As our knees come towards straight in order to weight bear the quadriceps comes into action to straighten the leg towards full extension, engaging the locking position of the knee. One of the characteristics of the human knee is that it ensures efficient and safe weight bearing when standing along with very low energy requirements, unlike the knees of apes. As the knee approaches fully straight the inside part of the quadriceps muscle helps the joint swivel inwards into the locked position. When we stand with our knees straight, we can remain in that position with no activity in the quadriceps and so with very low energy output.

The cartilages, structures known as menisci, are shaped like a banked track in a crescent configuration and fill in to some extend between the rounded condyles of the femur and the flat tibial surface. Their function has not exactly been demonstrated, however they may contribute to easing the knee into lock, minimising inappropriate movement of the condyles and bringing the condyles towards the joint centre in motion. The third component of the knee joint is the patella or kneecap, this small bone being lined with cartilage and placed anterior to the knee.

The tendon of the quadriceps muscle holds the patella or kneecap within it, the muscle’s main function being knee extension to raise the body from a chair or negotiate steps. The inner surface of the patella, divided into two facets, is lined with joint cartilage and articulates with the major groove between the condyles of the femur, sliding back and forth. The power of the quadriceps muscle to extend the knee against the body weight is significantly increased by the presence of the kneecap.

The flexion and extension plane is the natural plane of knee movement as this normal alignment makes knee pain problems occur less commonly. A bow-legged or knock-kneed posture allows abnormal sideways stresses to be applied to the knee, forcing pressure onto one side of the joint and increasing wear stresses which with time can cause pain symptoms or arthritic changes. Patellar misalignment can also occur, forcing one of its facets against the side of the femoral condyle groove and causing impingement pain due to increase in the friction forces.

During motion of the knee the menisci (the knee cartilages) and the kneecap are subject to high mechanical forces and are the cause of a number of common knee problems. The movement range of the knee is usually from straight (zero degrees) to full bend at about 140 degrees, varying with the body size and joint mobility. As the knee goes through the movements of extension and flexion the large rounded condyles glide and slide on the top of the tibia, with the tibial surface moving underneath them also.

It is in order to stop the femoral condyles slipping off the back of the tibial plateau that they perform the internal glide in a back and front direction. One bone does not move on its own as the joint changes its position, but rather both move in a complicated fashion on each other to allow the functionally desired movement to be achieved. A much more extensive range of motion is achievable with this design. Rotation also occurs at the knee joint but is less obvious, becoming more apparent as the knee extends more closely to the locking position and the internal rotation of the femur occurs.

Jonathan Blood Smyth, editor of the Physiotherapy Site, writes articles about Physiotherapy, back pain, orthopaedic conditions, neck pain, injury management and physiotherapists in Sheffield. Jonathan is a superintendant physiotherapist at an NHS hospital in the South-West of the UK.

I have been using spinal decompression in my San Antonio office for a few years now, and while it is a highly effective treatment for many people, it is not for everyone. Unfortunately, the costs of providing spinal decompression services sometimes influences doctors to recommend it in cases where it may not be entirely appropriate. Even with proper patient selection, spinal decompression is not 100% effective – no treatment is. But when doctors are not as discriminating as they need to be in what patients they accept, the results can be far from ideal and some patients may even get worse with this form of treatment when doctors prescribe it inappropriately for financial reasons.

Spinal decompression is a high-tech form of traction used to treat disc bulging and degeneration and their associated pain and disability. Spinal decompression differs from regular traction in that it uses computer-controlled motors to trick the spinal muscles into remaining relaxed and uncontracted during the treatment session. This results in much greater reduction in disc pressure than regular traction, which usually must work against the resistance of contracted muscles. Most people get excellent results from spinal decompression treatment, but some do not get any improvement, and a few may actually get worse. The following is an explanation of the reasons for the failures in spinal decompression treatment and ways you can know whether or not spinal decompression is likely to help in your particular circumstances.

From my experiences in my San Antonio practice, the patients who get the best results with spinal decompression are those with one or more bulging/herniated discs and patients with mild to moderate disc degeneration. Those patients who have previously had disc surgery still make good candidates for spinal decompression, provided they do not have any specific issues that would exclude them, such as metal implants in the spine, spinal instability, and/or some form of healing impairment at the site of the surgery. The vast majority of people who meet these criteria get very good results and are usually able to return to their normal activities without any significant pain.

While there are case reports that indicate complete disc ruptures can be treated with spinal decompression, in my experience, people with actual ruptures tend to not do very well with this form of treatment. It should be noted that even doctors sometimes incorrectly call a disc bulge or herniation a rupture. True disc ruptures (also called extrusions and sequestered discs), in which the inner gel of the disc is actually leaking out, are relatively rare, so it is good to find out for sure what your actual condition is.

In addition to the importance of applying spinal decompression only in the appropriate cases, it is extremely important for the doctor or technician operating the machine to set the patient up properly for the treatment. There are several different decompression machines on the market, each with their own specific set-up procedures. It is very easy to get sloppy with setting up patients on the equipment, and this leads to ineffective treatment. While the better machines are unlikely to produce any major injury if they are not set up exactly right, results can suffer tremendously if the patient is not positioned and secured on the machine correctly on every visit. To help avoid this problem, I recommend asking any potential spinal decompression provider you may be considering seeking treatment with about his or her training for the operators of the equipment.

One other consideration is the fact that some patients are not good candidates for spinal decompression treatment because of their inability or unwillingness to follow the recommended treatment protocol. In my experience, the primary reasons why a patient can’t or won’t follow the treatment recommendations are usually related to money and/or time.

A complete spinal decompression program of care that inclues decompression as well as additional treatments may seem expensive to some people. Since spinal decompression is an alternative to disc surgery though, a cost comparison with surgery will show spinal decompression to be much less expensive with statistically much better resuts, making it a good value in most cases. Even so, some people try to lower the cost by attempting to reduce the amount of treatment they get. In my experiences from my San Antonio office, this approach is often a very big mistake. The people who discontinue care prematurely will often feel better and return to activities before their disc condition is stable. This can lead to re-injury and even worse problems. In my opinion, it is far better to invest in the recommended treatment in order to get maximum benefits.

Of course, some people fail to follow treatment recommendations primarily because they have busy lives and are unwilling to spend the time on getting better. This type of patient tends to miss a lot of appointments and may go long periods of time between treatment sessions. Unfortunately, the success of spinal decompression usually depends on getting the recommended amount of treatment at the recommended frequency of treatments. The effectiveness and results are not as good when people don’t make time for their appointments. What some busy people fail to realize is that if they don’t set aside time to properly deal with their health problem, sooner or later that health problem will deteriorate to the point where it forces them to make time to get treatment, and this often occurs when they are at their busiest and treatment is least convenient. It is my recommendation to invest the necessary time in getting better, rather than do the treatment intermittently and not get the best results.

To summarize, spinal decompression can be an extremely effective treatment for people suffering with pain from bulging and degenerated discs, but it is important that doctors select patients for this treatment carefully and make sure that the technicians operating the equipment get refresher training regularly to be sure patients are being set up on the machine properly. Patients need to take the responsibility to follow the treatment recommendations to allow for maximum correction and healing.

Our necks are our spines continuing above shoulder level so that our head can be supported and facilitated in its job. The neck is beautifully designed and engineered and performs its highly complex functions automatically without us having to give them any thought. Our heads are very heavy and placed on top of the lever which is the neck, however we can move them or stop moving them very quickly, positioning them at a very specific point within the large ranges of movement the neck can perform. The ears and eyes, some of our most vital organs of sensory input, are placed on the head and the neck has to serve their needs.

The cervical spine is a complicated structure made up of ligaments, discs, joints, muscles and bones. What are missing from this description are the vitally important and widespread nets of nerve fibres which clothe the spinal structures here. Nerve functions include the control of movement, the transmission of sensory information for biofeedback and balance and the control of circulation and other reflex responses. The neck has a difficult job to do as the very large ranges of movement it needs to provide are at odds with its precision and delicate control.

When the neck starts to complain for the first time it is almost always via symptoms referred to as mechanical, symptoms which reflect the stresses and strains which are put on the structures involved. Suffering from pain and loss of joint movement are common complaints, with a series of other complaints including mental stresses, loss of muscle power, visual disturbance, unsteadiness and headaches. By settling the cervical structures down towards normal the physiotherapist can help the various other related symptoms settle down too.

The neck is an exceptionally mobile part of the body and in part that is due to the thickness of the cervical discs, which are thick when compared to the thickness of the cervical vertebrae. The thicker the disc the more movement the segment can perform. The facet joints are also larger in comparison those in the thoracic and lumbar spine, allowing large facet-like flat surfaces for gliding movement under close control. They allow much greater ranges of movement than in other areas of the body where stability may be more important.

The upper two vertebrae, the atlas and the axis, are very different from the remaining five cervical vertebrae, and they are specialised to serve the function of support and movement for the skull. The junction between the atlas (the C1 vertebra) and the axis (the C2 vertebra) is endowed with a rotatory type of structure, making up a significant proportion of all the rotation which occurs in the neck. The movements of the neck are very great, including flexion, extension, rotations and side flexions, allowing us to place our faces in any combination of degrees and position to perform many functional activities.

Our thoracic spine is the basic foundation for the stability and mobility of the cervical spine. It facilitates the mobility of the neck and without this the neck would be subject to greater stresses where it meets the skull and the relatively stiffer thoracic spine. The neck sticks up narrowly to the skull with the muscles around it acting like wire ropes of a, holding it steady so it does not shake. Since the head is heavy and mostly in front of the centre of gravity this job is difficult and they must work hard to control balance of the head, which needs to be stable for our sense organs.

The neck flexor muscles, situated anterior to the neck, do not have a lot of work to do as they only really function strongly in getting up from lying down. It is a different story for the extensor muscles behind the neck as they have the job of keeping the head up for the whole day without tiring, only showing their function when we get tired in a train when sitting and our head flops forward as the extensors turn off. While balancing the forces applied to the neck and maintaining posture is their key function they also produce levels of compressive forces.

Most of us start off with a beautifully mobile and smooth running back and rarely are we stiff backed unless there is a reason for it. The back is well evolved to do the job it has to do and does this mostly very well. Spinal bones are separated from the vertebrae by discs which are thicker in areas of greater mobility and greater load, allowing more movement. Facet joints at the back of the spine limit and control spinal motion, stopping inappropriate spinal displacement in response to the loads placed on the spine. Muscles are strong, in balance and working in harmony to achieve the movement and stability required.

Inhibition of the stabilising musculature occurs with an episode of acute spinal pain and this can persist beyond the resolution of the pain to generate a long-lasting instability which puts the segment at increased risk of re-injury over time. Longer term effects include the occurrence of degenerative alterations in the spinal structures such as joints and discs, causing segmental levels to develop stiffness and eventually chronic back pain. The discs have fluid forced out of them by gravitational compression forces and must counteract them by generating a fluid absorption force.

Discs will narrow and lose part of their hydration under the forces of compression which occur in normal life, the disc becoming stiffer and narrower. X-rays can show up this narrowing when it reaches a certain level, but many discs will be troublesome long before this stage. The intervertebral disc and the two vertebrae each side of it are referred to as a vertebral segment and an abnormal stiff segment will move in such a way as to impose inappropriate levels of load upon structures not adapted to take them. The stiffness of individual spinal segments can be felt by a physiotherapist palpating the spine.

Protective muscle spasms are common after an injury and this splints the affected area and allows the process of inflammation and healing to get started. With the gradual resolution of the injury and its pain reduction the amount of back spasms normally lessens and slowly normal movements begin to be apparent again. But muscles can remain in muscle spasm in some cases, leading to a stiffened and shortened group of spinal structures which, by this adaptive shortening, leads to the production of shortened and abnormal spinal joints, ligaments and muscles.

Sitting for extended periods can increase the likelihood of suffering from increased compression of the lumbar discs with consequent fluid loss. Repeated flexion maintains the regular cycle of fluid uptake and avoidance of this movement interferes with this important process for disc health. The maintenance of abnormal posture and lack of strength in the abdominal muscles are also important factors.

Having a series of acute episodes of lumbago can predispose to developing a segmental stiffness problem, often with the stiff or abnormally moving segments of the spine having been present for a long period before they start to give pain symptoms. Actions which make this syndrome worse will tend to hold the spine in flexion for long periods or at end ranges, such as sitting for extended times and bending forwards repeatedly, actions which push joints further than their limits of comfort. The spinal facet joints develop an extension dysfunction and the spinal segment can become adaptively shortened, compromising its movement ability. My own lumbar spine has some of these back problems and limits my ability to do repeated lifting or bent over work.

Sarah Key, a physiotherapist who is well known in the UK, has produced the Sarah Key’s Back Sufferers Bible, a book in which she sets out her views of what is going on in this most common of musculoskeletal syndromes. She does acknowledge that it is hard to bring solid evidence for many of her interpretations but seems to have many good and practical therapy ideas to approach the back pain problem with. She covers the main syndromes which typically occur, giving treatment routines for self management of each one, all of which I have found very useful for my own lower back pain. Now I have something I can do about it rather than accept it as a fact of life.

Most of us have a simultaneous love-hate relationship with our pets: one moment they are demolishing the brand-new sofa, and the next they are showering you with affection. But regardless of how they act, or how you feel about them, there are various reasons why having a pet is good for your health:

1) Decreased stress levels and blood pressure. Research conducted by the University of Warwick has revealed that, in many cases, stroking or playing with a pet relaxes the person and lowers their blood pressure. In another study, researchers tested whether pets had this effect on stockbrokers who had high blood pressure. It was found that stockbrokers that were pet owners had a significantly lower blood pressure reading than those who were not. Of course, you have to like animals in order for this to ring true; if you are nervous or afraid then pets will probably make you more anxious as opposed to more relaxed.

2) Recovery from illness. Pets have been known to help ill patients in the most wondrous ways, but heart attack patients have benefitted from pet power most frequently. Numerous studies have shown pet owners who suffer from heart attacks live longer and have a lower risk of heart disease than heart attack patients who do not have a pet at home. Pets also offer a great amount of comfort to their bed-ridden owners, and this support speeds up their recovery.

Pets have been known to help seriously injured patients to emerge from comas. There is not much research available that supports than claim, but surgeons have recommended pets to be brought in to their injured owners bedside to see if it helps them recover. Dogs, in particular, have also been used in elderly homes because they helped minimize the symptoms of Parkinsons and Alzheimers disease.

3) Improvement in social life. Most domesticated animals are highly social creatures, and are therefore great company. Whether it is a dog that follows you around the house, or a cat that rubs up against your legs, pet owners have a constant source of social interaction. Pets can also be great conversation topics both in and outside the home.

4) Happiness. People often understand how happy a pet can make us: they help us deal with pain and loss, stick with us through our frustrations, and have even helped people combat depression. Some psychologists have used pets in their therapy sessions, because stroking a cat, rabbit, or dog raises proven to boost the brains serotonin levels. Being greeted at the door by an ecstatic dog or a purring cat when you come home from work every day can really raise your self-esteem, especially if you are having a bad day. This is also why pets are sometimes used in elderly homes ” their mere presence disperses any loneliness or isolation.

Regardless of whether you face unemployment or divorce, your pet will continue to love you unconditionally; and it is precisely this love that keeps human beings healthy and happy.

In an age where we can access information with the click of a mouse and receive messages from across the world the very second they are sent, the internet is frequently applauded for making our lives easier. Even the rise of social networking sites such as MySpace, Facebook, and the BBCs myCBBC have been met with general positivity ” that is, until recently. Psychologists, health experts, and even biologists have lately been criticizing social networking cites for being hazardous to our health.

Experts are now presenting new research that reveals that the amount of time we interact with people face-to-face has drastically decreased, making us more and more isolated from the outside world. In a recent issue of Biologist, the journal of the Institute of Biology, Dr Aric Sigman warns that we are producing less of the oxytocin chemical (also known as the cuddle chemical) ” which is a chemical our body produces when we form a connection with someone ” as a result of our devotion to the internet. He argues that this decline occurs when people are not in close contact with one another, which can have major consequences.

Sigman warns that a serious addiction to the virtual world can increase the risk of both physical and mental health problems such as strokes, heart disease, dementia, depression, strokes, and cancer ” not exactly something that crosses our mind when we are watching YouTube. Spending too much time online has also been known to change the ways in which our immune system and hormone levels are regulated. But it basically all comes down to our lifestyle ” with more and more people choosing to work from the isolation of their homes rather than at the busy office, the lack of regular meaningful human contact comes to have a negative impact on our body.

Psychologists also warn the implications this has for our families. Research reveals that children as young as five years old use the internet regularly. This, according to experts, undermines the childs ability to learn to interpret body language and acquire essential social skills. Not that the parents set the best example either. Dr. Signman was quoted as saying “Parents spend less time with their children than they did only a decade ago. Britain has the lowest proportion of children in all of Europe who eat with their parents at the table.

While most of these warnings (about physical health, in particular) have not been 100% confirmed by scientific research, there is an element of truth in each of the allegations. Common sense tells us that spending much time behind a computer screen cannot be good for your health, especially if you neglect proper social interaction.

Social networking sites can therefore be seen in both positive and negative lights (or even both). They can be a negative influence that isolates us and encourages anti-social behaviour. Or they can simply be a place to get back in touch with old friends and relatives. The bottom line is that everything should be done in moderation. As long as the time we spent on the internet is balanced with exercise, and a social life beyond the blogosphere, there is no reason for us to disconnect.

Recent studies have shown that one tenth of all emergency department visits are attributed to injury of the ankle. Most of these injuries are simple sprains. Common treatment for acute ankle sprains involves the practice of RICE therapy. Patients are first instructed to rest the ankle. Next, they are told to ice the area for 20 minute sessions. Then, the ankle is wrapped in compression bandages. Jones compression dressing uses alternating layers of compression bandages and elastic bandages. Finally, the patient elevates the ankle. Ibuprofen can be prescribed as a pain killer. If the patient is intolerant to aspirin, a substitute like acetaminophen can be provided.

RICE therapy is a short term solution; it does not provide long term care. It simply serves as damage control for the initial injury. Future injury prevention is crucial. Approximately 25% to 40% of ankle sprains are recurrent injuries. When the initial injury receives improper treatment, future ankle damage is likely to lead to either temporary or permanent disability. Osteopathic manipulative treatment, or OMT, is one possible solution to this problem.

This treatment provides care on an individual level. The treatment each patient receives is entirely unique to their particular injury. The osteopath physician assesses the joint and surrounding muscles. They then decide which soft tissue techniques would prove most effective. Sessions are brief, lasting only 10-20 minutes. Several studies show that these treatments lower pain levels and greatly improve the patient’s overall range of motion.

There are many soft tissue treatments. The physician studies the bones, from toe to ankle, and decides where most attention should be focused. Osteopaths have many options for ankle treatment. Sometimes muscle energy and strain-counter strain techniques prove useful. In other situations, lymphatic drainage is the main focus of the treatment. Drainage is an important part of the pain reduction process. The majority of ankle injury pain is the result of the fluid that builds up in the joint areas around the bones. This fluid can severely decrease mobility and slow down the recovery process.

Ankle sprains require immediate treatment. Physicians aim to return the ankle to proper working order. The goal is to get the patient up and walking normally as soon as possible. They also try to increase the overall range of motion and reduce pain levels as much as possible. Studies prove that even one Osteopathic manipulative treatment session can greatly improve the recovery process for acute ankle injuries.

Ankle injuries are not to be thought of lightly. Even a slight sprain should receive medical attention. If injuries go untreated, proper healing may never occur, leading to permanent disability. Fortunately, treatment is readily available. RICE (rest, ice, compression, and elevation) therapy and a quick session with an osteopath physician can reduce pain and shorten recovery time. Osteopath therapy also reduces the risk of future ankle injury.

The shoulder, or more strictly the glenohumeral joint, is a major and important joint in the upper limb, responsible mostly for placing the hand in front of the body where the eyes can see it as it performs tasks. To allow this ability the shoulder has a very large range of movement, moderate strength and limited stability. This makes the shoulder a “soft tissue joint”, where the stability and satisfactory function depend on the function of the soft tissues, the ligaments, tendons and muscles. For physiotherapists the shoulder is an important joint, with much treatment and pre- and post-operative rehab required.

The shoulder joint is constructed from the socket of the scapula and the humeral head, the ball at the top of the upper arm bone. The head of the upper arm is a large ball and important tendons insert onto it to move and stabilise the shoulder, but the shoulder socket, the glenoid, is small in comparison and very shallow. A cartilage rim, the labrum of the glenoid, deepens the socket and adds to stability. The acromio-clavicular joint lies above the shoulder joint proper and provides dynamic stability during arm movements, being made up from part of the scapula and the outer end of the clavicle.

A great many muscles act on the shoulder joint and on the other joints in the shoulder girdle, the acromioclavicular, sternoclavicular and scapulothoracic joints. The glenohumeral and scapulothoracic joints are acted upon by the major stabilisers and movers in the area, varying from power muscles which allow forceful work to stability muscles such as serratus anterior and the rotator cuff to smaller movement muscles such as deltoid. The muscles must keep the relationship between the shoulder blade and the thorax and ribcage steady and under control for the glenohumeral joint to also enjoy stability and precise movement.

Around the shoulder all the muscles narrow down into flat, fibrous tendons, some larger and stronger, some thinner and weaker. All these tendons are anchoring themselves to the humeral head, allowing their muscles to act on the shoulder. The rotator cuff includes a group of relatively small shoulder muscles, the subscapularis, the supraspinatus, the infraspinatus and the teres minor. The tendons form a wide sheet over the ball, allowing muscle forces to act on it. The rotator cuff, despite its name, acts to hold the humeral head down on the socket and allow the more powerful muscles to perform shoulder movements.

The rotator cuff degenerates with age, small tears appearing across its substance which can progress to massive tears, completely interfering with muscular function of the shoulder. Rotator cuff tears are often painful but it is not clear exactly why, as many older people have tears and do not have pain. Physiotherapists work to strengthen the rotator cuff or by exercising the main shoulder muscles without gravity resistance and gradually increasing the effort. Physios also work on rehabilitation after rotator cuff surgery for rotator cuff tears, following the detailed protocols for small, medium, large or massive rotator cuff tears.

The shoulder joint is not typically affected by OA (osteoarthritis) but when it is physiotherapists treat arthritic shoulders by joint mobilisations, muscle strengthening and ranges of motion. Once physio has nothing else to offer, total shoulder replacement is one of the further options, with various surgical techniques involving replacing the humeral ball and the scapular socket either anatomically or in reverse. The shoulder is often called a “soft-tissue joint” as the soft tissues, their strength and balance, are vital to the function of the joint. Post-operative physio management is essential as the correct protocol must be closely followed to ensure success.

Physiotherapists treat many other types of shoulder problems such as impingement, tendinitis, hypermobility, abnormal muscle patterning, fractures and dislocations. Impingement is treated by strengthening the rotator cuff or by subacromial injection or acromioplasty operation, where the end of the acromion can be excised. Tendinitis is treated by direct treatment of the tendon and graded strengthening and hypermobility by stability work and accepting the limitations dictated by the condition. Abnormal muscle patterning is managed by teaching normal patterns functionally and fractures and dislocations by the protocols laid down by the surgeons and trauma physiotherapists.