Back to School Tips for Avoiding Pediatric Back Injuries

Sonoma County kids are heading back to school this month.  While for many parents, a return to school may feel like a relief from the constant activity of summer, there are still orthopaedic health issues to watch out for.  One such issue is back pain caused by improper use of one of the most mundane objects in your house – your child’s backpack.

According to an article* written by the American Academy of Orthopaedic Surgeons (AAOS), the Consumer Product Safety Commission (CPSC) has determined that “more than 24,300 individuals were treated in hospitals and doctors’ offices for injuries related to backpacks in 2012, and more than 9,500 of those injuries were kids 5-18 years old.”

Recently AAOS and the Pediatric Orthopaedic Society of North America (POSNA) looked into the problem of backpack-related injuries and released the following recommendations for school-aged children.  The following safety tips are extracted from the same July 2013 article:

Kids should carry no more than 15-20 percent of their body weight.
Use both shoulder straps to keep the weight of the backpack better distributed and adjust the shoulder straps to keep the load close to the back.
Remove or organize items if too heavy and pack the heavier things low and towards the center.
When lifting backpacks, bend at the knees.
School backpacks are for schoolwork. Carry only those items that are required for the day; if possible, leave books at home or school.
At home and at school, keep walkways clear of backpacks to avoid tripping.

They also had the following recommendations for parents:

Encourage your child or teenager to tell you about numbness or tingling in the arms or legs which may indicate poor fit or too much weight being carried.
If the backpack seems too heavy for the child, have […]

Are Women and Girls Really More At Risk For ACL Injuries?

We’ve been getting questions lately from some of our more active female patients about whether or not they should worry more about anterior cruciate ligament (ACL) injuries because of their gender and their propensity for “high-risk” sports like skiing or soccer.  The answer it seems is yes…and no.  Last year, the Journal of Bone and Joint Surgery*(JBJS), published a study where they compared MRI scans of male and female athletes with non-contact ACL injuries with athletes who participated in similar sports, but did not sustain injury to their ACLs.  What they found was that the common factor between those who sustained injury wasn’t gender, it was geometry.

Here’s how an February 2012 article published by the American Academy of Orthopaedic Surgeons** described it:

The ACL is a ligament that runs through, and stabilizes, the middle of the knee joint. While the ACL can be injured through contact, it is most commonly strained or torn without contact, when a person suddenly changes direction, stops abruptly or lands incorrectly after a jump, such as in soccer, basketball and skiing.

The study found that most of the women (those who had ACL injuries and those who did not) and only the ACL-injured men shared a common geometry on the outside of their knee joint: The upper part of their shin bone at the joint (tibial plateau) was much shorter and more rounded. This may help to explain why women have an ACL injury rate that is two-to-five times greater than that of men.

“A lot of people who have ACL tears have a high degree of laxity (loose ligaments) in their knee joints,” said Christopher J. Wahl, MD, the study’s lead author and an orthopaedic surgeon and team physician in the Department of […]

Beware of Herbal Supplements if You’re Having Surgery

It’s not unusual to see patients in our practice taking herbal supplements.  We don’t weigh in one way or another on the efficacy of “natural” vitamins and supplements but we do caution our patients who are considering having a surgical procedure done against taking them prior to and after their surgery.

While every patient experience is different, what many may not realize is that these supplements may cause abnormal blood pressure, heart rates, and bleeding.  They may also interfere with other medications, including anesthesia during your surgery.

We generally recommend to our patients that they disclose any “over-the-counter” medication they are taking (including aspirin, herbs, vitamins and dietary supplements) to their physician.  We also ask patients to stop taking them one week prior to surgery to reduce their risk of excessive bleeding, or negative interactions with other medications that we prescribe to treat orthopaedic problems and manage pain.

Not sure if your supplement may be a problem?  Here’s a list of common herbal supplements that we recommend against:

  Dong Quai
  Gingko Biloba
  Ginger
  Ginseng
  White Willow Bark (salix alba)
  Devil’s Claw (harpagophytum procumbens)
  Turmeric (curcuma longa)
  Boswellia (bosellia serrata)
  Stinging Nettle (urtica dioica)
  Cat’s Claw (uncaria tomentosa)
  Quercetin
  Reservatrol
  Cayenne
  Omega-3 FA
  St. John’s Wort

If you’re a patient and have questions about how a supplement you may be taking may interact with your prescribed medication, please contact our office.

Dr. Bollinger Featured In Washington Post Article About Anterior Approach Hip Replacement Surgery

In March, Dr. Michael Bollinger was featured in a Washington Post article* discussing the benefits of the anterior approach method used for replacing hips.  The article mentioned that the number of Americans having total hip replacements over the past two decades has risen to more than 300,000 per year (more than doubling the figures from 20 years ago), and that patients are eventually able to walk again without pain or the aid of a cane, but only after a lengthy, rigorous and sometimes painful recovery and rehabilitation period.

From the article:

The surgery is extensive: As its name suggests, it involves removing the joint — the damaged bone and cartilage — and replacing it with prosthetic parts made of metal, plastic or ceramics. Typically, surgeons enter the joint from the rear, which requires cutting through muscle and cartilage. But with a relatively new procedure, surgeons enter from the front and only stretch the muscles aside, avoiding the cutting and minimizing pain and recovery time. According to those who use this anterior technique, the benefits are substantial.

The article goes on to say:
Anthony Unger, medical director at the Institute of Bone and Joint Health at Sibley Memorial Hospital and a clinical professor of orthopedic surgery at George Washington University Hospital, says the anterior approach is “truly minimally invasive.” Unger, who has done about 4,000 hip replacements over 26 years and has used the anterior technique for the past eight years, says “patients have better overall functionality, can sleep on their sides and be confident the new hip won’t dislocate.”

But, as with many transitions in medical techniques, some surgeons have been reluctant to change. Although agencies and hospitals don’t track hip replacements by the type of procedure used, Unger says […]