Sports Medicine and Rehabilitation Bradenton FL & Parrish FL - Sports Medicine physician Florida USA

Bradenton FL 941.755.8819

 Sports Medicine & Rehabilitation


 Sports Medicine Home
About Dr. Kochno
Clinical Articles
Patient Info
Contact Us
Referral Process
Professional Staff
Press Release

Sports Events

Sports Medicine Overview
 Sports Performance
 Assessments in Sports
 Athletic Assessment
 Athletic Performance

 Baseball Pitchers and Hitting

Baseball Pitching Velocities

 Rehabilitation in Boxing
 Concept of an Executive Medical Boxing Board

Golf Facts
Golf Conditioning

Swing Mechanics
 Faults & Resulting Injuries
Shoulder in Sports
 Age and Injury
Muscle Memory
Science And Golf
 Golfer’s Spine
Spine Mechanics
Motor & Muscle Memory
Biomechanics Of Golf
Golf Mechanics - Questions

 Knee Capsule Strain
 Psoas Minor Strain

Basic Anatomical Review

Elbow Joint
Radial - Ulnar Joint
Wrist Joint, Fingers and Hands
 Hip Joint and Pelvis
 Ankle & Knee

Musculoskeletal Disorders
 Cervical Pain
Low Back Pain
Joint Mobilization of the Wrist
Upper Ankle Sprains
Lower Ankle Sprains

Alternative Health
Composition of the Human Body
Mattes Method®
Energy Medicine

Health Care Reform Issues
 Post-Acute Reimbursement System

Motor Vehicle Accidents
Overview of Motor Vehicle Accidents

Understanding Stress
Athletic Anxiety

 Role Of Physiatry
 Case Management in Subacute Settings
 The Road To Recovery Following A Stroke
 Viewpoint of Subacute Care
 MindDrive Study


Postural Muscle Pain

Posture And Gait:  Kinesiology Application To Motion

Posture Assessment

Chronic Forward Cervical - Head Posture 

Biking Biomechanics and Injuries

Frequently Asked Questions

Drug Lookup

Sarasota Memorial Nursing Home Facility

New Patient Forms

  Patient Information

Automobile Accident/Injury Form


Frequently Asked Questions 2008

Frequently Ask-The-Doctor Questions Asked

Archives 2009 2008 2007  2006  2005

Q & A

Posted August 25, 2008

Q I am an avid gamer (Xbox 360, wii) etc etc.  Supposedly a Dr. Told me I have a Tenosinovitis de Quervain he didn’t make any studies or anything.  Do you think I might have a misaligned bone or something. My wrist is ok I just get uncomfortable at the base of my thumb sometimes and when that happens I have trouble touching my thumb to my little finger in my right hand.  Any suggestions on treatment I'm using a splint sometimes so my wrist does not move.  It has helped but should I stop gaming? Will gaming hurt me more?  I really don’t want to get an operation on my hand, I rather rest 6 months and see if it gets better all by itself.

A The diagnosis is a repetitive overuse of the muscle groups that control thumb movement.  The carpal bones are like pulleys that help the tendons glide with the least amount of resistance and maximize their functional strength.  Reducing the reliance on these muscle, or resting helps reduce the inflammation, but returning to the same activity and with the intensity will probably cause the same situation. 

In the short term, rest, ice, anti-inflammatories, a resting splint are the usual remedies.  Alignment of the carpals would help, but may not permanently solve the problem, as these bones do have some potential to shift.  If one persists and ignores the inflammation, this inflammation may predispose to an early onset of osteoarthritis of the thumb joints.  Hope this helps you. 

Posted August 25, 2008

Q I am a professional golfer, I have lateral epicondilitis in my left elbow.  What are the best exercises I can use to prevent a recurrence.   Right now I am rehabbing it. But it has been 9 months I have been suffering with it.

 A Simple lateral epicondilitis can be resolved in various muscle-joint therapy techniques, especially if the condition is recent and mild in presentation.  As you have had rehab for over 9 months, your condition is doubtful to be a simple presentation.  First of all you are a professional golfer. 

The arms accelerate with a high velocity and decelerate quickly through the swing.  Hitting davits exacerbates the condition.  The common impression is that lateral epicondilitis is a simple muscle tendon attachment inflammation, most often from overuse activity.  That may be the most common scenario. 

However, this tendon has two attachments, one at the elbow and the other near the wrist.  The alignment of the small wrist bones has a direct correlation with the tension of this tendon.  Any increased tension of tissue increases the potential for muscular strain.  Therefore repetitive motion and force will cause increased tension across these attachment sites. 

Manipulation of the attachment points should be made for proper alignment and tension reduction before aggressive muscle stretching.  Additionally, a slight shift in the elbow joint could lead to increased tension across either or both proximal attachments of the extensor and flexor tendons of the forearm predisposing towards lateral and medial epicondilitis.  

A manual osteopathic or chiropractic adjustment can easily correct this alignment.  Additionally, if the tendon has been shortened by prolonged strains, various muscle stretching techniques such as Active Release Techniques, and Active Isolated Stretching can facilitate return to functional muscle length and reduction of secondary tendonous strains leading to inflammation.  Should you be in the Southwestern Florida region, please let us know and we would be happy to evaluate you and assist you. 

Posted August 25, 2008

Q I suffered a distal radius fracture last June then I had part ulna replacement in November then finally had my wrist manipulated in January.  However since my fracture I cannot supinate my left wrist.  My wrist gets to the neutral position and that's about it.  It feels like its at the end of its range.  Can any one shed any light on this? My consultant said that the next thing he could do was to manipulate it again and put my arm in full cast for 3 weeks but I don't think that would work.  Any information would be a great help.

 A The wrist is a complex joint.  As you read in my article, this was extremely difficult to find treatment successes for my son.  I was extremely fortunate to find a manipulative solution for his limitations and a few of my patients.  After a fracture, the bleeding that occurs is replaced by scar tissue.  Either the bone malalignment or the scar tissue are the obstacle to your flexibility.  Manipulation may offer one type of treatment option.  Should you be in the Tampa area of Florida, I would be happy to consult with you, examine your problem and based on my findings try my treatment techniques.

Posted August 25, 2008

Q I really need advice ASAP as I have no health insurance and I am concerned. Yesterday I was playing tennis for about 5 hours, and I played throughout much pain. It started about an hour when I started but got more and more painful (my fault I guess) but it was always a problem that was just slight many days before and always there throughout several tennis sessions just now it cries out for attention.

I came home and inside my right back near the spinal bone is sore (from serving I guess, which I d not do often) in addition to what I am certain is the psoas major muscle and I do not want to leave it untreated and have myself end up with long term problems. Please help me its the psoas major muscle that is most bothersome and I am limping some, I am very lean so each and every muscle on my frame can be easily analyzed visually as I have no fat or barely any, and the entire muscle raises on my slim frame.

The psoas muscle attaches to the spinal elements anteriorly so it would be unlikely that you can palpate them.  The trigger point that can correlate with a psoas muscle problem is found over the abdomen, below the umbilicus along the mid clavicular line.  The location is close to where one "finds" the appendix. 

You may try an experienced massage therapist.  Depending on where you live, you may try to find a massage therapist that has training in Active Isolated Stretching, developed by Aaron Mattes.  You can google his name and contact his web site,  Hope this helps you in the direction of resolving your muscular strain issues.

Posted August 25, 2008

Q I was very impressed the article:   Overview in the Development of Baseball Pitchers and Hitters

Can you recommend exercises for vision and to strengthen muscles related to the rotator cuff?

A Vision exercises have been perfected by ophthalmologists and used in high end performance training centers such as IMG and professional baseball clubs.  Unfortunately, I don't remember which system they use.  To strengthen muscles, Human Kinetics, a publisher has a book on baseball anatomy which provides a good summary of exercises for specific muscle groups.  Hope this helps.

Posted August 25, 2008

Q Is it not fair to say the term muscle memory is a misnomer.  It is really neurologic imprinting completely controlled by the brain.  Do  you think a better name could be coined?

A Thank you for your question, it is a good one.  I can't agree with you more, and now I refer to the learning as brain-muscle memory.  You can read the article "MindDrive" and not the definition and explanation.

Posted August 25, 2008

Q I turned my ankle to the outside during a fall about 5 years ago.  I did not seek medical treatment but used ice and elevation.

At this point the ankle is unstable and pops and cracks often.  The most worrisome problem is the large, soft swelling which has appeared to the front of the ankle bone.  I have a fear of tumors from past medical problems.

What should I do for the ankle? It is tender and prevents me from standing on toes to reach items or wearing higher heels than flats.  Thank you for your suggestions.

A Thank you for your inquiry.  Swelling associated with an ankle sprain usually resolves within one to two weeks.  The persistence of swelling needs investigation.  The best imaging would be an MRI of the ankle.  This imaging test will establish a diagnosis for the clinician.

Posted August 25, 2008

Q I was reading your article on wrist mobilization and I have a few questions please.

First, let me tell you my situation. I was hit by a car and ended up being thrown landing on my right arm severely crushing the end of my radial bone and a compound break of my ulna. A bone graft for the  radius and external fixation was performed. After 6 weeks internal  pins and external fixation was removed. I have been doing physio for  two months now. Because I have always be athletic, tennis, outrig  canoeing, swimming I am anxious to be able to do these things again.

My questions are:

If there has not been any fusion of the radius or ulna bones would  this therapy work to give me greater rotation (supination and  pronation)? I have about 70 now.  Also, even though there was great trauma in my injury is there any reason I couldn't get almost normal movement through the use of this technique.

The doctors seem to be quite negative and I am looking for something to go along with the traditional physio therapy I am doing.

A Your injury required a surgical correction of the large bones of the forearm.  These bones provide the attachments of important muscles from above the elbow and below.  Supination and pronation is a movement that requires the mobility of these muscles.

However, the smaller bones of the wrist, the carpal bones also play a role in pronation, supination, but more importantly in flexion and extension of the wrist.

Over the years that I have manipulated many wrists, I have been very successful in improving range, decreasing swelling and improving functional use of the wrist and hands. 

Again, the techniques I use are of my own findings and are not taught in therapy or medical schools. 

If you happen to travel to Florida, I would be glad to examine and assist as best as I can. If you should write back and inform me of your location, as I travel frequently, I may be available in your area and spare you a trip.

Posted August 25, 2008

Q My son was involved in a car accident 11 months ago which resulted in an 80% compression spinal fracture. He had surgery on L-4 and L-5, two 9 inch rods, two crossbars and 9 screws put in. He has gone through 11 months of therapy. The injury effected his bowel, bladder and reproductive functions. He has regained bowel and bladder use completely. The range of motion in his right ankle area is very limited. He has limited feeling in his toes. Therapy is soon ending except for what he is to do at home on his own. His balance has been effected and he isn't able to walk as a normal 25 year old should. He walks very slow due to the balance issue.

The surgeon shared with us post surgery, what he has back at 9-12 months is what he will get back.
My question is how long does it take nerves to heal from the area of his spine to his ankle? He is 6 foot 2 inches. Is there a chance that he may not regain total recovery to the nerves to his ankle? Someone said nerves heal at a rate of a half of inch every month.
Thanks for assisting me in helping to try to understand and be supportive to him.

A Thanks for your inquiry, and I apologize for the delay in responding to you.  Sorry about your son's injury.  The spinal nerves do get damaged and do recover at the rate that you were told.  My question is whether the nerve damage is at the level of the spin or lower in the leg or ankle. 

A neurologist can study nerves and their recovery patterns with a test called a nerve conduction velocity test and the muscles the nerve innervates with an EMG which are usually done together.  The balance issue may be of multiple causes such as head trauma, hip-pelvic fractures, and a neurologist can help determine the cause of his balance problem.  I know I wasn't as helpful as you may have wanted me to respond, but your son's case is a bit more complex for me to speculate of the origins of his deficits. 

Hope this is a start.  Best Regards, Taras V. Kochno MD

Posted April 5, 2008

Q I found your explanation on the wrist interesting.
I was looking for information on bony growth on the wrist, because I am having growing degrees of pain this last week, on my right wrist. A tiny area on the base of the thumb bone, is growing outwards and may be the culprit pushing on the nerves. Pain is mostly felt when I flip the wrist in or outwards, and during rotation, esp downwards.
My mother used to have such a bony growth at around the same area, when she worked as a clerk doing typing and paper work. Her growth was so apparent, protruding almost 8mm from the base of the skin, on her right hand too.
If I'm to lessen the use of this wrist in the next few weeks, do less typing / computer work, will the bony growth stop?
Please offer me some advice what I can do about it.

A The bone "growth" probably is not an actual growth, but the shift of the bones outward, in response to overuse.  Secondary inflammation and swelling then occur that creates osteoarthritis.  I would have a good massage therapist, chiropractor evaluate this condition.  These specialists can keep the alignment of the bones and thus reduce the progression of your condition. Also, reconsider how hard you work with your hands and fingers. 

Posted April 5, 2008

Q What is your opinion of boys that are 14 years of age and are in the early stages of puberty pitching from 60 ft 6 inches the same distance a Major League pitchers? Thank you for your time and I look forward to hearing back from you.

 A It is a very good question.  I will direct you to Dr. Mike Marshall a former Cy Young pitcher with a PhD in Kinesiology who would be best to answer this issue for you.  His web site is 


Posted March 10, 2008

Q I am a golf instructor and recently began learning a little about the tremendous stress we golfers put on our body.  In the future, I am quite sure that biomechanics will be of the utmost interest in my study of the golf swing.  I look forward to that day.  But for now, I wanted to simply ask you about the "Therbo Robot" or other robotic instruments that have been developed by companies such as Meilus Muscular Therapy & Sports, Inc. 

What do you think about these systems?  I had an opportunity to use the system at a convention and it appeared amazing (I'm no expert, however).  This was my first experience with any type of physical therapy treatment and I was amazed at the results from one sitting.

 A Although I do not have first hand experience with the Meilus Muscular Therapy system, I have had patients remark that it was beneficial to them.  The skill still remains in the clinician, diagnosing the problem and finding the most optimal solution to correct it.  Fortunately, I presume that you had the benefit of both. 

Treatments that have benefit with minimal cause for risk are worth trying if recommended by a qualified and trusted clinician.  Other forms of alternative, holistic and manual therapies are also quite successful.





Posted March 10, 2008

Q Finally, I think I found someone who knows what I am going through with my right wrist pain.  I just read your website page about how you manipulated your son's wrist late at night and cured him.

I am a golfer, and basically when I move my right wrist horizontally to the right and then up - say 5 degrees - I have this weird numb pain.  The pain is mirrored of course when holding the golf club with the right hand (as if addressing a ball) and swinging the club back about 2 feet in its backplane arc.  Right there at the 2 foot mark, the pain appears again.

I go to a great chiropractor who has helped my low back pain, neck pain, etc..., but he cannot seem to find the "right move" so to speak when adjusting my wrist. 

Guess I was wondering, is there anyway I could call you and you could walk me through how to manipulate (if possible) myself to reset the carpal bones.  The pain seems to be right where the capitate bone resides if that helps.

Or, can I have my chiropractor call you? 

Frustrated but optimistic, appreciate your time!!

A The wrist of a golfer sustains a great deal of force in its swing motion and mis-hits.  The carpal bones do shift.  Yes,you can have your chiropractor contact me at my office number.



Posted March 10, 2008

Q I'm having pain in upper neck , below the skull, which I would call the upper cervical part of the spinal column. It could have happened doing lat pull downs on weight machine. The pain is much less laying down. I have a second visit with a chiropractor tomorrow. Been going on about 2 weeks. Any suggestions?

A I think your evaluation by a chiropractor is warranted.  As I don't have the advantage of examining you, I will assume that your chiropractor will ease your discomfort.  If your pain persists or you have questions about any imaging studies, such as an MRI, I may be able to give more insight.



Posted March 10, 2008

Q I've been having abdominal and back pain for 2 months now, my doctor put the condition down to back pain , I get most pain in my stomach when I sit down or drive my car, I get relief when I stand up or lay down with a hot water bottle on my stomach, is these symptoms common with psoas minor?

A Your symptoms are generalized and I can't say that they are psoas minor related.  The circumstances of your injury or timing of symptoms are important.  Based on your general symptoms, a clinical assessment by an osteopath, a physiatrist (rehabilitation physician) or a myofascial therapist would be beneficial to establish that diagnosis.  There are some very good psoas major and psoas minor muscle web sites that you can also visit and find diagnostic presentations of pain and see if they correspond to your symptoms.

Posted March 10, 2008

Q I fractured  my wrist almost 8 weeks ago.  The doctor took the cast off after 6 weeks. It still hurts quite a lot and is still really weak.  What can I do to get it back to normal?

A The best advice I can give you is to find a specialized physical therapist or occupational therapist who provides hand therapy.  Aggressive physical range of motion with strengthening exercises would enhance your functional return of wrist function.

Posted March 10, 2008

Q My daughter who is now 13, was diagnosed with Spondylolisthesis Grade II when she was 9 years old.  At that time she took part in gymnastics, complained of back ache, chiropractor said she did not respond to his treatments, then went to Orthopedic surgeon, who discovered the Spondylolisthesis.  

He put her in a brace which she wore for 3 months (was supposed to wear it for 1 year….she hated it!) and was told to stop all sports, which she did for 2 years, during which she received prolotherapy shots every 2 -3 months. 

Prolotherapy helped with leg pains disappearing as well as sudden weakness in knees. (She has received 14 treatments of prolotherapy) Unfortunately, she has developed stress knots in shoulders and neck and is always very stiff, wanting to crack her body as soon as she gets up from bed. 

She seems constantly tired and also her right wrist and arm are hurting.  (I feel it’s all stemming from the fact that her spine is out of alignment).  The HMO primary doctor has no idea what to advise me to do next. 

When we visited the Orthopedic surgeons when she was 9, they both  said she should just take Tylenol if it gets worse and they can always operate if it slips more (These are doctors at Children Hospital in Los Angeles, and Cedars Sinai in Los Angeles)

My question to you is what would you do as the next step? On my own I have taken her for myofarcia massages to give her some relief for the stiffness. Can you also advise me as to what specific exercises she should do to correct her lordosis?  (The physical therapy from the HMO insurance was also not very effective).

I would appreciate any input you can give me.  My search for help for my daughter is not an easy one, especially not having any contacts in the medical profession.

A Your situation is rather complex.  First of all, a grade II spondylolisthesis is about a 50% shift of the vertebrae from one another.  Prolotherapy promotes scarring of tissue, notably the ligaments around this weakened area.  Immobilization of the spine with a brace allows the growing spine to functionally "fuse" its area of weakness. 

The spondylolisthesis is a greater concern when it reaches grade III where one considers surgical stabilization, but this is an extensive surgery.  Strengthening the extensors of the spine may offer some protective benefit, but please discuss this with your orthopedic surgeon. 

Myofascial release may be helpful, but only if it is done by a qualified and experienced therapist.  The therapist must caution on mild to moderate releases and aggressive or strenuous release may exacerbate her symptoms.  I would ask the orthopedic surgeon on whether there is any benefit to further prolotherapy as this is not an area of my expertise. 

Physical therapy would not be that beneficial with the exception of demonstrating spinal exercises, along with reviewing precautions and contraindicated therapy exercises.

Posted January 22, 2008

Q Thank you for your reply.  May I ask a few follow-up questions?  What is a lumbar pillow?  And, is 'extension exercise' where my back would be 'hyper extended'. What is 'flexion exercises'. 

I really don't understand the science behind laxity of the fascial leading to progression of the spondy... I thought the muscles and all that would keep it tight and 'stable'?   I'm kinda 'struck' in what to do because everything is all knotted up...I can see it and feel it through my back and now its pulling on my siatica...   so I was in the least looking into massage - but now u are sharing your opinion with me....not quite sure!!

In any event, and in advance, I thank you for taking time to share your knowledge with me.

A A lumbar pillow is a reference to a lumbar support that promotes the natural curve of your low back.  OBUS Forme has the best ones.  The lower lumber support is better than the larger entire spine support.

Flexion exercises are those that hinge the joint areas upon themselves such as doing sit ups.  Extension is the opposite, where one opens the joint such as arching ones mid and lower back.
Laxity of ligaments does occur with repetition or trauma, especially during the growth years prior to puberty in the spinal vertebrae.  The muscles overlie these small ligaments and provide support and promote spinal movement.  The goal of managing Spondylolisthesis is to help promote the back extensor muscles to be strong and maintain proper posture. 

Myofascial work has two purposes, to promote maximal flexibility and optimize myofascial response to muscle recruitment.  Some techniques are less "traumatic" to the muscle structure than others.  The less traumatic ones are Active Isolated Stretching or the Mattes Method and Active Release Technique. Massage is the superficial movement of tissue mass and fascia and usually is non specific, and unless you are receiving a massage for wellness, in many cases of trauma, massage may exacerbate the tightness and pain.

Sciatica has two types of presentations, one of nerve irritation, the other a muscle group trigger point.  The most common muscular referred pain is from the piriformis muscle in the buttock area, followed by the gluteal muscles, the most common sciatica from the spine is the lower segments of the lumbar spine and the disc material encroaching and touching the nerve fibers that comprise the larger bundle of nerves that make up the sciatic nerve. 
You may want to use the internet to get more information of the material I have provided you. 

Posted January 22, 2008

Q Quick history... Going to chiropractor for shoulder of now that is much better.  During an appt in Sept. doctor noticed my hips were out and adjusted that area.  This happened twice in one week.  The following Monday, I had soreness in the iliac crest area (anterior side).

In the past my daily regiment consists of the following 5am gym....weights 7am bike to work(12 miles) 12pm run 3-5 miles 5pm bike home(12 miles).  I haven't been able to do any of the above, except the weights, since mid September.  My left hip is painfully when walking, turning in bed, getting in and out of the car, standing for any length of time,  running is totally out.  I had a x-ray done but it came back normal.  Doctor put me on 2 weeks of naproxin, but no change.

A Reviewing what you have written, I suspect that the chiropractic adjustment to correct the posterior malalignment may have created an anterior shift.  I don't know if the chiropractor used a drop table technique, which I usually don't like, or a hands on manual  adjustment, which is less traumatic, but you may want to return to him or find another chiropractor or osteopathic physician who practices manual medicine and undergo another adjustment for optimal alignment.

Posted January 21, 2008

Q I was reading your article Overview of Sports Performance and I was wondering if you could explain what role physique plays in sports performance.

“Three components that comprise sports performance are physique, physical conditioning and psychological attributes.”

A Your question is a good one and important.  Recently golfers were analyzed in their performance based on three body types and frames.  They found that each body type, pear shape, skinny, or cylindrical has specific limitations that interfere their performance.  This book is a start to understand physique. 

As golf is the most studied biomechanical sport, every aspect plays a role in developing an effective swing plane.  Other sports may cross-reference these studies, but they are not as critical to other sporting activities as they are in golf.  Hope this helps. 

Posted January 20, 2008

Q I have a quick question - can you tell me if you have ever known of anybody with Spondylolisthesis at L5 S1 (at almost a grade 2 slip) to benefit from Myofascial Release (John F. Barnes)?
I'm 25, female, from the states but living in Guatemala....I have had this problem and pain for well over 10 years. Used to be a fast-pitch softball pitcher, basketball player, and now I swim (and occasionally run - about 2.5 miles a week only).
I'm looking to get the MFR treatment before leaving the country again and cannot find any articles on MFR and Spondylolisthesis...
Thank You for your attention in this matter!

A Grade 2 Spondylolisthesis is a challenge.  I have observed many myofascial techniques, active isolated stretch, active release, Feldenkries, and I find that any release that stretches this area usually increases laxity of this area leading to a progression of the Spondylolisthesis. 

Please understand that I am one of the greatest supporters of these myofascial techniques, but I think that you will find that avoiding manipulative motion in this area is best.  A lumbar pillow and support belt may also be better to stabilize this laxity in ligaments.  Back extension exercises should be of benefit, but you should avoid flexion exercises. 

Posted January 19, 2008

Q I have been looking for someone who can help me with my young baseball player. I have a nine year old who basically plays year around. Just so you will know I am also a coach on his select team. I do not make him play however. He simply love to play.

He is a catcher but is also a very good second baseman. He is small for his age and will probably always since I am 5'8". He is very advanced (a very solid player). My problem is all he wants to do is catch. He really believes he is going to be the greatest catcher ever. At the end of our year (we only take off about three months before we start practicing again) his knees were hurting him.

I took him to a very reputable bone doctor who looked at him and did an MRI. Long story short he said he had tendonitis in his knees and maybe some growing pains. My problem is I can't find anyone who can tell me hoe many is too many games for a nine year old to catch. He caught about eighty games.

Our head coach says it not to many but I was somewhat of an athlete and I feel its to many and has contributed to his knees being sore. Is there a rule of thumb on number of games someone this age should catch. I'm hoping you could give me some information on this.

A Your question is unique.  I don't think anyone has studied the knee in this scenario.  I am pleased that the doctors had done an MRI to assure that there are no obvious structural problems.  I only thought that comes to mind is the anterior and posterior ligaments. 

I have seen a few major league catchers who have had an anterior cruciate ligament tear and repair (ACL) injury as they get up quickly from the crouched position and with their knee flexed at 15 degrees, this angle is the most vulnerable for ACL tears.  This usually occurs when they try to throw back the ball quickly, especially to second base to throw out the runner. 

I suppose many great potential catchers ruin their knees too early and miss out on a professional career.  I don't want to frighten you, but you should be aware of this possibility.  Hope this helps.

Posted January 18, 2008

Q Since I've begun sleeping on a slanted pillow for GERD, my mild osteo-arthritic left knee has gotten worse, especially when I awake.
I sleep with a pillow between my knees, but this arrangement isn't addressing what I consider to be faulty position.  There's no pain when I sleep on my back, but I prefer sleeping on my side.
I need help--perhaps only education or retraining.

A Thank you for your inquiry.  The relationship of the pillow and knee pain seems plausible.  The question is why and what is the clinical impression.  Is it a sacral referred pain, a tightened hamstring, a pes anserine bursitis.....  I am at a disadvantage to provide any clinical direction. 

I see that you reside in Florida, how close are you to the Bradenton-Sarasota area?  As both knees have osteoarthritis, why doesn't the right one bother you?  Is there any visible swelling or fluid?  Does the knee "lock-up" on you?  Is it difficult to ascend or descend stairs?  Did you have previous injury to that knee, but not the other knee?  Do you have any systemic joint inflammatory disease?  These are questions to guide me to a clinical impression.

Posted January 17, 2008
Q Joint mobilization as you have done with your son-
My hand surgeon and therapists have read your description of this technique and remain puzzled.  Is there a video or further instruction available please? We have run into a real block after broken ulna, plates, pins, screws surgery- IMMOBILIZATION! Joints? Tendons? Help!
I'm just about ready to drive the 1200 miles to see you in person if you can't communicate with my Dr. Clayton Peimer at Orthopaedic Surgery Assoc. of Marquette. ph 906-288-7020.

A Thanks for your inquiry.  The technique was a result of a great desire to help my son with an intensive review of the physics of movement in the wrist compartment and much intuitive experimentation.  The end result was a "blessing" as I call it and the ability to "sense" the injury and the malalignments that I "feel".  I could do a video, but it would never substitute the technique, as each wrist problem is unique. I have been able to cross teach my therapists, as we see many wrists, and I am able to check their work and results.  Additionally, although a physician, I do manual adjustments and alignments on all my patient's, which is not taught in medical schools.  However, if you have screws, pins or plates in the wrists, I am less optimistic in an excellent result, but usually, I can improve the functional range and strength of the hand and fingers.  Please write back with more information on your specific situation.

Q....You are very kind to take the time to reply. If it would help to send X-rays we could do that. But I think, as you say, that much of this would be educated intuition that you would know more by feel. I am working with a naturopath, a massage therapist with cranio-sacral and myofafial treatments, as well as Sports Medicine. We are all learning by trial and error what works and what doesn't with my particular break, immobilization, therapy and what-all. I have greater function than when I wrote to you a week ago.

I am a 62 year old female, quite healthy and active. Take no drugs except some pain meds for this problem (details below). I take nutritional supplements and eat well. (more below on diet) I'm 5' 5 1/2" tall, 160 lbs. I run a small publishing/mail order company which keeps me hopping between 3 x weekly trips to town for PT and massages and such.
The thing that drives me nearly nuts is the incessant burning electrical nerve-ending pain in my entire thumb and area on down to the base. I believe this majorly results from constriction due to the sewing up the incision. It pulled kind of a tight "rubber band" effect around the base of my hand. From this has come from restricted tendons, weakened muscle and tissue adhesions which we are all working at releasing. There is a small spot on the inner side of my thumb near the nail that does not constantly burn. Progress, I guess. Working on releasing the stuck tissue, results in hot tissue-burn for some time following these exercises.
The actual wrist movement is slow to come. Rotation is a bit better- up to 30 degrees- than the "bye-bye" movement. (Don't the the term for that move.)
The best thing is hydrotherapy- with the jet used as a massage- in about 105 degree water. This loosens things up more than anything, then onto exercises.
I discovered a little trick a week or so ago. While soaking in hot sink water, I gently massaged the back of my wrist, and my stiff fingers curled right under nice as you please. Fore-finger and middle finger are most restricted...with the fore-being the tightest. Thumb is extremely restricted. The first joint is quite swollen and acting quite arthritic. It's frustrating that the stiffness of my fingers so quickly returns (in minutes!) after therapy that frees them up to some degree.
Speaking of which----I have studied anti-inflammatory and inflammatory food listings, and have pretty thoroughly eliminated all grains and sugar from my diet. I eat fruit, berries, vegetables, fish and chicken.

Breakfast and lunch is my "morning drink" of berries, Kefir, raw organic eggs, whey protein/aminos, and blueberry or pomogranite juice. This diet has kept inflammation/swelling down without having to take drugs. I also have ever-so-much less acid reflux, no knee or other joint pain, and I've lost 20 pounds, and have less mucous/runny nose, etc. Many benefits! For pain, I still take some hydrocodone with ibuprofin zero-to-3 times per day, depending on intensity of therapies.

This is more than you likely have time to fuss with, but if we are still considerably wrist-restricted in a few more weeks, I may just wish to drive to Florida to see you! It's been nearly 10 weeks since surgery, Oct 30th. some say this isn't so bad considering the time so far.
If you'd like to speak with my doctor on a consulting basis...if you think it would be of value, please tell me. I'll see if my insurance would cover it. I think it would. I have $2,500 annual I'm in for over 5 grand out of pocket now. Sure glad I got the major medical last spring!

A.....You are fortunate to have found such a team of healers that are focusing on your condition.  You are correct, my gift is the feel.  Surgical stabilization has succeeded in what it was intended to fix.  However, as such a force created did fracture the large two bones of your distal forearm, one can only envision the ligamentous tears, the internal bleeding of the trauma, yet alone the shift of the smaller eight wrist bones, the carpals. 

You may have a valid observation of surgical scar tightness at the base of the thumb, however, the base of the thumb exerts the most force, or torque and needs to be stable. One could consider an injection of a very small dose of cortisone into the scar tissue to promote some movement, but I leave this to the discretion of the surgeon or hand specialist.  X-rays may not show the subtle shifts of the carpal bones, again my blessing is the "feel" component of having worked with many wrists over the years.

You are welcome to visit me at my clinic in Florida.
Posted January 14, 2008

Q In August 2006 I had lateral epicondile on my elbow in continued to experience problems with pain and found another surgeon.

My new doctor explained that he felt other issues were going on and ordered mri,s and emg,s which showed ulnar nerve damage.

And failed tennis elbow surgery. In December I had tennis elbow, ulnar nerve decompression and radial nerve decompression, I'm still in a lot of pain please help.

A Your condition underwent comprehensive evaluation.  The surgery was based on this finding.  Occasionally I have found that the elbow joint shifts slightly and causes strains on the tendons and ligaments. 

Usually this occurs from striking the elbow, but can also occur through repetitive motion.  You may start by finding a local osteopathic physician or chiropractor that has experience in elbow alignment. 

Before you schedule a visit, inquire whether they "adjust" the elbow joint.  If they imply that the elbow joint does not need adjusting, just move on to find a physician who is familiar with elbow adjusting.  The adjustment is very simple, non painful and takes 2 seconds or less.  Hope this helps.



Sports Medicine Home | About Dr. Kochno | Sports Medicine: Clinical Articles | Physiatrist | Services | Kinesiology | Patient Info | Contact | Referral Process  | Press Release | Site Map | Search | Privacy Policy | Blog

 Copyright © 2004 - 2013 Sports Medicine And Rehabilitation, Bradenton FL