Achilles tendinitis is an inflammation of the Achilles tendon. Athletes whose sport involves running and jumping are at risk of developing Achilles tendinitis.

The Achilles tendon is the common tendon for the gastrocnemius and soleus muscles. The gastrocnemius and soleus muscles are commonly called the calf muscles and are involved in the action of planter-flexion (pointing of the foot towards the floor).

Indications

• History of change in training habits
• Tight Tendon Achilles
• Heel alignment may be in varus
• Localised tenderness and swelling in tendon

How is Achilles tendinitis treated?

• Stretching exercises
• Custom orthoses to alleviate overpronation caused by tibia varum or subtalar or forefoot varus
• Stretching of TA
• Cross-training

Achilles tendon rupture can occur during:

• Pushing off with the weight bearing forefoot while extending the knee
• Sudden unexpected dorsiflexion of the ankle
• Violent dorsiflexion of the plantar flexed foot as in a fall from a height

Achilles tendon rupture most frequently occurs in middle aged athletes in the 3rd decade of life.

Indications

• Palpable tendon defect
• Inability to do a toe-raise on the affected side
• Simmonds squeeze test

If I am an athlete am I better having surgery or casting?
Surgery allows for competitive activity to begin earlier with a lower re-rupture rate.

Over the past several decades, reduction in fat intake has been the main focus of national dietary recommendation. In the public’s mind the word “dietary fat” has become synonymous with obesity and heart disease, whereas the words “fat free” and “low fat” have become synonymous with heart health. In response to the low fat campaign, the food industry has produced numerous commercial products labelled as “low fat” or “fat-free” but with high amounts of refined carbohydrates and sugar. Ironically, while dietary fat intake has declined over the years, total caloric intake has not.

But to tell the whole story the body needs fats to function. Dietary fat carries fat-soluble vitamins – vitamins A,D,E and K- from your food into your body. Fat also helps your body insulated and provides a sense of fullness after meals (satiety).

Fat is also an energy source and used in the production of cell membranes, as well as in several hormone-like compounds called eicosanoids. These compounds help regulate heart rate, blood pressure, blood clotting and the nervous system.

There are three main types of fats: Saturated, Unsaturated and Trans

* Saturated fats are usually hard at room temperature and come primarily from animals except coconut and palm oil.
* Unsaturated fats (mono- and polyunsaturated) are usually liquid at room temperature and come primarily from vegetable oils and oily fish.
* Trans fats are man made and often found in cookies, biscuits and margarine

spreading the risk of disease?

 

Saturated and Trans fats (the so called “bad fats”) increase the risk for certain diseases. Saturated fats are mainly animal fats and Trans fats are fats produced by heating liquid vegetable oils in the presence of hydrogen, this process is known as hydrogenation. Most Trans fats are found in commercially prepared baked goods, margarines, snacks foods and processed foods.

Unsaturated fats are divided into monounsaturated and polyunsaturated fats (the so called “good fats”) and when eaten in moderation and used to replace Saturated and Trans fats can help to lower cholesterol levels and reduce risk of heart disease.

Bottom line

It is important to remember that all fats are not bad and you should aim to have around 15% of your daily calorie intake in the form of healthy fats. For cardiovascular health limit your intake of Saturated fat and try to avoid Trans fat. In general the best sources of fat are those from natural sources like those found in fish, olive oil, nuts and avocados.

Anylosing spondylitis is a seronegative spondyloarthropathy with a prevalence of 2:1000 in Western Europe. Males are affected more than females between 2:1 and 10:1. There is a genetic predisposition with HLA-B27 found in 90% of patients and 50% of their relatives.

Indications

• Gradual onset of backache and stiffness in an adolescent or young adult, recurring at a number of intervals over a number of years
• Pain may be referred into the buttock and be confused with sciatica
• Early in the disease process there is little to find on clinical examinations apart from slight loss of lumbar lordosis, limitation of extension of the spine and SI joint tenderness.
• Later patients have the characteristic posture
• Loss of lumbar lordosis, thoracic kyphosis, forward thrust of the neck and flexed hips and knees
• In advanced cases the entire spine may be completely ankylosed
• Chest expansion is often markedly reduced

Balancing Your Food Groups

Good nutrition is critical if you wish to perform at your best. For example when exercising, you must provide a supply of quality energy to your working muscles.  The easiest way to do this is to eat a variety of high-quality foods throughout the day, starting with a balanced breakfast.

A balanced diet can be demonstrated through the ‘Eatwell plate’ or ‘MyPlate’ graphic which gives a clear indication of how much of each food group you should be eating.

Fruit and vegetables

Fresh fruit and vegetables should make up at least one third of your daily diet and can be eaten with every meal, or in place of a snack.  You should always try to “get your 5 a day”, as it has been shown to reduce the likely hood of developing certain cancers, diabetes and coronary heart disease.

Starchy carbohydrates

Bread, rice, potatoes and pastas that are rich in starchy carbohydrates should make up another third of your diet.  Carbohydrates are the body’s main source of energy so you should try and base your meals around these foods, they give you a slow release of energy through the day, making you less likely to snack.

The final third of the ‘Eatwell’ plate contains all the other parts of a balanced diet that are important for normal health; milk, meat, fish, eggs, beans and foods high in fat or sugar.

These foods should be eaten in moderation because of the high saturated fat content, but do contain the mineral calcium that is important for bones and teeth.

Meat, fish and eggs

This food group is high in protein that is required for repair and growth of all cells.  But they only provide the body with between 10 and 15 percent of its daily energy, so look to have plenty of carbohydrates to provide quality calories for your energy.

Foods and drinks high in fat and sugar

Fast fix energy drinks and junk foods should be consumed sparingly because they contain very few nutrients and are often known as ‘empty calories’.  These foods are high in unhealthy components such as saturated fat, trans fatty acids, sugar and salt all of which can increase your risk of developing heart disease and obesity.

Bringing balance to your food groups can be difficult and may require you to change your eating habits dramatically.  But the health benefits can be noticeable even after a few weeks, with increased energy, smaller appetite and some weight loss.

Of course it doesn’t require you to make your dietary change immediately, you can bring it in slowly, trying new foods and balancing the essential nutrients, as you grow more confident.  But I hope that when you next look at your plate, it will make you think more about what you are putting into your body.

Are you training for a “trail run”? If you are there then it is important to also incorporate functional movement exercises as part of your training. This will build core strength and to help maximize your endurance and performance.  Activities like swimming and spinning are also excellent activities as they are non-weight bearing and target other muscle groups that might otherwise be ignored by running alone. Also remember that strengthening muscles around your joints will help reduce the chance of injury.

When training and during a race keep well hydrated….. and while on the subject of nutrition remember to take the right amounts of protein and carbohydrates this will give you the right energy for training and recovery.  With this in mind consider additional protein shakes, they are a convenient source of energy and is easy to fit into your daily intake.

The night before the big race, get plenty of rest; sleep is essential for your body to recover as well as your general well being and will help to give you the “right edge” to compete.

These few tips will help you enjoy your “trail run”

Good Luck.

Carpal tunnel syndrome is the entrapment of the median nerve within the carpal tunnel of the wrist.

Anatomically the carpal tunnel is formed by all the bones in the wrist. The tunnel is deepened by the tubercles of the trapezius and the scaphoid on the radial side and by the pisiform and hook of hamate on the ulnar side. The roof of the tunnel is formed by the tough flexor retinaculum, stretching between the tubercle of the scaphoid and the ulnar styloid. The eight flexors of the fingers, the long flexor of the thumb, and the median nerve travel through the carpal tunnel.

Generally women are more prone to carpal tunnel than men (2-5F:1M) usually in the 3rd and 6th decades of their life. The dominant hand tends to be affected more regularly and approximately 32-50% of people have symptoms in both hands.

Indications

• The hand may look completely normal
• Painful tingling in one or both hands during the night
• Tingling may occur in the thumb, index and ring fingers
• Reduced grip
• Occasionally the muscles at the base of the thumb (thenar eminence) may waste
• There may be weakness of thumb abduction
• Difficulty in performing activities for example tying shoe laces
• Positive orthopaedic test (phalen's test)

Am I at risk of developing carpal tunnel syndrome?
Research has identified certain conditions as being linked to carpal tunnel syndrome, these include:

• Colles fracture, Cushings syndrome
• Rheumatoid arthritis
• Acromegaly, amyloid
• Myxoedeoma, mass, Diabetes Mellitus
• Pregnancy
• Sarcoidosis, Systemic Lupus Erythematous

Cauda Equina Syndrome occurs when the nerves within the spinal canal have been damaged. As a result, the nerves supplying the muscles of the legs, bladder, bowel and genitals do not function properly.

The cauda equina is protected by vertebrae, however, it is still vulnerable to damage commonly by osteophytes (bone spurs), tumours and central disc herniations.

Indications

• Bilateral leg pain or sensory disturbances
• Perianal, perineal and saddle anaesthesia
• Urinary and/or faecal disturbance
• Low back pain
• Significant bilateral motor deficit
• Sexual dysfunction

If I notice any signs of Cauda Equina Syndrome what should I do?
If you notice any signs of Cauda Equina Syndrome especially urinary of bowel disturbance in accompaniment to low back pain, you should attend A&E for a medical assessment.

A cervical disc herniation is similar to a lumbar disc herniation with the nucleus pulposus protruding through the annular fibrosus. Cervical disc herniations are more common at C5, C6, and C7 unilateral and posterolateral. Disc herniations are commonly caused due to trauma for example during lifting. Rugby players commonly present with cervical disc herniations. Cervical disc herniations can occur due to degenerative changes if the onset is slow while patients with forward head posture are predisposed.

Indications

• Numbness or pins and needles in either or both arms
• Weakness in either or both arms
• Reduced or absent reflexes in either or both arms
• Increased pain with compression
• Alleviated by extension or side bending to opposite direction
• Worse with coughing or sneezing

Does traction help?
Traction is a method of helping relieve the symptoms of nerve compression. It is a skill which should only be practised by trained therapists.

How often is surgery required in cervical disc herniations?
Surgery is required in approximately 20% of cases. Cases requiring surgery are unresponsive to conservative management, extreme pain and neurological signs.

Cervical spondylosis is the non-specific degenerative process of the spine, which may result in varying degrees of stenosis of both the central spinal canal and root canals.

Contributing factors include:

• Degenerate disc
• Osteophyte
• Hypertrophy of lamina
• Articular facets
• Ligamentum flavum
• PLL
• Loss of cervical lordosis
• Vertebral body subluxation
• Cervical spondylosis occurs after the 3rd decade of life most commonly at C5/C6 and C6/C7.

Indications

• Pain
• Stiffness
• Symptoms come on gradually and are worse on getting up in the morning
• Pain radiation
• Occiput
• Back of shoulders
• Down the arms

Pain may be accompanied by:

• Paraesthesia
• Weakness
• Clumsiness in arms and hands
• Appearance normal
• Muscles at back of neck and scapulae are tender
• Neck movements limited and painful

How may cervical spondylosis be treated conservatively?
Conservative treatment may include: medication, heat, active range of motion and gentle stretching, submaximal isometrics if tolerated, patient education and postural exercises

Obesity during childhood has a profound effect on a child’s development and can severely impact on health, causing a problem is joints and bones.  Obese children can suffer from teasing by their peers, stereotyping which can lead to emotional problems such as low self-esteem and depression.  In addition obese children are more likely to become obese adults, increasing the risk of serious health problems such as heart disease and strokes.

The reasons for increased obesity in children are as much a part of the behavior as it is nutrition and simple measures can help to combat childhood obesity.

• Aim to increase your child’s intake of fresh fruit and vegetables.

• It is unlikely that you can monitor what foods they eat during the day, so make sure that breakfast and dinner are healthy meals.

• Sedentary behaviour should be limited, cut the amount of TV, Internet and computer time down to 7 hours a week.

• Include the child in physical activities, such as after school football, activity clubs, the scouts, and guides.  These are great extra curricular activities that will encourage them to become more active.

As a child becomes more active, they will naturally have more energy and enjoy life more, which is what every parent wants.  If you have any questions concerning weight management, or would like more advice, consult your doctor.

Coccyx pain is not uncommon and can be caused by a heavy fall on the base of the spine or over stretching of the ligaments and tendons.

indications

• Deep ache around the coccyx
• Pain on moving from sitting to standing
• Shooting pain down the leg
• Pain on defecation

If you go to a gym and eavesdrop on some conversations near the weights about supplements and protein shakes, you’re bound to hear the word creatine come up.  Creatine is a naturally occurring amino acid in the body that helps to supple energy to the cells in your body, especially your skeletal muscle, with 95% of your creatine being store in your muscles.  The presence of creatine in your muscles means that your muscles get plenty of energy when they need it.

What it does

An abundance of creatine is especially important when you’re working out or doing exercise.  It helps your muscles to be as efficient as possible, allowing you to work out harder and longer than you may otherwise.  This contributes to building more muscle mass if you’re doing body building-type exercises.  For this reason, this amino acid has become very popular among body builders, weight lifters, and those on a high-fitness regime, such as road cyclists or runner.

How you get it

Being stored in muscle, the best supply of creatine is in meats.  This amino acid is in all vertebrates, so every type of meat will have some amount of creatine in it, though herring, pork, salmon, and beef have the highest amounts.  It is also found in milk and cranberries, but not as much.  For this reason, vegetarians often have far lower levels of creatine in their bodies than meat eaters, though your body produces over half of your creatine naturally.  Creatine is also available as a supplement, often as a powder.

Any side effects?

Creatine from natural sources (food) has no ill effects; it is the supplements that may give some cause to worry.  Though creatine is often considered to be a safe supplement, any ingested product will likely have some side effects.  In addition, there’s limited systematic research done on creatine to confirm it is entirely safe to use.  Any type of supplements should always be taken under the guidance and supervision of a qualified health professional.

The first side effect many people notice is weight gain.  This is due to increased muscle mass but also the water gain as creatine attracts water to the muscles.  This shift of water in the body is thought to be responsible for other side effects, including nausea, dizziness, diarrhoea, and dehydration.  Long-term effects of this can include kidney problems, hypertension, stomach cramps and muscle cramps.  Some research has been conducted dispelling this shift of water and electrolytes in the body, but this has not convinced many researchers.

Though creatine is often considered safe, it can have some of the same side effects as anabolic steroids.  Studies have shown that a 2-week course of creatine shows up to a 40% increase in the amount of dihydrotestosterone.  Like the better-known testosterone, this male sex hormone contributes to feeling of aggressiveness, baldness, or excessive hair growth in women.

Alternatives

While creatine may seem like a great idea, remember there are still side effects.  If you’re able to achieve a healthy body shape and fitness level without the use of supplements, this is always recommended.  Another time we’ll have a look at some of the other ways you can achieve stronger muscles and higher fitness tolerance.  In the meantime, what are some ways you like to maintain your muscles?

Cubital Tunnel Syndrome (CTS) is the entrapment of the ulnar nerve at the elbow. Cubital tunnel syndrome can be related to a history of throwing activities. The ulnar nerve at the elbow can be entrapped by bony growths, swellings or pressure from soft tissues.

Indications

• Dull ache in forearm
• Intermittent pins and needles or numbness in the ring and little fingers
• Wasting of the base of little finger (hypothenar eminence)
• Wasting of the 1st dorsal interosseous
• Weakness of abduction of little finger
• Positive orthopaedic tests (Tinel's test)

Can I be treated without the need for surgery?
Yes, non-surgical treatment involves: rest, ice, anti-inflammatories, and muscle release techniques. If non-surgical treatment does not resolve the symptoms surgery may be indicated.

De Quervain's Syndrome is an inflammation of the tendon sheaths as they pass under the extensor retinaculum in the wrist.

The most commonly affected tendons include:

• Abductor pollicis longus
• Extensor pollicis brevis

Inflammation results from friction between the tendon and sheath and the extensor retinaculum in the wrist.

Indications

• Aching and discomfort over the radial styloid process (under thumb)
• Pain aggravated by movements of the thumb and wrist especially tilting the wrist in the direction of the little finger
• Swelling at base of the thumb
• Positive orthopaedic test (Finklestein's Test)

Everyone knows that exercise is good for you.  It improves your cardiovascular health, stress levels, and helps to maintain a healthy weight.  However, exercise also helps your mind to stay sharp and focused especially as you get older.

Exercise benefits your brain in the same way it benefits the rest of your body.  It increases blood circulation, allowing for more oxygen and glucose to reach your brain.  The oxygen is necessary to keep the cells alive and the glucose is used as an energy source for your brain cells to munch on.  The increased need for oxygen causes you to breathe deeper and more often, getting your lungs in good shape.  Good circulation also means any waste can be taken away from your brain quicker.

While it might not be news that exercise is good for your mind, two new studies have recently been published that have helped to cement the notion that lifelong exercise can reduce the risk of both Alzheimer’s and dementia.

In one recent study, adults aged 45-88 were asked about their physical activity over the last 10 years.  They all then had a brain scan that detected the presence of a specific protein linked to Alzheimer’s.  The scans indicated that those who exercised had significantly fewer protein deposits than those who never exercised.  Some people naturally have more of the protein deposits due to their genes; those who exercised showed as little protein build-up as those who exercised and did not have this gene.

A similar study asked older participants about their level of mental activity at different ages, from childhood to adulthood.  They found that those who were mentally active throughout their life have fewer protein deposits that can lead to Alzheimer’s than those who did not consistently read, write, or play mentally challenging games.

For you brain to receive the benefit of exercise, it doesn’t even need to be strenuous.  Increased activity of at 30 minutes a day can make a difference by getting your heart pumping and keeping your brain supplied with fresh blood.  Low-impact activities such as walking, gardening, yoga, or bicycling are great if you’re not able to do the higher intensity exercise, such as running or aerobic classes.  Anything will help, so long as your heart starts pumping!

Physical exercise isn’t the only type of exercise to consider.  Mental exercises can also keep your mind stimulated and your brain cells engaged and working hard.  Different types of mental activities, such as reading, memorisation games, or even doing activities with your non-dominant hand all help you to exercise different part of your mind and keep you clearheaded and focused.

Like anything else, brain exercise is coupled with a brain diet.  The AARP recommends various foods that can be included in your everyday diet to ward off Alzheimer’s and dementia.  These include olive oil, nuts, fish, poultry and veggies such as broccoli, cauliflower, cabbage and tomatoes.  Eating less red meat, butter and high fat dairy products also appears to have an impact on your brain health.

We are all making plans for the New Year;… new resolve for success in areas that we have not achieved, career, love and often health. The problem is that the enthusiasm to make real changes tends to fade once we realize that success does not happen overnight. To make these resolutions a reality, look at your attitudes to exercise, fitness and health.

While joining a gym will get you started it will only work if you continue to go and enjoy it! Many look at exercise as a punishment for eating the food they love or as a boring obligation. This can be a difficult cycle to break and we give ourselves excuses for not exercising, “it’s time consuming, its painful it’s not working”.

The most important aspect of exercise is to enjoy yourself! By immersing yourself in the exercise it allows time for your mind to rest, a break from the working day. The improvements to your health, wellness, and energy levels are an additional benefit of exercise.

Victory has a thousand fathers…

• Willpower alone will not change your attitude. Long-term success comes from proper planning, discipline and the rewards that come from finding new challenges everyday.

• Find a plan that works for you and try to follow it while being realistic that our lives evolve and so must your diet, your exercise and your attitudes to health.

• You must have a goal! Set your goals out by writing them down, (do not write down; “lose weight”) put how many miles you want to run, or kilos you want to lose and when your going to achieve this.

Success and how to enjoy it!

• Tell people about your plans and get them involved, it’s much easier if you have someone to support you and nag you, to push yourself.

• With your goals written down, make sure that every time you succeed you reward yourself, get new a sports watch, gym shoes or even an ipod! Congratulate yourself every time you exercise, never forget that you are the winner.

• Mix things up by changing your exercise routine, and revisit your goals. Examine why you started exercising again, how much progress you have made and what improvements can be made to your exercise.

Eventually your planning and commitment will pay off and you’ll start to see real improvements. Whether you wanted to run for charity, fit into your old clothes or have more energy, as long as you keep these goals in sight they will happen.

John F Kennedy committed to putting a man on the moon, he didn’t do it alone and it didn’t happen over night. It took planning, commitment, dedication and taking pleasure from the success. So remember why you are making your commitments to exercise in the New Year;

“not because they are easy, but because they are hard,”

How Can Lose Pounds without Watching Your Pennies? Feel like a Million Dollars without Spending a Cent?

At this time of year we are all looking to save a few pounds, whilst “trying to shed a few too”.  But staying fit doesn’t have to be costly; “you can keep fit on a shoestring!”

Garage sales and eBay can give you access to inexpensive sports equipment that others have given up on.  Dumb-bells are a good buy as they don’t cost much and can be used in different parts of your work out.  Also look out for chin up bars, pushup bars and sit-up bars.  These are usually inexpensive and effective exercise equipment.

Also don’t forget an exercise mat to perform exercises like; pushups, squats, lunges, bicycle crunches and back extensions, combined this with jumping jacks, side steps and knee lifts this is great for your cardiopulmonary system.

Resistance bands are another great inexpensive piece of equipment.  Unlike dumb-bells where your body is working the weight against gravity, you pull against the resistance of the band.  This can be worked into hundreds of different exercise routines, which will not just tone but also build muscle.

There is often a history of an unguarded movement. Tropism is an asymmetrical articular facings which predisposes to facet joint syndromes.

Indications

• Young adult
• Engaged in bending and/or lift activity
• Severe back ache and/or sciatica
• No neurological symptoms
• Pain relieved:
  • Rest
  • Manipulation
  • Exercises

• Pain with:
  • Hard work
  • Standing or walking
  • Increased sitting periods

• Muscle spasm
• 'Locked back' released by manipulation
• On examination
  • Range of motion can be restricted
  • Pattern of movement changed
  • SLR reduced
  • Neurological exam normal

What can be done to treat facet joint syndrome?
Manipulation of the lumbar spine is a highly effective method of treatment.

Can facet joint syndrome mimic other conditions?
A facet joint syndrome most commonly can mimic a herniated disc subsequently expert examination is required to make this distinction.

A few weeks ago l wrote about press ups, a great form of exercise that is simple, takes up very little space and can be part of your new year’s resolution to get fit.  Hopefully you’re starting to see the press up benefits, but maybe your waist line isn’t slimming down?  Rather than the traditional sit-up, try crunches.  While sit-ups work a broader range of abdominal, side, and back muscles, crunches focus more on the abs- trimming fat off your stomach, adding definition to your abdominal muscles and strengthening your core muscles.  Core strength is very important as it can help to prevent serious injury as you intensify your exercise regime.  By maintaining high core strength, you not only reduce your chances of sports related injury but also help to prevent hernias and spine-related problems later in life.

The Basic Crunch

This is the basic crunch; it will help to firm up your upper abdominals.

• Start by lying on your back, with your knees bent, feet flat on the floor and your hands crossed on your chest.  Don’t put your hand behind your head as this can cause you to pull on your neck rather than using your abs to pull yourself up.  It may seem like a shortcut, but all you will end up with is a pain in the neck!

• Now slowly raise your upper back up using your abs while pressing your lower back to the floor keeping your head and neck straight.  Try and be as controlled and smooth as possible, maintaining control across the entire range of motion, don’t cheat yourself!

• Perform at least 20-25 repetitions before resting for 90 seconds, then perform another 2-3 sets with a 90 second rest between each set.

The Reverse Crunch

These exercises will focus on the lower abdominals. When combined with the basic crunch, will give you the flat stomach of your dreams!

• In the same position as the basic crunch, start by lying on your back with your arms along either side of you.  Keep your back straight and your head on the floor to aid balance, and avoid injury to the neck.

• Lift your knees above your chest, with your ankles crossed, then slowly raise your hips about 2 inches off the floor.  Aim to perform this action smoothly while maintaining your balance. Now hold this repetition for about 3 seconds, before lowering your hips and legs down.

• Perform about 20-25 repetitions of this movement before taking a 90 second rest after your first set, then attempt to achieve 2 to 3 more sets.

When doing crunches, you may find that your breathing is a bit more difficult than with other exercises.  During normal, quiet breathing you use your diaphragm and abdominal muscled to breath, sometimes called stomach breathing.  Obviously, this is harder to do you’re crunching you these muscles.  Warming up with some trunk twists and stretching will help you control your breathing and allow you to maintain better control during each set.

Like the press up, crunches doesn’t require much space or equipment.  It’s fine to do them on the floor or any stable surface that will support you back.  As with any exercise, a healthy diet will go a long way towards achieving your goals. Carbohydrates and protein combined with a lower fat intake will give you a slow release of energy and the materials to build muscle.

Frozen Shoulder (Adhesive capsulitis)

Frozen shoulders occur in patients over the age of 40 years of age. In most cases the patient cannot identify a specific cause for the pain and stiffness.

Frozen shoulder consists of a three phase process incorporating:

• Acute inflammatory stage
• Stiffening phase
• Thawing phase

The presentation of frozen shoulder is dependent upon the presentation stage.

• Significant loss of active and passive range of motion
• Abduction, external and internal rotation are limited
• Flexion of the shoulder is least affected
• Pain interfering with sleep

Are there any conditions which predispose a patient to a frozen shoulder?

• Diabetes,
• hyperthyroidism,
• myocardial infarction
• lung disease

all  predispose one to a frozen shoulder.

Golfer's Elbow or medial epicondylitis is defined as an inflammation at the insertion (medial epicondyle) of the muscles involved with wrist flexion and the pronator teres.

Inflammation at the medial epicondyle occurs following repetitive sporting activities or occupational activities involving wrist flexion and pronation. Sports involving throwing as well as golf may cause this condition. Occupations involving over head and forehand strokes may precipitate 'Golfer's Elbow'.

Indications

• Tenderness at medial epicondyle (inside of elbow)
• Pain with resisted wrist flexion and pronation
• Pain or weakness on gripping
• Positive orthopaedic test (reverse Mill's Test)

Can other disorder's coexist with 'Golfer's Elbow'?
On occasion an ulnar nerve disorder can coexist with 'Golfer's Elbow'.

What is done initially with 'Golfer's Elbow'?
'Golfer's Elbow' is always treated initially with non-operative management using rest; activity modification, non-steroidal anti-inflammatory drugs (NSAIDs), physiotherapy; brace; steroid injections.

Well… you have really out done yourself this,… you have the “mother” of all hangovers… and you feel awful. Beside that you can’t remember 85% percent of what happened the night before and you don’t know who to apologize to first. But first you have to get rid of this pounding out of your head!!

DOES THIS SOUND FAMILIAR…

P.G Wodehouse the brilliant author and drinker noted that there were 6 types of hangover, from “The Broken Compass” to the “Gremlin Boogie”! This is just a bit of fun… and not scientifically proven, here are the types of Hang-over and Treatments.

• The Broken Compass – a feeling of utter indecisiveness and self-pity sets in.

Consume spicy comfort food until physiological funk dissipates, reigniting your passion for life.

• The Sewing Machine – a sadistic hangover with all the charm of a sewing machine in use on your temples.

Rehydration is the key along with comfort food from the house of Elvis Presley.

• The Comet – enveloped in a fuzzy vapor feeling disconnected with the world.

Get up and get out!  Just be careful crossing roads, answering emails and making toast.

• The Atomic – your insides are vaporized leaving nothing but a smoking crater.  May feel isolated like a South Pacific atoll.

Visit to the kitchen to make a full English breakfast; gigantic proportions should make you feel less flattened.

• The Cement Mixer – your insides are twisted inside out and around and around.

Tea, toast, newspaper and good conversation is the call.

• The Gremlin Boogie – your head feels like your swimming in a dark immobile sludge at the bottom of deep trench.  A real ‘never drink again’ hangover.

Get plenty of fruit, ham and purity on your plate.

Everything Else

Ease yourself into the day with a long walk or some light exercise; moving around maybe the last thing on your mind, but it really can work wonders.  If this sounds far too energetic then try and get some rest.  And when all else fails, a soak in the bath and a book might just be the ticket to get you back on the road to recovery.

Rehabilitation

Unfortunately there is no known cure, but try and get some sleep, some hearty food and an early night and remember that when you say “l will never drink again”, you won’t,…… well not until next time!

Happy and Healthy New Year

A vertebral disc comprises a gelatinous inner nucleus pulposus with a fibrous outer annular fibrosus. A herniated disc is caused when the nucleus pulposus protrudes through the annular fibrosus. With age the vertebral disc becomes inelastic meaning a disc herniation beyond 50 years of age extremely unlikely. Most disc herniations occur during the 3rd and 4th decades.

Disc herniations are classified as: bulging, protruding, extruding or sequestered. Bulging and protruding disc herniations have an intact posterior longitudinal ligament. A sequestered disc herniation has a disrupted posterior longitudinal ligament with disc material within the epidural space.

The most common area in the lumbar spine for disc herniation is between L5-S1, with 90% of herniations occurring at this level. Disc herniations tend to occur in the morning due to alteration of the disc during the night and day. An extreme form of disc herniation is termed 'Cauda Equina Syndrome' which presents a neurological emergency requiring immediate hospital admission.


Indications

• Sharp, excruciating pain in low back with or without leg pain
• Leg pain is in the distribution of affected nerve root
• Pins and needles or numbness in distribution of affected nerve root
• Previous history of low back pain
• Pain aggravated by flexion, coughing, sneezing, defecating, sitting, driving, and walking
• List to one side on bending forward
• Antalgic gait
• Reduced lumbar movement

If I have a disc herniation do I need surgery?
Each disc herniation is taken upon its own merits and a decision is taken based upon the presentation. Approximately 80% of patients with disc herniation, respond to non-operative treatment.

THE FOOTBALL ASSOCIATION MEDICAL SOCIETY (SE)

The next meeting of the Football Association Medical Society (SE) will be held on the 4th Floor at the London Independent Hospital, 1 Beaumont Square, Stepney Green E1 4NL on Monday, 18th February 2013 at 19:00 with the programme organised by our Chairman, Dr Imtiaz Ahmad (Tottenham Hotspur FC & Millwall FC).

Directions: Stepney Green (District & Hammersmith). Cross Mile End Road, turn Left. Then Right at White Horse Lane, next Right. The Hospital is at the bottom of the road.


Injections in Football - book now

18:50    Doors Open & Buffet

19:10    Introduction from the Chairman – Dr Imtiaz Ahmad

19:15    High Volume Injections

Dr Otto Chan, Consultant Radiologist

19:45    PRP Injections

Dr Ralph Rogers , Sports & Musculoskeletal Physician

20:15    BREAK

20:30    Prolotherapy

Dr Usamah Jannoun, Sports & Musculoskeletal Physician

21:00    Questions  

21:30    Finish

Meeting costs £20 if non member.  To renew membership please contact Alastair Rattray directly.

Alastair Rattray, Secretary,  22 Hardinge Avenue, Southborough, Tunbridge Wells TN4 0TU. 



Alastair Rattray (Secretary)

E-mail : This e-mail address is being protected from spambots. You need JavaScript enabled to view it         

Tel : 01892543588          (mob 07770851945)

A few weeks ago l encouraged you to make a start on your new exercise regime using running as an example, in the article Exercise is your New Years Resolution! This week I want to explain how important different exercises are to build up your strength.

Not only should strengthening your muscles make exercise easier, it protects the body from injuries.  This week I am going to look at how to get the most out of one of the most over looked exercises that you should be doing The “Push Up”

Push-ups may look simple in comparison to weight training machines, dumbbells and kettle bells, but they are the most convenient way there is to build up your chest, shoulder and arms. The average push up is performed sloppy without any real effort, which is a terrible thing!  Not only are you not benefiting from one of the best all over workouts it quickly becomes a chore, without any thought.

The Key is the Secret…

Start off by making sure that your hands are two to four inches wider than your shoulder width apart, the tips of your fingers should be inline with the tops of your shoulders.  In a “full push up” your back and legs are straight and off the floor.

• If you are new to doing push ups or haven’t done them in while, start with your knees on the floor.

• Now slowly lower your chests down towards the floor, counting down from one to three, then explosively push back up, with an aim to complete 10 repetitions.  Make sure that the movement is a smooth motion, controlled all the way from the ground up and back down again.

When you can successfully complete this push up with your knees on the floor, use the same technique with a standard push-up and you should really feel the difference!

Expanding your technique

When you have got the basics down, it will be time to introduce new functions into the push up to target different muscles.

Using a sofa or exercise ball to elevate your knees higher can and is a great expansion to the push-up, increasing the resistance on each push.

Moving the hand position will make the biggest difference to your push-up.  By moving the hands further apart you’ll focus the exercise on the chest, bringing the hands together will work out the arms. Raising one hand by 10-20 cm will really work out your arms, chest and abdomen.  “Weight shifting” as this technique is called, is intense and should only be done when you’re able to control your push-ups effectively.

The lateral collateral ligament prevents gapping of the outside of the knee. The mechanism of injury for damage to the lateral collateral ligament involves a force causing the knee to adduct, drawing the tibia towards the tibia in an inwards direction.

The ligament can be damaged so that it ruptures, partially ruptures or merely sprained. On occasion a small part of the head of fibula is pulled off (avulsion fracture) when the ligament ruptures. The treatment as such reflects the degree of damage. A strain of the lateral collateral ligament can heal slowly. It is common for pain to carry on for approximately two months. Recovery from a lateral collateral ligament sprain is expected.

Indications

• Swelling and bruising on the outside of the knee
• Tenderness of the lateral collateral ligament
• Gapping of the outside of the knee on examination

Can other structures be damaged along with the lateral collateral ligament?
On occasion a server force can cause damage to the common peroneal nerve causing foot drop and sensation changes in the foot.

This week you may have read in the newspaper meal made with love and affection tastes better. If you are convinced that nobody, but nobody, makes Sunday Lunch like your mum or Dad’s fry-ups are the best, you’re not alone. A recently published journal provides the evidence for why your taste buds are tantalized by home cooked food and repulsed by grub from the local greasy spoon.

A study published by the journal of Social Psychological and Personal Science described how our perception of food and pain is affected our relationship to the individual who is serving the food or care. Food cooked by a loving grandmother tastes better and being cared for by a sweet-natured nurse reduces your pain more. So it comes as no surprise that marketing people go along way to making us feel at home when selling us food, such as gravy, cornflakes and tea.

Researchers at the University of Maryland explain this phenomenon and how it relates to pain. Professor Kurt Gray attributes our interpretations of someone’s intentions alters how we view and perceive the world around us. He goes on to say ‘it seems we also use the intentions of others as a guide for basic physical experience.’

This explains why everyone’s grandmother makes the best cakes and why we demonize the person who steals the last parking space!

So how can this help you with exercise or weight control? The relationship between our perceptions that control our motivation and the sense of enjoyment can be used to help you achieve your goals. Exercising and dieting alone can make for difficult progress, it is better to share this with someone you trust, who is fun and will have a similar motivation to you. Not only will this create a social benefit to your exercise regime, it has also been found that group exercise can help to keep you on track.

If you are dependent on yourself for motivation and inspiration, it can be difficult to bring yourself to the gym. You may start to feel badly about yourself, which may have a downward spiral on your motivation. Without an additional kindly person to help you along, all your negative thoughts are directed onto yourself and your focus becomes your pain as opposed to the all the benefits.

Cycling or running may not compare to Grandmother’s apple pie, but enjoyment comes in many different forms. Try to do what you love and the rest will come easily!

Lumbar radiculopathy is the entrapment of the nerve root which emanates from the spinal cord. Lumbar radiculopathy occurs due to pressure on the nerve root via a number of pathologies:

• Disc herniation
• Subluxation
• Osteophyte growth
• Space occupying lesions

Indications

• Pain in the leg
• Pins and needles and/or numbness
• Muscle weakness
• Reflex loss

How is the specific nerve root identified?
Each nerve root has a specific function. The specific function is disturbed by entrapment of the nerve root. A health care professional is able to identify the signs and symptoms pertaining to each nerve and therefore treat accordingly.

Lumbar spinal stenosis is defined as the narrowing of vertebral canals. Within the canals of the lumbar vertebrae, nerves pass causing symptoms specific to the spinal cord or nerve root compressed. The classification of spinal stenosis includes developmental or acquired forms.

The most prevalent cause of spinal stenosis is degeneration and is the result of a long term arthritic process. Osteoarthritis in the lumbar spine is a gradual process beginning between the 3rd and 5th decades of life with changes in the intervertebral disc. The intervertebral disc looses its height and ability to act as a shock-absorber leading to increased stress on facet joints. Osteophytes (bone spurs) develop usually along end plates and canals often causing compression to nerves. Symptoms of spinal stenosis closely resemble those of a herniated disc and on occasion can be misinterpreted.

The likelihood of developing spinal stenosis to some extent is genetic in origin. Different shapes of canal exist leading to an increased likelihood of compression to nerves especially with an arthritic process. The intervertebral canals decrease in size while the nerve roots increase in diameter as you move down the spine. Thus the lumbar spine is most commonly affected.

Spinal stenosis can occur either centrally or laterally. A central stenosis causes narrowing of the spinal canal leading to compression of the spinal cord (myelopathy). A lateral stenosis causes compression of the nerves (nerve roots) emanating from the spine. On occasion both central and lateral stenosis can occur in tandem.

In rare circumstances a cauda equina syndrome may occur. This is a neurological emergency requiring immediate medical intervention. The main features of this syndrome are loss of bladder and bowel control with saddle anaesthesia.

Indications

• Pain in the midline of the back, directly over affected joints
• Pain in the buttock, thigh or leg with standing or walking
• Both legs may be affected
• Extension of the spine worsens the symptoms
• Flexion of the spine improves the symptoms
• Decreased range of motion
• Muscle weakness and atrophy
• Lower limb reflexes differences between limbs
• Sensation loss
• Bladder and/or bowel disturbance
• Unsteadiness when walking

Can I be treated without the need for surgery?
In many cases of lumbar spinal stenosis, treatment can be effective without the need for surgery. Failure of non-surgical treatment may necessitate surgery.

What tests can be done to see if I have spinal stenosis?
A plain x-ray may be taken to visualise osteoarthritis in the lumbar spine. Due to the prevalence of lumbar spine osteoarthritis it is often unnecessary to x-ray the spine. In cases where the canal size measurements are needed, a MRI or CT scan may be requested.

Massage has long been used to treat muscles which are suffering from fatigue and Delayed-onset muscle soreness.  In 2008 researcher’s in the USA found evidence that Swedish massage improves the time it took for the muscles to recover and the massaged muscles had less damage and less evidence of swelling and inflammation. Massage can be an extremely effective treatment for stress and tense muscles from daily living as well.

Pre-event sports massage can be used to help warm up the muscles, especially for those who are competing in running, triathlons, rugby and other sports, this helps with reducing the risks of injury during the event.

In the Performing Arts world massage is often used to increase functional movement, which helps to reduce the chances of injury for dancers and musicians.

The medial collateral ligament of the knee prevents gapping of the inside of the knee. A force causing the knee to abduct, drawing the tibia away from the femur in an outward direction is responsible for disruption of the ligament. The medial collateral ligament is the most common of knee injuries. Footballers commonly damage there medial collateral ligament during a tackle.

The ligament can be damaged so that it ruptures, partially ruptures or merely sprained. The treatment as such reflects the degree of damage. A strain of the medial collateral ligament can heal slowly. It is common for pain to carry on for approximately two months. Recovery from a medial collateral ligament sprain is expected.

Indications

• Swelling and bruising on the inside of the knee
• Tenderness of the medial collateral ligament
• Gapping of the inside of the knee on examination

Can other structures be damaged along with the medial collateral ligament?
Depending on the force exerted on the joint, other structures may be damaged. Commonly damaged structures in combination with the medial collateral ligament are: anterior cruciate ligament, meniscus and joint capsule.

If I have completely ruptured my medial collateral ligament, what can be done?
For complete rupture of the medial collateral ligament, surgery is generally advised.

Can minor injuries to the medial collateral ligament be treated without surgery?
Depending on the extent of the injury, minor sprains to the medial collateral ligament are treated with non-operative treatment under the supervision of a consultant or therapist.

Meditation has become widely accepted in the mainstream as an activity that can improve your health. Meditation has several definitions, depending upon whom you ask, but generally speaking it is the practice of sitting or lying calmly and focusing your attention inward. While it is often associated with religion, the act of mediation can be done by anyone as a means of relaxing your body and settling your thoughts. Studies since the 1960s have demonstrated the many links between meditating and positive health benefits.

Stress and Weight Control

As we’ve seen before, stress can have a huge impact on your body, leading to heart problems (among many others) if carrying on without check. Meditation is now one of the best documented alternative therapies available to reduce your stress levels. Research has demonstrated that meditating can lower the cortisol levels in your body- one of the major stress hormones that contributes to high blood pressure. Cortisol also has the added effect of making your body store extra fat in your abdomen and increasing craving for fattening foods. Reduction of this hormone will not only reduce your blood pressure but can also help you to lose weight!

Healthy Heart

Meditating often includes focus on your breathing to keep a slow and steady rhythm. This also reduces your heart rate, putting less pressure on your heart and your arteries. Over time, people who meditate regularly have been shown to have lower heart rates reduced blood pressure throughout the day. The reduced stress on the artery walls leads to less thickening and hardening of the artery walls (atherosclerosis) and up to a 23% reduction for the need of heart medication (specifically antihypertensives).

Psychological Benefits

Meditation often involves slowing down your mental activity and consciously redirecting it. This not only maintains your mental alertness but also can actually enhance it, making you feel calmer and more relaxed. Many people have found meditating brings about increased confidence, patience, alertness, and improved your concentration and listening skills. It reduced stress and anxietly as well. A study done in Sweden has even found evidence that admissions to psychiatric hospital may be lower in people who meditate that the general population.

Women’s Health

Women often have pre-menstrual symptoms that include headaches and increased stress levels. Meditation has been found to decrease the intensity of these tension headaches and reduces the body’s overall reaction to stress. This in turn leads to better sleep and a steadier emotional well-being.

It’s easy to meditate but may be hard to keep it up. Just find a quiet space where you’re comfortable. It might be easier to sit instead of laying down to prevent nodding off, but either is fine. Close your eyes and relax. Everyone has individual methods of relaxing; it’s not as easy as it sounds. Some people repeat a phrase, some count their breaths, or hum under their breath. Once you’re relaxed, you can let your mind drift or focus your attention to various parts of your body. It all depends on you and what you want to achieve. There are countless guides and recommendations available to direct you, but all you really need is the discipline to make this part of your daily routine.

As a stipulation of French law, all participants in the Paris Marathon must get a medical certificate signed by a doctor. I performed a stress test this week and it was mentioned in Men health. Read more about this article…

Sleep is just as important to your health and wellbeing as good nutrition, exercise, and stress management.   It’s far too easy to stay awake at night watching TV, surfing the web, doing some last minute work or just getting some ‘me’ time after the kids go to bed.  However, getting enough sleep will not only refresh you for the oncoming day, it also has immediate and long-term beneficial effects on your physical, emotional, and mental health.  The amount of sleep you get can affect the quality and longevity of your life.  Here are some examples.

Body repair and heart health

While you’re awake and active during the day, your body goes through lots of wear and tear.  Sleep is your body’s opportunity to repair any damage and keep your health at its best.  While you sleep, your body produces extra protein molecules that act to boost your immune to fight infection and keep you healthy at a cellular level.  Lack of sleep can also leads to higher blood pressures and irregular heartbeats due to this additional stress and less repair time.  We already know the problematic effects of stress on your body; proper rest forces your body to relax and release tensions from the day.

Weight control

People who have chronic sleep deprivation have been shown to have irregular metabolism.  This causes changes in how the body stores energy (glucose) and impacts the production of hormones (such as the previously mentioned ghrelin that regulate appetite when you’re awake.  This can increase your appetite and lead to erratic and unhealthy eating and cravings.  Unfortunately, this tends to be cravings for food high in immediate energy and calories to keep you awake, such as sugars, carbohydrates and fat.  This change in metabolism and energy storage can also effect how insulin works on your cells to promote energy production, which can lead to Type 2 Diabetes.  Studies have indicated that those who regularly sleep less than five hours per night have increased risk of developing diabetes.

Learning and memory

Sleep helps the brain to learn new information better the following day and retain it.  A study done on professional violinists showed that the top performers regularly got 8-9 hours of sleep each night as part of their training regime, two more than the average Brit or American.  It also improves concentration which is crucial when considering the impact of sleep deprivation and accidents at work or on the road.

Mood and emotions

It’s common to tell if someone has had a restless night judging by his or her cranky attitude the next day.   Often, a rough night will cause impatience, irritability, and ‘fogginess.’  Overtime, chronic lack of sleep can lead to long-term mood disorders such as depression and anxiety.

Beauty sleep

Though a popular belief, there may be some truth to getting your ‘beauty sleep.’ A recent study in Sweden tested the attractiveness of twenty-three people in a controlled test in accordance with the amount of sleep they were allowed to have.  Overwhelmingly, the photos of the individuals when they were better rested were deemed to be more attractive.  Ample sleep can decrease the appearance of wrinkles, facial puffiness, and reduce blotchiness.  Socially, people may also seem to be healthier when they appear to be less stressed and better rested.

Watch out for the next blog topic where I’ll be sharing some tips on how to improve your sleeping habits.

With Christmas and the New Year just around the corner, people have been asking me how to turn over a new leaf and start fresh for the up coming year.  Some of you have been asking me for advice about exercise, during these increasingly dark and cold nights.  Here are a few of these questions that l think can be applied to many of us at this time of year.

1.  I’m not in great shape after over indulging at Christmas and am a few stone heavier than I would like.  I would like to start a new fitness regime but am worried about over-doing it.  Do you have any advice on how I can get lose weight safely?

Of course many people wish to lose the weight after the indulgences of Christmas.  But there is a trick to weight loss and it’s one that is often overlooked; Be realistic.  Always set realistic goals when losing weight, too fast, more than 2lb a week can leave you at risk of malnutrition and gallstones.  Also weight loss by dieting alone tends to reach a plateau where you will need to make further changes to your lifestyle if you’re looking for greater change.  So make sure that you have a planned weight to achieve and timetable when you will get to this weight.  You will have to accept that you’re not going to reach this weight overnight, but rather it should be a long-term project to both reach and to maintain this weight.

This is often why fad diets do not work, as you will quickly revert back to the same foods and so too, will your weight.  Instead of the latest diet, try instead to make these useful changes to your lifestyle, cut down on saturated fat and sugar, replacing them instead with foods high in starch (which contain less fat per gram and also tend to contain more fibre, which can help with cholesterol) eat less salt and always have a proper breakfast.

To accelerate weight loss, try gentle exercise as this is a great way to burn off additional calories and produces feel good endorphins.  This will make you feel better immediately, especially if you are affected by the long winter nights.

2.  Every time I go to the gym I end up doing the same old exercises so never really feel like I get an all-round work out.  Could you recommend an exercise routine that will give my whole body a work out?

Try to identify what exercises can be done on the available resources in your gym.  Then look at how you’re using those machines to get the best out them on your circuit.   It is important that you work out on each part of your body, with the focus on trying to get a total body workout.  You can ensure a total body workout by making sure that no two consecutive exercises will exercise the same muscles.

Remember these important points;

Work every muscle, in all of your muscle groups and you will have greater benefit than focusing on just one muscle group.  If you only focus on upper body, do not be surprised if you do not see as great an improvement in muscle strength or size as if you work all muscle groups.

Keep your heart rate up, don’t stop or slow down, when you have completed your first exercise move straight on to the next.  Ensuring that it does not exercise the same muscle group as the exercise that you have just completed.

Evolve, and change you circuit if your becoming bored or if you find that you’re are doing the same exercises repeatedly.  The gym instructors can see if your missing any exercises and can show you how to exercise the same muscle groups but on different machines, or with different exercises.

Take a friend.  Exercise should be about your mind and body.  A friend who will push you and encourage you to complete the exercises, will renew even an old routine and may help you work out on the key areas that your missing out on.

3.  I’ve been doing my best to keep my fitness up over the winter months but unfortunately had a nasty fall when running and had to rest up for several weeks.  Is there anything I can do in terms of rehabilitation and getting myself ready to start exercising again?

If your fall has caused damage, such as a sprain or break do not consider running on it until it is fully healed, your doctor will be able to guide you on when you can start again.  But exercise is of course an important part of the healing process, which when done correctly, can maintain cardiovascular and pulmonary health that will allow you to get back into running more easily.

Depending on your injury, how extensive it is and how much exercise you can safely do, without causing additional damage, it is best to consider other forms of exercise;

Swimming is an excellent cardiovascular and full body work out, with all the benefits of other cardio activities, but with advantage of having your body supported and resisted against by the water.

Walking is lower impact than running and although it takes longer to get your heart rate up can still burn calories.  By just walking briskly, head up, back straight and swinging your arms you can burn 180 calories in just 30 minutes.

Or how about a home circuit-training program, similarly to running, it is low cost and can be made to work to your schedule.  Using sit-ups, back arches, cramps, gluteals and hamstrings and push-ups are good body strengthen exercises, with the focus on completing the exercises in a controlled manner.  Attempt on 10 reps on your first session and no more.  Build on this daily, always with the focus of the exercise to be completed in a controlled manner.

With these options you should find that when your ready to start running and training again, your body should be ready with you.  But with all of these options ensure that you are not causing additional damage.

I hope this Q&A helped you and that maybe there is something that you could us to help you in your New Year, New You.

The painful arc syndrome is characterised by pain in the shoulder and upper arm during the mid-range of shoulder abduction, with freedom from pain at the either the start or end of movement. The pain from the syndrome is produced mechanically by nipping of a tender structure between the tuberosity of the humerus and the acromion process and coraco-acromial ligament.

Clearance of the upper end of the humerus and the acromion process is small in the range of abduction between 45 and 160 degrees. A swollen and tender tendon beneath the acromion is liable to get nipped during the arc of movement in which the clearance is small. In neutral position and in full abduction the clearance is greater and pain less marked or absent.

Radiographic Features

• Vary with underlying cause
• Plain radiographs –› fracture or calcified deposit
• Calcified deposit differs from avulsed fragment because it is homogenous and does not show the trabeculation characteristic of bone

Indications

• During abduction pain begins at 45 degrees and persists through arc of movement up to 160 degrees
• > 160 degrees pain decreases
• Patient may twist or circumduct the arm to reduce the pain level

A bursa is a fluid filled sac which acts to prevent friction between two structures. The prepatellar bursa in the knee is prone to inflammation. The prepatellar bursa is situated in the lower half of the patellar and overlies the patellar tendon.

Two types of prepatellar are recognised:

1. Irritative
2. Infective

Irritative prepatellar bursitis is known as 'Housemaid's Knee' and reflects inflammation caused by long periods of kneeling. Infective prepatellar bursitis reflects inflammation caused by a organism which reaches the bursa through a wound or the lymph system.

Indications

• Swelling in the lower part of the patellar
• Tenderness
• Pain at the front of the patellar
• Pain with flexion of the knee

The patellar has the ability to dislocate. Patellar dislocation generally dislocates towards the outside (lateral) of the knee. The mechanism of injury for a lateral dislocation involves a twist or force whilst the knee is flexed or semi-flexed leaving the patellar sitting on the outside of the knee.

Lateral dislocation can occur in one of three forms:

1. Acute dislocation
2. Recurrent dislocation
3. Habitual dislocation

In the cases of recurrent and habitual dislocation, the knee shows abnormalities causing the patellar to be unstable.

Acute dislocation of the knee tends to occur in females more than males with weak a vastus medialis muscle. Recurrent dislocations begin with an acute dislocation, usually in adolescence, with further dislocations occurring with relative ease. Dislocation in such circumstances can occur with mere straightening of the knee from a flexed or semi-flexed position. A generalised laxity of joints may be identified.

Recurrent dislocations can occur due to inherent instabilities caused by:

• Shallow intercondylar groove
• High lying patellar
• Genu valgum where by the quadriceps pull in a biomechanically less stable direction

Habitual dislocation of the patellar is uncommon with the age of onset being in early childhood. In habitual dislocation of the patellar a shortening of the vastus lateralis may be identified causing an increase pull of the patellar towards the lateral dislocated position.

Indications

• Swelling of the knee
• Laterally (outside) displaced patellar
• Tenderness on the inside of the knee due to muscle strain or tear of the capsule

What can be done to prevent dislocation of the patellar?
Strengthening of the quadriceps muscles especially the vastus medialis is necessary in order to counteract the outward pull of the stronger muscles.

Can recurrent dislocation of the patellar lead to osteoarthritis?
Abnormal biomechanics of the patellar can lead to increased risk of osteoarthritis.

Patellofemoral pain syndrome is a condition resulting from a tracking abnormality of the patellar. A gradual deterioration occurs often related to maltracking or instability of the patellar. Predisposition appears to be caused by an increased Q angle.

Indications

• Anterior knee pain
• Pain worse with going up and down stairs
• Pain worse with sitting for long periods
• Crepitus of the patellofemoral joint

How is patellofemoral pain syndrome treated?
Patellofemoral pain syndrome is treated by correcting the maltracking of the patellar using orthotics and exercise therapy.

Piriformis syndrome is the entrapment of the sciatic nerve as it passes through or under the piriformis muscle in the buttock. Piriformis syndrome is more common in women and may be caused by trauma, pressure, spasm or sacro-iliac joint dysfunction.

Indications

• Weight shifting while sitting
• Sciatic symptoms
• Tenderness on the muscle
• May have SIJ pain
• Pain usually sudden, deep and aching
• Tightness

How can piriformis syndrome be treated?
Piriformis syndrome can be treated with stetching, ultrasound, massage, and manipulation of the sacro-iliac joint.

Often in the news you’ll hear about a new wonder diet that claims to help you lose weight, bulk muscle, or reduce your waistline.  Manoeuvring through these diets can be tricky as it’s hard to tell which ones are harmless and useful versus those that may be of little benefit (or harm!).

Fad diets are any diet that is in fashion; it may be centred around a particular food or product, type of food, or way of cooking or eating.  Often, these diets will guarantee quick weight loss, but it’s rarely sustainable.  Many diets will reduce your overall calorie intake for a specific number of days with some variation thrown in.  Anytime you eat less, you’re bound to lose weight.  Initially, the weight you lose quickly is likely to be ‘water weight’ or fluid from your tissues, not fat.  While this seems like a fine thing when you’re looking at the scale, your tissue should, and will, re-hydrate causing the weight to return.  A long-term approach to dieting will help to keep the weight off.

Ultimately, fad diets can be a good way to jump start your weight loss and give you motivation, but will only work for a short period of time.  If you return to your original ways of eating, you’ll gain the weight back quickly and the imbalance of your weight control may even cause to gain more weight than what you lost.

Some ‘fad’ diets include:

Grapefruit Diet

This diet focused around reducing calories and carbohydrates while eating plenty of protein and, of course, grapefruits and grapefruit juice.  Around since at least the 1930s, this diet focuses around an unproven claim that grapefruit contains a unique fat-burning enzyme that is a magic tool for weight loss.   Not only has this never been proven, grapefruit can react with some medications (including those for high blood pressure, high cholesterol, and anxiety) by increasing the amount of medicine that is absorbed into your system causing an overdose.

Baby Food Diet

This one is a newer celebrity diet that promotes substituting snacks or entire meals with baby food.  The idea is that pureed baby food is nutritious, low in fat, salt, and sugar and is only available in small portions.  The downfalls begin with the smooth texture.  The act of chewing can actually help to curb your appetite by informing your brain that you’re eating.  Not chewing your food can cause you to feel less full, regardless of the amount of calories you’re consuming.  Additionally, baby food lacks in the fibre, calcium and vitamin D that adults need and can lead to deficiencies.

Anytime you hear about a new diet that sounds too good to be true, it probably is.  Be way of diets that make a simplistic or dramatic sounding claim or are based around one study.  The best approach to losing weight will always be eating a healthy and varied diet with moderate portions combined with physical activity.  If you can maintain this healthier lifestyle, then the yo-yo effect of fad diets may well be behind you.

The posterior cruciate ligament prevents posterior translation of tibia on femur and prevents hyperextension. The posterior cruciate ligament is twice as strong as the anterior cruciate ligament and is therefore injured less commonly. The posterior cruciate ligament is injured most commonly through either a direct blow causing posterior displacement if tibia in a flexed knee or during hyperextension of the knee. The posterior cruciate ligament can be damaged in three areas:

1. Femoral avulsions in 25%
2. Tibial avulsions in 25%
3. Midsubstance tears in 50%

Indications

• Pain
• Instability
• Swelling

Can a posterior cruciate ligament be damaged in associated with other structures?
Yes, the meniscus, medial collateral ligament and anterior cruciate ligament can all be damaged along with the posterior cruciate ligament.

A common postural fault in the neck is termed a forward head carriage. With a forward head carriage the head sits forward on the neck creating a change in the curves of the spine. The alteration in head position causes the musculature to alter and become either tight or weak. Muscles become tired more easily as they take on roles not intended. The internal elements of the neck undergo increased stress with a distortion of tunnels causing possible nerve and arteries compression. Headaches are often an accompaniment to a forward head position. Associated forward shoulders are often identified. The causes of a forward head carriage are vast however office workers are more prone.

Abnormalities of posture are a common cause of pain and disability. Postural abnormalities develop slowly over many years with related pain and disability. A postural fault can be corrected; however, advanced cases require specialised treatment plans.

Abnormalities are a potential cause for soft tissue and bony changes (arthritis). Uncorrected postural abnormalities have the potential to develop into further more complicated and disabling conditions.

Indications
There are several signs and symptoms of neck postural syndromes including:

• Headache
• Muscle fatigue
• Muscle weakness
• Pain on the head and neck (neck and shoulder muscles with prolonged positions)
• Jaw pain
• Pain worse at the end of the day
• Pain relieved by rest

What causes abnormal posture?
Abnormalities of posture can be caused by trauma, occupation, hobbies, recreation, relaxation, and stress to name but a few.

Who experiences postural abnormalities?
Postural abnormalities can affect anyone however women are more commonly affected (3:1) up to the age of 45 years.

What can I do about abnormal posture?
Abnormal postures can be improved by stretching and strengthening of muscles, education on positions and ergonomics and massage.

Abnormalities of posture are a common cause of pain and disability. Postural abnormalities develop slowly over many years with related pain and disability. A postural fault can be corrected; however, advanced cases require specialised treatment plans.

Abnormalities are a potential cause for soft tissue and bony changes (arthritis). Uncorrected postural abnormalities have the potential to develop into further more complicated and disabling conditions.

Indications

• Hunched forward head position
• Constant aching pain in the middle and upper thoracic regions
• Pain relieved by activity
• Pain aggravated by working at a desk
• Hyperkyphosis
• Trigger points in muscles

Is it necessary to have a work placement assessment if I have a postural syndrome?
Professionals who spend a large proportion of their time at a desk can develop a postural syndrome. Symptoms can sometimes be improved following a work placement assessment.   

As the weather begins to turn a bit warmer, there will be a rush of joggers, bicycles, and all things fitness worthy on the roads and park pathways.  There will be seasoned veterans of the

road and novices who are just getting started and dipping their toe into the world of fitness and exercise.  As the street-wise veterans will attest to (and the novices will soon find out), nothing will slow you down quicker than painful feet.  There are entire encyclopaedias you could write about the many ways your feet can fail you, but the most common prevention of injury is good biomechanics and supportive shoes.

Biomechanics is a way of describing the how your body moves and works.  It’s an engineer’s perspective of how the bones align with the supporting muscles, tendons, and ligaments to make sure walking, running and jumping is effective, efficient, and easy on your body.  In the world of fitness, it’s important to think about your how your feet affect the rest of your body.  It all starts with the feet.  Your body is designed so that when you walk, the arch at the bottom of your foot absorbs some of your weight as you move about.  This lowers the amount of stress the rest of your body has to deal with.  Your bones (and helpful muscles) then take on the rest of the supporting work, to hopefully distribute your weight in a way that you don’t even notice it.

The problems come about when the arch of your foot isn’t working as well as it could be. This can happen for lots of reason; your arch may be naturally very stiff or very stretchy, the bones in your feet may not be lined up well, or you might have a small tear or inflammation that can cause major problems and irritations.  If it flattens too much or not enough, then the bones in the legs shift to compensate for this.  If the bones in your legs shift then your knee will also have to adjust, along with your hips and lower back.  It’s all this adjusting and compensating that can put extra stress on one part of the joint, causing anything from overstretched muscles and strained tendons to joint pain and osteoarthritis.

Luckily, there is loads you can do to prevent problems.  It’s worth having your feet looked at to see how good your biomechanics is with a gait analysis or functional movement screening.  This is assessed in many different ways, but usually includes watching how you walk on bare feet and looking at the soles of your feet for wear and tear.  You’ll also get advise on the best type of shoe support to get.  It varies for everyone, but some people need higher or harder arch support, extra cushioning in the heel or stiffer ankle support.  Depending on your needs, it can be useful to have an insole made which fits your foot and can be moved from shoes to shoe.

Check us out in a few days when I’ll be chatting about the different types of shoes and foot supports.  In the meantime, what ways have you discovered that boost your foot health?

A cervical radiculopathy is the radiation of pain into the upper extremity caused by compression of a nerve root in the cervical spine. Women are more prone to developing a cervical radiculopathy usually in the 4th or 5th decade of life. The most common causes of cervical radiculopathy are:

• Lateral disc herniation
• Osteophyte formation
• Space occupying lesions

Each nerve root has individual features therefore aiding identification of the area of compression. The most frequently compressed nerve roots are C7>C6>C8>C5.

Indications

• Unilateral neck pain, nape pain and pain at suprascapular, scapular or interscapula, usually precedes other symptoms
• Radiating arm pain
• Finger paresthesia
• Weakness
• Diminished deep tendon reflexes

What are the indications for surgery?
The indications for surgery are failure of conservative treatment, unbearable pain, and neurological deficits.

What is the conservative treatment for radiculopathy?
A number of methods can be used to treat radiculopathy, the effectiveness however is based upon the cause of the symptoms. Anti-inflammatory medication, traction, physiotherapy or an injection may be used.

We have all heard that red wine is good for you, but have you ever stopped to consider why?  Is it just an good excuse to have a glass or two?

Red wine is said to promote a long and active life, with benefits such as anti-aging properties and reduced risks of coronary heart disease and cancer.  These effects of red wine are linked to the French population, who are notorious for a diet high in saturated fats, yet have a relatively low incidence of coronary heart disease.

Known as the ‘French Paradox,’ red wine has been suggested in the past to be a factor in decreasing the incidences of cardiac disease.

Grape skin, which gives red wine its colour and distinct flavours, also contains a phenol compound known as resveratrol.  Resveratrol is believed to contain anti-aging, anti-carcinogenic, anti-inflammatory and antioxidant properties.  However, there is limited research in this field and no research on human has been done to either prove or refute this claim with the only successful trials being replicated in laboratory conditions using tissue samples or in other species.  Additionally, regardless of research efforts, red wine contains only a very small amount of resveratrol, far lower than what could be considered a therapeutic level.

However, another group of phenols, known as oligomeric procyanidins (OPCs), is abundant in red wine.  OPCs have been proven to improve vascular health and stabilize collagen and elastin fibers, which are essential connective tissues that support organs, joints, blood vessels, and tissues.  Wines containing OPCs are very region specific, coming from the southwest of France and Sardinia.  Demographic studies have also demonstrated an increased lifespan for these populations, further supporting the argument for the benefits of red wine.  However, eating one Red Delicious apple would provide at least four times the amount of OPCs as one small glass of red wine.

Drinking red wine for its purported medical benefits is unlikely to have a great effect on your diet, health or weight.  Although the claim that the French have lower incidences of heart disease has been refuted by the World Health Organization, there are many contributing factors that may explain why the French appear have a fitter, healthier lifestyle.  These may be linked to a lower intake of hydrogenated, trans fats and sugar in their diet with a much greater emphasis on foods that use natural ingredients over processed foods.

With research continuing, the medical world is still divided over the health benefits of drinking red wine.  But there is nothing to stop you enjoying a glass or two of good wine, in place of any other form of alcohol, as long as it is in moderation.

This week you will likely see or hear in the media that you should take at least 2 days off from alcohol.  This may be to promote awareness and education of the confusing alcohol units system and problems associated in excessive alcohol intake.  Regardless of the media’s intentions, a dry period can be beneficial to your liver, especially for those who drink daily or near daily.  They have a greatly increased risk of liver disease compared to those who drink intermittently.

If you are trying to lose weight and get fit, a good place to start is looking at your diet. Red wine may have some health benefits but they will not compare to advantages that you can have by starting a proper exercise regime and eating a balanced diet.

When broth is Better than water as a Nutritional Strategy

It’s common to hear people discuss the benefits of eating soup as part of a nutritional plan towards weight loss.  But is there any truth in this? Can soup or blending your food, help with wellness and weight management and assist in achieving the ideal healthy weight?   The short answer is yes it can, but there are many aspects to a definitive answer.

Consider a typical lunch of chicken and rice with veg on the side washed down with a glass of water.  When it comes to digesting your lunch, the solid food will be held in your stomach so that the digestive acids can get to work breaking it down.  Water however, unlike the rest of the meal, passes straight through into the intestines, so it doesn’t contribute to the feeling of fullness.

"..Managing Hunger with healthy choices is the key to nutritional wellness.."

If the water, meat and vegetables are blended together the mixture remains in the stomach, allowing the subject to remain fuller for longer, stopping the hunger pangs that are commonly associated with mid afternoon and encourage snacking.   In a recent study, this was found to be true whether or not the soup was chunks of food in a light broth or if it was all pureed together.

Spondylolisthesis is a condition whereby all or part of a vertebral body slips forwards on another vertebral body. The classification of spondylolithesis is based upon the causation of the anterior slippage.

• Dysplastic
• Isthmic
• Degenerative
• Traumatic
• Pathological

Indications

Only when the slip reaches more than 50 % of the width of the vertebral body will there begin to be a visible deformity of the spine. Range of motion is often not affected, but some pain can be expected on hyperextension.  Laboratory test results are normal in patients with one or both disorders.

How is Spondylolisthesis treated?
Depending on the classification and severity several modalities can be used to treat spondylolisthesis, these include:

• Activity modification
• Medications
• Injections
• Bracing
• Physical therapy
• Surgery

Now that it’s warming up outside, you’re starting to lose your excuse for not exercising.  Choosing your equipment is an important part of gearing up for the outdoor season.  It’s important to think about the most comfortable socks, shorts, shirts, helmets, gloves, etc that will do the best job for you.  I would argue, however, that the most important item of clothing you could think about would be your shoes.

We’ve looked at the importance of healthy feet and what can happen if your foot alignment is off.  The best way to ensure you have the best fitting shoes is to have an assessment by a professional to see if you need shoes with a certain type of cushioning or arch support.  You may even need or choose to have an insole made for you by an orthotist or podiatrist that will provide the exact type of support you need.  When you’re off trying on shoes, make sure to bring these insoles along so you can see how the inserts fit into the new shoe.  Many shoes have removable existing insoles you can replace with your own, but not, all so be wary.

Once you determine the best type of support for you, you can think about the most appropriate shoe for what you are planning to do.

Running

A spoonful of sugar might make the medicine go down. But it also makes blood pressure and cholesterol go up, increasing your risk for weight gain, liver failure, heart disease and diabetes.

We already know that vices such as alcohol and tobacco are heavily taxed.  Recently there’s been discussion to add sugar to this list.  This week, researchers at the University of California, San Francisco, have published an article calling for regulation in the added sugar in our foods, which includes suggestions for taxation and proposed age limits on buying.

Their research includes increasing evidence that obesity is on the rise across the globe.   While this has been a problem in developed countries for quite some time, it only recently that research has been done on how globalisation has altered the diet of developing nations as well.   Though, not entirely understood, it is not coincidental that obesity has risen at the same time that sugar intake has tripled over the last 50 years in developed countries.

Though weight gain is often associated with a sugary diet, it can also lead to long-term damage to the liver.  Sugar is often known as empty calories, but there is nothing empty in the toxic threat of liver disease and diabetes.

In its natural form, sugar in the form of fruit is only available for a few months a year during the ripening season and honey has always been closely guarded by bees.  Today, however, sugar is added to a wide variety of foods, ranging from soda to soup.  The researchers at UCSF note “nature made sugar hard to get; man made it easy.”

There are several different types of sugar.  Many found naturally, for example in fruit, are easily processed by cells throughout the body.  Added sugar however, especially fructose, goes straight to the liver to be broken down.  This put extra pressure on the liver to work, which over time takes its toll on the organ, leading the liver disease.  If there it too much sugar for the liver to process, than the excess will be released into the body and become fat.

Fructose has become a popular sweetener as it has a very long shelf life, it is easier to refine and the production is very cheap.  However, it can also suppress the hormones that regulate your appetite and decide when you are hungry.  Too much can make controlling your weight very difficult and can lead to weight gain.

There are some small measures that can be done to help with weight loss.  It is important to identify the foods that do carry high amounts of additives.  Fructose is often added to processed foods to increase the shelf life, so try to avoid these products.  Cooking meals from scratch is a great way to know what is going into your food and into you.  Unfortunately, there is no requirement (as of yet) to label fructose as anything other than sugar so it is hard to find the foods that do contain it thought these are often foods like soft drinks, ready meals, concentrated fruit juices and sweeteners.

Maybe it’s time for you to give your body an audit, and really think about the additives that are part of your diet.  Cutting down on additives and sugar intake may be the first step towards your goal to weight loss and a healthier lifestyle.

Tennis Elbow or Lateral Epicondylitis is defined as an inflammation at the insertion (lateral epicondyle) of the muscle the extensor carpi radialis brevis.

Inflammation at the lateral epicondyle can be caused by trauma or by constitutional factors. Trauma may occur through throwing activities in athletes or by direct trauma. The majority of cases of tennis elbow occur due to repetitive sporting activities (e.g. tennis or throwing) or occupational activities involving forceful wrist extension, radial deviation and supination.

Indications

• Tenderness of lateral epicondyle (outside of elbow)
• Pain made worse by gripping, forearm rotation, wrist extension
• Positive orthopaedic tests (Mill's Test)

Are there any professions who are prone to 'Tennis Elbow'?
Meat cutters, plumbers, weavers, and athletes are a few professions prone to 'Tennis Elbow'.

What is done initially with 'Tennis Elbow'?
'Tennis Elbow' is always treated initially with non-operative management using rest; activity modification, non-steroidal anti-inflammatory drugs (NSAIDs), physiotherapy; clasp; steroid injections.

Do most 'Tennis Elbows' respond to treatment?
Most occurrences of 'Tennis Elbow' respond well to non-operative therapies.

Stress is a problem for everyone at various points in your life.  It can be related to family, relationships, work or money but it all has the same negative effect on your health and wellbeing.

Some stress is important as it readies your body to react quickly.  For example, if suddenly confronted with a sabre-toothed tiger in the street, your heart beats faster and your blood vessels widen to pump more blood faster to your muscles so they can function better.  You breathe faster to get more oxygen in your body to feed these muscle cells.  Yours pupils dilate and your sense of hearing sharpen all to allow for a better reaction to the tiger.  This is sometimes called the fight-or-flight response.

While some parts of your body get more blood and energy, like the muscles, heart, and lungs, others that aren’t immediately needed for fighting or running away lose most of their blood supply temporarily.  The digestive system slows down and sexual response is placed on hold as these are not likely to be important for your immediate survival again that prehistoric tiger.

These reactions are great for short-term stress and certainly helped to save the life of our ancestors.  However, they are designed to be for a short time only.  The extra work on the heart and lungs is exhausting for the body and has a negative impact on your health.

Now imagine you’re stressed for several weeks or months at a time.  Your heart is working overtime, you’re not digesting your food properly, your muscles are tense, and you have sexual impotence.  It’s not surprising that stress over a lengthy period of time will have long term effects on your body.  However, because these may seem to be minor and always present, you may not even notice them to be signs of stress until something catastrophic has occurs, like a heart attack.

Often, the cruellest part of stress is that it tends to be a vicious cycle.  For example, you become stressed about your workload.  You then get nauseous and sweat more often.  The stomach troubles become worrisome and you worry more about what may be causing the pain and the excessive sweating is embarrassing and you get anxious about other people noticing.  This brings on additional panic which maybe make the current problems worse and bring on new ones to fret over!

But worry not!  Fortunately, there are many ways to control anxiety levels and manage your health.  Meditation has been proven to be very effective.  By focusing on your breathing you are slowing it, which causes your heart to beat slower, controlling your heart rate and your blood pressure.  It can relax your muscles and allow your mind to drift and not focus on what has been the cause of your stress.  Massage can help to release the tension in your muscles and exercise will create an outlet for your pent up energy and can allow you some time to let your mind wander while sweating.

A healthy diet will go a long way in helping you to decompress and de-stress.   If your digestion system is not working as well as it should be due to stress, then it’s important that you’re getting a well balanced diet.  While a stomach full of junk may seem like a good idea at the time, the lack of nutrients and vitamins will leave you tired and more prone to anxiety.  Food high in fibre and vitamins, such as salads and vegetable will help to combat you signs of stress.

How important is breakfast to your diet and overall health?  We’re always told the best way to start the day is with breakfast, but how true is this?  I bet you know several people, maybe even yourself, who regularly skip it.  Maybe it’s due to lack of time or the idea that meal skipping will help you to lose weight.  Some people just find that they are unable to eat much food in the early morning.

Regardless of your daily routine, having a bit of breakfast is important for everyone.  Think about what the word means.  It’s the breaking of a fast, in this case the first meal of the day after fasting for several hours throughout the night.  When you wake up in the morning, your last meal may have been 10-12 hours ago (often even longer for children).  In order to function, your body requires energy to do everything from thinking and breathing to walking and talking.  This energy is provided from the glucose in the foods we eat.  By skipping breakfast, your body will provide enough energy to function, but not to flourish.  You’ll feel sluggish, tired, dizzy, irritable, and your concentration will be poor.

While it may seem like common sense that skipping breakfast will help to lose weight (fewer calories overall, right?) it is actually the opposite.  You’re body needs nourishment in the morning to sustain itself.  The longer you wait to eat, the hungrier you will be.  This is bad news for several reasons.  When you’re very hungry, it’s easy to appease your hunger with a quick snack of something unhealthy like chocolate or biscuits at tea time.  However, this will provide you with little nutrients and empty calories.  If you do manage to wait until lunchtime, you’ll be so hungry you could end up eating twice as much as you normally would.  This giant mid-day meal will make you feel tired and drowsy as your body works to digest it during the afternoon.

It’s also important to pay attention to what you eat, not just when.  People who begin the day with a cup of strong, sweet coffee or orange juice may feel that they are off to a good start simply because they have something in their stomach.  However, the caffeine and the sugar in the coffee will hit your system very quickly as liquid is digested much faster than solid food.  Equally, while the juice has important vitamins, a cup of orange juice has the calories and sugar content as two whole oranges.  The orange also has the added bonus of fibre, which is great for your digestive system.  The fibre will help to keep the orange in your stomach for longer which will mean the sugar slowly enters your body as opposed to in one quick rush.

Some great examples of easy breakfasts that can keep off the calories are yogurts, toasts from seeded breads, whole fruits, and porridge.  If time is of the essence, then consider keeping some of these items on hand in your workplace so you can have something to eat before you start the workday.   Research has shown again and again that eating breakfast can help you to lose weight and maintain your current size.  It turns out it’s true what they say: breakfast is the most important meal of the day.

A lot of people know Vitamin D as the sunshine vitamin, but in fact there is a lot more it than just that.

Vitamin D is a fat-soluble vitamin, stored in the body's fatty tissue. Its function is to enable the body to absorb calcium and phosphates, two minerals that are essential for the formation of bone tissue. In addition, it also helps to regulate blood pressure and is attributed to regulating the immune system and lowering the risk of certain cancers.

Lack of Vitamin D can lead to serious problems. In infants and children it can prevent mineralisation of bone, causing soft bones which then become deformed and bowed. In adults this can contribute to osteoporosis and osteomalcia (soft bones) which manifest into persistent, everyday problems such as depression and fatigue, chronic backache, and obesity.

How to get Vitamin D in your body? Conveniently, it is synthesised in your skin by exposure to ultraviolet-B (UVB) radiation form the sun. Vitamin D is found naturally in very small quantities in very few foods, notably oysters and fatty fish like tuna, salmon, and mackerel. Unfortunately, unless you eat buckets of oysters each day (and who has the time?), it's not easy to absorb vitamin D in sufficient quantities from our food alone.It's thought that a light-skinned person only needs to expose their arms, legs, and face to direct sunlight for 5-10 minutes during the middle of the day 3 times a week for 9 months of the year to achieve their annual dose of Vitamin D. Many of us will accomplish this by merely walking to the store or doing yardwork. However, there are also many obstacles to consider.

Glass, clothing, and sunblock all block UVB rays. So sitting inside a car or in the sunny spot in the living room will not help your Vitamin D levels, nor will covering all or most of your body when you go outside. Even a lightweight sunblock of SPF 8 will prevent 95% of the UVB rays from stimulating Vitamin D production.

However, those with darker skin tend to suffer frequently with Vitamin D deficiency. Melanin, which gives dark skin its colour, also blocks UVB rays from penetrating. It's believed that dark skin needs 20-30 times the exposure as lighter skin to produce the same amount of Vitamin D. Though controversial, it has been suggested that the high rate of prostrate cancers among black men may be due to common Vitamin D deficiency.

To combat this, some foods are now commonly supplemented or fortified with Vitamin D including dairy products, soy milk, orange juice, and breakfast cereals.

Despite the need for Vitamin D, please don't see this as an excuse to never wear sunblock or a hat in the sun. Skin cancer is still dangerous, particularly in certain parts of the world or if you have very fair skin and common sense is always the best sense.

To get your quota of sunshine, think about how you can get the most out the daylight hours. Perhaps you could try getting off the train a stop early and jogging in, or taking a run around the park on your lunch break? Get creative and think about how you could start to get more of the 'sunshine vitamin' that is vitamin D. It could be the start of a new year and new you.

Having fats in your diet is important, for example it allows the body to absorb “fat soluble” vitamins (A,D,E,K) and plays a vital role in maintaining healthy hair and skin. In addition it helps to insulate the body organs against shock, maintains body temperature, promotes healthy cell function, and is a source of energy.  Knowing more about fats will allow you to choose the healthier ones and avoid the ones that can increase disease.

Types of Fat

There are two main types of fats found in food:  Saturated and Unsaturated.  These fats differ in their energy content and melting point. Unsaturated fat for example contain fewer carbon-hydrogen bonds than Saturated fat with the same number of carbon atoms. As a result unsaturated fats will yield slightly less energy during metabolism than Saturated fats.  Because of the different structures, Saturated fats “freeze” easier and are typically solid at room temperature. For example animal fats such as lard are high in Saturated fatty acid content and are solids. On the other hand olive oil is highly unsaturated and is oily at room temperature.

Saturated Fats raise Cholesterol level and increase your risk of many chronic diseases, such as Heart Disease, Stroke and certain Cancers.

These fats are found in any of the following food types;

• Fatty cuts of meat
• Sausages and pies
• Butter and lard
• Cheese, particularly hard cheeses
• Cream, ice cream and soured cream
• Chocolate and sweets
• Biscuits, cakes and pastries.

Unsaturated Fats come from vegetable sources and oily fish. Foods that contain unsaturated fats can also help to lower your cholesterol

• Oily fish such as mackerel, tuna and salmon
• Avocados
• Nuts and seeds
• Sunflower and olive oil

Low fat and reduced fat

In the supermarket food packets may contain the words “lower fat” or “reduced fat” claiming to be the healthier choice.  In fairness these products do contain a “lower fat” content, but still contain high levels of fat.  For example a jar of mayonnaise only contains “25% less fat” than the “unhealthy” version. But both are still much too high in fat.

If you are unsure about whether a food is a healthy choice, look on the nutritional label on the back of the product.  These guides are usually coded with traffic light colours to indicate if a product is high or low in fats, sugars and salts.

It pays to think about the amount of fat you take into your body, besides the obvious health issues, thinking about what you eat will help you make other adjustments to your diet and lifestyle.

Ok, so we’ve gone over the importance of sleep and the many ways it’s crucial for your health and wellbeing.  We all go through patches of sleep troubles (some more than others).  If you find that you’re especially tired in the morning or having a hard time going to sleep or staying asleep, try some of these tips to find your way to dreamland.

Stick to a sleep schedule

If you have a Monday-Friday 9-5 job, it’s common to go to bed more or less the same time during the week but then stay awake a few extra hours during the weekend and sleep in.  This begins a pattern every weekend of falling asleep a few hours later that need to be broken every Monday morning, week after week.  Sticking to the same bedtime throughout the week will help you to be awake and alert for the following day.  Over time, this may reduce your dependency on alarm clocks.  If you do find that you’ve stayed awake too late the night before, take a catnap (not too long!) during the afternoon to give yourself enough energy to make it to the en of the day.

Relax your mind and body

Making the effort to slow yourself down before bedtime will help you to get some shuteye.  Many of us might watch TV on work on the computer in the bedroom before turning in, but the bright lights and noises stimulate our senses and keep our mind active after the lights are off.  Instead, try reading a book or listening to soothing music as calmer alternatives.  Some use late-night exercise as a way or exhausting yourself into sleep.  This, however, has the opposite effect and energises your body.  While you may feel immediately tired after a tough workout, it will keep your body alert and awake and further from sleep.  Exercising in the morning is a better routine with calm stretches just before going to bed.

Make your bedroom a place to relax

If you spend time in your bedroom for working or watching TV, it can be difficult to fall asleep as the room has other associations for you.  Keeping your bedroom a separate place for sleep (and ‘quality time’ with a partner) trains your mind to understand that going to bed means sleep.

Time your meals

Knowing big meals make you tired, it makes sense that a large dinner is the best option.  The problem with this is that it can be hard work to digest large meals and fatty food and can keep your awake.  Many people also suffer from heartburn from spicy or acidic food.  Lying down usually aggravates the situation and wakes it worse.  Alcohol will also make you tired, but it alters your sleep pattern and may cause you to wake up during the night.  While caffeine effects people differently, but it’s a good idea to stay away from it for about ten hours before your bedtime if you’ve been having trouble sleeping.

Create a sleep-friendly environment

Despite all your best efforts, you still may have trouble falling asleep.  Make sure your bedroom is a conducive to drifting off as possible.  Light can affect this, so keep your blinds shut during the night and turn off any nearby lights.  Some find it helpful to use an eye mask, but make sure it is not too tight on your head.  Support for your body is another important point to consider.  Different people prefer soft or hard mattresses and pillows; just make sure that yours supports your back and head comfortably.

Trochanteric bursitis is an inflammation of the trochanteric bursa overlying the greater trochanter of the femur. The function of a bursa is to reduce the friction of two structures during movement. The trochanteric bursa reduces friction between the femoral trochanteric process and the gluteus medius and iliotibial band.

Trochanteric bursitis predominantly affects patients between the 4th and 6th decades of life. Trochanteric bursitis can result from either direct trauma or repetitive trauma. Direct trauma may result from a direct impact to the trochanteric brusa. Repetitive trauma can result from running orientated sports.

Indications

• Tenderness over greater trochanter
• Swelling over greater trochanter
• Radiation of pain along the outside of the thigh
• Pain increased with hip motion especially
• Night pain when lying on the affected hip
• Limp on affected side when walking (antalgic gait)
• Increased pain on internal rotation
• Positive orthopaedic tests (FABER test)

Are there any predisposing factors for trochanteric bursitis?
A leg length discrepancy or previous hip surgery may predispose a patient to trochanteric bursitis.

While there are health benefits to the immune system, this only touches the surface of what the essential nutrient Vitamin C can do for your health.
The most famous vitamin, Vitamin C is commonly associated with having a cold and drinking orange juice, but what are the benefits of vitamin c in your wellness and weight management plan.

A water-soluble vitamin, excess Vitamin C is excreted through the urine, making it difficult to overdose, as opposed to the sunshine vitamin D which is a fat-soluble vitamin.  However, this does mean that you need a constant supply, as you body keeps very little on hand in your liver, stored up for a rainy day.

As mentioned, Vitamin C is an essential nutrient and great supporter of the immune system. Acting as a natural antihistamine, it has been demonstrated to shorten colds and reduce their severity.  This reduction of histamine levels can also help with allergies and asthma.  Some take these benefits to the extreme and recommend a ‘megadose,’ which can be 2 grams (or 40 times the recommended daily allowance).   Though overdosing is unlikely, there appears to be a therapeutic limit of 2 grams, which if exceeded often leads to upset stomach.  More and more research is appearing which indicates that these megadoses may not actually be very helpful and can be a bit harmful.

I was interviewed last week at the beginning of the world cup and players fatigue is a topic I am willing to debate over the next few weeks.
Why the English season is such an important factor on the national teams performances in tournaments has always been one I have felt passionately about.

I welcome all your comments and if there is enough interest will review the injuries reported over the next few weeks in the World Cup. – here is a copy of the article..

Injuries to “tired” players ahead of the World Cup should come as no surprise, according to a leading sports medical expert.
Dr Ralph Rogers is a consultant in Sports and Musculoskeletal Medicine in Harley Street, London and feels a draining Barclays Premier League season cannot fail to have an impact on players’ ability to stay fully fit heading into South Africa.

England – who had already seen David Beckham sidelined by ruptured Achilles – lost captain and Manchester United defender Rio Ferdinand to a knee injury after just one training session at their base in Rustenburg.

Chelsea trio Michael Ballack, Michael Essien and John Obi Mikel have already been ruled out of their respective countries’ campaigns, while Ivory Coast are praying the operation on Didier Drogba’s broken arm will allow him to play some part in the competition.

Meanwhile, Liverpool’s Slovakia defender Martin Skrtel suffered a scare with an ankle injury and Holland winger Arjen Robben, the star of Bayern Munich’s run to the Champions League final, is battling to be fit following a torn hamstring.

Rogers believes the stresses and strains of such demanding club campaigns can only have a negative impact on some of Europe’s leading stars.

“It does not surprise me, or any other sports physician, that a lot of guys who play in the Premier League will not be going to the World Cup,” Dr Rogers told Press Association Sport.

“We are not only talking about physical injuries, it is also the mental preparation, and a lot of these guys are tired, but still have to gear themselves up for the greatest tournament on earth.

“We love the English Premier League, it is fantastic and exciting, but these guys do not get a break.

“Even someone like Wayne Rooney, who is a strong kid, will carry a couple of niggles into the World Cup.

“The big problem is that when people carry an injury, they are more prone to injury somewhere else.

“It is biomechanics.

“Your body is like a piece of metal – if you stretch it enough, then due to fatigue, it will break, we have seen it with Ferdinand.

“These guys never get a chance to recover completely.

“It is also mental as well, because if you are fatigued mentally, you will break down physically as well.

“This has been happening year after year, and it is ridiculous there is no winter break.”

Rogers moved to Britain from the United States in 1997.

The Americans will face England in their opening Group C game on Saturday.

Rogers feels England’s fatigue issues could give his compatriots a boost.

“The US team may not have the technique and may well get beaten by England, yet physically we will be better, stronger and faster, because we will be ready, but England will be tired,” he said

“If you look at what Manchester United, Chelsea, Manchester City and Tottenham have all done this season, you can’t say it has not been stressful for all those kids.

“Emotionally there have been so many ups and downs, then they have to prepare for the World Cup.

“These guys know they are tired and need a break.”

article courtesy of The World Game

http://theworldgame.sbs.com.au

Zinc is an important part of maintaining your dietary health and assisting with weight loss.  It contributes to a wide range of health benefits.  Its reproductive benefits include improving the production of testosterone in men and aiding the sperm to reach the goal of an ovum and penetrate it.   In women, it in essential for all phases of the menstrual cycle and can lessen the effects of PMS.  It can improve your sense of taste and smell and help to improve night blindness.  From the viewpoint of the immune system, zinc is great at reducing the length and severity of a cold (much like another well-known nutrient).  It also helps with wound healing and various skin conditions, such as acne and eczema, keeping the skin healthy to keeping infection out.

If you’re trying to lose weight, it’s important to make sure you’re getting enough of this important mineral.  Zinc is an essential factor for a healthy and happy thyroid.  Low levels of zinc will keep the thyroid from producing enough Thyroid Hormone for your body, which causes irritability, fatigue, and a decreased appetite.  The last bit may sound great for weight loss, but it also slows down your metabolism causing you to gain weight despite eating less food.

Like other water-soluble vitamins, zinc is not stored in your body, so it’s crucial to obtain it from your daily diet.  Lucky for us, there are a wide variety of foods that can boast of containing this fabulous mineral.

• Meats- This includes all types, but especially beef, lamb, pork, salmon, and dark meat of poultry.  Unfortunately, these are often the food that have high level of cholesterol and fat, so be sure to have a moderate portion for a healthier diet

• Nuts and Seeds- Almonds, peanuts, pine nuts, cashews, and sunflower seeds are all excellent sources for zinc and can be a great vegetarian substitute.  Pumpkin seeds have the highest level of zinc of all the non-meat foods.

• Cereals- Many cereals today, such as bran, multi-grain, and whole grain cereals, are fortified with minerals including zinc. Just remember, flavoured cereals can be a sneaky option loaded with sugar, so be sure to read the labels.

• Shellfish- This is one of the best ways to obtain zinc.  Crab, lobster, clam, and mussels all have very high levels with oysters leading the pack.

There is, however a tricky side to zinc.  It can be fickle and will not be absorbed into your body if certain other foods or types of nutrients are present.  Whole grains on their own contain phytates, which can slow down absorption, so it’s a good idea to mix in some nuts and seeds to ensure the zinc reaches your system.  Foods rich in iron can also impede the process, including spinach, raisins and beef.  Some medications, such as contraception’s or hormone replacement therapy can have the same effect as well.

If you’re worried about not getting enough, there are supplements either of zinc alone or in a multi-vitamin.  Again, taking supplements with calcium or magnesium affects the absorption of zinc, meaning that it may pass straight through without you getting any of the benefits!  A good way to counter this is to take them at different times of the day.