knee pains

Take care of your knees • Obesity puts strain on the knees. Maintain a BMI (weight divided by height in metre squared) between 23 and 25 • Do exercises to strengthen the knees. These exercises are available on the Internet, are part of yoga and can be taught by a physiotherapist • Always warm up before and cool down after exercise • If you have knee pain, shift to non-weight bearing exercises such as swimming or water aerobics

The knees are one of the larger joints in the body, supporting its entire weight. It is a hinge joint, like that of a door, capable only of moving forwards and backwards. Attempts to force a door to move sideways or push it open in the wrong direction will result in the door “coming off its hinges.” A similar problem occurs when the knee is forced to move in the wrong direction.

The knee joint is composed of three bones, the lower end of the femur and the upper ends of the tibia and fibula, articulating with one another. The raw bones do not grate against each other. They are separated by a “joint space” filled with synovial fluid, lined with articulating cartilage and separated by little washers called meniscii. There are ligaments inside the joint holding it in place. Considering the size of the knee joint, these ligaments are woefully inadequate. In the front of the knee is the kneecap or patella.

The knee undergoes constant wear and tear. Our daily activities involve walking and climbing stairs as well as exercising. In a lifetime, the knee joint functions over and above its capacity!

Pain in the joint can be acute and occurs owing to injury, infection, or age-(or overuse) related degeneration. The cartilage breaks down, exposing parts of the bone underneath. The raw nerves are exposed and this becomes very painful. Bits of broken cartilage can get trapped in the joint. When that occurs, movement can result is sudden pain and the joint can get locked.

Dislocations and injuries are more common in the young — basketball and football are notorious for causing knee injuries. This is because there are sudden abrupt changes in the direction of movement, which may be against the normal anatomical direction of movement. The player may land awkwardly or fall, bruising and injuring the joint.

The two knees support the weight of the entire body between them. The bones are physically capable of supporting only a certain amount of weight. Obesity causes the knees to degenerate rapidly. Depending on gait and posture, one side may wear out faster than the other. This may result in a bow-legged appearance. Walking is extremely painful and the gait may be crab like. The entire joint may be swollen and painful. Or, the pain may be localised on one side. At times, instead of the whole joint, the area under the patella gets worn down and irregular. As that rubs against the bones underneath, there is terrible pain with movement.

Children seldom develop knee pain without injury or a fracture. Boys can develop pain as part of certain inherited congenital syndromes or birth defects in the knee. The patella may also get dislocated. This is more common in teenage girls.

Infections, acute trauma and fractures result in swollen, warm and tender joints. Arthritis, especially rheumatoid or osteoarthritis, can produce a similar picture. Infection always produces fever. Gout usually affects the big toe but can present itself as a painful knee joint. It may be worth checking uric acid levels.

going for gold

Striking gold

YOUR HEALTH DR GITA MATHAI

AS GOOD AS GOLD: Vijender Singh Citius, Altius, Fortius” goes the Olympic motto in Latin. Translated, it means “Swifter, Higher, Stronger.” That is what every Olympic athlete strives for — to be the best. His or her single-minded dedication, tremendous personal sacrifice and discipline are to be admired and emulated. It is not easy to drive your body to its limits. Great athletes need the right genetic makeup, body proportions and physique. They can then be moulded for the job. Michael Phelps is 6 feet 4 inches tall, but has proportionately shorter legs attached to a long trunk, with giant size 14 feet that look and function like fins. Kip Keino, the Kenyan marathon runner, is only 5 feet 8 inches tall but has thin, long runner’s legs and a short torso. In short, aspiring athletes need the correct genes and a supportive family and government. A genetically apt form and physique is wasted without the right training, nutrition, mental discipline and financial support. This does not mean that we ordinary people cannot exercise and strive to be healthy. The human body has striated or voluntary muscles which function on demand. These muscles are either “fast-twitch” (white) muscles or “slow-twitch” (red) muscles. The white muscles contract rapidly and tire easily. They are good for sprinting. The red fibres are best for endurance sports as they have increased muscle power and are twice as efficient. With training it is possible to develop a particular muscle type, but a choice has to be made between speed and endurance. This is why a tall, strong, muscular and powerful human with more red muscle cannot move swiftly or manoeuvre as efficiently as a small, lean person with more white muscle. Animals show this distinction in evolution. The cheetah has tremendous sprinting speed over short distances, but the horse has far greater stamina and endurance. Once a particular muscle type has been trained, it is possible to excel in related events that have similar energy requirements. The same people will do well in the 100m and 400m sprints, the 110m hurdle and the long jump, but not in the 5000m event which requires more stamina. Tremendous torso strength is required to throw a shot put, hammer or javelin. These events require stocky athletes who may not be able to move fast and do well in sprints or jumps. Everyone (particularly all Indians) should prioritise staying fit and exercising to the limit of his or her endurance. This means exercising one hour a day and trying to achieve the target heart rate (80 per cent of 220 minus age). This habit needs to be started young. Unfortunately, many school going children today are obese with a Body Mass Index (weight in kg divided by height in metre squared) greater than 25. However, it is never too late to start. Despite age, infirmity and illness, the body when trained and pushed is capable of miracles. To start exercising, set a realistic primary fitness goal, and prioritise it as daily, monthly and lifetime goals. Decide if the exercise is to remain healthy, lose weight, contour the figure, improve cardiovascular status, control blood sugars, normalise blood pressure, for anti anxiety and anti depressant effects, to help work through fatigue or to compete in sports. The effort put in and the training will be different in each case. Targets will never be achieved without setting goals and if there is a tendency to procrastinate. Regular exercise should include a 15-minute warm-up, a one-hour workout and a 10-minute cool-down phase to prevent muscle injury. For the warm-up, do one or two pull-ups, spot jogging, skipping, push-ups and short stepping in place, gradually increasing the pace till sweating starts. Finish the warm-up with stretches. Slowly move the muscles, tendons and ligaments to increase flexibility. Stretch the Achilles tendon. Lunge from side to side and front to back. For each workout, pick and target a specific area that needs improvement. Decide ahead and fix a rotating timetable so that all the major muscle groups are exercised. Muscles accumulate lactic acid during high intensity exercise. This needs to be removed during a 10-minute cool down process that involves walking and stretching. Regular and judicious exercise can delay the onset of diabetes or hypertension by 10-15 years. It also increases breathing capacity and reduces the frequency of wheezing attacks in asthmatics. Body weight remains under control. Bones, muscles and joints stay flexible, reducing the pain of arthritis. Physically active people have better coping skills and are less likely to succumb to anxiety or depression. The feel good factor makes life pleasurable. The sense of achievement boosts morale. This in turn reduces illnesses, medication, the number of visits to the physician and hospitalisations. As you start your exercise programme, remember each year of exercise adds approximately a year of life. Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in

free radicals

http://www.telegraphindia.com/1140811/jsp/knowhow/story_18707974.jsp#.U_AbooCSx2A Radical changes Your Health DR GITA MATHAI No one wants to grow old. The body constantly battles against this process. Free radicals are responsible for the changes and shortening of the DNA in our cells, which in turn causes the visible changes of ageing. Free radicals are compounds created when a molecule in our body gains or loses an electron, rendering it unstable. The commonest free radicals are known as ROS (reactive oxygen species). Apart from damaging the DNA, excess free radicals body can harm protein structure and cell membrane. This results in diseases such as arthritis, vasculitis, glomerulonephritis, lupus erythematous, adult respiratory diseases syndrome, emphysema, hemochromatosis, gastric ulcers, hypertension, atherosclerosis, cancer, Parkinson’s disease, Alzheimer’s disease and obesity. Particularly, ROS can fragment atherosclerotic plaques, spreading them all over the body, causing heart attacks and strokes. Atherosclerotic plaques are fatty deposits on the walls of blood vessels that make them narrow. Production of free radicals increases with infection, inflammation and during exercise. It increases exponentially with exposure to environmental pollutants, cigarette smoke, radiation and solvents. Antioxidants act as scavengers, removing the destroyed or fragmented DNA caused by free radicals. These days they are being prescribed as the panacea of all ills. Conditions ranging from poor immunity, male infertility, heart attacks, diabetes, cancer to even ageing are said to benefit from antioxidant supplements. Antioxidants occur in a variety of foods, especially coloured (red, yellow, green, purple) fruits and vegetables. They are not heat stable, so it is better to eat the fruits or vegetables raw. People who eat 4-6 helpings of fruits and vegetables a day have a lower incidence of cancer and live longer. On the other hand, they tend to be health conscious, exercise, have healthier lifestyles and are conscious of body weight. A large amount of ROP is released during exercise. So taking antioxidant supplements should decrease recovery time. A number of studies have demonstrated that this is not the case. Ironically, taking antioxidant supplements actually slows down recovery. Patients with cancer are often advised to take supplements of megavitamins and antioxidants. They may actually be detrimental. High doses of betacarotene increases the risk of lung cancer in smokers. Vitamin E can increase the risk of prostate cancer and high doses of vitamin C the risk of bladder cancer. High-dose supplements of antioxidants are linked to worse cancer outcomes, especially in smokers. Instead of antioxidants, • Invest in a pair of gym shoes • Walk, jog or run 40 minutes a day. • Eat 4-6 helpings of fresh fruit and vegetables a day • Do not smoke or spend time around smokers Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in Share on emailShare on printShare on facebookShare on twitterMore Sharing Services

free radicals

http://www.telegraphindia.com/1140811/jsp/knowhow/story_18707974.jsp#.U-ls5oCSx2A

Radical changes

Your Health DR GITA MATHAI

No one wants to grow old. The body constantly battles against this process. Free radicals are responsible for the changes and shortening of the DNA in our cells, which in turn causes the visible changes of ageing. Free radicals are compounds created when a molecule in our body gains or loses an electron, rendering it unstable. The commonest free radicals are known as ROS (reactive oxygen species). Apart from damaging the DNA, excess free radicals body can harm protein structure and cell membrane. This results in diseases such as arthritis, vasculitis, glomerulonephritis, lupus erythematous, adult respiratory diseases syndrome, emphysema, hemochromatosis, gastric ulcers, hypertension, atherosclerosis, cancer, Parkinson’s disease, Alzheimer’s disease and obesity. Particularly, ROS can fragment atherosclerotic plaques, spreading them all over the body, causing heart attacks and strokes. Atherosclerotic plaques are fatty deposits on the walls of blood vessels that make them narrow. Production of free radicals increases with infection, inflammation and during exercise. It increases exponentially with exposure to environmental pollutants, cigarette smoke, radiation and solvents. Antioxidants act as scavengers, removing the destroyed or fragmented DNA caused by free radicals. These days they are being prescribed as the panacea of all ills. Conditions ranging from poor immunity, male infertility, heart attacks, diabetes, cancer to even ageing are said to benefit from antioxidant supplements. Antioxidants occur in a variety of foods, especially coloured (red, yellow, green, purple) fruits and vegetables. They are not heat stable, so it is better to eat the fruits or vegetables raw. People who eat 4-6 helpings of fruits and vegetables a day have a lower incidence of cancer and live longer. On the other hand, they tend to be health conscious, exercise, have healthier lifestyles and are conscious of body weight. A large amount of ROP is released during exercise. So taking antioxidant supplements should decrease recovery time. A number of studies have demonstrated that this is not the case. Ironically, taking antioxidant supplements actually slows down recovery. Patients with cancer are often advised to take supplements of megavitamins and antioxidants. They may actually be detrimental. High doses of betacarotene increases the risk of lung cancer in smokers. Vitamin E can increase the risk of prostate cancer and high doses of vitamin C the risk of bladder cancer. High-dose supplements of antioxidants are linked to worse cancer outcomes, especially in smokers. Instead of antioxidants, • Invest in a pair of gym shoes • Walk, jog or run 40 minutes a day. • Eat 4-6 helpings of fresh fruit and vegetables a day • Do not smoke or spend time around smokers Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in

gut flora

http://www.telegraphindia.com/1140804/jsp/knowhow/story_18684350.jsp#.U-JEYICSx2A

Gut factor

Your Health DR GITA MATHAI

Save yourself • Limit the amount of highly processed, chemical, preservative and transfat containing food that you eat. • Eat at least four helpings of fruit and vegetables a day. • Add natural yogurt to the diet. • Try to eat cereal with fibre, not the highly processed polished variety. • Do not opt for a caesarian unless there is a medical reason for doing so. • Breast-feed your baby for a year. • Exercise is a panacea for all illness. It is proven to help good gut bacteria grow. Bacteria are invisible to the naked eye but they are everywhere — in the soil, on our skin, in the air we breathe, and, most importantly, inside our bodies, particularly in our intestines. We wage an ongoing war on bacteria using soaps, disinfectants, antiseptics and antibiotics. It is a losing battle with periods of truce. Babies live in a sterile environment in the uterus. They start acquiring bacteria during the birth process, which (if it is a normal delivery) is messy with close contact between the baby and the mother’s skin, intestines and blood. This seeding colonises the baby’s skin and gut. Most of the organisms are harmless. As they thrive they help with the digestion of breast milk. They also fend off attacks from stray disease-causing bacteria and help develop appropriate immunity. In children born by caesarian section, there is no initial seeding with appropriate friendly bacteria. The immune systems of these babies do not develop quickly or appropriately. This makes them prone to allergies and infections. The composition of breast milk has baffled scientists. Despite repeated and expensive efforts, breast milk could not be replicated in the laboratory. It contains immunoglobulins from the mother that protect from childhood diseases and diarrhoea. It contains complex carbohydrates called oligosaccharides, which the baby’s gut enzymes do not digest. It actually serves as food for certain beneficial bacteria (bifidobacteria), which thrive and multiply and crowd out disease (diarrhoea)-causing bacteria. By the age of three, gut bacteria resembles that of the adult. It then remains stable and relatively unchanged till bacteria-altering events such as illnesses or antibiotic usage occur. Gut bacteria aid digestion and absorption of nutrients from the gut. They want to be well fed, so they release chemicals that effect human appetite. They control inflammation. They manufacture neurotransmitters like serotonin, vitamins from the B complex group and vitamin K. They influence our weight, our mood and our health. They may be responsible for obesity, autoimmune diseases, stress levels and mood swings. We can alter our gut flora in subtle, unintentional ways. Chlorinated drinking water and miniscule amounts of soap, toothpaste and hand sanitizers kill good and bad bacteria, altering the ratio and changing our internal environment. The biggest threat comes from antibiotic usage. The “broad spectrum” antibiotics do just that —they kill good and bad bacteria over a wide spectrum, completely changing our internal environment. We may have got rid of the infective “bug” but have left our bodies weaker and damaged after the treatment. Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on he

http://www.telegraphindia.com/1140721/jsp/knowhow/story_18635672.jsp#.U8-1OoCSx2A

Are you sleeping enough?

Your Health DR GITA MATHAI

Sleeping away one third of our life may seem like a waste of time. But it is essential for growth as during this time our body rejuvenates and maintains and repairs itself. In the long run, insufficient sleep has a negative impact on health. The hours of sleep we need varies with age and the individual. Infants may sleep up to 14 hours a day, growing children nine to ten hours and adults an average of seven to eight hours. Teenagers, who are still growing actively, need their sleep. More than 70 per cent in this age group suffer from chronic sleep deprivation owing to schoolwork, tuitions, television, and social media. As we grow older, our sleep requirement may decrease and be broken up into shorter segments with daytime naps. Some people seem to manage efficiently on four to six hours sleep. Long standing sleep deprivation occurs as an occupational hazard in shift workers. Sleep deprivation can be due to medical conditions such as obstructive sleep apnoea (when a sensation of choking repeatedly wakes the person) or restless legs. Inadequate sleep causes a “tired look”, stress, irritability (short fuse), forgetfulness and a tendency to repeat sentences. Academic performance can deteriorate. Burning the midnight oil may result in an inability to recall what was learnt the night before. Any repetitive task or dark environment (movies, lectures, conferences) may bring on an overwhelming desire to sleep. Driving or operating machinery becomes dangerous as “nodding off” can cause fatal accidents. Lack of sleep causes the weight to climb up slowly and inexorably. This is because the balance between sleep and appetite hormones gets reset. The feeling of fatigue is ineffectually combated by eating more. Obesity sets in, closely followed by lifestyle diseases such as diabetes and hypertension. Strokes and heart attacks are more common in the sleep deprived. Sleep can be elusive if there have been changes in schedule, venue or if there are unresolved tensions. Eating too much or too little food close to bedtime is also disruptive. Drinking too much fluid means nighttime trips to the toilet. Smoking stimulates the body, as does caffeine (coffee, tea, cola), making us awake and alert. Alcohol may initially help sleep to set in but the wearing off of the effect later leads to nighttime awakening. To ensure adequate sleep, try to go to sleep at the same time every night. Sleep in a darkened room with the television and computer switched off. If you do not fall asleep after half an hour, get up and drink some warm milk or water and try again. Awakening from sleep should be natural and will occur spontaneously when the duration of sleep has been sufficient. If an alarm is used, try to set it to the latest possible time, giving your body time to wake spontaneously before it goes off. Daytime naps interfere with nighttime sleep. It is better to avoid naps. If inevitable, sleep mid afternoon and not more than 30 minutes. You may get caught in a vicious cycle of daytime naps, sleeping later at night, leading to longer naps in the daytime and finally, insomnia. Physical and mental fatigue has to set in for proper sleep. Exercising aerobically for 40 minutes a day by walking, jogging, running, swimming or cycling will tire the muscles. After the exercise they need to be stretched for 10 minutes for relaxation to set in. Exercise must be completed at least an hour before bedtime. Otherwise the chemicals released will jolt you awake. One of the proven ways to overcome sleep is to jump up and down or skip! Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in

all that rage

http://www.telegraphindia.com/1140714/jsp/knowhow/story_18611110.jsp#.U8YwJJSSya8 All that rage Your Health DR GITA MATHAI Millions of people all over the world watched in horror as a player bit his opponent during a FIFA World Cup 2014 match. The question uppermost in people’s minds was why. Why bite? Biting is a primitive and aggressive expression of anger, frustration or fear. Anger occurs in an area of the brain called the amygdala. In a quarter of a second it releases the chemicals arginine-vasopressin, dopamine, noradrenalin, and corticotropin-releasing hormone and lowers serotonin levels. These chemicals make our bodies ready for a “fight or flight” reaction. The heart rate and blood pressure go up, pupils dilate and sweating occurs. Almost immediately, the blood supply to the frontal lobe of the brain increases. It reacts, releasing other chemicals like serotonin. As its levels rise, reason sets in and higher functions take over. Angry reactions are suppressed. When intense anger takes over, you can either leave the scene (probably an appropriate and safe response), or respond with physical or verbal aggression. If serotonin levels are low, unreasonable anger and aggression take over. During sports, especially contact sports such as football and wrestling, the body is already fine- tuned to win, and, if necessary, be aggressive towards the opponent. This reaction often makes the difference between winning and losing. For the rest of us, lashing out verbally or physically is not a viable option. “Anger management” is essential to make us productive, functioning members of society. People can “feel the heat” as anger builds up in the body. Three responses are possible at this point. The emotion can be vented out, suppressed or attempts can be made to calm down. Expressing anger to a superior or an authority figure may not be the wisest path. Suppression of anger, especially if the aggravation is continuous and long term, can have negative effects. The blood pressure can go up, it can precipitate a stroke or heart attack and it can result in overeating and obesity with its attendant problems or depression. Calming techniques have to be learnt, as they do not come naturally. As soon as you feel your heart pounding in anger, count mentally to 10 before retorting verbally or physically. This gives time for the frontal lobe to counter the amygdala. At the same time take a few deep breaths. Sometimes a word like peace or shanti repeated mentally several times can help with control. Yoga and meditation are time-tested ancient techniques. Logic defeats anger. Considering and analysing occurrences can often defuse anger. Listening to the other person, thinking things through, walking in the other man’s shoes, are all practical ways to tackle the problem of anger. Regular aerobic exercise such as walking, jogging, running, cycling or swimming for 40 minutes or more a day has profound effects on physical and psychological make up. Chemicals are released from the muscles and these elevate serotonin levels. Anger does occur in people who exercise regularly, but the chemicals released by the body tend to put a “brake” on violent, irrational anger. Toddlers sometimes throw tantrums. During these they may bite. The problem is compounded by frustration at the inability to make themselves understood. As the brain matures, the higher centres (frontal lobes) encourage social norms. If there is dysfunction in the frontal or temporal lobes of the brain, uncontrolled, aggressive and biting behaviour may persist into adult life. This can be picked up with EEG or MRI scans. Human bites are dangerous even if accidental or self-inflicted, if there is a break in the skin. The mouth contains a large number of viruses and bacteria that can cause infection. The wound should be thoroughly cleaned with soap and water and a topical antibiotic cream applied. Booster injections of tetanus toxoid and hepatitis B should be taken if they are due. The HIV virus can be transmitted through a human bite. Appropriate blood tests may be required. Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in http://www.telegraphindia.com/1140714/jsp/knowhow/story_18611110.jsp#.U8YwJJSSya8 Share on emailShare on printShare on facebookShare on twitterMore Sharing Services