Patient Satisfaction & Medicine

Here is a link to an interview between two brilliant Physiatrists discussing patient satisfaction and medicine.  The guest is Dr. Brian White from Columbia University at Cooperstown, New York.

I had the privilege of training with Brian White, DO, through medical school and internship. Dr. White is a great friend and colleague and we share similar interests. He has a great skill of taking complex issues and putting them into concrete concepts, using simple examples and analogies.  He has definitely been a fantastic teacher for me, and I think we all could learn more about how healthcare is changing, unfortunately not always in the best direction.

This may be a continuing forum and I hope to put a link about an interview with yours truly in the future!

Thanks!

Valley Sports & Spine Clinic
Giving you Back your Life
Dr. Ethan Colliver

 


What is your Fitness Age?

Here is a video featuring a colleague of mine who is the Director of Sports Medicine at Columbia University.  video on Fitness Age

The fitness calculator can be found here : Fitness Calculator

It was eye-opening to calculate my “Fitness Age”, which was 25.  Not bad, considering my 4 kids and full time practice make me feel 55, at times. … but I know I can do better.

I was discussing with our Physician Assistant, Holly, how I would rather sleep in every morning in stead of waking up at 5:30am to exercise.  Those extra 10 minutes in bed often will lead to 20, 30, …. oops, got to go to work. But, it is amazing how just after a few minutes of exercising I can say “This feels good.  I needed this.”

I workout 3-4 days a week now but I could improve by exercising 5-6 days a week.  It could be hikes with my family or biking to work in stead of driving. What could you do?  It does not have to be a fancy.  In fact, you don’t need any gym.  One trick, if you have kids, is to make up silly “races” back and forth in your living room: crab walks, bear crawl, hopping, skipping, etc.  Everyone has fun and you get your exercise.

Good Luck!

Valley Sports & Spine Clinic
Giving you Back your Life
Dr. Ethan Colliver

 

 


Why discs can hurt

Here is a great video from a colleague further explaining how a lumbar disc can cause back.  I thought this was a great extension on my last post.  My colleague, Dr Chimes, is brilliant at many topics.  I think it is wonderful that many of our posts have paralleled each other.

video on disc pain

Valley Sports & Spine Clinic
Giving you Back your Life
Dr. Ethan Colliver


Owww…. My disc hurts!

One of the most common causes of low back pain is lumbar disc pain.  The disc has an outer layer made up of cartilaginous (annulus fibrosus) layers surrounding a gel-like center (nucleus pulposus). There is one disc between each bony vertebral level in our low back.  According to Stuart McGill, PhD, it behaves more as a ball-bearing joint than a “shock absorber” (that is for a later topic).  The anatomy allows us to bend our low backs with great flexibility in all directions. The outer third of the disc is innervated by sinu vertebral nerves, meaning that it can transmit pain signals coming from the low back.  The annulus fibrosus is thinnest near to where the nerves to our legs are traveling in our spinal canal.

A disc injury is a tearing of the outer layer allowing the inner gel to work its way to the outside of the disc. The tearing and subsequent leakage of disc material causes a lot of inflammation in the spinal canal. This inflammation can cause back pain, muscle spasms and irritate the nerves to the leg, causing leg pain. If the disc material causes pressure and compression of the nerves of the legs, this can lead to weakness.

Stuart McGill PhD showed that the lumbar disc material can herniate through the outer layer (annulus fibrosus) in as little as 20,000 repetitions of forward flexion or twisting through the lumbar spine. It is unlikely to cause a disc herniation if you bend backwards or sideways. Stooping, sitting, and bending at the waist are causes of disc herniation and subsequently back or leg pain.

His research also has shown that humans will bend forward over 1,000 times a day and backwards only 150 times a day. With this in mind, it is easy to see how we can cause a disc herniation just by doing our day-to-day routines. However, we move in ways that are safe for our discs, such as backwards, very rarely. Therefore, WE CAUSE LOW BACK PAIN BY THE WAY WE MOVE!

There is good news. Proper lifting mechanics can decrease your risk of lumbar disc herniations and back pain. For example, professional weightlifters lift extreme amounts of weight in a squatting position and you find that they do not get disc herniations more frequently than the general population. Why is this? They have proper strength and flexibility within their core, pelvis, and in their hips.

 

Most treatments for low back pain are reactive, meaning that treatment is started after someone is already experiencing back pain.  Most treatments do not decrease your risk of future back pain. Research shows that the only thing to decrease your risk of future low back pain is exercise. So again I encourage you to get into that exercise program and if you have pain with exercise, ask for help from a physical therapist and physician.

Good luck!

Valley Sports & Spine Clinic
Giving you Back your Life
Dr. Ethan Colliver

 


Your back hurts because you’re pooping wrong!

Low back pain in Western society is very common.  Studies suggest up to 90% of Americans will have an attack of back pain and 26.4% have had back pain in the past 3 months.  Koreans have a lifetime chance of around 60% and 15% chance of having back pain in the past year.  Why the difference?  Squatting may be one of the most important things for your back pain and your health, and American toilets don’t let us do it.

 

Western toilets became common the late 19th century.  Prior to that, most people would squat to eliminate, over time sitting became a sign of being “civilized”.  With that change came a decrease in communicable disease like cholera but also brought new diseases like appendicitis, hemorrhoids, and back pain.

One of the best treatments for preventing back pain is proper exercise.  Exercise should focus on flexibility and strength training.  A full squat requires full hip flexibility and great hip, pelvic, and core strength to perform properly.  Asian or squat toilets require the user to perform a full squat to eliminate.  Now, if the average person uses the bathroom 4-7 times a day, that is an opportunity to do a great exercise for your back and health 4-7 times a day.  Further benefits may include decreased constipation, hemorrhoids, diverticulitis, appendicitis, and possibly colon cancer.

asian squat

You can take advantage of a squatting toilet without spending $1000 to install one in your house.  I recommend two products: Squatty Potty for a beginner and a Squat Platform for an advanced full squatter.

Valley Sports & Spine Clinic
Giving you Back your Life
Dr. Ethan Colliver

 

 


Introducing Holly Williams, PA-C

Have you met our PA, Holly Williams?  She started with us in May 2013, and is now seeing a full schedule of new and follow up patients.

Holly_w-1
Holly Williams is a board certified Physician Assistant from Southern West Virginia, with specialty training in sports injuries and  back and neck pain. She received her Bachelors Degree of Arts at at Bluefield State College. Then, continued her education at Mountain State University to receive a Bachelors of Medical Science and Masters of Science, Physician Assistant.

Miss Williams not only has specialized training in back and neck pain but also treats chronic migraines with botulinum toxin (BOTOX) injections. In addition, Miss Williams can treat chronic knee and shoulder pain with ultrasound-guided steroid injections and geniculate nerve blocks.

In her spare time, Miss Williams enjoys the outdoors, fishing, camping,skiing, and kayaking.


Dr. Colliver Earns Ultrasound Accreditation

Ultrasound can be as sensitive as MRI for diagnosing many muscle, nerve, and ligament injuries.  In fact, some injuries can only be found by ultrasound, such as a dislocating tendon or nerve. Also, ultrasound is useful for guiding injections with more precision than standard injections without imaging.  However, it is very user-dependent, it takes a lot of training and practice for a provider to be skilled enough to know how to interpret ultrasound images.

Dr. Colliver has been using ultrasound in the clinic setting longer than any other physician in the New River Valley, and now has added a nationally recognized accreditation to his list of accomplishments.  Registered in Musculoskeletal Sonography Credential (RMSK) is only given to qualified individuals who pass a national examination and who continue regular education in ultrasound interpretation. For further information please visit the ARDMS website.

*Image originally published by www.uwhealth.org



Stick with that new exercise program!

With New Years Resolultions abounding, lets discuss how to stick to a resolution to start exercising!  Naomi Beinart, BSc Psych, presented a recent review in The Spine Journal (December 2013, Volume 13, Number 12) of all the current research looking at this question.  According to Beinart, between 50-70% of patients with chronic low back pain stop their home exercise program, despite knowing that exercise is a major way to treat low back pain.

Here are some positive factors in predicting the continuation of an exercise program:

1. If you believe you have control over your health, and your back pain, you are more likely to keep exercising.

2.  Actively develop your own exercise program.  If you work with a personal trainer, or Physical Therapist to design a program specific to you and your needs, you are more likely to succeed.

3. Working with a health care provider or therapist while exercising  increases your success rate!

4. Psychological counseling to work on self-motivation will help you succeed.

In summary, the more you believe that you control your health, help develop your own exercise routine, and have supervision while exercising, the more likely you are to keep your exercise program and your New Years Resolution.  Some people may benefit from counseling to help motivate themselves.

For supervision, you can try working out with a friend who has lots of experience, or perhaps sign up for weekly sessions with a personal trainer.  Another option may be to enroll in an exercise class at a local community rec center.  If you have persistent significant pain with exercise, seek medical help.

Good Luck!

Valley Sports & Spine Clinic
Giving you Back your Life
Dr. Ethan Colliver


RFA of the Knee | Valley Sports & Spine Clinic

Do you suffer from knee pain?  You are not alone.  Knee pain is one of the most common pain complaints in the U.S., and the number one reason for joint replacement surgery. Common treatments include exercise, pain medicines (Tylenol and Ibuprofen), and injections (steroids or Synvisc/Euflexxa).

If you continue to have knee pain, knee replacement surgery is an option you could discuss with an orthopedic surgeon.  However, some patients are not ideal candidates for surgery either because they are too young (less than 60), too ill for surgery, or choose not to have surgery.

Now there is another option for persistent knee pain, radiofrequency ablation (RFA).  The knee joint is supplied by six nerves (genicular nerves).  If you disrupt the nerves, you can block the pain signals from the knee.  The RFA procedure is done in two steps.  The first step involves temporarily blocking the nerves in order to see if most of your knee pain goes away.  If so, then you can proceed to the second step––radiofrequency lesioning (disrupting) the nerves that supply the knee.  This lasts for 6 or more months and can be repeated if needed.

RFA of the knee does not affect the strength or range of motion and the patient may still have a knee replacement surgery in the future.  To learn more about this exciting new option for knee pain, check out this article from the Journal of Pain, May 2011, by Choi, WJ:
Radiofrequency treatment relieves chronic knee osteoarthritis pain: a double-blind randomized controlled trial.

Valley Sports & Spine Clinic
Giving you Back your Life
Dr. Ethan Colliver