Knee injury:  Warm weather brings many of us outdoors; here in San Diego, that can mean year-round soccer, lacrosse, football, gardening, golf, tennis and more. Sadly these same activities are often closely associated with osteoarthritis knee pain, a debilitating symptom which can hit the brakes on an otherwise active lifestyle.

My practice offers a number of remedies for chronic knee pain in San Diego, including some Tips of the latest revolutionary treatments such as Platelet Rich Plasma injections (PRP). Our goal is quite simply to Tips you as a whole person, and to help you avoid knee surgery through gentler, noninvasive techniques.

As one article recently advised:

Don’t wait too long to see a specialist. A doctor who specializes in knee pain can be very helpful in guiding you through all the treatment options, even in the early stages of knee osteoarthritis. The most common specialists for knee osteoarthritis are orthopedic surgeons, pain management, physical medicine and rehabilitation, and rheumatologists.

If you’re suffering from knee pain and want to relieve yourself of this daily struggle, I urge you to contact the knee pain specialists at my San Diego orthopedic surgery offices today.


Most of us who grew up in the 20th century were continually reminded about the importance of “cooling down” after vigorous exercise.  When we exercise, a biochemical reactions takes place that builds up lactic acid in the muscles.  The prevailing theory at that time was that an abrupt stoppage of activity could lead to muscle pain, cramping and soreness, possibly as a result of lactic acid that hasn’t had a chance to disperse.  The muscle soreness is referred to as delayed onset muscle soreness (DOMS).  The idea is that the gentle muscle motion during the cooling down period allows the blood to continue to be pumped through the muscles to wash away and prevent the lactic acid from building up, and thus prevent DOMS.

Now it turns out that advice may have been inaccurate.  As a recent article pointed out, cool downs are not as helpful as we once thought:

The available scientific evidence shows, in fact, little benefit from cooling down as most of us do it, with a prolonged, slow easing of physical effort.

So should we abandon the gradually slowing treadmill altogether? Not necessarily.  There are some smaller benefits to cooling off, especially given the fact that blood vessels can expand in the legs to shunt more oxygen to busy muscles. Halting exercise abruptly can lead to pooling of blood in the extremities (thigh and leg muscle), causing  a sudden drop in blood pressure.  Basically, a gentle cool down can keep you from fainting or getting light headed.

Spending five or ten minutes slowing down is probably no longer a necessary step in your daily routine and probably a waste of valuable exercise time.  A simple two to three minutes should suffice. To learn more about exercise and orthopedic care, contact my San Diego offices today.


Presidents do a lot of walking, from photo ops to those near-daily strolls to Marine One. Now one former president has joined the ranks of hundreds of thousands of Americans who every year undergo knee replacement surgery. George W. Bush recently traveled to Chicago for a procedure that has become extremely common among mature athletes and seniors alike: knee replacement surgery.

The procedure involves customizing and fitting a synthetic high grade metal joint to replace one that may have been ravaged by aging cartilage and damaged bones. Although orthopedic surgeons have refined this procedure over the years, it still remains an option of last resort, especially given the many new and developing techniques to control knee pain.  Although some surgeons have opted to focus their practice on only doing joint replacement, the more deft sports medicine surgeon is able to customize treatment measures to a unique patient’s situation.  The armamentarium of treatment options entails specialized injections (HA and PRP), arthroscopic cartilage restoration procedures (microfracture,  ACI [autologous cartilage implantation], osteochondral allografts), partial joint replacement of various types, and total knee replacement.  It is important that every patient make an educated choice and not rush into things.  Seek a second opinion.  But if you must go forward with knee replacement, it is worth noting that the prognosis has improved drastically:

Ford added that it was not a new injury and that Bush was “up walking around and even went up and down a flight of stairs just a couple hours after the procedure.”

With proper planning by both surgeon and patient, recovery from knee surgery can be optimized and occur quickly.  If you have knee pain and want to learn more about your options, please contact my San Diego orthopedic knee surgery offices today.


Orthopedic shoulder surgery can be an effective remedy for acute injury or for chronic pain and stiffness, but it’s a tool of last resort. Given the time commitment and lengthy recovery period, most patients would much rather try other strategies to avoid time in the OR.

The Web abounds with stories of shoulder pain sufferers who sought pain relief without medical interventions. This latest from the Los Angeles Times does a nice job of covering the full menu of options available to people in most cities. The highlight for me? This quote, which describes the basic problem of postures and inactivity that have become a national epidemic:

“What we are doing today does not support our eons of evolution,” said Heath Reed, a licensed massage and yoga therapist who practices in Phoenix. “There is no way our biology can keep up with technology. The lack of movement at all is our first problem. The secondary problem is our dysfunctional movement.”

I encourage you to read the full piece for a nicely balanced discussion of various interventions such as massage, exercise, physical therapy and Rolfing. Some additional tools to consider include Alexander technique and Feldenkrais.  And when you’d like to get checked out by an expert San Diego orthopedic surgeon, contact my offices today.


One of my main responsibilities as an orthopedic surgeon is to listen carefully when patients tell me about their pain. Sports medicine is largely defined by pain – shoulder pain, knee pain , elbow pain and more. People whose everyday activities have been curtailed by crippling pain are often desperate for solutions; understanding precisely where and how the pain arises is the first step toward a solid diagnosis. Once we have the diagnosis in hand, step two is to explore some reasonable ways we can draw down the pain and increase movement and mobility. I remain bullish about the many nonsurgical techniques that can help patients diminish the anguish of knee and shoulder pain. This article covers a few tips you should know. Money quote:

A recent publication in the Journal of Arthritis & Rheumatology reported that one out of every two people will suffer from arthritic knee pain at some point in their lives, but the good news was that they also determined some very specific exercises that target a particular muscle group were the most significant factor in a reducing knee pain .

If you’ve been looking for low-impact and highly effective ways to reduce knee pain on your own, I strongly recommend you clip and save these exercises. Extensions and lifts may seem simple, but their effects can be long-lasting indeed. Want to learn more about the best ways to relieve knee pain ? Please contact my San Diego orthopedic knee surgery offices today.


Frequent readers know that I write often about the latest advances in stretching and exercise, especially if they have shown promise in helping patients avoid orthopedic surgery. Good warm-ups, smart stretches and better athletic form can often be just as effective as more aggressive surgical procedures.

Now a new article has highlighted an age-old technique for treating curvature of the spine, and it is reviving the debate over whether “bracing” is the best treatment for an S-shaped spine. Known as the Schroth Method, the original customized approach involves stretching and breathing, and extends into everyday life:

The therapy, tailored to each patient’s curves, focuses on halting curve progression, reducing pain, and improving posture, strength and lung function. The exercises include stretching, strengthening and breathing techniques that counteract the rotation of spinal curvatures. Patients are supposed to do them at home and incorporate postural corrections into their daily lives.

Now a randomized study has been performed comparing the Schroth Method to more conventional techniques, and the results were noteworthy:

At the University of Alberta in Canada, researchers recently completed a randomized pilot study of Schroth, financed in part by the research society. The six-month study showed that adolescents with scoliosis who did these exercises fared better than teenagers who didn’t with regard to curve progression, pain and self-image.

This is just one step toward a better way to contain the progressive effects of scoliosis, but it could represent greater changes to come. If you’d like to learn more about the latest news and advances in orthopedic surgery, contact my San Diego offices today.


Calcific tendinits is an extraordinarily painful shoulder condition that deposits calcium crystals into the rotator cuff tendons.  This leads to subacromial bursitis.  A recent study was performed to determine whether shoulder pain from calcific tendinits could be relieved without surgery, through a technique known as shock wave therapy.

Tufts Medical Center researchers reviewed 28 clinical trials evaluating the efficacy of the therapy, which can be performed in a doctor’s office, and found that it was effective for a specific form of the condition where calcifications were present on an imaging scan of the tendons. The researchers also found that high-energy shock therapy worked better than the low-energy method, according to the results published Monday in the Annals of Internal Medicine.

This is a preliminary finding, but one which could eventually change the lives of many patients who suffer with the abiding agony of rotator cuff pain caused by calcific tendinits. Although the FDA has yet to approve shock wave therapy for this purpose, further trials are already in the works.  Currently shock wave therapy is used to treat achilles tendinitis and plantar fasciitis.

In the meantime, contact your San Diego orthopedic surgeon to learn more about the best options available today.


Knee injuries are not only a ‘pain in the knee’.  It gets in the way of maintaining an active lifestyle.  I often tell my patients that the best way to avoid knee surgery is to practice good preventive habits – stretch well, warm up right, and limit direct impacts at both work and at play.

But injuries have a tendency to happen without warning, laying waste even to the best-laid plans. A knee injury can cause damage to the meniscus, cartilage, or ligaments of the knee.  Some recently published research has shown that the trauma leading an ACL tear causes damage to the cartilage that only manifests itself decades later.

The term “recovery time” has something of a fluid definition in orthopedic surgery. Typically it describes the wait time before a patient can resume his or her normal life, but it does not speak to the lingering aftereffects which may be more subtle, and which in the case of knee surgery can be far more extensive:

Famous athletes such as quarterback Tom Brady and alpine skier Lindsey Vonn have come back after ACL surgery, so how bad can it be? The truth is that surgery can restore knee function, but it does little to diminish the risk of arthritis 15 to 20 years down the line. Regardless of whether an athlete has surgery, the risk of arthritis skyrockets later in life from an ACL tear. Kids who tear their ACL today are often left with 60-year-old knees when they’re 30.

My San Diego orthopedic knee surgery practice takes care to minimize pain and accelerate healing with a number of cutting edge technologies. If you’d like to learn more, please contact me here today.


It is ACL (anterior cruciate ligament) week here at the San Diego orthopedic surgery blog.  ACL tear is a knee injury which can be devastating to an athlete.  it is certainly a season ender.

A recent newsletter I published on treatment options for knee arthritis prompted several patients to ask me to comment on various types of knee injury.   At the core of many questions were inquiries into how to avoid an ACL tear.  As it happens, the Web is rife with generic exercises, but few resources are available for parents and athletes who want to know what to avoid on the gridiron, court, or field once the sporting action has commenced.

ACL tears occur when the ligament that stabilizes the knee is torn or ruptured; this knee injury is typically due to a sudden stop or change in direction. The knee injury is extraordinarily common in sports such as soccer, football, field hockey, gymnastics, and skiing to name a few.  Women will find themselves in particular peril with this knee injury.  But simply changing direction won’t do it; ACL tears arise within a particular kind of stop. Understanding its mechanics is the key:

These injuries often happen when the legs get into a position called “dynamic knee valgus.” That’s when you come to a stop or quickly change position with your knee straight and turned inward, with your foot behind. It’s a common position as players maneuver around a field or court, or in a gymnast’s routine.

Cutting inward for a basketball crossover, slaloming hard on skis, or switching fields abruptly in soccer can all lead to a torn ACL. Sometimes concomitant meniscus tears or cartilage injuries can occur.  Although you don’t want to surrender a competitive edge by abandoning such maneuvers from your agility armamentarium, a little foresight  into ‘prehab’ can go a long way toward helping you discover some safer ways to shift your weight and avoid devastating knee injuries.

To learn more about knee maintenance and knee surgery options in San Diego, please contact my offices today.


The world of orthopedic surgery in Southern California is full of fascinating stories. Although the Southland is widely considered America’s cosmetic surgery capital, it isn’t widely known that the surgeons of San Diego and its neighbors also tend perform a number of other elective surgeries.

This news story caught the eye of many of you: a piece in the New York Times about a trend to improve the aesthetic and structural beauty of patients’ feet. One cannot make up some of the extraordinary branding terms that lard the article from top to bottom, including such gems as “toebesity” and “Cinderella procedure.” The purpose of these procedures is to fulfill a timeless desire; one doctor calls them:

“the final frontier” for those who have had work done on their faces. “My practice has exploded because of Manolo Blahnik, Christian Louboutin and Nicholas Kirkwood,” he said in a recent phone interview. “There’s nothing like opening a shoe closet that’s been closed to somebody for years.”

Suffice it to say, your foot is a complex mechanical structure that must bear and redirect hundreds of pounds every minute. Altering the basic geometry or stability of a foot to fit into a pair of shoes is a dangerous game. Far better to find ways you can achieve the look you want without altering an essentially functional body part.

As an orthopedic surgeon, I can say with confidence: Those feet were made for walking.

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