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09/Sep/2014

Knee and Hip pain is 70% more common in patients with elevated BMI (body mass index).  In preparation to undergo a hip replacement or knee replacement for joint pain, it is imperative to shed any extra weight you may have.  Despite our active lifestyles in San Diego, sometimes it becomes necessary to utilize a diet. Here in America, it seems like most people are always on one type of weight loss diet or another. Comparing which diet helps you lose the most weight is a common topic of conversation these days. But, the answer remains unclear, as each diet has its benefits as well as disadvantages, based on the dieters’ needs. And, when it comes to overweight and obese adults, those needs tend to vary. Oftentimes, the need to eliminate pain is the biggest issue.

How Obesity or Being Overweight Affects Knee and Hip Pain

One thing is clear, though, the heavier you are, the more weight your hips and knees have to carry around all day and night. So, if you’re obese, or very heavy for your body frame, your weight is probably the cause of much of your body pain. If you’ve been having Knee and Hip pain that simply will not go away, your weight is adding to your orthopedic problems. And, even if your orthopedic surgeon recommends knee replacement or hip replacement surgery, the pain still won’t go away for good without your help. You’ll still need to lose a substantial amount of weight in order to improve the outcome of the surgical procedures. If not, eventually, your weight will simply wear down your new hips and knees, causing them to be in pain again in the near future.

JAMA Study on Popular Weight Loss Diets

The Journal of the American Medical Association (JAMA) published an abstract paper in regards to popular diets. Its objective was to determine the outcomes of various popular weight loss diets. In this particular study, overweight adults with body mass indexes above 25 were randomly assigned to a specific popular weight loss diet. They all had to report their body mass indexes and weight at 3-month, 6-month and 12-month follow ups. The study which included 7,286 individual participants.

Results of the JAMA Popular Weight Loss Diets Study

Low Carb Diets Results

The highest weight loss amounts related to low-carbs diets:

  • 8.73 kg at 6-month follow up
  • 7.25 kg at 12-month follow up

Low Fat Diets Results

The highest weight loss amounts related to low-fat diets:

  • 7.99 kg at 6-month follow up
  • 7.27 kg at 12-month follow up

Results for Individual Diets

When it comes to the results for individual weight loss diets, the differences were minimal. Here are some examples:

  • At 6-month follow up, the Atkins Diet showed greater weight loss of 1.71 kg than the Zone Diet
  • Between the 6-month and 12-month follow up periods, the Atkins Diet combined with behavior support had a greater weight loss of 3.23 kg than the Zone Diet.

Weight Loss and Knee and Hip Pain

In other words, both low-carb and low-fat diets can help you achieve your goal of weight loss. The specific named diet doesn’t really seem to matter as long as you cut down on carbs and fat intake. So, what’s the bottom line for overweight and obese adults suffering from knee pain and/or hip pain? Your weight can be a major factor when it comes to sustaining relief from your hip and knee pain. When you combine maintaining a healthy weight with hip replacement or knee replacement surgeries, your long-term outcome is so much more successful.  Much lower risk of infection, blood clots, residual pain, and much longer lasting implant!! If you have been told that you would benefit from hip or knee replacement due to ongoing pain, call our award winning physicians at Orthopedic Surgery San Diego for an appointment.


09/Sep/2014

ACL tear can happen to proathletes or the teenage competitive soccer player scrimmaging in a Carlsbad park on a sunny  San Diego Sunday afternoon.Isaiah-Pead-acl-tear

Arguably the most volatile position in the NFL is the running back. Injuries, everyday wear and tear, and age can shorten the career of a running back. For Isaiah Pead, the end could be near. He was a top five running back in the 2012 NFL draft. He has been off and on injured, had some off-the-field issues, and has been overall underwhelming when he is available to play. Unfortunately for Pead, his career outlook just got even bleaker as he has suffered a season ending injury during a preseason kickoff return. Pead was running down field full speed when his feet got tangled and he went down. The result: an ACL Tear.  This knee ligament injury will stop you in your tracks.  Most athletes report hearing and feeling a pop and then they go down.acl-tear-san-diego

The ACL or anterior cruciate ligament connects the front of the shinbone (tibia) to the middle of the kneecap (patella). The main purpose of the ACL is to provide rotational stability and to prevent the shinbone from getting too far ahead of the thighbone (femur).

Sometimes ACL tear can occur as a result of direct contact with the knee, but more times than not, an ACL tear is a non-contact injury such as in the case of Isaiah Pead. The cause of this non-contact injury is often due to rapid direction changes, sudden stops and decelerations, as well as incorrect landing and pivoting. The symptoms of a ACL Tear include knee pain, knee swelling, knee discomfort, knee tenderness, and decreased range of motion in the knee.

If a knee injury has occurred, an orthopedic physician will compare the structures of your injured and your non-injured knee and in most cases this is sufficient enough to diagnose ligament tears. However, the doctor will sometimes schedule an x-ray and an MRI in order to dismiss potential confounding problems, to validate the diagnosis, and to determine the degree of the injury.

Treatment for an ACL tear is dependent upon the severity of the injury. Grade I sprains involves overly stretched but still in tact. Grade I sprains typically require keeping the weight off the affected leg. Once the swelling has subsided, a physical therapy regimen will be prescribed. These exercises are meant to strengthen the leg muscles that support the ACL. Grade II sprains involves the ACL being stretched to the point that it has become loose. Grade II sprains are a little trickier to handle because they may or may not require surgery depending on lifestyle of the patient. The non-surgical approach is similar to that of grade I sprain but generally this is a longer process since these sprains are more severe. The surgical approach involves the rebuilding of the ligament via a tissue graft followed by rest and physical therapy. Grade III sprains occur when the ligament has been completely split into two pieces. In grade III sprains, surgery is required to rebuild the ligament. The recovery time for ACL surgery is often six to nine months. The prognosis for surgical recovery is positive and many athletes are able to return to their respective sport at near pre-injury form.ACL-Tear-Grades

As for Isaiah Pead, there is a very good chance he will make a full recovery, but considering his career thus far, it is doubtful he will ever become the player we once thought he could be. Then again, sometimes a player needs to hit rock bottom before they can really begin to understand what it takes to make it, maybe this, will be his wakeup call.

If you have been told you have an ACL tear or are suffering from knee pain, contact our top sports medicine specialists at Orthopedic Surgery San Diego to obtain a consult and be treated they way you deserve!

 

 


06/Sep/2014

Some folks with shoulder pain or knee pain walking around the streets of Carlsbad may be suffering from a very difficult pain syndrome called fibromyalgia. In fact shoulder pain can become so profound to a patient suffering from fibromyalgia that s/he may go on to develop a frozen shoulder (adhesive capsulitis).
Recent research has shown that treatment for fibromyalgia should be on an individualized basis, as opposed to a general, conventional basis. Experts tend to recommend treatment that includes non-pharmacologic approaches, which is often more effective than drugs. However, currently many orthopaedic surgeons and pain management specialists tend to rely on medications such as antidepressants, anticonvulsants, narcolepsy drugs, pain relievers, sleep aids, and the like. These medications alter brain chemistry to help reduce pain, improve sleep, and ease anxiety or depression, which often times seem to coincide with fibromyalgia. Some of the more common medications used include Cymbalta, Savella, Lyrica, Neurontin, Effexor, etc.
Fibromyalgia is a condition which causes muscular or musculoskeletal pain with localized tenderness at specific points on the body. These tender points include specific spots on the neck, shoulders, back, hips, arms and legs, hurt when pressure is applied to them.
fibromyalgia-tender-points

What is the musculoskeletal system?
The musculoskeletal system provides support, stability and movement to the body such as the connective tissue between joints, ligaments, muscles, tendons, nerves and bones. Inflammatory conditions such as fibromyalgia impair the normal function of this system, causing pain and negatively impacting on physical activities and joint mobility.
This is especially true of the shoulder joint which has a greater range of movement than any other joint in the body. Because of this very mobility, the inflammation of the connective tissue results in almost constant shoulder pain, seriously limiting movement.

Shoulder pain and shoulder injury.
A shoulder problem may be minor or serious, and besides the pain, could include swelling, numbness, a tingling sensation and weakness. This shoulder pain can make you more susceptible to shoulder injury, especially during sporting activities or work-related tasks. The severity of shoulder pain and the risk of shoulder injury can be reduced if fibromyalgia, being the root cause, is effectively treated.

How is fibromyalgia usually treated?
There is no single magic pill that will cure fibromyalgia. There are, however, medications that can help reduce pain and inflammation. Because of pain when moving about, many people tend to become inactive, which in effect just aggravates the condition, resulting in more pain. Now studies have shown that mild exercise, especially aerobic exercise, is of enormous benefit to fibromyalgia patients in helping them to stay functional.

fibromylagia_walking
What is aerobic exercise?
Aerobic exercise is any moderate exercise which maintains an increased heart rate for an extended length of time, oxygenating the blood which in turn feeds more oxygen to the muscles, improving their energy generating process and possibly reducing pain and inflammation.
How to manage your exercise program.
• Before starting a program, discuss it with your doctor.
• Don’t be over-intense, focus on moderate exercise.
• Be aware of your limitations.
• Opt for activities you enjoy doing.
• Start slowly and build up gradually.

Fibromyalgia is a chronic condition causing almost constant muscle and joint pain. The cause of the disorder is not known, and there is no cure. However it is treatable with anti-inflammatory and pain medication, and moderate aerobic exercise. A positive and proactive attitude to the illness will also help keep depression and anxiety at bay when you are feeling low.
If the condition is well-managed, it will give relief to muscle and joint pain including the important shoulder joint, and definitely reduce the risk of what could be a debilitating shoulder injury.


06/Sep/2014

player
NFL quarterback, NHL goalie, MLB starting pitcher, and NBA point guard are generally considered the most important positions in the major U.S. sports. A position that is arguably as important is the major league closer. The closer is responsible for whether a team wins close games. A majority of major league games are decided by only 2 runs or less. It is easy to see the importance of a quality closer. Unfortunately for the San Diego Padres, closer Joaquin Benoit has been sidelined off and on by ongoing shoulder pain. He has missed a number of games over the course of the season due to the shoulder pain. Benoit has described a pain fluctuates. That he will feel good for a couple of days but then the inflammation will return. The cause of this pain has not been diagnosed but there are some acute shoulder tears that may be attributing to Benoit’s discomfort.

A SLAP tear is a tear in the top part of the labrum. The labrum is a strong, fibrous tissue that stabilizes the shoulder joint. The labrum acts to deepen the shoulder socket and allows a stronger fit between the upper arm bone, the shoulder blade, and the collarbone. A SLAP tear occurs in both the top-front and top-back portion of the labrum and is often caused by repetitive shoulder motion such as constantly hurling MLB sized curve balls and sliders. When a SLAP tear is present, the patient may experience shoulder pain, decreased strength, decreased range of motion, and unusual and uncomfortable feelings that the shoulder is catching, locking, grinding, or popping out of it’s joint. For major league pitchers there will also likely be a decreased in their pitch velocity.
slap-tear
A partial thickness rotator cuff tear is an incomplete tear of the rotator cuff. The rotator cuff connects the upper arm to the shoulder blade and is essential for shoulder strength and lifting of the arm. A partial tear in the rotator cuff would include damage to the soft tissue of the rotator cuff but would not be severed and would not be disconnected from the upper arm or shoulder blade. When the rotator cuff is torn, a patient will likely experience shoulder pain, shoulder weakness, difficulty lifting and rotating arm, and a crackling sensation in the shoulder. For major league pitchers lifting and rotating the arm is an essential part of the pitching motion. A partial thickness rotator cuff tear can cause tremendous amount of pain and a decrease in pitcher productivity.
rotator-cuff-tear
For these acute injuries the suggested initial treatment is rest, anti-inflammatory medications, and physical therapy to restore the strength, flexibility, and range of motion. If non-surgical treatment is not sufficient and problems persist or worsen then the next step would be to review surgical options. At this point Joaquin Benoit is experiencing discomfort bad enough to miss some games, but team doctors do not believe that surgery is needed just yet. Time will tell whether he can overcome this nagging shoulder injury or if he will need to have the shoulder repaired via surgery. Call to schedule your appointment with our top notch sports medicine specialists at Orthopedic Surgery San Diego.
vote-players


03/Sep/2014

I had a small fracture my right foot as a result of a freak slip and fall last year. My
primary care doctor recommended Dr. Robert Afra as a specialist who she felt would be
a good referral for me in my situation
One of the first things I appreciate is I was always able to see the doctor within minutes
of an on time arrival for my scheduled appointments. My interactions with Dr. Afra were
clear, concise and caring. He is very pleasant and spends the necessary time
explaining, in lay person’s terms, what is going on. He listened to my concerns and laid
out the various options with the likely outcome of each and helped guide me to the best
plan. The result is that I am back to where I was before the incident.
I would highly recommend Dr. Afra and his staff in matters of Orthopedics and the like

Sincerely,
charlene
Charlene


01/Sep/2014

Our young athletes in Carlsbad and North County San Diego, especially soccer and football players, are particularly vulnerable to concussion.  This issue is particularly important to me; my daughter sustained a Grade 2 concussion as a result of a skiing injury.  I feel parental education regarding concussion awareness is tremendously important.  Middle school sports are more rigorous and ambitious than ever before. More physical demands, practice times, and pressures are placed on athletes and the path to perfection is often paved with injuries.concussion-football

One of the most popular sports, globally, is soccer. Children can begin playing as early as Kindergarten. While the sport is fun, good exercise, and a foundation for learning sportsmanship, it can also be damaging to young bodies.

Soccer injuries can range from something as mild as a small bruise to something as major as a concussion. Knee pain, calf pain, and ankle pain are commonly associated with soccer players. Some injuries, like a torn ACL (anterior cruciate ligament) or torn meniscus requires a visit to an orthopedic surgeon for knee pain treatment and possible knee surgery.  These types of injuries that occur in younger athletes may affect them their entire lives. Shin splints, which occur from overuse, stress and bone fractures, wrist sprains and fractures, and even painful shoulder dislocations can occur due to playing soccer.

One especially serious injury from playing soccer is a concussion. A concussion is a traumatic brain injury that occurs when a person is hit hard enough for the brain to shake inside the skull.  This can happen during a sport, a fall, or other types of hard hits. Many people assume a loss of consciousness is needed for a concussion, but this is not true. Symptoms of a concussion include confusion, dizziness, headaches, nausea, vomiting, changed sleep patterns, change of emotional state, and sensitivity to light. Any symptoms of a concussion should be discussed with a doctor as soon as possible.concussion-anatomy

Of all the sports for female middle school athletes, soccer causes the most concussions. High school female athletes have double the amount of concussions per year than male high school athletes.  A study was conducted from 2008 to 2012 that focused on 351 advanced female soccer players between the ages of 11 and 14. During this study, there were 59 concussion reported, which is about 17% of the players.

Because of the high amount of concussions, a class action lawsuit was filed against FIFA (Fédération Internationale de Football Association), along with U.S. Soccer Organization and the American Youth Soccer Organization. This lawsuit, as reported by The New York Times (8/28, Strauss), The Washington Post (8/27, Payne) and the Los Angeles Times (8/28, Baxter) among others, states that the groups have not acted responsibly in terms of monitoring concussions and head injuries.

The lawsuit was filed by parents and players and are asking for a change in the soccer rules. They ask that children under 17 be limited to the number of times to head a ball, and to allow substitutions for anyone being examined for a possible head injury, rather than limiting the number of substitutions in a game. While some are skeptical that new rules will make a difference, we can only wait and see.  As an orthopedic surgeon and sports medicine specialist, I back such legislation and policy change.

If you have questions or concerns about your child and their sports preparedness, feel free to reach out to our top notch Orthopedic Surgery San Diego sports medicine specialists.


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