There’s a lot of talk about stem cells, orthobiologics and regenerative medicine in orthopedics. Can they naturally heal tissues and pain? We invite you to join sports medicine physician Dr. Matthew Negaard for a free breakfast and a discussion on evidence-based and practical approaches to stem cells, orthobiologics and regenerative medicine.
This seminar is open to the general public.
Saturday, January 6, 2024 | 9 - 10:30 am
Orthopedic Center of Excellence
10767 Illinois St. Suite A2800, Carmel, IN 46033
Free parking is available in the attached garage.
Within 36 hours of shoulder replacement surgery, U.S. Army veteran Biane Kidwell could tell the procedure had been successful.
“There was a distinct difference between the shoulder pain I had for years and the post-op pain,” says Kidwell, a former paratrooper. “The pain I’d been living with was completely gone.”
As significant as a successful outcome was, being seen and heard by the surgeon who performed it was equally so.
Forté Specialist Offers Treatment Solution
Kidwell says Forté shoulder and elbow specialist Dr. Michael Bender took her concerns seriously during their first meeting. He didn’t shy away from her complex medical history – which resulted from a decade of military service filled with injuries and traumas.
“He did not offer the two demoralizing and insulting responses I most often receive from doctors, which are, ‘You can live with it,” and ‘Nothing’s wrong. You’re just an anxious woman,’” says Kidwell.
Instead, Bender performed a thorough exam of her left shoulder, reviewed prior tests and offered Kidwell a treatment solution – reverse shoulder replacement surgery. Reverse shoulder replacement involves switching the placement of the ball and socket implants. It is an effective option for patients like Kidwell who have had multiple rotator cuff injuries and surgeries.
Respect and Kindness for Patients with PTSD
Kidwell agreed to the surgery, but she knew there would be challenges to her surgical experience.
She has complex post-traumatic stress disorder, or C-PTSD, and can experience traumatizing flashbacks as she awakens from surgery.
“More than 50 surgeries have taught me the best strategies to handle these flashbacks, so prior to surgery, I share them with my surgeon and anesthesiologist,” says Kidwell. “They include using my first name and telling me I’m safe.”
After surgery, Kidwell’s shoulder was wrapped in a shoulder sling and ice wrap that enveloped her entire shoulder, front and back. She says she felt trapped as she started to wake up, which caused a panic attack and then a distressing flashback.
“I panicked and tried to remove the sling and ice wrap,” says Kidwell. “I tried to get out of bed, thinking I needed to escape, and suddenly, Dr. Bender was there.”
“What broke through the fear and panic was his calm manner, respect and kindness,” she continues. “There was zero recrimination – no yelling at me to calm down. He swiftly removed the sling and ice wrap, all the while talking to me gently and telling me I was safe.”
Kidwell says the C-PTSD-fueled panic attack and flashback receded within minutes.
“I cannot adequately express how unusual his response was,” says Kidwell. “In my experience, most medical personnel bark at you to ‘Just calm down!’”
Kidwell says she highly recommends Bender for his surgical skill, caring demeanor and ability to handle PTSD-triggered reactions post-surgery.
Looking to the Future from a Place of Gratitude
Kidwell is four months into her recovery and says Dr. Bender’s work has greatly improved her quality of life.
“I can now reach above my head into a cabinet, do yoga within current physical therapy guidelines and flip down the sun visor while driving,” says Kidwell. “It all seems so simple, but it matters.”
The former paratrooper is nearing the end of PT and setting new goals, such as skydiving again if given the okay by her doctors, gardening and returning to daily hiking. She is also considering a return to work as a patient advocate, a job she held in the past.
As Kidwell looks to the future, she’s doing so from a place of deep gratitude and renewed hope.
“When we encounter people who treat us with dignity, respect and kindness, we need to speak up and say thank you,” she says. “I am thankful Dr. Bender accepted me as a patient. He chose to say, ‘I think this can be fixed,’ and then he did just that.”
As of publication, U.S. Army veteran Biane Kidwell is four months into her recovery from reverse shoulder replacement on her left shoulder. She is also recovering after receiving VA approval for a procedure on her right shoulder, also performed by Dr. Bender.
It’s no secret orthopedic patients can sometimes wait weeks or months to be seen by a physician.
As Carmel resident Terry Lewkoski knows all too well, the wait is inconvenient at best and can affect your health.
Lewkoski suffers from gout, a common form of joint arthritis that can be extremely painful and life-limiting. When it flared up over the summer, his feet were red, tender and swollen. He struggled to put on shoes, let alone participate in the activities he enjoys, such as taking walks and driving his vintage Mustangs.
“When I contacted a physician’s office, the earliest appointment I could make was almost three weeks out,” says Lewkoski.
Forté Fast Makes It Easy to Get a Same Day Doctor’s Appointment
As his condition worsened, a family friend suggested he reach out to Forté Sports Medicine and Orthopedics. Lewkoski decided to forgo a phone call in favor of driving over to the Carmel location and pleading his case in person.
From the beginning, he says, the experience felt different.
“As I pulled up, the building was impressive, and there was plenty of covered parking,” says Lewkoski. “At that point in time, both of my feet were bothering me, so I appreciated the short walk into the reception area, which was bright and spacious.”
Perhaps most importantly, Lewkoski didn’t have to make his case for an appointment. He soon learned Forté offered an alternative to the standard appointment-making process with its walk-in expert-level orthopedic urgent care clinic known as Forté Fast.
“To my surprise, I was advised to take the elevator to the third-floor walk-in clinic where I could be seen that day,” says Lewkoski. “When I arrived, there were several people waiting to check me in, and boom, I was on my way.”
“I didn’t even finish the questionnaire before they called me back,” he adds.
Same-Day Convenient Services Under One Roof
In addition to a same-day exam with a fellowship-trained physician, Forté Fast offers convenient access to services, such as rehab, imaging, bracing, medical supplies and more.
“Right after I sat down to wait for an X-ray, another gentleman sat beside me,” says Lewkoski. “We didn’t even finish a two-minute conversation before we were taken back for imaging and then led to exam rooms. I can’t say enough about the process.”
Lewkoski soon realized the Forté Fast experience was not only quick but also thorough.
“I was seen by Dr. Matthew Negaard, who walked in and immediately put up the X-rays to look at them with me,” says Lewkoski. “He showed me there were no stress fractures and that it was clearly a case of gout.”
Negaard suggested Lewkoski try an over-the-counter anti-inflammatory gel and oral medication to relieve the pain and swelling.
“A benefit of getting the expert-level care at Forté Fast is that it does help a patient’s overall recovery by starting the healing process faster,” says Negaard, an emergency medicine and fellowship-trained sports medicine physician who serves as the medical director of Forté Fast. “The sooner we have a diagnosis, the sooner we can implement a treatment plan.”
Lewkoski was equally impressed during his follow-up visit when he showed Negaard how some shoes had been irritating his feet.
“He called down to the in-house pharmacy to request a gel pad, and by the time I got there, it was ready and waiting,” says Lewkoski.
Free from gout pain, Lewkoski soon returned to the things he enjoys, such as hitting his benchmark of 12,000 to 15,000 steps a day. He also climbed back behind the wheel of his Mustangs – including one of the first 9,000 ever produced.
“You use both feet for the accelerator and clutch,” explains Lewkoski. “Yesterday, I was out driving and had no problems shifting, engaging the clutch and things like that.”
He says his only regret is not visiting Forté Fast sooner.
“From the beginning, I felt like – wow, this is different,” says Lewkoski. “I never anticipated being seen that day.”
“Should I have any future orthopedic issues or gout flare-ups, I now have a group of professionals close to home that I can call upon,” he says.
For more information about Forté Fast Orthopedic Care, including walk-in hours for all three locations in Carmel, Noblesville and Greenwood, visit forteortho.com.
Adam Munoz is learning what it takes to be a sports medicine physician for professional athletes.
Throughout August, the medical student from Morehouse School of Medicine in Atlanta joined Forté physicians on the sidelines of the Indianapolis Colts’ training camp. While most of his time was spent observing and caring for the players, Munoz also got to know some of the athletes on a personal level.
“The players are hilarious,” says Munoz. “They’re very inviting. They were interested in why I was here, and they were supportive, too.”
A temporary addition to the sidelines, Munoz was one of 32 students from 19 medical schools selected to participate in the 2023 NFL Diversity in Sports Medicine Pipeline Initiative.
The program places students with an NFL team for a one-month clinical rotation. Its overall aim is to increase and diversify the pipeline of those interested in sports medicine careers and, over time, help diversify NFL club medical staff.
“There was an interview process, and Adam was embedded with us for training camp,” says Dr. Peter Maiers, a sports medicine specialist at Forté and the head team physician for the Colts. “He received broad exposure to all aspects of healthcare and what’s provided to NFL players.”
“It was a great opportunity,” adds Munoz. “We had the chance to get onto the field, see what it’s like to be a sports medicine doc working with NFL teams and experience some behind-the-scenes action.”
On the Sidelines and in the Clinic with Forté Physicians
For nearly 40 years, Forté physicians have served on the Indianapolis Colts’ sports medicine roster, helping the team’s injured athletes get back to play quickly and safely.
Under the supervision of Forté physicians and the team’s athletic trainers, Munoz gained a better understanding of return-to-play guidelines and on-field treatment considerations for NFL players. He also had access to the clinical side of sports medicine.
“It was an incredible experience,” says Munoz. “In addition to working with the players, I got to see what it’s like to help some of Forté’s patients who aren’t professional athletes and learn how the physicians translate what they do on the field to what they do in the clinic.”
An Added Focus on Mental Health
Initially a film and video major before deciding to pursue medicine, Munoz has developed an interest in sports psychiatry, a medical specialty that focuses on the mental health of athletes. When the Colts’ team physicians at Forté learned of his career focus, they helped ensure he made the most of his unique opportunity.
“They paired me up with some of the sports psychiatrists, so I got to do sports medicine from the physical aspect but also the mental aspect,” says Munoz.
In recent years, the NFL has increased its focus on mental health. Each team has staff trained in spotting, treating and preventing mental health disorders and teaching athletes techniques to help enhance their performance.
“The Colts organization has placed an emphasis on having mental health resources available for their players who are not only dealing with an injury but also just dealing with the stress of being a young man in a high-stress situation,” says Maiers. “The Colts have been very supportive of that for their athletes and the organization as a whole.”
“It can be devastating psychologically to have an injury,” adds Munoz. “Having a good mental outlook can help progress your recovery, and I think it helps speed up the physical process.”
Following his clinical rotation with the Colts, Munoz headed back to medical school in Atlanta where he’s on track to graduate in May 2024. As he embarks on his own career, he’ll be taking the memories and lessons of this experience with him.
“Working with the Forté physicians was wonderful,” says Munoz. “They asked me questions and made sure my knowledge was up to date. They were also super supportive and got me involved as much as possible.”
“It was an honor to help mentor him and hopefully provide some guidance as to what path he may choose for his career,” says Maiers.
Want to Learn More?
Forté has a section of its website dedicated to helping you learn more about its sports medicine and orthopedics team, which is nationally known for the care it provides professional, collegiate and high school athletes. Visit the sports medicine page to read about team specializations, treatment methods and more.
For more information about the NFL Diversity in Sports Medicine Pipeline Initiative, visit NFL.com.
Runners are often on the lookout for the latest and greatest footwear to help them run longer, faster and pain-free. With so many options available, it’s hard to know where to start.
Forté’s Run Fit program is designed to help, beginning with an evaluation and assessment designed specifically for runners.
“We look at your range of motion, flexibility, strength and several functional tests related to running,” says Brian Armstrong, a physical therapist and member of the Forté Run Fit team. “We then pair that information with a slow-motion video gait analysis to offer exercises and corrections to running mechanics that improve performance and help prevent injuries.”
“Many patients will also ask how to choose the right footwear,” continues Armstrong. “We make recommendations based on mechanics, previous injury history and performance goals, and then we turn to our partners at Athletic Annex to help patients decide what brand and style of shoe would work best based on what they’re trying to accomplish.”
The Science of Shoe Selection
With advanced technology and extensive knowledge of how different shoe brands fit, the staff at Athletic Annex, a specialty running store located in Carmel, Fishers and Nora Plaza, are experts at guiding patients through fittings.
“With the help of our 3D foot scanner, we can quickly narrow down the brands and models that will work best for you based on your arch, instep and foot width,” says Carmel store manager Jake Hostetler.
Gait analysis also helps the team at Athletic Annex analyze your running style. Most runners have a neutral style – landing on the outside of their foot and rolling slightly inward. Known as pronation, it’s a natural movement needed to support your arch and absorb shock. It only becomes a problem if you overpronate and roll too far inward or underpronate and roll too far to the outside.
“Typically, a neutral shoe will offer enough structure and support, but if a person has excess movement that could lead to injury, that’s when we want to look at a shoe with more control,” says Hostetler. “From there, it’s personal preference.”
How to Find the Right Fit for You
To help you stress less, Hostetler shares five things to keep in mind the next time you’re looking for the perfect running shoe.
Ultimately, finding the perfect fit can affect more than a person’s performance.
“We see a lot of customers who are at a point in their lives when they’re going through injury or trying to make a change through exercising,” says Hostetler. “If we can get them into the right product, we know we can make a difference in their lives.”
Both Athletic Annex and the team at Forté aim to begin that process by empowering you with personalized shoe options and recommendations.
“We’re not so strict that we’re going to say you have to be in this shoe,” says Armstrong. “We highly recommend that you try two or three options and see what works best to help you succeed.”
To make an appointment at one of our three Forté Run Fit locations in Carmel, Noblesville and Greenwood, call 317.817.1200.
Dr. Stephen Ritter debuted Stryker's Q Guidance System for spine patients in Indiana. The Q Guidience System produces real-time, 3D models of a patient’s spine, allowing him to operate through a small incision vs a big open surgery.
For patients who suffer from chronic pain, including symptoms related to complex regional pain syndrome or CRPS, rehabilitation and physical therapy are key to decreasing pain, increasing functionality and improving a person’s overall quality of life. But at Forté Sports Medicine and Orthopedics, we know that engaging in movement and activities alone isn’t always enough.
An additional way to help relieve chronic pain symptoms is to provide non-painful sensory signals to the brain through Graded Motor Imagery or GMI therapy.
“Patients tend to connect movement with their pain,” says Chris Gray, a physical therapist and board-certified orthopedic clinical specialist at Forté. “The benefit of incorporating GMI therapy is that it can help give those patients a positive experience with movement.”
Let’s look at the three different treatment techniques used in GMI therapy and what research shows about their effectiveness.
Left/Right Discrimination Training
The first treatment technique GMI therapy uses is left/right discrimination training. It focuses on the ability to quickly and accurately identify an image of a body part as either the left or right side. Research shows those who suffer from chronic pain can struggle with the task.
“It’s going to take them longer to identify which one’s right or left,” says Gray. “They’re going to have a higher percentage of error.”
Gray encourages patients to use the Recognise app with games and challenges using left and right discrimination. Patients can see an improvement simply by tapping on left or right images of body parts for five to ten minutes, two to three times a day.
“There’s research to show that it’s not going to take their pain from a ten to a zero, but it will bring it down on the pain scale,” says Gray. “I like to say it softens or brings down the fire just a little bit.”
A second technique of GMI therapy is called imagined movements. It involves thinking about moving a painful limb or body part. The exercise uses similar areas of the brain to those used when a person is actually moving.
“With imagined movements, we do a lot of talking about movements that are painful to the patient,” says Gray. “I want them to go through it in their head – actually doing that activity.”
The third technique, which Gray believes to be the most powerful tool in the GMI therapy toolbox, is mirror therapy. It creates the illusion that your painful limb or body part is moving when it’s not.
Here’s an example of how mirror therapy works. A patient keeps their painful hand behind their back or out of sight while looking in a mirror and focusing on moving their good hand. If they’re close enough to the mirror image, the exercise can help trick the brain into associating the pain-free movement with their painful side.
“I have them start with active range of motion, opposition and squeezing movements,” says Gray. “Our goal is to move into painful things. If writing, keyboarding or lifting weights is painful, we want them to do that with their non-painful side to tell the brain it’s okay to move.”
The Data on GMI Therapy
Gray has seen the effectiveness of GMI therapy firsthand, and the research agrees. Data shows GMI therapy can improve pain ratings, lower disability levels, increase function, and reduce healthcare utilization, such as the need for imaging, surgeries and pain medication. When a patient receives GMI therapy in addition to rehabilitation and physical therapy, research shows the benefits are even greater.
“I look at it as comprehensive care,” says Gray. “If you combine GMI therapy with other treatments, you’re going to get the best outcomes.”
“Our overall goal is to break the pain cycle,” he says. “We want to help patients have a positive experience with movement and get them to confront the fear of bending forward, or whatever the action may be. If we can do that, we can give them a better chance of recovery.”
To learn more about Forté’s rehabilitation services, request an appointment online or call 317-817-1200.
Most of us are familiar with the term “shin splints,” which refers to an achy, tender or sore feeling along the front of your leg that develops as you exercise. But the next time you jump to self-diagnose the pesky but non-emergent condition, it may pay off to take a closer look at your symptoms.
Shin splints can be confused with chronic compartment syndrome, also known as exertional compartment syndrome. Like shin splints, compartment syndrome is exercise-induced, but it differs by causing pain deep in muscles that can routinely prevent you from participating in a chosen sport or activity.
What is compartment syndrome?
The American Academy of Orthopedic Surgeons describes compartment syndrome as causing swelling or bleeding within a compartment in the body. The AAOS notes that because our connective tissue, known as fascia, doesn’t stretch, the condition increases pressure on capillaries, nerves and muscles in the compartment. While compartment syndrome most commonly affects the lower leg, it can also affect the thighs, arms, hands, feet and buttocks.
If you’re suffering from compartment syndrome, you may experience:
Additionally, pain and issues caused by compartment syndrome might follow a pattern, such as starting after a specific time, distance or intensity of your workout, progressively worsening as you exercise, and lessening or stopping completely once your workout ends.
You have a higher risk of developing compartment syndrome if you’re under 30 years old, overtrain your workout frequency or intensity, and participate in a sport involving repetitive impact.
“People who participate in activities such as running or marching are more likely to develop compartment syndrome,” says Dr. Thurman Alvey, sports medicine specialist at Forté Sports Medicine and Orthopedics.
Taking the lead in better understanding compartment syndrome
While the cause of compartment syndrome isn’t fully understood, Alvey is designing a research project to better understand why physicians appear to be treating more cases today than they did 10 years ago.
“It would seem that overtraining, poor flexibility, gait mechanics and growth cycles all play a role,” says Alvey. “Ultimately, none of those issues create tight fascia, but they definitely contribute.”
Examination and treatment
To diagnose compartment syndrome most accurately, Alvey uses a comprehensive testing process designed to reproduce the symptoms and when and how they happen.
“Most occur when running, so we utilize a treadmill-based test,” says Alvey. “If it is from biking, then a similar protocol is used with a stationary bike. Testing is taken into consideration on an individual basis.”
With a diagnosis, Alvey can implement a treatment plan to resolve pain, but typically surgery is the answer to release the compartments.
The team at Forté is standing by to provide an exam and a customized treatment plan so you can start feeling better, faster. Request an appointment online or call 317.817.1200.
For decades, Forté’s athletic trainers have been on the sidelines of major sporting events and athletic contests across the state. Their skills and training in injury prevention, triage, treatment and rehabilitation have benefited athletes of all ages and abilities, from high school and college to youth club sports.
Ensuring everything runs smoothly is a big job, one overseen by Forté’s outreach operations manager, Jillian Hacker. Hacker manages Forté’s partnerships and its team of 35 athletic trainers.
“My main role is that I’m the point person for any partner or event that needs athletic trainers,” says Hacker.
When Hacker receives a request from an organization, she determines how many athletic trainers are needed at the event. She ensures everyone is set up for success – and the safest possible experience.
“For large soccer tournaments, if 40 fields are going, we have 10 athletic trainers who keep an eye on four fields at once,” says Hacker. “We also have a floater so that there is an extra set of hands to come over and help if someone needs it.”
Offering On-Site Sports Medicine
Beyond providing immediate triage at major events, Forté’s athletic trainers are often embedded with teams and clubs, where they work alongside staff to enhance the team experience through services such as:
“One of the biggest benefits we’re able to offer is patient and parent education,” says Hacker. “When a child gets injured, parents want to know the next steps. We can make a recommendation if their child should be rushed to the ER or if they can wait to be seen by an orthopedic specialist.
Forté’s athletic trainers can also provide direct access to a timely appointment with some of the region’s top orthopedic specialists and physical therapists when needed.
“If it’s not an emergency, we can give you tips and tricks to help manage the injury through the weekend and then get you in to see one of Forté’s specialists first thing Monday morning,” says Hacker. “Another benefit of working with Forté is that our partners have access to everything they need, all under one roof.”
Sharing Knowledge and Shifting Perspectives
Forté’s athletic trainers currently serve 10 individual sports organizations, two dance companies, the Indianapolis Colts cheerleaders and six public safety departments.
“It’s been incredible to see the impact on the dancers,” says Hacker. “Most of them grew up without having that athletic trainer or direct access to a physician group. We’re starting to see a shift from ‘if I go to the athletic trainer, I look injured’ to ‘the athletic trainer can help me prevent an injury.’”
No matter the sport or activity, the knowledge possessed and shared by Forté’s athletic trainers can be invaluable to coaches and athletes.
“We can give those in-the-moment evaluations of whether you need to sit out or if you can keep going,” says Hacker. “We know if we can give you some kind of brace, tape or padding to keep you playing or if we need to get you in quickly to be seen by a physician.”
Learn more about Forté’s outreach program online or by calling 317.817.1200.