Restless Legs Syndrome

Common conditions, Exercise, Foot, Health, Lifestyle

restless leg syndrome

What is restless legs syndrome?

Restless legs syndrome (RLS) is a neurological disorder that is characterized by an uncomfortable sensation in the legs and rarely the arms. This leads to an overwhelming urge to move them continuously.

These movements may,

  • happen to partially or totally relieve discomfort.
  • begin or worsen during periods of rest such as lying or sitting
  • worsen during sleep, causes time to time movements also known as “periodic leg movements”.

It has also been suggested that RLS would be called “Willis-Ekbom disease”, as an homage to the two pioneers Thomas Willis and Karl-Axel Ekbom who first reported this condition. 

What causes RLS?

  • Unknown cause
  • Genetic cause

RLS symptoms are related to hyperexcitability of the central nervous system- brain and spinal cord due to a possible deficiency of a chemical called dopamine. Dopamine plays a role in controlling muscle movement and may be responsible for the involuntary leg movements associated with RLS.

  • Disorder of the peripheral nervous system

The peripheral nervous system involves the nerves that carry signals from different parts of the body to the brain. The most likely possibility is the presence of hypoxia (lack of oxygen) caused by changes in blood flow or metabolism in the lower limbs that irritates the sensory nerves of the legs causing restlessness. 

  • Iron-deficiency anaemia – low levels of iron in the blood can lead to a drop in dopamine, triggering restless legs syndrome
  • Chronic (long-term) health conditions – such as chronic kidney disease, diabetes, Parkinson’s disease, rheumatoid arthritis, an underactive thyroid gland or fibromyalgia.
  • Radiculopathies: Radiculopathies are problems with the nerves and occur due to nerve compression at the spine caused by disc herniation and protrusion and/or disc degeneration. It is most commonly seen in the lower back regions (Lumbar spine). Nerve compression could cause referred pain and tingling sensations along the back of the leg to the feet that may be a secondary cause for RLS. 
  • Pregnancy – particularly from week 27 until birth; in most cases, the symptoms disappear within four weeks of giving birth
  • Side effects of certain medication: Antidepressants, Antipsychotic medicine, Lithium (used in the treatment of bipolar disorder), Calcium channel blockers (used in the treatment of high blood pressure), Antihistamines, Metoclopramide (used to relieve nausea). 
  • Lifestyle problems: Excessive smoking, caffeine/ alcohol, obesity, stress and lack of exercise.

Who can be affected with RLS?

  • Both the genders are affected but women are twice as likely to develop RLS than men which is still unknown and is suggested to be related to genetics, body functions or emotional differences. 
  • People of all ages can be affected but more commonly seen among middle-aged people secondary to other health conditions.

What are the signs and symptoms of RLS?

Signs and symptoms may vary from day to day, in severity and frequency from person to person during rest and most often during sleep. 

  • Abnormal sensations (Paresthesias)- pulling, creeping etc.
  • Unpleasant abnormal sensations (Dysesthesias)- the sensations range in severity from uncomfortable to irritating to painful example, tingling, burning, aching or like electric shocks.
  • Periodic leg movements during sleep
  • Typical movements like pacing and walking, jiggling the legs, stretching and bending, tossing and turning, rubbing the legs.
  • Inability to sleep leading to sleep disorders like insomnia (lack of sleep) due to increased urge to move or sudden waking up from sleep due to periodic leg movements.
  • Hyperactivity may be seen among children with RLS.
  • Fatigue/tiredness, lack of concentration, problems with cognitive function (related to thinking, attention and decision making) due to lack of sleep and excessive movements in the leg most often felt throughout the day.

How is RLS diagnosed?

There are no diagnostic tests that can diagnose RLS.

A thorough clinical assessment of the patient is necessary to be able to diagnose this condition. 

  • Clinical history: The history of the patient about signs and symptoms associated with RLS will be important for the diagnosis. The frequency, duration, and intensity of symptoms the aggravating and relieving factors as well as their tendency to occur during day and night time will be noted.
  • Family and Medical History: Family history and problems of other health conditions and the use of medications will be noted that may be the suggestive cause for RLS.
  • Neurological and physical examination: Examination of other underlying conditions related to muscle or nerve problems. 
  • Blood tests: blood test can be done to identify iron and vitamin deficiencies as well as other medical disorders associated with RLS.  
  • Sleep studies such as polysomnography (a test that records the individual’s brain waves, heartbeat, breathing, and leg movements during an entire night of sleep) may identify the presence of periodic leg movements and other problems of sleep.
  • RLS in children: This may be difficult since it may be hard for a child to describe any uncomfortable sensations in the leg and the urge for leg movements, when and how often the symptoms occur, and how long they last.
  • Misdiagnosis: RLS may be often misdiagnosed as “growing pains” or “Attention Deficit Hyperactivity disorder” (ADHD) in children and may be mistaken to be an onset of another neurological disease, such as Parkinson’s disease in adults.

How can this condition be treated?

  • Most symptoms can be treated by therapeutic treatments that improve the blood circulation of the legs, muscle flexibility and allow the nerves of the legs to relax. This can help diminish the uncomfortable sensations caused by restless legs syndrome.
  • Identification and treatment of other health problems are important to reduce the symptoms of RLS.  
  • Intake of diet rich in iron and vitamins will be beneficial.
  • Reducing smoking and alcohol consumption.
  • Stress management will help reduce symptoms and improve sleep.

Severe problems with RLS can be also be treated along with prescribed medications that improve the dopamine levels in the body. However, RLS may generally be a lifelong condition.There may be periods of no symptoms but may eventually reappear sooner or later. Adhering to the treatment methods can help reduce the symptoms at all times. 

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Common Injuries of the Achilles Tendon

Ankle, Common conditions, Exercise, Foot, Injury, Lifestyle, Pain

Achilles tendon injury

The thickest and the strongest tendon in our body is the tendon of the calf muscles of the leg also known as the “Achilles tendon”. 

achilles Tendon main

Fig 1: Calf muscles and Achilles tendon

As shown in Fig 1, the calf muscles of the leg include the gastrocnemius and the soleus muscles that tapers and merges with a tough connective tissue of the Achilles’ tendon. The Achilles tendon then inserts into the heel bone (calcaneus).  Functions of the Achilles Tendon

  • Downward Movement of the foot: When the calf muscles contracts and pulls the Achilles tendon it causes the foot to push downward. This contraction enables: gait, standing on the toes, running, and jumping.
  • Bending the knee: The gastrocnemius muscle helps in bending the knee (flexion) during walking and running.
  • Transferring body weight: With each step of walking each of the Achilles tendon help to distribute the person’s body weight. Depending upon the speed, stride, terrain and additional weight being carried or pushed, each Achilles tendon may be subjected to approximately 3-12 times a person’s body weight.
  • Ankle stability: Along with the other muscles of the leg the Achilles tendon contributes to the stability of the ankle joint.

What surrounds the Achilles tendon? The Achilles tendon is protected by the Achilles tendon sheath and bursae. The sheath is the covering of the tendon that protects the tendon from friction and allows smooth movements. Similarly, the bursae around the Achilles is a thin fluid-filled sac that help to reduce friction between tendon and other tissue areas of the heel.

achilles Bursas

Fig 2: Bursae around the Achilles tendon

As shown in Fig 2, there are two bursae present at the heel. One of the bursae is present in between the surface of the tendon and the surface of the calcaneus at the distal attachment of the Achilles tendon. It is called the “retrocalcaneal bursa”. The other bursa is present between the calcaneum and the skin and is called as the “subcutaneous calcaneal bursa”. 

Brief History on Achilles tendon injuries

Because of the Greek Achilles legend, the Achilles heel is known as a vulnerable part for injury. Hippocrates described that “this tendon if bruised or cut causes the most acute fevers, induces choking, deranges the mind and at length brings death”. It was first reported that a ruptured tendon was to be wrapped with bandages dipped in wine and spices. Since then the cause and treatment of Achilles tendon injuries have brought growing interests among many researchers. 

What causes an Achilles tendon injury?

  • Overuse injuries

This is mostly sports related and is due to overuse of the calf muscles causing an injury to the Achilles tendon. Overdoing or rapid action of the calf muscles or resuming too quickly after a layoff can stress the Achilles tendon. For example, while running or walking faster, up and down on steeper hills or stairs  more powerful movements such as lunges, jumps, or push off.

  • Misalignment and muscle imbalances

Short or tight Achilles tendons or calf muscles, unequal leg length, over or under arched foot, disproportionally weak calf muscles.

  • Improper Footwear 
  • Side effects of certain medications  

Medications (Quinolone / Fluoroquinolone and Cortisone) can weaken the Achilles tendon and this may lead to an injury. Cortisone shots in or near the Achilles tendon may reduce pain in the Achilles tendon, but the weakness in the tendons persists which can an injury during activities.

  • Accidental trauma
  • Inflammatory conditions

Achilles injury may occur in relation to inflammatory illnesses, such as ankylosing spondylitis, reactive arthritis, gout or rheumatoid arthritis.

  • Genetic 

Individuals with a genetic predisposition like hypermobile people are reported to be more at risk of developing Achilles tendon problems. This is because they have excessive laxity in  ankle joints that lead to the wear and tear of the Achilles tendon. 

Achilles tendon injuries

achilles tendon injury locations

Fig 3. Locations of injury

As shown in Fig 3, different types of Injuries to the tendon can occur along different locations of the tendon. 

Musculotendinous junction: This explains the junction between the calf muscle and the Achilles tendon.

Mid portion of the tendon: This explains an injury midway between the top and bottom of the Achilles tendon.

Insertional Achilles tendon injury is an injury at the bottom of the Achilles tendon, where the Achilles tendon connects with (inserts into) the heel bone.

Non-insertional Achilles tendon injury means an injury to any part of the Achilles tendon except at the Achilles tendon – heel bone connection.

Types of Achilles injuries

The spectrum of Achilles injuries ranges from an acute inflammatory irritation to severe cases of rupture of the tendon as shown in Fig 4. The types of condition may co-exist depending on the severity of the injury.

Achilles Tendon course of injury

Fig 4: Types of Achilles Tendon Injuries

Tendonitis and tenosynovitis

Achilles tendonitis is an acute inflammation of the Achilles tendon as shown in Fig 5. Tenosynovitis is an inflammatory condition of the Achilles tendon sheath, rather than an inflammation in the Achilles tendon itself.

Tendonitis insertion

Fig 5: Achilles Tendonitis

Achilles Tendinosis (Tendinopathy): This is the degeneration and micro tears of the Achilles tendon that occurs over time due to overuse of an already inflamed and weak tendon (Refer Fig 6).

Both Achilles tendonitis and tenosynovitis can occur in parallel with, or lead to Achilles tendinosis.

Print

Fig 6: Tendinosis of Achilles tendon

Tendon Ruptures (Partial or complete tendon tear) Achilles tendon rupture is often described as an abrupt break with instantaneous pain that is felt in the foot or heel area. It occurs rapidly while performing activity like running or standing on the toes, which generates intense force on the tendon, leading to partial or complete rupture as shown in Fig 7.

Rupture complete

Fig 7: Complete and partial tear of the Achilles tendon

What can happen if you have an Achilles tendon injury?

  • Pain and tenderness along the Achilles tendon and at the back of the heel that worsens with activity.
  • Thickening of the tendon
  • Bone spur formation at the insert of the tendon
  • Bruising and Swelling around the tendon area.
  • Fibrosis and scarring may be seen in Achilles Tenosynovitis and tendinosis.
  • Restriction of Achilles tendon’s motion within the Achilles tendon sheath.
  • Bursitis: Inflammation of the bursas around the Achilles tendons.
  • Snapping or popping noise can indicate a tendon rupture.
  • Difficulty in moving the foot or pointing your toes (in complete tears of the tendon)
  • A limp may be seen on weight bearing immediately after an Achilles tendon rupture
  • Ankle instability
  • Nerve or blood vessel damage: Signs include numbness, tingling, pins-and-needles sensation in your foot and bruised skin.

How is an Achilles tendon injury diagnosed? An initial examination of the ankle can help differentiate a tendon rupture from other types of injury. When an Achilles tendon rupture occurs, it will not be possible for the individual to stand on toes as shown in Fig 8.

achilles tendon rupture and normal

Fig 8: Achilles tendon rupture of the Left heel

 An MRI or X-ray investigation can also be taken to further confirm the severity of the injury and differentiate the type of injury to the tendon. For example, an MRI scan of a ruptured Achilles tendon is shown in Fig 9.

Complete tear MRI

Fig 9: Achilles tendon rupture

When to seek expert care?

If you felt a sharp pain like a direct hit to the Achilles tendon or if you heard a distinct snap at your Achilles tendon, it calls for a medical emergency. If you have just begun with pain in the back of heels with swelling or discomfort in the Achilles tendon, it would be wise to seek expert assessment and treatment care. What may seem like a mild inflammation may lead to degeneration and rupture. Thus, an initial treatment for tendonitis will not only reduce problems of the tendon but will restore its strength and function which is important to prevent worsening and recurrence of the condition.  

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.    

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 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

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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.