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kostas-constantineDr. Kostas ConstantineIf your children are involved in sports, you know all too well how quickly an injury can happen on the field or in the gym. Do you have aging family members who are at risk of serious injury if they fall? Feel dull pain in your back after a long day of holding a baby? Wondering if you have carpal tunnel? All these questions and concerns can be answered and addressed by an orthopedic specialist!

Dr. Kostas Constantine, of Fredericksburg Orthopaedic Associates, P.C. (FOA), has graciously answered several questions for us regarding sports injuries, everyday wear and tear, and common childhood injuries.

QTell us about Fredericksburg Orthopaedic Associates. How big are you? When did you get started?

The group was formed in 1971. We have grown to seven partners with subspecialty interests in general (including common childhood injuries), spine, total joints, sports, shoulder and hand. We also have a podiatrist and five physician assistants, as well as three physical therapy locations to help us take better care of our patients.

Physicians are specially trained in advanced surgical procedures and each performs a particular surgical expertise for FOA. Specialties include arthroscopic surgery, arthroscopic knee and shoulder reconstruction, carpal tunnel repair, neck and back pain, shoulder surgery, total joint replacement and revisions, and more. In addition to medical and surgical expertise, FOA offers patients the benefit of receiving physical rehabilitation.

QWhat is orthopedics and what is your specialty?

It stands for "standing child" since originally the specialty was concerned with scoliosis, or bending of the spine, in children. It has now expanded to deal with all musculoskeletal injuries — joints, bones, ligaments, tendons, nerves and arteries — ranging from lacerations and broken bones to artificial joints from the neck to the foot.

QWhat age groups do you treat?

We treat all age ranges from newborns to centurions. I once treated a patient when I first started, 101 years old, who broke her hip kicking a ball in the nursing home. She was born in 1899 and none of the hospital computers could compute her age!

QWhat are the most common injuries you see in kids? How can we help prevent them?

Fractures are by far the most common injuries and unfortunately are very difficult to prevent since most are sports related or accident related.

QHow does physical therapy /hand therapy factor into your treatment? Do most of your patients need PT?

Our physical and occupational therapy is integral to helping patients heal quickly and get back to their normal activities as soon as possible. Not everyone needs to go, but it can be essential in certain injuries for the therapist to be involved in the healing process.

QWhen is weight training OK for growing teens? How about for tweens?

This is very controversial. I normally allow weightlifting after 12 years old. I would recommend a trainer or someone experienced to teach the safe use of the weights and correct technique. At 14, I would allow as tolerated. For children under 12, I recommend normal activities or supervised sports only.

QHow much weight training do you suggest? How many times a week?

None for under 12. One to two times per week between 12 and 14, then up to three times a week in high school.

QWhat are the most common injuries you treat from contact sports players?

Wrist and finger fractures as well as some ligament tears. We frequently see ankle and knee injuries, of which female ACL knee ligament tears have become much more common as noted in your question below.

QWhat are some good ways to reduce sports-related injuries in children?

I believe making sure the children know good techniques in their sports, stretch well, and are well conditioned for the sport they are playing is very helpful to reduce sports injuries. Also wearing the correct and well-fitted protective gear for the respective sport is essential.

QGirls playing field hockey or volleyball are tearing their ACL's more frequently. How long is the treatment and can full mobility be restored?

There are many theories on why we are seeing more ACL tears in young female athletes. The majority of these injuries unfortunately require surgery to repair. Luckily, in three to six months these heal well with surgery and therapy. I am more conservative and wait nine months to a year before allowing return to full contact sports.

QCan we avoid this injury short of not playing?

Not really. Maintaining strong thigh muscles and stretching may be helpful, but a misplaced pivot or being accidentally hit by an opposing player is hard to prevent in any contact sport.

QSome kids participate in high school sports as well as travel teams. How important is rest between games?

Depends on the sport. I am very careful with baseball and softball pitchers. I prefer at least 24 hours rest every other day or every third day, but with both schedules being demanding, it is difficult to control. If at all possible, some rest is definitely helpful and preferable if the child is able to get it, especially at younger ages.

QSo many times you hear a coach tell an athlete to "Walk it off. It's just a stinger." When is it not a stinger? What are the warning signs?

Stingers are temporary pinching of the nerves from the neck to the affected arm, usually lasting from less than a few minutes up to two weeks. Usually ice, stretches and anti-inflammatories help the symptoms resolve. If the pain or weakness is worsening, then I would seek orthopedic advice, especially if it lasts more than two weeks. Similarly with any limb that has persistent pain, swelling, bruising or any deformity, I would strongly recommend an orthopedic consult and X-rays within 24 hours of a game. Normally a responsible athletic trainer can tell on the field the severity of the injury, but if [you have] any questions, obtain orthopedic advice.

For Moms & Dads......

QI'm constantly bending over and picking up my kids. Are there ways to help relieve shoulder and back pain after a full day of kid lifting?

Yes. Try to bend at the knees instead of the waist. Doing back strengthening exercises and stretches also important to protect the back.

QHow can I help prevent carpal tunnel syndrome? I'm on my computer all day for work; will this aggravate the problem?

Carpal tunnel is a pinched nerve in your wrist due to a thickened ligament. Avoiding bent positions of your wrist can be helpful. An ergonomic keyboard and taking vitamin B6 (100mg daily) is protective. If it is waking you up at night, a night splint is also helpful. However, it is the number one hand problem we treat and it tends to progress with time. Although cortisone injections can give temporary relief, the most effective treatment when the symptoms are bad enough is surgical release.

QI play a lot of tennis, and have a pain that I'm assuming is tennis elbow — it's a dull achy pain on the outside of my forearm, just below the elbow. If that what this is, what do you suggest for treatment?

Tennis Elbow or lateral epicondylitis is the most common injury affecting the elbow. It is a partial tear of the insertion of one of the muscles that extends the wrist at the outside of the elbow. Anti-inflammatories, stretches, therapy, elbow straps and injections help it heal, but it can take up to one year. The key is to lift palm up when using the arm. For the 10 percent who do not improve with conservative measures, surgery may be appropriate.

Have a question you'd like to ask Dr. Constantine? He will be hosting our Ask The Expert session on November 20! Ask The Expert is a live discussion on our Facebook page between you and a local expert. Join us every Thursday at 8 p.m.

For more information about FOA, or to schedule an appointment, call 540-373-4602 or visit
Fredericksburg Orthopaedic Associates, P.C. (FOA) has locations in Spotsylvania, Fredericksburg, Stafford, and Woodbridge.


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