Volume 5, Issue 2 Body Wise - Improving Lives, … 5, Issue 2 Body Wise A Publication of The orThopaedic insTiTuTe Featured articles: Shoulder replacement Surgery By W. Preston Blake,

Volume 5, Issue 2

Body WiseA Pub l i ca t i on o f T h e o r T h o pa e d i c i n s T i T u T e

Featured articles:Shoulder replacement Surgery

By W. Preston Blake, M.D.IS your Knee paIn a torn menIScuS?

By Andrew F. Rocca, M.D.plantar FaScIItIS

By Amanda G. Maxey, M.D.anKle SpraInS

By Phillip L. Parr, M.D.ocala expanSIon

...To exceed standard outcomes and achieve high levels of patient satisfaction

and safety by providing top quality, efficient, patient centered service.”

ORTHOPAEDIC SURGERY CENTER4600 Newberry Road | Gainesville, FL 32607Phone: (352) 367-2310 | Fax: (352) 367-2515

Our MissiOn“To set the community standard for outpatient ambulatory surgery services in North Central Florida...

www.toi-health.com/OSC

Our patients choose the Orthopaedic Surgery Center because they understand that we are dedicated to providing surgical services that meet high standards of quality and safety. With 16,500 square feet, 5 operating rooms, comfortable recovery amenities and skilled staff, our facility was designed to meet the specific needs of our surgeons and patients. We are a fully licensed Ambulatory Surgical Facility and accredited through the Accreditation Association for Ambulatory Health, as well as Medicare certified. We accept most major insurance plans and are happy to answer questions about fees, our facility, or what to expect on the day of surgery. We look forward to serving you.

e are pleased to present the tenth issue of Body Wise. This publication is dedicated to patient education with articles addressing timely topics in health, sports and medicine. The “Featured Physician Articles” written by members of our group focus on the prevention and treatment of common musculoskeletal conditions and injuries. In this issue are articles related to: • Shoulder Replacement Surgery• Is Your Knee Pain a Torn Meniscus?• Plantar Fasciitis• Ankle Sprains• Ocala Expansion If you are not familiar with The Orthopaedic Institute, we are a private practice group of 24 fully trained, experienced specialty physicians that have been proudly providing quality musculoskeletal care to North Florida for more than 30 years. We have four full-service clinic locations offering same-day and next-day appointments in Gainesville, Ocala, Lake City and Alachua.

We hope the information contained in Body Wise is fun to read, assists you in making educated decisions regarding your health and supports your decision to select The Orthopaedic Institute when in need of musculoskeletal care.

Sincerely,

The OrThOpaedic insTiTuTeA Message from

W

The Orthopaedic Institute Physicians

Body Wise is designed and published by

Custom Publishing Group. 800-246-1637

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Interested in advertising in an upcoming issue of Body Wise?

Contact Rebecca Reed at(904) 242-7182.

sincerely appreciates the following businessesthat partnered with us to support this publication:

The OrThOpaedic insTiTuTe

Table of Contents

• Amsurg

• Better@Home

• Compass Bank

• DonJoy - Aircast

• Exactech

• Gentiva Health Services

• Interventional Medical Associates

• Lake Area Physical Therapy

• M & M Rehab./Mid- Florida Prosthetics & Orthotics

• North Florida Regional Medical Center

• Senior Home Care, Inc

• Stryker OCALA Expansion & Welcome Dr. Riley ............................................ 4

Ankle Sprains .................................................................................... 5

Is Your New Pain a Torn Meniscus .................................................. 10

Plantars Fasciitis .........................................................................12

Shoulder Replacement Surgery ....................................................... 20

Treating Deep Vein Thrombosis .................................................... 24

Don’t Strike Out! - Youth Baseball Injuries ...................................... 28

Tips to Prevent Swimming Injuries .................................................. 30

...To exceed standard outcomes and achieve high levels of patient satisfaction

and safety by providing top quality, efficient, patient centered service.”

ORTHOPAEDIC SURGERY CENTER4600 Newberry Road | Gainesville, FL 32607Phone: (352) 367-2310 | Fax: (352) 367-2515

Our MissiOn“To set the community standard for outpatient ambulatory surgery services in North Central Florida...

www.toi-health.com/OSC

Our patients choose the Orthopaedic Surgery Center because they understand that we are dedicated to providing surgical services that meet high standards of quality and safety. With 16,500 square feet, 5 operating rooms, comfortable recovery amenities and skilled staff, our facility was designed to meet the specific needs of our surgeons and patients. We are a fully licensed Ambulatory Surgical Facility and accredited through the Accreditation Association for Ambulatory Health, as well as Medicare certified. We accept most major insurance plans and are happy to answer questions about fees, our facility, or what to expect on the day of surgery. We look forward to serving you.

4 The Orthopaedic Institute

The OrThOpaedic insTiTuTe - imprOving Lives everyday

Ocala ExpansiOnTOI welcomes Dr. Riley and opens new medical office building

The Orthopaedic Institute has expanded its operations in Ocala with the addition of Michael K. Riley, M.D., in January and the construction of a new medical office complex.

Dr. Riley joined fellow orthopaedic surgeons Joseph Locker, M.D., Marc Rogers, D.O., Rodger Powell, M.D., and Fast Access primary care orthopaedic

physician, Paul Rucinski, M.D., enhancing the services offered by the Ocala facility.

Dr. Riley is a board certified orthopaedic surgeon, and his areas of clinical interest include shoulder replacement, sports medicine, arthroscopy, total hip replacement and total knee replacement. Dr. Riley graduated from the University of Michigan Medical School and completed his internship and residency at Shands at the University of Florida. He is a member of the American Academy of Orthopaedic Surgeons and also serves on the Continuing Medical Education Committee at Ocala Regional Medical Center.

“We are very excited to have Dr. Riley join the team,” said Eric Brill, CEO of The Orthopaedic Institute. “His affiliation with our group and the construction of our new medical office complex are major steps in our plan to further invest in the community

and provide more comprehensive services to patients.”

With the highly anticipated grand opening in July, the new medical office complex will offer countless improvements for patients. The new building will have 18 exam rooms compared to the current 10. The hand therapy department will have a private, fully equipped suite, while the physical therapy department will have twice the amount of room. In-house diagnostic testing will be available to patients, including digital X-ray and MRI.

Patients will be able to easily locate the new medical complex because of its prime real estate, and they need not worry about parking, as the private parking lot provides ample space. Once they arrive, they will also enjoy a spacious, comfortable and bright waiting room, complete with Starbucks coffee.


Ankle SprAinSBy: Phillip Parr, M.D.

SSprained ankles are the most common sports injury, occurring in 15 to 20 percent of athletes. A sprained ankle can also occur in non-athletes, adults and children alike. Although strengthening the ankles is every bit as important as strengthening the rest of the body, many fail to recognize the importance of incorporating ankle exercises into their strength training routine. Omitting this important step is like building a strong house on a weak foundation.

A sprain is an injury to the ligamentous structures about a joint, resulting in partial or complete tearing of the ligaments. Sprains can occur to any joint in the body, including the knee, shoulder, elbow, wrists and fingers, but the ankle is by far the most frequently injured joint.

During physical activity, the ankle is placed under enormous stress, making it all the more important to strengthen this vulnerable joint. The entire body’s weight rests on an area not much bigger than a cue ball, where the leg bone meets the foot. The ability to run, cut and jump depends on an athlete’s ability to balance his or her body weight over the small surface. If the soft tissue structures around the ankle are weak, the foot may turn in, stretching or tearing the ligaments on the outside of the ankle. If the supporting structures of the ankle are strong, it can reduce the risk of injury by nearly half.

Ankle sprains occur in virtually every type of sport that requires running and cutting maneuvers, especially soccer, basketball, football and

Dr. Parr is Board Certified in Orthopaedic Surgery. He has been practicing for more than 30 years in the North Florida community. Dr. Parr attended medical school at Vanderbilt University and completed his residency in Orthopaedic Surgery at the University of Florida. Additionally, he obtained fellowship training in Arthritis Surgery in Denver, Colorado. Dr. Parr is an active member of the American Academy of Othopaedic Surgeons, the Florida Orthopaedic Society and the Orthopaedic Spoorts Medicine Society. His personal interests include physical fitness, skiing and cycling.

The Orthopaedic Institute 5


Ankle SprAinSBy: Phillip Parr, M.D.

SSprained ankles are the most common sports injury, occurring in 15 to 20 percent of athletes. A sprained ankle can also occur in non-athletes, adults and children alike. Although strengthening the ankles is every bit as important as strengthening the rest of the body, many fail to recognize the importance of incorporating ankle exercises into their strength training routine. Omitting this important step is like building a strong house on a weak foundation.

A sprain is an injury to the ligamentous structures about a joint, resulting in partial or complete tearing of the ligaments. Sprains can occur to any joint in the body, including the knee, shoulder, elbow, wrists and fingers, but the ankle is by far the most frequently injured joint.

During physical activity, the ankle is placed under enormous stress, making it all the more important to strengthen this vulnerable joint. The entire body’s weight rests on an area not much bigger than a cue ball, where the leg bone meets the foot. The ability to run, cut and jump depends on an athlete’s ability to balance his or her body weight over the small surface. If the soft tissue structures around the ankle are weak, the foot may turn in, stretching or tearing the ligaments on the outside of the ankle. If the supporting structures of the ankle are strong, it can reduce the risk of injury by nearly half.

Ankle sprains occur in virtually every type of sport that requires running and cutting maneuvers, especially soccer, basketball, football and

Dr. Parr is Board Certified in Orthopaedic Surgery. He has been practicing for more than 30 years in the North Florida community. Dr. Parr attended medical school at Vanderbilt University and completed his residency in Orthopaedic Surgery at the University of Florida. Additionally, he obtained fellowship training in Arthritis Surgery in Denver, Colorado. Dr. Parr is an active member of the American Academy of Othopaedic Surgeons, the Florida Orthopaedic Society and the Orthopaedic Spoorts Medicine Society. His personal interests include physical fitness, skiing and cycling.



volleyball. Athletes with a history of a previous sprain are twice as likely to suffer recurrent injuries to the ankles. Targeted ankle strength and balance training can help keep athletes in the game, but before discussing treatment and prevention, it is important to understand the anatomy of the ankle and the mechanics of an injury.

There are three major ligaments (tough fibrous tissue that connects bone to bone) on the lateral side of the ankle that stabilize the foot and keep it from rolling inward: the talofibular ligament that attaches the fibula to the talus, the calcaneofubular ligament that attaches the fibula to the calcaneus or heel bone, and the tibiofibular or syndesmotic ligament that runs from the tibia shin bone to the fibula. The lateral talofibular ligament is the most commonly injured with inversion injuries to the ankle. Injuries to the tibiofibular (syndesmotic) ligament are called “high ankle sprains.”

Most injuries occur from forceful inversion or rolling over of the foot to the inside, usually when landing on an uneven surface, such as another player’s foot. This results in stretching and tearing of the fibers on the outside of the ankle. There is frequently an audible pop or a crunching sensation, followed by immediate pain, swelling and discoloration of the outside of the ankle from internal bleeding. Players with mild sprains frequently try to continue competing. With more severe injuries, the athlete is immediately disabled and has to be helped from the playing area. For the first few days, there is swelling and discoloration over the lateral side of the ankle extending down over the foot, with severe pain with weight-bearing or movement.

Initial treatment includes elevation, compression, application of ice and rest. Athletes with minor sprains can frequently return to competition within one to two weeks with protective devices on the ankle. Severe sprains generally require at least three to six weeks of rehabilitation before returning the athlete to competition. High ankle sprains involving the thicker ligament above the ankle joint sometimes require more than three months to completely heal.

The player will require the use of taping or a protective brace when practicing and competing for the remainder of the season.

Once an athlete is able to walk with minimal discomfort, proprioceptive (position sense) or balance training exercises are done to restore the patient’s functional strength. Recent studies in sports medicine care have indicated that incorporating this training into the regular pre-season training program, before an injury occurs, can cut the rate of ankle sprains by 40 percent.

The Physical Therapy Center at The Orthopaedic Institute has developed a balance training program to protect athletes from ankle injuries. The program is based on a compilation of published programs and can be performed both pre-season and during the season.

The program utilizes balance boards (also called tilt boards or wobble boards), which are invaluable devices to help in regaining proper balance. The balance board is a wooden disc with a spherical device attached to the bottom that allows for tilting and rotational exercises. Balance boards are affordable, readily available and should be included in any rehabilitative or sports training facility.



Below are the specific exercises for balance training, which can also be referenced in the balance board training guide following this article. All exercises should be performed for 30 seconds, alternating legs and progressing through the program weekly.

The key to balance training is to have your conscious mind focusing on activity while your subconscious mind is working on stability. A few minutes spent on the balance board each week will strengthen the structures of the ankle and help prevent injury.

Week 1 exercises begin by standing on one leg on the floor with eyes open. If this is too easy, modification can be made by turning the head side-to-side or up and down or swinging the opposite leg.

Next, a partial squat (30 to 45 degrees) can be performed during single-leg standing. Again, these are performed for 30 seconds.

Finally, we have single-leg stance with functional activities. These activities can include dribbling, playing catch, etc.

Week 2 is progression to flat surface activities with eyes closed. The same exercises can be performed as in Week 1, with the exception of the functional activities.

Single-leg stand with head movement and leg swings

Partial squat

Week 3 introduces the use of a balance board. Warning: These activities are risky and falls should be expected. Do these exercises with a spotter and follow the balance board manufacturer’s instructions.

Single-leg stand (eyes open)

Leg swings and head turning

Partial squats

Functional training – catch, dribbling

Week 4 and beyond modifies single-leg standing to closed eyes, continues partial squats and functional activities with eyes open, and adds board rotation and control activities.

Single-leg stand (eyes closed)

Leg swings and head turns

Partial squat

Functional training

Single-leg standing while rotating board, touch downs front to back, side to side

For more information, see the Balance Training Program on the next page.

Balance Board Manufacturer’s WARNING:

WE

EK

1W

EE

K 2

WE

EK

3W

EE

K 4

Week 2 is Progression to flat surface Activities with eyes closed. The same exercises as week 1 can be performed WITH THE EXCEPTION OF FUNCTIONAL ACTIVITIES.

Begin with standing with eyes open on one leg on the floor. If this is too easy, modi-fications can be made by turning head side-to-side or up and down or swinging the oppisite leg.

A partial squat (30˚-45˚) can be performed during single leg standing

Single leg stance with functional activities. These can include dribbling, playing catch, etc.

Single leg stand with head movent and leg swings

Partial squat(30˚-45˚)

Week 3 begins use of the balance board. WARNING: These activities are risky and falls should be expected. Do these exercises with a spotter and follow the balance Board manufacturer’s instructions.

Single leg stand

Leg swings and head turns

Partial squats

Functional training

Single Leg Stand (eyes Closed)

Leg Swings and Head turns

Partial squats Functional training Single leg standing while rotating board, touch downs front to back, side to side.

A BALANCETRAINING PROGRAM

THE ORTHOPAEDIC INSTITUTE PRESENTS:

A BALANCE TRAINING PROGRAM

This program is based on a compilation of published programs and can be performed both pre-season and during the season.

All exercises should be performed for 30 seconds alternating legs and progressed weekly.



Do not use this equipment without a complete understanding of its intended purpose and function. By stepping on this equipment the user accepts full responsibility for all risks and injuries and waives any right to themselves, their heirs, their executors or any part to hold the Manufacturer or its representatives responsible for any direct or indirect damages whatsoever caused by use of this equipment. Only use Fitter products in a safe clear area on a flat dry surface. Children must not play on this equipment unattended. Consult a physician before starting this or any exercise program.

WARNING:






Senior Home Care’s Orthopedic Rehabilitation Program helps ensure a more

complete recovery after surgery. Program benefits include: l Specially trained orthopedic therapists on staff l Compliance with physician protocol l Focus on optimal outcomes l Patient education l Anti-coagulation testing per physician protocol l Pre-surgical coordination of care

Surgery Recovery in the HomeSurgery Recovery in the HomeSurgery Recovery in the HomeSurgery Recovery in the HomeSurgery Recovery in the HomeSurgery Recovery in the Home

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Mid-FloridaProsthetics & Orthotics

Frank M. Vero, C.P.O.Licensed Prosthetist & Orthotist

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WARNING:







Is Your Knee PaIn a Torn MenIscus?By: Andrew Rocca, M.D.

EEssential for mobility and often over utilized, the knee joint becomes susceptible to problems and injury. One type of knee injury commonly seen in an orthopaedic clinic is a meniscus tear.

The knee is made up of three bones: the femur (thigh bone), the tibia (shin bone) and the patella (knee cap). The meniscus, is a half moon-shaped, wedge-like cushion that lies between the bones in your knee joint allowing your weight to be equally distributed across the bones.

Made up of cartilage, the wedges not only stabilize the knee, but also allow the joint to smoothly slide and move in many directions. When the meniscus is torn or damaged, you lose part of that cushioning system; your weight is no longer applied evenly across your bones, so grinding and wearing occurs as bone meets bone. After time, arthritis of the knee joint develops as the stressed bones take on more of the burden of your weight.

Meniscus tears are most commonly caused by trauma

(athletic injuries) and the aging process (as we age our cartilage becomes brittle.) When the injury occurs in athletes, the patient typically describes a “popping” sensation in his/her knee when participating in a sporting event. Surprisingly, most people are still able to walk after tearing their meniscus, and we often see athletes return to the field after this type of knee injury. The seriousness of the injury is not apparent until later, when the knee becomes inflamed, feels painful, tight and may be quite swollen.Symptoms of a torn meniscus may include (but are not limited to):• knee pain;• knee swelling, commonly

referred to as “water on the knee,” or technically an “effusion;”

• hearing a popping or clicking within the knee; and

• limited motion of the knee joint.

Treatment after initial injury should follow the RICE formula (Rest, Ice, Compression and Elevation.) If the knee recovers fully after RICE treatment, then no other treatment may be necessary. However, if there are still problems with the knee, a

Dr. Rocca is Board Certified in Orthopaedic Surgery. Prior to joining The Orthopae-dic Insitute, he practiced three years with the United States Navy. Dr. Rocca attend-ed medical school at the University of Pennsylvania and completed his residency in Orthopaedic Surgery at the National Naval Medical Center. He also performed a fel-lowship in Hyperbaric Medicine at the Naval Undersea Medical Institute. Dr. Rocca is a member of the American Academy of Orthopaedic Surgeons, Florida Orthopae-dic Society, Florida Medical Society, and Society of Military Orthopaedic Surgeons.



piece of the meniscus may be torn or loose and floating around inside the joint causing the knee to lock, slip or pop. In some cases, the knee will catch or lock, and the patient will have to manually manipulate the joint to straighten it.

Unlike the athletes, older folks often don’t experience trauma when they injure their meniscus. Instead, the wear and tear on the joint over the years weakens the meniscus until, one day, a degenerative tear appears.

If you think you have a torn meniscus, you should see your physician to have this evaluated further. Your exam will include your physician taking a careful history of your symptoms, palpating the joint and noting areas of tenderness. X-rays and an MRI may also be ordered by your physician to better visualize what is occurring inside your joint. If a meniscus tear does appear on your MRI, the next step is to determine treatment, and most pointedly, whether or not surgery is indicated. Sometimes an individual is not a good surgical candidate or his/her meniscus tear symptoms are minimal, in this case, we can take a “wait and see” approach. Surgery is sought when the knee becomes problematic and interferes with day to day activities.

If surgery is indicated, your surgeon will recommend either a meniscus repair (repairing the tear) or a partial menisectomy (trimming and removing the torn or loose pieces of meniscus in your joint), based on your

specific injury.

A meniscus repair is an attempt to fully restore the structure, and because it is a more extensive surgical procedure, requires a longer recovery. The failure rate is higher with meniscus repair because the delicate meniscus tissue lacks an adequate blood supply and does not heal well. However, if the repair is successful, the joint is healthier in the long run.

When the injured tissue has completely lost its blood supply or is tattered beyond repair, a partial menisectomy is performed. Menisectomy quickly relieves the most bothersome symptoms, has a faster recovery than meniscus repair, but, because a portion of the knee’s cushioning is removed, will not reduce the risk for further progression of arthritis.

Both meniscus repair and partial menisectomy are arthroscopic surgeries. The arthroscope gives your surgeon a clear view of the interior of your knee with the benefit of only a couple of small incisions (each,

approximately one centimeter in length). Using tiny instruments your surgeon can trim frayed areas, suture tears and remove fragments of the meniscus that have broken loose.

The outcome of the surgery depends on several factors, including the severity of the particular injury, the degree of damage and associated arthritis. As mentioned earlier, recovery is dependent on the type of surgery (repair versus partial menisectomy), but most report only needing a couple of days off from work until they are up again. However, further recovery and return to more aggressive activities or physical labor often takes longer, and physical therapy may be beneficial for recovering full function of the knee in the 6-8 weeks following surgery.

Please note that although arthroscopy can effectively treat many problems, you may have some activity limitations even after recovery. A return to intense physical activity should only be done under the direction of your surgeon.



Plantar FasciitisBy: Amanda G. Maxey, M.D.

Dr. Maxey is a Board Certified Orthopaedic Surgeon. She attended medical school and completed her orthopaedic residency at the University of Florida College of Medicine. Additionally, she obtained fellowship training in foot and ankle surgery at Crystal Clinic in Akron, Ohio. Dr. Maxey is a member of the American Academy of Orthopaedic Surgeons and the Florida Orthopaedic Society. In her free time, Dr. Maxey enjoys sea kayaking, mountain biking, water skiing and jogging.

NNearly two million patients are treated for plantar fasciitis each year in the United States. It is estimated that one in 10 people will develop plantar fasciitis during their lifetime.

The plantar fascia is a broad band of fibrous tissue that starts at the bottom of the heel and extends out to the toes. The tissue is not very flexible and is placed under significant tension during walking

and running. The tension is concentrated at the heel bone or calcaneus and is believed to be the cause of pain.

The problem is frequently referred to as “heel spurs.” In fact, only about 50 percent of patients with heel pain have a spur. The spurs occur above the fascia in one of the muscles, and although spurs can occur with heel pain, they are not considered the cause.

The pain is typically gradual in onset and is generally worse with the first few steps after awakening or after prolonged rest. There is rarely a specific injury.

In most cases, the diagnosis can be made by discussing symptoms and history and a physical exam. Other studies are seldom needed. An X-ray can help rule out other causes of pain such as a fracture. An MRI scan is only used in difficult-to-diagnose cases or in someone who is not responding to conservative treatment.

Non-operative treatment is truly the main remedy of heel pain. A home stretching program is the primary treatment in addition to education and activity. It is important not to stretch rapidly or too aggressively as this can actually increase pain by doing more damage. The stretching is designed to increase the flexibility of both the plantar fascia and the Achilles and in doing so, decreases the tension on the heel bone. Pre-stretching after prolonged rest is particularly important to avoid re-injuring the fascia when standing after prolonged rest such as sleeping, eating and driving.

Treating the inflammation with ice or an anti-inflammatory such as Aleve or Ibuprofen can also



help. Support and cushions can also help relieve the pressure on the heel and the fascia. Steroid injections may also be part of the treatment, but typically only provide temporary relief. Other treatment options include physical therapy and/or massage therapy, night splints, and on occasion, for severe cases, a cast or boot to rest the fascia.

Generally, surgery or more invasive procedures are not considered until all conservative options

have failed over several months. The procedure of choice is commonly considered to be an open plantar fascia release. Results are generally good, but the recovery can be long, especially when trying to get back to walking on ones feet or to athletic activities. Endoscopic plantar fascia release is another option. Some believe the return to activities is more rapid but the results leave many questions.

6 repetitions30 seconds each

2 x per day

Pre-Stretch #1Step #1In the sitting position, fully extend your knee (i.e., straight out) and place both hands on your knees.

Step #2Point your toes toward your head bending your foot upwards at the ankle (Fig. 1).

Step #3Hold this position for as long as possible (minimum 30 seconds at a time). Repeat six times for a total stretch time of 2-3 minutes.

Pre-Stretch #2(Alternate to #1)

Step #1In a seated position, cross the affected leg across the uninvolved limb, resting the ankle of the affected foot on the opposite knee (Fig. 2).

Step #2Grasp the toes of the involved foot with the arm of the same side and pull the toes toward the shin.

Step #3Hold the toes and foot in this position for a minimum of 30 seconds at a time of 2-3 minutes.

Note: Before standing, you should complete one of the stretches above.

Fig. 2


2 x per day

Fig. 1


Four convenient locations in north Florida

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same or next day appointments available

Because injuries can’t wait!

24 Fully trained, experienced, specialty physicians

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Fig. 3


2 x per day

Stretch #1

Step #1Position yourself with the ball of your foot on the edge of the wall.

Step #2You should be relaxed and no active muscle contractions in your legs should be necessary. Gradually lean in toward the wall until you feel a stretch.

Step #3Hold this position for 1-2 minutes. Work up to 4-5 minutes at least twice a day.

After completion, go on to Stretch #2

Stretch #2

Step #1Roll towel tightly so that its diameter is 1 to 1-1/2 inches and tape for future use.

Step #2 Place the towel under your toes, but allow the ball of your foot to rest on the ground (Fig. 4).

Step #3Place your opposite leg straight back for balance.

Step #4 Keeping your heel on the ground, now force your knee toward the wall or table that you are using for balance.

Step #5This position is difficult to maintain for long periods of time. Minimum time for each stretch should be 30 seconds. Repeat six times for total stretching time of 2 to 3 minutes at least twice a day.

Fig. 4

























Physicians

Arthur M. Sharkey, M.D.Board Certified Plastic Surgery

Edward M. Jaffe, M.D.Board Certified

Orthopaedic Surgery

Phillip L. Parr, M.D.Board Certified

Orthopaedic Surgery

Andrew F. Rocca, M.D.Board Certified

Orthopaedic Surgery

Jason Shinn, M.D.Board Certified

Orthopaedic Surgery

Adil Kabeer, M.D.Board Certified Plastic Surgery

Mark A. Petty, M.D.Board Certified

Orthopaedic Surgery

Marc J. Rogers, D.O.Board Certified

Orthopaedic Surgery

Jason J. Rosenberg, M.D.Board Certified Plastic Surgery

James W. Berk, M.D.Board Certified

FP & Sports Medicine

Timothy Lane, M.D.Board Certified

Orthopaedic Surgery

Rodger D. Powell, M.D.Board Certified

Orthopaedic Surgery

Paul J. Rucinski, M.D.Primary Care Orthopaedics

W. Preston Blake, M.D.Board Certified

Orthopaedic Surgery

Joseph R. Locker, M.D.Board Certified

Orthopaedic Surgery

Phil Rhiddlehoover, M.D.Primary Care Orthopaedics

J. Stephen Waters, M.D.Board Certified

Orthopaedic Surgery

James B. Slattery, M.D.Board Certified

Orthopaedic Surgery

John C. Stevenson, M.D.Board Certified

Neurological Surgery

D. Troy Trimble, D.O.Board Certified

Orthopaedic Surgery

Edward J. Sambey, M.D.Primary Care Orthopaedics

Frank D. Ellis, M.D.Board Certified

Orthopaedic Surgery

Amanda G. Maxey, M.D.Board Certified

Orthopaedic Surgery

Michael K. Riley, M.D.Board Certified

Orthopaedic Surgery

Surgical ProcedureS

general orthoPaedicS

occuPational Medicine

non-Surgical orthoPaedicS

• Hand Surgery• Shoulder Surgery• Knee Surgery• Hip Surgery• Spine & Neurosurgery• Foot & Ankle Surgery• Joint Replacement Surgery• Anterior Approach to Hip Replacement• Plastic & Reconstructive Surgery• Arthroscopic Surgery• Minimally Invasive Surgery

SPortS Medicine

WorkerS’ coMP PrograM

SPine diSorderS

Depending on the severity of your condition and diagnosis, you may require a surgical procedure. Below are the categories of the surgical procedures provided by the physicians of The Orthopaedic Institute:

other ServiceSIn an effort to provide the complete spectrum of musculoskeletal care, the following ancillary services are available on-site:

• Digital X-ray• MRI (Gainesville & Ocala)• EMG / Nerve Conduction Studies• Physical Therapy• Hand Therapy• Work Comp Pharmaceutical Program• Outpatient Surgery (Gainesville)

Diagnosis, treatment and rehabilitation of common injuries and diseases of the musculoskeletal system including: bones, joints, ligaments, muscles and tendons.

Diagnosis, treatment and rehabilitation of the wide range of orthopaedic problems that can occur in the workplace due to traumatic injuries and repetitive stress disorders.

Diagnosis, treatment and rehabilitation of sports injuries including: ligament tears, cartilage injuries, joint instability, overuse injuries and muscle weakness.

Diagnosis, treatment and rehabilitation of non-surgical injuries including: sprains, fractures and acute or chronic pain of the extremities. Non-surgical orthopaedics focuses on proper exercise and rehabilitation techniques as treatment rather than surgery.

Diagnosis, treatment and rehabilitation of spine disorders including: cervical and lumbar disorders, spinal stenosis and other spinal conditions.

- Fast access - PriMary care orthoPaedic

and SPortS Medicine clinicS

As soon as possible. The physicians and staff of The Orthopaedic Institute understand the importance of these words. In order to evaluate and treat patients as quickly as possible, TOI offers same or next-day appointments through the Fast access Primary Care Orthopaedic and Sports Medicine Clinics. After all, who has time for injuries and pain?

• Gainesville - Phillip L. Parr, M.D.• Ocala - Paul J. Rucinski, M.D.• Lake City - Edward J. Sambey, M.D.

Phil Rhiddlehoover, M.D.• Alachua - James W. Berk, M.D.

Fast access physicians treat musculoskeletal and workplace injuries, provide continued care of non-surgical patients and perform office-based procedures such as fracture care, joint injections, joint aspirations, casting, splinting and other procedures not requiring sedation or general anesthesia. Referrals to surgeons and specialists are offered as necessary.

Prompt service and effective communication are paramount to efficiently serve injured workers. In an effort to meet the needs of Workers’ Compensation patients, TOI provides a dedicated Work Comp department, available Monday through Friday from 8 a.m. to 5 p.m. As an added convenience, TOI offers pharmacy dispensing for Work Comp patients as well.

services

www.tOi-health.cOmA P r e s c r i P t i o n f o r P A t i e n t e d u c A t i o n

the orthoPaedic inStitute’S WebSite iS a valuable reSource Providing inforMation on the folloWing:

click Where it hurtSThe homepage of

www.toi-health.com includes a multimedia patient education element. Visitors can “click where it hurts” to view 3D

animations of common musculoskeletal conditions

and procedures. These animations provide easy-to-understand descriptions and detailed anatomical images, which can also be printed as

a hard-copy brochure with the click of a mouse.

• Profiles of Our 24 Physicians• Comprehensive List of Services• Online Appointment Request• Animation Library of Conditions &

Procedures• Physician-Authored Articles• Online Bill Payment• Workers’ Compensation Program• Referral Services Program• Surgical Facilities Information

• Fast Access Clinic Information• Maps of Our 4 Locations• Useful Links • New Patient Information and

Registration Paperwork• Insurance Information• Contact Information• Employment Opportunities• Blog and Links to Follow Us On

Facebook and Twitter

complimentary Wireless internet now available in patient Waiting

areas

www.tOi-health.cOmA P r e s c r i P t i o n f o r P A t i e n t e d u c A t i o n

the orthoPaedic inStitute’S WebSite iS a valuable reSource Providing inforMation on the folloWing:

click Where it hurtSThe homepage of

www.toi-health.com includes a multimedia patient education element. Visitors can “click where it hurts” to view 3D

animations of common musculoskeletal conditions

and procedures. These animations provide easy-to-understand descriptions and detailed anatomical images, which can also be printed as

a hard-copy brochure with the click of a mouse.

• Profiles of Our 24 Physicians• Comprehensive List of Services• Online Appointment Request• Animation Library of Conditions &

Procedures• Physician-Authored Articles• Online Bill Payment• Workers’ Compensation Program• Referral Services Program• Surgical Facilities Information

• Fast Access Clinic Information• Maps of Our 4 Locations• Useful Links • New Patient Information and

Registration Paperwork• Insurance Information• Contact Information• Employment Opportunities• Blog and Links to Follow Us On

Facebook and Twitter

complimentary Wireless internet now available in patient Waiting

areas


KNEE PAIN?Learn About Exactech and Optetrak®: The Peter Jacobsen Knee

Professional Golfer Peter Jacobsen is the picture of an

active lifestyle. Whether he’s playing golf or playing with

his grandson, being on the go is at the core of Peter’s

existence. Yet, after 32 years on the PGA TOUR and fi ve

years on the Champions Tour, knee pain began to threaten

his dynamic way of life.

That’s when he decided to fi nd out all he could about

knee replacement. He chose a surgeon who uses the

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Find a Surgeon Near You who UsesOptetrak®: The Peter Jacobsen Knee

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*As with all surgeries, results can vary. Your surgeon will discuss the possible risks or complications and will consider a wide range of variables when selecting the knee that’s right for you--factors like age, height, weight and activity level. The Optetrak knee is designed to accommodate these variations to provide the best possible outcome, striving to increase mobility and independence, returning patients’ quality of life.

B d i M i i dd / / PM

Your Hip Pain is Personal.

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Stryker’s Personalized Hip Solutions offers your doctor the ability to match the implants to your unique anatomy and help you meet your lifestyle recovery goals. The implant combination chosen just for you is designed to relieve your hip pain and get you moving again.

Don’t let the pain of arthritis change the way you live your life. Call 1-888-STRYKER or visit www.aboutstryker.com for more information about the Stryker Hip Solution that’s right for you.

Stryker provides educational information only, not medical advice. Joint replace-ment surgery, like any major surgery, involves recovery time and risks, including allergic reactions, blood clots, revision surgery, and in rare cases, death. See your orthopaedic surgeon to determine if joint replacement surgery is right for you, and discuss all the risks. The results and lifetime of joint replacement surgery vary depending on age, weight, activity levels, etc.

Stryker Corporation or its divisions or other corporate affi liated entities own, use or have applied for the following trademarks or service marks: Stryker. ©2010 Stryker.

Page 20 - JUNE 2010 - Voice News

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Shoulder replacement SurgeryBy: W. Preston Blake, M.D.

Dr. Blake is a Board Certified Orthopaedic Surgeon. He attended medical school at the University of Alabama and completed his orthopaedic residency at the University of Florida College of Medicine. Additionally, he obtained fellowship training in sports medicine in Jackson, Wyoming. Dr. Blake is a member of the American Academy of Orthopaedic Surgeons and the Florida Orthopaedic Society. In his free time, Dr. Blake enjoys flying his glider, working in his wood shop and riding bikes with his wife.

IIn my 30-year career as an orthopaedic surgeon, total joint replacements have become one of the greatest innovations I have observed. Taking an individual whose lifestyle is severely compromised by his or her arthritic joint and improving his or her function by replacing the joint is very gratifying. One of the joints that can be replaced when it becomes severely arthritic is the shoulder, and that is what I would like to discuss today.

Before we discuss the actual replacement, it is important to understand the special characteristics of the shoulder and the challenge of designing a shoulder joint replacement. The shoulder has a greater range of motion than any other joint. It is a ball and socket joint like the hip, but the shoulder socket is very shallow. As a result, the ball (humerus bone) is not as securely held by the socket (glenoid) and a deeper layer of muscles, called the rotator cuff, helps hold the ball in alignment with the socket.

Over our lifetime, the rotator cuff tendons become worn and lose their ability to keep the humerus centered on the glenoid. As a result, the ball is not held

in proper alignment with the socket, and the joint wears out – becoming arthritic. This leads to a special type of shoulder arthritis called rotator cuff arthropathy, which requires a specially designed shoulder replacement

called a reverse prosthesis. Therefore, there are two types of total shoulder replacements: a conventional prosthesis, which is used when the rotator cuff is functioning well, and a reverse prosthesis, used when the

Unlike the hip, which has a deep socket to keep the joint properly aligned, the shoulder socket is shallow and relies on the rotator cuff structure for support. If the rotator cuff is compromised, the humerus (ball) may shift on the glenoid (socket), wearing away cartilage and causing arthritis.

Shoulder Joint AnAtomy

hip Joint



rotator cuff is severely worn and functioning poorly.

If you are having pain in your shoulder and upper arm, a very common cause is “wear and tear” of your rotator cuff. This can be made worse by a superimposed injury. This is not treated with joint replacement, but an appropriate combination of therapy, injections and possible surgery, if appropriate. However, if your doctor finds that the cause of your pain is an arthritic joint and it is severe enough for surgery, then conventional or reverse arthroplasty can be considered. Usually, the X-ray shows us which prosthesis is appropriate though sometimes MRI or CT scans can provide additional information, which helps the surgeon plan your operation. The operation takes one to two

hours, and most patients remain in the hospital for one to two days.

Physical therapy following shoulder joint replacement varies according to the preferences of the surgeon and parameters that the surgeon determines at the conclusion of the procedure. I generally keep people in a sling for three to four weeks and have them perform exercises that will not disrupt the healing tissues but allows some progression of range of motion of the joint. Most people are using their arm for simple tasks and self care by six weeks after surgery. As the shoulder gains motion and strength, function can continue to improve for as long as two years, but most of the improvement is gained by six months.

How much improvement is obtained varies from person to person. Like total knee replacements, the major challenge is maximizing motion and strength. There is significant pain relief, but occasional soreness can persist. People with fairly healthy rotator cuffs have the most successful recovery, but significant improvement in pain and function is common even with the most damaged rotator cuffs.

Patients often ask me which prosthesis brand I will use when I replace their hip, knee or shoulder. I first tell them that many companies make excellent products and successful joint replacement results can be achieved with many different brands. I recommend that patients

Shoulder Joint hip Joint

The shoulder has a greater range of motion than any other joint. It is a ball and socket joint like the hip, but the shoulder socket is very shallow. As a result, the ball (humerus bone) is not as securely held by the socket (glenoid). While the hip joint is more stable than the shoulder joint, the tight fitting ball (femur) and socket (pelvis) does not allow for as much movement.



“Man, through the use of his hands, as they are energized by mind and will, can influence the state of his own health.”

-Mary Reilly OTR, 1962

“Man, through the use of his hands, as they are energized by mind and will, can influence the state of his own health.”

-Mary Reilly OTR, 1962

A) ConventionAl proSthetiC B) reverSe proSthetiC

A) The conventional prosthesis mimics the natural anatomy of the shoulder. The head of the humerus is replaced with an artificial ball (usually metal) and glenoid is replaced with an artificial socket (usually plastic). The goal is to remove the damaged cartilage and bone and restore the normal function of the shoulder joint.

B) The reverse prosthesis actually reverses the anatomy of the shoulder. A metal ball is attached to the glenoid and a plastic socket component replaces the head of the humerus. Because this procedure is performed on people with a poorly functioning rotator cuff, the prosthetic is designed with a deeper socket to help hold the joint in place.


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choose a surgeon who they are comfortable with and confident in and allow that surgeon to use whichever approach and prosthesis the surgeon has had good results with.

Shoulder joint replacement is not the “new kid” on the block but significant improvements have occurred in recent years. In my opinion, shoulder joint replacements offer the same expectations for improvement as do total hip and knee replacements.

Several images contained in this article were provided by Exactech, Inc.


TreaTing Deep Vein Thrombosis

EEach year, about two millionAmericans develop deepvein thrombosis (DVT). Forabout one out of four of these,DVT will lead to a pulmonaryembolism (PE), and for one out often with PE the condition will prove fatal.

DVT is relatively rare. Indeed, ofthe general population only aboutone in a thousand contracts it.Among the elderly, however, thecondition is more common,affecting about one in a hundredof those who are 80 years of ageand older. Further complicatingmatters is the fact that symptomscan vary greatly from one personto the next.

What is deep vein thrombosis?

What causes the condition, and how can it be detected?

What is DVT? The term deep vein thrombo-sis describes a blood clot that forms within a vein that is deep within the body. A clot that takes place in a superfi cial vein is less threatening, since superfi cial veins do not travel to the lungs. Deep veins are different, and clots that form in them can pose a serious threat.

Deep vein thrombosis can takeplace in virtually any deep vein,including those in the upper arms. More typically, though, DVT occurs in the pelvis or legs, par-ticularly in the calf or thigh. The blood clot itself may not be seri-ous. Indeed, small clots in a deep vein usually break down naturally, and a person who has one might not even be aware of it.

When the clot is large, however,a person may experience pain or

swelling, or even redness of the skin. If the clot breaks off and travels to the lungs, pulmonary embolism can result.

In this case, the sufferer may experience shortness of breath or feel chest pain when taking deep breaths. Some persons with pulmonary embolism cough up blood. Pulmonary embolism requires immediate attention. It is best if DVT is detected and treat-ed before reaching that point.

What causes blood clots that lead to DVT?

A number of conditions can lead to small blood clots deep within the body. For example, some people have poor circulation, and the reduced blood fl ow increases

the likelihood of blood cells stick-ing together. Particularly at risk

“Deep vein thrombosis can take place in

virtually any deep vein including those in the

upper arms”



are people who have recently suffered a heart attack, stroke, or other form of heart disease. DVT is also common in people who are overweight, pregnant, or who have a family history of DVT.

Another cause is long-term in-activity, which may be the result of extended bed rest following surgery or a long illness. DVT can also be caused by changes in the clotting mechanism in the blood, which typically occurs during pregnancy—a natural process to prevent loss of blood at childbirth.

Air travel can be another factor, particularly long fl ights in which passengers have little room to move their legs. “This condition is known as ‘Economy Class Syndrome,’” says health writer Tracee Cornforth at the web site womenshealth.about.com. “Certain people are considered most at risk for in-fl ight DVT; these people include pregnant women, people who are over-weight, those whose feet do not touch the fl oor, older passengers, smokers, and people with coro-nary artery disease and certain blood conditions.”

How is DVT diagnosed?

Ultrasound is onemethod that is used to diagnose DVT. In this painless procedure, gel is applied to the leg (or other suspected area) and a hand-held scanner is passed over it. Sound waves that are detected by the device are transferred

to a computer and displayed on a monitor, where the blood fl ow in the leg can be observed. When ultrasound is not suffi -cient, a venogram is performed.

In this procedure, a dye is inject-ed into the leg and then an x-ray is taken. The dye makes the vein visible, enabling the physician to detect any constriction in the fl ow of blood.

How is DVT treated? Treatment for DVT has a three-

fold purpose. It should (1) keep the clot from getting bigger, (2) prevent it from breaking off and moving to the lungs, and (3) reduce the risk of another clot. Treatment usually entails the use of anticoagulant drugs, or ‘blood thinners.’ Commonly used anti-coagulants are heparin (which is injected) or warfarin (taken in tablet form). Both drugs are used at the beginning of treatment, since warfarin takes several days to have its full effect.



Generally, however, heparin and warfarin are safe drugs that provide great relief to DVT patients. As with any medical problem, the choice of treatment should be discussed and weighed with a qualified physician.

After treatment begins, it is best to avoid standing or sitting for long pe-riods of time. Legs should be elevat-ed while sitting, as this will reduce swelling. Short walks are recom-mended, as is a healthy balanced diet. Excessive changes in weight can also interfere with treatment.

How can DVT be prevented during a long airline flight?

The simple solution is to get up and walk at least once an hour. “Simple exercise can help prevent other typi-cal symptoms experienced by peo-ple who fly, including leg cramping, toe cramping, and general lower-body aching,” says Marilyn Moffat, former president of the American Physical Therapy Association. “Sit-ting for long periods may lead to swelling of the feet, which becomes obvious to many passengers when they try to put their shoes back on at the end of the flight.” Also, observes Moffat, sitting in such a cramped position “puts a lot of stress on the lower back, especially for people who have pre-existing back prob-lems.” She recommends that plane passengers use their hand luggage as a foot rest to elevate the feet so that the knees are at a higher level than the hips.

What about side effects?

Since heparin and warfarin are anticoagulants, those taking themmay have an increased risk of bleeding. Patients using either of these drugs should immedi-ately consult their physician if they have unexplained bruising, heavy or persistent nosebleeds, or if blood appears in urine or bowel movements. A small num-ber of patients may experience an allergic reaction to anticoagu-lants, including difficulty breath-ing, skin rash, and itching.

“Simple exercise can help prevent other typical symptomsexperienced by people who fly, including legcramping, toe cramping, and general lower-body aching.”

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Don’T sTrike ouT - YouTh baseball injuries

TThe crack of the bat, smell of the leather mitt and running of the bases are a few of the things play-ers 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 Orthopae-dic Surgeons recommends that children use cau-tion when partaking in youth baseball, particularly year-round.

“We have seen a tremendous increase in the number of youth baseball injuries over the last five years. The reason is that kids are now playing 12 months out of the year and are overusing their bodies during the season,” explained James An-drews, MD, orthopaedic surgeon, founding mem-ber of the Alabama Sports Medicine and Orthope-dic Center (ASMOC) and chairman and medical director of the American Sports Medicine Insti-tute (ASMI) in Birmingham, Alabama and AAOS fellow. “Children involved in overhead throwing and hitting sports should actively rest from such activities for two to three months out of the year.

It is also important that children cross-train and change sports throughout the year to prevent one area from becoming overworked and stressed.”

• 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 concentrateon stretching his arm and back muscles.

• If a child is catching, the focus should beon the legs and back.

• Children should not be encouraged to playthrough pain. It is important that they takebreaks 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.

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

Orthopaedic surgeons provide tipsto prevent youth baseball injuries.


• Equipment should fit 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 emer-gency situations and have a plan to reach medical personnel to treat injuries such as concussions, dis-locations, elbow contusions, wrist or finger sprains, and fractures.

• To prevent sliding injuries, install breakaway bas-es 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 86pitches in approximately 1.4 to 2.6 games per week.




Don’T sTrike ouT - YouTh baseball injuries

Players should wear molded baseball shoes with cleats that fit comfortably.

Source:


At Gentiva, we have a unique specialty program in Orthopedics. Unlike traditional home healthcare, our therapists have special training designed to speed recovery, increase mobility and improve outcomes using the best methods available. The result? Physicians can enhance their reputation for providing the highest quality care while patients get the most from their surgery. Put simply, it’s a better way to deliver better outcomes.

Gentiva accepts patients for care regardless of age, race, color, national origin, religion, sex, disability, being a qualified disabled veteran, being a qualified disabled veteran of the Vietnam era, or any other category protected by law, or decisions regarding advance directives. © 2010 Gentiva Inc. HHA202600961 3160

• Regular progress evaluations• Ongoing outcomes measurement• Over 40 offices statewide• Guaranteed start-of-care in first 24 hours

For more information, call 352-376-3221 or visit www.gentiva.com

• Hands-on home therapy• Patient specific exercises based on our own LifeSmart Care protocols• 7-day a week availability

Program benefits include:

Orthopedic home therapy isn’t just something we do.

It’s our specialty.

3160_BodywiseAd_8.375x10.875_color_v1.indd 1 1/4/10 9:27 AM

Tips To preVenT sWimming injuries

Source:

EEach year, almost 150,000swimming-related injuriesare treated in hospitals,doctors’ offi ces, clinics,ambulatory surgery centers and hospital emergency rooms.

The American Academyof Orthopaedic Surgeonsoffers the following tips toprevent swimming injuries:

• Always take time to warm upand stretch. Research studieshave shown that cold musclesare more prone to injury. Warmup with jumping jacks, stationarycycling or running or walking inplace for 3 to 5 minutes. Thenslowly and gently stretch, holdingeach stretch for 30 seconds.

• Learn how to swim and do notswim alone. Swim in supervisedareas where lifeguards are present. Inexperienced swimmers should wear life jackets in the water.

• Do not attempt to swim if you are too tired, too cold, or overheated.

• Avoid diving into shallow water.Each year approximately 1,000

disabling neck and back injuriesoccur after people went headfi rstinto water which was shallowor too murky to see objects.

• Swim in a pool only if you cansee the bottom at the deepestpoint; check the shape ofthe full diving area to makesure it is deep enough.

• Dive only off the end of a divingboard. Do not run on the board,try to dive far out, or bouncemore than once. Swim away fromthe board immediately after thedive, to allow room for the nextdiver. Make sure there is only oneperson on the board at a time.

• When swimming in openwater, never run and enterwaves headfi rst. Make sure thewater is free of undercurrentsand other hazards.

• Do not swim in a lake or riverafter a storm if the water seemsto be rising or if there is fl oodingbecause currents may becomestrong. The clarity and depth ofthe water may have changed,and new hazards may be present.

• Check weather reports beforegoing swimming to avoid beingin the water during storms,fog, or high winds. Becausewater conducts electricity,being in the water during anelectrical storm is dangerous.

• Remember that alcohol andwater don’t mix. Alcohol affectsnot only judgment, but it slowsmovement and impairs vision. Itcan reduce swimming skills andmake it harder to stay warm.

• Be knowledgeable about fi rstaid and be able to administerit for minor injuries, such asfacial cuts, bruises, or minortendinitis, strains, or sprains.

• Be prepared for emergencysituations and have a planto reach medical personnelto treat injuries such asconcussions, dislocations,elbow contusions, wrist orfi nger sprains, and fractures.

At Gentiva, we have a unique specialty program in Orthopedics. Unlike traditional home healthcare, our therapists have special training designed to speed recovery, increase mobility and improve outcomes using the best methods available. The result? Physicians can enhance their reputation for providing the highest quality care while patients get the most from their surgery. Put simply, it’s a better way to deliver better outcomes.

Gentiva accepts patients for care regardless of age, race, color, national origin, religion, sex, disability, being a qualified disabled veteran, being a qualified disabled veteran of the Vietnam era, or any other category protected by law, or decisions regarding advance directives. © 2010 Gentiva Inc. HHA202600961 3160

• Regular progress evaluations• Ongoing outcomes measurement• Over 40 offices statewide• Guaranteed start-of-care in first 24 hours

For more information, call 352-376-3221 or visit www.gentiva.com

• Hands-on home therapy• Patient specific exercises based on our own LifeSmart Care protocols• 7-day a week availability

Program benefits include:

Orthopedic home therapy isn’t just something we do.

It’s our specialty.

3160_BodywiseAd_8.375x10.875_color_v1.indd 1 1/4/10 9:27 AM

North Florida Regional Medical Center ranks in the Top 10% in the Nation for General Surgery.When Kinnon Thomas and Pat Klaus needed surgery,

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thousands of other surgery patients do the same.

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Documents

Volume 5, Issue 2 Body Wise - Improving Lives, … 5, Issue 2 Body Wise A Publication of The orThopaedic insTiTuTe Featured articles: Shoulder replacement Surgery By W. Preston Blake,