Carpal Tunnel Syndrome

Carpal tunnel syndrome of wrist is a condition that affects the hand and the arm of a person. It is a caused primarily by compression to the median nerve. The median nerve is a nerve that runs on the inner side of the wrist (palm side) through a tunnel that is surrounded by the carpals (bones that form the wrist) and ligaments. This nerve supplies all the fingers except the small finger and ring finger.

What are the Causes?

The pinching of median nerve can be caused by various factors like-

• Fracture of the wrist
• Inflammation or swelling in the wrist area
• Blood flow stoppage
• Diseases like diabetes and hypertension can cause this syndrome.
• During pregnancy when the fluid is retained within various body parts

You can be at an increased risk of developing this condition if:

• You indulge in activities that cause the over-extension of your wrist like in case of typing
• You overuse any vibrating tool or gadget for prolonged duration
• You are gripping the mouse or a keyboard in an improper way causing the wrist to get fatigued more often.
• You are a female because females have smaller space within the carpal tunnel thereby increasing the chances of compression.

How do I understand that I have it?

The usual symptoms that you might observe are-

• Tingling sensation– During the initial phase, you might just observe a tingling sensation in your thumb and first three fingers and extending towards the arm. This may progress to a condition when you find your arm going numb.
• Pain– Since there is median nerve compression; you may have pain in the areas that are supplied by the nerve. The pain may increase at night while you fall asleep.
• Weakness– This is quite dangerous and, at times, embarrassing. Things might just fall from your hand because you may lose the capacity to hold them tight as your grasp needs the coordination of all your fingers and your thumb which have become numb.

If you find these symptoms bothering you persistently, you need to go to your physician for medical assistance. Early diagnosis can prevent extensive and irreversible nerve damage.

What are the tests conducted by the doctor?

1. History– Firstly, your doctor will ask the details about your symptoms like the time when it started, the severity and questions alike.
2. Examination– Now your doctor will check your wrist and arm for any swelling or other deformity. He will also tap your wrist to check how you respond.
3. Xray– This may be required to rule out other factors of pain like fracture.
4. Electromyography– This test is conducted to check the electrical activity in muscles.
5. Nerve conduction test– This test is to check if the propagation of nerve impulses slow down inside the carpal tunnel or not.

What are the treatment options available?

Orthopedists try to treat this syndrome non-invasively. The usual non-surgical treatment modalities are-

• Wrist splint– This holds the wrist so that the nerve does not get compressed while you are asleep.
• NSAIDS– Ibuprofen is good for pain relief in the arm.
• Injectable corticosteroids– They provide instant relief when injected to the affected area as they relieve pain and reduce inflammation.

Surgically, it can be treated by incising the bands inside the carpal tunnel that put pressure on the nerve. This is done in severe cases only.

Simple preventive measures are-

• Avoid over exertion.
• Take breaks when you work on a computer or any other vibrating tool.
• Stretch your fingers and wrist in between work so that the nerve impingement is avoided.
• Do not sleep on your hand.

If you have been told that you have carpal tunnel syndrome or you would like to have your hand evaluated, contact our nationally renowned specialists at Orthopedic Surgery San Diego today for an appointment.

Young athletes, especially soccer players, sometimes suffer anterior cruciate tears. Children who sustain ACL tears requires special type of surgical attention,  because they are skeletally immature.Some teenagers and their parents are reluctant to choose surgery to reconstruct ACL tears, because they have heard there is a risk of damaging the growth plate in the proximal tibia (upper leg bone) or the distal femur (lower thigh bone).

However, according to a study published in November 2014 in the American Journal of Sports Medicine, pediatric ACL reconstruction can be done safely with the use of specialized techniques.

The researchers concluded that the surgery is “a safe option” for young patients. They wrote that the procedure produces “high functional and satisfaction results, without significant growth plate damage.”

The study was titled “Transphyseal Anterior Cruciate Ligament Reconstruction in Patients With Open Physes: 10-Year Follow-Up Study.” The authors were Calvo, Figueroa, Gili, Vaisman, Mococain, Espinosa, Leon and Arellano.

The researchers acknowledged that the procedure “is controversial, (though) current evidence supports the view that surgical techniques restore knee stability and prevent progressive articular damage.” They suggested that most previous studies of ACL reconstruction in teenagers were too small or short term to produce reliable findings.

Calvo et al wrote that they sought “to determine the long-term functional outcomes and secondary complications of transphyseal intra-articular ACL reconstruction with hamstring graft in skeletally immature patients.”

The study involved 27 people who were between 12 and 16 years old when they underwent the surgical procedure. The researchers assessed them 10-13 years following their operations.

Among the factors examined to determine clinical outcomes were the patients’ preoperative conditions, details of their surgeries, follow-up medical reports and scores on knee-function tests. The analysis also took into account the patients’ ability to return to playing sports, and whether they sustained ACL reconstruction failures.

“The anteroposterior knee laxity was assessed by arthrometry, and the presence of deformities and lower limb length discrepancies were evaluated by radiographs,” Calvo et al explained. “The presence of degenerative signs on anteroposterior and lateral knee radiographs at final follow-up was also evaluated.”

The researchers noted that there had been “significant differences” in the patients’ preoperative scores on several types of function tests. Two patients reported instability in their knees when they resumed playing sports. Three people experienced ruptures of the ACL graft.

Overall, the study confirmed that the surgery is safe for young patients. That is good news for those who have been unable to relieve their knee instability, and restore function, with physical therapy and other treatment. Athletes are particularly susceptible to ACL tears because of the strain their activities put on the ligament. In about half of the cases, there is also damage to other knee ligaments, the articular cartilage or the meniscus.

Injured ligaments, classified as “sprains,” are graded on a severity scale. A Grade 1 ACL sprain is the least severe, typically just an over-stretched ligament that does not impair normal knee function. A Grade 2 sprain involves a ligament stretched to the point that it is loose. This is sometimes called a “partial tear.”  A complete tear, when the ligament is severed and the joint is unstable, is a Grade 3 sprain.

According to the American Academy of Orthopaedic Surgeons, ACL injuries are typically caused by abrupt movements like rapidly changing direction or suddenly stopping. They also result from slowing down while running, landing wrong after jumping and colliding with another person.

Women tear their ACLs at a greater rate than men. Sports like soccer, football and basketball are especially hard on knee ligaments. Among the symptoms are a popping sound in the knee, the joint giving out, pain and inflammation, diminished range of motion and pain while walking. If you have been diagnosed with an anterior cruciate tear, learn more about your options. Schedule an appointment for an evaluation by the nationally renowned sports medicine surgeons at Orthopedic Surgery San Diego.

hand injuries

It is hard to imagine that something we use daily for our small children could possibly hurt them. While engineers work hard to ensure safety when it comes to products for young ones, there is always a chance of a product failure that can cause pediatric injuries.Graco, one of the most trustworthy names in baby products, has issued a recall on 4.7 million strollers manufactured by the company for those in the United States, Mexico, and Canada. Eleven finger injuries have been reported which include a finger laceration, four partial amputations of the fingertips, and six fingertip amputations. The cause of the hand injury is an external fold0lock hinge on the sides of the stroller that can pinch the child’s finger, hard enough that it can potentially cause amputation of the baby’s fingertips. The recall includes the following strollers by the Graco and Century brand: Aspen, Breeze, Capri, Cirrus, Glider, Kite, LiteRider, Sierra, Solara, Sterling, and Travelmate strollers manufactured between August 1, 2000, and September 25, 2014. The Consumer Product Safety Commission is urging those with one of these strollers to contact Graco. Free repair kits, which include hinge covers, will be available soon beginning December 2014. Fingertips are sensitive and have many nerve endings. A partial or whole fingertip amputation can damage skin, nerves, and possibly bone. Even though it is a small part of the finger, a missing piece can change how the hand works, and if not treated immediately, could likely result in deformity.If a finger or hand injuries occurs that results in amputation of the skin, the first course of action is elevate the hand and apply ice to keep the swelling down. Ice also reduces bleeding, and can help temporarily numb some of the pain. Cover the injury site in sterile gauze, and keep the hand as still as possible. If you are able to locate the amputated part, clean it with water, cover it with gauze, seal it in a bag, then put the bag in ice. Do not put the amputated piece directly in ice, it can potentially cause irreversible damage. Take the amputated part to the doctor with you. Treatment for a fingertip amputation depends on the amount of skin lost, how bad the injury is, and the wound’s angle. Small cuts, with no bone exposure may heal without surgery. If the wound is too large to heal on its own, a skin graft may be needed to cover the injured site. Injuries with the bone exposed could result in a shortening of the bone in order to cover the wound. Reconstructive flap surgery is also an option. Replantation of the amputated site is considered when the wound is very large. If you or a loved one is using one of the stroller listed above, immediately contact Graco Children’s Products at 800-345-4109 to get the hinge covers for the stroller. Even though injury risk is very low at 2.3 for every 1 million strollers, it’s never low enough for your family. Feel free to contact our pediatric sports medicine specialists at Orthopedic Surgery San Diego if you have any questions about your chil

For many people who suffer severe knee pain due to arthritis, medication and physical therapy are not enough. Knee replacement is sometimes necessary to relieve the discomfort and restore mobility.Surgeons conducted more than 600,000 knee arthroplasties (or knee replacements) in 2012, a dramatic increase from about 250,000 in 1999, Gretchen Reynolds reported in a New York Times “Well” blog.

However, she pointed out, recent research indicates that a large number of patients have their knee joints replaced with metal and plastic prosthetics before giving other treatments a sufficient chance to work.

Virginia Commonwealth University was the site of two studies that suggested knee replacement is advisable only in cases of advanced arthritis. The researchers said the surgery is appropriate for patients who have not only extreme pain, but also greatly limited physical ability. People at this stage can no longer climb stairs, rise from a chair or walk without assistance.Another conclusion of the research was that knee arthroplasty makes more sense for the elderly because the prosthetics typically wear out within about 20 years. Younger patients sometimes require additional knee replacements.

One of the studies involved assessing the medical records of nearly 200 people with arthritic knees who underwent knee arthroplasties. About a third of the patients suffered only minor arthritis, so they might not have been appropriate candidates for the surgery, Reynolds reported.

In the other study, the same researchers found that those with advanced, disabling arthritis enjoyed the best results from receiving knee replacements. Their knee pain subsided significantly, and they were able to regain a great deal of function.

Patients with less severe arthritis showed, on average, only about one-tenth as much improvement in knee function following surgery. “They had less room for improvement,” Daniel Riddle, a professor of physical therapy and orthopedic surgery who led the studies, told the Times.He recommended losing weight and working with a physical therapist, rather than resorting to knee-replacement surgery, unless all the cartilage in the knee has deteriorated.

Arthroplasty “is a safe and effective procedure to relieve pain, correct leg deformity and help you resume normal activities,” according to the American Academy of Orthopaedic Surgeons. The organization reported that, since the surgical method was developed in 1968, it has evolved to the point that “total knee replacement is one of the most successful procedures in all of medicine.”

In the majority of cases, chronic knee pain and disability are caused by osteoarthritis, rheumatoid arthritis or post-traumatic arthritis.

Osteoarthritis develops over time, as the knee joint sustains wear and tear, so it is typically experienced by people 50 years of age or older. They suffer knee pain because cartilage between the joint’s bones become soft and eventually deteriorate. That results in bones rubbing on bones, triggering pain and stiffness.The disease known as rheumatoid arthritis, which features inflammation of the synovial membrane that surrounds the joint, also destroys cartilage.

Post-traumatic arthritis occurs following knee injuries.

“Fractures of the bones surrounding the knee, or tears of the knee ligaments, may damage the articular cartilage over time, causing knee pain and limiting knee function,” the AAOS explained

.If you have knee pain or have been told you have knee arthritis, call to schedule an evaluation with our nationally renowned sports medicine surgeons at Orthopedic Surgery San Diego to review your options for relief.

Tilting the head to look down at a phone, while reading or sending text messages, may lead to fibromyalgia and other conditions that require physical therapy, manual therapy or treatment by an orthopedist.In some cases, patients benefit from egoscue, a type of bodywork that relieves neck pain and restores physical function. The technique entails a series of “low-motion” movements.

Research by Dr. Kenneth Hansraj, chief of spinal surgery at New York Spine Surgery & Rehabilitation Medicine, showed that looking down at a phone can add as much as 60 pounds of pressure to the spine. The amount of strain depends upon the angle at which the neck is bent, Time magazine reported.

Hansraj’s study, “Assessment of Stresses in the Cervical Spine Caused by Posture and Position of the Head,” was published in Surgical Technology International.

The typical cell-phone owner spends two to four hours each day using the device, according to the research. Time noted that “over the course of a year, that adds up to 700 to 1,400 hours of excess stress on the cervical spine, or up to 5,000 hours for high school students.”  As a result, people’s posture becomes distorted into a hunched position, which causes neck pain and spinal wear and tear.

Hansraj acknowledged that it is “nearly impossible to avoid the technologies that cause these issues.” However, he pointed out that maintaining proper posture can help prevent pain from developing. He advised keeping the ears aligned with the shoulders while using a phone.When a person tilts the head forward, and droops the shoulders forward “into a rounded position,” the weight placed on the spine “dramatically increases,” the doctor said.

The introduction of Hansraj’s report noted that billions of people around the world use cell phones daily, and that most of them do so with poor posture. He explained that the purpose of his study was to “assess the forces incrementally seen by the cervical spine as the head is tilted forward,” and to help surgeons better understand “reconstruction of the neck.”

Hansraj created a model of the cervical spine, which he manipulated to determine how many pounds of pressure resulted from various movements.

“The weight seen by the spine dramatically increases when flexing the head forward at varying degrees,” he reported. “An adult head weighs 10 to 12 pounds in the neutral position. As the head tilts forward, the forces seen by the neck surge to 27 pounds at 15 degrees, 40 pounds at 30 degrees, 49 pounds at 45 degrees and 60 pounds at 60 degrees. At 90 degrees, the model prediction was not reliable.”

The doctor concluded that “loss of the natural curve of the cervical spine leads to incrementally increased stresses about the cervical spine.” He pointed out that “these stresses may lead to early wear, tear, degeneration and possibly surgeries.”

Hansraj wrote: “Cervical spine surgeons need to pay attention to the alignment and therefore to the stresses about the spine when performing anterior discectomies and fusion along with arthroplasties.”

He added that “with advancing spinal surgical techniques, such as the motion-sparing total disc arthroplasty, attention to the final position of the neck becomes critical.” The report warned against “misalignment of a reconstructed segment.”

“As far as we are aware, and after a review of the National Library of Medicine publications, there is no other study available to assess the stresses about the neck when incrementally moving the head forward,” Hansraj wrote.

If you are experiencing neck pain, or have been diagnosed with a condition like fibromyalgia, schedule an appointment for an evaluation by the nationally renowned sports medicine surgeons at Orthopedic Surgery San Diego to find out how you can relieve your symptoms.

Now this might sound a bit strange, but yes, it is absolutely true. However it is not that young children are running around using iPhones that result in broken faults.  On the contrary, the fault lies with their parents.

Research by a graduate student at Yale suggests that the explosive expansion of the 3G cellphone network has led to a remarkable widespread adoption of the iPhone. Parents who have discovered fascinating new apps on their phones, sometimes forget to pay attention to their young children. The studies conducted include only children under the age of 6 years, and the focus is on neighbourhood playgrounds only.

Information about playground accidents involving young children suffering sprains, broken bones and even concussion, gleaned from hospital emergency rooms, strongly points to parents not effectively watching their children. Visits to various playgrounds have also shown moms or dads engrossed in their new electronic toy, while small children clamber on potentially dangerous apparatus.

Most times it is the cry of pain from a child who has had a fall that attracts the attention of a parent! Depending on the nature of the fall, the injury could be nothing more than a scratch, or perhaps much more serious.

What kind of injury could my child suffer from a playground fall or accident?

The most common playground injuries seen are related to the wrist and elbow.

A wrist injury would include the following:

• A wrist sprain can occur from just a momentary loss of balance, quite easy for a young child. A tiny hand will naturally go out to break the fall and the force of impact can stretch and pull the ligaments that connect the wrist and hand bones. Severe wrist pain will follow.
• If the force of impact is very severe and the child falls awkwardly, it could result in a fracture.
• The best course of action will be to seek medical attention, especially if there is a lot of pain and swelling. If the wrist is hanging in an odd or bent way, it could signify a wrist fracture which would require immediate attention, and possibly even surgery.

Elbow injuries are common in children, and if not quickly and expertly attended to, can affect the growth and development of the bones, as bone growth continues throughout childhood. Symptoms and signs include the following,which could indicate an elbow sprain, fracture or another injury needing medical attention.

• Painful swelling in the area immediately above and below the elbow.
• A deformity of the elbow joint and elbow pain, could signify an elbow fracture.
• Any discolouration, bruising or redness.
• Pain and difficulty moving the elbow through a complete range of motion.

Fractures in children.

A broken bone or fracture in children cannot always be taken at face value. A simple fracture may heal well with just a cast treatment. Some types of childhood fractures might need surgical intervention for the bones to knit and promote future good growth. Medical diagnosis is of utmost importance.

Prevention is better than cure!

Parents, by all means enjoy your iPhone. But put it aside if you take your children to a playground with all its play apparatus and the potential for an accident or a fall for little ones.Paying attention to what your child is doing can prevent painful injuries from happening, as well as save you the added stress of coping with a child in pain from an injury, which could have been prevented.

If your child has sustained a wrist injury or has elbow pain, contact our pediatric sports medicine specialists at Orthopedic Surgery San Diego for a consultation.   

Many patients who experience knee or hip pain over the age of 40 may have underlying arthritis.  Sometimes various injection can provide adequate relief: steroid (cortisone), PRP (plate rich plasma)/ stem cells, and HA (hyaluronic acid).  Those active adults that have end stage or severe arthritis that do not improve with other options are best served ultimately undergoing joint replacement, also known as arthroplasty, which entails implanting prosthetic devices.

Many patients suffering from osteoarthritis or rheumatoid arthritis are able to relieve their symptoms by taking anti-inflammatory medications, receiving physical therapy and altering their activities.  For some, the hip or knee pain continues. The discomfort and stiffness make it difficult to walk, climb stairs, or rise from a seated position. The pain may persist even while the body is inactive. In such cases, orthopedists often recommend joint arthroplasty.

The procedure involves a surgeon removing damaged bone and cartilage; and implanting an artificial joint made of metal, plastic or polymers. The prosthetics are available in a range of designs for patients with differing ages, weights, activity levels and general health.  Over the last decade some designs have evolved to be customized to individual patients.
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A recently published study concludes that a newly proposed grading system is an effective method of assessing complications following total knee and hip replacement surgeries.

While the surgery has a high success rate, orthopedists have continued to search for ways to accurately measure patients’ recovery.

“Reliable classification of postoperative complications is important for quality improvement efforts,” Dr. Dorothy Y. Harris and her associates noted in their report titled “Correlations Between a Dedicated Orthopaedic Complications Grading System and Early Adverse Outcomes in Joint Arthroplasty.”

They analyzed a grading system that the Knee Society proposed earlier this year. The study was needed because “a relationship between complication grades and surgical outcomes has not yet been established,” the researchers wrote.  Their goal was to identify the early adverse outcomes following total knee replacement or hip arthroplasties into different grades. The results indicated that the grading system “is applicable to TKA and THA, in terms of documentation of complication severity, and as an indicator of increased length of stay (in a hospital) and increased unplanned readmissions or reoperation rates,” the researchers explained.  This will help orthopedists to potentially identifier preoperatively those at risk of these complications.

If you are experiencing knee or hip pain, and have been diagnosed with arthritis in one of the joints, you might be a candidate for total knee or hip replacement. Schedule an appointment for an evaluation by the nationally renowned sports medicine surgeons at Orthopedic Surgery San Diego to learn whether arthroplasty could be a solution for you.

Those suffering from knee pain caused by osteoarthritis may eventually need surgery to correct the problem. Procedures for knee osteoarthritis include arthroscopic surgery, partial knee replacement, and total knee arthroplasty (replacement). Arthroscopic surgery is a minimally invasive surgery where small cuts are made in the knee and a small camera is inserted to see and diagnose the extent of the damage. The doctor can then remove, repair, and smooth damaged tissue.

Partial knee replacements are often used for those with less damage to their knee, while total knee replacements are used for those with major osteoarthritic damage. While surgeries can help alleviate pain and increase mobility, it is important to understand and acknowledge there can be risks and serious complications, including death.

English investigators prompted a study to ascertain the risk of complications associated with knee replacement surgery. During that 9 year period, 467,779 knee replacements were performed with 1183 deaths occurring within 45 days of the surgery.  The incidence of death decreased to 37% in 2003 and to 20% in 2011. Findings show that mortality rates after unicompartmental knee replacement (partial knee replacement) was lower than with a total knee replacement. Causes of death were not related directly to surgery, as the patients suffered from comorbidities such as myocardial infarction, cerebrovascular accident, liver disease, or renal disease. The findings concluded that although early deaths have fallen drastically since 2003, more effort should be taken to reduce mortality in older patients with comorbidities.

A study was also done to compare adverse outcomes for those having total knee replacements (TKR) versus unicompartmental knee replacements (UKR) in England. The results showed that the failure rate for unicompartment (partial) replacement had a higher rate at 8years in comparison to total knee replacement.  However the risk of mortality was higher with total knee arthroplasty.

If you have been told that you have knee arthritis and are looking for treatment measures, it is in your best interest to seek treatment from a surgeon who has the skill set to tailor treatment to your specific condition instead of a ‘one size fits all’ approach.  Our nationally recognized sports medicine surgeons specialize in an individualized approach to alleviate your knee pain, whether by medication, injections, or surgery.

Hip pain after a falls is worrisome, as this often results in a hip fracture.  As the nation’s population ages, the number of injuries resulting from falls is reaching record levels.

More than 2.4 million patients older than 65 years of age required treatment at medical emergency facilities due to falling in 2012, the New York Times reported. Among older adults, falling is the leading cause of fractures, hospital admissions for trauma, loss of independence and injury-related deaths, according to the National Institutes of Health. From 2002-12, deaths of elderly Americans attributed to falls totaled 201,000.

In countless other cases, people suffered severe pain in their wrists, hips and other joints. A simple misstep can cause a person to lose balance and tumble to the floor.  It is so common that the concept has led to famous TV commercial slogan “I’ve fallen and I can’t get up”.  This may result in many types of injuries, including wrist and hip fractures. Seniors are particularly at risk, for a variety of reasons. They tend to have more balance issues, and less strength, than the young.  Most importantly, their bones may be vulnerable as a result osteopenia or osteoporosis.

“Balance is a complicated equation involving vision, muscle strength, proprioception (the body’s ability to know where it is in space), and attention. As people age, those elements deteriorate,” the Times explained.The newspaper noted that, according to geriatricians, “some older people possess an exaggerated sense of what they can still do, even as hazards (staircases, throw rugs, slick bathtubs, concrete bumpers in parking lots, tree roots, their own pets) lie in wait.”

About one-quarter of the time, a senior who fractures a hip in a fall dies within a year. Eighty percent of patients are in pain the rest of their lives, with severely limited mobility that costs them their independence and increases their reliance on others.

A recent study indicated that engaging in regular exercise can help anyone, especially the elderly, avoid falling. Those who work out, or at least take daily walks, have better strength and balance. Experts also advise keeping well hydrated to prevent dizziness. Medications for high blood pressure, psychotropic drugs and antidepressants are known to make patients dizzy, increasing the odds of falling.

Dr. Judy Stevens, an epidemiologist at the U.S. Centers for Disease Control and Prevention, told the Times: “Falls are a very difficult thing, because it’s such a scary idea. People don’t want to hear about it, and people affected don’t want to talk about it.”

Many older adults are afraid of falling, the National Institutes of Health noted, adding: “This fear becomes more common as people age, even among those who haven’t fallen. It may lead older people to avoid activities such as walking, shopping or taking part in social activities.”

Seniors limited by such fears are advised to consult their doctors or other health-care providers. Physical therapy can improve balance and promote confidence in walking ability. Relieving the anxiety allows a person to keep active, maintain health and prevent future falls, according to the NIH.

After falling, even if no injuries are apparent, it is a good idea to see a doctor. Many of the factors that cause falls can be treated or corrected. Falling may be a symptom of a medical issue like diabetes or improper blood pressure. Some people experience sharp drops in blood pressure when they stand up, which results in dizziness. Falls sometimes indicate problems with medications or vision. A doctor might prescribe eyeglasses, physical therapy or the use of walking supports like canes.

Experts suggest making a home safer by getting rid of loose rugs, installing handrails on stairways and in hallways, and providing adequate lighting.If you suffer from hip pain or wrist discomfort contact us at Orthopedic Surgery San Diego for an evaluation.

Getting regular exercise is a key to preventing falls; the risk of falls as we mature is that it can result in hip and wrist fractures.

Many people, particularly the elderly, suffer hip and wrist pain due to falls. Avoiding such accidents “isn’t simply a matter of being more careful,” according to the New York Times’ Katie Hafner. She reported that experts advise people to adopt exercise regimens, as a way of making them less vulnerable to falling.

“If you’re in better physical condition, you’re less likely to be injured,” said Judy A. Stevens, an epidemiologist at the U.S. Centers for Disease Control and Prevention.

One option is to sign up for an exercise class that features balancing drills, in which a person stands on one leg; and workouts with Bosu balls. Many have found tai chi effective in promoting better balance. The practice involves making slow movements accompanied by coordinated breathing.

Hafner noted that a nursing home near San Francisco offers a 12-week tai chi program twice a year. The facility reports significant improvement in participants’ mobility, as measured by their ability to get out of chairs without using their arms.

“If only we could put tai chi in a pill,” said Dr. Lewis A. Lipsitz, a professor of medicine at Harvard University who observed programs at two facilities operated by Hebrew SeniorLife.

“Integrating balance and strength work into daily life (standing on one foot while brushing your teeth, for instance, or simply putting one foot in front of the other) can help, as well,” Hafner wrote.

She pointed out that studies have confirmed the power of Vitamin D to improve muscle strength and balance, which lessen the risk of falling. It also is important to stay hydrated to prevent dizziness.

Among those who are most vulnerable to accidents are patients taking multiple medications. Psychotropic drugs such as antidepressants, antipsychotics and benzodiazepines “are most clearly implicated in falls,” according to Hafner.

Dr. Mary Tinetti, a geriatrician at Yale University, told the reporter that antidepressants “can directly affect your balance.”

Medication prescribed to treat high blood pressure also can cause the sort of dizziness that leads to falls. According to a study published by JAMA Internal Medicine, the danger of sustaining serious injuries from falling is much greater for people on hypertension drugs.

That is why Dorothy Baker, a research scientist at the Yale School of Medicine, advises taking reduced doses of such medication, if possible.

Patricia Quigley, a fall-prevention expert at the James A. Haley Veterans Affairs hospital in Tampa, Fla., offered this recommendation: “Instead of taking sleeping pills, drink warm milk, or listen to talking books or soft music.”

Patients on diuretics for high blood pressure or heart failure should take their drugs during the day instead of the evening, to reduce the number of times they need to walk to the bathroom during the night, Quigley said.

Homes can be made safer by removing trip hazards from floors and stairways. Loose rugs are a common cause of falls. Good vision also is important. People need to learn how to properly use bifocals, as studies have shown they can cause missteps, Hafner noted.

Tinetti told the Times it can be counterproductive to be overly careful when walking.

“People who are more cautious cut down on their activity, which makes their balance worse, their strength worse, and reflexes that prevent falls worse,” she said.

If you have progressive weakness or balance problems contact our specialists at Orthopedic Surgery San Diego to schedule an appointment.