Source: 62 mile club
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Of course, as with most things, there are always two sides of the story. There will be surgical cases where too much was promised, too little delivered. But often too, there is a case of the patient simply expecting too much either refusing to understand the risks and possible outcomes or simply (which often I believe is the case) the patient not having a firm enough grasp of the situation and implications.

As this is a musculoskeletal site, lets focus on orthopaedic surgeries as an example.

First of all, what do surgeries generally achieve.

Most of the surgeries, do one of the four things below.

1. The removal of some part that causes an obstruction, impediment or impingement – for example – disc bulges (Removal)
2. The replacement of some part that has failed or deteriorated for examples spinal discs (Adding)
3. The strengthen of the some part, for example – adding cement into vertebral body. (Enhancing)
4. The weakening of a part, for example tight muscles or severing inflammed tendons in the wrist (Weakening)

Complicated surgeries will combine two or more of these things. All of this seems simple enough. So where do we go wrong? Our tendency to over simplify the situation.

One of our most common tool we reach for to understand something is comprehension through analogy. We use somewhat similar alternative to explain key concepts. Like the human heart is the "engine" for the human body. The eyes are like video cameras. This helps narrows the gap in our understanding of new complex idea or concept. Unfortunately, analogies can sometime mislead us.

One common area is spinal disc replacement (Removal and Adding). Patients are often surprised that the new hi-tech disc doesn't work as well as their original human discs. Unlike, cars or computers where parts are easily replaceable. In fact with very specific numbered replacements parts. Parts in machine are relatively simple and have very precise functions and operated within a very specific range of conditions. Not so for the human body. In our human body, each part usually have several functions and interacts with the rest of the body in very unique ways. This helps us to be adaptable to our surroundings. Currently no replacement spinal disc has the same degree of freedom movement as a real human spinal disc. This implies a slight impairment to your body's actual biomechanics. Something and somewhere else will adapt to compensate for the slightly reduced degree of movement.

Also often fixing the faulty part does fix the underlying problem. In a machine when a part fails, it is usually because of poor quality rather than the machine operating beyond its specifications (thought that does happen. In fact, some machines are designed with some parts to be the designated failure points so that it is easily replaced and cheaply). Replacing a poor quality part if easy and usually eliminates the problem. But in the human body, parts fail not because of poor quality but often somehow it is not being used in the correct manner. Like sitting a poor posture leading to back pain. Solving the pain is only a short term solution if the external cause – poor posture is not corrected. This situation occurs less frequently for machine. Machines are usually used for the purposes they are designed for. If your coffee maker is crushed because you used it as a door stopper is not something covered under the manufacturer's warranty.

While some machines are large and more difficult to build (not something you can hammer out at your workbench) doesn't mean they are complex by any means. At least not relative to human body. Complex machines are far more difficult to repair and a point of failure can have far reaching and heavy consequences. Something that is beginning to show up in complex systems that we are building. So use analogies carefully. They help us understand a new complex topic but remember it is no substitute to actual understanding. Take you time and find out as much as you can about your pain and condition, and especially the solutions proposed.

Surgery: The Machine Analogy Misconception is a post from: Musculoskeletal Consumer Review by Core Concepts

Stretch.. Stretch.. Stretch your Fascia.. is a post from: Musculoskeletal Consumer Review by Core Concepts

Is the Outcome of ACL Surgery really better than Conservative Management? is a post from: Musculoskeletal Consumer Review by Core Concepts

In general, there are 2 main types of braces: hard brace and soft brace.

Hard braces are made of thermoplastic. It has been the main brace prescribed over the last a few decades. Common types of hard braces are Boston’s, Charleston’s, and Milwaukie’s etc.

Hard Brace	Soft Brace
Source: Well-women.com click for larger view	Source: spinecor click for larger view

Like what its name suggests, it is hard and non-flexible, and wearing which limits movements of the spine. Hence it greatly affects one’s sports participation and causes significant comfort and tolerance issues. Additionally, hard brace is usually bulky and heavy, and shows under the clothes, it is not easily accepted by image-conscious teenage girls. Besides, it also creates much stiffness of the spine, weakness and tightness of the spine muscles.

Soft brace on the other hand, allows movement of the spine when worn. Therefore, the spine is much more mobile during and after the treatment, there is also much less muscle imbalance and joint stiffness of the spine.

Currently the only available soft brace for scoliosis is SpineCor brace. You can get more information on SpineCor brace by following this link: http://www.spinecorporation.com.

How different are the two types of braces? Is one definitely better than the other?

It’s hard to say which brace is definitely better than the other, they work on different principles. Hard braces are designed to hold against spine deformity statically, soft brace on the other hand, is designed to use dynamic force to target on bone deformity and muscle re-training and balancing.

Both hard and soft braces can be effective before the bones of the spine reach maturity, which is usually between 13-15 years old for girls and 15-17 years old for boys. Hard braces can be used for any types of scoliosis such as neuromuscular scoliosis, congenital scoliosis, and idiopathic scoliosis. SpineCor brace is designed for idiopathic scoliosis only.

Both braces need to be worn regularly throughout the day (16 hours per day). Soft braces are lighter and more comfortable to wear; it is more cosmetically acceptable as it can be well hidden under the clothes. It also allows better posture & muscle development, and is able to promote good mobility of the spine while correcting the curve. Hard braces are usually much heavier and hotter to wear and may result in a poorer compliance compared to soft braces.

For people who participate in sports like dancing, gymnast, running or badminton, soft brace is of a much more practical choice. Soft brace is also recommended for individuals who are more prone to skin problems or who are likely to have compliance issues.

Bracing for Scoliosis is a post from: Musculoskeletal Consumer Review by Core Concepts

The Problems of this condition

The alignment of the knee joint in someone with knock knees is such that there is an increased force on the medial (inner) part of the knee joint. This can predispose the knee joint to osteoarthritis because of the increased loading on the medial compartment.
Symptoms from this may not even present within the knee joint, you may have ankle problems or hip problems as a result of having knock knees.

How do I get rid of it?

External aids:

1. Orthotics

The knee joint may appear to be misaligned if the foot is not biomechanically sound. This means that someone with a very pronated/inverted/flat feet may be at risk of developing a symptoms similar to someone with knock knees. Placing an insole or orthotics device may help correct the foot position, and indirectly the alignment of the knee joint.

2. Knee braces

These can help prompt correct alignment of the knee joint, but may create a degree of dependency.

3. Strengthening

A physiotherapist can design an exercise program to help strengthen weak muscles. By focussing on the specific muscles that require strengthening, you will put your body is a safe healthy direction, and will be able to train for all types of sporting challenges and limit your risk of injury.

4. Stretching

Stretching is an important component of knock knee reversal. When a joint has spent all it’s time in a misaligned position, certain structures will shorten and become stiff. Stiffness in the joints and muscles will make it very difficult to train and strengthen the area. A physiotherapist can assess the position of your knee, ascertain which structures are tight, and give you an appropriate stretching program.

Knock Knees – Can I reverse it? (Part 2) is a post from: Musculoskeletal Consumer Review by Core Concepts

Source: Ecce Medicus
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In this article, we would discuss on the different types of knock knees and the contributing factors that may develop with this condition. 

When discussing the reasons for knock knees, structure of the bones and joints must be assessed. Structural reasons for knock knees are not normally reversible, unless surgery is indicated. When it comes to the strength, control and stiffness of muscles that control the alignment of the knee, a full assessment must take place so that a corrective program can be enforced.

Structural reasons:

Genu varum: … Not Reversible

A structural deformity of the knee joint, causing the lower leg to be angled inwards and the upper thigh to be angles outwards, causing a bowing effect.

Tibial valgus: … Not Reversible

This is a deformity of the tibia.The bone angles outward towards the end furthest from the knee joint.

Coxa Varum: … Not Reversible

A deformity of the femur; the angle between the head and shaft of the femur is more acute, making the shaft of the femur angle inwards.

Q angle: … Not Reversible

This is the angle between the line of the femur, and the line of the mid patella – tibial tuberosity. A larger Q angle will mean more biomechanical problems within the knee joint.

Poor strength of:

Hip external rotators: … Reversible

• Gemellus inferior & superior
• Obturator internus & externus
• Quadratus femoris
• Piriformis
• Gluteus maximus
• Gluteus medius posterior fibers
• Sartorius

Weakness in these muscles will cause the femur to internally rotate causing an increased ‘knock knee’ effect.

Hip abductors: … Reversible

• Gluteus medius
• Gluteus minimus
• Tensor fasciae latae
• Sartorius

Without the strength of these muscles, the femur is more likely to adduct, increasing the knock knee appearance.

Quadriceps: … Reversible

• Rectus femoris
• Vastus medialis, lateralis & intermedius

Asymmetry in the strength of this muscle group may result in misalignment of the knee joint, giving the appearance of knock knees. Generally it will be the inner most compartment of this muscle that is weak.

Hamstrings: … Reversible

• Biceps Femoris
• Semitendinosis
• Semimembranosis

Similar to the quadriceps, asymmetry in the strength of this muscle group i.e. inner most compartments (semitendinosis and semimembranosis) may lead to this appearance.

Poor control of:

Hip External rotators: … Reversible

Hip abductors: … Reversible

Lumbo/pelvic muscles: … Reversible

If these muscles are not controlled well because they have poor activation or endurance, they muscles will not be able to hold the knee joint in a correct alignment constantly. In other words, the muscles will get tired, and they will not be doing their job.

Stiffness in the:

Hip: … Reversible

Tight muscles in the hip region may limit the range of motion available. If the joint is not moving correctly, the required muscles will not be able to work to correctly align the knee joint.

Knock Knees – Can I reverse it? (Part 1) is a post from: Musculoskeletal Consumer Review by Core Concepts

Source- webshots
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What are Corkies?

Corkies are also known as bruise or contusion. They are a type of a relatively minor bleeding (hematoma) of your tissues in which small blood vessels are damaged after a trauma. Bruises can occur at different layers of the body and include skin, deeper tissue, muscles and bones. Most bruises happen after a fall, hitting an object or getting a hit during sports. In many cases it takes a while till you notice a corkie and you will not immediately feel the symptoms right after an incident. Typical areas for corkies are at the front of the thigh, shin, at the frontal pelvic bone (hip pointer or iliac crest) and on your forearms.

How do I know I have a corkie/bruise and what are the symptoms?

A corkie presents with the following symptoms:

• initially short severe pain during trauma (hit, fall as mentioned above)
• later the pain reduces and becomes more of a local tenderness
• swelling (not always)
• bleeding (hematoma- dark blue colored spot on the skin)
• pain during action /use

What are the contributing factors?

The size and shape of a bruise is influenced by several factors such as age, condition- color and type of tissue. Furthermore the location, striking force of a hit or blood disorders (coagulation problems) have an impact on the size and shape of a corkie.

What should I do when I have a corkie?

The treatment of light corkies includes:

• RICE (Rest, Ice, Compression, Elevation) to reduce pain and swelling
• painkillers
• soft stretching after a few days when the pain settled down
• after the inflammatory phase (3-5days) heat to loosen up tight muscles

When should I see a doctor?

You should see a doctor if you have a moderate-severe corkie/bruising. This is indicated if:

• you have severe pain and tenderness
• you develop a massive swelling
• movements of the affected area are very painful
• you have a big corkie without any explanation/reason

Note: If you have unexplained bruises which occur very frequently over a long period of time it is advisable to see a doctor to rule out skin or blood disorders (platelet or coagulation disorder). Furthermore unexplained bruising may also be a warning sign of child abuse, internal bleeding or other serious health problems. The usage of several drugs (e.g. steroids, blood thinners) can cause easier bruising.

How long does it take for the corkie to disappear?

Normally light bruises heal within 2-3 weeks. Depending on the severity and the individual healing process it can take longer. Deeper bruises take more time to heal.

I have corkie (bruise)? What should I do? is a post from: Musculoskeletal Consumer Review by Core Concepts

Shoulder Anatomy Video is a post from: Musculoskeletal Consumer Review by Core Concepts

No. Surgery is usually only indicated when the curve is bigger than 50 degrees, or is severely affecting one’s everyday activities or his / her quality of life. Majority of scoliosis cases do not require surgery. Surgery will only be considered when the curve continues to worsen in spite of bracing or exercises, and is progressing near or beyond 50 degrees.

The degrees of scoliosis curves are measured by Cobb’s angle.

Source: Web MD click for larger view

Source: Pediatric Education click for larger view

One must be aware that there are complications with scoliosis surgery, such as stiff spine, spine muscle weakness and possible rods breakage. The spine will no longer grow again after scoliosis surgery, so if it is to be performed in growing children, it should be delayed as much as possible in order to preserve the growth of the developing spine.

What else can help control scoliosis besides surgery?

Besides surgery, the most common treatment is bracing and physiotherapy.

The purpose of using a brace is to control the progression of a curve, but not to eliminate it. Bracing is indicated when the scoliosis curve is between 25-40 degrees, and when the spine has not yet reached full maturity, which is usually between 13-15 years of age in girls, and 15-17 years in boys. In the case that though the curve is smaller than 25 degrees, but worsens more than 5 degrees within a period of 6 months, a brace is also recommended. To ensure the effectiveness of the brace, it needs to be worn 18-20 hours a day through the growing years.

Physiotherapy works to strengthen the weak muscles, to improve the flexibility of the shortened & tight tissues. It helps slow down the development of muscle imbalance and joint stiffness, and helps reduce back pain. It benefits individuals with scoliosis either are or are not on braces. The stiffer the curves are, the more strongly physiotherapy is recommended. Furthermore, physiotherapy enhances the correction achieved by braces during the bracing and after the brace is weaned off.

What can be done for Scoliosis? is a post from: Musculoskeletal Consumer Review by Core Concepts

Muscle Activation During Gait Video is a post from: Musculoskeletal Consumer Review by Core Concepts