Friday, May 23, 2014

Summer Injury Prevention and Training

As we head into Memorial Day weekend, the summer season brings warmer weather and an explosion of outdoor sporting and recreational activities.  The trend for year round scholastic sports has also taken what was traditionally a time of rest and made it just another season for games and training.  With that in mind today we'll discuss some things to keep in mind whether the summer is a time for further competition, recovery, or just enjoying the outdoors

For the scholastic athlete, ideally summer would be a time away from competition, especially if you're a spring athlete who will resume sports like soccer and football in the fall.  Giving your body periods of rest is one of the best injury prevention techniques available.  Even if it's a month, time away from vigorous training can minimize the chance of suffering overuse injuries such as stress fractures and tendinitis.  Rest should not mean becoming a couch potato however.  Athletes should continue to maintain a healthy diet and get regular exercise, but cross training and participating in activities other than organized sports such as hiking, cycling, and swimming can allow recovery while maintaining conditioning and muscle mass.   If mandatory training is scheduled over the summer, be aware that warmer weather will increase your fluid requirements, so hydrate before training and throughout practice to minimize the chance of dehydration.  Don't wait until you're thirsty, otherwise it's sometimes too late. Lastly, training during cooler times of the day before ten and after four can be beneficial in reducing heat related illnesses.

For the outdoor enthusiast, summer affords a range of fresh opportunities from water sports to climbing and hiking and golf.  Each of these activities can provide hours of beneficial physical activity and enjoyment but also exposure to injury.  

Water sports especially require diligence to prevent what can unfortunately be catastrophic accidents.  Learning to swim and appropriate utilization of flotation devices are paramount for anyone participating in these events.  Utilizing resources such as community pools and the YMCA in the winter and spring months can get you a head start on acclimating to the water and increasing your endurance.  Recognize that river and lake currents can fatigue one quicker than the backyard pool so take appropriate precautions to avoid cramping and fatigue while on the water.  Swim with a friend always, as unfortunately drowning is the second leading killer of children ages 1-14.  Adequate supervision and lessons can minimize harm for this age group.  

Activities in wooded areas such as hiking and climbing require their own preparation and precautions to ensure safety.  Checking safety equipment that has been stored all winter is the first step.  For remote destinations having adequate provisions for first aid, nutrition, water, and communications is mandatory.  Just as competitive athletics requires training, so do recreational activities such as these.  Being in appropriate shape and fitness and setting realistic goals for the level of difficulty one is ready for can go along way towards preventing injury.  Similar to watersports, don't travel alone.  Lastly many illnesses can be transmitted from insects such as ticks and mosquitoes so utilize appropriate clothing and sprays to minimize these pests.

With these and other guidelines, summer can be a great time for the weekend warrior to enjoy new activities and the scholastic athlete to optimize their recovery and conditioning.  If you are injured, we at Floyd Memorial Orthopedic Group are here to get you back and healthy.  Stay safe and enjoy the warm weather!

Friday, April 25, 2014

Free joint pain seminar for anyone with hip, knee or shoulder pain. More information at Floyd Memorial Events

Monday, January 27, 2014

Free shoulder pain seminar

Join me for a free shoulder pain seminar discussing a range of topics affecting the shoulder such as rotator cuff tears, shoulder instability, bursitis, and arthritis. Topics will also include minimally invasive surgery, joint replacement, and rehabilitation. The seminar will be held tomorrow at 6 pm at Floyd Memorial Hospital. For details http://floydmemorial.com/events/event-details/2679/

Monday, December 2, 2013

Updated ACL prevention

I've previously written on this space about ACL prevention. I wanted to update any readers that a new web site, sort of the next generation of the PEP program, has been unveiled. The FIFA 11+ program combines all the research of the PEP program and other ACL prevention strategies into a compact program meant to prevent a wide range of injuries, not just ACL tears. Check out more details and some great information at

FIFA 11+

Tuesday, November 26, 2013

Shoulder replacement, is it right for me?

Shoulder pain can be a debilitating condition. A range of issues can be the cause of this pain, from tendon and ligament tears that are more common in younger patients, to arthritis which more commonly affects middle-aged and older patients. Options for treating shoulder arthritis have increased dramatically in the last decade due to new technologies and research that has helped surgeons better understand the best approach to treating the various causes of shoulder pain in the older patient. Today I’d like to focus on that research, which predominantly involves shoulder arthroplasty, or replacement.



As in other joints in the body, the shoulder joint relies on smooth articular cartilage that lines the bones which form the joint. This smooth surface allows the shoulder to glide through a remarkable range of motion. If however the cartilage starts to thin out, those surfaces are no longer smooth. The human body will often react by forming bone spurs, or osteophytes, in an attempt to limit motion at this no longer smooth surface. This can result in further pain and loss of motion in the shoulder. At the same time, the muscles that stabilize the shoulder, the rotator cuff, can also be tearing. This can lead to further problems such as weakness in the shoulder, damage to the biceps tendon, and a special type of arthritis called rotator cuff arthropathy.




When this occurs, you will often notice pain, especially at night, in the shoulder. Motion will be lost, especially in attempting to reach overhead or behind your back. The shoulder may like it is grinding as well. If these symptoms are occurring the next step is to be seen in the office and evaluated by your surgeon. This will involve a physical exam and likely x-rays of the shoulder. In most cases of shoulder arthritis this is often enough testing to provide an accurate diagnosis and treatment plan. Sometimes an MRI or CT scan can be helpful for a more detailed assessment of the soft tissue and bony structure of the shoulder. Depending on the amount of cartilage loss and other damage to the shoulder, multiple treatment options exist. This can range from oral medications, ice, and physical therapy, to cortisone injections, to surgery.



The most predictable option to relieve arthritis of the shoulder joint is total joint replacement, or arthroplasty. This involves surgery to implant a combination and metal and plastic components that restore a smooth surface to the joint, improving motion and relieving pain. Standard arthroplasty is the most common option, with the newer reverse arthroplasty that I have displayed below an option for situations where there is a deficient rotator cuff. The surgery involves being placed under general anesthesia and several days stay in the hospital. After the replacement you can expect to wear a sling for 4-6 weeks and participate in physical therapy to focus on regaining motion and strength in the shoulder. Full recovery can take 3-4 months. Shoulder replacement surgery is highly successful. Risks of the surgery can involve infection, nerve injury, fracture, prosthesis related problems, and stiffness. Talk to your surgeon to discuss your specific condition and see if this surgery is an option for you.

Tuesday, August 20, 2013

Expanding Team Coverage

I wanted to write today and thank the new schools that have offered to have me as part of their already excellent medical teams. I'll be working with a stellar group of doctors and trainers to provide orthopedic and sports medicine coverage at Jeffersonville, Clarksville, Providence, Charlestown, and North Harrison High Schools for the upcoming scholastic season. This is in addition to continuing my work with Indiana University Southeast, the University of Louisville, and Waggener High School. Providing care for scholastic athletes is one of the highlights of my career and I look forward to a successful and healthy season for all the competitors. Thanks to everyone at these institutions for having me as part of the team.

Thursday, August 15, 2013

I tore my ACL

The words above are amongst the most dreaded that can be spoken by any patient, be it a scholastic athlete, weekend warrior, or a work injury. Although the widespread attention this injury and its treatment have garnered from the coverage of college and professional athletes who have suffered it, there is often a significant amount of fear and uncertainty when dealing with the diagnosis, management, and recovery from this injury. The following post will go over this and hopefully provide a primer for patients and their families’ as they begin the road to recovery.


What is your ACL?

The ACL, or anterior cruciate ligament, is one of four stabilizing ligaments of the knee. It is located within the knee joint and when torn, can leave the patient with the inability to perform activities that require cutting, pivoting, and a change of direction. Heavy lifting, climbing, and other job activities can be difficult as well. Walking, swimming, and other straight ahead and low impact activities are less often affected by this injury. ACL tears primarily occur via noncontact mechanisms. That is, an athlete will often be changing direction or landing when the injury occurs. These moments can be quite painful and patients will often feel or hear a pop, followed by rapid swelling of the knee and the inability to bear weight on the leg.




How do I know if I tore it?

Most ACL tears will have the typical history above. I recommend anyone with that history to be evaluated by a physician in short time. That evaluation will focus on several things. First the stability of the knee will be tested on physical examination. This can also diagnose other ligament tears that can be associated with ACL tears. X-rays are helpful to rule out other injuries as well. Commonly this evaluation will result in an MRI, or magnetic resonance image, being ordered. This test, which does not involve radiation, will evaluate the soft tissue, cartilage, and bone of the knee with higher detail than an x-ray. When this information is available, your physician will be able to provide a complete diagnosis and treatment plan.





What’s Next?

At this point the treatment plan becomes very individualized. Every ACL tear is different in the amount of pain and instability a patient will suffer from. Different physical demands also go into determining the best way to treat a tear. In general, the younger and higher demand that a patient’s sport, job, or daily activities require, the more likely a surgical option is to be recommended. Associated injuries like meniscus and cartilage tears occur in about half of these injuries and can play a role in determining the recommended treatment.

Nonsurgical Treatment

This treatment plan will progress from an initial focus on pain and swelling control through progressive physical therapy and rehabilitation. This may be supplemented with knee bracing. Many patients in this group will see a significant gain in function over the course of six to eight weeks, but full recovery can take several months. Some patients initially treated with nonsurgical means will find their knee to be too unstable and go on to have surgical treatment.

Surgical Treatment

The consensus on treating ACL tears surgically at this point is to reconstruct, rather than repair, the ACL. This means using a substitute graft made of tendon to replace the ACL. This graft can either come from another area of your own body, called an autograft, or from donated tissue, called an allograft. The choice of graft is often individualized based on associated injuries and surgeon and patient preference. Each option has its own pluses and minuses, but overall large studies show most grafts provide similar results in the long term.


The surgery will typically be performed with the assistance of small cameras, or arthroscopes, than can minimize the size of the incisions and aid in visualizing the joint. Most patients will go home the same day of their surgery. A brace may be used along with crutches to protect the repair in the early postoperative period. ACL surgery is very safe. Complications are rare but can include infection, bleeding, blood clots, stiffness, recurrent instability, and complications from harvesting tissue to replace your ACL.

Rehabilitation

While the surgery can often be the focus for many when dealing with an ACL tear, an equally important part is the rehabilitation. A combination of home exercises, formal physical therapy, and a return to full activity will take place over four to six months after ACL reconstruction. Crutches and bracing will be used in the first couple of weeks, and a period of restricted activity that may affect driving and certain job activities can be the norm. Long term, most patients will be able to return to their desired sport or other activity after going through this rehabilitation. If you or a family member is going through this injury, I hope everyone can use this information as a starting point to ask the right questions and feel comfortable starting down the road to getting back on the field!