Posts Tagged ‘knee injury’

Understanding IT Band Syndrome

IT Band Syndrome IT Band Injury

Iliotibial band (IT) syndrome, also referred to as IT band injury or IT band pain, is an injury that affects the outside of the  knee and is caused when irritation or inflammation of the IT band occurs.

If you have ever suffered from IT band syndrome, you know IT band pain is a pain you don’t want to feel again.  The good news is that you can prevent IT band injuries with strengthening and stretching exercises. Pay close attention and follow the information/suggestions here and you may be able to steer clear from the pain of IT band syndrome!

What is the IT Band?

The IT band is the long, strong, thick band of tissue that runs along the outside of the leg.  It starts at the hip area and runs all the way down to just below the knee.  The purpose of the band is to provide stability to the knee during movement.

IT Band Syndrome Causes

An IT band injury is an overuse injury,  primarily caused by inflammation of the IT band.   Tightness in the IT band can cause friction  where the IT band crosses the knee joint.   Causes of IT band syndrome can include:

  • Running up and down hill repeatedly
  • Running on a banked or sloped surface (like an indoor track or edge of a road)
  • Running up and down stairs
  • Weak hip muscles
  • Uneven leg length
  • Excessive foot strike force

IT Band Injury Symptoms

  • Stinging sensation above the knee
  • Swelling or thickening of the tissue where IT band moves over femur
  • Pain may intensify over time and may not occur immediately during activity
  • Pain occurs when foot strikes the ground
  • Pain may occur where the IT band attaches to the tibia

Preventing IT Band Syndrome

  • Warm up and stretch before competing or practicing
  • Recover properly between events/competitions/practices
  • Improve core strength with Pilates type exercises
  • Avoid running on banked surfaces
  • Avoid running the same direction on the track all the time
  • If you have flat fee, where arch supports or orthotics

Check out the exercises in this downloadable document: IT Band Stretching & Strengthening Exercises (PDF). And in this blog post, you’ll find more information on preventing running injuries.

IT Band Syndrome Treatment

  • Rest – most runners don’t want to listen to this advice but rest really will help alleviate the pain
  • Anti-inflammatory medication
  • Ice the painful area
  • Improve flexibility by stretching
  • Physical therapy

We hope you can steer clear of IT band syndrome and keep your legs moving!


Peachtree Road RaceEmory Healthcare is a proud sponsor of the AJC Peachtree Road Race.

Emory Healthcare is the largest, most comprehensive health system in Georgia and includes Emory University Hospital, Emory University Hospital Midtown, Emory University Orthopaedics & Spine Hospital, Wesley Woods Center, Saint Joseph’s Hospital, Emory Johns Creek Hospital, Emory Adventist Hospital, The Emory Clinic, Emory Specialty Associates, and the Emory Clinically Integrated Network.

Come visit us at the AJC Peachtree Road Race expo in booth 527 to get your blood pressure checked and learn more about how Emory Healthcare can help you and your family stay healthy!


About Dr. Brandon Mines

Brandon Mines, MD

Brandon Mines, MD, is an assistant professor of orthopaedics. Dr. Mines started practicing at Emory in 2005 after completing his Sports Medicine Fellowship at University of California – Los Angeles. Dr. Mines is board certified in both family practice and sports medicine. He has focused his clinical interest on sports injuries and conditions of the shoulder, elbow, wrist/hand, knee, foot and ankle. He is head team physician for the Women’s National Basketball Association’s (WNBA) Atlanta Dream and Decatur High School. He is also one of the team physicians for the Atlanta Falcons.  His areas of interest are diagnosis and non-operative management of acute sports injuries, basketball injuries, tennis injuries, golf injuries and joint injections.

ACL Injuries and Young Female Athletes

Thank you for joining me for the live chat on ACL injuries last week!  We had some excellent questions. One participant asked a key question about young females and ACL injuries and I would like to expand on my response to this important subject.

There are a growing number of  female athletes who are tearing their ACLs.  In fact, young female athletes (under 20 years old) are four to eight times more likely than males to injure their ACL.  Even though extensive research has been done on the reasons why this could happen, we are not exactly sure why females tend to injure their ACL easier. Luckily, if a young woman injures her ACL  we are able to get most athletes back to their previous level of play due to advances in arthroscopic surgery and specialized physical therapy.

Full recovery may take about eight to 10 months but important to note, is in rehabilitation, experienced physical therapists are working with the athlete to help them avoid re-injury.  The physical therapists and athletic trainers are teaching young girls how to jump, how to land, how to contract muscles correctly as well as specific exercises that will help strengthen the knee.  Some of the things we are teaching young female athletes are not instinctual but will greatly help reduce the risk of future injury if implemented correctly when the athlete starts participating in their sport again.

If you have had a ACL injury please make sure to work with your physical therapist to make sure you are working some of these aspects into your recovery.  If you have not had an ACL tear but you are a young female athlete, do some research on how to avoid injuries so you can excel in your sport without injury. One recommended source is the PEP Program which seeks to prevent ACL injuries.

For the full transcript on the chat visit - http://advancingyourhealth.org/orthopedics/past-doctor-chats/acl-injuries-chat/

About Dr. Sam Labib

Dr. Labib is an Emory Sports Medicine orthopaedic surgeon with special interest in problems and procedures of the knee, ankle, and foot. He is the head team physician for the athletic programs at Oglethorpe University, Spelman College, and Georgia Perimeter College. He is also an orthopaedic consultant to the Atlanta Faclcons, Georgia Tech and Emory University.

He has lectured both nationally and internationally at many orthopedic meetings. His research has been published in several journals, including JBJS, Arthroscopy, Foot and Ankle International and the American Journal of Orthopedics as well as numerous video presentations and book chapters. Dr Labib is Board Certified in orthopedic surgery with additional subspecialty certification in Sports Medicine Surgery.

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Cartilage Replacement Surgery – A Patient’s Success Story


cartilage repair
Marcus Hutchinson knows all too well about surgery and physical therapy – he has had 6 surgeries on his left knee. He has also been a physical therapist for 22 years. As a teenager, Marcus was diagnosed with osteochondritis dissecans, also known as OCD, a joint condition in which a piece of cartilage, along with a layer of the bone beneath it, comes loose from the end of a bone due to trauma or lack of blood flow to this area. Osteochondritis dissecans is most commonly found in the knee and often occurs in young men.

By the time Marcus arrived at Emory Orthopaedics & Spine in Dr. Sam Labib’s clinic in 2006, his left knee had been operated on 4 different times. Dr. Labib examined Marcus and determined he had a massive osteochondral defect in his left knee that involved his entire lateral femoral condyle, a portion of the top bone of the knee joint.

Previous doctors had told Marcus that the only option he had left was total knee replacement. Dr. Labib did not recommend knee replacement because Marcus was too young to have this procedure. Typically, a joint replacement will only last about 15-20 years so if Marcus were to have the knee replaced in his 30’s, he would probably need to have another knee replacement by his 50s.-

Dr. Labib was able to offer Marcus a unique procedure called cartilage replacement surgery. Marcus had a massive fresh allograft implantation taken from a cadaver in February 2010 to treat his osteochondral defect.

There are several surgical techniques available to treat patients with OCD.

Below are three that Dr. Labib regularly performs.

• Microfracture Surgery – In microfracture surgery, small holes are drilled into the underlying bone, creating blood clots. As the blood clots heal, new repair cartilage or fibrocartilage forms.

• Autologus Osteochondral Plug Transfer – In this procedure, the patient’s own cartilage and bone are harvested from a low-stress area of the knee and implanted into the patient’s knee in the damaged area to fill the holes and defects with healthy cartilage and bone.

• Fresh Allograft Implantation – In this surgery, the cartilage and bone are taken from a fresh cadaver that has been donated for medical use. The donated tissue, also called an allograft, is thoroughly screened and matched to the patient defect to give it the best possible chance of successful healing. The surgeon prepares the patient’s knee by removing the damaged area. The allograft is then implanted and anchored to the surrounding bone.

Marcus’ surgery was performed at Emory University Orthopaedics & Spine Hospital. When asked about his experience he states, “I had such a positive experience at the hospital. Great care! Very attentive staff. Clean, professional and efficient.”

Marcus had one major goal following surgery and that was to walk and stand without pain. “I stand all day at work when seeing my patients for physical therapy. Before surgery with Dr. Labib, I had so much pain in my knee that it was affecting my job and day to day life. I feel so much more stable and pain-free now after having cartilage replacement surgery.” Marcus says he has a new perspective on what patients are experiencing after surgery and during physical therapy which has made him better at his job as a physical therapist. He is back to enjoying life with no pain and participating in low-impact activities such as swimming, cycling, and yoga.

About Dr. Sameh (Sam) A. Labib

Sam Labib, MD, is a sports medicine fellowship-trained surgeon and director of the foot and ankle service at Emory. Dr. Labib started practicing at Emory in 1999. He is an Associate Professor of Orthopedic Surgery.

Dr. Labib has a particular interest in problems and procedures of the knee, ankle, and foot. He is the head team physician for the athletic programs at Oglethorpe University, Spelman College, and Georgia Perimeter College. He is also an orthopaedic consultant to the Atlanta Falcons, Georgia Tech and Emory University.

He has lectured both nationally and internationally at many orthopedic meetings. His research has been published in several journals, including the JBJS, Arthroscopy, Foot and Ankle International and the American Journal of Orthopedics as well as numerous video presentations and book chapters. Dr. Labib is Board Certified in orthopedic surgery with additional subspecialty certification in Sports Medicine Surgery. For the past 5 years, Dr. Labib has been nominated by his peers as one of “America’s Top Doctors” as tracked by CastleConnelly.com.

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Back to Life After an ACL Injury!

Prevent Joint PainACL, anterior cruciate ligament, injuries are one of the most common knee injuries among athletes. The American Orthpedic Society for Sports Medicine estimates there are over 150,000 ACL injuries each year in the US. ACL injuries can happen to everyone – from the professional athletes to the weekend warriors. The good news is that with proper treatment with an ACL specialist and adequate recovery, you can get back to the sport you love! Watch this short video of Neil, an Emory Sports Medicine patient, who has recovered from ACL surgery and is back to playing tennis and doing the things he loves to do.

About Dr. John Xerogeanes
Dr. Xerogeanes is Chief of Sports Medicine at the Emory Orthopaedic & Spine Center. Known as Dr. “X” by his staff and patients, he is an Associate Professor of Orthopaedic Surgery at Emory University as well as an Adjunct Professor at Georgia State and Mercer University. Dr. X is entering his 12th year as Head Orthopaedist and Team Physician for Georgia Tech, Emory University, Agnes Scott College and the Atlanta Dream of the WNBA. He specializes in ACL and ACL revision surgery performing over 200 of these operations each year. He is board certified in orthopaedic surgery and has his sub-specialty certification in orthopaedic sports medicine.

Dr. Xerogeanes has been recognized as one of US News & World Report’s Top Doctors with a special distinction listing him among the top 1% in the nation in his specialty. 

About Dr. Spero Karas
Dr. Karas is the Director of the Orthopaedic Sports Medicine Fellowship Program and an Associate Professor of Orthopaedic Surgery at Emory University. His specialties include sports medicine, surgery of the shoulder and knee, and arthroscopic surgery. He came to Emory in 2005, after serving as Chief of the Shoulder Service and team physician at the University of North Carolina in Chapel Hill. He is Board Certified in Orthopaedic Surgery, with a subspecialty certification in Orthopaedic Sports Medicine. He currently serves as head team physician for the Atlanta Falcons and is a consulting team physician for Emory University and Georgia Tech athletics. He cares for patients and athletes of all levels: professional, collegiate, scholastic, and recreational.

Dr. Karas was recognized as one of America’s “Top Orthopaedic Doctors” in Men’s Health Magazine April 2007 and “Top Sports Medicine Specialists for Women” in Women’s Health Magazine. Atlanta Magazine has named him “Atlanta’s Most Trusted Sports Medicine Specialist” for the past three years. Dr. Karas is an internationally recognized expert in the field of shoulder, knee, and sports medicine.

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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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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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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

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.