What Does "Being Proactive Over Reactive" Mean?

Proactive Interventional Orthopedics (PIO)…a concept we will continue to promote. What does it mean in orthopedics to be proactive over reactive? Here are some examples and brief explanations:

Choose maintenance and more long-term injections over short-term steroid/cortisone injections: platelet-rich plasma (PRP) and hyaluronic acid injections often produce a more clinically significant and longer duration of benefit than steroid injections. For your knee and hip arthritis, tennis and golfer’s elbow and plantar fasciitis, just to name a few, choose these injections.

A course of physical therapy over exercises you simply found online: patient outcomes are generally better when you work with a physical therapist over Dr. Google or YouTube. We have fantastic relationships with physical therapists across Middle Tennessee and can work with you to find the best fit.

Regular use of supplements over prescription or over-the-counter medications: there’s a time and place for prescription meds when managing orthopedic conditions. However, for long-term management, we prefer options like curcumin/turmeric, collagen, and glucosamine/chondroitin. That being said, it’s always wise to consult with a physician before starting new supplements.

Don’t wait for your pain or disability to reach high levels before you seek treatment: orthopedic conditions treated early after the onset of symptoms and when pain and dysfunction are at a low level typically respond better to less-invasive treatments, and this early treatment can lower the risk of further damage to the joint or tissue.

Choose a specialist over a primary care physician for your orthopedics needs: PCPs work really hard and a do a great job to care for your overall health, but they do not necessarily have the expertise, the tools such as on-site imaging and advanced equipment or the time to dedicate to your orthopedic conditions.

Healthy eating patterns over a fad diet: weight loss is a vital part of the treatment plan when it comes to weight-bearing joint problems like hip and knee osteoarthritis. Through a variety of options, we can help you a structure a plan to gradually lose weight in a manner that the weight will stay off and through means that can be maintained for the long-term.

As always, let us know if we can help you overcome an injury, treat an orthopedic condition or find the pathway to greater wellness with an improved quality of life!

F. Clarke Holmes, M.D.

Five Simple Reasons You Should Consider Platelet-Rich Plasma Injections For Your Tendon Or Joint Pain

Let’s make this one quick and easy. Some blogs, we may hit with you great details, information rich in scientific data and opinions full of medical jargon. Today, let’s share some simple information regarding why platelet-rich plasma (PRP) injections should be on your radar if you have OSTEOARTHRITIS, TENNIS OR GOLFER’S ELBOW, ACHILLES TENDONOSIS, PLANTAR FASCIITIS, LATERAL HIP, PATELLAR AND ROTATOR CUFF TENDONOSIS, just to name a few.

1) Most of the time, it works: let’s be real, nothing in medicine works all of the time. If we see a significant benefit in 75% of patients or more, then we are all pretty happy with a treatment. In our patient population, PRP meets this criteria.

2) Most medical studies suggest a clinically significant benefit: do a “pub med” search for PRP as it relates to orthopedic conditions. Although some studies always will be too small or of lower quality, once you start to pool the data, you find that PRP is not really “experimental” any more. There are now hundreds of studies looking at patients receiving PRP for arthritis and chronic tendon problems, and the majority of these studies demonstrate a clinically significant benefit with PRP.

3) It’s both natural and safe: PRP is derived from your own blood. It’s designed to concentrate your platelets that contain your growth factors. These growth factors have many positive effects, ranging from inflammation reduction to slowing down the deterioration process within a tendon or joint. Major side effects are extremely rare, and when compared to steroid injections, prescription medications and surgical intervention, PRP is a safer treatment option with fewer adverse effects.

4) It’s a relatively quick office procedure: 5 minutes to set-up and draw the blood, 5 minutes to transfer the blood to the centrifuge system, 10 minutes to spin the blood, 3 minutes to further separate the blood components and capture the PRP, 2 minutes to prep the patient, and 1 minute to give the injection. In some instances, we may first inject a numbing medication (anesthetic) and then give that 10 minutes to work. So, in total, 36 minutes for this procedure done in the office, all in one sitting.

5) Although typically not covered by insurance, it’s likely a wise investment in your health and may save you money in the long run: the days of insurance always covering the best and most innovative procedures for orthopedic conditions are over. If PRP works for you like we expect it to, then you will potentially save money on doctor’s visits, medications, physical therapy, surgical interventions and other treatments. Not to mention that if you have not yet met your deductible, you will pay out-of-pocket for all of the other treatments “covered by insurance” that may be less effective than PRP.

In an nutshell, PRP is not for everyone and every orthopedic condition. We carefully select those patients who we think can “win the battle” with their orthopedic condition with one or more PRP injections. 20+ years of experience in sports medicine and orthopedics and 10+ years utilizing PRP have given us the knowledge to determine what patients may truly benefit from PRP injections. Come see us if you are curious!

F. Clarke Holmes, M.D.

Impact Sports Medicine and Orthopedics

What Supplements Might Be Useful In Orthopedics?

Many people prefer to try a natural approach when it comes to preventing conditions or treating symptoms by taking various vitamins and supplements. There are many options for supplements and vitamins out there, but are they really effective? Unfortunately, there is little education or research on these products.

Remember, the FDA does not regulate supplements and vitamins. Talk to your healthcare provider before beginning any supplements or vitamins. If you are pregnant or breastfeeding, discuss supplements and vitamins with your provider.

Here are a few common vitamins and supplements we discuss with our patients in orthopedics.

Turmeric

Known for its anti-inflammatory properties, turmeric is a great tool to help combat full body inflammation. We recommend a turmeric supplement that contains extract instead of ground root powder, 95% curcuminoids, curcumin, and bioperine (black pepper) to help with absorption. Daily dose recommendation is 500mg-2,000mg. Turmeric can slow blood clotting and should be avoided in those who take blood thinners, have bleeding disorders, anemia, gallbladder conditions, or pregnant. Caution should be used in those who take diabetes medication, as turmeric may make the effects of these medications stronger and therefore may result in hypoglycemia. Note: cooking occasionally with turmeric does not provide the amount needed to reach anti-inflammatory effects.

Glucosamine

Glucosamine is thought to increase cartilage and fluid around joints and/or help prevent cartilage breakdown, therefore, decreasing pain and improving function. Research studies’ results have shown conflicting information. Taking this does not reduce your risk of getting osteoarthritis. The recommended dose is 1,500mg daily. Do not take this supplement if you take warfarin (coumadin) as it increases the effects of warfarin, elevating your risk of serious bruising or bleeding. Do not take this supplement if you have personal or family history of glaucoma, are on cancer treatments, or have allergies to shellfish. Take caution if you have diabetes, as glucosamine has been shown to increase blood sugar levels and decrease the effectiveness of diabetic medications. Also, take caution if you are pregnant and/or breastfeeding, have asthma, glaucoma, hyperlipidemia (high cholesterol/triglycerides), and hypertension.

Chondroitin

Usually taken in combination with glucosamine, chondroitin sulfate is one of the building blocks of cartilage. Used to help decrease osteoarthritis pain and improve function. Recommended daily dose is 800-1,200mg. Do not take if you have prostate cancer or are pregnant/breastfeeding. Take caution in those with asthma. There is an increased risk of bleeding if taken with warfarin.

Hyaluronic Acid (HA)

HA’s action in orthopedics is to lubricate the joints and maintain normal joint cushioning to provide more support, resulting in decreased pain and increased functioning. In osteoarthritis and as we age, this substance becomes naturally depleted due to wear and tear. It comes in many different forms, but injections are the most widely used and most effective in sports medicine and orthopedics. We like to tell our patients to think of HA injections like an oil change for your knee; the oil is the HA substance and, your joints are the car. HA oral supplements have not shown to be effective for musculoskeletal use.

Vitamin D

Most people do not receive enough daily vitamin D from food and sun alone. Vitamin D has many benefits. From an orthopedic standpoint, vitamin D modulates inflammation, prevents involuntary muscle spasms, and cramps, and enhances calcium absorption into the bone which helps with bone growth and bone remodeling. Vitamin D plays a key role in helping prevent osteopenia and osteoporosis (thin and brittle bones). The recommended dose is 600-800 international units (IUs) daily, yet supplementing with 1000-2000 IUs of D3 is safe for most patients. Some patients are found to have vitamin D deficiencies with a blood test and will require higher dosing often for at least a month. Foods high in vitamin D include salmon, sardines, tuna, egg yolks, mushrooms, cow’s milk, soy milk, yogurt, orange juice, cheese, fortified cereal, and oatmeal.

Calcium

Calcium helps build and protect bones. A low calcium intake can result in fractures, osteopenia, and osteoporosis. Most people get enough calcium in their normal diet. The daily recommended amount of calcium needed is dependent on age.

1-3 years old: 700mg

4-8 years old: 1,000mg

9-18 years old: 1,300mg

19-50 years: 1,000mg,

51 years to 70 years: males 1,000mg and females 1,200mg

71 years and older: 1,200mg.

Who needs a calcium supplement? Those who are vegans, lactose intolerance, consume large amounts of protein or sodium, on long term steroid treatment, those who have inflammatory bowel disease and celiac disease, and those who do get enough calcium in the foods they eat. Overall, it is better to get the calcium your body needs through food instead of a supplement. There are some studies that have linked calcium supplements to heart disease, colon polyps, kidney stones, and heart attacks. Foods high in calcium: almonds, oranges, dried figs, soybeans, garbanzo beans, white beans, pinto beans, milk, yogurt, dark leafy green vegetables.

Ashwagandha

Ashwagandha helps in reducing anxiety and stress. On the label you want to look for root extract, as this is more potent that ground root powder. KSM-66 ashwagandha root extract has been studied in many clinical trials with positive outcomes. Daily dose recommended is between 500-1,500mg.

Potential side effects include gastrointestinal upset or headache. It can potentially lower blood pressure, lower blood sugar, and affect thyroid hormones, and in rare cases, have a negative effect on the liver. Women who are pregnant or breastfeeding should not take this.

Taylor Moore, FNP-C

Impact Sports Medicine and Orthopedics