We Pay for the Sins of Our Youth

WE PAY FOR THE SINS OF OUR YOUTH

 

The information presented here came from research by Marie Suszynski (reviewed by Farrokh Sohrabi, MD) and my 40 years of treating patients including professional and college athletes.

When you were younger, kid and young adult, did you sprain an ankle, knee, have back, wrist shoulder, foot pain after an activity? If so, like most of us, yes, including me, it was ignored without treatment or shortly after recovery with treatment.

According to Joshua Baker, MD, assistant professor of medicine at the Hospital of the University of Pennsylvania and the Veteran’s Administration Medical Center in Philadelphia, you could end up with arthritis in the involved joint(s) several years later. From my professional experience, change the word COULD to PROBABLY.

As many as 15% of people who have been diagnosed with osteoarthritis may have developed joint problems as a result of injury. Damaging a joint raises your chances of developing arthritis seven fold according to the Academy of Orthopedic Surgeons. Again, from my experience, that percentage is more like 75. The surgeons see only those who seek a surgical opinion/solution.

According to Louis Kwong, MD, chairman and program director of the department of orthopedic surgery at Harbor-UCLA Medical Center in Torrance, California, having a bone fracture, tendon or ligament injury makes you more likely to develop arthritis in that joint in the years to come.

A classic example of someone with post-traumatic arthritis is the high school athlete who tears a ligament (partial is a sprain) or cartilage in his or her knee and ends up with arthritis, sometimes decades later, according to Kwong.

He further stated that an injury sustained in a car accident is another type that could cause post traumatic arthritis. Your knee or ankles could be crushed, your wrist sprained, a hand broken or your back/neck would become strained as a result of a sudden jolt (whiplash). Even a relatively minor event could eventually lead to arthritis—an ankle sprained while hiking or a slip on ice that leads to a sprain or fracture.

According to Kwong, people can slow the progression of arthritis by keeping their body weight within a healthy range and exercising. He also encourages people to be conscious of the stress they put on their joints every day. If two men have high school football injuries and one goes on to have a desk job while the other is a construction worker, the construction worker is more likely to get early onset arthritis.

The arthritis could be osteoarthritis or an inflammatory arthritis such as gout, according to Anjali Casey, MD, rheumatologist with North Shore University Health System in Skokie, Illinois.

Even when doctors treat the injury immediately after it happens, treatment can’t make it as through the injury never happened.

Any sport can cause a fracture or injure a ligament or tendon. Quickly changing direction on a soccer field, stopping suddenly while playing tennis/hockey, landing the wrong way on a basketball court, crashing into another player, hyper-extending the spine or a joint in gymnastics resulting in pain can, and quite possibly will, lead to arthritis later on.

A 2010 study of nearly 2,500 people in Iceland, showed that men with strenuous occupations such as farming and fishing were more likely to need total knee replacement or total hip replacement surgery because of osteoarthritis, compared to managers and professionals in non-strenuous occupations.

An example in my practice was a woman in her late 20s who had bad neck pain, with some numbness and tingling in her hands. Her x-rays showed a reversal of her normal lordosis (forward curve) in her neck and significant osteoarthritis. The latter was far greater than one would expect in someone her age. When asked if she had a car accident or played varsity football in high school, she replied no to both. I was perplexed. The third time she came in for treatment, she said she remembered that age 16, she flew out of the windshield of a car, landing on the side of the road. I was no longer perplexed.

The same has been evident in teenagers and early twenties for those who were in gymnastics and cheer leading at an early age.

There are many good treatments. Medicines, as you will see on television ads, have many negative side effects. If you are suffering, you need to decide if the benefits are worth the risks. Chiropractic, Light therapy, diathermy, GENTLE physical therapy are good choices with virtually no negative side effects.

The title of this Blog is, “We Pay for the Sins of Our Youth.” In truth, we didn’t know or wouldn’t have believed that our activities could cause long term damage. I always cringe when I see young children carrying their younger siblings. The pressure on their incompletely developed joints and spine are far more than they should possibly bear. Even that common day occurrence is the precursor to early onset arthritis.

Now you know. What you do with this knowledge is up to you.

 

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The First Amendment, The Supreme Court and Colin Kaepernick, et al.

 

The First Amendment of the United States Constitution prohibits the making of any law respecting the establishment of religion, impeding the free exercise of religion, abridging the freedom of speech, infringing on the freedom of the press, interfering with the right to peaceably assemble, or prohibiting the petitioning for a governmental redress of grievances. It was adopted on December 15, 1791, as one of the ten amendments that constitute the Bill of Rights.

The Supreme Court has ruled many times about the validity and interpretation of the freedom of speech portion of this amendment. Rulings were not made until the 20th Century.

In 1919, in the case Schenck v. United States, Justice Oliver Wendell Holmes, Jr., writing for the Court, explained that “the question in every case is whether the words used in such circumstances are of such a nature as to create clear and present danger (not the movie) that they will bring about the substantive evils that Congress has a right to prevent.”

The findings were similar in Debs v. United States, Frohwerk v. United States and Abrams v. United States. All were in 1919.

In Whitney v. United States (1927), Justice Louis Brandeis wrote, “Those who won our independence…believed that freedom to think as you will and to speak as you think are means indispensable to the discovery and spread of political truth; that without free speech and assembly discussion would be futile; that with them, discussion affords ordinarily adequate protection against the dissemination of noxious doctrine; THAT THE GREATEST MENACE TO FREEDOM IS AN INERT PEOPLE (my personal emphasis); that public discussion is a political duty; and that this should be a fundamental principle of the American Government.

In Yates v. United States (1957) the Supreme Court ruled that advocacy of abstract doctrine remained protected (Colin Kaepernick, et al.) while speech explicitly inciting the forcible overthrow of the government was punishable under the Smith Act.

During the Vietnam War, in Brandenburg v. Ohio (1969) the Supreme Court referred to the right to speak openly of violent action and revolution in broad terms. “Our decisions have fashioned the principle that the constitutional guarantees of free speech and free press do not allow a State to forbid or proscribe advocacy of the use of force or law violation except where such advocacy is directed to inciting or producing imminent lawless action and is likely to incite or cause such action.”

In Cohen v. California (1971), Justice John Marshall Harlan wrote in the majority opinion that Cohen’s jacket fell in the category of protected political speech despite the use of an expletive: “one man’s vulgarity is another man’s lyric.” Mr. Cohen wore a jacket with the words, “Fuck the Draft” in the corridors of a Los Angeles County courthouse.

**In the case of Texas v. Johnson (1989), the Supreme Court reversed the conviction of Gregory Lee Johnson who burned an American Flag at a demonstration during the 1984 Republican National Convention in Dallas, Texas. Justice William J. Brennan, Jr. wrote in the decision that, “IF THERE IS PRINCIPLE UNDERLYING THE FIRST AMENDMENT, IT IS THAT THE GOVERNMENT MAY NOT PROHIBIT THE EXPRESSION OF AN IDEA SIMPLY BECAUSE SOCIETY FINDS THE IDEA OFFENSIVE OR DISAGREEABLE.” (Kaepernick,et al.).

PETITION AND ASSEMBLY

In California Motor Transport Co. v. Trucking Unlimited (1972), the Court ruled; “The right not only protects demands for “a redress of grievances” but also demands for government action. The petition includes according to the Supreme Court the opportunity to institute non-frivolous lawsuits AND MOBILIZE POPULAR SUPPORT TO CHANGE EXISTING LAWS IN A PEACEFUL MANNER. (Kaepernick et al.).

In Borough of Duryea v. Guarnieri (2011) the Supreme Court ruled regarding the Free Speech Clause and the Petition Clause. “….Both speech and petition are integral to the democratic process although not necessarily in the same way. THE RIGHT TO PETITION ALLOWS CITIZENS TO EXPRESS THEIR IDEAS, HOPES AND CONCERNS TO THEIR GOVERNMENT AND THEIR ELECTED REPRESENTATIVES, WHILE THE RIGHT TO SPEAK FORSTER THE PUBLIC EXCHANGE OF IDEAS THAT IS INTEGRAL TO DELIBERATIVE DEMOCRACY AS WELL AS THE WHOLE REALM OF IDEAS AND HUMAN AFFAIRS. BEYOND THE POLITICAL SPHERE, BOTH SPEECH AND PETITION ADVANCE PERSONAL EXPRESSION…..(Kaepernick, et al.)

The First Amendment also guarantees the right of people to disagree with what is said or done. Doing so does not make them a better person or American than the person they are upset with.

People like Jerry Jones and the Coach of VMI are really good people. If they had said, “I respect your right to exercise the First Amendment, but I would prefer you do it outside the realm of our games.” Instead, they chastise and threaten Americans for doing what our Founding Fathers included in our Bill of Rights and confirmed countless times by the United States Supreme Court. THEY are the ones breaking the law. THEY are offending all those who died defending our Constitution and way of life.

 

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Privatized National Health Care–A Plan

About 23 years ago, a friend and I sat at lunch and talked about an idea he had about a national health plan that would cost taxpayers virtually nothing. We bounced ideas back and forth before leaving for our respective work duties. I continued thinking about it, made several modifications and put it on paper. I share it with all of you.

Using simple numbers, assume the accurate U.S. population is about 300,000,000. Congress will need to grant the six largest health insurance companies limited anti-trust immunity, similar to that enjoyed by professional baseball. This would apply to other insurance companies with whom the original six may choose to sub-contract.

Congress would also set up regional oversight committees, consisting of representatives form ALL licensed health care professions, but with a voting majority belonging to lay persons. Those committees, in turn, would appoint representatives on a rotating basis to meet nationally to review possible abuses or necessary improvements to the system.

The only other thing Congress would have to do is pass legislation establishing the severest possible penalties for any and all individuals involved in cheating, bringing profit to themselves and/or the company they work for. I suggest 20 years in prison for the first offense without possibility for parole for ALL people involved AND supervisors who knew or SHOULD HAVE KNOWN about those activities. This would include the CEO, COO and CFO. It is called accountability and necessary when dealing with billions of dollars.

The main companies, without tax dollars, would divide the population as evenly as possible. This would mean about 50,000,000 people per company would make up their risk pool (those who pay premiums and could possibly use the service). There would be mechanisms to “tweak” the number of individuals from all socioeconomic groups, health risk categories and age groups.

Why would this work? Even at only $10.00 per person per month, each company would bring in $500,000,000 per month, or $6 billion per year. That number could be even higher if necessary, but this is a lot of money, which is why penalties have to be so harsh for cheating. With this amount of income, the six companies will have tremendous purchasing power and can dictate prices to the drug companies and other suppliers to health care facilities and patients.

There would be plenty of money for more doctors, to cover ALL conditions regardless of them being preexisting, and provide preventive health care programs. The latter would be good for their bottom line.

What about those  who just can’t afford $10.00 per month per family member? This is where religious groups, civic and charitable organizations come in. Again, there would be NO TAX DOLLARS INVOLVED.

There will be profit for all the insurance companies. They will pay regular taxes just as those supposed to be paid by any other business. There will also be a Congress generated stipulation that at least 50% of after tax corporate profits have to be re-invested in the U.S. economy.

Every man, woman and child would be covered. Every form of treatment would be covered on an equal basis. Of course, the amount could be higher than the $10.00 mentioned. Then again, it wouldn’t be but a small fraction of what the cost is for the current, “Affordable Health Care Act.” In truth, most people DO NOT use their health care policies in the course of a 12 month period. The possibility for profit is staggering, in spite of an aging population. The average citizen will be healthier and doctors, not HMO’s will once again practice medicine. They will be able to prescribe tests and medicines that are necessary. People will not have to choose between food, rent, gasoline and medications. Doctors will be able to be reimbursed a fair amount for the services they provide.

This is a template. It can work. The weakest link appears to be Congress. This plan was submitted to Congress people Kolbe and Giffords as well as Senators Di Concini and McCain. A patient of mine is an attorney who really tried to tear the plan apart. He finally said, “This could actually work.” He called his son who is a lobbyist in Washington, D.C. and asked him to check into this. A few days later his son called to say that the plan had been floating around Congress for about 20 years.

It is reasonable that members of congress could be concerned. After all, for the most part, after passing a few regulatory laws, the government is out of the picture. They would certainly resent the thought that they had to have the same insurance coverage that every other American citizen had. It is reasonable that the insurance industry would neither like the accountability aspects nor the requirement for re-investment or profits into the American economy. For certain the pharmaceutical companies and other suppliers wouldn’t like it because they would no longer have total control over what they can charge for their products.

Since the lobbying efforts of the pharmaceutical, insurance and medical supply companies are what keep members of Congress in office, it is no wonder that this plan has been, “Floating around Congress for 20 years.”

The Affordable Health Care Act has several really good aspects to it, most significant being that, in theory, every American would have access to health care. Overall, the plan is terrible. I get the feeling that those who designed it and voted to pass it, did so with the intention that it would fail. It needed to be fixed. Congress did nothing. It could be replaces with a better plan, but, again, Congress did nothing.

Perhaps a more united voice from American citizens would get Congress to actually pay attention to what their constituents suggest. Perhaps those who read this will take the initiative to try to make their legislators pay attentions to the health care needs of all Americans and the need to eliminate any tax burden associated with an absolutely necessary national health care plan.

A patient of mine was a member of the American Arbitration Association. He said the measure of whether arbitration was successful was the reaction of the participants. If all parties walked away a bit dissatisfied, then the arbitration process was very successful. Based upon this criteria, the Privatized National Health Care Plan presented above should be an excellent option.

 

 

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NOT learning from the past

Our 34th President was a five star general, and a prophet (as compared to a profit). Dwight David Eisenhower, 10/14/1890 – 3/28/69, was supreme commander of allied forces in Europe during World War 2. With the help of countless others, he engineered the landing on the beaches of Normandy, France that led to the end of WW2. Near the final weeks,  information came to him about the concentration camps. He ordered EVERY military photographer and EVERY roll of film to those facilities and insisted that they completely document what happened there. He said, “We need total documentation because fifty years form now, no one will believe this could happen.” He was absolutely correct. Even with the documentation, people in the United States and around the world deny the Holocaust had ever taken place. Certain entities have tried to get all references to it eliminated from history books.

One of his first comments once he took office for the firs time (1953) was, “Beware of the military industrial complex, it will destroy this nation.” This, form the highest ranking military officer to ever serve as President. How correct was he? The United States has been involved in 21 wars since 1945. Sadly, none of them had anything to do with our national security and way of life (as defined by our Constitution). The cost of these is truly not measurable in dollars. It is measurable in our crumbling infrastructure and the fact that we lag far behind other nations of the world in education, health care, including mental health and services for our elderly. The shortfall in Social Security has nothing to do with lack of sufficient contributions by our citizens. It has everything to do with our government taking money and replacing cash with IOU’s. This was done to help cover remarkable deficits related to the cost of waging war(s).

Most recently, we have an example of the prophetic comment by President Eisenhower. Currently, the defense department is receiving F-35 fighter jets. The Army model is the F-35A and costs $148,000,000 PER AIRCRAFT. The Marine model, F-35B costs $251,000,000 PER AIRCRAFT and the Navy model, F-35C costs $337,000,000 PER AIRCRAFT. Each of those have approximately one hour of flying time before requiring refueling (or about 1,242.7 miles). In combat conditions, it uses fuel even faster.

The MQ-9 Reaper, a military drone which is capable of carrying numerous weapons, cost $12,548,710.60 PER AIRCRAFT and requires NO pilot. It can stay airborne for TWO DAYS without the need to refuel.

With the type of wars being fought in recent history and constantly advancing weapons technology, the use of fighter jets are becoming increasingly unimportant. The Pentagon has ordered 404 F-35’s. This does not mean we should not have a strong military. We just need to not waste money on technology that can be achieved more efficiently and at significantly lower cost.

It appears we have LEARNED NOTHING from our past leaders and experiences. Sadly we are following the pattern that existed in the fall of all great empires. Most significant has been unnecessary and costly wars. Include incompetent and corrupt leaders and we are on the slippery slope and gaining speed.

The good news is that most of the fallen great empires are still pretty good places to live. Egyptian, Greek, Roman, British, Danish, French and Spanish, to name a few, have survived losing that title. If you have visited those places, you will agree that their citizens are doing well and living generally good lives with better services for all their citizens.

It is important to learn about world history and, especially, our own past. Unfortunately, after we learn about it, we forget the lessons taught and keep making the same mistakes. I paraphrase Albert Einstein. “The ultimate stupidity is to do the same things over and over again and expect the same outcome.” We were fighting the same type war in the Middle East that we did in Vietnam. Enough said.

 

 

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+Famous Lies

I am sure you are familiar with some of the more famous lies. The check is in the mail and I’ll respect you in the morning are but two of the best known. I will now add another, less known but one that certainly qualifies to join the list. ” Parking spaces for guests are zoned with preferred leaving directions, to achieve the fastest possible movement of traffic.”

Please allow me to explain. Last Sunday, 9/11/16, my son Wayne invited me to go with him to see the Arizona Cardinals vs the New England Patriots at the University of Phoenix Stadium in Glendale. It was the best non-Father’s Day Father’s Day gift I have ever received. For the first time in about 40 years, Wayne and I got to spend about 9 hours together. Just the two of us, talking most of the time during the drive from Phoenix and back. It took about 2 hours to drive from Tucson to Glendale and 30 minutes to drive two blocks in order to get into the parking lot.

When the game was over, we found our vehicle (no easy task since the area we were in had numbers that were faded) and it took us 35 minutes to move about 50 feet. In all, we were in the parking lot for about an hour. Wayne was, reasonably, fretting because he had to be at work early on Monday. I was loving it because it gave me more time to be with Wayne. Same car, same time, different perspectives.

We spoke with a parking lot supervisor who said he had made two trips to the outlet to get a lane open to empty this lot. He said, “some genius decided to have three lanes empty from the another lot, leaving no place for the cars in this lot to exit. I said that, with all the money the NFL makes and the Cardinals organization have, one would think they could afford to hire some off duty police officers to control and direct emptying of the parking lots. For that matter, move traffic so cars can get into the lots in the first place. He agreed and shrugged his shoulders.

The stadium opened  8/1/06. It has a seating capacity of 63,400 for football. It cost $455,000,000 (give or take a few pennies) to build it. There are 14,000 on site and 12,00 adjacent parking spaces and 2,000 disabled spaces.  It is listed in the top 10 of sports arenas in the WORLD. It is the only American arena to qualify for that distinction. Interestingly, it is not considered the top NFL arena. It is the only one with both a retractable roof and a floor that can move outside so the grass can survive and thrive in natural sunlight. The floors vibrate with sound as though you were standing on a huge speaker. The large screen at what would be the open end of the stadium is amazingly clear and absolutely looks to be 3D. In theory, there are no obstructed seats. However, if people stand in front of you and you don’t or can’t stand, you can neither see the field nor the big screen. People rarely sit for the majority of the game.

Having said this, every effort should be made to go there at least once. More than that would be up to the individual. However, DO NOT plan on getting into and especially out of the parking lots in a timely manner. Best consider taking Monday off if you have to drive back to Tucson. In truth, we spent almost as much time getting into and out of the parking lot as it took for us to drive back to Tucson from Glendale.

So, now you know why I have added that statement about their parking lots and procedures to the list of famous lies. As I said, I enjoyed it. I suspect my opinion is not the same as the majority of drivers trying to get home.

Once again, in the words of George Carlin, “Question everything you read.” In this case it is okay to believe me and not the stadium propaganda.

 

 

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9/11

In 1996 President Clinton appointed a White House Commission on Aviation Safety and Security. The preliminary report was released in September, 1996. It elicited a flurry of unhappy responses from the airline lobbyists. Logan Airport was prominently mentioned. Nothing was done.

On 4/1/01, Deborah Sherman of Fox News, Boston, with the help of Steve Elson, a former member of “Red Team”, conducted a study of security at Logan Airport. It was aired on 5/6/01.  It showed serious security flaws including knives smuggled through security and unguarded access to secure areas, making Logan clearly vulnerable to terrorist attack. This was passed on to John Kerry, Senator for Massachusetts. Nothing was done.

On May 7, 2001, A report was made by Brian Sullivan, a retired FAA front line agent in Boston. He stated that, “…….This demonstrates what every FAA line agent already knows. The airport screening system simply doesn’t work as intended. The FAA would rather continue to promulgate a facade of security than honestly assess the system. Management knows how ineffective the current system is, but continues to tell Congress that our airport screening is an effective deterrent.” Nothing was done.

The FAA had sent more than 150 “Letters Of Concern” to Logan Airport about their bad security. Nothing was done.

In the mean time, an FBI agent in Phoenix reported that four foreign nationals on the terrorist watch list were taking flying lessons in Arizona. He further reported that they were only learning to “take off.” This was reported to his Agent In Charge (AIC). Either that information was never sent beyond the AIC or it ended at the next in line. Nothing was done.

In July, 2001, George Bush Jr. along with his Cabinet were briefed about the strong possibility of an attack on American soil using stolen planes. Once again, nothing was done.

This begs the question, “Who is really responsible for the attacks on 9/11?” Had any of the above mentioned people (besides those who reported the information) done their jobs, 9/11 would not have happened.

The response from our nation was to attack the one country that had NOTHING TO DO WITH 9/11. The real culprits were, Saudi Arabia, Iran, Syria and Afghanistan. But that should be the subject of another blog.

I have not stated opinion. I have researched this information. Sadly, this confirms the saying, “I have met the enemy and he is us.”

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Bigger, Stronger, Faster. A different observation.

I begin with an analogy. You purchase a standard vehicle, new or used, from a dealership. You decide to modify it from its original configuration by installing a 500 HP engine. Then you add a racing transmission, differential and drive shaft. However, you keep the original Universal Joints that connect to the transmission and differential.

The first time you stomp on the accelerator, the Universal or “U” joint snaps. It does so because it is the weak link in the now super powerful vehicle you have created.

Making athletes, high school, college and professional bigger, stronger and faster is good for the games and in many ways helps protect the participants. However, as in taking medicine that can save your life, there are side effects (just watch some drug company commercials on television).

There are certain parts of the body, like the “U” joint, that cannot be made stronger. Cartilage, ligaments, tendons and their attachment to bones are examples.

For many years I have been observing athletic injuries at all levels that occur without contact. This year at the University of Arizona, the nations top football linebacker, Scooby Wright, injured his knee and foot without any physical contact. In basketball, Kaleb Tarczewski injured his ankle and had a “stress reaction” (a really silly term) to a bone in his foot. Once again, there was no contact causing these injuries. Don’t forget Tiger Woods. He built himself to the size of a professional football linebacker. His knee and low back (multiple times have failed him. They should not have happened at his age, in a non-contact sport.

SF (name withheld on purpose) was recruited to be a linebacker at the U of A. He was changed to another defensive position and pushed to gain weight. He got up to 295+ pounds. He had spontaneous fractures to the cuboid bones in both feet. They occurred one at a time. Neither happened in a game and neither involved physical contact. His position has been changed again, and he was able to lose about 35 pounds. I strongly doubt he will have any non-contact injuries this year.

Just prior to the start of this NFL season, Terry Bridgewater, quarterback of the Minnesota Vikings, blew out his knee in a non-contact injury. Young, strong men like him should not be having such injuries.

The process is to make muscles bigger and stronger with faster”twitch.” This means that the muscles contract faster. It is like adding the bigger, more powerful engine.

The padding that provides a cushion between bones (cartilage) now bears more weight and faster, more frequent compression. Add to that twisting and that weaker area is subject to tearing.

Ligaments are the parts of the body attaching bone to bone. They can’t get stronger. Notice how many knees, over several seasons, end up with torn “ACL’s” and MCL’s? Every season more of those injuries happen without contact. Ligaments can stretch only 4% of their length before fibers tear. Anything more than that and you have a SPRAIN. That means ligament fibers have torn. A lot more stretching and the ligament tears completely.

Discs of the spine are also vulnerable weak spots. They can tolerate an unpredictable amount of compression, twisting and stretching (I refer again to Tiger Woods and the twisting associated with his golf swing).

Unfortunately, there is no way of knowing or predicting which part of a particular player is subject to being his/her weak link. However, will there ever be a point that an athlete is big enough, strong enough and fast enough?

At this point, it appears that as with medicines, the bigger stronger philosophy will continue until or unless it is proven that the negative side effects are no linger worth the benefits. Unfortunately, there has been little research into the “weak link theory.” However, it is based on the most basic anatomy and physiology that ALL people who work with athletes must master.

In summation, most people are aware of the benefits of bigger, stronger and faster. I just want to point out the possible negative side effects that have been observed during athletic competition at all levels for many years. I am not suggesting suspending strength and conditioning programs for athletes. I AM suggesting that more common sense, based on the science of anatomy and physiology be applied during the process. Just like we have in corporate America, will we ever see a time in sports training when enough is enough?

 

 

 

 

 

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