By Steven Smith, PTA, Tulsa Bone & Joint
For the majority of people out there who have sustained an acute injury, such as an ankle sprain, you have probably heard of the RICE method. This method quickly became the go to protocol for quick assessments of such injuries as of 1978 when it was created by Dr. Gabe Mirkin, MD in his best selling “Sports Medicine Book.” The guidelines for this protocol have since been used by coaches, athletic trainers, and physical therapy clinics with the intent of expediting the recovery process and reducing inflammation for acute injuries. However, as people are paying closer attention to results and the long- and short-term effects, they are finding it may not be the best way to address such injuries. A new era of treatment is evolving, where the MEAT protocol is proving to potentially be the better path.
There are varying opinions/problems with RICE:
- Rest. Studies have shown that it can actually be detrimental to the healing process. As the “Journal of Athletic Training” in 2012 points out, with earlier movement of the tendons, ligaments, and muscles injured, it could result in less time at a follow up clinic, or away from sport.
- Ice has long been the go-to for the prevention of swelling and reduction of pain at the injury site. But ice has been noted to actually delay and potentially reduce the healing process, as some people commonly confuse inflammation and swelling. The two in fact are vastly different, as inflammation is the first phase of the tissue repair, while swelling is accumulation of waste that has not yet been evacuated from the area. Inflammation is an important part of the healing process as an instantaneous defense mechanism whose main goal is to control the extent of cell injury, and preparing that tissue for the process of repair. Injuries to structures that have limited blood supply like ligaments, tendons, and cartilage are hindered by cryotherapy, which reduces blood flow thus prolonging the healing process in the acute stage. The RICE method wants to reduce swelling and decrease blood flow to the injured area. However, blood flow invites more oxygen and more nutrient- rich blood to the area which ultimately accelerates your recovery.
There is a substantial amount of evidence to support the new era of MEAT, and that gentle movement and exercise help expedite recovery, improve range of motion and blood flow, and prevent instability in the joint post injury. Movement should be started as quickly, and without exceeding pain tolerance, as possible. Gentle movements will allow for a small amount of load on the ligament, which could help the tissue grow back in a stronger way.
Rest is important when it comes to an acute injury, but in moderation. This is because collagen fibers (scar tissue) can quickly build up if a joint is left in the same position for extended periods, ultimately threatening long term stability. Evidence has shown that the more movement to the injury, the stronger and more flexible it will be in its healing process.
Analgesics are pain relieving medications that can be helpful to allow for movement and exercise before pain starts. Though these should not generally be anti-inflammatory for reasons listed above, as inflammation is important to the healing process. Over the counter medications that are good options include Advil, Ibuprofen or Tylenol, but always consult with your doctor first to decide which is safest for you!
The last two steps, Exercise and Treatment, go hand in hand, as a structured exercise determined by therapists in a treatment setting will show greater results than rest alone. A structured exercise routine will create functional stability and strength with a regimen and manual techniques provided by a certified therapist, and potentially prevent recurrent injuries. Therapeutic guided exercise is an excellent form of rehabilitation that minimizes the detrimental deconditioning effects of rest and immobility. These include muscle atrophy and weakening of connective tissue, such as tendons and ligaments.
While there is still not sufficient side-by-side evidence to prove that MEAT is in all cases superior than RICE, there is sufficient evidence that shows that movement, exercise, and treatment from a physical therapist leads to a faster, more complete healing than rest, elevation and compression.
Tulsa Bone & Joint Owasso welcomes Emma Strande, PT, DPT, ATC/L, OCS, as our new physical therapy clinic lead!
Emma grew up in rural western Kansas and remains a small-town girl at heart. She graduated from Northwestern College (Orange City, Iowa) with a B.A. in Athletic Training and a minor in Spanish. She has been a Certified Athletic Trainer (ATC) since 2012 and continues to enjoy working with athletes of all ages.
Emma received her Doctor of Physical Therapy degree in 2015 from Wichita State University. Since graduation, she has expanded her education through numerous courses in dry needling, ASTYM, and treatment of vestibular disorders, including post-concussion syndrome. In 2019, she achieved her board certification as a clinical orthopaedic specialist (OCS) and remains an active member of the Oklahoma Chapter of the American Physical Therapy Association.
Outside of the clinic, Emma enjoys spending time with her husband, Todd, and their two labradors. They enjoy traveling to Colorado for hiking or snow sports, as well as hosting family and friends for summertime cookouts and pool parties.
Norman L. Dunitz, M.D., died peacefully at his home on September 10, 2022. He was born to Ida and Philip Dunitz, the oldest of three children, on September 25, 1927, in Newton, Iowa which is also the home of the Maytag washing machine and the internationally famous Maytag blue cheese. Maytag played a pivotal role in Norm’s childhood: His earliest job was sweeping floors at the factory, and to this day, there is always a round of blue cheese in the Dunitz refrigerator. His High School yearbook describes Norm as “The brainy member of the Senior Class who found time for dancing and fun.” It reflects he was a Renaissance man; he lettered in golf, was on the varsity football and basketball teams, played clarinet in a Jazz Band, and was Senior Class Poet. When one of his grandchildren was told of this latter honor, he asked, “Is that a thing?”
After high school, Norm attended the University of Iowa, but in 1946, the Army interrupted his academic studies. After basic training, his assigned “duty” was playing on the Army basketball team. Upon discharge, he reenrolled at the University of Iowa, graduated from medical school in 1953, completed an internship in Detroit, a surgery residency in Iowa City, Orthopedic Surgery residencies at Mayo Clinic in Rochester, Minnesota, and Children’s Memorial Hospital in Chicago, and a Masters in Orthopedics at the University of Minneapolis.
While in college, Norm met and married Annette, his partner for 71 years. In 1958 Annette and Norm drove south to find the right community to start his medical practice, with the primary criteria being a place where he did not have to shovel snow. Landing in Tulsa, Norm opened his office at 21st and Lewis with Annette as his assistant and bookkeeper. This one-man medical practice led to Tulsa Bone and Joint Associates P.C., now with 30 physicians. But his medical practice was only part of his professional career. He served as Chief of Staff of St John Medical Center, President of the Tulsa County Medical Association, President of the Oklahoma State Medical Association, Chair of the American Orthopedic Foot and Ankle Society, President of the Clinical Orthopedic Society, a Charter Member of the MidAmerica Orthopedic Association and the American Association for Hip and Knee Surgery. He was a Professor at the University of Oklahoma College of Medicine, a visiting Professor at Mayo Clinic, on the Editorial Board of the Journal of Clinical Orthopedics and a Fellow in the American Academy of Orthopedic Surgeons and the American College of Surgeons. His favorite volunteer experience was impacting national health care policy as an AMA delegate.
Norm’s most important professional achievement is bringing total joint replacements to Oklahoma. In 1969, he traveled to Switzerland to train with Dr. Maurice Mueller on hip replacements. Rather than wait months for the FDA response to his request to use necessary “cement” for the operation, Norm and Annette made a personal appeal for approval in Washington D.C. Now total hip and knee replacements are ubiquitous, but Norm will always be known as the doctor who did the first one in Oklahoma.
Norm loved Tulsa and pursued his passions while benefiting the city by being on the Boards of Tulsa Opera and the Tulsa Philharmonic, secretary of the Committee of 100, and being Annette’s sidekick when she chaired various fundraisers. His involvement with athletics continued as a regular member of the University of Tulsa Hurricane Club, rarely missing a home basketball game, and a founding member of Philcrest Tennis Club. His tennis games with other octogenarians at Southern Hills Country Club are now legendary. Norm and Annette made lifelong friendships in Tulsa, around bridge, movie club, “the Rascals” and their house at Grand Lake. They loved international travel, making many trips throughout Europe, North and South America and the far east. His last international trip was to China at the age of 87!
Most of all, Norm loved his family. He attended almost all of his grandchildren’s music, dance, and theater performances and basketball, baseball, volleyball, soccer, and football games. After each grandchild turned three, he or she had an annual birthday date with “Papa Normy.” The date always included dinner, a special activity designed for the child, and a lot of Papa Normy Advice.
Norm will be remembered for his deeds of loving kindness by Annette, his children Elise (Terry) Brennan, Scott (Harriet) Dunitz, grandchildren Michelle (Ryan) McDonald, Drew Dunitz, Phil Dunitz (Whitney Mohr), Katie Brennan and Danny Brennan and great grandchildren Levi and Oliver McDonald, his sister Toby Newman, brother-in-law, Marvin Braverman, sister-in-law Jeri Dunitz, and numerous nieces, nephews, and cousins. In addition, he will be remembered by hundreds of patients and colleagues for his compassionate medical care. During the last few years, he has been shown this same kind care by Linda, Margaret, Gyn, Nicolate, Grace, Eva, Baily, Felicia, and Nikki, for whom the family is very grateful.
A Memorial Service will be September 22, 2022, at 4:00 p.m. at Southern Hills Country Club. In lieu of flowers, the family requests donations to the Orthopedic Research and Education Foundation, Tulsa Opera, Temple Israel, or B’nai Emunah.
Tulsa Bone & Joint Associates is pleased to welcome Ian Goodman, MD. Dr. Goodman is a sports medicine fellowship trained surgeon who will be seeing patients at our Owasso clinic. His interests include hip, shoulder and knee arthroscopy, complex knee and shoulder reconstructive surgeries, ankle arthroscopy and ligamentous stabilization, and fracture care.
Dr. Goodman is a native of Russellville, Ark. After completing his undergraduate degree at the University of Central Arkansas, where he played collegiate soccer, he then completed his medical training at the University of Arkansas for Medical Sciences. Dr. Goodman then spent five years in Orthopaedic Surgery Residency at San Antonio Military Medical Center (Brooke Army Medical Center and Wilford Hall Medical Center) in San Antonio, Texas. During this time, he trained at Level 1 trauma centers as well as the Air Force Academy and Rady Children’s Hospital in San Diego, Calif.
Dr. Goodman was active duty in the U.S. Air Force during his residency and was promoted to major while serving at Eglin Air Force Base outside of Destin, Fla. During this time, he cared for airmen, seaman, and army soldiers and spent time as lead team orthopaedic surgeon for the Army 7th Special Forces Group Green Berets and Air Force Special Operations Squadron. While serving as a staff surgeon, Dr. Goodman was deployed to Afghanistan for six months, where he served as Medical Director at Craig Joint Theatre Hospital at Bagram Airfield from June to Nov. 2020. At the conclusion of his active service, he was awarded a Meritorious Service Medal for the care he provided for his fellow service members, and the specific medical needs for the local Special Forces community.
After his tenure in the Air Force, Dr. Goodman went to fellowship training at the University of Kansas Medical Center in Orthopaedic Surgery Sports Medicine. While there, he learned the skills required to take care of complex shoulder, knee, hip and ankle injuries, including ligamentous injuries, cartilage injuries, instability, tendon ruptures, and restoration of complex joint biomechanics. He had the opportunity to treat and care for high performing athletes, weekend warriors and individuals of the community with both acute and chronic injuries. During this time, he served as a team physician for the University of Kansas Jayhawks football and national championship men’s basketball team, the Kansas City Chiefs, and the Kansas City Royals.
Tulsa Bone & Joint is thrilled to keep more residents of Owasso and surrounding areas close to home by offering a clinic in Owasso and orthopedic surgery at Ascension St. John Owasso. The hospital has implemented new equipment to accommodate Dr. Goodman’s surgeries, including a postless hip arthroscopy table, a computerized imaging system that is patient-specific to allow the physician to plan in advance for their hip surgery.
In addition to holding hospital privileges at Ascension St. John Owasso, Dr. Goodman will also have privileges at Ascension St. John Tulsa, Union Pines Surgery Center, St. Francis Hospital and St. Francis South and Natalie Surgery Center. He will perform surgeries primarily at Ascension St. John Owasso.
Dr. Goodman will serve as team orthopedist for the Owasso Rams sports teams and be on the sidelines during home football teams. Dr. Goodman and his family are excited to call Owasso their new home.
By Alecia Vaughn, OTR/L, CHT, Occupational Therapist, Certified Hand Therapist
Mallet finger is a tear or rupture of the extensor tendon that straightens the very tip of each finger is a common injury seen in hand therapy. This injury is common in athletes when the finger is hit with a ball. It can also happen during simple daily activities, such as getting dressed or making the bed.
Has your hand ever slipped while trying to place the super tight sheet on your mattress? Sometimes mallet finger can happen during something as quick and familiar as that! What happens to the extensor tendon? When the tip of the finger is bent beyond its limit, the excess strain can damage this relatively delicate tendon. When you have this injury, you will notice that the finger droops down, and the tip of your finger is stuck in a bent position. It is unable to straighten unless helped by another hand.
The treatment for this is to be fitted for a custom splint that keeps the tip of your finger fully straight and even into slight hyperextension. The fingertip must stay straight 100% of the time for 6-8 weeks. If at any point it bends then your time in the splint will restart, even if gravity is the culprit.
It is important to seek out treatment and get into a custom splint as soon as possible, otherwise you may have to wear the splint for a longer period of time. Custom splinting is preferred over AlumaFoam prefabricated splints because the AlumaFoam does not provide adequate support to ensure proper healing. Although the splint may not completely resolve the bend in your finger, the splint significantly reduces the deformity allowing for greater functional use of your hand. Delaying treatment may result in a permanent droop in your finger.