Transcript Ball and Socket, Pivot, and Gliding: Keeping Your Female

Ball and Socket, Pivot, and Gliding:
Keeping Your Female Hinges Healthy
Joanna Wilson, D.O.
HerCare at ADC
Famously Bad Posture
High Heels and Posture
Flat Feet
Posture To Prevent Muscle Spasms
Posture To Prevent Muscle Spasms
Sources of Joint Pain
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Muscle
Ligaments
Cartilage
Tendon
Bursa
Bone
Fascia
Joint Anatomy
Cartilage
• No blood supply
• Oxygen and nutrient delivery and waste
removal is done by compression
• Made up of four substances: collagen,
proteoglycans, water, and chondrocytes:
Cartilage
• Collagen:
Key component of cartilage; provides cartilage with its strength;
creates a framework that houses the other components of cartilage
• Proteoglycans:
Combination of protein and sugar, which trap water in cartilage;
woven around and through collagen, allowing cartilage to change
shape when compressed
• Water:
Healthy cartilage contains more than 70% water; shock absorber
and lubricates and nourishes the cartilage.
• Chondrocytes:
Cells produce new collagen and proteoglycans in cartilage; release
enzymes which help break down and dispose of aging collagen and
proteoglycans
Sex Differences in Cartilage
• Cartilage thickness and volume are greater in
boys and men vs girls and women
• Women lose cartilage from their tibia (the
larger bone between the knee and ankle) at 4x
the rate of men, and they lose cartilage from
the kneecap at 3x the rate
• Greater cartilage loss in women than in men
began at age 40 and increased with age
Osteoarthritis Has Active Inflammation
Osteoarthritis Risk Factors
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Excessive loading
High BMI
Previous knee injury
Age
Genetics
Sex
Female vs Male Hips
Osteoarthritis Risk: Overweight
• Goal BMI is <25 to reduce OA in
the population by up to 53%
Obesity-related pathways
• Accumulation of fat in muscle
which reduces muscle mass
and strength
• Instability of joint
• Reduced impact absorption at
joint by muscles
• Altered gait patterns
• Misalignment of joint
Osteoarthritis Risk: Excessive Loading
• Kneeling, squatting
• Pes Planus, Pronation of foot, Q-angle
• “Land and turn” movements
Osteoarthritis: Previous Knee Injury
• Ligament tears, meniscal injuries, and
fractures involving the articular surface
Anterior Cruciate Ligament (ACL)
• Injuries up to 10x more common in women
– Relatively smaller diameter, relative hamstring weakness,
sex hormone variations
• Due to deceleration with landing and pivoting
– 5%/year risk at collegiate level in volleyball, basketball, and
soccer
• Can cause chronic instability and osteoarthritis later
Joint Changes and Hormones
• Increased laxity during ovulatory and luteal
phases
• Increased collagen turnover during follicular
phase
• Highest likelihood of ACL injuries during menses
• Variations of hormone levels and receptors in
target tissues during peri and post menopause
– Hormone blockers and hormone replacement affect
joint pain
Prevention of ACL Injuries
• ACL –tear prevention programs:
Proprioceptive and neuromuscular training
programs
• Awareness of reduced joint position sense
during menses
Anterior Knee Pain
(Patellofemoral Pain)
• Twice as common in women
• Due to:
– Relative weakness of quadricep
– Delayed firing of vastus medialis obliqus
– Increased q angle
Treatment of Patellar Syndrome
• PT: strengthen medial thigh muscles and hip
external rotators, strengthen quadriceps
• Taping of patella
• Arch supports
Bursitis
• Inflammation of the sac filled with lubricating
fluid which separates joint structures
Common Bursitis Locations
Sprain
• Inflamed ligament
Tendonitis
• Tendon connects to bone and behaves as an
elastic strip
• Inflammation can occur
Enthesopathy
• Inflammation where a ligament or tendon
attaches to a bone causes calcium deposits
• Spurs develop
Iliotibial Band Syndrome
IT Band Stretches
IT Band Stretch
Supplements: Possibly Effective
• ASU (avocado and
soybean oils)- hip
• Boswellia (Indian
frankincense)
• Chondroitin Sulfate
• Curcumin (constituent of
turmeric)
• Ginger
• Kava Kava
• Bovine cartilage
• Cat's claw extract
(Uncaria guianensis)
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Devil’s claw
Vitamin B3 (niacinamide)
Rutin
DMSO
(Dimethylsulfoxide)
topical
Guggul
Yucca
Willow Bark
New Zealand greenlipped mussel
Supplements: Likely Effective
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Glucosamine Sulfate
SAMe
Stinging Nettle (topical)
Turmeric
Bromelain
Camphor (topical)
Supplements: Effective
• Capsaicin topical
Challenges in Supplement Research
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Content variability (amount, quality)
Judging endpoints
Quality of study
Number of participants
Nutritional Recommendations
• Fruits and vegetables for antioxidants (esp
Vitamin C)
• High calcium diet for bone strength and
muscle function
• Vitamin D for bone strength and balance
• High quality protein for muscle strength
Exercise To Promote Joint Health
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Allow compressive movement of cartilage
Increase bone strength
Tightens and thickens ligaments
Secure joint tracking with strong, balanced
muscle traction
Hamstring Curl
Stand with the front of
your thighs against a
surface (a table or wall).
Flex one knee up as far as
is comfortable. Hold for 5 10 seconds, then lower
slowly. If possible, do not
touch the floor between
repetitions. (Ankle weights
will increase the intensity.)
Do 1-3 sets with 12-15
repetitions each.
Remember to rest in
between sets.
Bent-Leg Raises
Sitting in a chair,
straighten one leg in
the air (without
locking the knee).
Hold for about one
minute. Bend your
knee to lower the leg
about halfway to the
floor. Hold for 30
seconds. Return to
starting position. Work
up to 4 reps on each
leg.
Abductor Raise
Lie on your side,
propped on one
elbow. The leg on the
floor bent, the other
straight. Slowly lift the
top leg, hold for 5 -10
seconds, then lower.
(Ankle weights will
increase the intensity).
Do 1-3 sets with 12-15
repetitions each.
Remember to rest in
between sets.
Step-Ups
Stand in front of a step,
like a sturdy bench or
stairs, about two feet high
(or less if necessary). Step
up onto the support,
straighten your knees fully
(without locking them) and
step down. Maintain a
steady pace. If you are
comfortable with your
balance, pump your arms
while doing this exercise.
Start with 1 minute, slowly
building your time.
Wall Slide
Leaning with your
back against a wall,
bend your knees 30°,
sliding down the wall,
then straighten up
again. Move slowly
and smoothly, using
your hands on the wall
for balance. Keep feet
and legs parallel, and
do not allow knees to
go out over the toes.
Repeat 5 -10 times.
Stationary Bike
Biking is a good way to
increase strength and
range of motion. Make
sure you have the
right positioning of
the legs. At the
bottom of the pedal
stroke, the bend in the
knee should be 15
degrees. Start with 10
minutes and slowly
increase your time.
Sex-Differences in Running
• Recreational, habitual exercise was not
associated with knee osteoarthritis
• Elite female runners were more likely than
male to develop knee OA
• Some studies report a higher risk of hip
osteoarthritis in men with high or moderate
levels of physical activity
The Best: Water Aerobics
Starting Exercise
• Increase intensity and novel movements with
caution
• Cross train
• Low-impact repetition is best
• Listen to your joints
• Improve range of motion, flexibility, and
balance
To Wrap It Up…
• Avoiding obesity and maintaining good
posture limits joint dysfunction
• Topical and oral supplements may be helpful,
but quality studies do not exist to confirm
benefit
• Varying your daily low-impact exercise puts
healthy stress on your joints
Thank you so much for coming today!
Joanna Wilson, D.O.
Freida Toler, FNP