extension and flexion of the foot

If you raise your arms in front of you above this level, the upper part is stressed and the lower part is strained below. As for the development of the external or internal part, this is a typical error, because, as already mentioned, the muscle fibers grow evenly along their length. They cannot grow in only one place - at the beginning (the inner part), while the shape of the outer part depends on the length of the muscle belly, which, in turn, is genetically determined. We conclude from this. For full development of the pectoral muscles, exercises should only be performed at different angles of arm movement in relation to the torso. In general, the typical forms of horizontal barbell or dumbbell presses and dumbbell curls on a horizontal bench actively engage the lower and middle pectoral muscles, but not the upper pectoral muscles.

Treatment of arthritis according to Dr. Yevdokimenko

The exercises by Dr. Yevdokimenko are an important part of the treatment of knee and hip arthrosis and accelerate the process of restoring the functionality of the elements of the musculoskeletal system. According to medical statistics, the use of this LFC complex contributes to the stabilization and improvement of the condition of 70-90 % of patients suffering from destructive-dystrophic pathologies of the mobile joints of the lower limbs of stages I and II.

Chronic, slowly progressive OA diseases, the development of which is accompanied by deformation and destruction of the interarticular joint structures and dystrophy of connective and muscle tissue, are divided into several types depending on the localization. The most commonly diagnosed anomalies of the lower limbs are gonarthrosis and coxarthrosis. The former affects the knee joints, the latter the hip joints.

The treatment is almost identical. Conservative treatment methods include:

1. Taking medication. NSAIDs (Diclofenac, Nimulide) are prescribed to relieve pain and inflammation, and chondoprotectors (Elbona, Structum) are used to repair cartilage.
2. Intraarticular injection of glucocorticosteroids (dipropane, hydrocortisone). These remedies can relieve acute inflammation and thus normalize the mobility of the leg joints.
3. Injections of hyaluronic acid preparations into the joint cavity. Hyastat, Fermatron improve the lubricity of the surface and restore the damping properties of the structures.

Taking vitamin and mineral complexes (Vitrum, Calcemin) contributes to the general strengthening of the musculoskeletal system.

Warming and analgesic ointments (Menovazin, Espol), NSAID-based ointments (Dolgit, Fastum) and compresses with Bischofite, Dimexide are used to improve blood circulation and relieve discomfort in the affected parts of OA in arthrosis of the hip and knee to reduce.

The essence of Dr. Evdokimenko

The exercises are based on complex exercises aimed at strengthening muscles, ligaments and vessels, activating blood flow and improving metabolic processes.

Therapy for primary osteoarthritis of the knee, hip and leg joints takes about a year. During this period, the patient undergoes two courses of manual therapy, takes medications and does daily exercises.

In patients diagnosed with grade II knee arthrosis, such therapy lasts more than 2 years. Healing is observed in 80 % of patients.

Secondary coxarthrosis requires long-term (in some cases up to 36 months) use of a complex method.

Return to knee extension with a trainer

Is knee extension really as bad as you were told? Maybe not when you look at the research and know how important quadriceps strength is for knee health, recovery from anterior cruciate ligament reconstruction, improvement in patellar pain syndrome (PFPS) symptoms, and even physical performance in the elderly is.

• A reduction in torque, total volume and cross-sectional area of the quadriceps muscle has been observed in patients with unilateral PFBS (Kaya D, 2011).
• Body weight-based exercises to develop quadriceps strength increase the contact area of the patellofemoral joint, which can reduce mechanical stress on the joint and thereby improve pain and function in people with PFBS (Chiu JK, 2012).
• The most effective and convincingly proven treatment for patients with PFBS is a combined physical therapy program that includes strength training of the quadriceps and hamstring adductors as well as quadriceps stretching (Rixe JA, 2013).

How important is quadriceps strength in relation to functional performance?

• High-resistance strength training (using a knee extension machine) results in significant increases in muscle strength, size, and functional mobility in frail nursing home residents under the age of 96 (Fiatorone MA, 1990).
• Quadriceps muscle strength is an important determinant of both performance-related physical function and self-assessment in patients with knee osteoarthritis (Maly MR, 2006).
• After total knee arthroplasty, quadriceps strength was the most important correlate of functional performance (Mizner RL, 2005).

So what exactly do all these studies tell us? Decreased quadriceps strength is an excellent predictor of decreased function after PCC reconstruction, correlates strongly with PFBS, and correlates very well with poor knee function in the elderly.

Can excessive joint mobility be acquired or is it an inherited trait?

Acquired excessive joint mobility is seen in ballet dancers, athletes, and musicians. Long-term, repeated movement stretches the ligaments and joint capsule of individual joints. In this case it is a local hypermobility of the joint or joints. Although it is clear that when choosing a career (dance, sport) those who are initially characterized by constitutional flexibility have a clear advantage, the training factor undoubtedly plays a role. Changes in joint mobility are also observed in many pathological and physiological conditions (acromegaly, hyperparathyroidism, pregnancy). Generalized HMS is a feature of many inherited connective tissue disorders, including Marfan syndrome, osteogenesis imperfecta, and Ehlers-Danlos syndrome. These are rare diseases. In practice, the doctor much more often deals with patients who have isolated HMS, not related to physical activity and in some cases combined with other signs of connective tissue weakness. It is almost always possible to establish the familial nature of the observed HMS and the coexisting pathology, which indicates the genetic nature of the observed phenomenon.

The term 'HMS syndrome' itself was coined by English authors Kirk, Ansell and Bywaters, who defined it in 1967 as a condition in which certain musculoskeletal complaints occur in hypermobile individuals without the presence of symptoms of another rheumatic disease.

Later work helped to clarify the nosological boundaries of this syndrome, termed 'mild joint hypermobility syndrome', in contrast to the more severe prognostic forms of Ehlers-Danlos syndrome and other hereditary connective tissue dysplasias.

The most recent, so-called Brighton criteria for benign HMS syndrome (1998) are listed in the table. These criteria also take into account extra-articular manifestations of connective tissue weakness, so that one can also speak of HMS syndrome in people with normal joint mobility (mostly older people).

Prevalence of joint hypermobility syndrome

HMS syndrome is a combination of HMS and musculoskeletal problems caused by ligament weakness. The actual prevalence of HMS is largely unknown. Constitutional HMS occurs in 7-20 % of the adult population. Although the majority of patients first appear in adolescence, symptoms can occur at any age. Therefore, the definitions of 'symptomatic' or 'asymptomatic' HMS are rather arbitrary and only reflect the condition of a person with HMS at a particular stage of life. It is possible to talk about the prevalence of HMS in individual clinics. For example, in a large European rheumatism clinic, 0.63 % men and 3.25 % women out of 9,275 inpatients were diagnosed with HMS. However, these data do not reflect the true picture, as most patients with HMS do not require inpatient treatment. According to national data, the percentage of patients with HMS at an outpatient visit to a rheumatologist is 6.9 % (Gauert VR, 1996). Due to the already mentioned lack of medical knowledge about this pathology, these patients are often registered under other diagnoses (early osteoarthritis, periarticular lesions, etc.).

The clinical presentation of HMS is diverse and includes both articular and extra-articular manifestations, which is largely reflected in the Brighton syndrome criteria for HMS.

A carefully taken anamnesis is very helpful for the diagnosis. Characteristic of the patient's life history is his particular sensitivity to physical exertion and his tendency to frequent trauma (sprains, joint subluxations in the past), which indicates connective tissue insufficiency. The excessive joint mobility detected by the Beighton method complements the actual clinical manifestations of SHMS.

• Arthralgia and myalgia. The sensation can be distressing but is not accompanied by visible or palpable changes in the joints or muscles. The most common locations are the knees, ankles and small wrists. A pronounced pain syndrome in the hip area that responds to massage has been described in children. The severity of pain is often influenced by emotional state, weather and phase of the menstrual cycle.
• Acute post-traumatic joint or periarticular pathology associated with synovitis, tenosynovitis or bursitis.
• Periarticular lesions (tendinitis, epicondylitis, other enthesopathies, synovitis, tunnel syndrome) occur more frequently in patients with SHMS than in the general population. They occur in response to unusual (unusual) stress or minimal trauma.
• Chronic pain in one or more joints, in some cases accompanied by moderate synovitis triggered by exercise. This manifestation of SHMS most often leads to diagnostic errors.
• Recurrent joint dislocations and subluxations. Typical locations are the shoulder, patellofemoral and metacarpophalangeal joints. Ligament stretches in the ankle area.
• Development of early (premature) osteoarthritis. These can be both true polyarticular nodules and secondary damage to large joints (knee, hip) resulting from concomitant orthopedic anomalies (flat feet, undiagnosed hip dysplasia).
• Back pain. Thoracic pain and lumbalgia are widespread in the population, especially in women over 30 years of age, so it is difficult to make a clear statement about the relationship of this pain to joint hypermobility. However, spondylolisthesis is reliably associated with HMS.
• Asymptomatic longitudinal, transverse or combined flatfoot and its complications: medial tendonitis, valgus deformity and secondary arthrosis of the ankle (longitudinal flatfoot), posterior bursitis, talalgia, corns, hammertoe, hallux valgus (transverse flatfoot).

Treatment of the ankle joints with kinesitherapy. Osteoarthritis, flat feet

If you suffer from recurring ankle pain, swelling and inflammation, morning stiffness, tingling, muscle spasms and muscle weakness, have your musculoskeletal system diagnosed at our center.

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Discomfort when bending over

If someone has pain in their leg when bending, it could just as easily be caused by cysts. In the majority of cases, a Baker's cyst occurs below the knee and causes the patient difficulty walking.

Baker's cyst

A Baker's cyst is essentially a hernia whose main content is fluid synovial exudate. It infiltrates into the cavity between the connective tissue formations. The cyst is located in the back of the knee near the synovial capsule. Cysts develop in childhood but also occur in adults as a result of trauma.

Patients usually come to the clinic with a patella cyst that has already formed - it is surrounded by dense tissue, feels soft, becomes slightly smaller when squeezed, but then fills again with synovial fluid. As fibrinogen builds up, the cyst becomes increasingly dense, making it increasingly difficult to move.

The causes of the disease are as follows:

• osteoarthritis of the knee;
• injuries to the knee;
• Deformities of the hip joint, causing the knee to participate in the decompensation process;
• sprains of the ligamentous apparatus;
• synovitis, bursitis.

Baker's cyst worsens after birth because the congestion of the synovial capsule can resolve in a stressful situation, as the increased strain of carrying a child promotes weakness in the connective tissue of the lower limbs.

Diagnosing a Baker's cyst is not difficult. It is visually visible below the knee on the inside back. If the cyst is medium to large in size, it will cause severe pain when bending and straightening the knee when the abscess has collapsed. In addition to pain, the skin around the knee is red and swollen, and patients have difficulty fully bending and straightening the leg. The leg often becomes numb as the large cyst presses on the nerve tissue.

Move

It is the widest back muscle and is always in the spotlight of all the muscles in the back of the torso. Everyone wants to have wide and thick broad muscles, so traditionally at least two types of exercises are performed for them: wide and thick. Additionally, a wide-grip pull-up is believed to develop the outer and upper parts of the widest muscles, while a narrow-grip pull-up is believed to develop the inner and lower parts of the widest muscles. As you can already guess, this is the same myth about the growth of individual parts of muscle fibers.

The main function of the broadest muscle is to pull the shoulder toward the trunk and retract the upper limbs toward the midline, rotating them inward. When the upper limb is anchored, we bring the trunk closer to it. Regardless of whether we are doing pull-ups, pull-ups on the vertical bar, pull-ups on the horizontal bar, or pulling a barbell (dumbbells) to the hip in an incline position, we always do it with all the fibers of the widest muscle. Although the widest muscle, such as the pectoral muscles, is shaped like a fan, the insertion point of the widest muscle on the upper arm is higher than the upper fibers so that all fibers point upward in the same direction (for the pectoral muscles the insertion point is at the level of the middle of the chest). Although the classification of exercises into thick and wide is correct, it does not apply to the widest muscle.

During back exercises in which the shoulders are pulled back (pulling a barbell or dumbbell to the waist, pulling a horizontal block), in addition to the broadest muscles, the middle part of the trapezius muscle, whose task is to bring the shoulder blades closer together, actively involved in the work. These exercises really help to strengthen the back, the middle part of which is formed by the trapezius muscles.

Therefore, the inclusion in training of exercises in which the upper arm moves down (vertical pull-ups on the pulley) and backwards (pull-ups with a barbell and dumbbell, horizontal block) can be considered legitimate if the goal is to to comprehensively develop the entire back muscle mass. However, to build powerful and wide levels, a single exercise, such as the horizontal bar pull-up, is enough. 'Training rules!' Splitting the weekly back workout into two parts, with 'width' exercises on one day and 'thickness' exercises on the second day, only results in the lats being loaded more often, and doubled, rather than supplemented. Without pharmacological support, this can result in a complete lack of progress.

Legs

Leg training typically involves developing the quadriceps and biceps femoris. For both quadriceps and biceps, trainers try to perform several exercises for each.

As the name suggests ('quadro' means four), this muscle consists of four heads, each of which has its own origin, but which all merge into a common tendon in the knee area that surrounds the kneecap and attaches to the tibial tuberosity.

The main function of the quadriceps muscle is to extend the lower limbs in the knee joint. As you can imagine, this stretching occurs through the combined action of all four heads as they are connected by the same tendon. Isolated work on the individual heads for lower leg extension exercises is not possible, just as you cannot build the muscles of the lower or upper quadriceps separately.

The width of the foot stance and the direction of the feet do not redistribute load between the quadriceps heads, but in some exercises can influence the activity of other muscles involved, such as the biceps and gluteus maximus. Quadriceps exercises are generally only differentiated based on whether they are core exercises (multi-joint) or isolation exercises (single-joint).

Since not only the knee joint but also the hip joint is moved during these exercises, in addition to the quadriceps muscle, the hip extensors (not to be confused with the extensors of the lower limbs) are also actively involved: M. gluteus maximus, M. gluteus adduction, M. biceps femoris, M. semitendinosus. In my opinion, to effectively train the quadriceps, you should always combine core exercises with isolation exercises, as both have their advantages and disadvantages.

And you can limit yourself to a few exercises - one core exercise and one isolation exercise (squats plus shin extensions on one machine). Separately, I would like to point out one of the benefits of multi-joint quadriceps exercises. This is glute training. This particular muscle group is not specifically trained, but should definitely not be forgotten. An athlete with jeans hanging down his butt looks ridiculous, the gluteus maximus has to have its place!

Causes of pain in the back of the knee

• Gonarthrosis is a progressive damage to the knee joint caused by metabolic changes in the cartilage. The sensation increases when the patient bends or straightens the leg but subsides at rest.
• Inflammation of joint tissue (arthritis) caused by an infectious or autoimmune process. The area around the knee is often swollen. A burning sensation may be felt.
• There is an injury to the lower extremity. A sharp or aching pain below the knee is caused by an injury to the kneecap or ligaments.
• Pinched nerve. Occurs suddenly, with the patient complaining of a stabbing pain in the knee area.
• Fracture or fracture. May occur with trauma to the shinbone or femur.

The type of radiation varies depending on the cause of the symptom. It can spread to the lower extremity, the foot, the right or left side of the knee.

diversity

The area of pathological process may be oppressive, 'burning' (with intense burning), 'shooting' or stiffening. The areas in which the symptoms spread (upward or downward) also vary. During the examination, doctors pay attention to the symptoms in order to find suitable examination methods.

If severe pain in the back of the knee persists for several hours or 24 hours, it is most likely an acute pathological process such as infection or inflammation. This often leads to swelling of the popliteal fossa on the back of the leg. The pulsation is felt in the front part and throughout the lower extremity. An injury results in limited mobility of the joint and swelling.

Chronic pain in the back of the knee

This symptom is constant but sometimes subsides or disappears after a short period of time. The tissue swelling caused by chronic inflammation leads to a flattening of the curvature of the popliteal fossa. The chronic syndrome occurs in degenerative-dystrophic joint diseases.

THE 'LEGS TOGETHER IN THE SQUATTING' TEST

• Take off your shoes and stand with your feet together and your hands in front of you;
• Slowly perform a full amplitude squat, stopping in the achieved position for 2 seconds;
• then slowly return to the starting position.

The test clarifies the functional status of the foot flexors. So if the client is unable to perform a full squat without lifting the heels, we are dealing with foot flexor shortening. A full squat with your hands in front of your body and your feet on the floor is considered normal.

To make the test more difficult, perform the squat with your arms down or your hands behind your back.:

• A full squat with hands down shows that the amplitude of foot extension is above average.
• In contrast, the client's ability to perform a full squat with the hands behind the back would indicate hyperextension of the foot with perhaps slightly limited flexion.

As a reminder: Adequate foot extension is essential for the leg muscles in many multi-joint exercises.

• For example, when performing a barbell squat, limited ankle mobility can result in excessive forward lean, which in turn increases stress on the intervertebral discs and other connective tissue structures of the spine.

QUADRICEPS LENGTH TEST

• In addition to limited ankle mobility, some individuals may experience functional shortening of the anterior thigh muscles.

This manifests itself in an insufficiently deep squat, in which the back surfaces of the shin and thigh touch, but the ischium and heel bone are far apart. If this is the case, check the length of the muscles in the front of the thigh using the quadriceps length test.

When the length of the quadriceps is correct, you can press the heel against the buttocks.

NoticeThe hip joint must be stretched when the heel strikes.

• If the distance between the heel and the buttocks is up to 13 cm despite passive help, this is a slight shortening. A greater distance means severe foreshortening.

Nott's disease in children and adolescents - types of pathology

In most cases, 1 finger (thumb) is affected. Fingers 3 (middle) and 4 (ring finger) and very rarely fingers 2 (index finger) and 5 (little finger) are affected much less frequently. It can occur in children of all ages. The problem most commonly occurs in children between the ages of 1 and 3 years. Stenotic ligamentitis is a unilateral lesion, meaning it usually occurs on one hand. If bilateral involvement of the fingers of both hands is suddenly noted, this should be a cause for concern. Bilateral involvement of the fingers requires screening for a genetic disease in the child (mucopolysaccharidosis is an early sign).

What is the risk of inflammation of the stenotic ligament of the hand?

First of all, it is a dysfunction of the hand (inability to grasp, clench a fist) and, of course, a cosmetic defect.

How does this happen and what is the cause of Nott's disease?

Currently, the exact cause of this condition is not fully understood, but it is believed that it could be a minor injury or a local inflammatory process.

What should I do if I notice that my toe isn't falling off?

First of all, don't panic. This condition can be detected by the parents themselves or during a routine medical examination and does not require special instrumental examination methods. However, a consultation with a pediatric orthopedist is required.

Treatment of stenotic ligamentitis - effective methods

There are two treatment options: non-surgical (conservative) and surgical (operative). The orthopedist/traumatologist decides on the choice of treatment depending on the stage and severity of the disease. Conservative treatment includes physical therapy, physical therapy, and the doctor may prescribe anti-inflammatory medications or glucocorticoid blockades. However, it should be noted that, unlike adult patients, in whom conservative methods can have a long-term positive effect, the conservative methods in children show little effect and only 10 % of patients in the age group of 1 to 2 years show satisfactory results achieve.

Surgery for stenosing inflammation of the toe ligament

Surgical treatment of Nott's disease in children should be carried out from the age of 1.5 years. The surgical treatment methods are divided into the so-called 'surgical approach'. open and closed procedures. The closed technique involves skin puncture and blind dissection of the annular ligament. This procedure is quite popular among adults and often produces good results. In children, closed ligament dissection carries a risk of neurovascular bundle damage and a higher recurrence rate than the open procedure. The open procedure is carried out through a small incision in the skin in the area of the annular ligament. The ring band is then plasticized. If the flexor tendon is thickened, a wedge excision is required to restore its normal parallel edges. This technique restores the normal width of the tendon, significantly reducing the risk of recurrence (this procedure cannot technically be performed using a closed technique).

Reconstructive management after surgery

An aseptic dressing and temporary immobilization (plaster bandage, thermoplastic orthosis or plaster splint) are applied. From the 7th day, passive movements in the finger joints begin. On the 14th day, the postoperative stitches and temporary immobilization are removed. The previously begun passive development continues and active movements of the fingers begin. After the stitches are removed, rehabilitation treatment continues for up to 2-3 weeks. This treatment includes the development of movements in the finger joints and physical therapy (aimed at reducing the formation of scar tissue). Rehabilitation treatment is mandatory, especially in the case of a long-term illness. Early detection and professional handling of the problem are the key to successful treatment and normal dexterity of the child.

• The flexion of the foot is.
• Pain in short fibula when walking.
• Medial head of the calf muscle.
• The muscles that move the foot.
• The flexor muscles of the foot.
• lower leg stretches.
• Bump on the side of the child's foot.
• Square soleus muscle.