Saturday, August 19, 2017

Can Sports Injuries Lead to Osteoarthritis In Your Joints?


Picture by Liji Jinaraj from Flickr
The first question I get always get asked when an injured athlete sees me in our clinic is "How quickly can I get back to training?"

Actually it's not just the athletes, every single weekend warrior or physically active patient that I see will ask when they can get back to their usual activity or exercise.

I'm guilty of doing the same. That's exactly what I asked my doctor after my bicycle accident.

There is now evidence to show that if you rush to get back to playing, whether as part of a team or elite sport or simply just your usual weekly recreational tennis game or jogging you may not allow the injured joint to heal fully.

Adequate recovery includes strengthening the structures the support the injured joint. This will allow joint stability to reduce risk of re-injury and stave off irreparable joint damage. If you're not careful, irreparable joint damage can eventually lead to post traumatic osteoarthritis (OA).

OA is a degenerative joint disease. It happens when the protective articular cartilage lining the surfaces of bones wear out. This causes pain, stiffness, swelling and often disability that diminishes one's quality of life.

Post traumatic OA don't just happen to older patients. It can affect adolescents or young adults too.

Researchers suggest that acute joint damage can lead to a deterioration of the surface of the bone itself and structures that cushion and stabilize bones of a joint like the knee (Anderson et al, 2012).

That same study found that OA can develop in more than 40 percent of people who seriously injure their ligaments, the meniscus in the knee or articular surface of a joint.

They also found that people with a history of knee trauma are three to six times more likely to develop knee OA.

In order to better manage post traumatic OA, a group of Athletic Trainers (ATC) has suggested a more aggressive approach to both preventing and managing post traumatic OA. Especially in younger patients who get injured playing sports.

They suggested that having less deficits (between both legs) in muscle strength, endurance, balance movement quality and stability will reduce a person's risk of getting injured. After the initial injury, it should be properly managed to prevent additional injuries to the same joint or other joints to minimize OA developing. Ideally a structured rehab program should be maintained for six to nine months.

So don't be too impatient to return to your usual physical activity especially after a joint injury. You may have to modify the activities you do in order not to place unnecessary repetitive stress on the injured joint. Remember our articular cartilage likes and needs weight bearing forces for nutrition. Inactivity will cause the articular cartilage to deteriorate.


References

Anderson DD, Chubinskaya S, Guilak F et al (2012). Post-traumatic Osteoarthritis: Improved Understanding And Opportunities For Early Intervention. J Ortho Res. 29(6): 802-809. DOI: 10.1002/jor.21359

Palmeri-Smith RM, Cameron KL, DiStefano LJ et al (2017). The Role Of Athletic Trainers In Preventing And Managing Post Traumatic Osteoarthritis In Physically Active Populations: A Consensus Statement Of The Athletic Trainers' Osteoarthritis Consortium. J Athl Train. 52(6): 610-623. DOI: 10.4085/1062-6050-52.2.04.

Friday, August 11, 2017

Don't Drink The Pool Water!


During the last couple of days over National Day, we took a family staycation at the Goodwoodpark Hotel. I ended up spending lots of time in the pool with my two boys as you can see in the picture above. Probably ended up drinking some too.

Not the greatest thing to do if you read what Canadian researchers found when they tracked two public pools for three weeks. Olympic swimmers have admitted doing it and now evidence shows that the rest of the general public are doing it too.

Doing what? Peeing in the swimming pool that's what!

The researchers tracked the concentration of an artificial sweetener, acesulfame potassium (ACE), which is found commonly in processed food and passes through our bodies unaltered. Great for the researchers if you happen to eat processed food and pee in public pools.

By tracking ACE levels, the researchers calculated that swimmers released 75 litres of urine (enough to fill a medium sized dustbin) in the first public pool (830,000 litres, about one-third the size of an Olympic pool).

There was 30 litres of urine in the second public pool, which was around half the size of the first pool over this two week period.

The research team sampled a total 31 different swimming pools and eight hotel jacuzzi hot tubs in two Canadian cities. ACE was present in 100% of the pools and hot tubs!

Number of pool visitors were not monitored, but the results also suggested that urine content in the pool was added several times each day.

If you thought that the pool readings were bad, measurement in the eight jacuzzi hot tubs were much higher. One particular hotel jacuzzi had more than three times ACE levels than the worst swimming pool.

Just so you know, urine is sterile, but the compounds in urine (urea, ammonia and creatinine) can react with pool disinfectants cause eye and respiratory irritation. Long term exposure to these compounds has been linked to asthma.

The results were not surprising as another anonymous survey showed that 19% of adults polled admitted to having urinated in a swimming pool at least once. Professional swimmers have confessed to being among the worst offenders.

Have you ever peed in a swimming pool? Hmmm, let me ask Jo Schooling when he next comes and sees me in the clinic.


References

Blackstock LKJ, Wang W et al (2017). Sweetened Swimming Pools And Hot Tubs. Environ Sci Technol. 4(4): 149-153. DOI: 10.1021/acs.estlett.7b0043.

Wiant C (2012). New Public Survey Reveals Swimmer Hygiene Attitudes And Practices. Int J Aquatic Research Edu. 6(3): Article 4. http://scholarworks.bgsu.edu/ijare/vol6/iss3/4.

Researchers Lindsay Blackstock and Xing Fang Li testing for ACE

Saturday, August 5, 2017

Joseph Schooling At Sports Solutions

Jo at Sports Solutions
For the past few days, our staff were already talking about taking pictures with him when they saw his name booked in for an appointment in our clinic today.

I was treating another patient when Jo arrived, so Jo went to see Aized for his appointment. My next patient was running late so I went to say hello to Jo. Aized said the first question he asked was "Where's Uncle Gino?"

Yes "Uncle Gino" is what Jo still calls me. We used to swim together from 2004 until early 2008 when we were both swimming at the Center of Excellence (COE) under coaches John Dempsey,  Au Yong Kim Moon and Herbert Yu. I used to treat all the swimmers there including Jo.

That was my agreement with head coach John Dempsey. He would allow me to swim with the COE swimmers (while I was still training for triathlons) on the condition that I treat all the swimmers who needed help.

In fact I first treated him at a swim meet in Kuala Lumpur, Malaysia in 2004. Jo used to kick my behind in the pool even when he was nine years young!

Great seeing you today Jo! As Aized said, our pleasure and honor to be treating you when you're home.

Saturday, July 29, 2017

Rhabdomyolysis - The Scary Side Effects Of Exercise


My patient just attended her first spin class with her colleagues. Prior to this, she's been running and wakeboarding for exercise.

The doors to the studio were shut, while the air conditioning was turned off. Other than that, she didn't find pedaling fast on the stationary bike to rhythms of popular music while an instructor shouted motivation too difficult. Neither did she feel she pushed herself too hard. Her legs at the end of the hour long class weren't too sore or wobbly afterwards.

Over the next two days, her legs started throbbing and she came into the clinic to see me. I noticed bruises on her thighs and asked if she knocked them against the stationary bike. She said she didn't recall that happening.

The next day she noticed blood in her urine and checked herself into a hospital where she was warded and after blood and urine tests and was told her she had rhabdomyolysis.

Rhabdomyolysis is rare but can be a life threatening condition often caused by extreme exercise. It occurs when muscles that have been overworked dies and leak their contents into the bloodstream. This strains the kidneys and can cause severe pain.

My patient ended up staying in hospital for a few days before being discharged and has since recovered.

Subsequently I saw an article that documented three unusual cases of rhabdomyolysis, each occurring after a first spin class all treated by the same doctors (Brogan et al, 2017).

The article also described 46 other cases of people developing rhabdomyolysis after a spin class (42 of them in people taking their first spin class). The authors wrote that the condition was rare and not a reason to avoid high intensity exercise.

Another published study found 29 cases admitted to the emergency department between 2010-2014 for exercise induced rhabdomyolysis. Weight lifting, running, cross fit were some of the causes, but the most common cause was spinning classes!

The patients were not unfit, they were in fact being pushed too hard. Since they were not used to the new exercise, they ended up getting really bad muscle trauma.

Remember this next time you try a new exercise. Rhabdomyolysis occurs when you do not give your muscles time to adjust to a new aggressive exercise. When you stress your muscles too much, they tend to break down, releasing contents like myoglobin into your bloodstream which causes brown or tea colored urine, a classic symptom of rhabdomyolysis.

While any intense activity can cause rhabdomyolysis, it almost always strikes the person doing something new. So when you try a new exercise, start moderately first.

Know your limits, don't be pressured by the instructor. You can stop the exercise if you're struggling. Exercise can be dangerous when your body is not prepared for really intense levels.


References

Brogan M, Ledesma R et al (2017). Freebie Rhabdomyolysis: A Public Health Concern, Spin Class-Induced Rhabdomyolysis. AJM. 130(4): 484-487. DOI: 10.106/j.amjmed.2016.11.004.

Cutler TS, DeFilippis EM et al  (2016). Increasing Incidence And Unique Clinical Characteristics Of Spinning-induced Rhabdomyolysis. Clin J Sp Med. 26(5): 429-431. DOI: 10.1097/JSM.0000000000000281.

Here's a picture of a spin class.

Picture from Soulcycle.com

Friday, July 21, 2017

Will The Real Athletes Please Stand Up?

Written by Rachel Wong.

Bella Hadid's picture from Nike 
Just last month, Nike announced that fashion model Bella Hadid would be the face of its previously popular Cortez sneaker, designed in 1972 for runners. If you're an older runner you will remember the Cortez, after all even Forrest Gump used it for his runs.

Picture from Sneaker news
The Cortez is being re-released as a fashion/ lifestyle sneaker. This follows a series fashion models being chosen to front the campaigns of other sportswear brands - Kylie Jenner (Puma), Karlie Kloss (Adidas) and Gisele Bundchen (Under Armour) just to name a few.

Naturally, some professional athletes have picked up on this and commented against this trend.


As a female football player myself, I think it is completely fair that people are upset that the big sporting companies are choosing to hire fashion models (instead of female athletes) to front the advertising campaigns.

It highlights the differences the way marketing is done in female sports. Emphasis is often placed on how good the women look rather than how well they perform, and women's sports are viewed as less prestigious.

Female athletes definitely do not get the same recognition and endorsement opportunities compared to their male counterparts. Not featuring female athletes in major advertising campaigns also perpetuates this problem as the wider population miss out on seeing more female athletes.

After all, most if not all sports brands instantly opt for professional male athletes in their advertising campaigns. Nike previously used Michael Jordan and now Lebron James for its basketball ads while Puma uses Usain Bolt. Why not the same for females?

However, it is not surprising that Nike (and other sporting brands) choose to use these fashion models with their massive social media presence guaranteeing a broader reach. The target audience is also different today - more people are wearing their sneakers as part of a fashion statement and not for exercise. I suppose from a business/ profit making point of view, this is justified.

Occasionally, these companies do get it right. Misty Copeland (ABT ballet dance), Simone Biles (Olympic gymnast), Ronda Rousey (UFC fighter), Annie Thorisdottir (crossfit) and even the USA women's soccer team have broken into the male-dominated world of sports endorsement deals.

Hopefully these big sporting brand names start to understand the value of real-life athletes to their consumers. I feel that the authentic stories of female athletes, rising above the pressures of their circumstances and beating the odds, are so much more powerful than looking good in whatever apparel they are marketing.

Seeing this will definitely attract my attention, and I might end up buying more clothes and shoes I don't need? :) Nike are you listening?


Friday, July 14, 2017

How Healthy Are Elite Athletes?

Taken with my iPhone off my computer from Cyclingnews.com
Compared to most people in the general population yes, elite athletes are very healthy if you read the article by Lemez et al (2015). However, this is a controversial topic that has been debated for years by athletes themselves, coaches and researchers.

I'm sure you've watched the riders at the Tour De France or the athletes competing at the Olympics. At these competitions, they usually rested and focused, look lean, powerful, slick and bursting with energy.

Can you guess how much it took for them to get there? All the grueling training and obsessive dedication required to reach those levels. Is at good for them? Will that pursuit of sustained excellence damage their health?

The answer depends on how you define health and who you compare elite athletes to.The findings from the comprehensive review on mortality and longevity in elite athletes is very clear. Elite athletes fare better than everyone else when it comes to longevity and disease if you define health as "the absence of disease and the capacity to enjoy life and withstand challenges."

That article by Lemaz et al (2015) examined more than 450, 000 athletes and found that elite athletes live four to eight years longer when compared to an equally matched control group in the general population.

Athletes who competed in running, cycling, soccer and swimming (sports with high aerobic demands) had the greatest benefits. Those athletes have lower rates of heart disease, stroke and smoke related cancers. The Tour de France cyclists for example have a 40 percent lower mortality rate than non athletes.

See how skinny he is (taken from Cyclingnews.com)
The other element of health is psychological, the question of enjoyment in life. That is difficult to quantify and answer.

Some studies show that elite athletes have better mental health after their retirement from elite sports. This may be due to the resilience they developed while competing or that exercise itself (trumps medication when treating depression).

However, other studies show comparable rates or even potentially increased risk for mental health issues. This is actually also dependent on the support the elite athletes received during their athletic career and early retirement (Rice et al, 2016).

Similar to an overworked doctor in the emergency department, corporate lawyer or investment banker, elite athletes often put into situations that require them to sacrifice a lot for their mind and body.

The best endurance athletes will push their bodies and their minds as far as humanly possible and this may not be good for them. If not controlled, that very same drive and determination that propels the elite athlete can eventually become harmful.


References

Lemez S, Baker J et al (2015). DO Elite Athletes Live Longer? A Systematic Review Of Mortality And Longevity In Elite Athletes. Sports Med Open. DOI: 10.1186/s40798-015-0024-x.

Rice SM, Purcell R et al (2016). The Mental Health Of Elite Athletes: A Narrative Systematic Review. Sports Med. 46(9): 1333-1353. DOI: 10.1007/s40279-016-0492-2.

Monday, July 10, 2017

Rise In Singapore Teenagers' Use Of Steroids?

"Muscular kids" gym bound at Holland V MRT today
I was a little annoyed with myself when I saw the Channel NewsAsia (CNA) headline on their website this morning.

I actually read about a similar report in the Journal of the American Medical Association (JAMA) just two weeks ago and was going to write about it but I got sick last week and didn't write it yet. So CNA beat me to it. 

Well, my wife told me the journalist (from CNA) does this for a living, whereas I am just a Physiotherapist. So it's already good I have the ideas (but not the time to write it). Grrrrrrr, guess I have to blame it on the fact that our whole family fell sick recently. 

Next time .....

So what does an American journal finding got to do with our local youths?

Well, ever since Holland village has sprouted three gyms, I've noticed a lot more "muscular kids" walking around. Yes, we do have three gyms right here in Holland Village. First F45 set up shop, followed by Ritual gym  and then Virgin Active opened it's doors recently.

Similar to the American article, it may be a widespread misconception that anabolic steroids is only an issue in elite sports. Both the American article and the Channel NewsAsia article suggest that there may be more anabolic steroid users among our teenagers. The Jama article suggest that "most young men using these drugs are doing it to improve their appearance."

Personally, I don't think it's a new problem. I've definitely had cases of teenage bodybuilders and young adults see me in our clinics for sports injuries (and telling me in strict confidence of course) that they've been injecting themselves with anabolic steroids. And that's all I'm gonna say.


Reference

Pope HG Jr, Khalsa JH et al (2017). Body Image Disorders And Abuse Of Anabolic-Andrrogenic Steroids Among Men. JAMA. 317(1): 23-24. DOI: 10.1001/jama.2016.17441