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Your Spine Surgery Questions Answered by Dr. Scott Boden

Having spine surgery is a big decision, and it’s in your best interest to ask questions so you know how to prepare, and what to expect both immediately after the surgery and long-term. A week ago, we asked you to send us your spine surgery questions through Facebook Messenger. Below are Dr. Scott Boden’s responses to the questions we received.

Your Spine Surgery Questions Answered

Question: I had spine surgery in March 2015. There’s something wrong in my L4 & L5 disks that cause me severe unbearable pain. The spine doctors don’t see anything wrong other than desiccation on the MRIs. I have nerve and muscle spasms constantly, can barely walk, and severe pain in my lower back and legs. I’m on Medicaid and can’t get the help I need because spine institutes don’t accept Medicaid. What can I do?

Dr. Boden:  It’s unfortunate that your type of insurance might limit your access to care.  There are physicians and centers that will accept your insurance.  With that said, if you have radiating leg pain but don’t have severe pressure on the nerve roots on your MRI, then it is much less likely that surgery will help and you may be better served visiting a pain management specialist rather than a spine surgeon.

Question: How do you alleviate severe spine pain? How do you restore broken cartilage of the spine?

Dr. Boden:  Unfortunately, there is currently no way to restore, repair, or replace damaged cartilage in the disc structures which are located between each of the spinal vertebrae bones.  Back pain can often be lessened through a variety of medications, exercises, and special pain treatment modalities.  Also, as the spine ages and naturally becomes less mobile, some of the painful causes of back pain in middle-aged patients will remedy themselves over time.  If the situation is associated with significant pain radiating down one or both legs, then surgery may be an option.  If the pain is due to a fracture, tumor, infection, or excessive mobility of the spine, then surgery may be an option.

Question: Are there any new advancements in scoliosis surgery? Is it still metal bars and being in a body cast for months?

Dr. Boden:  There are many new advancements in scoliosis surgery including less invasive surgical approaches, better ways to minimize blood loss, and use of biologics to improve the healing of bone necessary for scoliosis surgery to be a success.  With that said, metal rods, screws, hooks, and cages are still part of the process.  Use of body casts is much less common, but removable custom molded plastic braces are sometimes still utilized.

Question: I have disc degeneration at all lumbar levels, can surgery be performed, if not, what else can be done to relieve pain?

Dr. Boden: When there is disc degeneration at all levels and the primary symptom is back pain (and not radiating leg pain), we would typically not suggest surgery. You would have to come in to see a spine specialist to fully address your pain and specific situation, though.

Question: If less than 10% of patients who experience back or neck problems are candidates for surgery, why is that?

Dr. Boden: The majority of back or neck problems will resolve with time or non-operative treatments such as physical therapy or medications. Only a very small percentage will require or benefit from surgery.

Question: Could you walk us through a general sequence of determining whether or not a patient should consider surgery following a disc herniation, PT and epidural steroid injections? Having a hard time sorting out the difference between patience to allow healing and delaying and inevitable surgery now 2 years post injury

Dr. Boden: In general, a disc herniation might need surgery if the primary symptom is radiating leg pain rather than just low back pain. The majority of disc herniations – over 90% – resolve on their own within three months. During that time steroid injections, physical therapy and medications can be tried to help relieve pain while the body heals the disc. If the leg pain persists longer than 3 months than the ideal surgical window is between 3 and 6 months after the leg pain started. You can still get acceptable results after 2 years, but the likelihood of success is slightly smaller.

Question: When is it time to be evaluated by a spine surgeon?

Dr. Boden: Over 90% of spine related problems usually resolve on their own or with some simple non-operative treatment. Relatively few people need to get into the hands of a surgeon. If you have radiating pain or weakness down your arms or legs that has not been getting better within a short amount of time, is an indicator to be evaluated by a spine surgeon.

Question: Who is a good candidate for spine surgery?

Dr. Boden: Based on age, looking at the under 50 age group – one of the most common problems that could lead to spine surgery is a herniated disc. If that does not resolve with non-operative treatment, then that patient with that problem is usually an excellent surgical candidate assuming their main symptoms is persistent radiating arm or leg pain.

Question: What type of tools or techniques are generally involved with spine surgery?

Dr. Boden: It depends on what the patient’s specific spine problem is. For a herniated disc, it will be an outpatient surgery with a small incision that removes the herniated piece of disc cartilage and unpinch the nerve. For older adults (50+), our spinal canal eventually gets more narrow that causes pinching. In these situations, it involves surgery that will unpinch or decompress the nerve roots.


About Dr. Scott Boden


Scott D. Boden, MD, is Professor of Orthopedic Surgery and Director of the Emory Orthopaedics & Spine Center. Dr. Boden started practicing at Emory in 1992. During his fellowship at Case Western Reserve Hospital in Cleveland, Dr. Boden trained with one of the founding fathers of modern spine surgery, Dr. Henry Bohlman. A primary original researcher on bone growth factor development and spine fusion technology, Dr. Boden is also an internationally renowned lecturer and teacher and the driving force behind the Emory University Orthopedics and Spine Hospital (EUOSH).

Dr. Boden’s Clinical Interests
Dr. Boden’s areas of clinical interest include surgical and nonsurgical management of adult degenerative spinal disorders including herniated discs, spinal stenosis, and spondylolisthesis in the cervical and lumbar spine. He was recently named in another Becker’s list of Top 50 Spine Surgeons in the U.S. and is a skilled surgeon with techniques of microdiscectomy, laminectomy, spinal fusion, and laminoplasty.

Education
Medical School: University of Pennsylvania School of Medicine, Philadelphia, PA 1986
Internship: George Washington University Medical Center, Washington, D.C. 1987
Residency: George Washington University Medical Center, Washington, D.C. 1991
Fellowship: Case Western Reserve University Hospital, Cleveland, OH 1992

Personal
Dr. Boden is the proud father of triplets who graduated first and tied for second in their high school class. He is also a baseball aficionado and coaches high school and travel softball teams.

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Meet your Spine Surgeon: A Conversation with Dr. John Heller 

Spine Surgeon

The spine supports the body’s weight and protects the nerves in the spinal cord that run through it. It helps maintain the body’s muscle control and nerve coordination, and without it, we wouldn’t be able to function. Spine surgery, a subspecialty of orthopedic surgery, includes the treatment and management of a wide variety of conditions affecting the neck and back, including herniated discs and fractures.

For Emory Healthcare spine surgeon John G. Heller, MD, the care and treatment of patients with spine issues is personally rewarding. His practice works to improve the lives of patients while training the next generation of spine surgeons.

Patients, understandably, often have many questions regarding spine conditions and their treatment. Recently, Dr. Heller spoke with Dr. Bruce Feinberg for The Weekly Check-up on WSB Radio about a wide range of issues related to the spine surgery. The following are summarized excerpts.

Question: Tell us about your team.

Dr. Heller: Over the last 28 years I’ve been at Emory, our team of spine specialists has grown a lot and so has our field. Right now, we have a team comprised of 11 orthopedic and neuro-spine specialists who are surgeons. We also have more than a dozen non-operative specialists, whose job it is to keep people from meeting the surgeons. It’s the minority of folks who actually need to or end up seeing a surgeon.

Question: How have you seen your practice grow?

Dr. Heller: We’ve been really fortunate in recent years to have the Emory Orthopaedic & Spine Hospital, in addition to Emory Midtown, to work in. It’s been a game changer for us and our patients. We have an entire hospital with a mission focused on joint replacement and spine. It’s a smoother experience for patients and we’ve seen that in our patient satisfaction rates, which are some of the highest in the country. We’re very proud of what we have built as a team, and in doing that alongside our educational and research activities. We now have points of access across the region to serve patients closer to home.

Question: How do you spend your days?

Dr. Heller: I alternate days either in the office all day or in the operating room all day. If I’m in the office, I see about 15 to 20 patients a day, which means I get to spend a good bit of time with each patient.

What we do really takes some time to get to know the patient, what’s going on and their options, and to go over all the information. On the days I’m operating, it can vary between a few operations that are several hours long each, to one operation that lasts anywhere from 10 to 14 hours.

Question: What is myelopathy?

Dr. Heller: We see and treat many cervical spine conditions, and this is one of our most common. Myelopathy is compression of the spinal cord caused by wear and tear which creates multiple points of pressure. We see this most commonly in those aged 55 and over. Myelopathy commonly presents with little to no pain, wobbly legs, and clumsy hands. There are a variety of different operations that we can do to help people with this condition.

Question: What is spinal stenosis?

Dr. Heller: Spinal stenosis is the narrowing of the spinal canal. As patients get older, their discs wear out and the place for the nerves in the low back and neck get crowded out. This condition can be associated leg pain, arm pain, back or neck pain, and sciatica.

Question: What is disc herniation?

Dr. Heller: Disc herniation commonly occurs in young healthy people who have a piece of a disc break off and compress a nerve. More than half the time, they never need to see a spine surgeon.

Question: What are your thoughts on using opioids to manage pain, given the concerns from patients and the medical industry?

Dr. Heller: Opioid abuse is dangerous, and we take prescribing opioids very seriously. Daily, on average, 142 people in the U.S. die because of prescription opioid accidents. We also know that taking opioids for a long enough period of time can make the pain worse, not better since they change the body’s central nervous system. I tell patients to use common sense, use what you need to when you need to, and don’t use it when you don’t need to.

Listen to the full conversation >>

Dr. Heller practices at Emory University Orthopaedics & Spine Hospital. To learn more about Emory Orthopaedics & Spine surgeons and treatment options available to you, visit www.emoryhealthcare.org/ortho or call 404-778-3350.


About Emory Orthopaedics & Spine Hospital

Emory’s Orthopaedics & Spine Hospital has locations across the Atlanta metro area. Emory’s physicians diagnose and treat conditions ranging from simple herniated disc and lower back and neck pain to more complex problems such as spinal tumor scoliosis and spine fractures. Emory Healthcare has the only hospital in Georgia that is dedicated to spine and joint surgery as well as non-operative spine and joint surgical interventions for physical therapy. For more information, or to schedule an appointment or an opinion, visit www.emoryhealthcare.org/ortho.

About Dr. John Heller

John G. Heller, MD, is an orthopedic surgeon specializing in the research and development of instrumentation in cervical spine surgery, including cervical disc replacement and laminoplasty. His clinical interests include herniated disc sciatica, spinal stenosis, and spinal tumors. An internationally renowned lecturer and teacher, Dr. Heller is the past president of the Cervical Spine Research Society and was one of the first surgeons in the country to perform laminoplasty.

Learn more about Dr. Heller >>

Real Patients. Real Stories – Kathleen Karr’s Total Ankle Replacement

total ankle replacement karrKathleen Karr thought her dancing days were over — until she underwent total ankle replacement surgery. 

Kathleen suffered an ankle injury during a car accident when she was 39 years-old. Unfortunately, the injury worsened over time. She began to lose more and more mobility in her ankle until, finally, she found herself barely able to walk.

Frustrated with her lack of mobility, Kathleen scheduled an appointment with an orthopaedist. After performing an initial exam and reviewing her X-rays, the doctor found that she had end-stage ankle arthritis and recommended an ankle fusion. While the procedure would give her back some mobility, the doctor warned that she would still not even be able to walk uphill or downhill following her surgery.

Kathleen had always been an active, vibrant woman. The thought of living out the rest of her life with such limited mobility just felt wrong to her. She had dreams of roaming the streets of Paris and dancing the night away. For her, barely being able to walk on flat ground was just not going to cut it.

Unsatisfied with what she was told, Kathleen decided to seek a second opinion. That’s when she found Dr. Jason Bariteau of Emory Orthopaedics & Spine Center in Atlanta, Georgia. “Kathleen was severely limited from her ankle injury,” recalls Dr. Bariteau. “She had already tried several conservative treatment options, but still couldn’t do the things she wanted to do.” Kathleen and Dr. Bariteau discussed possible treatment options and weighed the risks and benefits of each. They decided that a total ankle replacement would be the best fit for her.

Total Ankle Replacement Procedure

Traditionally, patients with end-stage ankle arthritis have been treated with an ankle fusion, which can lead to significant limitations after surgery and could cause further arthritis in the foot. Fortunately, total ankle replacement has evolved over the last few years. Not everyone is a candidate for total ankle replacement, but those who are, often find it offers them consistent pain relief and improved mobility.

Kathleen had a great experience with the procedure and is now pain-free and loving life. “I went dancing last night. I’ve always been a very active person, and it feels good to get back to the things I enjoy. Going from not being able to do anything, to getting onstage to dance and sing, feels amazing. I’m back to my crazy old self!”

With her trip to Europe booked, Kathleen feels grateful to Dr. Bariteau. “He’s such a great doctor—so thorough and personable. That’s what gave me the confidence to have the surgery. And that’s why I have my life back! Thank you, Dr. Bariteau!”

Emory Orthopaedics & Spine Center

Emory Orthopaedics & Spine Center offers the full-spectrum of orthopaedic care. If you have a foot or ankle injury, we can help. We want to get you back to living the life you love.

Learn more about total ankle replacement

About Dr. Bariteau

Dr. Bariteau grew up in a small town just outside of Albany, New York. After completing his undergraduate degree in Biology at College of Saint Rose, he then pursued his medical degree at Upstate Medical University in Syracuse, NY where he graduated Magna Cum Laude. Following completion of his medical training, he developed his surgical skills during his orthopedic surgery residency at Brown University. He then subsequently completed two advanced orthopedics fellowships; the first at Brown University in orthopedic trauma and the second at Baylor Medical Center in Dallas Texas under the tutelage internationally known Foot and Ankle Surgeon James W Brodsky MD. He currently resides in Atlanta, GA with his wife and three children. Learn more about Dr. Bariteau.

The best (and worst) exercises for lower back pain

lower-back-painOver 80 percent of Americans will experience lower back pain at some point in their lives. If you have it, you may think rest is the key to recovery. In fact, back pain is one of the most common reasons people miss work.

But most lower back pain will actually get better when you stay active. Exercise can:

  • Ease your lower back pain
  • Help you heal faster after a lower back injury
  • Maintain your strength and flexibility
  • Prevent re-injury
  • Reduce your risk of disability from chronic back pain

Lower back pain exercises

You should focus on activities that strengthen your back, such as walking, swimming and walking in waist-deep water in the pool.

Also, these strengthening exercises can help combat back pain:

  • Back extensions. While lying on your stomach on the floor, press your elbows into the ground and push your upper body toward the ceiling. Hold this pose for 30 seconds, then allow your body to relax. Repeat four to six times.
  • Chair stretch (for hamstrings). Sit in a comfortable chair with your legs straight out in front of you in another stable chair. Reach forward gently to one foot and then repeat with other foot.
  • Hip stretch. Stand with your feet shoulder-width apart. Take a step back with your right foot and bend your left knee while shifting the weight to the right hip until you feel a stretch. Repeat on the other side.
  • Knee-to-chest stretch. Lie on your back on the floor and bend your knees while keeping your heels on the floor. Place your hands behind each respective knee and bring your knees to your chest for a gentle stretch.
  • Neck stretch. Sit in a comfortable chair with a straight back. Bend your head forward until your chin hits your chest, or you can feel a light stretch in the back of the neck. Return to the starting position.

Note: If at any time you notice increased pain while doing a stretch or exercise, stop immediately.

Exercises to avoid if you have lower back pain

If you have lower back pain, it’s best to avoid these exercises:

  • Heavy lifting above the waist
  • Leg lifts
  • Sit-ups, either with straight legs or with bent legs
  • Touching your toes while standing with legs straight

Many people can relieve lower back pain with simple at-home strengthening and stretching exercises. However, if you have a question about whether you need medical attention, it’s best to talk to your doctor to rule out a more serious injury.

Request an Appointment

To request an appointment, please use the link below.

Request an Appointment

Preparing for Summer Road Races Live Chat Transcript

 

Road race runnersHave you been training hard getting ready for summer races or events like the AJC Peachtree Road Race? Emory sports medicine physician Amadeus Mason, MD and Emory sports cardiologist, and Peachtree Road Race Medical Director, Jonathan Kim, MD, answered questions around preventing injuries, when and how to stretch and discussed appropriate treatment options for select injuries.  The live chat had a good turnout and the transcript is now available below.

Live Chat Transcript

June 13, 2017, 12:01 PM

EmoryHealthcare: Welcome everyone! Thanks for joining us today for our Live Q&A on Preparing for Summer Road Races with Dr. Mason and Dr. Kim.

June 13, 2017, 12:02 PM

EmoryHealthcare: We’ll get started in just a minute. The doctors are here to answer all your questions!

June 13, 2017, 12:04 PM

EmoryHealthcare: Please note that all questions are moderated before appearing in the stream, so you may not see yours appear right away, but we will do our best to answer all your questions today.

June 13, 2017, 12:05 PM

EmoryHealthcare: We received some questions that were submitted in advance of the chat, so we’ll get started by answering a few of those first.

June 13, 2017, 12:06 PM

EmoryHealthcare: Q: What is the number one mistake you see runners make?

June 13, 2017, 12:09 PM

EmoryHealthcare: A: Doing much too soon, increasing the amount of running, or the pace of before they are ready and that leading to overuse/fatigue injury, etc.

June 13, 2017, 12:11 PM

EmoryHealthcare: Q: Does weightlifting make you a faster runner?

June 13, 2017, 12:13 PM

EmoryHealthcare: A: No, lifting is not can a make you faster only speed work and do that. Lifting can help to increase your overall stamina and in turn, allow you to do better quality speed training which will, in turn, make you faster.

June 13, 2017, 12:20 PM

Guest9090: I’ve heard of people going into cardiac arrest. How concerned should the average Joe be?

June 13, 2017, 12:23 PM

EmoryHealthcare: We published a paper on this exact question – Kim JH New England Journal of Medicine 2012. Cardiac arrests are rare during marathon events. However, as we age, it’s important to get a risk profile work up by your physician before starting training.

June 13, 2017, 12:23 PM

Guest5817: Does the pace of your easy run matter?

June 13, 2017, 12:25 PM

EmoryHealthcare: Yes, it does matter. Your easy run is part of the recovery portion of your workout. Therefore, if it’s too hard, this can negatively impact progress, rest and recovery are crucial.

June 13, 2017, 12:27 PM

Abe: Why do I get a stich in my side when I run?

June 13, 2017, 12:29 PM

EmoryHealthcare: There are a couple of theories, 1) the oxygenation of the tissues in the core of the body is diverted to the legs during exercise.

June 13, 2017, 12:30 PM

EmoryHealthcare: 2) Electrolyte imbalance when you’re running there’s a subtle change in electrolytes which can cause the stitch like pain.

June 13, 2017, 12:31 PM

Guest2147: Is post traumatic injury disorder a real thing?

June 13, 2017, 12:32 PM

EmoryHealthcare: Guest2147, can you provide more information?

June 13, 2017, 12:34 PM

Guest2147: The fear of an injury returning—or a new one developing.

June 13, 2017, 12:36 PM

EmoryHealthcare: It is a real psychological issue and should be addressed for the person to get back to his or her previous level of play. Apprehension is real.

June 13, 2017, 12:38 PM

Guest8697: Any pics on the best running shoes?

June 13, 2017, 12:39 PM

EmoryHealthcare: We can’t give a brand name, but when choosing a shoe to get an assessment from a professional and choose the shoe that is the most comfortable. A German study in the early 2000’s determined that the comfort of the shoe was the most important, not the brand.

June 13, 2017, 12:43 PM

Guest5057: What should I eat before the race?

June 13, 2017, 12:44 PM

EmoryHealthcare: Pre-race diet isn’t important as making sure your overall diet is good throughout your training. Carb loading before a big race has fallen out of favor, especially when not in the context of an overall dietary plan. Eating carbs, protein, and simple fats within 30 mins after the race has proven beneficial. The perfect combination is chocolate milk.

June 13, 2017, 12:45 PM

Guest9090: Will Emory be at the PRR this year?

June 13, 2017, 12:47 PM

EmoryHealthcare: Absolutely! Emory will be providing primary medical oversight during the race. We’ll we work in concert with Grady EMS, Atlanta Fire and Police to provide excellent medical care throughout the entire course.

June 13, 2017, 12:49 PM

Guest2147: My friend’s running form is terrible, should I say something?

June 13, 2017, 12:49 PM

EmoryHealthcare: It depends on how close of a friend you are.

June 13, 2017, 12:49 PM

Guest9186: I’m in my first trimester, is it safe to run the PRR?

June 13, 2017, 12:53 PM

EmoryHealthcare: Consulting with your OB-GYN should be on your list of to-dos. From an environmental standpoint, I would be very conservative with your intensity and pay close attention to the heat and humidity.

June 13, 2017, 12:54 PM

EmoryHealthcare: These questions have been great! We have time for just one more question today. Any remaining questions will be answered by in a post-chat Q&A blog on http://advancingyourhealth.org

June 13, 2017, 12:56 PM

Guest5057: I know we’re not supposed to, but any thoughts on running a 10k with headphones?

June 13, 2017, 12:58 PM

EmoryHealthcare: We don’t think headphones are prohibited from the Peachtree Road Race. However, running on your own vs. on a closed course brings its own dangers, and runners should always be aware of their surroundings.

June 13, 2017, 12:58 PM

EmoryHealthcare: That’s all the time we have for today. Thanks so much for joining us! As we mentioned, we’ll follow up with a blog post to answer any questions we didn’t get a chance to address today.

June 13, 2017, 12:59 PM

EmoryHealthcare: Thanks for your questions!


Want to Learn More?

At Emory Sports Medicine Center, you have access to a broad range of services to care for sports injuries that affect bones, muscles, and tendons. We provide evaluation and treatment of sports-related injuries for athletes of all ages, at all levels, in all sports.

Live chat

The 4 Most Common Causes of Shoulder Pain

Causes of shoulder pain Whether you’re throwing a football, unloading the dishwasher or scratching your back, shoulder pain can compromise even the most basic daily activity. Here’s how to identify and treat the biggest instigators of shoulder pain, which include:

  • Arthritis
  • Fracture (broken bone)
  • Instability
  • Tendon inflammation and tears

The shoulder is made up of tendons, muscles and bones. Its main purpose is to position your hand for your everyday tasks and movements. Since the shoulder is such a mobile joint, it’s more prone to instability or impingement in its soft tissues. This can lead to acute (sudden) or chronic pain.

1. Arthritis

Arthritis is a frequent cause of shoulder pain. The most common form of arthritis in the shoulder is osteoarthritis, which is known as “wear and tear” arthritis and may crop up as you age.

Many people respond to arthritis pain by reducing their shoulder movements, but this can backfire and cause tightness or stiffness in the soft tissues of the shoulder joint. It can also lead to significant pain when moving the shoulder.

Osteoarthritis is often caused by chronic movements, inflammation of the joint lining from rheumatoid arthritis, work injuries or sports injuries.

Treatments: Rest, physical therapy and at-home range-of-motion exercises can be helpful in relieving pain. Your doctor may also suggest anti-inflammatory medication, such as ibuprofen, to reduce your symptoms. If conservative treatments don’t help, you may need to have joint replacement surgery.

2. Fracture

A fracture, or broken bone, is another common cause of shoulder pain, swelling and bruising. Shoulder fractures often involve the:

  • Collarbone (clavicle)
  • Shoulder blade (scapula)
  • Upper arm bone (humerus)

Fractures are typically caused by a fall in older patients or a sports or vehicle injury in younger patients.

Treatments: Depending on the severity of the injury, you may need to wear a basic sling for three to eight weeks. For worse injuries, you may need surgery.

3. Instability

Shoulder instability means the head of the arm bone (the humeral head) is displaced from the shoulder socket, often as a result of trauma or serious injury. This can cause a “catching” or slipping feeling the shoulder or even a complete dislocation where the ball of the arm bone comes out of the shoulder socket completely.

This can cause the muscles, tendons and ligaments around the shoulder to tear or loosen, which can lead to repeated dislocations. Repeated dislocations lead to pain, unsteadiness and eventually, arthritis.

Treatments: Your doctor will maneuver the arm bone back into the shoulder socket. After that, you will likely wear a sling for a few weeks as the injury heals. If you experience future shoulder dislocations, you may need surgery to correct the problem.

4. Tendon Inflammation and Tears

Shoulders are prone to overuse injuries from repetitive tasks, such as overhead lifting. This often shows up in the form of tendinitis, an inflammation of the tendons, and bursitis, inflammation of the bursa.

The bursa is a fluid-filled sac between tendons and bones that allows them to glide easily. If the bursa is inflamed, the tendons may scrape against the shoulder bones resulting in weakness or tearing. This is called impingement.

The four rotator cuff tendons are the most susceptible to tendinitis. When the tendons are inflamed, there’s less space for the tendons and muscles to move within the joint.

Treatments: Rest your shoulder and avoid positions or activities (like overhead lifting) that cause pain. If this doesn’t help, your doctor may recommend a cortisone injection to decrease inflammation and pain, as well as physical therapy.

Get Treatment for Shoulder Pain

If you’re experiencing frequent, disruptive pain throughout your day — and caring for your shoulder injury at home hasn’t helped — it may be time to get help from a medical professional.

The orthopedic surgeons at Emory Orthopaedic & Spine Center specialize in treating all types of shoulder conditions and injuries. Don’t live with the pain another day.

Call us today at 404-778-3350 to schedule an appointment.

Should You Use Heat or Ice to Treat an Injury?

Should You Use Heat or Ice to Treat an Injury?Whether you have arthritis pain, a sprained ankle or a pulled muscle, it’s important to know when to use—and when not to use—heat or ice to treat an injury.

Heat and ice—also known as temperature therapy—are very effective complements to medication and self-care when treating an injury at home. While both therapies can reduce pain, inflammation, and swelling, they aren’t appropriate for every injury.

When to Use Cold Therapy

It’s best to use cold therapy for acute or sudden pain caused by a recent injury that’s sensitive, red or inflamed. Inflammation is a normal bodily response to an injury, but it can be quite painful. Here are some of the most common acute injuries that benefit from cold therapy:

  • Ankle sprain
  • Inflammatory arthritis flare-ups
  • Muscle or joint sprain
  • Red, hot or swollen body part
  • Sudden intense pain after exercise

A joint or muscle sprain damages the blood vessels in the injured part of the body, which causes swelling. Applying something cold—such as an ice pack wrapped in a towel—helps constrict those blood vessels, which can reduce bruising and swelling.

Cold therapy is also beneficial for treating soreness or pain related to exercise. For example, you can apply an ice pack to the painful area after going for a run to reduce post-exercise inflammation.

How to Safely Use Cold Therapy

Cold therapy is safest and most effective when you follow these tips:

  • Apply ice as soon as an injury happens or after intense, high-impact exercise.
  • Do not apply ice to areas of the body that have poor circulation.
  • Never use cold therapy for more than 20 minutes at a time.
  • Only apply cold to the injured area.
  • Wrap the ice pack in a towel before applying it to the affected area.

When to Use Heat to Treat an Injury

Ice is most beneficial for treating acute injuries, while heat is best for chronic pain. Heat therapy allows the blood vessels to expand and the muscles to relax.

Heat Therapy:

  • Relaxes muscle spasms
  • Stimulates blood flow to the injured area
  • Soothes sore muscles

It’s Most Beneficial for:

  • Arthritis pain
  • Ongoing muscle pain or soreness
  • Stiff joints

How to Safely Use Heat Therapy

Get the most benefits from heat therapy with these tips:

  • Apply heat before exercising to relax the muscles. If you apply it after exercise, it can aggravate inflammation and existing pain.
  • Avoid direct contact with heating devices (like a heating pad). Wrap your heated device in a folded towel to reduce your risk of burns.
  • Drink plenty of water to stay hydrated during heat therapy.
  • Minimize prolonged exposure to higher heat therapy.

If heat relieves your pain, you can try a continuous, low-level heat wrap for up to eight hours at a time, even while you sleep. These wraps are available at most drug stores.

What to Avoid When Using Heat or Ice to Treat an Injury

Ice can worsen muscle spasms and tension, while heat can increase inflammation in a recent injury. The best thing to remember is to not overdo it with either form of treatment.

While it’s normal for your skin to be slightly pink after using heat or cold therapy, call your doctor if you notice blisters, hives or additional swelling.

Otherwise, simply follow these guidelines depending on your condition. Using heat and ice to treat an injury can be very helpful in reducing pain if used correctly. When in doubt about which therapy to use, ask your doctor.

Total Ankle Replacement – Valerie’s Story

Valerie's total ankle replacement

Valerie on Mount Kilimanjaro

After an accident in 1979 that resulted in an ankle injury, Valerie underwent surgery on her left ankle to repair the joint. At the time, total ankle replacement was in its infancy and regarded as an experimental procedure. It wasn’t until the late 80s and early 90s that advancements in design made total ankle replacement a viable option for patients.

Initially, the ankle surgery worked, but after five years, Valerie began to experience constant pain at her ankle. Being resilient, she didn’t let the pain stop her from living her life, so she carried on without realizing that she had changed her gait to compensate for the pain. Valerie walked on the tips of her toes for 25 years! She didn’t anticipate the arthritic damage caused by changing her body’s natural movement or the pain it would cause in other areas of her body.

After her husband’s successful knee surgery in 2010, she decided that there was still hope for her ankle. Valerie started to research and educate herself on treatment options for total ankle replacement. It was during this time that the years of walking on her toes finally caught up with her. Physical therapy was prescribed to address the severe hip pain caused by Valerie’s adapted gait. During one of her many physical therapy sessions, her therapist mentioned attending a lecture by Dr. Sameh (Sam) Labib of Emory Orthopedics & Spine Center. The lecture focused on treatment options for ankle arthritis. Valerie scheduled a consultation with Dr. Sameh’s office right away.

During the consultation, Dr. Labib reviewed Valerie’s case, described his diagnostic process, clinical reasoning, and delivered a tailored treatment plan that had the best outcome. In other words, Valerie was a good candidate for a total ankle replacement surgery. She was thrilled.

After careful consideration, Valerie decided to have total ankle replacement surgery in March of 2015. Post-surgery, things were uneventful – she had an average recovery. She had better function but continued to experience some pain due to bone spurs. At her one-year post-surgical follow-up, Dr. Labib arthroscopically, a minimally invasive surgical procedure, removed the bone spurs in July of 2016. Valerie has been 100 percent pain-free ever since.

Before surgery, I couldn’t walk far. After surgery? I climbed Mount Kilimanjaro — all 19,800 feet — and watched a glorious sunrise from “the roof of Africa!” with my 26-year old son and six friends and family members. I hiked and climbed for seven days to fulfill a life-long dream. Thank you, Dr. Labib. You made it possible. — Valerie


About Total Ankle Replacement Surgery

For patients with damaged ankles, ankle prosthesis may provide a reasonable option. Total ankle replacement is a procedure designed for mature patients with low impact activity demands. In this procedure, a badly damaged ankle is completely replaced with an artificial implant (prosthesis). Because the damaged ankle is completely removed, total ankle replacement can resolve serious ankle problems, like osteoarthritis.

Although not as common as a total hip or knee joint replacement, advances in implant design have made ankle replacement a feasible option for many people. Ankle replacement offers patients significant pain relief, better mobility and movement compared to fusion surgery. By allowing motion at the ankle joint, less stress is transferred to the adjacent joints, which means lessened chances of arthritis in those adjacent joints.

Ankle replacement is most often recommended for patients with:

  • An ankle condition that interferes with daily activities
  • Advanced arthritis of the ankle
  • Low impact activities

As with any joint replacement surgery, the ankle implant may loosen over the years or fail. If the implant failure is severe, revision surgery may be necessary.

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About Dr. Labib

Dr. Labib

Dr. Labib has an interest in problems and procedures of the knee, ankle, and foot. He is the head team physician for the athletic program at Oglethorpe University. He is also an orthopedic consultant to Atlanta Professional Teams as well as Georgia Tech and Emory University.

He has lectured both nationally and internationally at many orthopedic meetings. His research has been published in several journals, including Arthroscopy, Foot and Ankle International and JBJS -B as well as numerous video presentations and book chapters. Dr. Labib is Board Certified in orthopedic surgery with additional subspecialty certification in Sports Medicine Surgery. For the past 5 years, Dr. Labib has been nominated by his peers as one of “America’s Top Doctors” as tracked by www.CastleConnelly.com.

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Back Pain Diaries: Herniated Disc – Signs, Symptoms and Treatment 

Dr. Lisa Foster discusses herniated discs

Dr. Lisa Foster, Emory Clinic

A herniated disc is a common lower back injury, but did you know lower back pain is the number one cause of disability around the world, according to the 2010 Global Burden of Disease study. For this blog, we spoke with our own Emory Clinic physician, Dr. Foster, to better understand those rubber like discs that sit between our spinal bones.

Your spine is made up of 26 vertebrae bones. Between them are soft disks filled with gel-like substance. These discs cushion the vertebrae bones and keep them in place. As we get older, the discs tend to degrade. When this happens, the discs lose their ability to cushion the vertebrae bones and this can lead to pain if the back is stressed.

What is a Herniated Disc?

A herniated disc, also commonly referred to as a ruptured disc or slipped disc, occurs when a cartilage disc in the spine becomes damaged and moves out of place. Sometimes, it can result in a pinched nerve. You can have a herniated or ruptured disc in any area of your spine but most often it affects the lumbar spine (lower back area).

How Does a Herniated Disc Occur?

When a disk is damaged, the soft rubbery center of the disk squeezes out through a weak point in the hard-outer layer. A disc may be damaged by sports injuries or accidents, repeated strain, a sudden strenuous activity or sometimes, it can happen spontaneously without any specific injury.

What Are the Risk Factors?

  • Genetic predisposition
  • Jobs or tasks that require you to repeatedly lift heavy objects, especially if you are lifting with your back and not your legs
  • Being overweight can add stress on the discs of your lower back
  • Smoking can reduce the amount of oxygen/nutrition reaching your discs to cause more rapid degeneration.

What Are the Symptoms?

  • Back, leg and/or foot pain (sciatica)
  • Numbness or tingling in the leg and/or foot
  • Weakness in the leg and/or foot
  • Loss of control over the bladder or bowels (very rare.) This requires immediate medical attention.

How Do I Prevent a Herniated Disc?

  • Build muscle strength in the core and legs. This stabilizes the spine, increases shock absorption and decreases overall muscle fatigue.
  • Alternate activities to help prevent injury. Warm up before exercising, including stretching.
  • Practice correct posture while you are walking, sitting, standing, lying down or working.
  • Don’t lift with your back; use your thigh muscles to do the lifting.

What Are Herniated Disc Treatment Options?

Each patient’s treatment plan will be different and is customized based on the precise location of the pain within the spine, the severity of pain and the patient’s specific symptoms. For the most part, patients usually start with non-surgical treatment options, such as physical therapy, spinal manipulations, massage therapy and more. A process of trial and error is often necessary to find the right combination of treatments. If a course of non-surgical treatments prove ineffective, surgery may be considered as an option.

 

Did You Know?

Emory Healthcare has a dedicated Orthopaedics and Spine Center, with locations throughout metro Atlanta. To make an appointment, please call 404-778-3350.

View Emory Orthopedics & Spine Center 

 


By Dr. Lisa Foster

Dr. Lisa Foster is a board certified, fellowship trained interventional physiatrist, specializing in non-operative spine care. Dr. Foster has published numerous articles and presented at national conferences in the fields of spine and rehabilitation medicine. Most recently, she was a contributing author for a book chapter on the workup and conservative management of lumbar degenerative disk disease in JL Pinherio-Franco’s Advanced Concepts in Lumbar Degenerative Disk Disease.

 

Emory Healthcare named Official Team Healthcare Provider of Atlanta Braves

Atlanta Braves & Emory Helathcare

The Atlanta Braves announced a new medical partnership that names Emory Healthcare as the Official Team Healthcare Provider of the Braves.

The partnership provides the Atlanta Braves with comprehensive and seamless state-of-the-art medical care. This includes access to Emory’s world class Sports Medicine, Orthopaedics, and Spine Center physicians and more. The partnership also provides the Braves access to Emory’s sports science research and performance measurement expertise at the new Emory Sports Medicine Complex in Brookhaven, opening fall 2017.

“We are thrilled to develop this relationship with Emory Healthcare,” said John Hart, Braves president, baseball operations. “This agreement is very important to our club and will help us to continue to provide the best possible healthcare to our players and staff.”

“Everyone at Emory is very excited to play a role in helping the Braves organization perform at the highest level,” said Scott D. Boden, MD, director of Emory Orthopaedics & Spine Center. “Today, caring for professional athletes requires seamless integration of all medical needs in addition to musculoskeletal care, and Emory is honored to be trusted with this responsibility for the Braves organization,” said Jonathan S. Lewin, MD, President, CEO and Chairman of the Board of Emory Healthcare.

As part of the partnership, Emory Healthcare will be opening an outpatient orthopaedics clinic in Smyrna, Ga., giving Braves players and staff easy access to evaluations, treatment and high-quality imaging.

The Emory Sports Medicine physicians who will provide care for the Braves are: John Xerogeanes, MD, director of Emory Sports Medicine Center, along with physicians Kyle Hammond, Spero Karas, Jonathan Kim, Lee Kneer, Scott Maughon, Ken Mautner, and Jeff Webb. They join the Braves medical staff roster, which includes Head Team Physician Gary M. Lourie, MD, and returning physicians Marvin Royster, Tim Griffith, Jeff Hoadley, and Brooks Lide.

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