Running Injury Repair: Evidence Based Competent Self-Care

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Tibial "Stress Fractures"..Stress Reactions & Shin Splints

Just say no to practitioners of traditional Sports Medicine...........

"......primary research evidence only accounted for 24% of management......."

"Practitioners were unaware of literature supporting over 50% of the treatment modalities they used."

"This study highlights a lack of evidence base, a lack of knowledge of the research evidence..that is available for these conditions."

"Practitioners practiced evidence based medicine in under 50% of cases."

I.R. Murray, et al

How Evidence Based Is The Management Of Two Common Sports Injuries In A Sports Injury Clinic?

British Journal Of Sports Medicine..Volume 39 #12...December 2005..page 912

ETG Injury Repair, Healing The Tissues: Fibroblast Cells, & Osteoblast Cells -----

Tendon is comprised of a protein called collagen. Collagen is produced by cells called fibroblasts. When the rate of application of the training loads exceeds the rate of adaptation of the body tissues, a situation exists where collagen breakdown substantially exceeds collagen production by fibroblasts. Stretching tissues such as tendons and muscles that already have tearing is ill-advised as this simply recreates the injury every time you stretch. Injury to the bone consists of micro breaks in the matrix structure of the tibia.

The cells responsible for healing are bone building cells called osteoblasts. They are best activated by weight bearing activity since the movement of fluid through the bone (which is induced by weight bearing activity) is what most effectively stimulates these cells. "Bone Remodeling" is the general term used to describe the adaptations to training that take place in bone. There are two main players, osteoclast cells and osteoblast cells. Bone is comprised of calcium phosphate, which these cells will either breakdown or build.

When Training Loads Attack -----

Following a workout, there is debri from the matrix structure of bone that must be removed. Osteoclast cells are responsible for resorbing this debri and releasing the calcium into the blood stream. Osteoblast cells are like engineers that take up calcium from the blood stream and use it to lay down a new and stronger bone matrix to withstand greater loads. This process is the "stress reaction" aspect of bone remodeling. It is a normal adaptive function within bone.

However, when the rate of application of training stimuli exceeds the rate of adaptation, a situation exists where the rate of osteoclastic activity exceeds the rate of osteoblastic activity. Bone resorbtion exceeds bone deposition, thus there is a net loss of bone. This net degeneration of bone weakens the overall integrity of the bone, and pain symptoms result. Overtraining and psychological stress cause a decrease in production of estrogen and testosterone, which further facilitates osteoclastic activity and decreases osteoblastic activity.

There is no true break in the bone though it is often interpreted this way on an X-ray and bone scan. Usually by the time an X-ray or bone scan is taken, the area of osteoblastic activity shows up as a dim white blotch. On a bone scan, the area asbsorbs the dye that is injected into the runner so it shows up as a "hot spot". Unfortunately, the dye for the bone scan will be taken up in areas of stress reaction in people who have.....no.....pain or symptoms, thus the test is somewhat less than useful. Misdiagnosis and treatment is extremely common.

Repair of the bone is well underway by the time anything can show up on an X-ray or bone scan. It is best to stop training, and within 3 days later, begin aggressive high intensity strength training (high weight) of muscles that originate or insert on the affected bone. This type of training is the most potent stimulator of osteoblastic activity. Also, weight bearing exercise on the affected bone must be done. Fast walking is ideal for lower leg injuries. Pool running is ill-advised as the runner simply trades one form of overtraining for another.

Traditionally, most doctors are taught that a "stress fracture"/stress reaction takes about 6 - 8 weeks to heal. Thus, they often tell runners to take 6 - 8 weeks off from running. However, primary healing is likely to occur far sooner than this.

"The term "stress fracture" is itself somewhat of a misnomer and potentially misleading. Most of the injuries diagnosed and classified under the rubric of stress fractures show no evidence of a fracture line or break in the continuity of bone."

".....the term "stress fracture" implies a fracture, although in most cases no fracture is evident. "Stress reaction" is a more appropriate term for the majority of what are now called "stress fractures"."

B.H.Jones,et al.....1989

Exercise-Induced Stress Fractures And Stress Reactions Of Bone: Epidemiology, Etiology, And Classification

Exercise & Sport Sciences Reviews.......Volume 17.....1989....page 379 - 380

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"Magnetic resonance imaging is more accurate in correlating the degree of bone involvement with clinical symptoms, allowing for more accurate recommendations for rehabilitation and return to impact activity."

M. Fredericson, et al....July-August, 1995

Tibial Stress Reaction In Runners.

American Journal of Sports Medicine...Volume 23 #4...July-August 1995..page 472 - 481

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"At 3 weeks after the start of low-intensity ultrasound, the stress fracture responded well and the patient was allowed use of tumble track, trampoline, and to do some weight-bearing activities, such as jumping in the pool and loading-type activities. At 4.5 wk, the patient progressed to full workout activities and participated in a trial meet for the Olympics.At 6 wk, the patient's participation in the women's gymnastic team event was a factor in the United States receiving a gold medal."

J.E.Jensen

Stress Fracture In The World Class Athlete: A Case Study

Medicine & Science in Sports & Exercise......Volume 30 #6.....June 1998.......page 783 - 787

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"We understand the clinical implications of conditions such as tendinosis and stress fractures and can make the diagnosis, but we treat them imperfectly."

Robert Leach MD

Editor.....American Journal Of Sports Medicine

Volume 28 #3......2000.....page 281

ETG Evidence Based Competent Self-Care Injury Repair: Increase Strength Of Involved Tissues -----

High intensity work, based on a "hurt not harm" principle, is what yields results. If you're doing exercises with weight/resistance that allows you to do 12 - 20 reps without stopping.....this slows/prevents recovery, even though you are doing......"strength training"

For the shin muscles/tendons, the more force the attached muscle is trained to produce, the more force the tendon will be trained to endure. Ankle exercises (turning the heel/foot inward -- ankle inversion/supination) against high resistance, which train the muscles (tibialis posterior, tibialis anterior) that attach to the affected area of the bone, are effective. It is possible to perform these exercises and fail to sufficiently activate the specific muscle fibers that are attached to the injured tendon tissue. It may be necessary to adjust the angles of motion of the exercises accordingly.

To encourage bone healing, the compressive forces created by the 1/4 squat with high weight is effective. Start with whatever amount of weight is well tolerated, and progress from there. 1/4 squat (single leg) is a squat done on one leg, going only 1/4 of the way down...rather than going all the way down to a sitting position or further. Strength training adaptations are specific to the range of motion trained in the weight room.

You're never in a sitting position when you run, you're in a 1/4 squat position during the stance phase of the running stride......that's as far down as you get when running, thus its as far down as you should go in the weight room.--- Use high resistance/weight (doing 5 - 8 reps...cumulative total per training session) preferably once a day, each day for 1 - 2 weeks. Work with a weight you cannot lift more than 3 times without stopping. Precede this with a set of about 3 repetitions of low to moderate weight, with each repetition done extremely slowly.

Exercise List -----

[Start with whatever amount of weight is well tolerated]

-- Ankle exercise (turning the heel/foot inward -- ankle inversion/supination)

-- 1/4 squat (single leg)

-- stationary jumping [one leg at a time]

Start with whatever amount of weight is well tolerated, and progress from there. --- Use high resistance/weight (doing 5 - 8 reps...cumulative total per training session) preferably once a day, each day for 1 - 2 weeks. Work with a weight you cannot lift more than 3 times without stopping. Precede this with a set of about 3 repetitions of low to moderate weight, with each repetition done extremely slowly.

Heal Faster ---------

The primary reasons injuries often take people several weeks to several months to deal with are;

--- Provinding a low or no stimulus for healing. Doing so-called "strengthening exercises" with little or no weight//resistance [ie. use of rubber tubing, etc]. The amount of weight/resistance determines the amount of stimulus for cells that are responsible for healing.

--- Doing a bunch of reps and sets of "strengthening exercises" with no progressive increase in weight//resistance as strength of the tissues increase.

--- The frequency of application of a strengthening stimulus is a major determining factor on the rate of healing. If you're seeing a physical therapist, chances are you'll be going only once or twice a week. If this is the only time that strengthening of the tissue is being induced, recovery will take quite a few weeks.

--- Multiple uses of ice, anti-inflammatories, and anything else that decreases blood flow to a healing tissue, and/or decreases immune cell function in and around a healing tissue.....will also account for a slow recovery time. Rest and stretching are usually insufficient to improve the tissue's ability to withstand training loads.

--- Recurrent attempts to return to training before the tissue has acquired the strength necessary to endure their training loads.

"The repair and maintenance of connective tissues is performed predominately by.....cell known as a fibroblast. The activity of this cell is regulated, in part, by changes in the mechanical environment in which it resides."

M. Eastwood, D.A., McGrouther, R.A. Brown.....1998

Fibroblast Responses To Mechanical Forces.

Journal of Engineering in Medicine.....Volume 212 #2.....1998.....page 85 - 92

----------

".......the proliferation and activation of tendon fibroblasts is dependent upon the mechanical force applied...."

"Improved fibroblast response may lead to improved tensile strength of the healing tissue and identifying the optimal pressure to facilitate this response may lead to fewer treatment sessions."

G.M.Gehlsen, L.R.Ganion, R.Helfst.....1999

Fibroblast Responses To Variation In Soft Tissue Mobilization Pressure

Medicine & Science In Sports & Exercise.....Volume 31 #4 1999

----------

"This study shows that application of mechanical stress to tendon fibroblasts resulted in an alteration of cellular proliferation depending on the stress time."

J. Zeichen, M.van Griensven, U. Bosch.....2000

The Proliferative Response Of Isolated Human Tendon Fibroblasts To Cyclic Biaxial Mechanical Strain

American Journal Of Sports Medicine.Volume 28 #6.....November/December 2000..page 888 - 892

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".....in healing tendons the effect of mechanical loading, or its absence, is dramatic."

"Many studies show that tendons adapt to mechanical loading.....the healing of injured tendons comprises rapid proliferation and remodeling, and here the effects of mechanical loading is dramatic. Numerous animal studies show that immobilization of a healing tendon compromises the healing process."

"Patients with Achillies tendon injuries often have the injured limb immobilized for several weeks. Because animal data suggest that this impairs healing so much, it is important to develop clinical loading regimes during healing."

".....patients might be allowed early short loading episodes following for example, an Achillies tendon rupture, for a better outcome

T. Andersson, et al

Tissue Memory In Healing Tendons:Short Loading Episodes Stimulate Healing

Journal Of Applied Physiology......Volume 107 #2.....August 2009......page 417

Nutrition & Healing -----

Protein and vitamin C comprise portions of the tissues you're looking to heal, so their intake should be increased temporarily to improve the rate of healing. since their availability in your tissues will affect the rate of tissue regeneration. You may benefit from several days of --- protein 1.5 - 2.0 grams of proteing per kg of your body weight, Vitamin C 500mg, zinc 30 - 50mg, magnesium 500mg, a few grams of the amino acids leucine and arginine, 2 teaspoons liquid colostrum, Vitamin D 6000IU to 10,000IU, Lugol's Iodine 7 - 15mg.

The Role of Stretching [Range of Motion] -----

You'll find that muscle and tendon respond to what is done, and -not-- done. For example ------- sitting at a desk at work//school for many hours per day for many years means you're in a hip flexion position for many hours per day for many years. One should expect to see tight hip flexor muscles and tendons after a period of years, and perhaps lower back problems that may accompany them......Also, sitting at a desk at work//school for many hours per day for many years means you're in a -knee- flexion position for many hours per day for many years. One should expect to see tight -knee- flexor muscles and tendons [ie. hamstring, calf] after a period of years. That gradual loss of flexibility over time is due to exposing muscles and tendons to a given position for many hours per day for many years, without exposing them to the opposite position in a sufficient manner............that's -not- about age or aging.

The duration of stretch needed to increase muscle and tendon "pliability" prior to a workout, is somewhat different than that required to increase or maintain long term "range of motion". Its best to treat stretching in your training program, in the same manner as you would strength training............in that you should have a designated day(s) for specifically going through a designed routine. Muscle and tendon fibers respond to stretching sessions in a similar manner as strength training. Rather than gaining a wider width though, they get longer by adding more sections. If a muscle//tendon lacks the -length-- to allow for limb-joint movement through it's sport required range of motion..some sort of tissue damage should be expected.

The duration of the stimulus [how long you hold the stretch] determines the potency of the stimulus applied [though, a high frequency can take the place of a long duration]. The durations should be about 3 minutes for each position. In this manner, stretching should be treated as a workout, not preparation for a workout.

Usual Complications Of Running Injuries -----

If you've had an injury for a while, and haven't seen improvement inspite of things you've tried, the reason the pain persists is most likely because you haven't yet done anything that would improve the tissue's ability to withstand your training/racing loads. If the strength of the tissue in question is insufficient to match the strength needed to endure your training.....you "will" experience pain at some point, independent of what shoes you wear or how much they cost, or how biomechanically great or awful your running form is currently. Shoes can't strength train your body's tissues. Some of them are capable of reducing the motions of the foot in a manner that reduces the amount of strength your lower leg muscles must have to endure your training loads, and improvements in running form can have the same effect. But as the shoes wear out with use, their ability to provide this function wears out with them. The safest long term solution is to strength train. Rest, ice, stretching, anti-inflammatories........of these, none will improve the tissue's ability to withstand your training/racing loads.

Slow The Rate Of Application Of Training Loads -----

When the rate of application of the training loads exceeds the rate of adaptation of the body tissues, injury will eventually result in whatever tissue is your weakest link at that time. If you run every day, you're applying your training loads at a rate of approximately once every 24 hours. Reduce the rate of application of your training loads temporarily since it is clear that the current rate exceeds what the tissue can handle. You can slow the rate of application of your training loads by reducing how frequently you train. The way to do this is to provide for "OFF" days in your training (ie. every 2 - 3 days). "OFF" days are not cross-training days.......OFF days is are days that allow recovery, restoration, and adaptation to your training. If at some point in a given week, the tissue in your IT-band, shin, knee, or foot requires 48 hours without a training load placed on it, but you provide only 24 hours...injury is likely.

Reduce Training Loads -----

Reduce the magnitude of application of your training loads temporarily since it is clear that the current magnitude exceeds what the tissue can handle. You can reduce the magnitude of application of your training loads by reducing how long you train.......keep each training session to less than 20 minutes.

Say No To Drugs -----

Following the initial 24-48 hour period of injury, application of heat stimulus (5 - 10 minutes limb water submersion 100-105 degrees F) should be used to increase blood flow and energy production for repair processes. Ingestion of NSAID's (anti-inflamatories) should be avoided since this will impair recovery, and potentially mask pain, leading one to believe it is ok to return to training.

Never...ever....under "any" circumstances...allow a doctor to inject the tissue with cortisone or any other substance that is well known to cause degradation of collagen and other tissue proteins.

Just say --no-- to drugs..........

"The use of nonsteroidal anti-inflammatory drugs for the treatment of tendon inflammation might increase the levels of leukotriene B4 within the tendon, potentially contributing to the development of tendinopathy."

"This finding is of interest because NSAID's are routinely used in clinical practice for the symptomatic treatment of tendinopathy, such as inflammation and pain."

"..the increased LTB4 level due to treatment with NSAID's could potentially exacerbate the situation by leading to neutrophilic infiltration and lymphocytic activation, paradoxically causing further inflammatory and degenerative changes in the tendon."

"..the results of this study suggest that the routine use of COX inhibitors for the symptomatic relief of inflammatory tendon conditions might inadvertently worsen the processes responsible for the development of tendinopathy."

Zhaozhu Li, et. al

Inflammatory Response Of Human Tendon Fibroblasts To Cyclic Mechanical Stretching

The American Journal Of Sports Medicine..Volume 32 #2....2004...page 435 - 439

-------

iceing = cryotherapy --- just say no to cryotherapy........

"....the administration of nonsteroidal anti-inflammatory drugs or cryotherapy are common clinical practices to control the inflammatory process following connective tissue injury. However, there are contradictory conclusions on the potential of anti-inflammatory strategies to either prevent nonspecific damages or accelerate healing after acute tendon or ligament trauma."

"Cumulative evidences also show that, apart from releasing catabolic enzymes, inflammatory cells can ultimately favor tissue healing through different biological processes."

"Indeed, after the clearance of pathogens and other signals of danger, neutrophils will undergo apoptosis and be engulfed by phagocytic macrophages. Macrophages will then release growth factors that can stimulate fibroblast proliferation, collagen synthesis, and angiogenesis during the early phase of healing."

D.Marsolais, et al

Inflammatory cells do not decrease the ultimate tensile strength of intact tendons in vivo and in vitro: protective role of mechanical loading

Journal Of Applied Physiology.......Volume 102 #1......January 2007.....page 11 - 17

Restatement Of The Facts --------------------

--- The strength of the involved tissue must be raised to a sufficient level to match the strength needed to endure your training.

--- Start with whatever amount of weight is well tolerated, and progress from there.

--- follow a "hurt not harm" principle.....when doing high intensity strength training of the involved tissues.

--- Avoid recurrent attempts to return to training before the tissue has acquired the strength necessary to endure your training loads.

The problem should improve, if not resolve, quickly with strength training (within a few days following 4 back to back strength sessions).

"The repair and maintenance of connective tissues is performed predominately by.....cell known as a fibroblast. The activity of this cell is regulated, in part, by changes in the mechanical environment in which it resides."

M. Eastwood, D.A., McGrouther, R.A. Brown.....1998

Fibroblast Responses To Mechanical Forces

Journal of Engineering in Medicine.....Volume 212 #2.....1998.....page 85 - 92

--------------------

".......the proliferation and activation of tendon fibroblasts is dependent upon the mechanical force applied...."

"Improved fibroblast response may lead to improved tensile strength of the healing tissue and identifying the optimal pressure to facilitate this response may lead to fewer treatment sessions."

G.M.Gehlsen, L.R.Ganion, R.Helfst.....1999

Fibroblast Responses To Variation In Soft Tissue Mobilization Pressure

Medicine & Science In Sports & Exercise.....Volume 31 #4 1999

--------------------

"This study shows that application of mechanical stress to tendon fibroblasts resulted in an alteration of cellular proliferation depending on the stress time."

J. Zeichen, M.van Griensven, U. Bosch.....2000

The Proliferative Response Of Isolated Human Tendon Fibroblasts To Cyclic Biaxial Mechanical Strain

American Journal Of Sports Medicine.Volume 28 #6.....November/December 2000..page 888 - 892

--------------------

"Mechanical stress is an important regulator of bone metabolism. Fluid shear stress caused by mechanical load in bone tissue has been shown to be important.........through its effects on osteocytes and osteoblasts."

K.Sakai, M.Mohtai, Y.Iwamoto

Fluid Shear Stress Increases Transforming Growth Factor Beta 1 Expression In Human Osteoblast-Like Cells: Modulation By Cation Channel Blockades

Calcified Tissue International.....Volume 63 #6......December 1998......page 515 - 520

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".....bone adapts to imposed stress or lack of stress by forming or losing tissue."

"Remodeling is performed by individual, independent bone remodeling units which comprise bone-resorbing osteoclasts and bone-forming osteooblasts."

"Osteoblastic activity exceeds osteoclastic resorption, which leads to a net gain in bone. Net loss occurs when resorption is greater than formation."

"Osteoclastic activity removes the damaged material sot hat osteoblasts can deposit matrix and mineral along the paths of imposed stress."

"....exercise such as weight training, in which load is increased, would be more effective in improving bone mass than would jogging, in which repetitions are the primary training stimulus."

C.Snow-Harter, R.Marcus

Exercise, Bone Mineral Density, And Osteoporosis

Exercise & Sport Sciences Reviews.......Volume 19....1991....page 352 - 354

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Achilles Strain

Mechanisms Of Injury

1. When a given tissue lacks the strength to endure your training loads...you "will" get injured.

2. When the rate of application of your training loads exceeds the body's rate of adaptation to the training...you "will" get injured

3. muscle//tendon lacks the -length-- necessary for movement through sport required range of motion.

4. foot turned outward in standing, walking, running increases the rate and magnitude of foot pronation (heel motion of rolling outward). This increases the amount of rotation of the tibia (lower leg) which increases the torsion forces placed on the achillies tendon.

Just say no to practitioners of traditional Sports Medicine...........

"......primary research evidence only accounted for 24% of management......."

"Practitioners were unaware of literature supporting over 50% of the treatment modalities they used."

"This study highlights a lack of evidence base, a lack of knowledge of the research evidence..that is available for these conditions."

"Practitioners practiced evidence based medicine in under 50% of cases."

I.R. Murray, et al

How Evidence Based Is The Management Of Two Common Sports Injuries In A Sports Injury Clinic?

British Journal Of Sports Medicine..Volume 39 #12...December 2005..page 912

ETG Evidence Based Competent Self-Care Injury Repair: Increase Strength Of Involved Tissues -----

High intensity work, based on a "hurt not harm" principle, is what yields results. If you're doing exercises with weight/resistance that allows you to do 12 - 20 reps without stopping.....this slows/prevents recovery, even though you are doing......"strength training"

Calf raise exercise (single leg), stationary jumping exercises, are both effective. Start with whatever amount of weight is well tolerated, and progress from there. Use high resistance/weight (doing 5 - 8 reps...cumulative total per training session) preferably once a day, each day for 1 - 2 weeks. Work with a weight you cannot lift more than 3 times without stopping. Precede this with a set of about 3 repetitions of low to moderate weight, with each repetition done extremely slowly.

ETG Exercise List -----

[Start with whatever amount of weight is well tolerated]

--- Calf raise exercise [one leg at a time]

--- stationary jumping [one leg at a time]

Heal Faster ---------

The primary reasons injuries often take people several weeks to several months to deal with are;

--- Provinding a low or no stimulus for healing. Doing so-called "strengthening exercises" with little or no weight//resistance [ie. use of rubber tubing, etc]. The amount of weight/resistance determines the amount of stimulus for cells that are responsible for healing.

--- Doing a bunch of reps and sets of "strengthening exercises" with no progressive increase in weight//resistance as strength of the tissues increase.

--- The frequency of application of a strengthening stimulus is a major determining factor on the rate of healing. If you're seeing a physical therapist, chances are you'll be going only once or twice a week. If this is the only time that strengthening of the tissue is being induced, recovery will take quite a few weeks.

--- Multiple uses of ice, anti-inflammatories, and anything else that decreases blood flow to a healing tissue, and/or decreases immune cell function in and around a healing tissue.....will also account for a slow recovery time. Rest and stretching are usually insufficient to improve the tissue's ability to withstand training loads.

--- Recurrent attempts to return to training before the tissue has acquired the strength necessary to endure their training loads.

"The repair and maintenance of connective tissues is performed predominately by.....cell known as a fibroblast. The activity of this cell is regulated, in part, by changes in the mechanical environment in which it resides."

M. Eastwood, D.A., McGrouther, R.A. Brown.....1998

Fibroblast Responses To Mechanical Forces.

Journal of Engineering in Medicine.....Volume 212 #2.....1998.....page 85 - 92

----------

".......the proliferation and activation of tendon fibroblasts is dependent upon the mechanical force applied...."

"Improved fibroblast response may lead to improved tensile strength of the healing tissue and identifying the optimal pressure to facilitate this response may lead to fewer treatment sessions."

G.M.Gehlsen, L.R.Ganion, R.Helfst.....1999

Fibroblast Responses To Variation In Soft Tissue Mobilization Pressure

Medicine & Science In Sports & Exercise.....Volume 31 #4 1999

----------

"This study shows that application of mechanical stress to tendon fibroblasts resulted in an alteration of cellular proliferation depending on the stress time."

J. Zeichen, M.van Griensven, U. Bosch.....2000

The Proliferative Response Of Isolated Human Tendon Fibroblasts To Cyclic Biaxial Mechanical Strain

American Journal Of Sports Medicine.Volume 28 #6.....November/December 2000..page 888 - 892

Nutrition & Healing -----

Protein and vitamin C comprise portions of the tissues you're looking to heal, so their intake should be increased temporarily to improve the rate of healing. since their availability in your tissues will affect the rate of tissue regeneration. You may benefit from several days of --- protein 1.5 - 2.0 grams of proteing per kg of your body weight, Vitamin C 500mg, zinc 30 - 50mg, magnesium 500mg, a few grams of the amino acids leucine and arginine, 2 teaspoons liquid colostrum, Vitamin D 6000IU to 10,000IU, Lugol's Iodine 7 - 15mg.

The Role of Stretching [Range of Motion] -----

You'll find that muscle and tendon respond to what is done, and -not-- done. For example ------- sitting at a desk at work//school for many hours per day for many years means you're in a hip flexion position for many hours per day for many years. One should expect to see tight hip flexor muscles and tendons after a period of years, and perhaps lower back problems that may accompany them......Also, sitting at a desk at work//school for many hours per day for many years means you're in a -knee- flexion position for many hours per day for many years. One should expect to see tight -knee- flexor muscles and tendons [ie. hamstring, calf] after a period of years. That gradual loss of flexibility over time is due to exposing muscles and tendons to a given position for many hours per day for many years, without exposing them to the opposite position in a sufficient manner............that's -not- about age or aging.

The duration of stretch needed to increase muscle and tendon "pliability" prior to a workout, is somewhat different than that required to increase or maintain long term "range of motion". Its best to treat stretching in your training program, in the same manner as you would strength training............in that you should have a designated day(s) for specifically going through a designed routine. Muscle and tendon fibers respond to stretching sessions in a similar manner as strength training. Rather than gaining a wider width though, they get longer by adding more sections. If a muscle//tendon lacks the -length-- to allow for limb-joint movement through it's sport required range of motion..some sort of tissue damage should be expected.

The duration of the stimulus [how long you hold the stretch] determines the potency of the stimulus applied [though, a high frequency can take the place of a long duration]. The durations should be about 3 minutes for each position. In this manner, stretching should be treated as a workout, not preparation for a workout.

Usual Complications Of Running Injuries -----

If you've had an injury for a while, and haven't seen improvement inspite of things you've tried, the reason the pain persists is most likely because you haven't yet done anything that would improve the tissue's ability to withstand your training/racing loads. If the strength of the tissue in question is insufficient to match the strength needed to endure your training.....you "will" experience pain at some point, independent of what shoes you wear or how much they cost, or how biomechanically great or awful your running form is currently. Shoes can't strength train your body's tissues. Some of them are capable of reducing the motions of the foot in a manner that reduces the amount of strength your lower leg muscles must have to endure your training loads, and improvements in running form can have the same effect. But as the shoes wear out with use, their ability to provide this function wears out with them. The safest long term solution is to strength train. Rest, ice, stretching, anti-inflammatories........of these, none will improve the tissue's ability to withstand your training/racing loads.

Slow The Rate Of Application Of Training Loads -----

When the rate of application of the training loads exceeds the rate of adaptation of the body tissues, injury will eventually result in whatever tissue is your weakest link at that time. If you run every day, you're applying your training loads at a rate of approximately once every 24 hours. Reduce the rate of application of your training loads temporarily since it is clear that the current rate exceeds what the tissue can handle. You can slow the rate of application of your training loads by reducing how frequently you train. The way to do this is to provide for "OFF" days in your training (ie. every 2 - 3 days). "OFF" days are not cross-training days.......OFF days is are days that allow recovery, restoration, and adaptation to your training. If at some point in a given week, the tissue in your IT-band, shin, knee, or foot requires 48 hours without a training load placed on it, but you provide only 24 hours...injury is likely.

Reduce Training Loads -----

Reduce the magnitude of application of your training loads temporarily since it is clear that the current magnitude exceeds what the tissue can handle. You can reduce the magnitude of application of your training loads by reducing how long you train.......keep each training session to less than 20 minutes.

".....in healing tendons the effect of mechanical loading, or its absence, is dramatic."

"Many studies show that tendons adapt to mechanical loading.....the healing of injured tendons comprises rapid proliferation and remodeling, and here the effects of mechanical loading is dramatic. Numerous animal studies show that immobilization of a healing tendon compromises the healing process."

"Patients with Achillies tendon injuries often have the injured limb immobilized for several weeks. Because animal data suggest that this impairs healing so much, it is important to develop clinical loading regimes during healing."

".....patients might be allowed early short loading episodes following for example, an Achillies tendon rupture, for a better outcome."

T. Andersson, et al

Tissue Memory In Healing Tendons:Short Loading Episodes Stimulate Healing

Journal Of Applied Physiology......Volume 107 #2.....August 2009......page 417

------------

"The purpose of this study was to compare the results of operative and non-operative treatment of closed achilles tendon rupture."

"All patients were followed up with clinical evaluation at 3, 6, 12, and 24 months."

"18 patients had been operated on and 19 had been treated conservatively."

"In the operated group, 13 returned to previous athletic activity.."

"In the non-operated group, nine athletes returned to their level.."

"We conclude that operative treatment of Achilles tendon rupture is preferable, although non-operative treatment is an acceptable alternative method."

M.Kaseta, et al

Comparison Of Surgical And No Surgical Treatment of Achilles Tendon Ruptures In Athletes

Journal of Sport Sciences...Volume 18 #7..July 2000

-----------------------------------

"Our patients in the non-operative group have now reached a minimum of 60 months after the rupture. There have been no additional re-ruptures."

"..during our continuing experience with non-operative treatment of achilles tendon ruptures with now more than 50 additional patients, we observed only one additional patient with re-rupture."

"a sutured tendon..because the biological healing process is not faster than in a non-operatively approximated tendon."

M.Weber

American Journal Of Sports Medicine...Volume 32 #7..Oct/Nov. 2004..page 1777

Restatement Of The Facts --------------------

--- The strength of the involved tissue must be raised to a sufficient level to match the strength needed to endure your training.

--- Start with whatever amount of weight is well tolerated, and progress from there.

--- follow a "hurt not harm" principle.....when doing high intensity strength training of the involved tissues.

--- Avoid recurrent attempts to return to training before the tissue has acquired the strength necessary to endure your training loads.

The problem should improve, if not resolve, quickly with strength training (within a few days following 4 back to back strength sessions).

Say No To Drugs -----

Following the initial 24-48 hour period of injury, application of heat stimulus (5 - 10 minutes limb water submersion 100-105 degrees F) should be used to increase blood flow and energy production for repair processes. Ingestion of NSAID's (anti-inflamatories) should be avoided since this will impair recovery, and potentially mask pain, leading one to believe it is ok to return to training.

Never...ever....under "any" circumstances...allow a doctor to inject the tissue with cortisone or any other substance that is well known to cause degradation of collagen and other tissue proteins.

Just say --no-- to drugs..........

"The use of nonsteroidal anti-inflammatory drugs for the treatment of tendon inflammation might increase the levels of leukotriene B4 within the tendon, potentially contributing to the development of tendinopathy."

"This finding is of interest because NSAID's are routinely used in clinical practice for the symptomatic treatment of tendinopathy, such as inflammation and pain."

"..the increased LTB4 level due to treatment with NSAID's could potentially exacerbate the situation by leading to neutrophilic infiltration and lymphocytic activation, paradoxically causing further inflammatory and degenerative changes in the tendon."

"..the results of this study suggest that the routine use of COX inhibitors for the symptomatic relief of inflammatory tendon conditions might inadvertently worsen the processes responsible for the development of tendinopathy."

Zhaozhu Li, et. al

Inflammatory Response Of Human Tendon Fibroblasts To Cyclic Mechanical Stretching

The American Journal Of Sports Medicine..Volume 32 #2....2004...page 435 - 439

-------

iceing = cryotherapy --- just say no to cryotherapy..........

"....the administration of nonsteroidal anti-inflammatory drugs or cryotherapy are common clinical practices to control the inflammatory process following connective tissue injury. However, there are contradictory conclusions on the potential of anti-inflammatory strategies to either prevent nonspecific damages or accelerate healing after acute tendon or ligament trauma."

"Cumulative evidences also show that, apart from releasing catabolic enzymes, inflammatory cells can ultimately favor tissue healing through different biological processes."

"Indeed, after the clearance of pathogens and other signals of danger, neutrophils will undergo apoptosis and be engulfed by phagocytic macrophages. Macrophages will then release growth factors that can stimulate fibroblast proliferation, collagen synthesis, and angiogenesis during the early phase of healing."

D.Marsolais, et al

Inflammatory cells do not decrease the ultimate tensile strength of intact tendons in vivo and in vitro: protective role of mechanical loading

Journal Of Applied Physiology.......Volume 102 #1......January 2007.....page 11 - 17

-------

birth control pills and the Achillies tendon.........

"....recent evidence suggests that estrogen may decrease collagen density by attenuating fibroblast activity".

"....a sex based study has implicated higher endogenous estrogen levels in females with lower collagen fractional synthesis rates.

"The purpose of this study was to elucidate the effect of normal fluctuating non-monophasic oral contraceptive pill users] and low, consistent (monophasic oral contraceptive pill users users) endogenous plasma estrogen levels on the strain behavior of the Achilles tendon in vivo."

"....maximal isometric plantarflexion efforts were performed on a calf-raise apparatus while synchronous real-time ultrasonography of the triceps surae aponeurosis was recorded. Achilles tendon strain (%) was calculated by dividing tendon displacement during plantarflexion by resting tendon length."

"In conclusion, acute fluctuations in plasma estrogen across the menstrual cycle in non-MOCP users did not alter the strain behavior of the Achilles tendon. Conversely, long-term exposure to attenuated estrogen in monophasic oral contraceptive pill users resulted in a decrease in Achilles tendon strain..."

"These findings have a number of important functional and clinical implications."

A.L.Bryant, et al

Effects of estrogen on the mechanical behavior of the human Achilles tendon in vivo

Journal Of Applied Physiology.....Volume 105 #4....October 2008....page 1035-1043

.

- When the poster lacks the ability to write coherently, he "will" vomit forth a bolus of undigested material ripped from science journals.

-Fibroblasts in his brain "will" attempt to repair damaged tissue, but it is much too late.

Last Lap wrote:

- When the poster lacks the ability to write coherently, he "will" vomit forth a bolus of undigested material ripped from science journals.

-Fibroblasts in his brain "will" attempt to repair damaged tissue, but it is much too late.

When the replier lacks the ability to comprehend the material from the science journal, this person will try to discredit the information/poster in such a way that shows their true ignorance and immaturity.

The writer of all of this seems like a strange, strange man.

http://www.theetgtrackclub.com/index.cfm?fuseaction=club_history

you stooped too low wrote:

When the replier lacks the ability to comprehend the material from the science journal, this person will try to discredit the information/poster in such a way that shows their true ignorance and immaturity.

Oh you are SO right! I mean, what person could not take some valuable piece of wisdom from gems like this:

"Indeed, after the clearance of pathogens and other signals of danger, neutrophils will undergo apoptosis and be engulfed by phagocytic macrophages"

:

[quote]:

"Indeed, after the clearance of pathogens and other signals of danger, neutrophils will undergo apoptosis and be engulfed by phagocytic macrophages"

I think this should replace "Where your dreams become reality"

What do you say letsrun???

Hmmm, this website has a lot of gems:

The ETG in your track meet

--- your track meet inside United States = $free

--- your track meet outside United States = $100,000

Flat fee includes fee, travel, lodging, etc.. Primarily for Track Meets that are conducted on a 3 - 4 hour format. ETG club bylaws.....we do not compete in track meets outside the United States other than World Cup, World Championships, Olympic Games unless the meet is televised inside the United States.

ETG Mission: Track & Field

----- Pursue optimal human performance in distance running events

----- Promote growth in spectatorship of U.S track and field by producing fast times on U.S. soil

----- Proliferate the application of sport sciences based training programs

----- Break all World and American records at 800m, 1500m, 5000m, 10,000 meters, marathon

.

Plantar Fasciatis

Mechanisms Of Injury

1. When a given tissue lacks the strength to endure your training loads...you "will" get injured.

2. When the rate of application of your training loads exceeds the body's rate of adaptation to the training...you "will" get injured

3. muscle//tendon lacks the -length-- necessary for movement through sport required range of motion.

From a physical standpoint, injury consists of micro-tears in the thick sheet of tissue (fascia) that runs under the foot (called the plantar surface) from the heel to the base of the toes.

The fascia is comprised of a protein called collagen. Collagen is produced by cells called fibroblasts. When the rate of application of the training loads exceeds the rate of adaptation of the body tissues, a situation exists where collagen breakdown substantially exceeds collagen production by fibroblasts. Stretching tissues such as tendons and muscles that already have tearing is ill-advised as this simply recreates the injury every time you stretch.

Just say no to practitioners of traditional Sports Medicine...........

"......primary research evidence only accounted for 24% of management......."

"Practitioners were unaware of literature supporting over 50% of the treatment modalities they used."

"This study highlights a lack of evidence base, a lack of knowledge of the research evidence..that is available for these conditions."

"Practitioners practiced evidence based medicine in under 50% of cases."

I.R. Murray, et al

How Evidence Based Is The Management Of Two Common Sports Injuries In A Sports Injury Clinic?

British Journal Of Sports Medicine..Volume 39 #12...December 2005..page 912

ETG Evidence Based Competent Self-Care Injury Repair: Increase Strength Of Involved Tissues -----

High intensity work, based on a "hurt not harm" principle, is what yields results. If you're doing exercises with weight/resistance that allows you to do 12 - 20 reps without stopping.....this slows/prevents recovery, even though you are doing......"strength training".

With the towel pull, use a thick towel on a slick surface. Place the heel of the foot on the ground, use the toes to pull the towel towards you. Add weight on the towel every 3 - 4 days. Work with a weight you cannot lift more than 3 times without stopping. Begin doing the stationary jumps only once the pain in the foot is well tolerated. Add weight every 3 - 4 days. Do 5 - 8 reps...cumulative total per training session, preferably once a day, everyday for 1 - 2 weeks.

Calf raise exercise (single leg), towel pull, and stationary jumping exercises, are effective. With the calf raise, stand on one leg and push yourself up until the heel is slightly off the ground. Start with whatever amount of weight is well tolerated, and progress from there. Use high resistance/weight (doing 5 - 8 reps...cumulative total per training session) preferably in 2 days on, 1 day off, for 1 - 2 weeks. Work with a weight you cannot lift more than 3 times without stopping. Precede this with a set of about 3 repetitions of low to moderate weight, with each repetition done extremely slowly.

High intensity work, based on a "hurt not harm" principle, is what yields results. If you're doing exercises with weight/resistance that allows you to do 12 - 20 reps without stopping.....this slows/prevents recovery, even though you are doing......"strength training".....

ETG Exercise List -----

[Start with whatever amount of weight is well tolerated]

--- towel pull

--- Calf raise [one leg at a time]

--- stationary jumping [one leg at a time]

Heal Faster ---------

The primary reasons injuries often take people several weeks to several months to deal with are;

--- Provinding a low or no stimulus for healing. Doing so-called "strengthening exercises" with little or no weight//resistance [ie. use of rubber tubing, etc]. The amount of weight/resistance determines the amount of stimulus for cells that are responsible for healing.

--- Doing a bunch of reps and sets of "strengthening exercises" with no progressive increase in weight//resistance as strength of the tissues increase.

--- The frequency of application of a strengthening stimulus is a major determining factor on the rate of healing. If you're seeing a physical therapist, chances are you'll be going only once or twice a week. If this is the only time that strengthening of the tissue is being induced, recovery will take quite a few weeks.

--- Multiple uses of ice, anti-inflammatories, and anything else that decreases blood flow to a healing tissue, and/or decreases immune cell function in and around a healing tissue.....will also account for a slow recovery time. Rest and stretching are usually insufficient to improve the tissue's ability to withstand training loads.

--- Recurrent attempts to return to training before the tissue has acquired the strength necessary to endure their training loads.

"The repair and maintenance of connective tissues is performed predominately by.....cell known as a fibroblast. The activity of this cell is regulated, in part, by changes in the mechanical environment in which it resides."

M. Eastwood, D.A., McGrouther, R.A. Brown.....1998

Fibroblast Responses To Mechanical Forces.

Journal of Engineering in Medicine.....Volume 212 #2.....1998.....page 85 - 92

----------

".......the proliferation and activation of tendon fibroblasts is dependent upon the mechanical force applied...."

"Improved fibroblast response may lead to improved tensile strength of the healing tissue and identifying the optimal pressure to facilitate this response may lead to fewer treatment sessions."

G.M.Gehlsen, L.R.Ganion, R.Helfst.....1999

Fibroblast Responses To Variation In Soft Tissue Mobilization Pressure

Medicine & Science In Sports & Exercise.....Volume 31 #4 1999

----------

"This study shows that application of mechanical stress to tendon fibroblasts resulted in an alteration of cellular proliferation depending on the stress time."

J. Zeichen, M.van Griensven, U. Bosch.....2000

The Proliferative Response Of Isolated Human Tendon Fibroblasts To Cyclic Biaxial Mechanical Strain

American Journal Of Sports Medicine.Volume 28 #6.....November/December 2000..page 888 - 892

---------

".....in healing tendons the effect of mechanical loading, or its absence, is dramatic."

"Many studies show that tendons adapt to mechanical loading.....the healing of injured tendons comprises rapid proliferation and remodeling, and here the effects of mechanical loading is dramatic. Numerous animal studies show that immobilization of a healing tendon compromises the healing process."

"Patients with Achillies tendon injuries often have the injured limb immobilized for several weeks. Because animal data suggest that this impairs healing so much, it is important to develop clinical loading regimes during healing."

".....patients might be allowed early short loading episodes following for example, an Achillies tendon rupture, for a better outcome

T. Andersson, et al

Tissue Memory In Healing Tendons:Short Loading Episodes Stimulate Healing

Journal Of Applied Physiology......Volume 107 #2.....August 2009......page 417

Nutrition & Healing -----

Protein and vitamin C comprise portions of the tissues you're looking to heal, so their intake should be increased temporarily to improve the rate of healing. since their availability in your tissues will affect the rate of tissue regeneration. You may benefit from several days of --- protein 1.5 - 2.0 grams of proteing per kg of your body weight, Vitamin C 500mg, zinc 30 - 50mg, magnesium 500mg, a few grams of the amino acids leucine and arginine, 2 teaspoons liquid colostrum, Vitamin D 6000IU to 10,000IU, Lugol's Iodine 7 - 15mg.

The Role of Stretching [Range of Motion] -----

You'll find that muscle and tendon respond to what is done, and -not-- done. For example ------- sitting at a desk at work//school for many hours per day for many years means you're in a hip flexion position for many hours per day for many years. One should expect to see tight hip flexor muscles and tendons after a period of years, and perhaps lower back problems that may accompany them......Also, sitting at a desk at work//school for many hours per day for many years means you're in a -knee- flexion position for many hours per day for many years. One should expect to see tight -knee- flexor muscles and tendons [ie. hamstring, calf] after a period of years. That gradual loss of flexibility over time is due to exposing muscles and tendons to a given position for many hours per day for many years, without exposing them to the opposite position in a sufficient manner............that's -not- about age or aging.

The duration of stretch needed to increase muscle and tendon "pliability" prior to a workout, is somewhat different than that required to increase or maintain long term "range of motion". Its best to treat stretching in your training program, in the same manner as you would strength training............in that you should have a designated day(s) for specifically going through a designed routine. Muscle and tendon fibers respond to stretching sessions in a similar manner as strength training. Rather than gaining a wider width though, they get longer by adding more sections. If a muscle//tendon lacks the -length-- to allow for limb-joint movement through it's sport required range of motion..some sort of tissue damage should be expected.

The duration of the stimulus [how long you hold the stretch] determines the potency of the stimulus applied [though, a high frequency can take the place of a long duration]. The durations should be about 3 minutes for each position. In this manner, stretching should be treated as a workout, not preparation for a workout.

Usual Complications Of Running Injuries -----

If you've had an injury for a while, and haven't seen improvement inspite of things you've tried, the reason the pain persists is most likely because you haven't yet done anything that would improve the tissue's ability to withstand your training/racing loads. If the strength of the tissue in question is insufficient to match the strength needed to endure your training.....you "will" experience pain at some point, independent of what shoes you wear or how much they cost, or how biomechanically great or awful your running form is currently. Shoes can't strength train your body's tissues. Some of them are capable of reducing the motions of the foot in a manner that reduces the amount of strength your lower leg muscles must have to endure your training loads, and improvements in running form can have the same effect. But as the shoes wear out with use, their ability to provide this function wears out with them. The safest long term solution is to strength train. Rest, ice, stretching, anti-inflammatories........of these, none will improve the tissue's ability to withstand your training/racing loads.

Slow The Rate Of Application Of Training Loads -----

When the rate of application of the training loads exceeds the rate of adaptation of the body tissues, injury will eventually result in whatever tissue is your weakest link at that time. If you run every day, you're applying your training loads at a rate of approximately once every 24 hours. Reduce the rate of application of your training loads temporarily since it is clear that the current rate exceeds what the tissue can handle. You can slow the rate of application of your training loads by reducing how frequently you train. The way to do this is to provide for "OFF" days in your training (ie. every 2 - 3 days). "OFF" days are not cross-training days.......OFF days is are days that allow recovery, restoration, and adaptation to your training. If at some point in a given week, the tissue in your IT-band, shin, knee, or foot requires 48 hours without a training load placed on it, but you provide only 24 hours...injury is likely.

Reduce Training Loads -----

Reduce the magnitude of application of your training loads temporarily since it is clear that the current magnitude exceeds what the tissue can handle. You can reduce the magnitude of application of your training loads by reducing how long you train.......keep each training session to less than 20 minutes.

Say No To Drugs -----

Following the initial 24-48 hour period of injury, application of heat stimulus (5 - 10 minutes limb water submersion 100-105 degrees F) should be used to increase blood flow and energy production for repair processes. Ingestion of NSAID's (anti-inflamatories) should be avoided since this will impair recovery, and potentially mask pain, leading one to believe it is ok to return to training.

Never...ever....under "any" circumstances...allow a doctor to inject the tissue with cortisone or any other substance that is well known to cause degradation of collagen and other tissue proteins.

Just say --no-- to drugs..........

"The use of nonsteroidal anti-inflammatory drugs for the treatment of tendon inflammation might increase the levels of leukotriene B4 within the tendon, potentially contributing to the development of tendinopathy."

"This finding is of interest because NSAID's are routinely used in clinical practice for the symptomatic treatment of tendinopathy, such as inflammation and pain."

"..the increased LTB4 level due to treatment with NSAID's could potentially exacerbate the situation by leading to neutrophilic infiltration and lymphocytic activation, paradoxically causing further inflammatory and degenerative changes in the tendon."

"..the results of this study suggest that the routine use of COX inhibitors for the symptomatic relief of inflammatory tendon conditions might inadvertently worsen the processes responsible for the development of tendinopathy."

Zhaozhu Li, et. al

Inflammatory Response Of Human Tendon Fibroblasts To Cyclic Mechanical Stretching

The American Journal Of Sports Medicine..Volume 32 #2....2004...page 435 - 439

-------

iceing = cryotherapy --- just say no to cryotherapy.........

"....the administration of nonsteroidal anti-inflammatory drugs or cryotherapy are common clinical practices to control the inflammatory process following connective tissue injury. However, there are contradictory conclusions on the potential of anti-inflammatory strategies to either prevent nonspecific damages or accelerate healing after acute tendon or ligament trauma."

"Cumulative evidences also show that, apart from releasing catabolic enzymes, inflammatory cells can ultimately favor tissue healing through different biological processes."

"Indeed, after the clearance of pathogens and other signals of danger, neutrophils will undergo apoptosis and be engulfed by phagocytic macrophages. Macrophages will then release growth factors that can stimulate fibroblast proliferation, collagen synthesis, and angiogenesis during the early phase of healing."

D.Marsolais, et al

Inflammatory cells do not decrease the ultimate tensile strength of intact tendons in vivo and in vitro: protective role of mechanical loading

Journal Of Applied Physiology.......Volume 102 #1......January 2007.....page 11 - 17

Restatement Of The Facts --------------------

--- The strength of the involved tissue must be raised to a sufficient level to match the strength needed to endure your training.

--- Start with whatever amount of weight is well tolerated, and progress from there.

--- follow a "hurt not harm" principle.....when doing high intensity strength training of the involved tissues.

--- Avoid recurrent attempts to return to training before the tissue has acquired the strength necessary to endure your training loads.

The problem should improve, if not resolve, quickly with strength training (within a few days following 4 back to back strength sessions).

.

.

Iliotibial (IT) Band Syndome

Mechanisms Of Injury

1. When a given tissue lacks the strength to endure your training loads...you "will" get injured.

2. When the rate of application of your training loads exceeds the body's rate of adaptation to the training...you "will" get injured

3. muscle//tendon lacks the -length-- necessary for movement through sport required range of motion.

From a physical standpoint, injury consists of micro-tears in the thick sheet of tissue (fascia) that runs down the outer side of the leg from the upper hip to below the knee. The fascia is comprised of a protein called collagen. Collagen is produced by cells called fibroblasts. The more force the attached muscle is trained to produce, the more force the muscle and the tendon will be trained to endure. The IT band is attached to the glute muscles (butt muscles) and the tensor fascia latae (small muscle on the front/outside of the hip does hip flexion motion (raises thigh).

Just say no to practitioners of traditional Sports Medicine...........

"......primary research evidence only accounted for 24% of management......."

"Practitioners were unaware of literature supporting over 50% of the treatment modalities they used."

"This study highlights a lack of evidence base, a lack of knowledge of the research evidence..that is available for these conditions."

"Practitioners practiced evidence based medicine in under 50% of cases."

I.R. Murray, et al

How Evidence Based Is The Management Of Two Common Sports Injuries In A Sports Injury Clinic?

British Journal Of Sports Medicine..Volume 39 #12...December 2005..page 912

ETG Evidence Based Competent Self-Care Injury Repair: Increase Strength Of Involved Tissues -----

High intensity work, based on a "hurt not harm" principle, is what yields results. If you're doing exercises with weight/resistance that allows you to do 12 - 20 reps without stopping.....this slows/prevents recovery, even though you are doing......"strength training"

Hip Abduction exercise (leg moving in out to the side, away from the midline of the body), stationary jumping exercises, are both effective. Start with whatever amount of weight is well tolerated, and progress from there. Use high resistance/weight (doing 5 - 8 reps...cumulative total per training session) preferably once a day, each day for 1 - 2 weeks. Work with a weight you cannot lift more than 3 times without stopping. Precede this with a set of about 3 repetitions of low to moderate weight, with each repetition done extremely slowly.

1/4 squat exercise with high weight is effective. Use high resistance/weight (doing 5 - 8 reps...cumulative total per training session) preferably once a day, each day for 1 - 2 weeks. Work with a weight you cannot lift more than 3 times without stopping. Precede this with a set of about 3 repetitions of low to moderate weight, with each repetition done extremely slowly.

Exercise List -----

[Start with whatever amount of weight is well tolerated]

--- Hip Abduction

--- 1/4 squat exercise

--- stationary jumping [one leg at a time]

"Two Stanford University studies suggest that weakness in the hip abductors is another factor in IT Band Syndrome. Fredericson et al first evaluated 24 runners with ITBS and found that they all had significant weakness in the hip abductors of their affected limb compared with the uninjured limb and control runnes."

M. Fredericson, C. Wolf

Illiotibial Band Syndrome In Runners: Innovations In Treatment

Sports Medicine...Volume 35 #5...2005...page 453

Heal Faster ---------

The primary reasons injuries often take people several weeks to several months to deal with are;

--- Provinding a low or no stimulus for healing. Doing so-called "strengthening exercises" with little or no weight//resistance [ie. use of rubber tubing, etc]. The amount of weight/resistance determines the amount of stimulus for cells that are responsible for healing.

--- Doing a bunch of reps and sets of "strengthening exercises" with no progressive increase in weight//resistance as strength of the tissues increase.

--- The frequency of application of a strengthening stimulus is a major determining factor on the rate of healing. If you're seeing a physical therapist, chances are you'll be going only once or twice a week. If this is the only time that strengthening of the tissue is being induced, recovery will take quite a few weeks.

--- Multiple uses of ice, anti-inflammatories, and anything else that decreases blood flow to a healing tissue, and/or decreases immune cell function in and around a healing tissue.....will also account for a slow recovery time. Rest and stretching are usually insufficient to improve the tissue's ability to withstand training loads.

--- Recurrent attempts to return to training before the tissue has acquired the strength necessary to endure their training loads.

"The repair and maintenance of connective tissues is performed predominately by.....cell known as a fibroblast. The activity of this cell is regulated, in part, by changes in the mechanical environment in which it resides."

M. Eastwood, D.A., McGrouther, R.A. Brown.....1998

Fibroblast Responses To Mechanical Forces.

Journal of Engineering in Medicine.....Volume 212 #2.....1998.....page 85 - 92

----------

".......the proliferation and activation of tendon fibroblasts is dependent upon the mechanical force applied...."

"Improved fibroblast response may lead to improved tensile strength of the healing tissue and identifying the optimal pressure to facilitate this response may lead to fewer treatment sessions."

G.M.Gehlsen, L.R.Ganion, R.Helfst.....1999

Fibroblast Responses To Variation In Soft Tissue Mobilization Pressure

Medicine & Science In Sports & Exercise.....Volume 31 #4 1999

----------

"This study shows that application of mechanical stress to tendon fibroblasts resulted in an alteration of cellular proliferation depending on the stress time."

J. Zeichen, M.van Griensven, U. Bosch.....2000

The Proliferative Response Of Isolated Human Tendon Fibroblasts To Cyclic Biaxial Mechanical Strain

American Journal Of Sports Medicine.Volume 28 #6.....November/December 2000..page 888 - 892

---------

".....in healing tendons the effect of mechanical loading, or its absence, is dramatic."

"Many studies show that tendons adapt to mechanical loading.....the healing of injured tendons comprises rapid proliferation and remodeling, and here the effects of mechanical loading is dramatic. Numerous animal studies show that immobilization of a healing tendon compromises the healing process."

"Patients with Achillies tendon injuries often have the injured limb immobilized for several weeks. Because animal data suggest that this impairs healing so much, it is important to develop clinical loading regimes during healing."

".....patients might be allowed early short loading episodes following for example, an Achillies tendon rupture, for a better outcome

T. Andersson, et al

Tissue Memory In Healing Tendons:Short Loading Episodes Stimulate Healing

Journal Of Applied Physiology......Volume 107 #2.....August 2009......page 417

Nutrition & Healing -----

Protein and vitamin C comprise portions of the tissues you're looking to heal, so their intake should be increased temporarily to improve the rate of healing. since their availability in your tissues will affect the rate of tissue regeneration. You may benefit from several days of --- protein 1.5 - 2.0 grams of proteing per kg of your body weight, Vitamin C 500mg, zinc 30 - 50mg, magnesium 500mg, a few grams of the amino acids leucine and arginine, 2 teaspoons liquid colostrum, Vitamin D 6000IU to 10,000IU, Lugol's Iodine 7 - 15mg.

The Role of Stretching [Range of Motion] -----

You'll find that muscle and tendon respond to what is done, and -not-- done. For example ------- sitting at a desk at work//school for many hours per day for many years means you're in a hip flexion position for many hours per day for many years. One should expect to see tight hip flexor muscles and tendons after a period of years, and perhaps lower back problems that may accompany them......Also, sitting at a desk at work//school for many hours per day for many years means you're in a -knee- flexion position for many hours per day for many years. One should expect to see tight -knee- flexor muscles and tendons [ie. hamstring, calf] after a period of years. That gradual loss of flexibility over time is due to exposing muscles and tendons to a given position for many hours per day for many years, without exposing them to the opposite position in a sufficient manner............that's -not- about age or aging.

The duration of stretch needed to increase muscle and tendon "pliability" prior to a workout, is somewhat different than that required to increase or maintain long term "range of motion". Its best to treat stretching in your training program, in the same manner as you would strength training............in that you should have a designated day(s) for specifically going through a designed routine. Muscle and tendon fibers respond to stretching sessions in a similar manner as strength training. Rather than gaining a wider width though, they get longer by adding more sections. If a muscle//tendon lacks the -length-- to allow for limb-joint movement through it's sport required range of motion..some sort of tissue damage should be expected.

The duration of the stimulus [how long you hold the stretch] determines the potency of the stimulus applied [though, a high frequency can take the place of a long duration]. The durations should be about 3 minutes for each position. In this manner, stretching should be treated as a workout, not preparation for a workout.

Usual Complications Of Running Injuries -----

If you've had an injury for a while, and haven't seen improvement inspite of things you've tried, the reason the pain persists is most likely because you haven't yet done anything that would improve the tissue's ability to withstand your training/racing loads. If the strength of the tissue in question is insufficient to match the strength needed to endure your training.....you "will" experience pain at some point, independent of what shoes you wear or how much they cost, or how biomechanically great or awful your running form is currently. Shoes can't strength train your body's tissues. Some of them are capable of reducing the motions of the foot in a manner that reduces the amount of strength your lower leg muscles must have to endure your training loads, and improvements in running form can have the same effect. But as the shoes wear out with use, their ability to provide this function wears out with them. The safest long term solution is to strength train. Rest, ice, stretching, anti-inflammatories........of these, none will improve the tissue's ability to withstand your training/racing loads.

Slow The Rate Of Application Of Training Loads -----

When the rate of application of the training loads exceeds the rate of adaptation of the body tissues, injury will eventually result in whatever tissue is your weakest link at that time. If you run every day, you're applying your training loads at a rate of approximately once every 24 hours. Reduce the rate of application of your training loads temporarily since it is clear that the current rate exceeds what the tissue can handle. You can slow the rate of application of your training loads by reducing how frequently you train. The way to do this is to provide for "OFF" days in your training (ie. every 2 - 3 days). "OFF" days are not cross-training days.......OFF days is are days that allow recovery, restoration, and adaptation to your training. If at some point in a given week, the tissue in your IT-band, shin, knee, or foot requires 48 hours without a training load placed on it, but you provide only 24 hours...injury is likely.

Reduce Training Loads -----

Reduce the magnitude of application of your training loads temporarily since it is clear that the current magnitude exceeds what the tissue can handle. You can reduce the magnitude of application of your training loads by reducing how long you train.......keep each training session to less than 20 minutes.

Say No To Drugs -----

Following the initial 24-48 hour period of injury, application of heat stimulus (5 - 10 minutes limb water submersion 100-105 degrees F) should be used to increase blood flow and energy production for repair processes. Ingestion of NSAID's (anti-inflamatories) should be avoided since this will impair recovery, and potentially mask pain, leading one to believe it is ok to return to training.

Never...ever....under "any" circumstances...allow a doctor to inject the tissue with cortisone or any other substance that is well known to cause degradation of collagen and other tissue proteins.

Just say --no-- to drugs..........

"The use of nonsteroidal anti-inflammatory drugs for the treatment of tendon inflammation might increase the levels of leukotriene B4 within the tendon, potentially contributing to the development of tendinopathy."

"This finding is of interest because NSAID's are routinely used in clinical practice for the symptomatic treatment of tendinopathy, such as inflammation and pain."

"..the increased LTB4 level due to treatment with NSAID's could potentially exacerbate the situation by leading to neutrophilic infiltration and lymphocytic activation, paradoxically causing further inflammatory and degenerative changes in the tendon."

"..the results of this study suggest that the routine use of COX inhibitors for the symptomatic relief of inflammatory tendon conditions might inadvertently worsen the processes responsible for the development of tendinopathy."

Zhaozhu Li, et. al

Inflammatory Response Of Human Tendon Fibroblasts To Cyclic Mechanical Stretching

The American Journal Of Sports Medicine..Volume 32 #2....2004...page 435 - 439

-------

iceing = cryotherapy --- just say no to cryotherapy.......

"....the administration of nonsteroidal anti-inflammatory drugs or cryotherapy are common clinical practices to control the inflammatory process following connective tissue injury. However, there are contradictory conclusions on the potential of anti-inflammatory strategies to either prevent nonspecific damages or accelerate healing after acute tendon or ligament trauma."

"Cumulative evidences also show that, apart from releasing catabolic enzymes, inflammatory cells can ultimately favor tissue healing through different biological processes."

"Indeed, after the clearance of pathogens and other signals of danger, neutrophils will undergo apoptosis and be engulfed by phagocytic macrophages. Macrophages will then release growth factors that can stimulate fibroblast proliferation, collagen synthesis, and angiogenesis during the early phase of healing."

D.Marsolais, et al

Inflammatory cells do not decrease the ultimate tensile strength of intact tendons in vivo and in vitro: protective role of mechanical loading

Journal Of Applied Physiology.......Volume 102 #1......January 2007.....page 11 - 17

Restatement Of The Facts --------------------

--- The strength of the involved tissue must be raised to a sufficient level to match the strength needed to endure your training.

--- Start with whatever amount of weight is well tolerated, and progress from there.

--- follow a "hurt not harm" principle.....when doing high intensity strength training of the involved tissues.

--- Avoid recurrent attempts to return to training before the tissue has acquired the strength necessary to endure your training loads.

The problem should improve, if not resolve, quickly with strength training (within a few days following 4 back to back strength sessions).

.

.

Knee Pain: Patella tendonitis

Mechanisms Of Injury

1. When a given tissue lacks the strength to endure your training loads...you "will" get injured.

2. When the rate of application of your training loads exceeds the body's rate of adaptation to the training...you "will" get injured

3. muscle//tendon lacks the -length-- necessary for movement through sport required range of motion.

From a physical standpoint, injury consists of micro-tears in tendon tissue at the junction between the patella and the tendon, or the tendon and the tibia bone (lower leg). Tendonitis is a general term that covers this type of injury. Tendon is comprised of a protein called collagen. Collagen is produced by cells called fibroblasts.

Just say no to practitioners of traditional Sports Medicine...........

"......primary research evidence only accounted for 24% of management......."

"Practitioners were unaware of literature supporting over 50% of the treatment modalities they used."

"This study highlights a lack of evidence base, a lack of knowledge of the research evidence..that is available for these conditions."

"Practitioners practiced evidence based medicine in under 50% of cases."

I.R. Murray, et al

How Evidence Based Is The Management Of Two Common Sports Injuries In A Sports Injury Clinic?

British Journal Of Sports Medicine..Volume 39 #12...December 2005..page 912

ETG Evidence Based Competent Self-Care Injury Repair: Increase Strength Of Involved Tissues -----

High intensity work, based on a "hurt not harm" principle, is what yields results. If you're doing exercises with weight/resistance that allows you to do 12 - 20 reps without stopping.....this slows/prevents recovery, even though you are doing......"strength training"

1/4 squat exercise with high weight, and stationary jumping exercise, are effective. Start with whatever amount of weight is well tolerated, and progress from there.

1/4 squat (single leg) is a squat done on one leg, going only 1/4 of the way down...rather than going all the way down to a sitting position or further. Strength training adaptations are specific to the range of motion trained in the weight room. You're never in a sitting position when you run, you're in a 1/4 squat position during the stance phase of the running stride......that's as far down as you get when running, thus its as far down as you should go in the weight room.

Use high resistance/weight (doing 5 - 8 reps...cumulative total per training session) preferably once a day, each day for 1 - 2 weeks. Work with a weight you cannot lift more than 3 times without stopping. Precede this with a set of about 3 repetitions of low to moderate weight, with each repetition done extremely slowly.

ETG Exercise List -----

[Start with whatever amount of weight is well tolerated]

--- 1/4 squat exercise

--- stationary jumping [one leg at a time]

Heal Faster ---------

The primary reasons injuries often take people several weeks to several months to deal with are;

--- Provinding a low or no stimulus for healing. Doing so-called "strengthening exercises" with little or no weight//resistance [ie. use of rubber tubing, etc]. The amount of weight/resistance determines the amount of stimulus for cells that are responsible for healing.

--- Doing a bunch of reps and sets of "strengthening exercises" with no progressive increase in weight//resistance as strength of the tissues increase.

--- The frequency of application of a strengthening stimulus is a major determining factor on the rate of healing. If you're seeing a physical therapist, chances are you'll be going only once or twice a week. If this is the only time that strengthening of the tissue is being induced, recovery will take quite a few weeks.

--- Multiple uses of ice, anti-inflammatories, and anything else that decreases blood flow to a healing tissue, and/or decreases immune cell function in and around a healing tissue.....will also account for a slow recovery time. Rest and stretching are usually insufficient to improve the tissue's ability to withstand training loads.

--- Recurrent attempts to return to training before the tissue has acquired the strength necessary to endure their training loads.

"The repair and maintenance of connective tissues is performed predominately by.....cell known as a fibroblast. The activity of this cell is regulated, in part, by changes in the mechanical environment in which it resides."

M. Eastwood, D.A., McGrouther, R.A. Brown.....1998

Fibroblast Responses To Mechanical Forces.

Journal of Engineering in Medicine.....Volume 212 #2.....1998.....page 85 - 92

----------

".......the proliferation and activation of tendon fibroblasts is dependent upon the mechanical force applied...."

"Improved fibroblast response may lead to improved tensile strength of the healing tissue and identifying the optimal pressure to facilitate this response may lead to fewer treatment sessions."

G.M.Gehlsen, L.R.Ganion, R.Helfst.....1999

Fibroblast Responses To Variation In Soft Tissue Mobilization Pressure

Medicine & Science In Sports & Exercise.....Volume 31 #4 1999

----------

"This study shows that application of mechanical stress to tendon fibroblasts resulted in an alteration of cellular proliferation depending on the stress time."

J. Zeichen, M.van Griensven, U. Bosch.....2000

The Proliferative Response Of Isolated Human Tendon Fibroblasts To Cyclic Biaxial Mechanical Strain

American Journal Of Sports Medicine.Volume 28 #6.....November/December 2000..page 888 - 892

---------

".....in healing tendons the effect of mechanical loading, or its absence, is dramatic."

"Many studies show that tendons adapt to mechanical loading.....the healing of injured tendons comprises rapid proliferation and remodeling, and here the effects of mechanical loading is dramatic. Numerous animal studies show that immobilization of a healing tendon compromises the healing process."

"Patients with Achillies tendon injuries often have the injured limb immobilized for several weeks. Because animal data suggest that this impairs healing so much, it is important to develop clinical loading regimes during healing."

".....patients might be allowed early short loading episodes following for example, an Achillies tendon rupture, for a better outcome

T. Andersson, et al

Tissue Memory In Healing Tendons:Short Loading Episodes Stimulate Healing

Journal Of Applied Physiology......Volume 107 #2.....August 2009......page 417

Nutrition & Healing -----

Protein and vitamin C comprise portions of the tissues you're looking to heal, so their intake should be increased temporarily to improve the rate of healing. since their availability in your tissues will affect the rate of tissue regeneration. You may benefit from several days of --- protein 1.5 - 2.0 grams of proteing per kg of your body weight, Vitamin C 500mg, zinc 30 - 50mg, magnesium 500mg, a few grams of the amino acids leucine and arginine, 2 teaspoons liquid colostrum, Vitamin D 6000IU to 10,000IU, Lugol's Iodine 7 - 15mg.

The Role of Stretching [Range of Motion] -----

You'll find that muscle and tendon respond to what is done, and -not-- done. For example ------- sitting at a desk at work//school for many hours per day for many years means you're in a hip flexion position for many hours per day for many years. One should expect to see tight hip flexor muscles and tendons after a period of years, and perhaps lower back problems that may accompany them......Also, sitting at a desk at work//school for many hours per day for many years means you're in a -knee- flexion position for many hours per day for many years. One should expect to see tight -knee- flexor muscles and tendons [ie. hamstring, calf] after a period of years. That gradual loss of flexibility over time is due to exposing muscles and tendons to a given position for many hours per day for many years, without exposing them to the opposite position in a sufficient manner............that's -not- about age or aging.

The duration of stretch needed to increase muscle and tendon "pliability" prior to a workout, is somewhat different than that required to increase or maintain long term "range of motion". Its best to treat stretching in your training program, in the same manner as you would strength training............in that you should have a designated day(s) for specifically going through a designed routine. Muscle and tendon fibers respond to stretching sessions in a similar manner as strength training. Rather than gaining a wider width though, they get longer by adding more sections. If a muscle//tendon lacks the -length-- to allow for limb-joint movement through it's sport required range of motion..some sort of tissue damage should be expected.

The duration of the stimulus [how long you hold the stretch] determines the potency of the stimulus applied [though, a high frequency can take the place of a long duration]. The durations should be about 3 minutes for each position. In this manner, stretching should be treated as a workout, not preparation for a workout.

Usual Complications Of Running Injuries -----

If you've had an injury for a while, and haven't seen improvement inspite of things you've tried, the reason the pain persists is most likely because you haven't yet done anything that would improve the tissue's ability to withstand your training/racing loads. If the strength of the tissue in question is insufficient to match the strength needed to endure your training.....you "will" experience pain at some point, independent of what shoes you wear or how much they cost, or how biomechanically great or awful your running form is currently. Shoes can't strength train your body's tissues. Some of them are capable of reducing the motions of the foot in a manner that reduces the amount of strength your lower leg muscles must have to endure your training loads, and improvements in running form can have the same effect. But as the shoes wear out with use, their ability to provide this function wears out with them. The safest long term solution is to strength train. Rest, ice, stretching, anti-inflammatories........of these, none will improve the tissue's ability to withstand your training/racing loads.

Slow The Rate Of Application Of Training Loads -----

When the rate of application of the training loads exceeds the rate of adaptation of the body tissues, injury will eventually result in whatever tissue is your weakest link at that time. If you run every day, you're applying your training loads at a rate of approximately once every 24 hours. Reduce the rate of application of your training loads temporarily since it is clear that the current rate exceeds what the tissue can handle. You can slow the rate of application of your training loads by reducing how frequently you train. The way to do this is to provide for "OFF" days in your training (ie. every 2 - 3 days). "OFF" days are not cross-training days.......OFF days is are days that allow recovery, restoration, and adaptation to your training. If at some point in a given week, the tissue in your IT-band, shin, knee, or foot requires 48 hours without a training load placed on it, but you provide only 24 hours...injury is likely.

Reduce Training Loads -----

Reduce the magnitude of application of your training loads temporarily since it is clear that the current magnitude exceeds what the tissue can handle. You can reduce the magnitude of application of your training loads by reducing how long you train.......keep each training session to less than 20 minutes.

Say No To Drugs -----

Following the initial 24-48 hour period of injury, application of heat stimulus (5 - 10 minutes limb water submersion 100-105 degrees F) should be used to increase blood flow and energy production for repair processes. Ingestion of NSAID's (anti-inflamatories) should be avoided since this will impair recovery, and potentially mask pain, leading one to believe it is ok to return to training.

Never...ever....under "any" circumstances...allow a doctor to inject the tissue with cortisone or any other substance that is well known to cause degradation of collagen and other tissue proteins.

Just say --no-- to drugs..........

"The use of nonsteroidal anti-inflammatory drugs for the treatment of tendon inflammation might increase the levels of leukotriene B4 within the tendon, potentially contributing to the development of tendinopathy."

"This finding is of interest because NSAID's are routinely used in clinical practice for the symptomatic treatment of tendinopathy, such as inflammation and pain."

"..the increased LTB4 level due to treatment with NSAID's could potentially exacerbate the situation by leading to neutrophilic infiltration and lymphocytic activation, paradoxically causing further inflammatory and degenerative changes in the tendon."

"..the results of this study suggest that the routine use of COX inhibitors for the symptomatic relief of inflammatory tendon conditions might inadvertently worsen the processes responsible for the development of tendinopathy."

Zhaozhu Li, et. al

Inflammatory Response Of Human Tendon Fibroblasts To Cyclic Mechanical Stretching

The American Journal Of Sports Medicine..Volume 32 #2....2004...page 435 - 439

-------

iceing = cryotherapy --- just say no to cryotherapy.......

"....the administration of nonsteroidal anti-inflammatory drugs or cryotherapy are common clinical practices to control the inflammatory process following connective tissue injury. However, there are contradictory conclusions on the potential of anti-inflammatory strategies to either prevent nonspecific damages or accelerate healing after acute tendon or ligament trauma."

"Cumulative evidences also show that, apart from releasing catabolic enzymes, inflammatory cells can ultimately favor tissue healing through different biological processes."

"Indeed, after the clearance of pathogens and other signals of danger, neutrophils will undergo apoptosis and be engulfed by phagocytic macrophages. Macrophages will then release growth factors that can stimulate fibroblast proliferation, collagen synthesis, and angiogenesis during the early phase of healing."

D.Marsolais, et al

Inflammatory cells do not decrease the ultimate tensile strength of intact tendons in vivo and in vitro: protective role of mechanical loading

Journal Of Applied Physiology.......Volume 102 #1......January 2007.....page 11 - 17

Restatement Of The Facts --------------------

--- The strength of the involved tissue must be raised to a sufficient level to match the strength needed to endure your training.

--- Start with whatever amount of weight is well tolerated, and progress from there.

--- follow a "hurt not harm" principle.....when doing high intensity strength training of the involved tissues.

--- Avoid recurrent attempts to return to training before the tissue has acquired the strength necessary to endure your training loads.

The problem should improve, if not resolve, quickly with strength training (within a few days following 4 back to back strength sessions).

.

"Our species moving closer to 4:25 per mile pace for half-marathon [about 13.1 miles]. We're gonna see a sub-2 hour marathon within the next few years. Human performance marches on as we loosen our obsession with training volume and focus on training velocity and body rest. In our life time we're gonna see a sub 3:40 mile, women go sub 4:00 for the mile and sub 1:50 for 800m.

Gladly, each advance in human performance has confronted us with ourselves, our mindsets, our constant setting and re-setting of limitations that keep turning out to -not- exist.

As any monk learning Kung Fu at a Shaolin temple already knows, our cells can do some pretty serious stuff.

Just a matter of learning how to go about training them to do it, preferably in a methodical, controllable way rather than by the luck of one track season, once, stumbling upon something that works.

In track & field, perhaps the best example of the setting and re-setting of artificial limitations started in the middle of the last century. The term, "the 4:00 mile", rarely failed to appear in the same sentence with the word, "barrier". Then somebody ran sub 4:00. And then somebody ran a 2 mile race averaging sub 4:00. "

More greatness here:

"ETG Position Statement:

The Most Fit At Velocities Trained On Most

Your highest level of fitness will be at the paces upon which you do the most training. If you're following a mileage [volume] oriented training program, add up your "easy days", "recovery days", "morning runs", and long runs.

If most of your training is at 9:00 - 10:00 per mile pace, that is where you will be the most fit.

If most of your training is at 8:00 - 9:00 per mile pace, that is where you will be the most fit.

If most of your training is at 7:00 - 8:00 per mile pace, that is where you will be the most fit.

If most of your training is at 6:00 - 7:00 per mile pace, that is where you will be the most fit.

If most of your training is at 5:00 - 6:00 per mile pace, that is where you will be the most fit.

If most of your training is at 4:20 - 5:00 per mile pace, that is where you will be the most fit.

Your highest level of fitness will be at the paces upon which you do the most training.

If most of your training is at 6:00 - 7:00 per mile pace, that is where you will be the most fit.

If most of your training is at 5:00 - 6:00 per mile pace, that is where you will be the most fit.

If most of your training is at 4:30 - 5:00 per mile pace, that is where you will be the most fit.

If most of your training is at 4:10 - 4:30 per mile pace, that is where you will be the most fit.

If most of your training is at 3:50 - 4:10 per mile pace, that is where you will be the most fit.

If most of your training is at 3:30 - 4:00 per mile pace, that is where you will be the most fit.

The Reality As Long As You Live In This World ------ If you abandon the mileage [volume] oriented training program, by deleting the workouts that produce most of the mileage, your "easy days", "recovery days", "morning runs", and long runs.....you can more easily train on faster paces without over-training.

Your highest level of fitness will be at those faster paces, because your highest level of fitness will be at the paces upon which you do the most training."

whitey wrote:

Hmmm, this website has a lot of gems:

Oh they've covered this guy here at LetsRun before. Do a search. Plenty of entertainment.

.

Hamstrings Problems

Just say no to practitioners of traditional Sports Medicine...........

"......primary research evidence only accounted for 24% of management......."

"Practitioners were unaware of literature supporting over 50% of the treatment modalities they used."

"This study highlights a lack of evidence base, a lack of knowledge of the research evidence..that is available for these conditions."

"Practitioners practiced evidence based medicine in under 50% of cases."

I.R. Murray, et al

How Evidence Based Is The Management Of Two Common Sports Injuries In A Sports Injury Clinic?

British Journal Of Sports Medicine..Volume 39 #12...December 2005..page 912

ETG Evidence Based Competent Self-Care Injury Repair: Increase Strength Of Involved Tissues -----

High intensity work, based on a "hurt not harm" principle, is what yields results. If you're doing exercises with weight/resistance that allows you to do 12 - 20 reps without stopping.....this slows/prevents recovery, even though you are doing......"strength training"

Hamstring curls (lying on your stomach, flexing the knee to curl the lower leg towards the butt) should be done in the range of motion, going from the leg straight moving toward the butt, stopping about halfway there. Use high resistance/weight (doing 5 - 8 reps...cumulative total per training session) preferably once a day, each day for 1 - 2 weeks. Work with a weight you cannot lift more than 3 times without stopping. Precede this with a set of about 3 repetitions of low to moderate weight, with each repetition done extremely slowly.

1/4 squat exercise with high weight is effective. Use high resistance/weight (doing 5 - 8 reps...cumulative total per training session) preferably once a day, each day for 1 - 2 weeks. Work with a weight you cannot lift more than 3 times without stopping. Precede this with a set of about 3 repetitions of low to moderate weight, with each repetition done extremely slowly.

Range of motion exercise can be done --- such as sitting with legs straight in front of you, and leaning forward till you feel a stretch in lower back and hamstrings. Range of motion exercise should be included to increase the length (number of sarcomeres) of the muscle fibers by holding the stretch once or twice for 2 - 3 minutes on consecutive days, or doing many shorter (15 - 30 seconds) on multiple (30 - 50) occasions throughout a day.

ETG Exercise List -----

[Start with whatever amount of weight is well tolerated]

--- Hamstring curls

--- 1/4 squat exercise

--- Range of motion exercise

--- stationary jumping [one leg at a time]

Heal Faster ---------

The primary reasons injuries often take people several weeks to several months to deal with are;

--- Provinding a low or no stimulus for healing. Doing so-called "strengthening exercises" with little or no weight//resistance [ie. use of rubber tubing, etc]. The amount of weight/resistance determines the amount of stimulus for cells that are responsible for healing.

--- Doing a bunch of reps and sets of "strengthening exercises" with no progressive increase in weight//resistance as strength of the tissues increase.

--- The frequency of application of a strengthening stimulus is a major determining factor on the rate of healing. If you're seeing a physical therapist, chances are you'll be going only once or twice a week. If this is the only time that strengthening of the tissue is being induced, recovery will take quite a few weeks.

--- Multiple uses of ice, anti-inflammatories, and anything else that decreases blood flow to a healing tissue, and/or decreases immune cell function in and around a healing tissue.....will also account for a slow recovery time. Rest and stretching are usually insufficient to improve the tissue's ability to withstand training loads.

--- Recurrent attempts to return to training before the tissue has acquired the strength necessary to endure their training loads.

"The repair and maintenance of connective tissues is performed predominately by.....cell known as a fibroblast. The activity of this cell is regulated, in part, by changes in the mechanical environment in which it resides."

M. Eastwood, D.A., McGrouther, R.A. Brown.....1998

Fibroblast Responses To Mechanical Forces.

Journal of Engineering in Medicine.....Volume 212 #2.....1998.....page 85 - 92

----------

".......the proliferation and activation of tendon fibroblasts is dependent upon the mechanical force applied...."

"Improved fibroblast response may lead to improved tensile strength of the healing tissue and identifying the optimal pressure to facilitate this response may lead to fewer treatment sessions."

G.M.Gehlsen, L.R.Ganion, R.Helfst.....1999

Fibroblast Responses To Variation In Soft Tissue Mobilization Pressure

Medicine & Science In Sports & Exercise.....Volume 31 #4 1999

----------

"This study shows that application of mechanical stress to tendon fibroblasts resulted in an alteration of cellular proliferation depending on the stress time."

J. Zeichen, M.van Griensven, U. Bosch.....2000

The Proliferative Response Of Isolated Human Tendon Fibroblasts To Cyclic Biaxial Mechanical Strain

American Journal Of Sports Medicine.Volume 28 #6.....November/December 2000..page 888 - 892

---------

".....in healing tendons the effect of mechanical loading, or its absence, is dramatic."

"Many studies show that tendons adapt to mechanical loading.....the healing of injured tendons comprises rapid proliferation and remodeling, and here the effects of mechanical loading is dramatic. Numerous animal studies show that immobilization of a healing tendon compromises the healing process."

"Patients with Achillies tendon injuries often have the injured limb immobilized for several weeks. Because animal data suggest that this impairs healing so much, it is important to develop clinical loading regimes during healing."

".....patients might be allowed early short loading episodes following for example, an Achillies tendon rupture, for a better outcome

T. Andersson, et al

Tissue Memory In Healing Tendons:Short Loading Episodes Stimulate Healing

Journal Of Applied Physiology......Volume 107 #2.....August 2009......page 417

Nutrition & Healing -----

Protein and vitamin C comprise portions of the tissues you're looking to heal, so their intake should be increased temporarily to improve the rate of healing. since their availability in your tissues will affect the rate of tissue regeneration. You may benefit from several days of --- protein 1.5 - 2.0 grams of proteing per kg of your body weight, Vitamin C 500mg, zinc 30 - 50mg, magnesium 500mg, a few grams of the amino acids leucine and arginine, 2 teaspoons liquid colostrum, Vitamin D 6000IU to 10,000IU, Lugol's Iodine 7 - 15mg.

The Role of Stretching [Range of Motion] -----

You'll find that muscle and tendon respond to what is done, and -not-- done. For example ------- sitting at a desk at work//school for many hours per day for many years means you're in a hip flexion position for many hours per day for many years. One should expect to see tight hip flexor muscles and tendons after a period of years, and perhaps lower back problems that may accompany them......Also, sitting at a desk at work//school for many hours per day for many years means you're in a -knee- flexion position for many hours per day for many years. One should expect to see tight -knee- flexor muscles and tendons [ie. hamstring, calf] after a period of years. That gradual loss of flexibility over time is due to exposing muscles and tendons to a given position for many hours per day for many years, without exposing them to the opposite position in a sufficient manner............that's -not- about age or aging.

The duration of stretch needed to increase muscle and tendon "pliability" prior to a workout, is somewhat different than that required to increase or maintain long term "range of motion". Its best to treat stretching in your training program, in the same manner as you would strength training............in that you should have a designated day(s) for specifically going through a designed routine. Muscle and tendon fibers respond to stretching sessions in a similar manner as strength training. Rather than gaining a wider width though, they get longer by adding more sections. If a muscle//tendon lacks the -length-- to allow for limb-joint movement through it's sport required range of motion..some sort of tissue damage should be expected.

The duration of the stimulus [how long you hold the stretch] determines the potency of the stimulus applied [though, a high frequency can take the place of a long duration]. The durations should be about 3 minutes for each position. In this manner, stretching should be treated as a workout, not preparation for a workout.

Usual Complications Of Running Injuries -----

If you've had an injury for a while, and haven't seen improvement inspite of things you've tried, the reason the pain persists is most likely because you haven't yet done anything that would improve the tissue's ability to withstand your training/racing loads. If the strength of the tissue in question is insufficient to match the strength needed to endure your training.....you "will" experience pain at some point, independent of what shoes you wear or how much they cost, or how biomechanically great or awful your running form is currently. Shoes can't strength train your body's tissues. Some of them are capable of reducing the motions of the foot in a manner that reduces the amount of strength your lower leg muscles must have to endure your training loads, and improvements in running form can have the same effect. But as the shoes wear out with use, their ability to provide this function wears out with them. The safest long term solution is to strength train. Rest, ice, stretching, anti-inflammatories........of these, none will improve the tissue's ability to withstand your training/racing loads.

Slow The Rate Of Application Of Training Loads -----

When the rate of application of the training loads exceeds the rate of adaptation of the body tissues, injury will eventually result in whatever tissue is your weakest link at that time. If you run every day, you're applying your training loads at a rate of approximately once every 24 hours. Reduce the rate of application of your training loads temporarily since it is clear that the current rate exceeds what the tissue can handle. You can slow the rate of application of your training loads by reducing how frequently you train. The way to do this is to provide for "OFF" days in your training (ie. every 2 - 3 days). "OFF" days are not cross-training days.......OFF days is are days that allow recovery, restoration, and adaptation to your training. If at some point in a given week, the tissue in your IT-band, shin, knee, or foot requires 48 hours without a training load placed on it, but you provide only 24 hours...injury is likely.

Reduce Training Loads -----

Reduce the magnitude of application of your training loads temporarily since it is clear that the current magnitude exceeds what the tissue can handle. You can reduce the magnitude of application of your training loads by reducing how long you train.......keep each training session to less than 20 minutes.

Say No To Drugs -----

Following the initial 24-48 hour period of injury, application of heat stimulus (5 - 10 minutes limb water submersion 100-105 degrees F) should be used to increase blood flow and energy production for repair processes. Ingestion of NSAID's (anti-inflamatories) should be avoided since this will impair recovery, and potentially mask pain, leading one to believe it is ok to return to training.

Never...ever....under "any" circumstances...allow a doctor to inject the tissue with cortisone or any other substance that is well known to cause degradation of collagen and other tissue proteins.

Just say --no-- to drugs..........

"The use of nonsteroidal anti-inflammatory drugs for the treatment of tendon inflammation might increase the levels of leukotriene B4 within the tendon, potentially contributing to the development of tendinopathy."

"This finding is of interest because NSAID's are routinely used in clinical practice for the symptomatic treatment of tendinopathy, such as inflammation and pain."

"..the increased LTB4 level due to treatment with NSAID's could potentially exacerbate the situation by leading to neutrophilic infiltration and lymphocytic activation, paradoxically causing further inflammatory and degenerative changes in the tendon."

"..the results of this study suggest that the routine use of COX inhibitors for the symptomatic relief of inflammatory tendon conditions might inadvertently worsen the processes responsible for the development of tendinopathy."

Zhaozhu Li, et. al

Inflammatory Response Of Human Tendon Fibroblasts To Cyclic Mechanical Stretching

The American Journal Of Sports Medicine..Volume 32 #2....2004...page 435 - 439

-------

iceing = cryotherapy --- just say no to cryotherapy........

"....the administration of nonsteroidal anti-inflammatory drugs or cryotherapy are common clinical practices to control the inflammatory process following connective tissue injury. However, there are contradictory conclusions on the potential of anti-inflammatory strategies to either prevent nonspecific damages or accelerate healing after acute tendon or ligament trauma."

"Cumulative evidences also show that, apart from releasing catabolic enzymes, inflammatory cells can ultimately favor tissue healing through different biological processes."

"Indeed, after the clearance of pathogens and other signals of danger, neutrophils will undergo apoptosis and be engulfed by phagocytic macrophages. Macrophages will then release growth factors that can stimulate fibroblast proliferation, collagen synthesis, and angiogenesis during the early phase of healing."

D.Marsolais, et al

Inflammatory cells do not decrease the ultimate tensile strength of intact tendons in vivo and in vitro: protective role of mechanical loading

Journal Of Applied Physiology.......Volume 102 #1......January 2007.....page 11 - 17

Restatement Of The Facts --------------------

--- The strength of the involved tissue must be raised to a sufficient level to match the strength needed to endure your training.

--- Start with whatever amount of weight is well tolerated, and progress from there.

--- follow a "hurt not harm" principle.....when doing high intensity strength training of the involved tissues.

--- Avoid recurrent attempts to return to training before the tissue has acquired the strength necessary to endure your training loads.

The problem should improve, if not resolve, quickly with strength training (within a few days following 4 back to back strength sessions).

.

.

Groin Pull

Just say no to practitioners of traditional Sports Medicine...........

"......primary research evidence only accounted for 24% of management......."

"Practitioners were unaware of literature supporting over 50% of the treatment modalities they used."

"This study highlights a lack of evidence base, a lack of knowledge of the research evidence..that is available for these conditions."

"Practitioners practiced evidence based medicine in under 50% of cases."

I.R. Murray, et al

How Evidence Based Is The Management Of Two Common Sports Injuries In A Sports Injury Clinic?

British Journal Of Sports Medicine..Volume 39 #12...December 2005..page 912

ETG Evidence Based Competent Self-Care Injury Repair: Increase Strength Of Involved Tissues -----

High intensity work, based on a "hurt not harm" principle, is what yields results. If you're doing exercises with weight/resistance that allows you to do 12 - 20 reps without stopping.....this slows/prevents recovery, even though you are doing......"strength training"

Hip Adduction exercise (leg moving in toward the midline of the body), stationary jumping exercises, are both effective. Start with whatever amount of weight is well tolerated, and progress from there. Use high resistance/weight (doing 5 - 8 reps...cumulative total per training session) preferably once a day, each day for 1 - 2 weeks. Work with a weight you cannot lift more than 3 times without stopping. Precede this with a set of about 3 repetitions of low to moderate weight, with each repetition done extremely slowly.

ETG Exercise List -----

[Start with whatever amount of weight is well tolerated]

--- Hip Adduction

--- stationary jumping [one leg at a time]

Heal Faster ---------

The primary reasons injuries often take people several weeks to several months to deal with are;

--- Provinding a low or no stimulus for healing. Doing so-called "strengthening exercises" with little or no weight//resistance [ie. use of rubber tubing, etc]. The amount of weight/resistance determines the amount of stimulus for cells that are responsible for healing.

--- Doing a bunch of reps and sets of "strengthening exercises" with no progressive increase in weight//resistance as strength of the tissues increase.

--- The frequency of application of a strengthening stimulus is a major determining factor on the rate of healing. If you're seeing a physical therapist, chances are you'll be going only once or twice a week. If this is the only time that strengthening of the tissue is being induced, recovery will take quite a few weeks.

--- Multiple uses of ice, anti-inflammatories, and anything else that decreases blood flow to a healing tissue, and/or decreases immune cell function in and around a healing tissue.....will also account for a slow recovery time. Rest and stretching are usually insufficient to improve the tissue's ability to withstand training loads.

--- Recurrent attempts to return to training before the tissue has acquired the strength necessary to endure their training loads.

"The repair and maintenance of connective tissues is performed predominately by.....cell known as a fibroblast. The activity of this cell is regulated, in part, by changes in the mechanical environment in which it resides."

M. Eastwood, D.A., McGrouther, R.A. Brown.....1998

Fibroblast Responses To Mechanical Forces.

Journal of Engineering in Medicine.....Volume 212 #2.....1998.....page 85 - 92

----------

".......the proliferation and activation of tendon fibroblasts is dependent upon the mechanical force applied...."

"Improved fibroblast response may lead to improved tensile strength of the healing tissue and identifying the optimal pressure to facilitate this response may lead to fewer treatment sessions."

G.M.Gehlsen, L.R.Ganion, R.Helfst.....1999

Fibroblast Responses To Variation In Soft Tissue Mobilization Pressure

Medicine & Science In Sports & Exercise.....Volume 31 #4 1999

----------

"This study shows that application of mechanical stress to tendon fibroblasts resulted in an alteration of cellular proliferation depending on the stress time."

J. Zeichen, M.van Griensven, U. Bosch.....2000

The Proliferative Response Of Isolated Human Tendon Fibroblasts To Cyclic Biaxial Mechanical Strain

American Journal Of Sports Medicine.Volume 28 #6.....November/December 2000..page 888 - 892

---------

".....in healing tendons the effect of mechanical loading, or its absence, is dramatic."

"Many studies show that tendons adapt to mechanical loading.....the healing of injured tendons comprises rapid proliferation and remodeling, and here the effects of mechanical loading is dramatic. Numerous animal studies show that immobilization of a healing tendon compromises the healing process."

"Patients with Achillies tendon injuries often have the injured limb immobilized for several weeks. Because animal data suggest that this impairs healing so much, it is important to develop clinical loading regimes during healing."

".....patients might be allowed early short loading episodes following for example, an Achillies tendon rupture, for a better outcome

T. Andersson, et al

Tissue Memory In Healing Tendons:Short Loading Episodes Stimulate Healing

Journal Of Applied Physiology......Volume 107 #2.....August 2009......page 417

Nutrition & Healing -----

Protein and vitamin C comprise portions of the tissues you're looking to heal, so their intake should be increased temporarily to improve the rate of healing. since their availability in your tissues will affect the rate of tissue regeneration. You may benefit from several days of --- protein 1.5 - 2.0 grams of proteing per kg of your body weight, Vitamin C 500mg, zinc 30 - 50mg, magnesium 500mg, a few grams of the amino acids leucine and arginine, 2 teaspoons liquid colostrum, Vitamin D 6000IU to 10,000IU, Lugol's Iodine 7 - 15mg.

The Role of Stretching [Range of Motion] -----

You'll find that muscle and tendon respond to what is done, and -not-- done. For example ------- sitting at a desk at work//school for many hours per day for many years means you're in a hip flexion position for many hours per day for many years. One should expect to see tight hip flexor muscles and tendons after a period of years, and perhaps lower back problems that may accompany them......Also, sitting at a desk at work//school for many hours per day for many years means you're in a -knee- flexion position for many hours per day for many years. One should expect to see tight -knee- flexor muscles and tendons [ie. hamstring, calf] after a period of years. That gradual loss of flexibility over time is due to exposing muscles and tendons to a given position for many hours per day for many years, without exposing them to the opposite position in a sufficient manner............that's -not- about age or aging.

The duration of stretch needed to increase muscle and tendon "pliability" prior to a workout, is somewhat different than that required to increase or maintain long term "range of motion". Its best to treat stretching in your training program, in the same manner as you would strength training............in that you should have a designated day(s) for specifically going through a designed routine. Muscle and tendon fibers respond to stretching sessions in a similar manner as strength training. Rather than gaining a wider width though, they get longer by adding more sections. If a muscle//tendon lacks the -length-- to allow for limb-joint movement through it's sport required range of motion..some sort of tissue damage should be expected.

The duration of the stimulus [how long you hold the stretch] determines the potency of the stimulus applied [though, a high frequency can take the place of a long duration]. The durations should be about 3 minutes for each position. In this manner, stretching should be treated as a workout, not preparation for a workout.

Usual Complications Of Running Injuries -----

If you've had an injury for a while, and haven't seen improvement inspite of things you've tried, the reason the pain persists is most likely because you haven't yet done anything that would improve the tissue's ability to withstand your training/racing loads. If the strength of the tissue in question is insufficient to match the strength needed to endure your training.....you "will" experience pain at some point, independent of what shoes you wear or how much they cost, or how biomechanically great or awful your running form is currently. Shoes can't strength train your body's tissues. Some of them are capable of reducing the motions of the foot in a manner that reduces the amount of strength your lower leg muscles must have to endure your training loads, and improvements in running form can have the same effect. But as the shoes wear out with use, their ability to provide this function wears out with them. The safest long term solution is to strength train. Rest, ice, stretching, anti-inflammatories........of these, none will improve the tissue's ability to withstand your training/racing loads.

Slow The Rate Of Application Of Training Loads -----

When the rate of application of the training loads exceeds the rate of adaptation of the body tissues, injury will eventually result in whatever tissue is your weakest link at that time. If you run every day, you're applying your training loads at a rate of approximately once every 24 hours. Reduce the rate of application of your training loads temporarily since it is clear that the current rate exceeds what the tissue can handle. You can slow the rate of application of your training loads by reducing how frequently you train. The way to do this is to provide for "OFF" days in your training (ie. every 2 - 3 days). "OFF" days are not cross-training days.......OFF days is are days that allow recovery, restoration, and adaptation to your training. If at some point in a given week, the tissue in your IT-band, shin, knee, or foot requires 48 hours without a training load placed on it, but you provide only 24 hours...injury is likely.

Reduce Training Loads -----

Reduce the magnitude of application of your training loads temporarily since it is clear that the current magnitude exceeds what the tissue can handle. You can reduce the magnitude of application of your training loads by reducing how long you train.......keep each training session to less than 20 minutes.

Say No To Drugs -----

Following the initial 24-48 hour period of injury, application of heat stimulus (5 - 10 minutes limb water submersion 100-105 degrees F) should be used to increase blood flow and energy production for repair processes. Ingestion of NSAID's (anti-inflamatories) should be avoided since this will impair recovery, and potentially mask pain, leading one to believe it is ok to return to training.

Never...ever....under "any" circumstances...allow a doctor to inject the tissue with cortisone or any other substance that is well known to cause degradation of collagen and other tissue proteins.

Just say --no-- to drugs..........

"The use of nonsteroidal anti-inflammatory drugs for the treatment of tendon inflammation might increase the levels of leukotriene B4 within the tendon, potentially contributing to the development of tendinopathy."

"This finding is of interest because NSAID's are routinely used in clinical practice for the symptomatic treatment of tendinopathy, such as inflammation and pain."

"..the increased LTB4 level due to treatment with NSAID's could potentially exacerbate the situation by leading to neutrophilic infiltration and lymphocytic activation, paradoxically causing further inflammatory and degenerative changes in the tendon."

"..the results of this study suggest that the routine use of COX inhibitors for the symptomatic relief of inflammatory tendon conditions might inadvertently worsen the processes responsible for the development of tendinopathy."

Zhaozhu Li, et. al

Inflammatory Response Of Human Tendon Fibroblasts To Cyclic Mechanical Stretching

The American Journal Of Sports Medicine..Volume 32 #2....2004...page 435 - 439

-------

iceing = cryotherapy --- just say no to cryotherapy.......

"....the administration of nonsteroidal anti-inflammatory drugs or cryotherapy are common clinical practices to control the inflammatory process following connective tissue injury. However, there are contradictory conclusions on the potential of anti-inflammatory strategies to either prevent nonspecific damages or accelerate healing after acute tendon or ligament trauma."

"Cumulative evidences also show that, apart from releasing catabolic enzymes, inflammatory cells can ultimately favor tissue healing through different biological processes."

"Indeed, after the clearance of pathogens and other signals of danger, neutrophils will undergo apoptosis and be engulfed by phagocytic macrophages. Macrophages will then release growth factors that can stimulate fibroblast proliferation, collagen synthesis, and angiogenesis during the early phase of healing."

D.Marsolais, et al

Inflammatory cells do not decrease the ultimate tensile strength of intact tendons in vivo and in vitro: protective role of mechanical loading

Journal Of Applied Physiology.......Volume 102 #1......January 2007.....page 11 - 17

Restatement Of The Facts --------------------

--- The strength of the involved tissue must be raised to a sufficient level to match the strength needed to endure your training.

--- Start with whatever amount of weight is well tolerated, and progress from there.

--- follow a "hurt not harm" principle.....when doing high intensity strength training of the involved tissues.

--- Avoid recurrent attempts to return to training before the tissue has acquired the strength necessary to endure your training loads.

The problem should improve, if not resolve, quickly with strength training (within a few days following 4 back to back strength sessions).

.

.

Morton's Neuralgia

Evidence Based Competent Self-Care Injury Repair:

Stretch......

--- remove shoes and socks

--- kneel down to the floor placing your knees on the floor, hands on the floor, and the bottom of the toes [especially the big toe] on the floor

--- slowly move your body weight down and backwards, toward your heels, placing a stretch on the toes and bottom of your forefoot

--- either hold the stretch for 2 - 3 minutes, or perform the stretch a large number of times across the course of a day, which ever you prefer.

--- each day for 1 - 2 weeks.

Strengthen.......

--- put yourself in the same position as the stretch

--- rather than moving your body weight back to place the toes and bottom of your forefoot on a stretch, flex the toes, pushing them against the ground

--- hold each repetition for 3 - 5 seconds

--- do a cumulative total of 3 - 5 repetitions

--- exert as much force as can be well tolerated

--- each day for 1 - 2 weeks.

Strengthen.......

--- use a thick towel on a slick surface.

--- Place the heel of the foot on the ground, use the toes to pull the towel towards you.

--- Add weight on the towel every 3 - 4 days. Start with whatever amount of weight is well tolerated, and progress from there.

--- each day for 1 - 2 weeks.

Strengthen.......

--- Begin doing the stationary jumps only once the pain in the foot is well tolerated. Add weight every 3 - 4 days.

--- Do 5 - 8 reps...cumulative total per training session

--- each day for 1 - 2 weeks.

Strengthen.......

--- Calf raise, stand on one leg and push yourself up until the heel is slightly off the ground.

--- Start with whatever amount of weight is well tolerated, and progress from there. Then, move to working with a weight you cannot lift more than 3 times without stopping.

--- Use high resistance/weight (doing 5 - 8 reps...cumulative total per training session) preferably once a day, each day for 1 - 2 weeks. Work with a weight you cannot lift more than 3 times without stopping. Precede this with a set of about 3 repetitions of low to moderate weight, with each repetition done extremely slowly.

Just say no to practitioners of traditional Sports Medicine...........

"......primary research evidence only accounted for 24% of management......."

"Practitioners were unaware of literature supporting over 50% of the treatment modalities they used."

"This study highlights a lack of evidence base, a lack of knowledge of the research evidence..that is available for these conditions."

"Practitioners practiced evidence based medicine in under 50% of cases."

I.R. Murray, et al

How Evidence Based Is The Management Of Two Common Sports Injuries In A Sports Injury Clinic?

British Journal Of Sports Medicine..Volume 39 #12...December 2005..page 912

Say no to drugs......

--- avoid substances that may provide short term relief via immune suppression [pain killers, cortisone shots]

--- avoid surgery the removes the offending nerve, you can't get it back once it's gone

--- if you're going to let someone put a needle in you, make sure its for acupunture, rather than surgery or cortisone shots.

Never...ever....under "any" circumstances...allow a doctor to inject the tissue with cortisone or any other substance that is well known to cause degradation of collagen and other tissue proteins.

Nutrition & Healing -----

Protein and vitamin C comprise portions of the tissues you're looking to heal, so their intake should be increased temporarily to improve the rate of healing. since their availability in your tissues will affect the rate of tissue regeneration. You may benefit from several days of --- protein 1.5 - 2.0 grams of proteing per kg of your body weight, Vitamin C 500mg, zinc 30 - 50mg, magnesium 500mg, a few grams of the amino acids leucine and arginine, 2 teaspoons liquid colostrum, Vitamin D 6000IU to 10,000IU, Lugol's Iodine 7 - 15mg.

.

.

Anterior Cruciate Ligament (ACL) Tear..Meniscus (knee Cartilage) Tear

Receiving an accurate diagnosis can be challenging. Often, doctors are unaware that knee MRI's on people who have no knee pain can look similar to the knee MRI's of people who do......the point being that a lot of people have damaged looking knee ligaments and cartilage (meniscus) but have no pain or sport problems.

The most obvious thing about the damage which occurs with knee injury is that it is reversible. Traditional treatment makes this difficult. Anti-inflamatory pills (NSAID's) or injections of cortisone work to destroy immune cell function within the joint, reduces the production of new blood vessels into already blood starved tissues, and decreases fibroblast migration and therefore, new tissue production. This attempt to decrease the patient's pain and swelling, actually reduces the patients ability to heal.

Prior to opting for traditional surgery, or even for the more current tissue regenerative surgical approaches, it is best to try to take advantage of the cells in the knee to see if you can get them to regenerate the tissue via high intensity loading [strength training, ie. 1/4 squats, etc]. A hurt not harm principle should be followed. Its gonna hurt! Pain killers and anti-inflammatories reduce healing by suppressing the function of inflammatory cells that produce growth factors which stimulate tissue healing. Immobilization with anti-inflammatories and ice. This has been the standard post injury approach that has caused sports medicine practitioners to conclude that the meniscus fails to heal on it's own [especially the medial meniscus]. Lack of blood supply has taken most of the blame. Researchers are re-examining that assumption. It may be that immobilization with anti-inflammatories and ice are to blame. The attempt to reduce pain and swelling may be the enemy of non-surgical repair of the human meniscus.

"Fibrochondrocytes of meniscus adapt to changes in their biomechanical environment....."

"....the mechano--responsiveness of fibrochondrocytes under normal and inflammatory conditions was investigated."

"Our findings indicate that mechanical signals act as potent anti-inflammatory signals, where their magnitude and frequency are critical determinants of their actions. Furthermore, mechanical signals continue attenuating proinflammatory gene transcription for prolonged periods of time after their removal."

M.Ferretti

Dynamic biophysical strain modulates proinflammatory gene induction in meniscal fibrochondrocytes

American Journal Of Physiology.....Volume 290 #6.....June 2006.....page C1610-C1615

---------------

Tradition -----

The standard treatment is surgery to remove and/or reconstruct the tissue. This often contributes to later progression to osteo-arthritis in the joint. The reason a doctor will tell you that cutting out the loose portion of the meniscus is the "only" way to go is because the torn portion(s) has an insufficient ability to heal itself. This is because the cells responsible for healing the tissue (mesenchymal cells) have an insufficient ability to adhere themselves to the surface of the tissue in the torn area so that they can produce new tissue to heal the tear. However, there does exist ways of creating a situation where these cells can indeed adhere to the tear area and fill in the tear with new, strong, and healthy tissue.

Not Tradition -----

Surgical repair of an ACL should consist of placing a degradable sheath around the two broken ends of the ligament to form a tube like structure. Fibroblast cells will adhere themselves to the sheath and reproduce the ligament tissue. Fibroblasts can also be transplanted from the other knee, into the injured one. To aid healing, injection of growth factors to stimulate fibroblast function and injection of angiogenesis (production of new blood vessels) inducing substances to induce blood supply to damaged area and increase healing should be done.

Meniscus tissue tends to not grow back on its own in a portion of it where blood supply is lacking. This is generally due to poor number and function of the cells that reproduce meniscus tissue [chondrocyte cells]. Surgical repair of a torn meniscus should consist of injection of growth factors [basic Fibroblast Growth Factor] that stimulate chondrocyte cell production and function and injection of angiogenesis (production of new blood vessels) inducing substances to induce blood supply to damaged area and increase healing. This can be done instead of, or along with.....taking cells that reproduce menisus tissue [chondrocytes] from the knee, growing them into substantial numbers outside the body , then replacing them into the knee.

Just say no to practitioners of traditional Sports Medicine...........

"......primary research evidence only accounted for 24% of management......."

"Practitioners were unaware of literature supporting over 50% of the treatment modalities they used."

"This study highlights a lack of evidence base, a lack of knowledge of the research evidence..that is available for these conditions."

"Practitioners practiced evidence based medicine in under 50% of cases."

I.R. Murray, et al

How Evidence Based Is The Management Of Two Common Sports Injuries In A Sports Injury Clinic?

British Journal Of Sports Medicine..Volume 39 #12...December 2005..page 912

------------

"More than 700 patients had been treated with autologous chondrocyte transplantation by our group by the end of 1999. More than 400 of these patients had been observed for 2 years or more, and the group of patients whose treatment outcome had been evaluated over a long term [5 to 10 years] numbered more than 60."

"......51 of 61 patients had good or excellent results at 5 to 11 years later."

"Autologous chondrocyte transplantation for the treatment of articular cartilage injuries has a durable outcome........"

L. Peterson, et.al...........2002

Autologous Chondrocyte Transplantation

The American Journal Of Sports Medicine..............Volume 30 #1..............2002.........page 2

--------------------

"In 1987, Las Peterson, University of Goteborg [Sweden] found that chondrocytes isolated from a patients cartilage, could be grown in vitro and then returned to the site of damage to repair cartilage."

"This technique has been developed by Genzyme Tissue Repair [Boston, Massachusetts] as the Carticel Cell Culturing Service."

J. Fricker

Cartilage Transplantation: An End To Creaky Knees?

The Lancet....Volume 352..October 10, 1998

--------------------

"Previous studies that isolated chondrocytes seeded into both cartilaginous and meniscal matricies were able to bond separate pieces together"

"..adhesion strength increased over time.."

G.M. Perretti, et. al

Cell-Based Therapy for Meniscal Repair

American Journal Of Sports Medicine...volume 32 #1..2004.page 915

--------------------

"..basic fibroblast growth factor...stimulates the activity of fibrochondrocytes by enhancing proliferation..in all meniscal zones,including the inner [avascular] zone of the meniscus."

"These results indicate that meniscal cells...and cells from the avasucular zone are capable of responding favorably to the addition of basic fibroblast growth factor..."

N.S. Tumia, et. al

Promoting The Proliferative And Synthetic Activity Of Knee Meniscal Fibrochondrocytes Using Basic Fibroblast Growth Factor In Vivo

American Journal Of Sports Medicine...volume 32 #4...2004.page 915

--------------------

Quadriceps Or Hamstrings In ACL Rehab. -----

Most rehab programs are erroneously focused on strengthening the quadriceps [muscles on front of the thigh] in their role as a knee extensor [straiten leg]. Quadriceps function is actually helps to create the anterior [forward] movment of the tibia [lower leg] that the ACL is used to prevent. The rehab and prevention efforts, should focus on the hamstrings and glutes [muscles on the back of the leg] in their role as leg extensors. The hamstrings especially, since they have the ability to take over some of the forces that the ACL would otherwise have to deal with on its own, which is a mechanism of injury. Thus, it isn't weak quadriceps that is the mechanism of injury, but more likely weak hip extensors, especially the hamstrings in their role as an extensor muscle.

"....increased hamstring muscle force could dynamically substitute for the ACL during stressful actitivites."

"The hamstring muscles are believed to play an important role in the control of anterior tibia displacement."

".....reductions in anterior displacement of the tibia depended on hamstring muscle load with larger hamstring loads resulting i large posterior tibia shifts. It was concluded that hamstring muscle coactivation provides a synergistic action to the ACL by preventing excessive anterior tibia displacement."

L.R. Osternig, et al.......2000

Human Hip And Knee Torque Accomodations To Anterior Cruciate Ligament Dysfunction

European Journal Of Applied Physiology......Volume 83......2000......page 71 - 76

--------------------

Volume Vs. Intensity -----

Nearly all rehabilitation programs for knee patients end-up placing the tissue of the patient in an "overtrained" state. Combining this with NSAID's and repeated cortisone shots extends the rehab period for months or years and leads the patient to frustration and burnout. Doctors and physical therapists go in favor of low resistance, massive repetitions and/or sets.

In volume vs. intensity, it is a settled question in the research and conceptually, that it is volume that kills, and intensity that heals. Fibroblast cells in the mensicus area are stimulated to produce new tissue by the gravity induced compression forces we experience during standing, walking, squats, etc., basically all the things the patient will be told not to do for several days to weeks.

When the patient is allowed to be weight bearing, therapists are quick to put them on stair machines, which effectively places the tissues in and around the knee in an "overuse" situation where net destruction of tissue will far exceed net production. Compressive downward forces are the stimulus which activates fibroblasts in the meniscus, and the force of fluid movement in the knee joint produced by downward compressive forces also stimulates ACL fibroblast activity.

ETG Evidence Based Competent Self-Care Injury Repair: Increase Strength Of Involved Tissues -----

High intensity work, based on a "hurt not harm" principle, is what yields results. If you're doing exercises with weight/resistance that allows you to do 12 - 20 reps without stopping.....this slows/prevents recovery, even though you are doing......"strength training"

1/4 squat exercise with high weight is effective. Start with whatever amount of weight is well tolerated, and progress from there. --- Use high resistance/weight (doing 5 - 8 reps...cumulative total per training session) preferably once a day, each day for 1 - 2 weeks. Work with a weight you cannot lift more than 3 times without stopping. Precede this with a set of about 3 repetitions of low to moderate weight, with each repetition done extremely slowly.

Calf raise exercise (single leg), towel pull, and stationary jumping exercises, are effective. With the calf raise, stand on one leg and push yourself up until the heel is slightly off the ground. Start with whatever amount of weight is well tolerated, and progress from there. Use high resistance/weight (doing 5 - 8 reps...cumulative total per training session) preferably in 2 days on, 1 day off, for 1 - 2 weeks. Work with a weight you cannot lift more than 3 times without stopping.

Nutrition & Healing -----

Protein and vitamin C comprise portions of the tissues you're looking to heal, so their intake should be increased temporarily to improve the rate of healing. since their availability in your tissues will affect the rate of tissue regeneration. You may benefit from several days of --- protein 1.5 - 2.0 grams of proteing per kg of your body weight, Vitamin C 500mg, zinc 30 - 50mg, magnesium 500mg, a few grams of the amino acids leucine and arginine, 2 teaspoons liquid colostrum, Vitamin D 6000IU to 10,000IU, Lugol's Iodine 7 - 15mg.

Say No To Drugs -----

Following the initial 24-48 hour period of injury, application of heat stimulus (5 - 10 minutes limb water submersion 100-105 degrees F) should be used to increase blood flow and energy production for repair processes. Ingestion of NSAID's (anti-inflamatories) should be avoided since this will impair recovery, and potentially mask pain, leading one to believe it is ok to return to training.

Never...ever....under "any" circumstances...allow a doctor to inject the tissue with cortisone or any other substance that is well known to cause degradation of collagen and other tissue proteins.

Just say --no-- to drugs..........

"The use of nonsteroidal anti-inflammatory drugs for the treatment of tendon inflammation might increase the levels of leukotriene B4 within the tendon, potentially contributing to the development of tendinopathy."

"This finding is of interest because NSAID's are routinely used in clinical practice for the symptomatic treatment of tendinopathy, such as inflammation and pain."

"..the increased LTB4 level due to treatment with NSAID's could potentially exacerbate the situation by leading to neutrophilic infiltration and lymphocytic activation, paradoxically causing further inflammatory and degenerative changes in the tendon."

"..the results of this study suggest that the routine use of COX inhibitors for the symptomatic relief of inflammatory tendon conditions might inadvertently worsen the processes responsible for the development of tendinopathy."

Zhaozhu Li, et. al

Inflammatory Response Of Human Tendon Fibroblasts To Cyclic Mechanical Stretching

The American Journal Of Sports Medicine..Volume 32 #2....2004...page 435 - 439

-------

iceing = cryotherapy --- just say no to cryotherapy.........

"....the administration of nonsteroidal anti-inflammatory drugs or cryotherapy are common clinical practices to control the inflammatory process following connective tissue injury. However, there are contradictory conclusions on the potential of anti-inflammatory strategies to either prevent nonspecific damages or accelerate healing after acute tendon or ligament trauma."

"Cumulative evidences also show that, apart from releasing catabolic enzymes, inflammatory cells can ultimately favor tissue healing through different biological processes."

"Indeed, after the clearance of pathogens and other signals of danger, neutrophils will undergo apoptosis and be engulfed by phagocytic macrophages. Macrophages will then release growth factors that can stimulate fibroblast proliferation, collagen synthesis, and angiogenesis during the early phase of healing."

D.Marsolais, et al

Inflammatory cells do not decrease the ultimate tensile strength of intact tendons in vivo and in vitro: protective role of mechanical loading

Journal Of Applied Physiology.......Volume 102 #1......January 2007.....page 11 - 17

Restatement Of The Facts --------------------

--- The strength of the involved tissue must be raised to a sufficient level to match the strength needed to endure your training.

--- Start with whatever amount of weight is well tolerated, and progress from there.

--- follow a "hurt not harm" principle.....when doing high intensity strength training of the involved tissues.

--- Avoid recurrent attempts to return to training before the tissue has acquired the strength necessary to endure your training loads.

The problem should improve, if not resolve, quickly with strength training (within a few days following 4 back to back strength sessions).

"Fibrochondrocytes of meniscus adapt to changes in their biomechanical environment....."

"....the mechano--responsiveness of fibrochondrocytes under normal and inflammatory conditions was investigated."

"Our findings indicate that mechanical signals act as potent anti-inflammatory signals, where their magnitude and frequency are critical determinants of their actions. Furthermore, mechanical signals continue attenuating proinflammatory gene transcription for prolonged periods of time after their removal."

M.Ferretti

Dynamic biophysical strain modulates proinflammatory gene induction in meniscal fibrochondrocytes

American Journal Of Physiology.....Volume 290 #6.....June 2006.....page C1610-C1615

-------------------

"..prevalence of osteo-arthritis after ACL reconstruction ranges from 13% - 65% at 3 to 9 years, respectively."

"Five years after the start of treatment, the authors....found a higher incidence of osteo-arthrosis in patients who had undergone operative treatment than in patients who had non-operative treatment."

T. Hogervorst, et.al

Changes In Bone Scans After Anterior Cruciate Ligament Reconstruction

American Journal Of Sports Medicine....Volume 30 #6...November-December 2002...page 823

-------------------

"Menisectomy has been the standard surgical treatment for a torn meniscus, but clinical studies have demonstrated a strong association between menisectomy and the development of osteo-arthritis."

G.M.Peretti, et al

Cell-Based Therapy For Meniscal Repair

The American Journal Of Sports Medicine..Volume 32 #1.2004..page 146 - 154

--------------------

"We understand the clinical implications of conditions such as tendinosis and stress fractures and can make the diagnosis, but we treat them imperfectly."

"We need to find a true biologic solution for these types of chronic conditions. As usual, our old friends the torn meniscus and torn ACL lie waiting for the ultimate solution: primary healing."

Robert Leach

Editor.....American Journal Of Sports Medicine

Volume 28 #3......2000.....page 281

-------------------------------

"The 3-year randomised placebo-controlled trial suggests that an oral agent, glucosamine sulphate, retards the progression of symptomatic knee osteo-arthritis. The study is a landmark in osteo-arthritis research...."

"The idea that glucosamine has such effects originates from the notion that consumption of cartilage derivatives could provide substrates for cartilage repair....."

"......oral glucosamine sulphate is absorbed and distributed to joint tissues, and that it has.....anabolic properties."

T.McAlindon......January 2001

Glucosamine For Osteo-arthritis: Dawn Of A New Era

The Lancet........Volume 357....January 27, 2001.....page 247

-------------------------------

In 1987, Las Peterson found that chondrocytes isolated from a patient's cartilage could be grown in vitro and then returned to the site of damage to repair cartilage. This technique has been developed by Genzyme Tissue Repair [Boston, Massachusetts], as the Carticel Cell Culturing Service."

J. Fricker....October 1998

The Lancet......Volume 352....October 10, 1998....page 1202

-------------------------------

"A new 1-step method that does not require cartilage cells to be grown outside the body has been shown to be effective in repairing injured and arthritic knee joints."

R.Voelker.....March 1997

Journal Of The American Medical Association.....Volume 277 #12....March 26, 1997.....page 951

------------------------------

"......a U.S. Food and Drug Administration advisory committee agreed that a procedure to replace damaged knee cartilage was of clinical benefit, paving the way for approval of Carticel, a proprietary system to culture a patients own cartilage cells to replace worn-out knee cartilage. According to data presented to the FDA, 85% of U.S. patients treated with the Carticel, had improved at 12 months."

The Lancet......Volume 349.....March 15, 1997....page 780

------------------------------

[excerpts from KXAN.com, local Austin NBC station]...

A new medical breakthrough is bringing hope to people with chronic joint pain. For the first time ever in Austin, a patient's own cells have been used to repair cartilege injuries. Seaquist is the first Austin orthopedic surgeon to use a biologic product called Carticel.

The surgeon takes a small biopsy of healthy cartilage. In a lab the cells are grown until there are enough to repair the defect.

"Over the next 25 years, the major focus in orthopedics will be on cartilege repair, regeneration and restoration. In response to the expected demand Seton Medical Center this month will be opening a brand new Bone and Joint Center," Seaquist said,

"We're trying to develop a center of excellence, that is as good as any place in the country, and we do quite well now, and hopefully we'll improve that and really get on the cutting edge."

------------------------------

[excerpts from..Healthy Cartilage Grown To Replace Damaged Cells

By: Emily Schmitz - News 8 Austin, 2/11/2004]..

In Ragsdale's first surgery, orthopedic surgeon Dr. Jack Seaquist, of the Seton Bone and Joint Center, cleaned out the floating pieces of tissue. Then he did something revolutionary.

He used Ragsdale's own healthy cartilage cells to replace the damaged ones in a procedure called Carticel.

Here's how Carticel works: First Seaquist takes a biopsy of healthy cartilage. Then he sends it to a facility where the cells are cultured and grown for about five weeks. Once those cells have matured and multiplied, Seaquist injects them back into the knee to replace the damaged cartilage.

"We're taking these person's own cells so there's no chance of rejection or anything like that," Seaquist said.

Dr. Jack Seaquest [454-4561]

Medical Park Tower [1301 W 38th Street, Austin, Texas]

Jack L. Seaquist, M.D. was the first physician in the Austin area to perform the breakthrough surgery using Carticel.

People/companies you can call to try to locate a doctor in Texas who performs the type of surgery discussed;

--- Dr. Jack Seaquist, Austin, Texas (512) 454-4561

--- Dr.Kevin Stone [Stone Foundation For Sports Medicine and Arthritis Research....San Francisco, California]...(415) 563-3110 ----

www.stoneclinic.com

--- Genzyme Tissue Repair [Boston, Massachusetts] [617] 494-8484 [Web Site:

www.carticel.com

]

For others in your area

--- go to Knee1.com

--- look under "Reference"

--- click on "Find A Doctor"

--- then click on "Find A Cartilage Repair Specialist"

.

.

Back Pain In Runners: --The-- Treatment Program

As many as 80% of the U.S. population will have back pain at some point during a given year. Many athletes across many major sports suffer lowered performance and/or end-up leaving their sport after seeing doctor after doctor, "specialist" after "specialist", in an attempt to deal productively with chronic and/or re-occuring back pain.

Common Problems -----

Often, doctors are unaware that MRI's on people who have no back pain can look similar to the MRI's of people who do......the point being that a lot of people have damaged looking disks (intervertebral disks) but have no pain or sport problems. Thus, certain tissues in the back, often get pointed out as the cause of the runner's pain, though such may not be the case. About 70% of people with back pain have no identifiable cause.

".....treatment selection is often determined by unsubstantiated theories of pain production and the educational dogma of the treating physician."

".....patients are routinely labled as suffering from such problems as muscle strain....sacroilliac disorders....justified by negative or nonspecific findings on imaging studies (ie. X-ray or MRI). Few if any of these alternative diagnoses are based on validated clinical testing, yet they are widely used and accepted clinically."

Dr. Don Nelson.....1998

Journal Of Musculoskeletal Medicine....Volume 15 #5....1998...pages 29 - 39

Common Situations -----

On average, a person may go into flexion [bend-over] as many as 5000 times per day. People who have desk jobs may spend several hours each day in a flexed position. The tissues of the lower back adapt to these positions and motions over time. In the absence of putting oneself in the opposite position/motion [back extension], problems can result that produce chronic and/or re-occuring back pain.

Common Treatment Problems -----

The standard focus of traditional medicine is to do something "to" the runner with back pain. Either give a pill, cut something, remove something, or jerk something, apply heat, ice, and/or electrical stimulation, in an effort to relieve the pain symptoms. Generally, of the people who do absolutely nothing, about 40 - 45%% get better in one week. About 80 - 85% get better in one month whether they seek treatment or not. And about 90% get better in 2 months regardless of whether they seek treatment or not. So these time frames provide a standard by which to measure the results of various treatment protocols provided to the runner by doctors, chiropractors, or physical therapists. Obviously, if the runner is receiving treatment, but isn't getting better by 8 weeks [2 months], the treatment is perhaps no better than the effects of nature.....though runners often assume that "the treatment worked" when their pain resolved after 3 months of therapy.

"I was convinced that many of my patients were getting better in spite of me rather than because of me."

"......Sooner or later, therapists will have to stop treating patients based on the blackboard or the X-ray and start seeing the validity of treatment based on proper mechanical evaluation."

G.J. Silva P.T.,Dip.MDT....199

McKenzie Institute Journal....Volume 6 #3.....1998

Patient Empowerment -----

Perhaps the most important problem to deal with in runners with back pain, is the fact that it is highly likely that once resolved, the pain will return at some point in the future. Generally, back pain will re- occur in about 90% of people who get better. Thus, the focus on a short term solution, as is currently common in standard health care practice, is not the most effective solution. From a sport psychology standpoint, it is not the initial experience with back pain that leads athletes to leave their sport. It is the re-occuring experiences, placed together with repeated experiences of ineffective treatments, that gradually leads the athlete to frustration, burnout, and then withdrawl from sport.

MDT = Mechanical Diagnosis & Therapy -----

Mechanical Diagnosis & Therapy (MDT) is a manner by which a physical therapist, doctor, or chiropractor can use your own "mechanical" movements and pain perceptions to evaluate and develop a treatment for your back pain. MDT, developed many years ago by a physical therapist in New Zealand, Robin McKenzie, is --the-- most effective evaluation and treatment program available. MDT empowers the runner with the knowledge and tools necessary to play the primary role of healer of their own pain, rather than being dependent upon the medical practitioner or frequent and chronic doses of pain medications.

MDT effectively identifies people who need more extensive diagnostic exams (ie. MRI, etc) due to the nature of their problem. Rather than having to spend months going to physical therapy, and doctor after doctor, MDT is able to separate within a only a few visits, the people who will respond to treatment from those who will not.

The program is taught by the McKenzie Institute which has a branch in the United States. The Institute offers courses available to physical therapists, doctors, chiropractors, etc, through a series of four parts (Part A,B,C, and D). Practitioners who have completed all four parts are certified (cer.MDT), and certified practitioners can move on to an intensive three month diploma program (Dip.MDT). McKenzie certified clinics can now be found in the U.S., that focus their entire patient treatments on McKenzie methods.

Just say no to practitioners of traditional Sports Medicine...........

"......primary research evidence only accounted for 24% of management......."

"Practitioners were unaware of literature supporting over 50% of the treatment modalities they used."

"This study highlights a lack of evidence base, a lack of knowledge of the research evidence..that is available for these conditions."

"Practitioners practiced evidence based medicine in under 50% of cases."

I.R. Murray, et al

How Evidence Based Is The Management Of Two Common Sports Injuries In A Sports Injury Clinic?

British Journal Of Sports Medicine..Volume 39 #12...December 2005..page 912

A registry is maintained in the United States of both cer.MDT and Dip.MDT.

To find a practitioner in your area

http://www.mckenziemdt.org/approach.cfm?section=int

or call (800) 635-8380.

In planning to pursue treatment by a McKenzie trained person, I strongly suggest seeing someone who has the ---diploma [Dip.MDT]--- rather than someone who is certified. The primary difference being that in seeing a ---Dip.MDT--- you're more likely to get with someone whose traditional belief system and ways of doing things has been removed from them. Beware of people who simply "claim" to use McKenzie, or patient testimonials who say McKenzie method was used on them by their therapist/doctor [find out if they saw a person who had the diploma...Dip.MDT].

McKenzie Therapists in Austin, Texas

Besselink, Allan PT --- Dip. MDT --- 512) 914-0871

Smart Sport International

Austin, Texas

Mark Miller PT --- Dip. MDT ---512) 867-5092

St. David's Physical Therapy & Spine Center

Austin, Texas

Scott Herbowy PT --- Dip. MDT --- (512) 867-5092

St. David's Physical Therapy & Spine Center

Austin, Texas

Rodney Simonsen MD --- Dip. MDT --- (512) 478-3556

Physical Medicine & Rehab Associates

1015 E 32nd Street #411

Austin, Texas

Kimberly Greene PT --- Dip. MDT ---- (512) 218-8230

St. David's Physical Therapy & Spine Center

Round Rock , Texas

If you'd like to get away from spinal fusion-implants and the people who recommend them, below are people/companies who can be contacted for information about the near future of disc regeneration surgery, within the context of the growing field of "Regenerative Medicine"....

--- Jung U Yoo MD [Orthopaedic Surgery] University Hospitals of Cleveland and Case Western Reserve [216-844-8365]

--- MacroPore Biosurgery [858] 458-0900...www.macropore.com

--- David S. Bradford, M.D. [Department of Orthopaedic Surgery] University of California, San Francisco..

[415] 476-2280...

www.spineuniverse.com/biography/bradford.html

".......as many of us initially believe, ""I learned McKenzie in PT school"". Day one of Part A is forever eched in my mind as a ground-breaking moment in my clinical practice and thought process."

Allan Besselink P.T, Dip.MDT....1998

Editor Of McKenzie Institute USA Journal

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"From 1996 to 1999, back pain and radiological changes in the thoraco-lumbar spine were investigated in 134 former top athletes....."

"This is a long-term follow-up investigation of a previous radiological study of the spine with clinical correlation. Despite significantly more radiological abnormalities among the athletes, they did not report higher frequency of back pain than the non-athletes. "

O .Lundin., M. Hellstrom, I. Nilsson, L. Sward

Back Pain And Radiological Changes In The Thoraco-Lumbar Spine Of Athletes: A Long-Term Follow-up

Scandinavian Journal of Medicine & Science in Sports.....Volume 11 #2.....April 2001.....pages 103 - 109

------

"Lumbar spine pain accounts for 5 to 8% of athletic injuries. Although back pain is not the most common injury, it is one of the most challenging for the sports physician to diagnose and treat."

"Often....a specific diagnosis cannot be made.....due to the lack of pain localization and the anatomic complexity of the lumbar spine. A thorough history and physical examination are usually more productive in determining a diagnosis and guiding treatment than imaging techniques."

"Strong analgesics are also usually contraindicated, except for sleep, since they mask pain and may allow over-vigorous activity. "

"....exercises include the Williams flexion exercises and/or McKenzie extension exercises. Both exercise motions may often be prescribed. Athletes with an acute disc herniation, however, should only perform extension exercises initially. Athletes with spondylolysis, spondylolisthesis and facet joint irritation should initially be limited to flexion exercises."

J.Harvey, S. Tanner...1991

Low Back Pain In Young Athletes: A Practical Approach.

Sports Medicine.....Volume 12 #6.....December 1991.....page 394-406

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"Spinal magnetic resonance imaging often reveals alarming but clinically irrelevant findings, and adults with back pain who receive magnetic resonance imaging results may experience worse dysfunction than those not given the results."

"......"medicalizing" normal phenomena are as harmful as unrealistic expectations and are fostered frequently by marketing hype...."

C.M. Kilo, E.B. Larson

Exploring the Harmful Effects of Health Care

Journal Of The American Medical Association.....Volume 302 #1....July 1, 2009....page 89 - 91

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"The market for spinal implants and devices is estimated to be $2 billion a year, with an annual growth rate of 18 to 20 percent."

"A recently added indication is so-called diskogenic pain, or low back pain without sciatica in patients with degenerative disks."

"This controversial diagnosis is often identified by provocative discography, itself a controversial procedure."

R.A.Deyo et al.

Spinal-Fusion Surgery ---- The Case For Restraint

New England Journal Of Medicine...Volume 350 #7..February 12, 2004...page 745

---------

".....treatment selection is often determined by unsubstantiated theories of pain production and the educational dogma of the treating physician."

".....patients are routinely labeled as suffering from such problems as muscle strain....sacroilliac disorders....justified by negative or nonspecific findings on imaging studies (ie. X-ray or MRI).

"Few if any of these alternative diagnoses are based on validated clinical testing, yet they are widely used and accepted clinically."

Dr. Don Nelson.....1998

Journal Of Musculoskeletal Medicine....Volume 15 #5....1998...pages 29 - 39

-------

"Of the 65 million people in the United States with low back pain, approximately 151,000 undergo fusion of the lumbar spine each year."

S.J.Lipson

Spinal-Fusion Surgery --- Advances And Concerns

New England Journal Of Medicine...Volume 350 #7..February 12, 2004...page 643

------

"......Sooner or later, therapists will have to stop treating patients based on the blackboard or the X-ray and start seeing the validity of treatment based on proper mechanical evaluation."

G.J. Silva P.T.,Dip.MDT....199

McKenzie Institute Journal....Volume 6 #3.....1998

------

"..."elite athletes have a greater prevalence and greater degree of lumbar disc degeneration than the normal population."

"It has been noted that disc degeneration is significantly more common in elite athletes than in non-athletes [75% vs. 31%]. "

"..at least a third of asymptomatic people in the 20's have at least one degenerate lumbar disc."

A.Ong, et al

A Pilot Study Of The Prevalence Of Lumbar Disc Degeneration In Elite Athletes With Lower Back Pain At The Sydney 2000 Olympic Games

British Journal Of Sports Medicine...Volume 37..2003..page 263 - 266

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"Most cervical discs are morphologically abnormal, with outer annular tears found in both volunteers and patients."

K.P. Schellhas, et. al

Cervical Discogenic Pain: Prospective Correlation Of Magnetic Resonance Imaging And Discography In Asymptomatic Subjects And Pain Sufferers.

Spine...Volume 21 #3..February 1, 1996...page 300 - 311

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"The McKenzie approach is a popular method of evaluation and treatment of neck pain."

" McKenzie advocates that there is a mechanical origin for most spinal disorders and so classifies spinal pain into three syndromes.."

S.R.Mercer, G.A.Jull

Morphology Of The Cervical Intervertebral Disc: Implications For McKenzie's Model Of The Disc Derangement Syndrome.

Manual Therapy...Volume 1, #2..1996..page 76 - 81

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"At 7 weeks post onset of low back pain... the group receiving McKenzie treatment produced significant disability reduction compared with those treated with a NSAID."

A.P. Roberts;

The Conservative Treatment Of Low Back Pain..1990.

-------

"Following introduction of a McKenzie trained therapist to manage hospital employees, days lost due to back pain fell by 52%, number of staff off due to back pain fell by 27%, and number of episodes of absenteeism due to back pain fell by 30%."

J.E. Owen, et. al

Very Early McKenzie Protocol Intervention For Back Pain In Hospital Workers.

JBJS..82B. Supp III,..2000.,..page 212

Spinal Fusion surgery...Spinal Implant surgery

"The market for spinal implants and devices is estimated to be $2 billion a year, with an annual growth rate of 18 to 20 percent."

"A recently added indication is so-called diskogenic pain, or low back pain without sciatica in patients with degenerative disks."

"This controversial diagnosis is often identified by provocative discography, itself a controversial procedure."

R.A.Deyo et al.

Spinal-Fusion Surgery ---- The Case For Restraint

New England Journal Of Medicine...Volume 350 #7..February 12, 2004...page 745

--------

"Spinal Fusion Surgery - The Case For Restraint"

"Wide geographic variations in use suggest a poor level of professional consensus.."

[in 1993 there were 150,000 spinal fusion surgeries, 300,000 in 2001]

"Several factors may be contributing to the rapid increase in spinal fusion surgery. "....the financial incentives for surgeons, hospitals, and the device industry..."

R.A.Deyo et al.

Spinal-Fusion Surgery ---- The Case For Restraint

New England Journal Of Medicine...Volume 350 #7..February 12, 2004...page 745

--------

"Medicare spends an estimated $750 million on spinal fusion each year."

S. Mendenhall editor and publisher

Orthopedic Network News Newsletter

--------

"To compare the effectiveness of lumbar instrumented fusion with cognitive intervention and exercises in patients with chronic low back pain and disc degeneration."

" Sixty-four patients aged 25-60 years with low back pain lasting longer than 1 year and evidence of disc degeneration..were randomized to either lumbar fusion with posterior transpedicular screws and postoperative physiotherapy, or cognitive intervention and exercises."

"The cognitive intervention consisted of a lecture and a recommendation to use the back and bend it. This was reinforced by three daily physical exercise sessions for 3 weeks."

"At the 1-year follow-up visit, 97% of the patients..were examined. "

"The success rate according to an independent observer was 70% after surgery and 76% after cognitive intervention and exercises."

"The early complication rate in the surgical group was 18%."

"The main outcome measure showed equal improvement in patients with chronic low back pain and disc degeneration randomized to cognitive intervention and exercises, or lumbar fusion."

J. I. Brox.

Randomized Clinical Trial Of Lumbar Instrumented Fusion And Cognitive Intervention And Exercises In Patients With Chronic Low Back Pain And Disc Degeneration

Spine...Volume 28 #17..September 1, 2003...page1913-21

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Spine Physician Update [quarterly publication of the American Association of Spine Physicians]

There is evidence of high complication rates associated with lumbar fusion, and a relative lack of evidence demonstrating the effectiveness of the procedure for degenerative spinal conditions.

A review of 6,376 records of patients who underwent lumbar surgery (1,041 of whom underwent spinal fusion) reported that 18% required re-operation during the five years after the procedure was performed, and that complications were most frequent among fusion patients."

These results emphasize the need to examine whether potential long-term outcomes outweigh the short-term risks and costs associated with spinal fusion procedures. Nonfusion surgical procedures (i.e. laminectomy or discectomy) or alternative, nonsurgical interventions may prove more effective.

A.D. Malter et al.

5-year Reoperation Rates After Different Types Of Lumbar Spine Surgery

Spine...Volume 23 #7...March 1998..page 814 - 820

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The O'Connor Report

Insights And Commentaries On Health Care Today

In 1989, Dr. Richard Deyo, a professor at the University of Washington School of Medicine, directed a low back pain research study funded by the Agency for Health Care Policy and Research (AHCPR).

They looked at actual patient outcomes. By the early 1990's, his group found that one type of surgery for back pain-spinal fusion-was not well validated in its effectiveness. They also found that it actually resulted in higher complications and higher costs than other types of back surgery. This was not because the patients were older and sicker in the study-the patients were actually younger and healthier.

When his group published its findings and a related guideline was released in 1994, he and his colleagues were attacked. A national spine professional association lobbied Congress to eliminate the agency that funded the research and almost succeeded.

"It was unclear to us if anyone benefited from spinal fusion surgery except patients with spinal fractures or cancer," said Dr. Deyo. "At the same time this work was going on, the AHCPR created some guidelines on back pain with a panel of physicians that included neurosurgeons, orthopedic surgeons, rehabilitation doctors, internists, chiropractors and osteopaths, among others. When their recommendation was issued in 1994 after review of existing medical literature, the North American Spine Society began a letter writing campaign to Congress to cut the funding for AHCPR, Deyo said. "The Society had close ties to the companies that manufactured the screws and plates used in spinal surgery.

"The spine society had challenged our findings earlier saying our data were biased against surgery; that we were biased and bad researchers," he said. "And that our study was designed to reduce reimbursement for spinal fusion."

"Then when our guidelines were published, they really went after us and the AHCPR. A manufacturer of the plates and screws even tried to get a court injunction against publishing the guidelines."

Deyo also said that one the Board Members of the Spine Association started a non-profit organization-The Center for Patient Advocacy-advocating the elimination of AHCPR as well as seeking to curtail some activities of the FDA. "During this furor, it came out that the FDA had not really approved all the plates and screws for the particular uses where they were actually being used," he observed.

The AHCPR was eliminated by the House of Representatives, but restored by the Senate. The agency has been re-named to: Agency for Health Care Research and Quality. "But, to this day," says Deyo, "they have gotten out of the guideline publishing business entirely."

The Puget Sound Spine Interest Group was founded by a group of doctors in different medical specialties related to spinal care.

They were shocked when they started to meet to find that what one group of specialist took as a given, was completely unknown by the other professions.

One discipline-rehabilitation medicine-was taught non-surgical approaches for spinal care. Another group-orthopedic surgeons-was taught surgical solutions, often for the same condition.

Treatment often just depended on whom the patient was referred to by a primary care or other doctor.

The O'Connor Report

Insights And Commentaries On Health Care Today

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