fitness gadgets

I don't want to specifically endorse any commercial products. However, I know that most people are familiar with a variety of fitness gadgets on the market- for example, Sunday morning TV is filled with infomercials for all sorts of exercise gadgets.

In general, the best form of exercise is something that you do regularly, so anything that inspires you to exercise more is good. One of my medical school professors liked to say "The best exercise for you is the best exercise for you," meaning that there is no one perfect form of exercise that is universal.

In general, I am not a huge fan of machines that are designed to target one body part, for several reasons. First, it is not possible to spot reduce fat in one region of the body, so machines that market themselves as "hip and butt machines" or the latest and greatest ab machine tend not to be great purchases. Additionally, they tend to be expensive and bulky.

The one targeted machine that I do like is the ab wheel, shown to the left. It's a cheap item (it should certainly be less that $20, and you may be able to get one for as little as $5), small, and does work very well for strengthening the abdominal muscles.

As I discussed in an earlier post, I like anything that makes exercise easy and more convenient. Therefore, little gadgets that allow you to exercise during small windows of time are great. One example is "The Perfect Pushup." It's a $20 item that makes pushups more fun, and probably more effective. The rotation of the handles does place less strain on the wrists, and in my personal testing, I do find that my push-ups seem to be more effective when I use it. I keep mine near the television, which is also a useful reminder for me. When I see them while I am watching TV, it is a useful cue to do some push-ups during the commercial break.

Incidently, a pair of dumbbells serves a similar purpose, and may be an even better choice. The great thing about dumbbells is that they are so versatile- you can do many different exercises with them.

If one were to look into more expensive products that target more total body exercises, there certainly is not a shortage of devices available. Of the large, bulky devices, my personal favorite is the Total Gym, which is an infomercial staple with Chuck Norris and Christie Brinkley. It's a great machine, the main drawback being that you need a large enough space to use one.

Amongst smaller gadgets, one that I really like is the BodyBlade. It's basically a stiff flat blade, that somewhat resembles a very thin ski. The idea behind the BodyBlade is that by rapidly vibrating the blade in different positions, you can strengthen a variety of muscles through repeated contractions. I wouldn't recommend it for the novice exerciser, for those who are looking for a great way to add variety to their routine, it can be terrific. It is commonly used in physical therapy, so it is ideal for people who are using the BodyBlade in therapy, and want to extend it's use to the home. I like to collect fitness gadgets to play with so that I am familiar with them for my patients, and the BodyBlade is the one that I find myself using the most often. The main downside of the BodyBlade is that it can be quite expensive (usually over $100, depending on which size you get).

Again, my goal of discussing these gadgets is not to endorse any specific product. But I do think that anything that helps cue people to be more active is helpful, and these gadgets can be useful as part of your healthy lifestyle so long as you actually use them.

Accidental Exercise, Reversal of Flexion

One of the challenges of most working people is finding sufficient time to exercise. Because of the multiple obligations that most working people have (work itself, family, shopping, paying bills, keeping in touch with friends, etc), exercise is often the first thing that goes, usually with a pledge of "well, I'll fit it in later."

As one of my mentors in NJ used to say, later never comes.

One of the keys, then, is to find ways to sneak exercise into every day life.

One common strategy that has been discussed commonly is to find extra opportunities to walk. For example, you can park far from the entrance to your office, or make a point of using the stairs to work.

Another useful strategy is to turn seemingly mundane activities into exercise. I try not to endorse products, but I am going to make an exception for a book my friend and mentor, Joel Press, called the Couch Potato Workout.

http://www.amazon.com/Couch-Potato-Workout-Exercises-Home/dp/192998815X

In it, he describes some useful exercises that you can use while at home to get in a little bit of extra exercise. I don't want to steal his thunder (and I suppose his profits), but one of my favorites is to stand on one leg while brushing your teeth. This is a particularly effective exercise as the mini-perturbations from brushing stimulate the proprioceptive system to maintain balance at the hip and ankle. It sounds easy, but it's surprisingly challenging at first. Once you get good at it, try it with your eyes closed. For the super advanced toothbrush-exerciser, you can try it with your eyes closed while standing on a towel (to give your foot an unstable platform).

This is just an example of fitting exercise into your day. You can do a simple variation on the toothbrush exercise while shopping. When you are waiting on line, simply stand on one leg. Once you get the hang of that, you can progress by lightly twisting while standing on one leg.

An important time to fit in exercise is when sitting for prolonged periods. Sitting for prolonged periods can put significant strain on the disks in the lower back, especially if you sit with poor posture (which many of us do). It's important to reverse the flexion of sitting periodically. Here are some approaches to reversing that flexion:

1. Stand up. The simplest is to simply stand up and walk for a few minutes. I advise that office workers should (if their bosses will allow it) print all documents to a printer on the other side of the office. This will force you to periodically stand up to walk to the printer.

2. Upward facing dog. If you are in an environment that provides sufficient modesty (e.g., at home, or in an office with a closed door), a great exercise to reverse the flexed position of sitting is the upward facing dog exercise, common in the sun salutations from yoga. An example of this exercise is shown at the following link (http://www.yogajournal.com/poses/474). The upward facing dog exercise is very similar to the Prone Press-Up, which is one of the corner stones of McKenzie Physical Therapy, a form of physical therapy that is particularly effective for low back pain. I recommend doing this exercise at least every 30 minutes if your work environment allows to reverse the flexion of prolonged sitting.

3. Standing back extensions. Another great exercise, which may be able to do logistically, is to stand up and extend your back. It may be easier to place both of your hands in the small of your back as you arch backwards.

4. Push-ups. Another good exercise. In addition to strengthening the chest and shoulder muscles, the posture of the push up (a plank position) requires tightening your innermost abdominal muscles (the transversus abdominus), which is important for maintaining balance across your lower back. Push-ups are great for fitting in periodic exercise throughout your day- crank out a quick 5-10 pushups when you get out of your chair, during commercials while watching TV, or just before sitting to eat dinner.

I hope these exercises serve as useful examples for how you can fit small bits of exercise throughout your day.

Uncle Garii

My brother was kind enough to take a snapshot of my "Mii" that I used when playing my nephews on the Nintendo Wii. This is Uncle "Garii." Cute.

Wii

I try not to officially endorse products, but I was at my brother's this past weekend, and played the Nintendo Wii, so I wanted to give a few comments on it from the perspective of a physician and biomechanist

Overall, I really liked it. I'll list my essentially random observations, just to give some semblance of organization:

1. It's fun. It's entertaining for both adults and young children.

2. It's a better way of doing video games. There has been a trend over the past decade to find new ways to make videogames interactive- for example, the many dance oriented games like Dance Dance Revolution and Guitar Hero. The Wii clearly takes things to a new level- the controller is innovative and worthy of the hype.

3. You can get a great sweat playing. After boxing, playing tennis, or hula hooping on the Wii, my shirt was drenched with sweat. You can get a legitimate workout, if that is your aim, from playing the Wii. My nephews, however, did find ways to move the controllers less aggressively, so I suppose over time the workout may not be as intense as it was for me using it the first time.

4. Good motivator for kids. One of the highlights for me was watching my brother use a boxing game. His youngest son mimicked his dad's movements, and was getting exercise himself. One trend that has been noted in much of the pediatric exercise research is the importance of kids watching their parents be active. We spent a few hours as a family exercising on the Wii, and I think that beyond being fun, it helps establish to the kids that exercise is something that you should do.

5. Real exercise is still preferred. We also took a hike as a family, and that was still a better form of exercise. The Wii is ideally an adjunct to other forms of exercise. If your kids are going to be playing video games, though, it's probably better to do it on the Wii, where they are active, than on other forms of video games.

6. The Wii Fit is pretty awesome. I enjoyed playing the balance, yoga, and exercise games that are part of the Wii fit. I found the additional feedback of the Wii Fit helpful for giving feedback on my balance and stability, and for the most part thought the exercises were well designed and fun. My biggest complaint is that the Wii Fit board is a bit narrow for larger framed individuals like my brother or myself.

7. The Mii are a nice touch. My nephews made an avatar for me (they are called Miis, and they called my avatar Garii). It's amazing how detailed they are- Garii looked disconcertingly like the real me, which was especially concerning when my nephew wacked me in the face when playing the boxing game. It also took a little joy out of beating my nephew in boxing, as Garii knocked out a Mii that looked just like my little nephew.

8. There is some translation from real skills. On games I've never played before, my nephews beat me pretty easily. But I was able to occasionally beat my nephews on some of the activities that I do in real life, like boxing, yoga, tennis, or baseball. If I get a Wii, I think I would probably play the tennis game quite often, since it's certainly easier to turn on the video game system than find a similarly skilled partner.

Overall, I really enjoyed the Wii. For adults in particular, I thought the Wii Fit was great, and could be a enjoyable way to work on balance and strength exercises.

Ramblings: Externalities

I would like to discuss the concept of externalities. It may be a term that is used elsewhere, but I use it to mean the extent to which we rely on external factors to define ourselves.

The Olympics are, viewed through a certain filter, all about externalities. Athletes all want to know how good they are, but it’s impossible to define your success in athletics based on some intrinsic sense of self- the athletes need to compete against other athletes to get a sense of good they are.

Some images from the Olympics endure because of this sense of an athlete competing against others. For example, probably the single most impressive image of the Olympics was Usain Bolt in the 100m sprint, looking around and thumping his chest as he raced toward the finish line. What made it so impressive was that he was looking for peers to judge how fast he was going, and he couldn't find any. He was without peer.

I thought about this quite often when I biked in Little Rock this past year. My favorite ride was along the river trail along the Arkansas River which separates Little Rock and North Little Rock. During the Little Rock winter, I tended to ride on Saturday afternoons. Within the context of the Saturday afternoon crowd, I was very fast- I was almost never passed by another rider, and would regularly pass others.

However, as the weather heated up in the spring, I started to ride in the morning before work to avoid the heat. The cyclists on Monday morning at 5:30am were a dramatically different group than the riders on Saturday afternoon. Basically the only people who would wake up that early on a weekday morning to ride their bike were hardcore riders, and me. I had felt strong about my cycling ability based on my weekend rides, but all of a sudden everyone was passing me.

This is a good example of an externality- my sense of self as a cyclist was completely defined by the people I was riding alongside. Am I a good cyclist? I have no idea- it depends on the context.

Getting back to the Olympics …. I enjoyed the interactions between Mark Spitz and the media. For most of Mark Spitz’s life, it has probably been close to impossible for anyone to grasp what he did in winning 7 gold medals at the 1972 Olympics in Munich. No one else had done it before, and no one had been particularly close. But Michael Phelps’s pursuit now gave perspective for Spitz’s accomplishment. That Phelps tried and failed to match him at the 2004 Olympics, and that Phelps needed a strong leg by Jason Lezak in the relay and a dramatic touch in the 100m butterfly emphasizes just how hard it was to beat Spitz’s record. Spitz’s accomplishment now has meaning- Phelps’s performance is an externality that gives perspective to what Spitz had done.

A similar phenomenon exists in how I (and I imagine many others) view Roger Federer. I was never a big fan of his until he lost to Rafael Nadal at Wimbledon. It is only now that Federer has been supplanted as the #1 player in the world that I have perspective on how dominant he was prior to losing. I needed the externality of Nadal to appreciate Federer’s greatness.

As another example in another medium, one of my all-time favorite movies is Unbreakable by M. Night Shyamalan. I don’t want to spoil the movie for those who haven’t seen it, but it involves a struggle by both Bruce Willis and Samuel L. Jackson to define who they are, for which they both require the externality of the other man. I found that message extremely powerful.

Externalities play a role on a social level as well. For example, three top 3 tennis players have emerged from Belgrade, Serbia, within a span of one year of one another (Ana Ivanovic and Jelena Jankovic are the top 2 players on the women’s side, and Novak Djokovic is #3 on the men’s side. Both Ivanovic and Jankovic have been ranked #1, and Djokovic will presumably at some point in the next 2-3 years). The odds of this happening are actually quite good- all three were in formative years when Monica Seles, also from Belgrade, was the #1 player in the world, but beyond those influences, it helps to have a peer for comparison. All three actually trained substantially outside of Serbia for portions of their development, but they were compared. In the case of Ivanovic and Jankovic in particular, I think having a direct comparison with someone with a similar skill set and the same age can be a driving force to bring them to a higher level. Similar pairings are actually fairly common in tennis- Kim Clijsters and Justine Henin from Belgium, Venus and Serena Williams in the US, Marat Safin and Dinara Safina from Russia, and John McEnroe and Patrick McEnroe and Mary Carillo (who grew up with them). Other famous pairings are ample in sports- one of my favorites is Yogi Berra and Joe Garagiola growing up playing baseball in St Louis (the Cardinals chose Garagiola to be there catcher. They should have chosen the uglier guy).

I know it has for me in the past. I have a brother Mike 5 years older than me, and a twin sister Jill. We were all swimmers, and Mike was clearly the best of all of us. Both Jill and I started swimming competitively at age 5, and my drive was always to try and be as good as my brother. In addition to having the role model as an externality, I had a constant base for comparison, in my sister Jill. This was particularly a driving force when we were in our young teens, since she was faster than me for a few years in the time when she had undergone puberty and I had not. Even though I was nothing special as a swimmer, to the extent I was decent, a major factor was having Mike and Jill as externalities that helped me judge my progress.

Why do I bring this up idea of externalities in the context of a Kinemedics blog?

I think it matters in working with patients with musculoskeletal conditions. Understanding externalities is important in understanding that a person’s sense of self, a sense of who they really are is largely governed by phenomena that are external to themselves. Even more important, though, is that we can choose which of these external phenomena we will allow to define us, and that we can choose how these phenomena define us.

In the case of Michael Phelps and Mark Spitz- Michael Phelps was able to use the accomplishments of Mark Spitz as a goal to drive him to higher levels of performance. Mark Spitz, much to his credit, was able to graciously accept Phelps surpassing him as a sign of how hard he was to pass, and admire the inspiration he helped create.

The Williams’s sisters and Ivanovic/Jankovic have chosen to raise their games in face of competitors in their immediate peer group, and the game of tennis is better for it. Rafael Nadal has forced Roger Federer to redefine his greatness in the context of a new external force he cannot dominate, and in the process has allowed us to appreciate how great he was all along.

The same is true for patients. Many of patients see me to address an internality- they feel pain somewhere, whether it be their back, neck, knee, hip, shoulder, or elsewhere. I find that one of the most effective things I can do in helping the patients I work with is reframing their problem- rather than defining their problems by an internality, define it by an externality- what is it that you actually want to do?

I’ll use a personal example from my life to highlight what I mean. At the tail of end of my college career at the University of Wisconsin, I was involved on the UW triathlon team and had a long term goal of completing my first Ironman triathlon. On a training ride in May of 1995, I wiped out and tore the PCL in my left knee.

I spoke with multiple orthopedic surgeons in Wisconsin, New Jersey, and New York, and they all took a similar approach to my knee injury- they address the internality of my knee injury, and made a determination of whether I needed reconstructive surgery (I didn’t). But for me, they never addressed my externality- I was defining myself by my ability to race in an Ironman triathlon. They were answering a different question than the one I was asking- they were answering the question “do I need surgery,” when the question I was really asking was “what do I need to do to enjoy, compete, and excel in the Ironman?”

I’ve devoted my life to answering that question, both for me and my patients. It may not be the approach for everybody, but I think it helps many. Some examples:

Patient #1:

Internality: Initially comes in talking about her back pain

Externality: What she really wants to know is what does she need to do to pick up her granddaughter and play with her

Patient #2:

Internality: Comes in bothered by hip pain

Externality: What he really wanted to know is what he needs to do to finish a marathon he is training for with his brother

So- what is your externality- what is it that inspires you? What motivates you? What excites you? What is that makes you the best version of yourself? What can we do to help get you there?

The Stretching Trial

There is ongoing trial that is recruiting athletes to assess the effectiveness of stretching. I encourage those interested to take a look:

http://stretchingstudy.nokc.no/study-stretching-web/innhold/welcome.faces

US Open Preview- Women's Draw

As is often the case for me, I am more interested in the women's draw, particuarly because of one player. My predictions, in order:

1. Dinara Safina. I am very much excited about her chances. She's had a pretty dominant run the past 6 months:

Won 2 Tier I Tournaments: Berlin (clay), Montreal (hard)
Won 1 Tier II Tournament: LA (hard)
Lost in a Slam Final: French (clay)
Won Olympic Silver Medal: China (hard)

She's ascended from the number 15 last year to number 7 now. She is only 535 points outside of first place, and 297 points outside of first in the points race for the year.

For all these reasons, I think Safina is currently the best player. I think she's the strongest woman on the tour (I would love to see a "World's Strongest Man" type event featuring Safina, Serena Williams, Lindsey Davenport, and Ana Ivanovic. I'd put my money on Safina). She has superpowerful strokes from both the forehand and the backhand, and she's the most intense player on the tour. I could also see the NY crowd getting into her intensity (I could see them tearing into to her).

So, even if everyone wasn't injured, I'd be picking Safina. But everyone is injured. This makes it an even easier call. I give Safina a 35% chance of winning, which is pretty high- it's higher than I picked for Djokovic in the men's draw, for example

If she does win, by the way, I put the odds of her brother showing up to watch her also at 35%. You can never predict anything with the Safin/Safina family.

2. Elena Dementieva. I've never loved her game, but she is admittedly doing well recently, and did beat Safina for the gold medal. The main strength to her candidancy is a solid all around game, an improving serve, and a depleted field.

3. Serena Williams. Just on talent alone. I think I was premature in thinking Ana Ivanovic had surpassed Serena as the most talented player on the tour- at least until Ivanovic gets over her injuries. When Serena plays on her A game, she's going to beat everybody. I have no idea if she brings her A game- she should in NYC, but she actually hasn't been much of a world beater at the US Open.

4. Ana Ivanovic. I can't be completely neutral on her- she's my favorite player, so I want her to win. I don't know what to make of her injuries. I assumed that her hip abductor strain going into Wimbledon was a fake or minor injury to give her more time to rest after winning the French. But she was lackluster at Wimbledon, and would have been eliminated earlier if not for a lucky let cord shot. And her thumb injury has been limiting her substantially, including pulling out of the Olympics. A thumb injury could be very limiting, especially how important her rotation and top spin is to her dominant groundstrokes.

If Ana is healthy, though- well, I still might put her #2. She had a mental edge coming out of the French, but Ana's been playing so poorly that I think she will have issues getting her mental game back. If she starts off with a few dominant straight set wins, then she goes right to the top of the list with Safina. Otherwise, we may have to wait a few more months to let her thumb and confidence heal.

5. Venus Williams. Just too talented and too erratic to ever predict accurately.

6. Jelena Jankovic. Again, injuries are the main issue here. Clearly talented enough to win. If she gets rolling, her engaging style of play and ebullient personality will make her a crowd favorite in NY- she's just too darn likable. I'll be rooting for her.

7. Alize Cornet- my "what the heck" pick. She's been playing well, and shown she can hold her own with the big name players. I wouldn't be shocked to see her make the semi-finals

US Open Preview- Men's Draw

Here are my thoughts on the likely winners for the US Open, in order of likelihood:

1. Novak Djokovic
2. Rafael Nadal

I've gone back and forth on these two, who I consider co-favorites. It's certainly been Nadal's year. There are a few reasons, however, I am leaning toward Djokovic:

a. I think Djokovic's track record is still better on hard court
b. They've played each other pretty closely. Djokovic is one of the few players to have convincing wins over Nadal this year. Djokovic is probably the only player on the tour who thinks he should beat Nadal, and I include Federer in that comment.
c. Health. I think Nadal's style makes him a bit of walking time bomb, and I could see him running himself down over the course of the hard court tournament
d. Crowd response. The US Open is my favorite live event in any sport, and the main reason is the crowds- it is the one tennis event where the crowds can really rally a player. Of the top players, Djokovic has the most engaging personality, which definitely benefited him last year.

I think these are all very real advantages for Djokovic. Maybe I am just trying to convince myself to go against the best player, who is clearly Nadal.

I would probably say 27% chance for Djokovic, 23% chance for Nadal, and 50% for the rest of the field.

3. Federer. Still great, even if his not playing at a "greatest of all time" level. I am one of those people who appreciates Federer more now that his is mortal.

4. James Blake. Inconsistent, but I think he's the American most likely to have the crowd rally behind him and carry him to victory.

5. Andy Murray. The most talented player outside of the Big 3.

6. Marat Safin. I was impressed by his Wimbledon run, and I think it would make an interesting story to add to my predicted winner for the women's draw.

Michael Phelps

While Usain Bolt has certainly been incredibly impressive, this has clearly been Michael Phelps's Olympics.

Michael Phelps was already the greatest swimmer of all-time prior to the Olympics. What this Olympics did was put distance between him and #2, whoever that is (Mark Spitz presumably, although I suppose their are other people in the mix, like Matt Biondi, Ian Thorpe, Tracy Caulkins, and Jenny Thompson).

Michael Phelps's real peers now are people like Tiger Woods, Roger Federer, Michael Jordan, Jim Brown, Barry Bonds, Lance Armstrong, Babe Ruth, and Jim Thorpe- whether he is the greatest athlete of all time.

If I were his career adviser, I would recommend against trying to repeat in the same events he has already been swimming. I think there is limiting returns in trying to dominate 200 free, 200 and 400 IM, and 100 and 200 fly. He's already proven he can win these races, and it won't alter how he is perceived historically.

So what events would I like to see Phelps swim:

100m and 200m Backstroke: I have seen some talk that he is considering racing the backstroke as an individual. I think that would be a great choice. It would certainly add to his legacy if he could start beating Aaron Piersol regularly in the backstroke, since Piersol is arguably the greatest backstroker of all time. I think it would also help his dominance in the IM, since his closest competitor is Ryan Lochte, and Lochte is the current 200m record holder and gold medal winner.

100m Freestyle: I think he would also benefit from taking on the 100m freestyle as an event. I suspect that as he ages, he will be able to maintain his speed more easily than his endurance. His best time is 47.51 seconds, and the current world record is 47.05, which was just set at this Olympics by Eamon Sullivan. Phelps's time of 47.51 seconds would have been a world record as recently as March of 2008, and only Sullivan and Alain Bernard have swum faster. I suspect that if Phelps were to concentrate on the 100m freestyle, he would be very much in the mix for the best in the world.

200m Breaststroke: This is the event that would truly cement Phelps's place in history. Currently, the record of 2:07.51 is held by Kosuke Kitajima of Japan, who is probably the greatest breaststroker of all time. Breaststroke is most peculiar of the swimming strokes, and so it is unusual for great swimmers in the other strokes to also be great breaststrokers. If Phelps were able to take down Kitajima, he would dominate over the sport of swimming more than any other athlete in any sport.
I think he could do it. In the IM, Phelps held his own in the breastroke against the other IM'ers. I don't think he could beat Kitajima using his current stroke- I think he would have to evolve the stroke to better fit his body type. It would probably continue the progression of breastroke, which has over time has increasingly evolved to look more like butterfly. Phelps is the greatest butterflyer of all time, and if he could modify the breastroke to take advantage of his poweful dolphin motion and elongate the glide even more than is already case in the breastroke, I think he could beat Kitajima.

If Phelps were to become a world record holder in the 100m backstroke, 200m backstroke, and 100m free, then I think he would clearly be in the discussion for the greatest athlete of all time. If he were to beat Kitajima and break the world record in the 200m breastroke, then I think that more than being in the discussion for the greatest athlete of all time, he would become the starting point in the discussion.

Go for it Mike.

Kinesiotape- part II, and some related thoughts on doping

A reader posted a follow-up question regarding my post on kinesiotape:

"Let's say I'm a perfectly healthy athlete who decides to put kinesiotape on my shoulder to help with proprioception during my tennis match against Lindsay Davenport. Would you say this is more equivalent to me (a) wearing an Ace bandage around my prone-to-spraining ankle, (b) wearing a sweatband to keep my hair, sweat, etc. out of my face, or (c) me taking steroids to help improve my performance? Or (d) none of the above. I guess my more general question is, could kinesiotape be used to give injured and/or non-injured users any kind of advantage (beyond the band-aid type functionality)?"

-----------------------------------

I'll address the specific question asked here at the end of this post.

As for the more general question, and it's a good one- how should we view the benefits of kinesiotape- is it within the realm of clothing, or should it be considered a form of doping. These types of questions are tricky to answer, but they are becoming more important in the realm of sports. Before I give an answer, I'll provide a few more examples of things like kinesiotape, that are things that athletic boards need to consider:

1. Carbon fiber or other alloys in athletic equipment (including obvious things like bikes and tennis racquets, but also less obvious things like the soles of athletic shoes, where it could augment the propulsion of runners)

2. Nutritional supplements

3. Sleeping chambers to simulate sleeping at altitude

4. Anabolic steroids

5. Birth control pills and corticosteroids- both are also forms of steroids, also with multiple systemic effects, including some significant side effects, and both which are sometimes prescribed for athletic performance. For example, birth control pills are sometimes prescribed to help with menstrual irregularities associated with the training from female endurance athletes. As another example, corticosteroids are amongst the most commonly prescribed drugs in athletes, such as in inhalers for asthmatics, or joint injections for joint pain. These are interventions that are not without significant risks.

6. Prosthetics for lost limb segments.

7. Caffeine

8. Water- this may seem obvious, but some sporting events used to ban water, and it does offer some performance advantage. Should this be banned?

9. Weight training
-------

These are just a few examples. I think it is valuable, before making an arbitrary decision on whether to allow something like kinesiotape in recreational tennis matches or Olympic beach volleyball matches, to have a set of criteria by which that decision would be reached.

In my opinion, in order to ban an intervention, it should be meet both of the following criteria:

A. The intervention confers a definite performance advantage
B. The intervention causes a reasonable expectation of harm to the athlete who uses it

In my opinion, an intervention needs to meet both of these criteria for it to be banned. This discussion is explicity assuming that the reason to ban something is for the safety of the athlete (below, I will discuss other aesthetic considerations). To give a few examples:

1. Water. Water almost certainly meets critieria A (confers benefit), but doesn't meet criteria B (reasonable expectation of harm). Therefore, there is no need to ban it, since there is no significant harm in athletes using water. Athletes should use water. I would probably make a similar argument for caffeine.

2. Beer. Beer probably meets criteria B (reasonable expectation of harm), but it is unlikely to meet criteria A (confers benefit), so there is no reason to ban it, since athletes aren't going to use it anyway.

3. Cutting off your nose. I use this as a trivial example. Some may argue that for beer- "well, it's not likely to be beneficial, but since it can harm athletes, we want to ban it to protect the athletes." But it's not reasonable to ban everything that can harm athletes- the purpose of governing athletic bodies is to protect athletes within the context of their sport, not life in general. It may seem obvious that athletes shouldn't have to be reminded not to cut off their nose, but athletic bodies frequently ban interventions with no proven benefit, and in my opinion they are extending themselves into the personal lives of the athletes and no longer protecting the sport. As an example, I don't think regulatory agencies have any business regulating marijuana or alcohol consumption, since they are not directly related to athletic performance.

4. Cocaine. Cocaine probably does meet criteria A (it is a stimulant, and probably confers a performance advantage) and also meets criteria B (it has many well documented harmful side effects). This, to me, is the very kind of substance that should be banned- if it was not banned, athletes might feel a selective pressure to take cocaine in order to compete, and therefore put themselves in harms way.

Getting back to the initial question regarding kinesiotape- it is possible that it meets criteria A (offers a performance advantage), but it is highly unlikely that it meets criteria B (reasonably would expect harmful side effects), so I can see no reason to ban it for players, whether they are injured or otherwise.

-------

The other reason for banning an intervention, beyond protecting the safety of the athletes (which is what I was really getting to above) is protecting the aesthetic and performance standards of the sport. There are certain equipment changes which have fundamentally altered the nature of their sports. These include:

1. Composite materials. Materials such as graphite, titanium, and carbon fiber have revolutionized sports like tennis, golf, and cycling. There is frequent discussion about whether these changes have ruined their sports. I think the difference is most striking in tennis, where the advent of new materials has probably been the dominant factor in the shift from serve-and-volley to power baseline as the dominant playing styles. I happen to like this shift, but some people hate it.

2. Aerodynamics/hydrodynamics. Examples include aerobars and disk wheels in cyling and the much-talked about LAZR swimsuit from Speedo have played large roles in rewriting the record books.

3. Altered techniques. Probably the best examples I can think of are the Fosbury Flop in high-jumping (the technique of going over backwards, developed by Dick Fosbury) and the Berkoff Blastoff in swimming (David Berkoff would swim nearly the entire lap of backstroke underwater using a dolphin kick. This has since been banned- an example of outlawing a technique to preserve the aesthetic of a sport, even if the new technique is faster).

As an aside, the concept of altered techniques altering a sport became very apparent to me in my marginal high school swimming career. When I was in high school, one of my teammates was a guy named Keith Rizzi. We came up swimming together in youth programs, and while he was always good when we were younger, he didn't become truly outstanding until late in our high school careers.

I think two things occured during our junior year that led to rapid improvements. The first factor was puberty, which is always a difference maker in high school sports. The second is that when we were juniors, they made a seemingly small change in the rule for backstroke flip turns, allowing what was called the cross-over turn. Until our sophomore year, it used to be required that a swimmer touched the wall while still on their back before starting their turn. They changed the rule to allow a "cross-over" turn, where the swimmer was allowed to flip onto their stomach for one stroke prior to initiating their turn. This allowed the swimmer to gain momentum from twisting from their back onto their stomachs and use that to propel their turns, which was faster for everybody.

However, Keith Rizzi was better at this turn than anybody else, and it made him unbeatable. Furthermore, he was able to use the technique he refined on his turns in backstroke and use that on his freestyle flip turns, and he became unbeatable in freestyle sprints as well. This made a big impression on me as a young swimmer, because I was overwhelmed with how a seemingly small change in a rule could make such a large impact in the outcome of the race. I think about this often when assessing the biomechanics of athletes or my patients- small changes in movement can make dramatic changes in outcome.

4. Altered equipment. Sometimes equipment dramatically alters. Examples include shapes of the modern putter in golf. Another example, which hasn't particuarly caught on, is two-handed tennis racquets.

-------

So, should kinesiotape be banned from volleyball, tennis, or other sports for aesthetic grounds?

In my personal opinion, no.

Beach volleyball and tennis, though, provide interesting counterpoints to the extent to which they regulate their aesthetics. Beach volleyball promotes the aesthetics of their athletes more avidly than any other sport. Tennis, particuarly the women's game, probably goes more out of their way to downplay the aesthetics of their athletes than any other game. It wouldn't surprise me if tennis outlawed kinesiotape because they found it "off-putting." At the very least, I would imagine that at Wimbledon players would have to make sure their kinesiotape was white.

Anyway, let me get back to directly answering the readers original question. I would consider using kinesiotape most equivalent to using an ACE bandage on your prone-to-spraining ankle. And I still don't think you'd have any chance of beating Lindsay Davenport.