ANATOMY & ARTHRITIS The Basics

ANATOMY & ARTHRITISThe BasicsSteffany Moonaz, PhDand Nancy OBrien, RYT

1DirectionDistal/proximalSuperior/inferiorMedial/lateralProne/supineSagittal/horizontal/vertical

D/p elbow wrists/I headm/l lungs heartp/face down; supine, face upSag l/r (frontal/coronal vertical, anterior, posterior)

2Basic Landmarks- Lower LimbsToes- phalangesFeet- metatarsals, tarsalsShin- tibia, fibulaKnees- patellaThigh- femurPelvis- illium, ischium, pubis

Tibia shin boneMoves pelvis from axialIschium sitting bones, ischial tuberosity

3Basic Landmarks- Upper LimbsFingers- phalangesHands, Wrists- metacarpals, carpalsElbows- humerus, radius, ulnaShoulders- scapulae, clavicle

Forearm radius4Basic Landmarks- AxialSpine lumbar (5) thoracic (11) cervical (7)HeadFrontalParietalOccipitalMaxillaMandible

Arthritis in second metatarsal fibula familiar with that languageOcc- lowerParietal above occ5

Epithelial tissue lines everything (body, blood vessels, organs ) regardless of the type (single-cell thick or two or more-cell thickness) is usually separated from the underlying tissue by a thin sheet of connective tissue; basement membrane. The basement membrane provides structural support for the epithelium and also binds it to neighboring structuresPsoriatic arthritis -- Psoriatic arthritis tends to appear about 10 years after the first signs of psoriasis. For the majority of people this is between the ages of 30 and 55,-- Skeletal muscle -- add idea of belly of the muscle.All muscle tissues affected by cacechia lost tissuePolymyositis. Polymyositis is a disease of unknown cause in which skeletal muscle becomes inflamed and degenerates. It can affect skeletal muscle of the body as well as the pharynx.Skeletal muscle rheumatoid arthritisConnective tissue fascia (sheets of connective tissue) surrounds all, like white part of an orange dries, squeezes tight, stiff. Needs lubrication, movement, highway for movement of energy, electromagnetic and sub cellular, quantum energy pathway, acupuncture (gripping at the needles, as if wanting to be twirled and whirled, swirled, like whirlpools in a vast riverneedle grasp alters the makeup of the surrounding connective tissue, resulting in the release of chemicals and other substances that have healing properties. These effects may be prolongedMeridians follow acupuncture points in deeper connective tissue highway intersections that have deepest physiological implications-- Nervous tissue including spinal column, feet pressure, pain, protective inflammation, pressure, protecting, stiffness learned responses (pain) that can be retrained (less pain) chronic painLyme, neurological symptoms (bacterial)-- Cardiac function flight or fight, heart rate variability now seen as significant measure of physical resilience chronic stress/stress hormones wear out heart needs to pump as freely as possible, with as little resistance as necessary visualizations/happiness/love/peace/compassion, lowers blood pressureCaxechia (wasting) -- with RA, may be obese, but with deteriorating muscle tissue, including the heart muscle-- Smooth muscle -- Crohns inflammation(dysregulation) causes changes in smooth muscle contractility.6StressThe brain cant differentiate stress from a hungry bear or a job interview.

Same response: -- elevated blood pressure, -- faster heartbeat -- faster breathing -- suppressed immunity, digestion and reproductive function -- protective inflammation (injury)

Response temporary, but with disease, can be maladaptive.inflammatory, neuroendocrine and behavioral responses

cal to this homeostasis. Glucocorticoids modulate the stress response at a molecular level by altering gene expression, transcription, and translation, among other pathways. The effect is the inhibition of the functions of inflammatory cells, predominantly mediated through inhibition of cytokines, such as IL1, IL6, and TNF. The central effectors of the stress response are the corticotrophinreleasing hormone (CRH) and locus coeruleusnorepinephrine (LCNE)/sympathetic systems. The CRH system activates the stress response and is subject to modulation by cytokines, hormones, and neurotransmitters. Glucocorticoids also modulate the growth, reproductive and thyroid axes. Abnormalities of stress system activation have been shown in inflammatory diseases such as rheumatoid arthritis, as well as behavioural syndromes such as melancholic depression. These disorders are comparable to those seen in rats whose CRH system is genetically abnormal. Thus, the stress response is central to resistance to inflammatory and behavioural syndromes.

Increased system activation as a result of stress leads to central and peripheral changes, which facilitate behavioural adaptation and redirection of energy to the central nervous system, muscle, and stressed body sites. These changes serve to promote homeostasis. HPA axis activation results in glucocorticoid secretion. The principal role of glucocorticoids during the stress response is thought to be restraint of the effectors of the stress response.

7Chronic Inflammation Sustained stress response releases pro-inflammatory substances that attack instead of protecting -- healthy cells -- blood vessels -- tissuesChronic stress & chronic inflammation heighten risk of disease

chronic inflammation can increase the risk of a variety of disorders, including asthma, rheumatoid arthritis, cardiovascular disease, certain types of cancer, and depression.

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Key words: Cortisol, genes activated and deactivatedInflammatory cytokines proteins like interleukin-6 that regulate the immune system -- are released (they accelerate wound-healing and reduce the risk of infection. C reactive protein inflammatory markers my crp things to be familiar withGenetic -- cytonCortisol binds to the glucocorticoid receptor/heatshock protein (GRHSP) complex in the cytoplasm, leading to the dissociation of heat shock protein (HSP), and the nuclear translocation of the glucocortiocidglucocorticoid receptor complex. In the nucleus, the glucocortiocidglucocorticoid receptor complex binds to glucocorticoidresponsive elements and activates target genes, which results in a decrease of and on and on in a cascade with genetic involvement

While short-term inflammation is useful in battling an injury, chronic inflammation arising from the perception of stress is not. Key biomarker of inflammatory activity -- a receptor for tumor necrosis factor- (sTNFRII)

9Stress, Inflammation & Disease Diseases themselves can cause dysregulation of immune response

Inappropriate vs. appropriate responses (Rheumatoid Arthritis, etc.)

Why does my body hate me?

Important in how people conceptualize the diesease immune system is not a good gatekeepermy bodys fighting meAm I my body , my mind mind/body discordDisease cycle can lead to sstress inflammation break that at any point

10Effects Subject to InterventionChronic stress increases vulnerability to infectious diseases

Stress slows healing

Too little sleep wreaks havoc on the immune system, increasing inflammation.

Its not too bold to say that we can delay the onset of these dreaded diseases or even prevent them altogether if we nip chronic inflammation early in the bud. Yoga improves immune regulation helps immune system react appropriatelyCan change the expression of the disease because its genetic Meditation practices impact physiological pathways that are modulated by stress and are relevant to disease (Charles L. Raison, MD, clinical director of the Mind-Body Program, at Emory School of Medicine)

11Parasympathetic/Sympathetic Sympathetic - Flight or Fight -- Potential for chronic stress (cortisol) Parasympathetic --Rest, Restore, Renew, Tend & Befriend Frees up the energy for work crews to rebuild, cleanse, repair, heal

Turn down sympathetic, turn up parasympathetic -- Results: All systems of the body circulation, digestion, respiration, neurological, hormonal benefit

12Genes and TelomeresDean Ornish lifestyle program including yoga affects genes

Changes course of diseaseTelomeres lengthen -- better copies

13 THE CELL, Dave Bolinsky, TED

A hundred thousand of these things running around inside a hundred trillion cells now matter how lazy we feel, were not intrinsically doing nothing14Respiration/The BreathThe Diaphragm

-- Moves heart, lungs, upper abdominal muscles, ribs

--Facility with diaphragm allows practitioner to match or supplement states of energy (stimulating or calming circulation/oxygen delivery)

--- Pranayama can provide physical support for sitting and standing

--- Ujai breath can bring physical/mental support to an asana in form of strength or focus or centering

-- Longer exhalation sends powerful signal to the nervous system to bring out the work crews to build, cleanse, renew

Three part breath lower ribs, full exhalation, sense of physical release

15Gentle Waves, Rising and Fallinghttp://www.youtube.com/watch?v=c6LH_svUr5w-- Like a jellyfish pulsating through the ocean, moving with and thru all around it, giving, receivingCentral tendon down along the back to pelvic floor

-- Facility with diaphragm allows practitioner to match or supplement states of energy (stimulating or calming circulation/oxygen delivery)

--- Pranayama can provide physical support for sitting and standing

--- Ujai breath can bring physical/mental support to an asana or just moving, walking -- in form of strength or focus or centering

16The Diaphragm

What is Arthritis?Umbrella term for category of diseasesMusculoskeletalJoint conditionsSystemic or localizedCan be associated with weaknessinstabilitydeformityreduced quality of lifedifficulty with ADLsMay impact other organ systems

Does it all involve inflammation? All but osteo, where the inflammation may be a result of the condition, but is not a built-in result of the conditionGenetic?18Bones and Joints

Review all parts can be affected by various conditions, swelling, immune responses, skeletal abnormalities, surgeries, wear and tearStrengthen muscles to support joints19Arthritis Prevalence50 million adultsLeading cause of disabilityMore prevalent among:womenolderoverweightsedentaryExpected to approach 70 million by 2030Limits activities and work for many50 million includes all arthritis-related conditions

20Relevant ConditionsOsteoarthritis- wear and tearRheumatoid arthritis- autoimmune in jointsPsoriatic arthritis- red patchy skinGout- uric acidLupusFibromyalgia- tenderpointsAnkylosing Spondylitis- spinal fusionLyme Disease- prior infectionPolymyositis- skeletal musclesIBS, Crohns Disease- digestive tractYoga for arthritis should know what it is students best expert on themselves. They know what they can and cant do.appropriate vs. inappropriate immune responseOsteo arthritis by far the most prevalent Rheumatoid far 2dEverything else less commonPolymyositis. Polymyositis is a disease of unknown cause in which skeletal muscle becomes inflamed and degenerates. It can affect skeletal muscle of the body as well as the pharynx.

21Osteoporosis vs.OsteoarthritsOsteoporosisOsteoarthritisBone diseaseJoint diseaseCalcium absorptionproblemWear and TearBones lose densityInflammation, joint damageContraindicationsdifferent, i.e., forward bendsContraindicationscan be signaled by pain 22RA vs. OARheumatoid arthritisOsteoarthritisType of diseaseAutoimmunewear and tear"SymptomsPain, swelling, and stiffness, decreased ROM, fever, fatiguePain, stiffness, and decreased ROM Location of Symptomsswelling in pairsespecially smaller jointsUsually weight-bearing joints, neck, small finger joints and big toe Time of DayGenerally worse in morning or after lack of activity Tends to get worse with activity throughout the day Age of OnsetUsually 30-50 years, though can occur at any ageMost commonly middle aged and older peopleUS Prevalence1.3 million in US21 millionNo swelling with oa? Some swelling is with bursa23Important Considerations- OAMost prevalentOften diagnosed by PCP w/o radiographMay be undiagnosed or self-diagnosedMost common in weight-bearing jointsSymptoms can be reduced and progression delayed with weight loss (if overweight)Medications address symptoms onlySurgery can be solution if bone on boneGenetics, demographics, joint use, BMIYounger incidence w/obesity epidemic

Many people say they have arthritis but havent gotten x-ray confirmation.

24Important Considerations- RARequires close monitoring and regular care ofrheumatologistDeformities more common for those withdiagnosis prior to current treatment or iftreatment is delayedDisease modifying agents for lifetime useMay experience flares and require changein activity and/or medicationMiddle-age onset common, mostly womenImmune concerns, stress can exacerbateLoss of muscle tissue, heart diseaseWhile oa can be self diagnosed ra must be under proper care Juvenile RA different than RA. If your diagnosed before puberty, like 4 or 9, even when they become adults they have with juvenile RA25Common ComorbiditiesRAOACardiovascular EventsGI upset (NSAIDs)InfectionHypertensionDepressive DisordersRenal impairmentGI ulcersAge, Obesity-related conditionsInfection due to disease too be able to take antibiotics, or have surgery, people with RA have to go off some RA meds. Pregnancy, too cross barrier,Issue: not getting preventive treatment due to acute RA symptoms, docs timeRenal impairment -- NsaidAND with OA, renal impairment can be age related26The Role for ExerciseSlow RA muscle cachexiaReduce loss of function from low activityCan help prevent cardiovascular comorbidityWeight managementStabilize joints with muscle strengthMaintain mobilityIncreased self-efficacy for daily activitiesLessen likelihood of damaging fallsEvery pound of body weight is seven pounds of pressure on the active kneethe increased prevalence of coronary heart disease in RA patients may, at least in part, be attributed to inflammation and change of fat metabolism.Yoga affects levels of leptin and grehlin in body for weight loss, yoga increases mindfulness, leptin and grehlin affect appetite regulation

27BALANCE Grounding -- Feet & Toes activates cerebrospinal fluid mountain pose at the wall

Messages through all the bones, nerves, epithelial tissue, muscles tendons, fascia, senses

Stimulation, learning foot massage, tree pose at the wall

Increases awareness, neuronal links, propriocepcionLift the toes one at a time, lay each one downGround down through three/four corners of the feetFEAR --- as people age, more ppl get oa, more fear of falling, theyre worried mind body interventions decrease the fear of falling get rid of fear you can do more -- empowering

28The Role for MindfulnessStress reduction has biopsychosocial cascadeAbility to cope with daily disease fluctuationsAwareness of abilities, not just limitationsChange framing of diseaseUnderstanding of connection with othersTools to use during flares or other challenges

Pain . Stiffness . Loss of ROM . Isolation . DepressionChronic stress -- sympathetic use intent, compassion, awareness, to turn on the parasympathetic nervous system Change framing of the disease new normal wont feel the way you felt before, not a death sentence. You have great days. Youre always aware of it and considering choices. It requires increased awareness moment to moment about how you feel in the bodyImage of arthritic person not the life you have to liveUnionPeople say they are thankful for disease it it werent for diagnosis, would not have reprioritized, taken up yoga, quit job, etc.Think of what new awareness has to offer, but also giftsThose are the people who thrive resilience find things to be positive aboutHow important the bed is support, have a bed thats comfortable, know what feelings you have before flare so you can stave it offWhen they first start to feel it is they get into their bed, unknowingly, a kind of savasana, not sleeping, not thinkingThats enough that they dont get flare29The BrainMeditation changes it

More grey matter, connections, larger areas representing compassion -- Improved powers of observation

-- Improved ability to concentrate

-- Nonlocal healing effects (quantum consciousness, neutrinos, muons) Monks meditating on compassion had 500 to 600 times the activity in the areas of the brain involved in emotion and empathy///shambala sun // chk// Pain learning changes the perception particularly relevant for fibromyalgia pain responses overfiring like mad30Important PointsWe are not clinicians.Those of us who are clinicians are likelynot their treating clinician, or a rheumatologist.

Knowing more about our students condition(s)can help us understand their experience andhelp accommodate them.

Students should have medical clearance tobegin an exercise program at this time.Insure yourselfWaivers -- more a mutual understanding, doesnt necessarily protect youTrust in God but buy insurancePar Q safety and readiness

31More PointsLearn as much as you can about eachindividuals struggles and needs. Arthritisis incredibly variable, even in the same joints.

Sedentary students may not be familiar withthe difference between muscle engagementor stretching and joint pain.

Have few enough students that you can bevery aware of what each is doing.

When youre starting out, smaller groups more comfortableStart off with 4 to 6No more than 10 too difficult to see all the things going on around the roomToo few and It changes from being a class to being a private lesson need a group dynamic32Still MoreDetermine the range of function you cancomfortably accommodate.

When all else fails, breath and relax.

Dont hesitate to contact a mentor withquestions or concerns about your class orspecific students.Some able-bodied and physically fit and some in wheelchairWhole range lot of modificationFor authenticity, to create a healing relationship, practice and ritualistically wish the highest good for each of your students as you move hands front heart outwardThink of the teaching moving through you, you are a vessel instead of a holding tank.

33The Relaxation Response

Brings all body systems into a state of balance, freeing up energy the parasympathetic nervous system can put to work cleansing rebuilding repairing rinsing

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