WHAT IS A SPORTS MEDICINE DOCTOR?

If you or your child sustain an injury during exercise, sports participation, or any type of physical activity, you may be advised to see a sports medicine trained doctor for treatment. A sports medicine trained doctor has specialized training in both the treatment and prevention of sports-related injuries and is also knowledgeable about preventing injury in active people. These specialized doctors are board certified and have extensive additional training through residencies and fellowships.

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WOMEN'S HEALTH AND FITNESS

While many women strive for the finish line with nutrition and exercise, there is another competitor: good posture. As the fashion industry seeks to improve our appearance with sportswear, the battle exists between what looks good and what is truly reinforcing our hard efforts to sustain good posture.   Research shows we spend upwards of 5,000 repetitions of forward bending a day. Whether we are bending over to brush our teeth, tie our shoes or do the infamous leaning over a cellphone or….

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JOINT REPLACEMENT AND YOUR HEALTH AND WELL-BEING

Joint replacement is indicated for patients who are experiencing intolerable pain and problems with daily functioning. In other words, they have end-stage arthritis. The X-rays of this type of arthritis usually show “bone on bone.” We all want to maximize our health and well-being, so common questions from these patients include, “When should I have joint replacement?” and “What will happen if I wait?”

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BURNING THE NERVES

Chemical injections such as alcohol, phenol and glycerol work to destroy the peripheral nerve, but the flow cannot be controlled so the chemical may go to other structures. There is a higher risk of neuroma/neuritis formation afterwards.


Radiofrequency lesioning has been used since the 1950s. Radiofrequency energy at the tip of the electrode lesions the targeted tissue. The needle itself does not keep up, but the tissue around the tip of the needle usually heats up, causing the denervation of the nerve. This is the most common form of nerve denervation.


Radiofrequency denervation should be avoided if there is ongoing infection, bleeding disorders or pregnancy. Usually patients with pacemakers and defibrillator do not receive this type of treatment.


Complications are rare, but they can include developing bruising, infection and temporary increasing pain from neuritis that usually resolves over time, usually no more than two weeks.

Outcomes in double-blind studies indicate the success rate for short-term and long-term relief of facet joint pain is anywhere between 47 percent and 80 percent.


Evidence of radiofrequency denervation of the medial branch of the facet joint provides moderately strong evidence for short-term and long-term relief of pain originating from the facet joint. The mean duration of relief is found to be approximately 11 months. Repeat radiofrequency denervation success was at 85 percent. 

HARRY LOCKSTADT, M.D.


more articles by Harry Lockstadt

The facet joints in the spine can be a source of chronic pain in 15 percent to 45 percent of patients. The diagnosis is made, but the options are either injecting intra-articular anesthetic into the joint or the medial branch of the dorsal rami that innervated them. If the pain is eliminated by the diagnostic injection, this can indicate facet joint mediated pain.


The optimal patient for denervation of the joint is one who has chronic pain that has not responded to conservative treatment symptoms of pain in the spine or who has pain that radiates into the lower extremities. Pain that radiates into the lower extremities is suggestive of some form of nerve irritation as opposed to facet joint pain. The procedure is limited to the levels whether diagnostic did branch blocks that show a positive response of resolution of the symptoms from the diagnostic block. Most commonly three levels are targeted to denervate to adjacent facet joints.


Different forms of denervation can be utilized. They include the following:


Cryogenic denervation could allow for freezing of the nerve. These probes are larger in diameter and usually offer shorter-term ulceration compared to other modalities.


Ultrasound energy does work, but it is difficult to control the size and temperature of the lesion.