Flip Flop Running equals Plantar Fasciitis

Are your summer activities causing plantar fasciitis?

It’s sandal season! And while that might make you (and your toes) jump for joy, the rest of your foot might not feel the same. In fact, many people experience pain on the bottom of their heel as warmer weather allows us to trade in shoes and boots for flip flops and bare feet. A condition – called plantar fasciitis – is the most common cause of pain on the bottom of the heel according to the American Academy of Orthopaedic Surgeons (AAOS), which reports approximately 2 million patients are treated for this condition every year.

But why now? The plantar fascia, a ligament that runs along the bottom of your feet, is designed to act as a support mechanism for your foot. Plantar fasciitis is typically caused by too much pressure or repeated strain, and this time of year, a seasonal or lifestyle change could be the cause.

  1. Scrapping supportive shoes in favor of flip flops

Winter boots, tennis shoes and other supportive footwear do a great deal to protect the heel and foot. When you ditch sturdy shoes for a flimsy pair of flip flops (or no shoes at all!) and then hit the street, your feet take notice. Think about a time where a quick trip to the store turned into a full day in flip flops. Repeated days of coming down on hard pavement with very little cushion or support to protect your foot can lead to plantar fasciitis. 

  1. Couch to 5K… or None to Run

These popular workout concepts can kickstart your exercise plan, but “making too big a change too fast is also an invitation for injury,” says Dr. Keith Jacobson, podiatric surgeon at Advanced Orthopedic and Sports Medicine Specialists. True beginners need to build lower body strength and flexibility as they get started to avoid injury, and plantar fasciitis is very common among those who overdo it. In this case, the old saying “walk before you run” is great advice.

  1. Skipping the stretch

Especially if you are a beginner, don’t skip the stretch before or after working out. Tight calf muscles in particular put increased stress on the plantar fascia. Regular stretching improves your mobility and reduces the chance for injury.

  1. Getting your (outdoor) run on

Even if you’ve been hitting the gym year-round, running on a treadmill or cushioned indoor track is more forgiving on your joints and your feet. “A sudden switch to outdoor running often means pounding away the miles on city streets, says Dr. Scott Resig. “Asphalt or concrete is really rough on your feet and joints and can also lead to plantar fasciitis.”

  1. Started barefoot running?

No matter what surface you’re usually on, you’ve probably heard of barefoot running. But is it good for your feet and joints? Can it prevent, or does it cause, plantar fasciitis? The short answer is that more research must be done, and at the very least, it depends on how you started running.

Harvard researchers have extensively studied the mechanics of running and humans’ history as runners and found – among many other things – that most people who grew up and are accustomed to running barefoot strike the ground with the forefoot or midfoot first, rather than heel first, which is how most shod runners (aka most average Americans) strike the ground. But heel striking is not necessarily bad, and many shoe-wearing runners do it without discomfort or injury. Researchers even emphasize that “no study has shown that heel striking contributes more to injury than forefoot striking,” even though it is generally viewed as a higher-impact stride.

Does that mean you should lose the shoes and start barefoot running? Again, it depends, but know that merely removing your shoes does not immediately change your running gait and it’s wise to pursue any major adjustment with caution.

“If you already have heel pain or suspect plantar fasciitis, see an podiatric specialist before making any changes, and consider give yourself a break from running entirely while you determine the cause of your pain,” says Dr. Alan Ng, podiatric surgeon and foot and ankle specialist at Advanced Orthopedic and Sports Medicine Specialists. If you’re healthy and want to explore barefoot running, consider using a different shoe once per week, or start with a neutral or a minimalist shoe, which are lightweight and have a flat sole (vs the standard heel rise) but provide more protection and support than no shoes at all.

Listen to your body, get a professional diagnosis, implement treatment

If your heels are hurting and you’ve recently changed your activities (or your footwear), you might be suffering from plantar fasciitis and it’s time to see an orthopedic specialist. He or she will examine your foot, look for areas of tenderness at and in front of the heel bone.

Conservative treatment for plantar fasciitis helps 90 percent or more of those suffering and includes rest, ice, NSAIDs, cortisone shots and movement – including stretching and physical therapy. In more extreme cases, and only after failure of non-surgical treatment, surgical solutions may be recommended. 

Need more information or an appointment? Get in touch!

Best Foot Surgeons

Keith Jacobson, DPM

Dr. Keith Jacobson


Alan Ng, DPM

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Scott Resig, MD

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knee replacement

5 Signs You May Be Ready for Total Knee Replacement Surgery

“You’ll know when the time is right.” That’s what some doctors tell patients with persistent knee pain, when they ask whether they should have total knee replacement (TKR) surgery.

Of course, it’s not always that easy to tell. Yes, you may have arthritis and may suffer from joint pain when you bend your knee, but you may not think it’s serious enough to consider surgery.

There may be advantages to waiting – total knee replacement is a major surgery with possible complications, you’ll need time off from work and physical therapy to recover, and there are less involved measures that may offer some relief. But there may also be advantages to acting sooner — you may enjoy better results if the joint hasn’t deteriorated too much, you may not be a good candidate for surgery if you wait until you’re older and in poorer health, and you may want to get back as soon as possible to an active lifestyle.

Women, especially, tend to delay the decision to undergo total knee replacement reportedly because they have a higher tolerance for pain and inconvenience than men. In a study that compared men and women who were about to undergo knee surgery, females’ knees were in far worse shape than the mens’, even after controlling for other factors.

“Women are far more likely to suffer from knee pain due to osteoarthritis than men,” says Dr. Harold Hunt, Advanced Orthopedic surgeon and total knee replacement specialist. “And while studies like this show that they’re also more likely to tolerate pain and periods of low mobility before finally deciding on surgery, we don’t like to see anyone prolonging their discomfort for an extended period of time.”

Dr. Hunt and his total joint colleagues recommend you consider these five signals that you may be ready for a total knee replacement.

1. The pain is impairing your ability to function. If your osteoarthritis is advanced enough, it will have worn away some or all of the cartilage that protects your bones from rubbing against each other at the knee. You’ll be able to see that bone-on-bone contact in x-rays. You may even see the problem with the naked eye, as severe deterioration can sometimes deform your leg and make it bow.

As a result of the friction and pressure from loss of the cartilage cushion, it may hurt to perform everyday actions like walking, sitting, and climbing stairs. If your knee pain results in lost sleep, missed work, or stiffness and pain in your other leg from overcompensating, it may be time to consider TKR.

2. You’ve exhausted other options. While TKR is an increasingly common procedure, it’s still a major surgery. And even if the operation goes smoothly, you will still have a visible scar (though this will diminish with time), and you’ll need several weeks of physical therapy to recover most of the function in your knee.

There are other, less invasive ways for osteoarthritis patients to combat knee pain, although they may offer only temporary relief. Some patients treat their symptoms effectively with over-the-counter pain relievers such as aspirin, acetaminophen, ibuprofen, and naproxen. Physical therapy can help, and so can weight loss which reduces pressure on the knee. An injection of cortisone (to reduce inflammation) or synthetic fluid (to replace natural lubricant lost to osteoarthritis) can relieve knee pain for up to six months. You may also get the support you need from a knee brace. There are also less invasive surgeries – arthroscopic surgery to remove torn cartilage fragments, partial joint replacement surgeries, or partial bone reconstruction procedures like MAKOplasty – for patients with less advanced forms of arthritis.

Your doctor may suggest you try some or all of these therapies before you move on to a total knee replacement. But if you have tried them and they’ve stopped being effective, it may be time to go ahead with a total knee replacement.

3. You are the right patient for the surgery. The best outcomes after total knee replacement surgery occur in patients whose knees look the most arthritic on x-ray. A patient with bone-on-bone arthritis on x-ray should expect dramatic improvement in pain and function. To the same effect, a patient without much joint space loss on x-ray may want to consider more aggressive nonsurgical treatment options prior to knee replacement surgery. Age is also an important variable to consider. Most knee replacement surgeries occur in patients aged between 50 and 80, but there are individual situations where having the procedure at a younger or older age is appropriate. However, it is not always “the sooner, the better” when discussing timing of knee replacement surgery. Why? “A knee implant – which may be made of titanium, plastic, ceramic, or a combination of these – can last up to 20 years, so if you get one when you’re younger, you may need a revision later in life,”says Presley Swann, a revision specialist.

4. You’re physically prepared. The surgery is most effective and least risky for patients who are in decent physical This relates to patients who are not only non-diabetic or not prone to heart disease, but also those who keep fit through proper diet and exercise. Fortunately, you can prepare in the months leading up to surgery by improving your diet, losing weight, and especially building up your quadriceps. “Having stronger thigh muscles makes the recovery process easier because your quadriceps play such an important role in stabilizing the knee area,” says Dr. Jared Michalson, a fellowship-training total joint specialists at Advanced Orthopedic. So work those quads!

Being prepared also means having the proper equipment for your rehabilitation. As you recuperate, you may need a walker on every floor of your house. You may also need an ice-pack or cold therapy machine of the sort you can attach to your leg and wear for 20 minutes at a time to reduce pain and swelling in your knee. Aside from equipment, you’ll probably need the assistance of other people for a few weeks to drive you around or to perform strenuous tasks.

5. You’re mentally prepared. Many patients find the prospect of total knee replacement daunting since they know that recuperation can be painful and challenging. Therefore, it’s important for patients considering a total knee replacement to be in the right frame of mind.

First, you have to be committed to having the best outcome. That means being ready to be compliant, to do whatever the physical therapist instructs you to do, and to exercise as directed between your therapy sessions. After all, you will probably be seeing a physical therapist twice a week for about two months to increase the strength and flexibility of your new knee.

For the most effective rehabilitation, you need to commit to do the work every day, which means you shouldn’t expect to be able to go back to your job or your favorite sports for up to several weeks or longer. Even after the initial therapy, you may need up to a year of milder exercise before your implant feels normal.

Second, you should have realistic expectations. Your knee will probably never have the full functionality – the complete range of motion or freedom from pain – that you enjoyed before it became arthritic. For example, many total knee replacement patients report feeling pain when they kneel on hard surfaces.

Other than that, however, patients tend to feel vast improvements almost immediately. “Depending on the specifics of your surgery, you may be in the hospital for a couple days but your doctor and therapist will likely have you walking and climbing stairs before you go home,” says Dr. Scott Resig. And once you’re rehabilitated, you’ll typically be able to walk as much as you like and to engage in low-impact sports, such as hiking, biking, golfing, swimming, or ballroom dancing.

That’s another reason why it’s important for patients to be fit before undergoing total knee replacement surgery. If you didn’t get around much before knee pain, a new knee won’t have you running marathons. But you should be able to enjoy an active lifestyle again. Indeed, many patients, after waiting some time before deciding to have the surgery, wonder why they didn’t have it done sooner.

Do you think you may be ready for total knee replacement? Schedule an appointment with one of our knee specialists to discuss the best treatment options for your arthritis pain.

Best Knee Replacement Surgeons

dr harold hunt denver co

Dr. Harold Hunt


Jared Michalson, MD

Dr. Jared Michalson


H. Andrew Motz, MD

Dr. H. Andrew Motz


John Papilion, MD

Dr. John Papilion


Scott Resig, MD

Dr. Scott Resig


R. Presley Swann, MD

Dr. R. Presley Swann


spinal fusion for back pain

Can Spinal Fusion For Back Pain Help You Play Golf Like Tiger Woods?

Understanding the Back Pain Treatment that Propelled the Pro Golfer to a Masters Win

For his recent victory at the 2019 Masters Tournament, which many sports commentators are calling one of the greatest career comebacks of all time, Tiger Woods owes a lot of credit. First, of course, to his own tenacity, discipline, and skill. But the 43-year-old golf legend also owes a debt of thanks to the spinal fusion surgery he underwent two years ago.

Woods, who hadn’t won a major tournament in 11 years, notoriously suffered from debilitating back pain throughout the past decade, pain apparently caused by a slipped or ruptured disc in his lower spine. Three earlier surgeries failed to correct the problem, or at least to ease his pain enough for him to resume training for major tournament play. Finally, in April 2017, he underwent anterior lumbar interbody fusion, commonly known as ALIF or spinal fusion.

For half a century, ALIF has been a widely accepted treatment to replace the disc that joins the lowest of the five lumbar vertebrae to the highest of the sacral vertebrae – what doctors call the L5/S1 region. It’s an area in the lower back where sports injuries are common, especially from the torque a vigorous golf swing inflicts on the spine.

Doctors typically cite spinal fusion to treat L5/S1 pain only after other treatment options have been exhausted, but at least it’s a surgery that offers little disruption of tissue, a fairly short recovery time, and a strong likelihood of returning to a normal, active lifestyle. It clearly helped Woods get his swing back. But is it right for you?

Other back pain treatment options

Spinal surgeons often consider ALIF a last resort. There are other, non-surgical and conservative measures for those suffering back pain due to a damaged L5/S1 disc. Spinal fusion is often reserved for patients with a deformity or lack of stability due to disk degeneration, trauma or infection, and according to Dr. Michael Shen, a Denver surgeon who specializes in neck, mid-and lower back treatment, it may be used for patients with a diagnosis similar to Wood’s, but only after other options are explored.

Many L5/S1 patients can also decrease their pain and improve mobility through physical therapy. A regimen of simple exercises – just a few minutes a day spent doing knee-to-chest stretches, pelvic tilts, leg lifts, and wall squats — can help herniated disc patients strengthen their lower spines.

“I work with each patient to exhaust non-surgical solutions to their spine pain before we explore any kind of surgical solution.” says Dr. Shen. “These options include physical activity and exercise therapy, pain management through medication, and microdiscectomy.”

Woods had two of those (microdiscectomies), which removed disc fragments that were pinching his nerves. Eventually, however, he and his doctors felt it necessary to remove and replace the entire L5/S1 disc, via ALIF.

What happens during spinal fusion surgery?

ALIF is a more aggressive treatment, but it may be the right choice if you’ve already had other spinal surgeries, or if you surgeon wants easier access to the L5/S1 area. While spinal fusion does weld two of the patient’s vertebrae together, it does so on the theory that removing the damaged disc will remove the source of the pain, and that diminished pain allows for increased mobility.

One advantage to ALIF is that it’s a minimally invasive procedure. For one thing, as the “anterior” in the name suggests, the surgeon approaches the spine from the front of the body. He or she goes through the abdomen, through an incision only three inches long, and is able to reach the spine by pushing aside muscles, organs, and blood vessels, rather than having to cut through them. A vascular surgeon may assist your orthopedic surgeon in gaining safe access to the spine.

The orthopedic surgeon first removes the herniated disc, then fuses the lumbar and sacral vertebrae together with an artificial disc made of titanium or high-grade medical plastic. This piece is called a spacer or an interbody cage. Sometimes the doctor will bolt this cage into place, but what really makes the two bones grow into one is a core of bone graft matter inside the cage, which fools the vertebrae into fusing together over the next several weeks, like a broken bone healing. The surgery itself takes only two to three hours.

Because the ALIF procedure is not very invasive, recovery is fairly quick. In fact, the patient is encouraged to stand up and walk the same day and is usually discharged from the hospital by the end of the third day. Full recovery can take several weeks and may include basic walking exercises, but no bending, heavy lifting, or back-twisting.

Can ALIF help you play golf like Tiger Woods?

Um, no. In fact, it’s remarkable that it even helped Tiger Woods play like Tiger Woods. Doctors have marveled that ALIF didn’t just ease Woods’s back pain but also allowed him to play major tournament golf for four straight days. As Northwestern University orthopedics professor Wellington Hsu recently told the Washington Post, even pro football, basketball, and hockey players are more likely to return to professional, competitive play after ALIF than golfers are.

Even for an athlete as extraordinary as Woods, with incredible stamina and drive, the prospect of playing major tournament golf again after spinal fusion was slim to none. Nevertheless, Woods returned to training within 10 months of his ALIF surgery, and nearly two years to the day after the operation, he won the Masters.

If you’re not a pro golfer, though, spinal fusion is much more likely to help you return to a normal, active lifestyle. Indeed, the surgery is so routine, and its success rate so high, that it’s considered the control against which researchers measure more experimental treatments.

Is ALIF the right option for treating your lower back pain? Schedule an appointment with one of our orthopedic spinal specialists to discuss the best solutions for you.

Best Spine & Pain Doctors

Christopher D'Ambrosia, MD

Dr. Christopher D’Ambrosia


Michael Shen, MD

Dr. Michael Shen


elbow pain

How do you treat elbow pain?

Elbow pain can result from repetition or overuse of your arm during your favorite activity or the result of a new fitness routine that has you challenging your body in new ways. Being active is important, so whether elbow pain is a result of chronic overuse or new use, it’s time to figure out the reason behind that persistent pain.

Identifying potential causes of elbow pain

The key to properly treating elbow pain is to understand the cause. Aside from an obvious fall or other trauma to the elbow, there are many more subtle causes of elbow pain and injury. Whenever you change your activity level or take on a repetitive task, you can expect to be sore. But it’s important to understand the difference between temporary muscle aches and something more serious. Here are three of the most common symptoms and how to treat elbow pain.

Severe swelling or redness at the back of the elbow may be bursitis. Healthy tissue lies flat against your bone, but an aggravated bursa sac presents as visible inflammation of the cushion between bones in the elbow. Initial treatment often
includes rest, ice, and anti-inflammatories to reduce swelling.

Rest and immobilizing the area are important because continued movement and pressure on the inflamed bursa will not allow it to calm down and heal. People who have recurring bursitis can also consider drainage of the bursa or in some rare cases, surgical removal of the bursa if persistent. 

Continuous pain on the inside or outside of the elbow along with forearm soreness could be (inside) golfer’s elbow or (outside) tennis elbow. This pain is often more severe when people rotate their arm or hold on to things. Among the most common elbow injuries, they’re not reserved for tennis players or golfers. Repetitive motion of many types such as typing or repetitive lifting can be the cause.

As with many injuries, the same initial conservative treatments are often recommended: rest, ice, and NSAIDs can help with pain and reduce swelling. Some patients also participate in physical therapy or receive steroid injections. The most severe cases may require surgery. If you have a muscle or tendon tear or other serious damage, continued activity could make it worse, so see your orthopedic specialist for a diagnosis soon.

Numbness or tingling in the elbow, arm or finger may be different than pain, but is disruptive nonetheless. Pinching of the median nerve at the wrist, known as carpal tunnel syndrome, is one common cause of numbness in the thumb, index and long fingers. Pinching of the ulnar nerve (cubital tunnel syndrome), which wraps around the elbow, can also causes numbness or tingling but typically on the remaining fingers.

Work activities or exercise that put pressure on the elbow, or those that require the elbow to remain bent for extended periods can aggravate or pinch the ulnar nerve. This nerve is the least protected of the nerves in the elbow, which makes it more vulnerable to compression.

Keeping your elbow straight and avoiding long periods of bending is the first course of action you can take if you’ve been diagnosed with cubital tunnel syndrome. Many people benefit from a brace or splint that keeps them from bending their elbows while sleeping. Physical therapy can reduce stiffness and there are several surgical options if your nerve compression is severe or muscle damage has occurred.

While symptoms can vary widely, any chronic elbow pain, numbness or swelling means it’s time to see a doctor. He or she can provide a proper diagnosis and help you treat elbow pain. Your orthopedic upper extremity specialist can also help you find ways to remain active while still allowing your elbow to rest and heal.

For more information on elbow pain and elbow treatments, visit with one of our specialists:

Best Elbow Surgeons

A. Todd Alijani, MD

Dr. A. Todd Alijani


Wayne Gersoff, MD

Dr. Wayne Gersoff


Davis Hurley, MD

Dr. Davis Hurley


Cary Motz, MD

Dr. Cary Motz


H. Andrew Motz, MD

Dr. H. Andrew Motz


John Papilion, MD

Dr. John Papilion


Dr. Micah Worrell

Dr. Micah Worrell


Hurt Knee Skiing

Hurt my knee skiing

Avid Colorado skiers know that it’s been a good year so far, with snow levels pacing well ahead of last year. This is great news for locals who want to get in as many days as possible, but bad news if you hurt your knee skiing all that great powder. When people overdo it or get into terrain that is beyond their ability, knee injuries are common. If you hurt your knee skiing, there are several things you should know to minimize further damage and recover more quickly.

I hurt my knee skiing. Do I need to go to urgent care?

Thankfully, most knee injuries are do not require an expensive trip to the ER or urgent care and treatment can start at home as long as you see an orthopedist relatively quickly following your injury. Read on to learn about three of the most common skiing knee injuries, and how to prevent and treat them.

A) Knee Sprains – Knee sprains account for about 30 percent of all skiing injuries and are becoming more common than ever. Strains occur when one or more ligaments is stretched or torn. Skiing can naturally create circumstances where your knee is twisted or forced out of its normal position. If you have pain or swelling but still have range of motion and stability, you may have a knee sprain.

Sprains require RICE: Rest, Ice, Compression and Elevation, and then a trip to your orthopedic specialist. Your doctor will evaluate your knee to confirm it is indeed a sprain and recommend the right treatment to maximize the healing process. But be careful not to ice too long and avoid putting ice directly on your skin. A good rule of thumb is twenty minutes on, forty minutes off. Too much ice can cause nerve damage and frost bite.

B) Torn MCL – More severe than a sprain, a medial collateral ligament (MCL) tear is actually the most common skiing knee injury. The reason for this is twofold: first, beginner and intermediate skiers far outnumber advanced skiers and MCL tears are most likely to occur in less-skilled skiers. Second, the MCL becomes strained or torn when the knees are turned in, which is common when you go into a snowplow (or “pizza”) position.

The symptoms of an MCL tear are often similar to that of a sprain, so it’s important to see an orthopedic expert to ensure you are correctly diagnosed. Some MCL patients also experience a catching or locking feeling or recognize marked instability as well.

If you do manage to tear your MCL, the good news is that most MCL tears can often be treated without surgery. Treatment typically includes the RICE formula, physical therapy to maintain range of motion and build strength, plus the use of a protective brace as you get back into physical activity.

C) A torn Anterior Cruciate Ligament (ACL) is also one of the most common skiing knee injuries. ACL tears are usually considered more severe because they frequently occur in conjunction with damage to another part of the knee. An ACL tear is often caused by a sudden stop or change in direction (think crowds on the slopes, moguls, catching an edge, or navigating an unexpected turn).

While treatment often involves surgery, today’s technology is much less invasive than it was years ago, so you don’t have to worry about a giant “zipper” scar up the front of your knee and most patients begin physical therapy days after surgery. A good orthopedic surgeon can help patients get back to being active quickly with minimally invasive techniques and a comprehensive rehabilitation plan.

A fresh powder day is certainly tempting, but you don’t want it to be your last of the season! You can minimize your chances of these common skiing knee injuries by remembering a few key points:

  • Always ski within your ability and ensure that you keep yourself balanced as you go downhill. Keeping your weight forward (but not too far forward) with your hips and knees bent will help you maintain a balanced position. Leaning back forces your feet forward in your boots (ouch) and ensures you’ll be on your rear end more often than you’d like.
  • Take a break when you need to. It’s easy to get overly excited when there’s such great snow but remember if this is your first time up for the season (or the decade), take it slow! Skiing is a workout, and if you haven’t been doing many (or any) leg exercises, even a few runs can take their toll quickly. Don’t overdo it.
  • Get in ski shape. If you have time to start conditioning before you go, do it! Even just a few weeks of leg and core exercises will make a difference and help minimize your chance of common skiing knee injuries.

Even with all these precautions, accidents do happen, and knee injuries are quite common. If you are reading this because you think you may have injured your knee – we can help!

You know your body best, so never avoid emergency treatment if you think you need it. The good news is that many people are able to apply ice, elevate the knee, and use crutches to get around until their appointment. We can usually see you within 24 hours. Schedule an appointment today with one of our orthopedic knee specialists to get back on your feet and back on the slopes!

Dr. Roger Greenberg Retirement

Inspiration from the Desert: How Dr. Roger Greenberg Lives a BeActive Lifestyle in retirement

Dr. Roger Greenberg retired from Advanced Ortho at the end of 2016, but that doesn’t mean that his schedule is any less active. After spending more than 38 years helping hundreds of patients be more active, he and wife Diane lead an incredibly active life splitting their time between Denver and California’s Coachella Valley desert.

The couple’s schedule routinely starts at 6 am with a walk for Corzo and Skosh, their two Portugese water dogs, the family’s fourth and fifth of this breed over the years.

Twice a week they head to Pilates and other days they go to the gym to work out. And then there’s the golf. As a longtime golfer, Dr. Greenberg is a committed student of the game who practices or plays 4-5 days a week. As if 18 holes on a regular basis weren’t enough, he and Diane ride their bikes – eight miles round trip – to the course at least a couple of day per week as well.

All this happens on top of the couple’s active role in their community and Dr. Greenberg’s part time work reviewing orthopedic diagnoses for the social security administration. (Did we mention they’re “retired”?)

In addition to its warm climate, the Coachella Valley is known for its lively music and arts community and a remarkable desert ecosystem – all of which the couple celebrate and advocate for.

The Greenbergs are “Friends of the Desert Mountains” a local organization whose mission is to preserve land, support education, conservation and research in the Coachella Valley. “We’ve really enjoyed gaining an understanding of plant and animal life in the desert,” said Dr. Greenberg.

The couple has also participated in several University of California Riverside lectures on wildlife, including a recent series about big horn sheep migration patterns, some of which they’ve personally witnessed as the sheep have appeared on the fairway during more than one golf outing. “We had to work a bit harder to see scorpions,” says Greenberg, referring to a recent moonlit hike they took at the base of the Santa Rosa Mountains. “Scorpions naturally have a blue-green glow when exposed to UV or black light, and we were able to observe them at night using black lights.”

The Greenbergs often attend and host guests for the areas’ three major art festivals and the Coachella Valley Music Festival, the latter of which they attend with one of their two daughters, who works in the music industry.

While Dr. Greenberg loves his active life in California, he also misses the camaraderie of the Advanced Orthopedic group and seeing long-time patients. “I love staying in touch with the team and the practice,” he says. “And they’ve been very inclusive, keeping me up-to-date with the growth of the practice and what’s going on in their lives.”

And the feeling is mutual. The team in Denver never ceases to be impressed by the Greenberg’s latest adventures and activities – a family that truly lives the BeActive life. We’re inspired and hope you are too! Whether you balance work and play to find time to be active, or are busy in retirement like the Greenbergs, make sure physical activity is key part of your schedule. Have a great story about how you stay active? Get in touch.

runner’s knee pain

Did summer running season wear you down? How to cope with runner’s knee pain.

What is Runner’s Knee Pain?

Runner’s knee pain can encompass a wide range of aching pain around the kneecap that impacts runners and non-runners alike. Runner’s knee, also known as patellofemoral pain syndrome, often presents as discomfort that is experienced when bending down, walking downhill or descending stairs.

The pain from runner’s knee may be an indication of bone misalignment or a muscular deficiency; however, it is frequently the result of repetitive movements, high-impact training or blows to the knee. Common symptoms of runner’s knee include swelling around the kneecap and a corresponding clicking, popping or grinding sensation that occurs during movement.

Recovering from Runner’s Knee

Given the connection between runner’s knee pain and overuse or repetitive motion, “RICE” (Rest, Ice, Compression, Elevation) is typically the first line treatment. Wrapping the knee for support coupled with the use of NSAIDs like Advil are effective to aid short-term relief of pain or inflammation. In all scenarios, activity should be limited until the condition subsides.

How long it takes for the pain to subside varies by body type and degree of injury. It’s important to not rush back into your running shoes before you are fully healed. Signs of recovery include the ability to fully extend and bend the knee without pain and being able to successfully walk, run or jump without a pain sensation. Your injured knee should be able to demonstrate that it feels and performs like your non-injured knee.

Whatever you do, don’t rush the run. If you try to get back to impact workouts before you’re healed, you could damage the joint for good. Instead, try mixing up your routine with swimming or yoga – just stick to movements that don’t put force or repeated range of motion on the knee.

And when you do ease back into your running routine, be mindful of power movements or actions that require significant range of motion such as lunges.

If you’ve tried the RICE regimen and your pain persists, seek an orthopedic evaluation to ensure things don’t get worse. Your orthopedic specialist will assess your condition to determine if you need medical care such as physical therapy as it can be a successful aid to recovery.

Preventing Runner’s Knee

No one likes being on the sidelines, and there are preventative measures that you can take to reduce your chances of experiencing runner’s knee. Effective prevention tools include the right equipment, the right preparation and the right routine.

Your feet power your stride and overall mobility. Treat them with the care they deserve. Proper fitting shoes with strong support provide a vital foundation for your body whether on the road, the trail or even in the grocery store. Too often, however, we choose fashion over function or ignore the signs of wear and tear.

After a season of running in the Colorado sun, watch for uneven shoe wear. Worn soles can place significant strain on your legs and joints that lead to conditions such as runner’s knee. Don’t wait until Christmas to replace those worn treads; the gift of proper support is a year-round treat all feet should enjoy.

Depending on your pain and level of activity, you may also want to consider orthotics which help address many conditions by providing support for those with high arches or redistributing the energy caused by your foot’s natural pronation.

Once you have the right equipment, the right preparation powers peak performance. Maintaining a healthy weight to help minimize the strain on your body can be a challenging cycle for many but excess body weight has a direct impact on joint performance.

All bodies benefit from a regimen of proper warm up and stretching. Help your joints perform better by fostering flexibility and an adequate warm up prior to putting yourself through the paces.

Strength training builds muscle stability and is also an effective course of preventative action. In addition to the benefits of cross-training, muscle development reduces the strain on your body’s joints and bones.

A well-rounded approach to preparation and full-body training offers maximum protection from overuse conditions. It doesn’t mean that you must be any less intense of a runner. Cross training options can actually help you become a stronger runner while leaving some signs of overuse – such as runner’s knee – behind.

Feeling pain today? Schedule an appointment with one of our orthopedic knee specialists to find the right solution for you.

Best Knee Surgeons


Dr. Mark Failinger


James Ferrari, MD

Dr. James Ferrari


Wayne Gersoff, MD

Dr. Wayne Gersoff


dr harold hunt denver co

Dr. Harold Hunt


Jared Michalson, MD

Dr. Jared Michalson


Cary Motz, MD

Dr. Cary Motz


H. Andrew Motz, MD

Dr. H. Andrew Motz



Dr. Justin Newman


John Papilion, MD

Dr. John Papilion


Scott Resig, MD

Dr. Scott Resig


R. Presley Swann, MD

Dr. R. Presley Swann


numbness in hands

What to do if you experience numbness in hands or numbness in fingers.

Numbness in hands or fingers is a symptom that can be serious and should not be ignored. As with all health emergencies, call 911 or get emergency medical help if hand or finger numbness starts suddenly – especially if it occurs with weakness or inability to move, dizziness, or a sudden, severe headache.

Aside from emergencies, while numbness in your fingers or hands could be caused by several factors – including conditions like diabetes and various auto-immune diseases – it is frequently caused by some kind of nerve compression in your arm or wrist. A visit to your orthopedic hand and upper extremity specialist can evaluate for nerve-related causes, such as carpal tunnel syndrome and/or cubital tunnel syndrome.

What is cubital tunnel syndrome and how does it cause numbness in hands?

The ulnar nerve is one of three major nerves in your arm, and runs from the outside edge of your hand all the way up to your neck. Compression of this nerve occurs most frequently on the inside of the elbow, causing tingling and numbness in hands and fingers – specifically the pinkie and ring fingers. Your orthopedic hand specialist will work with you to relieve the symptoms using conservative treatments such as using a brace or adjusting the frequency and nature of daily activities. If these changes do not help, or if you have significant nerve or muscle damage, you may need to look at surgery.

Numbness in hands and fingers: How is carpal tunnel syndrome different?

While carpal tunnel may also present with numbness in hands or tingling in fingers, carpal tunnel typically causes pain in the thumb, index and middle fingers. Carpal tunnel is caused by compression of the median nerve, which runs down the length of the arm but passes through the carpal tunnel at the wrist, before going into the hand.

Without treatment, carpal tunnel syndrome generally gets worse over time. Early diagnosis is often the difference between non-surgical treatment to alleviate the compression and surgical options to avoid permanent damage to the nerve.

Pain and numbness in hands, fingers and thumbs from carpal tunnel can be influenced by a variety of factors including gender, genetics, age, occupation and activity level. Older people and females are more susceptible to carpal tunnel, and a small or “tight” amount of space in the wrist anatomy may be a hereditary factor. Prolonged or repetitive motions can lead to carpal tunnel. Medical conditions that range from pregnancy to thyroid imbalances, diabetes, and rheumatoid arthritis can also increase the occurrence of the syndrome.

If wrist pain or numbness in hands occurs at night, inadvertently sleeping with bent wrists (which is common) may aggravate carpal tunnel.

Although some patients experience relief by shaking their hands in an attempt to improve the numbness, the relief is fleeting. What’s worse, given the frequency that these conditions present gradually or come and go, it’s easy to ignore their signs. That can be a mistake, however, because early diagnosis can allow for the use of non-invasive solutions such as splinting and bracing as well as NSAIDS, or forgoing certain activities that aggravate the symptoms. Delayed diagnosis and treatment, on the other hand, can lead to permanent or irreversible nerve damage.

See a specialist to get the right diagnosis

If you have numbness in hands or numbness in fingers, see your orthopedic hand specialist for a proper evaluation, diagnosis and treatment. Your orthopedic hand surgeon will carefully examine, bend, flex, and test your wrists and arms. Strength assessments identify muscle weakness or atrophy and tapping along the corresponding nerve reveals sensitivity and numbness correlation. In addition to physical tests, nerve conduction studies can provide clear indication of nerve impingement.

Don’t ignore your symptoms – numbness in hands or fingers requires attention. Early diagnosis of hand and finger numbness can offer many non-surgical treatment and positive outcomes. Knowing what to look for makes a world of difference.

Best Hand Surgeons

A. Todd Alijani, MD

Dr. A. Todd Alijani


Davis Hurley, MD

Dr. Davis Hurley


Dr. Micah Worrell

Dr. Micah Worrell


Dr. Ng Success Story

Success Story: How endurance athlete Ryan Law got back on the race course after surgery with Dr. Ng

Ryan Law loves to run. So much, that in the past seven years, he’s run 11 marathons and seven ultra-marathons/endurance events (3X50 milers, 4X55k+, and Half Ironman – this guy knows how to #BeActive – we are talking serious distance here people!). But for years, he had been fighting through a chronic injury that was painful and performance-depleting.

After extensive online research to better understand the risks and potential upside of having surgery, in October, 2017 Ryan chose Dr. Alan Ng to perform surgery on his inflamed peroneal tendon. Due to an osteochondroma – a growth that forms on the surface of a bone near the growth plate – the tendon was inflamed and causing chronic pain.

Dr. Ng removed the osteochondroma and some damaged tendon tissue, carved out the channel along the ankle bone, and reattached the peroneal tendon. Shortly after surgery, Ryan began the road to recovery, working toward running and then up to more mileage over time.

“I started running again in March – about five months post-surgery – and I was able to return to my previously established 35 to 50 mile-a-week average by late May,” Ryan recalls. “My performance was not hindered by the surgery and if anything, it improved.”

Just this summer, in July, Ryan competed in the Copper Mountain Under Armor Mountain Running Series, less than a year after his surgery. And he’s still improving. This coming October will be a full year since the surgery and all signs point toward significant overall improvement. Ryan has every reason to be optimistic: “I suspect full recovery has not happened yet,” he said. “As I have yet to hit a full year and all my symptoms have improved since the surgery which is very reassuring.”

Dr. Alan Ng specializes in foot and ankle reconstructive surgery and trauma, and loves to help his patients getting back to the activities they love. And when he’s not helping patients he loves being active too – playing golf, skiing and mastering the martial arts of karate and Muay Thai kickboxing. Learn more https://advancedortho.org/alan-ng-dpm/

Hip pain

What is causing my hip pain? A look at top causes and how to treat them.

As the largest, and one of the strongest joints in the body, your hips can put up with a lot of repetitive motion and wear. Cartilage cushions the ball-and-socket to allow for smooth rotation as you walk, run and move.To keep your hip moving smoothly, a complex network of bones, cartilage, muscles, ligaments, and tendons must all work in harmony.

But as with all joints, the hip cannot withstand endless overuse,and the muscles, tendons and cartilage can wear down over time, or sustain damage from injury or disease. If you have hip pain, the first step is to understand what is causing it. There are numerous possibilities, depending on your medical and activity history. Seeing an orthopedic specialist is the best way to diagnose a hip injury, but understanding the most common causes of hip pain can be helpful.

Tendinitis

Tendinitis is inflammation or irritation of a tendonand canaffect tendons connected tothe muscles that control hip motion. The hip flexor, as the name implies, allows your hip to flex and rotate. It’s made up of two muscles known as the iliopsoas, which attach by a tendon to the upper thigh. The iliopsoasis called upon to help you walk and run, andalso to help other weaker muscles that aren’t pulling their weight leaving it susceptible to overuse and tightness. Translation – if you have weak gluteal or core muscles, your iliopsoas are probably doing more than their share and can becomeswollen and tender when put under repeated stress. This can certainly cause lingering hip pain.

Another common cause of hip joint tendinitis, particularly in runners, involves the thick span of tissue that goes from the outer rim of the pelvis to the outside of the knee known as the iliotibial or “IT” band. Also susceptible to overuse injury, it causes pain that can radiate along the entire length of the IT band from the knee all the way up to the outer side of the thigh to the hip. In fact, many people with IT band overuse present only with complaints pain to the outside of the knee.

Bursitis

Bursitis has many causes and can be intensely painful. Bursae are the fluid-filled sacs that cushion skin or muscle against the bone, allowing muscles and tendons to move smoothly. The most common hip related bursitis is on the outside of the hip socket near the “point” of the hip. Often triggered by repetitive motion and – you guessed it – overuse, this type of bursitis can also be brought on by things as simple as lying on the affected side for too long.

Labrum Tear 

Hip labral tears are actually not painful for many patients. When symptoms do occur, they generally take the form of deep groin pain, gluteal pain, clicking, catching, locking, or giving out. Limited range of motion or stiffness can also be indicators of a hip labral tear, which is why physicians test range-of-motion as part of an examination. Physical activities like golf, ballet, tennis and softball that repetitive twisting, pivoting and hip rotation cause strain on the joint that can lead to deterioration and ultimately a hip labral tear. Tears can also be caused by a collision (typically in contact sports) or structural abnormality.

Sciatica

When a herniated disc in the spine presses on the sciatic nerve, or if a tight muscle in the pelvis pinches around the nerve, it tends to cause pain that runs along the nerve from the lower back, down the hip and into one or both legs and feet. The pain is typically sharp or burning, and is often triggered by movement – even by a cough or sneeze –that can last for weeks. With sciatica, it’s uncommon for people to have hip pain alone.  Lower back pain is sometimes present, and patients often report a tingling, burning or feeling of numbness running down their leg.

Treatment

For most types of hip pain, there are multiple treatment options,available that typically begin with conservative, non-invasive options like a short course of NSAIDs (e.g. Advil or naproxen), periods of rest, yoga and stretching, physical therapy to increase hip strength, stability and range of motion.

If conservative options do not resolve hip pain, injections, surgery or hip replacement may be considered. Options can include:

Injections can both help to diagnose and treat some hip injuries. Orthopedic specialists can use an injection to numb the hip joint to determine if the joint is the source of hip pain, and then make treatment recommendations accordingly. Cortisone injections are also used to reduce inflammation and provide pain relief which may be done using ultrasound or fluoroscopy.

Hip Arthroscopy is a minimally invasive procedure that allows doctors to see the hip joint without making a large incision. It can be used to diagnose and treat a wide range of hip problems.

Hip Joint Replacement or Total Hip Replacement also known as Total Hip Arthroplasty (THA)to replace all or part of the hip joint with an artificial device to restore joint movement (prosthesis) when the cause of pain is significant arthritis of the joint.

The anterior hip approach allows your surgeon to access the hip from the front of the body and avoid cutting any major tendons or muscle groups, significantly reducing pain and recovery time. Many people back to an active lifestyle as soon as six weeks after the procedure, with far fewer post-procedure restrictions.

Revision total hip replacement is performed when the original primary total hip replacement has worn out or loosened in the bone. Revisions are also carried out if the primary hip replacement fails due to recurrent dislocation, infection, fracture or very rarely, ongoing pain and significant leg length discrepancy.

The hip is one of the largest weight-bearing and most interconnected joints in the body so it’s understandable why hip pain is so challenging. Don’t let hip pain keep you from being active. Get a professional diagnosis and treatment plan so that you can maintain or improve your mobility and remain active. Schedule an appointment today with one of our orthopedic hip specialists to find the right solution for your hip pain.

Best Hip Surgeons

dr harold hunt denver co

Dr. Harold Hunt


Jared Michalson, MD

Dr. Jared Michalson



Dr. Justin Newman


Scott Resig, MD

Dr. Scott Resig


R. Presley Swann, MD

Dr. R. Presley Swann