The anterior cruciate ligament, or ACL, is a major ligament in the knee, which acts as a stabilizer between the femur and the tibia. Research has shown that women have a higher incidence of ACL tears than men, especially in sports like basketball, soccer, and volleyball.  They are 3 to 8 times more likely to tear the ACL than men.(1)  There are many different factors that play a role: bone anatomy, hormones, decreased hamstring strength, and smaller cross-sectional area of the ACL.

Women tend to also have a greater Q angle (See Diagram A & B), which is determined by the lines connecting the anterior superior iliac spine to patella and tibial tubercle to patella.(2)  This is due to a shorter femoral length and increase in pelvic width during puberty.  Because of this, there is a bigger lateral pull on the patella by the quadriceps femoris, which causes more medial stress on the knee.  In addition, stress on the knee can also be a result of a greater lateral tibial slope.

Diagram A: Comparisons in the Q angle between females and males(3)

Diagram B: Finding the Q angle(4)

During the menstrual cycle, serum hormonal levels can increase laxity in the knee joint, and some researchers have claimed that this laxity may increase the incidence of ACL tears.(2)  Such hormones include estrogen, progesterone, and relaxin.  They tend to decrease collagen tension and affect the strength of soft tissue.

Women have weaker hamstring muscles, relative to their quadriceps because they activate their hamstrings much less.(5)  For that reason, they tend to rely more on their ACL for support and stability.  Their muscle tissue is more flexible, and that flexibility could result in more injuries.

Along with that, research has shown that the cross section of the ACL on average is almost 14 millimeters smaller in women.(5)  Thus, the width of the space through which the ligament travels is much smaller, leading to a higher incidence of ACL tears.

Although many factors increase the risk for women to have ACL tears, there are also various ways to prevent or reduce the injury.(1)

• Cross training between different sports allows time for rest, helping to avoid injuries related to over usage of muscles.
• Warming up and stretching muscles prior to physical activity allows the muscles to lengthen safely.
• Strengthening the leg and core muscles helps to stabilize the knee.
• Protect the knee with a healthy ratio between hamstring-to-quadricep strength, which should be at least 60 percent.(6)
• Proper landing and jumping mechanics prevent the knee from injuries. (See Diagram C)
•Various rehab exercises, such as bridges, squats, and clamshells can help provide injury prevention and knee stability. (See Diagram D)

Diagram C: Correct and Incorrect Jump Landing Mechanics(7)

Diagram D: (Left to Right) Bridges(8), Squats(9) and Clamshell (10) Exercises

If you believe you are at substantial risk for an anterior cruciate ligament tear, seek a professional medical evaluation by your physician or physical therapist today.

ADI Rehab, Inc.
10585 Santa Monica Boulevard, Ste.100
Los Angeles, CA 90025
Phone: 310-481-0644
www.adirehab.com
Email: Dipalee.Patel@gmail.com, Maglaya708@aol.com

About the Authors:

Dipalee Patel, a volunteer at ADI Rehab, Inc., is an undergraduate student at the University of California, Los Angeles (UCLA) and is actively applying to physical therapy programs.  She was a former student athletic trainer with the UCLA Sports Medicine Internship Program and former volunteer at the Presbyterian Intercommunity Hospital physical therapy clinic in La Mirada, CA.  She has served as a medical volunteer at the Palm Tree Classic Invitational Gymnastics Meet and South Coast Men’s State Gymnastics Championships attended by nationally ranked gymnasts.  Dipalee is a former varsity cross country and track and field athlete at Cerritos High School and is part of a nationally competing Indian dance team at UCLA.

Cora Maglaya, PT, ATC, CSCS is the Director of Sports Medicine at ADI Rehab, Inc. in Los Angeles, CA. For more biography information on Cora, click here.

References

1. Goldenberg, Lome. “Q Angles in Men and Women”. Picture.
http://athleticconditioningcenter.blogspot.com/2011/03/female-
athletes-knee-injury-prevention.html

2. Haverbush, T. (January 1, 2012). ACL injuries in women. In Online
Orthopedics. Retrieved July 10, 2012, from http://
www.orthopodsurgeon.com/aclinwomen.html

3. Healthwise. “Clamshell Exercise”. Picture
http://medicmagic.net/how-to-tighten-thigh-and-buttocks.html

4. Herman, Ellie. “Bridges Exercise”. Picture
http://www.dummies.com/how-to/content/how-to-do-the-pilates-
bridge-exercise.html

5. Hirst, S., Armeau, E., Parish, T. Recognizing anterior cruciate ligament
tears in female athletes: What every primary care practitioner should
know. The Journal of Allied Health Sciences and Practice. Jan 2007,
Volume 5 Number 1.

6. Medic Magic. “Squats Exercise”. Picture
http://medicmagic.net/how-to-tighten-thigh-and-buttocks.html

7. Medical Arts Rehabilitation, Inc. “Determining Q Angle”. Picture.
http://medicalartsrehab.com/muscle-leg-imbalance.html

8. Reid, Michael. “Good and Bad Knee Landings”. Picture.
http://michaelreid.typepad.com/michaelreid/2007/10/girls-and-
knees.html

9. Scott-Dixon, K. (September 2006). Weak in the knees. In Experience
Life. Retrieved July 10, 2012, from http://experiencelife.com/article/
weak-in-the-knees/

10. Wood, M. L. (September 22, 2011). Why are women athletes more
likely than men to tear their Anterior Cruciate Ligament
(ACL). In WakeMed Physician Practices. Retrieved July 10,
2012, from http://www.wakemedphysicians.com/landing.cfm?
id=847&action=detail&ref=10.

Sitting at your computer in the office with poor posture for long hours can create injuries to the spine.  A stressful job and bad sitting habits can easily provoke slouching.  This is characterized by rounded shoulders, head in a forward position, and a bent spine.(1)  The ligaments, muscles and discs that support the spine weaken and become more prone to injury.  These 5 ergonomic and work-friendly tips can help prevent spine injuries from painfully impeding our daily lives and help restore a normal lifestyle.

1. Shoulders should be not too high, nor too low.

Problem: Raising the shoulders towards your ears creates unnecessary tension in the cervical and shoulder muscles, while excessive lowering of the arms to reach the keyboard or desk area strains the shoulder joint.(2)

Solution: Keep forearms parallel to the ground, and shoulder depressed downwards.  Reposition your keyboard close enough to where your elbows are at your sides.  A healthy resting position of the shoulders is not rolled forward or excessively backwards, but wide in relation to your torso.

2. Use a lower back cushion for support.

Problem: A computer screen positioned too far can result in slouching, which
puts unwanted pressure on lumbar intervertebral discs and other areas.

Solution: Place a lumbar cushion between your low back and chair to support the natural arch of your lumbar vertebrae.

3. Place far reaching objects closer to you.

Problem: It is common for the computer mouse to be placed too far away from you in sitting resulting in rounded shoulders and a flexed or slouched spine. (3)

Solution: Your elbows should be at your side when your hands are resting on the keyboard.  You can place the mouse pad closer to your right hand or even install a lower keyboard drawer (See Diagram 2) to create a space to place your keyboard and mouse at a more comfortable and safe level.

4. Position your head neutrally to maximize visibility and comfort.

Problem: Looking slightly downwards to see the computer screen, or pushing
your head forward to visually see closer the screen content.

Solution: Don’t look slightly downwards.(4)  Eyes should be looking ahead directly to the center of the screen.  Change either the vertical height of the chair of computer screen to correct this.

5. Do upper back exercises to strengthen the core.

Problem: The upper back and scapular muscles of the shoulder are weak so the spine and shoulders are not able to support itself.(5)

Solution: Perform scapular and core exercises with your physical therapist to build the endurance to withstand prolonged sitting periods at work.  This will help maintain a comfortable posture, create muscle balancing, and prevent future onset of injuries.  Check with your employer to see if they office ergonomic fitting if you are unsure if your desk workspace is ergonomically fit.

Pain in shoulders, back and hands should prompt you to immediately correct your posture, and it can help to use the first 4 tips as a checklist every 20 minutes, to reinforce your awareness of your body.

If you believe you might have a medical condition related to computer sitting, seek a professional medical evaluation by your physician or physical therapist today.

ADI Rehab, Inc.
10585 Santa Monica Boulevard, Ste.100
Los Angeles, CA 90025
Phone: 310-481-0644
www.adirehab.com
Email: reahn@ucla.edu, Maglaya708@aol.com

About the Authors:

Regina Ahn is a former physical therapy volunteer at ADI Rehab, Inc. located in Los Angeles, CA.  She is a first-year neuroscience major at the University of California Los Angeles.  She is currently pursuing a career in medicine and medical research following completion of her undergraduate program in neuroscience.  A Bay-Area native and avid viola player, she spends her free time in Club Interaxon, Global Medical Training, the UCLA Symphony, and jogging.

Cora Maglaya, PT, ATC, CSCS is the Director of Sports Medicine at ADI Rehab, Inc. in Los Angeles, CA.  For more biography information, click here.

Bibliography

1. Ergonomics Made Easy. “Avoid shoulder and neck pain at work—move your mouse.” http://www.ergonomicsmadeeasy.com/pages/shoulder-and-back-pain/avoid-shoulder-and-neck-pain-at-work-move-your-mouse-and-keyboard-and-desk. (1)

2. Ergonomics Made Easy. “Shoulder and neck pain: causes and treatment.” http://www.ergonomicsmadeeasy.com/pages/shoulder-and-back-pain/pages/shoulder-and-neck-pain. (1)

3. Ergonomics Made Easy. “3 tips for eliminating neck and shoulder pain at work.” http://www.ergonomicsmadeeasy.com/pages/shoulder-and-back-pain/3-tips-for-eliminating-neck-and-shoulder-pain-at-work. (1)

4. Gold, J.E., Driban, J.B., Yingling, V.R., Komaroff, E. Characterization of posture and comfort in laptop users in non-desk settings. Applied Ergonomics. March 2012, Volume 43, Issue 2. Web. http://www.sciencedirect.com/science/article/pii/S0003687011000871. (398)

5. Triano. “Office chair: How to reduce back pain?” Spine-Health. December 2, 2010. Web. http://www.spine-health.com/wellness/ergonomics/office-chair-how-reduce-back-pain. (1)

6. Simplified Building Concepts. “How to: Build a Custom Ergonomic Computer Desk.” Picture. http://www.simplifiedbuilding.com/blog/how-to-build-a-custom-ergonomic-computer-desk

7. Spine Universe. “Slouching Reverses the Natural Curves of the Spine.” Picture. http://www.spineuniverse.com/sites/default/files/legacy-images/rtb_posture1-RR.jpg

8. Spine Universe. The cervical and lumbar regions are curved inward and properly supported. Picture.http://www.spineuniverse.com/sites/default/files/legacy-images/rtb_posture2-RR.jpg

Often misdiagnosed as Achilles tendinitis (inflammation of the Achilles tendon), Achilles tendinosis is the actual degeneration of the tendon due to small tears, called microtears, in the tissue.  No inflammation is present in the tendon.  These microtears and subsequent Achilles problems are commonly caused by overuse and repetitive movements performed in a variety of activities, ranging from work to sports.(1)  Achilles tendinosis can often result from poor arch supports, training on uneven terrain without adequate ankle strength, abrupt changes in the intensity or duration of exercise, and untreated gastrocnemius/soleus strains.  Pain indicative of Achilles tendinosis can be anywhere from mild to severe, with possible pain and pinching sensations felt in the tendon itself.  The pain usually begins as morning soreness and gradually progresses to pain felt walking or running.(2)

A large factor thought by many to play a role in the onset of Achilles tendinosis has been inadequate stretching.  Thus, stretching thoroughly has been a common preventative prescription given by medical professionals to avoid Achilles injuries.  However, experimental evidence is lacking, revealing that there is no definitive evidence that stretching successfully prevents this injury. Though stretching has not been shown to have any beneficial preventative effects, stretching already-sore, injured tendons and muscles has been shown to help alleviate pain and soreness.(3)  Therefore, it is advised that individuals suffering from Achilles tendinosis stretch their tight calf muscles that connect to the Achilles tendon.

Another cause of injury is repetitive eccentric muscle contractions.  An eccentric muscle contraction is when the muscle contracts while being lengthened.  As such, eccentric loading of the tendon has become a routine exercise prescribed in the rehabilitation process for Achilles tendinosis.  Research has shown that eccentric calf raises and calf drops are eccentric loading exercises that will successfully strengthen the calf muscle and tendon, ultimately providing the best path to recovery.(2)

The Achilles tendon takes anywhere from weeks to months to heal, so it is important not to rush the healing process and to approach the problem with conservative treatment methods, even in minor cases.(1)   Passive stretching and eccentric calf strengthening is emphasized throughout the treatment process while the tendon takes the necessary time to repair.  More drastic measures, such as steroid injections, are neither typical nor encouraged for individuals with Achilles tendinosis and the possibility of surgery should only be explored if the tendon ruptures.  During the recovery process, one should focus on correcting limb alignment, improving calf muscle strength, using a heel lift, wearing shoes with proper arch supports, and re-evaluating training programs to avoid any errors.(4)  This may include increasing exercise duration too quickly or training on uneven terrain when the ankles are not strong enough, which may result in the Achilles tendon being overstressed.

If you believe you might have Achilles tendinosis, seek a professional medical evaluation by your physician or physical therapist today.

ADI Rehab, Inc.
10585 Santa Monica Boulevard, Ste.100
Los Angeles, CA 90025
Phone: 310-481-0644
www.adirehab.com
Email: tayfuhrmann@ucla.edu, Maglaya708@aol.com

About the Authors:

Taylor Fuhrman is a former physical therapy volunteer at ADI Rehab, Inc. in Los Angeles, CA.  She will be applying to physical therapy programs and is currently a student at the University of California Los Angeles completing her undergraduate degree in psychology.  She is a research aid for the UCLA Middle School Diversity Project.   Taylor has previously volunteered at South Coast Medical Center Hospital, Kaiser Permanente Hospital, and the UCLA Care Extender Program at Santa Monica Hospital.

Cora Maglaya, PT, ATC, CSCS is the Director of Sports Medicine at ADI Rehab, Inc. in Los Angeles, CA.  For more biography information on Cora, click here.

References:

1. WebMD. WebMD.com. Retrieved February 2012 from http://www.webmd.com/a-to-z-guides/achilles-tendon-problems-topic-overview.

2. Core Concepts Pte Ltd. CoreConcepts.com. Retrieved February 2012 from http://www.coreconcepts.com.sg/mcr/achilles-tendinopathy-15/
3. Park, D.Y., and L. Chou (2006). Stretching for prevention of Achilles tendon injuries: A review of the literature. Foot Ankle Int. 27(12):1086-1095.

4. Galloway, M.T., P. Jokl, and O.W. Dayton (1992). Achilles Tendon Overuse Injuries. Clinical Sports Medicine 11(4):771-82.

While recently researching orthotic usage, I came across an alarming statement by a minimalist shoe manufacturer,” Pre-existing conditions or injuries may mean our shoes are not right for you. If you have an injury, a biomechanical issue, an anomaly or a predisposition to a particular type of injury, consult your physician, coach, or orthotics supplier before using Newton shoes.” Everyone using a orthotic obviously has some type of biomechanical issue, an anomaly or a predisposition to a particular type of injury, a pre-existing condition or current injury. If not, they wouldn’t be using an orthotic in the first place. I find it alarming that a shoe manufacture wants the runner to get clearance from their physician, coach, or orthotic supplier before running in these shoes.

As a physical therapist, I know that runners who require a hard orthotic need more support than any shoe can offer and are more prone to injury; therefore, as an orthotic supplier, I know it’s unsafe to try to create support by putting a stable orthotic onto an unstable surface. If a runner requires the level of support a hard orthotic provides, then minimalist shoes are not for them. For the safety of my patients and customers, I always recommend that hard orthotics sit level on the platform in a properly designed, manufactured, and fitted running shoe.

Complex regional pain syndrome (CRPS) is an often disabling condition that is characterized as having pain which is disproportionate in time and intensity compared to the inciting event. It is classified as a neuropathic pain disorder and the diagnosis of CRPS-1æis made when a nerve lesion cannot be identified (as compared to CRPS-2 which has an identifiable nerve lesion). 90% of cases are classified as CRPS-1. 

To read more, click here.

One of the great joys of owning or managing a business is you get to choose your workmates.  You target, interview, employ or contract people who you believe share your sense of values, have great skills and demonstrate a willingness to grow themselves and your business.

Yet on occasions it all ends badly. Of course is it always the fault of the other party(!) even though we soften the blow with comments such as ‘it’s not you it’s me’, or ‘we are moving in a different direction’, or ‘I think it is in your best interest professionally to work in different environments’.  However, you as the supervisor, manager or director of the business may have contributed to the problem. So I present to you the

Seven sure Ways to Mismanage Your Staff

1. Think ‘It’s my way, or no way’. Yes you are clever and have more experience. In fact you are so clever you seek and hire people with skills you might not have in order to grow your business. Then you crunch their enthusiasm and enterprise by forcing them to fit your system. You might as well hire clones of you (which many people inadvertently do) in order to remain the sole source of wisdom in your business.
2. Blame or criticize the other. Criticism is very useful when presented in a safe and structured environment (for example  in a performance review) but only if it is positively presented. In such circumstances the information is received at a rational level.  Negative criticism and/or blame will be received at an emotional level which taints the information before it gets to the frontal lobe for rational analysis. Even more so if the information is received second hand (often known as ‘gossip).
3. Be intolerant or inflexible. Leading a team is not easy, and the hardest part is being aware of what is happening in your own head. Understanding your own barriers to progress is critical and is far more difficult than being a barrier to others. This is even more true if your own emotional baggage (insecurity, anxiety, frustration, fear) is filtering any incoming data.
4. Behave in a hurtful manner. Never acceptable. Be respectful at all times if you want to command respect in return. You may be able to remove the person to whom you were hurtful, but the collateral damage in others who are now aware of your mean streak will remain in the organization.
5. React before you think. Many comments or actions made in the heat of battle are later regretted. Angry emails, derogatory comments or personal attacks are evidence of emotion being the driver rather than discipline. Emotions are a normal part of life but should be filtered through the frontal lobe (not to mention the mission statement, HR policy and the legal department) before being acted on. If you can ‘own the space’ between stimulus and reaction you will be a powerful force for good.
6. Dismiss or oppose the others viewpoint. See #1.
7. Give Up. No matter how good your professional mask and demeanor, staff members will know when you have given up on them. It might be an obvious sign, ‘Miss Brown, can you please document your position description.’ Or it will be a subtle blend of verbal and non verbal signals received at the other end. For example, not being included in office banter, or meetings to which they were previously welcomed, or handing them and empty carton and asking for the office keys to be returned. Giving up often means you haven’t paid attention to the preceding six mismanagement strategies listed above. And once someone realizes you have given up on them, it is a downward spiral that can damage the organization before the final separation occurs.

These seven items are pretty obvious as you read them now while your emotions and ego are in check. Avoiding them in the heat of battle when dealing with situations or pe0ple is indicative of a strong leader. Managing others always begins with managing ourselves, this list might help you identify where to focus your improvements.