mm

About Philip Downer

Phil Downer, MD Dr. Downer is a board-certified orthopedic surgeon with a special interest in hip preservation surgery. Dr. Downer enjoys seeing patients of all ages, but his special interest in joint preservation has led him to treat many younger patients with hip problems, such as hip dysplasia or hip impingement.

IRG Sports Medicine Update: Groin Pull/Strain

Tom Hutyler: Welcome to IRG’s Sports Medicine Update

Tom Hutyler: I’m Tom Hutyler and along with Shannon O’Kelley, physical therapist and president of IRG physical and hand therapy and our guest Dr. Phil Downer, Orthopedic Specialist from Orthopedic Specialists of Seattle.

Tom Hutyler: Dr. Downer, thanks for joining us.

Tom Hutyler: Hey, athletes and just people that sometime injure their lower leg muscles, particularly their groin muscles, sometimes that’s a hip problem that goes undiagnosed. Tell us about your experience there.

Dr. Downer: Well most things are not serious, but some are. And people who are getting these recurring what they call groin pulls may want to have them checked first by their family doctor and then possibly somebody more specialized just to make sure they’re not dealing with something that is more boney origin and can be addressed early to avoid bigger problems in the future.

Tom Hutyler: Yeah, those muscles that attach on that hip area or pelvis area, pretty big muscles and sometimes can you pull of a chunk of bone and just assume it’s like a strain?

Dr. Downer: That is one issue. Big muscles, powerful muscles, but the bigger issue I’m referring to are architectural problems with the hip, the shape of the hip that can predispose one to big problems in later in life.

Tom Hutyler: Recurring hip problems, continuous strains might be problematic have it looked at.

Dr. Downer: Yes, have a check.

Tom Hutyler: Yeah, that hip joint often overlooked in the sports medicine population. Thanks for coming back.

Dr. Downer: It’s been a pleasure.

Tom Hutyler: If you like more information on this topic as well as how to contact Dr. Phil Downer, go to irgpt.com and click on the health experts tab.

Non-surgical Treatment of Hip Arthritis

By Dr. Phil Downer

This is a discussion on the non-surgical treatment of hip arthritis.

First thing I recommend for people is to modify their activities. So this involves doing more of the light, low impact activities such as swimming, biking, walking or hiking.
You’re trying to avoid the higher impact activities such as running on the pavement or cutting-type sports, soccer, or hiking, you know, going up and down, steep inclines or declines. These types of heavy pounding, heavy impact activities generally irritate the hip more while they give you, can give you a workout, they often irritate the hip and therefore cause more harm than good.

In terms of medications, first thing we always recommend is Tylenol. This is purely a pain medication. And if this isn’t effect of its own, adding an anti-inflammatory is a good combination so you can take Tylenol with anti-inflammatory such as ibuprofen or Naproxen or Aleve. Together this combination is more effective than any of the medications on their own.

Physical therapy is often a thing we recommend. This can be done with a physical therapist or done on your own. It involves stretching, strengthening the hip, in the midrange of motion, so gentle stretching and strengthening, like I’ve said, mid-range, best type of activities are things again, like I said, swimming, walking, bike, stationery bike, trying elliptical or step machine, these low impact, Nautilus type machines on a very low setting, they move the hip through mid-range of motion and avoid the high impact that can irritate the joint.

Massage can often be very helpful. This reduces inflammation and can reduce muscle spasm and either done on your own or with a professional masseuse, it can be quite effective.
Diet is another thing. People talk about dietary triggers and I know there’s work being done on certain inflammatory diets that are, you know, can cause problems for more people. It’s difficult for me to discuss it, and difficult to make good comments. It’s not something I have much expertise in, but I know I have heard from patients and read that the diet plays a fairly large role in pain from arthritis.

And related to this is losing weight. The big reason why patients have difficult moving and dealing with arthritis is because they’re overweight. So losing weight and getting closer to your ideal body mass is critical.

Finally, cortisone injections are a way we use finally for certain patients to reduce inflammation. Basically we’re putting in steroids in the joint, inside the joint capsule to reduce inflammation and this can last from very little at all to 2-3 months for some patients and is sometimes an effective way. One of the reasons I typically recommend it is to patients, who can’t have surgery or can’t have surgery at the present time are in severe pain and also a good use of it is when you’re going on vacation and can’t have your hip treated prior to vacation. It’s a good way of enjoying your vacation.

So hopefully you find that helpful. That’s a brief discussion on non-surgical ways of dealing with hip arthritis.

One Weight-Loss Approach Fits All? No, Not Even Close

By GINA KOLATA | DEC. 12, 2016

“Dr. Frank Sacks, a professor of nutrition at Harvard, likes to challenge his audience when he gives lectures on obesity.

“If you want to make a great discovery,” he tells them, figure out this: Why do some people lose 50 pounds on a diet while others on the same diet gain a few pounds?

Then he shows them data from a study he did that found exactly that effect.

Dr. Sacks’s challenge is a question at the center of obesity research today. Two people can have the same amount of excess weight, they can be the same age, the same socioeconomic class, the same race, the same gender. And yet a treatment that works for one will do nothing for the other.

The problem, researchers say, is that obesity and its precursor — being overweight — are not one disease but instead, like cancer, they are many. “You can look at two people with the same amount of excess body weight and they put on the weight for very different reasons,” said Dr. Arya Sharma, medical director of the obesity program at the University of Alberta.”

READ FULL ARTICLE ON THE NEW YORK TIMES

Outpatient Hip Replacement

We performed our first hip replacement yesterday at our outpatient surgery center. We have been sending patients home the day of surgery from Swedish Ballard Hospital, but this was the first time at the outpatient surgery center.

Everything went as we had hoped and planned. The staff were all amazing.

I had discussed the options with my patient, and we both felt this was a good option. She is young and healthy, and a good candidate for this type of care.

We will be following here closely, and we have discussed at length being careful and not over doing it.

This is an exciting time for hip replacement surgery. Reducing the impact of this surgery on the body has enabled us to reduce the time in the hospital, and reduce the pain of recovery. I am sure we will continue to improve, but what a change over the past 10 years!

New Look At Dieting: Fat Can Be A Friend

This is an interesting article from the NY Times talking about some good diet guidelines, and some of the diet myths that have been around for some time.

“WEIGHT LOSS REPORT; New Look At Dieting: Fat Can Be A Friend”
By JANE E. BRODY | MAY 25, 1999

“Now hear this: avocados, walnuts, salad dressings with oil, sauteed vegetables, fatty fish and some kinds of margarine may be back on the menu for health-conscious Americans, even for those trying to lose weight, if the findings of recent studies are to be believed.

For three decades now, Americans have been bombarded with advice to eat less fat for the sake of their hearts and their waistlines. One well-known expert, Dr. Dean Ornish, advocates stripping away all added fats and naturally fatty foods to achieve a diet containing no more than 10 percent of calories from fat, down from the 44 percent typically consumed by Americans in the 1960’s and the 34 percent now consumed.”

Click for Full Article