Thyroid Home Test: Body Temperature & Pulse

Ever wonder why you often feel cold? How about trying so many exercise programs and diet protocols but you just can't seem to lose weight. Going to gym and attending regular bootcamp classes accompanied by dieting and dropping the calories off your foods, your body is finding it hard to lose weight or body fat. You step on that weighing machine every morning when you wake up, feeling miserable and confuse, what is going on, what else can I do to lose weight or feel better. You are always tired and low in energy, feeling lousy and fatigue most of the time. What next? 

Imagine, you walk in to a health screening department (after the medical doctor told you to go for a health check up), and the medical officer tells you that all looks 'normal' and there is nothing wrong with you. When the thyroid profiling results is reviewed, all looks normal and TSH is 'within range'. Question is, why am I still having thyroid symptoms and feeling lousy, overweight and tired all the time?

I will be writing a full blown posts about thyroid soon, but as for today, I will reveal the symptoms of hypothyroid and hyperthyroid symptoms, as well as hashimotos and graves disease (both autoimmune diseases for thyroid). Also, I share with you the home tests anyone can do by your own self, to manually measure the status of your thyroid, apart from performing functional lab tests to further investigate what is going on with the thyroid pathways. 

Hypothyroid Symptoms (underactive) -  most common

- Feels cold easily, also cold hands and feet

- Feeling depressed or stressed out

- Constipation (regularly)

- Poor memory (absent minded, tend to forget things)

- Poor concentration 

- Fine hair and nails

- Difficult to lose weight, gain weight easily

- Puffy eyes

- Often fatigue and exhausted, tired easily

Hyperthyroid Symptoms (over-active) 

- Diarheaa

- Anxiety

- Rapid weight loss

- Sensitive eyes

- High Blood Pressure

- Elevated heart rate

Graves & Hashimotos disease - (Autoimmune)

- Similiar to hypothyroid symptoms

- Thinning of the eyebrows

- Insomnia due to high cortisol levels nighttime. Poor sleep quality. 

Thyroid Home Tests

Test body temperature and pulse 5 times a day, when wakes up in the morning, 20 mins after each meal, and before bed during night time. Body temperature should be around 37 degrees celcius, and if it's below 36.3 degrees celcius, it is an indicator of underactive thyroid. If your metabolism if responding to each meal, the temperature should rise after 20 minutes. Meanwhile, ensure pulse is measured the same time whenever the body temperature measurement is performed too. The pulse should be around 75-80, ideally slightly above 80. 

Before I sign off, I compiled some of the questions which everyone should be asking themselves which regards to thyroid related problems.

- I have high total body fat, but why am I still feeling cold easily? E.g in office, cinema.

- I cut down calories in my diet and foods, why am I still not losing weight? 

- I exercise regularly, I'm still not losing weight or body fat, why is that so?

- My doctor said my thyroid status and profile is normal. Does that mean my thyroid is working normally?

- If my digestion is poor or having gut dsyfunction, will it affect my thyroid function?

- I sleep more then 7 hours a day, why do I often feel tired and fatigue daily?

- I have poor memory and often forgetfulness, could it be due to aging or thyroid related problems? 

- Will my metabolism be optimal or efficient, if perform regular exercise, but without finding out the health of my thyroid? 

- I can't sleep at night and having poor sleep quality, am I deficient in sleeping pills or is it related to my thyroid? 

- I'm often low in energy levels, will consuming caffeine or energy drinks ideal for this fix, or is it my thyroid? 

- Finally, the most important question of all. Which lab test to perform to investigate comprehensive thyroid functions? Is conventional medical health screening for thyroid sufficient? Would testing TSH and T4, T3 accurate enough to find out what is wrong with the thyroid? 

Are all eggs the same? - Purity tests 101

Eggs, have always a topic of discussion when it comes to health, diet, fitness and even bodybuilding. It has been eaten by humans and animals by as long as we all have step foot on this planet earth. In this post, I will mainly discuss about chicken eggs, one of my favorite foods, and arguably one of the healthiest cheapest foods one can consume and incorporate them in their daily diet.

This nutritional food, has been unfairly labeled and gotten a bad reputation from the media not long ago. To be exact, the newsplash came directly from a group of Canadian researchers. As always, there are bad science and good science, like what Gary Taubes mentioned. I won't discuss about the lipid hypothesis in this post, but I will share with you a few methods you could use to determine the quality of the chicken eggs you invested from supermarket, organic health store or fresh market. I call them eggs purity test.

Now, some of us may have been tricked into buying organic free range eggs. A recent local newspaper has published that chemical is used to make the chickens look 'yellow skinned', scamming the buyers to think it is free range 'kampung' breed. Again, it's all about the money. Me myself, was scammed a couple of times into buying so called free range chicken eggs by the market sellers, but I did not go back to these sellers, after these eggs failed the purity test badly multiple times.

Before you invest your money on so called free range eggs, try to 'interview' and get to know the seller in the fresh market, asking questions like "Where does the eggs come from?", or "How many chickens are breed in that farm/kampung?" or "Which does these chickens eat?". These questions will help you identify if the chickens are healthy and eating their natural diet, instead of soy, corn, wheat and other garbage which is not meant for these poor little birds. A healthy chicken lay a healthy egg. No rocket science here. 

We have been told to avoid eating egg yolks, since statins (cholesterol lowering drugs) is endorsed and commercially prescribed? Cholesterol has been labeled as a villain since Ancel Keys made a terrible biased study on saturated fats and cholesterol. "Don't eat that yolk, your cholesterol will go off the roof!". Everyone knows cholesterol is bad, and consuming eggs to it's minimum would be ideal. How come cardiovascular disease rates is increasing yearly? Why are we dropping like flies from heart attacks? How can an old food cause a new disease? That totally does not make any sense at all. I mean seriously folks, a little common sense here? Does anyone even know why an egg has so much cholesterol? Yes, it is because in order to grow and develop a healthy chicken, that much amount of cholesterol is required, same apply with humans. So, eat your eggs, eat the yolk, half boil it, or scramble it with coconut oil, it is one of the best foods one can consume. And it will not give you heart attack, but it may help you to lose weight, boost your libido and provide you tons of valuable nutrition. 

Anyway, let's get on with the egg purity test.

1) When preparing for half boil egg, ensure the egg DOES NOT tilt in any direction once it is in the boiling water. If you notice the tip of the egg tilt upward, or the whole egg floats, there is a very high chance that the egg is no longer fresh and partially rotten or contaminated. 

2) Once the egg is ready (half boiled), ensure the egg does not smell awkward, funny or nasty. A clean quality egg should not have any unpleasant nor nasty smell.

3) When the egg is cracked open to a small bowl or cup, the egg yolk and egg should be attached together (at least most of it), and not splattered into the bowl like fluid or watery form. Also, the egg shell should be fairly hard and strong, instead of flimsy and soft.  

4) Lastly, the egg yolk should look dark strong orange or mild orange, and not pale yellow. That will determine how much carotene the chicken has ingested from clean pesticide-free grass. 

One of the few free range eggs sold locally, and they are sold in small bulk, unlike hundreds of pile up eggs available for sale in fresh markets and supermarkets. 

One of the purity tests, clearly shows that the egg yolks has different colors, yellow base and dark rich orange. Two different eggs have been selected for this test, a genuine free range organic egg and a so called 'kampung' or free range eggs. Don't guess, test them yourself.

Which oils are ideal for cooking?

If any of you spend alot of time in the kitchen cooking, this post may be informative for you. The ones who love to cook with oils, you may find the following information to be 'heart-healthy' and beneficial. If you have been cooking  and eating foods most of your life laden with commercial vegetable oils, it is time to realize the truth about cooking oils.

For years, we have been hardwired and informed by medias such as newspapers, health and food magazines, friends, and even dietitians and nutritionists, to cook foods with commercial vegetable oils. No? Try walk down the alley of any supermarket, you will find a whole list of commercial vegetable oils such as peanut oil, soybean oil, canola oil, sunflower oil, corn oil, grapeseed oil, cottonseed oil, etc. Most people are still using these vegetable oils for cooking, at home, restaurants, and of course, road side hawkers stalls. Reason? It's simple, huge profits in cooking oil industry especially soybean and corn. It's all about money!

Let's take India for example. A nation who has been suffering from cardiovascular/heart disease for decades. Cardiovascular disease is the no.1 leading cause of death in India. Some sources from the media blame it on genetics, some blame it in diet, basically we have numerous contradicting factors. Which is correct? Is it the genes? Diet? Lifetysle? Most people, tend to blame their health on genetic. It's so simple to point finger on our genes and give up on exercise, diet, nutrition, sleep wake cycles and other lifestyle factors.

Human Genome project, proved that our genes has only approximately 5% contribution of our health. Minority of people may have up to 10%, and it is obvious that each of us has huge control over our own health, more then 90%. As most people are often full of excuses, it is time to stop giving excuses and take control of your health, your life. It is so easy to just blame on the genes and eat all you want and sit on the couch all day long without adequate physical movement. Aint it?

Let's go back to India. Anyone knows why India has such a skyrocket high rates of cardiovascular disease? Do you know how they cook their foods regularly? Yes, for decades, since commercial vegetable oils is commercialized, people in India (and also other nations) are using these oxidized free radicals vegetable oils to cook their foods. If any of you ever consume Indian cuisines before, you will realize most of the cooked foods are laden with vegetable oils.

In my country too, the mamak stalls foods are almost entirely cooked with commercial vegetable oils. Malaysia too, the leading cause of death is cardiovascular disease. We have been told that vegetable oils are 'heart healthy' and contains health fats such as Omega 3, 6 and even 9 and it has antioxidants. Even the conventional dieticians and nutritionists in most countries including Malaysia, said it is alright for the public to consume foods such as mee goreng (fried noodles), nasi lemak, etc. Wonder why Malaysia is one of the most obese nations in Asia?


High Cardiovascular Disease rates in India

http://www.thehindu.com/sci-tech/health/premature-deaths-by-noncommunicable-disease-high-in-india-who/article2452886.ece
http://www.thehindu.com/news/national/kerala/coronary-artery-disease-killer-no1-in-india/article2932229.ece
http://ajcn.nutrition.org/content/79/4/582.long

References:
http://www.kumc.edu/school-of-medicine/integrative-medicine/health-topics/healthy-cooking-oils.html
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3226610/
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1993956/
http://www.ncbi.nlm.nih.gov/pubmed/15333157/
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3541024/

PUFAs content in oils. Avoid using oils which has more then 20% for heated cooking, the lower the better. 

What is PUFA's? **

"Polyunsaturated fatty acids (PUFA):

PUFAs are easily oxidized by oxygen and heat, and form much higher amounts of toxic lipid peroxides than saturated or monounsaturated oils. These lipid peroxides cause oxidative damage, and their intake needs to be minimized. Some oils, such as canola and perilla, are high in alpha linolenic acid, which when heated, can lead to the formation of carcinogens and mutagens.

Oils high in PUFAs have to be manufactured, transported, and stored very carefully to be safe for eating. Ideally, PUFAs should be kept air-tight/oxygen-free and cold. PUFAs are not generally bad for you unless they are oxidized. All PUFAs that have been cooked with are oxidized and therefore bad.

PUFAs are considered damaged if at any stage in the manufacturing or transport and handling or use the oil has been exposed to excessive oxygen or heat. The same goes for nuts or seeds with a high PUFA content, although they are slightly more self-protected than naked oils.

Omega 3 and omega 6 oils are PUFAs. Many omega 3 oils have very beneficial effects, provided they are undamaged and handled very carefully, minimizing exposure to air and light and heat. For example, evening primrose oil is a commonly used supplement. Keep it in the fridge, and make sure it was not processed with heat.

Omega 6 oils are found abundantly in corn, soy, canola, sunflower, safflower and other commercially used cooking oils. The problem is that people are consuming too much of these oils, thus throwing off their omega 3 to omega 6 ratio. The proper balance is fats in a body is important, as if our fat balance is off, cell membranes and other cellular processes do not function quite as well. People today eat way too much omega 6 oils. The ideal ratio of omega 3 to omega 6 is about 1:4.

Part of the problem with commercial meats is that the animals are fed corn or soy, which not only are bad because they are GMO, but also bad because the ratio of omega 3 to omega 6 is imbalanced, and there is thus too much omega 6 and too little omega 3 in the resulting meat. People buying meat should look not only for organic, but also for free range."

** Article extracted from University of Kansas Medical Center.
http://www.kumc.edu/school-of-medicine/integrative-medicine


In a nutshell:

During processing and extraction of oils from these vegetables, high heat temperature is used which causes oxidation of the fats, thus transfat. Not to mention if we further use these commercial cooking oils to cook foods with high temperature, stir fry, deep fried, etc. It will then progress from bad to worst, further, elevating a much higher inflammation, carcinogens and levels of transfat.

Ideal oils/fats for cooking:
- Coconut oil (smoke point 450 degrees)
- Red Palm Oil (taken from the fruit)
- Lard
- Ghee
- Animal fats (free range, organic, antibiotic free)
- Butter (Preferably organic)
- Avocado oil (smoke point 510 degrees)
- Almond Oil (smoke point 450-490 degrees)


Oils to avoid at all cost for cooking:  (Avoid oils which is high in PUFAs)
- Soybean Oil
- Hemp Oil
- SafflowerOil
- Sunflower Oil
- Peanut Oil
- Corn Oil
- Canola Oil
- Cottonseed Oil
- Grapeseed Oil
- Perilla Oil

Body Posture & Muscles Functions: (Part 8)

I remember when I was young, attempting more then 100 reps of sit ups everyday, for months, thinking how I could develop a ripped mid section abdominal muscles. Oh boy, I was clueless and end up hurting my lower back terribly. With repetitive chronic trunk flexion, my lumbar spine just had it after months of insane sit up routine. Did I succeed my goal of getting 6 pack abs? Of course no. The core muscles and whole midsection abs musculature consists of more then just rectus abdominis. 

Fast forward to present day, I'm now training with a much efficient, effective and safer tools (if perform correctly) to seriously train a stronger and functional core muscles. Zero sit up, zero crunch exercises, end result? Six pack abs. Most of my friends, clients and even family members can't believe I could achieve that without performing the traditonal sit up and crunches movements. How do I train my core muscles? First of all, you need to bury the mindset that core muscles is your abdominal muscles. There are multiple components basically from the 'nipple to the knee', and rectus abdominis is just one part of your abdominal muscles. Transverse abdominis, obliques, multifidis, pelvic floor, quadratus lumborum are the other vital component of the core musculature. 

In current modern society, most people train the so called 'core' muscles, primarily for display purpose. Apart from chronic insane reps of trunk flexion, muscle imbalances is inevitable, and it is cause problems to other parts of the musculature, including lower back, hip flexors, etc. Compare person A doin primarily sit ups and crunches, and person B, performing exercises such as squat, lunges, plank variations and deadlift, the latter will develop a much stronger, fully functional core muscles and lower risk of injuries as well as minimal muscle imbalances. For me, I love playing with paralettes, suspension training movements, weight training (kettlebells, barbells), stability ball. I love varieties, fun and 'mind and body' connection, and isolation based training is just not my cup of tea. 

I will share with you today the continuation of abdominal muscles and this will be the final post for this series. Now, let's discuss about upper abdominal muscles.

ANALYSIS OF THE TRUNK-RAISING MOVEMENT

Before doing this test, examine the flexibility of the back so that any restriction of motion is not interpreted as muscle weakness. The trunk-raising movement, when properly done as a test, consists of two parts: spine flexion (i.e., trunk curl) by the abdominal muscles and hip flexion (i.e., situp) by the hip flexors.

During the trunk-curl phase, the abdominal muscles contract and shorten, flexing the spine. The upper back rounds, the lower back flattens, and the pelvis tilts posteriorly. On completion of the curl, the spine is fully flexed, with the low back and pelvis still flat on the table. The abdominal muscles act to flex the spine only. During this phase, the heels should remain in contact with the table.

The trunk curl is followed by the hip flexion phase, during which the hip flexors contract and shorten, lifting the trunk and pelvis up from the table by flexion at the hip joints and pulling the pelvis in the direction of anterior tilt Because the abdominal muscles do not cross the hip joints, they cannot assist with the sit-up movement If the abdominal muscles are strong enough, however, they can continue to hold the trunk curled.

The hip flexion phase is included in this test because it provides resistance against the abdominal muscles. The crucial point in the test is the moment at which the hip flexion phase is initiated. At this point, the feet of some subjects may start to come up from the table. The feet may be held down if the force exerted by the extended lower extremities does not counterbalance that exerted by the flexed trunk. However, if the feet are held down, attention must be focused on whether the trunk maintains the curl because at this point, the strength of the hip flexors can overcome the ability of the abdominals to maintain the curl. If this occurs, the pelvis will quickly tilt anteriorly, the back will arch, and the subject will continue the sit-up movement with the feet stabilized.

The trunk-raising test for the upper abdominal muscles is valuable when performed correctly. However, if the ability to perform a sit-up, regardless of how it is done, is equated with good abdominal strength, this test loses its value. During a curled-trunk sit-up with the legs extended, the pelvis first tilts posteriorly, accompanied by flattening of the low back and extension of the hip joints. After the trunk-curl phase is completed, the pelvis tilts anteriorly (i.e., forward), toward the thigh, in hip flexion, but it remains in posterior tilt in relation to the trunk, maintaining the flat-back position. During a sit-up with the low back arched, the pelvis tilts anteriorly, toward the thigh, as the sit-up begins, and it remains tilted anteriorly.

TEST FOR UPPER ABDOMINAL MUSCLES

Patient: Supine, with legs extended. If the hip flexor muscles are short and prevent posterior pelvic tilt with flattening of the lumbar spine, place a roll under the knees to passively flex the hips enough to allow the back
to flatten. (Arm positions are described below under Grading.)

Fixation: None necessary during the initial phase of the test (i.e., trunk curl), in which the spine is flexed and the thorax and pelvis are approximated. Do not hold the feet down during the trunk-curl phase. Stabilization of the feet will allow hip flexors to initiate trunk raising by flexion of the pelvis on the thighs.

Test Movement: Have the subject do a trunk curl slowly, completing spine flexion and, thereby, the range of motion that can be performed by the abdominal muscles. Without interrupting the movement, have the subject continue into the hip flexion phase (i.e., the sit-up) to obtain strong resistance against the abdominal muscles and, thereby, an adequate strength test.

Resistance: During the trunk-curl phase, resistance is offered by the weight of the head and upper trunk, and by the arms placed in various positions. However, the resistance offered by the weight of the head, shoulders and arms is not sufficient to provide an adequate test for strength of the abdominal muscles. The hip flexion phase provides strong resistance against the abdominals. The hip flexors pull strongly downward on the pelvis as the abdominals work to hold the trunk in flexion and the pelvis in the direction of posterior tilt.

A figure

With the hands clasped behind the head, the subject is able to flex the vertebral column (A figure) and keep it flexed while entering the hip flexion phase and coming to a sitting position. The feet may be held down during the hip flexion phase, if necessary, but close observation is required to be sure that the subject maintains the flexion of the trunk.

Because many people can do a curled-trunk sit up with hands clasped behind the head, it is usually permissible to have a subject place the hands in this position (initially) and attempt to perform the test. If the difficulty of this test is a concern, have the subject start with the arms reaching forward, progress to placing arms folded across the chest, and then place the hands behind the head

With the arms folded across the chest, the subject is able to flex the vertebral column and keep it flexed while entering the hip flexion phase and coming to a sitting position. The strongest force against the abdominals is at the moment the hip flexors start to raise the trunk. Performing only the trunk curl is not sufficient for strength testing.


For many years, sit-ups were done most frequently with the legs extended. More recently emphasis has been
placed on doing the exercise in the knee-bent position, which automatically flexes the hips in the supine position. Whether performed with legs straight or bent, the sit-up is a strong hip flexor exercise, the difference between the two leg positions is in the arc of hip joint motion through which the hip flexors act.

Ironically, the knee-bent sit-up has been advocated as a means of minimizing action of the hip flexors. For many years, the idea has persisted, both among professionals and normal people, that having the hips and knees bent in the back-lying position would put the hip flexors "on a slack" and eliminate action of the hip flexors while doing a sit-up, and that in this position the sit-up would be performed by the abdominal muscles. These ideas are not based on facts, they are false and misleading. The abdominal muscles can only curl the trunk. They cannot perform the hip flexion part of the trunk-raising movement. Furthermore, the iliacus is a one joint muscle that is expected to complete the movement of hip flexion and, as such, is not put on a slack. The two joint rectus femoris is also not put on a slack, because it is lengthened over the knee joint while shortened over the hip joint. If the hip flexors are not short, an individual, when starting the trunk-raising movement with legs extended,  will curl the trunk, and the low back will flatten before the hip flexion phase begins. The danger of hyperextension will occur only if the abdominals are too weak to maintain the curl, a reason not to continue into the sit up.

The real problem in doing sit ups with the legs extended compared to the apparent advantage of flexing the hips and knees stems from dealing with many subjects who have short hip flexors. In the supine position, a person with short hip flexors will lie with the low back hyperextended. The hazard of doing sit ups from this position is that the hip flexors will further hyper extend the low back, causing a stress on that area while doing the exercise, and will increase the tendency toward a lordotic posture in standing. The knee bent position, however, releases the downward pull by the short hip flexors, allowing the pelvis to tilt posteriorly and the low back to flatten, thereby relieving strain on the low back.

Bear in mind, if you genuinely desire to build a strong mid section foundation, try yoga or simple plank variations. I would not recommend to perform chronic sit up exercises to build a so called 6 pack abs. The goal is to train your core functionally, intentionally, and with safer methods preventing muscle imbalances. With all the hype and obsession of ripped abs muscles, most of us have forgotten how our ancestors move physically, how we evolved, from sprinting to jumping, climbing to crawling, and heavy lifting to even just brisk walking. The conventional training which most people are applying in their regular routines, is making the posture and core musculature even worst, increasing muscle imbalances and higher risk of injuries. We are living in fitness fradulent world, and people need to realize it.

Body Posture & Muscles Functions: (Part 7)

In this post, I will discuss about the 'CORE', one of the most popular muscle group in the body. In almost every fitness field, gym, yoga class and even bootcamp session, the so called 'abs section' or CORE is well known to most people who train in gyms and read fitness magazines. Many people have regard the CORE as abdominal muscles, and the minority fitness professionals would know better that the CORE, is much more then just 'abs muscles'. I will discuss a few areas of the mid section and areas of the CORE musculature, this post covers rectus abdominis, internal and external obliques as well as transverse abdominis. The ones who has more interest in building a stronger mid section and so called '6 pack abs', you may find the following illustrations beneficial to you in some way.

Let's start off with rectus abdominis. 

RECTUS ABDOMINIS

Origin: Pubic crest and symphysis.

Insertion: Costal cartilages of the fifth through seventh ribs and xiphoid process of the sternum.

Direction of Fibers: Vertical.

Action: Flexes the vertebral column by approximating the thorax and pelvis anteriorly. With the pelvis fixed,

the thorax will move toward the pelvis; with the thorax fixed, the pelvis will move toward the thorax.

Nerve: T5, 6, T7-11, T12, ventral rami.

Weakness: Weakness of this muscle results in decreased ability to flex the vertebral column. In the supine position, the ability to tilt the pelvis posteriorly or approximate the thorax toward the pelvis is decreased, making it difficult to raise the head and upper trunk. For anterior neck flexors to raise the head from a supine position, the anterior abdominal muscles (particularly the rectus abdominis) must fix the thorax. With marked weakness of the abdominal muscles, an individual may not be able to raise the head even though the neck flexors are strong. In the erect position, weakness of this muscle permits an anterior pelvic tilt and a lordotic posture (e.g increased anterior convexity of the lumbar spine).

Rectus Abdominis

EXTERNAL OBLIQUE, anterior fibers

Origin: External surfaces of ribs five through eight interdigitating with the serratus anterior.

Insertion: Into a broad, flat aponeurosis, terminating in the linea alba, which is a tendinous raphe that extends from the xiphoid.

Direction of Fibers: Obliquely downward and medially, with the uppermost fibers more medial.

Action: Acting bilaterally, the anterior fibers flex the vertebral column (approximating the thorax and pelvis anteriorly), support and compress the abdominal viscera, depress the thorax and assist in respiration. Acting unilaterally with the anterior fibers of the internal oblique on the opposite side, the anterior fibers of the external oblique rotate the vertebral column, bringing the thorax forward (when the pelvis is fixed), or the pelvis backward (when the thorax is fixed). For example, with the pelvis fixed, the right external oblique rotates the thorax counter-clockwise, and the left external oblique rotates the thorax clockwise.

Nerves to anterior and lateral fibers: (T5, 6), T7-11, T-12

EXTERNAL OBLIQUE, lateral fibers

Origin: External surface of the ninth rib, interdigitating with the serratus anterior; and external surfaces of the 10th through 12th ribs, interdigitating with the latissimus dorsi.

Insertion: As the inguinal ligament, into the anterosuperior spine and pubic tubercle and into the external up of the anterior 'h of the iliac crest.

Direction of Fibers: Fibers extend obliquely downward and medially, but more downward than the anterior fibers.

Action: Acting bilaterally, the lateral fibers of the external oblique flex the vertebral column with a major influence on the lumbar spine, tilting the pelvis posteriorly. Acting unilaterally with the lateral fibers of the internal oblique on the same side, these fibers of the external oblique laterally flex the vertebral column, approximating the thorax and iliac crest. These external oblique fibers also act with the internal oblique on the opposite side to rotate the vertebral column. The external oblique, in its action on the thorax, is comparable to the sternocleidomastoid in its action on the head.

External Obliques

INTERNAL OBLIQUE (lower anterior)

Origin: Lateral 2h of inguinal ligament and short attachment on iliac crest near the anterosuperior spine.

Insertion: With the transverse abdominis into crest of the pubis, medial part of the pectineal line and into the linea alba by means of an aponeurosis.

Direction of Fibers: Transversely across the lower abdomen. 

Action: The lower anterior fibers compress and support the lower abdominal viscera in conjunction with the transversus abdominis.

INTERNAL OBLIQUE (upper anterior)

Origin: Anterior 1/3 of intermediate line of the iliac crest

Insertion: Linea alba by means of an aponeurosis.

Direction of Fibers: Obliquely medially and upward.

Action: Acting bilaterally, the upper anterior fibers flex the vertebral column (approximating the thorax and pelvis anteriorly), support and compress the abdominal viscera, depress the thorax and assist in respiration. Acting unilaterally in conjunction with the anterior fibers of the external oblique on the opposite side, the upper anterior fibers of the internal oblique rotate the vertebral column, bringing the thorax backward (when the pelvis is fixed), or the pelvis forward (when the thorax is fixed). For example, the right internal oblique rotates the thorax clockwise, and the left internal oblique rotates the thorax counterclockwise on a fixed pelvis.

INTERNAL OBLIQUE (lateral fibers)

Origin: Middle xh of intermediate line of the iliac crest and the thoracolumbar fascia.

Insertion: Inferior borders of the 10th through 12th ribs and the linea alba by means of an aponeurosis.

Direction of Fibers: Obliquely upward and medially, but more upward than the anterior fibers.

Action: Acting bilaterally, the lateral fibers flex the vertebral column (approximating the thorax and pelvis anteriorly) and depress the thorax. Acting unilaterally with the lateral fibers of the external oblique on the same side, these fibers of the internal oblique laterally flex the vertebral column, approximating the thorax and pelvis. These fibers also act with the external oblique on the opposite side to rotate the vertebral column.

Nerves to Anterior and Lateral Fibers: T7, 8,19-11 LI, iliohypogastric and ilioinguinal, ventral rami.

Internal Obliques

TRANSVERSE ABDOMINIS

Origin: Inner surfaces of cartilages of the lower six ribs, interdigitating with the diaphragm; thoracolumbar fascia; anterior 3 /4 of internal lip of the iliac crest.

Insertion: Linea alba by means of a broad aponeurosis, pubic crest, and pecten pubis.

Direction of Fibers: Transverse (horizontal).

Action: Acts likes a girdle to flatten the abdominal wall and compress the abdominal viscera; upper portion helps to decrease the infrastemal angle of the ribs, as in expiration. This muscle has no action in lateral trunk flexion, except that it acts to compress the viscera and to stabilize the linea alba, permitting better action by the anterolateral trunk muscles.

Nerve: T7-12, LI iliohypogastric and ilioinguinal, ventral divisions.

Weakness: Permits a bulging of the anterior abdominal wall, which indirectly tends to increase lordosis. During flexion in the supine position and hyperextension of the trunk in the prone position, a lateral bulge tends to occur if the transversus abdominis is weak.

Transverse Abdominis

What are the functions of upper and lower abdominals muscles? 

The terms upper and lower differentiate two important strength tests for the abdominal muscles. More often than not, there is a difference between the grades of strength attributed to the upper abdominals compared to
those attributed to the lower abdominals. If the same muscles entered into both tests and the difference in strength resulted from a difference in the difficulty of the tests, there should be a fairly constant ratio between the two measurements. In order of frequency, the following combinations of strength and weakness are found:

1. Upper strong and lower weak.
2. Upper and lower both weak.
3. Upper and lower both strong.
4. Lower strong and upper weak.

The difference in strength may be remarkable. A subject who can perform as many as 50 or more curledtrunk sit-ups may grade less than fair on the leg-lowering test. This same subject can increase the strength of the lower abdominals to normal by doing exercises specifically localized to the external oblique. Because the oblique abdominal muscles are essentially fan-shaped, one part of a muscle may function in a somewhat different role than another part of the same muscle. Knowledge of the attachments and the line of pull of the fibers, along with clinical observations of patients with marked weakness and those with good strength, leads to conclusions regarding the action of muscles or segments of abdominal muscles. The rectus abdominis enters into both tests. There is a distinct difference, however, between action of the internal oblique and that of the external oblique as exhibited by the two tests.

When analyzing which muscles or parts of muscles enter into the various tests, it is necessary to observe the movements that take place and the line of pull of the muscles that enter into the movement. As trunk flexion is initiated by slowly raising the head and shoulders from a supine position, the chest is depressed, and the thorax is pulled toward the pelvis. Simultaneously, the pelvis tilts posteriorly. These movements obviously result from action of the rectus abdominis muscle. Along with depression of the chest, the ribs flare outward, and the infrasternal angle is increased. These movements are compatible with the action of the internal oblique.

No test movement can cause an approximation of parts to which the lower transverse fibers of the internal oblique are attached, because these fibers extend across the lower abdomen from ilium to ilium like the lower
fibers of the transversus abdominis. In posterior pelvic tilt and in trunk-raising movements, however, this pan of the internal oblique will act with the transversus to compress the lower abdomen.

Stay tuned for the final part of this abdominal muscles' post.

Body Posture & Muscles Functions: (Part 6)

In this post, I will start off with brief explanation about back extensors' test. Once we are done reviewing the test, I will discuss about the simple tests for glutes and QLO. This back extensor test, can be apply to general population and even professional athletes.

In the trunk extension test for the back extensors, the erector spinae muscles are assisted by the latissimus dorsi, quadratus lumborum, and trapezius. In the prone position, the low back will assume a normal anterior curve. To avoid false interpretations of the test results, it may be necessary to perform some preliminary tests. It is not necessary to do so routinely, however, because close observation of the subject in a prone position and of the movements taking place during trunk extension will indicate if preliminary tests for length of hip flexors and strength of the hip extensors are needed. Now, let me present to you the back extensor test. 

Patient: Prone, with hands clasped behind the buttocks (or behind the head).

Fixation: Hip extensors must give fixation of the pelvis to the thighs. The examiner stabilizes the legs firmly on the table.

Test Movement: Trunk extension to the subject's full range of motion.

Resistance: Gravity. Hands behind the head, or hands behind the lower back.

Grading: The ability to complete the movement and hold the position with hands behind the head or behind the back may be considered as normal strength. The low back muscles are seldom weak, but if there appears to be weakness, then hip flexor tightness and/or hip extensor weakness must be ruled out first. Actual weakness can usually be determined by having the examiner raise the subject's trunk in extension (to the subject's maximum range) and then asking the subject to hold the completed test position. Inability to hold this position will indicate weakness. Weakness is best described as slight, moderate, or marked based on the judgment of the examiner.

If the hip extensors are weak, it is possible that the examiner can stabilize the pelvis firmly in the direction of posterior tilt toward the thighs, provided that the legs are also firmly held down by another person or by straps. Alternatively, the subject may be placed at the end of the table, with the trunk in a prone position and legs hanging down with knees bent as needed. The examiner then stabilizes the pelvis and asks subject to raise the trunk in extension and hold it against pressure. In the presence of tight hip flexors, the back will assume a degree of extension (e.g lordosis) commensurate with the amount of hip flexor tightness. In other words, the low back will be in extension before beginning the trunk extension movement. In such a case, the subject will be limited in the height to which the trunk can be raised, and the mistaken interpretation may be that the back muscles are weak.

A similar situation may arise if the hip extensor muscles are weak. For strong extension of the back, the hip extensors must stabilize the pelvis toward the thighs. If the hip extensors cannot provide this stabilization, the pelvis will be pulled upward by the back extensors into a position of back extension. Again, as in the case of hip flexor tightness, if the back is already in some extension before the trunk-raising movement is started, the trunk will not be raised as high off the table as it would be if the pelvis were fixed in extension on the thighs.

Gluteus Maximus (How weak is your glutes?)

Lying prone on a table, this subject exhibits a normal anterior curve in the

lower back

The moment that back extension is initiated, the curve in the lower back increases

because of weakness in the gluteus maximus.

When extension is continued, the subject can raise the trunk higher, but not to

completion of the range of motion.

Holding the pelvis in the direction of posterior pelvic tilt, in the manner provided

by a strong gluteus maximus, enables the subject to complete the full

range of motion.

We've covered back extensors and glutes tests. Now, let's move on to a quick test on the quadratus lumborum. The quadratus lumborum acts with other muscles in lateral trunk flexion. It is difficult to palpate this muscle because it lies deep beneath the erector spinae. Although the quadratus lumborum enters into the motion of elevation of the pelvis in the standing position or in walking, the standing position does not offer a satisfactory position for testing. Elevation of the right side of the pelvis in standing, for example, depends as much (if not more) on the downward pull by the abductors of the left hip joint as it does on the upward pull of the right lateral abdominals.

Quadratus Lumborum (QLO)

Origin: Iliolumbar ligament, iliac crest. Occasionally from upper borders of the transverse processes of the lower three or four lumbar vertebrae. 

Insertion: Inferior border of the last rib and transverse processes of the upper four lumbar vertebrae.

Action: Assists in extension, laterally flexes the lumbar vertebral column, and depresses the last rib. Bilaterally, when acting together with the diaphragm, fixes the last two ribs during respiration.

Nerve: Lumbar plexus, T12, LI, 2, 3.

Patient: Prone.

Fixation: By muscles that hold the femur firmly in the

acetabulum.

Test Movement: Lateral elevation of the pelvis. The extremity is placed in slight extension and in the degree of abduction that corresponds with the line of fibers of the quadratus lumborum.

Resistance: Given in the form of traction on the extremity, directly opposing the line of pull of the quadratus lumborum. If the hip muscles are weak, pressure may be given against the posterolateral iliac crest opposite the line of pull of the muscle.

Grading: Grading the strength of this muscle numerically is not recommended. Simply record whether it appears to be weak or strong.

The coming weeks will be very busy on my schedule, stay tuned as I will try to finish off a couple more posts on this discussion.

Body Posture & Muscles Functions: (Part 5)

For some of you personal trainers and coaches out there, you may heard of anterior and posterior pelvic tilt during your fitness or CPT courses. And for some of you people, you may be aware of 'donald duck and pink panther syndrome'. What does these terms have in common? Well, if you notice people especially women with lower back arch, we call that posture 'Donald Duck' or also known as anterior pelvic tilt. As for people with 'pink panther syndrome' or 'butt dissapearing syndrome', it is also known as posterior pelvic tilt. 

Now, let's talk about the pelvic. An area which not many people show great interest, it plays an important role in biomechanics and postural alignment. The neutral position of the pelvis is one in which the anterosuperior-iliac spines are in the same transverse plane, and in which the spines and the symphysis pubis are in the same vertical plane. An anterior pelvic tilt is a position of the pelvis in which the vertical plane through the antero-superior-iliac spines is anterior to a vertical plane through the symphysis pubis. A posterior pelvic tilt is a position of the pelvis in which the vertical plane through the antero-superior iliac spines is posterior to a vertical plane through the symphysis pubis. In a standing position, an anterior pelvic tilt is associated with hyperextension of the lumbar spine and flexion of the hip joints, whereas a posterior pelvic tilt is associated with flexion of the lumbar spine and extension of the hip joints.

Now, let's take a look at the illustration below. 

In lateral pelvic tilt, the pelvis is not level from side to side, rather, one anterosuperior spine is higher than the other. In standing postition, a lateral tilt is associated with lateral flexion of the lumbar spine and with adduction and abduction of the hip joints. For example, in a lateral tilt of the pelvis in which the right side is higher than the left, the lumbar spine is laterally flexed resulting in a curve that is convex toward the left. The right hip joint is in adduction and the left in abduction. Please see illustration below.

I will show you a measurement test which requires minimal tool (only a ruler) to determine the length of the posterior muscles. Below are details of the measurement test and illustration of different common postural status.

Equipment: Same as for hamstring length test, plus a ruler. The ruler is used to measure the distance of the fingertips either from or beyond the base of the big toe. This measurement is used only as a record to show the overall forward bending; it in no way indicates where limitation or excessive motion has taken place.

Starting Position: Sitting with legs extended (long-sitting) and feet at, or slightly below, right angles.

Reason: To standardize the position of the feet and knees.

Test Movement: Reach forward, with knees straight, and try to touch the fingertips to the base of the big toe or beyond, reaching as far as the range of muscle length permits.

Reason: Both the back and hamstrings will elongate to their maximum.

Normal length of back, hamstring, and gastroc-soleus muscles

Excessive length of back muscles, short hamstrings and 

normal length of the gastroc-soleus.

Excessive length of the upper back muscles, slight shortness of the muscles in the mid back and in gastrocsoleus. Hamstrings and low back are normal in length

Normal length of the upper back muscles and short lower

back, hamstring and gastroc-soleus muscles.

Bear in mind, trunk muscles consist of back extensors that bend the trunk backward, lateral flexors that bend it sideways, anterior abdominals that bend it forward or tilt posteriorly, and combinations of these muscles that rotate the trunk in a clockwise or a counter-clockwise manner. All these muscles play a role in stabilizing the trunk, but the back extensors are the most important in this regard. The loss of stability that accompanies paralysis or marked weakness of the back muscles offers dramatic evidence of their importance. Fortunately, marked weakness of these muscles seldom occurs.

The term weak back, as frequently used in connection with low back pain, mistakenly suggests a weakness

of the low back muscles. The feeling of weakness that occurs with a painful back is associated with the faulty alignment the body assumes, and it is often caused by weakness of the abdominal muscles. Persons who have faulty posture with roundness of the upper back may exhibit weakness in the upper back extensors but have normal strength in those of the low back.

Despite the fact that the low back muscles are the most important trunk stabilizers, relatively little space will be devoted to them in this chapter compared to the detailed discussion of the abdominal muscles. Testing back muscles is less complicated than testing abdominal muscles, and in the field of exercise, few errors occur regarding back exercises. Many misconceptions and errors, however, occur regarding proper abdominal exercises. Furthermore, in contrast to the back muscles, weakness of the abdominal muscles is more prevalent. It is important to know how to test for strength and how to prescribe proper exercises for the abdominal muscles because of the effect that weakness of these muscles has on overall posture and the relationship of such weakness to painful postural problems.

Illustrations, definitions, and descriptions of basic concepts are used to help achieve this purpose. Both the illustrations of the trunk muscles that follow and the accompanying text provide information in detail about the origins, insertions and actions of these muscles. This information is essential to understanding the functions of these important trunk muscles.

Now, let's discuss about back extensors and neck. For back extensors, to raise the trunk from a prone position, the hip extensors must fix the pelvis in extension on the thigh. Normally, extension of the hip joints and extension of the lumbar spine are initiated simultaneously, not as two separate movements. If slight tightness exists in the hip flexors, there is no range of extension in the hip joint, and all the movement in the direction of raising the leg backward is accomplished by lumbar spine hyperextension and pelvic tilt. Please see illustrations below.

For hip extensors to raise the extremity backward

from a prone position through the few degrees of true

hip joint extension, the back extensors must stabilize

the pelvis to the trunk.

A subject with strong back extensor muscles and strong

hip extensor muscles can raise the trunk in extension.

A subject with weak or paralyzed back extensor muscles

and strong hip extensor muscles cannot raise the trunk

in extension. The hip extensors, in their action to fix the

pelvis, are unopposed. The pelvis tilts posteriorly, and

the lumbar spine flexes.

In the next post, I will discuss about the back extensors test as well as glutes and quadratus lumborum. Stay tuned.