For nearly six years, Bob Morreale has lived with a shoulder replacement. Most days, he does not think about it at all. 

That, he says, is the point. 

For Bob, 56, of Rochester, Minnesota, the road to shoulder replacement began decades earlier. A former Division III college baseball pitcher, he sustained shoulder injuries that led to instability, tissue damage, previous surgeries, and eventually, osteoarthritis. Over time, pain became part of daily life.  

“Turning a doorknob, holding a coffee cup, sleeping on my right side, and throwing became difficult,” Bob says. “It didn’t completely stop me from doing things, but I was constantly making adjustments.” 

Bob knew he needed a more permanent solution to manage his pain. At Mayo Clinic in Rochester, he met with Joaquin Sanchez Sotelo, M.D., Ph.D., an orthopedic surgeon, to discuss whether total shoulder replacement could be an option. 

Like many patients considering joint replacement, Bob wanted to know how long an implant might last and whether he could expect to regain comfortable motion. Dr. Sanchez Sotelo could answer those questions with confidence, drawing on decades of outcomes data from thousands of joint replacement patients treated at Mayo Clinic. 

How decades of patient follow-up help guide your care 

That confidence comes from more than 50 years of systematically tracking patient-reported outcomes. Since performing the first FDA-approved total hip replacement in the United States in 1969, Mayo Clinic has followed joint replacement patients throughout their lives, creating one of the world's largest collections of long-term outcomes data. 

"After surgery, we connect with patients on a regular basis. Even after a surgeon retires, another will step in and continue to check in with patients throughout the remainder of their life," says Matthew Abdel, M.D., chair of the Surgical and Procedural Practice at Mayo Clinic. 

For patients like Bob, that depth of follow-up matters. It allows surgeons to have more informed and honest conversations about what patients can expect — including pain relief, function, durability and whether another surgery may be needed in the future. 

Making an informed decision 

After discussing the benefits, risks and alternatives with his surgeon, Bob decided to move forward with an anatomic total shoulder replacement. Based on his age, anatomy and overall shoulder condition, the procedure offered the best opportunity to relieve pain, restore function and return to the activities he enjoyed.  

Recovery from surgery required patience. Bob spent weeks in a sling and worked through physical therapy to rebuild strength and motion. But as movement returned, so did the ordinary parts of life he had been missing. 

"The results have been remarkable," Bob says. "I have no pain, full range of motion, and can do everything I want to do. My sons are now adults, but I can still play catch with them!" 

How every patient helps improve joint replacement 

Every patient who participates in follow-up contributes to a deeper understanding of long-term outcomes, helping Mayo Clinic refine care and better guide future patients. 

For patients, that means care informed by decades of real-world outcomes, helping surgeons provide clearer expectations about recovery, function and long-term results. 

Like more than 200,000 joint replacement patients treated at Mayo Clinic, Bob continues to participate in periodic follow-up after surgery. 

Nearly six years later, he rarely thinks about his shoulder anymore. 

That's exactly what he hoped for. 

The post Why decades of patient follow-up make a difference in joint replacement care  appeared first on Mayo Clinic News Network.

For millions of people, cartilage damage can lead to chronic pain, limited mobility and require difficult decisions about surgery. Unlike bone, cartilage has little ability to heal itself, leaving many patients with treatment plans that require multiple procedures, lengthy rehabilitation or, eventually, joint replacement. But what if damaged cartilage could be encouraged to repair itself? 

In this episode of "Tomorrow's Cure," orthopedic researchers from Mayo Clinic and Mass General Brigham discuss RECLAIM, an investigational regenerative medicine approach designed to help restore damaged cartilage. The approach uses a patient's own cartilage cells combined with specialized donor cells that help create a healthier environment for healing. Rather than simply filling damaged areas, RECLAIM aims to support the body's natural repair process in a single procedure instead of multiple surgeries.  

Host Lindsey Sievert talks with Daniel B.F. Saris, M.D., Ph.D., and Mario Hevesi, M.D., Ph.D.,  orthopedic surgeons at Mayo Clinic and Christian Lattermann, M.D., chief of the Division of Sports Medicine at Brigham and Women's Hospital and director of research for Mass General Brigham Sports Medicine. Together, they discuss why cartilage injuries have challenged orthopedic medicine for decades and how advances in cell biology, minimally invasive surgery and artificial intelligence (AI) are creating new possibilities. They also explain how collaboration across specialties helped adapt the RECLAIM technology from the knee to the hip, why preserving a patient's natural joint is especially important for active people and what researchers still need to learn before treatments like RECLAIM become more widely available. 

The conversation also explores the future of regenerative medicine, including how AI could help identify patients most likely to benefit from these therapies and how insights from this research may eventually extend beyond cartilage to other tissues throughout the body. While RECLAIM remains under clinical investigation, the episode offers an inside look at how scientific discovery and patient collaboration are shaping the next generation of orthopedic care. 

Listen to the latest episode of "Tomorrow's Cure" wherever you get your podcasts. You can also explore the show's full library of episodes and guests on the show's playlist.  

The post From joint damage to regeneration   appeared first on Mayo Clinic News Network.

DEAR MAYO CLINIC: My back pain keeps getting worse. I've tried all the nonsurgical options, but is it time to consider surgery? 

ANSWER: It might be. The back is a highly complex part of the human body with several potential sources of pain — bones, joints, muscles and nerves.  

Joints: On the back of each spinal vertebra is a pair of facet joints that allow you to bend and twist. These two facet joints, together with the disc, enable the bones of the spine to move. Lower in the back is the sacroiliac joint, which connects the spine to the pelvis. As with any joint, these can be affected by arthritis and injury. The discs, which provide cushioning between the vertebrae, can slip out of place, allowing the bones to rub together. 

Muscles: An intricate muscle structure supports the spine. Strains, overuse and underuse can weaken and damage these muscles. 

Nerves: The spinal cord, which is a bundle of nerves, runs through the spine, ending where the mid back and lower back connect — about at your belly button. From there, nerve roots branch to each leg, providing function to your legs. Anywhere along the spine, but especially in the lower back, the nerves can become compressed. It's radiating leg pain that frequently drives patients to seek relief through surgery. 

The first step in finding back pain relief is to be assessed by a healthcare professional, who, as part of the examination, will check your ability to sit, stand, walk and lift your legs. You also may undergo some imaging. This assessment will help your clinician develop a treatment plan.  

Nonsurgical pain-relief options include: 

• Physical therapy. A physical therapist can teach you exercises to increase flexibility, strengthen back and abdominal muscles, and improve posture. Building these exercises into your daily routine can help prevent pain from returning. The therapist also can show you how to modify the exercises and your movement during a back pain episode.  

• Ice/heat. The use of an ice pack or heating pad can help relieve pain from muscle tension and spasms. 

• Pain relievers. These include nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil); acetaminophen(Tylenol); topical creams and patches that deliver substances through the skin; medicines containing opioids, such as oxycodone or hydrocodone (rarely used); and some antidepressants, including duloxetine (Cymbalta).  

• Muscle relaxants. If mild to moderate back pain doesn't improve with ice, heat or pain relievers, a muscle relaxant is another option.  

• Injections. If other measures don't relieve pain that radiates down the leg, an injection of cortisone plus a numbing medicine might help. 

• Other treatments. Yoga, massage, chiropractic adjustments and acupuncture also may bring relief. 

When these measures are no longer effective, patients typically seek out surgical options. For the best outcomes, it's essential that the surgical procedure matches the problem that needs to be addressed. These can include neurological compression, instability or spine deformity issues.  

A consultation with a surgeon usually includes an examination and imaging to pinpoint the problem, followed by a discussion of what surgical approach will provide the greatest benefit. After the consultation, you may want to talk over your options with family and friends or seek a second opinion to ensure you're comfortable with the plan. 

Before surgery, you'll be thoroughly assessed to determine if you're physically ready for the procedure. This will include evaluating your bone health and ensuring that any medical conditions are stable or optimized. 

The surgery depends entirely on what is needed to correct the problem. Some surgeries are relatively simple, while others may be quite complex. 

Recovery and healing depend on how extensive the surgery was. For instance, a herniated disc may require only a small incision, followed by a short period of limited activity. Recovery from a more involved surgery requiring a large incision may take months. 

However, most people fall somewhere in the middle of this spectrum. They generally feel pretty good within six to 12 weeks, although full recovery typically takes six to 12 months. 

Once a person has recovered, the key is developing a lifestyle that helps prevent back issues from returning. These include building good core muscle strength, increasing mobility, staying active, not smoking, and maintaining a healthy weight and diet. 

Being active and maintaining good core strength not only are essential to recovery from surgery, but they also are key to preventing back pain. 

Mel Helgeson, M.D., Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota  

The post Mayo Clinic Q&A: What’s up with my aching back? Do I need surgery? appeared first on Mayo Clinic News Network.

DEAR MAYO CLINIC: Our teenagers are both student athletes and active in their sports year-round. I'm concerned about injuries that could sideline them. What should we watch for?

ANSWER: As the school year ends, summer sports heat up for students and adults alike. Summer may be a prime season for a sport, such as baseball or running, but athletes of all types also may be on a traveling team, heading to a sports camp or just honing their skills with off-season practices.

No matter an athlete's age, they need to be aware of and condition their body to prevent injuries that can put their sport on hold. Here are several to watch for:

Heat-related injuries. When it's hot and humid, proper hydration is essential. Signs of overheating include not sweating, feeling extremely thirsty, becoming dizzy, experiencing a headache or vision changes. These symptoms call for immediate attention. All athletes should hydrate before, during and after their activity. Water is best, as are drinks that replenish electrolytes lost through perspiration.

Sprains and strains. These common injuries can affect ankles, knees, hips and shoulders. However, they aren't traumatic injuries like fractures or a complete ligament tear, and they tend not to require long-term recovery.

Tendons attach muscles to bones, while ligaments attach bones to bones. A sprain is the stretching or partial tearing of the fibers in a ligament. A muscle or tendon strain may result from overuse, leading to inflammation. Both are treated by modifying activity, rest, icing, and taking over-the-counter pain and anti-inflammation medications. Physical therapy may be needed to rebuild strength and range of motion.

Fractures. A fracture is a broken bone. Fractures often occur during falls, such as when skateboarding, or from collisions with other players or objects. Fractures can be cracks or complete breaks that may or may not require surgery. Treatment and recovery depend on the severity of the injury. Athletes should plan to be in recovery for at least 6 weeks.

Overuse injuries. With the emphasis on early sports specialization, young athletes often spend more time practicing or competing, increasing the risk of injury. This injury risk is especially true for young athletes who are still skeletally immature. That means they still have open growth plates in their bones, making them susceptible to injury, particularly from repetitive motion.

Athletes understand that repetitive motion is the way to improve. However, if a young athlete is pitching every day or repeatedly practicing a volleyball serve, they can overuse a single part of their body. This can lead to inflammation or even damage those areas. One indication of overuse is pain after a game or practice that takes longer to resolve, increasing recovery time.

Safeguards such as pitch counts, which limit the number of pitches a player throws during a game, and built-in rest days are important to preventing overuse injuries.

Another way to avoid overuse injuries —and burnout — is cross-training. For instance, a hockey player may add swimming to their routine, a runner may add weight training, or a soccer player may shoot hoops with friends. This allows an athlete to use different muscles and movements to build strength, flexibility and coordination, while also giving them a mental break.

Concussion. A concussion is a mild traumatic brain injury that affects brain function. Effects are often short-term and can include headaches and trouble with concentration, memory, balance, mood and sleep. Concussions can happen in any sport, not just those in which players intentionally run into each other, such as football or hockey.

If a player experiences dizziness, headache or nausea after an incident during a game or practice, they shouldn't shrug it off — they should step out of the game and tell a coach or parent. Today, most coaches are trained in concussion and return-to-play protocols developed for most sports. Athletes, parents and coaches should take concussions seriously to prevent further injury or long-term symptoms.

Injuries in older athletes. Older athletes returning to a sport or trying a new one are susceptible to the same injuries as young athletes. However, osteoarthritis, or the wearing down of the cushioning cartilage in joints, increases with age. This can lead to pain, swelling and a decrease in range of mobility. Once again, cross-training is key, no matter your age.

All athletes can reduce the risk of injury by getting plenty of sleep, developing healthy eating habits, hydrating and warming up properly before any sports activity.

For parents, if your child finds a sport they enjoy and are passionate about, encourage them, but don't let it become a "job." As a former professional athlete, I advise that, first and foremost, sports should be fun.

Michael Stuart, M.D., Orthopedics & Orthopedic Surgery, Mayo Clinic Health System, Owatonna, Minnesota

The post Mayo Clinic Q&A: Watch out for summer sports injuries in youth and adult athletes appeared first on Mayo Clinic News Network.

DEAR MAYO CLINIC: My nephew is in his 20s and has been complaining about ongoing hip pain, especially after working out. When it didn’t improve, he saw an orthopedic specialist and was diagnosed with hip impingement. What is that?

ANSWER: Hip impingement, also called femoroacetabular impingement, is a condition that often affects young, active adults. It occurs when the shape of the hip joint causes the ball and socket to pinch during movement. Over time, that can lead to pain, stiffness and wear in the joint.

Hip impingement exists on a spectrum. Some people have changes in the shape of the hip and never develop symptoms. Others develop pain that begins to affect exercise, work or everyday activities.

The hip is a ball-and-socket joint. In some people, the socket may develop differently, or extra bone may form where the ball and neck of the femur meet. That extra bone on the femur is often called a cam lesion. These shape changes can cause the bones to come into contact earlier than they should during movement, especially when the hip is bent deeply during sitting, squatting or sports. This can lead to pain and reduced range of motion.

Hip impingement is much more recognized today. The condition became better understood in the early 2000s, when specialists began linking some cases of hip pain and early arthritis to structural differences in the hip joint. Young adults also may be active longer, which can make symptoms more noticeable. However, not everyone with hip impingement has symptoms.

The most common symptom is groin pain. Some people also describe pain that wraps around the side of the hip in a C-shaped pattern. Symptoms often become worse with prolonged sitting, long car rides or activities that involve deep hip flexion, such as deep squats or stepping onto a high surface.

Occasional pain that goes away may not need immediate evaluation. However, you should seek medical care if hip pain persists for weeks or months, begins to affect daily life, or prevents participation in activities you enjoy.

Sports and activities that involve deep hip bending, agility and pivoting can make symptoms more likely. This includes hockey, rowing, soccer, hurdles and some forms of dance, especially ballet.

Typically, hip impingement isn't something people are born with; the shape of the hip develops over time. The socket reaches its final shape relatively early in life. Changes on the femur side of the joint, including cam lesions, are thought to develop during adolescence, especially in active teens.

Diagnosis often starts with the symptoms a person describes. Groin pain, pain with sitting, and a pinching sensation during activity can all point toward hip impingement. A physical exam also is important, since many people have reduced motion when the knee is brought up toward the chest. X-rays help evaluate the shape of the hip. In some cases, an MRI is used to examine the cushioning cartilage, such as the labrum, more closely, especially if surgery is being considered.

The first line of treatment often is physical therapy to strengthen the core, lower back and muscles around the hip. Activity changes and anti-inflammatory medications also may help. It’s important that therapy specifically targets hip impingement, since some exercises may worsen symptoms.

If symptoms continue and begin to affect quality of life, surgery may be considered. The most common procedure is hip arthroscopy, which uses small instruments and a camera to repair the labrum and reshape areas of bone. Recovery takes time, with crutches often needed for four to six weeks, followed by a gradual return to activity. Most people improve within three to four months, although returning to higher-level sports may take closer to six months.

If left untreated, outcomes for hip impingement depend on the severity of the condition.  In some people, it may raise the risk of arthritis later in life. In others, symptoms may stay mild or manageable. Not every person with hip impingement will need surgery, and treatment decisions should be based on symptoms and how much the condition affects daily life.

Hip impingement can be an overlooked cause of ongoing hip pain in young adults, especially in people who are active. It’s often manageable with the right treatment and activity changes. If hip pain keeps coming back or begins to interfere with daily life, it’s worth getting checked rather than assuming it’s just a strain.

Mason Uvodich, M.D., Orthopedics & Orthopedic Surgery, Mayo Clinic Health System, La Crosse and Onalaska, Wisconsin

The post Mayo Clinic Q&A: How is hip impingement affecting young adults? appeared first on Mayo Clinic News Network.

DEAR MAYO CLINIC: I'm in my 50s and have begun experiencing nagging back pain. Recently, I saw an orthopedic doctor and was diagnosed with scoliosis. Does this mean I have to have surgery? 

ANSWER: Not necessarily. Scoliosis in adults may require no treatment or be able to be managed without surgery. It all comes down to the severity of symptoms and whether there are accompanying problems, like arthritis or osteoporosis. 

Scoliosis is a change in the normal shape of the spine that leads to sideways or forward curving or twisting. It most often develops in children during their growth spurt just before puberty. Affected children who don't respond to nonoperative measures may undergo surgery to straighten and properly balance the spine. 

In adults, scoliosis may be a remnant of a curvature that began in childhood. More commonly, scoliosis is the result of wear and tear on the spine that comes with aging, usually in combination with another condition that affects the spine, such as arthritis or osteoporosis. Usually, it's these conditions that are causing discomfort. 

Symptoms 

Symptoms of adult scoliosis include low back pain and a stooped posture. Some older adults, despite having significant curves in their spines, may have no symptoms. In other cases, they have symptoms that respond to nonoperative measures such as weight loss, physical therapy, stretching, or maintaining an active, low-impact lifestyle. Both of these scenarios are unlikely to require surgical treatment.   

Many adults seek medical care when symptoms become bothersome or limiting. 

Typically, physical therapy is the first step in treatment. Recommended exercises, along with stretching and walking, may be all that's needed to relieve pain, improve mobility and keep you active.  

If osteoporosis or arthritis is contributing to scoliosis, your healthcare professional will want to address how best to manage your bone health and prevent the curve from getting worse as your bones get softer. 

Treatment options

Treatment may include bone scans to determine the degree of bone loss, weight-bearing exercises to strengthen your bones and medications or infusions that help your body repair and build bone. 

If your pain continues despite nonsurgical treatments or if your scoliosis symptoms become so severe that they limit your mobility or produce a disfiguring deformity, then it's time for you and your healthcare team to discuss surgery. 

For a good surgical outcome, it's not necessary to completely correct the abnormal curves. The goal for adults is a balanced spine — that means your head is positioned directly over your pelvis from front-to-back and side-to-side. This alignment can achieve a high degree of satisfaction and pain relief after surgery. Many patients' symptoms arise from arthritis or pressure on the nerves and can be effectively relieved by removing the pressure, not necessarily by fully correcting any deformity. 

Surgery

One of the most common surgical approaches for scoliosis is spinal fusion. In many cases, spinal bones that are out of alignment account for a significant portion of the deformity. Spinal fusion helps your surgeon realign the bones, improve the curvature of the spine and make the spine more stable. This may be performed alongside a spinal decompression to remove any bone spurs or pressure on the nerves. 

During spinal fusion, your surgeon places bone or a bone-like material in the space between two spinal bones. Metal plates, screws or rods might hold them together so the bones can fuse together and heal as one bone. 

After spinal fusion, you'll be required to stay in the hospital for two to three days. Depending on the location and complexity of your surgery, you may experience some pain and discomfort, which can be controlled with pain medications. 

At some surgical centers, scoliosis surgery can be performed using minimally invasive techniques that shorten recovery times. Regardless of the surgical approach, it can take several months after surgery for the spinal bones to heal and fuse together. During that time, you may need a brace to protect and support your spine. 

In the area where the bones were fused together, spinal mobility is limited. Physical and occupational therapy can teach you ways to sit, stand, bend and walk to improve your mobility and quality of life.  

Although spinal fusion surgery for adults with scoliosis may not eliminate all symptoms, in a high percentage of cases, it can effectively balance the spine, relieve posture symptoms and allow you to get back to doing the activities you enjoy. 

Paul Huddleston, M.D., Orthopedic Surgery/Spine Care, Mayo Clinic Health System, Red Wing, Minnesota, and Mayo Clinic, Rochester, Minnesota  

Related post:

• Tomorrow’s Cure: Shaping a new future for youth with scoliosis

The post Mayo Clinic Q&A: Scoliosis in adults appeared first on Mayo Clinic News Network.

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.

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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.