As a Board Certified orthopedic surgeon specializing in knee, shoulder, and sports medicine, Dr. Cunningham encourages patients to ask questions. See Dr. Cunningham’s Top 10 Questions to Ask Your Orthopedic Doctor and some of his answers to these questions.
Prevention Questions
1. What health habits are recommended for musculoskeletal health?
- Exercise – a base-line of 30 minutes everyday elevates mood and function
- Strength training – strengthen your muscles and bones
- Get outdoors – get sun for a dose of Vitamin D which is necessary for bone health
- Maintain good balance – for fall prevention, safety and confidence
- Sleep – Get good sleep to help your brain and body recover.
- Safety – know risks for injury
- Eat breakfast – boost longevity and prevent over-eating
- Plan meals – stay in control with optimal nutrition
- Hydrate – it supports brain function and all systems
- Minimize stress – slow down, unplug, practice meditation and mindfulness
- No smoking – eliminate the many risks and side effects
- Keep learning – new physical and mental activities
2. How to assess the risk of orthopedic injury?
Begin with a risk assessment examination with your orthopedic doctor. Richard Cunningham, MD, sports medicine specialist and his expert care team guide casual, amateur and elite athletes on injury prevention. The evaluation can range from general wellness and function to discrete performance metrics assessing baseline strength and areas for development. A prevention training program can be designed to reduce risk and increase confidence.
3. Best fitness program to increase protection from injury?
The top fitness program to prevent injury includes all 4 areas:
- Flexibility – movement and breath work using static and dynamic muscle and joint stretching
- Balance – strengthening leg and core muscles to maintain stability
- Strength training – use of resistance for muscle contraction to increase strength and endurance
- Aerobic training – develop cardiovascular efficiency and capacity which is essential for fitness
Working together, these four training essentials increase fitness and injury protection.
4. Training tips to prevent orthopedic injury?
Include these practices in your training program and reduce injury risk:
Warm up – Prep the body for training by increasing heart rate and blood circulation. Low demand aerobics for 5-10 minutes is adequate. End with a short set of specific moves similar to the work-out ahead. The body is warmed up. RIsk is minimized.
Stretch – After the warm-up, muscles are ready for movement. Combine static (10-30 count hold) and dynamic (a range of functional motions) stretches. This preparation readies muscles, joints and tendons, and facilitates flexibility through the full range of motion.
Proper progression – Avoid accelerating demand too hard and fast. Instead increase intensity and amount slowly. Use the metric of a 5% increase once a movement has become too easy. Observe proper form and use of equipment. Listen to the body for aches, pains and signs of overuse.
Cool down – Restore heart rate to its resting level. Low intensity aerobics, like walking in place, followed by stretching, will minimize muscle soreness and prevent injury.
5. Can personal body mechanics be improved?
Awareness of body alignment is the first step toward optimal body mechanics. Correct alignment of the musculoskeletal structure prevents injury. Proper alignment efficiently engages the center of gravity, creating a stable foundation for movement. Bending of the knees, maintaining a straight back, and widening the feet all contribute to an optimum body alignment. For patients with discrete misalignments affecting the knee or shoulder complex, Dr. Cunningham has the expertise to evaluate, diagnose and treat the condition to decrease the risk of injury.
Treatment Questions
6. When to see an orthopedic doctor?
Along with proactive preventative appointments, plan to see your specialist if pain, weakness and decreased range of motion does not improve. Aches and pains are common. Understanding when treatment may improve the condition requires a medical pro. What to notice:
- Is daily activity inhibited? Using stairs, walking the dog, etc., are examples
- Lingering pain lasting 90 days or more
- A loss in range of motion in one or more joints
- Decreased stability when rising and lowering from sitting position
- Increased swelling when standing and walking
- Soft tissue injury event such as a sprain, strain, or stress injury which does not respond to home treatment (RICE: rest, ice, compression and elevation) within 2 days
Please note: In the event of an acute injury affecting muscles, bones, joints, tendons and ligament, orthopedic attention should be sought as soon as possible.
7. How to prepare for an orthopedic appointment?
Come ready for an initial orthopedic appointment.
Items to Bring
- Healthy history, medical record, intake forms
- Notes on prior similar conditions and notes regarding prior surgical treatment.
- List of medications and supplements
- Copies of any recent xrays or MRI’s
Prepare Pertinent Information – Review dates, times and events to describe the onset, duration and symptoms of the condition. Was it a single event or did it occur over time? Is the injury related to an earlier condition or treatment? What is the level of pain; does it fluctuate and what makes it worse? What makes it better? Characterize the pain (throbbing, aching, etc.). Identify the range of pain on the 0 – 10 scale, including how and when it may vary. What home remedies have worked? How have you managed the pain? What are the goals for treatment? What lifestyle and activity level are desired?
8. What diagnostics are used in orthopedic medicine?
Orthopedic care utilizes a range of diagnostic options. These may include:
Physical Exam – The orthopedic specialist begins with a comprehensive physical examination. Depending on the affected area, specific patient moves such as walking and bending, combined with hands-on physician observations and manipulations are utilized. These physical components to the exam help the doctor evaluate reflexes, flexibility, range of motion, and the presence of swelling, redness, bruising, lumps, bumps, or other anomalies.
X-Rays – X-ray, also known as radiograph, is often the first imaging choice. A clear picture of the condition of bones, joints and the space around them, as well as some general soft tissue data is generated. X-ray is a quick, accessible, cost-effective tool. It will also indicate if further diagnostics are needed.
Computed Tomography / CT Scan – A CT Scan provides 3D imaging with detailed cross-sections of the affected area. For orthopedic care, this technology shows fracture patterns much better than an xray. It can also be used to show nondisplaced fractures, or an anomaly such as a tumor. The use of a contrast dye may be used to enhance internal visibility of an area.
Magnetic Resonance Imaging (MRI) – Utilizing magnetism, an MRI study results in high definition images of soft tissues which other tests do not capture. Detailed images of muscles, ligaments, tendons, cartilage and other soft tissue informs an accurate diagnosis.
Ultrasound High-frequency sound waves transmitted through the body can reveal the internal structures. The waves echo off the target area producing an image. It assists orthopedic doctors with assessing damage to tendons and ligaments or with blood flow abnormalities.
9. How is orthopedic treatment determined?
Patient goals are the guiding principle for treatment options. The orthopedic doctor provides the training, experience and expertise, but it is the patient who puts in the hard work. Knowing a patient’s goals, ranging from a pain free return to everyday activities, to getting back to a competitive sport, will inform the course of treatment. The treatment may span from conservative home care to surgery. Determinative factors include:
- Risk – Be informed on possible side effects and complications linked to the treatment. Understand problems and risks that may arise
- Benefits – Know the effect of the treatment. Recognize the range of and limitations to treatment impact.
- Expectations – Understand the expected level of improved range of motion, strength, function and pain reduction.
- Evidence – review the data that supports treatment efficacy and safety for similar patients
- Protocols – Understand patient responsibilities for treatment; from required preparation, compliance, ability to follow-through with short and long term therapies, and partnership with the medical team
Together, the doctor and patient will determine the optimal course of treatment and recovery that meets patient goals.
10. How to optimize recovery?
Follow Instructions – Follow doctor instructions for optimal progress. Attend all appointments. Follow pain management protocols. Begin physical therapy as soon as prescribed, and commit to the plan. Add activity and intensity in consultation with your orthopedic doctor.
Get in Motion – Continue with even the easiest movement while adjusting to recovery. Everything you can do, you should do, while avoiding excess pain. Keeping blood flowing facilitates healing. Use muscles to prevent atrophy.
Rally your helpers – Focus on your recovery by asking others to help with daily activities. Removing meal prep, pet care and housekeeping from a patient’s to-do list will free up time for rest, movement and therapy.
Choose high quality nutrition – Focus on fresh nutrient-rich foods. Choose fresh plant foods of many colors filled with antioxidants and phytonutrients as the body repairs. Be intentional about hydration.
Sun – Vitamin D is important for bone and joint health, metabolic balance and brain function. With sun exposure, our body manufactures Vitamin D. 8 minutes 3 times per day helps recovery.
Sleep – Rest and sleep are essential to healing. Be vigilant with sleep hygiene. Manage sedentary screen time during the day and avoid blue light at night. Maintain a comfortable sleep wake schedule.
Richard Cunningham, MD, is available to answer questions about optimizing orthopedic health and minimizing risk of injury. Contact Dr. Cunningham at the Vail location (970) 476-7220, and at (970) 569-3240 for Frisco.