When it comes to concussions, oftentimes people are tricked into thinking that the symptoms and signs they experience are only temporary, since some of the more common ones aren’t necessarily considered severe. But this isn’t always true, and we’ll hear first-hand from Harriet Owen how brushing symptoms off, even after the smallest of head injuries, can be extremely detrimental in the scheme of recovery.

Concussion Symptoms, Signs, and Grades

This mild to severe system of recognition manifests in the existence of ‘grades’ that concussions can be classified by. While there is usually only one diagnosis of “yes, you have a concussion” or “no, you’re clear,” sometimes, a diagnosis can be furthered into 5 grades that build off of each other.

1. Grade 0: A slight headache and perhaps some difficulty concentrating.
2. Grade 1: A dazed or confused feeling for less than a minute.
3. Grade 2: Cloudy, dazed, or confused senses that last longer than a minute, dizziness, amnesia, ringing in the ears, irritability
4. Grade 3: Becoming unconscious for less than a minute
5. Grade 4: Becoming unconscious for more than a minute

These aren’t the only symptoms of a concussion, though, and when it comes to the full list of signs of a concussion, the CDC categorizes them into 2 groups: observed and reported.

Observed symptoms are usually picked up externally, by outsiders who are watching the individual. This might include parents, teammates, coaches, friends, romantic partners, doctors, or trainers. It’s important to make note of head injuries so that if these signs do start appearing, then proper treatment can be sought and the injury isn’t left to become worse.

Observed Signs of Concussion:

• Can’t recall events prior to or after a hit or fall
• Appears dazed or stunned
• Forgets an instruction, is confused about an assignment or position, or is unsure of the game, score, or opponent
• Moves clumsily
• Answers questions slowly
• Loses consciousness (even briefly)
• Shows mood, behavior, or personality changes

Reported symptoms are the opposite – they usually don’t have any outward evidence (although some of them might), and it’s the individual that recognizes the change or feeling and then let’s someone else know.

Reported Signs of Concussion:

• Headache or “pressure” in head
• Nausea or vomiting
• Balance problems or dizziness, or double or blurry vision
• Bothered by light or noise
• Feeling sluggish, hazy, foggy, or groggy
• Confusion, or concentration or memory problems
• Just not “feeling right,” or “feeling down”

No matter how mild the concussion is, a checkup with a medical professional should be sought out, because brain injuries can be very dangerous, if given the chance.

Harriet Owen’s Growing Concussion Symptoms

Harriet’s specific symptoms provide a great example of what can happen if concussions are not taken seriously by individuals and the doctors that provide them care – what could have been a short recovery time snowballed into a 15 month period of pain, confusion, and misdirection.

Harriet describes the initial crash and subsequent signs as, “I knew almost immediately I’d hit my head, my helmet was scuffed and I had a bit of a headache, but I didn’t think it would have caused me a sustained concussion.”

This is why concussions are such slippery conditions – if it’s just a headache, it really doesn’t seem like anything to have to go to the doctor for. But even Grade 4 concussions can start out with symptoms of a Grade 0 concussion. Within a few days, that one small, unassuming headache didn’t go away and continued to become worse, and that’s when Harriet realized that something was wrong.

Her next problem? Her doctors didn’t. She was prescribed over the counter painkillers and more sleep, but no neurological or imaging tests were performed, even after persistent pain. Harriet began to experience more severe symptoms as time went on, with the reported worst being:

• Fatigue

Even the smallest tasks drained her, and that led to more time inside, in dark rooms, and unable to do the things she loved. This contributed to the worsening of other symptoms such as depression and physical activity difficulties.

• Headaches

What started as a small symptom quickly turned unbearable. This led to light sensitivity and contributed to a lack of concentration and memory from the constant pain.

• Personality Changes

Without the ability to cycle and complete daily tasks without pain and other side effects, the pain combined with the fact that her brain couldn’t regulate her emotions as well as it had been caused personality changes in the form of depression, mood swings, and reactive behavior.

She says that, “…my change in personality really impacted everyone around me the most. I wasn’t myself; they didn’t know how I was going to react or be each day, and they didn’t know how to help me.”

• Lack of Concentration and Memory

Even as a professional cyclist, Harriet still has a full-time job as a data-analyst for Trek Bicycle Corporation, which involves a lot of screen time. The light from the screen triggered headaches and the work caused mental fatigue, even when she already felt that she couldn’t function at 100% due to her lack of concentration and memory, and that was demoralizing.

• Difficulties Participating in Physical Activity

Cycling is Harriet’s passion and her profession, so slowly becoming unable to ride at all became a dark spot in her life, and this big change in her life greatly affected her mental health.

She says, “Cycling for me during this time, was mostly non-existent or very inconsistent. If I ever did ride, it would be no longer than an hour at a lower heart rate, and my body would play catch-up, and I’d pay for it a couple of days later. It wasn’t healthy for me to keep being in this vicious cycle, so there was a long period of time that I just couldn’t ride. It affected me mentally, as well as physically, I lost a lot of muscle mass!”

When asked which symptoms impacted her daily life the most, Harriet quoted headaches, fatigue, and personality changes. But the shift from cycling every single day to barely being able to do an hour of low-heart rate exercises exacerbated her condition and the side effects that came along with it, and the initial habits she formed when she hadn’t gotten a concussion diagnosis ultimately hurt her recovery.

Concussions Are All Around

Especially in athletes, concussions are a likelihood of every head injury obtained. We’ve heard from a professional just how easy it is to brush off the burgeoning symptoms, and how that can play a part in the recovery process.

Even if you don’t encounter concussive accidents much in your sport, it’s still a big risk! As a cyclist, Harriet didn’t believe that concussions were all that common in cycling, but once she deliberated further, she realized that a cyclist hits their head more often than not when they crash their bike, which is just a part of the sport.

Helmets and other head safety gear provide some protection, but concussions occur internally. So, while your head might still be intact thanks to the helmet, your brain doesn’t have the same stability, and is very susceptible to injury and, subsequently, the side effects.

No element of a concussion is enjoyable, but the worst part, according to Harriet, is that, “Life as you know it is taken away from you the moment you hit your head. People can’t see the injury, so it’s hard to anyone to understand what you’re going through. It is a real mental battle to get back.”

What to Do If You Have a Concussion

Don’t let a concussion trip you up or slow you down! Get help and a diagnosis as soon as you recognize any sign or symptom of even a mild concussion. If caught early, no matter the grade, treatment and recovery time will be far less intense and the toll on your body far less severe.

In the third and final installment of this blog series, we’ll explore the extensive and innovative treatment that Harriet went through to get back to her best form, and what she might have done differently if she had known that she would end up with sustained concussion.

If you or someone you love has suffered a concussion or head injury in the Louisville, Kentucky area, board-certified sports medicine physician Dr. Stacie Grossfeld at Orthopaedic Specialists PLLC can help. Orthopaedic Specialists PLLC is accepting new patients, and same day appointments are available. For additional information or to schedule an appointment, please contact Orthopaedic Specialists PLLC today at 502-212-2663.

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While commonly connected to those who have served in the military, post-traumatic stress disorder or PTSD, can impact anyone who has suffered from violence or emotional trauma. The National Institute of Mental Health defines PTSD this way, “Post-traumatic stress disorder (PTSD) can develop after exposure to a potentially traumatic event that is beyond a typical stressor.” According to the U.S. Department of Veterans Affairs approximately 12 million adults in the U.S. suffer from PTSD during a given year. 

Research has shown that acupuncture for PTSD reduces anxiety and stress levels. Acupuncture is also a great treatment option for those suffering from other health issues because of PTSD (i.e., insomnia, digestive issues, headaches, stress and anxiety, etc.). 

How it Works

Typically, acupuncture treatment for PTSD will focus on specific auricular points that focus on different areas of the brain. Some address the emotions, memories, or even amnesia. When the acupuncturist needles that point, the patient can find relief from symptoms. 

Perhaps a surprising reason acupuncture for PTSD is so popular is that it allows the person suffering from the trauma to receive help without having to go into detail about the cause of the trauma. While a full medical health history is taken, not having to relive the trauma helps patients to feel safe and perhaps a bit more relaxed.

One of the most complicated components of dealing with the treatment of PTSD is also reigning in the symptoms that result from it including depression, anxiety, sleep disorders, chronic pain, and other mental health concerns, just to name a few. The good news is that acupuncture has a proven track record of success in treating these issues. 

Each person with PTSD is different, however, depression and anxiety are often present, and both can manifest in physical and emotional symptoms. This is often an indication of an imbalance of Chi in the body. Chi is defined as the body’s energy pathways flowing through channels in the body called meridians. When Chi is balanced and flowing through the meridian network, our bodies operate optimally. When Chi isn’t balanced, depression, anxiety, loss of appetite, high blood pressure, and even digestive issues can be present. 

Many people who suffer from PTSD also have insomnia or other sleep issues. Acupuncture has also been proven to increase serotonin levels which helps to improve sleep as well as mood. It’s an effective drug-free treatment without the side effects often caused by prescription medications. A study from 2015 found “chronic fatigue patients who were given acupuncture as a supplement to conventional treatment showed greater improvement over patients who did not receive acupuncture.”

Chronic pain is often another complaint of those with PTSD and it can be debilitating for those suffering from it as it directly impacts their quality of life. People often treat chronic pain with anti-inflammatory medications (both prescription and over the counter), physical therapy, or with ice and heat, but those options don’t always provide long lasting relief. According to Harvard Medical School, “acupuncture is an option with a good track record that’s worth considering.” 

Whether you suffer from PTSD or any of the associated symptoms, acupuncture is an excellent prescription drug-free treatment option to help address a variety of health concerns. Even if you are looking to achieve better overall balance in your life, consistent acupuncture treatments just might be the solution you need. Make an appointment with your acupuncturist today. Your practitioner will do a thorough health history in order to get to the bottom of the symptoms. Call today and get your wellness journey back on track! 

Acupuncture Helps with PTSD Symptoms was last modified: November 28th, 2022 by admin

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In this blog, we will explain the findings of our recent review published in BJSM on the potential role of intratendinous pressure in the pathogenesis of tendon pathology. 

Why is this study important?

Tendinopathy is a major problem for athletes, accounting for about 30% of all overuse injuries. Despite strong advances in tendon research in recent decades, there is still a limited understanding of the underlying pathogenesis. The role of tissue pressure has not yet been considered a possible factor, although it has been associated with numerous other pathologies. 

How did the study go about this?

This narrative review article encompassed an extensive literature search on four main aspects: 

(1) the current understanding of intratendinous pressure in normal conditions 

(2) the role of tissue pressure in the pathogenesis of other disorders that share structural similarities with tendons

(3) the relationship between compressive overload and tendon structure

(4) how structural changes in tendon pathology might alter intratendinous pressure

What did the study find?

• First, a conceptual framework was established defining five possible steps how intratendinous pressure could be involved in the development and progression of tendon pathology.

• Compressive overload as pathogenic stimulus 

It was found that compressive overload might be an initial trigger in the development of tendon pathology. 

• (Mal)adaptive tendon matrix remodeling 

As tendon cells have the ability to detect and adapt to mechanical stimuli, overexpression of fibrocartilage-like tissue occurs as a result of compressive overload. This maladaptive remodelling is characterized by an increase of glycosaminoglycans (polysaccharides), proteoglycans (proteins), enlarged tenocytes and collagen type II and III.

• Volume expansion induces an increase in intratendinous resting pressure

Every structure in our human body has a stable total tissue pressure of less than 15 mm Hg. This pressure is the sum of solid stress, ie, cells and extracellular matrix and interstitial fluid pressure, ie, free fluid. Pathological tendon changes, particularly the increase of glycosaminoglycans and proteoglycans with their bound fluid, could lead to an increase in intratendinous resting pressure, as the associated volume increase is resisted by enclosed sheaths (ie, endo- or epitenon).

• Increased intratendinous resting pressure impairs vascularisation

It is suggested that hypoxia (low oxygen levels) is a feature of tendon pathology. An increase in intratendinous resting pressure might drive this, as it could impair blood supply by inducing vascular collapse and lowering the arteriovenous pressure gradient. In addition, leakage of hypoxia-induced neovessels could also further increase interstitial fluid pressure, creating a vicious cycle.

• Reduced permeability induces an increase in intratendinous dynamic pressure 

Tendons experience lateral contraction during tensile loading, generating intratendinous dynamic pressure and consequently fluid excretion. This fluid pressure increases sharply when the permeability of the extracellular matrix decreases, because of higher resistance to fluid flow. Such a decrease in permeability typically occurs in tendon pathology due to the increase of water-retaining glycosaminoglycans and proteoglycans. Fluid can therefore be trapped inside the tendon matrix during tensile loading, resulting in an increase in intratendinous dynamic pressure. This also implies that for the same amount of tensile load, tendon cells will experience more pressure in tendon pathology than in healthy tendons, which again could create a vicious cycle. 

• Second, it was identified how our novel theory might fit into the recognised continuum model of tendinopathy and correlate with its typical clinical manifestations (eg, load-related tendon pain). 
• Third, potential treatment strategies were discovered that could restore intratendinous pressure to promote tendon healing. On the one hand, maladaptive tendon remodeling must be addressed. This can be done by reducing the amount of compressive load, but still exerting sufficient tensile forces on the tendon during rehabilitation. On the other hand, hyaluronidase also seems promising, as it breaks down the excess glycosaminoglycans of the extracellular matrix to pre-injury levels, releasing bound fluid and reducing both intratendinous resting and dynamic pressure.

What are the key take-home points?

• Intratendinous pressure might be an important contributor in tendinopathy. Our conceptual framework provides a coherent view of how intratendinous pressure could be involved in the development and progression of tendon pathology and helps to identify unexplored research opportunities.
• Maladaptive remodeling into fibrocartilage-like tissue could lead to both an increase in intratendinous resting and dynamic pressure, due to excess water-binding glycosaminoglycans and proteoglycans.
• An increase in intratendinous resting pressure could explain hypoxia in tendon pathology. 
• An increase in intratendinous dynamic pressure might explain load-related tendon pain.
• Therapies aimed at inhibiting maladaptive remodeling (eg, modified physiotherapy) or reducing intratendinous pressure (eg, hyaluronidase) seem promising therapies that should be investigated. 

Corresponding author: 

Dr. Lauren Pringels, Department of Physical and Rehabilitation Medicine, Ghent University Hospital, Ghent, Belgium; [email protected]

Reference:

Pringels L, Cook JL, Witvrouw E, et al. Exploring the role of intratendinous pressure in the pathogenesis of tendon pathology: a narrative review and conceptual framework. British Journal of Sports Medicine Published Online First: 02 November 2022. doi: 10.1136/bjsports-2022-106066

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Home gyms are a great way to stay fit without the commitment and expense of joining a gym or going elsewhere every day. You can have everything you need right in your house by choosing the right equipment. But before you buy anything, there are some things you should know about all the options available and how they could impact your goals—and wallet!

Consider Your Space

If you plan to invest in a home gym, you’ll want to ensure that it fits into the space available in your house. It’s important to consider how much room there is for moving around and where exactly you will store all the equipment. Consider how much space it will take up when folded or disassembled and how easy it is to set up and take down. Some models come with storage systems, so they can be tucked away when not in use, but most will need a separate area for storage.

If you have limited space, you may consider a smaller model or one you can fold away. You’ll also need to consider how many people you plan on using your home gym with —if you’re planning on using it for yourself and your family, then a smaller model will probably be sufficient. If you plan on having friends and family over or training for an athletic event, you’ll want to get something large enough to accommodate everyone who intends to use it.

Think About Your Goals

What do you want to achieve? Are your fitness goals primarily aesthetic? Or do they involve gaining muscle and losing fat? Perhaps you’re aiming for an athletic body or a more functional physique that can handle all sorts of activities. Maybe it’s just a matter of being able to work out at home rather than driving somewhere every time you want to lift weights or jog on a treadmill.

Whatever the case, considering these questions will help get things off on the right foot when shopping for home gym equipment. You’ll be able to find an option that fits into your budget while still meeting all of your needs—and then maybe even exceeding them!

Budget

Your budget for your home gym equipment should be considered a guide, not a restriction. The best thing about having a home gym is that you can start small and add equipment as needed (or desired). Set aside enough money to cover the essentials, but don’t let the budget become an overbearing factor in your decision-making process. It’s more important to make sure that what you buy fits your fitness goals than spend hundreds of dollars on things that will remain unused because they’re too expensive or unnecessary.

The best way to ensure you don’t overspend is to list what you need and prioritize it. Your budget should be determined by the most critical items on that list, not by how much money is left over after everyone else gets what they want. If you start small with just one or two pieces of equipment and then build up from there as needed, your home gym will evolve like any other part of your fitness routine.

Is It Portable?

Another important consideration is how easy it is to move the equipment around. Ideally, you want to be able to reposition your home gym equipment quickly and easily. This will be essential in their selection process for people with limited space. This may not be much of an issue if you have a big garage or basement. You can leave your equipment in place if you want and move it out of the way when it’s not in use. The key is ensuring that your gym equipment is easy to assemble and disassemble so that moving it around will be a simple process.

When considering portability and ease of assembly/disassembly, remember that most machines weigh over 100 pounds (45 kg) and have several parts you must put together before using them for the first time. So, if multiple people are involved in this process, then consider whether or not having extra hands makes the job easier for everyone involved! Also, note how long each step takes so there aren’t any surprises later on down the road.

Prioritize Multi-Functional Equipment

If you’re looking for the best home gym equipment and want to save money, look for multi-functional exercise machines. For example, if you’re trying to decide between a Bowflex or an elliptical machine, the Bowflex may be the better choice because it offers more options for exercises and can work for both men and women.

Multi-functionality will help you get away with fewer pieces of equipment if space is at a premium in your home gym. Multi-functionality can also keep boredom at bay by giving you more variety when working out at home—and that’s important if you stick with working out! It might seem like having several different pieces of equipment would lead to confusion about which ones to use for what purpose, but once you set them up correctly, it shouldn’t be hard to remember how they work together effectively.

Finally: don’t forget that getting injured while exercising is never fun! Having multiple types of equipment available will allow people who may not feel comfortable using a kind in particular access other ways without sacrificing progress toward fitness goals because their joints aren’t up for specific movements.

Buy Quality and Ergonomic Equipment

When it comes to the best home gym equipment, you must look at the quality. The better the quality of your equipment, the longer it will serve you and make your workouts more comfortable. It’s wise to spend money on things that will last when purchasing equipment for your home gym.

You want to ensure that whatever item you buy is well-made and durable so it can withstand continuous use over time without breaking down or wearing out. It should also be ergonomic because it helps with comfort during exercise sessions, making them more fun!

Choose Equipment That Can Grow With You

Choosing the right home gym equipment will help you get the most out of your workouts. The best way to select equipment that can grow with you is by starting small and then building up from there. Beginners, intermediate and advanced athletes all need different types of home gym equipment, so it’s essential to know which type you will need as you progress in your fitness journey.

Choosing the right type of home gym equipment for where you are now can make it much easier for you to grow into more advanced exercises when it comes time for those extra heavy-duty workouts. Choosing adjustable items to fit different body sizes and shapes.

Conclusion

Whether you’re a professional athlete, weekend warrior, or want to get in shape, choosing the right sports equipment is the best way to stay fit in the comfort of your home. What you need in a home gym is personal, so choose equipment based on what will best support your goals and needs.

For example, if you need help with balance training, look for products that can provide stability while working out. To improve cardiovascular health, look for equipment for high-intensity workouts without sacrificing your joints or muscles during exercise.

Contact any of our Foothills Sports Medicine Physical Therapy clinics if you need help choosing sports equipment or assistance with your home workouts. We can advise what gear works best for particular goals, and we’ll help you develop a routine that will keep you healthy and happy.

If you are interested in personal or sports performance training with customized workouts tailored to all fitness levels and abilities, we have several FAST Performance Training locations throughout the valley. FAST trainers have the experience, education, and expertise to get you up and on your way to achieving your fitness goals—FAST!

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Injury prevention exercise programmes (IPEPs) efficaciously prevent injuries, but studies show challenges related to low adherence with IPEPs [1-3]. Irrespective of the IPEPs’ efficacy in preventing injuries, the programmes also need to be feasible in a real-world context outside the well-organised randomised controlled trial to be able to prevent injuries effectively. 

The main intervention in this randomised trial was extended Knee Control which was a further developed version of the original Knee Control programme from 2005. Knee Control has previously shown efficacy in preventing injuries in youth female football [4], youth male and female floorball [5], and youth male and female handball [6]. Earlier studies on Knee Control showed that coaches often modify programme content and/or dosage to work around barriers for programme use [1-2]. To improve programme feasibility and adherence, in extended Knee Control we added five extra exercise variations/progressions for each of the six main exercises in Knee Control to fit young as well as senior players. We also tried to make recommendations for programme use easier and more flexible. 

How did the study go about this? 

We conducted a study in one regional football district in Sweden in 2020, where teams were randomised to use extended Knee Control or an adductor strength programme. Teams who already used an IPEP on a regular basis took part in a non-randomised comparison group. In total, 502 male and female players (mean age 20.0±5.7 years) were included. Players responded to weekly questionnaires about occurrence of injury based on the Oslo Sports Trauma Research Center questionnaire, and their exposure to training and matches. 

Teams using extended Knee Control were recommended to use the programme on every training session for 15-20 minutes, 30-60 seconds per exercise and two sets. The adductor strength programme exercises and dosage were initially identical to the Adductor Strengthening Programme that has shown positive effects on groin injury rates in male sub-elite players     [7]. However, due to the COVID-19 pandemic we added two extra single-player exercises to avoid close contact, adductor squeeze with bent and with straight legs [8]. 

What did the study find?

We found 29% lower incidence of injuries to the hamstring, knee and ankle in extended Knee Control compared to the comparison group (Figure 1). To prevent one injury in the hamstring, knee or ankle, seven players would have to perform extended Knee Control during one season. We also saw 42-48% lower incidence of time-loss injuries in extended Knee Control compared to the other two groups.

Figure 1.  Injury incidence rates (IR) and 95% confidence intervals

We found 17-26% lower hamstring, knee and ankle injury prevalence rates in extended Knee Control compared to the adductor and comparison group respectively (Figure 2). Prevalence of substantial injuries was 27 and 25% lower in extended Knee Control compared to the adductor and comparison group respectively. No preventive effect was seen on groin injury rates from the adductor programme. 

Figure 2. Weekly injury prevalence rates (PR) and 95% confidence intervals

What are the key take-home points

The extended Knee Control group had a lower rate of injuries to the hamstring, knee and ankle combined, time-loss and substantial injuries as compared to the adductor and comparison group. The results are particularly interesting considering that the comparison group may already have had a relatively speaking low injury risk from having used preventive exercises on a regular basis at least the previous season. No effect was seen from the adductor programme but this group was smaller than the other groups and particularly included few male players, rendering low power.

References

1. Lindblom H, Waldén M, Carlfjord S, et al. Implementation of a neuromuscular training programme in female adolescent football: 3-year follow-up study after a randomised controlled trial. Br J Sports Med 2014;48:1425-30. 
2. Lindblom H, Carlfjord S, Hägglund M. Adoption and use of an injury prevention exercise program in female football: A qualitative study among coaches. Scand J Med Sci Sports 2018;28:1295-1303. 
3. O’Brien J, Young W, Finch CF. The delivery of injury prevention exercise programmes in professional youth soccer: Comparison to the FIFA 11+. J Sci Med Sport 2017;20:26-31. 
4. Waldén M, Atroshi I, Magnusson H, et al. Prevention of acute knee injuries in adolescent female football players: cluster randomised controlled trial. BMJ 2012;344:e3042.
5. Åkerlund I, Waldén M, Sonesson S, et al. Forty-five percent lower acute injury incidence but no effect on overuse injury prevalence in youth floorball players (aged 12-17 years) who used an injury prevention exercise programme: two-armed parallel-group cluster randomised controlled trial. Br J Sports Med 2020:54;1028-35.
6. Asker M, Hägglund M, Waldén M, et al. The effect of shoulder and knee exercise programmes on the risk of shoulder and knee injuries in adolescent elite handball players: A three-armed cluster randomised controlled trial. Sports Med Open 2022;8:91.
7. Harøy J, Clarsen B, Wiger EG, et al. The Adductor Strengthening Programme prevents groin problems among male football players: a cluster-randomised controlled trial. Br J Sports Med 2019;53:150-7.
8. Hölmich P, Larsen K, Krogsgaard K, et al. Exercise program for prevention of groin pain in football players: a cluster-randomized trial. Scand J Med Sci Sports 2010;20:814-21. 

Authors and affiliations

Hanna Lindblom(1, 2), Sofi Sonesson(1,2), Kalle Torvaldsson(1,2), Markus Waldén(2,3), Martin Hägglund(1,2)  

1. Department of Health, Medicine and Caring Sciences, Unit of Physiotherapy, Linköping University, Linköping, Sweden

2. Sport Without Injury ProgrammE (SWIPE) Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden

3. GHP Ortho & Spine Center Skåne, Malmö, Sweden

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Many of these athletes rely on the Emory Soccer Medicine Program, where a dedicated group of physicians, physical therapists, athletic trainers and sports scientists focus on keeping soccer players safe from injury and playing at their highest level.

Orthopaedic surgeon Mathew Pombo, MD, began the program in 2013 and currently acts as its director. A lifelong soccer player, Dr. Pombo is a renowned expert on soccer injury prevention and treatment and serves as a team physician for the U.S. Soccer Federation. Here, he shares his perspective on what sets Emory’s program apart and how it benefits local athletes, parents and coaches who love the game.

What Is the Emory Soccer Medicine Program?

The Soccer Medicine Program offers comprehensive injury prevention and specialty care for soccer players—young children, professional athletes and anyone in between.

Our physicians and physical therapists provide patient care at three Emory locations—Brookhaven, Dunwoody and Johns Creek. And our athletic trainers cover games for many local high schools and local clubs. We provide resources to coaches and parents who want to learn more about injury prevention, treatment and return-to-play guidelines. And we lead research studies to explore new treatments and injury prevention strategies, sometimes presenting our findings at national and international conferences.

Why Are You and Your Team Passionate about Caring for Soccer Players?

All of us have played soccer and follow the sport at the national and international levels. I started playing when I was three years old, and as a teenager, I trained on a U.S. Youth Soccer Olympic Development Team. I played in college until I experienced multiple anterior cruciate ligament (ACL) injuries.

When I came to Emory after my orthopaedic sports medicine and shoulder fellowship, I began putting together a group of specialists who shared my passion for soccer medicine. The Soccer Medicine Program is part of the Emory Sports Medicine Center and the only program of its kind in the region.

Every Soccer Medicine Program team member at Emory has earned a football medicine diploma from the International Federation of Association Football (FIFA), which signifies our expertise in soccer injury prevention and treatment. My colleagues and I see a big gap between what elite athletes and recreational players do to avoid injuries. We aim to close that gap and provide the highest level of care possible so local soccer players can enjoy the game, improve their skills and not miss any playing time due to injury.

What Type of Injury Risks Do Soccer Players Face?

A soccer player’s risk of injury varies depending on their age, gender and even the position they play. For example, the number one injury we see in players aged 12 and under is an arm fracture. That’s because these kids haven’t learned how to fall correctly yet. In older kids, you see a lot of lower extremity injuries—ACL tears and ankle sprains—that can keep them out of the game for a long time. College players, who typically play many more games than recreational athletes, need to focus on strength training to avoid wear-and-tear injuries.

Treatment plans vary, too. If I’m treating a 10-year-old with a long bone fracture, I need to protect their growth plates—the area of tissue near the ends of their bones that determine the bone’s future length and shape. If I’m surgically replacing a torn ACL with a graft (tendon), I need to use a different type of graft for a goalie than I would for a halfback or forward.

We Hear a Lot about ACL Injuries in Soccer Players. Are Those Preventable?

The most common ACL injury in soccer is “non-contact.” The injury isn’t caused by a collision with another player but by landing awkwardly after a jump, changing direction suddenly while running, or something similar.

A focused conditioning and warm-up program can help prevent two out of three ACL injuries. Our team offers resources for coaches who want to incorporate these programs into their practices and pre-game routines.

How Do You Help Players Return to the Field After an Injury?

The risk of reinjury is very high for soccer players who are out for two weeks or more. Research suggests they are at higher risk for any injury, including a concussion, a broken bone or an ACL tear. So it’s essential that injured players build up their endurance and strength before returning to play full out.

We focus on a controlled return to play with our injured athletes. Every athlete receives a personalized rehabilitation plan that includes exercise, nutrition and, if needed, sports psychology. During the rehabilitation phase, one of our physicians monitors their progress and guides them on returning to a high fitness level so they can get back to the field safely. Our providers work together to ensure each athlete has the support they need.

What Resources Do You Offer for Coaches?

We partner with coaches at every level of play who are interested in injury prevention and care. Our athletic trainers provide one-on-one education and do group presentations for coaches in the community. They also exchange cell numbers with coaches, so it’s easy to stay in touch. We want to be the first call coaches make when a soccer player goes down with an injury.

Every summer, we host a Soccer Medicine Conference for coaches and soccer club directors here in Atlanta. We give presentations on topics such as “the emergency evaluation of the downed athlete” and “concussion in soccer.” In 2022, we opened the conference to parents and got a great response. You can find several of our presentations on our website.

or call 678-506-8974, or complete the appointment form to schedule an appointment with our sports medicine team. Patient appointments are often available within 48 hours.

The post The Emory Soccer Medicine Program Offers Specialized Prevention and Treatment for Soccer Players of All Ages appeared first on Advancing Your Health.

The post Management after acute injury of the anterior cruciate ligament (ACL), part 2: management of the ACL-injured patient appeared first on Sports Medicine Research.

The Orthopedic & Sports Medicine Center of Oregon is an award-winning, board-certified orthopedic group located in downtown Portland Oregon. We utilize both surgical and nonsurgical means to treat musculoskeletal trauma, spine diseases, sports injuries, degenerative diseases, infections, tumors and congenital disorders.

Our mission is to return our patients back to pain-free mobility and full strength as quickly and painlessly as possible using both surgical and non-surgical orthopedic procedures.

Our expert physicians provide leading-edge, comprehensive care in the diagnosis and treatment of orthopedic conditions, including total joint replacement and sports medicine. We apply the latest state-of-the-art techniques in order to return our patients to their active lifestyle.

If you’re looking for compassionate, expert orthopedic surgeons in Portland Oregon, contact OSM today.

Phone:
503-224-8399

Address
1515 NW 18th Ave, 3rd Floor
Portland, OR 97209

Hours
Monday–Friday
8:00am – 4:30pm

The post 6 Ways to Ruin Your Knees appeared first on Orthopedic & Sports Medicine.

Meniscus tears are particularly common among athletes due to the repetitive twisting motions they perform while playing their sport. This type of injury can often be seen in high-intensity sports like soccer, basketball, and football. In fact, according to some studies, up to 50 percent of all sports-related knee injuries involve a meniscus tear.

If you suffer from this kind of injury, it’s important for you to contact a meniscal injury clinic and speak to a doctor as soon as possible. An MRI or X-ray can help confirm the diagnosis and allow your doctor to recommend an appropriate treatment.

What Does a Meniscus Tear Feel Like?

If you have a meniscus tear, it is likely that your knee will be painful, swollen, and tender to the touch. You may also have difficulty bending or straightening your knee joint, as well as a feeling of instability when walking or running. Sometimes, you may even hear a clicking or popping sound within the joint.

A meniscus tear can range in severity depending on the location and size of the tear. Some small tears may heal over time with rest and physical therapy, while larger tears may require surgery to repair the damage. The treatment plan for a torn meniscus will depend on age, activity level, and overall health factors.

What’s the Treatment for a Meniscus Tear?

There are a variety of treatments available for a meniscus tear. Non-surgical, regenerative medical treatments include physical therapy, rest, and over-the-counter medications such as ibuprofen or acetaminophen to reduce pain and inflammation. 

Ultrasound diagnostics, platelet-rich plasma (PRP) injections, and stem cell therapy are some of the more advanced regenerative treatments used to help heal a meniscal tear.

Ultrasound Diagnostics: Ultrasound technology is used to detect the location and extent of the tear. This helps guide physical therapy and other treatments for meniscal injury, effectively targeting the area to promote healing. Ultrasound is a non-invasive way of assessing the extent of damage more precisely and can also determine whether surgery is required.

Platelet-Rich Plasma (PRP) Injections: PRP uses a concentrated form of the patient’s blood to stimulate healing. It is a natural therapy that injects the patient’s healing factors into the injured area. The injection can stimulate new cell growth and reduce inflammation, helping the torn meniscus to heal faster than with physical therapy alone.

Stem Cell Therapy: Stem Cell therapy is a cutting-edge treatment option for meniscal tears. The stem cells are harvested from the patient’s body and then injected into the damaged area to help promote healing. Injecting new, healthy cells into the injured area can accelerate healing and reduce inflammation. Stem cell therapy is also a minimally invasive procedure, making it a desirable option for those seeking effective alternatives to traditional surgery.

Surgery may be necessary if non-surgical treatments are unsuccessful or the tear is large and complex. Surgical treatments for a torn meniscus often involve arthroscopic surgery, a procedure in which a surgeon will make several small incisions in the skin around the knee joint. They then insert instruments and cameras through these openings to view and repair the damaged tissue inside the joint. Depending on the size and location of the tear, they may be able to repair it by stitching it back together. In some cases, the tear may be too large or complex to repair, and the surgeon will need to remove the torn piece of cartilage.

When Will My Knee Feel Better?

Recovery from a meniscus tear typically takes several weeks. Doctors at a meniscal injury clinic will likely recommend rest, ice, and physical therapy to help manage pain and swelling. They may also prescribe medications such as anti-inflammatories or corticosteroids to further reduce inflammation and relieve symptoms. As you progress through your rehabilitation program, strength, flexibility, and range of motion should gradually improve in the affected knee.

Following your doctor’s instructions during your recovery period is essential to ensure that your injury heals properly and does not worsen over time. If you experience any persistent pain or discomfort in your knee joint, let them know immediately so they can adjust treatment accordingly. With appropriate care and treatment, most people can expect their knee pain to improve over time and return to normal activity levels.

How Can I Prevent a Meniscus Tear?

To prevent a meniscus tear, it is important to take steps to protect your knee joint. This includes wearing appropriate footwear and protective gear when engaging in physical activity and sports. Additionally, you should incorporate strengthening exercises into your routines, such as squats, lunges, and leg presses, which can help build the muscles that support and stabilize the knee joint. If you experience pain or discomfort while exercising, stop immediately and seek medical attention if necessary.

Proper warm-up exercises before any physical activity can also help reduce the risk of injury. These simple precautions will help ensure your knee stays healthy and strong for many years.

Conclusion

A meniscus injury can be a painful and debilitating injury, but with proper education and preventive measures, it doesn’t have to be. By understanding the mechanics of your knee joint and how to care for it properly, you can help reduce your risk of developing a meniscus tear or other injury. Additionally, incorporating strengthening exercises into your routine will help support the knee joint, making it less susceptible to injury. Taking the time to learn about and protect your knee joint can help ensure long-term health and mobility. 

If you are looking for more information about regenerative medical treatments, contact a trusted meniscal injury clinic like USA Sports. At USA Sports, we offer the latest in regenerative medicine treatments, including PRP, ultrasound diagnostics, and stem cell therapy. What’s more, our team of experts will answer any questions and walk you through every step of the recovery process.

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So for example ITB syndrome how now been renamed ITB pain as even using the word ‘syndrome’ implies long term, unchanging pain and this alone can effect how people feel.

Achilles Tendinopathy is now the official term for what sued to be called achilles tendinitis or achilles tendinosis as these 2 terms imply specific biological processes that are unclear and change the way the osteopath, physio and patient approach the treatment plan.

It’s seems crazy that the name of the diagnosis can have such an effect but the power of the mind never ceases to amaze. Underestimate at your peril!!!

The post NAD+ IV Therapy: Potential to Reverse Neurodegenerative Diseases appeared first on Physio Logic NYC.

Obesity is a significant public health concern, as it has been linked to a wide range of negative health outcomes, including heart disease, stroke, and diabetes. In recent years, research has also suggested that obesity may increase the risk of cognitive decline, particularly in older adults. Cognitive decline is a normal part of the aging […]

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The post Management of anterior cruciate ligament revision in adults: the 2022 ESSKA consensus part I — diagnostics and preoperative planning appeared first on Sports Medicine Research.

The Orthopedic & Sports Medicine Center of Oregon is an award-winning, board-certified orthopedic group located in downtown Portland Oregon. We utilize both surgical and nonsurgical means to treat musculoskeletal trauma, spine diseases, sports injuries, degenerative diseases, infections, tumors and congenital disorders.

Our mission is to return our patients back to pain-free mobility and full strength as quickly and painlessly as possible using both surgical and non-surgical orthopedic procedures.

Our expert physicians provide leading-edge, comprehensive care in the diagnosis and treatment of orthopedic conditions, including total joint replacement and sports medicine. We apply the latest state-of-the-art techniques in order to return our patients to their active lifestyle.

If you’re looking for compassionate, expert orthopedic surgeons in Portland Oregon, contact OSM today.

Phone:
503-224-8399

Address
1515 NW 18th Ave, 3rd Floor
Portland, OR 97209

Hours
Monday–Friday
8:00am – 4:30pm

The post 10,000 Steps a Day May Halve Dementia Risk appeared first on Orthopedic & Sports Medicine.

With the holiday season being a busy time of year, stretching and exercising often get on the back burner. Holiday preparation like festive decorating inside and out, shopping, standing, and carrying all of those heavy presents can take a toll on the body leading to aches and pains often in the hips and low back areas. Thankfully, these aches and pains can be managed with a few simple daily stretches that only take 5-10 minutes.

Four Stretches to Manage Aches & Pains

Pectoral Musculature Doorway Stretch
Cooking, cleaning, wrapping presents, and shopping all place us in a position where we lean forward with rounded shoulders, which cause tightness in the pectoral musculature.

One way to counteract this tightness is to stretch out your pectoral musculature in a doorway through an exercise called a doorway pec stretch:

1. Place both hands on each side of a doorway and step into the doorway to feel a stretch along the chest.
2. Hold this for 15-30 seconds at a time and perform it 3 times.

This stretch will help to bring your shoulders back and open your chest.

Piriformis Stretch
With prolonged sitting, standing, and walking, people often report they feel soreness in the “glutes.” Often times the soreness is caused by a tight piriformis.
You can stretch your piriformis while lying on the ground, the couch, or bed:

1. Lay on your back with one knee bent up towards your chest.
2. Place the bent leg’s foot over the other leg.
3. Place your hands on the bent knee and pull the leg across your body, towards your opposite shoulder, until you feel a stretch in the gluteal region.
4. Hold the stretch for 15-30 seconds at a time and perform 3 times on both legs.

This stretch can also be performed in a sitting position.

Hamstring Stretch
With increased activity, like walking the mall for holiday gifts, tightness is often felt in the back of the legs (hamstrings).
To stretch your hamstrings:

1. Start by finding a place you can lay on your back, like your bed or a spot on the floor.
2. Next, place a dog leash or beach towel around one of your feet. While lying on your back and your legs extended straight, use the leash or towel to pull the leg up while keeping the knee as straight as possible.
3. A stretch should be felt in the back of the leg. Hold for 15-30 seconds and perform 3 times on both legs.

This stretch can also be performed sitting on the side of the bed or couch; see the image below.

Seated Prayer Stretch
The final stretch is called a seated prayer stretch, which stretches the muscles of the low back.

1. If comfortable, go into the kneeling yoga pose, the child’s pose.
2. Lean forward so you can place your hands on the floor.
3. Walk your hands to the left. You should feel a stretch in the low-back musculature on your right side.
4. Hold for 15-30 seconds and then move to the right side, where a stretch should be felt in the left low back region.
5. Repeat these steps until you’ve done this 3 times on both sides.

If you are unable to get into the kneeling child’s pose position, this lower-back stretch can also be performed standing at a counter:

1. Lean forward and place both hands on the counter.
2. Walk your hands to the left.
3. You should feel a stretch in the low-back musculature on your right side.
4. Hold this for 15-30 seconds and then go to the right side, where a stretch should be felt in the left low back region.
5. Do this 3 times on both sides.

You can also do this stretch by sitting in a chair, placing your hands on a table, and then sliding the chair back to feel a stretch in the lower back musculature.

Tips to Prevent Back Pain This Holiday Season

Back injuries can be frustrating, time-consuming, and costly to fix. Having a back injury can prevent you from being able to be fully present in all of your holiday plans. Having good postural awareness at home, in the car, and at work are essential in providing care for your own back. Whether it involves baking cookies, decorating a tree, or hanging lights around your house, it is important to be cognizant of having correct body mechanics. Remembering correct body mechanics during this busy season can be extremely tough, but here are four proper lifting techniques to help keep you pain-free this holiday season!

1. Remember to bend your knees and lift with your legs when lifting an object.
2. Keep the object you are lifting close to your body.
3. Avoid twisting when lifting, but pivot instead.
4. Keep your core muscles tight when lifting.

Incorporating proper body mechanics, postural awareness, and exercise can lead to a successful outcome! We hope this helps you stay happy and healthy through the New Year.

If you still feel pain after performing these stretches regularly or following these proper lifting techniques, make an appointment at our physical therapy offices. We’ll provide a tailored exercise and stretching plan to help manage your pain so you can fully enjoy the season.

The post Stretches and Tips to Manage Aches and Pains this Holiday Season. appeared first on Foothills Sports Medicine Physical Therapy.

Winter has arrived, which means one thing for ski and snowboard fans: it's time to hit the slopes! However, that also means that Dr. Sterett, Vail Valley's leading orthopaedic surgeon, begins to see an increase in shoulder injuries – the most common being rotator cuff tears.

Your rotator cuff is a group of shoulder muscles responsible for stabilizing the arm while lifting, swinging, and rotating your arm. It's a crucial part of our anatomy, which is why it can be so painfully frustrating when we suffer an injury to this area. 

Signs of a Torn Rotator Cuff

An acute rotator cuff tear while skiing or snowboarding is often the result of a fall onto an outstretched arm or a direct hit to the shoulder from a collision. Rotator cuff tears can also develop over time from repetitive movements or natural wear and tear.

If you suffered a fall or collision while skiing or are experiencing shoulder pain and discomfort, here are six signs that may indicate a rotator cuff tear.

1. Immediate Pain - A sudden, acute tear from a crash while skiing or snowboarding will likely cause immediate and severe shoulder pain, followed by a dull ache. 

2. Pain With Movement - Lifting, lowering, or rotating your arm may result in sharp pain.

3. Pain While Sleeping - Pain may worsen when resting or sleeping, especially when lying on the injured side. 

4. Limited Range of Motion - You may find that you cannot move your arm in certain directions without experiencing significant pain and stiffness, such as lifting your arm above your head or trying to reach behind you. 

5. Weakness in the Shoulder - Certain activities, such as picking up objects, may become more challenging due to shoulder weakness. 

6. Clicking Sound - You may experience a popping or clicking sensation when moving the arm, which can be a sign that a muscle or tendon has been damaged. 

If any of the above symptoms sound familiar, it's time to contact an orthopaedic specialist. Not only is early treatment a key factor in preventing further damage, but it’s important to rule out other injuries that can occur in conjunction with acute rotator cuff tears.

How Is a Rotator Cuff Tear Treated? 

Dr. Sterett of Vail-Summit Orthopaedics & Neurosurgery will accurately diagnose your injury and work with you to develop a treatment plan that gets you back on the slopes as quickly as possible.  

The good news is that about 80% of rotator cuff tears can be treated nonsurgically with the following measures:

• Rest

• Ice

• Arm sling

• Anti-inflammatory medications

• Physical therapy

• Steroid injections

In some cases, Dr. Sterett may recommend surgery as the best option to restore full function to your shoulder. These situations include:

• If you have a complete or complex tear 

• You have continued pain and weakness, despite conservative treatments

• You are an athlete returning to a high level of performance

• Your job involves frequent, repetitive motions

Read more about rotator cuff surgery. 

Contact the Top Shoulder Surgeon in Vail Today

If you suffered a shoulder injury, contact Dr. Sterett and his team at Vail-Summit Orthopaedics & Neurosurgery!

As the leading orthopaedic shoulder surgeon in Eagle County — home to two renowned ski resorts — Dr. Sterett is known for his experience and skill in treating ski and snowboard shoulder injuries. He and his team will provide an accurate diagnosis and develop a treatment plan that prioritizes your unique lifestyle and goals. 

Call (970) 476-7220 today or request an appointment through Team Sterett's online form. Same-day and next-day appointments are often available. 

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This is a guest article written by Dr. Maureen O’Keefe, DPT who specializes in pelvic health.  She has been specializing in pelvic health and helping people overcome incontinence caused by jumping for over 2 decades.  You can find Dr. Maureen at Purple Mountain Physical Therapy in Grand Rapids, Michigan.  www.purplemountainpt.com.  Here at MUV Therapy Physio & Sports Medicine, we also treat pelvic floor dysfunction and athletes who experience incontinence with jumping by providing you much of the in-depth analysis and treatment that Dr. Maureen discusses here.  

In this article you will gain insights into why jumping causes incontinence and how you can correct it. 

Should I expect that jumping causes incontinence after giving birth?  

The short answer to this question is no.  You should never leak urine, even when jumping and after giving birth. Unfortunately, women have come to believe that it is normal.  But leaking urine is never normal, whether it is when jumping, sneezing or laughing.   Just because many of your friends’ experience incontinence with jumping does not make it normal.  One contributor to this problem is that postpartum physical therapy rehabilitation is not provided to you, so you never recover your pelvic floor muscles, core muscles and bladder control ability.  Research supports that working with a specialized pelvic health physical therapist will help your postpartum recovery, including your ability to jump without leaking urine.  

Are my pelvic floor muscles just weak and that’s why jumping causes incontinence?

It is unlikely that weakness in the pelvic floor muscles is the one and only cause of your leakage.  Many women falsely assume their pelvic floor muscles are stretched out and weak, because they gave birth vaginally.  Yes, vaginal birth lengthens and stretches the pelvic floor.  But, by the time you are back to jumping, your muscles likely have improved this somewhat and now those muscles are working in overdrive to try to stop leaking with jumping.  This overdrive is the problem and layering Kegels on top of a muscular system that is already overworked can worsen your leakage.  We need to take the pressure off the pelvic floor by treating your entire bladder control system, which means your back, posture, breathing, ribcage, abdominal wall, hips, knee and feet.  

Why does jumping cause incontinence?

Jumping creates so much up and down forces that jostle the bladder, urethra and pelvic floor.  When jumping we are also generating intra-abdominal pressure to achieve the explosive lift off and landing.  Sometimes we also generate excess intra-abdominal pressure when we hold our breath or bear down when jumping, which causes incontinence.  This jostling + intra-abdominal pressure strains the bladder control system.  When the pelvic floor muscles are overwhelmed by the entire experience, you are asking too much of them.  This is why Kegels don’t solve the problem.  The problem is not to solely strengthen the pelvic floor, the problem also involves your intra-abdominal pressure generators and learning how to optimize the forces  and movement patterns that are jostling and straining your bladder control system.  

When jumping causes incontinence, your pelvic physical therapist will sleuth out the numerous contributing factors to this leakage.  

Pelvic health PTs are specially trained to rehabilitate problems related to bladder and bowel control, pelvic organ prolapse, pelvic floor dysfunction and pelvic pain.  We have training that includes sports and orthopedics physical therapy plus pelvic-specific rehabilitation.  

Common things that cause leakage with jumping that a pelvic floor physical therapist treats:

1.  Diastasis recti abdominis:  this is a widening and thinning of the linea alba in the abdominal wall and is common after giving birth.  Physical therapy can correct this.  A problematic diastasis recti abdominis will not effectively transfer loads as you move around, so when you jump you lack the intra-abdominal pressure control management system necessary to keep you dry.

2. Weak deep abdominals:  Research shows that the abdominal muscles and pelvic floor work in tandem.  If the abdominals are not functioning well for you then your pelvic floor will not function optimally.

3. Lower back pain:  People who have lower back pain have been found in research to also have pelvic floor dysfunction.  Therefore, if you want to stop your incontinence with jumping, then we need to effectively treat your lower back, as well.  Otherwise, the tightness or stiffness you experience in your lower back leads to pelvic floor problems and more bladder leakage can happen.

4. Pelvic floor dysfunction: The muscles are slow, weak, stiff, tense, overworked or somehow not effectively generating the support necessary to prevent leakage.

5. Postural misalignment:  this is a very important contributor to jumping causing incontinence.  We often find our patients jump with the ribcage and pelvis not in optimal alignment.  This can lead to an easier pathway for the bladder and urethra to leak urine.  Correcting your posture during higher level activities, like jumping, requires a skilled physical therapist to help you, otherwise you won’t know what you are doing wrong. It is very difficult to make some of these micro-adjustments and figure it out on your own.

6. Weak hips:  If the glutes, hip flexors or hip rotators aren’t strong and flexible, you are setting your body up to overwhelm the bladder control system, including the pelvic floor muscles. 

7. Feet or knee problems:  We often see women jumping and experiencing a very slight (or quite large) misalignment of their ankles or knees when they jump.  For example, some women are flat footed, so they jump and the arch of their foot collapses and their knee deviates inward slightly.  Deviations in how the feet or knees land can imbalance the pelvis and alter the ability of the pelvic floor muscles to lift and squeeze to help keep the urethra closed.

8. Pelvic organ prolapse:  Prolapse is one of the most common things that pelvic health PTs treat.  If you are having prolapse, activities that generate a lot of downward force through your abdomen will strain your area and can contribute to incontinence. Fortunately, pelvic PT helps restore your pelvic organ support system, by addressing your posture, movement patterns, myofascial restrictions, scar tissue, pelvic floor muscle function, core strength, breathing habits, hips and more.  By working on all of these things, you will find that prolapse and incontinence symptoms improve.  

9. Hypermobile urethra:  If the urethra can move around too much, then urine can easily slip out.  In pelvic PT we work to optimize your body’s ability to support your urethra

10. Altered movement patterns:  This includes your jumping and landing mechanics, including your foot, knee, hip, pelvic, low back, ribcage and head positions.  How you take off and how you land directly impact your ability to control your urine. 

All of these things are treatable with high quality physical therapy, but it takes an in-depth assessment by your physical therapist to determine exactly what you need.   

At Purple Mountain Physical Therapy in Grand Rapids, Michigan and at MUV Therapy Physio & Sports Medicine, we treat athletes of all ages that experience incontinence caused by jumping.  Our pelvic health physical therapists are also fully trained orthopedic physical therapists and provide whole body treatment to comprehensively solve the problem of your incontinence with jumping.  If you are interested to learn more about Purple Mountain Physical Therapy, you can find us at www.purplemountainpt.com.

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As a runner, monitoring your heart rate is a common way to gauge your fitness level and track your progress. However, heart rate alone doesn’t provide a complete picture of your body’s response to training. That’s where heart rate variability (HRV) comes in. HRV is a measure of the time interval between heartbeats, and it […]

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History of hamstring injury mechanisms
Since 2006, we have known that the mechanism of injury impacts functional deficits, injury location and time to return to play (1-4) . At that point, these mechanisms were viewed as sprint type (occurring, of course, in sprinters) and slow-stretch type (occurring in dancers).  Stretch-type injuries were found to typically have a less severe initial presentation, but take longer to return, and often involved the free tendon of the semimembranosus. Sprint-type injuries meanwhile involved the biceps femoris, and conversely, presented more severely acutely yet tended to return to sport faster. Subsequently, most field-sport based studies describing hamstring injury mechanism call the mechanism simply ‘sprinting’. 

Although widely used, are ‘stretch’ and ‘sprint’ terminologies limited?
A thorough systematic review by Danielsson (5) summarises the mechanism of hamstring injuries. The authors concluded that the stretch type hamstring injury occurred in a position of excessive hip flexion with a hyperextended knee, and that sprint-related injuries most likely occurred during late swing phase. This is supported by the work of Thelen (6) who described peak force and maximal negative work being carried out by the lengthened biceps femoris long head during late swing phase, establishing this during upright treadmill running. While this is certainly a useful finding that advances our understanding, questions remain unanswered away from the treadmill, and in field sports where these injuries are so common. Agility and evasion require movements in 3 planes and across multiple joints, including the trunk (Figure 1). If the trunk has a role in ‘stretch’ injury, it follows that it may have a role In ‘sprint-type’ injury? Can such mechanisms be combined?

Two studies published at the beginning of 2022in the BJSM examine this concept by using systematic video analysis to describe the mechanism of hamstring injury in elite sport for the first time. Kerin, et al. (7) (Infographic 1) describe injuries in professional rugby occurring in five distinct patterns – running, decelerating, kicking, in the tackle and in the ruck. Importantly, the authors frequently observed trunk flexion and ipsilateral rotation, as well as knee extension at the point of injury.

Infographic 1: Infographic prepared by Yann Le Meur presenting the findings of Kerin et al 2022

Similarly, Gronwald, et al. (8) (Infographic 2) described the mechanism of hamstring injury in elite German soccer. This study ended any perception that all football injuries are ‘sprint type’ injuries. Of the 52 included, 25 were sprint type and 27 were stretch type. Table 1 demonstrates how the stretch type injuries occurred kicking and braking and were frequently caused by indirect contact from an opponent (i.e., contact to the body but not the hamstring).

Infographic 2: Infographic prepared by Yann Le Meur presenting the findings of Gronwald et al 2022

How can this impact prevention and rehabilitation?

With an evolving understanding of the biomechanics of injury, and possible tasks or position of risk, strategies can be put in place to potentially reduce injury incidence. Previously, injury prevention strategists have hypothesized that targeting robustness during late swing phase by training the hamstring muscles in appropriate positions. Such an approach is limited as it gives no consideration to the trunk in any plane. An approach to reduce injuries in rugby may involve improving technique around the tackle and ruck, and training hamstring strength at long muscle length (both in trunk and knee flexion), while challenging stability in multiple planes at the trunk (see video from Jurdan Mendiguchia). Exercises like a Split Stance Romanian Deadlift and Single Leg Hip Extension or Glute Ham Raise – incorporating a single arm row to add a transverse plane component – can be useful. The addition of lateral bounds while holding an Aquabag (or otherwise challenging multiplanar stability) may prepare the athlete for the demands of changing direction.  

Can unpicking the mechanism help us diagnose the injury location?
Another potential benefit of integrating mechanism analysis in hamstring injury management is that it may give us further detail as to the injury location. Although Askling found biceps femoris was more frequently injured by sprinters, and semimembranosis by dancers, those findings have not necessarily been replicated elsewhere (1-3). Most stretch-type injuries described by Gronwald, et al. (8) involved the biceps femoris. However, there may be cases where the mechanism of injury is a warning that may create suspicion of a more complex type of injury. 

T-Junction injuries – involving the distal confluence of the short and long heads of biceps femoris – have been shown to have amongst the highest re-injury rate of any injury (9) but can only be diagnosed by MRI, a form of imaging which will not always be available. In the same way as a position of forced trunk flexion and knee extension seems to be associated with semimembranosis injury (see Image 2), our group have repeatedly detected a theme amongst athletes with T-Junction injuries (see Image 1). Frequently these injuries occur during late swing phase (or early stance), with a rapid ipsilateral trunk rotation (often to catch a pass, make a tackle, reach for a ball or to look behind them). If this is indeed a pathognomic mechanism, it could be helpful in aiding clinicians and athletes in more optimally managing these challenging injuries.

Image 1: The mechanism of a T-Junction injury in a professional rugby union player, reproduced from Kerin, et al. (7)

Conclusion

• ‘Stretch’ and ‘sprint’ type mechanisms may be too limited terms to be truly useful in understanding hamstring injuries
• Recent publications have described multiple scenarios and types of hamstring injuries in football and rugby union using systematic video analysis
• These findings may impact upon injury prevention, modify rehabilitation, or assist in determining the most likely area on injury

References

1. Askling C, Saartok T, Thorstensson A. Type of acute hamstring strain affects flexibility, strength, and time to return to pre-injury level. Br J Sports Med 2006;40(1):40-4. doi: 10.1136/bjsm.2005.018879 [published Online First: 2005/12/24]
2. Askling CM, Tengvar M, Saartok T, et al. Acute first-time hamstring strains during slow-speed stretching: clinical, magnetic resonance imaging, and recovery characteristics. Am J Sports Med 2007;35(10):1716-24. doi: 10.1177/0363546507303563 [published Online First: 2007/06/15]
3. Askling CM, Tengvar M, Saartok T, et al. Acute first-time hamstring strains during high-speed running: a longitudinal study including clinical and magnetic resonance imaging findings. Am J Sports Med 2007;35(2):197-206. doi: 10.1177/0363546506294679 [published Online First: 2006/12/16]
4. Askling CM, Tengvar M, Saartok T, et al. Proximal hamstring strains of stretching type in different sports: injury situations, clinical and magnetic resonance imaging characteristics, and return to sport. Am J Sports Med 2008;36(9):1799-804. doi: 10.1177/0363546508315892 [published Online First: 2008/05/02]
5. Danielsson A, Horvath A, Senorski C, et al. The mechanism of hamstring injuries – a systematic review. BMC Musculoskelet Disord 2020;21(1):641. doi: 10.1186/s12891-020-03658-8 [published Online First: 2020/10/01]
6. Thelen DG, Chumanov ES, Hoerth DM, et al. Hamstring muscle kinematics during treadmill sprinting. Med Sci Sports Exerc 2005;37(1):108-14. doi: 10.1249/01.mss.0000150078.79120.c8 [published Online First: 2005/01/06]
7. Kerin F, Farrell G, Tierney P, et al. It’s not all about sprinting: mechanisms of acute hamstring strain injuries in professional male rugby union-a systematic visual video analysis. Br J Sports Med 2022;56(11):608-15. doi: 10.1136/bjsports-2021-104171 [published Online First: 2022/01/21]
8. Gronwald T, Klein C, Hoenig T, et al. Hamstring injury patterns in professional male football (soccer): a systematic video analysis of 52 cases. Br J Sports Med 2022;56(3):165-71. doi: 10.1136/bjsports-2021-104769 [published Online First: 2021/12/09]
9. Entwisle T, Ling Y, Splatt A, et al. Distal Musculotendinous T Junction Injuries of the Biceps Femoris: An MRI Case Review. Orthop J Sports Med 2017;5(7):2325967117714998. doi: 10.1177/2325967117714998 [published Online First: 2017/08/11]

Author: Fearghal Kerin

Affiliations: 

UCD School of Physiotherapy, Public Health and Performance Science, Belfield, Dublin 4, Ireland

Leinster Rugby, Dublin, Ireland

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Doctors are being asked to prescribe the diabetes treatment Ozempic, for purposes other than what it was prescribed for.

Watch the video.

Fortunately, science has come a long way to help us understand how aging actually works. In fact, a number of “myths” have been debunked in recent years. Some aspects of aging can be seen in a positive light and can now be easily managed with the help of modern medicine and anti-aging procedures.

From how our bodies change to how our minds work, here are four things everyone gets wrong about aging.

An Aging Appearance Is Inevitable

First and foremost, let’s talk about the most common concern among men and women as they age: their appearance. It’s no secret that our skin changes as we age, becoming more susceptible to wrinkles, sun damage, and other skin blemishes.

But contrary to popular belief, an “aging appearance” is not inevitable. Thanks to advances in medical science, particularly regenerative medicine, there are now more anti-aging treatment options than ever to help reduce signs of aging and keep your skin looking young and healthy. Botox, fillers, and various skincare treatments can all help reduce the visible signs of aging. And with a little bit of care and attention, you can slow down the aging process even further.

Of course, it’s important to remember that everyone ages differently. Some people will show signs of aging earlier than others, and there is no magic solution that will work for everyone. But if you’re concerned about how you look as you get older, regenerative medicine and anti-aging treatments can help.

You’ll Become More Sedentary

As we age, it’s common to become less active and more sedentary. We might have different energy levels than we did when we were younger, and it can be harder to motivate ourselves to stay active. But this doesn’t mean you have to give up your active lifestyle altogether.

There are plenty of ways to stay fit and active as you age. Taking up a new hobby, such as gardening or hiking, can help you stay physically active. What’s more,  research has shown that remaining active and engaged can help reduce the risk of dementia and other cognitive issues. So, don’t let the misconception that you have to become more sedentary as you age keep you from enjoying a healthy and active lifestyle.

But what if you feel like you’re stuck in a rut and can’t seem to find the motivation to stay active?

Again, modern medicine has come a long way, and there are now many options for treatments and therapies that can help. If you struggle to stay active, talk to your doctor about what anti-aging habits might work best for you. From energy-boosting therapies to specific exercise programs, there’s a solution to help you reap the benefits of staying active.

The Older You Get, the Less Sleep You Need

Another common misconception about aging is that the older you get, the less sleep you need. In fact, most experts recommend that adults over 65 get between 7 and 8 hours of sleep each night.

While it’s true that older adults tend to sleep less than younger adults, this is usually due to factors like medications or health conditions, not simply because they don’t need as much sleep. In fact, sleep is crucial for older adults to help them maintain their mental and physical health.

If you can’t get enough shut-eye, you might need to make a few adjustments to your routine. Anti-aging habits like exercise, new hobbies, and dietary changes can all help improve your sleep patterns. If these don’t help, talk to your doctor about potential causes and solutions for your routine and lifestyle.

You Become More Isolated as You Age

It’s a sad but common stereotype that older adults are isolated and lonely. While it’s true that some older adults do experience social isolation, this is by no means inevitable. In fact, some of the topics mentioned above can also be used to help you stay socially active.

For example, taking care of your appearance can boost your confidence and help you feel better about yourself, making socializing easier. Staying physically active can also help you stay connected to others, as many older adults participate in group exercise classes or other activities.

Moreover, there are many opportunities for socializing specifically designed for older adults. For example, there are often senior centers in communities that offer a variety of activities, from art classes to dance lessons to book clubs. There are also many online social networks and forums specifically for older adults.

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Benefits of Diaphragmatic Breathing

Diaphragmatic breathing helps you use your diaphragm correctly while breathing by:

• Strengthening the diaphragm
• Improving control of your core
• Slowing the breathing rate
• Lowering heart rate and blood pressure
• Promoting relaxation

What conditions does it help with?

Diaphragmatic breathing may help several conditions that cause symptoms that affect how you breathe, including:

• Anxiety/ Stress
• Asthma
• Chronic Obstructive Pulmonary Disease (COPD): In COPD, the airways within the lungs become damaged and inflamed, obstructing airflow in and out of the lungs. The diaphragm also tends to be weaker. The body often tries to compensate for this weakness by engaging the back, neck, and shoulder muscles while breathing.
• Stress: Reduces stress hormones in the body, mainly cortisol.

Diaphragmatic breathing can help treat certain conditions, but it shouldn’t be the only treatment. It may be a beneficial add-on treatment for people with anxiety or respiratory conditions such as COPD or asthma. However, it is not an effective standalone treatment for these conditions.

How do I practice diaphragmatic breathing?

1. To begin with, practice diaphragmatic breathing in a relaxing area, such as a quiet room. Avoid distractions like cell phones, televisions, and others. Instead, focus on the breathing technique and the bodily sensations you feel while practising.
2. Lie on a flat surface (or in bed) with your knees bent. You can use a pillow under your head and your knees for support if that’s more comfortable.
3. Relax your shoulders, shifting them down away from the ears.
4. Place one hand on your upper chest and the other on your belly, below your rib cage. This will allow you to feel your diaphragm move as you breathe.
5. Breathe slowly through your nose for 4 seconds, breathing deeply towards your lower belly. The hand on your chest should remain still, while the one on your belly should rise.
6. Tighten your abdominal muscles and let them fall inward as you exhale through pursed lips for 4 seconds. The hand on your belly should move down to its original position
7. Repeat these steps several times for the best results. Practice for five minutes several times a day if possible.

References:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5455070/

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We use cortisone for many diseases, such as allergies, autoimmune disorders, skin diseases, and musculoskeletal conditions. This drug can be given as tablets, liquid, nasal spray, or injections. It also has many potential side effects depending on the dose, duration of use, and how it is given. So, do cortisone shots cause weight gain and other side effects, and how do we prevent these side effects?

What is cortisone?

Cortisone is a synthetic derivative of a naturally occurring drug called cortisol. The adrenal glands above the kidneys produce cortisol to regulate and control many body processes including inflammation, hormones, body temperature, and the immune system. Taking cortisone has a powerful effect on reducing inflammation and regulating the immune system.

What are cortisone shots used for?

Cortisone shots are used for musculoskeletal arthritis (such as osteoarthritis or inflammatory arthritis) or tendonitis. Examples of common conditions include Achilles tendonitis, jumper’s knee, rotator cuff tendonitis, and knee and hip osteoarthritis.

Is there a difference between cortisone shots and tablets?

Yes. Cortisone tablets such as prednisolone are often taken by mouth and given to treat serious conditions such as lupus, severe eczema, and multiple sclerosis. However, the drug is used at high doses and for a long duration. The drug is absorbed by the gut and enters the circulation, affecting the whole body. As such, it also has the potential to produce many side effects, such as weight gain, insomnia, and Addison’s disease.

However, most steroids used for the musculoskeletal system are given as cortisone shots. These shots provide a high concentration of cortisone in a localised area such as a joint, bursa, or tendon sheath. Therefore, little cortisone is absorbed systematically, which reduces many side effects. Also, after 4-6 weeks, we expect all the cortisone from one shot to be eliminated from the body.

So do cortisone shots cause weight gain?

As a general rule – no. The amount of cortisone absorbed by the body is minimal after a single cortisone shot for joint or tendon problems. Moreover, a few cortisone injections over 3-6 months are unlikely to produce severe side effects such as weight gain. Compare this effect to long-term tablets. In a recent study, high-dose oral tablets over two years caused at least a 5% weight gain.

Side effects of cortisone shots for musculoskeletal conditions

While a cortisone shot does not cause weight gain, we must be aware of local side effects. These adverse effects include:

• Cortisone flare: This reaction is common 12-24 hours after local cortisone shot and can last up to a week. Treatment includes rest from activity, ice, and topical and oral anti-inflammatories.

• Skin colour changes: Cortisone injected just under the skin can reduce the pigmentation the skin produces, leading to a colour change. While the effect is not permanent, it can take months or years to settle, particularly in dark-skinned people.

• Fat atrophy: While oral tablets can cause you to put on more fat, localised injections cause fat shrinkage, also called fat atrophy. This effect causes a dimpling of the skin, which may look cosmetically unappealing.

• Tendon rupture: Recent evidence suggests that a localised cortisone shot can cause the weakening of tendons, increasing the risk of rupture. This effect is most pronounced in the first six weeks after injection.

• Infection: A cortisone shot can increase the risk of infection by altering the immune cells around the area injected. We can reduce this risk using a strict sterile technique, including sterile gloves and dressing packs.

• Damage to articular cartilage: Recent evidence suggests that repeated cortisone shots into a joint could decrease articular cartilage volume. We should be cautious about repeated injections into one joint.

• Increase in blood sugar: A cortisone shot can increase blood sugar for 2-4 weeks. This effect is pronounced in people who are diabetics. Therefore, we should be cautious about cortisone injections in unstable diabetes.

• Facial flushing: Some people develop a pronounced facial flush, which starts about 2-4 hours after an injeciton and lasts up to 24 hours. It can also happen with future cortisone shots.

Other commonly asked questions related to: Do cortisone shots cause weight gain?

How long does it take for a cortisone shot to work?

Generally, a cortisone shot takes 4-5 days to start working. However, we often say you should leave about a week before an event for the cortisone shot to work. Also, you need to be aware that cortisone can cause a flare of pain in the first few days. Therefore, you must rest for a few days after the cortisone shot to prevent the flare from worsening.

How long do cortisone shots last?

The effect of a cortisone shot can last from six weeks to six months. As cortisone reduces inflammation, it can make you feel great. However, this effect is temporary, as cortisone does not cure the disease. Nevertheless, this window of pain relief can help with rehab.

Are cortisone shots better under ultrasound?

Yes. There is good evidence that ultrasound guidance improves the accuracy and effect of a cortisone shot. Guidance also reduces the side effects such as skin changes and fat trophy. If you are thinking about a cortisone shot, you should see a doctor with experience in ultrasound-guided injections. Unfortunately, not all practitioners performing injections are qualified. See this blog for the top 4 questions to ask before you have an ultrasound-guided injection. 

Final word from Sportdoctorlondon: Do cortisone shots cause weight gain?

Cortisone shots concentrate the drug in the injected area, such as the tendon, joint, or bursa. So, systemic side effects such as weight gain are not common. However, local side effects, including skin depigmentation and fat atrophy, are. Therefore, you should see a doctor with injeciton experience to prevent side effects. Dr Masci has 15 years of experience in ultrasound and ultrasound-guided injections, including cortisone, PRP, and hyaluronic acid.

Related topics: 

• How long does it take for a cortisone shot to work?
• Are cortisone shots bad for you?
• Cortisone or hyaluronic acid for knee arthritis?

Dr. Masci is a specialist sport doctor in London. 

He specialises in muscle, tendon and joint injuries.

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Fluid on the knee, also called a knee effusion or water on the knee, can be a painful condition with fluid build up in and around the knee joint. Generally, we treat fluid on the knee with simple strategies such as ice, medication, and a compression wrap. However, sometimes we must drain fluid from the knee, also called a knee aspiration. So, how do you perform knee drainage, and when should you do it?

Causes of fluid on the knee

The knee joint is a synovial joint lined by synovium, producing fluid. This fluid protects the cartilage lining the joint surface and reduces friction with joint movement. However, when the joint becomes diseased, it has excess synovial fluid. Common causes of excess knee fluid include osteoarthritis, inflammatory arthritis, infection, or traumatic injuries such as meniscal or cruciate ligament tears.

When should you do a knee drainage? 

We drain fluid from the knee for two reasons:

• You want to find out the cause of water on the knee, i.e., for diagnostic purposes.

• You want to help reduce the swelling, especially when simple measures such as ice and ibuprofen fail. The build-up of knee fluid greater than 50mls often causes pain and restricts mobility. Draining the knee can ease the symptoms.

Can you diagnose knee diseases from draining fluid?

Yes. Knee effusions are not all the same. For example, fluid in the knee due to trauma, such as a meniscal tear, differs from fluid from inflammatory arthritis, such as gout.

When we drain the knee, we send it to a laboratory to analyze the types of cells in the fluid. Also, microbiologists look for bacteria or crystals in the fluid, which can point to the cause. We use this information with other tests such as X-rays, MRI, and blood tests to confirm the cause.

How do you drain fluid from the knee?

Ususally, we perform a knee aspiration in a clean clinic room. Generally, we target the top part of the knee joint just above the patella.

First, we clean the area with antiseptic. Second, we use a needle to puncture the skin to get to the knee joint. It is better to use ultrasound to direct the needle into the joint to improve accuracy. Also, ultrasound allows us to empty the knee of fluid entirely. Finally, we place a bandage on the puncture site to prevent bleeding from the skin. The entire process can take a few minutes.

Sometimes, when fluid on the knee is due to inflammation or an injury, we inject cortisone or other injectables such as hyaluronic acid or platelet-rich plasma. In addition, we recommend regular ice and a compression bandage to prevent the knee effusion from returning.

Risks of knee aspiration

Generally, the procedure is low risk, mainly if done in a clean room and with ultrasound guidance. However, there is a small risk of the knee joint returning or introducing infection. In addition, superficial swelling and skin bruising can occur at the entry site.

Does draining fluid from the knee hurt?

Generally no. You may feel slight pain or discomfort as the knee goes into the joint. However, taking the fluid out of the knee should not be painful. In addition, using ultrasound improves the accuracy of needle placement and reduces procedure discomfort.

If we analyze the fluid on the knee, we’ll need to speak to you after a few days.

What to do after a knee aspiration?

The steps after a knee aspiration are essential. First, leave the bandage on until your doctor tells you to take it off. You should keep the entry site clean. Second, you can go back to normal activities after the procedure, but you should avoid jumping back into sports or walking longer until you’re told to do so. Finally, if the knee is sore, you should ice every and take ibuprofen or NSAIDs every 4-6 hours until the pain disappears.

Other frequently asked questions about knee drainage:

What are the different ways to reduce fluid on the knee? 

Simple measures to control water on the knee include the following:

• Regular ice packs for 10 minutes every 4-6 hours
• Using a compression bandage to apply pressure to the joint
• NSAIDs such as ibuprofen or diclofenac
• wearing a knee brace for walking or sports

Can a knee effusion return? 

Yes. Fluid on the knee can return after days or weeks. The key is to find the cause so that the treatment can be more effective and stop it from returning.

A final word from Sportdoctorlondon about knee aspiration

Knee drainage is an excellent technique to help with diagnosis and reduce symptoms from knee fluid build-up. You should see an experienced doctor who can perform this skill efficiently, preferably with the help of ultrasound to improve the effect.

Related conditions to knee aspiration:

• Knee injections for arthritis: which is best?
• Gout in the knee
• PRP injections for the knee

Dr. Masci is a specialist sport doctor in London. 

He specialises in muscle, tendon and joint injuries.

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The knee is complex consisting of a hinge joint surrounded by tendons at the front, sides, and back. So is it any wonder we are prone to knee tendon injury? This blog explores knee tendon injuries which are common, and how to manage them.

How does a knee tendon injury happen? 

Most cases of knee tendon damage occur due to excessive activity. Generally, too much exercise without adequate rest leads to tendon overload. As a result, the tendon swells and loses its ability to function like a spring, causing pain. We call this process tendonitis.

Sometimes, sudden explosive activity causes stretching and tearing of knee tendons. This tear can be partial or full thickness.

In rare cases, knee tendons can injure from a direct blow leading to pain and swelling like tendonitis.

Common knee tendon injuries 

Tendon pain at the front of the knee includes patellar tendonitis, also called jumper’s knee, and quadriceps tendonitis. At the inside of the knee, we often see pes anserine bursitis. Finally, active people develop low hamstring tendonitis at the back of the knee, also called semimembranosus tendonitis.

Symptoms 

Usually, tendon pain presents as focal pin-point pain. The site of the pain depends on the tendon affected, e.g., pain from patellar tendonitis is felt below the knee cap, while quadriceps tendonitis presents above the knee cap. Generally, pain severity depends on exercise intensity; lower intensity means less pain, while higher intensity produces more severe, long-lasting pain.

In some cases, we see localised swelling around the swollen tendon. But symptoms such as generalised, swelling, giving way, or locking are not associated with tendon injuries and are more likely due to other knee problems such as a meniscal tear, osteoarthritis, or ligament damage.

Knee tendon injury diagnosis 

First, we start with a thorough history and physical examination. Then, in most cases, we follow up an assessment with investigations such as ultrasound or MRI. Typically, we see tendon damage, such as collagen breakdown. Also, imaging looks at other knee structures to exclude other causes of knee pain.

It is essential to find the reasons for developing tendon pain. Often, we find people who have pushed themselves too much with their training. Usually, there has been a recent increase in training intensity, such as the introduction of interval or hill training. In addition, in some cases, certain conditions, such as menopause, obesity, and diabetes, increase the risk of tendonitis.

Management 

We suggest you see a tendon specialist to determine the best treatment for your tendon injury.

First, we start with exercise therapy. Strength training reduces pain from tendonitis by improving tendon structure and increasing muscle strength to shield the injured tendon.

Second, we use additional treatments such as GTN patches, shockwave therapy, and tendon injections to help with exercise.

Finally, tendon surgery should be avoided unless all other treatments have failed, as surgery results are not guaranteed, and risks are higher than other treatments.

Final word from Sportdoctorlondon about tendon injuries.

Tendon injuries are common in the knee and are associated with pain and reduced function. You should see a tendon expert who can assess your tendon injury and decide on the best management plan specific to you and your demands.

Related conditions:

• Patellar tendonitis 
• Quadriceps tendonitis 
• Pes bursitis 
• Low hamstring tendonitis 
• How to treat tendonitis from a tendon specialist 

Dr. Masci is a specialist sport doctor in London. 

He specialises in muscle, tendon and joint injuries.

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About Dr Masci

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Our last update had Kevin D. Plancher, MD, MPH, FAOA, FAAOS as an honored professor at the Korean Shoulder and Elbow Society (KSES) Fall Symposium. This week we find Kevin in Levi, Finland for the FIS World Cup as a team physician with the Stifel U.S. Alpine Team Women’s Team! While in attendance Dr. Plancher had the honor of meeting the U.S. Ambassador to Finland, Douglas Hickey. The celebrations were non-stop as the team witnessed Ava Sunshine’s debut in the World Cup circuit earning her first points while coming in with two top-30 finishes. Katie Hensien also placed in the top-30. All eyes were on Mikaela Shiffrin this weekend as she ran away with her 75th and 76th World Cup victories and broke the record for the most podiums in a single discipline by any female skier. Read more about the debut World Cup weekend.

  

Kevin D. Plancher, MD, MPH, FAAOS, is a board-certified orthopaedic surgeon and founder of Plancher Orthopaedics & Sports Medicine. Dr. Plancher is one of only thirty-six Orthopaedic Surgeons who hold American Board of Orthopaedic Surgery certification in both Surgery of the Hand and Orthopaedic Sports Medicine. He is a Clinical Professor, Department of Orthopaedic Surgery, at Montefiore Medical Center/Albert Einstein College of Medicine and an Adjunct Clinical Assistant Professor of Orthopaedic Surgery, at the Weill Cornell Medical College, Cornell University in New York. Since 2001, he has been listed annually in the Castle Connolly directory as a “top doctor” in his field.

Plancher Orthopaedics & Sports Medicine is a comprehensive orthopaedics and sports medicine practice with offices in New York City and Greenwich, CT. Leaders in orthopaedics, sports medicine, and acute emergency treatment of sports injuries and rehabilitation utilizing the latest techniques in orthopaedic care. plancherortho.com.

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The Orthopedic & Sports Medicine Center of Oregon is an award-winning, board-certified orthopedic group located in downtown Portland Oregon. We utilize both surgical and nonsurgical means to treat musculoskeletal trauma, spine diseases, sports injuries, degenerative diseases, infections, tumors and congenital disorders.

Our mission is to return our patients back to pain-free mobility and full strength as quickly and painlessly as possible using both surgical and non-surgical orthopedic procedures.

Our expert physicians provide leading-edge, comprehensive care in the diagnosis and treatment of orthopedic conditions, including total joint replacement and sports medicine. We apply the latest state-of-the-art techniques in order to return our patients to their active lifestyle.

If you’re looking for compassionate, expert orthopedic surgeons in Portland Oregon, contact OSM today.

Phone:
503-224-8399

Address
1515 NW 18th Ave, 3rd Floor
Portland, OR 97209

Hours
Monday–Friday
8:00am – 4:30pm

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The Orthopedic & Sports Medicine Center of Oregon is an award-winning, board-certified orthopedic group located in downtown Portland Oregon. We utilize both surgical and nonsurgical means to treat musculoskeletal trauma, spine diseases, sports injuries, degenerative diseases, infections, tumors and congenital disorders.

Our mission is to return our patients back to pain-free mobility and full strength as quickly and painlessly as possible using both surgical and non-surgical orthopedic procedures.

Our expert physicians provide leading-edge, comprehensive care in the diagnosis and treatment of orthopedic conditions, including total joint replacement and sports medicine. We apply the latest state-of-the-art techniques in order to return our patients to their active lifestyle.

If you’re looking for compassionate, expert orthopedic surgeons in Portland Oregon, contact OSM today.

Phone:
503-224-8399

Address
1515 NW 18th Ave, 3rd Floor
Portland, OR 97209

Hours
Monday–Friday
8:00am – 4:30pm

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The Orthopedic & Sports Medicine Center of Oregon is an award-winning, board-certified orthopedic group located in downtown Portland Oregon. We utilize both surgical and nonsurgical means to treat musculoskeletal trauma, spine diseases, sports injuries, degenerative diseases, infections, tumors and congenital disorders.

Our mission is to return our patients back to pain-free mobility and full strength as quickly and painlessly as possible using both surgical and non-surgical orthopedic procedures.

Our expert physicians provide leading-edge, comprehensive care in the diagnosis and treatment of orthopedic conditions, including total joint replacement and sports medicine. We apply the latest state-of-the-art techniques in order to return our patients to their active lifestyle.

If you’re looking for compassionate, expert orthopedic surgeons in Portland Oregon, contact OSM today.

Phone:
503-224-8399

Address
1515 NW 18th Ave, 3rd Floor
Portland, OR 97209

Hours
Monday–Friday
8:00am – 4:30pm

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A sports medicine doctor can be a great resource if you are an active athlete looking to speed up your recovery or improve your game. Adding specialized sports medicine services can be the edge you need to stay in the game and optimize your performance.

In fact, sports medicine for athletes is more than performance training and injury prevention. You can expect many more benefits while working with a sports medicine expert.

Sports Medicine Specialization

Visiting a doctor who specializes in sports medicine means that you are working with an expert. Not only do these doctors have orthopedic training, but they work with active athletes all day long.

These specialists are trained to treat and diagnose athletic injuries. Since they are focusing on these types of injuries specifically, you can be confident knowing that they have years of experience with other patients who have similar conditions.

Injury Prevention

Don’t wait until after an injury occurs before you see a sports medicine doctor. If you are proactive about this care, then you can actually prevent injuries before they happen.

Sports medicine providers understand what athletes are going through in the game and during training sessions. In addition to treating acute injuries, such as a torn ligament or broken bone, these doctors also understand how to handle chronic, repetitive-motion conditions.

When you are actively working with a sports medicine doctor, then you will receive advice on preventing injuries in the future. Additionally, your doctor will offer recommendations to help you avoid re-injury when you get back in the game.

Rehabilitation Support

Even if you are careful in the game, there is always the risk of injury. As an athlete, a seemingly minor injury can take you out of commission, making you miss the season and stop your training.

Most of the time, sports injuries will require a recovery and rehabilitation period. It’s essential that you follow the doctor’s orders because the suggested treatments will be vital to your recovery.

An experienced sports medicine doctor will know the best methods for speeding up your recovery, minimizing symptoms, and improving the long-term prognosis after an injury.

Cutting Edge Treatments

General healthcare providers spend time helping patients with a wide variety of health issues. However, since the doctors are spread thin, they don’t often have a specialty or focus, which means they might not have the latest information about specific conditions or treatments.

On the other hand, sports medicine doctors focus on sports injuries and treatments daily. So, they are up-to-date on the latest treatments and cutting-edge technology. Having access to this relevant information can be vital to speeding up your recovery and improving your overall outcome.

Mobility and Strength

In addition to strength, athletes also need mobility and flexibility to move with speed and agility. A sports medicine doctor works with athletes to improve their individual performance.

You will notice a difference when you are participating in sports activities. Additionally, it’s nice to feel the strength and mobility in all other areas of your life as well.

Personalized Care

One of the most notable benefits of working with a sports medicine provider is that you get a personalized care plan. It’s all about you!

Our team at Orthopedic Associates takes the time to understand the needs of each patient. Then, we design a care plan that is tailored to your condition, fitness, and goals. We look at physical strengths and weaknesses and find ways to support your performance through specialized training, certain equipment, and more.

Getting Back in the Game

Of course, you are anxious to return to the field as soon as possible. But recovery takes time.

Your sports medicine doctor will offer recommendations about when you can start playing again. This personalized timeline helps you avoid re-injury and also prevents compounding problems in the future.

It’s important to follow your doctor’s timing recommendations so you can prevent any issues that could take a toll on your performance and future participation.

Patient Education

One of the benefits of working with a sports medicine doctor is that these healthcare providers partner with their patients. Instead of simply prescribing medication and sending you home, a sports medicine expert works to educate each patient about things they can do before, during, and after sports.

A sports medicine doctor can be your primary care resource, especially if you are a semi-professional or pro athlete. Your provider can help with everything from nutritional counseling to preventive health screenings, diagnosis, and more.

Athletic Team

Not only do your coaches and trainers help with developing the necessary skills, but other professionals can also be critical in support of each athlete. Building a team you can trust means you always have someone to turn to when you have questions or need assistance.

A sports medicine doctor understands the unique dynamics faced by athletes. Our doctors work with other people on your athletic team, including trainers, physical therapists, surgeons, and more.

How to Know When You Need a Sports Medicine Doctor

There are a few circumstances in which an athlete will contact a sports medicine doctor:

• Injury: Something happened, and you sustained an injury. Whether you are in pain or your performance is being affected, it’s essential to visit a sports medicine doctor as soon as possible.
• Chronic Pain: Some athletes will live with chronic pain due to the wear and tear on the joints and throughout the body. A sports medicine professional can be a great resource if you are looking for ways to reduce the pain and feel better each day.
• Performance Improvements: You don’t need to be injured to visit a sports medicine doctor. Many athletes are proactive about this type of care so they can improve their performance, strength, and agility.

Sports Medicine Services for Pro and Recreational Athletes

You don’t need to be a professional athlete to benefit from sports medicine services. Our team of doctors helps pro athletes as well as recreational “weekend warriors.”

Whether you are training for your first marathon or hoping to go to the championship game, we are here to support your journey. Schedule a consultation to learn more about how sports medicine can be individualized for your unique needs.

At Orthopedic Associates, we provide each patient with a full-service approach for sports injuries, chronic pain, and more. Contact us when you are ready to book an appointment. Call at your convenience:  (972) 420-1776.

The post Why Sports Medicine Is Important for Athletes appeared first on Orthopedic Associates.

What is an ACL?

The ACL is a ligament that connects the tibia (shin bone) to the femur (thigh bone) and helps to keep the knee stable during pivoting or twisting movements. Interestingly, there are case studies of people who are not born with an ACL and do not experience any difficulties. This suggests that people may be able to rehabilitate from ACL injury completely without surgery. 

Why Do ACL Injuries Occur?

An ACL injury occurs when the knee is subjected to forces beyond what the ACL can handle. That can occur from a plant and twist injury, a fall, a sudden deceleration or trauma to the knee. Many cases of ACL injuries are non-contact and are interesting from a physiotherapy perspective since it would be important to identify the factors that contributed to the injury in order to prevent recurrence. ACL injuries can be partial or full tears of the ligament.

There are some factors that are not changeable. Those are the Q angle, PTS angle, ACL size, and intercondylar notch size. Although these are not factors that are modifiable, there are modifiable factors such as: the control of the hip and ankle muscles which affect knee position when landing from jumps, training errors, and muscle imbalances. A good physiotherapist will be able to assess these risk factors for you and create a customized plan to get you back to 100%.

What are my options for ACL injuries?

There are three options when it comes to rehabilitation of an ACL injury (partial or full tear).

1. Surgery (full tear) - this option is for people who play sports at a high level such as competitive athletes or want to return their body as close to their normal anatomy as possible. The surgery and recovery time is typically 9-12 months, including the physiotherapy afterwards.

2. Non-Surgical management (full or partial tear) - this is a growing and potentially preferable option for people who want to improve their quality of life as quickly as possible including returning back to high level sports/competition. The advantage is that there is a quicker recovery and in some cases a near complete recovery without the delays and risks associated with surgery.

3. Bracing (full or partial tear) - bracing has evolved as a strong tool for the treatment and prevention of recurrences. A quality custom made brace such as the ones that we make for patients at our clinic are a great option.

What Do I do if I think I have torn my ACL?

The best way to rehabilitate an ACL injury is to have an accurate assessment by a trained physiotherapist. At MUV Therapy, our experts are trained in orthopedic manual therapy and testing in order to determine the cause of your knee problem and what may have occurred. Through close collaboration with a medical team, we can diagnose and treat ACL injuries and help return people back to sport, work, and life. Delaying the start of treatment can lead to complications such as knee flexion contracture, muscle imbalances, and potentially chronic pain. Not to mention a large component of an effective rehabilitation plan for an ACL injury includes addressing fears and beliefs around injury. Many of our patients appreciate the holistic approach that we take when helping our athletes return to sport, including addressing psychological factors.

What Does Physiotherapy do for an ACL?

After an ACL injury, physiotherapy focuses on helping you recover your normal movement, muscle strength, and balance again. A good physiotherapy program will also include a comprehensive biomechanical assessment of your body that will help to highlight why the injury may have occurred in the first place. Although it can be a long process, it is well worth it to get the right treatment for your knee injury. After all, people who have ACL injuries can be more prone to the development of osteoarthritis later in life and we know that maintaining your knee flexibility and strength helps to delay the onset of degeneration and arthritis.

Not sure if you may have injured your ACL? Click on the buttons below to learn more. We offer free phone consultations to help you make a better decision about your options after ACL injury.

The post Getting Back to Overhead Exercises in the Gym appeared first on Mike Reinold.

The post Dynamic Knee Valgus and Pelvic Pronation with Steve Dischiavi appeared first on Mike Reinold.

You get rear-ended on your way home from work, a stray foul ball hits you when your attention is elsewhere at your child’s baseball game, you trip over a root on a hike and don’t have time to catch yourself before your head hits the ground – head injuries are more common than you might expect in everything you do. When doing recreational activities, though, especially contact ones, our risk of concussion skyrockets more than any other time, and most people might not think to take the proper precautions once the injury occurs.

There’s an age-old myth of ‘concussions don’t happen in non-contact activities’ that manages to fool many of us, but without proper gear, training, or awareness, you’re just as vulnerable to concussions in non-contact activities as you are in contact ones. And you can, of course, still get a concussion that isn’t sports-related – adults are especially prone to getting them as a result of a fall.

Any head injury can result in a concussion, which is defined by the CDC as,

“…a type of traumatic brain injury—or TBI—caused by a bump, blow, or jolt to the head or by a hit to the body that causes the head and brain to move rapidly back and forth. This sudden movement can cause the brain to bounce around or twist in the skull, creating chemical changes in the brain and sometimes stretching and damaging brain cells.”

Each year, there’s a suspected 1.7-3.8 million concussions that happen due to sports and recreational activity, but there’s a catch: only 5 in 10 concussions are reported or detected, which means there’s a hidden 50% of concussions that go untreated.

If some concussions are so insignificant as to go undetected, then why worry about them? Surely a headache for a few days can’t be that bad, right?

Wrong, actually.

Meet Harriet Owen, a professional cyclist from the UK who took over a year to recover from a concussion – one she thought was simply a temporary headache that developed from crashing her bike like she had done so many times before.

Harriet Owen and Her Story

Having been cycling since she was 11 years old, Harriet Owen’s love for biking is a long, multi-generational one. Ever since she was a child growing up in Oxford, United Kingdom and watching her father compete in local races, Harriet looked at a bike and saw fun and excitement, but perhaps not her future as a professional cyclist, at the time.

Her cycling teams stretch back to 2011, but her professional career didn’t start until 2015, and she was a year into it before coming over to the United States to race in criteriums in 2016. Her experience with concussions, though, began in March of 2021, as she was participating in her team’s first training camp in Belgium.

On their first ride together, Owen and her team set out to practice some basic drills and rotating techniques. Whilst in the middle of the pack, the rider directly in front of Owen hit a bump in the road and subsequently knocked into the back wheel of the teammate in front of her, resulting in a crash that no one had time to react to.

As she and another teammate were sent right over the top of the crash, she collided head-first into the ground, earning what she thought was a scuff on her helmet and a bit of a headache that would go away after a while – nothing that she even remotely thought would end up being a concussion that would take 15 months to recover from.

From a minor injury to a nearly career-ending experience, Harriet quickly found that her concussion – left untreated or mistreated by the neurologists that she saw as the headaches persisted – was far more severe than she thought. Despite having to face a serious injury in a foreign country, Harriet found a support system that led her to the life-changing, innovative training and treatment that she received right here in Louisville with the help of Dr. Grossfeld, Dr. Mark Lynn of Lynn Family Vision, and their colleague Dr. Tad Seifert, a nationally-renowned neurologist.

Coming back from 15 months of constant pain, memory and concentration issues, personality changes, mood swings, and constant fatigue was a battle that Harriet had to struggle through with previous doctors telling her to take over the counter pain medications. She was constantly overexerting her body and mind, and demoralizing adjustments in her everyday life led to periods of depression. Now, though, with the ability to look back at her experience, Owen has come out of it with a depth of knowledge regarding concussions, symptoms, signs, prevention methods, and a high respect for and understanding of the consequences that result from leaving head injuries untreated, as well as a story to tell other athletes to raise awareness.

Make sure to tune into the next few blogs to learn more about Harriet’s story, her treatment, her roadblocks and hurdles on the way to recovery, and all about concussions, including their symptoms, their severity, and how they can affect facets of your life that you might not have considered.

If you or someone you love has suffered a concussion or head injury in the Louisville, Kentucky area, board-certified sports medicine physician Dr. Stacie Grossfeld at Orthopaedic Specialists PLLC can help. Orthopaedic Specialists PLLC is accepting new patients, and same day appointments are available. For additional information or to schedule an appointment, please contact Orthopaedic Specialists PLLC today at 502-212-2663.

The post A Study on Concussions: Meet Harriet Owen, Professional Cyclist appeared first on Louisville Bones.

When it comes to sports, especially athletes who are serious about their performance and further opportunities, equipment plays a big part in a lot of different aspects of the game. From how well they play, to how long, to if they can at all since there are a lot of requirements – sports gear can very quickly become a pricey addition to giving up evenings and weekends to get to practices or watch games. Unfortunately, some sports require more equipment than others and, for safety’s sake, need to be replaced more often.

From structural integrity to an entire change in your form that puts more pressure on your bones and joints, phasing out gear is integral to those who participate in sports regularly. If you’re not sure if you or your child’s equipment needs to be replaced, we’ve done the research for you and have come up with a list of sports and their subsequent equipment that needs to be inspected, monitored, and renewed once their time in the safety parameter is up.

Running Shoes

When it comes to specialized sports gear, running is one that doesn’t require an entire bag of different items. However, the equipment it does require – running shoes – are a very important detail that contributes both to performance and safety.

As shoes wear out, they will:

• Lose tread, which can lead to slipping
• Develop fabric holes in the top
• Lose sole cushioning, which leads to more impact on your muscles and joints and more strain in your tendons and ligaments, and even stress fractures
• Cause your gait to change with the deterioration of material

To avoid this, it is recommended that you change your running shoes out every 300-500 miles or 4-6 months. Pay attention to your runs, though, and if you run more than that, it could be sooner!

Signs that shoes (include cleats!) are getting worn down and need replacing:

• You feel more sore or have aches and pains in your feet, ankles, knees, hips, or spine
• You get new blisters/the shoes are uncomfortable
• The shoe shows excessive wear or breakage on the interior or exterior
• The shoe doesn’t feel like it protects you anymore

Cleats

So many sports require cleats to play; you’ll often find that cleats are not interchangeable between each individual playing field. Even so, some are similar in regard to how long you can wear them, and others are quite different. Sports gear that is categorized as non-running shoe footwear is just as important as running shoes, but with the highly differential nature between pure running and running during a game, need to be treated differently, as well.

• Cycling:

For these specialized cleats, it’s recommended that they’re replaced every 3,000-5,000 miles cycling or when you notice them either beginning to get stuck in the pedal or not catching on.

• Soccer:

Usually, every season does a number on soccer cleats. By the time a full, higher-intensity season is finished, they might be holding on by a few threads! For a lower-level season, such as a recreational or school league, cleats will usually last for a couple of seasons, but replace when they begin to lose shape or form holes, since every position will have a different playing style and intensity, which affects the life of the boot.

• Football:

Like soccer, football cleats will usually only last for one season. Depending on the surface that you’re playing on, though, you may be switching from one type of cleat to another, and each pair will last a little longer.

• Baseball/Softball:

In general, baseball and softball cleats will last around 6 months to a year, or approximately 1-2 years of weekly games, depending on how often they’re used. If they are used in a higher league, where practices and games multiple times a week occur, then it will be much shorter. Cleats should provide stability, grip, and acceleration; once they stop giving that, it’s time to invest in a new pair.

• Honorable mention: Skates:

With skates, since the actual fabric and material part never actually touch the ice, more often then not, it’s only the blade that needs to be replaced. It’s recommended that the blades be replaced once they are dulled down to lower than 3/8″ at the center of the ball of the foot area or the center of the heel area. In regard to the material part, you should be on the look out for loose rivets, holes, proper stiffness and support, and quality of the blade holder.

Mouth Guards

As a general rule, you should be replacing your mouth guard after every season or every 6 months. Not only does this provide cleanliness and sanitation, but mouth guards become less effective with use, thinning out and fraying and not being able to protect your teeth as well.

However, especially with younger mouth guard-wearers, there are some circumstances that they should be replaced sooner. These are:

1. If it gets damaged, thins, or deformed
2. If your mouth is still growing or you are undergoing orthodontic treatment
3. If your bite has changed (losing baby teeth or getting wisdom teeth removed will both change a bite)

Helmets

Depending on the sport, again, helmet replacement has a different time frame, especially in reference to the material it’s made with and how it’s used.

• Bike helmets: Every 5-10 years depending on amount of use. More biking = sooner. Less biking = later.
• Football helmets: The CDC recommends every helmet be replaced entirely every 10 years, but reconditioned and recertified every 2 years.
• Batter/catcher helmets: After 10 years, batter helmets are not eligible for recertification and should therefore be replaced. However, some helmets are recommend not to recondition/recertify at all, and should be replaced every 3-5 years, depending on the quality of it.
• Motor sports and equestrian helmets: Every 5 years is the standard, but if the material shows any signs of extreme wear and tear such as cracks, tears, breakage, or loose parts, its essential that it’s replaced sooner.

Gloves

There is a lot of nuance to softball and baseball gloves, which are the two sports that use them for safety reasons along with performance.

The life and safety that a glove provides depends heavily on the use and care put into the glove. For higher leagues, the normal life of a glove is about 2 years, and then noticeable wear and tear begins to show, and the replacement happens. In order to protect the thinly covered bones in your hand from the intense and often fast-moving projectiles that you’re trying to catch, your glove needs to be up to the task of giving you the best performance and the best protection.

It’s important to phase out gloves when:

1. The padding feels thin and your hand feels unprotected
2. The material feels dense and heavy when you use it
3. There is a ripping, cracking, or other physical deficiencies
4. The form is floppy, formless, and doesn’t hold shape anymore

Bats and Rackets

With these types of very necessary pieces of sports gear across the board, phasing them out can be a question of safety, especially when considering average breakage points and whether or not the gear breaking would put anyone at risk at any given time, but more often than not, this category of gear can be phased out when it loses its functionality.

Baseball bats, with as much as they’re thrown around in proximity to other players and fans, are probably the riskiest of the items in this category, and their time in the hands of players usually lasts from 1-3 years. Especially with wooden bats, which break and shatter more often than composite and aluminum bats, there should be consistent and often inspection of bats to make sure that there are no physical deformities, rips, tears, or sharp edges present.

Tennis, pickleball, squash, badminton, etc. rackets should be inspected for any fraying of the strings, as well as any exposed material underneath the grip of the racket that might cause you pain when it twists and shifts as you play. The materials begin to break down with the nature of the game – flexing and bending in a way that, overtime, will distort the racket and cause structural degradation. It’s suggested that, on average, around every 2 years, you might want to start looking for an upgrade.

Protective Gear/Pads

In football, with as much contact as there is, it’s important for the safety gear outside of helmets to be properly cared for, reconditioned, and replaced. Shoulder pads should be cleaned and sanitized after every use, reconditioned every year, and replaced every 3-4 years. Sometimes, the retired pads can be reused and passed down to the junior varsity team for practice or a younger league that isn’t as intense as others are, but protective sports gear needs to be up to standard and able to prevent injuries in those situations for them to be ethical.

Have You Had a Sports Injury Near Louisville, KY?

If you or someone you love has suffered a sports injury in the Louisville, Kentucky-area, board certified sports medicine physician Dr. Stacie Grossfeld at Orthopaedic Specialists PLLC can help. Orthopaedic Specialists PLLC is accepting new patients, and same day appointments are available. For additional information or to schedule an appointment, please contact Orthopaedic Specialists PLLC today at 502-212-2663.

The post When to Phase Out Sports Gear for Safety Reasons appeared first on Louisville Bones.

Deductibles 

Deductibles are the out-of-pocket costs determined by the insurance plan you chose. Once your deductible is met for the year, costs are either reduced or eliminated, making the cost of treatment much lower. If you’ve been thinking about an elective procedure or visiting Jaffe Sports Medicine an appointment, check to see if your deductible has been met and plan accordingly before the end of the year.

Out-of-pocket Maximums

If you have met your out-of-pocket maximum, all other costs will be met in full by your insurance. Assess your benefits to see what your out-of-pocket maximum amount is and if it has been met. It so, this is a great time to schedule any procedures or buy medications before the year is over. 

Government Savings Plans

Savings plans such as health savings accounts (HSAs) or flexible spending accounts (FSAs) help pay for medical expenses not normally covered by insurance. HSAs are tax-free savings plans that do not have to be met in a calendar year. It can help you pay for deductibles, co-insurances and co-pays as well as prescriptions. FSAs are tax-free accounts that must be used in the current year, or you will lose any remaining money. Be sure you have checked the amounts in these types of accounts so that you know what will roll over from your HSA for next year, or what you have left to spend in your FSA so that you do not lose it. 

Regardless of your plan, it is always good to be mindful of your benefits. December is a great month to “Use ‘em before you lose ‘em.” Call today to schedule doctor visits or procedures before the end of the year so they will be covered by insurance or at a lesser cost. To schedule an appointment with Jaffe Sports Medicine, visit jaffesportsmedicine.com/locations/ to make an appointment.

The post Now is the Time to Use Your Health Insurance Benefits Before the Year is Up first appeared on Jaffe.

Ankle Sprain

An ankle sprain occurs when the foot is twisted either too far inward or too far outward, damaging the ligament. Most sprains cause only a moderate amount of damage and pain and can be healed through the R.I.C.E. method–rest, ice, compression, and elevation. 

Sprained ankles are common in sports where a quick pivot is necessary, such as turning on a dime to intercept a ball carrier in football. Strengthening the core and leg muscles and ensuring the use of supportive footwear can help prevent sprains. If an athlete is prone to having “weak ankles,” they can also wear a brace to stabilize the ligaments. 

Achilles Tendinitis 

Achilles tendinitis is a cumulative injury that occurs due to overuse of the Achilles tendon. The tendon becomes inflamed, causing sharp pain along the back of the foot. This condition happens gradually over time as the tendon wears down after continued use. Most often, the onset of pain happens when an exercise routine becomes even more active, such as in various sports training camps. 

In many cases, cortisone steroid injections will help reduce inflammation and alleviate pain. It is recommended that the patient decrease their exercise and rest the affected foot whenever possible. Physical therapy can often be helpful as well, allowing the tendon to stretch so that it’s more resilient and resistant to injury.

Stress Fracture

Common in sports with a lot of repetitive motion, such as basketball or tennis, stress fractures are not breaks of the bone but rather cracks caused by repeated impact. Poor conditioning and improper equipment can create a situation where the foot or ankle are not getting the support they need, and the resulting fracture only compounds the problem with pain and swelling of the affected area.

Athletes should take care to wear supportive foot or ankle braces to help reduce the impact on vulnerable bones. Acknowledging pain and taking days to rest the foot can help prevent most stress fractures. 

When you’re involved in sports, it’s important to know your body’s limits and respect them. If you’re experiencing pain in your foot or ankle, notify your doctor and rest the affected area as much as possible. Doing so should help you avoid some of the most common sports injuries.

Contact our experts at Hampton Roads Orthodopaedics Spine & Sports Medicine. We want to help you get back to the activities you love by treating any new or old sports injury you may have. Call 757-873-1554.

The post 3 Common Foot and Ankle Sports Injuries (And How to Avoid Them)  appeared first on Hampton Roads Orthopaedics Spine and Sports Medicine.

Heidi joined Hampton Roads Orthopaedics Spine and Sports Medicine in October 2022 as a nurse practitioner. We are grateful to have her on our team. She is experienced, kind, caring and motivated. She genuinely cares for her patients and loves what she does.

Education and Experience

Originally from New York, Heidi received her Bachelor of Science in Nursing from Hartwick College and her Bachelor of Science in Athletic Training from Canisius College. She went on to earn her Doctor of Nursing Practice from the University of San Diego.

Heidi is board certified by the American Association of Nurse Practitioners. She was the recipient of the United States Air Force Health Professions Scholarship Program, and served in the United States Air Force as a primary care provider. In New York, she worked on a specialty orthopedic, trauma and spine unit at a level one trauma center.

Outside the Office

Outside of the office, you can find Heidi with her family and two dogs. She loves fitness, spending time outdoors, golfing and hiking.

Come see us in Hampton 

You can feel comfortable and confident knowing that you are in the experienced and caring hands of our healthcare professionals at Hampton Roads Orthopaedics Spine and Sports Medicine. If you are dealing with chronic pain or discomfort, a lingering sports injury, chronic wounds, or other orthopaedic concerns, schedule an appointment online or call (757) 873-1554.

The post Introducing Heidi Blaski, DNP, FNP-C appeared first on Hampton Roads Orthopaedics Spine and Sports Medicine.

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Grant Wahl was a well-respected and well-known soccer analyst and journalist. He died recently in Doha during the 2022 world cup. While the precise cause of death is not known, the symptoms he shared in his newsletter are telling. His story should help inform others about the risks of heart disease and how the symptoms […]

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As a runner, it’s essential to take care of your body and avoid habits that can lead to injuries or burnout. Here are four things that runners should avoid in order to stay healthy and keep improving. To properly warm up, start by doing some light stretches and dynamic movements, such as walking lunges, leg […]

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Don’t just reach for a protein shake or frozen pizza when dinner time rolls around. Invest your time and money in food that’ll foster your overall health, enhance your physique and reduce your chances of illness in the long run.

Bring this list with you to the grocery store and stock up on these 10 foods to help build muscle, increase strength and improve your health:

Eggs. As one of nature’s most complex, complete, and flexible foods, eggs are the gold standard of protein. Every egg contains 7 grams of protein, plus a host of other essential vitamins and minerals.

Wild Salmon. With 20 grams of protein in every 100-gram serving, wild salmon will accelerate your results while sports training in Phoenix. Wild salmon is also a great source of omega-3 fatty acids. Avoid farm-raised salmon, though – they’re often fed a poor diet, so contain limited nutritional benefits.

Quinoa. Interestingly, quinoa packs more protein than any other major grain. Moreover, it’s a rich source of minerals and vitamins, particularly B vitamins. If you’re unfamiliar with B vitamins, they help metabolize and digest proteins and carbohydrates, helping you bulk up.

Spinach. Take it from Popeye. Spinach is fantastic fuel for muscle building because it contains iron and nitrates to promote muscle growth. These nitrates also help regulate blood pressure, immune defenses, and cell metabolism. Serve your dinner on a bed of spinach (cooked or raw) every night for constant, delicious intake.

Greek yogurt. Dairy contains both high-quality protein and a mixture of fast-digesting whey protein and slow-digesting casein protein. Research has shown that people experience increases in lean muscle when consuming a combination of fast- and slow-digesting dairy proteins. But not all dairy is created equal. Greek yogurt contains approximately double the amount of protein as regular yogurt.

Sunflower seeds. With 23 grams of protein per serving, sunflower seeds are a delicious and healthy snack for building muscle. Sunflower seeds earn health food bonus points because they’re low in cholesterol and sodium.

Soybeans. Yes! Only half a cup of cooked soybeans contains 16 grams of protein, healthy unsaturated fats, and several vitamins and minerals. Soybeans are a particularly good source of vitamin K, iron, and phosphorus. Iron is used to store and transport oxygen in your blood and muscles.

Chicken. You probably already know that chicken is a staple in any high-protein, low-fat diet. Here’s why: chicken’s protein-to-fat ratio is unbeatable – a hearty 100-gram serving packs a whopping 31 grams of protein with only 4 grams of fat. For a delicious, protein-packed lunch, stir-fry your chicken with spinach, quinoa, and garlic.

Tuna. In addition to 20 grams of protein per 3-ounce (85-gram) serving, tuna contains high amounts of vitamin A and several B vitamins, including B12, niacin, and B6. These nutrients are important for optimal health, energy, and exercise performance. Additionally, tuna provides large amounts of omega-3 fatty acids, which support muscle health. Particularly important for older adults. Research has shown that omega-3 fatty acids can slow the loss of muscle mass and strength that occurs with age.

Lean jerky. When you’re on the go, try a high-quality protein from meat such as lean jerky. Many different types of meat can be made into jerky, so the nutrition facts vary. Most fat is removed from lean jerky during processing, so almost all calories in jerky come directly from protein.

Lastly, try protein powders if you need a quick meal replacement or a quick and easy option to add more protein to your daily routine. While any good diet should focus on whole foods, there are times when dietary supplements can be beneficial. If you have trouble getting enough protein from foods alone, you could consider adding protein shakes to your daily routine. Dairy protein powders, such as whey and casein, are some of the most popular. Other options are soy and pea.

If you would like more information on how to keep your body functioning at optimal performance, please contact your local Foothills Sports Medicine Physical Therapy clinic today!

The post 10 Foods to Increase Muscle Strength appeared first on Foothills Sports Medicine Physical Therapy.

MYTH 1: “Aches and pains are expected with exercise.”

This is absolutely not the case. Muscle soreness is often expected after workouts, but pain or discomfort in your back, knees, or ankles is never normal. Understanding the difference between muscle soreness and pain in the muscles and joints is essential. Muscle soreness can often feel dull or tight, or you may feel fatigued, whereas pain can be sharp and often linger with no relief. Aches and pains often arise when you are not adequately taking care of your body. Exercise should not be a negative experience for you; it should be a time you enjoy and are focused on yourself and reaching your goals.

MYTH 2: “The longer my workout, the more beneficial it is.”

Time is often one of the biggest excuses people use not to be active. Working out does not have to consume your entire day or even a whole hour. The American Heart Association suggests only 30 minutes a day for five days a week. Let’s put that into perspective: studies have recently shown that the average person spends about 90 minutes on their phone daily, leading up to about 23 days a year and about 3.9 years of an average person’s life. You can incorporate this activity into your daily routine by walking at lunch, parking farther away from your office, or even taking the stairs multiple times throughout the day. Be smart with your activity, work hard while you are training, and always put your best effort into your workouts, and you will not have to spend hours at the gym.

MYTH 3: “I’ll never be flexible—my muscles have been tight all my life.”

Muscles can be trained. It was inflexible stems from not correctly training your muscles. Whether you don’t exercise consistently or exercise incorrectly, both can cause muscle imbalances. Our body is a machine that needs every single part to work together correctly to function at its fullest potential. When we have imbalances in our bodies, we will find ways to compensate, creating restrictions. Incorporate a foam roll session into your daily routine to promote the tissues’ ability to return to a relaxed state.

MYTH 4: “If I’m not sore or in pain, I’m not working out hard enough.”

Do not make soreness your priority. Many factors contribute to being sore, including but not limited to the type of exercise, the number of reps, and the weights being used. Try to use other tangible measures to verify that you are working hard, i.e., your progress from session to session. Are you able to complete more this time? What is your fatigue level in comparison? Use your feelings after a workout. How is your stress level? Are you feeling happy?

If you have questions about what you may feel during your workouts or other activities, schedule a visit to one of our many locations for a complimentary Rapid Recovery Injury Assessment.

The post Debunking 4 Fitness Myths appeared first on Foothills Sports Medicine Physical Therapy.

IASTM is the newest soft tissue mobilization technique that has hit the industry. It is a type of treatment that allows your Physical Therapist to break down scar tissue and fascial restrictions effectively and restore normal soft tissue texture, flexibility, and function quickly.

It utilizes several specialized tools to treat soft tissue injuries. For example, it can be used on any body, including muscles, tendons, ligaments, fascia, and joints.

While many people use the IASTM technique as a treatment method for acute injuries (such as strains), some choose this type of therapy as a preventative measure – especially if they are highly active and know they’re at risk for overuse injuries. IASTM can help loosen up tight muscles and tendons—which allows your body to heal more quickly—reducing your risk of chronic pain or re-injury in that area.

How IASTM Works

IASTM uses a variety of instruments on the body, including flat and curved bars, rubber balls, and brushes, to apply pressure directly to tight muscles or tendons. The application of that pressure breaks down scar tissue, relieves inflammation, and stimulates healing underneath the surface of your skin.

The goal is to increase blood flow in those areas, so they heal more quickly and efficiently; this also improves flexibility as it loosens up stiff joints and moves quickly (which helps reduce pain). Increasing oxygenation in your injured joint or tendon tissue, IASTM helps relieve swelling, so you don’t suffer from chronic stiffness after every workout session (or a long day at work). The best part about IASTM is that it’s non-invasive, meaning you don’t have to worry about surgery or taking time off work to heal. It’s also much less painful than other forms of physical therapy (like deep tissue massage), so it’s easier for most people to handle.

Combining these two treatments is powerful, as it can help you recover from injury faster. With IASTM and physical therapy in your arsenal, you’ll be back to full strength (and pain-free) in no time!

What Are the Different Tools Used in IASTM Therapy?

IASTM tools are designed for the treatment of soft tissue injuries. They’re made from high-quality materials like stainless steel, Teflon-coated tips, and silicone. So they don’t irritate your skin as you work out knots in tight muscles that repetitive or strenuous movement patterns may have created (e.g., crossing arms over chest all day).

The variety of Instruments available makes it possible for therapists to customize their treatments based on the needs of their clients. Physical therapists can use IASTM tools to treat acute and chronic soft tissue injuries and provide preventative measures against future problems. The instruments can also work in other types of treatment, such as trigger point therapy and myofascial release. They can be used on many body parts, including muscles, tendons, ligaments, and fascia. The tools are designed to apply a specific amount of pressure to tissue so that a therapist can work through it without causing damage or pain to the client.

The tips of these instruments can be either blunt or sharp, depending on the treatment given. As a general rule, the sharper the tool, the more intense and specific the soft tissue treatment.

What Conditions Does IASTM Treat?

IASTM can treat a wide range of conditions, including:

• Muscle and tendon injuries
• Arthritis
• Frozen shoulder
• Sports injuries
• Tennis elbow
• Plantar fasciitis (heel pain)
• Fibromyalgia
• Sciatica (pain due to irritation or compression of the sciatic nerve)
• Carpal tunnel syndrome (numbness and tingling in fingers and hand)
• Tension headaches

Benefits of IASTM Therapy

The goal of IASTM therapy is to promote healing and reduce pain. It does this by increasing circulation, breaking up scar tissue and fascia (connective tissue), loosening tight muscles, reducing inflammation, and stimulating nerves. This helps the body recover faster from injuries and improves overall health by preventing future problems. The benefits of IASTM therapy include:

• Reduced pain and inflammation
• Increased blood flow and lymph flow
• Improve the following range of motion (ROM)
• Less muscle soreness after activity
• Better sleep
• Better overall health

How IASTM Helps Muscles and Tendons Heal More Quickly

When you have a muscle or tendon injury, your body will try to repair it by creating scar tissue and new collagen. This takes time and can cause pain and stiffness. IASTM helps speed up this process by breaking down scar tissue and fascia (connective tissue) to allow blood and lymph to flow through your tissues more easily. This helps speed up recovery while also preventing future problems.

How IASTM Increases Range of Motion

Muscles and joints are often restricted because of scar tissue or adhesions that have formed between your muscles and fascia. This is even more likely to happen if you’ve had an injury. IASTM helps break down these adhesions so your body can move more freely.

How IASTM Reduces Chronic Pain

The body naturally wants to be in a state of homeostasis or balance. When you injure yourself, your body goes into protection mode and creates adhesions between muscles and fascia to stabilize the area and prevent further injury. The problem is that these adhesions can cause pain when they limit the range of motion or make movement difficult. IASTM helps reduce this chronic pain by breaking down scar tissue so that blood and lymph can flow freely through your tissues.

Conclusion

Instrument Assisted Soft Tissue Mobilization (IASTM) is a safe, effective treatment for many conditions. IASTM uses a curved or flat surface instrument to apply pressure to tight muscles and tendons. This therapy stimulates healing by increasing blood flow and breaking up scar tissue.

IASTM can help you in the following ways: reduce pain, increase range of motion and improve muscle function. If you have any reason to believe that you may be suffering from injuries such as chronic low back pain or neck issues, please request an appointment with Foothills Sports Medicine Physical Therapy today to see if IASTM is the proper treatment for you.

The post What is Instrument Assisted Soft Tissue Mobilization (IASTM)? appeared first on Foothills Sports Medicine Physical Therapy.

If you've recently sustained a knee injury and are experiencing pain on the inner side of your knee joint, you may be wondering if you tore your medial collateral ligament (MCL). 

Whether from a fall while skiing, a twist of the knee playing soccer, or a hard hit during ice hockey, MCL tears are a common injury among athletes. 

In most cases, MCL tears can be treated without the need for surgery. However, they all require proper care to heal fully and avoid damage to other structures of the knee.

 How Do MCL Tears Occur?

The MCL is a band of tissue that runs along the inside of your knee, connecting the shinbone to the thigh bone. It helps stabilize the knee joint and prevents your knee from bending too far inward. 

The MCL can be stretched or torn when a force pushes the knee joint beyond its normal range of motion. Common causes include:

• A direct blow to the outside of the knee, like from a tackle in football

• Hyperextension of the knee (read more about how this commonly occurs in skiers)

• Landing awkwardly from a jump

• Sudden twisting of the knee during cutting or pivoting maneuvers, like in soccer

What Does a Torn MCL Feel Like?

Symptoms are often felt on the inner side of the injured knee and will vary depending on whether the ligament is stretched, partially torn, or in severe cases, completely torn. These include:

• Immediate pain

• Tenderness

• Bruising

• Feeling like the knee may give out

• Difficulty walking or bearing weight

• A popping sound when the injury occurs

What Is the Treatment for an MCL Tear?

The good news is that the MCL has an excellent blood supply, which means that the ligament can often heal on its own and without the need for surgery. 

At Vail-Summit Orthopaedics & Neurosurgery, Dr. Sterett will start by reviewing your medical history, symptoms, and how the injury occurred. He will then examine your knee for signs of tenderness, swelling, and instability. Imaging tests may be ordered to confirm the diagnosis and the severity of the tear, which is graded on a 1 to 3 scale.

• Grade 1: Mild injury where the MCL is stretched but not torn.

• Grade 2: Moderate injury where the MCL is partially torn.

• Grade 3: Severe injury where the MCL is completely torn.

Once a diagnosis is confirmed, Dr. Sterett and his team will work with you to develop a comprehensive treatment plan unique to your needs, recommending conservative measures whenever possible. Treatments methods may include:

• Rest, ice, compression, and elevation (RICE)

• Anti-inflammatory medication

• Restricted weight-bearing

• Knee brace 

• Physical therapy

Biologics such as stem cells or PRP have been used to promote a more rapid or robust healing of a complete MCL tear.  Make sure you ask about this option!

While recovery times vary widely depending on the injury's severity, grade 1 and 2 tears generally take two to four weeks to heal, while grade 3 tears can take up to eight weeks or longer. 

Surgery is usually only recommended in cases where:

• There is a complete tear of the MCL off of the tibia. MCL tears off the femur (these account for over 90% of tears)  typically do not need surgery. 

• There is damage to other ligaments.

• The tear isn't sufficiently healing after conservative therapy.

Contact Dr. Sterett for Expert Treatment of MCL Injuries

If you're experiencing knee pain and think you might have injured your MCL, contact Dr. Sterett and his team at Vail-Summit Orthopaedics & Neurosurgery today. 

Whether your goal is to get back to professional sports or return to your favorite mountain activities, Team Sterett will develop an individualized treatment plan that helps you achieve your goals.

Call (970) 476-7220 to schedule an appointment today at convenient locations in Edwards or Vail, Colorado. You can also request an appointment online. 

Whether you are a professional, college, or high school athlete (or maybe just a weekend warrior), you know that injuries can happen when you least expect it. Sometimes, it’s a traumatic injury because your body was pushed beyond its limit and sometimes, the injury comes from simple overuse. And every athlete wants to get back on the field, court, or track as quickly as possible.

Many athletes have discovered that acupuncture is an ideal treatment to augment recovery, speed up healing, and reduce pain. Acupuncture basically works like this. When you suffer an injury, the flow of energy (also known as Qi) to and from the area becomes disrupted which causes pain and stagnation. Blood circulation can also be limited which can extend healing times, prolong swelling and bruising, which all combine to most people taking more pain medications.

Acupuncture is used to reestablish the flow of Qi, or energy, to the injured area. This all helps to increase circulation, blood flow and to remove cellular waste from the injury. Your acupuncturist might also add herbal medicine to your acupuncture treatments to help alleviate pain. Herbs used for injuries can be applied topically or taken internally, depending on the type of injury sustained.

According to the Pacific College of Health and Science, “Specific acupuncture styles and techniques were developed to stop pain and dramatically increase recovery time. This tradition continues today, and its use has expanded into competitive athletics that result in similar injuries. Pain is one of the most common complaints in sports injuries followed by reduced function. The whole approach of Traditional Chinese Medicine and acupuncture to the treatment of pain and reduced function is to see it as a disorder in the body’s natural state. The treatment is geared toward rectifying the disorder and restoring internal harmony.”

“Recent studies show that acupuncture effectively treats sports injuries such as strains, sprains, neck, shoulder, elbow, wrist, hip, knee and ankle pain, swollen muscles and shin splints. In addition to treating the injury, Acupuncture can also improve performance and give athletes a competitive edge.”

Because of this “competitive edge,” many professional sports teams have acupuncturists on staff to help shorten healing time and resolve overuse injuries (i.e., throwing/pitching, tennis elbow/shoulder, track and field injuries, etc.). However, you don’t have to be a competitive athlete to benefit from regular acupuncture treatments.

A 2015 study from Zhengzhou University examined the effects of Traditional Chinese Medicine style acupuncture and herbal treatments on amateur and professional athletes suffering from motor impairments due to physical training. The study ultimately found that the “total effective rate for the acupuncture only group was 70% and the herbal medicine group achieved a 62% effective rate.” Not bad results at all. However, the group receiving both acupuncture and herbal medicine achieved a total effective rate of just more than 84%. The researchers concluded that “acupuncture combined with herbs is highly effective for the treatment of physical activity induced motility impairments. The combined therapeutic approach is more effective than either treatment modality as a standalone procedure.”

If you are training for a triathlon or marathon, or you are a regular at the tennis courts or the golf course, you might want to consider regular acupuncture treatments to keep those injuries at bay. Talk to your acupuncturist about different preventative measures to stop injuries before they start or talk to them about a recovery plan if you have already had an acute traumatic injury. They can help you reach your goals of getting back in balance and getting back to the sports you love. Don’t wait, make an appointment today!

Acupuncture for Sports Injuries was last modified: October 26th, 2022 by admin

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A Harris Poll released earlier this year found that approximately three out of ten U.S. adults currently suffer from chronic low back pain. To put it another way, that’s an estimated 72.3 million people! Common treatments usually include prescription medications which bring their own complications and side effects into the picture. If you are looking for a drug-free alternative to your back pain, acupuncture could be the solution you have been searching for. 

What the Research Says

According to the experts at WebMD, chronic low back pain is one of the conditions most touted by research suggesting acupuncture could be an effective treatment tool. WebMD also pointed to guidelines from the American Pain Society and the American College of Physicians who say “doctors should consider acupuncture as an alternative therapy for patients with chronic low back pain that’s not helped by conventional treatment.”

How It Works

If you have never experienced an acupuncture treatment, you might be wondering just how it works. First, your acupuncturist will take a detailed health history to determine the best course of treatment for your pain. They may also prescribe herbs and dietary changes to help your condition as well. 

A typical treatment involves inserting thin needles at specific points on the body. These points help to connect the meridians throughout the body, thus making sure the flow of energy (also known as Qi) is balanced. Stimulating the various points (depending on your particular health concern and the severity of the pain) can correct any energy imbalances, thus relieving pain with little or no side effects. The medical experts at WebMD also believe that “acupuncture has fewer adverse side effects than many of the standard treatments for back pain. 

Many people wonder how many treatments it will take to find relief. It all depends on the severity of the issue but typically six to twelve sessions are scheduled. Again, depending on the severity of the condition, sessions can be done once or twice a week and can last for 30 to 90 minutes. Less severe issues could require fewer treatments, but in severe cases, additional sessions may need to be scheduled to completely address the condition. 

In general, the acupuncture points that focus on treating back pain are found on the hands, at the back of the knees, on the hips, stomach, lower back, and feet. Two of the most common points that can help relieve back pain are Liver 3 and Kidney 3. A 2019 study published in Pain Medicine measured the effects of acupressure as a treatment of chronic low back pain. Researchers found that “the relaxing and stimulating acupressure groups showed a pain reduction of 35% and 36%, respectively, which was greater than the care group. The stimulating acupuncture group also experienced better fatigue improvement compared to the care group.”

It’s important to note that your chronic back pain could be a sign that there are other issues and imbalances happening in your body. This is something your practitioner will consider as they conduct the health history intake with you before treatment begins. In addition to relief from your back pain, you may notice other positive side effects like improved digestion, better sleep and less stress and anxiety. 

If you suffer from chronic back pain and are looking for a treatment option with little to no side effects, call your local acupuncturist and make an appointment today! 

Acupuncture for Chronic Back Pain was last modified: November 28th, 2022 by admin

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Why is this study important?

Mindfulness is an innate ability that is underpinned by skills that can be learned, practised, and enhanced. It entered western medicine in the form of group-based stress reduction programmes where participants are taught meditative practices. The aim is to improve their ability to focus on the present moment and be non-judgmentally aware of the thoughts and feelings that arise. Mindfulness has since become a popular and widely recommended means of improving mental health, with many other mindfulness-based programmes emerging, including some specifically designed for athletes.

Mindfulness-based approaches have also been used in sport as a way to improve athletic performance, so it’s feasible that they have the potential to improve both mental health and performance. By delivering the programmes to groups, rather than on an individual basis, some of the stigma associated with seeking mental health support could also be reduced. Our study evaluated the best available evidence to determine whether mindfulness-based programmes were an effective method of improving elite athlete mental health.

How did the study go about this?

Following guidelines for conducting a systematic review, we extensively searched the available literature for studies that randomly assigned half a group of athletes to a mindfulness-based programme and the other half to an active or non-active control (e.g., relaxation, or just training as usual). We included 12 studies that reported relevant mental health assessment scores. Results were extracted from each study and pooled together to allow the data to be analysed as a single dataset. We then compared the mental health results of 314 athletes that had undergone a mindfulness-based programme with the results of the 300 athletes that were in the control groups.  

What did the study find?

Overall, athletes that underwent the mindfulness-based programmes reported improved mental health compared to the athletes in the control groups. Significantly reduced symptoms of stress, psychological distress, and anxiety were reported. Both general symptoms of anxiety and competition anxiety reduced, indicating that mindfulness-based programmes could support performance alongside mental health. Significant increases in psychological wellbeing and mindfulness were also found. Symptoms of depression reduced, but this result was not statistically significant meaning further research measuring depression is required. Only four percent of athletes assigned to the mindfulness-based programme dropped out compared to nine percent in the control group. This tells us that these programmes are an acceptable form of intervention in elite sport settings.

We also found that mindfulness-based programmes designed specifically for sport may be the most effective, and that effectiveness increases as athlete age increases. The results were particularly strong in one study that assessed retired elite athletes. 

What are the key take-home points?

Mindfulness-based programmes improved mental health overall. By developing programmes that are specifically adapted for athletes, and delivering them in group settings with a focus on performance enhancement, it may be possible to broadly improve the mental health of many athletes at once. Mindfulness-based programmes also have the potential to navigate some of the barriers athletes face when seeking-help, and might contribute to reducing some of the stigma around mental health in elite sport. 

Infographic: 

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In this blog post, we will explore our study that investigated the association between degree of rapid weight loss (weight cutting) and in-competition injury in Division I collegiate wrestlers [1]. We used data that was collected over seven years at the University of Wisconsin for the analysis.

Why is this study important?

Weight cutting is a central feature of the sport of wrestling where athletes dehydrate themselves to make weight prior to competition. The goal of weight class sports is to make sure that athletes compete against other athletes of similar size. However, weight cutting is also perceived to be advantageous because it could allow athletes to compete against smaller and weaker opponents, assuming that they can recover quickly enough to be effective. In collegiate wrestling, athletes weigh in only 1-2 hours prior to competition, which doesn’t give them much time to recover and rehydrate [2].

How did the study go about this?

We used prospectively collected DXA scans (dual energy X-ray absorptiometry) from the preseason and midseason setting to assess body composition changes (fat, lean mass, body weight) in that interval. We then compared midseason weight to competition weight to estimate the degree of weight cutting our athletes undergo. In-competition injuries were recorded during those seasons and hazard ratios were calculated.

What did the study find?

The degree of weight cutting among our cohort of collegiate wrestlers was profound—on average, injured athletes cut 7% of their body weight and uninjured athletes cut 5.7% of their body weight. Dehydration of this degree has been associated with impaired cognitive function, lower power output, and lower muscle contraction velocity. In a sport as physical as wrestling, diminished function in these domains could lead to reduced ability to respond to an opponent’s actions and lead to injury. We found that for every kilogram of body weight lost, wrestlers had a 14% increased risk of injury during competition. We also assessed the relationship between win percentage and weight change and found no correlation between them.

What are the key take-home points?

Weight cutting is a feature of weight class sports like wrestling, but there may be opportunities to improve the health and safety of athletes. The NCAA has previously changed weight cutting rules after three Division 1 wrestlers died from complications of massive rapid weight loss. These rule changes have been effective at preventing death [3], but there is an opportunity to further reduce the risk of less catastrophic injury. In collegiate wrestling, athletes must undergo a weight certification process that determines the lowest weight class they may compete in based on their expected weight at a minimum of 7% body fat. One option could be to raise the minimum acceptable body fat percentage allowed. Another possibility is to further reduce the interval from weigh-ins to competition such that wrestlers step onto the mat to compete directly from the scale. This would not eliminate weight cutting, but it would further disincentivize athletes from massive rapid weight loss.

Efforts to transform the rules around weight cutting are likely to face stiff resistance from stakeholders within the wrestling community. Stories about weight cutting are a part of the lore of wrestling culture. As in most sports, discipline is a highly valued trait in wrestling. The ability to endure and excel despite weight cutting is a central feature of this paradigm. Indeed, when the NCAA transformed the weight cutting policies in 1998, prominent figures in the sport vocally opposed such changes even after catastrophic events within the sport [4]. Regardless, the health and safety of athletes are paramount. Education alone will not result in safer degrees or methods for weight loss unless the playing field is level. Reasonable policy changes to limit weight cutting should be considered by the organizations responsible for such legislation, as has been done to improve safety in other sports.

Author affiliations:

Department of Orthopaedics and Rehabilitation, Madison, WI, USA

University of Wisconsin-Madison, Badger Athletic Performance, Madison, WI, USA

University of Wisconsin-Madison, Biostatistics and Medical Informatics, Madison, WI, USA

References: 

1 Hammer E, Sanfilippo JL, Johnson G, et al. Association of in-competition injury risk and the degree of rapid weight cutting prior to competition in division I collegiate wrestlers. Br J Sports Med 2022;:bjsports-2022-105760. doi:10.1136/bjsports-2022-105760

2 Houston ME, Sharratt MT, Bruce RW. Glycogen depletion and lactate responses in freestyle wrestling. Can J Appl Sport Sci 1983;8:79–82.http://www.ncbi.nlm.nih.gov/pubmed/6883617

3 Oppliger RA, Landry GL, Foster SW, et al. Wisconsin minimum weight program reduces weight-cutting practices of high school wrestlers. Clin. J. Sport Med. 1998;8:26–31. doi:10.1097/00042752-199801000-00007

4 Media not telling rest of story, Smith says. The O’Colly. 1998.

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Although recent evidence supports starting non-operative treatment in anterior cruciate ligament (ACL) injuries, orthopaedic surgeons are uncertain in doing so. Will starting non-operative treatment lead to an increase in meniscal tears? This idea is often used as an argument to choose for an early ACL reconstruction. Treating patients is based on scientific evidence, mainly acquired on a group level. This blog is based on a recent study that has given us more high-quality evidence to consider bespoke treatment for the ACL injured patient (1). 

Why is this study important?

About 40 to 60 percent of the patients with an ACL rupture have an associated meniscal tear. A meniscal injury increases the risk for osteoarthritis, can lead to additional complaints such as a locking knee and pain, and often requires surgical intervention. It is thought that persistent instability in the ACL deficient knee leads to more meniscal injuries. Surgeons choose to perform an early ACL reconstruction to reduce instability and hopefully reduce the risk of new meniscal injury. The existing evidence is too weak to conclude that early surgery in ACL ruptures indeed protects for additional meniscal injuries. The available evidence is not from randomised controlled trials (RCT) and is therefore not optimal to address this question. Therefore, we evaluated the risk of additional new meniscal tears in our RCT.

How did the study go about this?

We performed a secondary analysis on data from the Conservative versus Operative Methods for Patients with ACL Rupture Evaluation (COMPARE) trial in which patients with an acute ACL rupture were randomised to early ACL reconstruction (surgery within 6 weeks after randomisation) or rehabilitation therapy with optional delayed ACL reconstruction (at least three months of physical therapy). In the COMPARE trial 167 patients were included and randomised, 85 in the early ACL reconstruction group and 82 in the rehabilitation therapy plus optional delayed ACL reconstruction group. Of the latter, 41 patients (50%) received a delayed ACL reconstruction during two-year follow-up. In the current paper we evaluated whether a meniscal procedure was performed during the two-year follow-up period (yes or no).

What did the study find?

During the two-year follow-up 25 patients in the early ACL reconstruction group (29%, 25/85 patients) had an additional meniscal procedure. In the rehabilitation plus optional delayed ACL reconstruction group 17 patients (21%, 17/82 patients) had a meniscal procedure in the ACL injured knee. Patients that had initial rehabilitation therapy had no more meniscal procedures compared to patients that had early ACL reconstruction (risk ratio 0.67, 95% confidence interval 0.40 to 1.12; p-value 0.12).

What are the key take-home points?

In this study the number of meniscal procedures in patients with an ACL rupture who were treated with rehabilitation therapy and optional delayed ACL reconstruction does not differ from patients who received early ACL reconstruction. Based on the results of this study on data of a high quality RCT, clinicians can safely start non-operative treatment in ACL injured patients without the risk of more meniscal procedures. However, there should still be a focus on preventing meniscal lesions and awareness of secondary risk of osteoarthritis.

Authors and affiliations: 

Sabine van der Graaff, MD, Department of Orthopaedics and Sports Medicine, Erasmus MC University Medical Centre, Rotterdam, The Netherlands

Max Reijman, PhD, Department of Orthopaedics and Sports Medicine, Erasmus MC University Medical Centre, Rotterdam, The Netherlands

Duncan Meuffels, MD, PhD, Department of Orthopaedics and Sports Medicine, Erasmus MC University Medical Centre, Rotterdam, The Netherlands

References:

1. van der Graaff SJA, Reijman M, van Es EM, et alMeniscal procedures are not increased with delayed ACL reconstruction and rehabilitation: results from a randomised controlled trialBritish Journal of Sports Medicine Published Online First: 22 September 2022. doi: 10.1136/bjsports-2021-105235

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Written By:

Brooklyn Wiley, Performance Coach at ATH-North Houston

INTRODUCTION

Stress is something that comes along with the joys of the holiday season and it is important that we prepare ourselves. One of the most important things is staying close to the daily or weekly routine that you and your family have in place. In this post we will give a variety of suggestions to help keep your stress levels under control and be able to enjoy the holidays. Don't let holiday stress keep you down this year by following these four simple tips.

Are you ready for a fitness challenge?

We were lucky enough to attend our annual APA breakfast and hear Peter O'Sullivan speak about recent advances in treatment of lower back pain.

Here are 10 facts about low back pain, backed by a review of the latest medical research evidence(O’Sullivan et al 2019):

1. Persistent back pain can be scary, but it’s rarely dangerous. It can be distressing and disabling, but it’s rarely life-threatening and you are VERY UNLIKELY to end up in a wheelchair.

2. Getting older is not a cause of back pain. Although it is a widespread belief and concern that getting older causes or worsens back pain, research does not support this, and evidence-based treatments can help at any age.

3. Persistent back pain is RARELY associated with serious tissue damage. Backs are strong – if you have an injury, tissue healing occurs within three months. So if pain persists beyond this timeframe, it usually means there are other contributing factors. A lot of back pain begins with no injury or with simple, everyday movements. These occasions may relate to stress, tension, fatigue, inactivity or unaccustomed activity which make the back sensitive to movement and loading.

4. Scans rarely show the cause of back pain. Lots of scary-sounding terms can be reported on scans such as “disc bulges”, “protrusions” or “prolapse” etc. However, the reports don’t say that these findings are very common in people without back pain symptoms and they don’t relate to how much pain you feel or how disabled you are. Scan results can also change and most disc prolapses shrink over time.

5. Pain with exercise and movement doesn’t mean you are doing harm. When pain persists, the spine and surrounding muscles can become really sensitive to touch and movement. The pain you feel during movement and activities reflects how sensitive your structures are, NOT how damaged you are. So it’s safe and normal to feel some pain when you start moving and exercising, and it usually settles down with time as you get more active. In fact, exercise is one of the most effective ways to treat back pain.

6. Back pain is not caused by poor posture. How we sit, stand or bend does not cause back pain even though these activities may be painful. A variety of postures are healthy for the back. It is safe to relax during everyday tasks such as sitting and bending.

7. Back pain is not caused by a “weak core”. Weak “core” muscles do not cause back pain, in fact, people with back pain often tense their “core” muscles as a protective response. Imagine this is like clenching your fist very tightly after you’ve sprained your wrist, which can cause your forearm muscles to feel tense all the time and doesn’t help in relieving the ache that has now spread to the forearm muscles. Learning to relax the “core” muscles will be more helpful in managing back pain.

8. Backs do not wear out with everyday loading and bending. In the same way, lifting weights makes muscles stronger, moving and loading make the back stronger and healthier. So activities like running, twisting, bending and lifting are safe if you start gradually and practice regularly.

9. Pain flare-ups don’t mean you are damaging yourself. While pain flare-ups can be very painful and scary, they are not usually related to tissue damage. The common triggers are things like poor sleep, stress, tension, worries, low mood, inactivity or unaccustomed activity. Controlling these factors can help prevent exacerbations, and if you have a pain flare-up, instead of treating it like an injury, try to stay calm, relax and keep moving!

10. Injections, surgery and strong drugs usually aren’t a cure. Spine injections, surgery and strong drugs like opioids aren’t very effective for persistent back pain in the long term. They can have unhelpful side effects. Finding low-risk ways to put yourself in control of your pain is the key.

Reference:

O’Sullivan, P., Caneiro, J., O’Sullivan, K., Lin, I., Bunzli, S., Wernli, K. and O’Keeffe, M., 2019. Back to basics: 10 facts every person should know about back pain. British Journal of Sports Medicine, 54(12), pp.698-699.

A dislocated shoulder can be quite a painful injury, but there are some excellent dislocated shoulder treatments available that can return the full range of motion.

Shoulder dislocation is a common sports injury. This happens when the upper part of the humerus (or the arm) bone pops out of the shoulder socket. But you do not have to be involved in athletics to have a dislocated shoulder.

Shoulder dislocation can be caused by trauma, such as falling on the arm or lifting a heavy object, or traumatic stress, such as repetitive pressure that gradually loosens the shoulder joint, causing instability and eventual dislocation. If you believe you have suffered a shoulder dislocation, you should seek treatment immediately.

An untreated shoulder dislocation can result in several complications, including torn muscles, ligaments, or tendons, damage to the blood vessels or nerves, or chronic shoulder instability that increases the chance of recurrence and can lead to other chronic orthoepic conditions such as arthritis.

What Are the Symptoms of a Dislocated Shoulder?

If, after a fall, impact to the shoulder area, or simply throughout ongoing physical activity, you experience any of the following symptoms, you should seek immediate treatment at a hospital emergency department or urgent care facility:

• Severe shoulder pain, especially at the joint
• Your shoulder looks visibly out of place
• Inability to move the shoulder, pain upon movement, or shoulder weakness
• Numbness and tingling

Physical palpation and medical imaging such as x-rays, CT scans, ultrasounds, or MRIs will be used to confirm a diagnosis of a shoulder dislocation.

Learn more here: Dislocated Shoulder Treatment 101: Things You Need To Know

Best Dislocated Shoulder Treatments

Treatment for a dislocated shoulder begins with having the dislocated bone replaced in its socket. Once the bone is replaced correctly in the socket, treatment does not end there.

• Additional dislocated shoulder treatments include.
• Activity modification and/or immobilization with a sling
• Anti-inflammatory medication
• Icing or applying heat to the shoulder joint
• Strengthening exercises and/or physical therapy

You should always follow up on any initial dislocated shoulder treatments with a consultation with an orthopedic surgeon. If the shoulder dislocation involves the tearing of tendons and ligaments, which could often be the case, shoulder surgery or other shoulder dislocation treatments may be necessary.

Dislocated Shoulder Treatment at All-Pro Orthopedics

A dislocated shoulder can be a severe injury. It would be best if you never attempted to reset or “pop back in” the dislocated shoulder bone on your own without medical supervision. You could cause further damage.

After going to the emergency room or having your primary doctor treat your dislocated shoulder, you should see a professional orthopedic surgeon like All-Pro Orthopedics for follow-up and additional dislocated shoulder treatment.

A dislocated shoulder often also involves tears in ligaments and tendons or other injuries to surrounding tissues which may require surgery or other orthopedic interventions to repair. At All-Pro Orthopedics, we offer the latest surgical as well as non-invasive and minimally invasive techniques for treating shoulder dislocation and soft tissue injuries.

We have perfected minimally invasive approaches and strive to use these whenever possible to allow for faster recovery times and less shoulder pain so you can get back to doing the things you love that much quicker.

If your dislocated shoulder does not respond to conservative treatment, or your imaging suggests tendon or other soft tissue damage, some of the other dislocated shoulder treatment options include:

• • Minimally invasive arthroscopic reconstruction
    This is a technique where the surgeon will make a small incision in your shoulder area and insert a very thin tube called an arthroscope to see and repair the damage. Arthroscopic surgery allows for quicker recovery times and less pain.

• • Ligament and Tendon Reconstruction and Repair
    It is pretty common for torn tendons and ligaments to also occur with a shoulder dislocation. As part of our advanced dislocated shoulder treatments, we offer arthroscopic techniques to provide ligament and tendon repair and reconstruction in a minimally invasive environment.

• • Bone Transfer and Grafting
    In certain situations, following shoulder dislocation, the bone of the shoulder socket or ball may be damaged. Bone grafting or bone transfer techniques using bone from other body parts may be used to repair this damage as part of your overall recovery from a shoulder dislocation.

All-Pro Orthopedics and Sports Medicine doctors specialize in treating common sports-related injuries and orthopedic conditions such as dislocated shoulders.

As a team of doctors specializing in orthopedics and sports medicine, we can help you reach your physical goals and prescribe individualized treatment plans for your specific needs to get you back in the game as soon as possible.

You can contact one of our friendly appointment specialists in Pembroke Pines, FL at (954) 399-5976 to schedule your initial consultation.

The post Best Treatments for Dislocated Shoulder appeared first on All-Pro Orthopedics & Sports Medicine.

Dr. Hill is a sports medicine physician who specializes in the care of athletes of all ages and a team physician for the Atlanta Falcons. On an episode of The Weekly Checkup, he spoke about injuries all athletes can face, and regenerative medical therapies available at Emory Healthcare’s Orthopaedics & Spine Center.

Caring for Players During a Game

Often, people ask Dr. Hill what it’s like being on the field and treating players during a game. “Four team physicians are at every game,” he says, “Two orthopedic surgeons, and two primary care sports medicine physicians.” Sometimes, cardiologists and neurologists from Emory Healthcare attend the games as well.

If a player may be injured during a game, Hill says, the Falcons’ head athletic trainer and Emory Healthcare’s lead team physician run onto the field. “Those are usually the two guys you see on TV, bending down, talking to players,” he says. “When they come off the field, we divide and conquer – maybe one of us takes the X-ray, or to the blue tent for concussion evaluation, something like that.”

After treating pro athletes for more than a decade, Hill says he’s seen how the NFL’s changes have made a difference to the players. “The NFL’s data has shown that there are less concussions occurring in the average NFL game than before,” he says. He also explained that new guardian caps helped reduce concussions. “So, another way the NFL’s trying to help protect the players by [them] wearing this active extra protection on the helmets.”

Go Where the Players Go

Dr. Hill estimates that 90% of his time is actually spent treating patients who aren’t professional athletes – and who have a variety of conditions or injuries. And at Emory Healthcare, the latest technology and innovative research is a part of making sure every patient receives expert care and new treatment options. For some orthopedic conditions, new research in regenerative medicine therapy might offer some patients pain relief – and one day, maybe more.

One condition that can benefit from regenerative medicine therapy is osteoarthritis, which affects an estimated 58.5 million adults in the U.S.

Osteoarthritis and Regenerative Medicine Therapy

Osteoarthritis is the most common type of arthritis and its symptoms often affect the fingers, knees, and hips. In 2012, physicians at Emory Orthopaedics & Spine Center were among Atlanta’s first health care providers to begin offering regenerative stem cell therapy, a treatment for osteoarthritis and related joint issues. This treatment harnesses the ability of a patient’s own stem cells to repair damaged tissue, reduce pain, and promote healing.

“Regenerative medicine is in the infancy stage in orthopedics,” says Hill. “We are doing lots of research trying to figure out exactly what it is and what it can become. The hope is that one day you may have a muscle tear or knee arthritis or something and you can put some of your own stem cells in there, and that fixes the problem for you – repairs the tendon, heals up your cartilage or your bones.”

Physicians at Emory Orthopaedics & Spine Center in Atlanta are among a select group of physicians around the country to offer stem cell therapy and other regenerative medical therapies for the relief of osteoarthritis pain and chronic tendonitis. These types of treatments are typically used for painful joints for patients who have moderate osteoarthritis in the hip, knee, shoulder, ankle, or thumb and it is not just available only to athletes. These injections provide a non-surgical treatment option for long-lasting relief from chronic joint pain. Emory Healthcare also sometimes treats soft tissue injuries such as tears or severe tendinosis–which is caused by chronic overuse of a tendon–with stem cell therapy.

How Does Stem Cell Therapy Work?

Stem cell therapy can be a treatment option for many patients with osteoarthritis. Stem cell therapy is a unique non-surgical procedure using the patient’s own stem cells and growth factors that may help repair damaged tissue, reduce pain, and promote healing. “Stem cells can be extracted from bone marrow, body fat, and amnio products. At Emory, the physicians practice from the patient’s own cells, which is either from their bone marrow or from their fat,” says Dr. Hill. This is a two-step procedure; a) harvesting of stem cells and b) either the bone marrow or fat is removed and collected to inject them into the patient. Overall, 75-80% of Emory’s patients have had significant pain relief and improved function of the joint following the procedure.

Platelet-Rich Plasma (PRP) Therapy

Another type of regenerative medicine Emory Healthcare provides is called Platelet-Rich Plasma (PRP) therapy, which is commonly used to treat athletes. PRP therapy is a safe, non-surgical procedure that offers pain relief to athletes who endure chronic pain from tendon injuries. PRP therapy uses platelets from the athlete’s blood to rebuild a damaged tendon. “The patient’s blood is drawn and placed in a centrifuge where the blood is spun down into different layers separating the platelets. Then, the platelet-rich plasma is injected into the injured part of the tendon with the guidance of an ultrasound machine,” says Dr. Hill. PRP therapy has been successful in relieving the pain within the three months after the healing process has started.

Physicians at Emory Orthopaedics & Spine Center like Dr. Hill provide lots of care to athletes as well as general patients. The innovative research done at Emory can benefit professional athletes along with patients with osteoarthritis and sports injuries. To learn more about your condition and the treatment options, visit emoryhealthcare.org.

About Emory Orthopaedics & Spine Center

Emory Orthopaedics & Spine Center constitutes over 90 musculoskeletal physicians; the team is supported by athletic trainers and therapists helping to care for the most professional, elite, and collegiate athletes in Georgia – serving as the Official Team Healthcare Providers for the Atlanta Falcons, Atlanta Hawks, Atlanta Braves and Atlanta Dream.

The post Regenerative Medicine Therapy and Sports Medicine with Dr. Destin Hill appeared first on Advancing Your Health.

“We know that the way children grow and develop impacts their risk for sports-related injuries,” says center director Gregory D. Myer, PhD, professor of orthopaedics at Emory University School of Medicine. “Helping kids play safe and stay safe through their growing years can keep them active and competitive.”

Myer began his sports medicine career studying anterior cruciate ligament (ACL) injuries in young women. The ACL is one of two ligaments in the center of the knee and can often be torn while playing sports. Meyer points to research showing that just over half of young athletes return to competitive sports following an ACL injury.

Created in collaboration with the Atlanta Falcons, the center’s efforts focus on the science of making sports activities—from football to fútbol—safer for kids. “Injury of any kind is a key factor for quitting sports,” Myer says. “And with so many young kids playing a lot of sports at a pretty high level, we know we have a huge opportunity to make a difference.

“It makes more sense to start implementing sports injury prevention programs early rather than after athletes play through their high-risk years.”

Myer has found that those high-risk years begin around puberty—a critical time to keep kids active.

“When injuries happen, kids are removed not only from their sport but also from that sport’s built-in social network,” Myer says. “This creates a big risk that kids will head down a pathway of physical inactivity.”

Gaming Their Way to Sports Injury Prevention

To gather information about injury and reach young athletes in a meaningful way, the Emory Sports Performance and Research Center team uses advanced imaging, augmented reality (AR) and virtual reality (VR).

Myer and his team use these tools to see how the brain responds to certain movements and help young athletes train their brains to be safer sports participants.

For example, the team is using magnetic resonance imaging (MRI) to study existing brain connections and whether they can be adapted to reduce injury risk.

The team is also investigating the effectiveness of biofeedback on sports injury prevention. In this study, athletes train by “competing” against characters in AR and VR worlds. There, they receive biofeedback—information about their movements—and can use that feedback to make movement corrections that could prevent future injury.

The center also focuses on concussion prevention and finding better ways to predict when it’s safe to return to play following a concussion. This work is important, Myer says, not only for the impact concussions can have on the brain but also because of the elevated risk they bring for secondary musculoskeletal injuries. Research has shown that sports-related concussions can affect muscle control, which could result in knee or other lower-extremity injuries even after athletes are cleared to return to play.

Broadening Their Reach

While their work relates to a range of sports, the center’s team focuses on basketball, volleyball and soccer, as these athletes have higher rates of knee injuries.

But of the three, soccer is where most injuries occur. That’s why soccer players account for the largest portion of their research population, both for concussion and knee injury studies.

But Emory Sports Performance and Research Center’s work with soccer injury prevention extends far beyond their own facility.

Recently, representatives from the Bundesliga—a professional soccer league in Germany—visited the center to learn more about the work they are doing and see how it could be implemented across their professional and developmental leagues.

As international organizations work to expand injury prevention abroad, the center is also working to reach more people across Georgia and the U.S.

The center’s home base is located next to the Atlanta Falcons training center and inside the Emory Orthopaedics & Spine Center at Flowery Branch. But the team believes they can expand their reach because of the advances and growing availability of personal AR and VR equipment.

“At the Emory Sports Performance and Research Center, we’re trying to find a way to bridge neuroscience with biomechanics to create a mind-body solution to build better and safer athletes,” Myer says. “We see our lab as a place for research, development and testing before deploying technologies more broadly.

“For us, it’s all about creating a healthy love of activity and sport and removing the negatives that injuries can create.”

Innovation at Emory’s Sports Performance and Research Center

The Emory Sports Performance and Research Center located next to the training facility and inside the Emory Orthopaedics & Spine Center at Flowery Branch is a new leading-edge research center, serving both the professional athletes of the Atlanta Falcons as well as community members of all ages. Researchers are focused on injury prevention in young athletes. The team conducts ongoing research and technology development for concussion prevention, sports injury prevention and performance enhancement.

About Emory Orthopaedics & Spine Center

Emory Orthopaedics & Spine Center offers a full range of services to diagnose, treat and repair bones, joints and connective tissue, such as muscles and tendons. Our team puts your health and well-being first. Part of our commitment to patients is making sure you receive the care you need when you need it.

We have 11 office locations throughout metro Atlanta and beyond. We are the official healthcare team provider for the Atlanta Braves, Atlanta Dream, Atlanta Falcons, Atlanta Hawks, and over 40 collegiate, high school and community sports programs.

The post Augmented and Virtual Reality Tools Are Making Sports Injury Prevention Real for Young Athletes appeared first on Advancing Your Health.

The post We Need to Workout How Much Exercise Affects Each Blood-Based Brain Measure for Concussions  appeared first on Sports Medicine Research.

Medial collateral ligament tears cause pain and swelling inside the knee. Generally, MCL injuries settle with a period of bracing and rehab. However, in some cases, the healing of an MCL tear is complicated by calcification, also known as Pellegrini-Steida syndrome. What is a Pellegrini-Steida lesion, and how do we treat it?

What is Pellegrini-Steida lesion? 

A calcium deposit on the top part of the medial collateral ligament is known as a Pellegrini-Steida lesion. Calcification leads to pain and stiffness of movement. Generally, these lesions are more common in men between 25-40, forming weeks after a knee injury.

Causes

In most cases, a Pellegrini-Steida lesion forms after an acute injury to the medial collateral ligament. Tearing of the ligament leads to bleeding and swelling of the ligament fibers. Rather than healing, the body responds by depositing calcium in the torn ligaments. Calcium deposits form within 2-4 weeks of an injury and may take up to 6 months to disappear. In rare cases, this condition can occur spontaneously without an injury history.

Symptoms of Pellegrini-Steida syndrome

Generally, people with this condition describe a history of injury to the inside of the knee. Ususally, symptoms improve initially, only to worsen after 2-4 weeks with increasing medial knee pain and restriction in movement. Some people find they can’t straighten their affected knee fully. In addition, touching the top part of the MCL is painful.

Other causes of inside knee pain need to be excluded, including knee arthritis, an avulsion fracture of the medial femoral epicondyle, semimembranosus tendonitis, or myositis ossificans.

Pellegrini-Steida syndrome Imaging

An X-ray will often confirm the diagnosis of calcification at the top part of the medial collateral ligament. Calcium deposits are seen after about three weeks. Calium can also be seen on ultrasound or MRI.

Treatment of Pellegrini-Stieda lesion 

Most cases of Pellegrini-Steida syndrome settle with conservative management.

Simple treatment 

Generally, we use oral anti-inflammatories to reduce pain and swelling. In addition, rest from sports, range of motion exercises, and rehab will accelerate recovery. Some examples of knee range of motion exercises include heel slides, seated knee bending, and seated chair slides.

Nonetheless, cases that prove stubborn need an ultrasound-guided injection. We direct a needle under ultrasound to break up the calcification into smaller pieces to help the body resorb the calcium deposits. An injection of cortisone around the calcification will also assist in recovery. Generally, it is important for you to see a doctor experienced in ultrasound-guided interventions.

Surgery for Pellegrini-Steida lesion 

Ususally, we only reserve surgery in cases that fail conservative management. In complex issues, we excise the calcification, careful not to remove too much normal ligament.

Overall, results from surgical excision are, at best, unpredictable. Recent studies show a high recurrence rate or laxity from excessive removal of the medial ligament.

Final word from Sportdoctorlondon regarding the Pellegrini-Steida lesion

Pellegrini-Steida syndrome is due to calcification of the medial collateral ligament after trauma leading to pain and restriction in the movement of the knee. Most cases settle with simple treatments such as ice and anti-inflammatory medication.

Related conditions:

• Medial collateral ligament sprain
• Inner knee pain

Dr. Masci is a specialist sport doctor in London. 

He specialises in muscle, tendon and joint injuries.

Ask a question

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About Dr Masci

The post Pellegrini-Steida lesion: What should you do? appeared first on Sport Doctor London.

Kevin D. Plancher, MD, MPH, FAOA, FAAOS traveled to South Korea this past week and attended the Korean Shoulder and Elbow Society (KSES) Fall Symposium. And the 12th Annual Daejoen Shoulder Symposium. While in attendance he gave two lectures representing his research team at the Orthopaedic Foundation; Anterior Instability With Bone Loss: Are You Overwhelmed? A Quick Algorithm To Pick The Best Procedure and Infections in Shoulder Surgery: My Thoughts, My Tricks, and Changing Dogma. Dr. Plancher was also awarded an Honored Professor and a KSES Lifetime Member.

Kevin D. Plancher, MD, MPH, FAAOS, is a board-certified orthopaedic surgeon and founder of Plancher Orthopaedics & Sports Medicine. Dr. Plancher is one of only thirty-six Orthopaedic Surgeons who hold American Board of Orthopaedic Surgery certification in both Surgery of the Hand and Orthopaedic Sports Medicine. He is a Clinical Professor, Department of Orthopaedic Surgery, at Montefiore Medical Center/Albert Einstein College of Medicine and an Adjunct Clinical Assistant Professor of Orthopaedic Surgery, at the Weill Cornell Medical College, Cornell University in New York. Since 2001, he has been listed annually in the Castle Connolly directory as a “top doctor” in his field.

Plancher Orthopaedics & Sports Medicine is a comprehensive orthopaedics and sports medicine practice with offices in New York City and Greenwich, CT. Leaders in orthopaedics, sports medicine, and acute emergency treatment of sports injuries and rehabilitation utilizing the latest techniques in orthopaedic care. plancherortho.com.

The post Globetrotter Kevin D. Plancher, MD, MPH, FAOA, FAAOS Is At It Again! appeared first on Plancher Orthopaedics & Sports Medicine.

Gymnastics Medicine founder Dr. Elly Hart on what to do if you are experiencing back pain in gymnastics.

Back pain is NOT normal for any gymnast or athlete to have. Any gymnast who experiences acute (an injury from a fall or awkward landing) or chronic (long lasting and without a specific fall/injury) back pain should be seen and evaluated by a medical provider.

The incidence of back pain in gymnasts ranges from 25-85% (1) and one study found that for women’s collegiate sports, gymnastics had the highest rate of back pain compared to all other women’s sports (2). Risk factors for having back pain include, but are not limited to, abdominal muscle weakness, tightness with hip extension, shoulder flexion, and thoracolumbar fascia, increased femoral anteversion, genu recurvatum (hyperextended knees), increased thoracic kyphosis (rounded upper back), and performing repetitive motions (specifically extension of the lumbar spine).

To understand more about back injuries, we have to learn about the anatomy. The back is made up of bones (vertebrae), muscles, tendons, ligaments, vertebral discs, nerves, and more. The cervical spine has 7 vertebrae and makes up your neck. The thoracic spine has 12 vertebrae and connects to the ribs. The lumbar spine has 5 vertebrae and makes up your low back. There are vertebral discs between each of the vertebrae and the discs help absorb force from landing and pounding.

If back pain is occurring in your gymnast, you should seek medical attention. During the medical visit a physical exam will be performed, and sometimes diagnostic tests may be ordered. These tests may include an x-ray, MRI, CT scan, or possibly a bone scan.

Once you have been seen by a medical provider you will be given a diagnosis or reason for your back pain. The most common causes of back pain in gymnasts are spondylolysis, spondylolisthesis, discogenic back pain, and mechanical/gymnast back pain (3).

Spondylolysis is a stress fracture or fracture of an area of the vertebra, mostly commonly in the low back, and occurs from repetitive hyperextension (arching backwards) and rotation of the lumbar spine (1,3). Preventable risk factors to have a spondylolysis include, but are not limited to, lacking shoulder flexion, reduced thoracic mobility, reduced hip extension mobility, hinging from your lumbar spine, decreased core strength, and sports/skills with repetitive hyperextension (arching backwards) (3). Gymnasts may explain that they have pain with arching/extension skills such as bridges, back walkovers, and back handsprings in the low back. A medical provider may order a variety of diagnostic tests to understand your back pain and where the spondylolysis is occurring. When a gymnast has a bilateral spondylolysis (fractures on both sides of the vertebra), and the vertebra starts to slide forward this is called spondylolisthesis.

Discogenic back pain is an injury to the disc of the spine and typically occurs in an adolescent or young adult gymnast, or a gymnast with a history of having a spondylolisthesis. It most commonly occurs in the lumbar spine and risk factors for having discogenic back pain include, but are not limited to, sports with repetitive hyperflexion (bending forward), and a history of a previous back injury (3). This typically occurs from repetitive flexion of the spine causing the disc to be pinched or squeezed. Gymnasts typically explain that they have pain with flexion-based skills, sometimes have tingling or pins and needles down their leg, and their pain is worse when they sneeze, cough, or strain. If this injury is suspected, you should see a medical provider and diagnostic tests may be ordered.

Mechanical/Gymnast low back pain is any type of back pain caused by placing abnormal stress and strain on the back and is a diagnosis of exclusion (meaning everything else was ruled out by a medical provider) (3). This can occur in any gymnast and at any age. Risk factors for mechanical/gymnast low back pain include, but are not limited to, decreases in shoulder flexion, thoracic mobility, hip extension, and core strength, and sports with repetitive hyperflexion (bending forward) and hyperextension (arching backward), and a history of previous back injury. Because this is a diagnosis of exclusion your medical provider may order several diagnostic tests.

Once you have been cleared by a medical provider it is important to follow the below steps with your progression back to gymnastics:

• Obtain clearance from a medical provider to go back to gymnastics
• Go slow
• However long you are out, is how long you should take to get back all of your skills
• Listen to your body
• Consider changing elements in your routine – eg if your gymnast has a spondylolysis and extension-based skills caused her injury, consider removing extension-based skills until a later date/farther out from the injury date
• Prevention, Prevention, Prevention (see the next paragraph)
• Have a plan in place and include the gymnast, parent, coaches, and medical team

Prevention is key to avoid back pain. Studies have shown that working on core stabilization/strength, increasing thoracic spine mobility, fixing posture, increasing hip flexor flexibility, and increasing gluteus and periscapular strength can decrease back pain and injuries (1, 3, 4). Other ways to decrease back pain is to look at the “hinge point”-where a gymnast is bending or hinging from (4). Gymnasts should be using their entire spine to arch backwards and flex forward. The back bend should look like a true arch and not an upside-down “V” (see below).

In summary, gymnasts who experience back pain should be seen by a medical provider, the most common causes of back pain are spondylolysis, spondylolisthesis, discogenic back pain, and mechanical/gymnast back pain, and prevention is key to avoid back pain and injury.

References:

1. Spine Injuries in the Sport of Gymnastics. David Kruse, MD and Brooke Lemmen, MD
2. Lumbar Spine Injuries in National Collegiate Athletic Association Athletes A 6-
Season Epidemiological Study. Jeffrey D. Hassebrock, MD, et. al.
3. The Young Injured Gymnast: A Literature Review and Discussion. Elspeth Hart, PAC, ATC; William P. Meehan III, MD; Donald S. Bae, MD; Pierre D’Hemecourt, MD,
FACSM; and Andrea Stracciolini, MD, FACSM
4. Stretching the Spines of Gymnasts: A Review. William A. Sands, et. al.

Dr. Elly Hart, DScPAS, PA-C, MPAS, ATC, LAT is a Physician Assistant at Boston Children’s Hospital and founder of Gymnastics Medicine: Education and Research.

Original blog post can be found in the October 2022 USA Gymnastics Newsletter: https://usagym.org/PDFs/About%20USA%20Gymnastics/wellness/backpain.pdf 

The post Back pain in gymnastics appeared first on Gymnastics Medicine.

Tennis elbow or golfer’s elbow is not a very common condition. It only impacts around 1 to 3 percent of adults every year. But your chances of developing it increase as you get older. Though its name makes it sound like it’s a condition that solely impacts these sports, it is possible to get tennis or golfer’s elbow even if you’ve never played either game in your life. 

Below you’ll find key information to know about this painful condition, including why it happens, how to tell if you have it, and what treatment options are available.

Understanding Tennis / Golfer’s Elbow

Tennis/golfer’s elbow is one of the most common causes of elbow pain. It is often persistent and painful enough to warrant physical therapy and/or a doctor’s office visit. Tennis/golfer’s elbow happens when the tendons that connect your lower arm to the outside of the elbow bone become swollen and inflamed.

As this happens, it can lead to microscopic tears in the muscles and tendons. These tears can cause a lot of pain, even though they’re very small.

Typically, people don’t experience these symptoms unless they make a lot of repetitive motions. Though the general population doesn’t have a high likelihood of getting tennis/golfer’s elbow, as much as half of all players will experience it at some point in their lives.

What Causes Tennis / Golfer’s Elbow

If you’re wondering what are the causes, the answer is a lot of things! As mentioned, tennis/golfer’s elbow usually occurs because of repetitive elbow joint motions. In addition to tennis and golf, here are some other activities that can lead to elbow pain and discomfort:

• Fencing
• Squash
• Weight lifting
• Racquetball
• Raking
• Typing
• Painting
• Carpentry
• Knitting
• Gardening
• Swimming

Did some of the items in the above list surprise you? Fortunately, there are things you can do to decrease your likelihood of developing elbow pain or minimize symptoms if you already have it. Keep reading to learn more.

5 Symptoms of Tennis / Golfer’s Elbow

Do you have elbow pain that makes you wonder whether you have tennis/golfer’s elbow or something else? Though a doctor or therapist should be consulted to make the most accurate diagnosis, these are five common symptoms:

1. Discomfort when you lift something
2. Weakness in your hand or forearm when making a fist or gripping something
3. Recurring pain just below the bend in your elbow (on the outside of your forearm)
4. Pain that radiates from the elbow down toward the wrist
5. Discomfort when twisting the forearm (for example, when opening a jar or a door)

As you can see, the primary symptom is pain in the elbow area. Conditions that mimic tennis elbow include the following:

• Radiocapitellar arthritis
• Osteochondritis dissecans  
• Intra-articular plica
• Rotary instability

A visit to your PT can help rule these conditions out if you aren’t sure whether you have tennis/golfer’s elbow or another condition.

Prevention Techniques

The best way to avoid developing tennis/golfer’s elbow is to avoid making repetitive motions too frequently. If you play a sport or do any other activity requiring repetitive use of your arm and handle muscles, make sure you take frequent breaks. During your breaks, stretch out the muscles of your arms.

It’s also important to warm up the muscles of your arms before engaging in any physical activity that requires using your elbows and/or arms. When the muscles are warm, they can stretch and retract more easily without causing injuries.

When you’re finished with a sports game or workout, and you’ve stretched out your arm muscles, consider applying ice to your elbows if you feel any heat or inflammation in those areas. If you already have tennis elbow symptoms despite your best efforts, consider getting physical therapy.

Physical Therapy Treatment Options

Physical therapy can help improve the flexibility and strength of your forearm muscles, so you’re less likely to develop tennis elbow again. Physical therapy can also facilitate healing and reduce pain by encouraging blood flow to the affected tendons and muscles. Blood contains oxygen, which the muscles need to heal and function optimally.

Six common physical therapy treatment options recommended for tennis elbow:

1. Muscle stimulation
2. Ultrasound
3. Ice massage
4. Braces and tape to support the affected area
5. Specialized stretches and exercises
6. Non-steroidal anti-inflammatory medications

During your recovery from tennis/golfer’s elbow, it’s important not to rush things. If you push your body before it’s ready and your condition has sufficiently healed, you could set yourself back. Before returning to your previous activity level, ensure you can grip objects without pain and that your elbow no longer appears or feels swollen. When you can flex and move your affected elbow without any trouble or discomfort, you can start returning to your normal activities.

Get Your Quality of Life Back

If you’re ready to get your life back and recover fully from your tennis/golfer’s elbow symptoms, we would love to help. Contact Foothills Sports Medicine Physical Therapy today to request your appointment.

The post Tennis / Golfer’s Elbow: What It Is and How to Treat It appeared first on Foothills Sports Medicine Physical Therapy.

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The outbreak of Coronavirus disease (COVID-19) resulted in suspension of youth, academic and professional sport in New Zealand, and around the world.  Following resumption of domestic and international competition there have been several reports of an increased number of athletes testing positive for COVID-19 after returning to competition (1). In light of these concerns, it is essential that sporting organisations provide ‘informative, consistent and specific guidance for safe return to training and competition’ (2), delivered in context to the sport. This blog presents an overview of the Basketball New Zealand COVID-19 Graduated Return to Play (GRTP) Guidelines and is written to assist athletes resume safe training ahead of return to competition that promotes health and performance in an easy-to-follow GRTP infographic.

Guidance Scope 

In light of recent concerns surrounding the return to play of athletes following COVID-19 disease, this document has been prepared by the Basketball New Zealand Coronavirus (COVID-19) Framework Project Team to provide guidelines for coaches and athletes, taking into consideration the New Zealand Public Health guidelines regarding COVID-19 at the time of publication (3).  As public health guidelines will continue to change as greater levels of evidence are published (4-6), these changes need to be considered before advising athletes.

Target audience and applicability of guidelines

The guidelines are ONLY applicable to those who have had mild to moderate illness (or are asymptomatic), and not requiring hospital care. The guidelines are NOT suitable for those who are not being closely supervised by a healthcare practitioner. In such cases, it is recommended that you seek guidance from appropriate physician.

Expert Opinion

The guidance is based on expert opinion of leading medical, academic and high-performance personnel, taking into consideration the current available literature on Graduated Return to Play (GRTP) outlining experiences of athletes who are known to have contracted COVID-19. This has resulted in published guidelines moving closer to a ‘symptoms’ as opposed to ‘time-course’ based approach (7-10).

Athlete Progression

As athletes may unintentionally detrain as a result of self-isolation periods following COVID-19 infection due to the illness and/or lack of facilities to maintain their fitness (11, 12) it is recommended that athlete training progressions follow a linear step-type loading principle with incremental increases in training load (13, 14). The GRTP guidelines outline that the athlete can advance to the next stage ONLY if there are NO worsening of symptoms at rest, and at the level of physical activity achieved in the previous GRTP stage without a worsening of  symptoms. The concepts of training load, progression, and recovery are key considerations for coaches, performance staff and team physicians supporting athletes (15), and have been previously addressed (13). 

50/30/20/10 Rule  

The “50/30/20/10” rule serves as a useful approach to individual and team load progression, as outlined in the Joint Consensus Paper by the National Strength and Conditioning Association (NSCA) and Collegiate Strength and Conditioning Coaches Association (CSCCa) (16).  With the reintegration of players into the training environment, it is recommended to reduce the overall training volume by 50% of the uppermost planned volume initially. This is followed by a 30% reduction in uppermost planned volume, then 20%, and 10%. Such an approach to progressive overload may assist with the successful reintegration into the training environment. Follow this link for more detail of the 50/30/20/10 rule (13).

Recovery Strategies

Recovery is defined as a ‘multifaceted (e.g., physiological and psychological) restorative process relative to time’ (17). From a basketball-specific perspective, recovery should target the physiological and psychological stress associated with the return to training and competition (18). Common recovery strategies include sleep, cold water immersion, massage, compression, nutrition and hydration interventions (19-21).  It is also important that psychological and emotional wellness is not be overlooked during this process (22). As there is no ‘one-size-fits-all’ approach to recovery (20), it is important to educate athletes about the importance of individualised, self-initiated, proactive recovery strategies (19-21).

Protocol Commencement

This GRTP protocol should only commence when the athlete is:

1. Free from all but the mildest ‘above neck’ symptoms (e.g., mild headache, loss of taste or smell); and
2. Off treatments that may mask symptoms (e.g., paracetamol).

NOTE: In the case that a symptomatic athlete tests negative for COVID-19 they should continue to consult with their physician during their recovery, as per any viral illnesses.

Red Flag Indicators

If any of the ‘red flags’ indicators outlined in Table 1 or other concerning symptoms occur, a medical practitioner should be consulted immediately, and as a minimum the athlete should rest and reattempt the previous stage after at least 24 hour without symptoms. It is recommended that a medical practitioner be consulted at any stage if there are concerning symptoms or indications (i.e., ‘red flags’).

Table 1. Red Flags Indications

Adapted from the UK Home Countries Institutes of Sport (10) and Elliott and colleagues (23).

GRTP descriptions and progressions 

Table 2 describes GRTP actives and progression of stages for athletes who experience any ‘below neck’ symptoms. While Table 3 outlines GRTP actives and progression of stages for athletes who are either asymptomatic or have mild above neck symptoms only. These stages are outlined in the accompanying infographic at the bottom of this blog.

Table 2. GRTP descriptions and progressions: ‘below neck’ symptoms

Table 3. GRTP descriptions and progressions: Mild above neck symptoms only

Key Considerations

1. In all cases, if any of the previously detailed ‘red flag’ symptoms manifest, or if the athlete or anyone else supporting them has any concerns, the medical physician should be consulted immediately, and the GRTP should be ceased.
2. Some people take over 3 weeks to recover and return to full training, and some mild symptoms may also persist (e.g., mild breathlessness, fatigue, reduced or altered smell / taste), which may extend the return to training process, according to the clinical scenario and performance requirements.
3. As previously detailed the self-isolation period should be followed in accordance with follow directions of the appropriate Health Authorities (i.e., 7 days) (24), so all activities during that period will need to be performed within the athlete’s home.

Basketball New Zealand GRTP Infographic for coaches and athletes:

AUTHOR NAMES & AFFILIATIONS:

Stephen P. Bird, BHMvt(Hons), PhD 

Athlete Health and Performance Lead, Basketball New Zealand, Wellington New Zealand

Professor, Sport and Exercise, School of Health and Medical Science, University of Southern Queensland, Ipswich QLD Australia

https://orcid.org/0000-0002-5607-3829 

Anousith Bouaaphone, PGDHSc (Musculo), BHSc(Phty)

Physiotherapist New Zealand Men’s Basketball Team, Wellington New Zealand

Hamish Osborne, MBChB, MMedSci, FACSEP

Sport and Exercise Physician, New Zealand Men’s Basketball Team, Wellington, New Zealand

Senior Lecturer, Sport and Exercise Medicine, University of Otago

Mel Downer

National Pathways Manager at Basketball New Zealand, Wellington New Zealand

Chris McLellan, BExSc, MPhty, PhD.

Vice President of Sports Performance, Florida Panthers, Sunrise Florida 

Professor, Sport and Exercise, School of Health and Medical Science, University of Southern Queensland, Ipswich QLD Australia

COMPETING INTERESTS
None for any author.

REFERENCES:

1. Forster V. Tokyo Olympic Games Releases Covid-19 Data – 127 People Test Positive So Far. Forbes Magazine. Jersey City, NJ Forbes Media, 2021.
2. Löllgen H, Bachl N, Papadopoulou T, et al. Infographic. Clinical recommendations for return to play during the COVID-19 pandemic. Br J Sports Med 2021;55(6):344-45.
3. New Zealand Government. COVID-19 (novel coronavirus) Wellington, New Zealand: Ministry of Health, New Zealand Government; 2022 [updated Apr 22. Available from: https://www.health.govt.nz/covid-19-novel-coronavirus [Accessed Apr 6 2022].
4. Biswas A, Elliott Niall , Martin R, et al. The BASES Expert Statement on Graduated Return to Play Following Covid-19 infection. Sport Exerc Sci 2021;67(Spring):62-67.
5. Davey MS, Davey MG, Hurley R, et al. Return to play following COVID-19 infection—a systematic review of current evidence. J Sport Rehab 2022;31(2):218-23.
6. Udelson JE, Rowin EJ, Maron BJ. Return to play for athletes after COVID-19 infection: The fog begins to clear. JAMA Cardiol 2021;6(9):997-99.
7. Elliott N, Martin R, Heron N, et al. Infographic. Graduated return to play guidance following COVID-19 infection. Br J Sports Med 2020;54(19):1174-75.
8. Hughes D, Saw R, Perera NKP, et al. The Australian Institute of Sport Framework for rebooting sport in a COVID-19 environment. J Sci Med Sport 2020;23(7):639-63.
9. Netball New Zealand. COVID-19 Care NetballSmart Auckland, New Zealand: Netball New Zealand,; 2022 [Available from: https://netballsmart.co.nz/netball-smart/resources.html#key-resources [Accessed Apr 10 2022].
10. UK Home Countries Institutes of Sport. Coronavirus graduated return to play for performance athletes: Guidance for healthcare practitioners who are supporting performance athletes: UK Home Countries Institute of Sport; 2021 [updated Apr 05. Available from: https://sportscotland.org.uk/media/7163/hcsi-coronavirus-grtp-v2-080421.pdf [Accessed Jan 12 2022].
11. Bhatia RT, Marwaha S, Malhotra A, et al. Exercise in the severe acute respiratory syndrome Coronavirus-2 (SARS-COV-2) era: A question and answer session with the experts endorsed by the section of Sports Cardiology and Exercise of the European Association of Preventive Cardiology (EAPC). Eur J Prev Cardiol 2020;27(12):1242-51.
12. Jukic I, Calleja-González J, Cos F, et al. Strategies and solutions for team sports athletes in isolation due to COVID-19. Sports 2020;8(56)
13. Bird SP, Osborne H, King L, et al. Basketball New Zealand Guidelines: Safe return to training for players in preparation for a condensed National Basketball League season following COVID-19 restrictions. NZ J Sports Med 2020;47(1):49-53.
14. Reiman MP, Lorenz DS. Integration of strength and conditioning principles into a rehabilitation program. Int J Sports Phys Ther 2011;6(3):241-53.
15. American College of Sports Medicine. Load, overload, and recovery in the athlete: Select issues for the team physician—A consensus statement. Med Sci Sports Exerc 2019;51(4):821-28.
16. Caterisano A, Decker D, Snyder B, et al. CSCCa and NSCA Joint Consensus guidelines for transition periods: Safe return to training following inactivity. Strength Cond J 2019;41(3):1-23.
17. Kellmann M, Bertollo M, Bosquet L, et al. Recovery and performance in sport: Consensus statement. Int J Sports Physiol Perform 2018;13(2):240-45.
18. Calleja-González J, Terrados N, Mielgo-Ayuso J, et al. Evidence-based post-exercise recovery strategies in basketball. Physician Sportsmed 2016;44(1):74-78.
19. Halson SL. Recovery techniques for athletes. ASPETAR Sports Med J 2015;4(4):12-16.
20. Minett GM, Costello JT. Specificity and context in post-exercise recovery: it is not a one-size-fits-all approach. Front Physiol 2015;6(130)
21. Bird SP. Implementation of recovery strategies: 100-point weekly recovery checklist. Int J Athl Ther Train 2011;16(2):16-19.
22. Bird SP. Impact of COVID-19 on athlete mental health: Strategies to promote emotional wellness. Int J Strength Cond 2021;1(1):e1-5.
23. Elliott N, Biswas A, Heron N, et al. Graduated Return to Play after SARS-CoV-2 infection – what have we learned and why we’ve updated the guidance [Blog]. British Journal of Sports Medicine 2022 [updated Apr 23. Available from: https://blogs.bmj.com/bjsm/2022/04/23/graduated-return-to-play-after-sars-cov-2-infection-what-have-we-learned-and-why-weve-updated-the-guidance/].
24. New Zealand Government. Advice for people with COVID-19 Wellington, New Zealand: Ministry of Health, New Zealand Government; 2022 [updated Apr 8. Available from: https://www.health.govt.nz/covid-19-novel-coronavirus/covid-19-health-advice-public/advice-people-covid-19 [Accessed Apr 8 2022].

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Platelet-rich plasma therapy, or PRP injection, is a relatively new treatment for common musculoskeletal diseases such as arthritis and tendonitis. However, there are so many practitioners offering different types of PRP. As a person who is thinking about Platelet-rich therapy for arthritis or tendonitis, which one do you choose? And does a more expensive system mean a better result? So, this blog will answer the most frequently asked questions on PRP.

What is Platelet-rich plasma therapy? 

Put simply, PRP is a blood sample with a higher concentration of platelets. We obtain PRP from your blood. Blood is centrifuged so the heavier cells, such as white and red cells, move to the bottom. The top part of the sample contains plasma with a high concentration of platelets. These platelet cells have a high concentration of growth factors, communicating with other cells in the joint or tendon to reduce inflammation.

Which PRP system is best?  

Not all PRP systems are the same. For example, some designs have a platelet concentration of 2-4X with low white cells. Other methods contain a higher concentration of platelets up to 8X with a higher concentration of white cells. Although studies continue, we think a platelet concentration of 3X with low white cells is better for knee arthritis. In comparison, a higher concentration of 6-8X with increased white cells is better for tendonitis.

What is the ideal platelet-rich plasma therapy? 

We don’t know. However, it is essential to use a system with a CE marking of 2B. A CE mark is a certification that the products meet a certain standard of safety and sterility. Most large companies developing PRP use a CE marking of 2B. However, some smaller companies developing cheaper PRP don’t have this certification. Therefore, you should ask your doctor about the CE marker for the PRP you are considering using.

Does Platelet-rich plasma therapy work?

Yes, but not for all conditions.

PRP is effective for the following conditions:

• Knee arthritis: We have 23 RCT trials showing PRP is better than placebo of other injectables.

• Tennis elbow: A review of studies shows benefits compared to cortisone or placebo, but not all studies are positive.

• Plantar fasciitis: 9 RCTs show PRP is better than cortisone for heel spurs or plantar fasciitis.

• Gluteus medius tendonits or greater trochanteric syndrome. There is one good RCT showing PRP is better than cortisone.

In addition, there is increasing evidence that PRP is better than cortisone for rotator cuff tendonitis, although we need more studies.

Is PRP injection safe? 

Yes. Given we are using your blood, there is little chance of a severe adverse effect. The risk of infection is much less than other injectables, such as hyaluronic acid or cortisone.

Does PRP regenerate cartilage or tendons?

No. Despite the hype, there is no evidence that PRP or any other injectable (stem cells, hyaluronic acid) regenerates your joints or tendons. Instead, they work by improving the environment of the joint or tendon so you feel less pain and can exercise more.

How long does PRP take to work? 

Generally, we think that PRP takes 4-6 weeks to start working. In addition, we recommend more than one injection – ususally 2-3 injections every 2-4 weeks.

How to prepare PRP for knee injection? 

Generally, we suggest little preparation but recommend the following:

• Hydrate with fluids (1-2L) on the day of the procedure
• Stop all simple anti-inflammatory medications such as ibuprofen at least a week before the procedure and for two weeks post-injection.

How long does a PRP treatment last?

Studies suggest the PRP effect lasts up to 12 months, perhaps longer. However, some studies, such as PRP in greater trochanteric syndrome, have shown a longer-term impact of up to 2 years. 

Cost of Platelet-rich plasma therapy 

PRP therapy can be expensive. But higher cost does not necessarily mean it will be more effective. Generally, PRP injections in London cost £350 to £1000 per injection.

Dr. Masci offers PRP injections for a cost-effective price from £375 to £475 per injection.

Alternatives to Platelet-rich plasma therapy: 

Hyaluronic acid 

Hyaluronic acid is a naturally occurring substance found in joints, ligaments, and tendons. We know that hyaluronic acid reduces inflammation and stops the breakdown of cartilage.

Evidence suggests that hyaluronic acid injections such as Durolane improve pain and function in knee arthritis. In addition, high molecular weight hyaluronic acid has a better effect than medium to low molecular weight.

Cortisone 

Cortisone is a potent anti-inflammatory that reduces pain and swelling in arthritis and tendonitis. Generally, we suggest limiting cortisone injections for inflamed joints from arthritis because cortisone hurts cartilage and tendon structure.

Stem cells 

Stem cell injections have become popular in the last five years. However, there is very little evidence to suggest that stem cells are better than other injectables, such as PRP. In addition, a recent study suggested stem cells were not better than saline for knee arthritis.

Arthrosamid 

Arthrosamid is a non-degradable hydrogel that attaches to the lining of the joint. We think that Arthrosamid reduces pain by decreasing inflammation produced by the synovial lining.

Although Arthrosamid has been shown to reduce pain in knee arthritis, we need longer-term data before we can offer it to patients as our first injection option.

Other frequently asked questions about PRP therapy

Can PRP therapy cause blood clots? 

No. We don’t think PRP increases the risk of blood clots. However, you should avoid PRP if you have been diagnosed with a blood disorder such as leukemia or lymphoma.

Does PRP treatment hurt? 

It shouldn’t be. Blood extraction from the forearm or elbow is simple. Injeciton of PRP into a joint or tendon is better tolerated with ultrasound guidance. However, as local anesthetic should not be used, the injeciton can be a little more painful than other injections.

After the injection, it is important to rest the joint or tendon for at least a week. If needed, you should also take painkillers such as paracetamol and/or codeine. You should avoid anti-inflammatories such as ibuprofen.

Generally, we estimate that 10% of patients get a short-term flare after PRP injections – more common in tendons than joints.

Platelet-rich plasma therapy contraindications

Generally, PRP is well tolerated. However, there are specific contraindications to PRP, including:

• Blood cancer such as lymphoma or leukemia
• Active cancer on chemotherapy
• Blood disorders causing reduced platelet count, such as thrombocytopenia
• Pregnancy
• Chronic use of anti-inflammatory or blood-thinning drugs such as aspirin or ibuprofen
• Suspected septic arthritis or infection
• Injecting into a joint replacement

Does PRP regenerate cartilage or tendons? 

No. We have no evidence that PRP regenerates cartilage or tendon structure. However, unlike cortisone, PRP does not harm tissue structure.

Does Asprin hurt platelet-rich plasma therapy? 

Yes. Aspirin will inactivate platelets and reduce the growth factor effect at the time of the injection. Therefore, we think Asprin causes a reduced PRP effect. However, Warfarin and Apixaban do not affect platelet function and can be used.

We suggest stopping anti-inflammatories such as Asprin and ibuprofen about one week before and up to two weeks after your last PRP injection.

Do we use local anesthetic with PRP injections? 

We think local anaesthetic is cytotoxic. So, in theory, mixing local anesthetic with PRP might negate the positive effects of PRP. In practice, you should limit the amount of local anesthetic you use for PRP injections.

What are rehab guidelines post-PRP injection?

It depends on the structure and pathology injected. However, generally, we suggest avoiding impact activity in the large weight-bearing joints for a week. For tendons, you need to be a little more conservative and suggest re-engaging with strengthening after 10 days and a graded return to running after 4 weeks.

Final word from Sportdoctorlondon regarding Platelet-rich plasma therapy

Platelet-rich plasma treatment has shown promising results in certain musculoskeletal conditions, such as knee arthritis, tennis elbow, and plantar fasciitis. However, it is not the panacea for all states and does not regenerate the cartilage or knee.

Related conditions:

• PRP for knee arthritis 
• Platelet-rich plasma injections for arthritis and tendonitis 
• Hyaluronic acid injections for arthritis and tendonitis 
• Durolane for knee arthritis
• What to do about no cartilage in the knee
• Can osteoarthritis be reversed?

Dr. Masci is a specialist sport doctor in London. 

He specialises in muscle, tendon and joint injuries.

Ask a question

BOOK NOW

About Dr Masci

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How often a person needs to work out to see results will depend on their fitness goals. Losing weight, building muscle, and increasing endurance and stamina each require a different approach to training.

Exercise has a range of important benefits. It enhances overall health, helps a person maintain moderate weight, relieves stress, and can promote restful sleep.

Due to this, what people wish to achieve through exercise differs among individuals. Some people may use exercise as a weight loss technique, whereas others may want to build their strength.

This article addresses how often a person should work out based on their particular goals.

It is advisable to consult a doctor before starting any workout or strength training program, as they can offer advice on how to work out safely and minimize the risk of injury.

How often to work out for weight loss

At its most basic level, weight loss is about solving a math problem.

A person must burn off more calories than they take in on a daily basis. Some of the ways a person can accomplish this include:

• eating fewer calories each day than they burn off
• increasing their physical activity to burn off more calories
• increasing their muscle mass so that they burn more calories at rest

There is controversy surrounding whether exercise alone is enough to achieve weight loss.

For example, some research suggests that exercise can cause the body to start to compensate by adjusting metabolism as a means to hold on to body fat.

Exercise still has a role to play in weight loss, but for maximum benefits, a person should combine it with a healthful calorie-controlled diet that reduces their calorie intake.

Researchers also note that continuing to exercise after weight loss can help stop people from regaining the weight.

The American Heart Association (AHA) recommend a combination of cardiovascular training and strength training to boost health and burn calories.

Cardiovascular training

The AHA recommend getting at least 150 minutes of moderate intensity activity or 75 minutes of vigorous activity throughout the week.

A person can also engage in a mix of moderate intensity and vigorous activities should they prefer.

Example of moderate intensity activities include:

• brisk walking at a speed of at least 2.5 miles per hour (mph)
• dancing
• gardening
• riding a bicycle slower than 10 mph
• tennis
• water aerobics

Examples of vigorous activities include:

• hiking, particularly uphill or while wearing a heavy pack
• jumping rope
• running
• swimming
• taking an aerobics class
• vigorous yard work, such as digging

Ultimately, a person can gain the greatest health benefits by engaging in at least 5 hours of physical activity a week.

Strength training

Strength training involves using resistance to build muscle.

Muscle can help make the body more metabolically active, increasing the rate at which it burns calories.

The AHA recommend engaging in moderate-to-high intensity resistance training on at least 2 days of the week. Examples of approaches to resistance training include:

• Lifting weights: This could involve using weight machines or free weights to perform exercises such as biceps curls, bench presses, and leg presses.
• Using body weight for resistance: Exercise examples include lunges, squats, and tricep dips. A person does not require any equipment to do these.
• Using resistance bands: Resistance bands are stretchy elastic bands that help increase the amount that a person’s muscles must work. Resistance bands vary in tightness, with tighter ones increasing the exercise intensity. A person can perform exercises such as squats, lunges, biceps curls, and triceps extensions using resistance bands.

Anyone who is new to exercise and unsure where to begin may wish to consult a certified personal trainer. A trainer can advise the individual on what exercises are suitable for their level of health and fitness, as well as how to perform them correctly and safely.

Summary

Exercise programs for enhancing aerobic capacity and building muscle strength can vary.

Often, the “best” exercise program is the one that a person is willing and able to perform on a routine basis.

With regular efforts and increasing intensity, a person should see their desired results over time.

The Orthopedic & Sports Medicine Center of Oregon is an award-winning, board-certified orthopedic group located in downtown Portland Oregon. We utilize both surgical and nonsurgical means to treat musculoskeletal trauma, spine diseases, sports injuries, degenerative diseases, infections, tumors and congenital disorders.

Our mission is to return our patients back to pain-free mobility and full strength as quickly and painlessly as possible using both surgical and non-surgical orthopedic procedures.

Our expert physicians provide leading-edge, comprehensive care in the diagnosis and treatment of orthopedic conditions, including total joint replacement and sports medicine. We apply the latest state-of-the-art techniques in order to return our patients to their active lifestyle.

If you’re looking for compassionate, expert orthopedic surgeons in Portland Oregon, contact OSM today.

Phone:
503-224-8399

Address
1515 NW 18th Ave, 3rd Floor
Portland, OR 97209

Hours
Monday–Friday
8:00am – 4:30pm

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If you are an athlete, you want to get back in the game as soon as possible. A sports medicine doctor can be a great resource to help you manage the pain and speed up healing.

Sports Medicine Doctor vs. Orthopedic Surgeon

While general physicians can offer support with pain relief, they don’t have the specialized training you need. So, primary care physicians will often refer you to a sports medicine doctor or orthopedic surgeon.

Both of these specialties overlap, but there are notable differences to consider, and you need to understand what sets them apart.

Sports Medicine Doctor

These specialists focus on nonsurgical treatment options to promote healing in a minimally-invasive way. But there are times when surgery is necessary because of physical trauma that must be repaired.

Some sports medicine doctors are also orthopedic surgeons, which means you can access a full range of treatments from one provider. In addition, if your sports medicine doctor doesn’t have surgical training, they often work alongside another orthopedic surgeon who can provide the necessary surgical care.

The benefit of visiting a sports medicine doctor is that they have specialized knowledge for a variety of injuries relating to sports activities: acute injuries, chronic pain, and overuse injuries.

Not only do sports medicine doctors treat injuries and pain, but they also partner with patients to help with performance improvements and steps to prevent injuries in the future. The goal is to boost overall performance on the playing field and protect the athletes as much as possible.

Orthopedic Surgeon

A doctor with orthopedic surgery experience has completed medical school and continued their training for an additional 5+ years of residency beyond medical school. Many orthopedic surgeons have subspecialties, such as a specific part of the body, like the back or feet.

Talk to your sports medicine doctor about referral options if your injury requires surgical intervention. Your sports medicine provider might be able to offer the surgical treatments that you need. Otherwise, they likely have a trusted surgeon for a referral.

Keep in mind that meeting with a sports medicine provider who is also trained in orthopedic surgery doesn’t necessarily mean that you will be going under the knife. In fact, our team of doctors always prioritizes minimally-invasive treatments first. Then, if the nonsurgical treatment methods aren’t enough, the doctor will discuss surgery with the patient.

While sports medicine doctors typically work with athletes, orthopedic surgeons often have a broader patient base. They treat a range of conditions, including arthritis, osteoporosis, carpal tunnel, back pain, bone tumors, and more.

The surgeon can help with different types of tissue repair, as well as spinal surgery, joint replacement, and any other surgical interventions necessary for improving a patient’s movement and function.

Can a Sports Medicine Physician Perform Surgery?

The skillset and training vary from one sports medicine doctor to the next. All of these doctors have an understanding of orthopedics and know the nuances of sports injuries and treatments.

Sports medicine doctors offer a comprehensive approach to assist in the healing and recovery process, including treatments paired with dietary recommendations and exercise/training regimens.

It’s common for sports medicine doctors to focus on nonsurgical options. However, some of these specialists might be surgically trained as well. 

Certain doctors can perform micro-invasive surgical procedures but don’t perform large open surgeries. If major surgical intervention is necessary, then they will refer you to meet with another provider. When you meet with a sports medicine doctor for your initial consultation, ask about their training and available services.

One of the benefits of choosing Orthopedic Associates is that we have a team of doctors with the full range of skills. Our goal is to provide everything you need in one convenient location. Your provider works closely to offer a customized treatment plan, with options available to bring in another in-office provider if additional treatments or services are needed.

Should You See a Sports Medicine Doctor?

A sports medicine doctor can be a great resource if you participate in any sports. It doesn’t matter if you are a pro athlete or a weekend warrior – sports medicine helps people of all ages and ability levels.

The benefit of visiting with a sports medicine doctor first is that you have access to a specialist who understands the nuances of injuries, diagnosis, treatment, and prevention for sports-related injuries.

Many of these sports medicine doctors can offer surgical treatments as needed. If they don’t have the specialization for surgery, they likely have a colleague who can assist with the treatments you need.

Sports Medicine: Injury Treatment and Beyond

An injury might seem like an unavoidable aspect of participating in sports. But the truth is that you don’t have to be at risk when you are in the game. Proactive training and care can be an effective way to minimize the chances of injury on the field.

Sports medicine doctors are passionate about helping athletes overcome their injuries. At the same time, these specialists like to take a proactive approach to help athletes who also want to prevent injuries in the future.

There are many ways to prevent injury through stretching and exercise. Your sports medicine physician can put together a personalized plan to improve your results going forward.

Full-Service Care for Sports Medicine and Orthopedics

Our team at Orthopedic Associates understands the importance of full-service care to help you get back on your feet as soon as possible.

Not only do you have access to a sports medicine expert, but your provider also works alongside orthopedic surgeons as well as nutritionists, athletic trainers, and physical therapists.

You can be confident knowing that your treatment plan is designed to help you achieve the best results possible. Every patient receives personalized services from a team that understands the details and nuances that impact a successful recovery.

Schedule a Consultation with a Sports Medicine Doctor

If you are experiencing chronic pain or have an acute injury from your training, we invite you to schedule a consultation with a sports medicine expert. Reach out to our team to book an appointment.

Not only do we assist with the diagnostic and treatment process. But our providers partner with each patient to offer ongoing care that will improve sports performance going forward.

Orthopedic Associates is here to help with a full-service approach. You are invited to book an appointment. Call today: (972) 420-1776.

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Over the past 20 years, more states have granted patients direct access to physical therapy without a physician referral. Although the state of Arizona has already offered this type of access for several years, it was not until recently that insurance companies began paying for physical therapy without a physician referral.

The main reason for this change comes from the mounting data proving that visiting a physical therapist first might reduce costs and improve the overall outcome of injury rehabilitation. Historically, the process from injury to recovery has been to see a physician, try medication, receive diagnostic imaging, rest, and hope for a resolution. If the problem was not resolved, the next step was to try physical therapy and maybe some sort of medical intervention such as injections or surgery. However, because of the increasing cost of medical care, insurance companies and patients have been looking for methods to lower the cost of rehabilitation. One of these methods is to try PT first for musculoskeletal problems.

Top Three Reasons to Seek Physical Therapy First for Pain

1. Reduce or eliminate pain.

Physical therapy provides the opportunity to reduce or eliminate pain through specific therapeutic exercises and manual therapy techniques, such as joint and soft tissue mobilization, to restore normal joint mechanics to support and help heal injured tissues. Modalities such as ultrasound, electrical stimulation, and taping techniques can also reduce pain during recovery.

2. Avoid or recover from surgery.

In many cases, if physical therapy can address the reasons contributing to pain, you may be able to avoid surgery altogether. If you do need surgery, pre-surgery physical therapy can improve mobility and strength and help get you in better condition, making it easier to recover from surgery with postoperative physical therapy more quickly and with better outcomes.

3. Improve mobility.

If you have difficulty with standing, walking, or transitioning, such as moving from a sitting to a standing position, exercises to improve flexibility and strength can improve your ability to move with greater ease, making everyday activities more enjoyable. Physical therapists can also instruct and fit you for an assistive device such as a cane, crutches, or other assistive devices designed to improve your mobility.

When looking at patients who went to physical therapy first, there was an average savings of over $250 in one study and over $1,000 in another. Overall, there were substantial savings across the board with less imaging, less medication, and even less treatment.
Similarly, a study looking at patients with low back pain reported significant cost savings.

Again, these savings came from PT first’s role in reducing emergency room visits, imaging such as X-rays and MRI, and opioid use. This study also found a 9% increase in completing functional goals when using PT first.

Physical therapy has evolved greatly over the past 20 to 25 years, as have the patients it serves.  Due to costs and other factors, the goal now is to fix the problem as soon as possible with as little healthcare use as possible. Physical therapy enables the therapist to treat the cause of the pain early on and to begin the rehabilitation by restoring the proper mechanics that may be causing the pain.

We are also trained to recognize when physical therapy is not the proper or best first course of action and can point patients in the best direction. The physician-physical therapy team is still the standard when dealing with musculoskeletal problems. This team will always be present for and critical to the care of a high percentage of patients. However, as healthcare evolves, the evidence favoring a physical therapy first approach continues to grow.

If you have any questions regarding direct access to physical therapy or to schedule a pain assessment contact your nearest Foothills Sports Medicine Physical Therapy clinic.

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Keywords: Rehabilitation, Anterior cruciate ligament, OPTIKNEE

Anterior cruciate ligament (ACL) tears are one of the most talked about injuries in sports medicine. Most people who tear their ACL will embark on a rehabilitation program (with or without ACL surgical reconstruction).  The international OPTIKNEE consensus project aims to optimize knee health and prevent post-traumatic osteoarthritis (OA) following knee injuries like ACL tears. As part of this consensus, we recently published a systematic review of systematic reviews in BJSM (OPEN ACCESS) examining the effectiveness of different rehabilitation interventions to improve symptomatic, functional, clinical, psychosocial and quality of life outcomes, and prevent re-injury after ACL (and/or meniscal) injury (1). The summary of this study is outlined in this blog.     

Why is this study important?

ACL and meniscal injuries can be devastating (2, 3). Although many people successfully regain pre-injury function and return to sport after extensive rehabilitation and surgery, pain, psychological distress and reduced function are equally as common. They cannot return to pre-injury sport – an activity that brings them enjoyment with all the long-term health and wellbeing participation benefits (4). There is little consensus about the optimal components of an ACL tear rehabilitation program to achieve pre-injury function, activity and quality of life, leading to significant variations in approaches. Systematic reviews of systematic reviews pull together the highest level of evidence as a one-stop shop to inform clinical practice.

How did the study go about this?

This study reviewed systematic reviews of randomised clinical trials that evaluated the effectiveness of any rehabilitation intervention following traumatic ACL and/or meniscal injury (a common secondary injury) to improve symptomatic and/or functional outcomes. We assessed outcomes relating to pain, symptoms, function, re-injury, psychosocial factors, quality of life and adverse events.

What did the study find?

We found 22 systematic reviews, including 142 randomised controlled trials of mostly men (56% – 95%), and almost all after ACL reconstruction (none following isolated meniscal injury). In general, there was a disappointingly low level of evidence for the effectiveness of rehabilitation interventions to improve symptomatic and functional outcomes after ACL injury.

The strongest level of evidence (moderate certainty) was found for:

1. Neuromuscular electrical stimulation to improve quadriceps strength.
2. Open versus closed kinetic chain exercises to be similarly effective for quadriceps strength, self-reported function, and knee laxity.
3. Structured home-based rehabilitation to be similarly effective to structured in-person rehabilitation for quadriceps and hamstring strength, self-reported function, and knee laxity.
4. Postoperative knee bracing to provide no benefit to physical function and knee laxity.

Low certainty evidence was found for:

1. 1. Pre-operative rehabilitation consisting of 3–6 weeks of muscle strengthening and neuromuscular (i.e., function and stability) control exercises to improve self-reported and physical function (e.g., hop performance) 3 months post-ACLR.

• Cryotherapy during the first 1-2 days post-ACLR reduces postoperative pain and analgesic use up to approximately 1-week post-surgery compared with no cryotherapy.

• Psychological interventions including guided imagery, relaxation, coping modelling and visual imagery 6-12 weeks after ACLR to improve psychological and knee laxity outcomes.

Figure 1: Evidence map for ACL rehabilitation interventions. Only the four most consistent outcomes reported across systematic reviews presented for clarity. CKC, closed kinetic chain; CPM, continuous passive motion; NM, neuromuscular; NMES, neuromuscular electrical stimulation; OKC, open kinetic chain.

Click here for an interactive version of the above figure!

See this infographic for the take-home messages from this study:

References

1. Culvenor AG, Girdwood MA, Juhl CB, et al. Rehabilitation after anterior cruciate ligament and meniscal injuries: a best-evidence synthesis of systematic reviews for the OPTIKNEE consensus. British Journal of Sports Medicine. 2022:bjsports-2022-105495. http://dx.doi.org/10.1136/bjsports-2022-105495
2. Bruder AM, Crossley KM, Mosler AB, Patterson B, Haberfield M, A. D. Co-creation of a sport-specific anterior cruciate ligament injury risk reduction program for women: A concept mapping approach. Journal of Science and Medicine in Sport. 2020;23(4):353-360. https://doi.org/10.1016/j.jsams.2019.10.019
3. Bruder AM, Patterson BE, Donaldson A, et al. Creating Prep to Play PRO for women playing elite Australian football: A how-to guide for developing injury prevention programs. Journal of Sport and Health Science. 2021;doi:https://doi.org/10.1016/j.jshs.2021.09.003
4. Bruder AM, Crossley KM, Donaldson A, AB. M. Through the athlete lens: A novel study exploring the perspectives and experiences of injury prevention practices in women playing elite Australian football. Brazilian Journal of Physical Therapy. 2021;doi:https://doi.org/10.1016/j.bjpt.2021.05.003

Author and Affiliations:

Andrea Bruder, Brooke Patterson, Adam Culvenor

Dr Andrea Bruder, La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Australia

[email protected]

@AndreaBruder

OPTIKNEE Steering Committee Lead Associate Professor Jackie Whittaker

@OPTIKNEE

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Blog by Nikki Simmons and Meredith Sorensen, MS, RD, LD

Meredith Sorensen is a performance dietitian for Memorial Hermann Rockets Sports Medicine Institute and former collegiate distance runner for the University of Houston. Nikki Simmons is a dietetic intern whoassisted with this project.

Anterior Hip Replacement surgery has many advantages over traditional hip replacement procedures.

The thought of replacing a hip probably conjures nightmare images of intense, invasive surgery and a long and protracted recovery. Such fears keep many people living with the pain of a damaged hip because they fear the surgical procedure.

However, patients needing hip replacement need to know about a relatively new technique – anterior hip replacement — which uses less drastic techniques to achieve just as effective results.

In an anterior hip replacement, we enter through the front of the body to replace the hip bone, which means we leave all of the muscles that are most important to mobility intact.

Here are the Top Five advantages of Anterior Hip Replacement.

1. Muscles are maintained – Because this technique involves little or no cutting of muscles during the procedure, there are few muscles to be repaired once the new hip joint has been replaced. This is the main advantage of anterior hip replacement; without damaging the muscles, that is what leads to less pain, more mobility, and quicker recoveries.
2. More accurate imaging – Advanced imaging techniques are used during this procedure, allowing for more precise placement of the replacement joint.
3. Return of greater range of motion – In a traditional hip replacement, patients are told to refrain from specific movements or activities even once the new joint is in place.Anterior hip replacement results in greater mobility and flexibility, and few, if any, such restrictions are in place, and patients can usually return to all of their regular physical activities.
4. Less post-operative pain – One of the most significant drawbacks of traditional replacement is that surgery is invasive and requires much cutting of bone and muscle. Patients experience considerable post-operative pain, which often has to be controlled with opioids, which have their own problems. Because this technique does not cut the muscles, patients have far less pain.
5. Faster recovery – Again, because no muscles are cut, the recovery time from an anterior hip replacement is much quicker. Usually, recovery is only about a week, and patients can return home the same day as the procedure. As opposed to traditional hip replacement, which requires a hospital stay and can take up to 8-weeks to recover from!

Anterior Hip Replacement Surgery At All-Pro Orthopedics

Since Anterior Hip Replacement surgery is such a new technique, there are not many orthopedic surgeons familiar with the procedure, and few, if any, who have been doing it as long as All-Pro,
Only the most advanced orthopedic surgeons should perform this operation.

At All-Pro Orthopedics, we have the training and experience to confidently perform anterior hip replacement surgery in Palmetto, Pembroke Pines, West Palm Beach, and Hollywood.

The results of anterior hip replacement at All-Pro can be life-changing. Ultimately you will want to meet with an orthopedic surgeon or sports medicine specialist to see if anterior hip replacement suits you.

You can contact one of our friendly appointment specialists at (954) 399-5976 to schedule your initial consultation.

The post Who Can Benefit Most From Anterior Hip Replacement? appeared first on All-Pro Orthopedics & Sports Medicine.

Subscribe to Better Than Ever Live!

Remember, if you are watching this show on YouTube or Facebook, and you want to make sure you don’t miss an episode, subscribe to Better Than Ever Live! as an audio podcast wherever you get your podcasts. If you are listening to this podcast and you want to comment on topics, join us live on YouTube and Facebook, and soon on other social media platforms. Go to YouTube.com/DrDavidGeier, click subscribe and hit the bell to be notified when I’m on live. And make sure to follow my Facebook page – Facebook.com/DrDavidGeier.

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Kevin D. Plancher, MD, MPH, FAOA, FAAOS attended the Eastern Orthopaedic Association’s 53rd Annual Meeting in Atlantic City October 26-29, 2022. Dr. Plancher moderated the Rapid Fire
Session 5C – Sports Medicine early Saturday morning. After which he was inducted as the incoming EOA President; pictured here with EOA 2022 President Amar S. Ranawat. Save the date for EOA 2023 54th Annual Meeting at The Charleston Place Hotel in South Carolina, October 26–28, 2023.

Kevin D. Plancher, MD, MPH, FAAOS, is a board-certified orthopaedic surgeon and founder of Plancher Orthopaedics & Sports Medicine. Dr. Plancher is 1 of only 36 Orthopaedic Surgeons who hold American Board of Orthopaedic Surgeons certification in both Surgery of the Hand and Orthopaedic Sports Medicine. He is a Clinical Professor, Department of Orthopaedic Surgery, at Montefiore Medical Center/Albert Einstein College of Medicine and an Adjunct Clinical Assistant Professor of Orthopaedic Surgery, at the Weill Cornell Medical College, Cornell University in New York. Since 2001, he has been listed annually in the Castle Connolly directory as a “top doctor” in his field.

Plancher Orthopaedics & Sports Medicine is a comprehensive orthopaedics and sports medicine practice with offices in New York City and Greenwich, CT. Leaders in orthopaedics, sports medicine, and acute emergency treatment of sports injuries and rehabilitation utilizing the latest techniques in orthopaedic care. plancherortho.com.

The post Kevin D. Plancher, MD, MPH Name EAO President appeared first on Plancher Orthopaedics & Sports Medicine.

Kevin D. Plancher, MD, MPH, FAOA, FAAOS is an orthopaedic surgeon holding certification from the American Board of Orthopaedic Surgery. More importantly, Dr. Plancher is one of only thirty-six Orthopaedic Surgeons who hold American Board of Orthopaedic Surgery certification in both Surgery of the Hand and Orthopaedic Sports Medicine. You can verify ABOS certification online at abos.org.

Kevin D. Plancher, MD, MPH, FAAOS, is a board- certified orthopaedic surgeon and founder of Plancher Orthopaedics & Sports Medicine. He is a Clinical Professor, Department of Orthopaedic Surgery, at Montefiore Medical Center/Albert Einstein College of Medicine and an Adjunct Clinical Assistant Professor of Orthopaedic Surgery, at the Weill Cornell Medical College, Cornell University in New York. Since 2001, he has been listed annually in the Castle Connolly directory as a “top doctor” in his field.

Plancher Orthopaedics & Sports Medicine is a comprehensive orthopaedics and sports medicine practice with offices in New York City and Greenwich, CT. Leaders in

orthopaedics, sports medicine, and acute emergency treatment of sports injuries and rehabilitation utilizing the latest techniques in orthopaedic care. plancherortho.com.

The post Kevin D. Plancher, MD, MPH, FAOA, FAAOS – One of Only Thirty-Six appeared first on Plancher Orthopaedics & Sports Medicine.

Kevin D. Plancher, MD, MPH, FAOA, FAAOS attended the American Association of Hip and Knee Surgeons 2022 Annual Meeting November 3–6, 2022. While in attendance at AAHKS 2022 Dr. Plancher presented his team’s paper – Lateral Patella Facet OA Is Not Contraindicated for Medial UKA: Mean 10-Year Outcomes & Survivorship.

Kevin D. Plancher, MD, MPH, FAAOS, is a board- certified orthopaedic surgeon and founder of Plancher Orthopaedics & Sports Medicine. Dr. Plancher is one of only thirty-six Orthopaedic Surgeons who hold American Board of Orthopaedic Surgery certification in both Surgery of the Hand and Orthopaedic Sports Medicine. He is a Clinical Professor, Department of Orthopaedic Surgery, at Montefiore Medical Center/Albert Einstein College of Medicine and an Adjunct Clinical Assistant Professor of Orthopaedic Surgery, at the Weill Cornell Medical College, Cornell University in New York. Since 2001, he has been listed annually in the Castle Connolly directory as a “top doctor” in his field.

Plancher Orthopaedics & Sports Medicine is a comprehensive orthopaedics and sports medicine practice with offices in New York City and Greenwich, CT. Leaders in orthopaedics, sports medicine, and acute emergency treatment of sports injuries and rehabilitation utilizing the latest techniques in orthopaedic care. plancherortho.com.

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Whether your kiddo is a little daredevil or just a bit klutzy, accidents happen.

The good news is that most mishaps result in minor injuries that can be treated with a dab of antibacterial ointment, a little rest, and lots of hugs and kisses. But the reality is that every tumble has the potential to be “the big one” – an injury that has you speeding toward the nearest hospital.

But it’s a fine line. What kinds of child injuries really raise the boo-boo bar? When is a trip to urgent care enough? And when might you need to seek highly-specialized emergency care at a pediatric trauma center?

1. Falls: The most common cause of injury for kids of all ages

Falls are the leading cause of injury among children. In fact, the Centers for Disease Control and Prevention (CDC) says that roughly 8,000 children are treated in U.S. emergency rooms for fall-related injuries every day.

When and where are falls most likely to happen?

Playgrounds, especially slides and monkey bars, are some of the most common causes of injury. Other common fall hazards include:

• Stairs
• Beds without railings
• Windows
• Elevated landings
• Baby walkers
• Slippery bathtubs
• Cluttered pathways

Also, while falls are the most common injury for kids of all ages, babies and toddlers are especially fall-prone. Little humans simply don’t have the same movement control and balance that older kids and adults do. Of course, there are numerous child fall prevention best practices that can help reduce the chances of a serious injury. But falls can still happen in a flash.

What types of fall injuries may need specialized trauma care?

Head, neck, back or spine injuries, and broken bones top the list. More specifically, these injuries can often need the highest level of trauma care – or what’s often called Level 1 trauma care. Why? These kinds of injuries can be more complex, which may require expert care from a range of specialists.

In addition, we suggest that you bring your child to a trauma center right away if they’re experiencing any of the following symptoms after a fall:

• Difficulty breathing
• Possible broken bones – especially if the potential fracture is located in areas like the head, face, neck, back or pelvis, or if a bone has pierced through the skin – ligament tears or a spinal cord injury
• New or worsening bleeding or swelling, headache, nausea or vomiting
• Loss of consciousness or memory loss surrounding the accident

Learn more about what to do if your child falls and hurts themselves.

2. Being struck by or against an object: Accidental impacts

Most kids get bumped into on a regular basis – especially if they play sports (or have older siblings). Usually these run-ins are minor accidents caused by playing a little too hard or getting distracted.

But according to CDC and NEISS All Injury Program data from 2000-2018, the frequency of emergency department visits after being struck by or against an object is second only to falls, especially for kids aged 0-14.

When and where are kids most likely to get struck by or against an object?

These types of childhood injuries can happen anytime and anywhere. Here’s just a sampling of some of the accidents that fall into this category:

• Walking into a wall, door or piece of furniture
• Being hit by an object such as a baseball or a falling storage box
• Getting hit and hurt by another player during a football, soccer, lacrosse, softball, baseball or other sports game
• Being pinned under a piece of furniture or an appliance that tipped over

What types of “struck by or against” injuries may need trauma care?

Head, neck, back or spine injuries, and broken bones are often top trauma priorities for these types of accidents, too. Also, if your child is injured after being pinned under or against something, internal injuries can be a concern.

We suggest heading to a pediatric trauma center if your child is experiencing any of the following symptoms:

• Difficulty breathing
• Possible broken bones – especially if the potential fracture is located in areas like the head, face, neck, back or pelvis, or if a bone has pierced through the skin – ligament tears or a spinal cord injury
• New or worsening bleeding or swelling, headache, nausea or vomiting
• Loss of consciousness or memory loss surrounding the accident

3. Motor vehicle accidents: The most common injury for teen drivers and riders

There are millions of motor vehicle accidents every year. Next to falls, these accidents are the most common causes of nonfatal injuries among teenagers.

When and where are motor vehicle accidents most likely to happen?

Whether your child is cruising in your family car or riding an ATV at the cabin up north, motor vehicle accidents can happen anytime. And teens between 16 and 19 are at a higher motor vehicle crash risk than any other age group, according to the CDC.

Why? One reason is because teens are less experienced drivers or they’re riding with less experienced drivers.

The CDC says that the crash risk for teen drivers is especially high during their first few months of licensure. In addition, the presence of other teen passengers increases crash risks.

When may trauma care be needed after a motor vehicle accident?

Motor vehicle accidents can cause a range of injuries – some obvious and some subtle. And even low-speed accidents can leave kids with an injury.

After any motor vehicle accident, we suggest getting your child checked out. Some injuries may or may not present themselves right away. Urgent care can be a good choice for minor bumps, scrapes or bruises.

If an ambulance arrives and paramedics say a trip to the ER is recommended, we suggest you follow their advice and ask to be taken to the nearest pediatric trauma center.

In addition, we recommend seeking pediatric emergency care if your child has any of the following injuries or symptoms:

• Difficulty breathing
• Visible or possible head, neck or back injuries
• Possible broken bones – especially if the potential fracture is located in areas like the head, face, neck, back or pelvis, or if a bone has pierced through the skin – ligament tears or a spinal cord injury
• New or worsening bleeding or swelling, headache, nausea or vomiting
• Loss of consciousness or has memory loss surrounding the accident

4. Cuts and puncture wounds: Injuries that are more than a little scratch

Whether they’re playing with friends or helping you in the yard, a lot of kids accidentally cut or poke themselves with something sharp. Most wounds will sting and throb, but once they’re cleaned and patched up they typically heal pretty quickly.

But more serious lacerations or piercings are relatively common, especially for kids between 5 and 14 years old.

When are cuts and piercings most likely to happen?

Usually, most deep cuts or piercings occur after another common kid injury occurs – namely a bad fall or being hit by something. But other household accidents involving machinery like yard tools, kitchen appliances or cutlery can be the culprits, too.

When may trauma care be needed for cuts and piercings?

If your child has any lacerations or puncture wounds that occurred after a fall, being hit by an object, or may involve a broken bone, head to the nearest trauma center. Multiple injuries will likely require care from multiple specialists.

If a cut or puncture is the primary injury, get emergency pediatric trauma care if your child’s injury is:

• Bleeding heavily or the bleeding hasn’t decreased after five to 10 minutes of direct pressure
• Causing numbness or inability to move fingers, toes, arms, legs, joints or other parts of their body
• Deeper or longer than ½ inch
• Located on your child’s head or face, or close to an eye
• Caused by a dirty or rusty object
• Embedded with dirt, gravel or other debris
• Has ragged or separated edges
• Caused by an animal or human bite
• Extremely painful
• Showing signs of infection (e.g. increased warmth, redness, swelling or drainage, or foul odor)

5. Bites and stings: Wounds caused by animals, insects and humans

The vast majority of bites and stings are minor – requiring little to no medical treatment. But according to the previously mentioned CDC and NEISS All Injury Program data, bites and stings are the third most common reason for ER visits for kids aged 0-9.

When and where are bites and stings most likely to happen?

Like any injury, bites and stings can happen anytime, anywhere. Among children, dog bites are some of the most common injuries we see.

When may trauma care be needed after a bite or sting?

After any bite or sting, seek emergency pediatric trauma care if:

• The wound (or wounds) is bleeding heavily or the bleeding hasn’t decreased after five to 10 minutes of direct pressure
• The wound (or wounds) is showing signs of infection (e.g. increased warmth, redness, swelling or drainage, or foul odor)
• Your child is having difficulty breathing or showing other signs of an allergic reaction such as swell hives, wheezing or trouble swallowing, rapid pulse or dizziness

Specifically for animal bites, seek emergency care if:

• The animal that bit your child is wild
• The bite or bites are deeper or longer than ½ inch – especially if they’re located on your child’s face and/or near an eye
• The bite is from a venomous snake or spider
  • Venomous snake and spider bites are rare in the Midwest, and Minnesota and Wisconsin have just two species of poisonous snakes
• The bite is from a bat (which is uncommon in Minnesota and beyond, but requires fast care)

6. Foreign bodies: When something is where it shouldn’t be

It’s safe to say that every kid experiences a “foreign body” at some point during their childhood. Whether it be a splinter in their finger or a sweet pea in their nose, curious kiddos get things stuck.

But more serious cases happen. In fact, it’s the fourth most common reason for an ER trip for kids between 1 and 4 years old.

When and where are foreign body injuries most likely to happen?

Most of the time, the child will inhale or ingest something on their own. This can happen during a mealtime or during playtime, when there are a lot of choking hazards around.

When may trauma care be needed for removing a foreign body?

Most foreign bodies can pass through their gastrointestinal track without issue, but sometimes they become lodged in the throat, stomach or soft tissues. Choking and bowel obstructions are the biggest concerns, and require emergency medical care.

If your child appears to be choking, take action by using choking first aid techniques like back blows or the Heimlich maneuver to dislodge the object. If you don’t know how or your efforts aren’t working, call 911.

If your child has swallowed something and you’re unsure if it can be passed naturally, call your doctor. Go to a pediatric trauma center if you notice any of the following symptoms of a possible bowel obstruction:

• Severe abdominal pain, cramping or swelling
• Vomiting
• Bloating
• Loud bowel sounds
• Inability to pass gas
• Constipation

7. Burns: Injuries that aren’t only caused by fire

Whether a curious hand grabs for a hot pan or repeated sunscreen applications didn’t get the job done, mild burns are pretty common for kids.

But only a little amount of time – sometimes just seconds – is needed for burn injuries to worsen.

When and where are burns most likely to happen?

Thermal burns – burns caused by coming into contact with flames, or hot metals, liquids or steam – are the most common among children. But other types of burns include:

• Chemical burns caused by acids or solvent cleaners (e.g. bleach, ammonia, paint thinner)
• Electrical burns after coming into contact with an electrical current
• Radiation burns (aka sunburn)
• Friction burns such as road rash or carpet burn
• Cold burns such as frostbite

When may trauma care be needed for burn injuries?

If a burn has caused any damage below the epidermis – the outer layer of the skin – some degree of specialty care may be needed. Blisters signal a second-degree burn that’s gone deeper, and any charring or whitish marks are a sign of the most severe third- or fourth-degree burns.

The more severe or widespread the burn, the higher degree of specialty care that is needed and suggest that kids get specialized burn care if:

• Burns are located on the face, ears, hands, feet or genital area where permanent damage is a risk if not treated properly
• Burns appear deeper than first-degree and/or cover a large area of the body (e.g. larger than the size of your palm)
• There are signs of infection (e.g. increased warmth, redness, swelling or drainage, or foul odor)
• Pain, irritation or discoloration worsens

For the worst kid injuries, get the best possible trauma care

Accidents happen. And the worst ones can result in injuries that need highly-specialized care from pediatric trauma experts.

The Orthopedic & Sports Medicine Center of Oregon is an award-winning, board-certified orthopedic group located in downtown Portland Oregon. We utilize both surgical and nonsurgical means to treat musculoskeletal trauma, spine diseases, sports injuries, degenerative diseases, infections, tumors and congenital disorders.

Our mission is to return our patients back to pain-free mobility and full strength as quickly and painlessly as possible using both surgical and non-surgical orthopedic procedures.

Our expert physicians provide leading-edge, comprehensive care in the diagnosis and treatment of orthopedic conditions, including total joint replacement and sports medicine. We apply the latest state-of-the-art techniques in order to return our patients to their active lifestyle.

If you’re looking for compassionate, expert orthopedic surgeons in Portland Oregon, contact OSM today.

Phone:
503-224-8399

Address
1515 NW 18th Ave, 3rd Floor
Portland, OR 97209

Hours
Monday–Friday
8:00am – 4:30pm

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After surgery, it is important to properly care for your wounds so that they can heal as quickly as possible and avoid infection. Depending on the type of surgery you have, your wounds may be different. However, there are some general guidelines that you can follow to ensure that your wounds heal properly. In this article, we will discuss the different types of post-surgical wounds, the average time it takes for them to heal and how to properly care for them.

Types of surgical wounds

There are three types of post-surgical wounds: closed, open and laparoscopic surgical wounds. Closed surgical wounds are those that are closed with stitches, staples or adhesive strips. They usually take about two weeks to heal properly. Open surgical wounds are those that are left open to heal. They usually take about four weeks to heal properly. Laparoscopic surgical wounds are those that are made with small incisions and a tiny camera is inserted into the abdomen through one of the incisions. The average healing time for these types of wounds is about two weeks.

How to care for post-surgical wounds?

Regardless of the type of surgical wound, you should keep the wound clean and dry during the period of recovery. You may need to keep the wound covered with a bandage or dressing, depending on the severity of the wound. Be sure to follow your doctor’s instructions on caring for the wound, and visit your doctor if the wound begins to bleed or ooze.

Why is it important to care for your wounds?

It is important to properly care for your post-surgical wounds because if they are not cleaned and dried correctly, they may become infected. Infected wounds can cause a great deal of pain and can delay the healing process. Additionally, improperly cared for wounds can also lead to scarring. Therefore, it is important to follow your doctor’s instructions on how to care for your wound.

When should you see a doctor?

If you notice any redness, swelling or discharge from your wound, you should contact your doctor. These may be signs of infection. Additionally, if your wound is not healing properly or if you have any other concerns, you should contact your doctor.

If you have any questions about how to care for your wound, be sure to ask your doctor or healthcare provider. Our physicians at Hampton Roads Orthopaedics Spine and Sports Medicine are experts in wound care and are here to answer any questions you may have. Just call (757) 873-1554.

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Instead of the bird bathed in butter …
This herb-roasted turkey comes highly rated and doesn’t call for any butter in the recipe.  Or, if you prefer a vegetarian option, make these wild-rice-stuffed butternut squash. With ingredients like cinnamon powder, dried cherries, and fresh sage, this recipe may make the holiday a vegetarian feast every year.

Instead of sweet potato casserole …
Make these roasted sweet potatoes with honey and cinnamon. You’ll get the same flavor without the calories. You can top the dish with chopped pecans to give a crunch that resembles the typical topping of a sweet potato casserole.

Instead of mashed potatoes …
Swap the butter for olive oil, put down the potato masher, and forget about having to add boiled potatoes to your Thanksgiving to-do list. Before baking, these red potatoes are diced up and placed on a baking sheet with rosemary, garlic, and salt.

Instead of canned cranberry sauce …
Make your own. Cranberry sauce is really easy to make. Plus, the sauce will turn out flavorful and fresh instead of … wiggly. An added bonus: you can make this side the night before.

Instead of high-calorie stuffing …
Try subbing out the carbs for cauliflower. This recipe is made on the stove, so it’s one less item to have to worry about juggling the cooking time along with the turkey in the oven. With the additions of carrots, onions, and mushrooms — the concoction is a vegetable medley that tastes more like stuffing, which we call a win-win.

Instead of creamed green beans …
Get a whole bunch of fresh green beans to make this recipe. Chop up some mushrooms and red onion. Toss in some olive oil and place in the oven for 15 minutes. While it’s cooking, sauté up some bread crumbs with oregano. Add in parmesan and the zest of a lemon. Top the green beans with the breadcrumb mixture, and serve!

Instead of a regular pumpkin pie …
This savvy baker manages to add delights like whipped cream to her pumpkin pie while still offering a recipe with less fat and calories and the addition of some protein. For best results, make the night before; it will be one less thing to have to add to the oven the day of and you’ll achieve much cleaner cuts.

Think about the plate
Sure, those potatoes look good, and cranberry sauce is one of those things you can only have during the holidays, but if you’re really trying to have a healthy Thanksgiving, you need to know what a healthy Thanksgiving plate looks like. A good rule of thumb is to think about your plate this way:

• ½ of the plate should have veggies
• ¼ of the plate is for protein
• ¼ of the place is for starches

For the remaining bits, like cranberry sauce and gravy — which we think should be enjoyed full-calorie — you should have very small servings. Think of them as garnishes.

8 tips for a healthier Thanksgiving!

Tip #1: Stay hydrated. Drink plenty of water to keep your body hydrated, as many Thanksgiving meals are loaded with sodium.
Tip #2: Pick 1-2 dishes to indulge in. Eyeing the pumpkin pie? Enjoy a slice, make sure it’s in moderation.
Tip #3: Get outside. Enjoy the beautiful Arizona weather with your friends and family. Try a new hiking trail, walk around your neighborhood, or even a local Turkey Trot!
Tip #4: Beat the post-Thanksgiving meal lull with a cup of coffee or hot green tea. Both options have been shown to help increase metabolism.
Tip #5: Try a lighter, healthier option on your holiday favorites. Pinterest is full of unique, fun, and healthy recipe alternatives.
Tip #6: Begin your day with breakfast. Eat a hearty and healthy breakfast like rolled oats, a veggie scramble, or rye bread to kick start the day.
Tip #7: Steer clear of the appetizer table. It’s hard to resist when there’s lots of finger food right before you. Instead, try sitting in the living room and enjoying conversation with your friends and family.
Tip #8: Schedule a fat-burning workout for the day after Thanksgiving. It’s a great way to jumpstart your long holiday weekend.

We hope you now know how to stay healthy on Thanksgiving. If you find that pain is getting in the way of enjoying your holiday, let’s fix that. Schedule an appointment with our physical therapy clinic today.

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Keywords: sprint mechanics; lower limb function; sports injury prevention.

Sprinting is important for athletes, coaches, and health professionals for both performance and injury risk management [1]. Sprinting can be defined as running with the intention of maximal acceleration and/or velocity. The performance of sprinting acceleration is associated with the ability to produce and apply high levels of force in the horizontal direction [2]. Such information is of great importance when we want to evaluate, monitor and/or train for sprinting. Evaluating and monitoring sprinting horizontal force production capacities is now used in field settings for sprinting performance enhancement, [3,4] as well as in more analytical evaluations such as isolated single joint strength assessments. This ability to produce horizontal force during sprinting is mainly associated with the lower limb posterior chain muscles actions [5,6]. Thus, we can consider that sprinting horizontal force production capacities evaluation allows an overall evaluation of the lower limb function during sprinting action. More specifically, this evaluation targets the overall posterior chain muscles function during sprinting action. Recent studies also supported the interest of evaluating sprinting horizontal force production for hamstring injury management [7–11]. 

This blog will explain how to assess sprinting horizontal force production capacities and why they can be of interest for both injury risk management and to performance improvement.  

What are sprinting “horizontal force” production capacities?

Sprinting horizontal force production capacities correspond to the maximal values of the force developed by an athlete onto the ground in the anteroposterior direction at any running velocities. These capacities decrease linearly when velocity increases, which is well described by the F-v relationship (see the graph 1.3 in the figure 1), [12] and its two extrema: FH0 and V0, corresponding to the force production capacities at low and high velocities, respectively (figure 1) [12]. Considering that sprinting horizontal force production capacities mostly depends on the lower limb and posterior chain muscles during sprinting action, [5,6] evaluation of FH0 and V0 can provide information about the lower limbs and posterior chain muscles function during the sprinting action.

Figure 1: Illustration of the sprinting horizontal force production capacities evaluated by the F-v relationship, FH0 and V0 as descriptors of the lower limbs function during the sprinting action (some graphics are inspired from Cross et al.[13]).

How can we evaluate sprinting horizontal force production capacities in field practice?

Evaluation of the sprinting horizontal force production capacities requires a maximal sprint acceleration up to maximal running velocity (~30 to 60 metres) during which  the  position-time or velocity-time data are measured. Such measurements can be done using any technology that provides reliable data (e.g., radar, laser, 1080, photocells, or Global Positioning Systems, video camera [4,12]. Such maximal sprint accelerations are a common task for most trained athletes and can easily be included at the end of the warm-up session or in a specific sprinting training session. To obtain reliable and valid information, testing protocols, measurements and data analyses should be accurate and rigorously standardised (e.g., similar fatigue, training, time of day, warm-up conditions [12].

Why are sprinting horizontal force production capacities of interest for injury risk management?

Since sprinting horizontal force production capacities can provide information on the function of the lower limbs during sprinting, lower limb impairment can cause changes to these force capacities, especially impairment of the posterior chain muscles. When changes to the force capacities are not compensated by other parts of the kinetic chain during sprinting, sprinting horizontal force production capacities can decrease (i.e., decrease in FH0 or V0). In other terms, the lower limbs are unable to produce the same levels of force in the horizontal direction over the sprinting entire acceleration. This can highlight a problem in the lower limb posterior chain. However, this is not specific to a single part of the chain. A FH0 decrease has been reported after hamstring injury [7,8]. In addition, lower FH0 were prospectively associated with higher risk of hamstring injury [9,11]. This could indicate that hamstring muscles could represent the weakest part of the kinetic chain. However, this is not always the case and decrease in sprinting horizontal force production capacities could be the consequence of other lower limb injuries, such as ankle sprain, calf muscle injury, knee pain, overtraining or fatigue. Therefore, sprinting horizontal force production capacities evaluation can help highlight an issue, with a more integrative, functional and performance-oriented approach, [9] justifying a subsequent deeper analysis. Such an evaluation can be done as a screening test [9–11] for primary prevention and/or as a return to sport test [7,8] for secondary prevention.

Increase the end-user’s “buy-in” by killing two birds with one stone:

• Implementation of new strategies, measures or tools always represents a challenge. End-users now have lots of possibilities/opportunities to assist training and injury risk management, but often little time available. There is a need for efficiency.
• Since sprinting horizontal force production capacities evaluation is already used in routine for acceleration performance enhancement, no additional measurement is required (from athletes or staff members) to generate information for lower limbs injury risk management.
• We therefore suggest an extension of the use of analysed data, with a two-way application opportunity: sprint acceleration training and injury risk management. This is a win-win performance-prevention approach.

Authors names & Affiliations:

Pascal Edouard 1,2, Jurdan Mendiguchia 3, Caroline Prince 4,5, Pedro Jimenez-Reyes 6, Kenny Guex 7,8, Johan Lahti 9, Pierre Samozino 4, Jean-Benoît Morin 1,10

1 Univ Lyon, UJM-Saint-Etienne, Inter-university Laboratory of Human Movement Biology, EA 7424, F-42023, Saint-Etienne, France

2 Department of Clinical and Exercise Physiology, Sports Medicine Unit, University Hospital of Saint-Etienne, Faculty of Medicine, Saint-Etienne, France

3 Department of Physical Therapy, ZENTRUM Rehab and Performance Center, Barañain, Spain

4 Univ Savoie Mont Blanc, Inter-university Laboratory of Human Movement Biology, EA 7424, F-73000 Chambéry, France

5 Physiotherapy department and motion analysis lab, Swiss Olympic Medical Center, La Tour Hospital, Meyrin, Switzerland

6 Centre for Sport Studies, Rey Juan Carlos University, Madrid, Spain 

7 School of Health Sciences (HESAV), HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland

8 Swiss Athletics, Haus des Sports, Ittigen, Switzerland.

9 Université Côte d’Azur, LAMHESS, Nice, France

10 Sports Performance Research Institute New Zealand, School of Sport and Recreation, Auckland University of Technology, New Zealand

Correspondence to

Pascal Edouard, MD PhD, Department of Clinical and Exercise Physiology, Sports Medicine Unit, IRMIS, Campus Santé Innovations, University Hospital of Saint-Etienne, 42 055 Saint-Etienne cedex 2, France. Tel.: +33 674 574 691; Fax numbers: +33 477 127 229; E-mail: [email protected]

Funding: No funding. 

Competing Interest: None declared. PE is Associate Editor for the BJSM and the BMJ Open Sports and Exercise Medicine.

References:

1 Edouard P, Mendiguchia J, Guex K, et al. Sprinting: a key piece of the hamstring injury risk management puzzle. Br J Sports Med 2022;0:1–2. doi:10.1136/bjsports-2022-105532

2 Morin J-B, Bourdin M, Edouard P, et al. Mechanical determinants of 100-m sprint running performance. Eur J Appl Physiol 2012;112:3921–30. doi:10.1007/s00421-012-2379-8

3 Morin J-B, Samozino P. Interpreting Power-Force-Velocity Profiles for Individualized and Specific Training. Int J Sports Physiol Perform 2016;11:267–72. doi:10.1123/ijspp.2015-0638

4 Morin J, Samozino S. Biomechanics of Training and Testing: Innovative concepts and simple field methods. Springer International Publishing 2018. 

5 Schache AG, Dorn TW, Blanch PD, et al. Mechanics of the human hamstring muscles during sprinting. Med Sci Sports Exerc 2012;44:647–58. doi:10.1249/MSS.0b013e318236a3d2

6 Morin J-B, Gimenez P, Edouard P, et al. Sprint acceleration mechanics: The major role of hamstrings in horizontal force production. Front Physiol 2015;6. doi:10.3389/fphys.2015.00404

7 Mendiguchia J, Samozino P, Brughelli M, et al. Progression of Mechanical Properties during On-field Sprint Running after Returning to Sports from a Hamstring Muscle Injury in Soccer Players. Int J Sports Med 2014;35:690–5. doi:10.1055/s-0033-1363192

8 Mendiguchia J, Edouard P, Samozino P, et al. Field monitoring of sprinting power–force–velocity profile before, during and after hamstring injury: two case reports. J Sports Sci 2016;34. doi:10.1080/02640414.2015.1122207

9 Edouard P, Lahti J, Nagahara R, et al. Low Horizontal Force Production Capacity during Sprinting as a Potential Risk Factor of Hamstring Injury in Football. Int J Environ Res Public Health 2021;18:7827. doi:https://doi.org/10.3390/ijerph18157827

10 Lahti J, Mendiguchia J, Ahtiainen J, et al. Multifactorial individualised programme for hamstring muscle injury risk reduction in professional football : protocol for a prospective cohort study. BMJ Open Sport Exerc Med 2020;0:e000758. doi:10.1136/bmjsem-2020-000758

11 Lahti J, Mendiguchia J, Edouard P, et al. A novel multifactorial hamstring screening protocol: association with hamstring muscle injuries in professional football ( soccer ) – a prospective cohort study. Biol Sport 2022;39:1021–31.

12 Morin J-B, Samozino P, Murata M, et al. A simple method for computing sprint acceleration kinetics from running velocity data: Replication study with improved design. J Biomech 2019;94:82–7. doi:10.1016/j.jbiomech.2019.07.020

13 Cross MR, Lahti J, Brown SR, et al. Training at maximal power in resisted sprinting: Optimal load determination methodology and pilot results in team sport athletes. PLoS One 2018;13:e0195477. doi:10.1371/journal.pone.0195477

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In people with rheumatoid arthritis (RA), the immune system attacks healthy tissues in the lining of the joints. It often affects the hands, wrists, and feet. Over time, these joints can become stiff and deformed. Here’s why RA often affects these areas, along with treatments that may help prevent and treat pain.

Why does RA affect the hand joints?

RA tends to affect many joints at once. Often, symptoms first appear in the small joints of the middle fingers and in the bases of the hands and toes. It usually occurs in the same joints on both sides of the body.

RA may affect small joints in the hands first because there are many more joints in the hands than in other parts of the body.

The hands have 29 joints each. These joints are supported by a complex network of muscles, ligaments, and tendons that has evolved to perform complex tasks.

In people with RA, the immune system attacks and causes inflammation in the joint lining, or synovium. The synovium produces a fluid that lubricates the cartilage covering the ends of bones, allowing the bones to glide smoothly against each other when a person bends the joint.

A person with RA may experience symptoms such as pain, swelling, and stiffness in the joints. Over time, chronic inflammation in the joints may cause the cartilage to gradually wear away.

The condition may also progress to larger joints, such as the knees, ankles, or elbows.

In addition to affecting the joints, RA can cause inflammation that can also impact a person’s:

• heart
• lungs
• eye
• kidneys
• skin

Common symptoms

Some research suggests that RA has a slow onset in more than 50% of cases.

Around 25% of people have abrupt RA onset. Experts believe that it is linked to gum inflammation from bacteria called Porphyromonas gingivalis. People will not experience gum inflammation or gingivitis (gum disease) from this infection unless they smoke.

RA is progressive, which means that the symptoms get worse over time. Treatments such as disease-modifying antirheumatic drugs (DMARDs) and nonsteroidal anti-inflammatory drugs can help slow the progression of RA but cannot cure the condition.

Early signs and symptoms of RA include tenderness, pain, swelling, or stiffness in joints that:

• affect more than one joint
• usually start in small joints, such as the hands, wrists, or feet
• affect the same places on both sides of the body
• last for at least 6 weeks
• may be accompanied by stiffness in the morning for 30 minutes or longer

The fingers may appear swollen, like sausages. Inflammation can eventually cause irregularities in the joints and an inability to properly bend or straighten these joints.

Some other common symptoms of RA include:

• weight loss
• fever
• weakness
• fatigue

Over time, inflammation can affect other parts of the body, leading to symptoms such as:

• dryness, pain, and inflammation in the eyes
• sensitivity to light
• small bumps in the skin over bones called rheumatoid nodules
• shortness of breath
• a dry mouth
• gum inflammation or infection
• a low red blood cell count

Home remedies

Home remedies do not replace medical treatments such as DMARDs, which can help slow the progression of RA. A person should never stop or change their prescribed treatment plan before speaking with a doctor.

Several home remedies may help alleviate pain, swelling, or stiffness in the joints due to RA. These remedies include:

• heating pads or warm baths, to loosen up stiff joints
• ice packs, to relieve joint pain and swelling
• meditation and deep breathing techniques, to help a person relax and take their mind off the pain
• acupuncture
• massage
• splints for the fingers or wrists
• assistive devices, such as ergonomic keyboards or jar openers
• lotions with capsaicin, to help relieve localized pain

The following supplements have limited scientific evidence proving their benefits but are worth bringing up with a doctor:

• cannabidiol (CBD) products
• fish oil
• turmeric
• glucosamine
• probiotics

Making certain dietary changes can also reduce inflammation throughout the body and help a person lose weight. This may help relieve RA symptoms. Having an anti-inflammatory diet includes eating:

• less sugar
• fewer processed foods
• less red meat
• less full fat dairy
• more fresh fruits
• more vegetables
• whole grains
• lean meat
• fish
• legumes
• nuts
• seeds

Some people with RA may find that avoiding gluten or eating more fermented foods, such as yogurt and sauerkraut, helps with symptoms.

A person should always talk with a doctor before trying any new supplements or making any major dietary changes.

Exercises

For people with RA hand pain, exercise may improve the symptoms and maintain joint mobility and function.

Some research suggests that performing therapist-recommended hand exercises may improve grip and hand function while also relieving RA symptoms.

A 2018 study in 841 people with RA suggests that hand exercises may improve mobility and function. The study also concludes that performing a hand exercise routine likely does not relieve pain or improve a person’s grip and strength in the short or long term.

• Here are three simple hand exercises that a person can try:
• Gently squeeze a small, squishy ball or a stress ball.
• Place the hand out flat with the palm up. Bend each finger, one by one, into the palm. Hold, release, and repeat.
• Place the hand flat on a table. Lift one finger off of the surface and release it back down. Repeat with each finger, one by one.
• Getting regular, gentle, full body exercise helps increase strength and range of motion in the joints, which can improve daily functioning. It also helps a person maintain a moderate weight, which can improve RA symptoms.

A person should aim to incorporate the following into their routine:

• cardiovascular exercises, such as walking or swimming
• full body strengthening exercises
• light stretching

Some exercise is always better than none. Although feeling some discomfort is OK, a person should stop exercising if they feel significant pain.

When to talk with a doctor

A person should talk with a doctor if they experience any early symptoms of RA, including:

• persistent pain or stiffness in the joints
• joints that are warm to the touch
• difficulty moving or engaging in daily activities

For people who already have a diagnosis of and treatment plan for RA, a doctor visit is warranted if they:

• experience any new symptoms
• feel that their treatments are no longer managing their symptoms
• develop any side effects from their medications

A person should also talk with a doctor before starting new supplements or a new diet. Also, they should always talk with a doctor before changing or discontinuing their medications.

• A person should ask questions of their care team as needed. The team will often consist of the following healthcare professionals:
• a primary care physician
• a rheumatologist, who will specialize in treating musculoskeletal conditions such as RA
• a rheumatology nurse, who can help educate the person about RA
• a physical therapist, to help with mobility issues and teach hand exercises
• an occupational therapist, to share devices and techniques that help a person live with their symptoms and go about their daily tasks
• a mental health professional, to help with stress and anxiety, which are more common in people with RA
• an orthopedic surgeon, to correct joint damage with surgery as necessary

The takeaway

RA is an autoimmune condition that affects many joints in the body. The condition causes the immune system to attack the lining in the joints, causing pain and swelling. Because there are many joints in the hands, people usually experience the first symptoms of RA in their hands.

Medications such as DMARDs help slow the progression of the condition. Several home remedies can also help manage the symptoms. Hand exercises may improve hand mobility, while full body exercise may relieve the symptoms and improve overall well-being.

A person’s healthcare team can help determine the best treatment plan to manage pain and improve functioning.

The Orthopedic & Sports Medicine Center of Oregon is an award-winning, board-certified orthopedic group located in downtown Portland Oregon. We utilize both surgical and nonsurgical means to treat musculoskeletal trauma, spine diseases, sports injuries, degenerative diseases, infections, tumors and congenital disorders.

Our mission is to return our patients back to pain-free mobility and full strength as quickly and painlessly as possible using both surgical and non-surgical orthopedic procedures.

Our expert physicians provide leading-edge, comprehensive care in the diagnosis and treatment of orthopedic conditions, including total joint replacement and sports medicine. We apply the latest state-of-the-art techniques in order to return our patients to their active lifestyle.

If you’re looking for compassionate, expert orthopedic surgeons in Portland Oregon, contact OSM today.

Phone:
503-224-8399

Address
1515 NW 18th Ave, 3rd Floor
Portland, OR 97209

Hours
Monday–Friday
8:00am – 4:30pm

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Ranging from a dull ache to sharp, stabbing pain, back pain can develop from an injury or may be due to advanced age. While back pain manifests in a variety of ways, the goal of Jaffe Sports Medicine is to diagnose and treat the root cause of your back pain with a variety of interventional modalities.

In order for Jaffe Sports Medicine to fully treat and understand your pain, it is important to first understand and identify where the pain is coming from. Most back pain falls under three categories: axial, referred or radicular pain.

Axial Pain

Axial pain is often confined to a single spot or region of the body. A muscle strain is a common example of axial pain and typically responds well to rest and medication.

Referred Pain

A dull or achy pain, referred pain can move around or vary in intensity. A common example of referred pain is lower back pain which can unfortunately be trickier to treat than others. Referred pain often responds well to physical therapy, injections, strengthening muscles and decreasing inflammation.

Radicular Pain

Radicular pain feels like searing, radiating pain and is caused by compression or inflammation of the spine. The pain is typically localized to the lower back and may include pain that radiates down the legs. Physical therapy, injections and nerve-blocking techniques can help alleviate this type of pain.

The duration of the pain is also used in diagnosing and treating back pain. Pain is considered to be acute, subacute or chronic. Acute pain may last a few days to a week, while subacute lasts a little longer and chronic pain lasts longer than 12 weeks.

Jaffe Sports Medicine is here to diagnose your back pain and provide an individualized treatment plan. Treatments for back pain may include one or a combination of the following methods: physical therapy, medication, injections and radiofrequency ablation. Surgery is an option but is used as a last resort.

Physical therapy exercises increase flexibility, while also strengthening muscles and improving posture. By itself or combined with other treatments, physical therapy is a great solution to lessen back pain.

For immediate relief from back pain, cortisone injections are a great option. The injections go into the space around the spinal cord and nerve roots, helping to ease pain by decreasing inflammation. While relief only lasts for a month or two at a time, injections are successful in diminishing back pain.

Radiofrequency ablation is a technique where a needle is inserted into the area causing pain. Radio waves pass through the needle to the damaged nerves, interfering with the pain signals from the brain. The technique is often successful diminishing back pain. 

Learn more about Jaffe Sports Medicine’s approach to treating back pain by visiting jaffesportsmedicine.com/conditions/back-pain/ and schedule an appointment by visiting jaffesportsmedicine.com/locations/.

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Every year, hundreds of thousands of people — visitors and locals alike — hit the slopes throughout Eagle and Summit counties in search of corduroy, bluebird days, and deep pow. 

 It's also the time of year when Dr. Sterett of Vail-Summit Orthopaedics & Neurosurgery begins to see an influx of knee injuries associated with skiing and snowboarding. 

 In this blog post, we'll look at three of the most common ski-related knee injuries and offer tips on how to avoid them.

#1 Medial Collateral Ligament (MCL) Tear

The MCL is a stabilizing ligament that runs along the inner side of your knee. An MCL sprain or tear can occur when your knee forcefully twists or the outside of your knee takes a strong, direct hit.

While anyone can suffer an MCL injury, they're more common among beginner and intermediate skiers due to the frequency of using the "snow plow" technique to slow or stop. When the skis' tips point toward each other, your knees are more vulnerable in a knock-kneed position. If you catch an edge or lose control, the sudden force can tear your MCL.

Symptoms of an MCL tear typically include: 

• Inner-knee pain

• Feeling like your knee might give out 

• A locking or catching sensation

• Swelling and stiffness

• Some people experience a popping sound

An MCL tear, while painful, can often be treated with conservative measures without the need for surgery. Read more about treating MCL tears. 

#2 Anterior Cruciate Ligament (ACL) Tear

The second most common injury — and also the most well-known — is an ACL tear. The ACL is one of four ligaments in the knee and provides stability for the knee joint by preventing excessive forward and backward movements.

The ACL can tear when the knee is twisted beyond its normal range of motion. This injury often occurs when someone falls backward (the ski's tail acts as a lever forcefully rotating the knee), catches an edge, or lands off-balance from jumps. 

One of the telltale signs of a torn ACL is feeling and hearing a pop. Other symptoms include:

• Pain that can be sharp and severe

• Swelling immediately or several hours later

• Difficulty putting weight on the injured leg

• Feeling like your knee might give out

• Limited range of motion

Unfortunately, a completely torn ACL can't heal on its own. Surgery is often recommended to restore stability and function and ensure a return to the activities and sports they love most. Read more about ACL surgery.

#3. Meniscus Tear

Your knees are stabilized by two C-shaped pieces of cartilage called menisci. These act as shock absorbers, helping to distribute weight evenly in the knee joint. 

A meniscus tear is an injury that can occur when there's a sudden twist or rotation of the knee, especially when you're bearing weight on a foot that's in a fixed position (such as within a ski boot).

Symptoms of a torn meniscus include:

• Pain in the knee joint

• Popping sensation when the injury occurs

• Swelling and stiffness

• Difficulty extending the knee fully

• A feeling of the knee locking or catching

Minor meniscus tears can be treated with conservative measures, but surgery may be recommended in moderate to severe cases. Read more about treatment for meniscus tears.

How to Reduce Your Risk of a Ski-Related Knee Injury

We know you're eager to hit the slopes, but before you do, check out these tips that can protect your knees and possibly prevent a season-ending injury. 

1. Focus on your fitness before ski season. Cardio and strength training combined with flexibility and balance exercises will help improve your performance and prevent injury.

2. Check your equipment. Ensure your boots, bindings, poles, and skis/snowboards are the proper size and fit for your height, weight, and ability level.

3. Warm up before hitting the slopes. A good warm-up routine will help get your muscles loose and ready for action, which can help reduce your risk of injury. 

4. Ski within your abilities. It's important to know your limits. You might want to head straight to the back bowls, but if you are a beginner or haven't been on the slopes in a while, take it easy at first. Build your confidence and skills by skiing on easier terrain before venturing into more challenging territory.

5. Use proper technique. Are you using proper form when skiing or snowboarding? If you're unsure, it's best to spend some time with an instructor. Not only will this improve your overall performance, but a professional can also teach you how to fall (it happens to everyone) in a way that reduces your risk of a knee injury.

6. Know when to call it. If you start to feel sore or tired, take a break! And although "just one more run" is hard to pass up, you don't want to be completely exhausted on the last lap of the day. There's a good reason why more injuries occur later in the day. Instead, head to aprés on a high note. 

Knee Injury in the Vail Valley? Contact Dr. Sterett Today. 

If you injured your knee on the slopes, contact Dr. Sterett: Vail-Valley's most trusted orthopaedic knee surgeon. 

As the Head Team Physician for the U.S. Women's Alpine Ski Team, plus one of the few knee specialists who have earned a Certificate of Added Qualification in Sports Medicine, Dr. Sterett will design a treatment plan that gets you back to making first tracks.

Call (970) 476-7220 and make your appointment today. Urgent care and same-day appointments are often available. 

You can also schedule a consultation using Team Sterett's online form.

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The health of our lungs isn’t necessarily talked about a lot when general health is discussed. Typically, cardiovascular health, chronic pain, cholesterol and stroke risk tend to be the more common topics. Many don’t think about lung health until there is a problem and then improving it becomes priority number one.

And it isn’t just lung cancer that is the biggest concern. There are a host of other respiratory diseases that can cause problems. Chronic Obstructive Pulmonary Disease or COPD has jumped up the list of lung issues causing airflow blockage and breathing related problems. According to the Centers for Disease Control, COPD was the fourth leading cause of death in 2018 with almost 15.7 million Americans being diagnosed.

There are some respiratory ailments that can be prevented but others might be due to poor lifestyle choices (like smoking) or due to genetics. Many of the drugs used to ease the symptoms of these issues come with dangerous side effects. Acupuncture is an effective and natural way to boost your lung health.

Acupuncture approaches each patient individually so treatment protocols for the same issue will almost certainly vary even if the same issue is being treated. Acupuncturists may also use nutritional changes and herbs to help ease and correct respiratory conditions.

Acupuncture, or Traditional Chinese Medicine (TCM) believes that the body is full of energy called Qi and when Qi is out of balance, a whole host of health issues can occur. Acupuncture helps to regulate this flow of energy throughout the body to achieve balance.

There are three main acupuncture points that are addressed when dealing with respiratory issues. Kidney 27 is located bilaterally on the chest, just below the collarbone. This point is used to open the lungs, encourage full breathing and to reduce coughing. Lung 5 can be found at the end of the crease in the elbow, just outside of the tendon. This point opens the airways and the throat while also reducing coughing and wheezing. Ren 17 is in the middle of the chest, right between both nipples. This point opens the chest, loosens congestion, stops coughing and encourages full breathing.

And the researcher backs up these claims. A 2012 study published by the National Health Research Institute shows that acupuncture can improve breathing ability in COPD patients. According to the study, patients received daily acupuncture treatments for 12 weeks using the same acupuncture points on each patient. The study found that patients receiving regular acupuncture treatments show significantly better scores rating their ability to breath.

Our entire bodies function more optimally when we nourish it properly. We all know certain foods can help with certain things (i.e., the anti-inflammatory diet, the heart healthy diet, the low cholesterol diet, etc.) like building immunity, lowering inflammation and contributing to a healthy heart. Believe it or not, there are foods that can help to open the lungs and increase circulation. Garlic and onions are anti-inflammatory and help to fight off infections. Chili peppers open the nasal passages, stimulate the mucus membranes and fight off bacteria. There are also five key herbs for lung health: astragalus, cordyceps, Ophiopogon, Ashwagandha, and Eleuthero coccus.

If you suffer from a respiratory illness like COPD, emphysema, a chronic cough or just want to make sure your lungs are functioning as best as possible, talk to your acupuncturist about your treatment options. When our lungs aren’t balanced, it can lead to many other health issues when we don’t get the oxygen we need. Your acupuncturist will do a full health history and talk to you about your concerns and health goals. Make an appointment today to boost your lung health and get your whole body back in balance.

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Why is this study important?

Despite knowing about the many established physical and mental health benefits of regular physical activity, many people lead sedentary lives and find it hard to increase their physical activity levels. Most clinical interventions in daily life are limited to a single message on the importance of regular physical activity for health and the need for its implementation in daily routines, which has limited efficacy. More successful means to combat physical inactivity are desperately needed.

Various interventions to promote physical activity have been tested in clinical trials, most compared interventions to  usual care. In recent years different self-monitoring devices such as pedometers, fitness trackers or smartphone apps (collectively known as activity monitors) have become widely available. Several systematic reviews have demonstrated that self-monitoring using different activity monitors can lead to substantial physical activity increases. However, until now, none of the systematic reviews have analysed the added value of complex physical activity interventions beyond self-monitoring. 

How did the study go about this?

We searched five databases to look for randomized controlled trials using different interventions to promote physical activity, but with self-monitoring in both treatment arms. The studied arms were therefore different only in terms of the additional intervention beyond physical activity self-monitoring. Eighty five eligible studies were found (including 12,057 participants) and 75 of those studies were included in the meta-analysis. We analysed the effect of any physical activity increase directly post intervention and for some studies we were also able to examine effects up to 24 months later. 

What did the study find?

We found that adding interventions to physical activity self-monitoring led to an initial increase on average of an extra 926 steps/day.  This positive initial effect of interventions was decreasing with time: each additional week decreased the step-count on average by approximately 10 steps/day. Interventions with a prescribed goal such as a number of steps daily and those involving human counselling, particularly via phone/video calls, were associated with a greater increase in the daily step-count than interventions with added print materials, websites, smartphone apps or incentives. In the long-term, there was a less evident but still positive effect, leading on average to an additional 413 steps/day up to 2 years post-intervention.

What are the key take-home points?

Based on available evidence, those who are physically inactive should be encouraged to use pedometers, fitness trackers or smartphone apps to monitor their daily step-count and to set goals to increase this by a specific number of steps. Other interventions can also be considered; however, these should provide additional benefit beyond simple self-monitoring. Remote phone/video counselling is another potentially highly effective and convenient component of physical activity interventions. Our findings should be further explored as a promising way of combatting the pandemic of physical inactivity, both at a population level and within individual clinician and patient encounters.

Author and Affiliations:

Tomas Vetrovsky, Tess Harris, Łukasz Małek 

Dr Tomas Vetrovsky, Faculty of Physical Education and Sport, Charles University, Prague, 16252, Czech Republic; [email protected]

References 

1. Vetrovsky T, Borowiec A, Juřík R, et al Do physical activity interventions combining self-monitoring with other components provide an additional benefit compared with self-monitoring alone? A systematic review and meta-analysis British Journal of Sports Medicine  Published Online First: 07 September 2022. doi: 10.1136/bjsports-2021-105198

The post How to combat the pandemic of physical inactivity? appeared first on BJSM blog - social media's leading SEM voice.

Also, as a Podium patient, you now have a resource for antibody testing wherever you live!

In today’s email:

• Risk of Obesity

• LabCorp Antibody Testing

Obesity and COVID

One thing we continue to see with this pandemic is that a patient’s experience with SARS-CoV-2 is often related to their health status when infected. I don’t know of any good research to suggest that you are less likely to contract COVID when otherwise healthy, but it is evident that patients with certain underlying medical conditions are likely to suffer much more severe illness if they do catch the virus.

In the US, a shocking number of adults have a chronic metabolic diseas (or multiple such illnesses). These are “diseases of lifestyle”, often preventable or extremely modifiable by the choices and actions of the patient. Included in this list are:

• Diabetes (Type 2)

• Hypertension

• COPD or Emphysema

• Coronary Artery Disease (Heart Disease)

• Obesity

All of these are, for the most part, related to lifestyle. Also important is the fact most occur on a gradient or spectrum. In other words, it’s not like you put on a couple of pounds one weekend and you’re suddenly “obese”. Weight gain occurs over many years, progressing through a spectrum of overweight designations. All along this spectrum, detrimental health consequences exist, and they become more prevalent and severe with increasing weight gain. (Of course, we’re talking about body weight gained as excess fat, not muscle.) For a person who is 5’ 10”, a diagnosis of “obesity” is attained when they weigh 209 pounds or more. That does not mean that at 208 they are perfectly healthy. By the same token, the risks of obesity when facing COVID are not so markedly defined. Someone who is 5’ 10” and 195 pounds may classify as “overweight” rather than “obese”, but they still have higher risk than someone who is 175 pounds. (Again, these are general numbers, not taking body composition into account.)

In the US, 88% of adults have either an underlying chronic illness or are overweight or obese. Stated another way, only 12% of our adult population would be considered metabolically healthy. To make matters potentially worse, much of that 12% is likely concentrated among younger adults. Once we start looking at cohorts of American adults in their 40s and 50s, the percentage of healthy individuals declines sharply.

While we do not yet have the direct data, it stands to reason that our country is paying the price for these excesses during this pandemic. The vast majority of patients who experience severe illness or death with COVID-19 have an underlying metabolic illness, including obesity. On the other hand, most of those otherwise healthy patients with COVID-19 (non-diabetic, non-smokers, healthy weight…) have relatively mild courses when infected. There is a direct correlation between metabolic health and likelihood of death from this virus.

I find it interesting to dig into the reasons why this is the case, but I recognize that not everyone wants to read the specifics around how belly fat increases inflammation and may predispose a patient to cytokine storm. So instead, let’s just think about the ramifications of these statistics. If we as Americans took better care of our bodies, it is reasonable to expect that our death rate with COVID-19 would be remarkably lower. If we valued metabolic health, real food, and active lifestyles, it is conceivable that our economy would not be taking the hit that it is now. We talk about reopening the country while protecting the vulnerable. This seems to be a great strategy toward getting our economy back on line quickly. In fact, what if we had been able to do this from the outset, never fully shutting down? How do you achieve those things when 88% of your population constitutes “the vulnerable” though?

As a population, we have put ourselves in a very weak position. There are numerous reasons for this, each worth its own dissertation. We fail to exercise regularly. We allow for food policy that values corporate welfare over population health. We prefer pharmaceutical solutions over lifestyle modification. Now, we find ourselves in a position where all of this comes to a head. For those among the 88%, there is no cure to purchase. The best odds lie in investment. Investment in your body and your health.

Admittedly, the readers of this email largely fall into the 12%. However, I feel it is important to note what we are seeing with this disease. All of you, my patients, take your health and fitness seriously. We should recognize this moment as a reminder why that is important, and consider how you can help those you love be better prepared in the future. The message here is not one of “doom and gloom”. Instead, it is a positive reminder that our fate often lies in our own hands. Every small decision and habit makes a difference. When you lace up your running shoes tomorrow, you can add to the list another reason why it feels so good to make the choice to invest in yourself.

Antibody Testing at LabCorp

As discussed last week, antibody testing is becoming more widely available and more reliable. Such serologic testing tells us whether you have been exposed to the virus and if you have evidence of immunity. These tests are now available through our testing partner, LabCorp. If you’ve not been tested and would like to be, please let us know.

I was recently asked by a patient, “So what’s new with COVID? Is there anything we’ve learned recently?” Ok, maybe I’m paraphrasing a bit, but that was the gist of it. The question made me realize that perhaps it’s a good time for a quick review of where we stand now. To keep it simple(r), I’ll do this in a bulleted fashion.

• The degree of risk after infection is dependent on a patient’s baseline health. Those with pre-existing conditions and certain metabolic health concerns are more likely to suffer severe illness or death. Conversely, if you are healthy, fit, and active, you are much more likely to have a mild case, should you become infected.

• There was a time when it seemed that possibly large numbers of infected individuals were asymptomatic throughout the course of infection. As more data has been gathered, we now know that unlikely to be the case. Instead, there is a fairly lengthy pre-symptomatic time frame, when an infected person may spread the illness without demonstrating current symptoms. However, most people who contract SARS-CoV-2 will have some degree of symptoms eventually.

• The primary means of transmission remains respiratory droplet spread when people are in close contact for extended time periods. While it may be possible to walk past someone and contact the virus in lingering aerosols, it is unlikely that this is a frequent mode of transmission. Likewise, it seems that spread via surfaces may not be as worrisome as initially thought. This is related to a concept called “viral load”, which describes how much virus a person is exposed to. Aerosols and surfaces may not provide enough viral load to reliably cause infection. That said, this is no reason to stop washing your hands or to start licking public countertops. Hygiene is still king! The real take-home is that you should be selective about who you spend extended periods of time around, as that is likely the highest risk activity.

• Long-term lung and heart injury is possible after infection, even when otherwise healthy individuals contract the illness. The specifics are not intimately understood, but this should provide rationale for not “just going out, getting the virus, and being done with it.” The risk of such ongoing disability is very low, but it exists.

• Infection generally confers some degree of immunity. There are surely some individual determinants of how long that immunity lasts and how robustly it manifests. It is estimated that most recovered patients will enjoy months or years of immunity, and they will likely have milder cases should they contract the illness again later.

• A “second wave” is almost a certainty. No one knows whether it will be a large spike or a more attenuated one. Perhaps a bigger question involves how society will respond. Will we shut down again? Will we instead choose to shelter only those who are vulnerable? I suspect it will be a piecemeal response in the US, running the full gamut with little overarching coordination. Could get interesting!

• A safe, effective vaccine is still quite a ways off, but progress is being made. In the past weeks, announcements have been made regarding various projects, and often times stock prices for these biotech companies jump upon such announcements. However, these are early trials, often trying to establish safety in small groups of 10-50 people. You might imagine, that’s a far cry from having data to suggest safety and efficacy across a population. We’re getting there, but I don’t suspect we’ll see a safe, effective, widely deployable vaccine in this calendar year…or perhaps even next year.

• Ultimately, we may need to move toward “herd immunity”, but we are still a long way from approaching this. Given the sickly nature of our general populace, we need to proceed with measured pace. This is where, unfortunately, our country’s poor health handicaps us economically. In the end, payment is always due.

• We are only a few months into this pandemic! It may seem like forever, but the pace of scientific advance has been incredibly fast when we consider the timeline. There is much yet to learn, but don’t discount the fact that we have been progressing by leaps and bounds, in a manner not typically seen in immunologic and public health science.

As things progress, I will send updates when it makes sense. At this time, I don’t see a need for weekly or even biweekly emails. However, as always, please contact me with any question that may arise. We may do some COVID specific podcasts in the coming weeks and months as well, especially if there are any topics you’d like me to dig into with more depth.

Here we go again…maybe?

As a country, our COVID-19 numbers have gone back to moving in the wrong direction. We enjoyed a slight plateau, even a bit of a drop in cases, for a short while. However, we have reversed that trend, which has the unfortunate consequence of generating another one of these emails from me :)

Previously, I’d written about the likelihood of a “second wave”. This is not a second wave though. What we are seeing now is the extension of the first wave, moving into regions beyond where the pandemic first struck the US. More than half of all states are seeing rising case numbers, some are setting records daily. It has been argued that this is due to increased testing, but the data clearly shows otherwise. Hospitalizations do not increase simply because more people get tested, yet that is what we are seeing. The percentage of all tests which return positive results has increased as well, so there is no validity to an argument that this increase is simply due to the US testing more people. Fortunately, we have not seen a rise in deaths. In fact, deaths continue to decline. Hopefully that signals a real change in the epidemiology, but I fear that deaths may simply be a lagging indicator, typically rising 2-3 weeks after case rates begin to rise. It could be the case that deaths are lower because many more of the infected individuals are younger. We are seeing more twenty- and thirty-year-olds getting infected, likely due to a widespread resumption of social activities. If those milder cases continue to comprise a greater percentage of all illness, perhaps that buffers the otherwise bad news of increased infection rates. Time will tell.

In my opinion, the current circumstances should serve as a reminder to all of us that normalcy has not returned. In fact, we are unlikely to see normalcy anytime soon. That doesn’t mean we need to castastrophize this increase in infections, but we should take it as a reminder that basic defenses still matter. Don’t let your guard down or be lulled into a false sense of security. COVID is here, and it’s not going anywhere in the near future.

There remain questions around immunity…probably more now than there were a month ago. It is still uncertain whether infection leads to immunity, and if it does, how long that lasts. It appears that some people may get infected, fight off the illness, yet not produce adequate antibodies to prevent a second infection. We just don’t know. Given that and the fact that infection presents a very real financial risk for many of my patients (athletes who can’t compete or earn a living when sick), I still think it makes sense to mitigate risk and avoid illness at this time.

Pro Advice

Last week, I attended the PGA’s RBC Heritage at Hilton Head Island. During the event, the PGA Tour had its first incidence of a player testing positive for COVID-19. This week, there have been a couple more positives at the event in Connecticut. Upon learning of the positive in Hilton Head, I sent an email to those of you who are PGA players. For the benefit of my patients who are not among this group, I’ve placed an excerpt of that advice below.

“I hope you all take this as a reminder that COVID is here and your actions matter when it comes to mitigating your own risk.  Hilton Head is crawling with people this week, and we’ve seen that very few of the vacationers are taking steps to socially distance.  You can make decisions to lower your risk of COVID…and avoid a forced withdrawal.

With this in mind, I want to address some things that may seem simple but will go a long way toward keeping you healthy this week and in weeks to come.

• This virus is primarily spread via close contacts with individuals in enclosed spaces.  This means any interaction closer than 6 feet from someone which lasts longer than 10 minutes while indoors.  Please limit these types of interactions, especially in public spaces.  In your daily routines while on the road, this typically occurs when in restaurants or gyms.  Of course, if someone seems ill, avoid interaction for any amount of time.

• In some of the emails I’ve sent during the pandemic, I discussed some strategies for supporting immune function and (hopefully) limiting your likelihood of infection.  Aside from basic hygiene, which is hugely important, there is scientific rationale for ensuring you are consistent with diet and supplement regimens.  Here is a link to one of the emails which included this information.

• As you get back to competing, things will seem more normal.  Don’t be lulled into a false sense of security.  Evaluate whether it makes sense to visit restaurants, bars, and coffee shops.  Consider options such as take-out or delivery.  Eat outside, away from others when you do visit restaurants, and limit trips into public spaces.

• When you go to the grocery or other locations away from the course, I would recommend that you wear a mask or cloth face covering.  Can’t hurt.  Might help.  Evidence for their utility is increasing.

• Consider ways that you can train without going to the gym.  If you can travel with equipment (dumbbells, kettlebells, TRX, bands), give it a try.  However, training in a gym may be necessary or simply preferred. If you do go to a gym, wipe down all equipment before you use it and again afterward, and avoid touching your face.  Take a container of Clorox wipes with you, and use them liberally.  Try to keep 12 feet or more between you and other exercisers.  As people exercise, their respiratory rate and force of breathing increases.  This would lead to an infected individual shedding greater amounts of virus while exercising.  Given that, I would suggest completing all aerobic or endurance training outdoors.

On the issue of masks, I find it strange and disheartening that it has become such a polarizing and politicized topic. Evidence for their utility continues to mount. The highly-respected journal, Annals of Internal Medicine, published a couple articles on this topic recently. For those inclined to read about it, HERE is one worth perusing. Masks aren’t perfect, but it’s not an issue of binary utility. In other words, it’s not that they either work or don’t work. Rather, it’s an issue of whether they help to limit spread, and the evidence suggests they do. Worst case, they don’t help much and you look silly in a mask. Seems a small price to pay for possibly helping to contain the outbreak. I honestly don’t see what all the fuss is about. When you go to the gym, the grocery, or take a flight, wear a mask!

The Podium (Our Podcast for You!)

The podcast is published! You can find it on our website, at Apple Podcasts, and most other places where you might get your podcasts. This project has been created as a resource for you, our patients at Podium! I hope you enjoy it.

We have started to record Season 2, but I want to highlight an episode from Season 1. Give this one a listen, as it has wide-ranging applicability!

Creatine

Episode 3 of Season 1 addresses the utility of Creatine as a supplement. Many think of it as something only for weight-lifters and power athletes, but there is good data to suggest its utility for endurance athletes and to aid in cognitive performance. I now take 2.5g of creatine every day, and I think there is likely reason for all of you to do the same. Take a listen, and let me know what questions you have!

**NEW CPD Course**
 medical acupuncture & dry needling
 when: July 13 & 14 2019
 where: Kensington Physio, 7 Russell Gardens W14 8EZ
 cost: £350
 to book: register here or call 020 7603 0040
LIMITED AVAILABILITY

The post CPD EVENT – Medical Acupuncture & Dry Needling Course – July 13 & 14 2019 appeared first on Kensington Physio.

Knee Osteoarthritis Treatment

Typical symptoms of knee OA include pain, stiffness, swelling and loss of motion. The symptoms can cause limitations in activity that can significantly affect your ability to function and your quality of life.

When you suffer from knee OA, your body is unable to grow new articular cartilage. Treatments primarily focus on controlling the symptoms of OA. Initially, you might treat the symptoms with over-the-counter medications such as ibuprofen or acetaminophen. As symptoms worsen, prescription medications and treatments such as physical therapy can be added. More severe pain can be treated with injections, including corticosteroids or viscosupplements such as Orthovisc. When those treatments stop working, your only option left is to have the knee replaced.

Stem Cell Treatment for Knee Pain

Recent advances in research have provided an alternative treatment that can often postpone the need for surgery. Stem cells provide hope for treatment for a number of severe, degenerative conditions, especially knee OA. Stem cells are cells in the body that are able to regenerate themselves through cell division. They serve as a repair system for the body.

Early stem cells were harvested from donated embryos that were not used during in vitro fertilization. There was a lot of debate regarding the ethical use of these embryos. Recently, much of the research has shifted to focusing on adult stem cells, where there is no ethical debate.

Injecting adult stem cells into the area of injury allows for healing of the damaged tissue. The property of differentiation provides stem cells the ability to heal tissues that the body otherwise is unable to regenerate due to poor blood supply. The injected stem cells help attract the body’s own stem cells to contribute to the healing process. In addition, stem cells have a broad spectrum of growth factors the help block inflammation, adding to the treatment’s success.

Early research has shown promising results with stem cell treatment for knee pain in improving patient’s pain and function following treatment. However, more research is needed to learn exactly how the stem cells work and if we are able to fully regrow the cartilage lost with knee OA.

Click HERE to learn more about the services offered for knee pain treatment at Jersey Shore Sports Medicine. To schedule a consultation with Dr. Sokalsky, please call us at 609-904-2565 or click HERE.

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A sports medicine physician has the additional training to treat most injuries to athletes, as well as weekend warriors and even patients who lead more sedentary lifestyles. Sports medicine physicians can diagnose and direct the treatment of sprains and strains to muscles, ligaments and tendons. They can also treat chronic conditions such as joint arthritis.

Non-surgical treatments that can be provided by sports medicine physicians include cortisone injections, viscosupplement injections, manipulative therapy and medications. They can also prescribe additional treatments such as physical therapy. Many nonsurgical sports medicine physicians additionally offer regenerative treatments such as platelet rich plasma injection and stem cell therapy.

With a background in general medicine, nonsurgical sports medicine physicians are also able to address non-orthopedic injuries like concussions. They are also able to help recognize the signs of underlying medical conditions that can cause pain or otherwise affect activity performance. For example, young, female athletes, particularly those in sports like figure skating and gymnastics, can be at risk of stress fractures due to physiologic changes from poor nutrition. Another example is athletes competing in cold weather can have asthma-like symptoms such as coughing and shortness of breath while training without having true asthma. These are conditions that if recognized and treated early can significantly improve performance and keep athletes on the field by avoiding injury.

Nonsurgical sports medicine doctors treat most “orthopedic” injuries without the need for surgery. In addition, they can help monitor the overall health of athletes, identifying potential medical problems that could be lurking under the surface.

And, remember sports medicine physicians are well suited to provide comprehensive medical care for the “non-athlete” as well, and are excellent resources for the individual who wishes to become active or begin an exercise program. For the “weekend warrior” who experiences an injury, the same expertise used for the competitive athlete can be applied to return the individual as quickly as possible to full function.

Common examples of treatment provided by nonsurgical sports medicine physicians include:

• Acute injury treatment (sprains, strains, knee & shoulder injuries and fractures)
• Overuse injury treatment (rotator cuff, tendonitis, osteoarthritis)
• Concussion (mild traumatic brain injury)
• Athletes with chronic or acute illness (such as asthma)
• Nutrition and performance issues
• Exercise prescription for patients who want to increase their fitness
• Injury prevention
• “Return to play” decisions
• Recommendations on safe strength training and conditioning exercises
• Healthy lifestyle promotion

Interested in learning more about services offered at Jersey Shore Sports Medicine? Click HERE.

To schedule a consultation with Dr. Sokalsky, please call the office at 609-904-2565 or click HERE for an appointment.

The post Why Should I See a Sports Medicine Physician? appeared first on Jersey Shore Sports Medicine | NJ.

5 Outdoor Winter Workout Health and Safety Tips

Layer Up

While it is a natural instinct to bundle up against the cold, it is important to remember that our bodies produce a lot of heat that needs to be dissipated while exercising. Be sure to wear multiple thin layers that can be easily removed during a workout to help release the built-up heat. Layers close to the skin should be made of synthetic fibers that can wick away moisture and keep the skin dry. Outer layers should help protect against the elements such as wind, rain and snow. Additionally, with shorter days, the outer layers should be lighter in color or include reflective materials for working out in the dark.

Protect Your Extremities

In cold weather, the body shunts more blood flow to the core of the body to help maintain proper body temperature. This leaves the outermost parts your body, fingers, toes and ears, more vulnerable to the cold and possible frostbite. Be sure to include additional protection such as hats or headbands for your ears and gloves your hands. Specialized winter footwear may be necessary to protect your feet as typical running shoes are designed to release heat while running. An additional option may be to buy your sneakers a half size bigger to allow space for thicker socks. Finally, the same rules apply for covering your hands and feet as with the rest of your body. Stick to synthetic fibers close to the skin with thicker fibers covering those.

Warm Up

All your workouts require a proper warmup. Increasing the blood flow to muscles and tendons increases the temperature and pliability of the tissues, decreasing the risk of injury. However, in the cold of winter, it can take longer to achieve the increase in blood flow and tissue temperature.

And be sure to make the warmup a dynamic one. The old form of static stretching, like bending over to touch your toes, does not provide the necessary effect to decrease injury risk. Instead, movements such as body weight squats and lunges can get the muscles ready for a winter workout involving running or cycling.

Hydrate

Many people forget about the importance of hydration in cold weather because they do not feel the added stress of excess heat and perspiration like in the heat of the summer months.
However, there are several factors in cold air that increase the demands on fluid maintenance in the body. Warming the cold, dry air as we breath it in and more rapid evaporation of sweat in the cold are just a couple causes of significant water loss during a winter workout. Make sure to maintain regular fluid intake throughout your workout to prevent dehydration. For workouts under an hour, water is sufficient. But longer workouts should include some type of sports drink or electrolyte replacement.

Keep Moving

Outdoor workouts are likely to be more popular than usual with the reality of COVID this winter. While the cold can be uncomfortable for many of us, the important thing is to keep some form of exercise routine. Moving our workouts outside can be performed safely by following the few, simple tips above.

Want to get better results from your exercise routine? Suffer from a chronic sports injury? Contact Us for a comprehensive Sports Medicine Consultation.

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The post 310. Sounds from nature, like birdsong, can improve your mental health appeared first on Dr. David Geier - Feel and Perform Better Than Ever.

In this blog we explain the findings from our recent review published in BJSM on the use of exercise, antidepressants and/or their combination for combating symptoms of non-severe depression in adults. 

Why is this study important?

Depression is a leading cause of disability worldwide and is estimated to affect over 320 million people (1). Depression can have debilitating effects on both mental and physical health, and can severely affect mood, interpersonal relationships and quality of life (2). 

Second-generation antidepressants are the standalone treatment for depression, however many depressed patients, especially those with non-severe depression, are hesitant to initiate antidepressant treatment. Some of the reasons for refusing treatment include high costs, adverse effects, social stigmatization and the belief that the treatment will not be effective (3). 

Lately, physical exercise has gained attention as a potential treatment alternative that is cheaper, safer and more accessible than antidepressants. However, it is unclear whether exercise can have similar benefits on depressive symptoms compared to antidepressants. 

This study is important because it compares the effects of exercise to the effects of a conventional clinical treatment for depression. The results will inform clinical practice guidelines about the potential of exercise to improve symptoms of non-severe depression.

How did the study go about this?

We conducted an extensive literature review and searched for studies on depressed individuals who were randomly allocated to an exercise, antidepressants, or exercise plus antidepressants intervention and that assessed symptoms of depression before and after the intervention. We then extracted relevant data from the included studies and compared the extent to which each of the treatment approaches alleviated the depressive symptoms of participants. We made use of recognized reporting guidelines (PRISMA, CINeMA) and conducted a number of statistical analyses to ensure that our results were accurate and were rigorously obtained. 

What did the study find?

Overall, we found evidence from 21 studies on over 2,500 participants that were randomized to an exercise, antidepressant or exercise plus antidepressant intervention, or to a non-interventional control condition. 

When compared to controls, studies of exercise, antidepressants and exercise plus antidepressants showed greater alleviations of depressive symptoms. However, when compared to one another, none of the three treatments was superior to the other. 

We also found that participants who were assigned to an exercise intervention were more likely to drop out from the study than participants who took antidepressants, although this was based on a lower number of studies. 

What are the key take-home points?

Physical exercise performed on its own or in combination with antidepressant treatment can alleviate symptoms of depression to a similar extent as antidepressants alone. Our results support the adoption of exercise as an alternative treatment for non-severe depression in adults. Clinicians should consider recommending exercise to individuals who show signs of depression of mild or moderate severity.  

References

1. World Health Organization. Depression and other common mental disorders: global
   health estimates. Geneva: World Health Organization, 2017.
2. Kessler RC. The costs of depression. Psychiatr Clin North Am 2012;35:1–14. 
3. Sansone RA, Sansone LA. Antidepressant adherence: are patients taking their
   medications? Innov Clin Neurosci 2012;9:41–6.

The post Exercise and depression: How does exercise compare to antidepressants for managing non-severe depression? appeared first on BJSM blog - social media's leading SEM voice.

The aging process is commonly associated with a loss of muscle strength and power, and an overall decline in function and physical fitness, with the result being weakness. This is often seen as being a non-preventable aspect of the human timeline, which to some extent is true, however, that is not to say that this decline cannot be slowed. Thus, the question is whether a loss in muscle strength is directly related to ageing (and non-preventable), or whether it is due to reduced exercise and activity as the individual ages.

There are some components of age-related weakness that cannot be controlled for, with a 1-3% loss in arm and leg muscle strength for every year of age above 601. This loss in muscle strength and infiltration of fat has been found to be one of the major predictors of functional decline and loss of independence1. More importantly, strength training and physical activity has found to be a predictor for maintaining, and even IMPROVING, muscle strength in elderly populations 2. Although, we do lose muscle mass as we age, with regular exercise, it is possible to build strength and reverse this process (to a degree), leading to an overall improvement in quality of life and independence2. Along with maintenance of exercise, individuals who have led a relatively active life (compared to a sedentary individual), generally have a slower decline in muscle mass/function, overall mobility and strength. This is important to know, as much like investing in your superannuation is setting you up for comfortable retirement, so is going to the gym or going for a run or walk with your friend.

Figure 1. Graphical representation of muscle fibre strength preservation with exercise (from Maula et al. 2019)

Although we generally become less active as we age, there is still plenty of opportunity to exercise, however, this is not the case for a lot of the population. The 2016 Centre for Disease Control report found that in the preceding month, 27.5% of adults older than 50 and 35.3% of adults older than 75 reported no leisure physical activity time4. Such an extreme lack of physical activity leads to higher morbidity and mortality, and an overall poorer quality of life, which are exaggerated for the elderly as there are already several age-related changes occurring in their bodies (loss of balance, strength and endurance)4,5,6. With more than one-third of our elderly population (and over one quarter of our middle-aged population) doing ZERO activity in the last month, it is no surprise that our rate of chronic disease across the population continues to increase. As our population continues to age, it is important that we investigate why this is occurring, rather than just acknowledging the issue at hand. Exercise does not always have to be structured and specific, rather it can whatever gets somebody moving and sweating, and a few examples are listed below

· Walking groups with friends in the area – walking to get a coffee counts!

· Hiking whilst on away on a holiday

· Tai chi or pilates classes in the park or at a gym/physio

· Following a body weight strength program/video at home

· Trying to go for a swim when at the beach

· Walking the long way whilst going to an appointment

Maula et al., (2019) found that there were four main categories which influenced physical activity levels of individuals aged >65 (Table 1). These categories have both barriers and facilitators included in them and as such, are areas which both health professionals and close social supports can address in the goal of improving exercise levels.

Table

There are numerous barriers which can be addressed to help promote physical activity in the elderly. These range from exercising with the individual to providing positive reinforcement and educating them on the benefits of physical activity. A large number of the elderly population disconnect from society as they age, and exercise offers the ability to reconnect through social outings and improved energy levels. With improved social integration, physical activity can address the mental and social wellbeing of the elderly, as well as the physical.

References

1. Frontera, W. R., Reid, K. F., Phillips, E. M., Krivickas, L. S., Hughes, V. A., Roubenoff, R., & Fielding, R. A. (2008). Muscle fiber size and function in elderly humans: a longitudinal study. Journal of applied physiology (Bethesda, Md. : 1985), 105(2), 637–642.

2. Lopez, P., Pinto, R. S., Radaelli, R., Rech, A., Grazioli, R., Izquierdo, M., & Cadore, E. L. (2018). Benefits of resistance training in physically frail elderly: a systematic review. Aging clinical and experimental research, 30(8), 889–899.

3. McLeod, M., Breen, L., Hamilton, D. L., & Philp, A. (2016). Live strong and prosper: the importance of skeletal muscle strength for healthy ageing. Biogerontology, 17(3), 497–510.

4. Watson, K. B., Carlson, S. A., Gunn, J. P., Galuska, D. A., O'Connor, A., Greenlund, K. J., & Fulton, J. E. (2016). Physical Inactivity Among Adults Aged 50 Years and Older - United States, 2014. MMWR. Morbidity and mortality weekly report, 65(36), 954–958.

5. Lee, I. M., Shiroma, E. J., Lobelo, F., Puska, P., Blair, S. N., Katzmarzyk, P. T., & Lancet Physical Activity Series Working Group (2012). Effect of physical inactivity on major non-communicable diseases worldwide: an analysis of burden of disease and life expectancy. Lancet (London, England), 380(9838), 219–229.

6. Carlson, S. A., Adams, E. K., Yang, Z., & Fulton, J. E. (2018). Percentage of Deaths Associated With Inadequate Physical Activity in the United States. Preventing chronic disease, 15, E38.

7. Maula, A., LaFond, N., Orton, E., Iliffe, S., Audsley, S., Vedhara, K., & Kendrick, D. (2019). Use it or lose it: a qualitative study of the maintenance of physical activity in older adults. BMC geriatrics, 19(1), 349.

This is a continuation of Trent’s amazing blog content, except through this new platform, we will also be keeping you up to date with dorsaVi’s amazing AMI technology. With interesting research articles, compelling case studies, and engaging interviews and webinar clips; from interviewees, such as Dr Trent Nessler himself and 10-41 Strength and Physical Therapy, dorsaVi customers.

This blog is a quick, easy way to keep apprised of our AMI! A space where we hope to provide you with tailored content and well-researched posts. We hope you will check it out, here: https://dorsaviami.blogspot.com/, enjoy our content, and subscribe!

A Note From Trent Nessler, PT, MPT, DPT -  Founder ViPerform AMI and Co-Founder Combat Athlete Science Institute

Thank you all for the tremendous support since the inception of this blog in 2008.  This has truly been a labor of love of mine.  However, with growing demands and obligations, I have had to move this blog to the above DorsaVi blog site.  This blog will be focused on the ViPerform AMI, our current research with and all the amazing things we are learning from mass data capture.  I am also the Senior Sports Medicine Contributor on www.SportsEdTv.com and will continue providing the latest in research on injury prevention and performance enhancement in athletics.  

For more information, please go to my website at www.drtrentnessler.com and our new website at www.combatathletescienceinstitute.com.  

Identifying these flaws in these movements not only help to identify those that are at risk but also give us a clear indication of what to do to prevent.  In a single leg squat for example, if the athlete’s knee is going in toward midline during the performance of the test, when we train them, don’t let them do that!  Is it really that simple?  Yes, it is.  If your athlete cannot do 10 reps of a single leg squat without letting the knee go in towards midline, have them do as many as they can with proper form.  When they can no longer control the motion and do with proper form, simply stop or better yet, regress the exercise.  

The last movement we will discuss on evaluating is the squat.  Why the squat?  One of the number one reasons is that we know that athletes who improve their performance on the squatting motion will increase their vertical jump and sprint speed.  Squatting motion is an excellent movement to improve explosive power.  In most athletic situations, this is also a movement that most athletes will be doing as a part of their training throughout their athletic career. 

Looking at the athlete from behind, visualize (or better yet have stand in front of) a plumb line that runs through the center of the skull, cervical spine all the way down the sacrum.  As the athlete performs the squatting motion, their hips should remain relatively equal distance from the plumb line.  If not, then the athlete is shifting his/her weight to one side.  

This shifting is a common motion that we first identified back in early 2000s and we call this a lateral shift.  In 2012, was the first research paper to describe this was published and the authors termed this a lateral displacement of the pelvis during a squatting motion.  As we initially suspected, this lateral shift results in several things:

• Increase in weight distribution to the side you are shifting to

• Increase in EMG (muscle activation) to the side you are shifting to

• Increase in GRF on the side you are shifting to

There is a whole slew of additional things that occur with this shifting motion but the key is the loading is abnormal and you don’t load the way the system was designed to be loaded.  With increase force on one side versus the other, this adds to a wearing and tearing on that side which can add to injury.  Same time, if the muscles are more active on one side versus the other, then strength will never ever be symmetrical unless this is addressed.  In addition, what we see is that if you can see this under body weight conditions, when the athlete goes into the weight room and starts doing this under a weighted bar, this motion gets even worse.  This means when squatting #225, the load on the spine, hips and lower limb is greater on one side than it is on the other.  For optimal performance AND injury reduction, we must balance this out.  

Next week, we conclude this discussion by talking about fatigue state training.  What is it and how do we do.  I hope you found this information useful and looking forward to sharing more with you.

*Dr. Nessler is a practicing physical therapist with over 23 years sports medicine clinical experience.  He is a nationally recognized expert in the area of athletic movement assessment and injury prevention.  He is the founder | developer of the ViPerform AMI,  ViPerform AMI RTPlay, the ACL Play It Safe Program, Run Safe Program, author of a college textbook on this subject and published researcher.  Trent has performed >5000 athletic movement assessments in the US and abroad.  He is the President of Rebound Vitality providing injury prevention services for the tactical athlete and movement consultant for numerous colleges and professional teams.  Trent also a Brazilian Jiu Jitsu purple belt and complete BJJ/MMA junkie. Follow Dr. Nessler on Instagram @ BJJPT_ACL_GUY or Twitter @ ACL_prevention.  www.drtrentnessler.com*  

But did you know that there’s a related therapy to A2M injections? We also offer PRP injections, a type of therapy that can restore worn-out cartilage and damaged tissue. Like A2M, PRP – or platelet-rich plasma – can be used to treat sports-related injuries and trauma. It’s a relatively experimental procedure, but has been endorsed by top athletes around the world. Healthline writes that Tiger Woods and Rafael Nadal both swear by this procedure to treat their sports-related injuries!

What Are PRP Injections?

Platelet-rich plasma (PRP) is a substance that can rebuild damaged cartilage if injected into the body. Unlike A2M, PRP does not occur by itself in the body. It’s created by concentrating plasma taken from the blood so it becomes – as the name suggests – rich in platelets. Platelets occur in the blood, and are involved in things like tissue healing and prevention of blood clots.

By separating out the platelets from the blood, PRP is more concentrated than the platelets or plasma found naturally in the body. This makes it a more powerful remedy for tissue damage than a typical recovery treatment. It also works faster than conventional recovery methods like physical therapy or medication. For this reason, it’s a popular choice among athletes of all ages.

Advantages of PRP Injections

Healthline writes that PRP injections treat anything from arthritis to sports injuries to hair loss. It’s most commonly used to remedy various forms of arthritis, tissue damage, and post-surgery healing. Studies have proven the effectiveness of this procedure in treating tennis elbow, rotator cuff tears, and chronic tendonitis.

The main advantage of PRP injections over other forms of recovery is its speed. It accelerates the healing process for a wide variety of injuries. If you’re an athlete who needs to return to the court or field as soon as possible, PRP can make a world of difference in your recovery. Another advantage of PRP injections is that they reduce the need for medication. As an alternative to conventional treatment methods, they limit the patient’s dependency on anti-inflammatories or pain relievers. Finally, as PRP is created using your own blood, there are little to no complications with this kind of treatment.

The Process

The process for PRP injections is much the same as A2M therapy. Dr. Dominguez can perform the whole procedure onsite at our office in as little as 30 minutes.

First, we’ll withdraw blood from your arm. Then we spin it in a centrifuge at high speed to separate out the platelets and the blood cells. Finally, we inject the platelet-rich portion back into the body at the point of injury, identified by an X-ray or ultrasound. It’s a simple but highly effective process.

For more information on PRP injections, or to schedule an appointment, contact 3D Sports Medicine today!

Further Reading

• American Academy of Orthopedic Surgeons – PRP Injections
• Healthline – PRP Injections
• Hospital for Special Surgery – PRP Injections

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The collarbone – also known by its formal name, the clavicle – is one of the largest bones in the shoulder. It connects the ribcage to the shoulder blade and helps your arms move. As with any bone, it is vulnerable to fractures through trauma. These can include a fall, a collision, or a sports-related injury. These types of injuries are not uncommon. The American Academy of Orthopedic Surgeons estimates that around 5% of all adult fractures are related to a broken collarbone. Read on to learn about the causes, risk factors, and treatment options for a broken collarbone, as well as what we do at 3D Sports Medicine to treat this type of injury. If you suffer a traumatic injury and think you have broken or injured your collarbone, call us at 3D Sports Medicine or, if it’s after hours, go to the emergency room immediately. It’s essential to start treating the injury as soon as possible.

Who’s At Risk?

Young people are at the highest risk for a broken collarbone, for a few reasons. First of all, the collarbone doesn’t finish fully developing until age 20. This means that children and teenagers have softer collarbones that are more susceptible for injury. Second, many collarbone injuries are caused by direct trauma, which in turn can often be caused by contact sports. This makes youth sports – particularly those with full contact like lacrosse and football – a particularly dangerous source of clavicle fractures.

Although children and teenagers under 20 years of age are at the most risk for collarbone injuries, older adults are susceptible as well. Just as the collarbone is under-developed in young people, it becomes brittle and easily broken in adults over age 70. In older people, collarbone injuries are most often caused by things like collisions or falls. Though these are the most common age groups for these types of injuries, anyone can suffer a collarbone fracture.

Symptoms of a Broken Collarbone

The American Academy of Orthopedic Surgeons writes that the most common symptoms of a broken collarbone include:

• A bump or protrusion at the point of injury, that could look like a “tenting” of the skin
• A bruise or swelling at the point of injury
• Severe pain throughout the collarbone and arm, that prevents you from lifting your arm
• Stiffness in the shoulder or arm area, preventing you from moving your shoulder
• A grinding sound in your shoulder when you try to move it

To confirm a broken collarbone, 3D Sports Medicine will take an X-ray of your clavicle. If more information is necessary, Dr. Dominguez may order a CT scan. We’ll also perform a detailed physical examination to make sure there are no other injuries or complications related to the broken collarbone.

Treatment: Where 3D Sports Medicine Comes In

As with any injury, treatment for a broken collarbone depends on the severity of the trauma. The Mayo Clinic recommends that all treatments include restricting movement of the collarbone using a sling, medication, and physical therapy. Medications include pain relievers, anti-inflammatory agents, or in more severe cases, prescription narcotics. Physical therapy is essential in regaining strength and motion in your arm and collarbone, and should begin as soon as possible. The extent of the therapy varies based on the injury – Dr. Dominguez will decide what’s best. If the broken collarbone cannot be treated with these options, then a routine surgical procedure may be necessary. These procedures usually involve inserting a plate or screw to keep the broken collarbone in place.

At 3D Sports Medicine, we specialize in treating traumatic fractures. Dr. Dominguez worked as an orthopedic traumatologist in Melbourne prior to specializing in sports medicine. This work gave him invaluable experience working with traumatic injuries, including broken collarbones and other fractures. For conventional collarbone injuries, we have state-of-the-art casting and splinting treatments. For more complex fractures, Dr. Dominguez may perform a minimally invasive surgery. For more information, see our Orthopedic Services page.

If you believe you may have injured or broken your collarbone, call 3D Sports Medicine for an appointment right away. (321) 610-8939.

The post Broken Collarbone: Basics, Symptoms, and Treatments appeared first on 3D Sports Medicine and Orthopaedic Center.

3D Sports Medicine utilizes the most cutting edge rehabilitative and surgical procedures tailored to your specific needs to achieve your goal, whether that entails walking up a flight of stairs without pain, or playing a round of golf comfortably. Treatment for general Orthopaedic problems does not always include surgery. Find out what your options are.

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