Embracing Re-Form

In early April, my orthopaedic practice, in conjunction with Wellington Ortho & Rehab became the first Canadian centre to offer the innovative DJO-Exos® bracing system as part of their expanding array of fracture management products.

Exos is the only bracing system that offers “a removable, adjustable, reform-able and waterproof solution for the treatment of fractures and other injuries (conditions) requiring stabilization.  I had a chance to get some hands-on time with this system last month and I was very impressed.

Exos is a heat moldable, rigid brace that performs the essential functions of a conventional cast.  Using a simple oven system, the brace can be warmed to the point of being almost rubbery in consistency.  Upon initial application, the brace can be gently molded for a snug, comfortable custom fit.  Now here’s the magic…  over the next few minutes, the brace hardens to a firm, cast-like consistency, fully capable of supporting the injured part.  Using the Boa® dynamic compression closure system, the brace can be tightened or loosened as required, maintaining a secure and comfortable fit.

Exos Short Arm Fracture Brace

How does Exos stack up against conventional casts?

	Plaster/Fiberglass Cast	Exos
Rigid immobilization/protection	Yes	Yes
Light weight	Fiberglass-Yes Plaster-No	Yes
Radiolucent, able to clearly xray through the device without removal	Fiberglass-Yes Plaster-partially	Yes
Water-proof (fully submersible)	Fiberglass-Yes (with specialized, bulky lining) Plaster-No	Yes
Adjustable, accommodates for swelling and/or muscle loss (atrophy)	No	Yes
Easy Removal	No-requires cast saw	Yes-but can be locked if indicated
Re-moldable, re-formable	No-requires removable and re-application	Yes
Allows easy examination/inspection of the fracture/injury site	No	Yes
Skin and/or cast cleaning to control odor	No	Yes
Ability to start rehab therapy earlier in the healing process (if indicated*)	No	Yes
Saw-less Removal	No	Yes

From a medical perspective, this system offers advantages over conventional casting.  From a patient perspective, the advantages are even more pronounced, leading one of my initial patient to ask “why would somebody want a cast when this (Exos) is available?”.

Exos braces can be fit and applied with referral from the physician managing your injury or by direct referral to my orthopaedic practice in Guelph, Ontario.  Call 519-837-2020, click here to book on line, or send us an email at "MyExosBrace@gmail.com" today so we can get you fitted for this remarkable product today!

Some important points to remember:

• Exos® is a medical device and should only be used under the advice of a physician, when treating a medical condition.
• Exos® may NOT be suitable for your specific fracture, ask your doctor.
• Exos® braces require that users follow simple, but specific instructions.  Ask for your instruction sheet at the time of initial application.  If you have questions, ask!
• Skin irritation can develop, particularly if device is over-tightened.  Please follow instructions given at initial application. 
• Consult your physician immediately should a problem develop or should you have concerns.

K McKenzie MD, Orthopaedic Surgeon
519-837-2020

Therapeutic Massage, a Scientific Basis?

Ken McKenzie MD, FRCS(C), Orthopaedic Surgeon

Patrick Stiles, our Director of Massage Therapy has always been our most vocal advocate for the therapeutic benefits of massage therapy. Massage as a popular therapy has struggled to gain respect as serious medicine. In his popular blog post last year, “Massage Therapy, More Than Just a Back Rub”, Patrick points out the therapeutic benefits of massage as well as detailing the intense training required to become a Registered Massage Therapist. He now has additional ammunition. A study just released (study) shows that massaging muscles after hard exercise decreases inflammation and helps your muscles recover. This study also hints that massage after exercise may help relieve soreness, and may also help muscles become fitter faster.

In the study, researchers put 11 young men through a hard bout of exercise. Following their workouts, each got a 10-minute, Swedish-style massage, but only on one leg (the other leg was rested and used for comparison). Researchers sampled muscle tissue from both legs before and after exercise. They used gene-profiling techniques to look for chemical changes in muscle cells.

The lead author for the study was researcher Mark A. Tarnopolsky, MD, PhD, professor of pediatrics and head of Neuromuscular and Neurometabolic Disease at McMaster University in Hamilton, Ontario.

Dr. Tarnopolsky and his team found two main differences between the legs that were massaged and those that were not:

1. Massage switched on genes that decrease inflammation. Many painkilling medications also work by blocking inflammation.

2. Massage activated genes that promote the creation of mitochondria, structures that are the energy factories inside cells. The fitter a muscle cell is, the more mitochondria it tends to have.

The Significance of This Finding

In recent years, a number of studies have shown that remedies for muscle soreness that work by turning down inflammation (like ice baths or anti-inflammatory medications), may also have a downside. They may block some of the inflammatory pathways muscles use to repair themselves and grow.

Regarding muscle fitness, "If someone starts an endurance exercise training program, after two or four months of training, depending on the intensity, you essentially double the volume of mitochondria in muscle," says Dr. Tarnopolsky. Mitochondria, he says, help the cell to take up and use oxygen. Exercise and massage both seem to enhance mitochondria and the ability to use oxygen efficiently.

As interesting as these findings are, however, there's still a lot the study is unable to say.

Priscilla Clarkson, PhD, who studies post-exercise muscle soreness, cautions that the study didn't look at whether massage actually improved pain.

What's also not known is whether massage may still be helpful if a person gets a rubdown hours or days after a hard workout instead of just minutes.

In 2010 a study published in The Journal of Alternative and Complementary Medicine found that Swedish massage boosted immune function and decreased stress hormones compared to a placebo.

The study is published in the Journal Science Translational Medicine.

Ken McKenzie MD, FRCS(C), Orthopaedic Surgeon