Educational Resources

Prevention & Safety

Preventing Injury and Health Conditions

General

Hip Pain

Knee and Leg

Back Pain

Safety

Home & Work

Lawnmower and Snowblower Safety

Falls

Footwear and Injury Prevention

Sports and Exercise

Wellness

Preventing Injury and Health Conditions

General

Weight management techniques | Diet | Exercise

Weight management techniques

The aforementioned key to keeping orthopaedic problems at bay is to stay relatively active and eat right. Current research shows that 66% of Americans are overweight, and 32% are classified as obese. This is bad news for our hips, knees and backs.

Let's talk BMI, or body mass index. BMI is the number you come up with when you divide how much you weigh in kilograms by how tall you are in centimeters squared. A BMI between 18.5 and 25 is considered normal. A BMI above 25 is considered overweight, and a BMI of 30 or more is classified as obesity. To find your BMI, there are several calculators on the Internet including the BMI recommendations from the Surgeon General.

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Diet

Losing weight can provide some instant relief for the body. Although we are constantly inundated with new diet fads, remember that logically, the way to lose weight is to consume fewer calories than we burn, and the way to maintain weight is to take in approximately the same number of calories that we burn. This method can be harder to follow than it is to understand, and once we build healthy habits, this lifestyle will become easier and easier to maintain. Some diets help you to do this. Others are shams. Be cautious. Anything that seems too good to be true probably is.

If you have arthritis, there are pain aggravators that should be avoided. For instance, paprika, pepper, tobacco, cayenne, eggplant and large amounts of potatoes and tomatoes can antagonize your arthritis since these foods have alkaloids that prevent the repair of collagen and cartilage. Aspartame (found in diet sodas and artificial sweeteners) can also worsen arthritis, since it can cause inflammation in the joints when regularly consumed.

There are health benefits from eating a diet rich in fiber and complex carbohydrates found in vegetables, whole wheat and fruits.

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Exercise

It is also important to incorporate exercise into your routine if you have hip or knee pain. Although it may seem like a catch-22 (you can't exercise because your knee or hips hurt, but your knee or hips hurt more because you can't exercise), strengthening the leg muscles can be crucial in alleviating pain. The more support the muscles can offer, the less stress and pain you will encounter. Please refer to our online exercise library, which will show you several strengthening exercises. Also, if you are hurting and you want to start up an exercise routine, why not try a stationary bike or swimming? While running or stair climbing can be taxing to the body, the stationary bike and swimming are both excellent cardiovascular activities that only place minimal pressure on the body.

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Back Pain

Preventing Back Pain at Work and at Home

• Plan ahead what you want to do and do not be in a hurry.

• Position yourself close to the object you want to lift.

• Separate your feet shoulder-width apart to give yourself a solid base of support.

• Bend at the knees.

  

• Tighten your stomach muscles.

• Lift with your leg muscles as you stand up.

• Don't try to lift by yourself an object that is too heavy or an awkward shape.

• Get help.

Guidelines for Protecting Your Back

Picking Up a Light Object:

• To lift a very light object from the floor, such as a piece of paper, lean over the object, slightly bend one knee and extend the other leg behind you. Hold on to a nearby chair or table for support as you reach down to the object.

Picking Up a Heavy Object:

• Whether you are lifting a heavy laundry basket or a heavy box in your garage, remember to get close to the object, bend at the knees, and lift with your leg muscles. Do not bend at your waist. When lifting luggage, stand alongside of the luggage, bend at your knees, grasp the handle and straighten up.

Holding an Object

• While you are holding the object, keep your knees slightly bent to maintain your balance. If you have to move the object to one side, avoid twisting your body. Point your toes in the direction you want to move and pivot in that direction. Keep the object close to you when moving.

Placing an Object on a Shelf:

• If you must place an object on a shelf, move as close as possible to the shelf. Spread your feet in a wide stance, positioning one foot in front of the other to give you a solid base of support. Do not lean forward and do not fully extend your arms while holding the object in your hands.

• If the shelf is chest high, move close to the shelf and place your feet apart and one foot forward. Lift the object chest high, keep your elbows at your side and position your hands so you can push the object up and on to the shelf. Remember to tighten your stomach muscles before lifting.

Supporting Your Back While Sitting:

• When sitting, keep your back in a normal, slightly arched position. Make sure your chair supports your lower back. Keep your head and shoulders erect. Make sure your working surface is at the proper height so you don't have to lean forward. Once an hour, if possible, stand, and stretch. Place your hands on your lower back and gently arch backward.

Tips for New Moms

Complaints of back pain by pregnant women are common. Usually, the pain diminishes within two weeks after delivery. But back pain may return as you begin lifting and carrying the infant on a daily basis. As the infant grows, the weight load increases and back pain can result.

Caring for an infant puts stress on your back. Initially, you may be lifting the 7- to 10-pound baby up to 50 times a day. By the time the child is a year old, you are lifting and carrying 17 pounds. Two years later, you will be lifting a 25- to 30-pound child.

Here are ten ways that new mothers can help reduce their risk of injury and back pain. Many of these tips also work well with new fathers!

1. Begin exercising soon after delivery to restore muscle tone to the abdominal and back muscles. While the baby is napping, take 10 minutes to do stretching exercises on the floor each day. This will help restore hip and back flexibility.

2. Try to return to your normal weight within six weeks after giving birth.

3. Do not stretch your arms out to pick up the baby. Bring the baby close to your chest before lifting. Avoid twisting your body.

4. To pick up a child from the floor, bend at your knees-not at your waist. Squat down, tighten your stomach muscles and lift with your legs.

5. Remove the high chair tray when you are trying to put the baby in or take the baby out of the high chair.

6. When lifting the child up out of the crib, put the crib side down and pull the child toward you. Do not bend over the crib side and lift the baby over the top.

7. Consider using a "front pack" to carry the baby when you are walking.

8. Do not carry a child on your hip; this overloads the back muscles.

9. To avoid upper back pain from breastfeeding, bring the baby to your breast, rather than bending over the baby. While you are nursing, sit in an upright chair rather than a soft couch.

10. Do not stand outside the car and try to place the child in the car seat. Kneel on the back seat as you place the baby into the car seat. Consider trading in your sporty two-door model for a four-door vehicle, which will make it easier for you to place the child in the car seat.

If you had a Caesarian-section (C-section) delivery, wait six weeks or until you get the permission of your obstetrician before you begin exercising. Additionally, the risk of back pain is greater among young, overweight women.

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Hip Pain

Falls and Hip Fractures

Ninety percent of the more than 352,000 hip fractures in the United States each year are the result of a fall. By the year 2050, there will be an estimated 650,000 hip fractures annually. This is nearly 1,800 hip fractures a day.

Women have two to three times as many hip fractures as men. White, post-menopausal women have a 1 in 7 chance of hip fracture during a lifetime. The rate of hip fracture increases at age 50, doubling every five to six years. Nearly one half of women who reach age 90 have suffered a hip fracture.

The risk of hip fracture for women 5'8 " or taller is twice that of women who are under 5'2. " Studies show that women who have broken their arm in the past have an increased risk of breaking a hip. Among people age 50 and older who fall, women have two to three times as many hip fractures as men.

Only 25 percent of hip fracture patients will make a full recovery; 40 percent will require nursing home care; 50 percent will need a cane or walker; and 24 percent of those over age 50 will die within 12 months.

Nearly one-in-four hip fracture patients will die within 12 months after the injury because of complications related to the injury and the recovery period.

The cost of hip fracture care averages $26,912 per patient.

Live It Safe

More than 353,000 people are hospitalized for hip fractures each year.

The total cost in medical bills and lost income resulting from hip fractures is more than $12.6 billion a year or an average of $37,000 per hip fracture.

Because of the aging U.S. population, the number of hip fractures is expected to reach 650,000 by 2050. Close to ninety percent of hip fractures are among persons 65 and older. Women over age 65 have a one in five chance of having a hip fracture during their lifetime.

Hip fractures are caused by a variety of factors that weaken bone and, often, are caused by the impact from a fall. The common characteristics of persons who are vulnerable to hip fractures are:

• Age. The rate increases for people 65 and older.

• Gender. Women have two to three times as many hip fractures as men.

• Heredity. A family history of fractures in later life, particularly in Caucasians and Asians. A small-boned, slender body.

• Nutrition. A low calcium dietary intake or reduced ability to absorb calcium.

• Personal habits. Smoking or excessive alcohol use.

• Physical impairments. Physical frailty, arthritis, unsteady balance and poor eyesight.

• Mental impairments. Senility, dementia, e.g., Alzheimer's disease.

• Weakness or dizziness from side effects of medication.

About 24 percent of hip fracture patients over age 50 will die within 12 months after injury because of complications related to the injury and the recovery period.

Most hip fracture patients who previously lived independently will require assistance from their family or home care. About half will require canes or walkers for mobility when they return home. 51 percent of hip fracture patients 65 and older are discharged from hospitals to long-term care facilities. All hip fracture patients will require walking aids for several months after injury and nearly half will permanently require canes or walkers to move around their house or outdoors.

How can I prevent a broken hip?

Orthopedic surgeons are experts in the care and treatment of patients with fractured hips. They are concerned about the epidemic of hip fractures and the impact these severe injuries has on patients, their families, and on society. Orthopedic surgeons know that prevention of hip fractures is far better, and far less costly, than treatment after the bone is broken.

Here's what you can do:

Calcium and Vitamin D

Be sure your diet contains the necessary calcium and vitamin D during childhood, adolescence, and adulthood. The typical American diet provides about 300 milligrams (mg.) of calcium a day from non-milk sources. Each dairy product serving provides an additional 300 mg. A recommendation by the National Research Council for a daily dietary intake of 800 mg. of calcium is thought to be too low.

The National Institutes of Health (NIH) recommends the following daily calcium intake:

• 11 - 24 years: 1,200 mg.

• Pregnant or nursing women under age 19: 2,000 mg.

• Pregnant or nursing women 19 or older: 1,400 mg.

• Before menopause: 1,000 mg.

• Menopausal, postmenopausal women not taking estrogen: 1,500 mg.

• Menopausal, postmenopausal women taking estrogen: 1,000 mg.

• Middle-aged men: 1,000 mg.

Vitamin D plays a major role in calcium absorption and its incorporation in bone. The Food and Drug Administration's USRDA (Recommended Daily Allowance) for vitamin D is 400 international units (IU). One glass of milk contains 100 IU. Your doctor may recommend an increase in your intake of vitamin D after menopause. Because elderly people may consume less vitamin D and absorb calcium poorly, they should ask their doctor about increasing their daily intake of vitamin D.

Exercise

Exercise to minimize bone loss. You should engage in weight-bearing exercises, such as walking (considered one of the best methods of maintaining bone strength), jogging, hiking, climbing stairs, dancing, aquatic exercises, treadmill exercises, and weight training. Consult your doctor before beginning any vigorous exercise program. Your doctor can evaluate your physical condition and help you decide which activity suits you best.

The National Institute of Aging recommends you begin exercising slowly, especially if you have been inactive. Start with short periods of about 5 to 10 minutes twice a week and build up slowly, adding a few minutes each week. You can build up to exercise periods of 15 to 30 minutes, three or four times a week.

Talk With Your Doctor

• Proper diagnosis and early treatment can help reduce the risks of osteoporosis. Consult your medical doctor because a treatment must be prescribed individually.

• Treatment plans should be initiated as early as possible because once bone is lost it is difficult to replace.

• Ask your physician about medication to prevent menopausal bone loss such as estrogen replacement therapy.

• Eliminate smoking and excessive alcohol use which cause bone loss and increase your risk for a fracture.

• Consult with your physician if you require medications regularly that can alter your balance or cause dizziness. Certain drugs, such as benzodiazepines, that are common treatments for anxiety or insomnia, may cause dizziness and falls.

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Knee and Leg

Care of the Aging or Post-Traumatic Knee

Playing team sports, jogging, or doing other high impact activities that repeatedly pound, twist, and turn the knees can stress aging joints. Highly active, middle-aged patients may develop painful knees as a result of osteoarthritis (OA). This painful condition happens when the cartilage lining on the ends of bones gradually wears away.

It can affect one or both knees.

Symptoms:

You may experience pain when standing or going up and down stairs. The knee may buckle and give way, lock in place, or become stiff and swollen.

Patients:

Most people with osteoarthritis of the knee are over age 55 and/or obese and/or have a family history of osteoarthritis. Younger, highly active people may also develop osteoarthritis if their knee suffered a significant injury.

Diagnosis:

See your doctor for diagnosis and treatment. The doctor will consider your comprehensive medical history, perform a physical examination and possibly order tests and/or imaging studies before recommending a course of treatment.

Substitute Smooth, Low-Impact Activities

Moderate physical activity lessens joint pain and improves flexibility and function. Baby boomer patients with osteoarthritis of the knee should continue exercising, but change the forms of their activities:

• Stop doing high-impact activities that twist and turn the joints. This includes running, tennis, racquetball, basketball, baseball, etc.

• Start doing smooth, low-impact activities that are easier on the joints. Recommended activities include stretching, swimming, water aerobics, cycling, walking on a treadmill or outside, playing golf, etc.

Other Conservative Options

Other options that may extend the life of your natural knee include medications, steroid injections, physical therapy, and mechanical aids.

• Medications: The doctor may prescribe nonsteroidal anti-inflammatory medications to help reduce inflammation. Certain dietary supplements such as Glucosamine and Chondroitin may also be helpful. (Note: The U.S. Food and Drug Administration does not test dietary supplements. These compounds may cause negative interactions with other medications or excessive bleeding during surgery. Always consult your doctor before taking dietary supplements.)

• Injections: The doctor may inject the knee joint with strong anti-inflammatory medications, called corticosteroids. This can relieve pain and swelling for awhile.

• Physical therapy: The doctor may give you a balanced fitness program including physical/occupational therapy to improve joint flexibility, increase range of motion, strengthen muscle, bone and cartilage tissues and reduce pain. It may also help to ice the affected joint for short periods, several times a day.

• Mechanical aids: You may need supportive or assistive devices such as an elastic bandage, splint, brace, cane, crutches, or walker.

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Safety

Home and Work

Home Safety Checklist

Stairs and Steps

• Make sure light switches are at both the top and bottom of the stairs.

• Provide enough light to see each step and the top and bottom landings.

• Keep flashlights nearby in case of a power outage.

• Install handrails on both sides of the stairway and be sure to use them.

• Do not leave objects on the stairs.

• Consider installing motion detector lights, which turn on automatically and light your stairway.

• Put nonslip treads on each bare-wood step.

• Do not use patterned, dark, or deep-pile carpeting. Solid colors show the edges of steps more clearly.

• Do not place loose area rugs at the bottom or top of stairs.

• Repair loose stairway carpeting or boards immediately.

Bathroom

• Install grab bars on the bathroom walls near the toilet and along the bathtub or shower.

• Place a slip-resistant rug adjacent to the bathtub for safe exit and entry.

• Mount a liquid soap dispenser on the bathtub/shower wall.

• Place nonskid adhesive textured strips on the bathtub/shower floor.

• Use a sturdy, plastic seat in the bathtub if you are unsteady or if you cannot lower yourself to the floor of the tub.

• Stabilize yourself on the toilet by using either a raised seat or a special toilet seat with armrests.

• Replace glass shower enclosures with non-shattering material.

Bedroom

• Clear clutter from the floor.

• Place a lamp and flashlight near your bed.

• Install night-lights along the route between the bedroom and the bathroom.

• Sleep on a bed that is easy to get into and out of.

• Keep a telephone near your bed.

Living Areas

• Arrange furniture to create clear pathways between rooms.

• Remove low coffee tables, magazine racks, footrests, and plants from pathways in rooms.

• Install easy-access light switches at entrances to rooms so you won't have to walk into a darkened room in order to turn on the light. Glow-in-the-dark switches may be helpful.

• Secure loose area rugs with double-faced tape or slip-resistant backing. Recheck these rugs periodically.

• Keep electric, appliance, and telephone cords out of your pathways, but don't put cords under a rug.

• Eliminate wobbly chairs, ladders, and tables.

• Do not sit in a chair or on a sofa that is so low it is difficult to stand up.

• Place carpeting over concrete, ceramic, and marble floors to lessen the severity of injury if you fall.

• Repair loose wooden floorboards immediately.

Kitchen

• Remove throw rugs.

• Immediately clean up any liquid, grease, or food spilled on the floor.

• Store food, dishes, and cooking equipment at easy-to-reach waist-high level.

• Don't stand on chairs or boxes to reach upper cabinets. Use only a step stool with an attached handrail so you are supported.

• Repair loose flooring.

• Use nonskid floorwax.

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Lawnmower and Snowblower Safety

Most lawnmower and snowblower injuries are preventable if you concentrate on your task and use common sense.

Some basic tips:

• Read the instruction manual before using a lawnmower or snowblower.

• Be sober (i.e., don't drink).

• Do not remove safety devices, shields or guards on switches, and keep hands and feet away from moving parts.

• Stay away from the engine cowling, as it can become very hot and burn unprotected flesh.

• Add fuel before starting the engine, not when it is running or hot.

• Use a stick or broom handle (not your hands or feet) to remove debris in lawnmowers or snowblowers.

• Never let children operate lawnmowers or snowblowers. Keep kids 15 years of age and younger away when lawnmowers and snowblowers are in use.

• Do not leave a lawnmower or snowblower unattended when it is running. If you must walk away from the machine, shut off the engine.

Lawnmower Safety Tips

• Keep lawnmowers in good working order with sharp blades.

• Remove stones, toys and other objects from the lawn before you start mowing.

• Wear protective gloves, goggles, boots and long pants when you use lawnmowers. Never mow barefoot or in sandals.

• Never let passengers of any age join you on a riding mower.

• Use caution when mowing hills and slopes. Mow across with a push mower; mow up and down with a riding mower. Do not cut wet grass.

• Be sure the motor is off before inspecting or repairing lawn mower equipment.

Snowblower Safety Tips

• If your snowblower becomes jammed, turn it off, disengage clutch and wait more than 5 seconds for blades to stop rotating.

• Beware of the brief recoil of motor and blades that occurs after the machine has been turned off.

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Falls

Reduce Your Risk of Falling

General Tips

• When you first wake up, sit on the edge of the bed and make sure you are not dizzy before you get out of bed.

• Eat breakfast every morning. Skipping a meal could make you dizzy.

• Be careful around pets, they can get in front of your feet or jump on you.

• Use a cane or walker if you are unsteady. Promptly replace worn rubber tips of these devices.

Bathroom Safety

• Never grab a towel rack, shampoo holder, or soap tray for support in the shower. These will not hold a person's weight.

• Let the soap suds go down the drain before you move around in the shower. Do not turn suddenly.

• If you are prone to falling, use a shower chair and a handheld shower attachment. · Clean up puddles of water immediately.

• Do not lock the bathroom door. That will delay help in reaching you.

Stair Safety

• Never carry any package that will obstruct your view of the next step.

• Keep at least one hand on the handrail.

• Concentrate on what you are doing; don't be distracted by sounds.

The Phone

• If you are not close to the telephone when it rings, don't rush to it. Fast, sudden moves could throw you off balance.

• Make sure you have access to a telephone that you can reach to call for help if you fall. Consider carrying a portable phone.

Eliminate Hazards

• Wear clothes that fit you properly. You can trip on a coat, pair of pants or bathrobe that is too long.

• Don't leave clothes or newspapers on the floor.

• Close cabinet drawers so you won't stumble over them.

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Footwear and Injury Prevention

Recommendations for Footwear

The American Academy of Orthopaedic Surgeons has developed tips to help people reduce their risk of foot problems.

• Have both feet measured every time you purchase shoes. Your foot size increases as you get older.

• Women should not wear a shoe with a heel higher than 2 1/4 inches.

• Try on new shoes at the end of the day. Your feet normally swell and become larger after standing or sitting during the day.

• Shoes should be fitted carefully to your heel as well as your toes.

• Try on both shoes.

• There should be 1/2-inch space from the end of your longest toe to the end of the shoe.

• Fit new shoes to your largest foot. Most people have one foot larger than the other.

• Walk around in the shoes to make sure they fit well and feel comfortable.

• Sizes vary among shoe brands and styles. Judge a shoe by how it fits on your foot not by the marked size.

• When the shoe is on your foot, you should be able to freely wiggle all of your toes.

• If the shoes feel too tight. don't buy them. There is no such thing as a "break-in period."

• Most high heeled-shoes have a pointed. narrow toe box that crowds the toes and forces them into an unnatural triangular shape. As heel height increases, the pressure under the ball of the foot may double, placing greater pressure on the forefoot as it is forced into the pointed toe box.

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Sports and Exercise

Sports

Proper Preparation

• Physical exam. A pre-season physical exam is important for both younger and older players. The goal is to prevent injuries and illnesses by identifying any potential medical problems. These may include asthma, allergies, heart, or orthopedic conditions.

• Warm up and stretch. Always take time to warm up and stretch.

• Warm up with some easy calisthenics, such as jumping jacks. Continue with walking or light running, such as running the bases.

• Gentle stretching, in particular your back, hamstrings, and shoulders, can be helpful. Your team coach or athletic trainer may provide a stretching program.

• First aid. Familiarity with first aid, including recognizing and treating the most common injuries, is especially important for coaches. Be able to administer basic first aid for minor injuries, such as facial cuts, bruises, strains, sprains, and tendonitis.

• Field knowledge. Be familiar with your field, including its telephone and cardiac defibrillator.

• Emergency situations. Be prepared for emergencies. Have a plan to reach medical personnel for help with more significant injuries like concussions, breathing problems like wheezing, heat illness, and orthopedic emergencies, such as fractures and dislocations.

• Follow the rules. Know the rules and encourage safe and appropriate play.

Helmet Use

No matter what your age or level of experience, whenever you ride a bike, inline skate, ski, or engage in other activities during which your head is vulnerable to injury, a helmet should be worn. Children younger than 12 years should also wear helmets when sledding. Helmets should be taken on every trip, no matter how short. Many accidents happen near home.

Choosing a Helmet

Discount department stores and bicycle shops offer many models of helmets that are typically priced around $20 and up. Be sure to choose a helmet that meets the standards of the Consumer Product Safety Commission or the Snell Memorial Foundation. Take some time trying on helmets and choose one with the right size and fit.

A helmet should be:

• Snug - It does not slide from side-to-side or front-to-back.

• Level - It is square on top of your head, covering the top of the forehead. It does not tilt in any direction.

• Stable - The chinstrap keeps the helmet from rocking in any direction. Chinstraps should be replaced if any part of the buckle breaks; otherwise, a helmet may fly off in an accident.

Your helmet should be smooth and round. Choose one that motorists will see. Many helmets are ventilated, lightweight, and come in a variety of colors

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Wellness

Stay Active: Safe at Any Age

Staying active as you age helps you remain healthy, live longer, and feel better.

More older people than ever before are involved in exercise and sports. They have learned that being physically fit does not have to mean aching muscles from workouts and hard-to-maintain exercise schedules. Many people are getting their exercise in active pastimes such as biking, skiing, and tennis. Others prefer less active recreation, such as walking, gardening or golf.

All are finding relaxation and fun while they secure a healthy future. Exercise helps you feel better because it improves your health. Orthopedic surgeons say that by spending a little time each day in some type of physical activity, you can enjoy these significant benefits:

• Longer, healthier life

• Stronger bones

• Reduced joint and muscle pain

• Improved mobility and balance

• Lower risk of falls and serious injuries like hip fractures

• Slower loss of muscle mass

People are living longer these days and their quality of life depends on being healthy and remaining independent. Staying active can lower your risk for many common diseases, relieve the pain of arthritis, and help you to recover faster when you do get sick.

While it is important to stay active, it is also important to play it safe. As more older people engage in physical activities, sports-related injuries are increasing. This is especially true for those who ride bicycles, ski, lift weights, and use exercise machines.

According to a recent study by the U.S. Consumer Product Safety Commission, an estimated 6 million people 65 years of age and older were treated in U.S. hospital emergency rooms for sports-related injuries in 2006. Additional injuries were treated in physicians' offices.

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Material modified with permission from the American Academy of Orthopedic Surgeons (www.aaos.org).