Sports medicine authorities warn that failing to get enough exercise and adequate nutrition can result in obesity. That leads to an array of health problems, from knee and shoulder pain to heart disease. According to a recent study, obesity damages the heart even for people who show no symptoms.
Health experts have long understood that diabetes, high blood pressure and high cholesterol often cause cardiovascular disease. Now, according to Health Day News, there is evidence that overweight people who have not been diagnosed with any of those conditions may still suffer heart damage.
“Obesity is a well-known ‘accomplice’ in the development of heart disease, but our findings suggest it may be a solo player that drives heart failure independently of other risk factors that are often found among those with excess weight,” said the lead investigator, Dr. Chiadi Ndumele, an assistant professor at the Johns Hopkins Center for the Prevention of Heart Disease.
The study, published in The Journal of the American College of Cardiology, involved more than 9,500 volunteers between the ages of 53 and 75 in four states. None of them had heart disease. Researchers tracked them for 12 years, during which 869 of the study participants sustained heart failure. “Severely obese” people were found to have more than double the risk of developing heart failure. The more weight gained, the greater the danger.
While obesity was shown to increase the likelihood of heart-muscle damage, the impairment in many cases produced no symptoms. Left untreated, the damage can result in heart failure, the inability of the organ to pump blood properly.
“The direct relationship we found between obesity and subclinical heart damage is quite potent and truly concerning from a public health standpoint, given the growing number of obese people in the United States and worldwide,” Ndumele said in a news release.
Dr. Roger Blumenthal, director of Hopkins’ Ciccarone Center for the Prevention of Heart Disease, also was quoted in the release. He said:
“These results are a wake-up call that obesity may further fuel the growing rate of heart failure, and clinicians who care for obese people should not be lulled into a false sense of security by the absence of traditional risk factors, such as high cholesterol, diabetes and hypertension. Obese people, even when free of cardiovascular symptoms, should be monitored for the earliest signs of heart failure and counseled on ways to improve their lifestyle habits.”
According to the National Institutes of Health, heart disease is the leading cause of death in the United States. For some people, it results in disability. The risk increases as a person ages, with most cases being reported in men older than 45 and women over 55. It is a hereditary disease, so those who have a close family member diagnosed with heart problems at an early age are at greater risk.
On its website, the NIH recommends the following prevention measures:
– “Know your blood pressure and keep it under control;
– “Exercise regularly;
– “Don’t smoke;
– “Get tested for diabetes and if you have it, keep it under control;
– “Know your cholesterol and triglyceride levels, and keep them under control;
– “Eat a lot of fruits and vegetables”; and
– “Maintain a healthy weight.”
If you are overweight and experiencing pain in your shoulders, knees or other joints, it is important to start getting proper nutrition and regular exercise. Schedule an appointment for an evaluation by the nationally renowned sports medicine surgeons at Orthopedic Surgery San Diego to learn about what else you can do to lower your risk of heart disease.


From shoulder pain to knee pain: this new technique for using stem cells to help patients cope with knee pain is garnering attention even before the results are in. The procedure is something of a hybrid, combining hyaluronic acid (HA) with concentrated stem cells to promote healing and “seed” the creation of new cartilage:

Patients who undergo the Abicus operation have the cartilage cut and tidied and undergo microfracture, but their cartilage tissue is then coated with a substance made up of bone marrow cells, platelet gel and hyaluronic acid.

During the 30-minute procedure, the bone marrow sample is spun in a centrifuge in the operating theatre to give a concentrated amount of the patient’s own stem cells.

These cells are then mixed with the gel and acid to create a “glue” substance which is placed over the cartilage defect and allowed to set.

If clinical trials show a clear benefit, it will represent yet another advance in our treatment of knee pain, and a new avenue forward for orthopedic knee surgeons who are always on the lookout for the latest innovations in patient care.

If you have chronic knee pain and want to avoid a more invasive knee replacement procedure, I urge you to contact my San Diego knee surgery offices today.


Greek epic The Iliad by Homer

If you are familiar with the Greek epicThe Iliad by Homer, you may know the story of Achilles. Achilles was the most powerful warrior in all of Greece. He is virtually undefeatable, if not for one small weakness, what is now known as the Achilles tendon. Potentially an equally powerful modern day warrior is Robert Mathis, defensive end of the Indianapolis Colt. Robert Mathis is one of the all-time greats. He is currently the number twenty on the all-time sack leaderboard and was one of the youngest players to ever reach the 100-sack mark. Unfortunately, like Homer’s Achilles, Mathis also has a weakness.

The Achilles tendon connects the heel bone to the calf muscle and it happens to be one of the longest tendons in the body. This tendon is actually somewhat vulnerable to injury, especially in athletics.  It can be injured from overuse and overstretching. When an injury occurs there is often a popping or snapping sound. There is swelling, pain, and inability to push off and walk. The onset of pain can often be sudden and excruciating.


A torn Achilles tendon often requires surgery. The orthopedic surgeon makes an incision in the lower leg and sews the ruptured tendon back together.  Once the surgery has been completed successfully, the healing process can begin. This process usually takes about four to six months. The first step of rehabilitation is immobilization and requires the individual to where a cast, brace, splint, or walking boot for about six to eight weeks. After immobilization, the individual can begin the process of strengthening. This includes the use of range-of-motion, strength, and balance exercises. Typically you would start with range-of-motion exercises of the leg and as the tendon heals you can begin working in range-of-motion exercises of the ankle, as well as strength and balance exercises. Crutches or a walking boot should be continuously used to protect the healing process. It is possible to recover from an Achilles tear without surgery; however this is only recommended for those who are less active as there is a greater chance of re-injury if treated non-surgically. The process of healing and rehabilitation is essentially the same whether the surgical or non-surgical approach is utilized.


While these injuries can often times be completely unanticipated, there are precautionary measures that can be taken to reduce the risk of injury. It is very important to properly warm up your leg muscles with dynamic exercises such as jumps, lunges, knee-lifts, and jumping jacks. In addition if you are at risk of injury to the Achilles you should spend plenty of your exercise regimen on strengthening your calf muscles. Remember, the Achilles tendon connects the calf muscle to the heel bone and the best way to prevent an injury to a tendon is to have strong supporting muscles.

The Achilles tendon connects t

Robert Mathis has been in league 10 years and a ruptured Achilles at this point in his career could be a devastating blow to his career. However, Robert Mathis has proven time and time again to be one of the toughest football players there is. He has personally vowed to return from this injury and you can color me a believer.

If you have been experience foot discomfort or ankle pain, contact our renowned sports medicine specialists at Orthopedic Surgery San Diego for an evaluation.


The Collegiate Scare:


Knee pain  felt by the  La Jolla tennis player or San Diego soccer player is no different than the pain felt by  collegiate athletes.

The athletes that are fortunate enough to make it to the professional level require a number of things: Physical gifts, talent, mental toughness, work ethic, and sometimes most importantly, luck. There have been many college athletes who were destined for greatness but had that destiny changed after a devastating injury. Navy’s star quarterback Keenan Reynolds can breathe a sigh of relief as he nearly completely dodged the injury bug. Last week Keenan Reynolds led his Navy team to victory over Temple, but with a serious scare as he took a helmet directly to the side of his knee. His knee twisted and from the looks of it the injury had the potential to be serious. As it turns out, his injury was just a simple knee contusion, or in layman’s terms a knee bruise.


 Knee contusion

Knee contusions are typically due to direct contact to the knee. In the case of Keenan Reynolds, this was a helmet to the knee, but for others this could be due to the knee hitting the ground during a fall. Symptoms of a knee contusion involve pain, tenderness, swelling, and bruising on the surface of the skin. The actual bruising on the surface of the skin is caused by damage to blood vessels in the knee.

A knee contusion generally does not require any additional medical attention. However, similar symptoms can exist in more severe injuries such as ligament damage and muscle damage, so if you fear that the injury is severe, please visit your family physician or your osteopathic doctor.

Treatment for a knee contusion is pretty standard and utilizes the RICE method: Rest, ice, compress, and elevate. It is important to rest the injured knee to prevent ongoing strain and worsening of symptoms. You should apply ice for 10-20 minutes at a time, each hour. You can slowly reduce the frequency you ice it as the symptoms regress. Utilize an elastic bandage for compression and be sure to keep the leg elevated as much as possible. The RICE method is a good way to reduce the pain, swelling, and inflammation associated with the bruised knee. If the symptoms persist for more than a few days for a minor contusion it is best to get checked out to eliminate any confounding problems such as ligament damage or damage to the muscles that surround the knee. For severe contusions, the symptoms can last weeks, but if managed properly there should be a noticeable improvement during that period.


Thankfully, Navy quarterback Keenan Reynolds dodged a bullet, walking away relatively unscathed after taking a helmet to his knee. If he follows the treatment guideline of rest, ice, elevation, and compression, there is a very good chance we will see the star quarterback on the field this weekend against Western Kentucky.




Whether a recreational competitor or the very best soccer player, athletes participating in cutting sports are vulnerable to knee injuries that are a result of ligament tears.

Within just a two-week period the NFL has witnessed one of its premier veteran running backs and one of the best young rookies both go down with knee injuries. First it was San Diego Chargers running back Ryan Mathews who went down last week and now this week Pittsburgh Steelers rookie linebacker Ryan Shazier joined him. Both players left their respective games early and did not return. Later the teams released reports that the injury sustained was a sprained MCL (medial collateral ligament).

femur-mcl-sprainsThe knee is made up of bones and ligaments that work together to support the knee and its range of motion. These bones are the thighbone (femur), the shinbone (tibia), and the kneecap (patella). These bones are joined together by ligaments. The collateral ligaments connect the femur to the tibia and fibula (which is a smaller bone in the lower leg). The MCL is the collateral ligament toward the inside of the knee, i.e., the one that is closest to your opposite knee. This ligament connects the femur to the tibia. As expected from the anatomy, the collateral ligaments act to support and control any sideways movements of the knee.


Injury to the MCL is typically sustained via direct contact to the outside of the knee. If the contact is forceful enough the MCL will stretch beyond its means and may become sprained to varying degrees. The severity of the sprain is diagnosed into three different grades. Grade I sprain is very minimal and while the MCL has been stretched abnormally, there is no structural damage to the knee. Grade II sprains are a bit more severe and involve the MCL actually becoming loose due to excessive stretching. Grade III sprains a very severe and involve a complete tear of the MCL into two separate pieces. Even a grade I sprain will cause some discomfort, pain, and swelling on the inner knee. The more severe sprains will cause feelings of instability as well.


Luckily for Ryan Mathews and Ryan Shazier, MCL injuries rarely require surgery. The only time that surgery would be required is if the MCL is so severely damaged that it cannot heal itself or if the injury is compounded by additional ligament tears in the knee. The non-surgical road to MCL recovery involves a combination of ice, immobilization, and physical therapy. Icing the knee helps to reduce the swelling associated with the injury. Preventing the knee from sideways movement via a brace and crutches prevents the ligament from enduring further stress and gives it the opportunity to completely heal. Lastly, exercises designed to strengthen supporting leg muscles should be used to regain strength and stability. Once the rehabilitation, a return to activity should be completed gradually to avoid any re-injury or aggravation. For Ryan Shazier and Ryan Mathews the timeline for their return is approximately 4-5 weeks. This is prototypical timeline for a Grade II MCL sprain and as long as they do not rush back too early, they should be good to go come mid-season.

Contact our top ranked orthopedists at San Diego Orthopedic Surgery Clinic for an appointment today.



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


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