OCI Sports Medicine Patient Perspective

One of the greatest fears of any parent of a student athlete is injury. We spoke with Dana Spencer about her recent expereince with OCI Sports Medicine for her twin boys, Dustin and Derrick Dawson, both football players at Porta High School. Dustin was seen by Dr. Maender and underwent surgery for a hand injury. Derrick was seen by Dr. Herrin and treated for a knee injury.

What was your thought when your sons’ trainer called you to tell you that they had been injured?
My first thought was that we’ll have to go to the emergency room and spend the entire night in the ER only to be referred to a specialist.

Did you find that your access to OCI physicians was timely?
Our access was very timely and convenient for a working mother of twin boys, it was really helpful.

What is something that stood out to you about your sons’ care at OCI?
The accessability and that staff at OCI getting the situation taken care of promptly. There wasn’t months of waiting. We saw the doctor, got the MRI, and realized my son needed surgery which took place a week after his injury.

Would you recommend OCI Sports Medicine to other student athletes and their parents?
I very much would!

What type of encouragement would you give other parents with student athletes that are facing injury?
I would tell them, that if you get your child into the right place, it will really help their overall outcome. Because I came to OCI, my son will play sports again. The doctors at OCI are wonderful and answered all of our questions before we could even ask them. We are very happy that this service is available. Having children in sports can be difficult enough, especially when one of them gets injured. We are just glad that OCI Sports Medicine was there for us when we needed them!

Spine Manifestations of Osteoporosis

by Timothy VanFleet, MD

Vertebral compression fracture in the setting of osteoporosis is a frequently encountered clinical problem that is becoming even more common with an aging population. Osteoporosis is characterized by decreased bone density and increased susceptibility to fractures. According to the World Health Organization osteoporosis is defined as diminished bone density measuring 2.5 standard deviations
below the mean bone density of healthy 25-year old same sex members of the population evaluated with a bone density study. Based upon this definition, an estimated 25% of postmenopausal women and 35% of women over the age of 65 in the United States suffer from osteoporosis.

The risk of hip, wrist, and shoulder fractures is significantly increased in postmenopausal women though vertebral compression fractures are the most common. The number of osteoporotic fractures of the spine is greater than 500,000 per year in the United States with women being affected twice as often as men. One quarter of women reaching menopause can expect to suffer one or more vertebral compression fractures in their lifetime. In the United States, 25% of women over the age of 70 years and 50% of women over the age of 80 years have x-ray evidence of vertebral compression fractures.

Vertebral compression fractures can be classified into three types: wedge, biconcave, or crush. Wedge fractures are the most common and the severity of the deformity seems to be directly related to the bone mineral density. Wedge type fractures cause increased kyphosis, or the rounding of the back we see in little old ladies, as well as decreased spinal column height making one shorter in height. Biconcave or codfish fractures occur mainly in the lumbar spine and can result in loss of lordosis and decreased spinal column height. Crush fractures are associated with greater than 50% loss of height and may occur in both the thoracic and lumbar spine. These fractures may have fragments of bone into the spinal canal, which can lead to neurologic deficits or leg pain.

The deformity associated with each of these fracture types may lead to loss of height and thoracic hyperkyphosis (dowager’s hump), abdominal protuberance, and loss of lumbar lordosis. The loss of height may lead to abdominal compression resulting in loss of appetite, early fullness, and weight loss. Thoracic hyperkyphosis leads to compression of the lungs resulting in decreased lung function and an increased risk of dying. One thoracic vertebra fracture increases the risk of pneumonia and lung
disease. Neurologic involvement is not usual although not rare and late neurologic involvement can be seen up to 18 months after a fracture. Aside from the various physical effects vertebral compression fractures also have a negative effect on the psyche with higher than average rate of depression and loss of self-esteem in addition to a deteriorating quality of life. Lastly the overall rate of mortality is increased 5-fold compared to the general population and is comparable to survival rates after
hip fracture.

The treatment of the patient with osteoporotic compression fractures is twofold: pain
management and prevention of instability or neurologic deterioration. Certainly to be complete in the workup it is important to understand the cause of the fracture. A medical workup is needed to determine the cause of the underlying osteoporosis to ensure that an occult cancer is not being overlooked. Laboratory studies including a CBC, and other blood studies should be completed.

Imaging studies include plain x-rays, CAT scans as well as MRI scans. MRI is quite helpful in distinguishing an acute fracture from a subacute or chronic fracture. MRI is also helpful in differentiating a benign fracture from a fracture as a result of
a tumor.

Pain management consists of non-narcotic pain relievers, muscle relaxants for muscle spasm, and narcotic pain relievers. Typically the severe pain resolves over a period of 6-8 weeks. Often times it can be difficult for elderly patients to tolerate these
medications due to the side effects of confusion, constipation,
increased fall risk, and potential for addiction.

Bracing is the treatment of choice for most fractures. A short period of bed rest may help to relieve severe pain but is contraindicated beyond a few days. Bracing is typically necessary the first 6-8 weeks or until the acute pain resolves. The type of brace is dependant on the location of the fracture. Most patients do not like the brace initially because it is somewhat constraining. Bracing may provide comfort however with activities of daily living or with prolonged standing or car rides at a later point.

Although most patients will recover from the acute pain associated with a new vertebral compression fracture, some will not and do continue to experience chronic persistent or recurrent pain. These patients may benefit from surgical intervention. The surgical treatment of vertebral compression fractures is challenging because of the deficient mechanical properties of osteoporotic bone. The surgical treatment for vertebral compression fractures ideally should address the pain associated with the fracture and the kyphotic deformity. Vertebroplasty and kyphoplasty are two techniques that address the pain but kyphoplasty also addresses the deformity. These operations utilize x-ray guidance to inject bone cement into the fractured vertebral body.

Vetebroplasty (see Fig. 1) was first described in 1987 in Europe and in the U.S. in 1993. The pain relief brought about by vertebroplasty is probably secondary to the fracture being solidified. The injected cement hardens and stabilizes micromotion at the fracture site. Ideally the patient with unimproving pain and less than 60% compressed is a candidate. If there is more compression it becomes difficult to do the procedure. Risks associated with the procedure include cement extending into the spinal canal, nerve root compression, or death. Additionally a new fracture is a relatively frequent occurrence. There is about a 50% chance for a new fracture within several years.
Kyphoplasty (see Fig. 2) is a similar technique that uses a balloon that is expanded within the vertebral body. It has several advantages: lower risk of cement squirting out, and better restoration of vertebral body height. By creating a cavity with the balloon the process of cement injection becomes safer as it is creating a low-pressure cavity into which the cement will preferentially flow. It can be used for any progressive or painful osteoporotic compression fracture. The technique is similar to that of vertebroplasty and in addition the inflatable balloon tamp is expanded under x-ray guidance until
maximum fracture reduction is achieved. The patient is discharged usually the following or same day without a brace.

Certainly early management of osteoporosis by prevention affords the least morbidity possible. However with a continually aging population and increasing incidence of vertebral compression fractures surgical reconstruction of the spine will be of significant interest. The development of new procedures such as vertebroplasty and kyphoplasty offer advancement in the field and newer techniques for open treatment will continue to evolve.


September Employee of the Month- Brian K.

The physicians and staff are proud to announce Brian K. has been named employee of the month for September 2017.

Brian joined OCI & Midwest Rehab in 2017.

Brian was nominated by co-workers for his willingness to always go above and beyond his duties and always does so with a smile on his face. He is a great motivator and leader for the rehab staff.

Congratulations, Brian!

August Employee of the Month- Tracy P.

The physicians and staff are proud to announce Tracy P. has been named employee of the month for August 2017.

Tracy joined OCI & Midwest Rehab in 2016.

Tracy was nominated by both patients and co-workers. One patient said, “She is kind, caring, and always there to lift you up if you are down.” A co-worker commented, “She is a great mentor. She is always smiling and it cheers up her patients and fellow employees.”

Congratulations, Tracy!

Compass for Kids is 2017 OCI Foundation Chip in fore Charity $20,000 Grant Winner

SPRINGFIELD, IL, July 17, 2017– The Orthopedic Center of Illinois Foundation (OCIF) announced that Compass for Kids was selected to receive $20,000 as the beneficiary for the 14th Annual OCIF Open: Chip in fore Charity. The community impact grant will be funded through proceeds from the OCIF annual golf outing scheduled for September 18th at Illini Country Club.

“The Orthopedic Center of Illinois Foundation is proud to partner with Camp Compass and its mission to provide summer education to low income children in our community,” said OCIF Board President Ron Romanelli, M.D. “Many very deserving organizations applied for the grant, but ultimately the deserving work of Camp Compass rose to the top for the benefactor of our 14th annual event.”

“We are so excited to be the Chip in Fore Charity grant recipient this year. The grant will go towards our summer program, Camp Compass, in 2018,” said Molly Berendt, Compass for Kids Executive Director. “Camp Compass is an academic intervention for low-income and at-risk elementary school students. Camp Compass prevents summer learning loss and chips away at the achievement gap that exists between low-income students and their higher-income peers. Three hours per day are spent on math and reading, taught by licensed teachers. In addition to being an academic intervention, students are treated to a fun, enriching camp experience that includes field trips, swimming, and afternoon activities taught by volunteers from approximately 50 local organizations and businesses. Camp Compass takes place from 8:30 am – 3:30 pm Monday through Friday at Ridgely Elementary School and is completely free to participants. Transportation to and from the camp is also provided.

Our community becomes a better place when its youngest and most vulnerable residents are supported with free high-quality summer programming. Thank you to the Orthopedic Center of Illinois for their generous support of children in our community.”

Through funds raised from the annual golf outing, OCIF has granted over $250,000 to Springfield area organizations. Past grant recipients include: Central Illinois Foodbank (2004), Boys and Girls Club of Springfield (2005), Contact Ministries (2006), Southwind Park (2007), Big Brothers Big Sisters (2008), Sangamon County Child Advocacy Center (2009), the Springfield YMCA (2010), Camp Care-A-Lot (2011), Springfield Sharefest (2012), genHkids (2013), Senior Olympics (2014), SIU ThinkFirst (2015), and Special Olympics (2016).

For more information on the Foundation or to be a sponsor at this year’s event, please visit the OCIF website: www.ocif.net or call (217) 547-9100.

Improve Your Core Knowledge with Midwest Rehab

From elite athletes to seniors, core exercises are acknowledged as an important part of any exercise program. They not only help athletes of all calibers perform at their best, but they are an important element in helping to reduce falls and injuries for seniors.

What exactly are the core muscles? Different experts include different muscles, but they all agree that they consist of the muscles of the abdominal region, the hips, and the back, including the deep muscles of the abdomen and back. The following are the most commonly included muscles:
• rectus abdominus, front of the abdomen
• internal & external obliques, abdominal front
and side
• transverse abdominus, deepest muscle of the
abdominal wall located under the obliques and
wrapping around the waist
• erector spinae, running from the neck to
lower back
• multifidus, under the erector spinae and along the
vertebral column to extend and rotate your spine
• hip flexors, front of the pelvis and upper thigh
• gluteus muscles, buttocks, outer thigh, hip
adductors, the medial thigh

Benefits of core strength
Strong core muscles can help reduce back pain and improve balance, posture and athletic performance.
While the abdominal muscles get most of the credit for protecting the back, it is the combination of the abdominals, the hips, and the back muscles that provide the foundation for maintaining normal posture and reducing the strain on the lower back.

Athletic performance is also improved by strong core muscles. The transfer of power to the arms and legs is provided by the stabilization of the spine. Powerful movement is accomplished from the center out, not from the extremities alone. We often hear of baseball pitchers working on leg, back, and abdominal strength to get more velocity on their pitches. The same is true for tennis players and their serve.

A strong core also improves balance and posture. Muscle imbalances and weakness can lead to poor posture which can lead to pain and injury. Muscle weakness and poor posture can also lead to poor balance, especially in seniors. In a 2013 article in Sports Medicine, studies showed that core strengthening can increase strength by 30% and balance and functional performance by 23% among seniors. Core strength training had an adherence rate of 92% based on a German study of 32 older adults, published in Gerontology in 2013.

Core strengthening is most effective when the exercises cross multiple joints and work together to stabilize the spine. A study published in March of 2013 in the Journal of Strength and Conditioning Research showed that exercises that move muscles farther away from the torso, such as buttocks and deltoids (shoulder muscles) elicited greater core activation than isolated exercises. A 2012 study showed that seated dumbbell exercises had an 81% lower rectus abdominus activation rate than standing dumbbell presses. Therefore, seniors should try to perform standing exercises when possible and safe.

There are many exercises that can strengthen the core. Many of them can be performed at home with little or no equipment. Abdominal bracing is a key element of core strengthening. To correctly brace, you should attempt to pull your navel back to your spine. This primarily recruits the transverse abdominus. You should avoid holding your breath when performing abdominal bracing and strengthening exercises. A core strengthening program should contain elements of spinal flexion, rotation, extension, and stability.

Pictures and instructions abound on the internet for core strengthening programs. However, you should check with your physician or physical therapist before beginning a new exercise program. Not all exercises are appropriate for every individual and every condition. Seniors with osteoporosis need to be especially careful with flexion and rotation exercises. The Midwest Rehab staff is available to work with you on developing a program specific to your abilities and needs, call our office today to schedule a consultation: (217) 547-9108.

What is Cervical Spondylitic Myelopathy?

by Christopher Graves, MD

Although as an orthopaedic spine surgeon I am terribly biased, I think that the cervical spine is one of the most interesting and complex structures in the human body. It has several very important functions, which at time seem like they are at odds with each other! The cervical spine is tasked with protecting the very important (and fragile) spinal cord, which requires it to be stiff and strong like a suit of armor. At the same time we ask the cervical spine to allow for an incredible amount of motion so that we can turn our heads in all sorts of directions to be able to see, hear, and otherwise use our senses in the most optimal position. This results in a beautifully complex structure that in most cases does its job unfailingly for decades.

The cervical spine is made up of 7 specially shaped bones called vertebrae. These bones are connected together by a series of complex joints, ligments, muscles and special shock absorbing structures called discs. We number the vertebrae C1 (directly underneath the skull) through C7. The first two vertebrae (C1 and C2) are extra special to allow the great range of movement of the human head. Subsequently, are shaped differently from the other vertebrae and have special names. The first cervical vertebrae (C1) is called the “atlas” because it holds the skull up like the mythological Atlas held up the earth. The second vertebrae is called the “axis” because it has a bony process on which the “atlas” rotates called the dens. Together the atlas and the axis account for more than 50% of the motion of the cervical spine.

The vertebrae below the axis are referred to as the “sub axial” cervical spine. These bones all look similar to one another, and serve similar functions to the axis and atlas. Each bone of the sub-axial spine is connected to the surrounding bones by no less than 4 joints! In addition to these joints, a shock absorber called the intervertebral disc acts to cushion the bones of the spine as we run and walk, and allow for even more freedom of motion between the vertebrae. Through the middle of these structures lies the intricate, fragile spinal cord. More than just a cable connecting the brain to the limbs and rest of the body, the spinal cord is a complex and delicate organ, with its own blood supply.

When we are born, the spinal cord is perfectly mated to the hollow area inside of the vertebral of our neck, even including a nice cushion of “extra” space to allow for movement. Unfortunately, as we age, some of these amazing structures that protect our spinal cord begin to lose their shape due to wear and tear. The intervertebral disc begins to deteriorate, and the smooth substance inside the joints (called cartilage) dries out and also deteriorates with age. This process of age related degenerative change is called arthritis when it happens elsewhere in the body. In the spine, we have a special name for this wear and tear — spondylosis.

Spondylosis is a normal process, and this process occurs in everyone as we age. Discs lose their height as they begin to dry out, and begin to “bulge” outward, including backward towards the spinal cord. As the discs lose height, the body responds by forming extra bone (“bone spurs”) in an attempt to become stiffer and protect the spinal cord. Sometimes people are born with less space in their spine, and this process of stiffening the spine for protection works against itself, causing the spinal cord to not have enough room to function properly. We call this process of spinal cord dysfunction “myelopathy”. Myelopathy can be caused by several different things including problems with the discs called “herniations”. If you think about the intervertebral disk like a jelly donut, the jelly-like nucleus pulposis is on the inside, while the tough, outer layer (the donut) on the outside is called the annulus fibrosis. A herniation happens when the nucleus pulposis pushes through the annulus fibrosis (the jelly squirts out of the donut). This can put pressure on the spinal cord and cause myelopathic symptoms as well. By far the most common cause of myelopathy in humans however is pinching caused by arthritis in the cervical spine. Therefore, this condition is known as Cervical Spondylitic Myelopathy(or CSM for short).

As we said earlier, the spinal cord is a very fragile structure, and it is extremely sensitive to pressure. It can become injured very easily, and unfortunately once it is injured there is not much we can do about it. Spinal cord injury is one of the most well funded and well researched areas in spine surgery, and although there have been many promising discoveries, there is currently no way in modern medicine to repair an injured spinal cord. Because of this, physicians go to great lengths to encourage people to protect their spinal cords from injury by doing things such as wearing seatbelts while driving. Early recognition and treatment of CSM is another important strategy of mitigating preventable cervical spine injury and dysfunction.

The most common symptoms of cervical spondylosis (neck arthritis) include neck pain and headaches.

The symptoms of myelopathy caused by CSM, however are even more subtle, and can often be overlooked, especially in elderly patients.

Patients with CSM will often report trouble with standing balance or walking. This is often noticed by family members rather than the patients themselves. Patients will describe feelings of weakness in their arms or legs which never goes away despite rest or exercise. Another one of the most tell-tale signs of CSM is difficulty with fine motor tasks or changes in their handwriting. Much of the literature that was written on myelopathy comes from Japan, and one of the classic signs of myelopathy in the Japanese Orthopaedic Association (JOA) scale is difficulty with using chopsticks. This may be less applicable however in central Illinois, as most of us tend to use easier to handle forks and spoons!

The first step in evaluating a patient for myelopathy is a history and physical examination performed by a physician who is trained to evaluate for the signs and symptoms of this type of spinal cord dysfunction. If there is clinical concern for myelopathy, your physician will likely order more tests such as x-rays and possibly an MRI scan of your spine to determine if there is enough space for your spinal cord, to see if it is showing signs of being pinched on imaging.

Treatment of cervical spondylitic myelopathy is different from treatment of most other spine pathology. If left untreated, most patients will progress as the arthritic changes worsen and the space for the spinal cord becomes less and less. The neurologic changes associated with CSM are often sudden and severe—with worsening and decline occurring in a “stepwise” fashion without warning. The story is usually “I was doing perfectly fine until one day I woke up and had trouble walking, buttoning my shirt, or signing my name”. While most problems in the spine warrant a conservative approach, the permanent and unfixable nature of injury to the cervical spinal cord means that many surgeons recommend operative treatment of CSM early in its course to prevent permanent neurologic damage.

The good news is that the surgical option most often recommended to decompress the spinal cord is one of the most successful operations in spine surgery – the Anterior Cervical Discectomy and Fusion (ACDF). This minimally invasive surgery is performed through a small incision in the front of the neck. The arthritic bone spurs compressing the spinal cord are removed, and the arthritic joints are fused together to prevent recurrence of compression. Often times this procedure can be done as an outpatient or with as little as a one overnight stay in the hospital. Many times, the symptoms are alleviated as soon as the patient wakes up after surgery.

Cervical spondylitic myelopathy is a disease that if diagnosed and treated early has an excellent prognosis. If you believe you or a family member is suffering from CSM, you should discuss this with your family physician or orthopedic surgeon. All of the physicians at the Orthopedic Center of Illinois are trained in evaluating for the signs and symptoms of cervical spondylitic myelopathy. We will be happy to help you get the right diagnosis and treatment. Call 217-547-9100 to schedule an appointment today!

May Employee of the Month- Christina P.

The physicians and staff are proud to announce Christina P. has been named employee of the month for May 2017.

Christina joined OCI in 2012.

Christina was nominated by several coworkers who commended her for always going an extra step to ensure satisfaction; whether it’s patients, immediate team members or co-workers, always having a pleasant attitude and looking for ways to be helpful without being asked.

Congratulations, Christina!

Orthopedic Center of Illinois Foundation Announces $5,000 Scholarship Recipient

After careful consideration by the Board of Directors, the Orthopedic Center of Illinois Foundation (OCIF) is proud to award Griffith Hatalla with its annual Foundation scholarship. The $5,000 award provides tuition assistance to a full-time, college-bound student majoring in a health-related field.

Dr. Rod Herrin presented the scholarship to Griffin Hatalla at an awards ceremony at North Mac High School.

Griffith is a senior at North Mac High School and is the son of Cory and Amy Hatalla. He plans to attend Southern Illinois University, Edwardsville for Biological Studies in the fall., with the ultimate goal of becoming a pediatric orthopedic surgeon. He has a 4.306 GPA and ranks in the 95th percentile of his class of 102 students at North Mac. His school activities include the Football Team, Baseball Team, Key Club, Student Council, and National Honor Society.

The Orthopedic Center of Illinois Foundation was formed to support projects promoting patient education, continuing medical education, and regional charitable organizations.  Since its creation in 2004, OCIF has awarded almost $250,000 to local charities and those pursuing careers in the medical field.