Dr. Tenforde takes a comprehensive approach to each patient who comes to his clinic. Your initial appointment will include a thorough review of your medical history and examination, with a treatment plan developed to optimize recovery and safe return to sport.
A majority of sports medicine and orthopedic conditions may be managed using non-surgical treatments. The foundation for this form of treatment is to improve the quality of movement through physical therapy. The goals for each patient should be taken into account to provide patient-centered care.
Physical therapy is the first-line in the treatment and management of injuries. Initial goals may include reducing irritation to tissue, joints and muscles followed by restoring range of motion, strength and progression to restoring the full kinetic chain (coordination of movements in adjacent segments such as spine, hip, knee and foot/ankle of the lower extremity).
Medications can be effective for initial strategy to reduce pain that inhibits movement, interferes with sleep, or is distressful. Short course of anti-inflammatory medications can be used to reduce inflammation and pain as long as the patient does not have underlying health issues (such as stomach, kidney, heart or vascular disease). Anti-inflammatory medications can be considered for most conditions except initial management of bone-related injuries or fractures due to concern for delay in bone healing.
Extracorporeal shockwave therapy is a non-invasive treatment that can help stimulate tissue healing and reduce pain. Multiple studies have demonstrated efficacy of treatment. Dr. Tenforde performs this procedure has written a review that is available for free download.
Injection treatments are sometimes considered to help reduce pain, especially if oral or topical medications cannot address pain. Steroids with anesthetics (a class of numbing medications) can be delivered to areas of pain or injury. Ultrasound is a method to visualize tissue, joint, muscles, bone and tendon and can improve injection accuracy. Other forms of injection may also be considered to facilitate healing.
Surgery may be considered to restore structure and function, especially when non-surgical management has been optimized or activity goals of the patient cannot be addressed through non-surgical care.
Specific Classes of Injury
The treatment plan for each patient must account for individual health status and goals of treatment. The general approach to management of injuries is detailed below but may require modifications. Care for patients should be individualized by medical provider.
Bone injuries may occur in two main classes. A traumatic fracture may occur when a high magnitude force is applied to bone and results in injury. In contrast, overuse injuries in athletes and individuals based on activity to bone may result in bone stress injuries (BSI). The class of BSI are the result of failure of bone to withstand forces over time. The injury is described as a continuum of injury, and identifying this injury is important to prevent advancement of bone injury or progression to fracture.
Initial treatment includes activity modification to reduce stress to bone and pain. This may require immobilization such as walking boot or crutches. Pain can be useful to guide patients to avoid activities that cause pain. Tylenol may reduce pain but non-steroidal anti-inflammatory medications (such as ibuprofen or naproxen) should be avoided to reduce delay in bone healing. Calcium and vitamin D intake should meet daily recommended intake values (specific recommendations can be downloaded here). Vitamin D supplementation may be required as dietary intake may not meet demands and sun exposure is not sufficient to meet vitamin D requirements. Other important considerations to bone healing include improving energy intake, adequate protein, carbohydrates, and other nutrients including phosphorus and magnesium.
After initial healing response, the second stage of management is advancing weight bearing and starting physical therapy to improve strength, range of motion, flexibility and underlying mechanics that contributed to injury.
Return to running and activity require progressive loading without pain; pain that returns to bone is a signal that the bone may not have healed completely. Prevention of bone injuries includes addressing biological, biomechanical, and anatomical risk factors for injury. Addressing low energy availability including Relative Energy Deficiency in Sport (RED-S) and Female Athlete Triad along with improved running mechanics can improve bone quality and landing mechanics. Training errors to ensure progressive training and recovery may also reduce risk for future injury.