Category Archives: Exercise and Health

Hamstring Injuries

Young women sport has thigh muscles injury ,Health conceptDr. Stickney, a Kirkland orthopedic surgeon, is an expert in sports medicinehamstring injuriesexercise and health, and more.

Hamstring injuries are a common, and often frustratingly persistent, source of limitation for both elite athletes and weekend warriors. These injuries can involve either the muscle belly or the tendinous attachment of the muscle to bone. The hamstring is one of the longest muscle bellies in the body as it stretches from the pelvis to the tibia spanning the hip and the knee. Hamstring tears, knee muscle tears and related injuries make up nearly 30% of all lower extremity muscle tendon injuries. These injuries are commonly sustained while running particularly with running uphill. They are very common in soccer, football and all sports associated with acceleration or kicking. Hamstring injuries also are common in weightlifting, skating, or water-skiing. This can be the result of a rapid uncontrolled Hip Flexion with knee extension. If the injury is associated with a loud pop that often signifies a tendon avulsion. In that case, the tendon has pulled off of bone. On the other hand, if there is acute muscular tearing pain followed by bruising and a palpable defect in the muscle, this typically signifies an intermuscular tear. Injuries that do not adequately heal or get adequate therapy can result in scar tissue which is prone to reinjure.  Hamstring injuries have a very high rate of recurrence as a result.

    The hamstring muscles in the posterior thigh, as well as the quadriceps muscle in the anterior thigh, work in concert during running jumping, acceleration, and deceleration. A muscular balance between these 2 muscles as well as flexibility of both muscles is crucial to preventing injuries. Core muscle development and hip muscle strengthening can also help prevent hamstring injuries. Hamstring injuries more commonly occur during eccentric contraction. Eccentric contraction means the muscle is firing but at the same time it is lengthening. During running the quadriceps extends the knee as your foot reaches forward near the end of that extension the hamstring slows down the extension while the foot is still moving forward just before impact. This is an eccentric contraction of the hamstring and this is the phase of running most commonly associated with hamstring injuries. These are typically intermuscular injuries. These commonly lead to bleeding into the muscle and then the development of scar tissue in the muscle which is less flexible than muscle, and more vulnerable to tearing in the future. As a result, an athlete with a hamstring injury has a 25% rate of recurrence of hamstring injury in the following season despite rehabilitation.

     A very good study was done in professional soccer players to try and prevent initial hamstring injuries and to prevent recurrence of hamstring injuries. The results of that study is the Nordic hamstring exercise protocol. In professional athletes, this protocol led to an 80% reduction in primary hamstring injuries and a 65% reduction in recurrent injuries. The Nordic protocol is a progressive strengthening of the hamstrings through eccentric loading. This protocol is best visualized on a YouTube video.

     Once a hamstring injury occurs it is very important to establish whether or not the tendon has pulled off bone or if it is an intermuscular injury. If the tendon has pulled off bone it is important to repair it in the early period after injury. On the other hand, most intermuscular injuries require rest, elevation, icing, compression (RICE) and then range of motion with deep massage. There have been a few studies to suggest that injection of platelet rich plasma with growth factors can enhance healing.  And some other studies suggested injection of steroids may decrease the likelihood of developing scar tissue. The time to recovery is largely dependent on the location and extent of injury. Most minor hamstring injuries can be treated with physical therapy and return to sport in approximately 6-12 weeks. It is very important to regain full flexibility and equal strength before returning to competitive sports to prevent future recurrent injuries.

Less Pain, Less Opioid Use After Total Knee Arthroplasty

Senior man on his mountain bike outdoorsDr. Stickney, a Kirkland orthopedic surgeon, is a knee expert specializing in new knee surgery procedures, total knee replacementsports medicine, and more.

Managing postsurgical pain after total knee arthroplasty (TKA) is critical to successful surgical outcomes including patient recovery, rehabilitation and overall satisfaction. Local infiltration analgesia (LIA) with anesthetic agents is shown to improve pain and reduce morphine consumption. It also shortens the length of hospital stays compared with using peripheral nerve blocks, which can hinder mobility. A randomized control PILLAR study conducted by Michael A. Mont, M.D., Walter B. Beaver, M.D., Stanley H. Dysart, M.D., John W. Barrington, M.D., and Daniel J. Gaizo, M.D. took a closer look at the efficacy of LIA with Liposomal Bupivacaine (LB) in improving patient pain scores and reducing opioid use after TKA.

Here, the study team compared the effects of LIA with or without LB on pain scores, opioid consumption including opioid-free patients, time to first opioid rescue, and safety after primary unilateral total knee arthroplasty.

The study involved 140 TKA patients randomized to LIA with LB to 266mg/20mL (admixed with bupivacaine HCI %0.5, 20mL) or LIA with Bupivacaine HCI %0.5, 20mL. Standardized infiltration techniques and standardized multimodal pain protocol were used. Co-primary efficacy endpoints were the area under the curve (AUC) visual analog scale pain intensity scores 12-48 hours post-surgery, and total opioid consumption 0-48 hours post-surgery.

Findings were notable. AUC 12-48 post-surgical visual analog pain intensity scores were 180.8 with LB, and 209.3 without the use of LB. Total opioid consumption 0-48 hours post-surgery was 18.7mg with and 84.9 without LB. Significant differences favoring LB were observed for the percentage of opioid-free patients (p<.01) and time to first opioid rescue (P=.0230).  In the TKA setting, LIA with LB administered with optimal techniques significantly improved post-surgical pain, opioid use and time to first opioid rescue, with more opioid free patients and no unexpected safety concerns.

My past TKA patients will tell you the SwiftPath protocols I utilize are well aligned to this study. With a reduction in (or no) opioids after TKA, less post-operative pain and overall patient satisfaction, the use of LIA with LB is well-supported.

If you are a total knee arthroplasty candidate and want to learn more about treatments such as LIA with LB, please contact our office. We’ll help you return to your healthy, pain-free lifestyle.

Can Activity Trackers Assist with Recovery After Knee or Hip Arthroplasty?

activitytrackerCommercial wrist-worn activity monitors, like those by Fitbit, the Apple Watch or Garmin, have the potential to accurately assess activity levels and have been gaining popularity in the last few years. In a 2018 study published in The Journal of Arthroplasty, researchers set out to determine if feedback from activity monitors can improve activity levels after total hip arthroplasty or total knee arthroplasty.

To conduct this study, 163 people undergoing primary total knee arthroplasty or total hip arthroplasty were randomized into two groups. Subjects in the study received an activity tracker with the step display obscured two weeks before surgery and completed patient-reported outcome measures. On the day after surgery, participants were randomized into either the “feedback group” or the “no feedback group”. The feedback group was able to view their daily step count and was given a daily step goal. Those in the no feedback group wore the device with the display obscured for two weeks after surgery and did not receive a formal step goal, but were also able to see their daily step count after those two weeks were up.

Average steps taken by both groups were monitored at one, two, and six weeks, and again at six months. At six months after surgery, subjects repeated their patient-reported outcome measures.

It turns out that the feedback group subjects had a significantly higher average daily step count by 43% in week one, 33% in week two, 21% in week six, and 17% at six months, compared to the no feedback group. Additionally, the feedback group subjects were 1.7 times more likely to achieve an average of 7,000 steps per day than the no feedback group subjects at six weeks after surgery. Six weeks after surgery, the feedback group participants were back to their pre-op activity levels (100%) and at six months, they were actually stepping more (137%). While 83% of the no feedback group participants reported they were satisfied with the results of the surgery, 90% of the feedback groups reported the same.

With mobility and physical activity being imperative to healthy aging and very helpful for recovery after total hip arthroplasty or total knee arthroplasty, incorporating an activity monitor into your post-operative rehabilitation is a great idea for health and exercise motivation.

Dr. Stickney, a Kirkland orthopedic surgeon, is an expert in total knee arthroplasty, total hip arthroplasty, exercise and health, and more. Contact Dr. Stickney to return to your healthy, pain-free lifestyle.

Home Exercise vs. Outpatient Physical Therapy Following Total Knee Arthroplasty

at-home-exerciseDr. Jeff Stickney, a Kirkland orthopedic surgeon, can help you determine whether outpatient physical therapy or home exercise is better suited for your recovery following total knee arthroplasty. He specializes in orthopedic surgeries and health care including total knee replacement, joint replacement, sports medicine, and more. Contact doctor Stickney’s office today to learn more.

Outpatient physical therapy (OPT) is the practice of visiting a healthcare facility such as a clinic or office to perform exercises to treat musculoskeletal problems. This strategic physical activity with the guidance of a physical therapist is a common means of both injury prevention and recovery from sports injuries, because it helps patients address joint pain and regain range of motion. While OPT has a long history as a fundamental part of proper treatment plans for recovery and maintenance following total knee arthroplasty (TKA), recent studies have questioned the need for OPT following total knee replacement surgery.

A new study, “Home Exercises vs. Outpatient Physical Therapy After Total Knee Arthroplasty: Value and Outcomes Following a Protocol Change”, explored the “health safety, efficacy, and home economics of routine home exercises following TKA compared with OPT immediately afterward”. It compared 251 patients who were prescribed OPT following TKA, and 269 who followed a home exercise program instead after their operations. Ultimately the study found that patients who practice home-directed exercise programs in place of formal OPT have seen comparable outcomes, and can even experience significantly reduced costs. They concluded that while some patients required OPT following their home exercise program, the majority did not.

As the study above highlights, the use of home-healthcare for knee postoperative knee rehabilitation following TKA is increasing. Many other publications have reported the same, claiming that supervised rehab such as OPT may not be necessary for optimal recovery following TKA. However, another recent study explored the association between physical therapy (PT) and functional improvements for patients in home settings. This study also explored factors related to PT utilization, meaning it identified the reasons patients did or did not use their home healthcare.

The study found that lower home-healthcare utilization was correlated with worse recovery. Participation in home-healthcare was generally lower for patients who had the help of physical therapists from rural agencies that came to their home. Medical complexity – such as depressive symptoms or dyspnea – factored into the patients’ levels of participation too.

Comparing the results of both studies, we can conclude that home exercise for joint replacement postoperative rehabilitation is effective, however it’s important that patients actually follow through on utilizing the home practice, performing the necessary amount for an optimal recovery. We can also see that those with medical complexities may need additional monitoring to verify that they perform the necessary amount of home PT sessions to achieve optimal knee surgical outcomes for a complete recovery.

Two Habits for Orthopedic Health

sleeping-during-yogaDr. Jeff Stickney, an orthopedic surgeon in Kirkland, is an expert in orthopedic health, modern pain management like the SwiftPath method, sports medicine, and more. Make an appointment with Dr. Stickney to learn how you can return to a pain-free lifestyle.

Prevention is key when it comes to joint pain, sports injuries, neck and back pain, and other complications to your orthopedic health. The best means of prevention is to consistently tend to your overall health, which is often easier said than done. However, maintaining a pain-free lifestyle may be as simple as adding these two healthy habits to your daily routine:

Sleep Evenly
Getting quality sleep is arguably the most crucial aspect of any daily routine, and the most impactful to your orthopedic health. Not only is it the time when your body recovers from activity or injury during the prior days, but it can also determine how your body feels in the days to come. By developing an awareness of your sleeping habits and adapting them, you can prevent waking up with back or neck pain, and set your musculoskeletal system up for pain-free success.

Sleeping on your back is ideal for pain prevention because it avoids any unnatural extension of your spine, while aligning your body from head to toe. This distributes your weight more evenly than sleeping on your stomach, which can exacerbate lower back issues by placing most of your weight on your middle. Stomach sleepers also have a greater chance of a sore neck because your head is twisted to the side. If you can’t sleep unless you’re on your belly, try sleeping with no pillow or a flat one under your head, and another placed beneath your hips.

Side sleepers should aim to keep their neck and spine aligned as much as possible too, and the best way to do so may be by curling both legs toward your chest and placing a pillow between your knees. This arches your back and keeps your hips aligned to prevent any strain on your lower back.

Stretch Regularly
Improving your flexibility and range of motion allows you to perform tasks without joint stress. Try these stretches in the morning to alleviate stiffness, or before you go to bed for a better night’s sleep. Make sure to stay within the limits of your flexibility, and perform static stretching only after a warm up or exercise to avoid injury and get the optimal benefit.

Perform a standing side bend with feet shoulder-width apart, lifting your arms above your head. Move your shoulders as close to your ears as possible and clasp your hands together, as if holding onto a rope from the ceiling. Stretch your spinal cord upward, then lean gently from one side to the other, while maintaining a forward gaze and making sure you don’t lean forward or back. Try holding the stretch on each side for 3-5 breaths to stretch both sides of your body, benefitting your obliques, shoulders, hips, and spine.

The forward fold involves the same stance followed by a bend at the waist, while keeping weight in your heels and allowing your neck and arms to dangle with gravity. This stretches the legs, hamstrings, and back. To target your lower back and hips, try a hip flexor stretch by lying on your back and bringing your knees to your chest. Gently pull the knee towards your shoulder while keeping your spine and the other leg flat on the floor, then repeat on the other side.

By adding regular stretching and quality sleep to your daily routine, along with proper nutrition and exercise, you can rest assured that you’re on the path toward overall orthopedic health, and living your life pain-free. Contact Dr. Stickney to learn more about stretches that are safe for you to perform.

Game Changers: Preventing Common Sports Injuries

soccerSummer 2018 has arrived and World Cup fever is in the air. While we certainly see our share of flops in these matches, many players endure legitimate injuries too. Those same injuries will be happening to people everywhere this summer as we spend more time being active outside. Reviewing these common sports injuries, their symptoms, and injury prevention tactics will ensure you know how to stay safe and keep the ball rolling.

Stay on Your Feet
Soccer players possess the remarkable ability to run nearly nonstop for 90 minutes. However, their effort often comes at a price, especially when warm weather factors in. Groin pulls, thigh strains, and calf cramps are among the most prevalent injuries we see, and they often result from overuse and dehydration. Make sure to stay drink plenty of water, wear the correct equipment, and listen to your body while exercising, especially in the heat.

Bend It
Bending your muscles, ligaments, and joints by stretching regularly will help you “bend it” like the pros. Injuries such as shin splints, ACL tears, and Achilles tendinitis aggravate when athletes don’t stretch or rush back into action too soon. Condition yourself by starting at a low-intensity level and gradually increasing to allow your body to adjust rather than straining its limits. Care for these injuries with rest, ice, and elevation – or call an orthopedic doctor for further evaluation if pain persists.

Tear Up the Turf, Not Your Knees
Soccer, like other summer activities, requires sharp cutting, quick stops, and pivoting. These sudden movements lead to some of the most notable injuries we see in World Cup matches and during summer– ACL tears and ankle sprains. They can occur without contact and may require surgery depending on severity. Take precaution by strength training, wearing the correct footwear, and practicing the proper technique for whatever exercise you choose.

Dr. Stickney, a Kirkland orthopedic surgeon, is an expert in exercise and healthshoulder replacement surgerysports medicine and more. Contact Dr. Stickney and return to your healthy, pain-free lifestyle!