Health Letter

Orthopedic injuries encompass a broad category of medical conditions involving musculoskeletal system damage. This includes the bones, joints, ligaments, muscles, tendons, and nerves.

These injuries may stem from accidents, falls, sports activities, overuse, or age-related wear and tear or deterioration. They may lead to strains, sprains, fractures, and limited function and mobility.

Doctors who treat musculoskeletal injuries include orthopedic surgeons (also known as orthopedists), physiatrists (physical medicine and rehabilitation doctors), rheumatologists, and sports medicine physicians. There are differences in the focuses of each of these specialists, although their approaches often complement and support one another.

The good news is that the majority of orthopedic issues can be treated non-surgically. From physical therapy and medications to injections and regenerative medicine, non-surgical orthopedics offers a wide range of treatments that cater to each individual’s specific needs.

Here’s a breakdown of common non-surgical orthopedic treatments:

Medications

Non-steroidal anti-inflammatory drugs (NSAIDs): Over-the-counter medications like ibuprofen or naproxen are most effective for mild to moderate pain with inflammation and swelling. They are typically used for arthritis and pain resulting from muscle sprains, strains, and back and neck injuries.

Corticosteroids: These powerful anti-inflammatory medications can be injected directly into the joint or tissues to reduce pain and inflammation. They are most effective when precisely injected using fluoroscopic (x-ray) guidance. However, they should be used only on a limited basis, as repeated use carries a risk of cartilage damage or bone loss.

Small amounts of anesthetic and corticosteroids can also be effective for trigger point injections, which help relieve myofascial pain syndrome.

Physical Therapy

Doctors, particularly those specializing in Physical Medicine and Rehabilitation, often prescribe Physical Therapy as part of their treatment plans. Physical therapists will work with patients for:

Strengthening and Range of Motion Exercises: Strengthening and range of motion exercises are crucial for regaining function and preventing further injury, often used to improve mobility and strength.

Manual Therapy: Manual therapy is a specialized approach within physical therapy where therapists use their hands to assess and treat musculoskeletal issues, aiming to reduce pain, improve joint mobility, and enhance overall function.

Aquatic Therapy: Aquatic therapy is a specialized form of physical therapy conducted in a pool. It is used to treat a wide range of conditions, focusing on pain reduction, muscle strengthening, and improved range of motion. It often benefits those with injuries, chronic conditions, or difficulties with weight-bearing exercises.  

Other Injections

In addition to corticosteroid injections, other types of injections can be effective for treating musculoskeletal conditions. These include:

Hyaluronic (Viscosupplementation) Injections: Viscosupplementation is a procedure in which a thick fluid called hyaluronate acid is injected into a joint, most often a knee joint. Hyaluronic acid mimics the properties of healthy, young synovial fluid, including its molecular weight, elasticity, and viscosity. The injection helps lubricate the joint and reduce pain with conditions like osteoarthritis.

PRP (Platelet-Rich Plasma) Injections: Platelet-rich plasma (PRP) therapy involves taking a patient’s blood, concentrating the platelets within that blood, and then reinjecting them to accelerate the healing of injured tendons, ligaments, muscles, spinal discs, and joints. It utilizes substances naturally found in the body to stimulate healing and regrowth at an injured site.

Stem Cell Therapy: Stem cell therapy, also known as regenerative medicine, stimulates the repair response of diseased, dysfunctional, or injured tissue by utilizing stem cells. Stem cells are unique because they can generate more cells like themselves and develop into different tissues.

Other Options

Ultrasound Therapy: Ultrasound therapy is a non-invasive treatment that uses high-frequency sound waves to penetrate deep into the body’s tissues. It is used to treat various musculoskeletal conditions, including pain, inflammation, and muscle spasms.

RICE (Rest, Ice, Compression, Elevation) or RICE alternatives: RICE and its alternatives are home-care, first-aid approaches for helping to recover from strains or sprains.

Minimally Invasive Interventional Procedures

In recent years, a variety of additional minimally invasive procedures have been developed to treat orthopedic injuries. These procedures utilize small incisions or punctures to access the body, offering benefits such as reduced pain, shorter recovery times, and a lower risk of complications compared to traditional surgery.

Depending on the nature of an underlying orthopedic issue or condition, additional outpatient, minimally invasive alternatives offer additional paths to recovery without major surgery, including:

• The Intracept procedure
• Basivertebral Nerve Ablation
• The MILD procedure
• Interspinous Spacers

The core takeaway is that many, if not most, orthopedic and sports injuries can be treated without surgery, except in cases of severe trauma or when conservative care options have been exhausted.

One cause of low back pain arises when the end of a spinal vertebra is inflamed. In many cases, if correctly diagnosed, this condition can be treated effectively. But it is often overlooked – particularly when imaging isn’t used to detect Modic changes.

What are Modic changes? They are degenerative changes in the end plates of your spinal vertebrae. We’ll review them so that you can discuss them effectively with your provider.

First, a Quick Review of Spinal Anatomy for Context

If you are suffering from back pain, you are already familiar with the anatomy of your spine. Two of the primary components are vertebrae and intervertebral discs.

The spine consists of 33 individual bones known as vertebrae. They are stacked on top of each other, forming a column. At the ends of each vertebra are junctions known as vertebral endplates.

In between each pair of vertebrae are discs. These are soft, spongy pads of cartilage that cushion the vertebrae and absorb shock. A disc is between each pair of stacked vertebrae along the spine column.

Ligaments help connect the vertebrae and stabilize the spine. Numerous muscles surround the spine, providing support and enabling it to move.

Our intervertebral discs will degenerate as we age, a condition called degenerative disc disease. The rate of this degeneration varies from individual to individual. But the degeneration, in itself, doesn’t necessarily lead to back pain. Instead, back pain is often a result of other conditions caused by degeneration.

Modic Changes

“Modic changes” are so named because they were first identified by Dr. Michael Modic in 1988. The endplates of vertebrae will sometimes degenerate, leading to inflammation and pain. Dr. Modic noted that when the endplate of a vertebrae degenerated against a dehydrated interverbal disc, bone marrow would change in 1 of 3 different ways. Knowing which of the three ways is crucial as it dictates the appropriate path for treatment.

Dr. Modic classified these bone marrow changes into three types: Types 1, 2 and 3.

• Type 1 involves inflammation and edema. Edema is a condition in which excess fluid accumulates in the body’s tissues, resulting in swelling.
• Type 2 involves fatty infiltration. Fatty infiltration, also known as steatosis, refers to the abnormal accumulation of fat within tissues.
• Type 3 involves sclerotic change and endplate thickening.

Vertebrogenic Low Back Pain

Vertebrogenic low back pain is a type of chronic pain originating from damaged vertebral endplates, the interface between the disc and the vertebral body, which is often caused by wear and tear. 

There is an effective treatment for this type of back pain, but it must be diagnosed correctly first. How do doctors do that? An MRI can reveal to them if Modic changes are occurring in the spine and which Type of Modic change is involved.

If it is Modic Type 1 or 2, then it indicates vertebrogenic back pain.

Treating Vertebrogenic Low Back Pain

One treatment for vertebrogenic low back pain involves a new procedure called Intracept.

As we’ve discussed, when a vertebral endplate is damaged, it can cause inflammation and pain. The basivertebral nerve, found within the vertebrae, carries these back-pain signals from the inflamed endplates to the brain.

Intracept is a minimally invasive procedure that uses a radiofrequency probe to heat the basivertebral nerve, thereby preventing it from sending pain signals to the brain. Patients are under anesthesia, and the procedure generally lasts an hour. It is an outpatient procedure.

Unlike other nerves in the body that regenerate, the basivertebral nerve has not demonstrated the ability to grow back as a pain-transmitting nerve following the Intracept Procedure.

If you are experiencing lower back pain, it may be advisable to consult your healthcare provider to determine if a Modic change assessment is appropriate in your case.

We gain wisdom with each passing year, but we may also begin to experience age-related body changes. Some are obvious to us, such as gray hair, creaky joints, or the need for reading glasses. Other alterations are not as visible as they occur inside the body – to organs, tissues, and even on a cellular level.  

Along with these changes, one of the issues that we begin to struggle with is at least one form of back pain. It’s a condition shared by almost everyone. Statistics show that more than 80% of adults in the United States visit a doctor for back pain at least once in their lives.

Is back pain something that you must accept as something that is bound to happen eventually? Is there anything you can do to prevent it? Why does it happen? What are its likely causes?

Age-Related Changes

As people age, the discs between the vertebrae (the bones in the spinal column) can shrink and lose their cushioning, resulting in reduced flexibility and potential pain. This is known as degenerative disc disease. It’s not a disease but rather a condition that occurs when the spinal discs in your back deteriorate.

Spinal discs are rubbery cushions that act as shock absorbers, helping you move, bend, and twist comfortably. Everyone’s spinal discs degenerate over time. It’s a natural part of aging.

Osteoarthritis

Osteoarthritis, or wear-and-tear arthritis, is a common cause of back pain, especially in the lower back, as the protective cartilage that cushions the ends of the bones wears away. It’s the most common form of arthritis, affecting millions of people.

Osteoarthritis symptoms can be managed, but the damage to joints can’t be reversed.

Spinal Stenosis

Spinal stenosis is the narrowing of one or more spaces within your spinal canal. Your spine canal is a tunnel that runs through each of the vertebrae in your spine. It contains your spinal cord and spinal nerves. The spinal cord is made of the nerves and cells that carry messages from your brain to the rest of your body.

When the spinal canal is narrowed due to spinal stenosis, it can put pressure on the spinal cord and nerves, causing pain, numbness, or weakness.

Herniated Discs

Herniated discs occur when the soft, jelly-like center of a disc pushes through its outer layer. Depending on the spinal level where the herniation occurs, it can put pressure on your spinal cord or nerve roots. This can irritate or damage them. It also can lead to pain, numbness, and weakness in your neck, back, arms, or legs.

Bone Spurs

Bone spurs are bony growths that form on the edges of your spine. They are also called osteophytes.

Bone spurs are most commonly caused by joint damage linked to osteoarthritis. They often cause no symptoms, but sometimes, they may cause pain and stiffness.

Spondylolisthesis

Spondylolisthesis occurs when one of the vertebrae in your spine slips out of position, placing pressure on the vertebra below it. This can put pressure on the nerves around your spine and cause back pain and other symptoms.

Other Factors

Other factors that can contribute to back pain with age include poor posture, lack of exercise, obesity, and smoking.

Losing weight can help alleviate back pain because carrying extra weight strains the spine, and excess body fat can contribute to joint damage and inflammation. Strengthening the back and core muscles through exercise also supports the spine and can help alleviate pain.

Treating Age-Related Back Pain

Many of us live with occasional back pain and treat it with at-home care. However, if back pain is severe, persistent, or accompanied by other symptoms, it’s essential to seek medical advice.

Fortunately, the vast majority of back pain issues can be treated with non-surgical approaches. This may involve a combination, including minimally invasive musculoskeletal therapies, pain management, physical therapy, and lifestyle changes, such as exercise and weight management.

The state of the art in restoring quality of life for patients with back pain continues to advance significantly, year after year. Specialists, such as Physical Medicine and Rehabilitation physicians, have many treatment alternatives at their disposal. For those with ongoing back pain problems, these doctors are often very effective in finding paths to restore quality of life.

Most of us will experience low back pain at some point in our lives. When it is severe, we often seek a medical specialist to help us restore quality in our lives.

When we see a doctor, their first step will be identifying the sources of that low back pain. These sources involve structures in our body that are called pain generators.

We spoke to Dr. Roy Lerman, a Physician Medicine and Rehabilitation physician at Main Line Spine, to learn firsthand about the diagnostic approaches used as the first step in treatment. What follows is a summary of a short video he made for us. (To watch the full video of Dr. Lerman’s discussion, click HERE).

Setting a Starting Frame of Reference

Before we can effectively discuss what may be causing low back pain, we need to establish a common frame of reference. We’ll start by reviewing the core structures of the lower spine, known as the “lumbar spine” (see Figure 1, below).

The main bone structure in the spine is the vertebra, and there are five in your lower back (see Figure 1, above). These lumbar vertebrae are the largest in the entire spine.

Sitting between the vertebrae are discs (see Figure 1, above), and inside each disc is a soft center with gel-like material called a nucleus (nucleus pulposus) (see Figure 2, below).

Surrounding each disc is the annulus (annulus fibrosis), a denser protective shell containing the soft nucleus (see Figure 2, above).

Diseases and Disorders of the Lower Spine

Many problems can occur in the lower spine. They can cause pain, limit function or mobility, and lead to weakness, tingling, or numbness in your back, hips, thighs, or legs.

A spinal disc can deflate like a tire running low on air (thinning disc) (see Figure 3, below).

Discs can also bulge with a protrusion or bulging disc (see Figure 4, below).

When the soft, gel-like center of the disc pushes through the annulus protective outer layer, it’s known as a disc herniation. Continuing our tire analogy, it’s like a bubble in a tire that bursts (see Figure 5, below).

As the gel pushes out, it can press on and impact nearby nerves behind the vertebral body (see Figure 5, above).

The Epidural Space

The spinal canal is at the center of the spinal column, running through each vertebra and disc. At the center is the epidural space (See Figure 6, below).

Spinal nerve roots run through the epidural space, and some emerge at each level of the lower spine (See Figure 6, above). These nerves serve different parts of your legs, hips, thighs, and lower back.

Five Lower Back Vertebrae, the Facet Joint, and Sacrum

The five lower back vertebrae are numbered 1 through 5. When we refer to lumbar spine levels, we reference each vertebra by number and level (See Figure 7, below).

Behind the epidural space and the nerve canal is the facet joint. The facet joint is a small, knuckle-sized joint between the vertebrae (See Figure 7, above). When we bend, that joint moves.

Below the lumbar spine is the sacral spine, also known as the sacrum. The sacrum is made up of five vertebrae that are fused together (See Figure 8, below).

Finally, the sacroiliac, or SI joint is a weight-bearing joint where the sacrum meets the pelvis on both sides (See Figure 8, above).

Potential Structures That May Cause Pain in the Spine

As we consider potential structures that may cause pain in the spine, we’ll start with the vertebral body itself. We look for specific findings on an MRI scan to determine if the vertebrae or vertebral endplates may be a pain source (see Figure 9, below).

A disc can also be a source of pain (See Figure 10, below). A disc can bulge out of place or herniate, putting pressure on surrounding nerves. Both of these conditions can cause pain that radiates down the leg. Individual nerves emerging from different levels of the lower spine serve different parts of the leg.

For example, the L5 nerve serves the outside of your leg. If pain originates from the L5 nerve distribution, it will radiate down the outside of your leg and into the side of your calf (See, Figure 11, below).

Similarly, the S1 nerve, the first sacral nerve, runs down the back of your leg.

By identifying where leg pain symptoms are felt, we can identify the spinal level where they may originate.

Pain may also arise at the facet joint. It may become arthritic and cause symptoms when using that joint – like any arthritic joint in the body.

Similarly, the SI joint can become arthritic and a source of pain.

Determining Where Pain May Be Originating

A key factor in helping us determine where pain may be originating is based on a patient’s history. There are certain elements that we look for.

For example, sitting puts more pressure on a spinal disc. So, if someone says they are having trouble sitting for any period, that may suggest a disc or vertebral body may be the source.

Or, when we stand, we have a slight curvature of the arch in our back – and we place a load on the spinal joints. If a patient experiences more pain issues when standing, it may suggest that it’s a facet joint problem.

If the pain is radiating down the leg, we then suspect that there is an issue along the path of the nerve. Nerves can be impacted by disc issues or bone spurs that develop as a result of degenerative changes in the body. The growth of bone spurs is the body’s way of stabilizing the impact of deterioration and degeneration.

As previously noted, the facet joint is like a knuckle joint. You’ve probably seen people with knuckles that become enlarged due to arthritis. When facet joints become arthritic, they, too, may become enlarged. This often leads to a narrowing of the spinal canal – a condition called spinal stenosis – which can cause the pinching of nerves, particularly when we stand up.

Confirming Diagnoses

We may ultimately use targeting injections to confirm a diagnosis. If we suspect it is nerve-related, we may administer medication around the nerve in a procedure known as a nerve block. If this temporary action provides relief, we know we are on the correct path to proceed with longer-lasting solutions.

At various points in our lives, we all experience musculoskeletal pain. It may result from physical overuse, injuries, illnesses, arthritis, stress, or excessive exercise.

Musculoskeletal pain arising from severe injuries or health conditions usually requires care from medical professionals. However, when musculoskeletal pain arises from minor injuries or conditions, it can often be alleviated with care at home.

With home care, our first instinct may be to take it easy. We’ll use the RICE home remedy method (Rest, Ice, Compression, and Elevation) to help minimize pain, inflammation, and tissue damage.

However, recent medical studies suggest that the RICE approach might delay healing. Instead, many doctors and physical therapists now recommend new therapies. These therapies focus on gentle movement and limited use of ice rather than strict rest. This encourages healing blood flow to the location of the injury.

These new approaches are sometimes coupled with additional medical treatments to help unlock and accelerate the body’s natural healing processes.

Viewing Pain Not as a Problem, But as a Means for Healing

Pain is a warning signal that alerts us to a threat to our body, helping us to survive. Pain can alert us to harmful changes in the body, like a fractured bone, or help us learn how to avoid something harmful, like overstretching a tendon. It helps keep us safe.

When an injury occurs and our body experiences pain, it usually triggers an inflammatory response. This is a crucial first step in the healing process. The pain itself causes us to protect the injured area, which helps prevent additional harm. With this inflammation, our body directs natural healing resources to repair damaged tissue and promote regeneration.

There are key differences in how the body responds to pain, depending on whether it is acute (short-term) or chronic (persistent).

Acute pain can be mild and short-lasting. We may experience acute pain from a twisted ankle or a pulled muscle. It serves a protective role and typically resolves once the underlying issue heals.

Chronic pain can last many months or longer. It may result from conditions like a torn ligament or arthritic spine deterioration. Chronic pain can occur without a known cause and persist even after an injury or a known underlying condition is resolved.

While acute pain usually stimulates a healing response from the body, chronic pain can disrupt healing by causing stress and inhibiting tissue repair. It follows that while acute pain usually responds to home care treatment, chronic pain relief generally requires help from a medical professional.

If you have musculoskeletal pain coupled with trouble breathing, dizziness, a high fever, or a severe injury that prevents movement, don’t hesitate to seek immediate medical care.

Why Alternatives to the Traditional RICE Home Treatment Protocol Are Now Being Recommended

According to current studies, where does RICE fall short, and how can acute-pain home care be improved?

Let’s Start with the ‘R’ in RICE – Rest.

The traditional thinking behind resting after an injury is to allow your body to regroup and send natural healing resources to the injury site. However, it is now believed that the healing process can be accelerated more quickly with gentle movement.

Resting can be important in the first 12 to 24 hours after an injury. However, after that, many doctors now recommend gently moving the injured area as soon as possible. This approach helps prevent muscle shortening and promotes healing blood flow to the injury site.

With this gentle movement, it’s essential to use common sense. Use the pain level you experience with movement to guide how far you should progress with an injury.

What about Ice, the “I” in RICE?

Ice encompasses any cooling therapy, including the application of ice packs, an ice water bath, or other methods. Cold causes your blood vessels to constrict and numb your tissues, reducing pain.

However, for minor injuries with low to moderate pain, many doctors now believe that inflammation usually isn’t something you should focus on suppressing. As discussed, inflammation is part of our body’s natural healing mechanism.

Using ice on an injured area interferes with this natural response by reducing blood flow and slowing the healing response. Some studies have also indicated that ice may kill muscle cells.

It’s now recommended that if you use ice to reduce pain and swelling, use it only for a few minutes within the first few hours of sustaining an injury. After that, you should avoid suppressing your body’s natural healing processes.

A Selection of New Acute Pain, Home Care Treatment Options

With the current evolution of thinking on acute pain treatment protocols, there are a variety of options beyond RICE.  Three of them are known by the acronyms MEAT, PEACE and LOVE, and RACE. We’ll take a short look at each of them below.

MEAT (Movement, Exercise, Analgesia, Treatment)

Some medical professionals now recommend the MEAT approach for home treatment. MEAT stands for movement, exercise, analgesics, and treatment.

Immediately after an injury, gentle range of motion movements will increase circulation to the area of injury. This will also help prevent the formation of scar tissue or adhesions around the injured body part.

Once you can tolerate gentle movements, low-resistance strengthening exercise is recommended. This will help further increase circulation in the injured area and reduce muscle atrophy and joint stiffness.

Analgesia refers to the use of medications or other protocols to block pain and reduce inflammation during treatment. The use of NSAIDs such as Advil or ibuprofen should be minimized as they suppress inflammation – and a degree of inflammation is needed to promote healing.

Other forms of analgesia include ice (but only for short periods), topical creams that desensitize the area (if there are no open wounds), and over-the-counter medications such as acetaminophen (Tylenol). However, before using any analgesia treatment methods, check with your doctor to ensure they are safe for you to use.

Finally, corrective exercise, manual therapy, joint mobilizations, and myofascial release are all treatment methods that can help you accelerate your recovery. Consulting with a healthcare professional, such as a Physical Medicine and Rehabilitation Physician, Physical Therapist, Chiropractor, or Registered Massage Therapist, can offer customized plans tailored to your injury.

PEACE (Protection, Elevation, Avoiding Anti-inflammatories, Compression, Education) and LOVE (Load, Optimism, Vascularization, Exercise)

Using medications to control pain may not be appropriate for those with certain existing medical conditions. Others may want to avoid analgesic treatments altogether to preserve the healing benefits of inflammation. The PEACE and LOVE approach may be a good alternative in these cases and others.

With PEACE, the approach is about finding a pragmatic balance. It’s about protection – not doing too much, too soon, while still doing enough gentle, functional movement to preserve your range of motion. While exercising, you seek to minimize the weight and pressure on the affected area.

As part of this protocol, you avoid using anti-inflammatory medications, thereby allowing the body’s natural healing processes to take effect. Education is critical; the more you know about your injury, the better prepared you will be to manage your recovery.

The LOVE approach is often paired with PEACE. With LOVE, you gradually increase the load, or weight, that you place on the injured area as you exercise it. Practitioners believe that a positive, optimistic outlook is also crucial for recovery.

Vascularization refers to the increase in blood flow that occurs with cardiovascular exercises, such as walking, swimming, or biking.

RACE (Recover Actively, Compress, Elevate)

Finally, RACE is a simplified alternative to the traditional RICE protocol.

Recovering actively means that you don’t suppress inflammation, which is the body’s way of initiating the healing process.

The lymphatic system is the body’s natural drainage system. It naturally and slowly removes all the waste products and excess fluid buildup caused by the inflammatory process. The lymphatic system relies heavily on muscle contraction, so early movement is key to faster recovery.

However, while swelling initiates and assists in recovery, excessive swelling can lead to muscle shutdown. Thus, gentle compression with an ace bandage or other compression sleeves can be helpful.

Elevating the injured area can also help encourage fluid to return to the lymphatic system, allowing healing factors to work on the area.

When Low Back Pain Is Too Intense to Exercise

Throughout this discussion, we’ve discussed the benefits of movement and exercise in promoting the healing of musculoskeletal injuries. However, pain can sometimes be too intense for movement, let alone exercise. During these times, consulting a specialist doctor can pave the way for relief.

Intense low back pain is a notable example. Doctors, such as Physical Medicine and Rehabilitation physicians, often recommend physical therapy to alleviate low back pain and prevent future injuries.

Physical therapists will guide exercises to strengthen core muscles, improve flexibility in the lower back and hips, and enhance posture. However, pain levels must be at a level where a patient can tolerate this treatment.

In these cases, physicians may recommend an injection of anti-inflammatory medication, such as a steroid or corticosteroid, into the epidural space surrounding the spinal nerves in the lower back. The goal is to manage pain effectively, allowing patients to participate fully in their physical therapy regimen.

Helping to Accelerate the Body’s Natural Healing Processes

We’ve also discussed how, with inflammation, our bodies direct natural healing resources to repair damaged tissue and promote regeneration. Recent medical advances now offer alternatives to accelerate these natural healing processes.

One such therapy is known as platelet-rich plasma (PRP). PRP therapy involves taking a sample of a patient’s blood. The blood is then processed to concentrate its healing factors, which are subsequently injected into the injury site. For those who respond to PRP injections, it can reliably decrease inflammation and promote accelerated healing.

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.