Dr. Heller

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.

 

Your mom knew what she was talking about!

Your mom was always telling you to sit up straight or stand up straight and to put those shoulders back. You may have laughed it off, but now you know she was just looking out for you. Such a simple thing can lead to less pain in the future.

Good Posture Helps Reduce Back Pain

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Written by John Schubbe, DC
www.spine-health.com

Correct posture is a simple but very important way to keep the many intricate structures in the back and spine healthy. It is much more than cosmetic – good posture and back support are critical to reducing the incidence and levels of back pain and neck pain. Back support is especially important for patients who spend many hours sitting in an office chair or standing throughout the day.

Problems Caused by Poor Back Support and Posture

Not maintaining good posture and adequate back support can add strain to muscles and put stress on the spine. Over time, the stress of poor posture can change the anatomical characteristics of the spine, leading to the possibility of constricted blood vessels and nerves, as well as problems with muscles, discs, and joints. All of these can be major contributors to back and neck pain, as well as headaches, fatigue, and possibly even concerns with major organs and breathing.

 

Identifying Good Posture

Basically, having correct posture means keeping each part of the body in alignment with the neighboring parts. Proper posture keeps all parts balanced and supported. With appropriate posture (when standing) it should be possible to draw a straight line from the earlobe, through the shoulder, hip, knee, and into the middle of the ankle.

Because people find themselves in several positions throughout the day (sitting, standing, bending, stooping, and lying down) it’s important to learn how to attain and keep correct posture in each position for good back support, which will result in less back pain. When moving from one position to another, the ideal situation is that one’s posture is adjusted smoothly and fluidly. After initial correction of bad posture habits, these movements tend to become automatic and require very little effort to maintain.

Office work often results in poor posture and strain to the lower back. Many people work sitting in an office chair that is not properly fitted to their body and does not provide enough lower back support. One strategy is to choose an ergonomic office chair that often provides better support than a regular chair and may be more comfortable for the patient.

Take a Break from Sitting in an Office Chair
In addition, the spine is made for motion, and when sitting in any type of office chair (even an ergonomic office chair) for long periods of time, it is best to get up, stretch, and move around regularly throughout the day to recharge stiff muscles.

Identifying Incorrect Posture
The first step in improving posture is to identify what needs improvement by examining one’s own posture throughout the day, such as sitting in an office chair, carrying objects, or standing in line. At regular intervals during the day, take a moment to make a mental note of posture and back support. This should be done through the normal course of a day to best identify which times and positions tend to result in poor posture. Some people find it easier to ask someone else to observe their posture and make comments or suggestions.

Examples of Bad Posture and Back Support:
The following are examples of common behavior and poor ergonomics that need correction to attain good posture and back support:

  • Slouching with the shoulders hunched forward
  • Lordosis (also called “swayback”), which is too large of an inward curve in the lower back
  • Carrying something heavy on one side of the body
  • Cradling a phone receiver between the neck and shoulder
  • Pillows and Positions for Easing Neck Pain Video
  • Pillows for Neck Pain Video
  • Wearing high-heeled shoes or clothes that are too tight
  • Keeping the head held too high or looking down too much
  • Sleeping with a mattress or pillow that doesn’t provide proper back support, or in a position that compromises posture

Examples of Bad Posture While Sitting in an Office Chair
The following bad habits are especially common when sitting in an office chair for long periods of time

  • Slumping forward while sitting in an office chair
  • Not making use of the office chair’s lumbar back support
  • Sliding forward on the seat of the office chair

Posture to Straighten Your Back
As already discussed, for correction of poor posture it is important to determine where improvement is needed, such as when sitting in an office chair. Next, patients must work on changing daily habits to correct those areas. This effort will improve back support and over time help decrease back pain. It will take some effort and perseverance, and will seem a little unnatural at first. It is typical to feel uncomfortable, and even feel a little taller, but over time the new posture will seem natural and more comfortable.

Following are some guidelines of how to achieve good posture and ergonomics in the workplace and other situations.

  • Be sure the back is aligned against the back of the office chair. Avoid slouching or leaning forward, especially when tired from sitting in the office chair for long periods
  • For long term sitting, such as in an office chair, be sure the chair is ergonomically designed to properly support the back and that it is a custom fit.
  • When sitting on an office chair at a desk, arms should be flexed at a 75 to 90 degree angle at the elbows. If this is not the case, the office chair should be adjusted accordingly
  • Knees should be even with the hips, or slightly higher when sitting in the office chair
  • Keep both feet flat on the floor. If there’s a problem with feet reaching the floor comfortably, a footrest can be used along with the office chair
  • Sit in the office chair with shoulders straight
  • Don’t sit in one place for too long, even in ergonomic office chairs that have good back support. Get up and walk around and stretch as needed

Standing Posture

  • Stand with weight mostly on the balls of the feet, not with weight on the heels
  • Keep feet slightly apart, about shoulder-width
  • Let arms hang naturally down the sides of the body
  • Avoid locking the knees
  • Tuck the chin in a little to keep the head level
  • Be sure the head is square on top of the spine, not pushed out forward
  • Stand straight and tall, with shoulders upright
  • If standing for a long period of time, shift weight from one foot to the other, or rock from heels to toes.
  • Stand against a wall with shoulders and bottom touching wall. In this position, the back of the head should also touch the wall – if it does not, the head is carried to far forward (anterior head carriage).

Walking Posture

  • Keep the head up and eyes looking straight ahead
  • Avoid pushing the head forward
  • Keep shoulders properly aligned with the rest of the body

Driving Posture

  • Sit with the back firmly against the seat for proper back support
  • The seat should be a proper distance from the pedals and steering wheel to avoid leaning forward or reaching
  • The headrest should support the middle of the head to keep it upright. Tilt the headrest forward if possible to make sure that the head-to-headrest distance is not more than four inches

Posture and Ergonomics While Lifting and Carrying

  • Always bend at the knees, not the waist
  • Use the large leg and stomach muscles for lifting, not the lower back
  • If necessary, get a supportive belt to help maintain good posture while lifting
  • When carrying what a heavy or large object, keep it close to the chest
  • If carrying something with one arm, switch arms frequently
  • When carrying a backpack or purse, keep it as light as possible, and balance the weight on both sides as much as possible, or alternate from side to side
  • When carrying a backpack, avoid leaning forward or rounding the shoulders. If the weight feels like too much, consider using a rolling backpack with wheels.
  • See Avoid Back Injury with the Right Lifting Techniques

Sleeping Posture with Mattresses and Pillows

  • A relatively firm mattress is generally best for proper back support, although individual preference is very important
  • Sleeping on the side or back is usually more comfortable for the back than sleeping on the stomach
  • Use a pillow to provide proper support and alignment for the head and shoulders
  • Consider putting a rolled-up towel under the neck and a pillow under the knees to better support the spine
  • If sleeping on the side, a relatively flat pillow placed between the legs will help keep the spine aligned and straight.

It is important to note that an overall cause of bad posture is tense muscles, which will pull the body out of alignment. There are a number of specific exercises that will help stretch and relax the major back muscles. Some people find that meditation or other forms of mental relaxation are effective in helping relax the back muscles. And many people find treatments and activities such as massage therapy, yoga, tai chi or other regular exercise routines, or treatments such as chiropractic or osteopathic manipulation, etc. to be helpful with both muscle relaxation and posture awareness and improvement.

BRO-Logo-color
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.

 

Is Minimally Invasive Spine Surgery ever an Option?

Is Minimally Invasive Spine Surgery ever an Option?

Article written by: Allison Walsh – spine-health.com

After months of conservative therapy, some spine patients may opt for spine surgery if their pain is uncontrolled or if they are unable to do their daily tasks, and if a surgeon can identify a spine lesion that is responsible for the pain.

Conservative vs Surgical Care for Lower Back Pain

spinal cord

Some surgical candidates worry that they will need a spine fusion, which is an invasive surgery requiring months of recuperation.

The good news is that some spine conditions can be treated with a minimally invasive surgery, like a discectomy.

Reasons you may need a spinal fusion

First, let’s take a look at the types of conditions that may need to be treated with a fusion.

A fusion surgery is designed to stop joint motions in the spine that are generating pain. This may happen as a result of:

 

For many patients, spinal fusion helps them get back on the road to leading a normal, pain-free life. But as stated above, the surgery is considered invasive and the recovery time can be up to a year long.

Spine Fusion Risks and Complications

Many patients who need spine surgery will find relief from less invasive surgical procedures known as microdiscectomy or a microdecompression.

 

Reasons you may need a microdiscectomy or microdecompression surgery

Sometimes nerves in the spine are compressed by a narrowing of the spinal canal, causing referred pain to radiate down the arms or legs. This pain is called radiculopathy. The narrowing of the spinal canal may be caused by a bone spur or by a herniated disc.

 

See herniated discs and bone spurs

 

A microdiscectomy or microdecompression spine surgery, considered a minimally invasive surgery, removes the small portion of the offending bone or disc, allowing the nerve to heal.

See also Microdiscectomy (Microdecompression) Spine Surgery

The majority of patients with only radiculopathy pain (in the absence of one of the conditions mentioned above as a reason for spine fusion) improve without fusion surgery.

Microdiscectomy is often done on an outpatient basis. Typically, the patient will have no restrictions on their activity immediately following the surgery, and the success rate is 90-95%.

Most back patients will never need surgery. If you do need spine surgery, it doesn’t necessarily mean you will need a spine fusion.

 

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.

Good Posture makes all the difference!

NeckPain04152014

How Poor Posture Causes Neck Pain

Article written by: Gavin Morrison, PT    www.spine-health.com

Most neck pain that is not caused by whiplash or other trauma has a postural component as part of the underlying problem. Sitting atop the body, the health of the neck is subject to the curvature of the spine below and the position of the head above.

The neck muscle pain can be caused by the following neck muscles becoming tight:

  • Scalene muscles (three pairs of muscles that help rotate the neck)
  • Suboccipital muscles (four pairs of muscles used to rotate the head)
  • Pectoralis minor muscles (a pair of thin triangular muscles at the upper part of the chest)
  • Subscapularis muscles (a pair of large triangular muscles near each shoulder joint)
  • Levator scapulae muscles (a pair of muscles located at the back and side of the neck).

If the alignment of the head and spine is not optimal, the neck can be predisposed to injury and/or the degenerative effects of wear and tear over time.

 

Forward Head and Shoulder Posture

The most common condition that contributes to neck pain is forward head and shoulder posture. Forward head posture is when the neck slants forward placing the head in front of the shoulders. This head position leads to several problems:

Article continues below

  • The forward pull of the weight of the head puts undue stress on the vertebrae of the lower neck, contributing to degenerative disc disease and other degenerative neck problems.
  • Similarly, this posture causes the muscles of the upper back to continually overwork to counterbalance the pull of gravity on the forward head.
  • This position is often accompanied by forward shoulders and a rounded upper back, which not only feeds into the neck problem but can also cause shoulder pain.

The more time spent with a forward head posture, the more likely it is that one will develop neck and shoulder problems.

 

Effects of Poor Posture on the Lower Cervical Vertebrae

The part of the neck that is particularly vulnerable to forward head posture is the lower part of the neck, just above the shoulders.

The lower cervical vertebrae (C5 and C6) may slightly slide or shear forward relative to one another as a result of the persistent pull of gravity on a forward head.

This shear force can be a problem for patients with jobs that require them to look down or forward all day, such as pharmacists who spend many hours counting pills or data entry workers who look at a computer screen.

Long-Term Negative Effects of Poor Posture

Prolonged shearing of the vertebrae from forward head posture eventually irritates the small facet joints in the neck as well as the ligaments and soft tissues.

This irritation can result in neck pain that radiates down to the shoulder blades and upper back, potentially causing a variety of conditions, including:

 

Workplace Ergonomics and Neck Pain

It is often important to look at the workplace ergonomics as part of treatment and prevention of neck pain. Perhaps the placement of the desk, computer workstation and/or placement of the computer monitor and keyboard can be improved to encourage improved upper back and neck posture.

When sitting erect at a desk and looking straight ahead:

  • Eyes should point directly at the top third of the screen.
  • Forearms should be approximately parallel with the floor when typing.
  • Elbows should be at the side.
  • Feet should be flat on the floor with the thighs parallel with the floor.

If patients have a standing work station or perform other sorts of sitting or driving tasks, make sure that one side of the body is not constantly rotated more than the other side, and that there is as much symmetry in repetitive tasks as possible.

Persistent movements to one side or constant rotation of the neck and back to the same side can often aggravate joints and soft tissues causing neck and back pain. Some patients can develop poor posture of the head, neck, and shoulders through repetitive work tasks and/or poor sitting habits.

There are stretches and exercises that are effective at helping restore good posture, thereby taking pressure off the neck and relieving pain.

See Simple Office Chair Stretch

BRO-Logo-colorBlue Ridge Orthopaedic & Spine Center has 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.

Chronic Pain Coping Techniques – Pain Management

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Article written by: Andrew R. Block, PhD   Spine-Health.com

Clinicians who specialize in treating chronic pain now recognize that it is not merely a sensation, like vision or touch, but rather chronic pain is strongly influenced by the ways in which the brain processes the pain signals.

Chronic pain can provoke emotional reactions, such as fear or even terror, depending on what we believe about the pain signals. In other cases (such as in sports or another engaging, rewarding activity), chronic pain may be perceived by the individual as merely a nuisance, a feeling to be overcome in order to be able to continue in the activity.

The important role the mind plays in chronic pain is clearly recognized in the medical literature, as well as in the International Association for the Study of Pain’s definition of pain, which states that pain is always subjective and is defined by the person who experiences it.

The corollary is that the brain can also learn how to manage the sensation of pain. Using the mind to control chronic pain, or coping strategies, for managing persistent pain, may be used alone or in tandem with other pain management therapies.

Ideally, use of the chronic pain management techniques outlined in this article can help patients feel less dependent on pain killers and feel more empowered to be able to control their pain.

Managing Chronic Pain

Of course, the first step in coping with chronic back pain or other types of persistent pain is to receive a thorough medical evaluation to determine the cause of the pain.

  • In some situations, such as a herniated disc in the spine, it may be important to pay attention to the level and type of pain so that it can serve as a warning signal of impending damage.
  • In other cases, especially when the back pain is chronic and the health condition unchangeable, one goal can be to try and keep the chronic pain from being the entire focus of one’s life.

Whatever the medical condition, there are a number of effective strategies for coping with chronic back pain. These techniques generally include:

  • Relaxation training: Relaxation involves concentration and slow, deep breathing to release tension from muscles and relieve pain. Learning to relax takes practice, but relaxation training can focus attention away from pain and release tension from all muscles. Relaxation tapes are widely available to help you learn these skills.
  • Biofeedback: Biofeedback is taught by a professional who uses special machines to help you learn to control bodily functions, such as heart rate and muscle tension. As you learn to release muscle tension, the machine immediately indicates success. Biofeedback can be used to reinforce relaxation training. Once the technique is mastered, it can be practiced without the use of the machine.
  • Visual imagery and distraction: Imagery involves concentrating on mental pictures of pleasant scenes or events or mentally repeating positive words or phrases to reduce pain. Tapes are also available to help you learn visual imagery skills.

Distraction techniques focus your attention away from negative or painful images to positive mental thoughts. This may include activities as simple as watching television or a favorite movie, reading a book or listening to a book on tape, listening to music, or talking to a friend.

  • Hypnosis: Hypnosis can be used in two ways to reduce your perception of pain. Some people are hypnotized by a therapist and given a post-hypnotic suggestion that reduces the pain they feel. Others are taught self-hypnosis and can hypnotize themselves when pain interrupts their ability to function. Self-hypnosis is a form of relaxation training.

All of the above-describe techniques for coping with chronic back pain make use of four types of skills:

  • Deep Muscle Relaxation
  • Distraction: moving attention away from the pain signals
  • Imagery: visual, sound or other pictures and thoughts that provide a pleasant and relaxing experience
  • Dissociation: The ability to separate normally connected mental processes, leading to feelings of detachment and distance from the chronic pain.

11 Chronic Pain Control Techniques

To prepare for any chronic pain coping technique, it is important to learn how to use focus and deep breathing to relax the body. Learning to relax takes practice, especially when you are in pain, but it is definitely worth it to be able to release muscle tension throughout the body and start to remove attention from the pain.

Coping techniques for chronic pain begin with controlled deep breathing, as follows:

  • Try putting yourself in a relaxed, reclining position in a dark room. Either shut your eyes or focus on a point.
  • Then begin to slow down your breathing. Breathe deeply, using your chest. If you find your mind wandering or you are distracted, then think of a word, such as the word “Relax,” and think it in time with your breathing…the syllable “re” as you breathe in and “lax” as you breathe out.
  • Continue with about 2 to 3 minutes of controlled breathing.
  • Once you feel yourself slowing down, you can begin to use imagery techniques.

Eleven specific imagery and chronic pain control techniques that are effective for pain control include:

  1. Altered focus
    This is a favorite technique for demonstrating how powerfully the mind can alter sensations in the body. Focus your attention on any specific non-painful part of the body (hand, foot, etc.) and alter sensation in that part of the body. For example, imagine your hand warming up. This will take the mind away from focusing on the source of your pain, such as your back pain.
  2. Dissociation
    As the name implies, this chronic pain technique involves mentally separating the painful body part from the rest of the body, or imagining the body and mind as separate, with the chronic pain distant from one’s mind. For example, imagine your painful lower back sitting on a chair across the room and tell it to stay sitting there, far away from your mind.
  3. Sensory splitting
    This technique involves dividing the sensation (pain, burning, pins and needles) into separate parts. For example, if the leg pain or back pain feels hot to you, focus just on the sensation of the heat and not on the hurting.
  4. Mental anesthesia
    This involves imagining an injection of numbing anesthetic (like Novocain) into the painful area, such as imagining a numbing solution being injected into your low back. Similarly, you may then wish to imagine a soothing and cooling ice pack being placed onto the area of pain.
  5. Mental analgesia
    Building on the mental anesthesia concept, this technique involves imagining an injection of a strong pain killer, such as morphine, into the painful area. Alternatively, you can imagine your brain producing massive amount of endorphins, the natural pain relieving substance of the body, and having them flow to the painful parts of your body.
  6. Transfer
    Use your mind to produce altered sensations, such as heat, cold, anesthetic, in a non-painful hand, and then place the hand on the painful area. Envision transferring this pleasant, altered sensation into the painful area.
  7. Age progression/regression
    Use your mind’s eye to project yourself forward or backward in time to when you are pain-free or experiencing much less pain. Then instruct yourself to act “as if” this image were true.
  8. Symbolic imagery
    Envision a symbol that represents your chronic pain, such as a loud, irritating noise or a painfully bright light bulb. Gradually reduce the irritating qualities of this symbol, for example dim the light or reduce the volume of the noise, thereby reducing the pain.
  9. Positive imagery
    Focus your attention on a pleasant place that you could imagine going – the beach, mountains, etc. – where you feel carefree, safe and relaxed.
  10. Counting
    Silent counting is a good way to deal with painful episodes. You might count breaths, count holes in an acoustic ceiling, count floor tiles, or simply conjure up mental images and count them.
  11. Pain movement
    Move chronic back pain from one area of your body to another, where the pain is easier to cope with. For example, mentally move your chronic back pain slowly into your hand, or even out of your hand into the air.

Some of these techniques are probably best learned with the help of a professional, and it usually takes practice for these techniques to become effective in helping alleviate chronic pain. It is often advisable to work on pain coping strategies for about 30 minutes 3 times a week. With practice, you will find that the relaxation and chronic pain control become stronger and last longer after you are done.

Sometimes, after you are good at using the techniques, you can produce chronic pain relief and relaxation with just a few deep breaths. You can then start to use these techniques while you are engaged in any activity, working, talking, etc. With enough experience you will begin to feel a greater sense of control over the chronic pain and its effects on your life.

 

BRO-Logo-colorBlue Ridge Orthopaedic & Spine Center has 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.

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