Learn how to prevent ankle sprains

Learn how to prevent ankle sprains!

An athlete is at a much greater risk of another ankle sprain for 2 years after an initial ankle sprain.  Rehabilitation exercises focusing on balance and proprioception results in a 2-3 fold decrease in risk after 8 weeks of exercises; also, ankle braces can decrease your risk by 3-4 fold.  Check out Dave, from Valley Active demonstrating some rehab exercises that can help!


To learn more, check out our Facebook page at Valley Sports & Spine Clinic, or at Valley Active.  Come visit us at our Blacksburg office, right next to Christiansburg, in front of Lewis-Gale Montgomery Hospital.


Good Luck!


Medicine Delivered at the Speed of Sound!

Dr Colliver & Crew after finishing up some Ultrasound training

Dr Colliver & Crew after finishing up some Ultrasound training

Last week was busy with several after-work activities.  One of these evenings was spent with Blacksburg Physical Therapy, reviewing musculoskeletal ultrasound.  But first, I should explain that I have known this amazing group longer than any other physical therapy group, and they have always impressed me.  For example, when a patient has a particularly difficult time in rehabilitation, we will do a “co-visit”- which is when the physician and the physical therapist meet the patient together and review the rehab plan. Also, we have done training together on Postural Restoration Institute courses and practiced Manual Medicine together.  So when they asked me to come review Musculoskeletal Ultrasound, of course I said YES!

At first, I went over my standard spiel on examination of the shoulder.  But that quickly devolved and soon everyone was looking at everyone else’s various musculoskeletal oddities, like the distal biceps pain of the professional powerlifter.  This group quickly figured out how Ultrasound is very efficient, diagnostic, and has lots of applications in the therapy setting.  This allows us to quickly evaluate shoulder pain; but also, foot, ankle, knee, hip, elbow, wrist and hand pain.

In this world of instant social media, selfies, Tweets, etc, musculoskeletal ultrasound allows the physician and patient to instantly see what inside the body looks like and how it reacts with motion.  MRI can’t even do the things that Ultrasound can!  But it does take a lot of training; and as the leading musculoskeletal ultrasound physician in the New River Valley, I feel excited to introduce this approach to as many providers who could benefit from this technology.

Thanks again, Blacksburg Physical Therapy, for a great evening.  Keep practicing.


Good Luck!

Valley Sports & Spine Clinic Giving you Back your Life

Dr Ethan Colliver

Muscle & Bone Health in Aging

The muscle and bone systems are constantly changing and reacting throughout our lives; and the effects are different for men and women, but remarkably similar. Both muscle and bone will undergo a normal decline as we age; somewhere around the age of 25 in men.  Muscles lose strength and power for various reasons:

1. muscles lose mass: there is a decrease in muscle fiber size and a decrease in muscle fiber quantity, starting at the age of 25, due to decreases in estrogen, testosterone, and Insulin-like Growth Factor-1 (IGF-1).
2. loss of motor units: the number of motor nerves that innervate muscle cells decreases
3. less muscle protein synthesis
4. loss of aerobic capacity: this is multifactorial in itself
5. loss of synchronization of the firing of motor units: also, multifactorial, such as with prior sciataca or disc herniation

Bones lose mass as we age because of several reasons:
1. loss of sensitivity of bones to muscle: loss of testosterone, IGF-1, and estrogen decreases bone response to mechanical stimulation by muscles and result in loss of muscle mass.
2. loss of muscle mass, area, and strength: due to loss of IGF-1, estrogen, and testosterone and this loss of muscle can also decrease the stimulation on bones.
3. increased bone resorption: due to loss of estrogen and testosterone

You can counteract this decline in bone and muscle health with strength and endurance training. Regular strenuous exercise (20-60min, 3-5 days/week)increases muscle strength and power, aerobic capacity, and bone density. Currently, no medications are approved for the treatment of muscle loss that occurs with aging and some treatments, including testosterone, can have dangerous side effects. For bone loss, exercise can increase the stimulation on bones by muscles and improve power and balance to decrease your risk of falls. Many medications exist for treating thin bones, including testosterone in men, but it appears that exercise can be as effective and both treatments should be implemented.

If you are concerned about your bone and muscle health, you should check with your doctor to see if an underlying medical condition is present, or if this a natural process with aging. Your doctor may prescribe medications and exercise to treat your issues.

Good Luck!

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



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

Sitting is Bad for Your Health | Valley Sports & Spine Clinic

Having a regular exercise routine is important; but, how much time you spend sitting throughout the day may be just as important.  A British Journal of Sports Medicine article in 2009 correlates total sitting time in a day to “an increase risk of type 2 diabetes, heart disease, and other prevalent chronic health problems- even if you exercise regularly.”  Research now suggests being active throughout the day, whether you like lawn care, gardening, hunting or fishing, for example, reduces your risk for cardiovascular disease and other chronic health conditions.

Long periods of sitting leads to a lack of muscle contractions and decreased blood flow.  Dr Vernikos, former NASA specialist, conducted research that supports getting up from sitting around 35 times a day to reduce your risk of cardiovascular disease.  The author of the cited article suggests setting a timer to remind you to stand up and move every 15 minutes.

Sitting with poor posture increases stress on your discs in your low back.  This is a common cause of back pain.  If you have a herniated disc, you may find sitting to be intolerable.  Avoid sitting for more than 15 minutes and avoid long car rides, as both will aggravate a disc injury.

To read more about prolonged sitting and your health, check out:
The Importance of Intermittent Movement For Longevity, by Dr. Mercola

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