Musculoskeletal Care of the Aging Athlete

Musculoskeletal Care of the Aging Athlete.

I received an urgent call, earlier this week, from a male friend skiing in Snowmass, Colorado. He had fallen while skiing and had been placed on crutches after a local medical clinic visit with a tentative diagnosis of a sprain around the hip. No X-ray had been taken. When he indicated he could not bear weight on the leg because of pain but was reasonably comfortable sitting or lying, I instructed him to return to the Clinic and request an X-ray. Later during the day a follow-up phone call confirmed my suspicion, a fracture. Fortunately though, the fracture was in the pubic ramus and not in the femur.

Fractures in the mature athlete, may be the result of severe trauma; but may be predisposed to by osteoporosis, even in a male. Nutrition, disease, genetics, activity imbalance and daily medications all contribute to osteoporosis and predispose to fracture. In the case of my friend, further discussion helped me identify that even though he is an avid athlete, a daily medication may have resulted in osteoporosis. I will assume his care once he returns to Chicago and I will direct him to a bone density scan. Any male over age 55 and any female over age 45 who sustains a fracture without massive trauma require a bone density test

The information concerning osteoporosis in the mature athlete is still incomplete. While Fosomax initially dominated the pharmaceutical market in preventing fracture and treating osteoporosis; several alternative medications are now available. With expiration of the Fosomax patent, generic substitutes are available. At the same time, time, a significant incidence of spontaneous femoral fracture is being reported in those who are under pharmacologic treatment for osteoporosis. While there are several theories behind this seemingly recent increase in spontaneous femoral fractures in the treatment cohort, there is as yet no scientific explanation. One must understand that osteoporosis may be generalized (osteopoenia) or may be very bone specific. It may be that the bone density enhancers preferentially strengthen some bones and not all. It may be that after seven years, the medications no longer work. Or it may be that generics are not the same as the proprietaries. Consult with your doctor, think of bone density testing as equal to the need for cardiac stress testing and take 2000 plus mgms. of vitamin D3 daily in addition to other pharmacologics and neutraceuticals

As You Get Older

AS YOU GET OLDER


Your body changes as you get older and so should your attitude. Anytime you can still be active as in golfing, skiing, running or biking, you should count your blessings. Think of the alternatives. You can sit around complaining about the high cost of pills or you may go out and try to “just do it”. Think of tomorrow and not yesterday.

If your mind is in good shape, you can get your body into it again. Pause not to rest but to reach your peak. It’s all in your legs and in your core. Work fitness in, no matter how little the spare time, no matter how packed your schedule. In the February 2010 periodical, SKI, pages 88 and 89 describe seven exercises you can sneak in throughout the day without even changing your clothes.

Once you have enjoyed some level of activity don’t stop. You might be able to participate on day one but at issue are the 36 holes on Tuesday and the century bike ride on Wednesday. In the week of my heli-skiing trip just completed, I was reminded again and again of the need to start the day with 30 minutes of stretching mixed with yoga. If you opt out for the 7:30 am session, you might as well not plan to ski that day. 200mgms of Celebrex certainly goes a long way as well. In my blog archives, you may read about Athletics for Arthritics and Skiing with Arthritis. The principles of preparing or continuing to be active are repeatedly emphasized. The winter isn’t over yet and spring is only two months away. I will stop writing now as I am off to the health club.

One Surgeon. One Patient

Over 1,000 times last year, I provided personalized care to one patient.

The science and art of medical care is to provide the right solution for each individual patient. This requires clinical mastery, a human connection between the surgeon and the patient, and the right tools for each situation.
As I strive to view my work through the eyes of one surgeon and one patient. I approach every service I provide as if it’s meant for a family member.
My approach to innovation creates real solutions that assist each of you by delivering a durable personalized care to each patient.
While that solution may ultimately require a minimally invasive surgical technique, advanced biomaterials, or a custom, patient-matched implant first I exhaust non-operative alternatives
When one surgeon connects with one patient to provide a personalized care, the promise of medicine is fulfilled.

To learn more, visit my web site at www.drsheinkop.com
or read my Blog at www.sheinkopmd.com

Do You Need This Surgery?

Do You Need This Surgery?

Millions of us are having operations on our hips, knees and backs; are they all necessary?Probably not, even the technically least demanding surgery is a serious undertaking for a patient. No surgery is minor. There is always a risk. While sometimes surgery is the only available treatment, in other cases less invasive options should be exhausted first. Would you be surprised to learn there is evidence to suggest in some parts of the country, certain procedures are overdone? Whether or not you undergo an operation for an arthritic problem may even depend on where you live. Many communities take a conservative approach and require you to go through hoops and hurdles before you have an elective procedure for an arthritic joint. Let’s take arthritis of the knee as an example. To have knee surgery because you have arthritis is not the solution. While it is true that about one in four people with osteoarthritis of the knee eventually becomes a candidate for total knee replacement surgery with a 90% chance of a better overall quality of life, knee arthroscopy for arthritis should be looked at skeptically with less than a 50% chance of improvement. If you have received a recommendation for arthroscopic knee surgery because of arthritis, get a second opinion.

What then is the answer for arthritis? Regenerative medicine, not a replacement, but what is the state of that art? Aging is the number one killer in the U.S. Growing old involves a long, slow decline and included in the decline is arthritis. While aging is an inevitable part of life, there are now several ways to intervene. This isn’t the place to explain the human genome program but suffice it to say there is a role you can play in regenerating well-being for your arthritic joint. Start with exercise, weight reduction, stretching, proper nutrition and plenty of rest. When you no longer can manage the problem on your own, call and make an appointment

Skiing with arthritis.

Skiing with arthritis.


Why?

“Date: Monday, January 25, 2010, 5:48 PM Lots of great snow. 20" in the last two days. Lovely skiing in knee deep powder---laughing all the way down the hill. The last 2 days have been great and lots of fun. I'm here another 2 weeks and am working up to 30 + days of skiing. And the sun shines almost daily! Get out here! Hope all is well. Love to all”.
My wife forwarded the above e-mail message she received last night

When you planned the 2010 ski trip last fall, you never gave thought to the possibility that skiing and golf pose different demands on your body. This week you learn that the mountains in Colorado are finally covered with snow and your thoughts turn to that annual winter sojourn, the same one you have relished for the past 25 years. “You can’t keep up any more,” says the family, “forget it”. “We had better change plans”.

Are you ready to give it up, to throw in the towel? Follow my prescription and in six weeks, you could again enjoy that Mountain High. After all, where else can an adult dress in a outlandish set of colors and go screaming down the mountain reliving the thrilling days of yesteryear. Skiing is back to the future; as good as it gets.


How!

The prescription for successful athletic achievement with or without arthritis is the same; follow the principles of fitness:
Stretch, strengthen, loose weight, hydrate, aerobics, anaerobics, and rest. Now do it again the next day.

What if?

Then it’s time for a ten-day course of antiinflamatories, an intraarticular cortisone injection or a viscosupplementation series. I am here to help; that is before or after my personal week of skiing

Athletics for Arthritics.

Athletics for Arthritics.

The big trick in training for fitness is to train as little as possible for the greatest benefit and do it with consistency. This approach limits the toll on your body while providing the necessary stimuli allowing you to achieve your goals. So how might you limit the toll on your body to prevent fatigue, injury, and aggravation of arthritis or accommodate the inherent restrictions following a hip or knee surgery? Cross training is the answer. In a given week, mix your routines with walking, elliptical trainers, cycling and water based activities. Effective cross-training methods challenge your aerobic system and provide some muscular endurance training. If you must run, run in a pool. Try a rowing ergometer, I use one. Additional benefits of cross-training include providing a change and mixing up training so you might keep your motivation and enjoyment as well as avoid cumulative and repetitive injury loads.

There is no reason for you as a patient to ever feel you can’t exercise before or after a joint replacement; with or without arthritis. You core is critical to all ambulatory movements. While your arthritic hip or knee may have or be contributing to some limitations; by strengthening your core, you improve well-being and performance of your entire body. For those unfamiliar, the term “core” refers to an area central to your body. It encompasses the regions from the lower ribcage to your mid-thigh: your abdomen, lower back and buttocks. If your core is strong, your legs work less. Many exercises can strengthen your core-Pilates, yoga, and ball/balance exercises to name a few. Of course, it requires commitment, consistency and self discipline; the same as for weight reduction, that common denominator in any and all phases of physical well being.

New isn't better

New isn't better.

One in every 12 hip and knee replacements done in Australia in 2008 required a revision, that's 8.3 per cent of procedures. Three per cent of joint replacement patients had more than one post-operative problem. These are the findings of Medibank Private, the largest health insurer in Australia.

Their National Joint Replacement Registry, which is studying the reliability of hip and knee replacements, has found the newer uncemented knee prostheses more likely to require further surgery than the older practice of cemented knee replacements. The results also suggest that cementless hip prosthetic results are dependent on the experience of the surgeon. Failure of a joint replacement is a potentially devastating problem for a patient and a costly problem for taxpayers and self-insured businesses.

We in the United States do not have the ability to gather similar data since we don't have a National Joint Replacement Registry. While there are voluntary registries offered by the various manufacturers of prosthetic joints, only a minority of orthopedic surgeons participates in data collection. As an aside, I have been gathering data on the results of my surgeries for over 30 years; so I have been cementing knee prostheses for a long time. There is an initiative within the United States to establish a universal joint replacement registry but the present proposal would be based on voluntary participation by an orthopedic surgeon.

Let's assume that you have visited an orthopedic surgeon and received a recommendation for a new hip or a new knee. For those of you who regularly read my blog, you may anticipate my advice, get a second opinion. Make sure that you have exhausted all non-operative alternatives. Before you undergo the surgery, ask questions pertaining to the type of prosthesis. The best outcome is not based on the length of the incision or an immediate discharge from the hospital; it requires a setting wherein the mantra is One Surgeon/One Patient