Menicsal tears treatment options

Meniscii tears
Menical tears can be treated with conservative treatment with better results than surgery in some cases.
The cause of the tear can be traumatic, overuse, poor biomechanics in the knee and inadequate nutrients being supplied to the meniscus, etc.
The meniscus is said to have a poor blood supply therefore the ability to heal is not very good.
In most cases a Meniscotomy or complete removal of the meniscus is performed, other options can be to use a implant.
The treatment that I have got most success is the conservative one where the biomechanics of the patients are examined and corrected resulting in improved performance of the knee joint. All the components of the knee need to be addressed like the bone, ligaments, muscles, the joint capsule, etc.
The Patients recover vey well without any residual signs or symptoms, they are able to do all activities without hindrance. In some sportpersons have managed to climb mountains, run marathons and lead a healthy life with improved physical performance.

                                                              TOP VIEW MENISCUS
                                          Images showing different parts of the meniscus.

Meniscii top view

Here is a example of recovery from a Meniscal tear. Mr. Kuntal Joisher suffered from a torn meniscus. After 4 months of treatment he managed to climb 6000 meters Mt. Shasta.

Kuntal Joisher atop Mt. Shasta.

High Altitude Acclimatisation.

We humans need Oxygen in air to survive. Oxygen is absorbed from air in the Lungs and then it is mixed in the blood to be used by the body for energy and survival.
As we go higher in altitude from1500 - 3500 m (5000 - 11500 ft) or higher the oxygen in the air reduces significantly and the body has to adapt to this phenomenon. the adaptation or acclimatization  process takes time from days to weeks. During acclimatization the body adapts in many ways. The Lungs, Blood, metabolism and other organs undergo adaptation. Muscle adapts by using all types of Fibers and using glucose as alternative to oxygen for fuel. increase in glucose and carbohydrate food is beneficial at high altitude. Changes are seen in basal metabolic rate.
Red blood cells increase significantly helping to increase oxygen carrying capacity of blood as a compensatory phenomenon to low oxygen content and pressure.

Gradual acclimatization over 4 to 6 days for altitudes from 10000feet to 20000feet helped us to bear the altitude gain safely and we could enjoy all the benfits of the training process!

Effect of lower limb muscle strengthening in athletes with knee pathology.

Strengthening of the lower limb muscles namely the gluteal muscles, the quadriceps, hamstrings, adductors and abductors, the calf muscles, tibialis muscles and even the muscles of the foot showed an improvement in patients with knee injury and in patients with knee pain. 

Especially in patients with quadricep tendon weakness, with patellar tendon weakness and chondromalacia patellae. 

The strengthening reduced the morbidity and improved prognosis in these patients. 

These improvements were also noted in patients with weak lower limb musculature and in patients who suffered from imbalance in muscles 

MRI in these patients, before exercise, were seen to have signs of inflammation, joint effusion etc ligament strain, bursitis 

Strengthening of lower limb muscles reversed these changes significantly. 

All patients exercised for a period of 4 months 3 to 4 times a week. 

The strengthening acted as a preventive treatment by improving biomechanics, gait, centre of gravity, increased lean body mass.

Endurance events and the heart.

The IRONMAN, Marathon de Sables, matathons and triathlons are long distance and long duration events, these take the human body and the concept of fitness to a whole new level. So they also entail extra precautions during training and competitions.
When training for any long duration endurance event special attention should be paid to the cardiovascular system, esp the heart.  The endurance athlete must let his heart recover just as he lets his skeletal muscles recover.
We must not forget that the heart is also a muscle and can develop complications if overworked.
Just as our muscles get sore after the event, the heart also experiences stress.
A common cause is known as Heart Muscle Hypertrophy (hypertrophic cardiomyopathy), a disease in which the heart muscle becomes abnormally thick. this, combined with the stress and epinephrine that come with strenuous physical activity, can lead to abnormal heart rhythms and sudden death.

Bio Mechanics of a slipped disk

The vertebral column is made up of thick cubical bones which are mounted on top of one another to form a tall structure eg., bricks mounted on top of each other.

the vertebral coloumn bones stacked up one on top of the other!

In between these bricks lies the soft cushion known as the inter vertebral disc.
A soft rubber like cushion is situated between the bricks or bones

An intervertebral disc is made up of a rubber like material, it has a central pulp(nucleus pulposus) surrounded by circular fibrous tissue called annulus fibrosus. shown below fig 1 fig 2 and fig 3

fig 1 fig 2

The function of the disc is to act as a shock absorber and joint between the two vertebral bones , as the person jumps, runs walks or lifts weight the disks absorb the shocks, also when we twist the waist. the disks acting as the joint around which the bones pivot.

The disk prevents the vertebral bodies from coming in contact with each other.

On top of the vertebral column lies the persons head and below, the vertebral column rests on the sacrum. The weight of the head causes the vertebral column to be compressed between the head and the sacrum. as we walk or run the forces generated travel up via the ankle joint, knee joint, hip joint and reach the sacrum bone, from here the forces collide against the vertebral coloumn(lumbar vertebrae)

fig 3

These forces can cause damage to the body and they need to be dampened.

To prevent compression and friction between the vertebrae the 'shock absorber disk' comes into action.

As the person jumps vertebrae, one on top of the other are pressed against each other, the pressure within the central pulp rises and the pulp tries to push out against the annulus fibrosus fig 4, The annulus counters this by tensing around the pulp! This mechanism contains the pulposus within the annulus! and prevents the pulposus from extruding out of the annulus and the vertebrae from coming in contact with each other.

fig4 fig 5 fig 6
If (1) the pressure built up within the annulus is too great or (2) if the annulus has hardened due to degeneration or simply dried up(dessicated) or (3) if the vertebral column is twisted in an abnormal fashion or pulled violently by the ligaments and muscles attached to it, then the annulus bulges out fig 6 or it gives way and the pulp finds its way outside called extrusion fig 7,8,9, resulting in failure of the shock absorber mechanism and giving rise to the phenomenon known as the slipped disk.

When the pulposus bulges into the spinal canal or the pulp breaks out of the annulus and enters the vertebral canal to come in contact and compress the spinal cord it is known as herniation/ prolapse of an inter vertebral disc.

extrusion of the pulposus fig 7,,8,9.

High Protein diets, calcium and Kidneys.

Precautions while on a high protein diet.

• Protein, water and calcium: When on a high protein diet, take care of the water input as high protein diet is known to cause increase concentration of calcium in urine. 
• Habitual excess protein intake is a significant risk factor for calcium loss via the kidneys. Calcium excretion also accompanied with daily urinary excretion of urea. The calcium excretion with animal protein intake was found to be significantly positive in both sexes and in each age group whereas that with plant protein was not. Findings suggest that regular use of excess protein in diets may augment calcium excretion in the urine, at least in the elderly.
• Sports persons especially bodybuilders control their water input when they are near the competition date, and they increase their protein intake at the same time, this may lead to excess excretion of calcium.
• Plenty of water, regular physical activity (30 minutes walking, more than 5 days a week) and monitoring kidney profile should prevent any adverse effects.

What is Vo2 Max or maximal oxygen consumption, maximal oxygen uptake, aerobic capacity?

Vo2Max determines the cardiovacular fitness of an individual. it is the volume of oxygen used by the muscles for contraction in a unit of time.
The muscles need energy for contraction, with the help of oxygen and few other elements energy(ATP) is created. This energy feuls muscle contraction. Thus the better the supply of oxygen the longer will the activity last.
Oxygen reaches the body via the Lungs, the lungs pass it on to the blood and the heart pumps it all around the body.
Oxygen is supplied to the muscle by blood vessels, the muscles extract the oxygen from the blood vessels and use it to create energy needed for muscular movement.

This phenomenon of providing and extracting oxygen to the muscle is the Vo2max = V - volume per time, O2 - oxygen, max - maximum.

It is essential for any athlete to have a high Vo2Max, whatever the sport. The Vo2Max is a indirect indicator of the individuals overall health. It is a standard for measuring physical fitness.
In endurance sports the greater the Vo2Max the longer and faster the sportsperson will perform.
In strength sports if the individual has a high Vo2Max then the formation of harmful chemicals or metabolites(lactic acid) is minimal and the sportsperson can maintain a set for longer duration for max strength gains.