The View from Sports Center

Hands Only CPR

According to an article in The Los Angeles Times, the American Heart Association has changed the requirements for CPR. They found that rapid chest compressions, 100 per minute, worked just as well as the former standard cardiopulmonary resuscitation (mouth to mouth and chest compressions) for sudden cardiac arrest in adults. You need to do two things now: call 911 and perform quick chest compressions - 100 per minute - until paramedics arrive or use an automated external defibrillator to restore normal heart rhythm.

Somebody's Lying but Does it Matter?

by Doug Kelsey

I watched a good portion of Roger Clemens' testimony before Congress today (2/13/08) on whether he used performance enhancing drugs and I came away befuddled. His former trainer, Brian McNamee, says Clemens did use the illegal drugs and Clemens claims McNamee is lying. It's he said, he said.

But, why are we doing all of this, spending who knows how much taxpayer money to end up in a standoff and likely about to spend a bunch more money (there were six FBI agents in the room) trying to process somebody for perjury when no one in  baseball has yet to figure out what's ok and what's not ok when it comes to performance enhancement? Clemens has already admitted to using performance enhancing drugs in 2005 but, baseball and society had no problem with it. Reason? It was Vioxx. Clemens was upset when the drug was taken of the market because he used it to manage inflammation and pain allowing him to compete, enhancing his performance, when he would otherwise not be able to play.

It's ok to inject a player's knee or shoulder or back with cortisone so the player can continue. It's ok for a player to have Lasik surgery, like Tiger Woods,  drastically improving his eyesight. It's ok for a player to use non-steroidal anti-inflammatory drugs like Motrin or Advil or other pain killers. Chugging a few cups of coffee or a can or two of Red Bull loaded with caffeine is ok. But it's not ok to use human growth hormone or anabolic steroids. I know there are health ramifications with these drugs but there are also ramifications with other drugs. And, Lasik may improve performance more than human growth hormone so, why is it ok?

Is the issue performance enhancement or is it that we (society) have a taboo on certain drugs? It wasn't all that long ago that alcohol was a banned substance and before that Coca-Cola actually had cocaine in it. Drug use in society is a very sensitive subject and perhaps what has happened is baseball got caught with its' pants down exposing a bum of flawed logic. If we use the logic that all drugs that alter human performance should be banned in baseball, including caffeine, then shouldn't the same be true for society as a whole? Well, that's never going to happen. Starbucks would become the worlds largest drug dealer.

Maybe we should debate this whole issue of performance enhancement and what we're willing to live with and what we're not and include everything that alters performance. All drugs, procedures, everything. Put it all on the table for examination, discussion, and argument. There are a lot of things in life that don't make sense but at least we could try to make some sense out of this issue.

Can You Really Strengthen Cartilage?

Improving the health of your joints by strengthening cartilage is one of the 12 Things I Believe. The reason I believe this is the mountain of experimental research on the topic dating back nearly 35 years, my 25 years of clinical experience, and now, I am very happy to say, a study that showed physiologic improvements in human cartilage from moderate exercise. In other words, the cartilage changed from the exercise in a similar way that muscle, bone, tendon, and other biologic tissues change in response to activity.

This is a very big deal. Prior to this study, these types of changes had only been seen in animal studies and this has made it difficult to apply to humans. But, thanks to changes in technology, we now have evidence that the changes seen in animals also occur in humans.

Maybe now, people won't look at me like I'm an alien who just beemed in from planet Goofalon when I talk about improving the health of your joints. I admit, it's nice to be validated once in a while.

The article was reported on one of my favorite web sites, Science Daily.

Will Santa Bring Me This Next Year?

At dinner just the other night, I was reminded of the fun of Dear Santa lists and it got me thinking. I haven't written a Dear Santa list in a long time. So, here's mine for next year.

Dear Santa,

I figured if I gave you a whole year's lead time, you could get some of these things for me because, well, I really could use them. They're not in any particular order or about any particular thing but see what you can do about the whole list. That would be really great.

• It would really be great if you could get the Texas legislature to pass a law allowing physical therapists to see people without requiring a referral from a doctor just like massage therapists or acupuncturists or personal trainers (and, no, the current law is useless even though technically a physical therapist could see a person without a referral). I think we're just as well trained so we ought to have the same opportunity to help people.


• United Health Care insurance needs a total over haul. They are way too concerned with buzz words like "maximum therapeutic improvement" or "maximum medical improvement" and way too unconcerned with whether someone can get up and down a flight of stairs without their knee swelling up. This will probably require more than a phone call though. You may have to write them a letter.

• Is there anyway you could convince the American Physical Therapy Association to write a position paper on the futility of daily note writing? You know, the note writing all physical therapists are required to do, to show some sort of progress in every single session no matter how long a person has been injured or ill? If you think about it, why would a person change a lot in one or two sessions when he or she may have had back pain for, oh, 15 years? It's absurd.

• I love Wii but there aren't any games that require you to use your lower body. How about a controller for the leg so you could kick, hop, skip, and other fun stuff? You know, like soccer?

• And, do you have a to-do list manager? I imagine keeping up with the entire world's gift requests is a big project. I beta tested THINGS which is very cool but these guys need to hurry up and finish it. So, if you could send an elf or two over there to get THINGS done, I know I would be really happy and you could probably use it too.

• 
• And while we're on the subject of technology, do you think Steve Jobs is working on a hand held writing device because if he's not, he should be. I'm sure if Steve could whip up some kind of writing table that makes keeping clinical notes easier than what we do now, Apple would sell a ton of them. And, I would talk about it and write about it a lot - if that helps at all.

• 
• Is there anyway you could get me this bike? I already have a kickbike, which is very cool, but this one, now, this is a bike that looks really fun.

• I would really like to be able to jog so I can get back to playing some basketball (no, just easy, nothing spine breaking) and, yeah, I can for a few minutes, but I'm just as impatient as the next guy so if you have a magic jogging wand or something, I could use it.

• 
• Could you get the people who make the True Stretch, which already is a great device and I love using it, to add an adjustable height mechanism? I'm tall so if I want to really create multiple-angle flexibility I run out of room but if I add the tall adjustment piece, then people who are shorter can't reach the top of the machine. I know it's picky but I have plans for it in the future and since they already make it......

• And, on the topic of machines, the Panasonic Core Trainer, another device I like a lot, is NOT like riding a horse and mainly because it's too narrow. A horse has a huge belly so if they could widen this thing to the dimensions of a horse, I could save myself a ton of money (from falling off the real horse).

• And, one more thing on machines....see if you can talk the people who make the Zero Gravity Chair into using this guy's patent on a lumbar continuous passive motion (CPM) device on one of their chairs. Seems like a great fit to me. CPM has been proven over and over to help injured joints and the chair is super comfortable. I use this device and it works ok but it's too hard to set up, and if I'm not careful, it can hurt. I would take this on but I already have about six projects going and I'm really trying to cut back.

• Last thing - we have an awesome machine we invented that you could really use in the off-season to keep yourself healthy, by the way, but we could use someone who knows how to manufacture these things. We're building them and we're doing a good job but I'll bet there's somebody out there who knows how to take a machine like this a make it a lot better for a whole lot less money. So, if you could hook me up with someone, Santa, that would really make my 2008.

I've been good, as you know, so, this shouldn't be a problem, right?

Cheers,

Doug Kelsey

New for The View: audio, new design, new features

The View is back and along with it comes a new look, new features, and an audio version. Check out the side bars for GOOD BOOKS, OUR READERSHIP, 12 THINGS I BELIEVE, and GOOD BLOGS and OTHER COOL STUFF.

At the end of each View, you will find a button to listen to the View (if there is an associated audio file - not all entries will have one). To listen, just click on the button. A new window will pop up with the player in it.

If you're new to The View and would like to subscribe, you have two options: email or an rss reader. Both options are available in the top left corner of the page.

As always, feel free to send your ideas and suggestions for topics to me here. Stay tuned....more to come.

Make today count.

Doug Kelsey

Will Lefty Be Left Out?

The View this week is a little earlier than usual. Reason? The final round of the US Open will be held this weekend at the Oakmont Country Club in Oakmont, PA. But this year the pre-tournament chatter is not about who will win. It's about whether Phil Mickelson, two-time Masters Champion, will be able to compete.

Over Memorial Day Weekend, Phil was practicing hitting out the rough at Oakmont and injured his right wrist. The injury was bad enough to force him out of his next two tournaments. He's had the usual battery of treatments for any type of athletic injury - ice, massage, rest, cortisone shots, and an elastic bandage - with minimal improvement. According to Phil, an MRI ruled out a fracture, and he saw two physicians who each rendered the same diagnosis: inflammation. And, as a result of the diagnosis, Phil has pursued a course of treatment to eliminate the inflammation consisting of cortisone injections, ant-inflammatory medication and massage.

So, why is Phil's wrist inflamed? What sort of injury does he have? We know what he doesn't have - a fracture - but beyond that I wonder if even Phil knows what's wrong with his wrist.

The more precisely you understand the reason for the symptoms, the easier it is to resolve the symptoms. Inflammation comes from all sorts of injuries: stress fractures, tendonitis, ligaments sprains, tenosynovitis. And, the treatment for one type of injury will be different than another or at least it should be.

So, in Phil's case, he likely has either an injury to one or more of the tendons in his wrist or the ligaments in the wrist. The treatment for a tendon injury involves stressing the tendon in the manner in which it will be used to facilitate healing and strengthening of the tendon. Tendons do two things for you: help move bones or help keep joints stable by transferring the force from muscle. Ligaments do one thing: keep joints stable. So, if you sprain a ligament, the last thing you want to do is move the joint a lot, or stretch it. Imagine spraining your ankle and then stretching it over and over. Doesn't work very well.

The dilemma for Phil is that in one case, a tendon injury, he needs to move the joint to stress the tendon while in the other case, a ligament injury, he needs to keep the joint still while he stresses the ligament.

All of the other things - massage, ice, ultrasound, taping - tickle your brain. Nothing wrong with any of them; nothing wrong with wanting to feel better. But, even though you feel somewhat better, maybe even a lot better, when you swing the club, stress the injured tissue beyond capacity, your injury springs to life. You may feel better but you're not really better.

So, what's your bet? Will Phil be in the final round of the US Open? Or will Lefty be left out?

Doug Kelsey

 

Volvo's Got Me Thinking

My wife just traded in her Lexus ES330 for a Volvo XC90. It's a great vehicle - well, at least for me. It's about the only one I've been in where I actually have some head room and am not bracing myself for a minor head injury every time we hit a speed bump. Thank you Volvo for considering the needs of the tall.

But, Volvo has done something else for consumers in their S80 series: the car can detect a heartbeat. The S80 can tell if someone else is in your car and alert you to it. So, the mental engine started whirring. If a car can detect a heartbeat, why not a regular office chair? Just think of the possibilities. Your boss could see who's on edge (high heart rate), who's relaxed (low heart rate), who's excited (sporadic heart rate), and who's missing (absent heart rate). You could monitor your heart rate while talking to an irate client, friend, or an especially irritating family member.  You could meditate in your chair and your chair tell you how well you're doing - "Breathe slowly John. That's it. In and out. In and out. Nice and slow. Your doing just fine." And, if we could place a heart rate sensor in the chair, we could also figure out how long you've been sitting. After all, sitting is the number one enemy of the spine (remember, get off your butt if you want to feel good).

It does feel just a little 1984ish to me though but the truth is we all need something to help us stay at least close to a healthy path. Might as well be my chair.

Doug Kelsey

PS - Sports Center will be knocking down a wall and nearly doubling our clinical space to handle a hugely successful explansion strategy (yes, explansion - a combo of explosion and expansion) and is looking for a special physical therapist to join our team. We have cracked the code on the three things physical therapists dislike most about their jobs and eradicated them at Sports Center. If you're ready to join a physical therapy practice built by and for physical therapists, send an email along with your resume to jobs@sportscenteraustin.com.

A New Type of Tennis Elbow

Nintendo has a new video game console, the Nintendo Wii, that allows the player to make more real world, whole body kind of movements during a game. The good news is that instead of sitting on your butt using your thumbs on the remote, you actually have to stand up for some of the games and move your body. So, you can play a virtual tennis game: the serve, forehand, backhand.

Hmmm....I wonder. Will we now have a new type of Tennis Elbow,  Nintendo Elbow?

Give Kids a Break

I know, last week I said I would give you part three of the Most Bang for Your Buck Workout, and I will. Promise. But, I have something else on my mind that seems more important right now.

An article appeared in the Austin American Statesman recently about the alarming number of kids who develop lower back pain while participating in sports. The piece showcased a young girl, 16, who developed lower back pain while playing tennis. She began tennis at the age of 5, practiced and played seriously until one day, at the age of 16,  her back was sore. She continued to play over the next few years, despite the pain, until she could no longer compete. She quit the game of tennis in her senior year of high school and along with losing a game she loved, she lost a chance at a tennis scholarship.

She eventually had spinal surgery. Her symptoms subsided but another condition, oddly enough missed by the rounds of x-rays and MRIs, scoliosis, a curvature of the spine, has sidelined her.

We praise athletes for playing in pain, playing with a broken arm, playing with fractured ribs, playing with a herniated disc as if the act is super human when in reality it's super stupid. Professional athletes, while seeming noble and brave, have significant incentives built into their contracts that pay them large sums of money to play hurt. I have had pro athletes look me straight in the eye and say, "Hey, man, I have got to play this weekend. If I don't I'm gonna lose like ten grand. So, can you fix me up enough to play?"

And, when kids or parents or coaches see Joe Super Star playing with a busted ankle, they adopt the "suck it up and play through the pain" attitude.  Like the 16 year old girl in the newspaper article. Ignore what your body is saying; it's what "real" athletes do.

Coaches and parents, and, yes, even some clinicians, should be ashamed of themselves for placing kids at risk. Spinal surgery is anything but simple. One complication is paralysis. Children need sports for things other than million dollar contracts or college scholarships. Kids need sports to help develop their minds; their bodies. They need sports to learn how to work as a team; what words like patience, discipline, and respect mean. They need to see coaches and parents actually use these values. When a kid hurts, it's the coach's and parent's responsibility to take care of the kid; to do the right thing and to not encourage the child to play hurt because of the misguided perception that that's what "real athletes" do. No. Real athletes respect their body, and have the discipline and the patience to do what it takes to help it heal.

Ignoring the signs of the body in trouble: aching, stiffness, swelling, persistent soreness and encouraging a kid to play hurt sets the stage for an older body at a younger age. 

What is so important that we are willing to sacrifice the youth of our youth?

Doug Kelsey

Happy Holidays!

From all of us at Sports Center, we wish you a very happy holiday season and a spectacular New Year!

Doug Kelsey