi, PhD MS. Personal Communication. 2011.
Najafi, Bijan. “Importance of Time Spent Standing for Those at Risk of Diabetic Foot Ulceration”. Diabetes Care. Volume 33. Number 11. November 2010.

If You're Not Man Enough To Do It Yourself..I'd be Happy to Oblige

2011-08-25T10:39:00.001-07:00

More times than I care to count I have had a patient return to the office frustrated that they are not improving. Well,have you done the excercises I prescribed, have you tried the yoga class I ask? Umm... no doc I didn't have the time might be the reply.It's hard to get better if you are not keeping up with the whole program. Some people want an easy fix. It is a lot easier to pop a pill but this does not lead to sustained improvement.

So I challenge my athlete patients like the opening monologue from "Midnight Cowboy",
"If you're not man (or woman) enough to do it for yourself , I'd be happy to oblige!

Got A Bridge To Sell You In Brooklyn And Some New Fangled Shoes

2011-08-11T07:29:00.000-07:00

The rage right now seems to be a new shoe for every occasion. Many companies are jumping on the forefoot running barefoot phenom and pumping out the latest greatest shoe. The companies tout their extensive research and tell you to throw your old running shoes and orthotics into the trash, but is there any substance behind their claims? There are no good studies to substantiate the use of any of these new shoes. Just recently a friend asked me my opinion of the new oesh running shoe. The shoe features a robust forefoot platform and reminds me of the sunglass windshield invention the Steve Martin's character came up with in the movie "The Jerk". One thing they got right is that here is a send aftershock in running hat is more intense than the initial heel strike. Saying that their forefoot platform shoe with a shock absorption system designed to minimize the secondary impact does not mean that it is a better running shoe. Human biomechanics is a complex system with many levers and pulleys. The interactions for each runner are individual and it is not ones size fits all. It is also important to remember that it is the car and the driver that make a racer.

Our Obsession with Lasers

2011-07-26T07:32:00.000-07:00

People have been fascinated with lasers going all the way back to the iconic image of James Bond being nearly split in two in the movie Goldfinger. Goldfinger was the first blockbuster movie ever. No doubt this brought the idea of lasers as being cutting edge into the American psyche. Lasers have been used in medicine for everything from zapping off warts to whitening teeth and now for treatment of those ugly thick fungal toenails. The treatment should be only part of a regiment for a pesky problem.
The laser helps eliminate the fungal spores that lie within and underneath the nail. Just as in fading with laser teeth whitening the nail fungus can come back. It should be used as an adjunct treatment either with an oral or topical treatment. It is also important disinfect the areas the fungal spores reside, so the nail does not get reinfected. There are now ultraviolet lights to do this, so your skin does not have to come in direct contact with the Lysol. Health insurance does not cover the cost of this treatment. The treatments are administered once a month over three months and does not require anesthesia.

Barefoot Running & Beyond

2011-06-06T16:43:00.000-07:00

The barefoot running movement has spawned a cascade of trends in the running shoe industry. The progression has been towards minimalist shoes the ever since Chris McDougall's seminal book "Born to Run". Prior to the sensation of “Born to Run” Vin Lanana has been using barefoot
running in training his runners at Stanford. He believed that incorporating barefoot running in training resulted in better times. When marketing executives from Nike visited him at the Stanford track they conceptualized a minimalist shoe; a shoe that simulate some of the elements of barefoot running yet provide some protection on the feet. needed to grasp and release on a variety of surfaces such as dirt, grass, road, concrete, and gravel.

Our profession should continue to play a leading role in setting parameters
for the new generation of minimalist shoes. It has become obvious to practitioners dealing with overly zealous runners transitioning to these shoes that they will end up in our offices with injuries. Although there are no injury data banks or studies to support these patterns the anecdotal cases should not be ignored.There seem to be more metatarsal fractures, achilles tendonitis and plantar fasciitis cases. In terms of trying to draw conclusions beyond clinical trends it has a non-polynomial solution. There are simply too many variables to factors to draw a conclusion. There are no current injury logs tracking injury patterns with barefoot and minimalist shoe conditions. This information could be something we as practitioners track.

There appear to be regional trends in terms of new purchases of minimalist shoes. While some mid Atlantic stores are reporting 10% of their sales with strict minimalist another 10% with very little structure some Florida markets are approaching 50% and this is often times based on requests by runners and not recommendations by the store.
Another trend that has fueled the industry is a self discovery desire by runners looking for more efficient techniques or a change to try to help alleviate chronic injuries. The self discovery applies to language that industry taps into. The industry has responded not only by cranking out more minimalist shoes but by scaling back shoes with multiple features. The other incentive for industry is the margins are better with less features and they are lighter to ship. Retailers that have responses later in the game have had to wait almost a full year for the most popular Vibram five finger shoe.

Paradigm Shift: It’s a Trend not a Fad

Declarations have already been made by some that there will be a paradigm shift away from stability shoes and orthotics. It would seem that that is a little early to say but this is certainly the perception by many enthusiasts of barefoot/minimalist shoe runners.
Four factors are driving the trend towards minimalism; function, lifestyle, fashion and price. In this case lifestyle and fashion are very closely related. The shift is a reflection of the market demand for more natural functioning footwear. Footwear specialist, Mel Chrestman points to the hangtag on the Merrrell program as a sign of the times. It emphasizes language such as running in a natural gait. The market is demanding a more raw connection to the earth. This is reflected not only in the running line but the hiking line as well. It is also a slightly edgy statement to be walking around in the gym wearing your Vibram five finger shoes. The shoe has become a nexus of marketing and radical function change akin to the Ronco veg-o-matic device of the 1970’s. In addition, some health club members say that the Vibram shoe helps improve balance and strengthen their leg muscles, particularly the calves, while working out. At a recent training run I saw a five finger runner doing a handstand with his feet backing into a tree in his best simean exhibitionist preen. Where the rubber meets the road, retailers are simply not selling the same amount of rugged hiking boots as the consumption is trending toward more stripped down hiking footwear. Chrestman also adds that at a recent Keen marketing seminar for the trail running and hiking industry the marketing research suggested that the $95 dollar price point was attractive to make the purchase.
There appear to be regional trends in terms of new purchases of minimalist shoes. While some mid Atlantic stores are reporting 10% of their sales with strict minimalist another 10% with very little structure some Florida markets are approaching 50% and this is often times based on requests by runners and not recommendations by the store.
Another trend that has fueled the industry is a self discovery desire by runners looking for more efficient techniques or a change to try to help alleviate chronic injuries. The self discovery applies to language that industry taps into. The industry has responded not only by cranking out more minimalist shoes but by scaling back shoes with multiple features. The other incentive for industry is the margins are better with less features and they are lighter to ship. Retailers that have responses later in the game have had to wait almost a full year for the most popular Vibram five finger shoe. That shoe seems to be the poster child for minimalist shoes. Anecdotally, I talked with several runners whose use of the five finger Vibram shoe, says it helped with their shin splints and IBT syndrome. The second generation Bikila has significant modifications from the original which was hardly more than a one piece boat shoe sole with an upper. A lug pattern was placed on the outsole to give it a true midsole and an achilles notch was placed with a true heel counter to prevent slippage and irritation.

Also entering the market are recovery shoes. Most purists reject the idea of a recovery shoe and it remains to be seen whether this is simply a marketing ploy or a functional piece of recovery equipment.

Also entering the market are recovery shoes. Most purists reject the idea of a recovery shoe and it remains to be seem whether this is simply a marketing ploy or a functional piece of recovery equipment.

Walking in Another Man’s Barefeet

The old adage walking in another man’s shoeapplies to running barefoot because until we try it out we are not experiencing the sensations of barefoot running. Malcolm Gladwell had a pilot put him in a death spiral for a few seconds when he was writing about panic and using the JFK Jr. crash as a case study. It should be no different for us then when we are treating this population. Propriopceptive input is one of the things that purists insist is the thing that prevents them from experiencing the same amount of injuries as in minimalist shoes. Biomechanics guru Benno Nigg Phd has supported the notion that feedback can affect injury rates. Declarations have already been made by some that there will be a paradigm shift away from stability shoes and orthotics Time will tell.

The Underestimated Power of the Legs in Swimming

2011-02-08T17:18:00.000-08:00

Gary Hall's race club site has some great info on your swim kick:

http://www.blip.tv/file/4698446

Second Place & The Cost of Being Too Demanding on Yourself

2011-02-05T12:05:00.000-08:00

My friend Scott Goldman is a sports psychologist in Arizona. We met recently at a sports medicine conference in Big Sky. This is an interesting piece he wrote on second place.

The costs of being too demanding on yourself: After the 1992 Summer
Olympics, scientists reviewed the emotional reactions of all the medalists.

They discovered some interesting results. It wasn’t a surprise that
the gold medal winners appeared the happiest and most content.
However, they didn’t anticipate that the bronze medal winners appeared happier than the silver medalists.
They concluded the bronze medal winners were happy merely because they medaled. Whereas the silver medalists appeared to feel worse because they saw themselves as “losers” and thought about “what might have been.” It is not uncommon in athletics to hear quotes like “second place
is the first loser” and “no one remembers who finishes second.”

However, these silver medalists forgot one very important point: For their event at that exact moment, they were better than the 6,707,376,502 other people on
this planet. Isn’t it interesting that they had tendency to focus on the one person who was
better that day than all the other people on this planet who they defeated?!
Being demanding on one’s self often leads to training hard, self-discipline and other
qualities for great performance. However, what happens when you are too hard on
yourself? What happens when you begin to demand only perfection? Often, athletes struggle when their system of pursuing perfection mutates into a demand for perfection. Let me clarify: pursuing perfection and trying to achieve greatness is healthy, whereas
demanding it only leads to fear, failure, and suffering. You may ask: “why is demanding so
much of myself such a bad thing when it has gotten me this far?”
Good question.

Allow me to answer the question with a series of questions: What happens when you set
a standard that is unrealistic and fail? What happens when you don’t meet your
perfectionist standards? Do you punish yourself? Are you overly critical? Athletes
“lose” their way when they focus too much on criticizing themselves rather than thinking
about ways to improve. Similarly, athletes will focus too much on what they did wrong rather than what they achieved. Remember, the silver medalists quickly forgot how well
they did and instead focused on the one person who outperformed them.

Exercise Is Medicine

2010-10-11T06:13:00.000-07:00

Reposting this for all you folks who haven't decided what to
make for your New Year's resolution focus for 2011.
And for all you trivia buffs the photo is of Marlon Brando training on the set of ""A Street Car Named Desire" from the 1950's.

Exercise is Medicine™ is an important new initiative being promoted to all physicians and healthcare providers, which is a shared vision of the American College of Sports Medicine (ACSM) and American Medical Association (AMA). Exercise is Medicine™ is designed to help improve the health and well-being of our nation through a regular physical activity prescription from doctors - including podiatric physicians - and other healthcare providers. As role models for health it is important for us to to become a vital part of this bold new initiative and incorporate its message into your daily practice.

What if there was one prescription that could prevent and treat dozens of diseases, such as diabetes, hypertension and obesity? Would you want your doctor to prescribe it to you? Certainly! Exercise is that prescription and it needs to be prescribed by physicians and healthcare providers to patients who are not exercising regularly.

The guiding principles of Exercise is Medicine™ have been well-documented in a new textbook titled, Exercise is Medicine™, which is supported by ACSM and written by Harvard-trained Steven Jonas, MD, MPH. Some of the highlights include the following principles:

1. Exercise and regular physical activity are important to health and the prevention and treatment for many chronic diseases.
2. More should be done to address physical activity and exercise in healthcare settings.
3. ACSM and AMA are making efforts to bring a greater focus on physical activity and exercise in healthcare settings.

Healthcare organizations (including AAPSM and APMA), physicians and other professionals, regardless of specialty, are being challenged to assess, to advocate for, and to review every patient's physical activity program during every comprehensive visit.

You can visit http://www.exerciseismedicine.org/ for additional information and a more detailed description of Exercise is Medicine™, including ways you can counsel patients on their exercise regimens, and information on how physical activity can be an integral part of any patient’s healthcare program. We are urged to make exercise consultation and referral a regular, important part of our interaction with every patient at every visit.

“Regular Exercise”

It has been suggested that the hardest part of “regular exercise” is the regular, not the actual exercise. Unfit patients should be encouraged to healthy lifestyle changes, including: regular exercise; consuming smaller, healthier food portions; and smoking cessation. Be a role model for patients and your children and lead by example! Karen Langone, DPM president of the AAPSM has continued the charge as part of the boards initiatives regarding exercise. She references a recent study that confirmed that doctors who exercise are more committed and comfortable in counseling patients on incorporating exercise into their lifestyles. She believes exercise is the most empowering tool we can give our patients.
Gary Hall an eye doctor and former Olympian, is part of a grass roots program called World Fit which targets middle school kids to get engaged in a regular walking program. Former and current Olympians including diabetes advocate Gary Hall Jr. are involved to get the kids excited about being part of the program at school rallies. A culture of exercise is developed and parents often start exercising as well.

Our US Surgeon General Regina M. Bejamin, MD and Robert E. Sallis, M.D., FACSM, Past-President, American College of Sports Medicine presented the foundation for the Exercise is Medicine™ initiative at the Inaugural Exercise is Medicine World Meeting in Baltimore. Listed below are important highlights, which you can use to discuss with your patients, friends, and families:

1. Our longevity depends on 3 factors; genetics, environment, and behavior. It is our behavior that is most problematic and that has lead to the leading causes of death (cardiac disease, cancer, and stroke) in the US.

2. The most preventable factors of premature death are tobacco use and physical inactivity. In 2004, a “tipping point” occurred with tobacco, when the number of ex-smokers outnumbered the number of current smokers.

3. The death rate for a fit 80 year old is lower than that of a sedentary 60 year old.

4. Exercise is a “wonder drug” and everyone should take it.

5. Our insurance industry needs to change. Why is it that insurance will pay to refer a patient for bariatric surgery, but will not pay to refer a patient to an exercise specialist?

6. We need to move from a treatment-oriented society, to a prevention-oriented society.

7. 7 out of ten Americans will die from a preventable disease.

8. Childhood obesity is our number one health problem in the US. For the first time in our history, our youth will have a shorter life span than adults, which is a terrible, embarrassing comment on our nation’s current health.

9. Each of us can play a key role to increase exercise in the US, starting by being a fit personal role model, and incorporating Exercise is Medicine™ into our practices.

10. Healthy food choices and lifestyle choices need to be part of the solution for healthy living.

Athletic Shoe Prescription

Athletic shoes can play an additional preventive role in exercise injuries by providing our newly-exercising patients with an appropriate athletic shoe prescription on each comprehensive visit. The athletic shoe prescription should include; proper athletic shoe type, athletic sock recommendation, lacing techniques, and supportive insoles or orthoses, if necessary.

Our Academy’s shoe review committee has made a tremendous effort to update our athletic shoe web pages (http://www.aapsm.org/), which include a wealth of contemporary knowledge needed to write an athletic shoe prescription - useful for the novice as well as the experienced podiatric practitioners. Also, a 2010 publication by Springer, Athletic Footwear and Orthoses in Sports Medicine, including 30 Academy-contributors, has provided an evidence-based resource on the benefits of appropriate footwear and orthoses recommendations.

Physical Activity Recommendations

The American College of Sports Medicine (ACSM) and American Heart Association (AHA) also recently released updated physical activity recommendations for adults. This message should be clear and consistent for all sports and medical organizations, and is listed below:

1- Moderate-intensity aerobic physical activity for a minimum of 30 minutes on 5 days each week, or

2- Vigorous-intensity physical activity for a minimum of 20 minutes on 3 days each week.

These recommendations are an update and clarification of the 1995 recommendations on the types and amounts of physical activity needed by healthy adults and older adults to improve and maintain health.

The core recommendation of the ACSM/AHA Physical Activity Guidelines is to promote and maintain health. The intent is to provide a more comprehensive and explicit public health recommendation based upon available evidence-based research of the health benefits of physical activity. The preventive recommendation specifies how adults, by engaging in regular physical activity, can promote and maintain health and reduce risk of chronic disease and premature mortality.

A single evidence-based message must continue to be drummed - from the surgeon general to the coach, including every contact from health-care provider, physical educator, school administrator, and yes, health insurance provider - into the daily routine of all Americans if we are to be successful in altering the exercise and activity behaviors in the United States.

Exercise is Medicine!

Matt Werd ,DPM is a graduate of Indiana University. He is past president and a current fellow of the American Academy of Podiatric Sports Medicine. He has completed over 70 triathlons including 3 Ironman triathlons.

Ben Pearl,DPM is a member of the American Academy for Podiatric Sports Medicine.
A graduate from PCPM, he was a competitive bike racer at Indiana University and currently teaches skiing part time. He has a private practice in Arlington, VA.

Barefoot Running , Minimalist Shoes and Beyond

2010-09-26T16:30:00.000-07:00

Ankle Sprain Article from Men's Health

2010-09-21T08:31:00.000-07:00

My colleague Dr. Karen Langone saw this in Men's health on ankles sprains. It gives a great rationale for why you want immobilization and not just a brace for a more severe sprains. The ice/heat contast drills are excellent.

http://health.msn.com/health-topics/articlepage.aspx?cp-documentid=100262883

Training Bode Miller Style

2010-09-14T08:13:00.000-07:00

I was looking to do a rant about being amused at people that break out their new toner shoes and expect that they are going to have buns of steel.

My comment on a recent link on the subject was that people should be focusing much more on training intensity a la old school Bode's Miller than some new fangled shoe that you're going to wear while drinking a latte on your urban hike.

Looking for a pic of some of Bode's workouts I came across a National Geographic article of one of Bode's self inflicted strength/stability workouts. He wheel barrels his friends up a hill.

Training equipment will only get you so far. It is true that you can buy time on a racing bike

but when it comes to training equpment many people lose the primary focus for the frills and fads.

November is National Diabetes Month:Diabetics are Athletes Too

2010-09-02T11:18:00.000-07:00

Gary Hall Jr. was something of a nonconformist in the pool during his gold medaled Olympic career. These days he makes waves on Capital Hill for diabetes advocacy and has made it his business to stay current with diabetes research.

Diabetics are Athletes Too: Knocking Out Old School StereotypesDiabetes and an athletic lifestyle are not mutually exclusive. Diabetics are tired of walking out of podiatrist’s office with a pair of prescribed shoes that look like Herman Munster's. They want a normal lifestyle. "Old school" doctors need to recognize that there are new and more appealing options for our patients. We must also take on the role of a coach for our patients that are athletes and those that need to become more like athletes. By helping out patients feel more comfortable and enthusiastic about exercising, we help reach their fitness goals and also help control their diabetes. High quality appealing footwear is an important component in helping our diabetic athletes and helping our diabetic patients to become athletes. Diabetic advocate and Olympic swimmer Gary Hall Jr. provides a first hand account of the problem:
"For all the efforts of removing the stigma attached to living with diabetes, the unfortunate mark of diabetes remains apparent in prescribed footwear. I dedicated my life to proving that diabetes didn't have to stop an individual from accomplishing their dreams, whatever the dream was. For me it was swimming in the Olympics. When I won gold I was able to help tear down that barrier (often viewed as liability) that separated people with diabetes from the rest of the pack. The important message was that while additional requirements were necessary in properly managing diabetes, a person living with diabetes was equal. Somehow that message hasn’t come through in shoe design. If you have diabetes you are asked to wear, let’s face it, ugly shoes.
It’s hard enough to get diabetes patients to comply with the call to exercise. Asking someone to slap on ugly shoes and exercise exacerbates that challenge. With a diabetes diagnosis we are bombarded with the mantra, “diet and exercise”. Regular exercise helps increase insulin sensitivity and lower blood glucose levels but competitions have a dramatically different effect.

The stress associated with competitions sends blood sugars soaring. Throw in endorphins and adrenaline and levels can reach dangerous and dizzying highs. My targeted blood sugar level before a major competition (last glucose test taken five to ten minutes prior) was around 140 to 150. I competed in the 50 meter freestyle; it typically took me 21 second to swim. I would test my blood sugar immediately after a competition and my levels were never less than the high 300’s. This dramatic hike associated with Game Day is common for athletes young and old, fast and not so fast and is in stark contrast to the blood glucose effects of Practice Days.

I enjoy sharing with people that as a swimmer about 60% of my training was done out of the pool. For any athlete living with diabetes, at any level, it is imperative to have a good pair of “trainers”. Is it too much to ask that a good pair of diabetes friendly sneakers be good looking too?"Fortunately, vendors that deal with diabetics are starting to get it. They are developing lines that incorporate style and function. Think about your experiences in everyday life and how that influences how you feel about the product or service. Flying Virgin Air on the way back from Seattle it struck me just how dramatic an effect style and attitude can have on an experience. The attention to lighting, elimination of listless airline stewardess safety instruction in favor of an upbeat graphic presentation on the multi-use personal movie screen convey a more relaxed, fun attitude. This will make me more likely to fly Virgin Air Again and the same holds true with our diabetic patients’ compliance with appliances, shoes and activities of daily living.

Fear has its place as a wake up call in certain cases but the unfamiliar will not help them comply when it comes to equipment. How much of what we dispense is actually worn at home? It turns out prescriptive shoes are only worn about 15% of the time in the home according to research by David Armstrong DPM. Appliances are only used about 25 % of the time.In an uncertain fast changing world people are more comfortable with things that they are familiar to them. In Martin Lindstrom's New York Times bestseller, Buy-Ology he attributes this phenomena to the ritualistic behavior that becomes attached to branding. It explains why people engage in tribal behaviors as well.

It's a lot more reassuring to trudging through the morning commute to be part of the "Apple Community" with an army of I-Phone users. The natural conclusion is that positive peer pressure and coming up with ritualistic hooks may be the key for less motivated diabetic would be athletes. The World Fit program is an example of positive peer pressure in action. At it's outset it was targeting middle school kids with a monitored walking program to combat obesity. Olympic athletes are involved as positive role models and Gary Hall Sr., also a former Olympic swimmer is one of the principal organizers. The unexpected benefit was that adults started participating in the program as well because of their kids. What happened here? In one sense a subculture was created. If we look at how strong that subculture can reinforce branding (think about a loyal legion of Harley Davidson riders) it may help us understand how we can create a subculture of diabetics as athletes instead of passive patients.

A Clockwork Orange and Compliance

The brutal movie, "A Clockwork Orange" explored how we are wired to do certain things like clockwork without consciously thinking about them and the limits to which behaviors can be conditioned. Conditioning and association can be so powerful it can even affect our memory. There was a study done where people were able to remember a series of playing cards that had normal colors and symbols better than a deck that had a reversed color scheme; red spades, black hearts etc. This helps explains why it can be so difficult to change behaviors to new ones when they are completely unfamiliar. Brain mapping research with MRI has shown that certain areas of the brain are consistently activated when it comes to making the choice to buy something impulsively or satisfying a craving such as lighting up cigarette for a smoker.
Medicine might do well to jump on the same research that Madison Avenue has been on to for some time.

Our routines are also somewhat wired. Consider the data on stopping and starting on ulcer formation and healing just presented in Seattle. New data suggest that takeoff and landing shearing is the most destructive factor. David Armstrong, DPM uses the analogy of the most dangerous periods for an airline flight being takeoff and landing. If we can change routines to reduce the number of start and stops we can improve ulcer healing outcomes. If the routine is to get up and change the channel on the TV because the remote has a dead battery a series of such routines can profoundly affect an outcome. When I related this research to a patient of mine that was having difficulty closing an ulcer he began wearing a pedometer to count his steps. The next visit the ulcer was closed. To that end, solutions that deal with that takeoff shearing would be something vendors could focus on in addition to our patients' lifestyle change.
Merging an Athletic Lifestyle for Diabetics with Technology in Training

Interest in exercise research is at an all time high. Just look at any list-serve with athletes or websites with forums on training. The following is just one example of useful training info for the diabetic athlete: A 10-second maximal sprint after moderate-intensity exercise reduces the risk of post-exercise hypoglycemia in young, otherwise healthy patients with type 1 diabetes.
Dr. Paul A. Fournier from University of Western Australia, Crawley, stated that, "It is our view that the effect of sprinting on reducing the risk of post-exercise hypoglycemia is probably not as marked in children and sedentary middle-age individuals with type 1diabetes, in part, due to their reduced capacity to engage in a maximal sprint effort.
In the area of biomechanics podiatry is starting to come out of its slumber in recognition of the research that needs to be done for diabetics and the translation of that research into product development.
Using more appealing athletic equipment may seem like a small thing however along with developing exercise networks with peer and family connections it will be the tipping point to establish an athletic lifestyle. Gary Hall Jr. recognized the importance of his own training style and being close to family networks in his competition and outside the pool in his daily life. He made it his own and that made the rigors of training more sustainable. When this attitude can be developed in our patients minds it will change everything.

Armstrong, David et al “Continuous Activity Monitoring in persons at High Risk for Diabetes Related Lower Extremity Amputation “ JAPMA volume 91 number 9 October 2001 451-455

Bijan Najafi, MD Crews RT, Wrobel JS.”The Importance of Time Spent Standing for those at Risk of Diabetic Foot Ulceration” Diabetes Care Aug. 2010
Lindstrom,Martin Buy-ology Broadway Books New York 2010
Dr. Ben Pearl is a member of the American Academy for Podiatric Sports Medicine. This article is part of a sport medicine series the Academy is collaborating with Podiatry Management.
A graduate from PCPM, he was a competitive bike racer at Indiana University riding in IU’s
Little 500. His senior thesis at IU was on sports as a vehicle for mainstreaming. He has a private practice in Arlington, VA.

Gary Hall Jr. is a three-time Olympian and a diabetes advocate who has testified on Capital Hill.
He currently is the director of business development at B2D Marketing. The Seattle based company exclusively represents a medical distribution network in China that services over 6,335 hospitals and health clinics. http://www.b2dmarketing.com/ .

Diabetics Are Athletes Too: Knocking Out Old School Stereotypes

2010-08-14T09:33:00.001-07:00

Diabetics are Athletes Too: Knocking Out Old School Stereotypes

November is National Diabetes Awaresness Month.The New York Times Best Seller "Diabetes Rising" lets us know we're not out of the woods yet...

Diabetes and an athletic lifestyle are not mutually exclusive. Diabetics are tired of walking out of podiatrists office with a prescription for shoes that look like Herman Munster's. They want a normal lifestyle. "Old school" doctors need to recognize that there are new and more appealing options for our patients. We must also take on the role of a coach for our patients that are athletes and those that need to become more like athletes.

Diabetic advocate and Olympic swimmer Gary Hall Jr. provides a first hand account of the problem:
"For all the efforts of removing the stigma attached to living with diabetes, the unfortunate mark of diabetes remains apparent in prescribed footwear. I dedicated my life to proving that diabetes didn't have to stop an individual from accomplishing their dreams, whatever that dream was. For me it was swimming in the Olympics. When I won gold I was able to help tear down that barrier (often viewed as liability) that separated people with diabetes from the rest of the pack. The important message was that while additional requirements were necessary in properly managing diabetes a person living with diabetes was equal. Somehow that message hasn’t come through in shoe design. If you have diabetes you are asked to wear, let’s face it, ugly shoes.

It’s hard enough to get diabetes patients to comply with the call to exercise. Asking someone to slap on ugly shoes and exercise exacerbates that challenge. With a diabetes diagnosis we are bombarded with the mantra, “diet and exercise”. Regular exercise helps increase insulin sensitivity and lower blood glucose levels but competitions have a dramatically different effect.
The stress associated with competitions sends blood sugars soaring. Throw in endorphins and adrenaline and levels can reach dangerous and dizzying highs. My targeted blood sugar level before a major competition (last glucose test taken five to ten minutes prior) was around 140 to 150. I competed in the 50 meter freestyle, it typically took me 21 second to swim. I would test my blood sugar immediately after a competition and my levels were never less than the high 300’s. This dramatic hike associated with Game Day is common for athletes young and old, fast and not so fast and is in stark contrast to the blood glucose effects of Practice Days.
I enjoy sharing with people that as a swimmer about 60% of my training was done out of the pool. For any athlete living with diabetes, at any level, it is imperative to have a good pair of “trainers”. Is it too much to ask that a good pair of diabetes friendly sneakers be good looking too?"

Fortunately, vendors that deal with diabetic are starting to get it. They are developing lines that incorporate style and function. Flying Virgin Air on the way back from Seattle it struck me that even the in coach class on a red eye style and attitude can dramatically affect the experience. They payed attention to lighting, eliminate the stock airline stewardess 2 finger point to the nearest exit in favor of a more friendly graphic presentation on the multi-use movie screen in front of your seat and convey a relaxed fun attitude.
Fear has it's place as a wake up call in certain cases but the unfamiliar will not help them comply when it comes to equipment. How much of what we dispense is actually worn at home? It turns out prescriptive shoes are only worn about 15% of the time in the home according to research by David Armstrong DPM . Appliances are only used about 25 % of the time.

In an uncertain fast changing world People are more comfortable with things that they are familiar to them. In Martin Lindstrom's New York Times bestseller, Buy-Ology he attributes this phenomona to the ritualistic behavior that becomes attached to branding. It explains why people engage in tribal behaviors as well.
It's a lot more reassuring to trudging through the morning commute to be part of the "Apple Community" with an army of I-Phone users. The natural conclusion is that positive peer pressure and coming up with ritualistic hooks may be the key for less motivated diabetic would be athletes. The World Fit program is an example of positive peer pressure in action. At it's outset it was targeting middle school kids with a monitored walking program to combat obesity. Olympic athletes are involved as positive role models and Gary Hall Sr., also a former Olympic swimmer is one of the principal organizers. The unexpected benefit was that adults started participating in the program as well because of their kids. What happened here?
In one sense a subculture was created. If we look at how strong that subculture can reinforce branding (think about a loyal legion of Harley Davidson riders) it may help us understand how we can create a subculture of diabetics as athletes instead of passive patients.

A Clockwork Orange and Compliance
The brutal movie, "A Clockwork Orange" explored how we are wired to do certain things like clockwork
without consciously thinking about them and the limits to which behaviors can be conditioned. Conditioning and association can be so powerful it can even affect our memory. There was a study done where people were able to remember a series of playing cards that had normal colors and symbols better than a a deck that had a reversed color scheme; red spades, black hearts etc. This helps explains why it can be so difficult to change behaviors to new ones when they are completely unfamiliar.
Our routines are also somewhat wired. Consider the data on stopping and starting on ulcer formation t just presented in Seattle. Apparently. takeoff shearing is the most destructive factor. If the routine is to get up and change the channel on the TV because the remote has a dead battery a series of such routines can profoundly affect an outcome. To that end, solutions that deal with that takeoff shearing would be something vendors could focus on in addition to our patients' lifestyle change.

A Local Hero is Gone

2010-07-24T20:34:00.000-07:00

A Local Hero is Gone

Rocky Belk died last week and the Arlington community was left with one less voice for the people that have none. Success did not come easy for Rocky. He was an athlete on the bubble; enough talent to make it all the way to the NFL but scrapping
every step of the way. Because Rocky had to carefully piece together his athletic career, he came to understand what it took to achieve his advanced education goals one piece at a time and he never forgot those that were not empowered with the same knowledge and voice along the way.

I met Rocky on the school yard one day while I was watching my daughter, Sirena, play in gym class. We had a conversation about youth, sportsmanship and life in general. We became friends that day and worked on a local project for the Arlington Career Center on better choices for student athletes. One night we went out to dinner at a restaurant off the GW parkway near closing and he got there first and they refused to serve us. I'll never know how much of it was racially motivated but that was Rocky's impression and it was upsetting to see that sort of thing play out for a man that was so giving of his time in the community. A few months later we saw "The Express, the Ernie Davis Story" together and I'm sure Rocky could relate to some of the scenes growing up particularly since he was also a Cleveland Brown for one season, a bit of life imitating art.

Rocky told me that when the Browns won a game the fans in his town home community would shovel snow in front of his door to greet him after the game. A celebratory snow in. He had skills but could not stomach the politics of pro football. The quarterbacks were partial to the players that they were used to and it affected who played. Sam Rutigliano was probably a bit ruthless for Rocky's taste. Nonetheless he got to experience a couple touchdowns in the pros and made good on his promise and ended up with a Sports Illustrated appearance while at the University of Miami. He got to catch more than few with hall of famer Jim Kelly when he played for the Hurricanes. His heroic exploits were more about what he did off the field.

Although he was always full of hale to greet his prized possessions,the children at Longbranch Elementary where he served as head gym teacher, Rocky had a very sensitive side. It was his big heart that in part played into his failing health at the end because he did not put the same level of focus on himself as he did on others. He had tremendous respect for the educational institutional process and for his
fellow faculty and head principal Felicia Russo. That process was so important to him because it was the ultimate equalizer. When Rocky finished up at school he gave more of his time to the Gum Springs Community Center near Fort Hunt where he went to high school.

Can we summarize a man's legacy, his life's work, in a memorial plaque? It would be kind of cool for students that knew him to tell those coming in that ask who was this Rocky Belk and what did he do? Those that knew him could tell them that Rocky Belk from Gum Springs followed his dreams and made it all the way to the NFL working every step of the way and after he got there he never stopped giving back. What motivated him was simply his love for the children he taught.
In the end, for those that knew him, it really doesn't really matter whether a plaque with Rocky Belk's name inscribed on it is put out at the horseshoe kiss and drop where the Longbranch students start their morning; because in the end every child and parent that Rocky touched will remember him at that horseshoe full of hale and with a big,easy,giving smile.

Wham-O! I'm not Supermam

2010-06-20T17:13:00.000-07:00

So I was goofing off one summer in Buffalo,New York with my nephews on a slip and slide. I thought I might try cruising down the Slip 'n Slide set up on the lawn Silver Surfer style instead of ala Pete Rose head first into home plate... Big mistake.At the time I had no problem. Somewhere around eight that night my ankle started to feel like it was being crushed. Wham-O! I'm talking about tears streaming down your face type pain. The torque on my ankle from my jumping had caused an acute bone bruise and sprain. The body has a memory to insult and it can react the opposite of delayed gratification. In this case it was pay your dues for your mortal sin of thinking you could crash your body like a teenager. 6 Advils and several sessions of ice and elevation later I was able to get to sleep a little past midnight. Just last week I was reminded of my weekend warrior body when after taking up my secondsessions of Gaelic Football I started experiencing intense pain this time in my foot about 2 hours into my daughter's friend's birthday party that forced me to the couch and crutches for 8 hours.This time an acute sprain of my foot. The deal is that once your foot starts to swell even a little bit there are a lot of nerves down there that are not very happy. You also don't get to rest the area unless you are put in a cat or on crutches. I have patients that look at me dumbfounded regarding their hobbled condition with foot pain and I ask them what they did and they tell me I hiked or whatever and were fine at the but the reality is that your body remembers. Particularly if you have an old injury. You have to respect that

The OJ We Hardly Knew

2010-06-18T05:31:00.001-07:00

Like a lot of kids growing up in the 70's my brother Mike and I grew up cheering for the Juice. I had an extra connection as my parents both grew up in Buffalo and my relatives were season ticket holders for the Bills so we would go up and watch them play around the holiday weekends.
OJ went to my families drugstore business in downtown Buffalo and was thought to be one of Buffalo's own; a regular sort of guy off the field. It is documented that OJ used to be very patient when filming various itterations of the Hertz Rent-A-Car commercials, the later of which, required him to be suspended from a wire harnass for hours on end.

I 'll tell you a story about OJ. I met an orthopedic surgeon at a conference in Montana who was MVP at a football camp & OJ gave the then kid an autographed football at the awards banquet
which was held in Niagara Falls. So later that night they cross paths in an elevator at the hotel & he says how he wanted to emulate his career. OJ looks him up & down and says "Fat chance kid!" OJ's pulling guard and best buddy Reggie McKenzie was with him at the time and protested "OJ why did you have to say that " And this is the best part of the story- he told me he took that football & threw it right in the trash. If I had been there I would have given the kid a standing o. Not exactly the iconic "Mean Joe Green" Coke commercial.

The truth was that OJ was cool with being OJ man of the people as long as OJ was the center of attention and adulation. Another running back, Gale Sayers wrote a book titled "I am Third". It was abook about his life and his short relationship with teammate Brian Piccolo. The title refers to the philosophy that the Lord is first, my friends and family are second and I am third. You look at our sports superstars today, Tiger Woods and the like and hope that a new generation of stars like rookie sensation Stephen Strasburg will give us sports heroes to cheer about on and off the field.

2010-05-22T17:45:00.001-07:00

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

2010-05-21T07:21:00.000-07:00

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 culture's 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 BubbleSome 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 RisksIt 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 UseOne 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 (PEDS)

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 therewas 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 TestingAlthough 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 an isolated problem. As the tell-alls come out and the dominos fall maybe people will begin to realize that somewhere along the way the have forgotten where they were going in the first place.

Does Getting Up at an Ungodly Hour to Workout Like Rocky Balboa Work?

2010-04-29T02:19:00.000-07:00

Who could forget the iconic image of Rocky Balboa getting up at some ungodly hour eating raw eggs in his quest to try and go the distance with Apollo Creed. There's only one problem.
If you are not getting your 8 hours of sleep particularly when you are
hammering in your training cycle your are not optimizing your body's recovery cycle.
Most of our healing and muscle building occurs while we are sleeping. It affect your body in so many ways. If someone comes into my office with warts I ask them if they are getting about 6 hours of sleep. About half of them will give me this look at me like I'm from another planet. Knowing that many people will answer yes thinking no problem because they are in denial that that they need more sleep versus simply asking them if they are getting 8 hours of sleep. Because a wart is a virus your sleep debt will make it more difficult for your body to get rid of it. Think about more severe illness like when you developed mono in college because you were burning both ends of the candle. If you have a disease that lowers your immunity like uncontrolled diabetes then sleep takes on an even bigger role. There are some Olympians that end up sleeping more than 8 hours on some days because of the stress they are putting their body through in training. Working out at reasonable hours in in the morning seems to fit our natural rhythm more. Working out too late can actually inhibit normal sleep patterns. If you can consistently get to bed early then getting up super early is not a bad thing. Remember, though , even Rocky broke training on his apartment couch with Adrien in the midnight hour so easier said than done.You may or may not get Salmonella if you eat the raw eggs but I guarantee you will not have your body performing optimally under a a demanding training cycle if you are not getting your 8 hours.

Wham-O! I'm Not Superman!

2010-04-25T05:30:00.001-07:00

So I was goofing off one summer in Buffalo,New York with my nephews on a slip and slide. I thought I might try cruising down the Slip 'n Slide set up on the lawn Silver Surfer style instead of ala Pete Rose head first into home plate... Big mistake.

At the time I had no problem. Somewhere around eight that night my ankle started to feel like it was being crushed. Wham-O! I'm talking about tears streaming down your face type pain. The torque on my ankle from my jumping had caused an acute bone bruise and sprain. The body has a memory to insult and it can react the opposite of delayed gratification. In this case it was pay your dues for your mortal sin of thinking you could crash your body like a teenager. 6 Advils and several sessions of ice and elevation later I was able to get to sleep a little past midnight. Just last week I was reminded of my weekend warrior body when after taking up my second
sessions of Gaelic Football I started experiencing intense pain this time in my foot about 2 hours into my daughter's friend's birthday party that forced me to the couch and crutches for 8 hours.
This time an acute sprain of my foot. The deal is that once your foot starts to swell even a little bit there are a lot of nerves down there that are not very happy. You also don't get to rest the area unless you are put in a cat or on crutches. I have patients that look at me dumbfounded regarding their hobbled condition with foot pain and I ask them what they did and they tell me I hiked or whatever and were fine at the but the reality is that your body remembers. Particularly if you have an old injury. You have to respect that.

On the Road to Recovery-Never give Up! What can we learn from the Bill's "Groundhogs Day"how many different ways can you lose a Superbowl

2010-04-14T02:27:00.000-07:00

Many people may have forgotten Leon Lett's stripped ball by Don Bebe at the goal line due to raw perseverance on the play in one of Bill's Groundhogs Day how many different ways can you lose a Superbowl but it demonstrates an important life lesson. Never give up!

I have some patients in my practice that simply give up on themselves. After an injury, I can give patients a game plan to help them rehab their injury like a coach but I can't go out to their homes and workplaces and make them do it.

When I injured my knee a second time doing jumping drills in a sports conditioning class I saw the Redskins's orthopedic surgeon. His answer was a surgical approach that would involve bone graft taken from my knee to fill in divots in my knee. I chose the consevative rout. I dedicated myself to getting the muscles around my knee as stong and flexible as they could be through strength yoga, condition and simply being active in sports year round. I also strengthened my core to take pressure of the joints. I got lucky avoiding the knife a second time but would not have had the chance had I not payed my dues in the gym.

I am now playing soccer and skiing hard but smart. I know I still have some instability in that knee.
Over time our body can develop movement patterns in sports that compensate for the weakness. Some injuries are to severe for this approach but unless you are a pro athlete on a fat contract you usually have time to make a decision for surgery. Take personal responsibility for your recovery. Most of it is up to you. Oh- and don't ever showboat at the big show unless that's how you want to come up when someone does a search on google.

On Sacrafice

2010-03-01T04:17:00.000-08:00

At the end of the race the athlete pants, “I’ve given everything to be here.”

The overwhelming majority of Olympians have given everything to be an Olympian. What does that mean? It means a lot of things in the way of sacrifice...from Gary Hall Jr.'s archives at the LA Times

http://latimesblogs.latimes.com/olympics_blog/gary-hall-jr/

Support Our Athletes at the Winter Games

2010-02-02T21:00:00.000-08:00

Team USA's dreams are on the line! We're in the final countdown to the 2010

If you'd like to be more connected to the games
click on team USA

Watch Out Nike!

2010-01-12T04:30:00.000-08:00

This study is part of a body of evidence that will reshape the running shoe industry. Because of the extreme cushioning in some running shoes there is a delay in the peak moment of force higher up in the leg.
Benno Nigg Phd confirmed this with his work with accelerometers. This will reverberate through the running shoe industry.

http://www.dailyfinance.com/story/do-running-shoes-make-us-run-the-risk-of-injury/19309476/?icid=main|netscape|dl3|link3|http%3A%2F%2Fwww.dailyfinance.com%2Fstory%2Fdo-running-shoes-make-us-run-the-risk-of-injury%2F19309476%2F

EET Fitness Intervals : The Ultimate Metabolic Message

2010-01-11T19:17:00.000-08:00

The EET (Eating and Exercise TIMING) Fitness Plan utilizes Fat Burning Interval Workouts that only take 15-30 minutes.

At the end of this post, you will find one of the many research articles on Interval Training and why it is the best method of exercise for weight loss and fitness.

There is strong evidence that interval training is highly effective to dramatically improve your fitness level and muscle tone, as well as burning fat while maintaining muscle mass. Plus, the fat burning continues after interval training throughout the rest of the day.

There are many many such articles and research studies that support these claims.

So the scientific research can satisfy participants that EET workouts are the most effective possible.

But, there is more to the story. EET included the interval workouts before reading very much scientific research at all.

Why else would interval workouts be part of EET?

The answer lies in the fundamental concepts behind the EET Fitness Plan. Survival Instinct and sending the most powerful messages to your metabolism possible in order to create a new metabolic memory, which assists participants in losing weight and becoming more fit. Here's how it works:

Assume you lived in the time of the Ancient Romans and that you were a slave who was forced to become a gladiator.

During your fights, you would push yourself physically as hard as you could for a relatively short time (until you killed your opponent or they killed you). Even within each fight you would have times of maximum exertion wrestling your opponent, and a few brief pauses when you could try to catch your breath.

And, each time you would be asked to fight, you would know that your life depended on it. Your upcoming fight would be on your mind far more than when you were just fighting, and your body would be aware that it was going to be asked to defend itself to the highest level possible far more often than just during your fights.

The gladiators workout regime has several similarities to an EET Fitness Participant. First, by pushing yourself as hard as you can you are sending a clear message to your body/metabolism that you must be CAPABLE of doing your workout at the highest level of intensity you can manage, and your body/metabolism must adjust so that you can perform and continue to succeed at your workouts. Your body/metabolism will begin to do what it takes to become lighter and leaner to make it easier to survive the intensity of your interval workouts.

The message is just as clear that your body needs to retain as much muscle as possible in order to perform the challenging intervals. Also, by taking short breaks between sets of your intervals, you are sending a clear message to your body that you will allow your muscles to recover so you have full access to them during your sets.

Everything about the interval workout sends the ideal message to your body/metabolism and your mind about how you want your body to look and the level of fitness you desire.

Secondly, your body/metabolism as well as your mind will be aware at all times that the next interval workout is coming soon (within 24-48 hours) and therefore must continue to prepare itself to be able to handle that workout, in order to "survive".

This is why the workouts don't have to be long in order to have dramatic results. If your body knows it will be pushed to your limits even for a short time, it must be prepared to handle it and therefore it will work all day to ensure you are prepared for your battle.

As you continue to repeat and improve at EET's Fat Burning Workouts, your body and metabolism will understand the powerful message you are sending, that you are asking it to do something different than it has before, and as a result, your body and your metabolism must change in accordance with the message being sent.

And, like the gladiator, your body/metabolism will ensure throughout the day that you are prepared to handle your next brief "test of survival". Repetition of interval workouts will become a key part of your new metabolic memory that your body needs to be lean and fit because intervals will be an ongoing part of your life.

HIGH-INTENSITY INTERVAL TRAINING:
THE OPTIMAL PROTOCOL FOR FAT LOSS?

James Krieger

As exercise intensity increases, the proportion of fat utilized as an energy substrate decreases, while the proportion of carbohydrates utilized increases (5). The rate of fatty acid mobilization from adipose tissue also declines with increasing exercise intensity (5). This had led to the common recommendation that low- to moderate-intensity, long duration endurance exercise is the most beneficial for fat loss (15). However, this belief does not take into consideration what happens during the post-exercise recovery period; total daily energy expenditure is more important for fat loss than the predominant fuel utilized during exercise (5). This is supported by research showing no significant difference in body fat loss between high-intensity and low-intensity submaximal, continuous exercise when total energy expenditure per exercise session is equated (2,7,9). Research by Hickson et al (11) further supports the notion that the predominant fuel substrate used during exercise does not play a role in fat loss; rats engaged in a high-intensity sprint training protocol achieved significant reductions in body fat, despite the fact that sprint training relies almost completely on carbohydrates as a fuel source.

Some research suggests that high-intensity exercise is more beneficial for fat loss than low- and moderate-intensity exercise (3,18,23,24). Pacheco-Sanchez et al (18) found a more pronounced fat loss in rats that exercised at a high intensity as compared to rats that exercised at a low intensity, despite both groups performing an equivalent amount of work. Bryner et al (3) found a significant loss in body fat in a group that exercised at a high intensity of 80-90% of maximum heart rate, while no significant change in body fat was found in the lower intensity group which exercised at 60-70% of maximum heart rate; no significant difference in total work existed between groups. An epidemiological study (24) found that individuals who regularly engaged in high-intensity exercise had lower skinfold thicknesses and waist-to-hip ratios (WHRs) than individuals who participated in exercise of lower intensities. After a covariance analysis was performed to remove the effect of total energy expenditure on skinfolds and WHRs, a significant difference remained between people who performed high-intensity exercise and people who performed lower-intensity exercise.

Tremblay et al (23) performed the most notable study which demonstrates that high-intensity exercise, specifically intermittent, supramaximal exercise, is the most optimal for fat loss. Subjects engaged in either an endurance training (ET) program for 20 weeks or a high-intensity intermittent-training (HIIT) program for 15 weeks. The mean estimated energy cost of the ET protocol was 120.4 MJ, while the mean estimated energy cost of the HIIT protocol was 57.9 MJ. The decrease in six subcutaneous skinfolds tended to be greater in the HIIT group than the ET group, despite the dramatically lower energy cost of training. When expressed on a per MJ basis, the HIIT group's reduction in skinfolds was nine times greater than the ET group.

A number of explanations exist for the greater amounts of fat loss achieved by HIIT. First, a large body of evidence shows that high-intensity protocols, notably intermittent protocols, result in significantly greater post-exercise energy expenditure and fat utilization than low- or moderate-intensity protocols (1,4,8,14,19,21,25). Other research has found significantly elevated blood free-fatty-acid (FFA) concentrations or increased utilization of fat during recovery from resistance training (which is a form of HIIT) (16,17). Rasmussen et al (20) found higher exercise intensity resulted in greater acetyl-CoA carboxylase (ACC) inactivation, which would result in greater FFA oxidation after exercise since ACC is an inhibitor of FFA oxidation. Tremblay et al (23) found HIIT to significantly increase muscle 3-hydroxyacyl coenzyme A dehydrogenase activity (a marker of the activity of b oxidation) over ET. Finally, a number of studies have found high-intensity exercise to suppress appetite more than lower intensities (6,12,13,22) and reduce saturated fat intake (3).

Overall, the evidence suggests that HIIT is the most efficient method for achieving fat loss. However, HIIT carries a greater risk of injury and is physically and psychologically demanding (10), making low- and moderate-intensity, continuous exercise the best choice for individuals that are unmotivated or contraindicated for high-intensity exercise.

1. Bahr, R., and O.M. Sejersted. Effect of intensity of exercise on excess postexercise O2 consumption. Metabolism. 40:836-841, 1991.

2. Ballor, D.L., J.P. McCarthy, and E.J. Wilterdink. Exercise intensity does not affect the composition of diet- and exercise-induced body mass loss. Am. J. Clin. Nutr. 51:142-146, 1990.

3. Bryner, R.W., R.C. Toffle, I.H. Ullrish, and R.A. Yeater. The effects of exercise intensity on body composition, weight loss, and dietary composition in women. J. Am. Col. Nutr. 16:68-73, 1997.

4. Burleson, Jr, M.A., H.S. O'Bryant, M.H. Stone, M.A. Collins, and T. Triplett-McBride. Effect of weight training exercise and treadmill exercise on post-exercise oxygen consumption. Med. Sci. Sports Exerc. 30:518-522, 1998.

5. Coyle, E.H. Fat Metabolism During Exercise. [Online] Gatorade Sports Science Institute. http://www.gssiweb.com/references/s0...20000006d.html [1999, Mar 25]

6. Dickson-Parnell, B.E., and A. Zeichner. Effects of a short-term exercise program on caloric consumption. Health Psychol. 4:437-448, 1985.

7. Gaesser, G.A., and R.G. Rich. Effects of high- and low-intensity exercise training on aerobic capacity and blood lipids. Med. Sci. Sports Exerc. 16:269-274, 1984.

8. Gillette, C.A., R.C. Bullough, and C.L. Melby. Postexercise energy expenditure in response to acute aerobic or resistive exercise. Int. J. Sports Nutr. 4:347-360, 1994.

9. Grediagin, M.A., M. Cody, J. Rupp, D. Benardot, and R. Shern. Exercise intensity does not effect body composition change in untrained, moderately overfat women. J. Am. Diet Assoc. 95:661-665, 1995.

10. Grubbs, L. The critical role of exercise in weight control. Nurse Pract. 18(4):20,22,25-26,29, 1993.

11. Hickson, R.C., W.W. Heusner, W.D. Van Huss, D.E. Jackson, D.A. Anderson, D.A. Jones, and A.T. Psaledas. Effects of Dianabol and high-intensity sprint training on body composition of rats. Med. Sci. Sports. 8:191-195, 1976.

12. Imbeault, P., S. Saint-Pierre, N. Alméras, and A. Tremblay. Acute effects of exercise on energy intake and feeding behaviour. Br. J. Nutr. 77:511-521, 1997.

13. Katch, F.I., R. Martin, and J. Martin. Effects of exercise intensity on food consumption in the male rat. Am J. Clin. Nutr. 32:1401-1407, 1979.

14. Laforgia, J. R.T. Withers, N.J. Shipp, and C.J. Gore. Comparison of energy expenditure elevations after submaximal and supramaximal running. J. Appl. Physiol. 82:661-666, 1997.

15. Mahler, D.A., V.F. Froelicher, N.H. Miller, and T.D. York. ACSM's Guidelines for Exercise Testing and Prescription, edited by W.L. Kenney, R.H. Humphrey, and C.X. Bryant. Media, PA: Williams and Wilkins, 1995, chapt. 10, p. 218-219.

16. McMillan, J.L., M.H. Stone, J. Sartin, R. Keith, D. Marple, Lt. C. Brown, and R.D. Lewis. 20-hour physiological responses to a single weight-training session. J. Strength Cond. Res. 7(3):9-21, 1993.

17. Melby, C., C. Scholl, G. Edwards, and R. Bullough. Effect of acute resistance exercise on postexercise energy expenditure and resting metabolic rate. J. Appl. Physiol. 75:1847-1853, 1993.

18. Pacheco-Sanchez, M., and K.K Grunewald. Body fat deposition: effects of dietary fat and two exercise protocols. J. Am. Col. Nutr. 13:601-607, 1994.

19. Phelain, J.F., E. Reinke, M.A. Harris, and C.L. Melby. Postexercise energy expenditure and substrate oxidation in young women resulting from exercise bouts of different intensity. J. Am. Col. Nutr. 16:140-146, 1997.

20. Rasmussen, B.B., and W.W. Winder. Effect of exercise intensity on skeletal muscle malonyl-CoA and acetyl-CoA carboxylase. J. Appl. Physiol. 83:1104-1109, 1997.

21. Smith, J., and L. McNaughton. The effects of intensity of exercise on excess postexercise oxygen consumption and energy expenditure in moderately trained men and women. Eur. J. Appl. Physiol. 67:420-425, 1993.

22. Thompson, D.A., L.A. Wolfe, and R. Eikelboom. Acute effects of exercise intensity on appetite in young men. Med. Sci. Sports Exerc. 20:222-227, 1988.

23. Tremblay, A., J. Simoneau, and C. Bouchard. Impact of exercise intensity on body fatness and skeletal muscle metabolism. Metabolism. 43:814-818, 1994.

24. Tremblay, A., J. Després, C. Leblanc, C.L. Craig, B. Ferris, T. Stephens, and C. Bouchard. Effect of intensity of physical activity on body fatness and fat distribution. Am J. Clin. Nutr. 51:153-157, 1990.

25. Treuth, M.S., G.R. Hunter, and M. Williams. Effects of ex

Choose the right tools for the job & avoid injury

2010-01-11T05:00:00.000-08:00

So I was playing soccer the other night with my Mundo shoes. The little nubbie things grabbed the indoor carpet and I had one of those While E. Coyote moments (you know where he suddenly realizes he’s over the edge of the cliff and his head stays there a second agape while the rest of his body keeps moving.) as my knee popped in and out of joint. I originally hurt my knee with a bucket handle tear of my meniscus and acl tear on a red clay field that soccer field that is indigenous to the Washington DC area developed on swampland. Again the shoe selection,in this case cleats instead of my Mundos was the wrong one for the field. Sometimes a small thing can have a major effect on an outcome.

What I did was akin to using a flat head screw driver for a Phillips screw. Lesson learned:choose the right tools for the job, in the case of the turf flats such as Sambas. In the case of the dry red clay no cleats.

Making a Man Out of Mac & Getting Back the Six Pack Back For Spring

2010-01-02T09:02:00.000-08:00

I was fascinated by the dude getting sand kicked in his face on the back of comic books growing up...
I now know that developing strength, tone and muscle building

is not a direct function of how much you max out on at the gym.
If you workout smarter and eat accordingly burning the fat and buffing
up does not have to eat up all your time.

For example if you work out one or two body parts per session i.e.
chest/ shoulders you will develop strength and muscle faster because
you are extensively working those targeted areas vs doing a bunch of
different body parts. Now throw on some Tabatta intervals on top of that
named after the Japanese speed skating coach which consist of 20
seconds at all out intensity of an activity such as jumping rope,
speed bag,or core work followed by 10 second rest for 4-5 minutes
and you will boost your adrenaline and testosterone levels promoting
fat burn and muscle building.

If you do additional cardio later that day you are burning down the calories
your body needs to muscle build. Also if you natural lean body mass like me
you have to up your calorie count particularly around the zones of your work out.
If you are on the other end of the spectrum then do not binge at night.
You can readmore on this on my friend Jon's posts on this blog.

In short order you will burn off the six packs watching ballgames and the
Olympics over the winter and build up your new six pack.
You still have to be consistent to make it back.

Making a Man Out of Mac (continued)

2009-12-06T08:26:00.000-08:00

It turns out that much of what we need to do to get in better shaped is

linked to when we choose to eat relative to our workouts and during the

course of our day. The following posts were provided by my friend Jon

who has designed a game plan for getting the most out of our workout

and eating schedules. If you have the discipline to keep to a schedule

you can accomplish more with shorter intense workouts.

There are so many options when it comes to food that you could eat a different food every time you eat something for the rest of your life. Same goes for drinking options.

You crave certain foods. If you are like most people, you tend to crave foods that are not typically helpful to weight loss and fitness efforts.

Yet most of us still want to lose weight (or at least maintain our current weight) and be more fit.

These are the reasons why most restrictive diet plans fail and exactly why EET has been designed with the key guideline that your eating plan has to be customized to fit your lifestyle and will include the foods you crave.

EET is not trying to change your food cravings, as if they are something bad or harmful. In fact, EET has a tremendous respect for the foods you crave. These cravings are part of your body's current metabolic memory and they are sending you a message that there is SOMETHING about these particular foods that is positive for you.

There are many possibilities to explain your food cravings. Maybe it's emotional, eating the foods you crave make you feel better. Maybe it has to do with your body's unique chemistry, the foods you crave might give you more energy or maybe your body just really wants to experience the particular taste of the foods you crave.

Whatever the exact reasons are, EET is clear about what the reasons for food cravings are NOT:

It's not that you are undisciplined, or unhealthy or that everything you want to eat is bad for you. That's what the existing world of diet and exercise plans would have you believe.

So food cravings are good, and your weight loss and fitness plan should be built around them, because if you satisfy these cravings and can still meet your weight loss and fitness goals, you are very likely to stay with such a plan. EET is such a plan. Possibly the only plan that will allow you to enjoy the foods you crave, every day.

Does EET's approach to embracing food cravings have risks? Yes. You have to learn when your body can best handle the foods you crave, so there might be times you have to wait to eat the foods you love, but you never have to wait for long. You have to learn to control the portions of the foods you crave, and some people are not good at that. However, like many of life's great benefits, too much of a good thing can be harmful. Take water and electricity as examples.

Correct amounts of water are among the healthiest items you can include in your diet (if you time it right). Too much water can be very harmful or even fatal.

The correct amount of electricity to meet your needs is one of the most helpful items in our lives, yet too much electricity is very harmful or even fatal.

We don't suggest people live without water or electricity, instead teachers explain how and when to use them to their greatest advantage. This makes them wonderful, positive parts of your life.

Teachers of EET have the same approach to the foods you crave the most.

Jon Pearlstone, age 46, is the founder of the EET Fitness Plan. He has lost over 30 pounds in the last 19 months eating the foods he loves and exercising less than 30 minutes per day 5-6 days per week. For more information on EET contact Jon at eetfit@gmail.com.

Here's a before and after picture update of Jon since his original post in Sept 2009:

May 2008 200 LBS

Sept 2009 176 LBS _________________ Dec 2009 168 LBS

________________________________ (Right after T-Giving!)

The Inches We Need

2009-11-16T19:28:00.000-08:00

Barefoot Running on MSNBC Dr. Nancy Snyderman

2009-11-14T13:22:00.000-08:00

http://www.msnbc.msn.com/id/31388323/#32986831

Core Exercises

2009-11-06T04:39:00.000-08:00

Beginning:

http://www.youtube.com/watch?v=hNUKn3H36lg

Intermediate/ Advanced:

http://www.youtube.com/watch?v=625STzGylwI

A 4 minute Workout to Max Fat Burn and Conditioning

2009-10-12T04:16:00.000-07:00

If you are traveling on the road or have kids , here's one way to never have an excuse not to work out again. Thanks to my friend Jon for sharing his research.

http://www.youtube.com/watch?v=ZojlJxF4J5M

Bike Fit

2009-10-08T05:23:00.000-07:00

My friend Paul put this article together:

If you buy a suit don’t you have it tailored? When you buy new tires for your car you have them balanced, right? When you get glasses you have a doctor examine your eyes to get the correct prescription. The last time you bought a new bike did you have a proper bike fit performed?

This article will explain all the specific measurements that should be taken in a bike fit and how to best make changes to your bike that correspond to those measurements. It will also explain why most people will need treatment to resolve muscular imbalances and flexibility issues.

Too often many people set up their bike by the way it feels to them only. If you have a bike fit completed not only will you be more comfortable on your bike but you will also perform better and reduce your chances of injury. When having a bike fit performed there are specific measurements that should be taken. The measurement that is most important for power production in the angle of knee bend when you are at the bottom of your peddle stroke. Besides this you also should know your hip angle when holding your handle bars in the position your most often ride in which should be on the brake hoods. The fore-aft position of your knee in relation to the pedal and the amount of sway of your knee during your pedal stroke are all important to power production and comfort on your bike. Cleat placement is also important. Other smaller changes that can affect your optimal position on a bike are saddle size, handle bar size and fore-aft position of the saddle. One aspect to an average bike fit that I think is missing is testing a person’s flexibility and strength. Most bike fitters don’t have the knowledge of how to accurately test someone’s flexibility. Even if the fitter does know how to, no fitter is able to treat those issues.

As I stated earlier the single most important measurement that will be taken during a bike fit is the angle of your knee at the bottom of the pedal stroke. Research has shown that the knee should flex optimally to 35 degrees to produce the greatest amount of force. This can be easily measured using a goniometer. A goniometer is basically a protractor that can be centered at the knee joint with each arm running along the shafts of both the femur (thigh bone) and fibula (shin bone). By lifting your saddle up as little as 2-5mm you can decrease the angle of knee flexion. What if you have an inability to straighten your knee to that degree because of extremely tight hamstrings? No alteration of your bike settings will allow you to have an optimum pedal stroke. This is why you need to check flexibility and then have treatment performed on your hamstring. Soft tissue techniques like Active Release Technique and Graston Technique are perfectly suited for a situation like this. These techniques are what we often use for treatment at Capital Sports Injury Center.

The angle of your hips will be the second most important measurement taken during a bike fit. The smaller the angle of your hips are the more aerodynamic you can become on your bike. With less of an angle you can get your upper body closer to parallel to the ground causing less wind resistance. This angle again can be measured with a goniometer using your femur and the midline of your abdomen centered about the hip joint. The correct angle to use depends on the rider. Are you more interested in comfort or aerodynamics? An aggressive rider would want something around 25 degrees while someone looking for more comfort would do fine closer to 30 degrees. The measurement of this angle is even more dependent on flexibility. A person may have tight erector muscles in their low back or tight hamstrings that don’t allow them to rock their pelvis forward. Even if a rider wants to be aerodynamic they would never be able to sit in that much of a tucked position.

The fore-aft position of your knee can affect the amount of knee flexion you can accomplish at the bottom of a pedal stroke. If your knee is too far forward the amount of flexion will be increased at the bottom of the pedal stroke and vice versa if your knee is too far back. Riders may also be shifting forward on their saddle either for comfort or extra power. This will change all the measurements. It is important to have the rider sit on their saddle correctly.
That brings me to a problem that I had previous to my bike fit. I was sitting on a saddle that was too narrow. This meant that I was not sitting on my ischial tuberosities (sit bones) but was rocking forward onto my pubic bone. As you can guess this was not very comfortable. The average size saddle is 130 mm wide at its widest point. If you are a larger rider chances are this will not be large enough for you. No amount of change in the different parameters of a fit will help if you can’t sit on the saddle correctly.

Cleat position is closely tied to knee sway most of the time. If your cleats are set up so that you have no movement at all or you will clip out your knees will have to sway more if there is a hip problem. Having said that you can make up for hip issues or increased knee sway if you increase the amount of internal rotation of your cleats. By doing this you can increase the internal rotation of your foot and allowed your knee to track straighter up and down.
Although not often an issue the size of your handlebars can be problematic with shoulder injuries. If you have had an injury where you have lost the ability to extend your arms or internally rotate them you may need a larger handlebar. With any shoulder injury some form of treatment and exercise should be performed to help recover the lost movement. A great internal rotation exercise can be performed with tubing. Start with the tube attached to something on one end and grasp the other end with your thumb up and arm abducted (away from your body). Facing perpendicular to the tube internally rotate your arm so that your thumb is down and reach behind your back to the opposite shoulder blade.

The final aspect to a bike fit may involve changing the fore-aft position of your saddle. When this is done it move your entire body either forward or backward. This is usually done when a rider’s knee fore-aft position or knee flexion at the bottom of a pedal stroke can’t be fixed with any of the other bike fit components.

One aspect to a bike fit that is typically missing is testing a person’s flexibility, caused by imbalance, and strength. This is called a functional movement screen (FMS). Since most bike fitters do not have this expertise, Drs. Horwitz and Glodzik add the FMS to help the bike fitter make the best decisions on equipment and placement. These imbalances cause compensatory changes in multiple areas of the body resulting in "energy leakage" and increase the potential for injury. As in the example above, if your hamstrings are tight, this may be due to weak gluteal and core muscles as well as due to adhesions in the muscle itself. A corrective exercise program and a program of care to resolve these issues must be undertaken. This will certainly change the bike fit! Even with all the different changes that can be made to make your bike more comfortable riders still need to fix the problems that are necessitating the changes. A rider should have their injuries treated and still perform other training off the bike to make it easier to be on the bike.

For any questions feel free to contact chiropractors Drs. Horwitz and Glodzik at painfree123@gmail.com. If you are interested in a bite fit or are experiencing any other problem and would like to make an appointment in our Silver Spring, Cleveland Park, or Georgetown offices, please call us at 301-622-9000.

Successful Junk Food Diet Shakes Up The 2% Club

2009-09-29T17:19:00.000-07:00

My friend, Jon Pearlstone, from I.U. put this plan together over the last year and has had success with it so I asked him to write about it for us.

Jon is a self taught fitness expert who, among other things, took up the Javelin at age 41 and made the State Finals of the California Community college Track meet as a by age 43. Now 46, he has used his experience, his sons' UCLA track and football experience and a lot of research to devise this plan. The version of EET he writes about here is for people who want to get lean and stay lean.

Personally, I'm getting involved with Jon's other version of EET. It's a Body Building Program to bulk up, get more muscular and fit I am hoping it helps with the upcoming triathlon season. I will keep you updated and let you know how it goes. In any case, his plan is different and interesting and worth reading about.

Successful Junk Food Diet Shakes Up The 2% Club
by Jon Pearlstone

It’s nearly impossible to get in, and has nearly 50 million applicants every year. Only the 2% of dieters who maintain their goal weight for over a year are admitted: It’s the exclusive “2% Club”.
For 20 years I stood outside the Club’s velvet rope with the masses only to get shot down again and again. Meanwhile, the spare tire around my waist kept growing.

But, my years of struggling ended this year thanks to my new approach to dieting. I lost 20 pounds and kept it off while eating junk food everyday. You read that correctly, EVERY DAY. Here’s my before and after pics and my story: May 2008 200 Pounds

September 2009 176 Pounds

THE DAIRY QUEEN MONOLOGUES

Through the years, I paid $1000’s to the 2% Club’s membership agents, including Weight Watchers, Atkins, Protein Power, and endless health club fees. Each effort had the same sad story line. Lots of hype and some success for a short time, followed by the “rebound” right back to where I started. Then, the painful torture of tacking on even more weight.

Then, last year at age 45, tipping the scale at 200 pounds for the first time, I was sneaking into the fridge to enjoy my 3rd Dairy Queen Dilly Bar of the day, and it hit me.

I LOVE JUNK FOOD AND DO NOT WANT TO GIVE IT UP.

At that moment, I knew the challenge I had to accept. To join the 2% Club by finding a diet plan that let me eat junk food and still lose weight.

HARSH REALITIES

I have zero willpower when it comes to eating, but I was prepared to increase my exercise if it meant I could eat my beloved Dilly Bars, BK Whoppers, and other fun foods. Just need to exercise more to pay for my weakness, right?

Uh, no. Multiple reputable sources made clear that nutrition is the key to weight loss, PERIOD. The evidence suggests that exercise is about 25% of the formula for losing weight, and too much exercise can even cause weight GAIN due to muscle fatigue, stress, and other reasons.

Great. Now I had to lose weight while eating whatever I want and exercising LESS. Cue the laughter from the folks at the 2% Club’s juice bar.

I USED TO EAT A TON AND NEVER GAIN WEIGHT, WHAT HAPPENED?

Amazingly, the very next day, fate intervened. My teenage sons walked into the house with a bag full of McDonald’s Cheeseburgers. AND DINNER WAS ONLY AN HOUR AWAY!

I remembered eating like that back in the day, and I never gained weight. It’s that insanely high teenage METABOLISM. Bingo! All I needed to do was to reset my metabolism to act like a 17 year old and that 2% Club membership was mine. Good Luck with that.

10,000 CALORIES OF CHOCOLATE FOR BREAKFAST

I saw no way to reverse the aging process and have a teenager’s metabolism. But, while studying other ways to reset and accelerate metabolism, I found a question that completely changed how I approach fitness. (I am paraphrasing):

Would you gain more weight if you ate 10,000 calories of chocolate for breakfast or right before bedtime?

Most agree that eating 10,000 calories of chocolate for breakfast will result in less weight gain than eating it right before bed as you have more “active” time in the day to metabolize it. The same concept made sense to me for exercise as well. Could eating and exercise timing be just as effective at less extreme examples? I was sure it could and was determined to prove it.

EATING AND EXERCISE TIMING (EET) – A COMPLETE PLAN

There’s months of research and lots of details behind my EET Fitness Plan, but, here are some key points and an outline of how EET works:

After exercise, when you have completed breaking down your muscles your body goes into “recovery mode” and ramps up it’s efforts to recover and rebuild. This creates a “metabolic window” if performed and timed correctly.

In addition, Dr. John Ivy of the University of Texas is his groundbreaking book Nutrient Timing, The Future of Sports Nutrition (2004) found that when a metabolic window is created, muscle recovery was most successful when HIGH GLYCEMIC CARBOHYDRATES were eaten along with protein (p.61).

To Dr. Ivy, high carbs meant something like a supplemented protein shake. To me it meant DILLY BARS and the wonderful world of junk food. (Let me be clear, my EET plan is very different from many of the suggestions in Dr. Ivy’s book and Dr. Ivy should not be considered affiliated with the EET plan in any way.)

I utilized the above information with other well supported findings, such as burning 3 times more fat in the morning that at any other time during the day, and how to best time eating a variety of foods day and night when the metabolic windows are closed. I also found studies with highly effective workouts which could be completed in under 30 minutes while maximizing fat burning throughout the day. By combining of all this and more, the EET Fitness Plan was born.

THEY WANT TO REVOKE MY MEMBERSHIP?

As I write this, it’s now been 17 months since I have followed my EET plan, and I am now a card carrying member of the 2% club.

THERE HAS NOT BEEN ONE SINGLE DAY IN THOSE 17 MONTHS THAT I HAVE NOT EATEN WHAT OTHERS CONSIDER “JUNK FOOD”

But, it’s not just about junk food. EET let’s me live a normal life that includes junk food. I also go out to lunch and dinner a few times a week, more during holidays and vacations. The difference is I have lost weight doing these things!
And for you naysayers from the 2% club that say a fitness plan that includes junk food has to be bad? I say you can’t help what you love. I’m sure I’m not alone loving foods that are considered bad for weight loss when I drive down street after street filled with fast food, bakeries, ice cream parlors, fancy restaurants and a lot more. All of these would kill any conventional diet. For me (and other 98%ers) it’s crazy to have a plan that doesn’t accept this reality.

And who knows if junk food is all that unhealthy? Some studies show junk food reduces stress. Maybe it’s keeping me healthier? Bottom line: I haven’t missed one workout in 17 months due to illness or injury, so you be the judge.

Last but definitely not least, let’s talk money. Here’s the cost to follow EET:

* HEALTH CLUB / GYM MEMBERSHIP: $0
* PERSONAL TRAINER FEES: $0
* SUPPLEMENTS $0 I take no supplements of any kind
(vitamins, fat burners, etc.) these can be riskier than junk food IMHO
* FOOD COSTS LOWER No prepackaged plan foods here. I
buy what’s on sale and make it work.

So much for the 2% Club’s mantra that you can’t lose weight without “investing in yourself”. I have now proven that you can actually lose weight and keep it off without spending a ton of money and I’ve cut my exercise time in half!

I’M IN. BUT, MEMBERSHIP CAN BE CANCELLED AT ANY TIME

I’m happy to finally be in the 2% Club, but there’s no lifetime guarantee. I will say my results to date certainly are encouraging for a longer term stay.
And, to help others and keep me motivated, I’m teaching the EET Plan to people who have yet to find a way into the 2% club. If I have my way, people will no longer have to apologize or feel guilty for loving to eat..

Jon Pearlstone is currently continuing to test and improve his EET Fitness Plan. He is offering trials of his EET Fitness Plan at no cost. For more information on EET and any questions or comments, Jon can be reached at EETFIT@gmail.com

Remembering 9-11

2009-09-07T18:24:00.000-07:00

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. 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.

Thinking Outside the Box

2009-08-18T01:01:00.000-07:00

Thinking outside the box is thinking outside traditional boundaries. . Management guru Mike Vance has claimed that the use of the nine-dot puzzle in consultancy circles stems from the corporate culture of Walt Disney . The phrase relates to a traditional management problem called the nine dot puzzle. The object is to connect the nine dots with only four lines. (solution at end of post)

Houston, We Have a Problem

Remember the movie Apollo 13, where the survival of the crew literally depended on fitting the square central module carbon dioxide scrubber canisters into the round holes of the lunar module unit and unless a way could be found to use the square ones the carbon dioxide levels would reach poisonous levels before the crew could get home. The solution came in the form of jerry-rigged duct tape, suit hoses and cardboard to make the connection. Their problems still were not over as they had to shorten the trajectory back to the earth with damaged navigational equipment and had to use the sun and crescent of the earth as reference points for their second rocket burn back.

In the world of sports John Madden redefined how people relate to football with his X's and O's on the telestrator. He made the technical aspects of the game more accesssible to the average viewer. He made the viewer more connected with the humor he injected in his telestrator such as steam vent lines off a bald player on the sidelines and circling old school barbeque at the cities he visited on the road. Known for his zingers on the air, perhaps his most profound quote was:"Coaches have to watch for what they don't want to see and listen to what they don't want to hear".

Olympian Gary Hall Jr. took the monotony of training laps in a pool outside the box devising his own training schedule which included spear fishing,boxing yoga and racing with swimmers from other countries at his base camp. Bucking the traditional Olympic development training model, he brought the training to his home on terms that worked for him so that he was able to compete successfully at an elite level while navigating through the meticulous monitoring needed with managing his diabetes.

In football, Redskin coach Jim Zorn has a reputation for being outside the box with unusual training methods such as the use of both Slip 'n Slides and Dodge Ball drills in his football practices. He once bought in a baseball player to teach his quarterback how to slide. He has manged to continue to earn the respect of outside of the box players such as Chris Cooley. He took a very unorthodox approach to the NFL code of private critique and public praise when he called out some players that were not playing up to snuff. Being candid about his players' performance level is something that is important for a unit to respect its leader in high risk situations according to Thomas Kolditz head of the psychologic testing
at West Point. In an office setting calling out staff is in public is not constructive. The critical difference is that shared risk mandates that decisions made on the football or battlefield have to happen in a very narrow time frame and the physical well being of your teammates and fellow soldiers depends on tight integration and performance of the unit. The Redskins record this year is not a
reflection on the coaching as much as the influence of upper management and injuries. An organization is ultimately only as good as its top brass.

Swimsuit Technology The Car & the Driver

2009-07-28T19:39:00.000-07:00

Its the car and the driver these days in swimming with the advent of super buoyant suits.
http://www.nytimes.com/2009/07/29/sports/29swim.html

Stretching Revisited

2009-07-25T04:06:00.001-07:00

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 hamstring and quadricep muscles of those that stretched before activity versus those that did not.1 The decrease was about 3%, minimal but not insignificant, particularly when fractions of a second can count in sprinting events. Vertical jumping height and torque were unchanged. Power is the application of work within a finite time. Torque is the application of force and does not require movement unlike work. Torque is the force you apply to a jam jar that is stuck. Work is what happens once you get the lid moving.. Similar reductions were found in the Achilles tendon in a previous study.2 Two other studies reported that strength was reduced up to one hour after static stretching.3

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. 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. 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 the inhibitory response. They instead get what McHugh calls “an excitatory message” to perform.

Much has been written about problems with ballistic stretching but dynamic stretching is different. Dynamic stretching consists of controlled leg and arm movements that extend to the limits of your range of motion. Ballistic stretches involve trying to force a part of the body beyond its range of motion. In dynamic stretches, there is no bouncing.
Flexibility is speed specific. There are two kinds of stretch receptors, one measures magnitude and speed and the other measures magnitude only. These receptors are also responsible for the stretch reflex, our body’s protective mechanism, which counters in the opposite direction to the part being stretched. This also explains why it doesn’t make sense to static stretch prior to dynamic activity. There is considerable but not complete transfer of static stretching to dynamic stretching.4 In another study that looked at static stretching done not in close proximity to testing, on groups that were doing no other training regimen, the stretching group performed better. The author concluded that stretching in this manner could help bridge to a regular training regimen.5

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."

The epidemiology program office at the Centers for Disease Control and Prevention conducted a study that reviewed 361 research studies on stretching. The results indicated that stretching increased flexibility but this did not decrease injury rates. Injury rates were higher for both the most flexible and least flexible study participants than for those in the mean.6 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. This would likely hinge on the flexibility of the athlete at baseline. Witvrouw et al believe that part of these contradictions in injury rates of studies can be explained by considering the type of sports activity in which an individual is participating. “Sports involving bouncing and jumping activities with a high intensity of stretch-shortening cycles (SSCs)(e.g. soccer) require a muscle-tendon unit that is compliant enough to store and release the high amount of elastic energy that benefits performance in such sports. If the participants of these sports have an insufficient compliant muscle-tendon unit, the demands in energy absorption and release may rapidly exceed the capacity of the muscle-tendon unit. This may lead to an increased risk for injury of this structure.” They add that recent studies have shown that stretching programs can significantly influence the viscosity of the tendon and make it significantly more compliant for the rigors of high intensity sports.7

How do these findings relate to some of our concepts of treatment? In 2002, Lance Barry, DPM reviewed static gastrocnemius-soleus stretching versus night splints in the treatment of plantar fasciitis. He found that the night splint group had a significantly reduced recovery time. The idea of putting the fascia at physiologic tension versus stretching the gastrocnemius had more of an impact on improving plantar fasciitis. Immobilization, a time honored strategy is part of the treatment with night splints. The splints that extended the toes, in this case the Strausberg Sock, had better results than the other splints although this variable was not part of the study design.8The parallel between these studies is that muscle static stretching just prior to activity does not promote better sports performance and runner's style static standing stretching for plantar fasciitis may damage the fascia and delay healing.

Naturally, there are many variables to consider when determining the best options for athletes and our patients regarding stretching. The evidence leans towards more dynamic stretching as part of a warm up routine in lieu of static stretching immediately prior to activity.

1.Samuel, MN, Holcomb, WR, Guadagnoli, MA, Rubley, MD, and Wallmann, H. Acute effects of static and ballistic stretching on measures of strength and power. J Strength Cond Res 22(5): 1422-1428, 2008
2.Rosenbaum, D. and E. M. Hennig. 1995. The influence of stretching and warm-up exercises on Achilles tendon reflex activity. Journal of Sport Sciences vol. 13, no. 6, pp. 481–90.
3. Fowles, JR DG Sale, JD MacDougall - Journal of Applied Physiology, 2000 - Am Physiological Soc. Vol. 89, Issue 3, 1179-1188, September 2000 Reduced strength after passive stretch of the human plantarflexors
Kokkonen et al. (1998) Research Quarterly for Exercise and Sport
4.Kurz, Tomas, Science of Sports Training, page 236
5.Kokkonen AG Nelson,C Eldredge, JB WInchester - Medicine & Science in Sports & Exercise , 2007 1831. Chronic Static Stretching Improves Exercise Performance.
6.Pope, RP, Herbert, RD, Kirwan JD, Graham, BJ A randomized trial of preexercise stretching for prevention of lower- limb injury. Medicine and Science in Sports and Exercise. 2000; 32:271-277.
7.Witvrouw E, Mahieu N, Danneels L, et al. Stretching and injury prevention: an obscure relationship. Sports Med 2004;34:443-449
8. Barry, Lance D. DPM et al. "A Retrospective Study of Standing Gastrocnemius Soleus Stretching versus Night Splinting in the Treatment of Plantar Fasciitis," The Journal of Foot and Ankle Surgery, Volume 41, Number 4, July/August 2002.

More Barefoot Running Info

2009-06-23T19:41:00.000-07:00

The following is some feedback from barefoot runner Ken Bob:

I enjoyed reading your post. Though it doesn't have any new information, it is a good round-up of the general issue.

I would add, that in the book, "Barefoot Runner"
http://runningbarefoot.org/?p=85
One of the reasons (may have been speculation on the part of the author) given for Abebe Bikila wearing shoes in the Tokyo Olympic Marathon, was so as not to dishonor his hosts, who presented him with the new shoes. I will be among the first to admit, that Abebe Bikila comes off as a bit naive in this account of his life.

As far as the arguments for support, or feedback - in engineering, any system that benefits from feedback, will be more stable than one that cannot sense it's own outcome. The problem I see with Robbin's and other's writings, is that they are written by doctors for doctors. Running barefoot is very simple. It provides precise feedback, via the thousands of nerve endings in our soles, that help us learn (if we take the time to listen) how to run more gently, and more efficiently.

As for runners who wear shoes because they have problems running barefoot... I suspect the opposite is more likely true, as many of the folks on my email group, have started running barefoot because they could no longer run with shoes. In our society, I suspect there are only a few who would give running barefoot a fair chance, until just these past few months, thanks to Christopher McDougall's book. The problem is, most of us have learned to run, without the benefit of the precise feedback from our soles, and so, if we simply step out of our shoes, and attempt to run the way we ran with shoes, which has in many folks, become a very strong habit, we will say, "Running barefoot hurts!" What we don't realize is that pain is trying to teach us to change the way we run. But, old habits are difficult to break, and few folks want to make changes in their lives, when they can simply pop a pill to kill the chronic pains they suffer from years of poor running technique. And most won't even try running barefoot, especially if it already hurts to run with shoes. So, I suspect, there are a great number of would-be runners, who have given up running, simply because the idea of running barefoot had not occurred to them, or they cannot imagine how it could possibly be better than with shoes.

While many of those who have given it a fair chance, like Barefoot Ted, who could not run more than a few miles with shoes, without severe pains in his knees, back, etc... Now, since he took the time to relearn HOW to run, while barefoot, has successfully completed, not just a few marathons, but also several ultra-marathons, up to 100 miles!

And Ted is not a rare exception, except for his interest in ultra-running and an eagerness to talk, both of which has given him some fame.

Some ten years earlier, there was another runner, who wanted to run, but had all sorts of knee and back pains whenever he tried any significant distance with shoes - and he had tried all sorts of shoes that were supposed to solve these problems. He found my web site, and being a registered nurse, was not only skeptical, but made it his mission to prove me wrong. Now we call him, "Barefoot Larry" and he has completed dozens of marathons, all barefoot.

Well, I could go on and on, but I think you might be better served by asking some specific questions, and I would like to express my gratitude that you, as a DPM, are actually showing an interest in this issue, for as a wise person once wrote, "Some will experience cognitive dissonance when their point of view is challenged." And for a long time, this has been our experience with foot doctors.

I am just another runner, who finding it difficult to run any significant distances in shoes, without ending up with bleeding feet ( I am a rarity in our society - one who never really adapted to running with shoes ), started the Running Barefoot web site, as a means of answering the many questions folks were asking me, anytime they saw, or heard about me running barefoot. I never intended to take on the shoe industry. But, I am happy if a few folks have begun questioning the accepted wisdom of seeking solutions from those whose business is to profit from the same solution. Now, I'm not opposed to making profit, after all, I too work for a living. However, I do believe we, as a society, need to be much more critical of marketing strategies, particularly, in realizing that they ARE marketing strategies, not necessarily gospel truth!

Have fun,
-barefoot ken bob

Saul Raisin: Coma to Comeback Road to Ironman

2009-06-08T04:53:00.000-07:00

I met Saul at the Clarendon Cup Bike Race this year and how could you not get drawn in by his story. I'm half way through his book and wanted to share some of his thoughts moving forward. Forget Tony Stark, Saul; you're the real Ironman, brother.

A little over three years ago I lay comatose in a French hospital. I almost lost my life. My massive brain injuries were the result of a high-speed bicycle crash. My parents stood at my bedside, trying to comprehend the prognosis. They were told by doctors that I could be possibly brain dead, if I was to live they needed to find a nursing home to put me in because I would need special health care assistance the rest of my life. At the time I am told that I was the youngest team leader ever in the Sport of Cycling. At the age of 23 my future in cycling could not have been brighter. In the blink of an eye my world changed. In that same instant, though I couldn’t possibly comprehend it at the time, my life gained real purpose.

Doctors have called my recovery miraculous. Within the last three years I’ve raced in the US Pro Cycling Championship, run the New York City Marathon,Married and Divorced within 8 months, and competed in several Triathlons. I told my friends and family when I was in the hospital if I ever lived a normal life again that I wanted to give back and help people like me. Now I have started the Raisin Hope foundation and I’ve written a book to let others know that they are not alone. If I am not giving motivational speeches to crowds numbering in the thousands, or competing in Triathlons, I plan on spending time with our Wounded Soldiers from the war. In short, my experiences have gone beyond the impossible. This year my goal is to be the first person to come back from a Brain Injury as severe as mine and complete the Ironman in Hawaii.

To find out more about Saul's story check out :
www.raisinhope.org = my foundation

What advice do you have for someone who has suffered an injury taking them of the bike a while in terms of building back up stamina & strength?

Take time and do not panic to get back into good form. Good condition is not something you can rush. I find that it is best to accept the condition you are in and use that to learn about yourself and improve as a person.

Where are you currently in your training for the Ironman

Georgia and Philadelphia

What sort of diet did you have which helped you recover?

I do not think my Diet helped in my recovery. I was 125lbs after my coma and I gained 50lbs in the hospital. My resting metabolic rate they calculated at 13,000 calories a day because of high temperatures and my brain trying to heal it's self. . I was eating 3 times a day put snack in-between.

What do you like about what Lance has done for the sport. Is there anything you would do differently that you are comfortable to say?

He has given millions of people hope. His comeback from cancer is inspiring and shows others that you can over come obstacles in life no matter how big they are. The only thing I would have done different is won the Tour de France on a French team.

Do you feel the sport has cleaned up the way it should?

It is getting better. Because of the longitudinal testing of the French riders and blood passports where they look for changes in blood chemistry it is impossible to take performance enhancing drugs in the sport. As a spectator you can rest assured that in the Tour de France is 100% clean and guys that try to cheat will get caught.

What is your view of North American bike racing today?

Cycling is growing and I hope is going to continue to grow.

What do you eat and drink while racing during event?

Gu H20, Gu Roctane gel(best gel in the market), GU Chomps Energy Chews
What is your back strengthening regimen?

Sit-ups, push-ups, very light weights.

How are you getting the message out on our Vets from Iraq.

As far a our vets. The deal is this is the first war were we are able to save the lives
of our VETS from injuries in all previous wars would have killed them. Because of this
it is creating tens of thousands of them with TBI and other disabilities that they
will take with them their whole lives. The disabilities are so sever the government is
over whelmed and is doing every thing in its power to get them the care they need.
The thing is that the Government is trying to build state of the art brain injury rehab centers
but there are not really in place much less can handle the needs of the thousands already with
brain injuries. It is sad to say that it has taken this war to get the governments attention on how
sever a brain injury it. As far as the American public, they pick up my book and
read the book jacket about a kid who came back from a life treating brain injury. But yet
they do not know how substantial that it. I believe it will be five years after the war when it
hits America how severe a brain injury is and the devastation we have done. This war will affect the lives of hundreds
of thousands of people. I am in a state of panic trying to raise awareness for brain injury and our wounded
warriors.

Knee Pain and Cycling

2009-05-16T10:46:00.000-07:00

You ride your bike and and expect your knees to hold up - until they don't.

Knee pain for cyclists, previous injury notwithstanding, is usually not an isolated event; it is a process. We lose our health, knee joint included, one sand at a time until the point where we begin to notice it and do something to try and change the downward trajectory. Knee pain has truncated training rides, spoiled centuries and even ended cycling careers. But it doesn't have to - learn how to diagnose and prevent knee pain to keep cycling a part of your life for years to come.

What types of knee pain are common to cyclists?
Anterior knee pain which includes patellofemoral (also known as chondromalacia) is the most frequent type. Patellofemoral stress syndrome is an overuse injury that involves cartilage breakdown underneath the kneecap. Have you ever wondered why your knee makes crunching or popping noises going up or down steps? Often times this is a symptom of patellofemoral stress syndrome, because of an imbalance occurring above or below the knee. Some of this imbalance is caused by posture on the bike. Cycling positioning involves hunching forward and flexing your hips while in the saddle for long periods. If you are not fit to the bike properly this can exacerbate the problem. Other factors are muscle development distribution or a muscle strength deficit which can throw things off.

What causes knee pain in cyclists?
The knee can be affected by weakness of the gluteal external rotators which can lead to increased internal rotation of the leg and increase patellofemoral stress due to altered bony alignment. Cyclists typically have more developed calf and quadricep muscles than the average person. The vastus medialis is the tear drop shaped muscle that bulges out just above the inside of the knee and is usually well developed in cyclists, but if you have let riding go for a while or are new to the sport you can strengthen it with straight leg raises, lunges and dips or step downs with one leg going lower than the other while the other leg is on a block or stair. Other problems include muscle imbalances, excess motion in one or more joints, and leg length discrepancies. As we age a phenomena called cross linking occurs. This results in our tendons and ligaments being less flexible making them more susceptible to injury. Massage yoga and proper stretching can help minimize this. The body has a memory regarding injuries and sometimes it takes only a little more stress to setup for another injury episode.

Solution 1: Cycling Orthotics
A cycling orthotic can be made to compensate for problems that stem from too much motion occurring at the foot pedal junction.Not only can an orthotic decrease injuries but it can improve performance. This is accomplished by filling the dead space between your arch and the insole of your shoe so that energy is transferred directly to your pedal and not lost inside the cleat. An example of an imbalance which may be corrected is building lift on one side of an orthotic if there is leg length discrepancy. As a general rule, I usually compensate for half the difference of the discrepancy. Larger differences have to be adjusted in the crank arms or with shims. Another problem that can be addressed is excess motion, which can cause knee or arch pain. By placing a cant into a prescription for an orthotic, this force can be decreased. In cases where there are only minor issues over the counter insoles can sometimes be used.

Solution 2: Professional Bike Fitting
Bike fit issues and pedal selection may be the primary source or exacerbate existing knee problems. A saddle that is too high can lead to stress on the ITB, and patellofemoral loading can occur. If it is too low stress on the patella or quadriceps tendon can occur. If the seat is pitched too far forward stress on the anterior knee occurs because of too much flexion. If the saddle is too far back the ITB can be stretched because of the increased length. If the inside of your knee is bothering you and your clipless pedals have too little or no float, consider changing to a pedal with more float. If initial measures do not solve your problem a professional bike fit is in order. With this many moving - and connected - pieces, getting a professional opinion can not only increase your comfort and power, but also help ensure you can hammer for years to come.

Solution 3: Avoid the need for a Solution in the first place
Finally, try to control what you can. Keeping the knee warm in cooler weather is critical if you have any knee stiffness. Consider joining a yoga class or check out some yoga DVD's. Some people swear by glucosamine supplements to mininmize cartillage breakdown. Make sure you have no allergies to any of the components before you try glucosamine. If you have chronic swelling after exercise this may be a sign of more specific damage such as a meniscus defect or tear or internal ligament damage and a visit with your friendly neighborhood orthopedist is advised.

Remember that knee health is a process, not an event. Maintain your body more care than you put into your bike, because you probably use it more frequently and replacement parts aren't as easy to come by.

2009-03-28T11:19:00.000-07:00

Diagnostic ultrasound is becoming an immediate way to evaluate injuries without having to be scheduled for an MRI in many cases

Yoga for Cyclists

2009-03-14T17:17:00.001-07:00

Cycling next to swimming, is one of the least damaging high
aerobic sports. Nevertheless, there are a few chronic injury syndromes that can occur while riding. Many of these problems can be avoided if you warm up properly and take a few minutes after you ride with an appropriate stretching regimen. This is critical if you are undergoing a fast-paced workout or hammering the hills.

The reason you warm up is to get blood moving to your extremities so that they can contract more efficiently. The muscles I recommend that cyclists stretch include the calves (gastrocnemius), the front upper leg muscles (quadriceps), the back upper leg muscles (hamstrings), and outer hip muscles (tensor fascia latae) and core work.

There are many cycling, running and fitness books and websites that have excellent diagrams of the proper stretches. Remember that some info may be dated and that dynamic stretching is currently supported by research. Gone are the days of holding a stretch for 20 seconds. The progressions today are focused on gaining stability as well as on stretching. Stretching after a workout is important because of the shortening, which occurs after a muscle has been vigorously contracted in physical activity. An even better solution is to take a yoga class.

Think of your core as the linchpin that is necessary for muscles to work efficiently that are rotating around it. When it is weak you will feel it particularly in your back and hamstrings. Boat pose (Paripurna Navasana) with extension and flexion of your legs is helpful along with Superman or Locust pose (Salambhasana)with opposite leg and arm extended. You can create sequences that will also help protect your knees such as going from chair pose to warrior 3 . Hip openers such as squatting with feet flat are great hip openers after the compression that occurs on long bike rides. Different sequences to stretch the illiotibial band such as making a figure 4 with your legs while on your back are essential.

Muscle imbalances are a potential problem area that can plague your cycling. This happens commonly with the bigger front thigh muscles (quadriceps) overpowering the hamstrings or the calf muscles overpowering the front muscles in the lower leg. A muscle strength and flexibility evaluation can identify these problems. Consult a sports medicine specialist if these initial steps do not resolve your discomfort.

Barefoot Running

2009-03-10T23:57:00.000-07:00

Mention barefoot runners and most people's first association is probably the legendary 1960 Rome marathon victory by Abebe Bikilla. To some advocates the conversation can get heated up quickly as if you were talking about politics. The fundamental question that has yet to be fully answered is whether one can accurately track a population of runners who are barefoot vs.shod.

Abebe Bikilla : Barefoot Icon
The story goes that Adidas who was the shoe sponsor for the games did not have any shoes that fit Bikilla by the time he trried on the shoes that were left. Bikilla decided to run the race barefoot as he had trained and won. Of his race he is quoted as saying that “I wanted the world to know that my country, Ethiopia, has always won with determination and heroism." . He did not repeat a barefoot run in 1964 in Tokyo. Part of this decision was attributed to the more industrialized roads in Tokyo. He also was recovering from an appendectomy 40 days prior and still managed to pull off a world record running this time in a pair of Asics.

Barefoot Running from the Savanna to the Track

Anthropologists such as Daniel Lieberman believe that the human foot developed to run barefoot. His hypothesis is that we were built for endurance running. He is doing a study with Vibram Shoes and is currently looking for barefoot runners. Prospective studies and randomized controlled trials of barefoot and shod running are difficult to achieve for obvious reasons. Robbins and Gouw argued that plantar sensation induces a plantar surface protective response whereby runners alter their behavior to reduce shock. The less-cushioned shoe permitted increases in plantar discomfort,a phenomenon that they termed "shock setting" Coaches such as Brooks Johnson and Vin Lananna have used barefoot running as part of an overall program to train the body to run long distances fast. In their opinion, to run properly, the foot needed to grasp and release on a variety of surfaces such as dirt, grass, road, concrete, and gravel.

The Shoe Industry Steps In

Several companies have weighed in with their versions of a running shoe which simulates barefoot running. Adidas approach was to try and copy the shape of the foot. In theory this will produce smaller lever arms which can react faster.The idea for the Nike Free was born out of a visit by a couple researchers to Stanford where Lananna was having athletes running barefoot as part of their training regimen. Many competitive runners I spoke to use barefoot running or shoes like the Nike Free as part of their training. Nike had students test it for 6 months and those using the the Free for 6 months had greater flexibility and strength in the foot. I interviewed Tobie Hatfield from Nike's Innovation Kitchen and Jeff Pisciotta from the Nike Sports Research Lab to find out how the shoe industry has incorporated the concept of barefoot training into their shoe design. They seem to be spearheading the shift back to their spirited roots to the old Bill Bauerman days when they made prototype soles on waffle irons. They studied 20 competitive runners on grass and kinematics analysis demonstrated a general trend towards full foot contact. If you watch the footage of Abebe Bikilla's Rome Marathon you will notice the same thing. The perception of some of the runners tested was that they were landing more towards the forefoot than they actually were. . Many believe that racing barefoot is difficult unless you have been running without shoes all your life. Many recreational runners are also starting to try barefoot running in an effort to prevent injuries and improve technique. The problem with this is that some of them will not have the conditioning to handle the transition to barefoot running. Experts in the field agree that any transition to barefoot running be done slowly.

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. 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.

For runners such as Dave Watts,the director of the American Running Association things have come full circle. He relates that some of the early Tiger shoes he ran in in the 70's were not very beefed up in terms of cushioning. They resembled the more fashionable running shoes you see in boutiques in Brooklyn and West Hollywood. At one point he was running in orthotics prescribed for plantar fasciitis and a conventional running shoe. Now he gravitates towards shoes like the Free. The trend in the shoe industry seems to be toward offering more shoes with more minimalist designs. Keep in mind that for most runners barefoot training is good to train the small muscles that are not trained in stable running shoes.

It is hard to isolate all the force vectors because of the complex arrangement of the joints of the lower extremity. Robbins association between injury and wearing shoes has the possibility that wearing shoes increases the risk of injury, but other explanations are possible; for example, in developing countries barefoot runners may be too poor to seek medical attention, shod runners may wear shoes because they have problems running barefoot.

There appears to be a continuum of preference for barefoot running related to a runner's efficiency and abilities. Certainly runners that have grown up running barefoot in areas where it is more prevalent, like Kenya, have been conditioned to run more efficiently barefoot than more industrialized countries. Beyond that elite athletes are exceptional in their foot musculature and would have an easier time in general running barefoot than others.

A word about zealots on both sides of running barefoot vs shod. Some will experience cognitive dissonance when their point of view is challenged. This means that when presented with evidence contrary to their point of view they will tend to deny it or reframe the evidence as if it was part of their argument all along. We should remember this, otherwise we are no better than the iconic Dr. Zaius who held both the posts of both minister of science and defender of the faith, a conflict of interest that does not seek out answers, only support for our own preconceived views. It turns out for the answers are very individual and may not be what we expect.

Judah Tim, Bikila: Ethiopia's Barefoot Olympian
Barry Block DPM personal communication
Tobie Hatfield Jeff Pisciotta,personal communication
Benno Nigg Phd personal communication citations
Nigg, B. M. and Wakeling, J. M. Impact forces and muscle tuning - a new paradigm ESSR Exercise and Sport Sciences Review (29) 1 37-41, 2001
Nigg, Benno New Ideas and Concepts in sport shoe development
(Robbins and Hanna, 1987). ,
Robbins SE, Hanna AM (1987). Running-related injury prevention through barefoot adaptations. Medicine and Science in Sports and Exercise 19, 148-156
Robbins SE, Gouw GJ (1990). Athletic footwear and chronic overloading: a brief review. Sports Medicine 9, 76-85

Hot Foot

2009-03-02T14:45:00.000-08:00

This is a post by my PT colleague Steve Berkey & Kerri Kramer.
He's developing a cycling clinic in Fredricksburg, VA.

Let’s be honest. Endurance athletes get some twisted satisfaction from
pushing their bodies to the limit. They - or dare I say we - spend hours
demanding more of our bodies so that we can experience the adrenaline
rush crossing yet another finish line that previously seemed unattainable.
We beat ourselves up, and during training in pursuit of the next great race,
aches and pains inevitably arise. After a while, it’s easy to forget what
“normal” workout symptoms are. Some clues: Numbness, tingling, and
burning sensations do not fall within the realm of expected pains, nor are
they safe to ignore. Swimming, biking, and running each have the
potential to wreak neurological havoc on specific regions of the body, but
in this article we will focus on an injury specific to cycling.
In the front of the line, waiting to inflict misery on the long-distance
cyclist, is the infamous “Hot Foot.” Some of you are already well-acquainted
with shooting pain under the ball of the foot, numbness and tingling in the toes,
and that debilitating sensation that someone is pointing a blowtorch at the
bottom of your foot. These unpleasant symptoms, known as metatarsalgia
in the medical world, are typically caused by compression of the interdigital
plantar nerves that run between the bones of the feet (metatarsal heads).
Inflammation of the capsules or bursae at the toe joints, as well as inflamma-
tion of the bones themselves, can place pressure on the nerves of the feet.
It sounds like these inflicted cyclists are in for nothing but trouble. But
wait! It’s not time to hang it up and retire yet. Localized metatarsalgia can
usually be solved with a simple modification to the shoe, pedal, or both. The
trick is to identify the specific cause and address it.
Put the Puzzle Together
Treating “hot foot” is much like solving
a puzzle. The problem most often exists
in the interface between the foot and
the pedal. By following the systematic
process below, “hot foot” can become a
problem of the past.
1. Loosen the shoes: The delicate nerves
and vessels of the forefoot can become
irritated when compressed. By loosen-
ing the straps on the shoes, the nerves
and vessels have room to “breathe.” It
is not uncommon for the foot to swell
after riding longer distances; therefore it
is very important loosen the shoes. For those who prefer the feel of tighter,
more secured straps, another option is to loosen them just during the rest
breaks.
2. Try thinner socks: Another method to increase the space within the shoe
is to wear thinner socks. Experiment with different cycling-specific socks
to alleviate pressure.
3. Adjust the cleat position for clipless pedals: Clipless pedals are great
and a necessity when cycling competitively. They maximize power, but can
also contribute to increased pressure under the forefoot. This can create
“hot foot” for certain types of foot anatomy. Most bicycle fit techniques
recommend positioning the cleat so that the knuckle of the big toe (the
first metatarsalphalangeal joint) lines up with the pedal axle (Figure 1).
Unfortunately, this is not always appropriate.
A simple method to reduce the pressure under the delicate nerves and ves-
sels is to move the cleat back towards the heel of the shoe, approximately
two millimeters. If this doesn’t change the symptoms, move the cleat closer
to the heel, as far back as possible. If you notice any knee pain after this
adjustment, consider a professional bicycle fit. Remember that, if the ad-
justment is large enough, other aspects of the bicycle fit may be affected.
4. Consider specific insoles: Gait patterns differ from person to person.
One pattern is overpronation, or walking more on the inside of the foot.
This movement dysfunction will cause a functional increase of compression
within the shoe while cycling. Using cycling insoles made by Specialized,
Superfeet, and Your Sole can provide additional support and may help al-
leviate “hot foot.”
More info about Steve on 90revolutions.com

Lost in Space

2009-02-15T06:58:00.000-08:00

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:
http://www.youtube.com/watch?v=NHH-6ZQktRQ

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.

My Sports Medicine Blog

2009-02-14T17:23:00.000-08:00

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.

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

2009-02-11T01:48:00.000-08:00

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.

Less is More, More or Less

2009-01-22T17:54:00.000-08:00

Much of our decision making process in based on our perception of reality. We may have a “gut” feeling about something one way or the other but what exactly causes this? Gerd Gigerenzer describes simple rules of thumb which become the basis for our decisions . The rules of thumb ignore other information. For example, we have a recognition rule of thumb or heuristic that enables us to process something familiar to us very quickly. Studies have shown that many times keying in on a couple of the most important variables is a much more valuable predictor of a future outcome than many weighted variables. The art is knowing which information to ignore.
An example is an ingenious study design in which used a very sophisticated set of computer generated variables to try and predict which Chicago schools would have the highest rate of dropouts. The data from the first half a of schools were used as a predictor for the second set of schools. It turned out that asking two questions fared better as a predictor of the future “What was the attendance rate” and if that was more or less the same moving on to the next question which was “what were the test scores”.
The healthcare arena has many examples. One of the most compelling was some research done at the University of Michigan on coronary care. It was found that predicting heart attacks as a basis for ICU admission was no better than chance. Much of this was attributed to the spector of malpractice ans so called “defensive medicine”.This meant that you had a 50/50 chance of being placed erroneously in the ICU with the associated risks of infection etc. It was discovered that too much emphasis was place on medical history questions such as a history of diabetes or hypertension. After constructing a very elaborate logistical regression instrument results improved as expected. Many of the doctors did not like using this method because they found the charts cumbersome. When the instrument was taken away surprisingly doctors were able to predict about as well because they were armed with a better internal algorithm for making a choice after being exposed to the more complex instrument.
It turned out that the most important question was whether or not there were ST segment changes on the EKG and if so the ICU was statistically the right choice.. The next most important question was whether the admission complaint was chest pain and if not a regular nursing unit bed was more appropriate.

Agility

2009-01-19T13:25:00.000-08:00

http://www.youtube.com/watch?v=NHH-6ZQktRQ

Fatigue and Injury

2009-01-18T18:29:00.000-08:00

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 with fatigue 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 awareness with agility drills. This is why track work deconstructs the running stride and uses drills to help perform more efficiently.

Lost In Space

2009-01-18T15:03:00.000-08:00

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. Much of coaching performance revolves around not over thinking movements.

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.

Resistance (Strength) Training for Cyclists

2009-01-16T18:53:00.000-08:00

This submission is from Dr. Paul Glodzik:

I decided that this would be a good topic to cover since I recently attended a very good seminar on Olympic lifting. I also just started to interact with some fairly high- level racing cyclists. One of them asked me how resistance training could benefit a cyclist. I had to stop and think because there are multiple answers, which led me to write this article. I need to explain some concepts that the average cyclist or person in general doesn’t know or correctly understand about resistance training. It is unfortunate that most people think about resistance training and someone like Arnold Schwarzenegger immediately comes to mind. There are many styles of resistance training that have completely different effects on the body than bodybuilding, the method Arnold used. Never mind the large doses of steroids he did as well. Bodybuilders are interested in increasing the size of their muscles without any regard for function. The increase in muscle size and mass is a concept known as hypertrophy. Most cyclists know that this extra size and weight is not advantageous when on their bike. Fortunately, there are other ways to resistance train and get stronger with little to no hypertrophy.
The types of resistance training that can be used by cyclists can be broken into three major categories - endurance, strength, and power. Of these the easiest to explain is endurance training. By endurance I am speaking of muscular endurance. This is something most cyclists have experience with. Muscular endurance can be increased in many ways. You can cycle for long time periods at lower energy outputs, run distances, perform aerobics, or resistance train using lighter weights with higher repetitions. If you are training for a century ride with the goal of only finishing this is the type of training you need to perform the most. That doesn’t mean you should neglect the other types of resistance training, however.
To understand strength training you need to know the definition of strength. Strength is the ability to exert a force against an object. When you are trying to increase your strength the object is to be able to produce more force. This can be accomplished in different ways in the body. Increasing the cross sectional size of the muscle (hypertrophy) is one way. However that is not what a cyclist wants. You can increase the amount of muscle fibers recruited within a muscle to make that muscle more efficient and you can increase synchronization of muscles that work together. Exercises such as squats, dead lifts or pull-ups are examples of this type of exercise. When performing exercises for strength you should work yourself up to a point where you are using very heavy weights but with only a few repetitions. By doing so you will minimize the hypertrophy but still increase your strength. One example of the effects of strength training would be the effects on your quadriceps. By performing strength exercises a cyclist will have more efficient quadriceps muscles that can keep a consistent pedal rate over a longer time. The muscle doesn’t need to recruit as many fibers to produce a certain force at first and then can recruit more fibers as fatigue begins to occur.
The final category is power training. To understand this, power needs to be defined as well. Power can simply be defined as follows: Power = Force x Rate. This means that a force is exerted on an object just like true strength training but there is a time component to it. Power exercises are also known as Olympic lifts because they are in the Olympics. The exercises that fall into this category are the clean and jerk and the snatch. These exercises are extremely explosive and they produce huge amounts of force over a very small time frame. Most cyclists would believe these exercises have no real benefit to them. I would have agreed until I went the seminar I mentioned earlier. There is research that proves that anaerobic exercise, which power exercises are, can actually increase aerobic capacity but not the other way around (Paavolainen). I wouldn’t advocate that cyclists start performing Olympic lifts without professional help, however. It is not say these exercises wouldn’t benefit a cyclist’s power output, but because they are very technical and hard to teach. There are power assistive exercises that can be used instead. Think of it this way - if you are in a race and suddenly someone jumps out of their saddle to try and break away, in many cases you want to be able to follow them. If you are 100 meters from a finish line, you may need to sprint. By performing power exercises, you would be able to increase your power output very quickly and be able to catch that rider or out-sprint the other riders.
A type of training that has become very popular, and in my opinion, most important, is core training. To truly tie together all of your training, you must train your core. Most core exercises are performed with the main goal of stabilizing joints, have fairly low force production, and can be held for long periods of time. A plank or side bridge is a good example of this type of exercise. Core exercises are usually performed with only your own body weight or a medicine ball. When you are riding for three or four hours in a row do you ever notice that your back starts to ache? There are many reasons for this, but a major one is that you are in a tucked position and your core muscles are not working to stabilize your spine. If you perform exercises to strengthen your core muscles, the increased stabilization will allow you to withstand the tucked position for longer periods of time on rides.
Now that I have explained the different types of resistance training, most people will want to know what exercises to do. That is a bit extensive for an article like this, but I can at least start you off in the right direction. To begin with, decide what you are attempting to gain from your resistance training. Are you looking to increase your leg strength, or decrease the effects of a long ride? Maybe you have been training using wattage and realize that you are not producing the output you would like so you want to increase your power. Once you have decided on what it is you are attempting to accomplish, you need to figure out how often, where, and with what equipment you are going to train. If you don’t have these questions answered you will never stay with your training program. I am not a fan of using machines to resistance train. When you are using a machine only one specific movement or muscle is being trained. Have you ever tried to ride by using your quadriceps only? It doesn’t work that way! By using free weights (dumbbells and barbells) you are training multiple muscles and also forcing yourself to stabilize joints. When you use a machine, stabilization is already done for you.
This is the point at which things become difficult because of the specificity of training for each person. Two riders may want to accomplish the same thing but are starting at totally different points in training. The easiest way to figure out what you should be doing is to know how much training you have had and how advanced you are with different exercises. If you have never touched a weight in your life, any basic exercise routine that works the major muscle groups will help. If you have trained for years and are proficient at many exercises, it may be time to find yourself a strength and conditioning coach. If you are looking for a trainer, your best bet is to talk to the other people you ride with or talk to the riders you would like to be more like about coaches (trainers) that they trust.
I feel I should discuss safety a little. Resistance training when performed properly has very little chance of injury (Stone). Having said that, you need to learn how to perform the exercises correctly and listen to your body. No one would get on a bike and ride 100 miles if they hadn’t trained for a while. The same concept applies to strength training. Don’t use weights that are too heavy and cause you to break technique. Remember that a good training regimen should always have rest periods or decreased training loads built into it. That way, over-training doesn’t occur.
If you have any questions feel free to contact painfree123@gmail.com.

Paavolainen L, Häkkinen K, Hämäläinen I, Nummela A, Rusko H. “Explosive-strength training improves 5-km running time by improving running economy and muscle power.” J Appl Physiol. 1999 May;86(5):1527-33.

Stone, M., et al. "Injury Potential and Safety Aspects of Weightlifting Movements" Strength and Conditioning 16(3):15-21, 1994.

Stretching

2008-11-30T14:31:00.000-08:00

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.

Efficient Use of Recovey

2008-11-26T00:56:00.000-08:00

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

Running Shoe Cushioning: Perception and Reality

2008-11-23T17:56:00.000-08:00

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.

Does your Bike Fit You?

2008-11-21T14:48:00.000-08:00

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 bj@powertrainingcoach.com

Iliotibial (IT) Band Syndrome In Cyclists

2008-11-13T09:20:00.000-08:00

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 painfree123@gmail.com.
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

Straight Talk on Steroids

2008-11-06T14:24:00.000-08:00

http://www.washingtonpost.com/wp-dyn/content/article/2008/11/03/AR2008110302830.html

Eddy Van Guyse 30 Years after "Breaking Away"

2008-10-23T20:48:00.000-07:00

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 still relate to a good story. This is true with relating to teachers as well. The better ones are able to articulate a good story.

Ben: You've told me in the past that Peter Yates pulled you aside for technical advice.
You put the kabash on the bikes with reflectors and coaster brakes.

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. 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: 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.

Imaging Sports Injuries

2008-10-06T19:09:00.001-07:00

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 www.mriandimagingofvirginia.com

plantar fasciitis

2008-10-06T04:59:00.000-07:00

http://rehabtoracing.com/Injuries.php

Paul Newman

2008-10-01T17:16:00.000-07:00

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.
http://www.youtube.com/watch?v=hlSkGUQBtDA

Cross Training

2008-09-20T19:22:00.000-07:00

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.

Power Yoga: For better balance and strength

2008-09-14T13:47:00.000-07:00

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:
http://www.insidetri.com/article/71916/the-athlete-s-guide-to-yoga-more-balance-poses

Fatigue and Injury

2008-09-14T07:32:00.000-07:00

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.

Balance, Injuries and Tom Brady

2008-09-08T14:58:00.000-07:00

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.

Remembering 9-11 and St. Paul's Chapel

2008-09-04T16:34:00.000-07:00

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.

Aqua Velo, Its not an aftershave!

2008-08-26T01:06:00.000-07:00

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!

Choose a Running Shoe - wikiHow

2008-08-24T13:22:00.000-07:00

Choose a Running Shoe - wikiHow

No Bolt from the Blue

2008-08-22T03:57:00.000-07:00

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.

Newton: Function vs. Hype

2008-08-12T20:01:00.000-07:00

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.

Gary Hall Jr. Covering the Olympics

2008-08-02T08:08:00.000-07:00

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.

http://latimesblogs.latimes.com/olympics_blog/2008/08/the-united-stat.html

Hall's in the house

Walking the Plank

http://latimesblogs.latimes.com/olympics_blog/2008/08/clean-athletes.html

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.

http://latimesblogs.latimes.com/olympics_blog/2008/08/faster-higher-s.htmljavascript:void(0)

VO2 MAX:Know What You're Paying For

2008-07-30T15:00:00.000-07:00

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, www.questssc.com

my sports medicine blog

2008-06-18T17:25:00.000-07:00

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)

2008-06-18T13:15:00.000-07:00

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 www.EvolutionRunning.com.

chi running

2008-06-18T13:04:00.000-07:00

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.

Glucosamine

2008-06-10T04:36:00.000-07:00

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.

Massage and Recovery in Sports

2008-06-07T02:59:00.000-07:00

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.

diagnostic ultrasound

2008-05-23T17:31:00.000-07:00

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 podiatricultrasound.com.

Arnica

2008-05-21T04:43:00.000-07:00

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.
linkinghub.elsevier.com/retrieve/pii/S1475491603000900
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.

Power Yoga: For better balance and strength

2008-05-16T16:09:00.000-07:00