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Sunday, January 31, 2010

Low Back Pain

Pelvic Tilting
One knee to chest stretch
Hamstring stretch
Quadrisep Stretch
Above are some certain exercise for Low back pain

What is low back pain?
Low back pain is pain and stiffness in the lower back. It is one of the most common reasons people miss work.
How does it occur?
Low back pain is usually caused when a ligament or muscle holding a vertebra in its proper position is strained.
Vertebrae are bones that make up the spinal column through which the spinal cord passes. When these muscles or
ligaments become weak, the spine loses its stability, resulting in pain. Because nerves reach all parts of the body
from the spinal cord, back problems can lead to pain or weakness in almost any part of the body.
Low back pain can occur if your job involves lifting and carrying heavy objects, or if you spend a lot of time sitting or
standing in one position or bending over. It can be caused by a fall or by unusually strenuous exercise. It can be
brought on by the tension and stress that cause headaches in some people. It can even be brought on by violent
sneezing or coughing.
People who are overweight may have low back pain because of the added stress on their back.
Back pain may occur when the muscles, joints, bones, and connective tissues of the back become inflamed as a
result of an infection or an immune system problem. Arthritic disorders as well as some congenital and
degenerative conditions may cause back pain.
Back pain accompanied by loss of bladder or bowel control, difficulty in moving your legs, or numbness or tingling
in your arms or legs may indicate an injury to your spine and nerves, which requires immediate medical treatment.
What are the symptoms?
Symptoms include:
• pain in the back or legs
• stiffness and limited motion.
The pain may be continuous or may occur only in certain positions. It may be aggravated by coughing, sneezing,
bending, twisting, or straining during a bowel movement. The pain may occur in only one spot or may spread to
other areas, most commonly down the buttocks and into the back of the thigh.
A low back strain typically does not produce pain past the knee into the calf or foot. Tingling or numbness in the calf
or foot may indicate a herniated disk or pinched nerve.
Be sure to see your health care provider if:
• You have weakness in your leg, especially if you cannot lift your foot, because this may be a sign of nerve
damage.
• You have new bowel or bladder problems as well as back pain, which may be a sign of severe injury to
your spinal cord.
• You have pain that gets worse despite treatment.
How is it diagnosed?
Your health care provider will review your medical history and examine you. He or she may order x-rays. In certain
situations a myelogram, CT scan, or MRI may be ordered.
How is it treated?
The following are ways to treat low back pain:
• Using a heating pad or hot water bottle.
• Taking ibuprofen, aspirin, or other anti-inflammatory medications. Occasionally muscle relaxants or other
pain medications may be
• Having your back massaged by a trained person.
• Wearing a belt or corset to support your back.
• Talking with a counselor, if your back pain is related to tension caused by emotional problems.
• Beginning a program of physical therapy, or exercising on your own. Begin a regular exercise program to
gently stretch and strengthen your muscles as soon as you can. Your health care provider or physical
therapist can recommend exercises that will not only help you feel better but will strengthen your muscles
and help avoid back trouble later.
When the pain subsides, ask your health care provider about starting an exercise program such as the following:
• Exercise moderately every day, using stretching and warm-up exercises suggested by your provider or
physical therapist.
• Exercise vigorously for about 30 minutes two or three times a week by walking, swimming, using a
stationary bicycle, or doing low-impact aerobics.
Participating regularly in an exercise program will not only help your back, it will also help keep you healthier
overall.
How long will the effects last?
The effects of back pain last as long as the cause exists or until your body recovers from the strain, usually a day or
two but sometimes weeks or even months.
How can I take care of myself?
In addition to the treatment described above, keep in mind these suggestions:
• Use an electric heating pad on a low setting (or a hot water bottle wrapped in a towel to avoid burning
yourself) for 20 to 30 minutes. Don’t let the heating pad get too hot, and don’t fall asleep with it. You could
get a burn.
• Try putting an ice pack wrapped in a towel on your back for 20 minutes, one to four times a day. Set an
alarm to avoid frostbite from using the ice pack too long.
• Put a pillow under your knees when you are lying down.
• Sleep without a pillow under your head.
• Lose weight if you are overweight.
• Practice good posture. Stand with your head up, shoulders straight, chest forward, weight balanced evenly
on both feet, and pelvis tucked in.
Pain is the best way to judge the pace you should set in increasing your activity and exercise. Minor discomfort,
stiffness, soreness, and mild aches need not interfere with activity. However, limit your activities temporarily if:
• Your symptoms return.
• The pain increases when you are more active.
• The pain increases within 24 hours after a new or higher level of activity.
What can I do to help prevent low back pain?
You can reduce the strain on your back by doing the following:
• Don’t push with your arms when you move a heavy object. Turn around and push backwards so the strain
is taken by your legs.
• Whenever you sit, sit in a straight-backed chair and hold your spine against the back of the chair.
• Bend your knees and hips and keep your back straight when you lift a heavy object.
• Avoid lifting heavy objects higher than your waist.
• Hold packages you carry close to your body, with your arms bent.
• Use a footrest for one foot when you stand or sit in one spot for a long time. This keeps your back straight.
• Bend your knees when you bend over.
• Sit close to the pedals when you drive and use your seat belt and a hard backrest or pillow.
• Lie on your side with your knees bent when you sleep or rest. It may help to put a pillow between your
knees.
• Put a pillow under your knees when you sleep on your back.
• Raise the foot of the bed 8 inches to discourage sleeping on your stomach unless you have other problems
that require that you keep your head elevated.
To rest your back, hold each of these positions for 5 minutes or longer:
• Lie on your back, bend your knees, and put pillows under your knees.
• Lie on your back, put a pillow under your neck, bend your knees to a 90-degree angle, and put your lower
legs and feet on a chair.
• Lie on your back, bend your knees, and bring one knee up to your chest and hold it there. Repeat with the
other knee, then bring both knees to your chest. When holding your knee to your chest, grab your thigh
rather than your lower leg to avoid over flexing your knee.

What Is the Role of Exercise and Movement in Low Back Pain?
Regular exercise can stretch and strengthen your back as well as help to relieve your pain. This
article provides extensive tips about correct body movement and outlines specific exercises to
increase low back strength.
Resuming Activity Levels after Acute Back Pain
Overexertion may be as unhelpful as prolonged bed rest during acute back pain. (In one study, recovery from
acute back pain was slower for patients who immediately embarked on flexibility exercises than for those who
gradually resumed normal activity.) Walking, stationary biking, swimming, and even light jogging, however, may
begin within two weeks of symptoms. An incremental aerobic exercise program is less stressful than stretching
or exercises strengthening the trunk muscles. Patients should never force themselves to exercise if, by doing
so, pain increases.
Exercises to Avoid during Recovery
It should be strongly noted that incorrect movements or long-term high-impact exercise is a cause of back pain.
People vulnerable to back pain should avoid activities that put undue stress on the lower back or require sudden
twisting movements, such as football, golf, ballet, and weight lifting. Jogging is usually not recommended, at
least not until the pain is gone and muscles are stronger. Exercises that put the lower back under pressure
should be avoided until the back muscles are well toned. Such exercises include leg lifts done in a prone (facedown)
position, straight leg sit-ups, and leg curls using exercise equipment.
Exercise for Chronic Back Pain
Exercise plays a very beneficial role in chronic back pain. In one study, for example, patients with back pain
lasting for an average of 18 months were assigned eight one-hour exercise sessions over four weeks. They
showed greater improvement in nearly every area, including reduced pain and increased capacity, compared to
patients who did not exercise. Patients who choose a passive route (massage and heat therapy) experience
slower recovery from pain than those who exercise (although after a year their conditions do not appear to differ
much). Some studies suggest that the positive impact of exercise on low back pain does not depend on
improving strength and flexibility but on changing the patients’ attitudes toward their disability and pain. Some
exercise programs used for prevention or for chronic low back pain include the following:
•Low Impact Aerobic Exercises. Low- impact aerobic exercises, such as swimming, bicycling,
and walking, can strengthen muscles in the abdomen and back without over-straining the back.
Programs that use strengthening exercises while swimming may be a particularly beneficial
approach for many patients with back pain.
•Lumbar Extension Strength Training. Exercises called lumbar extension strength training are
proving to be effective. Generally, these exercises attempt to strengthen the abdomen, improve
lower back mobility, strength, and endurance, and enhance flexibility in the hip and hamstring
muscles and tendons at the back of the thigh. [For examples of some good exercises for the
back, see Specific Exercise for Low Back Strength, below.]
•Flexibility Exercises. Whether flexibility exercises alone offer any significant benefit is
uncertain. One study suggested that any benefits derived from flexibility exercises are lost
unless the exercise regimens are sustained.
•Retraining Deep Muscles. Of interest are studies that are finding a link between low back pain
and impaired motor control of deep muscles of the back and trunk. According to these studies,
contraction exercises specifically designed to retrain these muscles may be effective for
patients with both acute and chronic pain.
It is important for any person who has low back pain to have an exercise program guided by professionals who
understand the limitations and special needs of back pain and who can address individual health conditions.
One study indicated that patients who planned their own exercise did worse than those in physical therapy or
physician-directed programs.
Specific Exercises for Low Back Strength
Perform the following exercises at least three times a week:
Partial Sit-ups. Partial sit-ups or crunches strengthen the abdominal muscles.
•Keep the knees bent and the lower back flat on the floor while raising the shoulders up three to
six inches.
•Exhale on the way up and inhale on the way down.
Perform this exercise slowly eight to tens times with the arms across the chest.
Pelvic Tilt. The pelvic tilt alleviates tight or fatigued lower back muscles.
•Lie on the back with the knees bent and feet flat on the floor.
•Tighten the buttocks and abdomen so that they tip up slightly.
•Press the lower back to the floor, hold for one second and then relax.
•Be sure to breathe evenly.
Over time increase this exercise until it is held for five seconds. Then, extend the legs a little more so that the
feet are further away from the body and try it again.
Stretching Lower-Back Muscles. The following are three exercises for stretching the lower back:
•Lie on the back with knees bent and legs together. Keeping arms at the sides, slowly roll the
knees over to one side until totally relaxed. Hold this position for about 20 seconds (while
breathing evenly) and then repeat on the other side.
•Lying on the back, hold one knee and push it gently toward the chest. Hold for 20 seconds.
Repeat with other knee.
•While supported on hands and knees, lift and straighten right hand and left leg at the same time.
Hold for three seconds while tightening the abdominal muscles. The back should be straight.
Alternate with the other arm and leg and repeat on each side eight to 20 times.
Note: No one with low back pain should perform exercises that require bending over right after getting up in the
morning. At that time, the discs are more fluid-filled and more vulnerable to pressure from this movement.
Tips for Daily Movement and Inactivity
The way a person moves, stands, or sleeps during the day plays a major role in back pain:
•Maintaining good posture is very important. This means keeping the ears, shoulders, and hips
in a straight line with the head up and stomach pulled in.
•It is best not to stand for long periods of time. If it is necessary, walk as much as possible and
wear shoes without heels, preferably with cushioned soles. Using a low stool, alternate resting
each foot on it.
•Sitting puts the most pressure on the back. Chairs should either have straight backs or low-back
support. If possible, chairs should swivel to avoid twisting at the waist, have arm rests, and
adjustable backs. While sitting, the knees should be a little higher than the hip, so a low stool or
hassock is useful to put the feet on. A small pillow or rolled towel behind the lower back helps
relieve pressure while either sitting or driving.
•Riding and particularly driving for long periods in a vehicle increases stress. Move the seat as
far forward as possible to avoid bending forward. The back of the seat should be reclined not
more than 30° and, if possible, the seat bottom should be tilted slightly up in front. For long
rides, one should stop and walk around about every hour and avoid lifting or carrying objects
immediately after the ride.
•Be sure to have a firm mattress. If the mattress is too soft, a 1/4-inch plywood board can be put
between the mattress and box spring. On the other hand, some people have experienced
morning backache from a mattress that is too hard. The back is the best guide.
Tips for Lifting and Bending
Anyone who engages in heavy lifting should take precautions when lifting and bending:
•If an object is too heavy or awkward, get help.
•Spread your feet apart to give a wide base of support.
•Stand as close as possible to the object being lifted.
•Bend at the knees; tighten stomach muscles and tuck buttocks in so that the pelvis is rolled
under and the small of the back is flexed slightly. Do not arch the back. (Even when not lifting
an object, always try to use this posture when stooping down). Hold objects close to the body to
reduce the load on the back.
•Lift using the leg muscles, not those in the back.
•Stand up without bending forward from the waist.
•Never twist from the waist while bending or lifting any heavy object. If you need to move an
object to one side, point your toes in that direction and pivot toward it.
•If an object can be moved without lifting, pull it, don’t push.

Vertigo

Vertigo adalah sensasi berputar yang dapat terjadi kapanpun, meski tubuh kita dalam keadaan berdiri tegak. Lingkungan sekitar tampak bergerak, baik vertikal maupun horisontal. Beberapa orang merasakan bahwa mereka benar-benar berputar. Efeknya bisa ringan atau bahkan berat hingga kita bisa jatuh ke lantai.

Vertigo berbeda dengan dizziness, suatu pengalaman yang mungkin pernah kita rasakan, yaitu kepala terasa ringan saat akan berdiri. Sedangkan vertigo bisa lebih berat dari itu, misalnya dapat membuat kita sulit untuk melangkah karena rasa berputar yang mempengaruhi keseimbangan tubuh.

Gejala vertigo
Vertigo dapat terjadi tiba-tiba dan berlangsung sebentar, tapi dapat pula terjadi selama beberapa hari. Mereka dengan vertigo yang berat bisa jadi tak dapat bangun dari tempat tidur dan hal ini akan mempengaruhi aktivitasnya sehari-hari. Untuk itu, gejala vertigo dapat bervariasi tergantung berat ringannya. Gejala yang dapat dirasakan antara lain:

  • Tempat anda berpijak terasa berputar atau bergerak-gerak
  • Mual
  • Muntah
  • Sulit berdiri atau berjalan
  • Sensasi kepala terasa ringan
  • Tak dapat memfokuskan pandangan

Penyebab vertigo
Vertigo seringkali disebabkan oleh adanya gangguan keseimbangan yang berpusat di area labirin atau rumah siput di daerah telinga. Kemungkinan penyebab vertigo yaitu:
Infeksi virus seperti common cold atau influenza yang menyerang area labirin
Infeksi bakteri
yang mengenai telinga bagian tengah
Radang sendi di daerah leher
Serangan migren
Sirkulasi darah yang berkurang dapat menyebabkan aliran darah ke pusat keseimbangan otak menurun
Mabuk kendaran
Alkohol dan obat-obatan tertentu

Pencegahan vertigo
Langkah-langkah berikut ini dapat meringankan atau mencegah gejala vertigo:
Tidurlah dengan posisi kepala yang agak tinggi
Bangunlah secara perlahan dan duduk terlebih dahulu sebelum kita berdiri dari tempat tidur
Hindari posisi membungkuk bila mengangkat barang
Hindari posisi mendongakkan kepala, misalnya untuk mengambil suatu benda dari ketinggian
Gerakkan ke
pala secara hati-hati jika kepala kita dalam posisi datar (horisontal) atau bila leher dalam posisi mendongak.
Benign positional vertigo adalah bentuk vertigo yang menyerang dalam jangka waktu pendek namun berulang-ulang. Gejalanya hanya dalam hitungan detik tetapi bisa cukup berat, seringkali muncul setelah kita terserang infeksi virus atau adanya peradangan dan kerusakan di daerah telinga tengah. Gejalanya bisa muncul jika kita menggerakkan kepala tiba-tiba, misalnya saat menoleh dengan gerakan yang cepat.

Umumnya kasus vertigo merupakan kasus yang ringan dan tidak berbahaya. Namun, jika gejala itu muncul berulang atau menetap, perlu dilihat apakah ada faktor yang menyebabkannya. Jika gejala tersebut sangat mengganggu aktivitas kita, segera periksakan diri ke dokter untuk menentukan apakah ada penyebab yang serius dan terapi yang tepat untuk menyembuhkan vertigo kita.

Upper Limb and Lower Limb Glossory

Fracture Clavicle: Occurs at middle/lateral thirds. Upward displacement of proximal segment (sternocleidomastoid muscle) and downward displacement of distal segment (deltoid muscle and gravity).

Injury to lower brachial plexus and hemorrhage of subclavian vein. Calcification Superior Transverse Scapular Ligament: May trap or compress the suprascapular nerve affecting functions of the supraspinatus and infraspinatus muscle.

Fracture of Humeral Greater Tuberosity: Occurs by direct trauma and affects the supraspinatus, infraspinatus, and teres minor muscles, all which attach there by tendons.

Fracture of Humeral Lesser Tuberosity: Accompanies posterior dislocation of the shoulder joint, and the bone fragment has the insertion of the subscapularis tendon.

Fracture of Humeral Surgical Neck: May injure the axillary nerve and the posterior humeral circumflex artery as they pass through the quadrangular space.

Fracture of the Humeral Shaft: May injure the radial nerve and profunda brachial artery in the spiral groove.

Fracture of the Humeral Medial Epicondyle: May damage the ulnar nerve which may be compressed in the groove behind the medial epicondyle ‘funny bone.’

Humeral Supracondylar Fracture: Are common in children and occur when the child falls on the outstretched hand with the elbow partially flexed and may injure the median nerve.

Colle’s Fracture of the Wrist: Is a fracture of the lower end of the radius in which the distal fragment is displaced posteriorly, producing the dinner fork deformity. If distal fragment is displaced anteriorly, this is then the reverse Colle’s fracture known as Smith’s fracture.

Fracture of the Scaphoid: Occurs with a fall on the outstretched hand and may damage the radial artery.

Fracture of the Hamate: May injure the ulnar nerve and artery. Also the ulnar nerve and artery may be compressed in Guyon’s canal formed between the hook of the hamate and the pisiform.

Bennett’s Fracture: Is a fracture of the base of the metacarpal of the thumb. Boxer’s Fracture: Is a fracture of the necks of the second and third metacarpals (experienced boxer) or fifth metacarpal (unskilled boxer).

Dislocation of Acromiclavicular Joint: Results from a fall on the shoulder with the impact taken by the acromion. It is called shoulder separation because the shoulder is separated from the clavicle with possible rupture of the coracoclavicular ligament.

Inferior Dislocation of Humerus: Is not uncommon because the inferior aspect of the shoulder joint is not supported by muscle tendons of the rotator cuff. It may damage the axillary nerve and the posterior humeral circumflex vessels.

Rupture of Rotator Cuff: May occur by chronic wear and tear and is manifested by severe limitation of shoulder joint motion, mainly abduction. Chiefly the supraspinatus tendon is injured which causes subacromial bursitis and a painful shoulder. Similar to Impingement Syndrome: which impinges on the subacromial space. Positive impingement tests are: Hawkins (flex arm 90deg and internal rotate), Mire (fully pronate arm and lift overhead), Jobe (empty beer cans and lift against resistance).

Breast Cancer: Occurs in upper lateral quadrant (60% of time) producing dimpling of skin or inverted nipple. A mastectomy may injure the long thoracic and thoracodorsal nerves.

Tennis Elbow (Lateral Epicondylitis): Caused by chronic irritation of the tendons of the extensor muscles of the forearm which originate in the lateral epicondyle.

Golfer’s Elbow (Medial Epicondylitis): Caused by chronic irritation of the tendons of the flexor muscles of the forearm which originate in the medial epicondyle.

Cubital Tunnel Syndrome: Is compression of the ulnar nerve behind the medial epicondyle.

Dupuytren’s Contracture: Progressive thickening and shortening of the palmar aponeurosis producing a flexion deformity of the third and fourth fingers.

Volkmann’s Contracture: Ischemic muscular contracture (flexion deformity) of the fingers and wrist produced by necrosis of the forearm flexor muscles (wearing a tight cast).

Carpal Tunnel Syndrome: Caused by compression of the median nerve. It results from either inflammation of flexor retinaculum, arthritis of carpal bones, or inflammation of the synovial sheaths of the flexor tendons (FDS & FDP). Will cause atrophy of the thenar muscles.

Tenosynovitis: Is an inflammation of the tendon and synovial sheath. Little finger is the ulnar bursa and may spread to the carpal tunnel. Thumb is the radial bursa.

DeQuervain’s Tenosynovitis: Inflammation of the abductor pollicis longus and the extensor pollicis brevis (two tendons of bottom of snuffbox), which travel through the first dorsal compartment tunnel. Shows a positive Finklestein test.

Injury to Long Thoracic Nerve: Results in paralysis of the serratus anterior muscle and inability to elevate the arm above the horizontal. Produces winged scapula in which medial border of scapula protrudes.

Injury to Posterior Cord: Caused by pressure of a crutch resulting in paralysis of the arm called crutch palsy (Saturday Night Palsy). It results in loss of function of the extensors of the arm and forearm and produces wrist drop.

Injury to Axillary Nerve: Caused by a fracture of the surgical neck of the humerus or inferior dislocation of the humerus. It results in weakness of lateral rotation and abduction of the arm

Injury to Radial Nerve: Caused by a fracture of the midshaft of the humerus. Results in loss of function of the extensors of the forearm and hand, producing wrist drop.

Injury to Musculocutaneous Nerve: Results in weakness of supination (biceps) and forearm flexion (brachialis and biceps).

Injury to Median Nerve: May be caused by supracondylar fracture of humerus or compression in the carpal tunnel. Results in loss of pronation and opposition of thumb, loss of flexion of the lateral two IP joints and impairment of medial two IP joints. Produces flattening of the thenar eminence and is referred to as Ape Hand.

Injury to Ulnar Nerve: Caused by a fracture of the medial epicondyle and results in Claw Hand. Ring and little finger are hyperextended at MC joint and flexed at IP joint. Fingers have loss of abduction and adduction (palmar and doral interossei are paralyzed). Thumb cannot adduct because of paralysis of adductior pollicis muscle.

Upper Trunk Injury / Erb-Duchenne Paralysis: Caused by birth injury or violent displacement of the head from the shoulder. Results in loss of abduction, flexion, and lateral rotation of arm, producing a Waiter’s Tip Hand.

Lower Trunk Injury / Klumpke’s Paralysis: Caused by breech birth, or cervical rib, or scalene syndrome. The injury results in Claw Hand.

Axillary Artery Ligated: The blood from anastomoses in the scapular region arrives at the subscapular artery in which blood flow is reversed to reach the axillary artery distal to the ligature.

Brachial Artery Ligated: The blood from anastomoses around the elbow allow blood to reach the ulnar and radial arteries.

Ulnar Artery: May be compressed or felt for the pulse on the anterior aspect of the flexor retinaculum on the lateral side of the pisiform bone. Allen Test: Is a test for occlusion of the radial or ulnar artery Trigger Finger: Results from stenosing tenosynovitis or if flexor tendon develops swelling. Symptoms are pain at joints and a clicking when moving joint.

Mallet Finger: A finger with permanent flexion of the distal phalanx due to an avulsion of the lateral bands of the extensor tendon.

Boutonniere Deformity: Abnormally flexed middle phalanx with an extended distal pahalanx due to an avulsion of the central band of the extensor tendon.

Olecranon Bursitis / Student’s Elbow: Swollen, tender mass at elbow which produces pain on flexion of elbow.

Dislocation of Femoral Head: Is usually associated with advanced age (osteoporosis) and presents with a shortened lower limb with medial rotation.

Pertrochanteric Fracture: Is a femoral fracture through the trochanters and is a form of extracapsular hip fracture.

Fracture of Neck of Femur: Interrupts blood supply from medial femoral circumflex artery and presents with a shortened lower limb with lateral rotation.

Dislocated Knee or Fractured Distal Femur: May injure the popliteal artery because of its deep position adjacent to the femur and the knee joint capsule.

Transverse Patellar Fracture: Results from a blow to the knee. The proximal fragment of the patella is pulled superiorly with the quadriceps tendon and the distal fragment remains with the patellar ligament.

Bumper Fracture: Is a fracture of the lateral tibial condyle, caused by an automobile bumper, and is associated with a common peroneal nerve injury.

Dupuytren’s Fracture / Pott’s Fracture: Is a fracture of the lower end of the fibula, often accompanied by a fracture of the medial malleolus or rupture of the deltoid ligament. Caused by forced eversion of the foot.

Pilon Fracture: Is a fracture of the distal metaphysis of the tibia extending into the ankle joint.

Fracture of the Fibular Neck: May cause injury to common peroneal nerve which laterally winds around the neck of the fibula. This results in paralysis of al musclesin the anterior/lateral compartments of the leg and presents with Foot Drop.

March Fracture / Stress Fracture: Is a fatigue fracture of one of the metatarsals produced from prolonged walking or ballet dancing.

Coxa Valga: Is an alteration of the angle made by the axis of the femoral neck to the axis of the femoral shaft so that the angle exceeds 135 degrees, this pushes the femur laterally.

Coxa Vara: Is an alteration of the angle made by the axis of the femoral neck to the axis of the femoral shaft so that the angle is less than 135 degrees, this pulls the femur medially.

Hemarthrosis: This is blood in the joint which produces rapid swelling of joint, mainly knee.

Drawer Sign: An anterior drawer sign (tibia sliding forward) is due to rupture of anterior cruciate ligament. A posterior drawer sign (tibia sliding backward) is due to a rupture of posterior cruciate ligament. Medial Meniscus: Is more frequently torn in injuries than the lateral because of its strong attachment to the tibial (medial) collateral ligament.

Unhappy Triad of the Knee: May occur when foot is firmly planted and knee is struck from lateral side.

1 Rupture of the tibial collateral ligament (excessive abduction of tibia).

2 Tearing of anterior cruciate ligament (forward displacement of tibia).

3 Injury to medial meniscus. Knock-Knee / Genu Valgum: Is a deformity in which the tibia is bent or twisted laterally. It may occur as a result of collapse of lateral compartment of knee and rupture of tibial collateral ligament.

Bowleg / Genu Varum: Is a deformity in which the tibia is bent medially. It may occur as a result of collapse of the medial compartment of the knee and rupture of lateral collateral ligament.

Patellar Tendon Reflex: Tap on the patellar tendon elicits extension of the knee joint.

Prepatellar Bursitis / Housemaid’s Knee: Is inflammation and swelling of the prepatellar bursa.

Hallux Valgus: Is a lateral deviation of the big toe vs. Hallux Varus which is a medial deviation of the big toe.

Gluteal Gate / Gluteus Medius Limp: Is a waddling gait characterized by the pelvis falling toward the unaffected side when the opposite leg is raised. It results from paralysis of the gluteus medius muscle, and damage to the superior gluteal nerve.

Piriformis Syndrome: Is a common condition in which the pirformis muscle irritates and places pressure on the sciatic nerve, this pain is called ‘sciatic.’ Positive Trendelenburg’s Sign: Is seen in a fracture of the femoral neck or dislocated hip joint. If the right gluteus medius is paralyzed then the unsupported left side will drop.

Anterior Tibial Compartment Syndrome: Ischemic necrosis of the anterior muscles. It results from a compression of the anterior tibial artery by swollen muscles. Intermittent Claudication is a condition of limping due to ischemia.

Popliteal / Baker’s Cyst: Is a firm swelling behind the knee caused by herniation of synovial membrane, this impairs flexion and extension.

Shin Splint: Caused by swollen muscles of the anterior compartment particularly the tibialis anterior in athletes.

Tarsal Tunnel Syndrome: Results from compression of the tibial nerve in the tarsal tunnel. May be caused by flat feet and excess weight.

Rupture of Achilles Tendon: Disables the triceps surae (gastrocnemius and soleus), and cannot plantar flex the foot.

Forced Eversion of Foot: Avulses the medial malleolus and ruptures the deltoid ligament.

Ankle Sprain / Forced Inversion: Results from rupture of the calcaneofibular and talofibular ligaments and a fracture of the lateral malleolus.

Flat Foot / Pes Planus / Talipes Planus: Disappearance of the medial longitudinal arch with eversion and abduction of the foot, stretches the plantar muscles and strains the spring ligament.

Pes Cavus: Exhibits an exaggerated height of the medial longitudinal arch. Clubfoot / Talipes Equinovarus: Foot is plantarflexed, inverted and adducted.

Foot Deformities: Equinas = plantarflexed. Calcaneus = dorsiflexed. Valgus = heel lateral.

Varus = heel medial. Damage to Obturator Nerve: Causes a weakness of adduction and a lateral swinging of the limb.

Damage to Femoral Nerve: Causes impaired flexion of the hip and impaired extension of the leg, due to paralysis of quadriceps femoris.

Injury to Superior Gluteal Nerve: Weakened gluteus medius and a gluteal gate.

Damage to Sciatic Nerve: Causes impaired extension at hip and impaired flexion at the knee, loss of dorsiflexion and plantarflexion at the ankle.

Damage to Common Peroneal Nerve: May occur from fracture of fibula and results in Foot Drop, loss of dorsiflexion.

Damage to Superficial Peroneal Nerve: Causes no foot drop but loss of eversion of foot.

Damage to Deep Peroneal Nerve: Results in Foot Drop and a high stepping gate.

Damage to Tibial Nerve: Causes loss of plantar flexion of the foot and impaired inversion resulting from paralysis of tibialis posterior.

Medial Femoral Circumflex Artery: Supplies most of the blood to the head and neck of femur.

Cruciate Anastomosis of Buttock: Bypasses an obstruction to the femoral artery.

Popliteal Aneurysm: Blood can bypass through the genicular anastomoses and reach the popliteal artery distal to the ligation.

Pes Aserinus: Inflammation of the anserine bursa (gracilis, sartoris, semitendinosis) and presents with knee pain and swelling on anterior/proximal/medial tibia.

Jumper’s Knee / Patellar Tendonopathy: Repetitive loading causes anterior knee pain.

Genu: Knee (varum=tibia medial & valgum = tibial lateral) Coxa: Hip (vara=femur medial & valga = femur lateral) A femur/neck angle of 95 degress (less than normal) will cause Coxa Vara and Genu Valgum. A femur/neck angle of 155 degrees (more than normal) will cause Coxa Valga and Genu Varum.

Thursday, January 28, 2010

Test Alzheimer

1. Temukan huruf “C” di bawah. Jangan gunakan bantuan cursor.

OOOOOOOOOOOOOOOOOOO OOOOOOOOOOOOOOOO OOOOOOOOOOOOOOO O
OOOOOOOOOOOOOOOOOOO OOOOOOOOOOOOOOOO OOOOOOOOOOOOOOO O
OOOOOOOOOOOOOOOOOOO OOOOOOOOOOOOOOOO OOOOOOOOOOOOOOO O
OOOOOOOOOOOOOOOOOOO OOOOOOOOOOOOOOOO OOOOOOOOOOOOOOO O
OOOOOOOOOOOOOOOOOOO OOOOOOOOOOOOOOOO OOOOOOOOOOOOOOO O
OOOOOOOOOOOOOOOOOOO OOOOOOOOOOOOOOOO OOOOOOOOOOOOOOO O
OOOOOOOOOOOOOOOOOOO OOOOOOOOOOOOOOOO COOOOOOOOOOOOOO O
OOOOOOOOOOOOOOOOOOO OOOOOOOOOOOOOOOO OOOOOOOOOOOOOOO O
OOOOOOOOOOOOOOOOOOO OOOOOOOOOOOOOOOO OOOOOOOOOOOOOOO O
OOOOOOOOOOOOOOOOOOO OOOOOOOOOOOOOOOO OOOOOOOOOOOOOOO O
OOOOOOOOOOOOOOOOOOO OOOOOOOOOOOOOOOO OOOOOOOOOOOOOOO O

2. Jika anda telah menemukan huruf “C”, sekarang temukan angka “6″ di bawah.

9999999999999999999 9999999999999999 999999999999999 99999999999999
9999999999999999999 9999999999999999 999999999999999 99999999999999999
9999999999999999999 9999999999999999 999999999999999 99999999999999999
9999699999999999999 9999999999999999 999999999999999 99999999999999999
9999999999999999999 9999999999999999 999999999999999 99999999999999999
9999999999999999999 9999999999999999 999999999999999 99999999999999

3. Sekarang temukan huruf “N” di bawah. Ini agak lebih sulit.

MMMMMMMMMMMMMMMMMMM MMMMMMMMMMMMMMMM MNMMMM
MMMMMMMMMMMMMMMMMMM MMMMMMMMMMMMMMMM MMMMMM
MMMMMMMMMMMMMMMMMMM MMMMMMMMMMMMMMMM MMMMMM
MMMMMMMMMMMMMMMMMMM MMMMMMMMMMMMMMMM MMMMMM
MMMMMMMMMMMMMMMMMMM

4. Sekarang temukan huruf “O” di bawah. Ini agak lebih sulit.
QQQQQQQQQQQQQQQQQQQ QQQQQQQQQQQQQQQQ QQQ
QQQQQQQQQQQQQQQQQQQ QQQQQQQQQQQQQQQQ QQQ
QQQQQQQQQQQQQQQQQQ
QQQQQQQQQQQQQQQQQQQ QQQQQQQQQ
QQQQQQQQQQ
QQQQQQQQQQQQQQQQQOQ QQQQQQQQQQQQQQQQ
QQQQQQQQQQQQQQQQQQQ QQQQQQQQQQQQQQQQ QQ
QQQQQQQQQQQQQQQQQQQ QQQQQQQQQQQQQQQQ

5. Sekarang temukan huruf “I” di bawah. Ini agak lebih sulit.
LLLLLLLLLLLLLLLLLLL LLLLLLLLLLLLLLLL LLLLLLLLLLL
LLLLLLLLLLLLLLLLLLL LLLLLLLLLLLLLLLL LLLLLLLLLLL
LLLLLLLLLLLLLLLLLLL LLLLLLLLLLLLLLLL LLLLLLLLLLLL
LLLLLLLLLLLLLLLLLLL LLLLLLLLLLLLLLLL LLLLLLLLL
LLLLLLLLLLLLLLLLLLL LLLLLLLLLLLL
LLLLLLLLLLLLLL
LLLLLLLLLLLLLLLLLLL LLLLLLLLLLLLLLLL LLLLLLLLLLLL
LLLLLLLLLLLLLLLLLLL LLLLLLLLLLLLLLLL LLLLLLLLLLLLI
LLLLLLLLLLLLLLLLLLL LLLLLLLLLLLLLLLL LLLLLLLLLLL
LLLLLLLLLLLLLLLLLLL LL

Alzheimer atau kepikunan merupakan sejenis penyakit penurunan fungsi
saraf otak yang kompleks dan progresif. Penyakit Alzheimer bukannya
penyakit menular. Penderita Alzheimer mengalami keadaan penurunan daya
ingat yang parah sehingga penderita akhirnya tidak lagi mampu mengurus
dirinya sendiri.

Alzheimer tergolong sebagai salah satu jenis dementia yang ditandai
dengan melemahnya kemampuan bercakap, kemampuan berpikir sehat, daya
ingat, kemampuan mempertimbangan, adanya perubahan kepribadian dan
tingkah laku yang tidak terkendali. Keadaan ini amat membebani penderita
dan juga anggota keluarga yang perlu menjaga dan merawatnya. Menurunnya
fungsi ingatan juga memengaruhi fungsi intelektual dan sosial penderitanya.
Sumber penyakit ini belum diketahui dengan pasti, tetapi bukan karena
proses penuaan. Sebagian ilmuwan memperkirakan bahwa kepikunan ini
berkaitan dengan pembentukan dan perubahan sel-sel saraf yang normal
menjadi semacam serat.

Resiko untuk mengidap Alzheimer meningkat seiring dengan pertambahan
usia. “Pada usia sekitar 65 tahun, seseorang berisiko lima persen untuk
menderita penyakit ini dan risiko ini meningkat dua kali lipat setiap
lima tahun,”menurut Ahli Psikogeriatrik, Kantor Pengobatan Psikologi,
Fakultas Pusat Pengobatan Universitas Malaya (PPUM), Dr. Esther
Ebeenezer. Meskipun kepikunan seringkali dikaitkan dengan usia lanjut,
namun terbukti bahwa penderita Alzheimer yang pertama diidentifikasi
adalah seorang perempuan berusia awal 50 tahunan.

Sejarah Alzheimer

Penyakit ini ditemukan oleh Dr. Alois Alzheimer pada 1907 ini, dinamakan
Alzheimer sesuai nama penemunya.
Alzheimer menemukan bahwa syaraf otak penderita Alzheimer tidak hanya
mengerut, bahkan dipenuhi gumpalan protein luar biasa yang disebut plak
amiloid dan serat yang berbelit-belit (neuro fibrillary).
Amiloid protein yang membentuk sel-sel plak protein tersebut, dipercaya
menyebabkan perubahan kimia otak. Musnahnya sel-sel saraf ini
menyebabkan syaraf otak yang berfungsi menyampaikan pesan dari satu
neuron ke neuron lain terpengaruh.

Meskipun sudah ditemukan hampir satu abad yang lalu, Alzheimer tidak
seterkenal penyakit yang lain seperti hipertensi, Sindrom Pernafasan
Akut Parah (SARS) atau pun penyakit jantung. Mungkin karena gejala
penyakit Alzheimer tidak segera terlihat, berbeda dengan hipertensi yang
dapat dipantau melalui pemeriksaan tekanan darah. Penyakit Alzheimer
tidak terdeteksi karena adanya anggapan bahwa sering lupa adalah hal
yang wajar dialami orang berusia lanjut karena faktor usia. Padahal
mungkin saja “sering lupa” tersebut merupakan tanda awal penyakit Alzheimer.

Penyakit Alzheimer menjadi lebih dikenal secara meluas setelah mantan
Presiden Amerika Serikat yang ke-40, Ronald Reagan mengemukakan keadaan
dirinya dalam suratnya yang tertanggal 5 November 1994. Penelitian
klinis terbaru menunjukkan bahwa konsumsi suplemen asam lemak omega-3
dapat memperlambat laju penurunan fungsi kognitif penderita alzheimer
ringan.

Gejala dan tingkat keparahan penyakit:

Pada taraf ringan gejalanya dapat berupa: lupa dimana menyimpan kunci,
lupa mengambil uang kembalian, lupa mau membeli apa di toko, lupa nomor
telepon atau tidak ingat mana obat yang setiap hari biasa dimakan.

Pada tingkat menengah: penderita misalnya, lupa mencampurkan gula dalam
minuman, garam dalam masakan atau lupa bagaimana cara mengaduk gula di
dalam gelas.

Pada tingkat yang parah, penderita sudah tidak mampu melakukan hal-hal
mendasar seperti mengurus diri sendiri, tidak lagi mengenali keadaan
sekitar rumahnya, tidak mengenali rekan-rekan atau anggota keluarga
terdekat.

Penderita Alzheimer dapat menjadi agresif, cepat marah dan kehilangan
minat untuk berinteraksi atau hobi yang pernah diminatinya. Penderita
tingkat menengah atau parah dapat menunjukkan tingkah laku aneh, seperti
menjerit, terpekik atau mengikuti orang ke mana saja, bahkan walau orang
tersebut ke WC.

Selain itu, penderita dapat juga mengalami semacam halusinasi seperti
mendengar suara atau bisikan halus, atau
melihat bayangan menakutkan. Penderita juga kadangkala berjalan mondar
mandir tanpa tujuan dan pola tidur mereka juga berubah. Penderita
biasanya akan lebih banyak tidur di siang hari dan terus terjaga pada
malam hari.
Keadaan tersebut secara tidak langsung memberi tekanan mental kepada
perawat atau anggota keluarga yang harus waspada menjaga penderita
selama ‘36 jam’ sehari.

Kebanyakan penderita Alzheimer meninggal dunia akibat radang paru-paru
atau pneumonia karena mereka tidak dapat melakukan berbagai aktivitas
fisik lainnya.
Yang menyedihkan, adalah bahwa orang yang sakit itu sendiri tidak
memahami apa yang terjadi pada diri mereka dan memerlukan bantuan orang
lain. Berita buruknya penyakit Alzheimer ini, tidak dapat disembuhkan.
Tetapi, gejalanya masih dapat dikendalikan dengan obat-obatan.
Obat-obatan yang diberi pada tingkat awal, dapat membantu ingatan
penderita seperti fungsi kognitif, aktivitas dan tingkah laku sehari2.

Prevalensi

Sekitar tahun 1950-an diperkirakan sekitar 2,5 juta warga dunia
menderita penyakit ini. Pada tahun 2003 Organisasi Kesehatan Dunia
(WHO), memperkirakan lebih dari satu milyar orang yang berusia di atas
60 tahun atau 10 persen penduduk dunia menderita Alzheimer.
Peningkatan jumlah penderita Alzheimer berkaitan dengan meningkatnya
jumlah warga dunia yang berusia lanjut, dan semakin panjangnya usia
atau masa hidup warga dunia. Usia hidup perempuan meningkat hingga
mencapai usia 80 tahun dan laki-laki mencapai usia 75 tahun. Selain
itu, faktor pemeliharaan kesehatan yang semakin baik dan menurunnya
tingkat kelahiran.

Orang yang berisiko menderita Alzheimer:
* Penderita hipertensi dengan usia di atas 40 tahun
* Penderita diabetes
* Kurang berolahraga
* Kadar kolesterol yang tinggi
* Faktor keturunan – memiliki keluarga yang menderita Alzheimer pada usia 50-an.

Knee Osteoarthritis

Knee Osteoarthritis, the most common type of osteoarthritis, is a chronic degeneration of the articular cartilage around a joint.

Knee osteoarthritis most commonly affects people over 45 years of age but can occur at any time.

The bones of the knees joint (the backside of the kneecap, bottom of thighbone, and top of shinbone) are coated with smooth articular cartilage.

When knee osteoarthritis develops, the cartilage undergoes gradual changes – loosing elasticity, hardening, and cracking, becoming more easily damaged and eroded by use or injury.

The bones can’t move smoothly over roughened cartilage, causing irritation to the bone. The end of the bones involved may thicken and bone spurs may form. Small bits of cartilage may break off and float around inside the knee. Over half of knee osteoarthritis sufferers also have mineral deposits in their cartilage. The joint fluid also changes in consistency, becoming thinner and less tacky, decreasing its lubricating and cushioning properties.

There are many different levels of severity of damage, from mild cases without symptoms or with mild symptoms to advanced cases where the cartilage is worn down to the point where bone rubs on bone, damaging the bones and causing severe knee pain.

Though osteoarthritis is considered to be non-inflammatory type of arthritis, minor inflammation is involved. The inflammation is not nearly as severe as the inflammation involved in inflammatory types of arthritis such as rheumatoid arthritis.

Knee osteoarthritis used to be considered a ‘wear and tear’ disease because it mainly affects middle-aged and elderly people and worsens over time. However, normal activity does not cause knee osteoarthritis, and the cause of cartilage deteriorating and wearing away is not known. Enzymes that damage the joint cartilage have been identified. Doxycycline, an antibiotic that has been shown to inhibit these enzymes, was shown to slow down cartilage deterioration in study led by Indiana University School Of Medicine’s arthritis and muscles diseases center. Cod liver oil has also been shown to inhibit these enzymes.

Many people reduce their activity because of knee pain or because they believe it will worsen knee osteoarthritis. As a result, the muscles that support the knee become weaker and more stress is placed on the knee joint.

SYMPTOMS OF Knee Osteoarthritis

The deterioration of cartilage is gradual and there may be no symptoms in the early stages of knee osteoarthritis. Symptoms of knee osteoarthritis are stiffness (especially morning knee stiffness), knee pain that is aggravated by going up or down stairs, limitation in range of motion, a crunching feeling in the knee, and weakness of knee. The knee may be swollen but not red and hot.

(Symptoms such as diffuse pain in knee joint and crunching sound in the knee can be caused by “runners knee”, which is a common cause of knee pain in all age groups, including teens and young adults.

Swelling of the knee may occur as a result of excess fluid accumulating within the knee joint. Damaged cartilage in the joint triggers inflammation of the joint lining (the synovium) and excess production of joint fluid (synovial fluid).

An accumulation of excess fluid within a joint is called joint effusion. In the knee, joint effusion is sometimes referred to as water on the knee. Knee joint effusion sometimes results in a Baker’s cyst.

In advanced cases, inflammation can also occur if bits of cartilage break off and float around inside the knee joint and cause irritation and inflammation of the soft tissue in the joint.

In advanced cases, there may be deformity of the joint. Cartilage has a limited ability to repair itself. The body compensates with the growth of extra bone, which results in visible enlargement of the joint.

Symptoms do not always correlate with the amount of damage to the joint. Symptoms can come and go for no apparent reason. This makes it difficult to assess whether or not a current treatment is working. Keeping the muscles that support the knee strong, keeping your weight down, and avoiding high impact activities can decrease the symptoms.

FACTORS increasing the risk of Knee Osteoarthritis

Aging
Muscle weakness in the quadriceps (muscles of the thigh that attach to the knee)
Injury to the joint
Repetitive movements (squatting, kneeling with heavy lifting)
Activities requiring repetitive joint impact – jogging
Genetic susceptibility
Skewed feet
Obesity
Inappropriate footwear

TREATMENTS for Knee Osteoarthritis

Exercise:
Exercise is beneficial for knee osteoarthritis: Strong leg muscles support the knee and absorb shock before it gets to the knee. Exercising the quad muscles increase circulation in the knee joint and has been shown to stimulate beneficial biochemical changes in the joint fluid of the knee, improving its lubricating properties. Exercise also improves the range of motion of the knee. However, in patients with knee osteoarthritis who have misaligned knees, over-strengthening of the quads can sometimes make matters worse. A doctor or physical therapist (physiotherapist) can determine whether or not your knees are properly aligned and which exercises would be most beneficial.

Heat and Cold:

Heat:
Applying heat to the knee joint reduces stiffness and pain by increasing blood flow. The heat is also a comforting distraction from the knee pain. DO NOT apply heat to an inflamed joint. Usually, inflammation is not present in the early stages of knee osteoarthritis.

Apply heat for 20 – 30 minutes at a time, waiting at least an hour between each application to prevent overheating of tissues. Dry or moist heat is beneficial but moist heat penetrates the tissues more quickly, and penetrates more deeply than dry.

For moist heat, you can use a towel soaked in warm water but it may cool off fairly quickly. An alternative is to place a moistened towel between your knee and a hot water bottle. There are also moist heating wraps available commercially.

*Do not use rubs and heat at the same time as a burn may occur.

Cold:
Cold reduces knee inflammation and knee pain by constricting the blood vessels. Apply ice wrapped in cloth to an inflamed joint for 15 – 20 minutes every 3 or 4 hours. Do not ice for longer than 20 minutes at one time to avoid frostbite. Moist cold (Place a wet towel between the skin and an ice pack for moist cold) penetrates more deeply and quickly than dry cold.

Weight Loss:
Being overweight places extra stress on the knee, a weight-bearing joint. Even 10 pounds can make a big difference in the symptoms of knee osteoarthritis.

Knee Taping:
Though the reason it works is unclear, knee taping has been shown to significantly reduce knee pain in patients with knee osteoarthritis. There are different taping techniques that a physical therapist (physiotherapist) can teach a patient. Sometimes the skin can become irritated from the tape.

Knee Braces:
Used For Certain Cases of Knee Osteoarthritis: Unloader braces are designed to provide knee pain relief for those with knee osteoarthritis. They are very expensive but some health insurance plans cover them. Quite frequently, the cartilage is more worn out of one side of the knee joint, causing the thighbone to sit on an angle and the thighbone to rub against the shinbone on the worn out side. Unloader braces take off the load (pressure) on a knee joint by changing the angle of the knee joint. By changing the angle of the knee joint, a space between the thighbone and shinbone is created, relieving knee pain and increasing range of motion. An x-ray can determine if the space between the thighbone and shinbone is angled. A doctor or physical therapist (physiotherapist) can assess whether or not an unloaders knee brace would be helpful in a particular case and recommend the appropriate knee brace.

TENS:
This therapy involves stimulating nerve endings with low voltage electric impulses through electrodes attached to the body at the site of the pain. It relieves pain in some patients

Sinusitis


Di dalam rongga hidung terdapat empat ruang atau saluran yang dinamakan sinus. Sinus memproduksi cairan yang melembabkan lapisan tipis pada hidung dan tenggorokan. Setiap sinus memiliki satu saluran ke hidung yang memungkinkan terjadinya pertukaran lendir dengan udara. Nah, sinusitis adalah peradangan atau penyumbatan pada sinus yang terjadi karena alergi, infeksi virus, bakteri, atau jamur. Secara klinis, sinusitis dibagi atas: sinusitis akut, sinusitis sub-akut, dan sinusitis kronis. Berdasarkan penyebabnya, sinusitis terbagi menjadi: Rhinogenik (kelainan pada hidung) dan Dentogenik atau Odontogenik (kelainan pada gigi).

Diagnosa terhadap sinusitis biasanya didasarkan pada pemeriksaan fisik dan gejala-gejala yang dialami. Selain itu, tidak jarang dokter menggunakan sinar x atau mengambil cairan hidung untuk pemeriksaan lebih lanjut.

Sinusitis biasanya menimbulkan sakit kepala; sakit pada rahang atas; sakit gigi; lecet di bagian hidung, dahi, dan pipi; bengkak di bagian mata; sakit dan infeksi pada bagian telinga; demam; lesu; batuk, serta ingusan. Hidung tersumbat akibat infeksi virus flu yang menyerang di sekitar hidung dan tenggorokan tak jarang menjalar ke sinus. Radang pada rongga hidung bisa juga disebabkan kesalahan membuang ingus. Ingus yang seharusnya keluar malah tersedot masuk ke rongga sehingga susah untuk dikeluarkan.

Setiap orang dapat terkena sinusitis. Namun, ada faktor yang meningkatkan risiko terkena sinusitis, yaitu merokok. Hawa panas dari rokok yang dihisap dapat merangsang organ di sekitar hidung sehingga menimbulkan iritasi sehingga memperbesar kemungkinan terjadinya sinusitis. Faktor lain yang dapat mempercepat seseorang terkena sinusitis adalah alergi. Alergi dapat mengakibatkan peradangan di dalam hidung yang kemungkinan merambat ke dalam sinus.

Mengobati dan Mencegah Sinusitis

Biasanya, sinusitis diobati dengan antibiotik dan berbagai jenis obat semprot hidung. Namun, pencegahan selalu lebih baik dari pengobatan. Salah satu cara mudah untuk mencegah peradangan pada sinus adalah menggunakan kain lembut yang sebelumnya direndam dengan air hangat lalu ditempelkan pada pipi. Selain itu, menjaga kebersihan hidung (sinus), khususnya selama serangan alergi dan demam terjadi, sangatlah penting. Membersihkan sinus dapat dilakukan dengan beberapa cara berikut ini: Menggunakan decongestan (obat pengencer dahak) dan obat semprot hidung. Namun, jangan menggunakan obat semprot hidung lebih dari tiga kali sehari karena dapat memicu pembengkakan sinus. Jika hendak melakukan perjalanan udara, maka sebaiknya gunakan obat semprot hidung sebelum pesawat take-off. Bila alergi terhadap sesuatu, maka sebaiknya hindari kontak dengan alergen atau zat yang menyebabkan alergi. Istirahat yang cukup. Duduk santai dengan bersandar adalah baik untuk proses pernapasan. Penderita sinusitis kronis disarankan menjalani terapi antibiotik. Operasi sebaiknya menjadi pilihan terakhir. Operasi hanya dilakukan bila proses pengobatan tidak berhasil. Hasil operasi yang baik tidak hanya membutuhkan teknik operasi yang tepat melainkan juga usaha yang maksimal, baik dari pasien maupun medis untuk proses penyembuhannya. Pencegahan terhadap sinusitis bergantung pada penyebab sinusitisnya. Beberapa cara di bawah ini adalah cara untuk mencegah terjadinya sinusitis: Biasakan mencuci tangan sesering mungkin untuk menghindari bakteri menempel di tangan dan menimbulkan alergi. Jaga pula lingkungan agar tetap bersih. Mencegah stres dan mengonsumsi makanan yang kaya akan antioksidan, terutama sayur dan buah yang dapat menguatkan sistem kekebalan tubuh sehingga akan mencegah serangan sinus musiman. Jaga kondisi sinus agar tetap kering dan bersih dengan minum air yang cukup agar cairan hidung tetap encer. Menggunakan obat semprot hidung untuk melawan alergen. Menghindari zat-zat yang menyebabkan alergi yang terdapat di lingkungan, seperti debu, asap rokok, dll

Skimmer Atm, You Must Know

Gambar di bawah ini adalah apa yang dikenal sebagai Skimmer, atau perangkat dibuat untuk ditempelkan ke mulut ATM dan diam-diam menggesek kartu debet kredit dan informasi ketika nasabah bank memasukkan kartu mereka ke dalam mesin untuk bertransaksi. SKIMMERS telah ada selama bertahun-tahun, tentu saja, tetapi pencuri secara terus-menerus memperbaiki mereka, dan perangkat digambarkan di bawah ini adalah contoh sempurna dari evolusi itu.




Skimmer khusus ini ditemukan 6 Desember 2009, melekat pada depan sebuah ATM Citibank di Woodland Hills, Calif.




Ini adalah pekerjaan profesional: Perhatikan bagaimana alat tersebut terpasang dengan tepat. Juga, lihat kamera pada lubang kecil (digambarkan di bawah), jelas dimaksudkan untuk mengaktifkan dan merekam gerakan korban ketika ia memasuki PIN mereka di ATM.




Sulit untuk mengetahui apakah ini merupakan Skimmer buatan sendiri, atau yang dibeli dari forum online kriminal. Beberapa SKIMMERS dijual di forum ini sangat canggih, menggabungkan fitur seperti kemampuan untuk mengirim pesan teks SMS ke pencuri 'ponsel setiap kali kartu digesek baru.


Semalam, Kapoltabes Denpasar Kombes Pol Gede Alit Widana telah menemukan alat skimmer itu di sebuah mesin ATM. Bagaimana bentuk skimmer tersebut, apakah sama seperti gambar di atas, Gede akan memperlihatkannya hari ini.

Menurut Gede, alat ini dipasang di mulut ATM. Kemudian, dipasang kamera kecil tak jauh dari mesin ATM tersebut. Sementara tak jauh dari lokasi tersebut pelaku memantau transaksi nasabah via laptop.

"Nanti kita akan mengundang kepala bank di Bali. Alat ini akan kita demokan di depan mereka sehingga mereka bisa mengetahui modus operandi pelaku dan pola antisipasinya, " paparnya.

Skimmer ini bisa ditangkis dengan alat anti-skimmer. Menurut ahli forensik digital, Ruby Alamsyah, sejumlah ATM di Indonesia telah dipasangi alat anti-skimmer.
Hanya saja jumlahnya baru sedikit.

Bagaimana menghindari Skimming?

  • Kenali mesin ATM yang digunakan dengan baik.
  • Kalau bisa, gunakan ATM di lokasi yang sama sesering mungkin sehingga akan terlihat jika terjadi perubahan.
  • Perhatikan bila ada hal aneh pada mesin ATM seperti goresan, bercak, selotip, bekas lem dan hal-hal mencurigakan lainnya.
  • Jika menemukan perubahan atau keganjilan pada ATM, laporkan pada pihak Bank dan tunda/jangan lakukan transaksi.
  • Upayakan untuk mengakses ATM yang ada di dalam bank atau di lokasi yang ramai dan terang untuk meminimalisir risiko.
  • Untuk penggunaan kartu di luar ATM (pada tempat belanja atau restoran) selalu perhatikan apa yang dilakukan petugas pada kartu dan tanyakan jika ada perilaku yang aneh.
  • Jika digunakan saat berbelanja, kartu harusnya hanya digesekkan pada mesin resmi dan mesin kasir, tanyakan pada petugas bila menggesekkan kartu ke alat lain (terutama jika alat itu ada di tempat tersembunyi seperti di balik meja).

Wednesday, January 27, 2010

Osteoporosis dan Latihan Fisik


Dikarenakan angka morbiditas yang terkait patah tulang disebabkan osteoporosis begitu tinggi, upaya langkah-langkah preventif merupakan prioritas utama dalam menguranginya. Pendeteksian secara dini dengan melakukan pemeriksaan massa densitas tulang merupakan satu hal yang penting karena dengan pendeteksian dini kelompok resiko tinggi atau orang yang terkena osteoporosis dapat diketahui. Osteoporosis merupakan suatu penyakit yang ditandai dengan berkurangnya massa tulang dan adanya kelainan mikroarsitektur jaringan tulang yang berakibat meningkatnya kerapuhan tulang yang mengakibatkan resiko terjadinya patah pada tulang sangat tinggi. Selain itu, osteoporosis juga dapat mengakibatkan nyeri pada tulang yang dirasakan secara merata dan perubahan bentuk tulang (deformitas).
Dalam upaya preventif atau pencegahan, selain pengkonsumsian makanan yang mengandung kalsium dan vitamin D3 aktif , pencegahan osteoporosis dapat juga dilakukan dengan melakukan latihan fisik. Latihan fisik merupakan langkah pencegahan yang terbaik dan paling murah pada osteoporosis. Latihan fisik pada penderita osteoporosis ini bersifat spesifik yang berprinsip pada latihan pembebanan dan tarikan (stretching) pada anggota gerak. Latihan fisik seperti jalan, jogging, renang dan bersepeda sangat bermanfaat dalam pencegahan osteoporosis.
Aktifitas jalan sangat bermanfaat dalam pencegahan ostoporosis, karena berjalan merupakan kombinasi gerakan seluruh tubuh yang menimbulkan rangsangan mekanik pada vertebra dan tulang-tulang anggota gerak bawah dan kontraksi intermittent otot-otot tulang belakang. Aktifitas bersepeda merupakan latihan kekuatan otot-otot tungkai yang berkontraksi secara simultan yang akan menstimulasi pembentukan tulang dan mengurangi resorpsi pada tulang. Aktifitas berenang dapat melatih otot-otot punggung, otot-otot anggota gerak atas dan bawah sehingga akan membentuk massa otot yang berguna untuk menyokong daya ketahanan tulang dalam melakukan aktifitas.
Untuk mendapatkan hasil yang terbaik, latihan fisik harus dilakukan dengan frekuensi yang teratur untuk menjaga densitas tulang dan menguatkan otot. Latihan fisik yang dilakukan diusahakan seoptimal mungkin bersifat dinamik (isotonis) dan berulang, dikarenakan dengan latihan yang bersifat dinamik (isotonis) dapat terhindar dari pengaruh meningkatnya tekanan darah dan denyut jantung yang akan terjadi bilamana dilakukan secara statik (isometrik).
Dalam melakukan setiap latihan hal yang perlu diperhatikan adalah latihan fisik yang dilakukan jangan berlebihan atau terlalu berat dikarenakan latihan fisik yang berlebihan dapat memicu peningkatan kehilangan massa tulang. Selain itu setiap orang dengan osteoporosis harus waspada dalam penggunaan tenaga yang berlebihan ataupun gerak yang tidak dikontrol, seperti membuka jendela yang keras, mengangkat barang berat dalam posisi bungkuk ke depan. Maka itu harus diajarkan jongkok dan berdiri perlahan dalam posisi tegak sewaktu mengangkat barang berat. Beban harus dekat dengan tubuh, untuk maksud memendekan lengan tuas sehingga akan mengurangi beban pada vertebra.
Untuk itu diharapkan dengan hidup yang aktif, latihan fisik yang rutin ditambah asupan kalsium yang cukup dan hindari faktor resiko, usaha pencegahan osteoporosis atau hidup nyaman dengan osteoporosis dapat tercapai.

Desk Stretching

Stretching adalah peregangan otot yang diperlukan dan digunakan baik untuk orang sehat atau sakit untuk mengulur, melenturkan atau menambah flexibilitas otot-otot yang dianggap bermasalah. Saat anda dikantor atau melakukan pekerjaan, stretching dapat sangat berguna untuk menjaga kebugaran tubuh atau kelenturan otot-otot anda. Bagi pekerja kantoran menjaga kelenturan tubuh dan otot sangat penting untuk menjaga kebugaran tubuh seseorang pekerja. Tidak terkontrolnya posisi kerja dan posisi postur tubuh yang tidak baik dari seseorang pekerja kantor akan dapat mempengaruhi kinerja. Posisi kerja dan posisi postur yang tidak baik dapat berpengaruh ke leher dan punggung anda yang akan menjadi sakit terutama bagi pekerja yang bekerja di depan layar komputer dengan jam kerja yang berlebihan. Pengaturan posisi dan postur sangat berperan penting dalam mempertahankan kebugaran atau kelenturan otot-otot tubuh. Berikut merupakan macam macam stretching untuk pekerja yang terbiasa kerja didepan komputer dan meja pada waktu lama

Stretching No 1 : Hand Stretching Stretching ini sederhana, genggam jari jari anda dengan keras tahan selama 6 detik dan lepas. Ulangi selama 5-10 kali. Starching ini berguna untuk merelexsasikan otot otot jari jemari dan lengan bawah anda. Otot otot yang terlibat merupakan otot-otot jari, otot-otot pergelangan tangan dan otot-otot lengan bawah anda.


Stretching No 2 : Facial Stretching, Stretching ini dikerjakan dengan mengucapkan huruf A, I, U, E, O dengan penekanan pada pengucapan, tahan selama 6 detik dan lepas. Dilakukan Selama 5-10 kali. Stretching ini berguna untuk merileksasikan otot otot disekitar mukan anda, pipi, dagu, rahang, bibir dan kening.


Stretching No 3: Shoulder Shrugging Stretching ini dilakukan dengan mengangkat kedua bahu atau pundak anda pelan pelan ke arah atas, dengan posisi postur tegak duduk, tahan selama 6 detik dan lepaskan pelan-pelan, ulangi 5-10 kali Stretching ini berguna untuk merileksasikan dan mengulur otot-otot sekitar leher, bahu bagian atas dan puinggung atas (belikat). Sangat berguna sekali bagi pekerja yang duduk dengan durasi lama,seperti rapat.

Stretching No 4 : Shoulder Retraction Stretching ini dilakukan dengan kedua tangan memegang kepala bagian belakang, pelan pelan gerakan lengan ke arah belakang sehingga bagian kedua belikat saling mendekat di tahan selama 6 detik dan lepaskan pelan-pelan, ulangi 5-10 kali. Gerakan ini berguna untuk meregangkan otot –otot punggung atas terutama kelompok otot otot daerah tulang belikat.

Stretching No 5: Neck Side Bending Stretching ini dilakukan dengan kedua lengan disamping, lalu gerakan leher ke salah satu sisi kanan atau kiri perlahan lahan sampai gerakan tersebut maximum atau tidak timbul gerakan lagi. Gerakan tersebut ditahan selama 6 detik ulangi selama 5-10 kali. Gerakan ini berguna untuk meregangkan otot otot leher bagian samping luar dan otot otot bahu.


Stretching No 6.Neck Rotation Stretching ini dilakukan dengan kedua lengan disamping tubuh, lalu gerakan leher dengan memutar leher kebagian kanan atau kiri perlahan lahan sampai gerakan tersebut maximum atau tidak ada gerakan lagi, tahan gerakan tersebut sampai 6 detik dan ulangi selama 5-10 kali. Gerakan ini berguna untuk meregangkan otot otot leher samping.



Stretching No 7: Neck Flexion Stretching ini dilakukan dengan posisi tubuh tegak, lengan disamping kanan dan kiri, gerakan leher menekuk ke bawah sampai maximum sampai terasa tarikan otot otot leher, tahan sampai 6 detik dan ulangi 5-10 kali. Gerakan ini berfungsi untuk meregangkan otot otot leher bagian tengah atau pas ditengkuk.


Stretching No 9: Shoulder Adduction. Stretching ini dilakukan dengan posisi lengan atas pada posisi 900, setelah itu rapatkan lengan atas ke tubuh pelan pelan lalu tekuk siku anda pelahan lahan juga menyesuaikan dengan posisi lengan yang menekuk, sampai terasa adanya tarikan pada otot otot bahu bagian samping, tahan selama 6 detik lalu lepaskan perlahan-lahan, ulangi 5-10 kali.


Stretching No 10: Shoulder Half Flexion bilateral. Stretching ini dilakukan dengan keduaa tangan saling menggenggam, lalu gerakan kedua tangan tersebut keatas sampai sejajar dengan muka, lalu putar bagian tangan dari mengepal keduanya menjadi terbuka keduanya dengan memutar tangan tersebut, tahan selama 6 detik ulangi 5-10 kali. Stretching ini melibatkan otot-otot lengan atas dan bawah sampai tangan.


Stretching No 11: Shoulder Full Flexion bilateral. Stretching ini hampir sama dengan stretching shoulder half stretching bilateral hanya saja gerakan bahu ditambah sampai diatas kepala tahan sampai 6 detik ulangi 5-10 kali. Stretching ini berfungsi mengulur otot otot seluruh lengan.


Stretching No 12: Shoulder Lateral Bending. Stretching ini dilakukan dengan kedua tangan kebelakang, salah satu tangan memegang siku lengan lainnya, setelah itu tarik perlahanlahan sampai adanya tarikan pada bagian bawah samping bahu anda, tahan smapai 6 detik dan ulangi 5-10 kali. Stretching ini berfungsi meregangkan otot tricep.



Stretching No.13: Hip Stretching Stretching ini dilakukan bisa dilakukan pada posisi duduk ataupun berdiri. Untuk posisi duduk, diusahakan duduk dengan tegap dan posisi lutut diusahakan 90 derajat. Angkat tungkai bawah anda dengan menekuk lutut, dekatkan ke bagian dada anda, tahan sampai 6 detik ulangi 5—10 kali. Stretching ini berfungsi meregangkan otot bagian paha bawah dan otot bokong.



Stretching No.14: IllioTibial Stretch Stretching ini dilakukan dengan posisi duduk tegap, satu tungkai melipat ke tungkai sebelahnya, dengan tangan memegang lutut pada tungkai yang berlawanan, tarik lutut tersebut dan leher menengok ke sisi yang berlawanan pada tungkai yang ditarik tahan 6 detik dan ulangi 5-10 kali..Stretching ini berfungsi untuk otot otot sisi samping luar paha anda.

Stretching No.15 : Pectoral’s Stretch Stretching ini dilakukan bisa pada posisi duduk atau berdiri. Dengan duduk atau berdiri posisi badan tegap, kedua lengan pada posisi kebelakang dengan saling menggenggam. Setelah itu puter balik telapak tangan ands sekaligus lalu dorong kebawah hingga seluruh bagian dalam lengan anda terasa tertarik tahan hingga 6 detik ulangi 5-10 kali.. Stretching ini berfungsi untuk otot otot pada lengan bawah dan atas anda

Stretching No 16: Calf Stretching Stretching ini dilakukan pada posisi berdiri. Dengan salah satu sisi tungkai pada bagian lututnya menekuk dan yang satu tungkainya lagi lurus kebelakang, dan telapak kaki sisi tungkai yang lurus kebelakang menapak dengan lurus kedepan , anda akanmerasakan tarikan pada sisi otot otot betis anda tahan sampai 6 detik dan ulangi 5-10 kali . Stretching ini berfungsi meregangkan otot-otot pada betis anda Nb: Tidak semua latihan diatas cocok untuk anda, konsultasikan terlebih dahulu keluhan anda pada fisioterapis anda

Knee Glossory

ARTHROSCOPE: A camera attached to a video monitor

ARTHROSCOPY: noninvasive way to do surgery. A camera attached to video monitor is inserted through small incision.

BURSAE: small fluid filled sacs providing lubricating surface between surfaces that need to move

CARTILAGE: Connective tissue that cushions the ends of bones and is found between bones – absorbs shock. Articular Cartilage is a smooth coating on the end of all bones that make up the knee joint. Meniscular Cartilage protects the articular cartilage and separates the bones of the knee. It is a spongy shock absorber.

Chondromalacia Patellae : chronic deterioration of the cartilage coating the back surface of the kneecap.(also called Lateral patella compression syndrome, anterior knee pain)

Extensor Muscle: Any muscle that causes the straightening of a limb.

Fascia : fibrous connective tissue covering, separating, or binding muscles and other soft structures of the body.

Femur: Thigh Bone

Hamstrings : Muscles of the back of thigh

Hip Abductors: Muscles of the outer hip, attached to the thighbone

Hip Adductors: Muscles of the inner thigh.

Iliotibial Band : A connective tissue that runs from your hip to your outer knee.

Knee Tracking: The kneecap (patella) slides over a groove (patellofemoral groove) on the lower end of the thighbone (femur) as your knee bends and straightens.

Ligament : Fibrous connective tissue that connects the bones and keeps joints stable and controls their range of motion.
anterior cruciate ligament (ACL) in the center or the knee
posterior cruciate ligament (PCL) in the center or the knee
medial collateral ligament (MCL) outside the knee joint, inner side of leg
lateral collateral ligament (LCL) outside the knee joint, outer side of leg

MRI (Magnetic resonance imaging): diagnostic technique using magnetic fields, radio frequency, and a computer to produce detailed images of structures within the body. shows soft tissue (and bones) can also show the joint in motion

Patella: kneecap

Patellofemoral: The junction of the kneecap and thighbone

Patellofemoral groove : A groove on the lower end or the thigh bone (femur), which the kneecap (patella) slides over

Patellofemoral Pain Syndrome (PFS) or Runners Knee: Injury and pain caused by incorrect knee tracking – which results in the kneecap rubbing against the thighbone when moving. Can lead to Chondromalacia Patellae

Pronation (the inward roll of the foot as the arch collapses after the heel contacts the ground)

Quadriceps : Large Extensor Muscle of the front of thigh divided into four parts (quad means four) that unite in a single tendon at the knee.
rectus femoris: middle front division of the quadriceps
vastus lateralis: outer front division of the quadriceps
vastus intermedius: front division of the quadriceps
vastus medialis: inner front division of the quadriceps

Runners knee : see Patellofemoral Pain Syndrome

Tendon: fibrous connective tissue joining muscle to bone.

Tibia: shinbone


Safety Tips for back pain from The National Safety Council











Back Care

Your back is involved in every job you do. Sitting. Standing. Walking. Lifting. Bending. Reaching. Running. Evey when you’re resting or sleeping, your back is on the job. It takes only a few minutes each day to take good care of your back. Remember these basics:
Keep your back and abdominal muscles strong. This lets them support the curves at your neck, middle back and lower back.
There’s a right way to stand, sit, lift, turn, walk and sleep. Learn it and live it!
Keep your weight low to reduce the strain on your back.
Learn how to cope with worry and stress.
Get professional help fast if your back hurts.

Cumulative Trau
ma

Using any motion once or twice may not cause problems. But when the same motion is used repeatedly for a long time, it can cause strain, discomfort, illness and disability and may require corrective surgery. These problems are called cumulative trauma, a condition that accumulates over time.
Make sure to use tools, machines or equipment in a way that won’t cause strain over time.
Search for ways to work that will accommodate your needs. Don’t try to force your work patterns to fit the job.

Safe Lifting
Safe Lifting is a challenge. Learning correct lifting techniques is vital to health and helps avoid the back pain that afflicts eight out of 10 Americans. Tips for safe lifting include:
Use common sense and take your time.
Wear the right personal protective equipment (ppe) for lifting and carrying. PPE may include the use of gloves, safety glasses, chemical specialty aprons, etc.(for moving hazardus chemicals) or mechanical equipment to assist with material handling.
Avoid bending, reaching and twisting.
Use the tilt test to estimate an object’s weight. (Tilt test: Get a good grasp on one of the object’s edges. Slowly try to tilt it up. If it’s difficult to move, it’s too heavy to lift by yourself. Get someone to help or use a lifting aid.)
Lift from the low risk position only.
Grasp the object securely.
Draw the object as close to you as possible.
Make sure your footing is secure.

Working with Computers

Working with a computer doesn’t have to be a strain. To make your work more pleasant and less stressful, stay on the lookout for warning signs that your working conditions aren’t right.
Eyestrain, Headaches: You may need new glasses or contacts. The computer screen is too bright or not bright enough, or not positioned correctly. Glare or reflections are distracting. The lettering on the screen isn’t crisp.
Sore Hands, Wrists, Arms, Shoulders: You aren’t sitting properly. Make sure you have arm and wrist support. Raise or lower the keyboard.
Sore Back: You’re slouching, or working in a chair that doesn’t give enough support. Try placing a rolled up towel in the small of your back to ease the strain.
Numbness in your Legs and Feet: The chair may be restricting blood circulation. Try using a footrest or a chair with a downward-curving front edge.

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