When Should I get A New Mattress? 

The age and quality of your mattress have a major impact on how you feel. A worn-out mattress can certainly contribute to back and neck problems. Most experts agree that traditional mattresses should be replaced every 5-8 years.



FAI starts you on the road to failure.

Your hip socket or “acetabulum” is covered by smooth, glassy cartilage extending all the way to its outer rim. The term “Femoroacetabular impingement” (FAI) means that this rim of cartilage is being pinched when you move your hip into certain positions. Repetitive pinching results in irritation, tearing, or even detachment of this cartilage from your hip socket.

FAI occurs because of a mismatch between the head of your femur and the socket of your hip. The mismatch may be from an abnormally shaped hip bone (cam deformity), or having too much cartilage on the rim of your hip socket (pincer deformity). Most frequently, FAI results from a combination of both (combined or mixed deformity).

FAI is most common in young active people. Although the deformity may be present on both sides, symptoms are usually one-sided. The condition is equally common among men and women. Symptoms of FAI include a constant dull pain with periods of sharp pain, made worse by activity. Walking, pivoting, prolonged sitting, stair climbing, and impact activities like running or jumping can aggravate your symptoms. Snapping, locking, and clicking are common.

Our office will help direct a rehab program to maximize your chance of recovery. You should attempt to stay active, but avoid activities that aggravate symptoms. You may consider temporarily switching to low-impact activities, like stationary biking or water-walking. You should avoid motions that combine flexion and internal rotation, like- getting out of a car with one leg at a time, swimming the breaststroke, or performing squats. Patients with FAI should avoid excessive stretching, as this could aggravate the condition, but will likely benefit from strengthening exercises in the type of treatment provided in this office.

An Open Letter to our Medical friends.


In the past year, many trusted medical establishments including the FDA (1), CDC (2), Joint Commission (3,4), JAMA (5), and The American College of Physicians/ Annals of Internal Medicine (6) have encouraged medical providers to prescribe spinal manipulation as a first line treatment for acute, subacute, and chronic low back pain.

Most recently, The Lancet echoed that endorsement, and provided a unique perspective:

The reduced emphasis on pharmacological care recommends nonpharmacological care as the first treatment option and reserves pharmacological care for patients for whom nonpharmacological care has not worked. These guidelines endorse the use of exercise and a range of other non- pharmacological therapies, including massage, spinal manipulation, and acupuncture.

Gaps between evidence and practice exist, with limited use of recommended first- line treatments and inappropriately high use of imaging, rest, opioids, spinal injections, and surgery. Doing more of the same will not reduce back-related disability or its long-term consequences. The advances with the greatest potential are arguably those that align practice with the evidence. (7)

Unfortunately, personal experience skews our perception of each other’s merit, i.e., we primarily see each other’s failures since the successes don’t need to seek additional care. Regardless of our professional degree, we all have failed cases mixed into our many clinical successes. We must not lose sight of the evidence supporting each other’s overwhelming proven value for a given diagnosis. If we judge each other by our successes rather than our failures, we will work toward an integrated model where the patient wins. Together, we will help more patients than either working alone.

We are honored for the opportunity to co-manage your patients.


1. FDA Education Blueprint for Health Care Providers Involved in the Management or Support of Patients with Pain. May 2017. Accessed on May 12, 2017
2. Dowell D, Haegerich TM, Chou R. CDC Guideline for Prescribing Opioids for Chronic Pain- United States, 2016. MMWR Recomm Rep 2016;65(No. RR-1):1–49.
3. The Official Newsletter of The Joint Commission. Joint Commission Enhances Pain Assessment and Management Requirements for Accredited Hospitals. July 2017 Volume 37 Number 7. Ahead of print in
2018 Comprehensive Accreditation Manual for Hospitals.
4. Joint Commission Online. Revision to Pain Management Standards. http://www.jointcommission.org/assets/1/23/jconline_november_12_14.pdf
5. Paige NM, Miake-Lye IM, Booth MS, et al. Association of Spinal Manipulative Therapy With Clinical Benefit and Harm for Acute Low Back Pain; Systematic Review and Meta-analysis. JAMA. 2017;317(14):1451-1460.
6. Qaseem A, et al. for the Clinical Guidelines Committee of the American College of Physicians. Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians. Ann Intern Med. 2017;166(7):514-530.
7. Foster, Nadine EBuchbinder, Rachelle et al. Prevention and treatment of low back pain: evidence, challenges, and promising directions. The Lancet, Published Online March 21, 2018 http://dx.doi.org/10.1016/ S0140-6736(18)30489-6

I’ve never baked anything in my life; how do I have a Baker’s Cyst?

Your body has strategically-placed, fluid-filled cushions called “bursa” around each joint. Bursa act to reduce friction where muscular tendons rub on bone. Your knee is surrounded by several bursa that share fluid with the inside of your knee joint and with each other. You can think of this like a chain of lakes connected by streams. If the inside of your knee joint or any of the bursa around your knee becomes inflamed, the entire system fills. When swelling exceeds each individual bursa’s capacity, this fluid creates a soft balloon-like swelling of the popliteal bursa behind your knee called a “Popliteal cyst”, or more commonly a “Baker’s cyst”.
This swelling is usually not from a problem with the popliteal bursa itself, but rather, inflammation somewhere else in the joint that has distended the popliteal bursa. This swelling is often the result of arthritis or damage to a ligament or cartilage within the knee.

A Baker’s cyst is often painful, and the discomfort may increase when you attempt to move your knee. Depending on the severity of your swelling, your symptoms may vary between a feeling of fullness and significant pain. It is not unusual for a Baker’s cyst to change in size from day to day, depending on the amount of swelling. Be sure to tell us if your pain progressively increases when you walk or if you notice warmth, redness or swelling in your calf, as these could be signs of a more significant problem.

Sometimes rest and elevation of your leg help to alleviate pain and swelling. Initially, you may need to avoid activities, like squatting, kneeling, heavy lifting, climbing stairs, or running. Wearing a brace on your knee may compress the cyst and cause an increase in your pain. Since Baker’s cysts are generally a problem that is secondary to another condition, treatment is most effective when directed at the underlying problem.

Spring Cleaning Tips

If you plan on doing a bit of spring cleaning soon, here is our friendly safety reminder: Don’t forget that some chores are a workout, so stretch accordingly before and after. Also, be mindful of your posture throughout your cleaning.

Keep a neutral spine, bend at your knees when lifting heavy items, and never twist your back at unhealthy angles.

I’ve got Shin Splints; what do I do?

Shin splints, also called “Medial Tibial Stress Syndrome,” (MTSS) is caused when the muscles of your lower leg pull too hard on your bone, causing local pain and inflammation. Over half of all leg pain in athletes is caused from shin splints. Up to 1/3 of runners and soldiers experience shin splints at some point in their lifetime.

MTSS is an overuse injury frequently seen in sports involving running, jumping, or frequent stopping & starting, i.e. field hockey, soccer and cross-country. Shin splints do not occur overnight but over a period of time, often show up during the first two or three weeks of training for a new season. Shin splints can occur when there are changes to your exercise regimen, such as an increase in activity, change in shoes or a change in the surface you play on. Some doctors refer to these training areas as “the terrible toos,” – too much, too hard, too long, too fast.

Symptoms of shin splints include tenderness or pain over the inside lower portion of your shin. The discomfort begins at the start of exercise and eases as you continue. Some patients report “bumps” when touching the inner portion of their leg bone. Be sure to tell your doctor if you experience weakness, numbness or cold feet during exercise or find a very small area of sensitivity.

Unfortunately, MTSS usually develops during a time when you are training heavily for a sport or an upcoming event. Continuing this activity will often lead to ongoing problems and decreased performance. Shin splints are now believed to be a forerunner to stress fracture, so adequate rest is critical. You may need to consider non-weight bearing cross training, such as using a stationary cycle or pool running.

When directed, your return to activity should start slowly, beginning with a 1/4 mile run and progressing by 1/4 mile each time you have no pain for two consecutive workouts. You should initially avoid running on hard or uneven surfaces and begin at a lower intensity and distance, increasing by no more than 10-15% per week- first increase distance, then pace, and avoid hard or unlevel surfaces, including hills.

Sports creams and home ice massage may provide some relief. Use ice after any activity. Patients who have flat feet are predisposed to developing shin splints and may need arch supports or orthotics. Avoid using heel cushions in your shoes, as they may increase the recurrence of this problem.

Trigger points in the serratus anterior

The serratus anterior muscle is located along the sides of the ribs. It originates on the outer surface of the upper 8-9ribs, and inserts on the medial border of the scapula. This muscle acts on the scapula in several different ways. First it rotates the scapula to turn the glenoid fossa upward. It also protracted and elevates the scapula. And lastly it helps to prevent wining. This muscle is often shortened from prolonged sitting and work on a computer. Active trigger points in this muscle refer pain locally around the trigger point with spillover down the inside of the arm. Pain can also radiate into the inferior angle of the scapula.