Saturday, May 11, 2013

Gout in the Knee - How to Ease the Pain


Gout is a form of arthritis that usually attacks the big toes of middle aged men but it can also attack women in the exact same way. It can even affect other joints of the body such as the elbow, the wrists, the ankles, the fingers and the one that we are going to talk about in this article, gout in the knee.

Unlike other forms of arthritis gout is almost 100% controllable with the correct diet and a few over-the-counter remedies. In this article we are going to teach you a few ways to control gout or cure it completely.

Gout in the Knee - Cures
1. In a recent 2009 studied carried out in the University of California 2 separate groups of people were given 2 different measures of vitamin C daily. The first group were given 1,500mg daily of vitamin C while the other group were given just the RDA of vitamin C. After the study was completed it was found that the people with the higher intake of vitamin C had up to 40% less uric acid in their body and were therefore less likely to get gout.

2. Black Cherry Juice - Black cherry juice will help gout in the knee due to its very high antioxidant levels. High level of potent antioxidants have been proven to reduce uric acid levels in the body and therefore can minimize the risk of you getting a gout attacks. Drinking one large glass of this wonder juice daily can lower your uric acid levels by up to 20%.

Why is Osteoarthritis So Darned Hard to Treat?


Recent research efforts from both Northwestern University in Chicago and the University of Pittsburgh Medical Center have described work on the use of a new nanofiber gel that promotes cartilage growth in joints.

The material is injected into the damaged joint and stimulates bone marrow stem cells to produce natural cartilage.

The nanofibers allow stem cells from bone marrow to produce cartilage containing type II collagen and repair a damaged joint.

Type II collagen is the major protein component in articular cartilage, the gristle that caps the ends of long bones within a joint.

This is distinctly different from the Type I collagen produced as a result of another procedure used to heal cartilage damage called microfracture. Microfracture is a surgical procedure where small holes are drilled into the bone beneath the area of cartilage damage. This leads to bleeding from the bone marrow.

Ostensibly, stem cells from the marrow create new cartilage.

Microfracture causes the production of cartilage having predominately type I collagen. Type I collagen is the type found most commonly in scar tissue.

Type II collagen is weaker than Type I collagen and probably does not hold up as well. This may be one explanation why microfracture surgery has not been as successful as first thought.

Another type of procedure called autologous chondrocyte transplantation has also been used. In this procedure, cartilage is harvested from a non-weight-bearing part of the joint. The cartilage is then specially treated in a laboratory so that individual cartilage cells multiply. The cartilage cells are then put back into the joint under a small flap of tissue that is sewn into place. Recovery is long and the cartilage produced also appears to contain mostly Type I collagen.

Mosaicplasty where multiple cartilage plugs are fitted into the cartilage defect has also been used. Results are mixed.

Stem cell treatment has the appeal of being less invasive and requiring less recovery time. However, controlled data is nonexistent. Supportive evidence consists of case studies and small numbers.

One issue that has plagued researchers and clinicians alike is the mechanical forces present within weight-bearing joints such as the hip and knee.

When asked his opinion regarding the nanofiber issue, Dr. William Arnold, a Chicago-based rheumatologist stated, "This isn't the first 'cartilage growth stimulator'...and it won't be the last. There's no way that cartilage regrows on the surface of the medial femoral condyle (of the knee) without a mechanical correction accompanying the "regrowth". The shear compression forces in the medial compartment are formidable... and would quickly chew up any flimsy cartilage surface beginning to grow on the surface of the condyle."

Dr. Nathan Wei, a rheumatologist specializing in stem cell treatment for osteoarthritis, concurs with Dr. Arnold to a point. He states, "The impact loading forces on weight-bearing joints such as the knee and hip are one thing to contend with but with the hip there is the added stress of rotational movement and in the knee there are gliding and rotational forces to deal with as well."

He argues though, "Animal models have demonstrated that stem cell procedures are effective. And while human data is sparse, early evidence supports further investigation... I do agree that mechanical forces need to be dealt with through various means in order to allow stem cells to 'take'. We are currently attempting to address this issue. Our results so far are very encouraging."

Martial Arts Sparring Defense For Beginners - Put Your Shields Up (On Guard - Head Protection)


I remember when I first started to learn to spar. I really did not know much about punching or kicking and most certainly did not understand how to block or defend. Imagine a bad dancer on 5 cups of coffee bouncing around while being punched, kicked and thrown to the ground. It would have been great if I fully understood the benefits of a good shield defense (I might have lasted a wee bit longer).

In the beginning, you should learn a few basic defenses in order to help you understand how to deal with attacks as well as watch your opponent in an attempt to READ them.

So, with that in mind - we are going to talk about the most basic defense, that will take you a long way in your full contact sparring - as well as provide you with a protective defensive wall.

Start with the following two shields (I call them, "shields" because they are all about blocking incoming attacks to the head or body):

01 Get the hands up and protect the HEAD

02 Get the knees up and protect the BODY

As the head is the most obvious target, you will need to learn to guard it. Dropping the hands is a mistake most beginners make and what intermediate to advanced opponents take advantage of. You need to learn to keep the hands up.

In the beginning, you want to program yourself to keep your guard up - your shield.

Note, you DO NOT want to program yourself to follow your opponent's movements with a block - instead, you want to react by bringing up your shields (or having them up already). You can learn to keep the hands up by trying some of the following "Lobes of Fun Strategy":

* Hold your ears during the majority of a sparring session to train yourself to keep your hands UP.

Please use some common sense with this and other strategies. For example, your hands will be up, but not forward in front of the face there they may need to be (though the side of the head often needs more protection as the front of the head has the cranium is already your best natural shield).

When I was first learning from a professional sparring coach, I was forced to grab and hold the lobes of my ears for the duration of class (or any time that did not require me to use my hands). This simple punishment taught me that the default position of my hands should be up. You can do this when you are shadow boxing or working on the bag too. When doing this exercise, be sure to remember to keep the elbows from going up and out (mimicking wings) and instead keep them close and tuck your body in so the elbows almost touch - this is a basic crunch that will improve your shield by:

* Pulling the chin down and keeping the forehead out front
* Tightening the abs
* Covering the ribs or decrease the exposure to attacks to the body

When bringing the hands up to block, try to keep the eyes forward and head up (though the chin should remain down and tucked in pushing the forehead foreword).

Keeping your hands up might seem like a basic concept or too simple to consider as valuable data in the world of full contact sparring. However, as I have been teaching for more than 20 years and working with martial artists of all shapes and sizes (mainly at our live-in martial arts camps where students learn full contact fighting) I have noticed that this is one of the most (if not the most) common mistakes of martial artists.

Usually this happens because many martial artists are taught to bring the hands down when they kick. It looks like they are pulling a rope that lifts their leg. Many beginners cannot kick without bringing their hands down. Ironically, I use this information to teach my students an offensive strategy when fighting other martial artists:

What is the benefit of someone kicking you? The answer - most likely, their hands will be down, so step in and knock them out. Again, we are talking about reading your opponent and will discuss that in other articles. As with many martial art tactics, keeping your guard up is a foundational skill that needs to be a conditioned part of your fighting strategy.

Boxing, Kickboxing and Martial Arts related sports can be dangerous and too much of it will be damaging to your brain or causing long-term physical injuries. Be sure to ALWAYS wear protective gear and learn the proper techniques to avoid injury.

Visit Pad-Up Martial Arts Equipment for a wide variety of high quality Boxing Equipment, Boxing Gloves, Sparring Gear, Sparring Gloves, Shin Guard, Headgear, Chest Guard, Mouthpiece and more.

Treating Jumper's Knee


A Treatment Plan for "Jumper's Knee"

If you've had tenderness and anterior knee pain on that little bony bump in front of the upper shin bone, where your kneecap tendon attaches, or tenderness at the lower end of the kneecap, then you've become acquainted with "jumper's knee." Technically, the pain is from a tendonitis, or an inflammation of the attachment of either end of the patella tendon to the bone. It generally comes about from trauma, by excessive or repetitive pulling on the tendon, as when jumping, hence, the name.

Microscopically, tiny, thin cords of fibrous tissue, called Sharpey's Fibers, which anchor the tendon to its bony insertion, are literally pulled out of the bone. It's not comparable to a rupture, in which the entire tendon is severed; just a few fibers are avulsed from the bone. But these few fibers are enough to stimulate local inflammation. This inflammation is manifested by tenderness, pain and swelling. Once you have it, it's difficult to resolve the condition, because you're constantly using your knees.

Treatment is simple, but takes time. Initial treatment is mainly rest and "tincture of time," aided initially by measures to relieve inflammation. This is followed by progressive rehabilitation, until symptoms have been resolved and full function regained.

For the acute case:
1. Cold applications, or ice for the first 24 - 48 hours.
2. Thereafter, intermittent moist heat, 20 minutes, 4-6X/day.
3. OTC anti-inflammatory medications (NSAID's or Non-Steroidal Anti-Inflammatory Drugs),
like ibuprofen (Advil, or Motrin IB), or naproxen (Aleve) are helpful, too.
4. Natural measures to reduce inflammation include:

a. Avoid red meat (potent source of arachadonic acid--a precursor of prostaglandins, chemical mediators of pain)

b. Fish Oil (or other sources of Omega 3 Fatty Acids, like Flax Seed Oil) 4000-6000mg/day

c. Ginger

d. Devil's Claw

e. Turmeric

f. Bromelain
5. Local application of DMSO +/- 1% hydrocortisone cream 2X/day
6. Prolotherapy (injection of highly irritating compounds into areas of degeneration, to provoke a proliferative tissue response and restore strong fibrous tissue where it is lacking) may be helpful in refractory cases.

Once acute inflammation has been controlled, you can begin tendon strengthening exercises:
1. Wall Sitting
2. Isometric squats.
3. Quadriceps stretching
4. Deep squatting and running should be avoided, until symptoms have been gone subjectively for at least a week or so.
5. Gentle jogging for short distances should precede full bore running or jumping, and only when no pain is elicited.

Collagen, the protein from which the tendons are made, has been shown to take about six to eight weeks to heal in the laboratory. Based on this observation, it's likely that the tendon will require that amount of time to heal. So, it's important not to rush the process. Be patient. Orthopaedic injuries take time to heal. If you rush it, you may be right back where you started.

Knee Pain and Chiropractic Care


When most people think about the types of pain that can be alleviated with chiropractic care, they tend to think about the head and neck. Knee pain, however, is becoming a more common complaint due to chronically poor posture and the eventual strain spinal misalignment can have on the leg joints. Knee pain is showing up more and more in people who work sedentary jobs and spend hours a day hunched over their desks and people who work manual labor and do not lift heavy loads properly.

Knee pain is often found in conjunction with back pain and can be caused both by sudden injury like stomping on the joint too hard or by incorrect posture. So what to do? While pain relievers may offer temporary relief for upper back pain, they fail to address to root of the problem and often lose potency after repeated doses. Chiropractic care can offer long-term solutions by targeting the problem areas and correcting the injury but also by preventing future harm.

The majority of knee pain is caused by muscular irritation and dysfunction in the joints. The reason the knee is prone to pain is that the nerves from the lower back and spine travel through the leg to the knee and the muscles and joints can become easily inflamed. A chiropractor can pinpoint which of these areas is causing the pain and proceed accordingly and safely. Your chiropractor will likely perform a physical exam and may use digital x-ray, MRI, or CAT scan to determine where your trauma is located and the areas being impacted.

Treatment for muscular irritation will often include a combination of massage therapy, stretching and strengthening exercises while the joint pain will require manual manipulation and stretching. A good chiropractor will also send you home with exercises and posture adjustments you can do on your own time in order to prevent further damage. A combination of chiropractic care and chiropractor supervised at home care could even keep you from expensive joint surgeries that would require a long healing time and set you on the road to long-term wellness.

If you suffer from chronic knee pain, it is time to visit a reputable chiropractor and address the issue before it worsens. A trip to the chiropractor can save you money and free you from pain you may have been dealing with for years! There's no reason to wait when relief is in sight.

Friday, May 10, 2013

How to Reduce Swelling in the Knee Following a Knee Replacement


After you have had your knee replaced besides learning how to manage the post-surgical pain, you will need to learn how to effectively manage the swelling that will accompany the surgery as well. Maintaining an acceptable amount of swelling in the knee will not only help in reducing your pain and overall comfort level but, it will also make your rehabilitation more productive.

Several recommendations that are made to help you with the swelling and, what I also recommend to my patients in the home health setting are

1. A Good Quality Cold Pack. I have seen all types of cold packs in use. Some are much better than others. I myself do not recommend using a bag of vegetables for instance for such a large joint. It is advisable that you purchase either a large cold pack that has a gel component inside or, you get a large plastic bag that can be filled with ice. The important thing to remember is that you want a cold pack that fully encompasses the entire knee both top and bottom. You should be able to wrap the entire cold pack around your knee.

Some hospitals also provide their own cryotherapy systems that you can take home and use. They are effective as well. The important thing to remember is to use a cold component on the knee immediately after exercise and as needed throughout the day. You cannot apply too much ice.

2. Ted Hose. This something to consider if you have a continual problem with swelling. Many orthopedic surgeons make the use of these compression stockings a part of their discharge instructions. They are effective when used. The problem can be getting them on and off for some patients and caregivers. You can wear them virtually 24 hours a day. They can be uncomfortable for many and rather restrictive. They are used also in the prevention of possible blood clotting in the affected limb as well.

3. Elevation. Keeping your affected leg elevated higher than your heart is another very common tool that is used and taught to everyone that has a knee replacement. The problem is many do not follow the instructions regarding proper placement. I find many will keep the affected leg lower than it should be. Placing it up on several pillows or other type of structure will help in getting the fluid to drain back towards your torso. This allows your body to properly handle and excrete the fluid at a later time.

4. Monitor Your Activity Level. Your activity level and how much you are up on your feet will dictate the amount of swelling you experience. This is another common area where people get into trouble. They are torn between how much to walk. It is pounded into our heads when we leave the hospital to walk. Yes that is important however, you can over do this easily and, cause your knee to revolt, causing the increase in swelling and accompanied pain.

Reducing the swelling in your knee therefore is learning how to merge and manage your activity levels, along with applying a cold pack to your knee after each exercise session and elevating your leg during your icing sessions.

There is nothing that will totally prevent the swelling of your knee. Swelling is how your body begins the healing process by bringing extra blood and nutrients to the area. You will go through a learning curve with the swelling. Everyone s body will react a little differently. You will learn through trial and error how to manage this process.

If you follow the triad of monitoring your activity level initially along with using ice liberally around the entire knee and, elevating it throughout the day than you will be doing all you can to keep your swelling to a manageable level.

Diagnosis: Trick Knee Or Luxating Patella In Dogs


Every year, thousands of small dogs and less frequently, large dogs are diagnosed with luxating patella or trick knee. The reason for the dog's trick knee is that the knee cap (patella), usually held in place by a ligament, slides or pops out of its track or grove.

The Mechanics
There are several reasons why the knee cap dislocates or luxates. The bony track that the knee cap slides in may be too shallow. The dog may have a twisted lower leg bone. Or the point where the ligament connects to the lower leg bone may be off-center. In any case, the medical community points the finger at genetics for the cause of canine luxating patella.

Note that the lameness usually associated with this condition may not show up until the dog is older and heavier and more pressure is applied to the knee joint as the dog walks or runs. This is the case with Simon, a poodle and cocker spaniel mix.

At about a year old, Simon was diagnosed with medial luxating patella, the most common type. His knee cap dislocated toward the inside of his right knee. Vet examinations at various times during his first year did not uncover a trick knee. But, during his second summer, he showed the typical symptoms.

Arriving At The Diagnosis
Here's what normally happens to arrive at a diagnosis for trick knee in dogs:

1. The owner notices limping or lameness that persists.

2. During a trip to the vet, the medical personnel ask question about the dog's gait and frequency of the problem and the vet examines the knee to see if it dislocates easily.

3. The vet may confirm initial diagnosis with X-rays.

4. The vet (you may have to ask) explains why the dog's knee is dislocating or is dislocated. (Simon's vet used a model of a dog's knee to explain the reason for his trick knee).

5. The vet may assign a grade indicating the severity of the luxation/dislocation. For example, because Simon's diagnosis was Grade I Luxating Patella.

The Owner's Responsibility

If your dog limps frequently and the condition does not resolve itself in a few days, take the dog to a vet. In Simon's case, he could relocate his knee cap quite easily, so he did not limp all the time. But, over time, the frequency of dislocation/relocation increased as evidenced by a distinct limp and stiff-legged hop.

Rheumatoid Arthritis in the Knee


Rheumatoid arthritis is a chronic type of inflammation that occurs symmetrically, affecting key joints of the body such as hands, knees, ankles, feet, hips, elbows and shoulders. The condition is more likely to affect women than men and is common in those who are aged 40 and above, though it can most certainly occur in much younger persons as well. It is blamed for a number of symptoms that include joint swelling and pain, stiffness and types of deformity. Rheumatoid arthritis in the knee can be particularly painful and cause severe restrictions to one's freedom of movement. Although there is no known cure as yet, the condition can still be managed to a fair degree.

Before we discuss rheumatoid arthritis of the knee let us look at this particular joint which is very important when it comes to mobility. Around the ends of the bones is the cartilage and this prevents the bones from rubbing against each other. Between the two cartilages of the particular bones is a small pouch that is covered with a thin tissue known as synovium and this secretes a liquid that helps keep the joint lubricated. When the synovium is affected as a result of the rheumatoid arthritis condition, the functions of the various parts that make up the knee get affected and fail to function as they should.

Common symptoms of this disease's effects on the knee include pain, swelling and inflammation, stiffness, a warm feeling around the knee, fever, flu symptoms and fatigue. While the exact cause for the disease in general and its effects on the knee are unknown even as of now, it is widely believed that genetics and living environments play a part in who is affected by it and who is not. Rheumatoid arthritis of the knee is diagnosed based on symptoms pretty much along the lines of general rheumatoid arthritis. Blood tests and X rays to verify the damage to joint are also used in the diagnostic process for this condition. A test of the fluid between the joints can also help diagnose the condition as a high level of inflammatory material therein will indicate rheumatoid arthritis affecting the said joint.

There are a few time tested treatments available for rheumatoid arthritis of the knee. Common types of medication include aspirins, acetaminophen (or Tylenol) and nonsteroidal anti-inflammatory drugs. Most of these treatments are targeted at the pain as there is no cure to completely eradicate the condition. Regular exercises targeting the health of the joints can also be recommended as a practice to keep the condition in check. Excess weight can meanwhile compound the condition as the excess weight places a disproportionate stress and pressure on them. As such it is best to maintain a weight that is recommended for your height or to reduce weight via a suitable diet plan in case you are overweight.

In a worst case scenario where damage to the joints is severe, a replacement procedure may be required. This last resort surgery can be expected to produce a successful outcome thanks to modern day advances in procedures of the sort.

Meniscal Transplant: A Welcome Boon for Patients After Menisectomy in India


Many young men suffer from knee pain in India after a meniscal injury in sports or a two wheeler accident. This might have resulted in damage to the ligaments(ACL) and cartilage and menisci. The pain continues despite taking pain killers and physiotherapy. Menicectomy and Ligament reconstruction would have been done. As they are young or middle aged, they have to grin and bear the pain as up to now, their orthopaedic surgeon did not have any surgical or medical solution except advising the above. It will be heartening for these patients to hear that a solution to their problems will be available in Chennai shortly. This procedure is called, "Meniscal transplant". It is suitable for young men to alleviate their pain for a short tem at least.

What are the menisci?

The knee joint is made by the lower end of the thigh bone (femur) and upper end of the leg bone (tibia). Two "C" shaped pieces of cartilage interposed between these two bones serve as cushions within the joint. They are situated, one on either site. They have several important functions in the knee joint and damage to them triggers damage to the articular or joint cartilage resulting in osteo arthritis, which is the cause of knee pain.

These important functions are 1) Acting as shock absorbers...

2) Increasing the congruity between the ends of the two bones within the joint.

3) Conferring stability to the joint by preventing the leg bone from sliding forwards while rapidly climbing downstairs or running around a curve.

4) Promoting and increasing the area of contact between the two bones, thus preventing overloading of the joint.

How are they damaged?

When your leg gets twisted in an accident in games or a two wheeler, ligaments and menisci are torn. This results in an immediate swelling of your knee indicating damage within. You will no longer be able to continue the game and your knee may feel unsteady. You might have consulted your doctor and he would have aspirated the blood within. An operation might have done to remove torn cartilage and repair the ligaments of the knee. However till date no one has attempted to replace the torn cartilage within the knee-joint in India. Some might have had the cartilage stitched back. Football, hockey, cricket, roller or ice skating are the games in which the knee is likely to be damaged. Many young men and women also get their knee done in in a two wheeler accident.

What are the initial symptoms?

Intermittent giving away of the knee and pain can result if there is persisting damage to the ligaments and menisci. This may lead to a deformity or curvature of the leg bone. Later arthritis develops due to increased friction between the soft articular cartilages.

What is done to treat this injury by orthopedic surgeons?

He might have done an arthroscopy and diagnosed the condition. Later he might have advised you to undergo surgery to reconstruct the torn ligament and might have removed torn cartilage. This corrects part of the problem. The damaged menisci still remain and no solution has been available so far.
What is a meniscal transplant? How is the operation done?

In case you have had a meniscus removed, then it is now possible to replace it with a meniscus from a recently brain dead person surgically.
Transplantation of organs from cadavers is not a new thing in our country and you might have heard of kidney, cornea and recently liver transplant. To this list' "Meniscal transplant" is likely to be added soon.

The menisci are removed from another person's knee and preserved and stored at minus 85 degrees. When another person with absent menisci needs to have his knee restored back to the original condition, these stored tissue can be transplanted into that person's knee. This is possible using an arthroscope or by minimally invasive open surgery.

The patient will have to stay in hospital for a day or two and need not consume medication for a prolonged period. You might have to remain non weight bearing for a short period and then get back to normal activities.
What is the cost?

It is likely to cost less than one lakh and around 70- 80,000 rupees.
What are the benefits in the short term?

As the surgery is often required for young and active working people, they need not worry about job losses and productivity. They can remain pain free for about 10 years. This is certainly a big blessing for the young whose knees will be doomed to develop arthritis and need for a knee replacement.

The Dangers of Wearing High-Heeled Stiletto Shoes


How can anyone manage to walk comfort when walking in high-heeled stiletto shoes?

It seems that there are guidelines on the internet that show you how to balance in these incredibly high-heeled shoes, or stilettos as they are called in the fashion world.

Sadly I must inform you about the dangers that you are causing to your skeletal gait by just walking in these so called shoes.

High-heeled or stiletto shoes are not shoes at all, because they are crippling your feet and doing enormous damage to your skeletal balance and posture.

I only remember buying one pair of black patent-leather 4" high-heeled shoes or pumps, as they are often shortened to, for attending a very lavish wedding in my early twenties.

The was the only time that I ever wore a pair and only made it to the church ceremony and the reception in them. I had to wear them because they made feel me more elegant in my suit and much slimmer as I was a good ten pounds overweight in my early twenties!

I will be honest and say that I have never worn them since, because my feet were never comfortable. Now they have high shoes without heels worn by Victoria Beckham, who is an amazing fashion icon. I would like to see a picture of her feet at the age of 50!!

High heeled shoes may make you make you appear taller and slimmer, because they raise your height and elongate your whole body and women believe it makes them look sexier.

But high-heeled shoes are damaging not only your feet, but putting your balance in grave danger when you walk. The height of the shoes pushes your balance from the center of your feet to the balls of your feet. This shifts the whole balance of your body weight to one small and creates so much pressure in this area that you will automatically have osteoarthritis when walking on these carpal bones.

Now your body weight is no longer balanced throughout your whole body; but your weight is tipping past your hips and over to your knee joints where unbalanced pressure forces both knee joints out of alignment.

It will lead to premature osteoarthritis in your hips, knees, and feet and you will not be able to walk safely. You may end up in a wheelchair and then a nursing home, because you will not be able to walk!

Walking on the balls of your feet means that there is no heel toe action in walking, so that there is a complete distortion in the way move or dare I say "hobble." It is no longer a walking pattern! It is dangerous movement and you will pay the consequences when you are older.

My mother's sister was very small in stature and always wore high-heeled shoes, so that when she became older, the nursing home could not get her into flat shoes or slippers!

This was because her Achilles tendon; which is the tendon at the back of your heel became shortened, through constantly wearing high-heeled shoes.

She had great difficulty walking and as a result ended up in a wheelchair before she actually needed one.

Shoes are very important to be comfortable for walking in otherwise you may walk with a limp, or scrunch up your toes in pain or numbness.

It is also not easy to walk in bare feet, because the arches of your feet need support when walking. The arches of your feet are shaped through the position of muscle tendons for maintaining the heel toe action of walking.

If you insist on wearing these stupid high-heels, please make it occasional and be sure you take good pair of walking shoes to walk in; then only use these stilettos to stand in.

This will save you from being forced into a wheelchair because you cannot walk!

Treating Hip Pain Using Chiropractic Methods


The hip is a stable joint, reinforced by strong ligaments, and several powerful groups of muscles. It is much easier to harm the shoulder, knee, and ankle than to injure the hip. Even so, hip problems can be highly disabling.

Daily activities such as walking down stairs, and turning in bed can be uncomfortable or painful for patients with a hip problem. The hip links to the lower extremity kinetic chain, transferring ground-reaction forces from the legs to the trunk.

Some hip problems are due to trauma, while many other conditions are due to overuse or misuse. Muscle imbalance impairs the normal joint function, limiting the functional range of motion. Degenerative and pathological hip conditions can be challenging to diagnose. Many times, patients who complain of pain and discomfort in the lower back, the buttocks, or the legs can be traced to a hip condition. And conditions such as hernia or aneurysm, without an obvious hip connection, may also prompt pain in the hip or groin.

Often, hip disease manifests as pain in the groin radiating all around the thigh and the knee. In such cases, the real challenge is ensure that the hip and thigh pain is a pathology of the hip as opposed to intra-abdominal or retroperitoneal pain. The majority of hip conditions are related to biomechanical issues. For example, when a patient strains a knee, and has knee or ankle problems, the gait is affected, causing hip pain. A change in gait may include carrying a baby or small child on the hip. People may also complain of hip pain when they are sitting differently. Basically, asymmetry of motion can cause a hip problem.

Doctors of Chiropractic see many hip conditions develop over a period of time, such as trochanteric bursitis, recurrent muscle strains, piriformis syndrome, and chronic degenerative changes in the hip joint (degenerative joint disease). Chiropractors have thorough knowledge of hip joint function, its involved muscles, and the adequate exercise regimen to help patients with hip problems.

Hip Treatments

Gentle stretching of specific muscle groups can be performed even right after an injury. Gradual movements of the joint should also be employed in order to prevent the formation of adhesions. In addition, vigorous exercise of the contralateral leg muscles helps create a neurological stimulus in the injured muscles that offsets atrophy. In the case of an acute injury with muscle swelling, however, an initial period of rest may be needed.

Piriformis syndrome and trochanteric bursitis may benefit from specific stretching exercises. Piriformis syndrome develops when the piriformis muscle inflames the sciatic nerve, causing hip aches down the back of the leg. Treatment should include gentle stretches of the piriformis muscle.

Trochanteric bursitis brings pain to the lateral part of the hip. Localized pain in this area indicates the need for stretches to lengthen this segment of connective tissue.

Weakened or injured muscles can be strengthened with the use of isotonic resistance exercises from a machine, elastic tubing, weights, or the body's own weight.

Since biomechanical alignment issues are linked with chronic hip complaints, patients must be screened for leg-length discrepancies and pronations. The failure to address these factors may cause recurring hip complaints, or symptoms in other locations. The lower extremities must be properly aligned to ensure the hip joints work smoothly.

Causes

In patients in their sixties and older, with preexisting conditions such as knee replacements, hip pain can result from age-related degenerative conditions. Osteoarthritis of the hip joint is one such degenerative condition that is commonly reported. Osteoarthritis of the hip joint may also occur after many years of improper biomechanics and dysfunction.

Here follows hip problems that originate within and around the hip:

  • Overuse injuries, repetitive motion, or gait conditions

  • Serious injuries, such as fractures

  • Avascular necrosis

  • Joint or bone infections near the hip. These are followed by fever, redness, and/or swelling

Contact a Chiropractic Doctor

A chiropractic doctor will evaluate the patient's medical history, ask about past exercise and movement that, in some cases, may point to a fracture or pathology. Chiropractic care will correct the subluxations and biomechanical faults of the pelvis and seek the right course of treatment to prevent and treat hip conditions.

Thursday, May 9, 2013

How To Get Rid Of Dark Skin On Your Knees


At times especially as you age, you will notice that your knees tend to look a bit darker than the skin around them on your shins or thighs. For some these dark spots become very noticeable. There are things that you can do that will help you get rid of this dark skin on your knees by making them much lighter to match the rest of your skin.

Exfoliate the skin on your knees. Part of the reason for that darker skin is that you have layers of skin that are on top of each other. The outer layers are dead and dark. If you exfoliate the skin, your knees will instantly start looking a bit lighter making you feel more comfortable.

Protect your knees if you are on them during the day. This is not only good to make them not get so dark but good for your joints as well. Get some knee pads if you are on your knees. They will also be less dirty looking a bit lighter.

Eat a healthier diet. Healthy diets tend to make your skin look better regardless of where it is on your body. This should help improve the look of dark skin under the eyes, on the knees, and the elbows.

Try to use lotion more often. It's good for the skin in these darker places. Sometimes it's a dry skin problem as the knee skin tends to be a bit more flexible than others. With lotion, you can help the situation quite a bit.

Some will make a mixture of fruits and berries to be put on the skin. You can purchase these or make your own at home. Various ones tend to work better on certain skin types than others.

Some people who have very dark spots on the knees might have to get skin treatments or surgery in order to improve the appearance. It's costly but will be effective if nothing else has been.

Bowling Games - From Six Pin Bowling to Crazy Bowl


You can find bowling alleys virtually everywhere in the US. But some people prefer to play other variations of the traditional ten pin bowling game. For example: using six pins there are simpler versions of bowling perfect for kids, as well as the 3-6-9 variation of the game of the ten point set up. When I was younger, especially in girl scouts, we used to do what is sometimes called "crazy bowl" - making up our own rules as we went along.

You can get kids' six pin (or ten pin) games at many major toy stores. The six pin method is definitely suited especially for kids. Six pin bowling is usually designed to set up at home. There really are no strict rules, just the basics. In addition, there are no official tournaments, or even venues that provide this type of bowling for children's entertainment. Often these toys can be great preparation for a child who might become very involved in competitive bowling later in life. Or you can purchase a bowling game for the purpose of just having some fun that your kids can enjoy - and no other, major goal.

The "crazy bowl" game I used to play in Girl Scouts is one of the goofiest kid's games ever. If you decide to rent a lane or lanes to play this with a group of children - I seriously recommend that you get the gutter bumpers that are almost always available. If you have children or if you have ever worked with children, then you already know that goofy is good.

There are rules for crazy bowl - but you can make up whatever rules you want. Of course the rules should be made considering the safety of the kids, those bowling balls are heavy, right? And heavy can be dangerous, as you probably already know. For example: my Girl Scout troop went on little field trips to the bowling alley with double bumpers. We sat with our legs in a V position - almost on the lane and pushed the ball as hard as we could to see how many pins we could knock over (or how far the ball would roll. We rolled the balls backwards between our legs, swinging our bodies and the ball in both hands and rolling it behind us down the lane.

Back when I played crazy bowl we also enjoyed the carefree task of pushing the ball in teams of two, sitting on our knees on the lane. There were usually two girls pushing with both hands. One last example is the only one in which we were actually using the finger and thumb holes in the ball, but there was a catch - we had to do it blindfolded and a non-blindfolded partner would point the girl who was bowling in the right direction so that no one would get hurt accidentally.

When you are trying to find fun ways to entertain your family, consider bowling. There are many ways to make bowling a wonderful family hobby. Your kids may want to join a league, it can become a regular family activity, or you can just play around with bowling toys at home. Whether you do it for fun, profession, competition or for a simple family focus, bowling is a great sport that has lasted thousands upon thousands of years.

Knee Pain Relief - Patella Knee Braces to Help Keep Your Knee Stable


Are you having problems with your kneecap (patella)?

If you experience knee pain or have a knee injury, it can be a frustrating process trying to let it heal.

Patella related knee conditions and injuries can take months to heal, and can be painful during the time they are healing. One condition that is common for people suffering from knee problems is called "patellar tracking disorder". Patellar tracking disorder involves an imbalance in the knee that can cause the kneecap to shift or to move out of place. This generally occurs when the leg is bending or straightening.

Symptoms of patellar tracking disorder include an aching feeling under the kneecap or around the kneecap, and a popping, slipping or grinding of the patella. There can also be signs of swelling around the knee and some people feel like their knee is going to give out and not be able to support the weight of the body. There are many things that can cause patellar tracking conditions in people of all ages.

A patellar tracking disorder is usually caused by more than one issue. The combination of the shape of the kneecap, muscles in the leg that are too tight or too loose, and overuse may lead to what is known as patellar tracking disorder. Moreover, a severe blow to medial (inside) aspect of a healthy knee can knock a kneecap out of alignment. When your kneecap suffers with this kind of issue it can obviously be painful, but the stability of the patella can become a serious concern of yours very quickly.

Knee braces for patella stabilization are one of the best things that you can do if you have a patellar condition. They can provide the support to the knee area that you need to help you move and protect the knee while it is healing. If you experience feeling as though the knee is slipping from side to side, you can benefit from wearing a patella stabilization brace. The braces work by surrounding the patella area and helping to keep the patella in place during all kinds of movements that can further cause damage or patella deviation.

They are available in different levels of support, depending on what your needs are. If you are having problems with your kneecap you should not just think that the problem is going to go away by itself. Consider providing meaningful support to your knee.

Pepper Spray Vs Stun Gun Vs Mace - Which Is The Best Choice For Women's Personal Defense?


Whenever I question a woman and ask her what piece of personal defense equipment she would carry if she had a choice, the answer is always different. Some choose pepper spray...Some choose Mace...And some choose a stun gun. Others tell me they "really don't need to carry anything like that"...They have no idea how mistaken they are in today's environment. Every woman needs to carry some form of protection with her at all times...period!

The best way to analyze which choice is the "most correct" for each case is to first explain the pros and the cons of each weapon; and then go from there to match them up to the specific individual. Let's begin...

Pepper spray is a common defensive spray that is inexpensive and easy to use...It is made from hot peppers. The active ingredient is oleoresin capsicum or OC. It causes tearing, intense eye pain and even temporary blindness. It comes in varying strengths and is delivered in a pressurized spray form (usually from a small canister held in the hand). There are stream versions and fog versions; each having a devastating effect on an attacker. It hides easily in a purse or on a keychain and has a simple "point and shoot" delivery. Depending on the size, the number of bursts and the distance it will shoot varies...The pros: Inexpensive, easy to use, easy to conceal and it will bring most attackers to their knees rendering them helpless for an extended period of time...The cons: Limited amount of uses, requires a steady hand and good aim, and you better be upwind!

Stun Guns are the most effective method of defending ones self as far as incapacitating an attacker without a doubt. Just touching the prongs of one of these beauties to an attackers body will deliver anywhere between 350,00 to 1.2 million volts of electricity and knock him or her down for the count. Stun guns are available in a variety of sizes and also a variety of disguises; such as cell phones, pens and even a lipstick! They are simple to use and more suited for hands on combat. The pros: relatively inexpensive, easy to use, comes in a variety of disguised versions and will knock even the biggest and strongest attacker down for at least 10-20 minutes. The cons: Illegal in several states, needs time to recharge after extended use, and you have to be close enough to your attacker to use it on him.

Mace is the final weapon of choice we will explore. Mace is actually the trademark name of a defensive spray made by Mace Security International in Mount Laurel, New Jersey. Mace Inc. manufacturers 3 types of defensive sprays...They are Triple Action, PepperGard and Pepper Foam.

Mace Triple Action is a combination of tear gas, UV dye and oleoresin capsicum (OC). This is the strongest formula they make. The UV dye is purple in color. The tear gas and OC combination causes coughing, tearing, temporary blindness and skin irritation. The affects will last up to 90 minutes. The dye aids law enforcement in later identification.

PepperGard (Also known as Pepper Mace) is 10% OC and contains UV dye; but contains no tear gas.

Pepper Foam is the exact same as PepperGard; except it sprays a thick foam instead of spraying in a liquid state. It also contains the UV dye for identification purposes. The pros and cons of Mace are the same as Pepper Spray; except for the fact that the Triple Action Formula will disable an attacker for a much longer time...3 times as long... minimum. And its effects are much more devastating and painful to the attacker.

In conclusion, my opinion as an expert in the personal defense industry is as follows: Every woman should carry a small can of pepper spray with them at all times...no exceptions! If they have a large purse they should carry a 4 oz. can as well...It holds 8 times the amount and shoots almost twice as far. And if it is legal in your state you should without a doubt carry a stun gun as well...You can never be over prepared in today's environment.

States Where Stun Guns Are Restricted:

Indiana (No Tasers), Hawaii, Massachusetts, Michigan, New Jersey, New York, Rhode Island, Wisconsin, Illinois

Cities Where Stun Guns Are Restricted:

Annapolis, Md Baltimore, Md Baltimore County, Md Chicago, Il Dension / Crawford County, Ia District Of Columbia Philadelphia

Any of the other 50 states are legal to possess a stun gun. So if you are a woman in today's world you should be well aware of your surroundings and learn to "people watch"...Carry pepper spray, Mace and / or Stun Guns for your protection whenever possible...Bottom line is it is better to be prepared and never have to use these items than to be in a life or death situation and not have any of them...Think about it...

An Introduction of Incentive Spirometer


There are many medical devices which are used to improve people's life quality. In this article, I will introduce one kind of them.

1. What is the incentive spirometer?

An incentive spirometer is a device used by a patient in a hospital. This medical device is small, portable and simple to use. It has a mouthpiece, which is attached to a six or eight inch piece of tubing. When the inhalation takes place, a piston rises, which can indicate the volume of air inhaled. In addition, most incentive spirometers have a coach indicator, which is a small ball that moves during inhalation, to indicate whether the inhalation is slow.

2. What benefits does the device have?

The device can benefit patients a lot. On one hand, it assists in detecting any respiratory problems that may occur after surgery or in conjunction with lung blood clots. The device is indispensable for patients who are suffering from a clot, because such patients can't breathe completely by themselves. Moreover, patients can't move after surgery, so it is hard to keep their lungs clear and healthy. With incentive spirometer, the problem can be released to some extent, correspondingly reducing the risks of respiratory problems. On the other hand, the device enables a person to exercise his or her lung, which helps the patients to take slow deep breaths and provides them more oxygen. It can increase patients' breathing capacity and enable them to breathe easily. In this case, patients and nurses can see how well medication is working.

3. How to use it?

You should make sure that you sit in an upright position with your back as straight as possible before using the device. Then place your lips tightly around the mouthpiece of the device. It is really important to guarantee that your lips are sealed around the mouthpiece very tightly, because only in this way can the device accurately indicate the situation of your lung. Next, breathe in as slowly as possible and hold your breath for at least five seconds before exhaling. The longer you hold your breath, the better the result is. When you find that you can't hold the breath anymore, it is time to exhale. Take a rest after the above process and repeat it according to your physician's order. This exercise should be done several times a day when you are awake, which is beneficial to your lung.

Now you have some basic knowledge about this device. Look for more information, which will help you to use it in a proper way.

How to Recover Faster From an Orthopaedic Surgery


Advancement in Orthopaedic surgery over the years has led to a lower risk of infection and a faster recovery process. Although Orthopaedic surgery brings a lot of pain to the patient, there are many pain relief medications that can be consumed to counter it. Recovery is a long and slow process that requires a lot of patience from the patient. It cannot be expedited or long term complications may occur. However, there are some things you can do to help recover faster. Let's look at some of them.

Begin physical therapy before the surgery

Contrary to what many people believe, recovery actually begins months before the surgery! About 6 months before the surgery, you should start going to the gym to build up muscles around your body. For example, if you will be undergoing knee surgery, you should build up muscles around it such as your Quadriceps muscles, calf muscles and thigh muscles. By strengthening muscles around the injured region, you are helping your knee to be able to depend on the surrounding muscles to support it. Coupled with physical therapy after surgery, the recovery time will be significantly reduced.

Start physical therapy immediately after surgery

Physical therapy starts immediately after surgery, gradually increasing the intensity as days passes. Gentle rotations around the injured region should be conducted and it will be pain-free due to the anaesthesia. These will also help to reduce scarring and stiffness of the injured part. As days slowly pass, you should increase your physical therapy session duration as well as the intensity.

Opt for minimally invasive surgery

Whenever possible, always try to opt for a minimally invasive surgery or arthroscopy. Instead of cutting open the surgical site, arthroscopy makes a few small incisions to allow cameras and surgical tools to be inserted into your body. With a small incision, it reduces chances of infection as well as significantly decreasing the recovery time. It also ensures that the pain will be much less as compared to traditional open surgery. However, arthroscopy will cost more than traditional surgery.

Consume nutritious foods

Proper nutrition after surgery will help to speed up the healing process. You should consume lots of protein since protein is the building block for the body. Foods that are rich in protein include chicken, fish and red meat. You should also consume sufficient greens. Spinach, broccoli, cabbage and asparagus are good sources of nutrients for the body.

Orthopaedic surgery often requires lengthy recovery periods that requires a lot of patience, dedication and perseverance from the patient. Do not rush through the physical therapy as it may do more harm than good.

Ginger - A Miracle Food and Drug, More Than You Think


Ginger has been touted consistently as a miracle food and drug. Are the praises heaped on ginger real and scientific?

Ginger: Topnotch Kitchen Staple
Ginger is native to South Asia, where it has been a part of the diet for over 3,000 years. Ginger was regarded as a rare, valuable treatment in Europe when Marco Polo first brought it back from Asia. Truly, ginger can do a lot more than put a snap in your cooking. It can take the crackle and pop out your joints. A new, rock-solid scientific study has proved the zesty spice is as good as prescription medicine at conquering arthritis pain.

Ginger: Alternative cure for Osteoarthritis
Ginger has played a major role in traditional Chinese medicine and in Indian Ayurvedic pain treatments for more than 2,500 years. Olympic track champion Carl Lewis, at one time the fastest man on Earth, claims ginger supplements are helping him with his battle with osteoarthritis, the most common form of the disease.

Now, researchers have compared the effects of concentrated ginger capsules with that of conventional painkillers in treating the inflammation of osteoarthritis, caused when the cartilage pads between joints gradually wear away.

During a six-week trial, 250 patients suffering moderate to severe osteoarthritis of the knee were given either a specific ginger extract or a placebo, a substance that has no medicinal properties. The ginger extract group took two 225-milligram pills daily. Both groups were allowed to take everyday acetaminophen pills if their pain grew too severe. By the end of the trial, two out of every three patients in the ginger group reported a market decrease in the crippling agony of arthritis. More importantly, the group suffered none of the severe side-effects-gastrointestinal upset, tissue damage and even internal bleeding--known to occur with powerful prescription arthritis remedies.

The ginger extract, according to the result, reduced significant pain. The pain after walking was almost twice as good an improvement as the placebo. The effect is similar to that seen with trials using conventional drugs.

The Many Uses of Ginger
It is used as seasoning to some baked goods like cookies, biscuits, pies, gingerbread, and to ad flavor to vegetable and meat dishes. It is also used as an ingredient of ginger tea, ginger ale, and other beverages. Ginger oil is used in perfume making and as an alternative medicine for certain common ailments like toothache and stomachache.

Wednesday, May 8, 2013

What Are Mesenchymal Stem Cells and Why Are They So Important in Osteoarthritis?


Mesenchymal stem cells are progenitor cells, meaning they are cells that can differentiate and become other cells. And in fact, they are the cells from each all other cells are derived.

They are found in a number of adult tissues including the bone marrow, fat, synovium (joint lining), teeth, skin bone, and cartilage.

What makes these cells unique is that when they're cultured outside the body, they multiply quickly but don't differentiate into anything specific until a unique stimulus is applied. What that means is that by culturing these cells, a large number of them can be grown in a relatively short period of time. The therapeutic potential is obvious.

Given the ability to expansively grow a large number of these cells, it has been a dream for a number of investigators to harness this potential for various tissue engineering endeavors.

The area of most excitement in our specialty or rheumatology is osteoarthritis.

Osteoarthritis is the most common form of arthritis, affecting more than 20 million Americans. It is a disease of articular cartilage, the gristle that caps the ends of long bones within a joint. Cartilage consists of cells, called chondrocytes, that manufacture a matrix, in which they reside.

Picture grapes sitting in a gelatin mold. The grapes are the chondrocytes and the gelatin is the matrix.

Under normal conditions, the matrix has an ideal balance of protein building blocks and water. When osteoarthritis develops, the ratio of water to proteins becomes unbalanced. In addition, the chondrocytes begin to manufacture destructive enzymes and inflammation causing chemicals, called cytokines. Also, the chondrocytes stimulate the environment around the joint, including the synovium, to manufacture destructive enzymes and cytokines. The end result is damage to the cartilage and the premature wearing away of this substance.

Once thought to be an entirely "wear and tear" disease, it is now firmly known that osteoarthritis damage occurs within an environment characterized by inflammation as well as other immunological disturbances.

Attention to the use of mesenchymal stem cells to act as repair cells is driven not only by their ability to proliferate and differentiate into different tissue types but also by their potential to engage in the anti-inflammatory and immunoregulatory battle taking place in osteoarthritis.

Also, according to recent research, it is now known that mesenchymal stem cells can produce factors that affect the local environment and protect the regenerative processes that have been started.

According to Chen and Tuan, (Arthritis Res Ther. 2008; 10(5): 223) " these properties make mesenchymal stem cells an ideal candidate cell type as building blocks for tissue engineering efforts to regenerate replacement tissues and repair damaged structures as encountered in various arthritic conditions."

New Discovery for Knee Pain Relief - Using Pilates As Non Evasive Way to Fix Knee Pain


Knee Pain is one of the most common kinds of pain, experienced by most people. In order to have the right treatment, a careful diagnosis must be initiated to determine where the problem is.

Causes of Knee Pain

A number of factors contribute to pain in the knees. It could be a trauma suffered during sports, a pain that comes and goes and eventually became chronic. Poor alignment or form is another very common reason that could easily lead to muscle imbalances. Improper walking or running gait creates stress and tension or overuse injuries like runner's knee, a result of continuous long distance running over time.

What Happens During Knee Pain?

Knee pain can be identified particularly by patello-femoral syndrome or pain experienced around the kneecap or patella. Bad positioning and sudden movements by the kneecap can lead to pain in the thigh bone during knee flexion or extension. This particular movement may lead to injury in the cartilage and tissues that surrounds and hold the kneecap.

It is not unusual that the patella is sitting in groove and facing forward between the condoyle of the thigh bone. During a patello-femoral condition, the knee cap is pulled side way from the normal groove, causing tension over the thigh bone and supporting structures, resulting in pain.

When the knee cap is pulled too far, it may lead to dislocation. Problems in the positioning and abnormal movements of the knee cap are usually caused by genetically determined leg structural alignment and imbalances in muscle development.

Pilates Remedy To Knee Pain Relief

Pilates knee pain relief exercises is highly recommended by medical doctors and physical therapists in treating various knee-related injuries including torn meniscus and anterior cruciate ligament (ACL), a common injury for athletes.

Specific knee pilates exercises teaches you how to align your knee during gait, when seated, running or standing. It improves the knee's range of motion, leading to improve flexibility, balance, and strength in the knees. These exercise routines allows for a gradual improvement over time, challenging the knee from its de-conditioned position to a stronger joint that is confident of being able to handle load with good form and posture.

Pilates Knee Pain Exercises

Check out the following Pilates Knee Pain Exercises.

1. Knee Cap Pull

- On a mat with the both legs extended.

- Slowly, draw up one knee cap.

- Do this without pressing the back of leg into the floor.

- Feel the muscles hug the knee joint.

- Tighten the muscles around the knee cap slowly.

- Do each side for 8-10 times.

- Repeat the other leg.

- Finally, repeat with both legs together.

2. Leg Lift (Point & Flex)

- Do as above.

- Draw up knee cap and tighten the muscles around the knee joint.

- Keep the muscles engaged and pull toes towards knee.

- Back of heel should be lifted up at this point.

- Pull toes towards knee and point away slowly. Flex and point toes.

- Do these, without dropping back of heel into the floor.

- Keep back of knees softly floating with some space.

- Do not flatten knees all the way back.

- Do each side for 8-10 times.

- Repeat the other leg.

- Finally, repeat with both legs together.

3. Leg Lift (Ankle Circle)

- As above.

- Keep knees engaged, thighs working.

- Keep breath free, breathing in and out.

- Circle ankle without moving knee cap.

- If knee cap starts to move, slow down the movement.

- Re-engage the thighs before starting ankle circle again.

- Circle clock wise 5 times.

- Repeat anti-clockwise.

- Repeat the other leg.

- Finally, repeat with both legs together.

Hip Replacement: When It's Time to Say Uncle


Let's say you are an active, 40 plus year-old jogger, tenniser, or gymnophile, and you or your best friend has noticed a change in your mobility, posture, or gait; or you are beginning to get some unusual pain in your knees or groin; or you notice you're not as quick to get up and go as you once were. It's more than likely, despite your 'youth' you are suffering from osteoarthritis (a common joint problem), what your grandparents called rheumatism. It develops as a combination of your genetics, aggravated by overuse (e.g. repeated running, martial arts, contact sports, etc) and if this is you-obesity.

Now, if it forces you into a change however gradual, in your lifestyle or activities, or you find you've started taking pain medication on a regular basis, it's time to stop, and see an orthopedic specialist. You may well be a candidate for a hip resurfacing or replacement by an experienced Orthopedic Surgeon.

Alternately, let's say you are 60 plus, and know you have to limit your activities, even walking short distances because they result in hurting, or you have morning stiffness often accompanied by pain. The problem and solution are likely the same.

I am an Orthopedic Surgeon, who has performed and taught young doctors in training to perform total hip replacement surgery. Then having experienced some of the above problems, needed and had two of my own hips replaced. So as the saying goes, I've been on both sides of the table.

Then as a result of the experience, determined to write a practical hand book that explained and narrated the experience from diagnosis to recovery in plain, common English for those who might need a Total Hip Replacement or it's younger version a Hip Resurfacing.

This year 450,000 people will undergo hip replacement surgery and another 100,000 have a hip resurfacing. It is anticipated that these numbers will increase by 175% over the next 2-3 years. Forty-Six million people in the USA sixty or over have arthritis of one or several joints. Their disability ranges from mild (heat, medication and rest do help) to disabling (nothing relieves).

Despite what you may have heard about miracle drugs, special joint treatments and substances, medications do not presently provide the cure for arthritis, BUT...the condition can be treated by replacing or resurfacing the joint. In other words we can't alter diseased or distorted hip, knee and shoulder anatomy, but we can replace it. Hips are among the most common joints affected by arthritis and hip replacement or resurfacing procedures the most successful.

If "Uncle, I quit" has become a reality for you- here are a few recommendations:


  • Don't ask a friend for an experienced surgeon; use your GP or internist to recommend.

  • On your first visit be sure to bring a written list of your history, medications, allergies and conditions - and note no question you want to ask is unimportant or off the table.

  • Avoid Metal-on-Metal implants-ask your surgeon about this critical issue.

  • Good information about the procedure will make you part of the solution, not part of the problem - be your own advocate. Read or watch any material your surgeon offers.

  • After your surgery YOU will be the first to notice any problem, however minor. Don't ignore it. Report immediately to your doctor for explanation or treatment.

------------------------------------------------------------------------------------------

Partial Knee Replacement - Range of Motion - What You Can Expect After Surgery


There are a great many reasons a person may have to undergo partial knee replacement. Traditional reasons include damage incurred from repetitive movement and injuries sustained from traumatic sports-related accidents. These days, however, an increasing number of surgeries are being performed because of obesity. Being drastically overweight puts an unnecessary amount of stress on your delicate knee joints. No matter the reason you need to have knee surgery, you may be curious what you expect to be a standard when it comes to a partial knee replacement range of motion.

The answer to this query depends on the time frame in which you are speaking. Immediately following surgery, patients can be known to experience more intense pain than what triggered them to have the operation performed in the first place. This lingering pain and soreness can last long after rehabilitation is over. This can be a highly discouraging fact, especially if you or a loved one is facing the imminently long and painful recovery time associated with replacement knee surgery. There are both certain partial knee replacement models you can get and things you can do after the surgery to increase your partial knee replacement range of motion.

For some of the quickest recovery times and widest partial knee replacement range of motion, DePuy models are becoming more and more popular. Their rotating design naturally leads to a more speedy recovery time and increased range of motion. With no extra effort, your knee can be restored to full use in under a year! Imagine, then, the time you can save and pain you can effectively reduce or eliminate with a few proven exercises and a diet program. Remember, obesity may be the thing that got you into this mess, and it can slow your recovery time as well.

Diet and exercise are important for restoring full partial knee replacement range of motion, but positive thinking is a huge influence as well. Pity parties never served anyone any good at all. If you want a change to happen, you have to make it happen! Also, consider the benefits of receiving updated newsletters in the mail with tactics and strategies to help you reach your goal of becoming and staying pain free, even after knee replacement surgery

The advances in medical technology have been astounding in resent years, but recovery from knee surgery is still very much the same. A patient's recovery time is directly related to their attitude and determination to do the necessary physical therapy to regain their mobility. Their altitude (how well they recover) is directly related to their attitude (determination) to achieve the desired outcome. Sometimes a trainer or mentor with this kind of attitude and mind set is your best choice for recovery from knee surgery.

Tips For a Quick Knee Surgery Recovery


After a knee surgery, one must take care of the knee. It has to recover so that there is no stress on it as it becomes normal again. The surgeon will give all tips on knee surgery recovery. He or she will mention about the dos and dont's after the surgery. Normally six to eight weeks is a good time for recovery after a knee operation. Mostly, within this time patients recover from the surgery and get back to normal life. Just as the surgery is crucial, even recovery after the surgery is an important post-operative activity.

Normally the following steps are involved in recovering from knee surgery:

1. Firstly, post surgery patients have to be under observation in the hospital for a few days. In case there are any problems with post surgery, the doctors will attend to them on time. After surgery, the patient's leg needs a raise for quick recovery.

2. A physical therapist will be attending to the patient. He or she will help in resuming physical movements of the knee. The patient will exercise and has to follow the routine well so that he or she can get back to normal life soon. The therapist will show proper movements that will help the patient recuperate post surgery.

3. Ice packs are very effective if applied on the knee that has undergone the surgery. These facilitate the rate of recuperation.

4. After a couple of days, the patient will be encouraged to leave the bed and start taking baby steps. The patient uses a walker for support that will allow him or her to slowly start putting weight on the knee that underwent the surgery.

5. The physical therapist or the physiotherapist plays a very important role in knee surgery recovery. Very slowly and steadily, the therapist will ask you to raise the intensity of exercises. Initially, it might be extremely painful, but slowly you will recover completely and will be in a position to walk on your own.

6. The entire recovery period of about six to eight weeks will require a lot of rest given to the knee. There must not be stress of any kind. You should follow only the exercises advised by the physiotherapist. You should follow strictly the exercise regimen for a fast recovery.

7. You must follow any form of medications or checkups diligently as the doctor has advised after the surgery. You should also update the doctor on the condition of the knee. In case there is, any problem or discomfort of any kind the doctor must know.

For a proper knee surgery recovery, the most important part is to follow the doctor's instructions. Rest your knee well and exercise as advised to. Within two months, you will be up and back to your normal work. You have to take extra care to see that there is no pressure or stress of any kind in the recovery period. Do not exert yourself in anyway and eat right. Following these steps will ensure a quick and comfortable recovery.

Problems Relating To Crepitus


Crepitus can be defined as an unexpected creaky noise coming from beneath the skin or due to joint movement or somewhere around the lungs. Also, referred to as snapping joints, popping joints or creaky joints, Crepitus is a growing problem among people of all ages nowadays.

Derived from a word that means frictional sounds, Crepitus can be categorized into several types depending on the region and cause.

Patellofemoral Crepitus happens when the structure of two very important bones of our body, femur and patella which is the knee cap, is not normal. A disorder called Patellofemoral Syndrome or Chondromalacia Patella takes where the friction between the trochlear groove of the femur and patella is more than 20% of that between two ice cubes,

Crepitus can happen in the knee joint too when there is excessive extension or augmentation of the joint which certainly means injury. The main reason can be degeneration of the patella-femoral joint or damages in other joints or joint capsule. Straightaway affecting the kneecap, knee crepitus can be quite alarming.

Crepitus happens in the neck when it has undergone serious soft tissue injuries or large surgeries. Usually no bone is involved in the neck crepitus, hence using anti-inflammatory medication can easily cure the problem.

Shoulder Crepitus generally happens in people who suffer from various osteo problems such as various types of arthritis, crepitus in shoulder gives a painful experience when there is any movement in the shoulder.

Usually a popping or cracking sound in the knee retropatellar crepitus is an indication of severe damage. The reason for such crepitus is the grinding of the two joint bones of the knee. It directly affects the posterior position of the kneecap.

Causes of Crepitus

Crepitus is mainly caused because of the recent disturbances that the joint has suffered which can be sensitive tissue surgery or some major damages to the ligaments or bones. Also, serious joint problems such as Arthritis can cause crepitus at various regions of the body. Crepitus is basically a symptom of a problem than being a problem as it might indicate damages or unceasing injuries. It can also happen in the tissue of the human body when there is a significant amount of air present in them.

Treating Crepitus

In some cases, elastic supports help in preventing further damage to the knee and eases tension on it. Some individuals also find it effective to apply ice packs for 15-20 minutes after exercising. Sometimes, using medicines like Advil, Aspirin or Aleve can also help get relief from pain and other discomforting symptoms.

A number of ways can be adopted to get rid of the annoying noise. Mostly comprising of exercises, methods adopted will not only improve the physical activity of the sufferer as well as increase the movement of the joint. The things that should be avoided while treating Crepitus of the knee are climbing the stairs, aerobics, bending knees, playing some outdoor sport like football, wearing high heeled shoes etc.

Tuesday, May 7, 2013

Bodyweight Exercises to Pull Back the Years - The Younger Man Challenge No Matter What Your Age!


Here's a simple challenge for you. As you will know, simple doesn't always mean easy.

Its called the "Younger Man Challenge", and its designed to boost strength and fitness levels fast. What's more its simple and clear cut. You know exactly what you have to do, and more importantly when you're done.

The exercise sequence is -

-Chin-ups - grab an overhead bar and pull, partial pull ups are fine for this challenge as we're seeking to build endurance and strength. Choose whatever grip suits you best,
-Hindu or Free Squats (no weights) - the basic free squat involves lowering your bum toward the ground as though preparing to sit down on a couch, and then powering back up again (there's a little more to the Hindu squat),
-Press-ups - you know the drill, hands shoulder width apart and crank them out. Again, if you're struggling with your number its okay to finish these on your knees once you tire at the beginning, as it continues to build strength and endurance,
-Sit ups - lie down on your back, bend your knees so that your feet are flat on the ground and curl up.

The deal is you want to do as many repetitions of each exercise as your AGE - for example I'm 30 years young, so I do 30 repetitions of each exercise.

Break it down, however it works best for you, say 4 sets of chin-ups, 2 of squats. This routine will certainly get you huffing and puffing, and when you can knock out this exercise routine in 1 set per exercise you will unquestionably be phenomenally fit.

Baseball Pants - You Get What You Pay For


If you or your child has ever experienced the embarrassment of your baseball pants tearing as you slide into second base, you know it's definitely not a pleasant experience. It's relatively common for some pants to tear, and the reason is quite simple - poor manufacturing.

The type of pants the big leaguers wear are made with a strong, durable material and generally feature reinforced kneed and double stitching. Little things like reinforcing the knees can add many additional games to the life of your pants, as the knees are a common area for adult and youth baseball apparel to wear down quickly or tear.

These days, savvy consumers are using the internet to purchase women's and men's baseball pants in order to save a few bucks. This is great, but buying generic pants that are poorly manufactured can actually cost the consumer more in the long run, as poorly constructed pants are far more likely to tear. This doesn't mean that nobody should ever buy pants online, in fact it's quite the contrary!

You can actually save a bundle on pants by buying online. The key is, instead of looking for the cheapest pants available, look for low prices on popular name brands. Russell baseball pants are widely thought to have been one of the best quality baseball products on the market. Southland baseball pants and Wilson baseball pants are also extremely high quality, and are far less likely to tear.

Instead of trying to save money on a cheap knock off, try to find low prices on brand name pants, or even buy them pre-owned. This way, you can still save money, and you'll actually probably end up getting an even better value in the long run, as high quality pants are less likely to wear down quickly.

Back Pain and Sciatica - Evaluating Your Options


You've been hurting for months. You can't stay on your feet for more than a few minutes. It hurts to sit for too long. Recently you can't get a good night's sleep because you just can't get comfortable. The painkillers aren't working, and you're starting to think seriously about back surgery. But after all the expense, rehabilitation and risk, will you bet better off? There are alternatives to surgery, and they just might work for you.

Back pain that leads to surgery is often associated with a damaged intervertebral disc or spinal stenosis. The discs are the tough, flat cushions between the vertebrae. Imagine a disc as the warm toasted marshmallow sandwiched between two graham crackers in a s'more. If the crackers are pressed together evenly, the marshmallow will spread out evenly as well. If you squeeze just one side of the sandwich together, the marshmallow (or disc) will ooze out to the opposite side. That's what happens with a "slipped" disc. The protruding part can irritate a nearby nerve. If it ruptures, there can be chemical irritation of the nerve as well. The discs also tend to degenerate, flatten and become less resilient over the years, so there is less space for the nerves where they come out of the spinal column.

Siatica (Sciatica) is an irritation of the siatic/sciatic nerve. It can cause radiating pain, burning sensations or cramping in the buttocks and down the leg. This may be caused by a nerve root problem in the lower part of the spine, but it can also be caused by impingement further down in the area of the buttocks. The piriformis muscle runs across the back of each hip joint, deep in the buttock, where it crosses paths with the sciatic nerve. Pressure from an overly tight piriformis muscle is believed to irritate the sciatic nerve causing buttock and/or radiating leg pain. This is known as piriformis syndrome. It can be addressed by releasing excess tension and any "trigger points" (knotted areas) in the piriformis and associated muscle groups.

Stenosis is a narrowing of the spinal canal that leads to compression of the enclosed spinal cord and nerves. Fractures of the spine can also result in unstable vertebral joints and irritation to the spinal nerves.

Treatment Options

Common surgical procedures for these conditions include discectomy, laminectomy, and fusion. In a discectomy, the part of the disc that is stressing the spinal cord or a nerve is removed. Removing or trimming part of the bony structure around the spinal cord (the lamina) is called a laminectomy. This may be done to widen the spinal canal when it has been restricted by stenosis, or to provide access for a discectomy. Spinal fusion fixes vertebrae together using bone grafts and screws or other hardware to prevent any movement between them.

Determining when surgery is appropriate is not always easy. Most incidents of back pain resolve themselves over several weeks. Even cases of severe chronic back pain or sciatica may respond very well to more conservative treatments. Individuals with substantial disc degeneration and/or stenosis can return to an active pain-free life without surgery. Surgeons may have a skewed perspective because their patients who are diagnosed as needing surgery, but who go on to rehabilitate themselves through non-surgical means, are unlikely to report back to the surgeon.

Even when there is clear disc impingement upon a nerve, non-surgical remedies are possible. Experiments have shown that a healthy nerve root (where the nerve exits the spinal cord) can withstand substantial pressure without pain or paresthesia (tingling or burning). When a nerve root is injured, pressure on it can cause loss of feeling, reduced reflexes and eventually reduced strength and motor reflex. However, when a nerve root has a poor blood supply (ischemia), it becomes very sensitive to pressure. So, a healthy nerve root with a good blood supply can tolerate a fair amount of mechanical abuse. But once it has become irritated, swollen, inflamed or otherwise suffered decreased blood flow, it will be much more easily irritated. Therapy should therefore be aimed at reducing mechanical irritation, reducing inflammation, and improving blood perfusion.

"Conservative treatment" is a term that can be applied to anything from pain pills and bed rest to much more aggressive therapy that involves substantial patient participation. The latter requires more commitment but is likely to give better results. The patient can also learn some useful self-care techniques during treatment. Analgesics, muscle-relaxers and anti-inflammatory drugs (or herbal formulas) may also have their place in the therapy.

Seeing the Bigger Picture

The muscular, skeletal, neural, vascular and lymph systems of the body all affect one another. A good treatment plan works toward optimizing all of them. When there is pain, as from nerve impingement, a common protective reaction of the body is to tighten up and stabilize the area. Unfortunately, this tightening can exacerbate the problem by putting more pressure on the damaged structures. Also, chronic spasm of the muscles leads to decreased blood infusion (ischemia) and poor lymph movement. The muscles become poorly nourished, and the tissues are not properly cleansed of cellular waste products. A large component of patient's pain can be from this muscular dysfunction, rather than from the direct nerve impingement itself.

Tight muscles, especially when their forces are not well balanced, are intimately involved with skeletal joint dysfunction. The skeletal system, after all, is aligned and controlled by the soft tissues around it (with limits set by the bony structures themselves and by the ligaments that surround the joints). When muscular action on one side of the spine is stronger and tighter than the other, it can significantly change the alignment between the vertebrae, and inhibit the natural smooth gliding at the joint surfaces. Besides nerve irritation (remember that squeezed marshmallow), this can accelerate arthritic changes in the joints.

Nerves are responsible not only for sending pain signals back to the brain, but also for sending motor control signals out to the muscles. Therapy should address the neural components of the problem. Neuromuscular reeducation refers to therapy that aims at normalizing the interaction between muscles and their nerve signals.

Many types of non-surgical therapies are available, and each has its strengths. Chiropractic adjustments can restore normal joint function, and thus release tension and inflammation in surrounding soft tissues. Unfortunately, some people do not respond well to this high-velocity approach, and normal muscular function often does not follow. Skilled massage, physical therapy, yoga, stretching, strengthening and other manual therapies can address the muscular components. Functional and postural habits that exacerbate the condition may need to be relearned. Acupuncture works via several pathways: it can release and balance muscle tensions, moderate nerve signals, decrease inflammation and increase local blood flow to the tissues.

The Benefits of Avoiding Surgery

Results from conservative therapy can be dramatic, but it typically takes weeks or months to effect lasting changes, and a combination of techniques may be needed. The reward for this effort is a reduction or elimination of pain, a better functioning body and more information about how to keep it that way, not to mention the avoidance of surgery, anesthesia, and post-surgical rehabilitation. This can save tens of thousands of dollars, and greatly decreases one's exposure to pharmaceuticals. Even with a course of anti-inflammatory drugs, a patient will be subjected to a much lower pharmaceutical load that when undergoing surgery.

Besides, surgery often fails. The U.S. Agency for Healthcare Research and Quality states that "Patients considering lumbar spine surgery should be informed that the likelihood of having another spine operation later is substantial." A study of 24,882 adults who had low back surgery for degenerative spinal problems in the early 1990's found that about one out of five had another back surgery within 11 years. That's about double the rate for hip or knee replacement. And one should not assume that the rest were living pain free.

Is Good Medicine Driving High Back Surgery Rates?

A study by the University of Washington's Center for Cost and Outcomes Research looked at spinal surgeries in the U.S. and confirmed some disturbing trends. In 2001, approximately 122,000 lumbar fusions were performed, representing a 220% increase from 1990. Were those surgeries more successful than in the past? It seems not. Reoperation rates actually increased during the 1990's, with a cumulative rate of about 12% just three years after the initial surgery.

The Department of Health Services at the University of Washington has noted that there are large variations in back surgery rates across different parts of the country. The Department also found that "The rate of back surgery in the United States was at least 40% higher than in any other country and was more than five times those in England and Scotland. Back surgery rates increased almost linearly with the per capita supply of orthopaedic and neurosurgeons in the country." That sounds more like supply-side economics than evidence-based medicine.

Meanwhile, the New England Journal of Medicine has published a new study of 283 patients with severe sciatica. The participants were randomly selected to have surgery early on, or to have extended conservative treatment and undergo surgery at a later time, if needed. Only 39% of this second group actually ended up having surgery. After one year, the outcomes were similar for those with early surgery and the conservatively treated group, although those receiving early surgery had somewhat faster pain relief and self-perceived recovery rates.

The decision to have surgery for back pain or sciatica due to degenerative conditions will usually be left to the patient. Trauma resulting in fractures, cancer, and other conditions causing back pain may permit fewer options. But for patients who are willing to participate in their own recovery, conservative treatment holds a lot of promise with very low risk. Surgery, after all, will remain an option. They may need to be more proactive in seeking out treatment. Learning stretches and other exercises from a skilled therapist will give them some control over their recovery. A willingness to try appropriate therapies and actively engage in the treatment process can lead to much greater success than simpler treatments involving only rest and drugs. Those who choose such a treatment plan may well be rewarded with a strong, pain-free body, and new knowledge that can help keep it that way.

Christmas on the Bayou


Teresa and Bobby had lost almost everything when the hurricane ravaged the bayou. Flood waters had swallowed up the meager little house in which they had lived, and had taken everything with it. Yet, Teresa considered herself fortunate, because she had managed to pack some clothes, pillows, and a box of photographs in the trunk of her car before escaping with her son. The two of them lived in the back seat of that car for several months. Teresa took jobs wherever she could to earn enough money for food, and to put a little away each month with the hope to return to the bayou with her son Bobby. The old house was gone, but the bayou was their home. She was determined to start again, to make a life for them, and to give them new hope.

When they returned to the Bayou, Teresa found work with her former employer. Jacques ran a small grocery store in the center of town. He was also in the process of rebuilding after the flood waters had devastated his business and everything inside it. Whatever had not been scavenged by looters before the storm was washed away in the torrent of the waters. It had taken months to salvage enough of the store to maintain canned goods, diapers, batteries, and other non-perishable items that were necessary to sustain the slow return of habitants to the bayou. Giving Teresa her job back was as important to Jacques as it was to Teresa, it was an unspoken recognition that they would overcome.

Jacques was a gentle and soft spoken man, except when he laughed. When he found something funny, Jacques would roll his head back and his infectious laughter would echo throughout the store. When he laughed, as he frequently would, he would place his large hands on either side of his large belly as it shook up and down. Jacques was very happy to have Teresa back in his store and operating the front counter. Jacques was particularly fond of Bobby, and of the jokes that Bobby would tell. No matter how many times that Bobby would repeat the same knock-knock jokes, Jacques would roll with laughter as if he had never heard it before.

In addition to paying Teresa her normal weekly wages, Jacques would give Teresa a box full of dented cans to take home every Friday. Jacques claimed that he could not sell the dented cans and did not want to leave them on the shelves. Jacques also knew that Bobby was particularly fond of Chef Boyardee. Every Thursday evening, after Teresa was gone for the day, Jacques would walk through the store and gather an assortment of soups, tuna fish, various canned goods, and a selection of Chef Boyardee. When the box was full, Jacques would take the items to a counter in the stockroom and carefully use a hammer to put a dent in each can. Jacques knew that Teresa was too proud and too conscientious to take the food if he were to simply offer it to her as charity, so he would gently dent each one just enough to make it inappropriate for sale in the store. Teresa never questioned how the store accumulated an entire box each week, but she was always grateful to take home the canned goods with her paycheck on Friday. Quite often, after paying the other bills, the dented cans provided the only food that sustained Teresa and Bobby until the next paycheck.

Christmas was an especially important time for Teresa. She was determined to make this Christmas special for Bobby, despite their circumstances. They had saved enough money to rent an apartment, buy a small Christmas tree, and a single string of white lights. For the last six months, Teresa preserved a few dollars from every paycheck to put aside into a fund for Christmas presents. This holiday was to be a crowning achievement, a symbol of survival, to have enough money to buy gifts and still have money to pay the rent. Teresa could not wait to see the expression on her son's face on Christmas morning. She was determined to make this a Christmas that little Bobby would think about throughout the year, and remember for a lifetime.

On Christmas Eve, schools were closed, so Bobby spent the day at the store with his mother. Bobby spent most of the day lying on his stomach on the floor, behind the counter, near his mother's feet, drawing and coloring pictures for Christmas. Periodically, Jacques would gather the hand-drawn pictures of Christmas trees, Santa Claus, and the Reindeer, and he would tape the pages to the front windows of the store. After several hours and several pictures, Bobby asked to see where his artwork was being used to adorn the small grocery store.

As Bobby stared proudly at his artwork in the front window of the grocery store, he noticed two large boxes with pictures of fire trucks on the front of each one. Teresa explained to Bobby that one box was used to collect canned goods and non-perishable food for the poor. She explained that the other box was being used to collect new and unopened toys for homeless children. The local fire department supplied boxes to collect these items each year, and then would distribute the items on Christmas day. The food would go to homeless shelters. The toys would be delivered to local orphanages and institutions for children without parents. Bobby stared at the two boxes for a long time before returning to his place behind the counter. For the rest of the day his pictures included firemen, Santa on a fire truck, and the delighted faces of little boys and girls receiving toys from men with big red hats and long yellow coats.

The next morning, Bobby walked out of his bedroom in his pajamas and was astonished to see a ring of presents surrounding his Christmas tree. He paused for a moment, unable to believe his eyes. Teresa stood in the kitchen and watched as Bobby raced down the hallway and dropped to his knees in front of the presents. One by one, Bobby picked up the gifts, shook it gently by either ear, and gave each one a hug. He touched each gift and ran his fingers over the packing, ribbons, and bows, without opening it or uttering a single word. Then, just as suddenly, he ran to the window and looked out into the street.

"What are you looking at?" asked Teresa.

Bobby looked up at the sky, then down to the street in both directions. "I am looking for Santa Claus and the firemen," explained Bobby.

Satisfied that there was nobody outside the apartment, Bobby turned and asked his mother, "Can I open them?"

Teresa smiled and nodded to Bobby. He raced back to the Christmas tree and reorganized the presents into a ring around himself on the floor. Teresa was amazed by the meticulous manner with which Bobby opened each gift. Rather than tear the wrapping and rip into each box, Bobby carefully removed the tape and unfolded the wrapping paper. He would then lay the paper like a tablecloth on the floor, open each box at one end, and place the contents on top of the box like a small shrine. Despite the limited number of gifts, this concentrated process took Bobby all morning and most of the afternoon to open each present and place it accordingly. By late afternoon, Bobby was sitting with his mother on the couch, eating his Chef Boyardee, and admiring the small shrines and small stacks of toys, boxes, and wrapping paper. Bobby did not play with any of the toys that day. From time to time he would pick one up, give it a soft hug, and then run back to the couch to cuddle with his mother. The two of them watched the presents twinkle under the dim glow of the tree lights with rapt attention into the evening.

Very early the next morning, Teresa was startled from her sleep by noises in the apartment. She tiptoed to the door of her bedroom and looked down the hall. She was surprised to see the soft glow of the lights from the Christmas tree. The lights had been turned off at night, to conserve and reduce cost of the electricity. But there, beneath the soft glow of the white lights, was a ring of brightly wrapped presents and cans of Chef Boyardee around the base of the Christmas tree.

Teresa slipped quietly down the hallway, not sure what to think of what she saw in front of her. The wrapping paper was very familiar, as were the slightly dented cans of Chef Boyardee. She quickly checked the front door, but it was still locked. Then she looked around the room and saw Bobby sitting quietly on the floor, beside the Christmas tree, a present in his small hands.

Bobby's face turned up to look at his mother. His brown eyes were round and wide, shining and full of tears. Streaks and stains lined his little round cheeks from the tears that had run down his face. A few tear drops still clung to his quivering chin, and his body shook with silent sobs as his fingers caressed the tape and wrapping paper on the present in his lap.

Teresa stood stunned for only a moment before rushing to the side of her little child. She placed her hands on his shaking shoulders, looking into his sad eyes and wanting to make sure that he was unharmed. The reflection from the lights from the Christmas tree danced in Bobby's eyes and sparkled on his tear stained cheeks. As Teresa looked at the presents and dented cans that surrounded them on the floor, she suddenly realized why they had looked so familiar. The presents were the same ones that Bobby had opened the morning before, in the same wrapping paper that he had meticulously placed beneath the boxes, and surrounded by dented cans of Chef Boyardee from their own cupboard.

"I want to take these to the big boxes for the firemen," Bobby said with a shaking voice. "I want to give these to the little boys and girls who are hungry, and do not have a mommy."

Teresa hugged Bobby and held him close to her. She kissed him on the top of his head and squeezed him as if to pull him closer to her heart. Bobby had given her something special for Christmas, something that she would cherish for the rest of her life. It did not require ribbon, or wrapping, or bows. They had made it together, Christmas was in her arms.

______________________________________________________

Words of Wisdom

"The parent who gets down on the floor to play with a child on Christmas Day is usually doing a most remarkable thing -- something seldom repeated during the rest of the year. These are, after all, busy parents committed to their work or their success in the larger society, and they do not have much left-over time in which to play with their children."

- Brian Sutton-Smith

"Do give books - religious or otherwise - for Christmas. They're never fattening, seldom sinful, and permanently personal."

- Lenore Hershey

"D'you call life a bad job? Never! We've had our ups and downs, we've had our struggles, we've always been poor, but it's been worth it, ay, worth it a hundred times I say when I look round at my children."

- W. Somerset Maugham

"Recommend to your children virtue; that alone can make them happy, not gold."

- Ludwig van Beethoven

"Grown-ups never understand anything for themselves, and it is tiresome for children to be always and forever explaining things to them."

- Antoine de Saint-Exupery