Category Archives: Injuries

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.

The Potential and Pitfalls of Stem Cell Injections

stemcallcautionWhen it comes to stem cell therapy, it’s wise to be a bit wary. While stem cells can have enormous implications for treatment of injury and disease, many facilities offering stem cell injections are simply looking to capitalize on the buzz surrounding this therapy. If you’re considering stem cell injections, it’s essential that you learn everything you can about stem cell practices so you can identify the healing potential and possible scams.

This type of therapy involves repurposing self-renewing stem cells found naturally in your body by injecting them into damaged tissue. When you experience an injury, the body’s healing reaction sends undeveloped cells through the bloodstream to the injured area. When they arrive, they develop into repair cells as a response to their surroundings. The goal of stem cell injections is to expedite treatment of injury or disease by harnessing this natural capacity your body has for healing itself.

The procedure begins with stem cell harvesting, where a doctor extracts cells from points within the body, like fat or bone marrow. Alternatively, cells from a donor like blood from an umbilical cord, could be used, but they must be treated first to prevent negative reactions in the patient. The doctor then proceeds to inject this collection of cells, including rare stem cells, to the site of injury. In theory, this enhances the rate at which the body can heal after injury.

With further research and more advances in the field, stem cells will eventually be extracted from your body and separated in a lab to identify cells with specific capacity. For example, when healing an arthritic joint, stem cells for joint cartilage healing will be cultured to increase their numbers, then injected back into your joint in a quantity sufficient to repair it. While this is the ultimate goal, years of clinical research and trials are required first. In fact, the FDA does not currently allow cell removal from your body, processing them in any significant way, and then putting them back into your body, unless the practice is conducted as part of an approved clinical trial.

Many stem cell therapy offerings charge anywhere between $5000 to $10000 to simply take cells from your bone marrow or fat, spin them in a centrifuge to concentrate the cells, and inject them back into the area of injury. This process makes no attempt to identify the number or quality of stem cells harvested. There are no controlled studies proving this process is effective thus far.

As with any treatment, each patient reacts differently. The current literature surrounding stem cell injections states that the treatment is limited by the quantity and quality of stem cells initially harvested. Patients carry varying levels of stem cells, which may result in ineffective transfusions. Another limitation is physical blockages, such as blocked arteries, that inhibit the body’s ability to transport cells throughout the injured area.

Even when the outcome of stem cell therapy is recovery, establishing a cause-and-effect relationship is difficult because of multiple distinct processes taking place during treatment, and the high potential for placebo effects and natural healing. Some patients improve drastically while others show no substantial alterations.

The efficacy of stem cell injections is a point of contention amongst medical professionals, and because we are still in the experimental stage there’s still a lot we don’t know. FDA regulations for stem cell therapy are subject to change. Be cautious of stem cell treatments offered without regulatory approval or that have not been tested in a registered clinical trial.

When it comes to proven treatments, Dr. Stickney, a Kirkland orthopedic surgeon, is an expert in exercise and healthjoint replacement surgerysports medicine and more. Contact Dr. Stickney and return to your healthy, pain-free lifestyle!

How to Prevent Winter Injuries

stickney-winterWith winter comes the holidays, ski vacations, and long-awaited snow days. However, the ice and inclement weather can also lead to an increase in slips, falls, and injuries that may need treatment by an orthopedic surgeon. To make sure you can get the most out of the season, follow these tips from Dr. Alan S. Hilibrand to stay pain-free while hitting the slopes and spending time with family.

Practice Ladder Safety
According to the Consumer Product Safety Commission, in 2015, nearly 566,000 Americans received a ladder-related injury and 69,000 went to the doctor or emergency room due to injuries incurred in holiday decorating. Whether you’re removing your holiday decorations or taking care of housework, prevent injury by selecting the right ladder — step stools and utility ladders for low and medium heights, extension ladders for outdoors — and never exceeding the ladder’s maximum load capacity. Make sure it doesn’t have any damage, is clean, and is set on a firm, level surface.

Don’t Rush Holiday Travel
Unfortunately, travel and stress can often be synonymous, and in our hurry to get to our destination or avoid lines, we might strain our backs lifting heavy luggage. In 2015, according to the CPSC, over 84,500 Americans sought medical attention for injuries incurred while lifting or moving luggage — minimize your risk by packing light, being conscientious when carrying a heavy suitcase, and always lifting by bending at your knees and using your legs, rather than your back or waist.

Stay Safe on the Slopes
In 2015, almost 150,000 people sought medical treatment for injuries from skiing and snowboarding. Make sure you’re not sitting the season out by stretching and warming up before tackling fresh powder, and always wear the correct protective gear to keep your joints safe. Know the rules of the sport you’re participating in, and allow your body time to rest in between runs.

Take Precautions Around Snow
Over 165,000 people visited the doctor or emergency room due to injuries from shoveling snow or using a snow blower in 2015. Whatever your preferred method of tackling snow, check with your physician ahead of time to make sure you don’t have any heart or vascular conditions that could be aggravated. Warm up with light exercise 10 minutes prior to going outside, wear correct footwear, and in the case of falling, try to land on your side or buttocks to minimize injury.

Drive Cautiously
Keep an eye out for black ice and other hazardous conditions, and to make sure you, other drivers, and pedestrians stay safe, err on the side of caution. Keep distance between cars, and give yourself plenty of time to brake before stop signs and red lights. If you feel uncomfortable, reduce your speed. 

Suffering from a winter-related accident? Dealing with joint pain that impacts your ability to make the most of the season? Contact Dr. Stickney, a Kirkland orthopedic surgeon specializing in procedures such as total knee replacement and shoulder surgery.

 

AAOS Tips for Preventing Summer Injuries

urban bicyclists

As summer arrives, it is inevitable that we come out of our winter hibernation and become more active. Regrettably though, with more activity comes the increased chance of orthopedic injuries. In hospitals the summer season is also known as “trauma season” because adult injuries spike by 25-30%. Although not all of these injuries are orthopedic, the vast majority of these injuries fall into this category.

The most common types of summer orthopedic injuries come from: biking accidents, lawn mower mishaps, ladder incidents, swimming injuries, ATV calamities, trampoline trauma, and funky falls. Luckily, AAOS has created a vast amount of resource information for orthopedic surgeons to provide to their patients, including public service announcements and safe walking and driving advice.

AAOS Public Service Announcements

This summer season, the AAOS decided to focus their public service announcements on ladder and bike safety. These injury-prevention efforts were taken so seriously that a ladder safety ad was created in conjunction with the American Orthopaedic Foot and Ankle Society, whereas the bike ad was created with the help of the Orthopaedic Trauma Association. In addition to these two ads, the AAOS also created postcards, posters, and downloadable images for some of their 2015 PSAs relating to swimming and motorcycle accidents. To access these additional PSAs visit OrthoInfo.org/divingsafety and OrthoInfo.org/cyclesafety.

Ladder Safety

Ladder safety is something that we all take for granted. Thus, AAOS felt it necessary to post a PSA on the matter. The ladder announcement advises that if injury is to be prevented, ladder safety should be learned BEFORE climbing the ladder. The ad tells people: that “Climbing a ladder might be the most dangerous thing [they] do all year,” due to the high risk of foot and ankle fractures. To avoid injury, the ad advises people to:

  • Make sure they have the balance and strength to use a ladder.
  • Take the time to secure it properly.
  • Not to stand above the marked level.
  • Always wear lace-up shoes or boots.

Additional precautions can be found at OrthoInfo.org/LadderSafety

Bike Safety

Bike safety is something that every parent tries to instill in their child, but sometimes the lessons don’t take hold. To pack a punch, the bike safety PTA depicts a bicycle made out of bones. The graphic points out just how fragile bike riders are in comparison to cars. The goal of the ad is to show how vulnerable to injury bikers can be. To highlight this fact the ad says: “So, even when a rider does something boneheaded, remember – your broken headlight is easier to fix than their broken bones. Take the high road and give bicyclist the space they need to ride safely.” The tips provided in the PTA are great tools for parents to use when teaching their kids about bike safety AND for the average adult biker and driver! For more information on bike safety, visit OrthoInfo.org/BikeSafety.

Distracted walking and driving

This summer, the AAOS saw fit to emphasize walking and driving safety. In 2009, AAOS launched the “Decide to Drive” campaign, which educates people about the danger of distracted driving. Decidetodrive.org gives all the statistics, videos, downloads, contests, and ideas for social media posts related to distracted driving that anybody could ever need. All of the tips provided on the page are extremely useful when providing patients with information on the orthopedic injuries that can occur as a result of distracted driving. So, be a responsible driver and check out all the tips “Decide to Drive” can offer you.

Due to the digital craze, people nowadays can be seen walking and texting with no regard for what dangers may lie outside of the telephone screen. Thus, the AAOS recently extended its injury-prevention efforts to include “Digital Deadwalkers.” This campaign includes radio and television PSAs that humorously highlight the dangers of pedestrians focusing on anything or anyone other than the task of walking to their destination safely. Be an informed citizen and check out the funny videos this campaign has to offer at
OrthoInfo.org/DistractedPedestrians. Who knows, you could be the “Digital Deadwalker” everybody is trying to avoid.

Although AAOS has chosen to highlight ladder and bike safety along with distracted driving and walking, there are plenty of other summer dangers that may result in a visit to an orthopedic doctor. Check out AAOS’ “Prevent Injuries America” website for more articles and videos to help you prevent summer injuries. Newsroom.aaos.org/patient-resources/prevent-injuries-america/

If you are interested in accessing the PSAs in this article, visit aaos.org/PSA.

Citations:
Hilibrand, Alan S. “Preventing Common Summer Injuries.” AAOS. AAOS, May 2016.
Toland, Bill. “Summertime Is ‘trauma Season’ for Hospital ERs.” Pittsburgh Post-Gazette. Pittsburgh Post-Gazette, May 2014. Web.