Dr. Ruhlman Finishes the California International Marathon (CIM)

Congratulations Dr. Ruhlman for completing the 2013 California International Marathon in Sacramento, CA on December 8, 2013!

According to the CIM’s web site, “The CIM was founded in 1983 by the Sacramento Running Association to bring a world-class running event to the Sacramento area. The same course developed then provides runners with a very fast, point-to-point, net-downhill marathon.

Tracing a historic route used by the gold miners during the 1849 Gold Rush, it begins at the Folsom Dam,passes through semi-rural suburbs into bustling midtown Sacrament, and has a spectacular finish in front of the California State Capitol. The CIM’s 26-mile, 385-yard distance is certified and sanctioned by USATF (#CA07004RS),and therefore is a Boston Marathon qualifier and an Olympic Marathon Trials qualifier. It is frequently a regional or national USATF Championship event as well.”

In Dr. Ruhlman’s words about the race, “”Great race, great people and a well organized race. The conditions and the distance pushed my limits as always, but it was really rewarding to cross the finish line.”Dr. Ruhlman’s official time for completing the marathon was 03:16:25!Congratulations Dr. Ruhlman and way to go!

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Preventing Ski Injuries through Conditioning

A busy ski resort in the United States may see dozens of injuries on the slopes each day. As an orthopedic surgeon, I also see many patients with ski-related injuries throughout the season. Most injuries are the result of poor conditioning, or equipment failure.

The most common injuries amongst downhill skiers are knee sprains, shoulder injuries, head/face injuries and wrist/thumb injuries. The knee is the most commonly injured joint, resulting in about one third of all ski injuries. Injury rates and type vary with uncontrollable factors such as weather and snow conditions. Proper equipment and conditioning, however, are factors that we can control.

Equipment

When skiers examine their equipment, it’s important to make sure that: Skis, poles, and boots are in good condition and properly sized for the individual’s weight,size and skill. Bindings are adjusted and tested prior to each ski season.Helmets are properly fitted and checked for damage prior to the ski season.Sunglasses, goggles and sunscreen are part of one’s safety equipment

Conditioning

Skiers can increase their safety and performance this winter by starting with a pre-conditioning program that includes four components: endurance, strength, flexibility, and balance. Aerobic fitness is the key to preventing the end of the day injuries (the last run).Cross training, which includes multiple sports and activities in the conditioning regimen, has become popular, especially with a seasonal sport such as skiing. Strength and flexibility focusing on the legs and trunk are vital in injury prevention specific for skiing. Balance training has been shown to be the single most important exercise for preventing ACL tears in women.
A typical conditioning program can include:

1. Aerobic fitness (5 days/week for at least 30 minutes)

  • Running
  • Cycling
  • Swimming
  • Elliptical or stair climber
  • Jumping rope
  • Treadmill

2. Strength (3 days/week, 2 sets of 60 seconds each)

  • Leg press
  • Wall squats
  • Hamstring curls
  • Toe raises
  • Lateral leg raises
  • Sit-ups

3. Flexibility (daily, 2 sets of 60 seconds each)

  • Hamstring stretches
  • Achilles stretches
  • Quad stretches

4. Balance Exercises (daily, 2 sets of 60 seconds)

  • Standing on one leg, perform mini squats
  • Single leg hop, holding landing for 5 seconds, repeat

In addition to a conditioning program, skiers need to adequately warm up – an activity that is often neglected with skiing. No one would think of running out on the football field or onto the basketball court without warming up first. But with skiing, one typically sits in the car for an hour or more to get to the slopes, and then stands in line for tickets and for the lift, before finally sitting on the chair for several minutes. By the time one has arrived on the top of the hill, he or she is often stiff and cold.

It’s important for skiers to remember to warm up and stretch before starting down the hill.Often an easy, predictable run is a good idea before heading to the more challenging terrain.The few minutes spent warming up will be well worthwhile in injury prevention.

More about knee injuries

Every ski season, I treat many knee injuries. In the 1970′s, ankle injuries were more common, resulting from soft, leather boots. The development of stiffer boots has transferred much of the force to the knee.

The most common knee injury from skiing is the MCL (medial collateral ligament) injury. It often results from catching an edge or having the skis diverge, so that the foot is forced away from the body. This creates a distraction force on the inside of the knee. Fortunately, the MCL has a good blood supply, and can be treated non-operatively, with a period of bracing for 4-8 weeks, depending on the severity of the injury.

ACL (anterior cruciate ligament) injuries are also common skiing injuries. They are thought to occur from the forces created by the long lever arm of the ski that are transmitted to the knee ligaments. Commonly, the ACL is injured with a hyperextension mechanism. In expert skiers,we see ACL injuries when saving a backwards fall by a strong quadriceps contraction, pulling the tibia (lower leg) forward with enough force to rupture the ACL. Recent boot and binding technology has reduced the rate of ACL injuries. In young, active individuals, the ACL injuries often require surgical reconstruction. Success rates from surgery are excellent, but require aggressive rehabilitation and six months of recovery time before one can return to skiing or other twisting or pivoting sports.

No one wants to go down the path of surgery and recovery. But too many people wait to think about preparing for skiing until half way through the season, when snow has already accumulated and they are on their way to the top of the mountain. Many times, this is to late. Although injury is a risk we all take when participating in any sport, a conscientious approach to skiing – including equipment inspection and conditioning – will minimize the occurrence. Not only will these precautions reduce injury rate, but they will also enhance performance, decrease fatigue, and ultimately, increase one’s enjoyment of the sport.

We are fortunate in the Pacific Northwest to have great skiing terrain so close. Be safe and prepared so you can enjoy a great skiing season this year.

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Orthopedic Injuries of Celebrities

On Sundays while reading the sports page or perusing through the Internet, you come across articles regarding athletes who have been injured during a sporting event, but did ever stop to think about the entertainment industry? Well, if you think about it, there are quite a few injuries that occur while on stage, or even in their off time while they were horseback riding. We compiled a list of orthopedic injuries in both the sports and entertainment genres to note that sometimes, unexpected injuries can occur, even to famous sports and entertainment legends.

Pink – During her Funhouse Tour in 2009, the famous singer-songwriter separated her shoulder while on a trapeze.

Jennifer Grey – She had back surgery in 2012 to repair a ruptured disc in her back while performing on Dancing with the Stars season finale.

Liza Minnelli – Years of dancing caught up with her and had knee replacement surgery in 2010.

Bono – U2 singer Bono underwent emergency back surgery in May 2012. His injury – Severe compression of the sciatic nerve and a serious tear in the ligament and a herniated disc.

Dana Torres – Olympic Medal Swimmer had undergone a cutting-edge procedure on her knee to repair severe arthritis in 2010.

Phil Collins – He had surgery to repair a dislocated neck vertebrae in April 2009.

Soledad O’Brien – She injured herself on a horseback riding excursion and tore out her knee and had reconstructive surgery.

Big Boi – The Rapper hurt himself in a performance at the Summer Camp Fest in Chillicothe, IL. He jumped and landed badly and had torn a patella tendon.

Peyton Manning – During the 2011 NFL season, he had neck surgery.

Lance Armstrong – He had a cycling accident in 2009 with a clavicle fracture.

Tom Brady – In the 2008 NFL season had an ACL tear.

Joe Paterno – Former football coach of Penn state had a tibial plateau fracture.

Floyd Landis – The cyclist had surgery for his hip osteonecrosis.

Frankie Hejduk – MLS player had an ACL tear repaired.

Ronald Reagan – Former President of the United States had work done for his hip fracture.

Donovan McNabb – During the 2005 NFL season, he had work done to repair his sports hernia.

Drew Brees – In the 2005 NFL season he had a shoulder dislocation.

Gwyneth Paltrow – She had broken her knee and it was discovered that she had osteopenia, a pre-cursor to osteoporosis.

Kobe Bryant – Basketball player for the Los Angeles Lakers underwent surgery to repair a torn left Achilles tendon back in April 2013.

Misty May-Treanor – Olympian and volleyball superstar underwent surgery to repair a torn Achilles tendon back in October 2008 when she injured herself while rehearsing a dance routine for the television series Dancing With The Stars.

Dr. Reed notes, “Even celebrities have orthopedic ailments. From sprains, to fractures, to arthritis no one is immune. At Orthopedic Specialists of Seattle we treat all orthopedic conditions, from the everyman to the celebrity.”

Seattle Seahawks WR, Percy Harvin and His Hip Labral Tear

Percy Harvin, Seattle Seahawk’s Wide Receiver is waiting out another week before he can return to the football playing field. NFL Spinzone reports, “Harvin was able to return to practice a couple of weeks ago, but the Seahawks have prudently decided to rest him. He has recovered quickly and well from off-season hip surgery, but Pete Carroll is 100% correct in being as cautious as possible with their new star receiver. The last thing they need is for the oft-injured Harvin to have a setback, especially since the 8-1 Seahawks clearly have their eyes set on a Super Bowl-winning season.”

The labrum is a unique structure found in the hip. The labrum is a specialized structure that lines the edge or rim of the hip socket. The shape and function of the labrum can be most easily understood as being similar to a bumper cushion on a pool table. The shape of the labrum is triangular in cross-section. The labrum acts as a cushion between the ball and socket of the hip joint during flexion of the hip.

The labrum is filled with nerve fibers that make tears in the labrum very painful.

What causes a labral tear?hip-labral-tear

Labral tears typically occur from:

  • Repetitive motion. Physical activity that requires one to repeatedly pivot the body can lead to joint wear and tear. This is common in athletes such as golfers and baseball players, who must repeatedly twist their bodies to hit a ball.
  • Osteoarthritis. Increased friction from osteoarthritis symptoms inside the hip joint may lead to labral tear.
  • Trauma. Dislocation or violent, direct impact to the hip joint may cause labral tears. This is common in athletes and victims of car accidents.
  • Birth defects. Some people are born with abnormal hip structures, which increase the progression of wear and tear on the hip joint. These problems may lead to labral tears.

What does it feel like?

Some labral tears cause no signs or symptoms; however, when symptoms are present, they include:

  • Radiating pain in the hip and groin
  • A catching or locking sensation in the hip joint
  • Stiffness in the joint
  • A limited range of motion

How do I know if I have a labral tear?

A physical examination by your doctor will help diagnose the cause of your symptoms. X-rays will allow your physician to take a closer look at the bone and rule out other possible underlying conditions. Magnetic resonance imaging (MRI) may also be used to further examine the soft tissues.

How are labral tears treated?

The level of treatment depends upon the severity of the condition. Some patients recover in only a few weeks using conservative treatments. However, patients with severe labral tearing may require surgery. One or a combination of these treatments may be used:

  • Rest and activity modification. By resting and allowing the inflammation of the joint to settle down, symptoms may be alleviated.
  • Medication. Anti-inflammatory medicines may help alleviate the pain and inflammation associated with labral tears. Your doctor may also recommend cortisone injections.
  • Physical therapy. Learning new exercises can help maximize hip range of motion, strength, and stability.
  • Surgery. In general, labral tears can be either repaired or trimmed during an arthroscopic procedure. Depending on the severity of the tear, the surgeon may cut out and remove the torn piece of labrum or repair the torn tissue by sewing it back together.

According to Dr. Watt, “Hopefully Percy will continue his recovery and return to the field soon. If you think you have labral tear or hip condition that is not getting better, I would be happy to evaluate your hip and devise an appropriate treatment plan.”

 

In the words of Russell Wilson, “Go Hawks!”

 

Seahawks DE Michael Bennett taken off field on stretcher

On Sunday, September 29, seattlepi.com reported that Seahawks defensive end Michael Bennett, who has been a big story this season as Seattle’s sack leader, was taken off the field Sunday on a stretcher after he was injured on a play against the Texans in Houston. The article reported, “Late in the second quarter, Bennett was rushing Texans quarterback Matt Schaub when he was pushed from behind by a Houston defender into Schaub’s leg. Bennett’s head appeared to snap back, and his helmet flew off as he hit the ground. Bennett laid face-down on the turf for several minutes as trainers tended to him.”

According to the news article, “Bennett suffered a strained muscle in his back that was close to his vertebrae. The location of the injury was why medical personnel were extra-careful and carted Bennett off the field on a stretcher.” Head coach, Pete Carroll said that he was “fine” and a tweet was sent out the next day stating that Bennet was practicing and that he may be able to play in their upcoming game against Indianapolis.

Treatment of a lumbar muscle strain is important to understand. Once you know the cause of your symptoms, you can proceed with treatment. It is important that if you are not sure of the cause of low back pain, that you are evaluated by a physician. According to Dr. Charlie Peterson, “Back injuries can be painful, frustrating and even scary, but are also common. As such, the vast majority can be managed with a few simple techniques. However, if you have unusual symptoms or your pain persists, it’s time to seek advice from a specialist.”

If you are experiencing pain in your lower back or it has been injured as a result of physical activity, below is a list to help you treat your injury:

Step 1: Rest

The first step in the treatment of a lumbar muscle strain is to rest the back. This will allow the inflammation to subside and control the symptoms of muscle spasm. Bed rest should begin soon after injury, but should not continue beyond about 48 hours. While it is important to rest the injured muscles, it is just as important to not allow the muscle to become weak and stiff. Once the acute inflammation has subsided, some simple stretches and exercises should begin.

Step 2: Medications

Two groups of medications are especially helpful in treating the acute symptoms of a lumbar back strain. The first of these are anti-inflammatory medications. These medications help control the inflammation caused by the injury, and also help to reduce pain. There are many anti-inflammatory options, talk to your doctor about what medication is appropriate for you.

The second group of medications commonly prescribed for the treatment of lumbar strains is muscle relaxing medications. Again, there are several options that you may discuss with your doctor. These medications are often sedating, so they need to be used with care. For patients who have back spasm symptoms, these muscle relaxing mediations can be a very useful aspect of treatment.

Step 3: Physical Therapy/Exercises

Proper conditioning is important to both avoid this type of problem and recover from this injury. By stretching and strengthening the back muscles, you will help control the inflammation and better condition the lumbar back muscles. The exercises should not be painful. Without some simple exercises, the low back muscles can become “deconditioned,” or weak. When the low back muscles are “deconditioned”, it is very difficult to fully recover from low back injuries.

It is also important to understand that even if you are “in good shape,” you may have weak low back muscles. When you have a low back muscle injury, you should perform specific exercises that stretch and strengthen the muscles of the low back, hips and abdomen. These exercises are relatively simple, do not require special equipment, and can be performed at home.

Step 4: Further Evaluation

If your symptoms continue to persist despite treatment, it is appropriate to return to your doctor for further evaluation. Other causes of back pain should be considered, and perhaps x-rays or other studies (MRI, CT scan, bone scan, laboratory studies) may be needed to make an accurate diagnosis.

If you believe you are suffering from a back injury and need specialized orthopedic care, Orthopedic Specialists of Seattle has excellent treatment options available for you.