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Category Archives: Common Problems and Guides

Avoiding Spring Gardening Injuries

Spring weather in the Pacific Northwest is beautiful and although we still have rain showers, it is the best time for gardening and getting in some spring cleaning.  If you are like some of us here at OSS, gardening is a popular hobby.  Over time however, it can take a toll on your body.  Creating a dream garden requires repetitive bending, kneeling, reaching, and twisting that may result in putting an extensive amount of strain on your muscles and joints.


According to Dr. Scott Ruhlman, “Spring time is a great time to get outside and do yard work. In this case the old adage rings true, that an ounce of prevention is much more than a pound of cure. Use the proper tools and body positioning when gardening. I am not only a hand surgeon but an avid gardener too.”

Raking, digging and planting may present injuries and OSS would like to share some helpful tips to keep you pain-free while you garden:


  • Sunscreen – Fair-weather skin tends to burn faster and in the Pacific Northwest when we see the sun peek out from the clouds, we rush to catch some of those sunshine rays.  Use sunscreen with SPF and wear a wide brimmed hat.
  • Light Stretching and Walk – Before you take on your dream garden, do some light stretching so that your muscles can warm up and take a short walk to get your blood flowing.
  • Spread out your workload – If your  garden took a toll over the winter months, pace yourself and spread out the work; this gives you the opportunity to see your garden progress and prevents you from injury by doing all the work at once.
  • Kneeling vs. bending – Place less strain on your back by avoiding bending; kneel instead.  Wear kneepads and use a cushioned mat to comfort your knees while working on the ground.
  • Keep Moving – Long periods of time in one position will put stress on your muscles and joints; so keep moving so that you avoid overworking specific areas of your body
  • Lift cautiously – Lift with your legs and not your back when carrying heavy loads and remember to hold objects close to your body when lifting.


If you believe you are suffering from a gardening-related injury and need specialized orthopedic care, Orthopedic Specialists of Seattle provide excellent treatment options available for you.  Please feel free to contact OSS at (206) 633-8100 to schedule an appointment or consultation with Dr. Ruhlman.


Knee Injuries on the Job


Driving down Interstate 5 through the Pacific Northwest, you see a lot of logging trucks pass you by.  Loggers and truck drivers do a lot of heavy lifting and/or climbing, but so do other professions, like nurses, construction workers, doctors or even chefs who walk long distances while lifting items they may need on the job.  You may not think of these jobs as a place where a knee injury might occur, but in fact, occasionally injure a person.


A knee injury might not be apparent at first, but over time, may become swollen and painful.  The knee injury now becomes an impediment, and you are unable to lift things because your stance is unstable.  Think about the last time you wobbled a little because your knee gave out and developed a nagging pain soon after.  Did you do anything to alleviate the pain you felt in your knee?


Common Knee Injuries

Meniscus Injuries: Meniscus tears can cause intense pain and instability in the knee depending on the severity of the tear. Clients with tears to the meniscus describe a sensation of their knee “giving out” or “coming out from under them” while walking or climbing stairs.

The knee will most likely swell in order to protect itself, which can be intensely painful and can limit movement. Although physical therapy, anti-inflammatory medication and cortisone injections can help reduce symptoms, an orthopedic doctor will often recommend arthroscopic surgery to repair the tear.


Ligament Injuries: Injuries to the cruciate ligaments – such as the anterior cruciate ligament (ACL), medial collateral ligament (MCL) and posterior cruciate ligament (PCL) – are sometimes referred to as sprains, but they can be much more complicated than simple muscle strains. These injuries can require months of treatment to recover, and some cruciate ligament injuries — e.g., anterior cruciate ligament (ACL) tears – may require reconstructive surgery.


Chondromalacia: Chondromalacia is a disorder caused by softening of the articular cartilage of the kneecap. It can be caused by traumatic injury or overuse or repetitive motion on the job. Signs and symptoms of chondromalacia include dull, achy pain in the front of the knee, increased pain when walking up or down stairs, pain in the knee when kneeling or squatting, knee pain after sitting for long periods of time, a grating or grinding sensation when you extend your knee and knee stiffness. To diagnose the problem, an OSS physician may require you to attempt simple knee exercises or recommend X-rays or other imaging tests such as an MRI or CT scan. Treatment options include rest, pain relievers or physical therapy. In rare cases, arthroscopic or realignment surgery may be options.


According to Dr. Watt, “Knee problems and injuries may be job-related or not.  Sometimes it is obvious and sometimes not obvious and this may be part of the initial evaluation.  I have extensive experience on all types of knee problems and injuries and would love to help anyone with a knee problem to try and regain a healthy knee.”


Dr. Watt is a board-certified orthopedic surgeon here at OSS who works with patients dealing with a wide range of orthopedic issues. Dr. Watt carefully weighs conservative and aggressive methods of treatment to devise a plan tailored to the specific needs of the individual. This personalized approach creates excellent outcomes, with patients working as close partners in the treatment process.


If you are suffering from a knee-related injury, contact OSS to schedule an appointment with Dr. Watt at (206) 633-8100.



Are you suffering from Hip Impingement?

Patients may have hip impingement for years before diagnosis because it’s rarely painful in its early stages. Early diagnosis is important; however, hip impingement if left untreated, can cause cartilage damage and osteoarthritis.

Once hip impingement becomes more advanced, symptoms include:

  • General stiffness in the groin or front of the thigh.
  • Running, jumping or sitting after flexing will also cause pain the groin region

What is hip impingement? Hip impingement (femoro acetabular acetabular impingement) is a more recently recognized cause of hip pain in the active adult.

Hip impingement is caused by a lack of room or clearance between the neck of the femur and the rim of the socket (acetabulum). In a normal hip, there is a gliding motion of the round femoral head within the socket, but with an impinged hip, the gliding motion is disturbed.  Dr. Downer states, “Mechanical problems do not always require surgical treatment; when symptoms affect function and lifestyle then surgery is justified.”

Dr. Downer, provides specialized care in hip restoration and replacement, and has a special interest in hip impingement conditions.  Treatment options may include:

  • First approach – Trying to control the pain with anti-inflammatory medications – If pain persists, surgical treatment may be necessary.
  • Surgical treatment of hip impingement involves removing or correcting the cause of the reduced clearance between the neck of the femur and the rim of the socket (acetabulum). This may require arthroscopic surgery of the hip to remove diseased portions of the acetabulem (labrum) as well as femoral neck.
  • In severe cases, it may be necessary to correct the deformity and reshape the femoral neck and/or rim of the socket through a larger incision. In cases of malposition of the socket, a redirecting procedure, called a periacetabular osteotomy (PAO) may be required.


Don’t let a hip impingement slow down your healthy, active lifestyle.  Find out treatment options so that you can continue doing the things you love.  Call Orthopedic Specialists of Seattle and schedule a consultation with Dr. Downer at (206) 633-8100.



Softball Pitchers’ Windmill Delivery Can Cause Injury

Softball pitching subjects the biceps to high forces and torques when the player’s arm swings around to release the ball.  Published in the March 2009 issue of the American Journal of Sports Medicine, the study of the “windmill” pitching motion appears to explain the high incidence of anterior shoulder pain observed in female softball players.

In the study, seven women — three collegiate and four professional pitchers — underwent motion analysis and surface electromyography to evaluate the muscle firing pattern of their biceps in the course of a windmill pitch. Electromyography detects electrical potential generated by muscle cells when they contract.

The researchers found that even though the upper arm movement in both baseball and fast-pitch softball gives the ball about the same velocity, the muscle force during the windmill pitch was much higher, according to the press release.

Moreover, the maximum force, or maximum contraction, occurred not when the arm was cocked, as in baseball’s overhand pitching, but when the arm circled around from the 9 o’clock position (i.e. almost fully extended back) to the 6 o’clock position (i.e. perpendicular with the ground), completing the windmill motion with the release the ball.

In one case, a pitcher had ruptured her tendon during play, which implicated the long head of the biceps tendon as the source of stress. Female softball pitchers are prone to overuse injury not only because of windmill pitching dynamics, but also because they pitch so many games.

Common injuries in softball players include tendonitis, rotator cuff and tendon strain, and ulnar nerve damage, but there are also plaguing lower body injuries that affect softball pitchers. So what is the source of injury? In simplest terms, the hips provide the platform for the scapula, and the scapula is the platform for the shoulder. If there is dysfunction in that system, this leads to injury. If a pitcher complains of shoulder pain, the shoulder may not be at fault for the pain, but rather faulty mechanics in the lower body.

Many times, softball pitchers experience upper body injuries that may be a result of faulty lower body mechanics. Force is produced in the ground, transfers through the legs and torso, and finishes in the upper body. If something along those lines isn’t functioning properly, injury will present itself.

Anterior shoulder pain is one of the most common complaints among windmill pitchers.  A typical overhand pitch sees around 108 degrees of motion, whereas the windmill pitch has around 360 degrees of motion; which is an increase in the eccentric action of the biceps.

Strength and conditioning for softball pitchers takes on a significant meaning because all of the energy is transferred from the ground up to the hand (the final point of contact with the ball) and pitch from a flat surface vs. baseball players who pitch off of a mound; this means that a softball pitcher would need to train in ground reaction-force, emphasizing gluteal exercises. Strong glutes will provide a strong base for the pelvis, then transferring energy through the core to the upper body.

When considering training regimens for windmill softball pitchers, much of the conditioning should focus on strengthening the lower extremity and lumbopelvic-hip complex. The lower extremities and lumbopelvic-hip musculature can often be addressed in the same exercises. Ideally, the lumbopelvic-hip complex should be addressed first in the training cycle in order to maintain a base of stability throughout all the conditioning exercises.

Dr. Shapiro states, “Warming up prior to the game and using the proper technique while playing will reduce the opportunity for injury; however, if you are experiencing pain this may be from overuse or an acute injury. It is best to seek medical attention and be evaluated by an Orthopedic and Sports Medicine Specialist.”

If you believe you are suffering from a softball-related injury and need specialized orthopedic care, Orthopedic Specialists of Seattle provide excellent treatment options available for you.  Please feel free to contact OSS at (206) 633-8100 to schedule an appointment.



Rules to Get Fit and Avoid Injuries this Spring Season for Runners



As we thaw from this winter’s frost, our bodies will need to acclimate to warmer weather once again.  The warmth of spring is upon us, and once again it’s time to start gearing up for a refreshing change to the winter routines that have kept us cooped up with muscles creaking.  Even if you managed to remain active through trips to the gym; the prospect of getting outside and in the sun offers a range of new exercises that require preparation and training. You may ask, “if I have maintained my exercises, why would I need any extra preparation?” The answer is that it’s specifically at the start of these new exercises that your body is most prone to injury.

As runners, think about the varied terrain and urban obstacles of jogging outdoors versus the treadmill’s regularity; now apply that same comparison to every gym exercise and the variables of its outdoor equivalent, from biking in the park to soccer on the grass.

The following are three important steps you should take to ensure that getting back into shape leaves you free from injury while offering the most beneficial takeaway of getting back into shape for spring.

1) Take a moment to set a goal. Setting a goal helps propel yourself towards a specific aim, a simple enough idea which cannot be understated in its power to focus yourself on a reasonable achievement.

2) Renew one of your new year’s resolutions or challenge yourself to meet or beat a pace that you haven’t quite kept up with over the past few years.

3) More importantly, set up a log book to keep track of your times and achievements. Having a physical record of where you started with a means to your ends is paramount to meeting your goal.

Speaking of physical reminders, the change in season is the perfect opportunity to change your sneakers! Most dedicated running stores offer in-depth analyses of your feet and gait to make sure that you get the proper equipment. Think about marking your shoes with the date of purchase so you can keep tabs on when you got them so that you don’t keep using them after their time is up.

Dr. Mark Reed states, “With so many different running styles gaining popularity; selecting the shoe that fits your style is important. A properly fitted shoe will help protect against injury and may also enhance performance. “

You should also set up an appointment with your OSS physician to go over all the requisites, making sure to get the OK for the goals you’ve set for yourself before the start of new routines.

The simple act of updating your equipment and evaluating your physiology are powerful motivators for getting back in shape and keeping you injury free.

If you believe you are suffering from a running-related injury and need specialized orthopedic care, Orthopedic Specialists of Seattle provide excellent treatment options available for you.  Please feel free to contact OSS at (206) 633-8100 to schedule an appointment.


March Madness – Preventing Basketball Injuries


The 2014 NCAA Men’s Basketball tournament starts on March 18, 2014 and OSS congratulates all the teams who have made it to the tournament.  March Madness is a frenetic tournament of college teams on their quest to be the best.  Getting to this tournament has been long and sometimes with injury, but we hope that they have performed all the necessary conditioning so that they can compete with the best.

Basketball is a fast, moving sport and sometimes, injuries can occur.  Common basketball injuries include:

Ankle sprains

Treatment for an ankle sprain involves rest, ice, compression, and elevation (RICE). The need for X-rays and evaluation by an OSS physician is determined on a case-by- case basis and depends on the severity and location of pain. Pain and swelling over the bone itself may need further evaluation. An injury to the ankle could represent a simple sprain or could be the result of an injury to the growth plates located around the ankle and should be evaluated by a physician.

Jammed fingers

Jammed fingers occur when the ball contacts the end of the finger and causes significant swelling of a single joint. Application of ice and buddy taping the finger to the adjacent finger may provide some relief and allow the athlete to return to play. If pain and swelling persist, evaluation by a physician or athletic trainer is recommended and an x-ray of the finger may be needed.


According to Dr. Scott Ruhlman, “It is often difficult to distinguish a devastating finger injury versus a simple sprain based on swelling alone. An x-ray is key to guide ideal treatment.”


Knee injuries

Basketball requires extensive stop and go and cutting maneuvers which can put the ligaments and menisci of the knee at risk. Injury to the medial collateral ligament is most common following a blow to the outside of the knee and can often be treated with ice, bracing and a gradual return to activity.

Deep thigh bruising

Treatment includes rest, ice, compression, and elevation. Commercially available girdles with thigh pads are now available for protection.

Foot fractures

Stress fractures can occur from a rapid increase in activity level or training or from overtraining. Stress fractures in basketball most commonly occur in the foot and lower leg (tibia). Once diagnosed, a period of immobilization and non-weight bearing is recommended. Return to play is permitted once the fracture has completely healed and the athlete is pain free.

Prevention of Basketball Injuries


  • Have a pre-season physical examination and follow your doctor’s recommendations for basketball injury prevention
  • Hydrate adequately – waiting until you are thirsty is often too late to hydrate properly
  • Pay attention to environmental recommendations, especially in relation to excessively hot and humid weather, to help avoid heat illness
  • Maintain proper fitness – injury rates are higher in athletes who have not adequately prepared physically
  • After a period of inactivity, progress gradually back to full-contact basketball through activities such as aerobic conditioning, strength training, and agility training.
  • Avoid overuse injuries - more is not always better. Many sports medicine specialists believe that it is beneficial to take at least one season off each year. Try to avoid the pressure that is now exerted on many young athletes to over-train. Listen to your body and decrease training time and intensity if pain or discomfort develops. This will reduce the risk of injury and help avoid “burn-out.”
  • Talk with your coach, an OSS physician and/or athletic trainer about an ACL injury prevention program and incorporating the training principles into team warm-ups.
  • The athlete should return to play only when clearance is granted by a health care professional.


Dr. Jonathan Franklin reminds everyone that “Conditioning and flexibility are key as they reduce the risk of injury during the season. Preparing your body for a game ahead of time will pay off with more success during the season.”

If you believe you are suffering from a basketball-related injury and need specialized orthopedic care, Orthopedic Specialists of Seattle provide excellent treatment options available for you.  Please feel free to contact OSS at (206) 633-8100 to schedule an appointment.





Preventing Injuries in the Gym while Maintaining Your New Year’s Resolution


It’s been a month or so now and you continue to be inspired by your New Year’s resolution of being more active and healthy. Hitting the gym was the biggest change to your new found resolve of an active lifestyle, especially here in the Pacific Northwest, where rain and even snow have kept us from enjoying the great outdoors. The gym is the best place to work on losing a few more pounds as well as conditioning your body for an active Spring and Summer season. OSS hopes that you are on your way to your healthier lifestyle and offers a few reminders of how to stay safe in the gym and avoid one of five common gym-related injuries and build a safe and stable foundation for your success. These common injuries include foot and ankle, knee, lower back, shoulder and neck injuries.

Foot and Ankle Injuries: Cause, Prevention, and Treatment

The most common foot and ankle injury to new gym goers are stress fractures. Stress fractures occur when a former couch potato hits the gym doing too much without building a foundation. By not allowing your feet and ankles to adapt to the stress of loading and unloading the bones, and not allowing enough recovery time between workouts, stress continues building on weak bone structure. Just as a pull tab on a soda can will break off as it is bent and unbent enough times, repeated stress on the small bones of the feet and ankles that have not been properly conditioned can snap and suffer a stress fracture.

Stress fractures can be prevented by:
• Starting slowly with any new weight bearing activities such as running on a treadmill
• Follow a sensible program of gradually increasing your workout by no more than ten percent week by week. (If that is a struggle, do less or stay at the same level for an extra week before increasing your workouts further)
• Be sure to wear proper shoes. Select in running or sports shoes that can assist in finding the right shoe for your activity and foot.

Treatments for stress fractures:
• Modifying workout to avoid weight bearing until pain lessens and the use of a stiff soled shoe for several weeks – Severe cases require the use of a cast or crutches. Healing can be a long slow process. Surgery may be necessary if the fracture fails to heal properly.

Knee Injuries: Cause, Prevention, and Treatment

Knee injuries are very common to gym goers and weekend warriors. More often than not, the cause involves weak muscles in the feet, ankles, hips and even the back. As you attempt to use muscles weaken from years of inactivity, it is easy to pull or twist the knee in an attempt to adapt to sharp or sudden changes in direction. Knee injuries may range from minor pulls and strains to major problems in dislocations, or torn cartilage.

Knee injury Prevention:
• Gradually working to strengthen core, hip, and foot and ankle muscles as all these work together to assist the knee in tracking in proper alignment.

Treatments for knee injuries:
• Standard R.I.C.E procedure (Rest, Ice, Compression, and Elevate) – If there is extreme pain, swelling or the knee seems misshapen, consult an OSS doctor as damage may require realignment of the kneecap or surgical repair to torn ligaments or cartilage.

Lower Back Injuries: Cause, Prevention, and Treatment

The risk of gym related lower back injuries is highest when first beginning an exercise routine. Moving too quickly and expecting weak muscles in your back, hips, and core to support your back and maintain proper spinal alignment is a sure formula for injury.

Lower back injury prevention:
• Warm-up before beginning a workout – Attempting to lift too much weight before you have built up a base, poor posture and lack of regular exercise leads to lower back injuries in and outside the gym.
• Proper recovery time – Acute lower back sprains occur when time is not taken to work up to higher weights used in many gym workouts. Overuse of muscles in the back causes tiny tears in muscle tissue, without proper recovery time between workouts, those microscopic tears do not have time to heal and strengthen the muscle. Chronic overuse can lead to sprains that are more serious or even disk injuries in the spine itself.

Treatment for lower back injury:
• Taking gradual steps to strengthen the muscles supporting the back, using good posture, avoiding sitting or standing in the same position for long periods of time, and scheduling weight training with days off for recovery will greatly reduce the chance of missing long-term workouts.
• Rest, over-the-counter pain medications such as aspirin or ibuprofen, medical treatments and gradually increasing exercise to strengthen the muscles of the lower back and core – In most cases, these steps will relieve lower back pain. If pain continues, is excruciating to the point it hinds daily activity, contact an OSS doctor. Traction or surgery is used as a last resort to treat severe lower back injuries.

Shoulder Injuries: Cause, Prevention, and Treatment

The large range of movement the shoulder has makes it at risk for injuries due to the repetitive movements during exercise. Rotator cuff injury, inflammation including tendonitis and bursitis, and compression of the bursa and tendons that leads to a condition call Impingement syndrome. The cause for most shoulder injuries is over training or improper form or techniques.

Simple guidelines for preventing shoulder injuries:
• Learning and using proper technique and form, warming up before exercising the shoulder by stretching the muscles by performing shoulder shrugs, stretches, and shoulder rolls, and begin a routine to gradually strengthen the shoulder muscles. – If injury does occur, do not try to ‘push through the pain. Doing so could lead to a serious rotator cuff injury requiring surgery. Treating shoulder pain and injury early is vital.
• Early treatment options include modifying exercise, ice or heat therapy, and the use of over-the-counter anti-inflammatory medications for pain control. Treating shoulder injuries may require consulting an OSS doctor to prevent long-term damage or loss of range of movement.

Neck Injuries: Cause, Prevention, and Treatment

Most neck injuries are muscle strain or over use. Tension from maintaining your neck in one position to long can cause pain in the neck and shoulders. Minor neck sprains may also result from twisting, attempting to lift too heavy a weight, or using improper form. Major life-altering damage, such as whiplash or fractures, can also occur to the neck when safety precautions and proper form is not consistently used.

Preventing neck injuries:
• Awareness – Remain aware of safety issues; do not leave free weights or other equipment where it will cause a falling or tripping hazard.
• Pay attention to proper form – Avoid sudden twisting or jerking movements. Know your own limits.
• Do not attempt heavy weights without a friend to spot for you or standby to help if needed.
• Always start slowly with a pre-workout warm up.

Treating neck injuries:
• Vary depending on the type and severity of the injury.
• Minor neck pain and strains from over use respond to treatment with rest and over-the-counter medications such as aspirin, within a few days.
• Ice therapy may also help during the first 24-48 hours of a minor injury – Serious injuries to the neck such as whiplash or fractures usually require immediate medical treatment. These injuries may require a neck brace, surgery, or traction. Consult with an OSS doctor as well as physical therapy is also part of the treatment for serious neck injuries. Treat all neck injuries seriously and do not attempt to ignore pain during a workout.

Dr. Joel Shapiro has this to say when you are in the gym, “Give up the push up. Pushups are hard on shoulders and there are better ways to strengthen triceps, biceps, pecs and deltoids. Work with a trainer on using the best form while working out. If you do sustain injury come in and see me for an evaluation.”
If you believe you are suffering from a gym-related injury and need specialized orthopedic care, Orthopedic Specialists of Seattle provide excellent treatment options available for you. Please feel free to contact OSS at (206) 633-8100 to schedule an appointment.

Dr. Ruhlman Featured in Swedish Ballard four-part Blog Series on the topic of Treating and Preventing Common Sports Injuries

This is Swedish Ballard’s third post in a four-part series to encourage and inspire Ballard residents and the surrounding communities to be healthy while leading active lifestyles in 2014.  Below, posted in its entirety, is the article from Swedish Ballard’s web site:; posted 1/29/14.

 By Scott Ruhlman, MD
Orthopedic Surgeon

Looking to be more active in 2014? Have you been waiting all year to enjoy winter sports such as skiing or snowboarding?

There are a few common injuries that often get my patients down when they are on the go. Below are a few tips and tricks to help you prevent these common injuries and determine the best treatment options should you need it.

The most common injuries in the wrist and ankle are sprains and fractures. Throwing, twisting, weight-bearing, and impact can put you at risk for a wrist injury. Ankle sprains and fractures are typically caused by making a fast, shifting movement with your foot planted on the ground.

In most cases, I recommend the RICE approach: rest for around 48 hours; ice the injured area to reduce swelling (use a pack wrapped in a towel); compress with an elastic ACE wrap; and elevate the injury above heart level.

However, if you experience these symptoms, contact your provider for further evaluation.

  • Pain at the time of injury
  • Swelling
  • Bruising or discoloration
  • Difficulty moving the wrist or ankle
  • A “popping” or tearing sensation during the trauma
  • Warmth and tenderness of the skin

More serious injuries will likely be treated with a splint, boot or cast. The healing process can take up to six weeks. Surgery may also be required.

ACL Tears
The ACL, or anterior cruciate ligament, is one of the major ligaments in your knee that helps with stabilization when turning or planting. ACL injuries take place during cutting or pivoting movements. The hallmark of a torn ACL is a distinct popping noise and your knee may give out. The affected knee will begin to swell and become stiff between 2-12 hours after the injury. People often experience pain or tenderness, and discomfort while standing or walking.

Treatment for ACL injuries depend on the severity of the tear, as well as your age and activity level. Non-surgical treatment such as physical therapy or using a brace may be sufficient. Other individuals will need reconstructive surgery. In all cases, it is important to consult with your provider as soon as possible if you suspect a problem.

Rotator Cuff Tears
The rotator cuff is a group of four small muscles and tendons in the shoulder that provide stability to the shoulder and mobility to the arm. A torn rotator cuff can happen in two ways. An acute tear happens suddenly, such as when you fall on an outstretched hand or lift a heavy object. Tears can also happen slowly over time. As we age, the tendons of the rotator cuff become weaker and gradually fray.

Symptoms of a rotator cuff tear include pain with movement of the shoulder and tenderness to touch. Inability to lift even household objects out to the side or overhead is also typical. Another indicator is a prior history of shoulder tendonitis or bursitis as this would point to excessive stress on the rotator cuff over time.

Treatment can be conservative for some tears, including physical therapy to improve shoulder mobility and progressively strengthen the cuff muscles. However, the majority of tears will likely require surgery to restore shoulder function.

Meniscus Tears
The meniscus helps to absorb shock, as well as stabilize the knee joint. A lot of your body weight is distributed through the meniscus when you move, especially when performing athletic activity. Meniscus tears are caused by twisting and compression that can occur with such activities as running or jumping.

If you have a meniscus tear, you may hear a popping sound or feel a tear or rip in the knee. Swelling generally occurs within a few minutes to a couple of hours and your knee might feel like it is out of place. In less acute injuries, swelling may not occur. Your knee might feel like it’s catching during movement, or like it’s “out of place”. If you suspect you may have a meniscus tear, make an appointment with your provider right away.

Initial treatment of a meniscal tear is typically nonsurgical, and may include RICE (rest, ice, compression and elevation). If the tear doesn’t heal, you may need surgery.

While the majority of these sports injuries are due to circumstance and pre-existing injuries, there are precautions that you can take to help prevent them from happening to you:

  • Maintaining a lifestyle involving consistent exercise
  • Warming up and stretching prior to rigorous activities
  • Cooling down and slowly relaxing after exercise.

Dr. Scott Ruhlman practices orthopedic surgery at Orthopedic Specialists of Seattle, and has extensive experience with sports medicine. If you have any questions regarding your shoulder pain or function, please feel free to contact Dr. Ruhlman’s office at (206) 784-8833.

The Importance of Snowboarding Safety


Snowboarding involves moving at very high speeds down steep hills past other skiers and boarders, as well as natural and man-made obstacles. Falls are going to happen regardless of how good a boarder you may be, and collisions are relatively common. Also, since snowboarding takes place at high altitudes in the winter, the weather can range from sunny and bright to bitterly cold, with conditions changing rapidly from one slope to the next and from one hour to the next; here in the Pacific Northwest, it is very much the case.

Gearing Up

Before you venture out to the slopes, it’s important to have the right gear and know how to use it. In addition to a snowboard and boots, you will also need warm clothing, protective eyewear and helmets intended specifically for snowboarding.

Here’s a list of what you should bring each time you head up the mountain:

  • Snowboard — In general, an all-mountain snowboard is the best bet for beginners, rather than a specialty board, which is harder to turn and balance on. Note that the longer a board is, the more difficult it will be to control. Choose a board that is the right length for your size and snowboarding ability.
  • Boots — The connecting point to the snowboard are boots, a vital piece of equipment. Make sure to get yourself real snowboard boots (not moonboots or hiking boots) that fit correctly to keep your feet comfortable and warm. For most beginner snowboarders, soft snowboard boots are easier to control than hard boots. Make sure you keep your boots laced up tight to give your feet and ankles the support they need.
  • Bindings — Most snowboard bindings are of the strap-on variety, which are compatible with the greatest number of boots. You should always keep your straps securely fastened to give them the most control over your snowboard. Some bindings, though, are step-in types. Make sure to get the right bindings for your boots, and have a trained professional at a snowboard shop adjust the angle of the bindings to put your feet in the right positions.
  • Helmet — A helmet is the most important piece of equipment when it comes to preventing life-threatening injuries. You should wear one any time you go boarding. Get a helmet that fits properly, and make sure you know to keep the chin strap fastened to keep it securely in place. Also, make sure to get a real snowboard helmet (not a football or bike helmet) that allows space for your goggles and ventilation on warm days.
  • Goggles and sunglasses — The sun’s rays are considerably stronger at high altitudes than they are at sea level, and when they bounce off the gleaming white snow, they can be a serious threat to the eyes. Sunglasses are the best way to protect eyes from the sun’s rays, but you should always bring a pair of goggles that are the right size in case it gets cold or begins to snow. Goggles are also better at protecting eyes from tree branches and other hazards.
  • Gloves or mittens — Many snowboard gloves include pockets for hand warmers to keep fingers nice and toasty. If you’re still worried about your hands getting cold, however, it’s a good idea to get mittens, which are generally warmer than gloves.
  • Wrist guards — When you first learn how to snowboard, you’ll spend a lot of time falling forward and breaking your falls with your hands. This can lead to broken wrists and forearms, which are very common snowboarding injuries. Be sure you wear rigid wrist guards designed for snowboarding or in-line skating to protect yourself when you fall.

Dress for Excess

Anyone who has snowboarded on a cold day can tell you, it’s no fun if you don’t have enough warm clothing. Likewise, on hot days having too many clothes can make you sweat, which will lead to you getting cold when the sun dips behind a cloud or the mountains. The best way to tackle this situation is to have dress in layers so that you can shed or put on depending on the temperature.

Here’s a rundown on what sort of clothes they should wear when you snowboard to avoid hypothermia and frostbite:

  • Thermal underwear
  • Thermal socks
  • Intermediate layers
  • Snowboard pants
  • Jacket
  • Neck gaiter

Additional Items

While you should always have the gear and clothing mentioned above, here are a number of other items you might want to consider bringing with you when you are snowboarding:

  • Hand
  • Boot warmers
  • Walkie-talkies
  • Sunscreen
  • Lip balm
  • Water and a snack
OSS January Newsletter!

Check out our January Newsletter here! We hope you enjoy!