Monday, September 2, 2013

Osteoarthritis of the Knee - Treatment Options


Treatment for osteoarthritis of the knee can take a variety of forms, from exercise and bracing, to pharmacological and surgical options.

When the disease process is in its early stages and symptoms are mild, treatment usually consists of analgesia and a conservative program of weight loss and physical therapy. As the symptoms grow in severity, the treatment also becomes more serious with a variety of surgical interventions considered. The decision to escalate treatment is dependent on the individual and their pain levels, their knowledge of the condition, and the advice of medical professionals.

In order to provide informed consent, one must first possess sufficient knowledge of the procedure in question, including the intended benefits and potential risks.

The following summarizes the different treatment options:

Pharmacological

Once the pain becomes unmanageable with non-prescription medication, a medical practitioner needs to be consulted as each persons' personal medical history affects which of the higher classes of drugs are suitable and safe to use. Typical medications include non-steroidal anti-inflammatories and low doses of opioids such as codeine.

Exercise

The quadriceps and hamstring muscles cross over the knee joint and provide support. Due to the pain of osteoarthritis, it is typical for sufferers to be less active than previously, and muscle strength decreases. The result is a reduction in support of the knee joint and a vicious cycle is established when more pain occurs. Exercise to increase the strength of these key muscles can stop this cycle and slow the progression of degenerative joint disease. This usually occurs with the help of a physical therapist. Weight loss is also a significant goal of this type of treatment.

Bracing

If only one half of the knee (inside or outside) is affected, orthopaedic bracing can help by offloading the affected side and redistributing the weight. It does not treat the affected area but can provide symptomatic relief and delay the need for more serious options.

Surgery

Surgical management can include relatively minor procedures like arthroscopy (key-hole surgery) and continue to total knee arthroplasty or joint replacement.

An arthroscopy can be both a diagnostic tool and a treatment. Through small incisions, a camera and implements are placed into the joint and the extent of the degeneration observed. Rough surfaces can be made less so, and meniscal tears trimmed. The surfaces remain worn and the benefits vary significantly between patients. Arthroscopy rarely provides long term relief but has a low complication rate.

For unicompartmental arthritis - where only either the inside or outside of the knee are affected - an operation called a High Tibial Osteotomy may be performed. This involves either adding or removing a wedge of bone to offload the affected side and return weight to the underutilized surface. This operation is usually done on patients too young to have a total knee replacement with the aim being to provide some relief from pain while the patient moves closer to a suitable age.

As the majority of the pain in arthritic knees comes from the worn joint surfaces, replacing these joints is an effective treatment. It is also a significant surgical procedure that involves the insertion of a prosthesis. With the increased benefits comes increased risks. There is also a limited life expectancy of the operation itself with the possibility of future revision surgery.

Potential complications include infection, DVT, nerve damage, ongoing pain / failure to improve pain, loosening of the prosthesis and complications from the anaesthetic.

Although these complications are thankfully rare, they should discourage people with mild pain from considering surgical intervention until their pain is having a significantly negative effect on their quality of life.

A sensible approach to the osteoarthritic knee would be to act early on the risk factors you can change such as weight and muscle strength. This can help decrease pain and delay the need for more drastic measures.

When pain no longer responds to analgesia, mobility is significantly decreased, and everyday activities become difficult, it is time to discuss your options with an experienced Orthopaedic Specialist. Even if surgery is required, previous work done in the areas of weight loss and strengthening will make the recovery easier and quicker.

Sunday, September 1, 2013

What to Expect During Knee Surgery Recovery


Several techniques of repair and transplant have been developed in the field of knee surgery with varying degrees of success. For meniscal repair, a surgeon attaches sutures to hold the edges together. After serious types of ligament injuries the mobility of the knee joint is restricted. Mild ligament injuries usually heal well. During knee surgery recovery, you will need to commit yourself to a program of rehabilitation and should take care to be free from infection during the post operative period.

A total knee replacement or half knee replacement is performed by the surgeon depending on the extent of degenerative damage that your knee has suffered. Half knee replacement is a procedure that is performed if only one side of the knee is damaged. Patients who have undergone this procedure show a quick knee surgery recovery and are able to get to get on with their normal lives within a short period.

Most artificial knees will last ten years or more. Subsequent surgical procedures may be less successful than the original surgery. So, knee replacement is advised for older patients who are less likely to need replacements. During knee surgery recovery, you will be given pain relieving drugs and a course of antibiotics to prevent infection from setting in the joint.

You can try walking the day after the invasive procedure as a part of knee recovery surgery. The physiotherapist will assist you in recommending a specific exercise routine that you may have to follow for resuming the movement in your knee joints. Recovery rates on this kind of surgery vary from person to person. After two weeks you may be able to move about using crutches and within six weeks you may be able to manage even climbing stairs without straining the area around your knee joints.

It is very essential that you practice knee strengthening exercises regularly during knee surgery recovery to maintain the stability of the knee joint. You should take care of your knee and protect it from damage for a period of six months from the time of the surgery. This will ensure that the knee surgery recovery is complete. It may take some more time for the knee to get back its full function.

You must follow an exercise program to strengthen and stretch the muscle groups that support the functioning of the knees to maintain the stability of the joint during knee surgery recovery.

Why Do My Joints Pop and Crack?


It is not unusual to hear somebodies knee joint crack, or someone crack their knuckle joints, or hear their neck joints pop. Maybe when they walk, their ankle joint cracks, their knee joint grinds or their ankle clicks. There are different reasons why a persons joints will crack, pop and grind like this. This is a general overview of three common reasons why joints snap, crack and pop.

Gas Release

All the joints in our bodies have a water balloon like structure that surrounds them called the joint capsule. The capsule is filled with synovial fluid, which along with containing nutrients for the joints, lubricates the joint and helps reduce friction. Inside of the synovial fluid is a variety of gases including nitrogen, oxygen and carbon dioxide. When the joint is stretched beyond its normal range of movement, the pressure inside the joint capsule changes, this pressure change creates a vacuum effect and forms a bubble from gases dissolved in the fluid. This change in pressure causes the bubble to collapse, and gas is quickly released producing the cracking or popping sound within the joint. The gases must build up inside the fluid again, in order for the joint to make the cracking or popping noise again. This is why your knuckles might crack, but it takes a little while before they will pop again.

Moving Joints

Movement between two bones forming a joint, and the attached ligaments and tendons of that joint can be another source of the joint cracking, popping or snapping. As the tendons and ligaments are in motion and their positions continuously changing, in some people the tendon may click over a bony prominence or outer knee or ankle bone and move a little bit in and out of place. As the tendon moves from one position to another it may 'snap" back to its alternate position. Sometimes after exercise your ligaments or tendons may tighten, and as you begin to move the knee, ankle or other joint, it may crack or make a popping sound due to this reason.

Arthritic Joints

Smooth cartilage surrounds the ends of bones in a normal healthy joint. If the joint surfaces become rough or damaged, some of the cracking or grinding noise may result from the friction between the two bone surfaces rubbing on each other. This can also be painful for some people as the damage becomes worse over time.

Are Cracking Or Popping Joints Bad?

Are cracking joints bad for you? Generally speaking there have not been any conclusive studies saying there are any negative long term effects of cracking your knuckles or other joints. Over manipulating your joints or the feeling that you constantly need to crack your joints may be evidence of an underlying mechanical problem or joint stress.

That said if you are starting to experience pain when you move your joints, and there is snapping, crackling or popping, than you should see a health care professional for a more in depth examination of your specific problem.

One of the positive benefits of increased joint movement may occur after a chiropractic adjustment. The response of certain sensory receptors around the joint, called the Golgi Tendon Organs, sends information back to the brain about joint function and how much tension is on the joint or muscle. Often times an adjustment helps to "reset" this tension and creates the feeling of looseness or relaxation. Some other receptors called mechanoreceptors are in discs, tendons, ligaments and muscles of the spinal joints. The cerebellum primarily functions as a result of input from these mechanoreceptors in the joints and muscle spindles. When this input is decreased, the cerebellum may function at a lower level resulting in the inability to perform precise movements, or maybe lose muscle tone, or maintain normal posture. Chiropractic adjustments may help to restore normal movement and firing of these joint nerve receptors. Proper joint movement and sensory feedback is very important to the healthy function of the cerebellum and nervous system.

This article is meant as a general overview and for informational purposes only and should not be used to replace the advice of a qualified professional. It is my goal goal for the public to better understand their health and general wellbeing. I urge you to consult with a qualified health care provider for diagnosis and for answers to your individual health questions.

Arthritis Knee Exercises Strengthen the Muscles That Support the Knee


Arthritis knee exercises are very important if one is experiencing arthritis in the knee joints. Exercise is one way to maintain a strong and healthy cartilage as it has the effect of strengthening the tendons and muscles that support the knee. However, not all exercises will help the person suffering from knee arthritis, as such; one must call an expert on arthritis knee exercise, because wrong exercise will just worsen the situation. Here are some knee exercises to help you in your arthritis problems.

The simplest way to exercise one's knee is by sitting in a chair and letting your feet flat on the floor. It is important to know that when one doing this exercise, one must see to it that one's thigh is parallel to the floor. The proper way of sitting can help the muscles and tendons surrounding the knee to relax and remove any stress accompanying it. One can put variations like pointing and moving one's toes, slowly lifting the feet to make it parallel to the ground or raising the feet and doing a small circular motion.

Another simple exercise is by sitting on the ground while the legs are crossed. In this way, the muscles and tendons are stretched without you exerting any effort. The person may remain in this position for at least 30 seconds and then incorporate certain variations. One can slowly push his knee to the ground in order to put additional pressure on the muscles of the joints. It can be noticed that when the legs are crossed, one leg is on top of the other, hence; one should change the position of the legs and then apply pressure again.

Some complicated arthritis knee exercises include the quad set exercise, knee extension with leg lift, drake exercises, static hold exercise, straight leg raise, hamstring set exercise, and many more.

The quad set exercise is done to tighten the muscles of the thigh and the legs in order to strongly support the knee joints. This is made by lying down comfortably and tucking in the knee into the stomach. Be sure that the legs are parallel to the ground and the toes are pointed. Fold the knee for 10 seconds, and thereafter rest it for 5 seconds, repeat the process but make the tuck tighter.

The knee extension with leg lift is done lying down and putting an object under your heel that will raise your legs at least 3 inches above the ground. In this position, try to slowly lift the leg up and then slowly putting it down. Do this exercise by lifting only one leg at the time and the other leg is used as a support.

When doing any arthritis knee exercises, one must be sensitive of any pain that he may feel. If the pain becomes unbearable, immediately stop what you are doing and see a doctor. As stated, not all exercises are suitable to all knee arthritis problems, and the best way to know the applicable knee exercise program is to consult a doctor or an experienced health professional.

Elena Georgian (Part III)


I was definitely tired and the night had been heavy upon my nerves which added to my fatigue. Naturally with the following day promising much in the way of activity, I needed to get a shower and in to bed so that I might benefit from at least some hours of sleeping time before I would be; once again forced to face another day of work.

The water felt so delicious upon my skin as it washed away all the dirt and grim off my body yet above all and in a metaphorical way; it took away all the worries of the day from my mind apart from the idea of slumber and the delicate beauty of my Elena Georgian. It would Elena's visions which would see me drift off to sleep as I with imagination created so many sensual and at times even erotic scenarios of her. It always being her sweet voice which surrounded my images as to yield in me the sensation that Elena was a woman whom I need beyond all else.

I finished my shower and as soon as I did, I put on my night clothes which were a simple pair of long shorts and a t-shirt and it was just as I turned off the light to go to bed that a knock at the door prevented me from going any further with my plans. Who it could be was but a question my hopes were more than willing that it would be my Angelic soprana, come to deliver upon my words of good night in her voice which always did find a way to arouse in me thoughts of all magnificence.

The knock on the door had brought my conscience being to that of almost being asleep and as I went over to the door; there was that part of me that almost knew as well as needed that it be my Elena Georgian. I asked who it was yet not without enthusiasm's hope yet to assure myself that I would not be opening the door to the wrong kind of person. The voice which came to my ears was as the light sound of music in hearing "It is me, Elena Georgian, please open the door.". I as instructed opened the door with so much keenness as if perked up by that which was mightier than any coffee or Red Bull as my eyes opened as widely as nature allowed them to.

There she was my Elena Georgian, standing directly in front of me in a display of beauty to go beyond that which I could merely appreciate and to the point where I was stunned. It perhaps being apparent to Elena as she gazed in to my eyes as she for a moment stood at my door in that long black dress of hers which almost seemed to have been created so that she might enchant all about her. I opened the door wider as I saw Elena so that she might come in and tell me that which had brought her to my door at such a late hour and it was with fervor to show that I could be a gracious host that I saw her as she sensually went past the door way.

As soon as Elena had entered my room, I closed the door as it would have never been my intension that any who might be passing by observe that she had come to my room at such a late hour of the night. Elena stood there in amazing style as her high heels shoes elevated her to where she took an air of a deity of the night or perhaps its queen; like in the famous aria by Mozart. How deliciously Elena sang this aria as her voices elevated itself to the peaks of ecstasy of all that was humanity.

Elena smiled at me as if she wanted to say something yet before she could speak or perhaps she was waiting for me to say something first; I with all the grace of not giving away my desire in soft voice said "Would you like to sit down and tell me what fortunes bring your lovely voice to my room?". "Multomesc" was her reply as she sat down on the sofa located in this rather large room of mine which did also include an arm chair as well as rather nice table between them. There was always something I could not really ever get over at seeing a lady I admired sit down softly and gently when wearing an evening gown. It being as if Elena's was a graceful act yet so simple in just taking a seat as one leg went over the other. This as if all too aware that the eyes of an admirer were upon her whom she meant to slightly enthrall as well as torture with her gestures of sensuality.

Elena took her seat and did appear tired yet kept her qualities of mystery as she without smile or wishes to hide her intensions, looked directly in to my eyes; who stood in front of her not fully aware weather I should offer her something. "I want my panties back, please give them to me. I need them, my husband likes and he was the one who gave them to me.". It was not so much what Elena said which surprised me but the way she spoke that intrigued me. Of course, I was all too aware that this was an item which belonged to her and it was my obligation to return it to her yet there was a mystery in the way she spoke as she sat there with all the confidence of a diva.

Elena exposing the typical posture in sitting of a woman who is all too sentient that eyes about dare not miss a moment or instant or even a single motion in the fear that she might expose another sight of her feminine elegance. Elena's lovely stocking covered leg leading the view on to the rest of the grand artist of the opera that she was. I must admit that I did not expect Elena to wish to get her panties back yet I held no quarrels which prevented me from handing them back without even the slightest protest from my part.

Elena looking at me as if those devilish eyes of hers held a trap which I was falling in to yet I simply turned around and went to where I kept them which was in the pocket of my jacket. I took them and it was as I stroked them again that I was reminded of their meaning yet I would be forced to return them. I walked over to where Elena waited for me as if she were a predator; I suddenly feeling her gaze and even hidden smile as she observed my almost devotion to the item of hers I held in my hand. I was about to give them to Elena who sat as coolly as she was beautiful without even holding her hand out but just remained seated. Elena having eyes fixed on me the whole time almost without expression as she with slight touch of foot removed the shoe from the leg which had been pointing toward me. What a classical move it had been as to make me almost giggle to myself in how somebody could be so desirable yet almost not be aware of it.

I got closer with Elena panties yet all the time, I felt like a teenager of no more than 13 who was experiencing his first view of a lady whom had fascinated him. My elation showed itself yet Elena remained unaltered as I walked toward her. I was close enough to Elena where all she needed to do was stretch out her arm that she might take them yet did not and if anything let me get nearer to my partial surprise. It was however as I was practically on top of her that that leg stretched itself out and with its length slightly bent; stroking my root in the most tender of ways with the bottom of her foot. A stroke perhaps would not fit the action yet it was but a caress as to resemble the most delightful of feelings upon my body. Elena's foot in part stopping me and in another; sending me a message.

"Don't give them to me, you took them off me now you have to put them back on!" was Elena's message which in way was a command direct from the logic of justice which to a large extent added up to a request which I could not deny. Elena did not change her expression as she held out her leg so that I might place the panties which had become famous, down one of her legs which is precisely what I did. This as my hands were allowed to savor the lovely silk and the sensuality which came from beneath. My mind being as if swamped with images to the point that it did not fully know where to send my eyes. Elena's glamorous leg and the way she set up her body was all too enticing yet as I started to slip on her panties, the feel of the foot which had taken so many liberties with my root seemed to capture my imagination. My attentions focusing on it as my hands were ever tempted to massage it yet were brought back by her second foot which would also be needed for me to put back the panties to their rightful place.

Carefully did I open Elena's panties that they might not tear and slid right in and as they did, the sight was of majesty to see the way her legs so warmly rubbed together as she almost wiggled so they might be brought back to be the cover for her rose. My hands moving them down with all the daintiness of her silks accompanying me as if a blind man yet it was once they reached Elena's thighs that she with hand stopped me and without word stood up. This as I followed what I could see was the path her intensions seemed to be setting for me. I dropping to bended knee in honor of my Elena as if in prayer to my diva whilst she stood above me; looking down with gentle gaze. Elena's panties had not been fully restored to their true owner which was her rose yet with her warm eyes upon my dedicated self giving back what my desire had previously taken; lust filled me beyond all reason.

At this point as it was Elena's delicacy and never anything that might be other which motivated me as I simply with slight madness lifted the dress which was hers and with daring not yet justified; placed a kiss on her rose. So smooth was Elena's flower in its depravation of hair as to make me feel as if the lips my mouth was caressing were those which decorated and face yet these were of her femininity. It being temptation of her fragrance and her warm look which neither proclaimed me to continue or pause for that matter yet held me as friend that I placed a passionate kiss upon them. My tongue making its way to her garden with all the ease of Elena's moisture which felt just like I imagined her mouth would and with as much sweetness. It being my hands which held Elena's pillow as my taste ventured further. Elena's approval was mine as her hands with force now pushed my head that it might not with cowardice nor bashfulness be stopped as her harmonies of delight reached my ears as the grandest of opera arias could.

It is hard to say how long my palate required yet as I looked up with all the melodies concluding, I noticed a smile on Elena's face that was different than I expected or would have ever thought after such a kiss. Elena then at that moment simply pulling up her own panties as I observed her ease in to them. I with a look of confusion as Elena simply placed back her panties to their rightful place as she walked around me; still on my knees at my mistress. Elena almost taunting me as she almost skipped around me like a girl who has just had her wish while I looked upon her in despair. Elena even taking joy in the way my eyes tried to devour her yet stood in front of me with certain decorum as she said "thank you for returning my panties but I really have to go now. I liked your kiss but time will give us more and all will come but not in one night. I know you understand. Good night my writer and I will see you tomorrow at the breakfast table so wake up early so you can eat with my husband and me.".

Elena at this moment taking on a sense of perhaps dark humor yet her body and all that composed her was sheer divinity. Elena's hair a red like a painting as it cascaded down in the dim light that was my room while her dress completed sensuous portrait of lady diva. Elena waited just that second that I might declare the night over with the words "good night". These words being precisely my last as she in a coquette way walked out of my room; leaving me to my sleep and dreams of her.

Knee Arthritis and Foot Orthotics


If you have painful wear and tear osteoarthritis of the knee, a podiatrist is probably the last medical professional that comes to your mind. Most people would think of an orthopedic surgeon or maybe a physical therapist. However, recent studies demonstrate that mild to moderate knee arthritis can be treated successfully using custom foot orthotics. Foot orthotics are orthopedic appliances made from a casting of your feet that enhance your natural walking motion.

Osteoarthritis of the knee is a common condition that can cause knee pain and disability. It is hard to walk, enjoy life, or do much of anything if your knee is stiffer than the Tin Man from the Wizard of Oz. Using foot orthotics as an additional treatment option should be good news for patients looking to take less pain pills, avoid injections, put off knee surgery, and struggling to lose weight.

How does a foot orthotic reduce knee pain? It is thought that wedging your foot with an orthotic shifts your weight away from the painful arthritic area of the knee. Also, orthotics can decrease rotational forces on the knee. Future studies are needed to investigate whether or not orthotics can really slow the progression of knee arthritis.

A study by Rubin and Menz found pain reduction in almost all subjects with the degree of pain reduction greater in patients with less severe arthritis. Another study by Butler used motion analysis methods and found foot orthotics reduced joint movements and forces (joint moments).

I perform a lot of walking slow motion video studies in my podiatry practice. Often I observe timing problems with the knee during these studies, which can lead to arthritis over time. Sometimes a knee will rotate inward excessively or it won't fully extend making that limb function shorter. Another example is when patients have their same side knee excessively flexed during heel strike. This has very poor implications for shock absorption.

If you think you may have knee pain from arthritis please see your primary care physician or a good orthopedist like Dr. Anthony Nwakama. We are truly blessed to have such a talented orthopedic surgeon here in Southwest Minnesota. Your doctor may want to take X-rays or blood tests to rule out other types of arthritis.

Now as a podiatrist, I don't really treat knee arthritis. I just treat the foot dysfunction that leads to knee pain or knee arthritis. If your knee arthritis is mild or moderate, then consider custom foot orthotics as a non-invasive drug free treatment alternative.

The Definitive History of the T-Shirt


Today the modern T-shirt has spawned a vast textile and fashion industry, worth over two-billion dollars to the world's retail trade. The unlikely birth of the t-shirt was a rather unspectacular event, however this humble piece of attire was set to change the styles and fashions of cultures for generations to come. Eventually the T-Shirt would be used as a political tool for protest and in certain times and places in history, a symbol of revolution and change.

At the very beginning the t-shirt was little more than a piece of underwear, an extremely utilitarian one at that. In the late 19th century the union suit, (also colloquially known as long johns), was in its hey day, worn across America and northern parts of Europe. Popular throughout class and generation, this modest knitted one-piece covered the whole body, from the neck to the wrists and ankles. The designs pièce de résistance featured a drop flap in the back for ease of use in the old outhouse. As cotton became more and more widely available, underwear manufacturers seized the moment to create an alternative to this mainstay and rather cumbersome design. Knitted material is difficult to cut and sew seams and thus with cotton a radical shift towards mass-made fashion could begin.

In Europe times were changing, as the Americans continued to sweat and itch, a simple "T-shaped" template was cut twice from a piece of cotton cloth and the two pieces faced and stitched together in a lowly European workhouse. It was half a pair of long johns, but it soon took on a life of its own. As the Industrial Revolution reached its inevitable conclusion, Henry T. Ford created the world's first production line, the ideas of functionalism, efficiency, and utilitarian style entered the mainstream consciousness of societies across the world, and Europe in particular. Many began to question the Puritanism of the past, Victorian buttoned-down ideas of modesty were starting to give way to scantier and scantier swimsuits, ankle-bearing skirts, and short-sleeved shirts. As World War One loomed upon the horizon, the t-shirt was about to be conscripted to the army.

Historical researchers define the first recorded incident of the introduction of the T-shirt to the United States occurred during World War One when US soldiers remarked upon the light cotton undershirts European soldiers were issued as standard uniform. American soldiers were fuming, their government were still issuing woolen uniforms, this wasn't fashion, it was practically a tactical military disadvantage. How could a sniper keep still and aim his rifle with beads of sweat pouring in his eyes, and an itch that just wouldn't go away? The US army may not have reacted as quickly as their troops would have liked, but the highly practical and light t-shirt would soon make its way back to the mainstream American consumer.

Due to their highly recognizable shape, and want for a better name, the word "T-shirt" was coined, and as the word found its place in the cultural lexicon, people across the world began to adopt the new and more comfortable alternative to the union shirt. A handful of American experts claim that the name was coined in 1932 when Howard Jones commissioned "Jockey" to design a new sweat absorbing shirt for the USC Trojans football team. However the US army contests the origins of the word come from army training shirts, being the military it was not long before practicality ensured the abbreviation. There is one alternative theory, little known and rather graphic in its interpretation. Essentially the idea that shortened-length arms were described as akin to the shape of an amputees torso, a common sight in the bloodier battles of the past, though this speculation cannot be verified, the idea has a gory ring of truth about it. During World War II the T-shirt was finally issued as standard underwear for all ranks in both the U.S. Army and the Navy. Although the T-shirt was intended as underwear, soldiers performing strenuous battle games or construction work, and especially those based in warmer climes would often wear an uncovered T-shirt. On July the 13th, 1942, the cover story for Life magazine features a photo of a soldier wearing a T-shirt with the text "Air Corps Gunnery School".

In the first few years after World War Two, the European fashion for wearing T-shirts as an outer garment, inspired mainly by new US army uniforms, spread to the civilian population of America. In 1948 the New York Times reported a new and unique marketing tool for that year's campaign for New York Governor Thomas E. Dewey. It was the first recorded "slogan T-Shirt", the message read "Dew It for Dewey", closely repeated by the more famous "I Like Ike" T-shirts in Dwight D. Eisenhower's presidential campaign.

In the early 1950s enterprising companies based in Miami, Florida, began to decorate tee shirts with Floridian resort names and even cartoon characters. The first recorded graphic t-shirt catalogue was created by Tropix Togs, by its creator and founder, Miami entrepreneur Sam Kantor. They were the original licensee for Walt Disney characters that included Mickey Mouse and Davy Crockett. Later other companies expanded into the tee shirt printing business that included Sherry Manufacturing Company also based in Miami.

Sherry began business in 1948, the owner and founder, Quinton Sandler, was quick to catch onto the new T-shirt trend, and quickly expanded the screen print scarf company into the largest screen print licensed apparel producer in the United States. Soon more and more celebrities were seen on national TV sporting this new risqué apparel including John Wayne, and Marlon Brando. In 1955 James Dean gave the T-Shirt street credibility in the classic movie "Rebel Without A Cause". The T-Shirt was fast evolving into a contemporary symbol of rebellious youth. The initial furore and public outcry soon died down and within time even the American Bible Belt could see its practicality of design.

In the 60's people began to tie dye and screenprint the basic cotton T-Shirt making it an even bigger commercial success. Advances in printing and dying allowed more variety and the Tank Top, Muscle Shirt, Scoop Neck, V-Neck, and many other variations of the T-Shirt came in to fashion. During this period of cultural experimentation and upheaval, many independent T-shirt printers made copies of "Guerrillero Heroico, or Heroic Guerilla", the famous portrait of Ernesto "Che" Guevara taken by Alberto "Korda" Diaz. Since which it is said to be the most reproduced image in the history of photography, mainly thanks to the rise of the T-shirt.

The 1960's also saw the creation of the "Ringer T-shirt" which became a staple fashion for youth and rock-n-rollers. The decade also saw the emergence of tie-dyeing and screen-printing on the basic T-shirt. In 1959, "Plastisol", a more durable and stretchable ink, was invented, allowing much more variety in t-shirt designs. As textile technologies improved, new T-shirt styles were soon introduced, including the the tank top, the A-shirt (infamously known as the "wife beater"), the muscle shirt, scoop necks, and of course V-necks.

More and more iconic T-shirts were designed and created throughout the Psychedelic era, including more and more home-made experiments. A tidal wave of tie-died t-shirts began to appear at the burgeoning music festival scenes in Western Europe and America. By the late 60's it was practically a required dress code amongst the West Coast hippie culture. Band T-shirts became another extremely popular form of T shirt, cheaply printed and sold at live gigs and concerts of the day, the tradition continues to the present, band T shirts are as popular as ever, however the price of them has risen dramatically.

In 1975 Vivienne Westwood makes her mark at 430 King's Road, London at the "Sex" boutique with her new Punk-style t-shirts, including her infamous "God Save The Queen" design. Punk introduced an explosion of independent fashion designers and in particular t-shirt designers. To this day many modern designs pay tribute to the "grunge-look" of this rebellious and anarchic period of Western culture.

The influx of corporate funding of the 1980's changed the whole face of the T-shirt market. Slogan T-shirts were gaining popularity again, "Choose Life" was produced to promote the debut album of George Micheal's band "Wham", whilst "Frankie Says" helped push a string of highly controversial singles to the top of the UK charts for Liverpool based band "Frankie Goes to Hollywood". Bands, football teams, political parties, advertising agencies, business convention organizers, in fact anyone after a piece of cheap promotion began to commission and sell vast numbers of T-shirts. One noble exception of the time was the now iconic "Feed the World" T-shirt, created to raise funds and awareness of the original and groundbreaking Band Aid charity event.

During the 80's and 90's T-Shirt production and printing technologies vastly improved, including early forms of D.T.G (Direct to Garment Transfer) printing, increased the volume and availability. Whilst in financial circles, the world's stock markets took notice as the American T-Shirt was classed as a commodity item in the apparel industry.

Branded corporate labels soon made their massive mark on the industry. A whole new generation of T-shirt designs swamped the market, promoting conformity and allegiance to a brand name, such as Nike, rather than an expression of individuality. This rather uninspiring tradition still continues to this day, the now iconic "Vintage 82" T-shirt from "Next" for example. Within a few years of its first printing, this design was allowed to flood the market, until cheap copies and black market knock-offs have saturated the world. There are many similar designs which have a similar limited cultural shelf-life.

More recently an inspiring movement towards re-politicizing the T-shirt has enabled pressure groups and charities to push their message to a wider audience. Over one million people marched into London wearing a vast array of anti war, anti Bush and anti Blair T shirts at the anti Iraq rally. Another example, reminiscent of the earlier Band Aid event, saw The Make Poverty History campaign of 2005 receive global media coverage. Soon after Vivienne Westwood re-emerges in the T-shirt world with her new slogan T-shirt "I am not a terrorist, please don't arrest me". Catherine Hamnett, another famous British fashion designer is well known for her protest T-shirts, including her work to highlight Third World debt and the Aids epidemic in Africa. Then again, Catherine has recently been quoted as saying political slogan shirts allow the consumer to "feel they have participated in democratic action", when in fact all they have done is a little clothes shopping. This maybe true, however they still bring enormous media attention to any just cause.

Over the years the styles, images, and contribution to free society that T-shirts have provided are taken as granted, the T-shirt is now an essential accompaniment for any fashionable wardrobe, no matter what part of the world. Still yet more technical advances in the industry have allowed for more choices in style and cut. Oversize T-shirts that extend down to the knees, are popular with hip hop and skater fashions. Seasons change, however from time to time the female market embraces more tight-fitting "cropped" T-shirt styles, cut short enough to reveal the midriff. The rise of the "hoodie" or hooded long sleeved T-shirt cannot be ignored, it is also fast becoming an essential addition to any street wise fashionista's collection.

Recently there has been a massive consumer backlash against the branded conformity of the corporate and licensed t-shirt market. The consumer is at last regaining some sense of individuality, people today are not satisfied with the notion of "brand loyalty". People want to reflect their own personality, political beliefs, sense of style or humor. Some are designing their own with the help of a wide selection of D.I.Y online t-shirt printing services, including "Cafe Press" and "Threadless" to mention just two. But many people neither have the time nor the inclination to design their own artwork, and so marks the rise of the independent T-shirt designer. Reminiscent of the 1960's but with a worldwide appeal, artists, graphic designers, renegades of the fashion world are beginning to get noticed. The greatest asset a modern T-shirt can have is its originality, a quality that will always be in demand, both now and hopefully far into the future.