When we go to the family doctor, we usually expect to have a prescription for medication given to us to help us feel better. What if the doctors wrote prescriptions for exercise, too? It would be no surprise if our orthopedist prescribed physical therapy to fix a knee injury, arthritis, or shoulder pain, because we know that is a necessary component to healing. It is also necessary to engage in regular exercise to remain as healthy as possible. While medications can help keep issues at bay, such as high blood pressure, high cholesterol, or diabetes, staying active is even better. The American College of Sports Medicine has started a program called “Exercise is Medicine” which is a way for family doctors and those in the healthcare industry to encourage activity in their patients.  Doctors are being asked to participate in lifestyle and exercise changes, too, to provide a positive example to patients. Most of us know and understand that exercise is beneficial and vital to our health, but we often have no idea how to go about it. One person’s idea of exercise could be walking around the block, while another’s is lifting weights and training for marathons. Both are fine, but they might not be the exercises that you need to help with any physical issues, or your health in general. If a patient has knee pain, deep squats and lunges are discouraged, while calf raises and leg lifts are encouraged. Many Americans believe they are getting enough exercise but studies show that only about 10% of adults are actually getting the minimum recommended amount of activity. Part of the problem is having no direction to begin. While the word “exercise” may seem like a four letter word, so many people acknowledge how much better they feel after engaging in some physical activity.Exercise can be prescribed for almost any issue. Depression can be lessened through aerobic exercise as moving the body releases endorphins which reduce stress and pain. Yoga helps with anxiety problems and is a great way to help the body relax.

Asthmatics can benefit from doing exercise later in the morning when attacks are least prevalent. Shoulder injuries can benefit from exercises that help straighten the posture and sit in the right position. Major health care businesses are beginning to incorporate exercise and accountability in patient consultations. Kaiser Permanente has a program called “Exercise as a Vital Sign” and includes the minutes a week the patients exercise with the vital signs, like blood pressure, temperature, weight, and pulse. The doctors discuss with patients what type of exercises would be best for each patient.
 
Doctors would much rather prescribe exercise than another medication to control blood pressure cholesterol, or diabetes. The lower the amount of medications we need to take, the better we will feel, and the healthier our bodies can become. Exercise is not a cure all for every ailment, but getting over the initial trepidation of starting a program is the first step. If you have questions about exercise or are faced with shoulder or knee pain, contact our sports medicine specialists at Orthopedic Surgery San Diego.

According to the latest America’s Health Rankings report, obesity is getting worse and people are increasingly sedentary. As a result, more Americans are suffering pain in their knees and hips, and are at a higher risk of sustaining injuries. In some cases, arthritis develops in the joints.
The number of patients requiring knee or hip replacement, also known as arthroplasty, is on the rise. The United Health Foundation, the American Public Health Association and the Partnership for Prevention have compiled the annual rankings for 25 years. They determined that obesity increased every year except 2013, USA Today reported. For the third straight year, Hawaii ranked as the healthiest state. Next on the list were Vermont and Massachusetts. Mississippi was in last place, just behind Arkansas and Louisiana.
The researchers found that Hawaii had “low rates of smoking, obesity, child poverty, preventable hospitalizations and deaths from cancer and cardiovascular disease.” Mississippi showed “high rates of physical inactivity, low teen immunization rates and small disparities in health status by age.” Nationally, the obesity rate among adults reportedly rose from 27.6 percent to 29.4 percent during the past year. Almost 25 percent of Americans told researchers they had not exercised or done any physical activity in the preceeding month. That was slightly more than the percentage of people who gave that answer in 2013.
The USA Today noted that obesity is “a leading contributor to death,” and that it has “more than doubled over the last 25 years.” Carrying too much weight has been linked to musculoskeletal problems involving the knees, hips and other parts of the body. Numerous studies have indicated that obesity also increases the odds of having high blood pressure, which can lead to heart disease; or contracting Type 2 diabetes. Almost one in 10 adults in the United States has been diagnosed with diabetes, more than twice as many as in 1994. “What people are not focusing enough on is that we are producing an extraordinary number of people who are unnecessarily sick,” Reed Tuckson of Atlanta, senior medical adviser to the United Health Foundation, told USA Today. “They are pouring into the medical system.
It’s a total crisis.” The newspaper pointed out that “rising numbers of American adults have the most dangerous kind of obesity, belly fat.” However, researchers also detected a 3 percent drop in the number of people who smoke tobacco. They reported a 5 percent increase in child immunizations and a 4 percent decline in infant mortality. The annual report breaks down the obesity data not only by state, but also in terms of income, education level and race. Health-care authorities use the information to measure the success of their wellness programs.

The American Council on Exercise has set a goal of ending what it calls “the obesity epidemic” by 2035. The organization advocates the creation of more safe places for children to walk and play after school, as well as walking and running routes for adults. “One of the areas we’re trying to spend a lot more time on is trying to understand the behaviors and why people make certain choices,” Anthony Wall, the council’s director of professional education, told USA Today. “They need tools to make a change themselves.”

Knee and Hip

Knee and hip pain can result from an injury, like a ruptured ligament or torn cartilage; or a medical condition, such as arthritis or gout. The discomfort may progress to the point that it becomes difficult to walk and engage in other simple, everyday activities. When conventional treatments fail to relieve the pain and restore joint function, knee or hip replacement (arthroplasty) sometimes becomes necessary. If you are suffering from pain and disability in a knee or hip, schedule an evaluation by the renowned sports medicine staff at Orthopedic Surgery San Diego to learn how to relieve your symptoms.

Exercise

Failing to get effective, regular exercise can eventually lead to a number of orthopedic problems, including knee pain. The staff at Orthopedic Surgeons San Diego recommends a regimen of regular physical activity to strengthen joints.
That advice was validated in a recent study, which indicated people benefit most from relatively easy 10-minute workouts that include one minute of strenuous exercise. The New York Times touted the findings as “good news for busy people who have tried, unsuccessfully, to fit even short workouts into their schedules.”
Martin Gibala, a kinesiology professor, led the study at McMaster University in Ontario.

He and his colleagues analyzed 14 men and women who were in good health, but overweight and sedentary.

The researchers monitored the volunteers’ blood pressure and blood-sugar levels, took biopsies of their muscles and measured their aerobic endurance, the Times reported in its “Well” blog.
The study participants rode computerized stationary bicycles “all out” for 20 seconds, pedaled slowly for two minutes, rested for three minutes, then repeated the process two times. The result was 10 minutes of exercise, including one minute of intense interval training. This was done three times a week for six weeks, after which the volunteers underwent another round of medical tests.
The doctors discovered that the exercise routine had improved endurance capacity by an average of 12 percent. Lower blood-pressure levels were detected in most of the participants, and their muscles produced more mitochondria (which boost energy and fitness). The tests showed healthier blood-sugar levels only for the men, possibly because women’s bodies burn sugar and fat differently during exercise, the Times noted.

Gibala told the newspaper that workouts of less than 10 minutes probably are not effective. He said: “We’ve dropped from 30-second all-out intervals to 20-second intervals because for many people those last 10 seconds were excruciating.”
The doctor explained that riding a bike is just one way to get the right kind of exercise. He mentioned running in place and racing up steps as alternatives. Other options include walking, jogging, swimming, and playing golf or tennis.
Experts recommend that people not accustomed to vigorous exercise start slowly to prevent injury. Brisk walks and stretching are good ways of easing into a workout regimen. That can evolve to things like floor exercises, aerobics and yoga.

Home-exercise equipment includes treadmills, stationary bicycles, elliptical trainers, weight machines, resistance bands and free weights.

A growing number of people a

re going to gyms, spas and fitness centers to work out on other types of machinery. Many of the facilities offer fitness training, yoga and aerobics classes, and other services.
The best kind of exercise, in terms of burning calories and achieving fitness goals, is called cardio because it entails elevating the heart rate. Multiple studies have proven the effectiveness of cardio workouts in warding off illnesses and diseases, as well as relieving stress. Such strenuous physical activity grows muscles while reducing fat.
If you are suffering from knee pain, schedule an evaluation by the renowned sports medicine staff at Orthopedic Surgery San Diego to learn how you can relieve your symptoms with exercise and other treatment.

Stem Cell Therapy

Stem cell therapy is one of the latest entrants in the field of therapeutic medicine. Although, stem cells have been in the news for several years now, they have mostly been confined to the research laboratories up until now. However, Stem cell therapy is now developing into something much more useful and applicable in mainstream medicine.
Stem cell therapy is basically the use of stem cells to treat, cure, or prevent certain diseases and conditions. The chief intent of stem cell therapy is to replace the dysfunctional or abnormal cells in the body with healthy and functional stem cells. Additionally, the stem cell therapy also stimulates the host’s immune responses to annihilate the dysfunctional cells. Stem cells also help the body produce enough red blood cells, white blood cells, and platelets to help prevent serious infections and anemia during certain medical procedures such as chemotherapy for the treatment of cancers. Although, stem cells are often thought to be in the research stages, they have been in use in the treatment of cancers such as Lymphoma, multiple myeloma, and leukemia and sickle cell anemia since several years.
What are stem cells and how are they used in stem cell therapy?
Stem cells are of several types, as they are usually formed in different parts of the body at different stages in one’s life. The embryonic stem cells usually do not last after the early developmental stages are complete. However, there are some tissue-specific and adult stem cells that may originate during fetal development but remain throughout one’s lifetime inside the body.  All of these stem cells perform certain functions that are only specific to them and certain tissues, as their potential is often limited to the tissues that they have been derived from alone.  These stem cells are mainly isolated from the patient’s bone marrow or adipose tissue through aspiration. The isolated stem cells are then cultured in laboratories to increase their numbers. The increased stem cells are then injected in specific areas for the purpose of regenerative therapy. The more number of stem cells injected into a specific area, the better are the results. Hence, these isolated stem cells are scientifically processed to increase their numbers before they are injected into the dysfunctional site.
Thus, stem cells have come a long way in their utilities in modern science. Cancer treatments, regenerative therapies, Blood disorders, and countering the side-effects of chemotherapy are just some of the many uses of this therapy today. Additionally, stem cell therapy shows great promise and is believed to play an extremely significant role in the future of therapeutic medicine.
All said and done, most aspects of this therapy are still under research. However, all of the initial results seem promising. Stem cell transplants also have the chances of producing certain side-effects such as graft versus host diseases. Since, the stem cells induce an immune response in the host body to kill off the cancer or unhealthy and dysfunctional cells, this process holds the risk of going too far and killing off healthy cells too in the bargain, if not performed with skill and care.
If you have pain and would like to be evaluated for the benefit of PRP or stem cell therapy, please contact our specialists at Orthopedic Surgery San Diego.

Patients with diabetes have a greater chance of developing complications such as infections after knee replacement surgery.  Knee replacement surgery, such as total knee arthroplasty, is commonly performed in patients with knee pain due to knee osteoarthritis.   In patients with diabetes, the blood levels of certain chemicals called “glycemic markers” may help the orthopedic surgeon predict the patients that are at risk for developing a complication after total knee arthroplasty.   Common glycemic markers include:  fasting blood sugar (glucose) levels (FBG), postprandial glucose (PPG2), glycated hemoglobin (HbA1c), and random blood sugar levels.
The purpose of this study was to determine if any of the commonly used glycemic markers are linked to complications such as infections after knee arthroplasty surgery in patients with diabetes.  The four glycemic markers that were studied were:  pre-operative fasting blood glucose (FBG), postprandial glucose )PPG2), glycated hemoglobin (HbA1c), and levels of random glucose levels on 2, 5, and 14 days after surgery.  The complications related to diabetes were:  surgical site infection (superficial and deep infections of the surgical would), wound complications such as drainage, hemarthrosis, skin necrosis, and/or dehiscence.
This study was performed on 462 patients with diabetes.  These patients underwent a total of 714 total knee arthroplasty operations.  Data was collected and statistically analyzed to determine any significant relationship between the glycemic markers and complications after surgery.  Statistical methods such as multivariate regression analysis were used to evaluate the data and control for confounding factors.  A p-value of less than 0.05 indicates significant statistical correlation.
Study results showed that pre-operative HbA1c and PPG2 levels were best correlated with development of diabetes related complications after surgery (p<0.001).  Additionally, after controlling for confounding factors, they found that the HbA1c level of 8 or higher (odds ratio = 6.1, 95% confidence interval 1.6-23.4, p=0.008) and FBG of 200 mg/dL or higher (OR=9.2, 95% confidence interval 2.2-38.2, p=0.038) were associated with a superficial surgical site infection.
In conclusion, the findings of this study show that patients with diabetes that are having a total knee arthroplasty, who have a HbA1c level of 8 or higher and/or a fasting blood glucose level of 200 mg/dL or higher developed a superficial surgical site infection
If you have been told that you are in need of a hip or knee replacement or suffer from pain, contact our specialists at Orthopedic Surgery San Diego to undergo an evaluation.

Arthroscopic Acromioplasty

Without thinking about it, we use our shoulders to accomplish many day to day tasks and we know immediately when something is not working correctly. Day to day use and wear and tear of the shoulder can cause pain and tenderness. A common shoulder injury, called subacromial impingement syndrome, can cause severe pain if not treated.
The shoulder is a ball and socket joint which, if functioning properly, moves freely in many directions. The AC joint, or acromioclavicular joint, where the clavicle (collar bone) and shoulder blade meet, is a common area for pain and lowered mobility due to injury or arthritis. The acromion is the part of the shoulder blade that meets the clavicle, and between them is cartilage that allows the bones to move together.  There are four muscles that raise and lower the arm which together are known as the rotator cuff.

The rotator cuff lies under the AC joint, and in between the space is subacromial bursa, which is filled with fluid that lets the shoulder glide in the socket.

When we raise our arm, the space between the rotator cuff and the acromion becomes narrow. If the acromion rubs against the bursa and the tendons in between, it can cause pain and irritation, and loss of mobility.
Sometimes and physiotherapy (PT) and injection of various medications can alleviate the symptoms of subacromial bursitis or rotator cuff tendinitis.  However, at time it becomes necessary to utilize surgical methods to treat this problem.  There are different surgeries used to correct the bursitis: open acromioplasty (OS) or arthroscopic acromioplasty (AS). Open acromioplasty is a procedure that involves a long open cut to the skin through the deltoid muscle to reach the inside of the shoulder. Damaged tissue is removed, part of the acromion is removed, and the shoulder is stitched back together. Arthroscopic acromioplasty is less invasive, uses smaller incisions, and a camera is inserted into the damaged area for assessment. Small tools are then used to correct the damage in the shoulder. Physiotherapy is the use of non-surgical techniques, such as analgesics and exercise to help heal the area. This has been effective in many patients with less severe damage to their shoulder.

A study was done on 87 patients to compare the different types of treatment, both surgical, and non-surgical, to understand the best course of action for those with subacromial impingement. The patients were randomly put into groups based on their treatment and all had comparable demographics. Both the OS and the AS groups had improved at a greater level than the PT group. The OS group had more strength than prior to the surgery, and all groups improved with internal rotation. In general there was no significant differences in the 3 groups, although the patients who had the most invasive surgery, open acromioplasty, versus shoulder arthroscopy, had a greater improvement over time.  These findings are interesting as most dedicated shoulder surgeons do not use open acromioplasty, as the arthroscopic approach uses a minimally invasive technique.
Shoulder pain, tenderness, and swelling is frustrating and limits basic mobility. There have been great strides in sports medicine in the last decade.  Contact our shoulder specialists and seek out the best orthopedists to treat your shoulder pain.

Due to the recent NFL lawsuit surrounding concussions and head injuries, helmets used in other sports are being questioned as to their safety. Lacrosse, a popular and fast growing sport, has relied on helmets to protect their players from head injuries. Recently, two brands of helmets worn by a large percentage of high school, college and professional players, have had their certification voided by the National Operating Committee on Standards for Athletic Equipment.
Due to an alarming 32 deaths reported in 1968 from injuries to the head and neck, Nocsae was created in 1969 to set standards for helmets. The goal was to enforce regulations to make the helmets safer and reduce the number of injuries during contact sports. For years, the standards were acceptable until the recent controversy over head injuries in the NFL. In light over the concerns of concussions and head trauma among football players, helmets that are used in sports are being scrutinized closely, and many of the top name brands are not making the cut.

One sport that uses helmets that are being looked over is lacrosse. While lacrosse may not instantly spring to mind when thinking about rough sports, it actually has some of the highest reported injuries at the high school level and higher, along with basketball and track. Most injuries are in the form of scrapes, cuts, and injuries to the chest arms, and legs, but head injuries can happen, too.

Lacrosse Helmets

Popular lacrosse helmets, the Warrior Regulator and the Cascade Model R, have not met the standards set forth by Nocsae, who also certifies football helmets worn for all levels of play. The helmets had not been tested adequately to see how they hold up in high temperatures.

Both companies were More than 190,000 boys and girls play high school lacrosse in the U.S. and tens of thousands of them have been wearing the voided (but not yet recalled) helmets,

which range from $200.00 to $250.00.  What is more striking is that girls at the junior and collegiate lacrosse levels don’t wear helmets at all.
A study done at Purdue University in 2013 compared 36 lacrosse helmets to 36 football helmets using a drop test. Every football helmet passed, while nine lacrosse helmets failed. The design of the lacrosse helmet, which are pointed, were ineffective for hard blows. Due to these findings, manufacturers are working hard to bring the helmets back to standard. This has caused confusion to those in the sport as to ascertain which helmets are actually, if at all, safe for the players to wear.

Orthopedic and sports medicine specialists often see patients with injuries from playing contact sports. Blows to the head, breaks and sprains, and arthritis later on in life are common for players. If a concussion or break is suspected contact an orthopedist immediately. The best way to prevent lacrosse. injuries is know the game, report any injuries, stay in shape all year, take breaks, and always wear the correct gear.
If you have questions about any sports related injuries, contact our sports medicine specialists at Orthopedic Surgery San Diego.

Total knee replacement

surgery has become one of the most common operations in orthopedic practice.  Knee replacement, also referred to as knee arthroplasty, is used to treat patients with severe knee pain.
One of the issues most commonly seen with surgery is blood loss.  Tranexamic acid (TXA) is a medication that has helped decrease blood loss during hip replacement and knee replacement surgery.  This is a drug called an aprotrinin. TXA can be given topically or intravenously.   Several studies have shown that topical TXA is better than placebo.  However few studies have compared the safety and efficacy between topical TXA and intravenous TXA.  The purpose of this study was to compare the effectiveness and safety of topical vs. intravenous TXA use in patients who underwent total knee replacement with cemented implants.
This was a Phase III, randomized clinical trial performed at one hospital comparing the outcomes of patients who received topical TXA (3 g of TXA in 100 mL of physiological saline solution) with those who received intravenous TXA (2 doses; 15 mg/kg in 100 mL of physiological saline solution, one dose before tourniquet release and another three hours after surgery). The primary outcome was the blood transfusion rate, and the secondary outcomes included visible blood loss at twenty-four hours after surgery and invisible blood loss forty-eight hours after surgery.
Seventy-eight patients were enrolled in this study (39 received topical intra-articular TXA  and 39 received intravenous TXA.  The two groups of patients were similar with regard to demographics and preoperative laboratory values.
Results showed that there were no blood transfusions in either of the two groups.  Drain blood loss at twenty-four hours was 315.6 mL (95% confidence interval [CI], 248.5 to 382.7 mL) in the experimental group and 308.1 mL (95% CI, 247.6 to 368.5 mL) in the control group (p = 0.948, Mann-Whitney). Also, estimated blood loss at forty-eight hours was 1259.0 mL (95% CI, 1115.6 to 1402.3 mL) in the experimental group and 1317.9 mL (95% CI, 1175.4 to 1460.4 mL) in the control group (p = 0.837). No significant safety differences were seen between groups.
In conclusion, the findings of this study showed that topical administration of TXA was equally safe and effective as intravenous TXA. This randomized controlled trial supports the topical intra-articular administration of TXA in primary total knee replacement with cemented implants.
If you have been told you are in need of a hip replacement or knee replacement, contact our orthopedic specialists at Orthopedic Surgery San Diego.

SHOULDER PAIN
The shoulder is made up of three bones:  the humerus, (upper arm) scapula, (shoulder blade) and clavicle (collarbone.)  This combination of muscles and tendons keeps the arm bone fixed in the shoulder socket. The tissues which cover the head of the upper arm bone and attach it to the shoulder blade socket are called the rotator cuff.
Any injury or damage to these muscles, tendons or bones, can result in a lack of mobility and severe pain. The pain could be temporary or it may get worse and require medical diagnosis and treatment.
Some common causes of shoulder pain.
Bursitis. A bursa is a small fluid-filled sac located in joints throughout the body, including the shoulder. They act as cushions between bones and soft tissue, helping to reduce movement friction. Overuse of the shoulder can lead to swelling and inflammation causing other tissues and tendons in the shoulder to become inflamed and painful.
Tendon tears.A tendon tear is usually the result of a serious shoulder injury from a fall or a sporting event. It can also be caused by degenerative tendon changes due to advancing age and long-term overuse, or wear and tear. The tendon is often separated from its attachment to the bone, bringing a great deal of shoulder pain.
Instability. Shoulder instability occurs when the shoulder is dislocated, either partially or completely. A partial dislocation involves the upper arm coming partially out of the socket, while a full dislocation means that the ball comes completely out of the socket. This type of shoulder injury also leads to huge shoulder pain.
Arthritis. The most common kind of arthritis in the shoulder is osteoarthritis, which is related to sports injuries, an injury in the work place or just chronic “wear and tear” resulting in a painful restriction of movement.
Broken bones, such as the collarbone, arm bone or the shoulder blade, which is most often caused by a fall, a contact sports injury, or perhaps a motor vehicle accident. Fractures often result in severe pain and swelling
Treatment protocols for shoulder pain and shoulder problems.
The very first option is a visit to a medical professional to identify the cause of the shoulder problem. The doctor will schedule various specific tests to help identify the cause of the pain or problem before making a diagnosis.
Will I require shoulder surgery?