Podiatry Management (October, 2010) has just published an article I’ve written titled Overuse Injuries: All The Small Things . You are just another click away from the PDF version. This is a challenging article. It introduces mechanotransduction, a theory of cellular and tissue function, which is little known in the sports medicine community. The article touches lightly on this topic and then reviews the latest literature and theory on overuse injuries to bone and tendon.
The Needle - Kenneth Snelson
The cellular level is where things start and where we will find many answers. I expect to add more details on the web site on mechanotransduction and mechanobiology for those with hardcore, deep science interest. The article is limited in size, but was longer than many published in PM Magazine. But, I didn’t even touch on the theory canalicular flow and osteocyte induction or mechanotransduction and control of stem cell development by matrix stiffness. Research in the field of mechanobiology is growing daily and the outlook is great that it will be fruitful.
Bipedalism (walking upright on two limbs) in hominids is considered a logical and efficient means of locomotion arrived at via hundreds of millions of years of evolution. At the newly instituted PLOS group of blogs a thorough post appearing on the newly moved blog Neuroanthropology describes Turkish individuals who are quadripedal and exhibit what is called Uner Tan Syndrome (UTS). There is some conjecture on the cause of this condition and on whether or not it is evolutionary atavism.
Human Quadrupeds
This syndrome was first discovered in 2005 by Üner Tan of Cukurova University in Turkey who is also a member of the Turkish Academy of Sciences.
I note that the quadripedal humans seem to be scurrying along at a fair clip. They are not wearing any coverings on their hands. From the photo it is difficult to determine what they wear on their feet. The video below does show some foot gear. At least some of the quadrupedal humans seem to have the forelimb contact on the heel of the hand, but others may contact further foreward. I’m sure this will be looked at closer. Evolutionary analysis and better coaching may lead to improved 4 limb locomotion for these individuals. So far I have not come across any reports of any quadrupedal long distance endurance events.
This does appear to be a real syndrome however and the blog describes the symptoms and results of MRI and PET scans on subjects. The findings include:
“signs of cerebellar dysfunction including: intention tremor, dysdiadochokinesis (inability to execute rapidly alternating movements particularly of the limbs), dysmetria (lack of coordination of movement typified by under- or over-shooting the intended position), and nystagmus (involuntary rhythmic eye movement, with the eyes moving quickly in one direction, and then slowly in the other). However, the cerebellar signs are relatively mild, and they are no more pronounced in the quadrupeds than in the one affected brother who walks bipedally.”
My take on this is that the syndrome appears to be an inherited motor and sensory issue (HMSN). There are many disorders in this category with a variety of symptoms. Some of the more common ones include Refsum’s syndrome and Charcot-Marie-Tooth disease .
Both a BBC and PBS Nova documentary have been produced on this condition.
There has been a trend to the increasing digitization of radiology information. This works great on Mac computers since Osirix Imaging Software has been a global favorite of radiologists for several years. In fact a 2007 white paper detailing the integration of this open source software at a hospital in Mannheim is available at:
Osirix works wonderfully for 2D and 3D information. It is a 2D viewer, 3D viewer, 4d viewer (time dimension) and a 5D viewer (3D data + temporal and functional data) It can integrate images derived from 2 sources such as Cardiac PET/CT angiogram. X-rays, bone scans, pet scans, cat scans and more are readily viewable. I’ve used Osirix for about 3 years and find it reliable and helpful. It is great for MRIs. I’ve found clinical problems, such as a torn plantar plate, that had previously been mistakenly read as normal. (Of course a physical examination should go a long way in leading one to suspect a plantar plate injury.)
The standard file format DICOM and over 20 other file formats are easily read using Osirix. The DICOM standard allows physicians using software and systems from different vendors to rapidly share imaging information. The only time Osirix will not work is if a proprietary format is used. The disks are sometimes hostilely marked “not compatible with Apple Macintosh computers”. Since every radiology center has the capability of outputting a standard format file, and it is readable by their own Microsoft Explorer based software, I don’t know why anyone would limit the readability of the disk. In fact, there is no good reason not to use DICOM format. But if by chance a radiology center near you has made the mistake of not using DICOM, that error is quickly remedied with a call requesting a standard format “DICCOM” disk. Osirix development is open source and distributed under the GNU Lesser General Public License.
What is DICOM?
DICOM is a radiological information standard file format. It is the de facto standard used in all hospitals worldwide. The file format was developed in 1993 and used for a variety of medical image types including MRI, CT, and Pet scan. The image is compressible. The National Electrical manufacturers Association (NEMA) created the standard and these same manufacturers embed the capability of creating these standard file formats for cross platform interoperability.
DICOM can even store information on radiation exposure for examinations. It is dependent on the device manufacturer to properly implement this using the current addendum to the standard called the “Radiation Dose Structured Report“. Phillips and GE create a separate image with the total exposure listed. For more details see David Clunie’s Blog.
MEDX3D format is a new format with ongoing work to incorporate the upcoming format in the DICOM standard and in OSIRIX.
Image by Mitch Mandel (September 2010 Runners World)
Exercising while barefoot is a good way to work on your balance, proprioception (joint position sense) and lower leg strength. Runners World has a fine short article on Barefoot Exercise written by Adam Bean (which I was interviewed for) in the September, 2010 issue and online.
Several Videos of an agile athlete demonstrating the exercises are online and on the iPad app.
The wobble board exercise is particularly good for many ankle injuries as part of a recovery plan. The toe curls and toe pickups can be helpful in conjunction with an overall plan for plantar fasciitis. Overall the series of exercises was set up for a healthy runner. In you have an injury, check with your sports doc or PT for advice specific to your injury.
Red hot chili peppers just might be good for you. An article in the current issue of “Science Signaling” (Aug 10, 2010. Vol 3, Issue 134, p ec241) summarizes two articles and gives the details.
Capsaicin, in chili peppers, is what makes them taste hot. For several years it has been used in topical creams that are used to decrease pain from a variety of causes. The biochemical means of action is via a cation channel of a receptor group called TRPV1, which allows calcium ions to enter the cell. The authors of the current article found that the TRPV1 receptors were also found in the endothelial cells of blood vessels. They studied the activity in rats and found that exposure to capsaicin resulted in an increase in the “amount of phosphorylated endothelial nitric oxide synthase (eNOS), protein kinase A (PKA) activity, and NO production.” They found that a 6 month long diet high in capsaicin triggerred a relaxation response in the arteries and that hypertensive rats were found to have lowered their blood pressure when they continued to have a diet high in capsaicin.
While they seem to suggest that a diet high in capsaicin may reduce blood pressure in humans or at least that targeting the receptor TRPV1 for further research, I think a direct test for a diet hypothesis would be to take your blood pressure before and after munching on a chili pepper. I’ll bet you may see a bit of a rise, at least in the short term.
References:
D. Yang, Z. Luo, S. Ma, W. T. Wong, L. Ma, J. Zhong, H. He, Z. Zhao, T. Cao, Z. Yan, D. Liu, W. J. Arendshorst, Y. Huang. M. Tepel, Z. Zhu, Activation of TRPV1 by dietary capsaicin improves endothelium-dependent vasorelaxation and prevents hypertension.Cell Metab.12, 130–141 (2010). [PubMed]
W. C. Sessa, A new way to lower blood pressure: Pass the chili peppers please! Cell Metab.12, 109–110 (2010). [PubMed]
Horse In Motion: Animated Gif of Sequential Photos
Edweard Muybridge visited the Corcoran Gallery of Art in 1887 to personally make a presentation of his eleven volume “Illustrations of Animal Locomotion”. They later purchased the text. An exhibition titled “Helios: Eadweard Muybridge in a Time of Change” at the Corcoran displaying Muybridge’s groundbreaking photography and motion studies has just concluded. I had the joy of spending a few hours at the exhibit in close study. As an added and unrelated bonus I was also able to see a new exhibit on the artist Chuck Close.
Artists and scientists have long had an interest in human anatomy and motion. Over the last 50 years, movement and gait have been analyzed using gait plates, computer force distribution systems, electromyogram (EMG) and video. When, where and how did modern analytic methods develop? What was their antecedent? Most textbooks and articles are skimpy at best about much of the early history of the study of locomotion and movement.
The science of biomechanics has forgotten about the 19th century developments that made for rapid progress in the last 100 years. The historical memories of biomechanics seem to start in the 20th century with Morton’s observations, and Elftman, Inman and Mann’s theories. Artists, however, remember Muybridge, and going further back, it is clear that Michelangelo was deeply interested in anatomy and Leonardo (performed dissections and) wanted to know how everything worked. Along the way to the present, many other artists and scientists studied and observed animal and human movement. But until the late 19th century there was no technology available to capture data and information of movement.
Edweard Muybridge (1830-1904) was the first to systematically develop equipment and techniques to photograph the movement of quadripedal and bipedal gait along with a variety of other movements, motions, and human athletic activities. In 1877 Muybridge was hired by Leland Stanford to demonstrate that all 4 limbs were off the ground at one point during the trotting gait of a horse. Muybridge developed an automatically triggering electronic shutter. In 1878, Muybridge hooked up a series of about a dozen cameras to automatically and sequentially fire and record the gait of a horse. While exposures at that time were often several minutes long, the 12 exposures occurred over about half a second. A highly contrasting, light background was designed to enhance the image. A numbering system was used which gave positional and, indirectly, timing information. Stanford ultimately won his bet and was able to use Muybridge’s photographs to demonstrate that all of the horses feet left the ground during a trot.
Out of the studies of motion that Muybridge did came several breakthroughs that were noted by Rebecca Solnit in “River of Shadows”.
1) An electronic automatically triggered shutter, which Muybridge felt would revolutionize photography.
2) Advances in plates and development which could capture movement and allowed for capture of an image in less time than anyone had accomplished previously.
3) Capturing of several images that could be mounted together to represent a cycle of motion (such as a gait cycle) rather than a single isolated moment.
4) The possibility of sequencing and showing an image sequence as a moving picture to reanimate the movement as a moving picture.
The first and second breakthroughs were accomplished in 1877, the other breakthroughs came in 1878 and 1879. It took celluloid and other much later developments to bring a motion picture industry to life. But both the methodical study of movement and a film industry had their beginnings with the work of Muybridge.
Early technology was so bad that images were often barely discernable and had to be painted in. In some cases the images were filled in and then re-photographed by Muybridge. (The equivalent of photoshopping your work today.) Ultimately, however, Muybridge recorded many sequences of activity making up about 11 volumes. The complete set of volumes was sold to the Corcoran museum in Washington, DC in the 1890’s for $600.
Stanford published a text on the movement of animals , while Muybridge was lecturing in England and employed by a professional society. Many images drawn after Muybridge’s plates and several of his images were used while the text gave Muybridge no credit for the work.
Muybridge’s work has often been discounted as merely “art”, but it was an important qualitative look at movement. Diagrams in modern texts detailing varieties of normal and abnormal gait look like they were sketched from his plates or photographed using methods similar to his. He influenced many artists, worked with Thomas Eakins and inspired Marcel Duchamp to paint “Nude Descending A Staircase“. Clearly there is inspiration, emotion, and art in his work, but using the scientific analysis and invention he was at the forefront in creating techniques that were later used to quantify motion and gait analysis. His text “Animals In Motion” has long been used by illustrators to draw sequences which when put together will stream as a moving animal. His work had great impact on animation and led to the development of film. Look for more details on Muybridge on my main website in the near future.
The Helios exhibit will next be seen at the Tate Britain in London from September 8, 2010 through January 16, 2011, and will finish at the San Francisco Museum of Modern Art from February 26 through June 7, 2011.
References:
River of Shadows: Eadweard Muybridge and the Technological Wild West. Penguin Books. 2003.
Helios: Eadweard Muybridge in a Time of Change. Philip Brookman. Corcoran Gallery of Art. 2010. (Exhibit and Catalog)
Picturing Time: The Work of Etienne Jules Marey. Marta Braun. University of Chicago Press: 1992.
The Future: A Pill To Prevent Cognitive Decline? Why not exercise?
For many years scientists believed that the adult human brain was not able to make new cross connections. Neurons were thought to stop functioning and die at a high rate as one aged. Altman, in 1964, hypothesized that vertebrates could create new neurons, but this did not become a prevailing view until much later. Neural plasticity, the ability of
Andrew Pieper, M.D., Ph.D.
the brain to change and respond to conditions and experiences was believed to get worse and worse each year. This is not the case. A number of studies have shown that the brain continues to be active, nerves can “learn” and cross connect actively, and aging doesn’t inevitably lead to a severe cognitive decline. Dementia also, is not inevitable. And exercise makes it significantly less likely.
Science Friday recently interviewed researcher Steven McKnight and reported on a new study that came up with what may be the first pill to lessen cognitive decline. The study was performed on rats and looked at the impact of P7C3 on the dentate gyrus of the hippocampus. The authors conclusions were:
P7C3 corrects hippocampal deficits in mice devoid of adult neurogenesis
P7C3 preserves cognitive capacity in aged rats
But, just as studies have shown that for many cases exercise can help with depression and sometimes be better than the “pills”, exercise has already been shown to be a good inhibitor in humans of both cognitive decline and dementia. The authors of the P7C3 study even noted that rats who perform voluntary exercise have a lower cognitive decline associated with aging. And social integration of the rats is another “environmental” factor associated with a decreased risk of cognitive decline.
While you are waiting for clinical trials and FDA approval of P7C3 and the “lose weight magic pill” you can take action today. Besides, the active ingredient of the pill already has a patent pending. So, get out there and exercise. Exercise should be a life long activity. If you find as you age that you can no longer do the same exercise you were doing before, it isn’t hard to find other activities to substitute. Run, walk, swim, bike, elliptical, rowing machine are all fine ways to get aerobic exercise. Body weight exercise, dumbbells, or machines all work well for strength training. The exercise recommendation is:
30 minutes of moderate aerobic exercise – 5 days per week
(or 20 minutes vigorous aerobic exercise – 3 days per week)
2 days of strength training each week
Altman J. Are new neurons formed in the brains of adult mammals? Science. 1962 Mar 30;135:1127-8.
He XZ, Baker DW. Body mass index, physical activity, and the risk of decline in overall health and physical functioning in late middle age. Am J Public Health. 2
Laurin D, Verreault R, Lindsay J, MacPherson K, Rockwood K. Physical activity and risk of cognitive impairment and dementia in elderly persons. Arch Neurol. 2001;58(3):498-504
McKnight, S.L., Pieper, A.A., Ready, J.M., DeBrabander, J. July 2010. Proneurogenic compounds. U.S. patent 2010/020681.
Piepersend A, Xie S, Capota E, et. al. Discovery of a Proneurogenic, Neuroprotective Chemical. ell, Volume 142, Issue 1, 39-51, 9 July 2010 10.1016/j.cell.2010.06.018
Strawbridge WJ, Deleger S, Roberts RE, Kaplan GA. Physical activity reduces the risk of subsequent depression for older adults. Am J Epidemiol. 2002;156(4):328-334.
Smith et. al. Aerobic Exercise and Neurocognitive Performance: A Meta-Analytic Review of Randomized Controlled Trials. Psychosom. Med. 2010;72:239-252.
van Praag, H., Kempermann, G., and Gage, F.H. (1999). Running increases cell proliferation and neurogenesis in the adult mouse dentate gyrus. Nat. Neurosci. 2, 266–270.
Yaffe K, Barnes D, Nevitt M, Lui LY, Covinsky K. A prospective study of physical activity and cognitive decline in elderly women: women who walk. Arch Intern Med. 2001;161(14):1703-1708.
The Diane Rehm Show will host Christopher McDougall (author of Born To Run), Amby Burfoot (winner of Boston Marathon, 1968, Editor at large: Runners World) and myself on Monday. The topic will be “Running In America. We should cover a lot of ground. Both Amby and Christopher are knowledgeable and entertaining. It should be an interesting show. The discussion will be on NPR starting at 11 am. If I’m early, according to the schedule, it appears I could stop in for a spot of tea.
You can tweet your questions to the show on twitter or ask via the show’s Facebook page. More information on calling and email is available at the show’s website.
The Diane Rehm Show is archived online and is available as a podcast through iTunes or as an rss feed.. I highly recommend Diane’s intelligent discussions and diverse subjects as food for the brain.
Blisters are a common sports injury caused by a combination of friction and moisture. Blisters normally
Blister
cause pain that limits your activity and resolve and go away. You should take good care of blisters to avoid infection. Running in pain with an altered gait can cause you to injure another body part. A couple of days off if needed can prevent a longer down time.
And no, you will not get gangrene from a friction blister. However, if you are diabetic with insensitive feet caused by diabetic peripheral neuropathy you will not have a normal response to pain. In that set of circumstances there is a higher danger of infection which can spread deeply and widely and cause serious problems. If you are diabetic please check your feet regularly and get professional care at the first sign of any problem.
More information on blisters can be found on my running injuries website.
PEN has partnered with ESPN to create the PEN/ESPN Literary Sports Writing award. This award will honor the best non-fiction book on sports for 2009. The winner will receive $5,000 and be invited to speak at the 2010 CUNY Pen Literary Awards ceremony on October 13, 2010.