While there are multiple causes of swelling and pain in the hands and feet, arthritis is probably the most common cause.
The term “arthritis” is derived from the Greek and means “joint inflammation”. It refers to more than 100 different diseases that can cause pain, swelling, and stiffness in the joints. Joints are where the ends of long bones connect and interact. The end of each bone inside a joint has a thin layer of cartilage and is held in place by ligaments, tendons, and muscles. A joint is lined with synovial tissue (synovium) that helps to nourish the joint. It is the synovium that often becomes inflamed in arthritis.
Arthritis may also affect other supporting structures around joints such as the muscles, tendons, ligaments, and bones. Some serious forms of arthritis can affect internal organs.
The common symptoms of arthritis are due to inflammation (swelling, heat, redness, pain):
o Swelling in one or more joints
o Stiffness in the joints in the morning or with prolonged inactivity
o Joint pain or tenderness
o Restricted mobility in the joints
o Warmth or redness
Diagnosing arthritis can be difficult because some symptoms are often common to many different diseases. A rheumatologist will first do a complete physical exam, looking for clues. The eyes, ears, nose, throat, heart, lungs, and other parts of the body will be examined along with the joints. Lab tests and imaging procedures such as x-ray, ultrasound, or magnetic resonance imaging (MRI) may also be ordered.
The most common forms of arthritis are:
Osteoarthritis (OA) is also referred to as degenerative joint disease. This is the most common type of arthritis. When it affects the hands, it can cause painful swelling in the last row (Heberden’s nodes) and middle row (Bouchards nodes) of finger joints. In the feet it will affect the toe joints as well as the mid-foot. This disease affects cartilage, the tissue that cushions and protects the ends of bones in a joint. With osteoarthritis, the cartilage starts to wear away prematurely. The swelling of the fingers and toes may lead to bony deformity.
Rheumatoid arthritis (RA) is an autoimmune disease; the body’s immune system (defense mechanism against infection) attacks normal tissues. This autoimmune reaction causes inflammation of the synovium. RA symptoms include pain, stiffness, swelling, rapid loss of joint function, and crippling. When severe, rheumatoid arthritis can also affect internal organs. This is the type of arthritis that most commonly causes severe inflammation in the hands and feet.
Rheumatoid arthritis tends to be symmetric- one side of the bodt being affected just like the other.
Fibromyalgia is a chronic disease characterized by generalized aches and pains. The pain is accompanied by stiffness that is worst in the morning but tends to last all day long. Patients may have localized tender points occurring in the muscles and tendons, particularly in the neck, spine, shoulders, and hips. These tender points are called trigger points. Fatigue and sleep disturbances may also occur. There is subjective swelling along with pain in the hands and feet.
Gout and pseudogout are inflammatory forms of arthritis due to deposits of crystals in joints and other body tissues. Uric acid is the culprit in gout and calcium pyrophosphate is the villain in pseudogout. Both diseases cause painful attacks of arthritis affecting the hands and feet.
Infectious arthritis is a type of arthritis caused by either bacteria or viruses. A relatively common form of infectious arthritis is Lyme disease. Infectious forms of arthritis can cause swelling and pain in the hands and feet. A diagnosis is often difficult to establish. Antibiotics will often be used to treat bacterial infectious arthritis.
Reactive arthritis is an autoimmune arthritis that develops after a person has an infection in the urinary tract or intestine. This problem is often referred to as Reiter’s disease. People who have this disease often have eye inflammation (iritis), rashes, and mouth sores. Inflammatory arthritis involving the hands and feet leading to a toe or finger that looks like a sausage (dactylitis) is common.
Psoriatic arthritis. Some people who have psoriasis also have arthritis. This disease often affects the hands and feet. It is usually asymmetric. It also causes deformity of the fingernails and toenails (onycholysis) that is often misdiagnosed as a fungal problem. Sometimes the spine- neck and low back-can be affected. As with Reiter’s disease, dactylitis often occurs.
Systemic lupus erythematosus is another autoimmune disease. Lupus can affect many organ systems including the joints, skin, kidneys, lungs, blood vessels, heart, and brain. This is a cause of swelling and pain involving the hands and feet.
Juvenile rheumatoid arthritis is the most common type of arthritis affecting children. It leads to pain, stiffness, swelling, and loss of function in the joints. A patient can also have rashes and fevers with this disease. Hands, wrists, ankles, and feet are often affected.
Polymyalgia rheumatica. Symptoms include pain, aching, and morning stiffness in the shoulders, hips, thighs, and neck. It is sometimes the first sign of giant cell arteritis, an inflammatory disease of the arteries characterized by headaches, scalp tenderness, weakness, weight loss, and fever. The hands and feet may be affected although less often than other joints. The erythrocyte sedimentation rate (sed rate), a blood test that measures inflammation, is often greatly elevated.
Bursitis is inflammation of the bursae- the small, fluid-filled sacs that help cushion joints. The inflammation may accompany arthritis in the joint or injury or infection of the bursae. Bursitis produces pain and tenderness and may limit the movement of joints.
Tendinitis is inflammation of tendons (the fibrous cords of tissue that connect muscles to bones) caused by overuse, injury, or arthritis. Tendinitis produces pain and tenderness and may restrict movement of joints.
Not all conditions that cause symptoms of pain and swelling in the hands and feet are due to arthritis. Here are some non-arthritis causes…
Polycythemia vera (PV) is a disorder that is due to excessive production of red blood cells, white blood cells, and platelets. Some patients with PV will not have any symptoms at all, but many will experience easy bruising or bleeding with minimal trauma. Also, the blood may become thick, causing it to clot in tiny blood vessels. If clotting does occur in the small blood vessels of the fingers and toes, a patient may experience numbness or burning. Swelling and pain in the hands and feet may also occur.
Some medical conditions cause edema…swelling of the hands, ankles, feet, face, abdomen, or other areas of the body. Swelling is most often seen in the hands, in the feet, or around the eyes. The swelling often causes pain.
Edema is due to excessive fluid accumulation. It can be caused by abnormal kidney function, chronic kidney disease, congestive heart failure, varicose veins, phlebitis, protein or thiamine deficiency, sodium retention, or cancer.
Other reasons for edema are pregnancy, standing for prolonged periods of time, premenstrual syndrome, oral contraceptives, an injury (sprain), hypothyroidism (low thyroid), anemia, adrenal disease, deficiencies of potassium and B vitamins, or allergic reactions.
The cause of the edema needs to be determined. Diagnoses such as congestive heart disease, kidney disease, or liver disease should be ruled out.
Insect stings can lead to swelling and pain in the hands and feet. The same type of reaction may occur with medications, such as penicillin or sulfa. This is referred to as serum sickness.
Acromegaly is a disease where a tumor in the pituitary gland causes an overproduction of growth hormone. This leads to swelling and pain in the hands and feet.
Frostbite is another cause of swelling and pain in the hands and feet.
Blood clots in the veins are another cause of swelling and pain in the limbs. This rarely affects the upper extremities (arms). If it does, diseases associated with clotting abnormalities should be suspected.
Reflex sympathetic dystrophy (causalgia) is an unusual disorder that leads to swelling and pain in an affected limb. Generally it occurs in an arm or a leg, rarely both at the same time. The preceding event is usually some type of trauma.
Budget Carrent
February 7, 2012
Do you suffer from severe pain in your heel after you open your shoes? Do you have a problem keeping the heel on the ground? Is there any inflammation of the heel or the appearance of a sac like fluid filled structure on the heel? If the answers for the above are all in affirmative, then you may be suffering from the problem of Calcaneal Bursitis. Calcaneal Bursitis is medical condition of the heel in which a victim suffers from severe pain and or inflammation in the posterior portion of the heel. The condition is the result of bruising of the tissue covering the heel bone. Calcaneal bruising is mostly caused by injury or continued stress on the tendons and ligaments of the heel. The result of the continued stress or injury is the formation of a fluid filled sac in the heel that causes a lot of pain and irritation. Calcaneal Bursitis can be very painful for people like athletes or runners who have to put more stress on their heels. The regular stress on the heels, result into this painful medical condition and it can be a cause of great concern for the victims as they cannot perform their daily tasks like walking and running.
Calcaneal bursitis can also exist adjacent to other medical conditions like rheumatoid arthritis or gout. Researchers have noticed that in the US there is an increase in the number of people suffering from Calcaneal bursitis and they attribute it to the increase in activities involving musculoskeletal body parts. Though this problem never takes a fatal turn but if proper treatment is not received in time, then it can result into permanent damage of the tendons. The women are at a higher risk of developing the problem because of the tight fitting footwear they use. Middle aged and elderly people are more likely to suffer from the problem but athletes of all age groups can fall victim to this dreadful condition. The general treatments for Calcaneal bursitis is injecting anesthetics or a mixture of corticosteroid, but they are all temporary treatments and do not provide long term relief.
People suffering from the problem of Calcaneal bursitis are advised to use heel seats or soft soled shoes for relief during excess pain in the heels. Heel seats in particular are very effective in treating the problem because they not only provide a soft padding but they actually stretch the ligament and provide acupressure to the heel. The use of heel seats have a long term healing effect as it not only gives relief from the pain, but gives extra protection from any future injuries or stresses. More and more victims of Calcaneal Bursitis are using the heel seats as they are very effective in acute pain and the success rate of these heel seats is also huge. More and more people are opting for the heel seats and the customer feedback is also very good. Heel seats are far better than the normal padding and cushioning shoes that are available because they ensure long term prevention from Calcaneal Bursitis. They also do not cost a fortune and are relatively less costly than he other modes of treatments available in the market. Heel seats have proved to be a real healer and a great help for people suffering from the excruciating pain of Calcaneal Bursitis.
Olympic Weight Set
February 5, 2012
A lot of us experience lower back pain whilst driving. A number of researches have investigated the relationship between driving and Back Pain, which uncovered uncovered some interesting results. One finding is a comparison of drivers in the USA and in Sweden found that 50% of people questioned in both countries reported low back pain.
So what is the connection of driving and back pain?
So far research has found three factors for low back pain whilst driving. The first one is the vibration from the engine (something that you can not change), the sitting position is the second factor and the third one is the length of time that we drive.
Scientists at laboratories have researched the effects of vibration of our body whilst driving. The Lumbar Spine(lower back) naturally resonates at a frequency of 4-5 Hertz and from research they found that this natural frequency can be distorted. This distortion can result into higher spinal loadings (compression) in the lower back, therefore causing an increased chance of low back pain. As mentioned before you can not change the vibration of the engine, but what you can do to reduce the effects of this on your lower back is to drive shorter periods at a time.
It is a lot easier to get comfortable in your seat when the car is stationary, a bit like sitting in a normal chair. But once you start driving the body will be subject to various forces like accelerations and decelerations, lateral movements from side to side and whole body vibrations.When we sit on a chair our feet, when on the floor, are used to support and stabilise the lower body. Whilst driving our abdominal muscles can not provide enough stability to our upper body and arms when turning the wheel. This will result in a significant increase of torsional stresses in the lower back, which in return will significantly increase the risk of low back pain.
To start with we should address one more important issue first – we all are guilty when it comes to adjusting our car seats correctly! In 2004 one of the largest car insurance companies (I won’t mention a name, after all you may think I am paid to write about this), released the findings of a research into how we sit in our car. (about 2.000 people were involved in this).
The research resulted in the following -
The headrest was found to be in an incorrect angle when driving of 61% of people involved in the study. This will increase the chance of ruptures of the spinal ligaments or worse when involved in an accident.
50% showed a slouched or hunched position over the steering wheel.
About a third of the drivers had back pain whilst driving.
25% tilted their heads or shifted in their seats each time they had to look into the ‘rear view mirror’.
Wearing unsuitable footwear or clothing happened to 34% of the drivers.
Please find below a list of 10 ways that can help to improve your seating position, make your driving experience more comfortable.
The Seat
Make sure that your bottom sits all the way in the back of the seat – where the base and the back of the seat meet. This will help to make you sit more upright and maintain the natural curvature of the spine, minimizing the stress on the spinal ligaments. If your seat has a lumbar roll built in have this all the way out – most cars with lumbar support that i tried do not allow enough support fom this lumbar roll, therefore it would be best to have it all the way out.
The Base length and Height of the Seat
The base of the seat should never touch the back of your knees and the front of the base should be slightly higher then the back, helping to provide more support and allowing you press the pedals without changing your spinal posture.
The Backrest
First relax back into your seat, place the seat at about a 10-15 degrees incline from the vertical position. If this feels unnatural to you then it probably means that the backrest is not upright enough for you. This can result into neck strain and / or coccyx (sitting bone) pain. Move the backrest more upright or if that doesn’t help you can place a small towel (folded in three) against the midspine, between the shoulder blades.
The Headrest
Have you ever noticed when watching an American movie that the headrests are often missing from the seats – it makes me crinch each time i see this (ooch). So much for giving a good example to our children. The position of your headrest will not only help to minimise the injuries of an accident but also to help to allow a better posture. The bony bit at the back of your head (known as the ‘inion’) is a good guiding point, the headrest should be level with this. There should be about 2.3 cm’s (1 inch for the non -metrics) between the back of your head and the headrest, when you are in the sitting position as described earlier. This to absorb shock as much as possible. This allows for the ligaments and the muscles of your neck to control the posture of your head better and giving better support in case of an accident.
Seat – Pedal distance
Make sure you have the distance between seat and the pedals so that when operating the pedals this does not cause you to over strech your legs or twist your body in any way. Thus your legs should not be straight when pushing the throttle or clutch all the way down. Obviously your knees should not be bend to the point you cannot easily move from one pedal to another. It is normally adviced to have your knees bend about 45 degrees.
The Arm position
Your arms should be as relaxed as possible, elbows bend around 20-30 degrees. If your steering wheel is adjustable have it in the mid to lower position (make sure the wheel does not partially obstruct the instrument panel), this will help to reduce the stress on your shoulders. Your hands should be positioned at ‘10 past10′ and not as is suggested left hand at 9 o’clock and right hand at 3 o’clock.
The Armrests
If your seat has armrests then it is adviced to use these. As a guidance you should position the armrests so that they gently support the elbows, any more will cause the shoulders to rise and increase the change of straining your neck.
The Mirrors
These should only be adjusted once you have positioned your seat as described above. If not sure then please revisit the information again how to adjust your seat. The mirrors should be adjusted to allow you to freely look into them without the need of having to move your head much. you either have adjusted the mirrors incorrectly or you are to close to the steering wheel.
Adjusting Seat at intervals
This sound great in theory but for most of us this may be akward whilst driving. For those who have electric seats it is easier (although it always advicable to stop first), just reach for the buttons to adjust the seat without the need to take our attention of the road. It is said that you should be doing this every 30 mins. to reduce the incidents of back pain. This allows to change the pressure that is placed on the spine is varied regularly. Once arrived at your destination it would be good to strech! (don’t worry if it looks funny, soon everybody in the carpark will join in – you can be proud having started a new ‘healthy’ trend)
Have breaks
We all have seen the ‘take a break’ sign along the roads, helping you to avoid falling asleep behind the wheel. Taking a break helps your back as well, so when you need to take a rest you can have a strech at the same time to help your back. An hour maximum is the current thinking, although these tips should be taken as a general rule. This is a good time to adjust your seating position!
Pearl Rings Split System
February 3, 2012
Crisis events are not only associated with adverse mental health conditions for our students, but also with significant learning difficulties. As educators, it is important for us to know what we can do immediately following a crisis involving our students in order to prevent the traumatization that contributes to these negative outcomes.
Crisis intervention in schools today is still in its infancy. No single model has been adopted because of the lack of scientific research indicating a reason to do so. We simply do not yet know what works best with students in schools. We grapple with what will work most effectively, as we continue to rely on cognitive approaches or so-called “talking cures” that ignore the physiology of trauma. Recent scientific research has not supported the use of what is still a widely adopted crisis intervention model: Jeffrey T. Mitchell’s model of critical-incident stress debriefing (CISD). Several studies have found Mitchell’s model to be no more effective than no intervention at all, and in some cases, found it actually increased posttraumatic stress symptoms in a number of the recipients.
Within approximately forty-five minutes, with up to thirty individuals at a time, CISD involves a “fact phase” during which basic information is provided to inform those involved of what to expect. Facts disseminated include common stress reactions and other more debilitating symptoms. This is followed by a “feeling phase” during which, the up to thirty participants are encouraged to answer such questions as “What was the worst part of the incident for you personally?” This phase is followed by suggestions for coping with stress and then “reentry” into the world.
At a presentation Mitchell made of his model that I attended with school district personnel and state department mental health workers, I was most struck by how uncomfortable the audience was as they listened to his proposal. The body language of the audience members indicated that their own stress levels were increased when only watching the video shown of a debriefing session. Many audience members actually rose and left the presentation visibly shaking their heads. During the video, we watched several people delve into the worst part of the trauma for them, clearly becoming aroused physiologically and emotionally, yet within moments, the time was up and the group was left with one last caution. “Be careful driving home,” they were warned, “as you may still be upset” after leaving the intervention.
Individuals have spoken out about their experiences participating in debriefing sessions. After 9-11, for example, many participants indicated that the intervention was not helpful. One participant said that he was “numb” throughout the session and that, weeks later, he was still having nightmares and often felt as though he was choking (Groopman, 2004). Another participant said that hearing other victims describe what they saw and what they suffered was too much. He had to flee the session when another participant described seeing a body part roll down a sidewalk (Begley, 2003). After an earthquake in Turkey, a recipient said, “It was as if the debriefers opened me up as in surgery and didn’t stitch me back up (Begley, 2003, p. 1).”
Cognitive approaches, such as Mitchell’s, that ignore the body’s physiology have the potential to create hysteria because of how readily the body experiences overwhelm. When the body goes through a flooding of stress and emotion, which often happens as one recalls the worst part of the trauma, it protects itself by creating another reality or dissociated state. Hysteria is a form of dissociation. Participants who become hysterical during debriefing sessions are removed from the group so they do not distract other group members (Mitchell & Everly, 1996a). Rather than accept this as an expected outcome of crisis intervention, however, we can bring our new knowledge of the brain and body to the work we do to prevent such responses.
Adaptations of Mitchell’s model are what many educators in the field of crisis intervention rely upon. Some hesitate to make broad conclusions that the model is not helpful (Brock & Jimerson, 2002) despite the growing number of studies that support abandoning debriefing approaches (Gist & Devilly, 2002). Practitioners “remain committed to the principle of debriefing” because “clinical experience” suggests value in the “opportunity to express feelings (Deahl, Gillham, Thomas, Searle, & Srinivasan, 1994, p. 64).” Others consider economic reasons for the continued use of the approach (Arendt & Elklit, 2001). We need something, and it seems we lack any other efficient model to work from. Why else would we continue to use debriefing techniques when calls for caution and restraint have been heard from so many responsible scientists and practitioners (Gist & Devilly, 2002)?
Instead of heeding the many warnings to abandon, debriefers continue their work by creating adaptations of their model. The concern with that response, however, is that without careful consideration of how crises impact the brain and body’s physiology, intervention models continue to be developed and implemented that have the potential to cause the harm described by too many recipients.
In a review of recent developments in the field of crisis intervention, I was alarmed to find how little discussion there was of how the brain and body are impacted by trauma. Crises are repeatedly referred to as psychological events that have to be intervened with psychologically, as though trauma happens to the mind alone. We seem to be determined that our cognitive mind is the most powerful tool we have for healing, when in fact, it is the body, mediated by the ancient reptilian brain, that has the wisdom to know how to naturally recover from trauma and heal itself.
Most people recover from catastrophic events naturally and spontaneously over time. In fact, any “abnormal” behavior witnessed in the aftermath of trauma is actually part of a healthy process of recovery (Groopman, 2004) during which the body does what it knows how to do to process stress to its natural completion. Recall the impala that takes moments to shake off the stress from its attack and then carries on (see chapter four). Whether we are aware of it or not, in most cases, our body naturally finds a way to do the same. It is only a small percentage of people who experience a catastrophic event that will require formal intervention. This small percentage is comprised mostly of individuals with previous histories of trauma, with “fragile emotional profiles and few available resources (Torem & DePalma, 2003, p. 12).” For example, we know that students with previous exposure to traumatic events are more at risk due to the accumulation effect of stress on the nervous system. “The new [traumatic] energy necessitates the formation of more symptoms…[so that the traumatic] response not only becomes chronic, it intensifies” (Levine, 1997, p. 105).
More vulnerable students will likely need formal assistance in recovering from a crisis at school. For the majority, however, we know that the body has the capacity to heal itself, and that healing from stress and trauma is possible simply by being in community with others. These are important points to keep in mind when creating an effective crisis intervention model for schools. Dr. Steven Hyman, the provost of Harvard University, reminds us that the rituals we have adopted through our various cultures can be supportive in our healing and recovery from crisis events. He makes note of shivahs in Jewish cultures and wakes among Catholics. Dr. Hyman stated that, “No one should have to tell anyone anything! Particularly not in the scripted way of a debriefing.” Dr. Hyman has argued that when facing crises it is the power of our social networks that helps us create a sense of meaning and safety in our lives (Groopman, 2004).
Dr. Hyman is not the only responsible academic making statements that “no one should have to tell anyone anything.” A panel of eminent researchers assembled by the American Psychological Society – Richard McNally of Harvard University, Richard Bryant of the University of New South Wales, and Anke Ehlers of King’s College London – has reached a clear conclusion: “Pushing people to talk about their feelings and thoughts very soon after a trauma may not be beneficial…For scientific and ethical reasons, professionals should cease compulsory debriefing of trauma-exposed people (Begley, 2003, p. 2).
With a growing number of studies cautioning us to abandon debriefing approaches, why is telling the story and verbally going over the details of a crisis still considered helpful? Why are cognitive and narrative approaches to crisis intervention gaining support in some professional circles? This trend may be part of a prevailing cultural bias that we can talk our way out of anything. Talking is, for most counselors, the best-known and most comfortable mode of operation. However, no explanation seems to warrant that, as ethical professionals, we ignore a striking body of evidence. Exposure techniques used in cognitive approaches to trauma are “not good for people with brains and not good for people with bodies;” telling the “story will re-traumatize and make things worse (van der Kolk, 2002).”
Dr. van der Kolk, when recently speaking at a professional conference, was open about the fact that like most counselors, he did not know how to pace the work he did with trauma survivors. Like most counselors today, he said he “wasn’t mindful about the effect of having people talk about these very scary things.” Learning about trauma’s impact on the brain is what prompted him to speak around the world educating professionals about the dangers of re-telling the story and the so-called “talking cure.” Crisis intervention specialists working in schools are beginning to acknowledge the dangers. School crisis management research summaries provided in the official newspaper of the National Association of School Psychologists (NASP) stated that early crisis interventions involving detailed verbal recollections of events may not be helpful and may place those with high arousal at greater risk (Brock & Jimerson, 2002).
What seems to be most helpful about current approaches in managing crises is meeting in a group and disseminating information. Litz and colleagues published a study comparing the CISD model with cognitive-behavioral therapy (CBT) (Litz, Gray, Bryant, & Adler, 2002). Common between the approaches was education on typical reactions and instruction in coping skills for stress and anxiety. Results indicated that meeting in a group is what helped to maintain morale and cohesion. Group interventions seemed to serve as an opportunity for those in the group to feel less stigmatized, more validated, and empowered. Psycho-education or dissemination of information regarding what to expect was also cited as a helpful part of these crisis approaches. Even single sessions when they were supportive rather than therapeutic were helpful when they (a) assessed for the need for sustained treatment, (b) provided psychological first aid, and (c) offered education about trauma and treatment resources.
Some group interventions have been found to reduce anxiety, improve self-efficacy, and enhance group cohesion (Shalev, Peri, Rogel-Fuchs, Ursano, & Marlowe, 1998). They have also been found to play a role in reducing alcohol misuse (Deahl, Srinivsan, Jones, Thomas, Neblett, & Jolly, 2000). However, it has also been found that single-session group crisis interventions are insufficient for high-risk trauma survivors, those with poor pre-trauma mental health (Larsson, Michel, & Lundin, 2000). Individuals with previous traumas, such as burns, accidents or violent crime, may actually be harmed by single-session group crisis intervention (Bisson, Jenkins, Alexander, & Bannister, 1997; Mayou, Ehlers, & Hobbs, 2000). This information is invaluable as we continue to work together as educators to develop an effective crisis intervention model.
Common Myths About Crises
It is important to address some of the myths that persist today regarding the impact of trauma on our students. These myths are pervasive and stem from outdated beliefs about children that we now have the brain research to refute.
Some Events are More Traumatic than Others
I have witnessed professionals in the field of crisis intervention delve into lengthy presentations about certain events being more traumatic than others. For the most part, these discussions are not helpful. I listened to one presenter talk extensively about a broken arm from a physical assault being more traumatic than a broken arm from a car accident, and about war being more traumatic than an earthquake. It is not a matter of some events being more traumatic than others. Trauma is not in the event; it is in the nervous system (Levine, 1997). Depending on the condition of the individual’s nervous system and available resources before, during, and after the event, what may seem benign to some can be very debilitating to another. Believing that some events can be objectively judged for everyone as more or less traumatic leads to very dangerous assumptions about individual students. We cannot expect that some students will be less traumatized by what we have judged as a less frightening event. This is how we misunderstand students and fail to see their trauma-related symptoms after an event that was terrifying to them.
Trauma Causes Psychological Injury
While it is true that trauma has the potential to induce psychological injury, such a statement does not reflect the whole truth concerning the damage caused by traumatization. When people who are traumatized learn that crises are not simply psychological events but physiological ones, they experience relief. What they are going through is not “in their head;” it is the natural response of the body. People suffer years of anguish following a car accident, for example, or a surgery, believing that they must be going crazy. Their medical doctors tell them that there is nothing physically wrong with them, that there is no reason for their suffering. No one talks to them about what their brain and body have gone through so they conclude that the problem must be in their head. With that conclusion comes the belief that they must be in need of some form of talk therapy. I have seen firsthand how this conclusion leads to hopelessness, as traumatized people make numerous attempts at various forms of therapy with little or no success. They know they do not feel the same inside. They know they have applied all the cognitive techniques they were taught by their well-meaning therapists. They simply do not get better.
Medical tests cannot detect the problem and psychological approaches that do not intervene with the body’s response to trauma leave traumatized people feeling like they are going crazy. When we look at physiology, however, we find answers. We learn that, among other physiological changes, traumatization increases resting heart rates and decreases cortisol levels. Hormones and neurotransmitters are altered in the short term or long term depending upon previous history and resources. Physiological symptoms require a physiological approach. This is what is missing from the crisis intervention programs used today.
Children Look to Adults to Determine How Threatening an Event Is
No matter how young children are, pre-verbal or verbal, they have their own nervous system, their own brain, their own body and mind, and they experience life and its events as much as anyone else. They may not have words for their experiences, and they may look to adults for comfort and understanding in the face of a frightening event, but they do not need to be guided when to feel fear. We cannot tell a student that they are fine and what happened is “no big deal” if, in fact, it was a big deal to them. We stand the risk of shutting down their body’s natural healing mechanism when we do so. There are ways to support the natural process of healing and there are ways to undermine it. Telling students how to feel is an example of how our cognitive mind can interfere with the body’s capacity to heal.
A colleague of mine once shared that when she was a young girl she fell from her bicycle and badly hurt her knee. She was so stunned from the fall that she could not cry. She realized as an adult looking back on the event that she must have been in a state of shock because all she felt was numb. When she arrived at the door of her home and her mother saw that she had been injured but was not crying she was praised for being such a brave girl. “Look at what a good girl you are,” her mother said, “You are not even crying.” After that incident, my colleague said that she made sure she did not cry no matter what else came her way. She used her words, the power of her cognitive mind, to shut down her body’s natural responses so that she would be regarded as brave and strong.
Adults have no way of knowing how threatening or frightening an event is to a child. If we think we can decide objectively what a student’s subjective experience will be, we have no chance of understanding or intervening with students in crisis.
Developmental Immaturity Can be Protective
Some believe that the younger a student is, the less the student will experience fear and terror. This is not supported by scientific evidence. One Nationally Certificated School Psychologist (NCSP) made a presentation at my school district encouraging us to utilize his crisis intervention model. As part of the introduction to his work, he said that both developmentally mature and gifted students are more vulnerable and impacted by crises than their less well-developed peers. Smarter students can be more traumatized than less intelligent students because they realize the event was threatening, he said. They realize the event was traumatic because they are cognitively sophisticated enough to judge the event as threatening. According to this presenter, “Developmentally immature students don’t understand the event, so it is not traumatic for them.”
Trauma is a physiological event that impacts everyone in its wake (to varying degrees) regardless of level of intellect. The school psychologist’s statements demonstrate a dangerous ignorance of science and what the brain and body experience in the face of threat.
Current Attempts at Crisis Intervention in Schools
Several educational professionals from various areas of expertise have attempted to develop crisis intervention models that will meet the needs of schools. Three different men who each developed their own approach presented to my school district on three separate occasions. I will review each of their proposals: (1) Bill Saltzman from the National Center for Child Traumatic Stress, (2) Michael Hass from Chapman University in Orange County, California, and (3) Stephen Brock, a nationally credited school psychologist and coordinator of the Crisis Management in the Schools Interest Group.
Saltzman
Dr. Bill Saltzman’s approach emphasizes the need to tailor crisis intervention to the developmental level of the students being served (Saltzman, 2003). He reminds us that students’ responses may be specific to their age and stage of development. For instance, preschoolers may display cognitive confusion. They may not know that the danger is over when a crisis event ends and may need to be given repeated concrete clarifications for anticipated confusions. Older, school-age students may display specific fears triggered by traumatic reminders. They may require help in identifying and articulating those reminders as well as associated anxieties. They may benefit from being encouraged not to generalize, according to Saltzman. Adolescents, on the other hand, may begin to exhibit posttraumatic acting out behavior such as drug use, delinquency, or sexual activity. Saltzman postulates that helping adolescents understand the acting out behavior as an effort to numb their response to, or to voice their anger over, the event may be of benefit.
Importance is placed on family and friendship. Maintaining and nurturing relationships is critical after a crisis event for students at every stage of development. Saltzman points out that sometimes crisis events cause physical relocations that can abruptly interrupt usual daily contact with loved ones. When this happens, it is helpful to make the effort to keep relational ties regardless of physical separation in order to be comforted by them.
Saltzman makes clear that it is always important to reintegrate students back into the school and classroom environment as soon as possible. Somatic complaints and specific fears related to school or loss of a loved one may make it difficult for a student to want to enter back into school. The family and the school need to work together to make sure students’ fears are resolved and attendance in school is maintained.
Saltzman’s model includes an initial interview protocol that asks crisis survivors questions in seven stages. The first step is to gather factual information about where the student was during the event, what they were exposed to and how they knew the people involved. One important question to ask at this stage is whether or not the student has ever experienced any other kind of crisis or trauma, including subjection to violence, serious illness or sudden, unexpected loss. The next four stages of questions have to do with the students’ responses to the crisis. What was their subjective response to the event? Are they exhibiting new behaviors or new concerns since the event? What type of grief responses are they displaying? Finally, in the sixth stage of the interview, students are asked about their coping mechanisms before the final stage of closing the interview is done.
Saltzman’s approach is useful. Awareness and consideration of the different expressions and needs of students at varying developmental levels is helpful. Caution should be made, however, that during times of crises, students may easily and quickly regress back to earlier stages of development so that even adolescents display the behaviors of pre-school children. Saltzman highlighted “anxious attachment” as a possible pre-school response that may involve clinging and not wanting to be away from the parent or worrying about when the parent is coming back. This can happen with teenagers. Like pre-school students, adolescents may also greatly benefit from being reassured about “consistent caretaking” of being picked up after school and always knowing where their caretakers are.
In a review of all of Saltzman’s hypothesized responses of students at different ages, it was easy to see that any one of these responses could come from a student at any developmental level. We do not want to make assumptions about how a student will act given their age. If we have expectations we may not see what we need to. Nonetheless, it is useful to be aware of the possibility of age and stage differences. Especially in teenagers should we expect to see such age-specific behaviors as “premature entrance into adulthood.” Certainly that is something specific to adolescence. However, behaviors attributed to adolescence in Saltzman’s approach, such as “life threatening re-enactment, self-destructive or accident-prone behavior, abrupt shifts in interpersonal relationships, and desires and plans to take revenge,” are readily seen in some younger school age children after a crisis event.
Saltzman’s approach, like most, is cognitive and emphasizes the use of verbal language and asking questions. It is unclear how soon after a crisis event all of the questions from the initial interview protocol are to be asked. Like other cognitive approaches, including the debriefing model, Saltzman asks crisis survivors to talk about their “most disturbing moment” and “worst fear.” We need to learn from the examples we now have available to us that this kind of questioning may increase suffering.
Hass
Dr. Michael Hass has attempted to help schools develop a crisis intervention model utilizing the principles of Solution Focused Brief Counseling (Hass, 2002). His emphasis, like most others, is on interviewing the crisis survivor. The stages of crisis interviewing in his approach include role clarification, a description of the problem, an exploration of current coping efforts, “scaling” of coping progress, formulation of the “next step,” and closure. The focus of this approach is on the establishment of helpful coping skills. Questions during the interview are intended to facilitate coping in order to empower students to take action on their own behalf.
Examples of coping questions include: What are you doing to take care of yourself in this situation? Who do you think would be most helpful to you at this time? What about that person would be most helpful? Have you been through a frightening situation before? How did you get through it then? Developing resources for the student to draw upon during difficult times is key. “Scaling” questions are also related to coping. They help students rate how much better or worse they think they are doing and give a gauge to crisis counselors of how much progress has been made. Together, the counselors and students problem-solve to arrive at solutions for moving the scale in the desired direction.
During Hass’ presentation, he highlighted the importance of telling the story of what happened during the crisis. He stated that researchers have found that putting a traumatic incident into language is a critical feature of the healing process. The idea being that language helps the images and feelings we have about a frightening event become more organized, understood and resolved.
The studies that Hass was referring to were led by Dr. Edna Foa, a professor of psychology at the University of Pennsylvania who, twenty years ago, began studying rape victims. She found that most rape victims spontaneously recovered without the need for formal intervention, but that fifteen per cent developed symptoms of posttraumatic stress (Groopman, 2004). Foa devised a technique of storytelling to restore resilience in those who continued to suffer. The women were asked to tell their story into a tape recorder and listen to it, then re-tell it and listen to it, and so on. Within approximately twenty sessions, Foa found that twenty-nine of the thirty participants experienced a marked improvement in their symptoms and ability to function. She attributed their improvement to the changing of the story over time. It became more organized, with a beginning, a middle, and an end. It was hypothesized that because they were able to give such a well-developed account of the incident, they were more likely to develop perspective on the event, create a sense of distance from it, feel a sense of closure about it, and feel more hopeful about the future.
Hass’ overall focus on strengthening and empowering students to cope after a traumatic event is very helpful. It is important to create a balance in the nervous system between the alarm response triggered by the event and whatever will be soothing to that sense of alarm. However, it is dangerous to recommend a technique to professionals who work with school-aged children, when the few studies that support such an approach have been done with adult women who experienced sexual assault. The appropriateness of using such an approach with students may be suspect, especially when other eminent professionals in the field have seen that telling the story can re-traumatize the victim (van der Kolk, 2002). It is true that when trauma survivors can tell their story in an organized, fluid way without becoming overwhelmed by it, this can be a sign that they are recovering from the experience. Telling the story at some point in a trauma survivors’ treatment may be relevant. However, we are not talking about adults receiving therapy. We are talking about crisis intervention for school-aged students. Now that so many responsible scientists and practitioners are warning us that telling the story can cause hysteria and re-traumatization, it is best not to endorse such an approach to schools.
Brock
Dr. Stephen Brock developed a model of crisis intervention for schools that takes into account the different stages of the event (Brock & Jimerson, 2002). The first stage is the impact, or when the crisis occurs. The next stage is the first phase of the school’s response to the event, which he calls “recoil.” Immediately after the event, the students involved receive “psychological first aid” and, in some cases, medical intervention. Support systems need to be enlisted during this phase, ensuring that loved ones are located and reunited. Psycho-education groups, caregiver training, and informational flyers are also important at this time, as is risk screening and referral for students who may require more intense intervention.
The “postimpact” phase occurs in the days and weeks after the event. This is the time that Brock suggests that group crisis debriefings occur, as well as ongoing psychological first aid, psychotherapy, and crisis prevention/preparedness for the future. Rituals and memorials may be helpful at this time, as well as in the next phase of “recovery/reconstruction.”
Recovery/reconstruction, the final stage of the approach, involves anniversary preparedness. Anniversary reactions have been found to be as intense as initial ones (Gabriel, 1992).
Brock recommends that, before the school responds in the recoil phase, all pertinent staff members meet as a team, clarify their roles, and decide who will do what. There will be a different part to play for school psychologists, nurses, counselors, and administrators.
The psychological first aid approach developed by Brock specifically for schools is called Group Crisis Intervention (GCI). It is designed to work with large groups of students who experienced a common crisis. Such large groups are typically classrooms. The approach is not intended for use with severely traumatized students, whose crisis reactions are thought to interfere with GCI (Brock, 2002). Like in Mitchell’s model, these students are removed from the group and referred to mental health professionals. It is suggested that GCI occur at the start of the first full school day following resolution of the event to ensure that participants are psychologically ready to talk about the crisis (Brock, 2002).
The six-step model includes an introduction, provision of facts and dispelling of rumors, sharing stories, sharing reactions, empowerment, and closing. GCI is ideally completed in one session lasting one to three hours, depending on the developmental level of the classroom of students. Similar to other approaches, group facilitators introduce themselves and define their roles. Opportunities are provided for students to share their stories, their reactions, and become “empowered” through a focus on coping and stress management.
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January 29, 2012
Hello Foot Fungus Sufferers!
If you have ever gotten a toenail fungus infection, you know by now that they are not the easiest things to get rid of. Not only that, but they are quite unsightly and even nasty in some of the most extreme cases. Luckily for both you and I, there are remedies for nail fungus.
Try this treatment you can do in your own home:
First cut your nails – First thing you need to do is cut your nails down as low as you can get them without injuring your finger. This processes helps get rid of the fungus on the surface of your nail, as well as open up the skin under your nail for the next treatment.
30 minute vinegar foot baths – Before I talk about this remedy, I want to say that this treatment does not work for everybody – some strands of fungus are immune to it and vinegar really isn’t powerful enough to cure heavier fungus infections. Anyway, what you need to do is fill up a container big enough for both your feet with vinegar(about 2-3 inches deep, or enough to cover your nails entirely). Then for 2-3 weeks, each day soak your feet in the bath for 30 minutes. You will want to change the vinegar every 4-5 days.
Some people say Listerine works too – I have read a lot of comments that people say to soak your feet in Listerine instead of vinegar for best results. That said, I still say Listerine foot baths are only good for minor infections. Like the vinegar, it lacks in penetrative power to get to the root of your infection.
Luckily for those with a worse infection, there is one solution that works very well – perhaps the best you can use for any nail fungus infection. Read the info below.
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January 24, 2012
A shocking statistic is that 80% of parents think their children are getting enough exercise but in fact less than 10% actually do!
This lack of exercise has been caused partly by the rise of the “playstation culture” which means children just don’t go out and play any more. This has caused a big rise in childhood obesity and related illnesses.
The difficulty can be persuading your children that exercise is fun and can be enjoyed. In fact, many adults would benefit from being taught this valuable lesson too!
A pogo stick is an excellent source of fun and exercise.
There is something about bouncing around on a pogo stick that puts a smile on your face. The challenge of mastering it and being able to bounce for ages makes it something that keeps both children and adults entertained for a long time.
Once you get good at pogo’ing then you can start doing tricks such as bouncing with one hand or no hands or even without any feet. After you’ve mastered these more basic tricks you can move on to more advanced tricks with a stronger stick and do somersaults and more.
The great thing about these pogo sticks for kids is that they are actually quite affordable. The Flybar Foammaster, which is a great starter stick can be bought for under fifty bucks. The advantage of the foam stick for kids is that it doesn’t get scratched and the foam reduces any bruises to the legs.
There are much more expensive pogo sticks out there which you can buy as they get into using their pogo stick, but to start with one of the cheap sticks will be more than adequate for their needs.
Some parents are worried about the safety of a pogostick but to be honest they aren’t any more dangerous than a bicycle. If we are really honest they are actually safer because then you fall of a pogostick you have more chance of landing on your feet than a bike. When you fall off a bike usually it lands on you resulting in injury.
Naturally, as a parent, you want to make sure your child is safe on their pogostick so you will want to buy them a helmet and maybe some elbow and knee pads. This will ensure they are safe if they do fall off and land on anything other than their feet.
Pogo sticks for kids are a great form of entertainment and exercise. When you children get used to them they will have hours of fun whilst getting some healthy exercise! You’ll be surprised how much your child will enjoy their pogostick. It’s good old fashioned healthy fun that they can show off to their friends and have some fun with.
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January 21, 2012
You should be able after reading this, to perform simple forming methods for linear footings and pier footings for a basic foundation. I will cover optional ways to form foundation walls as well. Along the way I will leave you hints that will either be ways to save money, safety items or perhaps a reference or two for you to go to for more information if you need it.
Linear Footing Formwork- Linear footings is a fancy word for strip footings that you may have seen being placed under a new house or garage. They are the first basic piece in the foundation system you will need for your project. Linear footings may form a square, a circle, an arc or perhaps just a projection sticking out from the main building that will support a knee wall or a retaining wall.
Observe therewill be several men involved as well as the use of wheelbarrows to haul the concrete and place it in the footing forms. Also note the small squares in the center of the excavation are for a pier footing that may support a column later on. The concrete is placed and leveled off flush with top of forms.
Materials: Materials for footings can range from dimensional lumber such as a 2″ x 12″ or 2′ x10″ to plywood, scrap lumber pieces, or any other wood you have laying around. Typically, footing lumber can be used over and over again to save money. 12 penny,10 penny and 8 penny common nails, some string line, pencils, level, ruler or measuring tape and a tripod and bubble level. A tripod and level can be rented by the day from most Rental centers. They will show you how to set it up and use it if you need help. A string line bubble level is approximately $2.00 at most home hardware stores.
Tools-Long handled pointed shovels, short handled square shovel, hammers, pick, 12 pound sledge hammer, tie wire, and a chalk line box.
Reinforcement- In most parts of the country steel reinforcement is required in foundation footings. It could be 2-#5 bars continuous or 2-#6’s and this information will be shown on your building drawings. Reinforcement bar sizes are based on 1/8″ increments of 1″. So #5vbar is 5/8″ thick, #6 bar is 6/8 or ¾” thick and so on. Bars range from #3 to ##24 but will never see anything larger than a #7 in any typical house footing. Rebar (for short) is available at home centers, lumberyards and if you have a local steel supplier in the phone book, they may deliver as well. Rebar comes in 20′ or 30′lengths with 20′ lengths which are easier to handle and are preferable. You can bend a #3, 4 or 5 in a simple jig made of stacked cement blocks or a trailer hitch on a pickup truck. It will take some effort but there aren’t that many to bend.
Cutting rebar may be done with a demolition saw or a skill saw with a carbide blade although that is much slower. WEAR SAFETY GLASSES AT ALL TIMES! Flying debris from the saw blade and sparks can cause serious eye injuries. Watch the sparks as well. Be aware of where you’re working and have a firm footing when doing this work. Make sure no one is standing in the path of the cutting debris or sparks.
Rebar installed in a pier footing. Many footings have 2 or 3 continuous bars tied together end to end for added strength of the footing. Walls may have just vertical bars or both vertical and horizontal bars in them.
Installation: Here’s the fun part where you actually see something getting done. Once you have performed the layout of the building lines, you are ready to start installing the formwork. Remember, this is not cabinet or finished work that will be seen later on. It is simply a temporary form to hold the concrete in shape until it dries. When your concrete is hardened, YOU RIP ALL THE FORMS BACK OUT! While we are here, when you have finished and poured your footings, remove ALL wood from around the work. Leaving wood in place and burying it will draw insects and especially termites. They just love damp wood. This will be a serious problem later on. Take your time to clean it all out. Start in one corner of your foundation (we will for now assume it is a rectangle) and start laying out the longest lengths of lumber you have to use. Your drawings will tell you if your footing is 20″ wide and 10″‘ deep or 24″ wide and 12″ deep and so on. The first number given such as 24″ x12″ typically means the width of the footing is 24″, and the depth is 12″. Typical means this is the size used everywhere unless the architect shows a different size in a specific place. If your footing is 24″ x 12″, you would be using 2″ x12″ x 12′ or 10′ dimensional lumber marked as SPF. (Spruce, Pine, Fir). In different areas of the country, faming lumber could be Southern Yellow Pine, white pine or other most common and cheapest wood available. Remember, this is not structural framing lumber so there is no reason to buy the highest priced wood for this work. Buy the Cheapest!
OK so you worked your way all around the building and find out the building doesn’t fit your lumber lengths. Amazing! Say the building is 42′ long. by lapping your forms one foot each, you will only get 39′ from 4 10′ pieces and you need 42′. Now you are allowed to cut some pieces to fit the corners. Try to keep the cutting to a minimum so you can save your lumber for another project. OK, now we have lumber laid out all the way around the foundation. Holding the lumber in place can be done by several methods and all are fine.
Formwork can be held in place by using wooden stakes, steel stakes, perforated strapping steel tape, or wood spreaders. Steel stakes are quicker but are expensive to buy. If you can rent a box of 24 or 48, do so as they greatly speed up the work. If you are using wood stakes you have to purchase some 1″ x 3″ x12′ lumber for cutting of stakes. If your ground is very soft or wet, the stakes may have to be 30″-36″ long, if the ground is firm 24″ long stakes will do. Cut a point on each stake and make a couple of dozen of them to start. Stand your first footing form directly under you layout line and drive a stake alongside on the outside! You have to be able to remove them later. Now keeping the form under your layout line, move along the board and place another stake at the other end keeping the entire length of the board under the string line. Make sure your form is in line with the foundation footing layout line. Place your second form alongside the first on the outside and lap it 1″ over the first. Drive a 16 penny duplex nail in the lap to hold it while you work along. Third form; place it to the inside of the 2nd board, lapping it one foot as well. Nail these together from the outside! Continue on around the footing until you have stood forms for the entire exterior of the footing including corners. Lapping in and out all the way around. Now start your inside form. Stand the board 24″ away from the outside form board and hold it in place with either a 28″ piece of the 1″ x3″ lumber scrap keeping a minimum of 24″ between the forms. The building inspector will check this dimension. He/she does not care if it’s slightly larger but he/she will fail it, if it’s less than 24″. Again work all the way around your footing until you have a full rectangle with a form board for both the inside and outside of your footing in place.
Now is the time to begin making your forms strong enough to hold the weight of the concrete. Starting in one corner, add enough wood stakes, nailing each one as you go to the formwork with 10 penny duplex nails. Steel stakes have pre-drilled holes in them so you simply insert the nail in a hole and drive it in. Continue this until one side is secured soundly. Now stand the inside forms making sure you maintain the minimum width required by your drawings. Install “spreaders” made of scrap lumber across the top of the forms to hold them apart and help hold them from tipping over when the concrete is placed inside. Continue on all the way around the footings until all forms are nailed and staked. NOTE: As you proceed with the formwork, using your level and tripod, make sure the forms are LEVEL! They are of no use if they weave up and down and will make installation of the foundation itself, nearly impossible. If you encounter rock or other obstruction, ask your building inspector how he/she wants to see the footing formed at that location. They may allow you to pin the rebar to the rock, ask that some of the rock be removed to provide a level surface and so on. Now install the rebar. Just slide the long lengths under your spreaders making bends at the corners. Using tie wire, hang the bars from the spreaders so the rebar is located within the bottom 1/3 of the footing height. 12″ high footing? Hang the bars 3-4″ above the ground. This will help provide the strongest footing you can make. When all rebar is complete, call for inspection and take a rest.
Placing the concrete-When pouring a large footing or foundation, you will most likely purchase the concrete from a Redi-mix concrete supplier. They will want to know, how many yards you need, what strength concrete and what time of day you would like it to be on site. Have your information ready. Order two days before you need it and check again on the day it is supposed to be delivered to make sure there will not be any delays. Weather, plant breakdowns and even manpower can sometimes delay truck delivery times. They will get there as closely to the hour you requested as possible. BE READY! When the truck shows up is not the time to find out you have a flat on the wheelbarrow or can’t find the shovels. Have your tools and manpower ready. Most companies allow up to 1 hour on site for unloading. After that you pay additional time charges for the truck and the driver. It can get costly! Unless you are superhuman and very well experienced do not try and unload 10yds of concrete with only 2 people. You most likely will spill more than you use, the concrete will get hard before you finish it and rushing around can cause an injury. Be prepared with sufficient manpower.
After the concrete is placed in your forms and roughly troweled off to the top of the forms, take a few minutes break. The concrete will start to setup and if your plans call for vertical bars in the footings for the new foundation walls, this is the time to install those. They should all be pre-made and laid out roughly where they are to go in the footings. Again, plan ahead. You may “stab” these rebar into the wet concrete, wiggling them around slightly to get the concrete to fill in around the hole you made. Your plans will tell you if the bars go on the inside or outside “face” pf the wall or in the center and how far apart they are to be. “Inside” and “Outside” face simply means the inside or outside of the new all. Most times the bars are to be placed 2″ away from the face. Your drawings will tell you this information. Starting in one corner, install one bar in intersection of the corner and then measure whatever dimension the drawing shows for centers. 32″ on center (O.C.). Just measure over 32″ and install the next bar and so on. When you come to the next corner, make sure one bar is at the corner intersection center again. You can add extra bars of you have a question, just don’t add too few.
Next day. Now that you found the muscles you never knew you had (just a little sore?) it is time to strip all the formwork off the footings. Yes all that great form work you did is now just scarp lumber pile material. Take ALL wood out of the foundation area. Rotting wood underground draws termites and other nasty insects! Footings are complete.
Foundation forms completed and filled with concrete. Not child’s play!
Foundation walls: Walls may be constructed of concrete block units (Masonry or CMU), poured concrete, pressure treated wood and today even Styrofoam foundation blocks are available. Whatever the type you are using, if you did a good job on your footings and they are nice and level, the walls are going to be easy to install. If your foundation is masonry, your work is done. Your mason will now layout the wall locations, lay the CMU, pour the CMU cells that have the rebar in them and install the straps for the sill plate for the house, shed, garage, etc. Make sure his contract includes all this work and materials. If the foundation is concrete, the concrete contractor will bring all the forms with him. Again, make sure all the formwork, wall ties, rebar required, windows and other accessories are included in his contract. It is possible for a homeowner to form and pour a foundation but it is not child’s play. For rentals, rebar installation for the walls, actual placement of the concrete, how to use the trucks properly and possibly the use of a concrete pump are all best left to the pros. Concrete is extremely heavy when wet. Improperly constructed wall forms can result in a “blow-out” of the formwork and serious injury or death can result.
Footings are the basic and first building block of your project. Sheds may sit only on 4 solid concrete blocks but those are the footings. They too must be solid and level to provide a good footing for your shed. Take your time and do it right and the rest of your building will be easier to keep plumb and level.
Hopefully this has given you lots of ideas and information on the right and wrong ways to install footings. Whether it is a large or small project, the theory is the same. Take your time to read your drawings, always use safety glasses when using a power tool or placing concrete.
Pete
Your Friendly Building Inspector
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BICES-Building Inspection & Code Enforcement System Software
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January 18, 2012
The Stresses Our Bodies Go Through
You may not realize how much stress we place on our bodies each and every day and how much it hurts our body.. Standing up or constantly picking up heavy boxes will put a lot of stress on your back. Sometimes these stresses may cause more harm later down the road such as arthritis. Other pains such as premenstrual syndrome are a way of life. There is no way to avoid this it is just a part of everyday life.
For instance, if you work at a job that has you stand up all day or that you are just too busy to sit down can cause back pain. Some shoes that do not fit well or even have worn out will back joint pain as well. Lifting or moving heavy furniture will cause a great deal of back and joint pain. over a period of time this back pain can turn chronic and then turn into arthritis. There are many different pain medications that you can purchase that will help take some of these pains away. Sometimes the pain is so great that you cannot even get out of bed. Going through the pain is very uncomfortable but having it everyday is annoying.
For many people that experience joint pain and bone pain is from an injury that happened when they were younger. Joint pain can be so serious that one may not be able to stretch their arms or legs. When you feel joint pain it is because your joints have worn out the cushion they need to move smoothly and without any pain. You can compare this to a motor vehicle running without oil. Joints will eventually wear out because of the bone and joint rubbing together.
Stress is one of the key causes of joint pain. Stress is all around us where ever we may be. Most people have jobs that are really stressful. Headaches and stomach problems are a result from stress work areas. Mentally warn is a term used for a stressful day? Blame it on stress. Stress can also cause a person to not sleep well at night even if they think they are. Being overweight, and other health problems are a result of stress. People sometimes do not eat anything all day but a snack due to stress and that causes nutrition issues. Stress is a big influence on a person’s health.
Some products claim they can fight stress or even cure it, arthritis [http://www.universitylabtechnologies.com], and joint pain. There may not be a way to cure the pain but there are some products that can help with the pain. Some need prescriptions to obtain the medication and some you can buy over the counter. Some online drugstores have the medication yo need and they also send it to you.
With all the stress in the world it is pretty unusual how our body keeps on going after all we put it through each and every day. Imagine if we did cure stress, i bet this world would be a much different place to live in for better or for worse.
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January 16, 2012
Total hip replacement has matured into a routine operation for the relief of hip pain and disability due to hip arthritis, giving some of the greatest quality of life increases of all medical procedures. Typically performed in older people, many get a good result from their hip replacement surgery but many do not reach their greatest potential due to lack of follow up rehabilitation in the post-operative period.
An osteoarthritic hip joint is likely to cause a degree of pain and disability for a year or more before the person comes to operation. This period of difficulty can cause influential changes in the tissues around the hip which can be relevant in the postoperative period. Pain and weakness can make us use our joints less, avoiding pushing them to the ends of their movement, a process which gradually reduces the joint’s range of motion. Adaptive shortening occurs in the hip’s ligaments, as the structures shorten in response to the fact that the joint is not being put through its full range any more in the normal daily pattern.
When a hip joint is not used in the normal way or through its full range the muscles which power it will lose some of their strength. The hip joint is designed to bear weight and to move the body around which involves high levels of power, provided by the largest muscles in the body, the gluteal muscles. The ability to run, walk, get up from a chair, climb stairs and go uphill is facilitated by the power of the gluteal muscles to a great extent. If these muscles weaken they can reduce a person’s independence to an important degree.
The hip abductors, a smaller muscle group of the gluteal muscles, are important in controlling the side to side stability of the pelvic girdle in gait, with weakness of these muscles interfering with walking. Standing on one leg in walking we hold the opposite side of the pelvis up to avoid it dropping and make bringing through the moving leg more difficult. The hip abductor muscles do this and if weak we feel unstable in walking and tend to lurch towards the weak side, making us lean our trunk towards the other side to restore balance. This is described as a positive Trendelenberg sign.
The abnormal Trendelberg gait imposes unnatural forces on the hip and requires side flexion of the spine to hold balance on each step. The abnormal gait which results fails to strengthen the hip abductors and remedy the problem. With hip problems we tend not to extend our hips fully so the gait cycle is shortened as the hip extensor muscles fail to attain full movement and power. A restriction in hip joint movement and the presence of muscular weakness makes mobility more difficult and can make the outcome of the operation less satisfactory in the absence of rehabilitation.
Patients typically have impaired balance and coordination even before they have their joint replacement operation, with some improvement occurring as the hip’s function moves more towards normal after the joint has been replaced and the mechanical function of the hip is restored towards normal. Other impairments usually include the sense of joint position sense, an important ability the lack of which compromises balance and makes falling more likely.
Physiotherapists assess a patient’s hip function and ability to get through their normal daily work, looking at the deficiencies in the joint so they can plan the rehabilitation. Noting the gait of the patient will be the first thing in the assessment, moving on to checking movements of the hip, knee and spine to check for any restrictions due to joint stiffness. An abnormal gait can be habitual and the physiotherapist will analyse and correct the gait pattern towards normal.
Excessive range is not encouraged in hip replacements due to the risk of dislocation. Next the muscle power in all the surrounding muscles will be tested and then the person’s balance reactions and joint position sense. Once the assessment is complete the physiotherapist will give the patient a programme including joint mobility, strengthening, and balance and gait correction. Many with hip arthroplasty do not reach their best potential due to a lack of rehabilitation care after the operation.
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January 15, 2012
Do you enjoy bowling, but your knee pain or instability are a growing concern for you?
Introduction : Bowling is great. Many of us would agree that being involved in the sport brings the game more to life. However, it is hard to stay involved if your knee pain or instability are getting the best of you. – This free article will discuss why bowlers turn to a knee brace when they play, and what many of said when they first try on their new knee support.
1.) Why Bowlers Turn To A Knee Brace
As you approach each shot on the lane, the last thing you want to be focusing on is the nagging knee pain or instability problem that you are suffering from. Rest, ice and elevation can really be of help, but these are methods you will use after you perform an activity and none of them are quite the same as a well designed knee brace.
The great thing about knee supports is that you can use them during an activity and many people often call their knee brace their “pain pill”. – Improved knee support, pain reduction and more knee protection are the main reasons why bowlers and other individuals state that they use knee braces on a regular basis.
2.) What People Say When They First Get A Knee Support
In a clinical setting, we asked many athletes, how their knee felt after they put on their new knee brace for the first time. The overwhelming response we get from people is that almost within the first few seconds they will state that their knee pain went down. Next they will usually say that the brace feels comfortable and now they feel much more stable, when they start to take a few steps. – The great thing about knee braces is that you do not just have to use the support for the activity of bowling. You can use it for multiple activities for support.
3.) Mental Support & No Regrets
The last points that we would like to make here are important for you to consider. Many people indicate that their confidence improves with the new knee support that they get because they do not have to worry so much about their knee pain or the joint giving out from underneath them. Also, it is a very good idea to support your knee now, in order to help avoid any knee issue from getting worse.
(*This is health information, not medical advice. Self diagnosis is not recommended and it is also important to speak with your doctor about medical advice.)
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