Bones and Muscle Metabolism

by Tyler Cymet, DO, FACOFP

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    00:01 The assessment of bone is kind of hard because people don’t complain if their bones aren’t long enough or they can’t use their bones, they don’t have long enough arms or long enough legs.

    00:11 That’s not saying that’s apparent to people.

    00:13 People tend to take the structure they have and live with it.

    00:18 They only complain to us when they get numbness and tingling, when they don’t have sensation in their whole body as they feel they should, or if they have pain or discomfort.

    00:29 But those are end products way beyond reaching the peak ability that the body has.

    00:36 So we haven’t gotten to the point of assessing structural integrity and assessing whether or not you’ve reached your maximum potential.

    00:47 Those are places we’re trying to go in the future.

    00:50 If you ask parents, they’ll assess your posture.

    00:53 They’ll assess whether or not you’re creating a lateral scoliosis, whether or not you’re standing straight enough, and that’s their assessment of bone.

    01:00 And true, posture will give a sign that people aren’t maturing bone but it also could be someone is shy.

    01:10 It could be the body, mind, spirit continuum affecting different things.

    01:15 It could be somebody not exhibiting their full potential even though their body has gotten there.

    01:22 Gait is also something that, in teenage years, we see lanky uncomfortable gaits.

    01:28 We see people growing into their ability to use their skeleton and those are clues. If they don’t start to grow out of it by 15 or 16 years of age, then that’s a sign that they haven’t reached peak muscle mass or peak bone mass.

    01:43 Bony integrity, usually more trauma related or break related, and it’s not unusual to have kids break bones.

    01:50 How do they heal? And how does that affect future growth? Joint function is another assessment of how the skeletal system is working.

    02:00 Are people comfortable with their joints? Are they having more pain above and below the joints? Because whenever you assess joint function in the skeleton, joint function affects one joint above and one joint below.

    02:13 So we need to expand our evaluation of patients we’re taking care of.

    02:19 Muscle strength typically is 5/5 and people can function all the way across a long continuum, ut have they reached peak muscle mass? Are they able to reach their potential? Those are assessments we’re still developing.

    02:35 And the neurovascular status, while the muscles do protect arteries, veins, and nerves, we haven’t gotten to a good sense of assessing them until later on in life.

    02:46 We tend to focus on when things go wrong.

    02:50 When does somebody have tenderness? When do they have decreased motion? When do they feel they can’t function as well as they think they should? And that typically happens when people have a change in the pattern of activity.

    03:02 We tell people if you’re working out and you want to grow muscle mass, reps matter.

    03:08 More weight matters for changing muscle mass.

    03:11 Lower weights helps you with aerobic metabolism and helps you with use that occurs over time.

    03:18 So people come and complain when they’ve been going for size not for the long term use.

    03:27 Fractures are a common complaint, but those are different and obvious to us.

    03:32 Dislocations tend to be less obvious, and at least earlier in life, people can dislocate joints and relocate them with some regularity.

    03:41 The ligamentous laxity, while strong for the ribs may not be as strong for the shoulders or hips, and we may see more dislocations that are not pathologic.

    03:53 Infections are another thing that do occur and should be watched out for because they do occur in muscles.

    03:59 Effusions of joints and muscles can be assessed, and DVT’s are more common than we thought in the past assuming we’re getting much better at assessing and finding.

    04:10 Less common musculoskeletal disorders that we see are spinal injuries, crush injuries, and compartment syndromes.

    04:18 Another obvious change is men and women look differently.

    04:22 Their muscle mass is different. Their muscle structure is different.

    04:25 Their muscle makeup in terms of how much ATP, creatinine phosphate, creatinine kinase, and glycogen, all differs.

    04:35 And the muscles make up about 50% of our bodies.

    04:39 The main job of the muscles are to take energy and turn it into movement, and the energy is going to come from chemicals within the muscles.

    04:49 So the ATP’s that are there for short term, creatinine phosphate and creatinine kinase which are turning to energy, glycogen and other carbohydrates which give us slower input of energy, are all part of the muscle system.

    05:02 And that’s going to be different for men and women, and it’s going to be different for those who grow up differently and work their muscles differently and train their muscles differently, to use energy.

    05:14 The chemicals are stored in small quantities but can be replenished quickly. We have a nice supply mechanism through the vasculature, but we need to be able to move quickly and utilize energy quickly.

    05:27 Preferably in an aerobic metabolism because aerobic tends to be more efficient and it tends to be safer.

    05:35 Anaerobic metabolism tends to create more acids and tends to be better for a short term use of motion because you get some ATP and you get the energy quickly.

    05:50 But then it starts to burn the body and have a longer recovery period.

    05:55 If you’re an aerobic metabolism, you can function longer without the need for recovery, washing out of the system, and rejuvenation.

    06:08 So aerobic tends to have advantages and disadvantages.

    06:12 The advantages of an aerobic metabolism is it generates a large amount of ATP.

    06:16 The disadvantage is it’s the slower onset and you require oxygen to use it.

    06:22 Anaerobic metabolism also has advantages and disadvantages.

    06:25 Anaerobic is relatively rapid.

    06:28 When you need it, it’s there.

    06:29 There’s no oxygen needed, no cofactors needed, and it will give you ATP’s quickly, but it’s going to cause an acidic buildup in the body which will then need to be metabolized by the liver and kidneys for people to rejuvenate themselves.

    06:44 So “while sweat is nature’s way of showing you that your muscles are crying,” it’s also a way of saying that your muscles are functioning and things are working as they should work.

    06:54 So again, the 4 types of energy the muscles are going to use: #1 short-term ATP that are in the muscles that will get you started; #2 creatinine phosphate, creatinine kinase, or the phosphagen system will produce ATP’s over a few seconds to 15 to 20 seconds that can be used to get you moving, and those ATP’s can turn into energy quickly and get things moving.

    07:19 Once it’s depleted, it takes a little bit of time to replenish the phosphagen system and the body gets better at it if you’re using it more often.

    07:28 That’s a part of exercise, muscle memory, and muscle learning that gets you better after doing things longer.

    07:36 Glycogen carbohydrate in the muscle gives you the 30 seconds and beyond.

    07:40 It’s a nice storage place, and if you exercise more, you’ll have more glycogen stored in the muscles, and your body will place more as you need it, puffs them up a bit, makes them larger— ot as large as the short high -weight repetitions, but still for use and functioning— very important.

    08:02 After the glycogen lactic acid system, the vascular supply of glycogen and carbohydrates to the muscles, help the muscles function, get energy, and function efficiently and without a debt occurring to the other organs of the body that are going to need to maintain the muscles so they do well.

    08:22 Again, aerobic metabolism for sports is something you want to aim for, strive for, work out for, and make sure you’ve got the necessary precursors for it to work.

    08:36 And the only other thing you need to know, and we’re going to repeat this again and again, is motion occurring comfortably? And that’s the thing we call type #1 or Fryette’s Law #1, where the body looks fluid, looks smooth, and works to minimize any one area of pain.

    08:55 Fryette’s Law is if you sidebend to the right you rotate to the left, and your muscles and your bones work togethe to displace energy, to make sure that you have the maximum support for the musculoskeletal system.

    09:08 It looks fluid. It looks comfortable.

    09:11 Fryette’s Law #2 looks uncomfortable.

    09:14 It is non-neutral mechanics and that’s when you sidebend and rotate to the same side.

    09:20 When you pinch a muscle, you’re still able to get there but your brain overrides what the body would like to do.

    09:27 So again, the muscles and bones are organs that function in many ways.

    09:31 They have effects on the body that are more than just biomechanical.

    09:36 And even though biomechanics tends to be the primary motion we look for, t’s important to look beyond that and know the health of the musculoskeletal system affects the health of the whole body.

    09:47 Thank you.

    About the Lecture

    The lecture Bones and Muscle Metabolism by Tyler Cymet, DO, FACOFP is from the course Osteopathic Principles and Tenets. It contains the following chapters:

    • Assessment
    • Muscle Energy

    Included Quiz Questions

    1. Adenosine triphosphate (ATP)
    2. Creatine
    3. Creatinine
    4. Glycogen
    5. Glucose
    1. ADP plus phosphate
    2. ATP plus Creatine
    3. Glycogen plus glucose
    1. Oxygen
    2. Carbon
    3. Hydrogen
    4. Carbon dioxide
    5. Water
    1. 2 ATPs
    2. 1 ATP
    3. 3 ATPs
    4. 4 ATPs
    5. 5 ATPs

    Author of lecture Bones and Muscle Metabolism

     Tyler Cymet, DO, FACOFP

    Tyler Cymet, DO, FACOFP

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