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Consultant Q&A with Mr Fares Haddad- leading knee and hip surgeon

Published on September 2, 2010 in Ankle and Knee, Arthritis, Orthopaedic Surgery, Uncategorized and knee pain. 0 Comments Tags: arthritis of the hip, arthritis of the knee, BOOST PHYSIO; Physiotherapy Blogs; Steven Berkman, hip surgery, knee surgery, physiotherapy.

Mr Fares Haddad- leading knee and hip surgeon

Considering having hip or knee surgery? Make sure you read my interview with top London knee and hip surgeon Mr Fares Haddad. During Consultant Q&A I ask Fares questions that are on my patients’ minds about his field of hip and knee surgery. If you want to know about latest advances, “lubricating” injections for the knee and more, then please read on.

At BOOST PHYSIO we’ve enjoyed rehabilitating many of Fares’ patients over the years following hip and knee operations and I’ve also had the benefit of watching Fares perform various knee operations-hence we highly recommend him to our patients. If you want to read Fares’ impressive biography and CV follow this link to his website, but in brief Fares Haddad is a Hip and Knee Reconstructive Surgeon at University College Hospitals, The Princess Grace Hospital and the Wellington Hospital. He is Divisional Clinical Director of Surgical Specialties at UCH, and Director of the Institute of Sport, Exercise and Health at University College London. Clearly an expert in his field!

Q: Fares, you are well known for being one of a few surgeons to perform key hole surgery for hip problems. Which patients do you find benefit the most from this procedure?
A: Hip arthroscopy is a procedure that has expanded dramatically over the last ten years. The indications have become much clearer. The most successful interventions are in cases where there are isolated labral tears or when patients present in the early phases of femorocetabular impingement (FAI) before the joint is irrevocably damaged. FAI is a condition where the bones of the hip joint develop in such a way that the patient can function relatively normally, and often very athletically, but where abnormal contact between the femur and pelvis damages the hip. These are typically in sporting individuals who either suffer an acute injury, the labral tear, or get the insidious onset of symptoms through activity such as running, cycling or football. Plain x-ray imaging and MRI scan gives us most of the information we need although CT scanning is occasionally necessary to look at the bony anatomy. By dealing with the primary bony impingement as well as the problems within joint we decrease symptoms and hopefully also prevent recurrence and further progression of the problem in future.

Q: What does the future hold for technological developments in treatments for arthritic hip and knee joints?
A: The management of early arthritis of the hip and knee is progressing at an impressive rate. Technical developments will focus in the first instance on prevention thus by replacing the damaged menisci and the damaged joint surface and injured ligaments. The new work on partial resurfacing of joints with novel materials such as Oxinium is very exciting. New work also on customising joint replacement will change the face of the management of arthritis giving us joint replacements that are much more functional and geared to high end activity such as sports.

Q: Which sports do you believe are suitable for patients following total hip replacement surgery?
A: Following a hip replacement operation, we encourage our patients to get back to normal day to day activity within 6 weeks. All non impact sports such as long distance walking, gym exercises, swimming, doubles tennis and golf are encouraged. It is perfectly feasible for patients to play singles tennis or indeed in certain circumstances squash and many of our patients do get back to running but it is important for the patients to realise that there is a tension between the amount of impact activity that they do and the wear that they will cause to their new joint.

Q: How effective do you find “lubricating” injections are for arthritic knees?

A: Our experience of the Hyaluronic acid lubricating injections for knee and hip arthritis has been mixed. There are some patients who have an extremely good response that lasts up to six months. There are others who do not respond at all. It is very difficult to predict. My personal experience is that those patients have dry knees without effusions tend to respond better to Hyaluronic acid therapy whereas those with effusions can respond to aspiration and injection but do so for a shorter period of time. These are nevertheless interesting therapies which we must continue to pursue both in our athletic population when we often use them after surgery and also in the arthritic population.

I hope that you have found this Consultant Q&A interesting, if you wish to discuss any issues regarding your hip or knee condition with myself or one of my physios, please do not hesitate to contact us, you can call the clinic in Hendon, NW London on 020 82017788 or email us at info@boostphysio.com

The BOOST Blogger- Steven Berkman

Regards… The Boost Blogger, Steven Berkman

Surfing Injuries, in London?

Published on August 17, 2010 in Uncategorized. 0 Comments

Having just returned from a wonderful family holiday in Cornwall, surfing capital of the UK, I can honestly say that we’ve never treated a surfing injury at BOOST PHYSIO. There are 2 possible reasons why this could be- either very few surfers injure themselves, or could it be that surfing isn’t big in North West London?

At least it's only his board that's broken!

I guess most people who contemplate surfing are more concerned about getting chomped by a shark and not too concerned about a sprained ankle or dislocated shoulder, but a little research into the injury incidence of surfing is quite revealing. A study of all surfing and body-boarding injuries from the emergency department of the Royal Cornwall Hospital showed that males injured themselves 4 times more than females (click here to read the article).

Is this because us men are more reckless and stupid when surfing that we are more likely to try surf a bigger wave than our female counterparts? This ratio of 4 male patients to every 1 female patient with a surfing injury is very similar to our statistics at BOOST PHYSIO, across all sports (running, football, netball etc). I think to generalise this is because more men are exercising for recreation and for fitness than women and hence we see more men with sports injuries. Secondly I think the psychology of the sportsman leads him to push his boundaries to the excess, the male is more likely to try and run faster, jump higher and in so doing is more likely to injure himself.

What surprised me in this study was the average age of those with surfing injuries was 27 years old- I was picturing Silver Surfers (no not over 60’s who are internet savvy, but those carrying surf-boards) limping in to the hospital! While it may be true that there are more youger people surfing and hence more injuries to younger people, I think it is also down to the experience of the older surfer that make them more aware of their limitations and less likely to push themselves into hazardous situations. It is likely that older surfers haven’t recently taken up the sport, but have been participating for many years and are thus more knowledgable about the dangers of the sport and more conditioned to the sport- I have termed this “Berkman’s law of sensible older people who exercise and don’t get injured as often”.

Surf's Up

The same holds true for most other sports injuries that we see, the club tennis players in their 50’s and 60’s tend to play within their capabilities and do not push themselves excessively (but there are exceptions- David you know I am referring to you!!!). As with all things in life there are exceptions and I believe that football is the exception. We treat many footballers over 45 who present with injury at BOOST PHYSIO. This does not conform with Berkman’s Law of sensible older people who exercise and don’t get injured as often. I believe that the psychology of men who play football beyond the age of 40 is such that they are trying to run faster and kick harder than they could when they were 20 and thus more likely to do themselves a nasty injury. The over 40 footballer is less likely to accept his limitations.

To summarise : if you are a female, not 27 years old and living in NW London you are less likely to suffer a surfing related sports injury- grab a board and dive in- Surf’s Up!

Oh and if you do surf and injure yourself- BOOST PHYSIO in Hendon specialises in treating NW London surfers!

by: Steven Berkman the BOOST BLOGGER www.boostphysio.com

Do you KNEEd help?

Published on June 29, 2010 in Uncategorized and knee pain. 0 Comments Tags: anterior knee pain, chondromalacia patella, knee pain, osgood schlatters disease, osteoarthritis of knee, physiotherapy for knee pain, rio ferdinand injury.

England football captain Rio Ferdinand may have missed the whole Fifa 2010 Football World Cup because of his knee injury, but you don’t have to be an international footballer to have trouble with your knees. In this blog I take a look at the range of knee problems affecting different age groups.

Osteoarthritis (“wear and tear”) of the knee affects 1/3 of people aged 63 and over, often causing knee pain, difficulty rising from a chair and climbing stairs. But knee pain is also not unique to older people- in fact there are many knee problems that are common in adolescents and teenagers, not to mention the knee problems that beset the athlete and sportsperson. Knee problems are one of the most common conditions that we treat at BOOST PHYSIO, let’s take a look at the type of knee problems that affect different age groups and how we treat them.

Active adolescent children (aged 10-14) complaining of knee pain at the front of the knee below the knee cap are often affected by Osgood Schlatters Disease. X-rays will confirm the diagnosis for this condition, but are often not

Diagram of Osgood Schlatters Disease

needed as the clinical examination can be enough to make the diagnosis. There will usually be a tender, enlarged area at the tibial tuberosity (this is the bump between the knee cap and the top of the shin bone), where the quadriceps muscle tendon attaches to the shin bone and pulls on the not yet fused tibial tuberosity. The ratio of boys to girls affected by this condition is 7:1. A Finnish study showed a frequency of 13% of adolescent athletes had Osgood Schlatters.

At BOOST PHYSIO our treatment programme for Osgood Schlatters involves decreasing of physical activity to allow the inflammatory reaction to subside, a programme of stretches to the knee muscles to assist in the muscle length and ensure that range of movement of the knee is maintained. Most importantly carefully guiding the adolescent back to sport with a graded programme.

Teenagers with knee pain are often affected by anterior knee pain. Anterior knee pain is often also called Chondromalacia Patella or Pattela femoral pain syndrome. Anterior knee pain by contrast to Osgood Schlatters is much more common amongst girls than boys. This prevalence amongst girls is partly due to the wider female pelvis which leads to an increased likelihood of knock knees (technically called genu valgus). Pain is usually at the front of the knee underneath the kneecap (patella) and is worse climbing stairs. Anterior knee pain is caused by poor alignment of the patella largely due the mechanics of the patient’s knees (often knock kneed and flat footed) which leads to maltracking of the patella causing excessive pressure under the patella. In severe cases this will roughen the cartilage surfaces under the knee cap.

Example of severe maltracking of the patella

We treat anterior knee pain by always tackling the root of the problem first which is normally the biomechanics of the legs. BOOST PHYSIO often recommends orthotics (inner-soles) to correct foot and knee position and always gives corrective exercises to deal with muscle-imbalances at the knees focussing on strengthening the vastus medialis portion of the quadriceps thigh muscle which helps to re-align the patella. We often also use special strapping techniques to off-load the patella and re-educate the muscles around the patella. Often “hands on” work is also needed to loosen tight structures around the patella.

Knee problems in people in their 20s-50s are often related to an injury or trauma and are often sports related. Whether it is the Sunday footballer with a torn meniscus (cartilage of the knee) or a runner with a tendonitis problem we assess all these patients very carefully with specific tests to accurately identify the nature of the injury. These knee problems can be challenging to deal with as tissue healing is slower in people over 20 and indeed sometimes the damaged tissue cannot repair itself at all. While the majority of our patients with sports injuries to the knee are treated successfully with physiotherapy a small number need the help of a knee surgeon and we make sure that our patients receive the appropriate advice and care in this regard. For those who do require surgery we work very hard on their rehab programme aiming to regain full strength and flexibility as soon as possible.

Over 60s suffering with knee pain can often be due to osteoarthritis of the knee which can also cause stiffness and often swelling of the knee. While surgery can be a very effective solution for many of these patients, most will respond very well to a programme of physiotherapy focusing on strengthening the leg muscles to off-load the knee joint and work to improve the flexibility of the knee. Both these elements lead to decreases in pain levels and improvements in functional ability.

If you would like to discuss your knee problem and have a thorough physiotherapy assessment and examination please do call us on 020 82017788 to arrange an appointment or visit our website www.boostphysio.com for more information.

Freestyle Footballer, Ethan Altman, following his injury treatment

Published on April 16, 2010 in Uncategorized, elite sports injuries and sports injuries. 0 Comments Tags: BOOST PHYSIO, Ethan Altman, football injuries, Freestyle Football, physiotherapy for football injuries.

Freestyle footballer, Ethan Altman, sent us this thank you video, after having treatment at BOOST PHYSIO he was able to return to this exciting sport of Freestyle Football. Have a look at him in action- he is amazing!!

This is what Ethan had to say: ” I’m Ethan Altmann, I had about 5 sessions with Jolene to help me through an injury. I am now fully healed!

I was given a lot of stretches and strengthening exercised to do and taught how to do them, I was told to rest for at least two weeks. I did the exercises and I rested, and I am really really happy I made a full recovery so quickly to return to my training!”

Jolene Sher, Senior Physiotherapist @ BOOST PHYSIO

This is a link to Ethan’s Youtube channel www.youtube.com/EraOfFreestyle

This is a link to Ethan’s “crew” homepage: www.thefootballfreestylers.com

Shoulder Injury? Could it be the rotator cuff?

Published on February 5, 2010 in Uncategorized. 1 Comment Tags: BOOST PHYSIO; Physiotherapy Blogs; Steven Berkman, physiotherapy for rotator cuff injuries, private physiotherapy NW London, rotator cuff injury, shoulder injuries.

This is an image of the front of the right shoulder showing examples of some tears to the rotator cuff of the shoulder

written by Jolene Sher, Senior Physio

What is the Rotator Cuff?

The shoulder joint is a ball and socket joint, formed by the ball-shaped end of the upper arm (the humerus) and a shallow socket on the edge of the shoulder blade (scapula). This allows for a large range of movement in many directions. Stability within the joint is provided by the muscles, with some support from the ligaments. The main muscles that give this stability are the Rotator Cuff muscles.

The rotator cuff is made up of a group of four muscles (called the subscapularis, supraspinatus, infraspinatus and teres minor) and their tendons. The tendons wrap around the shoulder, forming a cuff around the ball of the humerus providing the stability during movement of the arm.

On top of the shoulder joint is a bone called the acromion. In the gap between the shoulder joint and the acromion is a space that some of the rotator cuff tendons run through.

Types of rotator cuff injury

Rotator cuff injury is a general term to describe inflammation or damage to one or more of the muscles or tendons that make up the rotator cuff.

Rotator cuff tendonitis

The tendons of your rotator cuff can become inflamed. It most often affects the tendons which run underneath the acromion. When a tendon becomes trapped or squeezed, it’s known as impingement syndrome. Pain usually comes on gradually.
This is when the muscles or tendons that make up your rotator cuff become completely or partially torn. It may be a result of a trauma, such as a fall, or due to tiny tears to the tendon through use and wear over time. Pain usually comes on suddenly.

Rotator cuff tear

How does it start and who is affected

Rotator cuff injuries may occur due to one or more of the following:

Poor movements (e.g. repetitive or overhead activities) or poor posture around the shoulder are usually factors that can cause adverse strains and stresses in the rotator cuff.

Lifting or pulling an object that is too heavy for you or lifting it in the wrong way.
Landing on an outstretched hand to break a fall. Rotator cuff injuries often occur if you dislocate your shoulder.
Wear with age.
Muscle imbalance (When some of the muscles in your rotator cuff are stronger than others).
Musculoskeletal disease (e.g. rheumatoid arthritis)

Shoulder pain affects around one in five people in the UK and rotator cuff injury is the most common cause.

Symptoms

Symptoms of a rotator cuff injury may include:

Pain and tenderness over your shoulder (it may radiate down the arm) especially when you raise your arm out to the side, reach behind you or lift or pull a heavy weight
Pain at night, particularly when you sleep on the affected side
A feeling of weakness in your shoulder
A limited range of movement in your shoulder
Clinical findings from the Doctor or Physiotherapist. This includes special tests to pick up signs of shoulder impingment.
Medical treatment: Commonly used interventions are advice (e.g. rest and ice), medication (e.g. anti-inflammatories or analgesics), corticosteroid injections and/or referral for physical therapy.

Diagnosis

MRI
Ultrasound scan
X-rays cannot diagnose rotator cuff injuries.

Treatment

Conservative Treatment (Non-surgical treatments)

Physiotherapy Treatment

Appropriate initial assessment- NB history and observation.
Initial treatment is to help alleviate pain and inflammation. This can be achieved with ice, rest, soft tissue release and the use of electrotherapy modalities.
Identifying predisposing factors such as posture or ergonomics (work/sport positions) and pre-injury level of function.
Appropriate referral to a specialist if need be.
Rehabilitation to return to work/sport:

ü Stabilisation – to ensure that the shoulder joint can remain stable under increased tension.

ü Strength – to make the shoulder strong in all movements (using gym based exercises)

ü Function – enhancing the shoulder’s ability to cope with the demands needed to get back to pre injury level

Surgical treatments

If unable to treat it conservatively surgery may be indicated, for example to repair a tear in your rotator cuff or to remove calcium deposits.

Prevention

To prevent rotator cuff injuries, make sure you:

have the correct technique when playing sports or doing activities that use your shoulder, particularly overhead motions
do exercises and stretches to keep your rotator cuff muscles strong and supple

Icy Winter Injuries- what have we been treating?

Published on February 5, 2010 in Uncategorized. 0 Comments Tags: physiotherapy, physiotherapy for slips, shoulder injuries, winter injuries.

We've been busy dealing with winter related injuries People who've slipped on the ice and those with winter sports injuries

The icy weather over Christmas and early January led to A+E departments being rushed off their feet with injuries from people and cars slipping on the ice. Many patients and friends have been asking us what type of injuries have we been treating at BOOST PHYSIO relating to the bad weather… well unfortunately shoulders have born the brunt of these injuries…. here is part of the list:

26 year old man who fell on his shoulder, referred by his GP to see me 4 weeks after slipping and falling on his shoulder (xray was normal). When I saw him it was immediately apparent that he had a more significant injury than usual, sent him back to GP requesting MRI which has shown an impact fracture to the shoulder and a muscle injury too.
A man who fell and dislocated his shoulder (ouch!!)- he is doing well thanks to great treatment by Jolene
2 other men who have fallen onto their shoulders
a Snowboarder who has injured his shoulder
We have now started having enquiries from patients who broke their ankles or wrists and are coming out of plaster (after 6weeks) so watch this space!

Some of our these experiences have shown how a good musculo-skeletal physio with specialist experience and knowledge will pick up injuries that others will often miss!

Weekend Warriors Watch Out!

Published on February 5, 2010 in Uncategorized. 0 Comments Tags: BOOST PHYSIO, football injuries, Hamstring strain physiotherapy, physiotherapy, Physiotherapy Hendon.

Don't be a Weekend Warrior- make sure your fitness level matches your activity level

The key to injury prevention is always in the preparation! The ‘Weekend
Warrior’ patients that we see, are all guilty of doing too little training
during the week and not being adequately fit for playing their sport.

Don’t forget that training should be specific
to your sports, so if you are playing football,
cycling may be helpful but running and
shuttle sprints would be better. The most
common football injuries that are treated at
BOOST PHYSIO are hamstring, calf and groin
muscle injuries.
Most of our patients who have injured
themselves in sport do not warm-up. Spend 10
minutes warming up. Don’t confuse warmingup
with stretching, these are two different
things. Warming up involves aerobic exercise
to raise the heart rate and body temperature
gradually and should include activities specific
to the sport being performed. For sports like
football and netball starting with jogging and
progressing to a faster run for short shuttles
is important. During the last 2 minutes of
the warm up then do specific stretches to
the high risk areas such as the quadriceps,
hamstrings, groin and calf muscles – this
ensures there is sufficient elasticity in
the muscles.
While the research on stretching is
controversial as to whether it actually
reduces the chances of an injury, you will
not find an elite athlete who does not spend
time stretching.

BOOST PHYSIO starts Blogging

Published on February 4, 2010 in Uncategorized. 0 Comments Tags: BOOST PHYSIO; Physiotherapy Blogs; Steven Berkman.