healthcare in hampton roads
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August 2012 edition "Bones Joints Muscles & PainTRANSCRIPT
HealthcareNovember 2011 Edition
Local Advancements in Medical TreaTMenTs
www.dardenpublishing.net
Bones Joints
Muscles & Pain
MedicAre for duMMiesHypnotHerApy
nutritioncHiroprActic cAre
»
HealthcareAugust 2012 Edition
Thank You Hampton Roads
DarDen PublishingQuality Publications Since 1993
Check out our Virtual World at www.dardenpublishing.net
features 3 cover story
Bones & Joints Materials for replacement joints have improved and
orthopedic surgeons have improved their techniques
over thousands of procedures.
7 Partners in Motion: Physical Therapists After joint surgery, commiting to completing your
physical therapy routine from your doctor is one of
the most important things you can do to keep
yourself healthy.
10 What’s new in Orthopaedics and Pain Management?
12 Hypnotherapy and Chronic Pain Management
14 Backing Chiropractors
departments
16 Senior Living Medicare for Dummies
18 nutrition and Wellness
Want to Improve your Diet?
Bone, Joints, Muscles & Pain
7
3
12
Healthcare
Think color!
18Healthcare in Hampton Roads 1
froM tHe puBLisHer
Hello Neighbors
This edition is dedicated to my wife Jackie and to all of you orthopaedic surgeons, physical therapists, nurses, nutritionists and support staff that share a common practice “to help us live without pain”.
In my wife’s own words: “I am one of those individuals that grew up with knee problems. Even as a young child I would wake up during the night crying because of my “leg aches”. As an adult I still experienced knee problems. I exercised, biked, walked, played golf but
the pain continued. Finally I had had enough. The pain was constant in my right knee. My family doctor referred me to Atlantic Orthopaedic Specialists in Chesapeake for consultation with Dr. Shelton Cohn and then a MRI. Not only did I have arthritis but I had a torn cartilage and menis-cus. My arthroscopic surgery was performed at The Surgery Center in the W. Stanley Jennings Outpatient Center and 4 days later I was in physical therapy at the Atlantic Orthopaedic Specialists office in Chesapeake. My PT Danielle put me through a series of measurements and then exer-cises not only to do during my therapy sessions but also at home. I was determined to “get back on my feet again” and without Danielle and my sessions I would not have accomplished it. I can honestly say I enjoyed my therapy sessions at AOS and am now walking pain free.”
Can you relate to this scenario? As an aging senior trying to maintain an active lifestyle, I wake up some mornings unable to rise and shine like I did 30 years ago. Without our support group of friends it may be difficult to eat properly or maintain our habitual exercise programs. As baby boomers, it takes a daily conscious effort to keep our mind and muscles active, after all, we want to be able to enjoy every day for as long as we can. Sitting on the couch, watching TV is no way to avoid our pain. I have lost many friends in the blink of an eye. There are no guarantees in life…that we will wake up tomorrow to share and remem-ber our life’s adventures with the love of our family and friends.
Healthcare in Hampton Roads is my newest publication with a mission to spread the word about local health awards, accolades and quality of healthcare now available for people of all ages. I see it every day when I walk among the sick and listen to their stories of how our health professionals from Hampton Roads saved a life or recommended a new procedure that put bounce back in their step.
In upcoming editions we will present national health concerns in a way that you can understand and hopefully share your newfound knowledge with family and friends so we all can live longer, healthier lives with confidence that we are in good hands right here in Hampton Roads.
neXt up: DIABETES and CheckUp America, an American Diabetes Association program working to help people lower their risk for type 2 diabetes, heart disease and cancer.
To Your Good Health!
paul Q. darden, publisher
2 www.HRHealth.net
PUBlisHer
Paul Quillin Darden
coPy ediTor
Jackie Nelson Darden
arT direcTor
Sherril Schmitz
conTriBUTinG WriTers
Brian Cole
Paul Darden
Natalie Miller Moore
Alexandra Whiteside
Shannon Woods
Diane York
©Copyright 2012 by Darden Publishing.
The information herein has been
obtained from sources believed to be
reliable: however, Darden Publishing
makes no warranty to the accuracy or
reliability of this information.
Healthcare in Hampton Roads
is a bi-annual publication with
current distribution to area Chambers of
Commerce, and a delivery program to
selected health related businesses
throughout Hampton Roads. To obtain a
copy or to find a location nearest you,
please contact:
darden PUBlisHinG
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(757) 389-5473
www.dardenpublishing.net
www.HRHealth.net
Jackie Darden
Healthcare in Hampton Roads 3
Hip and knee replacement surgeries topped over 1 million
per year in 2009, according to the Centers for Disease
Control. They are among the most successful operations
performed in the US because of their low rate of complications
and the quantity performed by surgeons, which improves the
techniques. The result is better quality of life for patients, particu-
larly less pain and improved levels of activity. But, the number of
surgeries are also increasing due to obesity putting more pressure
on joints, and the increase in arthritis diagnoses.
Patients are benefitting from the innovations happening with
the surgical aspect, but also from a better understanding of what
makes for a good surgical candidate and what the best meth-
ods are for getting them back to their favorite activities. Physical
therapists have refined their patient’s regimens to include pre- and
post-surgery therapy. Recovery time has improved, and pain man-
agement during and after surgery has as well.
Dr. James Dowd, a Joint Replacement Surgeon at the
it’s an amazing, almost science fiction-like process, to be able to remove worn
out joints and to replace them with new ones, made of metal, ceramic or plastic.
Materials for replacement joints have improved and orthopedic surgeons have
improved their techniques over thousands of procedures.
Jordan Young Institute, performs more than 2,000 joint re-
placement surgeries a year. He tells a story about his brother’s
ACL surgery in the mid-1980s, “He was in the hospital for
three days, in a cast for six weeks, and had to go to physical
therapy to get it to move. Today, the surgery is a half hour,
you can leave the same day, wearing a knee brace a few
days. With immediate physical therapy, you could be running
again in six weeks.”
Dowd feels that the innovations in joint surgery are
better, and that it’s important to get people moving again
because “motion is life.”
Diagnostic tools aided doctors in assessing patient’s joint
conditions, such as a CT scan or an MRI. Dr. Jeffrey Carlson,
from Orthopedic Spine Center, said that “the MRI scan has
revolutionized back surgery. It gives us a very clear view of
back ahead of time. We have more tools now.”
Computer assisted surgery started being used in the
By natalie Miller Moore
Bones & Joints
the 49-60 year old age group, and that the field has seen a drop
in the average age of patient in past 10 years.
That may be due to more people needing joint surgery, or
it may be because people are doing it sooner than they used
to. This is important because living with a disabled joint may
severely limit mobility, and muscles may become damaged
in compensating for the injured joint. “Don’t limit your life,”
Carlson said.
Newer treatments offer better results, and there are more
advances on the horizon, such as genetic treatments, stem cell
advancements and the ability to create replacement cartilage.
Anesthetic techniques are much better than they used to
be, including nerve blocks and
epidurals for lower extremi-
ties. “This keeps patients
awake, they are sleepy but
there’s no tube down the
throat. There’s less feeling
a loss of control, and it
helps patients, they are
not worried about
going to sleep
and not nauseous
from anesthesia,”
Carlson said.
Opinions
vary about joint
surgery as an
outpatient proce-
dure, but increased
availability of home
nursing care and physi-
cal therapy follow up
seem to be leading
in that direction. The
orthopedic field seems
to follow a fairly ath-
letic mindset, one of
“let’s get back on the
field.” That means they
are finding ways to in-
novate to get patients
back into their lives.
A Sentara coor-
dinator for inpatient
rehab and physical
early 2000s, allowing for more precise reconstruction. Dowd
said that an increase in minimally invasive techniques means
less cutting, better pain control, and a quicker recovery. When
the patient is more prepared for the surgery, the surgery itself is
more precise, and the recovery and physical therapy protocols
are improved, hospital stays become shorter.
“When I was training 10-12 years ago, folks would stay
in the hospital for weeks,” said Carlson. Replacement joints
are lasting longer, too, which makes the replacement surgery
more successful. He also said that “materials in knee
replacements last 30 years rather than 10-15 years.”
All hip and knee replacements involve a two parts: a bear-
ing and a bushing, basically the ball
and cup of the joint for a knee
or hip, with some variations.
These parts can be made
from ceramic, metal
or polyethylene plastic.
“Think of it as going from
20,0000 miles to 100,000
miles of wear,” said
Dowd.
Parts that
are attached
to the bone
may be co-
balt chrome
or titanium,
because
they don’t
need to
move like the
joint parts. The
doctor decides on
the materials based
on the patient, in a
case by case fashion.
Dowd said that
a younger person
who is highly active,
might get a ceramic
ball with a high
density plastic liner.
He said that more
joint replacements
are being done in
4 www.HRHealth.net
a Sentara physical therapist assists an orthopedic surgery patient to get mobile as part of the rehabilitation process.
PHOTO COURTESY OF SENTARA
cover story
therapist Sandy Slovak said, “We help people get back on the
golf course. Someone might set the goal of a certain tee time,
or to dance at their 60th anniversary party.”
Here’s the scene at one Sentara hospital that shows just
how they do that: On the whiteboard, the man saw that the
woman had moved her marker ahead of him. So he took the
long way to get in the extra feet to pull even with her. The most
remarkable thing about this competition? It’s happening on
the Sentara Orthojoint Center floor with people who had knee
replacement surgery a few DAYS ago.
Everything about joint replacement has changed, from the
materials to the techniques, and especially the physical therapy
to get people back on their feet again. The OrthoJoint program
creates a class of people who have scheduled surgery around
the same time, work together on physical therapy, and encour-
age each other to do the work needed to recover from their
surgeries. They cheer each other on down the hall.
Kay Domine, 64, was in for her second knee surgery in
two years – she’d had the right knee joint replaced last year,
and the left one in April 2012. “I can already tell the difference,”
she said, as she worked her knee with the physical therapist.
Domine said that she’d had problems with her knees since
childhood. Was it daunting to have surgery and face the
recovery process again? “I asked myself, ‘Could I do it again?’
and decided that I could.”
KJ said that choosing to do the OrthoJoint program this
time helped her feel stronger sooner. “I realized I could move
my leg without my cane, and the muscles are healing sooner,
she said. “It’s creating a different experience and I think it will
be a different story than last time.
Her competitive cohort, Donald Kent, 73, a former
military man, worked equally as hard on stretching his leg after
surgery. They compare notes on stitches, staples, glue and
wraps.
Each day, they measure the angle that the knee can
bend to, with the same physical therapist, who knows what
benchmarks they should be reaching, and where each patient
was the day before. Physical therapy is for one hour twice a
day. The goal is for patients who have surgery on Monday to
be discharged by noon on Thursday.
Rita Wade acts as the Orthopedic Patient Navigator for
her patients, encouraging them to call her with questions. RN
Rita Wade supervises the program for hip and knee replace-
ments and she gave the Williamsburg unit a revolutionary
theme.
“People often say ‘I’ve had enough. Something has to
change.’ We have them sign their ‘declaration of indepen-
dence,’” she said. The markers on the leaderboard are even in
the shape of small revolutionary soldiers. If there’s a big improve-
ment, you get a cannon!
The Orthojoint Center is laid out in a triangle with three
hallways and nurses stations at each corner of the triangle. Maps
indicating the hallway’s distance in feet help encourage patients
to continue working their new joints. If they take a longer route,
they could go 352 feet rather than the shorter route where
they turn at a smaller hallway, which is a total of only 216 feet.
Whichever way they go, they are getting moving and that
matters a great deal to patients who’ve had joint surgery.
As part of the OrthoJoint program, patients and their
families are asked to first attend a class to educate themselves
about the process of having joint surgery and what kind of
commitment they’ll need to make to their recovery. One person
is designated the coach, usually a spouse or adult child, and
they encourage the patient to do their exercises during physical
therapy in the hospital and at home. Wade provides them with a
guidebook which includes what to expect prior to surgery, infor-
mation about their hospital stay, as well as the exercises week by
week for their “homework.”
Surgeries are scheduled at the beginning of the week and
every patient on the floor attends group physical therapy. The
Donald Kent, 73, works his way down the hall after his knee replacement surgery to his physical therapy session, aided by staff at the Sentara Williamsburg OrthoJoint Center.
Healthcare in Hampton Roads 5
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“class” gets to know each other during lunches and it “builds
camaraderie and competition.” They wear loose street clothes,
mainly shorts and T-shirts, to emphasize that they are not sick. They
are working towards returning to an active lifestyle.
In a change from past philosophies, patients are encouraged
to walk sooner after surgery. Bev Sabourin, the Nurse Manager
on the floor, called this “early ambulation.” They have large blue
recliners that staff follow them down the hall with, and that’s what
they use in the PT
room. The recliners
are designed with
no gaps between
the seat and the
footrest, preventing
the leg from being
able to fall through.
It’s a chair that’s all
one seamless piece,
and square plastic
exercise boards slide
under the legs to
allow more acces-
sibility for PT. “People
are surprised how
quickly they can
walk. Sometimes it’s
the day of surgery, if
they are stable, don’t have any nausea and their pain is managed.”
Rita Wade.
“Quality of life triggers it (the decision to have surgery.) Pain
issues vary from chronic to severe. People wait as long as they can,
until it’s impeding their walking, or driving even. They might have
to use a walker or a wheelchair,” Sabourin said.
6 www.HRHealth.net
This new program emphasizes on the whole patient, and get-
ting them moving more quickly after surgery. Research shows that
with this method clinical outcomes improve, patient satisfaction
increases, and length of stay decreases. Sentara has five facilities of-
fering this program currently, including Sentara Lee, Obici, Princess
Anne, Virginia Beach and Williamsburg.
“One of the benefits of this program is that you have team-
mates who get you moving, and raise expectations. We have
people doing laps
around the floor,
laughing,” said
Wade.
Patients are
still followed after
they go home, to
make sure their
functional and
clinical results are
on track. As part
of the OrthoJoint
program, there’s
a reunion lunch
three months
after the surger-
ies, so everyone
can get back to-
gether with their
classmates. Rita Wade acts as the Orthopedic Patient Navigator for
her patients, encouraging them to call her with questions. They
meet in the same multipurpose room where they did their physical
therapy, as a reminder of how far they’ve come. Wade said that
patients are thrilled and showing off what they can do – and see
how far their new joints can move!
Sentara OrthoJoint Class with OrthoJoint navigator at Sentara Leigh ann Phillips. One big element of the new patient centered experience of the OrthoJoint Centers is the OrthoJoint navigator and her accessibility and collaboration with patients.
COnSuLTinG an ORTHOPeDiC SuRGeOn
Here are some signs that you might want to consult an orthopedic surgeon:
• Are you limping?
• Do daily activities seem to be getting more difficult?
• Is pain keeping you awake?
• Have you tried other treatments for a reasonable amount
of time without success?
• Are you in general good health except for your joint?
• Have you given up activities you enjoy?The Sentara Patient Guide offers very detailed
information about how to plan for joint replacement, pre-operative schedules,
education and information about recovery.
PHO
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Healthcare in Hampton Roads 7
pHo
to c
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After joint surgery, one of the most important things you can do to keep yourself
healthy and be on the road to recovery is to commit to completing your physical
therapy routine from your doctor. Having to go to a physical therapy center three
times a week can be time consuming – but it may be worth it.
“the people who get better, do their homework,” said Tony Grillo, a physical therapist with tidewater physical therapy. Going to a physical therapy center can be motivating. “people may do a small number of exercises at home, and they might do 1 or 2 of them, but not all 12,” Grillo said. working with a physical therapist can make patients more compliant, and encourage them to keep the effort up. Grillo said he thinks it’s important to be an active participant in the recovery.
Wayne MacMasters, the president of tidewater physical
therapy, said that “Good therapy is timing.” Muscles heal best when they are activated and remain flexible, like rubber bands. not following a therapist’s exercise prescription could cause them to help more like ropes, and become stiff. But besides those recovering from surgery, many people dealing with orthopedic issues, chronic illness, sports injuries or pain can benefit from physical therapy. A trained and licensed physical therapist is an expert in movement, so they can assess your issue and create a plan to strengthen muscle,
Partners in Motion:
PHYSICAL THERAPISTS
By natalie Miller Moore
8 www.HRHealth.net
cover story
as well as control pain. There are a num-
ber of techniques, such as hands-on
mobilization and manipulation, as well as
heat to relax muscles, exercises, ice and
compression.
PTs (what physical therapists are
often called) may also prepare patients for
the surgery by helping them strengthen
their body so it’s in better shape to recov-
er. It’s also possible that physical therapy
can help joint issues so that surgery isn’t
needed, depending on the individual
issues.
Physical therapists can do manual
procedures to check the function of differ-
ent parts of the body, and assess whether
a joint is hypermobile or unstable (moving
too much) or if there is insufficient move-
ment and it’s too stiff or there is too much
scar tissue. The goal is strength and stabil-
ity for long term function.
A physical therapist can also be
like a detective looking for the cause
of problem; for example, sometimes a
knee hurts but it’s the actually hip that’s
weak. MacMasters gave an example of
a woman having pain on her right side,
particularly her shoulder. When they
discovered she worked in a narrow office
where her phone and her door were
sharply to her right, they suggested some
counter exercises – and that she rearrange
her office.
MacMasters said that for patients,
starting with physical therapy, or just hav-
ing an evaluation, is a low risk proposition.
“It’s non-invasive, we don’t use meds, and
it’s a reasonable and conservative first stop
option for a lot of patients,” he said.
The Comber Physical Therapy
practices in Williamsburg also promote
physical therapy as an alternative for
Joe Flannery, DPT, CiMT Williamsburg Physical Therapy Clinical Director includes cuboid supination mobilization in plan of care for patient with persistent lateral ankle pain.
Joe Flannery, DPT, CiMT Williamsburg Physical Therapy Clinical Director evaluates patient’s degree of shoulder impinge-ment. Shoulder impingement dramatically limits patients’ ability to perform many overhead, behind back, and across body activities of daily living (aDLs).
a CiMT certified therapist is trained to identify the underlying CauSe of patient’s
complaint, not just treat the symptoms.
(Page 7) Tony Grillo, DPT, OCS, CiMT & Clinical Director at Tidewater Physical Therapy transitions patient from aquatic to land based therapeutic exercise. aquatic Therapy allows patients with serious limitations to enjoy the benefits of gentle physical therapy with less pain. Conditions including: Leg fractures that cannot bear weight, Lower back problems, Post-surgery, especially lumbar laminectomy or reconstructive joint surgery, arthritis, osteoporosis and fibromyalgia benefit from aquatic therapy.
s
s
s
PHOTOS COURTESY OF TIDEWATER PHYSICAL THERAPY, INC.
Healthcare in Hampton Roads 9
www.tpti.com
32 Locations in Richmond, the
Peninsula & Southside
Hampton Roads
Our people.Independence.
Professionalism.Relationships with physicians and patients.
Specialized therapy and professional growth.
Dedication to clinical excellence and improving the lives of others.
Belief that physical therapy is a noble profession.
Knowledge that physicians use our services because they believe that we are the best option for their patients.
SOUTHSIDE: Virginia Beach Smithfield Kempsville Western Branch Great Bridge Battlefield Windsor Franklin PENINSULA: Executive Drive Magruder Oyster Point Tidewater Performance Denbigh Hidenwood WILLIAMSBURG: Williamsburg PT Williamsburg ASC Williamsburg Hand Therapy Norge Gloucester Courthouse Gloucester Point RICHMOND: West Point Brandermill Colonial Heights Glen Allen Kings Charter Midlothian John Rolfe Mechanicsville Ironbridge Powhatan Laburnum West Hampton
The Strength of Tidewater Physical Therapy is
considering surgery, or at least as the first
step. “People have a tendency to go down
the surgical route, and we educate them
on conservative treatments like lifestyle
changes – because many of them haven’t
exhausted conservative care plans yet,”
said erika Comber, the owner of Comber
Physical Therapy. “We say, ‘let’s try this,’ or
‘we’ll strengthen you before surgery’ and
they’ll tolerate it better,” she said.
The Comber post-rehab program
provides a safe place for people, particu-
larly older patients, to continue their exer-
cises. “They already know how to set up
the equipment, so that level of comfort is
already there,” she said. The atmosphere
is positive and she said that “people feed
off of the energy” as they work to build
strength and endurance. “Our patients
undergo a transformation, and we get
rewards in the form of hugs. It’s the best
job in the world,” Comber said.
One of those patients is Claire Sink,
age 68. After her second back surgery
and recovery in 2004, Claire continued
physical therapy at her doctor’s suggestion.
“The surgeries significantly improved my
quality of life, and so has in-depth physical
therapy. My muscles have been recondi-
tioned,” she said.
She continued with the post-rehab
program, and still exercises several times a
week to keep her muscles in shape. She
finds Comber’s post-rehab center very sup-
portive and friendly.
“I would go to Comber PT a couple
times a week to work on my muscles,
joints, and the overall mechanics of motion.
In essence, the PT provides a comprehen-
sive systems perspective to my exercising
that is enhanced over working with a
trainer at the gym. I do my own timing
and charting, with the PTs and technicians
overseeing my technique and form.”
Sink said that her advice to other pa-
tients is that they develop a regular exercise
routine, and stick with it.
“Patients need to understand once
they complete a physical therapy program,
they just can’t stop exercising and expect to
stay fit. They should continue their own
regimen, or do one under the guidance
of a PT or trainer,” she said.
She feels that having a regular place
to work out gives her accountability and
motivation.
“I know that I’m expected to be
there – it gets you there. Because you
don’t want to go back to have to do
rehab, you don’t want to lose ground, so
you have to have motivation and dedica-
tion to do it,” Sink said.
There are a variety of patients who
visit physical therapy, including chronic
illness, orthopedic issues and balance
dysfunctions. Comber said that balance
issues related to aging are often discour-
aging for people. “They lost hope and
faith. But when you tell them they can be
better and still be healthy, it makes them
so happy,” Comber said.
Physical therapy offices offer a vari-
ety of methods to help you get moving
again, which truly makes them partners in
motion.
In keeping with the theme of this edition of Healthcare in Hampton
Roads, the physicians at Orthopaedic & Spine Center have been asked to
comment on the medical innovations that are providing the most relief
to their patients or that are most-greatly impacting their quality of life.
Q: What unique surgical innovation has most influ-enced the care of your shoulder pain patients?
a: The greatest single advance in management of shoulder pain
in my career has been the development of arthroscopic shoul-
der surgery. Early in my career when the only alternative was painful
open surgery for conditions such as rotator cuff tears, many patients,
even physicians, chose to simply live with their pain. Today, the vast
majority of patients with shoulder pain can be successfully treated via
out-patient arthroscopic surgery, done through several small incisions.
This allows us to see clearly all the details of the anatomy, and carry out
repairs without large incisions, resulting in a shorter, less painful recovery.
The “Scope” has revolutionized shoulder surgery, and this technique
now represents the primary focus of my practice.
Martin Coleman, MD – Orthopaedic Shoulder Specialist
Q: What medical innovation(s) is having the biggest positive impact on the care that your
chronic Pain patients are receiving?
a: I believe that the biggest breakthrough we are seeing in the
field of Pain Management is the development of the Interdis-
ciplinary Pain Management team. This involves gathering experts in
the areas of Interventional Pain Management, Orthopaedics, Physical
Therapists and other Specialists (as needed) to collaborate in the care
of Chronic Pain patients. Using this team approach, I find that we can
actively manage patient care and work together to achieve the best
outcome. The patient benefits from such concentrated attention and,
as a result, they tend to live more active lives with less pain.
Jenny L. andrus, MD – interventional Pain Management
Q: as an orthopaedic surgeon and Fellowship-trained spine specialist, what advances in
surgery, medical technology or delivery of pain medi-cation do you believe most benefit your patient’s?
a: Minimally-invasive hip and knee replacement surgery offer
my patients the biggest life changing experience in the least
amount of time. My patients go into surgery, barely able to walk and
suffering a great deal of pain. They come out of surgery, in much less
pain, even after having a major operation, and walk with much greater
ease the same day of their procedure. Their recovery time is relatively
quick as well. Pain relief has been greatly aided by the use of the femo-
ral nerve block for knee replacement patients.
For patients with pinched nerves from herniated discs, Epidural
steroid injections offer great pain relief for those who do not want to or
cannot have surgery. Pain relief is usually felt within a week of having
the injection, lasts months, or even years, in some cases.
In the area of oral medications, extended-release formulations are
affording patients longer-lasting, stronger pain control without having
to ingest so many pills so often.
In spine surgery, better instrumentation is allowing us to operate
on the spine in a much more minimally-invasive way, minimizing blood
loss, scarring and infection. The biologics (bone proteins used in spine
fusion surgeries) are getting better and better and we are seeing more
successful fusions with fewer non-unions. Mark W. McFarland, DO – Orthopaedic Spine/Total Joint Replacement
Orthopaedic & Spine Center is an independent, physician-owned Orthpaedic and Interventional Pain Management Specialty practice that provides world-class patient care in a state-of-the-art facility in Newport News, VA. To learn more, check out their website and patient success stories at www.osc-ortho.com. To make an ap-pointment, please call 757-596-1900.
what’s new in orthopaedics and pain Management?By shannon Woods, osc outreach director
10 www.HRHealth.net
Healthcare in Hampton Roads 11
12 www.HRHealth.net
the benefits of hypnosis as a thera-peutic tool are wide ranging, including treatment of chronic pain, phobias, and unhealthy habits. Beyond empirical and anecdotal evidence, numerous clinical trials have returned impressive results on the effect of hypnotherapy in the man-agement of various pain conditions, such as childbirth, burns and fibromyalgia. through professionally guided suggestion by a hypnotherapist, the client is able to distance themselves from their pain and even decrease their perception of pain.
Hypnotherapy also assists the client in peeling away mental
layers of pain – memories of yesterday’s pain, anticipation of
tomorrow’s pain – which are piled on top of the
actual root cause of pain. By peeling away these
mental and emotional memory layers, the
perception of pain can be reduced to a level
where medical care and physical therapy
have a greater effect, the client can be-
come more functional with an improved
quality of life, and medications may
even be decreased or discontinued
(under the direction of a medical
professional). A 1991 study by
Haanen et al demonstrated that
a group of fibromyalgia patients responded to hypnotherapy
with reduced symptoms of pain and fatigue, and required less
medication than the group that did not undergo hypnotherapy.
His conclusion was that “in professional hands it is a safe and
inexpensive mode of treatment.”
Hypnosis is a natural state of mind that everyone passes in
and out of multiple times each day. When you daydream, get
lost in a book or are riveted by a good movie, when you’re driv-
ing and you realize that you don’t remember the last few miles
you’ve just driven – you are experiencing a natural hypnotic
state. Hypnosis is essentially a state of extreme focus, where
the usually busy conscious mind (beta wave activity) is quieted
down, and your subconscious (alpha and theta activity) is at the
helm instead. This is deep relaxation but is not deep sleep. This
is what allows you to experience mental imagery, to “get lost in
thought,” and to suspend disbelief in order to enjoy a thrilling
book or film.
Clinical hypnotherapy harnesses the natural hypnotic state
for therapeutic purposes. The hypnotherapist guides the client
purposefully into a state of relaxation and intense focus on
the issue to be treated. Many people express the fear of
“handing over control” to the hypnotherapist. This fear
stems from an erroneous mindset the general public has
developed largely due to the fictional way that hypno-
sis is portrayed in movies. The Mayo Clinic reports,
“Although you’re more open to suggestion during
therapeutic hypnosis, your free will remains intact
and you don’t lose control over your behav-
ior.” Even in a deeply relaxed state, you can
still hear what’s going on around you, and
you have complete control over your ability
HYPNOTHERAPY and chronic pain Management
By alexandra Whiteside, cPc, cHT
Healthcare in Hampton Roads 13
to move and respond to your environment. In natural hyp-
nosis, you are able to instantly respond to the sound of your
child suddenly crying, no matter how engrossed you are in a
book, for example. The same holds true in a clinical hypno-
therapy setting. You can move, scratch an itch, take a drink of
water or respond instantly to an emergency. It is you, the client,
who is in complete control during the session. The hypno-
therapist simply provides verbal suggestions to guide you into a
relaxed state and then to guide you through various therapeutic
imagery techniques. You can choose to accept or reject any of
these hypnotic suggestions, which means, if you are directed to
cluck like a chicken, and you don’t want to cluck like a chicken,
you simply are not going to cluck like a chicken. (Participants in
stage hypnosis shows are chosen because they have naturally
exhibitionist personalities and are highly likely to act on the hyp-
notist’s suggestions. They want to cluck like chickens! They are
not being forced or controlled.) So, contrary to popular belief,
hypnosis cannot be used to control someone else’s mind.
The hypnosis session typically progresses through five
stages: pre-induction, induction, deepening, therapeutic
suggestion and termination. The pre-induction period is an
interview between the hypnotherapist and the client to discuss
the client’s issues and address any concerns the client has
about hypnosis. Induction is the first stage of hypnosis, with
the hypnotherapist guiding the client into a relaxed state,
followed by deepening which takes the client into a deeper
state of hypnosis where imagery and hypnotic suggestion can
be utilized. Therapeutic suggestion can be accomplished via
a wide range of modalities such as
disassociation, guided imagery and
anchoring. In chronic pain manage-
ment, disassociation can help the client
remove themselves from their pain.
An example of guided imagery to help
lower perceived pain levels would be
envisioning cooling water washing
away the pain. Of course, the guided
imagery process is more involved and
detailed than this brief description.
Anchoring is a technique that enables
the client to activate a mental pain con-
trol mechanism as-needed outside of
hypnosis. A common anchor is pressing
the thumb and forefinger together as
a signal to the subconscious mind to
“feel” the cooling water flowing over
the area of pain. The anchor sugges-
tion is implanted in the subconscious
prior to termination of the hypnotherapy session. Termination of
the session is achieved by bringing the client back to a normal,
conscious state, usually by counting to 5, and then re-orienting
the client to time, since the awareness of time tends to be dis-
torted during hypnosis, the same as “losing track of time” when
you are totally immersed in an enjoyable activity.
The emphasis of chronic pain management is on improving
the quality of life. “Pain is a multifaceted, complex phenomenon
which can be treated successfully by hypnosis.” (Dowd) Hypno-
therapy offers numerous advantages with no side effects or risk
of addiction. When carefully integrated with medical treatment,
hypnosis can be clinically utilized to enhance the mind-body com-
munication with impressive results.
Sources:
Haanen H et al. Controlled trial of hypnotherapy in treatment of refractory fibromyal-gia; J Rheum 18:72-75 1991
Mayo Clinic online: http://www.mayoclinic.com/health/hypnosis/MY01020
Dowd, E. Thomas. Cognitive hypnotherapy in the management of pain; Journal of Cognitive Psychotherapy, Summer2001, Vol. 15 Issue 2, p87
Alexandra Whiteside is a certified life coach and certified hyp-
notist with advanced training in integrative clinical hypnotherapy.
Ms. Whiteside owns and operates Selformations, a wellness
coaching and hypnotherapy firm. www.selformations.com
14 www.HRHealth.net
this specialty hasn’t always
gotten respect – in fact, the
American Medical Association
boycotted chiropractic until
1987. this was determined to be illegal
by the supreme court, but the residue
of that bias still remains in the way that
chiropractors interact with the medi-
cal establishment. But that is chang-
ing, both with the many people who
turn to chiropractic care because of the
emphasis on treating the whole person,
and because of the evolving interaction
with the medical community.
Dr. Daniel Shaye, a second-generation chiropractor
and acupuncture provider and co-founder of Performance
Chiropractic, said that he gets referrals from medical doctors.
“Modern chiropractic methods have a growing body of
research supporting them; but there is a metaphorical, poetic
aspect that is an advantage in communicating with the pa-
tient, but a disadvantage in communicating with the medical
community,” Shaye said.
He also said, “Some physicians refer with a better under-
standing of what we do, and some have less of an under-
standing. What referring physicians have in common is recog-
nition that risks of chiropractic are relatively low compared to
other options, our outcomes are positive, and patients have a
very high level of satisfaction with their care.”
The people who walk through the doors of chiro-
practic clinics often come due to complaints of pain in their
neck, back, spine, or arthritis, headaches, sprains, or strains.
Sometimes they are patients who distrust the conventional
medical community or who have exhausted other options,
but more commonly, they are people just looking for the
least invasive path.
“I have seen a chiropractor for my back pain because
they are really good at keeping things aligned correctly and
can suggest exercises or lifestyle adjustments to help prevent
a reoccurrence. They help me fix the problem without sur-
gery and don’t try to mask the pain with pain killers,” said
Heather Hughes Ostermaier, from Newport News.
erika Comber, founder of Comber Physical Therapy,
actually added a chiropractor to her staff last year, because
she’d seen a demand for it from her patients. They were
going to see a chiropractor off-site anyway, so she thought
she’d make it one stop shopping for them.
Comber said she wanted to have her practice centered
around “treating the whole person” and the practice cur-
rently includes a chiropractor, in addition to physical thera-
pists. Keeping with that philosophy, the practice also offers
massage therapists and recently added a holistic nutritionist.
The chiropractor at Comber Physical Therapy, Dr. Michelle Booth, said that one of the best ways a chiroprac-
tor can help a patient is to alleviate chronic pain. Booth said
she sees people in pain, mainly in their back or neck, and it
tends to be recurring rather than sudden, traumatic pain. “It
doesn’t have to be catastrophic…we are improving quality
of life. It might not be a life or death situation, but we are
helping people do things they want to do again,” she said.
She also said that chiropractic is becoming more
understood and more conventional, and that working with
physical therapist has helped open doors. “It might take a
PT telling a patient, ‘I can work on muscles, but the align-
ment or rotation – this is hindering your progress. The best
way to get at that is to be adjusted’ (by a chiropractor.)”
Booth enjoys working in a multi-disciplinary environ-
ment. “We are working together here to give patients
the best of both worlds. There’s a multiple care approach
Backing chiropractorsBy natalie Miller Moore
for a single patient -- several people with
different disciplines looking at them and
communicating with each other,” she said.
For example, she said she might notice a pa-
tient’s shoulder is tight after an adjustment,
and refer them to a PT.
Many people see physical therapists
after injuries or to recover from orthopedic
surgery. For people who are seeing a
chiropractor after joint surgery, there
can be a change in the dynamics of the
body, and the chiropractor can make sure
everything is aligned, adjusting to a new
hip or knee.
Booth mentioned that during the
recovery process, a patient may experi-
ence some low back discomfort from
leaning or using crutches. Adjustments
“can really help, with function improved
and discomfort lessened,” she said.
It’s up to you to decide who makes
up your team of health care providers – a
chiropractor may be an addition you’d
like to make.
When should you see a chiropractor?
You know your body the best, so ask these questions:
•Doyouhaverecurrentinjuriesor aches that don’t seem to heal over time?
•Doyouhaveneckpain,backpain, or chronic aches and stiffness that you attribute to “just getting older?”
•Doyoufeeloutofbalanceoruneven?
•Doyourshoesshowunevenwear patterns, or do you suspect you have a short leg?
•Areyouunableorunwillingto tolerate the negative side effects of pain medications?
•Doyouturnyourwholebodyto check your blind spot rather than just your head?
•Areyousittingatacomputer8 hours a day, or perform-ing any repetitive, physically stressful activity?
•Haveyouhistoricallyhadbackpain, neck pain, or sprain/strain injuries?
Healthcare in Hampton Roads 15
16 www.HRHealth.net
Make yourself a cup of your favorite beverage, something warm
and comforting, tea, hot chocolate or something stronger. depend-
ing on your perspective you want to either sharpen your senses
with caffeine or dull them with something else. find a comfy chair
with good light, get your pen and legal pad and listen up as i tell
you about one of the most mind-deadening topics of all time, the
wonders of Medicare and supplemental health insurance.
Medicare – what it provides and how you
get it.
Medicare is a program designed to help
the elderly (65 and over) to get their medi-
cal needs covered. If you are receiving Social
Security benefits now you will automatically
receive a little pulp paper card in the mail
with your Medicare number on it. If you are
not receiving benefits yet- you can call and
apply for both Social Security and Medicare.
Medicare will cost you about $99 – deducted
from your social security check. There are two
parts. Part A covers hospital bills and part B is
for doctors and other medical expenses. Part
A, (hospital bills) pays for the first 60 days in
the hospital and most of the cost for the next
61-90 days. Part B pays 80% of your other
medically related expenses. This is a good deal
but you will still have a deductible for both
part A, hospital (around $1,000) and for doc-
tor’s bills, part B (usually about $135.) Simple,
right?
Yes, until you start looking at supple-
mental insurance (also called Medigap) to cover extra hospital days and that 20%
leftover from part B. Supplemental insur-
ance that you buy may cover an additional
365 days in the hospital (very handy) and
the 20% for doctors and other services not
paid by Medicare. Since hospital bills can be
astronomical this is a good idea.
The cheapest supplemental insurance
is called Part C or Medicare advantage.
These plans can be virtually free. You still pay
the $99 for Medicare but there is often no
other monthly charge. These plans operate
like your typical HMO or PPO plans. There
are significant limits to charges and co-pays
and deductibles. They may work for you if
Medicare for DummiesBy diane york
you are very healthy and plan on staying that
way. But because your choice of providers is
limited to your network, it won’t work if you
travel a lot or spend your winters in some
warm, sunny place other than your home
state.
Other supplemental insurance plans
are simply private insurance plans that fill in
that 20% gap that Medicare Part B does not
pay and perhaps the deductibles for Part A &
B. The cost runs anywhere from about $40
to $170 or more per month. Most major
health insurance companies offer their own
Medigap plan and AARP is associated with
one through United Healthcare. These rates
depend on where you live and which insur-
ers are in your area.
Confused yet? No, that’s good because
there’s more. Each company may offer as
many as 5-14 different plans designated by
the letters A-N. The plans are similar com-
pany to company. For example, the “F” poli-
cies provide the most benefits and cost the
most and are similar with United Healthcare,
Aetna, Anthem and others. What are the
differences in these plans? Predictably, the
higher the price, the more coverage you get.
The biggest other differences in options are
below:
Differences in supplemental insurance:
1. Whether or not the price will increase
each year per your age or stay the
same. Policies labeled age-related
increase as you age while others called
community or issue related do not.
All of these Medigap policies may
increase in price each year, but age
related policies will definitely increase
each year.
2. The number of extra in-hospital days
the supplement will pay for. (Some
pay as much as 365 extra days.)
3. The number of skilled nursing home
days the policy will pay for.
4. The amount of part B (doctor and
other services) each plan will pay for.
For example, each company may
have 5 or more plans. Some will
pay 100% of Part B expenses not
covered by Medicare, some 75%,
some 50%.
5. “Excess charges,” charges from hos-
pital or doctor that Medicare does
not find necessary or acceptable.
6. Foreign travel emergency care.
Hang in there- we are almost done.
One last wrinkle, none of these plans cover
your prescriptions. So if you want that
coverage you need Part D, (think D for
drugs.) If you are not on any long term
meds right now and do not have a chronic
illness you can let the drug coverage go
until later. If you wait to get drug coverage,
you will be able to apply only once a year
and there is a penalty to wait. For example,
let’s say you are in good health now and
not taking any medications and so you do
not elect to get drug coverage. Five years
from now however, you decide you need
it. Your penalty for waiting would be 1%
of the average monthly cost (now about
$40) which is .40 cents multiplied by the
number of months you waited, in this case
60 months. Your drug coverage would
cost the normal price- say $40 plus $24 a
month penalty. Drug coverage would then
cost you $64 per month if you wait till year
five to subscribe.
These are pretty much the basics of
Medicare. But just in case you were won-
dering what Medicaid vs. Medicare is,
let me explain. Medicaid was designed to
provide critical medical care for those with
little or no income and for those who are
disabled. If you are already receiving Social
Security Disability income you will qualify
for this regardless of age. If you are Medi-
care eligible by virtue of your age and have
virtually no income and less than $2,000 in
the bank, you may qualify for Medicaid in
addition to Medicare. In that case Medicaid
will kick in that extra 20% that Medicare
does not pay as well as the $99 per month
charge for Medicare (and you won’t need
to read about all those supplemental plans.)
Now for some good news. A really
great thing about both Medicare and
Medicaid is that they both cover some
preventive services that your health
insurance may not. These tests are not
provided every year, so check the Medi-
care website (below) or call to get more
specific information.
Some preventive services covered
by Medicare and/or Medicaid include:
Abdominal Aortic Aneurysm Screen-
ings, Alcohol Abuse Counseling, Bone
Mass Measurements (Bone density tests
for Osteoporosis.) Cardiovascular Dis-
ease and Screenings – Cholesterol, lipid
and triglyceride levels and a once a year
visit with your doctor to discuss preven-
tion of heart disease, hypertension and
dietary recommendations. Colorectal
screening tests to detect any signs
of colon or rectal cancer. Depression
Screenings, Diabetes Screenings and
Diabetes Self-Management Training,
EKG Screenings, Flu Shots, Glaucoma
Tests, Hepatitis B Shots, HIV Screen-
ings, Mammograms, Medical Nutrition
Therapy Services, Obesity Screening
and Counseling, Pap Tests and Pelvic
Exams, Pneumococcal Shots, Prostate
Cancer Screenings, Sexually Transmitted
Infections Screening and Counseling,
Smoking Cessation (counseling to stop
smoking.)
And you were wondering what
to do with all that free time once you
retired……
This US government website lists all the
carriers in your area and will help you
compare respective plans http://www.medicare.gov. You can call Medicare
at 1 800 Medicare or 1 800 633-4227.
They will ask for your Medicare number.
If you don’t have one yet simply say
“agent.”
senior LivinG
Healthcare in Hampton Roads 17
18 www.HRHealth.net
a decrease in joint inflammation. It’s also a great way to
increase antioxidants, by consuming dark red and purple fruits,
such as plums, grapes, cherries. You want to avoid having a
monochrome diet of tan fried foods!
It’s a dietician’s job to help people change the way they eat
– and they often are great resources for small steps to improve
eating habits. Johnson said that many people make assumptions
about what “seeing a dietician” might involve.
“It can be so positive if dietician knows how to
individualize,” she said. “It’s about helping them to their goals.
People often say ‘I don’t know what to do… where should I
start?’ and that’s where we can help.”
Johnson said that people often confess that they don’t
want to see a dietician because they think the dietician will
forbid them from eating their favorite food.
“I don’t do diets. You aren’t on a diet --
This is you making slow changes. My job is to
let people know that all foods can fit – but
the key is: frequency and amount!”
Unfortunately, the typical
American diet is made up of refined
grains, and high sodium foods,
saturated fats, transfats, and
cholesterol, all of which contribute to
the development of heart disease. Our
bodies were not designed to consume
or digest these foods in large amounts.
We’ve gotten off track and dieticians are
trying to help steer everyone towards healthier
options.
If you would like more tips, or a more personalized plan for
your life, think about consulting a dietician. They can help, or
they can reinforce that you are making good choices. Ask your
doctor if you can be referred to a dietician or find out if your
hospital system provides this service. If you want to do more
research about diet or joint health, see resources next page.
W hether you are facing joint surgery
or chronic joint pain, improving
your diet can improve your symptoms, and
how you feel about your overall health. Two
dieticians want you to know small steps are
the way to making healthier eating choices.
Both dieticians said that there is no proven way to change
the progression of a disease, but that changes to your diet can
decrease inflammation, and a healthier diet can benefit your
entire body.
Dietician Chantye Johnson, a certified
diabetes educator and outpatient dietician
from Sentara, said, “Healthy eating helps,
no matter the reason. Maintaining a
healthy weight is important for joint
health, because it puts less pressure on
the joints.”
Katherine alice Werner, a
registered dietitian at the Riverside
Medical & Surgical Weight Loss
Center, said that, “Both eating right
and incorporating physical activity into
your day are key components for a healthy
lifestyle. Eating the right foods – whole grains,
fresh fruits and vegetables, lean meats, fish, bean,
legumes, and nuts – can help our bodies recover faster from
illness, injury, or surgery.”
One of the biggest tips they have is easy: “Think color!”
Johnson said. “People should ask themselves, ‘How colorful is
my meal plan?”
Specific studies showed that pigmented foods, such
as cherries, onions, ginger, berries, turmeric apples, showed
By natalie Miller Moore
Want to iMProve your diet? small steps can move you forward!
Think color!
Healthcare in Hampton Roads 19
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Resources for people dealing with arthritis or joint problems:Arthritis Foundation website: Arthritis.orgAmerican College of Rheumatology: Rheumatology.orgJohn Hopkins arthritis center: Hopkins-arthritis.orgMayoclinic.com and www.mayoclinic.com/health/arthritis
nutrition And weLLness
concrete tips from the dieticians to help you improve your diet:
• use olive oil whenever you can in cooking – it can decrease
inflammation. Johnson recommended popping popcorn on the stove using olive oil for a healthier alternative to microwave popcorn.
• Replace meat dishes with beans or fish several times a week. Good quality complete proteins – fish, chicken, beef, pork, turkey, soybeans, and tofu – are key to reducing inflammation, healing, and preventing infection post operation.
• Dairy is commonly thought of as source of calcium, but other fortified items, such as almond milk, soy milk, and some juices can also provide calcium with less calories.
• If given a choice between whole grain and something else, always go for the whole grain! Switching to whole grain sandwich bread, or whole grain pasta is an easy first step.
• add berries to whatever you are eating for a quick burst of colorful antioxidants. They can be your dessert or added to a dish you are eating, such as oatmeal or a salad.
• For those specifically concerned with their bone and joint health, Werner recommends discussing supplements with your doctor. “Calcium, phosphorus, and vitamin D play a huge role in bone health. Those consuming the typical American diet will most likely need supplementation to ensure they are getting enough,” she said.
• avoid fried foods. Americans who eat diets that are high in Omega 6 fatty acids, which come from cooking oil, fried food, and processed foods, have more joint inflammation. Omega 6s, which are different from Omega 3s, should be a small part of any diet.
• Dairy products should always be low fat – that’s not 2%, that’s 1% or skim milk. Please consider a calcium / citrate supplement if you aren’t consuming your amount daily. Most patients don’t.
20 www.HRHealth.nett
Some common diagnoses include:
• Stenosis - a narrowing of the spinal canal causing nerve
compression
• Spondylolithsesis - one or more vertebrae are out of
proper alignment
• Sciatica - a symptom of an underlying problem not a diag-
nosis of the cause. The 5 sciatic roots originate in the lower
spine and run thru the muscles of the buttocks and down
the back of each leg. Compression can occur in the muscles
or at the spine.
• Herniated disc, pinched nerve, bulging disc, ruptured disc, etc. - all are terms that describe essentially the same
condition. This is not necessarily a permanent and often can
be treated successfully.
• Degenerative disc disease - not as bad as it sounds.
MRI scans will show some degree of it in most of us with
and without any pain or discomfort.
Very few problems actually occur as a result of an “event”.
Most trouble is a result of repetitive stress either from poor
biomechanics, faulty recruitment, poor posture and/or weak
musculature.
Many post-rehab techniques still focus on increasing range
of motion in the back and hamstrings (the muscles down the
back of the legs) by stretching and also on strengthening the
abdominals.
It is doubtful the cause of back pain is excessive tightness.
In fact, in muscles with a postural function, weakness precedes
tightness. The muscles are “tight” to protect themselves and
provide some semblance of posture because they are too weak
to perform as intended.
Armed with tons of up-to-date supportive research, I’m
Just about every movement of
the human body involves the
low back (lumbar) area so it can
be very debilitating. Low back
pain and the common cold are
the two most frequent dr. visits
and the two most cited reasons
Americans miss work.
Bones, Joints, Muscles & Pain
saying this old approach is not addressing the issue. Range of mo-
tion in the hips is usually poor in symptomatic backs. This results in
too much back range of motion especially when under load. Put
another way, if we free the gluteals (buttocks) and the hip flexors
to operate efficiently, pressure is properly proportioned and the
back is relieved of improper duties. While we work differently with
say, spondylolithsesis than with spondylosis, the goal is the same.
tHe GoAL is stABiLity. The back should be stabilized by
exercise not have its range of motion increased. The supportive
muscles all should be strengthened to provide stability and to be
capable of sustaining improved posture.
This prepares our vulnerable lumbar region to withstand the
many forces that attack us, to enjoy a lifetime of activity and to be
able to hold proper posture during our short stay in this life.
Our Training approach incorporates many of the beneficial
aspects of Pilates and Yoga which we combine with specific
strength work. Again, this is not about increasing the back’s flex-
ibility. This is focused on stability. Many of the Pilates principles
train the back and core to be stable during limb movements.
Many Yoga poses are designed to free the ball and socket hip
joint. This is a joint which is made for efficient movement. Un-
fortunately our forward-flexion ( seated) lifestyle deprograms our
hips and they just don’t operate freely which puts undue strain on
our spines. We sit to eat our meals, to drive everywhere we go, at
our desks, to watch television, at most entertainment shows,…
As a result the muscles that operate the hip joint become
shortened and weakened. This is why I don’t recommend biking/
pedaling in any form as the primary calorie burning cardiovascular
work. The position is just more forward flexion and therefore
doesn’t allow the hip flexors or extensors to move freely through
necessary range of motion. As a secondary supplement to upright
movement ( walking, running, elliptical, strider,…) pedaling is fine
but we benefit by exercising in a vertical position while holding
good posture.
What is the most common condition that lets us know
something is not right in our back? Muscle spasm. The muscles
tighten and restrict just about everything we try to do. Naturally
that makes us think we should try to gently stretch to address the
tightness. Sounds like reasonable common sense. Except it isn’t.
These muscles have a postural function. Their job is to hold us up-
right. So if they’re weak they can’t just atrophy or we’d be lying on the
ground in a heap. If your biceps aren’t trained, they atrophy and you
have weak arms. But weak back muscles still have postural responsibility
so their tightness is the sign they’re too weak to do their job. In postural
muscles weakness precedes tightness.
Whether your back has recurrent spasms, hasn’t had them yet,
or is in spasm as you read this, the goal is the same. These overly tight
muscles must be strengthened. This takes time, effort and knowledge
of how to do this safely.
I’ve focused here on our muscular system because improving it
is within everyone’s capability. Many of the conditions listed above will
necessitate intervention by a doctor of orthopedics, chiropractic or
neurology. But muscular function improvement will complement any
of those modalities and is essential for lasting relief.
nutrition And weLLness
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Bones, Joints, Muscles & Pain By Brian cole
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A Different WAy to think About Aging
For a personal consultation with our senior care navigator call (757) 856-7030 or visit
riversideonline.com/services/seniors.
It’s about honoring and supporting what people want as they get older — “As I age, I will control my destiny in a place of my choosing.” Seems simple enough. But in the world of healthcare where “we know best” has been the tradition, asking people what they value as they get older is a true innovation that’s making a difference in the lives of thousands.
It’s an approach that promises to change the way people think about aging. And it all begins by asking what matters most. That’s what happens at Riverside, where we have world class physicians and the most comprehensive network of services in the state dedicated to helping you reach your life goals as you age.
As I age, I will control my destiny in a place
of my choosing.