Category Archives: Injuries

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.

Hamstring Injuries: Risks, Treatment, and Rehab

hamstringDr. Stickney, a Kirkland orthopedic surgeon, is a sports medicine expert specializing in hamstring injuries, pitching shoulder injuries, Swiftpath knee surgery, and more.

Hamstring injuries are common among individuals with a hamstring injury risk–those living an active lifestyle, especially for athletes in sports that involve high speed running or kicking. Sports like track-and-field, soccer, dancing, football, long-distance running, and water-skiing all have a heightened risk for hamstring issues. Erratic contraction of the hamstrings while running at high speeds, quick-burst movements, and sudden trauma are believed to cause these injuries.

Three muscles make up the hamstring (semitendinosus, semimembranosus, biceps femoris), starting from the bottom of the pelvis (ischial tuberosity) down to the knee joint where the muscles connect with tendons to attach to the bones. Your hamstrings allow you to bend your knee and help with hip extension, though this is primarily done by the gluteus Maximus.

There are two prominent types of hamstring injuries – tears to the muscle belly (the thick part of the muscle or where muscle fibers join tendon fibers) and acute avulsions to the tendon (when the tendon completely tears away from the bone). The sciatic nerve running from the lower back down the back of the legs may also be compromised during hamstring trauma, due to its proximity.

Injuries arising from a single abrupt trauma rather than from smaller cumulative injuries tend to be more serious and affect younger patients (age < 25). However, with increasing age the likelihood of injury increases. The risk factors associated with this injury include, the type of sport, poor flexibility, asymmetric strength, and above all prior injury.

With so many variables to consider, how do you prevent hamstring injuries? What are the most important risks to be aware of, how should you treat a hamstring injury, and what is the best way to recover?

A review titled “Hamstring Injuries – Risk Factors, Treatment, and Rehabilitation” published by the Journal of Bone and Joint Surgery evaluated 9 different contemporary studies exploring predictive factors, diagnosis strategies, treatment methods, and recovery techniques for hamstring injuries. The studies involved varying sample sizes and methodologies tailored to their respective topics.

The findings:

  • The most predictive factor for a hamstring injury is any previous hamstring injury including sprains, tears, and avulsions. When a patient has a history of hamstring injuries, they’re also likely to have a longer recovery time – especially recreational athletes compared to professionals. The importance of early intervention cannot be overstated; one of the major reasons rec athlete’s recovery time is longer than the pros is because they prolong their first consultation and treatment. If you may have experienced hamstring injury, contact a sports medicine expert
  • MRI (magnetic resonance imaging) edges out ultrasound as the best means of evaluating the extent of a hamstring injury and whether surgical intervention is warranted.
  • Muscle belly tears are often better treated with conservative treatment, whereas hamstring avulsions may be better treated with surgery depending on the displacement of the tendon.
  • Conservative treatments such as RICE (rest, ice, compression, elevation), nonsteroidal injections (anti-inflammatory drugs), physical therapy, stretching, PRP (Platelet Rich Plasma) injections, and corticosteroid injections are indicated for acute hamstring strains, partial tears, and single-tendon avulsions. PRP injections combined with rehab exercises for hamstring injury, like physical therapy, is more effective than rehab exercises alone.
  • Surgical repair of complete proximal hamstring ruptures, both acute and chronic, results in improved postoperative outcomes compared with nonoperative management.
  • Repair of acute proximal hamstring tendon tears results in better functional outcomes than repair of chronic tears. Again, how long a hamstring injury takes to heal and the effectiveness of recovery depends on early intervention and careful rehabilitation.
  • Stretching and strengthening the hamstring tendons with eccentric exercise is helpful in conjunction with physical therapy after injury. Strengthening, Stretching, control of early inflammation, and massage of scar tissue all may reduce the risk of re-injury, or may prevent hamstring injuries altogether.

Having a better understanding of hamstring injuries allows clinicians to provide better treatment and patients to manage their injury most effectively. If you have questions regarding hamstring injuries or would like to schedule an appointment, contact our sports injury clinic.

Is Physical Therapy Effective After Rotator Cuff Tear?

shoulderptDr. Stickney, a Kirkland orthopedic surgeon, is an expert in shoulder injury treatment, total and partial knee arthroplasty, sports medicine, and more. 

Rotator cuff tears can occur from athletics such as baseball, weightlifting, competitive swimming or just over time with overuse and improper strength and flexibility. These shoulder injuries are extremely common, affecting at least 10% of people over the age of 60 in the United States – which equates to over 5.7 million individuals. Of the 5.7 million+ individuals who suffer from rotator cuff tears, fewer than 5% are treated surgically, and patients who undergo surgical repair experience a failure rate between 25 and 90%. What’s interesting though, is that patients with repair failures report satisfaction levels and outcome scores that are nearly indistinguishable from those whose repairs are intact. Because most of these surgical patients undergo postoperative physical therapy, it is logical to assume that physical therapy may be responsible for the improvements in outcome. A multicenter prospective cohort study conducted by the MOON Shoulder Group and published by Journal of Shoulder and Elbow Surgery takes a closer look.

To conduct the study, 452 patients with atraumatic full-thickness shoulder rotator cuff tears provided data via questionnaire on demographics, symptom characteristics, comorbidities, willingness to undergo surgery, and patient-related outcome assessments. Physicians also recorded physical examination and imaging data. Patients then began a physical therapy program developed from a systematic review of the literature and returned for evaluation at six and 12 weeks.

At those visits, patients could choose one of three courses: 1. Cured (no formal follow-up scheduled), 2. Improved (continue therapy with scheduled reassessment in six weeks), or 3. No Better (surgery offered). Patients were also contacted by telephone at one and two years to determine whether they had undergone surgery since their last visit and a Wilcoxon-signed rank test with continuity correction was used to compare initial, six-week, and 12-week outcome scores.

The results? Patient-reported outcomes improved significantly at six and 12 weeks and patients elected to undergo surgery less than 25% of the time. The patients who did end up deciding to have surgery generally did so between six and 12 weeks, and few had surgery between three and 24 months.

This study suggests that nonoperative treatment using this physical therapy protocol is indeed effective for treating atraumatic full-thickness rotator cuff tears in approximately 75% of patients followed up for two years.

If you have questions about treatment options for your shoulder injury or would like to make an appointment, please contact our office.

The Potential and Pitfalls of Stem Cell Injections

stemcallcautionWhen it comes to stem cell therapy, it’s wise to be a bit wary. While stem cells can have enormous implications for treatment of injury and disease, many facilities offering stem cell injections are simply looking to capitalize on the buzz surrounding this therapy. If you’re considering stem cell injections for injuries, it’s essential that you learn everything you can about stem cell practices so you can identify the healing potential and possible scams.

This type of therapy involves repurposing self-renewing stem cells found naturally in your body by injecting them into damaged tissue. When you experience an injury, the body’s healing reaction sends undeveloped cells through the bloodstream to the injured area. When they arrive, they develop into repair cells as a response to their surroundings. The goal of stem cell injections is to expedite treatment of injury or disease by harnessing this natural capacity your body has for healing itself.

The procedure begins with stem cell harvesting, where a doctor extracts cells from points within the body, like fat or bone marrow. Alternatively, cells from a donor like blood from an umbilical cord, could be used, but they must be treated first to prevent negative reactions in the patient. The doctor then proceeds to inject this collection of cells, including rare stem cells, to the site of injury. In theory, this enhances the rate at which the body can heal after injury.

With further research and more advances in the field, stem cells will eventually be extracted from your body and separated in a lab to identify cells with specific capacity. For example, when healing an arthritic joint, stem cells for joint cartilage healing will be cultured to increase their numbers, then injected back into your joint in a quantity sufficient to repair it. While this is the ultimate goal, years of clinical research and trials are required first. In fact, the FDA does not currently allow cell removal from your body, processing them in any significant way, and then putting them back into your body, unless the practice is conducted as part of an approved clinical trial.

Many stem cell therapy offerings charge anywhere between $5000 to $10000 to simply take cells from your bone marrow or fat, spin them in a centrifuge to concentrate the cells, and inject them back into the area of injury. This process makes no attempt to identify the number or quality of stem cells harvested. There are no controlled studies proving this process is effective thus far.

As with any treatment, each patient reacts differently. The current literature surrounding stem cell injections states that the treatment is limited by the quantity and quality of stem cells initially harvested. Patients carry varying levels of stem cells, which may result in ineffective transfusions. Another limitation is physical blockages, such as blocked arteries, that inhibit the body’s ability to transport cells throughout the injured area.

Even when the outcome of stem cell therapy is recovery, establishing a cause-and-effect relationship is difficult because of multiple distinct processes taking place during treatment, and the high potential for placebo effects and natural healing. Some patients improve drastically while others show no substantial alterations.

The efficacy of stem cell injections is a point of contention among medical professionals, and because we are still in the experimental stage there’s still a lot we don’t know. FDA regulations for stem cell therapy are subject to change. Be cautious of stem cell treatments offered without regulatory approval or that have not been tested in a registered clinical trial.

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

Middle-Aged Women Who Exercise Could Delay Dementia

exerciseFor middle-aged women, physical fitness may do more than give the heart a boost; it may also benefit the brain in a big way. Recent findings out of Sweden show that middle-aged women with a “high degree” of cardiovascular fitness are 90% less likely to develop dementia later in life than those who had just a moderate fitness level.

The study, published in the journal Neurology, also discovered that if the middle-aged women who maintained a high fitness level did develop dementia, the symptoms tended to emerge 11 years later (on average) than they did for the women who had a moderate fitness level.

To conduct this study, a team of researchers from the Center for Aging and Health at the University of Gothenburg studied the health data of 191 local women, ages 38-60, from 1968-2012. At the beginning of the trial, the participants were given an exercise test in which they cycled on a stationary bike until they felt exhausted.

After tracking the health of the women for 44 years, the researchers found that the initial fitness test scores helped predict whether the participants would be diagnosed with dementia later in life. The results showed that 32% of the women with a low fitness score developed dementia during the study period, compared with 25% of women with a moderate fitness score and just 5% of the highly fit women.

The highest dementia rates were seen in women who started the exercise test but couldn’t complete it: a whopping 45% of these women went on to develop dementia later on in life.

Though this singular study doesn’t fully prove a direct link between exercise and a lowered risk of dementia, it’s clear that exercising frequently (aim for 150 minutes per week) is extremely beneficial for both the body and brain. In years to come, studies like this one will allow researchers to provide clearer recommendations for exercise and other lifestyle modifications to reduce the risk of dementia and more.

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

How to Prevent Falls in the Winter

walkingonsnowThis time of year, outdoor walkways more closely resemble skating rinks, as they become slippery hazards obscured by leaves, rain, ice and snow. Though many falls are more embarrassing than they are painful, injuries and even deaths caused by falling are common and more prevalent in the winter months (though it’s important to be cautious of trip hazards year-round).

Senior citizens, being less agile and more fragile, are especially at risk. Unfortunately, falls are the number one cause of injury to seniors, one in three of whom will fall each year and too often, the result is a debilitating fracture, loss of independence or death.

So, how to avoid outdoor slips, trips, falls and their resulting injuries this winter? The New York Times offers a few tips:

  1. “Check your footwear. Shoes and boots should have slip-resistant soles (rubber or neoprene, not plastic or leather). Or equip them with external traction cleats, sold under brand names like Yaktrax.
  2. Take smaller steps, bend forward slightly, go slow and walk as flat-footed as possible when it’s icy or snowy. Check the steps and sidewalk for black ice before going out in the morning, even if only to pick up the paper or mail. Do likewise when stepping out of a vehicle. Although the air temperature may be above freezing, dew or fog can freeze on a colder surface.
  3. Always use a handrail when going up and down stairs. Consider installing a railing on stoops that lack them. If an item you want to carry is too big to hold in one hand or arm, ask someone to help.”

Along with these tips, it’s vital to maintain your physical strength and balance as much as possible as you age. Higher levels of physical activity have been shown to protect against falls, so keep active or consider sessions with a personal trainer or physical therapist if you aren’t sure where to start.

Even after taking all the precautions, falls are bound to happen, and when they do, it’s important to be prepared. Some experts recommend learning “the right way to fall” which involves trying to stay relaxed as you fall, tucking your head when falling backward to avoid hitting your head, rolling onto your back upon landing and more.

Do you have questions about staying active in the winter or preventing dangerous falls? Dr. Stickney, a Kirkland orthopedic surgeon, is an expert in joint replacement surgerysports medicine, exercise and health and more. Contact Dr. Stickney and return to your healthy, pain-free lifestyle!