Keeping Kids Safe In Sports
By Alan H. Beyer, MD, FACS
With the arrival of September, many children head back to school and to the soccer field, track or volleyball court. This is the time of year when we start to see a surge in sports-related injuries in kids. But heeding some common-sense tips can help you keep your child injury-free.
Be sure your kids are in condition before they engage in any vigorous sports activities. That means they should be shoring up their endurance through 20 to 30 minutes of cardiovascular activity that increases their heart rate, at least several times a week. An added bonus is that setting this as a goal now will serve them well as they enter adulthood, by developing good health habits that last a lifetime.
Strength training in children is not advisable, since pre-teen boys and girls have just not developed to the point where this will be of benefit. Light weights for conditioning purposes are acceptable, but girls under 14 and boys under 16 should avoid “power lifting” to bulk up their muscles.
Kids should also be sure to stretch their muscles before any exercise, especially the ones that will be worked during sports activity. Football players and runners should be sure to stretch their quadriceps and calves. Swimmers, volleyball and baseball players may want to add arm and upper chest stretches to their pre-game routine.
Encouraging physical activity is one of the most important ways parents can help their kids stay healthy. By stressing these pre-game measures, you can help keep your child on the playing field.
Hand Trauma: Can This Finger Be Saved?
By
No one likes to think about the possibility of losing a finger. But all too often, I am called to a local emergency room to help save or re-attach a finger or thumb. Usually the result of an industrial or handyman accident, these injuries are normally less severe if the patient was wearing protective gloves. Successful treatment and recovery usually depends on the severity of the injury, the location of the injury to the hand, and the overall health of the patient.
In the case of a partial laceration or amputation, the chances of successfully re-attaching the finger are good if the cut is a clean one with minimal additional trauma to the digit. “Crush” injuries may damage a finger to the point where the blood vessels are not viable, making a repair impossible.
A laceration or amputation of the index finger warrants a serious discussion with the patient. Repairing an injury to zone 2--the area of the finger between the knuckle and middle joint--often results in severe stiffness and scarring of the tendons. A great deal of physical therapy is required to regain functionality after an injury to this area, and the finger will most likely never be “as good as new.” The reality is that the loss of an index finger often results in a minimal decrease in function because the other fingers compensate quite well. Patient and physician need to seriously weigh the cost and benefit of replanting an index finger.
An injury to the thumb normally warrants the most aggressive course of treatment because this digit is the most critical to preserving function of the hand. Unfortunately, the prostheses which are currently available for the upper extremity have relatively poor functionality since none restore the sensation which is critical to the use of the hand.
If you or a loved one are at risk of suffering a laceration or amputation of a digit, keep the following tips in mind:
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Wearing protective gloves can make a big difference in minimizing the severity of an injury
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In the case of an amputation, the finger should be placed in saline-soaked gauze, then in a plastic bag with ice
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Treatment will require a full complement of specialists and technology, so an immediate trip to a well-equipped emergency room is critical---urgent care centers will probably not be able to handle this emergency
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Recovery will be a long process, with months of physical therapy necessary to restore functionality. It is not unusual for rehabilitation to go on over the course of six months to a year.
What’s New In Osteoarthritis Treatment?
By James T. Caillouette, MD
Osteoarthritis (OA) is a progressive disease that is sometimes referred to as "wear and tear" arthritis. It is the most common form of the disease—OA accounts for 80% of all arthritis cases--and about 30 million Americans are afflicted with the condition.
What happens with OA? Within the joints, an elastic tissue called articular cartilage covers the end of bones and helps them to glide smoothly against each other. Osteoarthritis results when chemical changes in the cartilage cause it to break down faster than it can be produced. When the cartilage gradually wears away, it becomes painful to move the joint.
Osteoarthritis can affect any joint in the body. Symptoms range from mild to disabling, and include pain and inflammation, swelling, stiffness, loss of range of motion, and weakness.
The good news is: many non-surgical treatments for OA are constantly evolving and yielding good results for patients. Omega-3 fish oil and the supplements glucosamine and chondroitin sulfate have been shown to improve osteoarthritis symptoms in some patients. Exercise--especially Pilates or swimming--and weight control are very effective in managing and treating OA. Non-steroidal anti-inflammatory medications can help reduce inflammation.
In terms of surgical treatment of OA, there has been a sea change in current medical wisdom on the timing of intervention. The old mantra was that patients should postpone surgery until the pain was nearly unbearable. We now know that assessment is just plain wrong. Many studies have demonstrated that, for patients with significant arthritis, there is no benefit to waiting on their surgery. In fact, clinical data show that postponing surgery only creates collateral damage to other structures in the body. Patients are much better off if we intervene sooner rather than later.
There are new advancements that are proving of great benefit to those patients who do opt for surgery. Techniques such as less invasive hip or knee replacement result in smaller incisions, less post-operative discomfort and quicker recovery times. Patients can get on with their lives sooner than ever before.
If you or a loved one is suffering with OA, seek medical attention. Chances are very good that your orthopedist can help you restore your quality of life and live as pain-free as possible.
Poor Posture: The Straight Story
By Alexander Francini, MD
Like many things in life, it turns out your mother was right. Poor posture is not just a bad habit or a sign of decreased confidence. Numerous studies have proven that poor posture puts pressure on the disks inside the spinal column and can lead to low back pain, tension headaches and neck problems. The stress that poor posture exerts over time can also lead to degeneration of the spinal disks and may require more invasive treatment. Is it really so difficult to stand up straight?
Small children who are learning to walk exhibit perfect posture. It allows them to maintain perfect balance as they begin exploring the world on two legs, rather than on all fours. That’s a clear indication that good posture comes naturally to us, and poor posture is actually an acquired habit. A lifetime of bad posture can eventually make you feel like you should be on all fours!
What is the ideal posture? Stand straight up against a wall, with your heels, buttocks, upper back and head touching the wall. This position is the ideal alignment of your spine. It allows your back muscles to support the disks and maintains the “s” curve that characterizes correct posture.
While it may feel odd if you have been slouching for years, a little effort to maintain correct posture will have a big payoff. It won’t take long before good posture becomes a habit, and you’ll go a long way toward avoiding the nagging health problems that plague those who don’t stand erect---a small trade-off for doing what comes naturally.
Shouldering The Pain: Bursitis
By Steven Gausewitz, MD
If you are having pain, loss of strength, or a limited range of motion such as difficulty raising your arm or shoulder, you may be suffering from bursitis. A sac-like membrane (bursa) between the rotator cuff and the shoulder blade cushions and helps lubricate the motion between these two structures. If there is excessive rubbing or squeezing of the rotator cuff and shoulder blade, an inflammation of the bursa may result.
Bursitis is a “wear and tear” injury. Those who are most at risk of developing bursitis in the shoulder include athletes who routinely extend their arm at high speed, weightlifters, and workers whose job entails prolonged extension of the arms overhead, such as painters and window washers. Studies have shown that the incidence of bursitis increases as we age, but anyone can develop the condition.
The first course of treatment for bursitis is rest. Icepacks may also be prescribed, as well as anti-inflammatory drugs, steroid injections and physical therapy. In some cases, a patient may require the temporary use of a sling. After the inflammation subsides, physical therapy will most likely be recommended to help strengthen the shoulder.
If these measures fail to provide relief, surgery may be necessary. The surgical repair can be performed arthroscopically on an outpatient basis. Extensive physical therapy may be required afterward to strengthen the shoulder and restore range of motion.
Bursitis rarely gets better on its own. If you suspect bursitis, be sure you get evaluated as soon as possible—there is no reason you should have to shoulder the pain.
Shoulder Pain
By Russell S. Petrie, MD
Although some orthopedic conditions are more common within certain age groups than others, shoulder problems are now becoming an “equal opportunity” affliction in all age brackets. Why? Because the rise in popularity of extreme sports—such as daredevil BMX riding and snowboarding--has young people literally throwing their joints out of whack.
Dislocation is one of the two most common shoulder conditions we see. It is most generally caused by a traumatic injury. Football players, snowboarders, surfers, and rugby players are particularly at risk of suffering this type of injury. Once a dislocation occurs, there is a high likelihood that it will recur. In fact, if the first dislocation happens in a young person before the age of 20, there is a 95 percent probability that another dislocation will occur. An arthroscopic procedure called labral repair can successfully reattach the ligaments to the bone to prevent the dislocation from recurring. Recovery following surgery takes between four and six months.
Rotator cuff tears are another common shoulder problem that we see, primarily in the older population. They are caused by a combination of overuse and poor blood supply. Very active people, especially those who play “overhead” sports such as tennis, volleyball and racquetball, are especially prone to develop rotator cuff tears. The rotator cuff eventually wears out because it doesn’t heal very well with repetitive stress over a long period of time. Depending on the type of tear, arthroscopic surgery may be employed, but some repairs will need to be done as an open procedure. It can take up to a year following the procedure to fully recovery from surgery because shoulders heal so slowly.
If you are experiencing pain, stiffness or a general weakness in your shoulder, be sure to have it checked. Arthroscopy has given us an even better understanding of how shoulders work, and how to treat them when they don’t.
Osteoporosis: A Brittle Reality
By Michael L. Gordon, MD
Osteoporosis is a progressive disease of bone loss that afflicts 28 million Americans. When bones lose their density, they become more porous and susceptible to fracture. It is estimated that 1.5 million bone fractures occur each year. Why is this alarming? Only 25 percent of hip fracture patients will make a full recovery. Forty percent will require nursing home care, and 50 percent will need a cane or walker. Nearly one-in-four hip fracture patients will die within 12 months after the injury due to complications associated with the injury and recovery.
Age is a major risk factor for osteoporosis because after 35, the body builds less new bone. Preventive measures are key to avoiding osteoporosis. An adequate calcium intake and a lifetime of weight-bearing exercise can help prevent loss of bone mass. But what can be done for an advanced case of osteoporosis?
At Newport Orthopedic Institute, we treat fractures associated with the disease every day. Although it more common in women, osteoporosis will lead to bone fractures in one in five men over age 65. For women over 65, the incidence of bone fractures is one in two. That is why we recommend that women have a baseline dexascan performed after age 50.
When I see a patient with osteoporosis, I usually recommend aggressive treatment with diet, exercise, and calcium supplementation. Drugs such as Actonel, Fosamax or Boniva can increase bone mineral density and decrease fracture rates by 50 percent per year . One drug, Forteo, is a synthetic hormone that can actually build bone mass , but requires daily injections for up to a year at a time.
When osteoporosis has led to collapse of the vertebrae, a minimally invasive procedure called kyphoplasty can help bring relief. Kyphoplasty uses a balloon and bone cement to restore the vertebral body height and shape, and strengthen the spine. The procedure may be performed under sedation using either local or general anesthetic, and generally helps alleviate the discomfort of painful vertebral fractures.
Could It Be Carpal Tunnel Syndrome?
By Tze C. Ip, MD
Carpal tunnel syndrome refers to an inflammation of the median nerve at the wrist. There is a structure in the wrist called the carpal tunnel, through which the median nerve and nine tendons pass from the forearm into the hand. Carpal tunnel syndrome results when swelling in this tunnel puts pressure on the nerve. Over time the increased pressure affects the way the nerve works, resulting in tingling, numbness and pain in the hand and fingers. Simply put, carpal tunnel syndrome can be likened to a pinched nerve at the wrist.
Although it has often been characterized as a repetitive-motion injury, there is no evidence to support this view. More likely, carpal tunnel syndrome is attributable to one of several conditions. These may include a swelling of the lining of the flexor tendons, called tenosynovitis. Joint dislocations, fractures, and arthritis can narrow the tunnel, putting pressure on the nerve. Keeping the wrist bent for long periods of time, which may arise due to improper keyboard technique, can also exacerbate the condition. Even thyroid conditions, rheumatoid arthritis, and diabetes can be associated with carpal tunnel syndrome. There may also be a combination of causes contributing to the condition.
The numbness or tingling associated with carpal tunnel syndrome usually occurs in the thumb, index, middle, and ring fingers. It may arise during daily activities such as driving or reading a newspaper, and some patients may notice a weaker grip, occasional clumsiness, and a tendency to drop things.
Conservative management of carpal tunnel syndrome is usually the treatment of choice when symptoms are not severe. This may include anti-inflammatory medications to reduce swelling and wearing a brace overnight. More serious cases of carpal tunnel syndrome may warrant cortisone injections. In chronic cases where conservative management has failed to provide relief, surgery may be necessary to release the tendon. Fortunately, this is an outpatient procedure and patients usually have the use of their hands and fingers immediately after surgery.
For more information on carpal tunnel syndrome, be sure to check out the interactive video on the Newport Orthopedic Institute website. Log on to www.newportortho.com, click on “Health Education” and click on “Hand.” If you are suffering from this debilitating condition, you’ll learn there is indeed relief from carpel tunnel syndrome.
Beating Bunions
By Alexander Tischler, MD
Anyone who has ever suffered with a bunion knows that, despite its peculiar name, bunions are no laughing matter. A bony growth that forms at the base of the big toe, bunions develop when the big toe angles in toward the rest of the toes. There may be a callus covering the bump, along with swelling, redness, or pain at the base of the big toe and in the ball of the foot. Walking becomes difficult and painful.
While some people are more prone to developing bunions due to heredity, they are more often caused by wearing ill-fitting shoes or high heels that shift weight to the toes. Very narrow-toed shoes will force the big toe out of alignment over time, putting extra pressure on the joint. Other conditions that can lead to the development of bunions include injury, loose ligaments in the foot, arthritis and hammer toe.
Bunions rarely get better on their own. And while conservative treatment such as corrective devices (orthoses) and pain medication can help relieve symptoms of a mild bunion, surgery is usually the most effective solution for severe deformities. It helps restore normal alignment, which relieves the pressure on the toe joint. Surprisingly, there are over 100 different techniques used during bunion surgery, and some may be used in combination during a single surgery. Consultation with an orthopedic surgeon specializing in the foot and ankle is imperative to determine the type of surgery that will be most effective for your unique condition.
When is surgery indicated? If you have already made changes in your footwear, are using pads to cushion the area and are still limited in your daily activities because of the pain, surgery may be the best option. The orthopedic specialists at Newport Orthopedic Institute can help you decide if surgical intervention is the best treatment for you.
Getting To The Bottom Of Ankle Pain
By Andrew Gerken, MD
The ankle is a complex structure that, when injured, can lead to pain and swelling, restricted movement, and mild to moderate instability. The most common ankle injuries are sprains, but breaks, stress fractures and the effects of arthritis can also cause these and other symptoms.
The ankle joint consists of three bones: the shinbone, the fibula, and the anklebone. The knobby bumps on either side of the ankle are the very ends of the lower leg bones. The bump on the outside of the ankle is part of the fibula; the smaller bump on the inside of the ankle is part of the shinbone. This configuration allows the foot to bend up and down.
Right below the ankle joint is another joint, where the anklebone connects to the heel bone. This joint enables the foot to rock from side to side. Three sets of fibrous tissues, called ligaments, connect the bones and provide stability to both joints.
A sprained ankle means one or more ligaments on the outside of the ankle were stretched or torn. If it is not treated properly, there could be long-term problems. Physical therapy is necessary. A broken ankle can involve one or more bones, as well as affect the surrounding ligaments. Initially, a cast may be applied, which can later be replaced by a short walking cast. It takes at least six weeks for a broken ankle to heal. Sometimes, surgical repair of the broken bones is required.
Sometimes, despite treatment, the pain and instability may not resolve. The most common cause of persistent ankle pain is incomplete healing after an ankle sprain. There may be a specific spot of tenderness in the front of the ankle that won’t go away. Without thorough and complete rehabilitation, the ligament or surrounding muscles may remain weak, resulting in recurrent instability. As a result, the ankle may be prone to additional injuries.
When is it time to seek additional treatment? If the injury is not at least 80-90 percent recovered two to three months following treatment, it’s time to seek a second opinion. This is especially true if the ankle is loose, or keeps twisting and turning. Ankle arthroscopy may be necessary to stabilize the joint or remove scar tissue, followed by additional rehabilitation.
What’s New In Treatment For Knee Pain
By Alan H. Beyer, MD, FACS
Patients with knee problems know how painful their condition can be. Damage to the articular cartilage--the smooth lining that covers and cushions the bones of the knee joint—can be caused by injury or degenerative conditions such as arthritis, and is usually the root cause of the pain.
New treatments for worn and torn cartilage are showing great promise. These treatments focus on repairing the defect by actually restoring and regenerating the cartilage. For smaller defects, we can now use artificial “scaffolds” of a cartilage-like substance to plug the defect and encourage the patient’s own cartilage to grow into them. The scaffolds are made of a calcium matrix similar to the composition of bone. The procedure is performed arthroscopically and has been in general use for only the last year.
More extensive damage to the cartilage requires greater surgical intervention, and new developments in surgical technique will greatly benefit patients. Autologous cartilage transplantation has been the treatment of choice for several years. It involves the removal of a sample of the patient’s own cartilage cells, which are then used to grow additional cartilage. The growth process normally takes four to six weeks, after which the new cartilage is implanted back into the knee during a second operation.
A new technique, however, is allowing surgeons to take the patient’s cartilage cells and rearrange them onto a scaffold matrix that is then reinserted at the site of the defect. It is performed arthroscopically during a single operation, and avoids the need for a second surgery. Although this technique is currently being perfected by only a few centers, Newport Orthopedic Institute physicians hope to offer this procedure to patients in about twelve months, when approval by the Food and Drug Administration is expected.
New treatment options such as these offer new hope for patients and may help postpone or eliminate the need for total knee replacement. Be sure to check back on the NOI website at newportortho.com, where we will continue to keep you abreast of the very latest developments in orthopedic care.
Orthopedic Surgery: A Brave New World
By Steven Gausewitz, MD
Not too long ago, patients undergoing joint replacement surgery could expect to stay in the hospital for about two weeks after a lengthy operation that left them with a foot-long incision. Thanks to many advancements that have transformed the realm of orthopedic surgery, patients are now experiencing much quicker recovery times. How is this possible?
Better implant materials used in combination with less invasive surgical techniques have shortened both the incisions incurred during surgery, as well as the time patients need to spend in the hospital following their procedure. In many cases, the length of stay can be as little as one to three days, but this is strictly dependent on the needs of the patient. In addition, improved anesthesia options and medical management of pain help patients recover more quickly and with less discomfort.
Comprehensive patient education before surgery helps families understand the procedure and what to expect post-operatively. For instance, with joint replacement, hips generally recover more quickly than the knees. This pre-operative education helps patients set realistic expectations on how soon life will return to normal. Rapid-recovery post-operative rehab has also been instrumental in facilitating a speedy return to a normal lifestyle.
Clinical advancements in surgical techniques and instrumentation have also changed the setting in which many orthopedic procedures are performed. Many knee and shoulder surgeries can now be performed on an outpatient basis. These include rotator cuff repairs and anterior-cruciate ligament surgery. We may soon may be performing some spinal procedures on an outpatient basis, as well. Because Newport Orthopedic Institute (NOI) has just opened a state-of-the-art surgery center with top of the line equipment and dedicated anesthesia coverage, many of these procedures can be conducted here in our building in
Neuromas: A Frequent Cause of Foot Pain
By William W. McNair, DPM
Are you suffering from episodic or chronic pain in the ball of your foot? People who experience foot pain may sometimes be told they have a stress fracture or bone bruise, when in fact the cause is a neuroma. An enlarged nerve between the third and fourth toes, neuromas develop over time and cause a sharp shooting pain radiating from the ball of the foot. Some people liken the pain to a red-hot poker being stuck into their foot. In extreme cases, the pain can radiate from the ball of the foot all the way up the back of the leg.
What causes a neuroma? The condition is more prevalent in people with flat feet, and women are especially prone to developing neuromas because tight shoes and high heels contribute to the problem. Over time, the nerve becomes inflamed and enlarged. Changing to less constrictive footwear can help. Icing the problem area and cortisone injections can also provide relief. This is especially true if the pain has only persisted for a few months.
If the pain endures for longer than a few months—and some people live years with the condition--surgery may be necessary. The operation involves removing the affected nerve and usually provides a permanent solution to the condition. Of the patients I see with neuromas that have lasted longer than three or four months, 20 percent of the men and 75 percent of the women will require surgery. In most cases, patients who have the surgery are back on their feet in three days, and to full activities within two-to-three weeks, following the procedure.
The good news is this: you don’t need to suffer with foot pain. If you suspect you may have a neuroma, be sure to seek the attention of a foot specialist.
Still In Pain?
By Alexander Francini, MD
If you have been suffering with pain for longer than three months, you are not alone. Chronic pain affects an estimated 86 million Americans. The most common complaints are low back pain and headache, but medical conditions such as arthritis, diabetes and cancer treatment are common sources of pain as well.
Traditional therapies for chronic pain include over-the-counter pain relievers such as Tylenol and Motrin, and prescription medications like Codeine and Vicodin. However, patients may be surprised to learn that many different kinds of medications help control pain from the “inside out.” For instance, anti-depressants and seizure medications have proven very effective in helping patients to manage their pain. Antidepressants are useful because they adjust the levels of neurotransmitters (natural chemicals) in the brain that help enhance feelings of well-being and relaxation. Anticonvulsants, or seizure medications, help minimize impulses to nerves that cause pain. These medications may be used in tandem with other therapies.
Medications are, of course, just one part of a comprehensive approach to treating pain. At Newport Orthopedic Institute, we employ physical therapy first. If the pain persists, we then consider medication and a means of controlling the discomfort. Other treatments that may also be effective include acupuncture, massage therapy, visualization techniques and psychotherapy. Transcutaneous electrical nerve stimulation, or TENS, delivers low-voltage electrical currents through the skin near the source of pain. The electricity from the electrodes stimulates nerves in the area where pain persists and “scrambles” the signals of normal pain perception. TENS is not painful and has proven to be an effective therapy to mask pain.
If you are experiencing chronic pain, you don’t need to continue suffering. Using a variety of traditional and alternative treatments, pain specialists can help you cope with the discomfort and regain your quality of life.
Winter Sports: Get In Shape Now To Avoid Injury
By Dani Skeie Janzen, MPT
Ski season is just around the corner in southern
Preparation training for skiing and snowboarding should cover three areas: core (trunk) strength, specific muscle strength, flexibility, and cardiovascular conditioning. A few exercises are included here to get you going, but you might want to be efficient and try enrolling in a well-integrated exercise and movement program, such as Pilates, that can address most of these areas efficiently at one time.
Core Strength:
1. Lie on your back with knees bent and feet on the floor. Perform crunches (2 sets of 15 repetitions), but keep your pelvis stationary allowing only the upper body to move (the movement is small).
2. Lift the chest (again keeping the pelvis stationary) and twist your upper body to the right (think of pulling your shoulder toward the opposite knee – the movement is small again). Return to the center maintaining chest elevation, then repeat to the left. Try to do 2 sets of 15 repetitions.
3. Lying on your back, bring your legs up so that the knees and hips are both at 90° angles. Keep the knees squeezed together. Rotate the legs to the right, and then use the opposite side of your abdominals to pull the legs back to center. Repeat to the left. Try to do 2 sets of 15 repetitions of this exercise, as well.
Specific Strength:
1. Wall squats. Stand with your back against a wall with the feet out in front of you and bend the knees. Lower yourself, until the thighs are parallel to the floor, then return to standing position. Make sure the knees stay in line with your feet but don’t go forward beyond your toes.
2. Walking lunges. Take a large step forward with the right leg; lower your body straight down until the left knee is hovering off the floor and the right thigh is parallel to the floor. Push off from the left toes and step forward with the left leg; lower again. Make sure the knees don’t go forward over your toes or bounce on the floor on this exercise.
3. Calf Raises. Lift up on the ball of your foot, and then lower. Then progress to walking calf raises; take a step and lift onto the ball of your foot. You can hold weights in the hands on any of these exercises, as you get stronger. Try 2 sets of 15 reps on all of the above.
Flexibility:
1. Hamstrings. Lie on your back with the towel around the ball of your right foot. Keep the knee straight and lift the right leg off the floor until a stretch is felt in the back of the leg/thigh. Then lower your leg out to the side until a stretch is felt on the inner thigh. Stretch and hold for a minimum of two 30-second intervals on each leg.
Cardiovascular Conditioning:
1. To feel better on the slopes and enhance your stamina, cardio conditioning is essential. You can practice your ski moves on the cross-country machines at the gym. The elliptical machines provide good work for the heart with less stress on the knee joints. Try to do at least 30 minutes, with the heart rate elevated, three times a week.
Investing time in prepping your body now will pay big dividends later on in terms of performance and injury prevention. Preparing your body for winter sports may not guarantee that you’ll be the hottest thing on the slopes this ski season, but it can help you enjoy more time on the slopes and decrease your risk to injury!
Rapid-Recovery PT: A Fast Track To Recuperation
By Bill Gabriel, PT, DPT
Rapid-Recovery Physical Therapy (RRPT) is the name given to the use of physical therapy to expedite post-surgical recovery. Prior to the 1980’s, a relatively inactive recovery from surgery was considered the “norm” and physicians typically recommended a cautious approach to working the muscles, bones and ligaments involved in a surgical repair. “Physical therapy was used cautiously, resulting in a fairly long, drawn out time from surgery to full resumption of activities,” notes Alan H. Beyer, MD, FACS.
“However, during the 1980s, physicians began noticing an interesting phenomenon: non-compliant patients who were ignoring their post-surgical activity restrictions, were actually getting better, faster than those who followed more restrictive recovery regimens, with no negative long-term side-effects. Since that time RRPT has become the new ‘norm,’ used to help patients return to full resumption of activities, safely, and in the shortest possible time.”
A case at point is surgery to repair a torn anterior cruciate ligament (ACL). In the past a physician might recommend that ACL patients refrain from resuming athletic activities for as long as 12 months, depending on the patient. Nowadays, progress through the various stages of rehabilitation is based, in part, on how quickly individual patients achieve critical clinical milestones with minimal increases in inflammation. For instance, some patients can tolerate light running on a treadmill just two to three weeks after ACL repair, depending on the degree of swelling and recovery of knee extension and flexion. Physicians have observed that other patients have been able to return to sport-related activities as early as eight weeks and competition-level activity may resume as early as three to four months after surgery for select, high-level athletes.
Hand surgery is another area where early post-operative rehabilitation has proven to be of benefit. Surgeons have noted that, following surgery to reconnect the tendons of the hand, patients who undertake RRPT, develop less scar tissue, thereby, preventing possible immobilization of the hand that could sometimes develop in patients who waited longer before engaging in rehabilitation.
Rapid-recovery physical therapy also benefits total joint replacement patients. Orthopedic surgeons have similarly noted that quicker recoveries have a direct correlation with how soon patients began their rehabilitation.
If your physician has scheduled you for an orthopedic procedure, it is quite possible you may be referred on for rapid-recovery physical therapy services. Rest assured that early rehabilitation is truly a clinically proven “fast-track” to recuperation following your surgery.
Striking Out With Baseball Finger
By Tze Ip, MD
Nothing heralds the arrival of Summer more than baseball season.
A common condition that afflicts players is baseball finger. Also known as
mallet finger, the injury occurs when the extensor tendon that serves to straighten the finger is damaged. It can be caused when a ball or other object strikes the tip of the finger or thumb, damaging the thin tendon. The force of the blow may even pull away a piece of bone along with the tendon, resulting in a digit that cannot be straightened.
How would you know if you’ve suffered this type of injury? The finger is usually painful, swollen, and bruised. The fingertip may droop noticeably. Blood may collect beneath the nail and cause it to be detached from the skin at the base of the nail. Injured players should seek medical attention within a week after injury---or immediately if there is blood beneath the nail or if the nail is detached. This may be a sign of nail bed laceration or open (compound) fracture.
Simple X-rays can usually determine if a major fracture or misalignment of the joint has occurred. Most baseball finger injuries can be treated using conservative measures. The doctor may apply a splint to hold the fingertip straight for a period of six to eight weeks. Although the finger usually regains an acceptable function and appearance, many patients may not regain full fingertip extension.
Surgical repair may be considered when injuries involve large fracture fragments or joint misalignment. In these cases, surgery is done to repair the fracture using pins, pins and wire, or even small screws. Fortunately, these cases are rare.
Summer: The Season For Heel Pain
By William W. McNair, DPM
When the weather turns warm and people break out their sandals and other flat, flexible shoes, I know it’s plantar fasciitis season. Plantar fasciitis is an overuse injury affecting the sole or flexor surface (plantar) of the foot. It occurs when you have inflamed the tough, fibrous band of tissue (fascia) connecting your heel bone to the base of your toes by wearing non-supportive shoes--among other causes.
This time of year, fully half of the patients I see are complaining of plantar faciitis. Most people can avoid plantar faciitis by wearing shoes with a one- to one-and-a-half inch heel. Not only does this heel height help take the pressure off the heel, it also aligns the knees, hips and back correctly and helps maintain correct posture. Treatment of those with the condition may include rest, ice and exercise to stretch the Achilles tendon. More severe cases may require steroid injections, but we try more conservative treatments first.
Another tip: if you have hardwood, tile or stone floors at home, make it a point to wear clogs around the house. Hard flooring can cause heel pain and the height of clogs is ideal for maintaining correct body alignment.
In addition to Dr. McNair, Newport Orthopedic Institute offers the services of two Board-Certified orthopedic surgeons who specialize in foot and ankle care. If you, your family members or friends experience foot or ankle problems this Summer, NOI can help!
Glucosamine and Chondroitin: Worth The Hype?
By Alan H. Beyer, MD, FACS
The vitamin and supplement industry is a billion dollar enterprise in this country. The Food and Drug Administration has reported that approximately one-third of all adult Americans have used some form of complementary or alternative medicine, and estimates that nutritional supplement sales total about $5 billion a year in America.[1][1] Glucosamine and chondroitin are two such substances that are enormously popular among people with joint pain. But do they actually work?
A number of studies have suggested that glucosamine and chondroitin do seem to create an environment within the joint that protects the cartilage and in some instances, helps re-build cartilage. This has never been scientifically proven. However, we do know that glucosamine and chondroitin are nutrients that are naturally occurring substances and are vital to the production of cartilage.
In my practice, I have seen a great deal of benefit in using glucosamine and chondroitin in my patients. I am using these substances as natural anti-inflammatories. In medicine, we have gotten away from long-term use of anti- inflammatories because there can be deleterious effects--on the GI tract, on the liver, even on healing. Anti-inflammatories can even mask injury so a person can almost hurt themselves more. These days, we try to use them only for flare-ups. That’s why glusosamine and chondroitin are so beneficial---there are no ill long-term effects and they are natural anti-inflammatories. I not only use these substances in my arthritis patients, but also in injured athletes and even in pre-operative patients, because they build an environment in the joint that is more conducive to healing itself.
Glucosamine and chondroitin are available in both liquid and tablet form, are relatively inexpensive and easy to find in stores and online. Because the FDA does not have regulatory control over supplements, however, it does become a “buyer beware” situation. The quality and actual dosages can vary significantly from one product to the next. I have am careful to use only pharmaceutical grade glucosamine and chondroitin. Two that I feel meet this requirement are Nutriex and Cosamine DS. Both are available online. Most people should aim at taking 1500 milligrams daily.
If you suffer from joint pain, glucosamine and chondroitin may help. But be sure to consult with your doctor before starting on any new supplements. There may be causes of your symptoms that may require more immediate medical attention.
