Certain things get better with age, our bodies do not.  We are filled with mechanical parts like joints, and tendons, and ligaments that can simply wear out. There are surgical options to help with this, but not everyone is ready for surgery or not an ideal candidate.

If you have one of these conditions, pay special attention! 

A few of the non-surgical options to help heal and reduce your inflammation and pain are:

Cortisone Injections

Cortisone (corticosteroid) is a powerful anti-inflammatory hormone that is injected directly into the affected area to decrease joint swelling which, as a result, increases mobility and function. By controlling inflammation, cortisone helps reduce or eliminate the pain with certain conditions. Cortisone injections may mean rapid inflammation relief, dependability, and minimal side effects. Relief can be felt in two to seven days with up to 3 weeks before the full effect is felt.  The result will last up to three months and can be done up to 4 times a year.

Viscosupplementation

There are injections which lubricate the joint or tissue injury. Viscosupplementation is one such procedure where a thick fluid called hyaluronic acid is injected into the knee joint. Hyaluronic acid 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.

Platelet Rich Plasma (PRP) Injection

PRP is being used regularly at the highest levels of sports, and on the most highly salaried athletes in the world today. This technique came into the spotlight when Hines Ward and Troy Polamalu of the Pittsburgh Steelers received PRP therapy prior to winning Super Bowl XLIII. There are similar success stories in all professional sports.

Our blood consists of a liquid component known as plasma, red blood cells (RBCs), white blood cells (WBCs), and platelets. Platelets play an important role in forming blood clots as well as consisting of special proteins, known as growth factors.  These help with our body’s healing process. Platelet-rich plasma contains 94% of platelets versus the normal concentration of growth factors found in normal blood (6%).  It increases the healing properties exponentially.

Your own blood is placed in a centrifuge to separate the platelet-rich plasma from the other components of whole blood. The concentrated platelets are injected into the site of the injury, often using ultrasound guidance for accuracy.  The growth factors stimulate tissue recovery by increasing collagen production.  This enhances tendon stem cell production, and tenocyte-related gene and protein expression. They also stimulate blood flow and cause cartilage to become firmer and more resilient.

PRP injections can help alleviate painful symptoms, promote healing, and delay joint replacement surgeries in conditions such as muscle, ligament, and tendon injuries; arthritis; and fractures.

Any tendon or ligament injury (except complete tears) may be treated successfully with PRP. It will reduce the downtime while also reducing the chance for re-injury.

There is some discomfort associated with both acquiring the blood to inject, the actual injection itself, and for several days after.  The relief found from a PRP injection is not immediate.

A visit to Dr. Marshall P. Allegra will help you choose the best option for you.  He is a board-certified orthopedic surgeon in private practice in Monmouth County for over 25 years. As an experienced diagnostician, Dr. Allegra can expertly determine sports-induced injuries, and then determine the best treatment options to return your student back to the playing field, restoring functionality and range of motion as quickly as possible and avoiding long term implications.

Request An Appointment

It is April!  Spring is in the air and the great outdoors is beckoning for a visit. So many choices, so little time.

Many people opt to take care of business before enjoying a little recreation. As a homeowner, business can mean getting your yard and garden ready for spring enjoyment.  Winter did a number on your landscaping, so a little sprucing may be needed.

Gardening is very physical.  Just as if you are going to do a workout, you should prepare and give your body a warmup by stretching.  A little correct limbering up never hurt anyone!  A cool down period when you are done is also a plus.

According to the Consumer Product Safety Commission (CPSC), emergency rooms treat more than 400,000 outdoor garden tool-related accidents each year. Let’s try to avoid becoming a statistic!

If you are already experiencing orthopedic problems, speak to your doctor before doing any physical activity.  You may need to adjust the way you garden, you don’t want to exacerbate your symptoms.

Helpful hints before hitting the yard:

• Dress appropriately for the work environment: Wear sturdy shoes or boots that provide adequate traction on slippery grass.
• Clear away debris and unneeded objects from the work area. Using a tool versus your hands can avoid hand injury but unknown objects in the soil.
• Something as simple as using a bench, or even better, a rolling bench for seating while you work will change your body position and relieve stress in certain areas.
• It is almost impossible to garden without being on your knees. Sitting back on your knees is a hard position for the knee joint. Getting up from this position requires you to push most of your body weight up with your hands and wrists. Kneeling for extended periods of time can cause knee injury as will repeated strain on the knee. Use knee pads to prevent these conditions if you cannot use a bench.
• Choose lighter weight gardening tools that are easier to manage. Choose tools that have a comfortable grip, is it the right size for your hand? Longer handles are helpful. Make sure to use the proper tool for the exact job. Following manufacturer’s instructions, use safety locks and keep the tools away from the children
• Buy smaller bags of soil and supplies so you are not carrying heavy weights.
• Be wary of a good position for your body type, good posture during gardening will avoid stress on muscles, tendons. and nerves.
• Wear protective gloves, this will not just reduce blistering. A good gardening glove will protect your skin from unwanted soil additives like fertilizers, pesticides, bacteria, and fungus that live in the soil.
• Repetitive motions such as digging, raking, trimming, pruning, or planting may cause irritation to skin, tendons, or nerves. Rotate your activities every 15 minutes or so to vary the body parts you are using to give other parts a rest.
• Make sure to put all of the tools away after use to prevent future injuries and maintain the integrity of the tools.

If you are experiencing any symptoms, don’t ignore it. Take a break or a day off, continuing the activity can make it worse. If symptoms persist, see your orthopedic doctor. Early diagnosis and treatment will get you back into your garden and living your life sooner.

Dr. Marshall P. Allegra is a board-certified orthopedic surgeon in private practice in Monmouth County for over 25 years. As an experienced diagnostician, Dr. Allegra can expertly determine gardening related injuries, and then determine the best treatment options to return you back to full functionality and range of motion as quickly as possible and avoiding long term implications.

March Madness is upon us once again, it happens just like clockwork…every second week of March through the first week of April, The National Collegiate Athletic Association (NCAA) Men’s and Women’s Basketball tournaments have the interest of sports fans everywhere. The championship team has to win at least six games in a row to claim the title, or single-elimination tournaments. Lose one and you’re going home. 68 men’s college basketball teams and 64 women’s college basketball teams are all striving for the biggest prize.

Basketball began in Springfield Massachusetts in 1891 in by a Canadian Phys Ed instructor, James Naismith with the intention of a sport less injury-prone than football. Maybe so, but 22% of all male basketball players sustained at least one time-loss injury yearly and 42% of the injuries were to the ankle/foot.  Sprains were the most common type of injury at 43%.  Over one million athletes participate in high school basketball with just over 36,000 going on to compete with the NCAA.

Basketball fans watch players running, jumping, cutting, making quick starts and stops, and plenty of direct contact with the other players. Tremendous pressure is exerted on the foot and ankle during this fast-paced sport. This is a physically demanding sport. The injuries which occur can be categorized into acute or chronic injuries.

Immediate action can save a lot of pain and shorten the recovery time. Combining ice and elevation with a quick dose of an anti-inflammatory can reduce swelling and pain the control. A medical professional should examine the ankle to determine if return to pay is advised.

The most common acute injuries consist of ankle sprains, torn ligaments, muscle pulls, tendon ruptures, and fractures which result from landing improperly or twisting. The sprain is an injury to the lateral stabilizing ligaments of the ankle, which are the 3 ligaments which form the lateral ankle ligamentous complex. Most commonly injured is the anterior talofibular ligament, or ATFL which happens when the ankle rolls in, or an inversion injury. The severity varies and can ruin the game, the week, the month, or the year for the athlete.

Insufficient loosening up can cause chronic injuries, as well as ineffective conditioning, ill-fitting or incorrect shoes. If you take your game seriously, invest in a good basketball shoe for stability, flexibility, and shock absorption, and take the time to warm up pre-game. If your ‘lucky shoe’ is too warn, your luck can turn bad. Stress fractures, plantar fasciitis, shin splints, Achilles heel, tendinitis, patellar tendinitis, and sesamoiditis are common to basketball players due to stress and overuse.

One of the most common injuries are fractures due to the chronic impact of the ballistic activity, running and jumping, as well as the athlete’s foot structure. Each foot is made up of 26 bones, each one is placed under so much pressure during their use in the game that they fracture. Small breaks such as stress fractures take time to develop and are typically related to overuse.  Sudden breaks are classically caused by impacts. Warming up well, avoiding overtraining and using proper landing techniques when jumping can help avoid these.

Severe cases or in recurring cases, physical therapy may be prescribed. If instability becomes chronic, surgery may be suggested.

Dr. Marshall Allegra spends time speaking with each patient at his office in Hazlet to understand their unique condition. With over 25 years of experience as an Orthopedic Surgeon, Dr. Allegra is an expert at diagnosing pain and prescribing the most appropriate non-surgical interventions before surgery is recommended.

Why do so many people have problems with their knees?  Possibly because the knee is one of the largest and most complex joints in the body?

The knee joins the femur (thigh bone) to the Tibia (shin bone).  A smaller bone runs alongside the tibia called the fibula, and the kneecap, or patella, are the other bones that make the knee joint. The kneecap rests against a groove at the end of the femur, allowing it to move around.

Additionally, all of these bones have a protective layer of tissue called cartilage which provides cushioning, allowing the bones to glide around without difficulty. Between the femur and tibia are disks of tissue called menisci which also help absorb the pounding the knee takes.  Now add tendons (which connect the knee bones to the leg muscles that move the knee joint) and ligaments (which join the knee bones and provide stability to the knee). Your knee also contains many bursae, or fluid-filled sacs, help the knee move smoothly.

That is a lot of moving parts and soft tissue in a body part that takes a lot of abuse. People seem to only realize how much they depend on their knees when they experience pain during movement.

Some of the most common knee injuries/issues are:

Dislocations when the bones of the knee get out of place. This can happen during a fall or impact, especially involving twisting.

Fractures of the patella or kneecap are common from a sports injury or a fall.  Your kneecap is your first line of defense as it protects the knee joint.

 Anterior Cruciate Ligament (ACL) Injuries effects the ligament that joins the lower and upper leg bones together, which stabilizes the knee. They account for around 40% of sports injuries.

Posterior Cruciate Ligament (PCL) Injuries involve the ligament which connects the shinbone and the femur. It’s located at the back of your knee and aids in preventing the shinbone from moving too far backwards.

Meniscal Tears are a damage to the piece of cartilage which acts like a cushion between the femur and tibia bones.

Tendon Tears of the quadriceps and patellar tendons are more common in middle age.

Osteoarthritis makes the protective cartilage grow thin and rough, which leaves the bones in the joint with less protection. Walking becomes painful when the bones can become damaged.

Tendonitis involves inflammation of a tendon. Tendons can also be torn.

Bursitis, or pain, swelling, and warmth in any of the bursae of the knee.

Rheumatoid Arthritis is an autoimmune condition that can cause arthritis in any joint, including the knees.

If you feel you have injured your knee, try RICE Therapy as soon as possible.

Rest (or reducing daily activities)

Ice

Compression (as with bandage support)

Elevation

Seeking medical treatment quickly can reduce the injury and the healing time.

A Physical Examination by a doctor gathers information about potential causes of damage or strain on the knee. Your orthopedist can perform a variety of tests to determine the problem, and the possible solutions, to take you out of pain and back into your normal lifestyle.

Once your injury is diagnosed, there are many options your doctor will go over.  They will usually begin with the least invasive.

• Over-The-Counter pain medication to alleviate your pain while healing occurs.
• Physical therapy can strengthen the muscles surrounding the knee, increasing the knee’s stability using an exercise plan made by a trained PT.
• Cortisone Injection of a steroid into the knee may help reduce pain and swelling.
• Hyaluronan Injection into the knee may reduce pain from arthritis and delay the need for knee surgery in some people.
• Knee Surgery may be needed to correct a variety of knee conditions such as replacing or repairing a torn ligament, remove an injured meniscus, or entirely replace a severely damaged knee.

Dr. Marshall Allegra spends time speaking with each patient at his office in Hazlet to understand their unique condition. With over 25 years of experience as an orthopedic surgeon, Dr. Allegra is an expert at diagnosing pain and prescribing the most appropriate non-surgical interventions before surgery is recommended.

It’s January 2019 and fortunately, we can still see the grass.  Do you remember January 2018? Snowmaggedon met Snowpocalypse during our Polar Vortex. Handling that kind of snow can actually be a life or death experience.

Whether you are dusting off the dusting or knee deep in cold and white, keep in mind that there are some safety measures you need to take to avoid the ER. Seriously!

According to the U.S. Consumer Product Safety Commission, in 2015:

• More than 158,000 people were treated in emergency rooms, doctors’ offices, and clinics for injuries that happened while shoveling or removing ice and snow manually
• More than 15,000 people were injured using snowblowers

Those are numbers to take seriously. Additionally, snow removal is responsible for 100 deaths per year for a variety of reasons.

Part of the reason can be what type of physical shape you are in.  Someone who is used to a vigorous workout and lifting weights is not is as much danger as a couch spud moving a foot of snow with a shovel after no physical exercise in prior months. It strains every muscle in your body, especially your heart. Snow blowers take a bit of the strain off…but not enough.

Cold weather can increase your heartrate and blood pressure before you exert yourself. Blood can clot more easily, and your arteries constrict. This can decrease your blood supply, even in healthy people. Those over the age of 40, especially inactive ones need to show caution.  If you suffer from heart disease, DO NOT TOUCH THAT SHOVEL!

Tips to shovel safely:

• Use a shovel that is comfortable for your height and strength
• Do not shovel after eating, digesting uses needed energy
• Do not shovel while smoking for obvious reasons
• Stretch out before you begin
• Take it slow and pace yourself
• Fresh, powdery snow is lighter than wet, heavy snow.
• It is best to push the snow rather than lifting it
• Use a small shovel to lift or a partially fill the shovel to reduce the weight
• Squat with your legs apart, knees bent, and back straight. Lift with your legs. Do not bend at the waist.
• Do not throw the snow over your shoulder or to the side. This requires a twisting motion that stresses your back.
• Take frequent breaks and prevent dehydration by drinking plenty of fluids.
• Do not work to the point of exhaustion

Snow Blower Safety

Be safe with these tips from the American Society for Surgery of the Hand and the American Academy of Orthopedic Surgeons:

• If the blower jams, turn it off
• Keep your hands away from the moving parts
• Do not drink alcohol and use the snow blower
• Be aware of the carbon monoxide risk of running a snow blower in an enclosed space
• Refuel your snow blower when it is off, never when it is running

RUMSON — (August 3, 2018) – “He goes above and beyond!” “He’s amazing!” “A man of few words with an abundance of skill.”
Those are just some of the comments patients of Rumson resident Dr. Marshall Allegra make when talking about the orthopedic surgeon with an office on Poole Avenue in Hazlet. The remarks give an indication into both the cutting edge of his surgical technology and his old-fashioned practice of taking the time to sit down and talk with his patients to ensure he answers all their questions.

He comes to both from education and experience and plans on passing the home spun lessons on to another generation. The son of the late Dr. Edward C. Allegra — who was also an orthopedic surgeon with a practice in Red Bank — Dr. Marshall Allegra, 62, is also the father of an orthopedic surgeon. His son, Paul, 27, also a medical doctor, is currently completing his residency in orthopedic surgery in Miami and will one day take over the Poole Avenue office, making him the third generation of Allegras offering orthopedic care to Monmouth County residents.

Dr. Marshall Allegra has been in the field for 30 years and estimates he has done about 10,000 surgeries in his career to date, averaging roughly 300-plus a year. Like his father, he chose to come back to Monmouth County after completing his studies and now has his office in Hazlet, with surgical privileges in several local hospitals and surgical centers.

Although he has treated patients of all ages with all varieties of injuries, sprains, fractures, hip replacements, hand surgeries, arthritis and more, Dr. Allegra said his patients now seem to be adults with a variety of problems, including sports issues requiring joint replacements or ligament reconstruction. Knees and shoulders seem to be areas most people come to an orthopedic surgeon for, he said, with dislocations and rotator tears fairly common.

Sports injuries can come from any number of sources, he said, ranging from trauma to repetitive use which results in wear and tear on a particular bone or joint. “Runner’s Knee” is a common overuse injury, he said, and can result from cartilage wearing down, creating serious pain. Ligament damage is also fairly common, he said, explaining that surgery is sometimes the best solution when those bands of connective tissue around a joint limit the movement of a joint, especially the knee, making it impossible or difficult to turn or twist the leg.

The surgeon, who earned his undergraduate degree at Bucknell University before studying at the University Autonomous at Guadalajara and completing his residency at the University of Medicine and Dentistry of New Jersey, said it is important to take care of problem joints and bones at early and middle age since ignoring it then only leads to arthritis and other problems in later years.

Patient knees and shoulders make up most of the surgeries and medical cures Allegra sees on a regular basis, with dislocations and rotator tears high on the list of serious injuries he has had to treat. He prefers to take the time to sit and talk with his patients, gather all their medical history and get to know them before recommending the best type of treatment. He tends to be conservative in his choices, preferring to try all medical measures before the more intense surgical procedures that can be used.
The physician and surgeon said he opted to specialize in orthopedic surgery after seeing how satisfying it was for his father, and learning he could make a difference in someone’s life through his ability as a surgeon.
“It’s rewarding and gives you a great sense of being able to help someone when you see how you can do something life-changing.”

He said he likes to talk with his patients and “explain things to make sure they know what’s going on.” As for the patient who said he’s a man of few words, Dr. Allegra laughed and said, “I like to listen, then I like to cut to the chase.”
Married for 30 years, Dr. and Maryanne Allegra have four sons and one daughter: Marshall, 29; twins Andrew and Dr. Paul, 27; Edward, 24 and Helena, 19, who works part-time in the Hazlet office.

The family lives in Rumson, the same town where Dr. Allegra was raised after his parents moved from Brooklyn when he was a child. Proximity to the water also enables him to pursue his two favorite hobbies — boating and fishing. He concedes that he, too has been the patient of an orthopedic doctor, once when he had knee orthoscopy six years ago.
He is on the staff of both Riverview Medical Center and Bayshore Hospital and is a Fellow of the American Academy of Orthopedic Surgeons and a Diplomate of the American Board of Orthopedic Surgeons.

Original Article: http://themonmouthjournal.com/rumsons-allegra-family-boasts-three-generations-of-orthopedic-surgeons-p7696-73.htm

Many people reach for a bottle of anti-inflammatory or pain relief rather than reaching for the source of the problem.  A quick visit to Dr. Marshall Allegra, a board-certified orthopedic surgeon in private practice, will allow him to supervise each phase of your diagnosis, treatment, and recovery.

One option to explore with him is Physical Therapy. Physical Therapy can help you optimize your quality of your life through prescribed exercise, hands-on care, and patient education. With Dr. Allegra’s diagnosis and instruction, your qualified physical therapist will generate a personalized treatment plan specific to your needs.

Not all patients are of equal age, strength, or ability so it is essential to have your PT Program tailored to you and monitored for you. This is why there are various specialties in physical therapy:

• Orthopedic Physical Therapy usually takes place in the hospital or an outpatient clinic directly following surgery.
• Pediatric Physical Therapy is designed for early detection of health problems among infants, children, and teenagers to strengthen gross and fine motor skills, strength, balance, and even cognitive functioning.
• Geriatric Physical Therapy is geared toward those who have trouble with the aging process.
• Neurological Physical Therapy is one possible treatment path for patients with a neurological disorder or disease—such as Alzheimer’s, cerebral palsy, brain injuries, strokes, spinal cord injuries and Parkinson’s.
• Heat Physical Therapy may help relax and restore your muscles and soft tissues by increasing your blood circulation. This is effective for joint stiffness but should be used with caution and a doctor’s orders as heat can also increase swelling.

PT can absolutely improve your mobility, help recover from injury, manage your pain, as well as increase your flexibility and strength to avoid future injury and build stamina.

When you experience pain, your natural response is to favor that body part.  This allows it to rest, although it can put strain on the rest of your body that is being used to compensate. Allowing too much rest can allow muscles to atrophy and stiffness to set in.  Your Physical Therapist will work with you to show you how to properly use your body to allow healing and minimize further damage.

October is National Physical Therapy Month, which was established in 1981 by the American Physical Therapy Association (APTA).  The stated purpose of the month-long campaign is to acknowledge the physical therapy profession’s efforts to ‘transform society by optimizing movement to improve the human experience.'”

Breaking the cycle of reaching for a pill to solve all ills is a big step in preventing Opioid overuse. Not a day goes by that this topic is on the news as epidemic proportions of use and abuse effects the population of all ages. Opioid abuse leaves you at risk for depression, overdose, addiction, plus the uncomfortable withdrawal symptoms when you stop.

Step one to living pain free is a visit to Dr. Allegra.

It’s here…Autumn. The footloose days of summer are behind us and families of school aged children are getting back into their school year routine. It’s the back-to-school mad rush to be sure your little student has all of the right gear to start the school year off right.

If your child loves sports, make sure they have the right gear for this too, especially if they play competitive or team sports. Injury prevention is essential, let them go out on their playing field and give it their all with the proper precautions to protect them.

Schools generally require Sports Physicals. This is a great start, being sure Jen and Joe are in good physical shape before Game Day. As a parent, it is up to you to be sure the examiner has full information of your child’s medical history and issues so they are properly addressed. Getting them on the playing field is one goal, keeping them safe and well is the primary one.

The Centers for Disease Control and Prevention estimates that nationwide 300,000 concussions occur during sports related activities, with more than 62,000 concussions annually in high school contact sports. Athletes, coaches, and the parents or guardians should be educated about the nature and treatment of sports related concussions and other head injuries. A student who may have sustained a concussion should be immediately removed from competition or practice.

The same can be said for sprains and fractures to avoid further injury or complications.

Thinking Points for Parents of Student Athletes

S Stretching and warming up muscles before practice and games avoids injuries such as muscle tears

P Protective Gear is so important, don’t use hand-me-downs if possible. Get your child the most effective choice there is.

O Offset the calories burned with a well-balanced, nutritional diet. Lead them to healthy choices that will give them enough energy. Avoid supplements and energy boosters as they aren’t always guaranteed to be safe.

R Rest and relaxation is a good choice for downtime. Our kids tend to overextend themselves. Exhaustion leads to illness and careless errors on and off the field.

T Team spirit and the right attitude is what Sportsmanship is about. You can be an aggressive player without aggressive behavior. Using the proper rules and techniques in the game avoids injuries and bad feelings.

S Seek help if an injury occurs. Your child may want to get right back into the game but you need to be sure the situation is properly assessed. Sprains, strains, possible fractures, head injuries, concussion, heat and hydration can all lead to big problems if ignored.

Dr. Marshall P. Allegra is a board-certified orthopedic surgeon in private practice in Monmouth County for over 25 years. As an experienced diagnostician, Dr. Allegra can expertly determine sports-induced injuries, and then determine the best treatment options to return your student back to the playing field, restoring functionality and range of motion as quickly as possible and avoiding long term implications.

Common Sports Injuries

Overuse injuries in young athletes can be overuse of the bones, muscles, and tendons. This is roughly half of the sports injuries that middle school and high school student athletes suffer from. These can possibly be prevented by significant rest periods, and appropriate training to optimally prepare the athlete for the stresses that their sport will put on their body.

Traumatic injuries happen when there is a violent collision between the athlete with another athlete, equipment or even the ground. These injuries impact bones, muscles, ligaments, and tendons. Movements such as collisions, cutting, landing, pivoting, and over-striding can lead to a traumatic injury.

Contact Dr. Marshall P. Allegra

879 Poole Avenue, Hazlet New Jersey, 07730 Phone: (732) 888-8388

mallegra879@yahoo.com