MONDAY, Feb. 22, 2016 (HealthDay News) — A Botox-like injection, added to physical therapy, may relieve a type of knee pain that’s common in runners, cyclists and other active people, a new study suggests.
The condition — called lateral patellofemoral overload syndrome (LPOS) — affects more than one in eight people who regularly exercise, the British research team explained. The condition causes pain in the front and side of the knee joint, and healing can be a challenge, experts said.
“Knee pain in runners and cyclists is often difficult to treat,” said Dr. Victor Khabie, Chief of Sports Medicine at Northern Westchester Hospital in Mount Kisco, N.Y. “Most will respond well to traditional therapy, but some will continue to have pain.”
According to the study authors, prior research has shown that 80 percent of people with LPOS have ongoing symptoms after undergoing conventional treatment, and 74 percent have reduced activity levels. Current methods of treatment include physical therapy, anti-inflammatory drugs and steroid injections. If these therapies fail, patients may opt for surgery, according to the investigators.
The new study was led by researchers at Imperial College London and included 45 patients. Each received an injection of a type of botulinum toxin called Dysport to relax a muscle at the front and outside of the hip, followed by physical therapy sessions.
The hip was targeted because, in prior research, the researchers had noted that people with LPOS tended to overuse this particular hip muscle, instead of using the gluteal muscles in the buttocks.
According to the investigators, two-thirds (69 percent) of the patients required no further treatment and were free of pain when assessed five years after the injection into the hip muscle.
“It can be incredibly frustrating to run out of treatment options for patients with this painful condition,” said study co-author Jo Stephen, a physiotherapist at Imperial College London and Fortius Clinic.
In a college news release, she said that “many athletes who took part in this study had exhausted all other treatment options and this was their last resort. We are really excited that our approach is showing positive results for patients, which could have implications for active people around the world.”
Khabie agreed. “This is a very important finding, because in the past surgery was the only other option [for these patients],” he said.
The Dysport injection “relaxes a very tight muscle/tendon unit on the outer aspect of the leg, which is often very tight in runners and cyclists,” Khabie explained. “Physical therapy aims to relax this muscle, but when therapy is not enough, this study shows that [the] injections are an option.”
Dr. Allyson Shrikande is a physiatrist (rehabilitation specialist) at Lenox Hill Hospital in New York City. She believes that use of the injection “offers a wonderful solution to aid in those who have failed a course of physical therapy.”
But, Shrikande also cautioned that the injected toxin may “spread” to adjacent tissue and so the “optimum dose” needs to be determined for each patient.
The Cold Hard Truth about Frost Bite!
By Alan N. Berman, DPM
How you can keep extreme cold from affecting your feet this winter.
During cold and damp weather conditions it is important to keep your feet warm and dry. Staying warm during freezing temperatures can be critical for the elderly and people with circulation problems. Here’s why: When it’s cold outside, the body tries to maintain a constant body temperature and will draw blood away from the outer limbs, such as the fingers and toes, in an effort to keep the core warm. Fingers and toes don’t just feel colder...they are colder and may even turn numb with prolonged exposure to cold weather.
Frostbite, damaging ice crystal formation, can happen when the affected areas freeze; it is the most serious of the cold weather-related injuries. Frostbite typically affects extremities--hands, feet, nose, or ears, although it can reach other parts of the body where there is a decreased blood flow and heat delivery to body tissues.
Frostbite injuries may be superficial or deep. Superficial frostbite injuries involve the skin and tissues just below the skin, while deep frostbite injuries could involve the tendons, muscles, nerves, and even bone. Superficial frostbite injuries have a better prognosis than deep injuries.
Frostbite may start with pain/burning to numbness and eventually result in the complete loss of sensation. The affected area may appear pale, red, bluish/gray or black with the presence of clear or purplish colored blisters. The skin and underlying tissue may feel hard to the touch with advanced injury.
Frost bite can hurt anyone, but certain drugs, people with peripheral vascular disease (a disorder of the arteries) put people at greater risk. Other things that may increase the risk include: smoking, windy weather (which increases the rate of heat loss from skin), diabetes, peripheral neuropathy, and Raynaud's phenomenon.
Diabetes-related circulation and nerve problems can mean icy cold feet for many people. People with diabetes may develop peripheral neuropathy or the loss of sensation especially in their extremities which makes them especially prone to frost bite. It’s important for people with diabetes to stay warm. They should stay well-hydrated as well--dehydration can raise blood glucose levels.
Raynaud's Syndrome or phenomenon may be triggered by exposure to cold and cause the arteries of the fingers and/or toes to go into what's called a “vasospasm”—a narrowing of the small arteries or vessels that dramatically limits blood supply. During an attack, affected skin may turn a pale or dusky color due to the lack of blood flow to the area. Once the spasms go away and blood returns to the area, the tissue may turn red before returning to a normal color. For some people, exposure to cold temperatures isn't necessary. Emotional stress alone can cause an episode of Raynaud's. If you have experienced this reaction to cold, check with your doctor. Chances are, it’s nothing to be concerned about, but it could be a symptom of a disorder.
Follow these important tips for safe outdoor fun:
- Wear thicker non-constricting socks.
- Wear comfortable fitting (never too tight) waterproof boots.
- Should your feet be exposed to cold and dampness for any prolonged period Do NOT put them in HOT water, near a flame (such as a fireplace) or use a heating pad.
- Instead soak them in Warm water at a constant temperature gradually allowing the feet regain their normal temperature.
- Be careful to not let the water get hot.
- Dry them thoroughly and repeat the process if necessary.
- Drink plenty of fluids.
For an appointment with Dr. Berman call (845) 278-8400
Click on the link below to watch Bob's personal story of Navio Robotic Knee Surgery performed by Dr. Victor Khabie. Bob’s recuperation period was quicker with Navio robot-assisted knee replacement surgery than with a conventional procedure.
Dr. Victor Khabie and Dr. Eric Grossman of Northern Westchester Hospital describe a remarkable new option that restores natural movement as never before possible. A great leap forward in precision and accuracy to benefit the patient.
Sep 28, 2015
Pat Mayo talks with Dr. Victor Khabie and Gregg Sussman about every significant injury from Sunday, and unleashes his Week 4 Waiver Wire Pickup Power Rankings for every position. Plus, the streaming QBs and DSTs of the week.
Pat Mayo talks with Dr. Victor Khabie and Jake Ciely about every significant injury from Sunday including Tony Romo, and unleashes his Week 3 Waiver Wire Pickup Power Rankings for every position.
Chalk Talk with NWH’s Dr. Khabie on sports injuries, Tommy John & Matt Harvey
Chalk Talk with NWH’s Dr. Khabie on sports injuries, Tommy John & Matt Harvey: If your son or daughter is a competitive athlete you’ve probably heard the: “Johnny needs to pick one sport and play year-round” line. Young athletes eager to play a varsity sport and maybe even in college are increasingly subject to the pressures of one-sport, year-round training – and with it the threat of overuse injuries.
Dr. Victor Khabie, Co-Chief of Orthopedic Surgery and the Director of Sports Medicine at Northern Westchester Hospital’s Orthopedic and Spine Institute, told us that 80% of his young athlete patients come in for overuse injuries. We had a chalk talk with Dr. Khabie who offered us a reality check on sports dreams and athlete’s health. Here’s what he had to say:
What is an overuse injury and what are their dangers?
Any injury that occurs from a repetitive activity in sports. We’re not talking about ACL or rotator cuff tears caused by a traumatic incident that require surgery. Stress fractures, muscle strains, tendinitis, patellar mal-tracking, labrum strains and growth plate inflammation are common repetitive stress injuries in young athletes. If it becomes a chronic injury that weakens the muscle and ligament structure and causes a tear that requires surgery and prolonged rehabilitation, you’re out for the season.
Who is most susceptible to overuse injuries?
I see a lot of baseball players, especially pitchers and catchers coming in with elbow injuries. It’s become fairly routine to see 12-15 year olds with micro tears of the ulnar collateral ligament – the same injury that requires Tommy John surgery.
Basketball and soccer players who have to run, jump and change direction get patellar tendinitis. It’s sometimes called “jumpers knee”. And I get a lot of long distance runners and cross country athletes with shin splints and stress fractures.
Does age or gender matter?
My patients are 50/50 girls and boys. We see a lot of soccer and cross-country injuries with girls. Boys are mostly baseball and basketball.
I don’t see a lot of young athletes under 9 or 10. They just don’t play with enough intensity. I start seeing overuse injuries between the ages of 12-17. When kids go through growth spurts they are more susceptible to growth plate fractures. That ends when their growth plates close up, between the ages of 14-15 for girls and 16-18 for boys.
And the symptoms are?
Pain. Swelling. Limping. Loss of function. When a pitcher loses velocity, that’s the kind of function loss you are looking for.
I go by the Red Light-Green Light method. If an athlete can play and has no pain the next day, that’s a green light. If they have pain for a day or two but it resolves with some rest, icing the area and some anti-inflammatories, that’s a yellow light. A red light is when they are still symptomatic after resting for 48 hours. It’s time to get concerned. If it lasts 5 to 7 days, it’s time to see a doctor.
How do you prevent them?
The simple answer is rest. And cross training. The best high school athletes used to be triple lettermen. Now they letter in one sport. Kids are committing to one sport at an early age, they play for multiple teams and they do it year round. If that sport is stressful on an elbow or a knee, it’s going to cause injuries.
So what to do?
We have to encourage a multi-sport culture. You can’t do one sport year round. You have to give it a rest. The first thing I do with a patient is a reality check. Where are you going with this sport? What’s your realistic goal? Who’s driving, you or your parents? Sometimes you can see it in the kid’s eyes. It’s more important to the parents than it is to them. If they’re not in it to reach the highest level then it’s easy. Give it a rest
But what if they want to compete on the next level?
I’ve been around sports all my life so I know how it works and I know how coaches think. I played football at the University of Pennsylvania. I was a team physician for the Lakers, the Dodgers the USC football team and now I’m the team doctor for Pace University. The truth is, if you want to be a Division 1 athlete or even play at a top Liberal Arts college you have to be all-in on one sport. But you can hone in on one sport in your junior or senior year – you don’t have to do it at ten years old.
Don’t college coaches like to see an early focus?
College scouts are looking for athletes. An athlete who double letters can get more attention. Cross training proves you have athleticism and not just a skill. They can teach you how to get to the next level. Look at the NFL draft. General Managers say they are always looking for the best available athlete. There’s always a tight end who may have only caught ten passes his senior year but his 3-cone drill was off the charts at the Combine and the next day his stock is rising. The best athletes on all levels are mutli-sport athletes. College coaches know this.
I’ve noticed that kids tend to improve most during the off-season and by mid-season they’ve peaked. So do you really need fall baseball or winter soccer?
I couldn’t agree more. During the off-season kids mature physically and emotionally and have a renewed energy for the game when they start training for a new season. A football player is never in better shape then the first game. Once the games begin, deconditioning begins. The kids start standing around, going over plays and they spend less time on conditioning. If you noticed your kid looked good on the mound in May and peaked in July, he or she is probably not going to take it to a higher level in September. Wait till next year.
We have to ask this one. Should the Mets shut Matt Harvey down after 180 innings?
He should limit his regular work until the playoffs begin. Put him in his normal pitching rotation so he does not get rusty, but limit him to 3-4 innings per start.
In the playoffs, they should use him normally as long as he feels well. He is a pitcher and should pitch in championship situations, that is what he is paid to do. Who knows when the Mets get back to the playoffs?
Dr. Victor Khabie received his medical degree from Harvard Medical School and completed a fellowship in sports medicine at the world-renowned Kerlan-Jobe Orthopaedic Clinic in Los Angeles, where he served as assistant team physician to the LA Lakers, Dodgers, Kings, Mighty Ducks, LA Sparks, and the USC Trojan football team. He specializes in arthroscopic and reconstructive surgery of the shoulder, elbow, and knee in athletes. He created and has patented an innovative patella alignment brace (“Victory Knee Brace”), and has been featured many times in the national media.
(Photo: Joe Larese/The Journal News)
Adolfo Calenda, 71, worked in construction for decades before retiring in 2006, and he knew that the job had taken a toll on his body.
“I used to do tiles and marble, so I would be on my knees a lot,” he says. “It got to a point where it was very painful.”
But Calenda didn’t use that as an excuse to be sedentary. Until his late 60s, he played tennis with friends about twice a week, and enjoyed gardening on the one-acre property he owns with his wife, Joy. And he would often start the day with a walk around a local lake, “to keep the muscles loose.”
All that changed two years ago, when the frequent pain in his left knee got worse. He had to quit his regular tennis game, because his knee would ache for days afterward. “It wasn’t worth it,” he says.
Gardening also became impossible, and he had to cut back on his morning strolls. The final, frustrating straw came late last summer while visiting relatives in Italy. Calenda’s sister lives in Trieste, a seaport on the Adriatic Coast, and he’d always liked to walk down the hill from her home to a nearby piazza. On this trip, he had to take the bus instead.
“This was holding me back,” he says of his knee pain. “It was time to do something.” Calenda was familiar with joint replacement surgery; Joy previously had operations on both hips and knees.
But unlike his wife, who needed to have those joints fully replaced, Calenda qualified for a partial knee replacement.
What he had done
Dr. Joel Buchalter, co-director of the Orthopaedic Institute at Putnam Hospital Center, performed a procedure in July on Calenda called MAKOplasty, a state-of-the-art treatment that uses a surgeon-controlled robotic arm.
It’s a quicker, less painful and less invasive operation than a total knee replacement, which typically requires a three- to five-day stay in the hospital. The robot also helps surgeons achieve a higher level of precision, since they must carefully secure the artificial implant in a way that lets the joint swing smoothly.
“A partial replacement is like doing an inlay in a mosaic,” says Buchalter. “You have to put it in perfectly.” With MAKOplasty, a CT scan of the patient’s knee is taken before the operation and fed into a specialized computer system, which creates a customized, 3D anatomical model – in other words, a kind of surgical map. Then in the operating room, the system guides the doctor in prepping the damaged bone for an implant, ensuring that no tissue or bone can be removed outside the previously planned area.
Buchalter says that the conventional style of partial knee replacement, which uses less exact X-rays and relies on a surgeon’s visual estimate, has fallen out of favor over the years because they don’t have the same success rate as complete replacements.
With MAKOplasty’s greater accuracy, patients like Calenda have another option. But this procedure isn’t for everyone. For instance, Buchalter says he likely would not recommend it for someone with rheumatoid arthritis, an inflammatory condition that tends to affect the entire joint. Yet, he adds, “this adds to the tool chest to help patients with various ailments.”
How it helped
Calenda went home from the hospital the day after surgery. By then, he was already able to go up and down stairs. Two weeks later, he could drive a car. A physical therapist came to his house until last month to help him exercise, and he now continues those sessions as an outpatient. To aid his progress, Calenda is thinking about taking up swimming, a low impact sport. But he does hope to get back to tennis later this year. “I’m taking it slowly, slowly, trying not to overdo it,” he says. Most significantly, though, he now has no pain at all when he walks. But the operation has made more than a physical difference in Calenda’s life. “Mentally, it makes you feel better,” he says. “Getting back to the things you love to do, it makes you feel younger.”