Physiotherapy for Ankylosing Spondylitis
December 20, 2008 | Leave a Comment
Ankylosing spondylitis belongs to a group of disorders called the spondyloarthropathies, a group which also includes psoriatic arthritis, reactive arthritis and arthritis related to inflammatory bowel disease. All these conditions are linked by the genetics of a gene on white blood cells called HLA B27 and by the presence of enthesitis, inflammation at the points where ligaments and tendons insert into bone. This can lead to fibrosis at these sites and then bone formation, causing joint fusion (ankylosis) in some cases.
The commonest spondyloarthropathy is Ankylosing spondylitis, which occurs as a reflection of the occurrence of the HLA B27 gene in the population. The gene occurs much less commonly near the equator and much more commonly in northern latitudes, and this is also the pattern with the development of AS. White race people are more commonly affected with around 0.1 to 1.0 percent overall, varying with latitude. Only 1 or 2 people of a hundred with the HLA B27 gene actually develop AS, but if they have a close relative who has the condition the likelihood rises to 15 to 20%.
Only one female is diagnosed with AS for every three males, and female patients’ symptoms are often much milder and some may be missed as a diagnosis of AS. The most typical presenting group is young men under 40 years old, with under sixteen year olds making up to twenty percent of this group. The symptoms appear on average at twenty-five years of age and the diagnosis is rarely made above fifty years old. AS can look like mechanical back pain if sufficient attention to detail is not made. Strong and persistent stiffness is often an answer to the question of how they are in the morning.
Low back pain is the major diagnostic alternative but AS patients are generally younger and the inflammatory process leads to different symptoms:
Morning stiffness in the lumbar spine, lasting at least 30 minutes or longer Exercise improves the back pain and stiffness Rest worsens the pain and stiffness Pain is usually worse in the second half of the night, after a time of rest Peripheral joints are affected in 30 to 50% of patients Tiredness is common AS has systemic affects from its inflammatory nature which can include feeling unwell, fever and loss of weight.
Physiotherapy examination of the spine in an AS patient usually uncovers significantly reduced ranges of spinal movement from normal, with perhaps a reduced lumbar lordosis and an increased thoracic curve. Neck movements may also be limited in later stages and a reduction in chest expansion noted due to rib joint involvement. Peripheral symptoms occur in around a third of patients and the physio will palpate the tender areas, searching for evidence of enthesitis in the insertions of the Achilles tendon and plantar ligament of the foot. These are areas of high mechanical stress and commonly affected.
Postural analysis of the AS patient is the first thing a physiotherapist notes after the subjective examination, recording spinal abnormalities, flexed knees, rounded shoulders or poking head posture. The ranges of movement of the cervical, thoracic and lumbar spine are measured and a battery of standard measures taken which allows assessment of the disease progression. The hips or other peripheral joints may be affected and these need to be measured also, with the physio likely testing out sites where the enthesis is likely to be painful and inflamed. If the disease is active then the patient may also have joint effusions and may appear unwell, be sweating and not have slept well.
Physiotherapists will concentrate on treating the inflamed areas first such as the areas where the ligaments insert into the bone, using insoles, cold, ultrasound and stretching techniques. Routine spinal range of motion exercises are taught to patients with an emphasis on getting to end ranges, concentrating initially on the anti-gravity muscles such as thoracic and lumbar extensors. Neck rotation and retractions and thoracic rotations are also important functional movements not to lose. Patients should rest themselves in good postures such as prone or supine with only one pillow, to avoid accentuating the typical spinal deformities. Treatment for AS in a hydrotherapy pool is beneficial and soothing and patient education important so they keep up their programme.
Hemroids-Piles-Pain, What to Do!
December 20, 2008 | Leave a Comment
Are you one of the 40% of the adult population suffering for Hemroids. What to do for piles/hemroids? In this article I reveal the truth about why you still suffer from hemroids, the treatments you have used that didn’t work and explain what will work.
Creams and ointments are a popular treatment for hemroids. These creams and ointments are rubbed to the rectal area, this soothes the blood vessels. Creating the tissues to relax so they do not bulge as much. When the tissue stops bulging the hemroid will be less lightly to be painful. This method for curing hemroids is usually temporary as the hemroids usually flare up again.
Another method what to do for hemroids that is very popular also are the use of suppositories. They are inserted inside the rectum to deliver moisture to the hemroid. The purpose of this is to ensure the hemroid heals before it ruptures again when the pressure is there.This treatment for hemroids seems to work for some but not at all for others.
Pills, are often used to regulate the blood pressure. Although sometime this can have side effects, the pills are used to tighten the tissue of the veins so it is less susceptible to problems. Be aware this method can cause side effects but big pharmacies do like to push this method.
Other options include cryotherapy or surgery, only after the other methods have been exhausted. This option depends on individual cases.
Each individual is different and what they can tolerate varies. Painful piles and hemroids can still get relief with safer options. In my experience it is better to try all safer options before attempting drastic methods.
Most people effected with hemroids only find temporary solutions for this problem. Are you one of the 40% of the adult population who ask the question “what to do for hemroids”
Hemroids are basically any form of inflamed vein tissue around the lower rectal regions. Sometime they are painless and you might not know you have them, Painful hemroids are exactly that “they are so sore”. They can affect posture and ability to sit. The fear of going to the toilet, this is a common problem as you know the pain!
Cure Type II Diabetes Naturally
December 19, 2008 | Leave a Comment
Here’s an amazing story of how one women determined to fight diabetes after her husband collapsed on a wedding night.
Click here to listen to her story
Let’s admit most of us don’t even know that we have diabetes until something like that struck us or our loved one. Unfortunately when that happens it is too late.
She went on declaring war on diabetes so to speak. After scurring through tons of information, she said that she was amazed at the amount of information available.
Unfortunately, over-information and mis-information were a big part of the problem. One doctor recommended a certain type of drug while other doctors recommended a different type while still others spoke out against drugs all together”.
There was a lot of diet charts, food graphs and medical manuals. She almost gave up until finally in her own word she said she cracked the code and stopped diabetes cold.
It is interesting that after talking to dozens of diabetic patients and medical professionals she spotted a patent on how to fight the disease. She began to test what she found on her husband and after confirming with their family doctors it proved that the methods work.
Here are some of the things that she found:
1) Why over a BILLION Asian never get diabetes?
2) Enjoy the food that you love and still be free from diabetes
3) How to defeat diabetes even if you have passion for sweet stuff.
4) The truth about artificial sweeteners, which one works and which one could even be dangerous to your life.
5) A supplement you can take that’s proven to reduce nerve damage from diabetes.
There are lots and lots more information that will even shock the nutrition expert!
If you or your love one are suffering from diabetes, please do yourself a favor listen to her story.
Click here to listen to her story
Cat Allergies Making You MEOW?
December 10, 2008 | Leave a Comment
Owning and caring for pets is a favorite pastime around the world. Many people grow as close to their pets as they do to their family members. They become a part of your family. Choosing the type of pet you will select depends on a variety of things.
Pets range from many selections. They can be: snakes, rabbits, birds and lizards. However, the most common pets to have are cats and dogs.
Due to cat allergies, many who would like to have a cat cannot and do not. Cat allergies can range from mild to severe, so it is most important to take special precaution when being around these particular pets.
Coping with Cat Allergies
Forty percent of people who suffer from asthma also have cat allergies and are much more sensitive to these creatures than to dogs.
The problematic element for those with this allergy is a protein found in the skin of the cat and in the saliva of the cat. When the cat licks his fur while cleaning himself, he deposits this protein on his fur.
While there are no cats known to be hypoallergenic, male cats cause more allergic reactions than there female counterparts due to the testosterone increase in the cat’s glands. The cat allergen is found primarily in homes of cats.
Male cats cause more allergic reactions than female cats due to the testosterone increasing in the cat’s glands. This in turn increases the amount of protein. Cat allergens are found mostly in homes where the cats live. This has however also been found in offices and places where animals are not allowed. It is quite sticky and is transmitted by people getting it on their clothing and carrying it from place to place. The protein particles causing cat allergies remain in the air for long periods of time, and those who are sensitive are more likely to have an allergic reaction when entering a room where there are multiple cats.
Wheezing, the most common symptom of cat allergy, begins upon entrance to a room with cats. There are also more subtle, delayed reactions that can linger to up to a week or more. Chronic asthma can be an ongoing malady for those who are exposed often. Hives and eczema may also occur. Be safe, if allergic to cats, don’t be in their presence. It is better to maintain good health and be aware of the symptoms of your allergy. By yourself a dog!
The Shoulder and Physiotherapy
December 2, 2008 | Leave a Comment
The gleno-humeral joint, known in lay terms as the shoulder, is a vital part of the links in the upper limb and responsible for our ability to place our hands where we can see them to perform activities. Because flexibility is a prime requirement the shoulder is a less stable joint with moderate muscle power and a large range of motion. It is described as a “soft tissue joint”, implying that the joint’s functional ability is dependent on its soft and not its hard components. Physiotherapists are closely involved in treating and rehabilitating the shoulder, dealing with the muscles, ligaments and tendons.
The gleno-humeral joint is made up of the ball of the humerus and the socket of the shoulder blade which is called the glenoid surface. The top of the arm bone, the humeral head, is large and carries many of the tendon insertions for the stability and movement of the shoulder. The socket or glenoid is a relatively small and shallow socket for the large ball but is deepened slightly by a fibrocartilage rim called the glenoid labrum. Above the shoulder is the acromio-clavicular joint, a joint between the outer end of the collar bone and part of the shoulder blade, a stabilizing strut for arm movement.
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.
The rotator cuff is a group of four small muscles which originate from the scapula and insert around the ball of the humeral head, the teres minor, subscapularis, infraspinatus and supraspinatus. The cuff tendons form a sheet around the ball of the arm bone and allow forces to be exerted on the humeral head by the shoulder girdle muscles. If the rotator cuff is not functioning normally the more powerful muscles tend to make the humeral head slide upwards on the socket, interfering with normal function and making a person unable to lift their arm up above their head.
As a person ages, the rotator cuff develops degenerative changes in its tendinous structures, causing small tears in the tendons which can enlarge until there is no continuity between the muscles and their attachments. This leads to loss of normal shoulder movement and can be very painful but is not always so and “Grey hair equals cuff tear” is a common saying. Physios work at rotator cuff strengthening, whilst in massive tears the main shoulder muscles can be progressively strengthened to improve function. Surgery is possible for massive, moderate and small rotator cuff tears and physiotherapists manage the post-operative protocols.
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.