Thursday, December 27, 2012

Stay Safe on the Slopes: Preventing Snowboarding Injuries

With the winter sports season quickly approaching, it is important to consider how to stay injury-free on the slopes. How do you make sure that you get the most of this year’s snow and not wind up in the operating room? We will discuss some important ways to stay safe and injury-free.

The two most common mechanisms of injuries in snowboarding are falling or a direct/traumatic blow. The most commonly injured body parts are the arm, shoulder, head and wrist. Many injuries are minor, but others can require surgery and have a recovery time of 3 to 6 months. 
Be smart and take some precautions so that you can get the most out of this year’s snow and not wind up in the ER.  There are a few simple precautions that one can take to prevent injury. 
Take a Lesson
If you are new to the sport, get a licensed instructor to help you learn the sport. Instructors can be instrumental in helping you master the sport of snowboarding.  They can make sure you have the proper equipment and guide you to the appropriate training terrain.  With an instructor, you will also be taught proper techniques and form.  An instructor will even teach you the best way to fall without getting hurt. 

Proper Equipment
Make sure you have equipment that fits properly. This is extremely important. Bindings that are too loose or too tight are definitely a contributing factor to many injuries.  Helmets are also extremely important for injury prevention. In addition to a helmet, it is recommended that boarders wear wrist guards, knee pads and elbow pads.  It is estimated that using protective equipment can reduce injuries by 43%!

Use Common Sense
Most injuries occur after lunch, when the boarder is tired and fatigued.  The conditions also change after lunch and can become more icy or ‘skied-off’.  Make sure to stay hydrated, take breaks and stay alert. If you feel tired; stop and rest. 

Obey the Rules – National Ski Associations Responsibility Code
Know the code!  Follow the responsibility code and prevent injury. 
·        Always stay in control
·        People ahead of you have the right-of-way
·        Stop in a safe place for you and others
·        Whenever starting downhill or merging, look uphill and yield
·        Use devices to help prevent runaway equipment
·        Observe signs and warnings, and keep off closed trails
·        Know how to use the lifts safely
There are many ways to prevent injury and stay safe this year on the slopes.  Be aware, wear proper equipment and stop when you are tired.  Follow these simple guidelines and have a great time on the slopes!
John Vitolo, MD is an orthopedic surgeon in Sparta, NJ.  He currently holds dual board certification in Orthopedic Surgery and Sports Medicine. For more information visit us online at


Thursday, October 18, 2012

Why are women more susceptible to ACL tears?

In recent years, there has been discussion on why women and young girls are more susceptible to ACL tears. There are many theories on the reasons why, but today we will examine a main anatomic difference between men and women that is a contributing factor: the Q-Angle and wider pelvis.

The Q-angle is the angle at which the femur (upper leg bone) meets the tibia (lower leg bone). The Q-angle is determined by three areas of the human anatomy – the Anterior Superior Iliac Spine (ASIS), the center of the kneecap (patella) and the tibia tubercle.  The Q-angle is basically a line drawn from the ASIS down to the center of the kneecap to the tibia tubercle (see picture below).

The Q-angle in women is greater because women are anatomically built with a wider pelvis than men.  A normal Q-angle in men is 14 degrees, while women have a normal angle of 17 degrees. The greater the angle, the more at risk the person is for knee injuries, including ACL tears.

The fact that the q-angle is more pronounced in women than men leads to more stress on the knee joint and makes it less stable when put under stress. For this reason, when a woman participates in sports involving jumping, running or pivoting, she is naturally more likely to suffer an ACL tear. 

What can we do to prevent ACL tears in women?

Recently, emphasis is being placed on neuromuscular training programs.  Neuromuscular training teaches the body better biomechanic movements to improve the control of the dynamic knee stabilizers (the ACL and major ligaments that surround the knee).  Exercises that are included in a neuromuscular training program include stretching, plyometrics and strength training.  The goal of these programs is to teach athletes how to land, pivot and control the knee without placing as much force on the ACL.  One program was developed by the Santa Monica Sports Medicine Research Foundation and is known as the PEP Program: Prevent Injury and Enhance Performance. To learn more about this program, please visit  

If you suspect that you have an ACL tear or other orthopedic injury, it is important to see an Orthopedic Surgeon.  Skyview Orthopedic, the office of John Vitolo, MD is available to treat all your orthopedic injuries and concerns.  Our office is focused on treating each patient individually and offering the highest quality orthopedic care.  John Vitolo, MD holds dual board certification in Orthopedic Surgery and Sports Medicine. For more information call the office, 973-300-1553 or visit us online at

Tuesday, September 11, 2012

Prevention of Shoulder Impingement/Tendonitis/Bursitis

The shoulder is a very important part of the human body. When injured, inflammation occurs causing pain and weakness in the shoulder. This can greatly impact a person’s quality of life. Today we will discuss a common condition, known as Shoulder Impingement and/or Bursitis. 

In order to understand shoulder pain and injury, it is important to learn about the anatomy of this joint. The shoulder is a ball-and-socket joint made up of three bones: the humerus (upper arm bone), scapula (shoulder blade), and clavicle (collarbone). The head of the humerus fits into the glenoid (a rounded socket in the scapula). These bones are held in place by muscles, tendons and ligaments. The ligaments hold the bones together and create stability, while the tendons connect the muscles to the bones and the muscles make movement possible.

Three common shoulder conditions are: Shoulder Impingement, Tendonitis and Bursitis. Shoulder Impingement occurs when the space between the acromion and rotator cuff narrows and the acromion rubs on the tendon or bursa.  This results in pain and irritation. Tendonitis occurs when the rotator cuff tendons and/or the bursa become irritated and inflamed and Bursitis occurs when the Bursa becomes inflamed and swollen with fluid. It is common for these conditions to occur in conjunction with one another since they are adjacent structures.

Symptoms of these conditions include: 

  • Pain while performing an activity and at rest
  • Pain that radiates from the front of the shoulder to the side of the arm
  • Pain with throwing
  • Pain with overhead motion 
  • Sudden pain when lifting/reaching

These conditions are often caused by overuse and improper lifting techniques. To help prevent these common shoulder injuries, follow these helpful tips:
  • Exercise regularly and strengthen the muscles of the shoulder joint
  • Focus on upper body strength and flexibility
  • When lifting and reaching overhead, pay attention to the position and form of your back
  • When lifting, keep back as straight as possible, bend and lift with your legs
  • When reaching to place or retrieve heavy objects, use a stable platform or stool
  • Know when to say when – when you are tired and fatigued; take a break!
Depending on the severity of the injury, shoulder impingement or bursitis can be treated non-surgically through rest, cortisone injections and physical therapy, and in some cases requires surgery.  Should surgery be required, minimally invasive, arthroscopic surgery to is the best method to repair the injury, followed by a rehabilitation program to get you back to full activity as quickly as possible. For more information or to schedule and appointment with John Vitolo, MD, please call 973-300-1553 or visit

Tuesday, August 14, 2012

Proper Protocol Following Rotator Cuff Surgery

For years, my practice has found that immobilizing the Rotator Cuff for 3-4 weeks after surgery has led to more positive post-surgical results.  Recently a study was released from the Center for Special Surgery that confirms doing this leads to more favorable healing. 

The rotator cuff consists of 4 small muscles in the shoulder blade and allows the arm to rotate.  A rotator cuff tear occurs when the muscles are torn from the bone in the upper arm. When torn, surgery is often needed to repair the injury.  Surgery is performed to reattach the torn muscle to the bone. 

Historically, many surgeons have pushed to have the patient start physical therapy one week post-surgery. However, we have found that allowing the rotator cuff to stay immobile for 3-4 weeks has led to better post-operative results. 

Recent studies have shown that up to 20-40% of Rotator Cuff Repairs fail or patients experience decreased strength and range of motion.  Due to this alarming number, the Center for Special Surgery conducted a study on post-operative protocol and found that immobilization for a longer period, does help the healing process. 

At Skyview Orthopedic, we strive to offer our patients the highest quality care and stay current with all the latest advances in orthopedic care.  We are proud to see that new studies confirm the protocol that we use is the best option for our patients.

Monday, July 9, 2012

Exercises to Prevent Shoulder Injury

One ways to prevent injury of the shoulder is to do a proper warm up and stretch before activity.  Not sure what to do?  Here are some simple warm ups and stretches to get you started. Check back soon for our next post on exercises to strengthen the shoulder muscles. 
To do these simple shoulder warm ups and stretches, all you need is a towel, yard stick or even a baseball or lacrosse stick. The goal is to warm up the muscles and gently stretch the muscles so they are ready for more vigorous activity. 
Exercise 1:  Hold the stick a little farther than shoulder distance apart. Raise arms in front of the body and above the head. 
Exercise 2:  Continue to hold the stick and raise arms side to side. 
Exercise 3:  Again still holding the stick, lower the stick behind the head. 
Exercise 4:  Finally, hold the stick behind the lower back and gently press up. 
Perform 3 sets of 10 for each motion.  Each stretch should be performed gently.  If a specific motion causes pain, stop. 
See pictures below:
Behind the Back Stretch

Behind the Neck Stretch

Side to Side Stretch

In Front Arm Raises


Monday, April 16, 2012

Baseball Season: Protect your Shoulder

Spring is in the air!  It is baseball season; time to get out and enjoy this classic American sport.  Many kids and adults play the game and probably give little thought to the impact playing can have on the shoulder.  It is important to be aware of the potential injuries that can occur so that a small strain does not evolve into a serious problem. 

Bursitis, rotator cuff weakness and rotator cuff tears are all possible complications from the constant throwing, batting and diving that are involved in the wonderful sport of baseball.   What are injuries should you be aware of and how are they caused? 
Rotator Cuff Weakness:  Rotator cuff weakness can be caused by a constant throwing motion.  Weakness occurs when the rotator cuff tendons become inflamed and may get pinched under the shoulder blade. 

Tendonitis/Bursitis:  Tendonitis occurs when the rotator cuff tendons and/or the bursa become irritated and inflamed.  Symptoms include extreme pain or weakness, especially when the shoulder is in motion.   These conditions often occur in conjunction with each other, but pain associated with Bursitis tends to be located just under the joint capsule. 
Rotator Cuff Tear:  Here we have the ‘worst case scenario’.   Rotator cuff tears occur when the tendon is ripped off the bone.  Symptoms include:  limited motion, decreased shoulder strength and aching and weakness when you lift your arm above your head.  Surgery is often required to fix a rotator cuff tear. 
The big question is:  how do you avoid these injuries and stay in the game? 
One great way to prevent injuries of the shoulder is Strength Training.  Around the shoulder blade (also called the scapula) are a series of muscles that together with the rotator cuff, allow a dynamic, fluid motion seen with throwing. Many athletes perform exercises that strengthen the large muscles of the shoulder, such as the pectoralis major and deltoid muscle, but ignore the rotator cuff and smaller muscles surrounding the shoulder blade.  Failure to strengthen these smaller muscles, called the parascapular muscles and rotator cuff muscles, can result in pain while throwing, and issues with shoulder function.   
Examples of rotator cuff exercises are resisted external and internal rotation exercises of the shoulder, reverse flies and seated rows (look for future posts for more details on these exercises).  All of these exercises should be performed with an emphasis on squeezing your shoulder blades together while doing each repetition.  These muscles are small in relation to other muscles in the body and do not require a significant amount of resistance.  A few pounds of weight or a light resistance band is usually adequate for strengthening. 

As a reminder, prior to performing any of these exercises it is important to see your orthopedic surgeon if you are unable to lift your arm, or if you are unable to perform these exercises due to pain or discomfort.

Prevention of these injuries is often possible.  In addition to the strength training mentioned above, here are some additional tips from STOP Sports Injuries (
  • Warm up & stretch -  it is important to  stretch out  the shoulder and start with a few “softer” throws.
  • Play various positions - this is especially important for the younger athletes.  Switching positions and using different body parts/muscles is an important component to preventing injury.  
  •  DON’T play through the pain!  If pain persists, see a doctor. 
  • Take time to rest.  If you are a pitcher, try to take a day or two off between games. 
  • Concentrate on control, form and accuracy when throwing or pitching

If you suspect you or your child has a shoulder injury, we are here to help.  Skyview Orthopedic Associates is an excellent resource.  Our staff is focused on individualized, state of the art patient care and is led by John Vitolo, MD.  Dr. Vitolo specializes in injuries and disorders on the shoulder and knee.  He is board certified in orthopedic surgery and sports medicine.  Dr. Vitolo was also recently named to the NJ Top Doc list.   For additional information, visit or call 973-300-1553.

Monday, February 6, 2012

Advances in ACL Surgery: Anatomic Reconstruction

This summer, John Vitolo, M.D. attended a conference on a new ACL reconstruction technique at the University of Pittsburgh Medical Center, home to one of the largest and most respected orthopedic clinical and research departments in the United States.  Dr. Vitolo is now one of a few specialized orthopedic surgeons trained in this new surgical technique, called the “Anatomic ACL Reconstruction Method”.  

Since adopting this new procedure, Dr. Vitolo has noticed that his patients experience less post-operative pain, improved range of motion and better overall results.  Dr. Vitolo stated, “Anatomic method takes each patient’s individual anatomy into consideration and attempts to restore that natural anatomy.  By using a medial portal approach, you are able to put the new graft where the original ligament existed.  The results have been phenomenal.  Post-operative pain has decreased and my patients are recovering more quickly and returning to activities faster.”

The anatomy of every patient is different.  The “Anatomic Technique for ACL Reconstruction” looks at each patient individually and anchors the ACL to its original anatomical position by using the medial portal approach; therefore keeping the natural anatomy of the knee.  By doing this, the patient is less likely to suffer a repeat tear and is able to return to activities in less time.  It is also believed that using this new method can decrease  the risk of developing arthritis later in life. 

When the ACL is injured it cannot be repaired by fixing the original ligament.  A “new” ACL must be constructed by grafting tissue from the patient’s body (autograph) or by using tissue from a cadaver (allograft).  It has been shown that anatomic graft placement is critical to the success and clinical outcome of ACL reconstruction.

The main benefit to the new procedure is that it helps prevent a re-tear of the ACL because the graft is placed lower and mimics the body’s natural anatomy.  Non-anatomic bone tunnel placement is the most common cause of a failed ACL reconstruction.  

For more information or to schedule an appointment, please visit our website: or call 973.300.1553.   

Thursday, January 12, 2012

Dodging ACL Injury on the Slopes

Here’s the scenario: twilight, it’s the last run of the day, you are tired and wobbly and as you get off the lift you veer to the right to avoid the two snowboarders fastening their bindings in front of you. Your leg goes one way, your knee the other; you hear an unsettling pop and a sudden sharp pain on the inside of your knee. Congratulations, you just tore your ACL.  For skiers, the dreaded ACL injury, the most common ski injury, can mean missing out on an entire ski season and a trip to the hospital, rather than tomorrow’s corduroy.    
You may be wondering what the ACL is and why is it such a common ski injury?  The Anterior Crutiate Ligament (ACL) is one of the four ligaments of the knee that connect the femur and tibia.  The ACL runs diagonally across the middle of the knee and prevents the tibia from sliding out in front of the femur.  It also provides the knee with the ability to rotate.  
For skiers there are 2 main ways an ACL tear occurs.  The first is a sudden stop or acceleration of the leg, resulting in a tear.  The other more common cause of a tear is when the leg (or ski) stays in place, while the rest of the body stays in motion.  Symptoms of an ACL tear may include a popping sound, swelling of the knee, pain and instability. 
ACL injuries happen suddenly and often without warning, but according to Vermont Ski Safety (, there are precautions that can be taken to help prevent them.   Resorts using the training & techniques offered by Vermont Ski Safety have seen a 50% drop in ACL injuries.  Also, according to Ski Magazine, new bindings are now available that can release directly at the heel and are expected to reduce knee injuries. 
Tips for on the Slopes:
1.       Overall follow the responsibility code and maintain balance and control.
2.       When you fall, keep your knees bent with skis parallel and together.  Also allow yourself to finish the fall -- don’t try to stop sliding with your ski edge.
3.       If you jump, know how and where to land – land on BOTH skis and keep knees flexed
4.       Use newer ski bindings that were designed to reduce knee injury.
5.       Stay hydrated and well nourished – this will increase your awareness on the slopes and help you avoid potentially dangerous situations.
Off the slopes:
1.       Strengthen hamstring muscles and muscles around the hips. 
2.       Keep your equipment in good shape and have bindings checked regularly.
3.       Work your upper body – knee injuries often are a result of the upper body becoming tired and letting poles drop behind.
4.       Work your core muscles.
5.       Cross-train, stay fit and eat a balanced diet. 

For more information and videos from Vermont Safety Research, please visit their website.  If you do suspect an ACL injury see a doctor.  Skyview Orthopedic, the office of John Vitolo, M.D., has locations in Sparta and Randolph.  Dr. Vitolo holds dual board certification in Orthopedic Surgery and Sports Medicine.  He specializes in arthroscopic surgery of the shoulder and knee.  Visit the website: or call 973.300.1553 for more information or to schedule an appointment.  Find us on Facebook at
References:  3.

John Vitolo, M.D.