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A Peril of Headbanging and Bungee Jumping

Whereas knee ligament injuries mostly occur when the person is upended while on foot, or maybe skis, another one commonly occurs while sitting. The colloquial name is “whiplash,” but it is best called the far less dramatic “cervical acceleration-deceleration injury.” This term describes the injury mechanism and doesn’t evoke the strong imagery of cracking a whip. CAD injuries were originally called “railway spines” because the earliest injuries occurred in train wrecks. It also occurs with headbanging among heavy metal musicians and with bungee jumping, even rollercoasters.

A car crash, however, is the common scenario. Vehicle (Car A) is sitting at a stoplight and gets struck from behind by Car B, causing Car A to suddenly accelerate and throwing the head of its driver back. Car A gets pitched forward and strikes the car in front of it, causing Car A to rapidly decelerate and jerking its driver’s head forward.

CAD injuries are among the most common disorders of the neck and yet are poorly understood. The severity of the acceleration and deceleration does not seem to correlate with the level of symptoms, most of which go away in a few days. It seems ironic, however, that at many major urban intersections, I can look up and see a billboard with ‘INJURY?’ in large letters followed by an area code 800 phone number.

An interesting article helps put CADs into perspective.[i] Investigators recruited 51 volunteers to undergo a low-speed “collision” where the car in which they were sitting was ‘rear-ended.’ Prior to the “collision,” each subject received a personality-profile psychological evaluation. Then each volunteer sat in a car with the rear window screened off. I say “collision,” because the rear end of their car was dropped a short distance as the car behind them moved forward, but it did not touch the subject’s car. Sounds of metal clashing and glass breaking heightened the authenticity of the event, and the subjects were shown broken taillights after the “crash.” Immediately after the placebo crash, nine subjects had neck symptoms. Three days later, 10 did. After four weeks, three still associated symptoms with the event. Subjects with complaints had significantly higher scores for psychosomatic disorders and emotional instability. Add to that, other studies have shown that the availability of medical care and the possibility of compensation are related to the frequency with which this injury seems to occur.

Based on the recognition that knee, finger, and ankle ligament injuries heal faster with early motion, current advice for treating a CAD injuries generally includes oral non-steroidal anti-inflammatory medications for pain relief, hot showers to relax tight muscles, and early discontinuance of a soft collar to allow rapid recovery of flexibility. As with a lot of other sprains, early recovery of motion is key to prompt and complete recovery.

As a preventative measure, it is important to adjust the headrests so that the tops are even with the tops of the ears for all occupants and the gap between the backs of everybody’s heads and the rests is not more than a couple of inches.

[i] Castro, W. H., S. J. Meyer, M. E. Becke, et al. 2001. “No Stress—No Whiplash” Prevalence of “Whiplash” Symptoms Following Exposure to a Placebo Rear-end Collision.” International Journal of Legal Medicine 114(6): 316-22

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Would you like to have a surgical procedure named after you?

Tommy John was an extremely successful Major League pitcher whose career spanned from 1963 to 1989. He was a four-time MLB All Star; and among baseball’s all-time leaders, he is 8th in games started and 26th in both wins and shutouts.

Yet after his stats and awards are eclipsed and forgotten, his name will live on because of what happened to his pitching elbow and the treatment he received. It changed the entire game. To my knowledge, Tommy John is the only patient to have a surgical procedure named after him—a form of immortality, I suppose, at least in the baseball world. (Another baseball great, Lou Gehrig, famously developed a deadly disease, which carries his name.)  

About 11 years into John’s Major League career, John ripped his elbow’s supporting (collateral) ligament on the side closest to his trunk. This is the ”ulnar side” in ortho speak. He said that it felt like his throwing arm was flying out over second base as the rest of his body continued its momentum toward the plate.

After a month of rest and rehab, he still couldn’t pitch effectively and so underwent an entirely untested ulnar collateral ligament reconstruction. His surgeon gave him a one-in-a-hundred chance that he would ever pitch again. Those were terrible odds, but the only alternative was to quit baseball.

His surgeon took a tendon from John’s opposite forearm, the one that 15% of people are naturally missing. The surgeon drilled bone holes on both sides of John’s elbow and laced the graft in figure-of-eight fashion to substitute for the failed ligament. John rehabbed for over a year and then returned to the Dodger’s starting lineup and pitched multiple shutouts and 20-game winning seasons over the rest of his career.

Aware of the success of John’s surgery, pitchers started gripping the ball tighter to make it spin faster and throwing harder over more innings with fewer rest days. They knew that if they tore their elbow ligament, they could have the “Tommy John procedure.” For MLB pitchers active in 2023, over a third of them had received this procedure at some time in their career. Some experts speculate that the recently instituted pitch clock, designed to speed up a baseball game, allows less recovery between pitches and contributes to the problem. If so, we are going to see more elbow injuries.

These are not sudden injuries to strong, healthy ligaments like what can happen to ones in fingers and ankles. Rather they are wear-and-tear issues that finally surface with a pop, like ACL tears. And they are not restricted solely to the pros.

Little Leaguers and high school pitchers are playing year-round; and naturally they emulate the Major Leaguers by trying to put more spin and more heat on their throws. For training, weighted baseballs ranging up to 70 ounces (half the weight of a woman’s shot put) are readily available on the internet, whereas a regulation baseball weights about five ounces. Additionally, dads may be behind home plate with radar guns hoping that a future Major League contract will put the whole family on easy street. Finally, the progressively overwhelmed ligament snaps. On examination, the joint may not gap open perceptibly when moderately stressed by an examiner, but it apparently opens up sufficiently while accelerating a baseball to 90 or 100 miles an hour to cause pain and momentary instability.

After a year of rehab, the surgery returns most pitchers to the mound, but some hurlers reinjure their elbow and require a second operation. There are even several who have had three reconstructions. At some point, they will run out of donor tendons to use for graft material. In anticipation of such a shortage, some surgeons are now reinforcing the reconstructions with strong, nonabsorbable suture material. As with other ligament reconstructions, doing so makes the reconstruction stronger early after surgery, but it may shield the transferred cells from performing at their best and strengthening the stabilization on their own. Time will tell.

Can you imagine that if this trend continues, a baseball rule change would be in order? “Any pitch over 88 MPH is called a ball whether or not it is in the strike zone.” It could be called the Tommy John rule.

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What do Tom Brady’s, Tiger Wood’s, and Fido’s knees have in common?

My previous two blog posts (Part 1, Part 2) describe vexatious tears of the anterior cruciate ligaments in athletes, but humans are not alone in sustaining injuries to this critical knee ligament.

The knees of dogs, horses, cattle, and other quadrupeds are called stifles. To add to terminology confusion, our ACL is their cranial cruciate ligament. Regardless of the name, the CCL can tear in quadrupeds just as the ACL can in bipedal humans. We don’t think about cattle running and jumping much, but bulls risk the integrity of their CCLs when servicing cows, and cows in heat risk theirs the same way when riding other cattle. A bovine slipping sideways while standing on its hind legs immensely stresses its stifle, which can cause the CCL to tear. (Gary Larson’s cattle and deer are always standing up. No telling how many of them have CCL injuries.)  

A CCL tear is the most common cause of lameness in dogs and, left unattended, results in the joint not tracking properly, thereby grinding the cartilage off the bone surfaces and leading to osteoarthritis. Large breeds are particularly susceptible, as are overweight and older dogs of any size. In younger ones, an acute injury from suddenly changing direction or jumping down from an elevation can be causative, which puts agility and disc competitors at particular risk.

For older canines, CCL tears more often result from accumulated degeneration. Dogs of any age are susceptible to the “weekend warrior syndrome,” where their muscles and ligaments become deconditioned while their owners are working and then overstressed when their owners finally have time to play.

A tear causes the dog to avoid weight bearing on that leg. Nonoperative management depends on the owner’s preference and the pet’s age, activity level, and general health.

In general, dogs undergoing surgical correction and followed by weight loss if necessary, nonsteroidal anti-inflammatory medications, and a specific rehabilitation protocol do better. Compared to humans, however, dogs are disinclined to use crutches or perform hamstring and core strengthening exercises, so the surgery must provide a limb that is immediately stable for weight bearing. Hence, there are work arounds to substitute for the function of the CCL rather than replacing it.

Barclay Slocum, a veterinarian in Oregon, developed the tibial plateau leveling osteotomy (osteo = bone, otomy = cut). The TPLO rotates the tibia’s joint surface so that it is nearly perpendicular to the bone’s shaft. This shift prevents the femur from sliding forward on the tibia, which provides the same function as an intact CCL. Slocum fixed the cut in the bone securely with a steel plate and screws.

This allowed the dog to begin weight bearing immediately, which minimized deconditioning of all its muscles and ligaments. When Slocum saw that his technically demanding procedure was successful, he did something unusual in veterinary and medical practice. He patented the procedure, and his reports at meetings and in journal publications were short on technical details. Rather he taught the procedure out of his veterinary practice and required signed contracts from his learners that they would not teach the surgical details to others. This approach did not sit well with many veterinarians, but Slocum had a point. Whereas he was achieving excellent results, inexperienced and headstrong surgeons might struggle with the operation, not attend to details, have unsatisfactory outcomes, and give the TPLO a bad name.

An alternative procedure to the TPLO is the tibial tubercle advancement procedure. If you feel your kneecap and begin sliding your fingers toward your ankle, you first encounter the tough, springy patellar ligament and then an inch farther on the hard prominence where it attaches. That bump on the shin bone is your tibial tuberosity, and the TTA moves it forward, which changes the quadriceps’ direction of pull and prevents the tibia from sliding forward on the femur, even in face of a deficient CCL. (The three Swiss orthopedic veterinarians who developed the procedure may have done so in response to Slocum’s closely held TPLO.)

 The TTA moves the tibial tubercle away from the tibia except at the bottom edge, where the tubercle is hinged forward and a titanium wedge and fixation hardware secure its new position. As with the TPLO, the TTA allows for some early, limited weight bearing.

Neither the TPLO nor the TTA has distinct outcome advantages over the other, and the choice of procedure may depend on the veterinarian’s personal experience. Both procedures benefit from a graded post-operative rehabilitation program, which can include underwater walking on a treadmill. There are some endearing videoclips on YouTube of contented pooches striding along chest deep in a tub of water. Who supervises such therapy? Either a vet, nurse, or technician who is certified in canine rehabilitation.

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What Tom Brady’s and Tiger Wood’s knees have in common. Part II

Somebody as far back as 1900 tried suturing torn anterior cruciate ligaments back together, but that was unsuccessful because of its poor capacity to heal. Next, surgeons tried all sorts of artificial substitutes, silver wire and silk cord among them, but they all stretched out, frayed away, or caused the body to reject them. Somebody even tried using a kangaroo tendon; and now, for older, less athletic people, human cadaver tendon grafts are available. That collagen-dense material is treated to avoid any infectious or immunity issues, but it is not as strong as a tendon borrowed from somewhere in the patient’s own body. The difficulty is that there are few areas where a sufficiently long and thick strip of tendon can be harvested without leaving a problematic donor site. The two current mainstays are a tendon from either the front of the knee or the back.

On the front, the surgeon may take strip of the dense tendon that attaches the kneecap to the tibia. It includes a chunk of bone on each end and is harvested through an incision running down the front of the knee. Then using small stab incisions, an arthroscope, drill bits, and graspers, the surgeon can see inside well enough inside the knee joint to drill holes in femur and tibia and fix the graft in place. (If you are curious, have a look at the procedure on YouTube.) The blocks of bone on each end help the graft heal faster.

The other graft that is frequently used is part of a hamstring tendon from just behind the knee. It is palpable when you are sitting in a chair with your feet pressed firmly on the floor. By trying to pull your foot under the chair, the hamstring muscles contract and tent the skin behind the knee like banjo strings. The incision to harvest a hamstring tendon graft is on the back side of the knee, so the scar is mostly invisible; but the absence of one of these three muscles may result in considerable weakness and put the knee at risk for another ACL injury. So unless the patient is a wrestler or plumber who would object to tenderness just below their kneecap, the bone-tendon-bone graft from the front is usually the chosen donor.

In a newer and incompletely vetted procedure, the surgeon leaves the torn ends of the ACL in place and spans the gap with a plug of bovine-derived collagen mesh. It is injected with the patient’s own blood, which supplies the plug with some of the same growth stimulants that are present in platelet rich plasma.

One potential benefit of this procedure is that it preserves specialized nerve endings residing in the ACL remnants. They are critical for providing position sense. So even though people with torn ACLs might not be all that unstable walking on level ground, they have a sense of their knee giving way most any time because their sensory receptors are not doing what sensory receptors do–receiving mechanical clues and sending them to the brain so that it knows the  levels of stress that the knee is experiencing.

This is potentially a great advantage of using a blood-infused collagen plug–it saves the native sensory receptors. By contrast, for the reconstructions using tendon grafts, the ACL remnants and their imbedded sensory receptors are trimmed out before the graft is placed. Position sense suffers.

Even in the face of a successful ACL repair or replacement, 10-90% of people have some degree of wear-and-tear arthritis 10-20 years later. Despite a successful operation, the joint never glides as precisely as before, so its cartilage surfaces slowly get ground away, sort of like driving a car with the front wheels misaligned–bad for tread wear. Compared to an ACL replacement, it is too soon to know whether an ACL repair will better protect the joint surfaces and offer better position sense with preservation of the sensory receptors.

Rehabilitation after ACL surgery is long and arduous, and the devotion that typically drives elite athletes to succeed is a boon to their recovery. Within a few days after surgery, all the muscles and ligaments in the limb benefit from being moved and mildly stressed to preclude deterioration. A graded strengthening and endurance program extends over at least eight months before the person should try unrestricted activity.

Several tests indicate whether the rehab is complete. The first is known as the timed six-meter (about 20 feet) hop test, first on the recovering leg, then on the sound one. The next is to see how far forward one can get by hopping on one leg and then demonstrating the ability to hop from side to side back and forth over a line on the floor. Try them yourself with your presumably intact ACLs. I did and was pleased that I didn’t fall over.

One last caution for recreational skiers. ACL injuries are more likely with increasing age, icy or new snow conditions, low temperature, and—get this—easy slopes, which is understandable for beginners; but carelessness and higher speeds may account for experienced skiers to catch an edge when they least expect it.

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What do Tom Brady’s and Tiger Wood’s knees have in common? Part I

Inside the knee, the anterior and posterior cruciate ligaments are positioned to prevent the tibia (shin bone) from shifting forward and backward, respectively, on the femur (thigh bone). These two interior ligaments along with the collateral ligaments spanning the outside of the joint allow the knee to bend through a 120-150-degree arc of motion while keeping the tibia firmly aligned on the end of the femur. The ACL is the more important of the two and is angled from the back side of the femur to the front edge of the tibia. It keeps the tibia from shifting forward. A rough analogy of its function is to imagine that the femur is a kitchen counter and the tibia is a drawer underneath. The ACL keeps the draw from sliding forward too far. Absent the ACL, the drawer flies out. Chaos ensues.

ACL tears draw greater attention from the people injured, their surgeons, investigators, news media, and the public than all other ligament injuries combined. Out of 900 ligaments in the body, why the ACL? The multiple reasons include the fact that an ACL injury can occur in a high-profile athlete, where it is wincingly reviewable on YouTube and sidelines the star for at least eight months, if not permanently. Soccer standout Megan Rapinoe tore her left ACL in college, had it reconstructed, and returned the next season only to tear it again. Eight years later, the one in her right knee gave way. That is not unusual. Research confirms that nearly a third of people with one ACL tear get another one, in that leg or the opposite, within two years after their first. That should make athletes, team owners, fans, and journalists nervous. Notable athletes who have so far escaped with just one ACL injury include footballer Tom Brady, skier Lindsey Vaughn, golfer Tiger Woods, soccer star Neymar, and basketball great Kawhi Leonard. For pro athletes and their team owners, the ACL is big money. The injury also occurs in high school and college athletes.

When the injury comes to attention, it is a grade III (complete, serious) ligament tear, which destabilizes the tibia on the femur and prevents the sharp turns and sudden stops that are integral to many sports maneuvers. Usually these sudden disruptions do not occur in an entirely normal ligament. It is likely that there has been fraying and degeneration for months, but the dramatic snap of the ACL giving way is the first sign of trouble.

Another reason attention is focused on the ACL is because if investigators and surgeons can solve the ACL problem, then restoration of any other ligament would be easy by comparison. Here’s the reason. Inside the joint the ACL has a paltry blood supply, even moreso than most ligaments. Without much nourishment, its potential for healing is virtually nonexistent. When chronic fraying precedes the fateful snap, the collagen fibers are completely disorganized, which compounds the repair problem.

ACL ruptures often result from sharp twisting and sudden starting and stopping maneuvers. For example, in basketball these injuries are more common in players who like to weave through the defense for layups. Several football players have surprised themselves with this injury stemming from a victory dance. Conversely, direct hits on the knee account for a minor percentage of ACL tears. They used to be common in football, but less so following a rule change that outlawed blocking from behind and below the waist.

ACL injuries are two to nine times more common in young women than men. Several factors seem to contribute. Women’s soccer shoes used to be just pink versions of men’s without any thought whether they fit a woman’s foot or if the cleats were too long for their weight. That has changed. What hasn’t changed is varying levels of estrogen through a woman’s menstrual cycle, peaking at the time near ovulation. The hormone weakens collagen, and there seems to be a correlation between ACL tears and where women are in their menstrual cycle. Also, women tend to jump differently than men and are more likely to land with their knee straighter and the foot pointing directly ahead, both of which stress the ACL. By contrast, ballet dancers, who are perpetually jumping and landing on one foot, are taught to “turnout” with their leg before landing. This aesthetically pleasing foot position seems to protect their ACL, which ballerinas rarely injure. So athletic trainers are helping female soccer players relearn how to jump and to strengthen the muscles that protect the ACL.

Regardless of sex, there is a debate whether knee injuries in soccer are more common on turf or grass. Most studies favor grass. (Several that favor turf were sponsored by turf manufacturers.) Artificial turf, especially when it is dry, tends to grab cleats more than grass does, which I learned when attending a Major League Soccer game at the Mercedes Stadium in Atlanta. No, I wasn’t playing. Rather Atlanta United was facing off against Inter Miami and their new superstar Lionel Messi. He didn’t show up. All we disappointed spectators learned later that his contract allows him to skip games that are played on artificial turf for risk of injury. I suppose in deference to the other players, the groundskeepers turned the sprinklers on the field for five minutes at half time, not to make it grow but to make it more forgiving on the players’ knees.

To be continued.

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What do ligaments look like, anyway?

Ligaments hardly get any respect. By comparison, bones in natural history museums and on X-rays are fascinating. We can also marvel at dissembled ones on otherwise empty dinner plates. Muscles, too, get their due. Since they are just under the skin, we have a sense of their shape, can feel them contact and relax, and note the effects of conditioning and overexertion. Artists have sculpted bulging muscles in bronze and stone figures for thousands of years as expressions of might. Nobody has ever done the same for ligaments.

Without ligaments, however, each of us would be a bag of bones and muscles flopping about without achievement. Consider too that muscle and bone together constitute over half of our body’s weight. Ligaments, by contrast, would hardly tip the scale at all. In spite of their importance, most people (surgeons, meat cutters, and hunters excepted) have never seen a ligament in its natural state, partly because others have fewer opportunities and are less inclined to be poking around, and heating ligaments in the kitchen turns them to mush.

For clarification, ligaments are the tough, fibrous bands that connect bones together. In humans, except for three that run the length of the spine, none are longer than several inches, and many are much shorter. Only occasionally are they thicker than a shoestring, and in the fingers, they are about that wide, whereas at the hip and knee they are much wider and thicker. The gaps that ligaments span between bones are, of course, joints, and ligaments control each joint’s motion.

Ligaments resist stretch and appear microscopically much like tendons; and both, aptly described as connective tissues, cross joints. The elemental difference between the two is that ligaments connect bones together whereas tendons join muscles to bones.

To enhance your appreciation of ligaments, I dissected a fresh chicken. Your ligaments look identical, just larger.

The asterisk identifies the strong ligament on the side of the elbow closest to the trunk–the medial collateral ligament. It resists side-to-side deviation of the elbow and is the cause of many baseball pitchers’ disability. (I will discuss this ailment and its treatment later.)

The asterisks mark the cruciate ligaments, which are located inside the knee. The smaller asterisk identifies the anterior cruciate ligament (ACL), which is prone to tear with twisting injuries. (Details later.)

This vexation also affects dogs. I am not certain about chickens.

Status of book, Ligaments, Appreciating the Bands That Bind Us

February, 2024: Publishing agreement signed with Johns Hopkins University Press

February, 2025: Completed manuscript submitted to JHUP. JHUP sends manuscript out for peer review.

April 4, 2025: Both peer reviews entirely favorable. Several images modified to improve clarity, returned to JHUP April 5, 2025 for the book to “go into production.”

Launch date anticipated for early 2026. Stay tuned for details.

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Contortionism, Part III

I thought I was finished after Parts I and II, but then a former UCLA orthopedic surgery resident who is a spine specialist in Las Vegas sent me an intriguing journal article. A group of radiologists he knows obtained MRIs on five contortionists from a Mongolian circus school. The performers ranged in age from 20 to 49. The investigators used an “open” MRI machine, which is routinely used for individuals who are claustrophobic or too large to fit into the conventional tube-like “closed” machine. This allowed them to obtain images while the performers were in their extreme spinal positions, either bending backward or forward.

The MRIs showed that the extreme flexibility required for a performer to bend forward and put their shoulders between their knees or even behind them comes from extreme flexibility in their hips. The radiologists noted that the performers seemed comfortable in this position for long periods of time.

Going the other way, the flexibility required for a contortionist to lean backwards and touch the back of their head to their buttocks comes from flexibility in their neck and in their lower back. These performers can only hold this position for a few minutes before experiencing back pain.

Before you consider trying these postures, understand that the MRI studies also showed chip fractures off the edges of the vertebral bodies of the backbenders. The ligaments under extreme tension pulled off bits of bone rather than elongating. The older the performer was, the more spinal segments showed these injuries.

I obtained the two photos shown here from wikimedia.org -> contortionism, where many more are archived if you are interested. The first one here was taken by Eadweard Muybridge (1830-1904). You have probably seen his “electro-photographic investigation of consecutive phases” of a running horse. (Funded by industrialist and horse breeder Leland Stanford.) Those photos proved for the first time that there are phases during a gallop when all four of a horse’s feet are off the ground at the same time. Muybridge became fascinated by the technique and used it to photograph a wide range of other animals’ gait patterns, testimony to the durability and versatility of ligaments across the animal kingdom.

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Contortionism, Part II

In my previous post, I began to describe my experience of first observing a “Flexibility 101” group lesson at the Cirque School and then a week later taking a private lesson.

After the group lesson was over, I asked several students what motivated them to contort. One, in her thirties, said that as a teenager she had been a gymnast and liked stretching again because it felt good and was more intense than yoga or Pilates. Another said that she was a pole dancer and that the class helped her keep in shape. My instructor related that she performs at private events and that her other students include ice skaters, gymnasts, and dancers. Both my instructor and the owner said that once the desired degree of flexibility is achieved it is alright to take a week off now and then without loss of bendiness. I was also impressed with how strong these people are, defying gravity with their bodies cantilevered in various unlikely positions. My instructor said that contortionists do not pump iron or need to but just gain strength by supporting their own weight in various positions. Also, stiffness with increasing age is not a given, and there are contortionists in their 60’s who still perform. It seems that the mantra “use it or lose it” holds here.  (A confirmatory note: I have seen elderly people in Asian countries resting with apparent comfort in a full squat position—buttocks on heels, feet flat on the ground, waiting for a bus or chatting in the market.  They have been doing it their whole life, including going to the bathroom without the aid of a raised Western-style toilet.)

Contortion originated in the Far East about 1000 BCE when Buddhist dances incorporated movements of great flexibility. It has become a symbol of national pride among Mongolian nomads and simulates the patterns of their fine arts. Bendy people in other cultures have followed, and some of their achievements are preserved on clay or in clay.

The most difficult pose in contortion is named for H. B. Marinelli (1864-1924). Beginning when he was seven, he was billed as “The Boneless Wonder.” With his teeth he gripped a mouthpiece fixed two feet off the ground and then hyperextended his back until his buttocks contacted the back of his head with his feet extended out in front.

Mongolian contortionists have extended this amazing feat of strength and flexibility by having a second contortionist performs a handstand on top of the one in the Marinelli bend—all supported through just the bender’s jaw and neck—a double Marinelli bend. At least once, and confirmed on a YouTube video, contortionists have achieved a triple Marinelli bend. Equally astounding, another video shows a single Marinelli bender, but she holds this pose for over four minutes—a Guinness World Record. I’d try a Marinelli bend but my dentist advises otherwise.

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Contortionism, Part I

It has been almost a year since I have reported on muscles and bones. That is because I have been working hard on a related topic that binds the musculoskeletal system together–ligaments. In their classic form ligaments span from bone to bone and allow joints to move in some directions and not in others, akin to hinge pins in the built world.

The manuscript is now at the publisher. Whew. As part of doing research for the book, I decided to “walk the walk” and give my ligaments a workout by taking a contortion lesson. Contortion is the performance art where extremely limber individuals showcase their flexibility in a choreographed set of moves and poses, often to music and while smiling continuously. For example, Cirque du Soleil features contortionists who dazzle audiences with their seemingly impossible postures, sometimes braced on just their hands, and then perhaps supporting one or more other performers on top of them. Some of the artists can also knot themselves up so that it is nearly impossible to describe how their various joints are positioned to achieve the pose.

A quick internet search provided the ten best contortion training facilities in Los Angeles, and I chose the Cirque School in Hollywood. Their website indicated that their performance-art classes included flexibility, handstands, trapeze, as well as aerial sessions for hoop, straps, rope, and fabric. Their website also had words of encouragement. “For anybody with any body.” That convinced me. After observing their Flexibility 101 class one evening, a week later I took a private lesson with the same instructor. Both times, other classes were going on in this large warehouse, which except for the entry area, was completely decked in thick squishy mats. Ropes, trapezes, and large rings dangled from the rafters. All the other students, predominately but not entirely women, were decades younger than me. To my surprise, not everyone was wiry; some approached stocky. (I consider myself in between.) I talked briefly to several students after class, to my instructor at length during my private session, and later to the owner, who formerly performed in the Cirque du Soleil. Here is what I learned.

Most contortionists discovered at an early age that they had some joints, particularly spine and hips, that were particularly “bendy.” (At age four, one famous contortionist could jump off the top of a bunk bed and land in a full split. Yow!) With the discovery of their unusual flexibility, they accentuate it by stretching daily for at least several hours. Contortionists generally are either “back benders” who can lean over backward and put their head between their knees or “front benders” who can lean forward and put their head between their ankles. However, that degree of suppleness in the spine ligaments in both directions is unusual. Hip flexibility is gained and maintained by prolonged positioning in a split-leg posture and performing “oversplits,” where the performer’s heels rest on two chairs with the body otherwise unsupported. It is not supposed to hurt, and apparently it does not, because I have seen people in that position blithely studying their cellphones or fingernails while the collagen in their ligaments is remodeling.

For me, even approaching 50% of a split position on the mat was what I describe as “sweet agony,” almost intolerable. My instructor said that it takes a month or two of regular work to stretch the muscles and keep them from reactively contracting and resisting the stretch. Then over the following months, the ligaments will begin to respond. During my hour-long session, I think I stretched every joint in my body except for my jaw and some toes—far deeper stretches than I have ever attempted or achieved in yoga or Pilates. I was perspiring at the end of my flexibility session, felt great for the rest of the evening, and, much to my relief, was not sore the next day. I continue to do some of the stretches, but I have no plans to run off and join the circus.

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Random Attractions Just Inside LA City Limits

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Travel Town in Griffith Park is mostly about historic railroad locomotives and rolling stock but also displays trucks, autos, and wagons, both circus and milk. Ride the miniature railroad to survey the exhibits. Walk close to the massive beasts. Learn the differences between a 4-8-8-4 & a 4-4-0.

S. Korea gifted a huge, 17-ton, bronze bell to the US to commemorate America’s 200th birthday. It resides in a pagoda-like pavilion on a grassy knoll overlooking LA harbor with Catalina Island not far away. On special days, the bell sounds its deep tone when struck with a log.

SQRD Lab ensures that legit weed is free from heavy metals, pesticides, bacteria, fungus & other yuckies. The lab samples every 50 pounds of leaves, gummies & brownies. Such tested & certified weed is likely only 20-30% of marijuana sold in CA. Health risks of illegal dope? ???

An old military barrack in San Pedro houses the Belmont Shores Model Railroad Club. The layout is 25×90′ The main line is a scale 20 mi. Members bring their engines & rolling stock to run through the wilderness, rural & urban scenes reflecting the ’40s & 50s. Awesome details. Fun.

The Marine Mammal Care Center, San Pedro, takes in malnourished, entangled, ill, & injured sea lions & seals, returns them to health, then tags & releases them. Current guest list & #s: elephant seals 29, harbor seals 2, sea lions 48. Sea lions can walk on land & bark. Seals can’t.

Moon jellies. Cabrillo Marine Aquarium, San Pedro. They are 90% water & wax & wane in size from 1-12″ according to food availability. All 7 species of sea turtles eat them, & they are the sole source for leatherbacks, weighing up to 2000 lbs. Fortunately, moon jellies are common.

Platinum Props on Rosecrans Ave. has something for everyone, especially if planning a birthday party, high school prom, wedding, or business event. Need a full-scale giraffe, robot, British phone booth, ninja turtle, Spiderman, gas pump, triceratops, nutcracker soldier, 6′ Oscar?

Over 100 displaced, rescued, & zoo-born wild animals call the Wildlife Learning Center, Sylmar CA, home. These include a sloth, bald eagle, blue & red macaws, porcupines, marmosets. Private interactive tours allow close-ups with a hedgehog, armadillo, others. I fed the giraffe.

Well-known recreational activities in Griffith Park include golf, tennis, hiking, horseback riding, star gazing, concert going and picnicking. Less well-known historical elements: a seminal moment for Babe Ruth, internment for WWII prisoners, and the old zoo that closed in 1965.

Griffith Park, a 7 sq. mi. urban jewel, offers golf, tennis, zoo, observatory, train rides, Holllywood sign, amphitheater, museum, picnic areas, old landfill, and remarkably, wilderness hiking trails where one can lose all sense of civilization, maybe even spot a mountain lion.

Kindred Spirits Care Farm joins rescued animals, at-risk people & sustainable farming. All benefit. The animals’ success stories can inspire people who have experienced abuse, abandonment or neglect themselves. Also, learning to grow food aids body, mind & spirit. Open Sundays.

Hiram Sims, poet & educator, owns Sims Library of Poetry, which contains 10,000 volumes, 3 by Sims. Hiram’s interest in poetry began in middle school. A poem he wrote softened a girl’s heart sufficiently that she went with him for 2 weeks. Powerful words. Readings most Saturdays.

JB Nethercutt prospered after going into business with his aunt, who founded Merle Norman Cosmetics. His collection of 130 perfectly restored and fully operative cars, often winners of Best in Show awards, is on display in Sylmar. It’s a duesy. It’s free.

Surprise! Ethiopian food in horse country at N end of San Fernando Valley! Along with American & Mexican hearty breakfast/lunch fare, two Ethiopian/American sisters also serve traditional food & injera flatbread with spices & teff flour imported from their native country. Worth a trip. Vegetarian plate with lentils, chickpeas, yellow peas, red beets, cabbage, and collard greens on injera flat bread, made from teff flour..

Inside a huge warehouse in Sylmar, Mb2 Raceway offers electric go-karting. Don a helmet, strap yourself in and fantasize Formula 1. Sitting inches off the track, the speed seems insane. The G-forces shout “spinout inevitable,” but it never happens. My best lap time: 27 secs. What’s yours?

A natural spring behind University High School in West LA was the site of a Tongva village from 5000 BCE. From his ship in 1769, Spanish explorer Portola saw smoke from the village and visited. Friendly terms slowly decayed. Tongva descendants maintain this sacred site today.

Discovery Cube is billed as a children’s museum, but adults have a great time too. Highly interactive learning. Make giant smoke rings. Sort recyclables against time. Play goalie & block shots. Hoist yourself with a block & tackle. Shop for healthy groceries & get scored. FUN!

In I-210’s shadow in Lake View Terrace, LA Succulents’ huge greenhouse nurtures an amazing array of spiny plants. The owner started w/ patio hobby cacti, quit his day job, now in big-time business. Ships widely, but only to SW in winter since plants are cold intolerant. Stop by!

Tujunga, at Mt. Lukens’ base, was remote from LA in the early 1900’s. Residential architecture was eclectic in the absence of building codes. Abundant local stone led to self-made homes popping up overnight. Despite earthquakes, some remain. Other wild styles coexist.

The first segment of my 342-mile walk around the city limits of Los Angeles is hiking down to “civilization” from the top of Mt. Lukens (5075′ high), which is in the far NE corner of the San Fernando Valley. In the far distance, San Pedro and the Pacific Ocean are faintly visible about 35 miles away as the crow flies, but about 160 miles away as my feet walk.