Friday, February 12, 2016

New option for ACL reconstruction

Anterior cruciate ligament, or ACL, tears can have a devastating impact on an athlete's ability to return to play.  Its important role in stabilizing the knee almost universally requires surgery to restore its function, and fortunately most patients will return to play after recovery.  I wanted to briefly discuss the use of a new graft option available for ACL reconstruction and why I feel it can be a great option for getting you back on the field.

ACL reconstruction surgery entails replacing the torn ACL with a graft.  One option is to obtain a sterile graft from a cadaver, or an allograft.  This can be a great option as it entails much smaller incisions, less initial pain and a quicker earlier rehabilitation.  The graft does take longer to heal, and there is an elevated risk of rerupture mainly in the young athlete.  The second source of graft material is from the patient's own body, or an autograft.  Benefits of this option include faster graft healing, no chance of disease transmission, and lower rerupture rates in young athletes.  Some downfalls include larger incisions and injury or weakness in the structures from where the graft is harvested from, primarily the hamstrings and patella tendon.

Recent research has identified a new source of graft, the quadriceps tendon.  This stout tendon connects the thigh muscles to the kneecap.  In obtaining this graft the surgeon only has to take a small piece of the quadriceps tendon, leaving a significant portion behind which likely lessens the chance for weakness in this area after surgery.  The very thick tendon is also much stronger than the traditional gold standard of the patella tendon, and does not typically require sawing the kneecap which can lead to pain after surgery and possibly fractures.   It is my belief that this graft option can provide a great alternative to patients worried about anterior knee pain after ACL reconstruction but who would like to use their own tissue, especially in young athletes.   Utilizing the newest technology and research here at Floyd Memorial, I believe this technique can offer yet another tool for getting our patients back in the game!

Friday, October 17, 2014

The Crossfit craze. How to train safely and avoid injury

Crossfit gyms seem to spring up almost on a weekly basis as this workout craze continues to gain popularity.  The combination of varying workouts, its potential for dramatic improvements in physical and mental fitness, and the sense of community has afforded it a growing place in the nation's fitness scene.  Televised competitions are now broadcast showcasing elite athletes performing at the highest levels further spreading the appeal of Crossfit.  As a sports medicine physician, I've witnessed the ups and downs of this rising sports firsthand.  Many of its movements and training regimens are being adopted by the sports teams I cover and recreational athletes I see every day tout its benefits but also suffer a variety of ailments in the course of training.  Hopefully this post will help answer some common questions such as is Crossfit right for me?  How do I get started?  How can I prevent injury?  And what should I do if something hurts or I'm injured during Crossfit.

Is crossfit right for me?
Finding the right workout regimen for me is one of the most effective injury prevention techniqes I can recommend.  Going from a sedentary lifestlyle to the rigors of crossfit is a recipe for injury almost every time.  My personal recommendation is that crossfit probably isn't the ideal program to get in shape, but is phenomonal for getting in top shape.  As in every physical activity, periodization, or gradually increasing the intensity and duration of workouts should be an integral aspect of all injury prevention strategies.   Many crossfit coaches are aware of this and incorporate it into their programs and in those cases crossfit may be a safe way to begin a fitness program.  However sometimes the athlete or the coach can be so motivated to keep up with their online and box community that this is ignored, leading to stress injuries and other ailments.  Overall, one should be comfortable in a moderate exercise program from a cardiovascular standpoint and free from significant joint pain with mild to moderate resistance activities before embarking on the rigors of crossfit.   If that's not the case then working up to that level is the first step I would recommend before enrolling in a crossfit program.

How do I get started?
Touching on the above items, being in an active exercise program and pain free with moderate exercise is for me the first step in considering a crossfit program.  Next is selecting the proper box, coach, and or community.  If you're a novice ensure that they have experience in acclimating new members in the proper techniques and basic movements first before proceeding with more complex tasks.  Ensure you can master basic kettle bell and air squats with good form before attempting clean and jerk type activities.   Several programs will even completely remove these olympic type activities from their regimens to lessen the wear and tear on the lumbar spine that these movements can put one at risk for.  Lastly ensure that as you begin the program you are getting adequate rest.  1-2 days a week, possibly more in the early weeks of training, of rest appears to be a good rule of thumb to allow your body to rest and recover.

How do I prevent injury?
Once you have ensured that crossfit is the proper level of training for you, found a good environment with people at similar fitness levels, and become acclimated to the program, how does one go about preventing injury during the rigorous training of crossfit to maximize the benefits it can provide?   Paramount is ensuring the proper supervision and training to ensure your technique is sound.  Experienced coaches are key in preventing injury.  Focusing on technique and repetition as opposed to speed and the amount of weight you're lifting should be to goal, especially as you acclimate to training.    Having done that, as one progresses to new skills and increasing levels of activity, constantly be aware of your limits.  One of crossfit's biggest benefits is when one pushes their body to its limits and achieves levels of strength and endurance you may not have thought possible for yourself.  Balancing this benefit with a realistic knowledge of your body's limits based on your age, fitness level, and pre-existing limitations is key to progressing without injury.  

No pain no gain
Crossfit is a strenuous workout and will inevitably lead to soreness and fatigue.  However severe pain that affects other activities of daily living, especially sleep, can be a warning sign of a more significant problem.  Resting, ice, over the counter pain medication, and modifying your workouts shoulder get you back in short time.  If not seeking professional evaluation is a recommended step to make sure it is safe to resume training or if further action is needed. 

Monday, August 18, 2014

Joint Preservation Options at Floyd Memorial Hospital

Joint pain and swelling can have a significant impact on one's activities and quality of life.  Traditional options for managing a frequent cause of this, osteoarthritis, or degenerative joint disease, have ranged from medication to injections to surgery, frequently replacing the joint with an arthroplasty.  While very successful, many patients are hesitant to undertake this step and are looking for other options to treat their pain.  Today's post will discuss a range of joint preservation options, some nonoperative and others that involve surgery, but which thankfully can be done in a minimally invasive fashion while preserving one's native joint.

One of the most successful options for mild to moderate arthritis is low impact exercise and weight loss.  Even minimal weight loss can result in dramatically less stress on the joints of the hip and knee.  Low impact exercise like cycling, swimming, and walking can strenghten the muscles and supporting structures of our joints as well.  

Oral medications commonly used in treating this condition range from traditional NSAIDs, or non-steroidal anti-inflammatories, to acetaminophen.  These can be used in an over the counter fashion, or be prescribed by your physician to provide easier once daily dosing.  Other medications such as glucosamine and chondroitin sulfate have flourished in health food and supplement stores.   Evidence for their benefit is quite mixed in large studies but there do appear to be patients who obtain pain relief from these medications.  It can be useful to perform a trial of these medications to see if they really do work, as taking them provides no benefit toward commonly marketed goals of cartilage restoration and preservation.  

Another category of medications is what I call injectables.  Steroid injections have been a mainstay for decades. They can be quite effective for acute flairs of joint pain that can occur.  It is prudent to space out these injections as their overuse can lead to further joint and soft tissue breakdown.  A newer class of medication, viscosupplementation, involves injecting the joint with a gel.  This gel is hyaluronic acid, a natural protein found in human joint fluid.  Multiple brand names exist, and treatments can range from one to five injections.  These injections can provide some with longer term relief than cortisone and may have fewer side effects in the long term.  The newest injection utilized is PRP, or platelet rich plasma.  This involves processing blood drawn in similar fashion to a blood test one may have performed to monitor things like cholesterol levels.  It is then processed to form a concentrated fluid of platelets and growth factors.  This is then injected in to the joint.  Studies have shown this treatment to be at least as, and for some, more effective than viscosupplementation.   At Floyd Memorial Orthopdic Group we can perform this as an office procedure to help minimize the costs until insurance companies agree to reimburse for its use.

If these options are not working, minimally invasive surgical management can then be discussed as an option.  For the shoulder, some patients with arthritis can benefit from procedures to address bone spurs and painful soft tissue conditions such as biceps tendon tears.  In the hip, early surgery to address bone spurs can slow down the progression of arthritis that appears to stem from these spurs.  And in the knee, a new procedure called subchondroplasty can be done in conjuction with a standard knee arthroscopy can offer some patients relief of their knee pain in an outpatient setting.  These surgeries aren't for everyone though.  Many patients will still be best served by traditional joint replacement options so a consultation in our office is still the best way to find what will work for you!  

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

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+