What Everyone Needs To Know For A Safe Pool Season

There’s really nothing better than taking a dip in a cool pool on a long, hot summer day.  With a nice swim, we can relax, exercise or just have fun with friends. We wouldn’t want anyone to miss out on a good time – or, more importantly, suffer a serious injury – so we’re sharing some easy-to-follow tips to think about next time you’re planning a day poolside.

Before You Plunge

Before you get into a pool, it’s important to evaluate first and foremost if you actually should. Ask yourself: Am I alone? Do I not see a lifeguard present? Is the weather report calling for lightning? Have I consumed alcohol? Am I too tired or too overheated? If you can answer ‘yes’ to any of these questions, reconsider.

Know Your Depths

Make sure you know how deep the water is. Look out for depth indicators throughout the pool, as depths can vary in different sections. NEVER dive in shallow water and always check depth markers before you go in headfirst. More on diving in our next section. If you are an inexperienced swimmer, avoid depths where you cannot stand comfortably with your head above water.

Diving

It bears repeating: NEVER DIVE IN SHALLOW WATER. Serious spinal cord injuries, including paralysis of all four limbs, can and do occur. Never dive headfirst in above ground pools or water that is murky and where you can’t see the bottom. Dive only off the end of a diving board and swim away from the diving area immediately to avoid the next diver.

Pool Deck

If you sit by a pool with children long enough, you’re sure to hear a lifeguard or parent yell “Don’t run!” at least once. It’s for good reason. The area around a pool will naturally be wet, creating a slick surface that is easy to slip on. Add in flimsy flip flops or bare feet and running, and chances of a fall increase. So walk carefully. Also, if swimming at night, make sure the area is well lit to avoid any hazards for trips or falls.  

Swimming for Fitness

If swimming is your go-to for aerobic exercise, you’ve made a great choice. It’s an activity that can be continued as you age, is gentle on your joints and is simply a great workout. As with any form of exercise, injuries can occur, so make sure to warm-up your body before you start, stretch often and include weight bearing exercises in your program to strengthen your shoulders and back.

With these basic guidelines, you’re sure to have a summer full of poolside fun, hopefully injury-free. However, should you encounter an issue, as always, the specialists at NEOSM are here to help.

Keeping Tennis and Golfer’s Elbow at Arm’s Length

By: Dr. Barry S. Kraushaar

Tennis Elbow and Golfer’s Elbow are names for similar tendon injuries that occur at the tendon attachments on the outer (lateral) and inner (medial) sides of the elbow joint. If you have pain on or near the points of bone that serve as the origins of the muscles of the forearm, you may have this diagnosis. The forearm muscles, which give power to your grip, attach to these anchoring points called epicondyles. They can tear off of the bone or within their fibers. Tendons are injured throughout our lives, but they usually heal themselves, making it rare to need medical help. When a tendon attachment to your elbow tears and fails to heal it can be Tennis or Golfer’s Elbow.

TENNIS ELBOW is an injury at the outer (lateral) bony prominence of the elbow. You can have this diagnosis even if you do not play tennis, but the name comes from the observation that tennis players get it as part of the sport. This is because the grip of a long tennis racquet and the wrist motions of the tennis swing put strain on the muscles which originate at the lateral epicondyle. Expert tennis players rarely get tennis elbow because they have powerful forearms and good swing mechanics. If you have the wrong grip size, string tension, timing (late swing), racquet type, or stroke mechanics (wrist motion), you are at risk for Tennis Elbow. In fact, any type of forearm overuse can cause tennis elbow, and the treatment options, described below, are the same.

GOLFER’S ELBOW refers to pain on the inner, medial side of the elbow. In this sport, the problem is caused by the combined effect of the long club length being gripped by the trailing arm (the right arm in a right-handed swing) as the club-head strikes the ground, such as in the rough, the sand or when taking a divot to get under the ball. The forearm is driving forward as the hand is held back, causing strain in the muscles that control the wrist. The damage occurs at the tendinous origin on the inner side of the elbow. Ironically, golfers can also get Tennis Elbow, because the leading arm sees strain on the outer, lateral side during the same movement.

Treatment

There are many additional reasons for tendon injuries about the elbow, usually involving pulling or twisting motions during exertion. It can happen from low level stresses or big motions. From an orthopedic view, the approach is to identify the causes and help the patient adjust activities to allow the tendons to heal themselves.  This may involve a period of partial or complete rest from the aggravating activity. It may involve different equipment or technique. During a flare-up, you may benefit by using a brace. If you wear a wrist brace it may help the elbow by limiting the motions that are traumatizing the injured tendon. A tennis elbow strap is different, as it works by re-directing forces coming up the forearm and deflecting the pulling effect on the tendon origin. Pills, such as non-steroidal anti-inflammatory drugs (NSAIDS like ibuprofen) or analgesics (acetaminophen, Tylenol) may temporarily help the symptoms, but they do not cure tendon injuries. Similarly, a steroid (cortisone) injection may relieve pain for now, but the chemical may damage tendon, and after a few months the problem can come back even worse. Sometimes, a small injection is used as part of a bigger plan.

The most effective and lasting way to manage Tennis or Golfer’s Elbow is to perform exercises to strengthen the forearm. Since the elbow is injured, the exercises need to be rehabilitation type, which is different than fitness exercise. Doctors often prescribe Physical Therapy because a therapist should know the gradually increasing exercises that achieve the goal of lasting recovery without a setback. While many videos exist online, there is no substitute for personal guidance. Once you learn these exercise you can do them yourself. 

Other non-operative treatments exist but are less commonly used. One promising intervention is Stem Cell Injection Therapy. Currently, this technique involves having your blood drawn and spun in a centrifuge. The provider injects a small volume of your own special stem-cells back into you at the site of the pain, and you grow new tendon in the damage zone. Stem cells can also be harvested from your fat or marrow. The use of Stem Cells is usually not covered by insurance, and the statistics of success are still not high enough for many people to be willing to pay out of pocket (costs hundreds to thousands of dollars).  Ask your doctor if you want to know the current trends.

Ultimately, surgery may be necessary for tendon injury at the elbow. There is a minimally invasive technique that requires a brief, light period of sedation and/or local anesthetic injection. The doctor introduces a special needle through your skin over the injured area and activates a device that either causes the tip of the needle to heat up and melt the damaged tendon, or it injects a pressurized water jet into the tendon to break up the scar tissue and cause the tendon to react by developing scar tissue to replace the damaged area. During this process, the surgeon may also use stem cells, described above.

The open surgical technique for Tennis or Golfer’s Elbow is well established and has an excellent success rate. The operation is not usually very long, involves little or no risk to nerves and vessels, and recovers rather quickly, although you may need a period of protection and rehabilitation afterward to give the tendon a chance to heal and the muscle groups time to recover. Basically, the surgeon opens the tendon and removes the bad scar tissue, the tendon is given a chance to grow fresh tissue in the place of the old, painful region, which is usually right where the pain was. In my practice, fewer than ten percent of patients with Tennis or Golfer’s Elbow go to surgery, and nearly every patient reports real improvement from the intervention. Return to sports and full activities is possible in most cases.

Summary

If you think you have Tennis or Golfer’s Elbow, try to identify the causes and address them yourself. Try to gently strengthen your muscled without overdoing it. Consider a brace and careful usage of medicines, if you can do so safely. If you do need orthopedic care, you may be discussing physical therapy and the other treatments described above. Know that if you have to go to surgery, the options in most cases are likely to be effective. Hopefully, you can continue to enjoy your active lifestyle, doing what you need or want to do. The specialists at NEOSM are there to help along the way.

At-Home Relief for Tight Hamstrings

Did you know lower back pain, hip and knee issues, poor posture and other problems can be associated with tight hamstrings? The hamstrings are a group of three muscles located in the back of the thigh. When these muscles are tight, or inflexible, they can cause discomfort beyond pain in the immediate area.  If it’s difficult to touch your toes without bending your knees, either from standing or when seated on the floor, you may be suffering from tight hamstrings. So what can you do to feel some relief?

Prevention

A common cause of tight hamstrings is being in a seated position for prolonged amounts of time. Too much sitting means your hamstrings are constantly flexed, so it’s important to give those muscles a chance to elongate. Take breaks to stand up, walk around or do some stretching.

Equally important is the time you give to stretching before and after you exercise. Proper warm up and cool down of your hamstrings can prevent injury.

Stretches

Consistent stretching is a great way to relieve tight hamstrings. Here are some stretches to try at home.

  • Simple Hamstring Stretch

Seated on the floor with both legs straight out, reach forward while bending at the hip towards your toes, being careful not to overly round your back. Hold for up to 30 seconds.

  • Hamstring Stretch with Strap

While lying flat on the floor, place a strap or towel around the bottom of your foot, hold on to each end in your hands. Slowly extend your leg so the bottom of your foot is raised towards the ceiling while keeping your knee straight. Your other leg should be extended on the ground. Hold for up to 30 seconds. Repeat with your other leg.

  • Standing Hamstring Stretch

While standing, cross one foot over the other. Bend at the waist and slowly lower your upper body toward your knees, careful not to bend your knees. Hold for up to 30 seconds. Repeat on the other side.

It’s always key to listen to your body. If you are experiencing prolonged pain, it may be a sign of a more serious issue. Contact us to meet with one of our orthopedic specialists for a consultation.

Which approach is right for your hip?

By: Dr. Barry Kraushaar

When a patient has arthritis of the hip, there really are only a few choices available for treatment. Most people try to ignore pain or live with it as long as they can.  Once daily life is affected, it becomes necessary to discuss other options. 

The non-operative care of the arthritic hip is rather limited. Options include:

  • Oral non-steroidal anti-inflammatory (NSAID) pills. 
    • These can help briefly, but they do not address the underlying problem, and they can cause bleeding, ulcers, kidney disease and high blood pressures,
  • Physical therapy 
    • This may help especially if there are surrounding thigh and low back issues
  • Hip joint injections 
    • Cortisone may briefly help
  • Less traditional measures 
    • Acupuncture, topical ointments and rubs, chiropractic care, prolotherapy, stem cell treatments, etc., though these are not proven to work by scientific standards

For those patients who do not improve with conservative measures, hip replacement surgery may be necessary. When this decision is made, a patient has two general choices about the surgical approach to the hip: Anterior or Posterior

  • Anterior hip replacement – this procedure is done with the patient lying face upward on the table. A special table may (or may not) be used to help the surgeon optimize the procedure. The approach allows the use of a video-type fluoroscope imaging system which permits real-time optimization of the process of implanting the joint. The surgery is performed by entering the hip between muscles, and no muscle is cut in the process. This procedure is optimal for some patients – ask your surgeon. Some patients report a more rapid return to walking and activities after the anterior approach – compared to the posterior approach. Also, after this approach there is no restriction to bending over, and patients are not required to follow “hip precautions” as is necessary in the posterior approach. Some patients feel the anterior approach is less painful in the early post-operative time period.
  • Posterior hip replacement – this approach has been the more traditional method, and the duration of a routine case may be a bit shorter than the anterior approach. The posterior approach does not require any special table to perform. It is “tried and true” and some surgeons perform only this procedure because it is so reproducibly good that they prefer to stay with it exclusively. The posterior approach involves crossing some fine-control muscles on the way into the hip joint. The ligaments in the rear of the hip are opened, so after the procedure is done, patients need to observe hip precautions, usually for three months. They are not allowed to bend past 90-degrees and should sleep with a pillow between the knees, among other restrictions. The fluoroscope cannot be used real-time during the case, but plain x-rays can be taken during the case to confirm that components are going in correctly. The posterior approach is felt by some surgeons to be best in difficult cases because it is easier to manage difficulties (such as a stress fracture) from this direction.

By 6 weeks most patients with either approach are doing similarly well. Infection rates are similarly low. Dislocation rates are slightly less with the anterior replacement according to some reports. Blood thinners are used in the same manner postoperatively for either approach.

Northeast Orthopedics and Sports Medicine has surgeons who perform both the anterior and posterior approaches to hip replacement. We are happy to answer your questions, so contact us today to schedule your consultation.

Preventing Gardening Injuries

For most of us who enjoy gardening, it is a relaxing, safe hobby.  However, every year we see many people who are needlessly injured in their backyards. Nationally more than 400,000 gardening injuries are seen in the ER every year.

By: Dr. Doron Ilan

For most of us who enjoy gardening, it is a relaxing, safe hobby.  However, every year we see many people who are needlessly injured in their backyards. Nationally more than 400,000 gardening injuries are seen in the ER every year. Back injuries, hand lacerations/puncture wounds, infections, overuse tendinitis, bug bites, and heat exhaustion are some of the more common medical conditions seen in recreational gardeners. Here are a few tips to keep you safe this spring and summer.

  • Warm up: One of the most common mistakes is to head straight to the shed and start lifting heavy bags of mulch, soil, and equipment. This can lead to back sprains and muscle strains.  Instead, first, take a 5-10 brisk walk to warm up the muscles, loosen the joints and get the heart rate up a bit.
  • Wear gloves: This will prevent most thorn punctures, blisters, lacerations, and bug bites. It will also protect your skin from pesticides, bacteria, and fungus (often live in soil). A small cut can lead to a major infection. A light long sleeve shirt and long socks or pants can’t hurt either.  Don’t forget the sunscreen and a hat.
  • Hydrate: It is very easy to spend hours gardening without drinking. Bring a bottle of water outside with you and sip regularly
  • Rotate your tasks: Avoid overuse repetitive stress injuries by not spending more than 10-15 minutes in a row doing the same motion. Make sure your gardening activities are varied so that the same muscles are not used repetitively.
  • Use proper equipment
  • Check your skin for ticks after you finish gardening for the day. Lyme disease and other tick-borne infections are very common in our area.

Following these tips can help minimize your risk, but of course, if you do sustain an injury make sure to get medical attention as soon as possible.  Have a great spring and summer — and enjoy your gardening!

If you do encounter an orthopedic injury while gardening, contact us today to find out what’s wrong and how we can help.

5 Simple Stretches for Sciatica

Sciatica can be a real pain in the back, among other things.

Also known as lumbar radiculopathy, sciatica (pronounced sci-at-ick-aa) is a term used to described a series of symptoms—most notably, pain—that occurs when the sciatic nerve is irritated. This large nerve runs from your lower back, past the buttocks and down each leg.

Sciatica is currently estimated to be the cause of low back pain in five to 10 percent of Americans.

What are some stretches to alleviate sciatica symptoms?

The beauty of creating a routine to manage your sciatic pain is that it also serves as a way to prevent sciatic pain and other symptoms from making a reappearance. In fact, though it may seem unlikely (or unpleasant), exercising actually helps to improve symptoms better than bed rest.

One of the forms of exercise to help relieve sciatica is performing stretches that externally rotate the hip. Here are five stretches that do just that:

  1. Reclining Pigeon Pose
    • While lying on your back, bring your right leg up to a right angle. Grip both hands behind the thigh and lock your fingers.
    • Lift your left leg and place your right ankle on top of the left knee.
    • Hold the position for a moment, then repeat with the other leg.
  2. Sitting Pigeon Pose (to be done once the reclining pigeon pose can be performed with ease)
    • Sit on the floor with your legs stretched out straight in front of you.
    • Bend your right leg, putting your right ankle on top of the left knee.
    • Lean forward and allow your upper body to reach toward your thigh.
    • Hold for 15 to 30 seconds.
    • Repeat on the opposite side.
  3. Knee to Opposite Shoulder
    • Lie on your back with your legs extended, and your feet stretched upward.
    • Bend your right leg and fasten your hands around the knee.
    • Lightly pull your right leg across your body toward your left shoulder. Hold it there for 30 seconds.
    • Push your knee so your leg returns to its starting position.
    • Repeat for a total of three reps, and then switch legs.
  4. Sitting Spinal Stretch
    • Sit on the ground with your legs stretched straight out with your feet arched upward.
    • Bend your right knee and place your foot flat on the floor on the outside of your opposite knee.
    • Place your left elbow on the outside of your right knee to help you gradually turn your body toward the right.
    • Hold for 30 seconds and repeat three times, then switch sides.
  5. Standing Hamstring Stretch
    • Place your right foot on a raised surface at or below your hip level. Flex your foot so your toes and leg are straight.
    • Bend your body forward slightly toward your foot (without feeling pain).
    • Release the hip of your raised leg downward as opposed to lifting it up. If you need help easing your hip down, loop a yoga strap or long exercise band over your right thigh and under your left foot.
    • Hold for at least 30 seconds, and then repeat on the other side.

If you are experiencing persisting pain, reach out to schedule an appointment with one of our pain management specialists today.

The Scoop on Basketball Injuries (And How to Avoid Them)

When most people think about sports-related injuries, the first sports that typically come to mind are collision sports such as football, or ice hockey.  However, many sports are considered contact sports, and carry with them a significant risk of injury. These include sports like soccer, baseball, and – you guessed it—basketball.

According to the U.S. Consumer Product Safety Commission, more than 501,000 basketball-related injuries were treated in hospital emergency rooms in 2009. In addition, a study published in 2010 that was conducted over the course of 17 years and 1,094 players, professional athletes in the NBA experience a high rate of game-related injuries. Patellofemoral inflammation—inflammation that is the result of worn-down, softened or roughened cartilage under the kneecap—was the most significant injury in terms of days lost in competition.

These startling statistics don’t just apply to professionals, either. In high school basketball (according to the National Athletic Trainers’ Association):

  • 11 percent of injuries involved the hip and thigh
  • 22 percent of all male basketball players sustained at least one time-loss injury each year.
  • 42 percent of the injuries were to the ankle/foot
  • 9 percent of injuries involved the knee
  • Sprains were the most common type of injury (43 percent)

What are some other common basketball injuries?

Due to the fast-paced nature of the sport, the majority of the injuries incurred while playing basketball involve the foot, ankle or knee. There’s also a risk of jammed fingers and stress fractures occurring in the lower leg and foot.

What are some ways to prevent injuries?

Thankfully, there are many preventive strategies athletes of all ages can utilize to make sure they’re ready leading up to and during basketball season:

  • Stay fit. Players should maintain a regular exercise routine—both on and off season—that incorporates flexibility training, strength training and aerobic exercise.
  • Keep hydrated. If the body is dehydrated, it will have difficulty keeping cool when it’s highly active. According to the National Collegiate Athletic Association (NCAA), players should:
    • Drink 16 ounces of fluid two to three hours before exertion and about eight additional ounces 15 minutes before exertion
    • Take breaks when possible while playing (around every 15 to 20 minutes) to take in approximately four ounces of fluid
    • Drink 16 to 20 ounces of fluid for every pound lost after exertion
  • Warm the body up. It’s always a good idea to take time to stretch and warm the body up before any extended physical activity to avoid injury. Players can warm up with activities such as jumping jacks or running/walking in place for two to five minutes. After that, slow stretching is recommended, holding each position for at least 30 seconds before moving on.
  • Don’t forget technique. Players should remember to only use proper techniques for passing and scoring. Not doing so may result in self-injury or injury involving another player.
  • Wear and maintain appropriate equipment. Players should choose sneakers that fit snuggly, offer support for the foot and have non-slip soles. Mouth guards should also be worn to protect the teeth and head from injury as well as safety glasses or glass guards to protect those with glasses.
  • Avoid overuse injuries. Overuse injuries are becoming more common, especially in younger athletes. Players should not be allowed to play one sport all year long and should be limited to how many teams they can play on within a season.

Come to the Sports Medicine Specialists

If sports-related injuries do occur, our physicians at Northeast Orthopedics and Sports Medicine (NEOSM) have years of experience in effectively treating all orthopedic conditions. Our multidisciplinary approach to care ensures that patients receive the customized treatment they need to get back in the game.


For more information on sports medicine or to schedule an appointment with one of our sports medicine specialists, contact us today.

New Games: 7 Tips for Transitioning From Winter Sports to Spring Sports

Spring sports and winter sports are similar: They require strength, speed, skill, agility and sweat. But while they both depend on these attributes, they have their own preparations and demands.

From playing surfaces to equipment to the stresses incurred by varying body parts, these changing needs require a winter-to-spring transition for athletes and fitness enthusiasts. This is particularly critical for younger athletes whose bones and joints are still developing, and who may be inexperienced at switching between sports seasons.

Safely transitioning sports is often a matter of experience. Many athletes—from recreational to professional—have learned through trial and error how to adapt to their activity, both for athletic improvement and injury prevention.

Below are some of the techniques they have used and you can use to make the smoothest transition possible between spring sports and winter sports:

1. Get a pre-season physical

Many sports require a pre-season physical for youth athletes as a rule of participation, but everyone should consider having a check-up. This will help to identify any potential health or injury risk, and in so doing, ensure you are ready to play.

2. Have a lesson or two

If you’re new to the spring sport or just rusty, consider investing in a lesson or two from a professional, such as a coach or a trainer. This will start you off on the right foot as proper technique aids both good performance and injury prevention.

3. Build up to the activity

Ideally, you want to do some pre-season conditioning and preparation relative to your spring sport. However, that conditioning can also be acquired by slowly acclimating to your new activity. If you’re not in shape in general, the best approach is to partake in some form of fitness prior to the season.

4. Invest in the proper equipment

Different sports mean different gear. Make sure you get the best gear for your spring activity. That includes sports equipment and attire. Constantly improving technology has resulted in clothing made of the most advanced sports performance fabrics.

5. Break in your equipment

Whether it is new shoes or getting accustomed to a racquet or glove, avoid discomfort such as blisters or foot and ankle problems by ensuring your gear is fully ready to use.

6. Remember general sports principles

Switching from one sport to another is no reason to change good habits. You can also use the new season to acquire them:

  • Always warm up and cool down
  • Drink plenty of fluids (but don’t overhydrate)
  • Don’t overdo your activity
  • Rest/recover between sessions

6. Protect your skin outside

Spring means enjoying the outdoors. An under-considered aspect of outdoor sports is the need for skin protection. Whether you’re young or older, whether it’s sunny or cloudy (the sun’s rays come through the clouds), apply sunscreen early and often, particularly if you perspire. Make sure children do so, as well. Now is a good time to educate them on skin safety.

Come to the Sports Medicine Specialists

If sports-related injuries do occur, our physicians at Northeast Orthopedics and Sports Medicine have years of experience in effectively treating all orthopedic conditions. Our multidisciplinary approach to care ensures that patients receive the customized treatment they need to get back in the game.

For more information on sports medicine or to schedule an appointment with one of our sports medicine specialists, contact us today.