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Ball and Socket, Pivot, and Gliding: Keeping Your Female Hinges Healthy

Ball and Socket, Pivot, and Gliding: Keeping Your Female Hinges Healthy

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Ball and Socket, Pivot, and Gliding: Keeping Your Female Hinges Healthy

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  1. Ball and Socket, Pivot, and Gliding: Keeping Your Female Hinges Healthy Joanna Wilson, D.O. HerCare at ADC

  2. Famously Bad Posture

  3. High Heels and Posture

  4. Flat Feet

  5. Posture To Prevent Muscle Spasms

  6. Posture To Prevent Muscle Spasms

  7. Sources of Joint Pain • Muscle • Ligaments • Cartilage • Tendon • Bursa • Bone • Fascia

  8. Joint Anatomy

  9. 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:

  10. 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

  11. 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 4xthe rate of men, and they lose cartilage from the kneecap at 3xthe rate • Greater cartilage loss in women than in men began at age 40 and increased with age 

  12. Osteoarthritis Has Active Inflammation

  13. Osteoarthritis Risk Factors • Excessive loading • High BMI • Previous knee injury • Age • Genetics • Sex

  14. Female vs Male Hips

  15. Osteoarthritis Risk: Overweight • Goal BMI is <25 to reduce OA in the population by up to 53%

  16. 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

  17. Osteoarthritis Risk: Excessive Loading • Kneeling, squatting • PesPlanus, Pronation of foot, Q-angle • “Land and turn” movements

  18. Osteoarthritis: Previous Knee Injury • Ligament tears, meniscal injuries, and fractures involving the articular surface

  19. 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

  20. 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

  21. Prevention of ACL Injuries • ACL –tear prevention programs: Proprioceptive and neuromuscular training programs • Awareness of reduced joint position sense during menses

  22. Anterior Knee Pain(Patellofemoral Pain) • Twice as common in women • Due to: • Relative weakness of quadricep • Delayed firing of vastusmedialisobliqus • Increased q angle

  23. Treatment of Patellar Syndrome • PT: strengthen medial thigh muscles and hip external rotators, strengthen quadriceps • Taping of patella • Arch supports

  24. Bursitis • Inflammation of the sac filled with lubricating fluid which separates joint structures

  25. Common Bursitis Locations

  26. Sprain • Inflamed ligament

  27. Tendonitis • Tendon connects to bone and behaves as an elastic strip • Inflammation can occur

  28. Enthesopathy • Inflammation where a ligament or tendon attaches to a bone causes calcium deposits • Spurs develop

  29. Iliotibial Band Syndrome

  30. IT Band Stretches

  31. IT Band Stretch

  32. 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 (Uncariaguianensis) • Devil’s claw • Vitamin B3 (niacinamide) • Rutin • DMSO (Dimethylsulfoxide) topical • Guggul • Yucca • Willow Bark • New Zealand green-lipped mussel

  33. Supplements: Likely Effective • Glucosamine Sulfate • SAMe • Stinging Nettle (topical) • Turmeric • Bromelain • Camphor (topical)

  34. Supplements: Effective • Capsaicin topical

  35. Challenges in Supplement Research • Content variability (amount, quality) • Judging endpoints • Quality of study • Number of participants

  36. 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

  37. Exercise To Promote Joint Health • Allow compressive movement of cartilage • Increase bone strength • Tightens and thickens ligaments • Secure joint tracking with strong, balanced muscle traction

  38. 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.

  39. 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.