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.

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.

Why You Should Consider A Multivitamin Before Surgery

Why You Should Consider A Multivitamin Before Surgery

Why You need a daily multivitamin

before getting surgery

When you are about to undergo surgery, you are usually given a pre-operation checklist for certain things to do or avoid as you prepare for your procedure. This can include things like a round of preemptive antibiotics, not eating certain foods or fasting 12-24 hours before your surgery, etc.


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It’s important to take your surgeon’s advice while you’re preparing for your surgery. Not only are surgeons skilled enough to understand the science behind these procedures, they are also experts in the science behind healing. Nutrition is a key factor in repairing tissues affected by surgery, and starting a supplement regimen is a great way to make sure your body is optimized and ready to begin the healing process.

healing after surgery

and getting back to normal

The healing process after your surgery centers on the building of collagen – which is the main component in many tissues, such as your skin, tendons, muscles, ligaments, cartilage, blood vessels, bone, and more. Basically, any tissue that can be affected by surgery – “surgically traumatized tissue” – needs collagen to rebuild. The production of collagen, and the overall healing process, happens in three stages after surgery:

  • Inflammatory phase (up to 5 days): Right after surgery, the body forms a blood clot to stop bleeding. Infection-fighting cells and debris-cleaning cells are sent to the surgical site. Redness, swelling, and inflammation ensues.
  • Proliferative phase (2 days – 3 weeks): Fibroblasts, specialized collagen-forming cells, start building tissue at the surgical site.
  • Remodeling phase (3 weeks – beyond): Over time, the body slowly replaces the collagen that was initially formed at the surgical site with stronger collagen – to strengthen the tissue at the surgical site and promote better function over time.

Without proper nutrition, this healing process can take longer and may even encounter complications. A balanced diet, including essential vitamins and minerals, is extremely important for your healing experience to go smoothly. This is why many surgeons will recommend a multivitamin or specialized supplement regimen before and after surgery.

The right amount and combination of supplements can greatly impact your surgical recovery in a positive way. But you shouldn’t start a supplement regimen without guidance.

Inform (And ask!) Your doctor

about supplements

While most supplements should be safe and beneficial to take as you’re preparing for surgery, there are some supplements that could actually harm your recovery process. For example, certain herbal supplements and over-the-counter drugs can reduce your body’s ability to clot blood – an essential component of a smooth recovery. Other supplements can interact negatively with other medications your surgeon may recommend for your healing process.

Your doctor would be more than happy to recommend certain vitamins and minerals to promote healing, and can tell you which supplements to avoid or discontinue while leading up to surgery. You should bring up supplements during your pre-op consultation to make sure there are no delays, as it can take a week or more for any medications to fully leave your system.

Surgeon-Designed Multivitamin

for your peace of mind

If your doctor prescribes many different vitamins and minerals, your pre- and post-op supplement routine can get expensive, and complicated, very quickly. It’s far easier to carefully choose an inclusive multivitamin and have your doctor confirm that none of the ingredients would interfere with your procedure.

In her years of practice, orthopedic surgeon Dr. Meredith Warner found herself prescribing many different supplements and multivitamins to help her patients prepare for surgery. She specializes in surgical procedures impacting the foot – which contains nearly one-fourth of all bones in the human body. The foot is a complex, flexible structure that contains bones, joints, and more than 100 muscles, tendons and ligaments… all working together to enable movement and balance.

For procedures as high-stakes as these, she believes that proper preparation is essential for ideal outcomes for her patients. This is why she created a multi to support the connective tissue in your body. It contains highly fortified ingredients ideal for pre- and post-surgery recovery, including Calcium Citrate, Magnesium Oxide, Full Spectrum Hemp Powder, Vitamin C (ascorbic acid),Vitamin D3 (cholecalciferol), Zinc Gluconate, and more.

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CBD Vitamin + Multivitamin by Well Theory

One convenient daily serving has everything she recommends her patients take daily to promote surgical recovery and overall musculoskeletal health. Gain peace of mind before your procedure by using our breakthrough formulation that was completely designed for orthopedic conditions.

More Details About Dr. Warner's Custom

designed connective tissue vitamin

These ingredients work best together – while each is a necessary supplement on its own, together they pack a powerful punch.

Full Spectrum Hemp Powder

Hemp interacts naturally with your endocannabinoid system to add a long-lasting anti-inflammatory, tons of antioxidants, and a pain-relieving component.

Vitamin C

Vitamin C promotes proper collagen formation and helps with wound healing, supports the joints, and contributes to healthy bones & teeth.

Calcium Citrate

Calcium Citrate helps promote healthy bone growth, and is integral to nerve signaling & muscle contractions.

Vitamin D3

Vitamin D3 aids in your body’s ability to absorb calcium and supports nerve health. Important to almost every human system.

Magnesium Oxide

Magnesium Oxide also regulates magnesium levels to reduce muscle cramps, fortifies the bones, and is essential for nerve and muscle function.

Zinc Gluconate

Zinc Gluconate is an awesome assistant for wound healing and connective tissue - and also promotes tissue growth and development.

Promoting balance + health at a cellular level is key to maintaining function for many years to come, and recovering from any procedures you may need in the future. Choose the Well Theory Bone & Joint Health Multi to help achieve baseline wellness and promote cellular health.

5 Most Common Causes of Knee Pain

Knee pain can be unbearable but can be even more frustrating if you don’t understand what is causing or why it’s not getting better. Unfortunately, most pain related to your knees gets worse over time. What can start out as stiffness or aches can, if left untreated, turn into a problem that can only be fixed with surgery. Sometimes, icing or over-the-counter medications may help. Other times, therapy or braces may be needed.

Recovery is determined by the condition and its severity. However, the first step in recovery is understanding what’s causing your pain in the first place.

Meniscal Tears

The sturdy and flexible, hard tissue that covers the ends of our bones is known as cartilage. Knee cartilage is supported by two menisci (semicircular cushions of collagen between the cartilage surfaces): the medial and the lateral meniscus. This information is essential because this is where most “tears” take place within the knee.

A meniscal tear is about as painful as it sounds – causing the torn edged to get stuck in the joint, creating a “catching” sensation in joint. Meniscal tears cause swelling and can sometimes lock the knee.


One of the most common causes of knee pain and disability is arthritis. As a general inflammatory condition, arthritis is split into three common types when it comes to knee pain: rheumatoid, post-traumatic, and osteoarthritis. While these all differ based on how they’re caused and what they affect, the most common of the three is osteoarthritis, which is the continual wear-and-tear of cartilage in the knee joint.

Osteoarthritis has a strong genetic component. Most frequently seen in older individuals, osteoarthritis can cause limited range of motion, tenderness, and weakness in the knees. No matter what form of arthritis is present, they all share the common characteristic of stiffness and swelling, making it hard to bend the knee. There is no cure for osteoarthritis at this time; however, there are several treatment options available to treat the symptoms.


Ligament Injuries

Ligaments connect the thigh bone (femur) to our lower leg bones (tibia). Ligaments hold our bones together and keep them stable. Most common in sports injuries, ligament sprains and tears can occur in the medial collateral ligament (MCL), posterior cruciate ligament (PCL), and anterior cruciate ligament (ACL). This type of injury can create severe pain and is characterized by the swelling and instability that these injuries cause. These injuries often need bracing and therapy and may require therapy.



Inflammation of the knee can become a problem for most as it is often the result or cause of other conditions such as arthritis, tendonitis, injuries, tears, etc. Inflammation can affect tendons, ligaments, cartilage, muscles and much more. While the pain you experience from inflammation can vary from mild to severe, you should always make sure to treat it before it gets worse. Chronic inflammation can often lead to more damage, increased pain, and a loss of cartilage. With inflammation, the body produces proteins and chemicals that promote swelling and pain.

Patellar Fractures

The kneecap acts as a protector to the knee, so a break within it is often caused by a fall onto the knee or against the dashboard during a vehicle collision of some kind. For those whose bones are weakened from osteoporosis, a fracture can occur by just misstepping, making it difficult or impossible to walk and straighten the knee. The patella increases the efficiency of the quadricep muscles and is often under a lot of stress. There are many other fractures of the knee possible as well.

Unless it’s a dislocation or fracture, the causes of knee pain may all seem the same to you. It’s difficult to honestly know what your condition is without seeing a professional. Don’t try and self-diagnose, or sweep the issue away, as untreated knee pain can only get worse over time. Contact a specialist today if you’re experiencing any knee pain or discomfort and so that you can start moving toward recovery.

Our Bone & Joint Health Multi is a great option for steadily improving joint health + function every day. Orthopedic surgeon Dr. Meredith Warner designed this multi based on what she recommends for her patients with musculoskeletal conditions – especially those who are considering surgery – so they can recover, faster. 

Shoulder Pain and Common Shoulder Problems

Are You Experiencing Intense Shoulder Pain?

There are a few signs you should look out for when determining whether to visit your doctor for a shoulder injury. The first and most immediate sign is extreme pain. If you’re experiencing severe pain as you move or touch your shoulder, it’s time to visit the doctor.

Before scheduling a visit, you may look at your shoulder and note any visible deformities. Your blood vessels and nerves may be damaged if you feel numbness, tingling or cold near the site of injury.

If your shoulder is injured due to trauma, we suggest seeking medical care immediately.

If you’ve been enduring persistent shoulder pain, that has worsened over time call a doctor immediately. Most home treatments are ineffective for serious shoulder injuries, and professional guidance may be necessary to ensure a safe recovery.

A waiting period helps some people determine whether they’ve severely damaged their shoulder. However, you shouldn’t wait longer than a few days if your shoulder is deformed, experiencing loss of feeling or extreme pain.

Again, if there has been trauma or there is moderate to severe pain or numbness and tightening, a professional assessment should occur as soon as possible.

Most Common Shoulder Injuries

People experience many types of shoulder injuries every year and identifying the true condition you’re experiencing is the most efficient route to finding the best treatment.

A rotator cuff tear is one of the most commonly reported forms of a shoulder injury. The condition is caused by tears or strains and often occurs with bursitis or tendinitis.

Frozen shoulder, which causes the tissue in the joint to thickens and tightens, is also one of the more common causes of shoulder pain. Frozen shoulder also presents a loss of motion.

Professional treatment is certainly required for these conditions.

Long-term conditions, like arthritis, cause persistent shoulder pain and are best treated with a professionally-developed treatment regimen.


Why Should You See an Orthopedic Surgeon?

Orthopedic doctors specialize in treatments related to the injuries or damage to the musculoskeletal system, including the shoulder.

Every day these doctors work with patients with injuries that have made it difficult to perform daily activities, suffer from chronic pain, and experience a decreased range of motion.

Orthopedic doctors can identify the source of your shoulder pain and develop a specific treatment path for you.


Care for Shoulder Pain & Shoulder Injuries?

Shoulder pain can result from a number of different causes, including arthritis, tendonitis, and joint dislocation.

Damage can occur from lifting heavy weight or through sports-related injuries, creating a dislocated joint or fracture. If you are experiencing any severe pain, visible muscle deformities, or persistent pain that has worsened over time, you should seek medical care immediately.

The severity of pain and damage to bones or joints will allow specialists to prescribe operative or non-operative treatment plans to help you return to a pain-free life.

Well Theory’s surgeon-curated line of products was designed to give you a safe + natural alternative to invasive measures. Use our cream and spray to gently, safely, and naturally soothe away topical aches and pains. Expertly crafted with soothing lidocaine, menthol, pure Hemp CBD isolate, and a carefully selected blend of essential oils.

Easy and Natural Tips to Heal That Bruise

Muscle contusions (bruise) are common in athletes but also in everyday people. In fact, are the second most common cause of sports injuries. Contusions typically heal quickly without forcing the athlete to take extensive time off. However, severe contusions can cause deep tissue damage and keep them out of the game for months.


Contusions occur after a blow from a blunt object strikes the body and crushes the muscle fibers and connective tissue without breaking the skin.

A contusion can happen from falling or pushing against a hard surface. A contusion can be as traumatic and painful as a tear or break (fracture); however, they are often underestimated since they can’t be seen.


Contusions are known to cause swelling and pain near the area of injury. Damaged blood vessels result in a bluish discoloration. A pool of blood can collect within the damaged tissue and form a bump. The muscle may feel weak, stiff and sore days after the injury is incurred. If damage is extensive a broken bone, sprain, tear or other injury may also be present.

Contusions of the abdomen may damage internal organs. Contusions in superficial locations, such as the shin (tibia) or elbow can have blue, black, brown and yellow discolorations for weeks.



The RICE (Rest, Ice, Compression, Elevation) formula can be applied to the contusion. Some doctors may recommend an non-steroidal anti-inflammatory drug like ibuprofen. The first 24 to 48 hours after the injury RICE will be the best method to employ for relief. If a large hematoma doesn’t disappear within a few days a doctor may need to drain it surgically. Compression marments are extremely effective to treat contusions.



Within a few days the inflammation should start to go down and the injury should feel less painful. A doctor may recommend gentle heat to the injury at this point. Activity levels can be increased gradually. Returning to sports or everyday activities may take several weeks. Putting too much stress on the area before it has healed can lead to scar tissue and more problems.

A doctor may recommend gentle stretching exercises to restore range of motion. Weight bearing and resistance exercises should be considered after range of motion has improved. Physical therapy is an excellent treatment for contusion; a professional therapist can optimize the muscles recovery and function.


Compartment syndrome and Myositis Ossificans can occur in serious cases. Compartment Syndrome may require surgery to drain excessive fluids and swelling to the muscle. This is a serious condition that usually causes extreme pain. Immediate attention is required. The condition is caused by rapid bleeding, a build up of fluid, and can disrupt blood flow.

Myositis Ossificans is a condition in which the bruised muscle grows bone instead of new muscle cells. RICE can help this condition and improve flexibility; surgery isn’t usually required. Myositis ossifican is common in the thighs of football players; however now all uniforms have padding on the front of the legs.

Use Well Theory’s surgeon-curated cream and spray to gently, safely, and naturally soothe away topical aches and pains. Expertly crafted with soothing lidocaine, menthol, pure Hemp CBD isolate, and a carefully selected blend of essential oils.

For more information on Muscle Contusions visit the American Society of Orthopaedic Surgeons.

Anterior Knee Pain and Patellofemoral Arthritis

Many people with pain in the front of their knee spend months or years without a true diagnosis or treatment plan. Often they are pushed from doctor to doctor, and occasionally are even relegated to pain management. Most patients with pain in the front of the knee, or anterior knee pain, however, are active and do not want to be medicated forever. The problem with anterior knee pain is that it is a difficult diagnosis to make and there are many possibilities.

One of the problems with medicine in the era of healthcare reform and ‘big-box’ medicine is that physicians no longer perform actual physical examinations.

Usually the doctors have a quota of patients to see that day that limit a visit to 8 minutes or so and the majority of that time may be spent documenting the visit in the electronic record.

While this satisfies the government and permits payment for the visit, too often the patient remains without a diagnosis simply because no physician ‘laid hands’ on them.

Anterior knee pain can be diagnosed with a good history and good physical exam with occasional confirmation via imaging. Make sure that your doctor performs a good physical examination of the knee prior to dispensing advice or treatment.

Arthritis is the common term for damaged cartilage. Cartilage is the substance that covers both sides of a joint. A joint is a connection between two bones that allows movement. Cartilage provides both a slick and strong surface that allows the two bones to slide against each other for motion and a surface that accepts impact and protects the surface bone beneath the cartilage.

As cartilage breaks down or after it is damaged, arthritis ensues. Once there is arthritis, the surface is not as strong and is not as frictionless as it should be. Movement becomes less efficient and also painful. Patellofemoral arthritis is a problem between the cartilage surface of the underside of the patella (knee cap) and the front-side of the femur (thigh/knee).


Patients with this problem often report pain, effusions or swelling and mechanical symptoms such as popping, locking or catching in the front of the knee.

Pain is actually coming from the bone under the cartilage and the surrounding soft-tissue as cartilage itself lacks nerves. By lacking nerves, cartilage cannot itself feel pain; however, the bone underneath and the tendons, muscle and ligament around that cartilage certainly can produce pain. Arthritis is more often than not due to life itself or age-related. However, occasionally trauma or injury can cause and progress the symptoms of arthritis.

For trauma to cause arthritis the cartilage itself must fracture (break) or have an identifiable impact injury. This can happen from patella dislocations or subluxations, osteochondral defects, fractures of the knee or patella, or constant improper loading of the joint due to abnormal mechanics and alignment of the knee. Instability of the patellofemoral joint is a problem and can sometimes progress to arthritis if not identified and treatment in a timely fashion. The patellofemoral joint sustains the most load and wear during activities such as ascending or descending stairs and/or squatting. When the knee flexes (bends), this joint undergoes more and more load and deformation. Maximum contact occurs at 90-degrees of flexion, but begins at 20-degrees.


The goal of treatment is to restore normal function (if possible) and reduce pain.

Usually, nonoperative treatment is the best course of action. This usually involved physical therapy, gait analysis and correction, orthotics and bracing, medications (topical and oral) and flexibility improvements. Soft-tissue balance of the knee capsule and surrounding ligaments and tendons is very important. Generally, this balance is difficult to achieve with a home-exercise-program and formal therapy or chiropractic care is necessary. In addition, the knee functions better if the hip motion and strength is optimized; this too requires formal analysis and correction.

Another method to treat arthritis of the patellofemoral joint is through viscosupplementation. This involves injections of hyaluronic acid directly into the knee itself. This substance improves the viscosity of the joint fluid. Improved viscosity allows better resistance to compressive forces. The injection also acts as an anti-inflammatory treatment and reduces the inflammation associated with arthritis. This inflammation is a source of both pain and swelling. Also, the viscosupplementation provides supplemental nutrition to the knee cartilage; this is especially important for areas as small and as hard to reach as the patellofemoral joint. Hyaluronic viscosupplementation is an excellent treatment method for arthritis of the patellofemoral joint.

Surgery has historically not had great results for this problem. Today there are newer technologies and better reported outcomes.

However, it should still be considered a last resort. There are procedures to restore the cartilage that involve cartilage substitutes and one’s own cartilage transferred to any significant lesions on the patella.

There are procedures to realign the patella and its tendons such that the biomechanics of the knee joint change. This typically involves actually removing the bone where the patellar tendon attaches and physically moving it over and then reattaching it with a screw. This type of surgery is done to unload the patellofemoral joint and reduce the forces across that joint.

Arthroscopy is utilized to perform what is known as ‘chondroplasty’. This is basically a procedure whereby the damaged cartilage is literally removed from the knee. This is very difficult to achieve due to the anatomy of the patella; the results have been limited and there are many times poor functional outcomes of that surgery. Also through the arthroscopy, the structures stabilizing the patella can be released to effect an offloading. This is known as a ‘lateral release’. Occasionally this procedure is accompanied with a partial resection of the patella.

Anterior knee pain is very common and very debilitating. Many patients spend years without a proper diagnosis or treatment plan. The physical examination should be thorough and supplemented with advanced imaging such as MRI or CT scan. Treatment should be nonoperative if at all possible. Surgery is possible, but functional outcomes are not guaranteed and the procedures require a great deal of technical expertise and significant rehabilitation afterward.

Looking for an alternative to surgery that will help you reduce your arthritis symptoms naturally? Download our free Arthritis Guide and start managing your symptoms today!


What is Hallux Rigidus & Your Options For Treatment

Dr. Meredith Warner is an orthopedic surgeon and founder of Well Theory, your resource for maintaining and promoting full body wellness and improving function as you age.

The MTP joint or the metatarsophalangeal is on of the most common sites of arthritis in the foot. Located at the base of the big toe, this joint is important because it must bend every time that you take a step. Once arthritis sets in and the joint begins to stiffen, walking can become particularly painful.

When two bones meet and move together, that is called a joint. The ends of the bones are coated in cartilage which is very smooth and allows motion. Eventually, this may cause reactive bone spurs to develop. In hallux rigidus a prominent spur will develop in the top of the bone and the joint. This spur prevents the toe from bending as much as it needs to when you walk; resulting in hallux rigidus or a stiff big toe.

Hallux rigidus generally develops in adults between the ages of 30 and 60 years old. While there doesn’t seem to be any scientific reason as to why it affects some individuals and not others, it is thought to result from differences in foot anatomy that increase stress on the joint. In addition, some specific injuries to the toe can damage the articular cartilage and cause hallux rigidus.


  • Swelling around the great toe joint
  • Pain in the joint when active, especially when walking
  • A bump that develops on top of the foot at the joint
  • Stiffness in the great toe coupled with the inability to bend it up or down
  • Hallux rigidus often looks like a bunion


If you begin to find it difficult to bend your big toe up and down or you are walking on the outside of your foot as a result of the pain in the toe, please contact us right away. Hallux rigidus is easier to treat when the condition is caught in the early stages of development. If you wait until the development of bone spurs that are visible in the form of bony bump on the top of your foot then the condition will be far more difficult to treat. However, it is still treatable with the right skills and technology.

Your doctor should examine your foot and will look for any evidence of bone spurs. She will also check the toe for mobility and to see exactly how much movement can be achieved without pain. X-rays will pinpoint the size and location of any bone spurs, as well as, the progression of any degeneration within the joint space and cartilage. X-rays are helpful to determine the overall architecture of the foot and to plan surgery or treatment.


Non-Surgical Treatment

Anti-inflammatory medications may assist in reducing swelling and easing the pain of hallux rigidus. Applying ice packs or taking hot and cold baths may also control the symptoms and reduce swelling and inflammation for short periods of time. Your physician will likely recommend wearing a stiff-soled shoe with a rocker or roller bottom design or even a shoe with a steel shank or metal brace. This type of design supports the foot while walking and also reduces the amount of bend in the big toe. Taping often helps. In addition, physical therapy can be very successful in treating this condition.

Surgical Treatment

Arthrodesis: Fusing the bones is recommended when there is severe damage to the cartilage. The damaged cartilage is removed and screws, pins or a plate are then used to fix the joint in a permanent position. The bones grow together over time. While this procedure has traditionally been the most reliable in terms of reducing pain, it is important to note that you will not be able to bend your big toe at all. Fusion should be a last resort procedure only.

Cheilectomy: This surgery is recommended for patients with mild to moderate damage. This procedure removes the bones spurs and a portion of the foot bone, so that the big toe has more room to bend. An incision is made at the top of the foot. It is important to note that while most patients do experience long-term pain relief after the surgery, the toe and the operative site may remain fairly swollen for several months post-op. When one has a cheilectomy it is expected that another treatment will eventually follow.

Arthroplasty: This procedure is best suited for patients who do not place many high impact functional demands on the feet. Arthroplasty is a joint replacement surgery in which the joint surfaces are removed and an artificial joint is then implanted. This procedure may relieve pain and preserve some joint motion. It is possible to remove one side of the joint or both sides. The surgery is successful for pain relief but often the will eventually need to be changed or revised.

Cartiva: Unlike traditional fusion procedures, Cartiva eliminates your joint pain without sacrificing the natural movement of the foot. The minimally invasive procedure places an implant, composed of a biocompatible organic polymer, that functions similar to that of natural cartilage. The procedure allows the foot full weight-bearing capacity shortly after surgery. Cartiva can be implanted with a block of regional anesthesia. Cartiva is a technology that is innovative and can reduce pain while preserving more normal foot motion.

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How Plantar Fasciitis Slows You Down

Plantar fasciitis affects over 2 million people a year and is thought to be the most common cause of pain in the inferior heel. If left untreated plantar fasciitis can become a disabling long-term condition. Plantar fasciitis affects a patient’s level of activity and affect mobility.

The natural history of plantar fasciitis can mean pain lasts up to two years without proper treatment. If treatment is implemented correctly and in a timely manner the patient can return to their regular activities quickly.


The plantar fascia is a band of fascia that runs directly beneath the skin and subcutaneous fat on the bottom of the foot. The plantar fascia connects the heel to the front of the foot and supports the arch. Passively, the plantar fascia helps bear the weight of the body and some studies estimate it supports as much as 14 percent of the total load of the foot.

The plantar fascia is also important during gait because it elongates as you move throughout the motion. As the plantar fascia elongates or stretches it provides increasing support to the arch and augments foot movement/function.


Since the plantar fascia functions as one of the primary support structures in the foot is prone to being overstressed. Too much pressure or overexertion can damage or tear the tissue. People who are overweight or constantly on their feet are specifically susceptible to developing plantar fasciitis. Individuals with flat feet or high arches are also more likely to develop the condition.

People who participate in running or walking are capable of developing plantar fasciitis because of the stress placed on the feet during these activities. Many people who have heel spurs develop plantar fasciitis however heel spurs are not the cause of plantar fasciitis. Nonetheless, the size of one’s heel spur corresponds to the intensity of pain.



If you feel pain in the heel and/or arch as soon as you step out of bed in the morning you may have plantar fasciitis. Patients who suffer from plantar fasciitis often report pain after long periods of being inactive; for instance, heel pain after a long drive or after working at a desk. Pain can also begin after periods of heavy activity; this is likely due to the stressors placed on the structure.



Simple home-based treatments can be effective in about 10 months for over 90 percent of patients struggling with plantar fasciitis. Reducing or stopping activities that make the pain worst can quickly reduce pain in most patients. However, over time inactivity is actually worse for the foot. Icing the heel three to four times a day can also be effective. Plantar fasciitis can be worsened if the muscles in the leg and foot are tight. Stretching and exercises can reduce pain and improve mobility. Physician directed treatment could further shorten healing time to one to three months.

Anti-inflammatory medication can reduce pain and inflammation as well. Supportive shoes and orthotics can benefit the plantar fascia as well and provide essential support. Night splints are sometimes recommended to wear as you sleep to stretch the plantar fascia as you sleep. Physical therapy is an excellent treatment for this condition. Occasionally injections are required. PRP therapy is also known to work for plantar fasciitis as well.

Surgical treatment is only recommended after 12 months of non-surgical treatment if the pain is still present. Plantar fascia release is a surgery some doctors recommend if you still have normal range of motion but continued heel pain. During this procedure the ligament is partially cut to relieve stress and tension in the plantar fascia.

Gastrocnemius recession is a surgery that lengthens the calf muscles to decrease stress on the plantar fascia. Tight calf muscles increase tension in the plantar fascia and gastrocnemius recession aims to reduce the amount of stress caused by plantar fasciitis. It is the goal at Warner Orthopedics to avoid surgery for plantar fasciitis if at all possible.


For more information about Plantar Fasciitis visit the American Academy of Orthopedic Surgeons.