Sports medicine

The Tips You And Your Kids Need To Stay Safe While Playing Sports

It’s no secret that playing sports and other forms of exercise are beneficial to your body and mind. However, all sports and exercise activities come with the risk of injury. While such risks shouldn’t keep you from doing what you love, they should remind you that steps can be taken to prevent and treat injuries as small as blisters and as large as broken bones. These tips for keeping yourself and your little ones safe while exercising and playing sports will ensure you enjoy many more seasons of fun on the field, at the ski hill, in the water and all of the other places you love to play.

1. Know Your Limits

One of the simplest and most important ways to prevent injuries in sports is to know your capabilities and advance them slowly. Start every exercise session with a warmup, and then proceed to exercise within your capabilities, and encourage your kids and workout partners to do the same. Don’t start with a 5-mile run if you haven’t run in decades, and don’t hit jumps on your skis before you’ve mastered downhill turns. The most common sports injuries result from doing too much activity too quickly, overestimating ability levels, pushing your body too hard, and using incorrect techniques.

2. Speak Up and Encourage Others to Do the Same

It’s easy to ignore the symptoms of athletic injuries, and young athletes may not feel comfortable being honest about what hurts. Sit your kids down before they start playing sports, and explain that they need to be open about pain or symptoms they feel before, during or after playing. Adults can be even more stubborn than young athletes, so be honest with yourself about what hurts, and consult a professional about sports injury treatment before the problem gets worse.

The “no pain, no gain,” theory to achieving your sports and workout goals will only exacerbate your pain and muscle or joint-related problems. Sports injury prevention starts with understanding that you feel pain for a reason, and it’s usually because your body is warning you about possible sports-related injuries.

3. Don’t Over Exercise

We all know that parent who pushes his or her kid’s athletic abilities too far. Yet what many don’t consider is that adults also push themselves too far. Young and old athletes often focus on one or two sports, overusing the same muscles day after day. According to personal health writer Jane Brody, children under age 8, should take part in organized games or practices for no longer than one hour and no more than three days a week. Kids ages 9 through 12, should only do so for a maximum of one and a half hours, four days a week; and kids over age 13 should not practice or play organized games for more than two hours, four days a week.

Parents should be just as cautious about overworking their muscles as their youngsters, and the days between each practice, game or workout session should be used for recovery and rest.

4. Understand Your Exercise Environment

Taking part in athletics is fun, and it makes you and your young athletes feel good. However, your desire to take part in every game or workout session shouldn’t lead you to making irrational decisions about safety. Professional athletes are careful to adapt to new environments before practicing or competing, and that’s a practice you should instill in yourself and your kids. Working out in an air-conditioned gym every day, then running outdoors on a humid, 85-degree day, is an easy way to cause heat stroke — a heat-related injury that can be fatal.

Understand your and your child’s tolerance for heat and always keep plenty of drinks nearby when exercising. Check with event supervisors to ensure water, ice and cold towels are available for athletes.

5. Don’t Do It Alone

You’re not expected to be an EMT or know all of the ins and outs of sports medicine or sports therapy when getting yourself or your kids involved in sports. However, you should always have an expert you can call on your side.

Blue Ridge Orthopaedic & Spine Center is home to the sports injury rehabilitation and sports physiotherapy experts you want on your family’s side. You can find us in Warrenton (540) 347-9220 and Gainesville (703) 743-2814, and same- or next-day appointments are available.

Evaluation Procedures for Orthopedic Problems



Adults – What are standard evaluation procedures?

Before a treatment or rehabilitation plan can be made, your orthopedist must first determine the reason for, and source of, your condition. This typically involves a complete physical exam and a review of your medical history profile, in addition to a description of your symptoms. Be sure to tell your healthcare providers of any other illnesses, injuries, or complaints that may be associated with the pain or condition. Also, tell him or her about any previous treatments or medicines prescribed. Initial tests may then follow.

Advanced evaluation procedures

If you need further evaluation you may have one of these tests:

  • X-ray. This test uses invisible electromagnetic energy beams to make images of tissues, bones, and organs onto film.
  • Arthrogram. This X-ray shows bone structures after an injection of a contrast fluid into a joint area. When the fluid leaks into an area that it does not belong, disease or injury may be considered, as a leak would provide evidence of a tear, opening, or blockage.
  • Magnetic resonance imaging (MRI). This test uses large magnets, radiofrequencies, and a computer to make detailed images of organs and structures within the body. It can often determine damage or disease in a surrounding ligament or muscle.
  • Computed tomography scan (also called a CT or CAT scan). This test uses X-rays and computer technology to make horizontal, or axial, images (often called slices) of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general X-rays.
  • Electromyogram (EMG). This test evaluates nerve and muscle function.
  • Ultrasound. This test uses high-frequency sound waves to create an image of the internal organs
  • Arthroscopy. This test is used to evaluate a joint. It uses a small, lighted, optic tube (arthroscope) that is inserted into the joint through a small incision in the joint. Images of the inside of the joint are projected onto a screen. It’s used to evaluate any degenerative or arthritic changes in the joint. It also detects bone diseases and tumors and may help determine the cause of bone pain and inflammation.
  • Myelogram. This test involves the injection of a dye or contrast material into the spinal canal. Next a specific X-ray study lets the healthcare provider evaluation of the spinal canal and nerve roots.
  • Radionuclide bone scan. This is a nuclear imaging technique. It uses a very small amount of radioactive material, which is injected into the patient’s bloodstream to be detected by a scanner. This test shows blood flow to the bone and cell activity within the bone.
  • Blood tests. Other blood tests may be used to check for certain types of arthritis.

After the evaluative information is collected and reviewed, the orthopedist will discuss the treatment options with you to help you select the best treatment plan that promotes an active and functional life.

Children – What are standard evaluation procedures?

Children will be treated much like the adults are with a full physical exam and a detailed medical history. At this time, be sure to tell your child’s doctor of any other illnesses, injuries, or complaints that have been associated with the pain or condition, as well as any previous treatments or medicines prescribed. Some early tests may then be done, including:

  • Blood tests
  • X-rays.A diagnostic test that uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.

Advanced evaluation procedures

Children who need further evaluation may undergo 1 or more of the following:

  • Magnetic resonance imaging (MRI). A diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body.
  • Computed tomography scan (also called a CT or CAT scan).A diagnostic imaging procedure that uses a combination of X-rays and computer technology to produce horizontal, or axial, images (often called slices) of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general X-rays.
  • EMG (electromyogram).A test used to evaluate nerve and muscle function.
  • Bone scan.A nuclear imaging method to evaluate any degenerative and/or arthritic changes in the joints; to detect bone diseases and tumors; to determine the cause of bone inflammation.
  • This is becoming a common test for evaluating musculoskeletal complaints.

After the evaluative information is collected and reviewed, your child’s orthopaedist will discuss with you all treatment options and help you select the best treatment plan to enable your child to live an active and functional life.

Blue Ridge Orthopaedic & Spine Center has two convenient office locations in Warrenton (540) 347.9220 & Gainesville (703) 743.2814 to serve all of your Orthopaedic needs.  Call us today to schedule an appointment.  Same day/next day appointments available.  For more information on all comprehensive services we offer, visit

Courtesy: Krames Staywell

Online Medical Reviewer: Ogiela, Dennis, MD
Online Medical Reviewer: Banerjee, Rahul, MD 

Run away from Running injuries

bodies in motion

Race season is off to a fast start this Spring and regardless of your running experience, there are many chances for injuries. So, how do you avoid them? Well, there are a few ways and this article gives a few good tips for staying injury free.

Running is a great way to get in shape, but it can also lead to injuries. Knowing about common injuries and how to prevent them can keep you on track toward achieving your fitness goals.

Experts recommend the following strategies to prevent injuries:

Identify your running goals
You may choose to start running to improve your physique, lose weight, increase cardiovascular fitness, or socialize with friends. Whatever the reason, it’s a good idea to identify this goal when creating your exercise program. If you want to improve cardiovascular fitness, for instance, you should run at a quick pace to maximize your heart rate. If you’re running to lose weight or reduce body fat, it’s better to run at a slower rate for a longer time. Depending on your goal, your doctor or personal trainer may decide that a modest walking or jogging program is appropriate. Setting goals helps you follow a safe pace and keeps you from overexertion, which can result in injury.

Have a physical evaluation
Certain health problems may hamper your running performance and increase your risk for injury. Specifically, osteoporosis, arthritis, and other degenerative joint diseases can increase your injury risk. If you have any significant health issues, you should discuss these with your doctor before you start to run.

Warm up before your run and stretch after you run
Doing so can prevent some of the most common injuries. It’s most important to stretch muscles that move joints. These include the calf muscle, which moves the knee and ankle, and the hamstring, which moves the knee and hip. Walk or gently jog for 5 minutes. Cool down at the same pace for another 5 minutes at the end of your run.

Wear the correct shoes
Buying shoes at an athletic store, where a salesclerk can help you choose a shoe that fits your foot type, can help prevent injuries.

Common injuries
The following injuries are common among runners:
Achilles tendinitis
This injury is marked by dull or sharp pain along the back of the Achilles tendon, calf tightness, and early morning stiffness. Stretching can help prevent this injury. To treat it, rest, and stretch until the pain is gone.

Plantar fasciitis 
This injury is an inflammation of the plantar fascia, a thick, fibrous band of tissue in the bottom of the foot. Proper stretching can help prevent such an injury. Anti-inflammatory medication, stretching, and ice compresses help relieve pain.

Shin splints
This injury is caused by overuse or poor conditioning and worsened by running on hard surfaces. This injury causes pain on the inside of the shinbone. Shin splints are treated by complete rest and stretching until the pain is gone. You can relieve symptoms by stretching and using ice and anti-inflammatories. Once your symptoms have eased, you should make changes in the distance you run and your speed.


Blue Ridge Orthopaedic & Spine Center has on-site state-of-the-art technology to diagnosis and treat orthopaedic conditions.
Both of our offices are equipped with in-office radiology departments. Not only does this facilitate rapid diagnosis but it is also convenient for patients who may be experiencing pain or disability at the time of their visit. To schedule an appointment with
one of our board-certified and fellowship trained physicians, call our Warrenton office at 540-347-9220 or our Gainesville office at 703-743-2814.

Beth Holloway, RN, M.Ed. and Kim Larson APRN, FNP © 2000-2015 The StayWell Company, LLC. 780 Township Line Road, Yardley, PA 19067. All rights reserved. This information is not intended as a substitute for professional medical care. Always follow your healthcare professional’s instructions.

Just what is Cartilage anyway?


What Is Cartilage?  –  Emmanuel Konstantakos, MD

Cartilage is a tremendously strong and flexible fibrous tissue that takes many forms and serves multiple purposes throughout the body. There are three types of cartilage: elastic cartilage, fibrocartilage, and hyaline cartilage.

Hyaline cartilage is the most common type of cartilage and can be found at the nose, windpipe, and most of the body’s joints. In essence, this cartilage can be thought of as the material that makes up the lubricant inside your joints. The word Hyaline is actually derived from the Greek word “Hyali” or “Γυαλί,” which means “Glass.” Under normal circumstances, a normal human joint is actually shiny and smooth similar to the inside of a glass.

In a joint, hyaline cartilage is referred to as articular cartilage because it covers bones’ surfaces where they articulate, or meet up with one another. This article focuses on articular cartilage.

Articular Cartilage
The thickness of articular cartilage varies from joint to joint. For example, cartilage at the wrist may be less than 1 mm thick 1 , while in some areas of the knee the cartilage may be as thick as 6 mm.2

Articular cartilage has two primary purposes:

  • Smooth movement. Extremely slippery, articular cartilage allows bones to glide over each other as a joint flexes and straightens.
  • Shock absorption. Articular cartilage acts as a shock absorber, cushioning bones against impacting each other during a weight-bearing activity, such as walking or jogging.

Articular cartilage also stores synovial fluid, a sticky, viscous fluid that lubricates and circulates nutrients to the joint. When the joint is at rest, the synovial fluid is stored in the articular cartilage much like water is stored in a sponge. When the joint bends or bears weight, the synovial fluid is squeezed out, helping to keep the joint lubricated and healthy.

Cartilage Damage
Despite its flexibility and strength, cartilage can be damaged. Problems can arise due to:

Wear-and-tear over time that can eventually lead to osteoarthritis
Diseases, such as rheumatoid arthritis or ankylosing spondylitis

Because it does not contain blood vessels, cartilage does not heal itself well. When cartilage has become thinned or damaged, a limited amount of new cartilage may be produced, but the new cartilage cells will grow in irregular, bumpy patterns. The result is that the bones may rub and grind against one another at the joint and this can be a source of pain.

Cartilage does not contain nerves, so damaged cartilage itself does not cause pain. However, the friction between bones and other resulting abnormalities in the joint can cause discomfort and pain as well as inflammation.

Gradual onset of stiffness, pain, and swelling in the joint can be a sign of osteoarthritis.



Blue Ridge Orthopaedic & Spine Center has on-site state-of-the-art technology to diagnosis and treat orthopaedic conditions. Both of our offices are equipped with in-office  radiology departments. Not only does this facilitate rapid diagnosis but it is also convenient for patients who may be experiencing pain or disability at the time of their visit. To schedule an appointment with one of our board-certified and fellowship trained physicians, call our Warrenton office at 540-347-9220 or our Gainesville office at 703-743-2814.


1. Pollock J, O’Toole RV, Nowicki SD, Eglseder WA. Articular cartilage thickness at the distal radius: a cadaveric study. J Hand Surg Am. 2013 Aug;38(8):1477-81. doi: 10.1016/j.jhsa.2013.04.037. Epub 2013 Jun 28. PubMed PMID: 23810572.

2. Cohen ZA, McCarthy DM, Kwak SD, Legrand P, Fogarasi F, Ciaccio EJ, Ateshian GA. Knee cartilage topography, thickness, and contact areas from MRI: in-vitro calibration and in-vivo measurements. Osteoarthritis Cartilage. 1999 Jan;7(1):95-109. PubMed PMID: 10367018.

Physical Therapy offers a non-drug alternative to Pain Management

NIH Says Current Treatment of Chronic Pain Has Created ‘Silent Epidemic;’ More Focus Needed on Non-Drug Approaches

News Now Staff – APTA

According to a report recently released by the National Institutes of Health (NIH), it’s time that treatment of chronic pain moves from a 1-pill-fits-all mindset to an evidence-based, individualized, multidisciplinary model that recognizes the value of non-pharmacological approaches, including physical therapy.

The report (.pdf) is the product of an NIH panel that looked at the current state of treatment for chronic pain, which is estimated to affect 100 Americans. In addition to looking into research on the issue, the panel convened a workshop that included more than 20 speakers. The results of the panel’s work were published earlier this week (.pdf), and featured in the online edition of Time magazine.

Much of the report is focused on the use—and possible overuse—of opioids as the “go-to” approach in almost all cases of chronic pain. In addition to contributing to patterns of drug abuse, the reliance on opioids may simply not be helping in all circumstances, according to the panel report.

“Together, the prevalence of chronic pain and the increasing use of opioids have created a ‘silent epidemic’ of distress, disability, and danger to a large percentage of Americans,” authors write. “The overriding question is whether we, as a nation, are currently approaching chronic pain in the best possible manner that maximizes effectiveness and minimizes harm.”

The answer to that question, the panel found, is no. Patients with chronic pain are typically “‘lumped’ into a single category, and treatment approaches have been generalized with little evidence to support this practice,” they write.

Because the manifestations and response to pain can be so varied, the report calls for a variety of treatment options that include physical therapy, which is specifically mentioned in the report. These non-pharmacological treatments can be very effective—the problem, as one speaker at the workshop noted, is that “lack of knowledge or limited availability of these non-pharmacological modalities and the ready availability of pharmacological options and associated reimbursement structure appear to steer clinicians toward the use of … opioids.”

An NIH press release on the report quotes panel chair David B. Reuben, MD, as saying that “clearly there are patients for whom opioids are the best treatment for their chronic pain. However, for others, there are likely to be more effective approaches.” The solution, he believes, is to ensure that “every patient’s individual needs are met by a patient-centered health care system.”

The panel report cites many barriers to the implementation of such a system, including lack of substantive evidence-based research, limited physician access to experts in other disciplines, and some insurance plans’ resistance to integrative treatment approaches. For now, authors write, the chronic pain landscape is one in which “large numbers of Americans are receiving suboptimal care.”

The release of the report comes at a time when the issue is receiving wider attention, thanks in part to Cake, and a new film starring Jennifer Aniston as a woman with chronic pain. Recently, the Washington Post addressed the issue in an article that called for a “blended approach” to chronic pain, including the use of physical therapy. That story followed up on a January 12 Washington Post article titled “8 ways to deal with chronic pain.” The article’s first recommendation: “embrace physical therapy.”

“The more you move, the better you feel,” reporter Rachel Noble Benner writes in the article. “Strategically strengthening and stretching the body, especially parts that are affected by chronic pain, can increase mobility, decrease pain, and improve overall mood. Find a physical therapist who is experienced in working with people who have chronic pain.”

The Physical Therapists at Blue Ridge Orthopaedic & Spine works exclusively in the treatments of Orthopaedic conditions and have experience working with patients who have chronic pain. In conjunction with your doctor and using evidence-based treatments, we create treatment plans to treat the patient as a whole, not just the injury, and to restore full functionality.

BRO-Logo-colorBlue Ridge Orthopaedic & Spine Center is Northern Virginia’s premier facility for diagnosing and treating back pain and spinal disorders. In addition to our regionally renowned Spine Center, our practice features Joint Replacement, Sports Medicine, Pain Management, Physical Therapy, Trauma Center, Shoulder Care, a Hand Center and a Foot and Ankle Center.

We are committed to treating not just injuries and physical ailments, but rather the whole person, by offering a wide range of specialty programs designed to support treatment. Specialty programs include Massage Therapy, Medical Nutrition and Aquatic Physical Therapy.

APTA has been at the forefront in helping the public understand how physical therapy can be a transformative agent in the treatment of chronic pain. The subject was featured in a Move Forward radio podcast, and the association offers a physical therapist’s guide to chronic pain syndromes. Additionally, the APTA Orthopaedic Section sponsors a special interest group in pain management, and the PT’s role in chronic pain management was featured in the September issue of Motion magazine.