The Cure for Back Pain is Active Physical Therapy – Not Drugs

The most common treatment for back pain causes more problems than it solves — pain medications (opiates).

Opiates have been widely used for back injuries created on the job for decades. But research is finding that the outcomes are grim. What’s more, a growing number of patients want alternatives to pain drugs and their notoriously bad side effects, like depression, sleep loss, liver problems, hormone loss, severe constipation, and addiction.

According to the American Academy of Neurology:

“The risks of powerful narcotic painkillers outweigh their benefits for treating chronic headaches, low back pain, and fibromyalgia. The drugs can cause serious side effects, overdose, addiction, and death. Research shows that 50 percent of patients who took opiates for at least three months are still on them five years later.”

Most physicians would agree that for most people with chronic pain, drugs aren’t even usually the right treatment. According to a study on the treatment of opiates dependence and chronic pain, the National Institute on Drug Abuse stated:

“There’s a false assumption that giving medicine makes pain go away, but in chronic situations that doesn’t always work. Many people only get some reduction in pain.”

As a result of the growing attention on pain medications’ bad side effects, more pain sufferers are weighing the pros and cons before they take any prescription medicine — or even any over-the-counter pain medicine. They are becoming savvy about not only the dependency and addiction risks, but also the entire spectrum of negative side effects of opiates on their lifestyles.

Even the cost of the drugs is cause for concern. Pain medication prices have gone up dramatically over the past decade. Plus, many insurance companies will not cover the costs of the more expensive drugs. So patients taking them must bear the significant out-of-pocket expenses.


Activity is the Ideal Prescription for Back Pain

Almost 95 percent of back injuries caused on the job are muscular injuries. And muscle injuries are ideally treated with a regime of passive and active physical therapy that includes heat, ice, ultrasound, massage, and movement within a safe range. Some studies even show that high intensity resistance exercises safely and effectively treats back pain.

In the past, patients suffering from back pain would stop moving, believing that remaining immobile would heal the injury. But actually staying immobile gradually reduces mobility because it stiffens the muscles. Stiff muscles create more pain, which further exacerbates the problem. Whereas, becoming active again within a safe range of movement, and using the body in the way it was created to be used, helps to reduce pain and restore full mobility faster. Immobilization also causes depreciation of cartilage, bone and muscle. There is no better way to make back pain worse than by being immobile.

It’s not all the patient’s fault either. Pain doctors, orthopedic surgeons and spine doctors have recommended and supported this approach for decades, including keeping patients from returning to work for extended periods. In fact, they were afraid to send patients back to work too soon and risk hurting them even more.


Movement and Activity Actually Help Relieve Back Pain

We’ve learned that movement and returning to work as soon as possible are two of the best approaches to treating any muscular pain. Studies and real-world examples have shown that being active and engaged in the world contributes to a better outcome overall.

This is a paradigm shift in treating worker’s compensation cases. We’ve learned the old ways didn’t work and, most importantly, didn’t help the patients. In fact, the medical industry failed patients who were in pain with this outdated modality of narcotics, inactivity and work-avoidance.

Today the ideal prescription for treating back pain is early-stage hands-on therapy, such as ultrasound, massage, heat, and ice, along with movement within safe ranges, stretching, and returning to work as soon as possible. It is very important that therapy include active motion, otherwise it is almost guaranteed to fail.

Our clinic provides that type of treatment for back pain that actually relieves pain faster— and helps patients move on with their lives sooner. Our clinic provides state of the art and evidence-based care of the spine and related pain. This allows people to get back to normal life quicker and with far fewer side effect from treatment.

Naturally improve your musculoskeletal health with our surgeon-designed Bone & Joint Health Multi! This multivitamin is designed to naturally reduce full-body inflammation + pain with a carefully curated blend of essential vitamins, minerals, and pure Full Spectrum CBD.

Avocado and Soybean Oil to Relieve Arthritis Pain

The pain of arthritis is very common. In fact, this is one of the most common reasons for people to see a doctor and certainly one of the main reasons to go onto disability. There is no cure for arthritis at this time, but there are a number of medications to treat symptoms. Most medications have side effects, however, and often cannot be used for arthritis pain.

There are a variety of natural supplements that can be taken for arthritis pain. Most supplements have decent science behind their use. One should remember that supplements or medication work best to treat arthritis pain when paired with a program for weight loss and with low-impact aerobic exercise.


There is an intriguing supplement on the market in Europe called Piascledine that is derived from avocado and soy. The supplement concentrates the active ingredient considered crucial for the control of arthritic pain. This supplement has been tested in placebo-controlled trials in France by the company that makes it. The Cochrane Collaboration, an independent science group, has evaluated these studies.

Basically, Piascledine has “moderate to high” evidence that it works in the short-term to relieve pain. This is good news as this is a natural product with little to no side effect profile. A more long-term study (three years) found little difference in pain control between the supplement and placebo. A review study in 2008 found that the use of the avocado-soybean oil supplement reduced and even stopped the need to use NSAIDs (anti-inflammatory pills).

The French company that makes Piascledine, Laboratoires Expanscience, sells this product in 46 countries but not yet in the USA. The French experience has demonstrated the safety of the supplement over a 15 year span of use in that country.



The avocado combination provides anti-inflammatory activity and has also been shown in laboratory testing to build up cartilage. This unsaponifiable and anti-inflammatory product has shown a decrease in destruction of the joints over time. This has been examined at the University of Arizona.

According to the Arthritis Foundation, the supplement blocks pro-inflammatory substances, can help to rebuild cartilage cells and also prevents the deterioration of the synovial (joint) lining. Typically, the supplement works better than simply eating the vegetables as the ingredient is concentrated for you that way. The dosage ranges from 300 to 600mg per day.

The product is derived from the unsaponifiable part of the vegetable oil. This is a tiny fraction of the overall mass of the soybean and the avocado. The amount of avocados and soybeans that would need to be consumed to equal the unsaponifiable dose in the supplement is too large to recommend a dietary source for this substance.

This product is another natural remedy with a good side effect profile that has been found to be an effective way to treat the pain of arthritis.

If you want natural relief without heavy medicinal fog, reach for our full line of safe, holistic pain-fighting products. You should check with your doctor to make sure any of these natural remedies will not interfere with any current supplements of medications prior to trying them for yourself.

How to Prevent and Treat Gout Flare-ups

Gout is a sophisticated form of arthritis, one that’s characterized by the quick and severe waves of pain, tenderness, and redness – often in the big toe. It can subside, bringing days without pain, only to be followed by another onset of attacks, known as flare-ups. There is no cure for gout, although prevention and management techniques exist to reduce the side effects of this painful illness.

How is Gout Caused?

Gout is caused due to too much uric acid in the blood. High levels crystallize the acid, which forms around the bone or cartilage. The exact cause can be attributed to genetics, diet, and various medical conditions. Those with gout cannot process these crystals properly, and so they collect in the joint.

Genetics has the strongest influence on your uric acid levels, while medical conditions can also affect them, with diet far behind. For the latter, it is believed that a healthy diet, mixed with exercise, can help manage uric levels. Specifically, avoiding foods such as shellfish, red meat, and beer help to control gout.

How can you Prevent Gout?

The best way to prevent gout is to focus on your uric acid levels, doing what you can to keep them under control. Achieving this involves lifestyle and dietary changes, focusing on drinking plenty of fluids to flush out the uric acid, as well as eating foods with low levels of purine (the compound that creates uric acid).

To manage your uric acid levels, you should lead a healthy lifestyle. That being said, there is no sure-fire, end-all solution out there, only ways to lower your uric acid levels. There is no available pharmaceutical explicitly used to treat gout, just medication to treat other illnesses that help with controlling uric acid levels associated with gout.

As far as medications, Allopurinol is often used to give baseline control. Colchicine and Indomethacin are used to help with flares.


What do you do during a Flare-Up?

Prevention is an excellent method of dealing with gout; however, if you already have it, what do you do during a flare-up to alleviate the pain? Let’s assume you are woken up in the middle of the night by an attack: first, you need to schedule an appointment with a doctor as soon as you can.

Gout is usually not life-threatening, but getting treatment within the first 24 hours of the start of attack is recommended. Professional help is recommended to treat flare-ups. Generally, a physician will first advise you to take some anti-inflammatory, over-the-counter medicine such as Motrin, Advil, or Aleve. Do not take any aspirin, as it can make the flare-up worse. You can also create an ice pack for yourself, putting it on the affected area, and drink plenty of fluids while you do this. Take the pressure off your foot and elevate it so that it’s higher than your heart.

Avoid alcohol and try to relax – there’s not much else you can do until you see your doctor. Also, if you don’t have any allergies to them, consider eating tart cherries or tart cherry extracts for management of gout. You can also try our soothing Pain Cream or Pain Relieving Spray for steady, natural relief from pain + inflammation.

What’s Causing Your Shoulder and Neck Pain?

Many people experience shoulder and neck pain while moving their upper extremities or lifting heavy weight.

In order to resolve this kind of pain, it helps to first understand the potential causes and the anatomy of this area of the body.

The shoulder joint is formed by the ball shaped head of the humerus (long bone of the upper arm) articulating with the socket of the scapula (shoulder blade) and the clavicle (collar bone). The socket where it articulates is called the glenoid cavity. There are many muscles and tendons that support the joint and form a rotator cuff around the joint preventing dislocation.


Shoulder and neck pain can be caused by rheumatoid arthritis, osteoarthritis, inflammation of the tendons, fracture, radiating pain from distant places, dislocation, frozen shoulder or bursitis.

  • Arthritis: Typically experienced as pain and limited range of movement while moving the hand above the shoulder – like while combing hair, arthritis is caused by inflammation of the synovial fluid and the synovial membrane.
  • Osteoarthritis: Related to wear and tear of the joints, osteoarthritis causes the formation of bony spurs (also called as outgrowths) on the smooth surfaces of the bones. The articulating surfaces become rough and there is decreased joint space, which causes pain with movement.
  • Tendonitis and Bursitis: The tendon is a strong cord-like structure that connects the muscle to the bone. Whenever there is a jerky movement, there is a pull produced in the joint that eventually leads to wear and tear of the tendon. Tendonitis can be acute or chronic. In acute tendonitis there is pain suddenly starting due to forceful and erroneous movements, while chronic tendonitis is due to repeated movements of the same joint.
  • Bursitis: A bursa is a small fluid-filled sac that acts as a cushion between the articulating bones to reduce friction during the gliding movements of the body. Pain occurs when the bursa in the joint become inflamed.
  • Frozen Shoulder: A sudden pain and spasm of the shoulder joints and muscles supporting the joint, frozen shoulder restricts the abduction movements (when the upper arm moves away the body), especially above the level of the shoulder. Exercise can help reduce the muscle stiffness and pain.
  • Fracture: A crack or break in the bones can be caused by injury, trauma or an accident. This is an extremely painful condition and typically will take a long time to heal. A cast will be necessary to keep the joint immobile until it heals.
  • Radiating Pains: Whenever there is chest pain or myocardial infarction (heart attack) it leads to squeezing pain on to the left side of the chest and in the heart muscles as well. This chest pain typically radiates from the heart to the left shoulder blade and the shoulder joint. If the patient has past history of heart problems as well as dyspnea and an unstable electrocardiogram then one should rule out angina pain immediately.
  • Dislocation or Subluxation of the Joint: The head of the humerus may come lower down from the socket in case of loosened tendons and ligaments and increased strenuous activities. The dislocation is medically termed as subluxation. It may be partial or complete. In case there is dislocation once there may be repeated dislocation on account of worn and loose ligaments. The limb will be stiff and the head of the humerus dislocates downward, causing pain while moving the hand upwards.


Diagnosis of shoulder and neck pain is typically conducted by taking a detailed history and clinical examination.

This may include:

  • X-rays will give information about the contour of the bones and can detect minute hairline fractures. This is the most basic test done by the orthopedic surgeon.
  • CT scan will show detailed structure about the bones and surrounding soft tissues of the shoulder joint.
  • MRI scan will show injuries and abnormalities of the soft tissues like tendons and ligaments.
  • ECG will help interpret cardiac functioning, rate and rhythm.
  • Arthrogram is a specialized X-ray wherein a dye is injected into the joint. This chemical dye produces a contrast effect when an X-ray is taken for the joint, enabling a better view of the bones, ligaments and the tendons.

Treatment for Shoulder & Neck Pain

Treatment consists of lifestyle modification, conservative modalities of treatment and medications or surgery. In case of lifestyle modification, one has to give intermittent rest to the joint that is painful, avoiding exertion and excessive use. Conservative treatment allows the patient to increase joint flexibility with physiotherapy exercises. Medications that can help relieve pain include:

  • Trigger Point Dry Needling
  • Analgesics (painkillers)
  • Supplements like calcium and ginseng, which allow the bones to become strong and stable.
  • Antibiotics are helpful in case of tendonitis and bursitis as they reduce the inflammation levels.
  • Non Steroidal Anti-Inflammatory Drugs are given in case of rheumatic arthritis of the shoulder joint for longterm relief.

Surgical intervention is needed in case of fracture or break in the bones. Cast or crepe bandage is useful in cases where rest and support to the ligaments is needed in cases like dislocation of shoulder.

Using natural means of reducing inflammation may be beneficial to include in your treatment plan. Our Bone & Joint Multivitamin was designed by an orthopedic surgeon, based on the vitamin recommendations she gives her patients every day! This multi is designed to steadily reduce pain + inflammation at its source by harnessing the power of your body’s endocannabinoid system.

Treating Ankle Arthritis With Ankle Replacement

For years ankle fusion has been the only treatment option available for people suffering from severe ankle arthritis. Fusion has always been an effective treatment technique, but it’s an option that completely alters the patient’s gait, changing the way they walk for the rest of their lives. It totally eliminates ankle motion and causes severe arthritis in the rest of the foot too.

New advancements in medical technology have offered a solution, that can produce long-term mobility, flexibility, and stability. Total Ankle Replacement surgery allows the patient to retain motion in the ankle joint, creating a new joint that functions like the old one, but without pain. Below we’ll explain why Dr. Meredith Warner prefers Total Ankle Replacement surgery for her patients, and detail each step of the procedure.

Ankle arthritis is a condition caused by damage to the joint that connects the foot to the leg, also known as the tibiotalar or ankle joint. There are three bones connected in this joint: the tibia, the fibula, and the talus. Ankle arthritis can involve any or all of these bones. Symptoms vary but most commonly include pain during movement, swelling, tenderness, and difficulty walking.

About 50 percent of people over the age of 60 are affected by ankle arthritis every year and seek out a treatment that may help relieve pain. Most ankle arthritis is post-traumatic and can usually be traced to an injury.


Ankle fusion is one of the most common ankle arthritis solutions offered by medical professionals in the United States, yet often comes with a variety of complications. During the procedure, the doctor will extract damaged cartilage and use pins, plates, and screws to set the joint in a stable position. The joint is removed, allowing the bones to fuse and grow together over time.

The procedure is often successful and reduces pain, however adjacent joint disease may develop in the months and years following surgery. Also, by removing the joint, range of motion is reduced in the ankle, ultimately affecting gait. The change can negatively impact the knee and hip, causing injury or damage.

An Innovative Alternative: Ankle Replacement

Total Ankle Replacement surgery may not be as conventional as total hip or knee replacements at this time, but is a solution that can be as viable and successful for individuals living with arthritis. Dr. Meredith Warner prefers this treatment method over fusion because it allows patients to maintain a more normal gait post-surgery.

During the procedure, damaged cartilage is removed, and a new metal and plastic joint is implanted in order to restore function. The method relieves ankle arthritis pain and offers patients more mobility and flexibility than fusion. Following surgery, the patient can safely move the ankle joint, meaning less stress is transferred to adjacent joints.

Most patients can begin weight bearing on their ankle within one month and begin physical therapy just a week following surgery. Studies have shown that ankle replacement leads to more normal gait than a fusion. On average, replacement joints start to wear out after about ten to 15 years. Once the total joint is worn down a doctor may recommend a second ankle replacement or at that time a fusion may be appropriate.

For many patients with ankle arthritis, an ankle replacement may be the best treatment path to explore to ensure long-term success, comfort and to protect the rest of the foot and leg from arthritis problems.

At Well Theory, we always advise working with your primary physician to find the least invasive option available to you for the successful treatment of your condition. Dr. Warner, the founder of Well Theory, uses this methodology with her own patients, and this led her to develop a line of natural, safe, pain-relieving products that harness herbal medicine and modern medical therapies. Click here to view our full line of wellness products!

Myofascial Pain and Breast Cancer

Up to 45% of those undergoing or post breast cancer treatment have pain. Usually, this pain is in the upper limb or mid-back region. It is generally thought that this pain is due to a myofascial trigger point, or areas of hyper-irritable spots in the skeletal muscle. These spots continually contract and/or become fibrotic. These spots are painful and cause muscle dysfunction around them and gradually increase pain in the area.

The myofascial matrix of the body is the area where muscle and fascia integrate. The myotendinous zone is where muscle and tendon integrate. There are weaker tissue connections and many nerve fibers at transition zones in the body. The myofascial area can become very painful. This is especially true if a faulty spot, or trigger point, is created.

Trigger Points

Trigger points not only are extremely tender and painful in and of themselves, but they also refer pain. As well, they can cause distant motor and autonomic or sensory effects. For example, a trigger point in the sternocleidomastoid muscle (front of the neck) can cause headaches that move to the crown.


Common areas of trigger points and pain in breast cancer patients include the upper trapezius muscle, pectorals, serrates anterior, and some shoulder muscles. In addition to being painful, the neck, mid-back, shoulders, and scapular areas may become stiff.

Treatment is possible and generally safe. First-line treatment should be with a physical therapist. These professionals have a variety of techniques to treat muscle and fascial pain. A good physical therapist will create an individualized program to include stretching, massage, deep tissue work, strengthening, and passive relief modalities for the patient. If physical therapy is not successful or fast enough, a physician can perform trigger point injections with a numbing medication and/or anti-inflammatory. These injections are directed into the painful trigger point itself.

Insurance covers both therapy and physician trigger point injections and treatments. In many states, there is a provision to allow direct access to a therapist for patients. 

At Well Theory, we advocate for patient-led, holistic alternatives to invasive procedures. Therapy is a great option for addressing discomfort caused by myofascial pain – and so are natural pain relieving products that harness the power of herbal remedies. Click here to view all of our surgeon-designed, safe, and holistic pain-relieving products!

A Solution to Arthritic Knee Pain Without Replacement

A minimally invasive, office-based treatment for chronic knee pain from arthritis.


Osteoarthritis of the knee is one of the most disabling conditions in the world. It is present in about 20-30% of the elderly population (over 65-years-old). With the aging of the population and the increasing number of people working longer, this is expected to increase. Also, most individuals are more active now than ever. The pain of arthritis is long-term and can render one unable to do even basic daily activities.

There are many non-operative treatments available for chronic knee pain from arthritis. These treatments range from braces to hyaluronic acid injections. However, many physicians recommend a replacement of the natural knee with a metal and plastic one when other treatments don’t work.

Many people do not want to undergo the trauma and expense of a total knee replacement. Some people are not healthy enough to undergo such a surgery. Some individuals wish to delay such a surgery for any number of reasons.

Also, 20-30% of patients still have pain and disability even after having a total knee replacement.

Treatment Options

There is a way to treat the pain without replacing the knee joint. By blocking the sensory nerves that provide the pain signal from the knee to the brain, the pain can be treated. First, the nerves must undergo a temporary block to see if the pain relief is adequate. Then, a minor procedure is completed that prevents the nerves from working to create a pain signal. The pain is effectively gone. This has been shown to provide a significant amount of pain relief in a number of scientific studies. While there is no cure for arthritis, there is a potential treatment for the pain of arthritis of the knee.

The nerve block is done in the clinic. An area around the kneecap undergoes a series of injections with a medication that numbs the nerves. If this proves to provide enough relief, the next stage of treatment occurs.


The patient with the painful arthritic knee is mildly sedated, and numbing medication is injected into the area to provide relief during the procedure. Specialized cannulas and probes are placed around the kneecap in key positions. Each probe is inserted under the skin into an area known to have a sensory nerve. Once positioned, the probes area activated and render the nerves ineffective. The probes utilize radio frequency to produce a minimally invasive heat source that essentially burns the nerve. The surrounding tissue has minimal to no damage due to the design of the probe and the procedural technique.

If successful, this procedure can provide an individual with long-term pain relief without the need for medication.

For daily, natural relief without medicinal fog, reach for our Pain Relieving CBD Cream! The holistic blend in our CBD cream is designed to relieve pain on contact, and interact with the endocannabinoid receptors in your body to further regulate inflammation.

Three Ways a Total-Knee Replacement May Affect an Arthritic Ankle

If you’re living with an arthritic ankle, a total knee replacement can have a tremendous effect on your life. Below we’ve shared three ways a total knee replacement can affect the health of an arthritic ankle.

Change The Position of the Ankle

When a total knee surgeon places a total knee implant, they must consider the position in three planes. It must be position in the lateral (side-facing), coronal (front-facing) and finally the axial (cross-section) planes. Often, a position of external rotation in the axial plane is selected to place the patella correctly in its femoral groove.


Sometimes the rotation of the femoral and tibial total knee components changes the rotation of the tibia (shin-bone), ultimately affecting the ankle.

If you have ankle pain or feel that you wear out shoes differently since your total knee replacement, it may be worth seeing a foot and ankle surgeon.

Tendinitis May Develop Due to Changes in Range-of-Motion

People with pre-existing ankle arthritis usually have limited range of motion; the same is true of the knee of course. Over time, with an arthritic knee and ankle, the walking pattern accommodates to the limits of both joints.

Once the knee is replaced (assuming all goes well), the knee will have a much better range of motion. This knee range of motion then puts additional stress on the already limited and arthritic ankle. It is not unusual to develop Achilles tendinitis, plantar fasciitis, peroneal tendinitis or posterior tibial tendinitis in the ankle region due to the changes in walking.

Reduced Flexibility in the Hindfoot

Again, total knees will change the alignment of the knee from being either valgus (knock-kneed) or varus (bow-legged),  and change the angle of the ankle in the forward-facing plane.

Because the ankle has changed its angle, the calcaneus (heel bone) must change its relative position.  If an ankle has been in valgus, typically the calcaneus compensates by moving varus.  Conversely, if an ankle has been in varus, the heel will correct by moving into valgus.  The goal of the body is to maintain an overall neutral position of the leg and body relative to the ground.

When the total knee is placed and suddenly the knee is straight (neutral) again, this places the ankle in a different plane. The change is happening along with the tibial rotation change discussed in the first point. The heel bone will need to compensate less but often becomes stiffer due to the new biomechanics of the ankle joint. A stiff hindfoot will increase midfoot and forefoot pain, contribute to plantar fasciitis and make navigating uneven ground difficult.

All this to say, if you find that you are having more foot and ankle pain after total knee surgery, you should be evaluated. Sometimes a simple custom insert is necessary. Other times, professional physical therapy can help. Injections, massage, and other techniques can reduce the discomfort also. Rarely surgery is required, but it happens.

Our Bone & Joint Health Multivitamin was designed by an orthopedic surgeon to naturally reduce pain + inflammation in the joints. Get all the essential vitamins and minerals your body needs with added mood-boosting and anti-inflammatory benefits from pure Full Spectrum CBD.

How Does Your Overall Diet Affect Your Skin?

What we eat everyday affects your skin in more ways than one!
Additionally, many people do not realize that your overall health and your skin are closely related. Eating bad foods such as items with too much sugar or even fast food can really wreak havoc on your skin. For example, sugar has been proven to cause inflammation. This in return produces enzymes that break down collagen and elastin, resulting in sagging skin and wrinkles.

Check out these easy and delicious 3 ways to alter your diet to heal you achieve healthier skin:

Eat “Clean” with Fish, Fruit, and Veggies

Eating more fish, leafy greens, and fruit can play a major role in the health of yoru skin. People who eat diets like this have more omega-3 fatty acids from fish that keep skin cells strong an elastic.

Reduction of skin elasticity is a fact of aging for most people. Skin elasticity is the skin’s need to stretch and then go back to normal. Preserving the elasticity in your skin allows for it to look more youthful.

Cut Back on Bread and Pasta

Lowering the intake of carb-heavy foods actually lowers the stress hormone cortisol. Lowering your cortisol levels helps to minimize pesky breakouts.

Breakouts can eventually lead to long-term blemishes that can really ruin your overall completion and can may require extra work to try to clear up. Swap these foods for better choices such as zucchini pasta instead of traditional pasta to lower your carb intake.


Introduce Olive Oil into Your Diet

Not only is olive oil a good way to help you skin within your diet, but it also can be applied directly to skin to reap the benefits. Olive oil also contains monounsaturated fat, unsaturated fats that are known to increase your overall cardiovascular health.

Increasing your intake of these foods can help you to achieve and maintain healthier, more attractive looking skin. Your diet has the ability to directly affect your skin and making healthier food choices can help you to fight against elasticity loss and premature skin aging.

Choosing a beneficial multivitamin is a fantastic way of ensuring you’re getting the daily recommended amounts of all your essential vitamins and minerals. Our multivitamin was designed by orthopedic surgeon Dr. Meredith Warner, who selected each ingredient according to what vitamins she recommends to her patients.



Four Ways That Trauma Can Contribute to Post-Traumatic Arthritis

Fractures (breaks in bone) through the joint surface increase the risk of post-traumatic arthritis 20 times. In fact, three out of four people that sustain a break through the joint surface itself may develop arthritis in that joint eventually.

i. Sudden mechanical damage to the cartilage at impact and break-point

ii. Biological response to injury
a. Bleeding, inflammation, etc

iii. Chronic cartilage damage and overload due to uneven joint surfaces and
a. Misalignment after a fracture

iv. Instability
a. Constant altered load on the damaged joint surface

Cartilage is the slick and firm surface of either side of a joint. A joint is two or more bones that move together; the elbow, knee, hip, ankle, wrist, etc are all joints. Cartilage is about 60-85% water by weight and is a matrix of collagen along with other biologic substances.

Cartilage is built to last. The function and structure of cartilage, as well as the body’s innate ability to adapt and heal, is such that it can handle a lifetime of repetitive use and demanding movements and even trauma. However, occasionally trauma is so severe that the cartilage has a difficult time recovering. This type of trauma involves such massive energy or force that the physiologic parameters of the bone and cartilage and ligaments are destroyed and the bone breaks along with the cartilage surface. Many other types of trauma the body can handle heal. If the body is incapable or recovery, then degradation ensues. Fractures through a joint are one cause of arthritis.

The massive energy of a fracture also impacts the cartilage before it too breaks. This causes cell death and dysfunction. The good news is that most of the cell damage has been shown to occur close to the actual fracture line itself. Cartilage and tissue away from that break-line does not show nearly as much damage.

One study demonstrated about 1 in four cells were damaged if directly at or adjacent to the fracture line; further away, less than 10% were. The very high energy required to actually break a bone is necessary for post-traumatic arthritis. Impact injuries that simply pound the cartilage but are not associated with a bone breaking are much less damaging. Basically, the amount of force matters and how long that force is applied to the cartilage.


The biological response to the fracture or impact also plays a role. The initial phase of healing is inflammatory.

Inflammation is totally necessary for healing to occur. However, inflammation also involves the release of reactive oxygen species, or free radicals, that damage tissue. The pro-inflammatory substances that flow into an injury zone can often cause further damage by matrix (collagen) breakdown. Again, the larger the force load applied to the joint surface and underlying bone, the more inflammation and free radicals are produced.

Tumor necrosis factor alpha, Interleukin-1, nitrous oxide, matrix metalloproteinase and others are all associated with ongoing damage. These are actually targets for therapies to treat arthritis. If post-traumatic arthritis occurs, it has been shown to occur rather quickly. Some studies demonstrate changes in the bone within 8 weeks. Others show transformation at the zone of injury in about 4 years. Either way, post-traumatic arthritis occurs earlier and more obviously than normal degenerative arthritis. Therefore, there should always be a difference in appearance of the affected joint relative to other joints in the body if this process happens.

When a joint has a fracture or a break in it, the joint surface changes. Joints are designed to be very smooth and congruent in most cases. A fracture will often leave a fissure or a fault line. Obviously, this will change how the joint moves and can change the pressures applied to the joint surface itself. An ankle fracture may cause changes of up to 300% in terms of pressure on the joint from a simple fracture line. This change in pressure on the joint over time will engender a sustained low-level impact to that particular part of the joint over time; therefore, that part of the joint is at risk of arthritis. One of the goals of fracture surgery is to restore the normal, smooth surface of a joint.


Misalignment and instability also occur after fractures. Typically, for the energy of an event to be great enough to actually break bone and cartilage, there are also torn ligaments and tendons.

Unless the proper soft-tissue balance is restored after such a break, chronic instability occurs. One of the most common reasons to develop ankle arthritis is to have untreated sprains that cause long-term instability. Instability changes where all the pressure on a joint goes and the new locations is likely not built to accept the weight of a person. The level of importance of alignment and instability varies depending upon the joint involved. Some joints can accept a large amount of variability (hip/shoulder) while others cannot (ankle/wrist).

Currently work is being done to further understand what happens to cartilage after it breaks along with a bone (articular fracture). The goals of treatment today are to restore the joint anatomically along with alignment, to produce stability of the ligaments, to limit the inflammation initially and to mitigate the damage at the time of the event.

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