More than 8 million student athletes participate in fall sports and many of them will be sidelined before the end of the season due to a sports-related injury.  In fact, according to the American Academy of Orthopedic Surgeons, nearly 1.8 million student athletes will be injured this year.

Heat exhaustion, sprains and strains, and acute injuries are commonly seen in athletes returning to fall sports. After a long summer, kids are less physically prepared to hit the playing field, which can lead to an increase in injuries. A pre-season physical, wearing properly-fitting equipment and recognizing pain early can prevent some of these injuries.

Following are some of the most common injuries faced by athletes that participate in the fall’s most popular sports, including football, basketball and wrestling:

Football
More than 920,000 student athletes are treated for football-related injuries each year – the most of any fall sport. The most common football-related injuries include:
• Strains and sprains: These are the most common injuries in football and usually affect the ankle, knee or wrist. Signs of this type of injury include pain, swelling, bruising and limited ability to move the affected muscle or joint.
• Fractures: Fractures to the wrist, arm and leg account for more than one quarter of all serious football injuries. Bruises, swelling, localized pain and the inability to move the affected area, are all signs of a fracture.
• ACL tears: Indications of a possible ACL tear include hearing a “pop,” instability of the knee, immediate pain and swelling.
• Concussions: If a player experiences a significant “blow” to the head it can be very serious. They should seek immediate medical treatment if they have a headache, nausea or confusion. Loss of consciousness is also possible.

Wrestling
According to the American Academy of Pediatrics, wrestling ranks fourth in participation but second in the rate of injuries suffered by athletes. In addition to concussions, the most common wrestling-related injuries include:
• Prepatellar Bursitis: Also known as “housekeeper’s knee,” key symptoms include swelling and pain on the top of the kneecap along with limited movement.
• Rotator cuff tendonitis: The wear and tear on the shoulder during wrestling can cause tendonitis, which is an inflammation within the shoulder joint. This can cause pain with movement of the arm, trouble sleeping due to pressure on the shoulder and weakness of the arm when reaching overhead.

Basketball
Each year, more than 481,000 basketball-related injuries are treated, according to the U.S. Consumer Product Safety Commission. Some of the most common basketball injuries seen are:
• Jammed fingers: Blunt impact to the tips of fingers can cause the joints in the fingers to jam, causing pain, bruising and swelling.
• Ankle sprains: Pay attention to tenderness, pain and swelling around the ankle. These symptoms, along with the loss of movement of the ankle, can indicate an ankle sprain.
• Plantar Fasciitis: A sharp pain in the heel of the foot, especially in the morning, is a common symptom of this injury.

As with any time of year, athletes that participate in fall sports must make sure their bodies are properly conditioned before hitting the playing field. If they do experience discomfort or an injury they should seek help from their onsite medical staff and follow up medical care from an experienced orthopedic surgeon.

More than 49 million Americans, young and old, will take to the roads on a bike each month. Whether it’s pedaling in the park or competing in a marathon, cycling does come with risks. In fact, more than 567,000 cycling-related injuries occur each year, according to the American Academy of Orthopaedic Surgeons.
Cycling is a great low-impact way to stay in shape but due to its repetitive nature, joint injuries and muscle pain are a common occurrence. If a person experiences pain around their knee cap, swelling or prolonged muscle inflammation they should consult an orthopedic surgeon.  However, prior to that there are measures that can be taken to avoid an injury.
If you enjoy an occasional bike ride or are an avid cyclist, it’s important to follow these tips to help avoid knee-related injuries:
• Take precautionary measures – It is important that your bike’s seat and handle bars fit your height.  If your bike is not properly adjusted, it could place unnecessary pressure on your knee joints. Too high of a seat can cause pain in the back of the knee, while a seat that is too low or too far forward can cause pain in the front of the knee. Also, make sure your foot and cleat alignment is correct. Pain on the inside or outside of the knee can be caused by improper foot position on the pedal.

• Wear appropriate gear – Head injuries are one of the number one reasons for emergency room visits. Wearing a helmet while riding a bike is one safety precaution that should never be overlooked. In fact, it’s estimated that wearing a helmet can reduce head injuries 85 to 88 percent. Cyclists should also consider wearing knee and elbow pads to reduce the risk of injuries to those areas if they experience a fall.

• Follow the rules of the road – It is important to follow the rules of the road when out on the street. Bike on even, dry surfaces and ride in the direction of traffic. Avoid biking at night, but if you do, wear reflectors. Also, stay alert and pay attention to your surroundings to avoid falls or collisions.

• Strengthen and stretch your muscles – As with any sport, stretching before a bike ride gets your muscles warmed up and ready for a more rigorous workout. Stretching not only prepares your muscles for a more efficient ride, but it creates flexibility and decreases the risk of a pulled muscle or injury. By strengthening the muscle around the knee joint through strength training, a knee injury is less likely.

• Rest your body and knees – Overuse injuries to the knee can be caused by riding too hard, too many miles or too long without giving your knees a rest. Lack of rest can lead to serious knee damage. When first starting out, bike at a low resistance to get use to road riding. Also use a gear that allows you to pedal quickly, approximately 70-100 strokes per minute. Since there can be increased tension when the quadriceps meet the knee cap during a ride, make sure to strengthen the muscles around the knee to reduce injury.

If you do experience an injury, it’s important to have it evaluated by an orthopedic specialist. Unchecked knee pain could be something more serious, such as a fracture, torn ligament or torn cartilage. Only a qualified orthopedic surgeon can determine the extent of an injury.

Participation in summer sports is a great way to stay physically fit, but it also increases the chance of injury – particularly to a person’s knees. In fact, according to the American Academy of Orthopedic Surgeons, more than 19 million visits a year are made to physician’s offices due to knee injuries.
Mark Ritter, M.D., an orthopedic surgeon with Methodist Sports Medicine/The Orthopedic Specialists, sees an increase in sports-related knee injuries during the summer months. “I see many patients who come in with knee injuries that could possibly have been avoided by using a few preventative measures,” says Dr. Ritter. “It’s important that athletes have a thorough medical evaluation and properly condition their body before participating in a marathon or a competitive sport. Doing so will diminish their chance of experiencing a sports-related injury.”
Dr. Ritter offers some other tips on ways to avoid common sports-related knee injuries:
• Warm up and cool down – It is important to stretch before and after any physical activity, especially a game. Your muscles need to be warmed up before any rigorous exercise as cold muscles are more prone to injury. There are stretches for legs and knees that you can perform. One easy exercise is to lie prone (face down) and grab the ankle of the leg, which helps stretch the front of the knee.

• Condition and strengthen muscles –Strengthening your overall core will also increase stability. Consistent exercise ensures your body is preparing muscles for more strenuous play. By working the quadriceps and hamstrings, your knee will be supported. Also, yoga is a good way to increase flexibility and create a strong core.

• Don’t “play through” an injury – Make sure to stop playing when you feel pain and to tell trainers and doctors all the symptoms of the pain. Playing through the pain could make the injury worse. Pay attention to your body’s signals and rest when you experience fatigue.

• Recognize pain, swelling and stiffness – If you recognize any pain, swelling or stiffness, stop playing and let your knee rest. These could be symptoms of tendonitis or bursitis – common injuries in soccer and sports that require running or where the knee could be overused. The pain could also indicate an injury known as Runner’s Knee or a torn cartilage.

• Pay attention to your surroundings – By doing this, you are less likely to receive a direct blow to the knee or fall. Twisting a knee during a fall or a blow to the knee can result in a few common injuries. A torn anterior cruciate ligament (ACL) is the most common injured ligament in the knee and occurs when the knee is twisted too far or in an odd way. Knowing where other players are on the field or court can reduce your risk of falling and incurring a knee injury.

• Use knee bracing and correct footwear – Wearing a knee brace can help stabilize and support the knee. Also, make sure to wear the proper shoes for the sport and replace them as they become worn out.

• Get a physical exam – Before starting any recreational or organized sport, it is important to get a physical exam. This allows your doctor to identify any problem areas in your muscles and joints. It also makes sure you’re in the right condition for the sport.

In most cases, it is best to rest the knee until the pain subsides and the injury heals. Don’t go back to sports too quickly or you could reinjure the knee. If you have severe pain, feel or hear a popping of the knee or have serious swelling, it is important to see an orthopedic specialist. Pain and swelling for more than 48 hours can indicate a more serious injury. Most knee injuries can be treated without surgery, though in more severe cases, surgery may be needed. For more information on how to stay safe during summer sports and activities, visit www.mykneehurts.info.

From baseball to soccer to football, everyday millions of children and young adults participate in sports activities. These activities teach children team work and improve their physical fitness, coordination and self-discipline.  It also increases their chance of experiencing sports-related injuries such as concussions, sprains, fractures, muscle tears, and back and neck injuries. However, there are measures that can be taken to help prevent these types of injuries, such as:
• Undergoing medical exams prior to the sport’s season, which should include concussion screenings and physical evaluations;
• Using proper protective gear, such as shin guards for soccer and helmets for football and baseball;
• Staying hydrated and always warming up before practice or a game;
• Never playing through pain or an injury.

If an athlete does experience an injury it is important that it is not ignored or taken lightly.
Sports-related injuries in children are of great concern because their bones, muscles, tendons and ligaments are still growing. To avoid long-term damage, young athletes should seek immediate care for any minor or serious injury.

Following are several signs to help determine if immediate care is needed:
• Inability to play following a sudden injury;
• Decreased ability to play due to a chronic or long-term complication following an injury;
• Visible deformity of the athlete’s arms or legs;
• Severe pain from a sudden injury, which may prevent the use of an arm or leg.

Sometimes, sports-related injuries occur after office hours or on the weekends.  If and when this happens I recommend that my patients visit the emergency room or an orthopedic walk-in clinic like the one we have at Methodist Sports Medicine / The Orthopedic Specialists. One of our fellowship-trained orthopedic surgeons is available to treat patients with sudden or recent sports or active lifestyle-related injuries.  Patients can visit our Avon or Greenwood locations Monday through Friday from 8 a.m. to 10 a.m., or our Carmel location Monday through Saturday from 8 a.m. to 10 a.m. For more information, please visit www.methodistsports.com or call 317-817-1200.

By Barb Berggoetz

Winter is upon us, and with that comes snow, ice and winter sports.

“Winter can be a great time to get involved in some fun sports, but if you are one of the millions of people who will take to the ice and snow this season, pay attention to your body and prepare yourself for the sport,” said Dr. Mark Ritter, an orthopedic surgeon at Methodist Sports Medicine/The Orthopedic Specialists.

According to the American Academy of Orthopedic Surgeons, snowboarding is the leading cause of winter sports injuries, affecting nearly 150,000 people. Next is skiing and snowmobiling.

For more information on how to stay safe during winter sports and activities, visit www.mykneehurts .info, www.mybackhurts.info, or www.methodistsports.com.

Here are some of Ritter’s tips:

1. Warm up and cool down: Stretch for about 30 seconds or more and do some light exercise for three to five minutes to warm up your muscles. This helps blood to flow to your back muscles and prepares your body for activity. A cool down afterward reduces cramping and tightening.

2. Gear up properly: It is important to wear the correct footwear, protective gear and layers to keep warm. Not only is proper gear important, but staying warm is essential to prevent frostbite and keep muscles flexible.

3. Don’t imitate stunts: Don’t try any stunts you see on TV. Those are practiced moves that can cause untrained athletes to injure themselves.

4. Never practice alone: Because extreme sports are just that, extreme, you should never practice alone in case of an injury.

5. Use good technique: Remember not to twist or jerk your body in a way that is uncomfortable. It’s wise to take lessons from a trained professional to prevent back strain or injury.

Unfortunately, there are several common misconceptions associated with knee replacement surgery.  The most common is the belief that the procedure will allow you to become a super athlete or do more than you could before you developed a knee injury or arthritis. I can tell you that this won’t occur. However, for those individuals that choose to undergo knee replacement surgery, 90 percent will experience a dramatic reduction of knee pain and a significant improvement in their ability to perform common everyday physical activities.

To improve upon your recovery results, your orthopedic surgeon will advise you to avoid certain activities such as lifting heavy objects, jogging or participating in high-impact sports – for the rest of your life.  He may also ask you to adhere to following guidelines:

• Follow your surgeon’s and physical therapist’s instructions carefully.  Doing so will improve your long term recovery.

• Keep up with your exercises. By closely following the directions of your physical therapist, the better your chances are for a successful recovery.

• Engage in lower stress activities. Try activities such as golfing, hiking, walking or swimming. These activities place less stress on your knees.

• Manage your pain as directed.  Be sure to take pain medications as prescribed by your doctor.  If the medication is not relieving your pain, speak with your doctor about other pain management options.

• Control swelling. Place ice cubes in a sealable plastic bag, wrap it in a towel and place it on your knee.  By reducing the swelling, you will help to reduce pain and improve circulation and range of motion.

• Rest.  It’s important to get plenty of sleep to help your knee heal.  You will want to minimize keeping the leg down (standing or sitting) too long during the first few weeks as it will cause increased swelling in the knee during this healing process.  When sitting try to keep the leg propped up.   

Following your surgery, you should conduct a yearly check up with your orthopedic surgeon.  Your surgeon will monitor for wear and tear, and other potential future complications. Remember, excessive activity or weight may accelerate the normal wear of your knee replacement, and cause it to loosen and become painful. With appropriate activity modification, a patient’s knee replacement could last for many years and hopefully for life!

As a result, researchers have begun to identify ways to improve the techniques and methods used during knee replacement surgery. These advancements aim to decrease the likelihood of repeat surgeries and provide patients of all ages with quicker recovery time and a better quality of life. A recent advancement that I use on all of my patients is computer-assisted surgery (CAS).

Below are answers to general questions that I often receive regarding the risks and benefits of CAS as well as an overview of the procedure.

How does computer-assisted surgery work?
Think of it this way. Computer-assisted surgery (CAS) works like your car’s GPS. By using a variety of infrared cameras, digital imaging and tracking devices, the computer allows a surgeon to instantly track the precise position of the patient’s leg, the implant and surgical instruments at all times during the procedure. This technology allows the surgeon to position each patient’s implant based on their individual knee geometry. CAS brings together the benefits of minimally invasive surgery with computer-guided placement, practically eliminating implant misalignments, reducing overall recovery times, and enabling surgeons to operate with smaller incisions and greater precision.

How is computer-assisted surgery different from traditional knee replacement surgery?
A surgeon performing traditional knee replacement surgery relies on skill and experience to align the implant. A surgeon performing computer-assisted knee replacement surgery combines skill with science. The computer enhances visualization during the procedure, which allows the surgeon to make the smallest incision possible and critical measurements that are not possible without the assistance of a computer. This technology causes fewer traumas to underlying muscle and soft tissue, and results in a small scar, less post-operative pain, shorter hospital stays and a quicker return to an active lifestyle.

Why is alignment important in knee replacement surgery?
To ensure that you get the best wear and performance from your implant, proper alignment is key. When a knee implant is placed inaccurately, it can wear faster, which decreases its life span and increases the likelihood of additional surgeries.

Am I a candidate for computer-assisted surgery?
In most cases, any patient requiring knee replacement surgery can benefit from computer-assisted surgery. However, in some cases the weight and size of a patient can affect the length of the incision. Trauma to the surrounding tissue will still be reduced when compared to traditional surgery.

By Barb Berggoetz

If you can resist hibernating this winter, participating in outdoor winter sports — skiing, hockey, snowboarding, ice skating — can be invigorating for the novice or seasoned athlete.

But they’re also fraught with the risk of injury.

If you want to avoid an emergency room trip, take steps to protect your- self, said Dr. Mark Ritter of Methodist Sports Medicine/The Orthopedic Specialists.

“Many winter sports injuries, like sprains, dislocations and fractures, can easily be avoided if athletes prepare for their sport by keeping in good physical condition, staying alert and stopping when they are tired or in pain,” he said.

He offers these tips:

1.     Hit the gym first: Since winter sports can be strenuous, condition muscles prior to hitting the slopes or ice to help maintain stamina and strength. To avoid muscle aches, keep fit during the off season by doing single leg squats, weighted quadriceps squats and other full-body workouts.

2.     Use proper equipment: If you don’t own equipment, never borrow someone else’s. Rent from a ski shop or resort, where employees can adjust equipment to fit you. For most winter sports, use wrist guards and knee pads to provide stability and reduce the risk of falling. Wearing a helmet for sports like ice hockey is smart.

3.     Know how to fall: The force of a fall while skiing or snowboarding can seriously injure an arm or knee joint. Learn proper stance. Having both feet strapped in one set position can cause snowboarders to brace for a fall with an arm, causing a wrist fracture. Learn how to roll into a fall.

4.     Learn from an expert: Take lessons or a class from trained professionals at ice rinks and resorts. Instructors can teach how to maintain proper balance and avoid common injuries.

Common afflictions of the knee in tennis players include arthritis, meniscus tears, ligament sprains, and knee cap malalignment. Arthritis literally means “inflammation of the joint” and is associated with the loss of cartilage. The most common form of arthritis is called osteoarthritis. Osteoarthritis is either the result of chronic degeneration of the cartilage due to wear (perhaps influenced by genetics) or trauma (post-traumatic osteoarthritis) which acutely damages the cartilage accelerating the wear process. A less common form of arthritis is called systemic arthritis which encompasses a group of diseases that affect multiple joints and include rheumatoid arthritis and lupus. Arthritis typically causes periodic swelling, achy pain, and stiffness. Mild cases respond well to rest and anti-inflammatory medications (i.e., Aleve, Motrin etc.) and analgesics, such as Tylenol. Physical therapy and injections of medications may be required for more advanced cases. Severe arthritis in the older player may require knee replacement. Fortunately, many players can still play doubles in a limited fashion after replacement surgery.

Meniscus tears are more common in players over the age of 35 years old. As we age the menical structure deteriorates and becomes vulnerable to minor trauma. In most cases the meniscus tears when a player is pivoting on their knee to change direction. The medial meniscus is more commonly torn than the lateral meniscus. Although meniscal tears may also cause swelling many patients do not have a significant amount of swelling. Sharp pain localized over the inside (medial) portion of the knee, especially with twisting maneuvers, is a hallmark symptom. Some patients can also experience locking of the knee as the torn piece can displace and become trapped between the femur and tibia. Conservative treatment can be successful in a limited number of patients. Persistent symptoms require arthroscopic surgery. In most cases the torn portion of the meniscus is simply removed. Less often, depending on the pattern of the tear, the meniscus needs to be repaired by sewing the torn fragments together.

Ligament injuries can occur as a result of either an indirect twisting force on the knee, a collision causing a direct forced to the knee, or less commonly a fall. The term “sprain” is reserved for injuries involving ligaments. A sprain is actually a tearing of the fibers of the ligaments. Mild-moderate sprains involve partial tearing of the fibers. A high-grade sprain describes a complete disruption of the ligament. All the ligaments in the knee can be injured in an isolated fashion or in combination. The most commonly injured ligament is the medial collateral ligament. Most sprains, even high-grade sprains, of the medial collateral ligament heal without surgery. Initial treatment involves rest, ice, compression, and elevation (RICE). Further treatment may involve bracing and physical therapy. The next most common ligament injury involves the anterior cruciate ligament (ACL). The ACL is the central stabilizer of the knee. Unlike the medial collateral ligament in ACL tear will only heal in about 5 percent of cases. Bracing and physical therapy are only effective in a small subgroup of patients. Physically active patients typically require surgical reconstruction of the torn ligament in order to restore full function.

The knee cap articulation, patellofemoral joint, is stabilized by the concave contour of the groove, the dynamic support of the surrounding muscles, the surrounding ligaments, and the overall alignment of the leg. Some patients have inherited characteristics that make it more likely for the patellofemoral joint to be malaligned and in some cases unstable. Malalignment of the knee cap in the femoral groove can result in asymmetric pressure on the cartilage surfaces which initially causes pain but over time can breakdown the cartilage leading to arthritic change of the joint. Most cases can be managed with a rehabilitation program which includes strategies to improve alignment such as bracing or taping the joint and strengthening exercises. In a small number of patients symptoms are persistent and realignment surgery is the final treatment.

As it appears on WTHR.com

In January, I appeared on Indianapolis’ channel 13 news, discussing the next generation in technology to help align knee implants.  Following is a transcript from that segment.

Technology Helps to Align Knee Implants

Anne Marie Tiernon/Eyewitness News – Indianapolis – The next generation in technology is helping baby boomers make sure their knee replacement stays aligned.

Doctors say knees are like alignment on a car. When it’s out of alignment, other parts will be damaged, and a simple repair gets more complicated. 

“Just a lot of pain, believe me,” says Helen Creviston, a 79-year-old Bainbridge resident who recently underwent a knee implant. “I have a lot of things I want to do and babies to hold.”

Dr. John Hur of Methodist Sports Medicine says a new tool called Smith-Nephew Navigation will increase the odds that her implant will be in alignment.

“We know from studies if we are off more than three or four degrees, that your rate of having to go back and do it 8-10 years from now go up by 25 percent,” Dr. Hur said.

In the operating room at Clarian North, Hur says the device improves accuracy within a degree, and makes it possible for him to repeat that accuracy in patient after patient.

“We’re trying to eliminate the human element,” he said.

The computer model provides extra measurement through a smaller incision and less manual manipulation.

“We know that when we manually align the total knee, we have to intrude upon the manual canal, the thigh bone, and when that pushes blood clots or fat emboli into your heart and that can cause medical issues,” Dr. Hur said. “We eliminate all that by doing computer navigation.”

Hur says he’s performed nearly 100 of the procedures and says using the device adds about ten minutes to the surgery time. 

“If that 10 minutes of time adds another 10 years to the life of the total knee, I think it is well worth it,” he said.

But technology can only get you so far. The patient still has to take responsibility for rehabilitation. 

“My younger daughter made charts for me so I would keep track of my exercises,” said Pat Meurer, who got a knee implant four months ago. Her exercise routine includes bending her knee back as far as she can, then bringing it fully forward, even applying pressure to increase her extension.

“He told me if I did that 50 times a day, I would get the extension and flexibility that I needed,” Meurer said.

She holds each position thirty seconds each time.”We even did a stopwatch to time the exercises, and I think it’s paid off,” she said. There are 14 Smith-Nephew Navigation systems in the state.