Phillip DePaola, Physician Assistant with Miami Orthopedics and Sports Medicine Institute, explains the ACL is in the middle of the knee, between what is called the two condyles. In the procedure they make tunnels that are going through the tibia and they also make a femoral tunnel.
“We prepare the need to receive the graft or the tissue that we’re going to be replacing the ACL with. Then, we do a couple of tests after we’ve inserted the ACL to make sure we have stability in the knee”. Knee pain, stiffness, and weakness, poor healing of the graft, and failure to achieve symptom relief are some of the ACL reconstruction risks.
Phillip DePaola, Physician Assistant with Miami Orthopedics and Sports Medicine Institute, says 50% of the success of the procedure is what doctors do and 50% is what the patient does. “We want them moving their need early to prevent scar tissue buildup in the knee.” Phillip DePaola, Physician Assistant with Miami Orthopedics and Sports Medicine Institute, says each surgeon has their own protocol. “Some physicians don’t want you to start therapy for a week or two because they want the healing to set in, but we start them in therapy that same day.”
He also explains his patients do the physical therapy at least two or three times a week. Phillip DePaola, Physician Assistant with Miami Orthopedics and Sports Medicine Institute, says warming up is key. “You definitely try to progress your warm-up to get to that level where you feel comfortable making those changes of direction. It is definitely very important.”
He also points out you can develop your own routine and you should be doing a certain amount of warm-up before doing any activity. Changing direction rapidly, stopping suddenly, slowing down while running, landing from a jump incorrectly, and direct contact or collision, such as a football tackle, are some of the causes of an Anterior Cruciate Ligament (ACL) injury.
Phillip DePaola, Physician Assistant with Miami Orthopedics and Sports Medicine Institute, explains changing of direction rapidly is the most common one. “We do have a portion of our population that can have grade one or even almost a grade two ACL sprain and can be treated conservatively and return back to their activities.” An Anterior Cruciate Ligament (ACL) can be grade 1 when the ligament is slightly stretched, but it is still able to help keeping the knee joint stable; grade 2 when it is a partial tear of the ligament; or grade 3 when it is a complete tear of the ligament.
Phillip DePaola, Physician Assistant with Miami Orthopedics and Sports Medicine Institute, says in grade 1 you get some pain and swelling. “Then, as the severity of the tear progresses, that definitely would increase your symptomology and you probably get more swelling, more pain, and possibly an inability to stand on the knee.” To prevent an ACL injury you need to improve your flexibility, strength, balance, and agility. You can also try to jump and land safely.
“It’s the mechanics of being able to land from a jump, it’s being able to change direction, it’s working with someone or just working on your own and being diligent in knowing how to properly do these activities, and then that should lead you to as minimal injuries as possible,” says Phillip DePaola, Physician Assistant with Miami Orthopedics and Sports Medicine Institute. What causes tennis elbow? Phillip DePaola, Physician Assistant with Miami Orthopedics and Sports Medicine Institute, explains what it is about and what are the common triggers, and he also talks about golfer’s elbow, and their similarities. Why are overuse injuries so common? Phillip DePaola, Physician Assistant with Miami Orthopedics and Sports Medicine Institute, explains what they are and what people commonly do that lead them to have an overuse injury. Runner’s knee is a very common overuse injury. Phillip DePaola, Physician Assistant with Miami Orthopedics and Sports Medicine Institute, talks about how avoidable it is, its symptoms, and how important it is to know about it. Rest, ice, compression and elevation are recommendations to treat overuse injuries. Phillip DePaola, Physician Assistant with Miami Orthopedics and Sports Medicine Institute, explains the benefits of following those steps. What is an acute rotator cuff injury? Phillip DePaola, Physician Assistant with Miami Orthopedics and Sports Medicine Institute, explains with a 3D image how a rotator cuff injury can be caused and what are the factors that can originate it. Pain in front of knee and knee swelling are typical symptoms of runner’s knee injury. Phillip DePaola, Physician Assistant with Miami Orthopedics and Sports Medicine Institute, explains those symptoms and also talks about stiffness and pain that worsens when moving. How do you know if you have a rotator cuff injury? Phillip DePaola, Physician Assistant with Miami Orthopedics and Sports Medicine Institute, talks about its symptoms, such as pain, swelling, limited motion, and weakness of arm, among others. Phillip DePaola, Physician Assistant with Miami Orthopedics and Sports Medicine Institute, explains arthritis means inflammation of a joint. He points out the most common type is osteoarthritis.
He also says when it comes to specific joints, he does not see in hips very often, but knees are much more common. Pain in joints that does not go away, warmth and redness in joints, swollen joints, stiff joints, trouble moving joints, and grinding feeling of joint are some of the arthritis symptoms.
Phillip DePaola, Physician Assistant with Miami Orthopedics and Sports Medicine Institute, says you can get arthritis anywhere. “We see predominately knee arthritic changes, but the pain is going to be universal to all of them.” When it comes to dieting, Phillip DePaola, Physician Assistant with Miami Orthopedics and Sports Medicine Institute, recommends meeting with a dietitian to see your daily habits, and getting an app on your phone to track your calories.
Regarding anti-inflammatory foods, he says there are many natural remedies that can help with inflammatory process. “If it doesn’t harm you, then there is no harm in trying it to see if it works.” Phillip DePaola, Physician Assistant with Miami Orthopedics and Sports Medicine Institute, explains how osteoarthritis looks like in the joint. He says what happens is that the cartilage is wasted away.
He also points out it causes discomfort and pain to the area where they have a loss of the cartilage or the soft covering of the bone. “It can lead to swelling of the joint and deformities in the joint.” Phillip DePaola, Physician Assistant with Miami Orthopedics and Sports Medicine Institute, says just because you are an athlete that doesn’t mean you are going to have degenerative changes.
“If you play a sport that requires a lot of running and jumping, a lot of pounding on the weight-bearing joints, that is going to likely cause a quicker degenerative change.” Age, certain types of exercise, foot mechanics, obesity and occupations that keep the patient in his feet are plantar fasciitis risk factors, describes Phillip DePaola, Physician Assistant with Miami Orthopedic & Sports Medicine Institute.
He explains he suffered plantar fasciitis during college and he got custom orthotics for his shoes which had corrected his pes planus. Also he did a lot of stretching and massages in that area.
The experts advises losing weight, because it can help to improve plantar fasciitis. Phillip DePaola, Physician Assistant with Miami Orthopedics and Sports Medicine Institute, says there are many causes of osteoarthritis, such as a traumatic episode, a mechanical issue, age can play a factor, gender and weight play factors.
“Genetics plays a role. We usually have patients saying their parents had replacements, and if you have active parents, there are chances of being active; that could play a role. It may not be a genetic component.” One of the most common injuries is called patellofemoral syndrome (PFS). It’s an irritation of the cartilage underneath of the knee cap.
Phillip DePaola, Physician Assistant with Miami Orthopedic & Sports Medicine Institute, explains PFS happens either from overuse or some activity the patient is doing.
The expert clarifies that runner’s knee is an inflammation of patella tendon to the front of the knee. It’s the mechanism that can cause that discomfort.
Pain with activities, pain after sitting for a long period, pain after change in activity level and popping or crackling sound in the knee are signs of runner’s knee and PFS, the expert explains. With a 3D imaging, Phillip DePaola, Physician Assistant with Miami Orthopedic & Sports Medicine Institute, explains what plantar fasciitis is.
He describes plantar fasciitis is a very common condition and it occurs when the sole of the foot is injured because of an activity or from inflexibility. Those micro tears can cause discomfort and pain.
Plantar fasciitis also appears in cases of significant pes planus or flatfoot or in cases of excessive high arches, the doctor explains. Medications, injections, diet, exercise, and weight loss are some of the conservative therapies to treat arthritis. Phillip DePaola, Physician Assistant with Miami Orthopedics and Sports Medicine Institute, says they use medications like anti-inflammatories to help with discomfort.
He also explains there are some natural therapies, such as supplements that can cause improvement of the symptoms. “We tend to not use narcotics, it is only going to mask the symptoms. We like to try the anti-inflammatory route.” There are several signs of emergency when injury happens such as: a joint or bone that is clearly broken or dislocated, inability to support any weight on affected area, extreme pain that is progressively getting worse, paralysis, tingling or numbness, unsteady breathing or pulse, noticeable paleness and disorientation or confusion.
Phillip DePaola, Physician Assistant with Miami Orthopedic & Sports Medicine Institute, also says any systemic issues need to be evaluated by a medical professional.
The expert considers there are a few upper extremity pathologies such as bursitis, calcific tendonitis or neck conditions that need to be treated in the E.R. Emergency room is usually attached to a hospital. Urgent care is a standalone facility and it usually has different capabilities, explains Phillip DePaola, Physician Assistant with Miami Orthopedic & Sports Medicine Institute.
Urgent cares do x-Ray, diagnostic studies, evaluate and they can start the ball rolling for management kind of point patients in the right direction, he says. They can’t admit them.
If someone needs to do a surgery, urgent care has to transfer the patient to E.R. RICE is an acronym and it stands for Rest, Ice, Compression and Elevation, explains Phillip DePaola, Physician Assistant with Miami Orthopedic & Sports Medicine Institute.
The specialist also describes RICE is the first line of treatment if patients have any kind of a soft tissue injury or any kind of extremity injury.
For him, rest has to do more with modifications of activities than with complete immobility. Ice therapy can help with inflammation in cases of injuries, also in a recovery process after them, explains Phillip DePaola, Physician Assistant with Miami Orthopedic & Sports Medicine Institute.
The expert considers heat therapy can also help depending on the pathology such as back spasms. In rehab process, heat can be combined with ice therapy.
However, the doctor advises using ice therapy with caution, because if the patient leaves ice for too long, it can cause burns.
His recommendation, about ice therapy, is 20 minutes on and 40 minutes off and never use it directly on the skin, he describes.
