A Complete Treatment and Management Plan for Groin Strain

The following is a very thorough and detailed management plan for the full recovery and rehabilitation of a groin strain.

Considering this management plan was written over ten years ago, my only addition would be the reduction of ice therapy and the addition of massage and heat therapy during the 2nd, 3rd, and 4th phase. Regardless of my suggestions, the following will be extremely useful for anyone who is, or has suffered from a groin strain.

Injury Situation:

A women varsity basketball player had a history of tightness in her groin. During a game she suddenly rotated her trunk while also stretching to the right side. There was a sudden sharp pain and a sense of "giving way" in the left side of the groin that caused the athlete to immediately stop play and limp to the sidelines.

Symptoms & Signs:

As the athlete described it to the athletic trainer, there was severe pain when rotating her trunk to the right and flexing her left hip. Inspection revealed the following:

• There was major point tenderness in the groin, especially in the region of the adductor magnus muscle.


• There was no pain during passive movement of the hip, but severe pain did occur during both active and resistive motion.


• When the groin and hip were tested for injury, the hip joint, illiopsoas, and rectus femoris muscles were ruled out as having been injured; however, when the athlete adducted the hip from a stretch position, it caused here extreme discomfort.

Management Plan:

This detailed management plan comes from one of my old university text books, called Modern Principles of Athletic Training by Daniel D. Arnheim. It's one of those 900 page door-stoppers, but it's the book I refer to most for information on sports injury prevention and rehabilitation. It's extremely detailed and a valuable resource for anyone who works in the health and fitness industry. So...

Based on the athletic trainer's inspection, with findings confirmed by the physician, it was determined that the athlete had sustained a second-degree strain of the groin, particularly to the adductor magnus muscle.

Phase 1

Management Phase: Goals: To control haemorrhage, pain and spasms. Estimated Length of Time (ELT): 2 to 3 days.

Therapy: Immediate Care: ICE-R (20 min) intermittently, six to eight times daily. The athlete wears a 6-inch elastic hip spica.

Exercise Rehabilitation: No Exercise - as complete rest as possible.

Phase 2

Management Phase: Goals: To reduce pain, spasm and restore full ability to contract without stretching the muscle. ELT: 4 to 6 days.

Therapy: Follow up care: Ice massage (1 min) three to four times daily. Bipolar muscle stimulation above and below pain site (7 min).

Exercise Rehabilitation: PNF for hip rehabilitation three to four times daily (beginning approx. 6 days after injury)

Optional: Jogging in chest level water (10 to 20 min) one or two times daily. Must be done within pain free limits. General body maintenance exercises are conducted three times a week as long as they do not aggravate the injury.

Phase 3

Management Phase: Goals: To reduce inflammation and return strength and flexibility.

Therapy: Muscle stimulation using the surge current at 7 or 8, depending on athlete's tolerance, together with ultrasound once daily and cold therapy in the form of ice massage or ice packs (7 min) followed by light exercise, two to three times daily.

Exercise Rehabilitation: PNF hip patterns two to three times daily following cold applications, progressing to progressive-resistance exercise using pulley, isokinetic, or free weight (10 reps, 3 sets) once daily.

Optional: Flutter kick swimming once daily.

General body maintenance exercises are conducted three times a week as long as they do not aggravate the injury.

Phase 4

Management Phase: Goals: To restore full power, endurance, speed and extensibility.

Therapy: If symptom free, precede exercise with ice massage (7 min) or ice pack.

Exercise Rehabilitation: Added to phase 3 program, jogging on flat course slowly progressing to a 3-mile run once daily and then progressing to figure-8s, starting with obstacles 10 feet apart and gradually shortening distance to 5 feet, at full speed.

Phase 5

Management Phase: Goals: To return to sport competition.

Exercise Rehabilitation: Athlete gradually returns to pre-competition exercise and a gradual return to competition while wearing a figure-8 elastic hip spica bandage for protection.

Criteria for Returning to Competitive Basketball:

1. As measured by an isokinetic dynamometer, the athlete's injured hip and groin should have equal strength to that of the uninjured hip.


2. Hip and groin has full range of motion.


3. The athlete is able to run figure-8s around obstacles set 5 feet apart at full speed.

Stretches and Exercises to Help With Hip Pain

Hip pain is one of the most persistent and painful which a runner can get. If it doesn't force you to stop running, it will surely slow you down. You can, however do the following stretches and exercises to help alleviate your hip pain.

Yoga pigeon - Lay one leg in front of you on the floor with your foot angled towards your pelvis. Put your other leg on the floor behind you with the top of the toes on the floor, and toes pointing directly behind you. While keeping your hips square to the floor, extend forward to stretch. Hold the position and relax for sixty seconds.

Hip hike - Stand sideways on step or curb with one foot off the ledge. Using only your hips, lift and lower the foot that is hanging off the ledge. Do ten reps to start with and build yourself up to thirty during the following weeks.

Side leg raise - Lie on your side with your legs and hips stacked. Keep your toes pointing toward the wall. Slowly raise your top leg as high as you can, keeping strict form all the way up and all the way down. Start with ten repetitions. Build to thirty repetitions during the following weeks.

Knee lean - Lunge forward and put your front leg at a ninety degree angle. Touch your back knee and shin to the floor, and drop your hips. Hold the position for ten seconds to start with. Build to thirty seconds during the following weeks.

The Many Uses of Lemon As a Health Supplement

The lemon is a hybrid citrus tree of cultivated origin. This fruit is used to make juice while its pulp and rind are meant for other uses. Citric acid makes up about 5% of lemon juice which has an acidic (sour) taste and a pH of about 2 or 3. Due to the acidity, lemon juice makes a readily available acid for use in high school chemistry laboratory experiments. Lemons thrive in tropical and sub-tropical climates but can not flourish in frost and extremely cold temperatures. They require an abundance of water but should be permitted to dry out between watering.

Lemon juice is normally sprinkled onto fish dishes because its acidity can neutralize the basicity of the amines found in fish thereby converting them an ammonium salt complex. Furthermore, lemon juice is widely used, in conjunction with other ingredients, when marinating meat before cooking. The citric acid can denature, or break down, the cadherin and cadhesin proteins that hold the meat's muscle fibers together. Therefore, use of lemon juice allows the meat to become tender. It is a myth that lemon juice makes a good antibiotic. In reality, lemon juice that is sprinkled on freshly cut fruit such as pears helps to prevent oxidation (or browning of fruit).

Some people choose to eat lemon as a fruit. By doing so, be sure to consume water afterwards to help wash the citric acid and sugar from the teeth. Failure to do so can promote a favorable environment for tooth decay and other diseases of the dentition. One hundred mL of lemon juice contain about 50 mg of vitamin C and 5 g of citric acid. In Ayurvedic medicine, it is believed that a cup of hot water with lemon juice in it can cleanse and purify the liver.

Lemons are ovoid in shape and light yellow in color and have a thick, rough skin when ripe. When buying lemons, be sure to choose smooth-skinned lemons in case you plan to store lemons for a period of time in your refrigerator. Lemons are plentiful in many food nutrients such as citric acid. They are widely used for medicinal purposes due to their citric acid and vitamin C content. In addition, they are highly regarded for their juice which is many times used as an accessory to food. Lemon juice has the ability to improve the flavor and increase the taste of many different dishes.

According to Jethro Kloss in his book Back to Eden, he writes that lemon is "an antiseptic, or is an agent that prevents sepsis (the presence of pathogenic bacteria) or putrefaction (tissue decomposition).

For those who have symptoms of indigestion such as bloating, heartburn, and belching, they will find that lemon juice can promote relief. By drinking lemon juice on a regular basis, the bowels can eliminate waste more efficiently thus minimizing constipation and diarrhea.

Other nutrients found in lemon include potassium 48.3%, calcium 29.9%, phosphorus 11.1%, and magnesium 4.4%. Lemons have been found useful in treating conditions such as asthma, colds, coughs, diphtheria, liver problems, scurvy, and rheumatism.

Scientists advise that lemon water should be used in every person that has a tolerance for it. That is, if there is no allergic reaction to lemon (as a small percentage of the population does have a true allergic reaction to lemon) and no active ulcers, then all children and adults should ingest lemon water. The juice in lemon provides a natural strengthening reagent to liver enzymes by helping to affix oxygen and calcium in the liver to regulate blood carbohydrate levels, which, in turn, affects blood oxygen levels. The liver can manufacture more enzymes out of fresh lemon juice than any other kind of food.

To treat a sore throat, mix one part lemon juice with one part water and gargle frequently. For those who have asthma, ingest one tablespoon of lemon juice one hour before every meal. For those with liver problems, mix the juice of one lemon with hot water and drink it down one hour before eating breakfast every morning. To break up the flu or influenza, mix the juice of one lemon with hot water and drink it down while at the same time soak your feet in water with mustard added to it. To relieve heartburn, mix two teaspoons of lemon juice with a glass of water and drink. To treat rheumatism, one or two ounces of lemon juice diluted in water should be taken three times a day...one hour before each meal and once at bedtime. To treat scurvy, take one to two ounces of lemon juice diluted with water.

There are many benefits to drinking lemon juice including the prevention of different kinds of disorders, viruses, and diseases.

• 
  Oral diseases: Due to the high concentration of vitamin C, this property of lemon juice helps to strengthen the gums and teeth. It is also highly effective in the prevention of acute inflammations of the margins of the gums, cavities, and other oral diseases.


• 
  Digestive problems: Lemon juice promotes the flow of saliva and gastric juice and is looked upon as an excellent digestive agent. It helps to kill intestinal parasites and eliminates gases that form in the gastrointestinal tract. This juice is very beneficial in treating several digestive anomalies such as dyspepsia (acid reflux) and constipation. Drinking fresh lemon juice with water easily relieves acid reflux.


• 
  Rheumatic affections: Even though lemon has a sour taste, its reaction in the body is basic (or alkaline). Taking advantage of this valuable information can allow one to treat rheumatic affections such as gout, sciatica, low back pain, hip joint pain, and rheumatism, which all result from too much acidity in the body. Taking in adequate amounts of lemon juice can prevent the deposition of uric acid crystals in the tissues and thus help eliminate the possibility of an attack of gout.


• 
  Circulatory problems: Lemon juice is not only abundant in vitamin C, it is also a rich source of vitamin P (bioflavonoids), which is found both in the juice and the peel of the fruit. Vitamin P is essential for controlling bleeding in a variety of conditions and for promoting capillary integrity. Lemon is highly regarded as a valuable food medicine in the treatment of high blood pressure and arteriosclerosis.


• 
  Foot relaxation: Soaking your sore feet in hot water is a great way to relax the feet. Then you rub your feet with fresh lemon juice. The heat from the water will promote opening of the pores while subsequent application of lemon juice will provide a cooling, astringent effect. It is believed that this method also promotes healthy sleep.


• 
  Throat problems: Throat disorders such as catarrh, choking sensations, and itching sensitivities can be relieved by the properties found in lemon juice. A ripe unpeeled lemon should be roasted slowly until it starts to crack open. Then harvest one teaspoon of its juice, add a small amount of honey, and ingest it about once every hour. Sip it slowly.


• 
  Fevers: Lemon juice is a great thirst-quencher when you are suffering from pox, scarlet, measles, and other fevers. These fevers promote dehydration, polydipsia (extreme thirst), and very hot and dry skin.


• 
  Cold: If you suffer from a bad cold, juice two lemons and combine with 500 mL of boiling water. Add honey, and take at bedtime. Again, sip it slowly.


• 
  Cholera: The properties of lemons can kill cholera bacilli instantaneously. Lemons are very effective for this purpose when freshly juiced.

As you can see, lemon juice has many uses as a health supplement. If you are looking for a natural healing alternative to prevent some of the conditions listed here, pick up some lemons at your local grocery store.

Cause of Lower Back and Groin Pain: The Iliolumbar Ligament

The iliolumbar ligament connects the fifth lumbar vertebra to the crest of the ilium, or hip bone, in the lower back. It is one of the thick, strong ligaments that supports the sacroiliac (SI) joint, which forms where the ilia meet the sacrum at the base of the spine on each side.

The ligaments around the SI joint facilitate pelvic stability and, since the pelvis is attached to the base of the spine, spinal stability. The lumbar spine is a highly mobile segment that bends forward, backward and sideways as well as rotating. The ligaments that attach to lumbar vertebrae are susceptible to injury if this spinal segment is overexerted.

Causes

The iliolumbar joint can be injured in a number of ways, including lifting a heavy object, impact from a fall or repetitive rotation of the lower back. Iliolumbar syndrome occurs when the ligament is chronically torn or strained. This is usually the result of a repetitive use injury, such as sustained by golfers, tennis players, or others who constantly twist at the lower back.

Ligaments have a difficult time healing; they naturally receive poor blood supply, meaning they do not get fresh oxygen and nutrients to facilitate healing. When a ligament is injured, inflammation in the region can cause pain in the area and in other parts of the body. The SI joint is affected when any of its supporting ligaments is injured; the joint loses support and becomes unstable. Inflammation in the area can cause the joint to seize up and interfere with nerves that pass through the area to other parts of the body.

Symptoms

Stabbing lower back pain, usually on one side

Hip pain

Groin pain

Pain on inner or outer thigh

Pain when bending to either side

Pain when twisting the spine

Misalignment of the L4 and/or L5 vertebrae, if ligament has been weak for prolonged period of time

Treatments

Treating an injured ligament is difficult; while any motion can irritate it, prolonged periods of rest and immobility carry their own risks. Treatment of the ligament depends on the severity of the damage.

If you have only a minor strain of the iliolumbar ligament, ice and a brief period of rest followed by gentle stretching and eventually strengthening exercises should suffice to recover.

More severe strains may benefit from friction therapy, a form of massage designed to stimulate the ligament just enough to break down scar tissue without aggravating the injury. Exercise therapy follows to build strength and flexibility in the hips, buttocks and lower back.

Iliolumbar ligament syndrome that doesn't respond to these forms of therapy may benefit from prolotherapy, a relatively new form of treatment for ligament injuries. It involves the injection of irritants into the ligament area to spark the body's inflammatory response, which is part of the healing process. Since ligaments receive poor blood flow, the body's initial inflammatory response may have been too weak to facilitate healing. Ligaments are expected to heal after 3-10 sessions of prolotherapy.

Injury to the iliolumbar ligament is fairly distinct in that it causes SI joint and lower back pain along with groin pain. If you have these symptoms, help your doctor arrive at an effective treatment plan for your pain.

Rumatory Arthritis - Tips for Pain Relief

For those dealing with rumatory arthritis, pain is a constant problem. The swelling and inflammation that comes with this disease causes stiffness and pain in the joints. Some of the main areas where pain can occur include in the hip joints, wrist joints, hand joints, knee joints, and the spine. To deal with this chronic pain, here are some helpful tips for pain relief that can provide the pain management needed.

Tip #1 - Healthy Diet - One excellent tip for rheumatoid arthritis pain relief is to eat a healthy diet. A diet that is well balanced can help to keep weight under control, easing the strain on joints. Limiting certain foods like saturated fats and read meats can help to reduce inflammation, since it limits arachidonic acid, which can make inflammation worse. Eating foods that contain omega 3s can also be helpful, since they are proven to help reduce inflammation in the joints.

Tip #2 - Cold and Heat Therapy
Many people find that cold and heat therapy can help to ease some of the pain that comes along with rheumatoid arthritis. When a joint is aching and inflamed, cold therapy can help to reduce some of the inflammation, easing the pain. Other people find that heat therapy is helpful for relaxing muscles and easing the pain felt in joints.

Tip #3 - Non-Impact Exercise
Exercise is an important part of reducing pain with this disease. Building muscles that are strong and fit provides better support for the body's joints. Exercise can also reduce pain symptoms and increase flexibility as well. Non-impact exercises are the best options for those with joint damage, such as water therapy and swimming. Speaking with your doctor before getting involved in a new exercise plan is a good idea.

Tip #4 - Massage
Even massage therapy can provide some pain relief for those with rheumatoid arthritis. Massage can help to warm up and relax muscles that are tense because of the constant pain. A good massage also can help the body to release endorphins, which are natural painkillers, alleviating pain.

Tip #5 - Medications
Today there are a variety of excellent medications that can help to treat rheumatoid arthritis and relieve some of the pain that comes with the disease. Inflammation can be reduced with medications like corticosteroids and NSAIDs, which leads to the reduction of pain. Other anti-rheumatic drugs are available today that actually treat the disease, leading to pain reduction as they begin to work. Some of the newer biological medications that are available include Enbrel, Orencia, and Humira. Several are taken by infusion, while others are given as injections.

Dealing with the pain that comes with rheumatoid arthritis can be frustrating. However, there are many great options available that can provide some pain relief. If you are dealing with this disease, consider some of these tips and talk with your doctor about the options that may work best for you.

How Sleep Positions Affect Our Sleep Quality

What position do you sleep in? Do you sleep all night or do have some nights where it is difficult to get to sleep much less stay asleep? Sometimes tossing and turning becomes our nightly ritual and our quality of sleep is sorely diminished.

The most common reason for a bad night of sleep is the many aches and pains we feel. In the adult population, about 15% of those surveyed report experiencing chronic pain. However, in older adults, that number rises dramatically to over 50%. Studies show neck and back discomfort and pain is the main culprit in reducing our sleep quality. The National Sleep Foundation (NSF) states that pain is a leading cause of insomnia.

While would we do to decrease our pain and sleep better if pain is the chief culprit to losing our sleep quality? Changing your sleep position may be an answer. The proper sleep position when one is young is ,"any position." Timed photography of children asleep show they are all over the bed. Adults on the other hand, after a life of various physical traumas find only a few positions that are maintained through the night. Time photography will show significant tossing and turning for those who report trouble sleeping.

Many adults only sleep in specific positions with other positions creating irritation at best and outright pain at worst. Either way these difficult feelings will eventually cause the sleeper to be restless, interrupting their repose, and disturbing their quality of sleep

Many argue that sleeping in the side position with normal curves is best to relieve aches and pains so you can sleep. To elaborate this would be laying on either the left or right side with the legs straight or with them bent. In this side sleeping position, the head and neck can be flexed or assume the normal ergonomic position with the ears above the shoulders and the shoulders above the hips. The normal spinal curves are maintained when the legs are straight and the head and neck are in the normal ergonomic position.

However, many can't sleep on one side or the other due to injuries to the shoulders or neck. Some complain about pain at the hip joints or knees while on their side with many using pillows between the knees. Everyone is different but side position sleep is the most popular.

Another popular position is in a back lying position. It is often the "fall back" position for those who no longer can sleep on their sides. For many, back sleeping it is their first choice and has been their favorite since they were young adults. Back lying with a pillow under the knees is also common. However, the back position often leads to snoring and can be a sign one is developing sleep apnea. Sleep apnea is the temporary stoppage of breathing during sleep, often resulting in daytime sleepiness. If back sleeping is your first and most comfortable position, awareness of the down sides of this position is suggested.

There is also the stomach position. Most would agree that the stomach lying position usually involves either the right or left knee bent with the head and neck turned to that side. This is a very popular position for children and young adults but may change for those over thirty when it is discovered that the neck rotated in this way one can lead to a stiff neck in the morning. It only takes a few experiences like this before one chooses a change to their position. Stomach positions are often thought to be hazardous for the adult with health care professionals stating that stomach sleeping may lead to increases in low back as well as neck pain.

Our chosen sleep positions influence the quality of sleep we get. We choose our positions randomly or consciously to avoid painful irritation. If your position choices allow you to sleep fitfully all night allowing you to wake refreshed then there is no need to change. But if you find pain and irritation interrupting your sleep you may want to experiment with new positions of sleep. Finding your positions for fitful sleep is a blessing and one worth considering for a consistent high quality sleep experience.

Can an Orthopaedic Mattress Help a Bad Back?

Most of us love the feeling of getting into our beds at night time. They are a place of comfort and a source of relaxation. This is not the case for everyone though. There are many people who suffer from crippling pain when they get into their beds. For example, did you know, that your mattress may actually increase existent pain? For sufferers, an orthopaedic mattress may be the solution.

Reasons Why You Might Need an Orthopaedic Mattress

To determine whether you need one you must observe your body's comfort levels throughout the night and even in the daytime too. If you suffer from a stiff neck, back pain (both lower and upper), painful hip joints or some spinal conditions such as scoliosis, sciatica or lumbar pain, this type of mattress could be beneficial to you.

How They Help

These mattresses are much firmer than the standard mattress. With a spring gauge of 12.5g compared to 13.5g in the standard variety, orthopaedic mattresses provide support for those suffering from aches and pains at night time.

The Features and Their Benefits

The specialty mattresses have two main features which offer support for suffering sleepers providing a number of benefits. The firmer mattress relieves pain by easing the pressure off the source of the pain. Imagine an extremely soft bed; the sleeper would sink right into it. For some this is ideal, optimum comfort but for others it can significantly increase pain by putting pressure on painful areas. The other main feature of an orthopaedic mattresses that the sleeper would find beneficial is the softer sleep surface; an extra covering on the mattress. This is done by covering the top of mattress in memory foam, cashmere, lamb's wool or latex. The firmness of the springs coupled with the softer sleep surface would allow sleepers to experience a mattress that provides support and comfort, alleviates back and joint pain and allows for a good night's sleep. Orthopaedic mattresses also last longer and are more durable than their standard counterpart.

For those sleepers who wake up with a bad back or for sufferers of spinal conditions, orthopaedic mattresses are suggested by orthopaedic specialists, surgeons and mattress experts. Getting a good night sleep is vital; orthopaedic mattresses provide the sleeper with a better quality of sleep, thus, in turn, providing the sleeper with a better quality of life, more injury free time while also lessing the likelihood of having another injury.

Chiropractic And Leg And Hip Pain

Subluxation of the spine results in leg pain and hip pain. This can result in irritation of the nerves, muscle spasms and pain. Hips and legs provide support to the entire body and provide stability, mobility, strength and flexibility. This is the reason why there is a lot of stress on these parts of the body. Due to the place where the spine connects with the pelvis, hip pain is at times confused with backache.

The hip is a ball and socket joint where the hipbone connects with the thighbone. Cartilage separates the two bones and it behaves like a cushion so that the bones do not rub against each other. When this cartilage wears out, there is swelling and pain and this result in hip pain. This condition is commonly also known as arthritis.

Some reason for leg pain and hip pain can be wrong posture and sitting for long period of time. These activities can cause ruptured or slipped disc. Cracks take place in the intervertebral disc and the soft nucleus leaks out. Slipped disc takes place in case the disc pushes on sensitive tissues and creates pain. Weakness in the legs, sciatica and numbness are caused due to disc pressing against the spinal nerve. There might be a need to perform surgery to remove the herniated disc material if the rupture is large and is not managed correctly.

Due to fracture or sprain, at times pain occurs. Usually, fracture takes place only in older people who fall and have osteoporosis. After a leg or hip fracture, you can observe swelling, stiffness, limited mobility and numbness. If you think you have fractured your leg or hip, you should go to a medical professional soon. Sprains are not very serious but should be treated by a doctor so that it does not result in a serious injury.

The main cause of your leg and hip pain can be determined by your chiropractor. Usually, these problems can be treated with the help of spinal adjustments. Your chiropractor will also give you advice on exercises so that you can stabilize and rehabilitate the misaligned and injured spinal structures. Work habits, posture and diet will also be examined and analyzed. This is because to completely get rid of the problem, you need to identify and correct the real cause of the problem. So, if you are suffering from hip pain or leg pain, you should go for chiropractic treatment immediately.

Soothe the Pain of Canine Arthritis and Hip Dysplasia

Caring pet owners attain a unique ability to know when their dog is not feeling well. You will notice the slightest change in behavior, eating habits, and how they walk or run. When your pooch is in pain from joint problems they seem to move a little slower, playtime is reduced, and they take longer to climb the stairs or get up from the floor. The question is, "Can orthopedic dog beds provide relief?"

Most pet owners associate these symptoms to old age; however, that may not be the case. Dogs suffer from two main joint problems:

• Hip Dysplasia


• Canine Arthritis

Hip dysplasia once thought to be heritable and then only in large breeds, can in fact affect any dog. This dog health problem can stem from over exertion at a young age while the hip joint is still developing. Injury at a young age is another cause, even repetitive motion in puppies, for example jogging with your puppy while their joints and muscles are still forming under the age of one. In dogs the problem usually appears by the time, they reach 18 months old. Some say that early vaccinations weaken the young joints.

Dogs suffer from the same arthritic pain as their human companions. These symptoms differ only slightly then those for hip dysplasia affecting older dogs. The adage of a dog year equals seven human years really starts when your dog reaches four years old. So when your dog is 12 years old they feel like an 84-year-old human.

In the severest of either case surgery is an option along with medications proscribed from your Veterinarian that can relieve pain, however there is no known cure. As pet owners, one area we can help, provide quality orthopedic dog beds for them to sleep and rest tired joints.

Like there human equivalents, orthopedic dog beds and memory foam dog beds take the pressure off any one area spreading the weight evenly as they rest. If you have hard wood floors, your pooch sleeps outside in a dog house, or in his/hers crate providing orthopedic dog beds will relieve the pain associated with hip dysplasia and canine arthritis.

With the choices available from size, color, and style, you will be able to locate the perfect dog bed to fit your four-legged family members resting space. As dogs want nothing more than to please their owners, orthopedic dog beds is one investment we can make to offer our thanks in return.

Back Pain Relief - 7 Simple Tips to Save Your Back While Sitting - Ergonomic Too! - Nurse's Guide

If you're looking for some simple tips to help save your back, hips and joints or get back pain relief, assuming you do a lot of sitting all day at work or at home on your computer, these are some of my favorite tips.

Oftentimes it isn't a better ergonomic chair that's needed but the fact that most of us are slouched forward with our earlobes in front of our shoulders. Then we sit that way for hours, hardly moving. So first of all check your posture and make sure you keep your head and neck back using your earlobes as a guide.

Good posture will also give your lungs room to breathe properly from your abdomen and help your voice and speech too.

Sitting for prolonged times like this, no matter what your age, can cause blood clots and hip, joint and back pain which is the leading cause of disability in people under the age of 45!

Sitting is the worst possible thing you can do for your back and puts a lot of stress on the spine and slouching makes it worse. So make sure to stand up every ten or fifteen minutes or so and clasp your hands behind you. Walking around for a few moments is even better. You want to keep from hunching into a C shape.

The disks that absorb the shock between our vertebrae need nutrients because they have no blood or nerve supply. They depend on movement for nourishment. So keep moving as much as you can.

Make sure your chair is not too low. This is one of the reasons people get back pain and are not aware that their chair is positioned too low. Consider buying an ergonomic chair or better ergonomic chair. Beware of those labeled ergonomical that aren't.

When you're on the phone try standing up instead of sitting at your desk or on the couch at home. You can also tighten your abs and lean back keeping your earlobes in check.

Some people use a treadmill desk and walk at about 2 miles an hour or so.

Get a lumbar roll. These are inexpensive and available at medical supply houses. You can put them behind you in the natural curve of your back to help keep your spine in the proper positioning.

You can set reminders to stand up every 15 minutes or so with timers, post-it notes or Outlook reminders.

Using these tips will help you avoid back pain and serious problems. If you're suffering now with pain and need relief, make sure you do these every day and work on your posture whether standing or walking. Try building up your back muscles at the gym or health club - I especially like the lat pull-down and seated row to keep my back healthy and ward off pain. Give these tips a try and avoid back, hip and joint pain like I do. There are a lot more tips and secrets you can use to help you get back pain relief or avoid it like I do - too many to mention in this article.

Adult Ballet Beginners - Muscle Stretching Exercises For The Lower Body

I previously wrote for adult ballet beginners, describing one of the muscles stretching exercises for the upper body, stretching the chest so you could open up and do one of those Black Swan arm moves.

(If you haven't just done a walk or some other kind of workout, warm up by walking on the spot. Add some arm movements, and move for five minutes.)

For the lower body, to get your leg up to the back, to do an arabesque, you need to get more flexible in the psoas muscle. This is a postural support muscle that runs from the top of your thigh to the spine. Attached at the front of the spine, this muscle controls the bending of the body at the hip joint. (Say you sneeze and one of your knees lifts up when your abdomen contracts. You bend at the hip joint).

If flexible, this muscle also allows your spine to bend at the waist, when you raise your leg to the back. There is a REALLY simple exercise you can do, to stretch this large, important muscle.

You do not need ballet turnout to do this, so I am going to describe this exercise with your legs in parallel. Release one leg to the beck, about a yard or meter behind you. Place the back foot on the ground. Holding onto a ballet barre or the back of a chair is a good idea.

Now straighten the back leg, without changing your spinal position. You may feel a pull up the front hip and the back leg hip. Pull up the lower abdomen muscles, and you will increase the stretch feeling.

Twist away from the back leg, a little. You will feel the stretch increase, perhaps more in the side of the hip muscle.

Twist toward the back leg, and again you will feel the stretch move somewhat in the hip joint area.

Hold each position for thirty to sixty seconds. Repeat the stretch at least three times, each position, each leg.

Lower Back Pain Strategies by a Musculoskeletal Therapist

Mobility - the ability of the musculoskeletal structures or segments of the body to move or be moved to allow the presence of range of notion for functional activities. The ability of an individual to initiate, control or sustain active movements of the body to perform simple to complex motor skills.

Hypomobility - caused by adaptive shortening of soft tissues and can occur as the result of many disorders or situations.

Factors -

• prolonged immobilization of a body segment


• sedentary lifestyle postural mal-alignment and muscle imbalances


• impaired muscle performance (weakness) associated with an array of musculoskeletal or neuromuscular disorders


• tissue trauma resulting in inflammation and


• pain congenital or acquired deformities.

All these impairments can lead to functional limitations and an increase in injury risk. Remedial massage treatment especially stretching can improve impaired muscle performance or prevent injury as they become an integral component of individualized intervention.

Contracture - is defined as the adaptive shortening of the muscle-tendon unit and other soft tissues that cross or surround a joint, which results in significant resistance to passive or active stretch and limitation of ROM.

Types of contractures

Myostatic Contracture - no specific muscle pathology present. Reduced number but not length of sarcomeres. Can be resolved in a relatively short time with stretching exercises.

1. Pseudomyostatic Contracture - a constant state of contraction giving excessive resistance to passive stretch. Associated with hypertonicity of spastic or rigid nature - a central nervous system lesion such as CVA, spinal cord injury, traumatic brain injury. Muscle spasm or guarding and pain may cause a pseudomyostatic contracture. Inhibition procedures to temporarily relax the spasm or tonicity will allow full, passive elongation of the muscle to occur.


2. Arthrogenic and Periarticular Contractures - intra-articular pathology including adhesion, synovial proliferation, joint effusion, irregularities in articular cartilage, or osteophyte formation. Connective tissues that cross or attach to a joint or it's capsule become stiff, this reduces normal arthrokinematic motion.


3. Fibrotic Contracture and Irreversible Contracture - these can cause adhesions and development of fibrotic contractures. It is possible to stretch fibrotic contractures and eventually increase ROM, it is very difficult to re-establish optimal tissue length.

Stretching is a general term used to describe any therapeutic manoeuvre designed to increase mobility of soft tissue and subsequently improve ROM by elongating structures that have adaptively shortened and have become hypomobile over time.

Physiology of the Stretch Reflex

It is a monosynaptic reflex arc, two types of neurons are involved (sensory and motor). The reflex occurs when a sudden contraction of a muscle occurs. Slight stretching of a muscle stimulates receptors in the muscle - muscle spindles - these spindles monitor changes in muscle length. The stretch reflex operates as a feedback mechanism to control muscle length by causing muscle contraction.

Physiology of the Tendon Reflex

The tendon reflex operates as a feedback mechanism to control muscle tension by causing muscle relaxation. It protects tendons and their associated muscles from excessive tension. Receptors called Golgi tendon organs detect and respond to changes in muscle tension caused by passive stretch or muscular contraction. When tension is applied to the organ nerve impulses are generated along a sensory neuron, this synapses with and inhibits a motor neuron that innervates the muscle associated with the tendon organ. As tension increases, and the inhibitory impulses increase, the inhibition of the motor neurons to the muscle creates excess tension and causes relaxation of the muscle. It is a protective mechanism to reduce muscle damage due to excessive tension.

Indications for Use of Stretching

• When ROM is limited because ST have lost their extensibility as the result of adhesions, contractures, and scar tissue formation, causing functional limitations or disabilities.


• When restricted motion may lead to structural deformities otherwise preventable


• When there is muscle weakness and shortening of opposing tissue


• As part of a total fitness program designed to prevent musculoskeletal injuries


• Prior to and after vigorous exercise to potentially minimize post-exercise muscle soreness.

Contraindications to Stretching

• When a bony block limits joint motion


• After a recent fracture before union is complete


• Whenever there is evidence of an acute inflammatory or infectious process (heat & swelling) or when soft tissue healing could be disrupted in the tight tissues and surrounding region


• Whenever a haematoma or other indication of tissue trauma is observed


• When hypermobility already exists


• When contractures or shortened soft tissues are providing increased joint stability in lieu of normal structural stability or neuromuscular control


• When contractures or shortened soft tissues are the basis for increased functional abilities, particularly in patients with paralysis or severs muscle weakness.

Types of stretching

1. Passive or assisted - sustained or intermittent external, end-range stretch force applied with overpressure elongates a shortened muscle-tendon unit and periarticular connective tissues by moving a restricted joint just past the available ROM. If patient relaxed it is Passive stretching. If the patient assists in moving the joint through a greater range it is assisted.


2. Self-stretching - (aka active stretching, flexibility exercises) independent stretching carried out after instruction and supervision


3. Neuromuscular Inhibition Techniques - ( aka PNF or facilitated stretching) reflexively relax tension in shortened muscles prior to or during stretching. MET used to stretch muscles and fascia and mobilize joints


4. Joint mobilization/manipulation - stretching techniques specifically applied to joint structures and used to stretch capsular restrictions or reposition a subluxed or dislocated joint.


5. Soft Tissue Mobilization and Manipulation - friction massage, myofascial release, acupressure and TP Therapy. Mobilize and manipulate connective tissue that binds down soft tissues


6. Neural Tissue mobilization - the Neural pathway is mobilized to release adhesions or scar tissue form around meninges, nerve roots, plexus or peripheral nerves.

Elements of stretching

Include alignment and stabilization. Intensity, speed, duration, frequency and mode of stretch; and the integration of neuromuscular inhibition and functional activities into stretching procedures.

Effect of poor Postural Support from Trunk Muscles - with total relaxation of the dynamic stabilizer muscles - the multifidus, rotatores, TA, internal obliques, and QL, the spinal curves become exaggerated and passive structural support is called on to maintain the posture. When there is continued end-range loading supporting tissues become more vulnerable to injury. Continued exaggeration of the curves leads to impaired muscle strength and flexibility. Muscles habitually kept in stretch tend to test weaker because of a shift in the length-tension curve - stretch weakness. Muscles kept in a habitually shortened position tend to lose their elasticity, they are strong only in the shortened position but become weak as they are lengthened - tight weakness.

Lateral shift correction

If the patient has lateral shifting of the spine, it should be corrected prior to flexion extension treatment for lower back pain.

Lateral shift correction when extension relieves discomfort -

standing on the side of the thoracic shift with the therapists hands clasped around the contralateral iliac crest and the shoulder against the patients elbow. Simultaneously pull the pelvis towards you while pushing the patient's thorax away. Continue with the lateral shifting if the curvature is reduced until normal curve is present.

Lateral shift correction when flexion relieves discomfort -

self-correction - standing whit the leg opposite the shift on a chair so the hip is in about 90 degrees of flexion. The leg on the side of the lateral shift is kept extended. Have the patient then flex the trunk onto the raised thigh and apply pressure by pulling on the ankle. Recheck the alignment and continue till pain reduction is greatest.

Exercise techniques and stretches to increase flexibility and ROM

Muscle strength or flexibility imbalance in the hip can lead to abnormal lumbopelvic and hip mechanics, which predisposes the patient to or perpetuates low back, sacroiliac or hip pain..

• To increase hip extension - prone press ups; Thomas test stretch; modified fencer stretch


• To increase hip flexion - bilateral knee to chest; unilateral knee to chest; Quadruped stretch; Chair (airline) stretch


• To increase hip abduction - V lying against wall knees extended butt against wall


• To increase hip abd & external rotation - sitting with soles of feet together hands on inner surface of the knees.

Lumbar stretching techniques

Increase lumbar flexion

Assisted stretching - cross-sitting. Patient lace the hands behind the neck, adduct the scapulae, and extend the thoracic spine. This locks the thoracic vertebrae. Have the patient then lean the thorax forward onto the pelvis, flexing only at the lumbar spine. Stabilize the pelvis by pulling back on the anterior-superior iliac spines.

Increase lumbar extension

Prone press-up (Self-stretching) - Prone, with hands placed under the shoulders. Patient to extend to elbows and lift the thorax up off the mat keeping the pelvis down. To increase the stretch force, the pelvis can be strapped to the treatment table, this exercise also stretches the hip flexor muscles and soft tissue anterior to the hip.

Increase Lateral Flexibility in the Spine

Used when there is asymmetric flexibility in side bending as well as in the management of scoliosis. They are used to regain flexibility in the frontal plane when muscle or fascial tightness is present with postural dysfunctions, designed to stretch hypomobile structures on the concave side of the lateral curvature. When stretching the trunk, it is necessary to stabilize the spine either above or below the curve.

Prone-Lumbar curve -

have the patient stabilize the upper trunk by holding onto the edge of the mat table with the arms. Therapist lifts the hips and legs and laterally bends the trunk away for the concavity.

Heel-sitting - Patient leans forward so the abdomen rests on the anterior thighs. The arms are stretched overhead bilaterally, and the hands are flat on the table. Then have the patient laterally bend the trunk away from the concavity by walking the hands to the convex side of the curve.

Neural Tension Impairments

If positive nerve tension signs are described by the patient while providing the history and positive signs are detected with testing maneuvers, techniques that are reported to mobilize components of the nervous system may be used to diminish the patient's symptoms.

Straight Leg Raise with Ankle Dorsiflexion -

• Once the position that places tension on the involved neurologic tissue is found, maintain the stretch position, and then move one of the joints a few degrees in and out of the stretch position, such as ankle plantar and dorsiflexion, or knee flexion and extension.


• Ankle dorsiflexion with eversion places more tension on the tibial tract


• Ankle dorsiflexion with inversion places tension on the sural nerve


• Ankle plantarflexion with inversion places tension on the common peroneal tract


• Adduction of the hip while doing SLR places further tension on the nervous system because the sciatic nerve is lateral to the ischial tuberosity; medial rotation of the hip while doing SLR also increases tension on the sciatic nerve


• Passive neck flexion while doing SLR pulls the spinal cord cranially and places the entire nervous system on a stretch.

Slump-sitting Stretch -

dorsiflex the ankle just to the point of tissue resistance and symptom reproduction. Increase and release the stretch force by moving one joint in the chain a few degrees, such as knee flexion and extension, or ankle dorsiflexion and plantarflexion.

Prone Knee Bend Stretch -

Prone neutral spine, pillow under treatment knee, and hips extended to 0 degrees. Flex knee to the point of resistance and symptom reproduction. Pain in the low back or neurological signs are considered positive for upper lumbar nerve roots and femoral nerve tension. Thigh pain could be rectus femoris tightness. It is important not to hyperextend the spine to avoid confusion with facet or compression pain. Flex and extend the knee a few degrees to apply and release tension.

Duration of stretch

• Despite extensive research there continues to be a lack of agreement on how long a single cycle of stretch should be held or how many cycles of stretch should be applied to achieve the most effective, efficient, and sustained stretch-induced gains in ROM.


• Duration most often refers to how long a single cycle of stretch is applied


• More than one repetition of stretch is referred as a stretch cycle and the cumulative time of all the stretch cycles is considered as aspect of duration.


• Long-duration referred to as static, sustained, maintained, prolonged


• Short term referred as cyclic, intermittent or ballistic.

Types of stretches

1. Static - most common term used to describe soft tissue lengthening. The duration 15 sec to several minutes when manual stretch or self-stretching employed.


2. Research shows static stretching is approx half that created during ballistic stretching.


3. Static Progressive stretching - Static stretch held until a degree of relaxation is felt by the therapist then lengthened further until a news end-range is felt. This capitalizes on the stress-relaxation properties of soft tissue.


4. Cyclic Stretching - short duration stretch forces that are repeatedly but gradually applied, released and then re-applied. Multiple stretches in a single treatment session. Held for 5-10 seconds but with no consensus on the optimum number of cycles in the treatment. Based on clinical experience, some therapists hold the opinion that end-range cyclic stretching is as effective and more comfortable for a patient than a static stretch.

Frequency of stretch -

• number of bouts per day or per week. Dependant upon -underlying cause


• Quality and level of healing


• The chronicity and severity of contracture


• Patients age


• Use of corticosteroids


• Previous response to stretch

Usually form two to five sessions for tissue healing and to minimize postexercise soreness. Ultimately dependent upon the clinical discretion of the therapist. Whatever frequency is decided upon the patient must utilize the new end-of-range into everyday tasks otherwise the connective tissue will return to the pre-stretched position.

Neuromuscular Inhibition and Muscle Elongation

Inhibition techniques increase muscle length by relaxing and elongating the contractile components of muscle. The sarcomere give will occur more easily when the muscle is relaxed, with less active resistance in the muscle as it is elongated. An advantage to the use of inhibition techniques prior to or during stretching is that muscle elongation is more comfortable for the patient.

Types -

1. Hold-relax or contract relax


2. Agonist contraction


3. Hold-relax with agonist contraction.

Stretch isolated muscles in their anatomic planes or opposite the line of pull of specific muscle groups rather than in combined diagonal patterns.

HR - prestretch, end-range, isometric contraction 10 sec followed by voluntary relaxation of the tight muscle. Then the limb is passively moved into its new range as the range limiting muscle is elongated.

AC - Deliberate and slow, concentric contraction of the muscle opposite the range limiting muscle. This causes reciprocal inhibition of the antagonist, and increases ROM.

HR with AC - use of a pre-stretch isometric contraction of the range limiting muscle in a lengthened position followed by a concentric contraction of the muscle opposite the range-limiting muscle.

For more information see http://www.yourmusculoskeletalspecialist.com

Causes of Shoulder Joint Pain

There are many causes of shoulder joint pain. Your shoulder is a ball and socket joint that is necessary for a wide variety of movements, from very small movements to large wide range movements. Most of the time you do not think much about the shoulder joint, that is until pain interrupts your natural usage. At this point, you suddenly become quite aware of just how necessary proper shoulder joint function is to your daily life.

There are several reasons you may be experiencing shoulder joint pain and here are a few of the most common causes.

Over Exertion

Over exertion is going beyond your abilities and strength, and when applied to the shoulder area is generally considered an over use injury from repetitive motion. Many jobs and even some hobbies require constant use of the shoulder, which can quickly lead to over exertion and shoulder joint pain. You see, even though the shoulder is the most movable joint in the body it is the most susceptible to injury. The upper arm ball is larger than that shoulder socket and therefore is stabilized by tendons, ligaments and muscles, which can become torn or injured from repetitive use. You will often hear the terms tendonitis or bursitis in reference to this type of shoulder pain.

Injury

A traumatic injury to the clavicle, humerus or shoulder blade can result in a great deal of shoulder pain. If you experience a fall or other blows to the area, you will want to have your shoulder thoroughly checked out by a medical professional. For less serious injuries rest and relaxation may be all the treatment you need, however some situations may call for a brace or other medical intervention.

Dislocated

You may have seen movies where the hero suffers a dislocated shoulder and bravely puts it back into place. Well in the real world that is probably not very accurate, especially the very first time this happens. Dislocation occurs when the ball is forced out of the socket, most of the time due to trauma while the arm is extended above the shoulder. The area may swell, bruise, look deformed and hurt very badly, you will likely be unable to move the joint. Unfortunately, once you have dislocated your shoulder for the first time, it is more likely to happen again. This is why some people simply pop them back into place on their own, because they have become accustomed to the issue.

Frozen Shoulder

Frozen shoulder is pretty much, what it sounds like, a shoulder that will not move or is frozen in place. There may be some small range of movement but nothing significant. This occurs because the tissue around the area has become inflamed and irritated. Scar tissue from a severe injury or surgery can also lead to shoulder joint pain, and frozen shoulder.

What You Can Do

There are many things that can cause shoulder joint pain, from simple over use to extreme injury and sometimes-underlying medical conditions can be to blame. The best thing you can do when experiencing this type of pain is see a physician.

Not moving your shoulder due to pain or arthritis can lead to further problems such as frozen shoulder. Take care of your joints if you want them to take care of you. Consider using natural supplements to assist in recovery. Prescription medications (drugs) work on symptoms such as pain, while natural supplements work toward healing and pain relief.

The Pros and Cons of Hip Replacements

Following on from last week's letter about the best ways to prevent and treat the pain and symptoms of arthritis, I've received a number of emails from people worried about the effectiveness and problems connected with hip replacement surgery.

So, let's start with the facts: There are approximately 65,000 hip operations in the U.K. every year, all of which carry certain risks.

In the past, it was difficult for those under 60 to receive a new hip as the lifespan of the replacement was only 10 to 15 years which meant there was the probability of replacements in the future.

Thankfully, new techniques and materials can now provide a lifelong expectancy for the new hip. Added to that there are also many new preventative treatments used to reduce the risks of post-operative problems.

Blood clots and infections are the most common post-operative problems. These are normally treatable, but you should discuss all the potential problems that could arise with your surgeon.

You should be aware that:

According to NHS Direct, post operative infections can be as high as 10%.

2. A recent study in the Journal of Bone and Joint Surgery found that blood clotting statistics after hip and knee replacement surgery were as follows:

O.25% suffered pulmonary embolism (obstruction of an artery by a clot of blood or an air bubble).
O.4% suffered painful symptoms of deep vein thrombosis
5.2 % suffered painless symptoms of deep vein thrombosis

*Also you must remember that all forms of hip replacement usually require a period of 18 to 24 months for the new hip to fully knit and this usually causes varying degrees of pain and discomfort during that time

TYPES OF HIP REPLACEMENT:

• Plastic socket and metal ball - this method is now becoming out dated because the plastic wears away over the years, leading to further replacements every 10 to 15 years.


• Metal on metal - The ball and socket are made from cobalt chrome and all the evidence shows that there is no significant wear and tear over time. Therefore, the new hip should last a lifetime. Some people have expressed fears about cobalt/chrome ions being released into the body, but as yet there is no evidence to support that.


• Ceramic on ceramic (aluminum oxide) - again, this will last a lifetime and has even less wear and tear than metal and has a minuscule risk of shattering. However, some experts believe that this is the best material for younger, more active patients.


• Hip resurfacing - Lasts for life, with no drilling into the femur required and it preserves the healthy bone. The new section is made from carbon hardened steel. Steve Backley, the Olympic javelin champion, had this procedure in 2005 and stated that it has allowed him to return to full and normal pain-free mobility.


• Magnetic Hip - A revolutionary new technique containing a magnet that helps the prosthetic last three times as long. It's currently undergoing laboratory testing and should start clinical trials on NHS patients within three years.

Once again, it is vitally important that you speak to your surgeon about all the options available.

If you are not completely satisfied with your surgeon's answers, then either insist on an official NHS printed list of possible risks, or utilise your right to ask for a second opinion.

Never forget you're the patient, its your body, its your life - don't be afraid to ask!

Obviously, as I've been saying all along, it's up to you to take care of your own health, especially your joints. This is vitally important if you want to ensure good health and mobility well into old.

For those of you that already feel the early onset of any arthritic hip problems, you must consult your doctor immediately and be proactive in treating the pain and dealing with lost tissue and grinding joints.

If you are middle aged , and especially if you have suffered from any sporting injuries or endured an arduous working life, you really must consider taking action now to stave off any joint problems, especially with your hips.

TOP TIPS FOR HIPS:

• Weight loss - I know its obvious, but relieving the stress on the joints is vital to retaining healthy tissue around the joint.


• Water exercise - The buoyancy of the water allows for comfortable movement and gentle exercise for the hip area.


• Hydrotherapy - A good physiotherapist can suggest a regime of warm water therapy that will alleviate pain and stress on the joint.


• Strengthening exercises - Again a good physiotherapist can help you to build up the muscles around the affected joint. This will help you with your posture and mobility.


• Artrosilium - Once again I would refer you to the all natural product Artrosilium that I mentioned here last week- its proven to help relieve the pain and even help rebuild lost tissue (and with no side effects!)
  


• I would recommend the regular application of Artrosilium combined with a daily dose of Arthritis Power Formula.

Together they provide a potent arthritis busting team that is completely natural and safe to take.

Remember that arthritis is a particularly cruel condition and can hit anybody at anytime, irrespective of your past physical history - arthritis does not discriminate!!!

Fractures and Back Pain - Who's at Risk?

Overview

Managing back pain due to back or hip injuries and fractures needs thorough assessment, diagnosis and immediate treatment. Having your back and bones thoroughly analyzed by a qualified medical professional is essential to increasing your chances of living a more normal life. The manner in which a doctor treats fracture-related back pain will be based on his evaluation of the type or mode of fracture incurred by the patient.

According to the International Osteoporosis Foundation, patients aging 65 years or older are more prone to fractures, particularly hip, spine or back fractures. By 2050, the worldwide incidence of hip fracture is said to increase by 310% in men and 240% in women. Aside from osteoporosis, age, falls and injuries due to certain activities, bone disease, and post-operative conditions cause hip fracture and hip injuries causing back pain.

Who are At Risk?

Everyone is at risk of incurring fractures. However, people suffer increased risks with conditions like old age, osteoporosis, osteomyelitis, type 2 diabetes patients and other diseases that make the bone porous, brittle and highly permeable. Unfortunately, falls and hip injuries are common on frail elderly patients, making hip fracture rehabilitation a primary concern. Elderly and other people like athletes and workers who are prone or highly likely to incur hip injuries must establish an ongoing communication with a qualified medical doctor or orthopedic surgeon.

Types and Modes of Fractures

There are several types of fractures, which doctors consider before diagnosis is set:

* Comminuted fracture - is the condition where the bones fragment into several pieces.
* Oblique fracture - the bone breaks acquired a curved or sloping pattern.
* Impacted fracture - otherwise known as the buckle fracture, this is the type of fracture whose ends are driven into each other.
* Transverse fracture - the type of fracture forming a right angle to the bone's axis.
* Greenstick fracture - occurs when the bone is just bent and not fully broken.
* Other types of fracture include pathologic, compressed, avulsion, depressed, and spiral.

Modes of Hip Fractures

Only a few types of fractures are associated with hip injuries, which cause back pain. With that, several modes of hip fractures and considered to thoroughly evaluate the extent of injury:

* Intertrochanteric hip fracture is the type of fracture that does not involve or cause damage to the blood flow in the bone. It usually does not require hip replacement for treatment.
* Intracapsular hip fracture is the type of bone breakage that occurs within the capsule of the joint.
* Extracapsular hip fracture is the type of fracture that occurs at the articular extremity of the bone, which is outside the line of the attachment of the capsular ligament of the hip joint.

Causes of Fractures

Bone fracture can happen to anyone. It is typically caused by various types of trauma on the bone. Bone trauma may result from accidental falls, motor vehicle accidents or a disease that weakens the bone. Hence, hip and back injury, bone fracture may cause back pain, swelling, bruising and internal bleeding.

Assessment of Fracture Risks and Fracture Damage

The risks of getting fractures can be assessed by performing tests and evaluations on bone density, current medications taken, medical conditions, medical history or personal history, and lifestyle or work factors.

To assess actual fractures, doctors usually perform hematology tests and x-rays to evaluate and locate the fracture area. X-ray results will guide them in locating the breaks on the bones while hematology tests help them spot the decreases in HCT and Hgb, which indicative the severity of damage incurred. Doctors may assess the condition by evaluating the pain experienced from motion and the tenderness, immobility, deformity, crepitus, ecchymosis, edema and paresthesia or creeping, tingling and pricking sensations observed and experienced on the affected site.

Pathophysiology

Pathophysiology is performed to perform further assessment of fractures, determining certain aspects like time and amount of stress applied on the bones, causing it to break. This way, doctors will be able to localize the tissues surrounding the injury and prevent complications like muscle spasms, edema, hemorrhage, ecchymosis, nerve compression and more.

On Back Pain

Pain is rather common with bone fractures or with the disturbance in the permanence of the bone. In addition to the tingling and pricking sensations felt with the injury, the inflammation and other forms of damage caused by the fracture on the surrounding tissues result to pain. Any type of bone fracture must receive immediate treatment to prevent back pain and chronic and often dangerous complications. The pain caused by fractures might be indicative of more serious conditions, which might pose serious health risks.

Tests for Back Pain

Accurate assessment and proper management of fractures are essential to relieving back pain. Since back pain is a common complication of fractures, diagnostic tests may be performed to effectively manage pain. Initially, patients will be put under physical examination where general inspection of posture, level of distress and range of movement causing back palpitation and pain will be performed.

Plan of Management

Rehabilitative exercises and proper diet and the two things involved in managing fractures and back pain. Performing stretching, ROM and isometric exercises are also helpful in minimizing back pain and gradually increasing movement over the affected area. Pay attention to your routine to prevent further bone damage. In general, a well-balanced diet and vitamin supplementation are important in getting adequate nutrition.

Prevention

Pay attention to your fitness and training routine. Make sure that you do proper warm ups and stretching before going over your reps. To prevent progressive bone loss or degradation, which increase the risk of fractures, taking preventive regimens like vitamin D, calcium and biphosphonate supplements is advised. People who have higher risks of getting hip fracture or hip injury must undergo a muscle strengthening and balance training program. This is particularly helpful to older people. Wearing hip protectors with force-diverting and force-absorbing padding makes a fine investment among the elderly.

Warning

Any type or mode of fracture demands immediate medical attention. Similarly, consulting your doctor when you experience back pain is essential in accurately determining its cause. Once you experience back pain that spreads down the legs, accompanied with numbness and tingling sensations, consult your doctor. These are common red flags of possibly more serious conditions or complications.

The 5 Trigger Points of Sciatica

Sciatica is a symptom, or group of symptoms, caused by any number of conditions which compress the sciatic nerve. The main symptom of sciatica is pain radiating from the lower back or buttocks, down the back of the thigh. Pain may travel as far as the calf muscles. There may also be associated tingling, numbness or weakness.

There are numerous conditions which may cause sciatic pain. These include a lumbar disc herniation (also known as a slipped disc, or herniated disc); spinal canal stenosis; sacroiliac joint dysfunction and piriformis syndrome.

Sciatic pain can also be caused by trigger points (T.P's) within the gluteal (buttock) muscles. This is sometimes referred to as myofascial pain.

A trigger point is also sometimes known as a muscle knot. They are hypersensitive points within a tight band of muscle which often refer pain throughout the area they are found in. T.P's can be felt as small, tender lumps within a muscle, which when compressed, often cause pain which may radiate elsewhere and a twitch response in the muscle.

What are the 5 trigger points of Sciatica?

Sciatic pain radiating into the hamstrings can be caused by trigger points found in the buttock muscles.

Sciatica caused by T.P's develops gradually with no specific point of injury; there may be a cramping or tight sensation in the buttocks or hamstrings and tenderness when pressing these muscles. There is not usually any lower back pain, walking and even running may be pain free and strength is rarely affected.

The 5 T.P's which most commonly cause sciatic pain are described here:

1, 2 & 3: Gluteus Medius

Gluteus medius is one of the three Gluteal muscles ('glutes') which form each buttock. They are responsible for extending, abducting and laterally rotating the hip joint.

Gluteus medius is found just below the Iliac crest. There are three common T.P's in this muscle which can refer pain into the posterior thigh. They are located at the origin of the muscle, all three in a row, just below the iliac crest.

4: Tensor Fascia Latae

TFL (as it is shortened to) is a small muscle found on the outer hip. It attaches to the front of the iliac crest and descends downwards to converge with the IT band on the outer thigh.

A trigger point can often be found in the superior half of the muscle, which radiates pain inferiorly, down the IT band and lateral hamstrings.

5: Piriformis

The Piriformis muscle is a small muscle found deep within the centre of the buttock. It originates from the Sacrum and crosses horizontally to the head of the Femur (thigh bone).

It is strongly associated with Sciatica as a condition called Piriformis syndrome can also cause sciatic symptoms. However, this is an actual compression of the nerve caused by muscle tension or an anatomical variation where the nerve passes through the Piriformis muscle (rather than behind it). This occurs in around 10% of the population.

This is not the same as a Piriformis trigger point which does not affect the sciatic nerve at all, but radiates the pain into the hamstrings in a similar fashion.

The most common trigger point found within the Piriformis muscle is in the muscle belly, slightly towards the insertional tendon. This trigger point will refer pain into the outer buttock and down the back of the thigh.

Trigger Point Therapy

There has been lots of research undertaken into the best treatment of trigger points. Acupuncture (or dry needling) and ischemic pressure have been shown to be the most effective.

Acupuncture is the insertion of a needle into the trigger point. The small needle is inserted into the trigger point and left in place for a few minutes. During this time, the muscle gradually relaxes and lengthens. 3-4 sessions of dry needling are usually required to eliminate the trigger point.

Ischemic pressure is the application of direct pressure to the trigger point, with enough pressure to temporarily cut off blood flow to the TP (ischemic = no blood!). The aim of this technique is to stimulate receptors in the muscle which regulate its tension, to reduce the muscle tone. This pressure also provides an analgesic (pain relief) effect due to the release of pain mediating substances. Once the pressure is released, a sudden influx of blood to the point helps to flush out any waste products and bring the required nutrients for healing.

Following either technique, it is recommended that the muscles treated are stretched thoroughly to reset the muscle spindle length.

To conclude, if you are suffering from sciatic pain which had no specific point in time when the pain first developed and you have no lower back pain, consider trigger point therapy to your glute muscles. This simple form of treatment can ease pain in a large number of sciatic patients.

Glucosamine Skin Products

Glucosamine is essential to maintain a healthy skin. Ample amounts of glucosamine in the blood are required for the production of hyaluronic acid, a substance necessary to heal skin injuries and surgical incisions. Studies conducted on the effectiveness of glucosamine on skin showed that patients who took glucosamine before undertaking a surgery and continued to take it till their incisions were healed showed faster rates of healing compared to patients who did not take it. Glucosamine is also being used to reduce the wrinkles and help the skin to stay more resilient.

The MSM/Glucosamine skin cream products provide support for healthy joint, cartilage, connective tissues and flexibility. The nutrients are encapsulated into liposomes for concentrated delivery to the required area. It has the sulfate form of glucosamine. It does not have any fragrance and is not tested on animals.

Some formulations help clear blemishes, uneven discoloration, age spots and melasma. It is an all- encompassing skin cream that eliminates unwanted pools of pigment in the skin. It contains beta carotene, azeleic acid, gluconic acid, licorice extract and glucosamine. This cream increases collagen synthesis and rejuvenates the skin.

Creams intended for removal of scars and wrinkles are reputed to produce an effect in less than 72 hours. The active ingredients present in such creams are glucosamine, Retinol, Beta Carotene, Vitamin E and Ascorbic acid, all of which are necessary for a healthy skin.

Glucosamine is also present in eye creams that are used to reduce under eye shadowing. Such creams provide a lift to the eye and reduce puffiness and sagging of the eye.

Apart from glucosamine hydrochloride the other important ingredients in several skin creams include water, stearic acid, grape seed oil, Vitamin E, hyaluronic acid and glyceryl stearate.

Research is now being conducted on a modified type of glucosamine called n-acetyl glucosamine to contain bleeding.

Diagnosing and Treating Hip Pain and Injuries

Hip pain and injuries are one of the most painful and stubborn that a runner can get. This is because there are so many types of hip injuries one can come down with, and the symptoms are all quite similar to one another.

Could it be a stress fracture? A hip stress fracture is characterized by a pain on the front of the hip that travels to the groin, back, or leg. When your hip bone can't handle the force of pounding and torque, it will develop a crack. Stress fractures develop rather easily in patients who have poor bone density, which is the result of poor calcium intake or absorption, usually caused by inadequate diet, biological changes (i.e. menopause), and disease. Stress fractures can also be caused by going too hard, too far, too soon. I hate to say, if you come down with a hip stress fracture, the only effective remedy is to take three months off of running, during which time you should do physical therapy, pool running, and swimming.

Could it be femoral acetabular impingement. This injury is characterized by an ache in the front of your hip or near your groin, which gets worse after a run. It is caused by the ball of the hip joint on being able to fit into the socket. This grinds and tears the cartilage lining within the socket. This injury usually requires eight to ten weeks of physical therapy. Sometimes surgery is needed to correct the injury.

7 Ways of Dealing With Hip Pain Without Surgery

1. Hip Specific Exercises - Hip pain can often be relieved or even eliminated completely with specific exercise routines designed to treat this particular problem. Pain in any of your joints may be an indication that the surrounding muscles are under unbearable strain. Being overweight, sitting improperly with poor posture, and a diet poor in nutrients but high in fat, calories, and sugars all contribute to pain in your joints. Exercise helps relieve this pain by strengthening the affected muscles, and improving your mental outlook.

2. Massage Therapy or Muscle Manipulation - Muscle manipulation or massage can help to eliminate pain in your joints and muscles, and also help you to relax at the same time which diminishes the pain sensations some. When your muscles and nerves are under constant tension or stay tightened up for long periods of time this can cause pain. Having a massage on a regular basis can keep your muscles relaxed and loose, and this can also be done with muscle manipulation in your hip area.

3. Biofeedback - Biofeedback has proven very effective with some people at stopping hip pain without the need for surgery. This method must be learned, and is not something that you can do on the spur of the moment. If you are willing to take the time and put in the effort to learn this method you could get considerable pain relief without drugs or invasive methods.

4. Ice and Heat Packs and Ointments - Joint pain can often benefit from either ice or heat. There are a number of ointments and patches available that can apply either ice, heat, or both to your hip joint and help to relieve pain. Some of these products alternate between a cooling sensation and heat for the best relief. These will also help relax your muscles surrounding the affected joint, which can also contribute to pain in the area.

5. Meditation - If you suffer from hip pain, or any other type of pain, then meditation can be an effective tool you can use to minimize this pain. With meditation you learn to focus and clear your mind. You will be able to minimize the discomfort you feel by focusing on other aspects instead, and clear all of the previous pain from your thoughts. Chronic pain can be devastating both physically and psychologically, and meditation can help with both of these aspects.

6. Electrotherapy - Electrotherapy can help relieve pain that affects muscles and joints. In this treatment you will receive a low dose of electricity, which will stimulate your nerve endings and cause the pain to be eliminated. Some patients swear by this method, while others may not get the best results. Some patients find the treatment a little unsettling, but it is not painful and can be a big help in stopping chronic pain before surgery is required.

7. Physical Therapy - For hip pain that is chronic or severe your doctor may prescribe physical therapy. During this treatment a combination of approaches and treatment methods are used to find out which ones work best for you. Your physical therapist will customize a treatment plan designed to eliminate your pain using exercise, relaxation techniques, whirlpool soaks, and other methods.

The Dreaded Back Pain

According to Stats Canada, four out of five adults will experience at least one episode of back pain at some point in their lives. Sometimes solace can be found in statistics, but that just unnerves me. Although four out of five adults is a huge number, there are even more alarming statistics about back pain. In Britain, an estimated 4.9 million work days are lost per year due to back pain, which translates to monetary loses of approximately 瞿5 billion a year, or roughly $8 billion (CDN).

Interestingly, Stats Canada offers some reasons that we might 'get' lower back pain, including poor muscle tone, sedentary lifestyle, obesity, smoking, poor posture and psychosocial factors (chronic stress and depression). As an Osteopath, it seems to me, that that some crucial factors have been missed, namely; muscle imbalance, postural control, sacroiliac dysfunction and digestive problems.

So how can we ensure that we are not just another 'statistic'? Well, first thing's first - let's look at what Stats Canada suggests may contribute to back pain:

1. Poor muscle tone and sedentary lifestyle.

Well, that should be pretty easy to change by joining a gym, walking more and stretching during the work-day, so why aren't more people doing it? In my practice, common excuses I hear for avoiding these simple activities are, "I work too hard to exercise" and, "I don't have enough time." Time is always a challenge, and if there genuinely isn't enough time to exercise, there are small things you can do. Rather than spending 3 hours straight at the computer, you can get up and stretch every 45 minutes or so. This will keep your joints and muscles more subtle, allow better blood flow though your body and, hopefully, make you feel like doing more. Rather than driving to the supermarket and seeing how close you can get to the entrance, make a conscious decision to park a little further away to lengthen your walk. These seemingly little efforts do add up and contribute to a better quality of life.

2. Overweight

In a few rare cases there are clinical explanations for obesity, but the vast majority of people are eating the wrong stuff at the wrong time in the wrong place. There are plenty of fantastic nutritionists out there, qualified in helping people tackle obesity. Why aren't we utilizing such invaluable resources and supports? Even a few simple changes can make a huge difference. Obesity prevention and reduction involves understanding the importance of walking at least 20 minutes per day, and recognizing that breakfast truly is important daily meal (for metabolic function), that a sugary drink is not a substitute for water, and that white bread raises blood sugar levels as quickly as eating sugar itself.

3. Smoking

Enough said.

4. Poor posture and psychosocial factors.

It is interesting that Stats Canada put these factors next to each other, as sometimes they do go hand in hand. We have all had the experience of seeing an old friend and, without exchanging words, been able to infer their emotional state. Posture and body language are reflective of the psyche. There are many psychosocial factors that can lead to a person developing back pain and many of them are under appreciated. In the western world, we are taught that the body is similar to a machine and immune to psycho-emotional influence. Many of my patients have had little or no findings on MRI or X-ray, and so the 'unspoken' conclusion by their Doctors is there is nothing wrong with them and they shouldn't have any pain. Well...they do have pain, so it must be coming from somewhere! A classical, well-accepted example of pain's psychosocial connection involves the phenomenon of phantom limbs. Many individuals with amputations have reported feeling pain in the missing limbs. Doctors accept these symptoms as real and visceral experiences, as phantom limb pain has been documented for centuries and it is understood that the pain is being generated in the brain. Through these studies of phantom limb pain, modern medicine is beginning to map the connection between back pain and psychosocial factors. (Schielp 2008)

Further Osteopathic Insights into Back Pain

There are many more reasons for back pain that Stats Canada does not list. I have highlighted 4 massive reasons for back pain that I routinely see in my clinic:

1. Muscle Imbalances

Research has shown that imbalance in hip flexor muscle length, strength, and endurance can play a role in back pain (1). Range of motion differences, in which one hip moves more than the other, have also been proven to affect the lower back. As long ago as 1964, a Czech researcher, Valadmir Janda, observed that weak gluteal muscles are significant in lower back pain (2). All these factors are reasonably easy to screen for and, unless there are multiple predisposing reasons for these imbalances, they are fairly simple to correct.

2. Postural Control and coordination

The spinal muscles should be able to contract in coordination with the other muscles of the trunk, namely the abdominals. To ensure correct muscle firing and contraction, the body relies on clear input from the eyes, ears and joints. All the information collected from these sites is processed by the brain, which enables correct muscle response to be executed. For example, if a person bumps into your shoulder while you are walking down the street (perturbation), your body should reflexively bring your trunk back to an upright, balanced position. Your ears, eyes and joint receptors provide instant feedback to your brain, which, in turn, sends out signals to the muscles in your trunk to contract and stop you from falling over. Researchers have also determined that people with chronic back pain have poor postural control. In instances of poor postural control, people may use their hips to correct movements instead of their ankles, leading to an overuse of the lower back. Also people with lower back pain showed delayed or altered muscle-firing times to perturbation.

3. Sacroiliac Dysfunction

In our clinic we have lots of people complaining about SI joint pain, a form of pain felt at the top of the buttocks on one side. Before treating for SI dysfunction, it is important to insure the pain actually originates from the SI joints, as the hip and surrounding muscles and ligaments can refer pain to that area. Fortunately, there are some simple tests we use to differentiate between these structures. Valadmir Janda worked out that the big gluteus maximus muscle can be 'switched off' if the SI joint isn't working properly. In addition to that effect, the SI joint can cause inhibition of one of the supporting muscles on the other side, the gluteus medius. He also found that this could happen in the absence of pain, so your SI joint doesn't even have to be painful for the inhibition of the muscles to happen. In addition, it has been discovered that the latissimus dorsi (the big back muscle) and the gluteus maximus work together to stabilize the SI joint. The latissimus dorsi is attached from the lower back, via the lower ribs and scapular, to the arm, so its proper function is affected by the mobility of the upper back. Since the average individual spends hours hunched over their computer, their upper back rounded and shoulders raised, it may be inferred the latissimus dorsi is negatively impacted and at the root of any SI dysfunction or pain.

4. Visceral (abdominal) Problems.

The contents of the abdomen, stomach, liver, intestines etc, are all attached to the spine. In fact, the spine acts as a bony scaffold that gives support to all those structures. As the back moves, the abdominal contents must also move. If the structures are not mobile, whether due to surgical scarring or internal adhesions, they can prevent the back from moving optimally. This leads to areas of stiffness in the spine and concomitant areas of hyper-mobility. The hyper-mobile areas of the spine are prone to overuse and injury and are commonly at the heart of complaints brought to Osteopaths. Clients will experience the pain as originating from their backs, which is true to an extent, but an Osteopath will recognize that the source of their discomfort lies in the abdomen. These abdominal adhesions can be helped with gentle visceral manipulation, freeing up the organs and reducing the load carried by hyper-mobile spine areas. Once visceral problems have been addressed, the body will be capable of repairing any damage to the back/spine and the associated pain will dissipate.

Treating Back Pain Through A Whole-Body Approach

Popular medicine addresses and successfully treats many causes of back pain, but, as reflected by Statistics Canada's areas of focus, other crucial sources are frequently overlooked. An Osteopath will not only consider the usual suspects, namely poor muscle tone, sedentary lifestyle, obesity, smoking, poor posture and psychosocial factors, but will approach the symptoms of back pain from a more holistic perspective. Back pain may be intimately connected to any of the above conditions, but, often, such broad diagnoses fail to recognize the intricacies of the body's systems. Through acknowledging the interconnection between muscles, connective tissue, the nervous system, viscera (organs), and the structural skeleton, an Osteopath is able to thoroughly comprehend and successfully treat the various elements that inform and contribute to back pain.

(1)Nourbakhsh, M.R, and Arab, A.M. (2002) Relationship between mechanical factors and incidence of low back pain. J Orthop Sports Phys Ther 32 (9): 447-60.

(2)Janda, V. (1964) Movement patterns in pelvic and thigh region with special reference to pathogenesis of vertebrogenic disturbances. Thesis, Charles University.

(3) Byl, N and Sinnot, P.L. (1991) Variations in balance and body sway in middle aged adults: Subjects with healthy backs compared with subjects with low back dysfunction. Spine 16:325-30