Health Letter

In our younger years, most of us have healthy spinal discs. These discs are filled with collagen fibers – often described as a soft, gel-like substance. They sit between the vertebrae and provide cushioning, which enables the spinal column to bend and flex without pain.

Over time, our discs can wear out with age and use, with deterioration and dehydration of the collagen fibers. They begin to lose their ability to absorb water and nutrients, leading to decreased disc height. This is known as disc degeneration or degenerative disc disease.

Disc Collapse with Disc Degeneration

As the collagen fibers inside a disc deteriorate and dry up, the disc begins to collapse. This enables the vertebrae on either side of the disc to get closer together. As the vertebrae get closer together, they and the additional joints and bones that support them experience more and more stress.

This stress can lead to pain that can range from mild to disabling. It can be felt in the lower back but can also affect the neck, buttocks, thighs, legs, and arms. Because it is often related to nerve issues, this pain can feel like it’s coming from different areas than the actual source in the spine.

Disc Anatomy

To set a foundation for our discussion, we should review the medical structure of discs. There are 23 discs in the spinal column, running from the base of the skull to the tailbone.

Each disc comprises two parts that work together to absorb and cushion the spine.

1. The annulus fibrosus is a sturdy yet flexible outer layer of the disc.
2. The nucleus pulposus fills the center of each disc – this soft, gel-like substance made up of collagen fibers acts as the spine’s shock absorber.

Think of a disc like a doughnut filled with jelly. The outside of the doughnut is like the annulus fibrosus outer layer. The jelly inside is like the nucleus pulposus center. As the jelly inside our illustrative disc doughnut begins to dry out and deteriorate with time, the outsides of the doughnut will start to collapse on itself.

Can a Disc’s Cushioning Function, Tissue Loss, and Height Be Restored?

A disc’s cushioning function, tissue loss, and height can be restored for some patients. There is a minimally invasive procedure intended for those who have experienced tissue loss within their lumbar intervertebral discs. It is called VIA Disc NP.

This procedure is designed for discs in the lumbar spine – the lower back. This part of the spinal column comprises five or six vertebrae (L1 through L5), the largest in the spine.

The VIA Disc NP procedure is an allograft, which means that Via Disc NP, healthy nucleus pulposus tissue is injected into the interior of a deteriorating disc. This Via Disc NP tissue is similar to a patient’s own nucleus pulposus tissue. It is intended to support the cushioning function of a disc, relieve pain, and rehydrate and supplement a patient’s tissue loss.

During this outpatient procedure, a doctor uses fluoroscopy imaging (x-ray guidance) and a spinal needle to deliver the allograft into the nucleus pulposus precisely.

Who Is a Good Candidate for the VIA Disc NP Procedure?

VIA Disc may be a good option for patients with chronic low back pain caused by degenerative disc disease. Other factors that may make a patient a good candidate include:

• Having an MRI that shows a degenerative disc.
• Having tried conservative care for at least six months without pain relief.
• Having experienced tissue loss within the lumbar intervertebral discs.

If degenerative disc disease is holding you back, you should fully explore the alternatives available to you to restore the quality of your life. VIA Disc NP may be one option if your doctor considers it appropriate for your case. Main Line Spine has been performing VIA Disc NP procedures for several years.

The Main Line Spine team is here to help you navigate your personalized path from clarity on your disc degeneration condition to appropriate treatments through recovery. Our patients find that we provide the highest standards of care with compassion, expertise, and unwavering dedication.

Incidents of tennis elbow are on the rise. Roughly half the cases are attributable to racquet sports – such as tennis and racquetball. However, many others who suffer from it don’t play these sports.

Tennis elbow is caused by repetitive motion of the forearm muscles, which attach to the outside of your elbow. Any repetitive movement can cause it. This might include:

• Painting with a brush or roller
• Using a chainsaw
• Regular use of hand tools
• Repeated hand motions during work, including vocations such as butchers, dentists, musicians, auto workers, and carpenters.

What Is Tennis Elbow?

Tennis elbow, medically known as lateral epicondylitis, is the swelling of the tendons that bend your wrist backward away from your palm.

Tendons are the tough cords of tissue that connect your muscles to bones. The tendon most frequently involved in tennis elbow is called the exterior carpi radialis brevis. This condition occurs more frequently in individuals between the ages of 40 and 60, and as many as 10 million Americans may suffer from it at one point.

When Does It Become Important To See a Doctor for Tennis Elbow?

If you have pain on the outside of your elbow that won’t seem to go away, you could have tennis elbow. The pain can travel from the outside of the elbow into the forearm and wrist. If you are suffering from it, you may notice pain or weakness when you shake hands, turn a doorknob, or hold a cup of coffee.

Initially, you can try self-care, such as rest, ice, and over-the-counter pain relievers. But if those efforts don’t ease your elbow pain and tenderness in a month or so, it’s time to make an appointment to see a doctor.

If you wait too long and your elbow pain persists, the tendon may continue to stay inflamed. In some cases, it may even begin to degenerate with a condition called tendinosis. At that point, the tendon’s collagen fibers break down, become hard, scarred, and rubbery – and don’t recover.

Conservative Options for Tennis Elbow Pain

When a patient visits their doctor to discuss tennis elbow pain, medical history, and an exam are often enough to diagnose tennis elbow. However, they may also conduct X-rays, ultrasound, or other imaging tests if they suspect something else might be causing your symptoms.

A physiatrist or orthopedic surgeon may advise a “wait-and-see” approach for patients whose symptoms are not severe. In this case, they’ll recommend modifying, reducing, or stopping activities that may aggravate the condition altogether. Full recovery may take several months or longer.

These recommendations may be coupled with over-the-counter pain relievers and ice to reduce pain. Physical therapy may also be effective by strengthening surrounding muscles, although it must be done carefully, as some exercises may further aggravate the pain.

Your doctor may also recommend a forearm cuff or brace to reduce pressure on the tendon. These braces distribute the forces in the forearm and can relieve pain in certain types of injuries.

However, when a patient’s symptoms persist or they do not achieve adequate relief from more conservative measures, a doctor may determine that a corticosteroid injection is appropriate.

Corticosteroid Treatment for Tennis Elbow

Corticosteroids are prescription anti-inflammatory medications. They can relieve elbow pain for some patients in the short term.

However, long-term, repeated corticosteroid treatments have risks. If overused, they can permanently weaken the tendon.

PRP Treatment for Tennis Elbow

Your doctor may also recommend platelet-rich plasma (PRP) treatments to try to heal injured tendons.

With this procedure, your doctor will take a sample of your blood and then process it to concentrate platelets. Platelets are your body’s natural proteins that encourage healing. Then, they’ll inject that blood sample into your elbow.

Everyone’s body is different, so each patient will have a slightly different PRP composition. In addition, younger patients have more robust platelets than older patients. Accordingly, outcomes with this treatment can vary widely. And because PRP is an emerging treatment that has yet to be FDA-approved, insurance does not cover it.

Surgery for Tennis Elbow

Most people don’t need surgery to repair tennis elbow. In the cases where it is appropriate, it is generally an outpatient procedure conducted by an orthopedic surgeon.

Preventing Tennis Elbow

The best ways to prevent tennis elbow include:

• Avoid repetitive movements: Repetitive movements can injure your tendons. 
• Warm up and cool down: Stretching and warming up before and after physical activity can help prevent tennis elbow. 
• Use the right equipment: Make sure your tennis equipment is the right size for you, including the racquet handle and head, and the strings. 
• Take breaks: Taking frequent breaks can help you avoid overtaxing your body. 
• Use proper technique: Make sure you’re using the correct techniques and movements during activities. 
• Strengthen your muscles: Strengthening the muscles in your arm, shoulder, and upper back can help prevent tennis elbow. 
• Ice down: Icing down your arm after heavy use can help reduce inflammation. 
• Don’t play through pain: Stop doing any activity that causes pain or find alternate ways to do it. 

If you follow Philadelphia sports closely, you’ll know that shoulder injuries frequently impact our favorite teams.

In June, Spencer Turnbull of the Phillies exited the Detroit series early with right shoulder soreness. C.J. Gardner-Johnson of the Eagles had a respectable first-season game in Brazil, but in August, he was dealing with his own shoulder injury. In a late March game against the Kings, the 76er’s Kelly Oubre Jr. was out with left shoulder soreness. And the Flyer’s Jamie Drysdale was out for portions of last season due to shoulder problems.

For the rest of us, according to population surveys, shoulder pain affects 18-26% of adults at any point in time. That makes it one of the most common sources of musculoskeletal pain.

The shoulder is unique in both its structure and function. Injuries can occur from an acute event or wear and tear over time. We’ll examine shoulder pain and what you need to know if it becomes an issue for you.

Shoulder Anatomy

The shoulder has the widest range of motion of all the joints in the body. It is comprised of a combination of bones and joints that enables it to accomplish this flexibility. Understanding this anatomy at a basic level is key before we discuss potential sources of pain.

The shoulder is made up of three bones:

• The upper arm bone, medically known as the humerus.
• The shoulder blade, medically known as the scapula.
• The collarbone, medically known as the clavicle.

These three bones form four joints:

1. The ball-shaped upper end of the arm bone fits into the socket of the shoulder blade to form the glenohumeral joint. This is a ball-and-socket joint.
2. The collarbone connects at the top of the chest to the breastbone (“sternum”) with the sternoclavicular joint.
3. The upper rear tip of the shoulder blade (known as the “acromion”) connects with the collarbone with the AC joint (“acromioclavicular joint”).
4. Where the shoulder blade glides across the rib cage in the back of the shoulder is the scapulothoracic joint.

These joints depend on soft tissue structures – such as muscles, tendons, ligaments, fibrous membranes, and cartilage – to keep the joints in place.

The “rotator cuff” is a group of muscles and tendons surrounding the shoulder joint (glenohumeral joint). It keeps the head of the upper arm bone firmly within the shoulder’s shallow socket.

Potential Sources of Shoulder Pain

Shoulder pain can arise from issues:

• inside the joints,
• in soft tissue structures that support joints such as muscles or tendons, or
• from problems unrelated to the shoulder, such as spine problems or heart conditions (known as “referred pain”).

Referred Pain

When shoulder pain originates from sources outside the shoulder, it is called referred pain. Why does this happen? Because the shoulder structure shares the same densely packed nerve pathways as other body parts.

When an injury or issue occurs in other parts of your body, your nerves don’t always tell your brain the correct location of your problem. When shoulder pain is referred, it often originates in the neck. This is one of the things that your medical professionals will consider as they work to distinguish the pain’s origin.

Common Conditions Within the Shoulder

Common conditions within the shoulder’s anatomy that may cause pain include rotator cuff injuries, shoulder impingement syndrome, bursitis of the shoulder, frozen shoulder, and arthritis.

Rotator Cuff Injuries

The rotator cuff surrounds the shoulder joint, the most flexible joint in the body. It enables arm movement and stability.

Common rotator cuff injuries include overuse syndrome, rotator cuff tears, shoulder sprains, and swimmer’s shoulder. Rotator cuff pain may feel like a dull, deep ache in your shoulder, sharp and stabbing pain, and arm weakness.

Shoulder Impingement Syndrome

Shoulder impingement syndrome may cause shoulder pain when a rotator cuff tendon rubs on nearby bone and tissue. It can result in weakness, loss of movement, and pain in the shoulder, arm, or near the top of the arm.

Bursitis of the Shoulder

Bursae are fluid-filled sacs that act as cushions to reduce friction between bones and soft tissues. They are found in all the joints around the shoulder.

Shoulder bursitis occurs when excess fluid builds up from inflammation in a bursa, the cushioning pad between bones and tissue in joints. Many people with shoulder bursitis also have shoulder tendinitis. The conditions cause pain and can affect arm mobility.

Frozen Shoulder

Frozen shoulder, also called adhesive capsulitis, involves stiffness and pain in the glenohumeral ball-and-socket joint of the shoulder. Symptoms typically begin slowly and worsen as the shoulder becomes frozen with limited movement.

Arthritis

The most frequently occurring types of shoulder arthritis are osteoarthritis, inflammatory arthritis, osteonecrosis, and post-traumatic arthritis.

• Osteoarthritis: Wear and tear arthritis that occurs as some combination of use, genetics, microtrauma, and increased forces across the joint
• Inflammatory arthritis: Caused by multiple factors often related to the immune system, which leads to inflammation of the joint and joint lining and ultimately wearing away the cartilage surfaces.
• Osteonecrosis: This unusual condition, also known as avascular necrosis, occurs when the blood supply to a shoulder bone is interrupted. It can lead to death and the collapse of a segment of the bone.
• Post-traumatic arthritis: This can result from a fracture or damage to the typically smooth surface of the joint’s cartilage surface. Eventually, the damage may cause the cartilage to wear out and disappear.

When Should You See a Doctor for Shoulder Sprains, Strains, and Pain

Shoulder discomfort is normal, particularly with older individuals, due to arthritis and normal wear and tear from overuse. It can also affect younger people who participate in sports involving overhead movements, especially swimming, tennis, pickleball, and baseball. Temporary rest and over-the-counter pain relievers can provide some relief.

However, shoulder discomfort can lead to more serious issues if it persists and is left untreated. Severe shoulder injuries, such as fractures or dislocations, require immediate attention. If you experience ongoing shoulder pain, hear a pop, or feel a tearing sensation that makes it impossible to lift your arm, make an appointment to see a musculoskeletal specialist.

Diagnosis

To diagnose your shoulder condition, your doctor will conduct a thorough physical exam and review your medical history. They’ll evaluate your shoulder’s range of motion and strength and assess your level of discomfort while you move. They’ll look to identify where you feel pain and whether it is consistent, intermittent, or worsens during movement.

They’ll also ask about any prior injuries you may have had to your shoulder and any incident that may have occurred, such as a fall, which led to shoulder pain. You may also be asked how you use your arms during work or athletic activities that may stress your shoulder’s soft tissues.

Your doctor may also use X-rays, ultrasound, or an MRI scan to provide a clear view of your shoulder’s condition.

Remedies and Treatments for Shoulder Pain

If your shoulder pain isn’t severe, there are several options for self-care:

• Cold therapy: A cold compress can be an effective way to manage shoulder pain. Ice packs can help reduce inflammation, restrict blood flow, and arrest further damage to muscles and ligaments.
• Heat therapy: Heat therapy becomes appropriate after an injury stops increasing from cold treatment and begins to heal. Health therapy promotes the smooth flow of blood and oxygen, which helps heal cells in the injured area.
• NSAIDs: Nonsteroidal anti-inflammatory drugs (NSAIDs) can help reduce pain and swelling in the shoulder and assist the healing process. These painkillers and muscle relaxants can help in reducing inflammation and promote recovery. However, even though they are often over-the-counter, you should consult medical guidance before using them to ensure no significant side effects.
• Physical Therapy: Physical Therapy, which involves working with a physical therapist and guided exercise, can help you improve mobility in your shoulder joints. The goals of this therapy include building strength, improving flexibility, and gradually working toward alleviating the pain.
• Stretching and Strengthening Exercises: Stretching and strengthening exercises, done correctly, can be effective methods to alleviate shoulder pain. By increasing the flexibility and strength of the muscles, tendons, and ligaments surrounding the shoulder joint, you can reduce pressure on the joint. This, in turn, will help reduce inflammation, relieving pain.

Nonsurgical Treatment

Recent clinical studies have examined various treatment options for shoulder pain issues to determine the most effective. In many cases, these studies found that the first line of therapy should be to inject a steroid into the shoulder joint to reduce inflammation.

After diagnosis, your doctor will determine if a corticosteroid injection for shoulder pain is appropriate for your case.

Platelet-rich plasma (PRP) is another alternative that can help patients with partial thickness rotator cuff injuries, some labrum tears, arthritis, and bursitis in the shoulder.

PRP uses a high concentration of platelets and growth factors taken from a patient’s own blood. These platelets can decrease inflammation and, subsequently, pain, as well as heal and repair damaged areas within the shoulder. However, this treatment is not yet covered by most insurance plans.

Referral to an Orthopedist

If you see a physiatrist (a physical medicine and rehabilitation doctor) for treatment, they may determine that nonsurgical treatment options for a patient’s condition have been exhausted. In that case, they often refer the patient to an orthopedic surgeon to consider more aggressive treatment options.

Many people experience hip pain at some point in their lives. It may result from strenuous exercise, incorrect movement, overstretching, or tearing of the muscles, tendons, or ligaments that support the hip joint. It may also develop from a too-sedentary lifestyle, being overweight, or having less flexibility.

But more often, it is caused by arthritis as we age. The three most common types of hip arthritis include osteoarthritis, rheumatoid arthritis, and post-traumatic arthritis – although other forms can also occur.

• Osteoarthritis, the most common form of hip arthritis, involves the wearing away of the protective cartilage covering hip bones where they form a joint. As the bones end up rubbing against each other, it may result in pain and stiffness.
• Rheumatoid arthritis is an immune system disease that attacks the hip joints – inflaming the protective synovial membrane, causing pain, swelling, and eventually, joint erosion. This can lead to pain, stiffness, and disability in the hip.
• Post-traumatic arthritis develops quickly after an injury – instead of over years of wear and tear like other forms of arthritis. It’s usually temporary, but many people recover in a few months without a need for major surgery.

At-Home Treatments

You may not need to see a doctor immediately if your hip pain is mild and not debilitating. Your options might include:

• Rest: Initially, resting and avoiding the activities that bother you for a few weeks is a good starting point for self-treatment. However, if your symptoms bother you after two to four weeks, it is a good time to see a doctor.
• Lose weight: Losing weight often will help to ease chronic hip pain. Every extra pound you carry places 3 to 5 pounds of extra pressure on your hips. Losing excess weight can significantly reduce stress on the hip.
• Stretch to ease stiffness: If you are unsure how to stretch your hips properly, work with a physical therapist or personal trainer to learn.
• Start your day with low-impact exercises: Sometimes, moving is the best thing to do if it involves low-impact activities. Walking, swimming, yoga, and resistance exercises can help reduce stiffness and build muscle around the hip joint. Individuals who exercise regularly despite their arthritis generally have less pain and better function than those who are inactive. Just avoid high-intensity exercises that put too much pressure on the hips.
• Avoid carrying too much: The added weight of heavy packages can hurt your hips. Remember the adage to bend at the knees when you carry anything.
• Use heat and ice: Cold compresses can provide relief when you have acute hip pain. And before you exercise or stretch, consider applying heat to loosen the muscles around the hip joint.
• Consider NSAIDS: While you should use them sparingly, over-the-counter NSAIDs, such as Ibuprofen (Motrin, Advil), Naproxen (Aleve), low-dose aspirin, and other nonsteroidal anti-inflammatory drugs (NSAIDs), can help ease inflammation and discomfort when hip pain flares up.

However, if you’ve tried these approaches and you don’t seem to be able to get control of your hip pain – or it gets worse – it’s time to see a doctor. If your pain is severe or you have difficulty moving, you should see a doctor immediately.

Conservative, Noninvasive Treatments for Hip Pain

Usually, your doctor will begin by considering conservative, noninvasive options to effectively manage and treat hip pain. Specialists who focus on this approach include Physiatrists, also known as Physical Medicine and Rehabilitation doctors. They focus on options to resolve musculoskeletal problems that don’t require major orthopedic surgery.

Physical Therapy

Your doctor will often recommend that you see a physical therapist as a first step to help with your hip pain. In fact, physical therapists regularly work with physiatrists to target treatment for your hip condition.

Physical therapists can help you strengthen the muscles around the hip to relieve pressure on the hip joint and increase hip flexibility to reduce joint stiffness and pain.

Injections for Hip Pain

Depending on your pain severity, corticosteroid injections can be another option for easing your joint pain and getting you moving again.

These injections offer a first line of defense against osteoarthritis symptoms. They can help relieve hip joint pain and inflammation. Your doctor will use fluoroscopic (x-ray) guidance to precisely target these injections during an out-patient procedure.

Platelet-rich Plasma (PRP)

PRP utilizes anti-inflammatory factors in a patient’s own blood to decrease inflammation. This option has fewer side effects and is often more potent than other types of injections like steroid injections.

PRP is only appropriate for certain hip pain conditions. When it is appropriate, many patients experience significant relief within the first week or two. However, this treatment is not covered by most insurance plans.

Reasons to See a Doctor, Sooner than Later

If you delay seeing a doctor for treatment until your pain is bothering you every day or is more intense, you run the risk of it becoming a chronic (ongoing) problem. When you find yourself questioning if it is the right time to schedule an appointment, it probably is the right time.

Arthritis isn’t a single disease but a term for joint pain or disease. It’s a complex condition with a wide range of manifestations. According to the Arthritis Foundation, there are more than 100 types of arthritis and related conditions, each with its unique characteristics and impact on the body.

Common arthritis symptoms include swelling, pain, stiffness, and diminished range of motion in joints. It’s important to note that symptoms vary from mild to severe and may come and go. Some may stay about the same for years, but it’s crucial to know that symptoms can progress and worsen over time.

Severe arthritis can result in chronic pain and difficulty performing daily activities, making walking and climbing stairs painful and grueling.

Arthritis is not just about joint pain. It can also lead to permanent joint changes, some of which may be visible, such as knobby finger joints. However, often the damage is only detectable on X-rays. Moreover, some types of arthritis can affect other organs, including the heart, eyes, lungs, kidneys, skin, and joints.

There are three main types of arthritis: rheumatoid, psoriatic, and osteoarthritis. Although they share similar symptoms, these three conditions have distinct causes, occur in people of varying ages, and have their own treatments.

We’ll take a look at the key differences between the three.

What Is Osteoarthritis?

Osteoarthritis is the most common type of arthritis, affecting 528 million people worldwide. It happens when cartilage, the rubbery connective tissue covering the ends of bones in your joints, breaks down.

Historically, osteoarthritis was thought to be a byproduct of aging, according to the Centers for Disease Control. However, experts now consider it to be a disease affecting the entire joint that doesn’t necessarily stem from getting older. It’s not just cartilage and bone that are impacted but ligaments, fat, and other tissues lining the joint.

Factors that can lead to osteoarthritis include injuries, overuse of joints, age, genetics, and obesity. Women are more likely to develop the condition, especially once they reach 50. Though osteoarthritis is associated with older adults, it’s not inevitable; some never develop the condition.

The most common symptoms are pain while using the joint, stiffness (especially after a period of rest), swelling, reduced flexibility, and hearing the joint click or pop. Osteoarthritis can affect any joint but frequently strikes the hands, hips, knees, neck, and lower back.

Because it’s a degenerative condition, it typically worsens over time. As cartilage becomes degraded, the bone can change shape or develop small bony growths known as bone spurs on the affected joint, causing pain and increasing the likelihood of disability.

There’s no cure for osteoarthritis, but the pain and inflammation can be managed with over-the-counter or prescription medications—such as pain relievers and nonsteroidal anti-inflammatory drugs (NSAIDs). Exercise and weight loss may also help the condition.

What Is Rheumatoid Arthritis?

Rheumatoid arthritis (RA) is a chronic inflammatory autoimmune disorder that impacts 18 million people around the globe, affecting nearly three times as many women as men. It occurs when the immune system mistakes specific healthy cells in the body as invaders and goes on attack. In RA, the immune system attacks the synovium, the tissue surrounding a joint that produces fluids to help it move smoothly.

When this happens, cytokines, the signaling proteins that help control inflammation, increase. The inflamed synovium thickens, making the joint red, swollen, and painful to move. Over time, this may ultimately lead to structural damage and joint destruction.

Signs of RA include stiffness, pain, and swelling in multiple joints. Patients tend to have the same symptoms on both sides of the body, such as both hands or knees. In some cases, RA affects other parts of the body, causing skin conditions, digestive issues, fatigue, eye problems, and heart and lung conditions.

The exact cause of RA is unknown, but it’s likely linked to genetics. It can occur at any age, but the risk increases as people age. Some research shows that smoking may raise the risk for RA.

When diagnosing RA, doctors rely on blood tests to look for inflammation and antibodies, or blood proteins, that are signs of the condition. Physicians might also take X-rays, ultrasounds, or MRIs to identify evidence that the joint is wearing away.

To treat RA, doctors typically prescribe disease-modifying anti-rheumatic drugs (DMARDs), which modify the immune system and slow the disease’s progression.

What Is Psoriatic Arthritis?

Psoriatic arthritis (PsA) is also a chronic autoimmune disease, causing the immune system to attack the body’s healthy tissue, including tissue of the skin and joints. It’s commonly linked with the skin condition psoriasis; about a third of patients with psoriatic arthritis develop psoriatic arthritis. Roughly 125 million individuals worldwide have the condition, and it can start at any age, even in childhood.

PsA specifically affects the joints and the junctions between the bone and the tendon near the joint, what is called enthesis. It is often found in the hands, feet, wrists, ankles, and knees.

Like other forms of arthritis, PsA causes pain, stiffness, swelling, and a reduced range of motion. However, it can also result in silver or gray scaly spots on the scalp, elbows, knees, and lower spine, as well as nail depressions or detached fingernails or toenails.

Left untreated, psoriatic arthritis can damage or weaken bones and lead to vision problems, gastrointestinal conditions, shortness of breath, and damage to blood vessels and heart muscles.

Like RA, the cause of PsA isn’t known, but it’s believed to be a combination of genetic and environmental factors—such as an infection, for example—that can trigger a flare-up of symptoms. Doctors diagnose the condition using blood tests, X-rays, MRIs, and a physical exam.

Both psoriatic and rheumatoid arthritis can be challenging for patients to distinguish since the symptoms are similar. However, it’s crucial to seek treatment when you notice joint swelling and pain, as all three types of arthritis can lead to long-term joint damage and other health consequences.

Sciatica is a symptom of a medical problem that causes pain, numbness, tingling, or weakness in the leg. It is most commonly associated with two different conditions: a herniated disk or lumbar spinal stenosis. 

Sciatica pain occurs along the path of the sciatic nerve, which runs down the lower back and into the legs. This symptom can result from a herniated disk, where the disk ruptures and its gel center pressures the lumbar nerve roots.

Lumbar spinal stenosis can also cause sciatica pain or cramping in one or both legs. Lumbar (lower back) spinal stenosis is usually caused by osteoarthritis. This is a “wear and tear” condition resulting in bone overgrowth. This overgrowth can extend into the spinal canal, narrowing the space, which pinches and puts pressure on nerves within the spine.

The potential for misdiagnosis is understandable, given the similarities in the leg pain and sciatica symptoms between these two conditions. However, getting the diagnosis correct is critical, as the treatments for each differ.

In this article, we’ll take a deeper look at the causes and symptoms of each.

Herniated Disks and Sciatica

Disks sit between vertebrae bones that stack to make the spine. These disks act as rubbery cushions that allow you to bend and move easily.

Each spinal disk has a soft, gel-like center called a nucleus and a firmer outer layer known as the annulus. A herniated disk occurs when the annulus tears and some of the nucleus’s gel center pushes through the opening. It is also known as a ruptured disk or slipped disk.

Herniated disks usually occur in the lower back or neck. Since our discussion is on sciatica symptoms, this review is specifically on ruptured lower spine disks. Aging, excessive weight, repetitive motions, and sudden strain from improper lifting or twisting can all contribute to a disk rupture.

Often, people experience no symptoms from a herniated disk. But for some, the rupture creates pressure on one of the sciatic nerve’s nerve roots. With sciatica symptoms, this usually occurs in the last lumber nerve root (L5) or the first sacral nerve root (S1) as they exit the lower spinal column. 

Sciatica from a Herniated Disk Symptoms

Sciatica pain may be experienced anywhere along its nerve pathway. Frequently, it follows a path that radiates from the lower back down one side of the buttocks into the leg and sometimes the foot. The pain can vary from a mild ache to a sharp burning. 

Other symptoms may include:

• Lower back pain.
• Tingling or numbness in the legs and/or feet.
• Muscle weakness.
• Pain while sitting and rising from a sitting position.
• Worsening pain from prolonged standing.
• Pain when bending forward.
• Pain that improves throughout the day after rising.

Treating Sciatica from a Herniated Disk

In most cases, pain from a herniated disk can be treated at home. If the pain is severe, it is recommended that sciatica sufferers rest for one to three days but avoid long periods of laying down to prevent stiffness. You can also take an over-the-counter pain reliever, such as ibuprofen or acetaminophen, and apply heat or ice to the affected area.

However, you should see a doctor if the symptoms don’t improve after four to six weeks or get worse. You should also see your doctor if the pain interferes with your everyday life, you develop loss of bladder or bowel control, or you have trouble standing or walking.

Lumbar Spinal Stenosis and Sciatica

By age 50, degenerative changes begin to affect 95% of people. One of those changes is spinal stenosis, the narrowing of one or more spaces within the spinal canal. The spinal canal is the tunnel that runs through the vertebrae bones of the spine. It contains the spinal cord, which connects the brain to the lower back.

As the spinal canal narrows due to bone overgrowth from spinal stenosis, it can cramp the spinal cord and the nerve roots that branch off it. The tightened space can irritate, compress, or pinch the spinal cord and nerves, leading to back pain and other nerve issues like sciatica. 

Spinal stenosis usually develops slowly over time. Lumbar spinal stenosis is less commonly known as lower back spinal stenosis.

Sciatica from Lumbar Spinal Stenosis Symptoms

Sciatica pain from lumbar spinal stenosis begins in the buttocks, runs down the leg, and may continue into the foot. It may involve one or both legs. 

Other symptoms involve neurogenic claudication, including:

• Lower back pain.
• A heavy feeling in your legs, which may lead to cramping.
• Numbness or “pins and needles” tingling in the buttocks, legs, or feet.
• Pain worsens when standing for long periods, walking downhill, or bending backward.
• Pain that lessens when you lean forward, walk uphill, or sit.

Treating Sciatica from Lumbar Spinal Stenosis

The treatment for lumbar spinal stenosis varies depending on the severity of the symptoms.

For mild symptoms, at-home care may be appropriate. This may include:

• Over-the-counter pain relievers.
• Head and cold applied to the aching joints.

If at-home care is insufficient, your doctor may recommend nonsurgical treatment options, including:

• Physical therapy to strengthen spine-supporting muscles and improve flexibility and balance.
• Corticosteroid injections in the space around pinched spinal nerves may help reduce inflammation, pain, and irritation.

Surgery for spinal stenosis is only considered in rare cases where all other treatment options have failed to provide adequate relief.

Wrapping It Up

Sciatica may result from two different conditions: a Herniated Disk or Lumbar Spinal Stenosis. Knowing which condition is causing sciatica pain is essential to establish the appropriate course of treatment.

You should usually see your doctor to get an accurate diagnosis.

If back pain is present for over three months, it is considered chronic. It can come and go and vary in intensity.

If you suffer from it, you are not alone. Surveys estimate that more than 8 percent of U.S. adults are currently experiencing chronic back pain. It limits everyday activities as a result.

While spinal back surgery can benefit some causes of back pain, it’s important to note that it’s rarely necessary. Back pain often resolves itself over a few months, especially with the help of effective non-surgical treatments. 

We’ll take a look at nine options to try to relieve back pain without surgery.

1. Follow an Anti-Inflammatory Diet

Inflammation is a natural response of the body in response to illness or injury. It follows that when you are experiencing back pain, you may have some accompanying inflammation. Recent University of Pittsburgh Medical School research suggests that anti-inflammatory diets are better for back pain.

Anti-inflammatory diets include a variety of whole grains, fruits, and vegetables, a mix like the Mediterranean diet. Conversely, processed foods and foods high in sugar tend to increase inflammation. 

Omega-3 fatty acids, found naturally in fish, seafood, nuts, and seeds, are also beneficial for anti-inflammation.

2. Achieve a Healthy Weight

According to multiple studies, excess weight contributes to lower back pain and degenerative disk disease. Every extra pound of weight significantly increases the strain on the muscles and ligaments of the back. 

Excessive weight can pull the natural curves of the spine out of alignment. It can overload the shock-absorbing disks of the spine. And fat can secrete chemicals that contribute to chronic whole-body inflammation and pain disorders.

Achieving a healthy weight can reduce some of the continuing damage to your back, but it can’t reverse existing damage.

3. Regular Exercise

A sedentary lifestyle can result in weak core muscles, poor posture, and increased low back pain. Lifestyle changes are required to reverse that trend.

There are no guarantees that an exercise program will completely alleviate back pain. However, research shows it often relieves pain and improves overall fitness and mobility. Studies have also found that doing regular exercise can reduce the occurrences of back pain by almost half.

Even ramping up daily activity by a small amount can significantly improve back pain levels.

However, if you last exercised regularly a while ago, you should consult your doctor before starting a fitness program.

4. Physical Therapy

Doctors often refer patients to a physical therapist as one of the first treatment options for low back pain. Their recommendations usually include that a physical therapist provide guided therapeutic exercises to strengthen lower back muscles and condition spinal tissues and joints.

These physical therapy programs aim to decrease painful symptoms, improve low back function, increase spine flexibility, and set up a long-term program to prevent back pain recurrence.

5. Alternative Treatments

Some patients may benefit from alternative treatments for chronic low back pain. Acupuncture, massage, and biofeedback therapy are options worth exploring. The potential benefits of these therapies outweigh their risks.

6. Injection-Based Treatments

Doctors may use injection-based treatments, including lumbar epidural steroid injections, for specific causes of chronic lower back pain. Lumbar epidural steroid injections are often effective for relieving pain from herniated disks and spinal stenosis. They are usually precisely targeted using fluoroscopic (X-ray) guidance.

These injected steroids can reduce swelling and pressure on the nerves that are causing back pain. This procedure often leads to temporary pain relief lasting three months or longer.

7. Ablation Procedures

When other back pain relief methods have been unsuccessful, ablation procedures may be an appropriate alternative. 

One such procedure is radiofrequency ablation (RFA), also known as a radiofrequency neurotomy. Radiofrequency ablation uses radio waves to heat a small area of nerve tissue in the spine identified as a source of back pain. The heat destroys that nerve area, stopping it from sending pain signals to the brain. 

Another ablation procedure, called Intracept, targets the basivertebral nerve that causes chronic vertebrogenic low back pain. Vertebrogenic pain is a distinct type of chronic low back pain caused by damage to vertebral endplates from disc degeneration or simply wear and tear from everyday life.

8. Orthobiologic Therapies

Orthobiologic therapies use blood, tissue, or cells to boost the body’s natural healing processes. 

The VIA Disc procedure falls into this category. This minimally invasive therapy rehydrates and supports the cushioning function of degenerated discs, which can relieve back pain. VIA Disc is one of the first orthobiologic therapies covered under Medicare.

Platelet-rich plasma Injections (PRP) are another therapy in this category. It uses a patient’s blood to isolate and concentrate platelets injected into an injured back area. Although clinical results for this procedure seem promising, it is still considered an experimental treatment. The use of PRP for chronic back pain is generally not covered by medical insurance.

9. Neuromodulation Therapies

Spinal Cord Stimulation (SCS), Dorsal Root Ganglion Stimulation (DRG), and Peripheral Nerve Stimulation (PNS) are three neuromodulation therapies used to relieve back pain. These therapies use mild electrical stimulation targeted to specific neurological sites in the body to interrupt pain signals before they reach the brain.

These minimally invasive procedures may be appropriate when multiple other treatments have failed to provide adequate relief. They each have the significant potential to restore patients’ quality of life.

Summing It Up

Spine surgery may be ultimately appropriate for some patients for pain relief. However, it should only be considered after all other alternatives have been exhausted. 

Those who periodically suffer from lower back pain know the reality. Staying active and using over-the-counter pain relievers may often be sufficient to restore the quality of your life. With this approach, lower back pain usually fades away with time.

However, for some, home remedies fail to relieve the angry pain that confronts them each day. At that point, it becomes time to work with a doctor to figure out an individualized path for pain relief. 

Lumbar epidural steroid injections are one of the standard treatment options doctors consider for many forms of lower back and leg pain. They have been used since the 1950s. For doctors who are Physical Medicine and Rehabilitation specialists, they are considered an integral part of the non-surgical management of lower back pain and sciatica.

What Is a Lumbar Epidural Steroid Injection?

An epidural steroid injection of an anti-inflammatory medication (also called corticosteroid) into the lower back to relieve pain in the legs or lower back. The medication is injected using fluoroscopic (X-ray) guidance into the epidural space, an area of fatty tissue surrounding the spinal nerves.

A lumbar epidural steroid injection can help reduce nerve inflammation and stabilize membranes. It can reduce swelling and pressure on irritated nerves in the lower back. Corticosteroids decrease the production of inflammatory chemicals and reduce nerve fibers’ sensitivity to pain.

What Are Corticosteroids?

Corticosteroids are man-made drugs that closely resemble cortisol, a hormone our body’s adrenal glands and brain produce naturally. Corticosteroids are often referred to as “steroids,” but it is different from the anabolic steroid compounds that some athletes use to build muscles.

Corticosteroids are used to help reduce pain and inflammation as well as treat a variety of painful conditions, including lumbar disc herniation.

The Goals of a Lumbar Epidural Steroid Injection

The goals of a lumbar epidural steroid injection are to:

• Relieve pain by reducing inflammation in and around nerve roots.
• Help a patient improve their mobility and lower back function.
• Improve leg mobility and function for sciatica sufferers.
• Enable a patient to participate and progress in a comprehensive physical therapy program.

Commonly, lumbar epidural steroid injections are only recommended when a series of other more conservative treatments have been tried without adequate results.

What to Expect from a Lumbar Epidural Steroid Injection

For many patients, a lumbar epidural steroid injection can provide relief for intense episodes of back and/or leg pain. 

These injections are normally administered in an outpatient setting, usually under twilight sedation. A local anesthetic is used at the injection site, and fluoroscopic (X-ray) guidance precisely targets the medication to nerve roots in the epidural space of the back. 

It generally takes a few days after an injection before the medication begins to take effect and lower back pain improves. Pain relief often lasts at least three months and may extend for years. 

For some patients, one lumbar epidural steroid injection is all they need to resolve their back pain issues. If more than one injection is required, there usually is a limit of three or four a year.

Sports medicine isn’t solely limited to procedures and treatments for athletes.

It does focus on preventing, diagnosing, treating, and rehabilitating sports-related injuries. But you don’t have to be a weekend, school, or professional athlete to take advantage of all it offers.

Sports medicine is also appropriate for those injured during physically demanding work activities, such as pulling a muscle while on a construction site. It has a place for those hurt while pursuing active lifestyles, such as throwing out your back while doing yard work. It provides services to those who injure themselves while doing recreational exercises, too.

In this article, we’ll help you better understand what sports medicine involves and determine if it might be a good treatment path for you.

Who Practices Sports Medicine?

Most sports medicine practitioners have a variety of backgrounds, ranging from physical medicine and rehabilitation to orthopedics, family medicine to internal medicine, pediatrics to emergency medicine, and other specialties. They all share one common goal: to get you back into the game and function at peak performance.

Sports medicine is also practiced with a team of supporting medical professionals. These may include:

• Physical Therapists
• Certified Athletic Trainers
• Exercise Physiologists
• Occupational Therapists
• Chiropractic Practitioners

Each of these professionals may play a role in your recovery, helping you return to full function sooner.

What Kinds of Injuries Does Sports Medicine Treat?

Sports Medicine covers various musculoskeletal conditions involving the bones, muscles, tendons, ligaments, and joints. These include:

• Ankle pain and injury
• Arthritis
• Concussions
• Elbow pain and injury, including bursitis, golfer’s elbow and tennis elbow
• Foot pain and injury
• Fractures and Dislocations
• Hip Pain and Injury
• Knee Pain and Injury, Including ACL Tears
• Shin Splints
• Shoulder Pain and Injury
• Sprains and Strains
• Sports-related Injuries
• Stress Fractures
• Tendonitis

There are two general categories within sports medicine care.

The first involves acute injuries. These kinds of conditions develop suddenly and usually last only a short period. Examples may range from a sprained ankle or an accidental fall to bone fractures, dislocated shoulders, or torn tendons.

The second category involves wear-and-tear disorders like arthritis that develop over time. These disorders can occur or get worse with sports or exercise, but they are more often a result of repetitive movement in our work or simple daily routines. This can lead to a loss in mobility, along with mild to severe pain from strain or stress on affected body parts.

How Are Sports Medicine Injuries Evaluated?

An initial sports medicine appointment will involve a full evaluation to fully understand a patient’s symptoms, medical history, daily activities, and goals. Most frequently, common musculoskeletal conditions can be successfully treated non-operatively.

Magnetic resonance imaging (MRI), X-rays, or ultrasound will be prescribed in appropriate cases to visualize and assess sports injuries.

X-rays provide valuable insights into fractures and bony abnormalities, while MRI and ultrasound offer detailed information about soft tissue structures, including muscles, tendons, ligaments, and cartilage. These imaging techniques help confirm diagnoses, assess the extent of injuries, and guide treatment decisions.

How Are Sports Medicine Injuries Treated?

Although a sports medicine doctor will take the lead in evaluating your injury, treatment plans often involve a team of supporting medical professionals.

Physical therapy and other types of rehabilitation are often integral components of sports medicine injury treatment.

Sports medicine professionals work closely with physical therapists to design individualized rehabilitation programs that focus on restoring strength, range of motion, and function. Rehabilitation may include exercises, manual therapy, specialized therapies, and functional training to aid recovery and prevent future injuries.

Medications and injections may be prescribed to manage pain, reduce inflammation, and facilitate healing. Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used to alleviate pain and inflammation associated with sports injuries.

In some cases, corticosteroid injections may be administered to target specific areas of inflammation and provide localized relief. These injections also reduce pain, allowing more effective physical therapy treatments.

When a sports injury is severe and non-surgical alternatives have been exhausted, a sports medicine doctor may suggest that surgical intervention be considered. Surgical treatments can involve fracture fixation, ligament reconstructions, cartilage repair, and other procedures to restore function and promote recovery.

How Can Sports Injuries Be Prevented?

There are ways that you can minimize the likelihood of sustaining sports injuries:

• Stretch and Cool Down: Warming up before a workout with an easy walk or jog will lessen muscle strain. After warming up, stretch to increase flexibility, and be sure to cool down afterward. This advice applies to preparing to participate in a sport, begin an exercise workout, or engage in any intense physical activity, such as construction or yard work.
• Learn and Use Proper Technique: Proper technique in your sport is vital for injury prevention. Seek guidance from experienced coaches or trainers to use the correct form and body mechanics during training and competition. This also includes using proper techniques in general activities, such as lifting heavy items.
• Develop Strength and Conditioning: Follow a fitness plan incorporating resistance training to target core stability and flexibility to support your body during sports and physical activities.
• Wear Protective Gear: Wearing appropriate protective gear, such as helmets, pads, and mouthguards, can significantly reduce the risk of severe injuries in contact sports. Wearing a helmet when biking, skiing, or participating in similar activities is essential. Use specialized equipment that is designed to protect you in everyday work situations.
• Wear the Right Shoes: Improperly fitting or inappropriate shoes can lead to conditions such as stress fractures, plantar fasciitis, Achilles tendonitis, and ankle sprains. Ensure you are using the right shoes for the activity you are participating in and that they are not worn beyond their useful life.
• Stay Hydrated: Drinking plenty of water before, during, and after exercise can help prevent muscle damage, fatigue, and other complications that can lead to injury.
• Pay attention to your body: Look for signs of fatigue, pain, or discomfort. If you experience pain while playing, exercising, or working, stop the activity. Pushing through injuries can worsen them and lead to longer recovery times.
• Adjust Your Routine in Hot Weather: Take extra precautions to prevent heat-related illnesses during hot weather. Wear lightweight, breathable clothing and schedule activities during cooler parts of the day.

When Should You See a Sports Medicine Practitioner?

When an injury still hurts after resting, or it feels better until you start to exercise again, you should make an appointment with a sports medicine physician or a specialist in musculoskeletal medicine, such as a physical medicine and rehabilitation doctor.

Golf provides some of us with moments of joy when hitting a great drive, sinking a long putt, or chipping in for a birdie. These emotional highs are mixed with crushing moments of frustration when other shots don’t meet our expectations.

We can even find great satisfaction from one great shot. Regardless of our scores, we push forward and embrace a lifetime of practice and fine-tuning that the game requires.

That is, until we suffer a golf injury.

Golf seems, on the surface, to be a gentle sport. But it can be easy to get hurt without good flexibility, strength, and proper technique.

We’ll look at common golf injuries and how to avoid them.

Common Golf Injuries

Many golf injuries can be traced back to an aspect of the swing, which involves balancing an explosive forward motion, violent muscle contractions, and the long lever arm effect created by the force of the golf club. Most golf injuries happen repetitively, over time, from taking many swings with incorrect form.

Common golf injuries include:

• Back injuries and strains
• Golfer’s elbow (medial epicondylitis)
• Tennis elbow (lateral epicondylitis)
• Rotator cuff injuries or shoulder pain
• Hip Injuries
• Knee injuries

We’ll look at each of these injuries in turn.

Back Injuries and Strains

During a round, a golfer spends shot after shot in a bent position while applying pressure to the spine and back muscles. This can strain muscles and result in pain. Lower lumbar spine injuries and disc herniation can also occur – or if these injuries pre-exist, they can be aggravated by golf swings.

Golfer’s Elbow

Golfer’s Elbow is caused by the excessive force used to bend the wrist toward the palm when swinging a golf club. It results in pain, soreness, and inflammation on the inner part of the elbow. The pain is caused by damage to the tendons that bend the wrist toward the palm. Tendons are tough cords of tissue that connect muscles to bones.

Tennis Elbow

While golfers don’t carry a tennis racket in their golf bags, they can also be susceptible to tennis elbow. Tennis elbow involves inflammation in the outer tendons of the elbow. Golfers will feel pain from this condition along the outside of the elbow when extending their arms during a golf swing.

Rotator Cuff Injuries or Shoulder Pain

Have you ever taken a shot off the fairway and hit a rock or a root during your swing? The force of that unexpected impact can cause a rotator cuff injury or pain in the shoulder. Improper swing technique can also lead to tendinitis, bursitis, shoulder separation, and shoulder impingement syndrome from repetitive swinging movements.

Hip Injuries

Most of the power in a golf swing comes from movement and rotation in the hips. Lack of hip flexibility can cause hip problems and lower back issues. One common hip injury and pain source for golfers is trochanteric bursitis, where the bursa on the outer part of the hip joint inflames and swells.

Knee Injuries

If a knee has weak muscles, the strain on it to stabilize the hip rotation at the beginning of the swing can cause severe knee pain. Extreme force applied to the knee can cause torn or sprained ligaments and kneecap injuries.

Partial meniscus tears in the knee can also be present without symptoms. A golf swing can further aggravate that existing tear to the point where pain and inflammation suddenly become apparent.

General Golf Injury Prevention

Maintaining fitness is an integral part of a healthy and competitive golf game. Those golfers who tend to stay healthy follow structured fitness and exercise programs outside of their time on the course.

If you live a sedentary lifestyle between your golf rounds, you are more likely to suffer injury when you do play.

Beyond being fit, the following recommendations are a good starting point for general golf injury prevention:

• Work with a golf professional to learn proper swing techniques. Good form and proper mechanics will reduce stress on the body and help improve flexibility and agility.
• Warm up and take practice swings before a round. Stretch and hit a few balls on the range to prepare your joints and muscles for play.
• Build up your tolerance for golf movements. Don’t overdo it with too many shots in a day or over a period of days without preparing your body for it.

If You Do Get Injured

If you do experience musculoskeletal pain during golf that continues after the round, see a doctor before getting out on the course again. You may be surprised by what can be done with proper diagnosis to get you back out again playing golf pain-free.