Return of Football Season Brings Attention to High Injury Rates and Need for Prevention

Post provided by The American Academy of Orthopaedic Surgeons (AAOS)

According to U.S. Consumer Product Safety Commission:

- The 2009 football season saw over 1.2 million football-related injuries
- Such injuries resulted in more than $2.8 billion total medical costs from treatments in hospitals, doctor's offices, and emergency rooms

"Traumatic injuries to the knee and shoulder as well as concussions are the most common types of injuries we see on both the professional and youth levels," said orthopaedic surgeon Matthew Matava, MD, team physician for the St. Louis Rams and spokesperson for the STOP Sports Injuries campaign and the American Academy of Orthopaedic Surgeons. "Overuse injuries, especially in the beginning of the season, are another big issue with kids pushing themselves too far and too fast without proper conditioning."

The STOP Sports Injuries Campaign was launched in the spring of 2010 by a coalition of leading healthcare organizations to expose the growing epidemic of youth sports injuries related to overuse and trauma.

Because most football injuries can be prevented, the American Orthopaedic Society for Sports Medicine and American Academy of Orthopaedic Surgeons encourage the following easy strategies for parents, coaches, and athletes:

- Have a pre-season health and wellness evaluation to determine ability to participate

- Warm-up properly with low-impact exercises like jogging that gradually increase the heart rate

- Consistently incorporate strength training and stretching. A good stretch involves not going beyond the point of resistance and should be held for 10-12 seconds

- Hydrate adequately to maintain health and minimize cramps

- Play multiple positions and/or sports during the off-season to minimize overuse injuries

- Wear properly fitted protective equipment and do not modify equipment

- Cool-down properly to gradually lower heart rate with exercises like light jogging or stretching

- Don't play through the pain. Speak with an orthopedic surgeon who specializes in sports medicine or athletic trainer if you have any concerns about injuries or tips on injury prevention

You Kick Like A Girl

Post provided by the American Academy of Orthopaedic Surgeons.

Significant differences in knee alignment and muscle activation exist between men and women while kicking a soccer ball, according to a study published in the Journal of Bone and Joint Surgery. Data reveals that males activate certain hip and leg muscles more than females during the motion of the instep and side-foot kicks - the most common soccer kicks - which may help explain why female players are more than twice as likely as males to sustain an anterior cruciate ligament (ACL) injury.

Prior research shows that females are more prone to non-contact ACL injuries than males and though many theories exist, a direct cause for the disparity is unknown. "By analyzing the detailed motion of a soccer kick in progress, our goal was to home in on some of the differences between in the sexes and how they may relate to injury risk, " said orthopedic surgeon Robert H. Brophy, MD, study author and assistant professor of orthopedics, Washington University School of Medicine in St. Louis. "This study offers more information to help us better understand the differences between male and female athletes, particularly soccer players."

The study found that male players activate the hip flexors (inside of the hip) in their kicking leg and the hip abductors (outside of the hip) in their supporting leg more than females. "Since females have less activation of the hip abductors, their hips tend to collapse into adduction during the kick, which can increase the load on the knee joint in the supporting leg, and potentially put it at greater risk for injury, " Dr. Brophy said.

In 2008, the Centers for Disease Control and Prevention published a study that found a new training program called the Prevent Injury and Enhance Performance (PEP) program, was effective in reducing ACL injuries in female soccer players. Developed by the Santa Monica Orthopedic and Sports Medicine Research Foundation and supported by the American Academy of Orthopaedic Surgeons among other medical and athletic associations, PEP is an alternative warm up regimen that focuses on stretching, strengthening and improving balance and movements and can be conducted during regular practice time and without special equipment. "Programs focusing on strengthening and recruiting muscles around the hip may be an important part of programs designed to reduce a female athletes' risk of ACL injury, " said Dr. Brophy.

Anterior Cruciate Ligament Tears: An Ounce of Prevention is Worth a Pound of Cure

Post provided by Scott Smith, MD

I saw my first surgical reconstruction of a ruptured ACL in 1981. I began studying ACL's in 1991. I performed my first ACL reconstruction in 1992. Since starting my practice in Austin in 1996 I have performed over 400 primary recontructions. The essential techniques remain basically unchanged. A graft of some sort is strung through the knee to "reconstruct" the anterior cruciate ligament. This process takes roughly six months to form a "new" ligament.

Wouldn't it be easier to just not have an ACL tear? YES! Prevention is worth a pound of cure. Until recently no one really considered that prevention was possible. It may not be. This point is argued in multiple disciplines: orthopedic surgery, physical therapy, sports medicine. No one knows. What is state of the art in 2010 is core training, jump training, hamstring fitness, proprioception improvement and flexibility.

Every orthopedic surgeon knows that anterior cruciate ligaments fail more frequently in female competitors. Why remains a mystery that is discussed wherever knees are contemplated. Do women jump differently? Do they land funny or have too straight a knee at contact? Do hormones play a role? All valid questions without certain answers.

There are many theories and lots of reseach being done. No conclusive findings regarding the difference between men and women have been found yet. There are many prevention strategies also with unproven results. I feel that there probably is some protection provided by these programs. I am also sure that athletic performance is enhanced by improved muscle strength and flexibility. I have been using these techniques with the teams that I coach for the last six years. I can't say that I've prevented any tears but we haven't had any. I continue to look for more effective proven regimens and solutions.

Round Rock Open House & Ribbon Cutting

Thank you to all those who joined us at our Round Rock Open House and Ribbon Cutting. The Round Rock office is located at 2120 North Mays Street, on the IH 35 access road just north of Highway 79. Doctors Scott Smith, Marc DeHart, and Christopher Danney will be seeing patients at this location.

Carpal Tunnel Syndrome, Part 2

Post provided by Robert Foster, MD

In the last post we discussed how CTS is diagnosed and nonsurgical treatment. Part two discusses the surgical treatment for carpal tunnel syndrome.

Surgical carpal tunnel release remains the standard of care for severe carpal tunnel syndrome or when conservative treatment modalities have failed. Unfortunately, there still seems to be a great deal of fear and misinformation surrounding carpal tunnel surgery. Today carpal tunnel surgery can be performed with local anesthesia, with the patient wide awake, eliminating the need for fasting or an I.V. Many patients who have local anesthesia will come to surgery alone and drive themselves to and from the surgery center. For those patients who are still anxious about being alert during surgery, oral and I.V. sedation can still be made available.

Mini-incision carpal tunnel surgery is performed with the patient lying flat on their back with a small tourniquet on their forearm to prevent bleeding during surgery. A small half inch incision is made at the base of the palm and through this incision the transverse carpal tunnel ligament is divided in half, essentially opening the roof of the carpal tunnel and removing the pressure on the median nerve. Once the ligament is divided, the incision is closed with only one or two stitches. The entire procedure usually takes only 10 to 15 minutes. Following surgery, a light, soft dressing is applied, with no splint, and is worn for four to five days. Once the dressing is removed, a simple band-aid can be used to cover the incision to protect the stitches. After surgery patients are encouraged to move their wrist and fingers frequently and use their hand as tolerated. Many patients return to work and normal activities the day after surgery, although a couple of days of rest and light duty are not uncommon. The stitches are removed 10-14 days after surgery and most patients have significant improvement of their symptoms by the time they are seen for the post-op appointment. Once the carpal tunnel is released, recurrence of carpal tunnel syndrome is rare.

Today both surgical and non-surgical treatment of carpal tunnel syndrome is relatively safe and simple. Surgical treatment has a very high rate of success and patient satisfaction with a low rate of complications and risk. Non-surgical treatments, while not a permanent cure, can provide significant relief of symptoms. If you are one of the millions affected with carpal tunnel syndrome, talk to your doctor about your options or get an opinion for a specialist.

Carpal Tunnel Syndrome, Part 1

Post provided by Robert Foster, MD.

In 2009 over one million people sought medical treatment for carpal tunnel syndrome (CTS). It is estimated that carpal tunnel syndrome affects nearly three percent of the population, or over 8 million people in the United States alone. Despite simple and effective treatments, many people continue to needlessly suffer with symptoms of CTS.

Carpal tunnel syndrome is caused from compression of the median nerve as it passes through the carpal tunnel at the wrist. The median nerve is responsible for supplying sensation to the thumb, index finger, middle finger, and part of the ring finger. Compression of the nerve causes slowing of the electrical signal that can result in a multitude of symptoms, such as numbness, tingling, burning, aching, weakness, and radiating discomfort up the arm.

Carpal tunnel syndrome is not caused from working on the computer or repetitive key stroking. In fact, most cases of CTS do not have an exact identifiable cause. However, repetitive motion activities, such as typing on a keyboard, can aggravate carpal tunnel symptoms in those who have it. Conditions frequently associated with or cause an increase risk of carpal tunnel syndrome include pregnancy, obesity, trauma, smoking, diabetes, hypothyroidism, rheumatoid arthritis, and kidney disease.

Treatment of carpal tunnel syndrome can be conservative or surgical. Conservative treatments include splinting, therapy, oral medications, and steroid injections. Splinting and steroid injections are the most common and effective conservative measures. Splinting is effective because it prevents excessive flexion of the wrist, which can increase pressure on the median nerve within the carpal tunnel space. Steriod injections into the carpal tunnel space decrease inflammation and swelling, which relieves pressure on the median nerve and improves blood flow to the nerve tissue. While usually not a permanent cure, steriod injections frequently can improve symptoms for a prolonged period of time and are often used in conjunction with wrist splints. Physical therapy and oral medications are less effective for the long term treatment of carpal tunnel syndrome. Other therapy modalities such as laser therapy, heat therapy, and chiropractic care seem to have less or even no effect.

Adult Repetitive Strain Disorders, Part Two

Post provided by Barbara Bergin, MD

In the last post we discussed what repetitive strain disorders are, why we get them, and what you can do about them. Today's post continues with getting back to what you love after getting better and how to prevent repetitive strain disorders.

Once I get well can I go back to doing things like I was before?

- Probably not. Most people get these disorders because they are somehow anatomically predisposed to getting them, or because they are not put together to participate in certain activities. Frankly, most human beings are not put together to perform certain sports activities on a regular or high intensity basis. Our joints just will not tolerate repetitive strain for extended periods of time. Sometimes it is just a matter of conditioning ourselves to participate; like building up to run or swim long distances. But most of the time we get repetitive strain disorders because we are just wearing out our parts. We must make permanent changes. Again, that can mean minor alterations of the way we do things around the house, but it can also mean changing the way we participate in a sport or even discontinuation of that sport. I'm sorry to say this, but it's true. Most of these repetitive strain disorders occur in people who are 40+. I just don't see them in twenty year olds. If you refer to an earlier post, "Having Peace with Your Pain, " you'll understand a little more about my thoughts on that subject.

- Treating these conditions is kind of like treating hypertension. If your doctor says you have to take an anti-hypertensive medication, do you think you can just take that for a short period of time and your hypertension is cured? Can you stop taking the pill? Will your hypertension come back? Are you ever truly cured of hypertension? No. Occasionally there are people who will make major lifestyle changes and can lower their blood pressure but most people have to continue taking the medications for the rest of their lives. This is the same with most of these repetitive strain disorders. They will come back if you go back to doing things exactly the way you were doing them before. If you make 90% of the modifications permanent, you might be able to continue to enjoying some of the activities which previously caused you pain! You can live with that!

How can I prevent repetitive strain disorders?

- Some of them might be unavoidable, but general principles can always be applied: maintain a healthy weight, exercise in moderation, avoid extremes of high impact and high intensity exercises as you age, and maintain flexibility. It's also important to recognize repetitive strain pain and address it early, either by seeing your orthopedic surgeon (that's me) or your primary care physician, or by making the modifications yourself. It's common for people to try to "work through" the pain, thinking that it's better to work it than rest it. This kind of approach to pain probably stems from the idea that you have to "work through" the conditioning pain of getting into a higher intensity exercise like running. The first time you run a half mile, it hurts; your lungs, your feet, your legs. But as you continue to run and run longer distances, it gets better. This is not the philosophy to take with the pain you experience in a tendon or joint as the result of a certain activity or after that activity. Learn to recognize the difference and address it. Rest it. Ice it. Take Aleve or Advil (if your doctor says it's okay). Then modify it!