By Gabe Mirkin MD, April 4, 2011  —  The most common long-term running injury is called runner’s knee. It is caused by the back of the knee cap rubbing against the femur, the long bone behind it.

When you suffer from runner’s knee, the back of the kneecap hurts when you walk or run, particularly when you walk down stairs. It usually does not hurt to pedal a bicycle. If it hurts to push the kneecap against the bone behind it, you have runner’s knee.

The back of the kneecap is shaped like a triangle with the point fitting in a grove in the lower part of the bone behind it. During running, the knee cap is supposed to move up and down. If it moves from side to side, the back of the kneecap will rub against the front of the bone behind it and hurt. Treatment is to stop the kneecap from touching the bone behind it which is usually caused by the knee cap being pulled toward the outside (laterally), while the lower leg twists the bone behind it inward (medially). When you run, you land on the lateral bottom of your foot and roll inward, causing the lower leg to twist inward. At the same time, three of the four quad muscles attached to the kneecap pull the kneecap outward and cause the knee cap to rub against the bone behind it.

People with runner’s knee usually can pedal a bicycle with their seats set lower than normal to prevent their knees from straightening completely. Orthotics, custom- fitted inserts in the shoes that restrict pronation, may help. They can also use special exercises that strengthen the vastus medialis muscle above the kneecap that pulls the knee cap inward when they run or pedal. Running backward may also help (1).

By Gabe Mirkin, M.D., for CBS Radio News

  1. TW Flynn, RW Soutaslittle. Patellofemoral joint compressive forces in forward and backward running. Journal of Orthopaedic & Sports Physical Therapy 21: 5(MAY 1995):277-282. The results suggest that backward running at a self-selected speed may reduce patellofemoral joint compressive forces and, coupled with the quadriceps strengthening that has previously been reported, may be beneficial in the rehabilitation of patellofemoral pain syndrome in runners.

    Checked 3/29/11

Photodisc/Valueline/Getty Images, April 4, 2011  —  When you suffer a kneecap dislocation injury, the patella—a bone shaped like a triangle over the knee—shifts out of its usual position, usually toward the outside of the knee, according to the National Institutes of Health‘s MedlinePlus website. Likely causes include turning suddenly without moving your leg in the same direction, a blow to the joint or a sports injury. Exercise can help to prevent and treat this injury.


Stationary Cycling

It’s not surprising that riding a stationery bike is a common exercise for knee rehabilitation. Done correctly, it can also help prevent knee injuries. According to the American Journal of Sports Medicine website, cycling strengthens the quadriceps, which is the muscle group at the front of your knee. Cycling is also low-impact and the stress on your knee ligaments and tendons can be controlled when you’re doing it. Cycling also increases your knee’s range of motion to improve function and mobility. For best results, adjust your seat so you can comfortably pedal without having to bend your knee too much or lift your foot off the pedal.


Strengthening and Stabilizing Exercises

Exercises that strengthen the muscles connected to your knees ease the stress on your knee joints, states the American Academy of Orthopaedic Surgeons. Less stress on the joint helps to control improved stability and movement, and wards off injuries to the knee. As the AAOS explains, strong quadriceps and hamstring muscles also improve your knee’s shock-absorbing abilities. Effective knee strengthening and stabilizing exercises include leg lifts, wall squats, lunges and hamstring curls. As your knee begins to regain strength, your physiotherapist will recommend adding weights while performing some of these exercises.


Flexibility Exercises

Strengthening exercises tighten muscles, which can reduce the mobility and function of your joint, thereby putting the muscles at risk for injury. Stretching exercises help to keep muscles loose. However, you should never stretch cold muscles; the AAOS recommends performing gentle stretches after you do strengthening exercises. Good flexibility exercises include quadriceps stretches and hamstring stretches performed sitting on the floor rather than standing.



Chronic Muscle Pain

Regular exercisers should expect their muscles to feel sore on the day after they exercise intensely, but if the soreness doesn’t go away, they need a medical evaluation. When you exercise vigorously, your muscles are injured. Muscle biopsies taken on the day after intense exercise show bleeding into the muscle fibers and disruption of the Z-bands that hold muscle fiber filaments together as they slide by each other. The soreness you feel should usually disappear within 48 hours, and even with the most severe workouts, it should disappear within a week or two.

If the soreness remains after a few weeks, you should check with your doctor. You may have an infection anywhere in your body, an autoimmune disease or other treatable condition. Doctors may call your chronic muscle soreness fibromyalgia, chronic fatigue syndrome or multiple chemical sensitivities. These diagnoses are an admission by the physician that he hasn’t the foggiest idea of the cause. There are reports of people with muscle pain and normal liver tests who are then found to have hepatitis C, which can be effectively treated. If you have urinary tract symptoms in addition to your muscle pain, you may be infected with mycoplasma or other bacteria which can be treated with antibiotics. You could have Lyme disease or some type of reactive arthritis. Don’t accept a diagnosis of chronic fatigue syndrome or fibromyalgia until you have a thorough evaluation for a hidden infection or other treatable causes.


Glucosamine and Chondroitin Sulfate for Arthritic Pain


By Gabe Mirkin MD, April 4, 2011  —  One in 10 Americans suffers from osteo or degenerative arthritis, a disease in which the currently used medications, acetaminophen, aspirin and nonsteroidal antiinflammatory drugs, do not slow or reverse the progressive destruction of joints and no cause is known. Over the last decade, reports have shown that pills containing chondroitin sulfate and glucosamine, two components of cartilage, may help alleviate the pain. Three major reviews in the scientific literature claim that the three studies showing that glucosamine relieves pain were poorly designed and therefore cannot be offered as proof of benefit. On the other hand, six studies from Europe and another from the United States show that chondroitin sulfate does help to slow joint destruction and pain caused by osteoarthritis (journal references for these studies).

One study in Rheumatology showed that glucosamine is not more effective than a placebo in controlling arthritic pain (8).

Several studies show that glucosamine helps control pain, but it is very difficult to test the effect of any drug on pain because a very significant number of people will benefit just as much from placebos. The authors performed a double blind study over six months in which they gave either 1500 mg glucosamine or placebo pills daily to patients with arthritis. Neither the doctors nor the patients knew who received glucosamine. One out of three patients receiving glucosamine had excellent control of their pain. but one out of three people receiving placebos also had the same excellent response.

Another study in the British medical journal, Lancet, showed that glucosamine helps to retard the breakdown of cartilage. Up to then, studies showed only that glucosamine helps to relieve pain. People with arthritis received either 1500 mg of glucosamine or placebo. X rays of their knees showed that the placebo group lost more distance between the bones of their knees than the glucosamine group.

The ends of bones at the knee joint are covered with cartilage, so the greater the distance between the bones on X ray, the greater the amount of cartilage. There is a serious problem with the study. People with arthritis often cannot fully straighten their knees, so it is impossible to use distance between bones to determine how much cartilage is lost. For example, if a person bends his knees a little, he will have the bones closer together than when he holds his knees straight. That means that anything that blocks pain will allow person to straighten his knees and have a greater distance between the bones at the knee. You should get the same benefit from any pain medicine. Furthermore, the study was sponsored by Rotta Research Group, who could gain billions of dollars from sales promoted by this study.

An earlier editorial in Lancet raises questions about the safety of glucosamine (2). Most research shows that glucosamine can help to relieve some of the pain associated with arthritis (3), but does not help to prevent cartilaginous damage and has not been shown to heal broken cartilage. Therefore, it is no more effective in treating arthritis than aspirin, but costs more than aspirin, but less than most brand name arthritis pain drugs that your doctor prescribes.

Glucosamine helps form aggrecan, the part of cartilage that allows cartilage to swell and shrink, acting like a shock absorber to help protect your knees from the trauma of running and walking. Adding glucosamine to cartilaginous cells in a test tube causes them to increases production of aggrecan (4).

However, in light of this good news, you should know that glucosamine can block the effects of insulin, causing blood sugar levels to rise (5,6,7), increasing likelihood of suffering the side effects of diabetes in susceptible people.


1) Lancet, January 27, 2001

2 )Mark Adams: editorial The Lancet, July 31, 1999, 354(9176):353-354.

3) Muller-Fabbender et al. Glucosamine compared to ibuprofen in osteoarthritis of the knee. Osteoarthritis Cartilage. 1994;2:61-69.

4)Bassler et al. Stimulation of Proteoglycan production by glucosamine sulfate in chondrocytes isolated from human osteoarthritis articular cartilage in vitro. Osteoarthritis Cartilage. 1998;6:427-434.

5) Am J Physiol Cell Physiol 1996;270:C803-11.

6) Diabetes 1995;45:1003-10089.

7) Proc Assoc Am Phys 1998;110:422-432.

8) A randomized, double-blind, placebo-controlled trial of glucosamine sulphate as an analgesic in osteoarthritis of the knee. Rheumatology, 2002, Vol 41, Iss 3, pp 279-284. R Hughes, A Carr. Hughes R, Ashford & St Peters Hosp Trust, Dept Rheumatol, Guildford Rd, Surrey KY16 0PZ, ENGLAND

Preventing Loss of Muscle Strength with Aging, April 4, 2011  —  As you age, you lose muscle size and strength much faster than you lose endurance or coordination. Researchers at the University of Nottingham in England show that a major cause of loss of muscle is that aging prevents muscles from responding to insulin and that exercising helps to slow this loss of muscle size and strength (The American Journal of Clinical Nutrition, September 2009).

Insulin drives amino acids into muscles to help them recover from exercise and maintain their size. Researchers traced radioactive amino acids and showed that insulin drives the amino acids into muscles much more effectively in 25-year-olds than in 60-year-olds. They also showed that the blood flow in younger people’s legs is much greater and supplies far more nutrients and hormones. However, three exercise sessions per week over 20 weeks markedly increased blood flow in the legs of the older subjects, enough to reverse muscle wasting.

People of all ages can use this information to help themselves become stronger. Athletes in all sports train by stressing and recovering. They take a hard workout, damage their muscles, feel sore the next morning, and then take easy workouts until the muscles heal and the soreness goes away. The athlete who can recover the fastest can do the most intense workouts and gain the most strength.

Eating a high carbohydrate-high protein meal within half an hour after finishing a workout raises insulin levels, increases amino acid absorption into muscle and hastens recovery (Journal of Applied Physiology, May 2009). The carbohydrates cause a high rise in blood sugar that causes the pancreas to release insulin. Insulin drives the protein building blocks (amino acids) in the meal into muscle cells to hasten healing from intense workouts. Muscles are extraordinarily sensitive to insulin during exercise and for up to a half hour after finishing exercise, so the fastest way to recover is to eat protein- and carbohydrate-rich foods during the last part of your workout or within half an hour after you finish.

Here’s how Diana and I (ages 67 and 74) use this information on insulin sensitivity. We ride hard and fast for about 20 miles on Tuesdays, Thursdays and Saturdays. On our recovery days, we ride slowly for one to three hours. Mid-day we go to a buffet restaurant and eat a large meal with fish, shrimp, vegetables and other sources of protein and carbohydrates. After eating, we ride slowly for one or two more hours. Riding before we eat makes our muscles very sensitive to insulin. This causes insulin to drive amino acids rapidly into our muscles and help them recover faster. Riding after we eat helps us to avoid a high rise in blood sugar that damages cells. You can use either plant or animal sources of protein; both contain all of the essential amino acids necessary for cell growth., April 4, 2011  —  Thinking your memory will get worse as you get older may actually be a self-fulfilling prophecy. Scientists at North Carolina State University have observed that senior citizens who think older people should perform poorly on tests of memory actually score much worse than seniors who do not buy in to negative stereotypes about aging and memory loss.


As per a research findings published earlier this month, psychology professor Dr. Tom Hess and a team of scientists from NC State show that elderly adults’ ability to remember suffers when negative stereotypes are “activated” in a given situation. “For example, elderly adults will perform more poorly on a memory test if they are told that older folks do poorly on that particular type of memory test,” Hess says. Memory also suffers if senior citizens believe they are being “stigmatized,” meaning that others are looking down on them because of their age.

“Such situations appears to be a part of elderly adults’ everyday experience,” Hess says, “such as being concerned about what others think of them at work having a negative effect on their performance and thus potentially reinforcing the negative stereotypes.” However, Hess adds, “The positive flip side of this is that those who do not feel stigmatized, or those in situations where more positive views of aging are activated, exhibit significantly higher levels of memory performance.” In other words, if you are confident that aging will not ravage your memory, you are more likely to perform well on memory-related tasks.

The study also found a couple of factors that influenced the extent to which negative stereotypes influence elderly adults. For example, the scientists observed that adults between the ages of 60 and 70 suffered more when these negative stereotypes were activated than seniors who were between the ages of 71 and 82. However, the 71-82 age group performed worse when they felt stigmatized.

Finally, the study observed that negative effects were strongest for those elderly adults with the highest levels of education. “We interpret this as being consistent with the idea that those who value their ability to remember things most are the most likely to be sensitive to the negative implications of stereotypes, and thus are most likely to exhibit the problems linked to the stereotype”.

“The take-home message,” Hess says, “is that social factors may have a negative effect on elderly adults’ memory performance”.

Hess is the main author on the study, “Moderators of and Mechanisms Underlying Stereotype Threat Effects on Older Adults’ Memory Performance.” Co-authors on the study are former NC State students Joey T. Hinson and Elizabeth A. Hodges. The study was published online April 1 by Experimental Aging Research, April 4, 2011  —  Eating salmon or other fatty fish just once a week helped reduce men’s risk of heart failure, adding to growing evidence that omega-3 fatty acids are of benefit to cardiac health. Led by scientists at Beth Israel Deaconess Medical Center (BIDMC) and reported in today’s on-line issue of the European Heart Journal, the findings represent one of the largest studies to investigate the association.

“Prior research has demonstrated that fatty fish and omega-3 fatty acids help to combat risk factors for a range of heart-related conditions, such as lowering triglycerides [fats in the blood] reducing blood pressure, heart rate and heart rate variability,” explains first author Emily Levitan, PhD, a research fellow in the Cardiovascular Epidemiology Research Center at BIDMC. “Collectively, this may explain the association with the reduced risk of heart failure found in our study”.

A life-threatening condition that develops when the heart can no longer pump enough blood to meet the body’s needs, heart failure (also known as congestive heart failure) is commonly caused by existing cardiac conditions, including hypertension and coronary artery disease. Typically heart failure is the leading cause of hospitalization among patients 65 and older, and is characterized by such symptoms as fatigue and weakness, difficulty walking, rapid or irregular heartbeat, and persistent cough or wheezing.

The scientists followed 39,367 Swedish men between the ages of 45 and 79 from 1998 to 2004. The scientists recorded details of the men’s diet and tracked the men’s outcome through Swedish inpatient hospital registers and cause-of-death registers. During this period, 597 men in the study (with no prior history of heart disease or diabetes) developed heart failure. Thirty-four men died.

Analysis of their numbers showed that the men who ate fatty fish (herring, mackerel, salmon, whitefish and char) once a week were 12 percent less likely to develop heart failure, compared with men who ate no fatty fish. Eventhough this association did not reach statistical significance, notes Levitan, the scientists also found a statistically significant association with the intake of marine omega-3 fatty acids, which are found in cod liver and other fish oils: The men who consumed approximately 0.36 grams a day were 33 percent less likely to develop heart failure than the men who consumed little or no marine omega-3 fatty acids.

“We divided the men into five groups based on their intake of fatty fish,” explains Levitan. “The first group consumed little or no fatty fish; at the other end of the spectrum, the fifth group consumed significant quantitities, three or more servings per week. We observed that while the ‘middle group’ who ate one serving per week had a 12 percent reduced risk of heart failure, the next two groups, who ate either two servings a week or three or more servings a week, had nearly the same heart failure risk as the men who ate no fish at all”.

The findings were similar when the scientists looked at fish oil consumption: Among five groups based on fish oil consumption, the middle group, who consumed 0.36 grams per day of omega-3 fatty acids showed a 33 percent reduced risk of heart failure, while the men who consumer greater quantities (approximately 0.46 grams per day or 0.71 grams per day) had a risk of heart failure similar to the men who consumed little or no fish oils.

“The higher rates of heart failure in men who consumed the most fatty fish or marine omega-3 fatty acids compared with the men who had moderate consumption appears to be due to chance,” explains Levitan. Alternatively, she explains, the men who ate more fish may already be in poor health, and appears to be trying to improve their health through fish consumption.

“Our study reinforces the current recommendations for moderate consumption of fatty fish,” notes Levitan. “Current guidelines from the American Heart Association recommend eating fatty fish twice a week. It will be important, going forward, to replicate these findings in other populations, especially those including women, as our study looked at men only”.

Mushrooms stuffed with tofutti, spinach and topped with soy cheddar cheese.

By Gabe Mirkin MD, April 4, 2011  —  Reports from Harvard School of Public Health shows that a diet rich in plants lowers high blood pressure (1,2). It’s called the DASH diet (Dietary Approaches to Stop Hypertension.) Other studies show that similar eating patterns lower cholesterol, help to control diabetes and cause weight loss in people who are overweight.

It took only two weeks for the diet to have an effect and after eight weeks, 70 percent of those eating the DASH diet had normal blood pressures, compared to 45 percent on the fruits-and-vegetables diet and 23 percent on the control diet. The authors feel that increasing minerals such as potassium, magnesium, and calcium lowers high blood pressure perhaps by suppressing calcium regulating hormones that close blood vessels. The diet appears to act the same way as the diuretics that are the most common drugs prescribed to control blood pressure: it gets rid of excess sodium (1a).

Most people will not have their high blood pressure lowered just by restricting salt. These studies show that a diet to lower high blood pressure should be rich in fruits, vegetables, whole grains, contain beans, seeds, nuts and low-fat dairy products, and limit everything else. Here’s a day on the DASH diet:

8 servings of grains
5 servings of vegetables
5 servings of fruit
2-3 servings of skim or low-fat milk, yogurt or cheese
5 servings per week of nuts, seeds or beans
1-2 servings of meat, poultry or fish
restrict sweets and fats

You should immediately notice that this is basically the diet that I have recommended for more than 30 years. Here’s my modified DASH diet for total heart health: to lower cholesterol and blood pressure, control weight, and prevent or control diabetes.

About 8 servings of WHOLE grains (not flour)
At least 5 vegetables
At least 5 fruits
Up to 3 fat free dairy products (optional)
Up to 2 servings of seafood (I recommend that you avoid meat from mammals)
Beans or legumes (no limit)
1-2 tablespoons nuts or snack seeds
Up to 3 teaspoons olive oil (optional)
Minimal added sugars (none if diabetic or trying to lose weight)

Note: Serving sizes are typically 1/2 cup of cooked foods, 1 cup of raw fruits or vegetables.


One serving of tomatoes and romaine mixed with balsamic vinegar, olive oil and basil; on

another day, add cucumbers and avocado to the tomatoes for variety


By Gabe Mirkin MD, April 4, 2011  —  The human race evolved on the foods that were available — plants and animals that were gathered and hunted. Our bodies adapted to use the nutrients available in these foods. In the last few thousand years, humans learned to cultivate foods to make their supply more reliable and convenient, but domesticated plants and animals still contain all the nutrients of their wild predecessors.The healthiest diet for humans contains a wide variety of plants; usually has whole grains and beans as the staple foods (the ones that supply the most calories) and may include meat, fish and dairy products in smaller amounts.



Our ancestors began to create nutritional problems when they found that they could store foods longer, make them easier to prepare and more tasty by removing the parts that spoiled quickest and eating only the starch, sugar or extracted oils. They discarded the minerals, vitamins, phytochemicals and omega-3 fatty acids that are found in the germ of seeds, creating serious deficiencies. We now have laws requiring some of these nutrients to be added back in to commercial flours, but that has only corrected the most obvious problems.


For most of human history the struggle has been to get enough food, so the survivors were those best equipped to cope with deprivation and scarcity. For most North Americans today, the problem is too much food that is too cheap, too convenient and too tasty to resist. We are bombarded with huge portions of sweet drinks, fried foods, bakery products made from white flour and other “empty” foods. It’s all too easy to meet your whole day’s calorie needs (2000-3000 calories or even more) with foods made almost entirely of sugar, white flour and added fats.


You may be able to exist on an unhealthy diet for a while, even for many years, but eventually it will catch up with you. Diabetes, heart problems, obesity, many cancers and other health problems are caused by or linked to unhealthy diets. If you are already in trouble, it’s never too late to make dietary changes to help to reverse your health problems. It’s far better to start early and eat in a healthy way all your life.



Plants make all the energy and phytochemicals they need from sunlight and air, with the help of water and minerals they draw up through their roots. We can’t do that; we get our energy and raw materials from food. We eat plants, and animals that have eaten plants, to get all the nutrients our bodies need to grow, reproduce and stay healthy.



She lost 125 pounds. Here’s her story, and how she lost the weight, April 4, 2011, by Julie Deardorff   —  When Naperville cardiologist Ann Davis decided to get serious about losing weight, she fished around in her purse for a crumpled and sticky piece of paper. Three months earlier, while at a restaurant with her kids, she’d scribbled down the name of a personal trainer on a syrup-stained placemat.

Davis, who was growing worried that she might end up a cardiac patient herself, made the phone call. Though well-versed in treating heart attacks, she had no idea how to strengthen her own ticker, or how to use weights and resistance to build calorie-burning muscle mass. At 44, her new life was about to begin.

It’s never too late to try or to change your life, said Davis, who has lost 125 pounds since 2009. “Anything is possible. Life is just way too short to wear a T-shirt to the pool.”

Davis, of Midwest Heart Specialists, plans to run the Chicago Marathon in the fall with her husband, Steve Kovar. In February, she finished a half marathon in New Orleans. Here she explains how she got motivated to lose weight:

JD: Congrats on the turnaround. What was your “a-ha!” moment?

AD: It wasn’t just one moment but a building of several. As luck would have it, I was not only fat but I don’t have the greatest family history for heart disease. Why was I so special that this wouldn’t happen to me? I have a wonderful husband, Steve, and two super awesome boys, Benny (8) and Sammy (5), and I want to be around for them and to share our lives together. I also want to have my children have a healthy legacy. You don’t realize what your weight makes you give up until you get active and healthy again. Your whole attitude changes from “I can’t do that” to “Hell if I can’t!” You will pass these habits along to your children so that hopefully they can lead happy, healthy and fulfilling lives.

JD: How did you put on weight? Did you realize it at the time?

AD: The time pressures of my job, family, stress and two babies left little time for me to think of myself. Sound familiar? Denial is pretty common when you are trying to multitask. There are a million excuses but one day I realized where Plan A was taking me and it wasn’t a good place. You just have to make time for lifestyle changes.

JD: In addition using a personal trainer what else did you do to lose weight?

AD: I started eating small frequent meals throughout the day to increase my metabolism. I brought all my food to work. The only thing falling from the sky at work is cookies and Butterfingers. It really is all about calories in calories out and exercise. But make the calories you eat count for something. Make them healthy, nutrient-dense food that gives you satiety and also increases your metabolism.

JD: Before your weight loss did you try to eat healthy foods?

AD: I really think I was as much in denial as the rest of the country. I would never eat breakfast. Then I’d be starving and eat a really late lunch. Usually something not very healthy, but quick, and then have a really late dinner at night. There are many ways to get fat. You don’t have to eat a lot of food if it’s really highly caloric. You can be a fat vegetarian as well.

JD: What food did you give up?

AD: You don’t have to give anything up. Just change the ingredients a little and the method it’s prepared, plan ahead and control portions. You will be golden!

JD: How did you find time to exercise?

AD: You can make time to do anything if you want it badly enough. I always remember that quote from the movie “The Shawshank Redemption”: “Get busy living or get busy dying.” I don’t mean to be a downer but if you change your life, you will be happier in the long run. You just have to take the first step and try.

JD: What did you learn about healthy living in medical school?

AD: Nothing. I’m so glad we have all the high tech to save people from heart attacks and heart failure and try to give them a good quality of life. But do you really want to utilize those options? Maybe a little low tech is in order, like diet, exercise, weights and resistance training and stress relief. Medical school taught us to treat heart problems. Prevention? Not so much.

JD: What do you tell your patients now?

AD: Trust in the process. Have a little faith in yourself and your abilities. Stop the negative self talk and take charge of your life again. You will never regret it. If I can do this, anyone can. Life is very precious and precarious. Anything can happen on any given day so take life on to the fullest. Enjoy your gifts and get going!