4 Common Orthopaedic Trauma Injuries & How We Treat Them

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Article featured on MedStar Health

How We Treat Common Othropaedic Trauma Injuries

Lower Extremity Fractures

We see a large number of lower extremity injuries from individuals getting struck by cars, such as a tibial plateau fracture, which occurs when you break the bone on the top part of your tibia, right below your knee. This often happens because a car’s bumper strikes someone from the side at about knee level. Other common lower extremity injuries, such as a femur fracture and pelvic fracture, occur the most in the spring and summer, when people are out riding their motorcycles, bicycles, and motorized scooters.

Treatment for lower extremity fractures typically involves a surgeon realigning a patient’s affected bone and joints to their natural positions and holding them in place with plates and screws in a way that allows for them to heal properly.

While bones typically take about three months to heal, the hardware we insert during surgery sometimes is strong enough to support patients’ weight, allowing them to walk right after surgery. But speak to your doctor to see what to expect from your surgery, as some fractures, such as those close to joints, need to be fixed with hardware that is not designed to support the patient’s weight, resulting in people waiting weeks to months to put weight on their legs. Once patients are able to bear weight again, physical therapists can help them with strength and flexibility exercises to minimize stiffness and regain muscle loss. Social workers also can help patients plan for disability insurance or any time off work while they recover.

Wrist Injuries

We often see individuals with wrist injuries after they try to catch themselves when they slip and fall. This is especially common during the winter months, when snow and ice are on the ground. One of the most common wrist injuries we see is a fractured distal radius (broken wrist).

Treatment for a distal radius fracture typically involves patients either wearing a cast for around six weeks to allow the wrist to heal or undergoing surgery to better align the wrist and stabilize it  in order for it to heal properly.

Bones That Don’t Heal Properly

Some people are referred to us by their primary care doctors or other orthopaedic specialists because they’re having complications from previous fractures, such as a bone healing crookedly or not healing at all (nonunion).

To treat a nonunion, we first try to identify whether the patient’s bones aren’t receiving enough blood supply or the patient is lacking vitamins and minerals, such as vitamin D, which are necessary for proper bone healing. If neither is the case, we typically can get the bone to begin healing by retrieving bone from another part of the body and inserting it into the fracture site of the bone that isn’t healing properly.  We may need to also stabilize the bone differently from what was tried initially.

For bones that heal crookedly, we may need to cut the bone to realign it to the proper position.  We then stabilize it to hold it in that position. Depending on the situation, this can be performed all on the inside of the body or by using a system on the outside of the body that connects with a computer program.

Bone Infections

Some patients are referred to us because of osteomyelitis, a complicated bone infection. Osteomyelitis often can occur after trauma and can affect any bone. Without the proper treatment, osteomyelitis can spread to the tissues near the bone, kill the bone, and prevent any fractures from healing.

We treat these bone infections with surgery in which we open up the bone, remove as much of the infection as possible, and prescribe the patient antibiotics to both kill any remaining traces of the infection and keep it away long-term.

Can You Prevent Orthopaedic Trauma Injuries?

Unfortunately, many orthopedic trauma injuries are due to random events, such as someone running a red light and hitting another person’s car. There isn’t much we can do to prevent these types of events.

But it’s possible for you to avoid some traumatic injuries by carefully selecting what activities you want to participate in and understanding your physical limits. If you’re riding a motorcycle or bicycle, for example, make sure you’re moving at a safe pace and are always aware of your surroundings. If you’re on a ski trip, don’t ski on the hardest trail without having the appropriate skill level.

What Should People Do in an Emergency?

If an individual experiences an orthopaedic trauma injury, such as a severely injured limb, call 911 right away to request an ambulance. While the ambulance is on the way, it’s important for the injured person to stay calm and keep the affected arm or leg still. This can not only reduce the pain but also help prevent further injury to the soft tissues surrounding the injured bones. If there’s newspaper or cardboard nearby, try rolling it up to form a makeshift splint.

If someone has an open fracture—when there’s an open wound or break in the skin near the broken bone, what used to be referred to as a compound fracture—or has any injury that causes excessive bleeding, applying pressure on the area helps reduce the bleeding while they wait for emergency medical professionals to arrive.

The Orthopedic & Sports Medicine Center of Oregon is an award-winning, board-certified orthopedic group located in downtown Portland Oregon. We utilize both surgical and nonsurgical means to treat musculoskeletal trauma, spine diseases, foot and ankle conditions, sports injuries, degenerative diseases, infections, tumors and congenital disorders.

Our mission is to return our patients back to pain-free mobility and full strength as quickly and painlessly as possible using both surgical and non-surgical orthopedic procedures.

Our expert physicians provide leading-edge, comprehensive care in the diagnosis and treatment of orthopedic conditions, including total joint replacement and sports medicine. We apply the latest state-of-the-art techniques in order to return our patients to their active lifestyle.

If you’re looking for compassionate, expert orthopedic and podiatric surgeons in Portland Oregon, contact OSM today.

Phone:

503-224-8399

Address
1515 NW 18th Ave, 3rd Floor
Portland, OR 97209

Hours
Monday–Friday
8:00am – 4:30pm

10 Common Hiking Injuries and How to Prevent Them

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Article featured on Austin Emergency Center

For hikers who plan on hitting the trail this summer, understanding the most common hiking injuries and how to prevent them is crucial for enjoying a safe and rewarding outdoor experience! This article will explore strategies for preventing and treating these common hiking injuries. By equipping yourself with knowledge and taking proactive steps, you can minimize the risks, maximize enjoyment, and ensure a memorable hiking experience.

1. Sprained Ankles

Ankle sprains occur when the ligaments surrounding the ankle joint are stretched or torn. This can happen to even the most experienced hikers due to uneven terrain, slippery surfaces, or missteps while traveling over diverse Texas landscapes.

Prevention:

Wear supportive footwear that provides ankle stability to prevent sprained ankles while hiking. Before hiking, warm up your muscles and perform ankle stretches.

Choose hiking trails that match your skill level, and be mindful of potential hazards, such as uneven surfaces or loose rocks—consider using trekking poles for added stability. Be sure to take smaller steps and avoid rushing.

Treatment:

To treat sprained ankles from hiking, follow the RICE method: Rest by avoiding weight-bearing, apply Ice for 15-20 minutes several times a day to reduce swelling, use Compression with an elastic bandage for support, and Elevate the ankle above heart level to minimize swelling.

You can also take over-the-counter pain relievers and gradually incorporate rehabilitation exercises under professional guidance.

2. Knee Injuries

Hiking involves strenuous and repetitive movements that can cause stress on the knees. Common knee-related hiking injuries include strains, sprains, and tendonitis.

Prevention:

To prevent knee injuries while hiking, practice proper hiking techniques and focus on maintaining good posture and taking shorter strides out on the trail.

Wear appropriate footwear with cushioning and support. Gradually increase the intensity of your hikes, and take regular breaks. Regulate the weight you carry in your pack, and listen to your body for any signs of injury.

Treatment:

When treating knee injuries caused by hiking, focus on resting the injured knee and avoid putting weight on it. Apply ice packs or cold compresses to reduce swelling and pain, and use compression bandages or wraps to support and stabilize the knee.

Elevate the injured leg above heart level to help reduce swelling, and take over-the-counter pain relievers if needed.

3. Blisters

Blisters are a common hiking nuisance caused by friction between the skin and footwear. Ill-fitting or wet shoes, as well as long hikes, can increase the likelihood of blisters.

Prevention:

To prevent blisters while hiking, wear properly fitted and broken-in hiking boots or shoes to reduce friction. Invest in moisture-wicking socks made of synthetic or wool materials that help keep your feet dry.

You can also apply lubricants or anti-blister products, such as petroleum jelly or specialized foot balms, to areas prone to blister formation.

Treatment:

Clean the affected area with mild soap and water, leaving the blister intact to protect the underlying skin and prevent infection. If the blister has already burst or is causing significant discomfort, gently clean the area, apply antibioticointment, and cover it with a sterile dressing or adhesive bandage.

4. Shin Splints

Shin splints are characterized by pain along the front or inner edge of the shinbone. They often occur due to overuse, improper footwear, or hiking on hard surfaces.

Prevention:

To prevent shin splints while hiking, wear proper footwear that provides adequate support and cushioning. Gradually increase your hiking intensity and distance to allow your body to adapt, avoid sudden terrain changes, and opt for softer surfaces when possible.

Treatment:

Rest and reduce or eliminate any weight-bearing activities that worsen the pain of shin splints. Apply ice packs to the affected area for 15-20 minutes several times daily to reduce inflammation and pain. You can also take over-the-counter pain relievers to alleviate discomfort.

Gentle stretching exercises for the calf muscles and the muscles in the front of the shin can help relieve tightness and promote healing.

5. Dehydration

Hiking in hot weather or at high altitudes can lead to dehydration and heat-related illnesses. Symptoms include dizziness, fatigue, nausea, and confusion.

Prevention:

To prevent dehydration while hiking, start by drinking plenty of water and staying hydrated before your hike. Carry an adequate water supply and drink regularly throughout your hike, even if you don’t feel thirsty.

Wear lightweight, breathable clothing and a hat to help regulate body temperature and reduce sweating. Avoid hiking during the hottest parts of the day and take regular breaks in shaded areas to rest and rehydrate.

Treatment:

When you are dehydrated, it’s crucial to replenish lost fluids and electrolytes. Immediately stop hiking and find a shaded area to rest. Drink plenty of water or rehydration fluids, taking small sips at regular intervals rather than gulping large amounts at once.

Applying cool, damp towels or using a misting fan with cold water can help cool your body and provide relief.

6. Sunburn and Heatstroke

Prolonged exposure to the sun without adequate protection can result in sunburns and, in severe cases, heatstroke. Heatstroke is a life-threatening medical emergency and requires immediate attention.

Prevention:

To prevent sunburn and heatstroke while hiking, wear sunscreen with a high SPF and apply it generously to all exposed skin. Wear a wide-brimmed hat and lightweight, breathable clothing that covers your arms and legs.

Plan your hike during cooler hours, such as early morning or late afternoon, to avoid the day’s peak heat. Consider using a moisture-wicking fabric or a cooling towel to help regulate body temperature.

Treatment:

When treating sunburn and heatstroke, move to a shaded area and protect your skin from further sun exposure. Apply a cool compress to soothe the burned skin, and moisturize with aloe vera gel or a gentle, non-irritating lotion to help alleviate discomfort.

Drink plenty of fluids to stay hydrated and replace lost electrolytes. For more severe sunburns with blisters, pain, or signs of infection, seek medical attention.

When treating heatstroke, it’s essential to cool the body down immediately. If possible, move to a shaded or air-conditioned area, remove excess clothing, and apply cool water or ice packs to the neck, armpits, and groin area.

Call emergency services or seek medical help promptly. Monitor vital signs and provide first aid measures while waiting for professional assistance. Remember, early intervention is crucial for both sunburn and heatstroke treatment.

7. Insect Bites and Stings

Hiking in areas with mosquitoes, ticks, or other insects can lead to unpleasant bites and stings that can cause itching, swelling, and even transmit disease.

Prevention:

Wearing long sleeves, long pants, and socks to minimize exposed skin while hiking. Tuck your pants into your socks and consider using insect repellent on exposed areas.

Choose to wear light-colored clothing, as insects are often attracted to dark colors, and avoid wearing strong fragrances, perfumes, or scented lotions, as they can attract unwanted attention from bugs. Stay on designated trails and avoid brushing against vegetation.

Treatment:

To treat bug bites, wash the affected area with mild soap and water to clean it. Use a credit card or a fingernail to gently scrape off the skin if there’s a stinger. Apply a cold compress or ice pack wrapped in a thin cloth to reduce swelling and alleviate discomfort.
Avoid scratching the bite to prevent infection. If needed, take an over-the-counter antihistamine to reduce itching and allergic reactions.

8. Overexertion

Pushing your body beyond its limits can lead to overexertion, resulting in muscle strains, fatigue, and exhaustion.

Prevention:

Listen to your body and know your limits when hiking! Plan your hike according to your abilities and choose trails that match your fitness level. Pace yourself and take breaks when needed, especially on long hikes or challenging terrain.

Treatment:

Allow your body to rest and recover when you begin to feel overexerted. Find a shaded area to sit or lie down and elevate your legs. Drink plenty of water or an electrolyte-rich beverage to rehydrate.

If you’re experiencing muscle soreness or stiffness, gentle stretching, and light massages may provide relief. Avoid further physical activity until you feel fully recovered. Pay attention to any lingering symptoms, such as persistent fatigue, dizziness, or rapid heartbeat, and seek medical attention if necessary.

9. Falls and Cuts

Trips, slips, and falls can happen while hiking, especially on uneven ground or steep slopes. Falls can result in cuts, bruises, and even more serious injuries like fractures.

Prevention:

To prevent falls and cuts while hiking, always stay alert and focus on the trail. Wear appropriate footwear with good traction to minimize the risk of slipping, and be sure to take your time and watch your step on uneven or rocky terrain. Be cautious when crossing streams or wet surfaces by using stable footholds and handholds if available.

Treatment:

When treating falls and cuts from hiking, it’s important to prioritize safety and address any injuries promptly. Carry a well-equipped first aid kit with essentials like adhesive bandages, antiseptic wipes, and sterile gauze to promptly address any cuts or injuries.

If bleeding is severe or the wound is deep, apply direct pressure with a clean cloth or bandage and seek medical attention. If a fall results in possible fractures or head injury, immobilize the affected area, keep the person still, and call for emergency medical assistance. It’s crucial to monitor for signs of shock, such as pale skin, rapid breathing, or weak pulse, and provide comfort and reassurance while waiting for professional help.

10. Poison Ivy

Brushing against poison ivy, poison oak, or other irritating plants can cause allergic reactions, including rashes and itching.

Prevention:

It’s essential to familiarize yourself with the plant’s appearance and avoid contact with it to prevent exposure to poison ivy exposure while hiking! Learn to recognize the three leaflets in a cluster characteristic of poison ivy.

Wear long sleeves, long pants, and closed-toe shoes to minimize skin exposure. As an added protection layer, consider applying a barrier cream or lotion containing bentoquatam to exposed skin areas. Always be cautious when sitting or leaning on surfaces that may have come into contact with poison ivy, such as fallen logs or rocks.

Treatment:

Wash the affected area with soap and cool water to remove the urushiol oil from the skin. Be sure to avoid scrubbing the area to prevent further skin irritation.

Apply a cold compress or take cool showers to soothe the itching and reduce inflammation. Over-the-counter hydrocortisone creams, calamine lotion, and oral antihistamines can help relieve itching and discomfort.

If symptoms are severe, widespread, or persistent, or if blisters or signs of infection develop, seek medical attention for further evaluation and treatment. Wash any clothing, gear, or tools that may have come into contact with poison ivy to remove any lingering urushiol oil.

The Orthopedic & Sports Medicine Center of Oregon is an award-winning, board-certified orthopedic group located in downtown Portland Oregon. We utilize both surgical and nonsurgical means to treat musculoskeletal trauma, spine diseases, foot and ankle conditions, sports injuries, degenerative diseases, infections, tumors and congenital disorders.

Our mission is to return our patients back to pain-free mobility and full strength as quickly and painlessly as possible using both surgical and non-surgical orthopedic procedures.

Our expert physicians provide leading-edge, comprehensive care in the diagnosis and treatment of orthopedic conditions, including total joint replacement and sports medicine. We apply the latest state-of-the-art techniques in order to return our patients to their active lifestyle.

If you’re looking for compassionate, expert orthopedic and podiatric surgeons in Portland Oregon, contact OSM today.

Phone:

503-224-8399

Address
1515 NW 18th Ave, 3rd Floor
Portland, OR 97209

Hours
Monday–Friday
8:00am – 4:30pm

How Does Exercising Keep the Brain Young?

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Article featured on MedicalNewsToday

Exercise greatly benefits brain health, improving cognition, mood and reducing the risk of neurodegenerative diseases. Several new studies have demonstrated the profound impact of exercise on various biological systems, further explaining its ability to enhance health and fight disease. In this Special Feature, we explore the most recent research on how exercise can protect brain health as we age.

Exercise is linked to increased muscle strength, improved heart health, lower blood sugar and numerous other health benefits.

Activities such as running on a treadmill, biking up a steep hill, lifting weights or taking a brisk lunchtime walk offer a wide range of advantages that go beyond enhancing physical appearance or stamina.

Evidence from studies suggests that regular physical activity could boost mood, alleviate stress, and sharpen cognitive function, underscoring the deep connection between body and mind.

However, different people can respond quite differently to various forms of exercise, such as aerobic workouts or strength training.

While it is well-known that regular exercise is crucial for a healthy lifestyle, some older research has suggested that intense exercise might have negative effects.

More recent research, however, showed that elite athletes experienced slightly extended life expectancies over the decades.

Exercise significantly enhances brain health by improving cognition, mood and by reducing the risk of neurodegenerative diseases through promoting neurogenesis and synaptic plasticity.

What does the latest evidence and expert opinion have to say about the ways in which regular physical activity helps maintain brain, as well as general, health as we age?

How exercise affects the body at the molecular level

In a new collaborative effort led by Stanford Medicine, researchers have explored the underlying mechanisms through which exercise promotes overall health, particularly brain health.

By understanding how exercise affects different organs at the molecular level, health care providers could tailor exercise recommendations more effectively.

This knowledge could also pave the way for developing drug therapies that mimic the benefits of exercise for those who are unable to engage in physical activity.

The study — whose findings appear in Nature — involved nearly 10,000 measurements across almost 20 types of tissues to examine the impact of 8 weeks of endurance exercise in lab rats trained to run on tiny treadmills.

Its conclusion reveals remarkable effects of exercise on the immune system, stress response, energy production and metabolism.

The researchers identified significant connections between exercise and molecules and genes that are already known to be involved in numerous human diseases and tissue recovery.

How endurance training affects the body

The Nature study examined the effects of 8 weeks of endurance training on various biological systems, including gene expression (the transcriptome), proteins (the proteome), fats (the lipidome), metabolites (the metabolome), DNA chemical tags (the epigenome) and the immune system.

The researchers conducted analyses on different tissues in rats trained to run increasing distances and compared these with the tissues of sedentary rats.

They focused on mitochondria in the leg muscles, the heart, liver, kidney, white adipose tissue — which accumulates as body fat — as well as lungs, brain, and brown adipose tissue — a metabolically active fat that burns calories.

This comprehensive approach generated hundreds of thousands of results for non-epigenetic changes and over 2 million distinct epigenetic changes in the mitochondria, providing a rich database for future research.

Alongside the primary goal of creating a database, some notable findings emerged. For instance, the expression of mitochondrial genes changed with exercise across different tissues.

Researchers found that training upregulated genes in the mitochondria of skeletal muscle of rats that are downregulated in the mitochondria in the skeletal muscle of individuals with type 2 diabetes.

They also showed that training upregulated genes in the mitochondria in the livers of rats, that are down regulated in people with cirrhosis.

These two findings suggest that endurance training may help improve muscular function in diabetes, as well as boost liver health.

Does biological sex affect how we respond to exercise?

Finally, the researchers identified sex differences in how male and female rats’ tissues responded to exercise.

After 8 weeks, male rats lost about 5% of their body fat, while female rats did not lose a significant amount. However, the female rats maintained their initial fat percentage, whereas sedentary females gained an additional 4% body fat during the study.

The most dynamic difference was in mitochondrial gene expression after exercise in rats was in the adrenal glands.

The study authors propose that differences observed due to exercise are largely due to changes in mitochondrial genetic expression in organs and tissues responsible for maintaining energy balance.

Exercise’s rejuvenating effect on immune cells

Another study, this time completed by a research group from The University of Queensland in Australia, and published in Aging CellTrusted Source, demonstrated how exercise might deter or decelerate cognitive decline as individuals age.

Researchers examined gene expression in individual brain cells of mice, discovering that exercise profoundly influences gene expression in microglia, the immune cells supporting brain function in the central nervous system.

Specifically, exercise reverted the gene expression patterns of aged microglia to patterns akin to those seen in young microglia.

Experiments depleting microglia demonstrated their necessity for the beneficial effects of exercise on the creation of new neurons in the hippocampus, a brain region vital for memory, learning and emotion.

This study also revealed that providing mice access to a running wheel prevented or reduced the presence of T cells in the hippocampus as they aged.

These immune cells are typically absent in the youthful brain but increase with age.

Co-corresponding author Jana Vukovic, PhD, assistant professor and head of the neuroimmunology and cognition laboratory at The University of Queensland, explained the key findings to Medical News Today.

Vukovic explained that: “[T]he aging process affects all of the different cell types in the brain with the greatest impact on the resident immune cells: microglia. Importantly, exercise reverts the microglial gene profile back to their youthful state.”

Understanding how exercise supports brain health “is a key question for many scientists globally,” Vukovic noted, adding that she and her colleagues “propose that exercise alters the immune landscape in the ageing brain and therefore enables the immune cells to continue to support nerve cell function.”

Exercise strengthens brain cell connections

Ryan Glatt, CPT, NBC-HWC, senior brain health coach and director of the FitBrain Program at Pacific Neuroscience Institute in Santa Monica, not involved in these studies, told MNT they “underscore the multifaceted benefits of exercise on brain health, particularly through gene regulation, mitochondrial function, and immune response.”

“They offer valuable insights by merging molecular biology with practical health interventions for aging populations,” he added.

For example, “exercise enhances synaptic plasticity and blood flow while reducing inflammation and increasing the expression of neurotrophic factors like BDNFTrusted Source,” Glatt explained. “These effects can synergistically improve memory, learning, and overall brain health.”

The best forms of exercise for a healthy aging brain

Vukovic noted that “there are ongoing studies to optimise exercise programs for elderly; however, Pilates is a good starting point for those who are looking to engage their muscles.”

Glatt agreed, adding that “aerobic exercises like cardiovascular exercise, strength training, and balance exercises are particularly beneficial to brain health, in both shared and unique ways.”

“Activities combining physical and cognitive challenges, like dance or tai chi, can be especially effective for certain aspects of brain health,” Glatt said.

Nevertheless, he cautioned that: “While exercise benefits brain health, individual variability due to genetics and baseline health can affect outcomes. Further research is needed to determine the long-term sustainability and optimal exercise types and intensities for different populations.”

The Orthopedic & Sports Medicine Center of Oregon is an award-winning, board-certified orthopedic group located in downtown Portland Oregon. We utilize both surgical and nonsurgical means to treat musculoskeletal trauma, spine diseases, foot and ankle conditions, sports injuries, degenerative diseases, infections, tumors and congenital disorders.

Our mission is to return our patients back to pain-free mobility and full strength as quickly and painlessly as possible using both surgical and non-surgical orthopedic procedures.

Our expert physicians provide leading-edge, comprehensive care in the diagnosis and treatment of orthopedic conditions, including total joint replacement and sports medicine. We apply the latest state-of-the-art techniques in order to return our patients to their active lifestyle.

If you’re looking for compassionate, expert orthopedic and podiatric surgeons in Portland Oregon, contact OSM today.

Phone:

503-224-8399

Address
1515 NW 18th Ave, 3rd Floor
Portland, OR 97209

Hours
Monday–Friday
8:00am – 4:30pm

Summer Sports Injury Prevention

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Article featured on U Chicago Medicine

Whether it’s because you’ve only done indoor workouts or because your winter involved too much Netflix-meets-couch time, warmer-weather sports injuries are common and can even sideline the most well-intentioned weekend warrior during what’s arguably the best time of the year.

Here are some of the most common questions my sports medicine colleagues and I often receive about how to stay safe when exercising – seasonally or otherwise:

What sports injuries are most common in the summer?

When the weather warms up, athletes tend to want to go back to their sports quickly to make up for the time they were inside. But increasing intensity and volume is a recipe of injury. Even for those less seasoned athletes, repetitive motion, particularly when you aren’t used to it during the winter months, can increase your risk of:

  • Stress fractures
  • Swimmer’s shoulder
  • Pitching elbow
  • Runner’s knee
  • Jumper’s knee
  • Achilles tendonitis
  • Shin splints
  • Tennis elbow
  • Rotator cuff injury
  • Pulled groin
  • Knee injuries (torn ACL, torn meniscus)
  • Dislocations

What causes sports injuries?

There are many causes of sports injuries. Everything from insufficient warm-up and stretching, poor conditioning and training techniques to previous injuries that have not properly healed or intense, high-level competition from contact (football, basketball) and noncontact (tennis, gymnastics) sports can lead to accidents. Common behaviors that can cause injuries this season include:

  • Working out too hard and/or overtraining, injuries are more likely if you are working out too often and/or for too long
  • Leveling up too quickly, changing the intensity of exercise or training too fast
  • Wearing the wrong shoes, such as shoes without enough support, increase risk of injuries
  • Poor training and/or incorrect technique can be very unsafe and ultimately lead to accidents and/or injuries
  • Not stretching before and after exercise
  • Dehydration can cause a range of symptoms, such as headache, fatigue, confusion and dizziness

Prevent Common Exercise Injuries this Summer

To perform the way you want and protect yourself from injuries, you need to take proactive steps to prepare your body properly. That means spending time during the off-season diversifying the types of activities you do.
You need to make sure you work your body in different ways. It’s important to help decrease the stress caused by repetitive motions, which goes a long way toward preventing injuries.

Prepare in the Off-Season/Winter

For anyone with warmer-weather sporting events lined up, or have plans to take up new sports this season, make sure your winter and/or off-season includes exploring new exercises that activate your core and build strength in the upper and lower body with cross-training activities, such as:

  • Pilates
  • Yoga
  • Swimming
  • Aqua jogging
  • Weight training

For runners and triathletes, strength training is not intended to build the muscle mass like a weightlifter, but instead to develop strength, power and endurance. Strength training can improve running performance and decrease injuries.

Build Up Exercise Overtime

Start with shorter distances (or a shorter duration for your workout) and build up progressively from there. Make sure you don’t increase your mileage or duration by more than 10% a week, especially if you’re running.

For example, if you ran three miles, three different times this week, your total weekly mileage is nine miles. Don’t run more than 10 total miles the following week. Build from there. Doing too much too soon means you may have to sit out the first weeks of spring nursing an injury. No one wants that.

Duration Before Speed

Speed should be the last thing you try to tack onto your training if you just started out. Once you’re comfortable with the mileage and/or duration of your workout, tempo runs or interval training will be the next steps.

Establish a Good, Consistent Stretching Routine

Make sure you stretch regularly and that the stretching encompasses your whole body. There are a lot of resources online if you’re unsure where to start. For whole-body workouts, the seven-minute workout has been scientifically validated to demonstrate benefits.

Incorporate Activity into your Workday

That could mean taking the stairs at work, do a walking meeting (weather permitting), sitting on an exercise ball at your desk, or doing calf raises and lunges while you’re on a conference call (nobody is watching you and will not think you are an exercise freak). Short bursts throughout the day can help maintain flexibility and strength when you can’t go outside. The goal is to work hard and smart with your time.

When is it time to see a sports medicine physician for a sports injury?

My best advice is to listen to your body. Working out is not about fighting through pain. Muscle soreness and the sensation of a good workout is what we are looking for. If pain has been persistent for more than two weeks even though you’ve been resting, icing and limiting your physical activity, it’s time to have your injury looked at. Swelling and bruising could indicate a more serious injury.

The Orthopedic & Sports Medicine Center of Oregon is an award-winning, board-certified orthopedic group located in downtown Portland Oregon. We utilize both surgical and nonsurgical means to treat musculoskeletal trauma, spine diseases, foot and ankle conditions, sports injuries, degenerative diseases, infections, tumors and congenital disorders.

Our mission is to return our patients back to pain-free mobility and full strength as quickly and painlessly as possible using both surgical and non-surgical orthopedic procedures.

Our expert physicians provide leading-edge, comprehensive care in the diagnosis and treatment of orthopedic conditions, including total joint replacement and sports medicine. We apply the latest state-of-the-art techniques in order to return our patients to their active lifestyle.

If you’re looking for compassionate, expert orthopedic and podiatric surgeons in Portland Oregon, contact OSM today.

Phone:

503-224-8399

Address
1515 NW 18th Ave, 3rd Floor
Portland, OR 97209

Hours
Monday–Friday
8:00am – 4:30pm

Common Heel Pain

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Article featured on OrthoInfo

Every mile a person walks puts 60 tons of stress on each foot. Feet can handle a heavy load, but too much stress pushes them over their limits. The result is often foot pain — the most common problem affecting the foot.

Anatomy

The bones of the feet are commonly divided into three parts:

  • The hindfoot (back of the foot)
  • The midfoot (middle of the foot)
  • The forefoot (front of the foot)

The heel bone is the largest bone in the foot. It lies at the back of the foot (hindfoot).

  • The Achilles tendon extends down from the calf muscle and attaches to the back of the heel.
  • The plantar fascia is a thick band of tissue that runs along the bottom of the foot and attaches to the plantar surface of the heel bone.

Both of these attachments — the places where soft tissues attach to bone — can become inflamed and be the source of heel pain.

Cause

Heel pain can have many causes, which generally fall into two categories.

Pain beneath the heel may be caused by:

  • Stone bruise. Stepping on a hard object, such as a rock or stone, can bruise the fat pad on the underside of the heel. The bruised area may or may not look discolored.
  • Plantar fasciitis. Too much running or jumping can inflame the tissue band (fascia) connecting the heel bone to the base of the toes. This inflammation can be worsened by performing these activities in older shoes with worn-out cushioning. Learn more: Plantar Fasciitis and Bone Spurs
  • Heel spur. When plantar fasciitis goes untreated for a long time, a heel spur (calcium deposit) may form where the fascia tissue band connects to the heel bone. A heel spur is usually the result of the problem (long-standing plantar fasciitis) and not the cause of the pain.
  • Calcaneus stress fracture. Repetitive stress to the calcaneus from high impact activities can eventually wear out and fracture the bone. Learn more: Stress Fractures of the Foot and Ankle
  • Nerve entrapment. Repetitive impact activities can cause swelling and nerve inflammation underneath the heel bone.

Pain behind the heel may be caused by:

  • Retrocalcaneal bursitis. People who have pain behind their heel may have inflamed the area where the Achilles tendon inserts onto (attaches to) the heel bone. This can be the result of running too much, or wearing shoes that rub or cut into the back of the heel.
  • Insertional Achilles tendinosis. This condition results from the breakdown of collagen in the Achilles tendon at the place where the tendon attaches to the heel bone. Over time, the tendon becomes thickened, causing pain.

Whatever the cause, continued impact on a sore heel will only worsen the pain and may lead to additional problems.

Symptoms

  • Symptoms of heel pain often include swelling and tenderness.
  • With plantar fasciitis, the pain is centered under the heel and may be mild at first. The pain flares up when taking first steps out of bed in the morning or when stepping out of a car after a long drive.  Even rising from a chair after sitting for awhile can cause pain.
  • Pain behind the heel may build slowly over time, causing the skin to thicken, get red, and swell. The pain flares up when first starting an activity after resting. Wearing normal shoes often also causes pain.
  • People with pain behind the heel may also develop a bump on the back of the heel that feels tender and warm to the touch. People born with this bump are more likely to experience heel pain as they get older.

Doctor Examination

Medical History and Physical Examination

During the appointment, your doctor will:

  • Ask you about your heel pain and symptoms.
  • Examine the bottom and back of your heel, looking and feeling for signs of tenderness and swelling that may indicate plantar fasciitis or retrocalcaneal bursitis.
  • Possibly squeeze your heel to determine if you have a stress fracture.
  • Possibly ask you to walk, stand on one foot, or do other physical tests to help your doctor pinpoint the cause of your pain.
  • Check your range of motion and flexibility.

Imaging Tests

X-rays. When heel pain continues for a long time, your doctor may order X-rays to evaluate the root cause of the pain. X-rays can help your doctor diagnose heel pain due to plantar fasciitis, calcaneus stress fracture, insertional Achilles tendinosis, and other issues that cause heel pain.

Magnetic Resonance Imaging (MRI) Scan. An MRI is rarely needed to diagnose heel pain. However, if initial nonsurgical treatment is not effective, and X-rays do not reveal the cause of your heel pain, your doctor may order an MRI scan. An MRI can help your doctor better evaluate the Achilles tendon, or diagnose a calcaneus stress fracture, retrocalcaneal bursitis, plantar fasciitis, or other soft tissue-related sources of pain.

Treatment

If your heel hurts, see your doctor right away to determine why it hurts and get treatment.

Treatment will depend largely on the cause of the pain.

Nonsurgical Treatment

Heel pain rarely requires surgery. Conservative (nonsurgical) treatments include:

  • Rest. Rest your foot as much as you can until the pain goes away. Heel pain that is the result of a stone bruise will gradually go away completely with rest.
  • Icing. If your pain is located behind the heel, consider placing ice on the back of the heel to reduce inflammation. Apply ice 20 minutes on/20 minutes off. Do not apply ice directly to the skin; use an ice pack, or wrap the ice in a towel or cloth.
  • Non-steroidal anti-inflammatory drugs (NSAIDs). Your doctor may recommend you take an NSAID, such as ibuprofen, to reduce swelling.
  • Tape. Placing tape around the heel may help reduce pain and promote healing in patients with plantar fasciitis.
  • Shoe inserts. Your doctor may recommend that you wear heel pads or heel cup inserts. Patients with a torn Achilles tendon may also want to wear open-backed shoes.
  • Night splinting: Your doctor may prescribe a splint for you to wear at night, which can be effective in reducing pain first thing in the morning.
  • Exercises. Your doctor may suggest special exercises. For example, leaning forward against a wall with your foot flat on the floor and heel elevated with the insert to stretch the Achilles tendon. Restoring flexibility in the calf muscle, Achilles tendon, and plantar fascia is a critical step in relieving heel pain and keeping symptoms from coming back.

Note: Heel pain that has been going on for a long time often requires a long time to improve. Your doctor will likely recommend several of these conservative treatments and explain that it may take several months of treatment before your symptoms improve.

Surgical Treatment

Most heel pain can be treated without surgery. If your heel paint has not improved after months of conservative treatment, your doctor may recommend surgery.

Surgical solutions target the anatomic source of the heel pain. Learn more about specific surgical treatment for:

Conclusion

Heel pain is a common foot problem. There are multiple causes of pain on the back, side, or bottom of the heel.

Clinical evaluation with a thorough exam is needed to diagnose the root cause of heel pain and to determine an appropriate treatment plan.

A sore heel will usually improve on its own without surgery — if you avoid placing significant impact on the heel and perform exercises to improve the damaged tissue.

The Orthopedic & Sports Medicine Center of Oregon is an award-winning, board-certified orthopedic group located in downtown Portland Oregon. We utilize both surgical and nonsurgical means to treat musculoskeletal trauma, spine diseases, foot and ankle conditions, sports injuries, degenerative diseases, infections, tumors and congenital disorders.

Our mission is to return our patients back to pain-free mobility and full strength as quickly and painlessly as possible using both surgical and non-surgical orthopedic procedures.

Our expert physicians provide leading-edge, comprehensive care in the diagnosis and treatment of orthopedic conditions, including total joint replacement and sports medicine. We apply the latest state-of-the-art techniques in order to return our patients to their active lifestyle.

If you’re looking for compassionate, expert orthopedic and podiatric surgeons in Portland Oregon, contact OSM today.

Phone:

503-224-8399

Address
1515 NW 18th Ave, 3rd Floor
Portland, OR 97209

Hours
Monday–Friday
8:00am – 4:30pm

What is Patellar Subluxation

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Article featured on Nationwide Children’s

Subluxation means partial dislocation of a bone. Kneecap (patellar) subluxation means the kneecap has briefly slid out of its normal place in the groove at the center of the bottom end of the thigh bone.

The Orthopedic & Sports Medicine Center of Oregon is an award-winning, board-certified orthopedic group located in downtown Portland Oregon. We utilize both surgical and nonsurgical means to treat musculoskeletal trauma, spine diseases, foot and ankle conditions, sports injuries, degenerative diseases, infections, tumors and congenital disorders.

Our mission is to return our patients back to pain-free mobility and full strength as quickly and painlessly as possible using both surgical and non-surgical orthopedic procedures.

Our expert physicians provide leading-edge, comprehensive care in the diagnosis and treatment of orthopedic conditions, including total joint replacement and sports medicine. We apply the latest state-of-the-art techniques in order to return our patients to their active lifestyle.

If you’re looking for compassionate, expert orthopedic and podiatric surgeons in Portland Oregon, contact OSM today.

Phone:

503-224-8399

Address
1515 NW 18th Ave, 3rd Floor
Portland, OR 97209

Hours
Monday–Friday
8:00am – 4:30pm

10 Common Kayaking Injuries & How to Avoid Them

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Article featured on Kayak Scout

In any sport or activity, there is a risk of injury, but being forewarned can prevent some of the more common kayaking injuries. While being injured is never a happy experience, it can happen to anyone.

There are all sorts of possible injuries sustained from kayaking, ranging from chronic overuse injuries to minor skin irritations.

Key Takeaways

  • There are different possible injuries you can get from kayaking, ranging from chronic overuse injuries to minor skin irritations.
  • Shoulder, lower back, arm, and leg pain are often caused by overuse, poor technique, or improper posture while paddling.
  • Tendonitis, carpal tunnel syndrome, numbness, and skin irritations are some of the possible soft tissue injuries that can affect kayakers.
  • Swimmer’s ear, hypothermia, and heatstroke are some of the environmental hazards that kayakers should be aware of and protect themselves from.
  • To avoid injuries, start slow, build up gradually, check your safety gear, pay attention to your body signals, and seek professional help if needed.

Top 10 Most Common Kayaking Injuries

These are some of the most common kayaking injuries you’ll see. We’ll go through these, and also take a look at what causes them, as well as how to avoid such injuries in the future.

1. Shoulder Pain After Kayaking

Kayaking uses a lot of the upper body musculature and includes the smaller muscles and tendons that stabilize the shoulders – this makes shoulder injuries of all kinds relatively common. In fact, this sports journal states that around 55 percent of paddlers report some kind of shoulder pain.

Sudden shoulder pain after kayaking is one of the most commonly reported injuries, however, understanding why your shoulder is hurting depends on your experience. The most common scenarios for shoulder pain are as follows:

  • Pain in the muscles (like after exercise) after your first couple of kayaking trips.
  • Joint pain that restricts proper movement and a chronic, almost dull pain.
  • A dislocated shoulder – this will be incredibly painful and uncomfortable.

If you’re experiencing pain in the muscles that feel like you’ve gone to the gym and you’re new to kayaking, this means that your body is adapting to the demands of your recent trips.

Don’t be alarmed by this, even someone in very good shape can still get this kind of muscle pain, but you should get it checked out if it persists longer than a week.

Joint pain that restricts movement or makes movement uncomfortable is usually because of an overuse injury or tendon inflammation. This is usually solved with a combination of therapeutic exercises and anti-inflammatory medication. Rotator cuff injuries can also be another reason for this kind of pain.

A dislocated shoulder usually requires emergency medical attention to reset it into place. You’ll also need to rest up the rotator cuff tendons or you can dislocate your shoulder again very easily. This is one of the more serious injuries and should be attended to immediately.

2. Lower Back Pain After Kayaking

This is another injury that depends on the kayaker, the most common reason for lower back (or lumbar spine region) is due to a combination of muscle imbalance and improper posture.

Sometimes your kayak doesn’t fit you well, and it can force you into positions that put pressure on the spinal discs in the lower back. If you combine this with weaker hamstrings, abdominal, and glutes, you have a recipe for lower back pain.

The other reason for lower back pain is engaging in more intense activities, like whitewater kayaking. This style of kayaking can push you from side to side and if it’s vigorous enough the impacts send a lot of force through your lower back, if the muscles around the spine aren’t strong enough, this can also lead to back pain.

If you have lower back pain, you can seek the aid of a sports physiotherapist, who’ll check you for muscle imbalances and they can also determine if your kayaking sitting posture is harming your back.

There are specific exercises and even yoga programs that can help strengthen the muscles in the back, especially the erector spinae (these are two almost column-like muscles that track either side of your spine).

3. Pain in Arms After Kayaking

Arm pain after kayaking is one of the more common physical ailments that paddlers may have to deal with. This can be due to:

  • Fatigued muscles
  • Irritated joints and ligaments
  • Gripping the paddle too tightly

As mentioned, kayaking makes extensive use of all the muscles in the upper extremities, and the arms get used a lot by any kayaker. However, poor technique can place too much stress on the arms and this then leads to overuse injuries down the line.

There are tons of ligaments and joints across the arms and excessive stress can lead to soft tissue injuries of all kinds. There can be all sorts of reasons that your arms are in pain after kayaking, but the cause is often similar.

In fact, having too tight a grip on a paddle, bat, or club (referred to as “white-knuckling”) is a cause of sports injuries among many athletes. It’s very easy to overdo it when you’re kayaking.

If this is a problem for you then you’re going to have to improve your paddling technique, use the arms less and the bigger, more powerful torso muscles more. You might have to get someone more experienced to show you how to do this.

Improving your technique will naturally place less stress on the arms and cause you to have a good grip (not a death grip) on your paddle.

4. Tendonitis

This is another one of the upper extremity injuries that’s prevalent in many sports but seems to occur regularly in water sports like kayaking.

Wrist, shoulder, and elbow tendonitis are the most likely kayaking injuries, as these joints and the ligaments that surround them are the ones most in use. Usually, tendonitis happens because of repetitive strain and such injuries are usually more common toward the end of a paddling season.

Poor technique can also play a part in chronic injuries, as you place less strain on the muscles and more on delicate soft tissue. Poor technique could be anything from your overall posture in the kayak, to how you paddle.

One sign of tendonitis is stiffness and swelling, and it can lead to lingering and chronic pain if not addressed.

One way to treat tendonitis is through joint rotations – arm circles, ankle rotations, or any exercise that runs a joint through its full range of motion. However, this doesn’t guarantee protection, and if you’re getting symptoms of tendonitis frequently it’s your body’s way of telling you to back off.

5. Wrist, Hand, and Finger Pain

Pain in the lower arms is a common sports injury and can have all sorts of causes, from tendon injuries to potentially trapped nerves. Numbness, tingling, pain, and weakness are often due to carpal tunnel syndrome.

Placing pressure on the median nerve in the wrist can cause carpal tunnel syndrome and improper technique can hurt the tendons that wrap around the wrist – this can cause pain practically anywhere in your hand.

Often, the paddling technique is the culprit here, and if you’re constantly feeling pain throughout the wrist, hands, and fingers then you might need some coaching to improve here, especially if you’re whitewater paddling or engaging in more intense forms of kayaking.

6. Numb Legs

Numbness is usually down to a loss of circulation or pressure on nerves. This is another one of the common injuries reported, and this is because compared to most other items on this list, it’s not the most severe injury, and some choose to just “grin and bear it.”

However, don’t fall into this trap, as simply tolerating numbness can make it worse over time.

So, why do kayakers get numb legs?

It nearly always comes down to seating positions and postures putting pressure on the sciatic nerve – which runs from the low back all the way to the feet. The best way to address numb legs is to stretch out the legs and strengthen the muscles in the core and the hamstrings.

This ensures that the body’s load is balanced and not just pinpointed in one portion of the lower back. A physiotherapist should be able to point out what the best exercises are for you.

7. Skin Irritation

Blisters and skin irritations often occur because of a lack of proper protection in the affected areas. The most common place to find skin irritations is on the hands – usually because your gloves aren’t padded enough.

If you do have any skin irritations then you can apply waterproof plasters over the affected areas, clean any grit, sand, or debris from the paddle, and then, later on, apply some skin cream.

Another major cause of skin irritations is allergens – while this is unlikely there could be something in your equipment that you’re allergic to.

8. Swimmer’s Ear (External Otitis)

Swimmer’s ear can be one of the potential “injuries” suffered by kayakers and can feel like your ear is tender on the outside, and swollen, itchy, and painful on the inside.

External  is an infection caused by your ear becoming host to bacteria and microorganisms present in warmer water, and  is a condition that can affect kayakers who spend time in warmer oceans.

A course of a cream that contains antibiotics will kill off the bacteria in your ear causing the infection in due time.

9. Hypothermia

Hypothermia is a condition where your body is losing heat faster than it can produce it – this causes you to rapidly lose body temperature and can potentially be life-threatening.

Water can get very cold – for example, if you’re whitewater kayaking and you get thrown out of your kayak a few times it’ll be cold but you’re probably not going to freeze to death.

However, if you’re not used to this and you’re being thrown in the water and pushing yourself hard then you should take caution, and watch for signs like uncontrollable shivering, slurred speech, and incoherent behavior.

Hypothermia isn’t exactly a super common injury but it is definitely something to pay attention to if you plan to do any sea kayaking at all.

10. Heat Exhaustion or Heatstroke

This is the final item on this list – while it’s easily avoidable and usually only applies to anyone who is kayaking in the summer or in the warmer states, heatstroke is still a risk factor.

This also applies especially to ocean kayakers for two reasons, there’s no treeline or surrounding terrain to filter or block some of the sunshine, and the ocean reflects the sun’s rays right back to you.

This means that if you’re not careful you can end up with heatstroke – while this one’s high on the injury severity list – it’s the easiest one to avoid, don’t forget your sunscreen.

How to Prevent Common Kayaking Injuries: Some Simple Tips

Now that we’ve covered the most common kayaking injuries, it’s time to learn what you can do to help prevent them. Take a look at the following tips and things to keep in mind to help you avoid the most common kayaking injuries, and stay safe while paddling.

Know Your Limits

A lot of the injuries here are due to overuse and inflammation. The root cause of these injuries is pushing too hard too quickly – if your muscles are tired it means that your technique is also poor.

Athletes spend an enormous amount of time honing their technique and building the stamina to execute their chosen activity as efficiently as possible. However, hobbyists often launch themselves at the deep end and kayaking is no exception.

It’s better to start slow and build up very gradually, the older you are the more this applies to you.

The Orthopedic & Sports Medicine Center of Oregon is an award-winning, board-certified orthopedic group located in downtown Portland Oregon. We utilize both surgical and nonsurgical means to treat musculoskeletal trauma, spine diseases, foot and ankle conditions, sports injuries, degenerative diseases, infections, tumors and congenital disorders.

Our mission is to return our patients back to pain-free mobility and full strength as quickly and painlessly as possible using both surgical and non-surgical orthopedic procedures.

Our expert physicians provide leading-edge, comprehensive care in the diagnosis and treatment of orthopedic conditions, including total joint replacement and sports medicine. We apply the latest state-of-the-art techniques in order to return our patients to their active lifestyle.

If you’re looking for compassionate, expert orthopedic and podiatric surgeons in Portland Oregon, contact OSM today.

Phone:

503-224-8399

Address
1515 NW 18th Ave, 3rd Floor
Portland, OR 97209

Hours
Monday–Friday
8:00am – 4:30pm

What is a Frozen Shoulder?

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The Orthopedic & Sports Medicine Center of Oregon is an award-winning, board-certified orthopedic group located in downtown Portland Oregon. We utilize both surgical and nonsurgical means to treat musculoskeletal trauma, spine diseases, foot and ankle conditions, sports injuries, degenerative diseases, infections, tumors and congenital disorders.

Our mission is to return our patients back to pain-free mobility and full strength as quickly and painlessly as possible using both surgical and non-surgical orthopedic procedures.

Our expert physicians provide leading-edge, comprehensive care in the diagnosis and treatment of orthopedic conditions, including total joint replacement and sports medicine. We apply the latest state-of-the-art techniques in order to return our patients to their active lifestyle.

If you’re looking for compassionate, expert orthopedic and podiatric surgeons in Portland Oregon, contact OSM today.

Phone:

503-224-8399

Address
1515 NW 18th Ave, 3rd Floor
Portland, OR 97209

Hours
Monday–Friday
8:00am – 4:30pm

4 Signs You May Have Nociplastic Pain

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The Orthopedic & Sports Medicine Center of Oregon is an award-winning, board-certified orthopedic group located in downtown Portland Oregon. We utilize both surgical and nonsurgical means to treat musculoskeletal trauma, spine diseases, foot and ankle conditions, sports injuries, degenerative diseases, infections, tumors and congenital disorders.

Our mission is to return our patients back to pain-free mobility and full strength as quickly and painlessly as possible using both surgical and non-surgical orthopedic procedures.

Our expert physicians provide leading-edge, comprehensive care in the diagnosis and treatment of orthopedic conditions, including total joint replacement and sports medicine. We apply the latest state-of-the-art techniques in order to return our patients to their active lifestyle.

If you’re looking for compassionate, expert orthopedic and podiatric surgeons in Portland Oregon, contact OSM today.

Phone:

503-224-8399

Address
1515 NW 18th Ave, 3rd Floor
Portland, OR 97209

Hours
Monday–Friday
8:00am – 4:30pm

Arthrodesis of the Ankle

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The Orthopedic & Sports Medicine Center of Oregon is an award-winning, board-certified orthopedic group located in downtown Portland Oregon. We utilize both surgical and nonsurgical means to treat musculoskeletal trauma, spine diseases, foot and ankle conditions, sports injuries, degenerative diseases, infections, tumors and congenital disorders.

Our mission is to return our patients back to pain-free mobility and full strength as quickly and painlessly as possible using both surgical and non-surgical orthopedic procedures.

Our expert physicians provide leading-edge, comprehensive care in the diagnosis and treatment of orthopedic conditions, including total joint replacement and sports medicine. We apply the latest state-of-the-art techniques in order to return our patients to their active lifestyle.

If you’re looking for compassionate, expert orthopedic and podiatric surgeons in Portland Oregon, contact OSM today.

Phone:

503-224-8399

Address
1515 NW 18th Ave, 3rd Floor
Portland, OR 97209

Hours
Monday–Friday
8:00am – 4:30pm