Knee Injuries

At-Home Workouts Ease Osteoarthritis Pain

Osteoarthritis at home workoutsIf you have osteoarthritis, you already know that exercise can help reduce pain and improve mobility. But did you know that working out at home with a DVD may bring even more relief?

According to a study presented at the 2012 Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS), 107 people with osteoarthritis in the knee were randomized to either a DVD-based exercise group or a control group. The DVD group received a DVD-based exercise program along with verbal and hands-on exercise instructions for the first four to eight weeks. Participants in the DVD group reportedly exercised 5.3, 5.0, and 3.8 times per week at three-, six-, and 12-month intervals and had significantly greater improvement in pain and physical function than those in the control group.

While exercise did not make a significant difference in the progression of osteoarthritis, the reduction of pain and mobility among the DVD group speaks to the benefits of adding a video-based home exercise program to an existing exercise regimen.

When you exercise regularly, you strengthen the muscles around the arthritic joint, which helps decrease the pain of osteoarthritis and improve function. We suggest you do whatever keeps you on track to exercise regularly, whether it’s a video-based exercise program or exercising with a friend. But first, we recommend that you have an exercise program designed specifically for you by a physical therapist who understands osteoarthritis, to avoid injuries from overdoing it or doing the wrong exercises. The physical therapists here at the Emory Orthopaedics & Spine Center have the experience and the expertise to develop an exercise plan that meets your unique needs and helps bring relief from osteoarthritis pain.

Do you have osteoarthritis? Has a regular home-based exercise program helped ease your pain? We welcome your questions and feedback in the comments section below.

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Why Are Women Over 50 More Likely to Suffer From Knee Pain?

Knee Pain in womenIf you have knee pain, you know how debilitating it can be. And if you’re a woman, you have an even greater chance of developing knee pain after you reach 50. In a recent “Health Minute” spot, CNN’s Elizabeth Cohen spoke with Emory orthopedic physician Dr. Ken Mautner about knee pain in women over 50.

According to Dr. Mautner, knee pain in younger women tends to come from tendonitis or irritation issues around the knee. However, as women age, earlier knee injuries may lead to arthritis. The American College of Rheumatology reports that nearly two-thirds of women ages 50 and older have some degree of knee pain, and that pain is often due to osteoarthritis. And, Dr. Mautner says, women are more at risk for arthritis than men.

“We think that estrogen may have some protective effect on the cartilage of the knee,” Dr. Mautner says. That translates to a greater chance of experiencing knee pain after menopause.

Overuse injuries can cause knee pain, as can weight. If you have knee pain, your first step is to see your primary doctor to start determining the cause. He or she may then send you to a specialist. Treatment options may be as simple as taking acetaminophen or anti-inflammatory medications or using exercise as medicine, to strengthen the stabilizing muscles around the knee. Physical therapy may also be an option. When working out, avoid high-impact exercises that can further injure the knee. Low-impact exercises, like swimming, are a good alternative.

To watch Cohen’s “Health Minute,” visit: http://www.cnn.com/video/#/video/health/2012/01/26/hm-womens-knees.cnn

Are you over 50 and suffering from knee pain? Would you like to learn more about knee pain treatment at Emory? We welcome your questions and feedback in the comments section below.

Returning to Competition after an ACL Injury and Surgery

ACL Rehab ProgramBecause our sports medicine specialists have created a new program dedicated entirely to ACL injuries and your successful recovery from them, we’ve been sharing blog posts that correspond with the stages of the program. In first post, we helped you identify goals and prepare for ACL surgery after an injury and also introduced you to the concept of prehabilitation, which is equally as important as rehabilitating after surgery. For more on that topic, check out part I of our ACL injury blog series. After helping you prepare for surgery, we then moved on to identifying your post-ACL surgery recovery goals week-by-week in part II of our series. Today, we’ll be covering the last stage of the program and the portion that’s probably most important to those who consider themselves athletes: Returning to Play.

The goals and exercises outlined below will guide you from 3 months until 8 months post surgery. It is vital to faithfully adhere to the following program to avoid re-injury to the ACL reconstruction. Having a physical therapist or certified athletic trainer to help hide you through this program is often helpful. If you’ve had ACL surgery, but are still in the early stages of rehabilitation, check out part I and part II of our ACL injury blog series before moving forward.

Months 3-4: Jogging Phase

During months 3 and 4 of your recovery after ACL surgery you will work on improving functional strength with forwards and backwards movement, increasing your cardiovascular fitness and starting a jogging progression, core strengthening and overall lower extremity flexibility. Tip: when performing exercises such as Schlopy Mini Jumps, use a mirror for feedback. Your hips should stay even and knees should not buckle in, you should flex at your knees not your hips.

Months 4-5: Agility Phase

Building agility in months 4 and 5 of your recovery is a key step in returning to play. During months 4-5, focus on your strength, cardio, flexibility, core, and agility workouts. From the exercises outlined by the program, lower extremity strength should all be done on same day and make sure you get 48 hours rest between strength exercises. Cardiovascular exercises should be done 3-5 times per week.

Months 5-6: Return to Drills Phase

Throughout months 5-6 you will continue to work on improving strength and balance and start getting back to your game. You can add the BOSU ball with your strengthening exercises and start sport specific drills and start to be a part of your team.

Months 6-7: Return to Practice Phase

During months 6-7 of your post-ACL surgery recovery, you can start practicing your sport with your team. You can get physical in practice but only progress to play when you are fully confident. You will need both the physical strength and mental confidence before you start to compete and play.

Months 7-8: Return to Competition Phase

Congratulations! Once you’ve made it this far through the ACL surgery and rehabilitation program, you are ready to return to competition!  Make sure you are in the best shape possible to return both physically and mentally. Your ACL strength and flexibility will only improve as long as you continue to challenge yourself and continue your strengthening.

Remember you won’t be 100 percent, fully recovered until 12 to 18 months. Professional athletes take one year to return to high level competition. Be patient!

If you’ve injured your ACL, whether or not you’ve had surgery yet, check out our ACL rehabilitation program website. All of the phases listed above are outlined on the site with detailed instructions, exercises and tips for making your recovery after ACL surgery as effective as possible.

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Defining Post-Op Goals After ACL Surgery

ACL post operative goals

It is estimated that there are approximately 80,000 anterior cruciate ligament (ACL) tears in the U.S. each year. Not surprisingly, 70% of those injuries take place while the person injured is participating in athletic activity. Because ACL tears are so common and can put a hindrance on an athlete pursuing his or her career or passion, our Emory Sports Medicine team has put together an ACL program specifically for people seeking guidance in their treatment and recovery from ACL injuries and tears.

In our last blog post on ACL injuries, we got you familiar with the idea of prehabilitation, or care and steps to take before surgery for an ACL-tear. which is part one of the ACL program at Emory. In this post, we’ll cover some of the details and goals of your post-op recovery from ACL surgery, including what you should expect to see week by week:

ACL Surgery Post-Op Weeks 1-3

Goals: The goals in the first three weeks of your recovery from ACL surgery are fairly straight forward, to get patients back on their feet (off crutches), reduce swelling in the joint by faithfully icing (20 min every 2-4 hrs), and to increase the knee’s range of motion and focusing on getting extension back. For specific measurements you should track and exercises to consider, check out the materials on our website.

ACL Surgery Post-Op Weeks 4-6

Goals: Consistently reducing swelling in the knee and continuing to work on increasing the knee’s range of motion are the core goals of ACL surgery recovery weeks 4-6. At this point in your surgical recovery, your knee should be able to be straight or equal to other knee. Your knee joint should be cooing and not warm to touch. Those 4-6 weeks out from surgery should focus on being able to walk without limping and strengthening quadricep muscles.

ACL Surgery Post-Op Weeks 7-12

Goals: 2-3 months after ACL surgery, swelling should be controlled and there should be minimal effusion in the knee joint. Range of motion should be nearly full or equal to the other side full extension and knee flexion should be to 120 degrees. Knee joint should be cool and normal temperature, compared to other side. By this point, patients should have achieved good quadriceps tone with their vastus medialis oblique (VMO) firing effectively. Patients should also seek to establish normal gait pattern and be able to walk without limping at this point.

Does your recovery timeline after ACL surgery match up with what you see here? If so, or if not, please feel free to share your story with us and with our readers.

Emory Sports Medicine’s ACL injury program specializes in providing care ranging from the prehabilitation stage to getting you back in the game. So, in our next ACL injury post, we’ll share with you specific exercises you can use and steps you can take (including video demonstrations) to help you return to play more quickly. Stay tuned!

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More Runners’ Chat Questions Answered

Dr. Amadeus MasonOn Wednesday, I held a live chat on the topic of running to help those preparing for the Peachtree Road Race and to educate runners of all skill levels on injury prevention, nutrition, and technique. It was my first so-called “live chat,” so I really didn’t know what to expect. The questions that I received in yesterday’s chat were fantastic. Not only do I feel like I got to help the 50+ people who joined me in the chatroom, but I myself was able to learn something in the process. Typically when I chat with people who have questions for me, they are my patients, in a one-on-one setting. This really gives me the time to feel them out and learn about them as individuals. Wednesday, I was charged with a new and equally inspiring and fulfilling task– to educate a group, without being able to see them in person or learn about them before we talked. It was an extremely eye opening experience.

I want to thank those who joined me Wednesday for a wonderful chat. It was so successful, in fact, that I didn’t get a chance to answer each and every question. For those who were in the room, I promised to follow up with a blog to answer all questions that were unaddressed, and I have done so below. At the bottom of this blog post, you will also find the documents I mentioned in the chat for your further reference. As an added bonus, to make sure everyone gets a chance to discuss the topic of running and all of its facets with me, we will be holding the next live chat on running on June 15th.

Larry: I ran a marathon with IT band issues.  What can I do to prevent it in the future?
Dr. Mason: Larry, to prevent IT band problems, you should strive to work on increased flexibility. I’d advise that you watch the rate at which you increase your mileage/distance and start training early enough to allow for a slow and steady progress with sufficient recovery times between training sessions.

Shirley: Dr. Mason, Why does my back hurt periodically when I am tired while running?  Should I bend over to stretch?  I am a beginner.
Dr. Mason: I can’t speak to your specific medical circumstances without seeing you in-person, but generally speaking, oftentimes people experience back pain while running due to hamstring tightness. For these patients, I advise that they avoid the typical stretch that involves bending over, and instead focus on extension type exercises.

M. White: How do I know when it is time for new running shoes?  This will be my first time running longer than a 5k.
Dr. Mason: My recommended guidelines for footwear are if you run more than 20 – 25 miles a week you should change you shoes every 3 – 4months ( ~300 miles); if you run less than 20 miles a week can change shoes twice a year.

Sylvia: Hi. Dr. Mason. Is there any particular type of shoe that you would recommend as best for protecting against injuries; Knees, ankles, shin splints, etc.?
Dr. Mason: Studies have shown that shoe comfort is a more important factor in preventing injury than the actual type of shoe.  I would recommend you get evaluated at your local running store to determine what class of running should would be best for you. After doing that, go ahead and pick the most comfortable one in that class.

Judy: I’m used to walking about 3 miles about 3 times a week.  I am signed for the Peachtree.  Obviously I will be walking it.  I have 6 weeks to step up my training.  How would you suggest I proceed to get to 6 miles in time for the race?  Thanks.
Dr. Mason: Good question, Judy. I’d recommend adding about ½ mile to your distance each week.

Steve: Dr. Mason, I have a chronic hamstring issue.  What can I do to help the issue?  What type of Dr. or therapist should I seek out for help?
Dr. Mason: I would recommend you see a physician with sports medicine training.

M. White: I have been training for a 5k (took 30min) – which I ran a couple of weekends ago.  To train for the Peachtree what should I do?  Increase distance or time?
Dr. Mason: My answer here depends on whether you want to run the Peachtree for time or just for fun.  Since this race is twice the distance of a 5k,  I would start out increasing your distance (1/2 mile a week. Once you get to 5 miles then you can start increasing your pace.

Mac: What are some good lower-fat proteins for vegetarian novice runners?
Dr. Mason: As a vegetarian you should be concerned about getting in GOOD fats as opposed to LOW fat.  To that end eating things like beans, nuts and/or soy would be good choices.

Dawn: When I ran the Peachtree last year, I found it difficult to actually drink water at the hydration stations (did more of a swish-and-spit).  I am concerned about dehydration during the race.  Should I increase my fluids before the race?
Dr. Mason: Yes, in a 10K there is LESS risk/concern for dehydration that in half or full marathons, but you should be starting your hydration process now.  I recommend increasing you fluid intake (electrolyte/water) weeks before you run and incorporating “water stops” in to your training.  You know you are well hydrated when you have to use the bathroom 30 min after fluid intake (when you’re not running).

1st Timer: Are there any weight training exercises you recommend?
Dr. Mason: In order to answer this question in detail, I would need more information from you.  What I can say is that weight /strength training should be a part of any running program. This type of training should primarily (but not solely) focus on lower body strength and be accompanied by a good flexibility program.

Jacqui: How frequently should you increase pace or distance?
Dr. Mason: I normally recommend increasing distance then pace. But, as we mentioned in the chat, it really depends on the goals you’re looking to achieve. If you are looking to run a long distance race, you’ll probably want to focus on increasing distance, more often than pace, and doing so every 2 weeks should work well. Just remember to never increase both distance and pace at the same time.

Shalewa: What about energy enhancers like sports beans or 5 hour energy drink?  Are those bad for you?
Dr. Mason: Most “energy enhancers” are just caffeine or a caffeine derivatives and I would stay away from them as they greatly increase dehydration risk.  Good nutrition that balance carbohydrates, proteins and good fats should give you the energy you need for a 10K.  With marathons, ultra marathons, and triathlons in-competition metabolic supplements (which are very different from the energy enhancers) are often provided and can be helpful.  You’ll want to be careful and make sure that you are using them throughout your training so your body has time to adjust.

Jennifer: Hi, Dr. Mason.  I am an active person who is new to running.  After my training runs I am experiencing some discomfort/tightness in my upper and outer knees.  What can I do to help prevent this?
Dr. Mason: If these symptoms are not preventing you from doing the type/intensity of run that you want, then I would recommend working on the flexibility and strength of you quads and hamstrings.  If you are having to modify your training runs then you should see a Sports Medicine Physician.

Thanks again to those who joined me in Wednesday’s chat. I hope to see you all in Part II on June 15th! Below are the documents I referenced in the chat, please feel free to download them and keep them for reference. If you missed Part I of the chat, you can check out the chat transcript. You can also sign up to attend Part II of the chat, which is taking place on June 15th at 12pm.

Related PDF Downloads:

 

 

New Technology for Reducing Risk & Recovery Times for Young Athletes

John Xerogeanes MDWhether your child plays football, basketball, soccer or gymnastics, a common worry for many parents is the looming possibility of a sports injury. In many of these sports, anatomic anterior cruciate ligament (ACL) tears are one of the most common injuries young athletes experience. For most children who injure their ACL, treatment consists of rehabilitation, wearing a brace, and reducing athletic activity levels until they stop growing (usually around their mid-teens), at which point ACL reconstruction surgery can safely be performed.

Why do we wait until kids stop growing to perform the surgery? ACL operations are typically conducted with extensive use of X-rays in the operating room, which often leads to a large margin of “chance” when working around growth plates. Essentially, performing ACL surgery on a young child significantly increases the risk of causing a growth plate disturbance.

To help ease this fear and risk, we’ve developed a new 3-D MRI technology at Emory Sports Medicine Center. The 3-D MRI technology makes it possible for surgeons to reconstruct ACL tears in young athletes without disturbing the growth plate. This technology allows us to better pre-operatively plan and perform ACL surgery with more precision and less risk.

As one of the four major ligaments in the knee, the ACL is somewhat like a rubber band, attached at two points to keep the knee stable. In order to replace the ligament, a tunnel is created in the upper and lower knee bones (femur and tibia) and a new ligament (typically taken from a hamstring or allograft tissue) is slid between those tunnels and attached at each end.

With the new 3-D technology being used at Emory, we can actually see from one end to the other on either side of the knee, and can correctly position the tunnels so we are able to place the new ligament with more precision. With this technology, ACL surgery can be done in less time than the traditional surgery, and we have great confidence that the growth plates in our young patients will not be damaged.

Kids who undergo this type of operation will still have at least one year of recovery time. The good news, is that it does allow them to eventually pursue normal activity much sooner than they would with the traditional surgery. This new method of ACL reconstruction is able to be performed on children and adults alike. My hope is that this new technology will aid us in preventing future re-injury for athletes who have suffered from ACL tears.

About John Xerogeanes, MD:

Dr. Xerogeanes, or Dr. “X”, is chief of Sports Medicine at the Emory Orthopaedic & Spine Center. He is also head orthopaedist and team physician for Georgia Tech, Emory University, and Agnes Scott College. As a member of a number of professional societies and organizations, including the American Orthopaedic Society for Sports Medicine, and the American Academy of Orthopaedic Surgeons, Dr. Xerogeanes has contributed to many textbooks and has received numerous research awards. Dr. Xerogeanes’ work has been featured on CNN, ESPN and network television news

When Doctors Operate on Doctors

A Chat with Dr. Sameh Labib and Dr. John W. Xerogeanes

Four years ago, Dr. X, a popular surgeon at Emory Sports Medicine, suffered a knee injury that required surgery. Who did he turn to? Dr. Sameh Labib of Emory Sports Medicine. The two doctors recently chatted about the surgery and recovery.

DR. X: I started to have back pain when I turned 40. Around that time, the football and basketball teams we treat at Georgia Tech were doing yoga classes with Diamond Dallas Page, the former wrestler. They all told me that it helped their flexibility and joint pains. I started taking the class once a week. As promised, I felt better and the back pain went away.

One year later, my wife was making fun of me for being the “Yogi Kudu.” (For those around my age, you might remember him as the yoga practitioner who made appearances in the 1980s on the TV show “That’s Incredible,” folding his six-foot frame inside small glass boxes.) In playful response to my wife’s comment, I showed her a new pigeon pose. Upon transitioning from one pose to another, I heard a pop in the knee and I had pain.

When the pain continued, I had an MRI, which showed a meniscal tear. To others who might have suffered this injury: When you tear your meniscus, you twist and feel sharp pain on the side of your knee—this is sometimes accompanied by a click.

DR. LABIB: Yoga is not a common cause of knee injuries. Football, basketball, soccer and tennis injuries are much more common. It’s best to have an experienced yoga instructor guiding you to avoid injury. Meniscus injuries usually happen due to twisting and pivoting. In yoga, it happens due to excessive knee bending or flexing with certain poses, such as the lotus pose.

When John injured himself, I remember thinking that doing knee surgery on the busiest knee surgeon at Emory was going to be a challenge! As you may know, sometimes doctors make the worst patients, and they can be noncompliant – as doctors, we tend to think that we’re bulletproof.

For that reason, I try to treat my “doctor” patients exactly as I treat everyone else and hope for them to follow instructions. Is this wishful thinking? Naive? Of course, there is also the “Doctor Curse,” where all the weird complications happen.

With the above in mind, I agreed to do John’s surgery. It went great and, to my surprise, he was very cooperative.

DR. X: My wife told me to listen to Sam, period! It still did not get me out of doing household chores …

Actually, it was no problem being operated on by someone else. The good thing about being a knee surgeon is that you KNOW who you think is the best guy to fix you. Thus, I had Sam take care of me.

If I hadn’t gotten surgery, I would have continued to experience pain. Doing athletic activities would have been painful, and the bending of my knee would be limited. Since I’m an athletic person, this wasn’t an option for me. I wanted to get better.

DR. LABIB: Once the surgery was complete, I told John to ice, elevate and avoid prolonged standing or walking for the first week or so. Also, he needed to start early motion.

I recommend making a gradual return to low-impact sports such as cycling and stepping. Swimming is allowed after the wounds have healed (approximately three weeks after). Knee swelling and stiffness are common in patients. Usually patients see that the incisions are small, and they feel good after the procedure so they end up “overdoing” it. We are often telling our patients to slow down and let the inside heal before they increase their activity. Three to four weeks are often needed before they can return to their sport.

I’m happy that John was a great patient. His knee has healed and he’s doing yoga again. I hope other doctors follow his example!

About Shaina Lane, MEd, ATC, LAT, OTC:

In 2006, Shaina applied and was accepted to the Emory Sports Medicine-Ossur Fellowship. She spent that year working alongside the physicians at Emory Sports Medicine, enhancing her clinical evaluation skills as well as learning how to assist in the operating room. After the fellowship, she spent several months working at a private practice in Tennessee before returning to Emory Healthcare as a clinical coordinator in the sports medicine department and program coordinator for the Emory Sports Medicine-Ossur Athletic Training Fellowship.

What to Do When It Hurts to Exercise

Exercising with pain can be a catch-22. Certain exercises can ease arthritis pain and keep stiffened joints limber. When you exercise, you strengthen muscles that help stabilize your joints. However, if you over-exercise, or go about it the wrong way, you can further damage the joints you’re trying to protect.

As a physiatrist at the Emory Orthopaedics & Spine Center, I work with athletes who make a living being active. When they’re hurt, they need to know when it’s best to exercise through the pain, or when they need to lay off for a while so that they don’t further injure themselves. So, how do you know when to exercise through the pain and when to give yourself a break?

My rule of thumb for exercising in pain: if the pain doesn’t get worse during exercise (and stays below a 3/10 on pain scale), and if you don’t feel increased pain later that night or the next day after exercising, then it was most likely a safe form of exercise.

On the other hand, if the pain becomes severe as you’re exercising, or you have an increase in pain after exercise, you probably shouldn’t continue with that particular activity. Additionally, if you experience any painful catching/locking (especially in the knee), don’t push through the pain. If these symptoms persist, or if the pain is present at night while you’re resting, it’s a good idea to schedule an appointment with a physician.

Low-impact, aerobic activity is the best way to get exercise and minimize pain from orthopedic conditions. Stationary or recumbent bicycling, elliptical trainers, and swimming are great examples of low-impact ways to get your heart rate up.

Are you dealing with pain when you exercise? Are you unsure whether to work through it, or stop until you feel better? Share your experience with us. We welcome your questions and feedback in the comments section below.

About Kenneth Mautner, MD

Dr. Mautner is an assistant professor of orthopedics, as well as an assistant professor of physical medicine and rehabilitation, serving both Spine and Sports Medicine. In addition to being a consulting physician for the Georgia Tech Athletics, he is head team physician for Agnes Scott College and team physician for Emory University Athletics. Dr. Mautner began practicing at Emory in 2004.

How Long Does It Take to Return From ACL Surgery?

If you’re a fan of the New England Patriots (or just a sports-medicine physician and surgeon), you’ve probably been watching the comeback of receiver Wes Welker from ACL reconstructive surgery very closely. Welker tore his ACL in January of this year, and the latest news suggests he’s aiming to start Game 1 of the NFL season on September 12. He’s already participated in contact drills with the Patriots.

Welker’s comeback has raised some eyebrows because he’s pushing conventional time limits for his return to the sport. Most people who undergo reconstructive knee surgery can return to athletic activities at six to eight months, but they’re usually not back to their previous level of competition until one year. Keep in mind—we’re not talking about tennis with a friend here; this is the NFL.

Professional athletes are like a Petri dish for the rest of us. They take the human body to the limits of what it can do, and so we learn from them. Ultimately, we often want to emulate them, which is why it’s important to put Welker’s comeback into perspective.

One of my patients, a Georgia Tech football player, is coming back from ACL reconstruction, and he’s complaining of soreness. We stress to kids that the average pro football player takes 54 weeks to return to play after an ACL injury. When a patient tries to return earlier, they often experience pain and swelling, and are at some level of increased risk of re-injury.

Here are some warning signs we look for that could indicate an athlete is pushing the limits on their comeback:

1. Pain and soreness in the front part of the knee (in the patella tendon area)

2. Swelling of the knee

3. A general feeling of fatigue

If a patient experiences one or more of these symptoms, they need to back off from their training, and concentrate on icing, riding the exercise bike, and resting. They can always resume training when they’re feeling better. If you’ve had ACL surgery and your “comeback” to the activities you enjoy isn’t going as expected, call us at Emory Sports Medicine. We can provide a safe, solid game plan for your return to action.

Meanwhile, if Welker succeeds and contributes another valuable season to Tom Brady and the Patriots, his determination should be praised; however, that doesn’t mean his quick comeback should be emulated.

About John Xerogeanes, MD:

Dr. Xerogeanes, or Dr. “X”, is chief of Sports Medicine at the Emory Orthopaedic & Spine Center. He is also head orthopaedist and team physician for Georgia Tech, Emory University, and Agnes Scott College. As a member of a number of professional societies and organizations, including the American Orthopaedic Society for Sports Medicine, and the American Academy of Orthopaedic Surgeons, Dr. Xerogeanes has contributed to many textbooks and has received numerous research awards. Dr. Xerogeanes’ work has been featured on CNN, ESPN and network television news.

The Tour de France and Common Cycling Injuries

We’re in the final stages of what has been a fascinating Tour de France. We’ve seen some heroic climbs, nail-biting descents, and more than a few changes of fortunes for cyclists who started out as top contenders. The once unbeatable Lance Armstrong is now far back in the field, his best hopes dashed by a series of crashes, and Team RadioShack is now working for Levi Leipheimer. Andy Schleck saw a mechanical problem steal away his hopes for a Tour win. And other favorites, such as Cadel Evans and Fabian Cancellera, are now out of serious contention. Alberto Contador appears poised to ride victorious into Paris… but, as this Tour has demonstrated, all it takes is one bad or unfortunately timed crash to completely change the standings. There’s surely plenty more excitement to come!

The crashes started early, in stage two, when it seemed like hardly anyone could stay on their bikes as they rode over slick terrain. In addition to some serious injuries, there was a lot of road rash that day. “Road rash,” as you may know, is the grimly lighthearted name that cyclists give to the extensive abrasions they often get when they fall off the bike and slide along pavement. Along with saddle sores, which are caused by the constant rubbing of the bike seat, road rash is one of the most common injuries in cycling. I spent a lot of time treating them both when I was the assistant medical director and head athletic trainer for the Tour de Georgia.

Treating road rash and saddle sores is, frankly, pretty straightforward. The interesting work on the Tour de Georgia had to do with figuring out and fixing the root causes of neuromuscular and mechanical issues. For example, we once had a cyclist – a talented, experienced competitor – whose cadence inexplicably became very inefficient, and he started having some trouble with his IT band (also a common problem for cyclists). We spent a day following him in a car, and I noticed that his right knee was dropping with every revolution. We ended up tracing the problem to weakness in his right adductor, which wasn’t properly supporting the force that his legs were delivering. The result? He had to compensate for that weakness, and that led to an overuse injury.

Scenarios like this happen quite a bit in sports medicine. A neuromuscular problem in one area of the body frequently ends up being the result of muscle deficiencies elsewhere. If you solve that deeper problem, the presenting issues go away as well. In the case of this cyclist, we worked with him to strengthen his adductor. He then went from having trouble even keeping up with the peloton in the early stages to being one of three cyclists in a breakaway in the final stage. It’s deeply satisfying when we can deliver those kinds of results.

At Emory Sports Medicine, we also use cycling as an important component of physical therapy, most commonly in the case of knee injuries and procedures such as ACL surgery. A lot of this therapy starts out on stationary bikes. We try to get many of our knee patients onto the bike as soon as possible after surgery – often within a week of the procedure – in order to keep down swelling and restore range of motion. At first, they’re cycling with no resistance – just spinning, promoting blood flow and range of motion. Then we gradually increase resistance to build back strength. Some patients eventually choose to graduate from the stationary bike to riding outside. Of course, fans of cycling might want to stick with the stationary bike for a little bit longer, so that, while they ride, they can turn on the TV and watch a very exciting Tour de France!

About Forrest Q. Pecha:

Forest is the Director of Athletic Training Services at Emory Sports Medicine. He was the assistant medical director and head athletic trainer for the Tour de Georgia from 2005 through 2008. He also serves as the liaison between Emory Sports Medicine and the United States Soccer National teams for athletic training coverage, and provides support coverage to the US Men’s Alpine Ski Team. Forest has been with Emory Sports Medicine since 2004.