FAQ Category: General

Removing a small piece of tissue for scientific study under a microscope can reveal many things. First, individual fibers can be identified. What type are they? How many of each type are present? What direction are the fibers oriented?

Any damage or disease of the muscle can be seen under a microscope. The microscope can be attached to a video camera and the tissue analyzed with a computer.

There are two types of muscle fiber types: type I and type II. Type I fibers are slow twitch fibers that resist muscle fatigue. Endurance athletes have more type I than type II muscle fibers. Type II muscle fibers shorten and develop tension faster than type I
fibers. Type II fibers are good for activities that require power and greater speed.

You are born with a set amount of each type of muscle fibers. You can’t change that with exercise or training. However, you can stimulate muscle fibers already present and develop them to their maximum potential. Training to increase speed or improve endurance is possible, but only within the confines of your body type and muscle type. There are some studies that suggest prolonged exercise training can alter fiber type, but this hasn’t been proven yet.

Bouncing while stretching was a common practice in years past. This ballistic style of stretching has fallen out of favor. In fact the first research to show the dangers of this method of stretching was published in 1961.

The concern about trauma to the connective tissue from this practice was shown in other studies. Over time the word got out and most coaches and athletic trainers know better
now.

It’s not clear yet what (if any) method of stretching is best. We know warm-ups are important before stretching. It’s also been reported that a 15- or 30-second stretch works better than shorter stretches. The effects of stretching on flexibility seem to last up to 90 minutes. A daily routine of stretching can increase flexibility that lasts several weeks.

Nothing’s been proven yet. All we have are theories right now. Some researchers think stretching decreases joint stability. This makes joint movement less efficient. Tendons
and muscle tissue normally absorb energy to prevent injury. An unstable joint could decrease the soft tissues’ ability to do this.

Stretching too far can also change the position of the joint. Dangerous loading effects along with decreased strength occur while the muscle is still recovering from the stretch. The changes may lead to tissue damage.

The President’s Council isn’t saying not to stretch. From the results of research thus far, it seems best to warm-up first before stretching. Conditioning and strength training are also important.

Flexibility does seem important to the prevention of injury. Too much or too little flexibility may be a risk factor.

Scientists report warm-ups are more important than stretching to prevent sports injuries.Warm-up exercises, such as jogging, cycling, or imitating the motion of your sport, improves blood flow to muscles and speeds nerve impulses. It also delivers oxygen and
energy to muscles and removes waste products.

Warm-ups tell the body to get ready for exercise. The metabolism of muscles goes up, which makes the muscle fibers move against one another more smoothly. The result is increased joint range of motion. This is what we call flexibility.

You may not need more muscle or joint motion, but giving the muscles energy needed to contract and move smoothly will prepare you for activity. There may be an added benefit of injury prevention.

A Dacron graft is a synthetic (man-made) material used to replace normal body tissues. It’s usually made into a tube shape for use in replacing or repairing blood vessels. It can be a flat piece of material, too.

Sometimes the injured blood vessel can be closed just with stitches. When it can’t and a graft material is needed to cover the hold, the Dacron graft works well. The body seems to be able to handle its presence easily.

Impairment ratings and disability decisions are made as objectively as possible. Whenever they can, doctors try to use tests and measures to put a number or percentage to a patient’s abilities and disabilities. Unfortunately, there isn’t a single tool or test for use with all injuries and all people.

A disability is defined as a loss in the ability to engage in gainful employment. This decision isn’t made lightly. You will probably see the medical doctor as well as other health care providers. A physical or occupational therapist or psychologist may test you. The results of all the tests are reviewed before a final decision is made.

It’s possible, but the body usually forms a protective coating around the bullet fragment. The bullet gets surrounded by a fibrous membrane filled with fluid.

Studies show the body can still absorb the lead and cause a toxic response. Lead poisoning occurs over time as the amount of lead absorbed increases. It’s usually a slow process, but can be speeded up by alcoholism or infection.

A blood test can be done to look for lead poisoning. Normal blood lead level is zero. Toxicity doesn’t appear until the lead in blood is more than 24 mg/dL, so we can’t depend on outward signs. Ask your doctor about your concerns and get a baseline blood level if you haven’t already done so.

Lead is still used in bullets because of its ability to shatter into many pieces on impact. There’s concern that lead-based bullets pose an environmental hazard. Lead can leach into soil and water systems. Copper has been used in some bullet manufacturing. This isn’t widely used and only makes up about one percent of the bullet market.

America’s military is also concerned about the dangers of lead poisoning on military bases and at in-door shooting ranges. To solve this problem, the Department of Defense started the Green Bullets program. New nontoxic “green” bullets are used in the M-16 rifles. Instead of a lead core, the bullet is composed of a mixture of tungsten and tin.

The Army hopes the new bullets will reduce the need for costly cleanups of shooting ranges, saving taxpayers millions of dollars.

Plumbism is a chronic form of lead poisoning caused by lead or lead salts absorbed into the body. The word plumbing is derived from plumbum, Latin for lead.
The symbol for lead (Pb) is an abbreviation of its Latin name plumbum.

Lead occurs naturally in the environment at very low levels. Higher levels of lead was present in car exhaust before 1980. Older paints contained lead as did some dinnerware, birdshot, and fishing weights.

In the past, toothpaste tubes were even lined with lead. Condensed milk used to come in cans soldered with lead. This has all been changed now. Lead has been removed from most
products. It can still be found in drinking water from homes with pipes soldered with lead solder. New building codes require lead-free solder.

Infants and children most at risk are those living in pre-1960’s housing where paint often contained lead. Small children often ingest paint chips or dust from lead based paint. Soil in cities with high traffic density may still contain high levels of lead
from car exhaust.

Muscle stiffness and soreness is the result of tiny tears in the muscle fibers. The body responds with fluid and white blood cells to the area to help the healing process. An inflammatory response occurs that’s often more than the body really needs. All that
activity in the muscle turns on the cells that pick up messages of pain and distress.

Whenever we use (or overuse) a muscle in a way it’s not used to, we can end up with sore muscles. Even if you think you are doing the same thing as always, there are times when we change the routine just enough that the muscle reacts as if it’s new training.

Other factors enter in, too. Fatigue and dehydration affect the muscles’ ability to contract repeatedly without microscopic damage. When we contract a muscle and then length it slowly it’s called an eccentric contraction. It’s like putting on the brakes during an activity or movement.

Muscles aren’t trained as well in eccentric motions and are more likely to get sore after activities requiring eccentric contractions. Since it doesn’t hurt at the time, it’s easy to over do an activity or motion. This is especially true for new exercises not done before.

A valid and reliable, easy-to-use tool is the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire. It’s in several languages
http://www.dash.iwh.on.ca. The patient answers 30 questions about the arm and hand.

The items ask how hard it is to perform physical activities because of the arm, shoulder, or hand problem. The severity of pain, activity-related pain, tingling, weakness and stiffness are also measured. DASH measures how much arm problems affect social activities, work, sleep, and self-image.

The test is scored with numbers. A final test score of zero means there is no disability.
The greatest disability is scored as 100. The DASH can be used to measure pain and activity levels before and after treatment.

If you would like to see how other therapists have used this tool, just go to Google and type in “disabilities of the arm, shoulder, and hand.”

There were many studies reporting the effects of tobacco use in general. This includes smoking cigarettes, cigars, pipes, and other substances. It also includes smokeless tobacco products.

In a few studies it appears there are an equal number of problems that can occur with either choice. Studies show smoking more than 15 years increases the risk of sciatica (shooting pain down the leg). Smoking volume (number of cigarettes) isn’t a factor here.

Number of cigarettes and the number of years smoked are both linked to chronic low back pain. Smoking increases the risk of osteoporosis and damage to the bones. It’s not clear if volume or duration or both are key factors.

New research into the effects of smoking after surgery shows many problems. Smokers heal slower and return to work later. Again smoking in general isn’t broken down into volume or duration. Since tobacco use is a known health hazard, most of the research and education is towards stopping, not just reducing it.

There’s some truth to that statement. But there are other factors as well. For example, ultrasound imaging depends on the person taking the ultrasound, too. This is called operator-dependent imaging. Ultrasound results do depend in large part on the skill of the operator. It takes a long time to learn this skill. Not all centers have experienced operators.

The patients also affect results. Someone with limited motion might not be able to get into the best position needed for the test. Large or obese patients don’t get as good of results.

The doctor who reads the imaging results is called a radiologist. The radiologist is more accurate reading tests he or she is familiar with and sees often. There is a learning curve here, too. Some hospitals and clinics have a second reading done when new staff is in training. This can help reduce errors and improve accuracy.

You can always ask for a second reading or second opinion if you’re in doubt about the results of any tests done.

Studies over the years have linked tobacco to many problems. Anxiety, depression, and panic disorders are some of the psychologic problems smokers report. But when the number
of these problems in nonsmokers increased, scientists started rethinking and retesting their theories.

New studies suggest a genetic trait puts the person at risk for both. It’s not clear yet where the cause and effect occurs, but studies are underway in this area.

You’re right about the link between tobacco use and certain health problems.

The bad news: lung cancer, heart disease, osteoporosis, and poor wound healing are linked with tobacco use. Depression and anxiety occur more often in smokers. Life span in smokers is five to 10 years shorter than for nonsmokers.

The good news: a recent study of outcomes after rehab for low back pain reports tobacco use may not be a factor in the results. Smokers had just as good a response to rehab as nonsmokers.

Other factors may be at work here. Perhaps higher rates of smoking occur in unemployed workers. There may be other reasons besides smoking for work absence. Future research will continue to assess effects of smoking in the workplace.

The anatomy itself hasn’t changed since the 1950s. The textbooks have improved. Artists are able to show the muscles more accurately with today’s computer software. The quality of the pictures has improved quite a bit in the last 10 years.

One big change you’ll see from then until now is the use of evolution. Since the mid-1990s more books include Darwin’s theory on evolutionary medicine. The most recent edition of Gray’s Anatomy (38th edition; the most widely used anatomy text) takes an evolutionary approach to anatomy.

Special care has also been taken to include the very latest imaging of the anatomy. These pictures come from MRIs and CT scans.

Our understanding of anatomy has also improved now that doctors can “see” inside the body. Instruments like the arthroscope for joints or the endoscope for organs has a tiny TV camera on the end. This allows doctors to view the body part from the inside. Today’s anatomy texts are updated using the pictures from these tools.

For your use a text from the late 1950s may not be up-to-date, but it will give you what you are looking for. It wouldn’t be advised for a medical student or other health care professional.

The break test is used by physical therapists, athletic trainers, and doctors. It gives them information about muscles. A negative break test means the muscle is normal. It’s not weak or torn.

This test is done by placing the patient’s arm (or leg) in one position. The patient is told to hold the arm in that spot. The therapist puts pressure on the arm to see if it will move with resistance. The examiner uses enough force to overcome the isometric
strength of the person.

Scientists have studied the body for hundreds of years. Each part has been carefully dissected (cut away from the body). Some researchers use electrodes on live subjects to test out each muscle. This helps define what actions muscles are responsible for.

Combining muscle testing equipment with computers has given us a lot of new information. Computer software has been designed to analyze muscle movement and function. Some muscles are divided in parts. Each section has its own job. This kind of testing makes it possible to compare one part of the muscle to another.

Elective usually means “by choice.” The operation isn’t needed to save a life or keep function. It’s often used to describe operations done for cosmetic reasons. This can include face-lifts, tummy tucks, or other plastic surgery.

Today there are many more elective operations possible compared to just 10 years ago. People with poor vision can have LASIK surgery to correct their eyesight. Some dental work is also considered elective. It may make the person look better, but it won’t
improve chewing or other functions.

Elective surgery for a herniated disc is more common in countries like Canada where they have national health insurance. Only the patients with extreme symptoms will have the
operation. Everyone else will be treated with more conservative methods until a doctor and operating room are available.