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10 Mysterious Pains You Shouldn't Ignore by Discovery Health

All of us have experience with random, mysterious and sometimes lingering pains at some point in our lives. Most of us shrug it off, and usually the pain leaves the same way it arrived -- on its own and without explanation. These pains aren't so different from the strange sounds your automobile makes from time to time. Something clicks, whirrs or squeals, and then the noise vanishes as quickly as it arrived. Those of us who aren't mechanically inclined may think nothing more of it. However, just like your automobile, your body's aches and pains often get worse over time, or signal a much larger underlying problem. In these cases, we ignore those warning signs at our own peril. Usually, doctors and mechanics alike wonder why we didn't bring these problems to their attention sooner. While not every pain you feel is indicative of a dire emergency, some mysterious pains simply shouldn't be ignored. While few people are enthusiastic about going to a doctor, few doctors are enthusiastic about treating a medical emergency that they could've detected or treated before the problem snowballed into a potentially life-or-death matter. So what mysterious pains shouldn't you ignore? Keep reading to find out. 10: More Than Chest Pain While this section focuses on heart disease, chest pain isn't the only indication that something's wrong. Take this scenario: It's a hot summer's day, and you're working up a sweat mowing your lawn, which resembles a modest jungle. You stop to wipe your brow, when suddenly your jaw starts hurting. While heart disease runs in your family, everyone has trained you to look out for the fabled chest pain. So you think nothing of it. You reason that you may have clenched your jaw tightly while sleeping because of stress at work. Unfortunately, your aching jaw could be a sign that your heart is stressed. Your jaw pain could serve as warning of an impending heart attack or a sign that one has just occurred. Pain from a heart attack often shows up in places other than your chest: your shoulder, arm, abdomen, lower jaw or throat. Ignore the mysterious pain in your jaw, and that overgrown lawn you're attempting to tame could be your ultimate undoing. If you do experience a sudden pain in your shoulder or jaw area -- especially if you are at risk of heart disease -- stop what you're doing, alert someone and seek medical attention. There aren't many good reasons why your jaw or the length of your arm would suddenly start throbbing with pain, and a doctor's investigation of what's happening could add years to your life. 9: Lower-back Pain Pain in the lower back is one of the most common pains people encounter and, as such, ignore. Most days, at least one person you know will complain of a bad back, and it makes it easy to deal with the pain when it happens to you. In fact, back pain is the leading cause of job-related disability. Every year, Americans spend nearly $50 billion trying to take care of their lower back pain [source: National Institute of Neurological Disorders and Stroke]. The high price tag points not only to the

frequency of Americans' lower-back troubles, but also to the complexity of that region of our bodies. Our backs contain most of our bodies' infrastructure -- muscles, tissues, nerve bundles, spines and vertebrae. Without these structures, our bodies would resemble nothing so much as a pile of unstructured flesh, like jellyfish. But sometimes lower-back pain is a symptom related to kidney trouble. The pain may relate to the formation of a kidney stone, which will usually pass (painfully) on its own. If your kidney is infected, it will swell, causing the discomfort in your lower back. If a kidney tumor has grown large enough, it will cause pain in the lower back, as well. You should always get back pain checked out, since ignored problems with your back can become chronic problems that only worsen over time. Being vigilant about finding the cause of pain in your lower back could save your kidneys -- and your life. 8: Severe Abdominal Pain When our stomachs start clenching and doing somersaults after we've eaten food that's been left out on a buffet table for too long, there's no doubt what's causing the discomfort. But other times, there's no clear cause for the pain. Your torso is a busy place, and an unusual pain in your abdominal area could be a sign that any number of things has gone wrong. Problems with nearby organs such as kidneys, lungs or the uterus could result in abdominal discomfort. Pain in your lower-right abdomen may mean your appendix is inflamed, and that means a quick removal is in order. Upper-right-abdominal pain could signal a problem with your gall bladder. Upper-abdominal pain (along with upper-back pain) may be a sign of pancreatitis, an inflammation of the pancreas. Rest, intravenous fluids and antibiotics may resolve this condition. Abdominal pain also could point to an intestinal blockage. If not immediately treated, this can result in death of intestinal tissue and other problems. And finally, a swollen liver due to hepatitis could cause the excruciating pain in your gut. There are different forms of this viral disease, some of which (hepatitis C) can cause liver failure. Nothing causing abdominal pain is good news, but each condition is the type of bad news you want to get sooner rather than later. If you have unexplained, recurring or sudden abdominal pain, see your doctor immediately. 7: Calf Pain Sore calves often mark the day after a good run (or a long climb up steep stairs). But sometimes calf pain -- especially when not linked to any type of injury -- may mean something else is amiss, and it's something you definitely don't want to ignore. Your leg has a network of arteries and veins that move blood to and from your muscle and heart. The veins you can see beneath your skin are called superficial veins, and they move blood farther into the muscle itself, toward deep veins. Little valves inside the veins prevent blood from flowing the wrong way. However, clots may form due to a rupture in the vein, damage to a valve or an injury to the leg. This is a deep vein thrombosis (DVT). The pain stems from the clot's presence causing a blood flow blockage,

which results in swelling. If a clot breaks loose -- an event called an embolism -- it could travel through your body, block an artery in the lung or brain, and damage your lung -- a pulmonary embolism -- or cause stroke. This doesn't usually happen, but when it does, it can be very serious and potentially deadly. Doctors usually prescribe anticoagulation drugs and keep tabs on the clot to make sure it's not growing. People with DVT who are overweight or who smoke should make lifestyle changes, as both of these factors increase the risk and severity of DVT. 6: Burning Sensations in Hands or Feet If you've ever left your legs crossed too long, you've likely experienced an almost-painful tingling sensation in your legs and feet caused by decreased blood circulation. Fortunately, the tingling goes away quickly once you're standing and moving about, but while it's there, it feels like a cruel combination of pain and tickling. If your feet or hands feel this way even when you haven't folded yourself up like a pretzel for too long in front of the television, it could be sign of nerve damage. Symptoms such as tingling, numbness and a burning sensation all point to peripheral neuropathy. Peripheral neuropathy has many causes, including diabetes, alcohol abuse, vitamin B-12 deficiency and other disorders such as shingles. Injury, infections and toxins can also cause nerve damage. Often -though not always -- treating the underlying cause of the tingling causes the painful sensations in your affected body parts to go away. Aspirin and over-the-counter analgesics sometimes help relieve symptoms, but antidepressants, anti-seizure medications, physical therapy or surgery have a greater chance of reducing or eliminating the burning sensation. It's important to seek treatment for this condition because the reduced sensation means you'll be less likely to notice injuries to your feet or hands. Injuries left unchecked can become infected, opening the door to a completely new set of problems. If you're diabetic, getting your blood sugar under control will prevent further nerve damage (among other complications that arise from this disease) and may improve the existing symptoms of peripheral neuropathy. 5: Vague, Random, Unexplained Pains Usually pain in a certain part of your body signals that something in that area needs attention. In fact, this is the how pain benefits us. Being the wise, nonprocrastinating person you are, you tell your family doctor about this. Then, the unexpected (though not entirely unwelcome) occurs: Your doctor performs tests like X-rays or an MRI, only to discover no obvious cause of the mysterious pains you're experiencing. You may have fibromyalgia, a mysterious condition that results in aches and pains, and affects more women than men. Fibromyalgia seems to result in heightened sensitivity to physical pressure or pain, and often involves sleep difficulties. Currently, no definitive test for fibromyalgia exists, but doctors will work to rule out other possible causes of your pain before making a diagnosis. This condition is treatable with physical therapy and analgesics, but researchers still have much to learn about it. It's incredible, but depression can also cause "floating," random and otherwise unexplainable pains in

various parts of your body. This may manifest in the form of back pain, headaches and heightened sensitivity to pain. How can this be? It turns out that pain and emotion travel down some of the same neural pathways in your brain. For some people, it seems that neurotransmitters carrying news of gloom and doom can jump the tracks and result in actual physical pain. Usually, antidepressants, therapy or some combination of the two helps to resolve the depression and, with it, the pain. 4: Testicular Pain You should never ignore testicular pain, as it often indicates a condition that could get worse -- much worse -- if ignored for too long. Anything from a hernia to cancer can cause testicular pain. The spermatic cord could be twisted, causing testicular torsion, which causes excruciating, fall-to-your-knees pain. Ignore it at your testicles' own blood-starved peril. If you've taken a direct hit to the jewels lately, the pain may go away in the following days, or be a sign of a hematocele, in which blood pools between the protective sacs of your scrotum. Inflammation of the epididymis, a coiled tube located in the back of each testicle that serves as a storage and delivery system for sperm, can also cause testicular pain. If the discomfort in your testicle accompanies a tactile sensation that your scrotum is full of noodles, you've likely got varicose veins, known as varicoceles. There's little in the way of good news if you suddenly feel testicular pain, and ignoring it in hopes it will go away may cause you to lose a testicle. The thought of it is enough to give you a headache, which we'll discuss next. 3: Thunderclap Headaches While headaches often appear to come out of nowhere, some headaches descend incredibly fast, striking like a clap of thunder. While they may soon pass as most headaches do, this mysterious and sudden occurrence could be a sign of something much more serious than a headache. If your headache causes nearly blinding pain, it could be a sign of stroke or transient ischemic attack (TIA). Strokes happen when a blood clot or piece of plaque in the body's veins or arteries breaks loose and travels through the body, eventually making its way to the brain. When this happens, the clot may temporarily or partially block an artery, resulting in a TIA, or it may fully block the blood flow, causing a stroke. In addition to a sudden headache, other signs of TIA and stroke involve neurological or cognitive difficulties, such as trouble speaking or walking. In fact, people may suddenly fall while standing or walking. In the case of TIA -- often referred to as a "mini-stroke" -- the symptoms include dizziness, temporary visual problems or simply trouble holding a pen. Either way, get immediate medical attention. Strokes call for clot-busting drugs to restore blood flow to brain tissue, and TIA episodes are often followed at some point by a real stroke. Pain is your body's way of telling you something's not right, so give your doctor a chance to discover what's wrong before it's too late. 2: Pelvic Pain During Intercourse

If you're a woman, you've no doubt seen the warning found on any box of tampons: leave a tampon in place too long, and complications may arise, including pelvic inflammatory disease (PID). One common symptom of PID is pain or discomfort in the pelvic region during sex. PID is a bacterial infection of the uterus or fallopian tubes that results in red, swollen and painful tissue. The inflammation can cause scarring, which can lead to problems such as infertility. PID can also result in the formation of abscesses, or chronic pelvic pain. Sexually transmitted diseases -most often chlamydia or gonorrhea -- or any source of bacteria that travels up to the reproductive organs are the usual suspects for PID. Left unchecked, the infection can spread to the blood or other tissues of the body. If a fallopian tube is infected and not treated, it could burst. PID affects three-quarters of a million women each year, and one out of 10 becomes infertile as a result [source: Centers for Disease Control and Prevention]. The pain may not be severe and may accompany other symptoms like frequent urination or abdominal pain. Early detection is important since doctors often can treat PID with antibiotics. However, in cases where the condition isn't detected early, surgery may be required. Ovarian cysts can also cause pelvic pain, and while cysts often go away on their own, they may require medical intervention. Next, we'll look at a common ailment that sometimes has mysterious origins. 1: Persistent Joint Pain Osteoarthritis -- generally age-related wear and tear to cartilage that causes bones to rub together -- is a common source of joint pain, but it's not the only one. Stiffness and swelling of the joints may be caused by lupus, a disease that cycles through periods of flaring up and remission. Other symptoms of lupus include fatigue, hair loss and fever. Hepatitis, a condition that affects the liver, also claims joint pain as a symptom. Need a good reason to get that joint pain examined by a doctor? Hepatitis is responsible for more liver transplants than any other condition [source: MedlinePlus]. Many other infectious diseases -- such as measles and chicken pox -- can also cause joint pain. Then again, it could be arthritis, but a more serious form of it: rheumatoid arthritis. Rheumatoid arthritis is an autoimmune disease, meaning that your immune system goes haywire and attacks your own tissue. This causes inflammation of not only the joints themselves, but of tissue surrounding the joints and even of other organs in your body. The result is pain and the breakdown of your joints. It's important to get medical attention as soon as symptoms present themselves to limit damage to your body -- while medications can alleviate discomfort and swelling, tissue damage is permanent.

Plantar fasciitis
Plantar fasciitis is inflammation of the thick tissue on the bottom of the foot. This tissue is called the plantar fascia. It connects the heel bone to the toes and creates the arch of the foot. Causes, incidence, and risk factors: Plantar fasciitis occurs when the thick band of tissue on the bottom of the foot is overstretched or overused. This can be painful and make walking more difficult. You are more likely to get plantar fasciitis if you have: Foot arch problems (both flat feet and high arches) Long-distance running, especially running downhill or on uneven surfaces Sudden weight gain or obesity Tight Achilles tendon (the tendon connecting the calf muscles to the heel) Shoes with poor arch support or soft soles Plantar fasciitis is seen in both men and women. However, it most often affects active men ages 40 - 70. It is one of the most common orthopedic complaints relating to the foot. Plantar fasciitis is commonly thought of as being caused by a heel spur, but research has found that this is not the case. On x-ray, heel spurs are seen in people with and without plantar fasciitis. Symptoms The most common complaint is pain and stiffness in the bottom of the heel. The heel pain may be dull or sharp. The bottom of the foot may also ache or burn. The pain is usually worse: In the morning when you take your first steps After standing or sitting for a while When climbing stairs After intense activity The pain may develop slowly over time, or suddenly after intense activity. Signs and tests The health care provider will perform a physical exam. This may show: Tenderness on the bottom of your foot Flat feet or high arches Mild foot swelling or redness Stiffness or tightness of the arch in the bottom of your foot. 1. Wapner KL, Parekh SG. Heel pain. In: DeLee JC, Drez D Jr, Miller MD, eds. DeLee and Drezs Orthopaedic Sports Medicine. 3rd ed. Philadelphia, Pa: Saunders Elsevier; 2009:section F. 2. Abu-Laban RV, Ho K. Ankle and foot. In: Marx JA, Hockberger RS, Walls RM, et al, eds. Rosens Emergency Medicine: Concepts and Clinical Practice. 7th ed. Philadelphia, Pa: Mosby Elsevier; 2009:chap 55. 3. Silverstein JA, Moeller JL, Hutchinson MR.Common issues in orthopedics. In: Rakel RE, ed. Textbook of Family Medicine. 8th ed. Philadelphia, Pa: Saunders Elsevier;2011:chap 30.

About kidneys
Everybody knows that some organs in the human body are necessary for survival: you need your brain, your heart, your lungs, your kidneys... KIDNEYS? Absolutely. Even though you won't find a Valentine's Day card with a kidney on the cover, the kidneys are every bit as important as the heart. You need at least one kidney to live! Kidneys normally come in pairs. If you've ever seen a kidney bean, then you have a pretty good idea what the kidneys look like. Each kidney is about 5 inches (about 13 centimeters) long and about 3 inches (about 8 centimeters) wide about the size of a computer mouse. To locate your kidneys, put your hands on your hips, then slide your hands up until you can feel your ribs. Now if you put your thumbs on your back, you will know where your kidneys are. You can't feel them, but they are there. Read on to find out more about the cool kidneys. Cleaning Up One of the main jobs of the kidneys is to filter the waste out of the blood. How does the waste get in your blood? Well, your blood delivers nutrients to your body. Chemical reactions occur in the cells of your body to break down the nutrients. Some of the waste is the result of these chemical reactions. Some is just stuff your body doesn't need because it already has enough. The waste has to go somewhere; this is where the kidneys come in. First, blood is carried into the kidneys by the renal artery (anything in the body related to the kidneys is called "renal"). The average person has 1 to 1 gallons of blood circulating through his or her body. The kidneys filter that blood as many as 400 times a day! More than 1 million tiny filters inside the kidneys remove the waste. These filters, called nephrons (say: NEH-fronz), are so small you can see them only with a high-powered microscope. The Path of Pee The waste that is collected combines with water (which is also filtered out of the kidneys) to make urine (pee). As each kidney makes urine, the urine slides down a long tube called the ureter (say: yu-REE-ter) and collects in the bladder, a storage sac that holds the urine. When the bladder is about halfway full, your body tells you to go to the bathroom. When you pee, the urine goes from the bladder down another tube called the urethra (say: yu-REE-thruh) and out of your body. The kidneys, the bladder, and their tubes are called the urinary system. Here's a list of all of the parts of the urinary system: the kidneys: filters that take the waste out of the blood and make urine the ureters: tubes that carry the urine from each kidney to the bladder the bladder: a bag that collects the urine the urethra: a tube that carries the urine from the bladder out of the body Keeping a Balance

The kidneys also balance the volume of fluids and minerals in the body. This balance in the body is called homeostasis (say: HOH-mee-oh-STAY-sus). If you put all of the water that you take in on one side of a scale and all of the water your body gets rid of on the other side of a scale, the sides of the scale would be balanced. Your body gets water when you drink it or other liquids. You also get water from some foods, like fruits and vegetables. Water leaves your body in several ways. It comes out of your skin when you sweat, out of your mouth when you breathe, and out of your urethra in urine when you go to the bathroom. There is also water in your bowel movements (poop). When you feel thirsty, your brain is telling you to get more fluids to keep your body as balanced as possible. If you don't have enough fluids in your body, the brain communicates with the kidneys by sending out a hormone that tells the kidneys to hold on to some fluids. When you drink more, this hormone level goes down, and the kidneys will let go of more fluids. You might notice that sometimes your urine is darker in color than other times. Remember, urine is made up of water plus the waste that is filtered out of the blood. If you don't take in a lot of fluids or if you're exercising and sweating a lot, your urine has less water in it and it appears darker. If you're drinking lots of fluids, the extra fluid comes out in your urine, and it will be lighter. What Else Do Kidneys Do? Kidneys are always busy. Besides filtering the blood and balancing fluids every second during the day, the kidneys constantly react to hormones that the brain sends them. Kidneys even make some of their own hormones. For example, the kidneys produce a hormone that tells the body to make red blood cells. By KidsHealth & Yamini Durani, MD

About large intestine


The large intestine has a larger width but is only 1.5 m (5 feet) long. The large intestine is divided into 6 parts: cecum, ascending colon, transverse colon, descending colon, sigmoid colon, and rectum. Most food products are absorbed in the small intestine. The large intestine is responsible for absorption of water and excretion of solid waste material. Food and waste material are moved along the length of the intestine by rhythmic contractions of intestinal muscles; these contractions are called peristaltic movements. Waste is solid because most of the water has been removed by the intestines as it travels through them. Arteries of Large Intestine - By: Frank Henry Netter

About scoliosis
What Is Scoliosis? By KidsHealth.org Your spine, or backbone, helps hold your body upright. Without it, you couldn't walk, run, or play sports. If you look at yourself sideways in the mirror or look at a friend from the side, you'll notice that the back isn't flat like a piece of board. Instead, it curves in and out between your neck and lower back. Despite that gentle curve from the side, a healthy spine appears to run straight down the middle of the back. The trouble for someone with scoliosis is that the spine curves from side to side. What Is Scoliosis? The word scoliosis (say: sko-lee-OH-sis) comes from a Greek word meaning crooked. If you have scoliosis, you're not alone. About 3 out of every 100 people have some form of scoliosis, though for many people it's not much of a problem. For a small number of people, the curve gets worse as they grow and they may need a brace or an operation to correct it. Someone with scoliosis may have a back that curves like an "S" or a "C." It may or may not be noticeable to others. While small curves generally do not cause problems, larger curves can cause discomfort. The X-ray image to the right shows what scoliosis looks like. No one knows what causes the most common type of scoliosis called idiopathic (say: ih-dee-uh-PA-thik) scoliosis. (Idiopathic is a fancy word for unknown cause.) Doctors do know that scoliosis can run in families. So if a parent, sister, or brother had scoliosis, you might have it, too. Most types of scoliosis are more common in girls than boys, and girls with scoliosis are more likely to need treatment. How Do Kids Find Out if They Have Scoliosis? Sometimes scoliosis will be easily noticeable. A curved spine can cause someone's body to tilt to the left or right. Many kids with scoliosis have one shoulder blade that's higher than the other or an uneven waist with a tendency to lean to one side. These problems may be noticed when a kid is trying on new clothes. If one pant leg is shorter than the other, a kid might have scoliosis. It's also possible that the kid does not have scoliosis, but one leg may be slightly shorter than the other or the ribs may be uneven. You might get examined for scoliosis at school or during a doctor visit. In the United States, about half of the states require public schools to test for scoliosis. It's an easy test called the forward-bending test, and it doesn't hurt at all. It involves bending over, with straight knees, and reaching your fingertips toward your feet or the floor. Then, a doctor or nurse will look at your back to see if your spine curves or if your ribs are uneven. What if I Have It? If a doctor says you have scoliosis, then the doctor and your parent can talk about whether treatment is necessary, and then talk to you about what happens next. If the doctor wants to get a better look, he or she may order X-rays of your spine. Sometimes the doctor will decide that the curve isn't serious enough

to need treatment. If you do need treatment, you'll go to a special doctor called an orthopedist (say: or-tho-PEE-dist), or orthopedic surgeon, who knows a lot about bones and how to treat scoliosis. The orthopedist will probably start by figuring out how severe your spine's curve is. To do this, an orthopedist looks at X-rays and measures the spine's curve in degrees, like you measure angles in math class.

What is Arthritis?
By Medical News Today Arthritis affects the musculoskeletal system, specifically the joints. It is the main cause of disability among people over fifty-five years of age in industrialized countries. The word arthritis comes from the Greek arthron meaning "joint" and the Latin itis meaning "inflammation". The plural of arthritis is arthritides. Arthritis is not a single disease - it is a term that covers over 100 medical conditions. Osteoarthritis (OA) is the most common form of arthritis and generally affects elderly patients. Some forms of arthritis can affect people at a very early age. What causes arthritis? In order to better understand what is going on when a person suffers from some form of arthritis, let us look at how a joint works. Basically, a joint is where one bone moves on another bone. Ligaments hold the two bones together. The ligaments are like elastic bands, while they keep the bones in place your muscles relax or contract to make the joint move. Cartilage covers the bone surface to stop the two bones from rubbing directly against each other. The covering of cartilage allows the joint to work smoothly and painlessly. A capsule surrounds the joint. The space within the joint - the joint cavity - has synovial fluid. Synovial fluid nourishes the joint and the cartilage. The synovial fluid is produced by the synovium (synovial membrane) which lines the joint cavity. If you have arthritis something goes wrong with the joint(s). What goes wrong depends on what type of arthritis you have. It could be that the cartilage is wearing away, a lack of fluid, autoimmunity (your body attacking itself), infection, or a combination of many factors. Does cracking knuckles cause arthritis?

Cracking the knuckles, also known as "popping", is a kind of joint manipulation that produces a cracking sound. Cracking one's knuckles is a deliberate action. In fact, humans are able to crack several joints, including the ankles, shoulders, feet, jaws, toes, neck and back vertebrae, elbows, wrists and hips. Two studies showed that chronic knuckle cracking does not appear to increase the risk of hand osteoarthritis, but may reduce the strength of your grip. Dr. Donald Unger won the Ig Nobel Prize in Medicine after spending 60 years cracking the knuckles on his left hand but not his right. He reported that neither hand had arthritis after all that time, or other problems. Types of arthritis There are over 100 types of arthritis. Here is a description of some common ones, together with the causes: Osteoarthritis - cartilage loses its elasticity. If the cartilage is stiff it becomes damaged more easily. The cartilage, which acts as a shock absorber, will gradually wear away in some areas. As the cartilage becomes damaged tendons and ligaments become stretched, causing pain. Eventually the bones may rub against each other causing very severe pain. Rheumatoid arthritis - this is an inflammatory form of arthritis. The synovial membrane (synovium) is attacked, resulting in swelling and pain. If left untreated the arthritis can lead to deformity. Rheumatoid arthritis is significantly more common in women than men and generally strikes when the patient is aged between 40 and 60. However, children and much older people may also be affected. Swedish scientists published their study in JAMA in October 2012, explaining that patients with rheumatoid arthritis have a higher risk of blood clots in the first ten years after diagnosis. Infectious arthritis (septic arthritic) - an infection in the synovial fluid and tissues of a joint. It is usually caused by bacteria, but could also be caused by fungi or viruses. Bacteria, fungi or viruses may spread through the bloodstream from infected tissue nearby, and infect a joint. Most susceptible people are those who already have some form of arthritis and develop an infection that travels in the bloodstream. Juvenile rheumatoid arthritis (JRA) - means arthritis that affects a person aged 16 or less. JRA can be various forms of arthritis; it basically means that a child has it. There are three main types: 1. Pauciarticular JRA, the most common and mildest. The child experiences pain in up to 4 joints. 2. Polyarticular JRA affects more joints and is more severe. As time goes by it tends to get worse. 3. Systemic JRA is the least common. Pain is experienced in many joints. It can spread to organs. This can be the most serious JRA. What are the signs and symptoms of arthritis? The symptoms of arthritis depend on the type of arthritis, for example:

Osteoarthritis - The symptoms develop slowly and get worse as time goes by. There is pain in a joint, either during or after use, or after a period of inactivity. There will be tenderness when pressure is applied to the joint. The joint will be stiff, especially first thing in the morning. The patient may find it harder to use the joint - it loses its flexibility. Some patients experience a grating sensation when they use the joint. Hard lumps, or bone spurs may appear around the joint. In some cases the joint might swell. The most common affected joints are in the hips, hands, knees and spine. Rheumatoid arthritis - The patient often finds the same joints in each side of the body are painfully swollen, inflamed, and stiff. The fingers, arms, legs and wrists are most commonly affected. Symptoms are usually worst on waking up in the morning and the stiffness can last for 30 minutes at this time. The joint is tender when touched. Hands may be red and puffy. There may be rheumatoid nodules (bumps of tissue under the skin of the patient's arms). Many patients with rheumatoid arthritis feel tired most of the time. Weight loss is common. The smaller joints are usually noticeably affected first. Experts say patients with rheumatoid arthritis have problems with several joints at the same time. As the arthritis progresses it spreads from the smaller joints in your hands, wrists, ankles and feet to your elbows, knees, hips, neck, shoulders and jaw. Infectious arthritis - The patient has a fever, joint inflammation and swelling. He will feel tenderness and/or a sharp pain. Often these symptoms are linked to an injury or another illness. Most commonly affected areas are the knee, shoulder, elbow, wrist and finger. In the majority of cases, just one joint is affected. Juvenile rheumatoid arthritis - The patient is a child. He will experience intermittent fevers which tend to peak in the evening and then suddenly disappear. His appetite will be poor and he will lose weight. There may be blotchy rashes on his arms and legs. Anemia is also common. The child may limp or have a sore wrist, finger, or knee. A joint may suddenly swell and stay larger than it usually is. The child may experience a stiff neck, hips or some other joint.

THE EYE
by Harvard Medical School The eye has often been compared to a camera. It would be more appropriate to compare it to a TV camera attached to an automatically tracking tripod a machine that is self-focusing, adjusts automatically for light intensity, has a self-cleaning lens, and feeds into a computer with parallelprocessing capabilities so advanced that engineers are only just starting to consider similar strategies for the hardware they design. The gigantic job of taking the light that falls on the two retinas and translating it into a meaningful visual scene is often curiously ignored, as though all we needed in order to see was an image of the external world perfectly focused on the retina. Although obtaining focused images is no mean task, it is modest compared with the work of the nervous system the retina plus the brain. As we shall see in this chapter, the contribution of the retina itself is impressive. By translating light into nerve signals, it begins the job of extracting from the environment what is useful and ignoring what is redundant. No human inventions, including computer-assisted cameras, can begin to rival the eye. This chapter is mainly about the neural part of the eye the retinabut I will begin with a short description of the eyeball, the apparatus that houses the retina and supplies it with sharp images of the outside world. THE EYEBALL The collective function of the nonretinal parts of the eye is to keep a focused, clear image of the outside world anchored on the two retinas. Each eye is positioned in its socket by the six small extraocular muscles mentioned in Chapter 2. That there are six for each eye is no accident; they consist of three pairs, with the muscles in each pair working in opposition, so as to take care of movements in one of three orthogonal (perpendicular) planes. For both eyes, the job of tracking an object has to be done with a precision of a few minutes of arcor else we see double. (To see how distressing that can be, try looking at something and pressing on the side of one eye with your index finger.) Such precise movements require a collection of finely tuned reflexes, including those that control head position. The cornea (the transparent front part of the eye) and lens together form the equivalent of the camera lens. About two-thirds of the bending of light necessary for focusing takes place at the air-cornea interface, where the light enters the eye. The lens of the eye supplies the remaining third of the focusing power, but its main job is to make the necessary adjustments to focus on objects at various distances. To focus a camera you change the distance between lens and film; we focus our eye not by changing the distance between lens and retina but by changing the shape of the rubbery, jellylike lens by pulling or relaxing the tendons that hold it at its marginso that it goes from more spherical for near objects to flatter for far ones. A set of radial muscles called ciliary muscles produces these changes in shape. (When we get older than about 45, the lens becomes hard and we lose our power to focus. It was to circumvent this major irritation of aging that Benjamin Franklin invented bifocal spectacles.) The reflex that contracts these ciliary muscles in order to make the lens rounder depends on visual input and is closely linked to the reflex controlling the concomitant turning in of the eyes.

The Earwax Post


What Is Earwax (Cerumen)? What Is Earwax Impaction? http://bit.ly/13Rj3Ab The Good, the Bad and the Eww of Earwax Removal:http://on.wsj.com/13TQItk Earwax Type: The Myth (full post dispelling the following myth here: http://bit.ly/16phB7N ) Some people have earwax that is wet, sticky and yellow or brown; other people's earwax is dry, crumbly and grayish. Variation at a single gene determines which kind of earwax you have; the allele for wet earwax is dominant over the allele for dry earwax. The allele for dry earwax appears to have originated by mutation in northeastern Asia about 2,000 generations ago, then spread outwards because it was favored by natural selection. It is very common in eastern Asia, becomes much less common towards Europe, and is very rare in Africa. Earwax type is not used very often to illustrate basic genetics, but unlike most human characters that are used (tongue rolling, attached earlobes, etc.), it really is controlled by a single gene with two alleles. (full post dispelling the myth here: http://bit.ly/16phB7N )

What Is a Motor Unit?


A motor unit consists of one alpha motor neuron together with all the muscle fibers it stimulates. Since the human body contains, on average, 250,000,000 muscle cells and approximately 420,000 motor neurons, a motor unit will generally consist of a single motor neuron paired with many muscle fibers. In strength training, the early strength gains seen by novices are often not gains in size or number of muscle fibers, but activation of motor units that had been previously dormant. The motor neuron is a specialized type of nervous cell that runs between the central nervous system and the muscles. Neurons typically consist of a cell body the axon and the dendrites. If a neuron were to be seen as a tree, the axon would be analogous to the trunk and the dendrites to the branches. Neurons found within the brain normally have relatively short axons, but neurons that are part of a motor unit because they must connect to the muscles of the body have elongated axons that run through the spinal cord, and out to the associated muscle fibers. Each muscle fiber is connected to a particular dendrite, and it is through the dendrites that messages are relayed between the central nervous system and the muscle fiber. Muscle fibers are elongated cells, specialized to carry out the functions of the specific muscles of which they are a part. This is true of the cardiac muscles of the heart, the smooth muscles that make up the lining of many internal organs, and skeletal muscles. Only skeletal muscles, however, are under conscious control. The size and shape of the muscle fiber is dependent upon its function, with the smooth muscle cells being flattened and tile-like; skeletal muscle cells, long and rope-like; and cardiac muscle cells having some properties of the other two.

A single muscle usually consists of a number of motor units working together, known as the motor pool. When the central nervous system requires that a muscle contract, an electrical signal is sent along the motor neuron, stimulating the muscle fibers to contract. Normally, each contraction is followed by a brief period of relaxation of the muscle fibers, and this pattern repeats in a wave-like pattern, known as a twitch. Skeletal muscle fibers can be divided into slow twitch and fast twitch fibers, depending on the length of time required for contraction and relaxation to occur. Slow twitch fibers are associated with endurance, while fast twitch muscle fibers are associated with power. Individuals may have a preponderance of one type of muscle fiber or the other, or a combination of the two. All the muscle fibers within a motor unit will be of a single type, meaning either fast twitch or slow twitch. This may include up to 1,000 muscle fibers, as in the large quadriceps muscles of the thigh, or fewer than ten, as seen in motor units requiring a high degree of precision, such as the muscles that control eye movement. Upon contraction, the smallest motor unit, that is, the one associated with the fewest muscle fibers, is the normally the first activated. As the contraction progresses, larger motor units are brought into play. Efficient muscle contraction depends on the motor units within a muscle working effectively together. Regular physical training makes this kind of coordination easier. Occasionally, a motor unit will receive a series of rapid contractile stimulations in such quick succession that the motor pool has no time to enter the relaxation phase of each twitch. When this occurs, it can build up to a state of maximal contraction, known as tetanic contraction. Significantly stronger than a natural twitch, tetanic contraction can result from a number of causes, such as illness or an adverse drug reaction. One of the more well-known reasons for this phenomenon is associated with tetanus infections.

All About Achilles Tendonitis


By Jonathan Cluett, M.D. Achilles tendonitis is a condition of irritation and inflammation of the large tendon in the back of the ankle. Achilles tendonitis is a common injury that tends to occur in recreational athletes. Overuse of the Achilles tendon can cause inflammation that can lead to pain and swelling. Achilles tendonitis is differentiated from another common Achilles tendon condition called Achilles tendinosis. Patients with Achilles tendinosis have chronic Achilles swelling and pain as a result of degenerative, microscopic tears within the tendon. Causes of Achilles Tendonitis The two most common causes of Achilles tendonitis are: Lack of flexibility Overpronation

Other factors associated with Achilles tendonitis are recent changes in footwear, and changes in exercise training schedules. Often long distance runners will have symptoms of Achilles tendonitis after increasing their mileage or increasing the amount of hill training they are doing. As people age, tendons, like other tissues in the body, become less flexible, more rigid, and more susceptible to injury. Therefore, middle-age recreational athletes are most susceptible to Achilles tendonitis. Symptoms of Achilles Tendonitis The main complaint associated with Achilles tendonitis is pain behind the heel. The pain is often most prominent in an area about 2-4 centimeters above where the tendon attaches to the heel. In this location, called the watershed zone of the tendon, the blood supply to the tendon makes this area particularly susceptible. Patients with Achilles tendonitis usually experience the most significant pain after periods of inactivity. Therefore patients tend to experience pain after first walking in the morning and when getting up after sitting for long periods of time. Patients will also experience pain while participating in activities, such as when running or jumping. Achilles tendonitis pain associated with exercise is most significant when pushing off or jumping. X-rays are usually normal in patients with Achilles tendonitis, but are performed to evaluate for other possible conditions. Occasionally, an MRI is needed to evaluate a patient for tears within the tendon. If there is a thought of surgical treatment an MRI may be helpful for preoperative evaluation and planning. Treatment of Achilles Tendonitis Treatment of Achilles tendonitis begins with resting the tendon to allow the inflammation to settle down. In more serious situations, adequate rest may require crutches or immobilization of the ankle. There are different treatments for Achilles tendonitis, including ice, manual therapies, medications, injections, and surgery. Sources: Saltzman CL, Tearse DS. "Achilles tendon injuries" J. Am. Acad. Ortho. Surg., Sep 1998; 6: 316 - 325. Schepsis, AA, et al. "Achilles Tendon Disorders in Athletes" Am. J. Sports Med., March 1, 2002; 30(2): 287 - 305. van der Linden PD, et al. "Fluoroquinolones and risk of Achilles tendon disorders: case-control study" BMJ 2002;324:1306.

Just Breathe The Simplest Means of Managing Stress


Our bodies arent shy about telling us that we are stressed out! Muscle tension, backaches, stomach upset, headaches, burnout and other illness states are ways in which the body signals to us the need to relax. Rather than run for that anti-anxiety medication, we can utilize our easiest, natural defense against stress: our breathing. The way we breathe can affect our emotions and mental states as well as determine how we physically respond to stress. Fight or Flight Response vs. Relaxation Response The general physiological response to stress is called the stress response or fight or flight response. When we experience stress, hormones activated by the sympathetic branch of the autonomic nervous system flood our bloodstream to signal a state of readiness against potential threats to our well being. While these hormones serve to help us act quickly and with great strength during emergency situations, they exemplify the concept that there can be too much of a good thing. Chronic stress results in excess release of stress hormones, which can cause immune-system malfunction, gastrointestinal issues, and blood vessel deterioration, among other health complications. Over time, such symptoms can evolve into degenerative diseases like diabetes, obesity, and cardiovascular disease. We can help preserve and enhance our health, though, by refusing to fall victim to chronic release of stress hormones, even if we are not able to control when or how stressful situations challenge us. We can learn to effectively manage our physiological reaction to stressors by teaching the body to induce a relaxation response. A relaxation response counteracts the effects of the fight or flight response by helping to boost immune system function, reduce blood pressure and cortisol levels, and protect tissues from damage caused by stress-hormones. Breathing and Relaxation Response The way we breathe affects our autonomic nervous system (ANS), the branches of which signal automatic physiological reactions in the body, like the fight or flight and relaxation responses. ANS activity is outside of our conscious control. The ANS is responsible for managing our breathing, heart rate, body temperature, digestion, and other basic processes necessary for survival. While the sympathetic branch of the ANS initiates the stress response, the parasympathetic branch induces a relaxation response. Our somatic nervous system, over which we do have conscious control, makes possible the movements of our eyes, limbs, and mouths, for example, as well as how (not whether) we breathe. Thus, we can, through somatic manipulation of our breath, affect which ANS branch remains active, especially during moments of stress. One of the best means of inducing a relaxation response is through diaphragmatic breathing: inhaling deeply through the chest and virtually into the stomach. Engaging the diaphragm may be the key to inducing a relaxation response through deep breathing because the diaphragms close proximity to the vagus nerve. The vagus nerve is a cranial nerve which supplies approximately 75% of all parasympathetic fibers to the rest of the body, and may be stimulated through diaphragmatic movement. Conversely, thoracic breathing that is limited to the chest cavity is associated with the sympathetic branch stress response.

Self-Empowerment through Breathing Situations may catalyze stress for us when we are uncertain about them or unable to control their outcome. We may feel helpless, overwhelmed, fearful, or forced into stifling our true feelings, and may experience additional anxiety over our inability to control the resulting hormonal fight or flight response. The key to stress management is recognition that while we may not be able to control the stressor, we can always control our reaction to it. We have choices: whether to relax through diaphragmatic breathing techniques until we feel ready to make beneficial decisions, or to just react while on sympathetic branch automatic pilot. Even if we dont find a solution to the stressful situation, choosing to take time out to breathe protects our bodies from detrimental effects of stress. Upon experiencing fear or anxiety, our diaphragm involuntarily flattens and we breathe in a shallow manner as our body prepares for action. Armed with the knowledge that we can create a counterresponse by breathing deeply, we can change any automatic course of action. When a stressor engages us, we can consciously control the speed and fullness with which we inhale, trusting that a relaxation response will happen as long as we keep breathing in this manner and do not lose patience. Recognizing the need to breathe diaphragmatically is half the battle; actually doing it is what empowers and frees us. Diaphragmatic Breathing Techniques To practice diaphragmatic breathing, lie down on your back or sit in a comfortable cross-legged position with your back as straight as possible (maybe against a wall) and close your eyes. Place your hands on your abdomen. Slowly inhale, filling your lungs and what seems like your stomach, to the point where your hands rise with the breath. Hold your breath for a few seconds, then slowly exhale completely. Repeat this process for many breaths, savoring the recognition that you are sending life-sustaining oxygen to all the cells of your body. One of the keys to creating a relaxation response is to be the breath. Focusing on the breath helps you be present. When thoughts enter your mind, acknowledge them, let them go, then refocus the mind on the sound of your breath. Perhaps visualize a relaxing scene or imagine continuous ocean waves slowly rolling into the shoreline. Maybe listening to peaceful music or repeating a mantra in your head that brings you serenity will help you free your mind of distracting thoughts. Your memory is another tool you have to facilitate relaxation. Recalling a time of great happiness can help you replace negative feelings with pleasant ones. Tapping into your particular spiritual belief system at this time might also help you relax; some people find that saying a prayer while breathing deeply can help decrease stress. Diaphragmatic Breathing Offers Multidimensional Benefits Bridging the mind and body through deep breathing is a multidimensional experience. Because the sympathetic and parasympathetic branches of the ANS are regulated by chemical messengers called neurotransmitters, rather than neural impulses from the brain, brain stem and spinal cord, these branches are influenced by our emotional responses to environmental stimuli. Neurotransmitters create physiological reactions by relaying information based upon our feelings to various cells within the body. The digestive tract is especially rich with neurotransmitter receptor sites, w hich may explain gut feelings."

Fear, for example, initiates thoracic breathing associated with sympathetic branch activity. When we breathe in a shallow manner, we utilize only half of the alveoli (air filled sacs) in our lungs. Diaphragmatic breathing employs all the alveoli in our lungs while helping the body and mind relax. By repeatedly expanding our lungs to full capacity, we improve our metabolism by increasing oxygen supply to the rest of the body, promoting detoxification in the lungs, and enhancing digestion. We may also be able to change the emotions which engendered the stress response by releasing their power over us through the breath. Clear thinking and creative decision-making may follow and lead to more positive emotions. The multidimensional effects of deep breathing illustrate the complex connections between the mind and the body and enhance our understanding of stress-related disease prevention and treatment. When It Comes to Stress, Be Your Breath The solution to stress lies within us. Nature has given us a defense mechanism with which to combat the physical effects of stress: parasympathetic nervous system activity catalyzed by diaphragmatic breathing. While breathing alone may not resolve the issue stressing us, it can empower us to healthfully adapt on mental, emotional, physical, and even spiritual levels. Consciously breathing is a core element of mind-body philosophies such as yoga, meditation and Tai Chi (diaphragmatic breathing as described in this article most closely resembles meditation). Mind-body disciplines, such as Yoga and Tai Chi, which embrace specific postures and/or fluid movements offer added benefits of improved balance, flexibility and circulation. Regularly practicing diaphragmatic breathing through any mind-body technique can help us establish a relaxation routine. When something is routine, we can just do it (i.e. let our thoughts go because we dont need to think so much about what we are doing). A movement based breathing practice may be the best means of relaxation for more physically active people, and can be a great way for less-active folks to get some exercise. For some, spirituality may permeate the mind-body breathing practice. The role of spirituality in stress management may relate to how we perceive situations beyond our control. Wayne Dyer, an inspiration guru, lectures and writes that we are eternal spiritual beings who are having temporary human experiences, which seems like another way of saying dont sweat the small stuff. Believing in a higher power (whatever that means to us individually) can relieve us of the perceived burden of always having to handle things on our own. Learning to cultivate a relaxation response may involve trying various methods until you discover the one that works for you. Finding a technique that you enjoy is the key to making it a lifestyle habit. When you feel the effects of stress just breathe. References and Resources: Merck Manuals Online Medical Library. Autonomic Nervous System: Introduction Sinatra, S. Heartbreak and Heart Disease. Keats Publishing, 1999. Stockdale B. You Can Beat the Odds: Surprising Factors Behind Chronic Illness and Cancer. Sentient Publications, 2009.

The intestines
The intestines are a long, continuous tube running from the stomach to the anus. Most absorption of nutrients and water happen in the intestines. The intestines include the small intestine, large intestine, and rectum. The small intestine (small bowel) is about 20 feet long and about an inch in diameter. Its job is to absorb most of the nutrients from what we eat and drink. Velvety tissue lines the small intestine, which is divided into the duodenum, jejunum, and ileum. The large intestine (colon or large bowel) is about 5 feet long and about 3 inches in diameter. The colon absorbs water from wastes, creating stool. As stool enters the rectum, nerves there create the urge to defecate. Intestine Conditions Stomach flu (enteritis): Inflammation of the small intestine. Infections (from viruses, bacteria, or parasites) are the common cause. Small intestine cancer: Rarely, cancer may affect the small intestine. There are multiple types of small intestine cancer, causing about 1,100 deaths each year. Celiac disease: An "allergy" to gluten (a protein in most breads) causes the small intestine not to absorb nutrients properly. Abdominal pain and weight loss are usual symptoms. Carcinoid tumor: A benign or malignant growth in the small intestine. Diarrhea and skin flushing are the most common symptoms. Intestinal obstruction: A section of either the small or large bowel can become blocked or twisted or just stop working. Belly distension, pain, constipation, and vomiting are symptoms. Colitis: Inflammation of the colon. Inflammatory bowel disease or infections are the most common causes. Diverticulosis: Small weak areas in the colon's muscular wall allow the colon's lining to protrude through, forming tiny pouches called diverticuli. Diverticuli usually cause no problems, but can bleed or become inflamed. Diverticulitis: When diverticuli become inflamed or infected, diverticulitis results. Abdominal pain and constipation are common symptoms. Colon bleeding (hemorrhage): Multiple potential colon problems can cause bleeding. Rapid bleeding is visible in the stool, but very slow bleeding might not be. Inflammatory bowel disease: A name for either Crohn's disease or ulcerative colitis. Both conditions can cause colon inflammation (colitis).

Crohn's disease: An inflammatory condition that usually affects the colon and intestines. Abdominal pain and diarrhea (which may be bloody) are symptoms. Ulcerative colitis: An inflammatory condition that usually affects the colon and rectum. Like Crohn's disease, bloody diarrhea is a common symptom of ulcerative colitis. Diarrhea: Stools that are frequent, loose, or watery are commonly called diarrhea. Most diarrhea is due to self-limited, mild infections of the colon or small intestine. Salmonellosis: Salmonella bacteria can contaminate food and infect the intestine. Salmonella causes diarrhea and stomach cramps, which usually resolve without treatment. Shigellosis: Shigella bacteria can contaminate food and infect the intestine. Symptoms include fever, stomach cramps, and diarrhea, which may be bloody. Traveler's diarrhea: Many different bacteria commonly contaminate water or food in developing countries. Loose stools, sometimes with nausea and fever, are symptoms. Colon polyps: Polyps are growths inside the colon. Colon cancer can often develop in these tumors after many years. Colon cancer: Cancer of the colon affects more than 100,000 Americans each year. Most colon cancer is preventable through regular screening. Rectal cancer: Colon and rectal cancer are similar in prognosis and treatment. Doctors often consider them together as colorectal cancer. Constipation: When bowel movements are infrequent or difficult. Irritable bowel syndrome (IBS): Irritable bowel syndrome, also known as IBS, is an intestinal disorder that causes irritable abdominal pain or discomfort, cramping or bloating, and diarrhea or constipation. Rectal prolapse: Part or all of the wall of the rectum can move out of position, sometimes coming out of the anus, when straining during a bowel movement. Intussusception: Occurring mostly in children, the small intestine can collapse into itself like a telescope. It can become life-threatening if not treated.

How Hugging, Kissing And More Displays Of Affection Help Your Health!
Good news, lovebirds! If you're planning to celebrate with your Valentine in the coming weeks, get ready to toast to your health. Earlier this week, a researcher at the Medical University of Vienna spread some good news in honor of National Hug Day. He pointed out that hugging someone you care about can ease stress and anxiety, lower blood pressure and even boost memory -- but hugging a stranger can have the opposite effect. While the association between hugging and your health isn't new, it's especially relevant this time of year -- with Valentine's Day on the horizon and many couples hurrying to cuddle away the frigid temperatures sweeping across much of the nation. Experts believe it all comes back to the hormone oxytocin. A simple embrace seems to increase levels of the "love hormone," which has been linked to social bonding. That oxytocin boost seems to have a greater calming effect on women than men, the BBC reported. In one study, the stress-reducing effects of a brief hug in the morning carried throughout a tough work day, USA Today reported. Perhaps the best news of all is that hugging isn't the only way getting close to your Valentine can boost your health. A few others also have big benefits: Cuddling Call it an extended hug -- cuddling also releases stress-easing oxytocin, which can reduce blood pressure and bond you with your mate. But you may not have guessed that a little cuddle time can help you and your partner communicate better. "Non-verbal communication can be a very powerful way to say to your partner, 'I get you,'" marriage and family therapist David Klow told Shape magazine. "Cuddling is a way of saying, 'I know how you feel.' It allows us to feel known by our partner in ways that words can't convey." Talking Speaking of communication -- even just spending time together without touching can put you at ease and lower blood pressure, compared to spending time with someone less significant, according to the BBC. Not to mention that making the effort to communicate openly can only strengthen your relationship. Kissing Of course, kissing has also been shown to affect oxytocin and cortisol levels, and, just like hugging and cuddling, can reduce stress. But one of the more surprising pros of puckering up is a cleaner kisser. The increase in saliva production that comes along with a smooch can wash bacteria off teeth and help fight plaque buildup. Sex In addition to relaxing you and burning some calories, some time between the sheets can help you fight off germs (Hello, flu protection!). As long as your partner isn't already sick, a couple of sexy escapades a

week can boost a particular antibody that fights off colds, according to a 1999 study. Sex may also promote better sleep, thanks to both the relaxing effects of that oxytocin and an increase in a hormone called prolactin, which is normally higher during sleep, according to Women's Health.

Deep Muscles of the Neck


Image from Anatomy In Motion app. Currently available for the iPhone, iPad, iPad Mini and iPod touch. http://bit.ly/GD4LDF Sub Occipital suboccipital \-k-sip-t-l\ triangle noun : a space of the suboccipital region on each side of the dorsal cervical region that is bounded superiorly and medially by a muscle arising by a tendon from a spinous process of the axis and inserting into the inferior nuchal line and the adjacent inferior region of the occipital bone, that is bounded superiorly and laterally by the obliquus capitis superior, and that is bounded inferiorly and laterally by the obliquus capitis inferior Semispinalis semispinalis noun \-sp-n-ls\ plural ; semispinales : any of three muscles of the cervical and thoracic parts of the spinal column that arise from transverse processes of the vertebrae and pass to spinous processes higher up and that help to form a layer underneath the sacrospinalis muscle: a : semispinalis thoracis b : semispinalis cervicis c : semispinalis capitis Longissimus longissimus noun \ln-jis-i-ms\ plural ; longissimi : the intermediate division of the sacrospinalis muscle that consists of the longissimus capitis, longissimus cervicis, and longissimus thoracis; also : any of these three muscles Splenius Cervicis splenius \-n-s\ cervicis noun \-sr-v-ss\ : a flat narrow muscle on each side of the back of the neck and the upper thoracic region that arises from the spinous processes of the third to sixth thoracic vertebrae, is inserted into the transverse processes of the first two or three cervical vertebrae, and acts to rotate the head to the side on which it is located and with the help of the muscle on the opposite side to extend and arch the neck

Splenius Capitis splenius \-n-s\ capitis noun \-kap-t-s\ : a flat muscle on each side of the back of the neck and the upper thoracic region that arises from the caudal half of the ligamentum nuchae and the spinous processes of the seventh cervical and the first three or four thoracic vertebrae, that is inserted into the occipital bone and the mastoid process of the temporal bone, and that rotates the head to the side on which it is located and with the help of the muscle on the opposite side extends it Scalenes scalenus noun \sk-l-ns\ plural ; scaleni (audio pronunciation) : any of usually three deeply situated muscles on each side of the neck of which each extends from the transverse processes of two or more cervical vertebrae to the first or second rib: a : one arising from the transverse processes of the third to sixth cervical vertebrae, inserting on the scalene tubercle of the first rib, and functioning to bend the neck forward and laterally and to rotate it to the sidecalled also anterior scalene, scalenus anterior, scalenus anticus b : one arising from the transverse processes of the lower six cervical vertebrae, inserting on the upper surface of the first rib, and functioning similarly to the scalenus anterior called also middle scalene, scalenus medius c : one arising from the transverse processes of the fourth to sixth cervical vertebrae, inserting on the outer surface of the second rib, and functioning to raise the second rib and to bend and slightly rotate the neckcalled also posterior scalene, scalenus posterior Deep Muscles of the Spine Interspinalis: interspinalis noun \int-r-sp-nal-s, -n-ls\ plural ; interspinales : any of various short muscles that have their origin on the superior surface of the spinous process of one vertebra and their insertion on the inferior surface of the contiguous vertebra above Intertransversarii: intertransversarii noun pl \-tran(t)s-vr-ser--\ : a series of small muscles connecting the transverse processes of contiguous vertebrae and most highly developed in the neck Rotatores rotator noun \r-tt-r also r-\ plural ; rotatorsor ; rotatores : a muscle that partially rotates a part on its axis; specifically : any of several small muscles in the dorsal

region of the spine arising from the upper and back part of a transverse process and inserted into the lamina of the vertebra above Multifidus multifidus noun \ml-tif--ds\ plural ; multifidi : a muscle of the fifth and deepest layer of the back filling up the groove on each side of the spinous processes of the vertebrae from the sacrum to the skull and consisting of many fasciculi that pass upward and inward to the spinous processes and help to erect and rotate the spine iliocostalis iliocostalis noun \-ks-t-ls\ : the lateral division of the sacrospinalis muscle that helps to keep the trunk erect and consists of three parts: a : iliocostalis cervicis b : iliocostalis lumborum c : iliocostalis thoracis Longissimus longissimus noun \ln-jis-i-ms\ plural ; longissimi : the intermediate division of the sacrospinalis muscle that consists of the longissimus capitis, longissimus cervicis, and longissimus thoracis; also : any of these three muscles Spinalis spinalis noun \sp-n-ls, spi-na-lis\ plural ; spinales : the most medial division of the sacrospinalis situated next to the spinal column and acting to extend it or any of the three muscles making up this division: a : spinalis thoracis b : spinalis cervicis c : spinalis capitis Semispinalis semispinalis noun \-sp-n-ls\ plural ; semispinales : any of three muscles of the cervical and thoracic parts of the spinal column that arise from transverse processes of the vertebrae and pass to spinous processes higher up and that help to form a layer underneath the sacrospinalis muscle:

a : semispinalis thoracis b : semispinalis cervicis c : semispinalis capitis Definitaions from Merriam-Webster Dictionary, Medical Image from the Anatomy In Motion app. Currently available for the iPhone, iPad, iPad Mini and iPod touch.http://bit.ly/GD4LDF FAQ's Universal Version: http://bit.ly/GD4LDF iPhone/iPod Touch Only Version: http://bit.ly/w9Kccz What is the difference between these versions:http://on.fb.me/Rpfg8T We are continuing to research the possibility of an Android version: http://bit.ly/QfMxkN To Give Anatomy In Motion as a gift: 1. Go to iTunes and log into your account:http://bit.ly/GD4LDF 2. Click the arrow next to the price of the app 3. In the menu that appears, click "Gift This App" 4. You will be lead to a form that lets add who you are sending Anatomy In Motion to and a place to include a personal message 5. Choose your delivery option: by email or to print out the gift information so you can deliver it yourself

How do muscles grow?


Young sub Kwon, M.S. and Len Kravitz, Ph.D. Article Reviewed: Charge, S. B. P., and Rudnicki, M.A. (2004). Cellular and molecular regulation of muscle regeneration. Physiological Reviews, Volume 84, 209-238. Introduction Personal trainers and fitness professionals often spend countless hours reading articles and research on

new training programs and exercise ideas for developing muscular fitness. However, largely because of its physiological complexity, few fitness professionals are as well informed in how muscles actually adapt and grow to the progressively increasing overload demands of exercise. In fact, skeletal muscle is the most adaptable tissue in the human body and muscle hypertrophy (increase in size) is a vastly researched topic, yet still considered a fertile area of research. This column will provide a brief update on some of the intriguing cellular changes that occur leading to muscle growth, referred to as the satellite cell theory of hypertrophy. Trauma to the Muscle: Activating The Satellite Cells When muscles undergo intense exercise, as from a resistance training bout, there is trauma to the muscle fibers that is referred to as muscle injury or damage in scientific investigations. This disruption to muscle cell organelles activates satellite cells, which are located on the outside of the muscle fibers between the basal lamina (basement membrane) and the plasma membrane (sarcolemma) of muscles fibers to proliferate to the injury site (Charge and Rudnicki 2004). In essence, a biological effort to repair or replace damaged muscle fibers begins with the satellite cells fusing together and to the muscles fibers, often leading to increases in muscle fiber cross-sectional area or hypertrophy. The satellite cells have only one nucleus and can replicate by dividing. As the satellite cells multiply, some remain as organelles on the muscle fiber where as the majority differentiate (the process cells undergo as they mature into normal cells) and fuse to muscle fibers to form new muscle protein stands (or myofibrils) and/or repair damaged fibers. Thus, the muscle cells myofibrils will increase in thickness and number. Afte r fusion with the muscle fiber, some satellite cells serve as a source of new nuclei to supplement the growing muscle fiber. With these additional nuclei, the muscle fiber can synthesize more proteins and create more contractile myofilaments, known as actin and myosin, in skeletal muscle cells. It is interesting to note that high numbers of satellite cells are found associated within slow-twitch muscle fibers as compared to fasttwitch muscle fibers within the same muscle, as they are regularly going through cell maintenance repair from daily activities. Growth factors Growth factors are hormones or hormone-like compounds that stimulate satellite cells to produce the gains in the muscle fiber size. These growth factors have been shown to affect muscle growth by regulating satellite cell activity. Hepatocyte growth factor (HGF) is a key regulator of satellite cell activity. It has been shown to be the active factor in damaged muscle and may also be responsible for causing satellite cells to migrate to the damaged muscle area (Charge and Rudnicki 2004). Fibroblast growth factor (FGF) is another important growth factor in muscle repair following exercise. The role of FGF may be in the revascularization (forming new blood capillaries) process during muscle regeneration (Charge and Rudnicki 2004). A great deal of research has been focused on the role of insulin-like growth factor-I and II (IGFs) in muscle growth. The IGFs play a primary role in regulating the amount of muscle mass growth, promoting changes occurring in the DNA for protein synthesis, and promoting muscle cell repair. Insulin also stimulates muscle growth by enhancing protein synthesis and facilitating the entry of glucose into cells. The satellite cells use glucose as a fuel substrate, thus enabling their cell growth activities. And, glucose is also used for intramuscular energy needs. Growth hormone is also highly recognized for its role in muscle growth. Resistance exercise stimulates the release of growth hormone from the anterior pituitary gland, with released levels being very dependent on exercise intensity. Growth hormone helps to trigger fat metabolism for energy use in the

muscle growth process. As well, growth hormone stimulates the uptake and incorporation of amino acids into protein in skeletal muscle. Lastly, testosterone also affects muscle hypertrophy. This hormone can stimulate growth hormone responses in the pituitary, which enhances cellular amino acid uptake and protein synthesis in skeletal muscle. In addition, testosterone can increase the presence of neurotransmitters at the fiber site, which can help to activate tissue growth. As a steroid hormone, testosterone can interact with nuclear receptors on the DNA, resulting in protein synthesis. Testosterone may also have some type of regulatory effect on satellite cells. Muscle Growth: The Bigger Picture The previous discussion clearly shows that muscle growth is a complex molecular biology cell process involving the interplay of numerous cellular organelles and growth factors, occurring as a result of resistance exercise. However, for client education some important applications need to be summarized. Muscle growth occurs whenever the rate of muscle protein synthesis is greater than the rate of muscle protein breakdown. Both, the synthesis and breakdown of proteins are controlled by complimentary cellular mechanisms. Resistance exercise can profoundly stimulate muscle cell hypertrophy and the resultant gain in strength. However, the time course for this hypertrophy is relatively slow, generally taking several weeks or months to be apparent (Rasmussen and Phillips, 2003). Interestingly, a single bout of exercise stimulates protein synthesis within 2-4 hours after the workout which may remain elevated for up to 24 hours (Rasmussen and Phillips, 2003). Some specific factors that influence these adaptations are helpful to highlight to your clients. All studies show that men and women respond to a resistance training stimulus very similarly. However, due to gender differences in body size, body composition and hormone levels, gender will have a varying effect on the extent of hypertrophy one may possibly attain. As well, greater changes in muscle mass will occur in individuals with more muscle mass at the start of a training program. Aging also mediates cellular changes in muscle decreasing the actual muscle mass. This loss of muscle mass is referred to as sarcopenia. Happily, the detrimental effects of aging on muscle have been shown be restrained or even reversed with regular resistance exercise. Importantly, resistance exercise also improves the connective tissue harness surrounding muscle, thus being most beneficial for injury prevention and in physical rehabilitation therapy. Heredity differentiates the percentage and amount of the two markedly different fiber types. In humans the cardiovascular-type fibers have at different times been called red, tonic, Type I, slow-twitch (ST), or slow-oxidative (SO) fibers. Contrariwise, the anaerobic-type fibers have been called the white, phasic, Type II, fast-twitch (FT), or fast-glycolytic (FG) fibers. A further subdivision of Type II fibers is the IIa (fast-oxidative-glycolytic) and IIb (fast-glycolytic) fibers. It is worthy of note to mention that the soleus, a muscle involved in standing posture and gait, generally contains 25% to 40% more Type I fibers, while the triceps has 10% to 30% more Type II fibers than the other arm muscles (Foss and Ketyian, 1998). The proportions and types of muscle fibers vary greatly between adults. It is suggested that the new, popular periodization models of exercise training, which include light, moderate and high intensity training phases, satisfactorily overload the different muscle fiber types of the body while also providing sufficient rest for protein synthesis to occur.

Muscle Hypertrophy Summary Resistance training leads to trauma or injury of the cellular proteins in muscle. This prompts cell-signaling messages to activate satellite cells to begin a cascade of events leading to muscle repair and growth. Several growth factors are involved that regulate the mechanisms of change in protein number and size within the muscle. The adaptation of muscle to the overload stress of resistance exercise begins immediately after each exercise bout, but often takes weeks or months for it to physically manifest itself. The most adaptable tissue in the human body is skeletal muscle, and it is remarkably remodeled after continuous, and carefully designed, resistance exercise training programs. Additional References: Foss, M.L. and Keteyian, S.J. (1998). Foxs Physiological Basis for Exercise and Sport. WCB McGraw -Hill. Rasmussen, R.B., and Phillips, S.M. (2003). Contractile and Nutritional Regulation of Human Muscle Growth. Exercise and Sport Science Reviews. 31(3):127-131. Biographies: Young sub Kwon, MS, CSCS, is a doctoral student in the exercise science program at the University of New Mexico, Albuquerque. He earned his master's degree in exercise physiology in 2001 and has research interests in the field of resistance training and clinical exercise physiology. Before coming to the U.S. he was an exercise specialist in a hospital in Korea. Len Kravitz, PhD, is the program coordinator of exercise science and a researcher at UNMA, where he won the 2004 Outstanding Teacher of the Year Award. He was also honored with the 1999 Canadian Fitness Professionals International Presenter of the Year Award, and was the first person to win the IDEA Fitness Instructor of the Year Award.

The Sciatic Nerve


The sciatic nerve is a large nerve that originates from the distal spinal cord and extends along nearly the entire length of the hind limb. In most vertebrates, it's the major branch of the sacral plexus, a complex mass comprised of neurons that exit the spinal column via spinal nerves L4 through S4. The sciatic nerve innervates most of the hind limb. As is the case with many of the large nerves of the vertebrate nervous system, the sciatic nerve is a mixed-function nerve, meaning it is made up of the axons of sensory and motor neurons. The sciatic nerve gives rise to branches as it progresses distally along the hind limb. Some of these branches contain motor & sensory neurons involved in control of the muscle groups of the upper leg, and the lower leg (both flexors and extensors). In addition, sensory receptors in the skin of the entire lower leg and the posteriolateral surface of the upper leg transmit information to the brain via sciatic nerve neurons. Damage to, or irritation of, the sciatic nerve at any point can result in a number of symptoms, some of

them potentially serious. The malady we call sciatica is the result of inflammation of the sciatic nerve, usually caused by chronic irritation of one or more of the spinal nerves L4 S4. The usual causes are trauma to the intervertebral discs associated with the roots of spinal nerves L4 _ S4, but a number of other causes, including improperly administered hypodermic injections into the gluteal muscle, have been documented. Whatever the cause, sciatica is characterized by pain along the course of the sciatic nerve through the hip and down the back of the leg. Pressure, either chronic or acute, applied to the sciatic nerve's dorsal and/or ventral roots can result in a number of symptoms in addition to pain. Impaired function of the motor neurons can result in weakness in the lower leg muscles. In extreme cases, inability of the lower leg muscles to control the ankle and foot can result in impaired gait due to foot drop (inability to dorsiflex the foot upward when stepping forward). Similarly, interference with normal function of the afferent fibers results in sensory disturbances such as paresthesia (a tingling or "pins and needles" sensation) or hyperthesia (increased or extreme sensitivity of receptors, particularly touch, temperature, and pain receptors). Severe sciatica can even result in wasting of the muscles of the lower leg as a result of a loss of normal stimulatory input to the muscle fibers. Categories of Sciatic Nerve Neurons As with other nerves in the vertebrate body, the sciatic nerve is comprised of the axons of hundreds of neurons. These axons vary greatly in diameter, from < 1 to 20 mm. Because conduction velocity is proportional to axon diameter, the conduction velocity of the sciatic nerve neurons also varies widely, from 0.2 to 150 m sec-1. Neurons are often categroized on the basis of their morphology and/or function (e. g., sensory or motor). However, neurophysiologists often employ an alternate approach that groups neurons (often referred to as "fibers" in this context) according to their axon diameter and degree of myelination. So-called Type A fibers, have large diameters, thick myelin sheaths and correspondingly high conduction velocities (30 _ 150 m sec-1). These neurons are mostly motor (efferent) neurons that control activity of skeletal muscles, or sensory (afferent) neurons that convey information from receptors in the muscles, joints, and epidermal tissues to the spinal cord. Type B fibers have less well developed myelin sheaths and conduction velocities in the range of about 3 _ 15 m sec-1. Most of these fibers are part of the autonomic nervous system's efferent pathways that innervate internal organs and blood vessels and provide for regulation of their activties. The smallest diameter fibers, termed Type C fibers, lack myelin sheaths and have correspondingly low conduction velocities (< 2 m sec-1). Many of the Type C fibers are efferent neurons of the sympathetic nervous system and afferent pain neurons.

Your Ribs
by Kids Health Your heart, lungs, and liver are all very important, and luckily you've got ribs to keep them safe. Ribs act like a cage of bones around your chest. It's easy to feel the bottom of this cage by running your fingers along the sides and front of your body, a few inches below your heart. If you breathe in deeply, you can easily feel your ribs right in the front of your body, too. Some thin kids can even see a few of their ribs right through their skin. Your ribs come in pairs, and the left and right sides of each pair are exactly the same. Most people have 12 pairs of ribs, but some people are born with one or more extra ribs, and some people might have one pair less. All 12 pairs of ribs attach in the back to the spine, where they are held in place by the thoracic vertebrae. The first seven pairs of ribs attach in the front to the sternum (say: STUR-num), a strong bone in the center of your chest that holds those ribs in place. The remaining sets of ribs don't attach to the sternum directly. The next three pairs are held on with cartilage to the ribs above them. The very last two sets of ribs are called floating ribs because they aren't connected to the sternum or the ribs above them. But don't worry, these ribs can't ever float away. Like the rest of the ribs, they are securely attached to the spine in the back.

Dysphagia
Introduction: Dysphagia is the medical term for difficulty swallowing, or the feeling that food is "sticking" in your throat or chest. The feeling is actually in your esophagus, the tube that carries food from your mouth to your stomach. You may experience dysphagia when swallowing solid foods, liquids, or both. Oropharyngeal dysphagia is when you have trouble moving food from your mouth into your upper esophagus. Esophageal dysphagia is when you have trouble moving food through your esophagus to your stomach. It is the most common kind of dysphagia. Dysphagia can strike at any age, although the risk increases with age. Signs and Symptoms: Symptoms of oropharyngeal dysphagia include the following: Difficulty trying to swallow Choking or breathing saliva into your lungs while swallowing Coughing while swallowing Regurgitating liquid through your nose Breathing in food while swallowing Weak voice Weight loss

Symptoms of esophageal dysphagia include the following: Pressure sensation in your mid-chest area Sensation of food stuck in your throat or chest Chest pain Pain with swallowing Chronic heartburn Belching Sore throat What Causes It?: Several conditions can cause dysphagia. In children, it is often due to physical malformations, conditions such as cerebral palsy or muscular dystrophy, or gastroesophageal reflux disease (GERD). Dysphagia in adults may be due to tumors (benign or cancerous), conditions that cause the esophagus to narrow, neuromuscular conditions, stroke, or GERD. It can also be caused when the muscle in your esophagus doesn't relax enough to let food pass into your stomach. Other risk factors include smoking, excessive alcohol use, certain medications, and teeth or dentures in poor condition. What to Expect at Your Provider's Office: Your health care provider may ask about your symptoms and eating habits. For infants and children, the health care provider may want to observe them eating. Your provider may also listen to your heart, take your pulse, and ask about your medical history. A variety of tests can be used for dysphagia: In endoscopy or esophagoscopy, a tube is inserted into your esophagus to help your health care provider evaluate the condition of your esophagus, and to try to open any parts that might be closed off. In esophageal manometry, a tube is inserted into your stomach to measure pressure differences in various regions. X-rays of your neck, chest, or abdomen may be taken. In a barium x-ray, moving picture or video x-rays are taken of your esophagus as you swallow barium, which is visible on an x-ray. Treatment Options: Health care providers typically treat dysphagia with drugs, exercises, and procedures that open the esophagus, or with surgery. Your treatment will depend on the cause, the seriousness, and any complications you may be experiencing. You usually do not need to go to the hospital, as long as you are able to eat enough and have a low risk of complications. If your esophagus is severely blocked, however, you may be hospitalized. Infants and children with dysphagia are often hospitalized. To treat oropharyngeal dysphagia, you may learn special exercises that help stimulate the nerves involved in swallowing. You may also learn to position your head in ways that help you swallow. For esophageal dysphagia involving an esophageal muscle that doesn't relax, your doctor may dilate your esophagus with a balloon attached to an endoscope. If the problem is GERD, you will be given antacids or proton pump inhibitors. Your physician may also prescribe medications that relax your esophagus and prevent spasms. If dysphagia is due to a tumor or other obstruction, you may need surgery. Complementary and Alternative Therapies Herbs: Herbs are generally a safe way to strengthen and tone the body's systems. As with any therapy, you should work with your health care provider before starting any treatment. You may use herbs as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts).

Unless otherwise indicated, make teas with 1 tsp. herb per cup of hot water. Steep covered 5 - 10 minutes for leaf or flowers, and 10 - 20 minutes for roots. Drink 2 - 4 cups a day. You may use the following tinctures, alone or in combination: Licorice (Glycyrrhiza glabra) standardized deglycyrrhizinated licorice (DGL) extract, 250 mg 3 times daily, taken either 1 hour before or 2 hours after meals, for reducing spasms and swelling and as a pain reliever specifically for the gastrointestinal tract. DGL has a chemical removed from the licorice that has been known to cause high blood pressure. Chewable lozenges may be the best form of licorice for treating GERD. Slippery elm (Ulmus fulva), as a tea, for demulcent ( protects irritated tissues and promotes their healing). One teaspoon of slippery elm powder may be mixed with water. Drink 3 - 4 times a day. Marshmallow (Althaea officinalis), as a tea, for demulcent and emollient effects. The dose is one cup of tea 3 times per day. To make tea, steep 2 - 5 g of dried leaf or 5 g dried root in one cup of boiling water. Strain and cool. Avoid marshmallow if you have diabetes. In addition, you may use a combination of 4 of the following herbs as a tea or tincture. Use equal parts of the herbs, 1 tsp. of each per cup of water and steep 10 minutes 3 times a day; or equal parts of tincture, 30 - 60 drops 3 times a day. Valerian (Valeriana officinalis) may improve digestion and help you relax, especially if you feel anxious or depressed. Skullcap (Scutellaria lateriflora) for antispasmodic and sedative effects. Linden flowers (Tilia cordata) for antispasmodic and as a mild diuretic. Homeopathy: Few clinical studies have examined the effectiveness of specific homeopathic remedies. However, a professional homeopath may recommend one or more of the following treatments for dysphagia based on their knowledge and clinical experience. Before prescribing a remedy, homeopaths take into account a person's constitutional type -- your physical, emotional, and intellectual makeup. An experienced homeopath assesses all of these factors when determining the most appropriate remedy for a particular individual. The following are some of the most common remedies used for dysphagia: Baptesia tinctoria if you can swallow only liquids, especially if have a red, inflamed throat that is relatively pain free Baryta carbonica if you have large tonsils Carbo vegatabilis for bloating and indigestion that is worse when lying down, especially wi th flatulence and fatigue Ignatia for "lump in the throat," back spasms, cough, especially when symptoms appear after you have experienced grief Lachesis if you cannot stand to be touched around the throat (including clothing that is tight at the neck) Acupuncture: Several clinical studies have reported that acupuncture can stimulate the swallowing reflex in people who have dysphagia due to stroke. However, other studies show no benefit. More research is needed to evaluate the therapeutic effect of acupuncture on dysphagia after stroke. Following Up: Dysphagia should not limit your activities, but your health care provider may restrict your diet. If left untreated, dysphagia can lead to inadequate nutrition, dehydration, recurrent upper respiratory infections, and even pneumonia.

What Happens When You Breathe?


By The National Heart, Lung, and Blood Institute (NHLBI) Breathing In (Inhalation) When you breathe in, or inhale, your diaphragm contracts (tightens) and moves downward. This increases the space in your chest cavity, into which your lungs expand. The intercostal muscles between your ribs also help enlarge the chest cavity. They contract to pull your rib cage both upward and outward when you inhale. As your lungs expand, air is sucked in through your nose or mouth. The air travels down your windpipe and into your lungs. After passing through your bronchial tubes, the air finally reaches and enters the alveoli (air sacs). Through the very thin walls of the alveoli, oxygen from the air passes to the surrounding capillaries (blood vessels). A red blood cell protein called hemoglobin (HEE-muh-glow-bin) helps move oxygen from the air sacs to the blood. At the same time, carbon dioxide moves from the capillaries into the air sacs. The gas has traveled in the bloodstream from the right side of the heart through the pulmonary artery. Oxygen-rich blood from the lungs is carried through a network of capillaries to the pulmonary vein. This vein delivers the oxygen-rich blood to the left side of the heart. The left side of the heart pumps the blood to the rest of the body. There, the oxygen in the blood moves from blood vessels into surrounding tissues. (For more information on blood flow, go to the Health Topics How the Heart Works article.) Breathing Out (Exhalation) When you breathe out, or exhale, your diaphragm relaxes and moves upward into the chest cavity. The intercostal muscles between the ribs also relax to reduce the space in the chest cavity. As the space in the chest cavity gets smaller, air rich in carbon dioxide is forced out of your lungs and windpipe, and then out of your nose or mouth. Breathing out requires no effort from your body unless you have a lung disease or are doing physical activity. When you're physically active, your abdominal muscles contract and push your diaphragm against your lungs even more than usual. This rapidly pushes air out of your lungs.

Arteries By The Columbia Encyclopedia, 6th ed.


Artery: blood vessel that conveys blood away from the heart. Except for the pulmonary artery, which carries deoxygenated blood from the heart to the lungs, arteries carry oxygenated blood from the heart to the tissues. The largest arterial trunk is the aorta, branches of which divide and subdivide into eversmaller tubes, or arterioles, until they terminate as minute capillaries, the latter connecting with the veins (see circulatory system). Other important arteries are the subclavian and brachial arteries of the shoulder and arm, the carotid arteries that lead to the head, the coronary arteries that nourish the heart itself, and the iliac and femoral arteries of the abdomen and lower extremities. The walls of the large arteries have three layers: a tough elastic outer coat, a layer of muscular tissue, and a smooth, thin inner coat. Arterial walls expand and contract with each heartbeat, pumping blood throughout the body. The pulsating movement of blood, or pulse, may be felt where the large arteries lie near the body surface.

What is a Bruise? By Kids Health


A bruise, also called a contusion (say: kun-TOO-zhun), forms because the soft tissues of your body have been bumped. Some people bruise easily, whereas others may have tougher skin tissue. When these soft tissues are injured, small veins and capillaries (the tiniest blood vessels) under the skin sometimes break. Red blood cells leak out of these blood vessels. These red blood cells that collect under your skin cause that bluish, purplish, reddish, or blackish mark. That's where black-and-blue marks get their name from their color under the skin. Bruises go through colorful changes as the body begins to heal itself. The color changes mean that your body is metabolizing (say: meh-TAB-oh-lye-zing), or breaking down, the blood cells in the skin. This is the process that your body goes through to repair itself. The Phases of a Bruise Imagine a baseball hits you in the leg. Ouch! Your body will go through the following phases: First, you'll probably have a bump that will look red or purplish and tender. The bump might swell from the blood collecting under the tissue. After a couple of days, the bruise will look blue or even blackish. After 5 to 10 days, it may look greenish or even yellow. After 10 to 14 days, the bruise will most likely be a light brown, then get lighter and lighter as it fades away. Most bruises will disappear after 2 weeks, and some go away even sooner. However, if a bruise does not go away after 2 weeks, let your parent know. To help reduce swelling or the amount of bruising after an injury, apply a cold compress to the bruise for at least 10 minutes. And be sure to wear a helmet and protective pads to avoid bruises altogether!

Nine Points: Address the lower back muscles!


by David Lauterstein - Deep Massage Book. Purchase here: http://bit.ly/TKGIcV "To do that, first lets be clear where to work. The lower back is not really accessible from the back! To be thorough you need to enter from the side particularly the side of the three primary lower back muscles: the erector spinae, multifidus, and quadratus lumborum. To be thorough you need to work into each muscle 1) virtually at the iliac crest, 2) halfway between the iliac crest and the 12th rib, and 3) just beneath the 12th rib. So this series of fulcrums works into: 1) the side of iliocostalis (the lateral-most erector) just above the iliac crest 2) the side of iliocostalis, halfway between the iliac crest and 12th rib 3) the side of iliocostalis just beneath the 12th rib 4) the side of multifidus just above the iliac crest 5) the side of multifidus, halfway between the iliac crest and 12th rib 6) the side of multifidus just beneath the 12th rib 7) the side of quadratus lumborum just above the iliac crest the side of quadratus lumborum, halfway between the iliac crest and 12th rib 9) the side of quadratus lumborum just beneath the 12th rib I know, by the way, that multifidus is quite medial and thin, but I like to believe that we are affecting it. Remember, living muscles are primarily fluid so, when you press, for instance, into the side of iliocostalis, you will, to some extent, also be pressing into and effecting the other erectors medial to it (longissmus and spinalis). So now that you know where to work, what shall you do when you get there? Nine Points Part 2 In Part 1 we covered WHERE to work to optimally and thoroughly address the lower back. Please refer to that post below to see where the 9 points are! Now let's look importantly at HOW to work there, with soft tissue fulcrums into the lower back. Lets just assume youre working the left side first (as in the illustration). Position your body so that you are standing alongside the clients upper thigh. You are facing the persons head at about 45 degrees.

Your right hand should be snugly up against the lateral margin of the lumbar muscles on the right side, pulling them medially. This communicates that your focus is clearly the lumbar musculature. As you see in the illustration, the fingers of your left hand should be gently curved and the hand angled at about 45. Nature is all in curves; so if we want to speak its language, we avoid meeting the body at right angles or poking straight into tension. Now press somewhat gently into the first point the side of iliocostalis just above the iliac crest to feel if theres significant tension there. Pause. Do you feel tension? If no, just clearly disengage and move on to the next point. If yes, press in just a little further. With the first pressure you were ON the tension; with the addition of just a little more pressure you are IN the tension. Now pause again. Hold it, hold it, hold it. Be patient, breathe -- allow your client the gift of intelligent pressure and time in which to let go. Too many bodywork practitioners emphasize working forcefully from outside in. In Deep Massage (and Zero Balancing) our goal is to facilitate the clients letting go from inside out. When you feel like youve held the fulcrum long enough or you see a sign of ease (such as a relaxed, deeper breath), then clearly disengage. And pause again before you go onto the next point. Some of clients most powerful windows of opportunity are when they are given non -manipulated time in which to assimilate the impact of the fulcrum. Continue exploring and putting into fulcrums as needed into approximately nine points medial-ward into iliocostalis, multifidus and quadratus lumboarum!"

What Is Depression?
by Medical News Today Depression, also known as major depression, clinical depression or major depressive disorder is a medical illness that causes a constant feeling of sadness and lack of interest. Depression affects how the person feels, behaves and thinks. Depression can lead to emotional and physical problems. Typically, people with depression find it hard to go about their day-to-day activities, and may also feel that life is not worth living. Feeling sad, or what we may call "depressed", happens to all of us. The sensation usually passes after a while. However, people with a depressive disorder - clinical depression - find that their state interferes

with daily life. Their normal functioning is undermined to such an extent that both they and those who care about them are affected by it. According to MediLexicon's Medical Dictionary, depression is: "a mental state or chronic mental disorder characterized by feelings of sadness, loneliness, despair, low self-esteem, and self-reproach; accompanying signs include psychomotor retardation (or less frequently agitation), withdrawal from social contact, and vegetative states such as loss of appetite and insomnia." What are the different forms of depression? There are several forms of depression (depressive disorders). Major depressive disorder and dysthymic disorder are the most common. Major depressive disorder (major depression) Major depressive disorder is also known as major depression. The patient suffers from a combination of symptoms that undermine his ability to sleep, study, work, eat, and enjoy activities he used to find pleasurable. Experts say that major depressive disorder can be very disabling, preventing the patient from functioning normally. Some people experience only one episode, while others have recurrences. Dysthymic disorder (dysthymia) Dysthymic disorder is also known as dysthymia, or mild chronic depression. The patient will suffer symptoms for a long time, perhaps as long as a couple of years, and often longer. However, the symptoms are not as severe as in major depression, and the patient is not disabled by it. However, he may find it hard to function normally and feel well. Some people experience only one episode during their lifetime, while others may have recurrences. A person with dysthymia might also experience major depression, once, twice, or more often during his lifetime. Dysthymia can sometimes come with other symptoms. When they do, it is possible that other forms of depression are diagnosed. Psychotic depression When severe depressive illness includes hallucinations, delusions, and/or withdrawing from reality, the patient may be diagnosed with psychotic depression. Postpartum depression (postnatal depression) Postpartum depression is also known as postnatal depression or PND. This is not to be confused with 'baby blues' which a mother may feel for a very short period after giving birth. If a mother develops a major depressive episode within a few weeks of giving birth it is most likely she has developed PND. Experts believe that about 10% to 15% of all women experience PND after giving birth. Sadly, many of them go undiagnosed and suffer for long periods without treatment and support.

SAD (seasonal affective disorder) SAD is much more common the further from the equator you go. In countries far from the equator the end of summer means the beginning of less sunlight and more dark hours. A person who develops a depressive illness during the winter months might have SAD. The symptoms go away during spring and/or summer. In Scandinavia, where winter can be very dark for many months, patients commonly undergo light therapy - they sit in front of a special light. Light therapy works for about half of all SAD patients. In addition to light therapy, some people may need antidepressants, psychotherapy, or both. Light therapy is becoming more popular in other northern countries, such as Canada and the United Kingdom. Bipolar disorder (manic-depressive illness) Bipolar disorder is also known as manic-depressive illness. It used to be known as manic depression. It is not as common as major depression or dysthymia. A patient with bipolar disorder experiences moments of extreme highs and extreme lows. These extremes are known as manias. What are the signs and symptoms of depression? Depression is not uniform. Signs and symptoms may be experienced by some sufferers and not by others. How severe the symptoms are, and how long they last depends on the individual person and his illness. Below is a list of the most common symptoms: A constant feeling of sadness, anxiety, and emptiness A general feeling of pessimism sets in (the glass is always half empty) The person feels hopeless Individuals can feel restless The sufferer may experience irritability Patients may lose interest in activities or hobbies they once enjoyed He/she may lose interest in sex Levels of energy feel lower, fatigue sets in Many people with a depressive illness find it hard to concentrate, remember details, and make decisions Sleep patterns are disturbed - the person may sleep too little or too much Eating habits may change - he/she may either eat too much or have no appetite Suicidal thoughts may occur - some may act on those thoughts The sufferer may complain more of aches and pains, headaches, cramps, or digestive problems. These

problems do not get better with treatment. Some illnesses accompany, precede, or cause depression Anxiety disorders, such as PTSD (post-traumatic stress disorder), OCD (obsessive-compulsive disorder), social phobia, generalized anxiety disorder and panic disorder often accompany depression. People who are dependent on alcohol or narcotics have a significantly higher chance of also having depression. Depression is much more common for people who suffer from HIV/AIDS, heart disease, stroke cancer, diabetes, Parkinson's disease, and many other illnesses. According to studies, if a person has depression as well as another serious illness he is more likely to have severe symptoms, and will find it harder to adapt to his medical condition. Studies have also shown that if these people have their depression treated the symptoms of their co-occurring illness improve. Dementia and mild cognitive impairment (MCI) - scientists from the University of Amsterdam, The Netherlands, found that elderly patients with depression were more likely to develop dementia and MCI. They reported their findings in Archives of Neurology (January 2013 issue). After gathering and examining data on a group of Medicare recipients in America, the researchers found that a significant proportion of seniors with MCI had depressive symptoms. Depression and discrimination 79% of people who have been diagnosed with depression say they have experienced discrimination because of their mental disorder. Most previous investigations have linked depression as a consequence of discrimination. This study, carried out by researchers from King's College London's Institute of Psychiatry, England, and reported in The Lancet in October 2012, found that it can occur the other way round; people may be discriminated because they have depression. Lead researcher Professor Graham Thornicroft said: "Previous work in this area has tended to focus on public attitudes towards stigma based on questions about hypothetical situations, but ours is the first study to investigate the actual experiences of discrimination in a large, global sample of people with depression. Our findings show that discrimination related to depression is widespread, and almost certainly acts as a barrier to an active social life and having a fair chance to get and keep a job for people with depression." What causes depression? We are still not sure what causes depression. Experts say depression is caused by a combination of factors, such as the person's genes, his biochemical environment, his personal experience and psychological factors. MRI (magnetic resonance imaging) has shown that the brain of a person with depression looks different,

compared to the brain of a person who has never had depression. The areas of the brain that deal with thinking, sleep, mood, appetite and behavior do not appear to function normally. There are also indications that neurotransmitters appear to be out of balance. Neurotransmitters are chemicals that our brain cells use to communicate. However, imaging technology has not revealed why the depression happened. We know that if there is depression in the family a person's chances of developing depression are higher. This suggests there is a genetic link. According to geneticists, depression risk is influenced by multiple genes acting together with environmental and others factors. An awful experience can trigger a depressive illness. For example, the loss of a family member, a difficult relationship, physical sexual abuse. Obesity gene makes people happy - FTO is a gene which is closely associated with obesity. It is also linked to an 8% lower risk of developing depression, researchers from McMaster University, Canada, reports in Molecular Psychiatry. Put simply, FTO is a gene that is not only linked to obesity, but also happiness. Folate and B12 deficiency associated with some depression symptoms - scientists from the Hospital District of Southern Savo, Finland, reported in the Journal of Affective Disorders (November 2012 issue) that people with low levels of folate and vitamin B12 have a greater risk of developing melancholic depressive symptoms.

Heart Failure Overview


by U.S. National Library of Medicine Heart failure is a condition in which the heart is no longer able to pump out enough oxygen-rich blood. This causes symptoms to occur throughout the body. Causes Heart failure is often a long-term (chronic) condition, but it may come on suddenly. It can be caused by many different heart problems. The condition may affect only the right side or only the left side of the heart. More often, both sides of the heart are involved. Heart failure is present when: Your heart muscle cannot pump (eject) the blood out of the heart very well. This is called systolic heart failure. Your heart muscles are stiff and do not fill up with blood easily. This is called diastolic heart failure. As the heart's pumping becomes less effective, blood may back up in other areas of the body. Fluid may

build up in the lungs, liver, gastrointestinal tract, and the arms and legs. This is called congestive heart failure. The most common causes of heart failure are: Coronary artery disease (CAD), a narrowing of the small blood vessels that supply blood and oxygen to the heart. This can weaken the heart muscle over time or suddenly. High blood pressure that is not well controlled, leading to problems with stiffness, or eventually leading to muscle weakening. Other heart problems that may cause heart failure are: Congenital heart disease Heart attack Heart valves that are leaky or narrowed) Infection that weakens the heart muscle Some types of abnormal heart rhythms (arrhythmias) Other diseases that can cause or contribute to heart failure: Amyloidosis Emphysema Overactive thyroid Sarcoidosis Severe anemia Too much iron in the body Underactive thyroid Symptoms Symptoms of heart failure often begin slowly. At first, they may only occur when you are very active. Over time, you may notice breathing problems and other symptoms even when you are resting. Symptoms may also appear suddenly after the heart is damaged from a heart attack or other problem. Common symptoms are: Cough Fatigue, weakness, faintness Loss of appetite Need to urinate at night Pulse that feels fast or irregular, or a sensation of feeling the heart beat (palpitations) Shortness of breath when you are active or after you lie down Swollen (enlarged) liver or abdomen Swollen feet and ankles Waking up from sleep after a couple of hours due to shortness of breath Weight gain Exams and Tests Your health care provider will examine you for signs of heart failure: Fast or difficult breathing

Leg swelling (edema) Neck veins that stick out (are distended) Sounds ("crackles") from fluid buildup in your lungs, heard through a stethoscope Swelling of the liver or abdomen Uneven or fast heartbeat and abnormal heart sounds Many tests are used to diagnose and monitor heart failure. An echocardiogram (echo) is often the best test for heart failure. Your doctor will use it to guide your treatment. Other imaging tests can look at how well your heart is able to pump blood, and how much the heart muscle is damaged. Many blood tests may also be used to: Help diagnose and monitor heart failure Identify risks for heart disease Look for possible causes of heart failure, or problems that may make your heart failure worse Monitor for side effects of medicines you may be taking

About the Heart and Circulatory System


The circulatory system is composed of the heart and blood vessels, including arteries, veins, and capillaries. Our bodies actually have two circulatory systems: The pulmonary circulation is a short loop from the heart to the lungs and back again, and the systemic circulation (the system we usually think of as our circulatory system) sends blood from the heart to all the other parts of our bodies and back again. The heart is the key organ in the circulatory system. As a hollow, muscular pump, its main function is to propel blood throughout the body. It usually beats from 60 to 100 times per minute, but can go much faster when necessary. It beats about 100,000 times a day, more than 30 million times per year, and about 2.5 billion times in a 70-year lifetime. The heart gets messages from the body that tell it when to pump more or less blood depending on an individual's needs. When we're sleeping, it pumps just enough to provide for the lower amounts of oxygen needed by our bodies at rest. When we're exercising or frightened, the heart pumps faster to increase the delivery of oxygen. The heart has four chambers that are enclosed by thick, muscular walls. It lies between the lungs and just to the left of the middle of the chest cavity. The bottom part of the heart is divided into two chambers called the right and left ventricles, which pump blood out of the heart. A wall called the

interventricular septum divides the ventricles. The upper part of the heart is made up of the other two chambers of the heart, the right and left atria. The right and left atria receive the blood entering the heart. A wall called the interatrial septum divides the right and left atria, which are separated from the ventricles by the atrioventricular valves. The tricuspid valve separates the right atrium from the right ventricle, and the mitral valve separates the left atrium and the left ventricle. Two other cardiac valves separate the ventricles and the large blood vessels that carry blood leaving the heart. These are the pulmonic valve, which separates the right ventricle from the pulmonary artery leading to the lungs, and the aortic valve, which separates the left ventricle from the aorta, the body's largest blood vessel. Arteries carry blood away from the heart. They are the thickest blood vessels, with muscular walls that contract to keep the blood moving away from the heart and through the body. In the systemic circulation, oxygen-rich blood is pumped from the heart into the aorta. This huge artery curves up and back from the left ventricle, then heads down in front of the spinal column into the abdomen. Two coronary arteries branch off at the beginning of the aorta and divide into a network of smaller arteries that provide oxygen and nourishment to the muscles of the heart. Unlike the aorta, the body's other main artery, the pulmonary artery, carries oxygen-poor blood. From the right ventricle, the pulmonary artery divides into right and left branches, on the way to the lungs where blood picks up oxygen. Arterial walls have three layers: 1. The endothelium is on the inside and provides a smooth lining for blood to flow over as it moves through the artery. 2. The media is the middle part of the artery, made up of a layer of muscle and elastic tissue. 3. The adventitia is the tough covering that protects the outside of the artery. As they get farther from the heart, the arteries branch out into arterioles, which are smaller and less elastic. Veins carry blood back to the heart. They're not as muscular as arteries, but they contain valves that prevent blood from flowing backward. Veins have the same three layers that arteries do, but are thinner and less flexible. The two largest veins are the superior and inferior vena cavae. The terms superior and inferior don't mean that one vein is better than the other, but that they're located above and below the heart. A network of tiny capillaries connects the arteries and veins. Though tiny, the capillaries are one of the most important parts of the circulatory system because it's through them that nutrients and oxygen are delivered to the cells. In addition, waste products such as carbon dioxide are also removed by the capillaries. By KidsHealth - The Nemours Foundation.

Arm
In zoology, either of the forelimbs or upper limbs of ordinarily bipedal vertebrates, particularly humans and other primates. The term is sometimes restricted to the proximal part, from shoulder to elbow (the distal part is then called the forearm). In brachiating (tree-swinging) primates the arm is unusually long. The bones of the human arm, like those of other primates, consist of one long bone, the humerus, in the arm proper; two thinner bones, the radius and ulna, in the forearm; and sets of carpal and metacarpal bones in the hand and digits in the fingers. The muscle that extends, or straightens, the arm is the triceps, which arises on the humerus and attaches to the ulna at the elbow; the brachialis and biceps muscles act to bend the arm at the elbow. A number of smaller muscles cover the radius and ulna and act to move the hand and fingers in various ways. The pectoralis muscle, anchored in the chest, is important in the downward motion of the entire arm and in quadrupeds pulls the limb backward in locomotion. The term arm may also denote the limb or the locomotive or prehensile organ of an invertebrate, such as the ray of a starfish, tentacle of an octopus, or brachium of a brachiopod.

What Is Dyslexia?
by Medical News Today Dyslexia is a specific reading disability due to a defect in the brain's processing of graphic symbols. It is a learning disability that alters the way the brain processes written material. It is typically characterized by difficulties in word recognition, spelling and decoding. People with dyslexia have problems with reading comprehension. The National Center for Learning Disabilities1 says that dyslexia is a neurological and often genetic condition, and not the result of poor teaching, instruction or upbringing. Dyslexia is not linked to intelligence. This information article by Medical News Today provides you with the essential details about dyslexia describing what it is, its symptoms, what causes it, how it is diagnosed, and what current treatment options are available. You can also read about what experts say is the likely outlook for people with dyslexia. What is dyslexia? The problem in dyslexia is a linguistic one, not a visual one. Dyslexia in no way stems from any lack of

intelligence. People with severe dyslexia can be brilliant. Albert Einstein (1879-1955) lived with dyslexia. The effects of dyslexia, in fact, vary from person to person. The only shared trait among people with dyslexia is that they read at levels significantly lower than typical for people of their age. Dyslexia is different from reading retardation which may reflect mental retardation or cultural deprivation. According to the University of Michigan Health System, dyslexia is the most common learning disability2. Eighty percent of students with learning disabilities have dyslexia. The International Dyslexia Association3 estimates that 15% to 20% of the American population have some of the symptoms of dyslexia, including slow or inaccurate reading, poor spelling, poor writing, or mixing up similar words. The National Health Service4, UK, estimates that 4-8% of all schoolchildren in England have some degree of dyslexia. It is estimated that boys are one-and-a-half to three times more likely to develop dyslexia than girls. The Dyslexia Association5 in Australia states "A dyslexic individual can be successful because of their abilities not in spite of. A dyslexic may struggle to succeed because of their negative experiences in the learning environment not because of dyslexia." Dyslexia affects people of all ethnic backgrounds, although a person's native language can play an important role. A language where there is a clear connection between how a word is written and how it sounds, and consistent rules grammatical rules, such as in Italian and Spanish, can be more straightforward for a person with mild to moderate dyslexia to cope with. However, languages such as English, where there is often no clear connection between the written form and sound, as in words such as 'cough' and 'dough', can be more challenging for a person with dyslexia. What are the signs and symptoms of Dyslexia? A symptom is something the patient senses and describes, while a sign is something other people, such as the doctor notice. For example, drowsiness may be a symptom while dilated pupils may be a sign. Billionaire Richard Branson, founder of the Virgin Group, was born with dyslexia. The Dyslexia Research Trust6 includes these as the most common signs and symptoms associated with dyslexia: Learning to read - the child, despite having normal intelligence and receiving proper teaching and parental support, has difficulty learning to read. Milestones reached later - the child learns to crawl, walk, talk, throw or catch things, ride a bicycle later than the majority of other kids.

Speech - apart from being slow to learn to speak, the child commonly mispronounces words, finds rhyming extremely challenging, and does not appear to distinguish between different word sounds. Slow at learning sets of data - at school the child takes much longer than the other children to learn the letters of the alphabet and how they are pronounced. There may also be problems remembering the days of the week, months of the year, colors, and some arithmetic tables. Coordination - the child may seem clumsier than his or her peers. Catching a ball may be difficult. Left and right - the child commonly gets "left" and "right" mixed up. Reversal - numbers and letters may be reversed without realizing. Spelling - may not follow a pattern of progression seen in other children. The child may learn how to spell a word today, and completely forget the next day. One word may be spelt in a variety of ways on the same page. Phonology problems - phonology refers to the speech sounds in a language. If a word has more than two syllables, phonology processing becomes much more difficult. For example, with the word "unfortunately" a person with dyslexia may be able to process the sounds "un" and "ly", but not the ones in between. Concentration span - children with dyslexia commonly find it hard to concentrate for long, compared to other children. Many adults with dyslexia say this is because after a few minutes of non-stop struggling, the child is mentally exhausted. A higher number of children with dyslexia also have ADHD (attentiondeficit hyperactivity disorder), compared to the rest of the population. Sequencing ideas - when a person with dyslexia expresses a sequence of ideas, they may seem illogical for people without the condition. Autoimmune conditions - people with dyslexia are more likely to develop immunological problems, such as hay fever, asthma, eczema, and other allergies.

What Is a Clavicle Fracture?


by Kids Health Your clavicle is the bone that runs horizontally between the top of your breastbone (sternum) and shoulder blade (scapula). The clavicle (also called the collarbone) helps connect the arm to the body. You can feel it by touching the area between your neck and your shoulder. Most people can see the clavicle beneath the skin when they look in the mirror. A clavicle fracture, also known as a broken collarbone, is one of the most common types of broken bones. Most clavicle fractures happen when someone falls onto a shoulder or outstretched hand, putting enough pressure on the clavicle to make it fracture or snap.

Most clavicle fractures heal on their own if the arm is properly immobilized in a sling and the injury is treated with ice and physical therapy. Sometimes, though, a clavicle injury may need surgery when it gets displaced or the break is particularly severe. What Causes a Clavicle Fracture? Clavicle fractures are common in contact sports like football, wrestling, rugby, lacrosse, and hockey. They also often happen in sports where there is a chance of falling hard, such as biking, skiing, snowboarding, and skateboarding. A clavicle also can fracture if the bone is hit directly, as in a car collision or other accident. Clavicle fractures happen in three situations where stress is enough to break the bone: a person suffers a blow to the shoulder someone falls onto an outstretched arm the clavicle is hit directly (as in a collision) A person's age plays a role in clavicle fractures: When we're young, our bones are still growing and are more susceptible to injury. Collarbones typically don't harden completely until a person is about 20 years old. That puts people younger than 20 at greater risk of a fracture. What Are the Symptoms? Signs that someone may have a clavicle fracture include: pain in the affected area difficulty moving the arm swelling, tenderness, and bruising along the clavicle increased pain when trying to move the shoulder or arm a grinding or crackling sensation when trying to raise the arm a bulge above the break (in rare cases, the broken end of the bone might even penetrate the skin and be exposed) the shoulder sags down and forward

Muscle Structure and Function


by Human Kinetics Defining Muscle The basic function of muscle is to generate force. Secondarily, muscles can provide some shape and form to the organism. Anatomically and functionally, muscle can be divided into two types, smooth and striated. Striated or striped muscle can be further divided into skeletal muscle and cardiac (heart) muscle. Regardless of the type, all muscles share the following basic properties (Gowitzke and Milner 1988): Conductivity: A muscle has the ability to conduct an action potential. Irritability: When stimulated, the muscle will react. Contractility: A muscle can shorten or produce tension between its ends. Relaxation: A muscle can return to resting properties after contraction. Distensibility: A muscle can be stretched by a force outside of the muscle itself. The muscle is not injured as long as it is not stretched past its physiological limits. Elasticity: The muscle will resist elongation and will return to its original position after passi ve or active elongation. Elasticity is the opposite of distensibility. Smooth muscle and striated muscle can easily be differentiated from each other in a variety of ways, including appearance. For example, smooth muscle is uni-nucleated and contains sarcomeres (the functional units of muscle) that are arranged at oblique angles to each other; under a light microscope smooth muscle appears to be relatively featureless as a result of the orientation of its sarcomeres. On the other hand, striated muscle contains protein arrays called myofibrils that are parallel to each other and thus form striations or stripes. Cardiac muscle can be easily identified as distinct from skeletal muscle by appearance and differences in function, such as an intrinsic ability to contract. (We will not go into detail on smooth and cardiac muscle because though interesting, such discussion is not within the scope of this book.) Muscle Structure and Function Skeletal muscle is found in many sizes and various shapes. The small muscles of the eye may contain only a few hundred cells, while the vastus lateralis may contain hundreds of thousands of muscle cells. The shape of muscle is dependent on its general architecture, which in turn helps to define the muscles function. Some muscles, such as the gluteal muscles, are quite thick; some, such as the sartorius, are long and relatively slender; and others, such as the extensors of the fingers, have very long tendons. These differences in muscle shape and architecture permit skeletal muscle to function effectively over a relatively wide range of tasks. For example, thicker muscles with a large cross-sectional area can produce great amounts of force; longer muscles can contract over a greater distance and develop higher velocities of shortening; muscles with long tendons can form pulley arrangements that allow large external movement (e.g., grasping by

the fingers) with relatively small movement of the muscles and tendons. Some long slender muscles such as the sartorius and biceps femoris are divided by transverse fibrous bands that form distinct sections or compartments (McComas 1996). Although fibers were previously believed to run the length of these muscles, because of these compartments the longest possible human muscle fiber is about 12 cm (4.7 in.) in length (McComas 1996). The individual compartments can have different fiber type distributions and different cross-sectional areas (English and Ledbetter 1982). Each compartment has a separate innervation; however, individual motor neurons often innervate muscle fibers in adjacent compartments. But the functional outcomes of compartmentalization are not completely understood. One possible consequence of compartmentalization is that it could ensure that contraction occurs relatively synchronously and rapidly along the muscle belly. However, it is also possible to recruit compartments separately (English 1984). Muscle fibers can be arranged into two basic structural patterns, fusiform and pinnate (also spelled pennate). Most human muscles are fusiform, with the fibers largely arranged in parallel arrays along the muscles longitudinal axis. In many of the larger muscles the fibers are inserted obliquely into the tendo n, and this arrangement resembles a feather (i.e., pinnation). The fibers in a pinnate muscle are typically shorter than those of a fusiform muscle. The arrangement of pinnate muscle fibers can be single or double, as in muscles of the forearm, or multipinnate, as in the gluteus maximus or deltoid. The fibers of a pinnated muscle pull on the tendon at an angle, and the amount of force actually exerted on the tendon can be calculated using the cosine of the angle of insertion. At rest, the angle of pinnation in most human muscles is about 10 or less and does not appear to have a marked effect on most functional properties such as force production (Roy and Edgerton 1992; Wickiewicz et al. 1983, 1984). However, during muscle contraction the angle of pinnation can vary and may change some functional parameters, at least in some muscles (Fukunaga et al. 1997; Otten 1988). It is possible that during muscle contraction the angle of pinnation increases enough to decrease speed of contraction and increase force production. It is also possible that hypertrophy, which adds sarcomeres in parallel and can alter the angle of pinnation, can alter functional properties (Binkhorst and vant Hof 1973; Tihanyi, Apor, and Fekete 1982). Pinnation offers a force advantage over fusiform fibers because with pinnation there are more fibers in a muscle of a given volume; thus the effective cross section of the pinnated muscle is larger. Pinnation also permits more sarcomeres to be arranged in parallel (at the expense of those in series), resulting in enhanced force production (Gans and Gaunt 1991; Roy and Edgerton 1992; Sacks and Roy 1982). Additionally, the central tendon moves a greater distance in comparison to the shortening length of the muscle fibers, allowing the fibers to operate over the optimum portion of their length-tension curves (Gans and Gaunt 1991; McComas 1996). About 85% of the mass of a muscle is made up of muscle fibers; the remaining 15% is mostly connective tissue. Muscle is organized and largely shaped by the connective tissue, which is composed of a ground substance, collagen, and reticular and elastin fibers of varying proportions. In muscle, the connective tissue is largely responsible for transmitting forces, for example the transmission of forces from the muscle to the bone by the tendon. The connective tissues elasticity and distensibility help to ensure that the tension developed by the muscle is smoothly transmitted and that a muscle will return to its original shape after being stretched.

Thus, the connective tissue of a muscle provides a framework for the concept of series and parallel elastic components within a muscle. When a muscle is passively stretched or when it actively contracts, the resulting initial tension is largely caused by the elastic properties of the connective tissue. During a contraction, the muscle cannot actively develop force or perform work against a resistance until the elastic components are stretched out and the muscle tension and resistance (load) are in equilibrium. There are three levels of muscle tissue organization: epimysium, endomysium, and perimysium. These three levels are a consequence of differing sizes and orientations of connective tissue fibers, particularly collagen. The outside surface of a muscle is covered by a relatively thick and very tough connective tissue, the epimysium, which separates it from surrounding muscles. Arteries and veins run through the endomysium. The collagen fibers of the epimysium are woven into particularly tight bundles that are wavy in appearance. These collagen bundles are connected to the perimysium. The perimysium divides the muscle into bundles typically containing about 100 to 150 muscle fibers, which form a fasciculus or fascicle. However, muscles that function in producing small or very fine movements have smaller fascicles containing relatively few fibers and a larger proportion of connective tissue (Gowitzke and Milner 1988). The muscle fibers take on a polygonal cross-sectional shape that allows a greater number of fibers to fit into a fascicle (McComas 1996). Typically the interstitial spaces between fibers are about 1 m. The perimysium also forms connective tissue tunnels, the intramuscular septa, which run through the muscle belly and provide a pathway for larger arterioles, venules, and nerves. The perimysium contains many large collagen bundles that encircle the outer surface of the muscle fibers lying on the outside of a fascicle. Some of the collagen bundles encircle the fascicles in a cross pattern, adding stability to the structure of the fascicle. Underneath the thicker perimysial sheets of connective tissue is a much looser network of collagen fibers that run in various directions and connect with the endomysium. The endomysium, which is made up of collagen fibers 60 to 120 nm in diameter, surrounds each muscle fiber, again adding more stability. Capillaries run between individual muscle fibers and lie within and are stabilized by the endomysium. Many of the endomysial fibers connect with the perimysium and likely connect to the basement membrane, which lies on the outside of the muscle cell sarcolemma (McComas 1996).