Archive for the ‘News’ Category

Healthy Aging: Preserve Your Bones and Joints

thumbnailMarried with children, single, seniors and everyone in between struggle to fit exercise into their morning routine. “Busy” is a well worn word among Americans.

Time constraints are not alone in the challenges to stay healthy as we age. Maintaining the ability to be mobile is critical to remaining vital as we age. This means avoiding injury and preserving bone and join health.

Aging itself conspires to chip away at your bone and joint health. “Bone and joint health are intrinsically linked to healthy aging,” explains Dr. Bright McConnell of Charleston Sports Medicine. “We are excited to bring orthobiologics, stem cell therapies, bioidentical hormone replacement and countless other advanced treatments for patients with bone and joint injuries to the forefront. But the key to avoiding injury altogether or recovering from injury lies in the development of bone and joint strength. 

Strong, healthy bones and joints translate to strong healthy men and women – regardless of age.”

Here are some recommendations for how to achieve bone and joint health.

1. Start Early

skelatonBone and joint health begin in childhood. Today, approximately 32% of American children and adolescents, ages 2 to 19, are considered overweight or obese.

Excess weight can cause vitamin deficiencies, hormonal imbalances, and increased stress and tension that can affect bone growth and overall musculoskeletal health, causing deformity, pain, and potentially, a lifetime of limited mobility and diminished life quality.

Physical activity is important for loading the bones and helping them strengthen. A healthy diet, along with regular physical activity in childhood—at least 35 to 60 minutes a day—can help ensure a healthy weight and strong bones for life.

The adolescent growth spurt brings a marked rise in fractures. If fractures occur with mild injuries, that can be a sign children have skeletal defects tied to low bone mass. This carries over into adulthood.

2. Drink Well: Calcium, Caffeine and Alcohol

A diet inclusive of calcium is critical. Limit caffeinated beverages – soda and coffee – particularly if your calcium intake is low. Drink water instead. Alcohol consumption can affect bone health. Drink in moderation.

If you aren’t drinking the recommended calcium intake for your age group, add calcium-rich foods to your diet or use a calcium supplement.

3. Exercise: Find The Time & Mix It Up

The dramatic increase in the number of children, adolescents and adults diagnosed as overweight or obese in the United States has reached epidemic status. Calcium, vitamin D, diet and exercise are the cornerstones of bone health. Staying at a healthy weight reduces negative impact on bones and joints.

Moderation and variety of exercise reduces the possibility of wear and tear related to repeating the same motion. So mix it up. Run one day and do weight bearing activities the next.

Make the time. Staying active isn’t always easy to fit into today’s busy schedule. Try to schedule your exercise time and spend more time on your feet. Take the stairs, stand up while working, walk while on the phone. We agree with Nike. Just do it.

4. Don’t Smoke. Just Don’t Do It.

Smoking reduces bone mass. Several research studies have identified smoking as a risk factor for osteoporosis and bone fracture. So don’t smoke. Period.

5. Boost Your Vitamin D.

Vitamin D plays an important role in protecting your bones and your body requires it to absorb calcium. Children need vitamin D to build strong bones, and adults need it to keep their bones strong and healthy. If you don’t get enough vitamin D, you may lose bone, have lower bone density, and you’re more likely to break bones as you age.

Schedule an appointment for a blood panel to test your Vitamin D. Take a high potency supplement and/or a nice walk in the sun if you test low. Enjoy the added benefit of a mood boost. Now everybody’s happy.

Treatments using patient-derived platelets and stem cells are an emerging tool for healing injuries

Everybody knows a kid who likes to roughhouse — he or she plays full-speed with seemingly no regard for life and limb.

Jay Noce is one of those kids, all grown up.

The 51-year-old Daniel Island resident and former collegiate tennis player is a black belt in karate, does intense CrossFit workouts, and plays tennis, basketball and golf. Being physically active is in his DNA but his sports, while keeping him physically fit and trim, have taken their toll on his knees.

Mining blood and fat

Five years ago, he took a karate kick on the outside of his right knee that hobbled him and later sought out injections of platelet rich plasma (aka PRP) and adipose-derived stem cells, taken from his own blood and fat, to help it heal.

Last fall, Noce was near the end of a tennis match when he felt the proverbial “pop” in the right knee, which ended up being a stable meniscus tear.

He went back to the same orthopedic physician, Charleston Sports Medicine’s Dr. Bright McConnell, who offered him another orthobiologic treatment as an alternative to surgery, which would have involved a painful recovery and weeks on crunches. Not ideal for a man who also travels internationally as part of his digital business.

Healing stem cells

McConnell used an amniotic allograft, which is derived from the amniotic fluid from the placentas of screened mothers who have elected to have Caesarian sections.

“It’s like PRP on steroids,” says McConnell, of the allograft that is rich in stem cells and growth factors.

Noce says improvements were slow but steady.

“I’m at least 60 percent better,” says Noce, who is back to playing golf, doing karate with a strap on his knee, playing basketball with his kids and hitting tennis balls but not competing.

He was back in for another allograft injection last week with the hopes that will complete the healing process.

Biologics boom

McConnell says Noce’s slowly improving condition is fairly common for orthobiologic procedure.

“With biologics, it’s not instantaneous. It’s like planting a seed. You gotta wait for the flower to grow,” says McConnell. “People who get biologic treatments start to feel a difference in six to eight weeks. Three months out, 50 percent say it’s either a ton better or ‘it’s better but …’ Six months out, you’ll know if it worked.”

While biologics have been used to speed healing in brain and vascular surgeries for decades, their use in musculoskeletal applications have been more recent, within the last five years.

Orthobiologics are gaining attention, probably quicker than most new treatments, because of their fairly common use in high-profile professional athletes. Yet long-term outcomes are obviously not known.

In the years that McConnell has been using orthobiologics, starting with PRP, he has seen a range of patients from baby boomer athletes to seniors seeking to avoid a joint replacement.

What’s old is new?

According to a study “Orthobiologics in Foot and Ankle Surgery,” in 2013, the term orthobiologic is actually a marketing term that comes from the industry that creates devices, such as the centrifuges that separate platelets and stem cells from blood, bone marrow and fat tissues.

The term implies that the addition of one of these bioengineered products or extrinsic forces can positively influence the healing of ligaments and tendons.

Dr. Joe Calandra, a trained orthopedist and team physician for the South Carolina Stingrays and Charleston Southern University sports teams, says the first reported use of what is now called an orthobiologic was a bone graft in the mid-1600’s and that other autologous (tissue taken from the patient and put back in him or her) grafting continued.

“In the early 1900’s, autologous bone grafting started to take hold as an adjunct to help certain fractures heal. In 1965, bone morphogenic protein (often referred to as BMP) was isolated from bone tissue. This protein was shown to have the ability to stimulate bone growth,” says Calandra.

“Since the discovery of BMP many physicians and scientists have been trying to isolate other proteins and biologic substances such as stem cells and platelets, which may stimulate healing in the musculoskeletal system.”

Calandra adds that various substances have been implicated in the improvement of the healing process.

“Some orthobiologics, such as autologous bone grafts have good science behind them and a long track record of use in the clinical setting, others such as PRP and stem cell therapy do not have the consistent science or appropriate clinical trials to support their widespread use at this time.”

Calandra believes the newer biologics as well as those not yet discovered or perfected will be a tremendous adjunct to the care of musculoskeletal injuries and diseases in patients.

But, he adds, caution must be taken and proper unbiased clinical trials undertaken before these should be routinely recommended.

What will it cost me?

Insurance, for the most part, does not cover orthobiologic procedures, even though the treatments could be a less expensive option to surgeries, such as knee replacements.

The cost of Noce’s amniotic allograft procedure, which was done in McConnell’s office, will run between $2,000 and $2,500, largely the cost of the stem cell product.

In McConnell’s case, his staff files the cost of the office visit and other services with insurance by Charleston Sports Medicine but not the cost of the orthobiologics.

McConnell adds that some health savings accounts also be applied to orthobiologics.

View Full Article from Post & Courier

View Full Article from Post & Courier

Men’s Health Day. Friday, June 19 Only

Schedule your Cardiometabolic Performance Test (VO2Max) screening for 20% off.

Five Ways Men Can Get Fit Now for Men’s Health Week

In honor of Men’s Health Week, June 15 to June 21, FitMed Partners and Charleston Sports Medicine have teamed up to provide you seven critical ways to get fit now. Count the ways you can feel better fast.

1. Save on Your Vo2Max Test
First, schedule your Cardiometabolic Performance Test (VO2Max) screening for 20% off on Men’s Health Day. Appointments are available from 8 am to 5 pm, Friday June 19 at Charleston Sports Medicine’s Daniel Island location with exercise physiologist, Anne Moore. “A Cardiometabolic Performance Test performed on a treadmill or cycle measures key data including peak VO2, anaerobic threshold and the precise number of calories burned at all exercise heart rate zones.This is a great first step to designing a results oriented fitness plan unique to your body,” says Dr. Bright McConnell.

2. Combat Low T with Testosterone Therapy
Men have an unfair advantage over women in the weight loss, fitness category. The simple truth is that men are larger and have more muscle than women due to the hormone testosterone. They are genetically designed to have a higher percentage of muscle and less fat — which works in favor of keeping them fit and allowing them to eat more calories. However, if testosterone levels are low, men can lose this edge and gain abdominal weight, begin to feel sluggish and experience overall muscle loss. Keep your edge and have a comprehensive blood panel to determine if you have low testosterone. http://www.fitmedpartners.com/hormone-replacement-therapy/bioidentical-hormone-therapy-for-men/

3. Think Greek or Go Caveman
The Mediterranean diet, which is rich in vegetables, healthy fats, whole grains, and fish, is associated with physical health and mental acuity in your old age. Or, go back to the caveman days with the Paelo diet. Dr. McConnell likes a PaeloMed hybrid diet for maintaining your health. Not sure what to eat, use the gylcemic index tool http://www.fitmedpartners.com/glycemic-index-reference-guide/

4. Do Not Ignore Erectile Dysfunction (ED)
Problems with performance in an intimate setting are a difficult topic for men to address. Do not ignore ED. Make an appointment with your doctor to address. Read this article http://www.huffingtonpost.com/2015/04/09/erectile-dysfunction-_n_6882636.html

5. Strength Train
Even a little weight training can go a long way. Whether you’re 100 lbs overweight or just need to lose the last 15, strength training is one of the most effective ways to burn fat and build muscle.Lifting has been shown to halt and even reverse sarcopenia – the reduction of skeletal muscle that occurs as we get older – which helps us stay independent (and out of a nursing home) and live longer. It prevents disease and degenerative conditions such as heart disease and the management of cholesterol, high blood pressure, obesity, diabetes, and mood.

My elbow hurts!

Two of the most common injuries around the elbow that sports medicine physicians evaluate and treat are related to overuse and stress to the muscle and tendons that are involved in gripping type activities.

Lateral epicondylitis, known as “tennis elbow”, results from overuse of the muscles and tendons that are used to extend your wrist and fingers. The pain is typically located on the outside, or lateral aspect, of the elbow and involves primarily a muscle-tendon unit called the extensor carpi radialis brevis (ECRB). This tendon is used to help stabilize the wrist when the elbow is extended, which occurs during a tennis ground stroke.

Medial epicondylitis, known as “golfer’s elbow” results from overuse of the muscles and tendons that are used to flex the wrist and turned the forearm. Pain and discomfort is typically located on the inside, or medial aspect, of the elbow and involves the tendon known as the common flexor tendon. Forces are increased on the flexor tendon while gripping a golf club during a golf swing.

Both conditions can be caused by other repetitious activities such as throwing and activities requiring repetitious grip, such as shoveling, hammering nails, and gardening activities. Typical symptoms include pain on grip, or weakness in grip strength.

The early phase of these conditions is an acute inflammation of the tendon called tendinitis. However, if the overuse syndrome has existed for several months or longer, the tissue can continue to degenerate and form a condition known as tendinosis. This is not a true inflammatory condition, but represents chronic degenerative changes in the collagen fibers of the tendon, which results in scar tissue, leaving the injured area in a weak and and painful condition.

Diagnosis is typically based upon physical examination. Occasionally, x-rays may show some irregularity or calcium deposits within the tendon. Occasionally, further diagnostic imaging such as MRI or ultrasound is utilized, which confirms the pathology. The use of office musculoskeletal ultrasound now allows for a much quicker diagnosis and earlier intervention.

Treatment for this condition is typically nonsurgical, and involves a rehabilitation program which may include rest and stretching exercises, non-provocative exercise and occasionally use of bands or straps that may take the pressure off the tendon for a period of time. It is imperative to identify and correct any biomechanical abnormality in the swing or stroke mechanics, which led to the problem initially.

Although it is not uncommon for physicians to utilize cortisone type injections to reduce the inflammation, recent evidence in the sports medicine literature suggests this should not be carried out more than once or twice, as this may further damage the collagen in the tendon.

Traditional surgical treatment requires an incision over the affected tendon area, with removal of the damaged tissue and repair back to the bone after removing any underlying bone spurs.

Over the past several years, new and innovative technologies have been made available which are much less invasive. There has been a significant increase in the utilization of growth factors, such as platelet rich plasma, as well as use of certain types of stem cell therapies, to allow a more aggressive, regenerative healing response. These type of treatment options are referred to as orthobiologics.

Recently, a minimally invasive procedure developed at the Mayo Clinic called percutaneous tenotomy, or the Tenex procedure (www.TenexHealth.com), allows a physician to repair the degenerative collagen using a high energy device on the tip of a very small probe. This can be performed under a simple local anesthetic injection and is performed under ultrasound guidance. It requires no incisions or sutures and typically allows for a quicker recovery and return to activity.

Typically, prevention is the best cure! Spring has arrived, and outdoor activities will increase. Early recognition of symptoms, with early rehabilitation efforts and utilization of a good swing coach to correct poor mechanics will typically prevent this from developing into a more chronic problem.

Treatments using patient-derived platelets and stem cells are an emerging tool for healing injuries

Everybody knows a kid who likes to roughhouse — he or she plays full-speed with seemingly no regard for life and limb.

Jay Noce is one of those kids, all grown up.

The 51-year-old Daniel Island resident and former collegiate tennis player is a black belt in karate, does intense CrossFit workouts, and plays tennis, basketball and golf. Being physically active is in his DNA but his sports, while keeping him physically fit and trim, have taken their toll on his knees.

Read full article

Concussion Risk Reducer- Athletes Should Consider Pre-Season Cognitive Testing

March is Brain Injury Awareness Month

Spring sports practices like baseball, soccer and lacrosse have begun. One local physician advises athletes to stop by the examining room before hitting the field. March is Brain Injury Awareness Month, and according to the CDC, as many as 3.8 million sports and recreation related concussions are estimated to occur in the United States every year. Brain Injury symptoms range from confusion, headache and blurred vision to vomiting and loss of consciousness.

The problem with brain injuries, like concussions, is that they are difficult to diagnose. Because of this, Dr. Bright McConnell of Charleston Sports Medicine advises athletes to be proactive and have a pre season baseline test before the games begin. He states, “Go into the season prepared. This will help in the long run.” Charleston Sports Medicine provides baseline testing with the CNS Vital Signs Program. Athletes are given neurocognitive index testing and while the physician gains insight into an athlete’s brain health status. Through the testing, information on key cognitive measures, such as memory, reaction time, and executive function are examined. If an injury occurs, this information will be beneficial with evaluation and help physicians determine an athlete’s readiness to return to play.

CNS testing take only thirty minutes and is covered by insurance. Charleston Sports Medicine offers this test alone or as part of an age management profile.
For more information, log onto www.charlestonsportsmed.com.

Take the Pain out of the Game

Recently, the world’s best tennis players took over Daniel Island at the Family Circle Cup. In the crowd, many recreational players watched in awe looking for tips to improve their game. For some, playing without pain would be a start because of the well-known injury “tennis elbow.”

Tennis elbow is a common condition caused by the overuse of the arm, forearm and hand muscles. Dr. Bright McConnell, an orthopedic surgeon with Charleston Sports Medicine has been treating tennis elbow for years. He states, “Tennis elbow is caused by the overuse of muscles and tendons around the forearm. Close to fifty percent of tennis players will experience tennis elbow at some point in their playing years. They are constantly hitting the tennis ball with their racket with force. This can cause a nagging pain outside of the elbow that increases over time.”

Carol Wilson is a 4.0 league player that has played tennis for twenty years. Ten of those years she has played through the on and off pain of tennis elbow. She states, “I played with tennis elbow for years. I wore the sleeves, the tape, anything I thought would help. I did not want to give up the game.” Finally the pain associated with tennis elbow forced Wilson to put the racket down. “It was achy, towards the end it was sort of a constant pain that I felt beyond the tennis court. I couldn’t pick up my purse, use my computer mouse because my elbow ached all the time,” she explains.

There are several treatment options for players with tennis elbow. States Dr. McConnell, “First a player generally tries to play through the pain. Then they may try the gels, the cortisone shots and even physical therapy.” Physical therapy is an effective treatment for some with mild tennis elbow. Wilson tried physical therapy, but her pain remained.

Now there is a new procedure that those suffering from tennis elbow. It is called the Tenex Health (previously know as the FAST) procedure. Dr. McConnell states, “The Tenex Health TX procedure, or fasciotomy and surgical tenomoty, is a minimally invasive procedure that requires no incisions and minimal downtime post procedure. This procedure has proven to be quite effective for those suffering from tennis elbow.”

Dr. McConnell, the only surgeon locally trained to perform the Tenex Health procedure, treated Wilson in December. He states, “After an initial examination, she proved to be the perfect candidate for this procedure. The pain associated with her tennis elbow was affecting her everyday life and physical therapy had been ineffective.” Based on technology developed in collaboration with the Mayo clinic, the Fast procedure is performed using local anesthetic to numb the area; patients are awake and alert. During the procedure, ultrasound imaging is used to identify the location of the scar tissue. Once located, a small instrument-the size of a toothpick-is inserted into the damaged tendon. The instrument delivers ultrasonic energy specifically designed to cut, break up, and remove damaged tissue safely and quickly, without disturbing the surrounding healthy tendon tissue.

According to Dr. McConnell, this procedure is a good alternative for tennis players that are considering surgery for tennis elbow relief. He states, “Unlike conventional treatment methods, the Tenex Health TX replicates the goal of an open surgical procedure by removing the damaged tissue with minimal invasion. The procedure usually takes 15 minutes or less and requires only an adhesive bandage to close the micro incision.” Unlike traditional open surgeries that may require several months of recovery, the Tenex Health TX recovery period is on average a 1 to 2 month timeframe. Following the short recovery a full return to the patient’s normal activities is expected.

A study done in April 2013 by the American Journal of Sports Medicine found the Tenex (FAST) procedure to be “safe, specific, minimally invasive and well tolerated treatment for recalcitrant lateral elbow tendinopathy.” All but one patient showed evidence of efficacy that was sustained at least one year. Wilson is not surprised by the studies’ outcome. By March, she was back on the court hitting tennis balls. While she is three months out from the procedure, assessment of patients for Tenex Health continues six months beyond the date of surgery. Wilson recommends Tenex Health TX (FAST) to any tennis player playing through the pain. She states, “The hardest thing is to put the racket down. I thought I could play through the pain. I now play pain free, it is like a new beginning.”

Dr. McConnell is an orthopedic surgeon that focuses on prevention and performance. He works with several local athletes as well as those on the national level. His office is located on Daniel Island. To learn more about this minimally invasive procedure for tennis elbow relief, go to www.charlestonsportsmed.com.

Dr. McConnell talks to patient, Deanna, about her TekScan evaluation for foot pain

Dr. McConnell Only Orthopaedic Surgeon to Perform New Minimally Invasive Procedures for Tendonitis

Is the source of your pain in the tendon or ligament? If medication and physical therapy have proved unsuccessful in relieving discomfort and pain related to tendon or ligament injuries, there are some recent advanced treatments worth exploring. Even better, these revolutionary treatments do not require open surgery.

Determining the actual source of your pain can be the first step to knowing if there is a minimally invasive treatment for which you are a candidate. Here are two very new options for patients with tendon and ligament damage.

Tenex Health TXTM
Focused Aspiration of Scar Tissue (FAST™) procedure or newly named, Tenex Health TXTM is a new outpatient procedure specifically designed for those who are suffering from pain associated to tendon damage. Tendon damage often occurs in patients due to repetitive stress and overuse of one area of the body.

Tendon pain takes many forms:
• Plantar fasciitis
• Achilles tendonitis
• Jumper’s / Runner’s knee
• Tennis / Golfer’s elbow

The revolutionary Tenex Health TXTM procedure is an advanced treatment that quickly and safely removes the source of tendon pain stemming from tendon and soft tissue injuries such as tennis elbow, golfer’s elbow, jumper’s knee, Achilles tendonitis and plantar fasciitis. The procedure is based on advanced technology developed in collaboration with the Mayo Clinic and is performed using a local anesthetic, allowing patients to remain awake and alert the entire time.

Using ultrasound imaging, the scar tissue is identified and a small instrument about the size of a toothpick is inserted into the damaged tendon. Ultrasonic energy then cuts, breaks up and removes the damaged tissue, without disturbing the surrounding healthy tendon tissue. The procedure typically takes about 15 minutes or less, requires only an adhesive bandage to close the microincision, and offers quick recovery time for patients.

This procedure is not invasive open surgery and can be performed in an office or procedure room.

Platelet Rich Plasma (PRP) Therapy:
PRP is blood plasma with concentrated platelets. These platelets include bioactive proteins that initiate connective tissue healing such as bone, tendon and ligament regeneration and repair.

PRP can be injected in tendons and ligaments all over the body, which can help with sports injuries and more specific injuries including tennis elbow, carpal tunnel syndrome, shin splints and many other damaged ligaments and tendons. Patients see significant improvement immediately, which may eliminate the need for aggressive treatments such as long-term medication or surgery.

Bright McConnell, III, MD 900 Island Park Drive, Suite #105
Charleston, SC 29492 Phone: (843) 284-5200

Dr. McConnell and Anne Ahern Moore on Lowcountry Live!

Dr. McConnell and Exercise Physiologist, Anne Ahern Moore discusses tests to customize your best fitness and nutrition plan for great results.

The Charleston Sports Medicine Team strives to become your partner in your total health. Our affiliated practice, FitMed Partners, also offers scientifically proven preventive age management, bio-identical hormone therapy and medically based fitness and nutrition programs. The FitMed Elite Athlete Program provides a menu of advanced sports performance testing, not typically covered under insurance, for affordable prices.

thumbnailMarried with children, single, seniors and everyone in between struggle to fit exercise into their morning routine. “Busy” is a well worn word among Americans.

Time constraints are not alone in the challenges to stay healthy as we age. Maintaining the ability to be mobile is critical to remaining vital as we age. This means avoiding injury and preserving bone and join health.

Aging itself conspires to chip away at your bone and joint health. “Bone and joint health are intrinsically linked to healthy aging,” explains Dr. Bright McConnell of Charleston Sports Medicine. “We are excited to bring orthobiologics, stem cell therapies, bioidentical hormone replacement and countless other advanced treatments for patients with bone and joint injuries to the forefront. But the key to avoiding injury altogether or recovering from injury lies in the development of bone and joint strength. 

Strong, healthy bones and joints translate to strong healthy men and women – regardless of age.”

Here are some recommendations for how to achieve bone and joint health.

1. Start Early

skelatonBone and joint health begin in childhood. Today, approximately 32% of American children and adolescents, ages 2 to 19, are considered overweight or obese.

Excess weight can cause vitamin deficiencies, hormonal imbalances, and increased stress and tension that can affect bone growth and overall musculoskeletal health, causing deformity, pain, and potentially, a lifetime of limited mobility and diminished life quality.

Physical activity is important for loading the bones and helping them strengthen. A healthy diet, along with regular physical activity in childhood—at least 35 to 60 minutes a day—can help ensure a healthy weight and strong bones for life.

The adolescent growth spurt brings a marked rise in fractures. If fractures occur with mild injuries, that can be a sign children have skeletal defects tied to low bone mass. This carries over into adulthood.

2. Drink Well: Calcium, Caffeine and Alcohol

A diet inclusive of calcium is critical. Limit caffeinated beverages – soda and coffee – particularly if your calcium intake is low. Drink water instead. Alcohol consumption can affect bone health. Drink in moderation.

If you aren’t drinking the recommended calcium intake for your age group, add calcium-rich foods to your diet or use a calcium supplement.

3. Exercise: Find The Time & Mix It Up

The dramatic increase in the number of children, adolescents and adults diagnosed as overweight or obese in the United States has reached epidemic status. Calcium, vitamin D, diet and exercise are the cornerstones of bone health. Staying at a healthy weight reduces negative impact on bones and joints.

Moderation and variety of exercise reduces the possibility of wear and tear related to repeating the same motion. So mix it up. Run one day and do weight bearing activities the next.

Make the time. Staying active isn’t always easy to fit into today’s busy schedule. Try to schedule your exercise time and spend more time on your feet. Take the stairs, stand up while working, walk while on the phone. We agree with Nike. Just do it.

4. Don’t Smoke. Just Don’t Do It.

Smoking reduces bone mass. Several research studies have identified smoking as a risk factor for osteoporosis and bone fracture. So don’t smoke. Period.

5. Boost Your Vitamin D.

Vitamin D plays an important role in protecting your bones and your body requires it to absorb calcium. Children need vitamin D to build strong bones, and adults need it to keep their bones strong and healthy. If you don’t get enough vitamin D, you may lose bone, have lower bone density, and you’re more likely to break bones as you age.

Schedule an appointment for a blood panel to test your Vitamin D. Take a high potency supplement and/or a nice walk in the sun if you test low. Enjoy the added benefit of a mood boost. Now everybody’s happy.

Healthy Aging: Preserve Your Bones and Joints

thumbnailMarried with children, single, seniors and everyone in between struggle to fit exercise into their morning routine. “Busy” is a well worn word among Americans.

Time constraints are not alone in the challenges to stay healthy as we age. Maintaining the ability to be mobile is critical to remaining vital as we age. This means avoiding injury and preserving bone and join health.

Aging itself conspires to chip away at your bone and joint health. “Bone and joint health are intrinsically linked to healthy aging,” explains Dr. Bright McConnell of Charleston Sports Medicine. “We are excited to bring orthobiologics, stem cell therapies, bioidentical hormone replacement and countless other advanced treatments for patients with bone and joint injuries to the forefront. But the key to avoiding injury altogether or recovering from injury lies in the development of bone and joint strength. 

Strong, healthy bones and joints translate to strong healthy men and women – regardless of age.”

Here are some recommendations for how to achieve bone and joint health.

1. Start Early

skelatonBone and joint health begin in childhood. Today, approximately 32% of American children and adolescents, ages 2 to 19, are considered overweight or obese.

Excess weight can cause vitamin deficiencies, hormonal imbalances, and increased stress and tension that can affect bone growth and overall musculoskeletal health, causing deformity, pain, and potentially, a lifetime of limited mobility and diminished life quality.

Physical activity is important for loading the bones and helping them strengthen. A healthy diet, along with regular physical activity in childhood—at least 35 to 60 minutes a day—can help ensure a healthy weight and strong bones for life.

The adolescent growth spurt brings a marked rise in fractures. If fractures occur with mild injuries, that can be a sign children have skeletal defects tied to low bone mass. This carries over into adulthood.

2. Drink Well: Calcium, Caffeine and Alcohol

A diet inclusive of calcium is critical. Limit caffeinated beverages – soda and coffee – particularly if your calcium intake is low. Drink water instead. Alcohol consumption can affect bone health. Drink in moderation.

If you aren’t drinking the recommended calcium intake for your age group, add calcium-rich foods to your diet or use a calcium supplement.

3. Exercise: Find The Time & Mix It Up

The dramatic increase in the number of children, adolescents and adults diagnosed as overweight or obese in the United States has reached epidemic status. Calcium, vitamin D, diet and exercise are the cornerstones of bone health. Staying at a healthy weight reduces negative impact on bones and joints.

Moderation and variety of exercise reduces the possibility of wear and tear related to repeating the same motion. So mix it up. Run one day and do weight bearing activities the next.

Make the time. Staying active isn’t always easy to fit into today’s busy schedule. Try to schedule your exercise time and spend more time on your feet. Take the stairs, stand up while working, walk while on the phone. We agree with Nike. Just do it.

4. Don’t Smoke. Just Don’t Do It.

Smoking reduces bone mass. Several research studies have identified smoking as a risk factor for osteoporosis and bone fracture. So don’t smoke. Period.

5. Boost Your Vitamin D.

Vitamin D plays an important role in protecting your bones and your body requires it to absorb calcium. Children need vitamin D to build strong bones, and adults need it to keep their bones strong and healthy. If you don’t get enough vitamin D, you may lose bone, have lower bone density, and you’re more likely to break bones as you age.

Schedule an appointment for a blood panel to test your Vitamin D. Take a high potency supplement and/or a nice walk in the sun if you test low. Enjoy the added benefit of a mood boost. Now everybody’s happy.

Treatments using patient-derived platelets and stem cells are an emerging tool for healing injuries

Everybody knows a kid who likes to roughhouse — he or she plays full-speed with seemingly no regard for life and limb.

Jay Noce is one of those kids, all grown up.

The 51-year-old Daniel Island resident and former collegiate tennis player is a black belt in karate, does intense CrossFit workouts, and plays tennis, basketball and golf. Being physically active is in his DNA but his sports, while keeping him physically fit and trim, have taken their toll on his knees.

Mining blood and fat

Five years ago, he took a karate kick on the outside of his right knee that hobbled him and later sought out injections of platelet rich plasma (aka PRP) and adipose-derived stem cells, taken from his own blood and fat, to help it heal.

Last fall, Noce was near the end of a tennis match when he felt the proverbial “pop” in the right knee, which ended up being a stable meniscus tear.

He went back to the same orthopedic physician, Charleston Sports Medicine’s Dr. Bright McConnell, who offered him another orthobiologic treatment as an alternative to surgery, which would have involved a painful recovery and weeks on crunches. Not ideal for a man who also travels internationally as part of his digital business.

Healing stem cells

McConnell used an amniotic allograft, which is derived from the amniotic fluid from the placentas of screened mothers who have elected to have Caesarian sections.

“It’s like PRP on steroids,” says McConnell, of the allograft that is rich in stem cells and growth factors.

Noce says improvements were slow but steady.

“I’m at least 60 percent better,” says Noce, who is back to playing golf, doing karate with a strap on his knee, playing basketball with his kids and hitting tennis balls but not competing.

He was back in for another allograft injection last week with the hopes that will complete the healing process.

Biologics boom

McConnell says Noce’s slowly improving condition is fairly common for orthobiologic procedure.

“With biologics, it’s not instantaneous. It’s like planting a seed. You gotta wait for the flower to grow,” says McConnell. “People who get biologic treatments start to feel a difference in six to eight weeks. Three months out, 50 percent say it’s either a ton better or ‘it’s better but …’ Six months out, you’ll know if it worked.”

While biologics have been used to speed healing in brain and vascular surgeries for decades, their use in musculoskeletal applications have been more recent, within the last five years.

Orthobiologics are gaining attention, probably quicker than most new treatments, because of their fairly common use in high-profile professional athletes. Yet long-term outcomes are obviously not known.

In the years that McConnell has been using orthobiologics, starting with PRP, he has seen a range of patients from baby boomer athletes to seniors seeking to avoid a joint replacement.

What’s old is new?

According to a study “Orthobiologics in Foot and Ankle Surgery,” in 2013, the term orthobiologic is actually a marketing term that comes from the industry that creates devices, such as the centrifuges that separate platelets and stem cells from blood, bone marrow and fat tissues.

The term implies that the addition of one of these bioengineered products or extrinsic forces can positively influence the healing of ligaments and tendons.

Dr. Joe Calandra, a trained orthopedist and team physician for the South Carolina Stingrays and Charleston Southern University sports teams, says the first reported use of what is now called an orthobiologic was a bone graft in the mid-1600’s and that other autologous (tissue taken from the patient and put back in him or her) grafting continued.

“In the early 1900’s, autologous bone grafting started to take hold as an adjunct to help certain fractures heal. In 1965, bone morphogenic protein (often referred to as BMP) was isolated from bone tissue. This protein was shown to have the ability to stimulate bone growth,” says Calandra.

“Since the discovery of BMP many physicians and scientists have been trying to isolate other proteins and biologic substances such as stem cells and platelets, which may stimulate healing in the musculoskeletal system.”

Calandra adds that various substances have been implicated in the improvement of the healing process.

“Some orthobiologics, such as autologous bone grafts have good science behind them and a long track record of use in the clinical setting, others such as PRP and stem cell therapy do not have the consistent science or appropriate clinical trials to support their widespread use at this time.”

Calandra believes the newer biologics as well as those not yet discovered or perfected will be a tremendous adjunct to the care of musculoskeletal injuries and diseases in patients.

But, he adds, caution must be taken and proper unbiased clinical trials undertaken before these should be routinely recommended.

What will it cost me?

Insurance, for the most part, does not cover orthobiologic procedures, even though the treatments could be a less expensive option to surgeries, such as knee replacements.

The cost of Noce’s amniotic allograft procedure, which was done in McConnell’s office, will run between $2,000 and $2,500, largely the cost of the stem cell product.

In McConnell’s case, his staff files the cost of the office visit and other services with insurance by Charleston Sports Medicine but not the cost of the orthobiologics.

McConnell adds that some health savings accounts also be applied to orthobiologics.

View Full Article from Post & Courier

View Full Article from Post & Courier

Men’s Health Day. Friday, June 19 Only

Schedule your Cardiometabolic Performance Test (VO2Max) screening for 20% off.

Five Ways Men Can Get Fit Now for Men’s Health Week

In honor of Men’s Health Week, June 15 to June 21, FitMed Partners and Charleston Sports Medicine have teamed up to provide you seven critical ways to get fit now. Count the ways you can feel better fast.

1. Save on Your Vo2Max Test
First, schedule your Cardiometabolic Performance Test (VO2Max) screening for 20% off on Men’s Health Day. Appointments are available from 8 am to 5 pm, Friday June 19 at Charleston Sports Medicine’s Daniel Island location with exercise physiologist, Anne Moore. “A Cardiometabolic Performance Test performed on a treadmill or cycle measures key data including peak VO2, anaerobic threshold and the precise number of calories burned at all exercise heart rate zones.This is a great first step to designing a results oriented fitness plan unique to your body,” says Dr. Bright McConnell.

2. Combat Low T with Testosterone Therapy
Men have an unfair advantage over women in the weight loss, fitness category. The simple truth is that men are larger and have more muscle than women due to the hormone testosterone. They are genetically designed to have a higher percentage of muscle and less fat — which works in favor of keeping them fit and allowing them to eat more calories. However, if testosterone levels are low, men can lose this edge and gain abdominal weight, begin to feel sluggish and experience overall muscle loss. Keep your edge and have a comprehensive blood panel to determine if you have low testosterone. http://www.fitmedpartners.com/hormone-replacement-therapy/bioidentical-hormone-therapy-for-men/

3. Think Greek or Go Caveman
The Mediterranean diet, which is rich in vegetables, healthy fats, whole grains, and fish, is associated with physical health and mental acuity in your old age. Or, go back to the caveman days with the Paelo diet. Dr. McConnell likes a PaeloMed hybrid diet for maintaining your health. Not sure what to eat, use the gylcemic index tool http://www.fitmedpartners.com/glycemic-index-reference-guide/

4. Do Not Ignore Erectile Dysfunction (ED)
Problems with performance in an intimate setting are a difficult topic for men to address. Do not ignore ED. Make an appointment with your doctor to address. Read this article http://www.huffingtonpost.com/2015/04/09/erectile-dysfunction-_n_6882636.html

5. Strength Train
Even a little weight training can go a long way. Whether you’re 100 lbs overweight or just need to lose the last 15, strength training is one of the most effective ways to burn fat and build muscle.Lifting has been shown to halt and even reverse sarcopenia – the reduction of skeletal muscle that occurs as we get older – which helps us stay independent (and out of a nursing home) and live longer. It prevents disease and degenerative conditions such as heart disease and the management of cholesterol, high blood pressure, obesity, diabetes, and mood.

My elbow hurts!

Two of the most common injuries around the elbow that sports medicine physicians evaluate and treat are related to overuse and stress to the muscle and tendons that are involved in gripping type activities.

Lateral epicondylitis, known as “tennis elbow”, results from overuse of the muscles and tendons that are used to extend your wrist and fingers. The pain is typically located on the outside, or lateral aspect, of the elbow and involves primarily a muscle-tendon unit called the extensor carpi radialis brevis (ECRB). This tendon is used to help stabilize the wrist when the elbow is extended, which occurs during a tennis ground stroke.

Medial epicondylitis, known as “golfer’s elbow” results from overuse of the muscles and tendons that are used to flex the wrist and turned the forearm. Pain and discomfort is typically located on the inside, or medial aspect, of the elbow and involves the tendon known as the common flexor tendon. Forces are increased on the flexor tendon while gripping a golf club during a golf swing.

Both conditions can be caused by other repetitious activities such as throwing and activities requiring repetitious grip, such as shoveling, hammering nails, and gardening activities. Typical symptoms include pain on grip, or weakness in grip strength.

The early phase of these conditions is an acute inflammation of the tendon called tendinitis. However, if the overuse syndrome has existed for several months or longer, the tissue can continue to degenerate and form a condition known as tendinosis. This is not a true inflammatory condition, but represents chronic degenerative changes in the collagen fibers of the tendon, which results in scar tissue, leaving the injured area in a weak and and painful condition.

Diagnosis is typically based upon physical examination. Occasionally, x-rays may show some irregularity or calcium deposits within the tendon. Occasionally, further diagnostic imaging such as MRI or ultrasound is utilized, which confirms the pathology. The use of office musculoskeletal ultrasound now allows for a much quicker diagnosis and earlier intervention.

Treatment for this condition is typically nonsurgical, and involves a rehabilitation program which may include rest and stretching exercises, non-provocative exercise and occasionally use of bands or straps that may take the pressure off the tendon for a period of time. It is imperative to identify and correct any biomechanical abnormality in the swing or stroke mechanics, which led to the problem initially.

Although it is not uncommon for physicians to utilize cortisone type injections to reduce the inflammation, recent evidence in the sports medicine literature suggests this should not be carried out more than once or twice, as this may further damage the collagen in the tendon.

Traditional surgical treatment requires an incision over the affected tendon area, with removal of the damaged tissue and repair back to the bone after removing any underlying bone spurs.

Over the past several years, new and innovative technologies have been made available which are much less invasive. There has been a significant increase in the utilization of growth factors, such as platelet rich plasma, as well as use of certain types of stem cell therapies, to allow a more aggressive, regenerative healing response. These type of treatment options are referred to as orthobiologics.

Recently, a minimally invasive procedure developed at the Mayo Clinic called percutaneous tenotomy, or the Tenex procedure (www.TenexHealth.com), allows a physician to repair the degenerative collagen using a high energy device on the tip of a very small probe. This can be performed under a simple local anesthetic injection and is performed under ultrasound guidance. It requires no incisions or sutures and typically allows for a quicker recovery and return to activity.

Typically, prevention is the best cure! Spring has arrived, and outdoor activities will increase. Early recognition of symptoms, with early rehabilitation efforts and utilization of a good swing coach to correct poor mechanics will typically prevent this from developing into a more chronic problem.

Treatments using patient-derived platelets and stem cells are an emerging tool for healing injuries

Everybody knows a kid who likes to roughhouse — he or she plays full-speed with seemingly no regard for life and limb.

Jay Noce is one of those kids, all grown up.

The 51-year-old Daniel Island resident and former collegiate tennis player is a black belt in karate, does intense CrossFit workouts, and plays tennis, basketball and golf. Being physically active is in his DNA but his sports, while keeping him physically fit and trim, have taken their toll on his knees.

Read full article

Concussion Risk Reducer- Athletes Should Consider Pre-Season Cognitive Testing

March is Brain Injury Awareness Month

Spring sports practices like baseball, soccer and lacrosse have begun. One local physician advises athletes to stop by the examining room before hitting the field. March is Brain Injury Awareness Month, and according to the CDC, as many as 3.8 million sports and recreation related concussions are estimated to occur in the United States every year. Brain Injury symptoms range from confusion, headache and blurred vision to vomiting and loss of consciousness.

The problem with brain injuries, like concussions, is that they are difficult to diagnose. Because of this, Dr. Bright McConnell of Charleston Sports Medicine advises athletes to be proactive and have a pre season baseline test before the games begin. He states, “Go into the season prepared. This will help in the long run.” Charleston Sports Medicine provides baseline testing with the CNS Vital Signs Program. Athletes are given neurocognitive index testing and while the physician gains insight into an athlete’s brain health status. Through the testing, information on key cognitive measures, such as memory, reaction time, and executive function are examined. If an injury occurs, this information will be beneficial with evaluation and help physicians determine an athlete’s readiness to return to play.

CNS testing take only thirty minutes and is covered by insurance. Charleston Sports Medicine offers this test alone or as part of an age management profile.
For more information, log onto www.charlestonsportsmed.com.

Take the Pain out of the Game

Recently, the world’s best tennis players took over Daniel Island at the Family Circle Cup. In the crowd, many recreational players watched in awe looking for tips to improve their game. For some, playing without pain would be a start because of the well-known injury “tennis elbow.”

Tennis elbow is a common condition caused by the overuse of the arm, forearm and hand muscles. Dr. Bright McConnell, an orthopedic surgeon with Charleston Sports Medicine has been treating tennis elbow for years. He states, “Tennis elbow is caused by the overuse of muscles and tendons around the forearm. Close to fifty percent of tennis players will experience tennis elbow at some point in their playing years. They are constantly hitting the tennis ball with their racket with force. This can cause a nagging pain outside of the elbow that increases over time.”

Carol Wilson is a 4.0 league player that has played tennis for twenty years. Ten of those years she has played through the on and off pain of tennis elbow. She states, “I played with tennis elbow for years. I wore the sleeves, the tape, anything I thought would help. I did not want to give up the game.” Finally the pain associated with tennis elbow forced Wilson to put the racket down. “It was achy, towards the end it was sort of a constant pain that I felt beyond the tennis court. I couldn’t pick up my purse, use my computer mouse because my elbow ached all the time,” she explains.

There are several treatment options for players with tennis elbow. States Dr. McConnell, “First a player generally tries to play through the pain. Then they may try the gels, the cortisone shots and even physical therapy.” Physical therapy is an effective treatment for some with mild tennis elbow. Wilson tried physical therapy, but her pain remained.

Now there is a new procedure that those suffering from tennis elbow. It is called the Tenex Health (previously know as the FAST) procedure. Dr. McConnell states, “The Tenex Health TX procedure, or fasciotomy and surgical tenomoty, is a minimally invasive procedure that requires no incisions and minimal downtime post procedure. This procedure has proven to be quite effective for those suffering from tennis elbow.”

Dr. McConnell, the only surgeon locally trained to perform the Tenex Health procedure, treated Wilson in December. He states, “After an initial examination, she proved to be the perfect candidate for this procedure. The pain associated with her tennis elbow was affecting her everyday life and physical therapy had been ineffective.” Based on technology developed in collaboration with the Mayo clinic, the Fast procedure is performed using local anesthetic to numb the area; patients are awake and alert. During the procedure, ultrasound imaging is used to identify the location of the scar tissue. Once located, a small instrument-the size of a toothpick-is inserted into the damaged tendon. The instrument delivers ultrasonic energy specifically designed to cut, break up, and remove damaged tissue safely and quickly, without disturbing the surrounding healthy tendon tissue.

According to Dr. McConnell, this procedure is a good alternative for tennis players that are considering surgery for tennis elbow relief. He states, “Unlike conventional treatment methods, the Tenex Health TX replicates the goal of an open surgical procedure by removing the damaged tissue with minimal invasion. The procedure usually takes 15 minutes or less and requires only an adhesive bandage to close the micro incision.” Unlike traditional open surgeries that may require several months of recovery, the Tenex Health TX recovery period is on average a 1 to 2 month timeframe. Following the short recovery a full return to the patient’s normal activities is expected.

A study done in April 2013 by the American Journal of Sports Medicine found the Tenex (FAST) procedure to be “safe, specific, minimally invasive and well tolerated treatment for recalcitrant lateral elbow tendinopathy.” All but one patient showed evidence of efficacy that was sustained at least one year. Wilson is not surprised by the studies’ outcome. By March, she was back on the court hitting tennis balls. While she is three months out from the procedure, assessment of patients for Tenex Health continues six months beyond the date of surgery. Wilson recommends Tenex Health TX (FAST) to any tennis player playing through the pain. She states, “The hardest thing is to put the racket down. I thought I could play through the pain. I now play pain free, it is like a new beginning.”

Dr. McConnell is an orthopedic surgeon that focuses on prevention and performance. He works with several local athletes as well as those on the national level. His office is located on Daniel Island. To learn more about this minimally invasive procedure for tennis elbow relief, go to www.charlestonsportsmed.com.

Dr. McConnell talks to patient, Deanna, about her TekScan evaluation for foot pain

Dr. McConnell Only Orthopaedic Surgeon to Perform New Minimally Invasive Procedures for Tendonitis

Is the source of your pain in the tendon or ligament? If medication and physical therapy have proved unsuccessful in relieving discomfort and pain related to tendon or ligament injuries, there are some recent advanced treatments worth exploring. Even better, these revolutionary treatments do not require open surgery.

Determining the actual source of your pain can be the first step to knowing if there is a minimally invasive treatment for which you are a candidate. Here are two very new options for patients with tendon and ligament damage.

Tenex Health TXTM
Focused Aspiration of Scar Tissue (FAST™) procedure or newly named, Tenex Health TXTM is a new outpatient procedure specifically designed for those who are suffering from pain associated to tendon damage. Tendon damage often occurs in patients due to repetitive stress and overuse of one area of the body.

Tendon pain takes many forms:
• Plantar fasciitis
• Achilles tendonitis
• Jumper’s / Runner’s knee
• Tennis / Golfer’s elbow

The revolutionary Tenex Health TXTM procedure is an advanced treatment that quickly and safely removes the source of tendon pain stemming from tendon and soft tissue injuries such as tennis elbow, golfer’s elbow, jumper’s knee, Achilles tendonitis and plantar fasciitis. The procedure is based on advanced technology developed in collaboration with the Mayo Clinic and is performed using a local anesthetic, allowing patients to remain awake and alert the entire time.

Using ultrasound imaging, the scar tissue is identified and a small instrument about the size of a toothpick is inserted into the damaged tendon. Ultrasonic energy then cuts, breaks up and removes the damaged tissue, without disturbing the surrounding healthy tendon tissue. The procedure typically takes about 15 minutes or less, requires only an adhesive bandage to close the microincision, and offers quick recovery time for patients.

This procedure is not invasive open surgery and can be performed in an office or procedure room.

Platelet Rich Plasma (PRP) Therapy:
PRP is blood plasma with concentrated platelets. These platelets include bioactive proteins that initiate connective tissue healing such as bone, tendon and ligament regeneration and repair.

PRP can be injected in tendons and ligaments all over the body, which can help with sports injuries and more specific injuries including tennis elbow, carpal tunnel syndrome, shin splints and many other damaged ligaments and tendons. Patients see significant improvement immediately, which may eliminate the need for aggressive treatments such as long-term medication or surgery.

Bright McConnell, III, MD 900 Island Park Drive, Suite #105
Charleston, SC 29492 Phone: (843) 284-5200

Dr. McConnell and Anne Ahern Moore on Lowcountry Live!

Dr. McConnell and Exercise Physiologist, Anne Ahern Moore discusses tests to customize your best fitness and nutrition plan for great results.

The Charleston Sports Medicine Team strives to become your partner in your total health. Our affiliated practice, FitMed Partners, also offers scientifically proven preventive age management, bio-identical hormone therapy and medically based fitness and nutrition programs. The FitMed Elite Athlete Program provides a menu of advanced sports performance testing, not typically covered under insurance, for affordable prices.

Everybody knows a kid who likes to roughhouse — he or she plays full-speed with seemingly no regard for life and limb.

Jay Noce is one of those kids, all grown up.

The 51-year-old Daniel Island resident and former collegiate tennis player is a black belt in karate, does intense CrossFit workouts, and plays tennis, basketball and golf. Being physically active is in his DNA but his sports, while keeping him physically fit and trim, have taken their toll on his knees.

Mining blood and fat

Five years ago, he took a karate kick on the outside of his right knee that hobbled him and later sought out injections of platelet rich plasma (aka PRP) and adipose-derived stem cells, taken from his own blood and fat, to help it heal.

Last fall, Noce was near the end of a tennis match when he felt the proverbial “pop” in the right knee, which ended up being a stable meniscus tear.

He went back to the same orthopedic physician, Charleston Sports Medicine’s Dr. Bright McConnell, who offered him another orthobiologic treatment as an alternative to surgery, which would have involved a painful recovery and weeks on crunches. Not ideal for a man who also travels internationally as part of his digital business.

Healing stem cells

McConnell used an amniotic allograft, which is derived from the amniotic fluid from the placentas of screened mothers who have elected to have Caesarian sections.

“It’s like PRP on steroids,” says McConnell, of the allograft that is rich in stem cells and growth factors.

Noce says improvements were slow but steady.

“I’m at least 60 percent better,” says Noce, who is back to playing golf, doing karate with a strap on his knee, playing basketball with his kids and hitting tennis balls but not competing.

He was back in for another allograft injection last week with the hopes that will complete the healing process.

Biologics boom

McConnell says Noce’s slowly improving condition is fairly common for orthobiologic procedure.

“With biologics, it’s not instantaneous. It’s like planting a seed. You gotta wait for the flower to grow,” says McConnell. “People who get biologic treatments start to feel a difference in six to eight weeks. Three months out, 50 percent say it’s either a ton better or ‘it’s better but …’ Six months out, you’ll know if it worked.”

While biologics have been used to speed healing in brain and vascular surgeries for decades, their use in musculoskeletal applications have been more recent, within the last five years.

Orthobiologics are gaining attention, probably quicker than most new treatments, because of their fairly common use in high-profile professional athletes. Yet long-term outcomes are obviously not known.

In the years that McConnell has been using orthobiologics, starting with PRP, he has seen a range of patients from baby boomer athletes to seniors seeking to avoid a joint replacement.

What’s old is new?

According to a study “Orthobiologics in Foot and Ankle Surgery,” in 2013, the term orthobiologic is actually a marketing term that comes from the industry that creates devices, such as the centrifuges that separate platelets and stem cells from blood, bone marrow and fat tissues.

The term implies that the addition of one of these bioengineered products or extrinsic forces can positively influence the healing of ligaments and tendons.

Dr. Joe Calandra, a trained orthopedist and team physician for the South Carolina Stingrays and Charleston Southern University sports teams, says the first reported use of what is now called an orthobiologic was a bone graft in the mid-1600’s and that other autologous (tissue taken from the patient and put back in him or her) grafting continued.

“In the early 1900’s, autologous bone grafting started to take hold as an adjunct to help certain fractures heal. In 1965, bone morphogenic protein (often referred to as BMP) was isolated from bone tissue. This protein was shown to have the ability to stimulate bone growth,” says Calandra.

“Since the discovery of BMP many physicians and scientists have been trying to isolate other proteins and biologic substances such as stem cells and platelets, which may stimulate healing in the musculoskeletal system.”

Calandra adds that various substances have been implicated in the improvement of the healing process.

“Some orthobiologics, such as autologous bone grafts have good science behind them and a long track record of use in the clinical setting, others such as PRP and stem cell therapy do not have the consistent science or appropriate clinical trials to support their widespread use at this time.”

Calandra believes the newer biologics as well as those not yet discovered or perfected will be a tremendous adjunct to the care of musculoskeletal injuries and diseases in patients.

But, he adds, caution must be taken and proper unbiased clinical trials undertaken before these should be routinely recommended.

What will it cost me?

Insurance, for the most part, does not cover orthobiologic procedures, even though the treatments could be a less expensive option to surgeries, such as knee replacements.

The cost of Noce’s amniotic allograft procedure, which was done in McConnell’s office, will run between $2,000 and $2,500, largely the cost of the stem cell product.

In McConnell’s case, his staff files the cost of the office visit and other services with insurance by Charleston Sports Medicine but not the cost of the orthobiologics.

McConnell adds that some health savings accounts also be applied to orthobiologics.

View Full Article from Post & Courier

View Full Article from Post & Courier

Healthy Aging: Preserve Your Bones and Joints

thumbnailMarried with children, single, seniors and everyone in between struggle to fit exercise into their morning routine. “Busy” is a well worn word among Americans.

Time constraints are not alone in the challenges to stay healthy as we age. Maintaining the ability to be mobile is critical to remaining vital as we age. This means avoiding injury and preserving bone and join health.

Aging itself conspires to chip away at your bone and joint health. “Bone and joint health are intrinsically linked to healthy aging,” explains Dr. Bright McConnell of Charleston Sports Medicine. “We are excited to bring orthobiologics, stem cell therapies, bioidentical hormone replacement and countless other advanced treatments for patients with bone and joint injuries to the forefront. But the key to avoiding injury altogether or recovering from injury lies in the development of bone and joint strength. 

Strong, healthy bones and joints translate to strong healthy men and women – regardless of age.”

Here are some recommendations for how to achieve bone and joint health.

1. Start Early

skelatonBone and joint health begin in childhood. Today, approximately 32% of American children and adolescents, ages 2 to 19, are considered overweight or obese.

Excess weight can cause vitamin deficiencies, hormonal imbalances, and increased stress and tension that can affect bone growth and overall musculoskeletal health, causing deformity, pain, and potentially, a lifetime of limited mobility and diminished life quality.

Physical activity is important for loading the bones and helping them strengthen. A healthy diet, along with regular physical activity in childhood—at least 35 to 60 minutes a day—can help ensure a healthy weight and strong bones for life.

The adolescent growth spurt brings a marked rise in fractures. If fractures occur with mild injuries, that can be a sign children have skeletal defects tied to low bone mass. This carries over into adulthood.

2. Drink Well: Calcium, Caffeine and Alcohol

A diet inclusive of calcium is critical. Limit caffeinated beverages – soda and coffee – particularly if your calcium intake is low. Drink water instead. Alcohol consumption can affect bone health. Drink in moderation.

If you aren’t drinking the recommended calcium intake for your age group, add calcium-rich foods to your diet or use a calcium supplement.

3. Exercise: Find The Time & Mix It Up

The dramatic increase in the number of children, adolescents and adults diagnosed as overweight or obese in the United States has reached epidemic status. Calcium, vitamin D, diet and exercise are the cornerstones of bone health. Staying at a healthy weight reduces negative impact on bones and joints.

Moderation and variety of exercise reduces the possibility of wear and tear related to repeating the same motion. So mix it up. Run one day and do weight bearing activities the next.

Make the time. Staying active isn’t always easy to fit into today’s busy schedule. Try to schedule your exercise time and spend more time on your feet. Take the stairs, stand up while working, walk while on the phone. We agree with Nike. Just do it.

4. Don’t Smoke. Just Don’t Do It.

Smoking reduces bone mass. Several research studies have identified smoking as a risk factor for osteoporosis and bone fracture. So don’t smoke. Period.

5. Boost Your Vitamin D.

Vitamin D plays an important role in protecting your bones and your body requires it to absorb calcium. Children need vitamin D to build strong bones, and adults need it to keep their bones strong and healthy. If you don’t get enough vitamin D, you may lose bone, have lower bone density, and you’re more likely to break bones as you age.

Schedule an appointment for a blood panel to test your Vitamin D. Take a high potency supplement and/or a nice walk in the sun if you test low. Enjoy the added benefit of a mood boost. Now everybody’s happy.

Treatments using patient-derived platelets and stem cells are an emerging tool for healing injuries

Everybody knows a kid who likes to roughhouse — he or she plays full-speed with seemingly no regard for life and limb.

Jay Noce is one of those kids, all grown up.

The 51-year-old Daniel Island resident and former collegiate tennis player is a black belt in karate, does intense CrossFit workouts, and plays tennis, basketball and golf. Being physically active is in his DNA but his sports, while keeping him physically fit and trim, have taken their toll on his knees.

Mining blood and fat

Five years ago, he took a karate kick on the outside of his right knee that hobbled him and later sought out injections of platelet rich plasma (aka PRP) and adipose-derived stem cells, taken from his own blood and fat, to help it heal.

Last fall, Noce was near the end of a tennis match when he felt the proverbial “pop” in the right knee, which ended up being a stable meniscus tear.

He went back to the same orthopedic physician, Charleston Sports Medicine’s Dr. Bright McConnell, who offered him another orthobiologic treatment as an alternative to surgery, which would have involved a painful recovery and weeks on crunches. Not ideal for a man who also travels internationally as part of his digital business.

Healing stem cells

McConnell used an amniotic allograft, which is derived from the amniotic fluid from the placentas of screened mothers who have elected to have Caesarian sections.

“It’s like PRP on steroids,” says McConnell, of the allograft that is rich in stem cells and growth factors.

Noce says improvements were slow but steady.

“I’m at least 60 percent better,” says Noce, who is back to playing golf, doing karate with a strap on his knee, playing basketball with his kids and hitting tennis balls but not competing.

He was back in for another allograft injection last week with the hopes that will complete the healing process.

Biologics boom

McConnell says Noce’s slowly improving condition is fairly common for orthobiologic procedure.

“With biologics, it’s not instantaneous. It’s like planting a seed. You gotta wait for the flower to grow,” says McConnell. “People who get biologic treatments start to feel a difference in six to eight weeks. Three months out, 50 percent say it’s either a ton better or ‘it’s better but …’ Six months out, you’ll know if it worked.”

While biologics have been used to speed healing in brain and vascular surgeries for decades, their use in musculoskeletal applications have been more recent, within the last five years.

Orthobiologics are gaining attention, probably quicker than most new treatments, because of their fairly common use in high-profile professional athletes. Yet long-term outcomes are obviously not known.

In the years that McConnell has been using orthobiologics, starting with PRP, he has seen a range of patients from baby boomer athletes to seniors seeking to avoid a joint replacement.

What’s old is new?

According to a study “Orthobiologics in Foot and Ankle Surgery,” in 2013, the term orthobiologic is actually a marketing term that comes from the industry that creates devices, such as the centrifuges that separate platelets and stem cells from blood, bone marrow and fat tissues.

The term implies that the addition of one of these bioengineered products or extrinsic forces can positively influence the healing of ligaments and tendons.

Dr. Joe Calandra, a trained orthopedist and team physician for the South Carolina Stingrays and Charleston Southern University sports teams, says the first reported use of what is now called an orthobiologic was a bone graft in the mid-1600’s and that other autologous (tissue taken from the patient and put back in him or her) grafting continued.

“In the early 1900’s, autologous bone grafting started to take hold as an adjunct to help certain fractures heal. In 1965, bone morphogenic protein (often referred to as BMP) was isolated from bone tissue. This protein was shown to have the ability to stimulate bone growth,” says Calandra.

“Since the discovery of BMP many physicians and scientists have been trying to isolate other proteins and biologic substances such as stem cells and platelets, which may stimulate healing in the musculoskeletal system.”

Calandra adds that various substances have been implicated in the improvement of the healing process.

“Some orthobiologics, such as autologous bone grafts have good science behind them and a long track record of use in the clinical setting, others such as PRP and stem cell therapy do not have the consistent science or appropriate clinical trials to support their widespread use at this time.”

Calandra believes the newer biologics as well as those not yet discovered or perfected will be a tremendous adjunct to the care of musculoskeletal injuries and diseases in patients.

But, he adds, caution must be taken and proper unbiased clinical trials undertaken before these should be routinely recommended.

What will it cost me?

Insurance, for the most part, does not cover orthobiologic procedures, even though the treatments could be a less expensive option to surgeries, such as knee replacements.

The cost of Noce’s amniotic allograft procedure, which was done in McConnell’s office, will run between $2,000 and $2,500, largely the cost of the stem cell product.

In McConnell’s case, his staff files the cost of the office visit and other services with insurance by Charleston Sports Medicine but not the cost of the orthobiologics.

McConnell adds that some health savings accounts also be applied to orthobiologics.

View Full Article from Post & Courier

View Full Article from Post & Courier

Men’s Health Day. Friday, June 19 Only

Schedule your Cardiometabolic Performance Test (VO2Max) screening for 20% off.

Five Ways Men Can Get Fit Now for Men’s Health Week

In honor of Men’s Health Week, June 15 to June 21, FitMed Partners and Charleston Sports Medicine have teamed up to provide you seven critical ways to get fit now. Count the ways you can feel better fast.

1. Save on Your Vo2Max Test
First, schedule your Cardiometabolic Performance Test (VO2Max) screening for 20% off on Men’s Health Day. Appointments are available from 8 am to 5 pm, Friday June 19 at Charleston Sports Medicine’s Daniel Island location with exercise physiologist, Anne Moore. “A Cardiometabolic Performance Test performed on a treadmill or cycle measures key data including peak VO2, anaerobic threshold and the precise number of calories burned at all exercise heart rate zones.This is a great first step to designing a results oriented fitness plan unique to your body,” says Dr. Bright McConnell.

2. Combat Low T with Testosterone Therapy
Men have an unfair advantage over women in the weight loss, fitness category. The simple truth is that men are larger and have more muscle than women due to the hormone testosterone. They are genetically designed to have a higher percentage of muscle and less fat — which works in favor of keeping them fit and allowing them to eat more calories. However, if testosterone levels are low, men can lose this edge and gain abdominal weight, begin to feel sluggish and experience overall muscle loss. Keep your edge and have a comprehensive blood panel to determine if you have low testosterone. http://www.fitmedpartners.com/hormone-replacement-therapy/bioidentical-hormone-therapy-for-men/

3. Think Greek or Go Caveman
The Mediterranean diet, which is rich in vegetables, healthy fats, whole grains, and fish, is associated with physical health and mental acuity in your old age. Or, go back to the caveman days with the Paelo diet. Dr. McConnell likes a PaeloMed hybrid diet for maintaining your health. Not sure what to eat, use the gylcemic index tool http://www.fitmedpartners.com/glycemic-index-reference-guide/

4. Do Not Ignore Erectile Dysfunction (ED)
Problems with performance in an intimate setting are a difficult topic for men to address. Do not ignore ED. Make an appointment with your doctor to address. Read this article http://www.huffingtonpost.com/2015/04/09/erectile-dysfunction-_n_6882636.html

5. Strength Train
Even a little weight training can go a long way. Whether you’re 100 lbs overweight or just need to lose the last 15, strength training is one of the most effective ways to burn fat and build muscle.Lifting has been shown to halt and even reverse sarcopenia – the reduction of skeletal muscle that occurs as we get older – which helps us stay independent (and out of a nursing home) and live longer. It prevents disease and degenerative conditions such as heart disease and the management of cholesterol, high blood pressure, obesity, diabetes, and mood.

My elbow hurts!

Two of the most common injuries around the elbow that sports medicine physicians evaluate and treat are related to overuse and stress to the muscle and tendons that are involved in gripping type activities.

Lateral epicondylitis, known as “tennis elbow”, results from overuse of the muscles and tendons that are used to extend your wrist and fingers. The pain is typically located on the outside, or lateral aspect, of the elbow and involves primarily a muscle-tendon unit called the extensor carpi radialis brevis (ECRB). This tendon is used to help stabilize the wrist when the elbow is extended, which occurs during a tennis ground stroke.

Medial epicondylitis, known as “golfer’s elbow” results from overuse of the muscles and tendons that are used to flex the wrist and turned the forearm. Pain and discomfort is typically located on the inside, or medial aspect, of the elbow and involves the tendon known as the common flexor tendon. Forces are increased on the flexor tendon while gripping a golf club during a golf swing.

Both conditions can be caused by other repetitious activities such as throwing and activities requiring repetitious grip, such as shoveling, hammering nails, and gardening activities. Typical symptoms include pain on grip, or weakness in grip strength.

The early phase of these conditions is an acute inflammation of the tendon called tendinitis. However, if the overuse syndrome has existed for several months or longer, the tissue can continue to degenerate and form a condition known as tendinosis. This is not a true inflammatory condition, but represents chronic degenerative changes in the collagen fibers of the tendon, which results in scar tissue, leaving the injured area in a weak and and painful condition.

Diagnosis is typically based upon physical examination. Occasionally, x-rays may show some irregularity or calcium deposits within the tendon. Occasionally, further diagnostic imaging such as MRI or ultrasound is utilized, which confirms the pathology. The use of office musculoskeletal ultrasound now allows for a much quicker diagnosis and earlier intervention.

Treatment for this condition is typically nonsurgical, and involves a rehabilitation program which may include rest and stretching exercises, non-provocative exercise and occasionally use of bands or straps that may take the pressure off the tendon for a period of time. It is imperative to identify and correct any biomechanical abnormality in the swing or stroke mechanics, which led to the problem initially.

Although it is not uncommon for physicians to utilize cortisone type injections to reduce the inflammation, recent evidence in the sports medicine literature suggests this should not be carried out more than once or twice, as this may further damage the collagen in the tendon.

Traditional surgical treatment requires an incision over the affected tendon area, with removal of the damaged tissue and repair back to the bone after removing any underlying bone spurs.

Over the past several years, new and innovative technologies have been made available which are much less invasive. There has been a significant increase in the utilization of growth factors, such as platelet rich plasma, as well as use of certain types of stem cell therapies, to allow a more aggressive, regenerative healing response. These type of treatment options are referred to as orthobiologics.

Recently, a minimally invasive procedure developed at the Mayo Clinic called percutaneous tenotomy, or the Tenex procedure (www.TenexHealth.com), allows a physician to repair the degenerative collagen using a high energy device on the tip of a very small probe. This can be performed under a simple local anesthetic injection and is performed under ultrasound guidance. It requires no incisions or sutures and typically allows for a quicker recovery and return to activity.

Typically, prevention is the best cure! Spring has arrived, and outdoor activities will increase. Early recognition of symptoms, with early rehabilitation efforts and utilization of a good swing coach to correct poor mechanics will typically prevent this from developing into a more chronic problem.

Treatments using patient-derived platelets and stem cells are an emerging tool for healing injuries

Everybody knows a kid who likes to roughhouse — he or she plays full-speed with seemingly no regard for life and limb.

Jay Noce is one of those kids, all grown up.

The 51-year-old Daniel Island resident and former collegiate tennis player is a black belt in karate, does intense CrossFit workouts, and plays tennis, basketball and golf. Being physically active is in his DNA but his sports, while keeping him physically fit and trim, have taken their toll on his knees.

Read full article

Concussion Risk Reducer- Athletes Should Consider Pre-Season Cognitive Testing

March is Brain Injury Awareness Month

Spring sports practices like baseball, soccer and lacrosse have begun. One local physician advises athletes to stop by the examining room before hitting the field. March is Brain Injury Awareness Month, and according to the CDC, as many as 3.8 million sports and recreation related concussions are estimated to occur in the United States every year. Brain Injury symptoms range from confusion, headache and blurred vision to vomiting and loss of consciousness.

The problem with brain injuries, like concussions, is that they are difficult to diagnose. Because of this, Dr. Bright McConnell of Charleston Sports Medicine advises athletes to be proactive and have a pre season baseline test before the games begin. He states, “Go into the season prepared. This will help in the long run.” Charleston Sports Medicine provides baseline testing with the CNS Vital Signs Program. Athletes are given neurocognitive index testing and while the physician gains insight into an athlete’s brain health status. Through the testing, information on key cognitive measures, such as memory, reaction time, and executive function are examined. If an injury occurs, this information will be beneficial with evaluation and help physicians determine an athlete’s readiness to return to play.

CNS testing take only thirty minutes and is covered by insurance. Charleston Sports Medicine offers this test alone or as part of an age management profile.
For more information, log onto www.charlestonsportsmed.com.

Take the Pain out of the Game

Recently, the world’s best tennis players took over Daniel Island at the Family Circle Cup. In the crowd, many recreational players watched in awe looking for tips to improve their game. For some, playing without pain would be a start because of the well-known injury “tennis elbow.”

Tennis elbow is a common condition caused by the overuse of the arm, forearm and hand muscles. Dr. Bright McConnell, an orthopedic surgeon with Charleston Sports Medicine has been treating tennis elbow for years. He states, “Tennis elbow is caused by the overuse of muscles and tendons around the forearm. Close to fifty percent of tennis players will experience tennis elbow at some point in their playing years. They are constantly hitting the tennis ball with their racket with force. This can cause a nagging pain outside of the elbow that increases over time.”

Carol Wilson is a 4.0 league player that has played tennis for twenty years. Ten of those years she has played through the on and off pain of tennis elbow. She states, “I played with tennis elbow for years. I wore the sleeves, the tape, anything I thought would help. I did not want to give up the game.” Finally the pain associated with tennis elbow forced Wilson to put the racket down. “It was achy, towards the end it was sort of a constant pain that I felt beyond the tennis court. I couldn’t pick up my purse, use my computer mouse because my elbow ached all the time,” she explains.

There are several treatment options for players with tennis elbow. States Dr. McConnell, “First a player generally tries to play through the pain. Then they may try the gels, the cortisone shots and even physical therapy.” Physical therapy is an effective treatment for some with mild tennis elbow. Wilson tried physical therapy, but her pain remained.

Now there is a new procedure that those suffering from tennis elbow. It is called the Tenex Health (previously know as the FAST) procedure. Dr. McConnell states, “The Tenex Health TX procedure, or fasciotomy and surgical tenomoty, is a minimally invasive procedure that requires no incisions and minimal downtime post procedure. This procedure has proven to be quite effective for those suffering from tennis elbow.”

Dr. McConnell, the only surgeon locally trained to perform the Tenex Health procedure, treated Wilson in December. He states, “After an initial examination, she proved to be the perfect candidate for this procedure. The pain associated with her tennis elbow was affecting her everyday life and physical therapy had been ineffective.” Based on technology developed in collaboration with the Mayo clinic, the Fast procedure is performed using local anesthetic to numb the area; patients are awake and alert. During the procedure, ultrasound imaging is used to identify the location of the scar tissue. Once located, a small instrument-the size of a toothpick-is inserted into the damaged tendon. The instrument delivers ultrasonic energy specifically designed to cut, break up, and remove damaged tissue safely and quickly, without disturbing the surrounding healthy tendon tissue.

According to Dr. McConnell, this procedure is a good alternative for tennis players that are considering surgery for tennis elbow relief. He states, “Unlike conventional treatment methods, the Tenex Health TX replicates the goal of an open surgical procedure by removing the damaged tissue with minimal invasion. The procedure usually takes 15 minutes or less and requires only an adhesive bandage to close the micro incision.” Unlike traditional open surgeries that may require several months of recovery, the Tenex Health TX recovery period is on average a 1 to 2 month timeframe. Following the short recovery a full return to the patient’s normal activities is expected.

A study done in April 2013 by the American Journal of Sports Medicine found the Tenex (FAST) procedure to be “safe, specific, minimally invasive and well tolerated treatment for recalcitrant lateral elbow tendinopathy.” All but one patient showed evidence of efficacy that was sustained at least one year. Wilson is not surprised by the studies’ outcome. By March, she was back on the court hitting tennis balls. While she is three months out from the procedure, assessment of patients for Tenex Health continues six months beyond the date of surgery. Wilson recommends Tenex Health TX (FAST) to any tennis player playing through the pain. She states, “The hardest thing is to put the racket down. I thought I could play through the pain. I now play pain free, it is like a new beginning.”

Dr. McConnell is an orthopedic surgeon that focuses on prevention and performance. He works with several local athletes as well as those on the national level. His office is located on Daniel Island. To learn more about this minimally invasive procedure for tennis elbow relief, go to www.charlestonsportsmed.com.

Dr. McConnell talks to patient, Deanna, about her TekScan evaluation for foot pain

Dr. McConnell Only Orthopaedic Surgeon to Perform New Minimally Invasive Procedures for Tendonitis

Is the source of your pain in the tendon or ligament? If medication and physical therapy have proved unsuccessful in relieving discomfort and pain related to tendon or ligament injuries, there are some recent advanced treatments worth exploring. Even better, these revolutionary treatments do not require open surgery.

Determining the actual source of your pain can be the first step to knowing if there is a minimally invasive treatment for which you are a candidate. Here are two very new options for patients with tendon and ligament damage.

Tenex Health TXTM
Focused Aspiration of Scar Tissue (FAST™) procedure or newly named, Tenex Health TXTM is a new outpatient procedure specifically designed for those who are suffering from pain associated to tendon damage. Tendon damage often occurs in patients due to repetitive stress and overuse of one area of the body.

Tendon pain takes many forms:
• Plantar fasciitis
• Achilles tendonitis
• Jumper’s / Runner’s knee
• Tennis / Golfer’s elbow

The revolutionary Tenex Health TXTM procedure is an advanced treatment that quickly and safely removes the source of tendon pain stemming from tendon and soft tissue injuries such as tennis elbow, golfer’s elbow, jumper’s knee, Achilles tendonitis and plantar fasciitis. The procedure is based on advanced technology developed in collaboration with the Mayo Clinic and is performed using a local anesthetic, allowing patients to remain awake and alert the entire time.

Using ultrasound imaging, the scar tissue is identified and a small instrument about the size of a toothpick is inserted into the damaged tendon. Ultrasonic energy then cuts, breaks up and removes the damaged tissue, without disturbing the surrounding healthy tendon tissue. The procedure typically takes about 15 minutes or less, requires only an adhesive bandage to close the microincision, and offers quick recovery time for patients.

This procedure is not invasive open surgery and can be performed in an office or procedure room.

Platelet Rich Plasma (PRP) Therapy:
PRP is blood plasma with concentrated platelets. These platelets include bioactive proteins that initiate connective tissue healing such as bone, tendon and ligament regeneration and repair.

PRP can be injected in tendons and ligaments all over the body, which can help with sports injuries and more specific injuries including tennis elbow, carpal tunnel syndrome, shin splints and many other damaged ligaments and tendons. Patients see significant improvement immediately, which may eliminate the need for aggressive treatments such as long-term medication or surgery.

Bright McConnell, III, MD 900 Island Park Drive, Suite #105
Charleston, SC 29492 Phone: (843) 284-5200

Dr. McConnell and Anne Ahern Moore on Lowcountry Live!

Dr. McConnell and Exercise Physiologist, Anne Ahern Moore discusses tests to customize your best fitness and nutrition plan for great results.

The Charleston Sports Medicine Team strives to become your partner in your total health. Our affiliated practice, FitMed Partners, also offers scientifically proven preventive age management, bio-identical hormone therapy and medically based fitness and nutrition programs. The FitMed Elite Athlete Program provides a menu of advanced sports performance testing, not typically covered under insurance, for affordable prices.

Schedule your Cardiometabolic Performance Test (VO2Max) screening for 20% off.

Five Ways Men Can Get Fit Now for Men’s Health Week

In honor of Men’s Health Week, June 15 to June 21, FitMed Partners and Charleston Sports Medicine have teamed up to provide you seven critical ways to get fit now. Count the ways you can feel better fast.

1. Save on Your Vo2Max Test
First, schedule your Cardiometabolic Performance Test (VO2Max) screening for 20% off on Men’s Health Day. Appointments are available from 8 am to 5 pm, Friday June 19 at Charleston Sports Medicine’s Daniel Island location with exercise physiologist, Anne Moore. “A Cardiometabolic Performance Test performed on a treadmill or cycle measures key data including peak VO2, anaerobic threshold and the precise number of calories burned at all exercise heart rate zones.This is a great first step to designing a results oriented fitness plan unique to your body,” says Dr. Bright McConnell.

2. Combat Low T with Testosterone Therapy
Men have an unfair advantage over women in the weight loss, fitness category. The simple truth is that men are larger and have more muscle than women due to the hormone testosterone. They are genetically designed to have a higher percentage of muscle and less fat — which works in favor of keeping them fit and allowing them to eat more calories. However, if testosterone levels are low, men can lose this edge and gain abdominal weight, begin to feel sluggish and experience overall muscle loss. Keep your edge and have a comprehensive blood panel to determine if you have low testosterone. http://www.fitmedpartners.com/hormone-replacement-therapy/bioidentical-hormone-therapy-for-men/

3. Think Greek or Go Caveman
The Mediterranean diet, which is rich in vegetables, healthy fats, whole grains, and fish, is associated with physical health and mental acuity in your old age. Or, go back to the caveman days with the Paelo diet. Dr. McConnell likes a PaeloMed hybrid diet for maintaining your health. Not sure what to eat, use the gylcemic index tool http://www.fitmedpartners.com/glycemic-index-reference-guide/

4. Do Not Ignore Erectile Dysfunction (ED)
Problems with performance in an intimate setting are a difficult topic for men to address. Do not ignore ED. Make an appointment with your doctor to address. Read this article http://www.huffingtonpost.com/2015/04/09/erectile-dysfunction-_n_6882636.html

5. Strength Train
Even a little weight training can go a long way. Whether you’re 100 lbs overweight or just need to lose the last 15, strength training is one of the most effective ways to burn fat and build muscle.Lifting has been shown to halt and even reverse sarcopenia – the reduction of skeletal muscle that occurs as we get older – which helps us stay independent (and out of a nursing home) and live longer. It prevents disease and degenerative conditions such as heart disease and the management of cholesterol, high blood pressure, obesity, diabetes, and mood.

Healthy Aging: Preserve Your Bones and Joints

thumbnailMarried with children, single, seniors and everyone in between struggle to fit exercise into their morning routine. “Busy” is a well worn word among Americans.

Time constraints are not alone in the challenges to stay healthy as we age. Maintaining the ability to be mobile is critical to remaining vital as we age. This means avoiding injury and preserving bone and join health.

Aging itself conspires to chip away at your bone and joint health. “Bone and joint health are intrinsically linked to healthy aging,” explains Dr. Bright McConnell of Charleston Sports Medicine. “We are excited to bring orthobiologics, stem cell therapies, bioidentical hormone replacement and countless other advanced treatments for patients with bone and joint injuries to the forefront. But the key to avoiding injury altogether or recovering from injury lies in the development of bone and joint strength. 

Strong, healthy bones and joints translate to strong healthy men and women – regardless of age.”

Here are some recommendations for how to achieve bone and joint health.

1. Start Early

skelatonBone and joint health begin in childhood. Today, approximately 32% of American children and adolescents, ages 2 to 19, are considered overweight or obese.

Excess weight can cause vitamin deficiencies, hormonal imbalances, and increased stress and tension that can affect bone growth and overall musculoskeletal health, causing deformity, pain, and potentially, a lifetime of limited mobility and diminished life quality.

Physical activity is important for loading the bones and helping them strengthen. A healthy diet, along with regular physical activity in childhood—at least 35 to 60 minutes a day—can help ensure a healthy weight and strong bones for life.

The adolescent growth spurt brings a marked rise in fractures. If fractures occur with mild injuries, that can be a sign children have skeletal defects tied to low bone mass. This carries over into adulthood.

2. Drink Well: Calcium, Caffeine and Alcohol

A diet inclusive of calcium is critical. Limit caffeinated beverages – soda and coffee – particularly if your calcium intake is low. Drink water instead. Alcohol consumption can affect bone health. Drink in moderation.

If you aren’t drinking the recommended calcium intake for your age group, add calcium-rich foods to your diet or use a calcium supplement.

3. Exercise: Find The Time & Mix It Up

The dramatic increase in the number of children, adolescents and adults diagnosed as overweight or obese in the United States has reached epidemic status. Calcium, vitamin D, diet and exercise are the cornerstones of bone health. Staying at a healthy weight reduces negative impact on bones and joints.

Moderation and variety of exercise reduces the possibility of wear and tear related to repeating the same motion. So mix it up. Run one day and do weight bearing activities the next.

Make the time. Staying active isn’t always easy to fit into today’s busy schedule. Try to schedule your exercise time and spend more time on your feet. Take the stairs, stand up while working, walk while on the phone. We agree with Nike. Just do it.

4. Don’t Smoke. Just Don’t Do It.

Smoking reduces bone mass. Several research studies have identified smoking as a risk factor for osteoporosis and bone fracture. So don’t smoke. Period.

5. Boost Your Vitamin D.

Vitamin D plays an important role in protecting your bones and your body requires it to absorb calcium. Children need vitamin D to build strong bones, and adults need it to keep their bones strong and healthy. If you don’t get enough vitamin D, you may lose bone, have lower bone density, and you’re more likely to break bones as you age.

Schedule an appointment for a blood panel to test your Vitamin D. Take a high potency supplement and/or a nice walk in the sun if you test low. Enjoy the added benefit of a mood boost. Now everybody’s happy.

Treatments using patient-derived platelets and stem cells are an emerging tool for healing injuries

Everybody knows a kid who likes to roughhouse — he or she plays full-speed with seemingly no regard for life and limb.

Jay Noce is one of those kids, all grown up.

The 51-year-old Daniel Island resident and former collegiate tennis player is a black belt in karate, does intense CrossFit workouts, and plays tennis, basketball and golf. Being physically active is in his DNA but his sports, while keeping him physically fit and trim, have taken their toll on his knees.

Mining blood and fat

Five years ago, he took a karate kick on the outside of his right knee that hobbled him and later sought out injections of platelet rich plasma (aka PRP) and adipose-derived stem cells, taken from his own blood and fat, to help it heal.

Last fall, Noce was near the end of a tennis match when he felt the proverbial “pop” in the right knee, which ended up being a stable meniscus tear.

He went back to the same orthopedic physician, Charleston Sports Medicine’s Dr. Bright McConnell, who offered him another orthobiologic treatment as an alternative to surgery, which would have involved a painful recovery and weeks on crunches. Not ideal for a man who also travels internationally as part of his digital business.

Healing stem cells

McConnell used an amniotic allograft, which is derived from the amniotic fluid from the placentas of screened mothers who have elected to have Caesarian sections.

“It’s like PRP on steroids,” says McConnell, of the allograft that is rich in stem cells and growth factors.

Noce says improvements were slow but steady.

“I’m at least 60 percent better,” says Noce, who is back to playing golf, doing karate with a strap on his knee, playing basketball with his kids and hitting tennis balls but not competing.

He was back in for another allograft injection last week with the hopes that will complete the healing process.

Biologics boom

McConnell says Noce’s slowly improving condition is fairly common for orthobiologic procedure.

“With biologics, it’s not instantaneous. It’s like planting a seed. You gotta wait for the flower to grow,” says McConnell. “People who get biologic treatments start to feel a difference in six to eight weeks. Three months out, 50 percent say it’s either a ton better or ‘it’s better but …’ Six months out, you’ll know if it worked.”

While biologics have been used to speed healing in brain and vascular surgeries for decades, their use in musculoskeletal applications have been more recent, within the last five years.

Orthobiologics are gaining attention, probably quicker than most new treatments, because of their fairly common use in high-profile professional athletes. Yet long-term outcomes are obviously not known.

In the years that McConnell has been using orthobiologics, starting with PRP, he has seen a range of patients from baby boomer athletes to seniors seeking to avoid a joint replacement.

What’s old is new?

According to a study “Orthobiologics in Foot and Ankle Surgery,” in 2013, the term orthobiologic is actually a marketing term that comes from the industry that creates devices, such as the centrifuges that separate platelets and stem cells from blood, bone marrow and fat tissues.

The term implies that the addition of one of these bioengineered products or extrinsic forces can positively influence the healing of ligaments and tendons.

Dr. Joe Calandra, a trained orthopedist and team physician for the South Carolina Stingrays and Charleston Southern University sports teams, says the first reported use of what is now called an orthobiologic was a bone graft in the mid-1600’s and that other autologous (tissue taken from the patient and put back in him or her) grafting continued.

“In the early 1900’s, autologous bone grafting started to take hold as an adjunct to help certain fractures heal. In 1965, bone morphogenic protein (often referred to as BMP) was isolated from bone tissue. This protein was shown to have the ability to stimulate bone growth,” says Calandra.

“Since the discovery of BMP many physicians and scientists have been trying to isolate other proteins and biologic substances such as stem cells and platelets, which may stimulate healing in the musculoskeletal system.”

Calandra adds that various substances have been implicated in the improvement of the healing process.

“Some orthobiologics, such as autologous bone grafts have good science behind them and a long track record of use in the clinical setting, others such as PRP and stem cell therapy do not have the consistent science or appropriate clinical trials to support their widespread use at this time.”

Calandra believes the newer biologics as well as those not yet discovered or perfected will be a tremendous adjunct to the care of musculoskeletal injuries and diseases in patients.

But, he adds, caution must be taken and proper unbiased clinical trials undertaken before these should be routinely recommended.

What will it cost me?

Insurance, for the most part, does not cover orthobiologic procedures, even though the treatments could be a less expensive option to surgeries, such as knee replacements.

The cost of Noce’s amniotic allograft procedure, which was done in McConnell’s office, will run between $2,000 and $2,500, largely the cost of the stem cell product.

In McConnell’s case, his staff files the cost of the office visit and other services with insurance by Charleston Sports Medicine but not the cost of the orthobiologics.

McConnell adds that some health savings accounts also be applied to orthobiologics.

View Full Article from Post & Courier

View Full Article from Post & Courier

Men’s Health Day. Friday, June 19 Only

Schedule your Cardiometabolic Performance Test (VO2Max) screening for 20% off.

Five Ways Men Can Get Fit Now for Men’s Health Week

In honor of Men’s Health Week, June 15 to June 21, FitMed Partners and Charleston Sports Medicine have teamed up to provide you seven critical ways to get fit now. Count the ways you can feel better fast.

1. Save on Your Vo2Max Test
First, schedule your Cardiometabolic Performance Test (VO2Max) screening for 20% off on Men’s Health Day. Appointments are available from 8 am to 5 pm, Friday June 19 at Charleston Sports Medicine’s Daniel Island location with exercise physiologist, Anne Moore. “A Cardiometabolic Performance Test performed on a treadmill or cycle measures key data including peak VO2, anaerobic threshold and the precise number of calories burned at all exercise heart rate zones.This is a great first step to designing a results oriented fitness plan unique to your body,” says Dr. Bright McConnell.

2. Combat Low T with Testosterone Therapy
Men have an unfair advantage over women in the weight loss, fitness category. The simple truth is that men are larger and have more muscle than women due to the hormone testosterone. They are genetically designed to have a higher percentage of muscle and less fat — which works in favor of keeping them fit and allowing them to eat more calories. However, if testosterone levels are low, men can lose this edge and gain abdominal weight, begin to feel sluggish and experience overall muscle loss. Keep your edge and have a comprehensive blood panel to determine if you have low testosterone. http://www.fitmedpartners.com/hormone-replacement-therapy/bioidentical-hormone-therapy-for-men/

3. Think Greek or Go Caveman
The Mediterranean diet, which is rich in vegetables, healthy fats, whole grains, and fish, is associated with physical health and mental acuity in your old age. Or, go back to the caveman days with the Paelo diet. Dr. McConnell likes a PaeloMed hybrid diet for maintaining your health. Not sure what to eat, use the gylcemic index tool http://www.fitmedpartners.com/glycemic-index-reference-guide/

4. Do Not Ignore Erectile Dysfunction (ED)
Problems with performance in an intimate setting are a difficult topic for men to address. Do not ignore ED. Make an appointment with your doctor to address. Read this article http://www.huffingtonpost.com/2015/04/09/erectile-dysfunction-_n_6882636.html

5. Strength Train
Even a little weight training can go a long way. Whether you’re 100 lbs overweight or just need to lose the last 15, strength training is one of the most effective ways to burn fat and build muscle.Lifting has been shown to halt and even reverse sarcopenia – the reduction of skeletal muscle that occurs as we get older – which helps us stay independent (and out of a nursing home) and live longer. It prevents disease and degenerative conditions such as heart disease and the management of cholesterol, high blood pressure, obesity, diabetes, and mood.

My elbow hurts!

Two of the most common injuries around the elbow that sports medicine physicians evaluate and treat are related to overuse and stress to the muscle and tendons that are involved in gripping type activities.

Lateral epicondylitis, known as “tennis elbow”, results from overuse of the muscles and tendons that are used to extend your wrist and fingers. The pain is typically located on the outside, or lateral aspect, of the elbow and involves primarily a muscle-tendon unit called the extensor carpi radialis brevis (ECRB). This tendon is used to help stabilize the wrist when the elbow is extended, which occurs during a tennis ground stroke.

Medial epicondylitis, known as “golfer’s elbow” results from overuse of the muscles and tendons that are used to flex the wrist and turned the forearm. Pain and discomfort is typically located on the inside, or medial aspect, of the elbow and involves the tendon known as the common flexor tendon. Forces are increased on the flexor tendon while gripping a golf club during a golf swing.

Both conditions can be caused by other repetitious activities such as throwing and activities requiring repetitious grip, such as shoveling, hammering nails, and gardening activities. Typical symptoms include pain on grip, or weakness in grip strength.

The early phase of these conditions is an acute inflammation of the tendon called tendinitis. However, if the overuse syndrome has existed for several months or longer, the tissue can continue to degenerate and form a condition known as tendinosis. This is not a true inflammatory condition, but represents chronic degenerative changes in the collagen fibers of the tendon, which results in scar tissue, leaving the injured area in a weak and and painful condition.

Diagnosis is typically based upon physical examination. Occasionally, x-rays may show some irregularity or calcium deposits within the tendon. Occasionally, further diagnostic imaging such as MRI or ultrasound is utilized, which confirms the pathology. The use of office musculoskeletal ultrasound now allows for a much quicker diagnosis and earlier intervention.

Treatment for this condition is typically nonsurgical, and involves a rehabilitation program which may include rest and stretching exercises, non-provocative exercise and occasionally use of bands or straps that may take the pressure off the tendon for a period of time. It is imperative to identify and correct any biomechanical abnormality in the swing or stroke mechanics, which led to the problem initially.

Although it is not uncommon for physicians to utilize cortisone type injections to reduce the inflammation, recent evidence in the sports medicine literature suggests this should not be carried out more than once or twice, as this may further damage the collagen in the tendon.

Traditional surgical treatment requires an incision over the affected tendon area, with removal of the damaged tissue and repair back to the bone after removing any underlying bone spurs.

Over the past several years, new and innovative technologies have been made available which are much less invasive. There has been a significant increase in the utilization of growth factors, such as platelet rich plasma, as well as use of certain types of stem cell therapies, to allow a more aggressive, regenerative healing response. These type of treatment options are referred to as orthobiologics.

Recently, a minimally invasive procedure developed at the Mayo Clinic called percutaneous tenotomy, or the Tenex procedure (www.TenexHealth.com), allows a physician to repair the degenerative collagen using a high energy device on the tip of a very small probe. This can be performed under a simple local anesthetic injection and is performed under ultrasound guidance. It requires no incisions or sutures and typically allows for a quicker recovery and return to activity.

Typically, prevention is the best cure! Spring has arrived, and outdoor activities will increase. Early recognition of symptoms, with early rehabilitation efforts and utilization of a good swing coach to correct poor mechanics will typically prevent this from developing into a more chronic problem.

Treatments using patient-derived platelets and stem cells are an emerging tool for healing injuries

Everybody knows a kid who likes to roughhouse — he or she plays full-speed with seemingly no regard for life and limb.

Jay Noce is one of those kids, all grown up.

The 51-year-old Daniel Island resident and former collegiate tennis player is a black belt in karate, does intense CrossFit workouts, and plays tennis, basketball and golf. Being physically active is in his DNA but his sports, while keeping him physically fit and trim, have taken their toll on his knees.

Read full article

Concussion Risk Reducer- Athletes Should Consider Pre-Season Cognitive Testing

March is Brain Injury Awareness Month

Spring sports practices like baseball, soccer and lacrosse have begun. One local physician advises athletes to stop by the examining room before hitting the field. March is Brain Injury Awareness Month, and according to the CDC, as many as 3.8 million sports and recreation related concussions are estimated to occur in the United States every year. Brain Injury symptoms range from confusion, headache and blurred vision to vomiting and loss of consciousness.

The problem with brain injuries, like concussions, is that they are difficult to diagnose. Because of this, Dr. Bright McConnell of Charleston Sports Medicine advises athletes to be proactive and have a pre season baseline test before the games begin. He states, “Go into the season prepared. This will help in the long run.” Charleston Sports Medicine provides baseline testing with the CNS Vital Signs Program. Athletes are given neurocognitive index testing and while the physician gains insight into an athlete’s brain health status. Through the testing, information on key cognitive measures, such as memory, reaction time, and executive function are examined. If an injury occurs, this information will be beneficial with evaluation and help physicians determine an athlete’s readiness to return to play.

CNS testing take only thirty minutes and is covered by insurance. Charleston Sports Medicine offers this test alone or as part of an age management profile.
For more information, log onto www.charlestonsportsmed.com.

Take the Pain out of the Game

Recently, the world’s best tennis players took over Daniel Island at the Family Circle Cup. In the crowd, many recreational players watched in awe looking for tips to improve their game. For some, playing without pain would be a start because of the well-known injury “tennis elbow.”

Tennis elbow is a common condition caused by the overuse of the arm, forearm and hand muscles. Dr. Bright McConnell, an orthopedic surgeon with Charleston Sports Medicine has been treating tennis elbow for years. He states, “Tennis elbow is caused by the overuse of muscles and tendons around the forearm. Close to fifty percent of tennis players will experience tennis elbow at some point in their playing years. They are constantly hitting the tennis ball with their racket with force. This can cause a nagging pain outside of the elbow that increases over time.”

Carol Wilson is a 4.0 league player that has played tennis for twenty years. Ten of those years she has played through the on and off pain of tennis elbow. She states, “I played with tennis elbow for years. I wore the sleeves, the tape, anything I thought would help. I did not want to give up the game.” Finally the pain associated with tennis elbow forced Wilson to put the racket down. “It was achy, towards the end it was sort of a constant pain that I felt beyond the tennis court. I couldn’t pick up my purse, use my computer mouse because my elbow ached all the time,” she explains.

There are several treatment options for players with tennis elbow. States Dr. McConnell, “First a player generally tries to play through the pain. Then they may try the gels, the cortisone shots and even physical therapy.” Physical therapy is an effective treatment for some with mild tennis elbow. Wilson tried physical therapy, but her pain remained.

Now there is a new procedure that those suffering from tennis elbow. It is called the Tenex Health (previously know as the FAST) procedure. Dr. McConnell states, “The Tenex Health TX procedure, or fasciotomy and surgical tenomoty, is a minimally invasive procedure that requires no incisions and minimal downtime post procedure. This procedure has proven to be quite effective for those suffering from tennis elbow.”

Dr. McConnell, the only surgeon locally trained to perform the Tenex Health procedure, treated Wilson in December. He states, “After an initial examination, she proved to be the perfect candidate for this procedure. The pain associated with her tennis elbow was affecting her everyday life and physical therapy had been ineffective.” Based on technology developed in collaboration with the Mayo clinic, the Fast procedure is performed using local anesthetic to numb the area; patients are awake and alert. During the procedure, ultrasound imaging is used to identify the location of the scar tissue. Once located, a small instrument-the size of a toothpick-is inserted into the damaged tendon. The instrument delivers ultrasonic energy specifically designed to cut, break up, and remove damaged tissue safely and quickly, without disturbing the surrounding healthy tendon tissue.

According to Dr. McConnell, this procedure is a good alternative for tennis players that are considering surgery for tennis elbow relief. He states, “Unlike conventional treatment methods, the Tenex Health TX replicates the goal of an open surgical procedure by removing the damaged tissue with minimal invasion. The procedure usually takes 15 minutes or less and requires only an adhesive bandage to close the micro incision.” Unlike traditional open surgeries that may require several months of recovery, the Tenex Health TX recovery period is on average a 1 to 2 month timeframe. Following the short recovery a full return to the patient’s normal activities is expected.

A study done in April 2013 by the American Journal of Sports Medicine found the Tenex (FAST) procedure to be “safe, specific, minimally invasive and well tolerated treatment for recalcitrant lateral elbow tendinopathy.” All but one patient showed evidence of efficacy that was sustained at least one year. Wilson is not surprised by the studies’ outcome. By March, she was back on the court hitting tennis balls. While she is three months out from the procedure, assessment of patients for Tenex Health continues six months beyond the date of surgery. Wilson recommends Tenex Health TX (FAST) to any tennis player playing through the pain. She states, “The hardest thing is to put the racket down. I thought I could play through the pain. I now play pain free, it is like a new beginning.”

Dr. McConnell is an orthopedic surgeon that focuses on prevention and performance. He works with several local athletes as well as those on the national level. His office is located on Daniel Island. To learn more about this minimally invasive procedure for tennis elbow relief, go to www.charlestonsportsmed.com.

Dr. McConnell talks to patient, Deanna, about her TekScan evaluation for foot pain

Dr. McConnell Only Orthopaedic Surgeon to Perform New Minimally Invasive Procedures for Tendonitis

Is the source of your pain in the tendon or ligament? If medication and physical therapy have proved unsuccessful in relieving discomfort and pain related to tendon or ligament injuries, there are some recent advanced treatments worth exploring. Even better, these revolutionary treatments do not require open surgery.

Determining the actual source of your pain can be the first step to knowing if there is a minimally invasive treatment for which you are a candidate. Here are two very new options for patients with tendon and ligament damage.

Tenex Health TXTM
Focused Aspiration of Scar Tissue (FAST™) procedure or newly named, Tenex Health TXTM is a new outpatient procedure specifically designed for those who are suffering from pain associated to tendon damage. Tendon damage often occurs in patients due to repetitive stress and overuse of one area of the body.

Tendon pain takes many forms:
• Plantar fasciitis
• Achilles tendonitis
• Jumper’s / Runner’s knee
• Tennis / Golfer’s elbow

The revolutionary Tenex Health TXTM procedure is an advanced treatment that quickly and safely removes the source of tendon pain stemming from tendon and soft tissue injuries such as tennis elbow, golfer’s elbow, jumper’s knee, Achilles tendonitis and plantar fasciitis. The procedure is based on advanced technology developed in collaboration with the Mayo Clinic and is performed using a local anesthetic, allowing patients to remain awake and alert the entire time.

Using ultrasound imaging, the scar tissue is identified and a small instrument about the size of a toothpick is inserted into the damaged tendon. Ultrasonic energy then cuts, breaks up and removes the damaged tissue, without disturbing the surrounding healthy tendon tissue. The procedure typically takes about 15 minutes or less, requires only an adhesive bandage to close the microincision, and offers quick recovery time for patients.

This procedure is not invasive open surgery and can be performed in an office or procedure room.

Platelet Rich Plasma (PRP) Therapy:
PRP is blood plasma with concentrated platelets. These platelets include bioactive proteins that initiate connective tissue healing such as bone, tendon and ligament regeneration and repair.

PRP can be injected in tendons and ligaments all over the body, which can help with sports injuries and more specific injuries including tennis elbow, carpal tunnel syndrome, shin splints and many other damaged ligaments and tendons. Patients see significant improvement immediately, which may eliminate the need for aggressive treatments such as long-term medication or surgery.

Bright McConnell, III, MD 900 Island Park Drive, Suite #105
Charleston, SC 29492 Phone: (843) 284-5200

Dr. McConnell and Anne Ahern Moore on Lowcountry Live!

Dr. McConnell and Exercise Physiologist, Anne Ahern Moore discusses tests to customize your best fitness and nutrition plan for great results.

The Charleston Sports Medicine Team strives to become your partner in your total health. Our affiliated practice, FitMed Partners, also offers scientifically proven preventive age management, bio-identical hormone therapy and medically based fitness and nutrition programs. The FitMed Elite Athlete Program provides a menu of advanced sports performance testing, not typically covered under insurance, for affordable prices.

Two of the most common injuries around the elbow that sports medicine physicians evaluate and treat are related to overuse and stress to the muscle and tendons that are involved in gripping type activities.

Lateral epicondylitis, known as “tennis elbow”, results from overuse of the muscles and tendons that are used to extend your wrist and fingers. The pain is typically located on the outside, or lateral aspect, of the elbow and involves primarily a muscle-tendon unit called the extensor carpi radialis brevis (ECRB). This tendon is used to help stabilize the wrist when the elbow is extended, which occurs during a tennis ground stroke.

Medial epicondylitis, known as “golfer’s elbow” results from overuse of the muscles and tendons that are used to flex the wrist and turned the forearm. Pain and discomfort is typically located on the inside, or medial aspect, of the elbow and involves the tendon known as the common flexor tendon. Forces are increased on the flexor tendon while gripping a golf club during a golf swing.

Both conditions can be caused by other repetitious activities such as throwing and activities requiring repetitious grip, such as shoveling, hammering nails, and gardening activities. Typical symptoms include pain on grip, or weakness in grip strength.

The early phase of these conditions is an acute inflammation of the tendon called tendinitis. However, if the overuse syndrome has existed for several months or longer, the tissue can continue to degenerate and form a condition known as tendinosis. This is not a true inflammatory condition, but represents chronic degenerative changes in the collagen fibers of the tendon, which results in scar tissue, leaving the injured area in a weak and and painful condition.

Diagnosis is typically based upon physical examination. Occasionally, x-rays may show some irregularity or calcium deposits within the tendon. Occasionally, further diagnostic imaging such as MRI or ultrasound is utilized, which confirms the pathology. The use of office musculoskeletal ultrasound now allows for a much quicker diagnosis and earlier intervention.

Treatment for this condition is typically nonsurgical, and involves a rehabilitation program which may include rest and stretching exercises, non-provocative exercise and occasionally use of bands or straps that may take the pressure off the tendon for a period of time. It is imperative to identify and correct any biomechanical abnormality in the swing or stroke mechanics, which led to the problem initially.

Although it is not uncommon for physicians to utilize cortisone type injections to reduce the inflammation, recent evidence in the sports medicine literature suggests this should not be carried out more than once or twice, as this may further damage the collagen in the tendon.

Traditional surgical treatment requires an incision over the affected tendon area, with removal of the damaged tissue and repair back to the bone after removing any underlying bone spurs.

Over the past several years, new and innovative technologies have been made available which are much less invasive. There has been a significant increase in the utilization of growth factors, such as platelet rich plasma, as well as use of certain types of stem cell therapies, to allow a more aggressive, regenerative healing response. These type of treatment options are referred to as orthobiologics.

Recently, a minimally invasive procedure developed at the Mayo Clinic called percutaneous tenotomy, or the Tenex procedure (www.TenexHealth.com), allows a physician to repair the degenerative collagen using a high energy device on the tip of a very small probe. This can be performed under a simple local anesthetic injection and is performed under ultrasound guidance. It requires no incisions or sutures and typically allows for a quicker recovery and return to activity.

Typically, prevention is the best cure! Spring has arrived, and outdoor activities will increase. Early recognition of symptoms, with early rehabilitation efforts and utilization of a good swing coach to correct poor mechanics will typically prevent this from developing into a more chronic problem.

Healthy Aging: Preserve Your Bones and Joints

thumbnailMarried with children, single, seniors and everyone in between struggle to fit exercise into their morning routine. “Busy” is a well worn word among Americans.

Time constraints are not alone in the challenges to stay healthy as we age. Maintaining the ability to be mobile is critical to remaining vital as we age. This means avoiding injury and preserving bone and join health.

Aging itself conspires to chip away at your bone and joint health. “Bone and joint health are intrinsically linked to healthy aging,” explains Dr. Bright McConnell of Charleston Sports Medicine. “We are excited to bring orthobiologics, stem cell therapies, bioidentical hormone replacement and countless other advanced treatments for patients with bone and joint injuries to the forefront. But the key to avoiding injury altogether or recovering from injury lies in the development of bone and joint strength. 

Strong, healthy bones and joints translate to strong healthy men and women – regardless of age.”

Here are some recommendations for how to achieve bone and joint health.

1. Start Early

skelatonBone and joint health begin in childhood. Today, approximately 32% of American children and adolescents, ages 2 to 19, are considered overweight or obese.

Excess weight can cause vitamin deficiencies, hormonal imbalances, and increased stress and tension that can affect bone growth and overall musculoskeletal health, causing deformity, pain, and potentially, a lifetime of limited mobility and diminished life quality.

Physical activity is important for loading the bones and helping them strengthen. A healthy diet, along with regular physical activity in childhood—at least 35 to 60 minutes a day—can help ensure a healthy weight and strong bones for life.

The adolescent growth spurt brings a marked rise in fractures. If fractures occur with mild injuries, that can be a sign children have skeletal defects tied to low bone mass. This carries over into adulthood.

2. Drink Well: Calcium, Caffeine and Alcohol

A diet inclusive of calcium is critical. Limit caffeinated beverages – soda and coffee – particularly if your calcium intake is low. Drink water instead. Alcohol consumption can affect bone health. Drink in moderation.

If you aren’t drinking the recommended calcium intake for your age group, add calcium-rich foods to your diet or use a calcium supplement.

3. Exercise: Find The Time & Mix It Up

The dramatic increase in the number of children, adolescents and adults diagnosed as overweight or obese in the United States has reached epidemic status. Calcium, vitamin D, diet and exercise are the cornerstones of bone health. Staying at a healthy weight reduces negative impact on bones and joints.

Moderation and variety of exercise reduces the possibility of wear and tear related to repeating the same motion. So mix it up. Run one day and do weight bearing activities the next.

Make the time. Staying active isn’t always easy to fit into today’s busy schedule. Try to schedule your exercise time and spend more time on your feet. Take the stairs, stand up while working, walk while on the phone. We agree with Nike. Just do it.

4. Don’t Smoke. Just Don’t Do It.

Smoking reduces bone mass. Several research studies have identified smoking as a risk factor for osteoporosis and bone fracture. So don’t smoke. Period.

5. Boost Your Vitamin D.

Vitamin D plays an important role in protecting your bones and your body requires it to absorb calcium. Children need vitamin D to build strong bones, and adults need it to keep their bones strong and healthy. If you don’t get enough vitamin D, you may lose bone, have lower bone density, and you’re more likely to break bones as you age.

Schedule an appointment for a blood panel to test your Vitamin D. Take a high potency supplement and/or a nice walk in the sun if you test low. Enjoy the added benefit of a mood boost. Now everybody’s happy.

Treatments using patient-derived platelets and stem cells are an emerging tool for healing injuries

Everybody knows a kid who likes to roughhouse — he or she plays full-speed with seemingly no regard for life and limb.

Jay Noce is one of those kids, all grown up.

The 51-year-old Daniel Island resident and former collegiate tennis player is a black belt in karate, does intense CrossFit workouts, and plays tennis, basketball and golf. Being physically active is in his DNA but his sports, while keeping him physically fit and trim, have taken their toll on his knees.

Mining blood and fat

Five years ago, he took a karate kick on the outside of his right knee that hobbled him and later sought out injections of platelet rich plasma (aka PRP) and adipose-derived stem cells, taken from his own blood and fat, to help it heal.

Last fall, Noce was near the end of a tennis match when he felt the proverbial “pop” in the right knee, which ended up being a stable meniscus tear.

He went back to the same orthopedic physician, Charleston Sports Medicine’s Dr. Bright McConnell, who offered him another orthobiologic treatment as an alternative to surgery, which would have involved a painful recovery and weeks on crunches. Not ideal for a man who also travels internationally as part of his digital business.

Healing stem cells

McConnell used an amniotic allograft, which is derived from the amniotic fluid from the placentas of screened mothers who have elected to have Caesarian sections.

“It’s like PRP on steroids,” says McConnell, of the allograft that is rich in stem cells and growth factors.

Noce says improvements were slow but steady.

“I’m at least 60 percent better,” says Noce, who is back to playing golf, doing karate with a strap on his knee, playing basketball with his kids and hitting tennis balls but not competing.

He was back in for another allograft injection last week with the hopes that will complete the healing process.

Biologics boom

McConnell says Noce’s slowly improving condition is fairly common for orthobiologic procedure.

“With biologics, it’s not instantaneous. It’s like planting a seed. You gotta wait for the flower to grow,” says McConnell. “People who get biologic treatments start to feel a difference in six to eight weeks. Three months out, 50 percent say it’s either a ton better or ‘it’s better but …’ Six months out, you’ll know if it worked.”

While biologics have been used to speed healing in brain and vascular surgeries for decades, their use in musculoskeletal applications have been more recent, within the last five years.

Orthobiologics are gaining attention, probably quicker than most new treatments, because of their fairly common use in high-profile professional athletes. Yet long-term outcomes are obviously not known.

In the years that McConnell has been using orthobiologics, starting with PRP, he has seen a range of patients from baby boomer athletes to seniors seeking to avoid a joint replacement.

What’s old is new?

According to a study “Orthobiologics in Foot and Ankle Surgery,” in 2013, the term orthobiologic is actually a marketing term that comes from the industry that creates devices, such as the centrifuges that separate platelets and stem cells from blood, bone marrow and fat tissues.

The term implies that the addition of one of these bioengineered products or extrinsic forces can positively influence the healing of ligaments and tendons.

Dr. Joe Calandra, a trained orthopedist and team physician for the South Carolina Stingrays and Charleston Southern University sports teams, says the first reported use of what is now called an orthobiologic was a bone graft in the mid-1600’s and that other autologous (tissue taken from the patient and put back in him or her) grafting continued.

“In the early 1900’s, autologous bone grafting started to take hold as an adjunct to help certain fractures heal. In 1965, bone morphogenic protein (often referred to as BMP) was isolated from bone tissue. This protein was shown to have the ability to stimulate bone growth,” says Calandra.

“Since the discovery of BMP many physicians and scientists have been trying to isolate other proteins and biologic substances such as stem cells and platelets, which may stimulate healing in the musculoskeletal system.”

Calandra adds that various substances have been implicated in the improvement of the healing process.

“Some orthobiologics, such as autologous bone grafts have good science behind them and a long track record of use in the clinical setting, others such as PRP and stem cell therapy do not have the consistent science or appropriate clinical trials to support their widespread use at this time.”

Calandra believes the newer biologics as well as those not yet discovered or perfected will be a tremendous adjunct to the care of musculoskeletal injuries and diseases in patients.

But, he adds, caution must be taken and proper unbiased clinical trials undertaken before these should be routinely recommended.

What will it cost me?

Insurance, for the most part, does not cover orthobiologic procedures, even though the treatments could be a less expensive option to surgeries, such as knee replacements.

The cost of Noce’s amniotic allograft procedure, which was done in McConnell’s office, will run between $2,000 and $2,500, largely the cost of the stem cell product.

In McConnell’s case, his staff files the cost of the office visit and other services with insurance by Charleston Sports Medicine but not the cost of the orthobiologics.

McConnell adds that some health savings accounts also be applied to orthobiologics.

View Full Article from Post & Courier

View Full Article from Post & Courier

Men’s Health Day. Friday, June 19 Only

Schedule your Cardiometabolic Performance Test (VO2Max) screening for 20% off.

Five Ways Men Can Get Fit Now for Men’s Health Week

In honor of Men’s Health Week, June 15 to June 21, FitMed Partners and Charleston Sports Medicine have teamed up to provide you seven critical ways to get fit now. Count the ways you can feel better fast.

1. Save on Your Vo2Max Test
First, schedule your Cardiometabolic Performance Test (VO2Max) screening for 20% off on Men’s Health Day. Appointments are available from 8 am to 5 pm, Friday June 19 at Charleston Sports Medicine’s Daniel Island location with exercise physiologist, Anne Moore. “A Cardiometabolic Performance Test performed on a treadmill or cycle measures key data including peak VO2, anaerobic threshold and the precise number of calories burned at all exercise heart rate zones.This is a great first step to designing a results oriented fitness plan unique to your body,” says Dr. Bright McConnell.

2. Combat Low T with Testosterone Therapy
Men have an unfair advantage over women in the weight loss, fitness category. The simple truth is that men are larger and have more muscle than women due to the hormone testosterone. They are genetically designed to have a higher percentage of muscle and less fat — which works in favor of keeping them fit and allowing them to eat more calories. However, if testosterone levels are low, men can lose this edge and gain abdominal weight, begin to feel sluggish and experience overall muscle loss. Keep your edge and have a comprehensive blood panel to determine if you have low testosterone. http://www.fitmedpartners.com/hormone-replacement-therapy/bioidentical-hormone-therapy-for-men/

3. Think Greek or Go Caveman
The Mediterranean diet, which is rich in vegetables, healthy fats, whole grains, and fish, is associated with physical health and mental acuity in your old age. Or, go back to the caveman days with the Paelo diet. Dr. McConnell likes a PaeloMed hybrid diet for maintaining your health. Not sure what to eat, use the gylcemic index tool http://www.fitmedpartners.com/glycemic-index-reference-guide/

4. Do Not Ignore Erectile Dysfunction (ED)
Problems with performance in an intimate setting are a difficult topic for men to address. Do not ignore ED. Make an appointment with your doctor to address. Read this article http://www.huffingtonpost.com/2015/04/09/erectile-dysfunction-_n_6882636.html

5. Strength Train
Even a little weight training can go a long way. Whether you’re 100 lbs overweight or just need to lose the last 15, strength training is one of the most effective ways to burn fat and build muscle.Lifting has been shown to halt and even reverse sarcopenia – the reduction of skeletal muscle that occurs as we get older – which helps us stay independent (and out of a nursing home) and live longer. It prevents disease and degenerative conditions such as heart disease and the management of cholesterol, high blood pressure, obesity, diabetes, and mood.

My elbow hurts!

Two of the most common injuries around the elbow that sports medicine physicians evaluate and treat are related to overuse and stress to the muscle and tendons that are involved in gripping type activities.

Lateral epicondylitis, known as “tennis elbow”, results from overuse of the muscles and tendons that are used to extend your wrist and fingers. The pain is typically located on the outside, or lateral aspect, of the elbow and involves primarily a muscle-tendon unit called the extensor carpi radialis brevis (ECRB). This tendon is used to help stabilize the wrist when the elbow is extended, which occurs during a tennis ground stroke.

Medial epicondylitis, known as “golfer’s elbow” results from overuse of the muscles and tendons that are used to flex the wrist and turned the forearm. Pain and discomfort is typically located on the inside, or medial aspect, of the elbow and involves the tendon known as the common flexor tendon. Forces are increased on the flexor tendon while gripping a golf club during a golf swing.

Both conditions can be caused by other repetitious activities such as throwing and activities requiring repetitious grip, such as shoveling, hammering nails, and gardening activities. Typical symptoms include pain on grip, or weakness in grip strength.

The early phase of these conditions is an acute inflammation of the tendon called tendinitis. However, if the overuse syndrome has existed for several months or longer, the tissue can continue to degenerate and form a condition known as tendinosis. This is not a true inflammatory condition, but represents chronic degenerative changes in the collagen fibers of the tendon, which results in scar tissue, leaving the injured area in a weak and and painful condition.

Diagnosis is typically based upon physical examination. Occasionally, x-rays may show some irregularity or calcium deposits within the tendon. Occasionally, further diagnostic imaging such as MRI or ultrasound is utilized, which confirms the pathology. The use of office musculoskeletal ultrasound now allows for a much quicker diagnosis and earlier intervention.

Treatment for this condition is typically nonsurgical, and involves a rehabilitation program which may include rest and stretching exercises, non-provocative exercise and occasionally use of bands or straps that may take the pressure off the tendon for a period of time. It is imperative to identify and correct any biomechanical abnormality in the swing or stroke mechanics, which led to the problem initially.

Although it is not uncommon for physicians to utilize cortisone type injections to reduce the inflammation, recent evidence in the sports medicine literature suggests this should not be carried out more than once or twice, as this may further damage the collagen in the tendon.

Traditional surgical treatment requires an incision over the affected tendon area, with removal of the damaged tissue and repair back to the bone after removing any underlying bone spurs.

Over the past several years, new and innovative technologies have been made available which are much less invasive. There has been a significant increase in the utilization of growth factors, such as platelet rich plasma, as well as use of certain types of stem cell therapies, to allow a more aggressive, regenerative healing response. These type of treatment options are referred to as orthobiologics.

Recently, a minimally invasive procedure developed at the Mayo Clinic called percutaneous tenotomy, or the Tenex procedure (www.TenexHealth.com), allows a physician to repair the degenerative collagen using a high energy device on the tip of a very small probe. This can be performed under a simple local anesthetic injection and is performed under ultrasound guidance. It requires no incisions or sutures and typically allows for a quicker recovery and return to activity.

Typically, prevention is the best cure! Spring has arrived, and outdoor activities will increase. Early recognition of symptoms, with early rehabilitation efforts and utilization of a good swing coach to correct poor mechanics will typically prevent this from developing into a more chronic problem.

Treatments using patient-derived platelets and stem cells are an emerging tool for healing injuries

Everybody knows a kid who likes to roughhouse — he or she plays full-speed with seemingly no regard for life and limb.

Jay Noce is one of those kids, all grown up.

The 51-year-old Daniel Island resident and former collegiate tennis player is a black belt in karate, does intense CrossFit workouts, and plays tennis, basketball and golf. Being physically active is in his DNA but his sports, while keeping him physically fit and trim, have taken their toll on his knees.

Read full article

Concussion Risk Reducer- Athletes Should Consider Pre-Season Cognitive Testing

March is Brain Injury Awareness Month

Spring sports practices like baseball, soccer and lacrosse have begun. One local physician advises athletes to stop by the examining room before hitting the field. March is Brain Injury Awareness Month, and according to the CDC, as many as 3.8 million sports and recreation related concussions are estimated to occur in the United States every year. Brain Injury symptoms range from confusion, headache and blurred vision to vomiting and loss of consciousness.

The problem with brain injuries, like concussions, is that they are difficult to diagnose. Because of this, Dr. Bright McConnell of Charleston Sports Medicine advises athletes to be proactive and have a pre season baseline test before the games begin. He states, “Go into the season prepared. This will help in the long run.” Charleston Sports Medicine provides baseline testing with the CNS Vital Signs Program. Athletes are given neurocognitive index testing and while the physician gains insight into an athlete’s brain health status. Through the testing, information on key cognitive measures, such as memory, reaction time, and executive function are examined. If an injury occurs, this information will be beneficial with evaluation and help physicians determine an athlete’s readiness to return to play.

CNS testing take only thirty minutes and is covered by insurance. Charleston Sports Medicine offers this test alone or as part of an age management profile.
For more information, log onto www.charlestonsportsmed.com.

Take the Pain out of the Game

Recently, the world’s best tennis players took over Daniel Island at the Family Circle Cup. In the crowd, many recreational players watched in awe looking for tips to improve their game. For some, playing without pain would be a start because of the well-known injury “tennis elbow.”

Tennis elbow is a common condition caused by the overuse of the arm, forearm and hand muscles. Dr. Bright McConnell, an orthopedic surgeon with Charleston Sports Medicine has been treating tennis elbow for years. He states, “Tennis elbow is caused by the overuse of muscles and tendons around the forearm. Close to fifty percent of tennis players will experience tennis elbow at some point in their playing years. They are constantly hitting the tennis ball with their racket with force. This can cause a nagging pain outside of the elbow that increases over time.”

Carol Wilson is a 4.0 league player that has played tennis for twenty years. Ten of those years she has played through the on and off pain of tennis elbow. She states, “I played with tennis elbow for years. I wore the sleeves, the tape, anything I thought would help. I did not want to give up the game.” Finally the pain associated with tennis elbow forced Wilson to put the racket down. “It was achy, towards the end it was sort of a constant pain that I felt beyond the tennis court. I couldn’t pick up my purse, use my computer mouse because my elbow ached all the time,” she explains.

There are several treatment options for players with tennis elbow. States Dr. McConnell, “First a player generally tries to play through the pain. Then they may try the gels, the cortisone shots and even physical therapy.” Physical therapy is an effective treatment for some with mild tennis elbow. Wilson tried physical therapy, but her pain remained.

Now there is a new procedure that those suffering from tennis elbow. It is called the Tenex Health (previously know as the FAST) procedure. Dr. McConnell states, “The Tenex Health TX procedure, or fasciotomy and surgical tenomoty, is a minimally invasive procedure that requires no incisions and minimal downtime post procedure. This procedure has proven to be quite effective for those suffering from tennis elbow.”

Dr. McConnell, the only surgeon locally trained to perform the Tenex Health procedure, treated Wilson in December. He states, “After an initial examination, she proved to be the perfect candidate for this procedure. The pain associated with her tennis elbow was affecting her everyday life and physical therapy had been ineffective.” Based on technology developed in collaboration with the Mayo clinic, the Fast procedure is performed using local anesthetic to numb the area; patients are awake and alert. During the procedure, ultrasound imaging is used to identify the location of the scar tissue. Once located, a small instrument-the size of a toothpick-is inserted into the damaged tendon. The instrument delivers ultrasonic energy specifically designed to cut, break up, and remove damaged tissue safely and quickly, without disturbing the surrounding healthy tendon tissue.

According to Dr. McConnell, this procedure is a good alternative for tennis players that are considering surgery for tennis elbow relief. He states, “Unlike conventional treatment methods, the Tenex Health TX replicates the goal of an open surgical procedure by removing the damaged tissue with minimal invasion. The procedure usually takes 15 minutes or less and requires only an adhesive bandage to close the micro incision.” Unlike traditional open surgeries that may require several months of recovery, the Tenex Health TX recovery period is on average a 1 to 2 month timeframe. Following the short recovery a full return to the patient’s normal activities is expected.

A study done in April 2013 by the American Journal of Sports Medicine found the Tenex (FAST) procedure to be “safe, specific, minimally invasive and well tolerated treatment for recalcitrant lateral elbow tendinopathy.” All but one patient showed evidence of efficacy that was sustained at least one year. Wilson is not surprised by the studies’ outcome. By March, she was back on the court hitting tennis balls. While she is three months out from the procedure, assessment of patients for Tenex Health continues six months beyond the date of surgery. Wilson recommends Tenex Health TX (FAST) to any tennis player playing through the pain. She states, “The hardest thing is to put the racket down. I thought I could play through the pain. I now play pain free, it is like a new beginning.”

Dr. McConnell is an orthopedic surgeon that focuses on prevention and performance. He works with several local athletes as well as those on the national level. His office is located on Daniel Island. To learn more about this minimally invasive procedure for tennis elbow relief, go to www.charlestonsportsmed.com.

Dr. McConnell talks to patient, Deanna, about her TekScan evaluation for foot pain

Dr. McConnell Only Orthopaedic Surgeon to Perform New Minimally Invasive Procedures for Tendonitis

Is the source of your pain in the tendon or ligament? If medication and physical therapy have proved unsuccessful in relieving discomfort and pain related to tendon or ligament injuries, there are some recent advanced treatments worth exploring. Even better, these revolutionary treatments do not require open surgery.

Determining the actual source of your pain can be the first step to knowing if there is a minimally invasive treatment for which you are a candidate. Here are two very new options for patients with tendon and ligament damage.

Tenex Health TXTM
Focused Aspiration of Scar Tissue (FAST™) procedure or newly named, Tenex Health TXTM is a new outpatient procedure specifically designed for those who are suffering from pain associated to tendon damage. Tendon damage often occurs in patients due to repetitive stress and overuse of one area of the body.

Tendon pain takes many forms:
• Plantar fasciitis
• Achilles tendonitis
• Jumper’s / Runner’s knee
• Tennis / Golfer’s elbow

The revolutionary Tenex Health TXTM procedure is an advanced treatment that quickly and safely removes the source of tendon pain stemming from tendon and soft tissue injuries such as tennis elbow, golfer’s elbow, jumper’s knee, Achilles tendonitis and plantar fasciitis. The procedure is based on advanced technology developed in collaboration with the Mayo Clinic and is performed using a local anesthetic, allowing patients to remain awake and alert the entire time.

Using ultrasound imaging, the scar tissue is identified and a small instrument about the size of a toothpick is inserted into the damaged tendon. Ultrasonic energy then cuts, breaks up and removes the damaged tissue, without disturbing the surrounding healthy tendon tissue. The procedure typically takes about 15 minutes or less, requires only an adhesive bandage to close the microincision, and offers quick recovery time for patients.

This procedure is not invasive open surgery and can be performed in an office or procedure room.

Platelet Rich Plasma (PRP) Therapy:
PRP is blood plasma with concentrated platelets. These platelets include bioactive proteins that initiate connective tissue healing such as bone, tendon and ligament regeneration and repair.

PRP can be injected in tendons and ligaments all over the body, which can help with sports injuries and more specific injuries including tennis elbow, carpal tunnel syndrome, shin splints and many other damaged ligaments and tendons. Patients see significant improvement immediately, which may eliminate the need for aggressive treatments such as long-term medication or surgery.

Bright McConnell, III, MD 900 Island Park Drive, Suite #105
Charleston, SC 29492 Phone: (843) 284-5200

Dr. McConnell and Anne Ahern Moore on Lowcountry Live!

Dr. McConnell and Exercise Physiologist, Anne Ahern Moore discusses tests to customize your best fitness and nutrition plan for great results.

The Charleston Sports Medicine Team strives to become your partner in your total health. Our affiliated practice, FitMed Partners, also offers scientifically proven preventive age management, bio-identical hormone therapy and medically based fitness and nutrition programs. The FitMed Elite Athlete Program provides a menu of advanced sports performance testing, not typically covered under insurance, for affordable prices.

Everybody knows a kid who likes to roughhouse — he or she plays full-speed with seemingly no regard for life and limb.

Jay Noce is one of those kids, all grown up.

The 51-year-old Daniel Island resident and former collegiate tennis player is a black belt in karate, does intense CrossFit workouts, and plays tennis, basketball and golf. Being physically active is in his DNA but his sports, while keeping him physically fit and trim, have taken their toll on his knees.

Read full article

Healthy Aging: Preserve Your Bones and Joints

thumbnailMarried with children, single, seniors and everyone in between struggle to fit exercise into their morning routine. “Busy” is a well worn word among Americans.

Time constraints are not alone in the challenges to stay healthy as we age. Maintaining the ability to be mobile is critical to remaining vital as we age. This means avoiding injury and preserving bone and join health.

Aging itself conspires to chip away at your bone and joint health. “Bone and joint health are intrinsically linked to healthy aging,” explains Dr. Bright McConnell of Charleston Sports Medicine. “We are excited to bring orthobiologics, stem cell therapies, bioidentical hormone replacement and countless other advanced treatments for patients with bone and joint injuries to the forefront. But the key to avoiding injury altogether or recovering from injury lies in the development of bone and joint strength. 

Strong, healthy bones and joints translate to strong healthy men and women – regardless of age.”

Here are some recommendations for how to achieve bone and joint health.

1. Start Early

skelatonBone and joint health begin in childhood. Today, approximately 32% of American children and adolescents, ages 2 to 19, are considered overweight or obese.

Excess weight can cause vitamin deficiencies, hormonal imbalances, and increased stress and tension that can affect bone growth and overall musculoskeletal health, causing deformity, pain, and potentially, a lifetime of limited mobility and diminished life quality.

Physical activity is important for loading the bones and helping them strengthen. A healthy diet, along with regular physical activity in childhood—at least 35 to 60 minutes a day—can help ensure a healthy weight and strong bones for life.

The adolescent growth spurt brings a marked rise in fractures. If fractures occur with mild injuries, that can be a sign children have skeletal defects tied to low bone mass. This carries over into adulthood.

2. Drink Well: Calcium, Caffeine and Alcohol

A diet inclusive of calcium is critical. Limit caffeinated beverages – soda and coffee – particularly if your calcium intake is low. Drink water instead. Alcohol consumption can affect bone health. Drink in moderation.

If you aren’t drinking the recommended calcium intake for your age group, add calcium-rich foods to your diet or use a calcium supplement.

3. Exercise: Find The Time & Mix It Up

The dramatic increase in the number of children, adolescents and adults diagnosed as overweight or obese in the United States has reached epidemic status. Calcium, vitamin D, diet and exercise are the cornerstones of bone health. Staying at a healthy weight reduces negative impact on bones and joints.

Moderation and variety of exercise reduces the possibility of wear and tear related to repeating the same motion. So mix it up. Run one day and do weight bearing activities the next.

Make the time. Staying active isn’t always easy to fit into today’s busy schedule. Try to schedule your exercise time and spend more time on your feet. Take the stairs, stand up while working, walk while on the phone. We agree with Nike. Just do it.

4. Don’t Smoke. Just Don’t Do It.

Smoking reduces bone mass. Several research studies have identified smoking as a risk factor for osteoporosis and bone fracture. So don’t smoke. Period.

5. Boost Your Vitamin D.

Vitamin D plays an important role in protecting your bones and your body requires it to absorb calcium. Children need vitamin D to build strong bones, and adults need it to keep their bones strong and healthy. If you don’t get enough vitamin D, you may lose bone, have lower bone density, and you’re more likely to break bones as you age.

Schedule an appointment for a blood panel to test your Vitamin D. Take a high potency supplement and/or a nice walk in the sun if you test low. Enjoy the added benefit of a mood boost. Now everybody’s happy.

Treatments using patient-derived platelets and stem cells are an emerging tool for healing injuries

Everybody knows a kid who likes to roughhouse — he or she plays full-speed with seemingly no regard for life and limb.

Jay Noce is one of those kids, all grown up.

The 51-year-old Daniel Island resident and former collegiate tennis player is a black belt in karate, does intense CrossFit workouts, and plays tennis, basketball and golf. Being physically active is in his DNA but his sports, while keeping him physically fit and trim, have taken their toll on his knees.

Mining blood and fat

Five years ago, he took a karate kick on the outside of his right knee that hobbled him and later sought out injections of platelet rich plasma (aka PRP) and adipose-derived stem cells, taken from his own blood and fat, to help it heal.

Last fall, Noce was near the end of a tennis match when he felt the proverbial “pop” in the right knee, which ended up being a stable meniscus tear.

He went back to the same orthopedic physician, Charleston Sports Medicine’s Dr. Bright McConnell, who offered him another orthobiologic treatment as an alternative to surgery, which would have involved a painful recovery and weeks on crunches. Not ideal for a man who also travels internationally as part of his digital business.

Healing stem cells

McConnell used an amniotic allograft, which is derived from the amniotic fluid from the placentas of screened mothers who have elected to have Caesarian sections.

“It’s like PRP on steroids,” says McConnell, of the allograft that is rich in stem cells and growth factors.

Noce says improvements were slow but steady.

“I’m at least 60 percent better,” says Noce, who is back to playing golf, doing karate with a strap on his knee, playing basketball with his kids and hitting tennis balls but not competing.

He was back in for another allograft injection last week with the hopes that will complete the healing process.

Biologics boom

McConnell says Noce’s slowly improving condition is fairly common for orthobiologic procedure.

“With biologics, it’s not instantaneous. It’s like planting a seed. You gotta wait for the flower to grow,” says McConnell. “People who get biologic treatments start to feel a difference in six to eight weeks. Three months out, 50 percent say it’s either a ton better or ‘it’s better but …’ Six months out, you’ll know if it worked.”

While biologics have been used to speed healing in brain and vascular surgeries for decades, their use in musculoskeletal applications have been more recent, within the last five years.

Orthobiologics are gaining attention, probably quicker than most new treatments, because of their fairly common use in high-profile professional athletes. Yet long-term outcomes are obviously not known.

In the years that McConnell has been using orthobiologics, starting with PRP, he has seen a range of patients from baby boomer athletes to seniors seeking to avoid a joint replacement.

What’s old is new?

According to a study “Orthobiologics in Foot and Ankle Surgery,” in 2013, the term orthobiologic is actually a marketing term that comes from the industry that creates devices, such as the centrifuges that separate platelets and stem cells from blood, bone marrow and fat tissues.

The term implies that the addition of one of these bioengineered products or extrinsic forces can positively influence the healing of ligaments and tendons.

Dr. Joe Calandra, a trained orthopedist and team physician for the South Carolina Stingrays and Charleston Southern University sports teams, says the first reported use of what is now called an orthobiologic was a bone graft in the mid-1600’s and that other autologous (tissue taken from the patient and put back in him or her) grafting continued.

“In the early 1900’s, autologous bone grafting started to take hold as an adjunct to help certain fractures heal. In 1965, bone morphogenic protein (often referred to as BMP) was isolated from bone tissue. This protein was shown to have the ability to stimulate bone growth,” says Calandra.

“Since the discovery of BMP many physicians and scientists have been trying to isolate other proteins and biologic substances such as stem cells and platelets, which may stimulate healing in the musculoskeletal system.”

Calandra adds that various substances have been implicated in the improvement of the healing process.

“Some orthobiologics, such as autologous bone grafts have good science behind them and a long track record of use in the clinical setting, others such as PRP and stem cell therapy do not have the consistent science or appropriate clinical trials to support their widespread use at this time.”

Calandra believes the newer biologics as well as those not yet discovered or perfected will be a tremendous adjunct to the care of musculoskeletal injuries and diseases in patients.

But, he adds, caution must be taken and proper unbiased clinical trials undertaken before these should be routinely recommended.

What will it cost me?

Insurance, for the most part, does not cover orthobiologic procedures, even though the treatments could be a less expensive option to surgeries, such as knee replacements.

The cost of Noce’s amniotic allograft procedure, which was done in McConnell’s office, will run between $2,000 and $2,500, largely the cost of the stem cell product.

In McConnell’s case, his staff files the cost of the office visit and other services with insurance by Charleston Sports Medicine but not the cost of the orthobiologics.

McConnell adds that some health savings accounts also be applied to orthobiologics.

View Full Article from Post & Courier

View Full Article from Post & Courier

Men’s Health Day. Friday, June 19 Only

Schedule your Cardiometabolic Performance Test (VO2Max) screening for 20% off.

Five Ways Men Can Get Fit Now for Men’s Health Week

In honor of Men’s Health Week, June 15 to June 21, FitMed Partners and Charleston Sports Medicine have teamed up to provide you seven critical ways to get fit now. Count the ways you can feel better fast.

1. Save on Your Vo2Max Test
First, schedule your Cardiometabolic Performance Test (VO2Max) screening for 20% off on Men’s Health Day. Appointments are available from 8 am to 5 pm, Friday June 19 at Charleston Sports Medicine’s Daniel Island location with exercise physiologist, Anne Moore. “A Cardiometabolic Performance Test performed on a treadmill or cycle measures key data including peak VO2, anaerobic threshold and the precise number of calories burned at all exercise heart rate zones.This is a great first step to designing a results oriented fitness plan unique to your body,” says Dr. Bright McConnell.

2. Combat Low T with Testosterone Therapy
Men have an unfair advantage over women in the weight loss, fitness category. The simple truth is that men are larger and have more muscle than women due to the hormone testosterone. They are genetically designed to have a higher percentage of muscle and less fat — which works in favor of keeping them fit and allowing them to eat more calories. However, if testosterone levels are low, men can lose this edge and gain abdominal weight, begin to feel sluggish and experience overall muscle loss. Keep your edge and have a comprehensive blood panel to determine if you have low testosterone. http://www.fitmedpartners.com/hormone-replacement-therapy/bioidentical-hormone-therapy-for-men/

3. Think Greek or Go Caveman
The Mediterranean diet, which is rich in vegetables, healthy fats, whole grains, and fish, is associated with physical health and mental acuity in your old age. Or, go back to the caveman days with the Paelo diet. Dr. McConnell likes a PaeloMed hybrid diet for maintaining your health. Not sure what to eat, use the gylcemic index tool http://www.fitmedpartners.com/glycemic-index-reference-guide/

4. Do Not Ignore Erectile Dysfunction (ED)
Problems with performance in an intimate setting are a difficult topic for men to address. Do not ignore ED. Make an appointment with your doctor to address. Read this article http://www.huffingtonpost.com/2015/04/09/erectile-dysfunction-_n_6882636.html

5. Strength Train
Even a little weight training can go a long way. Whether you’re 100 lbs overweight or just need to lose the last 15, strength training is one of the most effective ways to burn fat and build muscle.Lifting has been shown to halt and even reverse sarcopenia – the reduction of skeletal muscle that occurs as we get older – which helps us stay independent (and out of a nursing home) and live longer. It prevents disease and degenerative conditions such as heart disease and the management of cholesterol, high blood pressure, obesity, diabetes, and mood.

My elbow hurts!

Two of the most common injuries around the elbow that sports medicine physicians evaluate and treat are related to overuse and stress to the muscle and tendons that are involved in gripping type activities.

Lateral epicondylitis, known as “tennis elbow”, results from overuse of the muscles and tendons that are used to extend your wrist and fingers. The pain is typically located on the outside, or lateral aspect, of the elbow and involves primarily a muscle-tendon unit called the extensor carpi radialis brevis (ECRB). This tendon is used to help stabilize the wrist when the elbow is extended, which occurs during a tennis ground stroke.

Medial epicondylitis, known as “golfer’s elbow” results from overuse of the muscles and tendons that are used to flex the wrist and turned the forearm. Pain and discomfort is typically located on the inside, or medial aspect, of the elbow and involves the tendon known as the common flexor tendon. Forces are increased on the flexor tendon while gripping a golf club during a golf swing.

Both conditions can be caused by other repetitious activities such as throwing and activities requiring repetitious grip, such as shoveling, hammering nails, and gardening activities. Typical symptoms include pain on grip, or weakness in grip strength.

The early phase of these conditions is an acute inflammation of the tendon called tendinitis. However, if the overuse syndrome has existed for several months or longer, the tissue can continue to degenerate and form a condition known as tendinosis. This is not a true inflammatory condition, but represents chronic degenerative changes in the collagen fibers of the tendon, which results in scar tissue, leaving the injured area in a weak and and painful condition.

Diagnosis is typically based upon physical examination. Occasionally, x-rays may show some irregularity or calcium deposits within the tendon. Occasionally, further diagnostic imaging such as MRI or ultrasound is utilized, which confirms the pathology. The use of office musculoskeletal ultrasound now allows for a much quicker diagnosis and earlier intervention.

Treatment for this condition is typically nonsurgical, and involves a rehabilitation program which may include rest and stretching exercises, non-provocative exercise and occasionally use of bands or straps that may take the pressure off the tendon for a period of time. It is imperative to identify and correct any biomechanical abnormality in the swing or stroke mechanics, which led to the problem initially.

Although it is not uncommon for physicians to utilize cortisone type injections to reduce the inflammation, recent evidence in the sports medicine literature suggests this should not be carried out more than once or twice, as this may further damage the collagen in the tendon.

Traditional surgical treatment requires an incision over the affected tendon area, with removal of the damaged tissue and repair back to the bone after removing any underlying bone spurs.

Over the past several years, new and innovative technologies have been made available which are much less invasive. There has been a significant increase in the utilization of growth factors, such as platelet rich plasma, as well as use of certain types of stem cell therapies, to allow a more aggressive, regenerative healing response. These type of treatment options are referred to as orthobiologics.

Recently, a minimally invasive procedure developed at the Mayo Clinic called percutaneous tenotomy, or the Tenex procedure (www.TenexHealth.com), allows a physician to repair the degenerative collagen using a high energy device on the tip of a very small probe. This can be performed under a simple local anesthetic injection and is performed under ultrasound guidance. It requires no incisions or sutures and typically allows for a quicker recovery and return to activity.

Typically, prevention is the best cure! Spring has arrived, and outdoor activities will increase. Early recognition of symptoms, with early rehabilitation efforts and utilization of a good swing coach to correct poor mechanics will typically prevent this from developing into a more chronic problem.

Treatments using patient-derived platelets and stem cells are an emerging tool for healing injuries

Everybody knows a kid who likes to roughhouse — he or she plays full-speed with seemingly no regard for life and limb.

Jay Noce is one of those kids, all grown up.

The 51-year-old Daniel Island resident and former collegiate tennis player is a black belt in karate, does intense CrossFit workouts, and plays tennis, basketball and golf. Being physically active is in his DNA but his sports, while keeping him physically fit and trim, have taken their toll on his knees.

Read full article

Concussion Risk Reducer- Athletes Should Consider Pre-Season Cognitive Testing

March is Brain Injury Awareness Month

Spring sports practices like baseball, soccer and lacrosse have begun. One local physician advises athletes to stop by the examining room before hitting the field. March is Brain Injury Awareness Month, and according to the CDC, as many as 3.8 million sports and recreation related concussions are estimated to occur in the United States every year. Brain Injury symptoms range from confusion, headache and blurred vision to vomiting and loss of consciousness.

The problem with brain injuries, like concussions, is that they are difficult to diagnose. Because of this, Dr. Bright McConnell of Charleston Sports Medicine advises athletes to be proactive and have a pre season baseline test before the games begin. He states, “Go into the season prepared. This will help in the long run.” Charleston Sports Medicine provides baseline testing with the CNS Vital Signs Program. Athletes are given neurocognitive index testing and while the physician gains insight into an athlete’s brain health status. Through the testing, information on key cognitive measures, such as memory, reaction time, and executive function are examined. If an injury occurs, this information will be beneficial with evaluation and help physicians determine an athlete’s readiness to return to play.

CNS testing take only thirty minutes and is covered by insurance. Charleston Sports Medicine offers this test alone or as part of an age management profile.
For more information, log onto www.charlestonsportsmed.com.

Take the Pain out of the Game

Recently, the world’s best tennis players took over Daniel Island at the Family Circle Cup. In the crowd, many recreational players watched in awe looking for tips to improve their game. For some, playing without pain would be a start because of the well-known injury “tennis elbow.”

Tennis elbow is a common condition caused by the overuse of the arm, forearm and hand muscles. Dr. Bright McConnell, an orthopedic surgeon with Charleston Sports Medicine has been treating tennis elbow for years. He states, “Tennis elbow is caused by the overuse of muscles and tendons around the forearm. Close to fifty percent of tennis players will experience tennis elbow at some point in their playing years. They are constantly hitting the tennis ball with their racket with force. This can cause a nagging pain outside of the elbow that increases over time.”

Carol Wilson is a 4.0 league player that has played tennis for twenty years. Ten of those years she has played through the on and off pain of tennis elbow. She states, “I played with tennis elbow for years. I wore the sleeves, the tape, anything I thought would help. I did not want to give up the game.” Finally the pain associated with tennis elbow forced Wilson to put the racket down. “It was achy, towards the end it was sort of a constant pain that I felt beyond the tennis court. I couldn’t pick up my purse, use my computer mouse because my elbow ached all the time,” she explains.

There are several treatment options for players with tennis elbow. States Dr. McConnell, “First a player generally tries to play through the pain. Then they may try the gels, the cortisone shots and even physical therapy.” Physical therapy is an effective treatment for some with mild tennis elbow. Wilson tried physical therapy, but her pain remained.

Now there is a new procedure that those suffering from tennis elbow. It is called the Tenex Health (previously know as the FAST) procedure. Dr. McConnell states, “The Tenex Health TX procedure, or fasciotomy and surgical tenomoty, is a minimally invasive procedure that requires no incisions and minimal downtime post procedure. This procedure has proven to be quite effective for those suffering from tennis elbow.”

Dr. McConnell, the only surgeon locally trained to perform the Tenex Health procedure, treated Wilson in December. He states, “After an initial examination, she proved to be the perfect candidate for this procedure. The pain associated with her tennis elbow was affecting her everyday life and physical therapy had been ineffective.” Based on technology developed in collaboration with the Mayo clinic, the Fast procedure is performed using local anesthetic to numb the area; patients are awake and alert. During the procedure, ultrasound imaging is used to identify the location of the scar tissue. Once located, a small instrument-the size of a toothpick-is inserted into the damaged tendon. The instrument delivers ultrasonic energy specifically designed to cut, break up, and remove damaged tissue safely and quickly, without disturbing the surrounding healthy tendon tissue.

According to Dr. McConnell, this procedure is a good alternative for tennis players that are considering surgery for tennis elbow relief. He states, “Unlike conventional treatment methods, the Tenex Health TX replicates the goal of an open surgical procedure by removing the damaged tissue with minimal invasion. The procedure usually takes 15 minutes or less and requires only an adhesive bandage to close the micro incision.” Unlike traditional open surgeries that may require several months of recovery, the Tenex Health TX recovery period is on average a 1 to 2 month timeframe. Following the short recovery a full return to the patient’s normal activities is expected.

A study done in April 2013 by the American Journal of Sports Medicine found the Tenex (FAST) procedure to be “safe, specific, minimally invasive and well tolerated treatment for recalcitrant lateral elbow tendinopathy.” All but one patient showed evidence of efficacy that was sustained at least one year. Wilson is not surprised by the studies’ outcome. By March, she was back on the court hitting tennis balls. While she is three months out from the procedure, assessment of patients for Tenex Health continues six months beyond the date of surgery. Wilson recommends Tenex Health TX (FAST) to any tennis player playing through the pain. She states, “The hardest thing is to put the racket down. I thought I could play through the pain. I now play pain free, it is like a new beginning.”

Dr. McConnell is an orthopedic surgeon that focuses on prevention and performance. He works with several local athletes as well as those on the national level. His office is located on Daniel Island. To learn more about this minimally invasive procedure for tennis elbow relief, go to www.charlestonsportsmed.com.

Dr. McConnell talks to patient, Deanna, about her TekScan evaluation for foot pain

Dr. McConnell Only Orthopaedic Surgeon to Perform New Minimally Invasive Procedures for Tendonitis

Is the source of your pain in the tendon or ligament? If medication and physical therapy have proved unsuccessful in relieving discomfort and pain related to tendon or ligament injuries, there are some recent advanced treatments worth exploring. Even better, these revolutionary treatments do not require open surgery.

Determining the actual source of your pain can be the first step to knowing if there is a minimally invasive treatment for which you are a candidate. Here are two very new options for patients with tendon and ligament damage.

Tenex Health TXTM
Focused Aspiration of Scar Tissue (FAST™) procedure or newly named, Tenex Health TXTM is a new outpatient procedure specifically designed for those who are suffering from pain associated to tendon damage. Tendon damage often occurs in patients due to repetitive stress and overuse of one area of the body.

Tendon pain takes many forms:
• Plantar fasciitis
• Achilles tendonitis
• Jumper’s / Runner’s knee
• Tennis / Golfer’s elbow

The revolutionary Tenex Health TXTM procedure is an advanced treatment that quickly and safely removes the source of tendon pain stemming from tendon and soft tissue injuries such as tennis elbow, golfer’s elbow, jumper’s knee, Achilles tendonitis and plantar fasciitis. The procedure is based on advanced technology developed in collaboration with the Mayo Clinic and is performed using a local anesthetic, allowing patients to remain awake and alert the entire time.

Using ultrasound imaging, the scar tissue is identified and a small instrument about the size of a toothpick is inserted into the damaged tendon. Ultrasonic energy then cuts, breaks up and removes the damaged tissue, without disturbing the surrounding healthy tendon tissue. The procedure typically takes about 15 minutes or less, requires only an adhesive bandage to close the microincision, and offers quick recovery time for patients.

This procedure is not invasive open surgery and can be performed in an office or procedure room.

Platelet Rich Plasma (PRP) Therapy:
PRP is blood plasma with concentrated platelets. These platelets include bioactive proteins that initiate connective tissue healing such as bone, tendon and ligament regeneration and repair.

PRP can be injected in tendons and ligaments all over the body, which can help with sports injuries and more specific injuries including tennis elbow, carpal tunnel syndrome, shin splints and many other damaged ligaments and tendons. Patients see significant improvement immediately, which may eliminate the need for aggressive treatments such as long-term medication or surgery.

Bright McConnell, III, MD 900 Island Park Drive, Suite #105
Charleston, SC 29492 Phone: (843) 284-5200

Dr. McConnell and Anne Ahern Moore on Lowcountry Live!

Dr. McConnell and Exercise Physiologist, Anne Ahern Moore discusses tests to customize your best fitness and nutrition plan for great results.

The Charleston Sports Medicine Team strives to become your partner in your total health. Our affiliated practice, FitMed Partners, also offers scientifically proven preventive age management, bio-identical hormone therapy and medically based fitness and nutrition programs. The FitMed Elite Athlete Program provides a menu of advanced sports performance testing, not typically covered under insurance, for affordable prices.

March is Brain Injury Awareness Month

Spring sports practices like baseball, soccer and lacrosse have begun. One local physician advises athletes to stop by the examining room before hitting the field. March is Brain Injury Awareness Month, and according to the CDC, as many as 3.8 million sports and recreation related concussions are estimated to occur in the United States every year. Brain Injury symptoms range from confusion, headache and blurred vision to vomiting and loss of consciousness.

The problem with brain injuries, like concussions, is that they are difficult to diagnose. Because of this, Dr. Bright McConnell of Charleston Sports Medicine advises athletes to be proactive and have a pre season baseline test before the games begin. He states, “Go into the season prepared. This will help in the long run.” Charleston Sports Medicine provides baseline testing with the CNS Vital Signs Program. Athletes are given neurocognitive index testing and while the physician gains insight into an athlete’s brain health status. Through the testing, information on key cognitive measures, such as memory, reaction time, and executive function are examined. If an injury occurs, this information will be beneficial with evaluation and help physicians determine an athlete’s readiness to return to play.

CNS testing take only thirty minutes and is covered by insurance. Charleston Sports Medicine offers this test alone or as part of an age management profile.
For more information, log onto www.charlestonsportsmed.com.

Healthy Aging: Preserve Your Bones and Joints

thumbnailMarried with children, single, seniors and everyone in between struggle to fit exercise into their morning routine. “Busy” is a well worn word among Americans.

Time constraints are not alone in the challenges to stay healthy as we age. Maintaining the ability to be mobile is critical to remaining vital as we age. This means avoiding injury and preserving bone and join health.

Aging itself conspires to chip away at your bone and joint health. “Bone and joint health are intrinsically linked to healthy aging,” explains Dr. Bright McConnell of Charleston Sports Medicine. “We are excited to bring orthobiologics, stem cell therapies, bioidentical hormone replacement and countless other advanced treatments for patients with bone and joint injuries to the forefront. But the key to avoiding injury altogether or recovering from injury lies in the development of bone and joint strength. 

Strong, healthy bones and joints translate to strong healthy men and women – regardless of age.”

Here are some recommendations for how to achieve bone and joint health.

1. Start Early

skelatonBone and joint health begin in childhood. Today, approximately 32% of American children and adolescents, ages 2 to 19, are considered overweight or obese.

Excess weight can cause vitamin deficiencies, hormonal imbalances, and increased stress and tension that can affect bone growth and overall musculoskeletal health, causing deformity, pain, and potentially, a lifetime of limited mobility and diminished life quality.

Physical activity is important for loading the bones and helping them strengthen. A healthy diet, along with regular physical activity in childhood—at least 35 to 60 minutes a day—can help ensure a healthy weight and strong bones for life.

The adolescent growth spurt brings a marked rise in fractures. If fractures occur with mild injuries, that can be a sign children have skeletal defects tied to low bone mass. This carries over into adulthood.

2. Drink Well: Calcium, Caffeine and Alcohol

A diet inclusive of calcium is critical. Limit caffeinated beverages – soda and coffee – particularly if your calcium intake is low. Drink water instead. Alcohol consumption can affect bone health. Drink in moderation.

If you aren’t drinking the recommended calcium intake for your age group, add calcium-rich foods to your diet or use a calcium supplement.

3. Exercise: Find The Time & Mix It Up

The dramatic increase in the number of children, adolescents and adults diagnosed as overweight or obese in the United States has reached epidemic status. Calcium, vitamin D, diet and exercise are the cornerstones of bone health. Staying at a healthy weight reduces negative impact on bones and joints.

Moderation and variety of exercise reduces the possibility of wear and tear related to repeating the same motion. So mix it up. Run one day and do weight bearing activities the next.

Make the time. Staying active isn’t always easy to fit into today’s busy schedule. Try to schedule your exercise time and spend more time on your feet. Take the stairs, stand up while working, walk while on the phone. We agree with Nike. Just do it.

4. Don’t Smoke. Just Don’t Do It.

Smoking reduces bone mass. Several research studies have identified smoking as a risk factor for osteoporosis and bone fracture. So don’t smoke. Period.

5. Boost Your Vitamin D.

Vitamin D plays an important role in protecting your bones and your body requires it to absorb calcium. Children need vitamin D to build strong bones, and adults need it to keep their bones strong and healthy. If you don’t get enough vitamin D, you may lose bone, have lower bone density, and you’re more likely to break bones as you age.

Schedule an appointment for a blood panel to test your Vitamin D. Take a high potency supplement and/or a nice walk in the sun if you test low. Enjoy the added benefit of a mood boost. Now everybody’s happy.

Treatments using patient-derived platelets and stem cells are an emerging tool for healing injuries

Everybody knows a kid who likes to roughhouse — he or she plays full-speed with seemingly no regard for life and limb.

Jay Noce is one of those kids, all grown up.

The 51-year-old Daniel Island resident and former collegiate tennis player is a black belt in karate, does intense CrossFit workouts, and plays tennis, basketball and golf. Being physically active is in his DNA but his sports, while keeping him physically fit and trim, have taken their toll on his knees.

Mining blood and fat

Five years ago, he took a karate kick on the outside of his right knee that hobbled him and later sought out injections of platelet rich plasma (aka PRP) and adipose-derived stem cells, taken from his own blood and fat, to help it heal.

Last fall, Noce was near the end of a tennis match when he felt the proverbial “pop” in the right knee, which ended up being a stable meniscus tear.

He went back to the same orthopedic physician, Charleston Sports Medicine’s Dr. Bright McConnell, who offered him another orthobiologic treatment as an alternative to surgery, which would have involved a painful recovery and weeks on crunches. Not ideal for a man who also travels internationally as part of his digital business.

Healing stem cells

McConnell used an amniotic allograft, which is derived from the amniotic fluid from the placentas of screened mothers who have elected to have Caesarian sections.

“It’s like PRP on steroids,” says McConnell, of the allograft that is rich in stem cells and growth factors.

Noce says improvements were slow but steady.

“I’m at least 60 percent better,” says Noce, who is back to playing golf, doing karate with a strap on his knee, playing basketball with his kids and hitting tennis balls but not competing.

He was back in for another allograft injection last week with the hopes that will complete the healing process.

Biologics boom

McConnell says Noce’s slowly improving condition is fairly common for orthobiologic procedure.

“With biologics, it’s not instantaneous. It’s like planting a seed. You gotta wait for the flower to grow,” says McConnell. “People who get biologic treatments start to feel a difference in six to eight weeks. Three months out, 50 percent say it’s either a ton better or ‘it’s better but …’ Six months out, you’ll know if it worked.”

While biologics have been used to speed healing in brain and vascular surgeries for decades, their use in musculoskeletal applications have been more recent, within the last five years.

Orthobiologics are gaining attention, probably quicker than most new treatments, because of their fairly common use in high-profile professional athletes. Yet long-term outcomes are obviously not known.

In the years that McConnell has been using orthobiologics, starting with PRP, he has seen a range of patients from baby boomer athletes to seniors seeking to avoid a joint replacement.

What’s old is new?

According to a study “Orthobiologics in Foot and Ankle Surgery,” in 2013, the term orthobiologic is actually a marketing term that comes from the industry that creates devices, such as the centrifuges that separate platelets and stem cells from blood, bone marrow and fat tissues.

The term implies that the addition of one of these bioengineered products or extrinsic forces can positively influence the healing of ligaments and tendons.

Dr. Joe Calandra, a trained orthopedist and team physician for the South Carolina Stingrays and Charleston Southern University sports teams, says the first reported use of what is now called an orthobiologic was a bone graft in the mid-1600’s and that other autologous (tissue taken from the patient and put back in him or her) grafting continued.

“In the early 1900’s, autologous bone grafting started to take hold as an adjunct to help certain fractures heal. In 1965, bone morphogenic protein (often referred to as BMP) was isolated from bone tissue. This protein was shown to have the ability to stimulate bone growth,” says Calandra.

“Since the discovery of BMP many physicians and scientists have been trying to isolate other proteins and biologic substances such as stem cells and platelets, which may stimulate healing in the musculoskeletal system.”

Calandra adds that various substances have been implicated in the improvement of the healing process.

“Some orthobiologics, such as autologous bone grafts have good science behind them and a long track record of use in the clinical setting, others such as PRP and stem cell therapy do not have the consistent science or appropriate clinical trials to support their widespread use at this time.”

Calandra believes the newer biologics as well as those not yet discovered or perfected will be a tremendous adjunct to the care of musculoskeletal injuries and diseases in patients.

But, he adds, caution must be taken and proper unbiased clinical trials undertaken before these should be routinely recommended.

What will it cost me?

Insurance, for the most part, does not cover orthobiologic procedures, even though the treatments could be a less expensive option to surgeries, such as knee replacements.

The cost of Noce’s amniotic allograft procedure, which was done in McConnell’s office, will run between $2,000 and $2,500, largely the cost of the stem cell product.

In McConnell’s case, his staff files the cost of the office visit and other services with insurance by Charleston Sports Medicine but not the cost of the orthobiologics.

McConnell adds that some health savings accounts also be applied to orthobiologics.

View Full Article from Post & Courier

View Full Article from Post & Courier

Men’s Health Day. Friday, June 19 Only

Schedule your Cardiometabolic Performance Test (VO2Max) screening for 20% off.

Five Ways Men Can Get Fit Now for Men’s Health Week

In honor of Men’s Health Week, June 15 to June 21, FitMed Partners and Charleston Sports Medicine have teamed up to provide you seven critical ways to get fit now. Count the ways you can feel better fast.

1. Save on Your Vo2Max Test
First, schedule your Cardiometabolic Performance Test (VO2Max) screening for 20% off on Men’s Health Day. Appointments are available from 8 am to 5 pm, Friday June 19 at Charleston Sports Medicine’s Daniel Island location with exercise physiologist, Anne Moore. “A Cardiometabolic Performance Test performed on a treadmill or cycle measures key data including peak VO2, anaerobic threshold and the precise number of calories burned at all exercise heart rate zones.This is a great first step to designing a results oriented fitness plan unique to your body,” says Dr. Bright McConnell.

2. Combat Low T with Testosterone Therapy
Men have an unfair advantage over women in the weight loss, fitness category. The simple truth is that men are larger and have more muscle than women due to the hormone testosterone. They are genetically designed to have a higher percentage of muscle and less fat — which works in favor of keeping them fit and allowing them to eat more calories. However, if testosterone levels are low, men can lose this edge and gain abdominal weight, begin to feel sluggish and experience overall muscle loss. Keep your edge and have a comprehensive blood panel to determine if you have low testosterone. http://www.fitmedpartners.com/hormone-replacement-therapy/bioidentical-hormone-therapy-for-men/

3. Think Greek or Go Caveman
The Mediterranean diet, which is rich in vegetables, healthy fats, whole grains, and fish, is associated with physical health and mental acuity in your old age. Or, go back to the caveman days with the Paelo diet. Dr. McConnell likes a PaeloMed hybrid diet for maintaining your health. Not sure what to eat, use the gylcemic index tool http://www.fitmedpartners.com/glycemic-index-reference-guide/

4. Do Not Ignore Erectile Dysfunction (ED)
Problems with performance in an intimate setting are a difficult topic for men to address. Do not ignore ED. Make an appointment with your doctor to address. Read this article http://www.huffingtonpost.com/2015/04/09/erectile-dysfunction-_n_6882636.html

5. Strength Train
Even a little weight training can go a long way. Whether you’re 100 lbs overweight or just need to lose the last 15, strength training is one of the most effective ways to burn fat and build muscle.Lifting has been shown to halt and even reverse sarcopenia – the reduction of skeletal muscle that occurs as we get older – which helps us stay independent (and out of a nursing home) and live longer. It prevents disease and degenerative conditions such as heart disease and the management of cholesterol, high blood pressure, obesity, diabetes, and mood.

My elbow hurts!

Two of the most common injuries around the elbow that sports medicine physicians evaluate and treat are related to overuse and stress to the muscle and tendons that are involved in gripping type activities.

Lateral epicondylitis, known as “tennis elbow”, results from overuse of the muscles and tendons that are used to extend your wrist and fingers. The pain is typically located on the outside, or lateral aspect, of the elbow and involves primarily a muscle-tendon unit called the extensor carpi radialis brevis (ECRB). This tendon is used to help stabilize the wrist when the elbow is extended, which occurs during a tennis ground stroke.

Medial epicondylitis, known as “golfer’s elbow” results from overuse of the muscles and tendons that are used to flex the wrist and turned the forearm. Pain and discomfort is typically located on the inside, or medial aspect, of the elbow and involves the tendon known as the common flexor tendon. Forces are increased on the flexor tendon while gripping a golf club during a golf swing.

Both conditions can be caused by other repetitious activities such as throwing and activities requiring repetitious grip, such as shoveling, hammering nails, and gardening activities. Typical symptoms include pain on grip, or weakness in grip strength.

The early phase of these conditions is an acute inflammation of the tendon called tendinitis. However, if the overuse syndrome has existed for several months or longer, the tissue can continue to degenerate and form a condition known as tendinosis. This is not a true inflammatory condition, but represents chronic degenerative changes in the collagen fibers of the tendon, which results in scar tissue, leaving the injured area in a weak and and painful condition.

Diagnosis is typically based upon physical examination. Occasionally, x-rays may show some irregularity or calcium deposits within the tendon. Occasionally, further diagnostic imaging such as MRI or ultrasound is utilized, which confirms the pathology. The use of office musculoskeletal ultrasound now allows for a much quicker diagnosis and earlier intervention.

Treatment for this condition is typically nonsurgical, and involves a rehabilitation program which may include rest and stretching exercises, non-provocative exercise and occasionally use of bands or straps that may take the pressure off the tendon for a period of time. It is imperative to identify and correct any biomechanical abnormality in the swing or stroke mechanics, which led to the problem initially.

Although it is not uncommon for physicians to utilize cortisone type injections to reduce the inflammation, recent evidence in the sports medicine literature suggests this should not be carried out more than once or twice, as this may further damage the collagen in the tendon.

Traditional surgical treatment requires an incision over the affected tendon area, with removal of the damaged tissue and repair back to the bone after removing any underlying bone spurs.

Over the past several years, new and innovative technologies have been made available which are much less invasive. There has been a significant increase in the utilization of growth factors, such as platelet rich plasma, as well as use of certain types of stem cell therapies, to allow a more aggressive, regenerative healing response. These type of treatment options are referred to as orthobiologics.

Recently, a minimally invasive procedure developed at the Mayo Clinic called percutaneous tenotomy, or the Tenex procedure (www.TenexHealth.com), allows a physician to repair the degenerative collagen using a high energy device on the tip of a very small probe. This can be performed under a simple local anesthetic injection and is performed under ultrasound guidance. It requires no incisions or sutures and typically allows for a quicker recovery and return to activity.

Typically, prevention is the best cure! Spring has arrived, and outdoor activities will increase. Early recognition of symptoms, with early rehabilitation efforts and utilization of a good swing coach to correct poor mechanics will typically prevent this from developing into a more chronic problem.

Treatments using patient-derived platelets and stem cells are an emerging tool for healing injuries

Everybody knows a kid who likes to roughhouse — he or she plays full-speed with seemingly no regard for life and limb.

Jay Noce is one of those kids, all grown up.

The 51-year-old Daniel Island resident and former collegiate tennis player is a black belt in karate, does intense CrossFit workouts, and plays tennis, basketball and golf. Being physically active is in his DNA but his sports, while keeping him physically fit and trim, have taken their toll on his knees.

Read full article

Concussion Risk Reducer- Athletes Should Consider Pre-Season Cognitive Testing

March is Brain Injury Awareness Month

Spring sports practices like baseball, soccer and lacrosse have begun. One local physician advises athletes to stop by the examining room before hitting the field. March is Brain Injury Awareness Month, and according to the CDC, as many as 3.8 million sports and recreation related concussions are estimated to occur in the United States every year. Brain Injury symptoms range from confusion, headache and blurred vision to vomiting and loss of consciousness.

The problem with brain injuries, like concussions, is that they are difficult to diagnose. Because of this, Dr. Bright McConnell of Charleston Sports Medicine advises athletes to be proactive and have a pre season baseline test before the games begin. He states, “Go into the season prepared. This will help in the long run.” Charleston Sports Medicine provides baseline testing with the CNS Vital Signs Program. Athletes are given neurocognitive index testing and while the physician gains insight into an athlete’s brain health status. Through the testing, information on key cognitive measures, such as memory, reaction time, and executive function are examined. If an injury occurs, this information will be beneficial with evaluation and help physicians determine an athlete’s readiness to return to play.

CNS testing take only thirty minutes and is covered by insurance. Charleston Sports Medicine offers this test alone or as part of an age management profile.
For more information, log onto www.charlestonsportsmed.com.

Take the Pain out of the Game

Recently, the world’s best tennis players took over Daniel Island at the Family Circle Cup. In the crowd, many recreational players watched in awe looking for tips to improve their game. For some, playing without pain would be a start because of the well-known injury “tennis elbow.”

Tennis elbow is a common condition caused by the overuse of the arm, forearm and hand muscles. Dr. Bright McConnell, an orthopedic surgeon with Charleston Sports Medicine has been treating tennis elbow for years. He states, “Tennis elbow is caused by the overuse of muscles and tendons around the forearm. Close to fifty percent of tennis players will experience tennis elbow at some point in their playing years. They are constantly hitting the tennis ball with their racket with force. This can cause a nagging pain outside of the elbow that increases over time.”

Carol Wilson is a 4.0 league player that has played tennis for twenty years. Ten of those years she has played through the on and off pain of tennis elbow. She states, “I played with tennis elbow for years. I wore the sleeves, the tape, anything I thought would help. I did not want to give up the game.” Finally the pain associated with tennis elbow forced Wilson to put the racket down. “It was achy, towards the end it was sort of a constant pain that I felt beyond the tennis court. I couldn’t pick up my purse, use my computer mouse because my elbow ached all the time,” she explains.

There are several treatment options for players with tennis elbow. States Dr. McConnell, “First a player generally tries to play through the pain. Then they may try the gels, the cortisone shots and even physical therapy.” Physical therapy is an effective treatment for some with mild tennis elbow. Wilson tried physical therapy, but her pain remained.

Now there is a new procedure that those suffering from tennis elbow. It is called the Tenex Health (previously know as the FAST) procedure. Dr. McConnell states, “The Tenex Health TX procedure, or fasciotomy and surgical tenomoty, is a minimally invasive procedure that requires no incisions and minimal downtime post procedure. This procedure has proven to be quite effective for those suffering from tennis elbow.”

Dr. McConnell, the only surgeon locally trained to perform the Tenex Health procedure, treated Wilson in December. He states, “After an initial examination, she proved to be the perfect candidate for this procedure. The pain associated with her tennis elbow was affecting her everyday life and physical therapy had been ineffective.” Based on technology developed in collaboration with the Mayo clinic, the Fast procedure is performed using local anesthetic to numb the area; patients are awake and alert. During the procedure, ultrasound imaging is used to identify the location of the scar tissue. Once located, a small instrument-the size of a toothpick-is inserted into the damaged tendon. The instrument delivers ultrasonic energy specifically designed to cut, break up, and remove damaged tissue safely and quickly, without disturbing the surrounding healthy tendon tissue.

According to Dr. McConnell, this procedure is a good alternative for tennis players that are considering surgery for tennis elbow relief. He states, “Unlike conventional treatment methods, the Tenex Health TX replicates the goal of an open surgical procedure by removing the damaged tissue with minimal invasion. The procedure usually takes 15 minutes or less and requires only an adhesive bandage to close the micro incision.” Unlike traditional open surgeries that may require several months of recovery, the Tenex Health TX recovery period is on average a 1 to 2 month timeframe. Following the short recovery a full return to the patient’s normal activities is expected.

A study done in April 2013 by the American Journal of Sports Medicine found the Tenex (FAST) procedure to be “safe, specific, minimally invasive and well tolerated treatment for recalcitrant lateral elbow tendinopathy.” All but one patient showed evidence of efficacy that was sustained at least one year. Wilson is not surprised by the studies’ outcome. By March, she was back on the court hitting tennis balls. While she is three months out from the procedure, assessment of patients for Tenex Health continues six months beyond the date of surgery. Wilson recommends Tenex Health TX (FAST) to any tennis player playing through the pain. She states, “The hardest thing is to put the racket down. I thought I could play through the pain. I now play pain free, it is like a new beginning.”

Dr. McConnell is an orthopedic surgeon that focuses on prevention and performance. He works with several local athletes as well as those on the national level. His office is located on Daniel Island. To learn more about this minimally invasive procedure for tennis elbow relief, go to www.charlestonsportsmed.com.

Dr. McConnell talks to patient, Deanna, about her TekScan evaluation for foot pain

Dr. McConnell Only Orthopaedic Surgeon to Perform New Minimally Invasive Procedures for Tendonitis

Is the source of your pain in the tendon or ligament? If medication and physical therapy have proved unsuccessful in relieving discomfort and pain related to tendon or ligament injuries, there are some recent advanced treatments worth exploring. Even better, these revolutionary treatments do not require open surgery.

Determining the actual source of your pain can be the first step to knowing if there is a minimally invasive treatment for which you are a candidate. Here are two very new options for patients with tendon and ligament damage.

Tenex Health TXTM
Focused Aspiration of Scar Tissue (FAST™) procedure or newly named, Tenex Health TXTM is a new outpatient procedure specifically designed for those who are suffering from pain associated to tendon damage. Tendon damage often occurs in patients due to repetitive stress and overuse of one area of the body.

Tendon pain takes many forms:
• Plantar fasciitis
• Achilles tendonitis
• Jumper’s / Runner’s knee
• Tennis / Golfer’s elbow

The revolutionary Tenex Health TXTM procedure is an advanced treatment that quickly and safely removes the source of tendon pain stemming from tendon and soft tissue injuries such as tennis elbow, golfer’s elbow, jumper’s knee, Achilles tendonitis and plantar fasciitis. The procedure is based on advanced technology developed in collaboration with the Mayo Clinic and is performed using a local anesthetic, allowing patients to remain awake and alert the entire time.

Using ultrasound imaging, the scar tissue is identified and a small instrument about the size of a toothpick is inserted into the damaged tendon. Ultrasonic energy then cuts, breaks up and removes the damaged tissue, without disturbing the surrounding healthy tendon tissue. The procedure typically takes about 15 minutes or less, requires only an adhesive bandage to close the microincision, and offers quick recovery time for patients.

This procedure is not invasive open surgery and can be performed in an office or procedure room.

Platelet Rich Plasma (PRP) Therapy:
PRP is blood plasma with concentrated platelets. These platelets include bioactive proteins that initiate connective tissue healing such as bone, tendon and ligament regeneration and repair.

PRP can be injected in tendons and ligaments all over the body, which can help with sports injuries and more specific injuries including tennis elbow, carpal tunnel syndrome, shin splints and many other damaged ligaments and tendons. Patients see significant improvement immediately, which may eliminate the need for aggressive treatments such as long-term medication or surgery.

Bright McConnell, III, MD 900 Island Park Drive, Suite #105
Charleston, SC 29492 Phone: (843) 284-5200

Dr. McConnell and Anne Ahern Moore on Lowcountry Live!

Dr. McConnell and Exercise Physiologist, Anne Ahern Moore discusses tests to customize your best fitness and nutrition plan for great results.

The Charleston Sports Medicine Team strives to become your partner in your total health. Our affiliated practice, FitMed Partners, also offers scientifically proven preventive age management, bio-identical hormone therapy and medically based fitness and nutrition programs. The FitMed Elite Athlete Program provides a menu of advanced sports performance testing, not typically covered under insurance, for affordable prices.

Recently, the world’s best tennis players took over Daniel Island at the Family Circle Cup. In the crowd, many recreational players watched in awe looking for tips to improve their game. For some, playing without pain would be a start because of the well-known injury “tennis elbow.”

Tennis elbow is a common condition caused by the overuse of the arm, forearm and hand muscles. Dr. Bright McConnell, an orthopedic surgeon with Charleston Sports Medicine has been treating tennis elbow for years. He states, “Tennis elbow is caused by the overuse of muscles and tendons around the forearm. Close to fifty percent of tennis players will experience tennis elbow at some point in their playing years. They are constantly hitting the tennis ball with their racket with force. This can cause a nagging pain outside of the elbow that increases over time.”

Carol Wilson is a 4.0 league player that has played tennis for twenty years. Ten of those years she has played through the on and off pain of tennis elbow. She states, “I played with tennis elbow for years. I wore the sleeves, the tape, anything I thought would help. I did not want to give up the game.” Finally the pain associated with tennis elbow forced Wilson to put the racket down. “It was achy, towards the end it was sort of a constant pain that I felt beyond the tennis court. I couldn’t pick up my purse, use my computer mouse because my elbow ached all the time,” she explains.

There are several treatment options for players with tennis elbow. States Dr. McConnell, “First a player generally tries to play through the pain. Then they may try the gels, the cortisone shots and even physical therapy.” Physical therapy is an effective treatment for some with mild tennis elbow. Wilson tried physical therapy, but her pain remained.

Now there is a new procedure that those suffering from tennis elbow. It is called the Tenex Health (previously know as the FAST) procedure. Dr. McConnell states, “The Tenex Health TX procedure, or fasciotomy and surgical tenomoty, is a minimally invasive procedure that requires no incisions and minimal downtime post procedure. This procedure has proven to be quite effective for those suffering from tennis elbow.”

Dr. McConnell, the only surgeon locally trained to perform the Tenex Health procedure, treated Wilson in December. He states, “After an initial examination, she proved to be the perfect candidate for this procedure. The pain associated with her tennis elbow was affecting her everyday life and physical therapy had been ineffective.” Based on technology developed in collaboration with the Mayo clinic, the Fast procedure is performed using local anesthetic to numb the area; patients are awake and alert. During the procedure, ultrasound imaging is used to identify the location of the scar tissue. Once located, a small instrument-the size of a toothpick-is inserted into the damaged tendon. The instrument delivers ultrasonic energy specifically designed to cut, break up, and remove damaged tissue safely and quickly, without disturbing the surrounding healthy tendon tissue.

According to Dr. McConnell, this procedure is a good alternative for tennis players that are considering surgery for tennis elbow relief. He states, “Unlike conventional treatment methods, the Tenex Health TX replicates the goal of an open surgical procedure by removing the damaged tissue with minimal invasion. The procedure usually takes 15 minutes or less and requires only an adhesive bandage to close the micro incision.” Unlike traditional open surgeries that may require several months of recovery, the Tenex Health TX recovery period is on average a 1 to 2 month timeframe. Following the short recovery a full return to the patient’s normal activities is expected.

A study done in April 2013 by the American Journal of Sports Medicine found the Tenex (FAST) procedure to be “safe, specific, minimally invasive and well tolerated treatment for recalcitrant lateral elbow tendinopathy.” All but one patient showed evidence of efficacy that was sustained at least one year. Wilson is not surprised by the studies’ outcome. By March, she was back on the court hitting tennis balls. While she is three months out from the procedure, assessment of patients for Tenex Health continues six months beyond the date of surgery. Wilson recommends Tenex Health TX (FAST) to any tennis player playing through the pain. She states, “The hardest thing is to put the racket down. I thought I could play through the pain. I now play pain free, it is like a new beginning.”

Dr. McConnell is an orthopedic surgeon that focuses on prevention and performance. He works with several local athletes as well as those on the national level. His office is located on Daniel Island. To learn more about this minimally invasive procedure for tennis elbow relief, go to www.charlestonsportsmed.com.

Healthy Aging: Preserve Your Bones and Joints

thumbnailMarried with children, single, seniors and everyone in between struggle to fit exercise into their morning routine. “Busy” is a well worn word among Americans.

Time constraints are not alone in the challenges to stay healthy as we age. Maintaining the ability to be mobile is critical to remaining vital as we age. This means avoiding injury and preserving bone and join health.

Aging itself conspires to chip away at your bone and joint health. “Bone and joint health are intrinsically linked to healthy aging,” explains Dr. Bright McConnell of Charleston Sports Medicine. “We are excited to bring orthobiologics, stem cell therapies, bioidentical hormone replacement and countless other advanced treatments for patients with bone and joint injuries to the forefront. But the key to avoiding injury altogether or recovering from injury lies in the development of bone and joint strength. 

Strong, healthy bones and joints translate to strong healthy men and women – regardless of age.”

Here are some recommendations for how to achieve bone and joint health.

1. Start Early

skelatonBone and joint health begin in childhood. Today, approximately 32% of American children and adolescents, ages 2 to 19, are considered overweight or obese.

Excess weight can cause vitamin deficiencies, hormonal imbalances, and increased stress and tension that can affect bone growth and overall musculoskeletal health, causing deformity, pain, and potentially, a lifetime of limited mobility and diminished life quality.

Physical activity is important for loading the bones and helping them strengthen. A healthy diet, along with regular physical activity in childhood—at least 35 to 60 minutes a day—can help ensure a healthy weight and strong bones for life.

The adolescent growth spurt brings a marked rise in fractures. If fractures occur with mild injuries, that can be a sign children have skeletal defects tied to low bone mass. This carries over into adulthood.

2. Drink Well: Calcium, Caffeine and Alcohol

A diet inclusive of calcium is critical. Limit caffeinated beverages – soda and coffee – particularly if your calcium intake is low. Drink water instead. Alcohol consumption can affect bone health. Drink in moderation.

If you aren’t drinking the recommended calcium intake for your age group, add calcium-rich foods to your diet or use a calcium supplement.

3. Exercise: Find The Time & Mix It Up

The dramatic increase in the number of children, adolescents and adults diagnosed as overweight or obese in the United States has reached epidemic status. Calcium, vitamin D, diet and exercise are the cornerstones of bone health. Staying at a healthy weight reduces negative impact on bones and joints.

Moderation and variety of exercise reduces the possibility of wear and tear related to repeating the same motion. So mix it up. Run one day and do weight bearing activities the next.

Make the time. Staying active isn’t always easy to fit into today’s busy schedule. Try to schedule your exercise time and spend more time on your feet. Take the stairs, stand up while working, walk while on the phone. We agree with Nike. Just do it.

4. Don’t Smoke. Just Don’t Do It.

Smoking reduces bone mass. Several research studies have identified smoking as a risk factor for osteoporosis and bone fracture. So don’t smoke. Period.

5. Boost Your Vitamin D.

Vitamin D plays an important role in protecting your bones and your body requires it to absorb calcium. Children need vitamin D to build strong bones, and adults need it to keep their bones strong and healthy. If you don’t get enough vitamin D, you may lose bone, have lower bone density, and you’re more likely to break bones as you age.

Schedule an appointment for a blood panel to test your Vitamin D. Take a high potency supplement and/or a nice walk in the sun if you test low. Enjoy the added benefit of a mood boost. Now everybody’s happy.

Treatments using patient-derived platelets and stem cells are an emerging tool for healing injuries

Everybody knows a kid who likes to roughhouse — he or she plays full-speed with seemingly no regard for life and limb.

Jay Noce is one of those kids, all grown up.

The 51-year-old Daniel Island resident and former collegiate tennis player is a black belt in karate, does intense CrossFit workouts, and plays tennis, basketball and golf. Being physically active is in his DNA but his sports, while keeping him physically fit and trim, have taken their toll on his knees.

Mining blood and fat

Five years ago, he took a karate kick on the outside of his right knee that hobbled him and later sought out injections of platelet rich plasma (aka PRP) and adipose-derived stem cells, taken from his own blood and fat, to help it heal.

Last fall, Noce was near the end of a tennis match when he felt the proverbial “pop” in the right knee, which ended up being a stable meniscus tear.

He went back to the same orthopedic physician, Charleston Sports Medicine’s Dr. Bright McConnell, who offered him another orthobiologic treatment as an alternative to surgery, which would have involved a painful recovery and weeks on crunches. Not ideal for a man who also travels internationally as part of his digital business.

Healing stem cells

McConnell used an amniotic allograft, which is derived from the amniotic fluid from the placentas of screened mothers who have elected to have Caesarian sections.

“It’s like PRP on steroids,” says McConnell, of the allograft that is rich in stem cells and growth factors.

Noce says improvements were slow but steady.

“I’m at least 60 percent better,” says Noce, who is back to playing golf, doing karate with a strap on his knee, playing basketball with his kids and hitting tennis balls but not competing.

He was back in for another allograft injection last week with the hopes that will complete the healing process.

Biologics boom

McConnell says Noce’s slowly improving condition is fairly common for orthobiologic procedure.

“With biologics, it’s not instantaneous. It’s like planting a seed. You gotta wait for the flower to grow,” says McConnell. “People who get biologic treatments start to feel a difference in six to eight weeks. Three months out, 50 percent say it’s either a ton better or ‘it’s better but …’ Six months out, you’ll know if it worked.”

While biologics have been used to speed healing in brain and vascular surgeries for decades, their use in musculoskeletal applications have been more recent, within the last five years.

Orthobiologics are gaining attention, probably quicker than most new treatments, because of their fairly common use in high-profile professional athletes. Yet long-term outcomes are obviously not known.

In the years that McConnell has been using orthobiologics, starting with PRP, he has seen a range of patients from baby boomer athletes to seniors seeking to avoid a joint replacement.

What’s old is new?

According to a study “Orthobiologics in Foot and Ankle Surgery,” in 2013, the term orthobiologic is actually a marketing term that comes from the industry that creates devices, such as the centrifuges that separate platelets and stem cells from blood, bone marrow and fat tissues.

The term implies that the addition of one of these bioengineered products or extrinsic forces can positively influence the healing of ligaments and tendons.

Dr. Joe Calandra, a trained orthopedist and team physician for the South Carolina Stingrays and Charleston Southern University sports teams, says the first reported use of what is now called an orthobiologic was a bone graft in the mid-1600’s and that other autologous (tissue taken from the patient and put back in him or her) grafting continued.

“In the early 1900’s, autologous bone grafting started to take hold as an adjunct to help certain fractures heal. In 1965, bone morphogenic protein (often referred to as BMP) was isolated from bone tissue. This protein was shown to have the ability to stimulate bone growth,” says Calandra.

“Since the discovery of BMP many physicians and scientists have been trying to isolate other proteins and biologic substances such as stem cells and platelets, which may stimulate healing in the musculoskeletal system.”

Calandra adds that various substances have been implicated in the improvement of the healing process.

“Some orthobiologics, such as autologous bone grafts have good science behind them and a long track record of use in the clinical setting, others such as PRP and stem cell therapy do not have the consistent science or appropriate clinical trials to support their widespread use at this time.”

Calandra believes the newer biologics as well as those not yet discovered or perfected will be a tremendous adjunct to the care of musculoskeletal injuries and diseases in patients.

But, he adds, caution must be taken and proper unbiased clinical trials undertaken before these should be routinely recommended.

What will it cost me?

Insurance, for the most part, does not cover orthobiologic procedures, even though the treatments could be a less expensive option to surgeries, such as knee replacements.

The cost of Noce’s amniotic allograft procedure, which was done in McConnell’s office, will run between $2,000 and $2,500, largely the cost of the stem cell product.

In McConnell’s case, his staff files the cost of the office visit and other services with insurance by Charleston Sports Medicine but not the cost of the orthobiologics.

McConnell adds that some health savings accounts also be applied to orthobiologics.

View Full Article from Post & Courier

View Full Article from Post & Courier

Men’s Health Day. Friday, June 19 Only

Schedule your Cardiometabolic Performance Test (VO2Max) screening for 20% off.

Five Ways Men Can Get Fit Now for Men’s Health Week

In honor of Men’s Health Week, June 15 to June 21, FitMed Partners and Charleston Sports Medicine have teamed up to provide you seven critical ways to get fit now. Count the ways you can feel better fast.

1. Save on Your Vo2Max Test
First, schedule your Cardiometabolic Performance Test (VO2Max) screening for 20% off on Men’s Health Day. Appointments are available from 8 am to 5 pm, Friday June 19 at Charleston Sports Medicine’s Daniel Island location with exercise physiologist, Anne Moore. “A Cardiometabolic Performance Test performed on a treadmill or cycle measures key data including peak VO2, anaerobic threshold and the precise number of calories burned at all exercise heart rate zones.This is a great first step to designing a results oriented fitness plan unique to your body,” says Dr. Bright McConnell.

2. Combat Low T with Testosterone Therapy
Men have an unfair advantage over women in the weight loss, fitness category. The simple truth is that men are larger and have more muscle than women due to the hormone testosterone. They are genetically designed to have a higher percentage of muscle and less fat — which works in favor of keeping them fit and allowing them to eat more calories. However, if testosterone levels are low, men can lose this edge and gain abdominal weight, begin to feel sluggish and experience overall muscle loss. Keep your edge and have a comprehensive blood panel to determine if you have low testosterone. http://www.fitmedpartners.com/hormone-replacement-therapy/bioidentical-hormone-therapy-for-men/

3. Think Greek or Go Caveman
The Mediterranean diet, which is rich in vegetables, healthy fats, whole grains, and fish, is associated with physical health and mental acuity in your old age. Or, go back to the caveman days with the Paelo diet. Dr. McConnell likes a PaeloMed hybrid diet for maintaining your health. Not sure what to eat, use the gylcemic index tool http://www.fitmedpartners.com/glycemic-index-reference-guide/

4. Do Not Ignore Erectile Dysfunction (ED)
Problems with performance in an intimate setting are a difficult topic for men to address. Do not ignore ED. Make an appointment with your doctor to address. Read this article http://www.huffingtonpost.com/2015/04/09/erectile-dysfunction-_n_6882636.html

5. Strength Train
Even a little weight training can go a long way. Whether you’re 100 lbs overweight or just need to lose the last 15, strength training is one of the most effective ways to burn fat and build muscle.Lifting has been shown to halt and even reverse sarcopenia – the reduction of skeletal muscle that occurs as we get older – which helps us stay independent (and out of a nursing home) and live longer. It prevents disease and degenerative conditions such as heart disease and the management of cholesterol, high blood pressure, obesity, diabetes, and mood.

My elbow hurts!

Two of the most common injuries around the elbow that sports medicine physicians evaluate and treat are related to overuse and stress to the muscle and tendons that are involved in gripping type activities.

Lateral epicondylitis, known as “tennis elbow”, results from overuse of the muscles and tendons that are used to extend your wrist and fingers. The pain is typically located on the outside, or lateral aspect, of the elbow and involves primarily a muscle-tendon unit called the extensor carpi radialis brevis (ECRB). This tendon is used to help stabilize the wrist when the elbow is extended, which occurs during a tennis ground stroke.

Medial epicondylitis, known as “golfer’s elbow” results from overuse of the muscles and tendons that are used to flex the wrist and turned the forearm. Pain and discomfort is typically located on the inside, or medial aspect, of the elbow and involves the tendon known as the common flexor tendon. Forces are increased on the flexor tendon while gripping a golf club during a golf swing.

Both conditions can be caused by other repetitious activities such as throwing and activities requiring repetitious grip, such as shoveling, hammering nails, and gardening activities. Typical symptoms include pain on grip, or weakness in grip strength.

The early phase of these conditions is an acute inflammation of the tendon called tendinitis. However, if the overuse syndrome has existed for several months or longer, the tissue can continue to degenerate and form a condition known as tendinosis. This is not a true inflammatory condition, but represents chronic degenerative changes in the collagen fibers of the tendon, which results in scar tissue, leaving the injured area in a weak and and painful condition.

Diagnosis is typically based upon physical examination. Occasionally, x-rays may show some irregularity or calcium deposits within the tendon. Occasionally, further diagnostic imaging such as MRI or ultrasound is utilized, which confirms the pathology. The use of office musculoskeletal ultrasound now allows for a much quicker diagnosis and earlier intervention.

Treatment for this condition is typically nonsurgical, and involves a rehabilitation program which may include rest and stretching exercises, non-provocative exercise and occasionally use of bands or straps that may take the pressure off the tendon for a period of time. It is imperative to identify and correct any biomechanical abnormality in the swing or stroke mechanics, which led to the problem initially.

Although it is not uncommon for physicians to utilize cortisone type injections to reduce the inflammation, recent evidence in the sports medicine literature suggests this should not be carried out more than once or twice, as this may further damage the collagen in the tendon.

Traditional surgical treatment requires an incision over the affected tendon area, with removal of the damaged tissue and repair back to the bone after removing any underlying bone spurs.

Over the past several years, new and innovative technologies have been made available which are much less invasive. There has been a significant increase in the utilization of growth factors, such as platelet rich plasma, as well as use of certain types of stem cell therapies, to allow a more aggressive, regenerative healing response. These type of treatment options are referred to as orthobiologics.

Recently, a minimally invasive procedure developed at the Mayo Clinic called percutaneous tenotomy, or the Tenex procedure (www.TenexHealth.com), allows a physician to repair the degenerative collagen using a high energy device on the tip of a very small probe. This can be performed under a simple local anesthetic injection and is performed under ultrasound guidance. It requires no incisions or sutures and typically allows for a quicker recovery and return to activity.

Typically, prevention is the best cure! Spring has arrived, and outdoor activities will increase. Early recognition of symptoms, with early rehabilitation efforts and utilization of a good swing coach to correct poor mechanics will typically prevent this from developing into a more chronic problem.

Treatments using patient-derived platelets and stem cells are an emerging tool for healing injuries

Everybody knows a kid who likes to roughhouse — he or she plays full-speed with seemingly no regard for life and limb.

Jay Noce is one of those kids, all grown up.

The 51-year-old Daniel Island resident and former collegiate tennis player is a black belt in karate, does intense CrossFit workouts, and plays tennis, basketball and golf. Being physically active is in his DNA but his sports, while keeping him physically fit and trim, have taken their toll on his knees.

Read full article

Concussion Risk Reducer- Athletes Should Consider Pre-Season Cognitive Testing

March is Brain Injury Awareness Month

Spring sports practices like baseball, soccer and lacrosse have begun. One local physician advises athletes to stop by the examining room before hitting the field. March is Brain Injury Awareness Month, and according to the CDC, as many as 3.8 million sports and recreation related concussions are estimated to occur in the United States every year. Brain Injury symptoms range from confusion, headache and blurred vision to vomiting and loss of consciousness.

The problem with brain injuries, like concussions, is that they are difficult to diagnose. Because of this, Dr. Bright McConnell of Charleston Sports Medicine advises athletes to be proactive and have a pre season baseline test before the games begin. He states, “Go into the season prepared. This will help in the long run.” Charleston Sports Medicine provides baseline testing with the CNS Vital Signs Program. Athletes are given neurocognitive index testing and while the physician gains insight into an athlete’s brain health status. Through the testing, information on key cognitive measures, such as memory, reaction time, and executive function are examined. If an injury occurs, this information will be beneficial with evaluation and help physicians determine an athlete’s readiness to return to play.

CNS testing take only thirty minutes and is covered by insurance. Charleston Sports Medicine offers this test alone or as part of an age management profile.
For more information, log onto www.charlestonsportsmed.com.

Take the Pain out of the Game

Recently, the world’s best tennis players took over Daniel Island at the Family Circle Cup. In the crowd, many recreational players watched in awe looking for tips to improve their game. For some, playing without pain would be a start because of the well-known injury “tennis elbow.”

Tennis elbow is a common condition caused by the overuse of the arm, forearm and hand muscles. Dr. Bright McConnell, an orthopedic surgeon with Charleston Sports Medicine has been treating tennis elbow for years. He states, “Tennis elbow is caused by the overuse of muscles and tendons around the forearm. Close to fifty percent of tennis players will experience tennis elbow at some point in their playing years. They are constantly hitting the tennis ball with their racket with force. This can cause a nagging pain outside of the elbow that increases over time.”

Carol Wilson is a 4.0 league player that has played tennis for twenty years. Ten of those years she has played through the on and off pain of tennis elbow. She states, “I played with tennis elbow for years. I wore the sleeves, the tape, anything I thought would help. I did not want to give up the game.” Finally the pain associated with tennis elbow forced Wilson to put the racket down. “It was achy, towards the end it was sort of a constant pain that I felt beyond the tennis court. I couldn’t pick up my purse, use my computer mouse because my elbow ached all the time,” she explains.

There are several treatment options for players with tennis elbow. States Dr. McConnell, “First a player generally tries to play through the pain. Then they may try the gels, the cortisone shots and even physical therapy.” Physical therapy is an effective treatment for some with mild tennis elbow. Wilson tried physical therapy, but her pain remained.

Now there is a new procedure that those suffering from tennis elbow. It is called the Tenex Health (previously know as the FAST) procedure. Dr. McConnell states, “The Tenex Health TX procedure, or fasciotomy and surgical tenomoty, is a minimally invasive procedure that requires no incisions and minimal downtime post procedure. This procedure has proven to be quite effective for those suffering from tennis elbow.”

Dr. McConnell, the only surgeon locally trained to perform the Tenex Health procedure, treated Wilson in December. He states, “After an initial examination, she proved to be the perfect candidate for this procedure. The pain associated with her tennis elbow was affecting her everyday life and physical therapy had been ineffective.” Based on technology developed in collaboration with the Mayo clinic, the Fast procedure is performed using local anesthetic to numb the area; patients are awake and alert. During the procedure, ultrasound imaging is used to identify the location of the scar tissue. Once located, a small instrument-the size of a toothpick-is inserted into the damaged tendon. The instrument delivers ultrasonic energy specifically designed to cut, break up, and remove damaged tissue safely and quickly, without disturbing the surrounding healthy tendon tissue.

According to Dr. McConnell, this procedure is a good alternative for tennis players that are considering surgery for tennis elbow relief. He states, “Unlike conventional treatment methods, the Tenex Health TX replicates the goal of an open surgical procedure by removing the damaged tissue with minimal invasion. The procedure usually takes 15 minutes or less and requires only an adhesive bandage to close the micro incision.” Unlike traditional open surgeries that may require several months of recovery, the Tenex Health TX recovery period is on average a 1 to 2 month timeframe. Following the short recovery a full return to the patient’s normal activities is expected.

A study done in April 2013 by the American Journal of Sports Medicine found the Tenex (FAST) procedure to be “safe, specific, minimally invasive and well tolerated treatment for recalcitrant lateral elbow tendinopathy.” All but one patient showed evidence of efficacy that was sustained at least one year. Wilson is not surprised by the studies’ outcome. By March, she was back on the court hitting tennis balls. While she is three months out from the procedure, assessment of patients for Tenex Health continues six months beyond the date of surgery. Wilson recommends Tenex Health TX (FAST) to any tennis player playing through the pain. She states, “The hardest thing is to put the racket down. I thought I could play through the pain. I now play pain free, it is like a new beginning.”

Dr. McConnell is an orthopedic surgeon that focuses on prevention and performance. He works with several local athletes as well as those on the national level. His office is located on Daniel Island. To learn more about this minimally invasive procedure for tennis elbow relief, go to www.charlestonsportsmed.com.

Dr. McConnell talks to patient, Deanna, about her TekScan evaluation for foot pain

Dr. McConnell Only Orthopaedic Surgeon to Perform New Minimally Invasive Procedures for Tendonitis

Is the source of your pain in the tendon or ligament? If medication and physical therapy have proved unsuccessful in relieving discomfort and pain related to tendon or ligament injuries, there are some recent advanced treatments worth exploring. Even better, these revolutionary treatments do not require open surgery.

Determining the actual source of your pain can be the first step to knowing if there is a minimally invasive treatment for which you are a candidate. Here are two very new options for patients with tendon and ligament damage.

Tenex Health TXTM
Focused Aspiration of Scar Tissue (FAST™) procedure or newly named, Tenex Health TXTM is a new outpatient procedure specifically designed for those who are suffering from pain associated to tendon damage. Tendon damage often occurs in patients due to repetitive stress and overuse of one area of the body.

Tendon pain takes many forms:
• Plantar fasciitis
• Achilles tendonitis
• Jumper’s / Runner’s knee
• Tennis / Golfer’s elbow

The revolutionary Tenex Health TXTM procedure is an advanced treatment that quickly and safely removes the source of tendon pain stemming from tendon and soft tissue injuries such as tennis elbow, golfer’s elbow, jumper’s knee, Achilles tendonitis and plantar fasciitis. The procedure is based on advanced technology developed in collaboration with the Mayo Clinic and is performed using a local anesthetic, allowing patients to remain awake and alert the entire time.

Using ultrasound imaging, the scar tissue is identified and a small instrument about the size of a toothpick is inserted into the damaged tendon. Ultrasonic energy then cuts, breaks up and removes the damaged tissue, without disturbing the surrounding healthy tendon tissue. The procedure typically takes about 15 minutes or less, requires only an adhesive bandage to close the microincision, and offers quick recovery time for patients.

This procedure is not invasive open surgery and can be performed in an office or procedure room.

Platelet Rich Plasma (PRP) Therapy:
PRP is blood plasma with concentrated platelets. These platelets include bioactive proteins that initiate connective tissue healing such as bone, tendon and ligament regeneration and repair.

PRP can be injected in tendons and ligaments all over the body, which can help with sports injuries and more specific injuries including tennis elbow, carpal tunnel syndrome, shin splints and many other damaged ligaments and tendons. Patients see significant improvement immediately, which may eliminate the need for aggressive treatments such as long-term medication or surgery.

Bright McConnell, III, MD 900 Island Park Drive, Suite #105
Charleston, SC 29492 Phone: (843) 284-5200

Dr. McConnell and Anne Ahern Moore on Lowcountry Live!

Dr. McConnell and Exercise Physiologist, Anne Ahern Moore discusses tests to customize your best fitness and nutrition plan for great results.

The Charleston Sports Medicine Team strives to become your partner in your total health. Our affiliated practice, FitMed Partners, also offers scientifically proven preventive age management, bio-identical hormone therapy and medically based fitness and nutrition programs. The FitMed Elite Athlete Program provides a menu of advanced sports performance testing, not typically covered under insurance, for affordable prices.

Healthy Aging: Preserve Your Bones and Joints

thumbnailMarried with children, single, seniors and everyone in between struggle to fit exercise into their morning routine. “Busy” is a well worn word among Americans.

Time constraints are not alone in the challenges to stay healthy as we age. Maintaining the ability to be mobile is critical to remaining vital as we age. This means avoiding injury and preserving bone and join health.

Aging itself conspires to chip away at your bone and joint health. “Bone and joint health are intrinsically linked to healthy aging,” explains Dr. Bright McConnell of Charleston Sports Medicine. “We are excited to bring orthobiologics, stem cell therapies, bioidentical hormone replacement and countless other advanced treatments for patients with bone and joint injuries to the forefront. But the key to avoiding injury altogether or recovering from injury lies in the development of bone and joint strength. 

Strong, healthy bones and joints translate to strong healthy men and women – regardless of age.”

Here are some recommendations for how to achieve bone and joint health.

1. Start Early

skelatonBone and joint health begin in childhood. Today, approximately 32% of American children and adolescents, ages 2 to 19, are considered overweight or obese.

Excess weight can cause vitamin deficiencies, hormonal imbalances, and increased stress and tension that can affect bone growth and overall musculoskeletal health, causing deformity, pain, and potentially, a lifetime of limited mobility and diminished life quality.

Physical activity is important for loading the bones and helping them strengthen. A healthy diet, along with regular physical activity in childhood—at least 35 to 60 minutes a day—can help ensure a healthy weight and strong bones for life.

The adolescent growth spurt brings a marked rise in fractures. If fractures occur with mild injuries, that can be a sign children have skeletal defects tied to low bone mass. This carries over into adulthood.

2. Drink Well: Calcium, Caffeine and Alcohol

A diet inclusive of calcium is critical. Limit caffeinated beverages – soda and coffee – particularly if your calcium intake is low. Drink water instead. Alcohol consumption can affect bone health. Drink in moderation.

If you aren’t drinking the recommended calcium intake for your age group, add calcium-rich foods to your diet or use a calcium supplement.

3. Exercise: Find The Time & Mix It Up

The dramatic increase in the number of children, adolescents and adults diagnosed as overweight or obese in the United States has reached epidemic status. Calcium, vitamin D, diet and exercise are the cornerstones of bone health. Staying at a healthy weight reduces negative impact on bones and joints.

Moderation and variety of exercise reduces the possibility of wear and tear related to repeating the same motion. So mix it up. Run one day and do weight bearing activities the next.

Make the time. Staying active isn’t always easy to fit into today’s busy schedule. Try to schedule your exercise time and spend more time on your feet. Take the stairs, stand up while working, walk while on the phone. We agree with Nike. Just do it.

4. Don’t Smoke. Just Don’t Do It.

Smoking reduces bone mass. Several research studies have identified smoking as a risk factor for osteoporosis and bone fracture. So don’t smoke. Period.

5. Boost Your Vitamin D.

Vitamin D plays an important role in protecting your bones and your body requires it to absorb calcium. Children need vitamin D to build strong bones, and adults need it to keep their bones strong and healthy. If you don’t get enough vitamin D, you may lose bone, have lower bone density, and you’re more likely to break bones as you age.

Schedule an appointment for a blood panel to test your Vitamin D. Take a high potency supplement and/or a nice walk in the sun if you test low. Enjoy the added benefit of a mood boost. Now everybody’s happy.

Treatments using patient-derived platelets and stem cells are an emerging tool for healing injuries

Everybody knows a kid who likes to roughhouse — he or she plays full-speed with seemingly no regard for life and limb.

Jay Noce is one of those kids, all grown up.

The 51-year-old Daniel Island resident and former collegiate tennis player is a black belt in karate, does intense CrossFit workouts, and plays tennis, basketball and golf. Being physically active is in his DNA but his sports, while keeping him physically fit and trim, have taken their toll on his knees.

Mining blood and fat

Five years ago, he took a karate kick on the outside of his right knee that hobbled him and later sought out injections of platelet rich plasma (aka PRP) and adipose-derived stem cells, taken from his own blood and fat, to help it heal.

Last fall, Noce was near the end of a tennis match when he felt the proverbial “pop” in the right knee, which ended up being a stable meniscus tear.

He went back to the same orthopedic physician, Charleston Sports Medicine’s Dr. Bright McConnell, who offered him another orthobiologic treatment as an alternative to surgery, which would have involved a painful recovery and weeks on crunches. Not ideal for a man who also travels internationally as part of his digital business.

Healing stem cells

McConnell used an amniotic allograft, which is derived from the amniotic fluid from the placentas of screened mothers who have elected to have Caesarian sections.

“It’s like PRP on steroids,” says McConnell, of the allograft that is rich in stem cells and growth factors.

Noce says improvements were slow but steady.

“I’m at least 60 percent better,” says Noce, who is back to playing golf, doing karate with a strap on his knee, playing basketball with his kids and hitting tennis balls but not competing.

He was back in for another allograft injection last week with the hopes that will complete the healing process.

Biologics boom

McConnell says Noce’s slowly improving condition is fairly common for orthobiologic procedure.

“With biologics, it’s not instantaneous. It’s like planting a seed. You gotta wait for the flower to grow,” says McConnell. “People who get biologic treatments start to feel a difference in six to eight weeks. Three months out, 50 percent say it’s either a ton better or ‘it’s better but …’ Six months out, you’ll know if it worked.”

While biologics have been used to speed healing in brain and vascular surgeries for decades, their use in musculoskeletal applications have been more recent, within the last five years.

Orthobiologics are gaining attention, probably quicker than most new treatments, because of their fairly common use in high-profile professional athletes. Yet long-term outcomes are obviously not known.

In the years that McConnell has been using orthobiologics, starting with PRP, he has seen a range of patients from baby boomer athletes to seniors seeking to avoid a joint replacement.

What’s old is new?

According to a study “Orthobiologics in Foot and Ankle Surgery,” in 2013, the term orthobiologic is actually a marketing term that comes from the industry that creates devices, such as the centrifuges that separate platelets and stem cells from blood, bone marrow and fat tissues.

The term implies that the addition of one of these bioengineered products or extrinsic forces can positively influence the healing of ligaments and tendons.

Dr. Joe Calandra, a trained orthopedist and team physician for the South Carolina Stingrays and Charleston Southern University sports teams, says the first reported use of what is now called an orthobiologic was a bone graft in the mid-1600’s and that other autologous (tissue taken from the patient and put back in him or her) grafting continued.

“In the early 1900’s, autologous bone grafting started to take hold as an adjunct to help certain fractures heal. In 1965, bone morphogenic protein (often referred to as BMP) was isolated from bone tissue. This protein was shown to have the ability to stimulate bone growth,” says Calandra.

“Since the discovery of BMP many physicians and scientists have been trying to isolate other proteins and biologic substances such as stem cells and platelets, which may stimulate healing in the musculoskeletal system.”

Calandra adds that various substances have been implicated in the improvement of the healing process.

“Some orthobiologics, such as autologous bone grafts have good science behind them and a long track record of use in the clinical setting, others such as PRP and stem cell therapy do not have the consistent science or appropriate clinical trials to support their widespread use at this time.”

Calandra believes the newer biologics as well as those not yet discovered or perfected will be a tremendous adjunct to the care of musculoskeletal injuries and diseases in patients.

But, he adds, caution must be taken and proper unbiased clinical trials undertaken before these should be routinely recommended.

What will it cost me?

Insurance, for the most part, does not cover orthobiologic procedures, even though the treatments could be a less expensive option to surgeries, such as knee replacements.

The cost of Noce’s amniotic allograft procedure, which was done in McConnell’s office, will run between $2,000 and $2,500, largely the cost of the stem cell product.

In McConnell’s case, his staff files the cost of the office visit and other services with insurance by Charleston Sports Medicine but not the cost of the orthobiologics.

McConnell adds that some health savings accounts also be applied to orthobiologics.

View Full Article from Post & Courier

View Full Article from Post & Courier

Men’s Health Day. Friday, June 19 Only

Schedule your Cardiometabolic Performance Test (VO2Max) screening for 20% off.

Five Ways Men Can Get Fit Now for Men’s Health Week

In honor of Men’s Health Week, June 15 to June 21, FitMed Partners and Charleston Sports Medicine have teamed up to provide you seven critical ways to get fit now. Count the ways you can feel better fast.

1. Save on Your Vo2Max Test
First, schedule your Cardiometabolic Performance Test (VO2Max) screening for 20% off on Men’s Health Day. Appointments are available from 8 am to 5 pm, Friday June 19 at Charleston Sports Medicine’s Daniel Island location with exercise physiologist, Anne Moore. “A Cardiometabolic Performance Test performed on a treadmill or cycle measures key data including peak VO2, anaerobic threshold and the precise number of calories burned at all exercise heart rate zones.This is a great first step to designing a results oriented fitness plan unique to your body,” says Dr. Bright McConnell.

2. Combat Low T with Testosterone Therapy
Men have an unfair advantage over women in the weight loss, fitness category. The simple truth is that men are larger and have more muscle than women due to the hormone testosterone. They are genetically designed to have a higher percentage of muscle and less fat — which works in favor of keeping them fit and allowing them to eat more calories. However, if testosterone levels are low, men can lose this edge and gain abdominal weight, begin to feel sluggish and experience overall muscle loss. Keep your edge and have a comprehensive blood panel to determine if you have low testosterone. http://www.fitmedpartners.com/hormone-replacement-therapy/bioidentical-hormone-therapy-for-men/

3. Think Greek or Go Caveman
The Mediterranean diet, which is rich in vegetables, healthy fats, whole grains, and fish, is associated with physical health and mental acuity in your old age. Or, go back to the caveman days with the Paelo diet. Dr. McConnell likes a PaeloMed hybrid diet for maintaining your health. Not sure what to eat, use the gylcemic index tool http://www.fitmedpartners.com/glycemic-index-reference-guide/

4. Do Not Ignore Erectile Dysfunction (ED)
Problems with performance in an intimate setting are a difficult topic for men to address. Do not ignore ED. Make an appointment with your doctor to address. Read this article http://www.huffingtonpost.com/2015/04/09/erectile-dysfunction-_n_6882636.html

5. Strength Train
Even a little weight training can go a long way. Whether you’re 100 lbs overweight or just need to lose the last 15, strength training is one of the most effective ways to burn fat and build muscle.Lifting has been shown to halt and even reverse sarcopenia – the reduction of skeletal muscle that occurs as we get older – which helps us stay independent (and out of a nursing home) and live longer. It prevents disease and degenerative conditions such as heart disease and the management of cholesterol, high blood pressure, obesity, diabetes, and mood.

My elbow hurts!

Two of the most common injuries around the elbow that sports medicine physicians evaluate and treat are related to overuse and stress to the muscle and tendons that are involved in gripping type activities.

Lateral epicondylitis, known as “tennis elbow”, results from overuse of the muscles and tendons that are used to extend your wrist and fingers. The pain is typically located on the outside, or lateral aspect, of the elbow and involves primarily a muscle-tendon unit called the extensor carpi radialis brevis (ECRB). This tendon is used to help stabilize the wrist when the elbow is extended, which occurs during a tennis ground stroke.

Medial epicondylitis, known as “golfer’s elbow” results from overuse of the muscles and tendons that are used to flex the wrist and turned the forearm. Pain and discomfort is typically located on the inside, or medial aspect, of the elbow and involves the tendon known as the common flexor tendon. Forces are increased on the flexor tendon while gripping a golf club during a golf swing.

Both conditions can be caused by other repetitious activities such as throwing and activities requiring repetitious grip, such as shoveling, hammering nails, and gardening activities. Typical symptoms include pain on grip, or weakness in grip strength.

The early phase of these conditions is an acute inflammation of the tendon called tendinitis. However, if the overuse syndrome has existed for several months or longer, the tissue can continue to degenerate and form a condition known as tendinosis. This is not a true inflammatory condition, but represents chronic degenerative changes in the collagen fibers of the tendon, which results in scar tissue, leaving the injured area in a weak and and painful condition.

Diagnosis is typically based upon physical examination. Occasionally, x-rays may show some irregularity or calcium deposits within the tendon. Occasionally, further diagnostic imaging such as MRI or ultrasound is utilized, which confirms the pathology. The use of office musculoskeletal ultrasound now allows for a much quicker diagnosis and earlier intervention.

Treatment for this condition is typically nonsurgical, and involves a rehabilitation program which may include rest and stretching exercises, non-provocative exercise and occasionally use of bands or straps that may take the pressure off the tendon for a period of time. It is imperative to identify and correct any biomechanical abnormality in the swing or stroke mechanics, which led to the problem initially.

Although it is not uncommon for physicians to utilize cortisone type injections to reduce the inflammation, recent evidence in the sports medicine literature suggests this should not be carried out more than once or twice, as this may further damage the collagen in the tendon.

Traditional surgical treatment requires an incision over the affected tendon area, with removal of the damaged tissue and repair back to the bone after removing any underlying bone spurs.

Over the past several years, new and innovative technologies have been made available which are much less invasive. There has been a significant increase in the utilization of growth factors, such as platelet rich plasma, as well as use of certain types of stem cell therapies, to allow a more aggressive, regenerative healing response. These type of treatment options are referred to as orthobiologics.

Recently, a minimally invasive procedure developed at the Mayo Clinic called percutaneous tenotomy, or the Tenex procedure (www.TenexHealth.com), allows a physician to repair the degenerative collagen using a high energy device on the tip of a very small probe. This can be performed under a simple local anesthetic injection and is performed under ultrasound guidance. It requires no incisions or sutures and typically allows for a quicker recovery and return to activity.

Typically, prevention is the best cure! Spring has arrived, and outdoor activities will increase. Early recognition of symptoms, with early rehabilitation efforts and utilization of a good swing coach to correct poor mechanics will typically prevent this from developing into a more chronic problem.

Treatments using patient-derived platelets and stem cells are an emerging tool for healing injuries

Everybody knows a kid who likes to roughhouse — he or she plays full-speed with seemingly no regard for life and limb.

Jay Noce is one of those kids, all grown up.

The 51-year-old Daniel Island resident and former collegiate tennis player is a black belt in karate, does intense CrossFit workouts, and plays tennis, basketball and golf. Being physically active is in his DNA but his sports, while keeping him physically fit and trim, have taken their toll on his knees.

Read full article

Concussion Risk Reducer- Athletes Should Consider Pre-Season Cognitive Testing

March is Brain Injury Awareness Month

Spring sports practices like baseball, soccer and lacrosse have begun. One local physician advises athletes to stop by the examining room before hitting the field. March is Brain Injury Awareness Month, and according to the CDC, as many as 3.8 million sports and recreation related concussions are estimated to occur in the United States every year. Brain Injury symptoms range from confusion, headache and blurred vision to vomiting and loss of consciousness.

The problem with brain injuries, like concussions, is that they are difficult to diagnose. Because of this, Dr. Bright McConnell of Charleston Sports Medicine advises athletes to be proactive and have a pre season baseline test before the games begin. He states, “Go into the season prepared. This will help in the long run.” Charleston Sports Medicine provides baseline testing with the CNS Vital Signs Program. Athletes are given neurocognitive index testing and while the physician gains insight into an athlete’s brain health status. Through the testing, information on key cognitive measures, such as memory, reaction time, and executive function are examined. If an injury occurs, this information will be beneficial with evaluation and help physicians determine an athlete’s readiness to return to play.

CNS testing take only thirty minutes and is covered by insurance. Charleston Sports Medicine offers this test alone or as part of an age management profile.
For more information, log onto www.charlestonsportsmed.com.

Take the Pain out of the Game

Recently, the world’s best tennis players took over Daniel Island at the Family Circle Cup. In the crowd, many recreational players watched in awe looking for tips to improve their game. For some, playing without pain would be a start because of the well-known injury “tennis elbow.”

Tennis elbow is a common condition caused by the overuse of the arm, forearm and hand muscles. Dr. Bright McConnell, an orthopedic surgeon with Charleston Sports Medicine has been treating tennis elbow for years. He states, “Tennis elbow is caused by the overuse of muscles and tendons around the forearm. Close to fifty percent of tennis players will experience tennis elbow at some point in their playing years. They are constantly hitting the tennis ball with their racket with force. This can cause a nagging pain outside of the elbow that increases over time.”

Carol Wilson is a 4.0 league player that has played tennis for twenty years. Ten of those years she has played through the on and off pain of tennis elbow. She states, “I played with tennis elbow for years. I wore the sleeves, the tape, anything I thought would help. I did not want to give up the game.” Finally the pain associated with tennis elbow forced Wilson to put the racket down. “It was achy, towards the end it was sort of a constant pain that I felt beyond the tennis court. I couldn’t pick up my purse, use my computer mouse because my elbow ached all the time,” she explains.

There are several treatment options for players with tennis elbow. States Dr. McConnell, “First a player generally tries to play through the pain. Then they may try the gels, the cortisone shots and even physical therapy.” Physical therapy is an effective treatment for some with mild tennis elbow. Wilson tried physical therapy, but her pain remained.

Now there is a new procedure that those suffering from tennis elbow. It is called the Tenex Health (previously know as the FAST) procedure. Dr. McConnell states, “The Tenex Health TX procedure, or fasciotomy and surgical tenomoty, is a minimally invasive procedure that requires no incisions and minimal downtime post procedure. This procedure has proven to be quite effective for those suffering from tennis elbow.”

Dr. McConnell, the only surgeon locally trained to perform the Tenex Health procedure, treated Wilson in December. He states, “After an initial examination, she proved to be the perfect candidate for this procedure. The pain associated with her tennis elbow was affecting her everyday life and physical therapy had been ineffective.” Based on technology developed in collaboration with the Mayo clinic, the Fast procedure is performed using local anesthetic to numb the area; patients are awake and alert. During the procedure, ultrasound imaging is used to identify the location of the scar tissue. Once located, a small instrument-the size of a toothpick-is inserted into the damaged tendon. The instrument delivers ultrasonic energy specifically designed to cut, break up, and remove damaged tissue safely and quickly, without disturbing the surrounding healthy tendon tissue.

According to Dr. McConnell, this procedure is a good alternative for tennis players that are considering surgery for tennis elbow relief. He states, “Unlike conventional treatment methods, the Tenex Health TX replicates the goal of an open surgical procedure by removing the damaged tissue with minimal invasion. The procedure usually takes 15 minutes or less and requires only an adhesive bandage to close the micro incision.” Unlike traditional open surgeries that may require several months of recovery, the Tenex Health TX recovery period is on average a 1 to 2 month timeframe. Following the short recovery a full return to the patient’s normal activities is expected.

A study done in April 2013 by the American Journal of Sports Medicine found the Tenex (FAST) procedure to be “safe, specific, minimally invasive and well tolerated treatment for recalcitrant lateral elbow tendinopathy.” All but one patient showed evidence of efficacy that was sustained at least one year. Wilson is not surprised by the studies’ outcome. By March, she was back on the court hitting tennis balls. While she is three months out from the procedure, assessment of patients for Tenex Health continues six months beyond the date of surgery. Wilson recommends Tenex Health TX (FAST) to any tennis player playing through the pain. She states, “The hardest thing is to put the racket down. I thought I could play through the pain. I now play pain free, it is like a new beginning.”

Dr. McConnell is an orthopedic surgeon that focuses on prevention and performance. He works with several local athletes as well as those on the national level. His office is located on Daniel Island. To learn more about this minimally invasive procedure for tennis elbow relief, go to www.charlestonsportsmed.com.

Dr. McConnell talks to patient, Deanna, about her TekScan evaluation for foot pain

Dr. McConnell Only Orthopaedic Surgeon to Perform New Minimally Invasive Procedures for Tendonitis

Is the source of your pain in the tendon or ligament? If medication and physical therapy have proved unsuccessful in relieving discomfort and pain related to tendon or ligament injuries, there are some recent advanced treatments worth exploring. Even better, these revolutionary treatments do not require open surgery.

Determining the actual source of your pain can be the first step to knowing if there is a minimally invasive treatment for which you are a candidate. Here are two very new options for patients with tendon and ligament damage.

Tenex Health TXTM
Focused Aspiration of Scar Tissue (FAST™) procedure or newly named, Tenex Health TXTM is a new outpatient procedure specifically designed for those who are suffering from pain associated to tendon damage. Tendon damage often occurs in patients due to repetitive stress and overuse of one area of the body.

Tendon pain takes many forms:
• Plantar fasciitis
• Achilles tendonitis
• Jumper’s / Runner’s knee
• Tennis / Golfer’s elbow

The revolutionary Tenex Health TXTM procedure is an advanced treatment that quickly and safely removes the source of tendon pain stemming from tendon and soft tissue injuries such as tennis elbow, golfer’s elbow, jumper’s knee, Achilles tendonitis and plantar fasciitis. The procedure is based on advanced technology developed in collaboration with the Mayo Clinic and is performed using a local anesthetic, allowing patients to remain awake and alert the entire time.

Using ultrasound imaging, the scar tissue is identified and a small instrument about the size of a toothpick is inserted into the damaged tendon. Ultrasonic energy then cuts, breaks up and removes the damaged tissue, without disturbing the surrounding healthy tendon tissue. The procedure typically takes about 15 minutes or less, requires only an adhesive bandage to close the microincision, and offers quick recovery time for patients.

This procedure is not invasive open surgery and can be performed in an office or procedure room.

Platelet Rich Plasma (PRP) Therapy:
PRP is blood plasma with concentrated platelets. These platelets include bioactive proteins that initiate connective tissue healing such as bone, tendon and ligament regeneration and repair.

PRP can be injected in tendons and ligaments all over the body, which can help with sports injuries and more specific injuries including tennis elbow, carpal tunnel syndrome, shin splints and many other damaged ligaments and tendons. Patients see significant improvement immediately, which may eliminate the need for aggressive treatments such as long-term medication or surgery.

Bright McConnell, III, MD 900 Island Park Drive, Suite #105
Charleston, SC 29492 Phone: (843) 284-5200

Dr. McConnell and Anne Ahern Moore on Lowcountry Live!

Dr. McConnell and Exercise Physiologist, Anne Ahern Moore discusses tests to customize your best fitness and nutrition plan for great results.

The Charleston Sports Medicine Team strives to become your partner in your total health. Our affiliated practice, FitMed Partners, also offers scientifically proven preventive age management, bio-identical hormone therapy and medically based fitness and nutrition programs. The FitMed Elite Athlete Program provides a menu of advanced sports performance testing, not typically covered under insurance, for affordable prices.

Is the source of your pain in the tendon or ligament? If medication and physical therapy have proved unsuccessful in relieving discomfort and pain related to tendon or ligament injuries, there are some recent advanced treatments worth exploring. Even better, these revolutionary treatments do not require open surgery.

Determining the actual source of your pain can be the first step to knowing if there is a minimally invasive treatment for which you are a candidate. Here are two very new options for patients with tendon and ligament damage.

Tenex Health TXTM
Focused Aspiration of Scar Tissue (FAST™) procedure or newly named, Tenex Health TXTM is a new outpatient procedure specifically designed for those who are suffering from pain associated to tendon damage. Tendon damage often occurs in patients due to repetitive stress and overuse of one area of the body.

Tendon pain takes many forms:
• Plantar fasciitis
• Achilles tendonitis
• Jumper’s / Runner’s knee
• Tennis / Golfer’s elbow

The revolutionary Tenex Health TXTM procedure is an advanced treatment that quickly and safely removes the source of tendon pain stemming from tendon and soft tissue injuries such as tennis elbow, golfer’s elbow, jumper’s knee, Achilles tendonitis and plantar fasciitis. The procedure is based on advanced technology developed in collaboration with the Mayo Clinic and is performed using a local anesthetic, allowing patients to remain awake and alert the entire time.

Using ultrasound imaging, the scar tissue is identified and a small instrument about the size of a toothpick is inserted into the damaged tendon. Ultrasonic energy then cuts, breaks up and removes the damaged tissue, without disturbing the surrounding healthy tendon tissue. The procedure typically takes about 15 minutes or less, requires only an adhesive bandage to close the microincision, and offers quick recovery time for patients.

This procedure is not invasive open surgery and can be performed in an office or procedure room.

Platelet Rich Plasma (PRP) Therapy:
PRP is blood plasma with concentrated platelets. These platelets include bioactive proteins that initiate connective tissue healing such as bone, tendon and ligament regeneration and repair.

PRP can be injected in tendons and ligaments all over the body, which can help with sports injuries and more specific injuries including tennis elbow, carpal tunnel syndrome, shin splints and many other damaged ligaments and tendons. Patients see significant improvement immediately, which may eliminate the need for aggressive treatments such as long-term medication or surgery.

Bright McConnell, III, MD 900 Island Park Drive, Suite #105
Charleston, SC 29492 Phone: (843) 284-5200

Healthy Aging: Preserve Your Bones and Joints

thumbnailMarried with children, single, seniors and everyone in between struggle to fit exercise into their morning routine. “Busy” is a well worn word among Americans.

Time constraints are not alone in the challenges to stay healthy as we age. Maintaining the ability to be mobile is critical to remaining vital as we age. This means avoiding injury and preserving bone and join health.

Aging itself conspires to chip away at your bone and joint health. “Bone and joint health are intrinsically linked to healthy aging,” explains Dr. Bright McConnell of Charleston Sports Medicine. “We are excited to bring orthobiologics, stem cell therapies, bioidentical hormone replacement and countless other advanced treatments for patients with bone and joint injuries to the forefront. But the key to avoiding injury altogether or recovering from injury lies in the development of bone and joint strength. 

Strong, healthy bones and joints translate to strong healthy men and women – regardless of age.”

Here are some recommendations for how to achieve bone and joint health.

1. Start Early

skelatonBone and joint health begin in childhood. Today, approximately 32% of American children and adolescents, ages 2 to 19, are considered overweight or obese.

Excess weight can cause vitamin deficiencies, hormonal imbalances, and increased stress and tension that can affect bone growth and overall musculoskeletal health, causing deformity, pain, and potentially, a lifetime of limited mobility and diminished life quality.

Physical activity is important for loading the bones and helping them strengthen. A healthy diet, along with regular physical activity in childhood—at least 35 to 60 minutes a day—can help ensure a healthy weight and strong bones for life.

The adolescent growth spurt brings a marked rise in fractures. If fractures occur with mild injuries, that can be a sign children have skeletal defects tied to low bone mass. This carries over into adulthood.

2. Drink Well: Calcium, Caffeine and Alcohol

A diet inclusive of calcium is critical. Limit caffeinated beverages – soda and coffee – particularly if your calcium intake is low. Drink water instead. Alcohol consumption can affect bone health. Drink in moderation.

If you aren’t drinking the recommended calcium intake for your age group, add calcium-rich foods to your diet or use a calcium supplement.

3. Exercise: Find The Time & Mix It Up

The dramatic increase in the number of children, adolescents and adults diagnosed as overweight or obese in the United States has reached epidemic status. Calcium, vitamin D, diet and exercise are the cornerstones of bone health. Staying at a healthy weight reduces negative impact on bones and joints.

Moderation and variety of exercise reduces the possibility of wear and tear related to repeating the same motion. So mix it up. Run one day and do weight bearing activities the next.

Make the time. Staying active isn’t always easy to fit into today’s busy schedule. Try to schedule your exercise time and spend more time on your feet. Take the stairs, stand up while working, walk while on the phone. We agree with Nike. Just do it.

4. Don’t Smoke. Just Don’t Do It.

Smoking reduces bone mass. Several research studies have identified smoking as a risk factor for osteoporosis and bone fracture. So don’t smoke. Period.

5. Boost Your Vitamin D.

Vitamin D plays an important role in protecting your bones and your body requires it to absorb calcium. Children need vitamin D to build strong bones, and adults need it to keep their bones strong and healthy. If you don’t get enough vitamin D, you may lose bone, have lower bone density, and you’re more likely to break bones as you age.

Schedule an appointment for a blood panel to test your Vitamin D. Take a high potency supplement and/or a nice walk in the sun if you test low. Enjoy the added benefit of a mood boost. Now everybody’s happy.

Treatments using patient-derived platelets and stem cells are an emerging tool for healing injuries

Everybody knows a kid who likes to roughhouse — he or she plays full-speed with seemingly no regard for life and limb.

Jay Noce is one of those kids, all grown up.

The 51-year-old Daniel Island resident and former collegiate tennis player is a black belt in karate, does intense CrossFit workouts, and plays tennis, basketball and golf. Being physically active is in his DNA but his sports, while keeping him physically fit and trim, have taken their toll on his knees.

Mining blood and fat

Five years ago, he took a karate kick on the outside of his right knee that hobbled him and later sought out injections of platelet rich plasma (aka PRP) and adipose-derived stem cells, taken from his own blood and fat, to help it heal.

Last fall, Noce was near the end of a tennis match when he felt the proverbial “pop” in the right knee, which ended up being a stable meniscus tear.

He went back to the same orthopedic physician, Charleston Sports Medicine’s Dr. Bright McConnell, who offered him another orthobiologic treatment as an alternative to surgery, which would have involved a painful recovery and weeks on crunches. Not ideal for a man who also travels internationally as part of his digital business.

Healing stem cells

McConnell used an amniotic allograft, which is derived from the amniotic fluid from the placentas of screened mothers who have elected to have Caesarian sections.

“It’s like PRP on steroids,” says McConnell, of the allograft that is rich in stem cells and growth factors.

Noce says improvements were slow but steady.

“I’m at least 60 percent better,” says Noce, who is back to playing golf, doing karate with a strap on his knee, playing basketball with his kids and hitting tennis balls but not competing.

He was back in for another allograft injection last week with the hopes that will complete the healing process.

Biologics boom

McConnell says Noce’s slowly improving condition is fairly common for orthobiologic procedure.

“With biologics, it’s not instantaneous. It’s like planting a seed. You gotta wait for the flower to grow,” says McConnell. “People who get biologic treatments start to feel a difference in six to eight weeks. Three months out, 50 percent say it’s either a ton better or ‘it’s better but …’ Six months out, you’ll know if it worked.”

While biologics have been used to speed healing in brain and vascular surgeries for decades, their use in musculoskeletal applications have been more recent, within the last five years.

Orthobiologics are gaining attention, probably quicker than most new treatments, because of their fairly common use in high-profile professional athletes. Yet long-term outcomes are obviously not known.

In the years that McConnell has been using orthobiologics, starting with PRP, he has seen a range of patients from baby boomer athletes to seniors seeking to avoid a joint replacement.

What’s old is new?

According to a study “Orthobiologics in Foot and Ankle Surgery,” in 2013, the term orthobiologic is actually a marketing term that comes from the industry that creates devices, such as the centrifuges that separate platelets and stem cells from blood, bone marrow and fat tissues.

The term implies that the addition of one of these bioengineered products or extrinsic forces can positively influence the healing of ligaments and tendons.

Dr. Joe Calandra, a trained orthopedist and team physician for the South Carolina Stingrays and Charleston Southern University sports teams, says the first reported use of what is now called an orthobiologic was a bone graft in the mid-1600’s and that other autologous (tissue taken from the patient and put back in him or her) grafting continued.

“In the early 1900’s, autologous bone grafting started to take hold as an adjunct to help certain fractures heal. In 1965, bone morphogenic protein (often referred to as BMP) was isolated from bone tissue. This protein was shown to have the ability to stimulate bone growth,” says Calandra.

“Since the discovery of BMP many physicians and scientists have been trying to isolate other proteins and biologic substances such as stem cells and platelets, which may stimulate healing in the musculoskeletal system.”

Calandra adds that various substances have been implicated in the improvement of the healing process.

“Some orthobiologics, such as autologous bone grafts have good science behind them and a long track record of use in the clinical setting, others such as PRP and stem cell therapy do not have the consistent science or appropriate clinical trials to support their widespread use at this time.”

Calandra believes the newer biologics as well as those not yet discovered or perfected will be a tremendous adjunct to the care of musculoskeletal injuries and diseases in patients.

But, he adds, caution must be taken and proper unbiased clinical trials undertaken before these should be routinely recommended.

What will it cost me?

Insurance, for the most part, does not cover orthobiologic procedures, even though the treatments could be a less expensive option to surgeries, such as knee replacements.

The cost of Noce’s amniotic allograft procedure, which was done in McConnell’s office, will run between $2,000 and $2,500, largely the cost of the stem cell product.

In McConnell’s case, his staff files the cost of the office visit and other services with insurance by Charleston Sports Medicine but not the cost of the orthobiologics.

McConnell adds that some health savings accounts also be applied to orthobiologics.

View Full Article from Post & Courier

View Full Article from Post & Courier

Men’s Health Day. Friday, June 19 Only

Schedule your Cardiometabolic Performance Test (VO2Max) screening for 20% off.

Five Ways Men Can Get Fit Now for Men’s Health Week

In honor of Men’s Health Week, June 15 to June 21, FitMed Partners and Charleston Sports Medicine have teamed up to provide you seven critical ways to get fit now. Count the ways you can feel better fast.

1. Save on Your Vo2Max Test
First, schedule your Cardiometabolic Performance Test (VO2Max) screening for 20% off on Men’s Health Day. Appointments are available from 8 am to 5 pm, Friday June 19 at Charleston Sports Medicine’s Daniel Island location with exercise physiologist, Anne Moore. “A Cardiometabolic Performance Test performed on a treadmill or cycle measures key data including peak VO2, anaerobic threshold and the precise number of calories burned at all exercise heart rate zones.This is a great first step to designing a results oriented fitness plan unique to your body,” says Dr. Bright McConnell.

2. Combat Low T with Testosterone Therapy
Men have an unfair advantage over women in the weight loss, fitness category. The simple truth is that men are larger and have more muscle than women due to the hormone testosterone. They are genetically designed to have a higher percentage of muscle and less fat — which works in favor of keeping them fit and allowing them to eat more calories. However, if testosterone levels are low, men can lose this edge and gain abdominal weight, begin to feel sluggish and experience overall muscle loss. Keep your edge and have a comprehensive blood panel to determine if you have low testosterone. http://www.fitmedpartners.com/hormone-replacement-therapy/bioidentical-hormone-therapy-for-men/

3. Think Greek or Go Caveman
The Mediterranean diet, which is rich in vegetables, healthy fats, whole grains, and fish, is associated with physical health and mental acuity in your old age. Or, go back to the caveman days with the Paelo diet. Dr. McConnell likes a PaeloMed hybrid diet for maintaining your health. Not sure what to eat, use the gylcemic index tool http://www.fitmedpartners.com/glycemic-index-reference-guide/

4. Do Not Ignore Erectile Dysfunction (ED)
Problems with performance in an intimate setting are a difficult topic for men to address. Do not ignore ED. Make an appointment with your doctor to address. Read this article http://www.huffingtonpost.com/2015/04/09/erectile-dysfunction-_n_6882636.html

5. Strength Train
Even a little weight training can go a long way. Whether you’re 100 lbs overweight or just need to lose the last 15, strength training is one of the most effective ways to burn fat and build muscle.Lifting has been shown to halt and even reverse sarcopenia – the reduction of skeletal muscle that occurs as we get older – which helps us stay independent (and out of a nursing home) and live longer. It prevents disease and degenerative conditions such as heart disease and the management of cholesterol, high blood pressure, obesity, diabetes, and mood.

My elbow hurts!

Two of the most common injuries around the elbow that sports medicine physicians evaluate and treat are related to overuse and stress to the muscle and tendons that are involved in gripping type activities.

Lateral epicondylitis, known as “tennis elbow”, results from overuse of the muscles and tendons that are used to extend your wrist and fingers. The pain is typically located on the outside, or lateral aspect, of the elbow and involves primarily a muscle-tendon unit called the extensor carpi radialis brevis (ECRB). This tendon is used to help stabilize the wrist when the elbow is extended, which occurs during a tennis ground stroke.

Medial epicondylitis, known as “golfer’s elbow” results from overuse of the muscles and tendons that are used to flex the wrist and turned the forearm. Pain and discomfort is typically located on the inside, or medial aspect, of the elbow and involves the tendon known as the common flexor tendon. Forces are increased on the flexor tendon while gripping a golf club during a golf swing.

Both conditions can be caused by other repetitious activities such as throwing and activities requiring repetitious grip, such as shoveling, hammering nails, and gardening activities. Typical symptoms include pain on grip, or weakness in grip strength.

The early phase of these conditions is an acute inflammation of the tendon called tendinitis. However, if the overuse syndrome has existed for several months or longer, the tissue can continue to degenerate and form a condition known as tendinosis. This is not a true inflammatory condition, but represents chronic degenerative changes in the collagen fibers of the tendon, which results in scar tissue, leaving the injured area in a weak and and painful condition.

Diagnosis is typically based upon physical examination. Occasionally, x-rays may show some irregularity or calcium deposits within the tendon. Occasionally, further diagnostic imaging such as MRI or ultrasound is utilized, which confirms the pathology. The use of office musculoskeletal ultrasound now allows for a much quicker diagnosis and earlier intervention.

Treatment for this condition is typically nonsurgical, and involves a rehabilitation program which may include rest and stretching exercises, non-provocative exercise and occasionally use of bands or straps that may take the pressure off the tendon for a period of time. It is imperative to identify and correct any biomechanical abnormality in the swing or stroke mechanics, which led to the problem initially.

Although it is not uncommon for physicians to utilize cortisone type injections to reduce the inflammation, recent evidence in the sports medicine literature suggests this should not be carried out more than once or twice, as this may further damage the collagen in the tendon.

Traditional surgical treatment requires an incision over the affected tendon area, with removal of the damaged tissue and repair back to the bone after removing any underlying bone spurs.

Over the past several years, new and innovative technologies have been made available which are much less invasive. There has been a significant increase in the utilization of growth factors, such as platelet rich plasma, as well as use of certain types of stem cell therapies, to allow a more aggressive, regenerative healing response. These type of treatment options are referred to as orthobiologics.

Recently, a minimally invasive procedure developed at the Mayo Clinic called percutaneous tenotomy, or the Tenex procedure (www.TenexHealth.com), allows a physician to repair the degenerative collagen using a high energy device on the tip of a very small probe. This can be performed under a simple local anesthetic injection and is performed under ultrasound guidance. It requires no incisions or sutures and typically allows for a quicker recovery and return to activity.

Typically, prevention is the best cure! Spring has arrived, and outdoor activities will increase. Early recognition of symptoms, with early rehabilitation efforts and utilization of a good swing coach to correct poor mechanics will typically prevent this from developing into a more chronic problem.

Treatments using patient-derived platelets and stem cells are an emerging tool for healing injuries

Everybody knows a kid who likes to roughhouse — he or she plays full-speed with seemingly no regard for life and limb.

Jay Noce is one of those kids, all grown up.

The 51-year-old Daniel Island resident and former collegiate tennis player is a black belt in karate, does intense CrossFit workouts, and plays tennis, basketball and golf. Being physically active is in his DNA but his sports, while keeping him physically fit and trim, have taken their toll on his knees.

Read full article

Concussion Risk Reducer- Athletes Should Consider Pre-Season Cognitive Testing

March is Brain Injury Awareness Month

Spring sports practices like baseball, soccer and lacrosse have begun. One local physician advises athletes to stop by the examining room before hitting the field. March is Brain Injury Awareness Month, and according to the CDC, as many as 3.8 million sports and recreation related concussions are estimated to occur in the United States every year. Brain Injury symptoms range from confusion, headache and blurred vision to vomiting and loss of consciousness.

The problem with brain injuries, like concussions, is that they are difficult to diagnose. Because of this, Dr. Bright McConnell of Charleston Sports Medicine advises athletes to be proactive and have a pre season baseline test before the games begin. He states, “Go into the season prepared. This will help in the long run.” Charleston Sports Medicine provides baseline testing with the CNS Vital Signs Program. Athletes are given neurocognitive index testing and while the physician gains insight into an athlete’s brain health status. Through the testing, information on key cognitive measures, such as memory, reaction time, and executive function are examined. If an injury occurs, this information will be beneficial with evaluation and help physicians determine an athlete’s readiness to return to play.

CNS testing take only thirty minutes and is covered by insurance. Charleston Sports Medicine offers this test alone or as part of an age management profile.
For more information, log onto www.charlestonsportsmed.com.

Take the Pain out of the Game

Recently, the world’s best tennis players took over Daniel Island at the Family Circle Cup. In the crowd, many recreational players watched in awe looking for tips to improve their game. For some, playing without pain would be a start because of the well-known injury “tennis elbow.”

Tennis elbow is a common condition caused by the overuse of the arm, forearm and hand muscles. Dr. Bright McConnell, an orthopedic surgeon with Charleston Sports Medicine has been treating tennis elbow for years. He states, “Tennis elbow is caused by the overuse of muscles and tendons around the forearm. Close to fifty percent of tennis players will experience tennis elbow at some point in their playing years. They are constantly hitting the tennis ball with their racket with force. This can cause a nagging pain outside of the elbow that increases over time.”

Carol Wilson is a 4.0 league player that has played tennis for twenty years. Ten of those years she has played through the on and off pain of tennis elbow. She states, “I played with tennis elbow for years. I wore the sleeves, the tape, anything I thought would help. I did not want to give up the game.” Finally the pain associated with tennis elbow forced Wilson to put the racket down. “It was achy, towards the end it was sort of a constant pain that I felt beyond the tennis court. I couldn’t pick up my purse, use my computer mouse because my elbow ached all the time,” she explains.

There are several treatment options for players with tennis elbow. States Dr. McConnell, “First a player generally tries to play through the pain. Then they may try the gels, the cortisone shots and even physical therapy.” Physical therapy is an effective treatment for some with mild tennis elbow. Wilson tried physical therapy, but her pain remained.

Now there is a new procedure that those suffering from tennis elbow. It is called the Tenex Health (previously know as the FAST) procedure. Dr. McConnell states, “The Tenex Health TX procedure, or fasciotomy and surgical tenomoty, is a minimally invasive procedure that requires no incisions and minimal downtime post procedure. This procedure has proven to be quite effective for those suffering from tennis elbow.”

Dr. McConnell, the only surgeon locally trained to perform the Tenex Health procedure, treated Wilson in December. He states, “After an initial examination, she proved to be the perfect candidate for this procedure. The pain associated with her tennis elbow was affecting her everyday life and physical therapy had been ineffective.” Based on technology developed in collaboration with the Mayo clinic, the Fast procedure is performed using local anesthetic to numb the area; patients are awake and alert. During the procedure, ultrasound imaging is used to identify the location of the scar tissue. Once located, a small instrument-the size of a toothpick-is inserted into the damaged tendon. The instrument delivers ultrasonic energy specifically designed to cut, break up, and remove damaged tissue safely and quickly, without disturbing the surrounding healthy tendon tissue.

According to Dr. McConnell, this procedure is a good alternative for tennis players that are considering surgery for tennis elbow relief. He states, “Unlike conventional treatment methods, the Tenex Health TX replicates the goal of an open surgical procedure by removing the damaged tissue with minimal invasion. The procedure usually takes 15 minutes or less and requires only an adhesive bandage to close the micro incision.” Unlike traditional open surgeries that may require several months of recovery, the Tenex Health TX recovery period is on average a 1 to 2 month timeframe. Following the short recovery a full return to the patient’s normal activities is expected.

A study done in April 2013 by the American Journal of Sports Medicine found the Tenex (FAST) procedure to be “safe, specific, minimally invasive and well tolerated treatment for recalcitrant lateral elbow tendinopathy.” All but one patient showed evidence of efficacy that was sustained at least one year. Wilson is not surprised by the studies’ outcome. By March, she was back on the court hitting tennis balls. While she is three months out from the procedure, assessment of patients for Tenex Health continues six months beyond the date of surgery. Wilson recommends Tenex Health TX (FAST) to any tennis player playing through the pain. She states, “The hardest thing is to put the racket down. I thought I could play through the pain. I now play pain free, it is like a new beginning.”

Dr. McConnell is an orthopedic surgeon that focuses on prevention and performance. He works with several local athletes as well as those on the national level. His office is located on Daniel Island. To learn more about this minimally invasive procedure for tennis elbow relief, go to www.charlestonsportsmed.com.

Dr. McConnell talks to patient, Deanna, about her TekScan evaluation for foot pain

Dr. McConnell Only Orthopaedic Surgeon to Perform New Minimally Invasive Procedures for Tendonitis

Is the source of your pain in the tendon or ligament? If medication and physical therapy have proved unsuccessful in relieving discomfort and pain related to tendon or ligament injuries, there are some recent advanced treatments worth exploring. Even better, these revolutionary treatments do not require open surgery.

Determining the actual source of your pain can be the first step to knowing if there is a minimally invasive treatment for which you are a candidate. Here are two very new options for patients with tendon and ligament damage.

Tenex Health TXTM
Focused Aspiration of Scar Tissue (FAST™) procedure or newly named, Tenex Health TXTM is a new outpatient procedure specifically designed for those who are suffering from pain associated to tendon damage. Tendon damage often occurs in patients due to repetitive stress and overuse of one area of the body.

Tendon pain takes many forms:
• Plantar fasciitis
• Achilles tendonitis
• Jumper’s / Runner’s knee
• Tennis / Golfer’s elbow

The revolutionary Tenex Health TXTM procedure is an advanced treatment that quickly and safely removes the source of tendon pain stemming from tendon and soft tissue injuries such as tennis elbow, golfer’s elbow, jumper’s knee, Achilles tendonitis and plantar fasciitis. The procedure is based on advanced technology developed in collaboration with the Mayo Clinic and is performed using a local anesthetic, allowing patients to remain awake and alert the entire time.

Using ultrasound imaging, the scar tissue is identified and a small instrument about the size of a toothpick is inserted into the damaged tendon. Ultrasonic energy then cuts, breaks up and removes the damaged tissue, without disturbing the surrounding healthy tendon tissue. The procedure typically takes about 15 minutes or less, requires only an adhesive bandage to close the microincision, and offers quick recovery time for patients.

This procedure is not invasive open surgery and can be performed in an office or procedure room.

Platelet Rich Plasma (PRP) Therapy:
PRP is blood plasma with concentrated platelets. These platelets include bioactive proteins that initiate connective tissue healing such as bone, tendon and ligament regeneration and repair.

PRP can be injected in tendons and ligaments all over the body, which can help with sports injuries and more specific injuries including tennis elbow, carpal tunnel syndrome, shin splints and many other damaged ligaments and tendons. Patients see significant improvement immediately, which may eliminate the need for aggressive treatments such as long-term medication or surgery.

Bright McConnell, III, MD 900 Island Park Drive, Suite #105
Charleston, SC 29492 Phone: (843) 284-5200

Dr. McConnell and Anne Ahern Moore on Lowcountry Live!

Dr. McConnell and Exercise Physiologist, Anne Ahern Moore discusses tests to customize your best fitness and nutrition plan for great results.

The Charleston Sports Medicine Team strives to become your partner in your total health. Our affiliated practice, FitMed Partners, also offers scientifically proven preventive age management, bio-identical hormone therapy and medically based fitness and nutrition programs. The FitMed Elite Athlete Program provides a menu of advanced sports performance testing, not typically covered under insurance, for affordable prices.

Dr. McConnell and Exercise Physiologist, Anne Ahern Moore discusses tests to customize your best fitness and nutrition plan for great results.



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