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Exercise Times Could Replace Calorie Counts

Nutritional InformationIn an effort to give people a better understanding of portion size and dietary recommendations, scientists are suggesting calories counts on packages may soon be replaced by the exercise duration needed to burn off the food.

The authors of a study published in the American Journal of Public Health found that teens made healthier dietary choices when presented with the new caloric exercise information. To test their hypothesis, researchers presented dietary information in four different ways.

• Absolute calories

• Miles of walking needed to burn off the calories

• Minutes of running needed to burn off the calories

• Teaspoons of sugar

The four caloric variations were posted in the soda sections of local corner stores. Teens were then asked to go into the store and purchase a beverage of their choosing. According to researchers, when presented with the number of minutes of walking needed to burn off the beverage, more teens opted for a smaller sugar-sweetened beverage, a diet beverage, water or skipped the beverage altogether.

Researchers were encouraged by the findings, but noted that their study was limited to African American youth – a group at high risk for obesity and diabetes.

“Overall, we found that providing easily understandable caloric information might be an effective strategy for lowering calorie intake from sugar-sweetened beverages among low income Black adolescents and encouraging increased water and diet soda purchases,” the authors wrote.

The authors also wrote that even if teens didn’t choose a healthier option when presented with the exercise information, participants noted that they had a better understanding of the health impact based on the information than if they were simply given total calorie counts.

Dr. Silverman comments

This study’s results are consistent with similar studies that suggest people make smarter food choices when presented with easy to understand information. While not everyone may know exactly how many calories they should consume each day, it wasn’t long ago that even this information wasn’t present on fast food and restaurant menus. Now, all it takes is a glance at the menu to realize that Southwest Chicken Salad with Ranch dressing is just as bad for you as that Double Cheeseburger.

But these researchers are trying to make it even easier for people to understand, and it appears to be having the intended effect. 180 calories may not seen like a lot for a can of soda, but if it takes 45 minutes to walk that off, maybe you’ll be more inclined to opt for an Aquafina.

I would like to see the FDA make the next move on this. Surely product makers won’t put this information on their sodas if it has a chance to hinder sales, so it’s time for the government to take a closer look at the health impact this could bring.

Related source: Medscape

Loud Noises May Cause Knee Injuries

Loud NoisesAn intriguing study published in the Scandinavian Journal of Medicine & Science in Sports suggests that car horns or a nearby shout have been linked to an increased risk of knee injury.

For their study, researchers hooked 18 men and 18 women in their 20s up to a machine designed to capture leg spasm and movement. Participants were asked to resist downward pressure from a mechanical arm, but half the group was subjected to a loud beep prior to the downward pressure, while the other half heard no sound. Researchers say the sound was equivalent to the revving of a loud motorcycle engine.

Interestingly, those participants in the noise group exhibited significantly more muscle stiffness during the resistance and bend tests compared to those in the no beep group. Researchers also noted that muscle activity and joint stiffness reduced as the startled response subsided.

Researchers wrote that higher initial stress followed by markedly reduced stiffness likely indicates a disturbance in neuromuscular control that can lead to abnormal stress and unintentional injury. Considering there are an estimated 250,000 ACL sprains and tears in the US every year, it’s not unreasonable to suggest that at least some of them occurred as a result of a loud or unexpected noise.

The researchers noted that the beep used in the study may not compare to loud sounds during athletic competitions, and an athlete can reasonably expect to hear a whistle or a buzzer at certain intervals during the matchup. Instead, they say car horns, unexpected sirens or a nearby shout are the most likely cause of noise-induced injuries.

Dr. Silverman comments

This study is interesting because it focuses on how our brain’s reaction to an unexpected occurrence affects the rest of our body. A sudden jolt or flinch is your body’s way of going into “defense mode,” but if you’re running or playing a sport, that instantaneously reaction could cause major issues.

Related source: Wall Street Journal

Alex Morgan Injures Ankle, Out For World Cup Qualifying

Alex MorganThe US Women’s National Team will be without Alex Morgan for the remainder of the CONCACAF tournament after the striker suffered a nasty ankle sprain in Friday’s win over Guatemala.

Morgan exited Friday’s 5-0 win after colliding with a Guatemalan player in the 37th minute. As you can see in the video below, Morgan’s ankle twisted when she was hit from the side by a defender.

A subsequent MRI revealed no further damage, but the ankle sprain is expected to keep her sidelined for 4-6 weeks. Head coach Jill Elias said other members of the team will have to step up to fill the void left by Morgan.

“We certainly feel for Alex and of course having her go down is a big loss to our team, but as I’ve often said, one of our strengths is depth and everyone on the roster is prepared to step up,” said Ellis. “After talking with our medical staff and Alex, we all agreed that the best course of action for her is to head home to minimize travel and get into an environment where she can totally focus on recovery.”

The United States is 2-0 in group play and is considered the favorite to win the tournament and clinch a spot in the Women’s World Cup next summer. Morgan said she’s disappointed by the injury but knows the main goal is to be healthy for the World Cup.

“It’s unfortunate timing, but I know my teammates will take care of business and qualify for the World Cup and I’ll be watching from my couch,” Morgan said. “I have plenty of time to get healthy with a longer break coming up for the team so my job is to focus on the rehab and get back healthy as soon as I can.”​

Dr. Silverman comments

Despite what the Youtube video is titled, Morgan did not break her ankle during the play, which is somewhat surprising based on the force and twisting that occurred.

This type of ankle injury is classified as an ankle inversion. The lateral ligaments on the outside of the foot are stretched, and the timetable for return depends on the severity of the sprain. Based on the video evidence and the fact that an MRI revealed no structural damage, 4-6 weeks sounds about right.

While Morgan should have no problem healing with plenty of time to spare before the World Cup, there are some concerns about her ankle health. She missed seven months after injuring the same ankle last fall. When speaking about that injury, Morgan noted that the previous injury was not a typical sprain, saying she suffered a bone bruise that eventually led to a stress reaction. She ultimately had to be completely non-weight bearing for some time. She blamed herself for the improper care, but the doctors will certainly want to make sure Morgan isn’t dealing with a larger issue. They’ll also want to ensure she sticks to her rehab regimen.

Morgan is a bright young star for the women’s national team, so I hope she’ll be completely healthy when the World Cup rolls around. The team will certainly need her.

Related source: USA Today, Bleacher Report

Forward Lean Could Lessen Knee Stress While Running

Running LeanSlightly leaning your body forward while running can help reduce stress in your knees, according to a new study published in the Journal of Orthopaedic & Sports Physical Therapy.

For their study, researchers asked 24 runners who ran faster than an 8:00 mile to select one of three running styles; Flexed (Some forward lean), Erect (Essentially straight trunk) or self-selected (No intentional style). Researchers measured the reaction forces and stress levels exhibited by each group and uncovered:

• In the self-selected group, the runners with the least forward lean experienced the most patellofmoral joint stress.

• The difference was even more pronounced when comparing the flexed group to the erect group.

• No groups said they experienced pain before or after running, but researchers say the increased knee stress could cause problems over time.

“On average, a 6.8-degree increase in the mean trunk flexion ankle resulted in a 6.0 percent decrease in peak [patellofemoral joint] stress, whereas a 3.3-degree decrease in mean trunk flexion led to a 7.4 percent increase in peak [patellofemoral joint] stress,” researchers noted.

Dr. Silverman Comments

The study’s findings are interesting, but it’s nothing new. As I’ve said in previous posts about running, a midfoot strike is generally preferred to a heel strike pattern. Not only does a heel strike cause more stress to the knee, you’re also at a heightened risk for a heel bruise or calcaneal fracture.

You are more likely to run in a heel-strike pattern if you have an erect trunk. Leaning slightly forward will naturally push you towards a midfoot strike as your feet adjust to your new center of balance. That’s not to say a slight lean will automatically make you run with a midfoot strike, but the study appears to show that even in heel strikers some of the knee stress can be avoided by repositioning your trunk.

Another thing to keep in mind when running is to keep your hips facing forward. Running with a moderate to significant hip twist puts unneeded stress on your lower half.

In the end though, everyone has their own running style, but if you find yourself dealing with knee pain after your run, try leaning forward a bit during your next jog.

Excess Sugar Linked To Memory Problems in Teens

Excess SodaA new study out of the University of Southern California suggests that there’s a link between excess sugar intake and memory problems in teens.

For their study, researchers fed adolescent lab rats solutions of sugar or high fructose corn syrup in concentrations comparable to a 12-ounce soda. Researchers found that the rats that drank large quantities of the liquid were more likely to:

  • Exhibit memory problems
  • Experience brain inflammation

Adolescent rats who were not fed the sugary solution were less likely to develop the above conditions, but the truly interesting findings come when comparing adolescent rats to adult rats. Researchers said that adult rats who were fed the sugar solution did not have issues with memory loss or brain inflammation, suggesting the excess sugar may be more damaging to younger brains.

“The brain is especially vulnerable to dietary influences during critical periods of development, like adolescence,” said Scott Kanoski, a corresponding author on the study.

Memory Issues

Researchers used a spatial memory maze to see how sugar or its absence affected a rat’s memory. After completing the maze, the adult and adolescent mice in the sugar group were fed the sugar solution and then placed back in the course. The adolescent mice that did not receive the solution were given a similar interval between retrials. On the subsequent attempts, the adolescent rats that were fed the sugary solution preformed far worse than the other two groups.

Researchers believe neuroinflammation in the hippocampus may be to blame, as the hippocampus is part of the temporal lobe that controls memory formation. Adolescent rats in the sugar group were found to experience more hippocampus inflammation than the other two groups, and similar hippocampus degeneration has been associated with condition like Alzheimer’s and dementia in humans.

“Consuming a diet high in added sugars not only can lead to weight gain and metabolic disturbances, but can also negatively impact our neural functioning and cognitive ability.” Kanoski concluded.

Dr. Silverman comments

The plain and simple truth is that excess soda consumption is awful for your body. High schoolers who chug Mountain Dew to stay up late cramming for a test are probably doing more harm than good.

Practice healthy routines like a balanced diet and a good night’s rest. You’d be amazed what your brain can do when it’s fully rested.

Related source:

Kevin Durant Out 6-8 Weeks With Jones Fracture

Kevin DurantThe Oklahoma City Thunder are expected to be without Kevin Durant for the first month of the season after the reigning league MVP suffered a Jones fracture in his right foot.

“From what I’ve been told, a Jones fracture is the most common surgical procedure performed on NBA players as of late,” said Oklahoma City general manager Sam Presti said. “It has happened enough so that there is enough of a body of work to look at an average recovery time.”

Durant will be evaluated over the next few days before the team decides if he needs to undergo surgery to correct the issue. In my experience surgery has been the optimal route, and Presti said it appears the team is leaning in that direction.

“We’re heading in that direction,” Presti said.

What’s a Jones Fracture?

A Jones fracture is a fracture on the fifth metatarsal on the foot. They typically occur from stress reactions and cause a fracture near the base of the fifth metatarsal.

We’ve documented numerous Jones fractures on the blog before, from Rasheed Wallace to Julio Jones, and in each case the story is the same. Jones fractures are difficult to deal with for two main reasons:

• There is poor blood supply to that area of the foot.

• Surgical equipment can fail, even if screws are correctly inserted down the intramedullary canal.

It sounds like Durant will soon go under the knife, and it would be a wise decision. Just look at the case of Rasheed Wallace. He suffered a Jones fracture in December and attempted to let it heal on its own. He waited, and waited and waited, but the injury never fully recovered. He eventually underwent surgery in March, but it was essentially a career ending injury. Wallace returned to play in the final game of the season, more as a swan song than anything, recording two points in four minutes in his last game of his career. He likely would have been able to salvage a couple more months of playing had he undergone the operation back in December.

Now obviously Durant is much younger than Wallace at the time of his injury, but it simply doesn’t make sense to roll the dice that the injury will heal perfectly on its own. As I mentioned, even proper surgery isn’t a guaranteed fix, but operating on the foot will provide him with the quickest return. There’s a chance the hardware will fail – just ask Julio Jones – but as I noted in that piece, his broken screw could have been caused by another issue. As long as Durant’s doctors check for any related issues and follow proper techniques, I have no doubt that Durant will return to MVP form early this season.

Related source: ESPN

Our Hearts To Your Soles 2014

Our Hearts To Your SolesIt’s that wonderful time of year again. The leaves are turning colors, the air is crisp and cool and Red Wing Shoes is working closely with our team this year to help the homeless in the Twin Cities. I am very excited to announce our ninth annual philanthropic event, Our Hearts to Your Soles.

The event will take place the Tuesday before Thanksgiving on November 25 from 5:30pm to 7:45pm. We have a new location for the event this year – The Dorothy Day Center at 183 Old 6th Street in Saint Paul.

Silverman Ankle and Foot is once again providing the financial support for the event, and Dr. Silverman will be on hand to assist with evaluations and consultations. Dr. Silverman said he’s looking forward to the annual event.

“Our Hearts To Your Soles is a wonderful event that I look forward to each year, and this year is no different,” said Dr. Silverman. “Last year’s event was very successful, and I worked with so many wonderful people who helped make sure everything ran smoothly. The plans are still in their early stages, but we’ve already had a number of people volunteer to help out, and I see no reason why this year’s event can’t be the best yet.”

Topping last year’s event will be a tall task, as OHTYS 2013 set a personal best of 445 individuals fitted with a new pair of shoes. In addition to the new pairs of shoes, the event was also able to provide more than 300 hats and 600 pairs of socks for individuals in need.

Dr. Silverman said his favorite moment from the 2013 event occurred when he saw an 8-year-old girl receive a brand new pair of shoes. He said her smile and the generosity of others really helps keep life in perspective.

“This event always brings so many people together,” said Dr. Silverman. “It’s a rewarding experience for all involved.”

We Need Volunteers

We still need volunteers for the event, so if you’re free on the 25th and want to help a good cause, let us know. We are looking for people to help open boxes, lace shoes, assist with shoe fittings and of course set up and clean up.

We are going to begin setting up for the event at 3pm so everything will be in order when the event kicks off at 5:30pm. You don’t need to show up at 3pm or stay until clean up is done to help, just send us an email to with your availability, and we will work with your schedule. All we ask volunteers to bring is a smile, a Minnesota work ethic, and any recyclable shopping bags you can find to help attendees carry their old shoes when they leave.

If you want to help with this cause but can’t make it to the event, have no fear! You can make a donation of your choosing on the Our Hearts To Your Soles website. For as little as $15, you can provide an individual with a new pair of shoes, socks and a free foot examination at a time when they need it most.

If you have any questions about the event, please let us know by sending an email to or by commenting on the blog post or social media.

Gout May Be Precursor to Diabetes 

Foot GoutA new study out of the United Kingdom suggests that gout, a form of inflammatory arthritis in the toe, may increase a person’s risk of developing type 2 diabetes, especially in women.

Researchers tracked more than 35,000 gout sufferers and found that women with gout were 71 percent more likely to develop diabetes compared to a person without gout. Men with gout saw a 22 percent increase in their risk of developing diabetes.

“Gout seems to be contributing to the risk of diabetes independently of other diabetes risk factors, such as obesity,” said lead researcher Dr. Hyon Choi. “The association is clearly there, but why that is so isn’t known,” Choi said.

Understanding the relationship between gout and diabetes “is essential,” according to Choi. Currently, more than 3 million Americans currently suffer from gout.

What is Gout?

Gout occurs when excess uric acid to builds up in the body. These excess deposits settle in a person’s joints in the form needle-like crystals.

Gout causes significant pain and swelling in a person’s joints, and oftentimes the condition forms in a person’s feet. The joint of the big toe is the most common spot for gout to form.

The best way to prevent gout is also the best way to reduce your risk of diabetes; Eat a healthy diet, watch your cholesterol, and maintain a health weight.

Dr. Silverman comments

This is a neat study, and although it lacks causation it’s interesting to note that both gout cases and diabetes levels have increased in the past decade.

It’s clear that the authors hope to find a causal relationship between gout and diabetes, but for now, we’ll simply have to follow their advice of eating right, maintaining healthy cholesterol and blood pressure levels, and regular exercise. There’s no clear link that gout leads to diabetes, but hopefully it can serve as a wakeup call for some people. If you have gout, make healthy decisions or you might soon find it hard to regulate your glucose levels.

Related source: Web MD

Could NFL Head Injuries and Off-Field Violence Be Linked?

Football violenceNFL players have been in the news lately for all the wrong reasons. Ray Rice was suspended after a video surfaced of him punching his fiancé, and local players like Adrian Peterson and Jerome Simpson have had off-field issues of their own. When I write about football players on this blog it has to do with an injury they suffered on the field, and although I don’t specialize in head trauma, I’ve written a few posts on football concussions and prevention strategies. Now I’m beginning to wonder if the two problems – off-field violence and head injuries – are linked.

Previous research has shown that NFL players are at a heightened risk to develop what is known as chronic traumatic encephalopathy (CTE). In fact, scientists suggest that nearly one-third of all NFL players will develop permanent neurological disorders as a result of repeated head trauma throughout their careers. Neurological damage has been shown to cause memory loss, mood swings and behavioral changes, which can sometimes lead to bursts of violent aggression.

Violent behavior and mood swings as a result of head trauma can occur at a young age; It’s not confined to old men in wheelchairs. Research conducted by two doctors at Boston University found that the mean age for symptom onset in individuals diagnosed with CTE was 34.5 years of age, and one individual expressed symptoms at the young age of 19.

Obviously neither Rice nor Peterson have been diagnosed with CTE, but at the ages of 27 and 29, they’ve certainly taken their fair share of hits. Could their violent behavior be linked, even partially, to repeated head trauma? It certainly seems possible, yet the NFL only seeks to punish offenders instead of treating the true issue at hand.

Something needs to change. We need to treat behavior disorders as diseases. We need to stop retributive punishment and treat with rehabilitation. It’s doubtful that CTE can be reversed, but the behavioral disorders that accompany it can be addressed.

More From Dr. Silverman

There is a true disease present in these people, that only now we are seeing.

Years ago, people thought that children with epilepsy were possessed by the devil and they were tortured by exorcism. Some people still believe that today! Now the same thing is being said about football players that lose control and react violently. They are committing crimes and people are reacting with knee jerk punishment.

Are they responsible for their behavior? Yes. Are they capable of telling right from wrong? Yes. We were all too ready to accept the wear and tear football players put on their bodies – “That’s why they make the big bucks” – but when it affects their brains and their behavior, their families, children and other loved ones, somehow no one wants to address it.

What will happen when the next football player gets convicted of DWI? We punish alcoholics with jail time when they are repeat offenders. Of course the recidivism is massive and jail has not been shown to be a deterrent. Instead, Alcoholics Anonymous has the best cure rate. Somehow making the diseased people feel better isn’t what the public wants. They want to make themselves feel better so we continue to punish people with disease instead of treating the disease.

I don’t claim to have all the solutions. I can’t answer the families of those who have lost a loved one in an accident fueled by alcohol. Similarly, I can’t answer the families who have been tortured watching their loved ones violent behavior, and my heart bleeds for the children who have suffered at the hands of abusive parents.

I can say with definitive clarity that punishment will not fix this problem; As much as people want, you cannot legislate out a disease. Punishment does not deter this behavior because nothing stops the angry impulsive person. Our culture and genetics provide victims with an excuse to react out of proportion. In a moment of anger they believe they are the victim, impulsively react, then rationalize afterwards how they were victimized and how their behavior can be normalized (He pushed my buttons, She hurt me, etc). They look for excuses, they make apologies, and they sometimes get punished. It doesn’t fix the problem.

Combine an angry impulsive brain with Cumulative Trauma Encephalopathy, instruct them regularly to cause pain to other people, to ignore their own head injuries and then expect them to act like normal people in society, because they make a lot of money. It’s not going to happen. Ray Rice and AP have done terrible things, but Pandora’s box just opened. There is a lot more to come.

Related source: MedPage Today

The Link Between Obesity and Cancer

Cancer and ObesityIn an effort to prevent and treat patients with cancer, the American Society of Clinical Oncology is speaking out against a new threat – Obesity.

Calling obesity “a central challenge,” the ASOC is taking a new public stance against obesity. According to a statement by the ASOC, the group plans to:

• Increase its efforts to educate the public and raise awareness about the links between obesity and cancer.

• Intensify research about the link between cancer and obesity.

• Develop new resources and guidelines for clinicians.

• Implement policy changes to improve access to obesity screening, diagnosis, and treatment.

• Discuss new strategies and research at a medical summit later this year.

Former ASCO President Clifford Hudis, MD, said the goal is to make sweeping improvements, just like other disease prevention groups have done in their fight against obesity.

“Obviously, nobody is so simplistic as to suggest that we simply counsel patients to lose weight,” said Dr. Hudis. “Our sister societies in many areas of medicine have been highlighting the risks of obesity with regard to diabetes, heart disease, and other problems for decades.”

Dr. Hudis said the renewed desire to speak out against the link between obesity and cancer comes from a previous study that suggested as many as 20 percent of cancer deaths could be attributed to obesity.

“Research has clearly established that there is a critical relationships between cancer and obesity, but more work is needed to determine whether weight loss, increased physical activity, and improved dietary quality can lower cancer rates and improve outcomes,” added Jennifer Ligibel, MD, chair of the ASCO’s cancer survivorship and cancer prevention committees. “No single organization or medical specialty can address obesity alone, and we will collaborate with other groups to find evidence-based solutions for our patients.”

Dr. Silverman comments

It’s little surprise that obesity is now being linked to cancer. We already know it’s been linked to diabetes, heart disease, increased surgical infection rates, mental health issues, foot fractures and general foot pain.

If you continually shove junk into your body, should we really be surprised if junk develops inside your body? I’ve said it before and I’ll say it again. You only get one body, so treat it right.

Related source: MedPage Today