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Tue, 18 Feb 2020

Jumper’s Knee

free sports injury clinic

Jumper’s knee is a condition that involves an inflamed patellar tendon. This is why it is also called patellar tendonitis. The patellar tendon is the tendon that connects the kneecap to the shin bone. This is a condition that gradually weakens the tendon and can eventually lead to muscle tears if left untreated.

Jumper’s knee arises from overuse in the joint. This is often from sports that require a lot of jumping on hard surfaces. The constant jumping and force of the leg hitting the ground causes strains and stress to the tendon. If left untreated, the condition usually worsens.

It is important if you think that you have jumper’s knee to go see a specialist. They can help diagnose and come up with a treatment plan to prevent the condition from worsening. Some symptoms include:

  • Pain under the knee cap
  • Swelling
  • Bruising or redness
  • Leg or calf weakness
  • Pain when bending
  • Stiffness when squatting, kneeling, or jumping

Once someone with this condition comes in and is diagnosed with “jumper’s knee” there are a few ways it is often treated. The biggest thing doctors typically say is to take a break from the sports or activities that caused the injury.

Tips on treatments for the condition:

  • Rest
  • Ice
  • Compression (taping, wraps or straps just under the knee cap)
  • Ibuprofen or other pain relieving, swelling reducing medicine
  • Physical Therapy (this can be at home or with a physical therapist to start to know the best exercises and strategies for each individual)

It is important to note that sometimes, when the condition is not treated or the person does not rest the knee to allow it to heal, it can worsen. In some situations, surgery can be required. This is another reason why it is crucial to come in and see a doctor when you start exhibiting symptoms. It is also always a good idea to see a physical therapist upon diagnosis to help provide some guidance on the best way to get you back in the game more quickly.

Miller Orthopedic Specialists offers a free, walk-in sports injury clinic in Council Bluffs from 10:00 – 11:00 a.m. and by appointment in Omaha. The initial consultation is free, but extra will be charged for x-rays, supplies, or follow-up visits if needed. This is a great opportunity to come in and see a specialist to get peace of mind without having to pay a hefty doctor bill. Your specialist can also provide input on what activities you are able (or unable) to participate in. Getting a general timeline and advice on what to do while recovering can make the recovery go more smoothly.

Contact us today for more information or to schedule your FREE* consultation. 

Wed, 29 Jan 2020

If the Shoe Doesn’t Fit, Don’t Wear It

Podiatry in Omaha & Council Bluffs

Some people choose their shoes because they like the style or color. Other people choose their shoes because they fit the requirements by their job. Then, there are the people that choose shoes based on the comfort and support provided. A combination of these things can often contribute to the choosing of shoes. However, many people do not realize the importance of properly fitting footwear.

When choosing shoes is it important to look for a few things. Some people do not know not know why the fit of a shoe really matters. Improperly fitting footwear is a common cause of foot and ankle injuries. They can also further exacerbate other health conditions that are common. Seeing a podiatrist to assist in the process of choosing properly fitting footwear is also a great idea. It will help eliminate some of the guess work for what kind of shoes to get.

Proper Shape

First, it is important to choose shoes that take the natural shape of the foot. The heel should not be slipping around and the ball of the foot should fit into the widest part of the shoe. Pointed toes often cause the foot to be squished into the shape of the shoe, which is not good.

Signs Your Shoes Don’t Fit

  • Pain and discomfort
  • Callouses
  • Blisters
  • Bruising on toenails
  • Skin irritation (especially around toenails)
  • Bruising on the tips of toes

Here are some tips when going to the store to buy footwear:


  • Keep heels less than 2 ¼ inches tall. Too high of a heel can put unnecessary pressure on the ankle and balls of the feet that can cause injuries over time.
  • Consider shopping at the end of the day after walking around. This means your feet are more swollen than usual, and thus it is easier to be sure the shoes still fit, even with swollen feet.
  • Make sure the shoes are not ones that have to be broken in later. Walk around in them some to make sure they are comfortable both walking and standing.
  • Remember that not all shoes fit the same way, so do not rely solely on size, and be sure to try on both shoes to ensure they do not only fit one foot properly.

Another thing to consider if foot pain persists no matter what type of shoe, is a custom orthotic. Many people think it is only important to get orthotics if they have a specific condition such as plantar fasciitis, arthritis or diabetes. However, custom orthotics are a good idea for most people. A custom orthotic will help provide the kind of comfort needed for the individual. A certified podiatrist would be best suited to help each individual find the orthotic that works best for each individual’s feet.

Shoes and orthotics cannot solve everyone’s foot problems. They can help reduce some of the pain, but it is important to see a podiatrist to understand what things are causing the issues. Podiatrists can help devise a diagnosis and treatment plan to help reduce foot pain or injuries. Dr. Panesar is a Board Certified Podiatric Surgeon who can provide advice on what kind of shoes or orthotics would work best for each individual, and he can determine whether the problem goes deeper than just improperly fitting shoes.  Even if a custom orthotic or shoe is not ordered, a podiatrist can help provide recommendations for things to avoid or to purchase in order to help avoid any further foot problems that might occur from improperly fitting shoes.


Do you have pain in your feet? Our podiatry doctor is here for you. Click here to Contact us today for a consultation. 


Mon, 23 Dec 2019

Hip Pain May Not Be Because of a Hip Problem

 If you are experiencing hip pain there could be a variety of things impacting it. Sometimes, the hip pain is due to something wrong in the hip, other times it is a deeper, different problem all together. The following injuries could be causing your hip pain. 

hip pain and joint replacement


Many times, hip pain is due to a hip injury, such as a fracture. Fractures of the hip are more common as people get older. Often, hip fractures happen in conjunction with falling. The risk of falling is increased in the icy winter, so it is always important to be careful and to remember to walk like a penguin on the ice.


Arthritis is another big factor in causing hip pain. When arthritis hits in the hip, physical therapy is often ordered to help strengthen the muscles around the joint. A joint replacement is often needed once the more conservative treatment options have failed.


One other common cause of hip pain is bursitis, which stems from an inflammation of fluid-filled sac or the bursa. These sacs help cushion tendons, muscles and ligaments. Thus, when they swell it can cause a lot of tenderness and pain. Not all hip pain stems from an issue within the hip, sometimes it is something different.


Another reason one might be experiencing hip pain is sciatica, the inflammation of nerve roots from the spinal cord. Often times, this causes hip pain and pain that shoots down the leg. Sciatica can occur because of a variety of reasons such as spinal stenosis, which is often from osteoarthritis, spasms in the lower back, or bulging or ruptured disks. This pain, despite often occurring in the hip, is actually from an issue in the spine.

Peripheral Neuropathy

The sciatic nerve is not the only nerve that can become inflamed and pose as a hip problem. Peripheral nerves are another set that, when inflamed, can cause hip pain. This is often caused in pregnancy, but there are other triggers for it as well, including diabetes and too tight of clothing.

Receive a Proper Diagnosis Today

A proper diagnosis is crucial when trying to take care of hip pain. For instance, if someone were to get a cortisone shot in their hip, but the issue is a ruptured disk in their back, then the injection is not going to do a ton of good. Proper diagnosis is important to know the proper treatment plan. It can help people know what exercises might help or hurt their condition. It is also important for the patient to know if there is a deeper underlying condition that could be more serious of an issue than they originally anticipated.

If you are experiencing hip pain, come in and see one of our total joint doctors or come see our spine specialist if the pain is running through your back or leg as well. They can help provide a proper diagnosis and determine the root cause of the condition. This will help them work with you to come up with an individualized treatment plan to best address your pain. 

Contact Miller Orthopedic Specialists today for your individualized treatment plan for your hip pain today!


Wed, 13 Nov 2019

How to Treat Your Spine Better

spine doctor in Omaha & Council Bluffs

It is estimated that 80 percent of adults will experience back pain at some point in their lives (National Institute of Neurological Disorders and Stroke). There are a lot of factors that can lead to people experiencing back pain.

Age and Weight

Age is something that often leads to an increased amount of back pain. When people get old, their body often gradually starts to wear out. Thus, it is important to try to limit the breakdown of the body by staying as healthy as possible. Weight is an added stress to the spine, which often leads to back pain. Maintaining a healthy weight is a good way to minimize some of that potential pain.

Job Strain

Some people have a lot of physical strain in their jobs. Employees who have a lot of lifting and twisting will often lead to back pain. However, people who sit at a desk all day without adequate back support will often eventually start to feel the pain too. It is important to remember to stretch and walk around to give your spine a break if you are constantly sitting down all day or straining your spine.


Many people think that as long as they get out and exercise that it can limit their back pain. While exercise is important, it is important to be careful. Many “weekend warriors” do not exercise during the week and then do the strenuous activity on the weekend, which can cause pain to the spine. It is important to remain active throughout the week as well. Swimming is often a good option for those already suffering from back or neck pain. Also, always remember to stretch before and after to help reduce extra muscle tension and improve mobility.

Proper Lifting

People constantly hear the phrase, “Lift with your legs, not your back.” However, many people do not really know what that means. Be sure to stand as close to the object as possible. With bended knees, make your arms level with the top of the item. Then, be sure to keep your back straight and head down. Some things might be harder to do this with than others, so do not be afraid to ask for help. These tips will help limit some awkward twisting or pulling of your spine that often occurs with the improper lifting of objects.

How You Sleep

How people sleep can have an impact on back pain too. It is not only a matter of how one lays but making sure to get enough sleep so the whole body may be well-rested is important. Sleeping on one side is typically considered better than sleeping on the stomach. This method reduces some of the pressure on the spine that occurs when someone is on their stomach. It is recommended to have a pillow between the legs for this method, to increase support. It also can help with breathing and apnea, which often force people to awaken in the night. The more people are awake during the night, the less rested they will be in the morning.

Sleeping on one’s back with proper support under the knees to help with the natural curve of the spine is typically considered the best sleeping position for a healthy spine. Having proper neck and back support with pillows and mattresses are also important in helping with back pain. However, if people already have some back conditions, like a herniated disc, for instance, then a specialist might suggest a different sleeping position to help reduce pain and to open the spinal joints.

Stay Hydrated

One simple thing that can help maintain a healthy spine is staying hydrated. This is a small thing that can help the disks in the spine maintain their height, which minimizes the chance of bulging disks and lessens the pressure on the spine.

Contact a Specialist

It is good for someone to see a specialist if they have back pain. Spine specialists can help come up with a customized treatment plan to help diagnose the current issue, find methods to reduce pain, and give suggestions on other ways to prevent some future back pain.

Dr. Ricart is a Board Certified, fellowship-trained spine doctor. He is fluent in both Spanish and English and is accepting new patients in both Omaha and Council Bluffs. If you’re having issues with your spine then maybe it’s time to give Dr. Ricart a visit!

Contact Miller Orthopedic Specialists to have our specialists help relieve your back pain!

Mon, 14 Oct 2019

Treatments for Osteoarthritis in the Hand

hand arthritisOsteoarthritis is a common cause of hand pain. This disease is one of the most common forms of arthritis. This is a very common reason people experience pain or stiffness in their hands. Osteoarthritis is a form of degenerative arthritis, meaning the cartilage is being broken down due to the rubbing of bones on other bones. This often causes pain, inflammation, decreased range of motion, and stiffness.

If you are experiencing osteoarthritis there are a few things you can do to help ease that pain in your hands. Different things work for different people, so it is important to note that not everything will provide relief for all.


Hand exercisesExercise is one thing that can help ease the pain. This is something that might be painful during, but it can help build up those muscles around the arthritic joints. Maintaining daily range of motion is very important in helping with arthritis. This can help minimize some of the stiffness and help gain some strength in the hands that otherwise might dissipate as the arthritis progresses. So it is important to do various squeezing and stretching exercises every day.

Ice and Heat

Moist heat is another option that can help with some of the stiffness or pain. This is something that can be really good before a lot of use in the joints, such as first thing in the morning. Icing arthritic joints at the end of the day or activities can help. It is important to only ice or heat them for no longer than about 20 minutes at a time. These are both simple, inexpensive ways to help relieve some pain.

Cortisone Injections

Cortisone injection is often a treatment method for those with Osteoarthritis. This can help patients regain some range of motion and reduce some pain. It is important to note that this does not always work for everyone.

The things listed above are just a few common, non-surgical methods used to help relieve some pain caused by arthritis in the hand. These are good things with which to start once diagnosed with osteoarthritis in the hand. However, these are not cure-all options and many times patients eventually need something more.

Orthopedic Surgery

While these treatments can help the process slow down and relieve some pain, osteoarthritis is currently a disease without a cure. Many people will look to surgeons to help assist them when they need more help than what they can do at home. Surgery is an option that is used once the conservative treatment methods have failed. The goal of surgery can vary. Some include:

  • Restoring as much function as possible
  • Eliminating or minimizing pain to a tolerable level
  • Reconstructing joints
  • Fusing of joints

When needed, hand and finger joint replacement surgery can be done, similarly to how knee and hip replacements are done for arthritis.

Contact a Hand Specialist at Miller Orthopedic

If you are experiencing hand pain, visiting a hand specialists who can provide a proper diagnosis and treatment is important. Dr. Hsu is a hand surgeon who is fellowship trained and Board Certified. She can help work with patients experiencing hand pain or arthritis. Through a thorough examination, Dr. Hsu will come up with the best treatment plan for each individual patient.

Fri, 27 Sep 2019

Physical Therapy as a Treatment for Lower Back Pain

Guest article from Dr. Brent Wells

If you suffer from lower back pain, you’ve probably already searched for ways to help treat it. While there are various natural methods, sometimes they might not always work, especially if you have severe pain. However, there is one treatment to consider: physical therapy.

Physical therapy is not only a great holistic option, but provides incredible results. It usually will not only stop your pain, but also help your overall well-being. This article will explore more behind why physical therapy is a helpful treatment for lower back pain. You’ll also discover some techniques your physical therapist might use to help you.

What is Low Back Pain?

Low back pain is when the muscles around the lower portion of the back are either injured or sprained in some way. Low back pain can also be caused by a type of injury or disease to your spinal cord which results in tingling nerves or severe inflammation. If not treated, low back pain can lead to less mobility and other health issues.

What Causes Lower Back Pain?

There are a few things that can cause lower back pain. This includes:

Why Physical Therapy is an Ideal Treatment for Lower Back Pain

If you’re looking for a way to help treat your lower back pain without the use of surgery, physical therapy is ideal. This is because it works to:

  • Lower your pain levels
  • Increase mobility and flexibility
  • Help restore strength to your body

These are just a few of the many benefits that physical therapy will offer for lower back pain sufferers. In fact, many physical therapists will work to teach you how to deal with any painful flare-ups that might occur after your sessions. This can help to keep you calm while also reducing your pain.

Physical Therapy Techniques to Help Heal Lower Back Pain

There are many different techniques that a physical therapist will use to help heal lower back pain. Below are some you’ll find if you decide to use this form of therapy.

❏  They Will Use Various Modalities

Many physical therapists will encourage the use of modalities. This includes using cold or heat compresses, ultrasounds, and TENS (transcutaneous electrical nerve stimulation) therapy. These will work to naturally encourage your nerves to calm down while also reducing inflammation.

Depending on your needs, your therapist might recommend you use more intense versions of modalities for relief. Below is more information about these helpful modalities.

❏  Cold/Heat Compresses

Many physical therapists will ask you use to cold or heat compresses on your lower back. This is because this treatment can help to significantly calm down irritated sections in your body causing your pain.

Cold compresses will help to reduce swelling and inflammation. Heat compresses will help to release tight muscles and stop tension. Because of this, both of these can be very helpful when it comes to treating your lower back pain.

❏  Ultrasounds

Ultrasounds are a very helpful way to treat lower back pain. They will emit vibrations in the area where the ultrasound device is placed. This then works to release soft vibrations and heat to the area which helps to loosen the muscles in it. There have been a few studies which have shown that ultrasounds can help with lower back pain. They also can work to improve flexibility.


TENS therapy uses electric currents to encourage nerve stimulation. The TENS therapy machine is a very small device that is connected to electrodes. These electrodes are then placed on your body with a sticky tape. Once they have been applied, your physical therapist will turn the machine on. It will then start to release soft electric currents.

Depending on your needs, your physical therapist will either lower or increase the electrical impulses. You’ll need to have a few of these sessions done in order to have long-lasting results.

❏  Back Pain Exercises and Stretches

Back pain exercises and stretches will also usually be implemented into a treatment plan for you. This includes doing lumbar strengthening stretches (such as knee-to-chest ones) or various types of easy aerobic activities like walking and swimming. These exercises and stretches will usually be customized by your physical therapist depending on your needs.

❏  Spinal Manipulation

A few physical therapists might also implement common chiropractic techniques, such as spinal manipulation. This includes moving and adjusting your spine to help realign it. The movements will also encourage the reduction of inflammation around your spinal cord.

By doing these manipulations, it will also cause your body to release endorphins. These natural pain-killers can help to reduce lower back pain. Most sessions last only a few minutes and eventually can lead to the complete elimination of lower back pain.

❏  Deep Tissue Massage Therapy

You might be surprised to learn that many physical therapists also offer massage therapy services. Many physical therapists have seen the incredible impact that a deep tissue massage can have on lower back pain. This is because it helps to release tension and strain around the muscles near your spine. Because of this, it can help stop inflammation, calm irritated nerves, and even boost your immunity.

Massage can also help to encourage more flexibility in your body. This can help to not only reduce your lower back pain, but encourage you to be more active.

Most massage sessions will last for about an hour. They will involve various techniques depending on your needs. Some that your therapist might use are QL muscle massage and gluteus medius massage.

Physical therapy is an excellent treatment to use when it comes to naturally healing lower back pain. Your physical therapist will use various techniques, such as exercise and massage, to help provide you with relief. These treatments not only help to decrease and eventually eliminate your pain, but improve many other aspects of your health as well.

About Dr. Brent Wells

Dr. Brent Wells, D.C. founded Better Health Chiropractic & Physical Rehab in Alaska in 1998 and has been a chiropractor for over 20 years. His practice has treated thousands of patients from different health problems using various services designed to help give you long-lasting relief.

Dr. Wells is also the author of over 700 online health articles that have been featured on sites such as Dr. Axe and Lifehack. He is a proud member of the American Chiropractic Association and the American Academy of Spine Physicians. And he continues his education to remain active and updated in all studies related to neurology, physical rehab, biomechanics, spine conditions, brain injury trauma, and more.

Wed, 18 Sep 2019

Don’t Live with the Pain of Shin Splints!

shin splints

Shin Splints are things that many people will have to deal with at some point in their life. If you have pain in your shins when you run, then then this might be what you are facing. Whether you often run or just occasionally jog to get to the door more quickly that someone is holding open for you, if you have a throbbing pain in your shins when you go faster than walking pace, then it might be time to get it checked out.  

What are shin splints?

Shin splints or medial tibial stress syndrome is when the connective tissue on your shins have too much stress on them and they become inflamed. This inflammation can cause a lot of pain. The more you run, the more stress is on them and thus the pain continues or worsens.

How do you get shin splints?

You do not have to be an athlete to get shin splints. They often arise from poorly supported shoes or flat feet. Some people simply have weak ankles, muscles or hips, and that can cause shin splints as well.

Then, of course there are also those people who have overworked their legs or who did not allow enough time for a proper warm-up or cool-down for their workout.

If you have shin splints, then you might be wondering when that pain will go away. Many times, the pain can subside on its own. However, it is still good to see a doctor if you suspect you might have this condition.

How can an Orthopedic Specialist help?

Doctors can do a physical examination and take x-rays to look for possible fractures that might have occurred, which could be leading to your pain. Doctors can also provide some advice on ways to help your pain if you do have this condition.

Orthopedic surgeons who are specialty trained in sports medicine would be the recommended to check out your condition if you think you have shin splints because they are specifically trained to treat this kind of injury.

How do you relieve the pain from shin splints?

Some ways to help relieve some of the pain is to relieve some of the stress being put on your muscles. Working out on hard surfaces (concrete, gyms, etc.) all can lead to shin splints, so working out on softer surfaces whilst recovering can help relieve some of that stress and pain. This is if you do not choose the more effective treatment of rest.

Resting is one of the best ways to help relieve shin splint pain. Ice can also help ease the pain and swelling, but it is recommended to do this for multiple days to have the best result. If your condition was caused by flat feet or poorly supported shoes, then insoles or orthotics can be highly beneficial. This can help prevent your shin splints from returning as well. Finally, anti-inflammatory medicine can be good to help with pain and swelling as well.

“Will I ever be pain free again?”

Once you have taken proper care of your shin splints and seen a doctor to make sure there is not any underlying condition, then you should start to see positive results. You will be back to jogging, running and jumping in no time. Everyone heals at different speeds though, so it is important to continue to take care of your condition to help promote your healing.

How Miller Orthopedic Specialists Can Help

Miller Orthopedic Specialists offers a *FREE sports injury clinic at both locations. Council Bluffs has a walk-in clinic from 10-11am every weekday, and the Omaha office has a free sports injury clinic by appointment weekdays. We offer same and next day appointments for sports injuries. Call 402-991-9958 for an appointment. Closed on holidays.

Initial consultation is free, but charges may occur for x-rays, supplies or follow-up visits. Come into our Council Bluffs office for the walk-in clinic and ask our front desk about your free T-shirt!

We have 2 fellowship-trained, Board Certified, Sports Medicine Specialists, Dr. Larose and Dr. Atteberry They can treat patients of all ages, from children to the weekend warrior. Miller Orthopedic Specialists are proud to be the team physicians for the Iowa Western Reivers, UNO Mavericks, and College of Saint Mary Flames.

Contact us or visit us today!  Get back to living your life pain free.

Mon, 26 Aug 2019

What Exactly is Tennis Elbow?

tennis elbow

A lot of people have heard of tennis elbow, but many people do not know what it is. Tennis elbow might have a funny name, but it is not a funny condition. Tennis elbow, or lateral epicondylitis, is when the tendons and muscles in your elbow become weakened and inflamed. It often leads to minor tears in the tendons as well. This is often caused by repetitive motions of the arm and wrist leading to overuse.

It might be called tennis elbow, but anyone can get it. Many tennis players or golfers have such repetitive motions that it can overwork the tendons if using improper stroke technique, but construction workers, painters, plumbers, and anyone else who has a lot of repetitive arm movements are known to have a higher chance of getting tennis elbow. This is most common in middle aged adult, but anyone can get it if they are involved in the activities that may cause overuse.

The pain is often in the elbow area, hence the name, and it forms a bump on the outside of your elbow. Depending on the severity, the pain will often spread down the arm too. With this pain it makes it hard to grip everyday objects like cups or doorknobs. For many the symptoms worsen the more they use their forearms.

It is recommended that one sees a doctor if they are experiencing any of these symptoms. Once someone’s quality of life is lowered by their pain it is always a good idea to get their injury checked out. The examination to check for tennis elbow often involves a physical examination and can involve other tests like X-rays or MRI’s to help rule out a different underlying condition, such as arthritis.

Most patients do not require surgery upon finding out they have tennis elbow.There are many non-surgical options to help people recover. Rest is one of the most important steps to help with the healing process. This can help reduce pain and swelling. Many people also get a brace to help relieve symptoms and minimize movement. Steroid injections and Stem cell injections are also ways that people can have some more relief faster than they otherwise might.

If it is determined that surgery is the answer there are a couple different methods. Some surgeons choose to do an open approach which involves an incision over the elbow, and others do the surgery arthroscopically which involves small incisions and a small camera. Both methods are typically outpatient procedures. 

Miller Orthopedic Specialists offers a *FREE sports injury clinic at both locations. Council Bluffs has a walk-in clinic from 10-11am every weekday, and the Omaha office has a free sports injury clinic by appointment weekdays. We offer same and next day appointments for sports injuries. Call 402-991-9958 for an appointment. Closed on holidays. Initial consultation is free, but charges may occur for x-rays, supplies or follow-up visits. Come into our Council Bluffs office for the walk-in clinic and ask our front desk about your free T-shirt!

We have 3 fellowship trained, Board Certified, Sports Medicine Specialists, Dr. LaroseDr. Atteberry, and Dr. Huston. They can treat patients of all ages, from children to the weekend warrior. Dr. Huston is certified in pediatric sports medicine as well. Miller Orthopedic Specialists are proud to be the team physicians for the Iowa Western Reivers, UNO Mavericks, and College of Saint Mary Flames.

Wed, 17 Jul 2019

Are Robots Taking Over the World?

You see robotic technology used in more and more applications daily.  There are robotic devices designed to help with tedious, dirty and dangerous chores.  With a quick search you can find robotic tools to vacuum your house, mop floors, change the litter box, clean gutters, and the list goes on.  Robotics for domestic applications have come a long way since the introduction of the clothes dryer and dishwasher – and will continue to evolve.  Which brings us to the question:

Are robots taking over the world?

The use of robotic devices to assist surgeons in the operating room is not a new concept.  Recently, Miller Orthopedic Specialists announced the use of a robotic-arm to assist with partial and total knee replacement surgeries.  In this application, the robotic device is a highly advanced tool used to create a more favorable outcome for the patient.  The Mako robotic-arm assists in carrying out a pre-operative plan, mapped out with a 3D model of the patient’s knee.  Utilizing the pre-operative 3D model allows the surgeon to customize the size and orientation for each patient.  The robotic tool is not meant to replace surgical judgment.   It is meant to assist the surgeon in maintaining a more precise margin, with less damage to soft tissues.  What this means for the patient is less pain after surgery and shorter recovery times, getting them back to their active lifestyles quicker.

As you may have seen in multiple applications, all robotics are not created equal.  Robotics have constantly evolving software and are capable of completing tasks with increased accuracy as they graduate from one generation to the next.   As the brilliant minds at iRobot will attest to, the Roomba has come a long way from its 2002 launch.  The technology has evolved, and equipment has been perfected over the last 17 years.  Here are some things you should consider about the different types of robotic devices utilized for orthopedic surgery. 

There are three types of robotic systems:

Passive systems:  These systems help the surgeon with mapping and navigation to carry out a plan created during surgery. In these systems the robotic device is assisting with positioning but not making surgical cuts.

Semi-active systems:  These systems help with mapping, navigation, providing feedback to the surgeon for precise bone cuts, and eliminating mal-positioning intra-operatively.  Some semi-active systems utilize a 3D model for pre-operative planning. “The big advantage of 3D image-based systems is you are determining your target and your plan in three dimensions in a way that could not be otherwise intra-operatively determined and then you know that you will be hitting that target with a level of accuracy that cannot be achieved without a robot, in terms of an individual cut or an individual component’s position,” David J. Jacofsky, MD, founder and CEO of CORE Institute, a premiere orthopedic clinic located in Arizona.

Active systems:  With active systems, the surgeon creates the surgical plan, but they are not an active participant in the surgery.  The robotic device performs the work.

At this point, you may be asking yourself, why did Miller Orthopedic Specialists choose the Mako robotic device over all others?  The following graph is a representation of some current device capabilities:

This technology has been used for a number of years on both the east and west coasts.  However, the first surgeon to bring robotic assisted orthopedic surgery to the greater Omaha, Council Bluffs metro area is Dr. Clayton Thor.  Dr. Thor is a Board Eligible Orthopedic Surgeon with Miller Orthopedic Specialists.  Dr. Thor received his medical degree from University of Nebraska Medical Center in Omaha, Nebraska and completed his residency at William Beaumont School of Medicine, Department of Orthopedic Surgery in Royal Oak, Michigan.  He then completed a Fellowship Program focusing on Adult Reconstructive Surgery at Headley Orthopedic Institute in Phoenix, Arizona.  During his Fellowship, Dr. Thor had an opportunity to train on robotic total joint replacement under two Master Orthopedic Surgeons, who also focus on robotics.  Dr. Thor has done approximately 160 surgeries utilizing the assistance of the Mako robotic-arm, as of June 2019.

Before scheduling a robotic procedure, you may want to ask your provider the following questions:

  1. What type of technology are they using – Passive, Semi-active, or Active?
  2. How long has the device been in use?
  3. What certifications/training do they have for proper use of the device?
  4. How many surgeries have they completed with the assistance of the device?
  5. Is there clinical data available to show benefits, such as shorter recovery time? Or lower costs associated with using the device for assistance during surgery?

Are robots taking over the world?  As far as orthopedic surgery is concerned, at this point in time, robotic assistance is a highly advanced tool that allows the surgeon to create a patient specific surgical procedure, create a 3D model to ensure precision, and navigate placement to save soft tissue and balance the joint.  Over the last couple of decades, robotics related to orthopedic surgery have advanced well beyond simple navigational tools.  We are excited to see what capabilities the technology of the future will bring.

*Future Science Group, Journal of Comparative Effectiveness Research – A 90-day episode-of-care cost analysis of robotic-arm assisted total knee arthroplasty.

Sun, 07 Jul 2019

Dry Needling Can Help Relieve Your Muscle Pain

Dry needling is a treatment that is done to help ease some muscular pain through the use of needles and trigger points.

Dry needling involves the insertion of a fine filament needle into neuromuscular junctions /motor points, stimulating the muscles, and bringing unbelievable pain relief and significantly improved function to athletes and patients who have been suffering for years.

 There is no injectable solution and the needle which is used is very thin.  Most patients will not even feel the needle penetrate the skin, but once advanced into the muscle, the patient may have a sensation like a muscle cramp – which is often referred to as a “twitch response”.  The twitch response results in deactivating the trigger point, thereby reducing pain and restoring normal length and function to the involved muscle.

 Typically, positive results are apparent within 2-4 treatment sessions but may vary depending on cause and duration of the symptoms and overall health of the patient.    Dry needling is an effective treatment for acute and chronic pain, rehabilitation from injury, and even pain and injury prevention, with very few side effects.   This technique is unequaled in finding and eliminating neuromuscular dysfunction that leads to pain and functional deficits. How does this differ from acupuncture? Dry needling is similar in the aspect that they involve having needles poked into specific points in the body. However, they differ in that acupuncture has primarily a focus of healing the body through releasing healing energy, chi. This approach focuses on the nervous system and endorphin releases. Dry needling is primarily used with the focus of relieving tightness and pain through putting a needle directly into a pressure point or knot.

Dry needling typically helps treat things like lower back pain, headaches, sciatica, osteoarthritis, carpal tunnel, pain throughout muscles like shoulders, knees, back, neck and hips, sprains and tears, and overuse injuries like tendinitis, tennis elbow, and bursitis.

If you have some hesitation about having needles poked into you it is important to make sure you have a general understanding of what dry needling is before having the procedure done. The goal is to relieve one’s pain rather than cause more. There will be like pricking feeling while it is being done, but nothing too major due to the thin needles and precise pricking. Muscles also often contract during this before releasing the tension within them. This is something that cannot be controlled by the person being treated and sometimes can cause minor discomfort because it acts similarly to a muscle twinge for a few seconds, but once the muscle releases more relief can be felt. There is a chance that one can experience minor pain/soreness the day following the procedure, but drinking plenty of water, ice, heat, and some exercise or stretching can help relieve some of this pain.

This method has gradually been becoming more and more popular throughout the country. It is important to ensure that the person doing the dry needling has had training in some capacity. A physical or occupational therapist has had a lot of training with how the human body works/heals. Therefore, they can really help the individual figure out the best individualized treatment plan for them.  

If you think that this might be a good fit for your pain, call to schedule an appointment with one of our therapists: Joshua Bintz (DPT), Amanda Askey (PTA), Hannah Wooden (PTA), or Angel Arora (OTR/L, OTD).




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