The many aches and pains that we all experience could be due to minor injury, age, or even poor posture.  Regardless of their source, relief from such ailments is something we all seek out.  But, there are conflicting messages as to whether or not it is better to apply ice to an injury, or to apply heat.  We have cold compresses, and heating pads; we have ice baths, and hot showers; we have products such as “Icy Hot” that seem to combine both ideas.  So the question is, when is the proper time to ice an injury, and when should we turn on the heat?

Heat and ice have opposite effects on the body.  Whereas heat causes a widening of the capillaries and thus an increase of blood flow to muscles having a relaxing effect, ice constricts the blood flow and thus reduces swelling of the part of the body to which it is applied.  Therefore, it is important to understand the injury so that you know which method of relief to utilize.

Acute vs. Chronic Personal Injury

The type of injury you are seeking to treat is most likely one of these two types of injury.  An acute injury is one that is usually a direct cause of an impact of some sort:  a fall, a collision, a sprain.  It can be characterized by swelling and tenderness, redness, and of course pain.  The swelling and pain are caused from the trauma of the impact, which caused the capillaries, or tiny blood vessels, to break and “leak” blood into the surrounding areas.  Because these capillaries are indeed broken and causing swelling, it makes sense to treat acute injuries with ice, as its constricting effect will slow down the leakage and thus calm the swelling.  Acute injuries are usually rather short lived.  When the swelling goes down – as long as there is no damage to ligaments, tendons, or bones -  the pain often subsides.

A chronic personal injury is one that develops gradually over time and can be the result of overusing our bodies.  These injuries often are categorized by dull pain, recurring pain, tightness, or general soreness. Carpal tunnel syndrome and recurring lower back pain are examples of chronic personal pain caused by improper repetitive motions.   The chronic injury usually benefits from heat therapy because of the need for the relaxing effect that comes from the increase of blood flow brought on by the heat.  Pain that comes from stiff, sore muscles tends to be alleviated once heat is applied in 20 minute intervals.

It is very important to know the nature of your injury before you start any type of self-treatment; but as a general rule of thumb, ice an acute injury, and apply heat to a chronic injury.  As always, if your symptoms don’t improve, be sure to seek the advice of your doctor.

As schools let out for the summer, many student athletes sign themselves up for summer training camps to help them maintain their athleticism during the off-season.  The benefits of such camps that focus on conditioning and stamina are undoubtedly numerous, but the risk of heavy athletic activity in the hot summer sun should be a point of concern for student athletes, coaches, and parents.   Heatstroke, which is often commonly called sunstroke, is a condition that is very dangerous and can occur when the body is unable to regulate its own temperature due to vigorous activity in the heat.  This situation can lead to serious physical complications, or even death.  Teenage athletes are often very susceptible to heatstroke because of their competitive nature.  The desire to become stronger, faster, and better than their competition, in combination with their lack of knowledge about the dangers of working out in the sun, contributes to the numbers of teenagers stricken with heatstroke each summer.

What are the Warning Signs of Heatstroke?

One of the most dangerous aspects of heatstroke is that it can occur quickly.  Once the body’s natural thermostat loses the ability to cool itself – which is done through perspiration – the athlete’s temperature can rise rapidly.  This is why it is so important to for coaches and athletes to know and understand the symptoms of heatstroke.

Dizziness, headache, and fatigue are some of the early signs that the body is being pushed harder than it should.  The sun can be harsh to athletes training for long hours outdoors and the onset of these symptoms should be a warning sign to take a break.  Vomiting or fainting commonly occurs in people who ignored the early warning signs.  Also, a lack of perspiration in an athlete who is complaining of a headache or dizziness should be taken seriously.  Since the body’s way of cooling itself down is through sweating, an athlete with hot, dry skin, with little to no evidence of perspiration may be experiencing signs of heatstroke as well.

How Do Good Coaches Prevent Heatstroke?

A coach’s job is not only to prepare his athletes for competition, but also to teach them how to train safely.  There are a number of things coaches can do to prevent exposing their athletes to the dangers of heatstroke.

One of the most important parts of any athletic training regimen is staying hydrated.  By taking into account the hot summer temperatures and providing water breaks for their athletes in regular intervals, a coach can help his athletes steer clear of dehydration.  Also, many coaches consider it good practice to avoid holding training sessions at times when the sun it at its peak.  While these tips are generally just considered to be “good coaching,” one of the most effective ways a coach can help his players avoid heatstroke is to educate them on the symptoms and dangers, so that they can be aware of their bodies’ limits.

The debate has long ended on smoking, and it’s clear that it is very bad for you.  While many know the risks associated with smoking, including heart disease and lung cancer, the urge to smoke is often too great.  Now there’s hope!  A recently published study found that just 15 minutes of exercise can increase your chances of quitting, and can also reduce the chances of starting up again.

The research studied 434,190 people in Taiwan over the course of 12 years and tracked their progress in quitting smoking.  The results showed that people who exercised 15 minutes a day were 55 percent more likely to quit smoking.  For those that were able to quit, they were also 43 percent less likely to start smoking again.

Take things slowly to start.

While it would be ideal to quit smoking right away and get exercising, the study also warns that exercise for smokers can often do more harm than good.  It is important to quit smoking prior to beginning a rigorous exercise regimen, as smoking has the exact opposite effect on the body when compared to exercise.  Since smoking can put the organs at rest, smokers can experience increased blood pressure, fatigue, rapid breathing and elevated heart rates during rigorous exercise, which can damage the organs.  This also includes the occasional smokers, as they too can struggle with the effects of smoking limiting their ability to exercise properly.

If people are struggling to stop smoking completely, it is important to limit exercise to walking 15 minutes a day.  Just walking for 15 minutes can safely help increase the chances for smoking cessation.  Once a person quits smoking altogether, the study found that walking just 30 minutes a day can reverse the long-term effects of smoking and increase their life expectancy by 5.6 years on average.

How does walking help me to actually quit smoking?

The primary reason exercise helped participants quit smoking in Taiwan, was that it distracted them from thinking about the everyday need to smoke.  These short walks can also help people take time away from the daily stresses of life that may cause them to smoke more.  The people who took part in the study felt much better after just 15 minutes of exercise a day and it made it much easier for them to quit smoking.

What is the main takeaway from this study? 

Quit smoking!  Not only are the risks associated with smoking potentially lethal, smoking can also limit your ability to lead a healthy lifestyle.  The study also shows that just walking for 15 minutes a day can have a profound effect on the desire to smoke as well as overall health.

A recent study done by the Harvard School of Public Health has shown a correlation between overall optimism and hearth health.  The study shows that people who are generally happy and optimistic have a reduced risk for heart attack, stroke and other cardiovascular events.  Author Julia Boehm researched over 200 medical studies surrounding heart disease before releasing the results of the study.  The study showed that the most optimistic participants were up to 50% less likely to suffer from a heart disease related event.

Boehm is careful to point out that there is a distinction between being content and being optimistic.  The study showed little difference if participants were just simply content.  She told HealthPop, “The absence of the negative is not the same thing as the presence of the positive.”  The researchers point out that not being depressed or sad does not mean you’re happy.

Improve your Outlook to Improve Your Health

You may be asking, what can I do to be more optimistic?  Generally speaking, there are very simple ways to improve your outlook on life.  For example, people who were found to have a better outlook on life tended to eat healthier, exercise more, and get more exposure to the sun (which is rich in Vitamin D).  All of these activities can release endorphins into the bloodstream giving people a more positive mood and outlook.

Now this brings up an interesting contradiction to the study… Were patient’s hearts improved by the patient’s positive outlook and demeanor, or were they healthier because they were generally more conscious of their health? Of course, the real question here is, does it matter?

For her part, Boehm acknowledged that there is no easy way to determine what the reason for heart health was in her study without additional research.  While the numbers seem to show a direct correlation between a positive outlook and heart health, there just isn’t enough evidence to prove it.  Of course, if someone told you that exercising and eating healthier would make you generally happier; and they also told you that being happier would improve your heart health; wouldn’t it just make sense to exercise and be happy?

The Importance of Hearth Health

The most recent statistics from the American Heart Association show that 2,200 Americans die every day from heart disease.  That is one person every 39 seconds.  Heart disease is the leading cause of death in the United States killing more than 599,000 people every year.  Given the risks associated with heart disease, being happy isn’t a high price to pay.  Don’t worry, be happy!  Go outside and exercise today.  Your heart will benefit from it.

A recent study done by the American Journal of Sports Medicine has shown a disturbing disparity in the rate of concussions among young women when compared to men.  With the world seemingly turning their attention to head injuries and the long term effects that they may have, this recent study shows that women suffer concussions at twice the rate of their male counterparts in the same sport.  While football players continue to rate highest on concussions among all athletes, the focus has begun to shift to other physical sports that are causing concussions including women’s athletics.

Why Such Focus on Concussions Now?

The NHL has recently agreed to take part in a massive medical study to determine the effects of concussions as well as possible ways to prevent the injuries from occurring.  Most recently, Sidney Crosby, who is widely considered the future star of the NHL suffered a severe concussion that took him out of the game for nearly 2 years.

Also, the NFL has come under fire for player safety as many former players have filed a class-action lawsuit against the league.  This has led the NFL to take ground-breaking steps in the area of brain injury and concussion prevention.  As the NFL has taken a strong stance in recent years to protect its players, many professional sports leagues have followed their lead enacting new post-concussion policies to prevent more serious injuries, and investing in possible prevention methods.

Why Would Women be More Vulnerable to Concussions?

While multiple experts have debated this topic, the results of the study really come down to one of two common explanations.  The first explanation is that men have larger muscles surrounding their neck and shoulders, leading to a better ability to absorb physical contact to the head and neck.

Other experts in the field of concussions believe that the disparity may be a result of perception and not actually be caused by an anatomical difference.  Given the perception of the male athlete as a “rough and tough” individual, many experts believe that women are just more likely to report concussion symptoms whereas her male counterpart might be more likely to “walk it off.”  After all, that’s exactly what led to the class action lawsuit against the NFL, as players claimed to have been forced back into the game following a concussion.

Regardless of the stance taken on why the disparity between men and women exists, one thing is for sure, more research is necessary to determine the main causes for concussions and possible prevention methods.  The progress made over the past 5 years has been significant, but more research is necessary to ensure the safety of athletes of all ages and genders.

Competitive runners are plagued by nagging injuries. It could be the knee, the hip or the achilles tendon. It could be acute, chronic stiffness and soreness in the area that sometimes you can run off…but most of the time it simply gets worse.

To ease the pain and treat these injuries runners usually turn to ice, stretching and even ultra-sounds…but there comes a time when those therapies don’t even work. It can get so bad that you’ll start to limp.

Ever been in that type of condition? And do you think its time for more drastic measures?

Sometimes runners will undergo an MRI to find tears in their tendons. Sometimes you’ll  have to undergo surgery for that injury…other times you can opt for platelet rich plasma therapy.

[See the Ultimate Guide to PRP Therapy for more information.]

Although the research is lagging behind the science of PRP therapy, there have been enough anecdotal evidence to suggest that the treatment will help a runner recover. The treatment is a simple doctor visit versus surgery which could lead to months of recovery time and rest. The procedure involves nothing more than your blood being drawn [this is not blood doping by the way], spun in a machine called a centrifuge that separates the plasma, which is then injected into the affected area.

Some people believe it works because the body is given it’s own growth factors which feed the injury the nutrients it needs to heal itself.

Healing itself is a good thing.

PRP therapy works great for injuries to tendons like inflammation or tears, but it’s not a cure all. Speak to your doctor before pursuing such a course of treatment. Sometimes these injuries can get better through physical therapy our own their own.

This is an expensive procedure and is not covered by insurance.

Dr. Rick Lehman is a distinguished orthopedic surgeon in St. Louis, Missouri and an articular cartilage reconstruction pioneer He owns U. S. Sports Medicine in Kirkwood, MO, and LehmanHealth. Learn more about Dr. Rick.

If you’ve injured your anterior cruciate ligament (ACL), one of the treatment options is surgery.

Not all ACL injuries results in surgery.

But what kind of surgery options are there for ACL injuries? Let’s explore four and who are typically good candidates for the surgery.

Patellar Tendon Autograft (PTA)

The gold standard for ACL reconstruction, the PTA involves a third of the middle patellar tendon, a bone plug from the shin and kneecap of the patient. You’ll see high-performance, professional athletes undergoing this type of surgery.

You’ll also see patients whose jobs don’t demand they kneel a lot get this surgery, too.

The PTA has a lower rate of failure compared to the hamstring autograft (1.9 percent v. 4.9 percent) and shows better knee laxity in tests when compared to other surgeries. However, this surgery is known for a higher rate of pain behind the knee, pain when kneeling and slightly increased risk of stiffness after surgery.

Hamstring Tendon Autograft

The hamstring tendon on the inner side of the knee is used for this ACL reconstruction autograft. The gracilis, a tendon attached below the knee, is sometimes used by surgeons, creating a tendon that is made up of two or four strands. This ACL surgery is often used because of the ease in which surgeons can harvest the hamstring tendon.

There is also fewer problems knee or kneecap pain after surgery, less stiffness, a smaller incision is used and leads to a faster recovery. Some studies suggest that this surgery leads to stretching of the tendon and a lessening of strength in the patient. Hypermobile patients (those with knee hyperextension over 10 degrees or an intrinsic ligamentous laxity) are recommended to proceed with the PTA surgery.

Quadriceps Tendon Autograft

For patients who have failed previous ACL reconstruction, the quadricep tendon autograft is used. A bone plug from the knee cap and the middle third of the quadricep tendon are used, allowing for a larger graft for heavier, taller candidates. The fixation is not as solid as the PTA since there is only one bone plug. While their is a low risk of patella fracture, their is a high risk of post-surgery anterior knee pain. And the incision can be pretty ugly.

Allografts

This is becoming a popular procedure for first time ACL surgery patients, but as well as for those who have failed previous ACL reconstruction. This is also used when there is more than one knee ligament to be repaired.

There is no pain to the patient from harvesting a ligament from their body, there is less recovery time and the incisions are not as big.

However, the patellar tendon allograft does provide a stronger bony fixation, with screws. There is an association with infection risk with allografts including HIB and hepatitis C. Careful screening and processing doesn’t always catch the infections. Deaths linked to improper sterilization of allograft tissue are also associated with allografts. And the failure rate is also very high at 23% to 35%, this among patients who are young playing high-demand sports.

It’s unclear why the failure rates are so high, but possibilities include a too-soon return to sports or problems with the graft itself…like donor age or how the graft was stored.

Dr. Rick Lehman is a distinguished orthopedic surgeon in St. Louis, Missouri and an articular cartilage reconstruction pioneer. He owns U. S. Sports Medicine in Kirkwood, MO, and LehmanHealth. Learn more about Dr. Rick.

In the wake of the lawsuits against the NFL by former players over concussion-related symptoms I thought I would look back at some of the work that has been developing in the field of concussion research.

[See my post Parents and Coaches: Free Library on Concussions for more information on how to protect your child.]

Back in early 2009, the results for a study commissioned by the NFL was leaked just before a Boston University conference that was supposed to explore the impact of concussions on athletes…

The study showed that memory-related diseases like dementia and Alzheimer’s were prevalent among former players. In fact, it reported that they were 19 times more likely to suffer from these diseases than the male population in the U.S.

What the researchers of the study found was a connection between repeated blows to the head and a new motor neuron disease that looks a lot like Lou Gehrig’s diseas, or amyotrophic laterla scerosis (ALS). Those results were eventually published the September 2010 issue of Journal of Neuropathology and Experimental Neurology.

The results made one significant point: ALS-like diseases don’t all come out of nowhere. Your life choices can cause an ALS-like disease.

The researchers behind the study looked at 12 brains and spinal cords that belonged to former athletes. These brains and spinal cords were stored in the CSTE brain bank and showed evidence of chronic traumatic encephalopathy (CTE).

Wally Hilgenberg and Eric Scoggins–two former NFL players–had motor neuron disease late in their lives. Scoggins died in 2009 and Hilgenberg in 2008. Both were diagnosed with ALS, but showed symptoms that were connected to CTE, like cognitive decline and changes in behavior.

Of these players diagnosed with ALS, the researchers found something interesting: the abnormal protein TDP-43 in the brain and spinal cord was in a unique pattern. There was also an abnormal form of the protein tau.

You will not find abnormal tau deposits in ALS. What the researchers found was a new motor neuron disease.

The researchers have named this disease “chronic traumatic encephalomyelopathy” (CTEM), a disease they think is caused by repeated head trauma…trauma similar to what boxers and football players suffer.

The NFL’s Reaction to the Concussion Study

Understandably the NFL tried to distance them from themselves from it. But it promoted a slew of new hearings.

The study was conducted at the University of Michigan, so you can probably see why the Michigan Democrat John Conyers, who heads the House Judiciary Committee, ordered what turned out to be several hearings on the topic.

Dozens of researchers involved in the study testified, including players, former players, doctors, player’s wives, player’s widows, player’s union officials and NFL executives. The head researcher behind the study said this of the hearings:

There were a lot of ex–football players there. The older ones reminded you of a neurology clinic. It was very sobering. You got the sense that this was mainstream.

While some executives weren’t confident in the results, it is believed that Goodell and other officials in the league understood their could be a concussion problem in football because, under Goodell’s leadership, the NFL instituted a fund to help retired players who suffered from dementia.

Dr. Rick Lehman is a distinguished orthopedic surgeon in St. Louis, Missouri and an articular cartilage reconstruction pioneer. He owns U. S. Sports Medicine in Kirkwood, MO, and LehmanHealth. Learn more about Dr. Rick.

So far we’ve talked about how much sleep you should get and how much alcohol you should drink.  Let’s now talk about how much you should weigh…and what to do about it.

Stop Eating Out at Restaurants

I might sound like a food Nazi for saying this, but early in your plan you need to try to avoid eating out at restaurants frequently. You will learn quickly what is reasonable and what is not.
You will also learn approximate calorie amounts, but until then stay home.

Use a Calorie Counter

Calorie counters are very important. You can buy a little book at the check-out line at the grocery store.
When you are in the line right above the magazines that explain how Paris Hilton got impregnated by a Martian there will be a little blue and white book. It will have a picture of a tape measure around a loaf of bread.

That is the book.

The other option is to go on-line. Google “FREE calorie counter.”  Don’t sign up for anything because there are many sites with that special word “free” in the title.You will become familiar with the caloric number, fat, carb and protein content of most of the foods you eat.

Although, early on this will be cumbersome you will get used to it and then you will piss-off all of the people you work with when you start telling them that the Yo-Ho they are about to inhale has 650 calories and 64 grams of fat.

But this is important if you want to lose weight: you must be able to calculate the numbers.

Avoid Tempting Situations  

Try to stay away from situations that will pressure you to eat. Larry’s bachelor party, Superbowl pizza parties, all-you-can-eat- buffet’s, and worst of all your mother-in-law’s post-Thanksgiving dinner desserts.  Stay away.

Once you have mastered caloric control, go ahead and give the pizza a ride, but early on, STAY HOME.

Weigh Yourself Everyday

Furthermore, weigh yourself everyday. Do not believe the story that you weigh once a week. Make yourself accountable every morning.  Bad day, too many beers, get your punishment and look at the scale.
You need a good reliable scale. It will cost about $25.00 . Get your money’s worth and get on it every day. Write down your weight every day.

Start a Vitamin Regiment

A once-a-day vitaman, one aspirin, Omega 3 supplements and a branch chain amino acid supplement. The supplements are important if your dietary habits are to change.

Dr. Rick Lehman is a distinguished orthopedic surgeon in St. Louis, Missouri and an articular cartilage reconstruction pioneer. He owns U. S. Sports Medicine in Kirkwood, MO, and LehmanHealth. Learn more about Dr. Rick.

What about I’m about to share with you is what is called a rotation diet. The diet works by faking out your body’s need to preserve energy.

When you start a diet the first thing that happens is that you lose water weight. You think you are doing great because the first week you feel like a champ.

You lose 3-4 pounds and you think “Hey, this is easy.”

Then a week later you are pissed off because you think “This is impossible, I will never lose this weight.”

The truth is that weight loss is a journey, is a life long change, and is never easy.

It is easy to lose some weight, it is easy to stay on a diet for a period of time and it is easy to start your diet in the morning, but to change forever is hard.

The good news is once you have made the change and it becomes habit it goes back to easy.

The Rick Lehman Rotation Diet

Your body loses weight early because you suddenly decrease your caloric intake. It is used to 2750 calories and you eat 2250 and wham, you lost some weight.

But pretty soon your body is used to 2250 and you stop losing weight. So, wham I will just eat 2000. And , just like clockwork, you start to lose weight again.

Well, you can see where this is going. You can’t go so low you hit a plateau. And you tell your friends I haven’t lost weight in 3 weeks and I am doing everything the same.

So, what is the answer?

The Rick Lehman Rotation Diet. I actually did invent this diet. It makes sense and it is biologically how your metabolism works. The Rick Lehman part has nothing to do with it.

So, the little bit you have been waiting for.

Sixty percent of your calories need to be protein. 60% protein, 20% fat 20% carbs.

Rotating Your Calorie Count

The next parameter is the all important calories. Monday 950 calories Tuesday 1650 calories Wednesday 1100 calories Thursday 1700 Friday 750 calories Saturday 1750 calories Sunday 1000 calories.

These numbers are not etched in stone.

Look alive, this is important. If,or when you go over your allotted calories, the next day remains the same. If you go under your calories you may add them to the following day.

For example: you eat 1450 calories on Wednesday you go right back to the plan, 1700 on Thursday. If on Wednesday you eat 900 calories you can now eat 1900 calories on Thursday.

This way you can plan for a big bash or a good old fashioned pig-out.

There Is No Magic to Losing Weight

You have to eat less calories and you have to potentiate your metabolism. If you let your metabolism diminish you will not lose weight. You have to be on track most of the time.

If you cheat, no worries, start right back up.

Do not say ” I have blown it ” and quit. Do not quit. Do not be fat. You will feel better.

Remember the calories and live by them. Any diet that doesn’t break down your eating into the basics can’t work. There are 2 things to know:

1. Know the calories
2. know your percentages.

Once you have met your ideal weight, you can then increase your caloric content by 100 calories per day.

Remember you weigh yourself everyday. You count your calories everyday and you watch your percentages.

When you get to steady state , the calories that stabilize your weight you can then alter your percentages.

Initially, you start with 50% protein 25% fat and carbs. Then you can eventually go to 40% protein and 30% fat and carbs. When you get stabilized this is your intake forever.

If you notice that you are slowly gaining weight decrease your intake by 200 calories per day. You get the picture.

So here we go. If you have questions please ask on the website. Personalized diets, recipes and can be obtained at the US Center for Sports Medicine.

Dr. Rick Lehman is a distinguished orthopedic surgeon in St. Louis, Missouri and an articular cartilage reconstruction pioneer. He owns U. S. Sports Medicine in Kirkwood, MO, and LehmanHealth. Learn more about Dr. Rick.