Ask The Expert

Cervical Questions
I injured my neck playing football. The doctor said I was suffering from a condition known as a cervical burner. What is a cervical burner?

Your doctor is describing the sensation you felt when the injury occurred. While playing football, the mechanism of your injury involved your head being pushed into the direction of your shoulder. The nerves that come out of your cervical spine were abruptly stretched. A burning sensation is felt in your arm because those stretched nerves feed the arm with sensation and motor control. I would contact your coach in regards to providing you with a protective collar to be worn around your neck while playing football. Multiple burners are a serious condition and should be avoided.

One month ago, I was involved in an automobile accident. Since that time my neck has not been the same as it was previous to the accident. I’m suffering from stiffness in my neck primarily in the morning and occasionally my middle finger goes numb. My medical doctor took x-rays and said I had cervical disc disease. What is this and how do I fix it?

Trauma can add to the normal wear and tear of the vertebral disc. The vertebral disc contains fluid. As we age the fluid dries up. Without the fluid, spinal motion is decreased. If you were traumatized, there is a chance that the spinal fluid leaked out secondary to fragmentation of the outer portion of the vertebral disc. The occasional numbness you are experiencing may be a result of residual swelling where the spinal nerves exit the spinal cord. If the numbness you are experiencing is related to certain positions your head is in during the day, or when you are sleeping, it may be due to the pressure caused by a fragment from the damaged vertebral disc or disc fluid. Your initial trauma most likely also caused your cervical musculature to go into spasm. Spasm can contribute to the stiffness you are experiencing in your neck.

I find the best way to treat acute (just happened) and subacute (lasted for about 2-4 weeks) cervical disc disease is with a cervical collar to splint the neck. Wearing this collar during your active state and when you are sleeping will allow healing to take place. Your medical doctor will prescribe analgesics, anti-inflammatories and muscle relaxants. For the following four weeks, your medical doctor may prescribe physical therapy for a series of moist heat application and cervical spine traction. The moist heat will relax your muscles, and the traction separates the vertebral joint space allowing the fragments to recede back into their original place. When your numbness disappears and the neck stiffness resolves, a strengthening program is implemented. Unfortunately, symptoms related to cervical disc diseases occasionally return. It is very important that gentle strengthening learned in physical therapy continues forever. A regular routine will decrease the chance of a reoccurrence.

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Shoulder Questions
I was playing tag football and I fell on the back part of my right shoulder. Since that day, I am having a tough time raising my hand over my head. Why is my shoulder so stiff?

When you fell you most likely traumatized the scapular or shoulder blade muscles. These traumatized muscles shortened to protect themselves resulting in limited movement.

I play football in an over 35 league. There is a significant amount of body contact. It never seems to fail that the next day my shoulders are sore and stiff. Is there a way to avoid all this soreness and stiffness?

The soreness and stiffness you’re experiencing is a result of micro tearing and ripping of the muscles belly. Following six to twelve hours from the initial trauma, spasm and swelling occurs in the muscle. To help avoid this problem, a through warm-up and stretching program should be implemented. The trick here is to lengthen and heat the muscles prior to aggressive activity which will help flush blood into the muscle and raise its temperature. This, in turn, makes the muscles more pliable and resistant to tearing.

Immediately following the game, ice the shoulders for about twenty minutes then remove the ice for ten minutes then reapply the ice. Following 48 hours from the initial trauma, begin taking warm baths to speed up the healing process. Also, it may be a good idea to implement a gentle strengthening program using football specific exercises.

I fell down a flight of stairs and landed on my shoulder. I saw my orthopedic doctor and he said that I separated my AC joint and recommended surgery. What actually is an AC joint and why would I need surgery?

The AC joint stands for the acromioclavicular joint. This joint is created by two bones-one being the clavicle or the collar bone and the other being the acromion which is an extension of the scapular of shoulder blade. It can be found by placing your right hand on the top of your left shoulder. This joint is an integral part of the dynamics of the shoulder.

During the orthopedic evaluation, the doctor most likely concluded that the AC joint suffered a third degree separation. In essence, what had happen to your shoulder at the time of trauma is that the ligaments that guide the clavicle and the acromion completely tore away form themselves or the bones A third degree of separation is the most severe. Third degree separations do not heal well without surgery. If surgery is not performed there is a 100 percent chance that your shoulder will lose some mobility and the shoulder structure will be permanently be weakened.

I was painting my house and I fell off my ladder. Besides being completely startled, I had a real bad pain in my chest and shoulder. My wife took me to the emergency room where they x-rayed my chest and shoulder and revealed that I fractured my collar bone. The doctor said to wear a sling and to apply ice pack at regular intervals to control swelling. The odd thing is it feels as though the bone is separated form itself. I would think that there must be some kind of surgery to fix this separation. Is there?

Collarbone fractures almost always heal themselves. Surgery is very rare. In a few hours following the fracture, a pool of blood will form around the fractured site and the pool of blood will organize itself into a clot, which will feel like a soft putty ball. Following two weeks the soft putty ball will stiffen and bone will begin to be created. As it hardens, a lump will form at the site of the fracture. This process of hardening and bone creation normally takes about one year. The lump will remain permanently.

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Elbow Questions
My son is a pitcher and plays in Little League baseball. He’s been complaining of pain in the elbow. His medical doctor said it is pitcher’s elbow. What exactly is pitcher’s elbow?

Pitcher’s elbow is basically a wear and tear of the elbow. When releasing the baseball the fingers and the wrist must turn downward. The muscles of the forearm responsible for this motion are the wrist flexors and the wrist pronators (turns your palm down). With repetitive throwing motion, these muscles eventually weaken and small tears in the attachment of these muscles occur. These muscles attach along an area of the elbow called the medial epicondyle (inner part of the elbow). In young children this is an area of bone growth. The center of the growth area where the pronator and the flexor muscles attach is not strong enough to withstand such repetitive force as throwing a baseball. The best treatment is to stop throwing the baseball hard for up to three weeks. Gentle, long, arch throwing is best. Your medical doctor may prescribe an anti-inflammatory medication.

Gentle stretching of the wrist flexors and pronators are recommended before and after the long arch throwing followed by ice treatments for 10 to 15 minutes. It is also recommended to wear a long sleeve shirt to retain warmth. After three weeks of active rest, a strengthening program for the digits, forearm, upper arm, and shoulder are recommended.

An understanding of the biomechanics required to throw a baseball is: Throwing should be at 60% of pre-injury maximum for the first week, 70% for the second week, and 80% for the third week. Ask your coach if you can have an extra day’s rest in the pitching rotation until you are 100%.

What sport causes the greatest amount of injuries to the elbow?

Surprisingly it is not a sport that actively uses the elbow. Rollerblading, skateboarding, and the trampoline cause injuries to the elbow as a result of a fall either on the elbow or from outstretched arms where the elbow receives the greatest amount of force.

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Hand Questions
I have a condition known as deQuervains tendonitis. Can you explain what it is? How is it treated?

Basically it is tendonitis of the thumb. To identify the exact location of the tendon that is involved, point your thumb to the ceiling. You’ll notice two tendons pressing up against the skin at the base of your thumb, one closest to the back of your hand, and one closest to the palm of your hand. These are the involved tendons. Like all tendons, a sheath of tissue holds them down and guides them as the muscle pulls on them as they attach to the bone.

Repetitive motions involving the thumb could cause tendonitis, for example, sports or activities like racquet sports, bowling, softball or just household chores. The sheath of tissue that holds down the tendon normally produces a fluid. This fluid is produced when there is friction created by the tendon. If the friction is too great, fluid is produced in abundance and it presses against the tendon causing it to become inflamed. This fluid over time thickens. This produces less space for the tendon to move resulting in chronic tendonitis and decreased range of motion. Your medical doctor will prescribe an anti-inflammatory medication, and will suggest that you ice the thumb two to three times a day for twenty minutes.

A thumb splint will be placed around your thumb to prevent movement. With the thumb splint on you will be able to perform your daily activities without producing additional irritation to the thumb.

During the first three weeks your doctor may prescribe physical therapy for ultrasound and massage, followed by passive range of motion exercises. If the pain does not disappear in two to three weeks your medical doctor may inject cortisone.

My wife slipped and fell on a patch of ice fracturing a bone in her wrist called the navicular. The doctor put a cast on it and said that of all the bones to fracture, this is one of the bones that take the longest to heal. Why is that?

The navicular is one of eight carpal bones found in the wrist. It sits under the forearm bone called the radius. When fractured the healing process is delayed because of poor blood supply. Unlike other bones, the navicular receives its blood supply only at one end of the bone. Therefore half of the blood supply is cut off from nutrients. Your orthopedist will immobilize this fracture for three months. During your return visit, the doctor will take a series of x-rays to determine the rate of healing. Seventy to eighty percent of navicular fractures heal in that time period.

The most common injuries to the wrist occur in which sport?

The most common injuries occurring to the wrist happen with Rollerblading, skateboarding, ice skating and fencing.

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Lumbar Questions
My doctor has told me that in order to decrease my back pain I must wear a back brace. My college roommate said this was bad advice because the back and abdominal muscles will weaken causing another problem later on. What is your opinion?

Your medical doctor is prioritizing the course of your treatment for back pain. If atrophy does take place in your lower back and abdominal muscles but the symptoms disappear, the doctor’s advice was correct. At your next visit to the doctor’s office he will, in most cases, offer you a gentle strengthening program for the low back and abdominal muscles or refer you for physical therapy to increase the strength of your back and abdominal muscles.

I was playing football with my two young boys in my backyard. I was demonstrating a running drill that I was taught during my football training in college when suddenly I felt a stabbing pain in my back. The next day my right hip and outer thigh were painful with a numbing feeling between my first and second toe. I had an MRI, which revealed a herniated disc at level L5-S1. The doctor prescribed pain medication and muscle relaxants. He also recommended a course of physical therapy. What should I expect from the physical therapy?

The physical therapist will perform an evaluation consisting of testing your lumbar range of motion, flexibility of your trunk muscles and all the muscles of the thighs and legs, as well as strength testing of the abdominals… low back, hip, knee, and ankle muscles, followed by reflex and sensation testing.

The physical therapist will assess the location of active or latent muscle spasms. An evaluation of your sitting and standing posture will be assessed along with your functional abilities. At the conclusion of the evaluation, home exercises are given and a treatment plan with specific goals will be designed and discussed with your medical doctor. Your second visit to the physical therapist will involve the implementation of the treatment program.

I’ve had back pain for more than ten years. I never did anything about it. My wife just gave birth to our first child. I have severe pain in my back and left hip when lifting my son from the crib. My orthopedist took x-rays and said I have spondylolisthesis. What exactly is it and how is it fixed?

The prefix of the word spondylolisthesis is spondylo, which means vertebra. Listhesis means slipping of one spinal element on the other. The condition known as spondylolisthesis in most cases began as spondylolysis, which is a crack in part of the vertebra called the isthmus. The isthmus is the bridge between two articulating (joints) surfaces of a spinal segment. This spinal segment is called the pars interarticularis.

There are degrees of slippage. Your medical doctor will determine the degree of slippage. The degrees of slippage range from 1 to 4. The fourth degree of slippage is the worst. If your doctor determines that it is a 1 or 2, an educational back program will be given with specific instructions by a physical therapist to encourage proper body mechanics and exercises for your abdominals. Your doctor will also suggest non-contact sports. If the degree of slippage is a 3 or 4, all sport activities are discontinued. This degree of slippage warrants a spinal fusion to stabilize this unstable segment.

I’ve been seeing a chiropractor for two months now. She says that I have mechanical back pain. My original symptoms have decreased since chiropractic sessions began but the back pain returns every now and then. What is mechanical back pain and how can I prevent it from coming back?

In physical therapy we term mechanical back pain differently. During an evaluation we categorize back pain into three groups: The first is postural or mechanical, the second is dysfunctional, and the third is derangement. During the postural evaluation, we may notice an unequal leg length, flat feet, and poor sitting and/or standing posture.

  • Poor Sitting and/or Standing Posture: If a patient is assessed to have poor sitting and/or standing posture, we educate the patient on body mechanics and patterns of posture to avoid. We will also offer simple exercises to strengthen or lengthen muscles that have shortened or weakened due to poor sitting and/or standing posture.
  • Flat Feet: If flat feet are noticed, we educate the patient on how flat feet can have a negative impact on how the foot, leg, thigh, hip, lower back and neck absorb body weight forces while walking. If the absorption of body weight while walking is not spread out correctly throughout the body, an accumulation of force will, over time, affect the weakest area in the body resulting in pain. Ankle strengthening and temporary orthotics are recommended.
  • Unequal Leg Length: Unequal leg lengths also cause abnormal absorption of forces similar to flat feet. Depending on the cause of the unequal leg length, corrective measures are offered the patient.

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Hip Questions
This past spring I began a running program to shed a few winter pounds. Following the first week my hips hurt. Following a warm shower the pain decreases. This pain has lasted now over three weeks. Running increases this pain. I saw my doctor and he said that I have bursitis of the hip. How can I get rid of this pain and prevent it from coming back?

Understand that the bursa is a cushion that is filled with fluid. It protects the tendon of the muscle from rubbing against the bone. If the hip muscle and joint are not warmed up appropriately and the surrounding hip musculature is not strong enough to withstand the forces of running, the bursa will become irritated. This irritation will cause the bursa to produce extra fluid. When the bursa fills up it places great pressure on the surrounding tissue. Pain is felt at the site of the bursa, and in some cases along the outer part of the thigh and below the knee.

The treatment initially is to apply ice for fifteen to twenty minutes three times a day. Your doctor will give you an oral anti-inflammatory medication. This course of treatment should reduce your pain within 48 to 72 hours. If the pain persists your medical doctor may consider Novocaine and a cortisone injection into the bursa sac. Again, to avoid this problem, thoroughly warm-up by walking five to six blocks. At the end of the six-block walk, stop and stretch your calf, hamstrings, outer thigh, and quadriceps muscles. Begin your jogging at a slow pace. Don’t try to push yourself for at least the first six weeks. Enjoy yourself while exercising. It may be a good idea to see a physical therapist. The therapist will determine the exact cause of the bursitis.

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Knee Questions
I injured my knee playing football. The doctor said I should go for physical therapy. I know how to lift weights. Why do I need to go to a physical therapist?

Physical therapists are part of the health care delivery system. We are experts in rehabilitation. We can help with facilitating healing at a faster rate and prevent abnormal scarring from taking place. As therapists, our goal is to guide your physical rehabilitation so that you will progress to an early return to your sport or activity.

I was vacationing in Hawaii participating in all the water sports they have. On the fourth day of my vacation I tried parasailing. I had never attempted this activity but always wanted to. At first it was difficult getting on the surfboard because the wind and the waves kept knocking me off. I eventually got the hang of it. After an hour or so, I was riding the waves and having a great time when suddenly I was airborne…it was quite thrilling. When I came down I heard a pop in the front of my thigh. I could not maintain my balance any longer and fell into the water. When I got to the beach it was very difficult to move my hip and knee. There was not much pain just a dull ache. I immediately went to the hospital. After three hours the pain was getting increasingly worse. The doctor wrapped my thigh in ice and said it was a strained quadriceps muscle and sent me home using crutches to walk with. When I arrived back to New York, I saw my orthopedist. He said that I had a grade three tear of my quadriceps muscle. He recommended physical therapy. What is a grade three tear and what is the recovery time?

A grade three tear is when the muscle has separated from itself (ruptured) completely. The normal course for recovery is six to eight weeks.

I’m the fastest runner on my basketball team. But I keep pulling my hamstrings. Why does this happen and how can I treat it?

It most likely is the result of a strength ratio imbalance between the quadriceps and the hamstrings. The quadriceps are the muscles in the front of your thigh. Normally the quadriceps are one and one half times stronger than the hamstrings. Running athletes whose quadriceps are stronger than that are prone to hamstring pulls. When running, the quadriceps extend the knee and the hamstrings bend the knee. They work in opposite directions of one another. If the quadriceps are firing at a rate two times that of the hamstrings and the hamstrings cannot lengthen in an appropriate time frame, tearing can happen.

To prevent this make sure your hamstrings are flexible and begin a specific strengthening program for your hamstrings. Have your athletic trainer assist you in designing a strengthening program. Working out on an isokinetic machine will offer you a great workout and will be able to test your quad/hamstring ratios. Try running backwards when your hamstring muscles are healed.

I’m a high school football player. I have never injured my knee. Many of my teammates have injured their knees. Can you suggest ways of avoiding knee injuries?

There are six ways to protect against knee injuries:

  1. Exercise the muscles around the knee. There has been research that suggests the ligaments of the knee thicken with exercise.
  2. Don’t do full squats with a heavy weight added as a means of strengthening the knee.
  3. Most knee injuries occur when the foot is in contact with the ground. Short, choppy steps allow for less foot contact with the ground.
  4. Avoid running shoes with cleats. The cleats secure your foot to the ground. Use running shoes that professional football players use.
  5. Maintain flexibility of ankle, knee, and hip musculature. Remember, rigid structure breaks when excessive force is applied and flexible structure bends when excessive force is applied.
  6. Protect your knees from being hit from the side and from behind.
I was playing soccer and my teammate fell hitting the side of my knee. My knee became swollen and hot. I saw my orthopedist. He recommended that my knee be drained. While removing the fluid from my knee, I noticed that the fluid was red. After seeing the red fluid, he recommended that I receive an MRI. Why was the fluid red and why an MRI?

When your knee was aspirated, your doctor was looking for the color of the drained fluid. If your knee produced a clear, colorless fluid it suggests that the severity of the injury may not have involved the ligament structures of the knee. If the fluid aspirated was red, this would indicate a potential ligament structure may have been compromised. Ordering of the MRI will help the doctor determine the degree of the potential ligament damage.

My son and I were wrestling on the living room floor. He unintentionally elbowed the front of my thigh. It was one of those “Charlie horse pains”. In two days my thigh was bruised and a bump had formed. I saw my doctor and he said that I had a hematoma. What is a hematoma and how can I get rid of it?

The trauma to the thigh caused blood vessels to break in the skin, fat and muscle. The bleeding caused a bump that can become hard. After 48 hours from the initial injury, apply warm moist towels to the injured area. Continue this for 10 days from the initial injury. If the bump remains, perform a gentle massage to the area. Massaging will help break up the accumulation of blood in the area.

While skiing, my left and right skis crossed over one another causing me to fall. I felt a pop in my knee and pressure. There was not much pain. I was able to regroup. I collected my skis and poles and continued down the mountain. I took a break for lunch. While sitting eating lunch, my knee began to ache. I went to the first aid office to have my knee looked at. It was swollen and warm. Upon arriving home my knee grew twice its original size. My orthopedist took an MRI.

The results were an anterior cruciate ligament (ACL) tear. The doctor recommended surgery once the swelling decreased. What is involved with surgery and the rehabilitation process that follows?

The surgical techniques today are quite amazing and the results following an ACL reconstruction are fantastic. There are a few options the surgeon has prior to performing this ACL reconstruction. The most common is a patella tendon graft. This patella tendon is found under the kneecap. The middle third of the tendon is used as the site for the graft. Once removed, it is used as the replacement for the ACL that was torn. Following surgery you’ll be sent home using crutches and a straight leg brace with your knee bandaged. Two units of medication will be given to you to decrease swelling (cryocuff) and to increase range of motion (CPM).

Following a week to ten days from surgery, a physical therapy program will begin. The goal of the therapist is to re-establish normal range of motion with preset time frames outlined by your surgeon. The therapist will progress you off the crutches when appropriate and begin a strengthening program. When range of motion and strength have been regained, a specific program is developed to help you return to your daily activities and desired sport.

I twisted my knee playing soccer. My doctor said it was a grade one (1) sprain. How bad is a grade one sprain, and how long will I have to wait before I can play soccer again?

Of the three degrees of sprains, a grade one is the least severe. Following the injury, ice treatments should be applied six times a day for 15 to 20 minutes, and a compression dressing applied to keep the associated swelling down. After five days of this type of treatment, as well as avoiding full weight bearing on your injured knee, the swelling should be under control.

The next step is to find a physical therapy facility with a pool. When in the pool, walk laps for 15 to 20 minutes and perform range of motion exercises. After five therapy sessions in the water, begin walking on the treadmill with an elastic knee brace. Within two to three weeks from the initial injury you should be ready to return to soccer.

You may want to consider a non-cleat shoe if that is not what you are wearing. Cleats anchor your foot to the surface of the playing ground, which could cause your knee to rotate excessively. This excessive rotation could contribute to knee injuries.

My sister was playing basketball with my friends and me. My friend, Eddie, an overly large boy tripped and fell on my sister. We all heard a large popping sound. She was in a lot of pain. The doctor examined her and told my parents that she had a severely injured knee. He called it the “unhappy triad”. He said three things were damaged in her knee. What are they?

The “unhappy triad” consists of three important structures of the knee that help the knee maintain stability. There are two ligaments and one piece of cartilage. The first ligament is called the medial collateral ligament. It is found on the inner surface of the knee. The second ligament is the anterior cruciate ligament. This ligament is found inside the knee.

When these ligaments are damaged, the stability of the knee is compromised to the point that walking, climbing stairs, and other functional activities are decreased significantly. The cartilage, also called meniscus, is the cushion of the knee. This cushion protects the bones from rubbing against each other when weight bearing. Your sister unfortunately damaged all three.

I’m a dancer, or at least I want to be. I take dance lessons in school. I look forward to those classes so much. Recently I injured my knee. I was performing a new movement that involved jumping. When I landed I felt my kneecap move to the side of my knee. The pain was severe but it didn’t last long. Later that day my knee became hot and swollen. I saw my orthopedist and he said that I had a dislocated kneecap. He recommended ice and rest. I don’t ever want this to happen again. What exactly is a dislocated kneecap and how can I prevent it from happening?

When your kneecap moves completely away from its original position, it is called a dislocation. There are five reasons dislocation occurs. The first is caused from a strength imbalance in the thigh muscles. If the outer thigh muscles are more powerful than the inner thigh muscles, the kneecap is pulled in the direction of the more powerful muscle, resulting in dislocation.

The second is a genetic phenomenon. The kneecap “rides high”. It appears as though the kneecap is riding up the front thigh. Tall, thin people are known to have this high patella (kneecap). If the kneecap rides high, it is more prone to dislocate because it is not sitting in the groove created by the end of the thighbone.

The third cause of kneecap dislocation is the groove that the kneecap sits in is too shallow. The groove helps the kneecap function, as in a track. If the groove is too shallow the kneecap can easily move out of place (dislocate).

The fourth reason for dislocation is the kneecap is too small. Being too small, it becomes less congruent and is prone to dislocation.

The fifth reason for dislocation is trauma. A traumatic event to the knee can cause the kneecap to dislocate.

To prevent dislocations from occurring for the imbalanced muscles, a series of specific exercises are designed to balance the imbalanced thigh muscles and knee taping techniques. If you are actively involved in sports, to prevent the second cause of kneecap dislocation from re-occurring, a specific strengthening and stretching program and appropriate bracing technique should be followed. To prevent the third cause of kneecap dislocations, modify your sport and recreational activity. Keep the strength of both lower extremities proportional to your body weight and sport activity. Specific bracing is required if you had an initial episode of kneecap dislocation.

I’ve always had problems with my knees. Lately I’ve noticed that my knees make a crunching sound when I climb stairs. There is some pain but the noticeable sound is embarrassing. Why do my knees make that sound? How can I decrease it?

It sounds to me like your knees have a condition known as Chondromalacia Patella. The undersurface of the kneecap becomes worn. During the wearing process the cartilage forms fistulas that are cracks in the cartilage. When climbing stairs there is a considerable amount of pressure placed on the undersurface of the kneecap. Since the kneecap must glide up as you are ascending stairs, the cracks in the kneecap cartilage produce a grating sound. The term for the grating sound is crepitus.

To prevent additional wearing of the kneecap, strengthen the muscles surrounding the knee. The stronger these muscles are the less chance the force of your body weight will be distributed to the kneecap, and there is a greater chance the force will be spread to the surrounding muscles. If pain becomes an issue seek out the advice of an orthopedist. Nutritionists recommend a product that has glucosamine sulfate and chondroitin. This supplement has been known to improve the health of joint cartilage.

I’ve been bodybuilding for the past three years. I’ve noticed that when I squat I feel something snap over the inside of my kneecap. My orthopedist checked out my knee and said I had a healthy knee. However, I have an extra band of tissue that is causing the snapping sensation. He said that if my knee swells and it becomes annoying, it can be removed. What is this extra piece of tissue?

It is called synovial plica. This synovial plica did not just develop because of your bodybuilding activity. It forms after the twelfth week of embryonic life. An example of plica would be if you were to blow into a balloon. Once the balloon has reached its maximum extension, you are left with the nipple that you would tie with a knot. This knot is the plica. During your development from a child to a teenager this band of tissue did not grow as quickly as the rest of the joint and the plica was too short. When you bend your knee the plica stretches over the inner part of your kneecap and will snap if the tension is too much.

My son is the new pitcher for his Little League team. I’ve been helping him with practice throws. Since he’s a small guy I kneel to catch the baseball. While taking a shower I’ve noticed that my kneecap was swollen and warm to touch. I had my medical doctor look at it and he said that it was bursitis. What is bursitis and how can I get rid of it?

The knee has about 14 bursa sacs. These bursas cushion the tendons, ligaments, skin and bones. Of the 14 bursa sacs found in the knee, three cause problems. The first bursa that causes problems is the pre-patella bursa which is found slightly above and in front of the kneecap. The term commonly used to describe pre-patella bursitis is “housemaid’s knee”. Many years ago women would scrub the floor on their knees irritating the pre-patella bursa.

When irritated, the bursa would produce synovial fluid. This fluid is normally produced by the joint to lubricate itself. When synovial fluid is produced in excess because of irritation, swelling and pressure will be noticed within 48 to 72 hours.

To get rid of pre-patella bursitis, it is best to avoid kneeling and apply the RICE principle: Rest, Ice, Compression, Elevation.

I just began an aerobics class to get into shape for the summer. I’m about 30 pounds overweight. Following about a half hour of aerobics, my right knee became tender. I left the class and went home. Three to four hours later, the back of my knee was swollen and warm. I went to my doctor and she said it was a baker’s cyst and recommend that I receive an MRI of my knee. What is a baker’s cyst and why did she recommend an MRI?

There is a bursa sac behind the knee. If there is excessive unusual joint compression inside the knee this irritation can produce increased fluid. This fluid puts pressure on the joint. The extra fluid pressure pushes into the bursa sac resulting in pain and swelling. You will notice swelling along the entire knee, but predominately along the back of the knee. Bending of the knee is difficult and painful.

Following the examination by your doctor, ordering the MRI is done to rule out possible damage to cartilage, ligament and or bone. If these structures were damaged, additional medical care would be warranted.

My daughter plays soccer for her school. This past weekend while playing soccer on a wet playing surface she injured her knee. After the injury we went home, put ice on her knee and later that evening the pain subsided. While practicing soccer drills she complained of the same pain inside her knee. We saw an orthopedist and he said that the x-rays were normal and that his manual tests were also normal. He suspects that there may be cartilage damage. He recommended that he perform an arthrogram and/or an arthroscopy to determine the extent of the injury. What are the differences between the two procedures?

The arthroscopy procedure is used to look inside the joint to determine the extent of the damage, and at the same time has the ability to clean up unwanted debris. The arthrogram procedure involves injecting a dye into the knee. This dye outlines the bone surface. Your medical doctor can determine from the arthrogram the extent of the damage seen on the bone surface.

I’ve had a history of knee problems for the past 15 years. Recently, I went parachuting, and upon landing, I felt a severe pain in my knee joint. The orthopedist performed an arthroscopic procedure to determine the extent of my injury after six weeks of physical therapy. He claims that I have osteochondritis dissecans. What exactly is it?

Osteo means bone. Chondro means cartilage. Dissecans means a loose piece from the surface of the bone.

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General Questions
The most common question patients ask me is, “How long will it take following a musculoskeletal injury (muscle, tendon, ligament, cartilage and bone) before they can resume their daily activity level?”

There is no true cut and dry answer to this question. There are many variables that influence healing. Healing time is in direct proportion to blood supply to the area injured. If blood supply is ample, the rate of healing is best. If you are in good cardiovascular and musculoskeletal condition prior to the injury, healing will take place faster. The severity of the injury will influence the healing process. The more damage there is the more time is required.

Your age and medical history may impact the healing rate. In some instances, the initial trauma has healed in a pre-established time frame outlined by your medical doctor, but the surrounding tissues have atrophied or the involved joint has become restricted because of immobilization. Also, in some cases too much scarring is produced which prevents normal motion of the injured area. There are commonly used time frames your medical doctor will offer you.

Here are some examples of healing times:

  • Fractured fingers
  • for a child will take three to four weeks to heal and for an adult three to five weeks. (Great deal of blood supply.)

  • Broken toe will take three to four weeks to heal. (Great deal of blood supply.)
  • Muscle strain will take three weeks to heal. (Great deal of blood supply.)
  • Ligament sprain/ tendon strains will take five to six weeks and possibly longer to heal. (Small blood supply.)
  • Spinal discs can take three to four months to heal. (Small blood supply.)
  • Joint cartilage if torn will most likely not heal. (Little to no blood supply.)

Prior to discharge from physical therapy, I rely on the following six criteria to determine if the patient is ready to return to sport or their daily activity:

  1. The injured part is completely healed.
  2. There is no pain in the injured area following a simulated sport or daily activity that the patient performs in my office.
  3. Range of motion of the injured area and the joints above and below are within normal ranges.
  4. Strength of the injured area and the joints above and below are proportionate in strength to the sport and or daily activity.
  5. Balance and coordination are equal to the demands of the sport and or daily activity.
  6. Endurance is equal to the sport and or daily activity.
I have three young children. All of them want to play sports. As a concerned parent, I want to guide them into a sport that has the least potential for injury. Can you name a few?

Table tennis, kickball, stickball, bowling, handball and weightlifting.

It’s important to know that 60% of sport related injuries reported are in the form of sprains, strains, contusions, abrasions and lacerations. Of the sport injuries seen in the emergency room, 97% are treated and released. With this in mind all parents should learn basic first aid.

Which sport results in the highest incident of injury?

More than 60% of all sport injuries occur in four activities: bicycling, baseball, football, and basketball.

In what age ranges are most injuries seen?

Seventy percent (70%) of all sport related injuries occur between the ages of ten and twenty-four.

My girlfriend wants to participate in league basketball. I told her that she should not play sports. Women are more prone to injuries than men because they are weaker. She disagrees with me. What do you think?

There are very few variations in the musculoskeletal system between men and women. Injuries by their nature occur because the external force is greater than the internal force generated by the musculoskeletal system. If your girlfriend is interested in playing basketball, I would encourage her to go through a conditioning program first. Emphasis should be placed on endurance training, strengthening legs, arms, back, and abdominals, followed by a flexibility and coordination program. This advice also applies to men who are interested in sports.

During the course of my athletic endeavors, I have had my share of injuries. Some were serious others not so bad. My older son is extremely active. I’m concerned that he will injure himself but will not tell me. Are there guidelines I should be aware of to help me determine if medical attention is required?

Your child may have a high threshold of pain. If he complains of pain, ask him if he could grade it from 1 to 10. (1 being the least and 10 being the greatest). If it is above number 4, I would be concerned. If this pain does not subside in two weeks, seek medical attention.

If your child has lost function of a limb or if he says he cannot move it, medical attention is necessary.

If your son claims that he heard a popping sound in his joint and now it is swollen, medical attention is required.

Any injury that does not heal in three weeks should be checked by your medical doctor for structural abnormalities.

An abrasion or laceration that presents with pus, red streaks, swollen lymph nodes or fever should be checked by a medical doctor.

What exactly is inflammation and is it bad?

Inflammation is a natural response to injured tissue. The basic process of inflammation is good. All of the necessary components for healing are found in the inflammatory process. White blood cells are available to fight off infection, and clean up dead tissue. Nutrients are available to rebuild weakened tissue, and new blood vessels form to increase oxygen to the injured area. It is when the inflammatory process continues and becomes chronic that it warrants attention by a medical doctor.

My doctor said that the contusion I suffered during my weekend football game was quite severe. He claims that it disrupted the surface of the bone. My bicep muscle is where the contusion occurred and it hurt so much following the tackle I thought I broke the bone. It swelled and turned black and blue and was very hot. I didn’t report this to my coach for three weeks. I began to worry when my pain level didn’t decrease and a large lump was felt in the area of the injury. I went to the doctor and he said that I had myositis ossificans. What is this and how can I get rid of it so I can play football again?

The initial contusion ruptured the blood vessels in the skin, fat, and muscles. When the blood vessels were ruptured, blood leaked out causing the color changes in the area of the trauma. The blood vessels in the muscles that were damaged leaked out and formed a pool of blood resulting in something called a hematoma.

According to the doctor, the contusion was so bad that the lining of the bone called periosteum was torn away from the bone. When this happens bone cells that are designed to create new bone leaked out. If the bone cells leak out into the hematoma they quickly start making new bone. This process of creating new bone within the muscle is managed carefully by your doctor.

Normally, your doctor will start physical therapy following six weeks from the initial injury. Re-establishing range of motion of the joint above and below the injury is top priority. Gentle active range of motion with minimal resistance to the injured area is recommended. Too vigorous activity early in the rehabilitation process is not recommended because of the chance of bleeding in the area. When returning to football, a protective shield should be placed on the injured area. Most cases the new bone growth shrinks to insignificant size within a year.

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