Saturday, June 8, 2013

Orthopedic Surgeon - Do You Need One?


f you have struggled with joint pain or an injury to the musculoskeletal system, it may be time to turn to the services of an orthopedic surgeon. Here are some of the conditions treated by these specialists.

Arthritis

Arthritis is a term used for diseases of the joints that causes pain, stiffness, and inflammation, often leading to joint cartilage damage. This can make living daily life difficult, impacting a patient's ability to take care of his or her self. Patients with severe arthritis may not be able to walk comfortably, open jars or cans on their own, or even brush their teeth without pain. An orthopedic surgeon treats arthritis with medications, joint replacement surgery, and lifestyle changes.

Injuries

Injuries to the musculosckeletal system also send many patients to this type of specialist. Often these injuries are due to impact from high risk activities and sports. Ligament tears, for instance, often require the touch of an orthopedic surgeon to fully heal. Tendonitis, rotator cuff injuries, and other pulled or strained muscles also fall into the treatment range of these doctors.

Tumors

When tumors grow in or on the bones, it is usually an orthopedic surgeon who performs the surgery to remove them. The training these doctors have gives them the ability to treat this type of condition while preserving mobility as much as possible.

Joint Replacement

Joint replacement surgery is almost always performed by one of these specialists. While most joints can be replaced, the hip, elbow, and knee are some of the most common joints people have surgically replaced. If you have pain in one of these areas that has become so strong that you cannot function anymore, you may benefit from joint replacement surgery. Because the replacement joints do not last forever, doctors usually wait to perform this surgery until it is the only remaining viable option to relieve a patient's pain.

Broken Bones

The most common treatment performed by these doctors is the treatment of a broken bone. However, minor breaks do not necessarily require the help of a specialist. If you have a break that requires pins or surgery, or if a young child has broken a bone that is still growing, an orthopedic surgeon is the best option.

Before scheduling a consultation with any specialist, ask your insurance provider what you need to do. Sometimes you will need a referral from your primary care physician. If your injury is outside of his or her treatment expertise, getting a referral should not be difficult, and then you will have insurance coverage for any treatment from the specialist.

Tips for Tenpin Bowling


Bowling is a sport where pros and even amateurs love to play. It is a good sport to play and spend time together with family and friends. It also helps develop body balance and control. It exercises your legs and muscle groups which help burn your calories. With the help of consistent engagement with this sport, even when you are a beginner, you can improve your bowling skills and earn scores easier. Let me give you some basic tips to play like a pro and knock down all those pins.

The Bowling Ball
The bowling ball is the one that is thrown at the lane to knock down the pins. It is better to have you own bowling ball at least you are familiar with your ball and how much effort you should put as you throw the ball. The heavier the ball, the better! But make sure you are comfortable with it and you can lift it. The advantage of a heavy ball is that it you will have more control over the ball.

Bowling Shoes
Though you can use your comfortable and fit rubber shoes, it is better to have bowling shoes. Bowling shoes help you score better for they are really intended for bowling. It gives you the proper fit and comfort required in playing bowling. And it does not slip for the sole of the shoes has enough friction against the floor.

Standing Position
Where you place your feet at the start of the lane gives impact as where the ball goes. If you are still a beginner, experiment on where to stand. Once you found a stand that gives you a perfect throw, take note of it. Try doing it again and you will master it.

The Stride
If you are a right-handed person, step with your right foot first. Take three more steps ending with your left foot as you release the ball. This assures proper balance. If you can't get used to it immediately, you can try doing it at home with an imaginary ball. Practice is the key.

The Aim
Before striding the ball as you look at the pins, get your aim. There are arrows painted on the lane. Look at the closest arrows and choose one.

Joints
As you throw the ball, bend your knees comfortably as far as you can. The lower you are to the floor, it gives you more control over the ball. On the other hand, keep your wrist straight as you stride the ball and avoid turning it.

The Importance of Arthritis Knee Support


One way to treat arthritis pain and provide stability is with the proper arthritis knee support. For many patients suffering from osteoarthritis in the knee, a knee support will give them the relief and support they need.

Types of Knee Braces

There are several different types of arthritis knee support braces to choose from. In order to get the best fit you should always discuss knee support devices with your doctor or health professional. Most physical therapists are well versed in the use of knee support and can also offer helpful and knowledgeable advice.

The type of knee brace you chose will depend primarily on the location of the affected area.

A medial arthritis knee support brace will support the inside of the knee joint. A lateral brace will give stability to the outside of the knee joint, and a patellofemoral brace stabilizes the area behind the kneecap.

These types of braces are usually recommended for patients who suffer osteoarthritis and cartilage loss of the knee joint.

Breaking It Down: Different Types of Knee Braces

Arthritis knee support devices can be broken down even more into specific types of braces. One popular type of brace is the single piece sleeve. This brace is made from durable neoprene and is the basic type of knee brace. To put on the brace you simply pull it on over the foot and up to the knee. This brace is for mild osteoarthritis only.

An unloader brace is made from molded materials such as plastic or foam. Inside the mold are metal bars that limit the range of motion of the knee joint. This type of brace is individually fit to each patient. It works by moving the pain from the affected area with pressure.

Other Treatments

Medication is also popular treatment for the early stages of the disease. Medication is usually used to control pain until such time that you can begin a treatment plan. During this time you will work with a physical therapist and also do exercises at home. The goal is to not have to take pain medications for life.

Some patients will benefit from a simple change of diet with exercise. Overweight people are prone to arthritis of knee because of the added pressure on the joints due to their weight. Dieting and exercise can help overweight people get control of their weight and relieve pressure on the joints.

Knee joint surgery and knee replacement surgery are usually reserved for those persons who have not had success with other treatment options. In some cases this is the only way to reverse the damage and ease the pain.

Joint replacement surgery is performed everyday and considered very safe and successful.

If you decide to try using an arthritis knee support device it is important to consider all of your options. As mentioned earlier, your doctor will know the best type of brace for your specific condition. The success of the arthritis knee support device depends on your dedication - wear it always.

Hammer Toes X-Rays Can Be Revealing


Hammer toes x-rays are sometimes ordered when a patient has pain on the bottom or in the ball of the foot, especially if the deformity is not obvious. Redness on the top of the affected joint is often the first sign. If the redness is noticeable, your doctor might not order an X-ray.

Physical examination is sometimes the only necessary diagnostic tool. After evaluating the location of a person's pain, if pain is present, and physically manipulating the joints, it is often possible to see the stiffness that is symptomatic.

During the early stages, before obvious deformity occurs, it is possible to correct the problem by improving flexibility. Exercises geared towards stretching the tendons and increasing muscle strength may help. But, it all depends on the severity or advancement of the deformity.

Accompanying problems are another factor that helps to determine treatment. A condition called "cross-over-toe" can accompany a hammertoe and a bunion on the big toe. The root cause of this problem is the bunion.

During hammer toes x-rays, the bunion would be seen in views taken from the top of the foot. They occur in the first joint (closest to the foot) of the big toe. In the X-ray, the joint will appear enlarged and the toe will point towards the others, to varying degrees.

If the bunion is not corrected, there will be continued pressure on the second toe, which may cause pain, blistering, corns or calluses. Eventually, the second toe develops the hammer-appearance and in order to accommodate the deformity in the big toe, the second toe becomes an overlapping or cross-over-toe.

Like many other problems affecting the health of the feet, hammertoes and bunions are often caused by poorly fitting shoes. Narrow, pointy-toed shoes are common causes, but over-pronation may be involved, too.

Hammer toes x-rays may not reveal over-pronation. Taking an imprint of the bottom of the foot is the usual method of diagnosis. A low or absent arch will be present, which can be observed on the imprint.

In over-pronation, the heel angles inward. So, instead of balanced pressure throughout the foot, more pressure is placed on the inside area, the side with the arch.

Examining the person's posture and appearance of their knees is another diagnostic method. In severely pronated feet, the person appears knock-kneed.

If your doctor orders hammer toes x-rays, he or she may also do these other diagnostic tests to find related problems and come up with an effective treatment plan. If over-pronation is a problem, orthopedic insoles may be used to straighten to provide support and reduce the pressure on the knees and other lower-body joints.

These are not problems that should be overlooked or taken lightly. The health of your feet affects the health of your total body. Deformities can become permanent. The irritation and inflammation caused by the initial problem can contribute to arthritis in other joints of the body.

So, if your doctor orders hammer toes x-rays, take his advice. Before you even visit your podiatrist, consider buying more practical shoes. That's the first step.

Osteoarthritis of the Knee - What Exercises Are Right For Me?


Quadriceps strengthening exercises can increase mobility, decrease pain, and make recovering from surgery quicker.

No one set of exercises is suitable for everybody. The difficulty is in finding exercises that can fatigue the muscles without increasing pain. Try the examples listed below, but if you can't find any that don't increase your pain, see a physical therapist.

Cycling

This is a great exercise if your knees are up to it. Even if initially you are unable to cycle, it is worth trying again after you have had some success with other exercises as it is a good one to build up to. There are a few things you can do to make cycling less aggressive to your knees. Firstly, have the seat higher than usual. As high as it will go with you still being able to comfortably reach the pedals. This prevents your knees from having to flex to higher ranges which is often painful.Secondly, begin with little or no resistance and for brief periods of time. You can gradually increase both time and resistance as you knees get used to it.

Squats

This should never include deep squats as they are too aggressive. I usually recommend extremely shallow squats as for most people staying closer to full extension is less painful. One way of keeping them shallow is to look down at your kneecap then bend you knee until you kneecap lines up with your big toe. That is deep enough. If this exercise is too easy, do it on one leg only. Repeat until your thigh muscle starts to quiver.

In the Pool

Some stubborn knees are easily aggravated by weight-bearing exercise so a trip to the pool can be very beneficial. Cycle movements, Squats, and knee extensions sitting on a step are all good ways of working the quads in an environment that decreases the load on the joints.

Free Golf Tips to Improve Your Golf Swing


For instance how your hips might be rotating during your swing, where your hands are on the golf club or maybe even how your knees are bent before you get into your swing. All of these seemingly little things factor in when trying to develop a perfect golf swing, but most of them are overlooked.

Almost everyone who has ever attempt this game has failed miserable the first couple of times out on the golf course, mostly because their ego gets the best of them and they believe it is an easy sport to master. On TV the pros like Tiger Woods and Phil Mickelson make hitting 300+ drives down the fairway and 50 foot puts look easy, but that is as far from the truth as can be.

Playing the game of golf takes a lot of skill and concentration, especially around huge crowds like the pros are used to, but it all starts with a good, solid swing. A lot of people who just start off playing golf usually come up to the tee and try knock the ball into next week much like a baseball player would when he is up to bat, but developing a perfect golf swing takes a mixture of fitness and power, but more so control and concentration.

There are a few simple golf tips you can use when you are just starting out on the links. One is to never take your eye off the ball during your swing or you will hit the ball into God knows where. Keep your eyes fixed on the ball, shoulders square, arms straight with your left arm being like your cross hairs for the ball if you are right handed. Now that you have the form down when you swing you don't want to twist your wrists during the swing until after impact. Once you have made contact follow through with the swing motion until the club is behind your back and the ball is headed down the fairway.

Friday, June 7, 2013

Arthritis Cream: Does It Really Work?


There are many gels and arthritis creams that can safely and effectively be used as alternative arthritis treatment for a severe flare in your rheumatoid and osteoarthritis. But what are in these creams, and do they really work. The number one priority for relieving your arthritis pain is to reduce inflammation and swelling. Most arthritis creams are made to reduce inflammation and kill the pain. However, the effects are only temporary, and you should really be looking to decrease the inflammation by means of oral supplementation, but more on this later...

One ingredient often contained in these arthritis creams is Arnica, a medicinal herb that has been used for hundreds of years for bruises sprains, and backache. It is popular with athletes, especially long distance runners who are looking for localised pain relief for the long run. In terms of its benefits for osteoarthritis, one study showed it to be as effective as gel containing ibuprofen when applied twice daily for three weeks. It is seldom used internally, as it causes stomach upset. There are however homeopathic preparations available in pill form.

Another effective ingredient in arthritis cream is celadrin, another anti-inflammatory agent used to treat the symptomatic pain of osteoarthritis. It is essentially a matrix of fatty acid carbons. It has been shown to improve the range of motion of joints and people with arthritis of the knee can stand for longer and walk further before the pain becomes too bad. Some research claims that it lubricates cell membranes, leading to better fluidity and elasticity. The result is therefore better movement in the affected joint. Celadrin works quite quickly; benefits can be felt after one week of twice daily application.

Capsaicin is the active ingredient in chilli peppers. When used as an arthritis cream, capsaicin can be applied to sore muscles and joints to relieve inflammation and pain. Capsaicin relieves pain in two ways: It can interfere with the enzymes causing the inflammation in the joint, and it can interfere with the pain impulses sent to the nervous system. The relief you feel is only temporary, so it needs to be applied at least twice a day. If this means you can get by with fewer painkillers (NSAIDs), you have won a small battle against your arthritis. Capasiacin can also be taken orally as an effective way to relieve migraines, headaches and cluster headaches because of acting in on the nerve pathways. Some preliminary tests also show that it inhibits the growth of prostrate cells in petri dishes and slowed the growth of tumors in mice. It is also know to relieve sinus pain and relieves congestion. Furthermore, cultures eating a lot of chillies have a lower occurrence of heart disease. This is because capsaicin reduces cholesterol and triglyceride levels.

Knee Pain Relief - Football Knee Braces to Help Your Knees Survive in This Contact Sport


Do you enjoy playing football but are worried about your knees?

What you probably do not enjoy is the pain you feel in your knee after a game, or after practice. Of course, not everyone suffers from knee injuries after a game of football, but more often than you think these kinds knee problems do arise.

Because football is a contact sport, there can be many ways for knee injuries to occur while playing the game. You already know this to be true.

Each position played in football presents a unique set of circumstances were knee injuries can occur. For instance, if you play a running back you are more likely to suffer injuries due to repetitive movements like running, twisting and turning or a side on tackle. Or, if you play an offensive or defensive lineman position, you have different challenges. If you are a lineman you are more likely to suffer from a knee injury because of direct contact with another player, down after down, fighting tooth and nail to gain an advantage for your team.

Because of these different challenges there are different types of football knee braces that are available to you. This way you can help protect your knees no matter what kind of position you play or how hard you want to play.

What do you look for in a good football knee brace?

For starters, you need to determine why you are going to wear a knee brace. Is it to simply offer extra protection for your knee or do you already have pain? Or, do you have discomfort in your knee that you want to keep from getting worse?

Depending on your answer to that question, you can start to look for the proper football knee brace to suit your needs. There are different types of football knee braces that offer different levels of support to the knee. Unhinged knee braces (knee sleeves) are lightweight and allow for a lot of movement to occur, while still offering some support to the knee. There are different kinds of hinged knee braces that are designed to offer deeper levels of support to the knee and reduced movement in order to bring stability to the knee area.

Purchasing a football knee brace is not going to cost you a lot of money and it will save you a lot down the road by wearing one now. Some people who ignore their knee problems now may end up having to have knee surgery. Some are not able to play the game at all after an incident. The bottom line while playing this intense sport is: "Do what you can now to support your knees now, before the season ends too quickly!"

How to Use Cold and Heat Therapy After a Joint Replacement


There is a saying among some orthopedic surgeons to their patients that the surgery was the easy part it's the rehabilitation that is the hard part. Never have truer words been said. After either a knee, hip, or shoulder has been replaced keeping the pain and swelling to manageable levels is no doubt an art.

In physical therapy there are several hard and fast rules we tend to follow when preparing patients for rehabilitation. The use of heat and cold therapies are usually brought up somewhere in the overall discussion. Generally its recommended that a patient will use heat on the surrounding tissue before exercise and ice or other type of cold therapy after the exercises. Now there are multiple ideas behind this theory with most prominent being, heat will relax the muscles around the joint making them more pliable and easier to stretch and cold will help reduce the swelling after the treatment and also reduce pain.

Heat and cold therapies have been around since the beginning of man and still promoted today. When I treat a patient which is in the home setting for instance, the joint that was replaced will not be quite as acute as it was in the hospital Therefore, one or both of these therapies may be discontinued by the patient but that is something I do not recommend. Before I get to the home I will recommend to the patient that a heating pad is placed around the surrounding joint not directly on it and also the proper toweling is to be used to prevent burning the soft tissue around the incision. this is usually applied 20-30 minutes before therapy is started. If its a knee replacement for instance the patient is asked to also elevate the affected limb while getting the heat although this is not completely necessary.

The idea is by using the heat I can start by developing further range of motion in the knee or hip while the muscles are relaxed and easily manipulated. this can also of course be done by family members or yourself once properly trained to do so.

After the treatment or your exercise session is completed, this is the time to immediately apply a cold pack to the the affected area for 20-30 minutes to help reduce the swelling and pain that was initiated after having the joint exercised. Also if its a knee replacement its advised to elevate the limb higher then your heart to help with the reduction of swelling. Again as with heat, do not place the cold pack directly on the skin, the pain during a joint replacement is hard enough to handle at times without having to deal with frostbite as well. Unlike heat you can place the cold pack over toweling directly on the knee or hip. The cold therapy will not promote further bleeding and swelling like heat will if placed directly over the joint.

Every individual has different tolerances to pain and swelling. You will meet people for instance that never used heat during their therapy and, will from time to time meet some patients who did not use cold therapy as well. I find that you can skip these modalities after a hip replacement if you choose, however, it is advised not to skip the cold therapy after a knee replacement as they seem to be more temperamental then the hip. Pain and swelling is more prominent in the knee then in the hip.

Using heat and ice have their place in rehabilitation and can make your rehab experience tolerable.
Always check with your doctor or therapist if you have any questions regarding times or application of the above as there are many ways to use heat and ice with physical therapy and still be effective.

Natural Relief for Arthritis Joint Pain


Arthritis comes from the Greek arthro- meaning joint and -itis meaning inflammation. Arthritis joint pain causes a spectrum of pains from mild and intermittent annoyance to debilitating, life-altering agony. While there is no known cure for arthritis, the joint pain caused by the disease can be treated to improve the arthritis sufferer's quality of life.

Managing body aches caused by arthritis doesn't have to involve a narcotic, numbing out experience. There are natural solutions for treating the pain. One of the most promising discoveries in the battle against arthritis joint pain, whether the pain is in your knee, back, fingers, or hands, is Natural Eggshell Membrane, or NEM, for short. NEM is derived entirely from egg, so unless you have an egg allergy, it does not produce the side effects caused by prescription drugs. It is also vegetarian friendly, which makes this a great product for herbivores and omnivores alike.

NEM contains glycosaminoglycans, better known to us common folk as glucosamine, chondroitin, and hyaluronic acid. Before I explain how these carbohydrates help your joints, it's important to understand the basic structure of a joint. A joint is formed where two bones meet head to head. The joint is the cushion between the bones that keeps them from rubbing together and eroding each other. The connective tissue is called articular cartilage. The articular cartilage is lubricated by synovial fluid. A major component of synovial fluid is hyaluronan, from which hyaluronic acid is derived. Hyaluronan adds to the viscosity, or rich thickness, of synovial fluid. The lubrication provided by synovial fluid is important.

Imagine that your articular cartilage is a rubber band. Now, a new rubber band is very stretchy and flexible. But what happens to a rubber band when it gets old? When it sits out in the sun for days or weeks, when it gets dried out? It becomes brittle and will snap quite easily, or even crumble. It loses its ability to bounce back and to stretch and move comfortably. A similar effect happens when your articular cartilage is deprived of proper and adequate lubrication. The resulting joint pain - be it in your knee, back, hands, or fingers - is a result of both damage to the connective tissue or articular cartilage, and, potentially, your bones beginning to erode each other.

While arthritis pain is not always a result of injury or daily wear and tear (osteoarthritis), but can also include situations where the immune system attacks the body's tissues (rheumatoid arthritis), the basic joint pain arthritis treatment can be the same. NEM works by increasing joint lubrication, resiliency, and cellular function to potentially help rebuild articular cartilage. NEM's glycosaminoglycans also work in conjunction to help reduce the inflammation and swelling attributed to joint pain arthritis.

Multiple studies have produced statistically significant results correlating NEM with a reduction in arthritis symptoms specific to patients suffering from osteoarthritis. In one study, at the end of:

繚 10 days -
o 33% experienced a 30% reduction in joint pain arthritis in the knee, and
o 25% showed more than a 50% reduction in stiffness

繚 60 days -
o 32% of NEM-taking participants reported more than a 50% reduction in pain, and
o a 27% average improvement in stiffness

Such studies have shown NEM's effectiveness both on a short-term and long-term basis for treating joint pain arthritis.

Talk to your doctor about NEM. It may be the solution you're seeking for relief from joint pain arthritis in your back, knee, hands, or fingers, without the side effects of prescription drugs. Take your life back from the clutches of arthritis.

Soccer-Related Injuries Often Require the Attention of a Knee Specialist


Much to the dismay of soccer or "football" fans around the world, their favorite sport is often plagued with injuries that can bench their favorite players for an entire season. Collisions, running accidents, and repetitive kicking motions often leave players with injuries that can only be fixed by a skilled knee specialist.

One particularly gruesome and painful soccer-related knee injury is a dislocated kneecap. This condition can occur for a number of reasons, but is common in the soccer world because of collisions between players and the powerful kicking motions involved in the game. Such an injury is extremely painful, and requires immediate medical attention. The kneecap, medically referred to as the patella, can end up as far as the side of the knee.

It is possible for the kneecap to pop back into place on its own, but it will probably have to be repositioned by a knee specialist. A dislocated kneecap is treated much the same way as a broken bone. The piece is put back in place, and then placed in either a cast or immobilizing brace so that it can settle into its proper place and heal naturally.

Another category of injuries with which sports fans have become familiar are injuries to the ACL, PCL, MCL, and LCL. These are injuries that occur in the four ligaments located in the knee. Rough physical activity causes tears or ruptures in these ligaments. Injuries to the ACL and PCL, the anterior and posterior ligaments, are more severe injuries that often require surgery and up to a year of physical therapy. Surgery involves reconstructing the ligament by grafting similar tissue from other body parts because the ligament cannot merely be stitched together.

Many people argue that ligament tears and ruptures do not really require surgery. This may be true for the average person, but for someone who plays soccer on a professional, college, or even high school level, surgery is the only way to ensure the injury will not get worse when the player steps back onto the field.

MCL and LCL injuries involve the side ligaments of the knee. They are less common and less severe than ACL and PCL injuries, and do not usually require surgery. Treatment for this type of injury only involves icing the area and treating it with anti-inflammatory drugs to reduce the swelling, followed by physical therapy to regain strength and mobility in the ligaments.

It is important to find a knee specialist qualified in sports medicine. The main criteria to look for when choosing a doctor for any surgery is how many similar cases the doctor have dealt with before. You would not want to go under the knife for a kidney transplant by a doctor that specializes in liposuction. That may be an extreme example, but the same rule applies. A sports medicine doctor or surgeon will be not only very familiar with your particular injury, but also experienced in the necessary follow-up care that will allow you to get back out on the field as soon and as safely as possible.

Thursday, June 6, 2013

MCL Injury? Learn More About the Medial Collateral Ligament and MCL Tear From Orthopedic Surgeon


One very common knee injury is an MCL tear or a medial collateral ligament tear. The medial collateral ligament or MCL runs from the shin bone or tibia up to the thigh bone (also known as the femur).

Athletes commonly experience MCL tears following some type of knee related trauma. For example, sharp twisting or stopping can cause an MCL tear as can strong impact. An MCL tear is a common injury among dancers, and it is also a common injury among skiers, ice hockey players and football players. Soccer and basketball players may also be vulnerable to MCL tears as well.

Ligaments work to manage bodily movement by restricting the movement of joints. If the outside of the knee joint experiences some type of intense impact, sharp twisting or turning, you may experience an MCL injury. The MCL is particularly vulnerable to tearing if it is pulled too much or overstretched which can easily occur during athletic competition.

During a very intense injury to the knee, a person might experience tearing to the MCL, the Anterior Cruciate Ligament or "ACL" and the meniscus all at one time. Sharp pain on the inside of the knee often accompanies an MCL injury. This inner knee pain can last for hours and in more severe cases like with a Grade III MCL injury, a person may also experience a feeling of weakness in the knee or knee buckling.

Sometimes if you have an MCL tear, you may find that it hurts to touch the inside part of your knee around the joint area. MCL injury often includes swelling to the injured area and sometimes bruising in the days following the knee injury.

Following an MCL tear, it is generally recommended that you see a qualified health care professional like a board certified orthopedic doctor for a thorough examination and treatment recommendations.

Treatment to help an MCL tear includes putting ice on the injury, keeping your knee raised for an extended period of time above the heart, and reducing physical activity in order to avoid causing further damage.

You may also be required to wear a special brace and/or use crutches, depending on the severity of your medial collateral ligament tear. Sometimes physical therapy is also recommended to facilitate enhanced knee strength, especially if you have been sidelined by an MCL injury for an extended period of time. Physical therapy can be helpful to prevent additional injuries coming from the MCL injury.

If you think you may be suffering from an MCL injury, it is advisable that you seek out a medical assessment from your physician. A doctor specializing in knee injuries and sports medicine like an orthopedic surgeon may be particularly helpful in assessing your knee pain and the severity of your MCL injury.

How To Throw A Punch In 4 Easy Steps


When you look at boxing, kickboxing or other types of martial arts you will see that the punch is a highly used part of fighting and combat. It is the most frequently used attack form in any type of hand to hand combat.

There are various types of punches that can be used and each has their benefits. Some frequently used and frequently pointed out punches are the jab, the uppercut and also the overhand. Some punches that are not as famous is the hammer fist, the haymaker, the chambered punch and also the shovel hook, to mention just a few.

A number of factors are taken into account when throwing a good punch. Stance, hand level and hand-eye coordination are generally all equally important factors. In this article we are going to look at the steps to throwing a perfect punch.

The first thing is to decide which hand you will use to throw the punch. To start with we recommend using your dominant hand. Right-handed individuals can utilize much more force naturally with their right hand. Exactly the same applies for the left-handed men and women.

The second and very important step is the stance. To achieve the ideal stance, the legs should end up being at least hip width apart. One leg should be somewhat before the other as well as the knees ought to be bent somewhat. Both of your arms should end up being bent at approximately a forty-five degree angle as well as the hand ought to end up being balled directly into a tight fist. With the proper stance you will be quick on your feet. You will also be harder to knock down. Remember a strong punch starts from a strong foundation.

Next, it is vital to measure the distance from the opposition. The range between you and your opponent is very important. Make sure you are within an arm's reach of your opponent. This will insure any attempted punch from you will hit the target. In the event that a punch doesn't hit its landing, plenty of energy is actually wasted and it results in vulnerability for an immediate counter strike from your opponent.

Finally, the follow through is critical. The follow through of a thrown punch ensures that damage is actually caused to the opposing person. For the correct follow through, once a punch is thrown, twist the body so that the weight will be lifted through the heel of your foot planted furthest back. This will cause the shoulder to drive forward and place weight behind the punch, thus providing the proper follow through. Then quickly return to the fighting stance thus ready to throw another punch.

Now you know the basics of throwing a punch. You will want to practice these steps and once mastered continue to the other hand.

Conquering Arthritis - Mentally and Physically


Common Types of Arthritis

There are many forms of arthritis. They range from severely debilitating rheumatoid arthritis to common osteo-arthritis. Osteoarthritis is the most common form of arthritis. Over ninety percent of people over the age of fifty have some degree of oseto-arthritis. It is basically the wearing out of the joints over time, or plain and simple wear and tear. There are a lot of factors that determine when and how severe it will affect you, some factors you can control and some that you can't. Rheumatoid arthritis is less common, but much more destructive. It is a disease which the immune system attacks the joints for an unknown reason. The body treats the joints like invaders and slowly destroys them over time. It is unknown what causes rheumatoid arthritis and it can be severe. It can happen at any age and can stop and go into remission for no apparent reason. There are a lot of other forms of arthritis that are rare, but they all negatively affect the joints.

Osteo-Arthritis

Osteoarthritis affects every mammal on the planet and every person will eventually develop it if the live long enough. It is the joints wearing out with age. The first sign of osteoarthritis is stiffness in the joints. This is due to the fluid (synovia) that separates the bones of the joints becoming less viable and breaking down. Over time the joints will get closer together and lose the viscosity of the fluid. Calcium will start to form on the ends of the bones and slowly start to form a bridge between the two bones that make up the joint. This process is called spurring. Eventually the joint will lose all the fluid that lubricates the joint and spurs will take over the entire joint. The bones will fuse together to form one big connection. This process takes time and it can start as early as late teens or it can start much later in life.

Causes of Osteoarthritis

There are a lot of factors that determine the age and rate when osteoarthritis will start. Some factors can be controlled and others cannot. Did you ever see people in their eighties that look and move like they're in their forties? Then you see someone in their fifties that look and move like they are ninety. This didn't happen by chance. Many things determined this, but they all occur over time. It's never to late to change, unless your dead! The first factor is genetics. This is handed down by your parents and their parents. You can't pick your parents so this is 100% not controllable. If your parents developed osteoarthritis at an early age, chances are you will too unless you take precautions. Trauma is another factor that isn't exactly controllable. The amount of trauma your body, particularly the joints, has had will speed up the degeneration process of osteoarthritis. Most football players have a high rate of osteoarthritis in their hips and knees at young ages due to the amount of lower body trauma they endured while playing football. Livelihood is not really controlled either, and it is another factor that contributes to arthritis. I'll give a couple of examples. Mail carriers that carry heavy mail bags on their shoulders will develop osteoarthritis in their spines at a much faster rate than most people. Years ago they were taught to switch sides regularly to prevent on side from receiving most of the stress. This helps, but it still doesn't eliminate the increased stress on the spine day after day. Another example are dentists. My father was a dentist and my sister is a dentist. When my father started to age he had a finger that was crooked. It was just his first finger (pointer finger) on his right hand. This was due to the constant pressure he placed on the instruments while working. Rheumatoid arthritis hits all the fingers so it wasn't rheumatism. Dentists also bend to one side all day. This places a lot of stress on one side of the spine. I recommend switching sides, but it is impossible for them to do this because most dentists aren't ambidextrous. Over time this will degenerate the mid back of most dentists. I'm a chiropractor and I stand all day. I'm developing arthritis in my knee. I also had severe knee trauma (surgery) in high school form sports.

Slow Osteo-Arthritis Down

Regular moderate joint motion is one thing that slows the degenerative process down. A moving joint is typically a healthy joint. Regular daily motion stimulates the fluid (synovia) of the joint and will nourish the joint. It is similar to the difference between a pond (dirty) and a stream (clean). A pond develops scum due to the lack of moving fresh water, but a stream in constantly moving fresh water in and removing the dirty water. The joints of the body act similarly to this. They get their nourishment from the fluid in the joints so if the fluid isn't circulating the joint wont get proper nourishment and will degenerate at a much faster rate. Daily stretching and moving the whole body through a full range of motion is recommended. People that work hard often times don't get enough full ranges of motion in their entire body. They stimulate certain areas too much and other areas not enough and they become imbalanced. There are a lot of methods to stimulate and stretch, but I feel yoga and pilates along with swimming are the best ways to stimulate and stretch the entire body. Proper alignment of the joints, especially the spine is crucial in preventing osteoarthritis. If the bones are mis-aligned it is common sense they will wear out faster. Like making sure your tires are in alignment, the vertebra move and can become mis-aligned. When vertebra are mis-aligned they become fixated and don't allow proper motion in the joints. Muscle spasms are the biggest reason why this occurs. When a muscle goes into spasm, it gets tight and will move the bones or compressing the joint. A pulled muscle can create havoc on the spine, short and long term. Regular chiropractic treatments prevent mis-alignments and reduce muscle spasms. Proper nourishment and fluids are another big factor. Joints have been found to degenerate at a faster rate if they aren't hydrated properly and they also have been found to improve if proper nutrients are given to them. Glucosamine Sulfate, Chondroitin Sulfate, MSM, and Hyaluronic acid along with Omega 3 fatty acids have been found to aid in joint function. I also recommend natural ant-infammatories such as ginger and turmeric for preventing harmful inflammation of the joints and soft tissue.

Conquering Arthritis, Mentally

I don't care what type of arthritis you may have, your mental attitude is the most important factor that will enable you to manage it and help you live a happy productive life. Even the worst cases of rheumatoid arthritis can go into remission. Without positive thinking and positive preparation it usually won't happen. Osteoarthritis effects everyone. Some people let it destroy who they are and others empower it. It doesn't have to become who you are. Everyone has an identity or a story. Don't let the first thing you think of when you imagine yourself be arthritis. If you let it control you it will eventually destroy you. Arthritis is manageable and it is not going to prevent you from enjoying your life. Take preparations and you will be fine. Associate yourself with active and supportive people that enjoy life and don't dwell on the negative things such as their ailing health. Positive thinking and positive living will change your life. Energy breeds more energy. The more energy you use the more your brain and body will produce. You just have to get it started. So get moving, nourish your joints and keep them in align.

What is the Difference Between a Medial and Lateral Unloader Knee Brace?


Degenerative Joint Disease affects millions of Americans and with an aging baby boomer population will most certainly become more of an issue as we try to maintain a healthy lifestyle, and battle against the affects of our youth. The knee joint is one of the most effected areas in the body regarding the "wear and tear" effects of osteoarthritis. More patients and doctors are looking for alternatives to medication and surgery to improve patient mobility, reduce pain and swelling, and prevent the inevitable and dreaded "knee replacement".

"Unloader" knee braces, or "arthritis" knee braces, are designed to literally bend the knee into a position that reduces the stress and weight on the affected joint, thereby reducing pain and swelling. There are two compartments in the knee, referred to as medial or inner and lateral or outer compartments. The vast majority of patients suffer from medial compartment osteoarthritis (unicarpartmental oseoarthritis). When this occurs, the joint cartilage, synovial fluid are reduced or absent and the result is a "collapse" of the medial compartment.

The knee joint becomes misaligned and what was normally a joint that bears equal pressure to support the body, turns into a painful angular joint, with excessive wear and pressure on the inner compartment, with pain, swelling and in advanced stages, limitation of movement. The angular change caused by this medial compartment arthritis is referred to as a varus deformity. This term refers to an inward angulation of the lower leg in relation to the thigh. If you have ever seen a newborn and looked at their legs, you will understand what a varus or bow leg is. This is a varus deformity.

Likewise, the angular change caused by a lateral compartment arthritis is referred to as a valgus deformity. This term refers to an outwards deviation of the lower leg in relation to the thigh. Many people are familiar with the term "knock knee". In the old days, you would see movies, where the teenage girl sits with her knees and thighs together, and her feet spread out. This is a valgus deformity.

An "unloader" knee brace corrects the varus or valgus relationship of the leg to the thigh, making the entire leg straighter and aligning the joint back to its level position. By bending the knee joint back into a more aligned position, the brace opens up a gap or space between the leg and thigh bone, so the two bones do not rub up against each other. This reduces the pain or swelling that occurs when two rough arthritis bones come in contact with each other.

When purchasing an "unloader" knee brace, it is important to know if you have a medial or lateral osteoarthritis. This can be confirmed with x-rays, noting the collapse of the knee joint, and the angular changes that are occurring. It is also important to consult with your treating doctor prior to purchasing such a device. Wearing a lateral unloader knee brace with a medial compartment arthritis may result in increased pain, swelling and accelerated joint damage. There are many choices to be made when deciding which arthritis or "unloader" knee brace to purchase. Please check with your doctor and do your research before you choose.

Eight Tips For Arthritis Pain To Make Life Easy


Over the years, there has been a noticeable rise in the number of people afflicted with arthritis. It is a fairly common disease among the aged. According to a survey, as many as 1 in 5 adults in the United States presently suffer from chronic joint pains or arthritis.

This widespread prevalence has led to the search for effective pain relief measures to alleviate the debilitating symptoms of the ailment. There are eight tips for arthritis pain relief. Arthritis isn't just a single ailment; it is a compound disorder that consists of more than 100 different conditions and can affect people of any age group.

The two most widespread forms of arthritis are osteoarthritis and rheumatoid arthritis.

The eight tips for arthritis pain are applicable to these two forms of arthritis also.

Both these forms have completely separate root causes, risk factors and results on the body, but they both share a common symptom, namely, unrelenting joint pain.

In addition to joint pain felt in other parts of the body, pain in the hips, knees, wrists and hands are the most common symptoms of arthritis.

If you spend many sleepless nights suffering from joint pain, stiffness or swelling of the joints, chances are you're suffering from arthritis. Arthritis pain can be subdivided into two general categories - acute pain and chronic pain. Acute pain lasts for a short-term.

It can last for a few fleeting seconds or longer, but it eventually fades away as the healing process takes place.

Chronic pain ranges from mild to intense, and can last for weeks, months, years, or even a lifetime. The eight tips for arthritis pain help reduce the pain and allow for a more comfortable way of living.

Eight Different Ways To Help Ease Your Arthritis Pain

With the increase in the number of patients suffering from arthritis, the options for arthritis pain relief have also expanded.

There are various alternatives to help bring relief from intense arthritis pains.

These eight tips for arthritis pain are:

Homeopathy

Warm water therapy

Heat or steam therapy

Exercises

Massage therapy

Meditation, hypnosis, hypnotherapy

Magnet therapy

Prescription drugs

Natural treatment therapies can go a long way

* Water Therapy

Water therapy has become a very popular option for pain relief. It is also known as water aerobics, and it involves performing various types of aerobic exercises in a pool.

The main advantage of this kind of treatment is that there is virtually no pressure on your joints while doing the exercises, which is a boon for arthritics beset with excruciating pain.

For most cases of arthritis, moving the joint constantly is recommended. Water therapy is the best for this because you feel buoyant and weightless in water.

Hence, water therapy is not only an easier option, but an effective one as well. Another alternative for relieving arthritis pain is using heat.

Arthritis is especially painful in the cold weather, when stiffness and soreness increase considerably. When this happens, heat is a good choice for pain relief. However, heat only relieves temporarily.

Nevertheless, if you are experiencing mild pain, using heat could prove sufficient in relieving your pain. This is a better alternative if you prefer natural treatments instead of using drugs.

* Massage

Massage is a fairly common method of treatment for joint pains.

However, the extent of relief depends on several factors like the type of massage, the kind of arthritis, and the skill or expertise of the masseuse or therapist.

The type of massage that is reported to be of considerable help to people suffering from arthritis is Swedish or "Classic" massage.

The techniques involve stroking, kneading, rubbing and vibrating, which help by increasing the blood circulation and relieving the joints and muscles from aches and pains.

* Other Sources of Relief

Nowadays, over the counter medication is widely available to help bring relief to arthritis patients.

These drugs can be very helpful provided the pain is moderately mild. In case you suffer from severe pain, you will have to discuss pain relief alternatives with your doctor.

Initially, the only requirement could be a painkiller. Visiting your doctor frequently is highly recommended so that he/she can keep you informed about your arthritis pain relief plan.

If you follow these instructions, you will be able to live an active and pain free life.

Help the Body Recover With Proper Nutrition and Supplementation


Hip replacement is a major surgery. It is a widely practiced and largely opted for surgical treatment for hip joint disorders. The body undergoing a surgery suffers a jolt. Lots of rest and sufficient intake of nutrition are the essentials to restore the body to its former strength and stamina at the postoperative stage. Lack of nutritional richness of foods that a patient takes after the surgery delays the recover process. The body needs to repair itself at the postoperative stage. Nutrition and supplementation is the fuel to boost the repairing process of the body.

Losing weight and maintaining diet are not considerable during the period of recovery from a hip replacement surgery. The body needs to have a good amount of calorie to ensure smooth recovery after the surgery. The following are the nutritionally rich foods that you are required to take in the meals of a day.

Protein is a vital nutrient for proper nutrition and supplementation. A number of foods including milk, eggs, cheese, yogurt and beef are good protein sources. Many protein powders are available in the market. The solution of these powders in low fat milk or fat free milk meets the demand of the body for protein to repair the surgical site. Protein requirements vary with the physical conditions of patients who have undergone hip replacement surgery.

Intake of carbohydrates is a vital need to energize the body at the recovery phase following the hip replacement surgery. Due to lack of carbohydrate content in the diet, the body consumes its muscular energy. Carbohydrate rich foods like vegetables, oatmeal, sweet potatoes, pasta, and wholegrain are good for the body. Slow-burning carbohydrate foods are good for the body as they do not raise the level of blood sugar quickly.

Another food component for nutrition and supplement is fat. There are good and bad fats. Almonds and several other kinds of nuts provide good fats. Saturated fats are good for the body. Some certain fish types provide this type of good fats. The body of a patient needs to have fat content to keep the hormonal regulation normal at the postoperative stage after hip replacement surgery. Enrich your diet with green vegetables and fresh fruits. Take fluids in plenty and eating lean protein is advisable.

Maintaining proper body posture at the recovery stage is too important to help the body perform its biological functions properly. it is always advisable to consult your surgeon or a dietitian.

Wednesday, June 5, 2013

Osteo Arthritis - Ayurvedic Management with Medicines


Osteoarthritis which is known as sandhigatavata in ayurvedic medicine may occurs due to some particular food, poor blood circulation, dryness, over exertion or a low nutrient supply to the joint. It is an important vata disease described in ayurvedic classicals like Charak samhita and Ashtanga hridaya. It is caused by the inflammation and loss of cartilage and affects the joints of knees, hips, lower spine, fingers and toes.

It can be managed by


  • Eating lot of vegetables, freshly cooked foods, hot soups of lentils, pulse, moderate quantity of ghee and oils to lubircate the dried joints. By avoiding oily and deep fried foods.Doing a regular mild exercise programme to enable the joint to move and prevent further damages also by noti ndulging in any hard job which may damage the joints. Daily massaging with the mahanaraya oil or specific oils prescribed by an ayurvedic doctor is used to calm down the vata dosha.

  • Ayurvedic drugs aim to reduce the vitiated vata and also improves the kapha and pitha functions. The main drug that is recommended to treat this degenerative disease is Karaskara. Sahachara, bala, devdar, shallaki etc are also used. Main preparations used are qwath, arishta , choorna, tablets and ghrit.

  • In order to cleanse the toxins from the colon Triphala, which is a mild laxative is given. Triphala has specific action to pacify vitated vata.

  • Trikatu is given to enhance the digestive fire and will enhance the equilibrium of pitha dosha.

  • Guggul helps to strengthen the bone tissue. It reduces the inflammation and edema, pacify kapha dosha.

  • In order to control inflammation of the joints, Ayurveda suggests Boswellia gum or phellodendron bark and scute root and it is used in combination with myrrh gum, fang feng root, qin and jiao root.

Commonly used medicines are Sahacharadi qwath, Guggul thikta qwath, Maharasnadi qwath, Rasnerandadi qwath, Balarishta, Dhanwantharishta, Karasakar ghrit, Guggul thiktaka ghrit, Shadpala ghrit. Ashwagandha, Bala, Shallaki, Guggul and Rasna are used in pure herbs form.

5 Training Mistakes Which Will Cause Knee Pain


Knee pain is a common problem amongst the sporting population. The causes of knee pain are split between traumatic injuries and those where pain develops gradually for no clear reason. Whilst the first type is less avoidable, the second, can in many cases be avoided, or at least stopped in its tracks, before the condition really takes hold.

Here is our list of the biggest training mistakes to contribute to knee pain:

1. Wearing Poor Footwear
This is one of the biggest contributing factors to knee pain. Firstly, make sure the footwear is cushioning. Most sports involve running and the repeated impacts place a lot of stress on the knees. Cushioning footwear or insoles can really help reduce this. Secondly, make sure you have enough arch support. It is very common to have either a fallen arch, or to overpronate. This causes an inward rotation on the shin bone which in turn affects the positioning and functioning of the knee joint! Get a gait analysis to ensure you are wearing suitable footwear for you and your sport!

2. Developing Muscle Imbalances
Muscle imbalances occur when one muscle group is strong and tight, and the opposing group is weak and long. This leads to an uneven pull on a joint. Around the knee, common examples include tight lateral quads and IT band, whilst the medial quads (and VMO in particular) are weak. This can lead to mal-tracking of the kneecap as the strong lateral muscles pull it outwards. Inadequate stretching and an inadequate strengthening programme contribute towards these developments.

3. Lack of Fitness
Research has shown that fatigue towards the end of a match or event contributes towards knee injuries, even traumatic injuries such as ligament and cartilage tears. This is due to reduced control of the joint by the fatigued muscles. Increased fitness training can help with this.

4. Too much Jumping / Plyometrics
Jumping sports such as Basketball are known to contribute to conditions such as patella tendonitis (aka jumper's knee). Whilst jumping is unavoidable during match play and such techniques and plays must be rehearsed, players and coaches should be aware of over-doing things. This is especially important when just starting the sport, or when moving up a level.

5. Running on Hard Surfaces
Always training on hard surfaces, especially concrete, can contribute to knee injuries. There is absolutely no give in these kinds of surfaces and so the shocks passed up through the feet and lower legs are much larger than when training on softer surfaces such as grass.

Please visit our knee pain page for more information on different knee injuries, their causes and treatment.

Anti-Inflammatory Ingredients: A Key Component of Proactive Healthcare


Fish oil, glucosamine and chondroitin. One of the largest studies on the supplemental use of these three nutrients shows their potential to play a beneficiary role in the body's anti-inflammatory processes. Inflammation has been associated with numerous diseases including cancer and cardiovascular ailments so these ground-breaking results may soon revolutionize our methods of practicing proactive healthcare. The results have also opened up the possibilities of safe and effective supplement manufacturing options for dietary supplement business owners interested in offering their customers natural options for anti-inflammatory benefits.1

What is Inflammation?

Inflammation is the body's protective response to injury, irritation or disease and is designed to initiate a process of healing. Without inflammation, injuries and infections would not heal resulting in life-threatening situations. There are several types of inflammation but the two basic types are acute and chronic. Acute inflammation may last a few days or weeks, but chronic inflammation is more prolonged.

Since its implications on health are so wide and varied, no one can say exactly how many Americans suffer from an inflammation-related health concerns. Chronic inflammation is constant and this type of low-level inflammation has the body continuously fighting low-grade infection even though none may be present. Some experts believe inflammation is the root cause of arthritis, hay fever, Alzheimer's, cancer, stroke, heart disease, lung cancer, diabetes and a host of other diseases. While there is no specific age range for inflammatory health concerns, the onset of many of these diseases just mentioned is generally after 40.

The Study Results

The exciting study analyzed data from a nationally representative sample of 9,947 adults from the National Health and Nutrition Examination Survey. According to the team of scientists, a regular intake of supplements that contain fish oil, glucosamine and chondroitin were observed to lower markers of inflammation by 17%, 22% and 16% respectively.

Research scientists from Fred Hutchinson Cancer Research Center in Seattle and the University of Washington, Seattle say that the level in reduction of C-reactive protein (CRP) is similar to the results produced by taking statin. CRP, a protein found in the blood, is an established marker of inflammation. CRP is produced by the liver and levels rise in response to inflammation.

Other studies have also shown that an intake of omega-3 fatty acids (found abundantly in fish oil) for one month reduced inflammation and pain in more than 60 percent of patients who suffered from nonsurgical neck or back pain. About 59 percent said they no longer needed to use non-steriod anti-inflammatory drugs (NSAIDs) to reduce pain.2

A similar experiment was conducted using chondroitin sulfate supplements in comparison to NSAIDs. The group that took chondroitin sulfate was seen to experience anti-inflammatory benefits that lasted up to 3 months after the end of the trial.3

In patients with osteoarthritis, glucosamine, was observed to reduce inflammation allowing for reduced doses of NSAIDs. Glucosamine is often combined with chondroitin sulfate and used as a low-risk alternative to NSAIDs.4

How do these 3 nutrients work in the body to reduce inflammation?

Scientists believe these three nutrients reduce inflammation by blocking an enzyme called cyclooxygenase (COX). COX is responsible for producing prostaglandin, hormones that initiate inflammation.5

Manufacturing Anti-Inflammatory Supplements

The new research affirms that keeping inflammation under control is a key component of proactive healthcare. Supplement business owners should start educating their customers about inflammation and its possible consequences on health. Partner with a contract supplement manufacturer that has received GMP certification by NSF and can offer you a range of convenient manufacturing solutions including in-house label design, packaging, and fulfillment services. You can quickly and efficiently get your anti-inflammatory supplements up and running in the market by finding a supplement manufacturing firm that meets high-quality manufacturing qualifications and ensures timely delivery of your products.

References:


  1. Association Between Use of Specialty Dietary Supplements and C-Reactive Protein Concentrations, Am. J. Epidemiol. (2012) doi: 10.1093/aje/kws186 First published online: November 8, 2012.

  2. Omega-3 fatty acids (fish oil) as an anti-inflammatory: an alternative to nonsteroidal anti-inflammatory drugs for discogenic pain, Surg Neurol. 2006, Apr;65(4):326-31. PMID: 16531187. ncbi.nlm.nih.gov/pubmed/16531187)

  3. Comparison of the antiinflammatory efficacy of chondroitin sulfate and diclofenac sodium in patients with knee osteoarthritis, J Rheumatol. 1996 Aug;23(8):1385-91, PMID: 8856618. ncbi.nlm.nih.gov/pubmed/8856618).

  4. Glucosamine, Mayo Clinic. mayoclinic.com/health/glucosamine/NS_patient-glucosamine)

  5. Effects of Glucosamine and Chondroitin Sulfate on Cartilage Metabolism in OA: Outlook on Other Nutrient Partners Especially Omega-3 Fatty Acids, International Journal of Rheumatology Volume 2011 (2011), Article ID 969012, 17 pages, doi:10.1155/2011/969012. hindawi.com/journals/ijr/2011/969012/

What You Should Know About Muscle And Joint Pain In Lupus


Studies revealed that 90% of people with lupus experience joint and/or muscle pain at some time during this illness.Very often, the aching pain in joints and muscles can determine the patient believe he has a viral or flu-like illness, while other patients may have symptoms similar with those produced by arthritis. There exist also another category of patients with intense muscle inflammation, and they can also experience progressive weakness and loss of strength.

It must be said that muscle and joint pains are symptoms of lupus but usually it's not the systemic lupus erythematosus responsible for them. They are more frequently caused by other illnesses.

Usually, the joint pain caused by lupus arthritis comes, may last for days or weeks, and then disappear, returning at a later time. It is known that the joints farthest from the trunk of the body are most frequently affected. Characteristic to lupus is stiffness and pain in the morning which improves during the day and can return later in the day when the person is tired, and also the fact that the pain is usually symmetrical, similar joints on both sides of the body are affected. It is good to know that even if a person has been diagnosed with lupus, there can appear pains that have nothing to do with this disease. For example, backaches or neck pains, a single, chronically painful are not provoked by lupus.A fact that also should be remembered is that usually, lupus arthritis doesn't cause deformities or destruction of the joints.Best clues in order to determine if the pain is caused by the systemic lupus erythematosus is the pattern of joint pain and the setting in which it occurs.There can be made X-ras of the painful joints and an examination of the synovial fluid within a swollen joint, to rule out other possible causes for the joint. It is known that if arthritis is the only symptom of lupus, diagnosis can be extremely difficult.It is good to mention that sometimes, performing the anti-nuclear antibody test and the test for rheumatoid factor can be helpful.

For treating lupus arthritis, there are usually used non-steroidal, anti-inflammatory medications like ibuprofen, naproxen or aspirin. Usually, these medications have effect, but if this therapy is not effective, there can be added antimalarial drugs such as hydroxychloroquine.In rare cases, if the joints remain swollen and painful despite other treatment, there begins the treatment with corticosteroids.It is important that people learn joint protection procedures in order to rest the joints during flares of lupus arthritis, and another fact that must be known is that cytotoxic medications should not be used to treat only lupus arthritis.

It is known that the systemic lupus erythematosus can seriously damage the muscles, and as a result, there can appear muscle weakness and loss of strength. Inflamed muscles can be painful and tender to the touch, but the most common symptom that lupus myositis shows is muscle weakness. Usually, the muscles at he trunk of the body are affected , such as neck, pelvic girdle and thighs, shoulder girdle and upper arms.

There are some tests that can determine the severity of muscle involvement. These tests measure the level of some chemical enzymes in the blood. Normally, that enzymes are being concentrated within muscle fibers. They escape into the blood circulation when the muscle fibers are being damaged by inflammation.There can also be made an electromyogram to determine the character of muscle damage in lupus myositis, and also biopsy may be performed in order to confirm the presence of inflammation and to identify how severe it is.

As a treatment, corticosteroids are used initially in high doses, to keep the inflammation under control, and then, after it subsides, it is gradually reduced. Most of the patients responde well to this treatment, but there are rare cases when it is necessary to add cytotoxic or immunosuppressive medications.A well directed exercise program should be started after the inflammation passed, in order to regain normal muscle strength and function.

It may happen when the patient is prescribed high doses of corticosteroids with or without cytotoxic agents to appear bone damage and muscle weakness. These complications in rare cases appear due to the effects of the medications alone, they usually come because of a combination of factors.It was found that patients with systemic lupus erythematosus which took steroids for a long time can develop ischemic necrosis of bone. Altered blood flow to a portion of bone causes the death of that area, and as the bone repairs the area, a weakening of the bone occurs and a portion of the bone surface may collapse. Most affected are the hips, shoulders and knees.The first symptom of ischemic necrosis is pain when the joints are being moved or bearing weight, and the pain can be felt even when the person is resting, at night, when the condition progresses.Osteoporosis can also appear if a patient uses corticosteroids for a long time. Having osteoporosis means that the bone mass is decreased and a higher risk of bone fracture and compression of vertebrae in the spine appears. It is known that women are at a higher risk of developing osteoporosis and using calcium and vitamin D in addition to regular exercise may help prevent osteoporosis.

It is important to remember that people with lupus myositis should take a regular, well-designed exercise program in order to prevent muscle weakness.

Osteoarthritis Natural Ayurvedic Remedies and Causes


Arthritis is a joint disorder characterized by inflammation of joint, and Osteoarthritis is one of the several types of arthritis. It is the commonest form of arthritis noticeable in elderly people. Osteoarthritis is also known by the names of wear and tear arthritis, degenerative joint disease or old person's arthritis. When osteoarthritis occurs, there is wear and tear or degradation of articular cartilage and subchondral bone, as a result of which several mechanical abnormalities arise.

When cartilages are lost due to degeneration, bones at the joint are exposed to each other, and get damaged due to friction. The friction may often lead to the formation of spurs or bony outgrowths named as osteophytes. All these cause severe pain at the joints, and may even cause immobility at the joint. Due to decreased movement, atrophy of the muscles around the joint may occur, and the ligaments holding the bones in place may become loose, or stop functioning in their natural way. Hands, feet, spine, knee or hip joints are usually attacked by osteoarthritis. The pain at the affected joint may worsen, at the end of the day's usage. Humid or cold weather also worsens the pain in many osteoarthritis patients.

Causes of Osteoarthritis

1. Aging is the primary cause of osteoarthritis. As body starts aging, cartilages become weak, owing to accumulation of fluids in the cartilage and degeneration or breaking up of the protein make up. The cartilages thus become brittle, may start flaking or tiny crevasses may be formed on the surface of the cartilages. In no time total loss of cartilage may occur, exposing the bones to rub against each other. Such worn out joints become inflamed or swollen through repetitive use.

2. Obesity also causes osteoarthritis. As weight increases, the joints are compelled to bear the load of extra weight which is often beyond their capacity. The excessive pressure causes much wear and tear of the cartilage cushions.

3. Heredity or genetic grounds is also responsible for causing osteoarthritis. The disorder is often seen to run in the family.

4. Congenital joint disorder may also lead to osteoarthritis.

5. Past history of septic joint or any other joint infection may cause osteoarthritis in future.

6. Trauma or injury to joint due to accident may in future take the shape of osteoarthritis.

7. Ligamentous deterioration may cause osteoarthritis.

8. Inflammatory diseases like perthe's disease, lyme disease, gout, costochondritis may lead to osteoarthritis ultimately.

9. Diabetes is another factor causing osteoarthritis.

10. Marfan syndrome, Wilson's disease, hemochromatosis are other factors leading to osteoarthritis.

Ayurvedic herbal supplement Rumatone Gold Capsule is an effective natural remedy for osteoarthritis. One can apply Rumatone Gold Oil in conjunction with supplementing Rumatone Gold Capsule for getting faster relief from osteoarthritis.

Meniscal Tears


Arthroscopy of the knee is the most common procedure performed by orthopedic surgeons and the most frequent reason for arthroscopic knee surgery is to investigate and repair meniscal tears. Although there are two menisci in the knee: one medial and one lateral. The medial meniscus, located on the inside of the knee, is the one torn most often. There are two types of meniscal tears that occur: sudden/acute tears and degenerative tears. Sudden meniscal tears can happen during activities, like sports, through direct contact, like a football tackle, or by a movement that torques or rotates the knee. In this type of tear, some people report hearing a "pop". Conversely, degenerative tears tend to happen over time, typically without an acute injury or traumatic event. Medial meniscal tears are more likely to occur in older people, particularly from the fourth to sixth decades of life, simply because the aging tissue within the knee cannot withstand as much stress. During a flare-up, these tears can cause noticeable pain on the inside or outside part of the knee.

Common symptoms of a torn menisci are: stiffness, swelling, buckling or locking of the knee and a limited range of motion. Most patients are able to continue walking on their injured knee. The patient who has a degenerative meniscal tear tends to have good days and bad days, depending upon how irritated the meniscus is and how inflamed the knee becomes. If the patient has minimal symptoms that they can tolerate, then continued observation is appropriate. However, if the patient has disabling symptoms, arthroscopic surgery would be performed to alleviate the pain and restore motion and function.

If the symptoms become problematic for a period of six weeks or more, an MRI scan can help diagnosis the source of the problem. X-rays are not helpful in the diagnosis of a meniscal tear as they only provide imaging of the bone, but they may help your specialist rule out another problem, such as arthritis. If a meniscal tear is confirmed, your orthpaedic specialist will probably prescribe a regimen designed to reduce inflammation and to rest the injured knee.

The RICE protocol ( Rest, Ice, Compression and Elevation) along with Ibuprofen or Naproxen may provide enough relief so that the patient can tolerate the meniscal tear without considering surgery. However, if the painful symptoms do not resolve, further treatment is generally surgical in nature. The meniscus does not have a good blood supply on the inner two-thirds of its anatomy. Because of this, once a tear occurs, the likelihood of it healing is minimal.

Arthroscopic knee surgery is performed on an outpatient basis. The procedure is done through two small incisions in the front of the patient's knee, allowing access to the entire inside/outside part of the knee for treatment. The surgeon inserts a miniature camera into the knee so that the structures of the knee can be clearly visualized. Once the meniscal tear is visualized, the surgeon will insert very small surgical instruments into the knee and will trim or repair the menisci as necessary. The patient is able to go home the day of the surgery.

When recovering, the patient can put full weight on the knee and begin range of motion activities immediately. When comfortable, the patient may return to all activities. If there are no arthritic changes in the knee, recovery usually happens quickly. Your orthopaedic specialist may recommend special strengthening and Range of Motion exercises to help you achieve maximum recovery. Usually patients can rehabilitate at home, although Physical Therapy may be prescribed. Most patients recover well and without incident from Meniscal Surgery.

If you suspect you may have a Meniscal tear, you should consult with a skilled orthopaedic surgeon to get a definitive diagnosis and effective treatment plan.

Tuesday, June 4, 2013

A New Medieval Treatment For Knee Osteoarthritis


It sounds like something out of medieval times. Using leeches to treat every disease and condition known to man. But as it turns out leeches are actually very powerful for treating a wide variety of ailments including knee osteoarthritis.

Knee osteoarthritis is a degenerative joint disease that results in the breakdown of the cartilage between the joints in the knees. This leads to pain, loss of range of motion and bone damage. There appears to be several origins of knee osteoarthritis including joint deformity, repeated injury, or excess weight. There is no cure for osteoarthritis so the focus is on treatments for the pain and reduction of continued damage to the joint.

And this is where leeches come in. Leeches secrete morphine, a potent pain killer. Leeches also secrete an anticoagulant which improves blood flow to the area where the leeches are applied and an anti-inflammatory. Since inflammation is responsible for the symptoms of osteoarthritis, researchers believe that leeches might relieve pain in patients with osteoarthritis.

The U.S. Food and Drug Administration (FDA) classify leeches as medical devices and has approved them for microsurgery. The FDA is also involved in the regulation of the transport and sale of leeches. In Germany there has been an estimated 70,000 treatments a year over the last few years with four to five used for each treatment. Most of these treatments have been aimed at pain reduction in knee osteoarthritis.

Several studies have been conducted regarding the use of leeches for treating knee osteoarthritis.

One study, reported in the Annals of the Rheumatic Diseases, focused on 16 patients with an average age 68. These patients had experienced persistent knee pain for more than six months. None had suffered any knee injuries and all had x-ray evidence of osteoarthritis. These patients were already treating their knee osteoarthritis with physical therapy, relaxation, diet and exercise.

In this study, part of the group was provided traditional treatment and the rest were treated with leeches. Four leeches were applied to the knee for 80 minutes. Pain levels were measured three days before and 28 day after the treatment. The results were rapid. Treatment with leeches resulted in pain relief after three days and continued through the 28 day test period. The patients who received traditional treatment did not experience relief. There were no side effects noted from the leeches and the patients reported that the initial leech bite was mildly painful.

A larger study was conducted involving 51 patients age 40 and above with knee osteoarthritis with high pain. Four to six leeches were applied to the affected knee and were allowed to remain until they detached themselves, which took about 70 minutes. Then the patients rested the knee for 12 hours. Researchers then measured the patients' pain, stiffness and range of motion after 3, 7, 28, and 91 days.

The results were similar to the smaller study. The patients receiving leech therapy reported less pain, less stiffness, better function, and fewer total osteoarthritis symptoms through the full 91 days that the researchers followed them.

These studies give hope for alternative treatments of knee osteoarthritis for reducing pain and increasing mobility. In order to properly validate these studies additional research needs to be conducted over a longer period of time. But it appears that leeches do provide relief to knee osteoarthritis sufferers.

What is the Most Effective Supplement to Use For Joint Pain?


Joint pain or arthritis - regardless of what you decide to call it - is one of those health issues all of us anticipate we'll never ever have problems with. Regrettably, the simple fact is that 29% of people in the 45 to 65 year age bracket will display the condition. Once you hit 65 or beyond that number grows to over 50%. Studies tell us that the chances are piled against us for certain!

Arthritis (or joint pain) is the phrase applied to cover a range of associated diseases. One of those conditions is osteoarthritis - the form of joint pain many people recognize. This type of arthritis is normally common when you reach 45. What many people don't understand regarding arthritis is the fact that very early diagnosis of the condition can insure much lower severity in later years.

Before we look at what is the best supplement to take for joint pain, here are two invaluable suggestions to deal with inflamed or overtly swollen joints:

Treatment Using Ice: An ice pack should be your first course of action when attempting to manage swelling in your joints as a consequence of injury, surgery or an acute attack of arthritic joint pain. It's preferable to use ice in the afternoon and evening. Under no circumstances leave ice near to the skin for longer than 15-20 minutes at a time for the risk of frostbite of the skin. It can be remarkably effective in lowering pain, muscle spasm and inflammation.

Treatment Using Heat: Use heat in the morning while the joints are immobile after sleeping or just cold in the winter time. Warmth is perfect for maximizing the flow of blood to parts of our body that happen to be under tension. It's better utilized when swelling has reduced - never use heat on swollen joints (apply ice). Be mindful not to scold yourself when utilizing heat packs such as wheat bags or hot water bottles.

There are far too many health supplements intended for joint pain and arthritis available in the market to mention them all here in this article currently. This is not a comparison - it is merely a summary of the most likely joint pain nutritional supplement choices. Remember, what works for one person might not work for another person. Keep a positive open mind and keep trying till you locate something that starts to make a difference. Have patience, improvements frequently occur little by little at first.

There are some excellent natural alternative treatments for arthritis in shops to test. Combining supplements may perhaps work better for you than just one. An example of this could well be to put together fish oil with green lipped mussel extract. I typically get consumers informing me they consider green lipped mussel vastly better to glucosamine and chondroitin.

So - what is the best supplement to take for joint pain? Listed here are the most likely natural treatments for arthritis, as well as back pain and knee pain:

1. Check your Vitamin D levels as a protective measure against deteriorating bones as a consequence of deficient calcium uptake. You can get Vitamin D by soaking up the suns rays onto the skin each day, by way of eating habits and nutrition, and by way of supplementing. Individuals with substantial levels of Vitamin D experience less by physical diseases such as joint pain and arthritis.

2. Supplement with Glucosamine Sulphate and Chondroitin Sulphate products. Glucosamine is very nicely suited to the treatment of joint pain and inflammation since it is able to regulate cartilage metabolic process which, subsequently, helps to prevent cartilage from degenerating. Glucosamine encourages your system's natural restore mechanisms. Chondroitin works with glucosamine and should be taken simultaneously. It provides a lubricating affect on joints.

3. Fish Oil (omega 3 DHA) nutritional supplements come highly recommended in the battle against joint pain. Fish oil has both natural anti-inflammatory benefits and coronary heart health benefits. If you take hardly any other dietary supplements - you must take fish oil each day. Combine that together with green lipped mussel extract for unbelievable results in joint pain relief within just 1-3 months.

4. New Zealand Green Lipped Mussel Extract is quickly overtaking glucosamine in level of popularity and for very good reason. This natural and organic anti-inflammatory made out of ground up green mussels found solely contained in the seas encircling New Zealand can have surprising benefits with people affected by joint pain and arthritis. Loaded with omega 3 essential fatty acids, this joint dietary supplement can also be ideal for treating quite a few other inflammatory disorders for example asthma, crohns disorder, etc. Being a natural whole food, there are almost no side effects.

5. Gin-Soaked Golden Raisins. Quite a few people recommend this popular folk remedy for arthritis and joint pain. Soak the raisins in straight gin for about 7-10 days. Then eat 9 raisins on a daily basis so long as you obtain any benefit.

6. Cherry Juice contains powerful anti-oxidants known as anthocyanins that really help minimize and get rid of unfavorable free-radicals from the body. It has been found to be effective in the treatment of arthritis and gout by reducing uric acid in the bloodstream.

7. Turmeric happens to be an Asian spice that has an active ingredient named curcumin. It is this compound that is believed to be beneficial as a health supplement for joints. Include it with food or take it as a joint wellness supplement.

Is Bikram Yoga Safe For Knees After Surgery?


Knee surgery for a torn meniscus or entire knee replacement sometimes becomes imperative; its rehabilitation takes about seven to eight weeks; by that time any inflammation, redness or pain will be taken care of; as soon as you are able to put your weight on your affected leg without pain, you are ready for Bikram (hot) yoga. It is better to go slow in the beginning- right after the surgery- if there is any indication of redness, swelling or soreness, remember to ice it. Also avoid stretching or bending the leg too far. In Bikram yoga an hour and a half of performance of very challenging poses, in a room kept at 105 degrees Fahrenheit and humidity level at forty percent, produces profuse perspiration to relieve the body of all toxic wastes. It also increases the strength and elasticity in knees after surgery; and prevents injuries in future

Rewards of Bikram Yoga after Surgery


  • Strengthens inner and outer quadriceps

  • Strong inner, outer, upper and lower muscles support the weak knee

  • Increased blood flow and nutrients for the affected knee

Knee Protection while Performing Yoga

After knee surgery, one might want to return to one's lifestyle quickly, it is important to do so with extreme caution. Adopting wrong poses or pushing beyond limits can further endanger your knees. To practice Bikram yoga as you are recuperating, keep the following in mind.


  • Keep your feet well placed and aligned. Push down through all four corners of your feet for most of the asanas. If your feet are not in the right position, your knees will be affected adversely.

  • Your knees should be in line with your ankles, not moving out over them. This is important especially for lunges and knee bends. The knee must be directing towards the middle toe. In standing extended-leg forward fold, remember to pull up on the arches of the feet.

  • Some postures in Bikram yoga require locking the knees, refrain from that after surgery; you may pull in the knee-caps to take up a pose. If you need to hyperextend your knees for a certain pose, do so by keeping the knees slightly bent in most standing and forward folding positions.

  • If your hips are not opened up or extended fully, your knees will have to bear extra pressure during most of the standing postures. You must open your hips early in a class to avoid putting this strain on your knees.

Bikram yoga practitioners who have gone through knee surgery must take extra care to perform certain poses. Hero's pose if not performed rightly can pull at the knee-ligaments, while done properly, proves beneficial in healing the knees. In Triangle pose there is a risk of locking or hyper-extending your knees. In Seated-Forward Fold, bend your knees a little to avoid any further damage to your knee. To practice Child's pose, put a blanket between your buttocks and calves to reduce strain on your affected knee. As this branch of yoga puts a great emphasis on patience, you must remember to be patient and allow enough time for your body to heal fully before you put it through a demanding regimen.

Cyberwar in Estonia and the Middle East


Did a member of your family help launch a cyber attack that brought an entire nation to its knees? No, seriously, don't laugh. In April 2007, communications in the Baltic state of Estonia were crippled through a coordinated attack that relied on the computers of millions of innocent users around the world, just like you and your kin. The strike was notable in fully demonstrating how cyber war had moved from idea to reality. And it all started with the movements of a single soldier.

The Bronze Soldier is a two-meter statue which formerly stood in a small square in Tallinn, the Estonian capital, above the burial site of Soviet soldiers lost in the Second World War. The memorial has long divided the population of the country, with native Estonians considering it a symbol of Soviet (and formerly Nazi) occupation and a large minority population (around 25% of the total) of ethnic Russian immigrants seeing it as an emblem of Soviet victory over the Nazis and Russian claims over Estonia. When the country's newly appointed Ansip government initiated plans to relocate the statue and the remains as part of a 2007 electoral mandate, the move sparked the worst riots the country had ever seen - and a startling cyber attack from Russia.

On April 27, as two days of rioting shook the country and the Estonian embassy in Moscow found itself under siege, a massive distributed denial-of service (DDoS) attack overwhelmed most of Estonia's internet infrastructure, bringing online activity almost to a standstill. The targets were not military websites but civilian sites belonging to organizations such as banks, newspapers, internet service providers (ISPs), and even home users. Much of the onslaught came from hackers using ISP addresses in Russia, but the most devastating element in the attack was a botnet which co-opted millions of previously virus infected computers around the globe to pummel the Estonian infrastructure.

Anatomy of a Cyber Attack

The botnet fooled Estonian network routers into continuously resending useless packets of information to one another, rapidly flooding the infrastructure used to conduct all online business in the country. The attack centered mainly on small websites which were easy to knock out, but nevertheless was devastatingly effective. Bank websites became unreachable, paralyzing most of Estonia's financial activity. Press sites also came under attack, in an attempt to disable news sources. And ISPs were overwhelmed, blacking out internet access for significant portions of the population.

While the Estonian government was expecting there to be an online backlash to its decision to move the statue, it was completely unprepared for the scale of the cyber attack. Estonia's defense minister went on record to declare the attack "a national security situation", adding "it can effectively be compared to when your ports are shut to the sea."(1)

Once it became clear that most of the country's online business infrastructure was being affected, the Computer Emergency Response Team for Estonia (CERT-EE) issued a plea for help from IT security specialists worldwide and an ad-hoc digital rescue team was assembled, which included people from my own firm, Beyond Security. It took us a few days to get to the bottom of the threat and begin setting up frontline defenses, which mainly involved implementing BCP 38 network ingress filtering techniques across affected routers to prevent source address spoofing of internet traffic. The attack waned quickly once we started taking defensive measures. But in the days it took to fight off the attack, it is likely that the country lost billions of Euros in reduced productivity and business downtime.

Cyber War in the Middle East

The Estonian incident will go down in history as the first major (and hopefully biggest ever) example of full-blown cyber warfare. However, there is one place on earth where cyber war has become part of the day-to-day online landscape - and it is still ongoing.

In the Middle East, the Arab-Israeli conflict has a significant online element, with thousands of attacks and counter-attacks a year. This has been the situation since the collapse of peace talks in the region and was preceded by a spontaneous wide-scale cyber war between Arab and Israeli hackers in 1999 and 2000. Arab sympathizers from many nations are involved. A group of Moroccan hackers have been defacing Israeli web sites for the last six years or so, and recently Israel's military radio station was infiltrated by an Iraqi hacker.

Unlike the blitzkrieg-like strike in Estonia, this protracted warfare is not intended to paralyze critical enemy functions but more to sap morale, drain resources and hamper the economy. The targets are typically low-hanging fruit in internet terms: small transactional, informational and even homespun web sites whose security can easily be compromised. Taking over and defacing these sites is a way of intimidating the opposition - creating a feeling of 'if they are here, where else might they be?' - and leads to significant loss of data, profits and trust for the site owners.

Cyber War Spreads

If the Estonia and Middle East examples were our only experiences of cyber warfare then it might be tempting to put them down to local factors and therefore not of concern to the wider security community. Sadly, however, these instances are simply part of a much larger trend towards causing disruption on digital communications platforms. In January this year, for example, two of Kyrgyzstan's four ISPs were knocked out by a major DDoS hit whose authors remain unknown.(2) Although details are sketchy, the attack is said to have disabled as much as 80% of all internet traffic between the former Soviet Union republic and the west.

The strike appeared to have originated from Russian networks which are thought to have had links to criminal activity in the past, and probably the only thing preventing widespread disruption in this instance was the fact that Kyrgyzstan's online services, unlike those in Estonia, are poor at the best of times. It was apparently not the first such attack in the country, either.(3) It is claimed there was a politically-motivated DDoS in the country's 2005 presidential elections, allegedly attributed to a Kyrgyz journalist sympathizing with the opposition party.

China has also engaged in cyber warfare in recent years, albeit on a smaller scale. Hackers from within the country are said to have penetrated the laptop of the US defense secretary, sensitive French networks, US and German government computers, New Zealand networks and Taiwan's police, defense, election and central bank computer systems.

In a similar fashion, in 2003 cyber pests hacked into the UK Labor Party's official website and posted up a picture of US President George Bush carrying his dog - with the head of Tony Blair, the Prime Minister of the UK at the time, superimposed on it.(4) The incident drew attention to government sites' lax approach to security although in this particular event it was reported that hackers had exploited the fact that monitoring equipment used by the site hosting company had not been working properly. And as long ago as 2001, animal rights activists were resorting to hacking as a way of protesting against the fur trade, defacing luxury brand Chanel's website with images of slaughtered animals. (5)

The Case for the Defense

What do all these incidents mean for policy makers worldwide? Both the Estonian and Middle Eastern experiences show clearly that cyber war is a reality and the former, in particular, demonstrates its devastating potential. In fairness, Estonia was in some ways the perfect target for a cyber strike. Emerging from Russian sovereignty in the early 1990s with little legacy communications infrastructure, the nation was able to leapfrog the developments of western European countries and establish an economy firmly based on online services, such as banking, commerce and e-government. At the same time, the small size of the country - it is one of the least populous in the European Union - meant that most of its web sites were similarly minor and could be easily overwhelmed in the event of an attack. Last but not least, at the time of the Estonian incident, nothing on a similar scale had been experienced before.

It is safe to say that other nations will now not be caught out so easily. In fact, if anything, what happened in Estonia will have demonstrated to the rest of the world that cyber weapons can be highly effective, and so should be considered a priority for military and defense planning.

What might make cyber warfare the tactic of choice for a belligerent state? There are at least five good reasons. The first is that it is 'clean'. It can knock out a target nation's entire economy without damaging any of the underlying infrastructure.

The second is that it is an almost completely painless form of engagement for the aggressor: an attack can be launched at the press of a button without the need to commit a single soldier.

The third reason is cost-effectiveness. A 21,000-machine botnet can be acquired for 'just a few thousand dollars', a fraction of the cost of a conventional weapon, and yet can cause damage and disruption easily worth hundreds of times that.(6)

The fourth is that it is particularly difficult for national administrations to police and protect their online borders. A DDoS attack may be prevented simply by installing better firewalls around a web site (for example), but no nation currently has the power to tell its ISPs, telecommunications companies and other online businesses that they should do this, which leaves the country wide open to cyber strikes.

The last but by no means least reason is plausible deniability. In none of the cyber war attacks seen so far has it been possible to link the strike with a government authority, and in fact it would be almost impossible to do so. In the case of the Chinese hack attacks, for instance, the authorities have provided a defense which amounts to saying: 'There are probably a billion hackers on our soil and if it was us we would have to be stupid to do it from a Chinese IP address.'

A similar logic potentially provides absolution to the Russian administration in the case of Estonia: if it is so cheap and easy to get a botnet to mount a DDoS attack, why would the Russians bother mounting hack attacks from their own ISPs? And in the Kyrgyz attack, although the source of the DDoS clearly points to a Russian hand, the motives for Russia's involvement remain hazy, leading to a suggestion that it may have been caused by Kyrgyzstan's own incumbent party, acting with hired cyber criminals from Russia.

Tactics For Protection

With all these advantages, it is unlikely that any military power worth its salt is by this stage still ignoring the potential of cyber warfare. In fact, since the Estonia incident it is even possible that the incidence of cyber warfare has increased, and we are simply not aware of the fact because the defensive capabilities of the sparring nations have increased. After all, another important lesson from Estonia is that it is possible to mount a defense against cyber attacks. There is no single solution, no silver bullet, but a range of measures can be taken to deal with the kinds of DDoS issues faced by Estonia and the kinds of hacker attacks still going on in the Middle East.

For DDoS strike avoidance, there are four types of defense:
o Blocking SYN floods, which are caused when the attacker (for example) spoofs the return address of a client machine so that a server receiving a connection message from it is left hanging when it attempts to acknowledge receipt.
o Implementing BCP 38 network ingress filtering techniques to guard against forged information packets, as employed successfully in Estonia.
o Zombie Zappers, which are free, open source tools that can tell a device (or 'zombie') which is flooding a system to stop doing so.
o Low-bandwidth web sites, which prevent primitive DDoS attacks simply by not having enough capacity to help propagate the flood.

For hacker attacks such as those seen in the Middle East, meanwhile, there are
three main types of defense:
o Scanning for known vulnerabilities in the system.
o Checking for web application holes.
o Testing the entire network to detect the weakest link and plug any potential entry points.

A Doomsday Scenario?
All the above are useful defensive tactics, but what about strategic actions? First and foremost, the Estonian experience showed that it is important for the local CERT to have priority in the event of an attack, in order to ensure that things can return to normal as soon as possible.

Authorities can also as far as possible check national infrastructures for DoS and DDoS weaknesses,, and finally, national CERTs can scan all the networks they are responsible for - something the Belgian CERT has already started doing. Given the openness of the internet and the differing challenges and interests of those operating on it, these measures will of course only provide partial protection. But it is hoped they would be enough to prevent another Estonia incident. Or would they?

There is, unfortunately, another type of cyber war strike which we have yet to see and which could be several times more devastating that what happened in Estonia. Rather than trying to hack into web sites just to deface them - a time-consuming effort with relatively little payback - this tactic would involve placing 'time bombs' in the web systems concerned. These could be set to lay dormant until triggered by a specific time and date or a particular event, such as a given headline in the national news feed. They would then activate and shut down their host web site, either using an internal DoS or some other mechanism.

The code bombs could lay dormant for long enough for a malicious agency to crack and infect most or all of the major web sites of a country. And in today's networked world, this is no longer about simply causing inconvenience. Think of the number of essential services, from telephone networks to healthcare systems, which now rely on internet platforms. Knocking all these out in one go could have a truly overwhelming impact on a nation's defensive capabilities, without the need for an aggressor to send a single soldier into combat.

The means to create such an attack definitely exist. So do the means to defeat it. What has happened in Estonia and the Middle East shows we now need to consider cyber warfare as a very real threat. What could happen if we fail to guard against it really does not bear thinking about.

References
1. Mark Landler and John Markoff: 'Digital fears emerge after data siege
in Estonia'. New York Times, 29 May 2007.
2. Danny Bradbury: 'The fog of cyberwar'. The Guardian, 5 February 2009.
3. Ibid.
4. 'Labour website hacked'. BBC News, 16 June 2003.
5. 'The fur flies'. Wired, 23 January 2001.
6. Spencer Kelly: 'Buying a botnet'. BBC
World News, 12 March 2009.