Vitamin D Deficiency

Vitamin D Deficiency

When I first started my studies to be a massage therapist, we were expected to cover the basics in nutrition.Vitamin D Deficiency

Vitamin D was glossed over – as the body can store it in the liver, we were told, then it was unlikely that we would see signs of deficiency .

This was especially when you didn’t even have to eat ‘healthy food’ to get a supply of it. Simply by being in the sun would ensure you topped your stores of it up.

The only people at risk of deficiency were thought to be those who had a ‘goth’ lifestyle, for example slept by day and came out at night.

Presumably vampires are at risk too!

But more recently the media have been highlighting a growing concern that we are more and more likely to be deficient in this important vitamin. One study (but be cautious, they sell vitamin supplements!) claims their survey discovered 9 out of 10 people have symptoms of Vitamin D deficiency.

So What Does Vitamin D do?

Vitamin D aids the body’s absorption of calcium so it is essential to the growth and strength of bones. In extreme circumstances a deficiency in this vitamin causes rickets in children or osteomalacia in adults.

Vitamin D is important to the body in many other ways as well. Muscles need it to move, nerves need it to carry messages between the brain and every body part and the immune system needs vitamin D to fight off invading bacteria and viruses. Vitamin D is found in cells throughout the body. Together with calcium, vitamin D also helps protect older adults from osteoporosis, so this is a really important topic for post menopausal women. A prospective cohort study of 72,000 post-menopausal women in the U.S. reported that the women who took in at least 600 IU/day of vitamin D3 (through diet and supplements) had a 37% decreased risk of osteoporotic hip fracture than the women who consumed less than 140 IU/day.

Symptoms of Vitamin D deficiency include:

  • Weak immune system, including frequent coughs and colds
  • Fatigue, bone ache, joint and muscle pain
  • SAD or depression
  • Headaches and migraines
  • Rickets

So how much Vitamin D do we need and where do we get it from?

Although this nutrient is found in foods, the greatest source for obtaining vitamin D is through the skin. When bare skin is exposed to ultraviolet light, it synthesizes vitamin D3 that is then stored in the liver. You only need 10-15 minutes of sun exposure during peak sun hours (between 10 a.m. and 2 p.m. in most locations) during the summer months to produce up to 10,000 IUs of the nutrient. After that short exposure you can continue with safe sun habits and slather on a broad-spectrum sunscreen. It’s thought that if you live above 42 degrees North latitude then the sun’s rays do not provide sufficient Vitamin D from November through February. I think that puts most of us in the United Kingdom at a bit of a disadvantage! Remember too, that UVB rays do not penetrate glass or sunscreen with a sun protection factor (SPF) of 8 or more.

But in researching this topic I have found the NHS advice confusing on NHS Choices . In the article it tells us we need 10 or 5 mg a day and then tells us to take no more than 0.025mg, but mg refers to both micrograms and milligrams. Advice also varies as to how much time should be spent in the sun and how much of our skin should be exposed to absorb sufficient quantities of Vitamin D.

There is an increased risk of deficiency in people who have one or more of these risk factors:

  • Dark skinned
  • Live in Northern latitudes
  • Over the age of 50
  • Post-menopausal
  • A diet low in foods containing vitamin D
  • Fat malabsorption syndromes
  • Obesity
  • Inflammatory bowel disease

Some drugs reduce the absorption of Vitamin D: the weight loss drug, Orlistat (brand names include Xenical and Alli), antacids, some cholesterol lowering drugs, some anti-seizure medications, and steroids (like Prednisone) interfere with the absorption of Vitamin D, so discuss your vitamin D intake with your doctor or pharmacist if you take any of these drugs.

There are two forms of the vitamin, D2 and D3 (cholecalciferol), with D3 the form best metabolized by the body. Vitamin D is found in foods such as fish, eggs, fortified milk and that old remedy, cod liver oil.

What to do next: Vitamin D Deficiency

Try to eat Vitamin D rich foods every day. Get some sunshine on your skin, but make sure you follow healthy guide lines to avoid the risk of skin cancer. If you are concerned you have some signs of deficiency and particularly if you are in one or more of the high risk groups, talk to you doctor about getting tested for deficiency.

And finally a note of caution. Excessive consumption of Vitamin D is toxic particularly as the body can store it in the liver. Balance in everything is the key to good health.

For further information, do feel free to contact us.

Shoulder Pain – 4 Simple Exercises

Tracy at The Therapy Rooms Newcastle shows you how to get rid of shoulder pain

How many times do you catch yourself hunching your shoulders at your desk? Look around. How many of your colleagues have the tell-tale signs of shoulders pulling forward, their heads poking out like little turtle heads from their shells? How many of your family or friends ask you rub their shoulders at the end of the day to ease their shoulder pain?

It seems an epidemic, doesn’t it? So many people seem to complain of stiff sore shoulders even whilst they are sat at their desks, hunching over their lap top or tablet.

How To Help Your Spine Do Its Job

The thoracic spine consists of the 12 vertebrae between the neck (cervical spine) and lower back (lumbar spine). 12 pairs of ribs attach to it which forms the rib cage, acting as protection of some of our vital organs. As well as protection, the thoracic spine is vital for movement. It bends forward, backwards and twists to the right and left. Well it should! But lack of mobility in the thoracic spine is so commonplace that we don’t even realise that we could and should move more easily.

But what can you all do about it?

Try these 4 simple exercises to ease shoulder pain….

1. Towel Roll Stretch for shoulder pain

Take a large towel and place it on the floor or a firm surface. Lie on top of it so that the towel is lengthways along the spine. It shouldn’t be so low down that it lies below the ribs. Make sure you put a pillow behind the neck to support it. Lie there for 10 minutes and relax. You may be more comfortable if you lie with your knees bent.

2. Rotation of Thoracic Spine Using a Chair for Shoulder pain

This is a great one for when you’re sitting at a desk. Whilst sitting in firm upright chair, without wheels, turn to the right, as if you’re reaching for something behind you. Hold the back of the chair with the right hand, reach for the back of the chair with the left hand and pull yourself further round. Make sure you keep your bottom firmly planted in the chair as there’s a huge temptation to lift it off to get further round.

shoulder-pain-blog-chair-chest-rotation

3. Chest Stretch

It doesn’t, at first, seem to make sense to stretch the chest muscles, when quite clearly, it’s your back and shoulders that are sore and achy. But constantly sitting and standing with rounded shoulders, causes the chest muscles, particularly the pectoral muscles, to shorten. As a result, we need to stretch and lengthen these muscles, if we want to mobilise the upper back.

Lying on your back, hold a small weight in each hand, or if you don’t have weights, a bottle of water. Start by holding the arms outstretched with the hands above the shoulders. Slowly take the arms overhead at 45 degrees until you can feel a stretch across the chest. Bring the arms back to the starting position and repeat 8-10 times.

4. Thoracic Spine Extension for shoulder pain

Place a rolled up towel or a foam roller horizontally on a firm surface. Lie on the foam roller so that it is across the back, just below the shoulder blades. Take the arms up and over so that the upper back curls over the roller. If you’re comfortable stay in this position and enjoy the stretch. If not, come back into the starting position and repeat. The repetition will help to loosen the stiffness in the thoracic spine.

shoulder-pain-blog-thoracic-spine-extension

When should shoulder pain treatment be carried out by a professional?

If you take care of your shoulders with these exercises, you should feel much more comfortable. However, chronic shoulder pain may be due to underlying issues, which need to be investigated. Call Tracy Russell  at The Therapy Rooms Newcastle for a consultation on 07974 725546.

To book an appointment for remedial or sports massage with Tracy Russell call 0191 2136232 or 07974 725546 or email Tracy at tracy@thetherapyroomsnewcastle.co.uk   

Please make sure you connect with us on Facebook too.

Thanks to Jaime Moran Wilson, Sports Massage Therapist, for collaborating with me on this blog.

Total Hip Replacement – Part 1 Preparation for surgery

My journey started about five years ago. As a massage therapist, I was increasingly aware that the range of movement in my hips was poor. But as a reduction in range of movement is often gradual, I was able to rationalise with myself that nothing was wrong except that I was getting older.  I was 45!

My poor range of motion was particularly noticeable on abduction (moving my leg out to the side) and medial rotation (twisting my hip inwardly).  I was also in some discomfort if I had to walk for any length of time. The crunch came when I was running down the stairs and a crippling pain in my left hip forced my hip to give way.  I was able to steady myself but I was unnerved. A subsequent trip to the doctor and then the X-Ray unit showed I had arthritis of the hip joints and hypoplasia. Hypoplasia is a condition when the hip socket hasn’t properly formed and can lead to advanced degeneration of the hip joint. As a result of this diagnosis, I was determined to keep as fit and active as possible, as that was my best hope of maintaining my quality of life. I didn’t know how inevitable a hip replacement was, but it wasn’t something I relished so I implemented a consistent regime of massage, chiropractic, acupuncture and exercise, as well as a healthy diet with the emphasis on unprocessed home cooked food packed full of nutriton and supported with supplements. I’d like to think that all my efforts to stay as fit and healthy paid off, but ultimately there isn’t a parallel universe where there’s a Tracy Russell, who doesn’t exercise, eats take-ways and munches on pain killers to compare my progress to!

Five years on and the cracks were beginning to show! I knew it was time to have my hips looked at again. This is a list of the classic tell-tale signs of arthritis of the hip, that I experienced. It is not a definitive list of all possible symptoms, simply a list of those symptoms I experienced.

  • pain in the joint on weight bearing, particularly going upstairs
  • difficulty flexing the hip to raise the foot, to climb over obstacles, with either a straight or a bent leg
  • walking with a limp
  • muscle aches on over left gluteals, ilio tibial band and lateral left knee on walking more than 100 metres
  • fixed flexion deformity making lying supine uncomfortable
  • leg length difference
  • sharp pain and stiffness when making the first step, moving from sitting to standing
  • exhaustion at the end of the day, but exhaustion in the context that I was still running my busy massage therapy clinic, as well as running a home with 2 beautiful but demanding children

So it was with resignation, as I couldn’t continue living like this, that I sought advice from my GP. He referred me to the musculoskeletal unit at the Freeman Hospital, Newcastle. So on 13th December 2013, after a short consultation, examination and review of my X-rays, I was told that both my hips would need to be replaced. A part of me expected to be told that the left hip needed replacing. But there was also a part of me that was living in hope that there was a quick and easy resolution to my problems which wouldn’t need drastic intervention such as surgery. I definitely didn’t see two hip surgeries coming!

The waiting list for surgery was about 18 weeks. So part of my strategy for coping with these overwhelming emotions, was to work out a plan to be as prepared, that is as fit physically and emotionally as possible, for surgery. The plan below covers the strategies I put in place to get me through the impending 18 weeks. But as Rabbie Burns so eloquently put it, ‘the best-laid schemes o’ mice an’ men, gang aft agley’. A letter arrived at the end of January informing me that my surgery had been pulled forward to February 13th 2014 – in two and a half weeks!

Regardless, the plan was important whether I was having the surgery in February or April. A date in February just gave it more urgency. Here is what I did. My plan covered three main areas:

  • to ensure that my muscles were as strong as possible. Not only the leg muscles but after surgery I would need strong core and upper body.
  • to ensure that my body, but particularly my hips, were as mobile as possible.
  • to ensure that my general health was as good as possible to cope with the surgery and help the recovery process
  • to ensure that I nurtured myself emotionally to cope with the roller-coaster of emotions, that were to come. I felt that looking after my emotions would aid the recovery process.

THE PLAN

The Physical

  • 1 swim a week. Starting at 30 lengths of front crawl and building to 50 lengths. Front crawl is a tricky stroke to get the hang of but so much better for your fitness and your hips than breaststroke. Check out  http://www.swimming.org/swimfit/health-front-crawl/ for some great tips. There’s also a useful training video, which really helped me.
  • 1 cycle a week on a stationery bike. Starting at 5 kilometres and building to 10 kilometres. As with the swimming, I kept an eye on the time to maximise the fitness benefits, but I wasn’t a slave to the clock. Some days I could hardly turn the pedals at first, so it wouldn’t have been sensible to push it too hard and then be in pain later. But there wasn’t a session when I didn’t feel better after getting off the bike than before I had got on it. This definitely helped with my mobility and with my strength.
  • 1 leg strengthening session. Leg strengthening exercises focused on isolating muscles using equipment at the gym to develop quadriceps (leg extension), hamstrings (hamstring curl) and calf muscles (seated calf machine).
  • 1 upper body strengthening session to strengthen chest, back and arms. As well as the feel good factor from doing these exercises, I was hoping that, with a good strong upper body, I would be more mobile using crutches, post-surgery.
  • 3 times a week Pilates to promote core strength and mobility. For this I used My Pilates Guru app. I have done pilates for many years so I would say I knew the basics but I found this app really helpful in structuring the sessions and saving me from too much repetition and getting bored.
  • Regular chiropractic treatments helped to minimise the discomfort in my back, which was compensating for the fixed flexion deformity in the left hip and the leg length difference.
  • Regular massage therapy with Isabel Mineyko , my lovely associate at The Therapy Rooms. These treatments helped to relieve the discomfort in the gluteals and lateral left knee.

The Nutrition

  • My basic principles for healthy eating were continued during this pre-op phase. I mainly eat home-cooked family friendly meals. I eat 6-8 portions of vegetables and fruit a day, with the biggest proportion being vegetables. Thankfully I love dark leafy greens and they seem to be one of the foodstuffs that is universally considered healthy. (Please don’t tell me there is some new research suggesting that dark leafy greens are bad for you!) I eat 2-3 portions of fish a week and keep red meat and smoked foods to a minimum. I find a diet low in carbohydrates, which is very popular at the moment, very difficult to maintain but try to vary the type of carbohydrate I eat and keep my carbohydrates as unrefined as possible. I try to include essential fatty acids daily in my diet from not only oily fish but also nuts and seeds.
  • I have also believed that whilst the majority of our nutrition should come from good old honest food, I have always found a good multi-vitamin and mineral supplement, a vitamin C supplement and a fish oil supplement very helpful to my overall general level of fitness. In the lead up to the operation, on the advice of my health practitioner, I added to this Solgar’s Ultimate Bone Support and Pharma Nord’s Bio-Glucan Plus, to support my immune system.
  • I was conscious of the fact that, as movement and exercise became more and more difficult, so was keeping my weight under control. And as everyone knows, carrying excess weight is detrimental to arthritic joints. I used My Fitness Pal to keep a check on my calorie intake. But, in all honesty, I didn’t have the time or the emotional energy to be too zealous with this one. I also wanted to ensure that my diet is packed with nutrients which isn’t always easily married to calorie counting. And I often use food as a comfort, so inevitably, during this stressful time I did resort to food. The good news is that despite becoming less active and eating occasionally to comfort myself, I didn’t gain weight during this lead up to surgery.
  • 24 hours prior to surgery I started taking the homeopathic remedy, arnica, which is thought to be helpful for bruised and traumatised tissue.

The Emotional Side

It’s often when faced with a big challenge that you realise how strong you are but it is also when you find out what your weaknesses are. Facing Total Hip Replacement was certainly one of those challenges that was going to highlight the chinks in my emotional self. After the diagnosis, I experienced various emotions not dissimilar to The Five Stages of Grief, described by Elizabeth Kubler-Ross  in her pioneering book, On Death and Dying.  The five stages of grief, is the series of emotional stages that someone experiences when faced with impending death or other extreme, awful fate. The stages are shock, denial, intense concern, despair and finally recovery. After the initial shock and denial that this was really happening to me, I got locked in to a loop of intense concern, where I couldn’t think of anything other than my impending surgery and despair. The following things helped enormously :

  • talking to people who had successfully undergone THR and being encouraged by their stories of how the surgery had transformed their lives.
  • I got the chance to speak with my surgeon, a week before the operation to discuss issues I had. This was invaluable as I had ‘technical’ questions about the surgery which only he could answer. The questions such as ‘what happens to the muscle attachments and ligaments that are attached to the bone that is removed?’ could only be answered by the surgeon. In doing so, he allayed my fears that key attachments would not be disrupted.
  • visualising myself post surgery, being fit, well and active.
  • taking Bach Rescue Remedy daily but also when waves of panic overcame me.
  • meditating on a regular basis. I particularly liked Complete Relaxation Lite: Guided Meditation for a Happy, Stress Free Life. I found his voice soothing. But as we are all different, I suggest doing your own investigation to find a CD or app that suits.
  • planning and sorting out so that my home life and my business would run as smoothly as possible whilst I was out of action. I won’t bore you with the details but, for me, part of the anxiety was about what was going to happen to The Therapy Rooms whilst I was out of action. By sorting this out (as much as you can, in advance) I began to be less stressed about the operation.
  • I used the help and support from a reflexologist, chiropractor and massage therapist, which not only supported me physically but also provided invaluable support emotionally.

So the big day is looming. I’ve done as much as I possibly can to prepare myself. The next stage is the surgery and the critical 6 weeks post operation!

Why Computer Posture May be Giving you Back Pain

Good computer posture is something that we’re all aware of, but only when we remember it.

The computer: one of the most common tools in modern life…

Poor Computer Posture
Poor Computer Posture

… and a device which forces the user into a terrible postural position.

When our parents told us to ‘sit up straight’ at table, they actually had a good point. Correct (healthy) posture means to sit or stand with a straight back.  Why?

Simply put, this is the position of least stress for our bones and muscles – the position they are designed to work most effectively in.

The head should look forward, not down, hanging its weight from the posterior neck muscles.  The neck should be upright, not tilted forward or back and straining. The shoulders should be pulled back to open up the chest.

The problem with the laptop is that to use it, all these things cannot be true…  The arms tend to come forward, straining the mid back muscles and tightening the pectorals. The neck is permanently bent forward to study the screen.

If you’re suffering from back pain, check your posture!

Like many people you probably spend hours in front of a computer every day – so make sure you’re doing it right.

I’ve found a really great article you might like to read to learn more about what you’re doing wrong and how to put it right.

“Your job shouldn’t be a pain in the neck—at least not literally. Yet two out of three office workers have felt physical pain in the last six months, according to a new survey released by the American Osteopathic Association (AOA).

The survey compiled responses from about 1,000 office workers ages 18 and older across the U.S. The results also showed that in the past 30 days, 62 percent of respondents had felt pain in their lower backs, 53 percent in their necks, 38 percent in their shoulders, 33 percent in their wrists, and 31 percent in their upper backs. …”

If you’d like to read more, follow this link  http://blog.womenshealthmag.com/scoop/correct-posture/

How to spot Vitamin Deficiency

At certain times in our lives our nutrition may not be as good as we’d like it to be.

We take on more and more commitments and don’t take the steps necessary to maintaining ourselves

What are the signs that we can all spot, so we can make simple changes to make the most of our health.

Body Cue No. 1: Cracks at the corners of your mouth.

The Deficiency: Iron, zinc, and B vitamins like niacin (B3), riboflavin (B2), and B12.

The Fix: Eat more poultry, salmon, tuna, eggs, oysters, clams, sun-dried tomatoes, Swiss chard, tahini, peanuts, and legumes like lentils.  Iron absorption is enhanced by vitamin C, which also helps fight infection, so combine these foods with vegetables like broccoli, red bell peppers, kale, and cauliflower.
• • •

Body Cue No. 2: A red, scaly rash on your face (and sometimes elsewhere) and hair loss.

The Deficiency: Biotin (B7), known as the hair vitamin.

While your body stores fat-soluble vitamins (A, D, E, K), it doesn’t store most B vitamins, which are water-soluble. Body builders take note: Eating raw eggs makes you vulnerable, because a protein in raw eggs called avidin inhibits the body’s ability to absorb biotin.

The Fix: Reach for more cooked eggs (cooking deactivates avidin), salmon, avocados, mushrooms, cauliflower, soya beans, nuts, raspberries, and bananas.
• • •

Body Cue No. 3: Red or white acne-like bumps, typically on the cheeks, arms, thighs, and buttocks.

The Deficiency: Essential fatty acids and vitamin A and vitamin D.

The Fix: Skimp on saturated fat and trans fats, which you should be doing anyway, and increase healthy fats. Focus on adding more salmon and sardines, nuts like walnuts and almonds, and seeds like ground flax, hemp and chia. For vitamin A, pile on leafy greens and colourful veggies like carrots, sweet potatoes, and red peppers.
• • •

Body Cue No. 4: Tingling, prickling, and numbness in hands, feet, or elsewhere.

The Deficiency: B vitamins like folate (B9), B6, and B12.

The Fix: Seek out spinach, asparagus, beets, beans (pinto, black, kidney, lima), eggs, octopus, mussels, clams, oysters, and poultry.
• • •

Body Cue No. 5: Unusual muscle cramps in the form of stabbing pains in toes, calves, arches of feet, and backs of legs.

The Deficiency: Magnesium, calcium, and potassium.

The Fix: Eat more bananas, almonds, hazelnuts, squash, cherries, apples, grapefruit, broccoli, bok choy, and dark leafy greens like kale, spinach, and dandelion.

To find out more, follow this link to the rest of the article

Why Quadriceps Switch Off

In my article about knees, I mentioned that knee problems can be associated with the quadriceps muscles ‘switching off’.  I wasn’t terribly happy with this state of affairs – as a big fan of how the body works, I didn’t understand why we would switch off our own muscles, when we quite obviously needed them.  It just didn’t make sense.  So I set about investigating and this is what I came up with.

1. It seems that fluid or swelling in the knee, reduces the ability of the quads to fire up (Fahrer H, et al.  Knee effusion and Reflex Inhibition of the Quadriceps. A Bar to Effective Retraining. Journal of Bone and Joint Surgery 70 – B 1988)

In this study, excess fluid was removed from the knee using a needle, and there was an immediate increase in the strength of the quadriceps.   The critical amount appears to be about 15ml of excess fluid (about a tablespoon) on the knee, which will reduce efficacy.  This would not equate to a huge swollen knee, in fact I doubt if most people could spot if their knee was carrying an extra 15mls of fluid.

2. A study by Young in 1980 found that people who had injured their knee had a certain degree of muscle wastage.  The injuries were various including fractures, torn cartilage, ligament damage.  All of the injuries had been repaired and the patients were considered to have recovered.

Evidence pointed to the fact that the leg with the damaged knee was significantly smaller than the non-injured leg. Ultrasound revealed that the smaller leg size was due to the wasting of the quadriceps.

(Young et al Measurement of Quadriceps Muscle Wasting by Ultrasonography. Rheumatology and Rehabilitation 19(3): 141-48, 1980)

3.   A significant amount of the research  supports the theory that knees which are osteoarthritic have substantially weaker quadriceps.  Various studies compare ‘good’ knee to ‘bad’ knee; pairs of osteoarthritic knees to pairs of non-arthritic knees.  Repeatedly, the evidence suggests that knees suffering from arthritis have smaller, weaker quadriceps.

4. The final sub-section of this line of thinking is the role of pain in the function of the knee.  Research points to the fact that the quadriceps will switch off if there is pain on movement.  Clearly this may be related to the three conditions above but Jim Johnson in his book, Treat your Own Knees, feels that it is worth mentioning separately.  I’m not convinced, as I think it is unlikely that there will be many cases where there is knee pain yet there is no existence of fluid, osteoarthritis or existing damage to the knee.  But muscle weakening may be in part to the pain, separate to the other conditions.

Johnson quotes a bizarre study by Bertil Steiner, who applied pressure on to the side of one patient’s knee.  (The patient had a tumour on the side of his knee). Pressure on to the knee and therefore the tumour caused excruciating pain and the quadriceps gave out.  For the purposes of completeness and to reassure anyone who was worried about this poor man (as I was), the tumour was removed, the patient made a full recovery and his quadriceps quickly restored to normal function. Hopefully enough so that he could run away from Bertil Steiner!!

So to summarise, quadriceps that are weakened and wasting may be due to :

  • swelling
  • having had injuries, fractures
  • trauma to ligaments
  • arthritis
  • knee pain

So this research points to why we lose the strength and capacity of our quads. But the indications are that with the right rehabilitative exercises, we can have strong quads and avoid this catch-22 situation, that swollen arthritic painful knees turn the quadriceps off and without fully functioning quadriceps we risk getting swollen, damaged arthritic knees.

Knee Pain and Possible Treatments

knee photoAs massage therapists, we often see clients with painful knees. Professionals working with knees often bandy around the term VMO as the possible cause of the pain but what exactly does it mean. It stands for Vastus Medialis Obliquus but to most of us that makes us none the wiser.  The Vastus Medialis is one of four quadricep muscles that lie on the anterior of the thigh:

  • Rectus Femoris
  • Vastus Lateralis
  • Vastus Intermedius
  • Vastus Medialis

The main function of these muscles is to extend the knee, so it is fundamental in walking, running, squatting, etc but all of these muscles have unique roles in supporting and stabilising the knee.

The vastus medialis originates from the tendon of Adductor Magnus and inserts into the tibial tuberosity via the patella tendon (as do all the quadricep muscles). The oblique fibres of the Vastus Medialis have been singled out and therefore given special mention because they perform and important role in stabilising the kneecap (patella) and ensuring that it tracks properly.  Weakness and mis-firing of these muscle fibres mean that when the knee is straightened, the patella doesn’t track properly in the patella groove causing painful achy knees and, over time, long term damage to the surrounding structures.

But why is the VMO consistently showing up as weak and not firing properly and how can we ‘switch’ it back on.

First of all, you must determine whether your VMO is contracting :

  1. Sit with your legs out in front of you and a rolled up towel under your knee (the knee should be slightly bent)
  2. Put your fingers over the area of VMO (as shown above right).
  3. Push your knee down into the towel (so that your knee straightens and the foot lifts off the couch)
  4. You should feel a strong contraction under your fingers
  5. If the muscle does not contract, continue to practice whilst pressing down gently on the muscle and concentrating on contracting the fibres underneath your fingers.

If the muscle does contract, you can continue with strengthening exercises:

  • Sitting on a chair with the knees bent, palpate the VMO. Start to slowly straighten the knee and ensure the VMO contracts. Maintain the contraction throughout the movement as you fully straighten the knee and bend it again. Repeat this twice daily until you can maintain a strong constant contraction 10 times in a row.
  • Place a large ball (such as a football) in between your knees and squeeze it.
  • Try performing a squat against a wall by sliding your back down the wall until your knees are at a right angle (your shins should remain vertical).
  • Try Peterson step ups. This exercise is difficult to explain so this demo is helpful. http://m.youtube.com/watch?v=UUYBhnN6IJA

Vitamin D Deficiency

When I first started my studies to be a massage therapist, we were expected to cover the basics in nutrition.  Vitamin D was glossed over – as the body can store it in the liver, we were told, then it was unlikely that we would see signs of deficiency – especially when you didn’t even have to eat ‘healthy food’ to get a supply of it.  Simply by being in the sun would ensure you topped your stores of it up.  The only people at risk of deficiency were thought to be those who had a ‘goth’ lifestyle – slept by day and came out at night.  Presumably vampires are at risk too!

But more recently the media have been highlighting a growing concern that we are more and more likely to be deficient in this important vitamin.  One study (but be cautious, they sell vitamin supplements!) claims their survey discovered 9 out of ten people have symptoms of Vitamin D deficiency.

So What Does Vitamin D do?
Vitamin D aids the body’s absorption of calcium so it is essential to the growth and strength of bones.  In extreme circumstances a deficiency in this vitamin causes rickets in children or osteomalacia in adults.

Vitamin D is important to the body in many other ways as well. Muscles need it to move, nerves need it to carry messages between the brain and every body part and the immune system needs vitamin D to fight off invading bacteria and viruses.  Vitamin D is found in cells throughout the body.  Together with calcium, vitamin D also helps protect older adults from osteoporosis, so this is a really important topic for post menopausal women.  A prospective cohort study of 72,000 post-menopausal women in the U.S. reported that the women who took in at least 600 IU/day of vitamin D3 (through diet and supplements) had a 37% decreased risk of osteoporotic hip fracture than the women who consumed less than 140 IU/day.

Symptoms of Vitamin D deficiency include:

  • Weak immune system, including frequent  coughs and colds.
  • Fatigue, bone ache, joint and muscle  pain
  • SAD or depression
  • Headaches and migraines
  • Rickets

So how much Vitamin D do we need and where do we get it from?
Although this nutrient is found in foods, the greatest source for obtaining vitamin D is through the skin.  When bare skin is exposed to ultraviolet light, it synthesizes vitamin D3 that is then stored in the liver.  You only need 10-15 minutes of sun exposure during peak sun hours (between 10 a.m. and 2 p.m. in most locations) during the summer months to produce up to 10,000 IUs of the nutrient.  After that short exposure you can continue with safe sun habits and slather on a broad-spectrum sunscreen.  It’s thought that if you live above 42 degrees North latitude then the sun’s rays do not provide sufficient Vitamin D from November through February.  I think that puts most of us in the United Kingdom at a bit of a disadvantage!  Remember too, that UVB rays do not penetrate glass or sunscreen with a sun protection factor (SPF) of 8 or more.

But in researching this topic I have found the NHS advice confusing on NHS Choices . In the article it tells us we need 10 or 5 mg a day and then tells us to take no more than 0.025mg, but mg refers to both micrograms and milligrams.  Advice also varies as to how much time should be spent in the sun and how much of our skin should be exposed to absorb sufficient quantities of Vitamin D.

There is an increased risk of deficiency in people who have one or more of these risk factors:

  •  Dark skinned
  •  Live in Northern latitudes
  •  Over the age of 50
  •  Post-menopausal
  •  A diet low in foods containing vitamin D
  •  Fat malabsorption syndromes
  •  Obesity
  •  Inflammatory bowel disease

Some drugs reduce the absorption of Vitamin D: the weight loss drug, Orlistat (brand names include Xenical and Alli), antacids, some cholesterol lowering drugs, some anti-seizure medications, and steroids (like Prednisone) interfere with the absorption of Vitamin D, so discuss your vitamin D intake with your doctor or pharmacist if you take any of these drugs.

There are two forms of the vitamin, D2 and D3 (cholecalciferol), with D3 the form best metabolized by the body.  Vitamin D is found in foods such as fish, eggs, fortified milk and that old remedy, cod liver oil.

What to do next:
Try to eat Vitamin D rich foods every day.  Get some sunshine on your skin, but make sure you follow healthy guide lines to avoid the risk of skin cancer.  If you are concerned you have some signs of deficiency and particularly if you are in one or more of the high risk groups, talk to you doctor about getting tested for deficiency.

And finally a note of caution.  Excessive consumption of Vitamin D is toxic particularly as the body can store it in the liver.
Balance in everything is the key to good health.