Submitted by Victoria Tustin from Bath ,Ohio

Q: I'm a competitive gymnast. And just recently if I stand or move in a certain way my right hip with pop out of place. You can put your hand their and feel the extra movements. It goes back almost immediately, the pain isn’t bad until it goes back into place, but it is very bothersome. Almost anything I do is making it pop out of place. Is there anything I should do to take care of this problem? If so I need to know, the last thing I need is another injury with gymnastics meets starting up.

Answered 12/03/08 16:28:46 by Dr. Harlan Selesnick

A: I recommend you see an orthopedic surgeon. Most likely the cause of the popping is ITB syndrome. There is a bandlike muscle that runs from the pelvis(ileum) to the outside tibia. It can rub on the outside of the hip(trochanter) and cause popping and pain. Usually this can get better witha rehab program aimed at improving the flexibilty of thos muscle. However, there are other possible causes of popping such as a labral crtilage teat or psoas tendonitis. The docor will establish a correct diagnosis and treatment plan so you can enjoy your gymnastic career. Harlan Selesnick

Submitted by Alejandro Babero from Las Vegas, Nevada

Q: I am a kinesiology major at UNLV and I plan on going on to med school afterwords. I haven't totally decided because i know I have a lot more time to decide my specialty. As of right now I am very interested in orthopedic surgery or emergency and sports medicine. All my life I have been very active in sports,I was just wondering what advice you could give me and how you became a physician for a professional sports team. Thanks.

Answered 11/29/08 14:50:29 by Dr. Harlan Selesnick

A: You need to complete the requirements to apply to medical school. Once in medical school you will exposed to many specialties. If you are still interested in sports medicine you would want to take some electives in this while in school. After medical school a residency in orthopedic surgery or family medicine is usually required. After residency you would apply for a 1 year sports medicine fellowship. During your fellowship you would then look for a job likley joining a group of pysicians who are involved in a sports medicine practice taking care of a variety of level of sports activities(high school, college, porfessional, etc.). I know this sounds like a long haul but if you enjoy what you are doing it is worth it. Good luck. Harlan Selesnick

Submitted by MIshka from New York City

Q: Dear Dr. Selesnick, Thank you for reading this. I don't know what else to do. I am a 30 year old medical social worker living in NYC. I have been athletic all my life and experienced a grade 2-3 sprain of my left foot back in high school. Since then, I have run marathons, shorter races, ride my bike and of course, walk a great deal. Following a long race some two years ago, I experienced left foot pain which has now become unrelenting. I have gone to sports medicine doctors, attended PT, and literally done everything I have been advised to and it does not improve. The last dx was "peroneal tendonitis." One doctor now recommends the shock wave treatment to break up scar tissue. Can you please advise me? Should I go ahead with this? I do not know what else to do and I feel I have exhausted most everything else. Thank you for your valuable time and any response you can give to me.

Answered 11/29/08 14:44:14 by Dr. Harlan Selesnick

A: Shock wave therapy has been shown to be effective for plantar fascitis but I am unaware of any studies that have been done for insertional peroneal tendonitis. There are 2 peroneal tendons that help to bringthe foot outwards. Usually tendonitis gets better with anti infalammaories, physical therapy, orthotics, and activity modification. It is also possible you may have some partial tearing of one of the tendons or another diagnosis. You may want to get a second opinion from an orthopedic surgeon or foot specialist with sports medicine training. Good luck. Harlan Selesnick

Submitted by Kevin from Whiteville, NC

Q: Just recently had an MRI due to severe leg pain and weakness in both legs. This is the results: Mild to moderate degenerative changes are seen thoughout. Disc space narrowing with mild bulging annulus fibrosis is seen at L2-3, L3-4 and L4-5 with mild to moderate bilateral exit foraminal encroachment at these leves slightly more pronounced at L3-4 and L4-5. At L5-S1 there is more pronounced central disc protrusion whic is causing some mass effect on the ventral aspect of the Thecal Sac. Moderate bilateral exit foraminal encroachment is seen at this level as well. Could you please tell me in what all this means in words that are easier to understand? Also I have only seen my Family Dr. Do I need to see a specialisit?

Answered 10/28/08 18:28:38 by Dr. Harlan Selesnick

A: If you have severe pain and weakness in the legs, particularly with these MRI findings you should see a spine specialist. The mri shows you have narrowing of the spinal canal secondary to the disc as well as narrowing of the foramin where the nerve roots exit. This can cause pressure on the nerve roots that make up the sciatic nerve which can result in pain running down the legs and weakness.

Submitted by marlene schurr from miami, fl 33176

Q: I went on vacation, ran lots of steps in the London subway system. Next day was not able to put weight on my right leg climbing steps. It hasn;t improved after 1 month.

Answered 10/17/08 15:11:54 by Dr. Harlan Selesnick

A: It is [ossible you may have a microfracture of bone known as a stress fracture. It is also possible you could have a form of tendonitis or an inflammation of the lining of the bone known as periostitis. Since your still having pain after a month it would be appropriate ot get an appointment with an orthopedic surgeon to establish a correct diagnosis.

Submitted by carol camaino from augusta, ga

Q: was playing tennis felt something pull in hip - about 4 hrs later r quad was in severe pain. Ended up in er that night. Saw sports med dr put on percoset. had mri said not related to back. Quadricep was numb and severepain for weeks. Saw neurologist - did needle test said no nerve damage after 9 weeks still in severe pain burning and sore and still numb. Cannot even walk without pain. Who should I see now?

Answered 10/01/08 20:47:37 by Dr. Harlan Selesnick

A: You may want to get a second opinion from another neurologist and also see an orthopedic hip specialist. Hopefully one of these docs can establish a correct diagnosis and initiate treatment that is effective. Good luck. Harlan Selesnick

Submitted by Michele Branzer from Miami, Fl

Q: I am a 58 year old female who got a Mortons Neuroma in my right foot 5 years ago from a bad fitting custom figure skating boot. After numberous injections which did not help, I finally had surgery. I now have severe numbness in the ball of my foot making it very difficult to wear a shoe, jog and walk long distances. I also have trouble falling asleep because when my foot is elevated the numbness gets worse. I have been back to the podiatrist since the surgery and have had numerous injections which don't help. Is there anything else I can to?

Answered 10/01/08 20:43:59 by Dr. Harlan Selesnick

A: When a neuroma is removed a numb area is left where the nerve was. It is unlikely your numbness will improve but many people adjust to the numbness. If you are concerned you may want to get another opinion. Good luck. Harlan Selesnick

Submitted by Joe from Nassau, Bahamas

Q: I'm 42, 150 lbs. I had an MRI after severe left leg pain. It showed herniated disks (L4-5 &L5-S1) which I'm told requires surgery because of "ventral thecal indentation & bilateral neural foraminal encroachment". I would prefer non-surgical alternatives. Also, I am very anxious to resume participation in weightbearing activity, which the orthopedic surgeon, acupuncturist and chiropractor say is a no-no. Is my preference for no surgery a realistic one? Thanks so much for any attention you can give.

Answered 09/14/08 11:35:29 by Dr. Harlan Selesnick

A: Mnay patients with herniated discs can do well without surgery. However, if significant pressure is put on the nerve roots where weakness of the muscles may be permanent then surgery may be neccessary. Most patients after surgery can resume ther regular lifestyle but this would need to be discussed with your doctor. Good luck. Harlan Selesnick

Submitted by Julie Parker from Roan Mtn Tn.

Q: I am 44 and have Plantar Fasitis on the back of my left heel. I have broken pieces of spurs kind of floating on the rear of the heel. The area is like a grape size with little chips of spurs. Surgery has been suggested but is there any other way that is not so invasive?? Thanks in advance julie Parker

Answered 09/14/08 11:30:43 by Dr. Harlan Selesnick

A: Plantar fascitis refers to inflammation of the arch where it begins on the heel. There are many nonsurgical treatments that can be tried before deciding upon surgery such as physical therapy, stretching, orthotics, an air heel, injection, or high energy shockwave treatment(Ossatron). Usually the spurs have been present for many years without symptoms and may not need to be removed. You may want to get a secondopinion. Good luck. Harlan Selesnick

Submitted by Jeff Sparks from Davie,Fl

Q: I recenly had a patella debreadment on Jan. 31, 2008 and the pain went from a 5 to 8 now. I have had this injury for 3.5 years before surgery. I saw you for the injury in 2005. I was considering surgery again or ossatron treatment. What do you think?

Answered 09/14/08 11:26:53 by Dr. Harlan Selesnick

A: It is hard to know what was found at surgery and why you are not doing better. Therefore I can not say whether surgery would help a second time. The high energy shock wave treatment(ossatron) may be helpful for tendonosis of the patellar tendon. I recommend you get another opinion. Good luck. Harlan Selesnick

Submitted by Patrick Occide from Miami Gardens,Florida

Q: About 7 weeks ago my 16 year old son had a avulsion fracture of his tibial tuberosity with displacement.The doctor send he need surgery and to rehab and be back at 100% it will take up to 10 months. My son is going to be in the 11th next year and d1 unversity are looking at him. What should i do because he don't want the surgery. The displacemnt is at 180 degree and its getting better.

Answered 08/18/08 11:49:44 by Dr. Harlan Selesnick

A: Displaced fractures of the tibial tuberosity need to be fixed to restore normal strength and function to the extensor mechanism(Quad tendon, patella, patellar tendon). Displacemant can also result in arthritic risk amd loss of motion. If you are unsure you should get a second opinion. Harlan Selesnick

Submitted by Kathleen from Columbus, MS

Q: I fell about 3 weeks ago in the kitchen onto my right knee. I could not bend my knee for quite a while after the fall. I had severe pain when walking and milder pain when at rest right after this happened. The pain has now moved into my right shin and it is excrutiating. There is some swelling, but not much. My knee and leg are extremely tender to touch. I am a nurse, and must be on my feet all day. What could be the problem?

Answered 08/18/08 11:46:24 by Dr. Harlan Selesnick

A: It is possible you have a severe contusion, a patella fracture, or a traumatic prepatellar bursitis. Sometimes you can also develop an infection in the traumatized tissue. You should see your orthopedic surgeon now to determine why you are not getting better and treat you properly. Harlan Selesnick

Submitted by SALLY from CASTAIC, CA

Q: Hello there, My 14 year old son hyperextended his right knee about 1 1/2 mos. ago during a rugby game. He had an MRI done and the impression states the following: 1. Full thickness tearing of the more proximal fibers of the ACL. 2. Posterior and lateral plateau and to a lesser extent lateral femoral condyle contusion. Needless to say he is no longer playing rugby until next year. He went to practice last week but says he's still in pain. He has been doing some rehab excercises at home and a little bit of jogging. Do you think he needs surgery? Thank you, Sally

Answered 08/18/08 11:43:27 by Dr. Harlan Selesnick

A: A patient that young who wants to remain active for many years will usually need surgery to make a new acl(acl reconstruction). If your son is still growing this amy complicate the timing of surgery but it will still need to be done. Initially a rehab program is performed to regain full motion and strength prior to surgery. The surgical techniques and sources of acl graft also need to be discussed with your orthopedic surgeon. Good luck. Harlan Selesnick

Submitted by Tina Lewis from Rebecca,Ga

Q: I injured my back lifting something heavy about a week ago.I didn't see a dr. immediately; i was hoping it was just a muscle and it would go away.The 2nd day, I still could not get out of bed on my own so i called and made an appointment.I have terrible pain in my low back and occasionally a stabbing, shock-like pain in my right buttocks and down my right leg to my knee.X-rays they say are normal,no fracture.And they are treating me for a cramped muscle.800mg Ibuprofen and Flexiril.It's not helping.I'm wondering if it could be more than a muscle.What else could it possibly be?

Answered 08/17/08 18:07:58 by Dr. Harlan Selesnick

A: It is possible that you have sciatica which can be caused by a disc problem in the lower back. If symptoms persist then you may want to see an orthopedic surgeon or spine specialist. An mri scan may be helpful to confirm the diagnosis. Good luck. Harlan Selesnick

Submitted by Keith Boone from Louisville, KY

Q: Hi my name is Keith. Approximately 6 years ago I fell when running and stretched the inside of my knee. I limped on a cane for 6 weeks before seeing a doctor. He did flexation tests, took 2 MRI's, and gave me shots over the first couple years and never found anything wrong. A second doctor verify the firsts results and says my knee "feels tight". To this day I still have pain isolated to the inside of my knee when performing any high impact activity. I believe it is MCL pain based on the net, but am lost since I have had multiple doctors look at it. I am extremely active and my knee slows me down constently. Is there anything I can do at this point?

Answered 08/17/08 18:05:18 by Dr. Harlan Selesnick

A: It is possible that the mri's where not entirely accurate and you sustained an injury to the inside part of the knee such as an MCL sprai, medial meniscal cartilage tear, or articular cartilage injury. Technology has improved and I recommend you get another opinion from a sports medicine specialist who in addition to the physical exam may order a high resolution mri scan. Usually an accurate diagnosis and successful treatment can be acheived. Harlan Selesnick

Submitted by Richard from St. Leo, FL

Q: My son is 12 and is playing baseball in a local sports league. He has a sharp pain in his left side that only occurs when he is pitching. He is right handed and throws overhand, the mechanics do not seem to be any different than they were last year when he pitched. The pain does not occur when he throws from any other fielder's position like OF or SS nor does he hurt when riding his bike or tubing behind our boat. Any ideas?

Answered 08/17/08 18:00:51 by Dr. Harlan Selesnick

A: It is difficult to say what is wrong without doing an exam of your son. Different sports and different positions have different mechanics and this may explain why the pain is not present with this other activities. Possible diagnosis include an inflammation of the ribs(costochondritis), stress fracture, or muscle strain. If this continues you should have your son see an orthopedic surgeon. Harlan Selesnick

Submitted by Kathy Bolton from Concord NC

Q: I have severe tear of the peroneus longus tendon on my right foot. I am in a cast right now for the next couple of weeks. I am not in a position where surgery is an option so are there an alternatives to help heal this problem. Thanks.

Answered 08/17/08 17:56:08 by Dr. Harlan Selesnick

A: The peroneal tendons help to evert(bring your ouside of the foot upwards).Sometimes casting followed by a rehab program can result in normal painfree function for a peroneal tendon tear. Properly fitted orthotics for your shoes may also help. Many times non surgical treatment does not work and surgery is needed for normal painfree function. Good luck. Harlan Selesnick

Submitted by Dexter Romanez from Miami, florida

Q: I am 34 years old and have been suffering from pain in my right wrist for many years due to an old fracture. I recently aggravated my wrist lifting weights. What can I do to speed-up the healing time? Are there any exercises that I can do to strengthen my wrist to prevent future injuries?

Answered 08/17/08 17:50:37 by Dr. Harlan Selesnick

A: If your wrist is painful it would be a good idea to visit your orthopedic surgeon or hand specialist. The problem amy be as asimple as a tendonitis that could be treated with an anti inflammatory or exercise. However, it could be more significant such as a cartilage tear or early arthritis. Dpending upon the diagnosis healing time can vary and exercises and strengthening may not work. Harlan Selesnick

Submitted by J. Quereau from Palmetto Bay

Q: I had reconsructive surgery on my right wrist about 2 1/2 years ago. I have VERY limited mobility in it after 6 months of rehab. The doctor said that was expected and would not regain anymore flexibility. Are there any websites that offer exercises for people with this (and other) obstacles. I would like to strengthen my chest and back, but have found you need the wrist to bend farther than I am capable of. (or expensive equipment) Thanks

Answered 08/17/08 17:46:35 by Dr. Harlan Selesnick

A: Depending upon your range of motion and your diagnosis determines whether addional motion is possible. It would be unusual to gain significant motion this long after surgery. You would need to discuss this with your wrist surgeon as to what else could be done with exercise or surgery. Good luck. Harlan Selesnick

Submitted by Paula from Geneseo, IL

Q: I have spondylithosis of the lower back. What type of exercises should I do? I especially would like to know about riding a bicycle? Thank you

Answered 08/17/08 17:43:42 by Dr. Harlan Selesnick

A: Spondylolithesis is a condtion where a portionof the vertebrae of the spine"pars" is not fused with solid bone and is replaced with cartilage or fibrous tissue. There are differet degrees of spondylolithesis depeding upon the displacement of the vertebrae. Many patients with this condition have no pain and can fuction normally. Some spots such as gymnastics, football or tennis can aggrevate the condition. Depending upon the severity of your condition, age, activity level and pain determines what exercises are safe. Usually cycling is fine. However, it would be best to discuss the specifics of your condtion with a spine specialist. Good luck. Harlan Selesnick