• The top 10 tips to enjoy Thanksgiving (and have your body thank you for it)


    Thanksgiving is around the corner, and everyone’s looking forward to getting together with family and indulging (why not?). Fortunately, we have put together 10 ways for you to ‘have your turkey and eat it too.’
    Here they are:

    1. Drink plenty of water throughout the week – especially before heavy meals.
    2. Walk off that big dinner (you can even make it a family outing and exercise while enjoying one another’s company.
    3. Create a caloric deficit by upping your exercise routine the week of the big meal.
    4. Make simple substitutions, such as lighter milk and cream, to enjoy your favorite treats without the heavy health impact.
    5. Make small cutbacks on sugars and salts involved in the cooking process as most recipes call for more than is needed.
    6. Continue to have evenly-paced meals throughout the day. Having a normal breakfast and lunch will help you to refrain from overdoing it at dinner and dessert.
    7. Use smaller plates. Many times people will overeat purely because they pile larger portions onto wide plates.  Give yourself a mental edge by using a smaller plate and having smaller portions.
    8. Eat slowly to allow your body time to begin digestion. You may find yourself feeling full far earlier than you would have thought.
    9. Beware of alcohol intake. It’s easy to drink more than your normal amount during holidays, but too much alcohol can cause a variety of problems, including dehydration.
    10. Relax. Stress is a huge health risk and contributes to a vast variety of ailments.  Allow yourself to enjoy the holiday.

    From all of us at Nirschl Orthopaedic Center and Virginia Sportsmedicine Institute Physical Therapy we wish you a very Happy Thanksgiving!

  • Traveling For Surgery?


    By Derek Ochiai, MD

    Our society is becoming more global and travel friendly.  Many times, patients with a specific medical issue may decide to travel out of town to have definitive medical treatment, including surgery.  While there may be very good reasons to want or need to do this, the patient may have additional issues and needs that must be considered prior to making this commitment.  As a surgeon who often sees patients who travel from out of town for a specialized procedure that I do, I am well aware of these issues.  I have currently operated on patients from California, Idaho, Iowa, Michigan, North Carolina, Oklahoma, Pennsylvania, Puerto Rico,  and Texas. This article will talk about what to ask and look out for when traveling for surgery.

    Patients have reasons that they wish to travel to have surgery.  The doctor or center that they are choosing may have a specific expertise for a medical condition.  The patient may also travel to be closer to their family to make for an easier recovery.

    There are four specific issues that a patient should consider prior to having surgery out of town.  First, how long can the patient stay away from home?  While a surgery may normally take a set amount of time for initial recuperation, the surgery may not be without complications.  If the surgeon wants you to stay an extra week after the procedure, is that personally and financially feasible?  Second, what happens if there is a late complication after the patient returns home?  The surgeon may request that you return for follow-up care and this can be an additional expense and time away from home and work.  If you cannot get back to that surgeon, are their other physicians local to you who would be willing and able to treat you?  Third, how communicative is the surgeon?  Many orthopaedic procedures rely on physical therapy and post-surgery protocols after surgery.  If the patient or other health care providers have questions regarding this, how does this get communicated to the surgeon?  Does he/she answer email?  Is the surgeon comfortable with treating a patient “over the phone”?  Finally, how comfortable is the surgeon treating a patient whom he/she will not be following long term?  Do they have a system in place to handle issues of communication and follow-up?

    The most important step a patient can take is to research doctors and facilities ahead of time.  Many times, doctors who are accustomed to seeing patients from out of town have a system in place to accommodate this. The patient can gather their medical records, radiographic images and MRI’s, which can be mailed ahead of time for the surgeon’s review.  If a patient is thinking about having their surgery performed out of town, a call to the surgeon, asking if this system is in place, can save some unnecessary expense.  It is far better for patients to know ahead of time if they are an appropriate candidate for a procedure, rather than travel to the facility only to find out otherwise.  A patient should also ask to speak to the billing department, as the center and surgeon either may not participate with their insurance or the specialized procedure may not be covered by their insurance.  By talking to the staff, the patient can definitely get a sense of how experienced the office is in dealing with patients from out of town, which can help with the patient’s comfort level.

    All patients should set up a pre-operative appointment well before an intended surgery.  This will relieve pre-surgery anxiety for the patient who now knows their doctor prior to having the surgery.  Sometimes, no matter how great a doctor looks on the internet or how convenient it would be to have the surgery there, a patient may meet the surgeon and decide to look elsewhere.  If the pressure of already scheduling the surgery is looming, this may unduly influence an important decision.  Keep in mind that many centers may also have a surgical cancellation fee.

    Medical tourism has its benefits and drawbacks.  If a patient actively researches and prepares before surgery, the benefits can be maximized, and the drawbacks diminished.

    Dr. Derek Ochiai is a board certified orthopaedic surgeon, specializing in Hip Arthroscopy and Sports Medicine, at Nirschl Orthopaedic Center for Sports Medicine and Joint Reconstruction.  Follow him on Twitter @DrDerekOchiai. For more information go to the web site at www.nirschl.com.

    Nirschl Orthopaedic Center is a leader in sports medicine and general orthopedic services. In addition, Virginia Sportsmedicine Institute Physical Therapy has been rated on of the top sports medicine clinics in the Washington DC metropolitan area. If you have an orthopedic injury, schedule an appointment with one of our doctors today by calling our Arlington, Virginia office at 703-522-2200 or visit our websites to learn more about our services.




  • Hip Labral Tears and Femoroacetabular Impingement 

    Derek Ochiai, MD

    Nowadays, it is rather commonplace to read about an athlete undergoing hip arthroscopy for a labral tear of the hip. This article will review what a labrum is, why it’s important, how it tears, and what kind of treatment is available.

    What is a labrum?

    The labrum is a rim of cartilage that surrounds the hip joint. It attaches to the socket of the acetabulum. If you have friends who had a knee arthroscopy for “torn cartilage”, they had a meniscal tear of the knee. The meniscus of the knee and the hip labrum are made up of the exact same type of cartilage.

    Figure 1: Arthroscopic picture of a normal posterior labrum. The labrum attaches smoothly to the acetabular articular cartilage. The femoral head is on the bottom right of the picture.

    Why is the labrum important?

    The labrum increases the relative depth of the socket, which can confer additional stability to the hip. This can be especially important in ballet dancers, figure skaters, gymnasts, and other athletes who put their hips through extreme ranges of motion. In developmental dysplasia of the hip (DDH), the socket is much shallower than normal, and the labrum deepens the socket to keep the femoral head of the hip in that shallow socket. Also, there are medical conditions where a person has increased joint laxity (such as Ehlers-Danlos), where the hip is more unstable and relies on the labrum for stability.

    The labrum acts a seal around the femoral head, to maintain fluid pressure of the hip joint.

    What are the symptoms of a labral tear?

    The severity of symptoms can vary. The “hip pain” 90% of the time is perceived as deep in the groin. Sometimes, the pain can radiate to the side or the back of the hip as well. Many times, patients with a labral tear have pain and/or a feeling of catching in their hip, especially when going from sitting to standing. They may notice that they have to compensate to get in and out of cars. They may have pain with squatting and exercise, especially with sports that involve cutting and changing direction. Many times, patients also complain of pain with sex.

    I didn’t injure my hip. Why do I have a labral tear?

    The vast majority of labral tears are from FemoroAcetabular Impingement (FAI). FAI is a condition that develops in a person’s early teen years, where the hip is “out of round”. Since the hip joint and labrum are meant to function with round on round mechanics, this out of round conflict puts increased stress on the labrum. Over time, this increased stress can cause the labrum to tear. Symptoms of FAI greatly overlap with labral tears. In addition, symptomatic FAI can cause pain with prolonged sitting.

    How is a labral tear diagnosed?

    A medical professional can suspect a labral tear based on a patient’s symptoms and history. Clinically, the doctor can do provocative tests, such as the anterior and posterior impingement test, the McCarthy test, and the FABER exam, to further investigate. Many times, X-rays are very useful. FAI is a radiographic diagnosis, and usually can be easily seen on plain X-rays. With severe FAI, a labral tear can be inferred.

    Figure 2: On left side of screen, normal acetabulum. The anterior wall (red line) and posterior wall (blue line) do not cross. On right, there is pincer type FAI, where the red and blue lines cross.

    Figure 3: Typical cam type FAI X-ray finding. The yellow outline shows what the contour of a normal hip would look like.

    MRI (magnetic resonance imaging) directly shows the cartilage of the hip. While a labral tear can be diagnosed with a plain MRI, an MRI arthrogram is more sensitive to labral tears. An MRI arthrogram does involve an injection directly into the joint, but then the dye can easily be seen leaking into a labral tear, making the diagnosis clearer.

    Figure 4: MRI arthrogram of a left hip labral tear. Arrow points to the dye leaking between the labrum and the articular cartilage.

    I’ve been diagnosed with a labral tear. What do I do?

    The mainstay of initial treatment for hip labral tears is physical therapy and activity modification. Many patients ask me how this is going to “cure” their labral tear. Physical therapy can help improve core/gluteal strength, which can shift the femoral head back in the socket a bit. This can decrease stress on the labral tear, which is normally near the front of the socket. While this doesn’t “cure” a labral tear, it can make some patients feel significantly better. Sometimes, your doctor may suggest an intra-articular cortisone injection to the affected hip. While this also does not “cure” a labral tear, it can sometimes act as a physical therapy aid, allowing patients to “get over the hump” with initial therapy and start building core/gluteal strength.

    All that didn’t work. My surgeon says I need a hip scope.

    Labral tears and hip FAI can now be addressed by hip arthroscopy, using cameras and small instruments inside the hip. “Scoping the hip” means looking inside the joint; there are multiple possible procedures that could potentially be performed during hip arthroscopy. In the past, the most common procedure was labral debridement, or trimming out the torn labrum. While this has the advantage of not relying on the body to heal a labral repair, several studies have shown that labral repair has better long term outcomes than debridement. At least in my practice, labral repair is much more common. The labrum is repaired by drilling anchors into the bone of the socket, and using its sutures (thread) to wrap around and through the labrum to tie the labrum back into place. When doing a labral repair, any FAI should be addressed at the same time. Otherwise, there is a good chance of the repair failing (because the forces that tore the labrum would be the same forces causing it not to heal). Sometimes, a surgeon may tell a patient that the best procedure is an open surgical dislocation (through a large incision). There are some special cases where this approach may be preferable, but it is not common.

    Figure 5: Large anterior labral tear. Note the separation between the labrum and the acetabulum. Compare this to Figure 1.

    Figure 6: Picture of a labral repair. In the picture, there are three sutures that are anchored to the bone, sewing the labrum back to the acetabulum.

    A newer procedure to address labral tears is labral reconstruction. This uses a tendon graft to take the place of the torn labrum. Typically, this is only used for labrums that are so torn and degenerative, that repairing the labrum will not work to restore normal labral function.

    Figure 7: Labral reconstruction: In this picture, the labrum was not repairable. Instead, a tendon was used as a graft, to reconstruct the labrum.

    Hip arthroscopy is a passion of mine. I hope this has been helpful to you. If you have been diagnosed with a labral tear, please ask your surgeon specific questions. Over the years, I have seen many second opinions from patients who had less than successful outcomes from hip arthroscopy that thought they had a labral repair, but the surgeon actually did a labral debridement. To me, “fixing a tear” means sewing it back and anchoring the labrum; however, “fixing a tear” to some could also mean “fixing the problem caused by the tear”, which could mean debridement.

    Dr. Derek Ochiai is a board certified orthopaedic surgeon, specializing in Hip Arthroscopy and Sports Medicine, at Nirschl Orthopaedic Center for Sports Medicine and Joint Reconstruction. Follow him on Twitter @DrDerekOchiai. For more information go to the web site at www.nirschl.com.

  • What Is Good For Your Heart Can Be Murder On Your Elbow

    Dr. Robert Nirschl on televisions Good Morning America, with Charlie Gibson, discuss preventing tennis injuries. This interview was aired in 1996 but is still very relevant today.

  • Getting the most out of your orthopaedic doctors visit


    Robert P. Nirschl M.D., M.S.

    Your visit with your orthopaedic surgeon is an important meeting that can be most effective if you plan ahead. Research shows that understanding your diagnosis, and treatment plan, plays an important role in maximizing your results.

    Your orthopedic surgeon is a medical doctor with extensive training in the diagnosis and treatment, both nonsurgical and surgical, of the musculoskeletal system, including bones, joints, ligaments, tendons, muscles and nerves. At our orthopaedic center you will always be seen by an orthopaedic surgeon for diagnosis and formulation of the treatment program

    Be prepared to listen, and don’t be afraid to ask questions about your condition and treatment, whether basic or complex. It is important that you give your doctor all the information he or she needs and that you fully understand what your doctor is recommending.

    Be sure to tell your doctor everything about yourself including your diet, any current medication or herbal supplements you’re taking, any unusual habits, and any adverse reactions to medication you have experienced.

    The following checklist will help you and your doctor discuss the issues most important for getting the most out of the visit and ultimately to help establish a partnership between you and your doctor.

    1. Visit the physician’s web site and download the paperwork. Have it filled out and ready to go before you go in for your first visit.
    2. Bring all previous test reports, x-rays and MRI’s so they don’t have to be repeated or can be used as comparison to show how you are healing.
    3. Prepare a list of questions you would like to ask, starting with the most important issue to you.
    4. Bring a written list of all medications, herbs, vitamin supplements and over-the-counter medications you are taking.
    5. Bring a list of all medical problems, prior surgeries, and all current doctors and their locations and telephone numbers.

    Be honest and complete in talking with your doctor. Share your point of view and don’t hold back information about issues such as incontinence, memory loss, sex, or other issues that you might consider embarrassing. These can go far in helping the physician make an accurate diagnosis. Be sure to stick to the point to keep the visit on track.

    Take notes on what the doctor tells you, and ask questions if you don’t understand a medical term, the reason for the doctor’s recommendation, or the instructions for taking medication.

    Ask what to expect from your treatment, what effect it will have on your daily activities and what you can do to prevent further disability. If you feel the communication is not going well between you and your doctor, ask for a family member or friend to go with you to the next doctor visit. This person can help ask questions, and address concerns in areas you may have forgotten.

    Follow the doctor’s instructions. Take the full course of medication and make sure you follow the prescribed physical therapy or exercise routine. Remember, you have formed a partnership with your doctor. It is a team effort and requires understanding and support from both you and your doctor.

    If something is confusing or does not seem right, call the doctor’s office for advice. His/her staff often knows the answer or they will ask the doctor. If you are an active participant in your own care, things always go better. Ask questions, understand treatment, follow instructions, and you will be on the road to recovery. Remember it is a joint partnership, you and doctor working together, understanding your condition, treatment and each other.

    If you have an orthopaedic injury, contact the experts at Nirschl Orthopaedic Center in Arlington, Virginia. Schedule an appointment with an orthopaedic surgeon today by calling 703-525-2200 or visit our web site at www.nirschl.com. We are located on the campus of the Virginia Hospital Center in the center of Arlington, Virginia.