Activity, movement, and sport are critical dimensions of what it is to be human. And the branch of medical expertise related to activity, sport and performance is sports medicine. Dr. Melina Thibodeau and Dr. Alex Brothers have joined our team to extend our capacity to provide you with the expertise you need to recover, perform better, and reach your goals.
The Canadian Academy of Sport and Exercise Medicine (CASEM) is an organization of physicians committed to excellence in the practice of medicine as it applies to all aspects of physical activity.CASEM
Canadian Academy of Sport and Exercise Medicine (CASEM) The Canadian Academy of Sport and Exercise Medicine is the national medical specialty society for sport medicine physicians in Canada. The Academy is open for membership to medical doctors (MD). It was founded in 1970 and the Academy serves as a means to ensure its members are kept up to date with current medical practices in sport medicine.
The Diploma of Sport and Exercise Medicine (DipSportMed) developed by CASEM, is a recognized credential for sport medicine physicians in Canada. The Clinical Journal of Sport Medicine, founded by CASEM, is a peer reviewed sport medicine journal, now published by Lippincott Williams & Wilkins.1
Dr. Melina Thibodeau
BSc, MD, CCFP, dip Sports Medicine
Dr. Melina Thibodeau is a sports medicine doctor and family doctor. She has been practicing sports medicine in Victoria, BC since 2004. She has worked with Athletics Canada as the team physician for several international track and field and cross-country competitions.
What is Viscosupplement?
Viscosupplement is also known as hyaluronic acid. It is a naturally occurring substance found in the synovial (joint) fluid. It acts as a lubricant to enable bones to move smoothly over each other and as a shock absorber for joint loads. In people with osteoarthritis (OA), this fluid becomes diseased and no longer protects the joint effectively. The covering on the ends of the bones (cartilage) can also break down, becoming worn and frayed. These changes may result in inflammation, swelling, tenderness and pain in the joint, which leads to a reduction in mobility.
Although OA is most commonly found in the knee joint, it can also affect other joints such as the hip, ankle, shoulder or hand.
With viscosupplementation, your doctor injects a gel that is similar to healthy synovial fluid into your joint. The goals of the treatment is to:
- Restore the properties of shock absorption and lubrication to diseased synovial fluid.
- Reduce or stop the pain from osteoarthritis of the joint.
- Improve mobility
Hyaluronic acid does not have an immediate pain-relieving effect. You may notice a local reaction, such as pain, warmth, and slight swelling immediately after the injection. These symptoms generally do not last long. You may want to apply an ice pack to help ease them. For the first 48 hours after the injection, you should avoid excessive weight bearing on the leg, such as standing for long periods, jogging or heavy lifting.
Depending on the product used, treatment may involve 1 to 3 injections. Over the course of the injections, you should notice that you have less pain in your knee (or other joint). The effect should last for 6-12 months. You can have another injection of hyaluronic acid into the joint in 6 12 months if the effect was positive, but has worn off. The goal is to reduce pain and keep you more active and hopefully avoid a joint replacement.
There are several brand names of hyaluronic acid for injection: Synvisc, Durolane, Monovisc and Neovisc.
Post Prolotherapy Instructions
- Stay hydrated
- Do not take NSAIDs (Naprosen, Ibuprofen, Celebrex) for 7 days after prolotherapy
- Do take Tylenol, Tylenol#3 or Tramacet for pain if needed for a few days
- Use ice sparingly (remember you do want the inflammation response)
- Exercise in moderation - we encourage walking but no strenuous activity during the first week. Keep moving but not to the point of pain. Do not over stretch - we are trying to repair tendons and ligaments.
- Begin specific isometric exercises the second week – movement helps the healing process. These are gentle movements against resistance without using weights. You can use therabands if you wish. You need to exercise the relevant muscle groups - ie. where you have been treated. A physiotherapist can reinforce the correct exercises if required.
- Do not poke around the injected area. You can increase the risk of infection by touching the injected sites, and you can worsen the healing process. This means no massage, chiropractic, myofascial release, active yoga, manipulation at all of the affected area of your body. Patients who forget this often have increased pain and less chance of healing.
- Remember: your pain might be better or worse during the first 2 weeks after prolotherapy. Expect this and you won't be disappointed. But at 1 month you should notice you are improving. Some people only improve after the 2nd or even 3rd injection. These people are glad they persisted with treatment - it paid off in the end. Prolotherapy takes time to work as it is using the body's own repair mechanisms.
- If there is redness and swelling around the injection site that is worsening call Dr.Thibodeau.