Category: Physical Therapy

shoulder surgery

Myra Chait is a busy business owner, wife, mom and grandmother. She is originally from Rochester, NY and has lived in Arizona for 45 years. In her spare time, Myra enjoys gardening, reading and playing with her grandchildren.

She came to see Dr. Brian Gruber, board certified orthopedic surgeon when shoulder pain she was experiencing in both shoulders, which had gotten progressively worse over four years, began to significantly interfere with her daily activities. “It was hard to do simple things like carry a pot of coffee or reach for things, and I was losing range of motion,” said Myra.

Myra was referred to Dr. Gruber by her sister, who had also been his patient and had a great experience with him and his practice Integrated Orthopedics. After doing an initial consult with Dr. Gruber, Myra felt confident he was the right orthopedic doctor for her situation.

“Dr. Gruber is a great diagnostician,” said Myra. “He diagnosed both shoulders as ‘bone-on-bone’ where the cartilage has worn away and said I was a good candidate for a total shoulder replacement on both shoulders.”

Myra shared that Dr. Gruber did not pressure me at all, but just told her the diagnosis and provided treatment options. “He is very bright and definitely knows what he’s doing and has a lot of experience as an orthopedic surgeon,” shared Myra.

Being left-handed and with the left shoulder also in more pain than the right, Myra decided to have total shoulder replacement surgery on the left shoulder first, which Dr. Gruber performed in January 2018.

“I found the surgery to be pretty easy and simple. I only stayed one night in the hospital, was in very little pain and came home the next day,” said Myra. “I followed the doctor’s instructions and started physical therapy within a few days and recovered really well.”

Myra also completed her physical therapy at Integrated Orthopedics’ physical therapy clinic and her therapist was Jessica Tate, PT, DPT. She shared that she had a wonderful experience with Jessica. “I did everything Jessica told me to do and went to all of my therapy sessions,” Myra commented. “Jessica was impressed with how quickly and well I recovered.

Even though Myra’s surgery was less than 3 months ago, she was recently able to go on a Caribbean cruise pain-free in her left shoulder and had a wonderful time. “I had a great time and felt great,” said Myra.

Myra shared that Dr. Gruber has great people skills in addition to being a great diagnostician and surgeon. “Because he does so many surgeries, he is very skilled and experienced,” she noted.

“The team at Integrated Orthopedics is an all-around great team – from my therapist Jessica to the front desk staff who always greeted me warmly and knew my name,” said Myra. “They are all on the same page and have really coordinated the care and communication – everyone knows what everyone else is doing.”

Myra noted that the level of communication and care coordination at Integrated Orthopedics is rare and that few doctor’s offices operate that way. “I don’t know what Dr. Gruber’s formula is for the high level of communication and keeping everyone on the same page about a patient’s care is, but it works,” she said.

Myra is waiting to do her right shoulder, which will also eventually need a total shoulder replacement, but when she is ready she will definately have Dr. Gruber perform the surgery.



March is national athletic training month, a great time to explore the important role of Athletic Trainers in an orthopedic practice. Our team’s ATs work in our Physical Therapy clinic and help get our patients back up-and-running as quickly as possible. They are an integral part of our care team.

NATM, athletic training month, athletic training

Hammertoes is a very common condition. Learn all about it in this month’s featured infographic. Dr. David Larson, Fellowship Trained Foot & Ankle Surgeon at Integrated Orthopedics, specializes in all forms of foot and ankle injuries and surgeries, including hammertoe.

hammertoes, podiatrist, podiatrist phoenix, podiatrist scottsdale, foot surgeon, ankle surgeon

At the start of the New Year, many people decide to start a running program. We treat a lot of runners in our orthopedic and sports medicine practice and see a lot of the more common running injuries, with both new and long-time runners.

Running is a fantastic cardio workout, but if you’ve never run before – or are getting started again after an injury or break – it’s good to be aware of the more common running injuries.

Foot Mechanics & Running

During running, the foot is active in both the landing and push-off phase. It absorbs the shock of impact when landing and controls the forces generated by running during push-off. Most running injuries can be linked to one of these two functions.

Common Running Injuries

Here are the most common injuries runners experience and tips to prevent these injuries from occurring:

Plantar Fasciitis:
This is probably the most common running injury. It is usually due to overtraining, especially hill work and speed work; and not stretching the calf muscles. The plantar fascia – a think band of tissues that stretches from the toes to the heel – is prone to tearing when overworked. This tearing results in inflammation. The slow blood supply to the fascia hinders healing and results in a chronic condition.

To prevent plantar fasciitis, follow these tips:

  • Wear the right shows with good arch support and heel cushioning
  • Stretch the Achilles tendon regularly
  • Keep at a healthy weight
  • Increase your running gradually and alternate running with other activities
  • Try to minimize going barefoot at home which puts stress on the feet

Achilles Tendinitis:
This large strong tendon runs from the heel to the calf and propels you forward while running. Overworking the Achilles tendon results in inflammation.

A couple good ways to ward off Achilles tendinitis are:

  • Tennis ball roll: Loosen your plantar fascia by rolling a tennis ball under each foot. The muscles and tendons along the bottom of your foot exert pressure from below on the Achilles. This exercise helps keeps things loose.
  • Foam roller: You can increase the flexibility in your lower legs with a foam roller, rolling it over the front and back of the lower legs. This release tightness and tension.

Stress Fracture:
The most common runners’ stress fracture is to the tibia, or shin bone. This type of fracture occurs with issues related to the landing or push-off phase of running.

Here are a few tips to prevent shin fractures:

  • Do exercises to keep calf muscles healthy – do calf raises to strengthen them and stretches the loosen these muscles
  • Avoid muscle fatigue in the legs – when muscles fatigue, weight distribution shifts and the bone takes increased weight and impact
  • Don’t shift from soft trails to hard surfaces rapidly
  • Wear shoes with good shock absorbance

Runners Knee:
When the foot is not stable and lands in an uncontrolled way, runner’s knee can develop. It can also be caused by a biomechanical issue such as the patella being larger on the outside than it is on the inside, or a patella that easily dislocates. Worn cartilage in the knee joint also reduces shock absorption. High-arched feet can be a culprit as well as flat feet.

To prevent runner’s knee, follow these tips:

  • Run on soft surfaces
  • Do not increase mileage more than 10 percent per week
  • Gradually increase hill work
  • Go to a specialty running shoe store to get fitted for the proper shoes for your foot and gait
  • Incorporate exercises that strengthen the quadriceps muscles to improve patellar tracking
  • Stretch your hamstrings and calves to prevent over-pronation (too much inward rolling of the foot)

For many, losing weight – especially those extra holiday pounds – is a New Year’s resolution. Here’s some information to consider on obesity’s impact on knee health from a recent study.

knee health, knee pain, knee doctors, knee doctors phoenix, knee doctors scottsdale

Always warm-up before jogging or injury occurs…

Faron Kostyk – an investor originally from Alberta, Canada – came to see Brian Gruber, MD, MBA, board certified orthopedic surgeon, for knee pain that had been ongoing and progressively getting worse. He was unable to continue to participate in activities he enjoyed such as skiing and running.

“I was referred to Dr. Gruber by my regular doctor, who felt that my injury could best be addressed by an orthopedic surgeon,” stated Faron.

Upon physical exam and testing, Dr. Gruber diagnosed Faron with a torn meniscus and anterior cruciate ligament (ACL) injury. While some meniscus and ACL injuries can be treated conservatively, in Faron’s case surgery was the best option to achieve the results he was seeking.

Upon completing surgery and physical therapy, Faron hoped to have significantly better knee health and a return to the activities he enjoyed doing.

“Surgery definitely improved the quality of my life and improved my knee health,” said Faron. “My daily activities are better now, including walking and kneeling.

Faron completed physical therapy at Integrated Orthopedics’ in-house physical therapy clinic. The goal of offering onsite physical therapy to Integrated Orthopedics’ patients is to provide them with the most coordinated care possible. Team physical therapists meet regularly with Dr. Gruber and the other physicians in the practice to review a patient’s progress. This model ensures that the physicians are kept in the loop on a patient’s physical therapy progress at each step of the way.

“Our model integrating physical therapy with our orthopedic clinic and surgery ensures our patients receive not only highly coordinated care, but optimal recovery times,” said Brian Gruber, MD, MBA, board certified orthopedic surgeon and founder and lead physician of Integrated Orthopedics. “If there are challenges or issues with physical therapy, we identify and troubleshoot them immediately.”

“The physical therapy team at Integrated Orthopedics is fantastic,” said Faron. “From PT to the entire office staff, everyone is compassionate, friendly and professional.”

Faron is now back to doing many of the activities he enjoys. He is grateful for Dr. Gruber’s technical skills as a surgeon. “Dr. Gruber is a great communicator and genuinely cares about his patients. He and his team have changed my life,” he shared.

About Meniscal Tears

Meniscus tears are among the most common knee injuries. Athletes are most at risk for these injuries; however, anyone at any age can tear a meniscus. Sudden meniscus tears often happen during sports. Often squatting and twisting the knee cause the tear, or direct contact, like a tackle.

Older people are more likely to have degenerative meniscus tears rather than a sports-related tear. Cartilage weakens and wears thin over time and aged tissue is more prone to tears. Just an awkward twist when getting up from a chair may be enough to cause a tear.

About Anterior Cruciate Ligament (ACL) Tears

Another common knee injury is an anterior cruciate ligament (ACL) sprain or tear.

Athletes who participate in high demand sports like soccer, football and basketball are more likely to injure their anterior cruciate ligaments. The anterior cruciate ligament can be injured in several ways:

  • Changing direction rapidly
  • Stopping suddenly
  • Slowing down while running
  • Landing from a jump incorrectly
  • Direct contact or collision, such as a football tackle


Our bodies change as we age – some subtle changes, some more obvious. However, many of us can remain active, healthy and vibrant throughout their lives.

In fact, our physiologic age can often be younger than our chronological age – often due to diet and lifestyle factors combined with our genetics.

Let’s look at the effects of aging on the muscles, bones and joints. Then, we’ll explore some ways to counteract the effects of aging on these parts of your body.

Aging Muscles:

  • Muscles shrink and lose mass as they age – this is a natural process. However, living a sedentary lifestyle accelerates the process.
  • Muscle fibers also decrease with age, making it take longer for our muscles to respond as we age.
  • Tissues get stiffer with age and less able to tolerate stress. This is due to the decrease in the water content of tendons.
  • The heart muscle is less able to propel large quantities of blood to the body and we tend to tire more easily as we age and recover less quickly.
  • Our metabolic rate – how quickly we convert food into energy – slows with age. The effects can be obesity and an increase in “bad” cholesterol levels.

Aging Bones:

  • During our lifetime, our bones are consistently going through a process of absorption and formation called “remodeling.” The balance between absorption and formation shifts with age, resulting in loss of bone tissue.
  • Bones become less dense with age as the mineral content decreases.
  • With loss of bone mass, common age-related conditions like osteoporosis can develop, a condition responsible for nearly all hip fractures in older men and women.
  • Arthritis can develop from loss of cartilage between the bones, which occurs with age.
  • As we age, our ligaments, connective tissue become less elastic and we lose flexibility.

Aging Joints:

  • Changes in tendons and ligaments with aging result in less joint flexibility and motion.
  • As cartilage breaks down with age – which cushions our joints – the joints can become inflamed and arthritic.

Slowing the Progression of Age-Related Orthopedic Conditions

Now that we’ve covered the effects of aging on the muscles, bones and joints, let’s look at ways to counterbalance them.

Disuse is often the biggest culprit in our musculoskeletal system’s aging.

And, guess what? The most sedentary group of Americans is older than 50. The right lifestyle choices will go a long way to combat aging on the musculoskeletal system.

  • Stretching – Regular stretching will help to maintain joint flexibility.
  • Weight Training – Increases your muscle mass and strength. Maintaining muscle mass will allow you to do your daily activities much easier with less exertion.
  • Aerobic Exercise – Studies show that just 30 minutes of moderate aerobic exercise a day can help maintain your body’s response time, deliver and use oxygen efficiently and keep your heart muscle strong.
  • Healthy Diet – You are what you eat, so make sure to load up on nutrient dense real foods and get adequate amounts of lean protein in your diet.

When the Effects of Aging Occur

The body does age even with all the right lifestyle choices. Its muscles, joints and bones will change with age. As an orthopedic surgeon, we work with many patients over 50-years-old to help them manage age-related orthopedic conditions and stay active. Sometimes surgery is needed, but more than not, non-invasive treatments can manage these conditions, including:

  • Regenerative Medicine (Platelet-Rich Plasma Therapy and Stem Cells)
  • Injection Therapy (Steroid and Hyaluronic Acid)
  • Physical Therapy

hip health, orthopedics

Maintaining joint health as we age is a priority for many active seniors, and understandably so. The most common conditions that affect the joints as we age include:

  • Hip osteoarthritis (Hip OA)
  • Trochanteric bursitis (inflammation of the bursa that lies next to the trochanteric bursae)
  • Osteonecrosis of the femoral head (death of bone tissue due to a lack of blood supply)

Fortunately, orthopedic medicine offers many options for healthy hips, and increasingly so with advances in regenerative medicine. 

Conventional Treatments

Let’s start with more conventional orthopedic options for hip health. The basics of maintaining and improving joint health – including the hips – starts with having an exercise program and maintaining a healthy weight.

Research consistently demonstrates that patients who lose weight, even at modest amounts, see reductions in their pain and disability. While there is more research to support the effects of weight loss on knee arthritis, weight loss is likely helpful for hip OA and other hip conditions as well. Exercise programs that include strength training, aerobics and range of motion exercises can help with both pain and physical function. Notably, strengthening exercises can help with hip OA.

In our clinic, we often use two types of conventional treatments for hip arthritis and hip conditions:

  • Corticosteroid Injections: Corticosteroid compounds injected directly into the affected joins can be useful for short-term pain reduction. Reoccurring injections can be utilized judiciously (2-3x per year) to maintain relief, although many patients and providers are cautious with long-term corticosteroid injection therapy.
  • Hyaluronic Acid Injections: Hyaluronic acid mimics the body’s natural substance that gives joint fluid its viscosity. Research shows that hyaluronic acid injections typically reach their peak effectiveness at around eight weeks after being given and last for about 24 weeks. The HA injections are excellent for knee arthritis. Unfortunately, these are considered off-label for the hip and not covered by insurance for this body part.

Medications and supplements that can help with mild-to-moderate hip OA include:

  • Acetaminophen (Tylenol) – Long-term use is a concern as to the risks of ulcers, GI bleeding and loss of kidney function for healthy individuals. For those with preexisting conditions such as diabetes, high blood pressure, cardiovascular disease, GI bleeding and kidney failure, this medication is likely unsuitable.
  • Nonsteroidal anti-inflammatory drugs (NSAIDS) – These drugs can an option for pain relief, but come with more risks than acetaminophen, typically, and should be used with caution. Those with cardiovascular disease or GI bleeding should likely avoid NSAIDS completely and others with certain pre-existing conditions should ask their doctor before using them even for short-term use.
  • Glucosamine – While scientific evidence has yet to fully support the use of glucosamine for joint health, some studies show it improves pain and physical discomfort in hip OA and may be worth a try.

Regenerative Medicine

Now, let’s turn to regenerative medicine, an increasingly evidence-based form of medicine that offers exciting new solutions for orthopedic patients.

Hip conditions with aging, including hip replacement surgery, are relatively common. While there are times when surgery is the best option, increasingly regenerative medicine offers a safe and effective treatment alternative to more conventional therapies. At minimum, it can buy time for patients on track for a total hip replacement. I’ve seen evidence of this many times over in my practice.

What is Regenerative Medicine?

When tissue such as muscle, tendon, ligament or cartilage is injured, the body tries to heal the injury through its own repair mechanism. However, in certain situations (especially in areas where there is lack of blood flow – such as inside and around the joints) the body can’t heal the injury adequately, if at all. With regenerative medicine, we aim to augment the natural healing process to heal or even “grow back” the damaged tissue.

Within orthopedics, there are two forms of regenerative medicine we practice:

Stem Cell Therapy – Stem cell-based therapies for the repair or regeneration of muscle and tendon represent a promising technology going forward for numerous diseases.1 A type of stem cell called mesenchymal stem cells (MSCs) have gained the most attention in the field of surgery due to their ability to differentiate into the tissues of interest for the surgeon.2  These multipotent stem cells in adults originate from mesenchymal tissues such as bone marrow, tendon, adipose (fat) and muscle tissue. In orthopedics, we primary harvest stem cells from the bone, notably the iliac crest of the pelvis. As stem cell therapy continues to emerge, we will eventually add adipose (fat) stem cell harvesting.

We conduct many stem cell procedures right in the clinic – as opposed to in the operating room, where it’s costlier to the patient and often less comfortable. We pre-medicate patients to make them as comfortable as possible. Then the pelvis – where the stem cells will be harvested from – is anesthetized. A special needle called a Jamshidi™ needle is used to harvest the bone marrow.

Platelet-Rich Plasma Therapy (PRP) – PRP involves the use of the platelets from blood, which is mainly a liquid composed of plasma, but also contains red cells, white cells and platelets. Platelets contain hundreds of proteins called growth factors, which are very important in healing injuries.

PRP is conducted in the clinic unless it is being used as an addition to a surgical procedure. It begins with a standard blood draw on a patient, where we draw 15 milliliters of blood. PRP is then prepared by separating the platelets from other blood cells and increasing their concentration in a process called centrifugation. This is done in a centrifuge device, and a trained representative from the device company is onsite to prepare the PRP. The PRP with its increased concentration of platelets is combined with the remaining blood and injected via guided ultrasound into the injured tissue. The use of ultrasound is important as it allows us to be very exacting in placing the PRP.

Benefits to Patients

Both forms of regenerative medicine are appealing to patients as they are minimally invasive and often performed in the clinic in a relaxed setting with little down time. Both stem cells and PRP can be performed as an adjunct to surgery to enhance its outcome or as a standalone procedure done right in the clinic.

A major advantage of regenerative medicine that is appealing to patients is that it leverages the natural healing process using the body’s own tissue. Additionally, the ease of preparation and administration; relative safety; and cost-effectiveness, as compared with surgical options are attractive to patients. Both forms of regenerative medicine can be used to treat some aging-related hip conditions and offer an exciting option for patients.

To learn more about Brian Gruber, MD, MBA, board certified orthopedic surgeon and his orthopedic and physical therapy practice, visit

  1. Oh JH, Chung SW, Kim SH, Chung JY, Kim JY. 2013 Neer Award: Effect of the Adipose-Derived Stem Cell for the Improvement of Fatty Degeneration and Rotator Cuff Healing in Rabbit Model. J Shoulder Elb Surg. 2014;23(4):445-455.
  2. Jang KM, Lim HC, Jung WY, Moon SW, Wang JH. Efficacy and Safety of Human Umbilical Cord Blood-Derived Mesenchymal Stem Cells in Anterior Cruciate Ligament Reconstruction of a Rabbit Model: New Strategy to Enhance Tendon Graft Healing. Arthroscopy.2015;31(8):1530-1539.