5 ways to save your knees and joints

How to minimise injury risk and keep your hips, knees, and ankles running strong.

Let’s get this out of the way: running won’t ruin your knees, no matter what your smug, sedentary co-worker says.
“There are three large studies that show long-term endurance running doesn’t seem to affect joint health,” says Dr Richard Willy, an assistant professor of physical therapy at East Carolina University in the US.
In fact, runners may have healthier joints than their inactive counterparts, says Dr Max R Paquette, an assistant professor of biomechanics at the University of Memphis.
It’s well known that weight-bearing exercises such as running strengthen bone and muscle, and it’s believed that they might do the same for cartilage, the tissue that cushions joints. And strong muscles – built by running and strength-training – support joints so they are less vulnerable to injury.
Yet there’s a condition called “runner’s knee” for a reason. Patellofemoral pain (knee pain) is the most reported injury in the sport. Hip, ankle and foot injuries happen too.
But not because someone is running – it’s because he or she is running with flawed form or muscle imbalances. So while you can rest assured that running is healthy for your entire body – joints included – it’s important to learn what causes joint pain.
Taking steps to minimise the risk can help you keep running into your golden years.
What hurts? 
Common ailments that sideline runners:
Hip, knee, ankle, foot
Osteoarthritis: The wear-and-tear condition that occurs when cartilage breaks down over time. Blame genetics and biochemical responses (not necessarily running).
Bursitis: This friction syndrome is caused by inflammation of the bursa – the small sac of fluid that lubricates the muscles and tendons that run around the hip joint.
Patellofemoral pain (aka runner’s knee): Discomfort behind the kneecap (patella) caused by repetitive contact between the underside of your patella and your femur (thigh bone).
Patellar tendinopathy: Inflammation of the tendon that runs from the kneecap to the top of the tibia (one of two lower leg bones). The pain usually occurs at the bottom of the patella, especially when running downhill.
Torn meniscus: Cartilage on the inside and outside of the knee acts as bumpers between the femur and tibia. As you age, it becomes thinner and more susceptible to damage.
Achilles tendinopathy: One of the most common sources of ankle pain, caused by inflammation of the largest tendon in the ankle.
Ankle sprain: When the foot and ankle turn in or out suddenly, the ligaments that stabilise the ankle joint can become damaged.
Big toe
Bunion: Under repetitive pressure, the big toe joint can move out of place, swell and turn inward, causing a painful, bony protrusion.
Why does my knee ache? 
Probable causes of the pain:
Form flaws
Dr Willy says hip adduction – when the thigh moves inward from the hip mid-stride, causing a knock-kneed effect – is one of the most common sources of biomechanical-related knee pain. Over striding is another.
Muscle imbalances 
This is intricately related to biomechanics, since muscle imbalances can cause poor biomechanics – and conversely, poor biomechanics can result in imbalanced muscle development. If you can’t do a single-leg squat without wobbling or having your knee dive in or out at a steep angle, you may have some glute or hip weaknesses that need attention, says Dr Keith Spain, a sports-medicine specialist at the Orthopaedic Group.
While the link between running injuries  and genetics is still unclear, Dr Spain says that arthritis has a genetic component. “If your parents had arthritis, you’re more likely to have it,” he says. And while of course age is a factor, Dr Spain says that getting old doesn’t necessarily mean you’ll get arthritis. “I see 80-year-olds without any arthritic changes and 50-year-olds with terrible arthritis.”
Women are twice as likely to report knee pain as men, Dr Willy says. But researchers aren’t entirely clear on why. “The hypothesis has been that women’s lower-extremity alignment places the knee in a position where it’s more susceptible to injury; I think there’s more to it than that, though,” says Dr Paquette, adding that subtle differences in women’s connective tissue make-up may also play a role. Pregnant women or women who have just given birth are also more susceptible to joint injuries, because ligaments relax to prepare for childbirth.
Unknown factors 
Pain is something researchers are still working to understand better, says Dr Willy, adding that joint-related pain seems to be individual. “Two runners with the same biomechanics can go through the same training programme, and one gets injured but the other doesn’t,” he says. “We really don’t know exactly why that happens.” He says that variables such as sleep quality, nutrition, and even psychosocial factors – such as fear of getting injured – may contribute.
5 ways to protect your joints
Reduce the load:
Shorten your stride
“An increase in step rate of 5 to 10% can reduce patellofemoral joint load by up to 20%,” Dr Willy says. Garmin’s foot pod or the MilestonePod can help you monitor your step rate. Dr Willy says stride rates are highly individual, but it’s generally recommended to aim for 160 to 190 steps per minute.
A word of warning: be careful not to accidentally change how your foot hits the ground. Shifting your foot-strike pattern can change the load on your Achilles tendon.
Check your mechanics
Although Dr Willy doesn’t want you to change your foot strike, he does suggest having your running form evaluated if you suffer from joint pain – or if you’re really serious about preventing it.
A physical therapist who works with runners should be able to detect issues such as hip adduction and over striding – and instruct you on how to correct them. In research he conducted in 2012, Dr Willy found that runners with knee pain who did eight gait-retraining sessions had less knee pain when re-evaluated months later.
Watch your weight
Runners often complain of more joint aches and pains as they age, and one contributing factor can be weight gain. Dr Paul DeVita, director of the Bio­mechanics Laboratory at East Carolina University in the US, has conducted research that links excess weight with increased knee load – and possible injury risk – in runners.
“Many of us are simply too heavy for our joints,” Dr Spain says.
Replace worn shoes
The verdict is still out on what footwear is best for reducing joint load. Both Dr Willy and Dr Paquette say you need to find out what works best for you. When you do get a new pair, it’s key to break them in with a few short runs before going long in them.
“The exposure to a new shoe after being in an old one could potentially be a risk factor for injury,” Dr Paquette says.
Mix it up 
Changing where and how loads are placed on joints may keep injuries at bay.
“Runners who always do the same thing every day are more at risk,” Dr Willy says. “Change the surface, your route and your tempo, and cross-train. The more variable your movements, the less you stress your tissues.”
Pop a pill?
You’ve undoubtedly seen the rows of glucosamine supplements at the chemist and wondered if they help. While you’ll find plenty of people who swear by them, the data-driven answer seems to be mixed.
For a 2015 study published in the Annals of the Rheumatic Diseases, researchers gave 605 subjects with knee pain either glucosamine-chondroitin or a placebo.
After two years, both groups reported reductions in knee pain in equal levels – meaning the glucosamine had worked no better than a sugar pill. This builds on previous research.
A few studies have found that glucosamine could possibly slow arthritic changes.
Still, most doctors will tell you to keep extra kilograms off, strength-train regularly and shorten your stride.

This article was originally published on www.runnersworld.co.za


Here's why mental health care in SA is still in shambles

With the Life Esidimeni hearings underway, industry professionals are hoping that lessons will be learned and provincial health departments will make amends and implement established policies.

With all the promises and good intentions expressed at the Life Esidimeni hearings, the SA Federation for Mental Health (SAFMH) hopes that mental health care will become a priority; that funding and resources will be made available; and that policies which have been passed will be implemented.
The Mental Health Care Act 17 of 2002 was passed into legislation more than a decade ago. It was created to repeal outdated laws, and to take care of and protect SA citizens who need mental health care.
Not long after, the National Mental Health Policy Framework and Strategic Plan was established. One of the main objectives of this policy is to recognise that “… health is a state of physical, mental and social well-being and that mental health services should be provided as part of primary, secondary and tertiary health services” – this is documented in the policy.
Another main objective is to recognise that “… there is a need to promote the provision of mental health care services in a manner which promotes the maximum mental well-being of users of mental health care services and communities in which they reside”.
Money still the issue
As so often, money appears to be at the root of the problem – the lack of funding for mental health continues to cause a major problem throughout South Africa.
Marthé Kotze, Programme Manager for Information and Awareness at the SAFMH, said: “SA has the policies and legal framework to improve mental health care, but our biggest problem now is the fact that they are not being implemented.
“Mental health care needs to become a priority, in terms of funding and resource allocation. Until this happens, there will never be adequate mental health services to meet the needs of SA mental health care users.”
More financial hardship
Recently the Alan J Flisher Centre for Public Mental Health (CPMH) hosted a debate where several industry professionals presented information and findings from research they conducted. They also detailed their experiences working in communities and witnessing the numerous challenges people are facing on a daily basis.
Sumaiyah Docrat is a Health Economist and Doctrate candidate at the University of Cape Town’s Department of Psychiatry and Mental Health. She has done extensive research on a project called Emerald – Emerging Mental Health Systems in Low- and Middle-Income Countries.
The Emerald Project is funded by the European Union and has conducted surveys in South Africa, Ethiopia, India, Uganda, Nepal and Nigeria.
“As part of this work, we wanted to understand whether households affected by mental disorders – alcohol use disorders, depression, epilepsy and psychosis – are economically worse off when compared to households affected by physical health problems,” said Docrat.
Across the six countries over 4 000 households were surveyed. Docrat said that about half of the households were affected by one of these mental disorders, and the other half affected by a physical health condition.
“We consistently found that households affected by mental disorder were more likely to report lower levels of wealth which resulted in withdrawing their children from school, reducing the frequency of their meals and restricting their use of health care – due to financial hardship, when compared with households affected by physical health conditions.
“This is extremely worrying, particularly when you see that the ways these households are responding to financial difficulty are likely to have long-term intergenerational impacts – entrenching themselves in a vicious cycle of poverty,” said Docrat.
Ridicule associated with mental health
For years and even to this day, a dark cloud hangs over mental health. In the past, people who needed mental health care needed “special” care and were separate from those “normal” people. There was no integration, even though most people would be able to live normal lives with the aid of good mental health care.

Docrat said that the government has committed itself to transforming mental health services and ensuring the “quality mental health services are accessible, equitable, comprehensive and are integrated at all levels of the health system”.
“While the policy and strategic plan is consistent with the ongoing efforts to re-engineer the primary health care system and implement National Health Insurance, the objectives of this policy and plan have been notably absent from national health reform and transformation in SA.
“At provincial level, no resources or budgets have been allocated to support the achievement of the goals and commitments outlined in the policy and strategic plan. This clearly indicated that the provincial departments of health do not regard mental health as a priority. The implementation thus far has been largely determined by each province’s priorities, with limited financial incentives to improve efficiency of resource allocation for mental health services,” added Docrat.
Deinstitutionalisation and Life Esidimeni
A few changes proposed in the act and the policy and strategic plan speaks to deinstitutionalisation, integrating mental health care with primary health care and making it more accessible.
The only thing is, when we think deinstitutionalisation these days, we think about the lives lost in the Life Esidimeni tragedy.
Ingrid Daniels, director for Cape Mental Health, said that this tragedy could have been avoided, had deinstitutionalisation been carried out properly. Kotze and the SAFMH echoed Daniels’ sentiment when she told Health24 that we should be moving away from the model of institutionalised care to a model that allows mental health care users to receive treatment within their communities.
Kotze said: “We should focus on the upscaling and development of community-based mental health services. International studies have shown that mental health care users benefit if there are mental health services based within their community, which they can easily access and receive support from.”
Integrating mental health care into primary health care services may increase awareness and lessen the stigma and discrimination associated with mental health, something which is still an issue in society today, especially in certain cultures where people are still told “get their act together” and “stop looking for attention”.
Kotze added: “Adequate community based services lead to lower relapse rates. We need deinstitutionalisation, but it needs to be done in right way to avoid more tragedies like Life Esidimeni.”
Crick Lund, director for the Alan J Flisher CPMH and UCT Psychiatry and mental health professor, told Health24: “The critical point about deinstitutionalisation is that the money must follow the patient into the community. Where deinstitutionalisation has failed, as in the case of Life Esidimeni, there was inadequate budget allocated to mental health care facilities in the community.
“Where it has succeeded in countries, like Italy, the closure of psychiatric institutions was accompanied by major new investments in community-based care. It is absolutely imperative that those with severe and chronic mental health needs are able to access the support they need, whether for housing, rehabilitation and/or treatment within their communities in a humane and safe way.”
Skilled, well-compensated workers needed
Stellenbosch University professor and CPMH Co-Director, Ashraf Kagee, added that more posts are needed in public hospitals and that mental health workers, including counsellors and community care workers need to be paid properly and given due respect for the important work they do.
“There has to be a lot more oversight and monitoring of mental health service provision. This, of course, requires resources from government, who at present moment lack the political will, but this may also be a symptom of broader government inefficiency,” said Kagee.
Health24 approached the National Department of Health for comment, but due to the Life Esidimeni hearings being sub-judice, they declined to comment on any of the issues raised.


More evidence that depression shortens lives

While this is no new outcome, a new study confirms that depression can take a toll on people’s overall health and shorten lives significantly. 

People with depression tend to die earlier than expected – a pattern that has grown stronger among women in recent years, new research finds.
This is not a new finding – a previous Health 24 study also indicates that older people who suffer from depression may have a shorter life than those who don’t.
Both men and women affected
The study followed thousands of Canadian adults between 1952 and 2011. Overall, it found people with depression had a higher death rate versus those without the mood disorder.
The link only emerged among women starting in the 1990s. Yet by the end of the study, depression was affecting men’s and women’s longevity equally.
The findings do not prove that depression itself shaves years off people’s lives, said lead researcher Stephen Gilman.
The study could not account for the effects of physical health conditions, for example.
“So one explanation could be that people with depression were more likely to have a chronic condition,” said Gilman, of the US National Institute of Child Health and Human Development.
Link with physical health
But even if that were true, he added, it would not mean that depression bears no blame – because depression can take a toll on physical health.
“Many studies have found that people with depression have higher risks of heart disease and stroke, for example,” Gilman said.
The findings are based on 3 410 Canadian adults who were followed for up to several decades. The first wave of participants was interviewed in 1952, the next in 1970, and the final in 1992.
At each wave, roughly 6% of adults had depression, based on a standard evaluation.
And on average, those people had a shorter life span. For example, a 25-year-old man who was depressed in 1952 could expect to live another 39 years, on average. That compared with 51 years for a man without depression.
Men with depression at any point had a higher risk of dying over the coming years, versus those free of the disorder.

Outcome different for women
The picture was different for women, though. The connection between depression and mortality only surfaced in the 1990s.
Women with depression at that point were 51% more likely to die by 2011, compared with other women. That brought their risk on par with depressed men.
The reasons are unclear. “Why would depression be less toxic to women at one time point than another?” Gilman said.
He speculated that societal shifts have some role. Women in recent decades have been much more likely to juggle work and home life, or be single mothers, for example.
Another possibility, Gilman said, is that women tend to suffer more severe depression these days.
There was some evidence that the impact of depression lessened over time. Men with depression in 1952 no longer showed a higher death risk after 1968, for example – unless they also had depression at the later interviews, too.

Few suicides
As for causes of death, there was no evidence that suicides explained the risks among people with depression.
“There were actually few suicides,” Gilman said. “People with depression died of the same causes that other people did – like cardiovascular disease and cancer.”
Dr Aaron Pinkhasov is chairman of behavioural health at NYU Winthrop Hospital in Mineola, New York.
He said depression can indirectly shorten life span in a number of ways. Depressed people are less able to maintain a healthy lifestyle, and are more vulnerable to smoking and drinking. They may also be less equipped to manage any physical health conditions.
“Once depression sets in, you may not have the motivation or energy,” said Pinkhasov, who was not involved with the research.

Treatment can help
Gilman said his study can’t say whether treating depression erases the higher death risk associated with it.
But, Pinkhasov said, there is evidence that depression treatment can help people better control high blood pressure and diabetes, for example.
He stressed that there are various effective treatments – from “talk therapy” to medication.
Non-judgmental approach
“Don’t blame yourself for being ‘weak,’ or tell yourself you should just snap out of it,” Pinkhasov said.
John Hamilton, a counsellor at Mountainside Treatment Center in Canaan, Connecticut., agreed.
He said that women, in particular, can have a “sense of shame” over mental health symptoms in part because they feel they need to be the rock of the family. “They might even have people around them saying, ‘Snap out of it, you have kids,'” said Hamilton, who also had no role in the study.
“But depression is no different from any other chronic disease,” he said. “We need to have a compassionate, non-judgmental approach to it.”


Do we need a break from our smartphones?

Being available 24/7 for calls, texts and emails may have a negative effect on our lives.

It’s no secret that we love our smartphones and other electronic devices for staying connected.
Perhaps we love them too much.
According to one study on cellphone use by a mobile security company, 63% of women and 73% of men between the ages of 18 and 34 can’t go even one hour without checking their phones.
Missing out
And research published in the internet-based journal First Monday found that when college students took a break from social media, some were unable to find substitutes for the place it filled in their lives. Many had the feeling they were missing out on something when they weren’t connected.
A previous Health24 article asked the question if young children should even own cellphones.
But all this connectivity comes at a price. For starters, time spent on our devices may be time taken away from exercise. Like other sedentary behaviours, this can reduce your fitness level.
Research done at Harvard suggests that being available 24/7 for texts and emails may actually make you less productive at work and less satisfied with your personal life. Indeed, results from the latest American Psychological Association “Stress in America” survey found that 44% of people who check email, texts and social media either “often” or “constantly” said they feel disconnected from family, even when they’re together.

The need to unplug
And regularly using electronic devices (think cellphones, tablets, laptops) late at night has been linked to sleep disorders, stress and even depression symptoms. And your risk grows if you’re also a heavy cellphone user.
What’s the answer?
Unplugging – taking regular breaks away from your devices and putting limits on how available you are. The need to unplug is so strong there’s even a National Day of Unplugging, from sundown to sundown starting on the first Friday in March.
But you don’t have to wait until then. Try turning off your electronics an hour earlier at night and designate a few unplugged hours every weekend. It might be hard at first, but like any other habit, you’ll grow into it over time.
According to the American Psychological Association, these nuggets of quiet will help you relax, reflect and even be more creative.


Focusing on 'the good' helped me let go of worry and stress

Freelance writer Anneke Scheepers explains how she won the battle against negativity.


In 2015 I started realising that my physical well-being was taking strain because of my state of mind. I was anxious, tense and generally stressed out, but initially didn’t understand that my body was a reflection of how I was thinking about my life.
I was in a race, running from point A to B, chased by a perceived threat of scarcity, thinking, “What if I don’t have enough?”
Avoid a scarcity complex
The realisation that I was thinking myself out of physical well-being came gradually, through the practice of yoga. As I focused on the postures in class, I was distracted from the fear of scarcity; I was distracted from worry. As the instructors led me through the postures, “affirming” the practice, it became clear that I hadn’t been affirming myself. I had been scolding myself like a mean parent. I realised that that needed to change.
It has been confirmed so many times that a positive state of mind can help ward off illness and boost immunity. If this is such an obvious thing, why aren’t we doing it?
A scarcity complex takes us away from thinking about what we are thankful for and about what makes us happy. Instead, we spend our time worrying about what’s next, what’s needed and worst of all, what’s been lost.
I realised that my state of mind, and consequently the state of my body, was at the mercy of what I was telling myself. I had to begin to tell myself some good things. At first, I didn’t know how. I had no idea how to ease up and become my own best friend instead of my own worst critic.
‘A step toward contentment’
So to begin cultivating a more positive mindset. I started small and started backing away from the scarcity-motivated effort to try and “change or fix things” and began focusing on how I could accept things as they are. Most of all, I started making and effort to accept myself.
Think about it, if you really accept yourself, you won’t constantly think, “Oh, I need this and I wish I had that.” It’s a step toward contentment and away from resentment.
Reading positive affirmations, surrounding myself with people who are a good influence and practicing yoga were some of the steps I took – and my world started opening up. I started receiving the things I needed because I was open and no longer distracted by constantly wanting those things. I no longer felt “lacking”.
Perhaps the first thing to do is to observe how certain people or situations make you feel. There is nothing wrong with avoiding, if possible, the things that make you feel bad and lead you away from a healthy and peaceful state of mind.
I learned that paying attention to the things that made me smile made me smile more, and made me a happier and healthier person.