IT Band May Not Be The “Actual” Problem

Written by admin on July 10, 2014 – 11:52 am -


Posted in Health and Fitness | No Comments »

awesome paleo “not potato” potato soup

Written by admin on June 11, 2014 – 7:54 pm -

2 cauliflower heads

1 head cabbage

2 Leeks

2 celery root (sans greens)

chop and add to 6 qt pot

fill to rim with H2O (or combo H2O & bone broth)

bring to boil and then simmer for 2 hours

if you desire hard core paleo add (remember to “do” paleo, you have to eat more than just the “muscle” of the beast:

(this part is somewhat flexible, i usu use whatever i have on hand.)

2-4 chicken skins

2 chicken hearts

2 chicken gizzards

1 beef liver or (2 chicken)

2-4 oz of “grease/lard” (from sausage, ground pork/beef, or chicken/turkey (yes i save this stuff–and so should you!)

NOTE; THE ANIMAL PRODUCTS ARE ALL FROM PASTURE RAISED, NEVER GRAIN FED ANIMALS!! KEY POINT!

the fat from these animals has an advantageous lipid profile that is not at all harmful to your heart or heath.

once cooked, purree in Vitamix blender or with immersion blender.

Yum! Yum! Yum!

you will not believe how yummy, delicious this is

m


Tags: , ,
Posted in Uncategorized | No Comments »

Dr. Mark Galland Interview with TWC

Written by admin on May 27, 2014 – 11:24 am -

From the baseball diamond to hitting the pavement to prepare for a marathon, spring and summer can be tough on our bodies. Dr. Mark Galland, an orthopaedic surgeon from Orthopedic Specialists of North Carolina, has details on the best way to avoid injury

Watch the interview HERE

Dr. Mark Galland is a Board Certified Orthopaedic Surgeon and adjunct Clinical Professor, specializing in sports medicine, practicing in Wake Forest and Raleigh. He serves as team physician and Orthopaedic consultant to the Carolina Mudcats, High-A Affiliate of the Cleveland Indians of Major League Baseball, as well as several area high schools and colleges. Dr. Galland can be reached at (919) 562-9410 or by visiting www.orthonc.com or www.drmarkgalland.com, or on twitter @drmarkgalland.


Posted in Injury Prevention, Joint Replacements, News Releases | No Comments »

Dr Galland on WPTF discussing “The Aging Athlete”

Written by admin on April 28, 2014 – 2:41 pm -

Dr Mark Galland Discusses “the Aging Athlete” on WPTF.

Listen here: 20140423-Health-Sports-Inuries-1-Full

Dr. Mark Galland is a Board Certified Orthopaedic Surgeon and adjunct Clinical Professor, specializing in sports medicine, practicing in Wake Forest and Raleigh. He serves as team physician and Orthopaedic consultant to the Carolina Mudcats, High-A Affiliate of the Cleveland Indians of Major League Baseball, as well as several area high schools and colleges. Dr. Galland can be reached at (919) 562-9410 or by visiting www.orthonc.com or www.drmarkgalland.com, or on twitter @drmarkgalland.


Posted in News Releases, Uncategorized | No Comments »

ATC vs Coaches: How Did We Get Here?

Written by admin on March 31, 2014 – 10:26 am -

Preview the original article here

The author addresses a recent, growing and troubling trend in modern medicine. Medical decisions are increasingly influenced, if not driven, by the profit center concept rather than the best interest or the medical well-being of the patient. This represents further erosion in the doctor-patient relationship and an involuntary separation between the doctor and his Hippocratic Oath. This wedge of separation assumes a variety of names: hospital CEO, Board of Directors, Insurance Company, (Insert Name of Government Agency/Politician here), or as highlighted in the referenced article, collegiate athletic directors and head coaches. Many are unaware that Licensure of athletic trainers is dependent upon and subordinate to the medical oversight of their supervising medical doctor. Sports medicine professionals have allowed the athletic directors and universities to suborn this relationship. This has not been a conscious decision or a voluntary submission, rather a gradual erosion by the weight of financial expectations borne of the pressure to “win” above all else. The importune actions of others, including decisions by Universities to place athletic training providers under the purview of head coaches, does not abrogate medical-legal responsibility and does not supersede the doctor-patient relationship. Unfortunately, the team doctor and the athletic trainer can be replaced by the athletic director or head coach at whim, so as a result, the Athletic Director or Head Coach becomes the de facto supervising medical provider. The ATC and Team Physician are thus pressured to make decisions that put athletes on the field when they otherwise should not be allowed to play. How is this done? Providers that make decisions that anger the head coach/AD are not renewed for the next season or are dismissed, and the message is sent. Conversely, those providers that are malleable become the “coach’s guy.” When the coach gets a new job, he brings with him his own hand-picked personnel replacing the previous staff. Last season, during the NFL playoffs, we were all afforded a rare glimpse into these operations when the Redskins’ team physician publicly disagreed with team officials regarding the availability of an injured RGIII. We all know how that story ended. This is the exception—a team MD with the stature to defend the rights of his athlete, but highlights the inner-workings of the industry. Co-opt the MD and the ATC into making decisions in the best interest of the Club rather than in the best interests of the patient (the athlete).
The team physician must be afforded the autonomy for adjudicating the medical care of a patient, and the Athletic Trainer, as an extension of the Team Physician, must be accorded the same freedom. Athletic trainers and medical doctors cede this right only at their great and grave peril and at the expense of the athletes entrusted to their care. It is incumbent upon all health care providers, athletic trainers, and team physicians alike, to protect the health, well being, and rights of their patients whether or not they are athletes or weekend warriors. The excuse “I was just following orders (of the athletic director, the head coach, etc.)” is and ever has been unacceptable. It will stand neither the test of time in the court of law nor the court of public opinion. It not only fails the ethical responsibilities and obligations of the health care provider to the patient, but also shouldn’t we expect more from ourselves and other health care providers? It is ridiculous to suggest or operate under a different set of rules simply because the patient is a scholarship athlete and or under contract. Indeed, it can be argued that these patients, as they are subjected to higher levels of stress and danger of injury, should be even more closely protected than the average patient – not less so. Given the recent legal decisions regarding players’ safety in the NFL, the ever-increasing awareness of athletic-related injuries, and diminished longevity of playing careers at all levels, we should remain steadfast to our Hippocratic Oath and to our desire to always protect our patients above all else. Unfortunately, if we relinquish these rights, there are many who will be only too happy and quick to assume our responsibilities, as currently evident at the highest levels of athletics and sports medicine. If we are truly serious about protecting the rights and health of our athletes – our sons and daughters – then we must reclaim our position and our responsibilities as the preeminent decision makers in healthcare matters at all levels of athletics and sports medicine.

Dr. Mark Galland is a Board Certified Orthopaedic Surgeon and adjunct Clinical Professor, specializing in sports medicine, and is the Supervising Physician for over 20 ATCs in NC


Posted in Sports Medicine | No Comments »

Athletic Training: Expanding Horizons in Modern Healthcare

Written by admin on March 3, 2014 – 11:48 am -

Where does an athletic trainer work? You think you know the answer? Easy, right? In a college, high school, or with a professional sports team. As true now as it has ever been, but times are changing, and the reach of Athletic Training is at the forefront of that change. Although the origins of the profession are deeply rooted in athletics and in sporting events, their work environments now stretch far beyond those typical settings.
Though athletic trainers are now indispensable components in a variety of different organizations, it has only been in the past 10 years that they first began to appear in non-traditional settings: the military, motorsports, fire and police departments, and the performing arts. Perhaps most surprisingly, the U. S. military has fully embraced the athletic trainer as an integral member of their medical teams. Navy and marine bases now have Sports Medicine and Rehabilitation Therapy (SMART) clinics and the Army has the Musculoskeletal Action Team (MAT) to serve their soldiers. These clinics/teams, staffed by athletic trainers and physical therapists, are being implemented at military bases around the world. Their presence has proven to decrease the number of emergency room and orthopaedic physician visits (which are often costly, unnecessary and delayed from time of injury) and provide their personnel the immediate, specialty musculoskeletal care that they need. Initiating care earlier (often immediately after injury) and lowering the cost of the care provided. The Army and Marine Corps also utilize athletic trainers during basic training to keep their trainees “in the game.” The addition of athletic trainers to basic training camps has resulted in a noticeable increase in the number of trainees graduating. Not traditionally considered the seat of innovative thought, the U. S. military has proven agile in this instance and our soldiers, sailors and marines are the beneficiaries. Athletic trainers have been the very soul of that innovation.
From humble origins but always true to their core mission: health and welfare of athletes, athletic training has become an indispensable partner for various and disparate organizations. An athletic trainer is an invaluable healthcare asset to any organization. Athletic Training—thinking outside the box: it’s not just for sports teams any longer!

Alyssa Rabert is a nationally Certified, state Licensed Athletic Trainer and post-graduate Resident in training at The Galland Orthopaedics and Sports Medicine Athletic Training Residency– a 12 month immersional program allowing ATCs to maintain and hone clinical skills while developing those talents necessary to be effective in the clinical setting as an ATC/physician extender. Find out more at www.atcfellowship.com


Tags:
Posted in Injury Prevention, Sports Medicine | No Comments »

Kobe Bryant: Not Your Typical Knee Injury

Written by admin on January 28, 2014 – 1:11 pm -

As a result of his most recent bite from the injury bug, NBA superstar Kobe Bryant is expected to miss six weeks after sustaining a lateral tibial plateau fracture on December 19th. If you’ve never heard of this type of injury, you are not alone. Tibial plateau fractures are not among the most common injuries in sport.

The tibia is the shinbone that runs the length of the lower leg and is part of both the ankle joint and the knee joint. The tibial plateau is the top of the bone that flares out and widens to create a weight-bearing “seat.” There are two portions, one on the inner (medial) portion of the knee and one on the outside (lateral) aspect. There are many different types of tibial plateau fractures, but the main differentiating factor that determines treatment is the alignment of the fragments. In a displaced fracture, the bone is broken in two or more places and the edges are not lined up properly.

The most common mechanisms of injury are hyperextension of the knee and direct contact (say from a helmet in football, or in a car accident involving a pedestrian which has given this injury the nickname of “bumper fracture”). Replays of Kobe’s incident confirm his to be a non-contact injury. He plants and hyperextends on the soon-to-be-injured leg, which then buckles.
The injury results when the femur and tibia come into forceful contact with one, sometimes resulting in a bone bruise or, as in this case, a fracture. Tibial plateau fractures often result in acute swelling, stiffness, deformity, and inability to bear weight on the extremity. X-rays, CT scans, or MRI are used to diagnose this injury.

Often, the treatment for this type of injury is a surgical procedure which brings the edges of the fracture into close approximation and uses surgical screws and plates to hold them in place; a procedure known as open reduction and internal fixation. Smaller fractures that are not displaced often respond to conservative treatment of immobilization and non-weight-bearing on the affected leg. Kobe’s fracture is believed to be relatively minor and so his recovery spectrum is 6 weeks. More severe or complex injuries (such as those with vascular or nerve damage) or larger fractures require much longer recovery. In addition, tibial plateau fractures are often associated with injuries to the meniscus or ligaments in the knee. These associated injuries require additional treatments and rehabilitation. Fortunately for Kobe and the Lakers, this injury is (by all reports) relatively mild and with a majority of the regular season still ahead, Kobe has a chance to return and contribute meaningfully to the Lakers’ season.

Dr. Mark Galland is a Board Certified Orthopaedic Surgeon and adjunct Clinical Professor, specializing in sports medicine, practicing in Wake Forest and Raleigh. He serves as team physician and Orthopaedic consultant to the Carolina Mudcats, High-A Affiliate of the Cleveland Indians of Major League Baseball, as well as several area high schools and colleges. Dr. Galland can be reached at (919) 562-9410 or by visiting www.orthonc.com or www.drmarkgalland.com, or on twitter @drmarkgalland.

Alex Vitek is a nationally Certified, state Licensed Athletic Trainer and post-graduate Resident in training at The Galland Orthopaedics and Sports Medicine Athletic Training Residency– a 12 month immersional program allowing ATCs to maintain and hone clinical skills while developing those talents necessary to be effective in the clinical setting as an ATC/physician extender. Find out more at www.atcfellowship.com



Posted in Knee | No Comments »

Dr. Mark Galland Discusses “New” Knee Ligament

Written by admin on January 7, 2014 – 1:54 pm -

There has been much consternation, if not outright titillation, recently regarding the “discovery” of a new knee ligament. Multiple news outlets breathlessly report that doctors in Belgium have “discovered” a new ligament. Reader’s comments in these online articles range from excitement to incredulity and borderline outrage “that doctors could miss such an obvious thing.”

Is this possible? Is it likely that there is an anatomical structure that has gone undiscovered despite centuries of patient, methodical, laborious anatomical research by thousands of surgeons, anatomists and students?

Certainly, anything is possible (that’s the premise behind lottery tickets, right)? Is it possible that this ligament can go unnoticed by the literally millions of MRI that have been performed over the past 30 years? Maybe a little less possible than the previous example, but for the sake of argument, let’s say “Yes, it’s possible.” Except that it’s not. You see, this ligament was first described in 1879–the same year the light bulb was invented! The ligament has never had one single name that we could all agree upon (previous monikers include: mid-third lateral capsular ligament, capsulo-osseous layer of the iliotibial band (What a mouthful!) and even the current ‘anterolateral ligament’ have been used in the past). Though, until recently, no clear anatomical description had been provided, surgeons have long been aware of it. Most Orthopaedic surgeons (particularly those specializing in sports injuries) have been aware of its significance, abeit indirectly,for decades. The Segond fracture caused when this ligament sometimes avulses a fragment of bone from the tibia when an ACL is torn, bears the name, not coincidentally, of the first physician to “discover” the ligament (he called it simply a “pearly fibrous band”). To emphasize this point, the authors of the paper that initiated this furor, do not claim “discovery” they merely proffer a standardized name for this ligament and
postulate its significance in knee stability.

Why the delay? If it was first noted in 1879, why are we only now: 1. giving it a name and 2. postulating its function? To answer, one must first understand the structure of a joint. Every joint is surrounded by a capsule. The capsule is like a balloon that surrounds and attaches to the bones that comprise a joint. Certain parts of the capsule are thin and others are thick and well defined. those parts that are well-defined and thick usually merit a name and are considered “ligaments” examples are the MCL (medial collateral ligament) and LCL (lateral collateral ligament). Some areas are slightly thicker than the rest of the capsule but not nearly as much as the named ligaments. Sometimes these get a name, sometimes not, and sometimes doctors argue over what name, if any, should be assigned to this “thickened area.” as you can imagine, doctor-scientist cocktail parties can get pretty rowdy! These in-between ligaments typically have arcane names like posterior oblique ligament and popliteo- fibular ligament–names like these can only result as the brain-chlild of the aforementioned post-party delirium–scientists! still it’s better than listening to them argue these points at a medical conference.

Additionally, with the advent and popularity of minimally invasive and arthroscopic surgery, these ligaments are no longer exposed in surgical procedures, unless the procedure is intended to specifically address an injury to one of these ligaments.

Arthroscopic surgery occurs within the joint, these “capsule ligaments” are by definition outside the confines of the joint and are not seen during routine arthroscopic surgery. anyone want to trade the 2 tiny incisions typical of any “scope” surgery for a 10’‘incision (and all the extra rehab and lost work-time attendant to such incisions) so that we can have the satisfaction of looking at all the knee ligaments? No? I didn’t think so.

What about MRI? “Why has no one mentioned this ligament before now, if we can, in fact evaluate it with MRI?” good question. the answer is simple. radiologists may see the ligament/capsular area on every scan, but until we name it and tell them that it is important, they view it not unlike like the skin and fat and gristle also well-visualized on every mri but are not worthy of mention.

Far from the discovery of a new ligament, these distinguished Belgian surgeons have provided us valuable insight into the importance of a known but previously disregarded structure, and have suggested its importance merits a standardized name upon which we can all agree. While not as earth shattering as a truly unique discovery, it is exciting to learn that we may have new insight into the inner-workings of the human knee. Now it is time for those of us who care for those with such injuries to begin developing and utilizing techniques to repair it when injured. Truly exciting news, indeed!

Dr. Mark Galland is a Board Certified Orthopaedic Surgeon and adjunct Clinical Professor, specializing in sports medicine, practicing in Wake Forest and Raleigh. He serves as team physician and Orthopaedic consultant to the Carolina Mudcats, High-A Affiliate of the Cleveland Indians of Major League Baseball, as well as several area high schools and colleges. Dr. Galland can be reached at (919) 562-9410 or by visiting www.orthonc.com or www.drmarkgalland.com, or on twitter @drmarkgalland.


Posted in Knee, News Releases | No Comments »

“New” Ligament Discovered in the Knee

Written by admin on January 6, 2014 – 2:18 pm -

In October, a group of physicians in Belgium released a study that gives support to the idea that there may be an additional ligament present in the knee. Ligaments, as we know, connect bone to bone and lend stability to a joint. Previously, we had only really concerned ourselves with the four largest ligaments in the knee, the lateral collateral ligament (LCL), the medial collateral ligament (MCL), the posterior cruciate ligament (PCL), and the one you’ve probably heard the most about, the anterior cruciate ligament (ACL).

Building off of the work of a French surgeon, Paul Segond, that dates back to 1879, these surgeons worked with 41 cadavers and microscopic dissection techniques to visualize a small band of connective tissue that runs from the front, outside portion of the femur to tibia and so appropriately named it the anterolateral ligament, or ALL. They were able to identify what they believe to be the ALL in 40 of the 41 human specimens. Researchers believe that this ligament could help support movements that involve pivoting and change of direction, and thus, could also be torn under these same stresses. Because the ACL is also commonly torn as a result of excessive rotational stresses, it is hypothesized that these two ligaments could be sprained concurrently. The surgeons also speculate that because no effort previously has been made to restore function in this ligament during surgery to replace the ACL, that the ALL could be to blame in cases that have less-than-optimal outcomes where patients have continued complaints of instability and lack of full function in the knee. Orthopedic experts around the world have had mixed reactions to this news, but all agree the work is intriguing and they are interested to see the direction further research will take the field.

While its location and potential role in lower extremity biomechanics are becoming increasingly elucidated, there are still many questions that remain. For instance, what is the healing potential of the ALL? Does it even have the potential to heal on its own, similar to the MCL (small tears usually heal with rest, larger or complete tears often warrant reconstruction)? If it is possible to reconstruct, what kind of graft would be amenable to this and what surgical techniques would be used? And then, a few obvious questions: Why haven’t we seen this ligament before? What about the tens of thousands of ACL tears that are surgically reconstructed every year with excellent outcomes where individuals are able to return to their daily and athletic activities? And ultimately, would it even respond to reconstruction in that it could help to restore function and thus result in better outcomes?
This “discovery” must be accorded its proper place in our current compendium of knowledge. It is important not because a “new” ligament has been discovered but rather suggests a more important role for a ligament long-ago discovered but not accorded any particular significance. More investigation into the role and healing capacity of this ligament is certainly warranted.

Alex Vitek is a nationally Certified, state Licensed Athletic Trainer and post-graduate Resident in training at The Galland Orthopaedics and Sports Medicine Athletic Training Residency– a 12 month immersional program allowing ATCs to maintain and hone clinical skills while developing those talents necessary to be effective in the clinical setting as an ATC/physician extender. Find out more at www.atcfellowship.com


Posted in Knee | No Comments »

Running: Does it Really Matter What’s Under Your Feet?

Written by admin on November 3, 2013 – 2:33 pm -

Where’s your favorite place to run? Ask ten people and their results probably vary as much as the different types of shoes they sport while doing so. As a recreational runner myself, I stick to my trail running like I stick to my Asics—invariably. Being an athletic trainer, though, has made me concerned about my joints and longevity of this activity. And so I began wondering, what surface is best? I searched high and low, looking through published research articles and running magazines alike, and here are the most well-founded and useful tidbits I came across:

• Overall, grass is king. It is soft, has a good amount of give, and thus provides the lowest impact forces of all the typical running surfaces. Unfortunately by its nature, grass has a tendency to hide obstacles like rocks or holes and is slippery when wet so consider the quality of the ground before lacing up.

• Next best are trails that are made of ground/natural materials (woodchips, dirt, or that stuff that looks like kitty-litter [think American Tobacco Trail]). Trails can be a great way to mix it up and get closer to nature. In the summer months, they are an especially valuable option because trails that run through wooded areas are often much cooler. However, variables such as roots and snakes are cause to be on the lookout. Also, I would be careful of running on trails the day or two after significant rainfall because it loosens the running surface and can often leave channels in the trails that are dangerous to unprepared runners.

• If you have to, pavement will do but try not to run on banked surfaces and make sure you have a supportive shoe that is in good condition.

• Sand is a unique option that has its benefits if you are fortunate enough to find yourself at the beach. Loose sand easily dissipates the energy of your foot strike and challenges your leg musculature in ways harder surfaces cannot. If you choose to run closer to the water where the sand is more compact, pay attention because that is often where the steepest banking is, which can put uneven pressure on your joints.

• Variety is also beneficial, but ease into new training mediums. The different surfaces stress various muscle groups which can help with overall performance. If afforded different options such as track, trail, and treadmill; take advantage of them.

• If you’re more competitive and/or aiming for a race, it would benefit you to have your training mimic the race. This includes the running surface. If you know ahead of time that you’re going to running on pavement, increase the proportion of your running on similar surfaces as you get closer to race day.

• At the end of the day, as long as it’s even, debris-free, and dry, you’re probably good to go. Your body adjusts to the surface automatically after the first few steps by changing how much you flex your knees while running to absorb the shock. If you are truly a distance runner and really rack up the miles, it’s better to be kind to your joints and go for a softer surface if you have the option to do so.

When it comes down to it, there is considerable research on the forces experienced by the joints when running on various surfaces, which can have an impact (pun kind-of intended) in the long run (nailed it). However, you’d be hard pressed to find a study that directly relates any one kind consistently to injury, and so there is still room for question and a lot we don’t know. Take the above tips with a grain of salt and ultimately rely on your body’s feedback to guide your running choices. If you find yourself in a performance rut or with constant aches in the confines of your running routine, maybe it’s time to branch out and blaze a new trail (sorry, I couldn’t help myself). Happy running!

Alex Vitek is a nationally Certified, state Licensed Athletic Trainer and post-graduate Resident in training at The Galland Orthopaedics and Sports Medicine Athletic Training Residency– a 12 month immersional program allowing ATCs to maintain and hone clinical skills while developing those talents necessary to be effective in the clinical setting as an ATC/physician extender. Find out more at www.atcfellowship.com


Posted in Foot & Ankle, Health and Fitness, Sports Medicine | No Comments »