Chronic pain affects millions of people worldwide. With so many successful pain relief options for joint and back pain, why do people live for months, even years, in nagging discomfort?
Atlantic Health System orthopedists share some of the most common questions they hear from their patients. If these concerns are keeping you from seeking orthopedic care, talking with an orthopedic expert is a great place to start. You just may realize there’s a solution for you, and no need to live in chronic pain. Here’s how to get back to the activities you enjoy.
Jason Smith, MD
Physiatrist, Pain Management and Rehabilitation
Cedar Knolls, Bridgewater
1. How can a physiatrist relieve my stiff, achy and painful joints?
A physiatrist is focused on relieving pain in the neck, back, shoulders, hips and knees without surgery. I am a nonsurgical spine physician, helping people manage chronic back pain that has persisted beyond six weeks. Nine out of 10 people will find significant relief with the nonoperative therapies we use — and never need surgery. Our goal is to set you up for success, so your pain doesn't bother you six months from now, five years from now, and beyond.
2. I have terrible back pain and I think it’s from a herniated disk. Is there a treatment for this?
A herniated or bulging disk is one of the most common back problems I see. It can be accompanied by arthritis in the sacroiliac (SI) joint that connects the spine and pelvis. Or, the pain may be caused by hip problems, which often surprises people. The first order of business is to get a proper diagnosis, typically an MRI. Then we would start conservative treatment: physical therapy or chiropractic care. Maybe we’ll consider an injection to calm inflammation and allow your body to naturally heal.
3. I don’t want to visit a doctor because I’m afraid of surgery. What should I do?
Be open to a conversation. Talking to a physiatrist, sports medicine doctor, or orthopedic surgeon doesn’t mean you’re signing up for surgery. You’re just having a conversation about what’s going on in your body and your options. It’s a chance to ask a specialist questions — not Dr. Google. I’ve had patients come in with back pain afraid to sneeze because they think they could become paralyzed. This couldn’t be further from the truth. We’ll be honest with you about how to make your pain more manageable.
Peter Sugarbaker, DO
Sports Medicine
Phillipsburg
4. Do I need to be an athlete to see a sports medicine doctor?
Anyone with bone, joint, ligament or tendon issues can visit a sports medicine doctor. We’re primary care doctors for orthopedic problems. Most patients seek care for knee arthritis, chronic back pain, and tendon issues, but we see everything, including tennis elbow, ankle sprains, dislocated shoulders, and plantar fasciitis. Our approach is always nonsurgical. We use injections and medications for pain relief. We rely on physical therapy to improve mobility by addressing muscle imbalances, weakness and flexibility.
5. How can I be sure my diagnosis is correct?
Through an exam and a few tests, we will properly diagnose you. Once we know what’s wrong, we can manage your pain so you can avoid surgery, or to keep you comfortable until surgery is needed. We start with an X-ray, and maybe an MRI. I like ultrasound because we do it right here in our office with no additional cost and no insurance authorization. By moving the joint during the ultrasound we can pick up the subtle pathologies that are causing your pain and know, very clearly, the severity of an injury.
6. Can going to physical therapy do more damage to my injury?
Some people are hesitant to work with a physical therapist before they have an MRI or ultrasound done, and I understand that concern. That’s why advanced imaging is so important. For example, if someone thinks their rotator cuff is torn but they don’t know the extent of the damage, they may worry that physical therapy will damage it further. With proper testing, we’ll know it’s not a full tear and it will heal. Now, that patient can feel confident knowing physical therapy will strengthen and not damage the joint.
James Ryan, MD
Orthopedic Surgeon (Shoulder, Hip, Knee), Sports Medicine
Paramus
7. How can I reverse my arthritis?
Once arthritis begins in a joint, the degeneration is irreversible. The only thing to do is manage the inflammation, pain and stiffness. Several types of injections can also help reduce inflammation and pain, although nothing has proven to reverse the process. As an orthopedic surgeon who specializes in sports medicine, I focus on joint preservation rather than replacements. We repair soft tissue, cartilage, and ligament injuries to get teens and adults back in action. These procedures work to provide stability, relieve pain, and restore the joint with a long-term goal of preventing arthritis down the road.
8. When should I say “yes” to a total joint replacement surgery?
It’s important to note that scheduling a visit with an orthopedic surgeon is not the same as signing up for surgery. Many patients with joint pain can be treated nonoperatively. When you come in with symptoms, we evaluate and diagnose you to determine if you’re a candidate for a hip, knee, or shoulder replacement. We’ll work with you through nonsurgical treatment — physical therapy, anti-inflammatory medications, and different injections may provide sufficient relief. If symptoms persist after months of conservative management, you can decide when to say “yes” to your surgeon, based on how significant your symptoms are.
9. Do I have to go to physical therapy if I already go to the gym regularly?
Going to the gym regularly is great and certainly recommended as part of a healthy lifestyle. However, physical therapy is completely different than going for a “workout.” At physical therapy, you perform targeted exercises with trained professionals to help you strengthen the muscles surrounding the painful joint, providing pain relief and stability. Therapists can also help you regain range of motion in a stiff and painful joint, resulting in pain relief that is difficult to obtain independently. In the gym, we tend to strengthen our larger muscles, which can lead to an imbalance when the smaller muscles are overpowered.
Jeffrey Leary, MD
Orthopedic Surgeon (Total Hip and Knee Replacement)
New Providence
10. How am I going to cope with the pain from a joint replacement?
As an orthopedic surgeon who specializes in joint replacement surgery, I know that pain control is high on people’s list of concerns. A cocktail of medications, along with nerve blocks and nerve ablation prior to surgery, allows us to control pain and mobilize the joint quickly. You’re barely in the hospital for a day. You’re up and walking four hours after surgery — and you’re not miserable. I’m not saying it’s pain-free, but, for the vast majority, pain control is so good that they’re up, moving, and ready to work hard towards recovery.
11. Should I do one knee then the other, or both knees at the same time?
That’s a personal decision. If you get one knee done at a time, you’re out of commission longer but it’s an easier recovery. If you do both knees at once, there’s less downtime and no need to come back, but you’ve got to be in pretty good shape because you won’t have a sturdy leg to stand on. We don’t do bilateral knee replacements (both knees at once) for anyone over the age of 75 or who has a cardiac history. I do a fair amount of injections to nurse people along before they finally decide to have one or both joints replaced.
12. How long will it take before I’m functional and can return to activities?
I don’t restrict people much after surgery. The knee will work for whatever you feel up to, I generally tell people not to parachute or run a marathon, but I encourage them to return to the things they love as soon as they feel ready. Knee surgery takes a little longer to recover from than hip surgery. But for both procedures, when I meet with patients a year after surgery, 98% say the same thing: it wasn’t as bad as I thought and I should have done it sooner.
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