Dr. Heller

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.

Basic Knee Pain & Issues

Brief anatomy of the knee

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The knee is a vulnerable joint that bears a great deal of stress from everyday activities, such as lifting and kneeling, and from high-impact activities, such as jogging and aerobics.

The knee is formed by the following parts:

  • Tibia. This is the shin bone or larger bone of the lower leg.
  • Femur. This is the thighbone or upper leg bone.
  • Patella. This is the kneecap.

Each bone end is covered with a layer of cartilage that absorbs shock and protects the knee. Basically, the knee is 2 long leg bones held together by muscles, ligaments, and tendons.

There are 2 groups of muscles involved in the knee, including the quadriceps muscles (located on the front of the thighs), which straighten the legs, and the hamstring muscles (located on the back of the thighs), which bend the leg at the knee.

Tendons are tough cords of tissue that connect muscles to bones. Ligaments are elastic bands of tissue that connect bone to bone. Some ligaments on the knee provide stability and protection of the joints, while other ligaments limit forward and backward movement of the tibia (shin bone).

What are some common knee problems?

Many knee problems are a result of the aging process and continual wear and stress on the knee joint (such as, arthritis). Other knee problems are a result of an injury or a sudden movement that strains the knee. Common knee problems include the following:

  • Sprained or strained knee ligaments and/or muscles. A sprained or strained knee ligament or muscle is usually caused by a blow to the knee or a sudden twist of the knee. Symptoms often include pain, swelling, and difficulty in walking.
  • Torn cartilage. Trauma to the knee can tear the menisci (pads of connective tissue that act as shock absorbers and also enhance stability). Cartilage tears can often occur with sprains. Treatment may involve wearing a brace during an activity to protect the knee from further injury. Surgery may be needed to repair the tear.
  • Tendonitis. Inflammation of the tendons may result from overuse of a tendon during certain activities such as running, jumping, or cycling. Tendonitis of the patellar tendon is called jumper’s knee. This often occurs with sports, such as basketball, where the force of hitting the ground after a jump strains the tendon.
  • Arthritis. Osteoarthritis is the most common type of arthritis that affects the knee. Osteoarthritis is a degenerative process where the cartilage in the joint gradually wears away, and often affects middle-age and older people. Osteoarthritis may be caused by excess stress on the joint such as repeated injury or being overweight.Rheumatoid arthritis can also affect the knees by causing the joint to become inflamed and by destroying the knee cartilage. Rheumatoid arthritis often affects persons at an earlier age than osteoarthritis.

How are knee problems diagnosed?

In addition to a complete medical history and physical examination, diagnostic procedures for knee problems may include the following:

  • X-ray. A diagnostic test that uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.
  • Magnetic resonance imaging (MRI). A diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body; can often determine damage or disease in a surrounding ligament or muscle.
  • Computed tomography scan (also called a CT or CAT scan). A diagnostic imaging procedure that uses a combination of X-rays and computer technology to produce horizontal, or axial, images (often called slices) of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general X-rays.
  • Arthroscopy. A minimally-invasive diagnostic and treatment procedure used for conditions of a joint. This procedure uses a small, lighted, optic tube (arthroscope), which is inserted into the joint through a small incision in the joint. Images of the inside of the joint are projected onto a screen; used to evaluate any degenerative and/or arthritic changes in the joint; to detect bone diseases and tumors; to determine the cause of bone pain and inflammation.
  • Radionuclide bone scan. A nuclear imaging technique that uses a very small amount of radioactive material, which is injected into the patient’s bloodstream to be detected by a scanner. This test shows blood flow to the bone and cell activity within the bone.

Treatment for knee problems

Specific treatment for knee problems will be determined by your doctor based on:

  • Your age, overall health, and medical history
  • Extent of the disease, injury, or condition
  • Your tolerance for specific medications, procedures, or therapies
  • Expectations for the course of the disease, injury, or condition
  • Your opinion or preference

If initial treatment methods do not provide relief, and X-rays show destruction of the joint, the orthopaedist may recommend total joint replacement for the knee.

 

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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.

 

Online Medical Reviewer: Kolbus, Karin, RN, DNP, COHN-S 
© 2000-2014 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.

What is Bone?

Anatomy of the Bone

What is bone?

Our bones create a strong framework for which we are built. It protects organs, creates our unique shape, and is a living part of us. Bone also serves as a storage site for minerals and provides the medium–marrow–for the development and storage of blood cells. They are as fragile as they are strong. We must take care of our bones as well as we take care of our whole bodies.

Bone is living tissue that makes up the body’s skeleton. There are three types of bone tissue, including the following:

Front view of a leg bone with cut section showing bone marrow.

  • Compact tissue. The harder, outer tissue of bones.
  • Cancellous tissue. The sponge-like tissue inside bones.
  • Subchondral tissue. The smooth tissue at the ends of bones, which is covered with another type of tissue called cartilage. Cartilage is the specialized, gristly connective tissue that is present in adults, and the tissue from which most bones develop in children.

The tough, thin outer membrane covering the bones is called the periosteum. Beneath the hard outer shell of the periosteum there are tunnels and canals through which blood and lymphatic vessels run to carry nourishment for the bone. Muscles, ligaments, and tendons may attach to the periosteum.

Bones are classified by their shape–as long, short, flat, and irregular. Primarily, they are referred to as long or short.

There are 206 bones in the human skeleton, not including teeth and sesamoid bones (small bones found within cartilage):

  • 80 axial bones. This includes the head, facial, hyoid, auditory, trunk, ribs, and sternum.
  • 126 appendicular bones. This includes arms, shoulders, wrists, hands, legs, hips, ankles, and feet.

What are the different types of bone cells?

The different types of bone cells include the following:

  • Osteoblast. Found within the bone, its function is to form new bone tissue.
  • Osteoclast. A very large cell formed in bone marrow, its function is to absorb and remove unwanted tissue.
  • Osteocyte. Found within the bone, its function is to help maintain bone as living tissue.
  • Hematopoietic. Found in bone marrow, its function is to produce red blood cells, white blood cells, and platelets.

Fat cells are also found within the bone marrow.

bone make up

Bone development and growth

Osteogenesis (bone tissue formation) occurs by two processes:

  • Intramembranous ossification involves the replacement of connective tissue membrane sheets with bone tissue and results in the formation of flat bones (e.g. skull, clavicle, mandible).
  • Endochondral ossification involves the replacement of a hyaline cartilage model with bone tissue (e.g. femur, tibia, humerus, radius).

Long bones continue to grow in length and width throughout childhood and adolescence. Increase in length is due to continued endochondral bone formation at each end of the long bones. Increase in circumference of the bone shaft is achieved by formation of new bone on the outer surface of the cortical bone.

Bone Modeling

Modeling is when bone resorption and bone formation occur on separate surfaces (i.e. formation and resorption are not coupled). An example of this process is during long bone increases in length and diameter. Bone modeling occurs during birth to adulthood and is responsible for gain in skeletal mass and changes in skeletal form.

Bone Remodeling

Remodeling is the replacement of old tissue by new bone tissue. This mainly occurs in the adult skeleton to maintain bone mass. This process involves the coupling of bone formation and bone resorption and consists of five phases:

  1. Activation: preosteoclasts are stimulated and differentiate under the influence of cytokines and growth factors into mature active osteoclasts
    2. Resorption: osteoclasts digest mineral matrix (old bone)
    3. Reversal: end of resorption
    4. Formation: osteoblasts synthesize new bone matrix
    5. Quiescence: osteoblasts become resting bone lining cells on the newly formed bone surface

We often overlook our bones when we talk about staying healthy and strong, but we can’t dismiss them and must work to keep them in great shape. The doctors and PA’s here at Blue Ridge Orthopaedic & Spine Center are at the top of their field when it comes to treating you and your orthopaedic concerns.

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We have on-site state-of-the-art technology to diagnosis and treat orthopaedic conditions. For your convenience, 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:  http://www.iofbonehealth.org and The StayWell Company.

When Bone Spurs Attack!

Written by John H. Schneider, MD
Spine-Health.com

Bone Spurs (Osteophytes) and Back Pain
Many patients are told that they have bone spurs in their back or neck, with the implication that the bone spurs are the cause of their back pain. However, bone spurs in and of themselves are simply an indication that there is degeneration of the spine; the presence of bone spurs does not necessarily mean that they are the actual cause of the patient’s back pain.

The term “bone spurs” is really a bit of a misnomer, as the word “spurs” implies that these bony growths are spurring or poking some part of the spinal anatomy and causing pain. However, contrary to this implication, bone spurs are in fact smooth structures that form over a prolonged period of time.

The medical term for bone spurs is osteophytes, and they represent an enlargement of the normal bony structure. Basically, osteophytes are a radiographic marker of spinal degeneration (aging), which means that they show up on X-rays or MRI scans and are by and large a normal finding as we age. Over the age of 60, bone spurs on the spine are actually quite common.


Bone Spurs and Spinal Anatomy
The human spine is made of thirty-two separate vertebral segments that are separated by intervertebral discs made of collagen and ligaments. These discs are shock absorbers and allow a limited degree of flexibility and motion at each spinal segment. The cumulative effect allows a full range of movement around the axis of the spine, especially the neck (cervical spine) and lower back (lumbar spine).

Motion between each segment is limited by the tough outer disc ligaments and the joints that move (articulate) at each spinal level (the facet joint). Under each joint, just behind the disc, is a pair of nerve roots that exit the spinal canal. The exiting hole (foramina) that surrounds the nerve (disc in front, joints above and below) is relatively small and has little room for anything besides the exiting nerve.

Normal life stressors, possibly compounded by traumatic injuries to the spinal architecture, cause degeneration in the discs and the joints of the spine. With factors such as age, injury, and poor posture, there is cumulative damage to the bone or joints of the spine. For example:

  1. As disc material slowly wears out, ligaments loosen and excess motion occurs at the joint
  2. The body naturally and necessarily thickens the ligaments that hold the bones together
  3. Over time, the thick ligaments tend to calcify, resulting in flecks of bone or bone spur formation
  4. As the central spinal canal and the foramina thicken their ligaments, compression of the nervous system causes clinical symptoms.

Degenerative changes to normal vital tissue begin in early adulthood, but usually this slow process does not present with nervous system compression until we are in our sixth or seventh decades. Factors that can accelerate the degenerative process and bone spur growth in the spine include:

  • Congenital or heredity
  • Nutrition
  • Life-style, including poor posture and poor ergonomics
  • Traumatic forces, especially sports related injuries and motor vehicle accidents.

As always, to help avoid or minimize back pain it is generally advisable to stay well conditioned (both in terms of aerobics and strength) and to maintain good posture throughout one’s life.

 

BRO-Logo-colorBlue 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.

Cold Weather and Joint Pain – Is it related?

The winter weather seems to have blown in quickly this year and ready or not, it’s time to bring out those cold weather clothes. Do you seem to feel more pain in the cold? Here are some reasons why that could be.

Does Cooler Weather Affect Your Joints?

Article written by: Carrie DeVries
Spine-Health.com

As we say goodbye to warm weather and look ahead to fall and winter, many people look forward to breaking out their sweaters, scarves, and boots. But if you have rheumatoid arthritis (RA), you may dread the colder weather, as cool days make joints stiff and achy.

Here are a few tips for those with RA—or any arthritis affected by temperature change—to cope with the cold.

Weather is a factor

Researchers have done multiple studies to uncover the link between weather and arthritis pain. Their findings have failed to turn up clinical proof of a connection. But patient experiences tell a different story.

A majority of those with rheumatoid arthritis report feeling differences in pain based on changes in temperature, humidity, or barometric pressure. According to one study, levels of pain for study subjects with RA were highest on cold, overcast days.1

Other types of arthritis can be affected too. Patients with osteoarthritis will report that swelling and warmth in their joints gets worse during weather changes.

Heat therapy helps joints

If the cold weather makes your pain worse, try adding heat therapy into your daily routine. This can decrease stiffness and promote healing through better circulation.

Here are four ways you can generate a little heat:

  1. Hold a hot pack, warm towel, or heating pad on the painful joint.Doing this for 20 minutes at a time can warm up the joint and provide temporary pain relief.
  1. Try using over-the-counter heat wraps or patches. These items are available in most pharmacies and can provide warmth for up to 8 hours.
  2. Take a dip. You may experience pain relief by swimming or doing water therapy in a heated pool a few times per week, or by soaking a whirlpool or hot bath.
  1. Get moving. It can be tempting to hibernate during cooler weather, but inactivity can actually increase your pain. Regular physical activity will keep joints warm and lubricated. If you prefer to stay inside, consider purchasing a treadmill so you can walk while you watch TV. Check with your physician before you start a new exercise routine.

Read more…

Reference:

  1. 1.      “Rheumatoid arthritis patients show weather sensitivity in daily life, but the relationship is not clinically significant.” Pain.1999 May;81(1-2):173-7

 

BRO-Logo-colorBlue 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.

 

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