Original Equipment or Rebuild?

http://online.wsj.com/article/SB10001424052748704004004576270844211718806.html?mod=WSJ_article_RecentColumns_HealthJournal
I get excited reading these kinds of articles.  I hope it'll be another 15 years until I "have" to get something done for my knee, but fortunately for me, there are enough folks out there with wrecked knees and insurance (or cash) that the market for rebuilding joints is driving innovation and better solutions seemingly by the year.

One thing all these folks would benefit from both before and after surgery is to work on functional movements, learning and re-learning how to feel and utilize their musculature in ways they may not have since their injury.  Runners in particular are notoriously deficient in range of motion and hip/hamstring/glute development - this is not a good thing.  One friend I know who trains in a unique but intense and functional ways commented on finding his hamstrings after years of atrophe.  After a knee replacement surgery, this former D1 football player said "I felt my hamstrings firing for the first time in years!"  I think that bodes well for his future.


Joint-replacement patients these days are younger and more active than ever before. More than half of all hip-replacement surgeries performed this year are expected to be on people under 65, with the same percentage projected for knee replacements by 2016. The fastest-growing group is patients 46 to 64, according to the American Academy of Orthopaedic Surgery.
Many active middle-agers are wearing out their joints with marathons, triathlons, basketball and tennis and suffering osteoarthritis years earlier than previous generations. They're also determined to stay active for many more years and not let pain or disability make them sedentary.
To accommodate them, implant makers are working to build joints with longer-wearing materials, and surgeons are offering more options like partial knee replacements, hip resurfacing and minimally invasive procedures.
More younger people also need joint-replacement surgery due to obesity, and some orthopedists refer them for weight-loss surgery first to reduce complications later.
Even the most fit patients face a long period of rehabilitation after surgery and may not be able to resume high-impact activities.
"There is, to be honest, some irrational exuberance out there," says Daniel Berry, chief of orthopedic surgery at the Mayo Clinic in Rochester, Minn., and president of the American Academy of Orthopedic Surgeons. "People may be overly optimistic about what joint replacement can do for them."

How to Think About Training

This is a great comment from Robb Wolf's blog, that illustrates the way to think about training and injury.  BLUF: there's no free lunch.  There's certainly some risk of injury (the largest risk is a slight injury with moderate pain and a short rehab period; risk of catastrophic injury is very low, far lower for example than playing competitive sports), but there's also risk of injury if one does not train.  We see every day the virtual certainty of loss of function through weakness - it's such a certainty, it's not correct to call that outcome a risk!  It simply will happen if one does not train in functional movements, thereby preserving the strength in the muscles that allow our bones to bear our weight and support or movement as they are designed to do.

The writer is Dallas Hartwig, whom I've had the pleasure of meeting, and I respect his expertise greatly, even if I see fitness from an every so slightly different perspective. 

"Let me throw my comments out there regarding spinal degenerative conditions, specifically degenerative disc disease (DDD). Since the client in question is an active duty police officer (can I jump on her patrol car?), I'm going to assuming she's 50 or under, just for the sake of discussion. Given that I don't have any real info about her, I'm also going to assume that she doesn't have any history of spinal surgery, spinal trauma, overt instability of the spine, or compressive neurological conditions/symptoms. Lots of people have degenerative changes (often inaccurately lumped under the general term of "arthritis") in their spines and have no symptoms, but even if she has some spinal pain from degenerative changes of the discs or vertebrae, there's no reason that she can't still continue to train for her physical fitness test. As people age (or simply abuse their spines with poor postures and insufficient muscular strength to stabilize their spine under load or at velocity), the discs, which act as "cushions" between the vertebrae, can become drier and more brittle, and can actually become substantially thinner as part of this "drying out" process. This means that there is less space between the vertebrae, and can cause pain in a couple indirect ways (one of which is shifting more of the compressive load to the facet joints between the vertebrae). But for this discussion, let's mostly talk about what the trainer who sent in the question could/should actually do with this client to help her prepare for her fitness test (and the rest of her life!). As already mentioned, it's totally okay to work on big, heavy movements with clients like this, but maintaining a neutral spinal position during any of the movements is extra, extra important for them. One of the worst things you can do for a disc (especially one that is already less than bombproof) is to change spinal position under load, i.e. loss of lumbar lordosis at the bottom of a squat, lumbar hyperextension at the lockout of a DL, etc. So pay special attention to the quality of movement, and realize that you may have to dial down the intensity for a while to really dial in the technique. (I wrote about this on our Whole9 site: http://whole9life.com/2010/01/client-or-patient/ ) The other thing I'll comment on is shock absorption strategies, since additional impact on an already compressed and/or irritated disc or facet joint (especially with suboptimal positioning) can really fire things up. I'd look at her footwear and running technique, because the long-stride-and-monster-heel-impact kind of running, especially with poor hip strength or funky foot mechanics, can really transmit impact from the ground up to the back, and that can be distinctly un-fun for your client. So maybe get her working on a POSE-type running pattern with less impact, though I wouldn't steer most people towards Five Fingers-type footwear just yet. Also, think twice before prescribing high-rep box jumps, depth jumps, double unders, long runs, or other higher impact activities unless the client is pretty damn strong and good at keeping good spinal and lower extremity positioning when doing these things. At least for now, while prepping for her fitness tests, teach her how to maintain midline stabilization (neutral spinal position) with a variety of big, strong movements, and avoid the long, high-rep metcons that in my observation end up degrading into a whole pile of ugly movements in the name of "intensity" (Read: http://whole9life.com/2009/12/beware-the-lure-of-the-sexy-met-con/ )
Dallas

http://robbwolf.com/2010/03/02/the-paleolithic-solution-episode-17/

Diabetes Linked to Cognitive Decline

"Diabetes can take a toll on the body, taxing the heart, circulation, the kidneys and even the eyes. Now it's becoming clear that the disease may affect the brain as well, contributing to a decline in mental functioning.

Studies have shown that diabetes may speed up aging-related deficits in mental function and lead to a twofold increase in the risk of dementia. Some researchers have speculated that diabetes could even boost the risk of developing Alzheimer's disease. Roger Dixon, a psychologist at the University of Alberta in Canada, wanted to learn whether this was true and set out to study exactly how uncontrolled blood sugar affected the brain.

Dixon and his colleagues studied 41 adults with diabetes and 424 healthy adults between the ages of 53 and 90, and reported their findings in the journal Neuropsychology. After testing the participants on memory, recall, verbal fluency, executive functions involving critical thinking and the speed of their mental faculties, researchers found the most significant deficits in diabetes patients on tasks of executive function and speed. These problems showed up in the youngest patients as well as the older ones, and once the cognitive symptoms appeared, they did not seem to worsen or change over time. Although Dixon's study failed to add new information on the question of diabetes and Alzheimer's disease, other experts view these results as useful fodder in the growing field of diabetes research.

"This study in general supports what we understand," says Dr. Alan Jacobson, chief of psychiatric services at the Joslin Diabetes Center in Boston. "It's another study adding to our recognition that Type 2 diabetes portends some type of problem in terms of cognitive function."

Earlier this week, another group of researchers, from Columbia University, reported in the journal Annals of Neurology that spikes in blood-glucose levels affect a region of the brain that forms memories and can lead to faster memory decline in people with diabetes.

Exactly how diabetes is associated with cognitive deficits isn't clear, but there is evidence suggesting that certain areas of the diabetic brain — such as the amygdala, which processes emotions, and the hippocampus, which is related to memory — are smaller than normal, a difference that may affect learning and recall of information. Early studies have even suggested that these physical differences may also predict Alzheimer's disease. While Dixon's study did not find a difference between the diabetes patients and controls on memory skills, Jacobson says the connection between the two diseases is an area of intense research.

As more people develop Type 2 diabetes in adulthood — diabetes has been diagnosed in 20% of American adults, and the vast majority have Type 2 — "more and more people are going to show significant cognitive problems," says Jacobson. "This whole area of research is going to be one of considerable importance in coming years." And studies like this one remind us that conditions like diabetes have wide-ranging effects throughout the body — and that we have only begun to pick apart some of these network connections."

Read more: http://www.time.com/time/health/article/0,8599,1869815,00.html#ixzz0eimOiUmG

How to GH Raise by Tate

This one of the most highly recommended movements for powerlifters who desire to boost their lifts.  The focus is on the hamstring.  This sort of isolation movement is not common in CF, but would add a potent variant to your arsenal - and who wouldn't benefit from stronger hams?  Use it in your warm up, if nothing else.
http://www.elitefts.com/documents/glute_ham_raise.htm#

How to do a standard GHR

"To do a GHR, you'll start with your body in a horizontal position on the bench with your toes pushed into the toe plate. Your knees will be set two inches behind the pad and your back will be rounded with your chin tucked. You then push your knees into the pad and curl your body up with your hamstrings while keeping the back rounded. As you approach the top position, squeeze your glutes to finish in a vertical position."

Sprained your ankle? Here's 'DIY' rehab

http://well.blogs.nytimes.com/2009/07/08/how-to-fix-bad-ankles/?pagemode=print

What an awesomely simple approach - practice standing on one leg to rehab a sprained ankle. Wish I had known this when I used to frequently sprain my ankles - have not repeated that injury since I began CF.