Category Archives: News and Events

Hamstring Injuries: Risks, Treatment, and Rehab

hamstringDr. Stickney, a Kirkland orthopedic surgeon, is a sports medicine expert specializing in hamstring injuries, pitching shoulder injuries, Swiftpath knee surgery, and more.

Hamstring injuries are common among individuals with an active lifestyle, especially for athletes in sports that involve high speed running or kicking. Sports like track-and-field, soccer, dancing, football, long-distance running, and water-skiing all have a heightened risk for hamstring issues. Erratic contraction of the hamstrings while running at high speeds, quick-burst movements, and sudden trauma are believed to cause these injuries.

Three muscles make up the hamstring (semitendinosus, semimembranosus, biceps femoris), starting from the bottom of the pelvis (ischial tuberosity) down to the knee joint where the muscles connect with tendons to attach to the bones. Your hamstrings allow you to bend your knee and help with hip extension, though this is primarily done by the gluteus Maximus.

There are two prominent types of hamstring injuries – tears to the muscle belly (the thick part of the muscle or where muscle fibers join tendon fibers) and acute avulsions to the tendon (when the tendon completely tears away from the bone). The sciatic nerve running from the lower back down the back of the legs may also be compromised during hamstring trauma, due to its proximity.

Injuries arising from a single abrupt trauma rather than from smaller cumulative injuries tend to be more serious and affect younger patients (age < 25). However, with increasing age the likelihood of injury increases. The risk factors associated with this injury include, the type of sport, poor flexibility, asymmetric strength, and above all prior injury.

With so many variables to consider, how do you prevent hamstring injuries? What are the most important risks to be aware of, how should you treat a hamstring injury, and what is the best way to recover?

A review titled “Hamstring Injuries – Risk Factors, Treatment, and Rehabilitation” published by the Journal of Bone and Joint Surgery evaluated 9 different contemporary studies exploring predictive factors, diagnosis strategies, treatment methods, and recovery techniques for hamstring injuries. The studies involved varying sample sizes and methodologies tailored to their respective topics.

The findings:

  • The most predictive factor for a hamstring injury is any previous hamstring injury including sprains, tears, and avulsions. When a patient has a history of hamstring injuries, they’re also likely to have a longer recovery time – especially recreational athletes compared to professionals. The importance of early intervention cannot be overstated; one of the major reasons rec athlete’s recovery time is longer than the pros is because they prolong their first consultation and treatment. If you may have experienced hamstring injury, contact a sports medicine expert
  • MRI (magnetic resonance imaging) edges out ultrasound as the best means of evaluating the extent of a hamstring injury and whether surgical intervention is warranted.
  • Muscle belly tears are often better treated with conservative treatment, whereas hamstring avulsions may be better treated with surgery depending on the displacement of the tendon.
  • Conservative treatments such as RICE (rest, ice, compression, elevation), nonsteroidal injections (anti-inflammatory drugs), physical therapy, stretching, PRP (Platelet Rich Plasma) injections, and corticosteroid injections are indicated for acute hamstring strains, partial tears, and single-tendon avulsions. PRP injections combined with rehab exercises for hamstring injury, like physical therapy, is more effective than rehab exercises alone.
  • Surgical repair of complete proximal hamstring ruptures, both acute and chronic, results in improved outcomes compared with nonoperative management.
  • Repair of acute proximal hamstring tendon tears results in better functional outcomes than repair of chronic tears. Again, how long a hamstring injury takes to heal and the effectiveness of recovery depends on early intervention.
  • Stretching and strengthening the hamstring tendons with eccentric exercise is helpful in conjunction with physical therapy after injury. Strengthening, Stretching, control of early inflammation, and massage of scar tissue all may reduce the risk of re-injury, or may prevent hamstring injuries altogether.

Having a better understanding of hamstring injuries allows clinicians to provide better treatment and patients to manage their injury most effectively. If you have questions regarding hamstring injuries or would like to schedule an appointment, contact our sports injury clinic.

Is Physical Therapy Effective After Rotator Cuff Tear?

shoulderptDr. Stickney, a Kirkland orthopedic surgeon, is an expert in shoulder injury treatment, total and partial knee arthroplasty, sports medicine, and more. 

Rotator cuff tears are extremely common, affecting at least 10% of people over the age of 60 in the United States – which equates to over 5.7 million individuals. Of the 5.7 million+ individuals who suffer from rotator cuff tears, fewer than 5% are treated surgically, and patients who undergo surgical repair experience a failure rate between 25 and 90%. What’s interesting though, is that patients with repair failures report satisfaction levels and outcome scores that are nearly indistinguishable from those whose repairs are intact. Because most of these surgical patients undergo postoperative physical therapy, it is logical to assume that physical therapy may be responsible for the improvements in outcome. A multicenter prospective cohort study conducted by the MOON Shoulder Group and published by Journal of Shoulder and Elbow Surgery takes a closer look.

To conduct the study, 452 patients with atraumatic full-thickness rotator cuff tears provided data via questionnaire on demographics, symptom characteristics, comorbidities, willingness to undergo surgery, and patient-related outcome assessments. Physicians also recorded physical examination and imaging data. Patients then began a physical therapy program developed from a systematic review of the literature and returned for evaluation at six and 12 weeks.

At those visits, patients could choose one of three courses: 1. Cured (no formal follow-up scheduled), 2. Improved (continue therapy with scheduled reassessment in six weeks), or 3. No Better (surgery offered). Patients were also contacted by telephone at one and two years to determine whether they had undergone surgery since their last visit and a Wilcoxon-signed rank test with continuity correction was used to compare initial, six-week, and 12-week outcome scores.

The results? Patient-reported outcomes improved significantly at six and 12 weeks and patients elected to undergo surgery less than 25% of the time. The patients who did end up deciding to have surgery generally did so between six and 12 weeks, and few had surgery between three and 24 months.

This study suggests that nonoperative treatment using this physical therapy protocol is indeed effective for treating atraumatic full-thickness rotator cuff tears in approximately 75% of patients followed up for two years.

If you have questions about treatment options for your shoulder injury or would like to make an appointment, please contact our office.

Should You Consider Partial Knee Replacement?

kneeA partial knee replacement, also known as unicompartmental knee arthroplasty (UKA), can be a very appealing alternative to a total knee replacement for those suffering from severe knee pain. UKA is less-invasive, more cost-effective, promises the preservation of important bone, ligaments, and knee function, and provides an enhanced postoperative recovery. But is it the right procedure for you? The Medial Unicompartmental Arthroplasty of the Knee article by Jennings, J. M., Kleeman-Forsthuber, L. T., and Bolognesi, M. P. takes a closer look.

In years past, isolated anteromedial osteoarthritis or spontaneous osteonecrosis of the knee were the only primary indications for partial knee replacement. Patients needed to be under age 60, less than 180 pounds, avoiding heavy labor, and experiencing minimal baseline pain, among other restrictions, which left only 6% of patients meeting all parameters.

Over the last two decades, however, studies have shown that the traditional indications for UKA can be expanded significantly with excellent results still obtained. Focused preoperative examination and imaging are needed to identify appropriate surgical candidates, but once selected, patients who undergo UKA experience faster recovery, improved kinematics, and better functional outcomes compared with total knee replacement, also known as total knee arthroplasty (TKA).

What’s more, the ten-year survival rates for partial knee replacement in cohort studies have shown to be greater than 90% with outcomes after conversion to total knee replacement being very similar to outcomes for revision TKA. While this information is encouraging, survivorship data should continue to be scrutinized and take both patient factors and functional outcomes into careful consideration.

As more long-term data on partial knee replacement becomes available, it will further guide clinicians in counseling patients on whether UKA is the right procedure for them. When performed at high-volume centers with advanced surgical techniques and on the correct patient populations, partial knee replacement has the potential to be a great alternative to total knee replacement.

If you want to learn more and discuss whether or not UKA is the right procedure for you, please contact our office. We’ll help you return to your health, pain-free lifestyle.

Dr. Stickney, a Kirkland orthopedic surgeon, is an expert in total and partial knee arthroplasty, exercise and health, and more. 

Is Yoga Safe After Joint Replacement Surgery?

yogaIf you’re one of the 35 million people in the US practicing yoga, you may be wondering if you can return to your practice after joint replacement surgery. Or maybe you’ve heard about the benefits of yoga and are interested in starting it up postoperatively. But is yoga safe and recommended for your new joint? Carried out with awareness of your limitations after surgery, yoga can be a very useful tool in the rehabilitation process.

Physical activity, including yoga, is an important part of recovery after joint replacement surgery. It helps to restore function and mobility in your joint, ease pain and swelling, and more. Yoga, specifically, helps to strengthen the muscles surrounding your new joint, increase flexibility, reduce stress, and can help you become more aware of your body’s alignment and posture.

Consult with Your Orthopedic Surgeon First. Remember, your situation is unique to you, and no one knows the condition of your new joint better than your orthopedic surgeon. Whether or not your orthopedic doctor recommends yoga can depend on how your joint replacement surgery went, how your recovery is expected to go, and what kind of restrictions you may have. For example an anterior hip replacement would allow for unrestricted yoga a few months after surgery. However a posterior approach hip replacement would require restrictions that would limit flexion poses like down dog child’s pose. It’s extremely important to consult with your orthopedic doctor before starting any type of physical activity, including yoga.

Talk to Your Yoga Instructor. If your orthopedic doctor gives you the go-ahead, it’s wise to also talk with your yoga instructor(s). Qualified instructors will know about the anatomy and movement of the hip and knee. They should be able to give you advice on what poses and movements will be beneficial, and what poses and movements you may need to avoid, either permanently or just while you heal. Modifications will most likely be necessary for a safe postoperative yoga practice. Your instructor can also help you correct your alignment to stay safe and provide help with any props.

Choose the Right Practice Style. Early on in the recovery, a restorative yoga class may be beneficial. Restorative yoga classes are typically slow and gentle, use a lot of helpful props, and focus on relaxation. Once you receive an okay from your orthopedic doctor to do so, any style of yoga, including Vinyasa or Bikram yoga, is possible as long as proper modifications are made to your practice.

Trust Yourself. After joint replacement surgery, it’s even more important to listen to your body’s cues while practicing yoga to maintain proper alignment and protect your joint replacement. Remember, never force yourself into a pose that’s painful or feels wrong.

Dr. Stickney, a Kirkland orthopedic surgeon, is an expert in total knee arthroplasty, total hip arthroplasty, exercise and health, and more. Contact Dr. Stickney to return to your healthy, pain-free lifestyle.

Meniscectomy Biomechanics and Clinical Outcomes

Stickney_kneeThough the meniscus is just a small part of the knee, it plays a very important biomechanical role in regular knee function including load bearing, shock absorption, and joint stability. Unfortunately, meniscus tears are one of the most common injuries orthopedic surgeons encounter, and thus, partial meniscectomy is one of the most common procedures performed.

But not all tears require surgery. In fact, according to Biomechanics and Clinical Outcomes of Partial Meniscectomy by Freeley, Briant T., MD; Lau, Brian C. MD published in Journal of the American Academy of Orthopaedic Surgeons, an MRI study found that 61% of aging asymptomatic patients had a meniscus tear identified on imaging.

Because orthopedic physicians must identify patients who will likely benefit from a partial meniscectomy, it’s vital that they understand the biomechanical implications and clinical outcomes of partial meniscectomy. As a patient, it’s always best to be educated on the latest research as well, so you can be an advocate for your own health.

For cases that do require partial meniscectomies, there has been extensive research conducted evaluating the biomechanical consequences and clinical outcomes. It was found that as the portion of the meniscus that is removed increases, the greater the contact pressure experienced by the Articular cartilage attached to the bone. This can lead to altered knee mechanics and early cartilage wear. However; leaving a mobile meniscus tear un treated in an otherwise healthy knee, which is creating mechanical symptoms of popping or locking, can result in further tearing of the meniscus and early wear of the cartilage above and below the tear. This leads to early arthritis.

It’s important to note that the use of partial meniscectomy to manage degenerative meniscus tears in knees with mild preexisting arthritis and mechanical symptoms can be beneficial; however, its routine use in the degenerative, arthritic knees is not likely to provide long term benefit. Physical therapy may be more successful in this situation . In younger age groups, partial meniscectomies may provide long-term symptom relief, earlier return to activity, and lower revision surgery rate compared with meniscal repair. If a large peripheral tear in the vascular part of the meniscus is present in a young person this would be where meniscal repair can result in a near normal knee long term.

Perhaps the most valuable takeaway from this biomechanical study is a greater understanding of the implications of meniscectomy. Orthopedic surgeons must subscribe to the current principle of maintaining as much meniscal tissue as possible. Partial meniscectomy remains a mainstay of treatment for unstable, central meniscus tears and offers favorable clinical outcomes with a low risk to patients when done correctly. Treatment should always be patient specific in a shared decision-making process with the patient.

Dr. Stickney, a Kirkland orthopedic surgeon, is an expert in total knee arthroplasty, total hip arthroplasty, exercise and health, and more. Contact Dr. Stickney to return to your healthy, pain-free lifestyle.

Can Activity Trackers Assist with Recovery After Knee or Hip Arthroplasty?

activitytrackerCommercial wrist-worn activity monitors, like those by Fitbit or Garmin, have the potential to accurately assess activity levels and have been gaining popularity in the last few years. In a 2018 study published in The Journal of Arthroplasty, researchers set out to determine if feedback from activity monitors can improve activity levels after total hip arthroplasty or total knee arthroplasty.

To conduct this study, 163 people undergoing primary total knee arthroplasty or total hip arthroplasty were randomized into two groups. Subjects in the study received an activity tracker with the step display obscured two weeks before surgery and completed patient-reported outcome measures. On the day after surgery, participants were randomized into either the “feedback group” or the “no feedback group”. The feedback group was able to view their daily step count and was given a daily step goal. Those in the no feedback group wore the device with the display obscured for two weeks after surgery and did not receive a formal step goal, but were also able to see their daily step count after those two weeks were up.

Average steps taken by both groups were monitored at one, two, and six weeks, and again at six months. At six months after surgery, subjects repeated their patient-reported outcome measures.

It turns out that the feedback group subjects had a significantly higher average daily step count by 43% in week one, 33% in week two, 21% in week six, and 17% at six months, compared to the no feedback group. Additionally, the feedback group subjects were 1.7 times more likely to achieve an average of 7,000 steps per day than the no feedback group subjects at six weeks after surgery. Six weeks after surgery, the feedback group participants were back to their pre-op activity levels (100%) and at six months, they were actually stepping more (137%). While 83% of the no feedback group participants reported they were satisfied with the results of the surgery, 90% of the feedback groups reported the same.

With mobility and physical activity being imperative to healthy aging and very helpful for recovery after total hip arthroplasty or total knee arthroplasty, incorporating an activity monitor into your after-surgery-care checklist is a great idea.

Dr. Stickney, a Kirkland orthopedic surgeon, is an expert in total knee arthroplasty, total hip arthroplasty, exercise and health, and more. Contact Dr. Stickney to return to your healthy, pain-free lifestyle.