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.
That’s not saying that’s apparent to people.
People tend to take the structure
they have and live with it.
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.
But those are end products way beyond
reaching the peak ability that the body has.
So we haven’t gotten to the point
of assessing structural integrity
and assessing whether or not you’ve
reached your maximum potential.
Those are places we’re trying
to go in the future.
If you ask parents, they’ll
assess your posture.
They’ll assess whether or not you’re
creating a lateral scoliosis,
whether or not you’re standing
and that’s their assessment of bone.
And true, posture will give a sign that
people aren’t maturing bone
but it also could be someone is shy.
It could be the body, mind, spirit continuum
affecting different things.
It could be somebody not exhibiting
their full potential
even though their body has gotten there.
Gait is also something that,
in teenage years,
we see lanky uncomfortable gaits.
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.
Bony integrity, usually more trauma
related or break related,
and it’s not unusual to have
kids break bones.
How do they heal? And how does
that affect future growth?
Joint function is another assessment
of how the skeletal system is working.
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.
So we need to expand our evaluation
of patients we’re taking care of.
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.
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.
We tend to focus on when things go wrong.
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.
We tell people if you’re working out and you
want to grow muscle mass, reps matter.
More weight matters for
changing muscle mass.
Lower weights helps you with
and helps you with use that
occurs over time.
So people come and complain
when they’ve been going for size
not for the long term use.
Fractures are a common complaint,
but those are different and obvious to us.
Dislocations tend to be less obvious,
and at least earlier in life,
people can dislocate joints and relocate
them with some regularity.
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.
Infections are another thing that do occur
and should be watched out for because
they do occur in muscles.
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.
Less common musculoskeletal disorders
that we see are spinal injuries,
crush injuries, and compartment syndromes.
Another obvious change is men
and women look differently.
Their muscle mass is different. Their
muscle structure is different.
Their muscle makeup in terms
of how much ATP,
creatinine phosphate, creatinine kinase,
and glycogen, all differs.
And the muscles make up
about 50% of our bodies.
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.
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.
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.
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.
Preferably in an aerobic metabolism
because aerobic tends to be more efficient
and it tends to be safer.
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.
But then it starts to burn the body
and have a longer recovery period.
If you’re an aerobic metabolism,
you can function longer without
the need for recovery,
washing out of the system, and rejuvenation.
So aerobic tends to have advantages
The advantages of an aerobic metabolism
is it generates a large amount of ATP.
The disadvantage is it’s the slower onset
and you require oxygen to use it.
Anaerobic metabolism also has
advantages and disadvantages.
Anaerobic is relatively rapid.
When you need it, it’s there.
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.
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.
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.
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.
That’s a part of exercise, muscle
memory, and muscle learning
that gets you better after
doing things longer.
Glycogen carbohydrate in the muscle gives
you the 30 seconds and beyond.
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
but still for use and functioning—
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.
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.
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.
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.
It looks fluid. It looks comfortable.
Fryette’s Law #2 looks uncomfortable.
It is non-neutral mechanics
and that’s when you sidebend and
rotate to the same side.
When you pinch a muscle, you’re
still able to get there
but your brain overrides what the
body would like to do.
So again, the muscles and bones are organs
that function in many ways.
They have effects on the body
that are more than just biomechanical.
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
affects the health of the whole body.