DrRic -Knee Pain in the Outdoor Athlete (slideshare edition)


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REI Schaumburg presentation from May 2012

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  • Based on a survey of our patients, we found a consistent theme of what frustrates them about conventional medicine practices and why they felt First Health was different. Since identifying these 4 key areas, we have made a consistent effort to offer our absolute best to:Listen attentively to Patients concernsMake the patient the driving force as the center of careMinimize wait timesExplain all the options for treatment, and give the patient choices (medications, alternative medicine, nutritional medicine/supplementation, psychological medicine)
  • Design notes: list of providersWe want this to look much more inviting—these chairs are way too cold.Had thoughts about putting the actual providers in the chairs. Could be an actual live picture with a sample patient in the red chair or could be a group of providers sitting around the table.
  • DrRic -Knee Pain in the Outdoor Athlete (slideshare edition)

    1. 1. Knee Pain in the Outdoor Athlete Ric Saguil, MD First Health Associates Arlington HeightsWe didn’t invent the practice of medicine…. we’re just changing the way it’s provided.
    2. 2. DrRicWe didn’t invent the practice of medicine…. we’re just changing the way it’s provided.
    3. 3. The First Health Approach We didn’t invent the practice of medicine…. we’re just changing the way it’s provided.
    4. 4. Your Community of Care Ric Saguil, MD Jason Gruss, MD Tom Jordan, RD Katrina Christie, LCPC Jennifer Green, ND Joe Musolino, DC Emery Paredes, PT Courtney Day, EP Yu Zhu, MD China You
    5. 5. Staying injury free
    6. 6. Know your opponent1. Pain receptors2. Inflammatory cascade3. Stretch receptors4. Abnormally functioning nerves (Diabetes, Fibromyalgia, CF)
    7. 7. 1. Pain Receptors • Stay away from the light!Learn the difference between good and bad pain signals • The body is a miracle and can perform miracles…... if damage not too advanced and body is healthy.
    8. 8. The FibroblastThe fibroblast cell is the workhorse of healing in the joint…..if it is given the right tools! ( ….good nutrition, no toxins, no stress, no infection)
    9. 9. Every “knee” cell knows what to do…. …the brain has to be patient.Ignored = further injury and longer healing . Pampered = fastest healing attained
    10. 10. How to avoid 2nd prob’s2nd prob2nd prob2nd prob2nd prob 1st prob2nd prob
    11. 11. Facilitate Healing• R est• Ice Step 1 Step• Compression• E levation Ge t R e s c Stepe d u 2
    12. 12. Your Rescue team:1. Orthopedic surgeon MD or DO2. Sports medicine physician MD or DO3. Primary care doctor MD or DO or NP4. Chiropractor DC5. Physical therapist PT6. Exercise physiologist EP ACSM7. Kinesiologist T Cert ACSM8. Trainer T Cert ACSM+ Acupuncturist LAc
    13. 13. INTERMISSION Best bang for buckBetter than nothing Over kill
    14. 14. Saguil Approach – Compressing TimeRehab is mandatory!
    15. 15. 2. Inflammatory Cascade Bone MuscleLigament Blood Vessel
    16. 16. Caveat Emptor Safe Not Safe! Really Safe!!!
    17. 17. DrRic FavoriteTumeric is an excellent anti-inflammatory for swelling and healing but take with black pepper
    18. 18. Natural Facilitators • Vitamin D3 1000IU am/pm • Omega 3 (Fish, Flax or Krill) 1000mg am/pm • Multivitamin am/pm • Glucosamine Sulfate Chondroitin 1500/day • Magnesium 200mg am/pm • Anti-inflammatory Diet for life! • Traumeel/PanAway topical 3-5times/dHint: Save money, take glucosamine 30 days on then 90 days off…..still works all year round!!
    19. 19. “Synthetic” Facilitators• OTC NSAIDS motrin, advil, ibu, aleve, napro..• Script NSAIDS relafen, lodine, voltaren, indocin• Injectable NSAIDS toradol• Topical NSAIDS pennsaid• Oral Steroids medrol pack, prednisone• Injectable Steroids kenalog, celestone….• Muscle Relaxers flexeril, zanaflex, skelaxin• Narcotics tylenol #3, vicodin, ultram Prescription medicines can help but watch the side effects!!
    20. 20. 3. Stretch Receptors
    21. 21. Fluid build up from Friction Patellofemoral Syndrome
    22. 22. Prolonged Friction =Cartilage “Abrasion” Chondral Fracture
    23. 23. Chronic Friction =Cartilage and Bone Chip Osteochondritis Dissecans
    24. 24. High Q-angle rubbing/friction
    25. 25. Pes planus (pronation) Flat feet causes a “high Q-angle”
    26. 26. Pes planus = “fallen arches”
    27. 27. Pronation “fixes” alignment
    28. 28. “External Fixes”• Stabilizing shoes• Low dye taping• Orthotics Custom• Orthotics Off Shelf ask Avoid “Rocky” style shoes….(or ask an expert)
    29. 29. Muscular Imbalance1. Quads (usually big)2. Hamstrings (usually tight)3. ITB (Ileotibial Band) (slave to #1 and #2) With big muscle comes tight ligament Ileotibial band syndrome
    30. 30. Dominant forces winITB Q a n g l e ITB Syndrome
    31. 31. The patella gets pulled by ITB Syndrome Normal Pulled overITB Syndrome causes Patellofemoral Syndrome
    32. 32. “Internal Fixes”PT ATC SurgicalMT ALTERNATIVE
    33. 33. Physical Therapy• Covered by most insurance ($$$)• “Challenge” the therapist (find a sports tx)• Plan on graduation date/surgery (launch)• Modalities facilitate (u/s, phono, ionto)
    34. 34. Athletic Training Self-careField Experience Education • Cheaper • Great at taping/DTM • Great at keeping you honest after PT • Maximize on conservative therapy Ice Bath Ice Sleeve Kinesio Taping
    35. 35. Massage Therapy/Alternative AcupunctureYogaTissue Scraping Self Massage Chiro Alignment
    36. 36. Equipment
    37. 37. Your Life Changing Team:• Trainer• Kinesiologist• Exercise physiologist• Physical therapist• Acupuncturist• Chiropractor• Primary care doctor• Sports medicine physician• Orthopedic surgeon
    38. 38. Bottom line• Rescue from damage Stop training• Reverse inflammation Meds, supps, food• Re-strengthen muscle Therapy, acupuncture• Re-balance kinetic Chiro, trainer, yoga, chain crossfit• Return to activity Idea of K E Y (knowledge..)
    39. 39. Community HealthProject – YOGA?Northwest Community Hospital Wellness Center June 23rd (sat) 11:00-12:30pm (847) 618-3500 Ric Saguil, MD We didn’t invent the practice of medicine…. we’re just changing the way it’s provided.