Posts Tagged ‘injury’

Preventing and Treating Achilles Tears

Brandon Mines, MDYou may know that Chamique Holdsclaw, one of my former Atlanta Dream players (not to mention one of basketball’s most gifted female athletes), suffered an Achilles tendon injury this year. While this injury is common with basketball players, it is most prevalent in men ages 35-45. They’re often the “weekend warrior” types—so the injury is more likely to happen when they overdo it, and when they don’t have a good stretching regimen.

There are two basic variations of Achilles injuries: a bad sprain, and a complete tear. It’s important to know whether the Achilles is torn or not, because the treatment is very different: a torn Achilles means surgery; a strained Achilles means rehab and rest. Some people with Achilles tears are misdiagnosed with sprains, only to find out later that they have Achilles tears and they’ve missed the window to have it fixed. (An Achilles tear should be repaired within four weeks of tearing it.)

Here’s the difference between an Achilles strain and a tear: a strain is a gradual onset of pain that tends to get worse with more activity. An Achilles tear is a sudden injury, and it feels as if you were hit in the back of the ankle—the tendon actually pops and tears in a sudden fashion. Most people who have this tear will actually say, “Somebody must have kicked me me because I felt it in the back of my heel/ankle.”

If you’ve suffered an injury like this, it’s important for you to see a sports medicine doctor immediately. You can also take our Ankle Quiz.

If you’re healthy and uninjured, be sure to do everything you can to keep it that way. Here’s are some tips to prevent Achilles injuries:

  • Exercise regularly; in other words, don’t jump into a game of full-court basketball after not working out for a year.
  • Wear shoes with a lot of support.
  • Warm up and stretch for 15 minutes before playing.
  • Stretch and stay warm during breaks in the action.

Do you have any questions about the prevention or treatment of Achilles tendon injuries? If so, be sure to let me know in the comments section.

About Brandon Mines, MD:

Dr. Mines has been practicing with Emory since 2005 and specializes in family practice and sports medicine. His areas of clinical interest include ankle, shoulder, hand, knee, sports injuries, upper extremities, and wrist. Dr. Mines holds organizational leadership memberships at the American College of Sports Medicine and the American Medical Society of Sports Medicine.

Got Hip Pain? Get Back in the Game Quickly with Hip Resurfacing

hip resurfacing procedureIn my practice at the Emory Orthopaedics & Spine Center, I see a lot of patients who suffer from hip pain as a result of osteoarthritis, or degenerative joint disease. In the past, when surgery was called for, hip replacement was often the best option—and in many cases, it still is. However, in 2006 the FDA approved the first total hip resurfacing implant in the United States, allowing patients suffering from serious hip pain another highly effective option.

Unlike total hip replacement, in which the diseased head ball of the hip (femoral head) is completely removed, total hip resurfacing preserves the femoral head and removes only the damaged surface of the bone.

Only a small number of surgeons in the Atlanta area have the training and expertise to perform this procedure properly. I have been performing total hip resurfacing procedures at Emory since 2007, with excellent patient outcomes. This specialized operation has a number of potential advantages for the right patient. Total hip resurfacing can:

  1. Preserve bone
  2. Restore the natural anatomy of the hip
  3. Provide the largest possible head size to improve hip stability
  4. Enable restoration of hip function to allow a multitude of activities
  5. Allow for an easier revision (re-do) in the future, if needed

So who’s the perfect hip resurfacing patient? Hip resurfacing is best suited for the young, active male (<55 years of age) with osteoarthritis of the hip and normal hip anatomy. Healthy and active at 45, Mark Gabriel was the ideal candidate. I met Mark last year, after he’d been suffering from pinching and pain in his hip for a year and was referred to me for surgery. Mark, a director for an Atlanta IT solutions and staffing company, was in great shape, save for his hip. His hip pain had resulted in large part from 40 years of playing tennis on hard-surface courts. As he put it, his hip was like a brake pad that had been used too much. Eventually it wore out. Resurfacing his hip was a great way to preserve the hip bone and allow Mark to get back to the active lifestyle he enjoyed.

In July of 2009, I performed Mark’s hip resurfacing surgery at Emory University Orthopedic & Spine Hospital (EUOSH), our state-of-the-art inpatient facility. Mark was put under general anesthesia for the procedure, which went smoothly and took about two hours. Because Mark is young and had stayed active by cycling up to his surgery date, he recovered from the surgery quickly. He stayed in the hospital just two nights and was off pain medication completely three days after surgery. After six days, he was down to one crutch and was back to walking around his neighborhood.

Mark says that he is 100% satisfied with the results of his hip resurfacing. In the year since the procedure, he’s played tennis five days a week, enjoyed golf, and gone skiing. He chooses clay courts over hard surface when he has the option, but Mark is back in the game and loving life after hip surgery.

Have you had hip surgery, or are you considering hip resurfacing? We welcome your questions and feedback in the comments section below.

About Greg Erens, MD:
Greg Erens, MD,  is assistant professor of orthopedic surgery and director of the Emory Adult Reconstruction Fellowship. Board certified in orthopedic surgery, he specializes in both uncomplicated and complex problems of the hip and knee. Dr. Erens started practicing at Emory in 2003.

Top Four Ways PRP Therapy is Different at Emory Sports Medicine

Dr. Amadeus MasonFootball fans are anticipating a competitive Super Bowl match-up between the Pittsburgh Steelers and Green Bay Packers this Sunday. Steelers’ fans might remember that the last time the Steelers were in the Super Bowl—in 2009— wide receiver Hines Ward was very close to being unable to play because of a sprained medial collateral ligament of his right knee. Fortunately, he was able to contribute to his team’s victory over the Arizona Cardinals with the help of a cutting-edge procedure called platelet-rich plasma (PRP) injections.

Since Ward’s high-profile recovery, PRP therapy has become a popular treatment for those suffering from ligament and tendon injuries—and Emory Sports Medicine has become a leader in the PRP therapy field.

Here’s how it works: PRP therapy is an outpatient procedure, in which blood is drawn and placed in a centrifuge for 15 minutes to separate out the platelets. The layer of platelet-rich plasma is then injected into the diseased portion of the tendon with the guidance of an ultrasound machine. Patients are then put on a program of relative rest followed by physical therapy for the first six weeks. After about 6 to 12 weeks, patients are re-evaluated for improvement. (Many patients require only one treatment.)

Sounds simple, right? It can be, but only if it’s performed properly and with the right expert guidance. Below we’ve outlined four factors that allow Emory Sports Medicine to excel at PRP therapy:

  1. We’ve been doing this since the beginning. PRP therapy is a fairly new procedure, and Emory has two doctors on staff who are skilled in performing it: Dr. Kenneth Mautner and myself. Both of us are dedicated to keeping up with the latest developments in the field.
  2. A vital step in the PRP process is the separating of platelets. We use only the most advanced centrifuge systems to ensure the highest concentration of platelets harvested from the process.
  3. We use ultrasound guidance to place the PRP into the affected tendon. Many other practices don’t use ultrasound—and the difference can be compared to dropping an atomic bomb vs. using a laser-guided missile. Although utilizing PRP in a generalized area can be helpful, placing it in a specific area will give the best chances at a positive result, proper healing, and full recovery.
  4. Emory Sports Medicine has developed a standardized post-injection protocol – a daily and weekly follow-up program designed to give patients the best chance at recovery.

While PRP therapy is still a relatively new procedure, when a skilled team of physicians does it properly, the results are remarkable. Just ask Hines Ward!

Are you considering PRP therapy? Do you have any questions regarding this procedure? If so, be sure to leave a comment here, or contact Emory Sports Medicine for an evaluation today.

About R. Amadeus Mason, MD:
Dr. Mason specializes in family practice and sports medicine. His areas of clinical interest include ankle, foot, shoulder, sports injuries, wrist, and ultrasound. Dr. Mason holds organizational leadership memberships with the American Academy of Family Physicians, the American College of Sports Medicine, and the Georgia State Medical Association.

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

Ultrasound is Not Just for Babies Anymore

Melanie Hof, MS, ATCWhen most people think of an ultrasound, they imagine a pregnant woman getting a preview look at her baby’s fingers and toes while a doctor makes sure that all is well inside the womb—however, in recent years the medical field has found many new uses for ultrasound technology. At Emory Sports Medicine, where I work as an athletic trainer with Dr. Ken Mautner, we frequently use ultrasound diagnostics to pinpoint the causes of tendon and ligament pain. From time to time, Dr. Mautner even brings out the ultrasound as an aid in treating the injury.

Until a few years ago, the go-to test for diagnosing the cause of chronic tendon and ligament pain was an MRI. We still frequently use MRI at Emory Sports Medicine – it’s the best diagnostic tool in many situations – but more and more often we’re turning to diagnostic ultrasound to get a better picture of what is going on inside our patients’ bodies.

Ultrasound offers several advantages in diagnosing tendon and ligament injuries. One of my favorite advantages – and one our patients appreciate as well – is the instant gratification we get with an ultrasound. There’s no waiting for a report on an MRI that is just a static snapshot of one moment in time. You can point to where you’re hurting, and we can immediately get a look at that precise area, in real-time motion, as you’re moving and experiencing the pain. Dr. Mautner can show you pictures from the ultrasound right there during the appointment and explain to you what he sees. It’s always interesting to watch him take a picture that might first look like a confusing blob to most of us—then he explains the picture in such a way that patients can see what he’s seeing in it and understand what’s wrong. (I stick around after he leaves to answer any further questions patients might have about the ultrasound or their injury.) I love this aspect of diagnostic ultrasound. Often, in the span of a single appointment, we can hear what’s hurting, take a look at the affected area, find the problem, show it to you, and come up with a plan of action. It’s much easier for everyone involved.

Ultrasounds also allow us to look at injuries in greater depth, picking up very small tears that an MRI might miss. “Mystery pains” with no clear cause often reveal their secrets to the ultrasound. We’re seeing this quite a bit with hip pains, which have historically been very tricky to diagnose. Diagnostic ultrasound can look deep into the hip and the many crisscrossing tissues within it to find the source of the pain. Dr. Mautner even uses the ultrasound to guide treatment of the hip pain once the cause is found. Injections are often used to treat tendon and ligament pain, but they are notoriously difficult to administer precisely deep within the hip. Dr. Mautner uses ultrasound to guide him, in real-time, as he inserts the needle, delivering the injection to the optimal spot for healing.

The more we use diagnostic ultrasound, the more advantages we’re finding. Ultrasounds do not emit any radiation, so they are safe for people with pacemakers, spinal cord stimulators, and other medical devices that cannot handle the radiation of other diagnostic tools. And there’s no risk of feeling claustrophobic.

Just to be clear, ultrasounds are not replacing other diagnostic tools. For some injuries, an MRI or other test is the best approach, and Emory Sports Medicine has some of the finest, most innovative radiologists around. But for some injuries, we’re finding that ultrasounds are very helpful to us as we diagnose and treat the source of tendon and ligament pain.

And they’re still great for looking at babies, too!

Melanie Hof, M.S., A.T.C., is an athletic trainer at Emory Sports Medicine. She enjoys ultramarathon canoe and kayak racing, biking, and running.

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.