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.

Rotator Cuff Injury

Common conditions, Injury, Pain

shoulder

Our shoulders are the most movable joints in our body. Most activities whether simple or strenuous engage both our shoulders. That is the reason why with a little bit of pain in our shoulders, we find it very difficult to do even the simplest of tasks like putting on a coat or carrying groceries. Sometimes there is a crunchy sensation or you may hear clicking and popping sounds while you move your shoulder or do weights. This pain can worsen making you feel frustrated, leaving your shoulders feeling weaker than normal and stiff to move. There could be many reasons for the cause of your shoulder pain but the most common injury that could possibly show these type of symptoms would be a rotator cuff injury.

What is the rotator cuff and how does it get injured?

Rotator cuff injury

The Rotator cuff is a group of muscles coming from the shoulder blade and ending in tendons that attach to the arm bone. These muscles cup the shoulder and are responsible for its stability during movement. The muscles of the rotator cuff muscles include:

  • Supraspinatus
  • Infraspinatus
  • Subscapularis
  • Teres Minor

“Centralisation”- Your rotator cuff is important

The function of the rotator cuff, in addition to generating torque, is to dynamically stabilize the shoulder joint. It keeps the ball of the shoulder centred over the small glenoid socket. Thus, stronger rotator cuff muscles result in the better glenohumeral joint stabilization and hold the humeral head into the glenoid by depressing it. This prevents impingement and decreased chances of shoulder dislocation when the deltoid abducts(arm sideways up) the shoulder. Without an intact rotator cuff, particularly during the first 60 degrees the ball of the shoulder would migrate up the glenoid cavity causing the rotator cuff attachments to get compressed by the acromion leading to impingement of the rotator cuff. In patients with large rotator cuff tears, the humeral head is poorly depressed and can migrate cephalad during active elevation of the arm.

Rotator cuff injuries

Sometimes sudden fall or high impact sports could be the cause of injury but in most cases, it is due to the repetitive injury over the tendons as they being pulled beyond their capacity to stretch. This gradually worsens causing partial or full tear of the tendons. Due to the way these tendons cup the shoulder by being closely spaced, they are more at risk of friction. Especially when you turn your shoulder or lift any weight at the end range of shoulder movement, the tendons in this tight space become taut and rub against the bony knob (acromion process of the scapula) above them or against a ligament at the front of the shoulder. This causes friction, pain and as a normal response, inflammation sets leading to pain, swelling and movement restriction.

Physiology of rotator cuff damage

1. Tendonitis (acute Inflammation)

Tendonitis can occur in a particular rotator cuff tendon causing pain, inflammation and irritation. If this condition becomes more chronic, more tendons can become involved or it may progress to a tendinosis (degeneration).

2. Impingement Syndrome (compression of the tendon)

The most common site of impingements is within the “supraspinatus outlet”. This outlet is a space formed by the acromion process of the scapula, the coracoacromial ligament and the upper rim of the humeral head. Subacromial outlet

Impingement within the outlet can be caused by:

  • Thickened Coracoacromial ligament: This can cause impingement by becoming thickened due to excess calcium deposits that will compress the supraspinatus tendon.
  • Hooked acromium: In repetitive overhead activities, the tendons rubs against the acromion process of the Scapula and gets damaged. When the inflammation spreads into the pocket of fluids (subacromial bursa) that lubricates the rotator cuff tendons under the acromion bone. This causes subacromion bursistis and the pain gets even worse on movements.
  • Abnormal Scapular Movement: With normal shoulder movement, the scapula moves outward and upwards helping the shoulder to move up

scaphumerorhythm movement

  • In the case of an unhealthy shoulder, the scapula does not move in the same fashion as the healthy shoulder and gets “stuck” in a lower position. This could lead to abnormal movement of the scapula during shoulder movement. Poor scapular movement will cause compression of the tendons in the supraspinatus outlet increasing the chances of impingement of the rotator cuff tendon that goes under it.
  • The picture below shows an unhealthy right shoulder at a risk of impingement, showing improper movement in the scapula.

chances of impingement

3. Rotator cuff tears

A tear is a result of the worsening of the tendon damage. Although an acute fall can tear the rotator cuff tendon, chronic inflammation and degeneration due to impingement is the major cause of tears. This tear can start small and get larger over time due to repetitive use or a re-injury. When a tear occurs, there will be severe weakness and atrophy(loss of muscle mass) of the muscles around the arm and loss of movements of the shoulder. impingement

How is Rotator Cuff Injury Diagnosed?

Pain in the shoulder could be caused by various other reasons like joint injury, capsule injury, nerve problems and many more. A thorough examination of the shoulder should be done to distinguish the injury type. If a tear is suspected in the rotator cuff an MRI or an arthrogram (X-ray of the shoulder joint after injecting a contrast dye) can be taken.

normal

Prevention and Management

A proper diagnosis and plan of management is necessary for the treatment and prevention of rotator cuff damage. Initial treatment would be pain relief, rest and avoiding any activity that aggravates pain in order to enhance the healing process. Further treatments will be decided upon the individual’s condition. Thorough assessment and planning by the experts with an application of knowledge of the condition and correct methods of treatment will promote recovery and prevent injury reoccurrence.

Shoulder 101

anatomy, Exercise

shoulder

The main joint of our upper limb is the shoulder joint which can be moved in various positions when looked at in a three-dimensional perspective. In order to be able to have these movements, many other components help in order to maintain a stable shoulder. In short, there is a complex interplay between the shoulder joint, other joints, muscles and ligaments that make the shoulder a complex and unique part of our body.

Anatomy of the Shoulder Complex

The Shoulder complex consists:

  • The true joint called the Shoulder joint (Glenohumeral joint – GH)
  • The Clavicular joint with the scapula (Acromioclavicular joint – AC)
  • The Scapular joint with the body wall (Scapulothoracic joint – ST)
  • The Clavicular joint with the breastbone sternum (Sternoclavicular joint – SC).

The shoulder joint (GH) is made of two main bones that articulate with each other forming the ball and socket joint. The ball of the arm bone(humerus) and the glenoid cavity of the shoulder blade(scapula) is articulated at the shoulder joint (GH joint). Similarly, on the inner chest, the clavicle articulates with sternum to form the SC joint while on the outer end towards the shoulder the clavicle articulates with the acromion process of the scapula bone to form the AC joint. Both GH, SC and AC are true joints with union by fibrous, cartilaginous or synovial tissues. Lastly the ST joint, while this is not a true bony joint, its muscular attachments create a shoulder joint complex.SHOULDER

The humeral head (ball) is about three times larger than the glenoid fossa. Actually, only 25 percent of the humeral head articulates with the glenoid fossa. Glenoid cavity (fossa) forms a very shallow socket as compared to the hip socket of the hip joint. Therefore, the humeral head articulates with a smaller open and shallow saucer- type of articulation, lacking stability in its own. However, it is with all the soft tissue structures both inside and outside the joint that are responsible for the overall stability of the arm during movements.

Soft tissue structures that support the Shoulder Joint

The important soft tissue structures are:

  • Articular Cartilage
  • Labrum
  • Joint Capsule
  • Ligaments
  • Muscles

Articular Cartilage

A smooth, white tissue that covers the humeral head (ball) and the glenoid fossa to make it easier for the two bones to move at the joint. It allows the bones to glide over each other with very little friction.

Articular cartilage

Labrum 

Since the head(ball) of the upper arm bone is larger than the glenoid fossa, the articular cartilage forms a soft fibrous tissue rim called the labrum which surrounds the socket to help fit the head into it thus stabilizing the joint.

labrum

The socket can be divided into four regions namely anterior (front), posterior ( back), superior (the upper end near your head), and inferior (the lower end which is towards the elbow). Based on these regions the labrum is also called as superior, inferior, anterior and posterior labrum.

labrum 2

Joint Capsule

The shoulder joint capsule is a membranous sac that encloses the entire joint. The joint capsule of the shoulder is attached along the outside rim of the glenoid labrum of the glenoid cavity and attaches to the neck of the arm bone. The capsule by itself is quite loose and it is the surrounding reinforcement by the muscles, tendons, and ligaments that are largely responsible for keeping the shoulder joint stable.

capsule of the shoulder

Ligaments

In the shoulder, there is a group of ligaments that is responsible for the stability of the shoulder.

ligaments

Glenohumeral Ligaments (GHL)

This ligament attaches from along the outer glenoid socket covering the joint to the upper part of the arm bone.

  • Superior (upper) GHL
  • Middle GHL
  • Inferior (lower) GHL

Coraco-acromial Ligament (CAL)
This ligament attaches from the coracoid process to the acromion process of the shoulder blade (Scapula).

Coraco-clavicular Ligaments (CCL)
These two ligaments (trapezoid and conoid ligaments) attaches from the clavicle to the coracoid process of the scapula. This ligament can carry the load and is extremely strong. These tiny ligaments (with the AC joint) keep the stability between the scapula and the clavicle and thus keeping your shoulder ‘square’.

Transverse Humeral Ligament (THL)

This ligament protects the long head of biceps tendon muscle in the groove of the arm bone.

Muscles for the stability of the Shoulder Joint

Muscles of the shoulder connect the shoulder girdle, the clavicle and arm bone.

  • Muscles that origin from the spine and attaches to scapula and/or clavicle
  • Muscles that origin from the clavicle or scapula and/or body wall(ribs) to the top end of the humerus.

Trapezius, Levator scapulae, Rhomboids and Serratus Anterior

Originate from the base of the skull and/or spine and connect the scapula and clavicle to the trunk of the body.

traps, levator...

  • Trapezius forms cross-shaped web along the neck and run from the spinal column out to the shoulder blade and clavicle bone. It helps to shrug the shoulders.
  • Rhomboids and levator scapulae are important muscles that join the shoulder blade to the spinal column helping the scapular movements.
  • Serratus anterior muscle helps to stabilize the shoulder blade on the chest wall. When this muscle is weak, winging of the scapula occurs which is when the shoulder blade protrudes from the back.
winged scapula

Winged Scapula

Deltoid, Pectoralis major, Pectoralis minor, Latissimus dorsi, Teres major, Serratus Anterior

These arise from the clavicle and/or scapula and/or body wall and connect to the upper end of the arm (humerus) and anchor the shoulder joint to our body.

MUSCLES PECS

  • Deltoid muscle is a muscle that is responsible for overhead activities. It helps to move the arm sideways up.
  • Pectoralis major muscle like the deltoid is another powerful muscle which is the main muscle when doing push-ups. It originates from the front of the chest and collar bone and inserts on the upper part of the arm bone (humerus).
  • Latissimus dorsi is another powerful muscle that together with the teres major muscle pulls the arm down to the side. We use this muscle when doing chin-ups.

What are the Shoulder blade movements?

The muscles of the shoulder complex work together to perform a particular action. The Scapula and arm bone move together in a pattern to perform a movement.

The movements of the Scauplo-thoracic joint includes,

  • Depression – Downward arm and shoulder girdle movement
  • Elevation – Upward arm and shoulder girdle movement
  • Retraction – backward shoulder girdle movement
  • Protraction – forward shoulder girdle movement

movements in shoulder

Rotator cuff muscles- small in size, big in importance

The four rotator cuff muscles are important for the stability and movements of the shoulder joint. They are,

  • Subscapularis
  • Supraspinatus
  • Infraspinatus
  • Teres minor

Rotator cuff

These muscles connect the shoulder blade (Scapula) to the arm bone (Humerus) supporting the entire shoulder joint during movements.

The major function of the four rotator cuff muscles is to work simultaneously with each other to allow the arm to move freely in numerous positions. They do all this while pulling the humeral head downward and inward within the glenoid fossa.

Movements at the shoulder joint

The main movemnts at the GH joint are:

  • Flexion-Extension
  • Abduction-Adduction
  • Internal and External rotation

MOVEMENTS AT THE SHOULDER

  • Supraspinatus assists with lifting the arm with the deltoid above the head (abduction). This is the most common muscle / tendon to tear in the shoulder.
  • Subscapularis twists the arm behind (Internal rotation) the back.
  • Infraspinatus and the teres minor twists the arm outwards(External rotation) and sideways from the body.
  • Subscapularis assists with Deltoid, Biceps, coracobrachialis, Tere major to bring about shoulder forward flexion movement.
  • Triceps, latissimus dorsi, pectoralis major, teres major brings the arm backwards (Extension).

Why is the Rotator cuff is so important?

In order to prevent upward dislocation of the arm or tear within the inner soft tissue structures like labrum and capsule of the shoulder, balanced rotator cuff strength and function are necessary.  All the rotator cuff muscles work together stabilizing the humeral head within the glenoid while the larger muscles like the ltissimus dorsi, pectoralis major and deltoid produce the forces necessary for movements.

Common Injuries to the shoulder

  • Broken collar bone (Clavicle)
  • Dislocations of the shoulder
  • Frozen shoulder (Adhesive capsulitis)
  • Rotator cuff injury or strain (tendonitis or tendinopathy)
  • Acromioclavicular joint sprain
  • SLAP Tear (Superior Labrum Anterior Posterior tear)
  • Bankart’s lesion (Anterior inferior Labral tear, sometimes a part of the genoid cavity bone is also broken)

Most injuries to the shoulder are due to sudden trauma or repetitive trauma to the soft tissues and bones. Some of the injuries occur because of improper exercise selection, faulty technique, lack of warm-up, lack of dynamic stretches, dehydration and many more. However, knowing the anatomy and functions of the joints and soft tissue structures of the shoulder complex not only gives you a better understanding of it but will possibly give you a prospective as to how important is their role in maintaing the stability of the shoulder.

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.

 

Refined Carbohydrates – Don’t blame the butter for what the bread did.

Food, Lifestyle

 Variety of uncooked pasta and vegetables

I start to get tired, I start to get headaches; my liver basically starts to fill up with fat because there’s so much fat and sugar in this food. My blood sugar skyrockets, my cholesterol goes up off the charts, my blood pressure becomes completely unmanageable. The doctors were like, ‘You have to stop!’

These were the words of Morgan Spurlock, the man who had MacDonalds everyday for a month for an experiment on a fast food diet.

Most experts recommend that carbohydrates (Carbs) should be about 50 to 55 percent of your total daily calories for maintaining good health. However, according to a study by American Journal of Epidemiology 2013, carbs that have been stripped of their nutritional value are as good as consuming cholesterol-rich foods, leading to life-threatening conditions.

There are two basic types of carbohydrates, simple and complex carbohydrates. The way we get it now – there are refined carbs (artificially made) and unrefined carbs (available in natural form).

Metabolism of Carbohydrates

Metabolism

All carbs eventually break down into glucose to provide energy for the body. The only difference is the time taken by different carbs to break down into glucose.

  • Simple and complex carbs (refined or unrefined). Both are broken down to glucose with a series of metabolic changes.
  • As blood glucose level rises, your pancreas produces insulin. The hormone that helps your body cells (muscles, brain) to absorb blood sugar for energy and some of the glucose is stored as glycogen in the liver.
  • As cells absorb blood sugar, glucose levels in the blood begin to fall. When this happens, the liver then starts releasing the already stored sugar.
  • This interplay of insulin from the pancreas and stored glycogen from the liver ensures that cells throughout the body and especially in the brain, have a steady supply of blood sugar.

Carbohydrates – Refined vs Unrefined

“Refining” is a process applied to both simple and complex carbs. Refined carbs have a longer shelf life and enhanced taste. In exchange, you lose the fiber, nutrients, water and other benefits of the food as compared to its unrefined (natural) state. Unfortunately, this process also concentrates the sugar content causing a spike in blood glucose levels when consumed.

Refined Sugar

It is available in various forms of sugar like glucose, fructose and sucrose (table sugar, brown sugar, molasses, jams, jellies, processed honey, etc). These are all simple carbs. They are small molecules and are quickly absorbed as glucose in the bloodstream.

sugar food

Refined grains

These are commonly used as refined flour to make processed foods like commercial breakfast cereals, bread, tortillas, and many junk foods that contains a lot of starch. When eaten, they are broken down into sugar by the digestive tract. They convert rapidly into simple sugars and have a similar or if not worse effect on your body as refined sugars.

Refined Carbs (both Simple and Complex Carbs)

The Health Promotion Board in Singapore recommends whole unrefined grains and to limit refined sugar intake to no more than 10%(8-11 tsp) of your daily dietary energy. Studies have also shown that processed carbohydrates may increase the risk of obesity, diabetes, brain and heart problems, more than fats, because of its growing ill-effects.

Bad Effects of Refined Carbs

Pro-inflammation – “Slow fire rising within you”

  • Spiking blood glucose levels leads to increased  pro-inflammatory free radicals. Excess glucose and insulin in the blood causes inflammation of the cells of the blood vessels. In response to this, your body uses fat to be deposited around the inflamed cells causing the formation of atherosclerosis, increasing the risk of heart disease.

atherosclerosis

  • Excess glucose in your body is also stored in your liver by converting it into glycogen. Excessive sugar can fill your liver glycogen stores to its maximum capacity.  To compensate for the overload of glucose in your blood, your liver converts all the stored glycogen into fats causing the inflammatory process in your body.
  • Refined foods also elevate C-Reactive protein levels which will be identified by a blood test. It is an indication that there are high levels of inflammation in your body.
  • Excessive gluten consumption on the other hand not only causes inflammation of the blood vessels but also inflames your gut.

High Insulin Levels – “Are you at risk of getting diabetes?”

sugar diabetes

Glucose in the blood stimulates the pancreas to secrete insulin. Excess glucose in the blood causes excess insulin secretion. As insulin’s role is to absorb and help store sugar in your blood, excess levels of insulin can drop blood sugar levels very quickly as it stores it rapidly. If blood sugar levels go down too fast, it can cause the body to crave for more sugar. But if you eat food that is too high in glucose again, it can create a vicious cycle as the blood sugar levels are never adequately balanced. If this glucose roller coaster ride goes on for months, it can have short term consequences on your mood and concentration. Long term exposure puts you at increased risk of type II diabetes. This form of diabetes means the body becomes insensitive to insulin and the excess sugar in the blood can lead to chronic inflammation of blood vessels, which in turn can lead to heart disease or other severe illnesses.

Leptin Resistance – “I always feel hungry in the night”  
 
SNACKING
 
Leptin is a hormone that is released by fat cells to give the body a feeling of ‘fullness’ or satisfaction. By feeling satisfied by the food we eat, we can avoid taking in excess food. If we lack leptin, it will make us hungry. This is the body’s mechanism to ensure we get the exact amount of energy we need.  If we ingest foods high in sugar, it interferes with leptin function and this means we can eat far more than our body needs and still not feel full. If we continue to eat foods high in sugars, the brain can become addicted at the same time and fail to get satisfied by the food.
 
Loss of Nutrition Reserves – “Sick and tired of being sick and tired?”
 
BEING TIRED

Your body needs essential nutrients from your food in order to metabolise sugar. Refined foods are of very low nutritional value so the body is unable to properly control and regulate sugar metabolism. Your body still has to obtain these nutrients from other sources, causing a depletion in your nutritional reserves making you feel tired.

Brain function – “Something’s not right”

EATING CHOCOLATE

Glucose rollercoaster rides puts the brain (mood, concentration, thinking) on a roller coaster ride as well. There has been studies showing links between refined sugar consumption to hyperactivity, attention deficit hyperactivity disorder (ADHD), anxiety, irritability, reduced performance in school, juvenile delinquency, mental illnesses like schizophrenia and even increased criminal behavior.

Gastro-intestinal disorders – “I feel bloated”

Fibre content is reduced in refined complex carbs, this affects the function of the gut causing unwanted side-effects like excessive production of gas. This gas causes discomfort, bloating and flatus in many people. Digestive disorders come from constipation – difficulty to have a normal bowel movement.

Obesity – “I eat when I’m hungry and I’m hungry all the time”

Fructose is associated with increased fat deposition, which results from bad effects on hormones associated with satiety. Insulin-induced low blood sugar will specifically increase appetite and hunger for more carbohydrates, especially those with sugar content. Diet high in sugar content may cause greater appetite and increased hunger leading to obesity. Sugar is effectively addictive for the brain.

Eating in moderation is key and always consult an expert about your nutritional concerns when in doubt.

Avoiding the Glucose Rollercoaster

Food, Geeky stuff, Lifestyle

Several types of white sugar - refined sugar and granulated suga

We are all aware that Glucose is a primary source of energy for the body. it requires no further digestion and is available in your blood. Carbohydrates (carbs) is one such food group that breaks down into glucose during digestion.

The type of carbs that you consume will determine the amount of glucose present in your blood. The Glycemic Index (GI) is one such indicator which scales from 0 to 100, telling you the glucose level in your blood. The lower the GI, the better the food is for your body during the energy conversion process. Foods rich in protein and fats usually don’t have a GI value. While they do cause an eventual increase in blood sugar level, the process is slow unlike carbs/sugars which can cause an immediate spike.

Generally, when eating high GI foods together with proteins and fats, it slows down the body’s ability to convert the sugar as quickly. Slower sugar conversion results in a lower blood sugar spike. What this means is, if you ingest a fast-absorbing protein like casein which is found in milk, even though you will increase overall sugar levels, you decrease the effect of insulin and delay excessive absorption of the sugars in your blood. This in essence lowers the GI load on your body.

GI Standard Values (GI Low- less than 55, GI High- above 70)

Most fruits, vegetables and whole wheat foods  that we consume are on the lower side, with values in the 30s and 40s. On the other higher side of the scale, potatoes rank way up in the 80s, and white bread falls in the 70s.

White Pasta vs White Bread – Both made from Refined flour

stk78768cor

Non-whole grain bread and pasta noodles both contain similar amounts of starch. Their starches are similarly composed of long chains of the simple sugar, glucose. The structure of bread allows more of the starch to be exposed to enzymes in our saliva and in our digestive tract. This greater exposure to enzymes allows more of the starch to be broken down into sugars giving white bread a higher GI value than white pasta. Effectively, both are still high on the GI value scale so moderate consumption will be recommended.

Insulin Insensitivity

The problem with ingesting foods with a high GI load over a prolonged time  can cause your body to become insensitive to a hormone called insulin. In the early stages (pre-diabetic) this can be reversible by making dietary and lifestyle changes. If no changes are made, and the person continues to eat high quantities of GI rich foods, it can lead to type II diabetes.

Know the GI but also the nutrient profile of your foods 

While a very high intake of GI rich foods should be avoided, you must remember that GI load does not measure nutritional intake. The body needs more than sugar for health and some foods while high in GI values, may have benefits that outweigh the disadvantages. Like brown rice, bananas and oats are all foods high in GI values, but they are also high in important minerals, vitamins and proteins essential for a healthy body. Balancing the benefits of reducing GI load while also making sure you get your full nutritional requirements is much more important. Portion size also plays an important role when it comes to such foods.

Much research have shown the benefits of low GI diet in weight loss, lowering the risk of diabetes and eliminating the sudden sugar rush and crashes. However, some studies have also shown no difference in hunger, satiety, or energy level after eating high- or low-GI foods. With research, the results of studies can’t necessarily be replicated and generalized for everyone but yes, for people who eat only high GI foods knowing its bad effects is a must.

Eating sensibly is the key!

healthy snacks

Everybody is unique with different metabolisms. Having said that, people’s metabolism also have different effects on blood glucose levels.  And most often, we eat foods in combinations of all different nutritional values. All we have to understand is that even if research trials have shown the benefits of low GI diets, in reality, it is best to only incorporate the knowledge rather than eliminating all high GI foods. That would be impractical and impossible.

Here are some GI values of the most commonly eaten foods.

Enjoy eating healthy and making healthy choices because what makes you feel better on the inside will show on the outside.

High-carbohydrate foods   Breakfast cereals   Fruit and fruit products   Vegetables  
White wheat bread 75 Cornflakes 81 Apple, raw 36 Potato, boiled 78
Whole wheat/whole meal bread 74 Wheat flake biscuits 69 Orange, raw 43 Potato, instant mash 87
Specialty grain bread 53 Porridge, rolled oats 55 Banana, raw 51 Potato, french fries 63
Unleavened wheat bread 70 Instant oat porridge 79 Pineapple, raw 59 Carrots, boiled 39
Wheat roti 62 Rice porridge/congee 78 Mango, raw 51 Sweet potato, boiled 63
Chapatti 52 Millet porridge 67 Watermelon, raw 76 Pumpkin, boiled 64
Corn tortilla 46 Muesli 57 Dates, raw 42 Plantain/green banana 55
White rice, boiled 73     Peaches, canned 43 Taro, boiled 53
Brown rice, boiled 68     Strawberry jam/jelly 49 Vegetable soup 48
Barley 28     Apple juice 41    
Sweet corn 52     Orange juice 50    
Spaghetti, white 49            
Spaghetti, whole meal 48            
Rice noodles 53            
Udon noodles 55            
Couscous 65            
Dairy products and alternatives   Legumes   Snack products   Sugars  
Milk, full fat 39 Chickpeas 28 Chocolate 40 Fructose 15
Milk, skim 37 Kidney beans 24 Popcorn 65 Sucrose 65
Ice cream 51 Lentils 32 Potato crisps 56 Glucose 103
Yogurt, fruit 41 Soya beans 16 Soft drink/soda 59 Honey 61
Soy milk 34     Rice crackers/crisps 87    
Rice milk 86            

Management and Treatment of Scoliosis

Common conditions, Lifestyle, Scoliosis

Spine osteoporosis. Spinal cord problems on woman's back

Early management of scoliosis is the key to more successful treatment and improvement of body function. We don’t guarantee that scoliosis can be cured but we sure as hell will do what we can to influence the body in the right direction.

The body is like a garden. You can use the best soil, water regularly and provide ample sunlight but nobody can guarantee that the seeds will sprout. Our aim is to give your body the best environment and let nature work its magic.

Focused Muscle Retraining to Prevent Scoliosis Progression

Your brain is the boss. It is the ultimate centre that controls your muscles and nerves. No matter how long you hold your body in the correct position, it is of no good if your higher centre is unable to learn and organize your movements

Use a Mirror

Get visual feedback and awareness to do simple exercises for your brain to learn muscle control. It is important that you also focus on your legs, arms, head and hips as well as the body works as a whole unit.

posture

Improve Spinal Mobility

Focus on moving your back in varying positions while standing. It’s important you do small and gentle movements for constant brain signals. You should use your imagination to visualize the movements if trying to do it is too difficult and slowly work your way to incorporating them.

Twist and turn

tuck twist turn

When lying down, sitting or standing, place your arms with elbows bent to 90 degree with your thumb out. Then, gently twist your back and spine in the direction that is the easier one for you and rotate to the other side.

After you repeat this movement a few times, notice whether your back begins to move more easily if your spine begins to feel more mobile.

Stimulate the stretch reflex

The stretch reflex helps to control posture. When you bend slightly to your right, it causes a stretch in the spinal, hip and leg muscles on the left side. This activates the stretch reflex. What the reflex does, after the muscle is lengthened, is that there will be an immediate reflex contraction of the same muscle. Thus bringing your spine back to normal by adjusting and maintaining.

In most scoliosis cases, the muscles on one side of the spine are elongated while the muscles on the other side are shortened. Some might think stretching the shortened muscles will be the solution but that will actually stimulate the stretch reflex and cause further contractions.

Instead of stretching the short muscles, gently move to the side of your curve stretching the elongated muscles and let go to activate the stretch reflex.

Bending to lengthen

Correct Nutritional Imbalances

Improve the function of neurotransmitters in your brain in order to improve muscle contraction and control of posture.

Eggs/ Liver – They are rich in choline that forms acetylcholine a neurotransmitter for concentration and focus. It also plays a role in muscle coordination.

Brown rice: Serotonin, a calming neurotransmitter, plays an important role in brain activities such as learning and memory.

Spinach: Increase in folic acid that ensures your body synthesizes norepinephrine and serotonin.

Fish: Helps increase dopamine levels that are important for healthy nervous and immune system functioning

Dairy products: Increases norepinephrine a neurotransmitter that facilitates alertness, concentration and motivation.

Common Treatment Methods

  • Improving chest mobility

chest mobility

Mobilization and stretching techniques relieves the tight structures of the chest and back, helping your chest to expand.

  • Breathing exercises

diaphragm breathing Practicing diaphragmatic and deep breathing exercises will expand your chest and stretch the muscles of your chest, improving the oxygen uptake and lung function.

  • Foam roller for Myo-fascial Release

foamrolling

Scoliosis can cause chronic muscular strains, most commonly seen as trigger points in the muscles in the back, hips and abdomen. Using the foam roller will help loosen these muscles and potentially increase mobility.

  • Traction Therapy

scoliosis traction

Decompression traction therapy is another method used to treat back problems. This method is often used to treat mild scoliosis by giving the spine a chance to decompress and possibly influence it in the correct manner through stretching, exercises and manual therapy.

  • Correction exercises

exercises

Improving the muscle strength (especially in the abdominal muscles) and flexibility in the spine. To correct spinal curvature and stabilize scoliosis angle.

scoliotic curve heel

  • Insole Support

Scoliosis stemming from leg-length discrepancy due to a low arch and excessive inward position of your feet, can be corrected and stabilized using orthotics. Some may need a permanent heel lift due to an anatomical difference in leg length.

When there are differences in the alignment of your hips, you may be advised to use an insole to lift the lower side which will in turn, correct your posture.

  • Kinesio Taping 

RockTapeKinesio taping can be used to correct muscle imbalances and posture. This tape supports the muscles in their optimal length without restricting movements in your joints. It helps to adjust your posture correctly and reduce muscle strain. Due to the tape being an external support structure, it also provides proprioceptive feedback to the body when applied.

  • Forget about a perfectly straight back.

Instead, focus on having a strong healthy spine. It is natural to want a straight spine but opting for treatments that unnaturally forces your spine to be straight might leave you in unnecessary discomfort or pain. Even using braces or surgery have their limitations. A healthy spine would be one where you’re able to move in and out of different positions with ease.

It is still recommended to monitor the scoliosis twice a year with or without treatment.