Blue Ridge

Does the Epidural always work for Pain?

 

When Do Epidural Steroid Injections Work for Back Pain?

by: Sylvia Marten  spine-health.com

For most people suffering from back pain, surgery is scheduled only after all other options have been exhausted.

One non-surgical approach to pain relief is epidural steroid injections. They are only intended for temporary pain relief, but steroid injections coupled with therapeutic exercise may allow patients to postpone or even avoid surgery altogether.

Epidural injections deliver steroid medication directly to the source of pain.

Epidural steroid injections are most often used to treat low back and leg pain associated with sciatica, which is pain caused by a pinched nerve in the low back that radiates down the leg.

  • Sciatica can result from a number of conditions, including a herniated disc, degenerative disc disease, or spinal stenosis.

Epidural Steroid Injections Video

Many Spine-health readers have had epidural steroid injections and have shared their results with us:

  • There were many people who did experience relief, if only temporarily.
  • In several instances, injections helped our readers reduce their pain while they waited for their scheduled surgery.
  • There was also indication among our readers that a series of 3-4 shots provided the most relief, while anything more than that had little effect, or even made pain worse.
  • A select few were awarded complete relief and were able to return to normal activities.
  • For as many of our readers who have had success, there were just as many who experienced little to no relief from epidural steroid injections.

Fluoroscopy, or live X-ray, has been shown to be the most effective way to deliver the medication most accurately to the epidural space.

The most common reader complaints were centered on the side effects associated with steroids. Many reported significant weight gain and bloating, swelling of the face, feet and ankles, and headache and nausea.

Another concern for some readers, especially those with diabetes, was the rise in blood sugar associated with steroids.

Efficacy of epidural steroid injections

There is no conclusive evidence that epidural steroid injections work better for one condition than another. Success rates are different for each individual. For those hoping to postpone surgery, injections may provide enough temporary relief.

Steroid injections may also effect enough pain relief to allow you to begin a physical exercise program. Many people have gained enough pain relief through an exercise program to avoid surgery.

The most important thing is to find a doctor that you trust, and who will adequately answer any questions you may have regarding your condition or the injection procedure.

 

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Blue Ridge Orthopaedic & Spine Center has on-site state-of-the-art technology to diagnosis and treat orthopaedic conditions. Both of our offices are equipped with in-office  radiology departments. Not only does this facilitate rapid diagnosis but it is also convenient for patients who may be experiencing pain or disability at the time of their visit. To schedule an appointment with one of our board-certified and fellowship trained physicians, call our Warrenton office at 540-347-9220 or our Gainesville office at 703-743-2814.

Stiff Neck Causes and Symptoms

Stiff Neck Causes, Symptoms and Treatment
Richard A. Staehler, MD, www.spine-health.com

A stiff neck is typically characterized by soreness and difficulty moving the neck, especially when trying to turn the head to the side. A stiff neck may also be accompanied by a headache, neck pain, shoulder pain and/or arm pain, and cause the individual to turn the entire body as opposed to the neck when trying to look sideways or backwards.

Symptoms typically last for a couple of days or a week and may prompt neck pain that ranges from mildly painful but annoying to extremely painful and limiting. While there are a few instances in which neck stiffness is a sign of a serious medical condition, most episodes of acute neck stiffness or pain heal quickly due to the durable and recuperative nature of the cervical spine.

Neck Strains and Sprains Video

The most common causes of a stiff neck include, but are not limited to, the following:

Muscle Strain or Sprain
By far the most common cause of a stiff neck is a muscle sprain or muscle strain, particularly to the levator scapula muscle. Located at the back and side of the neck, the levator scapula muscle connects the cervical spine (the neck) with the shoulder. This muscle is controlled by the third and fourth cervical nerves (C3, C4).

The levator scapula muscle may be strained or sprained throughout the course of many common, everyday activities, such as:

  • Sleeping in a position that strains the neck muscles
  • Sports injuries that strain the neck
  • Any activity that involves repeatedly turning the head from side to side, such as swimming the front crawl stroke
  • Poor posture, such as slouching while viewing the computer monitor
  • Excessive stress, which can lead to tension in the neck
  • Holding the neck in an abnormal position for a long period, such as cradling a phone between the neck and shoulder.

Meningitis / Infection
A stiff neck, in conjunction with a high fever, headache, nausea or vomiting, sleepiness and other symptoms, may be indicative of meningitis, a bacterial inflection that causes the protective membranes of the brain and spinal cord to be inflamed. Other infections can also cause stiff neck symptoms, such as meningococcal disease, an infection in the cervical spine. Any time a stiff neck is accompanied by a fever, it is advisable to seek immediate medical attention to check for these possibilities.

Cervical Spine Disorders
Many problems in the cervical spine can lead to neck stiffness. The stiffness can be a reaction to the underlying disorder in the cervical spine. For example, a cervical herniated disc or cervical osteoarthritis can lead to neck stiffness, as the structures and nerve pathways in the cervical spine are all interconnected and a problem in any one area can lead to muscle spasm and/or muscle stiffness.

Stiff Neck Treatment

As a general rule, it is advisable to seek medical attention if the stiff neck symptoms do not subside after one week. Immediate medical attention is recommended if neck stiffness is noted after a traumatic injury, or if there are additional troublesome symptoms, such as a high fever.

In the vast majority of cases, a stiff neck may be treated within a few days.

 

 

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Blue Ridge Orthopaedic & Spine Center has on-site state-of-the-art technology to diagnosis and treat orthopaedic conditions. Both of our offices are equipped with in-office  radiology departments. Not only does this facilitate rapid diagnosis but it is also convenient for patients who may be experiencing pain or disability at the time of their visit. To schedule an appointment with one of our board-certified and fellowship trained physicians, call our Warrenton office at 540-347-9220 or our Gainesville office at 703-743-2814.

Run away from Running injuries

bodies in motion

Race season is off to a fast start this Spring and regardless of your running experience, there are many chances for injuries. So, how do you avoid them? Well, there are a few ways and this article gives a few good tips for staying injury free.

Running is a great way to get in shape, but it can also lead to injuries. Knowing about common injuries and how to prevent them can keep you on track toward achieving your fitness goals.

Experts recommend the following strategies to prevent injuries:

Identify your running goals
You may choose to start running to improve your physique, lose weight, increase cardiovascular fitness, or socialize with friends. Whatever the reason, it’s a good idea to identify this goal when creating your exercise program. If you want to improve cardiovascular fitness, for instance, you should run at a quick pace to maximize your heart rate. If you’re running to lose weight or reduce body fat, it’s better to run at a slower rate for a longer time. Depending on your goal, your doctor or personal trainer may decide that a modest walking or jogging program is appropriate. Setting goals helps you follow a safe pace and keeps you from overexertion, which can result in injury.

Have a physical evaluation
Certain health problems may hamper your running performance and increase your risk for injury. Specifically, osteoporosis, arthritis, and other degenerative joint diseases can increase your injury risk. If you have any significant health issues, you should discuss these with your doctor before you start to run.

Warm up before your run and stretch after you run
Doing so can prevent some of the most common injuries. It’s most important to stretch muscles that move joints. These include the calf muscle, which moves the knee and ankle, and the hamstring, which moves the knee and hip. Walk or gently jog for 5 minutes. Cool down at the same pace for another 5 minutes at the end of your run.

Wear the correct shoes
Buying shoes at an athletic store, where a salesclerk can help you choose a shoe that fits your foot type, can help prevent injuries.

Common injuries
The following injuries are common among runners:
Achilles tendinitis
This injury is marked by dull or sharp pain along the back of the Achilles tendon, calf tightness, and early morning stiffness. Stretching can help prevent this injury. To treat it, rest, and stretch until the pain is gone.

Plantar fasciitis 
This injury is an inflammation of the plantar fascia, a thick, fibrous band of tissue in the bottom of the foot. Proper stretching can help prevent such an injury. Anti-inflammatory medication, stretching, and ice compresses help relieve pain.

Shin splints
This injury is caused by overuse or poor conditioning and worsened by running on hard surfaces. This injury causes pain on the inside of the shinbone. Shin splints are treated by complete rest and stretching until the pain is gone. You can relieve symptoms by stretching and using ice and anti-inflammatories. Once your symptoms have eased, you should make changes in the distance you run and your speed.

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Blue Ridge Orthopaedic & Spine Center has on-site state-of-the-art technology to diagnosis and treat orthopaedic conditions.
Both of our offices are equipped with in-office radiology departments. Not only does this facilitate rapid diagnosis but it is also convenient for patients who may be experiencing pain or disability at the time of their visit. To schedule an appointment with
one of our board-certified and fellowship trained physicians, call our Warrenton office at 540-347-9220 or our Gainesville office at 703-743-2814.

Beth Holloway, RN, M.Ed. and Kim Larson APRN, FNP © 2000-2015 The StayWell Company, LLC. 780 Township Line Road, Yardley, PA 19067. All rights reserved. This information is not intended as a substitute for professional medical care. Always follow your healthcare professional’s instructions.

Take 2 aspirin & call me in the morning doesn’t cut it with chronic pain

5 Realities of Living with Chronic Pain
by Stephanie Burke  spine-health.com

Living with chronic pain is challenging enough because of the obvious reason—the pain—but there are other factors that go along with this condition that make life even more difficult.

If you live with chronic pain, consider sharing this blog with your loved ones so they can better understand what your daily life is like.

Chronic pain may persist even after a condition, such as spinal stenosis, is addressed through surgery.

  1. Pain is rarely “all in your head.”

People in pain are often treated as if their pain is actually made up or greatly exaggerated. While it is true that pain is subjective (people simply perceive pain differently) and some people may report pain because they have other agendas, for the vast majority the pain is real and present. It is not made up. The problem is that chronic pain is often caused by anatomical problems that are difficult or impossible to diagnose using standard medical tests, and pain cannot be diagnosed like other medical problems (such as a broken bone that can be seen on an X-ray).

Fortunately, most in the medical community are now trying to understand and appreciate that chronic pain is real and needs to be treated and managed differently.

  1. Pain is not the only problem—it breeds other health problems.

Thoughts and emotions related to chronic pain also can both aggravate and alleviate the pain. For example, depression, which is a serious disease, can worsen the pain. Sleep problems, again caused by the pain, can also make the pain worse. And increased pain usually leads to increased sleep problems.

Often all conditions related to the pain need to be treated concurrently in order for the patient to get any relief.

 

  1. Pain is deeply personal.

Everyone experiences and expresses pain differently. Any two people with the exact same health condition are likely to feel and express their pain in unique ways depending on a number of factors. Newer chronic pain theories now have physiological explanations for how and why people experience pain differently.

When it comes to back pain, this is especially true. Two people can have the same type of herniated disc, but one feels only slight discomfort and the other feels intense burning pain that is unresponsive to conventional treatment. It is also not uncommon that no anatomical cause of the pain can be detected.

Why is this point important? It means that chronic pain often needs to be treated as the primary problem, which is different than the conventional medical approach of identifying and treating the underlying problem causing the pain.

  1. Chronic pain is its own beast.

Unlike acute pain, which functions as a warning signal (e.g. I just stepped on a nail—better move my foot!), chronic pain does not have any useful function. It just is.

Often, chronic pain is caused by nerves that continue to send pain signals to the brain. When dealing with chronic pain, one of the most frustrating things is that there is nothing to “fix.” It just exists in your body.

  1. Chronic pain is LONELY.

After awhile, many people with chronic pain—especially pain that is caused by a condition that cannot be seen—begin to feel isolated. Here the Internet has done a world of good helping people in pain connect with others in similar situations and find a supportive peer group through online communities of people in similar situations.

Having a clearer understanding of how chronic pain works, as well as the central role that the mind plays in the experience of chronic pain, is becoming more mainstream in the medical community. Patients who start to gain more understanding of their own chronic pain may also benefit in terms of gaining increased emotional support, more effective and sustainable pain management, and even possibly harnessing the power of their minds to assist in coping with the pain.

 

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Blue Ridge Orthopaedic & Spine Center has on-site state-of-the-art technology to diagnosis and treat orthopaedic conditions. Both of our offices are equipped with in-office  radiology departments. Not only does this facilitate rapid diagnosis but it is also convenient for patients who may be experiencing pain or disability at the time of their visit. To schedule an appointment with one of our board-certified and fellowship trained physicians, call our Warrenton office at 540-347-9220 or our Gainesville office at 703-743-2814.

Just what is Cartilage anyway?

Cartilage-309x199

What Is Cartilage?

www.arthritis-health.com  –  Emmanuel Konstantakos, MD

Cartilage is a tremendously strong and flexible fibrous tissue that takes many forms and serves multiple purposes throughout the body. There are three types of cartilage: elastic cartilage, fibrocartilage, and hyaline cartilage.

Hyaline cartilage is the most common type of cartilage and can be found at the nose, windpipe, and most of the body’s joints. In essence, this cartilage can be thought of as the material that makes up the lubricant inside your joints. The word Hyaline is actually derived from the Greek word “Hyali” or “Γυαλί,” which means “Glass.” Under normal circumstances, a normal human joint is actually shiny and smooth similar to the inside of a glass.

In a joint, hyaline cartilage is referred to as articular cartilage because it covers bones’ surfaces where they articulate, or meet up with one another. This article focuses on articular cartilage.

Articular Cartilage
The thickness of articular cartilage varies from joint to joint. For example, cartilage at the wrist may be less than 1 mm thick 1 , while in some areas of the knee the cartilage may be as thick as 6 mm.2

Articular cartilage has two primary purposes:

  • Smooth movement. Extremely slippery, articular cartilage allows bones to glide over each other as a joint flexes and straightens.
  • Shock absorption. Articular cartilage acts as a shock absorber, cushioning bones against impacting each other during a weight-bearing activity, such as walking or jogging.

Articular cartilage also stores synovial fluid, a sticky, viscous fluid that lubricates and circulates nutrients to the joint. When the joint is at rest, the synovial fluid is stored in the articular cartilage much like water is stored in a sponge. When the joint bends or bears weight, the synovial fluid is squeezed out, helping to keep the joint lubricated and healthy.

Cartilage Damage
Despite its flexibility and strength, cartilage can be damaged. Problems can arise due to:

Injury
Wear-and-tear over time that can eventually lead to osteoarthritis
Diseases, such as rheumatoid arthritis or ankylosing spondylitis

Because it does not contain blood vessels, cartilage does not heal itself well. When cartilage has become thinned or damaged, a limited amount of new cartilage may be produced, but the new cartilage cells will grow in irregular, bumpy patterns. The result is that the bones may rub and grind against one another at the joint and this can be a source of pain.

Cartilage does not contain nerves, so damaged cartilage itself does not cause pain. However, the friction between bones and other resulting abnormalities in the joint can cause discomfort and pain as well as inflammation.

Gradual onset of stiffness, pain, and swelling in the joint can be a sign of osteoarthritis.

 

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Blue Ridge Orthopaedic & Spine Center has on-site state-of-the-art technology to diagnosis and treat orthopaedic conditions. Both of our offices are equipped with in-office  radiology departments. Not only does this facilitate rapid diagnosis but it is also convenient for patients who may be experiencing pain or disability at the time of their visit. To schedule an appointment with one of our board-certified and fellowship trained physicians, call our Warrenton office at 540-347-9220 or our Gainesville office at 703-743-2814.

 

References:
1. Pollock J, O’Toole RV, Nowicki SD, Eglseder WA. Articular cartilage thickness at the distal radius: a cadaveric study. J Hand Surg Am. 2013 Aug;38(8):1477-81. doi: 10.1016/j.jhsa.2013.04.037. Epub 2013 Jun 28. PubMed PMID: 23810572.

2. Cohen ZA, McCarthy DM, Kwak SD, Legrand P, Fogarasi F, Ciaccio EJ, Ateshian GA. Knee cartilage topography, thickness, and contact areas from MRI: in-vitro calibration and in-vivo measurements. Osteoarthritis Cartilage. 1999 Jan;7(1):95-109. PubMed PMID: 10367018.

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