Fabulous for Tom Boonen. Fabian Cancellera broke his collar bone at a feed zone and is out for next weekend’s Paris-Roubaix.

Here are the final standings:

1 Tom BOONEN OPQ 6:04:33
2  Filippo POZZATO        FAR      +0
3  Alessandro BALLAN      BMC      +1
4  Greg VAN AVERMAET      BMC     +38
5  Peter SAGAN            LIQ     +38
6  Niki TERPSTRA          OPQ     +38
7  Luca PAOLINI           KAT     +38
8  Thomas VOECKLER        EUC     +38
9  Matti BRESCHEL         RAB     +38
10 Sylvain CHAVANEL       OPQ     +38
11 Grégory RAST           RNT     +38
12 Oscar FREIRE           KAT     +38
13 Fabio SABATINI         LIQ     +38
14 Björn LEUKEMANS        VCD     +38
15 Alexander KRISTOFF     KAT     +38
16 Matthieu LADAGNOUS     FDJ     +38
17 Xavier FLORENCIO       KAT     +38
18 Karsten KROON          SAX     +38
19 Edvald BOASSON HAGEN   SKY     +38
20 Juan Antonio FLECHA    SKY     +38

Researchers in Taiwan studied a large group of people and found that just 15 minutes of moderate to intense exercise- brisk walking, jogging or running, reduced the risk of death by 14% and the risk of cancer by 10%. This was compared to an inactive group of people. So, it really does not take that much exercise to improve the quality of your life.

Dr. Jerry Sobel at Sobel Spine and Sports, is a physical medicine specialists that is an expert in pain management, low back and neck pain, arthritis, and sports related injuries. Dr. Sobel believes that exercise is a critical part of any rehabilitation program, and encourages all of his patients to exercise.

http://www.webmd.com/fitness-exercise/news/20110816/15-minutes-exercise-every-day-reduces-risk-death

Deaths from opioids prescribed for chronic non-cancer pain tripled in the United States between 1999 and 2007. The same trend is occurring in Canada, the United Kingdom and Australia writes Irfan Dhalla, MD, from the University of Toronto, Ontario, Canada, and colleagues in the British Medical Journal.

There are more than 12,000 deaths a year in the United States alone as a result of opioid overdose. These numbers are staggering! Over an 8-year period from 1999 to 2007, the number or deaths from prescription narcotics rose from 4,041 to 14,459. That is over a 300% increase. Such deaths are now more common than deaths from multiple myeloma, HIV, and alcoholic liver disease. Another way to look at it is that far more people are killed by prescription opioids than all those killed by heroin and cocaine combined.

Oxycodone is a major culprit in the staggering rise in opioid related deaths. In the Canadian province of Ontario, between the years of 1991 and 2004, oxycodone prescriptions increased by more than 850 percent, representing about one-third of all the opioid prescriptions given in 2006. In Canada the number of deaths due to prescription opioid use doubled between 1991 and 2004. Following the introduction of oxycodone into Toronto’s drug formulary in 2000, there was a 500% increase in deaths due to the drugs. Sadly, the vast majority of people who died from opioids had visited their doctor and received a prescription for the drug within a month of their death.

Dr. Dhalla believes that physicians have been misled to some degree by experts and pharmaceutical companies into believing that opioids are very effective for chronic non-cancer pain. They have also been misled about the risk for addiction, he says.

“In reality, the evidence for effectiveness is very thin. Our sense anecdotally is that many patients do not end up having significant relief from their pain. When you combine that with the fact that the risk of addiction is much higher than the pharmaceutical companies initially led physicians to believe, that creates a scenario where patients are being exposed to significant risks without certain benefits.”

For many years the pharmaceutical companies and experts suggested that the risk for addiction was less than 1%. Dr. Dhalla said.

“That’s the number you will see in a lot of papers in the 1990s, and even in the early 2000s. But in fact, we know that the risk of addiction for patients who are being treated for chronic pain for several months or longer is 35% — much higher than 1%. So addiction is a much bigger problem than physicians think it is,” he said.

Dr. Jerry Sobel in Phoenix, AZ, maintains that physicians need to be very careful in their prescribing of narcotics on a long-term basis for chronic non-cancer pain. Unfortunately, doctors have little high quality research to go on when writing prescriptions for these drugs. Considering that most patients on long-term opioids get limited relief of their pain, should we be prescribing them at all, especially when the addiction rate is as high as 35%? What are the medical and societal costs for chronic pain patients that get hooked on these drugs? These questions and many others need to be answered. Dr. Sobel at Sobel Spine at Sports is an expert in pain management and strongly favors non-narcotic treatments for chronic low back and other pain related conditions. He does assert that there are patients that can benefit from long-term narcotic use. Those are individuals that clearly have a significant improvement in their function and are working full-time. Further, their drug dose has not increased over time, i.e., development of tolerance to narcotics.

One of my favorite books on running is The Runner’s Body by Ross Tucker, PhD and Jonathan Dugas, PhD. What I enjoy so much about this book is the science based approach to exercise and running. The authors dispel many of the so called ‘truisms” of running and fitness training. A good example is the topic of sodium replacement during exercise. Can you drink enough of an electrolyte sports drink during a workout out to replenish the sodium that you lose during sweating? Do we even have to replace it? When we exercise our body temperatures go up. We sweat in order to help regulate the temperature and not allow overheating. Sweat is composed of primarily water and salt with the former being the overwhelming component. The more fit a person becomes the more efficient the sweating and the lower the concentration of sodium of the fluid. When we workout, the blood sodium level does not go down but instead goes up. This is because we lose considerably more water than salt in the sweat. Sports drinks contain too little salt to counteract the effects of sweating on the blood’s electrolyte concentration and therefore, can result in a drop in blood sodium level.

Blood contains 1.4 grams of salt per liter, while some of the best selling sports drinks have only 0.4 grams per liter. This is more dilute than our blood. So, if you consume a lot of a sports drink during a workout, your will actually dilute the blood. Don’t sports drink advertisements tell us that replacing salt is necessary during a workout or performance will suffer? In reality, you cannot elevate your sodium levels by drinking one of these products.

Are sports drinks a better alternative than water? Yes, from the perspective that your blood salt level will not drop as much as water because you are consuming a small amount of sodium. This is however, relative, as it will still drop if you try to drink as much as you can during the workout.

The best advice from the authors is not to overdrink and to listen to your thirst. 

Ross Tucker, PhD and Jonathan Tucker, PhD have a fascinating and very educational blog called The Science of Sports. If you are into the science of all things exercise you will love it.

How much do you really need to drink while exercising to prevent loss of performance and dehydration?

This is a very timely topic. The rate of Exercise associated hyponatremia (EAH) has been on the rise over the past 30 years. Before that it was very uncommon. Hyponatremia means low blood sodium levels. Many endurance athletes are under the impression this comes from loss of sodium and other electrolytes through sweating. While it is true that we all lose sodium through our sweat, and on really hot days it is more, the body over millions of years has developed complex mechanisms to keep the blood concentration of sodium in a very narrow range. This is even if you lose salt through your sweat. If an athlete overcompensates and takes in more fluid than is necessary to keep up with thirst and dilute their blood and sodium levels drop. This can result in EAH. This can make you very sick and can even lead to death.

It is currently estimated that between 0.3% and 13% of marathon runners finish the race with medical evidence of EAH, and the worldwide incidence is increasing in spite of the mechanisms and causes being well known.

In a recent study of 197 runners solicited by personal solicitation, e-mail and flyers distributed at three local races in autumn 2009, participants were asked about their beliefs regarding fluid replacement during exercise.

Most runners (58%) stated that they drink only when thirsty. Gastrointestinal distress was the most frequently cited (71.5%) reason to avoid overhydration. It was found that runners have a poor understanding of the physiological consequences of hydration behaviours that frequently reflect messages of advertising.The conclusion of the study was that runners at highest risk of EAH exhibit behavior that is shaped by their beliefs about the benefits and risks of hydration. These beliefs are frequently based on misconceptions about basic exercise physiology.

To try and reduce the incidence of EAH the International Marathon Medical Directors Association and United States of America Track and Field now recommend drinking to the dictates of thirst, although, the global marketing of sports drinks continues to promote over drinking.

I’d love to hear your thoughts on this……..when you exercise do you drink only when thirsty?

A big push these days in the cycling industry to use orthotics or wedges.  in cycling shoes to prevent injury. I was always under the impression that this was being recommended because it had been studied scientifically. I saw my podiatrist yesterday because I wanted to get a pair for my cycling shoes to make my knees feel better when I ride hard. He told me that there is no medical evidence that orthotics prevent or reduce injury rate in cyclists. What they may help with is cycling efficiency. I decided to do a search on this topic and he was right! Amazing how things get started in medicine and are taken as being the truth and standard for care when in reality it has never been studied. Another example is bed rest and back pain. It was once thought that if you have back pain you should lie in bed. This was recommended for decades by doctors and was written in the major medical textbooks. When it was finally studied, it was found to be wrong and that bed rest actually slows recovery. The one thing that you can always count on is that conventional wisdom is usually wrong.

This is a frequent comment I hear from my new patients. The story usually goes like this. ” I went to my doctor because my back was really hurting me. He took some x-rays and told me that I had arthritis and that was the cause of my pain.”

As a spine specialist there is some truth to that statement and then there is not. There are many causes of back pain. These include disc protrusions and herniations, pinched nerves, facet joint pain, arthritis, bone spurs, and pain from injuries to the ligaments, tendons and muscles. However, in the most of people with back pain alone, we never find out exactly what is causing the pain. That is usually fine, because the overwhelming majority of patients feel better within a few to several weeks even without medical attention.

One tool that a doctor has in trying to make a diagnosis of why your back hurts is an x-ray. X-rays are a great tool when you want to look at the bones and joints. It will tell you nothing about discs or nerves. It will give the doctor an idea about how much your spine has aged. It can also identify a fracture, possible infection or tumor or autoimmune disorder affecting the spine

Having arthritic changes does not imply arthritis. Arthritic changes are a normal part of aging and may not be associated with pain. There have been many medical studies that have tried to link these changes with back pain, but the strong connection was just not there. This is not to say that arthritic changes cannot cause pain, but determining that by x-ray alone is very difficult. Personally, I have patients with very arthritic spines on x-rays with almost no pain and others with virtually normal films but pain so bad they cannot get out of bed.

The “itis” part of arthritis implies in medical jargon that inflammation is present. An x-ray usually cannot determine that. However, MRI, blood studies, and/or a response to anti-inflammatory drugs such as cortisone or NSAIDS (i.e. Ibuprofen, Naprosyn) can help.

The age old advice from your doctor is that for runners, running on a soft surface is better for you than running on concrete and asphalt. But is this true? Are your knees and hips get less shock on a softer surface and thus be less prone to injury? It makes sense intuitively but there is a real lack of scientific evidence to support it. In an article published in the New York Times, Gina Kolata, a very well respected science writer, has a discussion with Dr. Tanaka, an exercise physiologist at the University of Texas at Austin. It seems that there are no studies to show whether soft surfaces are less injurious to ones body than hard. . The body is able to adapt to whether to harder surfaces by being more shock absorbing- more knee bend and more rigid to softer surfaces. Makes sense…….What do you think? Do you have an easier time running on softer surfaces or hard?

Another good point from the article- if you are used to running on soft surfaces and want to make the switch to hard  then gradually make the shift as your body has to adapt.

http://www​.nytimes.c​om/pages/h​ealth/inde​x.html

How much water do we need to drink in a day? Once again, conventional wisdom is incorrect or at least in this matter unproven. There is no scientific basis that we need to drink at least eight 8 oz glasses of water in a day. There is no science behind this claim. How this recommendation even got started is a mystery to me. Probably from a bottled water company as a way to push sales.

http://www.medpagetoday.com/PublicHealthPolicy/PublicHealth/27519

The Spine Journal is devoting an entire issue to critical reviews of published studies of Medtronic’s bone morphogenetic protein-2 product known as Infuse, a unprecedented publishing event that was prompted in part by a Milwaukee Journal Sentinel/Medpage Today investigation.

http://www.medpagetoday.com/Orthopedics/Orthopedics/27330?utm_source=breaking-news&utm_medium=email&utm_campaign=breaking-news