Sunday, February 21, 2016

What To Do About Your Torn Meniscus...

A torn mensicus is one of the most common problems we see in the office.  Once you have a the diagnosis of a torn meniscus, what does that mean?  The meniscus doesn't heal on its own but that doesn't mean that you have to have surgery.  Sometimes meniscal tears can be managed without surgery.  When they do need to be addressed surgically, most frequently this means removing the torn piece, much like clipping off a hangnail.  In the ideal situation (young, healthy patient with the perfect tear) the meniscus can be repaired.  This is only about 10-15% of the time.  Follow this link from the American Orthopedic Society of Sports Medicine to see how arthroscopic meniscal surgery happens.
Meniscus Tear

Saturday, January 16, 2016

Preventing Throwing Injuries

Truck Day is less than a month away.  For those of you non-Seam Heads, Truck Day is the distinctly New England holiday were Red Sox fans cheer the departure of the equipment truck as it leaves Fenway Park, heading to Spring Training.  With this in mind, it is about time to start thinking about preventing throwing and baseball/softball injuries.  We will be holding another thrower’s clinic toward the end of February, but until then here are some thoughts on injuries to throwers, and how to decrease your chances of missing games…

GIRD, Glenohumeral Internal Roation Defecit is one of the natural adaptations to throwing that occurs in the shoulder.

I once read that pitching is “... an injury in progress.”  The mechanics and repetitive nature of pitching cause such unnatural  forces through the arm that the body can’t help but attempt to adapt.  One of the adaptations that occurs is that the muscles in the back of the shoulder get stronger and tighter.  The Infraspinatus and Teres Minor muscles are important stabilizers in the shoulder and are engaged as a pitcher cocks their arm in preparation for the throw.  As a season progresses, the posterior muscles become stronger and tighter than the anterior muscles.  This uneven distrubution of strength causes the posterior muscles to act as a teather, forcing the shoulder joint to shift forward.  It also prevent the shoulder from being able to approriately internally rotate.  The forward shift of the ball in the socket causes wearing of the labrum and tendonitis of the biceps and the other rotator cuff tendon.  Ultimately, this can lead to shoulder pain, decrease velocity or control, altered mechanics and elbow issues.  This adaptation is very predictable but also very treatable.  With a little guidance from a physical therapist, trainer or strength and conditioning coach, pitchers can incorporate the “Sleeper stretch” and rotator cuff exercises to achieve better balance in the shoulder.


Saturday, December 26, 2015

How Do We Repair the Rotator Cuff?

Rotator cuff tears are a very common problem in the older, active population.  If you are like most people, you know someone that has been through shoulder surgery to repair the torn tendons but do you know how it was done?  Check out this animation from the American Orthopedic Society of Sports Medicine that explains the principles behind repairing a rotator cuff tear.

Diagram of the shoulder, including the rotator cuff

Monday, December 14, 2015

A Body in Motion...

Newton's First Law:

"When viewed in an inertial reference frame, an object either remains at rest or continues to move at a constant velocity, unless acted upon by an external force."

While Sir Isacc Newton was describing inanimate objects, this law is also true of humans and more topically, joints. With age and stress, the joints of our body break down. This process is often referred to as the Osteoarthritis, or more generically Arthritis. As joints become painful and inflamed, we move them less and they get stiffer. Along with the joints getting stiffer, the muscles weaken from disuse. The tendons become unhealthy and fragile and the ligaments tighten our joints even further. All of these processes conspire to "remain at rest". One of the mainstays of initial treatment for arthritis is physical therapy. The goal is to stem the tide of these degenerative processes with the hope of keeping us moving at a "constant velocity". While physical therapy is wonderful, it is not for everybody. There can be an expensive co-pay, the therapist's hours may not fit your life and the frequently traditional approach to disease and the human body may not fit your personality. Fortunately, there are alternatives! In a recent national meeting of the American College of Rheumatology, a series of studies were presented demonstrating the benefits of Tai Chi.

In a nicely done study, they found that a twice a week session with Tai Chi instruction was at least as good, if not better for patients with Osteoarthritis of the knees. It should be no surprise that a low impact exercise regimen that focuses on balance and strength, and includes life affirming meditation would be useful for people with knee arthritis. It has been demonstrated in the past to be useful in preventing hip fractures when use regularly in the elderly population. From these results, one could easily extrapolate that the practice of Tai Chi, or something similar would be good for people with arthritis of really any joint within the body.

There are many ways to say it: "Motion is Lotion", "People are like sharks, if they don't move, they die.", "Move it or Lose it!". The basic notion is the same, do what Newton recommends and stay in motion.

Sunday, November 1, 2015

How Safe is Artificial Turf?

There is a well intentioned women's soccer coach from the University of Washington who has brought up the possibility that the new generation of artificial turf is causing cancer in young athletes.  The first generations of artificial turf (AstroTurf) were thought to cause too many injuries in the athletes.  These surfaces were painful to play on and brought on a host of new injuries (rug burn, turf toe, etc...).  Enter the new generation of artificial turf, a combination of subsurface of stone and recycled rubber covered by artifical blades of grass and an in-fill of crumb rubber made from old tires.  These new surfaces decrease landfill use by re-using old tires.  They significantly decrease the use of water and fertilizer.  They decrease the maintenance costs.  But are they safe?  Athletes will spend countless hours sliding, diving and rolling around on these fields.  They will come home with black rubber granules embedded in their elbows, knees and shins.  They will end up with them in their ears, nose and mouth.  Along with Coach Griffin, there are a number of watchdog groups that have continued to advocate for young athletes by questioning if chemicals released by the re-purposed rubber is causing cancer.

The publicity was bad enough that a principal of a Maine elementary school wrote to the company that installed the Rubercycle surface at her school.  The school was searching for data to make an informed decision on weather to remove the existing playground surface.  The response she received was not from the company but from a Toxicologist from MIT and an environmental risk assessment firm.  Attached is her thorough and thoughtful review of the current research, leading her to the conclusion:
"... I have examined the relevant evidence, and have found that rubber mulch is neither known nor reasonably expected to cause cancer, and is otherwise safe for use in playgrounds. I know of no reason that this mulch should be removed from the playground at Jonesport Elementary School."

This response was fairly convincing and consistent with any scientific evidence that I have read. If you want more information on the subject, the Synthetic Turf Council summarizes a number of the recent research efforts.

Wednesday, October 7, 2015

Readers Choice Award

We are excited to announce that our orthopedic group has been chosen for the Gazette Readers Choice award.  Congratulations and thank you to all of the staff and doctors that have helped us take care of so many people.  Keep up the great work!