Friday 22 April 2011

Kyphosis and Lordosis


Kyphosis and Lordosis

First of all, let us start with another rant about terminology. No wonder folks get confused. "OSIS" sounds like a condition - something wrong. Oooo, you have halitosis. Oooo, you have anythingosis. Sounds bad. The osis part should have been "ness", a simple description of quality.

So think of kyphosis as kyphness. And think of lordosis as lordness.
Of course, anybody who knows the terminology will laugh at you. You can take it.
Can't? OK. OK. So we stick with lordosis and kyphosis. Just know that they are descriptions of shape and not diseases.
 In terms of normal posture, the small of the back (alias the low back) curves into the body as a hollow. That inward curvature is called lordosis.
The part that sticks out, the round shoulders, in particular, is a shape called kyphosis. Beware, that round shoulders term messes everybody up as the shoulders are not midline. The termslordosis and kyphosis are mid line contour descriptions. When the back sticks out because ribs are sticking out we do NOT use the term kyphosis. We call that ribs sticking out, from the Etruscian RibusStikusOutus. Way more often than not, the term kyphoscoliosis is just plain wrong as what is sticking out is ribs and typically the actual mid line spine shape is less kyphotic than normal.
The most common cause of lordosis is being a toddler. After that comes being a girl. Girls often exaggerate their natural low back lordosis for allure.
While parents are nagging kids to stand straight, a poker straight spine is trouble. Old fusions with straight rods often are associated with a sense of being off balance.
Extra low back (lumbar) lordosis may follow the abdominal muscles being weak or lazy. We see deep sway back standing that goes away on sitting.
That's a huge clue. On standing, we tickle the belly - have to be a good tickler - and the belly pulls away. So ? So, while the belly sucked in the back flattened.

Why? Because the pelvis is a sea-saw sitting on the two hips. Pull the pubis up and the low back flattens. Lower the pubis and the low back arches deeper - more lordosis.

Back muscles can directly stiffen the spine and straighten it but that is not the typical source of contour. The hamstring muscles (rear thigh muscles) pull the rear protruding lower pelvis (ishium) downward and thus straighten the lower spine.

Because the vertebrae are connected in a flexible rod like manner, when you straighten the lower back the shallower angle connection to the upper back tends to straighten that as well. Pulling in the gut flattens the upper (thoracic) kyphosis.

Now these are all generalities bases on normal anatomy and a reasonable range of flexibility.

In babies, the lower spine, the entire spine is kyphotic. Once the baby stands as a toddler, the short Psoas muscle (the powerful hip flexor) which attaches to the lower spine pulls the lower spine into lordosis.
The interplay between Psoas, hamstrings and rectus abdominus muscles then determines the standing posture. The hip joint capsule (canvas -like covering) may be thickened and resist the extended standing posture. That, too, may lead to excessive lumbar lordosis by pulling the pelvis down from the front.
The upper end of the femur is cartilage in young children. The extension of the thighs in walking and play will deform the extra forward twist that the femur bone has at birth so as to  lessen the inturn of the legs and allow more hip extension. This works if the hip joint is sound and stable and the forces reasonable.

When things are really off...
  PATHOLOGY:



Kyphosis and Lordosis


Kyphosis and Lordosis

First of all, let us start with another rant about terminology. No wonder folks get confused. "OSIS" sounds like a condition - something wrong. Oooo, you have halitosis. Oooo, you have anythingosis. Sounds bad. The osis part should have been "ness", a simple description of quality.

So think of kyphosis as kyphness. And think of lordosis as lordness.
Of course, anybody who knows the terminology will laugh at you. You can take it.
Can't? OK. OK. So we stick with lordosis and kyphosis. Just know that they are descriptions of shape and not diseases.
 In terms of normal posture, the small of the back (alias the low back) curves into the body as a hollow. That inward curvature is called lordosis.
The part that sticks out, the round shoulders, in particular, is a shape called kyphosis. Beware, that round shoulders term messes everybody up as the shoulders are not midline. The termslordosis and kyphosis are mid line contour descriptions. When the back sticks out because ribs are sticking out we do NOT use the term kyphosis. We call that ribs sticking out, from the Etruscian RibusStikusOutus. Way more often than not, the term kyphoscoliosis is just plain wrong as what is sticking out is ribs and typically the actual mid line spine shape is less kyphotic than normal.
The most common cause of lordosis is being a toddler. After that comes being a girl. Girls often exaggerate their natural low back lordosis for allure.
While parents are nagging kids to stand straight, a poker straight spine is trouble. Old fusions with straight rods often are associated with a sense of being off balance.
Extra low back (lumbar) lordosis may follow the abdominal muscles being weak or lazy. We see deep sway back standing that goes away on sitting.
That's a huge clue. On standing, we tickle the belly - have to be a good tickler - and the belly pulls away. So ? So, while the belly sucked in the back flattened.

Why? Because the pelvis is a sea-saw sitting on the two hips. Pull the pubis up and the low back flattens. Lower the pubis and the low back arches deeper - more lordosis.

Back muscles can directly stiffen the spine and straighten it but that is not the typical source of contour. The hamstring muscles (rear thigh muscles) pull the rear protruding lower pelvis (ishium) downward and thus straighten the lower spine.

Because the vertebrae are connected in a flexible rod like manner, when you straighten the lower back the shallower angle connection to the upper back tends to straighten that as well. Pulling in the gut flattens the upper (thoracic) kyphosis.

Now these are all generalities bases on normal anatomy and a reasonable range of flexibility.

In babies, the lower spine, the entire spine is kyphotic. Once the baby stands as a toddler, the short Psoas muscle (the powerful hip flexor) which attaches to the lower spine pulls the lower spine into lordosis.
The interplay between Psoas, hamstrings and rectus abdominus muscles then determines the standing posture. The hip joint capsule (canvas -like covering) may be thickened and resist the extended standing posture. That, too, may lead to excessive lumbar lordosis by pulling the pelvis down from the front.
The upper end of the femur is cartilage in young children. The extension of the thighs in walking and play will deform the extra forward twist that the femur bone has at birth so as to  lessen the inturn of the legs and allow more hip extension. This works if the hip joint is sound and stable and the forces reasonable.

When things are really off...
  PATHOLOGY:




Measures for removing fatigue using yoga


Purpose of yoga 




In due course of time, yoga is mainly looked upon as a set of techniques useful for achieving fitness in daily life and prevention and cure of sime specific diseases or disorders. But the goal of yoga was different when yoga practices came into existence more than three thousand years ago. Throughout its history, yoga seems to have undergone changes regarding the purpose for which it was practiced. Many different varieties of yoga came to be practived for different purposes. The main verieties fof yoga include 
Bhaktiyoga(Yoga of devotion): is the oldest variety of yoga in which the person practicing it invokes the Creator of the universe to shower grace and compassion. This grace and compassion is meant to help the devotee overcome all the travails and hardships of living . Practice of Bhaktiyoga includes prayer, worships of living. Practice of Bhajtiyoga includes prayer, worship, observing austerities and abstinence, and practice of virtue. In the middle ages in India, Many saints cultivated the way of devotion as mass-movement. 
Karamayoga(Yoga of duty or action): is described in great detail in the Bhagavad Gita. The main principles of karamayoga include 

(a) never giving up and never failing in one's duty, and
(b) looking equally upon opposites such as success and failure, pleasure and pain, heat and cold, etc., without being efected or swayed away by them. 

Jnyanayoga(Yoga of knowledge): is explained thoroughly in the Yogasutra of Patanjali (second century BC.). It consists of eight-fold yoga. Ynyanayoga includes outer and inner aspects of disciplining and training the body and mind. It has three important techniques: postures, breath-control, and meditaion. 
Hathayoga (Yoga of bodily performances): In recent times, Hathayoga has become very popular . It was popularised by the experts if Tantra, called the Natha-yogis in the periods between twelfth and fifteenth centuries AD. Two main experts who popularised hathayoga include Matsyendranatha, Gorakhnatha, etc. Hathayoga is described as the yoga of unity of ha and tha. This means the unity of the sun ad the moon in body or the unity of vitak airs - prana and apana. 

The purposes of the four varieties of yoga in daily life are not the same. Bhajtuyiga seeks to propitiate the object of worship, i.e. God. As a result of this worship, the practitioner of bhaktiyoga hopes to overcome difficulties in daily life and/ or to remove the hurdles on the goal of all religions. Karmayoga is based on the ideal that by equanimity (samattva) in relation to the opposites (dvandvas), the practitioner of karmayoga can be freed from the shackles of his/her deeds (karma-bandha), and thereby attain liberation (mukti). Patanjali's jnyanayoga or rajayoga involves techniques for purifying the mind by removing impurities through the eight-fold practice. These include: 
Abstinence or Yama
Observances or Niyama
Postures or Asana
Breath control or Pranayama
Retrieving the mind from objects of enjoyment or Pratyahara
Concentration or Dharana
Contemplation or Dhyana and
Absorption or Samadhi of the mind. 

The above eight-fold path leads to self-realization (atmadarshana). The purpose of hathayoga is achievement of mental stability by silencing the mind through pranayama. Achievement of mental stability arouses the dormant divine power in human being called kundalini. Arousal of the dormant divine power enables hearing the subtle sounds (nada) and absorption of the mind in the state of samadhi. 



Role of yoga for physical and mental well being ? 

The today's practitioners of yoga can be divided into three groups. The smallest group comprises of those who take it very seriously as a way of life and as a philosophy of renunciation and emancipation. Such person live in the monastries and ashrams.

The second group includes people who are disenchanted with the effects of affluence and wealth generated by the progress in science and technology. They seek a new way of life, for which they leave their homes, often join some of the new movements, change their dress and food habits, meditate, sing devotional songs, and try to find a new purpose and meaning to their otherwise dull ultra modern way of life.

The third and the largest group consists of people who are not very keen on the deep philosphical or esoteric implications of yoga or in a new way of life. Instead, they are able to overcome these health problems, they can lead a happier and more productive life. A large number of people in this group are interested in quick, easy cures to their problems. Some of them are those who seek benefits of yoga after having tried other methods and therapies without much success. The number of such yoga enthusiasts is growing very rapidly. It is they who have helped the opening of a new chapter in the history of yoga
.
Yoga for fitness and health consists of five main categories of techniques. Each one of them has its special importance and utility. These categories include:

(a) Postures or asanas: Asanas are a wide range of postures that improve flexibility of muscles and suppleness of joints. People who are not sufficiently well informed about various aspects of yoga believe that yoga practice mainly comprises of practice of asanas. This is perhaps because a large number of yoga teachers are teachers or experts of asanas, many books on yoga discuss only the techniques of various asanas, and many common discussion, exhibitions and performance of yoga deal only with the asanas. There are two main categories of asanas. These include
The meditational poses -good for sitting comfortably and steadily for a long time for the purpose of breath-control or meditation. They have three main benefits. These are to relieve tension from the body and mind, improve digestion and exertion, and overcome postural defects. There are about half a dozen such poses available.
The cultural or exercising poses - involve stretching, pressing or squeezing action and arrangement of the limbs in a sitting, standing, lying down, inverted, or balancing position. Hundred of such postures can be learned and practiced, and each one of them has its own special advantages.

(b) Breath control or pranayama with muscular looks or bandhas: Pranayama is a technique of controlling breathing. It involve sitting in a comfortable, steady, relaxed position, and taking deep, full breaths with prolonged, uniform and complete inspirations and expirations. After practicing deep breathing for some time, retention of breath inside and outside may also be practiced. Pranayama yields benefits for all functions like respiration, blood circulation, digestion, excretion, secretion, and for improving muscle tone, removing congestion of blood, and release of tension. It helps considerably to calm down an irritated and excited mind and make it steady. The bandhas that involve vigorous contractions of particular muscles enhance the benefits of pranayama. Meditation can be done easily after a few rounds of pranayama.

(c) Cleaning techniques or shuddhikriyas: Shuddhikriyas are cleansing techniques that cleanse various internal organs of the body. They are also called shatkriyas or shatkarma because they are six in number. These include: Neti, which is used for cleansing the nasal passage with water, a linen thread, or rubber catheter.
Dhauti, which is used for cleansing the stomach with water or with a twenty-two feet long strip of cloth.
Basti, which is the technique of cleansing of colon.
Trataka, Which is a technique to cleanse the eyes and the mind.
Nauli, which is the foremost among the cleansing techniques, is used to cleanse all the organs and glands inside the abdomen and make them strong.
Kapalabhati, which is an exercise in continuous abdominal breathing, is said to cleanse the skull and make it shining. 

(d) Relaxation : The dead pose, called shavasana is a special technique of yoga for deep relaxation in order to lesson the ill effects of stress. Meditational postures and pranayama are also effective in reducing the adverse effects of stress.

(e) Meditation: It is an effective method for improving the poise and stability of the mind. When meditation is combined with other techniques of yoga, its effect is greatly enhanced for treatment of a wide range of health problems or disorders. 

Benefits of yoga 

Can everyone benefit from yoga ?
 Yes. However, this benefit may not be possible if you do not practice the correct technique of yoga or practice it irregularly. As mentioned above, yoga includes a variety of techniques and you need to choose those that are useful to you and most suited for your individual needs. For example, the needs for specific techniques of yoga would differ for a housewife, a child, an athlete, a teacher, a student, or a factory worker. This is because their ways of life are quite different from each other. Because of the wide range of techniques in yoga, it can fulfill needs in almost all people. Basic fitness in daily life is a common need of everyone. Yoga can fulfill this need irrespective of the type of work you do, your role in life or the type of food you eat. Yoga can help everyone play his or her roles more efficiently, more smoothly and more comfortably.

What are the advantages of yoga ?
   Yoga has many advantages over other methods of maintaining health, such as gymnastics, athletics, aerobics, games, and various other forms of exercise. It does not need any costly equipment and materials, or playgrounds, swimming pool, gyms, etc. Yoga can be practiced throughout the year. It can also be practiced inside the house or in the open, singly or in groups. The only requirement is a thick carpet spread on the floor and covered with a clean sheet of cloth. Yoga should only be practiced on empty stomach. You can do it at any time during the day. It will benefit you irrespective of whether you are young or old, lean or heavily built, highly educated or unlettered, rich or poor, from higher or lower middle class, busy, over busy, or retired or worker in the factory or in the field. Yoga has something very valuable, and useful to offer to everyone. It is often described as the best form of health insurance for all from the age of seven to seventy seven or more. Two main advantages of Yoga are prevention of disorders and ailments and maintenance of health and fitness in daily life. Other advantage include flexible muscles, supple joints, relaxed and tension-free mind and efficiently working vital organs such as the heart, lungs, endocrine glands, liver, pancreas and good balance between various functions, such as neuromuscular coordination, etc.

Can all the yoga techniques be practiced in all age groups ?
    Although yoga can be practiced in all age groups, some techniques are more suited and desirable for specific age groups. For example, some asanas that involve forward and backward bending are good for children aged five to ten years. At about ten years of age, the asanas that have an upside down position and deep breathing can be started. Shuddhikriyas should not be practiced everyday. They need to be performed as and when required for removal of impurities from the body. However, Kapalabhati Nauli can be done every day. They are generally most suited for people in age group of twenty to sixty years. Relaxation is necessary for all, irrespective of age. People in all age groups can therefore practice mediation regularly. It is desirable that older people avoid asanas that involve excessive stretching, such as the plough pose or halasana. Strenuous poses such as the scorpion or vrischikasana head-stand or shirshasana should also be avoided older people. When yoga is practiced for therapeutic purpose to overcome or cure ailments, other restrictions are necessary . This is why yoga should not be practiced unless you have learned the correct technique from an expert.

Information provided above is merely a layperson's reference, not meant to replace the professional and authoritative guidance of your doctor. Self diagnosis and self-treatment are dangerous, and Hindustanlink.com strongly discourages it. The opinions expressed in here are those of the contributors for which Hindustanlink.com owns no responsibility.

Keep-fit- yoga routine and simple yoga techniques 

Most of the people of all age group are free from major illness that require hospitalistion, bed rest, etc. They are engaged in their roles in daily life, such as students, housewives, office-goers, workers, etc., and all of them need some programme of exercise for maintaining fitness and health.

Yoga is the most effective ways of maintaining healthier life. A large number of people prefer to spend a little time as possible on an exercise routine or yoga. Inertia is one of the fundamental laws of nature, and the tendency of not doing any effort for the maintenance of health is very wide spread.


Detailed below are some of the yoga techniques that can be practiced regularly despite busy schedule, over-crowded homes or others similar constraints of life. Health is a state of an individual that is a sum total of various situations concerning the body and mind. All of them may be summarised in one basic requirement - that all the organs must perform their functions effectively and condition to be fulfilled. But in fitness there is more emphasis on action, activity, or a particular task. Overall fitness and health are words that mean the same state of an individual. While recommending a minimum set of yoga techniques, this definition of health has been considered. It includes techniques that ensure efficient working of all organs and parts of the body such as the vital organs, muscles, joints, glands, tissues and all functions such as digestion, respiration, blood circulation, secretion, excretion, reproduction and functions of the nervous system. The keep-fit-yoga routine discussed here includes five techniques. These are (i) movements of joints, (ii) postures, (iii) deep breathing, (iv) relaxation and (v) meditation.

Movements of joints: This is called 'sandhichalana' In this technique, the joints of the body are removed in a sequence, and each joint undergoes a full movement. The steps in movement of joints include the following. 
Movement of the hands: 
1. Sit with the legs stretched together in front of the body.

2. Keep the arms parallel to the legs with palms facing down. Maintain a distance of nine to twelve inches between the hands.

3. Keep the neck and back erect.

4. Stretch the fingers out, opening the hands, and then close the fingers against the palms, forming tight fists. Repeat these finger movements ten to twelve times with the palms facing down. Next is movement of the wrist joint.

5. Hold the palms and fingers loosely and move the hands up and down at the wrist joint seven to ten times.

6. Turn the palms inside, facing each other, and repeat the movements of the wrist joint seven to ten times.

7. Turn the palms upward, facing the roof above, and move the wrist joints seven to ten times.

8. Turn the palms outward , and repeat the wrist movements seven to ten times.

9. Rotate the wrist joints so that the hands move in a circular fashion. Rotate them ten times each in both, clockwise and anti-clockwise directions.

10. Next, exercise the elbow joints by moving them ten times each in vertical and horizontal planes.

11. Lastly, move the shoulder joints as if you are rowing a boat.
It is important to remember that you should not move the legs or back during all the steps described above.


Movement of the neck: neck exercise are done by moving the neck in four different ways.
1. Keep the legs as for the movements of the hands. Keep the hands behind the hips, reclining the back slightly

2. First, do forward and backward movements ten times by moving the chin up and down.

3. Next, do sideward movements ten times by bringing the left ear near the left shoulder and then the right ear near the right shoulder. While doing the sideward movements, the chin should move in a semi circle.

4. The third movement involve turning to the left ant right shoulders. Repeat this movement also ten times.

5. The fourth movement is circular where the chin is rotated from right shoulder to left shoulder in clockwise and anti-clockwise directions.

Movement of the lower limbs:
 Detailed below are the steps for movement of the lower limbs. The feet are first moved in four different ways.

1. Keep the feet apart in straight and bend the toes forward and backward

2. Next, rotate the feet inward and outward followed by moving them forward and backward. Lastly , move the feet in a circular fashion.

The knee joints are moved in different ways.
1. Raising the feet from the ground.

2. Bring the heels near the body by bending the legs from the knees in a vertical and horizontal position.

3. Lie down on the back with right leg straight on the ground.

4. Bring the left knee near the chin, keeping the right one on the ground

5. In the third movement, bend both the knees together and touch them with the chin.

6. Do a rolling action by raising the hips and the neck alternately

All the joint movements should be tried only after learning the correct technique for yoga expert. You will need about three to four minutes to complete the above exercises. They will help keep all the joints of the body supple and flexible.

At the end of the movement of the joints, you need to practice postures of asanas. The joint movements are not mentioned in any ancient traditional texts of yoga. However, They have been included in this issue because they are very beneficial to every one and are good starters for an exercise routine 




Thursday 21 April 2011

PHYSICAL EXERCISE, FATIGUE AND REST


Rest, Fatigue, Work, and Exercise

            Fatigue is a very common symptom in people being treated for cancer. This is often not an ordinary type of tiredness but a "bone-weary" exhaustion that doesn't get better with rest. For some, this fatigue lasts a long time after treatment and can discourage them from physical activity.

However, exercise can actually help you reduce fatigue. Studies have shown that patients who follow an exercise program tailored to their personal needs feel physically and emotionally improved and can cope better.

If you are ill and need to be on bed rest during treatment, it is normal to expect your fitness, endurance, and muscle strength to decline a bit. Physical therapy can help you maintain strength and range of motion in your muscles, which can help fight fatigue and the sense of depression that sometimes comes with feeling so tired.

Any program of physical activity should fit your own situation. An older person who has never exercised will not be able to take on the same amount of exercise as a 20-year-old who plays tennis 3 times a week. If you haven't exercised in a few years but can still get around, you may want to think about taking short walks.

Talk with your health care team before starting and get their opinion about your exercise plans. Then, try to get an exercise buddy so that you're not doing it alone. Having family or friends involved when starting a new exercise program can give you that extra boost of support to keep you going when the push just isn't there.

If you are very tired, though, you will need to balance activity with rest. It is okay to rest when you need to. It is really hard for some people to allow themselves to do that when they are used to working all day or taking care of a household

Exercise can improve your physical and emotional health:

·         It improves your cardiovascular (heart and circulation) fitness.
·         It strengthens your muscles.
·         It reduces fatigue.
·         It lowers anxiety and depression.
·         It makes you feel generally happier.
·         It helps you feel better about yourself.

What Is Fatigue?
Acute vs. Chronic Fatigue
Cancer-Related Fatigue

        Fatigue is a feeling of weariness, tiredness, or lack of energy that varies in degree, frequency, and duration. Everyone has experienced normal fatigue, which improves with rest. Chronic fatigue associated with a disease or treatment of a disease does not improve with rest and can seriously affect a person's ability to function and quality of life. Fatigue can impact quality of life in many different ways -- physically, emotionally, socially, and spiritually. 

Acute vs. Chronic Fatigue 

Acute fatigue has a recent onset and is temporary in duration. It is usually related to excessive physical activity, lack of exercise, insufficient rest or sleep, poor diet, dehydration, increase in activity, or other environmental factors. Acute fatigue can be a protective body function, alerting a person to rest. It is anticipated to end in the near future, with interventions such as rest or sleep, exercise, and a balanced diet. 

Chronic fatigue persists, and recovery is not quickly anticipated. Chronic fatigue may be associated with numerous illnesses, such as cancer; AIDS; heart, lung or kidney problems; multiple sclerosis; and other medical conditions. Fatigue can also accompany psychological problems, such as depression, or result from the use of medications. 

Cancer-Related Fatigue 

Fatigue symptoms are common, yet underrecognized, in cancer patients. Fatigue experienced by cancer patients can result from the course of the disease, preexisting physical or psychological conditions, effects of medication, or lack of exercise. Fatigue may also result from treatment such as surgery, chemotherapy, and radiation therapy.

Fatigue from cancer surgery can last for weeks or months, and may be caused by anxiety as patients prepare for surgery, as well as the pre-admission testing for surgery. Pain after surgery, the effects of anesthesia, sedatives, or analgesics may also cause fatigue. 

Fatigue from chemotherapy affects most patients, lasting for one to two weeks following treatment then decreasing gradually. Fatigue as a result of radiation therapy affects almost all patients and may worsen during the course of treatment, peaking at 4-6 weeks. Fatigue may lessen after radiation therapy is completed but still continue for weeks or even months. Many patients undergoing interferon or interleukin therapy also experience fatigue. 

Patients may discuss adjusting therapeutic regimens with their doctors to relieve fatigue symptoms. Delaying chemotherapy treatments for 1 or 2 days to attend important life events, or changing the time of their treatment, may be considered.

Symptoms and Possible Causes

Common Fatigue Symptoms
        Fatigue is generally defined in terms of symptoms that occur over time, cause distress or impair function, or are likely to result from disease or treatment of disease. The following symptoms, which vary from patient to patient, are associated with fatigue: 

Diminished energy disproportionate to activity, causing distress
Diminished activity associated with lower physical or intellectual performance, e.g., lack of focus, short attention span, memory problems
Diminished motivation, interest in activities
Exhaustion, apathy, lethargy
Generalized (whole body) weakness or tiredness
Sleep abnormalities
Irritability, impatience, sadness, changes in mood

Possible Causes of Fatigue 
          Though little is known about fatigue prevention and treatment, fatigue may be related to a variety of medical and physical conditions and psychosocial factors. Fatigue can be caused by anemia or associated with major organ dysfunction, including severe heart or lung disease, kidney failure, or liver failure. Hypothyroidism (insufficient production of thyroid hormone) and adrenal problems, even if mild, can cause fatigue. Neuromuscular disorders, malnutrition, infection, dehydration orelectrolyte disturbances can also be associated with fatigue, as well as sleep disorders, immobility and lack of exercise, chronic pain, or the use of centrally-acting drugs (e.g., opioids). Psychosocial factors associated with fatigue are anxiety and depression, stress, and those related to the reactions of others to the fatigue.

Assessment

How Health Care Providers Assess Fatigue
            Assessment of fatigue begins with a detailed description of its history, development, symptoms, and causes. This information is acquired from the patient's self-report, medical history, physical examination, and review of laboratory tests such as a complete blood count, thyroid function, and imaging studies (CT or MRI scan). 

The onset of fatigue, course of the symptoms, severity or intensity, level of distress, and degree of interference with daily activities (e.g., grooming, shopping) should be addressed. Factors that relieve fatigue or make it worse should also be examined. These factors may be emotional (moods, etc.), social (relationships with family and friends), and psychological (effect on thought process). These areas can be assessed using a verbal rating scale: none, mild, moderate, and severe; or a 0 to 10 scale (where 0 means no fatigue and 10 means the worst fatigue imaginable). One scale is usually adopted and consistently used.


Treatment
Treating Anemia
Adjusting Current Medications
Commonly Prescribed Medications
Non-Drug Interventions to Manage Fatigue
Patient/Caregiver Education
Exercise
Change in Activity and Rest Patterns
Stress Management and Cognitive Therapies
Adequate Nutrition and Hydration
The treatment of fatigue includes identifying and managing the underlying cause and using a variety of interventions, including medication; education; exercise; sleep hygiene; stress management, and nutrition.

Treating Anemia 
Anemia (below normal levels of red blood cells) can be a major factor in cancer-related fatigue. Lack of red blood cells and oxygen in the body creates an energy deficit, causing tiredness or fatigue. Blood transfusion therapy, as well as recombinant human erythropoietin (a hormone produced by DNA technology), is used to treat anemia. Erythropoietin stimulates bone marrow to produce red blood cells, thereby increasing the number of red blood cells in the body.

Adjusting Current Medications 
Patients on medication who complain of fatigue may need their drug regimens reviewed or adjusted by their physicians. Centrally-acting drugs that are not essential may be eliminated or reduced (e.g., antiemetics, hypnotics or anxiolytics, antihistamines, and analgesics). If opioids are taken for controlling pain, dosage reduction is done cautiously to see whether fatigue improves without making the pain worse. 

Commonly Prescribed Medications
Drug therapy for treating fatigue associated with medical illness has not been evaluated through controlled studies. Some doctors consider the use of psychostimulants such as methylphenidate and pemoline. These drugs are often used to treat opioid-related cognitive impairment and depression in the elderly and medically ill. 

Sometimes low-dose corticosteroids (e.g., dexamethasone or prednisone) are used in the treatment of cancer-related fatigue.

Amantadine has been used for many years in the treatment of fatigue due to multiple sclerosis. 

An antidepressant drug may be used to treat fatigue due to clinical depression, preferably one of the serotonin-specific reuptake inhibitors, secondary amine tricyclics, or buproprion.

Non-Drug Interventions to Manage Fatigue 
In addition to medication, non-drug interventions may be used to manage fatigue.

Patient/Caregiver Education


Exercise 
Exercise may be beneficial in relieving fatigue. The exercise program should be tailored to the individual according to age, gender, physical and medical condition. Exercises should involve rhythmic and repetitive movement of large muscle groups (walking, cycling, or swimming). These exercises should begin gradually, several days a week, and not be performed to the point of exhaustion. Some contraindications to low-intensity exercise include cardiac abnormalities, recurrent or unexplained pain, and onset of nausea with exercise. 

Change in Activity and Rest Patterns 
Using a diary to assess fatigue may identify specific activities that increase fatigue. Patients can record changes in energy levels, and this information can help to modify, schedule, or pace these activities throughout the day. 

Naps should be taken in the morning or early afternoon; late afternoon or evening naps might interfere with sleep at night. Basic sleep hygiene principles, such as a specific bedtime and wake time, noise and light reduction, diversional activities (e.g., music, massage), avoidance of stimulants (e.g., caffeine, nicotine, steroids, methylphenidate) and central nervous system depressants (e.g., alcohol) prior to sleep should be employed. A specific wake time helps to maintain a normal sleep-wake rhythm. Consistent exercise tends to improve sleep and promote deeper sleep when done at least six hours before bedtime.

Stress Management and Cognitive Therapies 
Using stress reduction techniques or cognitive therapies (e.g., relaxation, deep breathing, hypnosis, guided imagery, or distraction) can promote coping skills and relieve stress. 

Coping skills such as seeking more information about the illness and its interventions, planning and scheduling activities, delegating tasks, and developing solutions to daily problems associated with fatigue are helpful to patients. 

Mental fatigue may be relieved by activities that conserve and restore mental capacity, such as decreasing noise and distractions while trying to concentrate, walking outside, gardening, and other environmental activities.

Adequate Nutrition and Hydration
A balanced diet that combines adequate caloric intake, e.g., grains, green vegetables, legumes, and iron-rich foods, can help maintain energy levels. Adequate fluid intake can prevent dehydration and hypotension, which can intensify fatigue symptoms. Regular exercise may improve appetite and increase nutritional intake.

Fatigue and Exercise

Fatigue is a part of life and we’re all familiar with it. But it can be difficult to describe and people express it in a variety of ways, using terms such as tired, weak, exhausted, weary, worn-out, fatigued, burnt out, wiped, etc. Health professionals describe fatigue using terms such as asthenia, fatigue, lassitude, prostration, exercise intolerance, lack of energy, and weakness.

Generally we can put the many ways that people express and experience fatigue into two categories, physical and mental. Although these two kinds of fatigue are sometimes difficult to separate and aspects of each can be involved when one feels tired, they’re separate enough in most of our minds. Physical fatigue is just that, our physical bodies are tired because of either too much physical work, including not enough time to recover from physical work, or lack of sleep, including jet lag. Mental fatigue can occur when we’re emotionally or psychologically worn out and not coping with the stresses and strains in our lives.

In a nutshell we have limited amounts of energy and reserves, and when these are taxed, either physically or mentally, or more commonly both, we experience fatigue. And when we’re fatigued we need to recharge our batteries in one way or another. We deal with the fatigue of our active days and physical activity by resting and by getting a good night's sleep. If we don’t rest enough or get enough sleep then we suffer from fatigue until we do. In a way it’s the same with mental fatigue only in this case we need to get some relief from whatever is causing it. In some cases, such as in chronic fatigue syndrome, the two types of fatigue run in together and we get debilitating mental and physical fatigue.

As well, certain medical conditions cause fatigue. A common example, especially in women, is anemia. Other causes of fatigue include chronic illness, heart and lung problems, cancer, diabetes, hormonal disorders, and a variety of other conditions. If you experience chronic fatigue then the first thing you should do is see your doctor and make sure everything is OK.

While we could go on ad infinitum about the different causes and effects of fatigue and how to deal with them, we’re going to limit the discussion in this article to the fatigue associated with exercise. What it is, why it happens and what we can do about it.
Assuming that there are no underlying problems, then we can divide the fatigue that we experience as a result of exercising into two types, peripheral and central. While the research in the area of fatigue has focused mostly on peripheral fatigue, research in central fatigue has been increasing although it mostly revolves around serotonin and the central fatigue hypothesis.

Peripheral fatigue deals with the capacity of muscle to do physical work. In this type of fatigue we’re dealing with an impairment in the normal functioning of the nerves and muscles involved in muscle contraction. This covers the gamut from the transmission of the impulses from nerves to muscle to the actual contractile apparatus of the muscle itself.

Central fatigue, on the other hand, involves the central nervous system, from our brain to the connections to the nerves that are involved in muscle contraction. Central fatigue can be the result of changes in various neurotransmitters in the brain secondary to changes that occur in the body and mind.

Most fatigue associated with exercise usually involves some degree of both peripheral and central fatigue. The degree that each is involved is often difficult to determine as the contribution of each to fatigue may vary between activities and even within the same activity. For example, when doing a multiple sets of an exercise using weights, the fatigue in the initial sets taken to failure may be mostly peripheral, while the fatigue experienced in later sets may more of a central component.

The problem with examining fatigue associated with a bodybuilding type of weight training, is that it’s not necessarily valid to extrapolate from studies on fatigue done using endurance or high intensity exercises that have different execution variables. For more information on these variables and their applicability to bodybuilding see the well done recently published review on the application of studies done on fatigue to bodybuilding.
Peripheral Fatigue - The mechanisms of fatigue within muscle (peripheral fatigue) are well studied and include impairments in neuromuscular transmission and propagation down the sarcolemma, dysfunction within the sarcoplasmic reticulum involving calcium release and uptake, availability of metabolic substrates and accumulation of metabolites, and actin-myosin cross bridge interactions.
The more important causes of physical fatigue, in my view, have to do with 1. systemic changes such as overheating and dehydration. And 2. the availability and accumulation of various compounds.
1. Systemic factors that may cause peripheral fatigue

Dehydration - While not as important as in endurance events, dehydration can cause fatigue even with resistance training. Dehydration doesn’t have to be extreme to impair performance and as little as a three to four pound loss of water weight (something that’s not too hard to imagine in a vigorous workout) can increase fatigue.
Pure water is not the best way to rehydrate during and after exercise. To restore the body fluids you sweat out during exercise, you should consume a beverage that contains some appropriate electrolytes, including sodium and potassium, and some glucose and perhaps a buffering agent. Sodium and potassium are volumizing agents and help to maintain blood volume and increase the absorption of water from the GI tract. It’s important, therefore to drink fluids before, during and after exercise to prevent dehydration and overheating.
Overheating - Body temperature increases with exercise, in some cases as high as 104 degrees even with resistance training. Since large volumes of blood are diverted to the skin to try and cool the body down, the circulatory system may become burdened and result in an increased temperature which in turn results in decreased performance and fatigue.
The best way to deal with this is to make sure you’re well hydrated and to decrease clothing worn so that sweat evaporates readily cooling the body off.

2. The availability and accumulation of various substrates, metabolites and metabolic byproducts.
First of all it’s important that there are no vitamin or mineral deficiencies as these can impact on performance and cause fatigue. For example, even marginal deficiencies in potassium, calcium, magnesium and zinc can cause fatigue, as can deficiencies of various vitamins including the B vitamins, folate, vitamins A, C and E.
It’s useful to examine the changes that take place in the muscle during exercise and compare these changes with the resting condition. As well, we can suggest ways in which any changes that may impact on performance and fatigue can be corrected, and as such reverse the fatigue and decreased performance.

Changes that take place with exercise over the resting state include:

  • Decreased ATP levels
  • Decreased levels of phosphocreatine (PCr)
  • Increased levels of ADP and Pi
  • Increased pH or acidity
  • Increased lactate concentrations
  • Increased ammonium levels
  • Decreased muscle glycogen
  • Strategies to combat fatigue
Based on the principle in which any differences from the resting state may be responsible for fatigue and decreased performance, one way to determine the cause or causes of fatigue, although limited, is to increase or decrease the concentration of a substrate which is depleted with exercise but is required for contraction or the absence or accumulation of substance that may fatigue. Keep in mind that because it’s likely that a number of changes are responsible for fatigue, there may be a number of individual strategies that will have an effect on decreasing fatigue. In all likelihood, the best approach to combating fatigue is one in which a variety of strategies are combined. Some of the more popular strategies are:
  • Creatine ingestion with the purpose of increasing PCr levels in the muscle cells, along with an increased ability to form PCr when needed. The ingestion of creatine, usually in the monohydrate form has been shown to increase levels of both creatine and PCr in muscle cells, and to result in increased performance and decreased fatigue. Interestingly enough a recent study has also shown that creatine supplementation also reduces mental fatigue in humans.
  • Use of a buffer solution to combat the acidosis. Several studies have implicated acidosis as a likely cause of fatigue, especially during high-intensity intermittent exercise and likely during high volume resistance training. In my view and according the literature, buffer solutions that might prove useful are ones containing either bicarbonate or the non bicarbonate natural buffers of vertebrate muscle including inorganic phosphate, protein-bound histidine residues, and the dipeptide carnosine.
  • Increasing muscle glycogen content and increasing the use of free fatty acids as the primary muscle fuel. Using strategies to maximize glycogen levels but restricting the use of glycogen for those times when it’s needed the most, the times when only anaerobic energy has to be produced, and fat adapting muscle so that fat is used as the primary fuel, increases performance and decreases fatigue. My Metabolic Diet (www.MetabolicDiet.com), besides maximizing body composition, is set up to achieve just that.
Use of antioxidants - Oxidant and radical damage to skeletal muscle membranes has been implicated in the fatigue process and several studies have found that the use of antioxidants, such as vitamin E, increases muscle contractile force and decreases fatigue.

Central Fatigue

In addition to focusing on the causes of muscle fatigue, recent research has also centered on mental fatigue during exercise. This is commonly called central fatigue because it results from impaired function of the central nervous system. Although central fatigue does not affect your muscles directly, it can reduce your capacity to perform.
The basis behind the central fatigue hypothesis is the theorized correlation between levels of the amino acid tryptophan in the brain, which is a precursor for the neurotransmitter serotonin, and the degree of mental fatigue. When tryptophan enters the brain, it leads to increases in serotonin levels, which can depress the central nervous system, causing sleepiness and fatigue.
One of the ways that has been suggested for fighting off the increases in tryptophan entering the CNS is the use of branched chain amino acids (BCAA) during exercise. Most of the blood tryptophan in the body is loosely bound to albumin, one of the blood proteins, with a certain amount free. The free tryptophan is transported, along with other amino acids (such as the branched chain amino acids leucine, isoleucine and valine) into the CNS. Thus tryptophan levels in the brain, and subsequently serotonin levels, increase when there is an increased ratio of free tryptophan to the total BCAA concentration. The more BCAA present the less tryptophan enters the brain and less serotonin is produced. The end result is less central fatigue. The process is much more complicated than what I’ve just described and there are many other players that can influence brain serotonin levels. Also there is still some controversy about whether the central fatigue hypothesis is even valid. Nevertheless, there are now intriguing theories and some evidence to support a possible role of nutrition in central fatigue during rest and exercise.
Stimulants - One of the ways to combat fatigue, both central and peripheral, is through the use of stimulants such as caffeine and ephedrine, either alone or in combination. Studies have shown that these compounds are effective in increasing both strength and endurance, and in allaying fatigue.