REI Schaumburg presentation from May 2012

1. Knee Pain in the
Outdoor Athlete
Ric Saguil, MD
First Health Associates
Arlington Heights
We didn’t invent the practice of medicine….
we’re just changing the way it’s provided.

2. DrRic
We didn’t invent the practice of medicine….
we’re just changing the way it’s provided.

3. The First Health Approach
We didn’t invent the practice of medicine….
we’re just changing the way it’s provided.

4. Your Community
of Care
Ric Saguil, MD
Jason Gruss, MD
Tom Jordan, RD
Katrina Christie, LCPC
Jennifer Green, ND
Joe Musolino, DC
Emery Paredes, PT
Courtney Day, EP
Yu Zhu, MD China
You

5. Staying injury free

6. Know your opponent
1. Pain receptors
2. Inflammatory cascade
3. Stretch receptors
4. Abnormally functioning nerves (Diabetes, Fibromyalgia, CF)

7. 1. Pain Receptors
• Stay away from the light!
Learn the difference between good and bad pain signals
• The body is a miracle and can perform
miracles…... if damage not too advanced and
body is healthy.

8. The Fibroblast
The fibroblast cell is the workhorse of healing in the joint…..if it is given the right tools!
( ….good nutrition, no toxins, no stress, no infection)

9. Every “knee” cell knows what to do….
…the brain has to be patient.
Ignored = further injury and longer healing . Pampered = fastest healing attained

10. How to avoid 2nd prob’s
2nd prob
2nd prob
2nd prob
2nd prob
1st prob
2nd prob

11. Facilitate Healing
• R est
• Ice Step 1
Step
• Compression
• E levation
Ge t R e s c Stepe d
u 2

12. Your Rescue team:
1. Orthopedic surgeon MD or DO
2. Sports medicine physician MD or DO
3. Primary care doctor MD or DO or NP
4. Chiropractor DC
5. Physical therapist
PT
6. Exercise physiologist
EP ACSM
7. Kinesiologist
T Cert ACSM
8. Trainer
T Cert ACSM
+ Acupuncturist LAc

13. INTERMISSION
Best bang for buck
Better than nothing Over kill

14. Saguil Approach – Compressing Time
Rehab is mandatory!

15. 2. Inflammatory Cascade
Bone
Muscle
Ligament
Blood
Vessel

16. Caveat Emptor
Safe
Not
Safe!
Really
Safe!!!

17. DrRic Favorite
Tumeric is an excellent anti-inflammatory for swelling and healing but take with black pepper

18. Natural Facilitators
• Vitamin D3 1000IU am/pm
• Omega 3 (Fish, Flax or Krill) 1000mg am/pm
• Multivitamin am/pm
• Glucosamine Sulfate Chondroitin 1500/day
• Magnesium 200mg am/pm
• Anti-inflammatory Diet for life!
• Traumeel/PanAway topical 3-5times/d
Hint: Save money, take glucosamine 30 days on then 90 days off…..still works all year round!!

20. “Synthetic” Facilitators
• OTC NSAIDS motrin, advil, ibu, aleve, napro..
• Script NSAIDS relafen, lodine, voltaren, indocin
• Injectable NSAIDS toradol
• Topical NSAIDS pennsaid
• Oral Steroids medrol pack, prednisone
• Injectable Steroids kenalog, celestone….
• Muscle Relaxers flexeril, zanaflex, skelaxin
• Narcotics tylenol #3, vicodin, ultram
Prescription medicines can help but watch the side effects!!

21. 3. Stretch Receptors

22. Fluid build up from Friction
Patellofemoral Syndrome

23. Prolonged Friction =
Cartilage “Abrasion”
Chondral Fracture

24. Chronic Friction =
Cartilage and Bone Chip
Osteochondritis Dissecans

25. High Q-angle rubbing/friction

26. Pes planus (pronation)
Flat feet causes a “high Q-angle”

27. Pes planus = “fallen arches”

28. Pronation “fixes” alignment

29. “External Fixes”
• Stabilizing shoes
• Low dye taping
• Orthotics Custom
• Orthotics Off Shelf
ask
Avoid “Rocky” style shoes….(or ask an expert)

30. Muscular Imbalance
1. Quads (usually big)
2. Hamstrings (usually tight)
3. ITB (Ileotibial Band) (slave to #1 and #2)
With big muscle comes tight ligament
Ileotibial band syndrome

31. Dominant forces win
ITB
Q
a
n
g
l
e
ITB Syndrome

32. The patella gets pulled by
ITB Syndrome
Normal Pulled over
ITB Syndrome causes Patellofemoral Syndrome

33. “Internal Fixes”
PT
ATC
Surgical
MT
ALTERNATIVE

34. Physical Therapy
• Covered by most insurance ($$$)
• “Challenge” the therapist (find a sports tx)
• Plan on graduation date/surgery (launch)
• Modalities facilitate (u/s, phono, ionto)

35. Athletic Training
Self-care
Field Experience
Education
• Cheaper
• Great at taping/DTM
• Great at keeping you honest after PT
• Maximize on conservative therapy
Ice Bath Ice Sleeve Kinesio Taping

36. Massage Therapy/Alternative
Acupuncture
Yoga
Tissue Scraping
Self Massage
Chiro Alignment

37. Equipment

38. Your Life Changing Team:
• Trainer
• Kinesiologist
• Exercise physiologist
• Physical therapist
• Acupuncturist
• Chiropractor
• Primary care doctor
• Sports medicine physician
• Orthopedic surgeon

39. Bottom line
• Rescue from damage Stop training
• Reverse inflammation Meds, supps, food
• Re-strengthen muscle Therapy, acupuncture
• Re-balance kinetic Chiro, trainer, yoga,
chain crossfit
• Return to activity Idea of K E Y (knowledge..)

40. Community Health
Project – YOGA?
Northwest Community Hospital
Wellness Center
June 23rd (sat) 11:00-12:30pm
(847) 618-3500
Ric Saguil, MD
We didn’t invent the practice of medicine….
we’re just changing the way it’s provided.