Rick Wright, MD, the author of this blog, is a sports medicine physician at Washington University Orthopedics in St. Louis and the head team physician for the St. Louis Blues. He specializes in the treatment of sports-related injuries, and has special interests in knee ACL and revision ACL injuries, meniscus injuries, articular cartilage injuries of the knee, shoulder instability, rotator cuff disease, and total knee replacements. Your comments and feedback are encouraged.
Monday, October 31, 2016
Diet Hints to Combat That Sit Down Job
Sitting all day at work is not healthy, but many of us find ourselves with jobs in the sedentary category. Some foods and snacks can help fight this with their anti-inflammatory characteristics. Read more detail HERE
Saturday, October 29, 2016
Maybe You Don't Have to Order That Egg White Only Omelette
For years we have been told eating high cholesterol foods resulted in increased cholesterol levels. Thus, egg yolks received plenty of bad press. Probably unfairly. Read this review which may surprise you. Egg yolks have plenty of good nutrients and don't necessarily increase cholesterol levels. Read the details HERE
Friday, October 28, 2016
Groggy in the morning -- Trouble Getting Out of Bed?
Having trouble rolling out of bed in the morning. See one thing that may be contributing HERE
Thursday, October 27, 2016
Not all Foods are as Healthy as They Appear
Several foods that many of us believe to be nutritious may not be as healthy as they appear. Read this article to learn foods no nutritionist will eat. Find it HERE
Tuesday, October 25, 2016
ACL Reconstruction Graft Choice in Young Athletes
Anterior cruciate ligament (ACL) injuries currently require a reconstruction for active individuals desiring to return to activities that involve planting, cutting, turning, twisting or jumping. A reconstruction simply means a replacement of the ACL since repair currently does not work (see this link for exciting news regarding ACL repair). As part of the reconstruction a graft must be chosen and used. There are several options available, but young athletes and their families need to be careful in their graft decision process. Certain graft choices may not be the best for younger patients.
Broadly, there are two categories of graft: 1.) allograft (cadaver) and 2.) autograft (patient’s own tissue). There are advantages and disadvantages for both types. Allograft offers the advantage of no need to obtain a graft from the patient which may mean less pain and a quicker recovery. Unfortunately, the disadvantages include risk of disease transmission (HIV and Hepatitis 1/1,000,000), slower graft incorporation and a higher rerupture/failure rate. In an important study by the Multi-center Orthopaedic Outcomes Network (MOON) Group that we participated in at Washington University as an original MOON Group site cadaver grafts were noted to have a 4 times higher failure rate vs. autografts for patients of the same age and activity level. For example a 16 year old female high school team sport athlete has an ~5% ACL autograft failure rate in the first 2 years after surgery and ~20% failure rate over the same time period for an allograft. Read the study here: (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3445196/) Obviously, that is a rate of failure unacceptable for young athletes. Conversely, in a patient over the age of 40 the failure rate remains 4 times higher, but at 2% vs. 0.5% the relative risk is very close and allograft may be a reasonable choice for an older adult patient.
This has been confirmed also in the revision (redo) ACL reconstruction setting with a 2.78 times higher failure rate for allografts noted by a study performed by the Washington University coordinated MARS Group. Read the study here: (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4447184/ )
There are 2 types of autografts commonly used: hamstring or patellar tendon. Both have advantages
and disadvantages. Hamstring grafts have a lower risk of kneeling pain, but less strong initial fixation and typically are ~1mm looser once healing is complete. Patellar tendon grafts have stronger initial fixation, heal a little tighter, but have a higher risk of kneeling pain. Data from Europe suggest the hamstring grafts may have a slightly higher (0.5—1.0%) risk of rupture, but this has not been duplicated in the US in similar studies. I typically recommend patients let their surgeons use the graft with which they are most comfortable. The small differences in the grafts typically do not matter clinically.
The Effects of Stopping Exercising
The effects of stopping your workout program accumulate quickly. Read the sad review of the multiple effects HERE.
Monday, October 24, 2016
The Concussion Protocol
It is not uncommon to read in the sports pages that an NHL or NFL player sustained a concussion and is undergoing the concussion protocol. What is the concussion protocol? There are significant similarities and I will try to explain the big picture of what the protocol means without becoming too technical.
Once a player sustains trauma to the head in either league that is worrisome or suspicious for a concussion the player is removed from the game and taken to a quiet place for evaluation. This will include formal testing of the player and determining any symptoms the player may have. Testing will include cognition, memory and physical tests of balance.
If the player is determined to have sustained a concussion or if there is suspicion of a possible concussion the player is removed from the rest of the game and monitored.
At this point the player may need additional testing or close monitoring. Following the game and the next day the player’s symptoms are monitored. The player is encouraged to avoid activities that might exacerbate symptoms including video games, TV, computer and smart phone activities. As symptoms improve the next steps are taken to determine recovery. When the player’s symptoms have resolved then physical activity can be attempted which typically is a short exercise session of light stationary cycling, jogging or another aerobic activity. If symptoms return then the activity is stopped. If the player tolerates the increase in heart rate without symptoms then in following days the player will continue to slowly increase the activity level and will repeat the neuropsychological testing done previously ---before the season began.
If the neuropsychological testing has returned to baseline and the player has remained without symptoms then they will be allowed to return to practice and increase activity as tolerated. Once their functional skills and conditioning has returned to a level consistent with returning to game action they are released to play. All of this is contingent upon remaining asymptomatic during the progression of activities. As can be seen it can involve several days to protect the health of the player and avoid worsening symptoms or returning them to play prior to resolution of any concussion symptoms.
Frequently associated with concussion can be cervical spine musculature aggravation due to the trauma to the head. Local modalities, stretching and massage can sometimes relieve these symptoms which can be confused with concussion symptoms. Addressing these can help speed recovery and eliminate confusing symptoms.
Saturday, October 22, 2016
How to Manage Hydration and Exercise
Previously we discussed proper nutrition for exercise. Hydration is just as critical. Look HEREfor suggestions
Friday, October 21, 2016
Proper Nutrition Before and After Exercise/Run
It's the Fall and many people are training for and participating in marathons and half marathons. That type of training and event requires proper nutrition before and after exercise. Read Time Magazine's helpful hints HERE
Monday, October 17, 2016
Knee Bone Bruise: Their Affect on Athletes and the 2016 Baseball Playoffs
The Blue Jay's playoff hopes were hurt when Devon Travis was diagnosed with a bone bruise.
He underwent a cortisone injection, but has not improved enough to play. These injuries which are increasingly diagnosed require a traumatic loading of the knee. In the isolated situation there is no structural damage. The knee will be swollen and painful with activity. Bone bruises are also frequently noted with ACL tears (80%) when the tibia (leg bone) subluxes and strikes the femur (thigh bone). Diagnosis can be suspected based on clinical exam and history, but requires an MRI for confirmation. That is why they were not known to exist before the mid 1980s.
In the common isolated situation there is little that can be done to speed recovery. Most physicians have felt that the recovery to full activities is 6 weeks, but in this study I published in 2000 we demonstrated different results. This was the first ever report of a series of isolated bone bruises. In this study published in the American Journal of Sports medicine it was shown that the average time to recovery and full normal activities was 3.1 months. This was much longer than health care professionals had previously thought it took for recovery. This has ended up as very helpful information in advising athletes, coaches and general managers as to the timeframe for their recovery from these injuries. You can read the entire study HERE
Saturday, October 15, 2016
Why You May Not Want to Overload on Protein to Lose Weight
A recent Washington University study demonstrated that in weight loss patients a diet with increased protein compared to balanced calorie restriction resulted in equal weight loss. The concern arose regarding insulin sensitivity where the higher protein diet did not result in an improvement. Read details of the study and the diets in the Time magazine study HERE
Wednesday, October 5, 2016
Meniscal and Chondral Predictors of ACL Revision Reconstruction Outcomes
Revision ACL reconstruction is known to result in worse outcomes. Meniscus and cartilage damage may contribute to these worse outcomes. With the MARS (Multi-center ACL Revision Study) Group we looked 1215 revision ACL reconstructions to analyze the impact of meniscus and articular cartilage damage on patient results We found that a previous lateral meniscectomy and femoral groove/trochlear groove cartilage damage most strongly contributed to worse patient outcomes. Read further details HERE
Tuesday, October 4, 2016
Exercise in the Elderly
There are multiple beneficial effects for the elderly from exercise. These include mental and physical effects. Physicl effects include not only improved balance and injury prevention but also injury recovery. Read the full story HERE
Monday, October 3, 2016
Patient Expectations Regarding Meniscus Injuries and Treatments
In a recently published study we anlyzed patient expectations and knowledge regarding meniscus injuries and treatments. Patients that had previously undergone meniscus treatment were much more knowledgable regarding meniscus issues. Only 28% of patients understood that meniscus resection is actually more common than repair. The most common concern regarding meniscus treatment was the risk of arthritis. You can read further details HERE
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