Ball and Socket, Pivot, and Gliding: Keeping Your Female Hinges Healthy

1. Ball and Socket, Pivot, and Gliding: Keeping Your Female Hinges Healthy Joanna Wilson, D.O. HerCare at ADC

2. Famously Bad Posture

5. High Heels and Posture

6. Flat Feet

7. Posture To Prevent Muscle Spasms

8. Posture To Prevent Muscle Spasms

9. Sources of Joint Pain • Muscle • Ligaments • Cartilage • Tendon • Bursa • Bone • Fascia

10. Joint Anatomy

11. Cartilage • No blood supply • Oxygen and nutrient delivery and waste removal is done by compression • Made up of four substances: collagen, proteoglycans, water, and chondrocytes:

12. Cartilage • Collagen:Key component of cartilage; provides cartilage with its strength; creates a framework that houses the other components of cartilage • Proteoglycans:Combination of protein and sugar, which trap water in cartilage; woven around and through collagen, allowing cartilage to change shape when compressed • Water:Healthy cartilage contains more than 70% water; shock absorber and lubricates and nourishes the cartilage. • Chondrocytes:Cells produce new collagen and proteoglycans in cartilage; release enzymes which help break down and dispose of aging collagen and proteoglycans

13. Sex Differences in Cartilage • Cartilage thickness and volume are greater in boys and men vs girls and women • Women lose cartilage from their tibia (the larger bone between the knee and ankle) at 4x the rate of men, and they lose cartilage from the kneecap at 3x the rate • Greater cartilage loss in women than in men began at age 40 and increased with age 

15. Osteoarthritis Has Active Inflammation

17. Osteoarthritis Risk Factors • Excessive loading • High BMI • Previous knee injury • Age • Genetics • Sex

18. Female vs Male Hips

19. Osteoarthritis Risk: Overweight • Goal BMI is <25 to reduce OA in the population by up to 53%

20. Obesity-related pathways • Accumulation of fat in muscle which reduces muscle mass and strength • Instability of joint • Reduced impact absorption at joint by muscles • Altered gait patterns • Misalignment of joint

21. Osteoarthritis Risk: Excessive Loading • Kneeling, squatting • Pes Planus, Pronation of foot, Q-angle • “Land and turn” movements

22. Osteoarthritis: Previous Knee Injury • Ligament tears, meniscal injuries, and fractures involving the articular surface

23. Anterior Cruciate Ligament (ACL) • Injuries up to 10x more common in women • Relatively smaller diameter, relative hamstring weakness, sex hormone variations • Due to deceleration with landing and pivoting • 5%/year risk at collegiate level in volleyball, basketball, and soccer • Can cause chronic instability and osteoarthritis later

24. Joint Changes and Hormones • Increased laxity during ovulatory and luteal phases • Increased collagen turnover during follicular phase • Highest likelihood of ACL injuries during menses • Variations of hormone levels and receptors in target tissues during peri and post menopause • Hormone blockers and hormone replacement affect joint pain

25. Prevention of ACL Injuries • ACL –tear prevention programs: Proprioceptive and neuromuscular training programs • Awareness of reduced joint position sense during menses

26. Anterior Knee Pain(Patellofemoral Pain) • Twice as common in women • Due to: • Relative weakness of quadricep • Delayed firing of vastus medialis obliqus • Increased q angle

27. Treatment of Patellar Syndrome • PT: strengthen medial thigh muscles and hip external rotators, strengthen quadriceps • Taping of patella • Arch supports

28. Bursitis • Inflammation of the sac filled with lubricating fluid which separates joint structures

29. Common Bursitis Locations

30. Sprain • Inflamed ligament

31. Tendonitis • Tendon connects to bone and behaves as an elastic strip • Inflammation can occur

32. Enthesopathy • Inflammation where a ligament or tendon attaches to a bone causes calcium deposits • Spurs develop

33. Iliotibial Band Syndrome

34. IT Band Stretches

35. IT Band Stretch

36. Supplements: Possibly Effective • ASU (avocado and soybean oils)- hip • Boswellia (Indian frankincense) • Chondroitin Sulfate • Curcumin (constituent of turmeric) • Ginger • Kava Kava • Bovine cartilage • Cat's claw extract (Uncariaguianensis) • Devil’s claw • Vitamin B3 (niacinamide) • Rutin • DMSO (Dimethylsulfoxide) topical • Guggul • Yucca • Willow Bark • New Zealand green-lipped mussel

37. Supplements: Likely Effective • Glucosamine Sulfate • SAMe • Stinging Nettle (topical) • Turmeric • Bromelain • Camphor (topical)

38. Supplements: Effective • Capsaicin topical

39. Challenges in Supplement Research • Content variability (amount, quality) • Judging endpoints • Quality of study • Number of participants

40. Nutritional Recommendations • Fruits and vegetables for antioxidants (esp Vitamin C) • High calcium diet for bone strength and muscle function • Vitamin D for bone strength and balance • High quality protein for muscle strength

41. Exercise To Promote Joint Health • Allow compressive movement of cartilage • Increase bone strength • Tightens and thickens ligaments • Secure joint tracking with strong, balanced muscle traction

47. Hamstring Curl Stand with the front of your thighs against a surface (a table or wall). Flex one knee up as far as is comfortable. Hold for 5 - 10 seconds, then lower slowly. If possible, do not touch the floor between repetitions. (Ankle weights will increase the intensity.) Do 1-3 sets with 12-15 repetitions each. Remember to rest in between sets.

49. Bent-Leg Raises Sitting in a chair, straighten one leg in the air (without locking the knee). Hold for about one minute. Bend your knee to lower the leg about halfway to the floor. Hold for 30 seconds. Return to starting position. Work up to 4 reps on each leg.