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Understanding Arthritis

May 24, 2021

Not one single disease as commonly thought, “arthritis” is the informal way of referring to joint pain or a joint disease. With May being National Arthritis Awareness Month, we are taking this time to talk a little bit more about this very common, yet not very well understood diagnosis.

Common arthritis symptoms are joint pain and stiffness, redness, swelling, and decreased range of motion. Symptoms typically worsen with age and severe arthritis can make it difficult to do daily tasks, walk comfortably, and can result in chronic pain.

Types of Arthritis

The two most common types of arthritis are osteoarthritis and rheumatoid arthritis.

Osteoarthritis

Osteoarthritis, a degenerative arthritis and the most common type, is caused by wear and tear of your joints’ cartilage, the hard, slippery tissue that covers and protects the ends of bones where they form a joint.

Ideally, your cartilage cushions the ends of your bones and allows nearly frictionless joint motion. When damaged, you can experience bones grinding directly on another bone, causing pain and restricted movement. This damage can take place over many years or can be accelerated by a joint injury or infection.

The disorder commonly affects joints in the hands, knees, hips, and spine, however it can damage any joint in the body. Signs and symptoms of osteoarthritis include pain, stiffness, tenderness, swelling, a grating sensation, bone spurs, and loss of flexibility. Symptoms tend to develop slowly and worsen over time.

Rheumatoid Arthritis

Rheumatoid arthritis is a chronic inflammatory disorder where the immune system attacks the lining of the joint capsule, which is a tough membrane that encloses every part of the joint. The lining becomes inflamed and swollen. Over time, the disease can destroy cartilage and bone within the joint. The disorder can also affect other body systems including the skin, eyes, lungs, and blood vessels.

Signs and symptoms may include tender, warm, swollen, or stiff joints, and fatigue or fever and loss of appetite. Rheumatoid arthritis typically effects smaller joints first, and then spreads to larger joints throughout the body. These symptoms often vary in severity and may come and go.

Additional types of arthritis include infectious arthritis where a bacterium, virus, or fungus can enter the joint and cause inflammation, and metabolic arthritis where uric acid is formed as the body breaks down purines, a substance found in human cells.

Risk factors for arthritis include family history, age, gender, obesity, and previous joint injury.

Arthritis symptoms can be reduced through weight loss, exercise, heating pads or ice packs, and assistive devices. It is important to learn about the disease and treatment options if you believe you may have arthritis of any kind.

Diagnosis

It is important to talk with your doctor if you are experiencing joint pain. Before your appointment, start keeping notes of any signs and symptoms you are experiencing. During your appointment you will want to make sure to touch on when your symptoms started, which joints are painful, which activities make pain better or worse, and if you have any family history of joint pain.

In order to obtain a diagnosis, your doctor will check your joints for redness, warmth, and swelling. They may also suggest lab tests of body fluids in order to identify the type of arthritis you are living with. Your doctor may also request imaging, which can detect problems within your joint. Imaging tests could include x-rays, computerized tomography (CT scan), magnetic resonance imaging (MRI), or an ultrasound.

Treatments

Treatments can vary depending on the type of arthritis. Since damage to joints cannot be reversed, the goal of most treatments is to reduce and relieve symptoms, improve joint function, and increase the quality of life. No one option works best for every patient, so several different treatments or combination of treatments may be tested before the most successful is determined.

Examples of treatments are medications, physical therapy, and joint repair, replacement, or fusion surgery. You can learn more about total joint surgery services at Orthopaedic Associates at https://www.oaduluth.com/surgical.php.

If you are experiencing joint pain or arthritis symptoms, scheduling an appointment with one of our Board-certified surgeons could start you on the path to getting back to your normal lifestyle. Fill out a contact form today: https://www.oaduluth.com/contact.php.

Tips to Avoid Injury While Training for a Marathon

April 26, 2021

As the warm weather hits here in Duluth, runners throughout the area have one thing on their minds. The approaching Grandma’s Marathon. Whether competing against others or against yourself, the importance of safely training for race day is something everyone should be taking into consideration.

We talked to a few of our physical therapists about their training tips to avoid injury before and after running a marathon. Not making your way to the start line? Don’t worry. Following these tips can be beneficial for even casual runners.

Stretching

Our physical therapist team recommends dynamic stretching both before and after a run. These stretches are controlled movements that prepare and warm-up your body for performance. This helps with mobility, which is important for good running form. Static stretching, where you hold a single position for a period of time, can be beneficial after a run to increase flexibility and range of motion.

Strengthening exercises like core and hip movements can also be highly beneficial to complete after a run. Specific muscle strengthening is important in order to maintain good running form and to prevent injuries.

Different Types of Workouts while Training

Following a training program that incorporates a variety of intensities and distances is critical to improve cardiovascular fitness. Typically, a week should include at least one threshold workout, an intensity workout, and a long run at a lower heart rate.

Cross training and other endurance activities including biking, swimming, or skiing, between runs can help to prevent injuries.

While it is important to put in the miles while training for a marathon, strength training is also essential to avoid injury and improve performance. Plan to include core, hip, and single leg strengthening exercises, as well as working in different planes. For instance, use movements within the lateral and transverse planes instead of only the sagittal plane. 

Doing bended and straight knee calf raises can also prevent calf strain, which effects almost every runner.

Universal Practices to Stay out of the PT’s Office

Most of the running injuries our therapists see are due to training error. Doing too much too soon can lead to injury, so progressions needs to be gradual. We recommend duration increases of 10% per week. Intensity can be safely increased at a rate of 3% per week.

When transitioning to different surfaces, for example from a treadmill to the road, it is important to keep your duration and intensity light for the first few runs since different muscles may be used depending on the terrain.

Make sure to keep hydration and fuel in mind. Eat about 40-60g of carbohydrates per hour during training and replenishing with at least 25g of protein and carbs after. Sleep can also be equally as important.

When to know you should see a Physical Therapist

If you feel any pain, monitor it over 24 hours. If the pain rates a 3 or 4 out of 10 during a run but goes back to a 0/10 within 24 hours, it is safe to continue running. If the pain gets worse during a run or over the next day, take a break from running for a few days. If the pain is from a tendon or muscle issue, try not to take more than a few days off. Otherwise you go into a pain – rest – weakness spiral. Tendons and muscles recover better with appropriate movement.

If you are having difficulty increasing weekly mileage due to pain, or symptoms persist after taking a few days off, then it is time to see a running specialist.

Good Tips for Marathon Day

Remember to be well hydrated and fueled by simple, easily digestible carbs before the race even starts (about 3 hours beforehand). Eat/refuel earlier in the marathon than you might think. If you allow yourself to go too far before consuming glucose, it may be difficult or impossible to catch back up to the fuel intake your body needs.

Also, remember to pace yourself! Don’t start out of the gate too fast or hard. Adrenaline will kick in when the race starts, but this jittery start will not be sustainable miles down the course.

Orthopaedic Associates Resources

Orthopaedic Associates of Duluth offers complete comprehensive running evaluations, which include a formal physical therapy evaluation and a running form assessment.

While training for any race - let alone a marathon - can be overwhelming, these tips should ease your mind and provide value to your running training program. Happy running!

Commonly Overlooked, SI Joint Dysfunction May Be the Cause of Your Back Pain

March 18, 2021

Are you experiencing pain, numbness, tingling, or weakness in your lower back, pelvis, or hips? Leg instability? Disturbed sleep or sitting patterns due to pain? Or pain going from sitting to standing, and have not been able to find a solution? Sacroiliac (SI) joint dysfunction is a commonly overlooked source of pain for many individuals.

What is Sacroiliac Joint Dysfunction?

The SI joint is located in the pelvis, linking the iliac bones (pelvis) to the sacrum (lowest part of the spine above the tailbone). The joint is an essential component for shock absorption to prevent impact forces from reaching your spine.

Like any joint in the body, the SI joint can be injured or become degenerative. SI joint dysfunction can cause back pain that may either be localized in your lower back or radiate all the way down through your buttocks and legs. This pain can range from mild to severe and often shows up while lifting, running, walking, or even sleeping on the involved side.

Clinical publications have identified the SI joint as a pain generator in 15-30% of chronic lower back pain patients. In addition, the SI joint is a pain generator in up to 43% of patients with continued or new onset lower back pain after a lumbar fusion.

There are several causes of SI joint dysfunction, so it can be difficult to pinpoint the primary issue. However, most common causes include injury due to an accident, triggering of pregnancy hormones, degenerative diseases such as osteoarthritis, and an inflammatory arthritis that primarily affects the spine called ankylosing spondylitis.

Making a Diagnosis

According to scientific data, it’s common for pain from the SI joint to feel like disc or lower back pain. For this reason, SI joint disorders should always be considered in lower back pain diagnosis.

A variety of tests performed during a physical examination may help reveal the SI joint as the cause of your symptoms. Sometimes, X-rays, CT-scan or MRI may also be helpful in the diagnosis of SI joint-related problems.

The most relied upon method to accurately determine whether the SI joint is the cause of lower back pain symptoms is to inject the SI joint with a local anesthetic. The injection will be delivered under either X-ray or CT guidance to verify accurate placement of the needle in the SI joint. If symptoms are decreased by at least 50%, it can be concluded that the SI joint is either the source of or a major contributor to the lower back pain.

Treatment

Once the SI joint is confirmed as the cause of symptoms, treatment can begin. Some patients respond to physical therapy, use of oral medications, or injection therapy. These treatments are often performed repetitively. If symptom improvement using these therapies only lasts temporarily, your surgeon may consider other options, including minimally invasive surgery.

If an SI joint fusion surgery is chosen as the next best course of action, Neurosurgeon Dr. Matthew T. Davies, MD is trained in the latest minimally invasive surgical technique, the iFuse Implant System from SI-Bone, Inc., which is proven to improve pain, patient function, and quality of life.

Join us on March 23 from 6-7 p.m. for a free patient educational webinar where Dr. Davies will discuss and review SI joint dysfunction. Click Here to Register

Expert Tips on Avoiding Winter Sports-Related Injury

February 22, 2021

While the winter blues may cause less motivation to get up and work out, it is important for both your physical and mental health to make sure you are exercising multiple times a week. This body movement may take the form of playing an organized sport, doing online videos in your home, and every option in between. Whichever activity you decide is best for your lifestyle and schedule, it is important to do so safely to avoid injury.  

While the winter season brings us some great opportunities to be active (hockey, Nordic skiing, downhill skiing, and fat tire biking just to name a few), it also brings opportunity for sports related injuries. 

We all look forward to a Northland favorite, hockey. Our area boasts some talented organized teams as well as provides great public outdoor and indoor rinks for community members to enjoy. In order to stay off the bench and on the ice, it is important to know about the common injuries that come along with the game. Hockey injuries primarily occur due to contact to the upper and lower body, which can result in shoulder separations or dislocations as well as knee ligament injuries. 

Another winter favorite includes downhill skiing, which takes place at high speeds and therefore the injuries occur with more “energy”. This can result in head injuries, concussions, knee ligament injuries, and fractured tibias or wrists. 

Now, we are definitely not recommending that you stop participating in these activities out of fear of injury. There are numerous ways to prevent these injuries. 

First, make sure you are wearing appropriate protective equipment for your sport or activity. Some of these items include helmets, mouth guards, and wrist guards. It is also important to understand the conditions of the terrain and snow you are skiing, biking, skating, etc. on. Ski, bike, and skate in control and always be aware of your surroundings so that you do not injure others or so that obstacles such as sticks or poles do not result in severe lacerations. 

Being active in colder weather can also make you more prone to injury. Outdoor activities and sports during the winter months require more time to warm-up our muscles before starting an activity. Remember to always stretch prior to working out or playing your sport. If you do not have time to stretch or warm-up, then try to ease into your activity and increase intensity gradually as your body warms up. 

Bumps, bruises, and minor injuries are common in any sport, but make sure to observe the following things that require medical attention: 

1.    Deformity of your limbs -- this may mean something is broken.
2.    Inability to move a joint or extremity -- this may mean something is dislocated. 
3.    Significant joint swelling -- this may mean a ligament has been torn. 
4.    Loss of consciousness – this may mean head trauma. 
5.    Abdominal pain -- this may mean you have bleeding from your spleen or liver. 

If you are experiencing any of these symptoms, it is time to see a professional.
 

The Sports Medicine team at Orthopaedic Associates of Duluth is here to treat any injuries and get you back in the action. Our board-certified surgeons specialize in sports medicine and work with patients from diagnosis to recovery for both surgical and non-surgical treatments. We also have a great team of physical therapists, occupational therapists, and athletic trainers who are dedicated to working with you until you are back to playing your sport. 

We are often able to schedule appointments for the same day as you first contact us by calling 218-722-5513.

Our goal is to provide you with the tools you need in order to avoid injury altogether. However, in the moments when a larger issue or injury does occur that impacts your ability to remain active or play your sport, know we are here with options to keep you enjoying a great active winter in the Northland.