PAR - Twist and Shout

PAR - TWIST AND SHOUT : THE OA FROM SPORT



ope, I don't mean the Song...Twist and Shout, think more of the action.

On the 9th of May our mate Pool_Viceroy (He calls himself Boy, we know better; he owns the club, not works for them), asked the question
"I wonder what the prevalence of OA is in BasketBall and Baseball?".

Tonight I attempt to shed some light on this question as we wait for the next lot of exciting news about iPPS and what it can do for a good deal number of people, one day in the future.


The Short answer is YES to Pool_Boy's question posed above, there is prevalence.

The longer answer is as follows, it's a long post again so be warned, please do enjoy.


Let's first take a high level look at the topics we will be covering tonight:



TABLE OF CONTENTS




INTRODUCTION

Fundamentally ANY sport or activity that involves twisting and constant pressure of the joints (think Pivoting, Jumping, Tackling etc) has an increased chance of OA.  A massive 73% of ACL reconstructions in Australia are a result of sporting activities.¹  Yes so basketball specifically does fall into this category.  Certainly there is  a "high rate of injury from sudden stops, starts, twists and turns – harsh on the knees and the back".²

Other sports such as Volleyball increases pressure on ankles, "In one study, a combination of chronic lateral ankle instability with intensive volleyball playing was suggested as possibly increasing the risk of ankle OA".³ We know  Aussie footballers have used iPPS to treat Osteo Pubis and the info I've heard is that it has worked well on these patients too.  (Osteo Pubis  "is a condition in which there's inflammation where the right and left pubic bones meet at the lower front part of the pelvis".⁴ )  Soccer and hockey and long distance runners are all at a higher chance of getting this infliction.

Later perhaps this month we will get the exciting news of how the American Footballers went with their EPA program.  This indeed could be an eye opener for many new investors to Paradigm.  

However, there is simply no better way, no better source of information,  to present to you the effect of such sports as Baseball and Basketball in terms of OA than to give you a quote from the all time Master himself, Dr David T. Felson:


          "I shall contend that most or almost all osteoarthritis is caused in part by mechanically induced injury to joint tissues". ⁵


The Great Doctor goes on to state:

          "...it has been known for at least 60 years that meniscal tears and meniscectomies done after tears lead to an extremely high risk of OA in that joint".


This in a nutshell answers the question posed tonight.



MECHANICALLY SPEAKING

It has been found by researchers that the removal of the meniscus usually due to surgery, in itself can lead to OA. What is a meniscus? The best way to think about the meniscus is as a washer...

Mozz, what is the purpose and function of a washer?

Three fold:

1)  Distribution of even force
2)  Provision of a smooth level surface
3)  Creation of an an effective seal


     
     _{Ahh the simple washer, so much good it does for us...}


But what is the equivalent in a human knee joint?


      
          _{The Human part equivalent of a washer...the meniscus.}



Quick washer fact?   When were washers first used?   Ahhh what a backdrop for a .....MOZZ QUIZ ^©


A)  1963

B)  Are you kidding me?  They date back to my Pa's time....1920

C)  Mozz is being silly with the above two answers..let's go back...way back    -   1878?



Of course....the answer could never be any of the above...they date back to they year 1346!

So, what can happen when the washer breaks, when it is worn out?    "Increased compressive stress" ⁵ results when there are ACL tears.
What activities lead to ACL tears? Well basketball, soccer, football, netball injuries are just a few examples.



FAST FACTS

Some quick Aussie facts in terms of Netball ⁶ , certainly some similarities between that and Basketball...

• At the recreational and sub-elite levels there are between 11 to 15 injuries per 1000 player hours sustained.
• ACL ruptures are responsible for 17% of hospital admissions in female netballers.
• According to a very comprehensive study looking at past studies, "Compared with unexposed persons, participants in soccer, elite-level long-distance running, competitive weight lifting, and wrestling had a higher prevalence of knee OA" ⁷
• Jeffrey B. Driban, an athletic trainer at Tufts Medical Center in Boston, said that one person in three who injures the anterior cruciate ligament “will have X-ray evidence of osteoarthritis within 10 years whether or not the injury is repaired surgically." ⁸

While this next fact is not strictly related to sports and OA, it's a fact I came across while researching for this topic, it was a MOZZEO^® (Mozz Eye Opener!):

• Recent estimates suggest that total costs for arthritis, including osteoarthritis, may exceed 2% of the gross domestic product.⁹

Another eye opener...if you would've asked me say 2 years ago...I would've thought OA mainly affects older people...like above 60....Wrong!

• "More than half of adults with symptomatic knee osteoarthritis are younger than 65.” ¹⁰

CONSEQUENCES

So we know there is a huge number of people that have sporting injuries.  Did you know some 50% of these result in OA? "Studies of meniscus and ACL injuries suggest an association between injury and OA development. In 67 Swedish female soccer players with a confirmed ACL injury sustained before age 20 years, radiographic evidence of OA was present in 51% of the injured knees after 12 years, compared with 8% of the uninjured knees ".¹¹  The myth that OA only affects you as you get old is truly smashed with this stat: "Sports related knee injury hospitalisation's peak between 15-24 yrs of age". ¹


IS YOUR JOB A SPORT?

There have been quite a few studies that have investigated and found that the nature of your job can contribute significantly to the chances of you developing OA and it can be very specific.  Some examples please Mr Mozz.Factory workers that had jobs that required repeated "pincer grip motions had a higher rate of OA in the distal interphalangeal joints".¹²  Farmers have been shown to have higher rates of hip OA.Jobs requiring repetitive kneeling or heavy lifting were specially associated with higher levels of knee and hip OA.On the construction site, Jackhammers have a higher prevalence of wrist OA, a normally rare form of OA.Lifting loads from squatting positions added significantly to chances of developing OA.  

It is the turning action from crouching while loading the joints that will add to the torsional stress.   If you are a sportsperson think basketballer, soccer player, netballer and of course rugby/footy player...you are in this higher risk category.  Why do you think athletes present with higher degrees of OA despite them being young.  It is for this accelerated load and the constant twisting turning and loading of their joints that puts them in this higher risk class.


TWIST AND SHOUT

Yes I was wondering when you would ask me about the relevance of the title of this post, a song titled Twist and Shout and what we attempt to address through iPPS?Well a little background first.  The Beatles version of the song was recorded way back in 1961.  Put your hands up if you are reading this and you were alive at the time?  I'm sure there are a few...do enjoy Appendix A below for a memory.  In honesty it was slightly before my time but I appreciate what Rock N' Roll meant to audiences back then. Twist and Shout spent an incredible 64 weeks in the charts and 21 of those were as Number 1 in the world! Par-Peoples, I can only dream that one day we will affect such numbers of lives in a positive way compared to such hit songs written and produced all those years ago and we may be as popular and have the drug of choice for so so many that are suffering OA and pain.


So getting back to the OA and Sports...Pool_Guru has hit the proverbial hammer on the head, I quote this specifically in direct answer to the question he posed:"Repetitive joint impact and torsional loading (twisting) also appear to be associated with joint degeneration, as seen in the elbows of baseball pitchers".¹³ The same applies to basketball, it definitely is a sport that will attract sporting injuries, it is the repetitive twisting motion with pressure and increased load on joints that causes the underlying damage.  The tearing of muscles, the injuries to bones can lead to a 40% chance of developing OA within ten years of an injury and this figure increases if the injury isn't managed.  See the next section for further details,


I'M NOT PLAYING ANYMORE

No this doesn't mean all exercise is bad, risky and I'm just going to sit at home and watch TV where it is safe.  You need to be active, the trick is to avoid injury and even more importantly, warm up and cool down.I mean:

1)  If you haven't exercised much in the past, don't all of a sudden go for a 10 km run.Do it slowly, progressively
2)  Avoid the very aggressive sports unless you are ready -  at least build up to them ...get a coach/trainer.
3)  Depending on your age and your current OA status, try less joint loading exercise such as swimming, cycling or cross training.
4)  Go see a doc/sports injury specialist if you do have pain before starting any exercise or training regime.
5) Cool down those muscles and stretch after any exercise.

Definitely time for a disclaimer, I ain't no sports medicine type doc...do not rely on what I have found, what I think....I'm not a professional advisor, you need to seek help from a professional if you find yourself in any of the above scenarios.

When I refer to 'how you manage your injury can play a significant role in the chance of developing something severe and serious as OA', I mean after sustaining an injury it is important to first rest and recover the affected muscle/joint.  To slowly work on re-strengthening the area over time.  This is critical.  Read Reference 2 for further information in this area in the Reference section below.

Once you have rested it, as the muscle/injury begins to mend start slowly by strengthening it.  Your chosen sports injury professional will guide you with appropriate first steps on the path to building strength into the affected and surrounding areas.  Thus, careful management can lead to a lower prevalence of OA in the future.  Yes we get frustrated that we cannot spring back straight into our sport or our exercise after an injury.  Not unlike when the PAR shares get clobbered due to some exogenous outside factor like the entire market taking a hit.  But you know Paradigmers, as I say, our day will come, there will be days on which we get such stellar news - it won't really matter what the market is doing at the time.  Again I state that we are dealing with the safe management of pain here, the opportunity is indeed large for iPPS.


SCIENCE ME UP


Right Paradigmers, I endeavour to bring the very best research straight to your door...well your screens.  Have a read of this one....If it's a muscle then we know that blood with fresh and much required nutrients gets taken to the cells via arteries...and then the system, now known as veins, remove the waste...thus keeping our cells nice and happy.  We know that the more you exercise, the stronger your muscles get..they effectively grow and are nourished at higher rates.

BUT did you know that if you do not exercise and live a more sedentary life then there is a higher chance the cartilage in your knees is likely to breakdown and lose strength?

Hey Mozz, you have forgotten something...there are NO arteries and veins that feed the pieces of cartilage between your bones ..how in fact do they get replenished/fed?   Ah ha....great question...here is the answer:Nutrients feed into the cartilage by pumping action.  What this means is that as you bear weight on your joints, fluid in the cartilage is squeezed OUT...and as you relax, fluid with more refreshed nutrients is sucked back IN!

So in other words, if you are fit and active...your cartilage gets replenished and it will last longer.  Mate...we do not need to know how a car works...but trust me..if you know at least a little about it...don't you think we can protect the engine a bit more...don't you think that we will tend to the oil..make sure it is at the right levels..make sure the viscosity is correct and is not too dark and black...ie replenish it as often as required?




_{If your car runs out of this stuff you are going to do a lot of damage to your engine...}


This is just a fraction of the science behind what we have.   iPPS is a safe drug that helps in the biomechanics...Wait another sec...so Mozz, are you in effect saying that there is nothing wrong with running......and that it actually does NOT increase OA? Yes...A large study in Medicine & Science & Exercise concluded that running does not increase OA.  In fact Runners actually had half the incidence of knee OA compared to walkers!  They also concluded that running can thicken the cartilage in your knee.²


A NEWBIE PRIMER

Wait, are you brand new to PAR?  Ok here is a quick primer to help....iPPS is a repurposed drug.  It is still used today for interstitial cystitis.  PAR have the rights to use the injectable drug to address the massive market of Osteoarthritis (OA).  OA is so big and so prevalent that it will blow you away (more to come on this topic later next week in a subsequent Mozz Eye Opening post).

For the first time in the entire world's history WE have the SOLE RIGHTS to soon administer a drug for OA once approved by the FDA and the EMA.  This is NOT just any drug....ask Sooly and a few other wonderful posters on here at HC PAR about it, they can tell you the hard evidence from the front line. Actually a quick shout-out to Happell, time for another update on your situation if you can...This is the first drug that is a DMOAD, yes that's DISEASE MODIFYING OSTEOARTHRITIS DRUG.  It not only works, it is safe. (my views)....   You are a part owner of this drug.



THE JOURNEY

Back in 2017 I had to good fortune of doing Base Camp. I wasn't terribly fit at the time but  I built up very gradually and went from barely being able to do a 3 km jog to being able to do a 15 km jog  I also went from being out of breath after just 3 flights of stairs to being able to build up and climb a 200 story building stair climb over a number of weeks as part of my training. Mozz at Base Camp?  I can hardly believe I made it...13 days of gruel constant climbing battling thin air and cold...but I'm glad I did it...I'm the person that's lazy...I will only be motivated to do exercise if I have a goal to reach...random exercise is hard for me, in actual fact I only did it to keep up with my wife who is more easily motivated and set herself this challenge. I wasn't going to let her go alone and I certainly wasn't going to be  the one that was going to slow her down or give up while she went on, that was motivation enough for me!....in the same way my Investment goals are set in concrete, I'm fully focused and motivated in this domain...I'll research to beyond the Base Camp of heights when it comes to our investment in PAR.

  

  _{Actual pics from Mozz's phone of Base Camp and the surrounding areas...around 5300 M elevation.  Yes that's 5.3 Kms above sea level.}


I managed to make it successfully to Base camp, it was a great challenge and wasn't easy but it was the preparation that helped no end. In the same way, it's preparation before tackling any sport, or for that matter, investment plan, that can really assist you to know what to do and when as our shares rise and fall.  Like sports, it depends on your goals and usually it's a good idea to have a mentor or someone that you can sound off.  Such sporting achievements aren't just physical, a lot of it is in the mind... and you know what?  I reckon PAR is doing their own Trek right now and for the next couple of years.  It will be hard at times, it will be a lot of work...odd hours, little sleep...but the rewards?  World changing.


I'll BE BACK

Not known for his Baseball or Basketball prowess, he was an athlete of sorts via his weight-lifting endeavours.  While perhaps not everyone's hero, I did enjoy Arnie's biography, Total Recall.  There were quite a few lessons (as well as mistakes he made) with one of them being the state of mind you need to accomplish what may seem impossibly hard.  Winning at sports, climbing a mountain and perhaps passing a Phase III trial is not just how physically fit and capable you are...it's also a game of strategy and mental aptitude.  You need to be in the right frame of mind.  Ask any footy player...ask any basketball player...One of Arnie's quotes in general (not from the book) is this one:

6 rules to success
1. Trust yourself;
2. Break some rules;
3. Don't be afraid to fail;
4. Ignore the naysayers;
5. Work like hell;
6. Give something back.

― Arnold Schwarzenegger


Look at how we can relate this to our holdings...

1. We have to trust ourselves, we may not always be right (cure everyone on the planet, pass every trial [Hay Fever]) but add up the individual parts and I'm sure you'd agree with have something compelling here in PAR

2.  Break some rules - Yes I have....one of those is my rough percentages I like to hold for any given investment...you need to take some sort of risk to make some sort of decent profit. (Not advice)

3.  We have failed...PAR didn't make it across the line in their HayFever Trial 2 (there is more to come on this ..my views).....we sort of failed from $4.50 right back down to a low of $1.08.  Yes these were mainly forces out of our control...but it is not the end of the world and fundamentally nothing had changed in the PAR realm.  Yes I was nervous once we fell below $2...but I held....and will continue to do so.  Not blindly, my eyes and ears are open...but we have researched, we have read...we are confident.

4.  Well there have been a few....ignore ignore ignore...Rusty? Do you agree? Long term for sure..maybe traders can make a buck on the way up..not me..I hold.

5. Arnie worked, trust me..read the book...reps...reps...reps.....Mozz researching is fun...yes there are other things I could be doing...I won't say it is a sacrifice as it is an enjoyable labour of love.  I do my best to try and come up with balanced responses to your questions, to your opinions.  As I have said in the past, I may sound enthusiastic, I am...but I do also want to hear the other side..the negatives, and no, I won't get sick of new guys and their questions, ask away.  Sometimes there will be a gem of a thought or question here and there that we all haven't thought of.

6.  Yes, I like this mantra.  Don't be a hoarder all your life...give back something to the community...to the poor....to the ones suffering.  Yes it's easy to think WE are the hard working ones..we deserve all the gold from our labour...but giving results in even more pleasure.  What's the point of taking millions to the grave.  Enjoy some part of it and make a difference to someone else too along the way.Ok I'll get off my soap box now...



_{A good read...there was a fair bit I didn't know about him...}





CONCLUSION

Yes there are many sports that can result in OA and it may not just affect you when you are old. More than the rigorous nature of competitive sports, it is the injuries you need to be careful of.  It is the injuries that can lead to OA. A lot of injuries are sustained during peak youth age...There are ways to mitigate such injuries by stretching before and after any exercise session and building up slowly in any forms of physical activity.  Don't jump into exercise too rapidly if you have had a spell from it.  If you get injured certainly seek out the help of a professional that knows what they are doing.  Basketball and baseball are just a couple of sports and yes, the incidence of OA is prevalent in such sports.  There are many injuries that occur in the sporting world and iPPS is a certainty to address the large number of people that have OA.



DISCLAIMERS

I'm not a doc or sports medicine professional, seek advice before beginning any intensive activity or work-out or changing your activities markedly.  Spec views expressed here, no one knows the future, be ready for anything, don't over-commit on any single investment.Do your own research is always best policy, I know not of your individual circumstances. Forward looking statements contained in this post.  Imagine, the only DMOAD all time in the world and we are the owners...compelling.





APPENDIX A

ATwist and Shout Song - The Beatles

Younger folk, yes it may seem daggy, they had no digital synthesisers and sophisticated mixers, lighting and computer graphics...yes in the old days they really had to walk down to their local record shop and hand over notes and coins to purchase a single song or an album.But you gotta remember just how many of these songs were finally sold and how popular they were back then....actually forget then...even today.

Did you know there is an estimated 300 million people that own Beatles songs/Albums?  Their music has been streamed some 1.7 Billion times and 30% of the streaming comes from those aged 18 to 24! ¹⁴

Note 1:  The below clip has had 35 million views
Note 2:  One day we may address a quarter of the Beatles fans by patient numbers...this day may only be some 5 or 6 years from now and the revenue involved will be incredible. My views.



_{Yeah sure, they were singing about the dance move, I meant twisting a joint and then shouting in pain!}  



REFERENCES

1]   https://www.richmondrehab.com.au/blog/physiotherapy/knees-in-netball
2]   https://www.ashcroftsurgery.co.uk/pils/good-and-bad-sports/
3]   https://ses.library.usyd.edu.au/bitstream/handle/2123/9957/23.pdf?sequence=3&isAllowed=y
4]   https://www.healthline.com/health/osteitis-pubis
5]   https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3538894/
6]   http://www.acsep.org.au/content/Document/2017%20conf%20preso's/updated%202017%20presentations/Silvia%20Manzanero%20-%20Developing%20a%20population-wide%20system%20for%20the%20longitudinal%20serveillance%20of%20musculoskeletal%20health%20in%20netball%20participants.pdf
7]   https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5488840/
8]   https://www.tuftsmedicalcenter.org/patient-care-services/departments-and-services/rheumatology/research-clinical-trials/center-for-osteoarthritis-research
9]   https://www.researchgate.net/publication/261067788_The_individual_and_socioeconomic_impact_of_osteoarthritis
10]  https://www.nytimes.com/2017/08/14/well/when-sports-injuries-lead-to-arthritis-in-joints.html
11]  https://lermagazine.com/cover_story/future-shock-youth-sports-and-osteoarthritis-risk
12]  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2920533/
13]  Metabolic Therapies in Orthopedics, Second Edition 2nd Edition. Ingrid Kohlstadt
14]  https://www.cnbc.com/2019/10/26/the-beatles-remain-a-pop-culture-phenomenon-even-among-gen-z-fans.html