Haaibo! I think I have a Hernia!

By: Bailey Cockerill

Hernia’s are caused when there is a weak area of muscle, tissue or membrane allowing the underlying internal organs to protrude through…ouch!!

The most common types are;

• Inguinal, found in the groin
• Umbilical, around the belly button
• Incisional, through a scar
• Hiatus, a small opening in the diaphragm that allows the upper part of the stomach to move up into the chest.
• Congenital diaphragmatic, a birth defect that needs surgery 

But these are only a few of the many various types of hernias that can occur, due to our vast anatomy.

“So, basically if I have weak muscles then I’ll get a hernia?”

No, we’d be seeing a lot of people walking with funny bulges all over the place if that were the case. Only if those weak tissue area’s are combined with an increased pressure due to something like the following, could you possibly develop a hernia;

• obesity or sudden weight gain
• lifting heavy objects
• diarrhea or constipation
• persistent coughing or sneezing
• pregnancy

Regardless of where the hernia is, it will be classified or graded into one of the following categories;

• Reducible hernia: This term refers to the ability to return the contents of the hernia into the abdominal cavity, either spontaneously or manually.
• Incarcerated hernia: An incarcerated hernia is no longer reducible. The vascular supply of the bowel is not compromised. Bowel obstruction is common.
• Strangulated hernia: A strangulated hernia occurs when the vascular supply of the bowel is compromised secondary to incarceration of hernia contents.

Symptoms?

• Asymptomatic hernia
• Presents as a swelling or fullness at the hernia site
• Aching sensation (radiates into the area of the hernia)
• No true pain or tenderness upon examination
• Enlarges with increasing intra-abdominal pressure and/or standing
  
• Incarcerated hernia
• Painful enlargement of a previous hernia or defect
• Cannot be manipulated (either spontaneously or manually) through the fascial defect
• Nausea, vomiting, and symptoms of bowel obstruction (possible)
  
• Strangulated hernia
• Symptoms of an incarcerated hernia present combined with a toxic appearance
• Systemic toxicity secondary to ischemic bowel is possible
• Strangulation is probable if pain and tenderness of an incarcerated hernia persist after reduction
• Suspect an alternative diagnosis in patients who have a substantial amount of pain without evidence of incarceration or strangulation

Can it be fixed?

Yes, but most likely it needs to be done surgically as hernia’s are structural defects. Basically, a reinforcing mesh needs to be place over the weakened tissue, to ensure that the protrusion through that area can be prevented from getting worse.

Post operatively, muscular strengthening needs to take place gradually, in order to help with structural support.

Ensure that your rehabilitation specialist/physical therapist and doctor have good lines of communication to fully understand the type of hernia and how the repair was done to give you the best possible treatment!

Happy healing J

Alzheimer's and exercise

By Robert Carew

Alzheimer’s is an irreversible, progressive brain disease that slowly destroys memory, thinking skills and eventually the ability to do the smallest tasks. In most people symptoms usually appear after the age of 60.

Alzheimer’s is named after Dr. Alois Alzheimer who, in 1906, noticed changes in the brain tissue of a woman who had died of an unusual mental illness. 

Memory loss is typically one of the first signs. As the disease progresses, memory loss worsens, and changes in other mental abilities arise eg. getting lost, trouble handling money and paying bills and repeating questions. Eventually damage occurs in those regions of the brain controlling language, reasoning and conscious thought. People begin to have problems recognizing friends and family and become delusional, paranoid and aggressive. In severe Alzheimer’s, people cannot communicate and are completely dependant on others for care.

The causes of Alzheimer’s are not yet fully understood. It is a series of complex events taking place in the brain over a long period of time. The causes seem to be a mix of genetic, environmental and lifestyle factors.

The main focus of Alzheimer’s treatment is to slow down or delay the symptoms of the disease. There are several medications approved for the treatment of Alzheimer’s. They help to maintain thinking, memory and speaking skills.

Studies have shown that exercise is beneficial for people with Alzheimer’s disease. Benefits of regular exercise include maintenance of motor skills, decreased falls, and a reduced rate of progression of the disease.

Light cardiovascular and resistance exercise is recommended. Walking is always a good exercise, coupled with light weights and stretching. The main goal of exercise is for enjoyment. It should be a social and fun activity for the patient. Functional, everyday activities will help them cope with their activities of daily living.  I would suggest 15-30 mins, at least 3x a week, in order for it to be beneficial.

For the Biokineticist, patience is essential. In my experience, care should be taken to make sure not to try and correct the person and make them aware of their memory loss. Answer questions as if they haven’t been asked 10 times before.

Motivation is a big factor, so try and find activities that the person enjoys and always be positive and encouraging. They may get agitated and aggressive. Don’t take it personally.

Research is still being done to better understand Alzheimer’s and its treatment. This effort is bringing us closer to improving management and prevention of this devastating disease. 

Muscle Cramp

By Nicole Picas

Overview and Definition

A common complaint at the practice where I work is that of skeletal muscle cramps, that is, cramps of the muscles involved in moving the limbs. A spasm is an involuntary muscle contraction. If the spasm is prolonged, it becomes a cramp. Thus, a muscle cramp is defined by emedicinehealth.com as: “an involuntarily and forcibly contracted muscle that does not relax”.

Prevalence

Muscle cramps appear to be more prevalent in the older male patients; however, it can affect anyone. Muscle cramping occurs most commonly in the lower limbs, particularly the calf muscles, hamstrings and the feet.

Symptoms

Those of you who have experienced muscle cramps will know that they can range from extremely uncomfortable to excruciatingly painful. These cramps may last for a few seconds to several minutes. One can generally see and feel the tight, hardened muscle underneath the skin.

Causes

Causes of muscle cramps may be dietary related – dehydration, or low levels of calcium, potassium or magnesium. They are often caused by prolonged physical exertion or can be due to nerve or muscle injury. Cramps can also be caused by certain medications; this may be listed as a side-effect. (emedicinehealth.com)

Treatment

The intense pain associated with muscle cramps often results in one tensing the affected muscle even more. In order to relieve a muscle cramp, one needs to relax the involved muscle. Heat and gentle massage may assist in relaxing the muscle, and stretching can aid in relieving symptoms and reducing spasms. The underlying causes, such as dietary deficiencies, must also be addressed. (emedicinehealth.com)

So, next time you are rudely awoken in the middle of the night with that familiar intense pain in your calf muscle, try to stretch out the muscle and gently massage it until the symptoms subside.

Spasm: A sudden, involuntary smooth or skeletal muscle twitch ranging in severity from merely irritating to very painful; may be due to chemical imbalances. In spasms of the eyelid or facial muscles, called tics, psychological factors have been implicated. Stretching and massaging the affected area may help to end the spasm. A cramp is a prolonged spasm; usually occurs at night or after exercise.

Marieb, E.N. (2004). Human Anatomy & Physiology. (6^th ed.). Pearson: New York.