DEAR MAYO CLINIC: I need to have a joint replacement, but I'm really nervous. What questions should I ask my orthopedic doctor?

ANSWER: Knee and hip replacements have changed so much due to advanced surgical techniques, making them far different from those even five years ago. From multiple-day hospital stays, total joint replacement has advanced to a one-night stay or even going home the same day as surgery.

Questions from my patients usually fall into three categories:

• How do I know it's time for surgery? 
• What will happen during surgery? 
• What will recovery be like?

Let's start with the "when" question. Patients undergoing replacement surgery have arthritis in the joint. Arthritis is the loss of the protective cartilage layer between bones, and when that cushioning is gone, you have bone-on-bone contact, pain and swelling. Physical therapy, over-the-counter medications and injections can help for a while. 

Eventually, the pain and discomfort affect your mobility and activities of daily living, whether it's walking the dog or playing with grandkids. That's when you may decide it's time.

But joint replacements aren't only for older patients. Total joint replacement in people in their 50s is no longer uncommon.

Deciding on surgery

Once you've decided on surgery, the next step is preparation, particularly making sure any chronic conditions like diabetes or high blood pressure are under control. To reduce your risk of infection, stop any steroid injections at least three months before surgery. You'll also need to address dental work, such as cleanings.

Your orthopedic care team will provide you — through classes and printed guides — with a wealth of information on how to prepare, including:

• Required preoperative tests and exams.
• Adapting your home for recovery.
• Arranging for care when you return home, such as having a support person with you through the early weeks.
• Setting up transportation to and from physical therapy and medical appointments. 
• Requesting a temporary accessible parking permit.

If you have questions or concerns, be sure to ask your care team so that you feel ready for surgery and recovery.

Your surgeon also will be preparing. This includes using X-rays or CT scans to study your bones and anatomy. 

If your surgeon is using robotics, they're able to make a 3D model of the joint to assist with planning your joint replacement. In knees, this lets them correct issues caused by arthritis, such as bow-leggedness or knock knees.  During your surgery, the surgeon will map your knee in the operating room to the 3D model on the computer built from your preoperative CT scan. Your surgeon will use the robot to collect information on ligament balance and alignment so they can determine the best position to place your implants. 

While robotics makes total joint replacement more accurate, it doesn't make it less invasive. It helps achieve a more precise balance, which can lead to less pain and wear and tear on the implant.

When it comes to hip replacement, there are multiple surgical approaches available. The two most common approaches are the posterior and the direct anterior. The direct anterior approach is a more recent surgical technique that has gained popularity over the last decade. The anterior approach is considered "muscle-sparing" because the surgeon is working between the muscles. As a result, patients tend to recover faster, and there's less risk of dislocation.

For both knee and hip replacements, don't hesitate to talk with your surgeon about the techniques they'll be using.

After surgery

After surgery, knee and hip recovery differ:

• Knees. For the first two weeks, there's pain and swelling, but also the need to regain range of motion to minimize stiffness and scar tissue. Therapy is a big focus of early recovery. At-home physical therapy is every day; in-person is typically twice a week. 
• Hips. The first few weeks are for letting the incision heal and reducing pain and swelling. That means gradually increasing activity, using a walker, then a cane. Most patients do home-based therapy but not in-person therapy.

Whether you've had a knee or hip joint replacement, you're able to return to your regular activities within three months. However, there may be some restrictions. For the hips, these may include avoiding extreme positions, such as deep squatting and certain yoga poses, to decrease dislocation risk. For knees, kneeling may be uncomfortable and often isn't recommended. Also, don't be alarmed by clicks and pops from your implants — they're normal. 

Overall, patients do well with total joint replacement. This is a long journey, so an incredibly important part of your success is the relationship with your surgeon and care team. They'll be with you from beginning to end to ensure you have the best possible outcome.

Kariline Bringe, M.D., Orthopedics and Orthopedic Surgery, Mayo Clinic Health System, La Crosse, Wisconsin

Related post:

• AI, robotics and motion-preserving implants expand spine surgery options for patients

The post Mayo Clinic Q&A: Questions to ask before joint replacement surgery appeared first on Mayo Clinic News Network.

DEAR MAYO CLINIC: I like to challenge myself physically, whether it's working out, cycling or cross-country skiing. I've heard about VO2 max testing. What could I gain from it?

ANSWER: A VO2 max test measures the amount of oxygen you breathe in and use at peak levels of exercise intensity, and it assesses how well your heart, lungs and muscles work together during aerobic (cardio) exercise. Whether you're an athlete or not, a VO2 max test can provide insights into your cardiopulmonary fitness.

Due to the cost and specialization of the equipment, a VO2 max test is typically conducted in a sports medicine setting or an academic exercise science department. Be sure to check with your insurance provider to see if this service is covered.

What to expect

During the test, the person wears a breathing apparatus while running on a treadmill or biking on a stationary cycle. Gradually, the exercise protocol becomes more difficult, such as increasing speed, ,grade or pedaling resistance. They're instructed to exercise as hard and for as long as they feel like they physically can. 

The equipment then captures the peak volume and flow rate of air being inhaled, later converting that data into the maximal volume of oxygen consumed and the rate of energy expenditure.

The results give the participant a baseline value. For instance:

• If a person is more sedentary, their baseline may be in the 20s (20 milliliters/kilogram/minute — ml/kg/min) of peak oxygen consumed. 
• For someone who's fairly active — maybe participating in a recreational activity coupled with some strength and cardio training — their score may be in the 40s. 
• Those with a VO2 max in the 70s probably are elite-level endurance athletes. 
• Elite cross-country skiers may have a VO2 max score in the 80s and possibly even 90s (80-90 ml/kg/min).

Thousands of published studies support the finding that cardiopulmonary fitness is associated with reduced risk of cardiovascular disease, obesity, sleep apnea, metabolic syndrome and a number of other chronic health conditions, in addition to reduced risk for all causes of mortality. 

Improving cardiopulmonary fitness

Your VO2 max isn't static. It can be improved with consistent exercise or training. 

For example, someone who's inactive can use their baseline values as a starting point. Working with a trainer or other fitness professionals, they can build a cardiopulmonary workout program using the most effective strategies to improve their cardiopulmonary fitness. Doing cardiovascular exercise three to four days a week may improve their VO2 max by 20%-30% over three to six months. The key is exercising regularly, and as fitness improves, gradually push the limits. This also can be done by adding high-intensity intervals to a program.  

Those with higher VO2 max scores to start with will have less room for improvement, since they're already at a higher fitness level. Genetics also play a role in aerobic fitness.

Test functions

Athletes are the most common participants in VO2 max tests. They're usually familiar with the test and how the measurement can be used to enhance their performance. This objective feedback is one way to help them measure progress and shape their training regime. For example, they may map out their training sessions based on what percentage of their VO2 max they want to work at that day. 

People who have had heart attacks or heart surgery typically enroll in a cardiac rehabilitation program. This often involves a stress test with cardiovascular function measured in real time by an electrocardiogram (ECG) unit. Throughout their rehabilitation, the test provides feedback for exertion levels, which also helps them rebuild their cardiopulmonary fitness. While not a VO2 max test, it encourages similar behavior of consistent, progressive physical activity.

Wearables, such as smartwatches, can provide good feedback on heart rate and regular exercise outputs. However, they aren't sophisticated enough yet to reliably measure VO2 max. 

But people also have a built-in measure of fitness. You know when you get out of breath and tired, whether it's on a long walk, climbing stairs or shooting hoops. This knowledge is subjective and doesn't provide hard numbers, but it can be a useful guide as you work to improve your fitness. 

For instance, you may be winded after climbing a flight of stairs. You start moving more, walking for 30 minutes rather than 15, notching up your walking speed or walking a more challenging route. After a few weeks, climbing those stairs might not be so hard. You know your cardiopulmonary fitness has improved, but you don't know by how much.

Some people want to see the hard numbers to confirm how they feel. That's what a VO2 max test can provide. 

Andrew Jagim, Ph.D., Sports Medicine, Mayo Clinic Health System, La Crosse and Onalaska, Wisconsin

The post Mayo Clinic Q&A: What does a VO2 max have to do with overall fitness?  appeared first on Mayo Clinic News Network.

For years, a lifelong athlete was sidelined by chronic wrist pain that took more than just her ability to compete — it took a part of her identity. Now, thanks to an innovative surgical approach at Mayo Clinic, a Minnesota woman is back on the court, returning to the game that means so much to her. 

Watch: Innovative wrist surgery helps athlete return to the pickleball court after decades of pain

Journalists: Broadcast-quality video (3:06) is in the downloads at the end of this post. Please courtesy: "Mayo Clinic News Network." Read the script.

"Being an athlete has always been a part of my life," says Tami Lucius.

A former college basketball player, the 54-year-old from White Bear Lake, Minnesota, also loved playing tennis. But devastating wrist pain kept her off the court for two decades.

"I didn't know what it was, but it was always on the outside of my wrist," she says. "I really had a sense of loss with my life and with that sense of community from not being able to be in sports. And then a girlfriend of mine from high school, out of the blue, said, 'Hey, come and play pickle with me.' I knew pickleball was something that I was going to love."

But unfortunately, almost immediately, Tami's wrist pain returned.

"It got so bad that I couldn't even do the acts of daily living. So even making a bed, washing my hair, it didn't matter what I was doing, the pain was always there and the instability was always there," she says.

Rather than giving up another sport and a community she loved, Tami came to Mayo Clinic to see Dr. Sanj Kakar, a hand and wrist specialist.

"She was struggling. I think the biggest frustration for her was the pain was affecting not only sport but also activities of daily living," Dr. Kakar says.

"He was such a kind person, and he knew that, for me, this journey was more than just the pickle, it was part of my life and my identity. And he took the time to really share with me what he felt we needed to do," Tami says.

"Just by listening to her, examining her, looking at the imaging, we then were able to pinpoint the major causes of her problem," says Dr. Kakar. "The TFCC, or the triangular fibrocartilage complex, sits right in this area. She had a problem not only with that TFCC, or that sort of shock absorber for that part of the wrist, but also the tendon. So for Tami — especially with sport — hitting tophand, topspin, forehand, backhands — anything with twisting and grip would cause pain in here."

Wrist surgery

With Tami's wrist problem diagnosed, Dr. Kakar recommended a novel surgical technique he and his colleagues developed at Mayo Clinic in Rochester, Minnesota.

"It's what we call the over-the-top TFCC technique, which allows us to more accurately place stitches, or sutures, in the tear exactly where the tear is, in a more minimally invasive manner," he says. "It's a very precise method to fixing an area."

Tears in the TFCC often don’t appear on traditional MRI scans and may only be identified once a camera is placed inside the joint. Dr. Kakar uses a smaller, more flexible camera system, allowing for clearer visualization and more precise diagnosis and treatment.

The technique has several benefits compared to some conventional wrist repair approaches, including faster completion, less radiation exposure and lower fracture risk.

Back on the court

After successful surgery at Mayo Clinic, Tami is now back on the pickleball court, three times a week — pain-free.

"My wrist is the most stable joint on my entire body today," Tami says. "It does bring tears to my eyes because I didn't realize how much I missed sports in general. I get such a sense of identity who I am, my passion for competition, my passion for people. Mayo didn't just give me my wrist back and the ability to play pickle again, Mayo gave me my life back."

Related post:

• Mayo Clinic Minute: How to prevent injuries when playing pickleball

The post Innovative wrist surgery helps athlete return to the pickleball court after decades of pain (VIDEO) appeared first on Mayo Clinic News Network.

Mayo Clinic orthopedic surgeon describes advances in care for common back, neck problems

ROCHESTER, Minn. — People worldwide seek medical care for back and neck pain, which can interfere with sleep, mobility and daily life. For individuals who need surgery for spinal conditions, advances in robotics, artificial intelligence (AI) and motion-preserving implants are expanding treatment options and allowing for more personalized treatment, according to Ahmad Nassr, M.D., orthopedic surgeon at Mayo Clinic.

Dr. Nassr treats a wide range of spinal conditions that can affect mobility and cause pain, including:

• Herniated disk, a problem with one of the rubbery cushions, called disks, which sit between the bones that stack to make the spine.
• Spinal stenosis, a narrowing of the space around the spinal cord that can put pressure on the spinal cord and nerves that travel through the spine.
• Scoliosis, a side-to-side curve of the spine that can cause pain and breathing problems. 
• Spinal tumors, lesions that start in or around the spine.
• Degenerative spine conditions that most commonly affect older adults, such as degenerative disk disease and adult degenerative scoliosis. These conditions can cause severe symptoms, including stiffness, numbness or tingling from nerve damage.

Research has shown that low back pain is the leading cause of disability around the world, and the elderly are one of the most vulnerable populations.

"My practice is to assess each of my patients holistically, regardless of their age, to determine whether they can benefit from spinal surgery based on the treatment goal, whether it's to reduce pain, restore their ability to work or improve their quality of life," Dr. Nassr explains.

Motion-preserving alternatives to fusion

Many spinal conditions — such as degenerative disk disease, scoliosis and spinal stenosis — used to be treated with fusion surgery, in which two or more spinal bones are connected and heal as one bone. The procedure reduces pain but also limits spinal flexibility.

Motion-preserving devices, such as artificial disk replacement, offer alternatives that maintain more natural spinal movement.

Dr. Nassr served as principal investigator at Mayo Clinic in randomized controlled trials that led to Food and Drug Administration (FDA) approval of the TOPS replacement device, which stabilizes the spine while preserving movement. The device can be used to treat pinched nerves and spondylolisthesis, which is a slippage between two vertebrae.

Mayo Clinic was the first medical center in the U.S. to implant the FDA-approved Minimally Invasive Deformity Correction (MID-C) device to treat scoliosis. 

Dr. Nassr and other researchers are studying next-generation implants designed to replace both the disk and facet joints to maintain natural flexibility.

Robotics and minimally invasive surgery

Surgeries that once required large incisions can now be performed through small openings, reducing postoperative pain, helping patients recover faster and shortening hospital stays.

Conditions such as herniated disks, misalignment of the spine, spinal stenosis or instability can now be treated with a minimally invasive approach.

Robotic-assisted platforms, combined with CT scans and MRI, allow surgeons to plan complex spinal procedures and determine the most precise pathways for implants before surgery begins.

"Advances in robotic-assisted surgery, AI, 3D models and motion-preserving implants are allowing us to treat complex spinal conditions with greater precision and less disruption to back muscles," Dr. Nassr says. "These technologies are changing how spine procedures are performed and can support faster recovery for patients."

Advances in anesthesia, including specialized nerve blocks, also have significantly improved postoperative comfort and shortened hospital stays.

Personalized surgery with 3D models

In complex cases, surgeons can create 3D-printed models of a patient's spine — including nerves and blood vessels — and design custom implants tailored to the person's anatomy. These models allow surgeons to rehearse procedures before the operation and refine surgical planning.

Complex cases — such as advanced adult scoliosis, revision surgery or spinal tumors — often involve a multidisciplinary team of specialists, including orthopedic surgeons, neurosurgeons, anesthesiologists and rehabilitation specialists.

AI in spine care

AI is integrated into multiple aspects of spine care at Mayo Clinic. AI-supported tools assist in analyzing clinical data to guide treatment decisions and enhance surgical planning. In research, Dr. Nassr uses AI to better assess bone health and osteoporosis for patients who may need spine surgery.

"Advances in spine surgery enhance patient care as well as our ability to provide more personalized treatments," says Dr. Nassr.

###

About Mayo Clinic
Mayo Clinic is a nonprofit organization committed to innovation in clinical practice, education and research, and providing compassion, expertise and answers to everyone who needs healing. Visit the Mayo Clinic News Network for additional Mayo Clinic news.

Media contact:

• Caroline Auger, Mayo Clinic Communications, newsbureau@mayo.edu

The post AI, robotics and motion-preserving implants expand spine surgery options for patients appeared first on Mayo Clinic News Network.

John Zajac, a certified golf physical therapist at Mayo Clinic Sports Medicine, demonstrates the best pre-golf dynamic warmup stretches. 

Watch: The Mayo Clinic Minute

Journalists: Broadcast-quality video (1:04) is in the downloads at the end of this post. Please courtesy: "Mayo Clinic News Network." Read the script.

Mayo Clinic doesn’t just advise golfers on stretches and strength. For 25 years, it has served as the official medical sponsor of the WM Phoenix Open, providing on-site care for athletes, event staff and spectators. Supporting one of the world’s largest golf events, from heat-related illness to musculoskeletal injuries, reflects deep expertise in both prevention and knowing when specialized care is needed. 

The golf swing requires coordinated rotation through the hips and upper back. When those areas are stiff, the lower spine often compensates, increasing strain and risk of injury. Spend 5-10 minutes warming up before each round. It helps improve performance and protects your joints. 

These golf warmup stretches help you stay healthy and out of the orthopedics office. See you on the green. 

Related posts:

• Mayo Clinic Minute: 4 physical therapist-recommended golf exercises
• Mayo Clinic Minute: Are the yips just nerves or something more?
• Mayo Clinic Q and A: Golf-related wrist pain and injuries

The post Mayo Clinic Minute: Dynamic golf warmup to prevent injuries appeared first on Mayo Clinic News Network.

Dancing is more than just a hobby or passion for 22-year-old Reagan McDaniel. It's her life's calling. When she entered the Bachelor of Fine Arts program at Jacksonville University in Florida as a dance major, Reagan felt like she was on her way to the life she had dreamed about. 

But after finishing a challenging dance routine during the fall recital of her freshman year, Reagan felt a sharp ache in her left hip. She stretched, and it felt better the next day. However, when the pain kept returning sharper and lasting longer, Reagan got the nagging sensation that something was wrong.

"I continued to dance on it for months," says Reagan. "I know a lot of dancers have chronic pain. I thought this hip pain might just be something I would have to learn to live with."

After five months of progressive pain, Reagan finally mentioned it to her mother, who works in the medical field. Her mom, who previously underwent surgery for a hip labral tear, recognized the signs and made an appointment for Reagan with a sports medicine and orthopedic specialist at Mayo Clinic in Florida, where she works.

Crushing news 

Reagan met with Dr. Luke Spencer Gardner, an orthopedic surgeon specializing in hip surgery. As Reagan's mom suspected, an MRI revealed a torn hip labrum, the cartilage lining the hip joint socket. 

Dr. Spencer Gardner explained that Reagan had femoroacetabular impingement (FAI). FAI occurs when the ball-and-socket of the hip joint don't fit together properly, and the hip bones rub together. In Reagan's case, a bony protrusion on the ball caused the misalignment. It's not uncommon for extra bone to develop during natural growth and development, but when it pinches the labrum, it can lead to tearing. Repetitive or twisting motions, like those used in dancing, are also a contributing factor and can make tearing more likely.

"I remember getting the news that I had been dreading," says Reagan. "I was so upset. But my mom assured me that Dr. Spencer Gardner would take good care of me, and sure enough, he did."

Hip preservation surgery times 2 

Reagan tried physical therapy to reduce the pain, but between her dance schedule and the severity of her tear, she was not making good progress. Dr. Spencer Gardner suggested hip preservation surgery to fix Reagan's structural hip injuries and eliminate her pain so she could get back to dancing. Hip preservation also has added long-term benefits by helping prevent early onset osteoarthritis and delaying the need for hip replacement.

In November of her sophomore year, Reagan underwent a hip arthroscopy and labral repair. Dr. Spencer Gardner fixed the tear and shaved down the bone spur, operating through small incisions using a tiny camera called an arthroscope and specialized instruments. 

The minimally invasive surgery was an outpatient procedure, and Reagan went home the same day with no complications. The expected recovery time for the procedure is typically six months. 

But less than two months later, Reagan once again experienced the nagging feeling that something was wrong. This time, the pain was in her right hip.

"I had just started my spring semester and was still using a crutch to recover from the first surgery, when I felt the same kind of pain," says Reagan. "I told myself that my hip was just sore from overcompensating during my recovery, but soon I was back in front of Dr. Spencer Gardner and getting another MRI." 

Imaging showed a similar labral tear and smaller FAI in her right hip. At the end of January, less than eight weeks after her first surgery, Dr. Spencer Gardner performed a second hip preservation surgery (arthroscopy and labral repair) on Reagan's other hip.

"I remember being in that hospital the second time and wondering whether I was ever going to dance the same way I had before," says Reagan. "Then I locked in and made the decision that I wanted to be back dancing by six months from my first surgery."

The road back to dancing 

Physical therapy was critical to Reagan's recovery. The physical therapists at Mayo Clinic guided and supported Reagan as she pushed to regain her strength and restore flexibility. Four months after the second surgery, Reagan started easing back into dance.

"I was worried I might get injured again, but I know my body well enough to know when to start," says Reagan. "I began with marking, a dance term for performing movements on a much smaller scale to mentally rehearse and then working yourself up to bigger and bigger movements."

Reagan spent time learning choreography and teaching at several local studios. She worked hard to make up for all the dance training she missed. Somewhere along the way, she found herself drawn to hip-hop.

"While I was not fully back by the six-month mark, I was doing hip-hop at that point," says Reagan. "Hip-hop doesn't require as much leg lifting and floorwork as other dance styles, so it was easy to start with it. But I realized how much I loved it."

Dancing toward a bright future 

Reagan is forever thankful to her entire team at Mayo Clinic. The nurses helped calm Reagan when she was nervous about anesthesia. The physical therapists pushed her and supported her quick recovery. Dr. Spencer Gardner gave Reagan back the gift of dancing.

After college graduation, Reagan has plans to move to Los Angeles, where she will be pursuing a career in professional dancing.

"I'm finally back to where I was before my surgeries," says Reagan. "I may not be as flexible as I used to be, but I have the same strength and movement quality I had before. And my passion for dancing is stronger than ever."

Related post:

• Mayo Clinic in Florida expands shoulder arthroplasty with robotics, scaling capability across sites

The post Dancer’s comeback made possible by hip preservation surgery appeared first on Mayo Clinic News Network.

Mayo Clinic in Florida recently performed its first robot-assisted shoulder arthroplasty, marking the arrival of enhanced, precision orthopedic care for patients in the Southeast and bolstering Mayo Clinic's commitment to advancing models of care across the organization.

Shoulder arthroplasties — also known as shoulder replacements — are reserved for patients with shoulder osteoarthritis whose symptoms are not manageable with nonsurgical treatments such as physical therapy, injections and medications. Shoulder replacements have traditionally been performed using manual instrumentation and surgeon-estimated alignment. While this approach has been effective, it is inherently limited by visual estimation and anatomic variability in patients. 

"What's happened over the past 10 to 15 years in orthopedics is we've started using computer navigation and now robotic assistance," says Dr. Erick Marigi, a Mayo Clinic orthopedic surgeon. "In the hip and the knee, they've been doing robot-assisted replacements for years, but for the shoulder (because it’s a smaller complex joint), it's just been harder to develop, until now."

In manual shoulder replacements, surgeons make an incision and use guides to position implants. Though 3D computer planning has been available and is helpful, execution in the operating room has remained manual.

"We're no longer limited by our eyes and using a guide, which has a few millimeters of variance," says Dr. Marigi. "Now it's one degree of variance and under a millimeter of precision."

Another key advantage of robot-assisted shoulder replacements is improved consistency and reproducibility, particularly in complex cases. The technology simplifies procedures for patients with significant bone wear or other challenges that make conventional techniques difficult, allowing surgeons to achieve more predictable results. 

Long-term efficacy data for robot-assisted shoulder replacements are emerging, but evidence from robot-assisted hip and knee replacements is promising. Cases once considered highly complex can now be approached more like standard procedures.

Innovation and integration

Dr. Marigi says the adoption and integration of robot-assisted surgery is a testament to Mayo Clinic's spirit of bridging innovation into action.

"It is the spirit of Mayo Clinic in general: constantly pushing the envelope and providing solutions that help patients," he says.

Dr. Marigi's mentors, Drs. Joaquin Sanchez-Sotelo and John Sperling, both orthopedic surgeons at Mayo Clinic in Rochester, laid the foundation for robot-assisted orthopedic surgeries across Mayo Clinic. 

"Collaborative efforts have never been better across Mayo Clinic as a healthcare enterprise," says Dr. Sanchez-Sotelo. "The implementation of robot-assisted shoulder arthroplasty across all campuses allows us to offer the same quality care to all our patients, regardless of geography. It also facilitates lines of collaboration for innovation and research across our institution."

Dr. Sperling, who in April 2024 completed the world's first robot-assisted shoulder surgery, says, "Robotic shoulder arthroplasty has the potential to significantly improve our ability to enhance the quality of care for our patients worldwide."

Later that year, Dr. Sanchez-Sotelo also performed a robotic total shoulder replacement. 

"Our new generations will embrace robot-assisted surgery and enjoy iterative processes through which digital enabling technology will only continue to improve," says Dr. Sanchez-Sotelo.

Among that new generation is Dr. Jeff Hassebrock, an orthopedic surgeon at Mayo Clinic in Arizona, who performed the first robot-assisted shoulder replacement in the Southwest, extending the site's leadership in robotic orthopedic surgery. He believes that the intersection of artificial intelligence, preoperative planning and robotic procedural execution will lead to a renaissance in how standard shoulder replacements are performed.

"Mayo Clinic's investments in advanced technologies reflect our commitment to providing innovative, patient-centered care," says Dr. Hassebrock. "Robotics improves the precision and execution of surgical plans that meet the evolving needs of orthopedic care. The era of pre- and postoperative measurement is at hand."

Dr. Marigi believes Mayo Clinic surgeons will continue shepherding this next phase of innovation in orthopedic care. Now, for patients in the Southeast, the technology offers access to innovation closer to home.

"Patients will all have access to this internationally renowned technology locally. That was a big deal for our team," says Dr. Marigi. "I think this is going to be one of our pillars in the future, and the people leading that charge will be Mayo Clinic surgeons."

The post Mayo Clinic in Florida expands shoulder arthroplasty with robotics, scaling capability across sites appeared first on Mayo Clinic News Network.

As golfers head back to the course during peak golf season, Mayo Clinic sports medicine and orthopedic experts are available to discuss the most common early-season golf injuries, how to prevent them, and when to seek medical attention.

While headlines may focus on injuries affecting professional golfers, including Achilles tendon, back and ankle issues, most golf injuries are not sudden. They develop over time and are often preventable with proper warm-up, strength and mechanics.

What causes most golf injuries?

"Golf may appear as low-impact, but the repetitive, rotational nature of the swing places stress on the spine, shoulders, hips and forearms," says John Tokish, M.D., a Mayo Clinic sports medicine specialist. "Over time, limited mobility, poor mechanics or lack of strength can lead to overuse injuries, especially early in the season when activity levels increase."

Common injuries include:

• Low back pain
• Shoulder and rotator cuff injuries
• Elbow injuries, including golfer’s elbow
• Wrist and forearm strain
• Hip and ankle instability

Many golf injuries are preventable

The majority of golf-related injuries are linked to doing too much, too soon or returning to play without proper preparation. Three key prevention strategies:

Warm up before every round
A dynamic warm-up prepares muscles and joints for the rotational demands of the golf swing. Learn more: Mayo Clinic Minute: Dynamic golf warmup to prevent injuries

Build strength off the course
Resistance training improves stability, balance and control. Strengthening the core, shoulders and lower body helps protect joints and supports a more efficient swing. Learn more: Mayo Clinic Minute: 4 physical therapist-recommended golf exercises

Focus on proper mechanics
Poor mechanics can increase wear and tear over time.

Golfers experiencing persistent or concerning symptoms should consult a qualified healthcare professional.

When is pain not normal?

Muscle soreness can be expected, especially early in the season. However, certain symptoms may indicate a more serious issue:

• Pain lasting more than a few days
• Pain that wakes you at night
• Pain that affects your swing or performance
• Sharp or worsening pain with activity

Early evaluation by a sports medicine or orthopedic specialist can help prevent minor issues from becoming more serious injuries. With proper preparation, golf remains a safe and lifelong sport for players of all ages.

Expert sources:

• Rochester, Minn.: Adam Tagliero,  M.D., Sports medicine/orthopedic specialist, Mayo Clinic
• Phoenix: John Tokish, M.D., Sports medicine specialist
• Jacksonville: Matthew Crowe, M.D., Orthopedics and Sports Medicine
• Mayo Clinic Health System: Bradley Kruckeberg, M.D., Orthopedics and Sports Medicine

About Mayo Clinic

Mayo Clinic is a nonprofit organization committed to innovation in clinical practice, education and research, and providing compassion, expertise and answers to everyone who needs healing. Visit the Mayo Clinic News Network for additional Mayo Clinic news. 

Media contacts:

Carey Stanton, Mayo Clinic Communications, newsbureau@mayo.edu

The post  Golf injuries are preventable — what to know as golfers return to the course during peak golf season  appeared first on Mayo Clinic News Network.

DEAR MAYO CLINIC: My daughter is on her high school soccer team and has seen teammates sidelined with ACL injuries. What can she do to prevent this from happening to her?

ANSWER: No one wants to hear the distinctive pop of an ACL tearing or rupturing, which typically means the player's season is at an end. The ACL, or anterior cruciate ligament, is located inside the knee and provides stability during movements such as cutting, turning, twisting and jumping. 

Risks of ALC injuries

Women and girls are up to 8 times more likely to experience ACL injuries than men. While the causes are still being studied, several factors may contribute to the increased risk:   

• More girls and women are participating in competitive sports.
• Women's wider pelvises create a greater angle from the hip to the knee, which changes how force travels through the knee.
• The ACL in women is thinner than in men.
• The strength of women's quadriceps — the muscles in the front of the thigh — is greater than the strength of their hamstrings — the muscles in the back of the thigh. The opposite is true in men. When women land from a jump, their quads can overpower their hamstrings, reducing the stability of their knees.
• Recent research is exploring the effect of hormones on the ACL during the menstrual cycle. One hormone, relaxin, does just that — relaxes women's ligaments before giving birth. It's also at higher levels in their bodies leading up to their period, which may relax the ACL and make it more prone to injury.
  

Prevention

Awareness of the factors behind increases in injuries can lead to improved training for women that addresses proper technique, muscle strength, balance and biomechanics. One resource for helping prevent ACL injuries is the FIFA 11+ Warm-up Program. It was developed by an international group of experts and is available online for free.

Divided into three segments, each segment has its own set of exercises with progression levels to add difficulty and variation. The exercises pay special attention to knee strength and position. Although this 20-minute warmup was developed for soccer players, it can be translated to any sport, from basketball to pickleball.

Whether you follow this program or something similar, players should commit to strength, balance and knee-position work for at least 10 minutes, three or more times a week. There's a push to incorporate this kind of training into youth, high school and college programs.

No one is completely protected from ACL injuries, which range from sprains to partial tears to ruptures. With a partial tear, segments of the ligament remain connected. A rupture rips the ligament in two. 

Treatment

If you experience an injury, you may seek treatment first from a sports medicine or orthopedics clinician. They'll ask questions about how the injury happened and if contact was involved. About 70% of injuries are noncontact and may have been caused while pivoting or landing from a jump. Typically, patients undergo an MRI to clarify the extent of the injury.

If it's a sprain, treatment may involve wearing a knee brace while the ligament heals, which can take weeks to months. Intensive physical therapy to strengthen the knee and alleviate biomechanical imbalances is a mainstay of treatment. Once the ACL heals, the athlete may return to their sport.

If the ACL is torn, the severity of the tear will determine if surgery is needed. A rupture requires surgery to reconstruct the ACL using a graft from the patient's patellar, quadriceps or hamstring tendon. No matter the type of graft, athletes can expect at least nine months of recovery and rehabilitation before returning to play.

For any ACL injury, part of recovery is regaining confidence in the injured knee. Physical therapy can help restore and reinforce confidence.

Recovery

While the recovery period may be up to a year or more, return-to-play rates are excellent — around 80%. However, once athletes return to play, there's a risk of reinjury, especially for those in their teens and early 20s. About 1 in 4 athletes will experience a second ACL injury.

Studies show that reinjury to the reconstructed knee is similar for men and women. However, some studies report women have a greater risk of ACL injury in the opposite knee. So prevention through strength and biomechanics training is key.

Before an injury happens, youth and student athletes should consider a biomechanical assessment by their team's athletic trainer, a sports medicine specialist or a physical therapist.

While this approach will lessen injuries, it won't completely prevent them.

Deanna Brinks, M.D., Physical Medicine and Rehabilitation, Sports Medicine, Mayo Clinic Health System, Mankato, Minnesota

The post Mayo Clinic Q&A: Addressing ACL injuries in women appeared first on Mayo Clinic News Network.

DEAR MAYO CLINIC: For the past several years, I've been competing in half-marathons. This year, I've decided to challenge myself and enter full marathons. What recommendations do you have for preventing sports injuries as I go to this next level?

ANSWER: Congratulations on continuing to stretch your goals — and for thinking about preventing injury before you begin more intense workouts. For anyone striving to boost their performance, injury prevention shouldn't be separate from your training program; it should be embedded into it. That includes incorporating it into warmups, strength sessions and practice design.

Preventing sports injuries

What does that look like? Starting with your warmup, think of it as preparing your system for the activity you're about to do. Your warmup should go beyond static stretching and focus on dynamic movements that activate the muscles that you're going to use in training and competition.

Then add sports-specific patterns to your warmup. For example, if you're a basketball player, jumping is a key movement. So, add that to your warmup. Not only does jumping mimic gameplay, but it also raises your heart rate and preps your system for the activity.

Remember, when you're designing your training program, you’re training for capacity, not just the sport itself. That means building general strength, having a good aerobic base, and sound technique and movement quality. 

That's what underlies your ability to progress to a higher level. Even elite athletes have become injured because they haven't built that capacity. Sudden spikes in the intensity and volume of exercise can lead to overuse injuries.

One of the key elements of building capacity and preventing injuries is progressive load management. The principle behind progressive load management means not going from zero to 100, but gradually increasing volume or intensity to build capacity.

Before you take any activity to the next level, address any underlying conditions. If you have knee pain while running, work with a physical therapist or an orthopedic or sports medicine clinician so you're not pushing through an injury and potentially making it worse.

Looking at your own experience, you've already built the capacity for running a half-marathon. A full marathon doubles the distance, making it a perfect example of how to apply progressive load management. That increased distance is a significant load not only on your cardiovascular system, but also on the orthopedic structures like bones, tendons and ligaments.

To condition your body and build capacity, design your running program so that over the next several months, you gradually increase mileage each week until you're at full marathon distance.

For someone who is coming back from a sports injury, the same progressive load management applies. A sports medicine specialist will work with the athlete to gradually rebuild strength, measuring progress along the way. Before getting back onto the court or field where they'll be expected to deliver 100%, they'll need to simulate the sport. 

One group of athletes particularly susceptible to overuse injuries is youth and adolescents. While participation in multiple sports is encouraged, young athletes still need time to build the physical capacity required for each sport as they transition between seasons. Gradually increasing training demands, rather than jumping from zero to 100, is key to reducing the risk of injury.

Pitchers are particularly vulnerable to overuse injuries. Finding the right balance between adequate time off and maintaining arm strength and conditioning can be challenging. Although there are published recommendations for annual time away from throwing, many athletes enter the season having done little or no arm-specific training in the offseason.

To reduce injury risk, conditioning and capacity building should begin well before the season starts. High-quality return-to-throwing programs, which are available both in person and online, can help guide athletes through a structured, progressive plan to safely get back in the game.

While the emphasis in youth sports is often on pitchers, catchers also throw at similar or higher volumes. They may not be throwing at the same velocity, but the volume is there. It's important to take this into consideration when tracking pitch counts. Pitching and catching in the same game should be avoided in most situations.

For student athletes, single-sport specialization and year-round competition are not in their best interest when it comes to injury prevention. Athletes need time away from each sport to allow their bodies to recover.

Participating in multiple sports is generally better for any athlete's overall physical health and helps reduce the risk of overuse injuries. It also promotes broader skill development and improved overall athleticism. By varying movement patterns and training demands, the body becomes more adaptable and is given a break from repetitive stress. Athletes often gain transferable skills that improve performance in their primary sport while also enhancing motivation and mental well-being.

Taylor North, D.O., Sports Medicine, Mayo Clinic Health System, Eau Claire, Wisconsin

The post Mayo Clinic Q&A: Sports injury prevention strategies that boost performance appeared first on Mayo Clinic News Network.