ACL Injury 101

Sports participation results in 70 percent of anterior cruciate ligament (ACL) tears and the majority of these occur in 15 to 45 year olds. Approximately 70 percent of ACL injuries are noncontact injuries that occur during a sudden change in direction with a planted foot (i.e., cutting) or stopping rapidly. In the United States there are between 100,000 to 250,000 ACL ruptures annually.

The ACL is one of the main stabilizing ligaments of the knee and helps provide the hinge that allows the knee to remain stable while moving. When an ACL tear occurs the athlete often reports hearing a pop and usually cannot walk on the injured limb. During the injury it is common for the knee to partially dislocate, resulting in bruising and sometimes a small fracture at the back of the tibia and on the femur. Also common is a sprain of the medial collateral ligament (MCL) which is located on the inside of the knee. These injuries result in a painful swollen knee that is tender outside and deep within the knee.


Female athletes are two to eight times more likely to rupture their ACL than male athletes. This is primarily due to mechanical reasons, such as weaker core muscles and hamstrings. Another factor that can increase the risk of ligament rupture is the interface between the player’s shoes and the playing surface that results in higher friction. For example, longer cleats or more cleats on a shoe resulting in better traction and more friction. High risk sports include soccer, basketball, volleyball, skiing, and football.

Prevention programs have been developed based on analyzing the mechanism of injury of ACL ruptures as well as the kinematics of female body position during landing and cutting compared to males. The goal of these programs is to train the athlete to keep her center of gravity forward and on her toes, as well as encourage better leg rotation and control. These programs may reduce the incidence of ACL rupture by up to 50 percent. Typically a prevention training protocol should be done at least 2 to 3 times a week and last 15–20 minutes. As an added bonus these programs often improve an athlete’s performance such as jump height and speed. Speak with your sports medicine professional about exercises and programs to help prevent ACL injuries.

Good Nutrition

Proper nutrition is essential for any athlete, but becomes a more relevant topic when discussing sports with weight classes for competition. Athletes who participate in sports with specific weight classes can often become victim to focusing on their weight rather than their sport. Wrestling is notorious for athletes who have been injured and in some instances have died because of unsafe practices when cutting weight by rapidly dehydrating themselves. Wrestling can be a safe and rewarding sport, if weight control is achieved through proper diet and exercise.


Question: Is it safe for my child/athlete to cut weight?
Ans: “Cutting” weight through rapid water loss is something that is actively discouraged in youth wrestling. The sport of wrestling should focus on the overall well-being and health of our youth athletes, and needs to include a discussion of weight maintenance issues. Wrestling requires a great deal of physical conditioning and youth athletes’ primary focus should be on being in good shape. The process of rapid weight loss through dehydration should be avoided in all athletes. More mature and experienced athletes can safely lose weight at a rate of approximately 1 to 2 pounds per week by appropriately balancing the number of calories consumed with the number of calories burned through exercise. Part of being in good shape is maintaining a healthy body weight based upon height, age, and body fat percentage.

Question: How should a wrestler eat before weigh in? Should they?
Ans:Wrestlers need to eat! Athletes should avoid fasting before a performance—your body needs fuel to perform. What and how much depends on how soon before competition weigh-ins occur. A wrestler should eat the day before, night before, and morning of competition. A pre-competition meal should ideally occur at least 3 to 4 hours before competition.

Question: What should my wrestler be eating?
Ans:During the season, it is important to consume ANSWER enough calories and not worry about restricting caloric intake. Athletes should eat a balanced diet to maintain their health and fitness throughout the season. Complex carbohydrates are an important nutrient for replenishing energy lost during exercise, but plenty of protein is also required to aid muscle recovery. The key to staying strong and gaining strength without gaining weight is to control your caloric intake early on during the season. Once the workout intensity picks up and a good body weight is established, weight lifting should still be encouraged. However, weight lifting during the season should be designed as a circuit style lift geared towards muscle conditioning and endurance rather than pure strength and power.

What is Frostbite? And How Do I Prevent It?

Athletes participating in outdoor winter sports, such as alpine and cross-country skiing, snowboarding, and mountaineering, are at increased risk for developing frostbite. Frostbite is a condition in which prolonged exposure to cold temperatures cause an injury resulting in tissue damage— starting superficially with the skin and potentially spreading deeper to blood vessels, muscles, tendons, and even bone.

Ice Skating

What Does Frostbite Feel Like?
Many people who are developing frostbite experience early symptoms such as numbness or a tingling sensation in the skin, such as the “pins and needles”
that you can feel after a hand or foot falls asleep. The affected body part may also be extremely painful, feel itchy, or have a burning sensation. The skin can initially appear white or grey with a surrounding area of redness, and as frostbite progresses, blisters may form and the skin will feel hard, waxy, or numb.

Who is at Risk?
While anyone can potentially develop frostbite, both the very young and the elderly are at particularly high risk and should take special precautions to prevent over-exposure in cold environments. In addition, athletes with medical conditions such as diabetes or heart conditions can be at increased risk due to decreased blood flow to the skin.

How Cold is Too Cold?
Generally, the risk of frostbite is low when the outside temperature is above 14°F (-10°C), but that risk can go up significantly with prolonged exposure, increased elevation (>17,000 feet), and increased wind speed.

How Do You Treat Frostbite?
Preventing injury begins with protection from the elements, which requires getting out of the cold as soon as possible and replacing all wet clothing with dry, warm, insulated layers. Immobilizing the extremity to prevent damage to the cold, stiff skin and muscles can prevent further injury. Once inside, rewarming the affected extremity should be done rapidly by immersion in a warm water bath at 104°–107.6°F (40°–42°C) for 15 to 30 minutes until thawing is complete.1,2 If warm water is not available, body heat can be used to rewarm the hands or feet, such as tucking them in your armpits. When successful, the skin becomes soft and pinkish again. Avoid rubbing or massaging the skin to avoid damaging the skin or rupturing blisters.

An Ounce of Prevention
While outdoor winter sports provide an excellent opportunity for physical exercise and competition, they can be dangerous if athletes are not properly prepared. Useful tips to help prevent frostbite include:
• Check weather forecasts to prepare for inclement weather or avoid extreme weather.
• Wear adequate clothing to protect from the cold and wind—dressing
in loose-fitting layers, including fabric that wicks away body moisture and sweat is best.
• Cover exposed skin with gloves or mittens, a hat, scarf, and face mask, if needed.
• Minimize alcohol consumption and tobacco use.
• Stay active! Physical activity maintains core body temperature as well as increases blood flow to the hands and feet.

Jammed Fingers:When Is It Time To See A Doctor?

It has happened to all of us at some point. You’re playing sports and a ball glances off the tip of your finger. Or you reach for something and jam the tip of your finger. Typically there is a lot of swelling and discomfort afterwards. But when is a jammed finger something more than a sprain and needs to be evaluated by a doctor?

The finger is a brilliantly designed machine with tendons running on both sides that allow you to flex and extend at each joint. Covering those tendons is
a sheath that allows smooth movement and pulleys that keep the tendons where they need to be for added mechanical advantage.
So when you jam your finger there are a lot of structures that could be damaged.

Injuries can occur at any of these structures. Most injuries are soft tissue injuries that heal well without surgery or immobilization.

However, there are several symptoms that should raise your suspicion for a more serious underlying injury and may require evaluation:

playing volleyball

Is your joint not sitting in a normal position?
If so, you may have an underlying dislocation or fracture that needs to be seen at the emergency room or urgent care center. Joints need to be in a normal anatomic position to prevent further damage and preserve function.

Can you flex and extend through each of your finger joints?
If not, you may have an injury to either one of the flexor tendons, extensor tendons, or bones that they attach to. This needs to be evaluated on an urgent basis as well, as the sooner it can be evaluated and repaired the better chance of avoiding a loss of function.

Barring any of the above symptoms, jammed fingers should reliably improve over the course of a few days with rest, icing for swelling, and anti-inflammatories for pain control. Depending on the location of the injury and the structure injured, your finger may need to be immobilized for a period of time. Immobilization can include taping the injured finger to an adjacent finger, a splint for the end of the injured finger to keep the joint extended, or a cast that extends to the forearm. Periods of immobilization vary depending on the structure injured.

Prompt assessment and treatment are the keys to ensuring that serious injuries do not result in any disability and and maximize the opportunity for a full return of function.

Recovering After Knee Replacement Surgery

recovering after knee surgery


A successful recovery after knee surgery has a lot to do with your rehabilitation process and physical therapy. Although it may be difficult to get on your feet the day after knee surgery, it is important to do so to begin building up your mobility in your artificial knee. Here are a few tips on what to do to have a successful recovery.


It is important to know that the first few days will be the most difficult – you will be tired and in pain, and won’t be able to get around as easily as you did prior to the injury. However, your physical therapy will begin after surgery to help you with basic mobility, like standing, sitting, and moving from room to room.

Light Exercises to Regain Mobility

In order to gain mobility back in your knee, you must do light exercises 10 to 15 minutes at least 2 to 3 times a day. With the help of a loved one and/or your physical therapist you can begin strengthening your knee muscles a little at a time.

Stay in Touch with Your Surgeon

Follow up with your knee surgeon to make sure your knee is in great condition. Continue taking prescribed medication, continue to elevate the knee, and continue following the light exercises. Do not stop taking your medication or antibiotics if you start feeling better, it can create a setback in your recovery time.

Due to advanced medical techniques and extensive background in knee orthopedics, patients now see a shorter recovery period. Within six weeks, patients see a dramatic improvement in their knee function. Schedule a consultation with a knee surgeon for your total knee arthroplasty in Los Alamitos.

Healing Tips after Rotator Cuff Surgery

Rotator cuff surgery Beverly Hills relates to repair of the four tendons and the related muscles that stabilize the shoulder joint. The rotator cuff allows a person to raise and rotate their arm. Surgery to the rotator cuff typically involves removing loose fragments of tendon, bursa, and other debris from the space in the shoulder where the rotator cuff moves. Sometimes, a surgeon will need to shave or remove bone spurs from the shoulder blade to make room for the rotator cuff tendon. Also involved in the surgery is sewing the torn edges of the supraspinatus tendon together and to the top of the upper arm bone.

A surgeon can choose to take a variety of approaches to repairing the rotator cuff. Sometimes, non-surgical treatment will help a great deal. For those who have been unable to regain full function and strength with other treatment, surgery is a good option.

After the rotator cuff surgery, patients may be allowed by their doctor to begin passive exercises that move the arm. About 6 to 8 weeks after the repair, and with the assistance of a physical therapist, a patient may begin active exercises. Each patient will go into the surgery with unique tears and the surgery can be complex. It is important to listen to your body and allow the repair the time it needs to heal.

The wellness experts at Livestrong remind patients that healing time from a repair procedure can differ a bit but it may be wise to think of the process in two phases. During the first phase, rehabilitation should be built around the healing of the rotator cuff. In the second phase, rehabilitation should be centered on gradual strengthening. Livestrong offers the following exercise and healing tips for patients to explore after rotator cuff surgery:

  • Pendulum Exercises
  • Passive Range of Motion Exercises
  • Active-Assistance Range of Motion Exercises
  • Active Strengthening Exercises

It is important to work with your surgeon and physical therapist to ensure that the shoulder is healing properly. Also, physical therapy and support during the healing process can certainly improve function and mobility. Sports injury treatment is advanced and individualized in the approach to treatment.

Contact an experienced surgeon in rotator cuff surgery Beverly Hills for more information. A consultation with Dr. Dee can determine what treatment options will work best for you and put you on the path to healing.

Not All Athletic Bodies are Built Alike

As a sports medicine clinic, we spend a lot of time treating athletes’ bodies. And while many people have a pretty clear mental picture of what that means, we know firsthand that what makes an athlete an athlete has little to do with fitting a certain silhouette. Or, to put it another way, this year’s Body Issue from ESPN The Magazine is probably the most representative yet.

Sports Medicine

It’s no coincidence that the magazine is called the Body Issue; thin, fit people have been giving the rest of us body issues for years. So it was nice to see one athlete in particular gracing this year’s issue: Prince Fielder. At 275 pounds, the Texas Rangers first baseman can hardly be called svelte, and in many ways that’s okay. As a sports medicine clinic, we’ve definitely seen bigger athletes who were still healthy. If you don’t think your body could be called athletic, remember these key things:

  • BMI is virtually meaningless. If you are an athlete with a high BMI, it may be due to muscle (which weighs more than fat, as we all know). Having a BMI over 25 does not necessarily make your overweight.
  • You can be overweight and still be an athlete. Although maintaining a healthy weight is ideal for your health, being a fit person with a few extra pounds is better than being thin and out of shape.
  • Sports injuries often come from doing too much, too soon. So if you want to shed some weight, make sure you take the time to increase your conditioning gradually. We rarely see someone get injured because of a little extra weight, so take it slow.

We have treated athletes with virtually every body type. The most important thing is being healthy enough to play the sports you love.

Are Adventure Races Safe?

Over the past several years, the popularity of adventure races – like Tough Mudder, Urbanatholon, Spartan, etc. – has soared. Once restricted to a few diehard fans and organizations, these extreme races test all manner of athletic ability with man-made and natural obstacles designed to challenge the body and mind. But as these races have grown in popularity, so has the complexity of the obstacles they feature. This is both an exciting and worrisome prospect for any athlete planning on competing in one of these races. After all, the risk for injury is high and these races have come under fire for safety issues, including the accidental deaths of racers.

Adventure Race

Every athlete wants a challenge, but it’s important not to expose yourself to unnecessary injury. When it comes to the obstacles in adventure races, as with other athletic endeavors, the proper training can help you stave off many common types of injuries (although they won’t save you from the wall of fire). If you are planning to run an adventure race and want to stay healthy, here are a few things to keep in mind as you prepare.

  • Work your whole body. Adventure races require more than the ability to run long distances. Most obstacles challenge you with some combination of strength, balance, and agility tests. You will need to be conditioned well enough to run distance, but also strong enough to lift and control your body weight (and possibility the weight of your teammates). For that reason, your exercise routine should include cardio and strength training.
  • Get used to awkward movements. Although these types of movements frequently cause sports injuries – like sprains and ligament tears – training for the odd movements of an adventure race requires that you prepare to make such movements. The best way to do this is with slow, controlled movements during training. For instance, practicing lunges on a somewhat narrow edge can help you train for the balancing beams that so many races set up. If you do your lunges in a slow, controlled manner, you’ll have the strength needed to cross the balance beams at higher speeds, even if you have to stop suddenly.
  • Vary your training speed. This includes running intervals (alternately fast for a few minutes, then slower for a longer period of time) and practicing more explosive movements that require you to accelerate quickly and then stop. Simply running long distances will not adequately prepare your muscles for the rigors of an adventure race.

Even with all the right training techniques, it’s still easy to get injured on one of these obstacle courses. Always remember to be mindful of what you’re doing and look out for dangers on the course. After all, there’s a reason these races require a legal release form before they let you participate.

Do you even lift (properly)?—Staying safe when Lifting Weights

Weight Lifting






Whenever you’re working out, you have a chance of being injured, but you can mitigate these odds through being safe and knowing proper form. Perhaps nowhere is this truer than when lifting weights. People love lifting weights, but many people (more than would care to admit) don’t know how to lift properly. So perhaps the new question ought to become, “Do you even lift properly, bro?” It’s a serious question worth asking.

What do you do before lifting?

When you’re lifting weights, what you do before you even start will determine your level of success and ability to stay injury-free. Men’s Health Magazine raises a number of good points about the proper pre-lifting routine, but one of their best reminders is about hydration. Human muscles are 75% water, which means they need h2o in order to function. The time to hydrate is before your workout, not during or after. You’ll also want to warm up gently. Never lift cold.

What to do during lifting?

  • Check that you have two towels. You’ll want one to wipe off weights as you go and one for when you’re finished. Don’t wipe your body off with the same towel used on machines and weights.
  • Use the proper amount of weight. What’s the proper amount? Not so much that you need momentum to lift and no so little that you can burn through a set of fifty reps like you’re lifting a kitten.
  • Move slowly. Most people try to race through their lifting reps like it’s some kind of…race. Well, it’s not a race. In fact, the beauty of weight lifting is that it requires slow, controlled movement to fully engage your muscles without risking injury and to maximize results.

Keep these basic tips in mind and stay safe and healthy. Remember; always check with your doctor before trying a new strenuous activity. If you’ve never lifted before, or are getting back in the game, keep in mind that your body will need time to acclimate to this type of workout. Go easy on yourself and have fun.

Common Injuries in the Top Three Youth Sports

Children need exercise for mostly the same reasons as adults, but for kids playing in organized sports there is an added bonus—playing as part of a team. Being a team member teaches children lessons about life and cooperation in a fun, friendly environment. For the 38 million youths signed up for official organized sports, there are bound to be injuries. Knowing what to look out for in three of the most popular sports when your child is on the field or court will help minimize potentially life-altering accidents.

Football Injuries

This all-American sport can be a lot of fun to watch and even more fun to play. The downside is that the number one football related injury is a concussion. Head trauma is no joke and should be taken very seriously. Make sure your child has all of the required, recently checked, up-to-date safety gear. Also, make sure the team coach is qualified to handle serious issues relating to concussions. After trauma to the head, knee injuries rank as one of the most common. Tears in the ACL/PCL can result in life-long problems if not properly treated.


Web MD points out that the world’s most popular sport is also the most dangerous for adolescents under the age of 15. Males can expect an average of 4 injuries per season, while females average 3.5 injuries per season. In 2006 there were over 180,000 injuries reported with a shocking forty-four percent of those injuries coming from players 15 years old and younger. The most likely injuries will occur at the knees, but soccer is known for concussions too. Be sure your child warms up properly before playing and cools down after a game.


You might think basketball players are less prone to injury than other athletes. While the injuries may differ between sports, basketball still has potential for serious injuries. The most common problems come in the form of sprains, jammed fingers, and bruises. These may not sound too serious, but they can cause sever damage is left unresolved, or ignored. Pay attention to what’s going on with your young player’s injuries and don’t assume that they should just shake it off.

Any time your child is injured you need to take it seriously. Be sure to have any issue looked at as soon as possible by a doctor specializing in pediatric sports injuries.