Every day, the long-term consequences of head injuries become more apparent. In particular, NFL players experience many concussions over the course of their career, leading to the various long-lasting symptoms associated with chronic traumatic encephalopathy (CTS). The disease is characterized by the degeneration of brain tissue, as well as the build up of tau protein. Externally, these symptoms might be expressed through social cues such as depression or aggression.

Together, new research and technology are paving a path for early detection of CTS and the tau protein abnormalities associated with it. Researchers from the University of California Los Angeles used positron emission tomography (PET) scanning with a tracer for tau protein and found significantly elevated binding values among retired players when compared with controls. These results are consistent with already-existing autopsy data coming from players that showed deposits of phosphorylated tau in neurofibrillary tangles.

The technique is also specific and sensitive enough to distinguish Alzheimer’s patients from those experiencing milder forms of cognitive impairment. According to the researchers, “using a tau marker for detection and tracking of neurodegenerative disease is critically important because severity of tau load, rather than amyloid burden, correlates with rates of neuronal loss.” so further studies into anti-tau treatments are on-going.

For further reading on the future of CTS detection, see NFL: PET Scan IDs Brain Damage in Players.

Rami Hashish , DPT has written a great article featured on the Huffington Post about the benefits and drawbacks of both running outside and on the treadmill. Most focusing on a handful of studies, Rami discusses how treadmills reduce the impact on joints while outdoor running can be good for those with Achilles strains. According to the studies he cites, treadmills can lead to reduced running speeds without the user realizing it. He also writes about how to simulate the additional energy required for running outdoors when on a treadmill. Here is an excerpt from his article:

It’s a beautiful day. The sun is shining and glistening off the ocean’s waves, causing a beautiful reflection of colors in the cloudless yet slightly misty morning sky. In other words, it’s a perfect day for an outdoor run. But it’s hot, too. And you have pale skin and burn easily. It’s also early in the morning, meaning that there aren’t too many sunbathers to gawk at, or at least check out discretely under your Ray-Bans. OK, so indoor treadmill running it is!

My good friend Forrest Gump would never contemplate the nuances of such a choice. Rather, he would just run. But we’re not Forrest Gump. So here’s the dilemma: Should you run on a treadmill or overground? To answer this, let’s disregard the rhyme and reason behind the choice and focus solely on the science.

Read Rami's article To Run Outside or on a Treadmill? A Dilemma Foreign to Forrest Gump on Huffingtonpost.com.

Do you find your feet to be in aching pain when going for a run in the morning or afternoon? Is it an intense, sharp pain on the heel of your foot and arch? You are not alone. Most likely, you are one of the ten percent of Americans who have an inflammatory condition in their feet known as “plantar fasciitis”. Plantar fasciitis is caused by stress in the foot’s arch tendon, and it can affect anyone. It is one of the most common medical conditions seen in America, affecting over two million people per year. It accounts for over one million physician visits yearly. Those who are most at risk are athletes, soldiers, and obese people who find themselves standing frequently and placing heavy strain on their feet.

Athletes of all levels and abilities are particularly vulnerable, because they are frequently driven to overtrain. Today more Americans than ever are under constant pressure to succeed at the next level, and neglecting healthy and recuperative rest leads to chronic strains and tears in ligaments. Furthermore, with increasing competition from other players to take over starting roles on a team, athletes are pressured more than ever to rush through injury rehabilitation. Without proper healing time, an athlete can quickly fall into a cycle of failing to properly heal and re-aggravating inflammatory conditions.

Pathology

Plantar fasciitis is the most common cause of pain on the bottom of the heel. The plantar fascia, a fibrous band of tissue that supports the arches, becomes inflamed and irritated. The plantar fascia is a very thin ligament that connects the heel to the front of the foot in order to absorb stress and shock that we place on our feet. The direct result of straining this ligament? Pain, swelling, weakness, and irritation that affects daily living activities.

Symptoms

The symptoms are generally noted as an intense sharp heel pain when a person takes her first few steps of activity. Sometimes there is occasional relief of the pain after a few minutes. However, the feet will hurt more as the day goes on, if activity (and weight-bearing pressure) continues. Walking on hard surfaces is especially hard on the plantar fascia.

Relief

Plantar fasciitis is usually a difficult problem to completely eliminate. However, treatment is generally nonsurgical and conservative in nature. To reduce pain and swelling, many physicians recommend taking an over-the-counter pain reliever like ibuprofen (Advil or Motrin), naproxen (Aleve), or aspirin. It will also help to do preventative calf stretches several times a day, especially when waking up and beginning daily exercises. Try to not run or walk on hard surfaces, and pick shoes that have good arch support and well-cushioned soles.

This article was written in collaboration with Haroon Andar MS on UglyFinish.com.

Concussions are a dangerous but sometimes subtle injury that can frequently occur in sports, particularly football. Much of the time, though a person is experiencing one, there may not be any obvious physical signs like scratches or bruising that would show it. When a person experiences a powerful blow to the head, the brain may knock against the skull and a concussion occurs when the brain is damaged. Although sometimes resting is enough to recover, concussions can last for weeks, affecting your vision, balance, and even your emotions.

Safety on the field is vital, especially when considering high school football concussions are on the rise. Check out the numbers from GlobeLifeInsurance.com.

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When we think of athletes, we often think of success, money, and the easy lifestyle that most of us can only dream of. It’s easy to forget the foundation of work, stress, and physical risk behind every hour of televised glory. Professional sports is a lifestyle job that requires grueling workout schedules, practice sessions, and game day routines. An athlete’s body endures a constant beating in training, and it’s far too easy to cross the line from helpful stress into repetitive stress injuries. Athletes are predisposed to common soft tissue injuries, which can affect their livelihood and even the quality of their life after their sports careers. In this article, we discuss one of the most common sports injuries witnessed: rotator cuff tears.

The rotator cuff is the soft tissue in the “socket” of your shoulder’s ball-and-socket joint—the joint that gives your shoulder a greater range of motion than any other body part. The rotator cuff is composed of a collection of four muscle groups: the teres minor, supraspinatus, infraspinatus, and subscapularis. These muscles, along with their tendons, form a covering around the head of the humerus bone. The rotator cuff is protected by a lubricating sac, known as the bursa, which shields the cuff from the bone on top of your shoulder (called the acromion). This lubricating sac allows the rotator cuff tendons to glide freely with arm movement. When the tendons are injured, this bursa can become inflamed and painful, which limits arm activity. Pitchers are especially prone to rotator cuff injuries due to repetitive overhead activities and trauma.

Rotator cuff injuries have symptoms similar to other soft-tissue injuries—shoulder pain, weakness, and loss of range of motion with movement and activity. If you have a rotator cuff injury, your shoulder pain might be exacerbated during the night, while you are otherwise at rest. You might also feel crackling sensations when you move your shoulder.

The good news is that if you don’t aggravate an already-injured rotator cuff, they can be quite resilient. Over 50% of rotator cuff injuries can be treated using non-surgical orthopedic treatments, though this naturally depends on the size and duration of the tear. Conservative treatment usually includes rest, activity modification, physical therapy, and the usage of anti-inflammatory medication such as Ibuprofen and Naproxen. If the inflammation and pain continue the next step might be a cortisone steroid injection, which is very effective in reducing inflammation. If there are continued symptoms beyond six months, then surgical consultation may be needed to facilitate full tendon healing.

Here are four tips that can help prevent shoulder injury:

1. Stretch your shoulder dynamically before performing intensive workouts.

2. Rest your shoulder regularly during practice and sports games.

3. Apply an ice pack if you start experiencing any shoulder pain.

4. Consider taking an anti-inflammatory pill such as Ibuprofen or Naproxen before and after every game to prevent swelling.

This article was originally featured on Inspiyr.com and co-written by Haroon Andar MS and Moshe Lewis MD. To view the original page, visit the online magazine’s website.

We will all miss Junior Seau whose life after the NFL seemed so full and productive. He had just completed a celebrity golf tournament for his foundation last month with other ex-NFL players. He had a successful restaurant and he was beloved by the city of San Diego years after starting off as an overly aggressive, if not immature player.

There is tremendous controversy in the way that Seau chose to end his life. Formally labeled as a suicide by the coroner, the question is: was Seau suffering from untreated depression, or experiencing the effects of years of chronic head concussions? Another player, Dave Duerson, also committed suicide this year and shot himself in the chest so that his brain could be studied. It showed moderately advanced evidence of chronic traumatic encephalopathy (CTE) — a progressive degenerative disease related to repeated concussive blows. The disease has been linked to at least 18 deceased NFL players, researchers have reported, but no definitive cause-effect relationship has been established. Seau’s family has just released his brain so that it can be studied by scientists to see if CTE played a role in his death. Untreated depression can certainly lead to suicide and even if Junior did fall asleep in 2010 when he drove off a cliff, that was a troubling warning sign of his potential for suicide and the demons lurking within. If he was deeply troubled this year, Seau concealed his private misery to most, even to family members who are also seeking answers for their untimely loss. However, it is understood that it is very difficult for many players once they leave the NFL to adjust to civilian life as they no longer have the same level of fame and their self esteem is challenged.

The NFL is under a lot of pressure to make changes to the way the game is played and Seau’s death will ratchet up those efforts considerably. Remarkably, eight Chargers from the 1994 Super Bowl team have died from a variety of causes, all before age 45. There is a lot of homework still to be done and long term, mental health support should be provided for players on and off the field. Finally, we as fans must do our part to support the NFL as the sport becomes less violent. Otherwise, our grief will not seem sincere.

Junior, whatever the circumstances may be, know that you have a virtual stadium full of fans who appreciate the passion that you brought to your game. Rest easy knowing that your death will not be in vain as we will seriously explore CTE and untreated depression to try and help other players in the future.

While cyclists tend to be very fit due to their love of the sport, there are some risks involved. In a recent article Nina Patterson, PT, explains that many injuries are inflicted on areas of existing weakness, with the compounding effect of additional stress or under-use in certain areas of the body. In each case, she says, the injury occurred due to “cumulative trauma.” So what can be done about these injuries?

Active Release Techniques® (A.R.T.*) is a soft tissue management system that breaks up adhesions in and between tissues. Using A.R.T., normal length and tension of tissues is restored. For those of you who have tried stretching and general massage with no avail, A.R.T. is for you.

She specifically tackles widespread issues such as neck pain, low back pain, hamstring strains, and Achilles tendon strains, and discusses how active release techniques can help with a problem that other therapeutic activities couldn’t solve. Read the article at the Sports + Orthopedic Leaders Physical Therapy blog and start living a more pain free life.

If you’ve been working like a weekday robot and using your weekends to workout, you just might be a Weekend Warrior! Weekend sports and outdoor activities like team sports, hikes and swimming are good for both the mind and the body. Plus you’ll feel alive again, until Monday rolls around.

But using physical recreation as a weekends-only reward comes with its own set of risks. Intermittent exercise quickly increases the risk of a muscle strain or ligament tear. Joints can easily be injured without the proper warm-up during the week. Repetitive stress injuries (RSI) like plantar fasciitis or shin splints can put you in a walking boot for weeks. Skimping on weekday workouts leaves muscles stiff and poorly conditioned for weekend performance, so you’re far more likely to get injured.

Luckily, a little bit of preparation goes a long way. You can start immediately to optimize your weekday routines in order to excel at your weekend sports activities. Here are six simple tips that can make your weekend performance better, safer, and more fun:

1. Reach for the Sky

Stretching should always be the first step in a warm-up routine. Basic stretching prevents allows you to prepare the muscles for the work they are going to do, preventing muscle strain injuries. More advanced stretching exercises like yoga and Pilates also improve your balance, core strength, back strength, and conditioning for the spine. You can reap the benefits of stretching even if you are unable to take a dedicated weekday class—just devote fifteen minutes to stretching a few days every week.

I was recently interviewed for a KTVU special on more efficient stretching: Certain Stretches Could Inhibit Athletic Performance

2. Pump Iron or Soup

Strength training is an essential way to build endurance for the Weekend Warrior. Muscles need resistance training to function at their full capacity. Utilize lighter weights with multiple reps to improve tone initially—even doing curls with a soup can will help to tone your muscles for endurance-based activities like hiking or distance running. If you’d like to build strength and bulk, gradually move to higher weights with fewer reps.

3. Get Conditioned

Many of us are weekend warriors by necessity, not choice—our routine simply does not permit a lot of time to train during the week. But if you can find the time for even a little bit of simple aerobic conditioning, you’ll see a huge change in both your weekend performance and your everyday energy level. Light, easy, and low impact activities — jogging, hiking, tennis — are a great way to optimize cardiovascular health, limit further damage to your cartilage and joints while burning calories, thereby mobilizing muscles naturally.

4. What About Supplements?

From Omega 3′s to glucosamine to antioxidants to vitamin D, the right nutrition and dietary supplements can make a big difference in your sports performance and your general well-being. Always consult your doctor, who can support your good health through the appropriate supplements. Remember, a healthy diet, including adequate fluid intake, are essential to all athletes, professionals and weekend warriors alike.

5. Happy Feet Are Healthy Feet

Good ergonomics, posture and even the wear of your shoes can make or break your technique. Take a page from professional athletes, who optimize the mechanics of their technique with custom orthotics, proper shoes, and correct body mechanics. Consider taking a few lessons from a professional trainer in your sport of choice. Also, consider seeing a podiatrist for advice on inserts and shoe wear, especially if you have foot pain. An investment in proper foot support is an investment in your long-term orthopedic health.

6. The Fun Factor

Most importantly, realize that exercise should be fun. This certainly goes for your weekend recreational events, but the fun doesn’t have to end on Sunday night. It’s far easier to keep up on your regular conditioning if you genuinely enjoy it and look forward to it. If you’ve been having trouble jogging to prepare for your weekend pursuits, why not substitute rigorous swing dancing? Swimming? Dog frisbee? Or even aerobic gardening? Any weekday physical activity is better than none, and regular light activity will help your body to be acclimated for weekly hard activity.

Remember that whether you are a full-time athlete or a weekend warrior, physical activity that keeps you moving and having fun will keep you motivated and help you reach your fitness goals.

This article was featured on HeathlyBlackMen.org.

Peyton Manning sustained a disc herniation in his neck which pinched a nerve that interfered with his throwing ability. He has undergone 3 surgeries to repair this in the past 2 years, one, just last September called a neck fusion. In this surgery, which is successful in the majority of patients, the spine is stabilized, in this case, with a piece of bone from Manning’s hip which was placed between two collapsed vertebrae so that the nerve could be unpinched. When nerves are pinched they can limit muscles in a quarterback’s throwing arm from functioning at their fullest. Over the next few months, Peyton Manning will continue the process of rehabilitating his arm and maximizing his throwing potential in order to lead the Broncos to the playoffs and hopefully to win another Super Bowl title.

History of the Injury

It is widely believed that Manning first injured his neck against the Redskins in 2006, when the quarterback was twisted between two defenders. He wiggled his arm after he stood, as if it had gone numb. Reportedly neither Manning or the Colts realized it until after the season, but Manning had pinched a nerve in his neck. On March 3, 2010, Manning had surgery at Northwestern Memorial Hospital in Chicago to repair it. This helped to alleviate Manning’s chronic pain for a while but then in the spring of 2011, the pain returned. On May 23, 2011 Manning went to Northwestern for a second surgery where doctors shaved part of the bulging disk that had pinched the nerve. Due to the persistence of his problem Manning reportedly went to Europe last summer to attempt stem cell therapy which did not work. He finally underwent a definitive anterior cervical discectomy and fusion surgery September 8, 2011 in Marina Del Rey by Dr. Watkins.

By Moshe Lewis MD and Fion Ng

Gymnastics is one of those sports that encompass agility, balance, precision and strength all in one. Although injuries are prevalent in all sports, gymnasts should take extra caution because any little injury that has gone untreated may turn into a chronic problem later in life.

1. Before any routine, no matter what age or gender, you MUST warm-up –Spend at least 20-30 minutes to warm-up all the major muscle groups and stretch out your wrists and ankles since these are the joints that are most susceptible to injury.
2. Wear appropriate attire – Wear fitted clothing as loose clothing can get caught in equipment and can also prevent the athlete from doing aerial movements. In addition, hair should always be pulled back out of the athlete’s face, dangly jewelry and body piercings should not be worn as it can also get caught in equipment and pose harm to other surrounding athletes.
3. Have a qualified spotter – Spotters play a very important role in assisting athletes attempting new and/or difficult skills.
4. Have emergency contact information handy – Because injuries are inevitable, it is crucial to have an emergency plan to minimize/ease any discomfort an injured gymnast may feel.
5. Stop performing at the first sign of pain – If you think you have hurt or injured any part of the body, no matter how minor the pain may be, stop gymnastics activity until you have been checked out by a coach or doctor.
6. Wear additional safety gear when appropriate – some apparatuses require athletes to wear grips.
7. Eat a well balanced diet when in training – at any stage of gymnastics training, it is important to maintain a well balanced diet in order to perform at your best.
8. Do not attempt skills that have not been practiced – a gymnast should be confident and know how to perform a skill before attempting it for the first time.
9. Talk to your coach(es) – coaches are there to explain to gymnasts how to safely execute skills, how to improve those skills and can discuss with the gymnast any other worries or insecurities he/she may have.
10. Know and understand your body – Not only is gymnastics a physically demanding sport but also requires the athlete to be psychologically and emotionally inclined. Being attuned to your body will allow the athlete to block out distractions and concentrate more on his/her training.

 

One of my good friends and fellow pain management specialists was recently featuring in an inspirational article about how she dealt with pain when weight lifting:

Liza Reichenberger knows about pain.   Suffering from chronic and severe pain secondary to familial osteoarthritis and degenerative disc disease, she has “a horrid neck” with a large herniated disc and multiple bone spurs causing her daily pain – especially in the morning as she struggles to move upon awakening.  Three different spine surgeons have recommended cervical decompression and fusion.  Their advice?  Stop exercising.  Yea, sure.

You don’t tell “Herculiza,” the greatest natural female bodybuilder of all time, to stop working out.  But, like most people, Reichenberger did what she was told and followed her doctor’s advice.  She stopped all upper body weight training for 6 months. Big mistake.

Read the full article on Examiner.com — Local bodybuilding legend helps patients conquer pain

One of my patients, Jim Fitzpatrick, was recently interviewed in the Mercury News on his on going fight with chronic pain and his success despite this disability. He also recently completed an interview with Cheryl Jennings and myself about alternative approaches to chronic pain at ABC. I am really proud of Jim and encouraged by his will to conquer pain.

Excerpt from the Mercury News article "From roller derby to art gallery":

About 10 years ago, the South San Francisco resident was coping with mobility issues and chronic pain after retiring as a firefighter due to a disability.

He went through years of physical therapy until, in recent years, his doctor recommended a treatment known as myofascial release, which decreased his pain and made him more mobile again.

Wanting to help others coping with chronic pain, Fitzpatrick and his doctor recently discussed his successful treatments on an episode of ABC7 TV's "Beyond the Headlines."

Read more at Mercury News: From roller derby to art gallery

From the exasperated fan's perspective, the NFL labor negotiation looks like an argument between billionaires and millionaires. But the truth is, no matter how well the union bargains, most players will end up broke - and broken in body. With all the picketing and anti-union sentiment swirling around, it's tempting to view players as lacking serious grievances compared with, say, public school teachers in Wisconsin. But let's pause a moment and carve up their paychecks in real terms.