What is Blood Pressure?

Exercise, Health, Lifestyle

Blood pressure main

What is blood pressure (BP)?

Blood pressure is the pressure exerted by the circulating blood on the walls of the blood vessels.

What system is it part of and why?

BP is a part of the blood circulatory system, which is also known as the cardiovascular system(Refer Fig 1)

  • The heart
  • The blood vessels – arteries and veins
CirculatorySystem

Fig 1: The Circulatory System

The heart acts as a pump that is responsible for,

  • pumping oxygenated blood carried by the arteries to our organs
  • pumping deoxygenated blood that it receives through the veins from our organs. 

One of the functions of the circulatory system is to regulate the blood pressure for maintaining good blood flow throughout the body. This is required in order to transport nutrients and oxygen for every body part, for regulating body temperature, pH balance and for normal functioning of the body.

For example, when the heart pumps out oxygenated blood through the arteries, the blood flow exerts a force on the walls of the arteries. This force is measured as arterial blood pressure as shown in Fig 2. Any problems with this arterial BP may lead to a problem with the normal functioning of the body.

blood pressure

Fig 2: Arterial Blood pressure 

How is Arterial BP measured? 

The instrument that can measure the blood pressure is called Sphygmomanometer (Refer Fig 

Sphygmomanometer

Fig 3: Sphygmomanometer

It consists of:

  • a cuff,
  • a pump, and
  • a calibrated mercury scale

Typically two numbers that are being recorded on the scale which is written as a ratio. For example, BP of 120/70 mmHg, where 120 is the top number and 70 is the bottom number.

BP Measurement

Fig 3: Measuring BP

As shown in Fig 3, the BP is measured in four steps,

Step 1: Locate the pulse on an artery of the arm

Step 2: The health professional wraps the cuff around your arm and inflates it to squeeze your arm. This is done to temporarily press on the artery and close the blood flow in your arm. 

Step 3:  After the cuff is inflated, the health professional will slowly let air out. While doing this, he or she will listen to your pulse with a stethoscope and watch the mercury level on the calibrated scale to accurately note the measurements. The first pulse sound is heard and simultaneously measured on the scale.

Step 4: As the successive pulse sounds continue the professional hears it until the last pulse sound is heard which is again measured. 

The scale used is in “millimeters of mercury” (mmHg) to measure the pressure in your blood artery.

Blood pressure numbers- what does it indicate? 

systole and diastole

Fig 4: Systole and Diastole of the heart

The top number- Systolic pressure

The top number, which is also the higher of the two numbers, is the measure of the pressure in the arteries when the heart beats or contracts to pump the oxygenated blood. This is also known as the systole of the heart as shown in fig 4. 

The bottom number- Diastolic pressure

The bottom number is also the lower of the two numbers. It indicates the pressure in the arteries when the heart muscles are relaxing between two heart beats and refilling with blood. This is also known as the diastole of the heart as shown in fig 4.

BP Categories

Fig : BP Categories

Fig 5: BP Categories

Typically more attention is given to the top number (the systolic blood pressure), however, both the systolic and the diastolic pressures are important for indicating if a person is at risk of any heart disease.

What are the risk factors that will lead to high or low BP?

Risk factors

High BP

Low BP

  • Family history of High BP
  • Advanced age
  • Men get High BP more than women
  • Sedentary lifestyle
  • Poor diet, excessive salt intake
  • Drinking too much alcohol
  • Obesity
  • Smoking
  • Stress
  • Sleep apnea- a sleep disorder in which tissues in the throat collapse and block the airway.
  • Prolonged bed rest
  • Pregnancy
  • Trauma- loss of blood from major trauma, dehydration or severe internal bleeding
  • Certain medications
  • Abnormally low heart rate 
  • Endocrine problems- thyroid problems, Diabetes
  • Severe infection
  • Severe allergic reaction
  • Anemia
  • Nutritional deficiency- low blood volume due to Vit B12 and folic acid deficiency
  • Extreme heat- hot sauna and hot bath

When to seek Medical help?

There’s a common misconception that people will experience symptoms such as nervousness, sweating, difficulty sleeping or facial flushing. But the truth is that changes in blood pressure can be a symptomless condition. If you ignore your blood pressure because you think symptoms will alert you to the problem, you are actually taking a risk. It is important to know your blood pressure numbers as everyone should prevent blood pressure problems.

However, there are few signs and symptoms that may possibly occur with low and high BP. 

Signs and symptoms 
High BP Low BP
  • Severe headaches
  • Severe anxiety
  • Shortness of breath
  • Nosebleeds
  • Blood spots in the eyes
  • Facial flushing

 

  • Dizziness or lightheadedness
  • Fainting
  • Dehydration and unusual thirst
  • Lack of concentration
  • Blurred vision
  • Nausea
  • Cold, clammy, pale skin
  • Rapid, shallow breathing
  • Fatigue
  • Depression

 

How to manage BP problems?

Routine Check-up: Most people are unaware of their BP problems and going for a check-up will detect any blood pressure problems. This will prevent any potential health conditions. 

Understand your normal level of BP: There is no healthy level of high blood pressure or low blood pressure.  Your healthcare professional will determine your treatment goals based on your overall lifestyle and your body.

Lifestyle modifications

  • A nutritional diet, which may include reducing salt depending on High or low BP, Vitamin and mineral rich diet.  
  • Physical activity – exercise
  • Maintaining a healthy weight
  • Stress management
  • Smoking cessation support
  • Alcohol limitations
  • Prescribed medication in specific cases

Take precautions while exposed to heat 

When your body gets heated up during hot weather or during a hot tub or sauna bath, your blood pressure could drop and your heart rate may increase to counteract a drop in blood pressure. Normally, these events don’t cause problems. However, if you have an existing low BP you may be at risk of fainting, falls and heart problems.

Some of the precautions can be,

  • Limit your exposure to heat. Most experts say no more than five to 10 minutes is safe.
  • Stay hydrated.
  • Regulate water temperature during hot tub or sauna baths.

Conclusion

Managing blood pressure requires an individual’s adherence to the lifestyle changes and habits. It is advisable to get early assessment and treatment of your blood pressure problems in order to have a healthy circulatory system and to prevent the risk of many health conditions.    

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Alcohol Flush Reaction – Why does it happen?

Common conditions, Food, Lifestyle

drinks

Many people experience a prompt reddening on their face after few drinks of alcohol. It is called “Alcohol flush reaction” and is also known as “Asian flush syndrome” due to its greater prevalence among Asians. The reaction is often considered to be a sign of natural body protection mechanism from excessive drinking. What might seem like an unexpected natural reaction is, in fact, a sign of alcohol intolerance. An associated risk factor to many health conditions.

Alcohol tolerance vs Intolerance

Alcohol tolerance is the ability of the body to metabolize alcohol and reduce its concentration in the blood. When the body and the brain are subjected to alcohol, it activates the liver to produce large amounts of liver enzymes for the breakdown of alcohol to flush out any toxic products of alcohol out of the body.

Alcohol intolerance is the inability of the liver to break down alcohol. It is related to a genetic disorder of aldehyde dehydrogenase gene (ALD­H2) that is responsible for normal functioning of the liver enzymes. Due to its absence, a toxic by-product of alcohol called ac­etalde­hyde builds up in the blood which causes intolerance.

Acetaldehyde in the blood triggers Alcohol flush reaction. It also releases a chemical called histamine in the body that causes inflammation and aids allergic reaction.  

Signs and Symptoms of high levels of blood acetaldehyde

  • Redness and flushing

One of the earliest reaction of Alcohol flush involves a persistently red face (refer Fig 1) due to enlarged blood vessels. This may also be seen on the chest and neck region.

before and after alcohol

Fig 1. Alcohol Flush Reaction

  • Palpitations

Acetaldehyde increases palpitation which is a sensation within the chest that brings awareness of an irregular or racing heartbeats.

  • Increased heart rate

An increase in heart rate is seen with increased levels of acetaldehyde. It causes the blood vessels to dilate, making the heart pump harder and faster for the blood to flow through relaxed blood vessels. 

  • Low blood pressure

Blood pressure is the pressure of blood in the circulatory system. Due to the alcohol reaction, the heart beats faster pumping out less volume of blood and dropping the blood pressure. One may feel light headed and dizzy which can get severe.

  • Extreme drowsiness and headaches

The direct cause is unknown, however, it is believed that due to the expansion of the blood vessels in the brain, histamine release and low blood pressure one may get extreme drowsiness and headaches. 

  • Pruritus (Itching)

This is an unpleasant sensation that provokes the desire to itch or scratch. This happens due to irritated nerve endings on the skin caused by histamine released by the acetaldehyde levels in the blood.

  • Nausea

A feeling of vomiting starts as the acetaldehyde levels in the body irritate the stomach lining, leading to inflammation (gastritis). 

  • Alcohol-induced asthma

Increased levels of acetaldehyde and histamine release in the body can trigger breathlessness due to constriction of the airway. It is often reported to appear after approximately 30 minutes post-alcohol consumption.

Risk Factors associated with people who get Alcohol Flush Reaction 

  • Esophageal Cancer

 Acetaldehyde in the blood is known to interfere with the DNA synthesis and repair mechanism and increases the risk of cancer by producing free radicals that are known to destroy healthy cells.

  • Alzheimer’s disease:

Alzheimer’s disease is a neurological disorder in which the death of brain cells causes memory loss and affects brain function. Research has claimed that genetic disorder related to the aldehyde enzyme also interact with the brain cells which are believed to be a risk factor of Alzheimer’s disease. 

  • Heart disease

 Continual drinking of alcohol among people with Alcohol flush reaction will affect the functioning of the heart and may lead to the risk of heart problems.

  • Liver disease 

Acetaldehyde causes oxygen deficits in the liver (hypoxia), including formation of harmful compounds that damage the cells of the liver leading to a liver disease.

Are you sensitive to alcohol or is it something else? 

If you are only experiencing this reaction with specific alcohol beverages. This may suggest that it is not alcohol intolerance but could be due to other ingredients involved that triggered the reaction. 

What can be done about the Alcohol flush reaction?

There is medication available to help with the flush. However, these drugs can only curb the redness but will not be able to break down the acetaldehyde levels in the body. Thus, individuals who drink often and use drugs to suppress the flushing will still be at risk of developing a health problems.

The best way to prevent alcohol flush reaction and minimise health issues is by not drinking alcohol at all. This may however be an unrealistic solution to many especially during social events.

There are few things one could consider that may help reduce the alcohol flush reaction:

  • Eating before alcohol consumption.
  • Having drinks with lower alcohol content.
  • Alternate alcoholic drinks with water or non-alcoholic drinks.

Like all things, always consume alcohol in moderation. Alcohol is a depressant, but it’s also an indirect stimulant. Never drink and drive. Medication can help mask the reaction but if you feel that it’s more than just a flush, always seek immediate medical attention.

Ankle Injuries – Sprain, Strains and Fractures

Common conditions, Exercise, Injury, Lifestyle, Pain

Ankle sprain main

An ankle injury is the most common type of injury that may involve the bones of the ankle and other soft tissue structures. Three are three types of injuries that are observed at the ankle:

  • Sprains
  • Strains
  • Fractures

Sprains are injuries to the ligaments that connect one bone to another. An ankle sprain may involve an injury to one or more ligaments that stabilize the ankle and the foot. 

Strains are injuries that involve musculotendinous (muscle and tendon) structures. Both sprains and strains can occur due to over-stretching or tearing of the ligaments and tendons due to sudden twisting of the ankle joint or when excessive forces are applied on them.

Fractures are injuries that involve bones of the ankle joint. It ranges from a simple break in one bone to several fractures, which causes your ankle to move out of place and puts you in great pain.

Who could be at a risk of an ankle injury?

Ankle injuries may occur among,

  • Dancers
  • Sports persons- Gymnasts, basketball players, players participating in jumping sports etc.
  • Women wearing unstable high heels
  • Hypermobile people who already have laxed ankle ligaments 

Types of Ankle injuries

  • Lateral ankle injury

This is the most common injury to the ankle. Often, an inversion sprain could be an associated with a fracture and a strain to the peroneal tendons.  

An inversion sprain happens when the ankle in twisted inwards with an inward rolled foot as shown in Fig 1.

inversion injury

Fig 1: Lateral ankle injury

  • The Medial ankle injury

This type of injury occurs at the inner aspect of the ankle. Like a inversion sprain, the eversion sprain may also be associated with fractures of lower ends of the leg bones and strains to the tibialis anterior muscle.  

Eversion sprain happens when the ankle is twisted out with the foot rolled outwards as shown in Fig 2.

eversion injury

Fig 2: Medial ankle injury

High Ankle Injury

This type of injury is very rare. A high ankle sprain happens when the tibia bone rotates injuring the ligaments that hold the lower end of the two leg bones (tibia and fibula) as shown in Fig 3.

Severe injuries may cause fracture to the lower ends of the leg bones.

syndesmosis injury

Fig 3: High ankle injury

Severity of an ankle sprain 

An ankle ligament sprain can be graded according to the severity of the tear in the ligaments as shown in Fig 4.
 
lateral ankle sprain

Fig 4: Grades of ankle sprain

Sign and Symptoms of Ankle Injury
 
    • Swelling: Increased fluid in the tissue due to inflammation and soft tissue damage.
    • Pain:  Depending upon the severity of the injury and the structures involved, pain intensity can vary. 
    • Redness/ Warmth/ Tenderness: Caused by increased blood flow to the area.
    • Unstable ankle: The affected side feels weak and difficult to weight-bear.
    • Deformity: Severe injuries can cause fractured bones to move out of place and make the ankle look deformed.
Causes of Ankle Injury
Trauma
  • Stepping in a hole or a stone
  • Running on uneven ground
  • Fall or slippage on wet floor
  • Contact injury during sports like basketball, when a player is accidentally hit by an opponent causing the foot to roll inwards as shown in Fig 5.
Basketball

Fig 5: Lateral ankle sprain during basketball

Muscle imbalances

Lack of flexibility in muscles can hamper joint movement. For example, if the calf muscles are very tight, it will affect the stability and mobility of the ankle joint. In such a state, if one engages in any physical activity like running there could be a potential risk of twisting an ankle. Sometimes even lack of warm-up and stretching could be the cause of muscle imbalances.

  • Lack of Postural control

Postural control is defined as the act of maintaining, achieving or restoring a state of balance during any posture or activity.

It helps to maintain a good base of support for balance so that the force of gravity can act on the center of mass (COM) of the body. Centre of mass is the point in the body where the entire body weight is concentrated (located in the lower end of the spine) as shown in Fig 6.

Figure_10_03_05

Fig 6: Line of gravity and base of support

During sports, sudden quick body movements or external forces like a push or a contact by an opponent will affect your balance. If you lack postural controlm you may lose balance and risk hurting your ankle. 

Diagnosis of an ankle injury

Most ankle injuries are usually straightforward ligament strains. However, the clinical presentation of subtle fractures can be similar to that of a ankle sprains and these fractures can be easily missed on initial examination. Fractures are usually detected via X-ray scans. If any fracture is left untreated, it may cause excessive pain and disability to an extent that you may not be able to bear weight on the joint. Therefore, an X-ray or an MRI scan is often recommended to understand the severity of the injury.

For example, a lateral ankle sprain showing fractured bones in an X-ray is shown in fig 7. 

ankle sprain with bone fracture

Fig 7: Lateral ankle sprain with fracture of the lower end of fibula bone

Ankle Injury management

Usually, ligament injuries heal in about 6-12 weeks and fractured bones take about 3-6 months to heal. This is however largely dependent on the severity of the injury and lifestyle of the individual so complete healing time frame may vary. 

Even after the healing process, ankle injuries may cause long term instability if not healed correctly. This may also be the cause of recurrent ankle sprains. An expert assessment of ankle mechanics is very important to decide on how long to protect and rehabilitate an ankle after an injury. The treatment plan will aim to restore the normal functions of the ankle and make return-to-play decisions based on the stability of the ankle thus preventing recurrent ankle injuries.

The ‘Wee’ problem about Asparagus

Food, Lifestyle

ASPARAGUS

The asparagus is a tall plant belonging to the lily family and is cultivated for its edible shoots. The tender young shoots of this plant are eaten as a vegetable and is well known for its health benefits.  However, for some, there can be a distinct odor in their urine after consuming this vegetable. 

Brief History of Asparagus cultivation

Asparagus was first known in ancient greek mythology, where the descendants of the greatest greek hero “Theseus” of Athens planted and protected asparagus by law and out of respect for the ancestors. Formal cultivation of asparagus came into being in Roman times (234-149 B.C). It became more popular in Europe, when John Gerard in 1597 called the plant “asparagi ” which he translated to signify “the first spring or sprout of every plant, especially when it be tender”.

Asparagus and Odorous Urine

The phenomenon of asparagus causing odorous urine was first documented in the 18th century. French botanist, Louis Lémery, reported a link in its ingestion causing the production of odorous urine. John Arbuthnot, a Scottish mathematician and physician to Queen Anne, noted in a book on foods first published in 1731, that asparagus affected the urine with the distinct smell (especially if eaten when they are white). French novelist, critic and essayist Marcel Proust described his experience with asparagus to be like a Shakespeare’s fairy-tale story that transforms his chamber-pot into a flask of perfume.

What causes the “Asparagus Wee Phenomenon” 

With the use of soil fertilizers containing sulfur, it is believed that the sulfate components from the soil must have been absorbed by the asparagus plant. It was believed that upon digestion, this produces an odor in the urine. But why is it that other foods like garlic, parsley, cabbage and egg that contain sulfur do not create the same odor in the urine? This is as the asparagus has a unique component of sulfur that even after digestion, stays present in the urine.

Odor producing component in Asparagus

A sulfur derived asparagusic acid (1,2-dithiolane-4-carboxylic acid) is believed to be the main component that produces the odor. This acid is known to be deadly to insects and has a higher concentration in young asparagus. Through digestion, asparagusic acid is converted to methanethiol and other dimethyl components that causes the smell in wee.

Detectors and Non-detectors

The asparagus urine phenomenon does not affect all asparagus-eaters! 

Research tells us that although every asparagus-eater produce smelly components in their urine, there is a variation in:

1. the amount of smelly components one produces.

2. the ability of one’s nose to detect the sense.

There is no known scientific evidence of any clinical problems associated with the production or detection of the asparagus odor.

Despite this, the asparagus has many health benefits that make it one of the most healthy vegetables.

Benefits of Eating Asparagus 

  • Anti-inflammatory action

Asparagus contains a good amount of beacasparanin A, sarsasapogenin, protodioscin, diosgenin and many flavonoids that have been reported to reduce inflammation in the body. It will help in reducing chronic inflammation which is one of the causes for many conditions of heart, liver, joint etc. 

  • Anti-diabetic

The extracts from asparagus have amino acid asparagine and chromium that improves insulin secretion which is responsible for glucose metabolism in the blood. 

  • Anti-oxidant 

Asparagus is rich in glutathione, a detoxifying agent that can help destroy carcinogens. 

  • Rich source of Vitamin B 

Asparagus has a rich content of B vitamins (B1, B2, B3, B5, B6, B7, B9, B12 ) that helps to turn the food we eat into energy, it metabolizes sugars and starches, decrease in fatigue. It is essential for healthy skin, hair, and nails. It helps in cell regeneration that help repair and constant renewal of the skin. Vitamin B12 helps protect against unhealthy cholesterol levels, stroke, high blood pressure and cancer.

  • Aid digestion

Asparagus contains a substance called “inulin” that acts as a prebiotic which is used by good bacteria to improve nutrient absorption. Also, the vegetable has a high fiber content that helps get food through the gut more smoothly. Therefore, can provide relief from digestive discomfort.

  • Improves brain function

The folate in asparagus works with the vitamin B12 to helps cognitive function which mean it improves the mental process of knowing, including aspects such as awareness, perception, reasoning, and judgment.  

  • Diuretic 

The diuretic and alkaline properties of asparagus help flush out the kidneys and eliminate water retention in the body. It contains a substance called asparagine that makes it the remedy of choice for urinary tract problems.

Considering the health benefits of asparagus, it would be wise to ignore the odorous urine and still consume the vegetable. If the smell is an issue, try eating older asparagus instead of young shoots. Though older asparagus have a woodier stem and will need that extra bit of peeling, its sulfate content is much lower yet they have the same amount of nutrients as the younger ones. 

Common Knee Ligament Injuries

Common conditions, Injury, Lifestyle, Pain

17vike0510.jpg

A ligament is a band of connective tissue composed mainly of collagen fibres. The knee joint ligaments connect the femur (thighbone) to the tibia (leg bone) at the knee joint to improve its stability and to limit the amount of mobility in the joint.

The four main ligaments of the knee joint are,

  • ACL: Anterior Cruciate Ligament
  • PCL: Posterior Cruciate Ligament
  • MCL: Medial Collateral Ligament
  • LCL: Lateral Collateral Ligament
knee ligaments

Fig 1: Ligaments of the knee joint

Functions of the knee ligaments

  • Stability to the knee joint

The ligaments of the knee are responsible for preventing the tibia (shin bone) from sliding out of the femur (thigh bone). During rotational movements, knee ligaments work together to prevent both valgus (knee moved inwards) or varus (knee moved outwards) stresses to the knee.

According to their attachments in the knee, the ligaments prevent tibial displacements. For example, ACL prevents forward displacement of the tibia while PCL prevents backward displacement of the tibia. Similarily, the MCL provides support on the inner side of the knee while the LCL provides support on the outer side of the knee.

  • Locking the knee during walking

Apart from supporting the bones, the knee ligaments contribute to the “screw-home” mechanism, a process that locks the knees during walking. For example, just before you strike the heel to the ground your knee is slightly flexed (about 20 degrees bent) then the screw home mechanism works to straighten the knee as your body moves over the planted heel as shown in Fig 2.

swing to stance

Fig 2: Screw-home mechanism

What does a ligament Injury mean?

A ligament injury is the over-stretching or tearing of the ligaments of the knee. A tear may be partial or complete.

mcl injury BY GRADES

Fig 3 Grades of  Ligament injury

What can cause a Knee Ligament Injury?

Extreme movements at the knee joint forcing the knee to move beyond its normal motion can injure a ligament. Most of the injuries occur during weight-bearing activities, as the ligaments resist against perturbations at the knee.

Types of people who usually get them

  • Sports people like football players, basketball players, skiers etc.
  • Hyper-mobile individuals who engage in high-impact sports may have an injury due to excessive laxity in the knee ligaments.
  • Accidental fall on the knees or hit on the knees during contact sports like rugby, football etc or automobile accidents (in which the knees can hit the dashboard)

Mechanism of an injury

hyperextension

Fig 4: Causes of knee injury

  • Hyper extension injury

Extending the knee too far by over straightening of the knee. This can happen when you stop suddenly while running.

  • Flexion and Hyperflexion injury

Jumping and landing on a flexed (bent) knee or falling on your knees with over overbent knees.

  • Rotational injuries

Valgum (inner) or varum (outer) stress on the knees due to twisting of your knee inwards and outwards. Sudden shifting of weight from one leg to the other.

  • Contact Sports

Accidental hit on the knee during sports as shown in Fig 5

PCL INJURY

Fig 5: Direct hit on the leg

Other Reasons that contribute to a Ligament Injury

  • Lack of force distribution

During movement, the body exerts a force on the ground and at the same time, an equal and opposite ground reaction force (GRF) is exerted by the ground on the body. This GRF is directed towards the center of mass (COM) of the body, a point in the body where the entire body weight is concentrated; in front of the tailbone.

If there is an imbalance, which means the athlete’s knee does not bend on landing and remains straight, the GRF creates a forward shear force that pushes the tibial forwards, stressing the ligaments. Hamstring muscles on the back of the thigh play a vital role in stabilizing the knee joint especially when the athlete lands. Normally, the knees normally bend slightly to absorb GRF as shown in Fig 6.

QUADS DOMINANCE

Fig 6: Hamstring action advantage for absorbing GRF

  • Lack of trunk control

Without trunk control, there will be greater movements in the trunk following a perturbation (disturbance) which could affect the distribution of the GRF.

Lack of control in the trunk motion happens because of diminished proprioception. In such a situation, if the trunk moves more on the side of the knee joint laterally, the GRF tracks the COG and follows the movement of the trunk. As the GRF tracks the COM, and if it progresses beyond the center of the knee joint, it results in a movement of the knee joint into a valgus alignment stressing the knee ligaments as shown in Fig 6.

Trunk dominance

Fig 6: Valgus alignment of the left knee

Signs and Symptoms of Ligament Injury

  • Popping sound at the time of injury can indicate a ligament rupture.
  • The knee swelling within the first 24 to 48 hours
  • Tenderness and possibly redness around your knee on touching. 
  • Knee feels unstable or may buckle during weight bearing. This may cause you to limp or feel wobbly at the knee during walking.
  • Bruising around the knee can develop. 

What to do if you think you have an injury?

If you are having any of the above signs or symptoms, seek immediate medical attention. What can appear to be a simple ligament or soft tissue strain may become something more if left untreated. Diagnostic tests such as an X-ray or MRI scan will be able to show any tears or rupture of the ligaments. According to the severity of the ligament injury, appropriate treatment care will be advised.

The Truth about Coconut Water

Food, Lifestyle

Benefits of drinking coconut

We are all familiar with the uses of the coconut fruit from coconut water to other derived ingredients like coconut oil and coconut milk. Coconut water being the latest health food fad.

From unmarketable by-product to the most popular drink

Traditionally, coconuts were harvested for their meat or white coconut kernel to extract coconut oil. Because fresh coconut water is quick to decompose once the coconut is cut, the water was often discarded as an unmarketable by-product. With developments in technology, coconut water is now being preserved in cans or tetra packs and exported to international markets.

Coconut water- Why so Popular?

Fresh coconut (Cocos nucifera L) water is a clear, sterile, colourless and naturally flavoured drink.

Its main constituents (depending on fruit maturity levels) are:

  • Water- H2O
  • Sodium- Na
  • Potassium- K
  • Chlorine- Cl
  • Sulphur- S
  • Calcium- Ca
  • Magnesium- Mg
  • Phosphorus- P
  • Manganese- Mn
  • Aluminium- Al
  • Zinc- Zn
  • Iron- Fe
  • Copper- Cu

Other traces of elements such as selenium, boron, molybdenum are also found. All of these minerals are in the form of electrolytes, which means it can be easily absorbed by the human body.

It is also a rich source of essential amino acids (lysine, histidine, tyrosine, L-arginine and tryptophan), fatty acids, glucose, fructose, cellulose, sucrose, and organic acids such as tartaric, citric and malic acids. The contents in the coconut water is similar to the body fluid plasma. In WWII, coconut water was used as intravenous fluid hydration and also as resuscitation fluid. In other words, coconut water was infused directly into the veins to improve the fluid balance in the body. Most of the health benefits attributed to coconut water can be traced to its amazingly rich mineral content.

Lets look at the health benefits of coconut water

  • Low-fat Low-sugar drink

Compared to other readily available soda drinks that are high in chemicals (artificial colour and flavouring agents), fat and sugar, coconut water is relatively low in fat and sugar. It contains only a fifth of the sugar that you get from an equal amount of fresh grape or apple juice. Even though it has a low sugar content, it has a mildly sweet and delicate flavour. Making it a healthier alternative to most retail drinks.

  • Prevent heat stroke

heat stroke and coconut

Dehydration and heat stroke is very common in hot weather. It has been shown that coconut water is better than normal water and even fruit juices when it comes to such conditions. This is because, coconut water  re-hydrates the body by providing essential minerals that correct the electrolyte balance in the body.

  • Nature’s sports drink

The natural electrolyte content in coconut water is better than the chemical electrolyte additives in the commercial sports drinks. The potassium content in coconut water will help you get rid of any muscle cramps and replenish the nutrients that your body has lost during a moderate workout.

sports drinks

  • Treatment for severe dehydration

Layout 2

Coconut water’s unique mineral composition is able to rehydrate the body and give it the necessary nutrients to recover. In addition, coconut water has a rich enzyme system which has been used in the treatment of diarrhoea, stomach flu as well as urinary stone dissolution.

  • Good heart, nerve and muscle functioning

Our body has the inherent ability to provide the nutrient supply for the functioning of various body parts. Coconut water has a rich content of potassium and some amount of sodium that plays a role in the normal bodily function.

Sodium K pump

Sodium is the principal ion in the fluid outside of cells while potassium is the principal ion in the fluid inside of cells. The concentration differences between potassium and sodium across cell membranes create an electrochemical difference known as the membrane potential. The membrane potential is the basis for any cell function. A large portion of energy in the body is focused at maintaining sodium/potassium concentration gradients and tight control of this cell membrane potential is critical for heart function, nerve impulse transmission and muscle contraction.

  • Controls Blood pressure (BP) and prevents heart disease

Doctor taking patient's blood pressure

High potassium content in coconut water can cause vasodilation in blood vessels and a significant improvement in endothelial cell (cells of the arteries wall) function. The walls of the arteries get dilated and improves blood flow. This will not only help reduce high BP but will also prevent any chances of atherosclerosis (Heart disease in which plaque develops in the arteries of the heart causing hardening and lack of blood flow).

  • Anti-aging effect

Coconut water contains a rich source of cytokinins which is a growth-regulating hormone. This aids in repairing cell damage and degeneration.

  • Treatment of Kidney Stones

Coconut water also helps to dissolve kidney stones by alkalizing the urine and acting as a natural diuretic. This means that drinking coconut water will increase urine production and flow.  Dilute alkaline urine has a lesser chance for crystal formation since most minerals get dissolved completely in alkaline urine.

  • Antioxidant effect

Amino acid L-arginine present in coconut water significantly reduces free radical damage. It reduces the oxidative damage to cells of our body, slowing down the aging process.

  • Hormonal effect

Coconut juice is also believed to contain phytoestrogen and other sex hormone-like substances which can be used in hormone replacement therapy. This can reduce the risk of dementia and aid wound healing in postmenopausal women.

Given its wide range of benefits, this drink has gained a huge following and widespread availability. While coconut water has its goodness, it’s always wise to have a balanced diet and consume all foods in moderation. When in doubt, always seek an expert for advice.

Anatomy of the Hip

anatomy, Hip, Lifestyle

hip joint

The anatomy of the hip includes the ball-and-socket joint that involve two separate bones namely, the thigh bone and the pelvis.The unique anatomy of the hip enables it to be extremely strong and agile controlling every position of the lower limb in both weight-bearing and non-weight-bearing movements.

Bones of the Hip 

The Bones of the Hip include,

  • Pelvic bones (Ilium, Ischium, Pubis)
  • Femur (Thigh bone)

Fig 1: Shows the two Hip bones, sacrum, the acetabular socket of the hip joint, the entire Hip.

Pelvis

As shown in Fig.1, the pelvis is made up of two halves or two hip bones. Each hip bone is formed from the fusion of three bones: ilium, ischium and pubis. Fusion of these three bones, form one solid pelvic bone. The Pelvic bone contributes to the hip socket or acetabulum. Each pubic bone connect in front at the symphysis pubis.

Between the two hip bones, lies the foundation for the pelvis, the sacrum. The sacrum is a triangular-shaped bone that comprise of five fused bones at the lower end of the spine.

Fig 2. The Femur (thigh bone)

Femur

As shown in fig 2, the femur is more commonly known as the thigh bone which consists of the round head, the neck, the shaft and two condyles (lateral and medial) at the base of the femur.

The HIP joint

Like the shoulder, the hip joint is also a ball-and-socket joint, where the ball is the head of the femur, and the socket is the acetabulum.

Fig 3: Ball and socket hip joint

HIP JOINT 1

Articular Cartilage and labrum

The articular cartilage is a protective material that covers the articular surfaces of the hip joint (refer Fig.4).  It is about one-quarter of an inch in thickness with a rubbery consistency.The function of the cartilage is related to its structure and thus acts as a shock absorber by allowing better transmission of forces. It also helps prevent friction between the bones and is slippery enough to allow the joint surfaces to slide against one another without causing any damage.

The Labrum is a fibrous rim of cartilage around the acetabular socket that holds the femoral head in the joint providing stability.

Fig 4: Shows articular cartilage and labrum

cartilage and labrum

Joint capsule and ligaments of the Hip joint

The joint capsule is a watertight sac that surrounds the hip joint. The capsule is reinforced by three major ligaments, which are denser bands of connective tissue.

Fig 5: Shows Capsule and reinforced ligaments of the hip joint

capsule and lig

The attachments of each of these ligaments can be identified by its name- the iliofemoral ligament extends from the ilium on the pelvis to the femur, the pubofemoral ligament connects the pubic bone to the femur, and the ischiofemoral ligament extends from the ischium to the femur.

A small ligament called ligamentum teres connects the very tip of the femoral head to the acetabular socket. It accommodates a small artery within itself that brings an important blood supply to part of the femoral head.

Muscles around the hip joint:

Back muscles of the hip 

These Muscles are responsible for hip joint extension (backward movement)

They include,

  • Gluteus maximus
  • Hamstrings (long head of biceps femoris, semitendinosus, semimembranosus)

Fig 6: Extensor muscles

gluteal and hamstring muscles

These muscles cause the hip to move backwards in extension (Fig 7), it also causes knee flexion (bending the knee by bringing the heel towards the buttock). Hip extension is important during gait especially to propel your body forwards.

Fig 7: Hip extension movement of the hip joint

hip extention

Gluteus maximus contraction is a powerful action that opposes the force of gravity. The action of gluteus maximus is to move the hip bone(thigh) backward from a position of full flexion(bent), as in climbing stairs, or rising from a squatting or sitting position.

Fig 8: Action of Gluteus Maximus muscle

Gluteus max sit to stand

Front muscles of the pelvis

These muscles are responsible for hip joint flexion (forward movement).They include,

  • Iliopsoas (iliacus and psoas)
  • Rectus femoris
  • Tensor fasciae latae
  • Sartorius

Fig 9: Hip Flexor muscles

fllexor muscles

The hip flexors help you to draw your leg towards your chest and also helps to you move your legs from side to side and backwards. It serves to stabilize your hips, keeping the joints of your pelvis and lower back strong.

Fig 10: Hip flexion movement

hip flexion

Hip flexion movement is also important during the gait cycle in order to bring you leg forwards for heel strike.

Inner thigh muscles

These muscles are responsible for hip joint adduction (inward movement).They include,

  • Pectineus
  • Adductor brevis
  • Adductor longus
  • Gracilis
  • Adductor magnus.

Fig11: Aductor muscles of the hip joint

hip adductors

When the foot is not planted on the ground, the adductors will bring the leg toward the midline of the body. Also known as an open kinetic chain movement (open kinetic chain is defined as a combination of successively arranged joints in which the terminal body segment can move freely).

Fig 12: Adduction movement

adductors

Apart from the adduction movement in open kinetic chain, adductors also contributes during closed kinetic chain movements (In a closed kinetic chain movement, the distal end of the extremity is fixed, emphasizing joint compression and, in turn, stabilizing the joints).

A simple example would be during bilateral stance (standing on both legs) movement like squatting, adductors of both the hip joints help contribute to the stability in the pelvis. These adductors work with abductor muscles synergistically to provide side-to-side stabilization of the pelvis.

During walking, adductors also contribute throughout the gait cycle. For example, when you foot is move forwards before striking on the ground, the adductors will bring the leg towards the midline. Similarily, adductors with help in flexing the hip when the thigh is in an extended position as in the swing phase of the gait (walking) cycle.

Fig 13: Action of adductors during gait

Gait cycle

They are not the prime movers but function in reflex response to gait activities.

The only two-joint muscle of the adductor group, the gracilis, functions as an inner knee stabilizer and helps stabilize both the hip and knee during weight-bearing.

Outer muscles of the thigh

These muscles are responsible for hip joint abduction (outward movement). They include,

  • Gluteus medius
  • Gluteus minimus
  • Tensor fascia latae

Fig 14: Abductor muscles of the hip

abductors

In open kinetic chain movement when standing on one leg, the abductors move the leg away from the midline of the body.

Fig 15: Abduction in single leg stance

hip abduction

The gluteus medius however, is more of a lower extremity dynamic stabilizer than it is a pure hip abductor.  If the gluteus medius and minimus are weak or atrophied, the pelvis will drop to the opposite side when you bear full weight on the same side during walking. This dysfunctional postural pattern is referred to as the Trendelenburg sign.

Fig 16: Pelvic stabilization (strong Gluteus medius) and pelvic drop (weak Gluteus medius)

Gluteus medius

As you can see in fig 16, weakness of the right gluteus medius will cause the left hip to drop when standing on the right leg. Thus, during walking the primary function of the gluteus medius is to stabilize the pelvis when weight is shifted from one side to the other.

External rotators of the hip joint

Muscles of the thigh responsible for hip joint external rotation (twisting hip outwards) include,

Primary External Rotators:

  • Obturatorius internus and externus
  • Gemellus superior and inferior
  • Quadratus femoris
  • Piriformis

Secondary External Rotators:

  • Gluteus Maximus (lower fibres)
  • Gluteus Medius and minimus muscles when the hip is extended
  • Psoas Major Muscle
  • Psoas Minor Muscle
  • Sartorius

In the open kinetic chain the primary and secondary external rotators turn the lower limb outwards in relation to a fixed pelvis. This action is seen with the movement of the hip with knee flexion as seen in Fig 17.

Fig 17: External rotation

hip-external-rotation

However, in the closed kinetic chain scenario, with the foot fixed on the ground, the activation of these same muscles will cause the same movement at the hip-pelvis interface will cause the pelvis/torso to rotate.  For example, refer Fig 18. a closed chain right lower limb, upon activation of the external hip rotators the person’s pelvis and trunk will rotate to the left simultaneously (counterclockwise rotation) along the vertical body axis about the fixed right limb.

Fig.18 external rotation of right hip

Standing twist

This rotation can occur from activation of not only the hip rotators but also from the muscles of the abdomen, thoracic spine and rib cage.

Role in Hip stabilization

The deep external rotators (quadratus femoris, obturator internus and externus and the gemelli) are also active stabilisers of the hip and, along with the internally rotator gluteus minimis, they are also described as the “rotator cuff muscles” of the hip. The quadratus femoris,

During weight bearing, the deep rotators having a short moment arm and smaller in area there is minimal capacity of rotational force and more of  a horizontal line of force, which is more important in the compression of the joint surfaces.Thus creating more stability in the hip joint during movements.

Hip Internal Rotators

The muscles that are responsible for twisting the leg inwards (Internal Rotators) are,

  •  Anterior portion of the gluteus medius
  • Tensor fasciae latae

The head of thigh bone (femur) rotates inwards within the hip joint. It also occurs in standing when the lower limb is fixed and the trunk/pelvis rotates as already seen in hip external rotation. Internal rotation is the exact opposite.

In the open kinetic chain, the internal rotators turn the lower limb inwards in relation to a fixed pelvis. This action is seen with the movement of the hip with knee flexion as seen in Fig 19.

Fig 19: Open chain internal rotation of hip joint

Hip Internal roation

Similarily, Fig 20 shows a closed chain right lower limb, upon activation of the internal hip rotators driven by the person’s pelvis and rotation to the Right side simultaneously (clockwise rotation) along the vertical body axis about the fixed right limb.

Fig 20: Right hip internal rotation and right side pelvic rotaion

Twist IR

Role of internal rotators

During walking, in order to sufficiently extend the hip toward the end of the gait cycle, there has to be enough hip internal rotation (Fig 21). Without sufficient internal rotation, the pelvis will move as far forward over the stance leg, and we instinctively shorten our stride.

Fig 21: Hip extension and internal rotation of left hip joint in the final phase of the gait cycle.

gait IR

In conclusion, a thorough understanding of pelvic and hip anatomy is important for undermining any cause of dysfunction or injury. Even a lack of range of motion due to tightness in the soft tissue structures can put you at risk of involving compensatory movements that can lead to postural problems. Always seek medical advice when in doubt.

Joint Hypermobility – Beyond the Normal Range of Movement

Common conditions, Geeky stuff, Lifestyle

Hypermobility pictures

Our joints are responsible for movements and stability (e.g ability to maintain and control movements in your knees). Different joints have varying degrees of inherent stability considering its function, the way it articulates, anatomical position, load-bearing capacity, strength and flexibility of the soft tissue structures (muscles, ligaments, and fascia).  

Joint mobility, on the other hand, refers to the range of movement in a particular joint. Like stability, it is dependent on the strength and flexibility of the surrounding soft tissue structures. This means that any problems with the soft tissue structures would affect the stability and mobility, making the joint susceptible to injuries and dislocations.

Hypermobility

You are said to be ‘hypermobile’ when you have the ability to move your joints beyond the normal range of movement. Sometimes it’s also called ‘double-jointed’. This condition is fairly common in the general population and might sometimes become an advantage for athletes or dancers.

Having said that, there are different problems related to hypermobility. The most important being the lack of stability in the joints.  One may be predisposed to soft tissue structure injury and experience excessive muscular stiffness.

‘Hypermobility’ – How did I get so flexible?

  • Genetics – Connective Tissue Disorder

The exact cause is unknown. Due to genetic problems, it can be seen among infants at birth with sometimes a possible decline in hypermobility during childhood, teens and adulthood. An improper gene resulting in joint laxity is due to the lack of collagen, elastin and fibrin proteins which usually help with the stability of joints, tendons and ligaments.

  • Acquired hypermobility 

Without having inherited laxity in the joints, many ballet dancers and gymnasts get hypermobile as they push the joints to the hypermobile range while working to get the flexibility to perform. Intense and excessive stretching of the muscles and soft tissue structures can also lead to hypermobility.

When do we say you have a Hypermobility Syndrome?

Joint Hypermobility Syndrome (JHS)

Individuals who suffer from chronic joint pain and other symptoms related to their hypermobility have a condition called joint hypermobility syndrome (JHS). As the name suggests the most affected part is the musculoskeletal system.

Due to hypermobility, the risk of injury to the joint structures, ligaments, tendons and other ‘soft tissues’ around joints are increased. In addition, the structure of the collagen fibres and the shape of the bone (articulating surfaces) both play a major role. Even a lack of neuromuscular tone and proprioception could be the contributing factors to this condition.

Aggravating factors, Symptoms and Common conditions associated with JHS

There is no specific activity that can trigger pain. For some individuals, repetitive movements, overuse, excessive weight bearing or even simple activities of daily living can cause pain.

  • Incorrect posture and alignment of joints: During daily or sports activities incorrect movements due to faulty posture can affect the hips, shoulders, knees, and elbows joints. For example, hyper-extending the elbows can injure the tendons on the sides of the elbow causing conditions like “tennis elbow” and “golfer’s elbow.”
  • Laxity in the soft tissue structures: This leads to increased strain, tearing and spasm causing pain and stiffness around the joint. Due to over extending and twisting flexible joints, partial dislocations or complete dislocation can also occur.
  • Muscle imbalances: Pain due to injury causes adhesions withing the soft tissue structures (Muscles, ligaments and fascia) of one joint leading to imbalances in the mobility of other joints and surrounding structures. Pain and spasm of the hip muscles can pinch the sciatic nerve resulting in pain called as sciatica which can be felt radiating down the back to the leg. Sometimes it could also be because of the inter-vertebral discs (made of collagen) that has become too soft than normal and has impinged the nerve.
  • High-impact exercises: Sports that involve running, jumping or physical contact predisposes lax joints to dislocate.
  • Stretching: Incorrect technique or type of stretching that involve grabbing a joint and pulling or pushing on it to loosen it up.
  • Heavy lifting, pulling and pushing: Odd-shaped weights and unusual angles often lead to injury due to excessive load on the joints.
  • Recurrent Ankle sprains: Sprains may take very longer to heal because they tend to get injured repeatedly while trying to heal.
  • Knee pain: This is most common in hypermobile. People because the cartilage between the kneecap and the knee get lax. Due to excessive mobility, the cartilage underneath the kneecap starts to wear down (a condition referred to as chondromalacia), causing pain and sometimes a crunching or grinding noise – while kneeling, squatting or climbing the stairs.
  • Chest pain: A condition called costochondritis or inflammation of the rib cartilage causing pain and tightness.
  • The jaw, or temporomandibular joint (TMJ): This is often affected because of loose structures.

Although pain and fatigue are the common complaints, the range of symptoms could be wider considering that cardiovascular and endocrine system could also be affected.

Are my symptoms related to Pain and Fatigue syndromes or is it because of Joint Hypermobility Syndrome?

Hypermobility predisposes people to developing Chronic fatigue syndrome (CFS), Fibromyalgia (FM), Chronic Regional Pain Syndromes (CRPS), Chronic Widespread Pain (CWP). In simple words, someone with hypermobility may have other pain and fatigue syndrome. However, people with pain and fatigue related syndromes may not be hypermobile. Thus, a careful diagnosis is necessary.

Hereditary Syndromes associated with JHS

  • Marfan’s syndrome or Ehlers-Danlos syndrome, Osteogenesis Imperfecta: These are usually inherited disorders that are passed on to children by their parents. Often, children with Down syndrome will also be hypermobile.

Diagnosis of Joint Hypermobility Syndrome and Management

In some cases, people may have inflammation in their joints but no presence of abnormalities of their blood tests (so called seronegative inflammatory arthritis). Similarly, confusion is very common among clinicians to come to a particular diagnosis with the number of pain and fatigue syndromes associated with the joint hypermobility syndrome.

Most clinicians use the Beighton score which is a nine-point scoring system that looks for hypermobility. In the thumb, elbow and knee on both sides of the body and the ability to bend forward and place the palms of the hands flat on the floor without bending the knees. Hypermobility is often found at the jaw, neck, shoulders, other small joints of the hands and feet, hips, ankles and mid-foot, sticking to the Beighton scoring method is not enough in clinical examination. A high degree of applied musculoskeletal expertise and knowledge of the condition will be required to address all the problems.

If someone has been diagnosed with hypermobility and symptoms of pain, it is advisable that particular care should be taken with physical treatments. Avoiding activities that would strain the hypermobile joints.

Treatments should focus on improving the functional stability and mobility of the soft tissue structures. Awareness such as perception of correct posture with neuro-muscular proprioceptive training. Maintaining an active lifestyle with lifestyle modification. Even simple things like nutrition and balanced diet to maintain optimal body weight will be beneficial.

What is Tennis Elbow

Common conditions, Exercise, Lifestyle, Pain

tennis player massaging elbow

You just upped the load of your weight training or might have recently engaged in an activity which was strenuous and involve repetitive movements of the wrist and elbow. This later results in a burning sensation on the outer aspect of the elbow which is painful, sore and very sensitive to the touch. All this describes a condition called  ‘Tennis elbow’ which is more commonly known as lateral epicondylitis among clinicians.

Tennis elbow was thought to be common only among tennis players. However, this condition has been affecting more than just sports people as it is actually common in occupations which involve repetitive forearm rotational activities.

It has been estimated that only 5-10% of cases occur in tennis players. More often than not, recreational players are more susceptible than elite tennis athletes due to improper stroke technique or faulty equipment use.

Pain in the elbow was first described as ‘writer’s cramp’ by Runge in 1873 and later was called ‘Lawn Tennis Arm’ now known as Tennis elbow or lateral epicondylitis. Nirschl and Pettrone in 1979, described the pathoanatomy of the area as tendinosis.

Though the acute stages of tendon injury can have an inflammatory component, chronic tennis elbow is considered as a degenerative pathology rather than a tendonitis. Degenerative in this sense as it is more a failed reparative process of the tendon with associated cellular changes rather than active inflammation causing the pain. Therefore, terms like “tendinopathy” and “epicondylalgia” are more often being used by professionals to describe this painful condition which affects both office workers and sports people alike.

All about Lateral Tendinopathy (‘Pathy’ meaning non-inflammatory disorder) or Lateral Epicondylalgia (‘algia‘ meaning pain)

  • What is the lateral epicondyle of the Elbow? 

The elbow joint consists of three long bones which meet in the middle portion of the arm. The upper arm bone (humerus) meets the two inner bone of the forearm (ulna) and the outer bone of the forearm (radius) to form a hinge joint. The radius and ulna bones are responsible for rotational movements of your forearm.

Lateral epicondyle

The elbow functions to move the arm like a hinge (forward and backward) and in rotation (twisting outward and inward). The outer bone of the elbow is referred to as the lateral epicondyle and is a part of the humerus bone.

  • What are the tendons that attach to the lateral epicondyle?

A tendon is a part of the muscle. Tendon function by joining the muscle to the bone providing leverage to perform a movement.

At the lateral epicondyle, the tendons of the extensor muscles start and runs along the forearm. Extensor muscles again end into tendons that pass over the wrist and attach to your fingers. These tendons cause upward or outward movement of the wrist and fingers.

extensor muscles

Extensor Carpi Radialis Brevis (ECRB) – Commonly affected muscle

When performing movements at the wrist or by holding the wrist downwards with the forearm in pronation (Palm facing downwards). The extensor muscles especially extensor carpi radialis brevis is at its maximum length.

ECRB

As the origin of ECRB muscle lies proximal to the axis of rotation for bending and straightening the elbow, it is subjected to shearing stress and most commonly affected in movements of the forearm and wrist.

extensor_carpi_radius_brevis

What are the causes of lateral tendinopathy or epicondylalgia?

  • Overuse injury

The repetitive motion of the wrist or any activity that requires excessive constant gripping/squeezing can cause injury to the extensor tendons.

Individuals who perform multiple sets of dips, push ups and chin ups can also develop pain and injury. Repetitive exercises that involve excessive wrist extension and forearm rotation stresses the extensor tendon. Especially beginners who are trying to perform exercises which their bodies are not used to. They may be executing these exercises with improper posture, incorrect body alignment or bad technique, which predisposes them to painful symptoms of lateral tendinopathy.

  • Weak Scapula Muscles

In a research study published in Journal of Orthopaedic & Sports Physical Therapy (2015), impairments of scapular musculature strength and endurance in individuals with tennis elbow was found. This suggested that muscles of the shoulder and scapula play a role in movements in the forearm and improving the strength and endurance of these muscles will prove beneficial.

  • Faulty techniques

During Racket sports, the overload occurs at the extensor tendons especially in the backhand stroke that is hit with improper technique. The key is to use the body weight and strength from the shoulder than overloading the forearm extensor muscles alone. In a faulty stroke, the elbow is straightening doing the racket motion. 

In the game of tennis, the following maneuvers can lead to tennis elbow:

1. One-handed backhand with poor form and increased load on extensor tendons.

AIG Open Day 7

2. A late forehand swing resulting in bending the wrist significantly stressing the extensor origin.

BNP Paribas Open - Day 10

3. Snapping and turning the wrist while serving with full power

twisting

  • Faulty Equipments

Racket 

A rigid and small size racket causes more compressive forces on the extensor muscles. Even though a stiff racket gives the player more power and control, a lot of compressive forces affect the forearm. The grip of the racket if too small or too large may require more strength to hold the racket. In both cases, the player may have to grip the racket too tightly to prevent it from twisting, and high grip force may increase the risk of injury.

Strings

High thicker string tension is problematic for the forearm because it reduces the dwell time of the ball on the strings. The lesser contact time of the tennis ball means that the shock of the ball impacts more to the forearm muscles.

Tennis ball

Old, wet and soft tennis balls affect the impact and contact point on the racquet requiring more effort from the forearm muscles during impact.

 What happens if you have an injury?

Tendinopathy is the result of overuse activity of the extensor muscles causing the tendons at the lateral epicondyle to have micro tears and reduce its blood supply. The tendon tissue develops large nociceptors that cause severe pain. Pain substances (substance-P and CGRP) irritates the surrounding nerve fibers to possibly inflame which further adds to the chronic nature of the painful condition. With the amount of pain, stiffness sets in causing weakness in the extensor muscles of the forearm affecting grip strength and daily activities. Chronic degenerative changes are seen in the collagen tissue of the extensor tendons that further worsens the condition.

Considering its severity from mildly irritating to a debilitating chronic painful condition, it can have a significant impact on social and occupational life.

How can you prevent tennis elbow?

If your injury is caused by an activity that involves placing repeated strain on your elbow joint, such as tennis or repetitive push-up workouts, changing your technique may alleviate the problem. Identifying and learning correct techniques, postural awareness and feedback for an experienced coach would be beneficial.

The best advice is to avoid too much stress on the muscles and tendons surrounding your elbow engaging in overuse activities. Mostly the condition is reversible with rest and treatment which will help prevent the condition getting worse.

Having said that, if it’s just an irritation, there are some precautions you would need to consider immediately while playing tennis. Watch out for faulty strokes or a playing situation which seems to exacerbate the problem. Get more information on the racket dynamics, tennis ball type and strings so that you can avoid injuries due to faulty equipment use.

Due to the insidious nature of the condition and a wait-and-see approach by many individuals, this condition becomes more chronic and debilitating. If pain persists and restricts the movements of the elbow, it will be best for you to get your elbow examined by experts to prevent any further damage.

Functions of the Patella – Knee Cap

anatomy, Common conditions, knee, Lifestyle, Pain

knee cap

The only time feeling weak at the knees would be a normal phenomenon is when you are standing at the edge of a cliff or doing a bungee jump.

Experiencing weak knees with joint pain can be quite debilitating. We can sit, stand, walk, run and move about easily because of our knees. What we should know is that our kneecap is a part of the knee joint and it should remain ‘in the groove’  for optimal function.

The kneecap, also called the patella bone, is a sesamoid bone in the front of your knee. It’s called the sesamoid bone as it has the shape of a sesame seed. The sesamoid bone is a bone that grows within a tendon. The patella has many biomechanical functions which are responsible for the protection, support and movements at your knees.

Anatomy of the knee cap

anatomy

The knee joint (Patellofemoral joint) is comprised of the three bones. The thigh bone (Femur), the shin Bone (Tibia) and the patella (Kneecap). The patella  lies in a groove at the lower end of the femur and acts as an attachment point for the four main muscles of the thigh (quadriceps). The lowest part of the patella continues on as a tendon that attaches to the tibia. The muscles pull on the patella and the patella pulls on the tibia allowing you to straighten your knee from a bent position.

knee extension action

Cartilage of Patella

articular cartilage of patella

The cartilage is a taut protective structure underneath the kneecap. It found to be among the thickest cartilage in the body providing cushioning for the patella bone. The cartilage helps to prevent friction and acts as a shock absorber protecting the bony surfaces.

Why is the patella so important?

  • Patella functions as a natural pulley

The kneecap plays an important role, it increases the leverage of the quadriceps tendon (thigh muscle tendon) and protects the front of the knee from direct trauma.

lever arm quads

The quadriceps muscle is providing the force like the man in the picture, the patella bone acts as a fulcrum to provide more leverage for lifting the stone.

In real life though, the patella is a little more complicated by not only providing increased force, but also by aiding in balancing forces as well as providing a direction for the forces.

  • Prevents excessive weight-bearing compressive stress 

As weight bearing stress falls on our knees, the patella acts as a spacer protecting the quadriceps tendon and bone from coming into compression and creating a frictional force. The patella also allows for smoother movements when bending and straightening the leg.

  • Maintaining the Quadriceps Angle

Q angle

The quadriceps angle or the Q angle is determined by drawing one line from the hip bone (anterior superior iliac spine) through the center of the patella and a second line from the center of the patella through the leg bone (tibial tuberosity).

normal Q angle

As the Q angle increases above 15 degrees, it potentially could cause the patella bone to move out of its groove. This is as if the Q angle is increased, forceful contraction of the quadriceps muscle can cause the patella to move outwards and possibly dislocate. Slight changes in the Q angle would cause imbalances in the muscle forces causing compression stress, symptoms of pain and inflammation at the knee joint.

Knee Pain related to the Patella 

Although patellar dislocation, fracture, and patellar tendon inflammation are the common sports-related injury. Many patella related problems may also occur during daily activities.

  • Runner’s knee/ Patellofemoral pain syndrome 

Patellofemoral joint pain is a condition seen in runners causing pain during running or while at rest. Pain usually occurs in the front of the knee.

  • Condromalacia Patellae (“soft cartilage under the knee cap”)

This often affects young, otherwise healthy athletes. Chondromalacia patella is one of the conditions that cause pain in front of the knee. When pain exists in the absence of cartilage softening, it can be referred to as patellofemoral pain syndrome (Runner’s knee). Although it’s common to sporting individuals, it can also affect individuals with weak quadriceps muscles. It is common among individuals engaging in activities like football, cycling, tennis, weightlifting, runners. In other words, any sport that involves running, jumping, squatting and landing on the knees.

  • Prepatellar bursitis (between patella bone and skin)

Prepatellar bursitis has historically been referred to as “housemaid’s knee”, which is derived from a condition that was commonly associated with individuals whose work necessitated kneeling for extended periods of time. Prepatellar bursitis is common in professions such as carpet layers, gardeners, roofers, and plumbers.

  • Infrapatellar Bursitis (Below the Kneecap)

This is common among individuals who engage in activities that involve kneeling down for long hours causing inflammation of the bursa below the patellar tendon. It can also occur conjunctively with a condition called jumper’s knee.

  • Suprapatellar Bursitis (Above the kneecap)

Injuries such as direct trauma and overuse injury to the bursa beneath the quadriceps tendon cause inflammation of this bursa.Overuse injuries caused due to running on uneven surfaces or doing jobs that require crawling on the knees.

  • Osteoarthritis 

Patellofemoral arthritis occurs when the articular cartilage on the underside of the patella wears down causing friction between the patella and the end of the thigh bones. It gets extremely painful during weight bearing with swelling, inflammation around the knee. It is generally a degeneration condition which requires immediate medical attention to manage the condition.

  • Patellar Dislocation 

This type of injury happens when the kneecap (patella) moves out of its groove due to the sudden change in direction engaging in high impact sports. It most commonly occurs among young girls or hypermobile individuals due to laxity and increased hip angle. Direct trauma to the kneecap could also cause dislocations.

As a precautionary measure, using knee pads during sports and regular exercises of your knee muscles will have great benefits for your patella. Generally, most of the injury conditions can be managed with appropriate treatment and rehabilitation.

However, if you’ve only begun to feel pain while doing activities or just by standing, you might like to seek medical attention to prevent long-term pain or further damage to your patella.