Misinformation Engineering

A Myth of Olympic Weightlifting

A Myth of Olympic Weightlifting

Andrew ‘Bud’ Charniga

www.sportivnypress.com

 

Figure 1. Weightlifters are able to react in the event of unanticipated circumstances and avoid injury because of their dynamic training and elasticity. They develop injury avoidance mechanisms  from their training. The overwhelming majority of exercises are dynamic: fast contraction conjoined with rapid relaxation of muscles; fast stretching and elastic recoil of muscles, tendons and ligaments. Training exercises with large amplitudes of motion in joints cultivate and enhance the ability to ‘react’ in dynamic sports.     

A series of essays (“Its all connected” Parts I-III, “Achilles tendon rupture and the NFL” I&II) explored the relatively low rate of lower extremities injuries in weightlifters; this despite the exceptional strain inherent to the performance of these exercises. Ankle injuries are so rare in weightlifting they are practically non – existent. On the other hand, some academics have reported ankle injuries in American sport make – up 45% of all sport injuries. Furthermore, with the passage of the title IX legislation in the USA (1972) which opened the door for mass female participation in American sport, anterior cruciate ligament (ACL) tears and American female athletes have become practically synonyms. 

Ankle injuries in sports such as football, basketball, soccer, volleyball in the USA are so common, the annual commercial market for ankle and knee braces is in excess of 1 billion USD; this on top of a massive expenditure on athletic tape for taping ankles in the aforementioned sports; especially football.

An accurate figure as to the annual expenditure of schools, universities and professional teams just for the athletic tape to support or otherwise restrict motion in joints, especially the ankle, is hard to find. However, division IA collegiate football programs such as University of Michigan have their athletic training staff routinely tape the ankles of the more than 100 players before each practice, not to mention every game; and that is just for football. a staggering expenditure of time and money.

For instance, the University of Michigan athletic department purchased approximately $50,000.00 on athletic tape for the 1995 academic year. This approximately 524 kilometers of tape would stretch from Ann Arbor, Michigan to Columbus, Ohio and back. If even this out of date figure were representative of the annual expenditures of the hundreds of universities, schools and professional teams in the USA; would this much ankle binding athletic tape stretch to the moon?

Ankle Joints are Connected to Knee Joints

Precise data and figures are somewhat sketchy, but most authorities agree approximately 1,000,000 joint (knee and hip inclusive) replacement surgeries are performed in the USA annually. And, this figure may be ten years old. At the present time an estimated 700,000 knee replacement surgeries alone are performed annually in the USA. (Fox, M., 2017)

Figure 2. Female weightlifter drops 135 kg barbell on bending/twisting legs without suffering a ‘contact’ injury. Charniga photo

As mind boggling as these figures are, apparently, they don’t include the estimated 7.5% of those undergoing joint replacements who will experience sufficient difficulty to necessitate ‘replacement’ of the just replaced joint.

Even more perplexing is:

“The demand for total joint replacement is expected to increase so dramatically in the next 25 years that there may not be enough orthopaedic surgeons to perform the surgeries….. Exponent Inc., an engineering and scientific consulting firm, projected that the number of procedures for primary (first time) total knee replacement would jump by 673 percent – to 3.48 million in 2030…. The number of primary hip replacements, the authors estimate will increase by 174 percent – to 572,000 – in 2030.” American Academy of Orthopaedic Surgeons, 2006

Also expected to become more prevalent is the repair or replacement an artificial joint, called revision joint replacement. The number of revision surgeries likely will double by 2015 for total knee replacement and by 2026 for total hip replacement, according to the authors (AAOS, 2006). Currently, hip revisions outnumber knee revisions, but knee revisions should surpass hip revisions.

Among the reasons for the expected increased demand is that total joint replacement is “gaining in acceptance.”

There actually exists research which claims this mind boggling quantity of radical procedures (known as total knee arthroplasty) in just 2009, resulted in a societal savings in the USA of $12 billion:

“The estimated lifetime societal savings from the more than 600,000 total knee arthroplasties performed in the U.S. in 2009 were estimated to be approximately $12 billion.” (Ruiz, et all, 2013).

The authors (Ruiz, et al) who happened to be surgeons, contend that people undergoing total knee replacements would actually earn more over the course of their working lifetime because they will miss less work; and that this massive expenditure for radical surgeries would actually save billions of dollars.

Consider this bizarre web site:

http://www.ajrr.net/

A tab displays the number joint replacement surgeries tracked from hospitals participating in the data collection of their network. Yet, this is a far – from – all – inclusive 915 hospitals in the USA performing these procedures.  As of 05/07/2017 the count was a collective 1,004,080 knee and hip replacement surgeries.

This site actively solicits people to join their “user group network”for this rather vague purpose :

“We (the AJRR) strive to create an environment within the orthopaedic community that fosters conversation about best practices and learning ways to improve hip and knee replacement Registry implementation and processes within their own institution.” http://www.ajrr.net/

Look if you will, but nowhere is to be found advice, scientific or otherwise, on this site of best practices to avoid radical joint replacement surgery.

To put this madness into perspective, a knee replacement surgery can cost up to $22,000.00 and hip up to $40,000.00 each. Consequently, the annual cost of joint replacements to the health care system in the USA would be approximately $29,200,000.00 (assuming 60% are knee and 40% are hip). And, that figure does not include the 7.5% which would require ‘replacement’ of the ‘replacement’ joints; nor the revision surgeries to replace already existing, but not properly functioning artificial joints. 

For instance:

“Traditional artificial hips, which are made of metal and plastic, typically last 15 years or more before requiring replacement.” Fox, 2017

At a rate of 1,000,000 (figure cited in 2009) joint replacements a year in the USA a major metropolis populated by people with at least one joint replacement is created every year. If the cited projection of 3.48 million annual knee is combined with an additional annual 572,000 hip replacements by the year 2030 are even remotely accurate; a city with a population greater than Los Angeles with people doddering around on artificial joints would crop up every year. Some of the reasons cited are an aging population, obesity and the active life styles of baby boomers.

If this staggering quantity of joint replacement surgeries were not a peculiarity of the USA, but in fact ‘normal’ across the globe; then assuming a USA population of about 350,000,000 by 2030; one could expect China, for instance, with a population of about 1.3 billion to need a mind boggling 15,000,000 joint replacements annually by 2030.

Are ACL injuries ankle injuries and vice versa?

Doctors don’t know

In the year 2003 alone, apparently  approximately 11,000,000 emergency room/doctor office visits for ankle and foot injuries were reported in the USA. If this figure seems outlandish it may not be such a stretch of the imagination when you consider athletic trainers believe 45% of all sports injuries are related to the ankle.

The market in the USA for orthotic bracing: knee, ankle bracing and supports, spinal, pain infusion pumps and the like is expected to exceed $2.48 billion USD by the year 2018. The growth of this market for ankle and knee braces is anticipated to be driven by the ubiquitous presence of these products for injury and prevention (prophylaxis).

Figure 3. Elite collegiate football player (only 21 years old) ruptures Achilles tendon in midst of non – contact running drills. This young elite athlete suffers an injury normally seen in middle aged men playing pick up basketball.

Convincing arguments something is radically wrong with the training and general preparation of football players in general; and, the NFL in particular, relative to the rising incidence of Achilles tendon ruptures were presented in previous articles. But, can the problem of the omnipresent lower extremity injury in football be connected with a macro problem of rotting joints in other American sports and the general population: 

“Each year, about 230,000 Achilles tendon injuries happen in the United States, and that number keeps going up. Doctors at Rush University have seen a 300 percent increase in these types of injuries over a ten-year span”. http://www.clickondetroit.com/health/achilles-tendon-injuries-on-the-rise

At the heart of the morass of American of ankle, foot and knee problems is that many will require surgery; which can lead to the onset of Arthritis later in life; and, due its acknowledged growing social acceptance; the distinct possibility of joint replacement surgery.

Consequently, of particular interest is the omnipresent knee injuries known as anterior cruciate ligament (ACL) and medial collateral ligament tears. What makes this problem especially noteworthy? According to literature, the ACL is torn or strained most often from non – contact running, jumping and so forth, i.e., very much like the etiology of the Achilles ruptures discussed in “Achilles tendon rupture and the NFL” I&II.

Consider the following:

“This injury is rampant. There are between 250,000 and 300,000 ACL injuries per year, and they’re almost exclusively happening to athletes. The chances of a non-athlete suffering an ACL injury are 1,000 to 1. The most common mechanism of injury is non-contact and caused by cutting. You’re running along, you plant to change direction, and your knee buckles.” SOURYAL, T. 2015

Figure 4. Contrasting examples of a ‘presumed’ knee injury inducing outcome to a female soccer player (figure on the far left). The lines illustrate perceived dangerous movement at the knee (‘collapse’) hip and ankle for running about soccer field. Compare that speculation, sans substantiation, to severe torques at knee, hip and ankle of uninjured female weightlifter falling with 80 kg barbell. In the figure on the far right, elite football suffers serious non – contact knee injury running: note the ankle joint is not bending as knee gives way.   

One cannot help but wonder with all of this money, time and effort spent supporting ankles and knees; why so many injuries to knees and ankles? And, of course why so many radical joint replacement surgeries?

Are football, soccer, basketball, volleyball really that hazardous?

For instance:

“Most ACL tears are in non – contact High risk sports football, basketball, soccer, volleyball. ACL injuries are becoming increasingly more common as more and more people participate in athletic activities. In college football, the risk of tearing the ACL for any particular athlete can be as high as 16%over a four year timeframe”. ACL Injuries, http://my.clevelandclinic.org/ccf/media/Files/ortho/acl-injury-guide.pdf?

And:


“ACL injury has an annual incidence of more than 200,000 cases with ~100,000 of these knees reconstructed annually. The majority of ACL injuries (~70%4) occur while playing agility sports, and the most often reported sports are basketball, soccer, skiing, and football. An estimated 70% of ACL injuries are sustained through non-contact mechanisms, while the remaining 30% result from direct contact.” {1}

Assuming the figures cited are reasonably accurate, 70% of the 200 – 300,000 incidence ACL tears occur without physical  contact. And, of those  athletes who suffer this calamity, an estimated 140 – 210,000 annually will require reconstructive surgery; which over time can lead to arthritis. And, you guessed it, the distinct possibility (due to its growing acceptance) of joint replacement surgery later in life. Unfortunately this all too common malady is not the only type of injury to the lower extremities in American sports.

Without precise data there is no telling how many joint replacement surgeries can be directly connected to athletic injuries as a contributing cause of arthritis later in life. Nonetheless, an annual contribution of 140 – 210,000 injured young American athletes for ACL surgery alone would result in a pool approximately 700,000 – 1,050,000 joint replacement candidates in just five years. And, that potential contribution to the joint replacement surgical pool is for injury to only one knee ligament.

Furthermore, it is common knowledge the medial collateral ligament (MCL) is the most commonly injured knee ligament. (Phitsikul, 2006; Miyamoto, 2009)

Figure 5. Weightlifter suffering bruises only from dropping 219 kg on his legs. Charniga photo.

If a interconnection between a predisposition for injury in dynamic sports and highly questionable conditioning exercise techniques is not apparent from this series of essays; it certainly should be.

Some ideas from the academic world which coalesce into the practice of conditioning athletes, rehabilitation, and so forth; inevitably make a significant contribution to the high injury rate of lower extremities in the USA; resulting in the later life onset of arthritis:    

/ Irrational application of anatomical structure to injury susceptibility: the ankle joint is unusually susceptible to injury because “the long tendons cross the ankle in a way that  contributes little to stabilization” Luttgens, 2002;

/ The integrity, hence susceptibility of ligaments to injury are deduced from cadavers;

/ The failure to recognize ligaments, tendons and fascia are the body’s spring mechanisms serving multiple functions;

/ The stretching of ligaments leads to joint instability; example: “This abnormal (hurdlers’ stretch) stretch places high stresses on the medial structures of the knee joint, which may lead to ligament damage and eventual instability.”
Luttgens, Hamilton, 2002

/ The inability or simply a lack of common sense to employ a scaling of relative strain to distinguish inappropriate movements: a simple full range of motion knee bend and a knee bend with maximum weight for instance;

/ The hazardous notion that one only need to bend joint (knees for example) as far as the sport requires when performing conditioning exercises;

/ Teaching athletes and non – athletes to restrict movement in conditioning exercises and supporting joints with taping or/and  with braces to prevent injury because they limit movements within ranges considered safe.

Conclusions

Such figures cited as one million knee/hip replacement surgeries annually; upwards of 600,000 ACL/MCL ligament tears/sprains, 230,000 Achilles injuries and untold number of ankle injuries annually related to sports in the USA indicates there has to be some underlying factor contributing to these statistics; not just happenstance.

“Joint replacement is becoming more common. More than 1 million Americans have a hip or knee replaced each year. http://www.beaumont.edu/press/news-stories/2013/1/beaumont-health-system-joins-american-joint-replacement-registry/

Ignorance, which in this case takes the form of a growing acceptance that hacking out body parts is an acceptable quick fix for pain is certainly part of the problem. However, without question, the statistics emanating from athletic injuries especially with an etiology interconnected with highly questionable conditioning practices have to be a major contributor over the long term.  

It is interesting to note, there is no mention in the literature cited of weightlifters and other athletes who perform high intensity large amplitude range of motion exercises like snatches, cleans and squats in the context of the  American morass of lower extremity injuries and radical joint replacement surgeries.

The sports where these injuries occur most often are American versions of football, basketball, volleyball, soccer and others which do not involve large bending of lower extremities. The preponderance of conditioning exercises employed by conditioning coaches, personal trainers for athletes participating in these sports are of the ‘ safe’ half bending, bodybuilding/powerlifitng exercises; and, where all the taping and bracing is used isn’t it?

Certainly the proponents of this  irrational fear of bending should be able to demonstrate the weightlifters and other athletes sans taping and bracing, who do these ligament stretching exercises which are believed to create unstable knees and ankles; should be the ones most injury prone. Shouldn’t the bulk these problems encompass athletes doing full squats and other ankle de – stabilizing motions? Should the literature reflect this circumstance? Yet there is no mention of full squatting weightlifters flooding the doctor’s offices across the USA with ankle injuries and ACL tears.

So what is missing here? The people preparing for dynamic sports performing ‘safe’ conditioning exercises, the ones who employ bracing and taping of joints to restrict motion are the ones disproportionately injury prone.

 References

 1/ Dept. of Othropedic Surgery UCSF, “Anterior Cruciate Ligament Injury (ACL) Overview”  http://orthosurg.ucsf.edu/patient-care/divisions/sports-medicine/conditions/knee/anterior-cruciate-ligament-injury-acl/

2/ Souryal, T.O., “ACL Injury, ACL Tear, ACL Surgery”,  http://www.txsportsmed.com/acl.php, 2015

3/ Treatment Guide: ACL Injuries, http://my.clevelandclinic.org/ccf/media/Files/ortho/acl-injury-guide.pdf?_ga=1.38845539.1913215647.1489163858

4/ Mayo Clinic Overview: ACL Injury http://www.mayoclinic.org/diseases-conditions/acl-injury/symptoms-causes/dxc-20167379,

5/ Hewett, T., Neuromuscular and Hormonal Factors Associatyed with Knee Injuries in Female Athletes, Sports medicine 29:52000:313-327 http://link.springer.com/article/10.2165/00007256-200029050-00003

6/ American Academy of Orthopaedic Surgeons, “Total Knee and Hip Replacement Surgery Projections Show Meteoric Rise by 2030″ http://www.prnewswire.com/news-releases/total-knee-and-hip-replacement-surgery-projections-show-meteoric-rise-by-2030-55519727.html

7/ Fox, M., “Knee Patients Spending Millions on Wasted Treatments”, http://www.nbcnews.com/health/health-news/knee-patients-spending-millions-wasted-treatments-study-finds-n733396

8/ David Ruiz, Jr., MA1; Lane Koenig, PhD1; Timothy M. Dall, MS2; Paul Gallo, BS2; Alexa Narzikul, BA3; Javad Parvizi, MD3; John Tongue, MD, “The Direct and Indirect Costs to Society of Treatment for End-Stage Knee Osteoarthritis”, The Journal of Bone & Joint Surgery, Volume 95, Issue 16

9/ Zajac, F.E., “Muscle Coordination of Movement: A Perspective”, J. Biomechanics 26:suppl1:109-124:1993

10/ “Achilles Tendon Injuries On the Rise”, http://www.clickondetroit.com/health/achilles-tendon-injuries-on-the-rise

11/ http://www.beaumont.edu/press/news-stories/2013/1/beaumont-health-system-joins-american-joint-replacement-registry/

12/ http://www.ajrr.net/

13/ Phisitkul, P. et al, “MCL Injuries of the Knee: Current Concepts Review”, Iowa Orthop J, 2006:26:77-90

14/ Miyamoto, RG, et al, “Treatment of medial Collateral Ligament Injuries”, J Am Acad Orthop Surg. 17(3:152-61:2009 “The medial collateral ligament is the most frequently injured ligament of the knee.”

15/ https://www.youtube.com/watch?v=NLU7DHaCdrs (example of how to injure elite athletes)

16/ Charniga, A., “It is all connected” I-III; www.sportivnypress.com

17/ Charniga, A., “There is no system” I-VI; www.sportivnypress.com

18/ “Achilles Tendon Injuries On the Rise”, http://www.clickondetroit.com/health/achilles-tendon-injuries-on-the-rise

19/ Wells, K.F., Luttgens, K., Kinesiology, Philadelphia, W.B. Saunders Company, 1976

20/ Hamilton, N., Luttgens, K., Kinesiology, Boston, McGraw Hill, 2002

21/ Kremers, M. et al,  ” Prevalence of Total Hip and Knee Replacement in the United States”,  J Bone Joint Surg Am, 97:(17) 1386-97;2015, https://www.ncbi.nlm.nih.gov/pubmed/26333733 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4551172/

21/ “Joint Replacement To Become The Most Common Elective Surgical Procedure In The Next Decades’,  https://www.ahrq.gov/news/newsletters/e-newsletter/503.html

 

 

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