Category Archives: Orthopedic Therapy

Back to Health

Chiropractic PainSpine Health: Making sure your back bend is not a back break

A healthy body is essential for healthy dancing. Spine health is not only important for injury prevention, but also important for improving your technique, strength, endurance, and quality of dance.

 

Core

Your core protects the spine and keeps your back healthy. Many dancers think of the core as the abdominal muscles (“abs”). The abs are one part of the core. The core also includes the back muscles, the abdominal muscles that wrap around the side of your waist, your hip muscles, and your buttock muscles. All of these muscles contribute to your core. Importantly, strengthening these muscles helps with your control. This means your extensions are able to be held higher and longer, your balance is better, your turns increase, and your artistry improves.

 

Outer Hip Leg Lift

One of my favorite core exercises focuses on the outside hip muscles. No matter what physical activity you do, you will tend to have muscle imbalances. Dancers work their turnout, so often times the other hip muscles are under-trained. You lie on your side, controlling your waist so you are not arching or tucking. Then, lift the top leg. It is best if you can bring the leg behind you in extension a few inches and turn it in just a little. I think of touching the toes of the moving leg to the arch or heel of the grounded leg. You should feel this working the muscles in the outside of your buttock/hip. You should not feel it working the muscles in your groin or hip flexor area – that means your leg is coming too far in front. Make sure to do both sides evenly.

 

Plank

Another favorite core exercise is planks. This is essentially a push up position that is held in place. It can be held either on the hands or the elbows/arms. Keeping a straight spine without arching or tucking under and not allowing your pelvis to move upward (which makes it easier) is important. Your body should be in a straight line. Ninety seconds is a good goal for a plank. Once you feel confident with your plank, add a side plank. Again, make sure your body is in a straight line and exercise both sides evenly.

 

Bridge

A bridge (also known as a half bridge) can also help strengthen your core muscles. Lie on your back with your feet on the ground and your knees bent up, arms by your side. Press your feet into the floor or exercise matt, lifting the hips upward so your weight is on your feet and shoulders. You are now in the bridge position. You then roll down from that position as you exhale and contract.

 

Technique

A strong core leads to a healthy spine. A healthy spine also comes from correct technique. At a young age, when they have less core development, dancers often arch their backs. This is for many reasons, but it can lead to injury. Teachers help their dancers correct this technique error, but sometimes dancers over correct an arching issue and end up tucking. Similar to a contraction, the dancer tilts the pelvis forward, often at the bottom of a demi or grand plié.

The correct alignment is to keep the spine neutral through a plié without arching or tucking. A correct plié influences a neutral spine just as the converse is true: a properly aligned spine produces a quality plié. Teachers at auditions may look for spine alignment and correct use of the core muscles. This is because how dancers use their spine can reveal potential information about their level of control, movement quality, and core strength.

 

Conclusion

Core cross training helps protect the spine, but it also helps your quality of dance. It is difficult, if not impossible, to maintain the positions required in dance technique without strength. While dance technique alone builds strength, it also builds imbalances, like any other physical activity. Adding a few core exercises can improve your health and your artistry. Happy, healthy dancing!

 

by: Dr. Kathleen L. Davenport, M.D.

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Which Brace Is Best for My Knee?

ID-100120677Braces can be prescribed for many reasons, depending on a patient’s symptoms or recovery point after injury. The following is a summary of braces prescribed, and ways that braces can assist the knee in performing regular activity.

  1. Sleeve or Wrap-Around Braces: These usually slide up the leg like a sock or wrap around the leg with Velcro. They fit snuggly around the lower thigh to the mid-calf. They are used to provide minimal stability and are mainly used to control swelling at the knee. These are usually sold in drug stores and do not require a physician prescription.
  2. Hinged Knee Brace: These braces usually have 2 types of fasteners. It can be held on by strong Velcro or with plastic buckles. They provide a moderate amount of support and help prevent with knee buckling. They will all have a metal support hinge on the inside and outside of the knee. They can be administered by a physician, or found at medical supply stores.
  3. Arthritis Brace: These braces are made of a rigid tough plastic and are held in place with straps. They are used to “unload” an arthritic area of the knee that may have significant more wear and tear than the other side. This may be beneficial in prolonging the need for surgery while increasing stability, and allowing more weight bearing with less pain. These braces are prescribed by a physician, and a trained professional will come to fit a custom brace for your knee.
  4. Stability Braces: These braces are used to protect the knee after ligament or tendon repairs. They are also made of a hard plastic, and fit snugly to the leg with straps. They are mainly used in the return to sporting and high level activity after surgery. They need to be custom fitted to an individual, and require a physician prescription.

If you feel that you need one of the following knee braces or have questions, make an appointment with one of our physicians, or ask your physical therapist.

 

Written by Chris Athos MPT, COMT

Preferred Orthopedics of the Palm Beaches

 

Image courtesy of FreeDigitalPhotos.net/ Ambro

It’s A Small World After All…A Tale of Three Hippies

It was the best of times (recall when we did what we wanted without being told NO by our bodies?); it is the worst of times. Okay, it isn’t the worst, but when our bodies start dictating what we can and can’t do, it seems the worst. Something must be done!

On April 13th, I had an appointment with orthopedist, Dr. Gregory Martin (Performance Orthopedics of the Palm Beaches, Boynton Beach) to discuss my ever aching hips.

On April 14th, Lana Mayer met with Dr. Martin about her medical condition. On May  6th, Maxine Herold met with Dr. Martin to discuss her hip problem. Little did we know  that we would become the medical talk of Bellaggio.

Word spreads fast in Bellagio. At the Memorial Day dance, I heard about two other people who were having hip replacement surgery the following week. That didn’t mean much to me as many people are having one procedure or another at one time or another. Six degrees of separation doesn’t exist here.  It’s more like one degree (Okay, maybe two).  Everyone knows someone who’s having a procedure and, if they don’t, they know someone who knows someone who…etc.

Lana and Maxine know each other from tennis. I “knew” the ladies, but didn’t really “know” them until we met at a pre-surgery prep and workshop on June 1st. It was then that the three of us realized the coincidence in having all our surgeries set for June 6th: Maxine’s at 5:30 am, mine at 6:30 am and Lana’s at 9:30 am.  Each surgery took about an hour after which we were settled into our luxurious private rooms at JFK. It’s private if you disregard all the medical staff that come in-uninvited-at all hours of the day and night. If you want a good night’s sleep, stay away from hospitals.

On day two, we passed each other in the halls as we began our physical therapy. Considering that we had major the day before, we were getting around pretty well albeit with the help of a physical therapist and lots of, at least in my case, drugs.  We would visit each others’ rooms even though it was against regulations (something about infectious diseases). Lana and Maxine were discharged on day three, me on day four (maybe I had better insurance coverage).

Lana and I had the same visiting nurse, Linda, and “physical therapist”, Fernando (I promised both that I would mention their names). Linda administered my daily injection (I’m a “wuss” and couldn’t and wouldn’t do it myself) and Fernando began what would be weeks of physical therapy. We called each other to monitor our progress and met every two weeks at the cafe to visualize our progress. Considering what we went through, we were doing pretty well.

 Our PT continued at the Fitness Center with Bellaggio’s own “physical terrorist,”  Kathleen. The three of us were often seen in the pool doing our exercises together. We  would encourage each other to keep going and, quite frankly, working out together made  it more like fun than work.

So here we are, ten weeks removed from our surgeries. Maxine and Lana hope to be  back  on the tennis courts soon, and me…back to feeling 65 again. On the lighter side,  you have    to experience an official TSA patdown. What a thrill!! Are you a candidate for  hip  replacement surgery? Want some advice or encouragement? Talk to us:  The Three  Hippies  of Bellaggio!

Featured  in the Ballagio Newsletter                                                                                                                                                                                  Written by: Jeff Robins

Kinesio Tape: What Does It Do?

Dr. Kenzo Kase a Japanese chiropractor invented Kinesio Tape in the 1970’s. In the first decade it was used by Orthopedist, Chiropractors, Acupuncturist, and other medical professional in Japan. Then in the second decade it became popular with Japan’s Olympic team and other professional athletes. In the United States it gained popularity after the 2008 Beijing Olympics. Kerri Walsh, Lance Armstrong, and Serena Williams are a few of the professional athletes who have used Kinesio Tape as modality and benefited from it.

Kinesio Tape is made of soft cotton and contains no latex or medications. It has a light medical-grade adhesive made from 100% hypoallergenic acrylic. The adhesive is heat-activated, you simply apply to the skin and rub briskly to activate. It is easily removed and leaves no sticky residue. Moisture dissipates quickly through the porous material of the tape, allowing it to withstand sweating, showering, and even swimming without coming off or irritating skin. This tape can be worn without binding, constricting or restricting movement.

Kinesio tape helps a variety of injuries and inflammatory conditions. It can be used to correct a movement deficiency, brace an unstable joint or assist with muscle re-education. Kinesio tape can either provide support or prevent over-contraction of muscles. When used for support, taping allows the patient to retain his full range of motion and normal mechanics and provides all-day facilitation of lymphatic drainage.

Kinesio tape is available in various cuts and colors to treat several different muscle groups, including neck, shoulders, knees, wrists, back and other common areas where injuries occur. These cuts, in shapes such as X, Y and I, are designed to mimic the structure and the makeup of the muscle fibers, so the tape can be placed along the length of the muscle and provide extra support for faster healing.

Besides using Kinesio tape for structural purposes, it can also be used to eliminate pain. When you apply Kinesio tape to the structure before beginning a strengthening program it can help recruit muscle groups to fire through the tactile feedback the tape provides. In turn, this can help correct poor neuromuscular firing patterns. Kinesio tape used along the spine can significantly help with postural corrections. When you move into an improper postural position the tape will become tight which will cue the muscle to maintain proper positioning.

Kinesio tape can be used post-surgically to help reduce swelling. When the tape is applied in a grid or lattice pattern it causes the skin to dimple in the small squares not covered by tape. In turn the dimpling creates alternating spaces of increased and decreased pressure, which creates a flow of fluid allowing the lymph system to better absorb it.

Patients with shoulder impingement or tendonitis typically also have a component of altered neuromuscular firing patterns causing poor glenohumeral and scapula thoracic mechanics. Kinesio tape can help provide a tactile feedback sensation which helps the patient feel how the shoulder should or should not be moving. The patient becomes more aware of their shoulder issues after the tape is worn for a few days and more in tune with their body mechanics. It is the tactile sensation of the tape on the skin when either activating or inhibiting that influences the muscle or muscle group.

Kinesio tape can be place over a bad bruise. You apply wide strips of Kinesio tape stretched in a spider formation which allows a breather under the skin. This allows the lymphatic system to do its job of removing the fluid.

Patients normally understand the benefits of traditional taping and do not need to be educated. On the other hand with Kinesio tape patients do need to be educated on what it is and how it works. There is a tendency for patients to be skeptical, but after using the tape several times they see the benefits. Kinesio tape is user friendly and can be easily removed. It can be applied in hundreds of ways and assist in returning the body to homeostasis.

By Rita Zimmermann

iTotal Knee Resurfacing now available at JFK Medical Center

We are pleased to announce that JFK will be among the firstmedical centers in the country to perform a new patient specific total knee resurfacing procedure.  The device, called the iTotal, is from a Boston area manufacturer named ConforMIS (www.conformis.com).   FDA approval was attained earlier this year.  The company is a leader in developing patient specific partial and, now, total knee implants.

Knee

Many companies and surgeons claim to perform patient specific total knee replacement, however what they are really doing is using patient specific cutting guides to implant off the shelf implants.  Off the shelf implants typically come in 6 or 7 different sizes and the patients bone is cut to fit the implant.

With ConforMIS, it is a big difference because the actual implants, as well as the cutting guides, are all specifically made for the individual patient.  This is important because we know that over or under-sizing an implant by just a few millimeters can be a predictor of pain after total knee replacement.  The ConforMIS implant fits the patient perfectly because it was made for them.  The device offers a wear optimized design with an anatomic shape and fit for natural kinematics.  Full coverage of weight bearing areas is achieved.  It can be implanted via a minimally invasive technique with less trauma to the patient and significantly less bone removed.

Patients who wish to be considered candidates are worked up with a complete history, physical, and xrays.  If they appear to be a candidate, a CT scan is obtained.  The CT scan is then sent to the company and about 6 weeks later their implant kit is ready.  The kit arrives sterile in a box with all the implants and the instruments.  The surgery typically lasts under an hour and patients can be rapidly mobilized.  Hospital stay will be 1 to 2 nights.   Recovery can be expected to last 6 to 8 weeks.

Like traditional total knee replacements, the complications can include infections and deep venous thrombosis/pulmonary embolism, amongst others.   At JFK, we do everything to prevent complications.  JFK is a high volume joint replacement center, and as many studies have demonstrated, higher volume centers have a lower risk of complications.

Total knee replacement has been widely regarded as one of the most successful surgical procedures and has been performed for about 40 years.  However, some studies show that as many as 1 in 5 patients who undergo total knee replacement are not satisfied with their outcome.  There is room for improvement.  iTotal hopes to improve satisfaction with total knee surgery by providing a device that fits the patient like their own knee.

By Gregory M. Martin, M.D.  Medical Director, Orthopedic Institute @ JFK

Knee Arthroplasty in the morning……..and home for dinner.

Osteoarthritis of the knee affects millions of Americans and is painful, debilitating and interferes with the quality of life of many of our patients.  Total Knee Replacement has been the gold standard treatment for end-stage disease, but the procedure can often be associated with pain, significant blood loss, medical risk, and recovery can often take months to years.  Because of this, plus fear of hospitalization and a period of incapacitation, may patients elect not to undergo the procedure.  Of those that do undergo total knee replacement, as many as 20 to 25% of patients end up not satisfied with their outcome.  At JFK’s Orthopedic Institute we are pioneering a procedure which may offer new hope.   We have been performing uni and bi-compartmental knee arthroplasty on an outpatient or overnight stay basis for over a year now. The procedures utilize Conformis Patient Specific Resurfacing implants called the i-Uni and i-Duo.  Soon, JFK will be one of the first centers performing total knee resurfacing with the recent FDA approval of the iTotal device.

The knee joint has three compartments (lateral, medial, and patellofemoral).  One, two or all three of these can be affected with osteoarthritis.  The implants, made specifically for each patient, are constructed off of a pre-operative ct-scan.   The technology, designed in conjunction with doctors from Harvard Medical School, has been FDA approved since 2007.  The advantage of the procedure is that it leaves the healthy parts of the knee and only addresses the diseased part or parts.  Because of this, the procedure is typically associated with less pain, minimal blood loss, shorter hospitalization, and a quicker recovery.  Minimal rehabilitation is required when compared with total knee replacement.  Patients typically say that it feels like their own knee, which is not typically heard of with total knee replacement.

Initial results have been promising.  In the first 50 cases in 45 patients, we performed 37 medial iUni’s, 7 lateral iUni’s, 5 medial iDuo’s, and 1 lateral iDuo.  Average operative time was 62 minutes.  Mean drop in hemoglobin was only 1.7 gms.  Mean length of stay was 1.3 days and recently 10 cases have been done on an outpatient basis.  Because of the diminished pain with the procedure, we have eliminated the use of continuous femoral nerve blocks for these patients in favor of other multi-modal pain control techniques.  Return to function is usually rapid with minimal physical therapy and mean flexion in the group was 125 degrees.

For those concerned about longevity of partial knee replacements, when one looks at recent follow up studies of modern partial knee designs, results are encouraging.  A study in 2004 demonstrated 96% survival at 15 years of follow-up.  In 2009, a study compared follow-up of partial versus total knee replacement, and found that 15 years after the procedures the partial knee group had higher survival and higher knee scores than the total knees.

We look forward to following the long term outcomes of these devices and are actively participating in a post-market clinical trial of the iUni device.  In addition, we are hopeful that the iTotal will address many of the shortcomings of traditional total knee replacement and meet the expectations of higher demand patients.  For more information visit www.conformis.com.

By Gregory M. Martin, M.D.  Medical Director, Orthopedic Institute @ JFK 

What’s up with Glucosamine and Chondroitin?

There is a lot to that question, and we’ll cover some details below if you care to read more, but the basic answer is: it probably can’t hurt, and it might help.

We have recently noticed a surge in advertisements for these two products, with claims to offer major benefit for stiff and painful joints. So, we felt it would be helpful to pass along our assessment of the value of these supplements and our opinion of what is sensible vs. what is nonsense.

First, what are we talking about?

Glucosamine and chondroitin sulfate are natural substances found in and around the cells of cartilage. Glucosamine is an amino sugar that the body produces and distributes in cartilage and other connective tissue, and chondroitin sulfate is a complex carbohydrate that helps cartilage retain water.1 In the United States, glucosamine and chondroitin sulfate are sold as dietary supplements, which are regulated as foods rather than drugs1. The interest in using these elements became popular as a result of the reports of successful use in the veterinary arena and in the 1997 book “The Arthritis Cure”2.

Most of the reports on the use of these supplements have come from non-scientific reports. Many sources advocate the inclusion of other substances with the daily dose of glucosamine and chondroitin, thus it makes it difficult to know if in fact any effect or benefit noted is a result of the glucosamine, the chodroitin, both, or from one or more combinations of the other ingredients in the product being marketed.

An ingredient that many preparations include is MSM (Methylsulfonylmethane). The reported advantage of this chemical, that is found in small quantities in many foods, is that it provides sulfur to the body in a very useable form. Sulfur is reported as being beneficial because it helps in forming connective tissue cross-linkages.3 Glucosamine and chondroitin are the building blocks of joint cartilage and, thus, are bound together by sulfur bonds.3 So, combining MSM and glucosamine and chondroitin would seem to be sensible.

There is one recent study that points to the potential benefit of MSM. The paper was published in 2006 and reported on the results of a study done in 2004 by Southwest College Research Institute, Southwest College of Naturopathic Medicine & Health Sciences, Tempe, AZ. It was published in Osteoarthritis and Cartilage and reported statistically significant reductions in pain and in difficulty performing activities of daily living compared to a placebo control group.

The scientific basis for use of glucosamine and chondroitin has been primarily grounded on the results of the 2006 study by the National Institutes of Health, “Glucosamine/chondroitin Arthritis Intervention Trial” (GAIT).5 Proponents as well as skeptics are able to find elements of this study to support their position, but the bottom line seems to be that for some patients there was relief of symptoms though no improvement of the overall degenerative changes within the knee. Thus, it may not help but it doesn’t seem to harm. Interestingly, of the almost 1,600 patients in the study, the small group in the moderate-to-severe pain group (22%) had significantly reduced pain while the larger “mild” pain group (78%) found no significant relief. Because of the small size of the subgroup the findings had to be classified as preliminary and thus need to be confirmed through larger studies to prove statistical significance.

So, what do we recommend based upon our reading and experience?

First, if you are going to try this dietary supplement then you should get a form of it that is of high quality so as to assure purity, potency, quality, and consistency among batches. Second, make sure the quantity of glucosamine and chondroitin is at a level at least that of the strength in the GAIT study – 1,500 mg glucosamine and 1,200 mg chondroitin. It is possible that MSM can help and so it makes sense to have a formula that includes that. Sources suggest between 1,500 and 6,000 mg. per day. We think the lower end of that scale makes sense. Lastly, since absorption in the intestine is important, the use of a liquid formula may allow for more complete uptake of the ingredients since pills have binding agents that may affect their breakdown within the stomach.

By Rett W. Talbot, PT, MS, SCS, ATC, CSCS

1National Institutes of Health National Center for Comlementary and Alternative Medicine “Questions and Answers: NIH Glucosamine/chondroitin Athritis Intervention Trial Primary Study” http://nccam.nih.gov/research/results/gait/qa.htm

2 “Glucosamine: Everything You wanted to Know” http://www.jointhealing.com/pages/productpages/glucosamine.html

3 “How MSM Works to Improve Joint Health”, http://www.msmguide.com/

4 “MSM Research Papers”, http://www.msmguide.com/

5 “Glucosamine/Chondroitin Arthritis Intervention Trial (GAIT)” http://nccam.nih.gov/research/results/gait/