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Musculoskeletal Consumer Review : Journal Vol 1

Musculoskeletal Consumer Review : Journal Vol 1

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When we first started planning for what eventually became Musculoskeletal Consumer Review or MCR as we call it, we asked ourselves - “Does the world needcanother collection of articles on health conditions?”. Socasked the people who knew best - our clients.

Surprisingly, the answer was yes. But with a few caveats.

First, write to them as intelligent people but who happen to have limited knowledge on matt ers of health.

Second, don’t barrage them with jargon. Most did not appreciate being swamped with jargon.

Last but not least, they wanted interesting and diff erent topics. There are literally thousands of musculoskeletal conditions but only a few common conditions get written up on all the time.

So with these few conditions in hand, we wrote clearly and simply. We pitched the articles somewhere between a lay-person and a medical professional. And we looked at conditions less frequently covered by other sources of information.

This journal collects a selection of articles from our main site. We hope that you fi nd them useful if not interesting and that we kept faith the few caveats above.
When we first started planning for what eventually became Musculoskeletal Consumer Review or MCR as we call it, we asked ourselves - “Does the world needcanother collection of articles on health conditions?”. Socasked the people who knew best - our clients.

Surprisingly, the answer was yes. But with a few caveats.

First, write to them as intelligent people but who happen to have limited knowledge on matt ers of health.

Second, don’t barrage them with jargon. Most did not appreciate being swamped with jargon.

Last but not least, they wanted interesting and diff erent topics. There are literally thousands of musculoskeletal conditions but only a few common conditions get written up on all the time.

So with these few conditions in hand, we wrote clearly and simply. We pitched the articles somewhere between a lay-person and a medical professional. And we looked at conditions less frequently covered by other sources of information.

This journal collects a selection of articles from our main site. We hope that you fi nd them useful if not interesting and that we kept faith the few caveats above.

More info:

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02/03/2013

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Musculoskeletal Consumer Review Volume 2009:1 1Published byMusculoskeletal Consumer Review
 A division of Core Concepts Pte Ltd
 
73 Tras Street, #02-01Singapore 079012Tel: 6226 3632www.CoreConcepts.com.sg
 Articles originally appeared inmcr.corecon
-
All rights reserved. No part of this book shall be reproduced, stored in
a retrieval system, or transmied by
any means, electronic, mechanical,photocopying, recording, or other-
wise, without wrien permission
from the publisher. No patent liabil-ity is assumed with respect to the useof the information contained herein.Although every precaution has beentaken in the preparation of this book,the publisher and author assume noresponsibility for errors or omissions.Nor is any liability assumed for dam-ages resulting from the use of the in-formation contained herein.
Copyright 2009 Core Concepts Pte LtdArtworks/Images: iStockPhoto
From the Editor
When we rst started planning for what eventually be
-came Musculoskeletal Consumer Review or MCR aswe call it, we asked ourselves - “Does the world needanother collection of articles on health conditions?”. Soasked the people who knew best - our clients.Surprisingly, the answer was yes. But with a fewcaveats.First, write to them as intelligent people but who happen
to have limited knowledge on maers of health.
Second, don’t barrage them with jargon. Most did notappreciate being swamped with jargon.
Last but not least, they wanted interesting and dierent
topics. There are literally thousands of musculoskeletalconditions but only a few common conditions get
wrien up on all the time.
So with these few conditions in hand, we wrote clear lyand simply. We pitched the articles somewhere betweena lay-person and a medical professional. And we lookedat conditions less frequently covered by other sourcesof information.This journal collects a selection of articles from our main
site. We hope that you nd them useful if not interesting
and that we kept faith the few caveats above.Cindy TanEditor, Musculoskeletal Review
MCR
MUSCULOSKELETAL HEALTH GROUP
 H 
ave you ever had the feeling thatyour headache is somehow relatedto the pain in your neck? How thatit is such a coincidence that every time your
headache is preceded by the sti neck that youare experiencing? You are not imagining it! It is
what the medical community calls cervicogenicheadaches, which means headaches originatingfrom the neck.
What are the usual complaints
from people who suer from
cervicogenicheadaches?
Most suerers complain of a
deep dull ache starting from the base of the skull to the top of thehead, usually over just one sideof the head. It may be presenton both sides if the neck pain
and stiness are on both sides
of the neck. Other complaintsinclude feeling pressure at the back of the eye and discomfortin the jaw.
Another symptom that conrms
the diagnosis is the presenceof tenderness when pressure isapplied over area of the cervicalspine immediately under theskull. In some cases, whenpressure is applied for long
enough, suerers feel some relief
from the headache.
What are some of the activitiesthat aggravate this condition?
Typically, activities that require the neck to bein a sustained strained position for a prolongedperiod of time will aggravate this problem. The
neck posture is oen faulty, the head is turned ortilted to one side or suerer is adopting the “poke
chin” position.Example of such activities include reading, using
the computer especially the laptop, puing on
make up, looking up for too long or watching
Neck-Related Headaches
Nerves to the Head
Spinal cordC1 vertebraC2 vertebraC3 vertebraNerves
source: visiblebody & core concepts
 
2 Musculoskeletal Consumer Review Volume 2009:1Musculoskeletal Consumer Review Volume 2009:1 3movies or theatre when seatedon the side of the hall.
Why do theseactivities aggravatethe headache?
When we adopt the “poke chin”posture, we apply compressivestress to the upper part of thecervical spine, namely, C1 andC2 levels (C1/C2 refers to the
rst two cervical vertebrae in
the spine). Similarly, when weturn our head to one side, wecompress the C1-2 level on thesame side. This happens asmost of the movement of thehead occurs at these 2 spinallevels. So if we sustained thesepostures or repetitively performthem, these 2 levels will startto degenerate and the cartilage wears out over
time. This in turn results in stiness of the upper
cervical spine.
What is relevance between the C1-2 levels and headaches?
The nerves that exit C1-2 and sometimes C3supply sensation to the back of the skull to thetop of the head and in some people to the jawarea. The nerves that exit from the right side ofthe neck will supply only the right side of the
head, likewise for the le.When these joints are sti or mal-aligned, thenerves at the aected levels will be irritated
causing pain. So when one has a right-sided
upper neck pain or stiness, the pain is always
referred to the right side of the head.
What can we do?
We need to improve the cervical joint alignmentand mobility at the C1-2 levels and to removethe compressive forces, which is to adopt goodposture. This will reduce the irritation to thenerves.If the cervical facet joints are slightly rotated dueto contractile forces of tight muscles surrounding
the neck, the aected joints are already in
some amount of compression and may notallow full functional or physiological range. Inthis situation, physiotherapists can apply the
“MUSCLE ENERGY TECHNIQUE” to realign the
 joint position. This technique uses the musclesto reposition the joint.Once the joint is in a neutral position, the actual
stiness (hypomobility) can then be accuratelyassessed. Stiness can be treated by various
techniques, such as passive mobilization through
C1 vertebraC2 vertebraNerves exiting between C1 andC2 vertebrae getirritated whencompressed
source: visiblebody & core concepts
C1-2 Nerve Compression
The Buckling Knee
 H 
aving a sense of the knee ‘giving way’ or‘locking’ is a fairly common complaint by athletes who have twisted theirknees in sports like basketball, netball, socceror badminton. The sensation of ‘giving way’is an indication that you might have torn yourAnterior Cruciate Ligament (ACL) while the‘locking’ sensation is an indication of a possiblemeniscus tear.
ACL Injury
The ACL is a fairly strong ligament found between the knee-joint. Its main role is to limitthe forward movement (anterior translation) ofthe leg bone (tibia) on the thigh bone (femur).When athletes change direction quickly duringtheir games, they twist their knee inwards. Thisincreases the strain on the ACL and places theligament at risk of tearing. The ACL tears whenthe knee is force downwards and inwards beyondthe ligament’s ability to hold. Athletes who tear
their ACL oen report hearing a ‘pop’ on injury.
Unfortunately, the ACL is very rarely the onlyligament involved in this kind of injury. It isnormally accompanied with a slight tear in theMedial Collateral Ligament (MCL) and either amedial or lateral meniscus (cartilage) tear. Thesethree tears are commonly known as the ‘UnhappyTriad’ or ‘Terrible Triad’.
Meniscal Injury
The meniscus, which is a crescent shaped cartilage between the knee, acts as a cushion to absorbthe impact between the leg and thigh bone. The
meniscus is beer at the handling stress from an
up and down motion. It doesn’t do as well undera twisting motion especially when compressed.This motion can cause a tear in the meniscus.The knee feels ‘locked’ when the torn part of themeniscus blocks the movement of the knee.Immediate swelling and severe pain in the kneeare common signs of this Triad injury. However,there are occasions where there will be a delayin the onset of swelling or even no swelling atall. Remember how you injured the knee. It helpsyour Doctor or Physiotherapist in diagnosingthis problem.
Solving the Problem
Sadly, the ACL doesn’t heal on its own due tothe poor blood supply to the ligament. It wouldneed to be reconstructed surgically by usingeither your hamstring tendon or patella tendon.
Rehabilitation aer surgery normally takes about
6-9 months before the athlete is able to go back tofull training.Nevertheless, there are about 20% of peoplewith ACL tears who are able to go about theirday-to-day activities without having their ACLreconstructed. To cope without surgery, thefollowing muscles need to have good strengthand control:Hamstrings
Quadriceps (thigh)
Gluteus MediusGastrocneumius (calf)
. . . continue on page 18

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