Free Joint Replacement Seminar this Thursday

Learn more about non-surgical arthritis treatment options as well as total hip and total knee replacement surgery at Arthritis Camp! Refreshments are served. Bring your friends and family!

Date: Thursday, May 5th
Time: 5 PM to 7 PM
Location: Northwest Austin, 4700 Seton Center Pkwy, Ste. 200, Austin, TX 78759

Please RSVP by registering online or call 439-1100.

This FREE informative seminar is held the first Thursday of every month so if you can't make it this Thursday, plan to attend our next seminar on June 2nd!

Tips for Fitness Goals

You went out to the local court over the weekend and played a few of your best pickup games ever. Now it is Monday, and your shins are stiff and painful, your back is aching, and your knees are starting to swell. If this scenario sounds familiar, then you have experienced what I call an “under fit” injury. I do not like to call them overuse injuries because that implies you should not use the muscles. “Under-fit” means you were not prepared for whatever activity you engaged in. You played three games of basketball instead of one. Basketball is an excellent sport for overall conditioning. It offers intense aerobic workout while strengthening muscles throughout the body. But it can also cause finger and ankle injuries, sprains, tendinitis, back spasms, and knee problems. Here are some tips on how to get the gain without the pain.

• Know your body’s limits. “Do not go out and try to ride like Lance Armstrong unless you have been training for a decade,” says Dr. Smith. “Gradually build up to your goal level. That might take six to 12 months, depending on your age.”

• Resist being a weekend warrior. Exercise some during the week as well, even if it is just a brisk, 30-minute walk. “The problem is we are episodic exercisers,” says Dr. Smith. “We tend to ping-pong back and forth between activity and inactivity rather than having a baseline.”

• Warm up. Begin with low-intensity aerobic activity before getting into the heat of the game. Stretching, however, is only recommended after playing. Stretching beforehand can actually make muscles weaker by fatiguing them.

• Use the right gear. Make sure shoes fit properly and offer the right support. If you have had wrist, knee, or ankle injuries before, it might be helpful to wear a brace. If you do feel you have overdone it, remember the acronym RICE — rest, ice, compression, and elevation. If pain persists, increases significantly with activity, or causes swelling, limping, or limited range of motion, see a physician immediately.

Your Fitness Threshold: The Key to Injury Prevention

Post provided by Scott Smith, MD

Many patients come to the doctor with aches and pains that “started out of nowhere” apparently without an injury. They have experienced a stress to their system that was above some undefined threshold and resulted in an injury.

Everyone has heard the term overuse. I don’t like it because it implies that there is something wrong with using our bodies. Our bodies are built to be used. I prefer to think more in terms of underfitness, meaning that the activity performed was above the fitness threshold resulting in damage to some part of the musculoskeletal system. In every case there are two options. One option would be to stop or limit the activity performed. This is not only no fun it’s unhealthy. The second option is raise the fitness threshold such that it is never surpassed and no injuries are incurred. This would be great except that it is unlikely that anyone can obtain and more importantly maintain their perfect maximum fitness level. Therefore it is inevitable that we all will have some aches even if we have a high fitness threshold.

These aches should be very mild, short lived and self limited. In fact most will resolve if the body is allowed to repair itself. Daily or at the very least weekly physical activities to “stress” your system will strengthen it. As the fitness level increases so will the amount of activity required to cause pain.

The inertia of being out of shape makes it extremely difficult to make any significant commitment to exercise. By exceeding our threshold in our first few workouts we become sore or even painful where we can no longer perform. This stops us in our tracks physically not to mention what it does to our mental outlook. The next re-initiation of a workout program is more difficult and less likely to succeed. A more gradual approach is much more effective. This allows the body to repair the “damage” from a work out and stepwise progress toward healthy fitness is made. If significant soreness is present don’t stop workouts just decrease intensity and persists at a lower level. Then make slower progress as the discomfort subsides. If problems persist seek professional help.

Specialists Who Treat Back & Neck Pain

There are many types of health practitioners that care for patients with spinal conditions, and each has a slightly different role. Selection of the most appropriate type of health professional—or team of health professionals—largely depends on the patient’s symptoms and the length of time the symptoms have been present.

There are three broad groups of health providers who treat back pain:

Primary care providers are often the first port of call for patients when back pain strikes:
Primary care physicians (Family practice doctors, Internists, Pediatricians)

Chiropractors

Doctors of osteopathy

Spine specialists have a specific area of expertise in diagnoses and/or treatments for back pain:
Spine
Physiatrist
Surgeons (Orthopedic surgeons and Neurosurgeons)

Anesthesiologists

Neurologists

Rheumatologists

Therapists for back pain or psychological help for chronic pain:

Physical therapists

Clinical psychologists

A Physiatrist is a Medical Doctor who specializes in Physical Medicine and Rehabilitation (PM&R). Essentially, physiatrists are nerve, muscle, and bone experts who treat injuries or illnesses that affect how you move.

Physiatrists diagnose and treat both acute and chronic pain and musculoskeletal disorders. They can order and interpret all types of spine imaging (x-ray, CT myelogram, MRI, bone scan) and perform specialized nerve tests (EMG and NCS) to help assess the location and severity of nerve damage. Typical treatments may include:

o Referral to Physical Therapy (e.g. exercise, stretching, heat/ice, TENS units)
o Prescription medications
o Electromyographic studies
o Interventional procedures (e.g. epidurals, joint injections)

Physiatrists treat a wide range of problems from sore shoulders to spinal cord injuries. Their goal is to decrease pain and enhance performance without surgery. Physiatrists take the time needed to accurately pinpoint the source of an ailment. They then design a treatment plan that can be carried out by the patients themselves or with the help of a team. This medical team might include other physicians and health professionals, such as neurologists, orthopedic surgeons, and physical therapists. By providing an appropriate treatment plan, physiatrists help patients stay as active as possible at any age. Their broad medical expertise allows them to treat disabling conditions throughout a person’s lifetime.

Texas Orthopedics has two physiatrist, Dr. Kenneth Bunch and Dr. Ai Mukai, that work closely with our orthopedic surgeons to provide comprehensive musculoskeletal care.

Back Pain

Post provided by Ai Mukai, MD

What can cause back pain?

There are many structures in the back area that can cause pain. Some of those structures are:
• Muscle – muscle strain and sprain – usually achy, may have spasms
• Disc – usually sudden pain, can pinch nerve, twisting and bending makes it worse
• Bone – fracture of the back bone or smaller bony structure in back – usually constant, may be sharp or achy
• Ligament – strain or sprain, usually worse with movement
• Nerve – pinched nerve – can shoot pain to one side or another, feels like burning, shooting, tingling pain
• Joint – sacroiliac joint – near the base of spine and buttock area, worse with transitional movements like sit to stand
• Joint – facet joints – “knuckles” of the back, pain with bending backward or twisting.
• Coccyx – tailbone pain- worse with prolonged sitting, feels achy and inflamed

How do you figure out what is causing the pain?

X-rays can show broken bones or alignment issues. MRI is usually needed if soft tissue injury or cause is suspected like disks, pinched nerves, and ligaments. Information about how the symptom started, what it feels like, what makes it better or worse and physical examination can help narrow down the possibilities. Sometimes, there are multiple causes for the pain and one pain can cause another. Lab work can diagnose issues that may be preventing you from healing or causing more widespread pain and inflammation.

What are some possible treatment options?

Physical therapy is the key to improving alignment, taking pressure off areas of pain, and preventing future injuries. For the spine, McKenzie method and looking at the stabilizing the pelvis seems to give the best long term results. To help with the symptom relief of pain, different types of medications aimed at the different causes of pain (nerve pain medicine, muscle relaxers, anti-inflammatories) can be taken short term while undergoing physical therapy. For more severe pain or long term issues, non-surgical procedures such as injections into joints, epidural space (space where discs and nerves live), and muscles may help. There are more specialized procedures geared towards specific structures like radiofrequency ablation (burn the small nerves that supply joints) and spinal cord stimulators. Sometimes, the procedure can help diagnose the cause of the pain. Lastly, if all options fail, or there is something that needs to be addressed surgically, spine surgery is an option.

Texas Orthopedics Physical Therapist qualifies for Boston Marathon

Amber Anderson, PT ran in the Austin Marathon with a final time of 3:39:56 placing 19th in her age group and 525 overall out of 4,796 finishers for the full marathon.

This was Amber's first full marathon! Congratulations Amber!

The Squat Debate

Post provided by Barbara Bergin, MD

There were many negative comments regarding my “Do No Squats” blog. I wasn’t surprised because the exercise industry is very invested in that exercise form. One has only to read a copy of SHAPE magazine and see that about every 10 pages has a product to assist in doing squats or a program using squats as its staple exercise.

Squats are an efficient way to strengthen the quads and gluteal muscles. Because they are the largest muscle masses in the body, exercising them results in more sweating, caloric expenditure and a great burn.

But I honestly do believe that the world would be a better place without the squat as a form of exercise. I see patients in my office 3 full days a week and every week I will estimate that I see 4 people a day, therefore 12 people a week with injury related to doing squats, deep knee bends or lunges. If you extrapolate that number, minus a few weeks for vacation then you have about 600 people a year! I’ve been doing this for over a quarter of a century so I would say I’ve probably seen 15,000 patients with disease related to doing squats. Most of them are women but many are men. All ages are affected.

I cannot think of another single activity which so consistently sends people to my office with complaints of pain in one specific place (the knee). There are other issues which are frequently associated with orthopedic problems. Motorcycles, for example, consistently injure people in an unfortunately predictable way, and obesity, which is associated with all sorts of lower extremity and bodily disease. I will also someday blog away on those two subjects as well. But right now, I’m addressing squats again because that blog made a lot of people very angry.

Sure, squats can be done without caution by some people. Some healthy people. Who defines a “healthy person” before the deed is done. One could also say that healthy people can eat all the sugar they want or drink all the alcohol they want. But who preemptively defines a healthy person? Define the healthy knee before a person starts a squatting program. Who knows what a healthy knee alignment is…before the fact? Does that person have any patellar malalignment? Do they have chondromalacia patella already? Do they have a meniscus weakened by former injury, age or genetics?

There are people who can probably do squats with abandon. Men are more likely to be able to do them without issue than women. Young men better than older men. A person with no existing crunching or grinding under their knee cap would be better at them! A thin person more so than a heavy person. These are very general categories and if a person came to me to ask if they could start a squatting program, I might be able to make a generalized prediction, but I could never give the recommendation because there would be liability for me in that recommendation.

If one has to squat for a living, then one should be conditioned to squatting. But I have seen many plumbers, electricians, welders and computer repair specialists who must discontinue that line of work because of patellofemoral disease related to their squatting job description. And as for the comment regarding the need to strengthen the muscles in order to be able to get off and on the toilet…well, most of us have been adequately conditioning those muscles since we got out of diapers.

But if one doesn’t have to squat to put food on the table, then one should proceed with a squatting exercise program with caution. Be aware of the presence of pain during and AFTER the exercises. Be aware of the development of crunching under the kneecap and swelling of the knee. Make sure you follow good instruction with regard to the positioning of your hip, knee, ankle and foot, and the depth of the squat.

One comment suggested that doctors bug off with the prevention and stick to curing disease once it has manifested itself. Most doctors practice prevention every bit as much as the curing of disease and it’s the purpose of my blog. I want this information to go out to the public for the purpose of prevention as well as cure.

In blogging about a controversial issue there is always the possibility that what I say might cause some readers to seek advice elsewhere. That’s a risk I must take. If more business was what doctors were all about, we would encourage squatting, motorcycle riding and overeating.