| Ligaments
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| Ligaments are strong structures which join
two bones together, giving the skeleton strength and structural
integrity. Because ligaments are so important in the stabilization
of joints, they are also highly susceptible to injury. Ligaments are
composed strands of collagen fibers. Injured ligaments and other
connective tissue may not heal properly after minor or repetitive
motion injuries. Partial tears are usually much more painful than
full tears, which can sometimes be painless. If ligaments are
stretched, either by injury, excess strain on a joint, or by
improper stretching techniques, the joint will become weaker, as the
elongated ligaments are unable to properly support it. Because
connective tissue such as ligaments must withstand a great deal
stress in day to day activities and have a relatively low blood
supply, injuries can take a very long time to heal. Injured
ligaments tend to be less flexible, and more prone to repeat injury.
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| Degrees of Ligament Instability
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| Type 1. Stable.
The ligaments are structurally sound, coping well with day to
day activities.
Type 2. Partial Instability.
The ligament become weak/ injured and the muscles try to compensate
to function properly. If the muscles fail to work effectively with the
ligament pain and weakness will be experienced during daily activities.
Type 3. Complete Instability.
The ligaments are unable to support the joint and this gross
instability cannot be compensated by muscle function. Severe pain
and disability, unable to perform daily activities. Pelvic girdle
instability can coexist with instability of the sacroiliac joints.
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| Some Causing Factors of Ligament Damage back |
Ligaments are damaged by a joint moving
beyond its normal range of motion such as the excessive motion
associated with whiplash. Ligaments also heal very slowly and are
often left weaker post-injury. Tendon damage is often a later
consequence of inefficient muscles, poor ergonomics and consistent
abuse. Muscles and ligaments work together to stabilize joints and
when one of them fails to work efficiently, it shifts the load to
the other. An under-active set of muscles will shift more of the
joint stability load to the ligaments. If the strain or instability
isn't treated properly, scar tissue can form and limit the range of
motion, which may contribute to further damage.
Common Causes
- Overuse.
- Unaccustomed repeated minor trauma.
- Unprepared for activity.
- Violent contraction.
- Excessive forceful stretch.
- Sudden movement.
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| Ligament and Scar Tissue back |
| If scar tissue gets in the way of proper
healing, then the fibers do not line up and painful adhesions can
develop that can lead to additional damage or myofascial trigger
points, sprains or additional strains. Too much movement can lead to
aberrant motion and excessive cartilage wear. Eventually incapable
of stabilizing the joint and painful "clunking" joint develop.
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| Cartilage back |
| Cartilage is a type of connective tissue in
the body. It is made of cells called chondrocytes embedded in a
matrix, strengthened with fibers of collagen and sometimes elastin,
depending on the type of cartilage. There are three different types:
hyaline cartilage, elastic cartilage, and fibrocartilage. Cartilage
serves to provide structure and support to the body's other tissues
without being as hard or rigid as bone. It can also provide a
cushioning effect in joints. Cartilage is avascular, meaning that it
is not supplied by blood vessels thus limiting repair capabilities.
The healing response of cartilage is poor; the defects fill with
fibrous tissue or fibrocartilage that soon breaks down.
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| Injury Process of Cartilage
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| First Stage
Disruption of collagen network through trauma and/or hormones
decrease in proteoglycan and an increase in water content that result in
cartilage swelling and softening.
Second Stage
Is characterized by a repair response in which the body attempts to
repair the damage with increased anabolic (constructive metabolism) and
catabolic (breaking down of tissue), activity within the cartilage as
well as with proliferation of chondrocytes which form clusters of cells.
This stage might last for years and can result in increased thickness of
cartilage.
Wear Types
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Abrasive: Irregular hard surfaces moves on a
softer surface and ploughs grooves in it.
Corrosive: Follows the disruption of the protective
surface oxide layer of metals.
Adhesive :Repetitive sliding movements fragments are
pulled from one surface and adhere to the other.
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| Muscle
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| Muscle contraction is important to regulate
bone loading. They can neutralise tensile load and allow bone to
carry increased load. Muscle attachment to the bony skeleton is a
type of fibro-osseous junction, and can be thought of as another
type a ligament. These muscle-bone attachment points are not
strictly classed as ligaments anatomically, but they can act in a
similar way to sprained ligaments after an injury. Myositis is a
general term for inflammation of the muscles.
Piriformis Muscle
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This pear shaped muscle is located in the posterior
pelvis and functions to laterally rotate and abduct the
thigh. It originates from the 2nd and 4th sacral segments
and inserts on the greater trochanter of the femur. The
piriformis and obturator internus play similar roles in
moving the femur.
Puborectalis
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The fibers which form a sling for the rectum are named
the Puborectalis or Sphincter recti. The fibers arise from
the lower part of the symphysis pubis, and from the superior
fascia of the urogenital diaphragm. They meet with the
corresponding fibers of the opposite side around the lower
part of the rectum, and form for it a strong sling.
Pubococcygeus
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The pubococcygeus muscle or PC muscle is an important
muscle in the human body. It is a hammock-like muscle, that
stretches from the pubic bone to the coccyx (tail bone)
forming the floor of the pelvic cavity and supporting the
pelvic organs. It controls urine flow and contracts during
orgasm. It surrounds the rectum, the vagina and bladder
openings. It aids in urinary control, and childbirth. For
some women who have pain and/or dysfunction in the symphysis
pubis they can feel discomfort to pain when going to the
toilet. It can be because of its attachment to the pubic
bone and the stresses placed upon this muscle.
Diastasis Abdominis Recti
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Approximately 1/3 of pregnant women will experience this
condition. A diastasis occurs when the right and left sides
of the rectus abdominis are stretched, separated or
partially separated along the vertical midline; this can
happen during the pregnancy or birth. The abdominal muscles
separate because of the increasing pressure of the growing
fetus. Diastasis abdominis recti is primary genetic, but it
may also be caused by weak abdominal muscles or rapid
abdominal growth. If you think you might have a diastasis
you will notice a bulging along the midline of your abdomen
and a space wider than 2 finger widths between the left and
right sides of your abdominal muscles.
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| Nerves
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| There are also numerous nerves that pass in
and around the pelvis. All branch out from the spinal column. The
spinal column is made up of the Cervical, Thoracic, Lumbar, Sacral
and Coccyx. Each region has its own specialty.
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| The Cervical Spine
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| The neck supports the weight of the head and
protects the nerves that come from the brain to the rest of the
body. This section of the spine has seven vertebral bodies (bones)
that get smaller as they get closer to the base of the skull. The 12
vertebral bodies in the upper back make up the thoracic spine. The
firm attachment of the rib cage at each level of the thoracic spine
provides stability and structural support to the upper back and
allows very little motion. The thoracic spine is basically a strong
cage and it is designed to protect the vital organs of the heart and
lungs.
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| The Lumbar Spine
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| The lower back has a lot more motion than the
thoracic spine and also carries all the weight of the torso.
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| The Sacrum
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| Contains a series of five openings on each
side through which the sacral nerves and blood vessels run.
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| The Coccyx
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| Is located at the base of the spine (also
called the tailbone) and is composed of three to five fused
vertebrae. Ligaments attach the coccyx to the sacral hiatus at the
synovial sacrococcygeal joint.
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| Sciatica
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| The nerve roots that exit the spinal cord and
form the sciatic nerve exit through little holes in the spine called
intervertebral foramen (literally, holes between the vertebrae.
Normally, the holes formed by the bony spine are big enough for
roots to exit through without difficulty. Sometimes, however,
disease, trauma or arthritis causes the diameter of these holes
diminish. This decrease in space may cause a tightening around the
nerve root, which can aggravate or irritate the nerve and cause
sciatica. In some cases the bony hole may have a spur or sharp bony
structure that actually touches the nerve root, further aggravating
the condition. There are other space-occupying lesions that can
cause sciatica, including tumour growth, organ enlargement (from an
underlying disease) or even severe scar tissue formation from
previous surgeries. In addition, some women complain of sciatica
after they receive an epidural during labour.
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| Symptoms Caused By Nerve Pain
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- Part of the leg feeling warm.
- Numbness and tingling.
- Dull aching pain.
- Trouble weight bearing.
- Part of the leg feeling warm.
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| Some reasons for nerve pain
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- The way the baby lies in your uterus.
- The pressure during a vaginal delivery.
- Pelvic instability.
- Pelvic surgery.
- A heavy fall.
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