Osteoporosis, Bone Health

Do you know how to protect your spine from osteoporosis?

Questions you should be asking (and the answers from an expert!)

When do adult bones start to weaken and become susceptible to osteoporosis? Who is most likely to get it? What are the symptoms? What can be done to prevent it?

No matter your age, knowing the answers to these questions is a great start to helping you prevent osteoporosis and bone fractures. We talked with Advanced Orthopedic surgeon and bone health specialist Dr. Cary Motz. to get answers to some of the most commonly asked questions about preventing osteoporosis. His team, including Angie Waller, PA and Brooke Shankar, PA, run the Bone Health Clinic at Advanced Orthopedics.

What is osteoporosis?

The team means “porous bones,” and the disease causes a reduction in the density of bone tissue – essentially bone loss – which often results in fractures. Small spine fractures, called compression fractures, can lead to curvature of the spine and pain, and larger fractures like a hip break can be devastating.

What are the symptoms of osteoporosis?

You may have heard it called the ‘silent disease’ because often there are few or no symptoms early on. Even small spine fractures – called compression fractures – often occur without pain. But over time, loss of bone density and compression fractures can have a significant impact on your spine, resulting in reduced range of motion, severe pain, loss of height, and a curved spine. All of these symptoms can wreak havoc on an active lifestyle.

What causes osteoporosis?

One of the most common causes of osteoporosis is reduction of hormones – specifically estrogen in women and androgen in men. This happens as we age and as menopause sets in for women. But other factors like lack of exercise, smoking, a lack of calcium in the diet and even heredity, can be contributing factors.

Who is at risk?

Osteoporosis is very common, affecting more than 10 million Americans, and it disproportionally impacts women, in particular those over 60. It is estimated that one in every two women over the age of 50 will break a bone due to osteoporosis, as will one in four men over the age of 50. So guys – it’s not something you should not ignore.

When should I take preventative measures?

It’s never too soon to be active in your health management and practice good bone health. Our bones are at their strongest right around age 30 – after we are done growing but before we start to experience any loss of bone density. From that point on, some bone loss is inevitable, but you may be able to impact how much. Part of being active in your health is practicing prevention whenever possible. Here are five simple things you can do at any age:

  1. Build bone mass while you are young! If you are younger than 30 – or have kids – it’s building time! The international osteoporosis foundation estimates a 10% increase of peak bone mass in children reduces the risk of an osteoporotic fracture during adult life by 50%!
  2. Get plenty of calcium and vitamin D in your diet. This is easy to do by eating fortified dairy products like milk, cheese and yogurt. If you are dairy free, consider a supplement with calcium and vitamin D, which aids absorption.
  3. Be Active! Studies show that those who regularly participate in weight-bearing activities build stronger bones and are less prone to osteoporosis.
  4. Avoid smoking and heavy drinking: Besides being terrible for you in general, both smoking and heavy drinking limit your body’s ability to maintain bone mass, which happens continuously in healthy adults. Slowing or stopping this process leads to osteoporosis.

If you have risk factors or have had a fracture, it’s definitely time to get in for a diagnosis. Osteoporosis can be diagnosed with a bone scan called a DXA. DXA scans are recommended every two years for the following populations:

  • Women over the age of 65, or younger with risk factors
  • Men over the age of 70, or younger with risk factors
  • Anyone over the age of 50 with a broken bone
  • Anyone with 1½ inches of height loss
  • Anyone with back pain due to a possible break in your spine

Osteoporosis can be devastating to an active adult, and it’s incredibly prevalent among older adults and especially women. It’s also preventable and a little information can go a long way to keeping you fracture free and active in every decade of life.

Start taking control of your bone health by ensuring you are getting enough calcium, maintaining a healthy weight and active lifestyle, and getting a bone health evaluation if you are over age 50. Our spine and bone health specialists are here to help you #BeActive! 

Bone Clinic

Specialized Bone Health Clinic Has Seen a 50% Increase in Osteoporosis Evaluations in the Past Year

DENVER – Oct 23, 2019 – Advanced Orthopedic & Sports Medicine Specialists marked its first anniversary of service to the Colorado community for its specialized Bone Health Clinic this month. Osteoporosis causes more than 8.9 million fractures annually – that’s one every three seconds. The specialized clinic provides osteoporosis management programs, tailored to each individual patient, and is home to three certified specialists who are committed to help the region change these trends:

“As one of the top orthopedic practices in the Rockies, we are committed to bone health and the management of osteoporosis,” said Dr. Motz. “Osteoporosis – and the fractures that come from it – are preventable and treatable. Colorado’s active population need not be impacted at the alarming national osteoporosis rate, but, because there typically are no symptoms in the early stages, it’s important to be evaluated.”

As people age, they lose bone density and bones become weaker. The National Osteoporosis Foundation estimates that half of women over the age of 50 will break a bone due to osteoporosis. And data shows that after experiencing a fracture due to osteoporosis, people are 86% more likely to have another fracture in the next year.

As Coloradans continue to be more active in their senior years, they need modern resources to support their healthy, active lifestyles. The bone health specialists at Advanced Orthopedic & Sports Medicine Specialists provide bone health evaluations and a variety of treatment options that help patients live full and active lives without the interruption of fractures or osteoporosis.

About Advanced Orthopedics & Sports Medicine Specialists

The premier orthopedic practice for Coloradans who love to be active, Advanced Orthopedics & Sports Medicine Specialists is home to top doctors in their fields of expertise. The team educates, prepares and supports patients from diagnosis through recovery and offers a full continuum of care – from physical therapy to non-surgical options to advanced surgery – for orthopedic injuries and conditions ranging from knees, hips, shoulders, backs, hands and feet. Learn more at advancedortho.org/ or facebook.com/AdvancedOrthoColorado.

Dr. Keith Jacobson, President of ABFAS

Dr. Keith Jacobson Begins Term as President of the American Board of Foot and Ankle Surgery (ABFAS)

Rigorous Certification Standards Remain Top Priority

DENVER – Oct 15, 2019 – Advanced Orthopedics and Sports Medicine Specialists, a division of Orthopedic Centers of Colorado announced that Dr. Keith Jacobson, DPM was elected as president of the American Board of Foot and Ankle Surgery. Dr. Jacobson’s term runs until September of 2020. 

In his role as president, he will advance the mission to protect and improve the health and welfare of the public by the advancement of the art and science of podiatric surgery.

“I’m honored to represent my peers – the best foot and ankle surgeons in the world – as president of ABFAS,” said Dr. Jacobson. “Ensuring that patients can select a qualified foot and ankle surgeon based on the rigorous ABFAS certification is critical to the integrity of our healthcare system, and I’m committed to ensuring that our certification represents the highest possible standard of care.”

ABFAS is the industry standard for qualified foot and ankle surgeons, and the organization works to promote lifelong learning and professional accountability, which are the board’s foundational principles for quality healthcare.

ABFAS certifies qualified foot and reconstructive rearfoot/ankle surgeons. Prior to receiving certification, candidates must become board-qualified in either foot surgery and/or reconstructive rearfoot/ankle surgery. ABFAS continues to review and improve the certification exams and uses a rigorous Case Review process combined with a didactic and computer-based patient simulation examination.


About Advanced Orthopedic & Sports Medicine Specialists

Advanced Orthopedic and Sports Medicine Specialists is widely recognized as the regional leader in comprehensive orthopedic services. The 19 physicians of Advanced Orthopedic and Sports Medicine Specialists have received specialized training in orthopedic surgery and in subspecialty areas within the field of orthopedic medicine. They diagnose and treat even the most complicated orthopedic conditions and are supported by a professional staff of physician assistants, medical assistants, x-ray technicians and administrative personnel at our two offices in Denver and Parker. Learn more at advancedortho.org. Follow us on Facebook, Twitter, Pinterest and Instagram

sports medicine specialists, Dr. Wayne Gersoff

Work Hard, Play Hard: How Sports Medicine specialist Dr. Wayne Gersoff Has Helped Pro and Amateur Athletes Be Active and Stay in the Game

The sports medicine expert’s lifelong love of athletics inspires him to help patients even with severe injuries return to an active life

“People who are active want to stay active,” says Dr. Wayne Gersoff, and he should know. Not only is he a leader in sports medicine who’s helped keep top athletes – professional, collegiate, and high school competitors – in peak playing condition, but he’s also a lifelong athlete himself in multiple outdoor sports.

Dr. Gersoff has been helping Colorado athletes since the 1987, when he set up the first sports medicine program at the University of Colorado Health Sciences Center, while also overseeing the care of all the members of CU’s athletic teams. He went on to become the first team doctor for the Colorado Rockies and served the Major League Baseball team at all home games for eight seasons. He also cared for the Denver Grizzlies minor league hockey team and has served with the Colorado Rapids soccer squad since its launch 16 years ago. Not to mention the US men’s and women’s soccer teams and Denver Public Schools, Grandview and Chapparal high school athletes.

He says he got into sports medicine in part because “I’ve always played sports.” At Yale, where he earned his undergraduate degree and did his residency, he played soccer (his lifelong passion) and had a mentor, Dr. Aversa. It was Dr. Aversa who, recognizing Dr. Gersoff’s love of athletics, recommended that he take up sports medicine. He started when he was still a resident, covering all the various Yale teams’ home games. He followed with a fellowship at the University of Wisconsin under sports medicine pioneer Dr. Clancy.

That led to the opportunity at CU, where the athletes under his care included the 1990 NCAA champion Buffaloes football team. He fondly remembers treating legendary Buffs quarterback Darian Hagan, who tore his patellar tendon at the Orange Bowl. Dr. Gersoff repaired the injury, but there was still uncertainty as to whether Hagan would be able to play again the following season. But he did, and after he scored his first touchdown, Hagan found Dr. Gersoff and gave him a big hug.

Colorado Rockies right fielder Larry Walker was similarly thankful for Dr. Gersoff’s treatment. He’d fixed up Walker’s shoulder during the off-season, and when Walker returned to the outfield in 1997, he had an MVP-winning season, for which he thanked Dr. Gersoff with a large, framed LeRoy Nieman print.

Dr. Gersoff was also on board for the Grizzlies’ championship season in 1995 and the Rapids’ championship season in 2010. And he’s been on duty for at least 300 games with Denver high school football teams. Dr. Gersoff says the thank-yous from these teens have made those cold nights and weekends all worthwhile.

In the meantime, after nearly a decade at CU, Dr. Gersoff left the university to go into private practice. A resident, Dr. Andy Motz, soon joined him, and with a few other specialists, they built the practice that became the Advanced Orthopedics group.

While working with all these sports teams, Dr. Gersoff kept up his own athletic pursuits, including soccer, running, mountain biking, and road biking. He and his wife stay active together by biking, hiking, and snowshoeing. In recent years, he’s taken up reining – a western equestrian discipline and precision-movement sport. Dr. Gersoff says he enjoys riding with his daughter.

When Dr. Gersoff’s daughters were children, he made it a point to schedule his professional commitments around their games and practices. Once, he recalls, he had to give a presentation in Baltimore, and he moved it so that he could fly home to Colorado in time to coach a game that afternoon. Today, his older daughter, who played two sports at Princeton, is a law school student at the University of Wisconsin, while his younger daughter, a highly accomplished equestrian athlete, is an undergraduate at Cal Poly in San Luis Obispo.

Both Dr. Gersoff’s personal Be Active lifestyle and his work with top athletes helps guide his treatment of patients with sports injuries. “Whatever activity they’re doing, they should do it for the love of it and not feeling like they have to do it,” he recommends. “When you enjoy it, you are willing to put the mental and physical preparation in, and while injuries may be unavoidable, the physical preparation will help minimize some of those risks.”

He encourages patients to remain active even after severe traumas. “You can move on,” he says of patients who’ve suffered a devastating injury, “but if it’s more severe, you can still be active, but you take a modified approach.”

As an example, he cites Juli Furtado, once a CU student who’d been a top slalom skier on the US National Ski Team before suffering multiple knee injuries. Dr. Gersoff successfully operated on her knee but told her he didn’t think it was wise to return to the slopes. Instead, he recalls, he suggested she take up biking. Within a year, she’d won a national women’s road biking race. She switched to mountain biking and became a champion in that sport, too, even racing in the 1996 Olympics before she finally retired.

Whether they’re world-class athletes like Furtado or everyday patients, active people who suffer injuries “don’t want to go from 100 to zero,” Dr. Gersoff says. “Part of our job is to listen and help them think of ways to preserve that injured body part for a long time.”

Has sports medicine helped you stay active after an athletic injury? Tell us your story.

tips for rotator cuff surgery

Patient Perspectives: 8 things you should know before having rotator cuff surgery

Top tips from a working mom, a caretaker, an elite athlete and a retiree who’ve been there, done that.

A rotator cuff tear is a common repetitive motion injury, caused by occupational and recreational activities, and can also occur more often as we age.  They can also occur with a specific traumatic event. According to the American Academy of Orthopaedic Surgeons, nearly 2 million people experience pain or limited range of motion due to rotator cuff problems each year. And while not all tears need surgery, full, or complete, rotator cuff tears, often defined as anything more than 90 percent torn, are almost always surgically repaired.

Orthopedic surgeons can provide great perspective on who is a good candidate for surgery, common outcomes and what to expect from the procedure. “Rotator cuff surgery is less invasive than many other surgeries and most patients with full rotator cuff tears experience a tremendous improvement in range of motion and a reduction in pain after surgery,” says surgeon Dr. James Ferrari.

“But surgery is not a silver bullet, and patients must be informed and committed to their rehabilitation to maximize a positive outcome,” Dr. Ferrari notes. “Every rotator cuff repair I do is different. Although you can learn from others’ experience, you cannot compare your personal outcome with anyone else. Long recovery and moving too much too soon can be more harmful than helpful.”

If you’ve already been diagnosed with a full or significant rotator cuff tear, and are considering or preparing for surgery, being prepared is one of the best things you can do for yourself.

“Preparation will help you to make an informed decision, arrange for the resources and support you may need post-surgery, and put yourself in the best position for a speedy and smooth recovery, ” notes Cary Motz, M.D.

Real patients who have recovered from rotator cuff surgery are an invaluable source of first-hand advice – for both patients and their caretakers. No matter how you describe your lifestyle, tips from four real patients can help you plan for the best possible outcome:

The Athlete: Tommy K. The longtime multi-sport athlete has had surgery before, but he says his shoulder procedure was the best result he’s had, due in great part to his commitment before and after surgery. His advice:

  1. Follow your surgeon’s post-operative protocol to the letter. Even when I felt that I was being too conservative with movements or not pushing hard enough with resistance/weight, I resisted the urge to go beyond the limits that the surgeon set, and it kept me on track.
  2. At the same time, it’s great to work towards a goal. I had a kiteboarding trip in the Outer Banks, planned for September (8 months post-surgery) and I wanted to be in great shape. Continuously thinking about this trip did two things to help my recovery. 1) It kept me working hard in PT and then later in the gym once I was released by the surgeon 2) It kept me from doing something stupid, like pushing too hard too soon and potentially setting myself back.

The Working Mom: Sarah H. An active mom of two, tennis player and dedicated Orange Theory Fitness member, this busy bond trader is up before the sun every day and at work before the markets open on the east coast. Her tips for planning ahead and the right equipment were key to a speedy recovery:

  1. Your surgeon will recommend a special ice machine that circulates ice water through a shoulder sleeve. There may be a small expense to buy the machine but it’s worth it. Plan ahead and buy one. The machine is so much better than an ice pack because it stays cold and in place on your shoulder. It helps to reduces pain and swelling. Using the ice machine regularly meant less pain (and fewer pain killers) after surgery. It helped me rest more comfortably and made it easier to start physical therapy.
  2. You’ll be asked to wear a supportive sling for several weeks, and it’s not always easy to comply. It restricts your range of motion and is tempting to take it off when you start to feel better. But it protects you more than you realize – and can even help you avoid re-injury while you’re healing. The sling helped me in two ways: It provided physical support to allow my shoulder to heal; and provided a visual reminder to myself – and others – that I was in fact, still healing. It limited my tendency to try to use my arm too much too soon and minimized the chance of reinjury from an unexpected strain, such as my daughter jumping into my arms unexpectedly, or a good intentioned nudge on the shoulder from a colleague or friend.

The Retiree: Marilyn J. A retiree with an active lifestyle, Marilyn is very active in the local community, and enjoys hosting events for neighbors and friends. She went into surgery while in the middle of preparing to sell her house! Her tips for tackling it all and the commitments she made that helped her get back to painting and moving only two months after surgery.

  1. Build strength before your surgery. No matter your fitness level, any improvement in your strength and fitness pre-surgery will contribute to a faster and better recovery. Give yourself some time prior to the procedure to improve your strength in complementary muscle groups and consult your doctor about other changes you can make to improve your overall health before your surgery day.
  2. Be committed to physical therapy. Your doctor will tell you when you are ready for physical therapy, but you may be asked to start a home exercise program almost immediately– be ready to get moving and take the process seriously. Even in retirement, it’s easy to cite a busy schedule as an excuse not to go to PT. Find a physical therapy location that is easy to work with, easy to get to and can accommodate your personal schedule.

The Caretaker: Kamee W. A busy professional, mom and wife, Kamee had the task of taking care of her usually active husband as he recovered from rotator cuff surgery. And while they planned ahead with many of these tips, managing work and family life with one less person to help makes a big difference. Her tips for the caretaker:

  1. Plan for more than just caretaking. Don’t underestimate the effect that the surgery will have on the caretaker. It’s so much more than meeting the patient’s needs for support and comfort, it affects everything you might have done as a team prior to the procedure: driving, household chores, family activities, cooking and more. You can do some things in advance, like cooking and freezing meals before surgery.
  2. Enlist help. For all those things that can’t be done ahead of time, ask for help! Hire a neighborhood teen to do regular household tasks like mow the lawn or walk the dog; share the pick-up and drop off schedule with family and friends— that goes for kids and for patient appointments; and splurge on grocery delivery for a few weeks. Using extra help and short cuts can add up and making the difference of keeping your sanity or feeling extremely overwhelmed.

Scheduling surgery is a big decision but with the right preparation and planning, you can have a smooth and positive outcome. Need a diagnosis or ready to consider surgery? Schedule an appointment with one of our shoulder surgeons.

Best Shoulder Surgeons

A. Todd Alijani, MD

Dr. A. Todd Alijani



Dr. Mark Failinger


James Ferrari, MD

Dr. James Ferrari


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



Dr. Justin Newman


John Papilion, MD

Dr. John Papilion


Dr. Micah Worrell

Dr. Micah Worrell


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

Dr. Alan Ng


Scott Resig, MD

Dr. Scott Resig


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!