Stretching, Flexibility and Range of Motion: The use of a pre-exercise stretch has been called into question over the past decade. Current research favors the use of a gradual warm-up routine that utilizes sports specific movement patterns. With this being said, it’s important we not forget about flexibility, or more accurately Range of Motion (ROM). It’s not about who can or can not touch their toes. It’s about having enough range of motion to perform a given activity. Consider incorporating into your conditioning and warm-up program the specific demands and range of motion needed in the sport you are training for.

For example the amount of hip extension required for offensive linemen while blocking greatly differ form that of a wide receiver. Not only do they extend their hips while blocking, they are generating force through that same joint. This has the potential lead to injury. Instead of simply having them stretch their hip flexor, have them do traveling lunges and slowly work themselves lower while increasing their extension at the hip. This will increase there motion while strengthening them in a functional position.

Work with your athletic trainer or conditioning specialist to develop a program that fits each position. Many times motion can be improved by incorporating specific movement patterns that carry over to the field of play and improve performance.

Balance (Neuromuscular Ability): Athletes with poor body control and balance are at a higher risk for injury. One of the simplest indicators of poor balance is an athlete’s inability to stand on one foot without erratic movement. To fully evaluate balance and to implement a neuromuscular training program, we recommend working with your athletic trainer or other qualified health care or strength and conditioning professional to develop.

Strengthening (Form and muscle balance): Weight training is pretty straight forward in theory. Over the decades some simple mistakes continue to be made when it comes to “hitting the weights”. Poor form in a recipe for disaster; it has been and will most likely always be an issue. Make sure you athletes are instructed on the proper form for all lifts they perform. Muscular balance is more important than many people believe. Many athletes become too dominant in one set of muscle while neglecting the muscles that balance them; this easily can lead to injury.

Example: too much bench press and chest work without an equal amount of back work put your shoulder at risk of injury. This imbalance changes the way the shoulder works and interacts with other joints and parts of the body. Poor form in a recipe for disaster.

A simple cure for this is for every time you do a pushing exercise do a pulling exercise, this will help maintain balance and avoid injury.

Running (Cardiovascular fitness): There are two schools of thought on this topic. One school says only train in the way you compete. If all you do is sprint that’s all you need to do. The other school of thought is that a good cardiovascular base is essential. With young athletes developing a good cardiovascular base has many benefits and should be encouraged. An off-season mix for longer runs (20 minutes of greater) combined with sprint work will provide your athletes with a good base. As the season nears shifting your work out to a more sprint related format will help condition your athletes for their sports.

These are basic guideline to help you evaluate your current conditioning program. Before making any changes, we suggest you enlisted the help of a certified athletic trainer or other professional to help you. To reach one at the Minnesota Orthopedic Sports Medicine Institute at Twin Cities Orthopedics call Jim Rakow, ATC at (952) 995-8730. If you are outstate, Jim, a board member of the Minnesota Association of Athletic Trainers, can help you connect with a certified athletic trainer in your area.

This information has been produced in conjunction with the Minnesota Athletic Trainers Association (MATA) National Athletic Trainers Association, (NATA). It is for educational and resource purposes only. Always consult your physician or health care provider before beginning or altering any exercise program. Use of any advice and information is at the sole choice and risk of the reader.

To get you back on the right foot, quickly, Twin Cities Orthopedics in Edina has opened an evening and weekend walk-in clinic for orthopedic and sports medicine injuries.

Every walk-in patient is treated by a board-certified orthopedic physician who specializes in muscle, bone and joint care. And with our extended hours, you can add a bit of convenience to your schedule, even during an inconvenient situation.

The after hours clinic is open from 5 p.m. to 9 p.m., Monday through Friday, and 9 a.m. to 1 p.m. on Saturday.

To be seen during the day, call our AccessORTHO hotline at 888-544-OUCH(6824) and set up a same day appointment at one of our 31 convenient locations.

TCO Edina Walk-in Clinic
4010 West 65th Street
Edina, MN 55435

Click here for directions.

Open house festivities include:

• Refreshments
• Giveaways
• Tours
• And a ribbon cutting ceremony at 5:30 pm. with Twin Cities Orthopedics officials and Edina Mayor, Jim Hovland.

They’ll be moving just a few blocks away to the new Twin Cities Orthopedics Edina medical center located on 65th Street between France Avenue and Valley View Road.

They are the first group of physicians within Twin Cities Orthopedics to move into the new building. However they be joined in two short weeks on June 21, 2010 by Twin Cities Orthopedics physicians who practice at the Centennial Lakes Medical Center on France Avenue and Parklawn Blvd. Physicians from the Minnesota Orthopedic Sports Medicine Institute will also be moving in, but not closing down any clinics, on July 12, 2010.

The physical therapy department practicing in the Southdale Office Centre located on 66th Street and France Avenue will also move their practice into the new medical center on Monday, June 7, 2010. In their vacated space in Edina, Minnesota Prosthetics and Orthotics will begin construction on an off-the-shelf store selling rehab and orthotics products.

MRI & x-ray services will also be open at the new medical center on July 7, 2010. If you have any questions about the move, please call the new main phone line in Edina at (952) 456-7000.

• Have a pre-season physical examination and follow your doctor’s recommendations
• Use well-fitting cleats and shin guards — there is some evidence that molded and multi-studded cleats are safer than screw-in cleats
• Be aware of poor field conditions that can increase injury rates
• Use properly sized synthetic balls — leather balls that can become waterlogged and heavy are more dangerous, especially when heading
• Watch out for mobile goals that can fall on players and request fixed goals whenever possible
• Hydrate adequately — waiting until you are thirsty is often too late to hydrate properly
• Pay attention to environmental recommendations, especially in relation to excessively hot and humid weather, to help avoid heat illness
• Maintain proper fitness — injury rates are higher in athletes who have not adequately prepared physically.
• After a period of inactivity, progress gradually back to full-contact soccer through activities such as aerobic conditioning, strength training, and agility training.
• Avoid overuse injuries — more is not always better!
• Many sports medicine specialists believe that it is beneficial to take at least one season off each year.
• Try to avoid the pressure that is now exerted on many young athletes to over-train.
• Listen to your body and decrease training time and intensity if pain or discomfort develops. This will reduce the risk of injury and help avoid “burn-out.”
• Speak with a sports medicine professional or athletic trainer if you have any concerns about injuries or prevention strategies

Suggestions courtesy of the American Society of Orthopaedic Surgeons and stopsportsinjuries.org. It is for educational and resource purposes only. Always consult your physician or health care provider before beginning or altering any exercise program. Use of any advice and information is at the sole choice and risk of the reader.

The foundations of the presentations come from recent research completed by Dr. Lervick and Dr. Larson at MOSMI. More specifically, Dr. Lervick will be presenting on MRI evaluation of healing after a microfracture surgery of the elbow and Dr. Larson will be presenting on ACL reconstruction in adolescent patients with open growth plates.

The following studies were the foundation of the presentations:

Magnetic Resonance Imaging after Arthroscopic Microfracture of Capitellar Osteochondritis Dissecans
Greg Lervick, MD, Corey Wulf, MD, M. Russell Giveans, PhD

Outcomes after Transphyseal ACL Reconstruction in Patients with Open Growth Plate
Christopher M. Larson, MD., Christie Heikes, MD., Chris Ellingson, MD., M. Russell Giveans, PhD.

Dr. Larson is also presenting an instructional course in regards to techniques require to perform hip arthroscopy.

Instructional Course Lecture: Hip Arthroscopy: Labrum, Impingement and Extra-Articular Problems
J.W. Thomas Byrd, MD., Carlos A. Guanche, MD., Victor M. Ilizaliturri, Jr., MD Christopher M. Larson, MD., Marc. J. Philippon, MD.,Thomas G. Sampson, MD

Those in attendance included Twin Cities Orthopedics physicians & administrators, Otsego Mayor Jessica Stockamp, and other officials from building project partners.

The new clinic, which has room for expansion to the East will feature clinical exam rooms, MRI, physical therapy, x-ray and prosthetics and orthotics.

“We are very excited to open this facility. And as our population ages and continues to remain active, we hope this facility will help us meet the rising demand for top-quality orthopedic and sports medicine health care,” said David R. Edwards, MD.

Dr. Edwards also announced the addition of a new physician, Dr. David J. Gerlach, a hand fellowship orthopedic surgeon at Washington University School of Medicine in Seattle. Dr. Gerlach will be joining the group this fall.

The following physicians will be practicing at the new Otsego facility:

• Kurt D. Anderson, M.D.
• David R. Edwards, M.D.
• Patrick F. O’Keefe, M.D.  
• Guy J. Rudin, M.D.
• Paul C. Biewen, M.D.
• David J. Gerlach, M.D.

To complete this project Twin Cities Orthopedics has and will continue to work with several partners.

• Construction: RJM Construction
• Architect: Sperides Reiners Architects, Inc.
• Project Development: Frauenshuh Commercial Real Estate Group
• Site Selection: NorthMarq

Twin Cities Orthopedics has been serving the Elk River, Otsego and the surrounding communities since 1993. They look forward to continuing to serve the community.

Best in Real Estate
Medical Development or Redevelopment
Edina Crosstown Medical Office Building: Winner
Minneapolis / St. Paul Business Journal – by Chris Newmarker Staff writer

Developers of the Edina Crosstown Medical Office Building thought it would be a great to have an underground parking garage — until they discovered there was an underground lake on their site.

“We were really thinking of renaming it Noah’s Ark,” said Gary Hegenes of Hegenes Management Inc., who formed a partnership with Twin Cities Orthopedics doctors to develop the building and what ended up being an above-ground parking garage.

Discovery of the underground water was one of many hurdles Hegenes and the doctors had to overcome to build the four-story office building and five-level parking garage at 4010 W. 65th St. The project is scheduled for completion in June.

The sole tenant will be St. Louis Park-based Twin Cities Orthopedics (TCO), which has about 80 doctors practicing at 31 locations around the Twin Cities. When the building opens later this year, the practice will consolidate its Edina operations there, vacating two locations in the area and scaling down another three sites.

The Edina Crosstown Medical Office Building will house clinic space, an MRI and an outpatient surgery center that will be operated in partnership with Fairview Health Services. The building also will include physical therapy, hand therapy and neck and back therapy operations.

For years, Twin Cities Orthopedics doctors wanted to become more efficient by consolidating some of their locations. They were especially interested in finding a location near Fairview Southdale Hospital, where many of them also work, said Troy Simonson, TCO’s administrator.

Read more: Medical Development or Redevelopment – Minneapolis St. Paul Business Journal

The crack of the bat, smell of the leather mitt and running of the bases are a few of the things players love about baseball and softball. More than 33 million Americans play organized baseball and softball each year, with nearly 6 million of these players being children from 5 to 14 years old. According to the U.S. Consumer Product Safety Commission, in 2003 more than 200,000 of these kids were treated in hospitals, doctors’ offices, clinics, ambulatory surgery centers and hospital emergency rooms for baseball-related injuries. That is why the American Academy of Orthopaedic Surgeons recommends that children use caution when partaking in youth baseball, particularly year-round.

“I continue to see increasing numbers of injuries related to youth baseball. I attribute this to the steady progression toward year-round participation and the addition of spring and fall leagues. The drive to compete can lead to overuse and result in minor pain or less commonly to major injuries,” explained Frank Norberg, MD, orthopedic surgeon specializing in the treatment of shoulder and sports medicine injuries. “Children involved in overhead hitting and throwing sports should have a break from these activities for 2-3 months out of the year. It benefits kids to cross-train and change sports throughout the year to avoid overuse injuries and help with balanced physical development. While pitch counts can help avoid overuse, it is more important to make sure players are not throwing with pain.  Persistent pain with throwing is a sign of muscle, ligament or bone injury and should be evaluated by a medical professional.”

The American Academy of Orthopaedic Surgeons offers the following tips to help keep your child off the injured list:

• Always take time to warm up and stretch before and after play. Research studies have shown that cold muscles are more prone to injury.
• If a child is pitching, he should concentrate on stretching his arm and back muscles.
• If a child is catching, the focus should be on the legs and back.
• Children should not be encouraged to play through pain. It is important that they take breaks if tired.
• Limit the number of teams your child is playing on in one season. Kids who play on more than one team are especially at risk for overuse injuries.
• Equipment should fi t each player properly and be worn correctly.
• A batting helmet should be worn at the plate, when waiting a turn at bat and when running bases.
• Facial protection devices that are attached to batting helmets should be worn by children, when available. These devices can help reduce the risk of a serious facial injury if you get hit by a ball.
• Players should wear molded baseball shoes with cleats that fit comfortably.
• Children need to wear the appropriate mitt in each position.
• Catchers should always wear a helmet, face mask, throat guard, long-model chest protector, protective supporter, a catcher’s mitt and shin guards.
• Inspect the playing field for holes, glass and other debris.
• Drink plenty of fluids.
• Supervising adults should be prepared for emergency situations and have a plan to reach medical personnel to treat injuries such as concussions, dislocations, elbow contusions, wrist or finger sprains, and fractures.
• To prevent sliding injuries, install breakaway bases in the playing fields and an extra large first base to avoid the runner stepping on the first baseman’s foot.

While there is no concrete guideline for the number of pitches allowed, reasonable limits are 80 to 100 pitches in a game and 30 to 40 pitches in a single practice session, depending on the child’s skeletal maturity, muscle strength and pitching techniques.

Additional pitching recommendations for young baseball players include:

• 8-10 year olds should only throw from 37 to 67 pitches in approximately 1.4 to 2.6 games per week.
• 11-12 year olds should only throw from 50 to 86 pitches in approximately 1.4 to 2.6 games per week.
• 13-14 year olds should only throw from 60 to 92 pitches in approximately 1.4 to 2.6 games per week.
• 15-16 year olds should only throw from 75 to 107 pitches in approximately 1.4 to 2.6 games per week.
• 17-18 year olds should only throw from 90 to 122 pitches in approximately 1.4 to 2.6 games per week.

Jay S Johnson, MD
For Jay S. Johnson, MD, an orthopedic surgeon in Edina, the call to serve meant traveling to Antigua, Guatemala, once with his wife and a second time with his entire family through the non-profit organization called Common Hope.

Dr. Johnson’s wife, Sue Dittmanson, MD, is an OBGYN physician at United Hospital. During their week-long mission at Hermano Pedro Hospital in Antigua, each operated on approximately 20 people. While in Guatemala, his daughters participated in non-medical social work visiting homes and educating the community.

 “The biggest challenge of the mission is that it is physically very demanding. You are operating all day long. And also you have to manage your time and figure out what you can do well with the equipment,” Johnson said.

In the United States, Dr. Johnson would have his choice between 20 and 30 bone rods when caring for a non-union fracture. In Guatemala, he had only three. When asked what he took away from his trip, Dr. Johnson replied. “We have it really good here.”

One of his highlights for Johnson included performing an ACL reconstruction on one of the Guatemalan World Cup Soccer players.

William Lundberg, MD
Orthopedic Surgeon, William Lundberg’s overseas trip wasn’t a typical medical mission, it was a military one. 

Dr. Lundberg, a member of the Army Reserve, has been deployed three times, twice to Germany and once to Iraq. By day in Iraq, Dr. Lundberg was caring for wounded soldiers in a “pop-up hospital” and by night he was sleeping in a tiny barracks with no windows and walls made of cinderblock with just single light bulb hanging from the ceiling. 

The “pop-up hospitals” had pretty much everything Dr. Lundberg needed to care for wounded soldiers. One of the major differences Lundberg cited while caring for soldiers is that follow-up care was not an option. It was an order, therefore the outcomes were highly successful. “The patients are young and active. They follow orders and tend to get better a lot faster than the average patient in the United States,” Lundberg said. 

When asked what he learned from his time in Iraq, Lundberg said, “It makes you more thankful for the soldiers that protect us. The stuff they do for us is dangerous. How good our troops work and how hard they work and the dangers they are exposed to all the time. They are all young kids; 20-something-year-olds. We should all be proud and thank them.”

Anthony Brown, MD
Through the non-profit group, Surgical Implant Generation Network (SIGN), Dr. Anthony Brown, an orthopedic surgeon in Robbinsdale, Minn., traveled to Vietnam and Indonesia in 2004 and 2005 to assist orthopedic surgeons in caring for patients with traumatic injuries.

While in Vietnam and Indonesia, Dr. Brown said that he was learning almost as much as he was teaching. He described the hospital environments at each location as very collaborative. At first glance that might seem difficult with an obvious language barrier, however according to Dr. Brown, “The good thing about orthopedics is that a picture is worth a thousand words and an x-ray always tells the story.”

According to Brown, the cases he had during each of his two-week long trips were more extreme than those that he typically sees in the United States. Instead of taking care of a fracture that occurred a day ago, he was taking care of ones that happened two months ago.

Additionally, Dr, Brown said he had to learn to do more with less. “In surgery they have much less resources than we have here, therefore you have to be more creative and more technically skilled,” Brown said. “I just think it is fun and interesting.”

Patrick Kraft, MD
Dr. Patrick Kraft, an orthopedic surgeon also practicing in Robbinsdale, Minn., has traveled to Guatemala eleven times. The trips, part of the ministries at Wooddale Church in Eden Prairie, Minn., helped a church in the Lake Atitlan area reach out to the community through providing general health and wellness and other services.

During the first few years of mission work, health education was focused on teaching the Guatemalans how small lifestyle changes could drastically improve their quality of life. Teaching people to cook outside and drink filtered water, vastly decreased the high incidence rate of pulmonary and digestive conditions. 

In later years of his mission work, Dr. Kraft spent his time traveling to more remote villages. “People would hear that we were coming to their village and they would wait in line all day to be seen.” Kraft said.

In treating Guatemalans, Dr. Kraft had to adapt to the local culture. For example, the Guatemalan people believe that in treating fractures the Shaman, an intermediary between the human and spirit worlds that can treat illness, must come in the middle of the night to strike the broken bone before it can heal.

“Patients had a feeling that we had an ability to cure them, but the spirits were just as important in the healing process.” And so over an 11-year period, many Guatemalans were treated by Dr. Kraft and the local Shaman.

UPDATE: Since this article was written, Dr. Brown and Dr. Anderson have traveled to Haiti to care for those injured during the earthquake that ravaged the country on January 12, 2010. Look for their stories and others in an upcoming eNewsletter. Sign-up at www.tcomn.com.

Support the Work
Twin Cities Orthopedics would like to encourage anyone interested in supporting physician mission work to contact the Twin Cities Orthopedics Foundation at www.tcofoundation.org or by phone at (952) 927-2989.