What can I do to protect my ACL?

ACL tears are rampant, especially among our youth. Why? There are a multitude of reasons. Let me list a few-

"Sport-Specialist Syndrome"- Is your child the type of athlete who plays the same sport in multiple leagues, all year round? Your child fits the mold! I have treated many young soccer players with blossoming talent, playing in not one or two different leagues, but maybe three to four different leagues, seven days a week- school team, town team, traveling team, regional team. Whew! Parents and coaches, where's the needed rest?! In sports like soccer, volleyball, basketball, football, lacrosse, the same type of rapid cutting and pivoting can set your child's ACL up for injury over time. It's no wonder that so many kids each year end up with career-ending injuries, like ACL tears. Coming from one parent to another, your child will perform better and be much happier rotating through different sports throughout the year.

Gender? Female athletes, particularly in soccer, are eight times more likely to tear their ACL than their male counterparts. Why? It may have to do with the hip width-to-knee ratio- Females tend to have wider hips, which causes their knees to buckle inward ("knock-knees") when they bear weight abruptly. Females also use their quads and hamstrings differently during activity than males. The hamstrings provide effective dynamic assistance to the ACL during activity, and males tend to contract their hamstrings more than their quads as compared to females.

The hip hype? More and more research over the last 5 years or so has pointed to gluteal muscles having a protective effect on the knees and ankles. Why? Your booty is the largest muscle in your body. Strengthening the glutes increases shock absorption of your legs during activity and can help direct your knee to be in a better position overall as you cut and run, keeping your ACL safer and more sound!

Proprio-who? Joint proprioception is the ability of your joints to know where they are in space and particularly during movement. Many athletes simply don't know how to position their knees for protection and can set themselves up for ACL injury. By re-training your knees to move in patterns that are protective during activity, you can reduce the potential for knee injury up to four times.

As you can, there are many tools out there to help prevent ACL tears. Feel free to contact Dr. Jerry Yoo at jerry@mavenpt.com.

How to Choose the Right Physical Therapist

Ok, so you got injured doing...something. Maybe you hurt your knee while playing some pick up basketball, maybe it was lifting your child the wrong way, or perhaps you were just innocently twisting your body while getting out of the car. You go to see your physician because it's been over a week, and as you "wait it out" you notice your pain isn't getting any better. The physician gives you a script for physical therapy. Often times, physicians will give you a few recommendations, but how do you really know who's good?

Well, there are handful of questions you should be asking the physical therapy office BEFORE you begin receiving care there.

1) How many patients is each physical therapist scheduled to see per hour? If you've ever been to a "mill" type physical therapy setting (see below) where there are 4-5 patients every hour, you're not gonna get the best care. The practices that are more quality-oriented will schedule one to two patients per hour.

2) Will I receive 1:1 supervision by the physical therapist or support staff during my visit? It's common for physical therapy assistants and aides to supervise clinical exercises during your visit. Just make sure you're not left all by yourself in a room full of patients (which happens quite frequently) and expected to do your exercises without any guidance.

3) Will I be seeing the same physical therapist every visit? Continuity of care is critical in keeping you moving forward and in the right direction. While the occasional switch is acceptable, many practices out there will swap physical therapists left and right, day-to-day. You really want one doctor to know you and your body.

4) Is the practice physician-owned or PT-owned? Typically speaking, physician-owned practices are "mills." Great business model, if you really think about. How can you beat self-referring patients to your own practice? However, since volume is key in these types of practices, the quality often suffers tremendously- I can't tell you how many patients I've spoken to who spoke with the physical therapist for 5 minutes and then was left to do "exercises". Years ago, a friend of mine sent his dad to a physician-owned practice for his shoulder; he was given electrical stimulation by the physical therapist, then was directed to ride a stationary bike for 30 minutes and received a bill for >$300. I don't know about other physical therapists out there, but I've never treated a shoulder injury by using a stationary bike (it was even one of those arm bikes for cryin' out loud!).

At Maven Sports Medicine, we focus our practice on providing quality care to our patients. After all, the best referral source is a content patient.

Questions? Contact us at info@mavenpt.com.

Help, my baby only turns her head to one side!

So, you just had a baby, (we'll call him, "Jimmy")...say 3-4 months ago, but being that he was your first, you're busy with the daily stresses of being a new parent. One day, a friend of yours comes to visit you and see the new baby. After the "oh, how cute" conversation, she looks at Jimmy with an eyebrow raised and mentions, "hey, why is Jimmy's head stuck to the left like that?" Then, you notice it yourself, and a surge of panic...and guilt comes on. "How could I have not seen this?!" In a single swoop of the arm, you rush out the door while grabbing li'l Jimmy, throw him in the car seat, leave your friend behind, and manage, somehow, to speak to your pediatrician en route to his office. "My God, Dr. Smith, I have an emergency! Jimmy's head is stuck on his left shoulder!" You get to the office, and in tears tell Dr. Smith about li'l Jimmy's head. He take a glance and dispassionately says, "oh, looks like torticollis". More tears stream down your face as you consider the worst case scenario- Jimmy is gonna be wheelchair-bound, live in a bubble, or be stuck with needles day-in/day-out. "Doesn't look too bad, he says. Let's send him to physical therapy."


You arrive at the physical therapist's office 10 minutes later. The physical therapist, with his trained eye, says," Yeah, definitely a left muscular torticollis." You finally gather the courage to ask, "What exactly is torticollis?"

Torticollis, or "wry neck" is a problem that affects the SCM muscles of the neck (see image above). Often times, infants with torticollis demonstrate limitations in turning their head in one direction as well as presenting with their head tilted to one side. Along with torticollis, often times infants will present with "plagiocephaly", which is a flattening of one side of the the head.

So, what causes torticollis and how is it diagnosed? The answers are not clear. Some incidences may be related to larger babies in utero who have less room to maneuver their bodies during the third trimester, in particular. Other incidences of torticollis may be a result of favoring one side, leading to a flattened side of the head (plagiocephaly), making it easier for the child continue preferring one side, especially when on his/her back. The formal diagnosis usually comes from the pediatrician or pediatric physical therapist, though parents, friends and fam may also point out the odd tilt to one side.

How is torticollis treated? The first step is ruling out other possible diagnoses (superior oblique nerve palsy, Sandifer's Syndrome, hemarthrosis, e.g.). The next step is extinguishing the harmful behavior- positioning activities and strategies are simple interventions, but VITAL in diminishing your child's tendency to one side. Stretching exercises, often performed by physical therapists, are reviewed with parents to be performed with their children at home.

Does it go away? Does it ever come back? 80-90% of the time, after 2-3 months of treatment and monitoring, torticollis will full resolve. The key point is getting infants earlier in the game than later!

More questions on torticollis? Contact Dr. Jerry Yoo at 201-977-4441 or via email: info@mavenpt.com

Tri season cut short?!?!

Oh man, my knee has been hurting. Sorry to say that unlike my business partner, Dr. Taylor Lee, who had a 24 hour "miraculous recovery" from his debilitating shoulder pain a few weeks back (check out Taylor's blog- www.jatofitness.blogspot.com), I am still suffering...3 months later. Oh, Lordyyyy.

Yes, even the most invincible and careful DPTs may succumb to injuries. During my first 15k last November, I felt a little stiffness/pain in my knee during the last 3 miles of the race, but of course, I was stubborn and decided to bite the bullet and persevere....well, I was rewarded for my tenacity; let's just say that my L knee has not been the same since. I'm my own best patient.

My symptoms? Pain on the outside of the knee when I run...and only when I run! I can skip, jump off of a plyo box, perform deep squats, jump in place on one leg, do knee extensions, heel raises, BUT, running more than 1/2 a mile causes my knee to really, really hurt. Yeah, I guess Runner's knee (IT band syndrome) may be the working diagnosis, but I'm not so convinced that it is. I'm gonna have my associate, Dr. Murphy, and my graduate student Bhairvi, take a closer look. As good as I am a physical therapist, I can't always treat my own body!

Knee injuries are rampant among runners. Meniscus injuries, patellofemoral syndrome, muscle strains, Achilles tendonitis and tears are just a few of my favorite things to treat. Most of these are biomechanically-driven, ie., the way you run is causing stress to structures over time.

I feel thwarted, and frankly, a bit frustrated, as even with active rest, I have not been able to run without pain...I hope it's not a sign that I'm actually getting...OLDer or WORSE yet, that I won't be able to complete, let alone just compete in my triathlons this year. = (

What a way to start of the new year.....Stay tuned.

Medicare or MediCUT?

Maybe you're still under the age of 65 and things regarding Medicare are an afterthought and don't really concern you...yet. Maybe you ARE a bonafide senior and have Medicare and wondering how Mr. Obama and his administration have been "reforming" our healthcare system....or, perhaps you have a parent or grandparent who has Medicare and may need a medical service, like physical therapy. How does the Medicare CAP affect you and your loved ones?
Well, for starters, $1,860/year (regardless of how many body parts need to be treated at any given time) is simply NOT ENOUGH. You really can't expect the best quality care or enough of the best care to be covered under less than $2,000 per year!

Case in point, I knew of a Medicare patient with a knee replacement who was discharged (though he needed the therapy) from out-patient physical therapy because his CAP amount was met for the year. Unfortunately, this poor chap, a few months later, fell and broke both his wrists and needed rehab...but guess what, because his CAP ran out, he was unable to afford rehab for this new problem(s). Sad, but true.

"APTA is discouraged and disappointed that Congress is allowing an arbitrary annual cap on outpatient rehabilitation services to be placed on Medicare beneficiaries on January 1, 2010. This is clearly inconsistent with efforts by President Obama's administration and the Democratic majority to reform health care by eliminating arbitrary limits imposed by private insurance companies. (www.apta.org)"

Need I say more? Well, ok, maybe just one more question to pose- Can someone explain to me why our beloved senators, congresspeople, etc are not subject to the same restrictions for their own healthcare?!?! For cryin' out loud, Mr. Obama, gimme THAT plan!

Jan 9, 2010- Back to Tri-training!

In a previous blog, I wrote that I would be setting my goal of completing a 1/2 Ironman and several other triathlon races this year, and I intend on doing so. So, how's my training going? Well, I had a shoulder injury from swimming in late November, which proved to be a longer-than-expected set-back to my training (yeah, can you believe it?! The irony....), then I hurt my left knee (IT band pain, if you're curious) last month. I felt somewhat defeated, and searched for a good divine reason as to why my joints were falling apart when I've been injury-free for the past few years. I decided to listen to my body and rested (at the expense of my formerly trim waistline).

FINALLY, last week, I started up in the pool, I fixed up my knee and shoulder during the rest time, and now I'm getting back on my training schedule.

So far, I'm scheduled for a 1/2 marathon in Asbury Park this coming April. Wyckoff is coming up again in June as well as the NJ State olympic distance triathlons. Hoping to get into the Eagleman 1/2 Ironman as a charity participant, but not guaranteed. Thankfully, the sport is growing and more and more races are popping up each year.

More on tri-training next time....

"Always keep in mind what's really important"

Of all the things I could do on Christmas morn', the Yoo clan decided to check out, "The Princess and the Frog". Man, what a heart-felt flick. Didn't expect the Adam's apple flutter while watching a cartoon! Anyway, the one line that moved me was when Tiana's (the heroine) late father emphasized in a loving way to "always keep in mind what's really important." It was obvious that he was alluding to the fact that while life may be busy as we pursue our all-consuming ambitious endeavors, we cannot and must not discount the relationships we have in our lives and, of course, love. The last three years were truly a blur for me when I think out my family life.

Working part-time jobs to make ends meet in the first year of business and doing my best to accommodate patients at wee-early and way-late hours were trying times back then. Fast forward two years and here I am, two practices later, working on getting the patient to get our two locations flowing and growing, yet not seeing my kids and wife for days at a time had become a source of conflict in my personal life- wanting the professional and financial success, but sacrificing the quality life with the fam, is not a path I desire to take any further. 2010 is starting off on the right foot. Learning to be more efficient at work while making a conscious effort to be present (mentally, physically, spiritually) at home is the plan for this year.

Now, how exactly do we fit in triathlon training?!?!