Read about Michael's trip to Japan!

In April our office manager had the opportunity to go to Japan and race a 10k. Michael wrote about the experience and his recap is featured in this month's Vulcan Runner, the monthly newsletter for Birmingham Track Club (BTC)
Check out the PDF version here:



Tennis Elbow - Not Only for Tennis Players

Do you have to play tennis to have "tennis elbow"?

The answer is 'no.' Although tennis elbow commonly affects tennis players, it also affects other athletes and non-athletes! Someone who is involved in activities requiring repetitive arm, elbow, or wrist movement. Tennis elbow is caused by an inflammation of the tendons surrounding the elbow, especially near the forearm area. Other activities that can lead to the development of tennis elbow includes golfing, playing basketball, gardening, sweeping, vacuuming, or scrubbing. 


  • Tenderness over lateral elbow
  • Pain with gripping (ex. shaking hands)
  • Pain with wrist movements or extensions (ex. turning door knobs, pouring from a pitcher)
  • Morning stiffness


  • Rest and ice the injury 
  • Avoid aggravating activities 
  • Exercises to stretch and strengthen forearm muscles and tendons
  • Non-steroidal anti-inflammatory medication and cortisone injections
  • Use braces and support on affected elbow and tendons

If pain continues and does not subside, call Fagan Sports Medicine for an appointment: 205.879.8206

Stress Fractures - A Sneaky, But Common Injury

Stress fractures are very common with athletes who run and jump on hard surfaces. That means you basketball players, distance runners, and even ballet dancers. Stress fractures are commonly known as "very small sliver or crack in the bone."

Why do stress fractures occur?

Stress fractures happen when there is unusual or repeated stress on a bone. The muscles that are meant to support and protect that bone become fatigued, which leaves them unable to absorb added shock from an activity.  When that bone's response stress cannot maintain the pace of the repetitive demands, a stress fracture is very likely to result from this repeated trauma.

Repeated trauma: Bones are constantly attempting to remodel and repair themselves, especially during a sport where extraordinary stress is applied to the bone. Over time, if enough stress is placed on the bone that it exhausts the capacity of the bone to remodel, a weakened site - a stress fracture - on the bone may appear.

The fracture does not appear suddenly. It occurs from repeated traumas, none of which is sufficient to cause a sudden break in the bone. 

How does one prevent stress fractures?

Proper footwear and warm-up/cool-down exercises are great ways to help prevent stress fractures in the lower extremities. Before a run or any other strenuous activity, walk and stretch out in order to warm up your muscles that protect your bones. Focus on strengthening and stretching the calf muscles. And always try to stretch and cool down after an exercise session. By strengthening and stretching your muscles after an exercise session, you are preparing your muscles for the next workout and your every day activities.  


What is Viscosupplementation?

The knee is a work horse for walking, running, jumping, climbing, and squatting among numerous other daily activities requiring it to bend over a million times a year.  Like any other hinge, it requires lubrication.  In a healthy knee, synovial fluid provides this lubrication and acts as a shock absorber for the joint. In a knee damaged by arthritis due to trauma, wear and tear, or rheumatologic disorders, the normal synovial fluid is diminished or thinned. The knee joint loses its lubrication and shock absorptive properties that the synovial fluid once provided.

This is where viscosupplementation comes into play. Viscosupplementation is fluid replacement therapy to replace the normal synovial fluid with Hyaluronates.

What is Hyaluronic Acid?

Hyaluronic Acid (HA) is a substance that naturally occurs in the body. It is a thick viscous substance found in synovial fluid, cartilage and skin. Viscosupplements, designed to replace the abnormal synovial fluid found in arthritic knees, are purified HA derived from either rooster combs or genetically engineered cells to add to the naturally occurring HA cells in the knee joint.

The Role of Viscosupplementation.

Viscosupplementation is a treatment option for those with osteoarthritis of the knee.  It is administered through a series of injections into the joint.  It is believed that by replacing the thinned synovial fluid of the arthiritic joint by HA which mimics normal, healthy synovial fluid that lubrication and shock absorption will again be provided for the joint.  Increased protection of the joint and decreased pain is the expectant result.

Could You Benefit?

Viscosupplementation is considered for those with knee osteoarthritis.  The typical patient has failed or had limited improvement with non-steroidal anti-inflammatory medications, analgesics, and therapeutic exercises. 
Early use is desirable. It may be considered in those who are trying to delay or are simply not candidates for a knee replacement surgery.  (Viscosupplementation has been used in other joints.  This is typically determined on a case by case basis. Use in other joints is routinely not covered by insurance.)

How Is It Administered?

Viscosupplementation is given by direct injection into the joint.  It is given in a series of 3-5 injections spaced approximately one week apart. This is performed in the clinic. Local anesthetic/ ethyl chloride spray is used for numbing prior to the injection.
Ultrasound guidance is utilized for placement of the needle to assure the medication is delivered through the capsule and into the joint space.  Studies have shown that 25% of “blind injections” deliver the medication into the surrounding fat pad and not into the knee joint. The ultrasound guarantees the medication is delivered to the desired target.

Is There Any Risk?

If you are allergic to chicken products or have had any previous reactions to hyaluronates you are not a candidate.  If you have an active infection at the site where the injection is to be given then you should not have the injections at that time.  If you have a febrile illness of any kind it is recommended that you postpone your injections.
Otherwise, the risk for the injections are no different from any other injections and like any other injection are very low if done with the sterile techniques and care that is recommended.  These include local bleeding, joint redness and swelling, infection of the surrounding skin or joint, and pain.

HA is safe and effective.  Depending on the severity of the arthritis injections can be 72-75% effective for 6 months to a year. The injection series can be repeated after 6 months.

*For more information on the procedure and if it can benefit you, call our office at (205)879-8206 and schedule an appointment.