Congratulations to Chris Contois, PT of the Month for February! Chris has been a Physical Therapist at our main campus in Tulsa for 1 year.
Chris graduated from the University of Oklahoma Health Sciences Center Physical Therapy program. He is a Certified Strength and Conditioning Specialist, Graston Certified, Dry Needling Certified, Level 1 and 2 Functional Movement Screen Specialist, Full Body Active Release Technique Certified, Spidertech Kinesio Taping Certified, and Certified Cupping Specialist.
He grew up in a military family and has lived on both coasts, in the middle of the country, and overseas. He recently moved from Rhode Island to return to Oklahoma.
Chris’s favorite part of being a PT is being able to help people return to higher levels of function.
We’re glad you’re a part of the team, Chris! To learn more about physical therapy at Tulsa Bone & Joint, click here.
Knee injuries are commonly seen in sports activities, but also occur in everyday activities. What course of action should you take if you have a knee injury?
Some injuries are caused by a direct blow to the knee, while others are the result of a twisting force often without contact. Fractures of the bones around the knee often require a direct contact mechanism, but many significant ligament and meniscal (cartilage) tears occur due to the twisting force of the injury. Some injuries are a combination of both mechanisms.
Symptoms to pay attention to are swelling, giving way (instability), and catching or locking with movement of the knee. Swelling can be immediately after the injury or may not show up for 24 hours. Giving way with weight bearing suggests a possible ligament injury. Catching or locking symptoms with knee motion is more indicative of meniscal or cartilage tears.
What Should I Do After a Knee Injury?
When a knee injury occurs, initial treatment should be rest, ice, compression, and elevation. Crutches are often helpful if you are unable to bear weight. If significant pain occurs with motion, then a straight leg brace, such as a knee immobilizer, is beneficial. If a bone fracture is suspected due to deformity at the knee, then a trip to the Emergency Room for x-rays is indicated. But most knee injuries do not require immediate evaluation and can wait a few days to be evaluated by a physician. Often times, the exam is more helpful after the initial pain of the injury has settled.
Orthopedic surgeons are specially trained to evaluate and treat injuries of the bone and joint system. They are the specialists regarding knee injuries. Evaluation by the Orthopedist will include the history of the injury, to include the mechanism of injury, as well as discussion of the symptoms of swelling, giving way, and locking or catching.
The examination at this time is very important. Based on location of pain, laxity of various ligaments, and results of certain manipulative tests, an experienced Orthopedist can narrow down the possible structures that have been injured. X-rays are usually taken to rule out subtle fractures or underlying structural problems of the bones. An MRI of the knee may be ordered but sometimes is not needed to establish the diagnosis.
What Will Treatment of My Knee Injury Be?
Many knee injuries will heal without surgery. Mild sprains of the collateral ligaments just need protection for a few weeks in a brace and do well. The torn ACL may need surgery, but there is no benefit to early surgery, and waiting a month may help with motion post-operatively. Meniscal tears usually require surgery within the first few weeks. Severe tears of the lateral collateral ligament and posterolateral structures need to be addressed within the first two weeks of injury. Multiligament injuries may require a staged surgical approach. Luckily, these injuries are not frequent.
In summary, knee injuries are common in sports and everyday activities. The majority of these injuries heal without surgery within 6-8 weeks. If symptoms are not improving significantly within a week, then evaluation by an Orthopedic Specialist is reasonable. History of the injury and examination of the knee, with x-ray studies if needed, will help guide the treatment plan. Discussion of the various treatment options can lead to the appropriate plan for each individual patient.
By Lindsay Cunningham, D.O., RhMSUS
Rheumatoid Arthritis Awareness Day is February 2, so this blog post addresses the top questions asked in my clinic regarding rheumatoid arthritis (RA):
- What can I do for myself to help my RA?
- Is there something that I should or should not be eating?
- What diet will help with my rheumatoid arthritis symptoms?
These are great questions, and unfortunately, there is not a straightforward answer with regards to diet. Diets impact our health in more ways than we could imagine, making it a very difficult subject to study. Despite the host of limitations, there is still some evidence that certain dietary changes can reduce general inflammation or symptoms from rheumatoid arthritis. One key thing to remember: Changing inflammation in our body or improvement in RA symptoms does not mean that we are changing the inflammatory process in our joints.
There is no evidence to show us that changes in diet will slow progression of rheumatoid arthritis. Dietary and lifestyle changes should only be one aspect of your complete rheumatoid arthritis care and should not be relied on solely for treatment.
There is not one specific diet recommended for rheumatoid arthritis. Symptomatic relief with regards to arthritis and diet varies greatly among individuals. There is evidence that some aspects of our diets can improve certain types of inflammation, and if desired, could be incorporated into your daily life. The changes with the most evidence include the following: high intake of foods rich in monounsaturated fats and fiber and low intake of processed foods and foods with high content of saturated fats.
The fiber intake is best if it comes from the foods we eat, not from supplementation or pills. These foods include vegetables, fruits, beans, nuts, and whole grains. Food sources rich in omega-3 fatty acids include fish, such as salmon, mackerel, oysters, etc. Try cooking with virgin olive oil, instead of vegetable oil. Remember that the focus is on a well-balanced diet that includes foods rich in fruits, veggies, healthy fats, and fiber. Other than cutting out processed foods and “junk food,” there really hasn’t been an established food group to eliminate.
One thing that’s important to notice: These dietary changes tend to be viewed as good suggestions for most health conditions, not just arthritis. Are these improvements related to weight reduction and other lifestyle improvements, or to the foods themselves? Most of the studies can’t really tell us. There’s probably a little truth to both, although the link to weight loss and reduced disease activity has been fairly well established.
Physical activity is highly recommended for those with rheumatoid arthritis. There is no evidence that being physically active does any additional damage to the joints of those with RA; however, evidence has shown that physical activity improves functional capacity. Find physical activities that focus on aerobic capacity and muscle strengthening with low joint impact overall. If you’re having trouble getting started, physical therapy is a great place to get direction.
And finally, the dreaded but most important topic: weight. Being overweight not only increases your risk of developing RA, but it also increases your body’s level of inflammation (fat tissue produces inflammatory chemicals) and has been shown to worsen control of RA.
If you are overweight, the best news to take from prior studies: weight loss has been shown to reduce disease activity! Weight loss appears to be the most important player in non-pharmacologic management of RA. Weight loss and physical activity should be emphasized over specific dietary changes.
Lifestyle, diet, and other non-pharmacologic changes are important to include in your care of rheumatoid arthritis but should not be done as the sole treatment for RA. Weight loss has been shown to have the largest benefit. Individualized improvements of RA symptoms have been noted with dietary changes, especially with incorporation of vegetables, fruits, fiber, and healthy fats. Consult with your rheumatologist regarding the best way to manage your rheumatoid arthritis in entirety, and do not rely on diet or weight loss alone.
Remember that not all diets or lifestyle changes are safe for all people. If you’re considering any changes to diet or physical activity, you should consult with your health care provider first.
By DiAnne Adams, DO
When it comes to the healing of an injury or condition, having a doctor and physical therapist who work closely together can be extremely beneficial to the patient. At Tulsa Bone & Joint Sand Springs, I work hand-in-hand with our physical therapy team on a daily basis.
In many cases, orthopedic or sports medicine doctors have to refer outside their company to a physical therapy group. Sometimes they are referring to a PT they have never met or perhaps never even spoken on the phone with. However, at Tulsa Bone & Joint, we have a qualified group of PTs on our staff – and at Sand Springs, we are literally under the same roof.
3 benefits to using a sports medicine doctors and PT who work together:
- Improved communication.
I’ve been working closely with Dan Skierski, DPT, manager of physical therapy here at our Sand Springs clinic, for the last year and a half. During that time, there have been countless times when we’ve been able to consult about a patient face-to-face. Since PT visits are usually quite frequent, the PT can help if there has been an acute change between appointments, or they can identify other contributing factors to the patient’s original diagnosis that the patient may have forgotten to mention during the doctor visit.
This leaves out the middle man of a front desk person, nursing staff, etc. This direct communication can often lead to quicker outcomes on treating the patient.
Also, this direct communication increases accountability for the patient. If I ordered PT for a patient, and he only showed up once out of the six weeks that were directed, Dan lets me know. This helps me know how committed (or uncommitted) the patient may be to the healing process.
- Quicker outcomes.
For better or for worse, much of healthcare is driven by what insurance companies require. When it comes to treating injuries, insurance companies try to steer physicians to take the most conservative approach in treating patients.
As a nonsurgical sports medicine physician, I am committed to exploring various options that will help my patients, and one of the most beneficial options is often physical therapy. Insurance companies frequently mandate that before they will cover higher-level imaging (like an MRI), the patient needs to first try six weeks of physical therapy.
There have been times when this approach has actually worked to speed up the process toward needed imaging. Since the PT has a one-hour session with the patient two or three times a week, and I only see the patient for 10 or 15 minutes, the PT has more interaction with and observes the patient’s movements more than the physician. There have been times that I’ve been able to request approval for higher-level imaging just a week or two into therapy thanks to something the PT has noticed and mentioned to me.
This speeds up treatment and allows us to jump through some of that insurance red tape a little quicker.
- Convenience to the patient
It’s very convenient for a patient to be able to see both the doctor and PT in one afternoon. This means less time in the car, less time waiting for appointments, and overall – happier patients!
The next time you’re looking into sports medicine or orthopedic care, consider a group that employs its own PT team. It will no doubt benefit you as a patient in the long run!
As a former collegiate athlete myself, I try to keep the athlete’s best interest at heart. With the recent recommendations from the AMSSM and AOSSM, my job as a sports medicine physician is to help educate athletes, parents and coaches about the dangers of sports specialization at a young age.
According to a study by the American Academy of Pediatrics in 2018, athletes who specialize in a single sport are 81% more likely to experience an overuse injury. However, multi-sport athletes have less potential for injuries, burnout and have a higher likelihood of scholarship opportunities at the college level.
Studies suggest that early sports specialization engages frequent repetitive movement, which leads to higher stress in muscles, ligaments and tendons. In a growing child, this is a perfect storm for injury patterns to develop. This in turn leads to burnout and decreased athletic performance.
How to prevent burnout and overuse injuries:
- Limiting repetitive movement in sport and training, for example, high pitch counts during practice and games.
- Preseason conditioning programs and 2+ hours a week in injury prevention training can reduce the risk of injury.
- Plan on periods of isolated and focused integrative neuromuscular training to enhance diverse motor skill development and reduce injury risk factors.
- Ideally, give yourself two consecutive months/year away from the specialized sport to allow the body to recover.
- To reduce the likelihood of burnout, emphasis should be placed on skill development rather the competition or winning.
Multi-sport athletes tend to be better athletes and have the potential for collegiate scholarships and professional contracts. Encourage your athlete to have fun, and remember: If they are not, they may be suffering from burnout or an overuse injury.