I broke my leg two years ago, and it still hasn’t healed. My orthopedist says it’s because of my age (I’m 77) and the fact that I have to take steroids for my arthritis. I haven’t time to hobble about. Anything new out there?

Yes and no. Low-frequency ultrasound has been around for decades, so it’s not new. However, new evidence shows that treating a problem fracture like yours with ultrasound for 20 minutes a day can improve healing by up to 90%. Talk to your doctor to see whether ultrasound could be used to help your leg.


Why don’t I feel anything when my therapist rubs the ultrasound head on my skin? I thought it was supposed to feel warm.

Ultrasound waves are high-frequency sound waves. These sound waves are too high for you to hear, and they are not hot in themselves. Your therapist can adjust the frequency and intensity of the ultrasound so that the sound waves create heat energy in your body. Ultrasound treatment can cause vibrations in the molecules of your tissues, which creates heat. You cannot feel these vibrations, however. Ultrasound also creates heat in tissues that absorb the sound waves, such as tendons, ligaments, and bone.


Not feeling any heat doesn’t mean that the ultrasound isn’t working. If the ultrasound is targeted to deep tissues, it could be creating heat that you can’t feel. There are no heat sensors below the surface of your skin. That means you only experience heat during an ultrasound if the warmth can travel back to the skin surface.


It is also possible that your therapist is setting the ultrasound so that it doesn’t cause a build-up of heat. Therapists usually try to avoid building up heat in tissues that are swollen or severely inflamed.


How does ultrasound work to heal bone fractures?

No one knows for sure, though there are many theories. Some think ultrasound mimics signals our body sends that triggers bone building. Others believe the sound waves are absorbed by the bone, causing needed chemicals to move across the bone’s surface and help it heal. More time and research will be needed to tell what really happens. The most important thing is that it appears to work, and without the side effects of more aggressive treatments, such as surgery.


Why do I feel heat when my therapist treats my aches and pains with ultrasound?

Therapeutic ultrasound creates high-frequency sound waves. These waves are not sources of heat themselves, but they can cause a heat reaction in your body. At certain settings, ultrasound waves can cause vibrations in the molecules of your body’s tissues. The vibrations cause heat. Also, tissues high in collagen, such as bone, tendons, and ligaments, absorb some of the sound waves. This also creates heat energy.


You can’t feel heat below the surface of your skin. However, if there is enough heat energy, or if the heat is created close enough to travel up to your skin, you will feel warmth within the skin during ultrasound.


What can ultrasound treatments do for my pain?

Ultrasound treatments are used to ease pain, improve circulation, and speed healing. Ultrasound treatments can be manipulated to have different effects. Your therapist can set the frequency and intensity of the sound waves to create heat in the sore area. This thermal effect brings in blood to the sore area. The blood brings in oxygen and nutrients, and it flushes away waste products and chemicals that may be causing pain. Thermal treatments can also stimulate the nerve sensors to start easing pain. As the pain eases, tight muscles can relax, which further relieves the cycle of pain.


The ultrasound machine can also be set in a way that avoids a thermal effect. This is often necessary if the area is swollen or severely inflamed. The non-thermal treatments can help move body chemicals to and from the cells in the sore area. This can help speed the healing process.


 


My therapy treatments help my pain so much. Why can’t I just keep coming once a week?

It’s great that therapy works so well for you. However, the goal of therapy and all your other medical treatments is to get you back to your normal life. Your therapist wants to help you manage pain and movement problems on your own.


Your therapist won’t just stop your visits. You will begin spacing out your visits. Then, when your visits come to an end, you will be given a home program of exercises. This program will be designed specifically for you. It can help you manage your pain and avoid or minimize future problems. So stick to it.


You can still check in with your therapist now and then to help iron out problems or track your progress. Even when your regular visits have ended, your therapist is still a resource for help with your pain.


What is a bone scan?

A bone scan involves injecting a radioactive chemical, called a tracer, into your blood. A technician takes pictures using special imaging equipment that detects the tracer as it circulates through your blood stream. Accumulations of the tracer show up as dark areas in the bone scan. The tracer builds up in bone “hot spots.” Hot spots are areas of bone cells that are rapidly turning over. This occurs in such situations as compression fractures, osteoporosis, overuse, and bone tumors. Locating hot spots helps your doctor make a diagnosis and develop a treatment plan.


I have finished chemotherapy for breast cancer. My doctor says this puts me at high risk for osteoporosis. What can I do to lower my risk?

Women who have had chemotherapy for breast cancer are at higher risk for osteoporosis. The cancer can cause the loss of bone mineral density, as can some of the chemotherapy drugs.


There are a few different options for reversing the loss of bone minerals. Doctors usually don’t like to prescribe estrogen to women who have had breast cancer. But you can take extra calcium and vitamin D. The recommended dose of calcium ranges from 1000 milligrams to 1500 milligrams, depending on your age and whether you are past menopause. Vitamin D is usually prescribed up to 800 IU per day.


In addition to supplemental calcium and vitamin D, there are some medications that can help. Alendronate has proven to be nearly as effective as estrogen. Raloxifene, while effective, has not been studied in women who have had breast cancer. Calcitonin seems to help most in women who are past menopause.


Weight-bearing exercise can also help combat the effects of osteoporosis. Regular walking, dancing, low-impact aerobics, or other forms of exercise can help strengthen your bones, as well as improve your overall conditioning.

After a day at work, my neck and arms ache, and I have a pounding headache. Most of the time, all I do is sit at a desk and work on a computer. What is causing this pain?

The way you sit and the ergonomics of your workstation may very well be the cause of your problems. Ergonomics refers to the way your workstation is designed and how your body uses the space.


First, look at the way you use your body while you work. Make sure your sitting posture is good. Don’t slouch. Slouching makes your neck and head jut forward, putting pressure on the nerves to your shoulders and arms. Slouching also puts extra pressure on the joints of the neck and makes your small neck muscles work extra hard to hold your head forward.


Second, get your workstation checked by someone who is knowledgeable about ergonomics, such as a physical or occupational therapist. Sometimes very minor changes in the way your chair, computer monitor, or keyboard is positioned can make major differences in your comfort level. Good lighting is important, as is making sure your monitor isn’t situated so that reflections from other light sources interfere with your vision of the screen. The monitor should be directly in front of you and slightly lower than your eye level, to avoid eye or neck strain. Your feet should rest on the floor or on a footrest. Your keyboard should be situated so that your elbows are bent at a 90-degree angle when you type. Your chair needs to support your lower back.


Finally, take breaks during the work day. Get out of your chair. Do gentle stretches or walk around a bit. Your body needs to change position from time to time. And your eyes can’t handle staring at a screen without rest. Make sure you take the time to look out a window or down the hallway to let your eyes focus on something farther away than your computer screen.


If you follow these recommendations and your pain continues, see your doctor. There may be simple techniques or exercises that can help ease your pain.

My doctor recommends a cortisone injection to control my pain and swelling. I don’t want to take a steroid. Will the cortisone injection hurt me?

Cortisone is a steroid, and steroids have gotten a bad reputation. When they are given in pill form over a long period of time, they can have some really bad side effects. But getting a cortisone injection into a sore spot is much different. Used sparingly, this type of injection can help stop inflammation. It is important that cortisone injections not be done too often. Done over and over, they can cause the soft tissues to break down.


I’ve heard that you can get blood clots after surgery. I’m having surgery soon, and I’m worried. Are blood clots really a problem, and can they be prevented?

Blood clots can be a problem after many kinds of procedures, including back surgery. The condition is called deep venous thrombosis (DVT). In DVT, blood clots form in the veins of the legs, blocking the normal blood flow. This makes the area become swollen and sore. If the clot doesn’t break up, it can damage that area of the leg. If the clot breaks loose and travels to the lungs, it can get stuck. This cuts off blood supply to a section of the lung and causes a pulmonary embolism. In a pulmonary embolism, part of the lung collapses. You can die from a pulmonary embolism.


The good news is that there are several steps you can take to help avoid DVT. Your doctor will give you drugs that make the blood less able to clot. There are several different kinds of medications that work against clots.


You can also try different kinds of support stockings. Pulsatile stockings inflate like a blood pressure cuff to squeeze the veins in your leg. Wearing a special stocking called TED hose also helps squeeze the veins to help prevent formation of a clot.


The best strategy for avoiding blood clots is to get moving as soon as possible after surgery. Blood that is moving has a harder time forming a clot. Even if you need to stay in bed, you can move your feet. Pump your feet up and down throughout the day. This gets the muscles working and the blood moving in your whole lower leg. Try to stand and walk as soon as your doctor gives the OK.


I am going to have fusion surgery. My doctor wants me to use a bone growth stimulator after surgery. What is it? Does it work?

Bone-growth stimulators are devices that send small electrical currents through the bones that need to heal. Research has consistently shown that electrical charges help stimulate bone growth. The electrical currents cause a chemical reaction that promotes healing.


There are three types of electrical stimulators. Direct current stimulation involves surgically placing a device right by the bones that need to be fused. Pulsed electromagnetic stimulators use two coils placed on the skin. Capacitative coupling uses two plates worn on the skin.


What is a TENS unit? What does it do?

TENS is the abbreviation for transcutaneous electrical nerve stimulation. TENS units are used to help control pain. They are usually small enough to fit in a pocket. They are issued by physical therapists and doctors when other pain management strategies aren’t working.


TENS units send small electrical currents through your skin, giving you a feeling sort of like a massage. The idea behind TENS units is that the electrical stimulation replaces the pain impulses. Doctors call this the gate theory. The gate theory suggests that when the electrical stimulation reaches the spinal cord first, the “gate” closes and blockes the pain impulses. As pain lessens, the muscles around the sore area relax, further lessening pain. TENS units can also be set to help your body release endorphins. Endorphins are body chemicals that reduce your feelings of pain.

My doctor wants to do an X-ray. What will that show?

An X-ray gives a picture of your bones. It can show fractures, alignment problems, spurs, bone degeneration, and bone abnormalities. It can also suggest whether tumors or infections might be present.


Your doctor may be doing an X-ray to help diagnose your condition. Or the X-ray may be a way to document the state of your bones right now. Further X-rays over time can then help track the progression of your condition. In many cases, doctors use an X-ray as a preliminary look at your bones. Further imaging studies, including MRIs or CT scans, may then be used to look more specifically at your bones and the tissues around them.


What is osteopenia? It just sounds like osteoporosis to me.

Osteopenia and osteoporosis are related. They both involve the loss of minerals from the bones. Osteopenia is the loss of a measurable amount of bone. Osteopenia can progress to osteoporisis. In osteoporosis, the bones have lost so much material that they have become porous.


When you have your bone mineral density tested, the results are described by a T score. A T score compares your bone density to the average bone density of a healthy person of your same age and gender. A positive score means that your bones are denser than the average healthy person. A negative score means you have less bone density than average. If your T score is between -1 and -2.5, you are classified as having osteopenia. If your score is -2.5 or lower, you have osteoporosis.


Are there other health-care professionals who can help me with my chronic pain?

Treating chronic pain is usually most successful when you use the team approach. Many types of medical professionals can contribute to treating your problem. They include:



  • Physical or occupational therapists

  • Chiropractors

  • Dieticians

  • Naturopathic physicians

  • Counselors, psychologists, or psychiatrists

  • Ergonomic specialists

Which professionals you need to work with will depend on your problem and your specific symptoms.

What is a spinal tap, and why do I need one?

A spinal tap is done to collect a sample of the cerebrospinal fluid that surrounds your spinal cord and brain. The doctor gives a shot of local anesthetic in your lower back and then slides a needle into the spinal column. Fluid is removed through the needle. While the needle is in, the doctor also checks the pressure of your spinal fluid.


Spinal fluid is usually clear, with no red blood cells and few white blood cells. It contains proteins, sugar, and other body chemicals. Analyzing the content of your spinal fluid can help detect many conditions. Too much protein might mean infection, tumors, or a hemorrhage. A high number of the infection-fighting white blood cells suggests an infection. If red blood cells are present, there is bleeding somewhere in the spinal column. 


What is an SSEP test?

SSEP stands for somatosensory evoked potential. SSEP tests are used to determine whether the sensory parts of nerves are damaged. Damaged sensory perception means that a nerve can’t receive or send information like touch, temperature, or pain. SSEP tests involve putting electrodes over the skin or into a nerve or part of the brain using a needle.