1. Ball and Socket, Pivot, and Gliding: Keeping Your Female Hinges Healthy Joanna Wilson, D.O. HerCare at ADC

2. Famously Bad Posture

5. High Heels and Posture

6. Flat Feet

7. Posture To Prevent Muscle Spasms

9. Sources of Joint Pain Muscle Ligaments Cartilage Tendon Bursa Bone Fascia

10. Joint Anatomy

11. Cartilage No blood supply Oxygen and nutrient delivery and waste removal is done by compression Made up of four substances: collagen, proteoglycans, water, and chondrocytes:

12. Cartilage Collagen: Key component of cartilage; provides cartilage with its strength; creates a framework that houses the other components of cartilage Proteoglycans: Combination of protein and sugar, which trap water in cartilage; woven around and through collagen, allowing cartilage to change shape when compressed Water: Healthy cartilage contains more than 70% water; shock absorber and lubricates and nourishes the cartilage. Chondrocytes: Cells produce new collagen and proteoglycans in cartilage; release enzymes which help break down and dispose of aging collagen and proteoglycans

13. Sex Differences in Cartilage Cartilage thickness and volume are greater in boys and men vs girls and women Women lose cartilage from their tibia (the larger bone between the knee and ankle) at 4x the rate of men, and they lose cartilage from the kneecap at 3x the rate Greater cartilage loss in women than in men began at age 40 and increased with age

15. Osteoarthritis Has Active Inflammation

17. Osteoarthritis Risk Factors Excessive loading High BMI Previous knee injury Age Genetics Sex

18. Female vs Male Hips

19. Osteoarthritis Risk: Overweight Goal BMI is <25 to reduce OA in the population by up to 53%

20. Obesity-related pathways Accumulation of fat in muscle which reduces muscle mass and strength Instability of joint Reduced impact absorption at joint by muscles Altered gait patterns Misalignment of joint

21. Osteoarthritis Risk: Excessive Loading Kneeling, squatting Pes Planus, Pronation of foot, Q-angle Land and turn movements

22. Osteoarthritis: Previous Knee Injury Ligament tears, meniscal injuries, and fractures involving the articular surface

23. Anterior Cruciate Ligament (ACL) Injuries up to 10x more common in women – Relatively smaller diameter, relative hamstring weakness, sex hormone variations Due to deceleration with landing and pivoting – 5%/year risk at collegiate level in volleyball, basketball, and soccer Can cause chronic instability and osteoarthritis later

24. Joint Changes and Hormones Increased laxity during ovulatory and luteal phases Increased collagen turnover during follicular phase Highest likelihood of ACL injuries during menses Variations of hormone levels and receptors in target tissues during peri and post menopause – Hormone blockers and hormone replacement affect joint pain

25. Prevention of ACL Injuries ACL –tear prevention programs: Proprioceptive and neuromuscular training programs Awareness of reduced joint position sense during menses

26. Anterior Knee Pain (Patellofemoral Pain) Twice as common in women Due to: – Relative weakness of quadricep – Delayed firing of vastus medialis obliqus – Increased q angle

27. Treatment of Patellar Syndrome PT: strengthen medial thigh muscles and hip external rotators, strengthen quadriceps Taping of patella Arch supports

28. Bursitis Inflammation of the sac filled with lubricating fluid which separates joint structures

29. Common Bursitis Locations

30. Sprain Inflamed ligament

31. Tendonitis Tendon connects to bone and behaves as an elastic strip Inflammation can occur

32. Enthesopathy Inflammation where a ligament or tendon attaches to a bone causes calcium deposits Spurs develop

33. Iliotibial Band Syndrome

34. IT Band Stretches

35. IT Band Stretch

36. Supplements: Possibly Effective ASU (avocado and soybean oils)- hip Boswellia (Indian frankincense) Chondroitin Sulfate Curcumin (constituent of turmeric) Ginger Kava Kava Bovine cartilage Cat's claw extract (Uncaria guianensis) Devils claw Vitamin B3 (niacinamide) Rutin DMSO (Dimethylsulfoxide) topical Guggul Yucca Willow Bark New Zealand green- lipped mussel

37. Supplements: Likely Effective Glucosamine Sulfate SAMe Stinging Nettle (topical) Turmeric Bromelain Camphor (topical)

38. Supplements: Effective Capsaicin topical

39. Challenges in Supplement Research Content variability (amount, quality) Judging endpoints Quality of study Number of participants

40. Nutritional Recommendations Fruits and vegetables for antioxidants (esp Vitamin C) High calcium diet for bone strength and muscle function Vitamin D for bone strength and balance High quality protein for muscle strength

41. Exercise To Promote Joint Health Allow compressive movement of cartilage Increase bone strength Tightens and thickens ligaments Secure joint tracking with strong, balanced muscle traction

47. Hamstring Curl Stand with the front of your thighs against a surface (a table or wall). Flex one knee up as far as is comfortable. Hold for 5 - 10 seconds, then lower slowly. If possible, do not touch the floor between repetitions. (Ankle weights will increase the intensity.) Do 1-3 sets with 12-15 repetitions each. Remember to rest in between sets.

49. Bent-Leg Raises Sitting in a chair, straighten one leg in the air (without locking the knee). Hold for about one minute. Bend your knee to lower the leg about halfway to the floor. Hold for 30 seconds. Return to starting position. Work up to 4 reps on each leg.

51. Abductor Raise Lie on your side, propped on one elbow. The leg on the floor bent, the other straight. Slowly lift the top leg, hold for 5 -10 seconds, then lower. (Ankle weights will increase the intensity). Do 1-3 sets with 12-15 repetitions each. Remember to rest in between sets.

52. Step-Ups Stand in front of a step, like a sturdy bench or stairs, about two feet high (or less if necessary). Step up onto the support, straighten your knees fully (without locking them) and step down. Maintain a steady pace. If you are comfortable with your balance, pump your arms while doing this exercise. Start with 1 minute, slowly building your time.exercise

53. Wall Slide Leaning with your back against a wall, bend your knees 30°, sliding down the wall, then straighten up again. Move slowly and smoothly, using your hands on the wall for balance. Keep feet and legs parallel, and do not allow knees to go out over the toes. Repeat 5 -10 times.

54. Stationary Bike Biking is a good way to increase strength and range of motion. Make sure you have the right positioning of the legs. At the bottom of the pedal stroke, the bend in the knee should be 15 degrees. Start with 10 minutes and slowly increase your time.

55. Sex-Differences in Running Recreational, habitual exercise was not associated with knee osteoarthritis Elite female runners were more likely than male to develop knee OA Some studies report a higher risk of hip osteoarthritis in men with high or moderate levels of physical activity

56. The Best: Water Aerobics

57. Starting Exercise Increase intensity and novel movements with caution Cross train Low-impact repetition is best Listen to your joints Improve range of motion, flexibility, and balance

58. To Wrap It Up… Avoiding obesity and maintaining good posture limits joint dysfunction Topical and oral supplements may be helpful, but quality studies do not exist to confirm benefit Varying your daily low-impact exercise puts healthy stress on your joints

59. Thank you so much for coming today! Joanna Wilson, D.O. Freida Toler, FNP