HUMAN KNEE ANATOMY

The newspaper clipping my client sent me came from Melbourne's "The Age" (12/7/2009) and was written by Gary Tippet on this exact topic. It stated that Professor Neville Owen, of Behavior Health at University of Queensland claims that too much sitting is associated with a unique sedentary physiology. According to his study, cells in the muscles start putting out signals and chemicals into the blood that cascade up through a series of changes to things like unhealthy triglyceride patterns, too much glucose. He also claims that long periods of sitting are also a likely factor in heart disease and breast and bowel cancers.

As a species, the Homosapien has been around for approximately 2 million years. "Lucy" one of the first primate fossils discovered that had the pelvic and femur joint of a "bipedal" (up on two legs) species was dated as being approximately 4 million years old.

Paul Chek a world renowned Holistic Lifestyle Exercise Practitioner describes seven primal movement patterns for the human species. These include, squat, lunge, push, pull, bend, twist and gait (walk, jog, and run). You'll note that sitting down was not one of those patterns and this is because our physical make up was never designed to sit down.

Archaeology tells us that the first time our species ever sat in chairs was only 14,000 years ago, when ancient Aztec's had the highest people (their rulers) sit on thrones. So when you think about it, in terms of evolution, 14,000 years is only a very small period of time and so, we have yet to fully evolve into a "sitting" species, but we are getting there.

Over the past 100 years, our lifestyle evolved so much though that we can almost perform an entire day's activities in the seated position. That's a total of our entire waking life, sitting down.

This causes all sorts of problems because as we haven't yet evolved to cope with all this sitting.

Lets have a quick anatomy lesson to see how sitting all day affects your posture. Even sitting in a perfectly designed ergonomic chair, it is physically impossible to maintain perfect posture for your entire seated work day. Sitting down invokes what is known in the fitness industry as the "Double Flexed" Position. Flexed at the hip and flexed at the knee.

Flexion is simply an anatomical term used to describe when the angle at a joint is decreased. When we stand upright our hip and knee joint are at 180 degrees. When we sit down, both of these joints are held at 90 degrees, they are both reduced and therefore they are flexed.

An issue with maintaining this constant state of flexion is that the muscles that cross over these two joints on the shortened side of the angle become short and tight, often causing a muscular imbalance within the body, thus affecting posture. Correspondingly, on the other side of the joint, there are balancing muscles that will become longer than normal and therefore weaker as a result. Remember muscles are similar in properties to rubber bands, if it's stretched, it's weaker. These muscles that shorten include the hip flexors, superficial abdominals, quads and hamstrings. The muscles that become longer and weaker can include the Glutes (that's your backside) and lower back.

So, sitting all day can shorten and tighten some major muscles and stretch and weaken others. That's one major downside to sitting all day.

What else is detrimentally wrong with sitting? (Posture related that is) For those of you who spend the majority of your time behind a computer as part of your working life, then there are other postural issues, that I'm about to describe. Spending all day in front of a computer screen causes your shoulders to roll forward towards the screen. This causes your chest muscles to become short and tight. On the opposite side, muscles including your rhomboids and middle trapezius become stretched and weak. This rounded shoulder position can decrease your ability to take deeper breaths than normal thus requiring you to breathe more often.

Also, staring at a computer screen all day can lead to your eye sight fatiguing leading to people often squint to see the words on the screen. A by product of this is that people will move their head closer to the screen to re-focus and this can lead to what we call forward head carriage, or poke neck.

(This is a syndrome, when your chin arrives in the room 5 mins before the rest of you) Next time you are out and about, see if you can spot someone with this affliction and look at the position of their head in relation to their shoulders. So what you ask? Well if you think about it, your head is attached to your body via your neck. In fact 8% of your body weight is contained in your head. Here's an experiment for you when you are next in the gym. Take an 8kg medicine ball and hold it in the palm of your hand directly overhead.

Now without bending your arm, move the medicine ball 5 degrees forward of your head line. How much heavier did the medicine ball just become? Like all postural imbalances, muscles on the front of your neck become short and tight and conversely, muscles on the back of your neck become long or stretched and weak. This particular condition, if left undiagnosed and untreated can lead to severe postural issues further down your spine because your head is considered the most important part of your body and so in order to compensate for any deviations from normal, your body will make adjustments down the spine to compensate for your heads position, however, this is the topic of another article. That's another major downside to sitting all day.

I've left the most obvious downside to sitting all day to last and that is, sitting all day reduces your calorie expenditure and is probably the leading cause of obesity today. When you move less (i.e. sit all day) but don't adjust your calorie intake downwards, you gain body fat. Compound this simple equation (calories in more than calories out equals body fat gain) by eating more refined sugars and more saturated fat and your weight gain propensity explodes uncontrollably upward. I don't have the time to detail the downsides of obesity. There's ample information out there outlining all of the major causes of death today are related to obesity.

So, what have we learned so far?

1. Sitting all day creates postural imbalances that can lead to decreased range of movement (motion) with various muscles
2. This can lead to a decreased ability to perform our primal movement patterns of squat, lunge pull, push, bend, twist and gait
3. Leading to a reduction in every day functioning.
4. It also can lead to a reduction in calorie expenditure, increasing the chances of gaining body fat.

So, are we all doomed? I don't believe we are. I've got some very simple strategies to help you minimise the effects of sitting all day, that A; won't deviate your daily activity from what it is today, meaning they should be reasonably easy to implement and maintain without too much trouble, B; they won't cost the earth and C; are time efficient for today's time poor person. SO, here they are:

1. If you drive to work, park 5 minutes away from your workplace and spend the extra 5 minutes walking to the office. As you become used to this walk, you can choose to park further away until such time as time constraint prevents you from parking too far away.

2. If you catch public transport, try and avoid sitting all the way. Stand up 5 minutes earlier than your proposed stop, again enabling you to stretch. Better still, get off one stop early and walk the extra distance.

3. When using escalators, don't stand still. Even though they are moving up or down, continue to walk on them. If you find your path obstructed by someone standing still, politely say "excuse me please" and you'll find they will step aside and allow you to pass. This applies to travelators at airports. By all means use them but continue to walk while on them, that way you continue to move.

4. Once you get to work, sitting down can't be helped, because you have a work station, but the length of time spent sitting can be broken down into more manageable bite sized chunks. Where's your printer located? Is it in your office? Can your default printer be changed to another one on the floor further away from you? If so, change your default printer forcing you up out of your chair so that you have to get up and walk.

5. Where is the water fountain? Is there more than one on your floor? If so, refill your water bottle from one furthest away.

6. Likewise for toilets. Do you have a choice? Can you use the one further away from you? If you drink your required amount of water per day, (that's the topic of an article on its own) you should be forced to go to the toilet a few times a day, thus creating the need to get up out of your chair.

7. Why do board meetings, staff meetings and other formalized gatherings at the workplace have to be conducted sitting down? Why can't they be done standing up? This will encourage them to be more productive and kept to shorter time frame, thus minimizing the time spent "in meetings".

8. If you work in a building with multiple floors, avoid using the lifts. Some may find this difficult, so my suggestion here is to get off a floor short of your destination and walk one floor up or down. Then as you become used to this, slowly increase the distance you walk.

9. Once you're home at night time and want to sit down to watch TV, don't sit on the couch, grab yourself a pillow, lie on the floor and do some relaxing stretches. It's a fantastic way to unwind after a long day at the office and you'll slowly wind down.

10. When sitting down for dinner, enjoy this family time. Turn off the TV, put away books and newspapers and spend some quality time with the family. Talk about the day's activities; who did what etc and re-bond with your family.

So, all is not lost. Implement what I've shown you here and you can certainly make a difference to your "incidental moving" equation and this will lead you down the path to a healthier and longer life.

An important point to remember though is that simply moving more is not enough on its own. You'll need to introduce some form of exercise routine, perhaps make some nutritional adjustments, reduce your stress levels, perhaps improved your sleep patterns all of which I can help you with.

For more information on what I've covered here, please don't hesitate to contact me. So until next time,

At a basic level, most people with fibromyalgia are suffering from diffuse muscle and tendon shortening, driven in part by multiple nerve compressions throughout the spine and limbs. Spinal origins from the neck, mid back and low back figure prominently in it's source of pain. It seems deep spinal muscles cause deep nerve compressions and traction that cause further muscle problems in the spine, limbs and head. Pain can be directly from the muscles crushing a joint, or from pain referring into the joint from the spine. Typically both exist at the same time. Headaches can exist from referred pain from the neck but also from local muscle problems around the head.

Fibromyalgia is very much a chicken and egg story. Which came first- the muscle problems or the nerve problems. The answer, for most is that the disease originates from paraspinal muscle problems. To better understand the condition, we must learn some biophysics.

One of the most important principles that must be understood is that, once adulthood is reached, adult skeletal muscles shorten with exercise, injury or any movement of the muscle. This is probably related, in part, to a decrease in growth hormone levels as we move into adulthood. It appears that growth hormone has an affect upon the degree in which muscles sustain exercise and injury.

In general, the more like a child we are, the better. This is why a child can run all day and not tire out or ache and then wake the next day and run all day yet again. This is also why most adults over thirty have difficulty running a block or two without hobbling to their car. Fortunately ,there are some people who run into their thirties and beyond. In fact, one of my patients is over sixty-five and has run as much as two marathons within a few days!

This ability is possible for several reasons. One is that most have become accomplished stretchers and can overcome the first principle. Also they probably have well-aligned biomechanics for running and likely have good running technique. Nevertheless, many of the over-thirty crowd will eventually succumb to knee pain from running .

Another important principle is that muscles that are injured during work , shorten from those injuries during rest, such as during sleep, sitting or standing. This will cause joint compression of the spine and limbs and causes crepitus, or cracking of the joint, joint stiffness, joint pain, and eventually osteoarthritis of the joint. Much of this shortening is gradual ,over months or years, but it does happen. This is why we are stiff when we wake, or after sitting or standing for a period of time. Anything that aggravates your sleep will also make the muscle shortening worse.

These very important points are part of the fibromyalgia devil's triangle that I describe. The triangle being - severe pain which causes sleep problems - which causes anxiety - which causes more muscle pain - which causes more sleep problems - which causes more anxiety and around and around it goes.

Chronic pain will disrupt normal sleep cycles by acting as a "stimulant" to your sleeping ability. Medications, supplements and treatments that block this affect will help fibromyalgia significantly.

The Fibromyalgia Triangle

Chronic Pain - Sleep Disruption - Anxiety/Depression

Walter Cannon demonstrated in the 1940's that any animal tissue that becomes denervated would become supersensitive. In other words, pinch a nerve, and all tissues supplied by that nerve would become very irritable and electrically sensitive. This actually makes sense because the tissue has lost direction from its nerve.

Not all tissue is affected in a bad way but muscle tissue responds by becoming tighter or more spastic. This kind of spasm does not go away until the nerve function is restored. This is why a person with a pinched low back nerve has trouble with hamstring lengthening and cannot bend over. There are many more possible examples but remember that a pinched nerve will cause persistent muscle spasm and other tissue abnormalities.

Another important principle is that muscles that remain persistently spastic or short will eventually scar into a tight spastic position causing abnormal joint movement and compression. This will lead to disk compression and herniation, arthritis and subluxations of the spine. It will also cause joint compression in the limbs and abnormal tracking ,which will cause abnormal wear points and osteoarthritis.

This is why I have renamed osteoarthritis compression arthritis, as it is a more accurate description of the cause of the arthritis.

To understand further, the spine is lined with five layers of muscles. The three top layers are designed to be the heavy work muscles for the spine and the two deepest layers are designed to be the structural integrity for the spine. These deep muscles, primarily the multifidus and the rotator brevis and longus muscles are probably the most important muscles of the body.

These muscles allow our spines to move without falling apart. They are very strong but also very small. They are not designed for heavy work but unfortunately will be exposed to work and injury over time. These muscles become very tight and scarred and can literally crush segments of your spine. They can be released but only with very hi-tech needling techniques, or very hi-tech exercise therapy. These muscles will be the primary cause of most spinal disease.

I should introduce the term neuropathy and myofascial pain at this point. Neuropathy is a term to describe nerve disease or injury. This includes diseases such as multiple sclerosis, but also includes myofascial compression/traction neuropathy, or "pinched nerves". The most common neuropathy, or nerve "disease" is definitely a pinched nerve because virtually all adults and most adolescents will have some degree of compression neuropathy at the base of their neck and low back. The deep spinal muscles cause directly, or indirectly, most of the pinched nerves we experience in our lives.

The term myofascial pain or MFP for short is a term to describe muscle and tendon pain. "Myo" refers to muscle, and "fascia" refers to the connective tissue of muscle and tendon. Together they refer to a group of conditions caused by muscle dysfunction that lead to various patterns of acute or chronic pain. Myofascial dysfunction or MFD is similar, but refers to the abnormal function of muscle due to neuropathy and myofascial pain.

From a biophysical point of view, the base of the neck and low back are the weak links of the spine. The base of the neck and low back are most susceptible to muscle injury and scarring. The areas of note are between the fifth cervical, or neck vertebrae and the seventh cervical vertebrae. In the low back, the weak areas are between the fourth lumbar vertebrae and the first sacral vertebrae.

Although these areas are the most susceptible by design, I will remind the readers that I have found severe abnormalities virtually at all levels of the spine and, in the case of fibromyalgia, this is generally so.

Injury factors are simply the factors related to a person's pain problem. Even though many will deny any obvious injury, I will assure that person, injuries have occurred. A quick list of injury factors include:

Increased Age Repetitive Work Types and Severity of Accidents Joint deformity Hormonal Effects (Growth Hormone, rapid cycling of periods, low estrogens and progestins, low testosterone) The Presence of Stress or Worry Inherent Anxiety Level Types of Work and Workload The Absence of Stretching Muscle Bulk and Strength Muscle Length Nerve function Inherent flexibility of muscle Types of Hobbies and Past-times Drug Effects upon muscles

There are an infinite number of Injury Factors related to MFP and MFD. The ones that I have listed are really the common ones that I see everyday. The importance in understanding the idea of an injury factor, is that it helps the individual attempt to identify which factors might be important in their pain disorder.

Not every one has the same factors at the same level of importance. The identification of a person's individual factors is very important for both recovery and maintenance of health. For instance, anxiety and depression can contribute to increased intrinsic muscle tone, especially in the upper back and neck. Stress reduction techniques will help those individuals with "stress" acting as a major factor for their condition. Hormones, or the lack thereof, may play a role in the gradual onset of MFP for most adults with chronic pain over 50. Supplementation may play a role in their recovery but probably not a singular major role.

Sharing my understanding of the importance and benefits of muscle length and stretching is a personal crusade for me. The health of a nerve can determine the health and function of its affiliated muscle groups.

Medications can have a negative and positive effect. As example, some of the cholesterol lowering medications can cause an increase in muscle spasm and shortening all over our bodies causing increased joint pain and compression. Other medications, such as anti-inflammatories, can make a dramatic change in our muscles ability to combat or recover from injury. The work we do has a large impact on the pain problems we will develop.

As a general rule, the muscle groups most used will be the groups most affected. (e.g. Letter carriers will tend to suffer torsion of their spine from carrying the postal bag and repetitive strain of their dominant arm due to sorting.)

Contrary to what might be expected by most, athletes suffer more severely than the average person does because they traumatize their muscles and joints more than the average person. However, this not need be the case, most athletes are not receiving the proper preventative care for arthritis.

One of my most important points that I am often quote is ...

"Given that a person lives long enough, we all will develop fibromyalgia. The best you can hope for is to keep it at bay."

The cause of most, if not all, fibromyalgics pain is a combination of nerve and muscle dysfunction. The deep spinal muscles cause minor or even major nerve entrapment syndromes. Those nerve injuries will cause pain that refers into our limbs, head and body. They can create dizziness, ringing of the ears ,abdominal pain and bloating. Palpitations may be created by sympathetic exaggeration .Visual blurring may originate from neck problems.

The weakest segments of the spine are the base of the neck and back but the middle of the back is also commonly affected.

Fatigue occurs for several reasons ,commonly because of a protracted disruption of sleep due to stimulation from the chronic pain. Muscles will tighten up when a nerve is pinched, as Walter Cannon proved in the 1940's. Injury factors will determine the age of onset, the severity, and the pains associated with the condition.

A comprehensive stretching program will prove to be the single determining factor for prevention. Career, lifestyle, depression and age are also important.

Good news! Although it seems like this condition is incurable, this is not so. Fibromyalgia is potentially reversible! I have demonstrated this with thousands of my patients and myself.

An example of recovery:

First a plan of attack is helpful. This is war and the stakes are high. Understanding your condition is extremely important- become comfortable with the main aspects and anatomy of the condition.

No Fear. Do not be afraid of fibromyalgia. At first the severity of pain is very scary and frustrating. However, it is very important that calmness prevails because anxiety will only make the pain and your sleep patterns worse. People do not usually die of fibromyalgia, they often only wish they did.

Learn as much as you can about stretching, physiotherapy and chiropractic.

Prevent injury. An ounce of prevention is worth a ton of cure. If you are suffering from a chronic pain syndrome, do not test the limits of the condition by over-exercising or doing tasks that you know are going to cause you more pain later. Pace yourself and attempt to reduce injury and pain. Do however, try to avoid being a couch potato.

Begin with a good, comprehensive stretching program like my Stretching Videos http://www.stretch-doctor.com Always use stretching programs in consultation with a therapist because if you "race through stretching with all guns ablazing", you are bound to get hurt. GO-SLOW is the rule of the game.

Research physiotherapy in your area and find out who is respected. Some one who has the time and patience to help a fibromyalgic is very important. Within the area of physio there are numerous tools such as "cold laser", traditional ultrasound, and a new powerful focused ultrasound that can break muscle scarring. Manipulation, stretching and traction can be helpful but are often a little too painful for the fibromyalgic in the early stages of therapy.

Chiropractic can be very effective for many people. The theories of spinal and joint relocation are basically proven. Chiropractic can be effective but it has downsides. Some of the manipulations can be too painful to endure early on in the recovery but may be more effective as the recovery proceeds.

Injection Therapy is a huge area. There are as many ways to perform this, as there are needle therapists. I myself, have developed various techniques that I call upon to break the spinal and limb muscle spasm and scars. One of my techniques is a modified version of Intramuscular Stimulation, or IMS. My mentor Dr. Chann Gunn of Vancouver, B.C, invented IMS. I have made a few modifications to "tweak it a bit." It is very important to break loose virtually all the scars in the muscle of the neck, mid-back and low back. You must then proceed to treat the limbs in their entirety. The problem with this technique is that it involves literally two to three hundred needle injections, most of which are quite painful. However, there are techniques to overcome the pain of the treatment. Paraspinal nerve blockade can diminish the pain, as well as pre-medication with analgesics like codeine and oxycodone.

Some benefit can be achieved with Botox, and, in fact, I am one of the first reported, if not the first, to treat the deepest spinal layers with Botox injection in North America. I would, however, not begin with this drastic technique, as I do not believe Botox to be the solution for fibromyalgia. Due to the extent of the muscle problem, I believe that most fibromyalgics will require some form of needle therapy to have a good recovery.

Massage Therapy can be very effective as an adjunct to fibromyalgia treatment. Patients who suffer mild symptoms may benefit even more from massage therapy but I would still add personal stretching to this. Heat is important as a therapy in itself. Many physicians are advocates for cold, where as I am a strong advocate for heat. Moist and dry heat can both be very helpful. Trial and error will be necessary for most to find which works best for you and it may vary ,time to time and area to area. This of course, is true of all the therapies.

Exercise is important to keep up in some way. I know this can be very difficult or near impossible for the severe fibromyalgics. I often suggest walking, swimming or biking in limited amounts. Remember to stretch before, sometimes during and of course, after exercise. You will find stretching after exercise will be easier and more effective.

Drugs! Doctors have an excellent knowledge of the pros and cons of medication and supplemental/herbal therapy. I should add that supplements and herbs are not the same thing. Supplements are medications that supplement what you already have in your body. Herbs are sometimes supplementing what you already have but are more often new chemicals that are foreign to your body like prescription medication. All can be very helpful but should be considered to be medications with potential side effects. The mainstay of any doctor for the treatment of fibromyalgia includes non-steroidal anti-inflammatories such as Voltaren, or the new kids on the block such as Celebrex and Vioxx (recently withdrawn from the market). These medications can be very helpful. They may not work well initially but may work as the spinal muscles are returned to their normal length. Muscle relaxants can be helpful but can be addictive. Examples include Robaxacet and Flexeril. Some of the older anti-depressants can be amazing for pain and sleep disorders. Amitrptyline, Nortriptyline and Trazadone are very effective for increasing the ability for sleep and decreasing the pain.

Remember good sleep can help break the triangle of chronic pain, sleep disorder and depression. "Brain fog" may also improve. Tryptophan and Immovane are often used for poor sleep but may be less effective. B-Blockers such as Inderal can be very effective for calming a person and reducing much of the upper body pain of fibromyalgia. Inderal, however, is contraindicated in asthmatics and possibly depressed individuals. Supplements can be very helpful. There are so many of them and the science behind them is huge, so I will only list a few. There are the old standbys of Glucosamine Sulfate, Chondroitin, Devil and Cat's Claw and Sharks Cartilage. Most of these products are aimed at cartilage supplementation and reducing inflammation. I have found them all to be helpful in some way but greatly successful for a reserved few.

Nevertheless, I often recommend them, as most people do not chew on pieces of cartilage in their diet and thus may benefit from supplementation. MSM has been recently introduced but has not been shown to be the cure-all that was promised.

Hormones. I often suggest different forms of hormone supplementation for some of my older patients with chronic pain. These hormones include testosterone for men and estrogen and progesterone for women. There will be a limited benefit for pain but some people will respond better than expected.

Growth Hormone will be a major player for pain and rehabilitation in the future. Growth Hormone is very much a "repair hormone", and will allow for pain sufferers to heal faster, and resist injury better. Be careful though, there is a downside, all hormone therapy may be associated with increased risk of cancer.

Other supplements include Melatonin, a central brain hormone that can dramatically help sleep and pain in some. It also stimulates growth hormone secretion but is not completely proven to be safe. L-Arginine is one of many amino acids that stimulates growth hormone naturally and may become a major player for pain and rehabilitation.

Creatine and Pyruvate are muscle supplements that enhance aerobic metabolism. This has the effect of allowing muscles to tolerate more injury with less shortening, i.e. less MFP. Be careful though, creatine may damage your kidneys. Calcium-B-hydroxy-B-methylbutyrate monohydrate, also known as HMB is an amazing muscle supplement that prevents muscle shortening and injury and therefore can help MFP , joint pain and performance enhancement for sports. CMO-cis-9 is an unusual fatty acid ester that is not found in humans but is found in some white mice. These specific white mice do not seem to suffer from arthritis. I have postulated that CMO-cis-9 probably acts to remyelinate (repair) damaged nerves of the spine and limbs that contribute to arthritic neuropathy.

Finally anti-oxidants may be of some benefit, as they help to reduce the damaging free-radicals that are moving through our bodies at all times. Everyday examples include Vitamins A, C and E but some stronger ones include grape seed extract and French Maritime Pine Bark. Of course, it is not a great idea to combine all these medications at once.

There is no one definite solution for fibromyalgia for all people. However, most fibromyalgics will respond gradually to a combination of physical therapy, medication and meditation. So yes, there is a cure for most patients suffering from fibromyalgia! Some people can not be totally cured but may be helped by a combination of therapy and analgesics.

Most sufferers can be reversed with a consistent but modifiable therapy consisting of stretching, physiotherapy, chiropractic, advanced needle therapy (IMS), supplemental medications, anti-inflammatories, pain killers, sleep enhancement therapy and stress reduction techniques.

All of my patients that were cured of fibromyalgia had one common thread-they all actively took part in their own recovery. I insist upon it because recovery is very difficult without the patient's deep participation and education.

You must find a physician who can guide you through the therapies and "can roll with the punches", as there is usually a wild ride up and down the road to recovery- but recovery is possible for most!

Also remember that some patients have a combination of myofascial pain with other conditions such as rheumatoid disease, cancer, radiation injury, depression, or even drug side effects. These conditions can greatly aggravate recovery and may make it impossible to fully recover unless they too are addressed.

Finally, please remember that I, and other physicians or therapists are not gods but are simply people trying to make a difference in a person's life that is truly suffering.

But there is hope!

In 1904 Dr Scholl graduated from the Illinois Medical College as a doctor of medicine. In 1912 he founded the Illinois College of Chiropody and Orthopaedics with a shoe fitter, a pharmacist, a chemist, a chiropodist, and five other doctors. The college was later renamed the Dr. William M. Scholl College of Podiatric Medicine, it is a part of the Rosalind Franklin University in North Chicago, Illinois. Today, it educates about a third of all U.S. podiatrists.

In the year of his graduation, 1904, Dr Scholl made and sold his first foot care product, the Foot-easer for arch support. By 1907, he had founded the Scholl Manufacturing Co. Inc. The worldwide expansion of the company started in 1913 with the first Foot Comfort Service shop opened in London.

Dr Scholl never stopped inventing devices to help customers with all sort of foot and leg ailments. By the 1930s, the Scholl brand sold compression hosiery to help against swollen ankles and varicose veins. Many cushioning devices that are designed to improve a wide range of foot conditions were created by Dr Scholl.

The first Scholl Exercise Sandal was launched in 1959. An international fashion hit, the Scholl Exercise Sandal became an icon for the Scholl brand. During the 1960s and 1970s celebrities, models Twiggy and Jean Shrimpton among them, wore their Scholls with pride. Nowadays, Scholl shoes are available in a full range of models with a Scholl shoe available for every need, weather, or occasion

Scholl sandals do not longer look as if the wearer has a foot problem. Women get to choose from many stylish designs from glamorous high heel sandals that are sure to make an impression at dinner parties, and gladiator style sandals for comfortable walks through the city. Scholl has comfortable casual ballerina shoes for everyday wear with leisurely clothes. Boots are available in many different styles from ankle high to over the knee. Robust boots for hiking and soft leather boots for the city in a wide range of colours ensure there is a Scholl boot for everybody. Sandals, athletic shoes, mules, professional clogs, and flip flops with Orthaheel technology are available for men and women.

The Scholl vision is to be the leading brand for foot health and wellbeing. Scholl keeps listening to consumers and developing new products that meet the needs of modern people. Responding to the needs of customers, Scholl launched Scholl Flight Socks in the late 1990s to help against the incidence of travel related Deep Vein Thrombosis (DVT). In today's world where many people take planes for transport, these special socks are clinically proven to reduce DVT in travellers.

Party Feet was brought to the market in 2003. Consumers who enjoy an active nightlife, like to wear high heels, flip flops, or sandals with narrow slings find comforting products in this line. Scholl Party Feet Flip Flop Strips help with the discomfort between the toes. The balls and the heels of the feet of those who enjoy wearing high heels can be cushioned with invisible clear gel cushions that fit into all sandals that are worn without any socks. Burning pain in the balls of the feet while wearing high heeled shoes is a thing of the past with Scholl cushions. The Party Feet line also encompasses a special plaster to give immediate pain relief at pressure points and prevent blisters from forming.

Scholl has not limited its range of products to shoes and insoles. The skin on the feet is specially adapted and thicker than at any other spot on the body. The Scholl brand has remedies for nearly any foot skin ailment from rough skin to warts. Beautiful feet begin with healthy toe nails. The Scholl Nail Brightening System is designed to whiten, brighten, and condition the nails. The Crackling Ice Spray cools and refreshes feet instantly. The Scholl Verruca Removal System helps to remove warts and is also approved for use by children. Scholl's Athlete's Foot Power or Spray reduce soreness and itching, treat the condition, and prevent reinfection.

Foot odour can be combated with Scholl Deo Active Fresh Spray or Gel. The Deo-Active Fresh products are formulated with an enhanced oxygen active component called Aseptix. It delivers instant and long lasting freshness by limiting the growth odour causing bacteria for up to 24 hours. Scholl also has odour control insoles.

Athletes are served by Scholl with the Pro Sport line, which supplies knee, ankle, and elbow support to help prevent injuries or to help the healing of sport related injuries.

Vasyli

These types of footwear were created for walking comfort with built in orthotic footbeds to help reduce excessive pronation. They have an added comfort of soft orthotic midsoles and also the adjustable straps. This is why most of the orthotics patients will always want to wear them. They are the perfect choice for patients suffering from plantar fasciitis, the Achilles tendonitis, shin splints and also heel spurs. The good thing about them is that they are available in three models, which are unisex sport model which comes with a hook and also a loop closure. There is the unisex flip-flop which comes with thong strap or women's adjusts and men's trek model which comes with adjustable heel, instep and forefoot straps. The good thing about all these models is that they are durable and also have a slip resistant outsole.

Adjust sandals

These are the types that feature a lightweight and flexible shock absorbing footbed. These pronation sandals have the build in orthotic support designed to reduce fatigue and at the same time are responsible for promoting the good posture of a human being. They have fully adjustable straps which provide a more secure fit. They have some features like the biomechanically contoured arch support and a deep heel cup. They have a shape of an anatomy that helps prevent moderate to excessive pronation. They are good in relieving heel pain and improved stability. They also relieve knee and back pain and aching legs.

Orthaheel trek sandals

These types of Orthaheel sandals are trim and light weight. They have an adjustable ankle and heel straps which provide a more secure fit. They are good especially with the many people who enjoy the active outdoor lifestyle. They have a unique motion controlling footbed which features a contoured arch support and a deep heel cup chat which realigns your stride and at the same time helps relieve foot and lower body pains. They are water resistant, lightweight, and flexible and are durable with a sole that is made or pure rubber.

High heeled shoes have been historically apart of human culture. It was first documented on ancient Egyptian murals showing both men and women of royalty wearing heels for religious ceremonies and Egyptian butchers wearing them to walk above the blood of butchered animals. In Greece and Rome, heels were worn in theatrical plays to indicate social status. Regardless of its purpose, heels have been perpetually apart of daily life since ancient civilization.

Effects of High Heeled Shoes on the Body

High heels are unique compared to other footgear due to the shoes anatomy. The structure of heels changes the positioning of bone orientation in the foot and ankle, resulting in postural changes of the body.

1. Narrow toe box

The shoe covering over the toes is called a toe box. In the design of most high heels, the toe box tends to be narrow, decreasing the space inside the shoe and increasing friction between the foot and shoe. This results in increased risk of blisters and corns forming on the foot. Additionally, a narrow or pointed toe box squeezes the ball of the foot causing bones in this area to be forced closer together. This pressure increases the likelihood of irritating the nerves that run in close proximity to the bones. Constant use of heels can exacerbate nerve irritation leading to inflammation of the nerve called a neuroma. This condition is associated with a numbing or throbbing sensation at the ball of the foot and may radiate to the toes. A narrow toe box in can also aggravate bunions and hammertoe deformities.

2. Heel Cup

The covering around the heel is called a heel cup and is often very hard and rigid in high heeled shoes. Additionally, the heel cup protrudes forward into the heel resulting in friction between the back of the wearer's heel and the shoe. This increases the pressure on the back of the heel and overtime can create a bony protrusion in the area known as a "pump bump" or Haglund's deformity, which can be painful when walking in shoes.

3. High Heel

The increased heel height places the ball of the foot lower than the heel. This position of the foot and ankle is called plantarflexion. As plantarflexion increases, the foot loses its shock absorbing ability and creates increased shock applied to the foot when the shoe hits the ground. This shock wave is transmitted through joints in the foot, knee, and hip causing leg and back pain when wearing heels.

Increased plantarflexion of the foot and ankle also shortens the calf muscle. This shortening decreases the ability of the calf muscle to help lift the foot off the ground. Overtime, a shorten calf muscle can create a tight Achilles tendon, which strains the tendon and causes pain to the area when transitioning back to normal shoe gear. Additionally, heels change body posture by increasing pressure on the ball of the foot and decreasing pressure on the heel. This results in increased pressure in the knee joint and strains the knee joint tendons, leading to arthritis of the knee. Studies have shown that even moderate heel heights of 1.5 inches can significantly increase strain to the knee. By distributing body weight unevenly and causing the wearer to lean forward, heels can increase the risk of falls.

Preventing Adverse Effects of High Heeled Shoes on the Body

Statistics has shown that 35-65% of women wear heels. However, there are preventive treatments that can alleviate pain and decrease adverse effects associated with wearing heels.

1. Custom Inserts

Custom made inserts that are placed inside heels can reduce the impact force the body experiences when wearing heels. Custom inserts support the arch and heel of the foot by increasing the area of foot contact to the shoe and distributing body weight to the middle of the foot. This can relieve some of the pressure from the heel and ball of the foot. Research studies have shown that custom inserts have been clinically proven to improve comfort.

2. Stretching

As mentioned above, higher heels tend to shorten and contract muscles in the foot and shorten the Achilles tendon and calf musculature, which results in increased workload on these muscles and tendons. Therefore, stretching these areas can relieve pain and aid in more comfortable transitioning between heels to flat shoe gear. Wrapping a towel around the ball of the foot and pulling the towel towards the body stretches the bottom of the foot. It is usually recommended to hold the stretch for 30 seconds and alternating between each foot 3-4 times. A runner's stretch is often recommended to stretch the Achilles tendon. This stretch entails pushing against a wall while one foot is forward and bent and the other foot placed back and straight. The foot placed back is stretching the muscles and tendons in the back of the lower leg. This stretch again is held for 30 seconds and is alternated with the other foot 3-4 times.

3. Rotating types of shoes

Alternating between supportive athletic shoes, flats and heels can decrease the potential problems associated with wearing high-heeled shoes.

Aries:

· Head, pituitary, cerebrum, cerebellum, facial bones, upper jaw
· Wounds, fevers, short temperedness, diseases of impure blood, inflammatory disorders, sleeping sickness, headache, pyorrhoea, insomnia eye trouble.

Taurus:

· Neck, gullet, throat, bones of neck, ears, thyroid gland, lower jaw
· Goitre [swelling in neck], weak venous system, obesity

Gemini:

· Skin, respiratory canal, lungs, nervous system, bones of shoulder, collar arms and hands, upper ribs
· Tuberculosis, pneumonia, asthma, nervous tension, gout

Cancer:

· Breast, chest, heart, stomach, digestive organs, epigastric region
· Cancer, smallpox, dropsy, constant mental maladies,

Leo:

· Spine, back, pancreas, liver, heart
· Heart, stomach, blood, and spine diseases, Diabetes, low stamina and will power, fainting

Virgo:

· Abdominal umbilical region, intestines and bowel
· Appendicitis, constipation, nervous breakdown, masturbation, venereal diseases

Libra:

· Skin, kidneys, lumber region, ovaries, sperm ducts, uriters, epidermis
· Gout, arthritis, venereal diseases, diabetes, renal stones, Bright's disease, nephritis

Scorpio:

· Urinary system, sexual organs, anus, bladder, nasal organs, pelvic bone, colon
· Piles, boils, urinary tract infection, ulcers, and nervous troubles

Sagittarius:

· Hips, arterial system, thighs, nerves
· Anaemia, jaundice, cold, diabetes, high fever, poor digestion, gout, paralysis, fits

Capricorn:

· Bones, knees, joints, hair, nails
· Eye, throat, teeth diseases, joint pains, leprosy, leucoderma, elephant feet

Aquarius:

· Legs, ankles, blood circulation
· Cancerous disease, leg fractures, nervous diseases

Pisces:

· Bones of feet and toes, lymphatic system
· Gout, joint pains, tumours, excess of mucous, tuberculosis

BY: GEETA JHA [SPIRITUAL HEALER]

INDIA

CMA training commonly takes 5 months to a year to finish and most schools issue a diploma or certificate upon completion. If you have a little more time on your hands you can receive your Associate's Degree which will take up to two years to complete the program. The more time you devote to your education the more prepared you will be.

So what are the majority of MAs trained to do in an office? And is it difficult to get trained as a medical assistant? We will consider those questions in the following article.

Typical Job Duties

Most CMAs work in the office of a physician. Ordinarily, they find work in medical offices of general practitioners.

Medical assistants work with the medical staff in many various ways. CMAs can work in an administrative and clinical capacity. Administrative duties could require scheduling appointments, signing patients in and handling basic billing issues.

Learning Special Skills

As a CMA you have the flexibility to work in all sorts of professions including podiatry and optometry. These are very specialized areas of medicine that necessitate specific skills. As an example, a podiatric CMA will need to take foot castings of patients and will need to be familiar with that part of the human anatomy.

If you work with an orthopedic physician you will need to be familiar with the knees and spinal cord, two areas that are susceptible to injuries. It also helps to be familiar with physical therapy techniques and common sports injuries. This knowledge will help you to assist your physician more thoroughly.

Extra Certifications

Fundamental medical assistant training will give you the skill sets that are required to work in an office. But if you're wanting a challenge, you should examine becoming certified in some specialized procedures. With further certification you can draw blood, monitor stress tests and take basic x-rays. Normally, these procedures require extra education. You could be asked to pass the AAMA exam. These additional skills will help you advance in your career and make a higher salary.

Training for Your Certification

So what should you think about before applying for a job as a heathcare assistant? You should enjoy working with people and possess a sympathetic and patient demeanor. It really helps to have an interest in the medical environment.

You likely already know that most employers only want to hire certified medical assistants. Before you can acquire your certification you will want to take a training course that can run between 6 months to a year.

Upon completion of your training it's time to take the AAMA exam. Once you pass the test you will take home your credentials as a CMA - a certified medical assistant. Now that you are certified your employer will feel more confident giving you extra tasks, and you may even get a pay hike!

A Career With a Bright Future

Yes, working as a medical assistant will certainly have it's challenges, but the rewards are wonderful. Both administrative and clinical MAs can expect to receive a great amount of challenge and reward in their arena of employment. Do not wait any longer - find a school near you and begin on your medical assistant certification soon!