Knee Pain in the Outdoor Athlete

We didn’t invent the practice of medicine…. we’re just changing the way it’s provided.

Ric Saguil, MDFirst Health Associates

Arlington Heights

Nutrition

Grounding

Movement

We didn’t invent the practice of medicine…. we’re just changing the way it’s provided.

First Health Associates

2010 S. Arlington Heights Rd

Arlington Heights, IL(847) 593-3330

DrRic

The First Health Approach

We didn’t invent the practice of medicine…. we’re just changing the way it’s provided.

Your Community of Care

Ric Saguil, MDJason Gruss, MDTom Jordan, RD

Katrina Christie, LCPCJennifer Green, NDJoe Musolino, DC

Emery Paredes, PTCourtney Day, EPYu Zhu, MD China

You

Staying injury free

Know your opponent

1. Pain receptors2. Inflammatory cascade3. Stretch receptors

4. Abnormally functioning nerves (Diabetes, Fibromyalgia, CF)

• Stay away from the light!

• The body is a miracle and can perform miracles…... if damage not too advanced and

body is healthy.

1. Pain Receptors

Learn the difference between good and bad pain signals

The Fibroblast

The fibroblast cell is the workhorse of healing in the joint…..if it is given the right tools! ( ….good nutrition, no toxins, no stress, no infection)

Every “knee” cell knows what to do….

…the brain has to be patient.

Ignored = further injury and longer healing . Pampered = fastest healing attained

1st prob

2nd prob

2nd prob

2nd prob

2nd prob

2nd prob

How to avoid 2nd prob’s

Step

Facilitate Healing

• R • I• C• E

est

ce

ompression

levation

Get Rescued

Step 1

Step 2

Your Rescue team:

1. Orthopedic surgeon

2. Sports medicine physician3. Primary care doctor4. Chiropractor 5. Physical therapist6. Exercise physiologist7. Kinesiologist 8. Trainer

MD or DOMD or DOMD or DO or NPDCPTEP ACSMT Cert ACSMT Cert ACSM

+ Acupuncturist LAc or Dipl. Ac

INTERMISSIONBest bang for buck

Better than nothing Over kill

Saguil Approach – Compressing Time

Rehab is mandatory!

2. Inflammatory Cascade

Knee In

jury

Swelling

Heat

Pain

BoneMuscle

Ligament

Blood Vessel

Caveat Emptor

Not Safe!

Safe

Really Safe!!!

DrRic Favorite

Black Pepper

Tumeric is an excellent anti-inflammatory for swelling and healing but take with black pepper

Natural Facilitators

• Vitamin D3 1000IU am/pm

• Omega 3 (Fish, Flax or Krill) 1000mg am/pm• Multivitamin am/pm• Glucosamine Sulfate Chondroitin 1500/day• Magnesium 200mg am/pm• Anti-inflammatory Diet for life!• Traumeel/PanAway topical 3-5times/d

Hint: Save money, take glucosamine 30 days on then 90 days off…..still works all year round!!

“Synthetic” Facilitators

• OTC NSAIDS motrin, advil, ibu, aleve, napro..• Script NSAIDS relafen, lodine, voltaren, indocin• Injectable NSAIDS toradol• Topical NSAIDS pennsaid• Oral Steroids medrol pack, prednisone• Injectable Steroids kenalog, celestone….• Muscle Relaxers flexeril, zanaflex, skelaxin• Narcotics tylenol #3, vicodin, ultram

Prescription medicines can help but watch the side effects!!

3. Stretch Receptors

Flat bag of fluidFu

ll bag o

f fluid

Fluid build up from Friction

Patellofemoral Syndrome

Normal tracking

Abnor

mal

track

ing w

ith

fricti

on/p

ain

Extra

fluid

Prolonged Friction = Cartilage “Abrasion”

weeks

Chondral Fracture

Chronic Friction =Cartilage and Bone Chip

Months

Osteochondritis Dissecans

High Q-angle rubbing/friction

Pes planus (pronation)

Flat feet causes a “high Q-angle”

Pes planus = “fallen arches”

Pronation “fixes” alignment

Shoe inserts

Or good shoes

“External Fixes”

• Stabilizing shoes• Low dye taping • Orthotics Custom• Orthotics Off Shelf

Avoid “Rocky” style shoes….(or ask an expert)

ask

Muscular Imbalance

1. Quads (usually big)

2. Hamstrings (usually tight)

3. ITB (Ileotibial Band) (slave to #1 and #2)

Ileotibial band syndrome

With big muscle comes tight ligament

Dominant forces win

ITB

Qangle

ITB Syndrome

The patella gets pulled by ITB Syndrome

ITB Syndrome causes Patellofemoral Syndrome

ITB Syndrome

Normal Pulled over

“Internal Fixes”

PT

ATC

MT

ALTERNATIVE

Surgical

Physical Therapy

• Covered by most insurance ($$$)• “Challenge” the therapist (find a sports tx)• Plan on graduation date/surgery (launch)• Modalities facilitate (u/s, phono, ionto)

Athletic Training

• Cheaper• Great at taping/DTM• Great at keeping you honest after PT• Maximize on conservative therapy

Ice Bath Ice Sleeve Kinesio Taping

Field Experience Self-careEducation

Massage Therapy/Alternative

Chiro Alignment

Yoga

Tissue Scraping

Acupuncture

Self Massage

Equipment

Your Life Changing Team:

• Trainer• Kinesiologist • Exercise physiologist• Physical therapist• Chiropractor • Primary care doctor• Sports medicine physician• Orthopedic surgeon

• Acupuncturist

Bottom line

• Rescue from damage• Reverse inflammation• Re-strengthen muscle• Re-balance kinetic

chain• Return to activity

Stop trainingMeds, supps, foodTherapy, acupunctureChiro, trainer, yoga, crossfitIdea of K E Y (knowledge..)

Community Health Project – YOGA?

We didn’t invent the practice of medicine…. we’re just changing the way it’s provided.

Northwest Community Hospital Wellness Center

June 23rd (sat) 11:00-12:30pm(847) 618-3500Ric Saguil, MD

QUESTIONS?

COMMENTS?

CONCERNS?