I’m writing to you from the Olympic Village, Beijing, where I am the Team Physician for the Men’s Olympic Hockey Team. It is an honour and a privilege, and something of a surreal experience. But nonetheless with lessons that can be applied to each of our #RiseAbove health journeys towards healthy movement and wellness…  

For most athletes, competing in an Olympic Games represents the pinnacle of their sporting careers. It is the culmination of years of training, competitions and sacrifice.  Working the 2018 Olympics as Team Doctor with our Men’s National Hockey team was my first glimpse at the incredible atmosphere and spirit of competition that exists at the games.  Compared to IIHF World Championships or NHL season and playoffs, Olympic Hockey is different in that the hockey team is just one part of a bigger Team Canada, made of athletes from every winter sport across our country.   

Within an Olympic Games, the practice of sports medicine is simplified in a sense because every member of the team has one goal in mind: win the gold medal.  Every aspect of an athlete’s physical and mental health is therefore optimized and every treatment decision made with the ultimate goal in mind.  

At Group23, we strive to practice Sports Medicine differently – and your personal goal is what drives our treatment plan.  To develop our unique concept of care, we drew on the wealth of experience within our physician and physiotherapy group which is comprised of practitioners that have worked at the highest levels of sport such as the NHL, CFL, USports, Alpine Canada, World Championships, and Olympics Games.  This concept of care stresses the critical importance of having G23 patients set a goal (what we call a #RiseAbove Goal) in the same way that an athlete sets a goal of winning an Olympic gold medal.  

#RiseAbove goals are SMART goals, that is they are Specific (win a gold medal in Men’s Ice Hockey), Measurable (we win or we don’t), Actionable (team is capable to performing at elite level), Realistic (yes, we qualified for the Olympics and have a team with the talent to win a gold medal), Time-bound (Gold medal game is February 20, 2022).   

Now most of us presenting with an injury or chronic musculoskeletal complaint aren’t trying to win Olympic medals, but I would argue that ANY goal set by a G23 patient should be treated as though it’s means everything to them, that in a sense, it is their equivalent of a “gold medal.”  It might be something as simple as, “I want to be able to go for 20-minute walk 3 days a week by July 1, 2022.” But going from where they are currently, to achieving that goal can be as challenging as winning a medal.   

So how does a SMART #RiseAbove Goal help a Group23 patient?   

1. It sets an objective benchmark for what “success” looks like when it comes to evaluating the results of any treatment plan. 

1. It ensures that every decision made by your treating sports medicine physician or physiotherapist reflects YOUR priorities not theirs.  

Group23’s concept of care is hard at work here in Beijing and the #RiseAbove Goal for this Olympics is to return to Calgary with a Gold Medal!  Start your #RiseAbove Journey at Group23 today.  Go Canada Go! 

An interview with lesley on her patient health journey.

I met Lesley in March of 2021. She is a vibrant, 5 foot, 70-year-old! She first came into my office due to an unfortunate fall on an icy sidewalk. Her weight wasn’t part of the injury, but it did become part of her healing.

After an injury, extra weight on our body can make things more difficult. Every pound on our body places four pounds on a joint. There was no doubt that taking some weight off her joint would help facilitate her healing. Upon working with her I enjoyed her zest for life, dedication to helping others, and her desire to move freely. Lesley went from 151 pounds at 39% body fat to 124 pounds at 29.8% body fat – that is 108 pounds of weight off her joints! This is her #RiseAbove interview.

What do you think was the largest contributor to your weight gain over the years?

I have always had a weight problem since the age of nine.  I remember being told by my parents ‘finish what’s on your plate or there is no dessert; finish your meal as there are poor starving children in Africa etc.’  Or when feeling sad and crying about something, my grandmother would say ‘here have a cookie.’  I have been through numerous programs:  Weight Watchers, Trym Gym, Dr. Bernstein, and a few others.  I would lose weight, but then would regain it because of not being mindful of what I was consuming and why.  I was doing Weight Watchers again for about 3 years and was able to lose weight, but then the pandemic hit and suddenly I was not accountable to what my intake/outtake looked like.  I started to gain weight during the pandemic as one of my past times has been binge eating potato chips and dip, and what with the various lock downs and limited access to my community fitness programs, I really began to eat unhealthily. 

In 2018 I had a slip and fall on ice and have been dealing with pain from Sciatic Nerve damage since then. My body crashed, physically and mentally, from the agonizing pain and I began to realize I was doing more harm to my body than good. I was seeing a Pain Management Specialist for cortisone injections at Group23 during this time, and decided to also start sessions for Health & Wellness.

There are many factors to your weight loss over the year – what do you think was the largest contributor?

Weight loss is more than dieting, it entails a change in what one consumes and why!  Through a few of the weight loss programs I’d tried, tracking was part of the program, but not the inclusion of mindful eating. Nor did they show the percentage of body fat being lost, or offer one on one sessions.  With the Weight Management Program at Group 23, you are educated to plan out your meals over the weeks of the program and track what goes in, and begin to understand how your emotions can contribute to loss or gain. Meeting with Jason has been an influential aspect to my weight loss as he assesses one’s behavioural and social eating methodologies, not just counts calories.  The individual support has been a huge asset, as well as exploring the reasons behind why I eat.

What advice would you give to anyone who is starting their own lifestyle change?

Find a program that fits your needs. Be realistic and cognizant of the programs that are out there that do not educate you about an integrated healthy lifestyle: eating, weight loss, behaviours and emotions are all connected!  Be prepared to work with an certified consultant in a reliable program and understand there will be times in your life and seasonal events that can cause weight gains, and work through those times/events.  One needs to be serious about weight loss, identify the risk factors in your life and what it is that has caused your weight gain in the first place.

It is so encouraging to know you can decrease weight and body fat, but also prevent health conditions through the program.  I have been a Type II Diabetic for over 20 years and have been able to control my A1C to a stage of Pre-Diabetes, and am working with my physician to begin to reduce my medications. The work really is worth it!

What do you think will always be a struggle in keeping your weight off?

Social events and not being mindful of the food that I consume are such difficult areas for me. I am actually hungry or just bored, sad…? I believe that chips and dip will always have some gravitational pull when I go to the grocery store, so being mindful of that pull is necessary to avoid slipping back into overall unhealthy eating patterns.

My exercise program is one commitment I hold to and it is important for me to continue to recognize the benefits of my weight loss, the work that has gone into the program, and of course the monetary cost.  But the benefits outweigh those challenges!  I have had to completely donate all my old clothing as I’m 1-2 sizes smaller in tops, and 2-4 sizes smaller in pants.

The program has certainly been worth the time, money, mindfulness as my brain is beginning to understand the reasons why I ate and the type of food that I consumed, while not taking control of my lifestyle. 

Lesley has learned about herself through her weight loss journey. She understands more about her emotions, behaviours, and mindsets. The unfortunate accident has led to a stronger more intuitive person and she is a perfect demonstration that when something knocks you down, there is still an ability to #RiseAbove. She has inspired me to always look for opportunity amidst various struggles.

To book a free needs assessment, and begin your own Health and Wellness journey, click here.

How do I know if a knee brace is for me?

There are many situations when a knee brace can benefit patients. The goals can differ from decreasing pain, improving alignment and/or improving performance.

Some diagnoses that use a knee orthosis as part of the treatment are:

• Osteoarthritis

• Ligament instability

• Patellofemoral instability

What is the difference between a knee brace I can buy online and a custom knee brace from a Certified Orthotist?

A Certified Orthotist understands and can explain the physics and biomechanics of the knee brace options. They will pick the correct orthosis for you based on your needs and activities. Not only will you get a customized knee brace, but one that is fitted by a trained orthotist has the potential to qualify for funding opportunities. Also, a Certified Orthotist has the necessary skills to modify and adjust the brace to fit you if changes are needed; for example, if your leg changes shape or size. And, a Certified Orthotist has access to warranties with custom braces.

Is there funding for knee braces?

Access to funding can be determined once the Certified Orthotist has completed an assessment. Please investigate your personal health benefits prior to your assessment. If your personal health benefits do not pay the full cost of the knee orthosis, you may be eligible for government funding if you meet the criteria (identified by the Alberta Aids to Daily Living Program).

What is the process for booking an appointment?

Group 23 Sports Medicine makes it easy to book an appointment with a Certified Orthotist. Prior to booking, it is recommended you have a prescription (no older than three months) accompanied by an imaging report (x-ray report). You can call the main booking line 403-284-4040 or book online.

My injury occurred in February 2021.  I weight train 3 days a week with a trainer and I was doing dumbbell chest presses.

My sequence was: 35 pounds – 40 pounds – 45 pounds, all of which I had done several times before. But while doing the 40 pound reps there was an unpleasant ‘popping’ sound and I dangerously lost control of the weights.

Diagnosis

I contacted a physiotherapist who arranged for an x-ray and ultrasound that afternoon (always have your injuries seen to as quickly as possible!). At my follow up appointment later that week, we reviewed the results and was advised I had an 11 millimetre tear in my rotator cuff. No wonder I had so much pain and difficulty moving my arm!

Thankfully, the physiotherapist recommended Group 23 Sports Medicine and made the appointment for me with Dr. Auld (a referral from a physiotherapist, chiropractor or physician is required to see any sport medicine physician). After examining my shoulder Dr. Auld made some recommendations and took the time to carefully review the possible benefits and overall process of Platelet Rich Plasma (PRP) injections, which was his principal treatment suggestion.

Treatment

My first injection was in August, and I saw Dr. Manning who again explained the process for the injection and the possible benefits, which I really appreciated. The injection process itself was quite interesting to watch on the screen (and is a nice distraction if you’re a bit uncomfortable with needles!).

My second injection was scheduled for September and by the night of the second injection my pain level had dropped significantly and the arthritis in my shoulder stopped hurting!  I have had significant progress in movement and little or no pain since the second injection.

Recovery

My overall experience with the doctors and staff of Group 23 Sports Medicine was fantastic. From beginning to end, they carefully guided me through the various options, and I really appreciated the follow-up phone calls after the injections to ensure there were no problems. My final review with Dr. Auld in October was excellent. I was able to happily tell him the PRP injections worked, and I was very pleased with the results.  Without the injections, I would not be where I am now, and I never expected to make a full recovery due to the severity of the tear. However, I’m now confident I will soon be back to my original strength, range of motion and most importantly, pain free!

Here at Group23 Sports Medicine, we are so excited by David’s, and many others, successful Patient Health Journeys. If you have a recent or lingering injury, pain or other physical aliment – we urge you to seek treatment! We’d love to help you to #riseabove on your path back to full health.

To limit the spread of Covid-19 many countries initiated lockdowns. These measures had additional social consequences beyond the direct death toll attributed to the virus.

I think most people would agree that their lifestyles changed due to Covid-19: working from home, increased stress, fear of the unknown, and less social activities led to different circumstances which ultimately led to different behaviours. Many of my clients attribute some of their weight gain to Covid-19 and maybe we don’t really need science to tell us that (*Robinson et al., 2021). However, a study was done in the UK to evaluate the impact of Covid-19 on weight-related behaviours and here is what they learned.

Weight related behaviours

There were 11 weight related behaviours evaluated. The percentage represents the number of participants who saw the behaviour increase during lockdown.

1. Eating large meals or snacks (44%)

2. Snacking (56%)

3. Dieting or fasting (19%)

4. Skipping meals (23%)

5. Using weight control products (3%)

6. Exercising (45%)

7. Physical activity (46%)

8. Spending time sitting down (73%)

9. Drinking alcohol (36%)

10. Getting a good night’s sleep (30%)

The conclusions were highly dependent on the habits and circumstances you had before Covid-19. For example, the diet quality during lockdown worsened for those who are male, younger, lower in education, and with a higher BMI (body mass index). Whereas females with lower education, higher BMI, and in a more negative mental health state were more likely to increase the quantity they ate (overeating).

As you can see, most saw an increase in time spent sitting down in lockdown. I’m sure these answers may look different in a colder climate such as Canada, but let’s get personal. What behaviours did you see increase during lockdown? Did you sit more? Did you drink more? Were you able to find time to do an online yoga or fitness class? Did you see an improvement in your sleep patterns? With a change in the structures and schedules we depend on for many of our healthy habits, where did you notice changes?

So, what now?

Different ‘seasons’ in life can change one’s weight. It doesn’t always mean it’s going to lead to weight gain – some changes cause weight loss and others cause weight gain. But, if you’re in a season of weight gain and would like to change the trajectory of your path, we can help you. Through our Biopychosocial approach to weight management we can help you navigate the season you’re in and find a healthy place for new habits to support your goals.

Book your free needs assessment to learn more about how our approach is different.

*Source: Robinson, E., Boyland, E., Chisholm, A., Harrold, J., Maloney, N.G., Marty, L., Mead, B.R., Noonan, R., & Hardman, C.A. Obesity, eating behavior and physical activity during COVID-19 lockdown: A study of UK adults. Appetite., 156 (2021) 104853.

Ankle sprains are one of the most common musculoskeletal injuries in people of all ages.

There are 3 regions of the ankle that can be sprained. By far the most common type of ankle sprain is the lateral ankle or inversion sprain. This comprises over 90% of all ankle sprains. The other 10% of ankle sprains are made up medial or eversion sprains and then there are high ankle sprains.

Many people who experience an ankle sprain do not seek medical attention.

When do I need to get medical attention?

Many ankle sprains can be self-managed if the pain, the instability, and the swelling are not too bad. However, if there is an inability to weight-bear comfortably more than 4 or 5 steps, then the person should likely access medical care. If there is marked swelling and associated instability, then there is likely good reason to be assessed by a medical professional.

Will I need an x-ray?

Most ankle injuries involve only the ligaments which cannot be assessed by x-ray. This is the reason why many ankle sprains do not need imaging. If a fracture is suspected, then an x-ray will likely be ordered. Physicians use a guideline call the “Ottawa Ankle Rules” to determine if an x-ray is needed. This is a system to decide if pain, the region of tenderness and inability to weight-bear may suggest a fracture. These rules identify patients with ankle fractures more than 95% of the time. It also helps reduce the unnecessary x-ray radiation for the patient, and expense to the system.

The Ottawa ankle rules include:

1.      Inability to weight-bear more than a few steps

2.      Lateral ankle bone point tenderness to pressure on the lower 6 cm of the back part of the tibia or the fibula

3.      Tenderness on the tip of the tibia or the fibula

4.      Tenderness on the base of the fifth metatarsal or tenderness on the navicular bone on the inside of the ankle

If you’ve recently sprained your ankle, you can self-refer to a Group23 Sports Medicine Physician using our Accelerated Access Sport Injury Clinic (AASIC).

Setting your #RiseAbove goals is the beginning of your treatment journey. Having a SMART #RiseAbove Goal is an important part of tracking your recovery process and motivating you for long-term success!

A SMART goal is Specific, Measurable, Actionable, Realistic, and Time-Bound.

A Specific goal is clear and well defined. When setting your #RiseAbove Goal, consider the individual details of that goal. Try to paint a picture of what you want to accomplish.

A Measurable goal will allow you to track your progress.  For example, instead of saying, “I want to run”, specify how far you want to run and how many days a week you want to run. This will allow you to clearly track the progress that you are making. Your goal could be measured with dates, times, amounts, or distances, or it could be a specific event that you are working towards such as a race.

An Actionable goal is something that you are capable of taking the actions to achieve. You should consider whether you have the resources to achieve your goal or what resources you might need. For example, if your goal is to be able to ride a bike for 20km five times a week BUT you do not have a bike, that goal would not be actionable. There are two solutions to turn this goal into a SMART goal, either you go buy a bike, or you change your goal to something that you already have the resources to accomplish.

A Realistic goal will be possible for you to achieve. When setting your #RiseAbove Goal, think about whether the goal is possible for you to accomplish and whether you are willing to put in the effort needed to achieve it.  If you set an unrealistic goal, you will not feel very positive about your rehabilitation and you will be less motivated to do things that will lead to your success.

A Time-Bound goal means that you have a deadline for when you want to accomplish this goal. This is important because wanting to achieve something in 2 months compared to wanting to achieve something in 2 years is a very different timeline. Having a time-bound goal will help you and your #RiseAbove team decide how aggressive your treatment should be.

An important question to consider when setting your #RiseAbove goals is ‘Why is accomplishing this goal important to me?’ Setting a goal that is personal to you will not only motivate you to be an active participant in your #RiseAbove journey, but it will also coordinate team actions between your Sports Medicine Physician and Physiotherapist to create a custom plan to help you achieve your goal(s)!

It is also important to consider the Bio-Psychosocial-Spiritual approach and how all of these elements relate to your goal and treatment. When taking these factors into account, it is highly unlikely that you will be able to devote 100% of your time to your #RiseAbove journey and that is okay! However, it is important to take these elements into consideration when you are setting your goal(s) because they will help you understand whether your goal meets all the elements of being a SMART goal.

If you are ready to set your #RiseAbove goals and get back to movement, you can self-refer to the Accelerated Access Sports Injury Clinic (AASIC).

IT’S NOT A DIET, IT’S A LIFESTYLE, AND THAT’S EXACTLY HOW LORETTA APPROACHED HER WEIGHT LOSS JOURNEY.

What was the largest factor to your weight gain in the past?

There were two: complacency and lack of education. Growing up, I watched the females in my family get less fit as they aged. They’d say ‘your body changes after you have kids’, so I just accepted that that was going to happen to me too. I was never taught (because my parents were never taught) what a healthy lifestyle actually looked like.  Yes, I took gym classes in school and knew about the Canada Food Guide. And I knew that being active was important and that portion size mattered, but never knew what that entailed for me personally until I started using the FitMethod. 

There were many factors to your weight loss. What do you think was the largest contributor to your weight loss?

There were two large contributors that worked simultaneously for me. The first contributor was trust: I chose to go to the experts so I had to trust the plan that they laid out for me. But the plan was devised with me, as much as it was for me. Once I committed, I saw slow, steady results. Not going to lie – it was work at first, but only because I was learning new things. I still follow the plan, but it is engrained in my life now, so it is less effort. A healthy lifestyle requires effort, but the payoff is worth it. The second factor is the ability to think big-picture or long-term. Yes, I could eat this box of crackers for a snack or have cookies every day (and I used to do both of those things) and that would satisfy the hunger pangs or emotional eating binge, but long-term the result is what you see in the before photo. For an older parent with two young children, that behaviour was impacting how much and how actively I could play with my kids. I wanted to be able to actively play with them and I couldn’t comfortably do so. 

What advice would you give to anyone that is starting their lifestyle change? 

#1 – Don’t go for the quick fix diets for two reasons: they aren’t personalized, and they aren’t sustainable. FitMethod is not a diet; it’s a lifestyle. I am living proof that FitMethod works and is sustainable. Trust me – I am not deprived: I have treats and eat out in restaurants, but I have learned how to make smart choices. At almost 53 years young and I am in the best shape of my life physically too.

#2 – There will be ups and downs in your journey but keep your eye on your long-term goals.

#3 – It isn’t about ‘being skinny’; it’s about being strong and healthy.

You have managed to keep the weight off for years. What reasons can you attribute to keeping the weight off?

I continue to periodically check in with Jason. It is immensely valuable to have someone completely impartial to review my progress. I’ve had periods of weight fluctuation over the years (read ‘gain’) but working with Jason helps me to understand why so I am able to regain control over my choices. Even after all these years, there are still things I can tweak because it is a lifestyle. I choose to live this way to live my best life and to be a role model for my teen girls. It is not about losing weight so much as it is about being strong and healthy.

I started skiing when I was 46. It was a ‘never ever’ before then and my husband wanted our girls to learn how to ski. If I hadn’t felt strong and healthy, I would have never tried it. And now, we have this special time together as a family. For your readers, it may not be about skiing, but my point is that everyone has the ability to change their lifestyle for the better. I know that I’ve done that working with Jason.

SEEING THE CHANGES TO HIS BODY HAS KEPT ROBERTO MOTIVATED TO STRIVE FOR MORE.

I remember getting the call from Roberto’s wife. I was driving to work and picked up the phone. She was concerned about her husband. He had changed the way he was eating and was committed to exercise yet wasn’t seeing any visible changes on the scale or in the mirror. She was concerned that something else was at work. His story was a classic doing the right thing, yet not quite doing things right. We made a few tweaks to his plan, so subtle that if you asked him what changes we made, he may struggle with telling you what those changes were. When I met Roberto he was 340lbs at 51% fat and today he is 265 at 31% fat. This is his story.

What do you think was the largest contributor to your weight gain over the years?

Stress, overeating, and not understanding what food meant to me. I’ve never been a sweets guy but my portions of actual food were not on point. I was putting in the work and doing the exercise, but not seeing the results. Which in turn lead to frustration and a lack of motivation to continue to put forth the effort.

There are many factors to your weight loss over the year. What do you think was the largest contributor to your weight loss?

Seeing Group23 and discovering through the metabolic screening that my body needed certain foods more than others. Really learning with Jason what my 40-year-old body requires. Seeing results as I put nutrition/diet and exercise together has made it easier to continue to make the efforts needed. Seeing change motivated me to continue to see more and do more.

What advice would you give to anyone that is starting their lifestyle change?

Patience and effort! Every body is so different. What we put into our bodies is such a contributing factor to our overall health. Understanding what you specifically need is step one, second is the patience to overcome triggers that may want to stand in your way of your goal.

What do you think will always be a struggle in keeping your weight off?

Stress! Running a small business can be stressful and time consuming. It’s important to take the time to plan or have a plan in mind, so that I can continue to make smart decisions about my nutrition and diet. I keep reminding myself that my health is a priority in turn allowing me to continue to plan what I need to do to continue to be successful.

Roberto is challenging himself even further. The changes he has experienced has built confidence that he can go further than he even expected. He exercises with his wife almost every day, and he is starting to visualize a completely different person. One who never thought losing weight was possible to challenging himself beyond a scale weight and body fat percentage. Seeing a body who can lift heavy and aerobically do things that were even beyond his youth. He has inspired me to be better and to strive more. I hope his story inspires you to #RiseAbove.

How do you know how to choose the best possible injection therapy for your knee, hip, or shoulder pain?

Like many other simple questions that don’t have simple answers, the correct and honest answer to this question is “IT DEPENDS.”  You may ask: depends on what??? You mean to tell me there isn’t just one type of super injection that fixes, repairs, heals, and makes me feel forever young?  I thought I heard about that on Dr. Oz? Not true? Unfortunately, no.  

There are, in fact, many factors, variables and considerations that go into answering this question correctly.  Whether you are considering a cortisone “steroid” shot, a Hyaluronic Acid “Viscosupplement” injection, or a regenerative technology such as Platelet Rich Plasma (PRP) or Prolotherapy injection, there are many things you should consider when deciding on how best to proceed.   

Before we get into the specifics surrounding injection therapies, it’s important to reflect on the unique concept of care employed at Group23 Sports Medicine, which is outlined within our proprietary #RiseAbove Patient Health Journeys. This concept of care would argue that it is a mistake for any patient or physician to look at any single treatment variable (such as an injection therapy) in isolation, without consideration for the other factors that will ultimately determine successful treatment outcomes. As a patient embarks upon a Group23 #RiseAbove Patient Health Journey, we specifically ask that they commit to three preconditions:

1. Becoming an expert in their condition. 

2. Seeing their treatment plan as a journey. 

3. Taking an integrated bio-psychosocial-spiritual approach

Why this concept is important will be reflected in the answers provided below as we examine some of the most common variables that will influence your decision of how to choose an injection. 

What is the purpose of the injection?

This may seem obvious, but when we do Group23 Ultrasound Guided Injection Clinics, we’ll often ask a patient presenting for their injection to: “pretend I’m your friend and explain to me the problem and reason we are doing this injection today.”  You might expect most patients would know the answer as they are about to let someone inject a substance into their body, but very often, patients struggle to answer the “why” behind what we are about to do. Some might say “it’s going to heal my knee” or “it’s going to fix my shoulder rotator cuff tear” or our favorite, “I have no clue! I’m here because my doctor told me to get this injection!”. While we don’t expect our patients always give the correct answer, we do see that patients who are on #RiseAbove Journeys and who have “Become an expert in their condition” have a much easier time answering this question than those who are not. Patients on a Patient Health Journey fully understand their condition, know and the differences between each type of injection therapy, specifically understand WHY they are proceeding with the injection being done that day and how it can help them reach their #RiseAbove goal(s).  

What are your priorities and timelines?

Every patient has different priorities, timelines, and expectations. Doctors are notorious for making assumptions about patient’s wants and needs, but at Group23, we want your priorities to be explicit and stated by you. In other words, we don’t want to recommend a treatment until you tell us what you are wanting to achieve. This is codified within the #RiseAbove Patient Health Journeys by having set #RiseAbove goals that serve as both a reference point and benchmark by which decisions are made and success realized.  #RiseAbove goals are SMART Goals – that is (Specific, Measurable, Actionable, Realistic, and Timebound) and timelines are determined by the patient. For example, a patient with knee pain whose goal is long term (I want to be golfing by 6 months from now in the summer) may choose a regenerative therapy injection such as PRP, where as a patient whose goal is to play 3 rounds of golf at Pebble Beach NEXT WEEKEND, will only have the option of a cortisone injection as it is the fastest acting and gives them a chance to enjoy that golf trip.  

Is it safe?

“Do no harm” is part of the Hippocratic oath all doctors take when they receive their degree.  Thankfully, all the injection therapies offered at Group23 are very safe procedures. While no injection procedure is completely without risk, we ensure that we do everything possible to minimize that risk.  Patient medical history, medications, allergies are reviewed, and the consent forms outline the most common potential risks/side effects. If the injecting physician feels there are risks that outweigh the benefits or if you have “absolute contraindications” then alternative treatments will be discussed. 

“I heard that cortisone is bad for my joints, is that true?”  

This is a very common question and a very misunderstood subject. Unfortunately, preconceived beliefs that are not fully informed can result in many patients missing out on an effective treatment option. What we tell our patients and what the research tells us is that there is some truth in the statement that cortisone is not the best thing for HEALTHY joints. In other words, if you take cortisone and inject a perfectly healthy knee every 3 months for 2 years, in some patients, you may see some “thinning” of articular cartilage (the smooth cartilage at the ends of the bones in a joint that make them slippery).  Is this significant? The answer is maybe, but studies have failed to show that simply seeing thinning of cartilage on an MRI can reliably predict clinically significant changes to pain or function. Therefore we recommend a concept of “treating the patient, not the picture.” While imaging studies are valuable tools for diagnosis and monitoring progression, it is your function that is the most important measure of “health” in a joint.  

When we have this discussion about cortisone in clinic, there are two key concept we relay to our patients: 

1. Remember that if we are discussing cortisone as an option for injection, then we are typically NOT dealing with a “healthy” joint. That is, you likely have some arthritis, pain, inflammation, etc.  No one would ever suggest you prophylactically shoot your knee up with steroid and risk some minor cartilage thinning “just in case” it might one day be sore. Rather, if you are considering a cortisone injection, it’s because your joint is not “healthy,” rather it’s in an inflamed state, painful and not able to function normally. 

2. Once you accept this is not a “normal” or “healthy” joint, think of cortisone as the LESSER of two evils when contemplating injection vs. leaving it alone to run it’s natural course.   

To explain this, we like to use the burning table analogy.  Imagine you have a lovely mahogany dining room table, a family heirloom, that is very important to you, and one day you walk into the house and see it on fire. As you contemplate what to do, someone runs into the room with a fire extinguisher to put out the fire. Now, would you tell them “NO!!! Stop! Don’t spray the table with that! Don’t you know how damaging the chemicals in that fire extinguisher fluid are to mahogany wood tables?”.  If they listened to you, and let the fire burn, then you won’t have a table, you will have ash. In this instance, the fire-extinguisher fluid and chemicals it contains, while certainly not the “healthiest” thing for the wood, would nonetheless be the lesser of two evils as compared to letting it burn. At least once the fire is out, you’d still have a table! 

I’m worried that injections may hurt.

This is a very common question. Thankfully, except for a few specific types of injections (PRP or prolotherapy into tendons or ligaments), the vast majority of injections cause very little in the way of patient discomfort. There are three reasons for this at Group23: 

1. The use of “freezing” or local anaesthetic which “numbs” the injection site so you don’t feel pain. After the little twinges of the poke, most people just feel a small pressure but not sharp pain or discomfort. 

2. The use of very tiny needles – because the vast majority of the injections we do are under ultrasound guidance, we can use the smallest needles possible to get the job done. This means much less discomfort for the patient.

3. At Group23, we do injection therapy differently: Our injecting physicians are not only very experienced, but more importantly, they know your history, know your #RiseAbove goals, have listened to your complaints, and have physically examined you BEFORE they ever come at you with a needle. This means that our physicians can and will adjust any procedure to fit what they feel works best for the patient. This is quite different from simply getting an injection done at a clinic where they are simply carrying out the request of another physician without verifying if it’s the best thing to do. 

Can I afford it?  

Injection therapies have a wide range in cost with some being free to others such as advanced PRP preparations being as much as $1300 per injection. At Group23, in all the #RiseAbove journeys, we reference the importance of considering the Bio-Psycho-Social-Spiritual approach to care. Within the social domain is finances. For most patients, they don’t have unlimited health spending accounts or an endless supply of cash to be throwing at their care. At Group23, we understand this, therefore every patients’ health journey is designed in a stepwise manner which aims to do the least costly, least invasive treatments first, before moving onto more costly or invasive treatments.   

How often do I need to get an injection?

This question again is best answered by ‘It Depends.”  The same themes recur! What’s the #RiseAbove goal, what’s the timeline, what are the patients’ priorities (short term, long term), and what is their budget. At Group23, we will work with you to determine what the best frequency of injections will be. We don’t say things like “come every 3 months for your repeat cortisone shot” or “you need PRP injections every year”. This is not great care, and you deserve better. 

What happens if it doesn’t work?

This is a very important question. It brings to mind a patient from a few years ago, before we started using our #RiseAbove journeys, who after getting a series of injections into his shoulder reported back at his three month follow up visit that the injection didn’t work. Upon further questioning, he reported that he had been able to get back to doing all the activities that he loved to do (skiing, tennis and golf) with no limitations, BUT, the injections didn’t work because he still had some pain in the shoulder form time to time. This represents a misunderstanding of what injections can do, but it also highlights how important it is to set reasonable expectations as it relates to injection therapies.    This is one of reasons why in our new Patient Health Journeys, we first establish the patients’ #RiseAbove goals. What we are doing is setting the benchmark by which we can judge if the comprehensive treatment has worked, because we can measure when a patient has reached their goal. So, in this sense, it’s not about a single injection working or not working, it’s about the overall progress and whether an injection was one of many interventions that helped move a patient closer towards reaching their goals. Furthermore, if a patient sets an unrealistic goal (ex. after my knee injection I want to run a marathon and have no pain anywhere in my body after the race…) it allows us to quickly recalibrate expectations in line with reality.

We like referring to injection therapies, medication trials, braces, and other interventions as potential tools.  Your journey should be more about the process of establishing what set of tools works for you, in relation to your goals and your timelines, then it is about using a single intervention like an injection to fix a problem.  Unfortunately, there is no standard formula, and everyone must establish what works for them. About two thirds of people who get an injection of any kind, whether PRP, Prolotherapy, Viscosupplement, or cortisone, will report that it helped, and they are glad they did it. But that does leave one third of patients who say, that didn’t work. At Group23, we point out that all that means is that that it didn’t work for you, but now that we know that we can move onto other options because thankfully an individual’s probability of responding to an injection is still 67% for many of the other injection therapies that they have yet to try. 

In conclusion, when it comes to choosing the right injection therapy for your knee, hip, or shoulder, it’s not a simple as just recommending the one injection that works for everyone.  At Group23, we have created a process that ensures that patients receiving injection therapies:

1. Understand their condition and why they are getting an injection (They’ve become an EXPERT in their condition) 

2. Understand how the injection being done supports them along their #RiseAbove Patient Health Journey as they work towards their #RiseAbove goal(s).  (They see their treatment plan as a journey)

3. Understand that every intervention, including injection therapies, must take into consider cost/benefit analysis to ensure it’s the best decision for them in the context of their broader life. (They take an integrated  bio-psycho-social-spiritual approach)

Dr. David E. Manning / CEO / Sport Physician, MD CCFP(SEM) DipSportMed