Cartilage Health


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Of our major synovial joints, the knee and hip are most affected by osteoarthritis (OA). Although the exact cause of OA is unknown and probably varies somewhat from person to person, factors such as advanced age and mechanical injury to a joint are associated with the development of OA. As the condition progresses, articular cartilage begins to soften and demonstrate fibrillations (shown here). At the same time, the underlying bone may hypertrophy due to having to accommodate extra stress as the cartilage matrix becomes disrupted.

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So, what can you do to help maintain cartilage health? There are a few things and they revolve around loading the cartilage appropriately in order to help optimize nutrient delivery to this tissue. First and foremost, excessive stress (increased height to weight ratio, excessive exercise without sufficient rest, etc) have been associated with early cartilage breakdown. On the flip side, inadequate loading of cartilage (sedentary lifestyle) and not using a joint through it’s full range of motion may impair nutrient delivery. Cartilage, unlike many other tissues, does not have a pump to deliver nutrients, so it relies on a special type of diffusion called imbibition. You can think of your articular cartilage like a sponge and in order for water, synovial fluid and nutrients to move in and out, the sponge must be squished (loaded) and then unloaded so that absorption can occur. This is why loading a joint appropriately throughout the day (this might mean losing a little weight or modifying your exercise program) and using our joints through a full range of motion are so important for maintaining cartilage health long-term.

HOW TO DECOMPRESS YOUR NECK![neck posture fix]


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Stretching the neck is definitely a good idea, but if it isn’t combined with neck decompression exercises, it will only help transiently!

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The most basic neck decompression exercise is the CHIN TUCK! (See above)

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The idea is that when you’re stuck in forward head posture (FHP-🅰), your upper cervicals gets stuck in too much extension and your lower cervicals are in too much flexion. As you perform the chin tuck (🅱) , you introduce more upper cervical FLEXION and more lower cervical EXTENSION into your system

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This simple exercise will increases upper and middle thoracic extension and also puts a good active stretch on all the superficial neck muscles/fascia/ligaments of the posterior cervical and upper thoracic spine as well as the sub-occipitals muscles

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It serves a dual-purpose of lengthening short muscles and strengthening 💪🏼 key postural muscles, which act against gravity and are subject to postural fatigue

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👉🏼Remember that while doing this exercise you’re trying to POSTERIORLY translate your head back (like a 🐢) you do NOT want the head to tilt back. The head must remain parallel with the body throughout the movement (you’re essentially giving yourself a double-chin at end range 😝)

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Start with 3 sets of 5-10 reps every day and slowly build up to 12-15 reps!

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Do muscles attach to bone? -🍲 for 💭 –


Almost everywhere anatomy 💀 is taught that muscles 💪 are individual units, but research 📚 shows that fascia distributes strain 🔄through neighboring structures or pit stops (muscles) which is over 600 stops..

The myofascial bag is 1️⃣one big network that forms, stabilizes and moves🤼‍♂️ the joints and skelton. Let’s consider that the outter layer of the bag would be a freeway 🚗 (fascial network) and the inner bag would be the freeway exits 🚧(muscles) so it’s not an end just a quick ✋ stop. It’s all one big road.. with a lot of stops along the way. –

Sooo. Does the brain recognize attachments from muscle to bone? 🤔

Double Crush Phenomenon 


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Pain resulting from compromise of neural structures (neuropathic pain) is common in various regions of the body and is often thought to be associated with excessive tension or compression on a nerve leading to ischemia (loss of blood flow). One of the most familiar syndromes associated with neuropathic pain is carpal tunnel syndrome (CTS). In this case, the median nerve is thought to be compromised at the carpal tunnel of the wrist.
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What many people are not told is that there is a concept referred to a the double crush phenomenon where it is believed that when a nerve is compromised in one area along it’s path, then it is more likely to demonstrate symptoms somewhere else. In the example of CTS and the median nerve there are numerous areas where the median nerve could run into problems including the neck, inter-scalene triangle, near the first rib, under pectoralis minor, under the pronator trees muscle and at the carpal tunnel. When these areas are addressed, through conservative care, the carpal tunnel symptoms (usually found in the hand) often clear up. So, before rushing into surgery or allowing someone else to do so for neuropathic pain, make sure they are examined by a practitioner who can check the entire nerve’s path. All too often we see patients who have surgeries like a carpal tunnel release and are found to be no different than individuals who only underwent conservative care at long-term follow-ups.

Muscle- Tendon Unit


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The muscle-tendon unit can be broken down into three components which include the muscle itself (contractile element), muscle membranes (parallel element) and tendon (series element). Both the muscle membranes and tendons are connective tissue structures and can be collectively group as the ‘elastic elements’ of the muscle-tendon unit.

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When developing force, the contractile element is often the only component that is considered, but the elastic elements are also important. The muscle membranes and, even more so, tendons can store energy and contribute to total force production. Connective tissue structures also undergo physiological adaptations (hypertrophy, stiffness, etc) associated with training just like the muscle tissue.

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Each of these components are susceptible to injury and/or pain too. Muscles can be strained and tendons can undergo reactive changes leading to tendinopathy when load surpasses capacity. When it comes to the muscle-tendon unit and injury prevention, the most useful concept to keep in mind is the relationship between load and capacity. Load that surpasses capacity, that is appropriately dosed, can be positive for adaptation. However, if load magnitude extends far beyond tissue capacity or volume is too high, then injury may result. Many problems can be prevented if one puts a little thought into how they will manage the load-capacity relationship.

IS YOUR PIRIFORMIS FLARING UP YOUR BACK?[back pain advice]


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This muscle, if cramped 😖😫 will compress on the sciatic nerve and cause you to have pain that may radiate down your leg ⚡️

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This condition is called piriformis syndrome

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If you have this condition, odds are you will have a shortened and tight piriformis!! This tightness will rotate your pelvis to one side and change your hip biomechanics. This will also causes the thoracic spine to counter-rotate which will create 🔀torsion throughout your back 😑

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💡QUICK PIRIFORMIS SYNDROME Facts

1️⃣ It’s cause is unknown

2️⃣ Can be a cause of acute and chronic low back pain

3️⃣ It usually starts from the buttocks and can spread down to the hamstring or as far as the calves

4️⃣Typically pain occurs during the stance part of running, or during extended sitting periods

5️⃣Stretching too aggressively will irritate the problem more and is not recommended

6️⃣ 15% of people have the sciatic nerve traveling through the piriformis, which make these people more likely to experience this problem

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🕵🏼If you have this problem what do you do? Usually people recommend strengthening/stretching exercises, ice, and rest. These work to a certain degree, but there are better ways to go about it!

ECIPROCAL INHIBITION SUPRASPINATUS RELEASE –

 Reciprocal inhibition in simple terms is when one muscle contracts, the other relaxes. For example when you flex 💪 your bicep the triceps will lengthen and relax, and the opposite is true.
For this release we will find the muscle, sink in and use reciprocal inhibition to relax the supraspinatus and then contract again. This release is best done if you have a partner to sink into the muscle due to the awkward position of bringing your opposite arm over your shoulder. If you don’t have a partner, below is a self release method: 

1️⃣ Find a chair/table sit up straight, bring your opposite arm over your right shoulder(if you are treating the right supraspinatus). Let right arm hang roughly 10-15 degree away from the chair/table and let the palm of the hand touch the side of the chair/table.

2️⃣ Palpate for the spine of scapula by running your fingers up and down

3️⃣ Once you have located the spine of scapula roll on top of it sink into the muscles on top(supraspinatus).

4️⃣ Begin at the medial end of the spine of scapula and work along till the lateral end for 1-2 mins while doing step 5 below⬇️

5️⃣ Press your palm towards the chair(adduction) to relax the supraspinatus and sink in deeper, then relax and contract again.
Tips – You may need to release your upper traps before you can reach the supraspinatus – This may not work for everyone due to other compensation patterns that needs to be resolved before targeting the supraspinatus – Seek out a professional if you need to 

Give this a shot hope this helps with your neck and tennis elbow!!! 

IT’S ALL ABOUT RELATIONSHIPS! 👫[muscle theory]

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People always ask me, my [insert body part] hurts here, what can I do!? The reason why I can never give anyone a direct answer is because it really doesn’t matter where the pain is

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To figure out the source of your pain, I need to look at the relationship between different areas of your body, and then based on how they interact with each other I can come up with a plan of action

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To reinforce my point, let’s look at the upward + downward rotators of the shoulder

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Let’s say you have shoulder problems with a lat-pull down (or any movement for that matter)

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It could be that

🔹your downward rotators are unable to coordinate together to do the ⬇️motion smoothly

🔹your upward rotators are overactive and won’t allow smooth motion

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🔹or maybe 2/3 of your downward rotators are sleeping on the job and 1/3 is overactive!

🔹etc. the combinations are endless…😑

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Basically it’s all about relationships, how do the upward and downward rotators relate to each other? And within each group, how do the 3 muscles interact with each other to produce ⬆️ or ⬇️ rotation?!

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Knowing your anatomy is one thing, but understanding how each body part relate to each other is what separates the noobs from the rehab gods 🙏🏼

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DO YOUR HIPS CLICK OR SNAP? 😳


About CLICKING or SNAPPING you feel in the hips?😫

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As highlighted in the picture, a snapping feeling in the front area of the hip/groin region could be from the tendons of the illiacus/psoas muscles that are rolling over something called the ILIOPECTINEAL EMINENCE (say that one 5 times fast 😐) as the ILIOPOAS BURSA may be inflammed.

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This issue is called INTERNAL IMPINGEMENT of the hip. There are others which I will discuss later on.😜

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So imagine this issue occuring during your squat, stairs, or even simply walking throughout your day – not too fun is it? In hip flexion (deep squat) the tendon is lateral to this “eminence” and then going into flexion causes it to go medial. This produces a feeling of snapping or sometimes even an audible sound.👂🏼

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To help with this, you can try the stretches . In addition, try out this quick hip distraction drill/stretch to see if it helps! .

SETUP

1️⃣Wrap the band around something steady and then around your leg as in the picture

2️⃣Slide it all the way up as high as it can go

3️⃣Go into a PIGEON POSE (yoga) by folding your leg under your body so that your shin is running perpendicular to your spine

4️⃣Slowly lower your hips backwards as if you’re going further into the stretch

5️⃣Posteriorly tilt your pelvis as we’ve discussed previously

6️⃣Move around slightly to find the position that works best for you! 

7️⃣Breathe, and relax 👌🏼💆🏻‍♂️💆🏽

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⚠️DISCLAIMER: A less prevalent but more serious issue may be something within the hip joint itself (ie – issue with the labrum or potentially the overall structure of your hip joint). .

HIP FLEXORS AND PELVIC TILT

The role of the hip flexors and how they impact overall alignment. The hip flexors are quite complex due to the number of muscles that actually contribute to hip flexion.

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What’s interesting is that these can be an issue across a wide range of people from the very athletic to the traditional desk worker.

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Typically discussed are the following muscles:

👉🏼Psoas major

👉🏼Illiacus

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But in addition to these there are a number of other muscles from other muscle groups which also play a role in flexion the hip:

👉🏼Tensor Fascia Lata (TFL) of the gluteal muscle group

👉🏼Rectus femoris of the quadriceps

👉🏼Sartorius

👉🏼Pectineus (adductor group)

👉🏼Adductor Longus (adductor group)

👉🏼Adductor Brevis (adductor group)

👉🏼Gracilis (adductor group)

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Furthermore, the adductor muscle groups can even be divided into two parts based on their action. Believe it or not, they can actually FLEX AND EXTEND the hip. I know, right?😅

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From this list we can see how important it is to understand various aspects of someones activity patterns that may point us in the proper direction when dealing with issues around the hip. These muscles will work in different amounts depending on the specific tasks and position of the leg itself.

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As these muscles are “HIP FLEXORS” the corresponding action on the pelvis is a an anterior tilt of the pelvis (APT).

@rontherapy

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