Monthly Archives: May 2011

ABS-solutely, no more crunches!

If you’ve ever stepped into a commercial gym or attempted to “get in shape” in the discomfort of your own home, then you’ve almost certainly done a crunch. It’s a movement that’s as ingrained in our fitness culture as bench presses and biceps curls.

But what if you learned that crunches are far from the most effective and efficient way to work your abdominal muscles?

This is not a revolutionary concept among fitness professionals. It’s been out there for at least a decade. But you’d never know it by watching what people in health clubs do. Sit-ups may be out of fashion, but the basic crunch is alive and well and performed by almost everyone trying to improve his or her appearance.

Most people feel abdominal muscles work the same as a biceps muscle. They can feel it shorten and lengthen so it must make it stronger and bigger.  Well, the abdominals are different in both structure and function.  Their primary job is to protect the spine and assist other core musculature – those in your hips and back – keep your lower back in a safe, neutral position.

That’s what we mean when we talk about “core stability.” It’s not what your muscles look like when you flex them in a mirror. Function is what matters the most. How well can your muscles protect your spine while moving through from position to position.

A foundation for core workouts should be based around planks and side planks. These may be the best entry-level core workouts you will find. There are also, so many variations on all planks that the progression is nearly endless.  If you have never tried a plank, you will be surprised at how challenging they can be.

(A basic plank is simply holding a push-up position on your forearms. A side plank is a 90 degree rotation onto one arm and the sides of your feet. Modifications can be made to make the positions easier but still just as effective.)

While holding these plank positions may not seem difficult, when you hold them for 30-90 seconds, you will discover how little endurance and strength you have through the core.  If you can’t keep your spine in its natural position when working out or playing sports – you are risking a serious injury to the discs in the lower back.

Remember, you cannot have a strong building without a strong foundation.

By: Rocco Ferraiolo PTA, NASM-CPT, SPARQ certified


Platelet Rich Plasma Injections (PRP)

Platelet Rich Plasma injections, or PRP, is an emerging treatment which has gained much popularity through the media, marketing, and with its use on some high profile athletes. However, there are no scientific studies to date that confirm its efficacy.

The body’s initial response to injury is the delivery of platelets. Platelets, in turn, release healing proteins called growth factors.  In theory, a concentrated delivery of platelets could accelerate soft tissue healing, and potentially reduce pain.

PRP injections are performed as follows:

  1. A sample of your blood is drawn (about 1 “vial” of blood).
  2. The blood is centrifuged, which separates the platelets from other blood components.
  3. The concentrate of Platelet Rich Plasma is then injected into injured area.

PRP injections are presently utilized in shoulder conditions (rotator cuff tears/labral tears), elbow tendonapathies (“tennis” elbow and “golfer’s” elbow), Achilles tendon injuries, knee conditions (osteoarthritis/osteochondral lesions), etc.

HOWEVER, although there is anecdotal evidence in some patients that supports the use of PRP, there are no scientific studies to date that show any benefit to its use.

In conclusion, although PRP remains a part of our non-surgical armamentarium,

1.         We still do not know how PRP “works”, or if it actually does work.

2.         Not all PRPs are the “same”.

3.         More research is necessary to determine how PRP reacts with tendons, ligaments, cartilage, and bone.

If you have any further questions about PRP, feel free to discuss it further with your POPB physician.

Joseph B. Chalal, M.D.

Performance Orthopedics of the Palm Beaches

Sports Medicine

Arthroscopic Knee and Shoulder Surgery

The Aging Knee

The knee is commonly referred to as a hinge joint, as its primary plane of motion works like a simple hinge on a door.  In reality, there are rotational, compressive, and shearing forces in addition, all of which make the knee the most commonly worn out joint in the body.  This wearing out process is commonly known as ARTHRITIS.  Arthritis involves the thinning of the cartilage that covers the surface of the bone, known as articular cartilage.  It also involves tears of the meniscus, which is another type of cartilage that serves as a cushion between the bones of the knee.  These two findings, in addition to bone spurs, are almost always present together in the arthritic knee.

Arthritis typically presents with any, or all, of a set of symptoms and findings.  Pain is the most common complaint, and can range from an aching sensation to severe and disabling, depending upon the degree of the arthritis.  Most arthritic knees also swell, crack or pop, buckle, and sometimes even lock.  These symptoms can be mild and intermittent, or constant, all depending upon the severity of the disease. Symptoms can also vary based upon one’s activity level or even the weather, as cold and humid climates can foster symptoms.

There is a broad spectrum of treatment for the arthritic knee, divided between surgical and nonsurgical approaches.  It is important to realize, however, that there is no true CURE for arthritis.  In our practice, we prefer to begin with the basics, and work toward more aggressive treatment as needed.  Ice, rest, activity modification, and anti-inflammatory medications are the mainstay of the conservative approach.  In those who are active on their feet, a brace may help to support the knee and diminish symptoms.  Over-the-counter supplements – i.e. glucosamine, chondroitin, MSM, amongst others – can theoretically help to improve the health of cartilage already in the knee.  Contrary to popular belief, these supplements will NOT help to form more or new cartilage within the knee.

Injection therapy can offer significant relief to the arthritic knee, albeit temporarily.  Corticosteroids, commonly referred to as “cortisone,” can relieve pain and swelling by calming down the inflammation within the knee.  It is the inflammation that produces the sensation of pain.  There is also injection therapy known as viscosupplementation – i.e. Euflexxa, Synvisc, Hyalgan, Orthovisc, amongst others – which involves a series of injections administered over three to five weeks.  These injectibles diminish inflammation in a more delayed fashion than the steroids, by thickening the fluid already in the knee, thereby reducing friction between the moving parts of the knee.  This is similar to the manner in which an oil change would minimize friction in an automobile.  The effectiveness of newer injection therapies, such as platelet concentrates and stem cells, is not yet known and requires further study at this time.

Surgical management for the arthritic knee, in most cases, should be reserved for a time when the above conservative modalities have failed.  Arthroscopic, or microsurgical, treatment may be effective in the early stages of arthritis by “cleaning up” the knee.  In the more advanced knee, arthroscopy has been shown to be ineffective in diminishing symptoms.  In the more advanced cases of arthritis, particularly in more elderly individuals, knee replacement procedures have been shown to be a reliable source of pain relief and improved function.  Whether the knee can be treated with a minimally invasive, partial, or a total knee replacement depends upon the age of the patient, the severity of the arthritis, how much of the knee is involved, and the extent of the deformity of the knee. The choice of the required procedure is typically based upon the judgement of the surgeon, who should always educate the patient as to why a particular procedure is best for him or her.

There is an abundance of treatment possibilities available for the arthritic knee given today’s science and technology.  The decision regarding treatment should be based upon a team approach, which includes the patient, his/her family, and the treating Orthopedic Surgeon.  It is extremely important for there to be a trusting relationship between patient and physician, so that when decisions are made, particularly for surgical management, the patient realizes that his surgeon has his or her best interests in mind at all times.

By: Dr. Jeffrey Press

Performance Orthopedics of the Palm Beaches

Heel Pain – Hands on Physical Therapy and Stretching are Effective for Treating Heel Pain

Do you wake up, put your foot on the floor and get immediate pain in your heel? If so, you might have plantar fasciitis, the most common type of heel pain. With this problem people commonly report having a sharp pain in the heel of the foot that may spread into the arch. The pain is often felt most severe when the person puts weight on the foot after lying or sitting for an extended length of time such as the first few steps in the morning or standing up after watching TV or playing cards. Though the pain may decrease with walking and moving around it often returns at the end of the day after long hours on the feet. Plantar fasciitis is not likely to be caused by a direct injury but rather develops gradually and, if untreated, may get worse over time. Current estimates suggest that 2 million Americans develop heel pain each year, and about 10% of all people will have heel pain at some point in their life. The February 2011 issue of the Journal of Orthopaedic and Sports Physical Therapy published a research study that provides new evidence that can help people who suffer from heel pain.

In the study, 60 patients with heel pain were randomly assigned to one of two treatment groups. One group of patients performed calf and foot stretches and had hands-on therapy provided by a physical therapist. The other group only performed calf stretching. The treatment performed by the physical therapist focused on treating tender spots in the muscle, sometimes called “trigger points.” Trigger points are small areas of muscle that feel like a nodule or are “knotty” and, when pressure is applied, are tender and even painful. The results showed greater improvements in patients who performed both the stretching and received hands-on therapy.

Although stretching the calf and foot can reduce heel pain, the addition of hands-on physical therapy resulted in better pain relief and greater improvements in function during the first month of treatment. Three stretches were used in the study, each performed for 20 seconds with a 20 second rest period; each stretch was done 3 times twice per day. Contact your orthopedic surgeon if you want more information about the treatment of heel pain.

Performance Orthopedics of the Palm Beaches