Over 80% of the population has or will suffer from back pain at some point in their lives! Proper footwear can potentially prevent, reduce and treat biomechanical factors associated with low back pain in runners. Back pain can be a mysterious thing. Every time your feet hit the ground, the reacting shock is transferred up your legs to your hips and spine, and any biomechanical imbalance can ultimately cause lower back pain.

It could be that you have flat feet, and your over-pronation (rolling in of your feet) is causing your back ache. It could be that you have really high-arched, rigid feet and the lack of pronation is causing your back pain. It could be that one of your legs is ever-so-slightly shorter than the other, or that your pelvis is just a tiny bit uneven or tilted. You could have a curve in your spine. More seriously, one of the discs between the vertebrae of your spine could be degenerating or arthritis is setting in.

Back pain can be a tough mystery to solve, but with a little help from your friendly neighborhood sports medicine specialist you should be able to track down the cause. By far the most common diagnosis in patients with low back pain is the lumbar sprain/strain, which accounts for about 75% of all cases of low back pain. While muscle strain is the most common cause of back pain for runners, play it safe and visit a sports medicine orthopedist or a chiropractor to have your spine and vertebrae examined if you are experiencing severe pain.

If you have ruled out all the worrisome spine issue, you may have an uneven pelvis or unequal leg lengths. These conditions are relatively common and can be ascertained with a good biomechanical exam. With either, the muscles on one side are being pulled. They’re tense to begin with, and the added stress of running can put them into spasm. Relatively weak abdominal and lower back muscles might also contribute to the problem. Running generally tends to cause strength imbalances between these muscle groups. Add tight hamstrings, another common condition among runners, and you have a nifty recipe for back pain. Core strengthening exercises and a lot of stretching can help.

Finally, the root cause is often in your foot, the last place most people look! Back pain is a common injury associated with flat feet and over-pronation. Likewise, if your feet are rigid and high-arched, their lack of stress relief and under-pronation can cause stress imbalance resulting in back pain.

For immediate relief, cut back on the mileage, moist heating pads, anti-inflammatories like ibuprofen, and a good massage. If the problem is disc deterioration or spinal arthritis, surgery may be necessary, and an adjustment in training is absolutely required. Take this condition seriously, and see a spinal specialist. If your spine is merely out of alignment, manipulation by a chiropractor or physical therapist may help ease your pain. This may also ease your muscle strain.

If your doctor confirms that you have an uneven pelvis or unequal leg lengths, the solution will likely be to try to correct the problem with a heel lift on the short side. This may be as simple as putting a piece of 1/4″ foam or cork into the heel of your running shoe. If you don’t get any relief at all within a week, go ahead and take the lift out. If it does no good, its better just not to wear one; your body may have adjusted to different leg lengths, and “fixing” it may cause more discomfort. Whatever the case, make sure that the remedy matches the problem; do not use a heel lift if your doctor does not confirm that you have an uneven pelvis or unequal leg lengths, or you may only make your problems worse.

If your problem is in the structure of your foot, your solution may be as simple as wearing different running shoes or adding orthotics to the mix. Shoes have been shown to lose almost 75% of their shock absorption after approximately 500 miles. This appears to be the critical point in which injuries tend to develop as a result of shoe wear. Thus it is important to have a rough idea how many miles are on your shoes and to replace them before soreness begins. If your shoes are not worn out, see your podiatrist for recommendations of shoe types and to see if an orthotic will help decrease the biomechanical strain causing your back pain. . In most cases of lower back pain, you will benefit from exercises to strengthen your back and abdominal muscles.

Back pain can be an indicator of a serious problem and can lead to a cascading injury that slows your running to a complete halt! Muscular back pain is the most common and can be annoying and complicated to treat due to the myriad of causes. If you have severe pain, seek medical attention immediately. If your pain is mild and seems to be directly related to your running, look to your feet as a possible contributor to you pain.

Shoulder pain is one of the commoner complaints seen by GPs. The shoulder girdle itself comprises five separate joints: the sternoclavicular, acromioclavicular, subacromial, glenohumeral and scapulothoracic joints. Problems in any of these can cause shoulder pain.

Patients may also experience shoulder pain referred from distant areas such as the cervical spine, thoracic inlet, mediastinum and lungs, the diaphragm and even sub-diaphragmatic problems such as hepatic problems. So the clinician needs to keep an open mind as to the cause of shoulder symptoms, although here l will focus on problems within the shoulder girdle.

The sternoclavicular joint

This is a synovial joint with a small meniscus, and is between the manubrium of the sternum and the medial end of the clavicle. Problems with this joint are rare, which is just as well because solutions for sternoclavicular pain tend not to be effective. Degenerative change in this joint is usually post-traumatic and can be treated usually by a series of up to three hydrocortisone injections into the sternoclavicular joint. An excision arthroplasty of the joint can be done in severe cases. Sternoclavicular dislocations are rare and are usually treated conservatively with the patients being managed symptomatically.

If the patient continues to have pain and instability from a long-standing sternoclavicular dislocation or subluxation surgical options include either stabilising the dislocated joint or an excision arthroplasty, but only about half the patients see a significant improvement.

Problems affecting the glenohumeral joint

The glenohumeral joint is the main joint of the shoulder girdle and can be involved in a number of problems.

Glenohumeral osteoarthritis

This presents with a painful, stiff shoulder and is confirmed radiologically with the expected signs of loss of joint space, subchondral sclerosis, cysts and osteophyte formation. Management is usually conservative with analgesics, NSAIDs and intra-articular steroid injections. Joint replacement is rarely required.

Adhesive capsulitis

This is a poorly understood condition, presenting with spontaneous onset of increasing pain and stiffness in the shoulder girdle. The condition affects the normally lax lining of the glenohumeral joint.

Marked inflammation of the lining of the joint leads to the joint capsule tending to glue itself together, producing a marked, restriction in range of movement at the glenohumeral joint. Patients have restricted internal and external rotation compared with the normal side, with a lesser degree of restricted elevation.

The natural history is typically eight months of pain, followed by eight months of pain and stiffness, followed by eight months of stiffness before resolution. Therefore after 24 months, the majority of patients with this condition will settle. The diagnosis is made from the history, examination and normal X-rays.

Management consists of informing the patient about the natural history of the condition, and ,symptoms are managed according to their severity. A few patients are so disabled by this condition that they need a manipulation under anaesthetic and intra-articular steroids.

Glenohumeral instability

The extreme mobility of the glenohumeral joint is achieved because the socket is only one-third of the area of the ball of the humeral head. This architectural arrangement allows great mobility at the expense of stability. Shoulder instability is a therefore a frequent problem.

In 90 to 95 per cent of cases there is an anteroinferior dislocation. Patients who suffer three or more dislocations, that is have become recurrent dislocators, should be referred for consideration of surgical repair. This usually means a Bankart repair, in which the glenoid Iabrum is reattached to the anterior aspect of the glenoid.

An arthroscopic approach is replacing open surgery, although patients should be aware that success rates for arthroscopic surgery are about 70 per cent, whereas open surgery is up to 95 per cent successful. Arthroscopic repair rates continue to improve, however. Patients are managed postoperatively in a sling for six weeks, and this is followed by a six-week rehabilitation programme.

Problems with the subacromial joint

The subacromial joint is the articulation between the top surface of the rotator cuff and the under surface of the acromion, and presents two main problems.

Subacromial impingement syndrome

This is probably the commonest problem affecting the shoulder. Patients report pain in the rcgion of the lateral deltoid or deltoid insertion. It can disturb sleep, be aggravated by lying on the affected shoulder, and typically causes pain whenever the arm is used at or around shoulder height.The patient usually points vaguely to the latcral deltoid area as being the source of the pain. There is often evidence of wasting of supraspinatus and secondary wasting of the deltoid muscle. There are usually no particular tender areas.

Positive findings are of a mid-range painful arc when the arm is elevated through abduction and flexion.The patient may also show an abnormal rhythm of movement when the arm is raised and lowered. This trick is subconsciously learnt by the patient and takes the traumatised part of the rotator cuff away from the under surface of the acromion. A specific test consists of asking the patient to abduct the arm to 30¡ while resisting the movement. This should cause a reproduction of the pain.

Treating impingement syndrome

Conservative treatments include physiotherapy to strengthen the subscapularis and infraspinatus muscles, thereby pulling the inflamed and irritated top surface of the rotator cuff away from the undersurface of the acrimony. Other conservative measures include steroid injections into the subacromial joint. A diagnostic local anaesthetic injection is made into the subacromial joint to help confirm the diagnosis, and this is effective at relieving pain. Up to three hydrocortisone injections can be given at four- to six-week intervals. A combination of physiotherapy and a series of steroid injections will resolve symptoms in about 80 per cent of cases.

If patients fail to respond, referral is indicated as they may need an arthroscopic subacromial decompression to relieve symptoms and prevent rotator cuff rupture. This generates more space in the subacromial joint to stop the inflamed and swollen tendons from being further rubbed. This 40-minute procedure is successful in about 80 per cent of cases, but full recovery takes about 12 weeks.

Rotator cuff rupture

Rupture of the rotator cuff can be either partial or complete.The rotator cuff is a tube of muscle emanating from the shoulder blade and encircling the humeral head. Its function is to pull the humeral head firmly on to the socket of the glenoid as the arm is elevated. Even with a tear, the rotator cuff may still be able to stabilise the humeral head and the glenoid. In these cases the rotator cuff is defined as functionally intact.

A large rupture will not allow the rotator cuff to stabilise the head of the humerus in its socket, and the patient will be unable to abduct the arm at all. This is because when the deltoid contracts, the humeral head is pulled up through the rent in the rotator cuff. Patients with suspected rotator cuff ruptures require referral to an orthopaedic surgeon with an interest in shoulder problems for investigation and possible repair. Rotator cuff repairs are a major undertaking and require extensive rehabilitation programmes.

The acromioclavicular joint

Problems with the acromioclavicular joint (ACJ) are common, and usually involve osteoarthritis or ACJ dislocation.

Osteoarthritis

Patients localise tile pain extremely well to the area of a degenerate joint, usually pointing with one finger at the ACJ. Using the arm when it is raised typically aggravates the pain. Often there is a history of trauma. When examined, the ACJ is tender and pain is reproduced when stressing the ACJ by fully adducting and internally rotating the shoulder.

The patient also complains of pain when the arm is in full elevation in either flexion or abduction. Physiotherapy or oral anti-inflammatory drugs are used initially, but if there is no response a GP can give a series of up to three hydrocortisone acetate injections to the joint.

Injection technique

Injecting a degenerate ACJ can be quite difficult as the joint space is often narrowed. Infiltration around the joint with local anaesthetic is followed by an injection of I-2m1 of lignocaine into the joint. After a minute or so, test movements to ensure that the local anaesthetic block to the ACJ has resolved the patient’s symptoms. It is then usually fairly easy to inject hydrocortisone into the joint without causing undue discomfort. About 70 to 80 per cent of patients will be cured by a series of up to three such procedures at four- to six-week intervals. If the response is unsatisfactory then refer to an orthopaedic surgeon to consider an arthroscopic ACJ arthroplasty or an open ACJ arthroplasty. I prefer the former operation as this preserves the superior joint capsule and is cosmetically more acceptable.

ACJ dislocation

This is a common injury, particularly on the rugby field when players typically fall onto the point of their shoulder. Most patients will have been seen in a casualty department and may have been referred to a fracture clinic. The jury among orthopaedic surgeons is still out regarding the best treatment for ACJ dislocations.

Most patients can be treated conservatively, because even with a dislocated ACJ most patients are able to compensate well and have a normal range of movement and function of the shoulder. Patients with a marked cosmetic deformity, or those engaged in upper-limb sports or work should be counselled concerning the pros and cons of conservative management versus reconstructive surgery.

An ACJ reconstruction is easy to perform if done in the first few weeks. However, by the time an ACJ dislocation has become chronic – that is, after six weeks – then reconstruction becomes more difficult, requiring ligament or coracoid process transfer. Patients who may justify ACJ reconstruction should therefore be referred to a specialist early.

The scapulothoracic joint

Fortunately, problems in the scapulothoracic joint are rare. The commonest complaint is a painful or snapping scapula. In many of these patients no obvious cause for their symptoms can be found, although a small proportion of patients will have pain arising from the supramedial border of the scapula as it moves over the posterior chest wall.

Usually they are investigated with a CT scan. This investigation can provide a three dimensional picture of the architecture of the shoulder girdle.

Management

A physiotherapy programme is the first route to try and improve their Scapulothoracic control, but if patients fail to respond a small proportion of them may be offered excision of the abnormally angled supra-medial border of their scapula. This procedure may help alleviate their symptoms.

Patients likely to benefit from this operation represent only a small proportion of patients with scapulothoracic pain, however. All patients with scapulothoracic pain and clicking should be referred initially for a physiotherapy programme in the first instance to look at their scapulothoracic control.

Only if this fails to alleviate their symptoms is referral to an orthopaedic surgeon with an interest in shoulder problems recommended.

From an original article published in GP, 18TH MAY 2001

If you’re reading this article right now, chances are that you fall under one of these 3 categories…

1) You’re an average, skinny guy with a rocket fast metabolism who is sick and tired of being thin and underweight. You hide behind baggy clothes, you hate going to the beach and you feel flat-out embarrassed every time you look in the mirror.

2) You are what people might consider “chubby” or “overweight”. You can’t stand seeing that extra body fat hanging from your legs, arms and stomach and would absolutely love to slim down and achieve a more muscular and defined look.

3) You are somewhere in between. You aren’t necessarily skinny, but you aren’t fat either. Whatever you are, one thing remains true: you aren’t satisfied with what you see in the mirror. You look at those guys with ripped, muscular physiques and say to yourself “Man, I really want to look like that!”

Which one of those descriptions best fits your situation? Whatever category it is that you fall under, the bottom line is that you will never be truly happy until you achieve the body you desire…

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He has been in the trenches. He has experienced all of the joys, pleasures, pains, ups and downs that bodybuilding has to offer. Moreover, he researched every theory and technique under the sun, have tried virtually every muscle-building method know to man and have flat-out trained my ass off for years on end.

Tried lifting outside in the pouring rain, built squat racks made of piles of rock, and have pushed his body so hard that his lunch went flying on many occasions.

He has written articles for many of the top bodybuilding and fitness sites on the Internet, have had his program featured in the New York Times, have helped thousands of aspiring muscle-builders achieve their dream bodies, and receive emails every single day from people just like you thanking him for the amazing results they’ve achieved.

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Questions are often asked me, how can I pack on a extra 5 to ten pounds of muscle before the summer or my next vacation? Maybe you can help me prepare for my first bodybuilding or fitness model competition? Could you help me build a body that turns heads and demands respect?

As a skinny guy muscle building expert, These question come up very frequently. Every single hard gainer I consult with wants to know how to gain muscle fast and how to do it safely and effectively.

Hard gainers, please listen up! There is hope for you. I am happy to say that learning how to gain muscle fast is not as hard as some would make you believe but it also not as easy as you might think. However, you must be prepared to train smarter and not harder. Don’t get me wrong, I’m not talking about wimping out during your workouts. I am referring to the big picture of training more intelligently.

Here is some of the most popular advice I give to the hard gainer when he wishes to gain muscle fast.

1. Never Perform More Than 10 Reps.

If you are lifting weights beyond 10 reps than you are emphasizing your slow-twitch muscle fibers which have the smallest opportunity for muscle growth. You are a hard gainer and you need recruit the maximal amount of muscle fibers in every set. You do not want to go passed the 10th rep. If you really want to gain muscle fast you have to get into the mind set of lifting heavier. Every single set and every single exercise. Keep the weights heavy and never more than 10 reps. Approach every workout knowing that you are going to be venturing into new territory and waging war on your skinny genetics. I recommend these workouts with a workout partner so you can eliminate any safety issues, not slack off and push your limits every inch of the way.

2. Reduce Your Workout Time

Try to do your workout faster, and taking a shorter rest to help improve your workout capacity. Work refers to the number of sets, reps and poundage within your workout. Who is fitter? The guy who can do 4 sets of 185 pounds bench press with 30-second rest or the guy who can do 4 sets of 185-pound bench press with 90-second rest? The one who can do the same amount of work in less time. Guess who is more muscular? The one who has a higher work capacity.

Next time you enter the gym, try to complete your current workout in less time. Take shorter rests. Move from one exercise to the next much quicker. Don’t be surprised if you feel out of shape! Your respiratory system is used to taking longer rests so it will a few weeks to get up to the speed that will be more beneficial for you growing added muscle. This is one of the easiest tips you can take away to increase your muscle density and take your fitness to a new level. Be prepared to humble yourself and get out of your comfort zone.

3. Do Only One Exercise Per Muscle Group

Only one? Yes, only one, you do not want to mutilate a muscle for over an hour to try to get any growth out of it. Consider this typical day in the gym. Today is your chest day. Your first exercise is bench press. You perform your first set with 185 lbs, second set with 205 lbs, third set with 225 lbs and fourth set with 245 lbs.

Assuming this is your max weight for the desired number of reps, is it not safe to say that you have used the maximal number of muscle fibers? Your goal is to simply spark your muscles into growth. Not exhaust them to death. Once they experience an unknown assault (stimulus), your body will be forced to grow and create new muscle to prevent future assaults! Therefore, your take home lesson is this: Once you have out performed your last workout, it is time to move onto the next exercise.

4. Do No More Than 3-5 Sets Per Muscle Group

I question a hard gainers workout intensity if they must do more than 3-5 sets per muscle group. Now if you are using anabolic steroids or have muscle friendly genes than you can safely dismiss this advice. Remember, learning how to gain muscle fast for the hard gainer requires following a new set of rules.

Consider the first 1-2 sets at 85% maximal effort. The third set at 95% maximal effort and the fourth (and sometimes fifth) set at 100% maximal effort. It is only this last all out set that contributes to the greatest muscle growth. Anything over and above this last go till you blow set simply exhausts the muscle beyond reason and delays your recovery ability to hit the muscle again. It is this last set that you should perform at least 1-2 extra reps or 5-10 extra pounds than last workout. Mission accomplished. You have sparked your muscles into growth. Time to move on.

5. Increase Your Strength 5% Every Two Weeks

There is one big mistake that a lot of people that workout make. That is not keeping accurate records of each workout and tracking your progress. This is something that you just don’t want to guess about, because it could lead to your failure. They return week-after-week to simply rehearse the same workouts. How do you expect to gain muscle fast if you continue to lift the same weights each workout? Your body is designed to tolerate stress. Assault it and let it get bigger. Assault it and let it get bigger. It’s a simple concept.

So your take home message is to aim for a minimum of 5% strength increase every two weeks. You might progress a little quicker with larger muscle groups like back and legs versus smaller muscles like biceps and triceps. Just think, in six months from now, you will be twice as strong as you are now! I would actually recommend writing down your strength goals for six months from now and than work backwards. If you are currently dead lifting 135 lbs, aim to be dead lifting 270 lbs over the next few months!

Conclusion

I know these five tips were not your typical Muscle and Fitness 101 advice and not your typical generic bodybuilding advice. I learned a long time ago to question everything you read and hear. Learn for yourself by doing and not by talking about it. You cannot follow the herd thinking that you will make gains like the easy gainer. You must take a different road as a hard gainer to shock those muscles into making the gains that you seek. You can do it. The questions is, Will You?

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No Nonsense Muscle Building: Skinny Guy Secrets To Insane Muscle Gain found at http://www.healthywithmuscle.com/

© All rights reserved Keith Crovatt

You see them everywhere in advertising. Muscled, buffed, smooth hard bodies are promoting everything thing from cars, tools and even beer. Obviously, the marketing behind this muscle building practice works but that is not the point behind this article.

We are bombarded by the advertisements, visuals and suggestions that our lives will be forever changed if we only had that body. Build bigger muscles in 10 minutes a day and you too will look like the model. This is what is suggested. What most advertisements, self help books and weight loss systems fail to tell you is not everyone’s body is the same!

Trying to grasp and capture the variation in human physical properties and appearance is also known as anthropometry or the measuring of the human being. Utilizing these bodily dimensions and then customizing products around it, is quite a common practice in fields like ergonomics, clothing design, even architecture.

This practice is not so much so in the field of fitness, health and wellness, weight loss and management, and overall optimal functioning type considerations, products and services. We have somehow overlooked, underestimated or not considered it seriously enough it seems. It can in fact hold and harbor some real secrets, cues and clues as to what to expect when we use the one to better understand and maximize the other. Quite the thought! How revolutionary is that?

A much better way to analyze our bodies is using body mass index calculations (BMI) and individual assessments directed by experts that understand your body type.

Skinny muscle people are also known as being ectomorph types. The characteristics are as follows:

- Hard time building any muscle

- Shoulders and hips are the same size (with little variation)

- Slim

- Smallish build

- Tendency to ‘over-train’ somewhat

- Thin

- Weight fluctuates a lot and significantly

Sound familiar? The common mistake many people make in trying to build muscles and get the buffed body is not understanding their body type will make a big difference in the results.

Some initial exercise suggestions for this body type or shape: – Heavy weight workouts

- All muscle groups need work (regularly and frequently)

- Cardio

- 2-3 exercises per body part

- 3-4 sets with 6-10 repetitions

Results: strength and muscle added top priorities and outcomes, with persistence and disciplined work

Recommended work could include: – Core Training

- Kickboxing Class

- Martial Arts

- Tae-Bo

- Treadmill

- Walking

- Work on buttock and thigh area

What to eat and how to adjust your diet somewhat to accommodate and support some of the work that you are doing on the exercise front to let the shape come to its full potential:

DO NOT: – EAT or consume lots of empty calories convenience, junk, fried or fast food

- Have trans-fats in your diet

- Skip any of your meals

DO:

- Eat lots of protein and carbohydrates(grains, granola, nuts, dried fruits)

- Fats and healthy oils (as much as 30% of total intake calories)

It follows that many feel that your body type, shape and physical characteristics and feature can oftentimes greatly affect the nature, intensity, type and duration, frequency and effectiveness of your exercise routines, workouts and regimen overall.

Body shape or type are just parts of the large puzzle in question here for either fitness training, weight loss and management and overall toning, sculpting and functioning. You will achieve superior results when the program you use matches your body type. Thin, ectomorph bodies respond very well to specific muscle building practices to produce killer muscles. Go forth, learn, lift and live the life you were given. Blessings!

Do you exercise? So many people around the globe are taking up some sort of physical regime in order to stay healthy and fit. Whether you’re trying to shed unwanted fat or simply build muscle mass, there are a number of ways to tackle the situation.

As a man, I typically look for exercises that will help me build muscle mass, rather than burn calories. It basically all comes down to your body type and goals. In the end, a good fitness routine is mandatory for everyone for basic health reasons.

Did you know that weekly exercise is imperative for staying healthy? It’s true and shouldn’t be dismissed. What do you do to stay in shape? Personally I like to practice martial arts. Along with self-defense training, I strive to build muscle mass. Let’s face it, you want a toned body. This characteristic gives you confidence, not to mention strength. Who doesn’t want to be stronger? Some of the more basic routes to a fit figure can be done without machines. For example, have you ever considered push-ups, pull-ups, crunches, dips, leg raises, running, jogging, jumping jacks, jump rope, or maybe even lunges? And that’s just to name a few. The list goes on and on. That is why I laugh when individuals claim they simply can’t get into shape because they lack the proper equipment. You don’t need any!

One of the best ways to build muscle mass is with weight training. You can join a gym if you prefer access to a variety of new-age weight machines, or you can purchase a few dumb bells and a bench. For those who want to build some muscle mass, but don’t have extra dough to spend, I recommend simple muscle building exercises. Do push-ups, pull-ups, and dips. Hop online for some great ab exercises and more. It’s all free if you have Internet access. You certainly don’t have to spend money in order to build muscle mass. You’d be amazed at all the free exercises at your disposal. One factor you should consider is diet. If you are pumping iron five days a week, but not seeing a significant result; you may want to alter your current diet. High levels of protein are needed to build muscle mass. You can find this nourishment in a variety of healthy meats like fish and chicken. There are also protein bars galore out there to help you build muscle mass. The key is diet and proper training. You can have that ripped body you crave in no time.

Despite their importance to a wide range of athletic and sporting activities, the hip flexors are the most neglected major muscle group in strength training. It is very rare to find training programs that include hip flexor exercises. By contrast there is usually a great deal of emphasis on exercises for the leg extensors.

There are some obvious reasons for this comparative neglect. The principal muscles involved in hip flexion are the psoas and the iliacus, collectively known as the iliopsoas. Because they are relatively deep-seated rather than surface muscles they may have been overlooked by bodybuilders who have traditionally been the major innovators in strength training. Secondly, there are no obvious ways to adequately exercise them with free weights. Finally, these muscles do not have the obvious functional importance of their extensor counterparts. Yet, as antagonists, both hip and knee flexors perform a vital role in controlling the rate of descent and ascent in leg extension exercises such as the squat.

There is no corresponding problem of underdevelopment with the muscles responsible for knee joint flexion, the hamstring group. Because they cross two joints they are active in both leg extension and leg flexion. They act to flex the knee joint and also to extend the hip joint. Therefore they tend to be strengthened by complex leg extension exercises. Also hamstrings can be developed and strengthened through the use of the leg curl apparatus.

Strong hip flexors provide an advantage in a wide range of sports and athletic activities. In sprinting high knee lift is associated with increased stride length and therefore considerable attention is given to exercising the hip flexors. However, they are usually not exercised against resistance and consequently there is unlikely to be any appreciable strength increase.

Hip flexor strength is directly relevant to a range of activities in football. Kicking a ball is a complex coordinated action involving simultaneous knee extension and hip flexion, so developing a more powerful kick requires exercises applicable to these muscle groups. Strong hip flexors can also be very advantageous in the tackle situation in American football and both rugby union and rugby league where a player is attempting to take further steps forward with an opposing player clinging to his legs.

In addition those players in American football and rugby who have massively developed quadriceps and gluteus muscles are often unable to generate rapid knee lift and hence tend to shuffle around the field. Having stronger flexors would significantly improve their mobility.

It is commonly asserted that marked strength disparity between hip extensors and hip flexors may be a contributing factor in hamstring injuries in footballers. It is interesting to speculate on whether hip extensor/flexor imbalance might also be associated with the relatively high incidence of groin injuries.

Other sports where increased iliopsoas strength would appear to offer benefits include cycling, rowing and mountain climbing, in particular when scaling rock faces.

The problem in developing hip flexor strength has been the lack of appropriate exercises. Two that have traditionally been used for this muscle group are incline sit-ups and hanging leg raises, but in both cases the resistance is basically provided by the exerciser’s own body weight. As a consequence these exercises can make only a very limited contribution to actually strengthening the flexors.

Until now the only weighted resistance equipment employed for this purpose has been the multi-hip type machine. When using this multi-function apparatus for hip flexion the exerciser pushes with the lower thigh against a padded roller which swings in an arc. One difficulty with this apparatus is that the position of the hip joint is not fixed and thus it is difficult to maintain correct form when using heavy weights or lifting the thigh above the horizontal.

With the release of the MyoQuip HipneeFlex there is now a machine specifically designed to develop and strengthen the leg flexors. It exercises both hip and knee flexors simultaneously from full extension to full flexion. Because the biomechanical efficiency of these joints decreases in moving from extension to flexion, the mechanism is configured to provide decreasing resistance throughout the exercise movement and thus appropriate loading to both sets of flexors.

The absence until now of effective techniques for developing the hip flexors means that we do not really know what benefits would flow from their full development. However, given that in elite sport comparatively minor performance improvements can translate into contest supremacy, it is an area that offers great potential.

In fitness the biggest fascination in fitness is getting a flat stomach or having washboard abs. However, in this article I want to talk about the anatomy of the ab muscles.

There are 4 muscles in the anterior (front) abdominal wall. They are the rectus abdominus, the external oblique, the internal oblique and the transversus abdominus.

The rectus abdominus might be the most popular ab muscle because this is the muscle that makes up the 6 pack. The rectus abdominus runs straight down the abdomen and attaches the ribs to the pelvis.

It works really hard when you do crunches and sit ups or any other exercise in which your spine bends forward against resistance. The rectus abdominus is primarily a mover of the spine, but in addition it helps to stabilize the pelvis and lower back.

The external oblique is located on both sides of your waist. This muscle goes diagonally from the back of your lower ribs down to your pelvis. The external obliques on both sides work to help your spine bend forward like in crunches and sit ups, so when you so crunches all of your ab muscles work.

However, if you want to emphasize the obliques you need to incorporate twisting, rotation, or side-bending. When you turn your legs to the side or twist your body at the top part of a sit up or crunch your external oblique muscle will work harder than during a regular crunch.

The internal oblique is located underneath the external oblique. It goes diagonally from the pelvis up to the lower ribs. Just like the external oblique, the internal oblique works during regular crunches, but it is emphasized with twisting or rotation.

The internal obliques are built more for stability since they are deeper and closer to the spine. Isometric side planks are a good exercise for the internal obliques.

The fourth abdominal muscle is the transversus abdominus. Although it is the least popular muscle, many physical therapists think it is the most important muscle.

As the name suggests, the transverse abdominus runs across the abdomen. It is the deepest of all the abdominal muscles, and since it is so close to the spine it is the major abdominal stabilizer of the spine.

The transversus abdominus does not move the spine forwards or help it to twist and rotate. The only function of the transversus abdominus is to stabilize the spine and stop it from moving.

Sometimes the transverse abdominus is referred to as your natural girdle because it acts like a girdle to keep your stomach pulled in. It will work during every movement and every ab exercise, but you can emphasize it by pulling your belly button towards your spine.

All of the abdominal muscles have a unique role, and all of them are important. In a fitness program, I suggest that you take an integrated approach and focus on different types of exercises to condition all of the abdominal muscles.

Cardiac Asthma

Cardiac asthma isn’t asthma in its true sense. It’s wheezing due to congestive heart failure.

Cardiac asthma is a clinical condition caused by severe reflexive blocking and/or by edema of the lungs. It is an asthmatic-type breathing caused by sudden blockage of the pulmonary circulation. The bronchial spasm in cardiac asthma is caused by back pressure from the left side of the heart to the lungs (the left part of the heart has a sudden disproportion between its work load and work capacity).

Cardiac asthma is quite similar to lung asthma. In this, patients with heart failure or heart valves that do not open properly experience shortness of breath, wheezing and coughing.

What causes cardiac asthma?

Cardiac asthma is usually due to a major mechanical fault of the heart and may pose to be life threatening, if not checked at the right time.

In this kind of asthma, the reduced pumping efficacy of the heart leads to a build up of fluid in the lungs. This build up of the fluid causes the air passages to narrow up and eventually cause wheezing and other related symptoms.

Symptoms:

Symptoms usually occur with exercise or at night after going to bed. Excessive fluid in the lungs associated with heart failure causes symptoms such as shortness of breath, coughing and wheezing, which imitate asthma.

Both cardiac asthma and pulmonary edema are symptoms of coming heart failure. It is a life-threatening condition and one must seek medical advice immediately on experiencing any symptoms.

Some of the main symptoms are:

* Shortness of breath, not necessarily accompanied by wheezing.
* Increased rapid and superficial breathing.
* Increased blood pressure and heart beat rate.
* A feeling of uneasiness.
* Cardiac asthmatic people wake up breathless a few hours after sleeping, and have to sit upright to again properly breathe. This is due to lying down too long.
* Swollen ankles which worsen rapidly during the stretch of the day.

Treatment:

The key to effective management of cardiac asthma is right diagnosis, which includes differentiation between patients who wheeze only due to acute heart failure vs those who wheeze from other disorders, such as asthma, chronic obstructive pulmonary disease, pneumonia or acute respiratory distress syndrome.

Treatment is directed at improving the pump function of the heart along with medications. If the asthma is caused by a heart valve that is not working properly or a hole between the heart chambers, surgery or other procedures may be suggested.

Treatments mainly focus on controlling the night coughs, control of the edema, control of inflow load and the amount of residual blood in the left ventricle.

Treatment of heart failure involves using diuretics (water pills) to free the lungs of excess fluid and medications to help the heart muscles pump more effectively. When the heart failure has been well controlled, the wheezing will gradually stop. Some people may suffer from asthma and heart failure simultaneously, and thus require treatment for both conditions.

Patients suffering from cardiac asthma generally respond well to a combination of bronchodilators, supplementary oxygen, and treatment of the heart failure.

Corticosteroids for a patient with acute cardiac asthma are only prescribed depending on clinical circumstances and the patient’s response to initial therapy. When treatment of pure cardiac asthma is effective, the wheezing usually resolves automatically. Corticosteroids require several hours to give peak effect.

Who are prone to cardiac asthma?

Cardiac asthma usually occurs in elderly people who have wheezing and shortness of breath that are due to heart failure. When the heart is too weak to pump blood effectively, fluid will accumulate in the lungs. Fluid in the lungs causes shortness of breath and wheezing.

A thallium scan-a radionuclide study-can help evaluate heart muscle perfusion. The examiner injects thallium I.V. and then performs the scan. Ischemic and infarcted areas of heart muscle don’t take up the thallium, and they appear as cold spots on the scan. A physician may order an exercise stress test with a thallium scan to assess a patient for ischemia during exercise. Scans are performed at levels of peak exercise and 2 to 4 hours after exercise.

A physician may use dipyridamole thallium scanning for patients who are physically unable to exercise. Dipyridamole simulates exercise conditions by dilating the coronary arteries. Scans are performed when the arteries are dilated and 2 to 4 hours later.

In a multiple gated acquisition scan, another radionuclide scan, technetium is injected, and the heart is scanned during several cardiac cycles. This test analyzes ventricular wall motion and determines the ejection fraction-the amount of blood ejected from the ventricle during contraction. In a patient with CAD, this test shows abnormal movement and reduced performance of the left ventricular wall and a below-normal ejection fraction.

Using Cardiac Troponin Levels to Determine Myocardial Damage

Cardiac troponins, proteins that regulate calcium-dependent interactions between myosin and actin, facilitate cardiac contraction and relaxation. These proteins have three forms: troponin C, troponin I, and troponin T. Troponin C is found in cardiac and skeletal muscle cells. Troponin I and troponin T are specific to cardiac muscle.

Studies of patients with chest pain show that measurements of troponin I and troponin T levels may be more sensitive indicators of myocardial damage than measurements of creatine kinase levels. And measuring cardiac troponin blood levels may more specifically identify patients who are at increased risk for cardiac complications.

In one study of 1,404 patients with unstable angina and non-Q-wave myocardial infarctions (Mis), those with troponin I levels of 0.4 ng/ml or more had a significantly higher short-term risk of death.

In another study, patients with lower troponin T levels had improved long-term outcomes. During the first 4 months of follow-up, the risk of an Ml or death increased with higher troponin T levels.