The greater part of eyeball (posterior 5/6^th) is spherical & anterior 1/6^this convex. The posterior 5/6^th part has outer white opaque wall called sclera & anterior 1/5^this transparent called cornea. The center of cornea has pigmented part called iris with an aperture in center called pupil.

There are 3 pairs of muscles responsible for movements of eyeball. 2 pairs are straight hence called Superior Rectus, Inferior Rectus & Medial & lateral Rectus. One pair has oblique muscles, called as Superior Oblique & Inferior Oblique.

Movements of eyeball mediated by these muscles are up & down, medial (inward) & lateral (outward), combined convergence (downward & upward) & divergence(downward & upward). In addition, there is torsional movement called intorsion & extorsion.

Nerve supply to these muscles is by three cranial nerves

1. Trochlear- the 4^th cranial nerve supplies to Superior oblique muscle

2. Abducent- the 6^th cranial nerve supplies to Lateral rectus muscle

3. Oculomotor- the 3^rd cranial nerve which supplies to all remaining muscles

with one additional muscle called Levator palpabrae superioris which keeps upper eyelid lifted. This nerve also has parasympathetic fibers supplying sphincter pupillae & ciliaris muscle. Former causes narrowing of pupil and later causes accommodation reflex. This reflex makes the lens more convex for near vision.

Central control of eyeball fixation has two components – Voluntary & Involuntary.

Involuntary fixation of eyeballs is required during head, neck, body movements also in response to auditory stimulus. This is achieved by connecting fibres from visual cortex to brainstem nuclei of oculomotor nerve which controls 4 muscles of eyeball & parasympathetic fibers to sphincter pupillae & ciliary muscles.

Voluntary fixation of eyeballs is controlled by a specific area in cortex which is present in posterior region of Prefrontal cortex. Fibres arising from this area also project into brainstem nuclei of oculomotor nerve via a separate tract.

Tratak- is a shuddhikriya described in Hath Yoga. One has to gaze at a small object & keep eyes steady until tears come out. This is the description of Tratak given in Hatha Pradipika II-32. The II-33 says that process of Tratak cures many eyes diseases & removes laziness.

The tratak can be practiced with pinpoint small circle at eyesite level or using a flame of candle.

Voluntary fixation of eyeballs on a pin point or flame of a candle will bring signal to brainstem nuclei of oculomotor nerve. Voluntary fixation of eyeballs is done by downward convergence to gaze at tip of nose or upward convergence at center of eyebrows. Since the oculomotor nerves carries parasympathetic fibres, voluntary fixation of eyeballs in Tratak may help to increase parasympathetic tone.

Gazing at tip of nose as mentioned in BG-6-13 & gazing at center of eyebrows in Shambhavi mudra leads to downward convergence or upward convergence respectively. This may lead to activation of parasympathetic system via oculomotor nerve nuclei

Tip about Lacrimal Secretion– Lacrimal gland is the tear producing gland situated at upper part of eyeball. This gland produces tears to keep cornea moist & also protects it from external microinvasion.

This gland is innervated by branch of maxillary division of 5^th cranial nerve called Trigeminal nerve. The Secretomotor fibres come from Pterygopalatine ganglion which is peripheral ganglion of parasympathetic outflow. (These fibres also lead to secretomotor effect for glands of nasal & palatine mucosa).

The net effect of tears flowing through eyes (during Tratak) may be intended to increase parasympathetic tone at this ganglion.

Conclusion – Yogic science offers many techniques to reach the efferent connections of Parasympathetic system. Tratak, Shambhavi mudra & nasal tip gazing are some of them.These techniques are based on voluntary fixation of eye balls. The concerned nerve is third cranial nerve called Oculomotor nerve which carries parasympathetic fibers for sphincter pupillae & ciliary muscles.Reaching & stimulating parasympathetic system helps to generate relaxation response of body.

This response helps the process of homeostasis of body.

******************************************************************

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The cellular component of bone consists of fibroblasts  & fibrocytes which produce type I collagene & other ECM components.The osteoblasts are the primary bone forming cells,which are responsible for its synthesis,deposition & mineralization.When osteoblasts cease to function they are called osteocytes.Osteoclasts are monocytes derived large multinucleated cells responsible for bone resorption.Homeostasis between bone synthesis & deposition is fine tuned by Nutrition,Hormonal status & Mechanical loading.Bone remodeling is a lifelong process of bone formation & its resorption.The condition called Osteoporosis results when an imbalance occurs between bone synthesis & its resorption.This leads to decrease in bone mass or it’s density. 

This happens due to faster rate of bone absorption by osteoclasts than its rebuilding by osteoblasts.Because of decreased mineral density or mass,they are weaker & hence more susceptible to fracture than bones with  normal density.

Menopause is a stage in woman’s life when ovaries stop producing Esterogen due to depletion of follicles.Since esterogen hormone has a stimulatory effect on osteoblatic activity,its abscence seriously affects the bone synthesis.Since the osteoclastic activity continues,every post menopausal year will decrease the bone mass. Trivial fall of injury may lead to fracture affecting her quality of life.HOWEVER THIS CAN BE PREVENTED BY REGULAR PRACTICE OF SELECTIVE YOGIC POSTURES & ACTIVE LIFE.

How?

Bone responds to external forces or loads such as pull of tendons & the weight of the body during functional activities. This change in form to match the function is Wolff’s law. Numerous studies have shown that bone deposition is increased with weight bearing exercises & in the areas of  increased muscle force . Application of external forces or loads repetitively or over time causes osteoblast activity to increase & as a result bone mass increases.

In addition, to increase in Bone mass,the regular practice of selective Yogic postures, increase muscle mass( hence strength) which helps the woman to delay Osteoarthritis of knee joint & prevent Cervical & Lumbar Spondylosis. This practice helps her for proper erect posture which maintains her dignity in spite of her increasing age.

Following are the selective Yogic Postures to be practiced by a woman since Peri menopausal phase of her life & to be continued till the last day of her life.

Set 1 ( Prone)

Sarpasan 1,2,3

Shalabhasan

Naukasan

Dhanurasan

Set 2 ( Supine)

Padangushthasan ( Single leg up & down & both – 30 degrees)

Lift torso with head & both hands in line with shoulder joints

Setubandha

Naukasan

Set 3

Konasan 1

Konasan 2

Urdhwamukh

shwanasan

Set 4

Anantasan ( Side lying leg raising)

These Yogic postures are weight bearing postures ( self weight) hence of immense value to maintain bone mass and muscle mass. 

We have to pay attention to Nutrition which should be rich in proteins, calcium & Vitamin D.

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How is bone formed?

It is formed in three stages.

1) Osteoid formation

2) Mineralization Of Osteoid

3) Modeling till puberty & later on remodeling

Osteoid formation-  Bone is composed of tough organic matrix,which consists of 90 to 95% collagen fibers with gelatinous ground substance. Collagen fibers extend primarily along the line of tensions force.Ground substance is composed of extracellular fluid plus proteoglycans namely chondroitin sulphate & hyluronic acid.They help in deposition of calcium salts.These are formed by osteoblast cells of bone.As Osteoid is formed some of the osteoblasts are trapped in it which are called osteocytes.

Mineralization Of Osteoid- ocurres within a few days of Osteoid formation, by deposition of calcium & phosphate on the surface of collagen fibers which grow over a period of days & weeks to form the finished product  called hydroxyapatite.Other ions present in bone are magnesium,sodium,potassium & carbonate.Collagen fibers offer great tensile strength & calcium salts offer great compressive strength to bone.

Modeling & remodeling – The skeleton increases in size by linear growth & by apposition of new bone tissue on the outer surface of cortex. This apposition process is the phenomenon of modeling which also allows the adaptation in shape to respond to stressplaced upon them.Once the peak skeletal mass is attained,the process of remodeling becomes the principle metabolic activity of skeleton.This has three primary functions.

1) Repair microdamage in the bone

2) To maintain bone strength

3) To supply calcium from skeleton to maintain serum calcium level.

Process Of remodeling occur by actions of osteoblast cells  to form the bone & osteoclast cells to absorb the bone. This is regulated by estrogen,androgens,Vitamin D & Parathyroid hormone. Osteoclast cells are large,multinucleted,phagocytic cells.They are under influence of Parathyroid hormone.The net result of remodeling is mass of the bone remaining constant by balance of osteoblast & osteoclast cells activity.

Pathophysiology of Osteoporosis – 

1) After the age of 30 to 45 the resorption & formation process becomes imbalanced. The resorption exceeds formation.It May begin at different age & vary at different skeletal sites.

2) Nutrition – Sufficient  protein intake is necessary for Osteoid formation.Inadequate calcium & or Vitamin D will lead to secondary hyperparathyroidism leading to increased osteoclastic activity.Hence adequate calcium & Vitamin D is essential to maintain normal bone mass.

3) Physical activity – helps to maintain bone mass by stimulating osteoblast activity.Athletes & rural people have more bone mass due to physical activity

4) Menopause – Estrogen deficiency causes bone loss by reduced osteoblast activity.This leads to imbalance of bone formation & resorption. ( remodeling imbalance) Remodeling is initiated at surface of bone.Trabecular bone has larger surface area than cortical bone,hence get affected more commonly.Bones which have more trabecular component e.g. vertebrae face fractures more commonly.

5) Chronic Diseases – Of different types may lead to excessive bone loss by poor nutrition,less physical activity & factors affecting remodeling rates. e.g. Cushing’s syndrome,Rheumatoid arthritis

6) Medications – Glucocorticoids,anticonvulsants,immunosuppressants are found to lead to bone loss.

7) Cigarette consumption – for a long period may lead to bone loss by toxic effect on osteoblast cells

Measurement of bone mass

DXA  ( DEXA scan ) is highly accurate X ray technique to measure bone mass ( density) T score of -1 is normal Less upto – 2.5 is suggestive of Osteopenia Less than – 2.5 is considered as Osteoporosis.It is tested in Lumbar vertebrae & neck of femur.

Ultrasound is used for screening for osteoporosis.It detects bone mass by calculating the attenuation of signal as it passes through the bone.

Treatment

Physical activity

Calcium,Vitamin D,Protein supplementation

Bisphophonates – reduce osteoclstic  activity

Calcitonin nasal spray – reduces the osteoclasic activity

Teriparatide injection given subcutaneously for three months, which is a synthetic form of Parathyroid Hormone.Its intermittent use stimulates osteoblast to deposit bone to increase bone mass.

Yoga as a controlled Physical activity- Carefully selected  Yogic Postures offer a safe & easy form of physical activity involving many bones,joints & muscles.

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The modern version of Hippocratic oath says ,I will remember that there is art to Medicine as well as science & that warmth, sympathy & understanding may outweigh the surgeon’s knife or the chemist’s drugs.So as to follow this principle in our clinical practice we need to understand the patient as a whole individual & not by its part or organ which is diseased.More than that the surrounding conditions in which he or she is living should also be considered.

This approach has a lead to the branch of Mind Body Medicine.As we all know emotions affect body structure & function & vice a versa,we need to learn management of emotions & thought process as early as possible in our life.

Science of  Ashtanga Yoga, our ancient wisdom provides us a methodical pathway to avoid the sufferings of future as described by Mahamuni Patanjali,”Heyam Dukhham Anagatam”Homeostasis is the final aim of all our systems to live well,so is Samatva the aim of Yogic science,both being complimentary to each other.So to say that Samatva helps Homeostasis.

Improper lifestyle & psychological stress are the major contributors to the diseases of modern civilisation.Ashtanga Yoga provides a new way of looking at life,so everything remaining the same the person starts feeling better.A method based not on changing the circumstances but on changing our attitude to circumstances is potentially infallible.

Psychoneuroimmunology has provided a solid scientific foundation for mind – body relationship.While stress,anger and hostility or relaxation,peace,love & intimacy may be difficult to measure their effects on cytokines levels or NK cell activity can be quantified.So PNI has acted as a bridge between ancient wisdom & modern science.

Ashtanga Yoga as the name suggests guides us at eight limbs to be remembered & followed for 365 days,24  by 7 hours.First & second are called Yama & Niyama being social & personal disciplinary code which helps at our healthy behaviour.Third is Asana popularly known as Yogic postures which disciplines us at skeletal level but slowly reaching our mind. Fourth limb is Pranayam which teaches us the place,duration,number,depth & subtleness Of our breathing.It constantly reminds us to control our emotions & energy metabolism.It offers us a pathway to reach autonomic responses of our body.Fifth is called Pratyahar which  takes the discipline at sensory inputs.Every sensory input reaches the respective area in cerebral cortex with information relayed to limbic  system.Parts Of limbic system generate emotions which have an impact on our body functions.Pratyahar practice constantly maintains our awareness to optimise our sensory inputs & to observe their effects.This changes our perspective  & attitude to face the circumstances.Sixth limb is Dharana ,called as concentration meditation.This is the practice we observe when we are doing something with keen interest,passion & dedication.This enhances our ability in performance.Seventh is Dhyana,the Meditation state which is to be experienced by an individual with practice.The EEG in meditation shows unaltered alpha rhythm in spite of stimulations by vibration,sound or heat/cold. Eighth is Samadhi state which enlightens us for our existence at energy level.

Ashtanga Yoga offers a potent instrument to deal with commonly observed ailments in life.To name a few….1)  degenerative disorders like Osteoarthritis of knee joint,Spondylosis can be best prevented & palliated with restoration to near normalcy. 2) Acid peptic disorder , habitual constipation & irritable bowel syndrome has good prognosis.3) Anxiety – depression states can have a support for long term care 4)Type II Diabetes mellitus receives a good support by Yogic Postures ,breathing techniques & Pratyahar for glycemic control,5) HPO axis controlling the female life is helped by Yogic approach from perimenarchal to post menopausal phases.5) Coronary artery disease does have an emotional aspect to its presentation which can be attended by Yogic approach.

How much role Ashtanga Yoga has in health and disease depends on what one understands by Yoga and what one expects.If Yoga is viewed comprehensively as a foundation  of peace & joy,it has extensive & potentially all pervasive application S in medicine ranging from primary prevention to care of terminally ill.

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Let us understand its structure.

Knee Joint is made up of three bones. Thigh bone, one leg bone & knee cap. Their surfaces taking part in joint are covered by smooth cartilage. They are nicely bound in a bag like structure (capsule) The Inner lining of this bag produces fluid to reduce friction during movement. The bands (ligaments) surrounding this bag help in mobility & stability of knee joint. Muscles around, move the knee joint into folding & straightening actions. The knee Joint bears 50% of our body weight in upright position, so also our hip joint & ankle joint. Then why knee joint suffers most & no other joints? It is because the bony surfaces forming joint are not matching well with each other.

Let us see how we take care of it. 

1. While standing we have to stand with awareness to bear body weight on both lower limbs equally…..50% + 50% ,not more on one limb
2.  While standing for long time, develop the habit of tightening the knee cap periodically.
3. While walking, try to keep toes in, heels out pattern & not the reverse.
4. While walking, we have to maintain total body awareness, in the form of tummy tuck in, rib cage up, shoulders pulled back & widened, head in line with trunk, gaze parallel to ground. This awareness keeps our weight bearing axis in optimum position.
5. Appropriate foot wear, preferably well-fitting shoes help the knees.
6. Prolonged standing, prolonged walking & sitting (cross legged) may injure the knee joint. We need to optimize our activity.
7.  To delay the wear & tear (Osteoarthritis) of our knee joint, we need to work on the muscles working on it.
8. We have to stretch the calf & hamstring muscles by various techniques 
9. We have to strengthen the front thigh muscle (Quadriceps) To Keep our knee joint healthy & fit by various ways.
10. We need to give sufficient rest to body & mind to help new cell formation (regeneration) 

Let us take care of our dear knee Joint & explore the world!!

Dr Vineeta Ketkar 

MBBS Family Physician 40+ years

8390572626 (whatsapp only)

The post Simple Tips to Save Knees!! Life is Movement! appeared first on Gnosis Medical Yoga - Blog.

Of course it will be of different intensity & in various actions.

But as we know, pain is an indicator of something is wrong somewhere, knee pain gives us hint to pay attention to it & do the needful.( means it expects its servicing)

In fact we should thank the pain & not blame it as a trouble. In case Of Knee pain, If not associated with swelling & other joints ‘ complaints ,it can be reduced by Selective Yogic Postures.

These Postures help to reduce pain & stiffness in the knee joint. Prolonged sitting or standing leads to adaptive shortening of certain muscles in the leg .This also needs correction at hip & ankle joints to mobilize them. This is servicing of knee joint, simple but effective. Selective Yogic Postures offer palliation of symptoms, reducing the need of painkiller medicines. We all know these medicines are injurious to stomach, liver, kidney & bone marrow.

In addition to pain relief, a different set of Selective Yogic Postures are beneficial to delay the wear & tear (degeneration) effects at knee joint. These Postures aim at strengthening of selective muscles .Their sufficient strength keeps the weight bearing axis in balanced position.

So let us respect the signal of knee pain by appropriate action & not bypass it.

After all, Life is Movement & it depends on KNEE FITNESS!

Dr Vineeta Ketkar

8390572626 (whatsapp only)

MBBS Family Physician 40+ years 

Founder Gnosis Medical Yoga Foundation 

www.gnosismedicalyoga.com

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Zero Point

Now to reach Lachung – 8738 ft. the next day. This is once again a stopover to reach Yumthang valley at 12,000 ft. But excitation is further….that is to travel further to reach Zero point- 15,300 ft.  the last civilian reach. Here you view a large panorama of Himalayan Mountains with soft snow everywhere to cater hundreds of tourists!!

Then of course back to Lachung to different destinations in Sikkim or back to Gangtok.

What I experienced is the 5 to 6 hours of daily car travel (all mountain travel……round & round), at times even 10 hours requires lots of patience. But expert, polite drivers, Xylo cars, perfect stops for waterfalls & healthy food ( momos, noodles, rice……piping hot!) make you forget everything.

The walking, climbing is not much! But sufficient strength in your muscles habit of stretching selective muscles, deep breathing techniques taught in Yogic practices surely multiply the pleasure.

Kala Pathar      

Above all the Art Of relaxation, enjoyment but being careful is well taught by Yoga.

GAURI…..Thanks once again!!

Dr Vineeta Ketkar

Visit website- www.gnosismedicalyoga.com

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2) Ganglia & Branches of Vagus

3)  Supply of Vagus

NUCLEI

Are present in Medulla Oblongata (lower most part of Brain Stem)

They are in the vicinity of Dorsal Respiratory nucleus.

1. Nucleus Ambiguus
2. Dorsal nucleus of Vagus
3. . Tractus Solitarius
4.  Upper part of Spinal nucleus of Trigeminal

1. Nucleus Ambiguus- gives rise to Special Visceral Efferent ( SVE) fibres which supply to muscles of pharynx, larynx & soft palate.
2.  Dorsal nucleus- gives rise to General Visceral Efferent (GVE) fibres which supply Para sympathetic innervation to heart, bronchi & gastrointestinal tract. These fibres are preganglionic ending in postganglions situated near viscera or in the walls of viscera. They innervate smooth muscles & glands of viscera.
3.  Nucleus Solitarius – Receives Special Visceral Afferent  (SVA) fibres For Taste from posterior most part of tongue & epiglottis.It also receives General Visceral Afferent (GVA) fibres from pharynx ,larynx, trachea ,thoracic wall, oesophagus & thorasic & abdominal viscera
4. Upper part of Spinal nucleus of Trigeminal – Receives General Somatic Afferent ( GSA) fibres From skin of auricle.

GANGLIA & BRANCHES

1. Superior
2. Inferior

1. Superior ganglion – gives
2. Meningeal branch supplying dura matter in the region,
3. Auricular branch supplying posterior wall & floor  of external acoustic meatus 

• .Inferior ganglion – gives    
• Pharyngeal branch dividing into numerous branches to form a plexus. These supply to muscles of pharynx & soft palate.( The pharyngeal plexus is joined by branches of Glassopharyngeal nerve & branches from Sympathetic trunk)
• Carotid body branches ( responsible for Baroreceptor buffer reflex of arterial pressure)
•  Superior Laryngeal nerve ends by dividing into internal & external laryngeal nerve. Internal laryngeal nerve is sensory, carries the sensory signals from posteriormost part of tongue, pharynx, epiglottis & mucus membrane of upper part of larynx.( upto vocal folds)External laryngeal nerve is motor supplies crick thyroid muscle.
• Recurrent laryngeal nerve course is different on right & left side. It has sensory & motor fibres. Sensory fibres supply to lower half of larynx, trachea, oesophagus. It gives branches to cardiac plexus. Motor fibres supply to all intrinsic muscles of larynx ( except cricothyroid)

Cardiac branches– Each Vagus nerve gives one or more Superior  Cervical Cardiac branch( in upper neck),Inferior Cervical Cardiac branch ( in lower neck),additional branches from its mediastinal part & from Recurrent laryngeal…..all together end in superficial & deep Cardiac plexus.

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Vagus means *wandering*. The name suggests that it has a long wandering journey for its supply, reaching abdominal cavity.

Vagus nerve carries 75 % of Parasympathetic fibers. Parasympathetic system is the branch of Autonomic nervous system. As the name shows, this systemic is not under our will or wish. It works when we rest & are peaceful. Its function is vital for repair, regeneration & energy conservation.

Science of Yoga has deep understanding of this nerve. It gives us many techniques to reach this nerve. Vagus nerve stimulation will benefit us for healing & health. Today’s era, where sympathetic system is overworking due to persistent stressful situation, it is vitally important to learn these techniques to balance both systems.

(Sympathetic system works for * flight, fight, fright* response)

Let us study this nerve under three headings….

1) Anatomy

2) Physiology

3) Medico Yogic Correlation

Dr Ketkar

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 But still it needs attention, as when it comes to health, someone may get confused as to which path to walk.

Gym workout involves a meticulous study of skeletal muscles & various gadgets to increase the strength & endurance of them .It also pays attention to cardiac fitness by slowly increasing the heart rate in a span of 6 to 8 weeks so that the left ventricular muscles increase in number to increase the stroke volume. This later on reduces the increase in heart rate, which is called cardiac fitness. Gym workout is called Training as it leads to slow & sustained changes in Physiology. This involves multiple endocrine glands to maintain the Homeostasis .For example…release of endorphins, growth hormone, antidiuretic hormone, aldosterone, prolactin etc. Thus initially the body looks at exercise as a stress leading to stress response which slowly gets converted to training effect.

Gym workout thus has a definite role in body build up & fitness. Yoga on other hand is an ancient science which has its roots from Pre Vedic period, Vedic period, Upanishadas & Bhagvatgeeta. It is compounded by Mahamuni Patanjali as Patanjal Sutras (196) about 500 years BC. He has called the Yogic Technique as Ashtang Yoga. This pathway of eight limbs namely Yama, Niyam, Asan, Pranayam, Pratyahar, Dharana, Dhyana & Samadhi teaches us to practice the discipline. This discipline is aimed at self-control of body, sense organs, mind & thought process. It proves an invaluable companion to face the changes & challenges of life.

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