Abu Ahmad Hanbali Ibn Adam

*BENEFITS OF CUPPING THERAPY/HIJAMA*

🚨 _Opens occlusions of capillaries._

🚨 *Hijama can increase your intelligence, concentration, memory, and especially awareness!*

🚨 _Stabilizes blood pressure._

🚨 _Helps the body to return to normal balanced state (by removing acidity and strengthening alkaline environment)._

🚨 *Improves the cardiovascular system.*

🚨 _Reduces inflammation._

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Assalaam Alaykum Warahmatullaah Wabarakaatuh

PLANTAR FASCIITIS SELF-TREATMENT

Regular, gentle stretching of your Achilles tendon and plantar fascia may help to ease your symptoms. This is because most people with plantar fasciitis have a slight tightness of their Achilles tendon. If this is the case, it tends to pull at the back of your heel and has a knock-on effect of keeping your plantar fascia tight. Also, when you are asleep overnight, your plantar fascia tends to tighten up (which is why it is usually most painful first thing in the morning). The aim of these exercises is to loosen up the tendons and fascia gently above and below your heel.

1. Soleus Stretch
With both knees apart and your toes facing forward, lean into the wall until you feel the stretch in your lower calf. Hold for 30 seconds and repeat 3 times.

2. Step Stretch
Stand with your toes on a step and your heels off the edge. Slowly lower your heels down, hold for 15 seconds, and then lift your heels to their starting position. You can either do both feet at the same time, or one foot at a time. Repeat five times.

3. Roll Stretch
Using a mini roll, roll it back and forth from your toes to your heels. Alternatively you can use a tennis ball or a glass bottle.

4. Plantar Fascia Massage
Using two fingers, apply small circular friction to any tight knots or lumps in the plantar fascia. The pressure should be deep, but not so much that you tighten up with pain.

5. Elastic Strap Stretch
Sit on the floor with your legs straight in from of you. Take a stretch strap and place it around your toes. Gently pull the strap towards you. Hold for 15-30 seconds, then release. Repeat 3 times.

6. Toe Stretch
Place just toes up on the wall with the ball of the foot and heel on the ground. Lean into the wall slowly until stretch is felt. Hold for 30 seconds and repeat 3 times.

Can plantar fasciitis be prevented?
There are certain things that you can do to try to prevent plantar fasciitis, especially if you have had it before. These include:

▪️Regularly changing training shoes used for running or walking
▪️Wearing shoes with good cushioning in the heels and good arch support
▪️Losing weight if you are overweight
▪️Regularly stretching the plantar fascia and Achilles tendon, especially before exercise
▪️Avoiding exercising on hard surfaces

🔈 ANATOMY OF THE SCIATIC NERVE

Several important nerves arise from the sacral plexus and either supply the gluteal region (e.g., superior and inferior gluteal nerves) or pass through it to supply perineum and thigh (e.g., the pudental and sciatic nerves, respectively).

Sciatic Nerve is the largest nerve in the body and is the continuation of the main part of the sacral plexus. The branches converge at the inferior border of the piriformis to form the sciatic nerve, a thick, flattened band approximately 2cm wide. The sciatic nerve is the most lateral structure emerging through the greater sciatic foramen inferior to the piriformis.

Medial to the sciatic nerve are the inferior gluteal nerve and vessels, the internal pudendal vessels, and the pudendal nerve. The sciatic nerve runs inferolaterally under cover of the gluteus maximus, midwy between the greater trochanter and ischial tuberosity. The nerve rests on the ischium and then passes posterior to the obturator internus, quadratus femoris and adductor magnus muscles. The sciatic nerve is so large that it receives a named branch of the inferior gluteal artery, the artery to the sciatic nerve.

🔈 PES ANSERINE BURSITIS

Pes Anserine Bursitis causes pain on the inner side of the knee, approximately 2-3 cms below the knee joint. It typically affects athletes especially runners and swimmers due to overuse, or overweight middle aged females due to increased pressure through the bursa.

Pain from pes anserine bursitis usually develops gradually rather than suddenly and tends to get worse with activities such as stair climbing and running. There are a number of things you can do to aid the healing process and stop the problem from coming back.

Here we will look at the causes and symptoms for pes anserine bursitis to help you make a full recovery.

➡️ What Is Pes Anserine Bursitis?

Pes Anserine Bursitis is when there is inflammation of the pes anserine bursa, causing medial knee pain.

The pes anserinus is an area on the medial (inner) side of the knee where three muscle tendons attach to the tibia (shin bone).

Pes anserinus means “goose’s foot” and it gets its name from the webbed-foot shape made by these three tendons where they join together forming one tendon and attach to the shin bone. From front to back they are:

The Pes Anserine Bursa sits underneath the conjoined tendon of sartorius, gracilis and semitendinosus.
1) Sartorius: the longest muscle in the body which runs across and down the front of the thigh helping to bend the knee and hip
2) Gracilis: a hip adductor (draws the leg inwards)
3) Semitendinosus: one of the three hamstring muscles that work together to bend the knee

Sitting underneath this conjoined tendon is the pes anserine bursa, a small sac filled with fluid. The bursa is there to reduce friction between the tendon and the tibia as the knee moves by providing cushioning and allowing smooth gliding movements of the tendon without any friction.

➡️ What Causes Pes Anserine Bursitis?

Repetitive stress or friction over the area results in inflammation of the pes anserine bursa. The bursa produces excessive fluid and thus swells, placing pressure on the surrounding structures. The most common causes of pes anserine bursitis are:

1) Repetitive Stress
Activities where the three muscles are being used repetitively, such as in running (particularly uphill), cycling, swimming (particularly breaststroke), and side-to-side movements can cause friction and pressure on the bursa.

2) Muscle Weakness/Tightness
Weakness and/or tightness in the hip and knee muscles can place increased tension on the pes anserine tendons which damages the tendon itself and increases pressure on the bursa. Tight hamstrings are a common cause of pes anserine bursitis.

3) Poor Training Techniques
Training errors such as sudden increases in distance or intensity, not warming up and inadequate stretching can over stress the area.

4) Other Medical Conditions
Joint inflammation associated with arthritis can cause swelling of the bursa. Studies have shown that approximately 20% of people with osteoarthritis of the knee suffer from pes anserine bursitis. People with Type 2 Diabetes or Osgood Schlatters are also more likely to develop bursitis.

5) Gender
Pes anserine bursitis is more common in women, due to a wider pelvis and the angle of the knee joint.

6) Altered Biomechanics
Subtle changes to the position of the leg bones and soft tissues, such as flat feet or a turned out foot can place extra pressure on the Pes Anserine region

7) Obesity
More weight goes through the area increasing the pressure on the bursa

8) Trauma
A direct injury such as a blow to the pes anserinus area can lead to swelling of the bursa

Pes anserine bursitis is often accompanied by tendonitis where small tears develop in the pes anserine tendon. It is hard to clearly distinguish between the two problems, but the causes, symptoms and treatment are basically the same for both.

➡️ Symptoms of Pes Anserine Bursitis

1) Pain
The most common symptom of pes anserine bursitis is pain and tenderness on the inner side of the knee approximately 2-3 inches below the joint.

Symptoms of bursitis tend to build up gradually rather than suddenly. People often complain it hurts more when they exercise or go upstairs, with resisted knee flexion or when they stretch their hamstrings.

2) Swelling
When the pes anserine bursa is inflamed, there will often be some swelling and redness over the area and the inner side of the knee may feel slightly warm to touch.

3) Sleep Disturbance
Sleep is often affected by knee bursitis, particularly if you sleep on your side with your legs together placing pressure on the bursa. You may be woken by pain when you roll over as you bend or straighten the knee. It can help to sleep with a pillow between your knees to provide some cushioning to the pes anserine bursa.

4) Weakness & Stiffness
Pain from pes anserine bursitis often limits movement so the knee gradually loses strength and range of movement. Stiffness and weakness develop which can then make it more painful to move.

Symptoms may develop suddenly if there has been a direct blow to the knee, but it is worth considering other possibilities such as an MCL sprain if the pain develops suddenly.

Treatment for Pes Anserinus Bursitis will be discussed in the next post, so stay tuned.

🔈 RHOMBOIDS MUSCLE PAIN

Each one of us has had muscle pain at some point in our lives. Some people, however, experience worsening and commonly occurring muscle pain in certain areas. Among this is rhomboid muscle pain, which is more common and worse than any other pain and is one of the most frustrating pains. There are many people who don’t know where exactly is rhomboid muscle situated, but they have felt pain in that region at some time or other for sure.

Pain of the rhomboid muscle is the pain, which is present in the upper back region just beneath the neck and between the upper shoulder blades. Rhomboid muscle helps in controlling the arms and shoulders. If you have spent an entire day carrying heavy load, then the rhomboid muscle bears the brunt of it. The rhomboid muscle is shaped like a triangle and is a very thin muscle. It is a skeletal muscle that is connected to the bone and helps in movement of the joints. The rhomboid muscles include rhomboid minor muscle and rhomboid major muscle.

Rhomboid muscle connects the spine to the medial edges of the shoulder blades along with helping in maintaining a good posture. If these muscles are used excessively then it causes pain. This excessive use can result from playing sports, such as golf or tennis and can also occur from carrying heavy load on the upper back and even wrong movements, such as trying to reach for something heavy from a high shelf. All the muscles in the body are composed of many tiny muscle fibers. They have to move in unison for movement of the joints and limbs. All these tiny muscle fibers build up the muscle and hence are very strong. However, if isolated and left on their own they become weak and become more susceptible to tear. This is commonly seen when an individual goes to gym. Pain in the rhomboid muscle causes difficulty in the patient in moving his/her arms and can be described as mild to severe pain in the upper back. Treatment for Rhomboid Muscle Pain comprises of rest, cold compresses and medications.

Possible Causes of Rhomboid Muscle:
* Sitting on chair for long time with poor posture especially from prolonged use of computer
* Sitting in a car for long time can strain your rhomboid muscles causing inflammation of the rhomboid muscle.

Signs & Symptoms of Rhomboid Muscle Pain

* Patient experiences pain and loss of movement. This is called as shoulder blade pain or rhomboid pain.
* Patient will also have swelling as the body is healing from rhomboid muscle pain. This will result in more discomfort.
* In some patients, there is compression of a nerve leading to acute shooting pain resulting in painful and difficult movements.

🔈 INJURIES OF THE ACROMIOCLAVICULAR JOINT + SHEAR TEST

A fall onto the shoulder or outstretched arm frequently causes dislocation of the acromioclavicular joint and damage to the acromioclavicular ligaments. Ligament injury allows the lateral end of the clavicle to move independently of the scapula, causing it to appear upwardly displaced.

The clavicle can be pushed down (with significant pain), but will spring back up when pressure is released (piano-key sign). Three grades of acromioclavicular separation can be distinguished clinically based on the degree of ligament damage (Toss classification).

🔑 TOSSY I

The acromioclavicular and coracoclavicular ligaments are stretched but still intact.

🔑 TOSSY II

The acromioclavicular ligament is ruptured, with subluxation of the joint.

🔑 TOSSY III

Ligaments are all disrupted, with complete dislocation of the acromioclavicular joint.

Radiographs in different planes will show widening of the space in the acromioclavicular joint. Comparative-stress radiographs with the patient holding approximately 10kg weights in each hand will reveal the extent of upward displacement of the lateral end of the clavicle on the affected side.

🚑 SHEAR TEST

✅ Purpose

To test for acromioclavicular joint pathology or injury

✅ Technique

Patient: sitting or standing with the arm dependent or in a neutral position on the lap.
Clinician: standing adjacent to the patient. The heel of one hand is placed posteriorly over the spine of the scapula with the fingers pointing upwards; the other hand is positioned in a similar fashion anteriorly over the mid section of the clavicle. The fingers of both hands are then interlocked over the upper trapezius area of the shoulder.

✅ Action

The hands are gradually squeezed together, imparting a shear stress through the ACJ created by the approximation of the clavicle and scapula.

✅ Positive test

Localized pain over the ACJ or increased joint excursion are considered to be positive findings and are indicative of ACJ pathology or injury.