MCL Sprain Options

Ask the Doctor

I was playing football in the yard with my 2 boys, was tackled, twisted my knee and down I went like Matt Forte in the recent Bears game. My knee’s been swollen and really sore for a few days now. It feels different than just a bruised knee. Could this be an MCL sprain? If so what are my options?

Dr. Bach

Dr. Bernard R. Bach

Bears’ running back Matt Forte suffered an MCL sprain in his knee. The MCL or medial collateral ligament of the knee is a thick band of tissue located on the inside of your knee. This ligament connects the thigh bone to the shin bone and provides stability to the inside of the knee.

An MCL sprain is usually the result of the knee being directly hit on the outer part of the knee or from repeated stress to the ligament, which causes the MCL to stretch or tear. This will result in pain and possible instability along the inside of the knee. Your symptoms would suggest that you may have torn or sprained your MCL.

Treatment Options:

In most cases, a torn MCL will not require surgery. MCL injuries are graded 1, 2 and 3.

Grade 1 tears are considered mild sprains. Treatment consists of icing, physical therapy and anti-inflammatory medications. Most patients can get back to pre-injury level of activity without difficulty.

Grade 2 tears are moderate to partial tears of the MCL. A brace is usually recommended to provide stability to the knee. You may or may not require crutches. The remainder of treatment is the same as a Grade 1 injury. Recovery may take four to six weeks.

Grade 3 tears are considered complete tears of the MCL. A consultation with an orthopaedic physician is usually recommended. If the injury is isolated to an MCL tear, patients may need to use crutches for a week or two. A brace would be used to provide stability to the knee during the healing process. The remainder of the treatment plan would be the same as Grade 1 or 2. Generally speaking, the recovery time may take two to four months of treatment.

If your pain persists, I would recommend that you consult with a physician for a proper diagnosis and treatment plan.

Midwest Orthopaedics

Unloader One® by Össur – Steve Peterson’s story

Suffer from knee pain? Or do you know someone who does? Check out Steve Peterson´s story on how Unloader One changed his life:
“After my initial surgery, the goal of the surgeon was to get me to 55 before my first knee replacement. Well, I am 63 wearing an Unloader One and doing everything I want to do.”

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Have you ever experienced pain in the front of your knee after running or kicking?

By Michelle Helberg for Athletico

You probably have a condition called Jumper’s Knee or patellar tendonitis.

JumpersKnee_PatellarTendonitis_AthleticoThe patellar tendon plays a vital role in helping the body take the force of extreme jumping and running activities. On very rare occasions, the patellar tendon can fail and rupture from the repetitive force applied to it, requiring surgery. The patellar tendon attaches the patella (kneecap) to the tibia (shin bone) and it helps with explosive movements. Jumper’s knee is classified as pain both above and below the knee. It impacts the quadriceps as well due to the force being applied with jumping and cutting movements.

At first, it seems like a minor injury. However, if it goes untreated or someone continues to push through, what might seem like minor discomfort in the beginning, it can lead to more tearing and possibly a rupture of the structure. This injury can impact all ages, but tends to be more present in the younger to young adult demographic.

This type of injury is classified into 4 specific stages based on pain and level of playing:

  • Stage 1: pain after sports activities
  • Stage 2: pain during and after activity (the athlete is able to perform at the appropriate level)
  • Stage 3: Pain during activity and prolonged after activity (athletic performance is hampered): may progress to constant pain and complete rupture” (Prentice, 2006, p.645).
  • Stage 4: Rupture

Many of the chief complaints of someone that has this condition notices or states is typically one or more of the following:

1)  Pain and tenderness along the inferior pole of the patella
2)  Weakness
3)  Pain in the quadriceps muscle from compensating or possible strain
4)  Pain/soreness with activities such as squatting, achiness, bending, climbing stairs, or any sports-specific exercise
5)  It might be warm to the touch
6)  Inflammation to the area

So now that you heard that you should listen to your body and not continue to work through the pain/discomfort what do you do next?

1)  Activity modifications.
2)  RICE (rest, ice, compression and elevation) and Advil, Aleve, etc..
3)  Physical therapy which includes modalities such as phonophoresis, iontophoresis, ultrasounds and various other heating modalities.
4)  Light stretching to surrounding musculature (hamstring, quadriceps, calves, hips, and IT band, etc.).
5)  Buying a patellar strap to add support to the structure while it heals.
6)  Cross friction massage has also shown to be successful in treating Jumper’s Knee.

Listening to your body is the first step in acknowledging that something may be injured. The 2nd step is having the education on what the condition is to best treat. Remember to give it time and take it slow on your recovery process. Once you do that, you are one step closer to getting back to the activity that you love.

Athletico Physical Therapy

PRP: A Promising Panacea or a Premature Procedure?

PRP.medicalCan a patient’s own platelet-enhanced blood augment traditional
orthopedic procedures and reduce post-surgical healing time?

By Ellen Blum Barish for Chicago Health

The soreness in Brent Jurceka’s shoulder was not only causing him terrible pain but getting in the way of his pitching at his college baseball games. That’s when he contacted Rush University Medical Center orthopedic surgeon Brian Cole, MD, to schedule a platelet-rich plasma (PRP) treatment, an injection of his own blood, superconcentrated with platelets. Jurceka rested his shoulder for three days after the procedure and on the fourth day, he returned to the mound, pain free. This was the Orland Park native’s second successful experience with PRP. Jurceka’s first was two years prior for a sharp pain in his elbow while he was playing baseball in high school.

“I had heard about Dr. Cole’s success using PRP to treat injuries for some of the Chicago Bulls and White Sox [players],” Jurceka says. “And I thought, if it worked for professional athletes with minimal side effects, then why not give it a try?” The jury is still out on the effectiveness of this therapy. Healing results from the PRP injections on local professional athletes such as the Bulls’ Joakim Noah and Kirk Hinrich, as well as nationally known players like golfer Tiger Woods, basketball’s Kobe Bryant, football’s Troy Polamalu and tennis player Rafael Nadal, has pushed this treatment onto center stage in the orthopedic arena. PRP has become an increasingly more recommended and utilized procedure by orthopedic surgeons for patients who suffer from tennis elbow, torn rotator cuffs, acute ligament and muscle injuries, pain from knee arthritis and bone fractures. It is also used as a supplement in surgery to help with tissue healing. The side effects are usually limited to soreness, stiffness or swelling at the injection site.

According to the American Academy of Orthopaedic Surgeons (AAOS), platelet-rich plasma “holds great promise.” Chicago-area orthopedic physicians like Cole and J. Martin Leland, MD, orthopedic sports surgeon in the University of Chicago Medicine and Biological Sciences Department, point to its low risk. There are few, if any, side effects and it is easily accessible because the patient is both the donor as well as the recipient.

To make PRP, blood is drawn from the patient and placed in a centrifuge, a tabletop mechanism that separates the platelets from the red blood cells in a process known as fractionation. Proteins that might normally dissolve in plasma fluid become insoluble in this process and are collected into protein-rich clumps. The entire process takes about ten minutes in the doctor’s office. The plasma is injected into the site of injury, stitched into torn tissues or sprayed onto the site during surgery. Regulatory issues require that PRP be used as a “point-of-care service,” says Cole. Because of regulatory issues, PRP cannot be stored or reused other than at the time of acquisition and placement.

“Platelets contain more than a thousand different proteins that stimulate cell growth and repair,” says Cole. “These chemicals are known for their ability to heal injury, reduce inflammation and relieve pain.” Together, they may have a synergistic effect, which is one of the explanations for why PRP can work so well. “Platelets act as a storehouse for healing. PRP reduces pain more quickly and initiates a swifter healing response than the body would normally do on its own,” Cole explains. PRP has been called by some orthopedists a “platelet-rich panacea.” He adds, “For this reason, we have an obligation to rigorously investigate the potential benefits of PRP for various orthopedic processes.”

PRP was first widely utilized in the 1980s by dental surgeons who noted that the upper and lower jawbones weren’t healing well after surgery because there are fewer blood vessels in these areas. In the early 2000s, veterinarians began to use PRP to treat tendon, ligament and cartilage injuries in racehorses. At this time, PRP was also being used by plastic surgeons to reduce wrinkles and otherwise rejuvenate the face, which led to the procedure being dubbed the Vampire Facelift. By the mid-2000s, orthopedic surgeons began to integrate the treatment into their practices. Cole has been utilizing the platelet-concentrating process in his own sports medicine practice for about five years. Though PRP appears to be growing in use and acceptance in orthopedic medicine, there are concerns that there is not enough research to support all of PRP’s claims.

An AAOS report stated that “Although PRP does appear to be effective in the treatment of chronic tendon injuries about the elbow, the medical community needs more scientific evidence before it can determine whether PRP therapy is truly effective in other conditions.” A 2010 article in the Journal of the American Medical Association (JAMA) concluded that PRP was no more effective than salt water and that there were inconsistencies in the reproduction of results. The article also concluded that “the injections may have different effects on different injuries.”

To date, there have been no large human trials of PRP, and the procedure has been FDA approved for only a certain number of applications following specific guidelines. Generally, it is not fully understood. Some orthopedists have expressed concern that results can vary depending on the patient, his or her blood and the type of centrifuge used to make the PRP. There are many commercially available centrifuges as well as homemade approaches. Cole says that physicians who frequently use PRP are looking at customization options for making PRP to maximize platelet levels and to minimize the inflammatory effects by reducing the number of white blood cells. Most orthopedists agree that while there is still much about PRP that is unknown, it has great potential.

“The biggest myth about PRP,” Leland says, “is that this is a panacea or a treatment that will replace all surgeries. We are still trying to determine what problems can be helped with the use of PRP; also, what type of PRP is the best.  There are five to ten different systems for making PRP, all of which produce different recipes. We don’t even know what the best concentration is for platelets.” Is it two, five or ten times the normal concentration of platelets in the blood? “But,” Leland says, “PRP can be an important tool for the orthopedic surgeon. As further research is performed, we will learn more about when and where to use it in order to get the absolute best results for our patients.”

Like PRP, stem cells, specifically allogeneic mesenchymal stem cells from umbilical cord blood, are being used for experimental cartilage-repair surgery. But stem cells are used less frequently because of the stricter regulatory environment and a more complex cell-expansion process. In light of this, new techniques to use the patient’s own cells harvested from bone marrow are now more commonly used. Both Leland and Cole, advocates of PRP and also some stem cell procedures, say that more extensive human trials are necessary for both treatments to determine their rightful place in medicine.

Brian J. Cole, M.D., M.B.A.

Dr. Brian Cole

For now, one of the biggest deterrents for widespread utilization of PRP is its cost. Fees for one injection range from $500 to $2,000, and insurance companies often do not cover the procedure. For the professional athlete whose livelihood depends on being able to play, combined with their hefty salaries, the cost and PRP’s low risk is well worth it. But for college athletes like Brent Jurceka, who may or may not have a sports-related career, the $500 price tag he paid will likely keep his PRP access to a minimum.

Midwest Orthopaedics

Weight Training & Shoulder Injuries; What is The Pose Method?

Episode 14.17

Segment One – Weight training & Shoulder Injuries 

Dr. Anthony Romeo discusses the evolution of weight training, cross-training and Plyometrics related to shoulder injuries; causes, treatment and proper technique to avoid injury.

Dr. Romeo is a distinguished orthopedic surgeon with over 20 years experience working in academic medicine. In addition to his role as professor in the Department of Orthopedics at Rush University Medical Anthony A. Romeo, M.D.Center in Chicago, IL, he serves as the program director of the Shoulder and Elbow Fellowship, and section head of Shoulder and Elbow Surgery in the Division of Sports Medicine at Rush. Dr. Romeo also serves as co-team physician for the Chicago White Sox and the Chicago Bulls.

 

Segment Two – What is the Pose Method?

With Shilpi Havron from Accelerated Rehab

Developed by three-time Olympic running coach Dr. Nicholas Romanov, the Pose Method uses gravity, key body poses and body weight to increase efficiency. It consists of three elements: “Pose – Fall – Pull” and uses gravity as the primary force for forward movement instead of muscular energy.

Guided by an Accelerated physical therapist certified in the Pose Method who uses video analysis of a patient’s gait and form, Pose Method runners learn how to adjust their body position and use gravity to conserve energy and increase speed. This is typically done in in an Accelerated clinic, but can also be taught outdoors.

running pose sequence

The Pose Method emphasizes a whole body pose, which vertically aligns shoulders, hips and ankles with the support leg, while standing on the ball of the foot. The runner then changes the pose from one leg to the other by falling forward and allowing gravity to do the work. The support foot is pulled from the ground with efficient use of the hamstring, while the other foot drops down freely, in a change of support. This creates forward movement, with the least amount of energy use and effort. This simple sequence of movements: the fall and the pull, while staying in the pose, is the essence of this technique.

Shilpi Havron received her Doctor of Physical Therapy from University of Southern California and has been a physical therapist for 11 years. A running injury specialist, she sees patients at the North Naperville Accelerated center at 115 E. Ogden Avenue in Naperville.  An avid runner herself, she has been hitting the pavement for 30 years.  She works with the Nequa Valley High School track and cross country teams and recently ran the Ragnar Relay with a former patient. The relay starts in Madison, WI and ends in Chicago.

Play Podcast – 30 Minutes

From Kids to Kids at Heart: Common Summer Sports Injuries

ATI Sports Medicine looks at common summer sport injuries.Now that summer is finally here, outdoor sports and activities are in full swing. From little league tournaments, to friendly pick-up games of basketball, kids and adults alike are playing their favorite sports.

Unfortunately, with any activity, there’s a risk for injury. Randy Highbaugh, Certified Athletic Trainer with ATI Sports Medicine, talks about some common summer sports injuries and offers tips to stay safe.

“With any physical activity, it’s important to remember to take a few minutes to stretch before you start,” says Randy. “Also, if you are going to use modalities such as heat and ice, remember to heat before activity to loosen muscles, and ice after to control soreness and swelling. Most importantly, listen to you body. If you are start to feel pain, stop and take a rest.”

Overuse: Injuries caused by repetitive motions over time.

  • Elbow and Shoulder: A common area of injury among baseball and softball players. Be sure to properly warm-up and adhere to pitch-count recommendations offered for both sports.
  • Golfer’s Elbow: Inflammation and pain in the tendons found on the inside of the elbow. The key to prevention is to proper warm-ups, avoid overuse and stop activity if you feel pain.
  • Tennis Elbow: Caused by injury to the tendons on the outside of the elbow. Help prevent this injury by properly warming-up, avoid overuse and incorporating rest time in your schedule.

Muscle Strain: A strain is caused by a quick pull, twist or micro-tear of the muscle or tendon, especially when muscles are not stretched or warmed-up properly.

Muscle Sprain: Unlike a strain (which many use interchangeably) this injury affects the ligaments and is caused by the ligament being stretched beyond its capacity.

Concussion: When players suffer a blow to the head, it is important to check for signs of a concussion: feeling confused, difficulty thinking clearly, memory loss, feeling sluggish, headache or blurry vision and nausea or vomiting after a blow to the head. Players with symptoms after a blow to the head should NOT return to play the day the injury occurred, and should seek medical attention immediately.

If your injury presents with the following, Randy suggests seeking immediate medical attention:

  • Severe swelling, pain or numbness.
  • Inability to bear weight on, or utilize a limb.
  • A dull pain that increases, and is accompanied by increased swelling or joint instability.
  • Obvious fracture or dislocation.
  • Feeling confused, difficulty thinking clearly, memory loss, feeling sluggish, headache or blurry vision and nausea or vomiting after a blow to the head.

If you are not experiencing the above symptoms, you can try treating the injury at home at first to see if symptoms decrease. Randy recommends the R.I.C.E. method during the first 48 hours:

  • Rest – rest and/or stop using the injured body part and avoid painful activity.
  • Ice – place a covered ice pack on the injured area for 15 minutes at a time, every 1-2 hours.
  • Compression – use an ACE™ elastic wrap or compressive devise and wrap the injured area to help decrease swelling.
  • Elevation – elevate the injured body part above the heart. Use a pillow to prop-up an injured limb.

If symptoms don’t subside after R.I.C.E. within 48 hours, Randy recommends seeking medical attention.

ATI Physical Therapy

Hot tips for summer running

As the weather heats up this summer, so does marathon training. Be sure to use caution when running in the heat. High temperatures can lead to overheating and dehydration—two problems known to harm health and performance.

According to a recent study in the Journal of Athletic Training, runners who began a 12K race on an 80-degree day already dehydrated completed the race about two and a half minutes slower than when they ran fully hydrated.

Kate ReicherDehydration occurs when too many fluids are lost through sweat and/or not drinking enough. In the process of sweating, water and electrolytes are lost and, after prolonged periods of time, body functions are compromised. Common signs of dehydration include thirst, headache, confusion and abnormal fatigue.

Overheating occurs when your body is unable to cool itself due to the amount of water evaporating from your skin. The most common symptoms of overheating are headaches, fainting, dizziness, and after long periods of time, heat stroke.

According to Denise Smith, Accelerated Physical Therapy running specialist, dehydration and overheating can cause serious symptoms, but simple adjustments to your training schedule can help you avoid these conditions altogether.

She suggests these five tips for hot weather running:

  • Run at the right time–Even at the hottest time of the year, temperatures are coolest in the morning and at night when the sun’s rays aren’t as strong.
  • Wear appropriate clothing–Running gear that is a light color, lightweight and is breathable will help cool you down significantly. Light colors absorb less heat and clothes with vents or mesh will allow for air-flow and breezes to decrease your body temperature.
  • Consume sports drinks–In high temperatures, electrolytes are so crucial and just drinking water isn’t enough. Many sports drinks increase your water-absorption rate and replace the electrolytes lost through sweat. Drink a sports drink about one hour before your run to fill your body’s electrolyte stores. Always drink again after you run.
  • Be smart–It can take some time for bodies to fully acclimate to the high temperatures and humidity. Instead of starting your training with high intensity runs, take your time and gradually increase the length and speed of your runs.
  • Embrace the breeze–If possible, begin your run going with the breeze and finish your run against it. The wind will cool you down when you are running into it, so use that to your advantage when you are at your hardest part of the run… the end.

If you would like to discuss your summer training program or are experiencing pain that concerns you, call Accelerated Physical Therapy at 877-97-REHAB and ask for a running specialist. We can schedule you for an appointment within 48 hours at your nearest Accelerated location.

AcceleratedRehab

Obstacle Course Racing after Microfracture Surgery

On October 15, 2011, I participated in my very first Spartan Race, the Midwest Sprint. I’ve been participating in sports for as long as I can remember and I’ve had some experience running a few obstacle course races before, so I thought I was prepared for this race. About a mile in I knew I was in for one of the most difficult races I have ever done. It was 4.5 miles of gnarly terrain plus obstacles that included 8ft wall climbs, 40lb sand bag carries, mud crawls, and fire jumping. When I crossed that finished line completely exhausted, I was hooked. I couldn’t wait to do my next Spartan Race. Unfortunately the reality of my situation hit me like the sand bag I had carried as my right knee pain was just too much for me to consider doing yet another Spartan Race.

Three days later, Dr. Cole performed my scheduled right knee microfracture. I woke up in the recovery room and remember hearing that there was not 1 articular cartilage defect in my knee but 2 and microfracture was done at both sites. It wasn’t exactly what I wanted to hear, but my faith was in Dr. Cole and his staff. I knew I was in good hands and the only thing I could do was move forward.

The first few months post surgery were tough, not so much physically, but more mentally. I spent my life being active and having to slow my activities to an almost literal crawl was hard. I’m sure I drove Dr. Cole and his P.A.s Kyle & Natalie nuts with all my questions and e-mails. But I will tell you, every question I had, and every e-mail I sent was answered in record time. I can’t say enough about how much that meant to me and my recovery. I can’t thank them all enough for being ‘available’ and taking time to show that they really do care.

I put in a lot of time and hard work, dedicating myself to getting back to where I was before my injury, if not better. Throughout the entire year long process, there was always one thing in the back of my mind – would I be able to do another Spartan Race again? There were times that I seriously questioned if I would even be able to run again, much less participate in an obstacle course race. If it wasn’t for the support and encouragement from everyone in Dr. Cole’s office, I’m not sure I would have been able to deal with the whole recovery/rehabilitation process.

I’m happy to say that on October 11th I was finally given a clean bill of health and told I could move forward with my normal activities. The only thing that was on my mind was participating in the next Spartan Race, the Midwest Super. So on October 27th, I laced up my shoes, joined my friends at the starting line and raced with nothing but my heart. I finished the 8 to 9 mile course in just over 3 hours. Three weeks later, I found myself at the starting line at another Spartan Race. This time it was at the first ever Fenway Spartan Race Time Trials inside of historic Fenway Park in Boston. This once in a lifetime opportunity allowed me to climb a cargo net along the Green Monster, carry a 70lb sandbag throughout the outfield bleachers, do burpees on the warning track in center field, and do box jumps in the Red Sox dugout.

It really is amazing how much difference a year can make. I have already started training for my next race season which currently includes 7 obstacle course races.

None of this would have been possible if it wasn’t for Dr. Cole, his staff, and everyone at Midwest Orthopaedics at Rush. While dealing with injuries and surgery is never something anyone wants to have to go through, it does happen, and I would never trust my care with anyone else.

Thank you for EVERYTHING!

    — Missy Morris

More Patient Experiences

Summer Training Tips for the Chicago Marathon

July 14, 2014 – On October 12, 2014, over 45,000 people will hit the ground running for the Bank of America Chicago Marathon. The course, which boasts four world record times, is a flat and fast paradise for runners from all over the world. The Chicago Marathon is notably one of the best races for runners to reach for their personal record.

With cool and dry temperatures, the month of October brings perfect racing conditions. At the same time, this means that runners must train for the Chicago Marathon in the hot and muggy summer months, which can be very challenging.

Experts claim that the higher the temperature the higher the risk a runner has of suffering from dehydration, exhaustion and reduced blood flow to the muscles used for running.

Training in heat not only affects a runner’s body and health, it also affects their pace. According to a recent article in Runner’s World, for every 10-degree increase in temperature above 55 degrees, runners can expect a 1.5 percent to 3 percent increase in their finish time.

Dr. Jeffrey Mjaanes, Midwest Orthopaedics at Rush sports medicine physician, and one of the official team physicians for the Chicago Marathon offers advice for training in the heat. Dr. Mjaanes recommends:

  • Get a physical before beginning marathon training.
  • Hydration is key. It is important to begin each training session hydrated and to remain hydrated throughout each session by drinking 16 to 28 ounces of fluid per hour.
  • Help your body adjust to the temperature changes by running at the same time every day.
  • On very hot days, run either indoors on a treadmill or in the early mornings or evenings.
  • When a long run is scheduled for a very hot day, consider moving the run to a cooler day. Remember that skipping a day will not affect your performance – in fact, a break may improve your overall time.
  • Create your own shade by wearing sunscreen, a hat and sunglasses.
  • Seek help and get out of the sun if you feel dizzy, chest pain, heart palpitations, shortness of breath, or you’ve stopped sweating and get the chills.

Team Össur Athlete Rudy Garcia-Tolson Attempts World’s Largest Ironman-Distance Triathlon

2 x Paralympic Gold Medalist, Rudy Garcia-Tolson will attempt to complete his second Ironman at Challenge Roth (Germany) – a 2.4 mile swim, 112 mile bike ride, and 26.2 marathon. Garcia-Tolson, 25, became the first double-above knee amputee to complete an Ironman in 2009 at Ironman Arizona.

Garcia-Tolson will be one of six athletes featured in the film “Challenge Roth,” a documentary that showcases the physical and mental toughness one must exhibit to rise above various obstacles. He has also recently announced that he will attempt to compete in 3 sports at the 2016 Rio Paralympics – athletics, swimming and triathlon.

“Having no legs is really a gift,” says Rudy Garcia-Tolson. “If I wasn’t an amputee, I probably wouldn’t have the same drive to do what I do.” What Rudy does is spend six or seven hours a day in athletic training, routinely break world records in swimming, compete in triathlons, and tour the country as a motivational speaker to spread his message that “A Brave Heart is a Powerful Weapon.”  He’s been picked to carry an Olympic torch and named one of People Magazine’s 20 teens that will change the world. Oh, and he’s buddies with movie star Robin Williams and has appeared on Oprah. All of that would be a staggering achievement for any young man, but Rudy was born with multiple birth defects: a club foot, webbed fingers on both hands, and a cleft lip and palate.

Follow Garcia-Tolson’s Challenge Roth Ironman and Paralympic journey onhttp://rudygt.com.

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