4 Common Causes of Leg Pain

August 28, 2013September 27, 2016 / Thomas Cohn, MD

Our legs are one of the most used parts of the body. We utilize them regularly – walking to work or school, and (hopefully) exercising on a regular basis. This constant use often leads to painful conditions. As with any pain, the first step to treatment is determining the exact cause of pain. With that in mind, here are 5 of the most common causes of leg pain:

Sciatica & Low Back Pain. Sciatica is an inflammation of the sciatic nerve. It can create pain that starts in the lower back and radiates down through the buttocks into one or both legs. Read more about symptoms and treatment of sciatica.
Shin Splints. Often the result of overuse and excessive amounts of exercise, shin splints are marked by sharp pain in your lower leg (usually after running). Generally shin splints can be effectively treated with rest and icing the shins.
Peripheral Artery Disease. This condition occurs when blood vessels in the leg narrow, decreasing the amount of blood supply to the leg. A person with this disease will most often feel an aching pain when walking or exercising.
Blood Clot. A blood clot is similar to peripheral artery disease in that it restricts blood flow. However, a blood clot is more severe since it completely blocks off an artery or vein, thereby cutting off blood supply. Depending on the location of the blood clot, treatment can include medications or injections to thin the blood, or surgery (in the worst cases).

Leg pain is common in many adults. Depending on the cause of the pain, it may or may not be cause for concern. If your leg pain does not go away with conservative treatment methods, or becomes severe, it’s important to seek out a physician right away.

Fibromyalgia: Symptoms & Pain Management Options

August 26, 2013September 27, 2016 / Thomas Cohn, MD

Fibromyalgia is a disorder characterized by diffuse musculoskeletal pain throughout the whole body. It is often accompanied by sleep issues, jaw pain, headaches, stomach problems, and depression. There is no special test, blood work, nerve or muscle test, or X-ray that confirms the diagnosis. Rather, diagnosis of Fibromyalgia is based on a patient’s history, medical exam, and the exclusion of other diseases that may cause similar problems.

Symptoms of Fibromyalgia

There are 2 core symptoms of fibromyalgia:

Diffuse muscle pain
Fatigue

With diffuse muscle pain even a light touch of the skin produces pain. Typical locations of muscle pain include all four extremities, head and trunk. Muscle pain often interferes with sleep, and contributes to fatigue and depression. This constellation of problems is thought to be driven by an over-active nervous system, which is hypersensitive to sensory inputs.

Treatment Options

Treatment of fibromyalgia is aimed at minimizing symptoms and maximizing function. People with fibromyalgia often greatly diminish activity and withdraw from normal interactions. A comprehensive strategy that teaches a person to understand the physical and mental aspects of the disease is often helpful. A multidisciplinary team that includes medical management, lifestyle, psychology, and physical therapy is one of the most effective strategies. Physical Medicine based pain clinics often coordinate such programs.

Medication Management

Medication management of fibromyalgia is aimed at modifying symptoms. There are 3 drugs now approved specifically for fibromyalgia. All these medications are considered neuropathics. They reduce the sensitivity of the nervous system so that stimuli are not perceived as intensely. Analgesics can be helpful when used judiciously, especially acetaminophen, anti-inflammatories, and occasionally tramadol. Symptom treatment for depression, and sleep management is also extremely important.

Fibromyalgia is a disorder that affects the whole body and every aspect of daily function. At this time, there is not a known cause and no definitive cure. Management of symptoms is the key to treatment. An experienced pain physician with a multidisciplinary team will often lead to the most beneficial personalized treatment strategy.

4 Rehabilitation Techniques for Ankle and Foot Pain

August 21, 2013May 24, 2017 / Thomas Cohn, MD

Ankle and foot problems affect people in all walks of life (pun intended). In fact, over 30,000 people sprain their ankle on a daily basis. Because your feet and ankles shoulder your weight as you move about, it is extremely important to take proper steps to avoid injury. This includes proper stretching before and after exercise, wearing appropriate footwear, and using ankle supports.

Despite our best efforts, we all know the pain associated with missing a step and rolling our ankle. Sometimes you can walk off the pain, but other times you may find yourself on a doctor’s table. Whether your diagnosis calls for physical therapy or a surgical procedure, following through with your post-visit rehabilitation is vital to ensuring your foot returns to pre-injury form. To aid in your rehab, we put together a series of rehabilitation videos that can help get you back on your feet in no time. Take a look at the videos, and check out the descriptions to learn more about how each technique strengthens your foot.

Toe Fists

Toe fists are a great exercise because they really work the muscles in your feet. The exercise also helps increase mobility and range of motion in your arches. Hold your toes in a fist formation for three seconds, then release. Repeat this exercise for a couple of minutes each day.

Bridges

Bridges are a valuable exercise because they target another area of your body that may be indirectly affected by your foot injury – your hips. While lying on your back with your feet flat on the ground, thrust your hips into the air and make a straight line from your knees to your shoulders. This stretch will build pelvic support and stabilization, which is key if you are forced to forgo weight bearing for a period of time.

Toe Splay

Toe splaying is technique used to increase the lateral range of motion in your toes. Sometimes this stretch is tough to preform after surgery, but it’s important to remember that the benefit of the exercise is the challenge it presents, more so than the movement itself.

Toe Extensions

Toe extensions can be preformed either actively or passively. You can preform the passive exercise by slipping a towel or rag underneath your toes and gently pulling upwards. This will help maintain flexibility in your toes. The active exercise is done without the aid of a towel; patients simply try to raise their toes in the air as high as they can.

About the Author:

Dr. Lance Silverman is an orthopedic specialist and founder of Silverman Ankle & Foot. Dr. Silverman is an accomplished orthopedic surgeon. He received his medical degree from Baylor College of Medicine in 1996 and is a board-certified member of the American Academy of Orthopaedic Surgeons and the American Orthopaedic Foot and Ankle Society. You can find him online his website.

4 Common Causes of Knee Pain

August 19, 2013November 17, 2015 / Thomas Cohn, MD

There are many causes of knee pain and treatment is dependent on determining the exact cause. The knee has many components including multiple ligaments, tendons, cartilage, bursa, and bones. Because there are so many components, determining the problem is often difficult. Age and activity level can often be a clue to the existing problems. Younger and more athletic people have injury type problems, while older people develop issues related to degeneration. Below are four of the most common causes of knee pain:

Osteoarthritis is the most common type of degeneration that occurs in the knee. It is the progressive wear of the joint cartilage that occurs with age and use of the joint. Read more about Osteoarthritis causes and treatment.
Obesity worsens and stresses the joints even more as people age. The knee becomes chronically swollen, and painful with activity. Treatment is symptomatic – keep the knee moving and strong, and use over the counter medications for the pain as necessary. If you are obese, try to reduce your weight to relieve additional stress. When the deterioration is severe, there are orthopedic surgeries that can help including knee replacement.
Traumatic injuries to the knee include torn ligaments, meniscus tears, and tendonitis. Bony injuries also occur to the patellar and the other bones of the joint area. The anterior cruciate ligament is the most common ligament damaged in sports, caused when there is a sudden change in direction of the body. The side ligaments can also be injured in sports. These are usually treated conservatively. The meniscus is part of the cartilage in the knee and is a shock absorber. Injury to the meniscus occurs with twisting while weight bearing, and is fairly common in older active adults. Surgical repair is simple if conservative management is unsuccessful.
Bursitis & Tendonitis. Brusitis is inflammation of small sacs of fluid that cushion ligaments and muscles around the knee. This condition often resolves with rest. Tendonitis commonly occurs to the patella tendons in runners, skiers, and cyclists. This condition is also best treated with rest.

Pain in the knees is relatively common. Traumatic injuries often respond to conservative care. If not resolving, evaluation by a physician is recommended to determine the cause and best treatment options. Age related changes, such as osteoarthritis, are usually treated conservatively as long as possible. If conditions worsen, physicians can prescribe stronger medications, special joint injections, and help determine when surgery may be beneficial.

Spondylolithesis of the Spine: Definition, Causes, & Treatment

August 14, 2013May 24, 2017 / Thomas Cohn, MD

Spondylolithesis is a condition in the spine where one vertebral body has slid forward or backward in relation to another. It is most common in the lumbar area.

As people age, the likeliness of spondylolithesis increases. The presence of spondylolithesis is not necessarily a problem, however it may lead to the spinal cord or nerve roots being compressed. The compression of the spine or nerve roots is often gradual, and sometimes leads to numbness, weakness, and pain especially in the legs. The slippage can also appear without any symptoms; therefore its presence does not necessarily mean that a problem exists. Even very significant spondylolithesis can be present with no or minimal symptoms and can be managed by very minor levels of treatment.

Causes of Spondylolithesis

The slippage in the spine is caused by problems in the posterior elements of the spine – the facets and connecting bony structures. When these joints are not functioning correctly, slippage can occur. Joint damage can occur from:

Birth defects
Physical damage by trauma or stress fractures
Arthritis

Spinal slippage can also result from sports injuries and arthritis as people age.

Diagnosis & Treatment

Spondylolithesis can be easily diagnosed with plain X-rays. Again, the presence of the slippage does not necessarily mean that there needs to be any special treatment. Many people are completely without symptoms. However, if painful symptoms do exist, there are several options for treatment.

Treatment starts with using proper body mechanics for movement, and maintaining core muscle strength. Seeing a physical therapist may help learning the right strengthening and stretching. If spondylolithesis is irritating nerves, more intense physical therapy may be necessary, and working with a pain physician may be beneficial. Chiropractic manipulation of the slippage is not advisable. If significant weakness occurs or bowel and bladder control is lost, then surgical intervention may be necessary.