Patient Questions

David Neuman is an Expert Contributor on FindaTopDoc. Here are some of their recent answers to patient questions.

David Neuman

Thanks for your question related to massage and pain relief. I am happy to offer my tips and suggestions regarding this. Many people believe that pain and arthritis means stop using the joints. However, this is simply not a correct way to think. By following some of these steps: you can overcome pain and keep your joints functioning well. It is quite common for aging to bring about imperfect and painful joints (as the normal smooth surfaces become worn out and rough). However, massage plays a great role in increasing blood flow to the joints and allowing them to loosen up and become more mobile. This link helps support that: Strengthening the muscles around the aging joint will help maintain the function of that joint and less pain will ensue. I hope this helps.

Hello and good day. Thanks for sharing your question with the FATD community. Your dad is a smart man and is only trying to offer his thoughts regarding your mammary glands. After all, breasts are not made of bone, but rather fat, ligaments (the cord/rope like structures that support breasts and also connect bones to each other), and ducts to allow breast milk to flow when the hormonal balance is right. Whether or not you choose to wear a bra will not affect the function of the breasts. However, I like to think about the ever-pulling effect gravity has on structures (not only dropped or thrown objects, but including breasts). Couple the force of gravity with the impacts you have when walking, stair climbing, running, jumping, hopping or landing from a fall, and then some physiologic changes of the breasts can occur (I mean, how they look without support). This does not mean that wearing no bra for a day here and there will make a change, but think about not wearing one for years or decades. The ligaments support the breasts and hold them up. They are not muscles and have no ability to contract (become shorter) or to get stronger (by working out). They are like rubber bands. And, if a rubber band gets over stretched or is held in an elongated shape for a ‘long’ period of time, then they can become permanently stretched, or can even break. This is what causes sagging in breasts over time (there are other variables, too, but without the support of bras, these changes can happen sooner in life or to a more-severe degree). Over time, these relatively small and delicate ligaments can stretch out and make it so the breasts sag more than you like. I have young daughters in my life, and a wife. I hear from them about how uncomfortable and constrictive bras can be. However, unfortunately, society and social media has made it more difficult for an aging person to enjoy natural aging and their (still beautiful) aging bodies. Perhaps your dad is trying to give you advice that will help you mature and age in line with society’s unrealistic standards.

Hello and thanks for sharing your knee problem with the FATD community. Allow me to offer my thoughts, tips, and suggestions regarding it. Knee pain can arise as a consequence of trauma, but also from overuse or a part of normal aging. I do not see much of history from what you wrote. A thorough history and a good physical examination help determine the ‘best’ course of action 80-85% of the time. Pain around or behind the kneecap can be due to inflammation of the tissues that line the joint (the synovium). I like to refer to this link when it comes to overcoming the pain associated with inflammation. Making the move to better joint health I do not recommend ‘pushing through the pain’ when it comes to exercises. Allow your body about three weeks before vigorous weight-bearing (running, jumping, hopping or squatting) exercises. Every week you should be feeling less pain or having an increase in function. If by 5 weeks there is no noticeable improvement, I would recommend a consultation with an orthopedic doctor. I hope this helps and that you heal quickly.

Hello and good day. Thanks for sharing your knee bursitis treatment question with the FATD community. Please allow me to offer my thoughts, tips, and suggestions regarding this matter. There are essentially three bursal sacks around the knee (these are fluid-filled bags around pressure points in joints, in order to diminish friction and permit the easy moving of soft tissue structures over each other or over boney prominences). Knowing which is painfully inflamed (the ‘itis’ at the end of the word signifies a painful condition) would be helpful, but the treatment is about the same in each. The goal is to diminish the inflammation around the bursa, but then also to figure out and fix whatever is making the bursa inflamed. Sometimes it gets inflamed after a trauma, and other times it is part of the aging process. The treatment is similar to any inflammatory flare-up. I find that this link is quite helpful: The process may take 2-4 weeks to subside. If it does not subside, there may be soft tissue that is irritating the area and therefore needs to be cleaned out (depending on which bursa you are referring to, this can be an arthroscopic surgery or open procedure). I find that usually bursitis resolves on its own (but following the PROACTIVE steps can help it resolve quicker). I hope this helps and that you feel better soon.

Good day and thanks for sharing your knee issue with the FATD community. Please allow me to offer my thoughts, tips, and suggestions. My first thought: have you ever had a trauma to your knee (sporting, work, accidental, motor vehicle accident)? Since you did not fill out much of the optional reporting (age, gender, medications), I am not sure how old you are. From what you wrote, it is either a ligament problem (the rope-like structure that stabilizes and supports the knee joint when it is not moving – static stabilizer), a muscle problem (the meaty soft tissue that dynamically stabilizes the knee), or a neurological problem (the nerves give feedback to the brain and communicates to help with coordination, strength and control of the knee). If there has been no large trauma to the knee and the other one is working well, then it may be a neurological or strength imbalance issue. f you do not have these feelings of knocking or moving in an unstable fashion when walking or stairclimbing, then it may be a ligament issue. I suggest you get a good examination from a well-trained orthopedic doctor. I hope this helps.

Thanks for sharing your wrist issue with the FATD community. Allow me to offer my thoughts, tips and suggestions. From the description of your wrist and hand issue, it seems as if there are two problems. One is a bone/joint (arthritis) problem and the other is a nerve compression problem. I think it is important and valuable to get a good physical examination from a well-trained and knowledgeable orthopedic surgeon. To this end, it will help you better understand exactly what is causing your pain and dysfunction. From the description of the symptoms, it is hard to figure out exactly where the main problem is. Since there are so many fingers and many bones in the wrist, it leaves me lacking in specifics. It would also be helpful to know whether or not you have had trauma to the hand and wrist, how your neck is functioning, and the treatments you have bad. I usually suggest intermittent bracing (including at night), anti-inflammatory medication taken for 7-10 days (if your stomach is healthy), and then a ton of range of motion, flexibility and strengthening exercises. If after 6 weeks there is minimal/no change, then an injection around the compressed nerve can help a lot (there are several non-steroidal injections that are available and range in efficacy). Ultimately, a carpal tunnel release surgery done by a hand specialist with good technique is an excellent treatment option for carpal tunnel syndrome (but not for arthritis). I hope your wrist and hand feel better, and hope this helps.

Hello and thanks for sharing your question with the FATD community. Carpal tunnel syndrome an be annoying. How long have you had it? If you and your doctors are sure that is what you have, then after conservative care (bracing, PT, anti-inflammatory medication) injections or surgery are the next steps. If you are adverse to surgery (which works quite well in the right hands and with the right patient), then injections can help. They do not need to be steroids, but a good injection doctor can try and use normal saline as this has been shown to break up adhesions around the nerve and may alleviate symptoms. I hope this helps. Feel better. Happy Holidays!

Hello and thanks for sharing your back problem with the FATD community. Allow me to offer my tip, thoughts, and suggestions. Sorry to hear about your back. It sounds like it is more of a mid-back issue and maybe even a rib problem. Does it hurt to breathe deeply? A sharp pain could be a cracked rib, but can also be a torn or overstretched muscle, tendon, or ligament (soft tissues). Give it another week and see if the pain slowly resolves. If your stomach is ok I would recommend Aleve (Naproxen) two pills twice a day with food for three days. Warming up the area in a bath or shower and then gently stretching can also help. As long as this is getting better each week, it should completely resolve but may take 3-6 weeks. I hope this helps. Feel better.

Hello and thanks for sharing your knee issue with the FATD community. I would like to share my thoughts, tips and suggestions with you. I am sorry to read about your knee pain. Hearing or feeling a ‘snap’ could mean that you stretched or tore some soft tissue structures in your knee. The feelings of pain, dizziness and wobbliness are normal after a painful twisting action. I think your uncle gave you good advice about icing and elevating the knee. It may take 2-3 days for the swelling to go away, and if you have an elastic bandage you can use that too (for 2-3 days, not much longer than that). Some over-the-counter medication like Tylenol or ibuprofen (Motrin) can help with the pain and swelling (taken with food, following the directions on the bottle). These medications should not be taken for more than 3 days in a row. If you tore a ligament (the soft tissues holding the bones together), then it can be a slight tear or a big one. The big ones will give you feelings of continued and worsening pain and instability (wobbly) that will not go away. A partial or small tear should slowly get better, but this may take 2-6 weeks. I recommend ice and elevation, and also to gently move the knee (make the leg straight as you can and then using your hands make it as bent as you can, and compare it with the uninjured side). In the long run (your life), if you feel that ‘I am not a active person and I am overweight’ then I would strongly encourage you to try and become more active and to slowly lose weight by eating smaller portions, drinking more water, taking in more fiber, and not eating fried, processed, or salty foods. Life is long and those people who are less active and carry around too much weight for their body frames run the risk of getting chronic diseases (pain, high blood pressure, diabetes, high cholesterol, and obesity). I have faith that with the right changes you can make a positive impact on your bodily health over the long-term. If you still have feelings of giving way or wobbly when putting weight on it (or twisting or stairs) by next week (Monday/Tuesday) then I recommend going to see your primary care doctor so they can refer you to see an orthopedic doctor.

Thanks for sharing your cortisone question with the FATD community. Please allow me to give my thoughts, tips and suggestions. Sorry to hear about your knee. Unfortunately, there are so many side effects of cortisone, that nausea can be one of them. There has been no study that has ever shown that a cortisone injection significantly helps joint problems over the long-term. I do not suggest you get another one. Other side effects can be weight gain, hormonal imbalances, water retention and heart palpitations. I hope your nausea subsides. I recommend getting rest and staying hydrated. I hope this helps.

Good day and thanks sharing your finger/hand issue with the FATD community. I will share my thoughts, tips and suggestions with you. If you had broken a bone you would have markedly swollen digits filled with black and blue coloration, with a high amount of pain upon any motion. However, fingers occupy a small space, and therefore after a crush injury there will be bruising of soft tissues. This will lead to inflammation: swelling, warmth, redness (bruising) and pain. Loss of function (inability to fully bend it) also occurs. Once it occurs, it can last for 2-8 weeks. And for fingers, sometimes it is even longer and sometimes ‘full motion’ never returns. Suggestions: ice (fingers into ice water for 15-20 minutes 2-3 times a day for 2-4 days), elevation (above the heart for the first 3-5 days), anti-inflammatory medication [with food, Advil (4 times a day) or Aleve (2 times a day) for 3 days, and motion (both active and passive motion beginning 5 days after the injury)]. The swelling prohibits ‘fully bending’ the fingers. Manually bending all joints in the fingers (3 joints in all fingers, 2 in the thumb) with the other hand helps a lot, but can cause discomfort. If this is done in the first 2 weeks, icing afterwards can help. It may take 2-4 months to get full motion back (depending on several factors). I hope this helps.

Good morning and thanks for sharing your hip issue with the FATD community. Allow me to offer my thoughts, tips and suggestions. You have the benefit (unfortunate benefit) of having a labral injury on the other side, so you have the experience as to how the other injury occurred and how it made you feel prior to seeking specialist guidance. If this new injury feels the same and occurred in a similar manner, then maybe it is a labral tear more than hip flexor injury. Sometimes, depending on the mechanism of injury, both soft tissues are damaged (but one more than another). The hip flexor is a tendon. Tendons are painful with active and passive range of motion (revealed in a good physical exam). Labral tears (ligaments) are more reveled with stability aspects of a physical exam, or manipulation of the affected joint during an exam. Painful clicking, catching and giving way of the hip (with twisting, sudden change of direction movements during sports, and stairclimbing) is experienced with labral pathology. However, if the forces across the hip during the trauma that led to the pain (if this was the mechanism) may have simply bruised the labrum and not torn it. As an 18 year old your body can still heal very well. Since the injury was only 8 days ago (at the time of your writing the submission), the best option at this time is rest. Rest is best to allow your body to start the healing process. Too much activity, not listening to your body, or pushing through the pain has very limited upside. The downside aspects are many and can lead to permanent damage and changes to your hip (and body) forever. Keeping an avid athlete on the sidelines is not easy but is so worth it (for them). Your body is young and healthy. Damage to joints does not always heal and sometimes leads to injury in other parts of your body. Be careful and courteous to your body. I hope this helps.

For your problem, it depends on several factors. How long has it been ongoing? How did it come about? Is this the first time or has it reared its angry head before? Sciatic nerve pain comes from irritation of the biggest nerve in your body. As the nerves leave the spinal canal in the lower back, if they are impeded by the bones of your lower back or the soft tissues around the small joints in the lower back, then they will become irritated and painful. This can be sharp, shooting pain down the leg through the buttocks, or sometimes can be feelings of numbness, tingling, burning, or cramping. Overcoming the acute inflammation is the first step to alleviation of sciatica. This can be achieved with physical therapy, rest, heating pad, anti-inflammatory medication and topical creams and ointments. Once the pain subsides, in order to diminish the potential to have it again (or with the same severity), there are several things I can recommend. Keeping your abdomen trim and strong is the best long-term solution. Being mindful of the way you lift, carry and twist will also lessen the forces across your lower back. I hope this helps.

Good day and thanks for sharing your wrist issue with the FATD community. Allow me to give you my thoughts, tips and suggestions. Obtaining a thorough history and physical examination is paramount to understanding what you have the the best way to treat it. Was there ever a traumatic injury to the right wrist? Does it hurt while you are playing (bumping, serving, spiking, setting)? Many athletes have overuse injuries. This means that your sport is stressing out and damaging the soft tissues around your wrist (from the mechanics of the sport and the forces going through your wrist during sporting activities). Without a big trauma or injury to the wrist, and with such a short duration of the symptoms, REST is the best answer. I know that is not easy to read if you a devoted and avid volleyball player. Wearing a brace and not playing for 3-5 weeks will allow your soft tissues to heal and allow the inflammation to subside. If you play through the pain you may permanently tear some structures or damage the delicate surfaces of the many small bones in your wrist. And as a 19 year-old, and your dominant (maybe) wrist, I would recommend letting it rest and no undergo the twisting, impact, shearing and distracting forces it is susceptible to during volleyball. During this time immobilization and gentle range of motion, with formal physical therapy, is worthwhile. If by 4 weeks or so, upon increasing the forces and work of the wrist, you still have a lot of painful noises and limited function, then an MRI scan would be medically necessary. I hope this helps and sorry to read about your pain and encouraging you to rest and stop playing for a period of time.

Hello and good evening. Thanks for sharing your wrist issue with the FATD community. Did you have a traumatic event? Usually strong forces of shear, torsion, impact, and/or distraction can cause a fracture or a break to a bone. Bones have two unique properties that clinically become evident when they are fractured. The fascia covering the non-joint surfaces of bones is called the periosteum. There are many nerves within it. When the bone is fractured there is a lot of pain that slowly worsens over the first 2-3 days after fracture. Number two: bones at every vascular (a lot of blood and blood flow). When they break there is a lot of internal bleeding. This leads to progressive swelling and black-and-blue bruising by 3-5 days after a fracture. So, if there has been a lot of progressive and unrelenting pain coupled with bruising, swelling and stiffness, then there is a good chance there was a fracture. An X-ray will help determine the ‘if and how bad’. And will also dictate treatment. I hope this helps and that you do not have a fracture.

Hello, good evening, and thanks for sharing your leg/lower back issue with the FATD community. I will give you my thoughts, tips, and suggestions. I am a bit confused, shocked and curious as to the origin of your ‘I have no thigh muscle in my right leg statement. How did this occur, and when? In addition, does this mean the muscle in the front of the thigh only, or in the sides and back of the thigh as well? A basic bit on muscles: they are soft tissue structures that consist of muscle (red, sponge-like ‘meat’) and tendon (rope-like structures attaching the meaty part of a muscle to a bone). The muscles contract and elongate to move joints (the coming together of two or more bones) and create motion. Muscles also serve as shock absorbers and protectors of the bones and joints. For example, when we walk, the muscles lower the forces across bones and joints by compressing and becoming firmer upon striking the ground. If there is ‘no thigh muscle’, that means that the bones and joints are ‘carrying’ you around. With the gait (the way you walk) altered due to no thigh muscle, your right hip joint and lower back area compensate and can lead to bruising, tearing, stretching, and inflaming. So yes, essentially the weight placed across that leg, and the altered lower back mechanics are causing your lower back and right hip pain. Suggestion: If possible, stretch to regain the full range of motion of the lower back and right hip, and then more importantly work on strengthening that whole leg and your core, through resistive exercises. In addition, practice balance.

Hello, good evening and thanks for sharing your lower back issue with the FATD community. I will give you my thoughts, tips and suggestions. I would first think about your old neck problem and assess how the neck is moving, the pain in it, and any headaches or numbness and tingling into the upper extremities. Has there ever been trauma or injury to the lower back? The lower back is so complex (the muscles and nerves around it and the number of pain fibers in the tissues around the lower back) that obtaining a good history and physical examination are important aspects when trying to figure out a practical approach to the problem. When was the last time you underwent formal physical therapy for the lower back? I would recommend that over yoga. I would also suggest finding a comfortable position in bed for 24-36 hours to relieve some of the back pain. A heating pad can also help. Ultimately, strengthening the muscles around the lower back will diminish the pain and perhaps make you feel a lot better during activities of daily living. I hope the MRI is approved and that you can follow up with an orthopedic doctor soon. Stay positive and determined to feel better.

Good day and thanks for the extensive history of your foot issues. Allow me to give you my thoughts, tips and suggestions. I hope you have had all the blood tests needed to evaluate the likelihood of having a tick-borne disease within your body. Please do not go for long walks in crocs or in shoes that are not supportive. You simply may have some residual inflammation or the results of inflammation (scar tissue entrapping some small nerves that at giving you the sensory feelings of cool sensations or tingling around your foot). Regarding the foot: How is the pain? How is the range of motion? How is the strength? If you can stair climb, hop and run without much pain, then your tendinitis is gone. If you have not had tissue massage and strengthening exercises with a physical therapist, I would recommend that. If you do not have access to a therapist, I would recommend heating the foot up (bath or shower) and then massaging the area with your hands and fingers. Then practice balance activities, single-leg hopping and stair climbing activities. You should eventually compare the injured foot with the one that has not been injured. I hope this helps.

Good morning. Thanks for sharing your sharing your leg issue with the FATD community. I am happy to offer my thoughts, tips and suggestions regarding your concerns. Understanding a thorough history of the problem would help me answer your question in a more reliable way. When it comes to fractured or broken bones (including the tibia bone), knowing the timing, treatment and x-ray findings help a lot. From your question, I am confused as to whether or not you had fractured it a while ago and then had a new injury (car accident) which prompted the removal of the hardware. I think your question revolves around the current healing of the tibia bone that has no more hardware in it. If you are a healthy 39 year old, then the tibia bone should heal. However, if there is an underlying infection, sometimes the bone will not heal. The tibia bone is a strong yet nearly-hollow tube (the canal or inner aspect is not a solid structure but rather a lattice or mesh of calcified tissue). The healing is successful only when there is good blood flow around the damaged area. If the blood flow is not good or complete, then the body can try and heal but fails to bridge the fractured area with bone. If fibrous (soft-tissue scar) tissue forms instead of bone, then the bone will not mend and become strong enough to carry you around. It may also lead to continued pain or lack of confidence in the leg. Depending on how the most recent x-ray looks, you may benefit from another surgery, whose goal is to re-establish an open canal (which will allow new blood vessels to form and thus complete healing of the bone). There are external bone growth stimulating devices that can sometimes be used to complete healing without more surgery, but this depends on how the serial x-rays look, and your pain level. I hope this helps and that you can now go back to the surgeon (or to a new one) and make a plan. I hope you eventually heal and can get back to an active lifestyle that brings you happiness. David T. Neuman, MD FAAOS Sports Medicine and Orthopedics 131 West 33rd St. Suite 12E New York, NY 10001 P: 212-813-3634 F: 212-857-9411 Confidentiality Notice: This e-mail communication and any attachments may contain confidential and privileged information for the use of the designated recipients named above. It may contain confidential and protected health information subject to privacy regulations such as the Health Insurance Portability and Accountability Act of 1996 (HIPAA). If you are not the intended recipient, you are hereby notified that you have received this communication in error and that any review, disclosure, dissemination, distribution or copying of it or its contents is strictly prohibited. If you have received this communication in error, please notify me immediately by replying to this message and deleting it from your computer.

Hello and thanks for sharing your ankle issue with the FATD community. Allow me to give you thoughts, tips, and suggestions regarding this ankle problem. I am relieved to read that the problem was not due to a specific traumatic injury and that it has not been ongoing for more than a day. Therefore, it is most likely a fatigue-based or overuse type of onset of pain. If it is a symptomatic blood clot then the pain is usually in the inner thigh (tight and painful). I am not sure how much you exercise (or the type) and when the last time was that you exercised. My patients feel a bit more energy and less pain when they exercise. It can be something as simple and range of motion and gentle stretching exercises. Unfortunately, COVID-related bodily issues can be different for different people, so it is not easy to reliably related COVID to specific feelings of bodily pain. Severe anxiety may also play a factor in bodily pain manifestations. I recommend staying positive, getting rest, hydrating, and if your doctor permits it, taking anti-inflammatory medications with food for 2 days or so. Finally, exercise should be a part of the healing process. If the pains become worse over the next 10 days, then it may be best to consult a doctor. A more detailed history and a good exam would be a great step if the pains continue. I like this link: