• Four Layers of The Hip & How They Factor Into Athletic Injuries

    Posted by Stacie Grossfeld

    A recent article from the April edition of American Academy of Orthopaedic Surgeons focused on how hip injuries can lead to long-term negative effects within the athletic community. To thoroughly explain how these injuries occur, the authors Dean Lynch, Aseesh Bedi, and Christopher Larson discuss the hip joint according to four separate layers.

    The Osseous Layer

    Hip Joint Injuries in Athletes

    The first layer involves the femur bone, the pelvis and the hip socket. Hip injuries to this layer often include:

    • Static overload

    • Impingement

    • Dynamic instability

    Another less common hip injury is femoroacetabular impingement, or FAI. FAI is a condition that limits range of motion in the hip because of improper bone formation during childhood. The decrease in movement within the hip causes abnormal stress to the sacroiliac joint, pubic symphysis, and lumbar spine. Cam impingement is one variety of FAI where the femoral head is not round and therefore cannot rotate smoothly inside the acetabulum. A bump forms on the edge of the femoral head that grinds the cartilage inside the acetabulum. Also, if an anterior cam effect is present it can limit internal rotation. So it may cause levering of the femoral head which could also create posterior hip subluxation or dislocation and resultant labral tearing and cartilage damage.

    The Capsuloligamentous Layer

    This layer includes:

    • Labrum

    • Joint capsule

    • Ligamentum/capular complex

    • Ligamentous teres

    Asymmetric wear of the chondral surfaces of the femoral head and/or the acetabulum may result from stress of the Osseous layer. The authors noted in their study that the structure of layer one produces an injury pattern for the second layer. For example, if an athlete has FAI and hip pain then a labral tear is highly likely.

    The Myotendinous Layer

    Layer three includes all the muscles around the pelvis, lumbosacral and pelvic floor regions. Dynamic impingement from a cam deformity in layer one causes increased strain on the SI joints, pubic symphysis and ischium. Secondary strain is placed on muscles attached around the hip joint. Due to the increased strain of the muscles and tendons it can cause tendinitis of enthesopathies.

    The Neurokinetic Layer

    Layer four includes the nerves within the hip area:

    • Thoracolumbosacral plexus

    • Lumbo pelvic tissues

    • Ilio inguinal

    • Iliohypogastric

    • Genitofemoral

    The Neurokinetic layer is responsible for the posture and the ability to sense stimuli of the pelvis over the femur.

    Athletic Hip Injuries

    Common hip injuries for athletes include:

    Adductor Strains

    Specific muscles contribute to adductor strains. These muscles include: the adductor longus, adductor magnus, adductor brevis, gracilis, obturator externus and pectineus. The adductor longus is the most common muscle to sustain injury. On average, a soccer player with a strained adductor longus will lose 2 weeks of play time, and will have a 18 percent recurrence rate. It is important to take time to heal because player who return to practice too quickly will likely worsen their injury.

    Four layers of hip injuries

    Osteitis pubis

    This condition occurs from overuse and stress of the pubis symphysis. It can cause lower abdominal pain secondary to stress and abnormal motion of the joint. The rectus abdomens elevates the pubic bone and the adductor tensions depress the pubic bone. An imbalance can cause a stress injury to the pubic bone. Chronic pubic symphysis can cause chronic sclerosis and widening of the symphysis. The best imaging for diagnosis of the condition is a MRI.

    Athletic pubalgia/core muscle injury

    Athletic pubalgia/core muscle injury is commonly referred to as a sports hernia. There is no actual hernia associated with the condition, rather it’s more of a weakening or tearing of the abdominal wall. The pain radiates into the groin and proximal adductors during sporting activities. Pain will be reproduced with a resisted setup, palliation over the pubis and the abdominal obliques and or rectus abdominus. Most imaging studies will be normal. On occasion an MRI can pick up a thinning of the abdominal wall or a tear called a cleft sign. Management is done through activity modification, NSAIDS and physical therapy. Sometimes injections will help diagnosis and treat the condition. Sports hernias rarely resolve without surgical intervention. Surgical procedures fall under three classes. These classes include: open repair with or without mesh, scope repair, pelvic floor repair with or without adductor release/repair and neurectomy.

    Dr. Stacie Grossfeld is a double board-certified orthopedic surgeon in Louisville, KY with a specialty in sports medicine. If you are suffering from hip pain that is not going away or you have injured your hip and need medical attention from an experienced orthopedic doctor, contact Dr. Grossfeld today by calling 502-212-2663.

    Shoulder Dislocation Research Discovers Age as Biggest Threat

    Posted by Stacie Grossfeld

    Shoulder Dislocation Research News

    Competitive sports and accidents may result in shoulder dislocation injuries for some individuals. This type of injury is treated through rehabilitation, immobility, and sometimes surgery. Shoulder dislocations can be debilitating, uncomfortable and painful. Dr. Grossfeld has some of the latest research on shoulder dislocations to help you better understand this injury and further complications.

    The researchers evaluated 100 patients who had undergone shoulder dislocations and subsequently underwent a Bankart reconstruction. A Bankart reconstruction is used to repair the capsule and labrum that gets torn in a shoulder dislocation. The researchers were interested in the amount of recurrent dislocations that occurred after surgery. They also wanted to know the percentage of patients that then developed osteoarthritis and the severity of the osteoarthritis.

    It is a well-known fact that once you have had a shoulder dislocation, your shoulder is at risk for two future problems: 1) Recurrent dislocation and, 2) The development of osteoarthritis within the shoulder joint. The trauma sustained at the time of the dislocation can damage the cartilage that involved the shoulder joint which can result in early onset osteoarthritis involving the shoulder.

    There is scientific documentation that after shoulder dislocations, arthritis can occur. A study completed in Munich, Germany, specifically looked at how many shoulder dislocation patients developed osteoarthritis post-injury.

    This research was published in the American Journal of Sports Medicine in May, 2015 by Dr. Plath. The researchers included 100 patients that were available for evaluation. They found that 31 percent of the patients show no evidence of osteoarthritis in the shoulder joint at 10 years of follow up. Twenty-one percent of the patients sustained a recurrent dislocation even after undergoing a shoulder stabilization procedure, and 31 percent of the shoulder showed no evidence of glenohumeral joint arthritis.

    The researchers divided up the patients that had osteoarthritis after the shoulder dislocation and after undergoing surgery. They found that 41 percent of the patients had mild osteoarthritis, 16 percent had moderate osteoarthritis, and 12 percent had severe osteoarthritic changes.

    In Conclusion

    In conclusion, the researchers stated that on average, 13 years after arthroscopic Bankart repair, osteoarthritic changes were a common finding. They noted that the age of the patient seemed more relevant for long term dislocation arthropathy than the treatment. They felt that avoiding preoperative dislocations is more important for the prevention of osteoarthritis than short term treatment.

    Older age and initial dislocation and surgery appear to be a particular shoulder osteoarthritis development. In fact, age at the time of surgery is the most consistent risk factor in the literature to date. The findings related to the normal aging process found that older patients have a higher incidence of arthritis than younger patients; however, primarily shoulder arthritis is a rare condition, and given the strong correlation of osteoarthritis and age within the study, it is evident that an older joint is more susceptible to damage at the time of the shoulder dislocation.

    We also know that if you are over age 60 and you have a shoulder dislocation, 80 percent of the time there is a full thickness rotator cuff tear that occurs secondary to the injury.

    The number of dislocations before Bankart repair correlated with the grade of the dislocation osteoarthritis. This implies that regardless of surgery, the extent of the trauma likely decides the fate of the long-term joint injury/degeneration.

    If you have suffered a shoulder dislocation in the past and are suffering from osteoarthritis, we can help. Call Dr. Stacie Grossfeld at 502-212-2663 today or visit Orthopaedic Specialists in Louisville, KY to seek medical care.

    Are There Benefits in Undergoing ACL Reconstruction After 60?

    Posted by Stacie Grossfeld

    ACL reconstructionACL stands for Anterior Cruciate Ligament and this part of the human body runs between the femur and the tibia. It is one of a pair of cruciate ligaments in the human knee. The other is the Posterior Cruciate Ligament which is located deeper within the knee joint. When an ACL is injured, or torn, it is due to the ligament being overstretched. Most often, ACL injuries occur as a result of a sudden stop or twisting movement. The most common form of repair for a torn ACL is a complete ACL reconstruction. More often than not, the reconstruction is done by autograft and arthroscopically. Despite the repair tissue coming from the same body in which the injury has occurred and the invasiveness of the surgery being minimal, recovery time is set at anywhere between one to two years before a patient can return to normal sports activity.

    When Dr. Stacie Grossfeld was training, the idea of performing an ACL reconstruction on a patient over the age of 60 was unheard of. In the past, ACL reconstructions were only offered to patients who were much younger. This was in part due to the extensive recovery time. Over the years, Dr. Grossfeld has found that patients in their 60s who have remained active and show no signs of knee arthritis do benefit from ACL reconstruction. This is especially true in regards to patients that live very active lifestyles. The benefits of undergoing ACL reconstruction are evident when observing patients who are over the age of 60 and have undergone the surgery.

    In March of 2017, an article was published in the American Journal of Sports Medicine by authors Dr. Toanen, et al. This group of researchers conducted a study and observed patients who had ACL injuries. All patients were over the age of 60 and athletic with no signs of knee arthritis. These patients underwent ACL reconstruction and their recovery was observed by the group of researchers responsible for the article. What they found was that these patients benefited greatly from the reconstructive surgery. Not only were they able to return to their normal level of activities including: twisting, turning, jumping, and running; they also had no increased incidence of arthritis two years post reconstruction.

    Based on these finding, the ground of researchers led by Dr. Toanen concluded that regardless of your age, ACL reconstruction is the best choice for repairing a torn ACL. Age is a factor that should in no way be considered when discussing options for reparation of a torn ACL. Other medical research papers and articles have been published in the past that reinforce Dr. Toanen’s team’s findings.

    In December of 2014 a study was done on the long-term outcomes after ACL reconstruction in patients 60 years and older. This team of doctors, led by Dr. Champ L Baker, found that all 13 patients within their study who underwent ACL reconstruction regained their full range of motion and made complete returns to their sports or exercise of choice. This led to the conclusion that “patients aged 60 years or older have good to excellent outcomes with ACL reconstruction and should not be excluded from ACL reconstruction opportunities based on age alone.”

    So, Are There Benefits in Undergoing ACL Reconstruction After 60?

    In conclusion, yes, there are benefits that come with undergoing ACL reconstruction after the age of 60. Benefits include complete return of mobility, the ability to return to daily sports activity, and the lack of increase in incidence of arthritis. Furthermore, age should not be considered when deciding if a patient is eligible for an ACL reconstruction. If a patient is active, healthy, shows no signs of arthritis in the afflicted knee, and is willing to undergo ACL reconstruction, they should be considered a candidate for the surgery.

    If you are 60 years old or over and an active adult who has suffered from a tear in an ACL, contact Dr. Stacie Grossfeld at Orthopaedic Specialists, PLLC in Louisville, KY. Dr. Grossfeld has been routinely performing ACL reconstruction surgeries for over 10 years. She is constantly staying up-to-date on the latest research findings surrounding ACL reconstruction. If you still have questions about ACL reconstruction for patients over the age of 60, call 502-212-2663 and make an appointment today.

    Loving Your Shoulders: 5 Shoulder Strengthening Exercises that Benefit Shoulder Health

    Posted by Stacie Grossfeld

    shoulder strengthening exercisesThis July, Orthopaedic Specialists is raising awareness about shoulder health through blog posts. These posts will focus on medical research regarding shoulder injuries as well as shoulder strengthening exercises and tips. If you struggle with pain and tightness in your shoulders that prevents you from living your life to the fullest, follow along for five exercises that are clinically proven to increase shoulder strength and benefit shoulder health.

    The human shoulder consists of three bones: the clavicle (more commonly called the collarbone), the scapula (shoulder blade), and the humerus (upper arm bone), plus multiple ligaments, tendons, and muscles. These bones, tendons, ligaments, and muscles all work together as a ball and socket joint. This construction makes the shoulder one of the most mobile joints in the body. This wide range of motion makes the shoulder unstable and prone to injuries including dislocations. The proneness to injury the shoulder is subjected to means it’s pertinent to integrate shoulder strengthening exercises into your life. It isn’t necessary to have a gym membership, or even at-home gym equipment, in order to practice the following five exercises and improve your shoulder health.

    5 Shoulder Strengthening Exercises that Benefit Shoulder Health

    1. The Body Saw

    While it sounds more like a magic trick than an exercise, the Body Saw benefits your core and scapular function. It can be performed on hardwood flooring or carpeting; however, if you do it on hard flooring than you need to wear socks and if you are working out on carpeting, you will need to place your feet on furniture moving discs. You will start out in the standard plank position and retract your shoulder blades together, so that your upper back is straightened out and not rounded. Push your body from your hands while maintaining a planking position. You will want your feet to slide about half of a foot back from the starting position. Pull your body back into the starting position and repeat for the number of reps that you choose to do.

    2. “Empty the Can”

    While it may sound more like a chore that you’d delegate to one of your children, this exercise is proven to work the muscles throughout your upper back and shoulders that are important in raising your arms above your head. It is recommended by Active.com to use a light weight when completing this exercise, but if you don’t have at-home weights then you can use anything from a bag of dry rice to a can of soup as a starting substitute.

    To complete this exercise, you will start with your feet set apart as wide as your hips with your knees relaxed and a weight in one hand with your thumb resting against your thigh. Lift your weighted arm up until it is in a 45 degree angle from your body and rotate your thumb to point down while raising your arm. This is where the motion gets its name – your movement should mimic pouring out a can. Continue to lift your arm until it is at shoulder height, hold, then move back to the starting position.

    3. The Classic: Push-Up

    The push-up is a great place to start if you are looking to strengthen your shoulders, but aren’t too savvy at exercising. This simple and straightforward exercise will also help you maintain shoulder strength over time. A push-up helps to strengthen multiple areas of your body including: your triceps, shoulders and chest and strengthens them all at the same time!

    Start by lying down on a mat and placing your hands where they are shoulder width apart. Get into a planking position and slowly bring your chest towards the ground using your upper body and arms. Lower your chest until it touches the ground and then push back up into the starting position. Repeat 10-20 times for 2-3 sets depending on your exercise experience.

    If you are working on building shoulder strength and are not experienced in exercising – you can also do push-ups with your knees on the ground. Just make sure that your back is straight and your buttocks is low to the ground, so you do not strain your back.

    4. Clasping Exercise

    This is an exercise that originated from a yoga pose and is an easy shoulder strengthening exercise to complete at home, at work, or in the gym. Additionally, if you are dealing with shoulder pain, this exercise will help to alleviate that pain quickly and naturally.

    To complete this exercise, start by standing up and clasping your hands behind your back. Inhale as you open up your chest and clasp your hands. Exhale as you bend forward at the waist, bringing your clasped hands up into the air. Hold this position for 4 seconds, and slightly pulse with your arms as you inhale again. Exhale and return to the standing position. Repeat for 10 reps and complete 2 or 3 sets of this exercise.

    It is recommended to complete this exercise in the morning or before bed depending on when your shoulders hurt. If you suffer from tight shoulders in the morning when you wake up, try this exercise out the night before. If your shoulders start to cause you discomfort midday, the morning may be a better time to complete this exercise.

    5. Shoulder Circles

    Another classic exercise that will take you back to middle school gym class and is a great shoulder strengthening exercise are shoulder circles. While it may be assumed that shoulder circles do not need explanation, it is important to complete this exercise correctly and avoid injury.

    Stand with your feet shoulder width apart and your knees slightly bent with your arms out and parallel to the ground. Instead of keeping your arms straight out, bend them slightly at the elbow. This helps to stave off fatigue and also concentrates the exercise on the shoulders. Once you are in this position, complete clockwise circles with your arms for 1 minute. Then reverse the direction and complete counter-clockwise circles for another minute. Repeat for 5-10 sets.

    If you want to increase the difficulty of the exercise, you can alternate standing on one leg for each set. This will include your core in the workout while you try to maintain balance.

    Shoulder strengthening exercises are not only important if you want to build and maintain shoulder strength. If you are recovering from a shoulder injury or shoulder surgery, shoulder strengthening exercises can benefit your recovery. As you progress in your exercise regimen, continue to encourage yourself and increase weights gradually in exercises where weights are involved. Before starting a workout regimen that involves shoulder strengthening exercises, consult your doctor. This is especially important if you are recovering from a shoulder injury or surgery.

    For More Information on Shoulder Strengthening Exercises

    Dr. Stacie Grossfeld is a double board-certified orthopedic surgeon in Louisville, KY with a specialty in sports medicine. She has successfully treated injured shoulders and performed shoulder surgeries for over twenty years. She commonly treats rotator cuff tears, dislocated shoulders, frozen shoulders, shoulder impingement syndrome, pitcher’s and swimmer’s shoulder injuries. Dr. Grossfeld also routinely performs rotator cuff repairs arthroscopically at both of her private practice locations. If you are suffering from shoulder pain that is not going away or you have injured your shoulder and need medical attention from an experienced orthopedic doctor, contact Dr. Grossfeld today by calling 502-212-2663.

    Lyme Disease Symptoms in Women

    Posted by Stacie Grossfeld

    lyme diseaseLyme disease is a bacterial infection that is transmitted by Ixodes ticks, more commonly known as deer ticks. These nymphal ticks are about the size of poppy seeds, yet they carry the dangerous Lyme disease in their bites. Ticks are thought of as insects, but they are actually arachnids that are related to scorpions and spiders. Deer ticks are found all over the United States and in more than 60 other countries. These ticks attach to one’s skin through questing and are able to feed for several days on one host. If left undisturbed, they are more likely to transmit Lyme disease and other pathogens into one’s bloodstream.

    The Center for Disease Control and Prevention has found that nearly 300,000 people are diagnosed with Lyme disease every year. It’s hard to believe, but that number is 1.5 times the amount of women diagnosed with breast cancer each year. And, that number is actually slightly higher, because many people are misdiagnosed with other similar diseases.

    Lyme disease has been called, “The Great Imitator,” because many of the symptoms are confused with conditions like fibromyalgia, multiple sclerosis and many other more common and easier to diagnose diseases. Lyme disease can become very serious if it is not diagnosed early and treated properly. Chronic lyme disease begins to affect organs and cause brain damage, heart problems as well as cognitive issues.  It is also very important to recognize symptoms of Lyme disease in small children or women that are pregnant as pregnant women have the ability to pass Lyme disease onto their child. Although it is not common, sometimes this transmission results in a stillbirth.

    Because this disease is so similar to other types of conditions, it is important to get all of the facts about symptoms. If you have been outside recently and begin to feel any of these symptoms, it is important that you seek medical attention. You can also use the symptom checker worksheet lymedisease.org has createdto help with your diagnosis.

    5 Symptoms of Lyme Disease

    1. Fever

      Most of the time Lyme disease begins with flu-like symptoms such as fever, chills, sweats, muscle aches, and nausea. If you begin to run a fever after being in wooded areas or after camping, you will want to take over the counter medication, like Tylenol, to lower your fever and be sure to drink plenty of water. If your symptoms do not go away within 72 hours, you will want to assess yourself for the following symptoms as they may be related to Lyme disease.

    2. Rash

      Most patients who are infected by this disease develop a rash in the shape of a bull’s eye. This rash usually occurs on areas of the body that were not clothed while being outdoors. You may notice an asymmetrical rash on your arms or legs, but a recent study looked at the connection between rashes and Lyme disease and found that about 27-80 percent of people develop a rash when diagnosed with Lyme disease, so this symptom may not apply to every case. If you are suffering from a fever, but cannot find a rash then look for the following symptoms.

    3. Joint Pain

      Lyme disease tends to cause joint pain and muscle weakness in the knees, elbows, wrists, and shoulders. If you begin to notice a new development of pain in any of your joints, you will want to apply ice to the area and contact your physician.

    4. Fatigue

      Many people are often misdiagnosed when it comes to Lyme disease because of the reported fatigue. This disease is capable of affecting any organ of the body. But because it can be widespread, symptoms of fatigue are often misdiagnosed as chronic fatigue syndrome and sometimes depression. If you are suffering from a fever, fatigue and a third symptom on this list, get in contact with a medical professional immediately.

    5. Bell’s Palsy

      As Lyme disease begins to affect other areas of the body it has the potential to affect one’s facial nerves. Bell’s Palsy is a paralysis or weakness in facial muscles on one side of the face. This may cause one’s face to droop and holds the rise of potentially losing sense of taste for anywhere from a few days to weeks.

    All of these symptoms are specific to Lyme disease as a whole. When the symptoms come in stages, it is sometimes difficult for physicians to diagnose it. If you experience any symptoms, it is important to monitor your health and seek medical guidance from a physician. If you are pregnant woman and feel that you have one or more of these symptoms of Lyme disease seek help as soon as possible before the disease is passed to the fetus.

    Prevention is key in protecting yourself from Lyme disease. Next time you are doing activities outdoors make sure that you are clothed properly and always check the surface of your skin once you return inside following a shower. It is always best to treat early symptoms of Lyme disease with importance. If you suspect you could have this disease, do not hesitate to speak with your physician. If you have any more questions about Lyme disease or ways to relieve joint pain, call Dr. Grossfeld’s office today at 502-212-2663.

    Does Your Uninjured Leg Weaken After ACL Surgery?

    Posted by Stacie Grossfeld

    Dr. Grossfeld wants her patients to stay informed on the latest research that becomes available. Many patients that come in needing an ACL repair surgery fear the possibility of weakening the uninjured leg while healing. This common concern has prompted researchers to analyze and study this issue.Leg Weakness in Uninjured Leg following ACL

    An excellent study published in the American Journal of Sports Medicine in December, 2015 specifically looked at the question, “Does the non-injured leg after an ACL injury and subsequently surgery become weak?”

    The researchers out of the University of Seoul, Korea, with the lead author of Dr. Chung, found that patients with ACL injuries of one leg also experienced significant weakness that occurs to the non-injured leg. Their conclusion of the study was in addition to rehabbing the injured leg, the non-injured leg must undergo rehab, too.

    What they found is that by 24 months after ACL reconstructions, the isokinetic extensor muscle strength and functional status of the contralateral leg fell, but both measurements improved significantly as the follow up time progressed. It is important to not only strengthen the surgical/injured knee with the ACL injury, but also the contralateral leg.

    For those that may be undergoing ACL surgeries in the future, remember that this is a process. This information has proven that it is not only important to strengthen the injured leg, but this will also be required for the uninjured leg as well. Try to not get discouraged during this rehabilitation journey. Because this process requires double rehabilitation, it may be slow, painful and difficult at some times. Just remember that this process will help get you back on your feet and possibly on the playing field or court!

    More Information

    For more information about treatment of ACL injuries and the latest research, check out more blog posts from Dr. Grossfeld. After reading up on this material, if you still have questions, comments or concerns, call 502-212-2663 to make an appointment with Dr. Grossfeld today!

    Lower Extremity Avulsion Fractures in the Pediatric and Adolescent Athlete: A Study in Review

    Posted by Stacie Grossfeld

    Avulsion Fracture

    An X-ray of a knee joint affected by an avulsion fracture where the ligament tore a part of the bone away from the knee.

    The April 2017 issue of the Journal of the American Academy of Orthopedic Surgeons features a compelling review article covering the topic of lower extremity avulsion fractures in pediatric and adolescent athletes. Drs. Jonathan Schiller, Steven DeFroda and Travis Blood discuss the effects of misdiagnosing lower extremity avulsion fractures. Avulsion fractures are more common in adolescents and happen when there is an injury to the bone in a place where a tendon or ligament is attached. The fracture causes the tendon or ligament to pull off a piece of bone.

    Types of Avulsion Fractures

    The JAAOS article discusses the most common places where the pediatric athlete will get avulsion fractures. The pediatric athlete has growth plates that are still open and attached to the tendon. Typically the growth plate is weak and when there is a traumatic event, the plate can often suffer an avulsion fracture. 

    The most common places where pediatric patients will have avulsion fractures are at the anterior superior iliac spine and the anterior inferior iliac spine along with the ischial tuberosity. It is extremely important for medical professionals to conduct a plain x-ray when physically examining a patient in this case. The physical examination could be consistent with a muscle strain or apophysitis.  Apophysitis tend to occur with overuse whereas an avulsion fracture tends to happen acutely. The athlete may describe a popping sensation at the time of the injury.

    Another avulsion fracture, tibial tubercle avulsion, is not very common, but requires immediate surgical fixation. A healthcare provider should be quite cognizant if their patient comes in with knee pain that could perhaps be the result of a tibial tubercle avulsion fracture.

    How to Treat Avulsion Fractures

    The most common way to diagnose an avulsion fracture is by x-ray. However, other injuries may require the use of a CT scan or MRI. CT imaging is more commonly used in the case of a tibial tubercle avulsion fracture. In general, treatment for this type of avulsion fracture is conservative unless there is a significant amount of displacement.

    Nonsurgical treatment is divided up into a five stage protocol, which consists of:

    1. Ice, rest, anti-inflammatories for the first week of the injury  
    2. From week one to week three, involves gentle passive range of motion and assisted partial weightbearing is performed
    3. Resistance training occurs
    4. Allows aggressive stretching and sport specific activity after one to two months
    5. Two months post injury when the athletes are returned back to sports without restriction

    Ischial Tuberosity

    The ischial tuberosity is the origin of the hamstring muscles which involve the long head of the biceps femoris, semitendinosus and semimembranosus. Avulsion fractures in this area are caused by a forceful flexion of the hip joint and extension at the knee. It typically takes place during sprinting or kicking. If the avulsion fracture is displaced more than 15 mm, surgery is recommended.

    Anterior Superior Iliac Spine 

    These fractures are secondary to increased force from the sartorius and tensor fascia lata. They both originate from the anterior superior iliac spine. Nonsurgical management is recommended except if displacement is greater than 2 cm. These typically occur as a result of sudden straining, twisting, such as in baseball, jumping, and sprinting.

    Anterior Inferior Iliac SpineAvulsion fracture of the spine

    AIIS fractures are secondary to an increased force from the rectus femoris.  AIIS injuries typically occur during forceful hip hyper-extension and knee flexion. Conservative treatment is recommended for these avulsion fractures unless displacement is greater than 2 cm.

    Pubic Synthesis and Iliac Crest 

    These avulsion fractures are rare and occur from increased activity or force from adductor tendons, which originate from the pubic synthesis. These tend to occur during kicking type activity.  An MRI scan is typically needed to facilitate a diagnosis in this area. The rectus abdominis muscles attached to the iliac crest and avulsion fractures can occur during forceful turning or lateral flexion of the area. If the fracture is greater than 3 cm of displacement, surgery would be recommended.

    Tibial Tubercle 

    These fractures occur with forceful contraction of the quadriceps. It is important to quickly diagnose this particular injury because nonsurgical treatment is not only ineffective, but can also cause the lower extremity to become dysfunctional. X-rays are sufficient to make the initial diagnosis, but CT scans are able to better classify the extent of the injury. Because of the strong contraction of the quadriceps causing fracture displacement, these injuries rarely heal without surgical intervention.

    Greater Trochanteric 

    Fractures of the hip are rare in the pediatric population and are typically encountered in obese patients. This type occurs with the hip in flexion and with external rotation. Nonsurgical treatment is recommended for all trochanteric fractures. Surgery should be considered if there was significant displacement at the site of the fracture greater than 2 cm.

    If you are feeling any significant pain in your joints, regardless of if you are an athlete or not, visit Dr. Stacie Grossfeld of Orthopaedic Specialists, PLLC in Louisville, KY. With the help of Dr. Grossfeld, you can prevent further damage to your ligaments, joints, and bones while starting a treatment plan to fix any existing damage. Contact Dr. Grossfeld here or by calling 502-212-2663 today!

    Love Your Heart: 10 Ways to Keep Your Heart Healthy and Avoid Heart Disease

    Posted by Stacie Grossfeld

    heart diseaseCoronary Heart Disease (CHD) is the most common type of heart disease to affect Americans and is also the type of heart disease that people are most likely to be talking about when discussing heart disease. CHD occurs when plaque builds up in the coronary arteries. Coronary arteries are the enlarged veins that move blood into the heart. When plaque builds up in these arteries, they narrow and less blood is able to travel to the heart. Narrowed arteries and less blood flow increase the risk of heart attack or chest pain which means it is very important to keep your heart healthy and avoid heart disease.

    June is National Safety Month and at Orthopaedic Specialists, PLLC, we like to promote safety through healthy living. Below we’ve outlined ten ways that you can keep your heart healthy and avoid heart disease.

    10 Ways to Keep Your Heart Healthy and Avoid Heart Disease

    1. Eat a Healthy Diet

      One of the most important steps to take towards keeping your heart healthy is eating a healthy diet. Once a healthy diet is established, all other steps to keeping a healthy heart come much easier. A heart healthy diet includes fruits and vegetables, whole grains that are a good source of fiber, and fish. Doctors recommend incorporating fish twice a week into a diet targeting heart health. What you eat is important, but so is how much you eat. Once you have established a healthy grocery list, research portion control and practice eating correct portions instead of overloading your plate.

    2. Live an Active Lifestyle

      Most people are ready to give excuses when faced with living an active lifestyle. From working overtime to having a family, it is easy to put exercise on the back burner and never take it off; however, an active lifestyle is not as big of a burden as most people think. Getting only 150 minutes (2 and a half hours) of aerobic exercise in every week constitutes as having an active lifestyle. Only 2 and a half hours a week of exercise and you’re sure to have a healthier heart for it.

    3. Maintain a Healthy Weight

      Over time, healthy eating and an active lifestyle will lead to you being able to maintain a healthy weight, but in the meantime it is important to understand what a healthy weight for your build and body type is, as well as, if you are there or if you have some work to do. Start by measuring your Body Mass Index (BMI) to see if you are at a health weight or not. If you aren’t, a 12 week weight loss program is the best place to start. Most come with meal plans that are health conscious and the bundled packages are often easy to follow.

    4. Quit Smoking (If You Do)

      Putting cigarettes down is the single, most important thing you can do to ensure heart health and overall health. Smoking cigarettes is the top cause of CHD and once you give up smoking cigarettes, your chances for developing heart disease drops by 50%. There are hundreds upon hundreds of free guides out there to help you quit smoking, but you are more likely to quit with assistance from the National Health Society or Smokefree.gov – the American equivalent. Click here to learn more about the National Health Society and their stop smoking services.

    5. Keep Low Cholesterol

      The main culprit behind high cholesterol is saturated fat. By cutting back on the amount of saturated fat that you consume in your diet, you will increase your heart health quickly. There are some very easy ways to lower your cholesterol including: picking leaner cuts of meat up at the grocery store and opting for 1% fat or skim milk instead of whole milk. Talking to a doctor about high cholesterol is a step that may need to be considered, especially if you struggle with lowering your cholesterol through changes in diet and exercise.

    6. Manage High Blood Pressure

      If you take all of the steps above then blood pressure shouldn’t be much of a problem; however, some people do struggle more than others with high blood pressure. If you have taken the steps above and have not been able to successfully lower your blood pressure, look at your caffeine consumption and consider cutting back on that. Not a caffeine drinker? Then it may be time to contact your doctor and discuss options in medication.

    7. Drink in Moderation

      In small amounts, alcohol can be beneficial to your health; however, in excess it is more likely to be detrimental than helpful. If you are drinking more than one 12 oz. beer, one 5 oz. glass of wine, or one 1 oz. pour of liquor a day – it is time to revisit what moderation means. Not only can alcohol have negative effects on your heart, but it can also raise your blood pressure and lower the effective properties of blood pressure medication.

    8. Manage Stress

      Stress is a huge factor that can negatively affect your heart health, but thankfully there are many ways to help manage stress. In this day and age, it is understandable that one can get overwhelmed time and time again; however, the time we live in is not an excuse. Manage your stress through exercise, deep breathing, making time for hobbies, discussing things that are bothering you, and going easy on yourself in tough times.

    9. Lower Sodium Intake

      Lowering sodium intake is a lot more difficult than not salting your dinner, but it is possible! Holding back on shaking salt over your dinner plate is the best place to start. It may take some time, but eventually your taste buds will get used to the taste of food without salt. Then you can stop using salt completely! Be aware of hidden salts in packaged foods. If there is more than 1.5 grams of salt per 100 gram servings then the food is considered “high in sodium” and should be avoided.

    10. Get 5-a-Day Every Day

      Getting your five-a-day every day is a fun and challenging way to promote your own heart health. The FDA recommends getting five separate servings of fruit and vegetables in your daily diet. This doesn’t mean making five vegetable sides with dinner or eating five apples a day. Find creative ways to incorporate fruits and vegetables into your healthy diet. Some ways to do this include: cutting a fresh piece of fruit over your fibrous morning cereal or adding a vegetable garnish into the pasta sauce that you’ve recently started making meatless.

    From this article, it should be clear that heart health and overall health go hand in hand. If you look further into lowering your blood pressure or reducing your cholesterol, you’ll see that all medical advice starts with the same steps: eat a healthy diet, live an active lifestyle, maintain a healthy weight, and stop smoking. These steps are easy to take and easy to make into life practices with a little bit of determination and a lot of patience with yourself. Avoid Coronary Heart Disease and start now! There’s no better time to choose to practice a healthy lifestyle than National Health Month, this June.

    If you are interested in learning more about how to live a healthy lifestyle that promotes heart health, contact Dr. Stacie Grossfeld at Orthopaedic Specialists, PLLC in Louisville, KY by calling 502-212-2663 or visiting her website today.

    Tumbling, Trampoline and Acrobatic Gymnastics – Louisville Orthopedic on Gymnastics Injury

    Posted by Stacie Grossfeld

    gymnastics injuryResearch led by Xavier Grapton (2013) and colleagues examined gymnastics injury information induced by tumbling, trampoline usage, and acrobatic gymnastics. Over a 5 year period, researchers looked at 357 traumatic events in acrobats and gymnastics injuries were identified based on the location of the gymnastics injury, the type of tissue injured, and causation.

    Researchers found that gymnastic injuries related to acrobatic moves typically occur in lower limbs and often involve ligament related damage. Wrist injuries tend to be common among acrobatic athletes. Trampoline related injuries involved the knees or forearm while gymnastic injuries involving tumblers proved to be more ankle related. Researcher found landing-induced gymnastics injuries common across all activities and involved incorrect form, as well as, the landing surface.

    In Conclusion

    In conclusion, researchers found that the most significant injuries that occur in acrobatic sports are similar to artistic gymnastic injuries. Most injuries result from falling and incorrect or incomplete landings. Research documents clearly stated that landing surface also greatly impacts the possibility of injury in gymnasts and acrobats.

    What is the Risk of Tearing Your ACL on Synthetic Surfaces?

    Posted by Stacie Grossfeld

    The risk of tearing your ACL on synthetic surfaces has become a hot debate among physicians, coaches, and players.

    With the level of competition improving and more year-round programs developing, synthetic surfaces are becoming the arena for many sports. In an American Journal of Sports Medicine article, published in July, 2015, Dr. George Balazs and his team looked at 963 ACL injuries. These injuries were reported on soccer or football fields. These reports were used to determine if synthetic surfaces increased the risk of tearing your ACL.

    They stated that since the introduction of artificial turf in the 1960s, use has been a source of controversy. In trying to determine whether they are placing the athletes at increased risk, they looked at many factors. For one, artificial turf has largely been used as a secondary option to grass fields; however synthetic surfaces have increased durability, equate less cost, and present more consistent field conditions than natural grass. They also noted there’s been a steady increase in the use of artificial turf among  competition levels since the ’60s.

    Over the past five decades, manufacturers have made significant changes to synthetic field surfaces. Some changes include: the fiber type used and its density, an increase in under-field padding, and the addition of rubberized soles to give the surface a more natural feel. All these changes have been made to ideally decrease field-related injuries.Tearing Your ACL

    The authors noted that biomechanical studies have generally supported increased friction force on all types of artificial turf.

    Theoretically this increases the risk of injury relative to natural grass. The potential elevated risk of tearing your ACL is a critical concern to athletes, coaches, team trainers, and physicians. The authors also stated that their study would evaluate data related to the effect plain surfaces had on the ACL. After reviewing journal articles, they found  there was an increased risk in American football players, but not in soccer players.

    Part of the issue on evaluating whether artificial turf is the cause of lower extremity injuries is the result of multiple factors that may influence athlete injury rates. These include: field moisture, precipitation, and the temperature. Other factors like player position, types of play, period in the game, timing of the game within the season, legal or illegal play by an opponent, and type of shoe wear also affect study results.

    The authors stated that there are so many different variables outside of just “artificial turf” that there were some tentative conclusions that could be drawn from this review article. They stated that earlier generations of artificial turfs (densely woven nylon fiber carpets placed on shock absorb with padding) appeared to have an increased risk of ACL injury. They also stated that there is an observed increased risk of ACL injury for football players on modern artificial turf (which is synthetic fibers with rubberized infill) and this seems to increase with higher levels of competition.

    In Conclusion

    There was no indication that an athlete participating in soccer had increased risk of ACL injury on modern artificial turf. The authors felt that more comprehensive studies looking at other factors needed to be completed to give a better answer as to whether artificial turf does increase the risk of tearing your ACL. But, based on the literature they reviewed in their analysis study, they noted that American football players are at increased risk while soccer players are not at increased risk for tearing their ACL based on turfs types. So good news for soccer players, but not the best news for football players!

    If you are on a sports team and want to learn more about this study – call Dr. Stacie Grossfeld of Orthopaedic Specialists in Louisville, KY today at 502-212-2663. If you have suffered a tear in your ACL and are in need of orthopedic care, visit Orthopaedic Specialists today.