I have written before about the many ways our body’s natural substances can aid and expedite recovery via injection. Platelet-rich plasma is just one of the revolutionary advances in knee pain management that has earned attention in recent years, for instance, while stem cell therapies continue to gain momentum.

This recent video from the Boston Globe highlights one such approach; dubbed Regenics, it is a proprietary stem cell treatment designed to ease the inflammation and distress of shoulder injury, and promote faster healing:

I am proud to report that my San Diego orthopedic surgery practice remains at the forefront of innovative procedures in pain management and shoulder surgery. If you’d like to learn more about the best options to restore natural mobility and function, please contact the orthopedic shoulder surgery experts today.


Much has been said about whether running has net beneficial or detrimental effects on an athlete.  The cardiovascular upside on overall health is clear cut.  But what about all that trauma that a runner’s knees must endure with each step slamming into the pavement?

Protecting your knees and back while running is a battle that must be fought on several simultaneous fronts.  Simple strategies such as proper shoe maintenance and alternating exercise regimens are simple ways to avoid foot and ankle injuries that are commonly seen in runners.  When it comes to the knees and low back, a well-conceived functional strengthening program can help avoid injury.  The concept is very similar to what any recreational athlete feels at the end of a long day skiing.  Most injuries in skiing tend to occur at the end of the day when our muscles are fatigued and less apt to allow us to recover from some perturbation/fall.  Basically, tired muscles have difficulty protecting us from injury when compared to muscles that are better conditioned.  The core muscles are at the ‘core’ of injury prevention with respect to the knee and low back.  The core muscles help to shock-absorb and avoid injuries to the adjacent joints.

This list offers a nice starting point for strengthening.  It features some simple exercises to keep your core, back, hips and shoulders in reasonably loose and powerful form.

Still suffering from knee pain, hip pain, back pain or shoulder pain? Visit my San Diego orthopedic surgery practice to learn more about how you can achieve lasting health without losing a step.


Knee surgery is a common solution to intractable orthopedic disorders such as ACL tears, meniscus tears and isolated cartilage injuries. Yet despite the fact that such procedures have good success rates, there remains a small but stubborn percentage of patients who experience lingering discomfort even after their projected recovery time has elapsed.

This is especially common in total knee replacement surgeries, which involve equipment designed to exist permanently in this highly trafficked joint. Now orthopedic surgery specialists are refining the tools used to map and fit these medical devices to your body’s natural contours:

Careful fitting and expert aftercare are essential to ensure your knee surgery procedure works as well as you need it to. To learn more about how to get started with some of the most advanced surgical techniques in Southern California, please contact the San Diego orthopedic knee surgery experts today.


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.


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.


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.


Many patients come to my San Diego orthopedic surgery practice with injuries they have recently read or heard about. One question that often follows is why particular sports are more likely to give rise to certain injuries. Baseball, for instance, seems to spawn a high number of shoulder and elbow injuries; basketball produces many back injuries; and of course the NFL is the home of the concussion.

The immediate answer is self-apparent, of course: Different sports require different movements. Of the three big American sports, however, baseball is unique in that there are few direct collisions with other bodies. (This squeaker of a World Series ending notwithstanding.) As a result, baseball remains an excellent source of study on the ways we can injure ourselves through repetition alone.

Injuries endemic to baseball tend to involve the muscles of the arm, neck and shoulder. This is because of the simple reason that much of the sport involves swinging, throwing and extending. Recently I came across this ESPN page which provides an outstanding overview of why these injuries arise so often. My favorite quote covers the preponderance of elbow injuries among pitchers:

The injury label can be as generic as elbow tendinitis, which simply means inflammation of some tendon around the elbow. For throwers, the most commonly affected tendons are those located on the medial or inner aspect of the elbow. It is here that the tendons of the wrist flexors (which bend the wrist down toward the ground) and the forearm pronators (which rotate the forearm from a palm-up to a palm-down position) attach, hence the term flexor-pronator group. The flexor-pronator muscles provide protection to the elbow joint by countering the torque produced during pitching, so lingering problems here can put the elbow at risk.

Of course you don’t have to be a pitcher to acquire an elbow injury such as lateral or medial epicondylitis, or even cubital tunnel syndrome. The wisest course of action for any stress injury is rest and recovery. But when the body is unable to heal itself adequately from an injury, sometimes the body needs a little extra help in the form of medication, bracing, or soft tissue manipulation techniques. On occasion elbow surgery performed by an expert orthopedic surgeon is necessary to achieve maximal recovery and return to your activity of interest.


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.


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.


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.

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