Sports Medicine

Exercises for Increased Bone Strength

An estimated 10 million people in the United States have developed osteoporosis. Osteoporosis is characterized by chronic bone loss that leads to weak bones that fracture easily. Fractures of the spine, hip, and wrist are the most common. With the right steps and effective care, it’s possible to boost your bone health and lower your fracture risk.
The Best Exercises for Bay Area Orthopaedic Specialists


Exercise increases your muscle mass which in turn can enhances your strength, muscle control, bal­ance and coordination. Good balance and coordination can mean the difference between falling, suffering a fracture or staying on your feet. Medical studies have proven that regular physical activity can reduce falls by nearly a third in older adults at high risk of falling.



This form of exer­cise challenges your muscles by working against resistance such as dumbbells and elastic bands. Resistance exercises including classic strength training or even using your own body weight to rely on muscle contractions that stimulate muscles to build up.



Weight bearing exer­cise are activities such as running, walking, dancing, hiking, climbing stairs, playing tennis, golf, or bas­ketball in which you carry your body weight and work against gravity. The force you exert to counteract gravity when you do weight bearing activities stimulates your bones to become stronger.  This is in contrast to non-weightbearing activities such as swimming or cycling where the water or bicycle supports your body weight.



When you run, jog or power walk you mul­tiply the weight bearing effect of gravity. Higher impact activities have a more pro­nounced effect on your bones than lower impact exercises. Impact can be increased even more if your speed increases.



Changing direction benefits your bones. When researchers reviewed bone strength in the hips of athletes, they found that those who played sports such as soccer which involve rapid turns, start-and-stop actions had bone strength similar to those who did high impact sports like high jumpers, they all had greater bone density than long distance runners.



Balance exercises involves doing exercises that strengthen the muscles that help keep you upright, including legs and core. These types of exercises serve as a bone-protecting function that improves health, stability and helps to prevent falls.

Consult your specialist before starting any exercise program if you have been diagnosed with osteoporosis. In the meantime, think about what kind of activities you enjoy most. If you choose an exercise you enjoy, you’re more likely to stick with it over time. Regardless of age or gender it’s never too late to start exercising!

Reviewed by David T, Braun.  MD

Patellofemoral pain syndrome can happen to anyone, whether on the playing field or simply when making a wrong move at home

Patellofemoral Pain SyndromePatellofemoral pain syndrome is a term used to describe pain in the front of the knee and around the kneecap. It is sometimes called “runner’s knee” or “jumper’s knee” because it is common in people who participate in sports but it can occur in nonathletes as well. Patellofemoral pain syndrome is caused by physical activities that put repeated stress on the knee such as jogging, squatting and climbing stairs. It can also be caused by a sudden change in physical activity including the frequency or intensity of the activity.

In most cases patellofemoral pain will improve with simple home treatments including:

1. Stop doing the activities that make your knee hurt until your pain is resolved. This may mean changing your training routine or switching to low impact activities such as riding a stationary bike, using an elliptical machine or swimming that will place less stress on your knee joint.

2. Practice RICE – Rest, Ice, Compression and Elevation.

Rest. Without rest, movement and weight bearing can continue to aggravate an injury and cause increased inflammation and swelling. Avoid putting weight on the painful knee.

Ice. Use cold packs for 20 minutes at a time, several times a day. Do not apply ice directly on skin.

Compression. To prevent additional swelling, lightly wrap the knee in an elastic bandage. Elastic bandages, such as ACE wraps, are most commonly used.

Elevation. As often as possible, rest with your knee raised up higher than your heart.

3. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen can help reduce swelling and relieve pain.

If your pain persists or it becomes more difficult to move your knee, contact our office for an evaluation.

Gruesome Sports injuries of the lower extremity: How are you going to fix that!?!?

sports injuriesWith the return of Fall sports, namely contact sports like hockey and football, you can expect to see traumatic injuries. Most recently, Dak Prescott of the Dallas Cowboys sustained a right ankle fracture dislocation while being tackled.

Dak had notable deformity to his right ankle, and you could see the shock in his eyes as he looked down to see his foot turned the wrong direction.

So the questions many of you ask is “What do you do next?” and “Will he ever play again?”

On the field and immediately after the injury the teams’ orthopedic physician will reduce the ankle back into place by pulling traction, exaggerating the deformity, and then placing it back to where it belongs. The ankle will then be maintained in that position with an air cast or form of splint. The ankle itself is very unstable and if the reduction is not maintained it will likely dislocate once again.

The next step is for operative fixation. Surgical fixation will most frequently entail the placement of plates and screws to reduce and maintain the position of the bones that were broken while allowing them to heal. If the fracture is open, meaning the bone comes through the skin, the patient may need to be placed into an external fixation device until the soft tissue injury heals. Ultimately, they will then undergo removal of the external fixator device with placement of internal hardware.

The patient will then remain off of the extremity completely for at least 6 weeks depending on physician protocol. They are then transitioned into a walking boot which immobilizes the ankle and allows for weight bearing and walking. This is usually done for 2-3 weeks before finally being transitioned back into a normal shoe with an ankle brace for added support and stability.

When all is said and done, one can expect about a 3 month recovery which will most likely include a course of physical therapy to get the patient back to their pre-injury activity level.

If you or a family member sustains an ankle injury, call us at 727-209-6677 to get your same day appointment with Dr. Troxell.

Shin Splints – What You Need To Know

Shin splints (medial tibial stress syndrome) are often considered a runner’s ailment but any vigorous activity can bring them on. Repeated pounding and stress on the muscles, tendons and bone tissue of the lower leg can cause repetitive microtrauma resulting in pain and inflammation. The most common symptom of shin splints is lower leg pain. The pain can range from mild to severe. It typically occurs both during and after exercise and may be aggravated when the sore spot is touched. You may also experience tenderness or soreness along the inner part of the lower leg.

People who have a higher risk of developing shin splints include:

  • Runners, especially those who run on hard or uneven surfaces or suddenly increase their running program
  • Athletes who participate in stop-start sports like tennis, racquetball, soccer or basketball
  • Dancers
  • Members of the military and people who march or walk a lot
  • People with osteoporosis
  • People who wear inappropriate or worn-out footwear

Most shin splints can be diagnosed through a physical exam. Your doctor will ask about the types of activities you enjoy and how often you participate in them. He or she will examine your lower leg checking for pain and tenderness along the shin bone. Your doctor may order imaging tests such as a bone scan, X-ray, or MRI to rule out stress fractures or other shin problems. Most shin splints respond to non-surgical treatments that can include:

  • Taking a break from vigorous physical activities to give your legs time to heal
  • Elevate your legs
  • Use ice packs
  • Take an over-the-counter anti-inflammatory, such as Advil or Aleve
  • Stretch your lower leg muscles
  • Wear elastic compression bandages
  • Use a foam roller to massage your shins
  • Wear arch supportive shoes
  • Biomechanics assessment
  • Physical therapy

Shin splints usually resolve within one or two weeks of rest and or limited activity.

Check with your doctor before resuming physical activities. Ease back into your sport or exercise routine. Begin slowly and gradually increase the duration, intensity and frequency. If the pain returns stop the activity immediately, ice the area and rest for a day or two before trying again.

Reviewed by Ronald D. Troxell, D.P.M.

Dr. Troxell offers both conservative and surgical management to the lower extremity. Ronald treats all aspects of the foot and ankle, from ingrown toenails and skin lesions to complex fractures and nerve pain. He specializes in arthroscopy, trauma, bunions, Charcot, total ankle arthroplasty, complex reconstructive surgery of the foot and ankle, and sports medicine.