News Flash – Sore Knee Cap Leads to Sleepless Nights – How to Deal With the Pain – Special Report

Do you have sore knee caps?

Sometimes the pain for a sore knee cap is due to climbing or descending a set of stairs, or getting up from a seated position. Other times it is caused from sitting in a position where your knees are bent, and after hours of the same position, the pain can get to be really bad! – Can you relate to any of these scenarios?

These are all scenarios the involve daytime activities (unless you walk in your sleep) But what if you end up moving your legs into this same bent position while sleeping? Gosh, What a thought! The truth is you will end putting your knees through the same irritation they experience in your waking moments, but you might not even know it. – Many people do not think about this but the irritation can also build at night when you are not even really conscious of the problem.

This can result in a restless feeling wherein you will not get the sleep and rest that you need, and these days we all could use as much sleep as we can get! Moving around at night and allowing your knees to move into the same irritating position can actually result in additional irritation and could possibly worsen your pain issues you are having currently.

How Can I Help Control My Legs At Night?

The answer to this question will help ease the discomfort you have… Many times you can help control sore knee caps with a simple knee brace. These braces can help control your knee cap from deviating into painful and more unstable positions whether you are still awake or not.

Well designed knee braces are designed to move with the shape of the knee. They are helpful because they help restrict excessive positions where the pain comes due to misalignment. Some supports are more restrictive than others so it is always good to ask the brace provider for optimal brace for your needs.

Implementing the use of a knee brace both while sleeping and while awake has proven effective in alleviating many common pains and soreness that inflict so many people’s knee caps. – Do not look back regretting what you could have done to help support your knee.

Question: Do you know how the soreness sets in for you? – We would like to know.

Aluminum Cans Recycling Business Ideas – Building a Big Business Without the Bend Over Back Pain

How many times have you noticed the aluminum cans that litter the side of the highways? It doesn’t look very nice does it? Well, the great news is, you can help and you can make great bucks at the same time. But the work is time consuming and hard on the back bending down to pick these valuable pieces of money laying around everywhere. It really can get tiresome doing it yourself, but being in this business, does not mean you have to be the one that collects the cans!

People just love their soft drinks. And drinks that come in the aluminum cans are quick and easy for little league games, family reunions and everyday use. They cool quickly and you don’t need a glass. And the aluminum in the cans is recyclable. When you collect them and take them to a recycling area, they will pay you for the cans.

There are lots of ways to collect the cans, beginning in your own home. Provide a separate container to put the cans in so that you do not have to go through the garbage to get them. Volunteer to pick up the cans at school and after church functions. Go to the local parks and check out the trash. Some parks already provide a separate container for cans; see what they do with them. Take walks along the roadside and collect the cans. Speak to the people in your neighborhood, you may find that while people like the idea of saving the aluminum cans for recycling, most of them do not follow through. If you would be willing to provide them with a separate container, or maybe green colored trash bags, they would gladly give you their cans.

These are all ways to get volume cans, but why do all that work yourself, when a little organization would see you making some real money professionally training people to do it. First do it yourself to get experienced and adept at all the places you can find this valuable commodity. Then once you know how to best bring in volume quantity, train people and pay them cash at your door, while you collect the full price value at the depot. This type of attitude will serve you well and building this type of business can really pay off.

You may find that aluminum cans recycling business ideas can include other items as well, and lots of people will co-operate with you, they want to do their part, they do not want to contend with going to a recycling area.

Can Too Much Coffee Cause Sciatica? The Strange Truth Behind Your Cup of Joe

Okay, this is another odd-ball article topic here, but please bear with me. Have you ever wondered if the coffee you grab in the morning on the way to work might be causing your back pain and sciatica?

Well, of course there are foods that you can eat that either hurt or help inflammation in your body, which may contribute to back pain. Foods like junk food, fast food, red meats, fried foods, pastries, and cakes are of course not good for you. These foods are loaded with trans fat, saturated fats, and have a high glycemic index. All of which will only exacerbate inflammation and make your back pain worse.

On the other end of the spectrum there are foods like walnuts, blueberries, salmon, cod, and other fruits which are extremely good for your health. These foods are filled with Omega 3 fatty acids, antioxidants, and vitamin D. All of these foods are great for you for a lot of different reasons, but when it comes to your back, these all help to reduce inflammation which takes pressure off of your spinal nerves and relieves back pain.

But where does coffee fit into this spectrum? Now, of course there are extremely sugary, high-calorie coffees that you can get at coffee shop chains. These types of coffees have high glycemic indices and many of them contain a high amount of saturated fats in them. These coffees are definitely not good for your inflammation and your back pain.

But what about straight black coffee without all the sugar and other goodies that turn a breakfast drink into more of a dessert?

Well, black coffee is a lot better for you and it doesn’t really have the “not good for you” ingredients. But it also doesn’t have any of the good ingredients either.

However, I’m sure you’re aware that coffee has caffeine in it. If you’ve ever had to write a college term paper the night before it was due, you’ve probably used this to your advantage.

But did you know that caffeine can actually elevate levels of anxiety that you experience? This is why people that get the jitters from too much coffee seem a little jumpier than normal. Essentially the coffee is putting them on edge and sending their bodies into the fight or flight condition.

When you are in fight or flight, your muscles are a bit more tense than normal, mostly to prepare you for a quick escape or confrontation with any perceived threat.

Now, if you have back pain, this isn’t good news. Even a little bit of muscle tension can cause your piriformis or psoas muscle to irritate your sciatic nerve and cause back pain. Definitely not good.

So, you see, although there probably isn’t much real danger in drinking a cup of coffee in the morning, it can contribute to back pain issues. If your back pain is something you’ve been struggling with for awhile, it might be worth the effort to cut back on the coffee.

Lower Back Pain Strategies by a Musculoskeletal Therapist

Mobility – the ability of the musculoskeletal structures or segments of the body to move or be moved to allow the presence of range of notion for functional activities. The ability of an individual to initiate, control or sustain active movements of the body to perform simple to complex motor skills.

Hypomobility – caused by adaptive shortening of soft tissues and can occur as the result of many disorders or situations.

Factors –

  • prolonged immobilization of a body segment
  • sedentary lifestyle postural mal-alignment and muscle imbalances
  • impaired muscle performance (weakness) associated with an array of musculoskeletal or neuromuscular disorders
  • tissue trauma resulting in inflammation and
  • pain congenital or acquired deformities.

All these impairments can lead to functional limitations and an increase in injury risk. Remedial massage treatment especially stretching can improve impaired muscle performance or prevent injury as they become an integral component of individualized intervention.

Contracture – is defined as the adaptive shortening of the muscle-tendon unit and other soft tissues that cross or surround a joint, which results in significant resistance to passive or active stretch and limitation of ROM.

Types of contractures

Myostatic Contracture – no specific muscle pathology present. Reduced number but not length of sarcomeres. Can be resolved in a relatively short time with stretching exercises.

  1. Pseudomyostatic Contracture – a constant state of contraction giving excessive resistance to passive stretch. Associated with hypertonicity of spastic or rigid nature – a central nervous system lesion such as CVA, spinal cord injury, traumatic brain injury. Muscle spasm or guarding and pain may cause a pseudomyostatic contracture. Inhibition procedures to temporarily relax the spasm or tonicity will allow full, passive elongation of the muscle to occur.
  2. Arthrogenic and Periarticular Contractures – intra-articular pathology including adhesion, synovial proliferation, joint effusion, irregularities in articular cartilage, or osteophyte formation. Connective tissues that cross or attach to a joint or it’s capsule become stiff, this reduces normal arthrokinematic motion.
  3. Fibrotic Contracture and Irreversible Contracture – these can cause adhesions and development of fibrotic contractures. It is possible to stretch fibrotic contractures and eventually increase ROM, it is very difficult to re-establish optimal tissue length.

Stretching is a general term used to describe any therapeutic manoeuvre designed to increase mobility of soft tissue and subsequently improve ROM by elongating structures that have adaptively shortened and have become hypomobile over time.

Physiology of the Stretch Reflex

It is a monosynaptic reflex arc, two types of neurons are involved (sensory and motor). The reflex occurs when a sudden contraction of a muscle occurs. Slight stretching of a muscle stimulates receptors in the muscle – muscle spindles – these spindles monitor changes in muscle length. The stretch reflex operates as a feedback mechanism to control muscle length by causing muscle contraction.

Physiology of the Tendon Reflex

The tendon reflex operates as a feedback mechanism to control muscle tension by causing muscle relaxation. It protects tendons and their associated muscles from excessive tension. Receptors called Golgi tendon organs detect and respond to changes in muscle tension caused by passive stretch or muscular contraction. When tension is applied to the organ nerve impulses are generated along a sensory neuron, this synapses with and inhibits a motor neuron that innervates the muscle associated with the tendon organ. As tension increases, and the inhibitory impulses increase, the inhibition of the motor neurons to the muscle creates excess tension and causes relaxation of the muscle. It is a protective mechanism to reduce muscle damage due to excessive tension.

Indications for Use of Stretching

  • When ROM is limited because ST have lost their extensibility as the result of adhesions, contractures, and scar tissue formation, causing functional limitations or disabilities.
  • When restricted motion may lead to structural deformities otherwise preventable
  • When there is muscle weakness and shortening of opposing tissue
  • As part of a total fitness program designed to prevent musculoskeletal injuries
  • Prior to and after vigorous exercise to potentially minimize post-exercise muscle soreness.

Contraindications to Stretching

  • When a bony block limits joint motion
  • After a recent fracture before union is complete
  • Whenever there is evidence of an acute inflammatory or infectious process (heat & swelling) or when soft tissue healing could be disrupted in the tight tissues and surrounding region
  • Whenever a haematoma or other indication of tissue trauma is observed
  • When hypermobility already exists
  • When contractures or shortened soft tissues are providing increased joint stability in lieu of normal structural stability or neuromuscular control
  • When contractures or shortened soft tissues are the basis for increased functional abilities, particularly in patients with paralysis or severs muscle weakness.

Types of stretching

  1. Passive or assisted – sustained or intermittent external, end-range stretch force applied with overpressure elongates a shortened muscle-tendon unit and periarticular connective tissues by moving a restricted joint just past the available ROM. If patient relaxed it is Passive stretching. If the patient assists in moving the joint through a greater range it is assisted.
  2. Self-stretching – (aka active stretching, flexibility exercises) independent stretching carried out after instruction and supervision
  3. Neuromuscular Inhibition Techniques – ( aka PNF or facilitated stretching) reflexively relax tension in shortened muscles prior to or during stretching. MET used to stretch muscles and fascia and mobilize joints
  4. Joint mobilization/manipulation – stretching techniques specifically applied to joint structures and used to stretch capsular restrictions or reposition a subluxed or dislocated joint.
  5. Soft Tissue Mobilization and Manipulation – friction massage, myofascial release, acupressure and TP Therapy. Mobilize and manipulate connective tissue that binds down soft tissues
  6. Neural Tissue mobilization – the Neural pathway is mobilized to release adhesions or scar tissue form around meninges, nerve roots, plexus or peripheral nerves.

Elements of stretching

Include alignment and stabilization. Intensity, speed, duration, frequency and mode of stretch; and the integration of neuromuscular inhibition and functional activities into stretching procedures.

Effect of poor Postural Support from Trunk Muscles – with total relaxation of the dynamic stabilizer muscles – the multifidus, rotatores, TA, internal obliques, and QL, the spinal curves become exaggerated and passive structural support is called on to maintain the posture. When there is continued end-range loading supporting tissues become more vulnerable to injury. Continued exaggeration of the curves leads to impaired muscle strength and flexibility. Muscles habitually kept in stretch tend to test weaker because of a shift in the length-tension curve – stretch weakness. Muscles kept in a habitually shortened position tend to lose their elasticity, they are strong only in the shortened position but become weak as they are lengthened – tight weakness.

Lateral shift correction

If the patient has lateral shifting of the spine, it should be corrected prior to flexion extension treatment for lower back pain.

Lateral shift correction when extension relieves discomfort –

standing on the side of the thoracic shift with the therapists hands clasped around the contralateral iliac crest and the shoulder against the patients elbow. Simultaneously pull the pelvis towards you while pushing the patient’s thorax away. Continue with the lateral shifting if the curvature is reduced until normal curve is present.

Lateral shift correction when flexion relieves discomfort –

self-correction – standing whit the leg opposite the shift on a chair so the hip is in about 90 degrees of flexion. The leg on the side of the lateral shift is kept extended. Have the patient then flex the trunk onto the raised thigh and apply pressure by pulling on the ankle. Recheck the alignment and continue till pain reduction is greatest.

Exercise techniques and stretches to increase flexibility and ROM

Muscle strength or flexibility imbalance in the hip can lead to abnormal lumbopelvic and hip mechanics, which predisposes the patient to or perpetuates low back, sacroiliac or hip pain..

  • To increase hip extension – prone press ups; Thomas test stretch; modified fencer stretch
  • To increase hip flexion – bilateral knee to chest; unilateral knee to chest; Quadruped stretch; Chair (airline) stretch
  • To increase hip abduction – V lying against wall knees extended butt against wall
  • To increase hip abd & external rotation – sitting with soles of feet together hands on inner surface of the knees.

Lumbar stretching techniques

Increase lumbar flexion

Assisted stretching – cross-sitting. Patient lace the hands behind the neck, adduct the scapulae, and extend the thoracic spine. This locks the thoracic vertebrae. Have the patient then lean the thorax forward onto the pelvis, flexing only at the lumbar spine. Stabilize the pelvis by pulling back on the anterior-superior iliac spines.

Increase lumbar extension

Prone press-up (Self-stretching) – Prone, with hands placed under the shoulders. Patient to extend to elbows and lift the thorax up off the mat keeping the pelvis down. To increase the stretch force, the pelvis can be strapped to the treatment table, this exercise also stretches the hip flexor muscles and soft tissue anterior to the hip.

Increase Lateral Flexibility in the Spine

Used when there is asymmetric flexibility in side bending as well as in the management of scoliosis. They are used to regain flexibility in the frontal plane when muscle or fascial tightness is present with postural dysfunctions, designed to stretch hypomobile structures on the concave side of the lateral curvature. When stretching the trunk, it is necessary to stabilize the spine either above or below the curve.

Prone-Lumbar curve

have the patient stabilize the upper trunk by holding onto the edge of the mat table with the arms. Therapist lifts the hips and legs and laterally bends the trunk away for the concavity.

Heel-sitting – Patient leans forward so the abdomen rests on the anterior thighs. The arms are stretched overhead bilaterally, and the hands are flat on the table. Then have the patient laterally bend the trunk away from the concavity by walking the hands to the convex side of the curve.

Neural Tension Impairments

If positive nerve tension signs are described by the patient while providing the history and positive signs are detected with testing maneuvers, techniques that are reported to mobilize components of the nervous system may be used to diminish the patient’s symptoms.

Straight Leg Raise with Ankle Dorsiflexion

  • Once the position that places tension on the involved neurologic tissue is found, maintain the stretch position, and then move one of the joints a few degrees in and out of the stretch position, such as ankle plantar and dorsiflexion, or knee flexion and extension.
  • Ankle dorsiflexion with eversion places more tension on the tibial tract
  • Ankle dorsiflexion with inversion places tension on the sural nerve
  • Ankle plantarflexion with inversion places tension on the common peroneal tract
  • Adduction of the hip while doing SLR places further tension on the nervous system because the sciatic nerve is lateral to the ischial tuberosity; medial rotation of the hip while doing SLR also increases tension on the sciatic nerve
  • Passive neck flexion while doing SLR pulls the spinal cord cranially and places the entire nervous system on a stretch.

Slump-sitting Stretch

dorsiflex the ankle just to the point of tissue resistance and symptom reproduction. Increase and release the stretch force by moving one joint in the chain a few degrees, such as knee flexion and extension, or ankle dorsiflexion and plantarflexion.

Prone Knee Bend Stretch

Prone neutral spine, pillow under treatment knee, and hips extended to 0 degrees. Flex knee to the point of resistance and symptom reproduction. Pain in the low back or neurological signs are considered positive for upper lumbar nerve roots and femoral nerve tension. Thigh pain could be rectus femoris tightness. It is important not to hyperextend the spine to avoid confusion with facet or compression pain. Flex and extend the knee a few degrees to apply and release tension.

Duration of stretch

  • Despite extensive research there continues to be a lack of agreement on how long a single cycle of stretch should be held or how many cycles of stretch should be applied to achieve the most effective, efficient, and sustained stretch-induced gains in ROM.
  • Duration most often refers to how long a single cycle of stretch is applied
  • More than one repetition of stretch is referred as a stretch cycle and the cumulative time of all the stretch cycles is considered as aspect of duration.
  • Long-duration referred to as static, sustained, maintained, prolonged
  • Short term referred as cyclic, intermittent or ballistic.

Types of stretches

  1. Static – most common term used to describe soft tissue lengthening. The duration 15 sec to several minutes when manual stretch or self-stretching employed.
  2. Research shows static stretching is approx half that created during ballistic stretching.
  3. Static Progressive stretching – Static stretch held until a degree of relaxation is felt by the therapist then lengthened further until a news end-range is felt. This capitalizes on the stress-relaxation properties of soft tissue.
  4. Cyclic Stretching – short duration stretch forces that are repeatedly but gradually applied, released and then re-applied. Multiple stretches in a single treatment session. Held for 5-10 seconds but with no consensus on the optimum number of cycles in the treatment. Based on clinical experience, some therapists hold the opinion that end-range cyclic stretching is as effective and more comfortable for a patient than a static stretch.

Frequency of stretch

  • number of bouts per day or per week. Dependant upon -underlying cause
  • Quality and level of healing
  • The chronicity and severity of contracture
  • Patients age
  • Use of corticosteroids
  • Previous response to stretch

Usually form two to five sessions for tissue healing and to minimize postexercise soreness. Ultimately dependent upon the clinical discretion of the therapist. Whatever frequency is decided upon the patient must utilize the new end-of-range into everyday tasks otherwise the connective tissue will return to the pre-stretched position.

Neuromuscular Inhibition and Muscle Elongation

Inhibition techniques increase muscle length by relaxing and elongating the contractile components of muscle. The sarcomere give will occur more easily when the muscle is relaxed, with less active resistance in the muscle as it is elongated. An advantage to the use of inhibition techniques prior to or during stretching is that muscle elongation is more comfortable for the patient.


  1. Hold-relax or contract relax
  2. Agonist contraction
  3. Hold-relax with agonist contraction.

Stretch isolated muscles in their anatomic planes or opposite the line of pull of specific muscle groups rather than in combined diagonal patterns.

HR – prestretch, end-range, isometric contraction 10 sec followed by voluntary relaxation of the tight muscle. Then the limb is passively moved into its new range as the range limiting muscle is elongated.

AC – Deliberate and slow, concentric contraction of the muscle opposite the range limiting muscle. This causes reciprocal inhibition of the antagonist, and increases ROM.

HR with AC – use of a pre-stretch isometric contraction of the range limiting muscle in a lengthened position followed by a concentric contraction of the muscle opposite the range-limiting muscle.

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Back Injuries and Penile Nerve Damage

As a man ages, certain parts of his body are destined to feel it more than others. This is absolutely true in the case of back pain. A man can be in perfect health but then one day, out of the blue, he turns a certain way and boom – back pain becomes his constant companion for a while. And unfortunately, even the best penis care regimen can’t protect that man from the possibility of penile nerve damage as a result of a serious back injury.

In the aftermath of a back injury, one of the first signs of nerve damage might be a serious lack of penis sensitivity. Things that felt good before suddenly don’t have as much of an ‘oomph.’ And in some cases, there are other signs of penile nerve damage, such as numbness, pain, tingling, or a burning sensation.

How to fight penile nerve damage

The good news is that in many cases, nerve damage can be reversed. The first step is to get to the doctor immediately. Rather than a urologist, a guy will want to see someone who can address the underlying issue first – that’s the back pain. Look for a doctor who specializes in treatment for back pain and start there.

In some cases, the problem will become clear through imaging scans. For instance, a man who has a herniated disc will likely be able to see the problem on those scans. But for some, more in-depth testing will be required to figure out where the problem is and how to fix it.

In the meantime, a man can take steps to avoid aggravating the nerves in the back that lead to the nerves in the penis. One way to do this is to ask the doctor which kind of pain a guy is dealing with. In flexion-intolerant pain, a man can’t handle any positioning that would force him to bend forward. In extension-intolerant pain, it’s the opposite – anything that would force a man to bend backward is cause for serious pain.

Why does this matter? Because if a man wants to continue to have an active sex life while dealing with the usually long recovery from back pain, he needs to know which positions are going to help make that work.

Positions for alleviating back pain

When a man is in bed with a partner, those who suffer from flexion-intolerant pain should look to rear-entry positions that allow him to keep his back straight, as well as modified missionary, where a man is holding all his weight on his hands. For those with extension-intolerant pain, positions include missionary where a man is resting on his elbows above his partner, as well as spooning.

No matter which position a man chooses, the key is to go slow and easy. A guy who is really into it might move his back without meaning to do so. This means a guy must try to always remember that there could be consequences for that – that’s why slow and easy is the name of the game. Enlist the partner’s help to ensure things stay tame.

Other ways to fight nerve damage

Penile nerve damage can be alleviated somewhat with the use of a high-quality penis health crème (health professionals recommend Man 1 Man Oil, which is clinically proven mild and safe for skin). A crème designed with healthy amounts of vitamin B5, C and D is great for cellular health. Look especially for acetyl L carnitine, an amino acid known for protecting the penis from nerve damage. The application of these vitamins and nutrients through a Shea butter base can help combat the nerve damage that can occur from vigorous activity, excessive friction and yes, back injuries.