Patients in the News

Darius Rucker is a Star on the Stage, on the Golf Course, and in the Community

By Jim Brown, Executive Editor, SPRI News

“By the time I got to Dr. Steadman and the Steadman Clinic, my knee was a mess,” recalls Darius Rucker. “I had a history of bad knees, mostly caused by wear and tear, but this time it was worse. I couldn’t straighten my leg — couldn’t get it past 45 degrees.”

Darius Rucker is a Capitol Records Nashville award-winning country music star. Earlier in his career he skyrocketed to fame as the lead singer for the rock band, Hootie & and The Blowfish. Darius was given the 2010 Country Music Association New Country Artist of the Year Award (former called the Horizon Award), and his albums and singles have reached the top of all three national music charts. In 2008, his “Don’t Think I Don’t Think About It,” became a number one single.

But his knee problems were slowing Darius down both on the stage and off. “My knee bothered me, but you try not to let something like that stop you,” he says. “At one point, I had a staph infection that kept me in the hospital for two weeks. A torn meniscus, several operations, three surgeries to clean out the infection, and all the scar tissue put me in a lot of pain.”

“When you have a chance to see . . . .”

“A friend of mine, Al Perkins (a Steadman-Philippon Research Institute Board Member), told me I needed to see Dr. Richard Steadman,” Darius continues. “I knew who he was. Anybody who follows sports knows who he is, but I didn’t know him personally. Al arranged an appointment and I went to Vail.”

“I guess I could have gone somewhere else, but when you have a chance to see Dr. Steadman, you’d be a fool not to do it,” says Darius. “Once I met him, I felt like everything was going to be okay. When he walked into the room, the thing that struck me instantly was how laid back and real he was. After we had talked for two minutes, I felt like he had been my doctor for 12 years. It was like he didn’t have another patient to see that day. I thought that was pretty cool.”

Dr. Steadman and his colleagues “fixed” Darius’s left knee, cleaning out loose objects, smoothing frayed tissue, and repairing areas damaged by scar tissue — using techniques either pioneered or refined by research conducted at the Institute and put into practice every day by the team of physicians at the Steadman Clinic.

Stronger Than Ever

Darius, his music, and his knees are stronger than ever. His schedule is packed with dates at some of the most famous music venues in the world. In July, he will perform for the Institute’s annual summer fundraiser at the Gerald Ford Amphitheater in Vail, Colorado.

“I told Al I wanted to play a show for the Institute,” says Darius. “I’m busy, but not too busy to do something that might help the Clinic and the Research Institute.”

He is also back on the golf course. His knee feels fine, he plays five days a week, and he has a seven handicap, although he grew up in South Carolina wanting to be — believe it or not — a professional hockey player.

His charity event, “Monday After the Masters,” is in its 15th year. In April, a sold-out crowd of 6,000 fans watched Darius and his friends host scores of celebrity athletes and entertainers at The Dye Club at Barefoot Resort & Golf in South Carolina. The event has donated more than 4.5 million dollars to the Hootie & The Blowfish Foundation, which supports the educational needs of South Carolina and the South Carolina Junior Golf Foundation.

“As a former patient,” adds Darius, “I try to keep up with sports medicine, and what they are doing at Steadman-Philippon is always on the cutting-edge of orthopaedic technology and surgery. I respect everyone associated with the Steadman Clinic and the Steadman-Philippon Research Institute, and I support what they do.”

PATIENTS IN THE NEWS

Lindsey Vonn: On a Mission to Conquer the World

By Jim Brown

Lindsey Vonn, professional skier and a former Steadman-Hawkins patient, has a global view of things. As in Lindsey Vonn, Olympian, winner of two World Cup overall titles, four World Championship medals, two-time gold medalist already in 2009, and winner of a World Super G title. And that’s just the short list.

At 24, Lindsey has been called the most successful American skier in history, but thanks to her great talent, competitive nature, and cutting edge surgical techniques developed at the Steadman-Hawkins Research Foundation, she wants more and is likely to get it.

When your day job is to fly down the side of a mountain on skis at 60 miles per hour without a trapeze artist’s safety net or a NASCAR roll bar, getting health insurance can be a challenge. A sprained knee here, another knee injury there, a busted hip, and a severed tendon in her hand can make for high premiums or high deductibles — take your pick. At one point, Lindsey had to ski with her hand duct-taped to her ski pole (one of the few high-tech procedures not developed or refined at Steadman-Hawkins) because she couldn’t grip it tight enough without help.

Super G Crash in Austria

Downhill skiers know about injuries, so when Lindsey fell — make that crashed — during a 2006 Super G training run in Austria, she knew something bad had happened. “I was going real fast and something caught the edge of my ski. I did a few somersaults and hit my left knee ‘kind of funny’,” she recalls. “I knew it was bad right away.”

She had considerable pain, swelling, bruising, and a MRI that showed a probable small fracture. The first race of the season was coming up, so she took a week off and kept skiing. That’s what skiers do, and Lindsey kept doing it for the next few months.

“Toward the end of the season, I went to Vail to see Steadman-Hawkins orthopaedic surgeon, Dr. William Sterett,” says Lindsey. “I had suffered an injury to my other knee when I was 14, and he was my doctor then. He found cartilage damage and recommended surgery.”

The procedure performed by Dr. Sterett is called “The Package,” which is a series of arthroscopic procedures conducted during one operation designed to treat pre-arthritic and arthritic patients and to preserve joints. It was invented by Dr. Richard Steadman and has been validated through research at the Foundation.

“In the American and international skiing communities,” says Lindsey, “it’s just known that Steadman-Hawkins is the place to go if you have a knee injury. That’s where my mom took me when I was a kid. Dr. Sterett took good care of me then and he’s been my doctor ever since. He’s the best around and he’s my guy. I trust him.”

“The surgery didn’t take long,” she says. “When I woke up, I felt like a million dollars — like I had been sleeping a several days. My husband, a nurse, and the anesthesiologist were there right after the operation, and Dr. Sterett came in shortly to check on me.”

Lindsey recalls that, at first, the rehab program was tough. “The knee was swollen and moving it through a range of motion was difficult. I did rehab at the Howard Head facility three-four hours a day, then continued icing my knee and doing exercises at home. (Lindsey now owns a home near Park City, Utah.) When they repair cartilage, you have to give it time to heal. If not, you could have even more damage.”

The Steadman-Hawkins Experience

“The whole procedure and rehab program worked out great. I got stronger each week. By the time I got back on the snow, it felt great. No pain and I haven’t had any problems since. I’m 100 percent back. Even the three small scars have faded away. The procedures performed by Dr. Sterett allowed me to continue doing what I do, and now I have healthy knees.”

“I’ve been in other hospitals, but in my opinion, none of them take care of you like they do at Steadman-Hawkins,” says Lindsey. “And not just because I am a skier. I actually like to go back and visit with the staff. My surgery was easy because everyone made me feel so comfortable. That’s not normal.”

“Somewhere else they might have told me told me to either deal with the pain or stop skiing,” says Lindsey. “But because of the research conducted at the Foundation and the expertise of Dr. Sterett, I can do whatever I want to do.”

What she wants to do now is to conquer the skiing world. Watch for her when World Cup competition starts this fall and in the 2010 Winter Olympic Games in Vancouver. Lindsey Vonn may become one of the most famous Steadman-Hawkins ‘Patient in the News’ ever.

Larry Mullen, U2 Founder, Drummer, Brings International Perspective to Foundation

PATIENTS IN THE NEWS

Larry Mullen, U2 Lead Drummer, Moves Beyond the Music to Bring an International Perspective to the Foundation

By Jim Brown, Executive Editor, The Foundation News

Although Larry Mullen describes himself as just a “street drummer,”
he is, by the highest of standards, considerably more. As founder,
partner, and lead drummer for one of the world’s most famous rock
bands, U2, he has moved beyond entertainment to make a difference
in the lives of people around the world.

This should not be a surprise to those who have followed the
careers of Larry and his fellow U2 band members. This legendary
group has a well-deserved record of using its high-profile platform
to promote philanthropy, service, and social responsibility to a
worldwide audience. Now he has added his voice to the mission of
the Foundation as a member of its Board of Directors, the governing
group he joined in 2007.

Three Reasons

Why? “Three reasons,” explains Mullen. “Firstly, I have
benefitted so much from the incredible, cutting-edge resources,
expertise, and practices available here in Vail and I thought it
important to share the news. Secondly, I feel strongly that this
level of care should be available to everybody — celebrity and
non-celebrity, sportsman and non-sportsman — all over the world.
Lastly, the Foundation’s willingness to invest money and resources
back into the community was probably the single biggest part
of my signing on with the Board.”

Like other board members, athletes, and exercisers, Larry
first became aware of the Clinic through injury. “I was having
trouble playing due to a knee problem. I saw Dr. Muller-Wohlfahrt
in Germany. He recommended surgery, and suggested that I have it
done by surgeon Richard Steadman in Vail at the Clinic. I had been
told that Dr. Steadman was a pioneer in his field and I was desperate
and intrigued.”

The rest is history, but it is history still in the making. “I have
already seen Dr. Steadman, Dr. Philippon, and Dr. Millett, among
other physicians, as well as receptionists, lab technicians, imaging
specialists, scientists, administrators — practically everyone in the
building, and the way things are going with my body, I’ll probably
meet the rest of them by the end of the year.”

Occupational Hazards

“I’m a street drummer and I’ve physically abused—neglected
may be a better word— my body for a long time, through bad
posture, questionable technique, throwing myself around a stage,
not eating or hydrating as I should have, and sitting too much.
Almost all the things I do as part of my job are bad for my body.
It’s not just the physical act of hitting things. Rock and roll is about
freedom and escapism, it’s like running away to the circus. That’s
okay for about 10 years, then bits start to fall off. I was not trained
as an athlete, but I have to perform like one.”

His travel schedule is frenetic, exciting, and adds to the problem.
The day before he made a stop in Vail to have a hamstring
injury checked (and to give us this interview), he performed before
70,000 people at the new Dallas Cowboys football stadium. He left
Vail and flew to Houston for another concert the next day. During
the two weeks that followed, his schedule included dates in
Phoenix, Los Angeles, Norman, Oklahoma, Las Vegas, Vancouver
and New York, before performing in Berlin to finish the tour.
Larry Mullen is not a member of a flier program; he IS a frequent
flier program.

Confidence Based on Evidence

“That’s why Vail has become so important to me,” he says. “It’s
a ‘one-stop-shop’ for anybody with sports related injuries. I consider
it an integral part of my maintenance and recovery. The doctors are
willing to listen and are anxious to develop new ways to treat you
and heal you quickly, based on their expertise and supported by the
Foundation’s research. This is very important for me. What sets the
Clinic and Foundation apart is the confidence the doctors, scientists,
and staff members have in their own ability.”

Mullen now sees an opportunity to get this message out to the
rest of the world. “Larry’s international viewpoint and expertise at
branding and message delivery is invaluable to our Foundation,”
says Mike Egan. “Larry agrees with our mission of taking our expertise
and ability to educate around the world so that we can have a
positive impact on the next generation.”

Mullen’s Message:

“We have an incredible resource here,” concludes Mullen.
“I want to re-emphasize that this facility, its resources, the data it
has amassed, and its educational programs are not exclusively for
the privileged. It is available to all — and we should figure out ways
to share this treasure with people in the rest of the world so that
their quality of life can be improved.”

Articles

Vibration Training
CorePerformance.com, March 2009
By Jim Brown

The concept of vibration training, also called whole body vibration, is not new, but interest into its application for exercise and sports performance is higher than ever. Vibration training for athletes and serious exercisers involves standing, sitting, or lying on a platform that vibrates while the person performs exercises. The unstable platform activates, according to some studies, up to 95 percent of the fibers in a muscle, muscle group, or whole body compared to 40-60 percent of fibers activated during traditional resistance training. It also stimulates and challenges musculoskeletal structures (bones, muscles, tendons, and ligaments) as they adapt to the vibrating movement. The supporters of this training method claim benefits of strength, flexibility, and power. Its detractors are not convinced.

There is ample evidence that whole body vibration (WBV) can recruit more muscle fibers than other resistance training methods, but activating muscle fibers does not automatically translate to physiological or performance gains. WBV stimulates blood flow, which may speed up recovery after workouts and healing after an injury. Whole body vibration appears to have potential benefits in the areas of health (maintaining balance following a stroke, for example), rehabilitation (after an ACL injury), and athletic performance (that requires strength, power, or flexibility).

What the Research Says
Dozens of studies have demonstrated potential benefits, as well as shortcoming of vibration training. Following are some examples:

• Vibration training is an effective training method to improve maximal strength and flexibility if training equipment is properly designed. (Journal of Biomechanics, April, 2005)

• Whole body vibration resulted in an increased activation of leg muscles. (Journal of Strength & Conditioning Research, February, 2006)

• Acute whole body vibration training increased vertical jump and flexibility performance in elite female field hockey players. (British Journal of Sports Medicine, Volume 39, 2005)

• Whole body vibration over a six-week period produced significant changes in running kinematics and explosive strength. (Journal of Sports Science and Medicine, March, 2007)

• Whole body vibration training improved proprioception and balance in athletes who underwent reconstructed anterior cruciate ligament surgery. (British Journal of Sports Medicine, January, 2008)

• Combined whole body vibration and conventional resistance training did not increase maximal muscle contraction or performance. (European Journal of Applied Physiology, March, 2006)

• Whole body vibration has the potential to induce strength gain in knee extensors among untrained females to the same extent as traditional resistance training at moderate intensity. (Medicine & Science in Sports & Exercise, January, 2003)

• WBV is a suitable training method and is as efficient as conventional resistance training in improving knee extension strength and speed of movement in older women. (Journal of the American Geriatric Society, Volume 52, 2004)

• Knee extensor and knee flexor strength are not significantly different between vibration training and control groups. Also, “getaway” out of the blocks, acceleration, and top speed were unaffected in sprinters. (International Journal of Sports Medicine, Volume 26, 2005)

• Among the four studies presented at a recent meeting of the American College of Sports Medicine, none found a significant immediate effect of vibration training on physical performance.

• With WBV training, younger fit subjects may not experience gains unless some type of external load is added to WBV exercise. WBV has demonstrated gains in flexibility in younger athletic populations. (Current Sports Medicine Reports, May/June, 2008)

Opposing Views
Michael Marotti, CSCS, Director of Strength and Conditioning at the University of Florida, says, “Our players like vibration training, they believe in it, and it works for them, so we’re going to use it.” This bit of anecdotal support is noteworthy and an example that the method is being used in high-profile NCAA Division I sports programs.

Edward R. Laskowski, MD, co-director of the Mayo Clinic Sports Medicine Center has a less-than-enthusiastic view. “Whole body vibration is unlikely to result in any measurable weight loss or fitness gains.”

No large-scale studies involving recreational or elite athletes have been conducted. Those that have been completed, regardless of results, have been limited by small samples, specific demographic groups (sprinters, women, or older adults, for example), and a variety of research designs. Although these limitations exist, they are typical of early research in any scientific field. A body of supporting evidence collected over a period of time, as well as measurable on-the-field results, is the ultimate indicator of the value of any training method, including whole body vibration.

Training Variables
Before beginning a program of vibration training, decisions must be made regarding several variables, all of which can be modified. Those variables include frequency, amplitude, duration, body position, and external load.

Frequency refers to how many repetitions or oscillations the platform completes during a one-second cycle. In theory, the higher the frequency, the greater the load placed on the muscles and bones. Frequency is measured in hertz, and frequency in commercially available platforms usually range from 14 to 60 Hz.

Amplitude determines platform’s range of motion — how far it moves in any direction. The higher the amplitude, the greater the movement of the platform and the greater the intensity of a workout. Amplitude ranges from 3-10 mm.

Duration is how long each session of vibration training lasts. At present, the length of time ranges from 40-240 seconds (four minutes).

The number of repetitions (how many times the athlete repeats a vibration training sequence of exercises) used in research thus far is as few as three and as many as ten.

The types and amounts of external load are also variable. A person might perform any of several lifts (barbell squats, triceps dips, or knee extensions, for example) with specific loads or complete a vibration training session without external loading.

The results of vibration training are likely to depend on each individual’s response to the variables just described. There are no research-supported guidelines that apply to everyone. The same thing, however, was once said regarding the effects of traditional resistance training.

Conclusions
There is enough scientific evidence to indicate that whole body vibration training has the potential to become an effective tool when added to conventional resistance training exercises. There is not enough evidence, however, to conclude that every athlete should incorporate vibration training into his or her exercise program or that it is superior to other types of training. The cost of vibration platforms, which can be several thousand dollars, must be weighed against potential benefits.

If ongoing research continues to provide more supporting evidence than it does evidence to the contrary, vibration training combined with external loading may become an accepted adjunct to resistance, flexibility, and aerobic training. Based on how long it has taken other innovative forms of training to be fully accepted by the scientific community (weight machines, elastic bands, plyometrics, dynamic stretching), vibration training may be years away from fulfilling its promise. Establishing proper guidelines for its use could speed up that projection.

Vibration training has already been incorporated into training many routines, including those at Athletes’ Performance Institute and the Core Performance Center. It is likely to be used in combination with — not as a replacement for — conventional exercise protocols. A recreational athlete or elite performer cannot vibrate his or her way into peak condition or athletic performance. The formula for those achievements will always include personal dedication, wise use of training time and equipment, sound nutritional practices, and evidence-based principles of training.

Reaction Time
CorePerformance.com, March, 2009
By Jim Brown

Overview
Scientists have been studying reaction time for more than a hundred years and they are still discovering new elements of the process and their effects on sports performance. In 2008 researchers at the University of Alberta found that Olympic sprinters closest to the starter’s pistol reacted more quickly than those farther away. Why? Because the louder the noise (within reason), the shorter the reaction time. The difference in reaction time was measured in hundredths of seconds, but at the elite level hundredths of seconds can mean the difference between winning and losing, fame and relative obscurity, and first place money versus lower payouts.

How It Works
There are at two ways — some say three — to classify reaction time. Simple reaction time refers to a single stimulus (hearing a starting pistol) and a single response (running). Choice reaction time means reacting to more than one stimulus (in baseball, hearing the sound of a bat hitting the ball and visually gauging the speed and path of the ball after it is hit). Reaction time itself is an inherent ability, but overall response time involves a variety of factors, including practice, experience, anticipation, strength, and coordination. Each athlete has a built-in, limited time range to react, but within those boundaries is plenty of room for improvement.

“The process loop is very important for reaction time,” says Mark Verstegen, Founder and CEO of Athletes’ Performance and Core Performance. “We have to be sure the athlete can take the stimulus — whether it is verbal, visual, tactile, or in some other form — and turn it into a response. A person can have great reaction time, but it doesn’t help if his or her body can’t do anything about the stimulus. You have to be able to take advantage of the process. That means being in the right body position (with all the right angles) to take advantage of the situation.”

By the Numbers
190 milliseconds (0.19 seconds) – the amount of time it takes a college-age person to react a visual stimulus

140 - 160 ms (0.16 seconds) – the amount of time it takes a college-age person to react to a sound stimulus

0 - late 20s – the ages at which simple reaction time shortens (get faster)

late 20s – 50s & 60s – the ages during which simple reaction time slowly increases (gets slower)

.375 seconds – the amount of time a baseball players has to react to a 90 mph fastball

Reaction Time Research
Hundreds of studies have been conducted over the past century, and each one reveals a little more about reaction time and sports performance. Here are some examples:

• Researchers in Great Britain found that sprinters, although they might have an inherent reaction time advantage, learn to react more quickly to a starter’s pistol than distance runners. Even when the length of sprints was artificially increased, sprinters took more time to react to the gun — a learned response.
In related research, French exercise scientists found that reaction time was progressively quicker as race length shortened from 400 meters to 60 meters. They also discovered that decreased, or shortened, reaction time was not observable in less experience sprinters (18-19 years old). And they observed that sprinters in 60-meter and 100-meter events tended to anticipate the starter’s gun, while those in longer races were content to respond to the sound of the shot.

• At the University of Alabama at Birmingham, sports scientists performed vision screening tests of 213 minor league baseball players, then matched test results with hitting ability. Age and race did not affect hitting performance, but an association was found between visual reaction time and batting skill. No association was found in fielding skills, although it could be assumed that catchers and third basemen better have quicker response time than pitchers and outfielders to play well at their positions.

• Japanese researchers tested 22 baseball players, 22 tennis players, and 38 non-athletes. There were no differences in simple reaction time between the two groups of athletes, but baseball players scored better the GO/NOGO test, which involves pressing a button or not pressing a button as a result of a stimulus. The GO/NOGO reaction time of higher skill baseball players was significantly shorter than that of less skilled players. Professional baseball players had the shortest reaction time of all groups. The research team concluded that practice can improve GO/NOGO reaction time, but not simple reaction time.

• A study conducted at the University of Illinois found that highly skilled tennis players used visual skills to react to balls hit by their opponents, something they were not able to do as effectively on balls projected by a machine.

• Based on a review of reaction time research, the authors of an article in Perceptual Motor Skills concluded that “reaction time must be considered a skill dependent upon experience and learning.”

Coaching Keys
There is plenty of evidence that strength training, aerobic and anaerobic development, and sports skills should be practiced in a manner that simulates game or event conditions as much as possible. Movements that are practiced in game-like situations are the ones most likely to be used in competition. Those non-specific, look-good, why-am-I-doing-these drills that still take up valuable practice time in every sport should be questioned. (Think quickness drills in football in which players, on command, rapidly move their hands from head to knees to shoulders to other parts of the body. Impressive looking, but which positions require those patterns of movement?)

Examples of sport-specific drills include the following:

• Wave drills and one-on-one drills in basketball
• Rapid fire volley drills in tennis
• Football drills in which linemen drop to the ground, then return to a starting position
• Starting drills in swimming and track
• Digging, sprawling, rolling, recovering, and blocking drills in volleyball
• One-on-one defensive drills and short-range goal-defending drills in hockey and soccer
• Face-off drills in hockey
• Smash-return drills in badminton

There is still a place in the training routine for less-than-sport-specific activities. Explains Verstegen, “If a football player doesn’t have basic motor abilities, he won’t pick them up just playing football. For example, if a running back just does position work, it won’t necessarily improve his speed, quickness, cutting ability, or acceleration. That’s why we try to find exactly the right activity at Athletes’ Performance and Core Performance to develop those skills.”

Take-Away Messages
There are several take-home messages for coaches, athletes, and parents of athletes regarding reaction time. The first is that although there are inherent limitations to reaction time, each athlete can improve — shorten — response time and offset some of the limitations that still exist through experience and anticipation.

The second message is to allow enough time to develop motor skills (running, stopping, changing directions, jumping, and throwing, for example), as well as strength, speed, flexibility, and endurance that are needed to play a sport.

Finally, incorporate your improved reaction time, enhanced motor skills, and better overall fitness into sport-specific training and competitive situations.


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Matt LaPrade: Raising Awareness of FAI

Steadman-Hawkins Research Foundation News, Summer, 2009

By Jim Brown, Executive Editor

Question: What do the following athletes have in common: Alex Rodriguez, Greg Norman, Nancy Kwan, Mario Lemieux, Kurt Warner, and Matt LaPrade?

Answer: They all had a relatively unknown condition called femoroacetabular impingement (FAI), they were all successfully treated by Dr. Marc Philippon, one of the famed orthopaedic surgeons at Steadman-Hawkins, and they all returned, or will return, to very high levels of competition in their respective sports.

Matt LaPrade is a two-sport honor student who will return to his hockey team this fall at Holy Catholic High School in Victoria, Minnesota, near the Minneapolis-St. Paul Metro Area. He was an All-Conference goalie during his freshman and sophomore seasons. Matt may not be as well-known — yet — as the Hall of Fame athletes mentioned above, but his case will be important in raising national awareness of FAI among young athletes. Here is his story.

More Than Just a Groin Injury
“My hips started hurting early in the 2008-2009 season,” he explains. “I thought I had just tweaked a groin muscle. It was sore at first, then the pain gradually increased. Both sides hurt, but the pain was worse on the right side. By the end of the season, I felt it almost all the time — sitting, walking, getting down into the butterfly position, whatever.”

[Editor’s Note: The butterfly technique is a style of play used by goalies in hockey. Butterfly goalies play with their feet apart and knees bent. On low shots they drop to their knees and spread their legs to cover the bottom of the net. Don’t try this at home.]

Matt had hip pain four years earlier, but x-rays did not reveal FAI. Once the 2009 season was over, he had another set of x-rays in taken Minneapolis and they showed FAI in both hip joints. The x-rays illustrate that FAI is a developmental condition. It doesn’t exist at birth, but it can develop during the years when a person’s bones are still growing.

Professional Advice at Home
Matt’s mother, Sandy, was a critical care nurse and is now a fulltime mother of three boys. Chris, 18, just graduated from high school and will attend the University of Minnesota. Jeff , another goalie in the LaPrade family, is 14. Matt’s father is Robert LaPrade, M.D., Ph.D., a nationally prominent knee and shoulder surgeon at the University of Minnesota.

The LaPrades decided that Matt’s treatment should be done in Vail. Matt says he didn’t know about Steadman-Hawkins or Dr. Philippon, but his parents did. “We knew that Steadman-Hawkins is the best orthopaedic clinic in the country and that Dr. Philippon is the best hip specialist in the world,” explains Sandy. The treatment Matt would receive is an orthroscopic procedure to correct excessive bone growth at the hip socket that characterizes FAI. It has been developed and validated by Dr. Philippon and his colleagues through research conducted at the Foundation.

First Impressions
“My first impression of Steadman-Hawkins was good,” remembers Matt. “Everything felt comfortable. The placed was packed, but everyone looked happy, and walking down those hallways and seeing the jerseys of all of those famous athletes who had been treated there made me feel good. I knew that this was not going to be career-ending surgery.”

Within hours after the first surgery, Matt was already doing rehab exercises. He stayed in Vail for a week in order to participate in specialized hip therapy at Howard Head Sports Medicine in the Vail Valley Medical Center. Four weeks later he was back in Vail for surgery on the other hip.

“Dr. Philippon is probably one of the few hip surgeons in the world so familiar with the FAI condition that he knew a 16-year-old’s body would be able to recover quickly,” says Sandy. “That’s why we were able to have the second procedure done so soon after the first.”

Update
How does Matt feel today? “Really good,” he says. “I started skating yesterday (six weeks after the second surgery). No pain, a little tightness in the left hip, but it gets better every day.”
What about the Steadman-Hawkins experience? “It’s the best possible care you could get,” answers Sandy. “State-of-the-art everything. It’s like nothing I had ever seen. The atmosphere is upbeat, everyone works together, and you know the decisions they make are backed by research.”

Matt has a word for other young athletes who might have hip pain or even FAI. “If the pain doesn’t go away pretty quickly, see a doctor. Even if it happens after a season has started, do something about it sooner rather than later. That way, you’ll be able to go all out the next year.”

The Big Picture
Dr. Philippon, not surprisingly, sees the big picture. “Matt has a great future ahead of him. We were able to intervene early and treat his injury. The procedure gives him a healthier joint and a chance to continue playing his favorite sport at a high level without worrying about his hip as a limiting factor.”
Matt LaPrade didn’t choose to be injured or to need surgery. But, to our knowledge, he the only hockey player in the world to have successful FAI surgery on both hips at the young age of 16. By going through this process early in life, he has raised the awareness of a potentially career-ending condition and injury, and his story might encourage others to seek medical attention early rather than waiting and hoping that their hip pain will go away. That’s enough to put Matt in our FAI Hall of Fame.
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Dr. Marc Philippon and the Foundation: A Perfect Fit
Steadman-Hawkins Research Foundation News, Summer, 2009
By Jim Brown, PhD, Executive Editor

Consider this scenario. You have successful practices in two states. You serve as a consultant to professional teams and leagues, and you treat high-profile athletes in multiple sports. You are on the faculty at a large, well-respected research university and you direct the sports medicine/hip disorders programs. You’ve already been recognized as one of the leading orthopaedic surgeons and hip specialists in the world, and you can live and work anywhere you like. You’re set for life, right?

Not if you are Marc Philippon, M.D., who left what many would consider a dream job to move his family to Vail and to become a partner in the Steadman-Hawkins Clinic and member of the Steadman-Hawkins community. Why?

“It was a perfect fit,” answers Dr. Philippon. “I had known Dr. Steadman (and Dr. Hawkins) for some time, and they been referring patients to me. I knew that Dr. Steadman was a great surgeon and a great innovator, and I was honored to become a part of the Clinic and Foundation. Dr. Steadman asked me to continue what I had been doing at the University of Pittsburgh and to keep developing the fellowship program I had in Pittsburgh with the same type of program here in Vail.”

“But probably the most important factor was the Steadman-Hawkins Research Foundation,” says Dr. Philippon. “It was well established and well-known in the orthopaedic medical community and around the world. I thought this position would allow me to do with hip disorders what Dr. Steadman had done with the knee.”

And then there are those Colorado mountains. “There were also the mountains, the skiing (Dr. Philippon and his wife, Senenne, both like to ski), the town of Vail, and the positive energy at the Clinic and Foundation,” he adds. “Everybody I’ve met is happy. They are willing to help, and everybody from the person at the front desk on seems to be happy to be here. It’s like a big family.”

Dr. Philippon is now a managing partner of the Clinic, a member of the Foundation’s Board of Directors, and a member of the Scientific Advisory Committee. “The decision to come to Steadman-Hawkins,” says Dr. Philippon, “turned out to be a very good idea.”

International Recognition
Dr. Philippon treats a variety of hip disorders, but much of the international recognition he has received comes from his innovative, arthroscopic treatment of a condition called femoroacetabular impingement. (Luckily for us, we’ll call it FAI from here on.) FAI, which affects 10-20 percent of the general population, is a developmental condition (not something that exists at birth) in which abnormally shaped bones of the hip rub against each other during movement. This repetitive action eventually damages the soft tissue in the area, particularly the articular cartilage, and damaged cartilage is hard to treat. Any sport that involves forceful rotation — golf, hockey, baseball, football, and soccer, for example — can compound the FAI problem.

“FAI is a disease of active people,” says Dr. Philippon. “It has been seeing us for many years, but we were not recognizing it. And until recently, we didn’t have a predictable treatment. Now we have a better understanding of the problem and better surgical techniques. Many people who might not have sought treatment earlier follow the example of professional athletes who have the procedure to correct FAI and return to their sports relatively quickly.”

Treating High Profile Athletes
Although Dr. Philippon and the other surgeons at Steadman-Hawkins don’t deliberately seek professional athletes as patients, the athletes find them. Dr. Philippon had already treated golfer Greg Norman and hockey great Mario Lemieux before coming to Vail, and more recent patients have included Arizona Cardinals quarterback Kurt Warner and Yankee slugger Alex Rodriguez.

“These people make a living with their bodies,” explains Dr. Philippon. “They try to go a place where they are safe and where they think they will have a good outcome. The word gets around to other elite athletes and then to the general public.”

Does he feel any added pressure treating high-profile athletes? “Not really,” answers Dr. Philippon. “I treat everyone like I would treat my parents and my family. The key is preparation. The work of the Foundation prepares us for any kind of surgery. If we are well prepared, it is easy to execute well. The goal of the Clinic, the Foundation, and the physician to is provide every patient with the best possible care.”

The Next Big Thing
Dr. Philippon’s vision for the injuries he treats and for the research of the Foundation extends beyond FAI. “I’m interested in the prevention and treatment of hip injuries, but also in figuring out a way to actually modify the course of cartilage damage. We need to make cartilage more durable. It will be difficult because every joint has specific cartilage, several layers of tissue, and a lack of blood supply. It’s very complex.”

There are other items on his already-full agenda. “Repairing the labrum (the ring of cartilage around the joint), reconstructing the labrum, treating cartilage injuries, and early detection are all in the future of hip injuries,” he says.

The Foundation and its surgical outcomes database are making Dr. Philippon’s work possible. “When I came in 2005, we didn’t have much of a database for hip injuries. Now we have 2,000 cases in our database and in five years we’ll probably have close to 4,000. Most importantly, we’ll have more answers in terms of the prevention of hip injuries and in the health of cartilage after FAI treatment.”

“If the Foundation’s research allows us to discover better prevention and better techniques to repair cartilage, it will have a huge impact. We’ll be able to help more people remain active as long as they want without having hip joints replaced.”

When — not if — that happens, it will truly have been a perfect fit for Dr. Philippon, the Foundation, and patients who want to keep their hips healthy.
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When Knee Pain is Not Arthritis
Cleveland Clinic Arthritis Advisor, February, 2009

Osteoarthritis (OA) is the most common cause of knee pain in people over the age of 50, but a formidable list of other conditions can cause similar pain. You might not associate some of the ailments on that list with the knee.

“Gout, bursitis, stress fractures, meniscus damage, and osteonecrosis are just a few of the problems that might affect older adults,” says Susan Joy, MD, Director, Women’s Sports Health at Cleveland Clinic.

Gout
Gout affects the big toe 75 percent of the time, but it can also affect the knees, ankles, wrists, fingers, and elbows. It is an accumulation of needle-like crystals of uric acid in the connective tissue, in the joint space between the two bones, or both. Men are more likely to develop gout than women, and it rarely occurs in women before menopause.

When the knees are involved, how will you know whether it is gout or knee osteoarthritis? “Your doctor may have to perform tests to give you a definitive answer, but you can provide information about your symptoms that could make a diagnosis easier,” says Dr. Joy. “Typical knee OA symptoms are pain with activity, limited range of motion, stiffness, swelling, joint tenderness, and the feeling that the knee may not support your weight.”

“The onset of gout often develops suddenly,” adds Dr. Joy, “and may be triggered by certain medications, surgery, stress, illness, eating cured meats, or drinking alcohol, particularly red wine.” Symptoms include pain and swelling in the joints, and episodes usually subside within three to 10 days, with or without treatment. The next attack may not come for months or even years. Over time, however, attacks can last longer and happen more often.

The goal of treatment is to ease the pain with nonsteroidal anti-inflammatory drugs (NSAIDs), such as indomethacin (Indocin) and naproxen (Naprosyn) or corticosteroids (prednisone).

Bursitis
Bursitis is an inflammation of the fluid-filled sacs around joints that allow for ease of motion, and it can develop on its own or accompany osteoarthritis, rheumatoid arthritis (RA), or gout. It is often associated with the shoulder and elbow, but affect any joint, including the knees.
“Look for swelling and limited range of motion — both symptoms that could be confused with OA — complicated by the fact that the conditions could occur simultaneously,” according to Dr. Joy. “Bursitis pain may be milder than OA pain. Self-treatment includes rest, ice, and medications for pain and inflammation and specific exercises to improve strength and flexibility.”

Stress Fractures
Fifty percent of women over the age of 50 and 25 percent of men over 50 will have an age-related bone fracture, according the Berkeley Lab, a U.S. Department of Energy research facility that investigates a wide range of scientific disciplines. Older, brittle bones can withstand only a fraction of the pressure they once could. Persons with osteoporosis, diabetes, and RA are at even higher risk for stress fractures. In older adults, most stress fractures occur in the lower leg, and knee pain could be one of the symptoms. A dull ache, swelling, or a tender spot are among the warning signs.

“Your doctor will ask about symptoms, check for swelling and tenderness, and may use x-ray or MRI to help make a diagnosis,” says Dr. Joy. “Stress fractures may not be visible on an x-ray for several weeks after an injury has occurred. If a stress fracture is found, the treatment is very conservative —the key is rest from the activities that cause pain.”

Meniscus Damage
The two menisci in each knee rest between the two long bones of the leg. They are essential for distributing weight evenly, absorbing shock, and maintaining stability of the knee joint. When they wear out or tear because of the degenerative process in older adults, the primary symptoms are pain and swelling. The joint may lock, you may not be able to straighten your leg, and you might hear a popping or clicking sound.

Physical examination and sometimes MRIs are commonly used to diagnose meniscus tears, and treatment varies with the severity of the injury and the lifestyle of the person. In young patients, efforts are often made to preserve a damaged meniscus rather than remove it. In older adults, according to Dr. Joy, meniscus replacement is not currently used. There are ongoing investigations on possible ways to repair or replace an injured meniscus.

Osteonecrosis
Also called avascular necrosis (AVN), osteonecrosis is a disorder in which there has been a decrease in the supply of blood to an area of bone — often the upper head of the femur, which is part of the hip joint. The knee and shoulder joints are also commonly involved. The exact cause is unknown, but associated risk factors include trauma, medications (steroids), and excessive alcohol use.

“The mechanism that leads to death of the bone has not been established,” explains Dr. Joy, “but the cartilage overlying the dead area deteriorates, which causes pain and limits range of motion.”
The symptoms of AVN are a dull ache in the joint or severe pain, and there can be pain at rest. Among those at risk are people who take steroids and those with RA or systemic lupus. According to the National Institutes of Health, AVN affects those between 30 and 50, but rheumatologists, primary care physicians, and orthopaedic surgeons also see the condition in the knee joints of women over 65.

Osteonecrosis is usually diagnosed with a MRI, but sometimes the condition can be observed in routine x-rays. No definitive treatment has been established, but surgery if often required, especially if the joint has collapsed. Recently, patients have been treated with bisphosphonates and blood thinning medications, but with mixed results.

Infection, Tendinitis
“Infection and tendinitis are two more possible causes of non-osteoarthritis knee pain,” adds Dr. Joy. “Knee pain and swelling, sometimes accompanying fever and chills, could develop after surgery, after an injection, or in people with poor over-all health. Tendinitis does not generally cause swelling in the knee joint, although it may be tender in that area. Tendinitis often improves with stretching exercises, ice applications, and a gradual return to walking and other activities.”

The Short List
The conditions discussed in this article represent the short list of things that can go wrong in the knee. OA is a common cause of knee pain, but recognizing symptoms of other conditions and being able to describing them to your doctor can result in an accurate diagnosis and effective treatment.

What You Can Do
• Avoid foods and beverages, specifically cured meats and excessive alcohol, that might trigger episodes of gout.

• Make a list of specific knee pain symptoms (severity, location, how long symptoms last, time of day or night) you are experiencing to share with your doctor.

• While waiting to schedule an appointment with a doctor, rest the knee, apply ice applications, and use over-the-counter medications for pain and inflammation caused by bursitis, possible stress fractures or meniscus damage, and tendinitis.

• Ask your doctor or physical therapist about appropriate strength and flexibility exercises to protect your bones and joints.
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Arthritis and Exercise: Rules of Engagement

Cleveland Clinic Arthritis Advisor, July, 2009

There is a fine line between exercise that strengthens the joints of the body and increases flexibility and those that could make the symptoms of osteoarthritis (OA) worse. Even the results of research can send conflicting messages. Some studies show an association between mechanical strain, weak muscles, and knee arthritis, while many others have proven that strengthening joint-supporting muscles can reduce pain, and enhance both flexibility and mobility.

A.J. Cianflocco, MD, Program Director for Cleveland Clinic Primary Sports Medicine Fellowship, and physical therapist Dr. George Sibel, provide some direction regarding which exercises to avoid, and they suggest the types of activities that could help you diminish or prevent some of the symptoms that accompany osteoarthritis.
“Activities to avoid are the ones that hurt, particularly while you are engaged in the activity,” says Dr. Cianflocco. “Pain is a red flag that tells you to stop what you’re doing and perhaps eliminate it from your exercise routine. If the discomfort develops only after an activity, you may be able to get back to doing it with either less intensity, fewer repetitions, or for a shorter period of time.”

What Are the Risks?

The risks of engaging in dangerous exercises are as clear as they are simple: pain and further injury to a joint that has already been damaged. “An arthritic knee may not be as strong or as stable as a healthy one,” explains Cianflocco. “The wrong kind of exercise could aggravate the condition, cause more pain, and lead to progression of the disease. In the case of knee osteoarthritis, the joint could buckle under the weight of your body.”

The impact of dangerous exercises depends on you. What kind of shape are you in? Is your weight in an acceptable range? Are you used to participating in a particular activity? If you already have severe OA, you could make a bad condition even worse. If you are in the beginning stages of the disease, you might get away with temporary discomfort and a warning sign that tells you to take a second look at what you’re doing to your body.

Dr. Cianflocco has painted a broad picture of potentially dangerous exercises, George Sibel gets more specific. “Be careful with leg extension exercises that are normally used to strengthen the quadriceps muscles (on front of the upper leg) and leg curls for hamstring (on back of the upper leg) strengthening,” he says. “Both should be done in a pain-free arc, avoiding full extension and avoiding flexion (bending the knee) more than 45 degrees. Specific activities that risk knee damage are those that cause high impact, such as running, aerobic exercise on hard surfaces, skiing, and playing singles in tennis.” In addition, let’s assume that your football, soccer, and full court basketball days are already over.

Dr. Cianflocco adds this advice regarding muscle and joint pain during and after exercise. “There may be some discomfort, but there does not have to pain or soreness for exercise to be effective. The premise of no pain, no gain does not apply. It is possible to work within a comfortable range and still make progressive gains in strength.”

Arthritis-friendly Exercises and Activities

Having knee osteoarthritis is not a reason to discontinue a resistance training, range of motion exercise programs, or all sports. “The key term is ‘low-impact,” says Dr. Cianflocco. “Swimming, walking, cycling, dancing, bowling, resistance training, tai chi, and golf are okay unless they aggravate symptoms. From there, you may be able to move up to doubles in tennis, softball, or even common-sense basketball, depending on the severity of the condition and the amount of pain these activities cause.”

Both Cianflocco and Sibel agree that water exercise is an acceptable activity for those with knee OA, but only in the proper context. “Everybody needs a basic land-based quad and hamstring strengthening program. The stronger the quads, the more stable the knee and the amount of pain. Following that basic program, you can add a water-based program, but understand that in doing so, you are working against resistance that is 50 percent of what it would be on dry land. The next level of exercise would bring into play seated leg presses, stationary bicycle work against resistance, and step-ups — stepping up and down a single step, using body weight for resistance.”

Guidelines

Regardless of the kind of exercises, there are guidelines for people with OA to follow. Here are four to follow:

• Warm-up before beginning an activity. You can even warm up before you warm up. “I’m a guy who turns on his car heater regardless of the time of year to warm up my back on the way to the golf course,” Cianflocco confides.

• Start slowly and increase the exercise intensity and duration gradually. Follow the ten percent rule: Never increase exercise intensity, frequency, or duration more than 10 percent a week.

• Be careful with or avoid rapid movements of affected joints. Slow and moderate-speed body movement is okay.

• Adapt your favorite activity to your situation. Doubles is safer than singles in tennis. Walking is safer than jogging. Swimming and cycling may be more appropriate than running or walking.

Forty-eight hours between activities may be more appropriate than 24 hours. You can get around that rule by participating in different activities (that involve different joints) on alternate days.

Take-to-the-Gym Message

Participating in a program of exercise, physical activities, and even sports might be even more important now than it was before the onset of osteoarthritis. It will not get better without your intervention, and it doesn’t have to ruin the quality of your life.

Drop the exercises that are dangerous. If that is not an option, modify them to reduce the risk of pain and further damage. If that doesn’t work for you, it may be time to find new and challenging physical activities that are enjoyable, healthy, and safe, and within the restrictions imposed by a condition that is likely to last as long as you do.

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What You Can Do to Avoid Dangerous Exercises and Activities

• Use pain as a guide to safe exercise. If an activity hurts, stop doing it.

• If you feel pain only after an exercise has been completed (or on the next day), try doing the exercises the next time with fewer repetitions, less intensity, or for shorter periods of time.

• Avoid high-impact activities such as running, playing singles in tennis, and aerobic exercise on hard surfaces.

• Choose low-impact activities such as swimming, walking, cycling, dancing, bowling, resistance training, tai chi, and golf, as long as they do not cause pain.

Biomarkers Predict Rheumatoid Arthritis Before it Develops

Duke Medicine Health News, July, 2009

Researchers at Brigham and Women’s Hospital and Harvard Medical School have detected two proteins released by the immune system that, when elevated, serve as biomarkers for future rheumatoid arthritis (RA). The findings appeared in the March 2009 issue of Arthritis & Rheumatism.

Rheumatoid arthritis is a severe form of the disease and affects more than two million people in this country. Three out of four are women. The exact cause is not known, but it is thought to be an autoimmune disease — one in which the immune system attacks its own connective tissue and joints.

Blood samples from 77 women in the Women’s Health Study plus 93 women from the Nurses’ Health Study were taken up to 12 years before all of them eventually developed recognizable symptoms of rheumatoid arthritis. At the time of the sample, tumor necrosis factor (TNF) and interleukin-6 (IL-6) levels were elevated, but no symptoms of RA were present. Those findings were compared to TNF and IL-6 levels in three matched control group subjects who did not develop RA for every case in which arthritis later appeared.

When the Boston team analyzed the results, they discovered a 40 percent increased risk when comparing the top and bottom quartiles on IL-6 concentrations and a 100 percent increased risk of rheumatoid arthritis in the top and bottom 25th percentiles among those who had elevated TNF levels. They also measured high-sensitivity C-reactive protein levels, which is an indicator of inflammation, but did not find significant associations.

“Even modest elevations in these biomarkers were predictive of time intervals up to eight years before the onset of rheumatoid arthritis symptoms,” says Elizabeth W. Karlson, MD, Division of Rheumatology, Allergy, and Immunology at Brigham and Women’s Hospital.

Three-Phase Process

Based on their findings and the results of previous studies, the researchers determined that rheumatoid arthritis appears to develop in three distinct phases. The first is a genetic predisposition to the condition. Up to 70 percent of RA patients fall into this category. The second is a stage in which there is pre-clinical (no symptoms), abnormal activity involving the autoimmune system. The final stage is rheumatoid arthritis and the symptoms normally associated with the disease, including joint pain, swelling, and tenderness, red, puffy hands, tissue bumps under the skin of the arms, fatigue, morning stiffness, fever, and weight loss.

Possible Prevention of RA

“Our study suggests that biomarkers of inflammation may be useful in the prediction of disease risk,” adds Dr. Karlson, “and this opens up the opportunity for the prevention of RA based on identifying high risk individuals with auto-antibodies and elevated markers of inflammation.”
Screening for the two proteins could also be used to counsel women about the risk of rheumatoid arthritis and to develop methods that might some day allow doctors to treat RA sooner and more effectively.
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Exercise May Slow, Reverse Brain Decline

Duke Medicine Health News, March, 2009

Moderate-intensity aerobic exercise — the kind that can make you breathless — is likely to improve brain function and reverse the neural decay frequently observed in older adults, according to a study published online October 16, 2008, by the British Journal of Sports Medicine.

“Brain deterioration and cognitive decline are not inevitable characteristics of aging,” says Kirk Erickson, PhD, co-author of the study. “Older adults can live long, happy lives without experiencing severe memory impairments, lapses in attention, or other cognitive deficits, as long as they engage in regular exercise. ”

Dr. Erickson and Dr. Arthur Kramer, both of the University of Illinois Beckman Institute, examined the findings of ten studies regarding exercise and mental decline among approximately 450 subjects. The review, not surprisingly, showed the benefits of aerobic exercise and physical activity on the aging brain. However, the research also found compelling evidence that the benefits extended to “executive-control” brain functions.

Executive Control Tasks
Deterioration in white and gray matter in certain areas of the brain is known to cause cognitive decline. The most profound effects are those related to executive control functions, which include task coordination, planning, goal maintenance, working memory, and the ability to change tasks.

Kramer and Erickson had previously conducted a six-month study among adults ages of 60 to 75 who walked briskly for 45 minutes a day, three days a week. Aerobic fitness and mental capacity among the exercisers improved significantly over a control group that performed muscle-toning and stretching exercises only.

Other studies in the review showed that subjects who had higher fitness levels also had less evidence of deterioration of brain gray matter, which is vital for the thinking process. In one investigation, older women whose lifestyle included moderate amounts of aerobic exercise had more gray matter, and the women did better on executive control tests than women who were less fit. The findings held up regardless of whether the women took hormone replacement therapy, which has been shown to improve cognitive function.

Kramer and Erickson also discovered that some of the effects of aerobic exercise apparently extend to those who have been diagnosed with early stage Alzheimer’s disease.Perhaps the most important finding of all is that aerobic exercise reversed age-related mental decline and helped older adults retain plasticity — the capacity of the brain to grow and develop. Until recently, it was thought that the ability of the brain to continue growing ceased at a relatively young age.

Frequency, Intensity, Duration
The take-home message is that exercise frequency (three times a week, intensity (enough to cause breathlessness), and duration (six months) can help retain an older person’s capacity to perform executive tasks, increase the speed and sharpness of thought, and add to the actual volume of brain tissue. Moderately intense exercise may even be able to reverse some of the age-related decline that has already occurred.

“Our results add to the growing research demonstrating the importance of getting up off the couch and getting your heart pumping,” concludes Dr. Erickson. “If you want to thwart cognitive decline, don't wait for the magic pill. Go out and take a walk. Exercise in old age is not futile.”

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