Reston Hospital Center - April 06, 2015

Answer: Your pain and weakness could be due to cervical stenosis. Cervical Stenosis refers to when the spinal cord or spinal nerves in the neck are compressed. If there is spinal cord dysfunction with this type of spinal stenosis, symptoms can include pain, weakness and numbness in the shoulders, arms, hands, legs and feet, trouble with coordination and balance. Cervical spinal stenosis can often be managed with physical therapy, anti-inflammatory or analgesic medications, and activity modification. Patients with severe pain from cervical spinal stenosis may be recommended for surgery to help relieve pressure on the spinal cord.

Answer: The ACL (Anterior Cruciate Ligament) is one of the four major ligaments in your knee. It helps stabilize your knee and does not heal when torn. As a result, once you’ve torn your ACL, you may find that your knee occasionally gives way or buckles. This instability will most often occur when you are doing pivoting and jumping activities like racquet and team sports, hiking and dancing. On the contrary, in most people who have torn their ACL and who are not doing these types of activities, the knee will often feel stable.

Therefore, the decision as to whether you should undergo surgery to replace your ACL is based on whether you wish or need to resume pivoting and jumping activities. If so, then surgery to replace your ACL will not only enable you to enjoy the sports and activities that you want but it will also reduce the chance of further injury to your knee. If, however, you are not interested in those types of activities, then you may wish to try nonsurgical treatment, including physical therapy. If you choose nonsurgical treatment and you are among the few who have instability with everyday activities, then you will also need to consider surgery.

Jeffrey Berg, MD

Town Center Orthopaedic Associates

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Answer: Hip arthroscopy may relieve painful symptoms of many problems that damage the labrum, articular cartilage, or other soft tissues surrounding the joint. During hip arthroscopy, your surgeon inserts a small camera, called an arthroscope, into your hip joint. The camera displays pictures on a television screen, and your surgeon uses these images to guide miniature surgical instruments. A range of procedures can be done, depending on your needs such as smoothing off/repairing torn cartilage, trimming bone spurs and/or removing inflamed tissue.

Answer: Oftentimes, pain with squatting can be caused by cartilage damage from behind the knee cap. This can be referred to as chondromalacia of the patella or patellofemoral syndrome. Diagnosing this is fairly easy with a physical exam. The treatment may involve anti-inflammatory medicine, physical therapy for quadriceps strengthening or possibly a cortisone injection.

Answer: Platelet rich plasma (PRP) accelerates healing of muscle and tendon injuries using the body’s own platelets. PRP therapy is a specialized process that involves taking blood from the patient, spinning it down to harvest growth factor-rich platelets, then injecting them directly back into the injured tissue, often under ultrasound guidance. PRP enhances the body’s natural healing capacity, but in a much more powerful form. It is most commonly used to treat tendon and muscle tears, acute and chronic muscle strain, degenerative disorders, and joint pain.

Answer: Hip pain can be caused by a number of etiologies however, in an athlete, it is often due to overuse, muscle strain or labral tears and an entity known as femoroacetabular impingement. This often presents clinically as pain in the groin, particularly with cutting, running, squatting or quick changes in direction. This can be detected on physical examination in a doctor's office and frequently requires imaging studies such as X-rays and MRI scans. In many cases, appropriate rest and physical therapy can help resolve symptoms. Steroid injections may also be used selectively as well. In cases that don't resolve with conservative methods, arthroscopic hip surgery is an option.

Ryan Miyamoto, MD

Fair Oaks Orthopaedic Associates

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Answer: That’s a great question, and you have the right approach to be prepared going into surgery. I always say that the healthier you are going into surgery, the easier your recovery will be afterwards.

In order to have a successful total joint replacement, you need to be prepared both mentally and physically. We recommend that all patients go through a “Pre-Hab” course – or a short physical therapy course - to get your body in the best shape you can before proceeding to joint replacement surgery.

We also recommend patients have a physical and blood work completed by their primary care physicians to ensure everything is medically stable prior to surgery. Some patients may require additional clearances by a cardiologist, hematologist, or vascular surgeon if there are any other underlying medical conditions.

Dentists are a critical component to a successful total joint replacement surgery. We require all our patients to see a dentist prior to surgery to confirm there are no preexisting infections in your mouth. Infections in your mouth can travel through the bloodstream and infect your new joint. Following surgery, it is imperative to always take antibiotics prior to any dental procedures for the rest of your life as a means of preventing joint infection.

Nutrition also plays an important part of the healing process after surgery. Patients require 30 grams of protein three times a day prior to and after surgery in order to maintain lean muscle mass – that’s equivalent to about a protein serving the size of a chicken breast three times a day. If your body doesn’t intake protein it will take away muscle to provide protein for healing, thus decreasing muscle mass, which will result in a slower recovery. My practice has a dietician on staff to help our patients both before and after surgery and provide the necessary tools to help our patients heal and recover as rapidly as possible.

The best thing anyone can do after joint replacement is to walk and move the joint. For my patients, they can expect to walk (with assistance) around the same day of surgery. We get you moving on stairs the second day and many can do stairs on the same day of surgery. The more you walk, the better you will do!

The entire goal of joint replacement surgery is to get you back to what you love to do - whether that means walking without pain, playing tennis or golf, or running around with your kids or grandkids. My goal and any surgeon’s goal is to not only give you a new joint but to give you a new outlook on life.

Randall Peyton, MD

Arthritis and Sports Orthopaedics

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Answer: If all non–surgical methods of treatment fail, a diagnosis of arthritis is confirmed, other medical problems are developing as a result of arthritis, requirements for pain medications are increasing and significant lifestyle changes have occurred as a result, then you should consider knee replacement surgery. Many younger adults with knee arthritis, ages 50-65, are concerned about how long will the replacement last. Thanks to improvements in materials and design, the vast majority of knee implants will last 20 years or more based on current scientific studies. It is likely that current techniques and materials will prove to last even longer.

Answer: Bicycling is a great way to stay in shape and in many ways is a “low impact” exercise. If you are just taking up bicycling it is important to remember that bicycling does not provide great conditioning of the back musculature and for some people poor posture on the bicycle can increase strain on the low back or on the neck. Back strengthening exercises are important in conjunction with your bicycling routine in order to prevent injury.

If you are riding your bike over rough terrain or over long distances, increased jarring and compression can occur affecting the discs in the spine, which can also cause back pain. In order to prevent back pain or injuries when bicycling it is important to choose the best bicycle for your purpose. When choosing a bicycle, getting the advice of an experienced rider or a professional bicycle shop can ensure that you have the best bike for your body and your riding style.

For beginners or people with back or neck problems:

  • Consider using a mountain bike with higher, straighter handlebars to allow you to ride in a more upright posture
  • Bigger tires and shock absorbers can decrease stress on the spine while riding
  • Other biking accessories including seats, padded covers, and gloves can also decrease the amount of stress on your body

Seat Height:

  • Sit on the seat and dangle your feet- you should not be able to have the balls of your feet touch the ground
  • Seat height should allow your legs to extends with a slight flexion at the knees
  • Position the seat at a level where you can maintain a stable position- not too forwards or too backwards

Handlebar Height:

  • Your posture should have a slight flexion at the lower back with a wide chest and shoulders
  • Arms should not feel overstretched
  • Avoid low handle bars- this can cause excess lordosis (curvature) of your lumbar spine
  • Your wrists should not be over extended

Remember when riding that the pulling component with your legs is just as important as a pushing component! Following these tips and making sure you have the proper equipment can help you get great exercise and have fun while minimizing your chance for injuries.

Answer: ACL tears are one of the most common knee ligament injuries. Sports and fitness routines that involve running, pivoting, turning, and jumping may lead to torn ACLs. Symptoms include sudden onset pain, swelling, joint line tenderness, sense of instability and subsequent stiffness.