At The Stone Clinic, we think about it all the time. We are passionate believers in the power of the human body to fix itself. After all, we have several hundred thousand years of evolution on our side; our cells know what they are doing.  To us, it makes sense that if we give our extraordinary human body a nudge in the right direction, it will to do what it does best: regenerate and repair.  Simply put, if we can replace worn out tissues with new natural ones, then the injured joints have a better chance to perform like new.

(If you cannot view the video, here is a link! Why Biologics Trump Bionics)
Biologics

We take a natural, biologic approach to healing joints. Rather than using artificial materials, our goal is to figure our how our body responds to an injury and then stimulate that response, making it faster and more directed. For instance for the arthritic knee joint,  we re-grow the articular cartilage using our stem cell paste graft technique, replace the missing meniscus with  a new natural meniscus cartilage,  and  re-build the ligaments of the knee in order to stabilize the joint.  Our patients then progress to sports and other strenuous activities on the body’s natural shock absorbers.

Bionics

“Bionic” or artificial materials are superb for replacing completely worn out body parts in joints, but they are not quite as good as the natural thing.  Bionic may sound super human but as far as we’re concerned, nothing can beat biology except when there is no choice, such as complete bone on bone wear throughout the knee joint. We use total artificial joints sparingly.  Often we can replace part of the knee, called a Uni, which is like capping tooth rather than a complete set of dentures. Out total and our partial joint replacement patients are encouraged to return to non impact sports.  And we warn the patients that all artificial materials will eventually wear out.  But best of all, if we can replace the missing parts with biologic tissue we avoid the wear problems and limitations of metal and plastic.

What it means for patients

Unlike the invasive open surgery required for artificial joint replacements, almost all biologic surgical procedures are arthroscopic outpatient procedures.  However, a biologic approach requires more dedication by the patient in order to protect the tissues while they are healing. This challenges us to design new and novel ways of carefully exercising the joint and the patient to stimulate healing without breaking down the tissue.

20 years of experience

While biologics is on the cutting edge of joint replacement surgery, the techniques we are using we have developed over the last 20 years.. We designed our first articular stem cell grafting in 1991 and did our first meniscus replacement for an arthritic knee in 1995.  Our outcome studies now confirm that the techniques are well founded with long term improvements in pain and function.  Our recent study confirmed return to high level sports for most previously competitive athletes.

Highly specialized

Over the years, the techniques we have pioneered have become more mainstream but in a limited way.  The surgical procedures are relatively technically difficult; the tissues expensive and the rehabilitation team must be highly trained. There are still only a few centers around the world that focus on biologic joint replacement rather than artificial joint replacement.

We’re confident this will change and we hope the change happens quickly because we hate to see people end up with artificial joint replacements who didn’t really need them. You can trust that at The Stone Clinic, we’ll always remain biased towards biology, searching for new and better ways to help our own bodies work to heal us. We believe that biology trumps bionics any day of the week.

Hello again world! We’re excited to re-launch our blog this month, especially since it’s National Arthritis Awareness Month in May and we’ve got a lot to share on how to prevent and treat arthritis. We are determined to put an end to this debilitating condition; it’s a silent, insidious disorder that ruins far too many lives.

Prevention is better than cure

So how about we start by letting you know that if you have osteoarthritis, or if you think you may develop it later, you don’t have to just “suck up” the symptoms or change your life to manage the disorder.  There is something that you can do about it, especially if you catch it early.  You can fill the hole in your cartilage that’s causing the arthritis.  You see, Osteoarthritis (OA) is when the cartilage that protects the end of your bones has worn away and, as a result of bone-on-bone friction, exposed the underlying bone and launched the pain.  When you fill the hole, you reverse the symptoms. Simple as that.

It’s like going to the dentist

Think of it like having a filling at the dentist. You have fillings to prevent holes getting any worse; to stop the decay in its tracks and save the tooth.  Imagine you notice a cavity in one of your teeth and then proceed to watch it get bigger and bigger until it hits a nerve and starts to hurt.  Perhaps you can chew on the other side of your mouth for a bit and then take painkillers to mask the pain and carry on. Meanwhile, the hole keeps growing until eventually it gets so bad you have to have the tooth removed and an implant put in its place. It doesn’t seem like the best course of action, does it?

Well it’s not the best way to deal with arthritis either.  A joint is a little more complicated than a tooth (though don’t tell your dentist we said that), since the hole in the cartilage is more difficult to fill but it’s the same concept: fill the hole to end the pain and to stop the hole getting bigger, causing further damage.

So – how do we patch up cartilage?

We’d like to take all the credit for fixing the hole in the cartilage but the fact is that your body does most of the work.  Let us introduce the stem cell paste graft: A small amount of the patient’s own bone, stem cells (from the patient’s bone marrow) and cartilage is taken out of the knee, smashed into a paste, and impacted back into an arthritic defect in the joint. From there, the knee grows replacement tissue, right inside the joint, taking full advantage of the healing ability of the patient’s own stem cells.

We explain it here in this video:

For a demonstration of the technique in action you can also click this link: Articular Cartilage Paste Graft (Regeneration) Surgical Technique

We believe the best healing is through your own tissues, and that an intervention is an opportunity to not only “heal” but to improve.  Unlike most other authorities on arthritis, The Stone Clinic sees osteoarthritis as a “fixable condition” not an “incurable disease.”  Don’t just suck it up, do something about it.

Read more about arthritis on our arthritis resource page.

September is here and all of us avid skiers and riders are starting to chomp at the bit. But, if you haven’t been keeping your body in good bikini form this summer, now is the time to start whipping it into shape for the slopes. First, work on your leg strength by doing squats, lunges, box step-ups and/or box jumps. You can also do some stair climbing and we recommend taking two at a time (easier on the knee joints and harder on the muscles).

Core strength is also important due to the fact that those trunk muscles (gluts, abs, and muscles along the spine) are the “foundation” from which our extremities move. A strong core equals a strong foundation. My favorite core exercises are: the plank, the bridge, and side planking. These are high endurance-type muscles so instead of repetitions, go for length of time you can hold good form. Both skiing and riding require high levels of cardiovascular endurance so jogging, biking, swimming, or rowing can help build that endurance. If you’ve ever been caught on the flats and had to “pole it,” you know that tricep strength is a bonus. Push-ups, dips, and/or tricep pull-downs will help prepare you for those flat spots. Another area to work on is your balance. Start by testing your own balance on a hard, flat surface and see if you can single-leg balance for at least 60 seconds. If you can, challenge yourself by single-leg balancing on an unstable surface. Another way to challenge your balance or proprioceptive system is by single-leg balancing with your eyes closed. All this preparation will guarantee a more enjoyable ski/snowboarding season and reduce your risk of injury.

See you on the slopes!

The Stone Clinic Team

Have you ever pulled your car into the driveway only to realize you barely remember driving home…..almost like your car had driven itself home…your body on autopilot while your brain was elsewhere, swimming with thoughts, worries, or plans?

Scary, isn’t it?

Have you ever reached the end of a bag of chips only to realize in disbelief that you ate the whole thing? You remember opening the bag and taking out a handful as you reached for your laptop….

Mindless driving has it’s obvious dangers: without proper focus, you could cause a major accident! Mindless eating, albeit much less dramatic, can also cause serious harm to the body. When eating mindlessly, we usually eat far more than we would eat if we were acknowledging the true tastes, sensations, and pleasures derived from the food. Not only does mindless eating cause weight gain due to overeating, it can be a major roadblock in maintaining a healthy weight as it disturbs your body’s natural hunger and satiety cues. These cues are the body’s natural mechanisms to keep your weight in homeostasis – taking in as much energy as is being put out. These messages from the brain tell your body that you are hungry as well as tell your stomach that you feel full and should stop eating.

Mindless eating can trick your mind and body in many different ways. Appetite, for instance, is a very natural part if the hunger cycle. It can be thought of as the emotional component of hunger or as a message from the brain to seek satisfaction and pleasure from food. Natural appetite is a good thing, it ensures that we eat enough when energy is needed, yet also aids us to decline food when our body does not require the fuel. Unfortunately, however, when we eat with distractions, we drown out our appetite cues. This can occur in several different ways:

Firstly, eating mindlessly, especially from an open container holding multiple servings of food, usually results in robotic eating: going through the motions until the food is finished. With this style of eating, we usually eat far more than one serving since we are not paying attention to the quantity we are consuming.

Equally problematic is the way in which we ignore the quality of the food when we eat mindlessly. When distracted, we do not savor and experience the full enjoyment of the food, which usually drives us to eat more in order to achieve the same amount of enjoyment. For example, eating a piece of pizza while checking your email: you may be so distracted by what you are reading or writing that your body barely experiences any pleasure from the pizza. Once you are finished with your email, your body still feels as though it needs nourishment or pleasure. You’ll likely reach for another piece.

Mindless eating also happens during times of procrastination. Sometimes people find themselves opening the fridge when they start to think about the long list of things “to do.” Other people may find themselves prone to snacking while standing up at the kitchen counter……un-motivated to start a chore or prepare for a presentation at work the next day. In these instances, eating serves as a distraction from the inevitable. The eating is masked as a productive activity: we all need to eat, so it doesn’t seem like a waste of time…..yet it certainly is! Eating while procrastinating is often mindless because your thoughts are focused on the task you are dreading rather than the food you are eating. When eating to procrastinate, you are neither acquiring pleasure from the food nor are you any closer to completing your task. This type of eating is often a motivational mechanism with regards to the work to be done rather then a response to genuine hunger cues from the body. No matter how tedious the task is that you are avoiding, consuming calories when your body does not actually need them will result in excess weight gain.

Mindful eating, the healthful contrary to mindless eating, is indeed a lifestyle that takes practice and conscious effort. When working with my clients on mindful eating, I encourage setting small goals such as eating mindfully for two weeks. I ask them to take note of the pleasures, as well as the frustrations, of mindful eating and write them down in a journal. Most importantly, I encourage them to not give up if they slip up. Mindless eating is a habit that most people have been doing for years; it takes time to build up new, healthy habits and lose the old, unhealthy ways. After practicing hard for two or more weeks, it is usually easier for people to incorporate mindful eating into their everyday lives and schedules. Try it for yourself!

Rather than consuming food while paying attention to other thoughts or tasks, eating mindfully requires that you place your full attention on your food. When you eat, savor each bite; experience it with each of the five senses. Take note of the smell of the food or the way it looks on your plate. Take note of the sounds the food makes, such as the crunch of a juicy apple. Acknowledge the tastes and textures of the food and the way it fills you and fuels you.

To some readers, the concept of mindful eating may seem implausible in a busy work week. However, it is crucial to realize the importance of mindful eating in long-term weight maintenance. Before embarking on a lifestyle change, it is important to make a plan to ensure your success. Take 10 minutes to contemplate what changes you may need to take in order to eat mindfully. Perhaps you will need to wake up 15 minutes earlier, log-in to Facebook less often, or alert your friends and co-workers that you may take slightly longer to respond to emails as you will no longer be using your smartphone over lunch. Whatever it is you need to do, set yourself up for success! By consciously enjoying your food, you’ll likely find you experience more pleasure from eating and need less food overall.

Guest Blog by: Barb Lankamp, MFTI

Principles of Orthotics

Foot pain, ankle pain, knee pain, and even back pain are all common problems that can often be significantly improved with orthotic intervention or sometimes more simply, through appropriate footwear. Plantar fasciitis, chronic patellofemoral pain, heel pain, foot and ankle tendonitis, and low back pain are just some of the diagnoses that can be helped with orthotic intervention.

What are the Best Athletic Shoes?

The answer actually depends on your foot type and of course, your sport. Feet fall into one of three main types:

Pronator – Those with a very low arch or flat foot.

Supinator – Those with a high arch and generally rigid foot.

Neutral – Those whose foot in within what is considered normal.

Pronators usually do better with a more supportive shoe with a medium arch for support. Supinators tend to do better with a cushioned shoe that does not try to correct the foot, but only accommodates it and helps it better absorb shock.  Runners need to be especially aware of their foot type and need to choose the appropriate brand, style, and fit based on their foot type.  Many running injuries could be prevented if the person had chosen the correct shoe to begin with.

The Stone Clinic recommends that people with osteoarthris and other knee problems wear a running shoe for day-to-day activity even if they never intend to run.  The clinicians at The Stone Clinic can help you decide what type of foot you have and which brand and style would be best for you.

Do You Need Orthotics?

Orthotics are used when it is necessary to influence the function of the foot to a greater extent than a shoe itself could do. The device is a small insert placed in the bed of your shoe that helps to make the foot more efficient and therefore, reduce stress through the foot and lower body. A thorough evaluation by a physical therapist trained in orthotic fabrication is the best way to find out if you need orthotics. If you have large or many calluses on your feet or bunions, or if you wear out your shoes in odd ways, you will most likely benefit from orthotics.   The therapists at The Stone Clinic will look at your feet, ankles, knees, hips, and low back to determine what type of intervention may be necessary for you.

Laura Keller, MPT

CrossFit Training for Triathlons

Cross training using strength training while training for triathlons is important for building strength and power that will correlate to better performance during competition. Using CrossFit workouts allows an athlete to build lower body power and trunk stabilization while incorporating plyometrics and sprint drills that will translate to improved strength and endurance with running, cycling, and swimming. Using CrossFit workouts at a high intensity, while constantly varying parameters of the workout, is an efficient and effective way to cross train in association with long, sustained running, cycling, and swimming workouts specifically designed for triathlon training. It is important to have adequate strength that can be built through cross training with CrossFit workouts to maintain technique with long-endurance activities associated with triathlon events so you can avoid injury and inefficient energy expenditure.

- David Birkey, DPT, CrossFit Level One Certified Trainer

Barefoot Running

Barefoot running has gained popularity in recent times, especially after the book “”Born to Run”" has become available. Also, the introduction of the Vibram 5-finger shoe has sparked interest in running with the idea of minimal protective footwear.

The concept of barefoot running is based on the utilization of natural foot mechanics. The human foot naturally strikes the ground at the midfoot, absborbing the shock and dispersing it throughout the foot as the remainder of the foot rolls through the great toe to push-off. The addition of a sneaker onto the foot decreases the awareness of the foot as it strikes the ground and also alters the mechanics so that the heel strikes first. Repetitive heel striking may lead to pathology in the foot itself and possibly up the kinetic chain of the leg.

Tricia Fong, MSPT, COMT

Aging and Avoiding Injuries

As we age, our tissues become less elastic and are more prone to injury due to tearing. Although this fact is somewhat depressing, there are things we can do to avoid injuries. Some of these things are: keeping your body hydrated, eating right/good nutrition, having a strong core, having good flexibility, and having a fit cardio-vascular system.

Drinking water and staying hydrated is so important because our tissues are mostly made up of water. Every organ in our body relies on water; it is our life source.

Good nutrition is also just as important. The cells of our body are constantly turning over – meaning breaking down (catabolic processes) and building-up (anabolic processes). As we age, the catabolic processes vs anabolic processes proceed like a bell curve so that at approximately the age of 30, things are breaking down faster than things are building-up. Nutrition can help give our bodies the necessary ingredients for building-up. For instance, building muscle requires protein, and therefore, we need the right amount of protein in our diet for this building to occur.

Having a strong core can help with avoiding injuries because the “core” muscles are the foundation muscles from which our limbs move. Although most people think of the core as just the abdominal muscles, there are many other trunk muscles that are included. If these muscles are strong, they protect the spine and improve the mechanics of our moving limbs.

Flexibilty is also important for avoiding injuries because if our muscles are too tight, they can tear more readily. For example, think of a baseball player sprinting to 1st base. The act of sprinting requires quick and explosive contraction of the hamstring muscles. If the muscles are already too short due to poor flexibility, the hamstring is more likely to tear.

Having a good cardiovascular system is also key to avoiding injuries. This system is the transportation system of our bodies. It transports nutrients for the healing of damaged tissues and takes away waste.

These are just some of the ways to stay proactive in order to avoid injuries as we age.

Susanne DeCosterd, MPT