Traditionally a more common and well-known approach, cortisone injections are used by orthopedic specialists at Forté Sports Medicine and Orthopedics to treat a wide variety of conditions. Derived from a type of steroid called corticosteroids that became popular because of their strong anti-inflammatory properties and instant pain relief, cortisone injections are most commonly administered to reduce joint inflammation and pain and get people back to their everyday activities.

Considered a short-term solution, cortisone injections act as more of a band-aid to the underlying issue and require close monitoring, as frequent usage can cause tissue damage and unwanted side effects. While the injection reduces pain, it typically doesn’t cure the underlying problem causing the inflammation.

What is a cortisone shot good for?

Cortisone shots effectively treat conditions like arthritis, tendonitis and bursitis, among others. These injections target inflammation to relieve acute injuries or chronic conditions causing joint pain. However, since they are not intended for frequent use, your doctor will guide you on how often you can have a cortisone injection to minimize risks. At Forté Sports Medicine and Orthopedics, we administer cortisone judiciously and as part of a broader interventional pain management plan.

What to expect after a cortisone shot?

You may notice initial soreness or swelling at the injection site, which typically subsides within 24 to 48 hours. Many patients experience noticeable pain relief within a few days, but for some, it takes up to a week to feel the full effects. Rest the treated area and avoid strenuous activity for at least 24 hours to allow the medication to work effectively. Your doctor may recommend certain follow-up care or physical therapy to maximize the injection’s benefits.

How long does a cortisone injection last?

Relief from a cortisone shot typically lasts a few weeks to several months, depending on the condition and the individual’s response. Many patients enjoy significant pain reduction and improved mobility during this period, allowing them to participate in physical therapy or other treatments aimed at addressing the root cause of their pain.

Where can I get a cortisone injection?

Forté Sports Medicine and Orthopedics provides cortisone injections, with experienced medical providers administering treatment based on your unique situation. Our locations in Carmel, Greenwood, Noblesville, Mooresville and Tipton, IN, make it easy to access the care you need.

You have had a corticosteroid injection with anesthetic.

• This is an anesthetic (numbing medicine) and a steroid mixed together.
• The anesthetic may help initially with pain and the site of the injections may feel numb for the next 4-6 hours.
• When this medicine wears off, you may have an increase in your pain. Patients often describe this as a "full" or "tight" feeling. Do not be alarmed. This feeling will go away.
• You may not feel relief from the steroid right away. On average, the steroid begins to take its pain-relieving effect in 2-3 days but may take up to 14 days.

Side effects:

You may have some bleeding, a bruise of feel tender at the site. An ice pack or your usual pain medicine may help. Do not use heat for 24 hours. There are side effects that could happen from the steroid medicine. these are much less common than the side effects from oral steroids but include:

• Increase in local pain
• Headaches that go away within 24 hours
• Red or hot face
• Anxiety
• Sleeplessness
• Fever the night of injection
• High blood sugar. If you have diabetes, monitor your blood sugar carefully
• A decrease in your body's ability to resist infections for a short time
• A change in the skin color at the injection site
• Infections can happen but are extremely rare
• Further cartilage or other tissue damage including avascular necrosis

Please call us if any of the following happen:

• Fever over 101 F
• Redness or drainage at the injection site
• Increase in pain at the injection site
• New weakness, numbness or tingling at or below the level of the injections
• Severe headache that does not go away

Activity:

• We may ask you to do physical therapy. Do your therapy as instructed. This will help you get the best results from the injection.
• Restrictions:
  • No strenuous activities on the day of the injection
  • You can gradually re-introduce activity as your pain allows
• Do not submerge the injection site under water for 48 hours. You may shower but no baths or hot tubs where the site would be completely submerged under water.

Our very own Dr. Matthew Negaard specializes in ultrasound-guided injections, PRP treatments, orthobiologics and sports medicine. Whether you’re considering cortisone, PRP, or other treatments, we’ll help you overcome obstacles to achieve the best possible outcomes. Contact us today to request a consultation at one of our offices in Carmel, Greenwood, Noblesville, Mooresville or Tipton, IN.

A hip fracture is more than just a broken bone; it is a serious injury that can impact your mobility, independence, and quality of life. Most often caused by falls or accidents, hip fractures typically require surgery and a structured recovery plan. At Forté Sports Medicine and Orthopedics, we understand how overwhelming this injury can be. That’s why our team of experts provides you with advanced treatment options and personalized recovery plans to help you get back on your feet as safely and quickly as possible.

What is a Hip Fracture?

A hip fracture refers to a break in the upper portion of the femur (thigh bone) near the hip joint. As the longest and strongest bone in the body, the femur typically requires significant force, such as a fall, car accident, or other trauma, to break it. For patients with conditions that can affect bone health, such as advanced age, osteoporosis, or chronic health problems, hip fractures can occur with a simple fall from standing. Most hip fractures require surgical intervention to repair, and recovery can be extensive. It is important to understand that hip fractures are serious and potentially life-altering injuries, especially for older adults.

Types of Hip Fractures?

The hip is a ball-and-socket joint, where the rounded head of the femur fits into the socket of the pelvis. A hip fracture involves any break in the upper part of the femur and is categorized based on the specific location of the break.

• Femoral Neck Fracture: The femoral neck connects the femoral head to the long shaft of the thigh bone. This is the most common site for hip fractures, particularly in older adults.
• Intertrochanteric Fractures: This type of break occurs between two bony projections (the greater and lesser trochanters) just below the femoral neck. These areas are key attachment points for muscles and tendons around the hip.

 “The goal of any treatment is early mobilization and weight bearing.  I want to get people as close to the quality of life they had prior to the accident.”  says Dr. Patrick Laboe, an orthopedic trauma surgeon who specializes in acute fractures and traumatic injuries.

What are Hip Fracture Symptoms?

The most common hip fracture symptoms include falling and being unable to move/get up; others include:

• Groin pain that can radiate to the knee
• Inability to bear weight
• Severe hip pain
• Not being able to move your hip or leg
• Shortening and rotation of the leg

What Can Cause Hip Fractures?

It usually takes a trauma to break your hip, such as a slip or fall. The most common causes of hip fractures include:

• Low energy fall from ground level or standing.
• Falls from ladders or step stools

What are the Risk Factors?

While anyone can experience trauma that results from a hip fracture, certain individuals are at a higher risk, including:

• Adults over the age of 65
• People with health conditions that weaken their bones, such as osteoporosis or osteopenia, diabetes, and chronic kidney failure
• Females (more likely to develop osteoporosis)

Older adults and individuals with weakened bones may sustain a fracture from a small slip or fall. Sometimes, even while performing daily activities. Any medical condition that affects balance, coordination, or walking can increase the risk of hip fractures. Examples include:

• Parkinson’s disease
• Vertigo
• Gait abnormalities
• Chronic health conditions

How Do Healthcare Providers Diagnose a Hip Fracture?

To diagnose a hip fracture, your healthcare provider will start with a physical exam and then confirm the injury using imaging tests. These may include:

• Hip X-ray
• MRI
• CT scan

What Are the Treatment Options for a Hip Fracture?

Surgery is almost always required to repair a fractured hip. The specific type of procedure depends on factors like the location and severity of the break, your age, and overall health. Common surgical treatments include:

• Hip Replacement (Hip Arthroplasty): Most common for patients over 65. This involves replacing part or all the damaged hip joint. You may receive a partial or total hip replacement depending on the fracture type.
• Open Reduction and Internal Fixation (ORIF): In this procedure, your surgeon realigns the broken bones and secures them using metal screws, plates, or an intramedullary nail.

What is the Recovery Time for a Fractured Hip?

Recovery timelines vary from patient to patient, depending on factors like age, overall health, and the type of surgery performed. The goal is early mobilization.  Most individuals will need inpatient rehab or assistance from a skilled nursing facility before they go home to ensure they can go about their daily tasks without help. Most people experienced some initial swelling and discomfort, but pain generally improved within a few weeks. Regaining full strength and mobility may take several months to up to a year. Following your care team’s instructions, including physical therapy and at-home exercises, is key to a successful recovery. We will also schedule regular follow-up appointments for four to six months to monitor progress and set realistic goals.

Contact Forté Sports Medicine and Orthopedics Today

A hip fracture doesn’t have to define your future. At Forté Sports Medicine and Orthopedics, we offer expert surgical care and comprehensive recovery at our location in Greenwood, IN. Contact us today to schedule a consultation and begin the path toward better mobility.

Platelet Rich Plasma (PRP) treatments use concentrated growth factors from your blood that are injected into the area of injury. You will not feel pain relief from the procedure right away, and you will likely experience an increase in discomfort after the procedure. Tendon injections often have a significant increase in pain post procedure that can last several days. Joints can take 6 weeks to start feeling better and tendons can take 8 weeks to start feeling better. Maximum improvement takes place over a period of several months.

Orthobiologic treatments have not been authorized by the FDA and are considered experimental by the FDA.

Discontinue any Anti-Inflammatory anti-platelet medications:

• Advil
• Aleve
• Aspirin
• Celebrex
• Coumadin
• Diclofenac
• Fish Oil
• Ibuprofen
• Meloxicam
• Nabumetone
• Naproxen
• Plavix
• Xarelto
• Do not discontinue antiplatelet therapy without discussing with your primary physician first.

What do I need to prepare for injections:

• Bring a driver
• Bring DME (durable medical equipment) such as: crutches, boots, sling, splint, etc.
• Drink lots of water for 48 hours prior to your injection

Compression:

• If the PRP is in your hip, groin or thigh please bring compression shorts with you.
• We will provide a compression sleeve for all other areas.

Activity:

• Do not submerge the injection site for the first 48 hours following injection. You may shower but no baths or hot tubs where the site would be completely submerged by water.
• Please discuss possible work/activity restrictions prior to the procedure.
• Rest the area for the first 2-3 days.
• No excessive activity for the first 2 weeks.
• Return to activities will be determined by your medical team on the day of the procedure.
• Physical therapy will begin after 1-2 weeks.

Pain Control:

It is common to have pain and swelling after the procedure. Pain often lasts 3-4 days but may last up to 2 weeks after the injection.

Ice:

• You may use ice for pain control 1-2 days after the procedure for 15-20 minutes at a time. Allow at least 30 minutes before repeating.
• Do not use ice after the second day.
• Do not apply heat the first 3-4 days after the injection.

Medications:

• You may use acetaminophen (Tylenol) over the counter if needed.
• Avoid non-steroidal anti-inflammatories (NSAIDs) for at least 2 weeks after and up to 6 weeks after the procedure if able.

Please call us if any of the following happen:

• Fever over 101 degrees F (or 39.0 C)
• Redness or drainage at the injection site
• New weakness, numbness or tingling at or below the level of the injections
• Any other concerns

We are tracking patient clinical outcomes. What does that mean?

We use a secure data tracking system called Data Biologics. You'll receive an email to complete a survey the day of the treatment and a few months post treatment. This data allows us to compare our patient outcomes to other providers across the country to help us better modify our protocols and individualized treatment plans.

Forté Sports Medicine and Orthopedics provides exceptional care tailored to our patients’ needs. With over 40 years of experience, our team of providers and clinicians know the importance of putting patients first. Our flexibility and comprehensive services mean you can see a physician, get diagnostic imaging, and start treatment all in one convenient location. Contact us today to request an appointment.  We’ll help you take the next step toward a pain-free life.

If you have questions on pricing, please click here.

What is ESWT?

ESWT is a procedure where a form of shockwaves are passed through the skin to the injured or painful part of the body. Shockwaves are low-energy sound waves, which work by increasing blood flow to the injured area. This speeds up your body’s healing process. You will usually require a course of 3-6 treatments, 1-2 weeks apart.

Why should I have ESWT?

ESWT is a noninvasive treatment option that is often used in conjunction with physical therapy for tendon, muscle and other soft tissue pain and abnormalities. It is a safe treatment with clinical benefits with no downtime compared to other treatment options.

What are the risks/side effects?

You will experience some discomfort during the treatment, but most patients tolerate this very well. Following the treatment, you may experience more pain, redness, bruising, swelling and numbness to the area in the first 1-3 days. These side effects should resolve within a week, before your next treatment.

You should not receive EWST if you:

• are pregnant
• are taking antiplatelets excluding aspirin 81mgs (for example, Clopidogrel) or anticoagulants (such as Warfarin or Rivaroxaban)
• have a blood clotting disorder
• have open growth plates
• have been diagnosed with bone cancer or are being treated for active cancer
• have an infection in the area of pain
• have a history of tendon or ligament rupture in the area of pain
• have had a steroid injection into the affected area in the previous 12 weeks

These will be discussed with you by your healthcare professional when the treatment is offered. Your doctor will discuss the benefits and risks of the procedure with you in more detail — please let them know if you have any questions or would like any further information.

How can I prepare for ESWT?

You will need to be available for the full course of treatment. Treatments will take 3-7 minutes and are performed 1-2 weeks apart. You should not take any non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, for two weeks before your first procedure, and throughout your treatment if you are able. We recommend the use acetaminophen for pain during the course of treatment.

Who will carry out the procedure?

Your ESWT will be carried out by a fellowship-trained physician who has undertaken special training to carry out the procedure.

What happens during ESWT?

The physician performing the treatment will put ultrasound gel on the injured area and then place the hand piece of the device on the gel. The ESWT is delivered using this hand piece — it delivers compressed air pulses through the ultrasound gel.

Will I feel any pain?

Most patients do experience some pain or discomfort during the procedure. You will be asked how much pain you are experiencing during the treatment, and we will try to adjust the treatment to help manage the pain.

What happens after ESWT?

After the treatment you will be able to get up and walk straight away. If you do experience discomfort following the shockwave treatment, you can take over-the-counter painkillers (such as acetaminophen/Tylenol). Do not take anti-inflammatory medication (such as ibuprofen/Advil, Naproxen/Aleve or Meloxicam) or use ice therapy as these can interfere with the body’s healing process.

What do I need to do after I go home?

You will be able to return to your usual activities including returning to work straight away. However, we advise you not to undertake any strenuous, pain-provoking activity or high-impact exercise for 48 hours after the procedure.

Will I have a follow-up appointment?

You will have a follow-up appointment with your physician to monitor your symptoms and progress.

Is ESWT covered by insurance?

No. ESWT is not covered by insurance companies at this time therefore will be an out-of-pocket expense. Scan the below QR code for pricing options. For additional pricing questions, please call: 317.419.6019.

Are there any studies to support the use of ESWT?

Yes. There are several studies to support the use of ESWT for multiple different conditions. Click the below links for a couple of studies reviewing the use of ESWT.

• Effect of Shockwave Treatment for Management of Upper and Lower Extremity Musculoskeletal Conditions: A Narrative Review
• Extracorporeal Shockwave Therapy in the Management of Sports Medicine Injuries

Forté Sports Medicine and Orthopedics provides exceptional care tailored to our patients’ needs. With over 40 years of experience, our team of providers and clinicians know the importance of putting patients first. Our flexibility and comprehensive services mean you can see a physician, get diagnostic imaging, and start treatment all in one convenient location. Contact us today to request an appointment.  We’ll help you take the next step toward a pain-free life.

What is Regenerative Medicine?

The American Medical Society of Sports Medicine (AMSSM) defines regenerative medicine as an “interdisciplinary therapeutic approach that aims to repair, replace, regenerate, and/or rejuvenate lost, damaged, or diseased cells, tissues, organs to restore or establish normal form and function.”

What are Orthobiologics?

The American Medical Society of Sports Medicine (AMSSM) defines orthobiologics as the “use of biological substances to enhance biological healing of orthopedic injuries or alter the natural course of an orthopedic disease.” Orthobiologic treatments have not been authorized by the FDA and are considered experimental by the FDA.

What are common substances used in regenerative medicine and orthobiologics?

Platelet rich plasma (PRP) is plasma obtained from the patient’s own blood that has a higher platelet concentration than whole blood. Lipoaspirate (MFAT) is obtained from the patient’s adipose tissue which contains a high concentration of mesenchymal signaling cells (MSCs) which are believed to have
anti-inflammatory, proangiogenic, and proliferative effects, though their mechanism is poorly understood. Alpha-2 Macroglobulin (A2M) is a protein that is found in your blood that can help stop the inflammatory and cartilage degradation pathways that cause joint pain and progression of arthritis. A2M can be isolated from your blood through a blood draw and then is injected at higher concentrations into
your painful joint. Perinatal products are often what people think of when a person says they have received a “stem cell” injection. These products are usually derived from umbilical cord blood, amniotic tissues, and Wharton jelly. These are currently not legally available in the United States outside of FDA approved trials.

Are orthobilogic treatments covered by my insurance?

These treatments are currently considered experimental and are not covered by insurance.

What conditions are orthobiologics used to treat?

There are a variety of acute and chronic musculoskeletal conditions that orthobiologics are being used to treat. They are often used to treat osteoarthritis, tendon problems and acute muscle injuries. Ask your physician if your condition or injury could potentially benefit from an orthobiologic treatment.

What experience does Dr. Negaard have with orthobiologics?

Dr. Negaard developed an interest in regenerative medicine early in his medical training and further developed his skills and experience with orthobiologics during his Sports Medicine Fellowship. Since fellowship, he has continued to look for ways to use orthobiologics to help treat his patients. He believes that patients should fully understand the potential benefits, limitations and the scientific studies for
these products on various conditions. Dr. Negaard believes in the basic science, future of the
technology and promise these products have shown to help patients. This is why he remains engaged with up-to-date information in the field by being a member of the American Medical Society for Sports Medicine (AMSSM) subcommittee on regenerative medicine and orthobiologics, in addition to being a member of the Biologics Association. Additionally, Dr. Negaard is actively engaged in research in regenerative medicine and collaborates with colleagues across the country.

Orthobiologic Offerings:

We are tracking patient clinical outcomes. What does that mean?

We use a secure data tracking system called Data Biologics. You'll receive an email to complete a survey the day of the treatment and a few months post treatment. This data allows us to compare our patient outcomes to other providers across the country to help us better modify our protocols and individualized treatment plans.

Forté Sports Medicine and Orthopedics provides exceptional care tailored to our patients’ needs. With over 40 years of experience, our team of providers and clinicians know the importance of putting patients first. Our flexibility and comprehensive services mean you can see a physician, get diagnostic imaging, and start treatment all in one convenient location. Contact us today to request an appointment.  We’ll help you take the next step toward a pain-free life.

What is Arthritis?

Arthritis occurs when the cartilage in your knee wears away. There are two main types of cartilage in your knee, the meniscal cartilage (shock absorbers) and articular cartilage (shiny part at the end of chicken bone). As these types of cartilage wear down, they can lead to knee pain.

Are there different types of Arthritis?

Yes. There are many different types of arthritis with the most common being osteoarthritis. Rheumatoid arthritis, inflammatory (i.e. gout) and post-traumatic arthritis are other common types of arthritis.

What tests are needed to determine if I have Arthritis?

The severity of arthritis can often be seen on x-ray imaging. Sometimes, your physician will collect fluid from the knee to determine if that fluid has crystals in it (i.e. gout) or an infection.

Do I need an MRI of my knee?

An MRI is often not necessary if you have x-ray findings of arthritis. MRI results would likely not change your treatment plan.

Can I still exercise if I have Arthritis?

Yes! Staying fit and active is important for your overall health. Furthermore, running does not appear to accelerate the progression of osteoarthritis if there is adequate rest between runs. Additionally, there are many forms of exercises that do not put as much stress on your joints. These types of exercise are often referred to as “low impact” exercises and include biking, swimming, yoga and many others.

Do supplements help with Arthritis?

There are many different supplements on the market that claim to help with arthritis. To date, there are no definitive studies that show a specific supplement improves arthritis symptoms in the general population. However, some supplements may provide individual benefits.

What are the treatments for knee arthritis?

There are several different treatment options for knee osteoarthritis. Some of the more beneficial treatments can be lifestyle modifications including weight loss, dietary changes and implementing an exercise routine. Physical therapy, topical or oral NSAIDs (naproxen, acetaminophen) and bracing are also often used. There are also many different injection and surgical options.

Why is physical therapy important in knee arthritis?

Physical therapy can help improve pain and range of motion of the knee joint. Additionally, it can provide you with exercises to help strengthen your body to help optimize the function of your knee.

What different type of injections can be performed for knee arthritis?

The most common type of injection for knee arthritis is a corticosteroid injection, often referred to as a “cortisone” injection. Other injections that are performed include viscosupplementation and regenerative medicine / orthobiologic injections.

What are Orthobiologics?

To quote the American Medical Society for Sports Medicine Position Statement: Principles for the Responsible Use of Regenerative Medicine in Sports Medicine, “Orthobiologics are biological substances intended to enhance healing and alter the natural course of orthopaedic disease.” The most common substances used in these treatments include Platelet Rich Plasma (PRP), “stem cells,” lipoaspirate and
bone marrow concentrate (BMAC). This is a rapidly advancing field with ongoing research thus these
treatments are still considered experimental and are not covered by insurance.
*Are you interested in enrolling in our orthobiologic study for knee arthritis? If so, ask your treating team for more information.

How do I know if I am ready for a knee replacement?

Only you can decide when you are ready for a knee replacement. We often tell people that if they are unable to do the things they want to do in life because of their knee pain despite conservative treatments, they should meet with one of our joint replacement surgeons to discuss their options.

What does a knee replacement surgery look like?

This is a great question. We recommend you meet with one of our joint replacement surgeons to discuss what a joint replacement surgery would entail for you including the procedure in detail, time in the hospital, time off work, activity level post-surgery and any other questions you might have.

Forté Sports Medicine and Orthopedics provides exceptional care tailored to our patients’ needs. With over 40 years of experience, our team of providers and clinicians know the importance of putting patients first. Our flexibility and comprehensive services mean you can see a physician, get diagnostic imaging, and start treatment all in one convenient location. Contact us today to request an appointment.  We’ll help you take the next step toward a pain-free life.

What is a concussion?

A concussion is a mild traumatic brain injury (mTBI) caused by biomechanical force transmitted to the brain from a direct blow to the head, neck, or body. This trauma can lead to rapid onset of symptoms that typically resolve spontaneously within a few weeks. However, some individuals may experience persistent symptoms lasting several months.

How is a concussion diagnosed?

Concussions are diagnosed through clinical evaluation by a licensed healthcare provider trained in
concussion management. The assessment includes a thorough history, symptom checklist, cognitive evaluation (such as orientation, memory, and concentration tests), balance assessments , and a neurological examination. Neuroimaging, such as a CT scan or MRI, is not routinely required unless there is suspicion of a more severe injury such as a brain bleed.

Why is it dangerous to play sports with a concussion?

Continuing to participate in sports while experiencing concussion symptoms increases the risk of sustaining another concussion, which can lead to more severe and prolonged symptoms, delayed recovery, and in rare cases, catastrophic outcomes like second impact syndrome. It is
crucial to allow the brain to heal completely before resuming contact activities.

How long should I rest after a concussion?

Strict rest, often described as sitting in a dark room, until symptoms resolve after a concussion is no longer recommended. Relative rest for the first 24-48 hours is now recommended. Relative rest allows and encourages activities of daily living while not exacerbating symptoms.

What are the recommendations for limiting screen time after a concussion?

The current recommendations are to reduce screen time for the first 48 hours after sustaining a concussion. Activities like watching TV, using computers, or smartphones may increase
cognitive load and should be reduced for 48 hours. A gradual reintroduction of screen time is advised based on individual tolerance.

What is the average return to school after a concussion?

We encourage students to return to school three days after a concussion, if not sooner. A gradual return-to-learn strategy (RTL) is recommended, starting with partial attendance or reduced cognitive load and progressively increasing as tolerated. The average return to learn without academic support is 10 days.

What is the average return to sport after a concussion?

The return-to-sports (RTS) timeline is highly variable and will depend on each individual’s response to treatment. The average return to sport for athletes recovering from a concussion is approximately 20 days. The initial symptom score is the strongest predictor of the duration of symptoms. The return-to-play process involves a stepwise progression that is mandated by the Indiana High School Athletic Association and consistent with international concussion guidelines. Athletes progress through each stage of the return-to-play progression under the guidance of their athletic trainer and/or physical therapist in communication with the treating provider. Returning to team practice will only begin after being symptom free.

How can exercise & physical therapy help with concussion recovery?

Exercise
Under the guidance of a healthcare professional, engaging in light aerobic activities that do not exacerbate symptoms may promote recovery and reduce the risk of prolonged symptoms. Emerging evidence suggests that controlled, light aerobic exercise beginning as early as one day post injury can aid in concussion recovery and reduce the risk of having prolonged symptoms beyond 28 days. We often
recommend to start going on walks and progressively increase the intensity of aerobic exercise as tolerated.

Physical Therapy
Physical therapy, particularly vestibular and cervical spine therapy, can be beneficial for individuals experiencing persistent symptoms such as dizziness, balance issues or neck pain following a concussion. We will refer you to a physical therapist trained in concussion management to
develop a personalized treatment plan if we believe it will be beneficial for you.

Is it safe to take OTC meds for symptoms?

Over the counter medications such as acetaminophen, naproxen, or ibuprofen can help with symptom management after initial evaluation.

Can protective equipment help prevent concussion?

While helmets, mouth guards and other protective gear can reduce the risk of severe head injuries and orofacial injuries, they have not been shown to consistently reduce the risk of concussions across all sports. Mouth guards have been shown to reduce the risk of concussion in ice hockey but have not
shown consistent results of reducing concussion in other sports. Proper fitting helmets and approved helmets in NFL players have shown trends that may decrease the rate of concussion. Jugular vein compression devices have been studied in ice hockey and football and have not shown to
reduce the head impact severity.

When should I consider disqualification from sport because of concussion?

There are no universal guidelines for disqualifying an athlete from sports due to concussions. Decisions should be individualized, considering factors such as the number of concussions sustained increase concussibility, symptom severity, duration of symptoms and the athlete's medical history.

Contact Forté Sports Medicine and Orthopedics

Forté Sports Medicine and Orthopedics provides exceptional care tailored to our patients’ needs. With over 40 years of experience, our team of providers and clinicians know the importance of putting patients first. Our flexibility and comprehensive services mean you can see a physician, get diagnostic imaging, and start treatment all in one convenient location. Contact us today to request an appointment.  We’ll help you take the next step toward a pain-free life.

Dr. Joseph Maratt, Forté Sports Medicine and Orthopedics hip and knee replacement surgeon, has advanced training in hip replacement, knee replacement and robotics in joint replacement. An early adopter of robotic surgery over a decade ago, he has been involved in the development of robotic and navigation systems to improve patient care. He is a pioneer in the use of muscle-sparing approaches with robotic knee replacement and has taught surgeons across the country in the use of these techniques.

The Subvastus Approach: A Smarter Approach to Total Knee Arthroplasty (TKA) If you’re considering knee replacement, you’re likely focused on one thing: getting back to your life with as little pain and recovery time as possible. At Forté Sports Medicine and Orthopedics, Dr. Joseph Maratt offers muscle–sparing surgical technique – the subvastus approach. When paired with advanced tools like robotic assistance and kinematic alignment, it represents the next generation of personalized knee replacement care. 

An Overview of the Subvastus Approach 

Knee replacement is typically done through a medial parapatellar approach or a midvastus approach. These approaches cut either the quad tendon or the vastus medialis muscle, respectively. The subvastus approach, however, avoids cutting either of these by entering the joint medially and under the entire quad muscle. This muscle-sparing approach causes less trauma and pain in the early period following surgery. The early period, as it turns out, is not just a matter of a couple of weeks of benefits. The early period being better sets the stage for the months of recovery that follow. 

How Does the Subvastus Approach Differ from Traditional Knee Replacement Techniques? 

The primary difference of the subvastus approach to a knee replacement is that it is muscle sparing. When combined with a torniquet-free, robotic, kinematic approach for total knee replacement, this technique provides patients with the least amount of tissue (less ischemia from tourniquet, less releases of tissue to balance knee) and muscle damage possible during a total knee arthroplasty. All these choices together, along with our prep and recovery pathway, make this knee replacement approach better than previous options. 

 Am I a Good Candidate for the Subvastus Approach?

While 99% of patients can have a total knee arthroplasty with the subvastus approach, it is best to decide together with a physician on the approach that is best for you. 

What is the Recovery Time for the Subvastus Approach?

Patients typically stand and walk on the day of surgery, and off assistive devices within a few days. Patients will see marked improvements within a few weeks and be back to almost all activities by three months postoperatively. Patients will feel better as recovery progresses, but we advise not to overdo it. 

What Are the Risks of the Subvastus Approach?

This surgery is done through a smaller, less invasive approach, compared to other approaches to knee replacement. It requires more skill and specialized tools to minimize the risk.

Is Recovery Less Painful with the Subvastus Approach?

Yes, studies have shown patients who have total knee arthroplasty with the subvastus approach have a less painful recovery. Our patients also take significantly fewer opioid pills after the subvastus approach than with the medial parapatellar approach to total knee arthroplasty. 

Contact Forté Sports Medicine and Orthopedics

Forté Sports Medicine and Orthopedics provides exceptional care tailored to our patients’ needs. With over 40 years of experience, our team of providers and clinicians know the importance of putting patients first. When you meet with Dr. Joseph Maratt to discuss your knee pain concerns, expect to leave with a detailed action plan in hand. Our flexibility and comprehensive services mean you can see a physician, get diagnostic imaging, and start treatment all in one convenient location. If you’re considering knee replacement, contact us to request an appointment. We’ll help you take the next step toward a pain-free life.

What is Vitamin D?

Vitamin D is a vital nutrient that helps your body absorb calcium, maintain bone strength and support your immune system. It plays a crucial role in muscle function, cardiovascular health and inflammation reduction—important factors for athletes.

How does Vitamin D impact athletic performance?

• Enhancing Muscle Strength: Vitamin D helps maintain optimal muscle strength and coordination. Low levels have been linked to muscle weakness and an increased risk of injury. A study by Barker et al. (2013) demonstrated improved sprint performance and muscle strength in athletes after vitamin D supplementation.
• Reducing Inflammation: Athletes often experience muscle inflammation due to training. Vitamin D helps regulate the inflammatory response and aids in recovery. A systematic review by Owens et al. (2020) highlighted how adequate levels of vitamin D improve recovery times after intense exercise.
• Improving Endurance: Vitamin D can enhance cardiovascular health and oxygen delivery, potentially improving endurance. Research by Carswell et al. (2018) showed that athletes with sufficient vitamin D performed better in endurance events compared to those with low levels.

Vitamin D Levels for Athletic Performance Benefits

For athletes, it’s important to maintain optimal blood levels of vitamin D to experience performance benefits. Research indicates that:

• Optimal Range: Blood levels of 40-50 ng/mL (nanograms per milliliter) of 25-hydroxyvitamin D are considered optimal for improving muscle strength, reducing injury risk and enhancing recovery in athletes.
• Suboptimal Levels: Blood levels below 30 ng/mL are associated with an increased risk of muscle weakness, bone injury and compromised immune function, which can negatively affect performance.
• Deficiency: Athletes with levels below 20 ng/mL are at significantly higher risk for stress fractures, muscle pain and suboptimal performance.

Athletes should aim for a blood level between 40-50 ng/mL for maximum benefits. This range supports muscle strength, enhances recovery and reduces the risk of injury, especially in high-impact sports.

Vitamin D in Healing and Bone Health

Vitamin D plays a vital role in maintaining strong bones, which is essential for athletes to avoid fractures and recover from injuries. Key benefits include:

• Accelerating Fracture Healing: If you’ve experienced a fracture, vitamin D supports bone healing by promoting calcium absorption. A study by Bischoff-Ferrari et al. (2005) found that individuals with optimal vitamin D levels had faster fracture healing and reduced risk of complications.
• Preventing Stress Fractures: Athletes, especially those in high-impact sports, are prone to stress fractures. A study by Ruohola et al. (2006) in female military recruits found that those with higher vitamin D levels were significantly less likely to suffer from stress fractures compared to those with deficiencies.

Other Health Benefits of Vitamin D

Beyond its impact on bones and muscles, vitamin D has several additional health benefits:

• Supporting the Immune System: Vitamin D helps your body fight off infections, which is crucial for athletes exposed to various environments. Research from Gombart et al. (2020) has shown that vitamin D plays a key role in enhancing immune defense.
• Boosting Mental Health: Low levels of vitamin D have been linked to depression and anxiety. For athletes under physical and mental stress, ensuring sufficient vitamin D can help maintain mental well-being. A study by Ganji et al. (2010) showed that vitamin D supplementation improved mood in those with deficiencies.
• Improving Cardiovascular Health: Vitamin D may contribute to heart health by supporting blood pressure regulation and reducing the risk of heart disease. According to a review by Wang et al. (2012), vitamin D deficiency has been associated with a higher risk of cardiovascular issues.

Types of Vitamin D: D2 vs. D3

There are two main types of vitamin D:

• Vitamin D2 (Ergocalciferol): This form is derived from plant sources and is often found in fortified foods. While it can raise blood levels of vitamin D, it is not as effective as vitamin D3.
• Vitamin D3 (Cholecalciferol): This is the more potent and effective form of vitamin D, derived from animal sources or synthesized through sun exposure. Vitamin D3 is better absorbed and retained in the body compared to D2. A study by Tripkovic et al. (2012) showed that vitamin D3 is superior in raising and maintaining vitamin D levels in the blood.

Recommendation: For athletes and those aiming to improve bone and muscle health, Vitamin D3 is the preferred form of supplementation.

Dosage of Vitamin D

The optimal dosage of vitamin D depends on individual factors like age, skin type, geographic location and current vitamin D levels. Here are general guidelines:

• General Population:
  • Recommended daily allowance (RDA) for adults: 600-800 IU per day
  • For athletes and active individuals: 1000-2000 IU per day is often recommended to maintain optimal blood levels.
• If You Are Deficient:
  • Higher doses may be needed if you have a deficiency. A common prescription is 50,000 IU once a week for 8-12 weeks, followed by maintenance dosing.
  • For deficiency treatment, consult your doctor, as high doses need medical supervision.
• Optimal Blood Levels:
  • A blood level of 40-50 ng/mL of 25-hydroxyvitamin D is generally considered optimal for athletes to improve muscle strength, reduce injury risk and support recovery.

Sources of Vitamin D

• Sunlight: Your body can produce vitamin D when exposed to sunlight. However, factors like season, skin color and sunscreen use can affect how much vitamin D your body makes.
• Foods: Foods such as fatty fish (salmon, tuna, mackerel), fortified dairy products, egg yolks and mushrooms contain vitamin D.
• Supplements: If you don’t get enough from sunlight and food, supplements may be recommended, especially during the winter months or if you live in areas with limited sunlight.

Conclusion

Maintaining adequate vitamin D levels is essential for athletes to optimize performance, reduce injury risk, and support overall health. By ensuring proper sun exposure, dietary intake, and supplementing with Vitamin D3 if needed, you can improve bone health, speed up recovery, and enhance your physical capabilities.

Consult Your Doctor

Always talk to your healthcare provider before starting vitamin D supplementation, especially if you have underlying medical conditions or are experiencing symptoms like bone pain or frequent illnesses. Regular blood tests can help monitor your vitamin D levels to ensure you’re in the optimal range for athletic performance.

Key Studies and Publications:

1. Barker T., Schneider E. D., Dixon B. M., Henriksen V. T., Weaver L. K. (2013). “Vitamin D deficiency and muscle function in athletes.” Medicine & Science in Sports & Exercise.
2. Owens D. J., Allison R., Close G. L. (2020). “Vitamin D and the Athlete: Current Perspectives and New Challenges.” Sports Medicine.
3. Carswell A. T., Oliver S. J., Wentz L. M., et al. (2018). “Influence of Vitamin D Supplementation by Simulated Altitude Exposure on Aerobic Capacity.” Journal of Sports Sciences.
4. Bischoff-Ferrari H. A., Dietrich T., Orav E. J., et al. (2005). “Higher 25-hydroxyvitamin D concentrations are associated with better lower-extremity function in both active and inactive persons aged ≥60 y.” American Journal of Clinical Nutrition.
5. Ruohola J. P., Laaksi I., Ylikomi T., et al. (2006). “Association between serum 25(OH)D concentrations and bone stress fractures in Finnish young men.” Journal of Bone and Mineral Research.
6. Gombart A. F., Borregaard N., Koeffler H. P. (2020). “Human cathelicidin antimicrobial peptide (CAMP) gene is a direct target of the vitamin D receptor and is induced in myeloid cells by 1,25-dihydroxyvitamin D3.” FASEB Journal.
7. Tripkovic L., Lambert H., Hart K., et al. (2012). “Comparison of Vitamin D2 and Vitamin D3 Supplementation in Raising Serum 25-Hydroxyvitamin D Status.” American Journal of Clinical Nutrition.

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