Stress Fractures

stress. fractures, tibia, fibula

What’s up ? This is THE stephane ANDRE. With my training, I’m interested in biomechanics to avoid injuries. I read « Sport Medicine Media Guide » and I learned some good stuff.

A stress fracture is an overuse injury. Human body creates a new bone to replace a bone that has been broken due to the stress of everyday life. This process is done every day to keep the balance. Unfortunately, this balance can be disrupted because of excessive physical training. There are several factors that can prevent the body from creating enough bone and this make microcracking, called « fracture stress ».

The most common factor of fracture stress is an excessive increase in the intensitiy or frequency of physical activity without adequate rest period. Other factors are nutritional deficiencies, mechanical influences, lack of sleep, systemic factors (hormonal imbalance, etc.) and metabolic bone disorders.

There are case of development of eating disorders and/or amenorrhea (infrequent menstrual periods) for some female athletes who are preparing for a competition. These 2 conditions can create a decrease in estrogen that can decrease bone mineral density. This increase the risk of stress fractures.

Stress fractures are often seen in athletes (especially runners) or military recruiting. For an athlete, 1.6km run is 110 tons of force absorbed by the legs. Bones aren’t made to resist this force (energy) so it’s the muscles that have the function of absorbing shocks.

When the muscles get tired, they stop absorbing the forces and eveything transferred to the bones. Stress fractures occur in almost all bones but are more common in lower bone, expecially the tibia. Depending on the type of sport, there’re distinctive stress fractures such as the elbow in throwing sports, the ribs in golfing and rowing, the spine in gymnastics, the lower extremity in running activities and the foot in gymnastics and bascketball.

Diagnosis

stress, fracture, foot, metatarsal, 5th
stress, fracture, foot, x-rays, metatarsal,2nd

Stress fractures create pain in a limited area directly above the tip of the bone where the fracture occurred. The pain is raw because of physical activity and relived with rest. The sensitivity of the bones is the most obvious conclusion to the physical examination.

With regard to X-rays, this isn’t a tool that actually helps to diagnose an early stress fracture because the bone often looks normal and the microcracking aren’t visible. It’s difficult because after several weeks of rest, the bone begins to repair itself and shows a healing reaction or callus on X-rays.

An early stress fracture is usually confirmed by a bone scan or magnetic resonance imaging (MRI).

Treatment

Stress fractures are generally classified as low-risk (will not become a serious fracture) or high-risk (will become a serious fracture).

Low-risk stress fractures usually require a rest period of 1-6 weeks of limited weight bearing activity progressing to full weight bearing may be necessary. Return to physical activity should be a gratual process.

Low impact activities like swimming or biking are recommended to maintain cardiovascular condition when the pain is gone. When the patient can comfortably perform low impact activities for long, pain-free periods, the patient can begin high-impact activities.

High-risk stress fracture have the danger of becoming a complete fracture. For athletes suffering from chronic pain and having normal x-rays results, it’s recommanded to use a bone scan or MRI. High-risk stress fractures should be treated as traumatic fractures (with cast or surgery) because of complications.

Prevent

food, vitamin,d, carrot, papay, meat, ,egg, chees, broccoli, fish, sweet, potato, mango, pepperoni, apricot, peach, melon, avocado
calcium, food, almond, amarant, grain, aparagus, apricot, artichoke, baked, bean, haricot, blackberry, blackstrap, molasse, blackcurrant, bok, choy, brazil, nut, bread, wholemeal, brocolly, chickpeas, cinnamon, edamame, soya, fennel, kale, kidney, olive, orange, sesame, seed, milk, spring, green, tofu, swede, walnut, watercress

Here are tips developed by AAOS to help to prevent stress fractures :

  • When an athete does a new sport activity, it’s necessary to program progressive goals. For example on the 1st day, don’t run 8km but rather increase the distance gradually per week.
  • Cross-training => Alternate activities to achieve the same fitness goal helps to avoid stress fracture injuries. For example to achieve a cardiovascular goal, alternate cycling and running (cycling one day and riding the other day) is excellent. Adding strength training and doing flexibility exercises help improve performance.
  • Have and maintain a heathy diet with foods rich in calcium and vitamin D.
  • Use good equipment. Don’t use running shoes, gloves, etc, very old and very worn.
  • If during physical activity it start to swell or the pain starts, stop the activity right away. It’s essential to rest for a few days. If the pain continue, you should see an orthopedic surgeon.
  • It’s important to recognize early symptoms and treat them appropriately to return to the sport with a normal level of play.

Stats

  • Stress fractures occur less frequently in those of black African descent than in Caucasians, due to a generally higher BMD (bone mineral densitiy) in the former.
  • Women and highly active individuals are also at a higher risk, The incidence probably also increases with age due to age-related reductions in BMD.
  • Children may also be at risk because their bones have yet to reach full density and strength.
  • The female athlete triad also can put women at risk, as disordered eating and osteoporosis can cause the bones to be severely weakened.

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-Steph

P.S. If you’re in Miami and you like Caribbean food, go to my cousin’s bistro to eat Haitian food, click here .

Articular Cartilage Injuries

articular cartilage injury

What’s up ? This is THE stephane ANDRE. With my training, I’m interessted in biomechanics to avoid injuries. I read « Sport Medicine Media Guide » and I learned some good stuff.

Definition

Articular cartilage is difficult to understand because there are 3 types of cartilages in the body : articular of hyaline cartilage (covers joint surfaces), fibrocartilage (knee meniscus, vertebral disk) and elastic cartilage (outer ear). These cartilage’s types differ in their structure, elasticity and strength.

Articular cartilage is a complex element, it’s a living tissue that is on the joint’s surface. The function is to provide a low friction surface to allow the joint to withstand weight loads through the range of motion needed to perform activity of daily living. To put it simply, articular cartilage is a very thin shock absorber. It’s built in 5 distinct layers and each layer has a structural and biochemical difference.

Injury

articular cartilage injury

Articular cartilage injury may be due to trauma or progressive degeneration (wear and tear). This can be mechanical destruction, a direct blow or other trauma. The healing of articular cartilage cells depends on the severity of the damage and the location of the lesion. Articular cartilage has no direct blood supply so it has very little ability to repair itself. It the lesion penetrates the bone under the cartilage, the bone provides blood in the area which improves the chances of healing.

Mechanical degeneration (wear and tear) of articular cartilage occurs with progressive loss of normal cartilage structure and function. This loss begins with the softening of the cartilage, then progresses to fragmentation. As the loss of articular cartilage lining continue, the underlying bone no longer has any protections against normal wear and tear of daily life and begins to get damaged leading to osteoarthritis.

In many cases, a patient experiences knee swelling and vague pain. At this stage, continuous physical activity isn’t possible. If a loose body is present, words such as « locking » or « catching » might be used to explain the problem. With wear and tear , the patient often experiences stiffness, decreased range of motion, joint pain and/or swelling.

Diagnostic

The physician examines the knee to look for a decrease in range of motion, pain along the joint line, swelling, fluid on the knee, abnormal alignment of the joint’s bones, and ligament or meniscal injury.

Cartilage lesions are difficult to diagnose and it’s possible that the use of magnetic resonance imaging (MRI) or arthroscopy may be necessary. Plain X- rays don’t usually diagnose articular cartilage problems but they used to rule out other abnormalities.

Treatment

articular cartilage injury treatment

 

Articular cartilage injury that doesn’t penetrate the bone doesn’t repair itself. A lesion that penetrates the bone can heal but the type of cartilage created is structurally unorganized and doesn’t work as well as the original cartilage.

Lesion less than 2 cm have the best prognosis and the best treatment options. These options are arthroscopic surgery using techniques to remove damaged cartilage and increase blood flow from the underlying bone (drilling, pick procedure or microfracture ).

For smaller lesion of articular cartilage surgery is not required.

For larger lesion, it’s necessary to transplant the articular cartilage from another area of the body. Talk to your doctor or specialist to have more information about the decision to have a surgical operation.

For patients with osteoarthritis, non-surgical treatment consists of physical therapy, lifestyle modification (for example reducing activity), bracing, supportive devices, oral and injection drugs (like non-steroidal inflammatory drugs, cartilage protective drugs) and medical management.

Surgical options depend on the severity of osteoarthritis and may provide a reduction in symptoms that are usually short-lived. Total osteoarthritis may relieve the symptom of advanced osteoarthritis but this usually requires a change in the lifestyle and/or level of activity of the patient.

Statistics

Based on published studies, the overall prevalence of articular cartilage injury in the knee is 36% among all athlete and 59% among asymptomatic basketball players and runners.

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-Steph

Tear Of Hamstring Muscle

hamstring muscle anatomy tear

I read a Frederic Delavier’s book « Strength Training Anatomy » and I learned good stuff.

In bodybuilding, tears of hamstring muscles are common. This often happens during squat when the torso is too much inclined. All hamstrings muscles (except biceps femoris short head) are extremely stretched and squeeze strongly to straighten the pelvis. Precisely at this point, there may be a muscle tear in the upper or middle part of this muscle group.

It’s possible that the tear of hamstring muscle occur with machine (leg curl). There may be a muscle tear with a heavy weight at the beggining of the movement when legs stretched and muscles stretched.

Usually, tears of the muscular fibers of hamstrings are small and not serious (it’s rare to see a major muscle tear or tendon disinsertion) but these tears are always painful and causes complications.

Indeed, often after a tear on this muscle group, there is a fibrous scar that causes a painful and disabling rubbing for sport practices. And it’s important to note that this scar isn’t elastic and can tear again during an intense effort.

Tip to avoid hamstring tears

To avoid theses muscle tears during squat or deadlift, it’s important to make specific stretching movements for hamstrings, before or between sets.

There are also other exercise like « Good-morning », stiff-legged deadlift or Romanian deadlift which helps because of their combined actions of muscle building and stretching.

After a tear of hamstrings

To avoid having a fibrous scar, it’s necessary to do a re-education a week after the tear. It’s important to do stretching exercises for the back of the thigh slowly. This allows you to stretch the injured muscles and to soften the scar so that it doesn’t tear when you start again the training.

feedback of hamstrings muscles

hamstring muscle anatomy tear pelvis

In modern societies, we sit for several hours. This can create in some people a feedback of hamstrings muscles. This muscles retraction of the back of the thigh puts the pelvis in retroversion and this creates a bad position of the spine.

This poor position of the spine causes the natural curvature of the spine to be lost over time. This results in poor posture, flat buttocks and round back that can trigger spinal pathologies.

To limit this feedback of hamstrings muscles, it’s recommended to do exercises that have a combined action of muscle strengthening and stretching at the back of the thigh as the « Good-morning », stiff-legged deadllift and Romanian deadlift. Then after this exercise session, it’s advisable to do some sets of stretching for hamstrings.

Action of hamstrings at squat

hamstring muscle anatomy tear squat

During squat, hamstring muscles squeeze to straighten the pelvis. This prevents the torso (in this phase the torso is bound to the pelvis by the contraction of the abs and lumbar) from bending too much forward.

hamstring muscle anatomy tear

Note

Fibrous scars can also be treated in parallel by a physiotherapist with manual or mechanical massages to soften the lesion.

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-Steph

Fitness History – United States (1865 – 1900) Part 9

united states post civil war

United States – Post Civil War

united states post civil war

One of the most important events regarding the modern fitness in the United States was the industrial revolution that led to cultural changes in the country. The advances in industrial and mechanical technologies have replaced labor-intensive jobs. Rural life changed to an urban life. The life of the new city generally required less movement and work than rural life, which has led to reduced levels of physical activity.

At the turn of the century, the most common causes of death were influenza, polio, rubella and other infectious diseases. The risk of illness and death from infectious diseases were relieved by the discovery of Penicillin. The cost of industrialization and urbanization has become obvious in the 1950s and 1960s. An epidemic of hypokinetic diseases including cardiovascular disease, cancer and type 2 diabetes, never before prevalent, began to be recognized as the main causes of illness and death. The improved lifestyle brought in part by the industrial revolution also brought with it an unwanted and alarming cost to health.

Physical education

united states post civil war

After the end of the civil war in 1865, Swedish and German gymnastics experienced an average growth in popularity. However, the most popular form of gymnastics during this period was « The New Gymnastics » introduced by Dioclesian Lewis. Individuals who played an important role in the development of fitness during this period were Edward Hitchcock, William Anderson and Dudley Sargent.

Hitchcock knew the results of its fitness programs (combination of differents gymnastics) to improve health. He also introduced the concept of using anthropometric measures to assess progress in fitness. Sargent added scientific research to teaching fitness and developed organized teaching methods for instructors. Anderson’s work focused on physical education instruction was the development of fitness in a professional organization.

An interesting argument developed during the post Civil War period, still exists today. Several physical education instructors believed strongly in the value of incorporating exercise programs that would improve health-related fitness. However, sports were also gaining popularity in the United States during this era. Therefore, the majority of physical education programs were focused on sports and games. The debate between health-related fitness and skill-related fitness physical education programs continues to exist.

That’s all for today. Soon the rest of the fitness history

-Steph