Blue Ridge

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.


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

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.



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?


What Is Cartilage?  –  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:

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.



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.


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.

Back Pain Getting on your Nerves?

Types of Back Pain  –  Ralph F. Rashbaum, MD

It’s important to have a general understanding of the major different types of back pain, because the type of pain dictates the treatment options.

Nociceptive Pain and Neuropathy

The medical community usually classifies pain in one of two general categories: neuropathic pain and nociceptive (somatic) pain.

  • Nociceptive pain is pain that is sensed by the “nociceptor” sensory fibers after an injury to a muscle, soft tissue (ligaments, tendons), bones, joints, or skin (or other organs). Nociceptive pain is often characterized as a deep aching, throbbing, gnawing, or sore sensation. Common examples of nociceptive pain related to back pain include: pain after trauma (e.g. back pain after a car accident or a fall), pain after back surgery, and arthritis pain. Nociceptive pain is usually localized and gets better with healing.
  • Neuropathy or neuropathic pain is pain caused by damage to nerve tissue. Neuropathy is often characterized as burning, severe shooting pains, and/or persistent numbness or tingling. Common examples of neuropathic pain related to back pain include sciatica, pain that travels from the spine down the arm, pain that persists after back surgery.

It is thought that in some cases prolonged nociceptive pain may progress to neuropathy, and a patient may have both nociceptive pain and neuropathy at the same time.

Acute Pain and Chronic Pain

It’s also important to distinguish between acute pain and chronic pain, as the two types of pain are very different in form and function.

  • Acute pain- With acute pain, the severity of pain directly correlates to the level of tissue damage. This provides us with a protective reflex, such as the reflex to move your hand immediately if you touch a sharp object. This type of pain is a symptom of injured or diseased tissue, so that when the underlying problem is cured the pain goes away.

Acute pain is a form of nociceptive pain.

  • Chronic pain – In chronic pain, the pain does not have the same meaning as with acute pain – it does not serve a protective or other biological function. Rather, the nerves continue to send pain messages to the brain even though there is no continuing tissue damage.Neuropathy is a form of chronic pain.


Anatomy Of Nerve Pain

The spinal cord is the main part of the body’s central nervous system that conveys signals from the brain to the nerves throughout the body. Nerves coming from and leading to all parts of the body enter and exit the spinal cord along its entire length.

How Nerve Pain Occurs

Peripheral Neuralgia Video

There are 31 pairs of spinal nerves that exit the spinal cord through openings between the vertebrae. The point at which the nerve exits the spinal cord is called the nerve root, and where it branches out into many smaller nerves that control different parts of the body is called peripheral nerves. For example, a nerve that exits the lower back has peripheral branches that extend all the way down to the toes. Peripheral nerves comprise the peripheral nervous system.

The peripheral nerves include both motor nerves and sensory nerves:

  • Sensory nerves are nerves that receive sensory stimuli, such as how something feels and if it is painful. They are made up of nerve fibers, called sensory fibers (mechanoreceptor fibers sense body movement and pressure placed against the body, and nociceptor fibers sense tissue injury).
  • Motor nerves lead to the muscles and stimulate movement. They are made up of nerve fibers called motor fibers.

Nerve Injury and Neuropathy Pain

While it has not been firmly established, it is thought that injury to any of the above types of nerve tissue can be a possible cause neuropathy pain.

The part of the nerve cell that is damaged by a neuropathy is the axon (the inner information pathway of the nerve cell) and/or its myelin covering (the fatty outer sheath that protects the nerve cell and assists in conveying information throughout the nervous system).

When neuropathy pain occurs by damage to the above structures, neuropathy is sustained by abnormal processing of sensory input by the peripheral nervous system and the central nervous system.

Most pain is a signal to the brain that there is damage or an injury to the tissues or structures of the body, and is known as nociceptive pain. Neuropathic pain is caused by an issue with the nerves themselves.

Dr. Daniel Heller and Dr. David Kim, here at Blue Ridge Orthopaedic & Spine Center are incredibly skilled at treating all types of pain and your well-being is their priority. If you are experiencing any of these  types of pain or you just aren’t sure what’s happening but you’re suffering, please don’t hesitate to contact us and make an appointment. 


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.

Physical Therapy offers a non-drug alternative to Pain Management

NIH Says Current Treatment of Chronic Pain Has Created ‘Silent Epidemic;’ More Focus Needed on Non-Drug Approaches

News Now Staff – APTA

According to a report recently released by the National Institutes of Health (NIH), it’s time that treatment of chronic pain moves from a 1-pill-fits-all mindset to an evidence-based, individualized, multidisciplinary model that recognizes the value of non-pharmacological approaches, including physical therapy.

The report (.pdf) is the product of an NIH panel that looked at the current state of treatment for chronic pain, which is estimated to affect 100 Americans. In addition to looking into research on the issue, the panel convened a workshop that included more than 20 speakers. The results of the panel’s work were published earlier this week (.pdf), and featured in the online edition of Time magazine.

Much of the report is focused on the use—and possible overuse—of opioids as the “go-to” approach in almost all cases of chronic pain. In addition to contributing to patterns of drug abuse, the reliance on opioids may simply not be helping in all circumstances, according to the panel report.

“Together, the prevalence of chronic pain and the increasing use of opioids have created a ‘silent epidemic’ of distress, disability, and danger to a large percentage of Americans,” authors write. “The overriding question is whether we, as a nation, are currently approaching chronic pain in the best possible manner that maximizes effectiveness and minimizes harm.”

The answer to that question, the panel found, is no. Patients with chronic pain are typically “‘lumped’ into a single category, and treatment approaches have been generalized with little evidence to support this practice,” they write.

Because the manifestations and response to pain can be so varied, the report calls for a variety of treatment options that include physical therapy, which is specifically mentioned in the report. These non-pharmacological treatments can be very effective—the problem, as one speaker at the workshop noted, is that “lack of knowledge or limited availability of these non-pharmacological modalities and the ready availability of pharmacological options and associated reimbursement structure appear to steer clinicians toward the use of … opioids.”

An NIH press release on the report quotes panel chair David B. Reuben, MD, as saying that “clearly there are patients for whom opioids are the best treatment for their chronic pain. However, for others, there are likely to be more effective approaches.” The solution, he believes, is to ensure that “every patient’s individual needs are met by a patient-centered health care system.”

The panel report cites many barriers to the implementation of such a system, including lack of substantive evidence-based research, limited physician access to experts in other disciplines, and some insurance plans’ resistance to integrative treatment approaches. For now, authors write, the chronic pain landscape is one in which “large numbers of Americans are receiving suboptimal care.”

The release of the report comes at a time when the issue is receiving wider attention, thanks in part to Cake, and a new film starring Jennifer Aniston as a woman with chronic pain. Recently, the Washington Post addressed the issue in an article that called for a “blended approach” to chronic pain, including the use of physical therapy. That story followed up on a January 12 Washington Post article titled “8 ways to deal with chronic pain.” The article’s first recommendation: “embrace physical therapy.”

“The more you move, the better you feel,” reporter Rachel Noble Benner writes in the article. “Strategically strengthening and stretching the body, especially parts that are affected by chronic pain, can increase mobility, decrease pain, and improve overall mood. Find a physical therapist who is experienced in working with people who have chronic pain.”

The Physical Therapists at Blue Ridge Orthopaedic & Spine works exclusively in the treatments of Orthopaedic conditions and have experience working with patients who have chronic pain. In conjunction with your doctor and using evidence-based treatments, we create treatment plans to treat the patient as a whole, not just the injury, and to restore full functionality.

BRO-Logo-colorBlue Ridge Orthopaedic & Spine Center is Northern Virginia’s premier facility for diagnosing and treating back pain and spinal disorders. In addition to our regionally renowned Spine Center, our practice features Joint Replacement, Sports Medicine, Pain Management, Physical Therapy, Trauma Center, Shoulder Care, a Hand Center and a Foot and Ankle Center.

We are committed to treating not just injuries and physical ailments, but rather the whole person, by offering a wide range of specialty programs designed to support treatment. Specialty programs include Massage Therapy, Medical Nutrition and Aquatic Physical Therapy.

APTA has been at the forefront in helping the public understand how physical therapy can be a transformative agent in the treatment of chronic pain. The subject was featured in a Move Forward radio podcast, and the association offers a physical therapist’s guide to chronic pain syndromes. Additionally, the APTA Orthopaedic Section sponsors a special interest group in pain management, and the PT’s role in chronic pain management was featured in the September issue of Motion magazine.

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