Sunday, August 30, 2015
“I banged my head during the Packers game in the playoffs, and the next day I was fine,” says Wilson. “It was the water.” -Rolling Stone Magazine
“I didn’t have a head injury, but what I was trying to say is I think it helped prevent it,” he said. “I think your brain consists of like 75, 80 percent water, so I think that just being hydrated, drinking the Recovery Water, really does help.” -Huffington Post
There are lessons to be learned from the latest quotes from Russell Wilson, the quarterback of the Seattle Seahawks. Science is hard work and it takes time, effort and skill to design a research study so that the results can be interpreted in a meaningful way. What Mr. Russell described was an anecdote, a story that links one event to another, without proving any relationship between the two. In the Rolling Stone story, he also mentioned a teammate who drank the water and recovered from a knee injury. It seems that Mr. Russell wants to put many orthopedic and neurosurgeons out of work.
According to the Huffington Post, the company that makes Recovery Water did not tout head injury prevention as a benefit of drinking their special water but they did say that their product “helps to jumpstart recovery from injury and muscle related stress while also decreasing symptoms of fatigue.” If only this could be proven, think of the many people who labor and use their bodies as tools, who could benefit from this product. If only there was research to support their claims. The company’s website offers studies to back their claims.
The next lesson has to do with reading the original text and deciding how good the science might be. Off to the World Wide Web for the four research studies listed by Reliant Recovery Water. Before we start, it is important to know that Reliant Recovery Water is a wholly owned subsidiary of Revalesio Corporation, a biotech company in Tacoma, Washington.
Link #1 Consumption of Revalesio Sports Beverage Alters Markers of Exercise. Performance and Cardio-respiratory Fitness in Healthy Males
This is an abstract (summary) of the data collected on 25 men who drank either regular water or Revalesio Sport Beverage for two weeks and ran on a treadmill. The results show that in highly trained athlete, there was an increase in VO2max (oxygen consumption), a good thing, but the benefit was not statistically significant. In less fit athletes, there was a trend to decreased rating of perceived exertion, meaning the running didn’t seem as difficult.
The authors of the study work at Revalesio Corporation and perhaps cannot be considered independent and without potential conflict.
Link #2 is the same study but now as a poster presentation at an American College of Sports Medicine meeting. The purpose of scientific posters is to present work to an audience who is walking through a hallway or exhibit.
The information and data have not been independently reviewed.
Link#3 Oral consumption of electrokinetically modified water attenuates muscle damage and improves postexercise recovery
Published in 2013, in the Journal of Applied Physiology, they studied 40 untrained people, twenty who drank Recovery Water for 18 days and twenty who drank regular water. On the 19th day, the subjects did 3 sets of 20 bicep curls and had blood tests to measure chemicals that can be associated with muscle damage and inflammation. Measurements of muscle soreness and range of motion were also completed. They found that those who drank the specialized water had lower muscle damage markers in the blood but “…did not show any significant differences in muscle strength or soreness between the experimental and placebo-control groups after exercise. Both the EMW and placebo-control groups did demonstrate strength deficits of ∼22% at 48 h, followed by an equal recovery with residual strength deficits of 12–13% at 96 h postexercise.”
In 2014, there was a correction: The authors thank Dr. Andreas Kalmes (Revalesio Corporation) for assistance with manuscript preparation.
Link#4 Daily Controlled Consumption of an Electrokinetically Modified Water Alters the Fatigue Response as a Result of Strenuous Resistance Exercise
The same authors tested 40 relatively fit people who did not do any upper body lifting and gave twenty regular water and 20 Recovery Water for 18 days. They measured the maximum amount of weight each person could bicep curl, as well as rating of perceived exertion and fatigue. The people who drank the regular water had 20% less maximum strength measured after their lifting. And those who used the special water felt like they didn’t work as hard.
The authors thanked Dr. Andreas Kalmes (Revalesio Corporation) for help with editing.
Recovery water is plain water with a little potassium, magnesium and calcium added. Revalesio uses their technology to bubble oxygen through it to increase oxygen concentration. The preparation is relatively unstable and needs to be refrigerated.
It may be that Recovery Water is the next greatest thing since sliced bread but the scientific evidence that has been published and available for review is based on less than a hundred people who did bicep curls. As well, the literature cited on the company’s website was performed or written in house, leaving the potential bias and conflict of interest, The appearance of independence is lost.
As for Russell Wilson, it is fine for him to endorse any product he chooses, but he should not step outside his role as a quarterback and discuss how water prevents concussion. He is a quarterback who is not a scientist. He is a celebrity and now he is dangerous. Russell’s words carry weight. Many people, including kids, wear his jersey, imitate his on field mannerisms and hang on his every word. He has the power of his pulpit and should not abuse it.This entry was tagged concussion, head injury, recovery water, research, russell wilson
Monday, August 17, 2015
That Geno Smith, Jets quarterback, broke his mandible in two places, is not a testament to the severity of the blow that struck him, but instead, a result of the physics and anatomy and design. There are many circles found throughout the human body and whether it is the mandible (jaw bone), the tibia and fibula (shin bone), the radius and ulna (forearm) or pelvis, it is tough to break a circle in just one spot. Just imagine breaking a pretzel.
Mr. Smith was in a locker room altercation when he was punched in the face and sustained a fractured mandible (jaw). Just to be clear with word, fractured and broken mean the same thing. The jaw is a common facial bone to break, second only to broken noses and the most common causes are motor vehicle crashes and altercations. Most people know that something is wrong almost immediately. Aside from the pain, there is a sense that the teeth don’t quite fit properly. The muscles that attach to the mandible, and allow us to open and close our mouths, shift the bone fragments and the lower teeth that are attached don’t quite align with the upper teeth in the maxilla. And as with any injury, swelling and spasm occurs gradually making it difficult to open the mouth. This is called trismus.
For the doctor, though, the important thing to remember is anatomy and physiology and how the body absorbs force. If there is one fracture found in the jaw, the search must happen for the second break. Most often, a fracture of the body of the jaw is associated with a fracture of the condyle on the opposite side. The condyle is the thin bone that connects the jaw to the skull.
Even before worrying about the broken bone, other issues need to be thought of. If there is enough bleeding and swelling, breathing can become an issue. Associated broken teeth or dentures can fall into the back of the throat, trachea or lung, obstructing the airway, so making certain breathing happens is always job one.
In boxing, the one goal of the sport is to inflict a concussion and knock out the opponent. If there is enough force to break the jaw, there is also enough potential force to cause a head injury or break a neck. With most trauma resuscitation, the obvious injuries are appreciated but take second stage to the injuries that are lethal or permanently disabling. Even if takes just a minute or two to consider what badness might occur, that time is invaluable in caring for the patient.
The diagnosis of a broken jaw is often made clinically by appreciating the swelling, pain and disfigurement that is associated with the broken jaw. X-ray and CT scan then confirm the location of the break. Sometimes special dental x-rays are required to assess damage to individual teeth and their roots, especially if the fracture line goes into the tooth socket and that might affect treatment options.
Treatment is almost always surgery to align the bone fragments, especially those that are teeth bearing. Some children or elderly patients without teeth may be spared the scalpel. The teeth must be aligned as perfectly as possible so that bite is maintained. Fractures that heal with poor alignment can cause wear and tear on the temporomandibular joint (TM joint). This is the joint where the mandible attaches to the temporal bone of the skull. Like any joint that is placed under stress; it can develop arthritis, inflammation and pain. There are many surgical options but often titanium plates are screwed in place across the fracture site to hold it in place. Not only does the fracture needs to be plated, but in some cases, the jaw needs to be wired shut s the bone heals.
The use of wiring depends upon the clinical situation, the stability of the fracture and the discretion of the surgeon. There are different wiring techniques but, in general, wires are tightened from the upper teeth to the low teeth preventing the jaw from moving and opening. Just like any other bone, a mandible fracture needs about 6-8 weeks to start to heal and that means the jaw will be wired shut for that long as well. There are exceptions, especially with condyle fractures, where the wires are kept in place for only a couple of weeks.
If the mandible fracture is an isolated injury, then there is little reason to limit activity. Geno Smith was seen playing catch shortly after surgery and for a football player that seems like a pretty reasonable thing to do… as long as he avoids helmets, pads and the risk of getting hit in the jaw again.
It goes without saying that when it comes to trauma, prevention is always the best treatment. From seatbelts to bicycle helmets, it’s what is done before the accident that can help minimize damage. Unfortunately, in Mr. Smith’s case, turning the other cheek didn’t quite work out.
This entry was tagged broken jaw, concussion, Geno Smith, mandible fracture, plates, screws, surgery, wiring
Dr. Wedro weighs in
“The difference between doctors who look after mere mortals and those who look after elite athletes may have to do with how many tests they can order, regardless of the cost.”