“Orthopedic Injuries”

Confused about the new research on calcium and preventing osteoporosis?

IMG_0159I came into the ED the other evening and could hear a new patient being moved into the stretcher by the ambulance staff, and even the most subtle movements caused her to cry out in pain.  She was in her 90s and had tons of spunk (her comment of “well, if you’re old enough to be a doctor, then I’m the pope!” clued me into that), but had just stepped “badly” when getting out of her chair, twisted her leg, and broken her hip.  She had such bad osteoporosis that it took only a minor trauma to cause a fracture, and now she was in immense pain.  She wasn’t alone–the lady next door had so many compression fractures in her spine from osteoporosis that her neck curved at a 90 degree angle to her back, and she was in constant pain.

So, while I know that osteoporosis may <seem> like a long way off for many of you, I want you to take steps to prevent it as much as possible.

Maybe you’ve been hearing about a new report saying that Calcium and Vitamin D were NOT effective for osteoporosis and hip fractures (read the USPTF report here)? If you were confused, I was too, especially with the recent WHI report recommending them) so I went to the source. Here are my conclusions and what I plan to do:

  • Premenopausal women and men below 70: The USPTF study did NOT say anything about this population, which is definitely confusing from what the news outlets were saying.  Calcium and vitamin D are really the only things that we have to prevent osteoporosis.  Remember, it’s MUCH better to get it from your diet than from pills, so aim for that first.  Me? I’m drinking my milk, eating my leafy greens, and taking a supplement every day.  ALSO, your bones are in their peak growth BEFORE the age of 30, so anyone with young daughters–the greatest impact you can have is when they’re young! 
    • Stick to 1000mg Calcium + 400-800 iU Vitamin D daily.
  • Post-menopausal women and men over 70 : The USPTF saw no benefit, but the WHI did show some benefit in people who had been taking these supplements for over 5 years (sorry, still waiting for that miracle pill!) There was a small increased incidence in kidney stones, so people with kidney stones already definitely should talk to their doctor before taking these.
    • Stick to 1200mg Calcium and 800-1000 IU Vitamin D.  
    • Of course, always check with your own doctor for your own condition and before starting or changing supplements.

Part 2: 911 FASHION Emergency–Killer Heels

**So, here’s part 2 of keeping your tootsies comfy and you looking amazing.  You can read part 1 at http://drdarria.wordpress.com/2012/09/14/552/ to find out about how to buy the best heel.  Now, read below for how to wear them, and what to do when you’re not in them.

Happy heel-wearing!!!

WEARING:

(6) I am a HUGE fan of inserts.  Dr Scholls makes some great ones, for all kinds of heels.  They keep your foot in the right place (thus avoiding the slip forward and toe smoosh in a high heel), give some support, and they will make your feet so much happier. 🙂

(7) Make friends with your cobbler.  The sole of many high heels is smooth–aka, very slippery.   As soon as I get a new pair of heels, I take them to my friendly, lovely cobbler. He puts a strong rubber sole on the bottom (here, it’s CRUCIAL that you go to a good cobbler–you don’t want your new pair of dainty pumps to come back with a combat boot sole–you want the reinforced sole to be the same color as the old one, and be flush, so no one could ever tell), giving the shoe a good grip, more cushion, and a longer lifespan than a slick leather sole alone.

(8) Know that sometimes, you just grow apart: It’s a sad fact, that as we age, our feet continue to grow (what?!?).  Due to periosteal bone growth (umm…aren’t there other places where growth would be nicer??), your shoes from college (or whatever is 10-20 years ago) may just be too small.  The upside? Not only do you have an excuse to go shoe-shopping, you can call it MEDICAL NECESSITY!

TAKING THEM OFF

(8) Dont be monogamous (at least not with your shoes): It’s well-known in orthopedics that repetitive stress on any one part of the body is a bad thing, leading to stress fractures, callouses, and tendonitis.  So, swap up your shoes, mixing in different heights/angles and toe shapes.

(9)Sometimes, you just need “space”: As soon as you take off your heels, give your Achilles and calves a good stretch, as high heels can shorten your Achilles tendon or give you tendonitis (click on the link here or here).  Also, prevent (or treat it if you’re having symptoms) plantar fasciitis by stretching out the bottom of your feet –try rolling a tennis ball back and forth under each foot for 2-3 minutes.

Women at HIGHER Risk for Sports Injuries

We constantly hear news about professional athlete injuries–but did you know that the group at most risk for many sports injuries is…Women?

It’s true–women are eight times more likely than men to tear their ACL, as well as to develop stress fractures and a host of other knee pain syndromes.  Due to a number of factors, from Estrogen acting on our ACL too (really?!?! Yep), to imbalance from weaker muscles and wider hips, we have to be proactive to prevent ourselves from getting these injuries.

For this episode, I interviewed Dr Elizabeth Matzkin: an orthopedic surgeon, Chief of the Women’s Sports Medicine Program at Brigham and Women’s Hospital, and team physician for the US Women’s Soccer Team.  Below the videos, you’ll find links  for Dr Matzkin and the Women’s Sports Medicine Program, as well as an exercise protocol to follow to keep your knees strong and healthy for life!

Three Things to Remember (for more details, watch the videos)

  1. Look out for the “Female Athlete Triad” in yourself or other women in your family, to address it early
  2. Build up your bones! Take Calcium and Vitamin D supplements and do weight-bearing exercises—ESPECIALLY before the age of 30!
    • How much? 9-18 years old, take 1300mg/day, 19-50 years, take 1000 mg per day, and after 50, take 1200mg per day
    • Also take 200-600 IU of Vitamin D daily–it helps your body absorb the calcium
  3. Strengthen imbalanced or weak muscles by doing the specific strength and stretching exercises we mentioned in the video and protocol linked below

Contact Information (click on the links)

Knee Strengthening Protocol to Prevent Injuries: Knee Strengthening Protocol

Athletic Injuries or Arthritis? How to Prevent and Treat them–and When You Need a Doctor

Has the warm weather pulled you outside for rounds of golf, tennis, or just a good run? So much that maybe you couldn’t walk or lift your arm above your head the next day? I’m guilty of this too–I wrote a couple of weeks ago about my own knee injury (which was mainly a result of my not doing the strengthening exercises that I was supposed to do).  So, I brought in the best for this week’s show–Dr Thomas Gill is an orthopedic surgeon, the Chief of Massachusetts General Hospital’s Sports Division,  team doctor of the Boston Bruins, and medical director for the New England Patriots.  (Yes, he’s the one that you’ve seen on ESPN running onto the field when an athlete is down).

Well, this week he took off time from them (really…he did…it was in the middle of the hockey playoffs) to talk about the injuries that burden us non-professional athletes.  Watch the demo segment at the end to learn the top 5 exercises to strengthen your shoulders and knees, and to keep rotator cuff injuries and torn ACLs or other knee injuries OUT of the picture!

For more information on where to find Dr Gill, as well as the specific strengthening and stretching protocols from the MGH Division of Sports Medicine (which is what I followed after I injured my knee), check out the links below today’s videos.

MGH Strengthening/Stretching and Rehab Protocols:

Fourteen Exercises to Prevent and Heal Knee Pain

I’m sorry for the belated post this week! We just started filming for the “OnCall with Dr Darria” tv show, and I was waiting to post that—but as it’s still in the studio, it will be next week’s post. Stay tuned!

For this week, I thought I’d post on something that’s been troubling me, too—knee pain.   I had been modifying my running stride, and in the process  developed a frustrating knee pain.  While being married to an orthopedic surgeon meant I did not get TOO much sympathy (I had, after all, ignored his advice to do knee strengthening exercises for some time), it did mean that I was able to get great information on both knee rehab exercises as well as strengthening ones to PREVENT knee pain, and I wanted to share them with you.

Fascinating Facts about your knee: There’s a reason why knee pain is so common—we demand a lot from it! Just with walking, your knee carries a force equal to 1.8 times your body weight with each step (hence, you can see the multiplier effect of why being overweight leads directly to knee pain).  When you’re climbing up stairs, it carries 3.5 times, and going down stairs, 5 times your body weight.  If you’re running, the force can exceed 10-12 times your body weight, or easily over 1000 pounds.

Also, did you know that the friction between joints in your knee is one-fifth that of ice sliding against ice?? Wouldn’t that be trouble for driving… but it means that any irritation to the surface of the knee joint increases the friction and causes symptoms.

Seven Exercises to PREVENT Knee Pain (avoid if you are currently having pain) –these are especially important for women, as we tend to have weaker muscles around our knee, making us more prone to some injuries.

You can find more details and a video at Massachusetts General Hospital’s Sports Medicine website, including instructional videos

Perform these 2-3 times per week (3 sets of 10-15), after warming up (more information at MGH Sports Medicine protocols)

  1. Leg Press
  2. Hamstring curl
  3. Knee extension machine
  4. Wall slides (hold dumbells for resistance)
  5. Chair Squat: sit in a firm, armless chair with your feet flat. Slowly stand up, using controlled movement. Stand upright for a second or two, the slowly sit down. Repeat for 1 minute.  If this is to difficult at first (or you find you need to use your arms), instead put a firm cushion on the chair.  Be careful: when you are going either up or down, don’t let your knees bend forward beyond your toes
  6. Calf raises
  7. Hip Abductor and Adductor machine

If you already have knee pain: A very common type of knee pain includes a condition known as “Patellofemoral Syndrome” in which your kneecap (patella) and the femur (thigh bone that makes the upper part of the knee) become injured/inflamed lead to pain.  It occurs most commonly in women, largely because we are more likely to have weak/imbalanced strength in areas of our thighs, thus making our knees more prone to instability and pain.  Symptoms include pain in the front of the knee that gets worse with going up and down stairs, if you’ve been sitting for a long period with your knees bent, or by doing deep knee bends. Also, you may notice a grinding or popping when the knee straightens.   For more information on this, you can go to the MGH Sports Medicine Patellofemoral Syndrome Protocol, which I’ve summarized below (and yes, started doing myself).  Of course, before you begin this or any exercise program, you should speak to your doctor to determine if you have this or a different type of knee injury.

Seven Exercises to Treat Patellofemoral Syndrome (daily):

*Avoid: going up and down stairs and hills, deep knee bends, kneeling, high-impact or step aerobics, or squats, lunges, stair-stepper machines, or  knee extension machines.  They also advise that you NOT wear high-heeled shoes (well, I didn’t say that I followed ALL of the instructions perfectly….)

  1. Straight leg lift: Resting back on your elbows, raise your entire affected leg off of the floor.  Now, it’s important that BEFORE you raise your leg, you first tighten your quadricep muscle, THEN lift the leg, fully extended.  Hold at 45 degrees for 1 second, then lower, relax your muscle, and repeat 20 times
  2. Short Arc Lift: place rolled towel under knee, lift foot until knee fully extended, hold for 5 seconds, then slowly lower, repeat 20 times 
  3. Wall Slides: place back and buttocks against a wall, feet 12 inches apart, 6 inches from wall.  Slowly lower hips and slide down wall until knees are flexed 45 degrees.  Pause 5 seconds, slowly slide up, and repeat 3 sets of 10-15 times.  Do NOT do if you have worsening knee pain or if there is crunching/popping in your knee
  4. Hamstring Stretch 
  5. Quadriceps Stretch 
  6. Calf Stretch 
  7. Lateral Hip and Thigh Stretch: cross your left leg in front of your right.  Lean to the left, letting your right hip jut out to the side.  Hold for 15 seconds when you feel a gentle stretch 

I want to hear from you–if you’re having knee pain and find these exercises helpful, drop me a line and let me know how you’re doing!