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CLASSIC LIST

21/Apr/2014

Large-scale cohort studies have a tough time proving that one thing causes another, but they can raise interesting questions about strong correlations. This week, for instance, saw a published study which found that people who drink more milk may have less pain and slower progression of osteoarthritis, an affliction which strikes roughly a third of adults in the U.S.:

[The researchers] found that increasing milk consumption was associated with slower progression of the disease in women. In men, only those who consumed the most milk — seven or more glasses a week — saw the effect. More than 90 percent of the people in the study drank fat-free or low-fat milk, and the study did not find the effect with cheese and other dairy products.

It is possible, of course, that people who drink more milk are just healthier in every way, and that the milk is merely a signpost of that lifestyle than the cause of arthritis prevention. But we can safely assume that the milk isn’t causing any joint distress – and that upping your intake of liquid dairy may, in fact, represent a doorway to safer living.  That being said, it is extremely important for growing children, lactating women, and postmenopausal women to ensure adequate calcium intake.  That threshold may more easily be met with calcium supplements.  Most of the better quality supplements will also have the necessary Vitamin D dosage as well.  For further details reach out to your primary care physician or me to answer your questions.

We’ve spent lots of time in previous posts to discuss how to manage arthritis.  We have now also touched on measures to try to prevent it.  So try it if you like and see if that glass a day keeps the knee pain at bay. As an expert in orthopedic surgery, I have certainly seen enough chronic joint pain to know that every preventive measure is worth a shot.


21/Apr/2014

The debate has been raging for some time: is walking or running better than an elliptical machine? And what does “better” mean, anyway?

As it happens, some talented physicians, technicians and orthopedic specialists have looked at the respective motions and benefits of both forms of exercise, and a few clear answers have emerged.

First things first: the calorie question seems to be a wash. That is to say that it takes roughly the same energy to propel your body forward no matter how you’re moving.  My advice is “Just move!”  and do what you like (by that, I mean exercise the way you enjoy to exercise).  Some feel better on a treadmill.  Some feel better in a spin class.  Some feel better running on the open road.  At the end of the day, the more you move the more calories you burn.  So, obviously you must walk longer or farther to make up for the slower pace, when compared to jogging.

 

But the larger questions surrounding musculoskeletal health get a bit trickier. Yes, ellipticals offer a more robust workout for your thighs and buttocks, while running offers a better workout for your calves. But for orthopedic surgeons such as myself, the real question is about joint pain. And here, the winner is clear:

According to a study published this month in The British Journal of Sports Medicine, walking causes 112 percent of someone’s body weight to strike the ground with every step, while only 73 percent does in elliptical training. This slighter jarring is an advantage for people with sore joints, but less so for those who hope that exercise will improve bone health.

In summary, while elliptical training is less ‘traumatic’ to joints, it does less to prevent osteoporosis (bone thinning).

And there it is. Sore joints such as knees and ankles are more likely to worsen by running on concrete, whereas joints are less likely to become inflamed on the comparatively smooth trajectory of an elliptical machine.  But I would recommend you do what you like, because that is what is gonna get you out to do it again.  And that is the best form of exercise.

 

Do you want to learn more about how you can prevent joint pain and head off the need for knee surgery? Please contact my San Diego orthopedic surgery offices to set up an appointment today.


21/Apr/2014

3D Printed Orthopedic CastThe plaster cast is a mainstay of modern orthopedic medicine. It is the star of countless movies and memories in which an injured child returns to school and collects signatures from dozens of fawning friends. There is nothing like a cast.

Yet now the vaunted cast may be threatened. 3D printing promises to disrupt just about everything about the way objects are created, especially in medicine. Recently a graduate student created a prototype for a lightweight, printable cast made of polymer that includes low-intensity pulsed ultrasound (LIPUS) within its casing. The benefits are clear – far less weight, far more customization in form and appearance, and a greatly increased chance of faster healing thanks to the proven benefits of LIPUS.  Most importantly, depending on the 3D printed cast material, it may be safe to use in the water.

Think of this as just one of many new technologies that are changing the field of orthopedic surgery, giving patients across the country better access to more comfortable aftercare and healing. To learn more about some of the most advanced technologies in sports medicine, please contact my San Diego orthopedic surgery center today.


21/Apr/2014

It is a question that has bedeviled physicians, nutritionists and trainers for generations: Why do some people hit the gym every day without fail, while others can barely find the motivation to hit the restroom in the morning?

Now scientists may have found a clue. A new study in the Journal of Physiology suggests genetic loading may influence the level of activity in which most of us engage on a daily basis. A rat study suggested that identical twins have a tendency to exercise a similar amount no matter what environment with which they are faced. Researchers then bred rats that were inclined to be highly active, and a separate group inclined to be more sedentary. Once again, the rats did as their genes predicted:

Even so, Dr. Booth said, his group’s data would seem to suggest “that humans may have genes for motivation to exercise and other genes for motivation to sit on the couch,” and over generations, one set of these genes could begin to predominate within a family. But predispositions are never dictatorial.

The silver lining in this particular study, however, is that rats who spent more time sedentary soon began to mimic their active counterparts; studies indicated that their brains actually began to look more like their motivated cousins across the lab. It seems possible that you, too, can raise your energy level just by, well, raising your energy level.  Just say to yourself “I will do it!”  Get out there and move!

We have plenty of hard data that tells us exercise can prevent knee pain and back pain, and prevent costly orthopedic knee surgeries. This study should be a strong reminder that exercise is a choice we can all make when necessary.


04/Apr/2014

There was a time not too long ago when countless pitching careers were cut short by strain on the elbow ligaments. That was before Dr. Frank Jobe came up with a legendary innovation in orthopedic elbow surgery – a procedure known officially as ulnar collateral ligament reconstruction, and unofficially in clubhouses across the nation as Tommy John surgery.

Deceptively simple in its execution, the procedure, which involves relocation of a forearm tendon to the elbow, has undergone precious few changes since it was first performed on – you guessed it – Tommy John, formerly of the Dodgers. The pitcher’s transformation was swift and decisive.  Today the same technique is prescribed for thousands of athletes, including tennis players and javelin throwers, who undergo extreme  elbow strain on a daily basis.

It’s hard to argue with this watershed in prognosis:

In 1974, Jobe estimated that John’s chance of regaining his form was 1 in 100. Current studies suggest a rate of success, generally defined as an athlete’s reaching the same plane for at least one season, of more than 80 percent.

Dr. Jobe passed away recently, but his legacy lives on in the many active people who appreciate his work every day. As a specialist in orthopedic elbow surgery here in San Diego, I am indebted to Jobe for one of the most effective tools in my arsenal.


04/Apr/2014

Much has been said about whether running has net beneficial or detrimental effects on an athlete.  The cardiovascular upside on overall health is clear cut.  But what about all that trauma that a runner’s knees must endure with each step slamming into the pavement?

Protecting your knees and back while running is a battle that must be fought on several simultaneous fronts.  Simple strategies such as proper shoe maintenance and alternating exercise regimens are simple ways to avoid foot and ankle injuries that are commonly seen in runners.  When it comes to the knees and low back, a well-conceived functional strengthening program can help avoid injury.  The concept is very similar to what any recreational athlete feels at the end of a long day skiing.  Most injuries in skiing tend to occur at the end of the day when our muscles are fatigued and less apt to allow us to recover from some perturbation/fall.  Basically, tired muscles have difficulty protecting us from injury when compared to muscles that are better conditioned.  The core muscles are at the ‘core’ of injury prevention with respect to the knee and low back.  The core muscles help to shock-absorb and avoid injuries to the adjacent joints.

This list offers a nice starting point for strengthening.  It features some simple exercises to keep your core, back, hips and shoulders in reasonably loose and powerful form.

Still suffering from knee pain, hip pain, back pain or shoulder pain? Visit my San Diego orthopedic surgery practice to learn more about how you can achieve lasting health without losing a step.


02/Apr/2014

There is a growing momentum in sports medicine to encourage athletes and their coaches to warm up in more effective ways. Born partly out of the Santa Monica Sports Medicine Foundation’s PEP program, and spurred on by success stories such as this one, these new exercises are widely touted as simple and powerful, reducing knee surgery numbers by a substantial percentage:

These programs, formally known as neuromuscular training, use a series of exercises to teach athletes how to land, cut, shift directions, plant their legs, and otherwise move during play so that they are less likely to injure themselves. Studies have found that the programs can reduce the number of A.C.L. tears per season by 50 percent or more, particularly among girls, who tear their A.C.L.s at a higher rate than boys do (although, numerically, far more boys are affected).

The good news: these are easy-to-perform and familiar exercises which resemble the calisthenics we all learned growing up. Educating yourself or your local sports team is as simple as watching a few online videos. Yet the savings in medical care costs can be staggering, especially as you diminish the likelihood of ACL tears and their attendant recovery measures.

While a warm up run to get the juices flowing and proper stretching prior to the main work out helps to prevent muscle strains, neuromuscular training is an entirely different concept.  Neuromuscular training is really nothing more than a functional core workout.  Yup, that’s it!  What you do in martial arts, or yoga, or pilates….these strengthening activities helps the young female soccer athlete avoid that infamous ACL tear.  The muscles in the torso, abdominal wall, pelvis, and proximal thigh help the athlete to properly position the knee, which minimizes risk of ACL tear.  It has been proven!!!

For some mature athletes, in addition to neuromuscular training, further measures to maximize knee longevity and function include oral supplements (glucosamine, chondroitin, MSM), platelet rich plasma (PRP) or stem cell injections, and hyluronic acid (HA) injections.

I specialize in knee surgery and orthopedic surgery in San Diego, and encourage all my patients to take every precaution they can to stay active and nimble. Please call my offices today to learn more about how you can prevent knee surgery.


02/Apr/2014

The medical community is never short on opinions on how to manage chronic pain. Common recommendations range from the use of anti-inflammatories such as NSAIDs, to stretches, exercises, even meditation. One effective fix that isn’t usually mentioned: weight loss. Now a new study has appeared which suggests the effects can be profound:

The study included 20 obese patients who had weight-loss surgery and 40 patients who had total knee replacement due to arthritis.

One year after their procedure, the patients who had weight-loss surgery reported significant improvements in knee pain. Their results were comparable to the patients who had a knee replacement, according to the study, which was presented Friday at the annual meeting of the American Academy of Orthopaedic Surgeons, in New Orleans.

It is yet another reminder that our knees are complex mechanical systems, and that ensuring their safe operation has as much to do with reducing loads as reducing stress. The collateral health benefits of weight loss only shore up the case, of course, and lend credence to a holistic view of sports medicine that incorporates the entire body as a single system.

Furthermore, there is growing scientific evidence that injections of PRP (platelet rich plasma) and/or stem cells into the arthritic knee provide significant pain improvement.  In fact more and more evidence seems to indicate that PRP is more effective in reducing knee pain than the highly touted hyaluronic acid (HA) injections, such as Synvisc, Hyalgan, Orthovisc, and Suppartz.

Want to learn more about knee pain or knee surgery in San Diego? Please contact my orthopedic surgery offices here today.


20/Mar/2014

A provocative article in last week’s New York Times discusses the quiet epidemic of older people living with serious pain who fail to report it to their doctors. Whether it’s due to stoicism, resignation, or something else, the net effect can be devastating:

[S]tudies have found that elderly patients are less likely than younger adults to report pain to their doctors. Instead, many suffer in silence at considerable cost to the quality of their lives. . . .

Untreated or inadequately treated pain is disabling and can hasten the death of an older adult by interfering with the ability to exercise, eat properly or maintain social contacts. Persistent pain can lead to immobility, depression, sleep problems, loss of appetite and isolation, all of which may increase the need for expensive medical care.

The article addresses cases of shoulder pain, hip pain and knee pain. Each could have been addressed earlier with proper orthopedic care, especially in cases where arthritic pain has led to a vicious cycle of immobility and declining health.

Agonizing pain is not a natural byproduct of aging, and no one should accept its arrival as a sort of grim “new normal.” If you have chronic knee, shoulder, elbow or hip pain and desire expert orthopedic care in San Diego, please contact my offices.


20/Mar/2014

Knee surgery is a common solution to intractable orthopedic disorders such as ACL tears, meniscus tears and isolated cartilage injuries. Yet despite the fact that such procedures have good success rates, there remains a small but stubborn percentage of patients who experience lingering discomfort even after their projected recovery time has elapsed.

This is especially common in total knee replacement surgeries, which involve equipment designed to exist permanently in this highly trafficked joint. Now orthopedic surgery specialists are refining the tools used to map and fit these medical devices to your body’s natural contours:

Careful fitting and expert aftercare are essential to ensure your knee surgery procedure works as well as you need it to. To learn more about how to get started with some of the most advanced surgical techniques in Southern California, please contact the San Diego orthopedic knee surgery experts today.


© 2023 Dr. Robert Afra – San Diego Orthopedic Surgery Shoulder – Knee – Elbow