Monday, August 31, 2009

Dietary nitrate supplementation reduces the O2 cost of low-intensity exercise and enhances tolerance to high-intensity exercise in humans

Beetroot Juice Intake May Improve Exercise Endurance

Keywords:EXERCISE, ENDURANCE - Beetroot Juice, Dietary Nitrates

Reference:“Dietary nitrate supplementation reduces the O2 cost of low-intensity exercise and enhances tolerance to high-intensity exercise in humans,” Bailey SJ, Jones AM, et al, J Appl Physiol, 2009 Aug 6; [Epub ahead of print]. (Address: Exeter University. E-mail: ).

Summary:In a double-blind, placebo-controlled, crossover study involving 8 men aged 19-38 years, results indicate that consumption of nitrate-rich beetroot juice may enhance exercise endurance. The participants were randomized to 500 mL per day of either beetroot juice (BR, containing 11.2 mM of nitrate) or a placebo juice (negligible nitrate content) for a period of 6 days, following which the interventions were crossed over for another 6 days. On the last 3 days of each intervention phase, the men completed a series of 'step' moderate-intensity and severe-intensity exercise tests. Dietary nitrate supplementation (beetroot juice) was associated with significantly greater plasma nitrite, significantly lower systolic blood pressure, and reduced muscle fractional O2 extraction, compared with placebo. Additionally, beetroot juice consumption was found to significantly reduce the O2 cost of moderate exercise and increase the time to task failure during severe exercise. Thu s, the authors of this study conclude, “The principal original finding of this investigation is that three days of dietary supplementation with nitrate-rich beetroot juice (which doubled the plasma nitrite) significantly reduced the O2 cost of cycling at a fixed sub-maximal work rate and increased the time to task failure during severe exercise.”

Thursday, August 27, 2009

Concussions in athletes New recommendations in Sport

In an article published in the June issue of The Physician and Sportsmedicine entitled "Consensus Statement on Concussion in Sport - The Third International Conference on Concussion in Sport Held in Zurich, November 2008," new information and guidelines on the definition and treatment of concussions in athletes are presented. This is a revised and updated statement of the recommendations developed following the 1st (Vienna) and 2nd (Prague) International Symposia on Concussion in Sport. By developing core questions on how to treat concussions and best "return-to-play" recommendations, the conference members worked to improve the current recommendations as well as aiming to make this information readily available to health care professionals.

The article features numerous tips and guidelines on how to diagnose and treat individuals with concussions. Information presented includes a list of the common signs of concussions, step-by-step instructions on evaluating possible concussions, both on the sports field and in the emergency room, and a stepwise return-to-play strategy that will secure the well-being of the injured athlete. The authors also address potential complications that may influence concussion management, such as loss of consciousness, amnesia, and depression.

The article also includes smaller subsections of individuals, specifically adolescents, athletes, and non-athletes. The panel unanimously recommended that children should be completely symptom-free before returning to practice or play to prevent possible future complications. They also stated that all athletes should be given the same treatment for concussions, regardless of their level of participation.

The panel recommends that individuals should be educated on the symptoms and diagnosis of a concussion because available options for treatment are limited. By using a variety of resources, such as Web pages, educational videos, and outreach programs, the panel believes that people will become more aware of the causes and dangers of concussions.

In addition, the article contains the newly developed Sport Concussion Assessment Tool 2 (SCAT2), a standardized checklist designed for health care professionals to aid in the diagnosis of a concussion in an athlete. This new form was created to replace the original SCAT, which was published in 2005. By adding the new information from their discussion, the panel was able to create a tool that they believe will help medical professionals worldwide diagnose concussions successfully, ensuring their health and well-being.

The Physician and Sportsmedicine

Monday, August 24, 2009

Acetyl-L-Carnitine May Increase Nerve Regeneration


Reference: "Acetyl-l-carnitine increases nerve regeneration and target organ reinnervation - A morphological study," Wilson AD, Hart A, et al, J Plast Reconstr Aesthet Surg, 2009 Aug 5; [Epub ahead of print]. (Address: Andrew D.H. Wilson, Blond McIndoe Research Laboratories, Tissue Injury and Repair Group, University of Manchester, Room 3.106 Stopford Building, Oxford Road, Manchester M13 9PT, UK E-mail: ).

Summary: In a placebo-controlled study involving rats subject to surgical sciatic nerve division followed by immediate repair, parenteral administration of acetyl-l-carnitine (ALCAR - 50 mg/kg/day) from the time of operation until termination at 12 weeks was found to increase nerve regeneration and target organ reinnervation. In the subjects treated with ALCAR, the mean number of myelinated axons was significantly greater than the placebo and control (normal nerve) groups, and the mean myelin thickness was greater than that found in a placebo group. In addition, treatment with ALCAR was found to increase dermal PGP9.5 staining by 210%, as compared to sham treatment, and significantly reduce mean percentage weight loss in the gastrocnemius muscle (0.203% vs. 0.312% in the sham group). In light of the fact that, "Peripheral nerve injury frequently results in functional morbidity since standard management fails to adequately address many of the neurobiological hurdles to optimal regeneration," these results are significant and warrant further investigation into the use of ALCAR for nerve regeneration.

Heat illness, Heat Stroke for fall Sports

As the start of another school year looms and practices for fall sports begin, young athletes - and not just football players - are challenged by the hot weather and face significant heat injury and illness risks, say experts from the American College of Sports Medicine (ACSM).

Education, planning, acclimatization, modification, and monitoring are all key to keeping heat injuries and illnesses at bay - effective prevention strategies that coaches supervising practices often don't implement, says Michael F. Bergeron, Ph.D., an ACSM Fellow and Trustee and one of the nation's most highly regarded youth sports heat stress experts.

"Teaching coaches the warning signs of heat illness would be a huge step toward prevention," said Bergeron, who co-wrote the ACSM Roundtable Consensus Statement on Youth Football Heat Stress and Injury Risk. "But it's not enough. Coaches need to progressively introduce practice duration and intensity, as well as the uniform and any protective equipment, so that young athletes can safely adapt. Regular fluid breaks should be mandatory and practice should be appropriately modified for safety as the heat and humidity increase. Long gone are the days of refusing players water or using heat as a strategy to 'toughen up' a player. Unless the coach wants a collapsed athlete - or worse - on the field, it's just not acceptable. All athletes need to be closely monitored for signs and symptoms of developing heat illness, and participation should immediately stop and medical attention should be promptly sought at the earliest point of recognition."

The National Center for Catastrophic Injury Research, commissioned by the National Federation of State High School Associations, says that "heat-related deaths continue to be the cause of a majority of indirect deaths" in high school sports. In the report, heat stroke and other heat illnesses were experienced in variety of sports, including cross-country running and wrestling, with wrestlers working out in heat-holding rubber suits to try to "make weight" for events. Even marching bands should be concerned and take precautions - a study at the 2009 ACSM Annual Meeting showed band participants had heat illness risk and levels similar to those of athletes.

"I've attended numerous junior tennis tournaments where kids were competing from morning to dusk in excruciatingly hot summer conditions," Bergeron said. "Football might get the most attention for severe heat-related injuries and illnesses, but the risk in other sports is very real."

The ACSM Consensus Statement provides helpful prevention guidelines that can be applied to all outdoor sports, not just football:

- Avoid holding practices between 12 and 4 p.m., typically the hottest hours of the day (although later hours can also be as hot or hotter).

- When heat is extreme, hold practices indoors or use outdoor practices as lighter walk-through sessions.

- Increase the frequency and duration of rest breaks in the shade during practice, and give plenty of opportunities for sufficient fluid consumption.

In addition to promoting these proven heat illness prevention strategies, ACSM is developing new initiatives to educate not just coaches and schools, but also sport governing bodies and policymakers on heat illness prevention.

The American College of Sports Medicine

Friday, August 21, 2009

High Fat Diets and Exercise Performance

High-fat diets may impact short-term memory, exercise endurance

Adding to a body of research that has associated long-term consumption of a high-fat diet with decline in cognitive function—as well as weight gain and heart disease—a study published in The FASEB Journal finds that eating fatty foods may have an almost immediate detrimental effect on short-term memory and exercise performance.

For the study—which was funded by the British Heart Foundation, and led by a researcher then at the University of Oxford in the United Kingdom—a research team fed 42 rats a low-fat rat-food diet in which just 7.5% of the calories came from fat and trained them for two months to complete a challenging maze and run on a treadmill. The researchers then switched half of the rats to a high-fat diet in which 55% of the calories came from fat. Comparing the cognitive performance and endurance of the rats for five days—after letting the rats eating the high-fat food get acclimated for four days—the researchers found that the rats on the high-fat diet made mistakes sooner in the maze task than the rats on the low-fat diet. Specifically, the rats on the number of correct decisions before making a mistake in the maze dropped from more than six in the low-fat diet cohort to an average of five to 5.5 in the high-fat diet cohort. Additionally, the rats eating the high-fat diet ran 30% less distance on the treadmill than rats on the low-fat diet on day five of the diet and 50% less distance on the ninth day of the high-fat diet. The researchers also found that rats on the high-fat diet had increased levels of a protein that interferes with the process of energy creation in cells—thus reducing the efficiency of the heart and muscles—and that, after nine days, the rats eating high-fat food had significantly bigger hearts than those eating low-fat food.

According to the researchers, the findings of similar studies performed on humans—which are still being reviewed—appear to have similar short-term effects. In addition to helping to inform athletes of the optimal diets for training regimens, the researchers suggest that the findings may help develop ideal diets for patients with metabolic disorders such as diabetes and patients who are obese, among others (Murray et al. The FASEB Journal, 8/10 [subscription required]; Parker-Pope, New York Times Well Blog, 8/13; University of Cambridge release, 8/11).

Cyclist Palsy - Ulnar Neuropathy - Handle Bar Palsy

Cyclist Palsy
Many cyclists' first bout with injury on the bike is usually one of the three points of connection between man and machine: the hands, the gluts, and feet. Today we will look at the hands which often can give rider's pain as well as numbness or worse yet muscle weakness. The last thing we need is a decrease in the ability to hold on to the handle bars and get feedback from the road. One common injury is Cyclist's Palsy or Ulnar Neuropathy , which is an injury to the ulnar nerve. We can take a closer look at the anatomy and the mechanism of injury in an effort to better understand the problem. Lastly, we will look at various types of situations where this problem can arise and the solutions to them.
If we look at the anatomy of the hand we see that the ulnar nerve runs along the anterior (front) ulnar(pinky) side of the hand. The ulnar nerve supplies motor and sensory supply from the medial (inside) side of the hand to the pinky finger and part of the ring finger. When the ulnar nerve enters the wrist it goes through Guyon's tunnel, which is made up of two bones called the pisiform and hamate, which are connected by ligaments. One important thing to note is that this is a tight area, so once an injury occurs and you get inflammation to the area, and it will be more difficult to heal due to the repetitive stress and pressure. In addition, the nerve gives off sensory branches before it enters the tunnel of Guyon. This is important because the branches create two areas of possible injury. One being the sensory branch which if injured, gives you numbness and tingling. Second, the motor branch, which if injured would cause a loss of muscle strength. You can have an injury that affects one or both branches. Therefore, some people have only numbness, tingling, and pain, while others have motor weakness and some lucky patients have both.
So how does the ulnar nerve get injured? First and most common is a poor bike fit with too much weight on the front of the hands and an increase in the angle at the wrist closing down on the tunnel of Guyon and compressing the nerve. Other factors to consider are the length of saddle time; for example, touring cyclists are in the saddle for an extended amount of time and are exposing the area to more pressure, and vibration. Multi-day road races also have longer saddle times and usually more overall training. Lastly, for road cyclists, riding on rough terrain means that there are a number of bumps, increased vibration on the hands, and this can add but not solely cause an injury to the nerve. The constant vibration and pressure on the ulnar nerve can cause Neuropraxia which is a disruption of the outer layer of the nerve and the worst cases cause an interruption of the fibers of the nerve, known as Axonotmesis. Thereafter, you then can get inflammation at the site of inury, which causes an increase in pressure on the nerve at the tunnel. In its worst case, it can potentially lead to surgical decompression. I have also found that some of the amateur cyclists' day jobs can cause a constant irritation of the tendons in the wrist which may increase the inflammation and delay healing of the ulnar nerve.
So how do you know if you have cyclist palsy? (ulnar neuropathy). Some patients will get a pins and needle sensation or numbness of the pinky and part of the ring finger. Others may get weakness in the pinky and ring finger and may feel a decrease in their grip strength. You can also look at the muscles of the hand for any wasting or decrease of muscle tone between and around the two fingers. Another severe case of nerve disturbance is where you can have a claw like appearance of the pinky finger due to the damage of the ulnar nerve supplying innervation to certain muscles and leaving others unopposed, which can cause deformity. Pain is also associated with this problem and may occur with severe or mild cases.
So what do you do if you fall victim to this nasty little injury. You have to correct the problem! First, you have to make sure your fit is "spot on," or better yet get a bike fitting by an expert. Here are some tips one should adhere by in order to avoid injury or inflammation. You should avoid holding all your weight on the hand and wrist, paying special attention to the fact that the nose of the saddle is not slanted forward. If you happen to feel upper body fatigue in your shoulders and triceps muscles when riding, then you are supporting too much weight with your upper body. The next thing I recommend is rest! This is something no one wants to do whether you're a pro athlete or amateur cyclist. If you are an amateur rider it is essential to get to some rest off the bike. At a minimum you should decrease the volume and work and slowly go back up in an effort to give tissues time to heal. The next question I frequently get asked is how long should the rest be. This one is virtually impossible for me to determine without seeing the cyclist, the bike, and riding biomechanics. My advice is to work with someone who has treated these types of conditions before and can properly guide you. Another tip would be to change to a recumbent bike at the gym. During this healing time make sure you are conscious of how you use your hands and wrists, in terms of decreasing repetitive movements or continued flexion and extension of the wrist. This will only make the problem worse. The next change you can make is to use bar foam like Fiziks or Aztecs that absorbs vibration and gives some cushion to the wrists and hands. You can try proper fitted gloves with some gel protection, once again to give cushion and decrease vibratory force. The brand Brontrager also makes a bar end plug that helps with road vibration. Watch your hand position, try not to extend the wrist or smash the area around the pisoform bone and change your hand positions as often as possible.
So you have made the right changes to your bike and you find its time to see a doctor. You need to find someone with a background in sports or sports medicine. Because there is a chance, due to the lack of their experience, they may not give you the very best care. I will use my clinic as an example as to what procedure I feel should be taken. First, a detailed history and examination is preformed with details about the rider and bike. Most of the time I have the patient bring the bike into the clinic for evaluation, a criteria you may only find in a few clinics. After evaluation, if I suspect ulnar neuropathy I give the patient various options for treatment and recommendations. The hardest part is suggesting they rest, as many people have key events that they have trained for all winter and spring. For those special cases, we try to work out something based on the severity of signs and symptoms. Most case's typically resolve in 3 weeks with no residual issues after that. In other cases, an Electromyograpy (EMG)/Nerve Conduciton Velocity (NCV) test can be done in order to test the nerve and muscles of the hand to determine the extent of the injury. Some of my colleagues usually prescribe NSAIDS to decrease the inflammation, which works very well. I recommend aggressive treatment to the areas of injury with the use of Ice and heat for home care. In the clinic we will use some manipulation and joint mobilization techinques of the wrist in order to maintain proper biomechanics and decrease the chance of other issues like tendonitis and scar tissue formation. We will also use other modalities such as electric stimulation, ultrasound, low level laser, and soft tissue techniques.
There are other less conservative measures you can take such as injection of a steroid to the area of inflammation. I do not recommend this because we have found that it causes more problems. Although I have used a modality called Intophoresis, which is a way to get anti-inflammatory medications into the tissue through electrical impulses. This is done without puncturing the tissue and I have had better results. I always give home care instructions that included some basic stretching and rehabilitative exercises. In this case, self massage to prevent adhesions from forming in the area and proper use of ice and heat. Some people have also used vitamin B6 to help; however, all of the research I have read was based on carpal tunnel not ulnar neuropathy. B6 is an inexpensive vitamin and the adequate daily intake will not cause any tissue damage. An adequate dosage is around 250mg during treatment, which may be of some benefit.
Lastly, I find that most patients wait too long to receive a consultation. Do not wait! The earlier we start treatment the better. In addition, follow the 10% rule of cycling so your body's muscles, joints, and tendons have time to adapt to the workout. Never do a hard or long workout with new equipment, otherwise, you're kind of asking for it! Small changes or postitional errors can make big problems for the cyclist. In conclusion, your body adapts and makes small pshysiological changes so that over time it "conforms" to the bike.
I also instruct people not to get too depressed about the situation and watch their diet. I find that during the time of injuries, some athletes tend to gain weight and begin making poor food choices. Try using this time to enjoy time with family or friends that may have been neglected due to training and have some fun and begin fresh from your injury, ready to go!

Thursday, August 20, 2009

Baseball Pitching injury Study

Medical College study on pitching mound height provides insight into baseball injuries
23-Mar-2008 -- A study involving several Major League Baseball pitchers indicates that the height of the pitcher’s mound can affect the athlete’s throwing arm motion, which may lead to potential injuries because of stress on the shoulder and elbow.

The study was led by William Raasch, M.D., associate professor of orthopaedic surgery at the Medical College of Wisconsin in Milwaukee, who also is the head team physician for the Milwaukee Brewers. Major League Baseball funded the study in an effort to help prevent injuries among professional baseball players.

The results of the study were presented at the 2007 MLB Winter Meetings at the joint session of the Major League Baseball Team Physicians Association and Professional Baseball Athletic Trainers Society.

The researchers recruited 20 top-level, elite pitchers from Major League Baseball organizations and Milwaukee-area NCAA Division I-A college pitchers for the study, which was conducted both during 2007 spring training in Arizona and at the Froedtert & Medical College Sports Medicine Center in Milwaukee.

“Our researchers employed a motion analysis system using eight digital cameras that recorded the three-dimensional positions of 43 reflective markers placed on the athletes’ bodies. Then we analyzed the pitching motion at mound heights of the regulation 10-inches, along with eight-inch and six-inch mounds, as well as having the athletes throw from flat ground,” Dr. Raasch explains.
The study focused on determining if there is increased stress on the shoulder or the elbow based on the height from which the pitcher has thrown. A kinematic analysis provided information regarding pitching motion (position and velocity), while the kinetic analysis determined the forces and torques generated at the shoulder and elbow.

“We found that compared to flat ground, pitchers using a 10-inch mound experience an increase in superior shear and adduction torque in the shoulder – meaning there’s a greater amount of stress on the joint surface and surrounding structures. That greater stress may result in injury to the shoulder including tearing of the rotator cuff or labrum which may result in surgery and long-term rehabilitation. It also can make it difficult for the athlete to replicate the same throw and develop a consistent strike,” Dr. Raasch says.

“The most notable kinematic difference was the increase in shoulder external rotation at foot contact. This probably represents a change in the timing of the foot contact relative to arm position, because the foot lands earlier in the pitch delivery during flat ground throwing than with a slope,” he says.

While the study did not result in enough data to recommend reducing the 10-inch mound height, which became standard in 1968 and also used in college and high school baseball, Dr. Raasch says the findings give trainers information that can help them determine if pitchers would be better off practicing on flat ground especially after an injury.

“Nolan Ryan, who played major league baseball for 27 years, often threw pitches more than 100 mph, even past the age of 40, and he liked to throw on flat ground in his waning years. I think others might follow his lead,” Dr. Raasch says.

Check out some of the Video's from the study

1. Pitcher throwing
2.Computer Generated markers
3. Computer Generated markers with frame
4. Skeleton

Wednesday, August 19, 2009

Disc Degeneration in Athletes

Lumbar Intervertebral Disc Degeneration in Athletes
Mika Hangai, MD, PhD
Koji Kaneoka, MD, PhD
Shiro Hinotsu, MD, PhD
Ken Shimizu, MD
Yu Okubo, PT
Shumpei Miyakawa, MD, PhD
Naoki Mukai, MD, PhD
Masataka Sakane, MD, PhD
Naoyuki Ochiai, MD, PhD


Several studies have reported that physical loading related to competitive sports activities is associated with lumbar intervertebral disc degeneration. However, the association between types of sports activities and disc degeneration has not been clarified.

The frequencies of disc degeneration may vary with the competitive sport because of the different postures and actions specific to each sport.

Design Cross-sectional study (prevalence); Level of evidence, 3.
Methods Study participants were 308 well-trained university athletes (baseball players, basketball players, kendo competitors, runners, soccer players, swimmers) and 71 nonathlete university students (reference group). Disc degeneration was evaluated using T2-weighted magnetic resonance imaging. A self-reported questionnaire concerning low back pain was also conducted.

The proportions of the participants who had disc degeneration among the baseball players (odds ratio, 3.23) and the swimmers (odds ratio, 2.95) were significantly higher than among the nonathletes using logistic regression analysis. When all patients were grouped together, the association between lifetime experience of low back pain and participants with disc degeneration was significant, and a linear association between the degree of severest low back pain experienced and participants with disk degeneration, analyzed by a Cochran-Mantel-Haenszel test, was also significant.

Continuous competitive baseball and swimming activities during youth may be associated with disc degeneration. Furthermore, the study indicates that the experience of severe low back pain might be a predictor of disc degeneration in youth. The authors hope that preventive measures and management to protect against disc degeneration and low back pain in athletes will be established by further studies based on these results.

Monday, August 17, 2009

Anti-inflammatory Supplements

Two more studies on Inflamation and supplements mostly concerning cardiovascular health.

L-Arginine Exerts Anti-Inflammatory Effects
Reference: "Oral l-arginine supplementation improves endothelial function and ameliorates insulin sensitivity and inflammation in cardiopathic nondiabetic patients after an aortocoronary bypass," Lucotti P, Monti L, et al, Metabolism, 2009 July 8; [Epub ahead of print]. (Address: Internal Medicine Department, Cardio-Diabetes Trials Unit, Scientific Institute San Raffaele, 20132 Milan, Italy. E-mail: ).
Summary: In a randomized, double-blind, placebo-controlled study involving 64 patients with cardiovascular disease who previously underwent autocoronary bypass, supplementation with l-arginine (6.4 g/d) for a period of 6 months (in 32 of the 64 patients found to have a non-diabetic response to an oral glucose load), was found to decrease asymmetric dimethylarginine levels, decrease indices of endothelial dysfunction, and increase cyclic guanosine monophosphate, l-arginine to asymmetric dimethylarginine ratio, and reactive hyperemia. In addition, increases in adiponectin and the insulin sensitive index and decreases in interleukin-6 and monocyte chemoattractant protein-1 were also associated with l-arginine treatment. The authors conclude, "…insulin resistance, endothelial dysfunction, and inflammation are important cardiovascular risk factors in coronary artery disease patients; and l-arginine seems to have anti-inflammatory and metabolic advantages in these patients."

Omega-3 Fatty Acids Exert Anti-Inflammatory and Cardioprotective Effects in Hyperlipidemic Subjects
Reference: "Anti-inflammatory and cardioprotective effects of n-3 polyunsaturated fatty acids and plant sterols in hyperlipidemic individuals," Micallef MA, Garg ML, Atherosclerosis, 2009; 204(2): 476-82. (Address: Nutraceuticals Research Group, School of Biomedical Sciences, Faculty of Health, University of Newcastle, Callaghan, NSW, Australia. E-mail: ).
Summary: In a 3-week, randomized, double-blinded, placebo-controlled trial involving 60 hyperlipidemic subjects, supplementation with omega-3 PUFAs (1.4 g/d) plus plant sterols (2 g/d) was found to reduce several markers of inflammation. C-reactive protein reduced by 39%, tumor necrosis factor-alpha reduced by 10%, interleukin-6 reduced by 10.7%, leukotriene B(4) reduced by 29.5%, and adiponectin increased by 29.5%. Overall cardiovascular disease risk was reduced by 22.6%. The authors conclude, "We have demonstrated, for the first time that dietary intervention with omega-3 PUFA and plant sterols reduces systemic inflammation in hyperlipidemic individuals. Furthermore, our results suggest that reducing inflammation provides a potential mechanism by which the combination of omega-3 PUFA and plant sterols are cardioprotective."

Sunday, August 16, 2009

Physicians and nurses use and recommend dietary supplements: report of a survey

Physicians and nurses use and recommend dietary supplements: report of a survey


Numerous surveys show that dietary supplements are used by a large proportion of the general public, but there have been relatively few surveys on the prevalence of dietary supplement use among health professionals, including physicians and nurses. Even less information is available regarding the extent to which physicians and nurses recommend dietary supplements to their patients. Methods: An online survey was administered in October 2007 to 900 physicians and 277 nurses by Ipsos Public Affairs for the Council for Responsible Nutrition (CRN), a trade association representing the dietary supplement industry. The health professionals were asked whether they used dietary supplements and their reasons for doing so, and whether they recommend dietary supplements to their patients. Results: The "Life...supplemented" Healthcare Professionals Impact Study (HCP Impact Study) found that 72% of physicians and 89% of nurses in this sample used dietary supplements regularly, occasionally, or seasonally. Regular use of dietary supplements was reported by 51% of physicians and 59% of nurses. The most common reason given for using dietary supplements was for overall health and wellness (40% of physicians and 48% of nurses), but more than two-thirds cited more than one reason for using the products. When asked whether they "ever recommend dietary supplements" to their patients, 79% of physicians and 82% of nurses said they did.

Conclusion: Physicians and nurses are as likely as members of the general public to use dietary supplements, as shown by comparing the results of this survey with data from national health and nutrition surveys. Also, most physicians and nurses recommend supplements to their patients, whether or not the clinicians use dietary supplements themselves.

Wednesday, August 12, 2009

Quercetin The Lance Armstrong Supplement?

Ok I admit it I shamelessly used Lance Amrstong in hopes of getting more hits to my blog but everyone else does it so why not. Seriously though Lance's endorsement of FRS has lead to many questions about whats inside this energy boosting supplement and if it works at all.The key ingredent is Quercetin is a common chemical pigment in the rinds and barks of a wide variety of plants. It is one of the main flavonoids in the diet, and is found in large amounts in apple skins, onions, tea, and red wine. It is also found in leafy green vegetables, berries, and in herbs such as ginkgo and St. John's wort.Quercetin's anti-inflammatory activity appears to be due to its antioxidant and inhibitory effects on inflammation-producing enzymes (cyclooxygenase, lipoxygenase) and the subsequent inhibition of inflammatory mediators, including leukotrienes and prostaglandins.7,8 Inhibition of histamine release by mast cells and basophils also contributes to quercetin's anti-inflammatory activity.

Quercetin is available in higher amounts in dietary supplements than would typically be found in food sources. Supplements are sold as capsules or tablets ranging in doses from 50 milligrams (mg) to 500 mg. There is no recommended standard dose for quercetin. In FRS the amount is 325mg and they also add 85mg green tea extract and the RDI of several vitamins (B,E,C)

What most people don't realize is that this flavonoid has been around for a while and was orinaly linked to being a cancer producing compound but was later found to be unrelated. Plants containing flavonoids have a long history of use in traditional medicines in many cultures, but flavonoids themselves were not discovered until the 1930s. Quercetin first gained attention several decades ago when it was found to cause DNA mutations in bacteria, a sign that it might actually contribute to causing cancer. Animal research done since that time has been inconclusive, and what little evidence there is in humans does not seem to support this idea. Research in recent years has focused on several possible helpful effects of quercetin, including its potential role in preventing cancer.

I first read about Quercetin a few years back when I was making a pack of supplements for myself to take to help with overall health and recovery. My concept was based on the idea's of Dr. Dave Seaman and his idea that alot health problems are related to inflamation so I was putting together a pack of supplements that would act as an antioxidant and natural anitinflamatory. Quercetin has been study for its antioxidant properties as well as anti-inflammatory properties and I must admit that I have been impressed with the body of research that has been produced. At the time I did not add it to my pack because the manufacture did not have it available and I used many other bioflavanoids that have had a great deal of research on them as well. I am going to post 3 summary's that have been posted over the past few years that I find very interesting as it relates to Quercetin and its effect on athletes.

“Quercetin Increases Brain and Muscle Mitochondrial Biogenesis and Exercise Tolerance.” Am J Physiol Regul Integr Comp Physiol.2009. Davis et al., University of South Carolina.

A pre-clinical study examined the effects of 7-days of quercetin supplementation on markers of mitochondrial biogenesis. Results indicate that quercetin supplementation enhanced mitochondrial biogenesis - the production of cellular mitochondria - in the muscle and brain. This increase in mitochondria was associated with an increase in both maximal endurance running capacity (VO2max) and active involvement in physical activity with the mice being more willing to exercise.

“Dietary Antioxidant Supplementation Combined with Quercetin Improves Cycling Time Trial Performance.” International Journal of Sports Nutrition and Exercise Metabolism, 2006, 16, 405-419. MacRae and Mefferd, Pepperdine University.

An independent, double-blind, placebo-controlled crossover study on the effect of FRS on cycling performance in eleven elite cyclists showed a 3.1% improvement in time to complete a simulated 30km mountainous time trial when subjects consumed FRS for a 3 week period.

“Dietary Flavonoid Quercetin Increases VO2max and Endurance Capacity” International Journal of Sports Nutrition and Exercise Metabolism. Davis, Carlstedt, Chen, Carmichael, and Murphy, University of South Carolina .

An independent, randomized, double-blind, placebo-controlled, cross-over study showed that when 12 healthy, active (but not highly trained) men and women consumed 500 mg of quercetin (QU995™) in an enriched drink mix twice daily for 7 days, they experienced a 13.2 percent increase in ride time to fatigue (based on bicycle endurance capacity) and a 3.9 percent increase in VO2max (maximum oxygen consumption) .

In reviewing the's articles as well as others I must admit that most of the studies are invitro or animal studies but results suguste some interesting benefits I am very interested in the idea of increased mitonchondria production as this would also help many other none athele related issues. In looking at the pharmacokinetics Few human quercetin absorption studies exist. It appears that only a small percentage of quercetin is absorbed after an oral dose, possibly only two percent, according to one study. A recent study of absorption in "healthy" ileostomy patients revealed an absorption of 24 percent of the pure aglycone and 52 percent of quercetin glycosides from onions. However, no intestinal permeability values were obtained in this group, and thus the results might not be reliable. Quercetin undergoes bacterial metabolism in the intestinal tract, and is converted into phenolic acids. Absorbed quercetin is transported to the liver bound to albumin, where some may be converted via methylation, hydroxylation, or conjugation

Quercetin appears to be safe for most people when up to 500 mg twice daily are taken by mouth. It is not known if larger amounts might be safe. Quercetin can cause headache and tingling of the arms and legs. Very high doses might cause kidney damage.

Do not take quercetin if:

You are pregnant or breast-feeding.


Antibiotics (Quinolone antibiotics) interacts with QUERCETIN

Taking quercetin along with some antibiotics might decrease the effectiveness of some antibiotics. Some scientists think that quercetin might prevent some antibiotics from killing bacteria. But it's too soon to know if this is a big concern.
Some of these antibiotics that might interact with quercetin include ciprofloxacin (Cipro), enoxacin (Penetrex), norfloxacin (Chibroxin, Noroxin), sparfloxacin (Zagam), trovafloxacin (Trovan), and grepafloxacin (Raxar).

Cyclosporin (Neoral, Sandimmune) interacts with QUERCETIN

Cyclosporin (Neoral, Sandimmune) is changed and broken down by the liver. Quercetin might decrease how quickly the liver breaks down cyclosporin (Neoral, Sandimmune). Taking quercetin might increase the effects and side effects of this medication. Before taking quercetin talk to your healthcare provider if you take cyclosporin (Neoral, Sandimmune).

Medications changed by the liver (Cytochrome P450 2C8 (CYP2C8) substrates) interacts with QUERCETIN

Some medications are changed and broken down by the liver. Quercetin might decrease how quickly the liver breaks down some medications. Taking quercetin along with these medications that are changed by the liver might increase the effects and side effects of your medication. Before taking quercetin talk to your healthcare provider if you take any medications that are changed by the liver.
Some medications that are changed by the liver include paclitaxel (Taxol), rosiglitazone (Avandia), amiodarone (Cordarone), docetaxel (Taxotere), repaglinide (Prandin), verapamil (Calan, Isoptin, Verelan), and others.

Medications changed by the liver (Cytochrome P450 2C9 (CYP2C9) substrates) interacts with QUERCETIN

Some medications are changed and broken down by the liver. Quercetin might decrease how quickly the liver breaks down some medications. Taking quercetin along with these medications that are changed by the liver might increase the effects and side effects of your medication. Before taking quercetin talk to your healthcare provider if you take any medications that are changed by the liver.
Some medications that are changed by the liver include celecoxib (Celebrex), diclofenac (Voltaren), fluvastatin (Lescol), glipizide (Glucotrol), ibuprofen (Advil, Motrin), irbesartan (Avapro), losartan (Cozaar), phenytoin (Dilantin), piroxicam (Feldene), tamoxifen (Nolvadex), tolbutamide (Tolinase), torsemide (Demadex), warfarin (Coumadin), and others.

Medications changed by the liver (Cytochrome P450 2D6 (CYP2D6) substrates) interacts with QUERCETIN

Some medications are changed and broken down by the liver. Quercetin might decrease how quickly the liver breaks down some medications. Taking quercetin along with these medications that are changed by the liver might increase the effects and side effects of your medication. Before taking quercetin talk to your healthcare provider if you take any medications that are changed by the liver.
Some medications that are changed by the liver include amitriptyline (Elavil), codeine, flecainide (Tambocor), haloperidol (Haldol), imipramine (Tofranil), metoprolol (Lopressor, Toprol XL), ondansetron (Zofran), paroxetine (Paxil), risperidone (Risperdal), tramadol (Ultram), venlafaxine (Effexor), and others.

Medications changed by the liver (Cytochrome P450 3A4 (CYP3A4) substrates) interacts with QUERCETIN

Some medications are changed and broken down by the liver. Quercetin might decrease how quickly the liver breaks down some medications. Taking quercetin along with these medications that are changed by the liver might increase the effects and side effects of your medication. Before taking quercetin talk to your healthcare provider if you take any medications that are changed by the liver.
Some medications that are changed by the liver include lovastatin (Mevacor), clarithromycin (Biaxin), cyclosporine (Neoral, Sandimmune), diltiazem (Cardizem), estrogens, indinavir (Crixivan), triazolam (Halcion), verapamil (Calan, Isoptin, Verelan), alfentanil (Alfenta), fentanyl (Sublimaze), losartan (Cozaar), fluoxetine (Prozac), midazolam (Versed), omeprazole (Prilosec), lansoprazole (Prevacid), ondansetron (Zofran), propranolol (Inderal), fexofenadine (Allegra), amitriptyline (Elavil), amiodarone (Cordarone), citalopram (Celexa), sertraline (Zoloft), ketoconazole (Nizoral), itraconazole (Sporanox), and numerous others.

Medications moved by pumps in cells (P-glycoprotein Substrates)) interacts with QUERCETIN

Some medications are moved by pumps in cells. Quercetin might make these pumps less active and increase how much of some medications get absorbed by the body. This might cause more side effects from some medications.
Some medications that are moved by these pumps include diltiazem (Cardizem), verapamil (Calan, Isoptin, Verelan), digoxin (Lanoxin) cyclosporine (Neoral, Sandimmune), saquinavir (Invirase), amprenavir (Agenerase), nelfinavir (Viracept), loperamide (Imodium), quinidine, paclitaxel (Taxol), vincristine, etoposide (VP16, VePesid), cimetidine (Tagamet), ranitidine (Zantac), fexofenadine (Allegra), ketoconazole (Nizoral), itraconazole (Sporanox), and others.

So whats my take on the Lance Armstrong Supplement? Well its one of many bioflavanoids that help with inflamation and may very well be one that can cause an increase in mitochondrial production but we still need more research to get a conclusive answear to that question.
Athletic Performance Not Found To Be Enhanced By Popular Supplement Quercetin

Tuesday, August 11, 2009

Coenzyme Q10 Exerts Performance-Enhancing Effects in Sedentary Men

Coenzyme Q10 Exerts Performance-Enhancing Effects in Sedentary Men
Keywords: PERFORMANCE ENHANCEMENT, PHYSICAL ACTIVITY, ENERGY, FATIGUE, EXERCISE - Coenzyme Q10, CoQ10, Ubiquinone, Exercise, Ergogenic Aid
Reference: "The Effects Of Coenzyme Q10 Supplementation on Performance During Repeated Bouts of Supramaximal Exercise in Sedentary Men," Gökbel H, Gül I, et al, J Strength Cond Res, 2009 July 28; [Epub ahead of print]. (Address: Department of Physiology, Meram Faculty of Medicine, Selcuk University, Konya 42080, Turkey).

In a randomized, double-blind, placebo-controlled, crossover study involving 15 healthy but sedentary men, supplementation with 100 mg/d coenzyme Q10 for a period of 8 weeks was found to exert performance-enhancing effects during repeated bouts of supramaximal exercises. Subjects completed 5 Wingate tests with 75 g/kg body weight load, with 2 mins between tests, at baseline, after 8 weeks of coenzyme Q10 supplementation, and after 8 weeks of placebo supplementation. In both groups, peak power and mean power decreased and fatigue increased during the Wingate tests. During the Wingate test 5 (WT5), mean power increased after coenzyme Q10 supplementation, and not placebo. In addition, fatigue indexes decreased with CoQ10 supplementation; however, decreases in fatigue index were found with placebo supplementation as well. The results of this study led the authors to conclude that coenzyme Q10 may be beneficial as an ergogenic aid. Additional research is warranted.

Wednesday, August 5, 2009

Chiropractic in Baseball

A great article from Professional Baseball Athletic Trainers Society. See below...

Spring 2009 • Vol. 22 • No. 1

Influence of Czech Techniques: A Historical Perspective
Ken Crenshaw, ATC, CSCS, Head Athletic Trainer, Arizona Diamondbacks; Dr. Craig Liebenson, DC, LA Sports and Spine

As sports medicine becomes in¬creasingly specialized, athletic trainers entrusted with the care of Major League Baseball (MLB) players constantly work to stay on the cutting edge of prevention, treatment and rehabilitation. Surprisingly, the Czech Republic, a country not known for base¬ball, has a rich history of integrated sports medicine approaches and methodologies helpful in rehabilitating elite athletes. The exposure of Czech methodologies has influenced many MLB athletic trainers.

History of Czech Techniques
The emergence of Czech ideas within the United States is a direct result of the efforts of renowned practitioner Craig Liebenson, DC, owner of the LA Sports and Spine in Los Angeles. Several MLB teams are now using forms of the Czech methodologies in their programs as this rehabilitation innovation continues to increase in popularity.

As these practitioners have influ-enced many sports health professionals, a genesis of hybrid and integrated pro¬grams has emerged within athletics. This line of thinking has resulted in an integra¬tion of functional methodology within sports medicine and has positively influ¬enced many elite athletes competing at the collegiate and professional levels.

Alternative Thinking
The Czech School of Manual Medicine has revolutionized the management of musculoskeletal pain (MSP). Beginning in the early 1950s, two neurologists, Karel Lewit and Vladimir Janda, took a keen interest in the rehabilitation of the motor system. They had a strong commitment to manual modalities and focused on a patient’s medical history and physical examinations. While west¬ern medicine became progressively high-tech, Lewit and Janda realized the merits of osteopathy, chiropractic and neuro-rehab (e.g., PNF) as vital compo¬nents of rehabilitation. Lewit focused on joint dysfunction and the passive osteoligamentous struc¬tures, while Janda’s research pioneered a new direction in the assessment of faulty movement patterns and muscle imbal¬ance. To frame the object of their care, they coined the term “functional pathol¬ogy of the motor system.” This was in contrast to medicine’s growing emphasis on structural pathology as identified by myelograms, X-rays, CT scans and MRIs.

In a nutshell, Janda was one of the first individuals to realize that muscle imbalances seen in neurological diseas¬es were present in orthopedic patients. For example, children with cerebral pal¬sy (CP) have spasticity of flexors, ad-ductors and internal rotators. Similarly, adults who suffer strokes have paralysis of extensors, abductors and external ro¬tators. To that end, Janda proposed that orthopedic or MSP patients typically experience the presence of a postural syndrome, which includes a predictable pattern of tight and inhibited muscles. Janda was the first to name these pos¬tural syndromes (upper and lower crossed syndromes) and was the first to document the muscles that tended to be¬come tight or inhibited.

Subsequently, Janda developed a treatment program incorporating post-inhibitory stretching techniques for the tight, postural muscles and sensory-motor balance training to facilitate and stabilize the inhibited chain of phasic muscles. Because sedentary lifestyles serve as the main promulgator of these MSP syn¬dromes, reactivation through activity, such as increasing daily walking and reducing prolonged repetitive strain as¬sociated with excessive sitting postures, were recommended as preventive options.

Concurrent with Janda’s efforts to focus rehab on the quality of movement (e.g., coordination, balance, motor con¬trol) rather than the quantity (e.g., strength, sets, reps, resistance), Lewit innovated new and gentler forms of manipulation. He defined the source of restricted mobil¬ity as a “pathological barrier.” Next, he extended this barrier concept from joints to other mobile structures such as muscles, fascia and even skin. Lewit refined meth¬ods from osteopathy and physical therapy making them more physiological. For in-stance, he showed how both respiratory and visual synkinesis could be utilized to enhance the “release” of tissue tension at the barrier.

A third Czech neurologist, Pavel Ko¬lar’s work represents a new and powerful window to the central nervous system’s control of movement. It is grounded in developmental kinesiology with integra¬tion into manual medicine and reflex lo¬comotion, whereas Janda’s emphasis was on how a sedentary environment pollutes our motor patterns and posture. These two complementary approaches give us an extremely powerful assessment and treatment approaches for subtle, motor control dysfunction that predisposes to MSP and injury. Kolar has now shown how to intervene at the deepest possible level to activate neurally driven, func¬tional muscle chains. Kolar has extended Vaclav Vojta’s (another Czech neurolo¬gist of Lewit and Janda’s generation) work from the neurologically impaired child to the healthy adult with MSP or the elite athlete. Kolar has shown how subtle neuro-motor deficits are genetically pre-determined in as many as 30% of our healthy population including elite ath¬letes. Using reflex techniques (Vojta’s Reflex Locomotion) developed for acti¬vating “hard-wired” normal patterns in CP children, Kolar has utilized these same methods to reboot the body’s stabil¬ity patterns in sedentary patients or ath¬letes suffering from overuse syndromes. This also helps speed recovery from in¬jury, rehabilitate function and enhance performance.

Expanding Techniques
The Czech School of Manual Medi¬cine’s influence on all modern research¬ers in the MSP field has been significant. Local, segmental treatments of individu¬al muscle and joint dysfunction is still a common treatment of chiropractors, massage therapists, physical therapists, athletic trainers and other manual thera¬pists. Thanks to the Czech clinicians, therapists are now beginning to look for the predictable patterns of dysfunction that link these individual tissues into functional chains. Janda’s work has had far-reaching diagnostic implications for focusing all clinicians on how to find the key chain of dysfunction. And, now due to Kolar’s applications that access the central nervous system program, opti¬mal movement patterns are within the grasp of every clinician or therapist.


I would personally like to acknowledge Dr. Liebenson’s help in writing the his¬tory involved in this article and also thank him for opening my mind to Czech ideas.

Tuesday, August 4, 2009

NFL Injury Report: Carlos Rogers Calf injury

Carlos Rogers has missed a few practices and sits under the Trainers tent rehabbing and "keeping lose" a Calf injury that he sustained. Calf injuries are very difficult to gauge and without an examine I am hard pressed to give an idea of when he will be able to practice. When you have an ACL injury you are going to have altered biomechanics after it heals. So some times the Calf and Achilles tendon can get overworked. I think he will be fine in the end as long as it not his tendon.

NFL Injury Report: Albert Haynesworth Knee injury

Albert Haynesworth received an injection Sunday to "help cushion" his left knee.
It's the same knee Haynesworth sprained late last season with the Titans.

Albert Haynesworth assured reporters Monday that the knee he's been needing injections in at Redskins camp isn't badly injured.
"It's not serious," Haynesworth said. "If I had to play today, I could." It sounds like he's day to day and the Skins are just taking necessary precautions.
Source: Washington Post

Looking at this case in my opinion the Redskins are going to have some issues with injuries with Haynesworth. Why? Because at 28, 6'6" and 320lbs he is already predisposed to Degenerative Arthritis all over his body and this is the second issue with the knee and to me it sounds like he is getting synvisc injections something we use in sports medicine for Degenerative issues of the knee.(That will not go away) It will act as a cushion and I will bet good money that they drained his knee and also used cortisone injection to decrease inflammation. That type of knee injury will always be waiting to sprout up again even after he passes this acute phase of healing. I don't think I am on a limb when I say he will have various issues with his knee and back that will take him out of the season. Don't expect him to play full season (not great when you spend 100 million on a guy)

Monday, August 3, 2009

Acupuncture and Neck Pain

Electrical Stimulation on Acupuncture Points of the Wrist May Reduce Neck Pain

Keywords:NECK PAIN, CHRONIC PAIN - Acupuncture, Chinese Medicine, Traditional East Asian MedicineReference:"Electrical acustimulation of the wrist for chronic neck pain: a randomized, sham-controlled trial using a wrist-ankle acustimulation device," Chan DK, Johnson MI, et al, Clin J Pain, 2009; 25(4): 320-6. (Address: Hong Kong Acupuncture and Physiotherapy Pain Center, Hong Kong SAR, Hong Kong Special Administrative Region, China. E-mail: ).

Summary:In a randomized, single-blind, sham-controlled trial involving 49 patients with chronic neck pain, electrical stimulation of acupuncture points on the wrist (traditionally used in Chinese medicine to treat neck pain) in addition to neck exercises was found to be more effective than neck exercises alone in alleviating chronic neck pain. Subjects received real electrical stimulation or sham stimulation for 30 minutes, 2 times/week, for a period of 4 weeks. Simultaneous with the stimulation, 30 minutes of standardized neck exercises were performed. Immediately post-treatment and one month post-treatment significant improvements were found among the patients who received electrical stimulation. 39% of subjects in the acupoint electrical stimulation group reported a greater than 50% decrease in symptoms, as compared to only 8% in the sham treatment group. These results suggest that adding electrical stimulation to acupuncture points on the wrist may enhance the ef fects of neck exercises and reduce chronic pain, without producing any adverse effects. Receiving treatments twice/week for a period of one month was found to yield beneficial effects that lasted at least through 1-month post-treatment.

Saturday, August 1, 2009

Tyler Hansbrough Shin Injury

The Indiana Pacers surprising #13 first-round draft pick, Tyler Hansbrough, may miss up to 2 months with a shin injury. Sources say that Hansbrough will be ready for the beginning of the season. Here's the article from Yahoo! Sports...

Shin injury may sideline Hansbrough for 2 months

INDIANAPOLIS (AP)—Tyler Hansbrough(notes) could miss up to two months with a right shin injury, but the Indiana Pacers believe their first-round draft pick will be healthy enough for the start of the season.

The Pacers did not provide details of the injury Friday other than to say the 6-foot-9 forward is expected to miss six to eight weeks ahead of the season. The NBA regular season begins Oct. 27.

Indiana said Hansbrough hurt the shin last season, his final year at North Carolina.

The Pacers took Hansbrough at No. 13 overall in last month’s draft and signed him to a three-year contract.

Hansbrough led the Tar Heels to the national championship last season and finished his career as the ACC’s career scoring leader.