A P U B L I C A T I O N O F T H E C O R E I N S T I T U T E
Back in the Saddle Again
Knee replacement helps horse enthusiast reclaim the life she loves
Specialty Spotlight When is it time to see a pain management doctor?
Cutting-edge spinal implant to prevent re-injury
Strength Train right, pay attention to pain and fatigue, to prevent shoulder injuries
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WELCOME VOLUME 11, ISSUE 1 – SPRING 2020
FROM THE CHAIRMAN
Time for Spring
enewal. Rejuvenation. Regrowth. Poets and authors have long used those words to describe the extraordinary impact spring has on our planet and on ourselves. The return of longer days and warmer temperatures summons plants and flowers back to life and it’s easy to be almost overwhelmed by the colors that erupt around us. But sometimes nature needs a little help and that’s where The CORE Institute comes into play. In this Spring issue of CORE Ink, it’s time for spring training. Baseball is back and our Dr. William Kesto has important information on preventing and treating shoulder injuries. This is a must-read for players at every level. In fact, anyone with shoulder problems will want to understand what this expert thinks. Plus, a great comeback story featuring Mary Sproule, who was adamant that severe arthritis was not going to sideline her from the life she loves, especially riding her horses. Mary knew a determined attitude alone wasn’t enough, so, she turned to Dr. John Thompson at The CORE Institute for a total knee replacement. Less than 8 weeks after surgery, Mary was back in the saddle. How did she manage that? Her story is sure to inspire you! Pain control plays a big part in this issue and Dr. Shad Siddiqi, a member of The CORE Institute’s integrated Pain Management team, discusses how our treatments are customized for each individual patient. He also provides an overview of new therapies that offer hope to millions of people suffering from debilitating pain. Finally, you’ll read how The CORE Institute and MORE Foundation have teamed up for a national research study aimed at providing long-term help for people with large herniated spinal discs, which are prone to re-herniation. It’s a fascinating project and part of our ongoing commitment to the cutting edge research that produces better healthcare outcomes for our treasured patients. So, please enjoy this issue of CORE Ink! May your spring be filled with rejuvenation, and remember your friends here at The CORE Institute are always ready to help you — spring, summer, winter and fall!
Keep Life in Motion!®
David J. Jacofsky, MD Chairman & CEO
CREATED BY REPUBLIC MEDIA CUSTOM PUBLISHING FOR THE CORE INSTITUTE Editor: Jim Williams, JLWilliams@republicmedia.com Design: Rachel Tullio
8 COVER STORY
Season of Strength
Train right, pay attention to pain and fatigue, to prevent shoulder injuries. 8
Back in the Saddle Knee replacement helps horse enthusiast reclaim the life she loves. 12
D E PART M E N T S
20 connect with us 1.866.974.2673
6 T he CORE Institute is pleased to introduce its newest provider
18 N ow or later: When is it time to see a pain management doctor
Ask the Expert
7 B races bolster ankles better than taping
19 Hip replacement: Anterior or posterior?
16 Research trial
evaluates spinal implant to prevent re-herniation
20 F ood Tech: Go-to gadgets for healthy spring cooking
WHAT’S NEW NEW PROVIDER
STACY BRANDL, DO SPORTS MEDICINE, PHYSICAL MEDICINE & REHABILITATION
Stacy Brandl, DO, is a board certified and fellowship-trained physician specializing in both sports medicine and physical medicine and rehabilitation. Before joining The CORE Institute, Dr. Brandl completed a Sports Medicine fellowship at John Peter Smith Health Network affiliated with Texas Christian University Athletics. She completed residency in physical medicine and rehabilitation at The Ohio State University Wexner Medical Center. Dr. Brandl received her medical degree from Midwestern University – Arizona College of Osteopathic Medicine, graduating magna cum laude. Dr. Brandl remains active in the medical and sports medicine community, holding memberships with the American Medical Society of Sports Medicine, American Academy of Physical Medicine and Rehabilitation, and the Arizona Sports Medicine Society.
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ASK THE EXPERT
Braces Bolster Ankles Better Taping athletes is only a temporary solution
By Julie Maurer o wrap or not to wrap — that is the question that faces many athletes when considering taping their injured ankle. With millions of ankle sprains each year in the United States, ankle wrapping is a quick way for athletes to get back on their feet every day. But according to Ryan T. Scott, DPM, a Foot and Ankle Surgeon and Sports Medicine Specialist with The CORE Institute, using tape should just be a temporary solution. “It definitely depends on what you are trying to accomplish. It’s a way for them to get back in the game relatively quickly, and they can do it easily with their trainers,” Dr. Scott said. “But I often talk with my patients about the role of bracing versus taping.” BRACE YOURSELF He often recommends to chronic ankle strainers or those who have had any kind
of surgical reconstruction to use a brace instead. Dr. Scott tells his patients that taping can lose up to 40% of support after 10 minutes of exercise. “Meanwhile, players who wear high tops and a brace have a 50% better chance of preventing injury compared to low top shoes,” he said. For those who have experienced ankle pain and want to tape Ryan T. Scott, DPM up before an event to provide extra stability, Dr. Scott recommends a visit to their physician prior. “Individuals who routinely sprain their ankles may have an underlying injury to the ligaments or tendons,” Dr. Scott said. “This can lead to much bigger complications and the potential for future injury.” When athletes visit with ankle pain or a history of injury, he conducts proprio-
ception tests to evaluate their balance and ability to stand in awkward positions without rolling over. “My goal is for them not to wear a brace long term,” Dr. Scott said. “We send them to physical therapy to increase proprioception and home exercises to help strengthen their ankles.” LEAVE IT TO EXPERTS For those who do feel the need to tape their ankles and do not have access to a trainer, he recommends people should not self-tape unless they are experienced and fully understand the methodology. “Taping is definitely an art form. If you don’t know what you are doing it can be time-consuming and you won’t have the appropriate results you are looking for,” Dr. Scott said. “For most people who do not have access to a trainer — purchase a sports brace — you may get better support.”
DON’T END YOUR SEASON BEFORE IT STARTS — TRAIN RIGHT, PAY ATTENTION TO PAIN AND FATIGUE TO PREVENT SHOULDER INJURIES
By Brian Sodoma
aseball is back. Spring training is underway for Major League Baseball, and many youth baseball programs around the country are kicking off their
seasons as well. In todayâ€™s competitive sports environment, young throwing athletes may push their limits in hopes of catching the eye of a big-league scout or winning a league championship. That can lead to shoulder injuries. Here are some tips to prevent these setbacks from happening in the first place, along with some new treatment options for those nursing an injury today.
COMMON SHOULDER INJURIES together, the first common injury is an A collection of 17 muscles surrounding impingement, Dr. Kesto says. Here, the the shoulder blade known as the shoulder’s humerus, the long bone in scapular stabilizers help the upper arm, contracts throwing athletes do and an athlete experiences their job, explains William soft tissue pain in the front Kesto, MD, a Sports or back of the shoulder. Medicine Specialist at If the athlete doesn’t rest The CORE Institute. the arm, tendonitis, or “It’s very important that inflammation, may occur all these muscles work in the shoulder or elbow. together properly,” he Eventually, with continued William Kesto, MD emphasizes. overuse, problems may If these stabilizing muscles don’t work extend down the arm to the elbow,
potentially tearing the ulnar collateral ligament (UCL), for which “Tommy John” surgery is required. This procedure, named for the first major league pitcher whose career was saved by it, involves removing a tendon from elsewhere in the body to replace the damaged ligament. PREVENTION Athletes can prevent these injuries, Dr. Kesto says, by learning good throwing mechanics. Stretching and conditioning the shoulder muscles is also important, but don’t neglect the lower body and
INJURIES DON’T HAPPEN AT PITCH NUMBER 20, IT’S NUMBER 60. PAIN, LOSS OF VELOCITY OR CONTROL, THOSE ARE ALL YOUR BODY’S SIGNAL TO STOP.” —William Kesto, MD
core muscles, the area that generates most of the power behind a throw. “By the time that ball releases from the fingertips, the power really comes from the lower extremities, from the ground up,” Dr. Kesto says. “For the upper body, training is really more about refining your technique and having good form. Too many people just want to work on pectorals and biceps, those showoff muscles, when they should really be working on the legs and core.” Dr. Kesto recommends conditioning both the upper and lower body equally.
Work the hamstrings, gluteus muscles, quadriceps, and when you throw pitches, slowly build your repetitions. Above all, listen to what your body is telling you. “Injuries don’t happen at pitch number 20, it’s number 60,” Dr. Kesto advises. “Pain, loss of velocity or control, those are all your body’s signal to stop.” TREATMENT OPTIONS Shoulder injuries usually require a combination of rest, physical therapy, myofascial stretching and
anti-inflammatory medications such as cortisone. Dry needling, which uses a needle to treat the trigger of myofascial pain in the shoulder area, is another technique used to help with shoulder pain and weakness. A minor impingement may take only a couple weeks to heal, but anything that requires surgery may require six months, depending on severity. Cutting-edge treatments that can help some athletes avoid surgery are available at The CORE Institute. Lipogems is a newer cell therapy treatment, that involves harvesting mesenchymal stem cells from fat in the thigh or abdomen. These cells are then injected around the injured or damaged tissue to promote healing and symptom reduction. Platelet-Rich Plasma (PRP) injections have also shown some potential benefit for these situations. Here, a patient’s blood is collected to concentrate the anti-inflammatory growth factors found in platelets which can be used to reduce symptoms. Regardless of your treatment, Dr. Kesto emphasizes correcting any and all form issues or physical weaknesses with recovery. “It’s critical that you make sure you’re solving the problem and address whatever led to that injury. Otherwise, it’ll happen again,” he noted.
GET MORE INFORMATION To learn more, visit TheCOREInstitute.com.
Knee replacement helps horse enthusiast reclaim the life she loves
Photo: Mark Lipczynski
BACK IN THE SADDLE By Elise Riley
ver the years, Mary Sproule knew her hobbies were putting extra
aman Benjamin Br Inset Photo:
wear and tear on her body. But she battled through the pain until 2019 when she realized she had to take action to save the lifestyle she loved.
“I’ve had horses my whole life. I used to ski and ride motorcycles as well. Riding is hard on the knees. I’ve always been active, but my knees were slowing me down a lot. I could only stand about an hour and a half in the saddle — I’d normally spend four to five hours,” Sproule said. Sproule, 63, met with Dr. John Thompson, a Hip and Knee Surgeon at The CORE Institute. His message was clear: Mary’s left knee needed replacement, and her right knee wasn’t far behind. “My first question: When can I get back on a horse?” Sproule said. “I wasn’t hesitant to have
Photo by: Benjamin Braman
the surgery, but I wanted to know when I could get back to my horse.” Dr. Thompson made it clear that Sproule’s knee and recovery would decide when riding was an option again. The damage from years of activity was evident. “We often select the most painful knee first,” Dr. Thompson said. “And I recommend operating on one at a time.” Sproule prepared for her knee replacement by going
to the gym, working on her leg strength and losing some weight. After the replacement, she spent six weeks in outpatient physical therapy with The CORE Institute’s rehabilitation team in Surprise, AZ. Her focus was singular: returning to horses Buck and Rocky. “Mary’s physical therapy was custom fit to her needs and wants to return to riding her horses”, said Physical Therapist Nick Bellinaso. “Our first goal was gaining her knee the active range of motion needed
“It was more of a determination. ‘I’ve got to get through this. I’ve got a horse to ride.’ And man, I sailed through physical therapy.” — Mary Sproule
Photo by: Mark Lipczynski
to step up and, on her horse, and then post in the stirrups. She was very motivated, worked hard, and was very pleased with her progress. She exceeded our expectations for returning to riding pain-free as soon as she did.” Mary knew she had a goal to achieve. “It was more of a determination,” Sproule said. “I’ve got to get through this. I’ve got a horse to ride. And man, I sailed through physical therapy.” Sproule credits her entire support team for her rapid recovery. That includes not only Dr. Thompson and her physical therapy team but also the network of friends who ensured she was safe at home in those crucial early weeks. “I had a friend of the family staying with me and my brother brought me home,” Sproule said. “Another person fed my horses and unloaded my hay. A family friend helped me feed the dogs. I don’t know how somebody can do this without help at home. The people who gave me emotional support helped me
heal, too.” On New Year’s Day, marking seven weeks since her surgery, Sproule went for her first post-surgery ride. “I was able to ride for about 15 minutes that day,” Sproule said. “The longest I’ve been out now is an hour. It doesn’t hurt at all. Absolutely no regrets. I feel pretty normal now.” While Mary continues to heal — it can take up to a year for the healing process — her story serves as a reminder to prospective jointreplacement patients. “I believe patients that are John Thompson, DO more active and more eager to perform tasks after the surgery actually do better,” Dr. Thompson said. “The main thing that we can learn from Mary is that she had a goal to get back to riding and performing normal activities of daily living. Nothing was going to keep her from that.”
FORM and FUNCTION Research trial evaluates spinal implant to prevent re-herniation By Brian Sodoma
atients with nagging numbness or weakness in their legs caused by a herniated disk in their lower back may have access to a ground-breaking new surgical implant option, thanks to The CORE Institute’s involvement in a new clinical trial.
A “bulging,” or herniated, disk affects approximately one in 100 people at some point during their life. The condition may create severe pain in the lower back, which can radiate down the leg, causing weakness. The culprit is a tear in the fibrous outer wall, called the annulus, of Ali Araghi, DO the spinal disk. The annulus is spongy and acts as a cushion between the spinal vertebrae and
allows for flexibility. When the annulus tears, the softer inner portion of the disk can protrude through the tear, placing pressure on important nerves of the spine. Surgery to remove the compromised part of the disk is usually very successful for relieving pain and restoring function. However, patients with a large annulus tear are at high risk of the disk’s soft interior to once again bulge through the tear. One of the challenges with surgical
FOR MORE INFORMATION To learn more, visit www.more-foundation.org/research
correction of large herniations is closing the hole that remains in the outer wall of the disk to prevent reoccurrence. For small holes, re-herniation is very uncommon. However, for defects larger than 6mm, re-herniation can occur in up to 25% of cases. As part of a national clinical trial, The CORE Institute’s Spine Division Director, Ali Araghi, DO, will partner with MORE Foundation — an Arizona-based nonprofit dedicated to studying musculoskeletal and neurological conditions — to help evaluate a new composite
implant. This new implant could potentially reduce re-herniation and greatly improve outcomes for these high-risk patients. THE BONE-DISK CONNECTION A spinal disk has the consistency of a gummy bear and creates a critical interface between its own soft material and the hard bones of the vertebrae in the spinal column. In herniated disk surgery, it’s critical that an implant be able to match the properties of both soft and hard materials.
Enter the Barricaid device, manufactured by Intrinsic Therapeutics. This composite device uses a fabric material that flexes with the soft disk materials attached to a metal anchor that can be secured to the bone. “The fabric portion is inserted into the tear in the disk and unfurls like a flag. The fabric then prevents the disk from protruding through the hole that remains in the disk’s wall,” Dr. Araghi explains. Although much more data is needed to fully understand the potential benefits of this technology, a large clinical research study conducted in Europe found a 61% reduction in reoperations with the use of the Barricaid device. In the U.S. trial, for which The CORE Institute/MORE Foundation partnership hopes to enroll 20 patients over the course of the next year, Dr. Araghi will use the Barricaid device on a select subset of patients at highest risk of re-herniation. “When I saw the research on this, it made me feel this really could be beneficial,” Dr. Araghi adds. “Anytime we can improve the quality of care for our patients, it’s exciting and it’s great to be at the cutting edge and forefront of medicine.” POWER OF PARTNERSHIP Conducting clinical research trials at multiple sites across the country comes with extremely stringent guidelines. That’s why MORE Foundation’s involvement in the trial is critical, Dr. Araghi says. MORE Foundation assures guidelines are followed and data is collected to FDA standards. Patients will be monitored closely for one year, but ultimately tracked for up to 10 years to gauge longterm success, said Marc Jacofsky, PhD., MORE Foundation’s Executive Director. “These partnerships give patients in our community potential access to the latest and greatest cutting-edge technologies, in some cases, years before they are more widely available to the public,” Dr. Jacofsky said.
Now or Later? When is it time to see a pain management doctor?
By Tressa Jumps Shad Siddiqi knows all about pain. Personally, and professionally. He knows pain can be debilitating; it affects your mood, your ability to focus and puts challenging, which is the part I love. It’s added pressure on your relationships. not a one-size-fits-all field. The opioid He is one of The CORE Institute’s epidemic is certainly at the forefront. premier Pain Management Specialists in “Some patients around the country Michigan, his home state. And currently, were prescribed this appropriately, but, he’s in pain himself, so he understands unfortunately, others were prescribed the plight of his patients. inappropriately. It certainly was not “I was in a car accident and broke a a cure like some may have once small bone in my hand,” Dr. Siddiqi says. thought. I try to educate my patients “It impacts every aspect of your life — about the different types of pain and your family’s life.” management — both conventional and While his pain will inevitably heal and unconventional. There fade, he knows it’s not are a lot of cutting-edge the same for many of treatments and therapies his patients. He started evolving in the field that his career practicing are revolutionizing pain anesthesiology but found management. Even he missed the clinic at-home healthy practices life — seeing and caring like Thai Chi and yoga for patients for periods have been shown to help of time, seeing their Shad Siddiqi, DO patients manage chronic successes and helping pain,” Dr. Siddiqi says. them with their on-going Dr. Siddiqi explains that pain challenges. management needs to be specialized “Debilitating pain can affect your to the individual patient. What works lifestyle and create stress on your for one person may not work for family, too,” says Dr. Siddiqi. “Pain is another. Recent advancements in such a huge topic right now and it’s
medical management, including new non-opioid medication for pain, nerve blocks, infusion therapies, spinal cord stimulation, and regenerative medicine, are all at the forefront of the pain management practice. The key to any successful treatment, according to Dr. Siddiqi, is knowing the source of your pain. That can confuse many patients. Certain types of pain that are felt in one part of the body may originate from another part of the body. This is where a pain management specialist comes into play. From chronic neck and back pain to headaches and fibromyalgia to post-surgery healing, he works to identify the source and, whenever possible, eliminate the pain. “If pain is affecting your daily life, it’s time to see your doctor,” Dr. Siddiqi says. “You don’t have to live with pain and neither does your family. You don’t have to settle for that lifestyle. There are so many pain management options that can be tailored to your individual needs and dramatically improve the quality of your life.”
Anterior or Posterior? Approach for hip replacement depends on the surgeon’s preferred technique
By Elise Riley ust as no two hip joints are identical, the same can be said for the method of hip replacement. A hip replacement can be performed, for example, in an anterior (front) or posterior (back) procedure. It all depends on the surgeon, their training and their preference for that particular patient. “There are many ways to get into the hip,” said Dr. Peter Boyle, a Fellowship Trained Hip and Knee Surgeon with The CORE Institute. “Anterior is my favorite because you don’t have to cut into any muscle. But there’s a lot of disagreement as to which method (anterior or posterior) is better.” The difference between the two procedures relates only to how a surgeon gets into the hip joint. The actual implant is the same, regardless of the method. Peter Boyle, DO “The joint functions the same,” Dr. Boyle said. “The hip functions the same. It’s just a matter of how you get in the hip.” An anterior approach — in which the surgeon replaces the hip joint through an incision along the front of the hip — was once thought too difficult to result in successful patient outcomes. But now that more surgeons receive extensive training in the anterior method, patients across the country report positive results. “It can be a more difficult surgery,” said Dr. Boyle, who prefers the anterior method. “It takes a long time to learn this approach. There’s a steep learning curve. Nobody was doing it
this way 25 years ago. Done well, it’s a great option.” Patients who have more tissue might experience trouble with the anterior incision. Dr. Boyle also noted there is a nerve that can become problematic in some anterior procedures. Patients could experience numbness in their thigh. Meantime, the posterior method of hip replacement presents a different set of issues, namely the elevation of muscles around the hip to gain entry to the joint. Either way, Dr. Boyle says it’s vital that all patients understand that no two replacements are identical and that healing and recovery vary from patient to patient. “It’s easy to focus just on success stories,” Dr. Boyle said. “Hip replacement has been called the operation of the century given how many patients it has helped. You can have great results. But you should always be cautious about comparing yourself to someone else.” Dr. Boyle’s best advice? Get information upfront FOR MORE INFORMATION and be prepared. Visit TheCOREInstitute.com or call “Ask your doctor about (866) 974-2673 to learn more. their method and the types of implants they use. No matter what, you should strongly consider whatever your doctor feels he or she does the best.”
FOOD TECH Go-To Gadgets for Healthy Spring Cooking
By Michelle Jacoby hile the turn of the year is a time when resolutions are made and healthy lifestyle changes are planned, this is actually the time when these plans “spring” into action. If you’re ready to ward those winter habits away — especially when it comes to eating — try these latest gadgets designed to make cooking easier and healthier. INSTANT GRATIFICATION Part pressure cooker, part slow cooker, part rice cooker and part yogurt maker (among many other things), the Instant Pot has become the darling of the
kitchen appliance world. In an article in The New York Times, Lorna Sass says the promise of a fast, fresh homemade meal is a pressure cooker’s greatest appeal. She should know. As the author of four cookbooks on pressure cooking, Sass says, “It doesn’t matter if you’re paleo or vegan or just trying to eat better, pressure cooking is the answer for healthy fast food.” The Instant Pot — and the latest generation of electric pressure cookers — include sensors that monitor the unit’s temperature and amount of pressure. It slow cooks, steams, sautés, browns, warms … it even cooks rice. And when it comes to cooking healthy, the benefits are plentiful. It helps retain vitamins and nutrients in foods, it preserves food’s appearance and taste, and it eliminates harmful microorganisms.
AIR TIME The next best thing since Instant Pots and sliced bread, the air fryer is next in line to the healthy cooking gadget throne. Imagine crispy fried chicken and crunchy fries without being deep-fried in oil — it’s a fried food lover’s dream come true! Contrary to the name, air fryers don’t fry food. Rather, hot air circulates around the food to cook it and give it a crispy taste and golden brown color. While air fryers do require using oil, the amounts are considerably less, often just a tablespoon to achieve a similar taste and texture to deep-fried foods. And by most measures, air frying is healthier than frying in oil — it cuts calories by 70 to 80% and has a lot less fat. In addition, air frying may also cut down on other harmful effects of oil frying. Recent studies have shown air frying lowers the amount of acrylamide — a chemical produced when you fry starchy foods — in fried potatoes by 90%.
Beet & Burrata Salad with Pistachio Vinaigrette GO FOR A SPIN From faux fur to faux foods, weâ€™re all in when it comes to putting a new spin on thingsâ€Šâ€Śâ€Šliterally. Designed to turn fresh vegetables into â€œnoodlesâ€? is the spiralizer, the latest gadget taking kitchens by storm. Simply place your vegetable (such as zucchini or squash) in the gadget, crank the handle and watch as mounds of noodles instantly appear. Top it with your favorite sauce and youâ€™ve got a healthier version of your favorite pasta dish. Spiralizing allows you to add more vegetables to your diet, without sacrificing flavor. Spiralized fruits and vegetables are also helpful for those who are vegan, vegetarian, follow a Paleo lifestyle, or have sensitivities to gluten.
1-1/2 cups water 2 lbs. red and golden beets, trimmed and unpeeled 1 shallot, medium, thinly sliced 1 tbsp. Champagne vinegar 2 tbsp. pistachio oil 1 tsp. Dijon mustard 1/4 tsp. black pepper 3/4 tsp. kosher salt, divided 4 oz. burrata cheese, torn 1/2 oz. beet microgreens 1 tbsp. pistachios, finely chopped, roasted, unsalted Insert steamer rack into a 6-quart Instant Pot or programmable electric pressure cooker; add
water. Arrange beets on the steamer rack. Close and lock the lid of the cooker; turn the pressure release valve to the sealing position. Program cooker to cook on manual on high pressure for 20 minutes. Allow the cooker to release pressure (steam) â€œnaturallyâ€? for 10 minutes. Turn pressure release valve to the venting position to release remaining pressure from cooker until float valve drops; carefully remove the lid. Transfer beets to a plate to cool slightly, about 10 minutes. Rub skins off beets and slice into 1/2-inch
wedges. Combine shallot and vinegar in a small bowl; let stand 10 minutes. Whisk in oil, Dijon, pepper and 1/2 teaspoon of the salt until combined. Arrange beets and burrata on a serving platter or divide among 4 small plates; sprinkle evenly with remaining 1/4 teaspoon salt. Spoon dressing over beets, and top with microgreens and pistachios. Source: https://www.cookinglight.com/recipes/beetburrata-salad-pistachio-vinaigrette
Failure is Not an Option
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Weâ€™ll help you get back in the swing of things with the right physical therapy plan designed speciďŹ cally for you. Because with Team Rehab in your corner it isnâ€™t over â€˜til you say so.
Find a location near you at
Air Fryer Zucchini Enchiladas 1 large zucchini 1 cup chicken, shredded 1 small onion, diced 1 tsp. ground cumin 1 tsp. chili powder 1 tsp. garlic powder 1 tsp. smoked paprika 1 cup enchilada sauce 1/4 cup Mexican cheese blend, shredded 2 tbsp. olive oil Salt and pepper, to taste Sour cream and green onion, to garnish In a large frying pan over medium heat, warm up the olive oil and brown the diced onion until translucent. Add garlic powder, ground cumin, chili powder and smoked paprika, salt and pepper, and mix well. Add the shredded chicken and mix well. Add 3/4 cup enchilada sauce and let simmer for 2 minutes until the sauce coats the chicken. Check and adjust any seasoning if needed. Set aside to cool. While the chicken cools, cut the zucchini in half lengthwise. Using a Y-shaped vegetable peeler, make thin strips of the zucchini (you can easily get 6 to 8 slices from each half). Layout 3 zucchini slices, overlapping each other. Add about a tablespoon of the chicken mixture, on one end of the zucchini strips. Roll up and place on a greased baking dish that can fit in an air fryer basket. Repeat with the remaining 1/4 cup enchilada sauce on top of the rolled zucchini strips. Sprinkle the shredded cheese. Air fry at 330 degrees for 10 minutes. Serve hot with a drizzle of sour cream and a sprinkle of green onion. Source: awefilledhomemaker.com/air-fryer-zucchini-enchiladas-low-carb/
Instant Pot Ground Turkey Quinoa Bowls 1 lb. ground turkey (chicken or beef) 1 tbsp. oil 1 tsp. taco seasoning, low sodium 1 tsp. oregano, dried 1 tsp. salt Ground black pepper, to taste 1-1/2 cups water 1-1/2 cups quinoa, uncooked 1 large onion, chopped 3 garlic cloves, grated (1 tbsp. garlic powder) 1 bell pepper, finely chopped 2 tbsp. soy sauce 2 tbsp. maple syrup or honey 2 cups green peas, frozen 2 cups corn, frozen 1/4 cup green onion, finely chopped On Instant Pot, press “sauté” and wait until the display says “hot.” Swirl oil to coat and add ground turkey. Cook until no longer pink or for about 5 minutes, constantly breaking into small pieces and stirring. Add taco seasoning, oregano, salt, pepper, and water. Stir to deglaze the bottom of the pot to avoid burn. Press cancel, add quinoa and stir. Add onion, garlic, bell pepper, soy sauce, and maple syrup. Do not stir. Close the lid and move pressure valve to “sealing” and pressure cook on low for 12 minutes. Release pressure using the quick-release method; turn the pressure valve to “venting.” Add peas and corn, stir, close the lid and let sit for 5 minutes. Add green onion, stir and serve warm. Source: ifoodreal.com/instant-pot-ground-turkey-quinoa-bowls/
The Power of One is Here.
Pain Relief in a Single Injection
DUROLANE is a single-injection hyaluronic acid (HA) treatment that has proven: • Greater reduction in knee pain vs. Synvisc-One® (hylan G-F 20)1* • Longer-lasting knee pain relief vs. steroid2 • Clinically equivalent performance to five-injection HA therapy3,4
*Some patients were treated with a three-injection Synvisc® regimen. A three-injection Synvisc regimen is equivalent to one injection of Synvisc-One. Summary of Indications for Use: DUROLANE is indicated for the treatment of pain in osteoarthritis (OA) of the knee in patients who have failed to respond adequately to conservative non-pharmacological therapy or simple analgesics, e.g. acetaminophen. Do not inject DUROLANE in patients with knee joint infections, skin diseases, or other infections in the area of the injection site. Do not administer to patients with known hypersensitivity or allergy to sodium hyaluronate preparations. Risks can include transient pain or swelling at the injection site. DUROLANE has not been tested in pregnant or lactating women, or children. Full prescribing information can be found in product labeling, at www.DUROLANE.com, or by contacting Bioventus Customer Service at 1-800-836-4080.
Active Healing Through Orthobiologics
References: 1. McGrath AF, McGrath AM, Jessop ZM, et al. A comparison of intra-articular hyaluronic acid competitors in the treatment of mild to moderate knee osteoarthritis. J Arthritis. 2013;2(1):108. doi:10.4172/21677921.1000108. 2. Leighton R, Åkermark C, Therrien R, et. al. NASHA hyaluronic acid vs methylprednisolone for knee osteoarthritis: a prospective, multi-centre, randomized, non-inferiority trial. Osteoarthritis Cartilage. 2014;22(1):17-25. 3. Zhang H, Zhang K, Zhang X, et al. Comparison of two hyaluronic acid formulations for safety and efficacy (CHASE) study in knee osteoarthritis: a multicenter, randomized, double-blind, 26-week non-inferiority trial comparing Durolane to Artz. Arthritis Res Ther. 2015;17:51. doi: 10.1186/s13075-015-0557-x. 4. DUROLANE [package insert]. Durham, NC: Bioventus LLC; 2017. Bioventus, the Bioventus logo and DUROLANE are registered trademarks of Bioventus LLC. Synvisc and Synvisc-One are registered trademarks of Genzyme Corporation. ©2019 Bioventus LLC SMK-002435
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