by Dr Alex Jimenez DC, APRN, FNP-BC, CFMP, IFMCP | Chiropractic, Mobility & Flexibility, Power & Strength
I have been travelling through Athens and now Istanbul. My 11 year old is a Percy Jackson nut and has been filling me in with the who’s who of Greek mythology and I am learning Latin words every day. Quite an education!
I looked up the word syndesmosis and the Latin translation is “(New Latin, from Greek sundesmos) bond, ligament, from sundein, meaning to bind together”. As sports injury professionals, we know syndesmosis to be the joint articulation between the tibia and the fibula bones around the ankle. These two bones are �bound’ together with very firm and strong ligaments.
Syndesmosis comes to mind after I saw a girl sprain a syndesmosis at the Archaeological Museum in Istanbul today. This poor girl was preoccupied by the hundreds of cats and kittens running all over the place and did not see the uneven cobblestones on which she placed her foot. At the same time, she turned to change direction. This is a common mechanism of injury for a syndesmosis – a forced dorsiflexion and rotation on a fixed foot.
Rehab Masterclass Issue 140 Of Sports Injury Bulletin
Of all the ankle injuries, injury to the syndesmosis is the biggest pest to sports physios and the like. And unlike simple garden variety ankle sprains that heal quickly, the syndesmosis takes a LONG time to heal properly. If you deal with athletes that are susceptible to syndesmosis sprains, I’m sure you will agree that these are harder injuries to manage because of the severe consequences if done badly.
I go into a fair bit of detail in my Sports Injury Bulletin piece about syndesmosis injuries, detailing how they happen, how to identify them and then manage them. What I would like to highlight here are the implications of mismanaging a syndesmosis sprain.
In the current issue of The Journal of Sports and Physical Therapy, a group of Japanese researchers discovered that individuals who had chronic ankle instability (CAI) had a distal fibula that was positioned more lateral compared with healthy individuals with no CAI. In effect, those who had suffered serious syndesmosis injuries in the past and ended up with a wider distance between the fibula and the tibia, suffered more ongoing ankle pain than those without a tibfib separation.
Research shows that even a 1mm displacement of the talus within the mortise (due to a wider placed fibula) can reduce the contact area in the talocrural joint by 42% (Ramsey and Hamilton 1976). Mismanaged syndesmosis injuries, resulting in an excessive amount of opening, can lead to early onset arthritic changes and chronic ankle instability. The talus bone bounces around in the now wider tibfib articulation.
A Widening Of The Fibula Is Due To One Of The Following:
Poor initial management, whereby the athlete is allowed to weight bear too early and this weight bearing forces the fibula away from the tibia as the syndesmosis ligaments are trying to heal.
The degree of damage is so severe that proper tightening of these ligaments is not possible without surgical intervention such as a screw or similar being placed between the two bones to �force’ them together.
The key for a sports injury practitioner, is to properly identify a regular ankle sprain from a more serious syndesmosis injury. If you get this part wrong and allow the athlete to get back to weight bearing too early, then expect some complaints about a chronically painful ankle some time down the track.
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Kobayashi et al (2014). �Fibular malalignment in individuals with chronic ankle instability.’ JOPST. 44(11); pp 841-910.
Ramsey and Hamilton (1976). J Bone and J Surgery Am. 58(3); 356-357.
by Dr Alex Jimenez DC, APRN, FNP-BC, CFMP, IFMCP | Fitness, Health, Wellness
Yoga can be an effective way to prevent and ease aches and pains—but it can also cause them if you’re not careful. The key is proper alignment. Go from “ow” to “om” in seconds by making simple alignment tweaks to common poses. In this video, Yoga With Kirby founder Kirby Koo shows you quick fixes to take pressure off your knees, wrists, and neck. These basic principles can be applied throughout your practice to help prevent pain before it starts.
Warrior II
Once you’re set up in Warrior II, pay attention to the position of your front knee. Is it sticking out beyond your ankle? Is it collapsing inward? Pull your knee back into place, so it’s stacked directly above your ankle, and tracking in the same direction as the toes of your front foot. This protects the ligaments in your knee and prevents knee pain.
Related Content: Try This 15-Minute Yoga Flow for Stress Relief
Plank
Plank is a great core stabilizing exercise if you have proper alignment. But if your belly and hips sag in this pose, then your wrists are probably taking on the brunt of your body weight. In plank, engage your core muscles by imagining a zipper running up from your pubic bone to your belly button. This should help raise your hips so your body forms a continuous line from the top of your head to your heels, a more stable position that will help distribute your body weight more evenly and ease the pressure in the wrists.
Cow Pose
Cow pose can feel super satisfying, but it’s easy to go overboard and strain your neck while you’re enjoying the gentle backbend. When you’re in cow pose, it’s important to remember not to tip your head too far back, shortening the back of the neck. You’ll get a lot more out of the pose (and avoid neck strain) if you imagine your neck as an extension of the gentle curve of the spine. Lift your gaze only as far as you can without compromising the curve in your spine and the length in the back of your neck. The same concept can apply for Upward-Facing Dog, too!
by Dr Alex Jimenez DC, APRN, FNP-BC, CFMP, IFMCP | Natural Health, Wellness
The mixture of pollutants in many U.S. streams are more complicated and potentially more dangerous than previously thought, a new study suggests.
Researchers checked for 719 organic chemicals in water samples from 38 streams across the United States and found more than half of those chemicals in the different samples.
Every stream — even those in wild and uninhabited areas — had at least one of the chemicals and some had as many as 162, the study found. It was led by scientists from the U.S. Geological Survey and the Environmental Protection Agency.
The detected chemicals included: insecticides and herbicides, along with byproducts from their degradation; antibacterials such as triclosan; and medications such as antihistamines and the diabetes drug metformin.
Some of the chemicals were often detected together in streams. Further research is needed to determine the potential for complex interactions between these chemicals, to assess if they pose a threat to aquatic life, the food chain and human health, the researchers said.
The study was published April 12 in the journal Environmental Science & Technology.
by Dr Alex Jimenez DC, APRN, FNP-BC, CFMP, IFMCP | Natural Health, Wellness
Your weight just might influence your risk of migraine headaches, a new review finds.
“Those with migraine and [their] doctors need to be aware that excessive weight and extreme weight loss are not good for [migraine sufferers], and that maintaining a healthy weight can decrease the risk of migraine,” said study corresponding author Dr. B. Lee Peterlin.
She is director of headache research at Johns Hopkins University School of Medicine in Baltimore.
“Healthy lifestyle choices in terms of weight management and diet and exercise are warranted,” she added.
Migraines affect about 12 percent of U.S. adults, according to background information from Johns Hopkins. These debilitating headaches are often accompanied by throbbing, nausea and sensitivity to light and sounds.
Peterlin’s team evaluated 12 previously published studies with nearly 300,000 people, a process known as a meta-analysis.
The investigators found that obese people were 27 percent more likely to have migraines than people who were at a normal weight.
And those who were underweight were 13 percent more likely to have migraines.
The researchers used the standard definitions of both obesity — a body mass index (BMI) of 30 or higher — and underweight, a BMI of less than 18.5. A person who is 5 feet 4 inches tall and weighs 175 pounds has a BMI of 30, while someone of the same height who weighs 105 has a BMI of 18.
In previous research, Peterlin’s team found that the link between obesity and migraines was greater for women and for those under the age of 55. This new study reaffirmed those findings.
The new review found that the link between obesity and migraines is a moderate one, Peterlin said. It’s similar to the link between migraines and ischemic heart disease, in which the heart doesn’t get enough blood, she added.
Peterlin said she can’t explain with certainty how body composition affects migraine risk. But, she speculated that fat tissue “is an endocrine organ and like other endocrine organs, such as the thyroid, too much and too little cause problems.”
The change in fat tissue that occurs with weight gain or extreme weight loss alters the function and production of several proteins and hormones, Peterlin explained, changing the inflammatory environment in the body. This could make a person more prone to a migraine or it could trigger a migraine, she said.
However, the study only found an association, and not a cause-and-effect relationship, between weight and migraine risk.
The review was published April 12 in the journal Neurology.
Would weight loss or gain help? It’s not certain, Peterlin said.
“Limited data in humans show that in both episodic and chronic [migraine sufferers] who are extremely obese and undergo bariatric surgery for other health reasons also have a reduction in headache frequency by over 50 percent,” she said. Aerobic exercise has also been shown to decrease headaches.
“What is not yet clear is if it is the weight loss per se or other factors related to exercise that result in the improvement,” Peterlin said.
One headache specialist who wasn’t involved with the study lauded the findings.
The new analysis is “a valuable addition to the growing body of literature on migraine and body mass index,” said Dawn Buse, director of behavioral medicine at the Montefiore Headache Center in New York City.
With her patients, Buse said, she has seen migraine frequency increase with weight gain. And she has also seen improvement in migraines after weight loss, she said.
Buse acknowledged that, while weight loss appears to help, losing weight can be challenging. Health care professionals should discuss with their patients the relationship with migraines, and help them by providing education and referrals for treatments that may help weight loss.
by Dr Alex Jimenez DC, APRN, FNP-BC, CFMP, IFMCP | Anti Aging
You should be adding a magnesium supplement to your daily vitamin regimen in middle age to prevent fractures later, says a new study.
Bone fractures, which are often caused by osteoporosis, are one of the leading causes of disability in the elderly. Calcium and vitamin D are known to play a role in bone health, and while magnesium is a vital nutrient and an important component of bone, no studies have shown that supplements might have a beneficial effect on bone health.
Researchers at the Universities of Bristol and Eastern Finland followed 2,245 middle-aged men for 20 years. They found that men with lower blood levels of magnesium had an increased risk of fractures, particularly fractures of the hip.
Men who had higher blood levels of magnesium lowered their risk by 44 percent. None of the men who had very high magnesium levels suffered a fracture during the 20-year follow-up.
However, dietary magnesium intake was not found to be linked with fractures. Only supplements were shown to be beneficial.
“The findings do suggest that avoiding low serum concentrations of magnesium may be a promising though unproven strategy for risk prevention of fractures,” said Dr. Setor Kunutsor of the University of Bristol.
Low blood levels of magnesium are common among the middle-aged and elderly, since the mineral becomes harder for the body to absorb as it ages, but the majority of people have no symptoms. Since blood magnesium isn’t measured routinely in the hospital, those with low levels are usually not diagnosed. The researchers believe their findings could help trigger initiatives to include blood magnesium screening in routine blood panels, especially for the elderly.
Magnesium may also help solve another problem faced by seniors — getting a good night’s sleep. British researchers found that magnesium helps cells keep track of the natural cycles of day and night.
Other studies show that magnesium provides a wide range of health benefits, including boosting the immune system and lowering the risk of heart attacks. Studies have also shown that people who have migraines tend to have lower levels of magnesium than those who are headache free.
by Dr Alex Jimenez DC, APRN, FNP-BC, CFMP, IFMCP | Anti Aging, Seniors
The health benefits of exercise are well-established for people of all ages. But until now, little has been known about which type of exercise best counters the aging process in senior citizens.
The answer may be high-intensity interval training, suggests a new study published in Cell Metabolism by researchers from the Mayo Clinic.
High-intensity interval training (HIIT) alternates short bursts of intense aerobic activity such as biking or walking with short periods of easing up on the same activity.
This type of exercise, which originated in Sweden, is promoted as an efficient training method that avoids the risk of injuries associated with non-stop, repetitive activity.
Compared to other types of exercise, it appears to be dramatically more effective at boosting the activity of aging cells and even reversing age-related cellular damage.
The Mayo Clinic researchers recruited 72 healthy but sedentary men and women from two age groups: “young” subjects ages 18-30 and “older” subjects ages 65-80.
The researchers conducted baseline measurements of aerobic fitness, lean muscle mass, blood-sugar levels, and insulin sensitivity. After taking biopsies from the subjects’ thighs, they also assessed genetic activity in muscle cells and the health of the energy-producing mitochondria within those cells.
As we age, mitochondrial capacity gradually deteriorates. As a result, cells become damaged and weak.
The researchers randomly assigned subjects to one of three groups:
HIIT on stationary bicycles. Three days per week, they pedaled hard for four minutes, eased up for three minutes, then repeated the sequence three more times. On other days, they did a moderate treadmill routine,
Moderate-intensity training. Three days per week, they pedaled on stationary bikes for 30 minutes. On other days, they lifted light weights.
Vigorous weight training. Participants engaged in weight lifting several times per week.
No exercise. A fourth group did not engage in organized physical activity.
After 12 weeks, the researchers found that all three exercise groups experienced significant gains in fitness and blood-sugar regulation compared to non-exercisers.
As expected, they found that the high-intensity interval training group had the biggest improvement in endurance while the weight training group had the biggest improvement in muscle mass and strength.
But they were astonished to find that high-intensity interval training was most strongly associated with age-reversing changes at the genetic and cellular levels.
In the “younger” group assigned to high-intensity interval training, the activity level changed in 274 genes. That compared to activity-level changes in 170 genes in the moderate-intensity training group and 74 genes in the weight training group.
Genetic changes were even more dramatic in the “older” group assigned to high-intensity interval training. They saw activity-level changes in nearly 400 genes. That compared to activity-level changes in only 33 genes in the weight training group and only 19 genes in the moderate-intensity training group.
High-intensity interval training had a similar effect on mitochondrial capacity: a 49 percent increase in the “younger” group and a whopping 69 percent increase in the “older” group.
This type of exercise also led to improved insulin sensitivity, which is associated with a reduced risk of diabetes.
The researchers cautioned that their primary goal was to show how exercise works at a molecular level, not to provide prescriptive exercise for seniors or anyone else. They hope to learn more about how exercise benefits different tissues in the body.
For the time being, they say that vigorous exercise remains the most effective way to bolster health.
“There are substantial basic science data to support the idea that exercise is critically important to prevent or delay aging. There’s no substitute for that,” senior author Dr. Sreekumaran Nair said in a statement.
Most experts agree that many older adults can participate in an age-appropriate high-intensity interval training program that takes into account their physical limitations.
Older adults are more likely to have an underlying health issue such as osteoporosis, arthritis, diabetes, hypertension or a history heart disease, heart attack, or stroke.
So it’s essential for them to consult with their primary care provider and take a cardio-stress test before beginning a new exercise program, especially one that involves vigorous activity.
by Dr Alex Jimenez DC, APRN, FNP-BC, CFMP, IFMCP | Diets, Fitness
Local bans on artery-clogging trans fats in restaurant foods led to fewer heart attacks and strokes in several New York counties, a new study suggests.
The study hints at the potential for widespread health benefits from an upcoming nationwide ban, the authors and other experts say. The U.S. Food and Drug Administration in 2015 gave the food industry until next year to eliminate artificial trans fats from American products.
New York City enacted a restaurant ban on the fats in 2007 and several counties in the state did the same. Hospital admissions for heart attacks and strokes in those areas declined 6 percent starting three years after the bans, compared with counties without bans. The results translate to 43 fewer heart attacks and strokes per 100,000 people, said lead author Dr. Eric Brandt, a Yale University cardiology fellow.
His study was published Wednesday in JAMA Cardiology.
Trans fats, also called partially hydrogenated oils, enhance food texture and structure. They were once commonly used to make restaurant fried chicken, French fries, doughnuts and other foods and found in grocery items including cookies, crackers and margarine.
These fats can boost blood levels of unhealthy cholesterol, increasing risks for heart problems. The FDA in 2006 required them to be listed on food labels and the food industry has been switching to healthier oils.
The researchers examined hospital admissions data from 2002 to 2013 in 11 New York counties that adopted bans and in 25 counties that did not. Admissions for heart attacks and strokes declined in all counties, going from more than 800 to less than 700 per 100,000 people, but the drop was steeper in counties that enacted bans.
Alice Lichtenstein, a heart and nutrition specialist at Tufts University’s Boston campus, said the results are encouraging but that other changes could have contributed, such as smoking bans and mandatory calories on menus.
Dr. Mark Creager, former American Heart Association president, said the results echo previous studies “and are consistent with the thinking of most scientists” on potential benefits of these bans.
“Policies such as these when adapted on a nationwide level will be good for our entire population,” said Creager, director of Dartmouth-Hitchcock Medical Center’s heart center in Lebanon, New Hampshire.
