At the finish line of the Boston Marathon are the flags of the world. The winners for the last many years are all welcome and come from the third world. New York also celebrates the entire globe. The statue of liberty still stands there with a saying that welcomes all and truly needs all.

In the running community there has been an ongoing debate about evolution that focuses on one very small issue of “foot strike”. This issue is dwarfed by many, many other issues of biology, physiology, psychology, genomics, the role of exercise in disease prevention and in improved health both mental and physical and even human behavior both in small and large groups.

Evolution involves more than whether you hit the ground with your forefoot, midfoot or rearfoot. It doesn’t have much to do with whether you wear a minimalist shoe, run barefoot, or wear a stability shoe.

We have a long way to evolve as a species. Recent theories have involved cooperation and altruism as an important part of evolution. That was seen today in the actions of the first responders in Boston. It is far more than survival of the fittest. The barbarians will not survive long.

Professional runners are lean, but not usually mean. And while they may overtrain, which has a host of manifestations, they aren’t usually found to have overt hypothyroidism.

One endocrinologist in particular has apparently been diagnosing and treating many thin, lean, athletes with “subclinical hypothyroidism.” That is a real diagnosis, in which the TSH values are below what is generally considered abnormal. The estimates of the incidence of this condition range from 5%-10%.

So many things are altered by overtraining and by having a negative caloric balance in the case of withholding calories that one wonders if it is wise to give athletes synthetic thyroid hormane when they have a normal, but borderline TSH level. Could giving thyroxine lead to heart arrhythmia or decrease heat tolerance? Could it enhance performance although it isn’t on any prohibited list? The answers regarding performance enhancement seem to be both no and yes from the same sources. How common are TSH levels in the range of 2-5 mU/Liter among high level and hard training athletes? Does rest or an improved diet have an impact on these levels? All worthwhile questions which are not entirely answered.

The Wall Street Journal presents the side of the doctor who has diagnosed about 17% of the “Nike” athletes training with Salazar as having this condition. Carl Lewis was diagnosed with it before attempting to qualify for his fourth Olympics. The doc compares himself to “House” of TV fame as a mystery solver. I always considered House a sad story. He was addicted to Vicodan and usually needed at least five to seven attempts before he’d come up with the right diagnosis.

Flo Track presented a mature discussion on the topic with Lauren Fleshman saying that if only one doctor in the country was giving athletes the answer they wanted to hear, something just might be wrong with the picture.

I believe subclinical hypothyroidism exists. And I believe over training exists even more often. I’d recommend any athlete considering treating hypothyroidism while having a body fat of less than 12% should research the topic thoroughly and hope to soon find better statistics on training and endocrine hormone levels.

For all of us non-elite, non-professional athletes – make sure you pay attention to your body. Take the breaks you need, rest well, and eat well. And always avoid too much, too soon, too fast, too often, with too little rest. If you have signs of hypothyroidism, be sure to see your doctor.

References:

The treatment of Subclinical Hypothyroidism Is Seldom Necessary. Chu, J and Crapo, L. Journal of Clinical Endocrinology & Metabolism. JCEM. October 2001,

Flo Track discussion on WSJ article and Subclinical Hypothyroidism

U.S. Track’s Unconventional Physician in Wall Street Journal

Subclinical Hypothyroidism: An Update for Primary Care Physicians Vahab Fatourechi, MD Mayo Clin Proc >v.84(1); Jan 2009 >PMC2664572

The Beatles “I’m Down” (Cause my thyroxine is low & my TSH is high?)

Jacquelin Perry, M.D. has just passed away at age 94. She was born on May 31, 1918 and died on March 11, 2013.

Dr. Perry was a key researcher in gait and abnormal gait. She was a pioneer as one of the few female orthopedists in the 1950′s becoming board certified in 1958. It is hard to imagine today, but there were only 10% women in her medical school class, 7 out of 76.  She taught at USC Medical School from 1972 until the late 90′s. She worked at Rancho Los Amigos Medical Center in California for many years and was Chief of Pathokinesiology and later Chief of the Biomechanics and Gait Lab among other positions. More recently the Jacquelin Perry Musculoskeletal Biomechanics Laboratory was dedicated in December, 2008

She is best known for her work on polio patients and her 1992 text Gait Analysis: Normal and Pathological Function” became an instant classic. The Salk vaccine, introduced in the mid-1950′s, effectively ended polio in the Western World fairly quickly. Dr. Perry directed her attention to improving a rehabilitation program for spinal cord injury, work on hemiplegia, and children’s neuromuscular disorders including primary muscular dystrophy, myelodysplasia, and cerebral palsy.

Before beginning her medical studies Dr. Perry studied physical therapy and served as a physical therapist in army hospitals during WWII from 1941-1945. She reported that in addition to trauma patients, she had been exposed to polio patients during this time which spurred her interest.

From an early time in her career she began observational gait analysis and worked to codify her observations. Later video and EMG (electromyography) and forceplate observations were added.

Her clinical observations and descriptions of “loading response” were clear and had implications for many biomechanists. She also well described the terminology which led to an emphasis by some on “sagittal plane biomechanics”:

• Heel Rocker
• Ankle Rocker
• and Forefoot Rocker

She is acknowledged often in the physical therapy community. Dr. Perry has inspired many to research in gait and biomechanics. But all biomechanists know of her work and realize the thanks owed to her for her interests, work, inspiration and research. We often have had a more limited acknowledgment of our forebearers but she is certainly a major one in the realm of biomechanics and gait analysis.

While we now have improved measuring devices (in laboratories and sometimes in clinical offices) and we measure and make observations of moments of force in addition to the things we can see, her work has had tremendous impact and has had much value. As Galileo performed visual observation with his telescope long before we could study pulsars, quasars and black holes, Jacquelin Perry worked well with the instruments she had available. Eyes and a brain were among the instruments she often put to good use and was the starting point for much research and treatment. Her life is an inspiration to innovation, passion, dedication, persistence and endurance.

The Mental Mistakes of Running

The cause and prevention of many running injuries is still a mystery. The treatment of most of them is not a total mystery. To lessen the possibility of the injury returning you will need to alter your training, improve core strength, flexibility, evaluate your recovery, obtain adequate sleep, nutrition, check your stride, muscle strength and symmetry, evaluate your biomechanics, your training shoes, and check on a variety of other factors.

With all the studies that have been done on running injuries they still are reported  to occur in somewhere between 24% and 65% of runners. Those numbers themselves speak to the lack of precision even in studies that measure running injuries. Studies which attempt to measure whether a slower progression in ramping up mileage have failed to demonstrate that also. Design errors and interpretation errors contribute to this lack of precision and clear information. To fill the knowledge gap on running injuries, some would find one thing to explain most injuries. Shoes can contribute to injury.  So some have looked back a few million years to say we should not wear shoes. Others have gone back a few million years to say that we need a paleodiet. Or perhaps we need a paleo-footstrike.

Does it all come down to shoes, minimal shoes, no shoes or midfoot, forefoot, or “gentle” rearfoot strike? Is it a matter of the terrible too’s: too much, too soon, too fast and too often with too little rest? That seems to be a large contributor. Overuse and overtraining contributes to many injuries. Is the knowledge of all things 15 million or 500,000 years ago all we need to run outside today? That is debatable but I’ll avoid that debate at this time and look for something more practical.

Life is complex. While there is wisdom and embedded knowledge in the past, the philosophy that the past is prologue, carried to the extreme of the past is still with us, may not may not invariably tell us where we are headed with the unpredictable future of life and scientific knowledge. Let’s look at something that we often skip.

We often ignore the mental mistakes that lead to running injuries. “Too much, too soon” is a mental mistake. Overestimating your readiness for harder, faster, and more training is a mental error. Ignoring warning pain is a mental error. Failing to distinguish between discomfort and pain from healthy training versus that from bone, muscle and tendon injury is a mental error. It is often hard to tell how signficicant pain is and to interpret what it means.

There is value in some of what has been said before. George Sheehan declaring “we are all an experiment of one” is signficant and the Delphic Oracle saying “Know Thyself” is another significant statement. (Although Aristophanes in the play “Clouds” used “know yourself” in a harsher sense which I’ll skip here.). The Delphic Oracle of ancient Greece had another aphorism that is not widely quoted among runners: “Nothing in excess”. These are wise statements. In fact an entire Philosophy course is available on Coursera called “Know Thyself” with Professor Mitchell Green of the University of Virginia. The bulk of my MOOC experiences at EDx.org and Coursera.org  do run a bit more to harder sciences, but being well rounded is something that most of us would benefit from.

As Barney says “everyone is special” which is another way of saying we are all alike in being a “case of one”. Luckily, sports medicine physicians and practitioners usually have a knowledge base and more than one case to draw on while evaluating a new patient’s symptoms. It is still vital that each runner take the responsibility to carefully monitor themselves. Examine on each run on you feel after you have warmed up gently, how you feel during your run, how you are progressing, how you are recovering, and what happens during and after the run.

The only way you can learn from your errors is to pay careful attention and catch them early before they result in a disaster. Improvement is something we are all looking for. Avoiding injury is another. Evaluate the changes you are making. Give yourself time to adapt. And most important pay attention to what your body is telling you. If you avoid most careless mental errors, you’ll run longer, faster and healthier.

In The Long Run: Eagles 

“I used to hurry a lot,
I used to worry a lot,
I used to stay out till the break of day.

Oh, that didn’t get it.
It was high time I quit it.
I just couldn’t carry on that way!“

Vapor wear or Vaporware? 

The Nike Vapor Laser Talon is a new Football clete which is manufactured, in part, using 3D printing. It weighs 5.6 oz. The prepared press on the shoe states:

“Nike’s new 3D printed plate is contoured to allow football athletes to maintain their drive position longer and more efficiently, helping them accelerate faster through the critical first 10 yards of the 40.”

“”SLS technology has revolutionized the way we design cleat plates – even beyond football – and gives Nike the ability to create solutions that were not possible within the constraints of traditional manufacturing processes,” said Shane Kohatsu, Director of Nike Footwear Innovation.”"

3D printing has been used for prototypes for several years. This is said to be the first shoe in which 3D printing using Selective Laser Sintering technology (SLS) as part of the standard manufacturing process.

Don’t look to be printing this out at home any time soon. It will be manufactured at the Nike production facilities. And it is not going to be individually customized at this time.

There has been some discussion about the name, with one blogger saying that it seemed cool enough to come from Spike TV. For me it rang a bell: shoes, wear the shoes, run in the shoes, play foot ball in the shoes. Vapor. Hmm, vapor – vapor and shoes. Vapor wear. Vaporware.

Vaporware is a term applied to software products that are announced and somehow never see the light of day. Wikipedia sums it up for those of you not familiar with the term Vaporware.

I don’t believe I’ve seen Nike fail to deliver on an announced shoe, so this new Vapor Wear is likely to be worn and not be like vaporware.

If you are ready to try your hand at 3D design but can’t afford a printer, I came across Shapeways, which offers tutorials and the ability to get started.

The Mediterranean diet has long been said to have significant health benefits. Finally, a long term study has been performed which demonstrates these benefits.

The Mediterranean diet includes moderate fish and poultry; avoidance or a low intake of red meat and dairy products, high intake of olive oil, fruit, nuts, vegetables, and cereals. Wine is encouraged in moderation. In this study the bonus was either more olive oil or 30 g of mixed nuts per day (15 g of walnuts, 7.5 g of hazelnuts, and 7.5 g of almonds).

Previous studies have indicated benefit from this diet. The latest study is a randomized trial which compares two different Mediterranean diets: one including extra-virgin olive oil and another with nuts, in comparison with a low-fat diet.

The results were so good that the study was declared finished early. 3 major cardiovascular events were prevented per 1,000 person-years. Or 1 per 333 people/years or one more way to look at it: “relative risk reduction of approximately 30%, among high-risk persons who were initially free of cardiovascular disease.”

Mediterranean Diet

Perhaps one day I’ll break this up into 5 slideshares and 5 articles. But for now, here are the slides from a lecture presented at the Sports Medicine Section of the  American Podiatric Medical Associations Annual Scientific Conference.

I believe that basic science and research is an important component for advances clinical medicine. This lecture highlights some of that research from barebones systems biology to mechanotransduction. Cell mechanics, structure and biology are where the action is.

Slideshare: Overuse bone and tendon injuries – science and theories of tomorrow

We may be trying out slideshare and seeing if it is popular or not. The first lecture is just a test case. It was developed for non-specialists, biomedical engineering students, as a model look at an injury. The lecture is not comprehensive, but gives an overview of the anatomy, structures affected, the “Ottawa criterion”, PRICE (protection, rest, ice, compression, elevation, and what systems connect together for proper ankle functioning and stability.

Check it out here and with Creative Commons (attribution) you are free to download it:

A Quick and Simple Look at Lateral Ankle Injuries

You may also view, at my running injuries website, a short article on ankle sprains with a rehab protocol.

The hardest steps are always the first ones out the door. #NewtonsLaws #running

— steve pribut (@iSteeve) January 28, 2013

Mary Cain running 4:32, kills U.S. women’s high school indoor mile record which has stood since 1972.#running bit.ly/12400S7

— steve pribut (@iSteeve) January 28, 2013

 

The cell phone crime is because of a loophole in the DMCA. Penalty by the Librarian of Congress.Wait till you see the overdue book fines!

— steve pribut (@iSteeve) January 28, 2013

Can electrical stimulation help you get better sleep and make up for age related sleep and memory deficits? nytimes.com/2013/01/28/hea…

— steve pribut (@iSteeve) January 28, 2013

The best treatment for frostbite is avoidance: dress properly! Too late for prevention? Rewarming is the way to go.drpribut.com/sports/spcold.…

— steve pribut (@iSteeve) January 25, 2013

A healthy mind in a healthy body or  “a sound mind in a healthy body” is an ideal to strive for.

Where does this “aphorism” or “motto” come from? A running shoe company? The Romans? Those are two popular answers, but neither rings true.

Often we see this rendered as “mens sana in corpore sano” and ascribed to the Latin satirist and poet Juvenal if anyone wants to dig that far. Juvenal (Decimus Iunius Iuvenalis) was active in the late first and second century AD. There is less information available on his life than on Shakespeare. Most knowledge of his life derives from his “poems” rather than historical documents.

The 10th Satire of Juvenal is thought by many to be the origin of the saying adopted by many modern proponents of sport and exercise today. See Satire X or view the extract at Wikipedia.

English translation (Wikipedia):

You should pray for a healthy mind in a healthy body.
Ask for a stout heart that has no fear of death,
and deems length of days the least of Nature’s gifts
that can endure anykind of toil,
that knows neither wrath nor desire and thinks
the woes and hard labors of Hercules better than
the loves and banquets and downy cushions of Sardanapalus.
What I commend to you, you can give to yourself;
For assuredly, the only road to a life of peace is virtue.

In Original Latin:

orandum est ut sit mens sana in corpore sano.
fortem posce animum mortis terrore carentem,
qui spatium uitae extremum inter munera ponat
naturae, qui ferre queat quoscumque labores,
nesciat irasci, cupiat nihil et potiores
Herculis aerumnas credat saeuosque labores
et uenere et cenis et pluma Sardanapalli.
monstro quod ipse tibi possis dare; semita certe
tranquillae per uirtutem patet unica uitae.
–Roman poet Juvenal (10.356-64)

Many aspects of the Roman empire from sculpture to the columns of their buildings had their origin in ancient Greece. This saying also derives from a far older Greek philosopher who predated Socrates. Thales of Miletus seems to be the origin of the saying. Thales was also a mathmatician who is often called the first true mathematician and applied geometry to practical problems. He was born sometime before 620 BC. Herodotus reported that Thales predicted a solar eclipse of 585 BC. Aristotle, himself, mentioned Thales as a precurser to his own writings and philosophy. The aphorism “Know Thyself” is often attributed to the Delphic Oracle, but Thales is also one to whom these words are ascribed.

Ben Franklin, known for his sayings, said that those sayings seen in “Poor Richard’s Almanac” were old wisdom reworked, they were the “wisdom of the ages and nations”. But back to Thales.

Νοῦς ὑγιὴς ἐν σώματι ὑγιεῖ

A healthy mind in a healthy body

This is ascribed to Thales, long before the Romans marched on the world.

Ancient Greece is the origin of the Olympics. Sparta and Athens both had a culture of Sport with Athens adding in an emphasis on mind. Plato was said to be an athlete in his youth. Plato and others wrote who the society was wrong to over value athletes and felt others deserved rewards as great or greater. Plato felt that the educational ideal was to strive for a balance and harmony between body and soul.

Lucky for us that entertainers are valued so well also. Soon our gladiators, the one’s who haven’t fallen, will be seen in the “Superbowl”. Other events will follow. While the Superbowl is a big event, I take an interest in a number of other sports and still watch the sports that have descended from the Greek games. No, not Greco-Roman wrestling, more likely track and field. Not long ago though, I did have an interesting conversation with a professional wrestler who has participated in the WWE and in the Ring of Honor about the athleticism and drama of entertainment wrestling, and both are integral features of that manner of wrestling.

A good chair sport is checking out the quotes and sayings you see on Facebook, emails, and scatterred across the web. A good number of them have never been seen before the 1990′s although they may be ascribed to Thomas Jefferson, Mark Twain, wise Indian chiefs or any number of others.

“History doesn’t repeat itself, but it does rhyme” Author Unknown

That is a catchy saying. I first heard this phrase in the last few months on a talk show attributed to Mark Twain by a historian who wrote a recent book on Thomas Jefferson. In reality, a quick google search will show that this statement is not found in any of Mark Twain’s prolific writings or in any news stories about him. When a historian uses bad quotes, I start to wonder about the rest of the histories he has written.

But we can go back to the point we started on and agree that however it is said “a sound mind in a healthy body” is an ideal to strive for.

References:

Juvenal (1992) The Satires, Trans. Niall Rudd, Oxford: Oxford University Press.

Juvenal - Wikipedia

Thales - Wikipedia

Thales: Math Open Reference

Heroditus - The Histories

Athletics in Ancient Athens, Donald G. Kyle (Google Books)

Plato And Athletics, Dombrowski

Musical Accompaniment

Traffic “Heaven Is In Your Mind”

Eve – Let Me Blow Your Mind