Tag Archives: injury

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.

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!

Like Exercising? Avoid Painkillers

painkillersOver-the-counter painkillers like ibuprofen and aspirin may seem a great way to alleviate soreness and pain after a particularly vigorous run or strength training session. These nonsteroidal anti-inflammatory drugs, or NSAIDS, suppress inflammation, but recent studies published in the Emergency Medical Journal and The Proceedings of the National Academy of Sciences have found this may not be without consequence. When combined with exercise, they may overwork the kidneys and impede the muscles’ recovery. 

Unfortunately, ibuprofen and similar drugs have a long relationship with athletes, especially those engaging in more strenuous activities like marathon running. Some studies have found that more than 75% of long-distance runners rely on anti-inflammatory medications (NSAIDS) as a form of pain meds to blunt the strain of training and competitions. 

A team from Stanford University began investigating the true impact of NSAIDS after it was found that those that take them may still experience muscle soreness.

Essentially, NSAIDS block the production of prostaglandins, a biochemical that heads to the site of an injury and begins the process that creates pain and inflammation. To increase blood flow to the area, prostaglandins also stimulate blood vessels to dilate. NSAIDS limits the amount of prostaglandins, lessening inflammation. 

The Stanford researchers studied 89 participants in multi-day marathons around the globe, having them swallow either an ibuprofen pill or placebo pill every four hours during a 50-mile leg. They then studied the amount of creatinine in the racers’ blood. Creatinine, a byproduct of the kidneys filtering the blood, can help show kidney injury — the higher the levels of creatinine in an otherwise healthy person, the more likely a person is to have an injury. 

Runners who took ibuprofen were 18% more likely than their counterparts to have developed an acute kidney injury. Though 44% of all runners had high levels of creatinine, those who ingested ibuprofen had more severe injuries. 

The Stanford team followed this with a study looking at how anti impact a body’s response to exertion within the muscles. They found that, in mice, NSAIDS block muscles’ ability to rebuild after strenuous exercise, and the healed muscle tissue isn’t as strong as that which hasn’t been exposed to a painkiller. 

It’s important to remember that inflammation, while uncomfortable, is part of the body’s natural healing process and an essential component to regeneration and regrowth. If pain is an issue, ice baths can be an effective, safe remedy to sore muscles, keeping your body strong, healthy, and primed for competition.

Is joint pain impacting your ability to live an active life? Questions about exercising after joint replacement surgery? Dr. Stickney, a Kirkland orthopedic surgeon,  is an expert in knee surgery and hip replacement surgery and can help combat pain and return you to an active lifestyle. 

Research Shows Benefits of “Weekend Warrior” Lifestyle

weekend-warriors-stickneyWorking out may stave off premature death, but that doesn’t mean it’s easy to squeeze the recommended amount of exercise into your week. To combat this, the trend of “weekend warriors” has emerged: adults who condense physical activity into Saturday and Sunday. While opinions on how effective this is have been mixed, a recent study showed that the benefits for working out only one or two days are almost the same as spreading exercise throughout the week.

The study, published in JAMA Internal Medicine, looked at over 63,000 adults from the UK over 15 years, studying how long they exercised, what their exercise consisted of, and what days they exercised. The participants were grouped into two categories: inactive (those who never exercised) and sufficiently active (those who exercised for the recommended amount). The latter was split into those who worked out for three or more days a week, and those who compressed their activity into one or two days, the preference of about one out of every three American adults.

The so-called “weekend warriors” were primarily male and 90% of them participated in vigorous activities like competitive cycling or team sports one day a week. Compared to the inactive group, they were 29% less likely to die prematurely. However, those who spread their workouts over several days were still better off: they were 30% less likely to die early and their risk of heart failure was reduced by almost 50%.

However, weekend warriors are more at risk of sports-related injuries. Should this occur, consult an orthopedic surgeon so you can quickly and safely return to an active lifestyle.

What of the people that opt for frequent exercises in small doses? A recent study in the Journal of the American College of Cardiology studied 55,000 people over 15 years and found that even running just five minutes a day dramatically reduces incidents of heart disease and deaths from other causes.

Guidelines from the Centers for Disease Control and Prevention suggest 150 minutes of moderate or 75 minutes of vigorous exercise every week to prevent diseases and premature death. Unfortunately, about one-third of American adults don’t exercise at all and 80% don’t meet the recommendations. However, the results of these studies indicate that even small amounts of daily exercise can have considerable health benefits and hopefully could motivate formerly sedentary adults to integrate more activity into their week, even if just for short spurts at a time.

Is joint pain or other sports injuries impeding your ability to exercise? Contact Dr. Stickney, a Kirkland orthopedic surgeon and sports medicine expert specializing in procedures including total knee replacement and ACL reconstruction.