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24Jul 2017

UntitledPhysical Therapists (PTs) are extensively educated and licensed health care professionals who diagnose and treat individuals of all ages with medical problems or other health-related conditions or injuries that limit their ability to move and perform functional activities in their daily lives1.

Physical Therapists work with patients to achieve these overall goals1

  • Reduction in pain
  • Increased movement or flexibility
  • Increased strength and endurance
  • Increased functional capacity to perform daily tasks
  • Patient is informed and educated about their condition, treatment and rehabilitation to become competent in self management through appropriate exercise, lifestyle, posture and pacing of activities.

When combined, the above goals increase the overall quality of life for the person and their family. Within these goals, the PT will work WITH each individual patient on their specific goals at an appropriate pace depending on the presentation of symptoms, associated history and functional capacity.

A person may attend physical therapy through a variety of pathways during an episode of pain, after sustaining an injury or due to a new or existing condition.

Here’s how1:

  • Make an appointment directly with a physical therapist for an evaluation
  • Referral from your Primary Care Physician
  • Referral from a speciality for example – Spine, Orthopedic, Rheumatology
  • Pre and post surgery (as an inpatient and as an outpatient)

What will happen during my first physical therapy appointment?

Like a physician, a physical therapist will complete a full subjective history including past medical and surgical history, social history including occupation, hobbies and activities. They will ask questions about your pain to build a picture of where the pain is coming from and how it is affecting your daily life. These questions combine with a thorough physical exam where they assess your posture, movement, strength, sensation and ability to perform functional tasks1. Like physicians, this information enables them formulate a diagnosis and develop a treatment plan suited to your individual needs.

Physical Therapists can use a number of different treatment options1,2 to reduce pain and increase your ability to participate in daily life (work, household tasks, sleep, hobbies, sports). These options will depend on their analysis of the assessment and will be individualised to you.

These options can include:

  • Passive modalities: these include the use of heat, ice, electrical stimulation, ultrasound to a painful area (modalities are the treatment)
  • Manual therapy: means the use of massage, joint mobilisations, myofascial and trigger point release techniques (PT uses his/her hands to treat the joint/muscle/tendon or ligament)
  • Exercise prescription: Includes mobility and flexibility exercises, aerobic training, strengthening exercises. This aspect of treatment ranges from the simplest finger exercises to high intensity aerobic conditioning depending on the individual patient
  • Posture and movement retraining: alteration of posture to restore muscle length, to alter weight bearing or walking patterns to reduce pain and improve functional movements.
  • Education: surrounding healthy joints, movement patterns, how different parts of the body are connected and influence and explaining how certain movements cause pain and why/how treatment will assist in the reduction of symptoms.

A physical therapist will use a combination of the above treatment categories to assist you in your recovery and return to normal function. They may also use yoga or pilates based exercises in conjunction with their treatment or refer you to a yoga or pilates class.

So… I am in pain… what do I do? which comes first? Physical Therapy? Medications? Injections? Surgery?

This is a frequently asked question and unfortunately it is not a simple one-fit-all answer.

Depending on your background history, the intensity and the cause of your pain, you may already have a PT, a neurologist, a rheumatologist, a spine specialist or an orthopedic physician who you attend routinely or, as needed depending on the individual history and presentation. Typically many people present to their primary care physician or PT who completes an assessment and may opt to treat conservatively or where necessary, will refer you to a specialist doctor such as those mentioned above for further assessment and treatment.

Different scenarios of how PT and pain management “fit”together exist1,3. For example, if your pain is intolerable; medications or an injection may be used first in order to reduce the intensity of pain to allow you to attend physical therapy comfortably. On the other hand, physical therapy may be used as a first line of treatment before progressing to medications or injections to relieve pain. Often, for chronic conditions, physical therapy, pain medications and injections work together to maintain and improve pain, function and overall quality of life. Surgery (unless indicated as an emergency or required for a particular condition such as a fracture or compression for example) is often only discussed after all other options have been exhausted. It is important to remember that each person is different, no two presentations of symptoms are ever the same so each treatment plan will be different.

Untitled2

Clinical research has demonstrated that a multimodal approach through a variety of specialties including physical therapy, pain management, orthopedic, rheumatology, nutrition and psychology ensures the best outcomes for patients in terms of pain management, return to function and overall quality of life3,4. It is important to remember that not every individual patient will need each speciality and the team here in SPNY will discuss the best treatment options for you and the required input from other specialities on an ongoing basis.

A crucial part of physical therapy is the promotion of physical activity and exercise. In a recent gold-standard rated review, exercise and physical activity was not dangerous or caused further damage to those in chronic pain2. In fact, exercise and physical activity fact improve symptoms, increase functional capacity and quality of life2,4. However, it is important to discuss the type, intensity of any physical activity with your physical therapist or physician before starting or changing your current activity.

“Lack of activity destroys the good condition of every human being, while movement and methodical physical exercise save it and preserve it” Plato

References:

  1. apta.org : American Association of Physical Therapy
  2. Geneen LJ, Moore RA, Clarke C, Martin D, Colvin LA, Smith BH. Physical activity and exercise for chronic pain in adults: an overview of Cochrane Reviews. Cochrane Database of Systematic Reviews 2017, Issue 4
  3. aps.org American Pain Society
  4. acsm.org American College of Sports Medicine
21Jun 2017

cadetpicDr. Maggie Cadet, Board Certified Rheumatologist and Director of The Bone and Joint Health and Osteoporosis Center at the Spine & Pain Institute, explains Fibromyalgia.

Fibromyalgia is a chronic health condition that can cause widespread musculoskeletal pain. Contrary to popular belief, it does not cause systemic inflammation and it is not considered an autoimmune disease. Individuals may have a chief complaint of symptoms such as tenderness to touch/pressure (for at least 3 months), severe fatigue, sleep disturbance or waking unrefreshed from sleep, impaired memory or a reduced ability to think clearly (“foggy state”). In the clinical history, an individual may also report a personal history of conditions including: Migraine or tension headaches, anxiety and/or depression, irritable bowel syndrome (IBS) or gastroesophageal reflux disease (GERD), irritable or overactive bladder, pelvic pain, temporomandibular jaw pain or sleep disorders (restless leg syndrome, sleep apnea).

Diagnosis is dependent on a subjective clinical history. There may be specific tender points on the body that are present on a physical exam. There is no specific blood test or imaging to diagnose Fibromyalgia but often these are used to rule out other conditions with a similar presentation, like hypothyroidism (underactive thyroid), rheumatoid arthritis and lupus.

Remember, rheumatoid arthritis and lupus can cause inflammation in joints and various organs.

There is no known direct cause of Fibromyalgia, however certain factors are believed to increase the risk of development

  • Gender: Women have a higher prevalence than men
  • Genetics: Certain genetic mutations may increase your risk of developing Fibromyalgia – but genes alone do not cause fibromyalgia
  • Existing conditions: People with autoimmune disease including Lupus, Rheumatoid Arthritis are thought to be at an increased risk of developing Fibromyalgia. Osteoarthritis (“wear and tear arthritis” may also be a factor)
  • Stress/trauma: Physical trauma, like a car accident; emotional or psychological stress such as a bereavement may also trigger Fibromyalgia

A healthcare professional may monitor for depression and anxiety in individuals with fibromyalgia due to the chronic pain and sleep disturbance that may be experienced with Fibromyalgia.  

Although there is no cure for Fibromyalgia, medication, lifestyle modifications and alternative therapies may help relieve symptoms and improve quality of life.

  • Physical Activity and exercise: low-moderate impact aerobic activity such as walking, cycling swimming, yoga and tai-chi can be beneficial in improving one’s quality of life. Low impact exercise is not harmful, although some pain may be experienced initially. A patient should consult with a physician and or physical therapist to confirm what exercise regimen is best for the individual.
  • Cognitive behavioural Therapy (CBT) may help an individual better comprehend how specific thoughts and behaviours may impact pain. CBT may result in stress and tenderness reduction.
  • finroDiet and Nutrition: Lifestyle modifications such as avoidance of excess alcohol, caffeine, and sugar and ensuring a diet rich with nutrients and adequate hydration can help improve symptoms by improving self-care.
  • Recognizing and identifying triggers for fibromyalgia as well as participating in activities that reduce stress and anxiety such as meditation, mindfulness, and deep breathing exercises are crucial.
  • Correcting and enhancing sleep patterns can help reduce sleep disturbances and encourage relaxation.
  • Medications: There are some approved drugs to help treat Fibromyalgia and reduce pain. These drugs can include duloxetine (Cymbalta), milnacipran (Savella), Lyrica (pregablin) or gabapentin (Neurontin), however your doctor will determine the best course of treatment depending on your individual presentation. Other medications such as acetaminophen (Tylenol), nonsteroidal anti-inflammatory drugs (NSAIDS) or cyclobenzaprine (Flexeril) may be useful to treat other causes of pain that can be seen with fibromyalgia such as arthritis and muscle pain. Opioid narcotic medications and sleep medications such as benzodiazepines should be avoided.

A rheumatologist specializes in the treatment of musculoskeletal and autoimmune disease. As symptoms of fibromyalgia often mimic some autoimmune diseases, it is often a rheumatologist who will evaluate the patient for other autoimmune diseases such as rheumatoid arthritis. A primary care physician in addition to other specialists such as a physiatrist, sleep medicine doctor, psychiatrist or therapist may be involved in creating a treatment plan aiming to help the patient self-manage their fibromyalgia long term and continue monitoring an individual’s progress.

 

This information is for educational purposes only, not as medical advice or as a diagnosis. Please see your physician should you have any questions, symptoms or any concerns. For more information: www.rheumatology.org, www.mayoclinic.org, www.fmaware.org.

 

07Jun 2017

The-Need-to-Know-about-the-Knee-1The Need to Know about the Knee! Now that spring is in full swing, many runners have kicked up the gear in preparation for the summer months. Recently, I completed the 2017 Shape NYC FITNESS half marathon for the fourth time and there have definitely been some moments during my training when my knee ached a little bit. Let’s talk about some of the things we can do for knee pain.

If the pain is due to an overuse syndrome or an acute injury, try resting the joint first for a few days to weeks. Avoid the activity that aggravates your knee pain. Heat and Ice are often initially recommended to decrease the inflammation and swelling. REMEMBER RICE: Rest, Ice, Compression, and Elevation

Being overweight imposes a risk of developing knee osteoarthritis or a ligament/cartilage injury therefore weight loss and lifestyle modification is necessary. For every pound that an individual is overweight, additional excess weight and force is applied to the knee joint.

Diet is a crucial component of reducing the risk of osteoarthritis which can cause knee pain!
a. Try incorporating an anti-inflammatory diet focused on avoiding or limiting foods that promote inflammation like saturated fat, trans fat and simple refined carbohydrates into your diet.

b. Highly processed foods and foods that have high sugar content like red meat, sugary sodas, pasta, candy, and high fat processed meats like bacon are not your buddies. Try limiting these foods.

c. There are foods which may aid in fighting inflammation. These foods may include vitamin C, selenium, carotenes, bioflavonoids, extra virgin olive oil, and omega-3 fatty acids.

Why do I love omega-3 fatty acids?

I encourage my patients to incorporate the omega -3 fatty acids into their diets since it is a healthy polyunsaturated fat. These fatty acids may help suppress inflammation by blocking the production of chemicals that can eat away at the cartilage in osteoarthritis. The anti-inflammatory effects can result in less joint stiffness, tenderness and pain in some people. You can find the omega-3 fatty acids in salmon, flaxseed, sardines, walnuts, anchovies, herring, and omega-3-fortified eggs.

The incidence of gout can also be decreased by avoiding foods that are rich in purines which can be converted to uric acid. Cutting down on the red meat, shellfish, and beer may help with decreasing the incidence of a gout attack.

What about medications?

Over the counter pain medications like acetaminophen (Tylenol) can be taken to improve symptoms. Nonsteroid anti-inflammatory medications (NSAIDS), such as Naproxen, Ibuprofen, Celecoxib, Meloxicam can also be used to aid with the pain and inflammation for osteoarthritis, tendonitis, or bursitis. These medications do have side effects so you MUST consult with your physician about the risks and benefits and have a discussion on how these medications affect underlying medical conditions, especially diabetes, kidney disease, high blood pressure, and heart disease.
People living with osteoarthritis do have other pharmaceutical options such as receiving steroid joint injections into the knee or artificial joint fluid injections of hyaluronic acid which may help improve knee pain for several months. For people, who are diagnosed with rheumatoid arthritis, there are disease modifying medications (DMARDS) which aim to block certain chemicals in the body that cause significant inflammation and destruction of the joint.
What else can be done?

KEEP MOVING!

Often, people may limit physical activity completely to avoid aggravating the knee however, it is important to gradually return to mild activity that might help improve knee strength, such as swimming. Some physicians may also encourage individuals to participate in a comprehensive physical therapy program for several weeks. Remember every person’s body is different and you should discuss with your trainer, fitness instructor or physician whether certain exercises are safe for you to do. Women and men can engage in quadriceps (muscle on front of thigh) and hamstring (muscles in the back of thighs) stretching exercises at home, outside or in the workplace to help strengthen the ligaments and tendons around the knee joint. Tai chi, yoga and plain old stretching are all examples of activities that will keep the muscles flexible and promote better mobility and range of motion. Sometimes orthotics, a brace, or a splint may be needed to allow extra support for the weakened knee or prevent the knee from moving too much. Some people have even tried acupuncture as an alternative option but it is unclear if this therapy works. There are so many exercises out there that can help improve knee strength and pain. Checkout my favorite exercise for a stronger knee! I usually do this exercise two to three times during the week.
STRAIGHT LEG RAISE SPOTLIGHT

I like to start my workout with this move!

The-Need-to-Know-about-the-Knee-2Lie on your back with some support if needed. Bend one knee while straightening the other leg and lift the leg. Flex the foot of the straight leg toward your head and hold for five to ten seconds. Hold the leg at approximately a 45 degrees and return the straight leg to the floor. The straight leg should not surpass the height of the other bended knee. It is important to make sure that the leg is straight while tightening the quadriceps muscle. You can repeat this maneuver ten to fifteen times before switching to the other leg. You can do 3 sets. Sometimes if I want a challenge, then I can consider adding an ankle weight while performing this exercise. Check out these other exercises with your physician and determine which ones work best for you! For most of these exercises, you can repeat for 3 sets.

 

 

 

 

 

The-Need-to-Know-about-the-Knee-3a) Side Leg Raises

Lie on one side and bend the bottom leg for support while the top leg is straight and can be raised to approximately 45 degrees. Hold for a few seconds and lower the leg. Repeat this maneuver ten to fifteen times and then alternate to the other side

 

 

 

 

 

 

The-Need-to-Know-about-the-Knee-4b) Hamstring curls

I like to do this exercise standing up while holding onto a chair or gym equipment and lift my heel as close to my buttocks and hold for a few seconds. For a quadriceps stretch, repeat this maneuver but grab your ankle and pull the heel closer to your body and hold.

 

 

 

 

 

 

The-Need-to-Know-about-the-Knee-5c) Calf stretch or calf raise

I like to use a step platform or face the back of a chair or gym equipment for support for this move. Simply elevate the heels as high as you can and then lower

 

 

 

 

 

 

The-Need-to-Know-about-the-Knee-6d) Wall squat

The feet (shoulder width apart) must remain planted on the floor while positioning the back against a wall. Bend the knees in a controlled manner while having the back and pelvis/hips remain against the wall and hold for five to ten seconds. You can hold for longer periods for a challenge. It is important not to cause knee discomfort if over bending occurs. Remember to adjust the position if you feel uncomfortable or have pain in the knee. Remember to seek medical attention if sharp or sudden pain occur in any joint or surrounding muscles during any exercise or activity. Now that summer is here, there are many more races to run in the upcoming season. Protect that knee and feel free to join me at the next race if you are in NYC!

 

 

 

 
References

http://orthoinfo.aaos.org

http://www.mayoclinic.org

www.rheumatology.org

Disclaimer: This blog contains my personal opinion based on personal and clinical experience, tips from trainers, health coaches and lastly research. This blog does not endorse specific treatments, procedures, products. You should always consult with a doctor, nutritionist, or other healthcare professional to discuss your own health and lifestyle goals and regimen based on your medical history. Thank you for reading!

26May 2017

botoxIn today’s media when we hear “Botox” (Botulinum toxin) we often associate it with cosmetic enhancement and the relentless war against ageing within the celebrity and beauty industry. But did you know Botox has proven symptom reduction for many medical conditions?

For instance many people suffering from neuropathic pain, spasticity, myofascial pain, bladder pain and chronic migraine have all found to benefit from a series of Botox injections1,2. Although many conditions are improved with this treatment, the benefits of Botox for Chronic Migraine will be today’s focus.

 

 

So, before we discuss Botox as a treatment for chronic migraine, what is “chronic migraine”?

migraneFirst of all, migraine is not just a bad headache. For anyone who has experienced migraine, or, who has witnessed a family member or friend suffering from migraine knows it is an extremely debilitating and incapacitating collection of symptoms which can include some or all of the following:

 

 

 

 

  • Severe throbbing, pulsating pain, usually on one side of the head (but it can be both)3,4
  • Visual disturbance including blurred vision, sensitivity to light or with the presence of an aura (flashing lights, blind spots, patterns in front of the eyes)3,4
  • Nausea and/or vomiting3,4
  • Sensitivity to sound3,4
  • Tingling or numbness to the face3,4

Symptoms increased by routine physical activity3,4

whoFew people know that migraine is the 6th most disabling illness globally according to the World Health Organization4. The vast majority of those who suffer with migraine are women. While many people experience migraine periodically, over 4 million people experience chronic migraine4. Specialist criteria apply for chronic migraine3 to be diagnosed, including:

 

 

 

  • Headache (not due to to another illness/condition) on at least 15 days of each month for at least 3 months. The headache should include at least 2 of the following:
  • Pain located on one side of head
  • Pulsating quality
  • Moderate to severe pain intensity
  • Symptoms aggravated by routine physical activity
    • And at least 1 of the following:
  • Nausea and/or vomiting,
  • Photophobia (sensitivity to light)
  • Phonophobia (sensitivity to sound)

 

Due to the debilitating nature of migraine and the development into chronic migraine, effective treatments are essential to reduce pain and symptoms, increase function in daily life (such as the ability to attend work, care for family members, participate in hobbies) and improve overall quality of life for those who suffer with migraine and their families. One such treatment is Botulinum toxin (“Botox”).

What is Botox and where does it come from?

Botox is a drug made from a toxin produced by the bacterium Clostridium botulinum. It works by weakening or paralyzing specific muscles or by reducing or blocking particular nerve pathways. It’s effects can last anywhere from 3 to 12 months depending on the area treated and the individual person5. Strong research exists for the benefits of Botox in the treatment of chronic daily headaches and chronic migraine5,6,7.

In October 2010, the Food and Drug Administration (FDA) approved the use of Onabotulinumtoxin A (Botox) as a treatment strategy for patients with chronic migraine. This approval was based on 2 landmark research trials across America and Europe demonstrating reduced number and intensity of migraine headaches and improved overall quality of life in those treated with Botox6,7.

What is involved?

Like every condition, the team here in the Spine & Pain Institute will complete a thorough assessment, evaluation and create an individualised treatment plan.  Other treatment options may be exhausted prior to discussing or utilising Botox. If Botox is deemed to be an appropriate treatment, the physician will complete a series of specific dose injections outlined by strict and comprehensive guidelines depending on the individual, the site of migraine pain and the symptoms experienced6,7,8.

Are there any side effects?

Like any medications or invasive treatments, there are always associated risks and possible adverse effects. These can include8:

      • Skin tightness
      • A drooping eyelid
      • Pins and Needles/tingling to the area
      • Neck stiffness
      • Facial paresis
      • Muscle weakness
      • Neck pain
      • Muscle spasms

 

Is it for me?

Firstly, Botox has only been proven for those with chronic migraine, so it is important to establish that you are experiencing chronic migraine and not another condition with similar symptoms. This is why the team of physicians and nurse practitioners will complete a thorough assessment and evaluation. It is crucial that each patient has an informed discussion and consultation surrounding their headaches and all the options for treatment such as medication, lifestyle changes (exercise, stress management, diet, meditation9) discussed before a decision to use Botox is reached.  It is important to be aware, people with particular conditions may be at a higher risk of experiencing some adverse effects mentioned above which is why the Spine & Pain team spend such time discussing and evaluating if Botox is right for you.

 

 

Sources:

    1. Persaud et al 2013 An evidence-based review of botulinum toxin (Botox) applications in non-cosmetic head and neck conditions
    2. Wissel et al 2009. European Consensus Table on the use of Botulinum Toxin Type A in Adult Spasticity.  
    3. International Classification of Headache Disorders, 2nd ed. ICHD-II 1.5.1 & 1.6.5
    4. World Health Organisation Classification of Disabling diseases http://www.who.int/mediacentre/factsheets/fs277/en/
    5. Jackson et al 2012. An evidence-based review of botulinum toxin (Botox) applications in non-cosmetic head and neck conditions
    6. Aurora et al 2010. OnabotulinumtoxinA for treatment of chronic migraine: Results from the double-blind, randomized placebo controlled phase of the PREEMPT 1 trial.
    7. Diener et al 2010. OnabotulinumtoxinA for treatment of chronic migraine: Results from the double-blind, randomized, placebo-controlled phase of the PREEMPT 2 trial.
    8. Injection Workbook for Chronic Migraine: Guidance for identifying BOTOX® candidates, the injection
    9. www.migraineresearchfoundation.org
16May 2017

pudN3

 

 

 

 

 

 

 

 

Pudendal Neuralgia

Imagine experiencing pain, severe sensitivity, numbing or a mixture of these symptoms in your most intimate and private areas but feeling too embarrassed to seek help.  Or, worse, taking the brave step to seek medical help only to find that they may not be knowledgeable or comfortable in evaluating and treating your genital/pelvic pain and discomfort.  

Either situation is far from ideal, which unfortunately, is the case for many suffering from a condition with these symptoms called Pudendal Neuralgia, a type of pelvic pain.

Do you have these symptoms?

  • Pain while sitting, which may be relieved on standing/walking
  • Progressive pain during the day
  • Burning pain in the pelvic area
  • Numbness in genital area
  • Increased sensitivity to touch or pressure (hyperesthesia or allodynia)
  • Knife-like or deep aching pelvic pain
  • Feeling of a lump/swelling present internally
  • Twisting/pinching pains in the pelvis on certain movements
  • Painful intercourse and/or sexual dysfunction
  • Urinary retention (bladder does not empty fully) or increased urgency/frequency of urination
  • Straining or burning with bladder and bowel movements

A person with Pudendal Neuralgia may experience some but not all of the above.1,2  

Symptoms for this condition, as illustrated, can be wide-ranging.

What is it and how is it caused?

PNThe genitals, anal area and urethra1 send and receive sensory, autonomic and motor signals (“messages”) via a network of nerves. The pudendal nerve is a prominent part of this network, located in the pelvis. Should this nerve become inflamed — as a result of an autoimmune disease, a virus, or through mechanical damage/trauma to the nerve — Pudendal Neuralgia may result1,2,3.

 

 

 

 

 

 

With regard to mechanical damage1,2 to the pudendal nerve, it can occur from

  • nerve entrapment (by a ligament or muscle pressing on the nerve as it passes),
  • childbirth,
  • a fall landing onto the buttocks, or
  • after sacral surgery such as a sacroiliac fusion.

Pudendal neuralgia may also be accompanied by musculoskeletal pain in other parts of the pelvis such as the lower back, coccyx (tailbone), piriformis or sacroiliac joint2,4.

So, who can get it?

bikesUnfortunately, anyone can present with Pudendal Neuralgia. It can be experienced by both men and women, although it has a higher prevalence in women5. For women, areas affected may include the clitoris, mons pubis, vulva, lower aspect of the vagina and labia. In men, the penis and scrotum may be involved1.

However, there is some research to suggest that certain individuals may be more prone to developing the condition.

 

 

 

 

These can include those who:

  • Sit or who drive for prolonged periods of time2,3
  • Participate in sports/activities involving repetitive hip flexion such as heavy weight lifting, cycling2
  • Have anatomical differences in pelvic structure, ligament or muscle alignment2

How is it diagnosed?

  • Detailed history surrounding medical history, the pain and activities relating to the pain2,3
  • Physical Examination2
  • A pudendal nerve block under fluoroscopy or CT guidance can act as a diagnostic tool2 in addition to a treatment

What treatments are available for this debilitating condition?

There are various treatment options available such as neuropathic pain medications and pelvic floor physical therapy4, which may be tried before any injections like the pudendal nerve block. This pudendal nerve block may also be completed to assist in the diagnosis of Pudendal Neuralgia. Pudendal nerve blocks are a minimally invasive, non-surgical treatment for chronic pain with a growing body of evidence for their beneficial effects on reducing the sensitivity of the nerve and improving function and quality of life2,5. If the symptoms are quite severe, a nerve block may be more appropriate before any physical therapy is attempted.

If conservative management is unsuccessful, more invasive treatment options include neuromodulation4 and decompression surgery2.  It is important to remember that no two patients will present exactly the same which is why our team of physicians, nurse practitioners and physician assistants here at The Spine & Pain Institute of New York will complete a comprehensive evaluation and create an individualized treatment approach for each  patient presenting with these symptoms.

I have these symptoms but I feel embarrassed… Will it resolve itself? What if I do not get treatment for Pudendal Neuralgia?

Unfortunately, Pudendal Neuralgia tends not to resolve without seeking medical help. If left untreated, Pudendal Neuralgia may cause both worsening bladder and bowel incontinence, chronic constipation and sexual dysfunction2,3. It can lead to debilitating, constant pain, even when you are in a standing or lying position (not just seated)2,3.

Our team here in the Spine & Pain Institute of New York are highly trained and experienced in diagnosing and treating this condition and, as with any patient, you will be assessed and treated with the utmost sensitivity, confidentiality and care.

For further information on Pudendal Neuralgia or to schedule an appointment to discuss your symptoms with one of our Physicians, please click here.

Sources:

1 – Labat et al 2007. Diagnostic Criteria for Pudendal Neuralgia (Nantes Criteria)

2 – Hibner et al 2007. Pudendal Neuralgia, A review Article. www.pudendalhope.org

3 – Gupta et al 2015. A multidisciplinary approach to the evaluation and management of interstitial cystitis/bladder pain syndrome: an ideal model of care.

4 – Mamlouk et al 2013. CT guided for Pudendal Neuralgia: Diagnostic and Therapeutic Implications

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Marie Geraghty, Medical Assistant        Casey Grillo, Nurse Practitioner         Kallback, Marketing Manager

WRITER                                                       EDITOR                                                    EDITOR

 

10May 2017

MAY IS LUPUS AWARENESS MONTH! – MAY 10, 2017 IS WORLD LUPUS DAY! – JOIN ME AND PUT ON SOME PURPLE!

From the Desk of “Dr. Maggie” Cadet

I can remember the first time I heard the word “systemic lupus erythematosus” (SLE or lupus).

DRCADETIn my first blog, I briefly shared the story about meeting a girl during my time at medical school who had complained of several months of joint pain and swelling, extreme fatigue, and mild hair loss.  She told me that she had been diagnosed with lupus.  At that point in medical school, I barely knew the details of this disease.  From lectures, I recalled that it was considered to be a type of autoimmune disease.

Autoimmune diseases are illnesses that occur when the body’s tissues are attacked by its own immune system.  Patients with autoimmune diseases produce proteins or antibodies in their blood that target tissues within their own body rather than foreign infectious agents like viruses and bacteria, resulting in inflammation.

I could tell that this young woman was in disbelief about her diagnosis. Moreover, she was given a therapeutic regimen that consisted of steroids and other medications. She never fully understood the extent of her disease. For example, she was unaware of the association of early heart disease, lung disease, brain involvement or kidney damage, that can occur with SLE if early and aggressive treatment is not taken to control disease activity.  I also didn’t understand how serious this disease could be, or I would have tried harder to persuade her to follow up with doctors and take her medications regularly.  Sadly, I received the tragic and surprising news that she had passed away from complications of the disease.

Over the years, I have met numerous women and men who come from different countries and have never heard about this disease and have limited knowledge about diagnosis and treatment.  Raising awareness in different ethnic groups especially African Americans, Afro-Caribbean, Hispanics, Native Americans, Native Hawaiians, Pacific Islanders and Asian females is very important to me and has been a focus in my clinical practice over the years.

I have so many positive stories of people who live with this diagnosis every day and are living incredible lives.  Several years ago I was invited to a cosmetic workshop in NYC.  After the workshop, the women were paired off with a makeup artist from one of the biggest beauty brands.  I was immediately taken to a woman who appeared to be so energetic, vibrant, and not to mention gorgeous. We instantly connected as we started to chatter.  Sometime in the middle of the conversation, I told her what I did for a living.  When I told her that I was a rheumatologist, her eyes widened with amazement and told me that she has been living with SLE for many years.

We proceeded to talk for the next hour about how she grew up coping with the disease and how she refused to let this disease control her life.    She continued to tell me how she was diagnosed in college and she had complaints of joint pain and chest pain from inflammation around her heart.  Her disease was complicated by kidney failure requiring weekly dialysis and eventually two kidney transplants because her first one was complicated by a blood clot.  She told me that she had a successful second kidney transplant and had been treated with several years of steroids, chemotherapy (cyclophosphamide) and other agents.

The last time I saw her she was on a regimen of low dose steroids and anti-rejection medications.    It was so great to see this amazing, forty-something, married, professional in one of the best cosmetic companies of the world stand before me after enduring two kidney transplants.    At the end of my makeover, we exchanged our contact information.  This woman was a perfect example of how aggressive treatment, a healthy lifestyle, a supportive physician and social network, and a positive outlook on life can help control the disease despite flare ups.

Last summer, I cared for another young, beautiful and successful legal professional who had moved to NYC to pursue a job opportunity and move forward in her relationship.   She had a history of kidney disease related to her lupus, but was in remission. She was taking an immunosuppressant called mycophenolate and living her life to the fullest.

Although I have seen the ugly side of this disease, I have also witnessed many success stories.  I mainly see women, but men as well, who live with the strength and courage to wake up every day and fight this disease by keeping their disease activity in remission with the help of caring physicians, potent medications and healthy lifestyle modifications. There are effective therapies to help women and men live productive lives, but the benefits and risks must be discussed with a physician.

There are so many role models living with SLE in today’s world.   In recent years, the attention to lupus has been increasing. Sensational singer and actress Selena Gomez told the public in 2015 that she was diagnosed with lupus and took some time away from the spotlight to treat her lupus with chemotherapy (which can be used to help control inflammation for this disease).  Rapper Snoop Dogg’s daughter was seen on the “View” many years ago opening up about her battle with juvenile lupus.  Toni Braxton has spoken candidly on Dancing with the Stars and mainstream media about her battle with lupus and early heart complications.  Since being diagnosed with lupus and nephritis (kidney disease) in 2012, entertainer and television personality Nick Cannon has also taken the opportunity to educate more people about this complex disease.

Every day when I go to work, I keep the faces of the individuals that I have cared for in my mind and in my heart.  These patients inspire me to increase awareness about the clinical symptoms, diagnostic evaluation, and complications like heart disease and diabetes associated with this disease.  Thank you for taking the time out to read this story and share it with any male or female that may have symptoms suspicious for lupus (see below).  That individual should be referred to a rheumatologist and follow up every few months.   Most people can live normal and productive lives but the disease is chronic and can be challenging in terms of activity limitations and quality of life with flares.  Individuals must take an active role in their treatment plan and find support with family, friends, health care professionals or other individuals living with the disease.  There is so much hope for a future cure!

You may have Lupus…

if your doctor finds that you have at least four of these problems:

  1. Rashes
    1. malar rash- butterfly shaped rash over the cheeks (spares nasal  creases)
    2. discoid rash- round or disk-shaped lesions that can be scaly and thick. Lesions may be red or can become discolored and scarring over time.
    3. photosensitive rash  (rash with sun exposure in sun exposed areas like face, neck, arms, legs)
  2. Mouth or nasal ulcers/sores, lasting at least a few days or more
  3. Heart or lung inflammation. Pleurisy/pleuritis- swelling of the tissue lining the heart (pericarditis) or lungs that can result in chest pain with deep breaths.
  4. Kidney problem (Nephritis). Blood or protein in urine can be detected, facial or leg swelling, kidney function can be abnormal
  5. Pain and swelling lasting several weeks to months in more than two joints
  6. Neurologic problem. Stroke, seizure, confusion, memory difficulties or other mental health problems like psychosis, depression
  7. Abnormal blood tests
    1. anemia, low white blood cells or platelets counts
    2. positive proteins or antibodies called antinuclear antibodies (ANA) that may cause the body to attack different organ systems. Present in many lupus patients but are also found in healthy individuals
    3. complement proteins (part of the immune system, complement 3 and complement 4)
    4. other specific antibodies that show an abnormality in the immune system
    5. anti-double stranded DNA
    6. anti-Smith
    7. antiphospholipid antibodies
    8. false positive blood test for syphilis (no actual syphilis infection)

    Individuals may also note fever for more than a few days, extreme fatigue for days to weeks despite sleep, sudden unexplained hair loss.

    Complications of Lupus

    1. Early and or accelerated heart disease/atherosclerosis, heart attack. This is a MAJOR COMPLICATIONand leading cause of death among people with lupus.
    2. Stroke
    3. Miscarriages, pregnancy complications like preeclampsia (high blood pressure in pregnancy), premature birth
    4. Areas of gastrointestinal system may be affected (liver, pancreas, bile ducts)
    5. High blood pressure and loss of kidney function
    6. Higher risk for miscarriages or premature birth
    7. Blood clotting (thrombosis)
    8. Blood vessel inflammation called vasculitis
    9. Infection
    10. Diminished blood supply to bone causing bone tissue death (avascular necrosis)

    Healthy Lifestyle Modifications

    1. There is no specific diet but maintain a well-balanced diet with fresh fruits, vegetables (spinach, broccoli), and whole grains. Possibly consider incorporating omega 3 fatty acids (flaxseed oil and fish oil) and adequate calcium and vitamin D (which play a role in bone health and immune function).  Steroids can worsen bone quality.
    2. Reducing stress (meditation, walking, yoga, pilates)
    3. Stop smoking
    4. Wearing sunscreen and sun protective clothing against UVA and UVB light
    5. Stay active with exercise.
    6. Rest during the day and establish good sleep regimen
    7. Discuss herbs and dietary medications, vitamins with your physician first

    There is no cure for lupus but there are some treatment options that can help individuals live a productive life despite the challenges. Sometimes other specialists like a nephrologist, cardiologist, gastroenterologist, hematologist or OBGYN may get involved and be part of the medical team since lupus may affect multiple organ systems.

    Treatment Options

    There must be a discussion about benefits and risks of a specific medication, as well as a review of an individual’s medical history with a rheumatologist first!

    Common treatment options that a rheumatologist may consider are:

    1. Nonsteroidal anti-inflammatory drugs (NSAIDS)
    2. Antimalarial drugs (hydroxychloroquine)
    3. Steroids (prednisone, methylprednisolone, prednisolone)
    4. Immune suppressants
      1. Azathioprine (Imuran)
      2. Methotrexate (for predominant joint symptoms)
      3. Cyclophosphamide (Cytoxan)- a form of chemotherapy in lower doses to control inflammation
      4. Cyclosporine (Neoral)
      5. Mycophenolate mofetil (Cellcept)
      6. Biologics (newer drugs that block certain chemicals)
          1. Belimumab (benlysta)- FDA approved medication for active but not severe lupus adult patients
          2. Rituximab (Rituxan)- a form of chemotherapy
          3. Abatacept (Orencia)

        Note: Some of these treatments are already approved for other rheumatic diseases like rheumatoid arthritis and may be an option for some individuals.

        For more information on Lupus, please check out these websites:

        I am involved with this wonderful nonprofit organization which helps individuals who are living with lupus and other autoimmune diseases connect to each other and feel that there is an online support community.

            • ebook Lupus: Real Life, Real Patients, Real Talk by Marisa Zeppieri-Caruana

        Read some of my personal experiences with lupus patients.

27Apr 2017

An Introduction to Platelet Rich Plasma (PRP) Treatment

What is it?

UntitledPeople living with conditions affecting cartilage, tendons, ligaments, and bone, such as  tendinopathy and osteoarthritis1,2, stand to benefit from Platelet Rich Plasma (PRP) Treatment. The aim of PRP is to give a biological “boost” to the natural healing process in the body.

As it is a treatment created by the patient themselves, it is a low risk option with possible benefits in terms of healing.  PRP is not known to have any adverse effects, unlike the commonly used non steroid anti-inflammatory drugs (NSAIDs) that are known have effects on the gastrointestinal, cardiovascular and renal systems of certain populations2.

Key words

Platelets : a type of cell whose function is to help clot the blood

Liquid plasma: the fluid part of the blood

Centrifuge: a piece of laboratory equipment which separates the blood into different parts

How it’s done?

PRP is actually produced from the patient’s own blood. The blood itself has different parts including platelets and liquid plasma – both critical components for healing and repair in the body1. A blood sample is obtained from the patient and is placed in a centrifuge. PRP is collected from the centrifuge and treated before being injected in the patient’s body, under ultrasound guidance.

What to do? The Before and After

The goal of of PRP treatment is to optimize the initial inflammatory response of healing, where nutrients and oxygen are in greater to supply to the affected tendon/ligament, thus helping it to help. For this to occur, anti-inflammatory medications (which prevent this inflammation) should be stopped prior to and after the PRP treatment3. It is important for the patient to avoid exercise for a short time after the treatment before resuming their rehabilitation program. However, your physician will guide  you on regarding these medications and exercise for this type of treatment on an individualised basis.

Is it effective?

To date, in terms of evidence and clinical trials in the use of PRP, there are few well designed, high quality studies evaluating PRP1,2. More trials are needed to assess the effectiveness of PRP in different body structures. For example, weight-bearing tendons like the Achilles tendon (at the ankle) may require different treatment parameters to non-weight bearing tendons, like those in the shoulder.  

Is it for you?

Although more studies need to be completed, it is a low-risk option that could be explored by patient candidates and attending physicians due to the potential for some pain relief and the possibility of increased rates of healing. Tanzina Khan, M.D., M.P.H., our newest physician at The Spine & Pain Institute of New York, has a special interest in this option for pain management. Learn more about Dr. Khan who is accepting new patients at our New Hyde Park office in Long Island by visiting her biography, here. For further information on PRP or to arrange an appointment, please call (516) 209-2357 or email us at Help@SpinePainNY.com.

 

SOURCES

  1. P Halpern et al. The Role of Platelet-Rich Plasma in Inducing Musculoskeletal Tissue Healing, HSSJ (2012) 8:137–145
  2. Zhou and Wang. PRP Treatment Efficacy for Tendinopathy: A Review of Basic Science Studies. BioMed Research International (2016) 7: 1-8.
  3. https://www.painscience.com/articles/platelet-rich-plasma-does-it-work.php

 

21Apr 2017

image2[20][1]The Spine & Pain Institute of New York welcomes Dr. Khan to our “family!”

To help us all get to know Dr. Khan, we asked her a few questions:
1. Why Medicine?
When I was a kid, I went to a conference with my mom for Bangladeshi doctors. On the last night of the conference, they had a dinner where they awarded an American Orthopedist for his work in Bangladesh during the 1970’s and 80’s. This Orthopedist used his talent to develop low cost, practical solutions to help amputees who were wounded during the war for independence. What he thought to be his routine work turned out to help hundreds of people regain their ability to participate in daily life, and to help families recover from the years of war and violence. I thought that night that if I could help people — even if it was only a fraction of the work that this doctor had accomplished — it would be my greatest achievement.

2. What are your special clinical interest areas?
Before my fellowship in interventional pain, I studied regional anesthesia and acute pain management at Columbia University Medical Center. Since mastering ultrasound was the cornerstone of that fellowship, I was able to integrate those skills and knowledge into my pain management practice, as well. Therefore, from my earliest days learning interventional pain, I have been able to use ultrasound for various treatment injections, especially for joints and peripheral nerve blocks. Ultrasound is another method of viewing the body to guide injections but it is important to note that it is not appropriate for every procedure or body part, especially the back which is why we use the x-ray machine (fluoroscopy) to take pictures. However, an advantage of ultrasound is that it provides another approach to some of the peripheral joint injections (shoulder, hip, knee). For example, sometimes the x-ray machine cannot be used for positioning reasons or we are unable to see an important structure using the x-ray machine. Ultrasound also reduces radiation exposure and, at times, is easier to monitor the injection as the ultrasound provides real-time imaging.

3. How does the M.P.H. influence your practice as a physician?
Having a Master’s in Public Health (M.P.H.) really helped me to achieve a greater global perspective on my practice. My background in population health informs me as to how my patients deal with the healthcare system and the challenges they may face in receiving healthcare or living a healthy lifestyle. These challenges can range from smoking cessation to achieving a healthy weight with the correct nutrition and exercise.

4. How do you balance your time between being a physician and a mother?
I believe mothers go through “trial by fire” when it comes to multitasking. I think this is especially true when working outside the home. So, being organized, having schedules and having an excellent support system helps me immensely. Plus, I try to remind myself that although the list of tasks at work and for the kids never ends, I can prioritize and tackle what needs to get done one step at a time. Although I may have serious commitments in and out of my home, I think this motivates me to be a better physician as I like to think of my patients as an extended family. As I tell my patients, I wish to treat them as I would my own family members.

image3[20]5. Any advice for those interested in becoming a physician and specializing in Anesthesiology and Pain Management?
I would advise anyone pursuing this field to always be mindful that patients are not defined by their condition. They have full lives and responsibilities. They have important relationships. Mostly, patients come to pain management to figure out ways to function in their lives after suffering from injuries or degenerative conditions. So, we treat the whole patient and come up with new strategies to achieve the best outcome for the patient.

When not working, Dr. Khan will be found spending quality time with her husband, two young children and extended family on Long Island. She enjoys cooking and is an avid traveler having visited many countries including Bangladesh, Kenya, India, United Arab Emirates, Spain, Morocco, Singapore, Costa Rica, Canada and Thailand to name a few. Dr. Khan has a future goal of completing trails in the Himalayan Mountains. In addition to English, Dr. Khan also speaks Spanish and Bengali.
Dr. Khan is now accepting new patients in our New Hyde Park, Long Island office. Learn more about Dr. Khan by visiting her biography, here. For further information or to arrange an appointment, please call (516) 587-5500 or email us at Help@SpinePainNY.com.

18Apr 2017

image001

IS IT FOR YOU?
If you have back pain and are found to have a vertebral compression fracture, that is, a break or collapse of the vertebral bones, the minimally invasive procedure known as Kyphoplasty may be recommended as a treatment option for you. According to one of our pain specialists, Dr. Kenneth Chapman, “If you can grin and bear it, then that is the first option. The least invasive option is always the best route. What needs to be considered is to what degree the pain causes disability. An inability to function normally can lead to loss of muscle mass, deep vein thrombosis, weight loss, depression and can lead to falls, which can lead to further fractures. The risk of developing these secondary effects of pain and disability far outweighs the risks of the Kyphoplasty procedure.” The pain from a vertebral compression fracture can range from mild, and can be confused with a simple backache, to severe and debilitating, leading to hospitalizations resulting from the pain. Pain from a broken bone in the spine can heal. Time, rest, anti-inflammatory medications (Ibuprofen, Alleve, Naprosyn), opioids medications, and sometimes a brace are the first line treatments for a fracture. However, when the pain is too severe, the disability from the pain is too limiting, or a patient’s improvement is not moving quickly enough, there may be a need for an intervention.

HOW DID WE GET HERE?
Vertebral compression fractures can occur for several reasons. Something so trivial as lifting a laundry basket or opening a window may be the culprit. Or, it may result from a traumatic event such as a fall. Most commonly, however, it occurs as a consequence of Osteoporosis, which is the loss or decrease of the mineral constituents of the bones. These bones are thus ‘softened’. Weakened bones are the primary cause of painful fractures. When a compression fracture occurs, it may involve the collapse of one or more vertebrae in the spine that results in pain, hunched back, loss of height, numbness, tingling, weakness, incontinence, and other unpleasant symptoms that may vary from patient to patient. Kyphoplasty is designed to relieve the pain, to stabilize the bone, and to restore lost mobility. An important portion of the procedure is taking a biopsy of the collapsed bone. This assures us the fracture is from Osteoporosis and not other possible causes of bone weakness. “More often than we would like, we find other causes of compression fractures like multiple myeloma or a metastatic cancer. A compression fracture can be a presenting symptom in these diseases — and it’s our job to find that,” says Dr. Chapman.

HOW IT’S DONE
kyphoplasty-spine-surgery-2The kyphoplasty procedure is performed through trochars (larger needles) with the patient awake or sedated. One of the benefits of our specialists performing this procedure is that you do not need general anesthesia, which most Kyphoplasty that an orthopedic or neurosurgeons perform require. “Avoiding general anesthesia is one of the biggest benefits of us performing the procedure. We, as pain specialists, are used to patients being awake and talking during the procedure. Surgeons tend not to be used to that. The risk of a general anesthetic can outweigh the benefits of the procedure in this compromised, often elderly population” adds Dr. Chapman. Be sure to see a specialist regarding the severity of your back pain. It is also important that if you are not getting treatment for Osteoporosis, that you should see a specialist for an evaluation. “It’s never too late to change your lifestyle and/or potentially start treatments for the condition,” according to the doctor. If you or a loved one are found to have a compression fracture and have pain you can consult one of our physicians to determine if Kyphoplasty is right for you. The board-certified pain specialists at The Spine & Pain Institute of New York are regarded as experts in the field and are available for consult and more information on Kyphoplasty and related procedures.

05Apr 2017

Dealing with knee pain as an avid runner.
– Magdalena Cadet, M.D. – Rheumatologist
IMG_3752“Spring is officially here in NYC and the weather is starting to get nicer. Some runners have been loyal to their outdoor regimen and managed to brave the cold during the winter season. Some of us who are not fans of the frosty weather took a little hiatus, but now it is time to get back to the GRIND!  My love of running ignited when I attended Georgetown University and I decided to pick up this form of exercise after I gained more than the “Freshman 15” pounds. I was getting adjusted to a schedule at college that didn’t involve daily ice skating or ballet practices and we can all remember late night snacking during those college years. I found running a stimulating sport where my priority was focused on improving endurance and speed while trying to maintain good joint function and prevent injury. This activity also served as a peaceful outlet as my mind escaped from the day’s reality. I loved running by the amazing Lincoln and Jefferson Memorials as well as the other famous sites in Washington D.C. when I was younger. In NYC, running through Central park and down the West Side highway by the Hudson River has become one of my favorite activities. As I have begun to slowly start my running routine again this season, I’ve noticed some aches and pains that are creeping in. With repetitive running and other aerobic exercise during the last thirty years, there have been periods in my life where I have complained of knee pain. Sometimes it may just be a simple runner’s injury, but we all still need to pay attention to our bodies and explore the causes for knee pain.” – Dr. Cadet

 

 

Look for these symptoms in your knees:
• Stiffness in the knee
• Locking
• Grinding
• Snapping
• Catching
• Warmth
• Swelling

It is very important to seek medical attention when:
• there is significant swelling or fever with the knee pain
• the knee can’t support the body’s weight
• if the knee locks up and doesn’t relax
• if falls occur from the knee pain

After a complete history and physical examination by a specialist, some of the common reasons for knee pain may include:

• Chondromalacia Patellae – This condition also known as patellofemoral syndrome results from softening or irritation of the smooth cartilage under the knee cap which can result in the knee cap rubbing against the thigh bone with movement pain. Younger individuals may complain of pain on top of the knee, especially runners. Pain may be noted when climbing and descending stairs or with squatting, kneeling, and standing up from chairs after prolonged sitting.
• Ligament injuries of the anterior cruciate ligament tear (ACL), posterior cruciate ligament (PCL) and medical collateral ligament (MCL) often occur in younger individuals who are involved in athletics.
• Meniscal Tear – The meniscus is an important part of the knee cartilage by distributing a person’s body weight across the knee joint. Runners may have decreased ability to move their knees or hear a “popping” or “clicking” noise in the knee. Meniscal or cartilage tears can be seen in both older and younger patients.
• Bursitis (prepatellar) – This often occurs in individuals who often kneel for their occupation or are involved in tasks, which involve kneeling for a significant period, like cleaning or getting your little one to crawl. There is a small sac of joint fluid of the kneecap and fluid can accumulate to cause pain and swelling.
• Patellar Tendonitis – It is referred to as “jumper’s knee”. The patellar tendon is located over the front of the knee and may become inflamed with overuse and may result in pain. This condition often occurs in people who engage in sports like running, soccer, volleyball, and basketball.
• Baker’s or Popliteal Cyst – Knee pain may arise from swelling that occurs in the back of the knee. Sometimes the cyst or swelling may become so large that the cyst ruptures and causes significant pain in the knee and calf. A baker’s cyst may be a sign that there is an underlying problem, such as osteoarthritis, rheumatoid arthritis, or meniscal tear.
• Osteoarthritis – It is often referred to as “wear and tear” arthritis, since the cartilage which cushions the joints breaks down with aging and results in the bones of the joint rubbing together. This breakdown of cartilage may cause knee pain, swelling, and stiffness lasting less than thirty minutes.
• Rheumatoid Arthritis is a debilitating arthritis associated with inflammation, joint destruction, and possibly involvement of other organs in the body.
• Post Injury or Trauma Arthritis can result in knee pain from cartilage damage, ligament tears or bone fractures.
• Gout- a type of arthritis linked to an increase of a substance in the body called uric acid. When there is a large buildup of uric acid in the body, crystals form and may settle in the joint causing severe pain, redness, and swelling at first. Pseudogout, which is often found in women in their mid-forties to sixties, can result from an accumulation of calcium crystals in the body and cause knee pain.
• Hip conditions like Iliotibial (IT) Band Syndrome may also sometimes refer pain to the knee. This specific condition which is often seen with runners and cyclists can cause pain on the outside of the knee with overuse of the band of connective tissue (iliotibial tendon) that extends from the outside thigh to the knee. When the band tightens and rubs across the hip bone, inflammation may occur.
It is very important for the physician to consider other conditions such as an infection (septic arthritis) or a neurologic condition if these other causes are not suspected. It is very important for you to clearly tell their physician the details of their knee pain in order for a complete evaluation to be initiated.

Here are some SIMPLE MEASURES that may help with knee pain.
• Avoid tasks that involve kneeling or squatting for several hours, lifting heavy objects, excessive climbing stairs or prolonged walking!
• Scale back on engaging in sports that require repetitive direct impact on the knee joint such as basketball, soccer, or excessive running. Participating in stationary cycling for up to 15 minutes a day may be a better alternative to these high impact sports. This may be difficult to do for some of us but it may be time to try that Soul cycle or Fly Wheel class!!
• Keeping the knee relaxed and avoiding overextension may also help with knee pain.
• Sometimes massaging the knees by slowly rotating the knee cap or patellae can be beneficial.
• If the pain is due to an overuse syndrome or an acute injury, try resting the joint first for a few days to weeks. Avoid the activity that aggravates your knee pain. Heat and Ice are often initially recommended to decrease the initial inflammation and swelling.
REMEMBER “RICE”: Rest, Ice, Compression, & Elevation
13-Natural-Treatments-for-Osteoarthritis-01-722x406For any female or male who is overweight and imposes a risk of developing knee osteoarthritis or a ligament/cartilage injury, weight loss and lifestyle modification is necessary. For every pound that an individual is overweight, additional excess weight and force is applied to the knee joint.  “Now that I’m in full swing of my running regimen and half marathon training as some of you may be, I’ll be making a solid effort to pay attention to my knees. I’ll keep you posted on the training and stay tuned for my next blog on different treatments and exercises for knee pain. Keep that knee strong and fit!” – Dr. Cadet

 

If you are interested in learning more about Dr. Cadet, please feel free to email or call one of our offices for a consultation. She would be more than happy to discuss your condition and treatment options for an individualized treatment plan. www.OsteoCenterNY.com