Massage Therapy: Treating Tendinosis (Tennis Elbow) with SCIENCE
Tags:achilles tendinosis cause individuals chronic condition chronic injury cross fiber friction massage deep transverse friction massage elbow pain functional status grip strength inflammatory drug lateral epicondylalgia lateral epicondylitis muscle contraction nsaid patellar tendinosis phonophoresis randomized clinical trial tendinosis tennis elbow transverse friction ultrasound application voltarenTendonosis is misnamed tendonitis (an inflammation of the tendon) when in reality the tendon has suffered chronic injury, often from when your body has tried to reverse a moving load. This time when injuries are most common is the “eccentric” phase of muscle contraction, as compared to the “concentric” phase of picking up a load.
Many tendinosis conditions cause individuals a great deal of pain, e.g.:
- achilles tendinosis
- patellar tendinosis, or “jumper’s knee”
- tendinosis on the medial or lateral epicondyl of the humerus (”golfer’s” or “tennis elbow” respectively)
See the latest treatments beyond the jump:
Massage Therapy: Assessing Carpal Tunnel
Tags:arm pain carpal tunnel massage massage therapy thoracic outletWe’ve all heard of “Carpal Tunnel Syndrome” — that pain or numbness going down the wrist and into the fingers. However, there are many similar symptomologies. This is a quick guide to figuring out exactly which pathology may be causing pain in the arm. Many times, the median nerve is not actually being compressed by the flexor retinaculum in the carpal tunnel at all; muscles entrap the nerve before it even reaches the wrist.
To assess carpal tunnel-like syndromes, assess in order:
CERVICAL DISK PATHOLOGY
You can quickly check for the possibility of a herniated nucleus pulposus (herniated disk) or other vertebral problem by a quick compression/distraction test. Compressing the neck (cervical compression — press the head straight down) should reproduce the symptoms; pulling on the neck (cervical distraction) should relieve the symptoms. You can also check for a cervical disk pathology by having the client extend his/her neck and SLOWLY rotate the head left and right.
THORACIC OUTLET SYNDROME
Having ruled out a cervical disk pathology, check for thoracic outlet syndrome — compression of the nerves of the brachial plexus. Two muscles commonly entrap the nerves of the brachial plexus: the scalenes and the pectoralis minor.
Scalenes
To test for scalenes entrapment, examine Adson’s sign. This test is an indicator that the client may have a scalenes problem, as will a history of forward head posture or paradoxical breathing and a palpatory finding of the scalenes as ‘locked short.’
Pectoralis Minor
The pectoralis minor can entrap the brachial plexus as well. Test for it using the Wright Abduction Test (see this Youtube video), where the client moves his/her arm into maximum abduction and leaves it there for a minute. Numbness/tingling/etc. in this position is a positive sign. Also look for a history or assessment of forward (protracted) shoulders.
PRONATOR TERES SYNDROME
The median nerve passes through the two heads of the pronator teres before entering the carpal tunnel. You can quickly test for pronator teres syndrome using a manual resistive test (”don’t let me move it”) of pronation of the symptomatic arm. By having the client forcibly pronate against your attempt to supinate his/her forearm, you shorten the muscle and therefore increase the pressure on the median nerve if it is entrapped.
TINEL’S SIGN
Using Tinel’s sign helps differentiate where the nerve innervating the wrist is entrapped. Perform Tinel’s sign at each location of possible entrapment: the carpal tunnel, the pronator teres (distal to the inside of the elbow), the pectoralis minor, and the scalenes. If the compression is occurring in the carpal tunnel, you will produce pain only at the carpal tunnel. Otherwise, you will cause nerve pain at each site up to and including the actual culprit.
PHALEN’S TEST
Finally, using Phalen’s Test — forced wrist flexion with the elbows extended and hands apart — allows a final double check for carpal tunnel. This maneuver increases the pressure in the carpal tunnel. With the wrists apart, a positive Phalen’s Test is a strong indicator of carpal tunnel. With the dorsal surfaces of the wrists pressed together, as this test was originally proposed, Phalen’s test could also indicate a pronator teres problem because of the extreme pronation in this position.
MYOFASCIAL TRIGGER POINTS
Active trigger points can cause referred sensation. Refer to a trigger point book that includes pain patterns. See e.g. The Concise Book of Trigger Points By Simeon Niel-Asher from pages 130-135.
There you go!
Ten minutes and some simple tests are all you need to understand what’s likely causing “Carpal Tunnel” arm pain.
Answer Difficult Questions
Tags:A friend gave me the following advice for answering hard questions:
- Avoid Adjectives
Don’t make judgments one way or the other. - State Facts
Make simple, declarative statements. - Stick to the Question
Don’t answer other questions that you want them to ask, just the questions they ask.
To summarize: don’t embellish. Talking too much will get you in more trouble than talking too little.
It was a random conversation, but I thought these were some good points. Maybe Roland Burris needs to read this!
Chocolate Coconut Almond Cookies, Gluten Free
Tags:nutritional dataMy mom and I just made up this reasonably low-carb, high-protein cookie recipe. The cookies are a bit gooey inside and delicious!
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Volunteering at Guus Kieft School
Tags:amsterdam evolution guus kieft school study abroad volunteeringI’ve done a lot of amazing things while living in Europe, and I feel that I’ve matured emotionally and grown as a person. I’ve already written about how to volunteer in Amsterdam, but I haven’t discussed what may be my favorite study abroad experience. With the school year coming to a close, I recently gave my last evolution lesson at the Guus Kieft School. I’ve always loved volunteering, but I never imagined how much fun and pleasure I would take from volunteering with Dutch children.
It is a so-called sociocratic school, where the children are treated as adults and choose what they want to learn. A mixed-age semi-private elementary school, it’s the most chaotic school I’ve ever attended, but it’s definitely somewhere I could imagine sending my own child one day. The children are surprisingly mature, sociable, and knowledgeable about whatever interests them. Although I sometimes harbor doubts of how they will cope with gaps in their knowledge and adapt to the more rigid format of secondary school, I think that in general the students will emerge with the skills to succeed and with a more open worldview.
One day, I was climbing trees with a few children when the head teacher, Eliane, called them inside. They instantly ran inside with as much energy as they had been playing, sat around on some couches, and started calmly planning a theatre production with their teachers.
Initially, I came to teach English and just socialize with the children. Although the children are all 5-12 years old, I quickly realized that nearly all of them already spoke passable English, either from an English-speaking parent or just having picked it up. I was amazed, and decided to plan weekly lessons in evolution, a subject that I think many students of all ages fail to be taught in depth, if ever. Several students were interested, and I often had Eliane or another volunteer translate as I gave miniature, hopefully fun PowerPoint presentations of biology topics… heredity, Charles Darwin, artificial selection, natural selection, variation. One day we played evolution games on the computer, where boys vs. girls tried to make whatever shaped animal I told them to.
The bloemen (pictured at right) that I received as a surprise goodbye gift from Eliane are bittersweet. As they’ve started to wither over the past days, it’s hitting me that I will be moving away in a scarce three weeks.
Contact information for the Guus Kieft School.
How to learn Ruby on Rails in one week
Tags:programming rails rails 2.0 rails2 ruby ruby on rails screencasts speed learning tutorials web 2.0 web development webcomicRead and view these in order:
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Why’s (Poignant) Guide to Ruby
a very readable webcomic that teaches & is totally free (Attribution-ShareAlike)
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Programming Ruby - The Pragmatic Programmer’s Guide
This will take you from newbie to expert Ruby programmer
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Getting Real by 37 Signals
This is a fantastic free-to-read-online book about design principles of web development (with Rails).
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Must Know Facets of Ruby on Rails
The 8 essential things you have to know to understand Ruby on Rails.
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Ruby On Rails Quick Start - From Nothing To A Simple Database Driven Web Application In Ten Simple Steps
Great guide to turn you on to fully functional rails in five minutes
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How to use SQLite in Ruby on Rails
SQLite is a SQL database that’s great for small database
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Ruby on Rails from Scratch Part I
$9 Peepcode screencast that shows you how to get up and running with rails in 75 minutes
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Ruby on Rails from Scratch Part II
$9 Peepcode screencast that explains the finer points of rails in 80 minutes
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Ruby on Rails: Test First Development
$9 Peepcode screencast that explains the importance and easy of test-first development in ruby
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Rails Code Review .pdf
$9 Peepcode guide meant for beginners that is really top notch and covers a ton of topics
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How to Avoid Hanging Yourself with Rails
.pdf presentation on how to use ActiveRecord right the first time
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ActiveRecord Relationships Cheatsheet
covering belongs_to, has_many, etc. Printable!
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Rails2 .pdf
$9 Peepcode guide that discusses all the new features of Rails2, which is pretty standard as of 2008.
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RailsCasts.com
Free Ruby on Rails Screencasts; several new ones discuss features in Rails 2.1.
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Multiple belongs_to relationships
What if your article has three authors, each of which you want to reference with a foreign key?
Total cost? $45. The total cost of one credit hour of computer science at my university, Virginia Commonwealth University? $245. Most courses at my university are three credit hours.
derek’s stream of consciousness guide to amsterdam
Tags:I wrote this to a friend — it’s mental vomit of the best things to do in two days in Amsterdam. FYI for anyone who might ever be attending the VU!! And I apologize for the spelling mistakes and writing style. I call this “don’t worry, everyone here speaks english — a quick guide to a’dam.” Enjoy!
quick guide to the city: public transport is super easy but if you’re staying in the city center you can walk everywhere — but to take a tram you buy a “strippenkaart” from either the machines that sell them or a lot of stores e.g. in centraal station, i think ako nieuws sells them; you stamp one strip for each zone plus one for yourself (i.e. traveling within a zone is 1 + 1 = 2 strips, stamp the second; or just tell the conductor where you’re going and he/she will do it for you). the markets in amsterdam are really great, i like waterlooplein which has mostly clothes, nieuwmarkt whenever it’s open which i’m not really sure about, and albert cuypmarkt a bit southeast of the city on albert cuypstraat, maybe 25 minutes walking max from centraal station but close to some. albert cuypmarkt is close to some metro stops like weesperplein or something…
at night rembrandtplein is awesome (stop on some random trams, i always bike or walk there, it’s just south of muntplein where there’s a big tower), leidseplein (stop on #5) is super popular but really touristy, personally i like dutch bars and there’s tons of random ones & they’ll be cheaper than other places. there’s a “jaeger bar” (1,50 euro jaegermeister shots) called st. christopher’s hostel which you can easily get to by walking north from the dam not on the main street with the trams but the street behind the national penis i mean wwii remembrance obselisk. it’s on the right, Warmoesstraat 129
for a cool view of the city you can walk behind and to the right (east) of centraal station and follow the signs to post-cs/stedelijk museum (a modern art museum, temporarily located there)
as far as museums van gogh and rijks are both really nice, i also like a few others like the fotographie museum but you obviously aren’t here very long.
for fast food i like kantjil to go, which is takeaway indonesian food on nieuwzijds voorburgwal just north from the spui on the tram #5, (actually in front of that tram stop, look for a red and white box of takeout food next to a restaurant called kantjil and de tijger, just south of the amsterdam historical museum and north of the american bookshop). maoz falafel which is a bit ubiquitous (there’s one on the main drag of tram #5, leidsestraat which goes from leidseplein to koningsplein over the canals) is also great. new york pizza apparently sucks… i also know a great dutch place i can take you.
if you want to just walk around, go west and south from the city center and you’ll end up in the jordaan/nine streets of amsterdam, which is pretty and has boutique shopping. kalverstraat the main shopping street runs through the dam, it’s pretty hard to miss.
don’t eat mushrooms (sold at “smart shops”) and fall into a canal! those are mutually exclusive — feel free to do either (the second one is more dangerous) but not at the same time!! hahaha.
as far as coffeeshops go (places that sell weed, coffee houses sell coffee), if you’re into that my friends have recommended to me: “de dampkring” just north of koningsplein (stop on tram #5), “homegrown fantasy” (by nieuwzijds voorburgwal, also a stop on tram #5 and the name of a street), and “the bluebird” for hashish (located between waterlooplein and nieuwmarkt). you can have weed on you outside the coffeeshops, really you can smoke it on the street it’s no problem. i’ve seen people do so, especially in the red light district. i’m pretty sure people get harassed more for bicycling improperly i.e. without lights than for smoking weed. if your hostel is cool there’ll be a room that you can party in.
the van gogh museum is really easy to get to, just take tram #5 and get off at hobbemastraat, the stop between leidseplein and museumplein. the “heineken experience” is Tweede Weteringplantsoen 21, just walk from leidseplein southeast past a club called paradiso and a small plein with a hard rock cafe to your south (the holland casino is just south of that) and keep walking for about 5 minutes until you have to walk across a traffic circle and then you’re there, just look for the signs.
if you’re at all into classical music, we should definitely hit up the concertgebouw while you’re here. 7,50EUR for any concert, no matter who is playing, or we could go to the free lunchtime concert wednesday at 12:30pm (we should be there by noon).
i don’t know if you’re flying into amsterdam, if so you can really easily take a train to amsterdam centraal station, which is the city center. or hope on one to amsterdam zuid/WTC and take anything heading north, e.g. tram #5 or metro #51.
of course, a lot of this stuff but not all of it is represented on derek’s google map of amsterdam
have fun and take it easy!
Koninginnedag 2008 (Queen’s Day)
Tags:amsterdam Koninginnedag orange orange craze Queens Day study abroad the netherlands
Queen’s Day is my new favorite holiday. Taking place annually on April 30, everyone in the Netherlands parties outside to celebrate the Queen’s birthday. In a typically Dutch twist, they actually celebrate on the old Queen’s birthday since it generally has wonderful weather.
To celebrate the House of Orange, everyone dresses up in the Dutch national color, orange. Orange is also my favorite color, so I was more than ready for Queen’s Day. I have never seen so many ridiculous hats or nationalist (provincialist) symbols in one place!
I love that on Queen’s Day, the country turns into a free market (Dutch: vrijmarkt) — anyone can sell anything, anywhere. Basically, Amsterdam had a city-wide yard sale. I was pleasantly surprised that Dutch people also think people are interested in buying their household shit that they don’t want, and by late afternoon no one seemed to be selling much of anything worthwhile. Street food vendors were extremely successful and common across the city (I quite enjoyed my five Vietnamese loempias, or fried spring rolls made with rice paper).
People — my friends and myself included — go out the night before on “Queen’s Night,” when the city hosts almost as many free concerts as on Queen’s Day. I don’t recommend it, unless you’re biking — the night buses were so overcrowded that they were leaving people waiting for the next one.
Unlike most holidays I’ve seen overtake the city of Amsterdam (Christmas, New Year’s), Queen’s Day had surprisingly few tourists. Of course, few is relative… there were probably a few hundred thousand foreign tourists swarming the city, but they were matched or surpassed by Dutch people celebrating their only national holiday.
It’s not all great, though — many Dutch people are over it, since they’ve been celebrating it since their birth. Plus, in any of the crowded areas (any of the pleins, most of Vondelpark, and anywhere there is a concert), it can get a bit rowdy. It’s not a fun holiday if you aren’t a party person. However, I love it.
I know that this won’t be my last Queen’s Day, even though I’m moving away this summer when my exchange ends. Like Schwarzenegger, I’ll be back.
Suburbia in the US and the Netherlands
Tags:amstelveen amsterdam differences between the united states and the netherlands richmond study abroad suburbia suburbs the netherlandsI’ve recently been amazed by the incredible differences between urban sprawl outside of Richmond, VA (i.e. in suburbs like those I am from) and outside of Amsterdam. Compare these two maps, both about 10km away from the downtowns of their respective cities:
10km south of Amsterdam, in Amstelveen
10km north of Richmond in what is still called the City of Richmond (click “View Larger Map” and check out Street View for a real look at the area)
These areas are of what I assume are comparable income levels*, but as you can tell, the housing and environment are way different. The Dutch neighborhood is extremely typical of what I’ve seen in Amstelveen — tall buildings of apartments for families, short, connected houses with connected but fenced yards, and farmland. All right next to each other. Fast public transport is a few minutes walk away, there are nearby (walking- or biking-distance) shops, and families don’t have much space of their own. Tons more stuff is within biking distance, including a sports park.
*Richmond data: $250,000 median house price, with 50% of people renting, and a $37,000 median salary according to http://www.city-data.com/zips/23227.html
The US is covered in suburbs like the one shown above. The nearest bus stop to get into Richmond city from that American neighborhood is a 4km walk south along a road with no sidewalk, so a car is mandatory. It’s practically impossible to walk to anything interesting. Each house has its own yard, and there are absolutely no housing skyscrapers anywhere close until you get to the heart of the city. And there is zero farm land, even though most of the land is probably arable… Anything “undeveloped” is left as fallow woodland. You’d have to drive at least a dozen kilometers in the right direction to find some small farms. Most of those — at least near where I’m from — are being bought up and developed into offices or shopping malls.
I find it amazing that people live so close together here in the Netherlands. It doesn’t really affect me as a student — my rent here (260EUR or something per month with utilities; I don’t pay it since I’m studying through ISEP) is way cheaper than typical Richmond rent ($450+ without utilities and with roommates, maybe somewhat cheaper if you share a room with a roommate in a dorm, but not cheaper in the single-room dorms). Of course, the rooms in the US are generally bigger, but for there being so many of them and so few rooms in Amsterdam, I would think rent would be more comparable. But, on the other hand, I would never live this far away from the center of Richmond or any “college town,” since I would likely need a car — 45 minute commutes on a bicycle are no fun when there isn’t a bike lane nor room of a bicycle. Suburbia is just yet another interesting difference between the US and the Netherlands.
2nd Floor Chili Cook-Off
Tags:amsterdam student life study abroad the guesthouse
I like living in the Guesthouse. Sure, the bathrooms smell like piss, it’s apparently more expensive than comparable rooms for Dutch people, and I’m living in Amstelveen with a view of a giant, empty field. But other than that, I like living among only international students — who all speak, as my Argentinian neighbor put it, “Guesthouse English.” I have the rare opportunity to learn and grow from dozens of unique worldviews and cultural experiences every day. And, in a recent case, I had the opportunity to sample world cuisine in the comfort of what is basically my living room.
Despite DUWO, the housing corporation, having a “no partying” rule (yeah, right), we had a common dinner party on my floor about two weeks ago. What was supposed to be a smallish birthday celebration with lots of food expanded, in typical Guesthouse fashion, to a huge, crowded, and raucous party. With lots of food.
I made a humongous pot of spicy American chili with ground beef and quinoa that was demolished by the end of the night. There was a really spicy Cameroonian sauce, fried fish, quinoa patties/cakes, Chinese spicy chicken, boiled plantains, pastries, and more. I even helped my two Chinese neighbors bake a cake, that I couldn’t eat.
It turns out that plantains are absolutely delicious in chili. I never would have known without our kitchen party!
It was a fun night… the sort that I know I will miss when I leave the Netherlands.