Tag Archives: Orthopedic Surgeons

DON’T LET BACK PAIN RUIN YOUR GOLF GAME

golf feet

While an estimated 75% of people will experience some form of back pain at some point in their life, that number is even higher among golfers. Pro golfers and weekend warriors are both subject to the pain. There are ways to avoid back pain, and, non-invasive treatments if it does happen to you.

Some of the more common causes of back pain in golfers are rotational stress from an improper swing, overextension, pivoting/twisting of the hips, and muscle spasms from overuse. Those with prior history of back injury or pain are at higher risk of re-injury. Deficits of hip range of motion as well as lumbar extension are also common in golfers with back pain. Research studies that have looked at differences seen in golfers with back pain versus pain-free golfers have shown statistically significant differences in techniques. Specifically what was observed is greater spine flexion when addressing the ball and less trunk rotation compared to pain free golfers who had twice as much trunk flexion velocity. That greater spine flexion versus trunk rotation increases risk of back injury.

There are simple solutions to avoid back pain in golfers:

  • Proper stretching and warm up prior to play
  • Strengthening back and shoulder muscles on days not in play
  • Knowledgeable coach/trainer to correct your swing
  • Correct fitting footwear
  • Cut back on number of days per week
  • Avoid playing a full round after a long hiatus from playing

At home remedies for reducing discomfort include icing, rest, or NSAIDS.

If your pain is not resolved after a few days, it may be time to see an Interventional Pain Management Physician for a non-surgical or minimally invasive solution. Some of the methods might include:

    • Injections. This may include injection of an anesthetic, a steroid, or both.
    • Radiofrequency ablation. This is used as an option to stop back pain that has become chronic and is no longer responding to injections.
    • SCS (spinal cord stimulation). Another option to stop chronic pain especially back pain that comes with severe pain in the legs.

At Sarasota Orthopedic Associates, we have three locations and offer same day appointments.  Ashot Kotcharian, MD is a PM&R physician with a specialty in  Interventional Spine & Sports Medicine. With proper attention and treatment for the discomfort, you can get back in the game with minimal down time. Fore!

BUILD YOUR GAME FROM THE GROUND UP

golf stance

A powerful, and effective golf swing starts with a stable foundation. From a solid foundation the entire swing can be leveraged and a low handicap status can be achieved. The important but often overlooked foundation, are pain free and well-functioning feet and ankles. While there is a lot of discussion about back, hip and knee injuries in golf, most golf instructors will tell you that the power of a swing is created “from the ground up”.

Injuries to the great toe

At the end of follow through, the great toe of the dominant foot experiences an increase in pressure. This can cause a jamming of the toe into the top of the shoebox. With repetition, the area under the toenail can become injured causing blood to form or the nail to lift from the nail bed. These types of injuries should not be taken lightly. Even though the toe is a small portion of the body, if not treated injuries to this area can cause significant pain, infection and loss of function. Wearing proper fitting shoes and adjustments in the golf swing to prevent the irritation of the nail is necessary to eliminate recurrence.

Ankle Instability

Stability is an important factor in performance in both accuracy and distance, and is also a contributor to the amount of power generated. The lower body needs to be the stable foundation for the upper body during the rotation required for the backswing and the trail foot is expected to remain relatively stable during this rotation. The lateral, or outside of the ankle is a common site of injury for golfers and other athletes alike. Repetitive strain will cause laxity of the lateral ankle ligaments and predispose that ankle to easier spraining. Sprains of the ligaments can lead to weakness and a lack of stability in the golf swing and while walking on the uneven terrain of a golf course.

Golfing is a highly coordinated sport that, by its nature, is associated with risk of repetitive motion injuries. Being intentional about maintaining good foot form and taking care of a stable foundation can keep golfers free of injury and enjoy years on the course.

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Dr Jemaar Graham is a Board Certified Foot and Ankle Podiatrist at Sarasota Orthopedic Associates treating all related problems related to the foot and ankle with both surgical and conservative modalities. He joins the mission of SOA to get his patients back on their feet, back to work, back in the game, and back to life.

THE DOCTOR IS IN: Separating Facts from Fiction of Knee Replacement

Knee-Pain

Knee replacements have come a long way over the years, and along with improvements are misconceptions. Modern medicine is now able to reduce your post-surgical “down time” and in many cases, avoid surgery altogether. Let’s take a look at some of those myths.

Myth: You have to have knee surgery.

Truth: No one should tell you that you have to have surgery. YOU, the patient, determine when the time is right. Your orthopedic surgeon can show you the progression of your condition and discuss your discomfort level, however you are the one who makes the final decision.  Many times knee discomfort may be managed conservatively with options such as NSAIDS, physical therapy, strengthening, injections, or PRP (platelet rich plasma).

Myth: Advertising shows people running and jumping after knee surgery.

Truth: Don’t fall prey to marketing.  Everyone is unique and outcomes are different based on your individual situation.  Returning to golf and tennis are reasonable expectations after knee replacement for many patients.  Dropping 10 pounds prior to surgery and following your physical therapy instructions will make a difference in recovery.

Myth: My knee should feel like it did when I was 17.

Truth: All surgeries require a period of adjustment in recovery. If you’re 60 years old, expecting your knee to behave as it did when you were a teen is not realistic. Since everyone is different, your recovery will depend on you. Most patients are happy how their knee feels after replacement and would recommend replacement.

Myth: I heard a lecture that knee replacements don’t work and I should have regenerative therapy instead.

Truth: According to the American Academy of Orthopedic Surgeons, over 90% of people having a knee replacement experienced reduced pain and are able to return to their normal activities they previously gave up. While PRP and Stem Cell Therapies are options, they aren’t the “golden ticket” you may hear in lectures peddling the fountain of youth. These may be helpful for some, but they do not “cure” arthritis and are not presently covered under insurance. Remember, everyone is different and what works for some, won’t work for others.

Bottom line: Know your orthopedic surgeon and ask questions. Based on my condition, how much improvement should I expect? What are the risks/complications? When can I go back to work? May I drive? The more you know, the lower your anxiety level and the better your ability to make decisions. ###

Steven Page, MD is a Fellowship Trained / Board Certified Orthopedic Surgeon with a specialty in Sports Medicine. He specializes in surgical and non-surgical treatment of knees and shoulders. Sarasota Orthopedic Associates offers same day/next day appointments in all three locations. Visit www.SOA.md or call 941-951-2663 for more information.

Meet Ashot Kotcharian, MD: Interventional Pain Management Physician

Kotcharian lab crop

This is a continuing series of interviews we do with our physicians here at SOA. Dr Ashot Kotcharian is a Board Certified/Fellowship Trained Physical Medicine & Rehabilitation Physician with a specialty in Interventional Spine and Sports Medicine. Dr Kotcharian has a strong background in interventional therapies for spine disease, complex pain syndromes, peripheral joint disease, and sports injuries. He served a most distinguished career in medicine as Assistant Professor of PM&R at Johns Hopkins University School of Medicine. Learn more about what motivates him and how he spends his time when not at work.

What inspired you to become a physician? What inspired me to become a physician is the legacy of my great grandfather. He was my namesake. Although I have no memory of him I grew up hearing so much about him. Before me he was the only physician in our family history. I grew up listening to stories of his work and all the good he did treating those who were ill.  I knew early on that just like my namesake I too wanted to have a career that can result in good to others and help those who are ill. One of my younger sisters was born with epilepsy and has a learning disability. As a young boy I witnessed how much my parents cared for her. From city to city, hospital-to-hospital, my parents searched for the best medical treatment available. Seeing her go from one hospital to another, I wondered why nobody could help her become better. I watched my parent’s worried faces and how hard they tried to get answers and care for my sister. Once they were able to get her the care she needed and the doctors were able to get her seizures under better control the relief and joy it brought was immeasurable. This is what I wanted to do with my life.  I wanted to be able to take away peoples pain, fear and confusion and give them hope and relief.

Why orthopedics? While on my journey through medical school and residency training what I found myself enjoying the most was anatomy and musculoskeletal medicine. I learned how crucial good understanding and knowledge of anatomy can be in diagnosing nerve injuries, ligament tears, or radiculopathies. I developed a greater interest in diagnosing and treating patients who presented with muscle and tendon injuries, repetitive stress injuries, as well as back and radicular pain to name a few.

What do you love most about your job? I love how in this field the convergence of good anatomical knowledge, physical exam skill, and history taking can often lead to diagnosis without a need for invasive tests.  I get a satisfaction out of being able to arrive at the solution simply from what the patient told me and what I find on my physical exam. I get a satisfaction from knowing that I was able to treat disabling pain be it from back, muscle or tendon injury, without the need of invasive surgery.

What is your biggest challenge? Helping my patients through difficult diagnoses where treatment options are few and without a “cure” can definitely be challenging.  I would also say that being able to convey the importance of daily exercise, stretching, as well as proper posture is another big one.  While I have a lot of skills and tools with which to help stop pain, its what the patient is able to do on their own at home and in their daily life that can really keep the pain from coming back. If I weren’t an orthopedic physician I’d be either a martial art instructor or a university professor. Although, to be honest, this is a difficult question, because I can’t see myself doing anything else. I truly love what I do and I am very passionate about it.

Your proudest moment? My proudest moment is completing my fellowship training.  As I looked back at my journey through medical school, residency, and fellowship I knew I was becoming the person I wanted to be and the person I wanted my sister and great-grandfather to be proud of.

Where is the most interesting place you’ve travelled?  Why? It would have to be Rome.  The layers and layers of ancient history, the architecture, the people, and the food were truly amazing.

Any hobbies?  Activities? One of my biggest passions outside of medicine is martial arts, exercise, and mindfulness meditation. I have been a student of martial art since I was just a kid. Most of my studying and training has been in Taekwondo and I have earned a rank of 2nd degree black belt. I have also studied some techniques of hapkido, karate, kungfu, and Brazilian jujutsu while attending a mixed martial arts school. What I love most about martial arts is the respect, the discipline, the mindfulness, and the physical exercise.

What’s your next adventure? I don’t really know. I am pretty happy exploring the Gulf Coast for now.

Your guilty pleasure food? Oh gosh, too many probably.  Hamburgers, Chinese food, fried chicken, pizza, oh now you’re making me hungry!

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Sarasota Orthopedic Associates has three locations and offers same day/next day appointments when needed.  For more information on Dr Kotcharian or any of our physicians click here.

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Meet Dr Raye: Interventional Pain Management Physician

Raye lab cropped

We sat down with Sarasota Orthopedic Associates physician, Dr Justin Raye to learn what motivated him to pursue the medical profession and how he helps his patients non-surgically.

What inspired you to become a physician?

I always had an interest for human physiology as well as health/fitness, which led me to pursue a major in Physiology and Kinesiology at the University of Florida. As an undergraduate I volunteered in multiple different health/medical related fields in order to experience each possible career first hand. I became confident I wanted to become a physician after working closely with physicians within the Orthopedics and Sports Medicine Institute at UF. I felt I was able to align my interests for athletics and human physiology while having the opportunity to closely interact and affect the lives of those within my community.

My father suffered from heart disease and had to undergo multiple cardiac procedures under the care of multiple different medical teams. When I was in high school he underwent his second open-heart surgery at Shands Hospital in Gainesville Florida. I was able to observe the interaction between multiple physicians as they helped care for my dad with the common goal for him to have the most successful outcome. Everyone was very professional and caring as they put in long hours yet always took the time to make sure my family was thoroughly informed. I knew from that experience that one day I wanted to put in the hard work so I would have the chance to be a part of a team in order to help others live their best quality of life with their family by their side.

My mom is a nurse and has always been a positive influence as I expressed interest in a medical career. She has always been someone in my family to talk to with a common interest of medicine.

Why orthopedics?

The musculoskeletal system and the biomechanics regarding movement of the human body have always been strong interests of mine throughout my medical education. I enjoy interacting with others while applying my knowledge in order to help my patients improve their pain in order to improve their overall quality of life.

What do you love most about your job?

I enjoy affecting someone’s life in a positive way whether it’s by performing a procedure to decrease their pain or by taking the time to listen to and educate them on something that will impact their health. I can’t express how much I enjoy hearing that someone is getting better or moving back to some of the activities they love because their pain is improved.

What is your biggest challenge?

I enjoy listening to my patients and clearly explaining to them their problem while at the same time making sure they understand all planned treatments.  I wish I could take even more time with each patient. I definitely do my best to answer all questions because it is important to me for my patients to be well informed regarding their care.

If you weren’t an orthopedic physician, what would you be doing?

If I weren’t an orthopedic physician I’d be a professional soccer player in Barcelona (HaHa). Realistically though, I would have probably further explored my undergraduate major of exercise physiology and looked into teaching at the college level or becoming a strength and conditioning coach for a university or professional athletic team.

Your proudest moment?

Graduating medical school. The hard work and sacrifices along the way make an accomplishment that much better when you finally achieve it.  I would never change a thing and ask myself, how can use my knowledge to improve the lives of others.

Where is the most interesting place you’ve travelled?  Why?

I recently travelled to St Lucia for a week to relax and take in the culture/beauty of the island. We were able to spend several hours on the beach but also had the opportunity to hike the Gros Piton Mountain, go snorkeling in the coral reefs, and sailing at sunset.  We are already planning our next vacation- Spain or a short Euro trip!

Any hobbies?  Activities?

I really enjoy playing and watching just about any sport. I grew up playing soccer and always enjoy a game of pick up basketball. I plan to get more involved with golf. I am a big Florida Gator fan and try to get to Gainesville for football games as much as I can.  I enjoy being outside whether it’s boating, fishing, paddle boarding or just spending time with family and friends.

What’s your next adventure?

I am always looking for a new place to explore and trying new things. My sister recently told us that Barcelona has been one of her favorite places that she travelled which is high on our list. I am open to all suggestions.

Your guilty pleasure food?

Pizza for sure. I also enjoy a good burger and BBQ ribs.

Dr Raye is an Interventional Pain Management Physician at Sarasota Orthopedic Associates and his treatment focus includes, but is not limited to, back/neck pain, sciatica, spinal compression fractures, headaches, and chronic regional pain syndrome. His therapies include RFA, SCS, and regenerative therapy among many other non-surgical treatments. SOA has three locations and accommodates patients on a same day/next day basis when needed.

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TEXT NECK? What You Need To Know …

texting adults

Those who experience pervasive, uncomfortable symptoms such as neck and shoulder pain, headaches, and numbness and tingling in the arms and hands might be surprised to learn that smartphone use could be the culprit. “Text neck” is caused by poor posture while using handheld devices. The average head weighs about 10 pounds, which puts substantial weight on a neck bent at 60 degrees to read a smartphone screen. While this condition is an epidemic, it’s also preventable. Untreated, this may cause damage to the neck or spine. Here’s what smartphone users need to know about avoiding text neck.

Adjust Posture

The correct way to look at a phone to avoid straining your neck is to hold it at eye level. Your head should be held upright with ears directly above your shoulders. While on a phone call or streaming media, using headphones can help encourage better posture.

Switch to the Desktop

Save long articles to read later at the monitor, where positioning makes users less likely to compromise posture. Instead of checking and replying to emails on the phone, set aside time every day to do so at the desk rather than bending your neck uncomfortably.

Take a Break

It’s called text neck for a reason. Rather than relying on texting alone, reduce symptoms by picking up the phone and calling the recipient for more lengthy conversations. While taking a break, stretch your neck and shoulder muscles to provide relief. Set an alarm on the phone to encourage hourly breaks.

Use Voice Dictation

Take advantage of this smartphone function to dictate messages while holding your head upright. This will help reduce the amount of time spent looking at the screen.

If you’re struggling with symptoms of text neck you may want to consult with one of our physicians at Sarasota Orthopedic Associates. We offer diagnosis and non-invasive treatment of issues that affect the musculoskeletal system. We offer same-day appointments when needed at our three convenient locations.  The mission of SOA is to get our patients back on their feet, back to work, back in the game, and back to life.

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TENNIS ELBOW? IT’S NOT WHAT YOU THINK!

elbow-pain

Many people will come to our Sarasota Orthopedic Associates sports clinic with complaints of pain on either side of their elbow which has been present for months and is aggravated by gripping things or shaking hands. While often referred to as Golfer’s or Tennis elbow, this painful tendon condition usually occurs not from playing golf or tennis, but from repeatedly gripping or lifting objects improperly. Unfortunately, the condition can become severe enough where the tendons on either side of the elbow will become swollen, degenerated, and possibly torn causing persistent pain.

Despite being referred to as lateral or medial epicondylitis by the medical community, this condition is known not to be an inflammatory condition.  Because of this, typical anti-inflammatory medications like Ibuprofen or Naprosyn often will not help. While steroid  or “cortisone” injections can be tried and may give temporary relief, studies have shown that the condition often returns weeks to months later causing further delay in healing.

The good news is that this condition can be treated non-surgically. Medical studies have revealed that a dedicated specific exercise program that concentrates on eccentric (lengthen) strengthening of the elbow and wrist tendons often will successfully cure the problem. Even when rehabilitation fails, other procedures less invasive than having surgery can often be performed which can significantly improve pain in 90% of the cases.

So whether you are struggling with chronic elbow pain from playing doubles tennis or from lifting luggage at the airport, the physicians at Sarasota Orthopedic Associates can evaluate your elbow problem, correctly diagnose the cause of the pain, and suggest a specific treatment regimen which will get you back on the road to recovery.

Paul Lento, MD is Fellowship Trained and Triple Board Certified in Physical Medicine and Rehabilitation. He is a distinguished Sports Physician having served as team physician for major sporting events such as the Winter Olympics and major city marathons. Locally, Dr Lento is Team Physician at Lakewood Ranch and Booker High Schools. He is also a Castle Connolly Top Doc, a national recognition of the best physicians in healthcare. Dr. Lento sees patients at Sarasota Orthopedic Associates, voted the #1 choice for Orthopedic Care in Sarasota and Manatee .

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THE ULTIMATE GUIDE TO CARPAL TUNNEL SYNDROME

cello player

Until about 75 years ago carpal tunnel syndrome, or CTS, was thought to be caused by the compression of structures in the frontal portion of the neck or from a network of nerves from the spinal cord, over the first rib, and into the armpit.  Today we recognize this condition of CTS as a compression of the median nerve travelling through the wrist. The carpal tunnel is a tiny passageway on the palm side of the wrist.

The cause of CTS continues to be a subject of debate. Typically, the common age range of patients with CTS is between 45 and 60 years of age.  CTS is less common in people under 30 years of age.  Untreated, CTS can lead to lack of coordination between the fingers and thumb along with weakness in the hand.

What are the most common symptoms in patients with Carpal Tunnel Syndrome?

  • Hands get numb, fall asleep
  • Loss of grip, dropping items
  • Tingling
  • Feeling of tightness or swelling

When might an individual most notice these symptoms?

  • Driving, painting, knitting, typing, writing
  • Waking during the middle of sleep with wrist pain, usually the dominant hand
  • Temperature changes, sensitivity to cold

How is CTS diagnosed?

A physician can typically diagnose CTS with a patient history, physical exam (usually focusing on the median nerve running from the forearm into the hand), x-ray, and possibly a nerve conduction study.

What are some home remedy treatments for relieving CTS?

  • Night wrist splints
  • Gentle shaking of the hand/wrist
  • Immerse the hand in warm water and gently flex

If home remedies do not provide relief, it may be time to see an orthopedic physician who specializes in treatment of the hand and wrist.  Hand therapy may be recommended with a Certified Hand Therapist. An anti-inflammatory (NSAID) may provide some relief.  Cortisone injections may provide a temporary reprieve of discomfort.  If conservative methods do not provide relief, minimally invasive surgery to remove a band of tissue in the wrist should provide relief.

CTS is a common condition treated at Sarasota Orthopedic Associates by our orthopedic specialists and hand therapists.  SOA offers same/next day appointments when needed at each of our three locations. The commitment of SOA is to get our patients back on their feet, back to work, back in the game, and back to life.

Source:  MedScape 3/22/16, CTS Quiz;  WebMD; Cleveland Clinic; AAOOS

THE GIFT OF GETTING BACK TO LIFE

Maggie W

Sarasota Orthopedic Associate’s Occupational Therapy Department continues celebrating National OT Month. To commemorate we are sharing a case study of one of our Occupational Therapy Star graduates.

Matthew exemplifies how Occupational Therapy can help patients get “back on your feet, back to work, back in the game, and back to life”, the SOA mission statement. Matthew is a 28 year old male who was injured at work as an Ocean Rescue Lifeguard. An injury to his cervical spine was a result from practicing dolphin dives as part of a work training exercise.  He experienced temporary paralysis in all four  extremities from his spinal cord compression and  underwent emergency surgery to fuse his neck from C3 to C5.

Matthew was then referred  for inpatient therapy immediately following his surgery to begin his long rehabilitation. Once stabilized, he was discharged home and referred to outpatient Occupational and Physical Therapy.  On his first visit at SOA, he presented as a very motivated, hopeful young man despite his multiple deficits.  His cervical spine was stabilized in a neck brace, and he was able to walk with a rolling walker.  He required assistance to stabilize his balance while his upper extremities were assessed.

The OT/PT team found Matthew to have limited range of motion of his arms, significant weakness, both gross motor and fine motor coordination deficits, and sensory deficits. Initially, Matthew was able to do his own basic self-care with extra time, utilizing adaptive equipment, like a reacher/grabber, shower chair, and grab bars. Basic functions of cutting food and driving were not possible and he was lucky enough to reside with his parents as he recovered.

After careful assessment of his strengths and deficits, his Occupational Therapist derived a plan of care to return him to independent living. Through Mathew’s diligence with his home exercise program and his motivation and positive outlook, he is now walking on his own and performing all of his self-care with improved efficiency.  His goal is to return to work, be able to paddle his rescue board out a quarter mile to a predestined location, dive down 20 feet, grab a handful of sand, and emerge a new, stronger man. Matthew wants to be ready to pursue his passion… rescuing others in need.  “I want to get back to doing what I love.”

Occupational Therapy and Physical Therapy is available at all three locations. If you would like an appointment please go to our website at www.SOA.md to schedule online, or call us at 941.951.BONE. We are able to accommodate same day appointments when needed.

Vivian

Article submitted by Vivian Robinson, OT, CHT at SOA.

A REASON TO CELEBRATE

OT

April is National Occupational Therapy Month … that may not mean much to you now, but very likely it will someday in your future. This year’s theme is living life to its fullest! An Occupational Therapist can help with common upper extremity and hand conditions like arthritis, tendonitis, or repetitive strain which could limit you from doing the activities you enjoy.

So what does an Occupational Therapist do?

After assessing your condition in collaboration with your orthopedic physician, we establish a treatment plan to improve flexibility and strength, recommend and fabricate an orthosis to support the joints of the wrist, hand, or fingers to reduce pain/swelling during activities, and educate you on joint protection techniques to reduce wear and tear of the joints during daily activities.

An Occupational Therapist may also help with rehabilitation after traumatic injuries such as fractures and tendon/nerve injuries. Most important, they provide customized, one-on-one care to help you achieve the best outcome.

What training is required to become an Occupational Therapist? More than you think.  While master’s and doctoral degree programs are common, some colleges also offer combined bachelor and master’s degrees in occupational therapy. There is a focus on general anatomy, the nervous system, physiology, movement, activity, and trends in rehabilitation techniques. A certification process must also be completed before receiving state licensure.

AOTA (American Occupational Therapy Association) describes an OT visit as:

  • Individualized evaluation where patient goals are determined by patient and therapist
  • Customized intervention to improve ability to return to daily activity
  • Outcome evaluation to ensure goals are met, or, changes are made to the plan

If you have a physical condition keeping you from living life to its fullest, the Occupational Therapists at Sarasota Orthopedic Associates can help. For an appointment, call 941.951.BONE or schedule through our website at www.SOA.md. We have locations in Sarasota, Lakewood Ranch, and Venice. Our mission is to get you back on your feet, back to work, back in the game, and back to life.