Hamstring muscle injury and The Stick

This might be my first product endorsement ever, but I was that impressed with The Stick. I’ll say right from the start that I am NOT being paid for this post in any way.

I have had numerous hamstring injuries over the course of my life. Hamstring strains, sprains, tears, and pulled hamstrings, are all part of a spectrum of injuries of the hamstring, which is the muscle in the back of the thigh. They occur during sprinting activities. My injuries were typical. I pulled hamstrings several times during high school football and track. Some of those were muscle tears, as I remember heavy bruising at the time. I remember being frustrated at being sidelined for weeks with each of those events. I had more hamstring trouble playing college rugby. After college, I had occasional hamstring strains being a weekend warrior. Over the years I have learned how to best avoid or minimize the injuries, but I continue to have them to this day, in my fifties.

There is plenty of online information about hamstring injuries and how to care for them. Stick to advice from reputable sources, especially if the advice is consistent among the various sources you explore. Be quick to seek professional attention if the injury is severe, as you might avoid chronic problems that could irritate you for the rest of your life.

A few practical things I have learned include:

  1. Warm up, stretch out, and self-massage.
  2. Train gradually and smartly for any given event. Especially as you grow older, don’t take on a heavy activity for which your body isn’t prepared.
  3. If you are running injured, be willing to limit the force and duration of your exertion to prevent further injury. You don’t have to win every race. It’s even better to take the time and do what it takes to heal, to recover your full potential. Nobody wants to be chronically injured and never be at their best.
  4. Stop at the first sign of the muscle twitching. It’s not worth finishing a particular event if it is going to sideline you for weeks afterward.
  5. Hamstring injuries tend to occur during an all-out sprint, and other than having a good training program, these are unavoidable. But a particular situation where a hamstring injury might be avoidable is downhill running. Downhill running usually increases your speed and stride length. The force of impact is usually greater, and you will have more of a heel strike than usual. This is a perfect storm for a hamstring injury. I have found that the very best way to avoid an injury in this situation is to make a mental effort, after heel strike, to quickly bend your knee and roll off your heel. The idea is to not take the full brunt of your downhill weight, with an outstretched leg, on your heel. That’s a huge force that gets transmitted to your hamstring.

And finally, The Stick. Too bad I have discovered this gem so late in life. I’m sure it would have helped me right from the start in my teens. The idea is self-massage. The Stick is simply a tool anyone can use to pin-point localize the part of the muscle that is injured, and to rub the swelling out, relax the muscle fibers, stretch out the muscle, recover faster, so you can get back out there and play! I can do this with The Stick much better than I can by just using my hands and fingers. The company suggests using it before and after activity, and I totally agree with that, especially if the muscle is already tight or sore. I now use The Stick regularly. I use the Standard 24″ Body Stick. I haven’t tried any of the other models.

Here’s how I use it:

My hamstring feels better than it has in a long time, and I’ve been able to kick up my running program. I can definitely recommend The Stick to anyone who shares my hamstring woes!

Thoughts on the Definition of Alcoholism

Thoughts on the Definition of Alcoholism

There is no specific, universal definition of alcoholism that can be used to identify alcoholics at an early stage. It may be helpful to envision alcoholism not as a static condition, but rather as a pattern in motion. To use a mathematical analogy, alcoholism is not a point, or a point on a line, or a shape, or the simple arithmetic of addition and subtraction. Alcoholism is more like a function in calculus, describing a process in motion. Using a different analogy, the pattern of alcoholism can be compared to cloth patterns of Scottish plaid, which of course we know come in endless variety. When comparing different plaids up close, one sees lines of different thickness and color intersecting at ninety degree angles. But from a distance one can recognize these variations as a common pattern we generically call a plaid.

Continuing with the plaid analogy, the variable elements of lines and colors which compose the plaid are like the human characteristics which compose alcoholism. The lines of a plaid may be thicker or thinner, and of any color imaginable. Similarly, the human characteristics of alcoholism are common yet variable.

Returning to the mathematical analogy of alcoholism as a calculus of a process in motion, we infer that in alcoholism the behavior gradually changes, and the consequences gradually worsen over time. Alcoholism is not a static condition. It is a pattern of alcohol consumption and destructive consequences that develop over time.

From these analogies, a functional definition of alcoholism can be imagined as a process or pattern rather than a specific static condition: Alcoholism is a somewhat variable pattern of behavior involving the consumption of alcohol which is progressively destructive over time.

Patterns and Characteristics

It is common knowledge that certain populations, e.g. the Irish and the American Indian, are more prone to alcoholism than others. It is also well known that alcoholism can be prevalent in certain families. As technologies gradually improve, scientific research will continue to elucidate the nature of the genetic factors at play. Perhaps this is true for some alcoholics and not for others. Perhaps these factors are stronger in some and weaker in others. Suffice it to say that genetic factors do play some role in alcoholism.

Many arbitrary indicators have been used to support a diagnosis of alcoholism. Drinking in the morning, drinking alone, drinking before work, drinking and driving, traffic violations, motor vehicle accidents, missed days at work, a binge pattern of drinking, excessive intoxication, blackouts, fights, injuries, and other such signs are often pointed out by people concerned about another’s alcohol drinking. Because of their widely variable nature, these same signs are easily dismissed by the true alcoholic as variations of normal. However, for the true alcoholic, these are the threads of different thickness and color that are being steadily woven into a human fabric of alcoholism and self destruction.

Progressive Destruction

It is the destructive aspect of alcoholism that makes it a disease. Ethanol, the alcohol we drink, is a chemical that causes direct and permanent injury to many if not all parts of the human body. The physical consequences are perhaps the easiest to observe and measure. Alcoholic liver disease, alcoholic neuropathy, alcoholic cardiomyopathy, and brain manifestations such as delirium tremens and the Wernicke-Korsakoff Syndrome are all common knowledge to the general public, even if they do not know the exact medical terminology. None of these things happen overnight. The twenty-five year old alcoholic does not see this coming in his future. The physical destruction happens insidiously and progressively, and there is no escaping this direct damage to the body.

The progressive destruction also happens in other parts of an alcoholic’s life. There are lost relationships, damage to existing relationships and marriages, lost job opportunities,  financial crises, and legal trouble to name a few. Again, these are not unique to alcoholism, so it is common for the true alcoholic to ascribe these things to bad luck, poor choices or persecution.

The emotional aspects of alcoholism are of paramount importance. For each individual alcoholic, emotional factors probably played a key role in the development of alcoholism in the first place. With time and continued alcohol drinking, the emotional makeup predictably worsens. It is common to see depressed alcoholics and angry alcoholics. In fact, a radical change in the basic personality of an alcoholic gradually evolves over time. At twenty-five years old, an alcoholic may be normally social, pleasant, logical, funny, the life of the party. It is difficult for that person to imagine life twenty or thirty years later as a rejected, unreasonable, depressed or angry/bitter alcoholic.

The spiritual destruction caused by alcoholism includes a steady decline in self esteem. This occurs as an alcoholic gradually breaks the external rules of society, deservedly earning a sense of guilt. At the same time and perhaps more importantly, the alcoholic is breaking his own internal set of rights and wrongs, building a powerful sense of shame. With the losses that are typical of alcoholism, feelings of self-pity and resentment are common consequences, as the alcoholic is often loathe to admit the basic diagnosis and to take personal responsibility, but instead tends to externalize the blame. All this serves to gradually alienate the alcoholic, taking away more and more of the normal human experience, the spirit.

What To Do

As a physician, I assume people want to be as healthy as possible for as long as possible. In my work I aim to prevent disease. When that is not possible, the goal is to identify disease at an early stage when treatment is most likely to be effective and beneficial. Since alcoholism is currently not a preventable disease, early detection is the ideal strategy. Actually, that is the easy part. Alcoholism is a disease that is all too obvious to observers of the suffering person. The difficult part is the acceptance of an early diagnosis by the suffering person himself. Alcoholism is created and perpetuated by a complex of forces, including but not limited to genetic, emotional and social. For many if not most alcoholics, alcoholism serves as a temporarily-effective coping mechanism. But over time, the losses and destruction created by alcohol drinking surpass any benefit it may have as a coping mechanism. By then, the alcoholic behaviors and personality are so ingrained that most sufferers never recover.

In my experience, alcoholics and other addicts generally have an opportunity in their young forties, at “midlife,” to more clearly see the big picture, reassess their lives, and make a change for the better. In my experience, this effective resolution unfortunately happens for only a small minority of alcoholics and other addicts. The vast majority miss their opportunity for recovery, and continue on their path to self destruction.

Wellness programs concentrate their efforts and resources on people with a high degree of willingness to change, and the least effort and resources on those with the lowest degree of willingness to change. That strategy has proven to be the most efficient use of our time, effort, energy and resources. In a wellness program, if any effort at all is paid to those with low degrees of willingness to change, it is to at least try to increase that degree of willingness to change. For the alcoholic, we do that by providing honest reality checks at every opportunity, and by providing consistent “tough love” in order to not consciously or subconsciously support the addictive behaviors. The concept that Alcoholism is a somewhat variable pattern of behavior involving the consumption of alcohol which is progressively destructive over time should be pointed out to every alcoholic person who is willing to listen. Acceptance of a definition opens the door to the possibility of effective recovery. To best preserve health and happiness, this acceptance should come at the earliest age possible.


Ferd Crotte, M.D.


February 14, 2012


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400 pound people should pay for two seats

I was in the hospital the other day, ironically tending to the the medical care of a young, morbidly obese patient, when I had to stop to listen to the illogical whining of a young woman on the patient’s TV. She was being interviewed about a recent shaming experience inflicted upon her by one of the airlines. She had apparently been told she had to pay for two seats, because her 400 pound frame would spill over the 17 inch wide airplane seat into the next passenger’s seat. She felt publicly humiliated.

She told the interviewer she had been trying really hard to lose weight. (What’s the relevance? She’s still 400 pounds.) She said she had actually succeeded in losing 80 pounds. (That’s good, but she doesn’t get a prize of a free airplane ticket for that.) She cried “discrimination.” She claimed she was being “singled out.” (She’s unfortunately very wrong about that. The majority of Americans are overweight/obese. Airlines have had to make policy about this issue. It applies to all such individuals.) She actually said that the airline industry has a responsibility to provide wider seats to accommodate her wider body. (She apparently doesn’t realize that it costs money to lift weight off the ground and move it from here to there.) And I learned that there is actually a lobby group in Washington that argues for “obesity rights.” (One has the right to be obese, but don’t expect me to pay for it!)

Maybe it’s too much to expect the average person to know the concept of an airplane’s payload. Nah, I think it’s common knowledge. I think some people are just deluding themselves, are in denial, or just simply want someone else to take care of them. The simple concept is that an airline company is in the business of carrying loads, ie people and their baggage, from one place to another. There is a direct cost to the company for every pound that is carried. It has every right to dictate what and how it charges for that service. It competes in an open market with other airline compaines, the American way of encouraging creativity, good service and value. And we the people have a right to either buy their service or not.

I did a quick google search on this topic before writing this post, and I came upon an interesting article in the Washington Post from November, 2004. This issue has been simmering for a long time.

I know there are people who have a lot of difficulty with being overweight/obese, and that they suffer in many ways. I am often (not always) sympathetic. There are people I know and love who are overweight/obese. But it is not right for them to expect and demand that others pay for their troubles.

We are responsible for our words and actions, and for our very selves. Here in NC, the land of the free and the home of the brave, our state government has decided that people who smoke and people who are obese, since they cost the healthcare system much more than non-smokers and the non-obese, should pay more for their health insurance. They can dictate that for state workers. They are sending a message. Obese people have to carry their own weight.

The Charlie Sheen Freak Show – Bipolar Entertainer of the Year?

Riddle: How many Psychologists does it take to change a light bulb?

Answer: Just one, but the light bulb has to want to change.

Even though he probably can’t help it, Charlie Sheen is the “dim” brother. He probably can’t help it because he is very sick. He is crazy and he can’t see it. He thinks he is God’s gift to the world of entertainment and to women. He thinks he is above everything. He has all manner of excuses and answers for the interviewers who have interrogated him these past few days, and his answers are ridiculous. He talks faster than I have ever heard him talk, rapid fire bullshit. He has lost his job. He is probably ripping through his money. He has already lost his wife and children, and his next relationship. He is putting himself at risk with his behaviors, not the least of which is the hypersexuality with porn stars. He is losing weight and looks haggard. He is in the manic phase of bipolar disorder.

Add to that the element of alcohol and substance abuse. He has some characteristics typical of addicts. He is in denial. He makes excuses, minimizes, rationalizes, lies. He has an angry demeanor. He is out of control. His losses are mounting day by day. And because of his substantial resources, he doesn’t appear to be close to hitting rock bottom, so he probably has a lot further to fall.

Unfortunately for him, manics like being manic. There is an energetic high to it. There is a grandiosity and a sense of invulnerability. There is total lack of judgement, leading to decadent, hedonistic and self-destructive behavior. And there is injury to others along the way. But it feels good to the manic person. In his case, he is “on a drug called Charlie Sheen” and he loves it! At this point, why would he want to change? There is no listening to reason, as it doesn’t compute in the manic brain.

Sooner or later, the “drug called Charlie Sheen” will wear off. A sense of deep depression will take its place. When this happens and he becomes more aware of how his mania has played out on a world wide stage, he may well develop an enormous sense of shame. He will look around and count his devastating losses. I wouldn’t be surprised if he becomes suicidal.

Charlie’s father, Martin Sheen, said the right thing. He said that if someone had cancer, everyone would understand it as a serious disease, deserving of the best treatment to save that person’s life. He then compared Charlie’s disease to cancer, and mentioned that his son needs the same kind of approach, life saving treatment and care. The big difference, though, is that cancer patients will look for answers to cure their disease, while Charlie will remain in self-detruct mode until his mania resolves itself, and who knows how long that might be.

He referred to one of his interviews as “entertainment.” I guess so, in the way a freak show is entertaining. We laugh at another’s misfortune.

How to Fix the Health Care System

Being in the healthcare biz, I have been surrounded my whole adult life by people griping about our healthcare system. And just to be clear, I entirely agree. Our system sucks! One of the things that irks me the most is when I hear politicians saying how they will fix the system, only to cave in to the pressures of the powerful special interest groups, especially the insurance, pharmaceutical and legal industries. It is now painfully evident that Obama was all talk. His “change” was to put us 3 trillion dollars further in the hole, without addressing the heart of the problem: those special interest groups. They will continue to rape the system, taking the money we all pay through our taxes and insurance premiums, instead of it going to help people who are sick.

Well, I’m not a politician, and I do have a simple answer to our problem. I have been saying this for years, so now I will make it official by posting it on my blog. The way to fix the healthcare system, IMHO, is to simply copy exactly what other, more successful countries are doing. They have already figured it out. Why re-invent the wheel?

Health Care Systems Compared:

You’ll notice that of these 9 countries, the USA is dead last in life expectancy and infant mortality rate, but tops in most money spent on health care per capita and as a precent of our gross national product. And these are just a few of the measures. Our system sucks in many more ways than these. When you hear people say we have the best health care system in the world, you can rightfully say, “No we don’t.”

So why spend 3 trillion dollars on a proposition  that is almost certain to fail? Just copy exactly what any of these other 8 countries are doing! The financial healthcare pie will get smaller, and the pieces will be apportioned differently. Patients would get more of the pie. Insurance companies, drug companies, many lawyers, and many politicians would go hungry. They would have to live off the fat they have stored for way too many years now.