Orthopedist
David Neuman
I am sorry to read about your bulging disc problem. Thanks for allowing me to respond and give my thoughts, tips and suggestions to you. Bulging discs are incredibly common. Some occur with trauma and others occur as a normal process of aging. Therefore, unless you are hurting on a near-daily basis, and have tried many modalities (heat, physical therapy, chiropractic, modalities, injections), I would not undergo surgery for a bulging disc. Once a disc is operated on, the repair process forms scar tissue and not ‘100% normal’ annulus fibrosis (the soft tissue envelope that holds the vertebral bodies together and house the gelatinous intervertebral discs/‘nucleus pulposus’). Therefore, it is at risk for further problems in your lifetime. ‘Treatment’ of bulging discs include those listed above. In addition, maintaining motion, flexibility, strength, endurance, and conditioning of the muscles around the imperfect discs. Here are some good activities and exercises to help you: https://www.pop-doc.com/browse.cgi?category1=Lower%20Back I hope this helps. David T. Neuman, MD FAAOS
Hello. Thanks for sharing your question and sorry to hear about your sciatica woes. I also appreciate your giving me an opportunity to share my thoughts, tips and suggestions with you. Sciatica is a condition that brings about pain in the buttocks or affected leg, ‘electrical shocks’ down an affected leg, or a feeling of numbness and tingling into an affected leg. This occurs when the Sciatic nerve (a relatively large electrical wire that leaves the spine at 4 different levels and joins together to run down the legs; transmitting feelings of sensation and coordinating the muscles of the entire leg (to the toes). When utilizing ‘exercise’ as an effective modality in overcoming (treating, healing, alleviating the symptoms) Sciatica, it is first important to let the acute problem calm down. That is, the inflammation that is causing the nerve irritation. In your case, I am not sure how it began, how often it rears its angry head, and for how long it has been angry. Generally, 2-3 weeks after the feelings begin, it is time to start ‘exercising’ (before that, rest, ice/warmth, anti-inflammatories if OK’d by your doc, and topicals are indicated). I am a big believer in a step-wise approach to exercise and ‘recovery’: range of motion activities for the lower back and hip, followed by activities to activate the muscles around the lower back and abdomen, and then strengthening and conditioning exercises for the core (lower back muscles, pelvic floor muscles, and abdominal muscles). This link (https://www.pop-doc.com/browse.cgi?category1=Lower%20Back) can give you guidance and action items to help you on your way. Feel free to show them to your doctor prior to beginning them. If done in step-wise fashion and over a 2-6 week period (and then every few days, forever), you may be able to lessen the occurrence rate and severity of Sciatica. I hope this helps. David T. Neuman, MD FAAOS
Hello. Thanks for sharing your question and sorry to hear about your strained back problem. I also appreciate your giving me an opportunity to share my thoughts, tips and suggestions with you. First of all, do you think you have a sprained back or a stained back? A sprain is a stretch, tear or inflammation around a ligament (the fibrous tissue that holds the bones of the back together, around the joints of the lower back). A strain is a stretch, tear or inflammation of the tendons and muscles of the lower back. Sometimes they exist together, and sometimes they arise from an acute trauma. Other times they arise due to overuse (fatigue failure) and can be part of a normal aging process. In any event, the timing of the ‘actions’ or ‘exercise’ depends on the mechanism (‘how) of the onset of the problem, when ‘it’ happened, how often this has happened before, and how severe it is/was. Generally, the inflammation around a sprain/strain needs to calm down before ‘healing’ occurs. Healing is also a vague word, since some ‘tears’ that occur do not ever heal on a microscopic level, but rather scar tissue (unorganized fibrous tissue with suboptimal mechanical properties) forms and the nerve impulses (the ‘why’ we feel the pain) become less intense. When the pain resolves and you can get back to doing things you like doing for a prolonged period of time without onset of pain, then you may as well have ‘healed’. If you did nothing but rest and take some anti-inflammatory medications (after the OK from your doctor, topical or oral), you can begin to feel less pain and become more active in 2-6 weeks (depending on several factors: age, physical shape, tolerance of pain, balance of your immune system, quality of the lower back, etc.). But to ‘heal’ and not have another issue like this arise, nothing beats regaining good lower back and core range of motion, flexibility, strength, endurance and conditioning (see this link: https://www.pop-doc.com/browse.cgi?category1=Lower%20Back). In addition, doing smart things and living a preventive orthopedic lifestyle can also diminish the return of a sprain or strain of a lower back. Finally, avoiding ‘accidents’ can also be helpful when it comes to not straining or spraining your lower back. I hope this helps. David T. Neuman, MD FAAOS
Hello. Thanks for sharing your question and sorry to hear about your scoliosis. I also appreciate your giving me an opportunity to share my thoughts, tips and suggestions with you. Scoliosis does not usually progress significantly when a person’s bones stop growing (around puberty or within 2-3 years of puberty). During the rapid growth period of puberty, some scoliosis curves become worse (on X-ray, and clinically too, with some increasing the pain as well). Surgery for this condition should be explored in detail with a spine surgery specialist who specializes in this type of surgery. The surgery involves stabilizing the curved spine and correcting some of the cosmetic (and structural) deformity of a curved spine. It is not supposed to ‘completely’ straighten the curved spine, partially since the deformity occurs in three planes (front-back, side-side, and top-bottom) and a complete correction of all three planes is difficult and not usually attained. In addition, if a person is not yet growing when this surgery is performed, the curve may continue to form after the surgery. Therefore, if the scoliosis is painful, progressing quickly (despite bracing and physical therapy/stretching), diminishing your ability to breath easily and deeply, or diminishing your self-confidence, then surgery with a skilled spine surgeon may be beneficial. However, it is best to realize and understand your expectations before undergoing this procedure. I hope this helps. David T. Neuman, MD FAAOS
Good day! Thanks for sharing and thanks for allowing me to give you my thoughts, tips and suggestions regarding your ankle question. ‘Mild’ is a relative term, and I wonder where you got that quantification. If so, I am glad it is only mild. There are some studies that show that the residual deficiencies after ankle sprains can negatively impact the function and happiness of people for a long time (perhaps even ‘forever’). An ankle injury can come in many flavors or types. The healing of it depends on what ‘it’ is. ‘Heal’ is also a term with many levels of meaning. ‘Mild’ soft tissue injuries can heal enough to put force against them by three weeks. But the time from injury or pain in the ankle means you are using it differently since the problem began. Therefore, the muscles and soft tissues around the ankle (fascia, tendons, capsule, ligaments, articular cartilage, etc.) have also not been used well since the problem began. My suggestions are that by three weeks (depending on the type of injury you had) working towards regaining a full and painful range of motion is step one. Then working on balance, flexibility and strength follow. However, this should be a slow and controlled process that puts more demands on the ankle (and entire leg) only after milestones have been successfully achieved (regarding motion, balance, strength). I hope this helps! Happy Holidays!
Thanks for sharing your MSK issue. Thanks for allowing me to give you my thoughts, tips and suggestions regarding this issue. There are many types of flat foot. If there is no pain, then there is nothing to do. Having varying degrees of flat feet is normal. Some arches are higher than others. There are some foot strengthening exercises that can help strengthen the arch on the inside aspect of your foot. It has been shown that inserts do not help increase the size of an arch, unless your bones are still growing. I have relatively flat feet, and like to think it offers me some more balance since there is more surface area contacting the ground when I stand. If you can, do a two-legged or one-legged heel raise, and your arch forms, then you do have functioning tendons (the ropes connecting the muscles to the bones). This is a good exercise when done in a controlled fashion. One can strengthen the foot by ‘gripping’ a piece of paper that is on the floor or on a rug, by bending the toes (as if you are grasping a piece of paper with your hand), and then holding and releasing 5-10 times 2-3 times a day. If there is no pain, I would encourage you to embrace your feet for how they look, and trust them to carry you around for many years (as long as you keep them flexible, mobile and strong). David T. Neuman, MD FAAOS
Thanks for sharing your MSK issue. I hope my thoughts, tips and suggestions help you. If I know more about the history of the ankle pain, I could be of better assistance. Is that the only time it hurts? How far do you run? Are your running shoes new? Do you run on asphalt/concrete or rubber (track) or grass? Do you perform gentle and controlled stretches prior to the run? Perhaps you can try cross-training (bike, elliptical, roller blade, Nordic track, rowing machine, etc.) instead of running to see if your ankle hurts after those activities. Perhaps too much impact across your ankle bones cause the surfaces of the bones to become over-pressured and bruised. If the pain completely resolves within a few hours, then I would not think there is a lot of roughening in the smooth joint. Therefore, keeping a ‘normal’ weight for your height and not running too fast or too long can perhaps lessen the feeling of pain. I hope this helps. David T. Neuman, MD FAAOS
Thanks for sharing this question. I hope my thoughts, tips and suggestions help you understand more about your disc herniation. As with many other questions I field, getting a better perspective on the fine points around the question can help guide and build an appropriate response. How did you come to learn about the disc herniation? How do you think ‘it’ happened? If it was an acute (occurred from one specific event) trauma, when was it? What types of symptoms are you having? Disc herniations in the ‘normal’ population are quite common. Starting at around 40, your age represents the % of people who have a ‘disc herniation.’ However, not all are symptomatic (cause pain, numbness, tingling, burning, cramping, etc.). If the herniation comes from tearing of the soft tissue walls around the gelatinous disc (nucleus pulposus), then it is not likely that the wall ‘completely’ heals up 100% with the ‘normal’ tissue. However, if the pain subsides (completely or near-complete resolution of pain), and your function returns to a high level (can do those things that bring you joy and happiness), then you may as well have ‘healed’ it. Healing is enhanced by following this link: https://www.pop-doc.com/jointpain-preactive.html But please pay a lot of mind and time to maintaining good flexibility, mobility and strength around those damaged discs. Finally, if there is prolonged pain, numbness, tingling, stiffness and weakness, then sometimes a consultation with an orthopedic spine specialist or pain management doctor is suggested. I hope this helps. David T. Neuman, MD FAAOS
Thanks for sharing and allowing me to give some thoughts, tips and suggestions to you. I am sorry to hear about your disc problems. As you may know, with our knowing about your history of the pain (when/how it happened, what types of pains you have, what you have done about it, etc.), it is hard to give you ‘optimal’ advice. Who told you you have ‘disc pain’? I ask, because disc problems do not always give pain. But rather, the inflammatory response around the disc problem is the root cause of the pain. This pain can be from the bones, joints, ligaments or tendons/muscles. Relieving the inflammation can be achieved using the following link: https://www.pop-doc.com/joint-preactive.html If there was a traumatic beginning to the disc problem, then it may take 6-12 weeks for the pain to resolve. Every two weeks you should begin to feel better rather than worse. If there is progressive numbness, burning or tingling into the fingers or toes, then it is recommended that you seek care from either your primary care doctor or a rehab specialist. I hope this helps.
Thanks for sharing and allowing me to respond with my thoughts, tips and suggestions. Much of my professional work revolves around hearing a history of the problem (for you, lower back pain and ‘what is it’?). A disc problem means that the house that holds the disc in (the ligaments or ‘annulus fibrosis’ when it comes to back ‘discs’) place has failed. So, your problem is either muscular or ligamentous. How the problem began sheds a lot of light on which it may be. Sometimes it is both. Muscle pain can be felt easier (by someone pushing on the sore area), and can be made worse with movement. Ligament or disc pain is a deeper pain and can exist even at stillness (or at rest, no movement). The initial ‘treatment’ is basically the same. See this link: https://www.pop-doc.com/joint-preactive.html If the pain gets worse, or there are feelings of numbness, tingling, burning or cramping to your legs, and this does not resolve or feel like it is getting better after 5-7 days, then a visit to your primary care doctor is suggested. I hope you heal well and soon.
The following are my thoughts, and sometimes my tips and suggestions in response to your inquiry: I encourage you to have hope and strength to combat your medical condition. As an orthopedic surgeon, I have not come across that specific medical/neurological condition. If you are having bone pain, then I feel it is important for you to be working closely with a doctor who is knowledgeable of Diabetes and treats their patients with empathy, compassion and success (success = the patients generally learn to adapt and relate to something that empowers them to practice a new routine that leads to a change in mindset and elevated physical feeling of less pain and more function). I generally feel that keeping ‘all’ (over 500 joints) joints moving through a full range of motion helps keep them mobile, healthy and strong. Completion of this specific joint-health activity is likely to lessen the severity of pain. David T. Neuman, MD FAAOS
The following are my thoughts, and sometimes my tips and suggestions in response to your inquiry: And the ‘snap’: potentially soft tissue tearing, or rubbing over another soft tissue or bone prominence. Soft tissues consist of rope-like structures with thousands of fibers. These fibers connect to other soft tissues, or to bone. A tearing may cause an inflammatory response, which can lead to swelling, stiffness and pain. Being PREACTIVE may help you overcome at a more rapid rate. David T. Neuman, MD FAAOS
The following are my thoughts, and sometimes my tips and suggestions in response to your inquiry: I thank you for sharing and I am sorry to read about the painful feelings in your boyfriend’s arm. When I think of ‘cold and numbness’ I think of nerve-related disturbance or pain. It can also be a vascular issue (having to do with the blood vessels). Obtaining a thorough and revealing history of these feelings would greatly help. Perhaps there may be something compressing the arm (squeezing the vessels or nerves) for a prolonged period (sleeping, resting, assuming one position for a time of more than 30 minutes)? If this continues for more than 3-4 weeks and feels like it is staying the same or getting worse, and/or waking him from sleep, then a visit to a nerve doctor or orthopedist (a doctor dealing with muscles, bones and joints) is suggested. David T. Neuman, MD FAAOS
The following are my thoughts, and sometimes my tips and suggestions in response to your inquiry: I heard spine surgery is a painful surgery. Post-operative pain medication may depend on the type of spine surgery you had. In any surgery type, the surgery is close to the nerves, and after any surgery there is an inflammatory response in the body. I am not an advocate of narcotic medication. I believe in Tylenol and an anti-inflammatory medication (with food, upon the approval of your spine surgeon), but also feel there are several other non-pharmacologic (not doctor-prescribed medication) treatment modalities that can help you get to a feeling of less pain. I like this link (https://www.pop-doc.com/joint-preactive.html) for more useful tips and suggestions, but let your decisions be influenced by your spine surgeon as well. David T. Neuman, MD FAAOS
The following are my thoughts, and sometimes my tips and suggestions in response to your inquiry: Thanks for sharing your MSK (Musculoskeletal) issue. Oftentimes, the history (of how the pain began, when it began, and what makes it better/worse) is an important part of the diagnosis and the treatment plan. A tendon is a rope-like structure that connects a muscle to a bone. The tendon has many fibers. If some get stretched, or torn, then this usually comes from a specific traumatic event. If there was no specific traumatic event, then it is not likely to be a tear. However, if there is overuse of a tendon, microscopic tearing can occur, and this can lead to an inflammatory response. Inflammation involves swelling, pain, warmth and discoloration (redness). Therefore, the feeling of pain and loss of function can become worse before it becomes better. I’m happy to read that there was no swelling or bruising. After a day or two, activities towards regaining full movement should occur, and this link can help: https://www.pop-doc.com/joint-preactive.html. If the pain becomes worse and swelling occurs, after 6-9 days, then an appointment with a doctor may be best. David T. Neuman, MD FAAOS
The following are my thoughts, and sometimes my tips and suggestions in response to your inquiry: Thanks for sharing this, and I am hopeful you feel better soon. It sounds like you have some scar tissue build up in the knee, and maybe some bruising to the covering of the bone, behind the knee cap, or at the end of the thigh bone. This covering is called articular cartilage, and does not show up on an X-ray. Strengthening the muscles around the knee, without putting too much pressure on the knee, can help diminish the pain and creaking sounds. If the pain becomes more severe or more often during the day and during regular activities, then an MRI and visit to an orthopedic doctor may be needed. David T. Neuman, MD FAAOS
The following are my thoughts, and sometimes my tips and suggestions in response to your inquiry: As I read this (the shot of Depo), I can only wonder about the circumstances around why this shot was offered to you. As a strong corticosteroid, Depomedrol basically shuts down the body’s immune system for a period of time. Once it is given, the effects begin within 4-6 hours and continue for a period of time. I am not sure what you can do to speed the processing of this drug, but believe in staying hydrated and getting plenty of rest. In addition, raising your heart rate and breathing rate (through safe and controlled exercise) will circulate the drug at a faster pace, and this can maybe speed up the time you feel the negative effects of the drug. Perhaps treating the headache with some medicine that usually works for you can also help. David T. Neuman, MD FAAOS
The following are my thoughts, and sometimes my tips and suggestions in response to your inquiry: Thanks for sharing. I am sorry to read about this tingling. When does it come on? How long does it last? When I think of tingling I think of nerve-related irritation, and less common would be a vascular issue (blood flow). Since it is reported to involve the upper and lower extremities, I lean more towards a nerve irritation. The neck is the pathway from the brain to the upper and lower extremities, and the nerves are like electrical wires that transmit feelings and coordinate actions in the musculoskeletal (MSK) system. Then, there is a vast meshwork of soft tissue in the body called fascia. It essentially covers muscles and joints, and helps with coordination, communication and overall function of the MSK system. From what you wrote, perhaps the nerves around the neck and/or lower back are irritated. I would recommend gentle yet complete range of motion exercises and see how the numbness/tingling responds over the next 1-2 weeks. If it resolves or lessens, then give it some more time. If it worsens, then seek consultation with a nerve doctor (neurologist) or your primary care doctor. David T. Neuman, MD FAAOS
The following are my thoughts, and sometimes my tips and suggestions in response to your inquiry: ‘Dislocated’ ankle, to me, occurs after a forceful and powerful twisting, impact to the ankle. It is a relatively rare occurrence, and can be quite painful. If this happens, it is not likely you (or anyone) will simply be able to relocate the ankle at home. Getting an X-ray and having an exam (quite soon after the occurrence) Is highly recommended. David T. Neuman, MD FAAOS
The following are my thoughts, and sometimes my tips and suggestions in response to your inquiry: I am hopeful that you have a good WC attorney (lawyer) and that if this happened at work, then your disability insurance should be covering this surgery. It will depend on where the laceration was and where exactly your pain is. A trigger finger is a tendon compression across a soft tissue tunnel whose job is to stabilize a flexor (bending) tendon, in your palm. With the right diagnosis and caring, meticulous surgeon, an empathetic and thorough physical or occupational therapist post-operatively, and a motivated and knowledgeable patient, you should do fine. I find it is a pretty successful surgery in terms of pain relief and functional improvement. Good luck and listen to your doctors and care team. David T. Neuman, MD FAAOS