Ice After, Not Before Sports Participation

What is this ?  Ice is, after all, the “I” in the acronym RICE (rest, ice, compression, elevation), which remains the standard first-aid protocol for dealing with a sports-related injury. Icing is also widely used to deal with muscles that twinge but aren’t formally injured.

Icing muscles significantly reduced muscle strength and power for up to 15 minutes after the icing had ended. It also tended to lessen fine motor coordination. Some of the reviewed studies found that people experienced impaired limb proprioception, or their sense of where their limb was in space after it had been iced.

The result was frequently, at least in the short term, poorer athletic performance. Volunteers were not able to jump as high, sprint as fast, or throw or strike a ball as well after 20 minutes of icing.

“The current evidence base suggests that the performance of athletes will probably be adversely affected should they return to activity immediately after cooling,” the authors conclude.

“The most likely reason is that ice reduces nerve conduction velocity,

 That means for most of us, there may be times when it’s fine to ice sore muscles – like after a hard workout or when we experience serious injury — provided we do not jump back into the field.

Ice remains an accepted therapy for an acute injury and is popular with many athletes to help them to recover after exercise. But relying on ice to get you back into that senior-league basketball game or onto the running track when you’re already sore is inadvisable. “Athletes should consider that pain is usually a sign that something is wrong with your body.”  Listen, and stay out of the second half of the senior-league basketball game or skip a day’s run. You have the rest of 2012 to fulfill your resolution.

Talk About Complications - Roadblock To Medicare Reform a Big Problem

CRS report outlines hidden SGR roadblock.  

"The Sustainable Growth Rate is an ineffective formula that has an pending, accumulated major decrease in physician payments something on the order of 30%.  If these cuts were allowed to be enacted many anticipate a major exodus of physicians from the Medicare Provider panel.  In other words, not many doctors would remain to provide services to Medicare recipients.  This is a huge deal." ---Dr. Tarlow.  

According to MedScape Today, a report compiled by the Congressional Research Service (CRS), a division of the Library of Congress, outlines a fiscal complication that works against legislative repeal of the Medicare Sustainable Growth Rate (SGR) formula. The Congressional Budget Office (CBO) has estimated the 10-year cost of SGR repeal to be $300 billion. Because the law requires beneficiary premiums to equal approximately 25 percent of the total cost of the Medicare Part B program, repeal of the SGR would pass the corresponding cost increases to seniors. Should Congress act to repeal the SGR and avoid the premium increase, the CBO-estimated cost of repeal would swell by an additional $75 billion. The U.S. Congress recently delayed an SGR-mandated 27.4 percent cut to physician reimbursement until March 1, 2012.

New Year's Resolution - Lose the Knee Fat !

A New Year's resolution is a commitment that a person makes to one or more personal goals, projects, or the reforming of a habit. A key element to a New Year's Resolution that sets it apart from other resolutions is that it is made in anticipation of the New Year and new beginnings. People committing themselves to a New Year's resolution generally plan to do so for the whole following year. This lifestyle change is generally interpreted as advantageous.


Need motivation for your New Year's Resolution?


What better topic to discuss to start the New Year than body fat and the consequence of excessive fat on knees.   


I would like to post this photograph as impetus for exercising, eating healthy and caring for our bodies. Excessive body fat invades and accumulates in every nook and cranny in your body, not just in the belly.  This accumulation is unhealthy and is detrimental to healthy body functions.


What you are seeing is the accumulated fat removed from the knee of an obese man at the time of Total Knee Replacement surgery.  For reference, a 5 inch pen is in the field.  


In obese people the extra fat absolutely stuffs the inside and outside of a knee joint.   This fat limits knee motion, probably causes pain, and certainly makes total knee replacement more difficult to perform. 


So there you have it, a new wrinkle on how to motivate Americans to follow through on their New Year's Resolution.  For the health and happiness of our country, let's hope this helps.  

Ice/Compression Helps Knees Heal After Arthroscopic Surgery

Everyone knows that icing the knee after injury or surgery helps with pain control, limits swelling and speeds recovery.  This study identifies the chemical mechanism for these benefits.  Perhaps these authors did this study to prove to Health Insurance Companies that the commercially available Ice/Compression devices are have a medical necessity and are worthy of being reimbursed when used after knee surgery - patients sometimes bear this cost as an out of pocket expense.  


Local cryotherapy (cooling of the knee with "ice machine") - with devices such as Game Ready and Cryo Cuff - and compression after knee arthroscopy significantly lowered the temperature in the knee postoperatively, and  the decreased inflammation in the knee (measured synovial PGE2 concentration was correlated with the temperature. Since PGE2 is a marker of pain and inflammation, the postoperative local cooling and compression appeared to have a positive anti-inflammatory effect. In summary, local application of a cooling and compression device after knee arthroscopy significantly lowered the knee temperature and maintained the low temperature during the initial postoperative period. This is the first study to demonstrate a correlation between the PGE₂ concentration in the synovium of human subjects and the temperature in the knee joint. Since PGE₂ is a marker of pain and inflammation, this finding implies that postoperative cooling and compression of the knee has a positive anti-inflammatory effect. The proposed protective effect of hypothermia on post-ischemic and hypermetabolic tissue is likely due to decreased metabolism and energy needs of the cells, as shown by the stability of the lactate concentration despite the decreased blood flow indicated by the increasing ethanol ratio.

Narcotic Pain Dependence Has Adverse Affect on Total Knee Replacement Results

Background: 

Chronic use of narcotic pain pills (opioid medications) leads to dependence or hyperalgesia, both of which adversely affect perioperative and postoperative pain management, rehabilitation, and clinical outcomes after total knee arthroplasty. This study evaluated patients who underwent total knee arthroplasty following six or more weeks of chronic opioid use for pain control and  compared there outcome with a matched group who did not use opioids preoperatively.

Forty-nine knees in patients who had regularly used opioid medications for pain control prior to total knee arthroplasty were compared with a group of patients who had not used them.

Outcomes were worse in the narcotic pain pill group including Knee Society scores the opioid group had a mean of 79 points  as compared with a mean of 92 points in the non-opioid group. A significantly higher prevalence of complications was seen in the opioid group, with five arthroscopic evaluations and eight revisions for persistent stiffness and/or pain, compared with none in the matched group. Ten patients in the opioid group were referred for outpatient pain management, compared with one patient in the non-opioid group.

Patients who chronically use opioid medications prior to total knee arthroplasty are at a substantially greater risk for complications and painful prolonged recoveries. Alternative non-opioid pain medications (such as Aleve or prescription NSAID) is preferred and more commonly taken preoperatively for patients with painful degenerative disease of the knee.  A majority of patients with advanced knee arthritis do not regularly take narcotics prior to surgery.  These people have two distinct and separate medical problems, one being knee OA and the other being Chronic pain.  Both conditions need to be treated to obtain a successful outcome. The narcotic dependent patients need to have both their knee OA and their chronic pain conditions addressed by the orthopedic surgeon and the pain management physician in order to have a successful outcome after knee replacement surgery.