Sports, traumatic injuries and regular tasks can take a toll on our bodies, but with the right combination of proactive steps and health care advancements, recovery is easier than ever before.
The need for orthopedic treatment affects people of all age brackets. While there is a tendency to believe that such physical conditions as arthritis, tendonitis and other afflictions of the body’s vulnerable joints are related to aging, the truth is more revealing. Sports, traumatic injuries and everyday tasks can damage our bodies, too.
The trick to preventing harm, say local orthopedic specialists, is an ounce of prevention and an early diagnosis.
Dr. Michael G. Kogan is a board-certified sports medicine orthopedic surgeon with Fox Valley Orthopedics in Algonquin. He treats patients of every age, and, shockingly, some are in their teen years or younger.
“When I first joined what eventually became Fox Valley Orthopedics in 1995, I was approached by Jacobs High School to serve as its sports doctor, primarily for its football and basketball teams,” says Kogan, who’s still the Algonquin school’s team physician. “Even then, we were seeing evidence of early inflammation of joints in teens as early as middle school – seventh and eighth grades.”
The reason behind these injuries, Kogan suspects, is tied to intense physical training for sports. Such a routine can cause significant damage to developing bodies.
“For example, an 8- to 10-year-old who is focused on becoming a baseball pitcher may train year-round exclusively on pitching,” Kogan says. “This can lead to ligament injuries in their elbows or growth plate fractures in their shoulders. We call this Little League shoulder, and it’s more prevalent than you’d believe.”
Prevention requires a balanced cross-training routine supplemented with periods of rest, Kogan adds. Otherwise, problems can appear early and carry throughout a person’s life, resulting in rotator cuff tears and other damage down the road.
“Children heal quickly, so it’s important to diagnose the condition early and treat it aggressively,” he adds.
Of course, cross training, adequate physical conditioning and early, conscientious treatment of injuries can help active bodies of any age. Kogan routinely works with patients in their 50s, 60s and 70s who are experiencing arthritis and other problems brought on by earlier injuries. He encourages all patients to properly prepare for any sort of exercise or sports activity.
“Light resistance exercises to build muscle tone and strength are good,” he adds. “Putting heat on the area before beginning helps loosen the muscles and tendons, preventing injury. This should be followed by icing down the area for 10 to 15 minutes later in the day.”
However, injuries can sometimes happen despite the best preventions. When that’s the case, treatment begins with physical therapy and anti-inflammatory medications, including cortisone injections when needed. If these do not alleviate the pain or relieve the stiffness, swelling or lack of flexibility, the next step may be surgery.
“Joint pain can be treated with arthrosopic surgery,” Kogan says. “This minimally invasive surgery is used to treat minor issues such as meniscus tears with tissue repair or removal.”
Major injuries including tears to the anterior cruciate ligament (ACL) in the middle of the knee require more complex surgery. Kogan says it may be necessary to reconstruct the ACL with tissue taken from the patient’s hamstring tendons.
“This is major surgery which will require eight to 10 weeks of recovery time coupled with individualized physical therapy and a full six months to return to high-level activities and sports,” he adds.
The knee is one of the most vulnerable joints in our bodies. Dr. Brian Flanagan, an orthopedic surgeon with Northwestern Medicine Huntley Hospital, says that he sees many patients who are suffering from pain, lack of flexibility and swelling in their knees. Sometimes these conditions indicate a recent injury, but other times arthritis has further complicated earlier damage.
“Knee issues are as common as hip issues, and often for the same reasons,” Flanagan says. “Accidents, falls, twisting, even stepping down hard or onto an uneven surface can injure knees. Worse, a knee or hip injury can create an equally adverse reaction in the adjacent knee or hip, effectively doubling the pain and disability.”
Flanagan says the first line of treatment for knee pain is nonsurgical. Depending on the type and extent of the damage, he adds, much can be done with physical therapy and medications to improve the patient’s condition.
When nonsurgical methods fail to help, minimally invasive arthroscopy is one technique used to repair knee injuries. A tiny fiber optic camera called an arthroscope is inserted through a small incision into the afflicted joint area and used to repair or remove soft tissue damage such as torn cartilage, torn meniscus and tendons.
“It is limited, but quite effective in treating minor cases,” Flanagan says.
After the procedure, patients recover quickly and are back to work and other activities in a short time. Flanagan stresses that arthroscopy is constantly improving and offers the patient maximum relief for the least invasive effort. But when a patient needs a full knee joint replacement, the strategy changes.
“Major surgery demands pre-op preparation before the patient is cleared,” Flanagan says. “The heart and lungs are evaluated as well as the patient’s ability to tolerate anesthesia. We order blood work for diabetes, anemia and other underlying conditions. It’s a team effort involving not only the surgeon but also the patient’s cardiologist, primary doctor and any other specialists the patient sees to determine risk. Occasionally, we also order pre-surgical physical therapy to help ensure the patient recovers more quickly.”
Post-surgical treatment depends on the patient’s specific needs and condition.
“Some patients can progress fairly quickly while others may need to stay off the knee for a longer length of time,” Flanagan says. “For some, four to six weeks of recovery time is sufficient for both arthroscopy and traditional surgery while others may need much longer. This includes physical therapy sessions two to three times weekly, preferably on an outpatient basis.”
Outpatient post-operative care can include in-home visits if the patient does not have ready transportation to a therapy clinic. Flanagan points out that while in-home patients may not have all the equipment available at therapy sites, they will be able to progress to the point where they can drive to the sessions.
“Complications are fairly rare after knee surgeries,” Flanagan adds. “There is less than a 5% risk of infection, blood clotting or other reactions. I have patients past the age of 80 who do well with knee surgery while other patients in their 50s might not do as well. So much depends on the individual.”
The good news is that replacing the knee joint also eliminates arthritis.
“Age is not a determining factor in how well a patient does,” he says. “The important thing is that, no matter how many years a patient has ahead, they can live a pain-free and active life.”
Caring for Shoulders
Shoulder injuries can occur at any age. One of the most common involves the rotator cuff, a group of muscles and tendons surrounding the shoulder joint. These muscles and tendons keep the head of the upper arm bone firmly within the socket, allowing mobility when doing things such as swinging a golf club, throwing a ball or combing one’s hair.
“When there is an injury involving that group of muscles and tendons, we quickly realize how much we have taken those rotating shoulders for granted,” says Dr. Craig Cummins, a board-certified orthopedic surgeon at the Illinois Bone & Joint Institute. “Injuries to the rotator cuff can happen in a variety of ways; however, most have to do with an increase in age or repeatedly performing overhead motions. Sometimes, rotator cuff tears may occur as a result of a single traumatic injury.”
Cummins, who practices in Barrington and Crystal Lake, is one of less than 5 percent of orthopedic surgeons with additional certification in sports medicine. His unique expertise helps patients fully recover from the pain and loss of mobility associated with all types of shoulder issues.
“Rotator cuff problems are by far the most common shoulder problem I see in the office,” Cummins adds. “Many patients put off evaluation and treatment way too long, as they are concerned the only treatment is surgery.”
At times, surgery is the correct treatment, particularly if a significant injury results in a large rotator cuff tendon tear.
“However, the majority of patients I see for shoulder pain and rotator cuff pain can be treated with non-surgical methods with a successful result,” Cummins says. “These non-operative methods include education, medications such as NSAIDs (example: ibuprofen), injections and a home exercise program or formal physical therapy. Additionally, newer technologies are evolving, although not fully proven, that include viscosupplementation (gel shots), platelet rich plasma (PRP) and stem cells.”
Cummins says he recommends evaluation following significant injuries or persistent pain. Additionally, Cummins notes that if surgery is required, the surgical techniques have advanced significantly.
“Rotator cuff tears are now routinely treated with minimally invasive techniques using arthroscopy, which involves using a camera (arthroscope) and specialized instruments to work through small incisions,” Cummins adds. “For those tears that are unrepairable – generally older tears that were never properly treated – specialized patches as well as shoulder replacements are available.”
Cummins stresses that patients should not be afraid to seek evaluation for shoulder problems.
“It is the shoulder surgeon’s responsibility to make a correct diagnosis and then provide patients with the treatment options available,” Cummins says. “Knowledge is always a good thing; it allows patients to understand the pros and cons of the decisions they make regarding their shoulder’s care.”
Moving those Hips
Hip joints are equally vulnerable to falls, accidents, repetitive movement and injuries, especially in contact sports including football, basketball and ice hockey. As with other injuries, the sooner it is diagnosed and treated, the better the prospect is for a pain-free future.
Dr. Benjamin Domb is a board-certified orthopedic surgeon, medical director of the American Hip Institute and director of the Hip Preservation Program at AMITA Health St. Alexis Medical Center in Des Plaines. He says one of the most common hip-related injuries is a tear to the labrum, the ring of cartilage that follows the outside rim of the hip joint socket. Not only are these injuries painful and debilitating but, if left untreated, these tears invite arthritis into the afflicted area. Similar to rotator cuff tears in the shoulder, labrum tears need immediate treatment.
“If left for too long, the tears encourage the development of arthritis,” Domb says. “My No. 1 goal is to cure arthritis through early diagnosis and treatment of the original injury. When labrum tears are treated quickly, arthritis is prevented before it can set in.”
Labrum tears can be treated with injections, medications and, if necessary, minimally invasive robotic arthroscopic surgery. Domb says this is done with three goals in mind: precision, customization and minimal invasion.
“Patients who undergo this surgery can put their full weight on the hip the same day and go home the same day,” he adds. “We have built a repertoire of surgical options for patients ranging in age from 10 to 100-plus years of age.”
Physical therapy is scheduled on an outpatient basis, often starting the same day as the surgery.
“We start them on the bicycle the day after surgery and guide them through an individualized program with a sports specialist,” Domb says. “How long it takes also depends on the patient and the extent of the rehabilitation needed.”
By catching and treating the damage early, athletes of all ages can look forward to an active lifetime free of pain, stiffness, swelling and inflexibility.
“The goal is to preserve the hip’s integrity as early as possible and for as long as possible,” he adds. “The patient can get back to sports, work, or whatever else they love to do.”
The earlier a patient seeks orthopedic treatment for any joint, tendon or muscle injury, two positive results occur. First, the pain and incapacity are alleviated. The secondary advantage is the prevention of additional pain and diminished capacity. The key, orthopedic specialists agree, is to get diagnosed and treated immediately in order to enjoy life to the fullest without pain or limitations.