WHY YOU SHOULDN'T EVER SKIP YOUR STRETCHES

Here at Champion Performance and Physical Therapy, we have a number of patients who, while they eat healthy, exercise consistently, and get plenty of nourishment and water, are in pain because they're missing one of the most under appreciated aspects of physical health in their daily lifestyles - stretching. 

It may seem like the most basic additive, but you must remember: the skeletal body is a lever system manipulated by musculature. In other words, your skeletal system will not move without the help of your muscular system, and each bone is almost entirely surrounded by muscles for this purpose.

During exercise (and after your warm up), your body is warm due to increased blood flow, the muscles are loose and firing.  Afterward, the muscles will cool, and if not properly stretched, will stiffen due to the biochemical aftereffects of exercise. While an effective fitness program should absolutely consist of cardiovascular training and strength training, the flexibility component is often overlooked. 

This is where skeletomuscular injuries come into play, specifically those relieved via physical therapy. When muscles tighten and stiffen, they pull just slightly on the bones in their direction. For example: runners often have tight hip flexors and quadriceps (the front of the thigh).  These muscles attach and originate along the anterior aspect (front) and inside of the pelvis. When they stiffen, they pull the pelvis slightly forward. Over a long period of time, the pelvis will shift so far forward that it will start to cause low back pain that can sometimes radiate into the hips, and SI - sacroiliac - joint, which is the point of attachment between the spine and pelvis. This can even radiate down the leg and into the knees, as the muscular insertion for the quadriceps are just below the knee on the tibia (shin bone).  Often times when patients come in with knee pain and all X-rays and MRI scans show no injury, it is because the muscles have pulled the skeletal system just out of sync enough for you to notice. 

Flexibility exercises are not only an essential part of recovering from aerobic activity, but can reduce your risk for further injury. The American Academy of Orthopaedic Surgeons (AAOS) encourages individuals to incorporate these exercises into their daily workouts.

EXPERT ADVICE
“Increasing your flexibility improves your ability to move easily,” said orthopaedic surgeon and AAOS spokesperson Raymond Rocco Monto, MD. “Some joints lose up to 50 percent of motion as we age. There are many ways to improve your joint flexibility including controlled stretches held for 10-30 seconds, stretches that rely on reflexes to produce deeper flexibility, as well as yoga and pilates.”

Before skipping flexibility exercises during your next workout, consider these five benefits of adding them to your workout regimen:

• Less back and joint pain: A 2011 study in the Archives of Internal Medicine found that regular stretching was effective in relieving chronic back pain. Other research has shown quadriceps stretches helped decrease knee pain.
• Better circulation: A 2009 study in the American Journal of Physiology discovered that torso stretches decreased stiffness and improved blood flow. This also may be why regular bedtime hamstring and calf stretches decrease the frequency and intensity of night-time leg cramps.
• Improved joint motion: Flexibility naturally decreases with age. Stretching can help restore lost joint motion and improve function.
• Better athletic performance: Like a good rubber band, muscles and tendons generate more force under tension when they are supple and compliant. 
• Improved muscle health: Mobility exercises can increase the amount of stress muscles can handle in high tension activities that involve jumping and cutting movements.

Get the most out of your flexibility training by following these simple guidelines:

• Always warm up before your stretch. Stretching cold muscles can cause injury.
• Stretch slowly and gently. Breathe into your stretch to avoid muscle tension. Relax and hold each stretch 10 to 30 seconds.
• Do not bounce your stretches. Ballistic (bouncy) stretching can cause injury.
• Stretching should not hurt. If you feel pain, take the stretch easier, breathe deeply and relax into it.
  
  Stretching is important and can be tough to master to maximum efficiency. The trouble is, it takes some time to stretch muscles back out to a healthy length. A combination of stretching, manual therapy to help relieve some tension in the joints that are being pulled on, and strengthening the opposing muscles to those inflicting pain should easily solve the problem and have you pain free within weeks. Here at Champion Performance and Physical Therapy, this is probably the most common cause of injury we see, and we approach it with a unique, biomechanically-based mechanism meant to relieve pain and tension through multiple planes of your body. Why?  Because your body doesn't move in just one plane. 
  
  Talk to your doctor today about what physical therapy can help do for you. For more information, visit us on the SW corner of 75th and State Line Road in Prairie Village, or by phone at 913-291-2290.

2015's FOREFRONT OF ORTHOPEDIC INNOVATION

The SourceTrust custom contracting team recently traveled to Las Vegas for the 2015 Annual Meeting of the American Academy of Orthopedic Surgeons (AAOS), the nation’s leading educator in the specialty. The team met with suppliers, networked with peers and learned about the latest technologies and trends in orthopedics. Hot topics this year included:

1. 3D printing technology: Biomet released the G7 OsseoTi shell, to be used with its acetabular platform launched last year that employs color coding to reduce instrument sets and increase efficiency flow in the OR during hip arthroplasty procedures. One of the surprisingly innovative aspects of this product is the use of human CT data in combination with 3D printing technology to build a structure purported to directly mimic that of human cancellous bone. Biomet claims that this process generates a single porous architecture allowing creation of complex shapes while maintaining the consistent porosity and strength necessary to facilitate bone and tissue ingrowth and implant stability.

2. Advanced technology for total knee revision arthroplasty: One innovative technology for revision knee procedures is DJO Global’s Exprt System, which has the potential to improve patient outcomes as well as efficiencies in the operating suite. Exprt’s streamlined, compact design reduces turnaround times, minimizes waste and has proven implant design technology―all for 40 to 70 percent of the cost of comparable knee revision systems. A simple, comprehensive two-tray system replaces the traditional eight-tray setup used during complex total knee revisions, reducing prep time, eliminating unnecessary surgical steps and improving the precision skills of revision surgeons.

Lowry Barnes, M.D., chairman of Orthopaedics at University of Arkansas for Medical Sciences, comments that “the Exprt approach leads to efficient operations that save both time and money, while providing excellent early results. My operating team especially appreciates the fact that only two pans of instruments are opened. I believe that I can speak for the entire Exprt design team when I say that we have met our goals in offering a high-value, high-quality revision knee system for the accomplished surgeon.”

“In today’s value-driven healthcare environment, cost effectiveness is crucial in order to provide stakeholders with a high-quality result at a reasonable cost,” says Dr. Richard Lorio, chief of Adult Reconstructive Surgery at NYU Langone Medical Center. “Putting the patient ahead of profits, the Exprt System allows skilled surgeons to provide TKA [total knee arthroplasty] patients with a functional knee at a fraction of traditional costs.”

3. Robotics: As with AAOS 2014, robotics continues to be an area of great interest. The two main players in this arena are MAKO Surgical Corp. and Blue Belt Technologies. Limitations of the former include restricting surgeons to using only MAKO or Stryker implants, increasing disposable costs. In addition, MAKO manufactures implants for use in total hip and partial knee arthroplasty (although it anticipates launching a total knee platform later this year). Acquiring MAKO robotics is also costly. Blue Belt is more economical and provides surgeons with the option of using its STRIDE implants as well as those manufactured by Smith & Nephew, DJO Global, StelKast and DePuy Synthes. However, Blue Belt is currently approved only for partial knee procedures. Like MAKO, it expects to release a total knee implant in late 2015.

4. Patient-reported outcomes measures (PROM): These days, surgeons and hospitals can’t just say they are good at orthopedics. To gain market share, they have to prove they are clinically excellent. That means demonstrating that they are high-quality, low-cost providers of care while providing a good patient experience. The measures used to prove value are evolving from research-focused tools toward scoring instruments that are meaningful to patients. A good example is PROMIS, a means of measuring patient-reported physical, mental and social health status that is backed by the National Institutes of Health. InVivoLink demonstrated its platform for capturing PROMIS scores pre- and post-procedure to better understand clinical performance across patients, procedures and surgeons. When these PROM measures are analyzed along with implant consumption and cost data, they’re a powerful tool for driving surgical volume, surgeon engagement and cost savings. 

5. Outpatient surgery: To get ahead of this increasing market trend, Zimmer rolled out its Z-23 initiative that endeavors to limit hospital stays for hip replacement patients to no more than 23 hours. The program stresses the importance of better patient selection and creating efficiencies in the OR. More total joint procedures are moving entirely to outpatient settings thanks to better medications and anesthesia, the popularity of minimally invasive approaches, younger patients seeking such procedures, and private payer support.

6. Shoulder market: Matthew P. Willis, M.D., a fellowship-trained orthopaedic surgeon at Baptist Hospital and TriStar Centennial Medical Center in Nashville who specializes in disorders of the shoulder, discussed emerging technologies and pricing in the shoulder market at a HealthTrust-sponsored dinner during the annual meeting.

“More than hips or knees, shoulder technology continues to make significant advances,” Willis says. “This is particularly true with regards to reverse shoulder arthroplasty technology. Impending developments such as universal glenoid baseplates for total and reverse arthroplasty as well as patient specific instrumentation are on the horizon.”

Willis also addressed pricing and reimbursement. “As reimbursements for hospital systems continue to decline, competitive pricing on shoulder implants becomes more important than ever. There are no shoulder implant companies that currently offer technology to justify significantly higher pricing than [their] competitors.”

On the subject of hospital and physician alignment, Willis says the “best approach to achieving hospital and physician alignment is for the two parties to have open and transparent discussions about what is important to each. Most physicians are willing to help on cost containment if approached with reasonable alternatives and accurate data. The best case scenario is when both parties are incentivized to manage costs. If not currently, such a model may be attainable in the future. “