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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.


13/Feb/2014

Elbow surgery in San Diego is often an effective remedy for chronic pain, but it is a remedy of last resort. Most elbow injuries resolve on their own with some basic rest. That said, there are some ways to speed the process a bit by promoting healing and mobility.

This list describes some of the most common elbow stretches designed to combat elbow tendinitis using nothing more than gentle flexion. Although elbow tendinitis is likely to respond to one or many of these options, it could take some time; be sure and try them all for a week or more before you make an assessment of success.

The core treatment measures to address tennis elbow or golfer’s elbow is rest, an epicondylar brace, oral non steroidal anti-inflammatory tablets, acupuncture, physical therapy.  Sometimes injections such as steroids or platelet rich plasma (PRP) do the job.  And if the time should come that your elbow pain has grown too intense? Just contact the elbow surgery experts at San Diego Orthopedic Surgery to set up an appointment today.


08/Feb/2014

As a San Diego orthopedic surgeon, I field a lot of questions about how to minimize joint pain from repetitive and everyday activities. One of the most common: “How can I minimize knee pain when I’m going down the stairs?”

The short answer is a healthy dose of stretching and exercise.

But a more detailed answer has recently surfaced in the New York Times’ Well column, which outlined a simple prescription:

This discomfort is magnified if you have weak quadriceps or thigh muscles, [Dr Bozic] added, since the force that might otherwise be absorbed by those large muscles moves through the knee instead. So to strengthen your quadriceps, try straight leg raises, [he] said. Simply lie on your back with one leg bent. Lift the other leg, straightened, at least six inches off the ground; tighten the thigh muscles and hold for a few seconds. Lower and repeat several times. Then do the same exercise with the other leg. Your physician or an athletic trainer can suggest other safe exercises that target those muscles.

Dr Bozik’s approach is a fairly simple answer.  The more complex answer lies in the practice of yoga and pilates.  Yogi and pilates practitioners learn to engage the ‘core’.  Strengthening the thigh muscles (one of which is the quads) and strengthening the ‘core’ takes you a tremendous way.  But the holy grail is a concept called ‘muscular co-contraction’; this activity entails teaching your core muscles to activate with the use of the thigh muscles.  This is what all exercises aimed at protecting athletes from ACL tears and preventing the resurgence of anterior knee pain is all about.  There, the genie is out of the bottle!  Further recommendations included stay in motion, avoid sitting in a chair all day, take a stretch break from computer work (say 5 min every hour) when you can.…if all else fails call it a bathroom break.

And if your knee pain should require knee surgery in San Diego? Contact the knee surgery experts here to schedule an appointment today.


03/Feb/2014

Here’s what’s tricky about knee surgery. It’s really important that a surgeon pay attention to the complaints a patient has and to corroborate those complaints with physical examination and MRI findings.  When there is the synergy of all three, surgery is warranted and works well.  We know this, and medical literature supports it.

Unfortunately, often times patients have undergone surgery for the wrong indications.  Indications are what surgeons learn in residency and fellowship and can be cured by performing surgery.

Even when surgery is performed for the right indications, the postoperative recovery can take unexpected twists and turns.  Prone to periods of accelerated improvement punctuated by stretches of apparent stasis. For example, there is no calendar for how we recover from ACL knee surgery. Although most often patients ‘recover’ over four to eight months after surgery, our bodies follow their own timeline despite medical efforts.

So when an athlete offers a date for when she expects to be fully recovered from knee surgery, that day isn’t written in stone. Even someone clearly on track to regain full mobility and flexibility can reinjure their knee, setting or even resetting that recovery process back to zero.

All of which brings me to Lindsey Vonn, the world-class athlete whose triumphant return to the slopes at Sochi has been scuttled by reinjury:

Vonn tore her anterior cruciate and medial collateral knee ligaments in a tumbling crash 11 months ago at the world championships, but had appeared to be ahead of schedule in her recovery for the Sochi Olympics until a training crash Nov. 19 in Colorado. At that time, she said that she had partly torn her rebuilt anterior cruciate ligament and would still be able to participate in the Olympics. . .

On Dec. 21, Vonn entered a more demanding World Cup downhill in Val d’Isère, France — with Woods at the bottom of the hill, watching. About halfway through the course, her right knee buckled as she tried to make a high-speed turn, and she skidded off the course. After the race, for the first time, Vonn acknowledged her A.C.L. injury was more severe.

She said the ligament had been ruptured.

She has not been on skis since.

It is a teachable moment and a cautionary tale when an athlete pushes harder than most orthopedic surgeons might recommend in the interest of meeting a deadline. In Vonn’s case, that deadline was the Olympics: who could blame her? We have tons and tons of young elite level female soccer players in San Diego who feel the same drive of getting back out there…push push push.  I’m onboard, as long as the body can keep pace with our type ‘A’ drive. Often times that type ‘A’ drive gets us to the finish line with respect to our strength training and back out on the field to score.  Sometimes athletes get out on the field for contact or agility sports to early and are vulnerable to reinjury.  Know anyone who underwent revision ACL reconstruction?  For those of us non-Olympians with knee injuries recovering from ACL reconstruction here in San Diego, there is nothing quite as effective as rest, patience, rehabilitation….lots and lots of self-directed core-strengthening and agility training!

It all starts with an expert orthopedic surgeon.  One that you can trust will guide you to conservative care when appropriate and to surgery when appropriate.  Seek a consultation with a doctor that will take the time to listen to you, examine you, and properly treat you. To schedule your own San Diego knee surgery, please contact the experts here today.


14/Jan/2014

Although I’ve spent a good amount of time working with professional and NCAA athletes, the majority of my patients nowadays come to me with more conventional injuries. Case in point: most wrist surgeries I perform these days are more likely to be for repetitive stress symptoms from activities such as golf and tennis than for gridiron trauma.

Still, it is helpful sometimes to highlight what professional athletes go through, and why their outsized physical injuries can benefit from the same orthopedic surgical procedures as the rest of us. Star Yankees first baseman Mark Teixeira is a perfect example: After straining a wrist tendon at the World Baseball Classic last year, Teixeira eventually was forced to take a seat for more than 100 games.

And how is he feeling now after his wrist surgery?

“I’m close to 100 percent. I feel like I’m healed. I wish I was a little bit looser; my wrist is going to be tight for a while because of the way the surgery was performed. They had to kind of tighten everything up to make it secure. It’s still a little bit tight, but that’s why I’m doing rehab every day and doing exercises every day. I’ll start swinging a bat in January and that will also help loosen it up.”

Just a little snapshot into how fast and seamless recovery can be in the hands of an experienced orthopedic surgeon. If you suffer from elbow, wrist or hand pain and want to speak with a wrist surgery expert here in San Diego, please contact my offices today.


08/Jan/2014

Stanford University, that perennial hotbed of innovation, does not discover all of its new ideas in the computer lab. As a recent New York Times profile makes clear, Stanford has also developed one of the most unusual strength and conditioning programs in the country for college football players.

The program prizes flexibility over brute strength and mobility over locked bodies. The goal of strength coach Shannon Turley is to minimize injuries and enhance practical strength. But does it work?

From 2006, the year before Turley arrived on the Farm, as Stanford’s campus is known, through last season, the number of games missed because of injury on the two-deep roster dropped by 87 percent. In 2012, only two Cardinal players required season-ending or postseason surgical repair; this year, only one.

The science behind this approach is based largely on stretching, on deep and symmetrical strength exercises, and even on yoga. Plus there’s this:

Turley pays particular attention to his players’ Functional Movement Screen scores. The F.M.S. is a durability index, what Turley calls “a predictive, quantitative analysis of quality of movement.” That is the first test he conducts. It evaluates seven movements and scores players as balanced, functional, overpowered, dysfunctional and injury prone. It shows if a player executes a movement better with his left leg than his right, pointing out asymmetries.

It is a smart approach that has cut down on the sorts of knee surgeries and shoulder surgeries which can plague NFL prospects long before they ever hit the big time. As a San Diego orthopedic surgeon who has spent a lot of time with professional sports teams, I can attest that there is no substitute for enhancing the body’s natural ability to flex and twist without injury. Plus gaining a berth in the Rose Bowl isn’t too shabby either.

If you’d like to learn more about sports injuries, sports surgery and how to maintain an active life, please don’t hesitate to contact the sports medicine experts here today.


26/Dec/2013

World-famous magician Chriss Angel has joined the ranks of countless athletes, CEOs and active people by announcing he will soon undergo shoulder surgery to repair several torn tendons.

Like so many mortals before him, Angel resisted as long as he could, but eventually the symptoms grew too grave to continue. “The pain is intense,” he recently told the Las Vegas Sun. “It’s there constantly but then goes from bad to worse before easing up.”

This is a familiar trajectory, one which far too many people travel before ultimately succumbing to the wisdom of surgery. When shoulder injuries such as rotator cuff tears and labral tears occur, they may feel a bit like prior injuries which heal on their own. But make no mistake – these are chronic issues which simply will not get better without expert orthopedic surgery. But the magic man himself has an ambitious game plan:

“[W]e have no other choice but to close it in January. But then in February and March I’ll be able to go back onstage to host a new limited-engagement show with many of the other magicians you’ve seen on the Spike series of ‘Believe.’ I promise, though, to be back in full force with the ‘Believe’ stage show in April and add illusions never done before live.”

And that’s the point. Expert shoulder surgery is an invasive process, but it also comes with an excellent prognosis for full recovery. If you want to learn more about this and other San Diego orthopedic surgery procedures, please contact my offices for a consultation here.


16/Nov/2013

One can’t spend much time in the field of orthopedic surgery without noticing countless mentions across every section of the newspaper. This month alone brought a fine set of case studies in the power of knee surgery and its transformative effect on active lives.

In my last post I covered the NFL, so this week let us take a small detour here into the world of cinematic icons and discuss the case of Dame Judy Dench. The legendary actress underwent knee replacement surgery in September and is already performing live and walking red carpets with aplomb. My favorite recent quote from the notoriously feisty 78-year-old: “I’m not feeling my age at all. I am about 43, a tall willowy blonde 43-year-old with long legs.”

Meanwhile the sports section brings us news of the Magic’s Solomon Jones, whose torn meniscus has left him sidelined and primed for surgery. The most likely option given his injury is arthroscopic knee surgery, which should involve some reconstruction and rehabilitation to help minimize any deleterious and lasting longterm effects of the meniscus tear.

And of course there is this new athletic power couple, who share the dubious honor of having both undergone knee surgery. Tiger Woods returned to form as expected, and Lindsey Vonn is currently enjoying a full complement of races on the way to this winter’s Olympics in Sochi:

Knee surgery is an orthopedic surgical procedure that comes in many forms. It remains a stalwart of our profession and one of the best-studied interventions we have for knee injuries. If you are suffering from impaired movement, comfort or balance due to pain in your knees, contact me at the San Diego Orthopedic Surgery center today to learn about your options to return to play and enjoy your youthfulness.


26/Oct/2013

One of the interesting parts about working in sports medicine is that my field literally appears on the sports page on a regular basis. Athletes undergo surgery often because their work involves frequent exertion, extension and – for certain sports – hard collisions. And fans rarely hesitate to weigh in about the relative wisdom and prognosis of a given procedure.

The truth is often far less complex than fans and team owners would imagine: when orthopedic surgery is indicated, it simply must be done. Scar tissue and lingering injuries typically don’t heal on their own, especially when a patient is required by his or her job to keep doing whatever caused the injury in the first place. Case in point: the outcry over Mark Sanchez’s recent announcement that he’s undergone season-ending shoulder surgery.

Absent any intimate knowledge of the case, I can say that it’s likely Sanchez’s shoulder pain did not respond to soft tissue techniques or steroids. So what’s next? Shoulder surgery is the most effective way to rebuild structures that have been injured, and to restore a full and pain-free range of motion. The upside far outweighs the downside in this case: Sanchez’s season is over, but his career may well have been saved.

As an experienced orthopedic surgeon here in San Diego, I see a great number of athletes and active people. Surgery is rarely a first strategy, but under the right circumstances it often represents the surest way to repair tears, tendinitis and instability. If you’re suffering from ongoing shoulder pain and want to review all the best options, I urge you to contact my orthopedic surgery offices here today.


01/Oct/2013

Orthopedic surgery and sports medicine are demanding disciplines, highlighted by a constant stream of innovative medical technologies. As an experienced orthopedic surgeon here in San Diego, I field a lot of questions from my patients about how to treat sports injuries and musculoskeletal pain. Although I make time to answer questions in person, I have often wished I had a space where I could explore some of these questions in a bit more depth. This blog is that space – a place designed to discover and discuss what’s new, what’s next and what’s best in the field of orthopedic medicine. A brief word about me: I am the former Chief of Sports Medicine at the University of California, San Diego. I have completed fellowships and training at Boston University, Hawaii’s Queen Emma Medical Center, and the world famous O’Brien Microsurgical Institute in Melbourne, Australia. Earlier in my career, I studied at UCLA and conducted research at the Salk Institute on an NIH research stipend. As you look around this site, you’ll see that I offer a wide array of services, including cutting edge procedures in shoulder surgery, knee surgery and hand and elbow surgery. If you are experiencing lasting discomfort and want to consult with the finest team in Southern California, I invite you to visit my orthopedic surgery offices here today. In the meantime: please bookmark this site and check back often! We have lots of fascinating medical studies, news, ideas and developments ahead. Welcome aboard.


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