knee pain Archives - Page 2 of 3 - Orthopedic Surgery San Diego

06/Aug/2014

One of the most common sports related injuries is a torn ACL (Anterior Cruciate Ligament). Many people think that ACL injuries happen mostly in contact sports but the truth is that a majority of ACL injuries occur without contact. One example of a non-contact ACL injury was during a recent major league baseball game. Los Angeles Dodgers pitcher Paul Maholm ran to cover first base on a relatively routine ground ball. Maholm arrived at first, planted the toes of his right foot on the edge of the bag and then went down riving in pain and reaching for his right knee. After watching the replay about a dozen times it is still hard to say that anything even truly happened. However, within a day it was confirmed that Maholm had a complete ACL tear. A simple misstep and his whole season is over.

The ACL is one of four major ligaments that help to align and stabilize the knee. The knee is the point at which thighbone (femur), shinbone (tibia), and kneecap (patella) meet. The ACL attaches the center of the kneecap to the front of the shinbone. The function of the ACL is to assure proper alignment of the shinbone and thighbone. In addition, the ACL provides very important rotational stability. Like many other ligament injuries, ACL injuries can be diagnosed by severity. Grade 1 ACL sprains are considered mild and involve the ACL being stretched but not detached. With grade 1 ACL sprains, the ACL is still capable of stabilizing the knee joint. Grade 2 ACL sprains are moderate or partial tears and occurs when the ACL is stretched to the point of becoming loose. Grade 3 ACL sprains are the most severe of the ACL injuries. Grade 3 ACL sprains occur when the ACL is completely torn into two separate pieces making the knee joint very unstable.

Grade 1 and some grade 2 ACL sprains can often be treated without surgery as long as instability symptoms are at a minimum. The process of healing involves a heavy regimen of progressive physical therapy but can often restore the ACL close to its pre-injury form. For a more severe tear or what is called a ‘complete tear’, surgical reconstruction is the only way to achieve pre-injury form if there are symptoms of instability. Instability is when the knee gives away or buckles. The ACL is replaced using a tendon graft typically from the patient’s patellar tendon, hamstring tendon, quadriceps tendon, or from various cadaver tendons. The success rate of ACL replacement is tremendous and many athletes come back after surgery and rehabilitation to perform similar to their pre-injury performance. One such example of this was Minnesota Vikings running back Adrian Peterson. Peterson nearly broke the NFL rushing record just one year after suffering a complete tear of his ACL and MCL.

As for the case of Paul Maholm, his surgery has not yet been scheduled, but should be scheduled soon. Given the recent success of professional athletes on surgically replaced ACLs, I have no doubt that we will see Paul Maholm on the mound for the start of the 2015 season.

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06/Aug/2014

Some people wonder what happened to the Tennessee Titans RB Chris Johnson (CJ2K)Did you know that CJ2K played a majority of the season on a torn meniscus last year? Yup, it’s true, since week 3 on the NFL season, CJ2K played on a meniscus tear. If his silver-plated teeth weren’t a dead give away, then playing on a symptomatic torn meniscus does Mr. Johnson is the real deal…he is as tough as they come.

To understand toughness that it would take to play on a torn meniscus, you must first understand the meniscus itself. The meniscus is essentially a wedge of cartilage in your knee. This tough and rubbery meniscus acts as a shock absorber between the femur and the tibia. In layman’s terms, the meniscus is a cushion between the thighbone and the leg bone. An intact meniscus is essential for proper cushioning and stability. When the meniscus is torn, there will be significant pain and swelling. It can cause a sharp searing pain that will bring you to your knees…literally. It can cause instability which can lead an athlete to fall. One of the worst feelings when dealing with a torn meniscus is the feeling you get when you place the brunt of your weight on that knee. It almost instantaneously does one of two things, locks up or gives out. Now imagine running for 1,000 yards and 6 touchdowns against an NFL defense on one of those bad boys. Gives you a new respect for CJ2K, doesn’t it?

There are two real ways to treat a torn meniscus and neither of them involves continuing to use your knee the way that Chris Johnson did. Non-surgical treatment involves the age-old acronym RICE. Rest, ice, compression, and elevation. This is pretty standard protocol for any inflammatory process. Measures like these can work for what is called a “degenerative tear”. Much of the scientific studies today talking about how arthroscopies aren’t helpful are targeting treatment of degenerative tears. However, acute meniscal tears that occurs in relatively younger athletes usually happens as a result of a twisting or pivoting maneuver. The tears usually require an arthroscopy for symptom relief. Knee arthroscopy is one of the most common orthopedic procedures involves the use of miniature cameras and surgical instruments to repair and/or clean away the tear. After a successful surgery comes a tremendous amount of rehabilitation. Rarely, meniscus tears are actually repairable. This is a special kind of tear that can actually be repaired. We can use platelet rich plasma (PRP) clots to augment the healing. The rehabilitation process for repairs takes longer but is well worth it. After a meniscus repair, the athlete will need a month on crutches followed by range of motion and strength exercises. The total rehabilitation time is approximately 3 to 4 months.

So what does this all mean for our 2009 fantasy football MVP, Chris Johnson? He had a successful meniscus repair surgery at the end of January and was completely rehabilitated by training camp. He gets a change of scenery as he heads to the run-happy New York Jets. To expect another 2,000-yard season would be foolish, but to think that he will bounce back to be the back we all thought he was, is not completely out the realm of possibilities

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01/Aug/2014

Like Santa, bones know when you’ve been sleeping, and they know when you’re awake. They know when you’ve behaved or misbehaved. They know when you’ve been exercising–so go out and walk! In all seriousness, bones are aware of what is happening in your body (not Skynet aware, but more like The Sixth Sense aware). What’s truly amazing is that the bones adjust accordingly, based on your exercise routine. When you exercise, your bones help retain minerals and will be there like a good friend supporting you through your activities into maturity. If you do not exercise, your bones stop caring about minerals and will hang out on the couch with you eating potato chips. Your bones do as you do, not as you say.

What Exercises Help the Bones?

Impact activities are the most successful at strengthening the bones. Sports like soccer, track, volleyball and other sports that require a significant amount of running and jumping will give the best results. Weight-lifting is also useful when used in conjunction with other impact activities. All of the fun stuff you used to do around the neighborhood as a kid: tag, football, racing, jump rope, and toilet papering the neighbor’s house at night (after all, one must jump to get the proper paper placement in the tree) are great for strengthening the bones.

“I’m Too Old to Play Those Games!”

No, you’re not. It is never too late to get your body up and moving. It may sound counterproductive, but even if you have problems such as osteoporosis or weak bones, it is better for your body to stay mobile rather than stay at rest. Luckily, the older you are, the less impact you need to do to strengthen your bones. In fact, a brisk walk a few times a week can be all you need to start getting stronger. You can become stronger still by throwing in a hip shake and a side step while you’re walking. This type of movement can also help prevent falls in the elderly.

Shake It Up

If walking briskly while thrusting out the glutei seems daunting, there are other ways to help strengthen bones. While not for everyone, there are vibrating platforms one can use to build bone. According to Dr. Keith DeOrio, your entire skeletal structure is affected by vibration platforms and “Your muscle spindles fire secondary to the mechanical stimulation produced by the vibrating plate, and this rapid firing of the muscle spindle causes a neuromuscular response that leads to physiological changes in your brain as well as your entire body.”

The studies on the vibration platforms are few for now, but there have been no downsides to using it. People 65 and older seem to benefit from just 12 minutes a day a few times a week. It is even suggested that doing squats while standing on the platform can increase speed and agility. While helpful, be mindful that it isn’t such a significant amount you will be begged to participate in the summer Olympics, but chances are your bones and body will feel better and stronger.

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28/Jun/2014

Knee injury while at rest. Seemingly contradictory. It has long been suspected that an active life and daily movement represent good ways to reduce your likelihood of getting arthritis. Now some researchers have finally looked at the numbers to see if this popular notion withstood statistical scrutiny. Their conclusion?

When they analyzed the step data from the pedometers, they found a strong link between participants’ activity level and knee health. Their results suggest 6,000 steps marks an important threshold: 70% of participants who developed knee impairments walked less than this amount while 70% of those who remained healthy walked more.

Using nothing more advanced than off-the-shelf fitness trackers, these researchers were able to study and control for a variety of factors in a population of about 2,000 people. Sure enough, the more active participants seemed considerably less likely to develop knee pain and other symptoms associated with this progressive disorder. From a scientific standpoint, this makes sense. Cartilage and the locomotion machine (i.e., body) function better when the ‘engine’ is kept warm. Not turned off and allowed to collect dust; and not when the engine is ‘revved’ too high, wherein the parts fall into disrepair. For example, the fascinating thing about cartilage is that cartilage requires, as a part of its normal maintenance, it’s use (such as with walking) to deliver the nutrients from the joint fluid into the cartilage structure. It’s use actually prolongs it’s longevity!

Of course a cohort study like this cannot officially separate causation from correlation; it is possible, for instance, that people who walk fewer steps do so because they already have bad knees. Yet this study remains a tantalizing clue in support of the idea that sedentary lives can be injurious lives, and that we would all do better to move around more during our active years.

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10/Jun/2014

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.

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29/May/2014

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.

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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.

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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.

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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.

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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.

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CLASSIC LIST

The common cold of sports injuries-torn ACL

Meniscus repair surgery revitalizes a career… maybe?

Exercise to Strengthen Bones

Walking to prevent osteoarthritis

Tips for knee pain in san diego

Smart exercises for knee pain

The link between milk and arthritis pain

Walking vs. elliptical exercise for joint pain

Don’t Feel Like Exercising? Blame Your Genes

Want to Reduce Knee Pain? Try Diet and PRP injections

How Acupuncture Can Help With Fibromyalgia Pain

ACL Reconstruction Surgery in San Diego

Fibromyalgia and Chiropractic

Physical Therapy and Fibromyalgia

Fibromyalgia – More than Just Aches and Pains

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