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On Monday March 16, 2009 Natasha Richardson, 45, was taking a ski lesson without a helmet (she declined the offer to wear a helmet) on a beginner slope at the Mont Tremblant ski resort north of Montreal, with an instructor. Toward the end of the lesson, Richardson fell and struck her head and the ski instructor called the ski patrol for assistance. She was alert and conversational afterward, even joking about her fall, and did not complain of any ill effects. One hour later, in her hotel room, she developed a severe headache.

Ambulance dispatch records obtained by the New York Times show that Richardson was not hospitalized until almost four hours after suffering the brain injury that ultimately killed her — three hours after developing symptoms.

Yves Coderre, director of operations for Ambulances Radisson, which provided the emergency transport for Natasha Richardson, had told the Toronto Globe and Mail that when paramedics initially arrived 1 p.m. at the Mont Tremblant resort, they were told they were not needed. As they were turned away, paramedics did observe from a distance that Natasha Richardson was sitting on a stretcher at the resort.

The next request for the ambulance for Natasha Richardson, still conscious, came at about 3:00 p.m. followed by a reported “enroute hospital” time of 3:42 p.m. to Centre Hospitalier Laurentien in Ste. Agathe — a 25-mile trip from Mont Temblant.

At 4:20 p.m. Natasha Richardson was examined by a physician.

A transfer was ordered to a larger hospital in Montreal, the Hôpital du Sacré-Coeur de Montréal. Natasha Richardson arrived at the Montreal hospital at about 7:00 p.m. Monday.

Tuesday, Natasha Richardson was accompanied by husband Liam Neeson and flown to Lenox Hill Hospital in New York City in critical condition, where she died on Wednesday after surgery.

Epidural or extradural hematoma (haematoma) is a type of traumatic brain injury (TBI) in which a buildup of blood occurs between the dura mater (the tough outer membrane of the central nervous system) and the skull. The dura mater also covers the spine, so epidural bleeds may also occur in the spinal column. Often due to trauma, the condition is potentially deadly because the buildup of blood may increase pressure in the intracranial space and compress delicate brain tissue. Because the bleed come from an artery the pressure can build up quickly while there is an eye before the storm giving the condition the name ‘Talk and die syndrome.’ The condition is present in one to three percent of head injuries.Between 15 and 20% of patients with epidural hematomas die of the injury. Epidural hematoma is usually found on the same side of the brain as impact.

Skull fractures often accompany epidural hematomas.

Signs & Symptoms of Epidural Hematoma
Expanding hematoma causes headache, nausea, and vomiting. Shifting brain tissue causes local brain dysfunction such as weakness, numbness, or speech problems. If severe progression of the hematoma occurs, central areas of the brain and the brainstem become displaced, causing loss of conscious, abnormal positioning of the arms and legs (decerebrate posture). At this point irreversible brainstem damage can occur. Documentation exists of rapid deteriorating conditions from injury to decerebrate posture in as little as two hours.

Full symptom list in severe head injury:
A lasting headache which worsens, or is still present over six hours following the injury.
Extreme difficulty in staying awake, or still being sleepy several hours after the injury.
Two or more bouts of vomiting.
Unconsciousness, either for a short or extended period of time.
Unequal pupil size.
Straw colored or blood stained fluid coming from the nose or ears. This is cerebrospinal fluid which normally surrounds the brain.
Severe dizziness or loss of balance.
Confusion or strange behavior.
Problems with memory.
Bleeding from the scalp that cannot be quickly stopped.
Not being able to use part of the body, such as weakness in an arm or leg.
Difficulty seeing or double vision.
Slurred speech
Unusual breathing patterns.
Ringing or deafness in one or both ears.
Having a seizure or fit (when your body suddenly moves uncontrollably).

An autopsy revealed that a torn artery bled between the outer lining of the brain and the skull.

Natasha Richardson picture collage.

Sources:
Bor Seng Shu E, de Almeida Leme RJ, Aguiar PH, de Andrade AF, Teixeira MJ, Plese JP. Traumatic acute giant epidural hematoma in a hydrocephalic shunted child. Pediatr Neurosurg. 2000 Apr;32(4):176-9.

Gerlach R, Dittrich S, Schneider W, Ackermann H, Seifert V, Kieslich M. Traumatic epidural hematomas in children and adolescents: outcome analysis in 39 consecutive unselected cases. Pediatr Emerg Care. 2009 Mar;25(3):164-9.

Chicago Police Department Supt. Jody Weis is a wellness, fitness and exercise advocate for his members.

“It is essential that recruits begin the academy with a minimum level of physical fitness to ensure safe and successful participation in training,” according to a statement of the Chicago Police Department released Friday, March 13, 2009.

Under the State of Illinois POWER test (Peace Officer Wellness Evaluation Report), a man in his 20′s must do a minimum of 37 sit-ups in a minute and run 1.5 miles in 13:46. A woman in her 20′s is required to do 31 sit-ups and run the same distance in 16:21. The test also includes a bench press and a sit-and-reach (flexibility) evaluation.

Several recruits typically fail in each class. New recruits are given the option of resigning or getting in shape for the next class. The POWER test is videotaped for legal documentation.

The City of Chicago is pushing for mandatory fitness tests for veteran officers. Failing officers would be assigned a trainer and be recommended special diets. Details and resolution are part of ongoing contract negotiations with the police union.

Currently, veteran officers may volunteer to take the POWER test and get a $250 award if they pass. There’s no remedial action if they flunk.

Show me your goals. We’ll align your practical, real world goals with physiological goals that help your mind, body and soul. Then, we’ll have a plan. A plan that is available online. Anytime. Anywhere.

Article under development.

Being Out of Shape is Relative
“Out of shape” has a lot of different meaning to different folks. To a marathon runner it is missing a day or two of distance running. To the disinterested couch potato it is a way of life. In between are people who have missed a few weeks, a few months, or a few years of regular exercise.

Exercise Physiologists call being out of shape deconditioning or detraining. People who are exercising should know there are two main kinds of deconditioning: strength and cardiovascular. If a person stops lifting weights, they really don’t lose any strength on Day 1 or Day 2 … 3 … or even Day 10. In fact, within a three to ten-day period of rest, a person might get stronger. If you can do 10 reps of a certain heavy weight, there is a pretty good chance you can do at least 7 or 8 reps and maybe even still 10 reps of the same weight after no workouts for up to 10 days. You might even be able to lift a heavier weight, but probably fewer reps within that 10-day rest. But after 10 days to 14 days, then you will start to see a decline in strength.

Cardio is a different story. Stopping cardiovascular training results in a significant decrease in conditioning immediately. Cardiovascular detraining primarily causes drops in blood volume and mitochondrial enzyme activity — that’s the activity that gets energy to repeatedly contracting muscles from the combination of food and oxygen at the cellular level. Most endurance runners can feel a disappointing loss of power, endurance and speed with associated discomfort in as little as three days of absolute rest. Athletes with adaptations of heart size and muscle capillarization with years of development seem to hold their morphological or structural adaptations for about three months. But the blood volume and mitochondrial activity starts discharging like a cell phone battery in 2 or 3 days. Twelve days of detraining takes about 36 days of re-training to restore the body to the trained levels of mitochondrial activity. In studies involving complete rest of trained individuals, the mitochondrial activity has been shown to have a 50% decline in 12 days. Note that reduced training or moderate training keeps the loss of conditioned cellular physiology (mitochondrial activity) from being so severe.

Article under development.

Action:
Elbow flexion brings the forearm up at the elbow joint with the wrist and hand in either supinated, pronated or neutral range or any degree in between.

Forward flexion at the glenohumeral joint brings the arm straight up in front of the body in the sagittal plane.

Supination of the forearm at the proximal radioulnar joint rotates the forearm outward as in turning the palm upward or turning the thumb away from the midline of the body.

Lesser Actions:
In Horizontal adduction the biceps brachii helps bring the arms together, as in a dumbbell chest fly.

In Shoulder abduction, the biceps brachii helps raise the arms to the side, as in a standing dumbbell fly or lateral raise.

EXPANDED REPORT …

Action:
The muscle as a single unit causes both hip extension and knee flexion. Both heads of the Biceps Femoris cause knee flexion. Only the long head of the biceps femoris, which originates in the pelvis — and therefore crosses the hip joint — causes hip extension. The long head of the bicep femoris is a weaker knee flexor when the hip is extended, and a weaker hip extender when the knee is flexed because of active insufficiency. Active insufficiency is the inability to produce maximal measurable tension (actively) because joint angles and levers put a muscle in a slackened position. The slackened position causes a less-than-optimal length-tension relationship of the muscle. Muscles generate less force when overstretched, as when origins and insertions are spread too far, or when the muscles are allowed too much slack, as when origins and insertions get too close. The length-tension relationship is measured from a percentage of 100% resting length of a muscle. The biceps femoris in exercise is an excellent example of active insufficiency, which explains one of the reasons leg curl strength can be stronger in a seated leg curl (hips in flexion) when compared to a prone leg curl on a flat bench (hips in extension). Consider also the effects of standing leg curl machines and prone leg curl machines with slightly flexed body boards.

When the knee is semi flexed, the Biceps femoris has a tendency to rotate the leg slightly outward — external rotation. The external rotation can cause the feet to turn outward and seems to be a common sign of fatigue, visible by observing a walking gait.

EXPANDED REPORT …

Article in development … The Semimembranosus muscle shapes the medial part of the hamstring muscles.

The Triceps Brachii muscle shapes the lateral part of the upper arm and causes elbow extension, which which straightens the arm at the elbow …

Usain Bolt, 22, of Jamaica broke a 12-year-old record for the 200 meters Wednesday, crossing the finish line in 19.30 seconds. Bolt turns 22 on the day after his 200-meter world record on August 21.

Usain Bolt (nicknamed “Lightning Bolt”) is the first man to break a record in the 100 meter and the 200 meter sprint.

According to Jamaican sprint coach Bert Cameron, Usain Bolt at age 12 ran 52-flat for the 400-meter on a grass track — a grass track with ruts.

Recent 200-meter world records:
The top 10 200-meter times.

19.30 — Usain Bolt (Jamaica), 2008. Beijing

19.32 — Michael Johnson (U.S.), 1996, Atlanta

19.62 — Tyson Gay (U.S.), 2007, Indianapolis (AT&T USA Track and Field Championships)

19.63 — Xavier Carter (U.S.), 2006, Lausanne, Switzerland (Grand Prix)

19.65 — Wallace Spearmon (U.S.), 2006, Daegu, South Korea (Meet)

19.66 — Michael Johnson (U.S.), 1996, Atlanta (Olympic Trials)

19.67 — Usain Bolt (Jamaica), 2008, Athens

19.68 — Frankie Fredericks (Namibia), 1996, Atlanta

19.69 — Walter Dix (U.S.), 2007, Gainesville, Fla.

19.72 – Pietro Mennea (Italy), 1979, Mexico City

Swimming butterfly in the third leg of the 4X100 United States Medley Relay Team, Michael Phelps won his eighth Gold Medal in the 2008 Summer Olympics in Beijing. The U.S. Team also included Aaron Peirsol (backstroke, 53.16), Brendan Hansen (breast stroke) and Jason Lezak (freestyle) won in a world record 3:29.34 — a world record.

Silver went to Australia and Bronze to Japan.