Why do muscles shrink after surgery or if a cast is applied?

The process of muscle wasting after surgery or casting is called disuse atrophy. Muscles require a balance of enzymes and hormones that is constantly adjusted according to how much the muscle is being used. Unused muscles shrink because this balance is thrown off. The more a muscle is stressed or used, the more muscle-building enzymes are active. When a muscle is not used regularly, muscle-degrading enzymes take over and cause the muscle to shrink. In other words, muscles work on the “use it or lose it” principle.

My doctor has prescribed a COX-2 inhibitor for my pain and inflammation. What is it? Will it work?

COX-2 inhibitors is the short name for a class of medications called cyclooxygenase-2 inhibitors. These fairly new medications stop the pain-causing enzyme cyclooxygenase. They can be very effective in relieving pain and inflammation. Vioxx and Celebrex, two COX-2 drugs, have been shown to be more effective in treating osteoarthritis than more familiar nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen. And COX-2 inhibitors don’t seem to cause the stomach upset of NSAIDs.

What will happen on my first visit to the doctor?

The goals of your first doctor’s visit are to get to know each other and to communicate all the information you have about your symptoms and condition. This includes asking any questions you have, even if you are a little embarrassed to ask.

The first step in the exam is a health history. Your doctor will probably have you fill out a form about your pain, your symptoms, and your medical history. You will also be asked questions about your family’s medical history. Typical questions include:
*Does anyone in your family have similar problems?
*Do you have any other medical conditions?
*Are you taking any medications?

After your doctor looks at the form, he or she will ask you more questions. These tend to be more specific to the pain and other symptoms you are having right now. Typical questions include:
*When did your pain start?
*Did it start because of an injury?
*Where exactly is the pain located?
*Have you ever been injured in that spot?
*How strong is your pain? (You may be asked to rate it on a scale of one to 10.)
*What makes the pain go away?
*What makes the pain worse?

Your doctor will then physically examine you, concentrating on the area of pain. Your doctor will prod the sore area and move it. The prodding and movement may hurt, but it is important that your doctor know exactly where and when you feel pain.

The first exam is just the beginning. Try to be as open with your doctor as possible. Express your worries and concerns right away. They better you communicate with your doctor, the easier it will be for the two of you to develop a treatment plan for your pain. 

What is an EMG test?

EMG stands for electromyogram. EMGs are used to test the function of nerve pathways to the muscles. Tiny electrodes are inserted into the muscles. If nerve pathways are injured or damaged, the EMG will show abnormal signals. EMGs can be used to test muscles and nerves in many different parts of the body. 

Will my doctor prescribe medication for my pain?

Yes. Doctors have many medications they can prescribe for pain and inflammation. Your doctor may prescribe only one of these medications or several.

*Nonsteroidal anti-inflammatory drugs (also called NSAIDs) effectively relieve muscle pain and inflammation. Ibuprofen is an over-the-counter type of NSAID. A doctor must prescribe some types of NSAIDs.
*COX-2 inhibitors help relieve inflammation like other familiar NSAIDs, but they aren’t as hard on the stomach and intestines.
*Non-narcotic analgesics attack the pain at the point of injury. (“Analgesics” means “pain relievers.”) Tylenol and aspirin are examples of over-the-counter analgesics.
*Muscles relaxants can sometimes help ease the pain from muscle spasm.
*Narcotic pain medications are sometimes used in cases of severe pain. These medications numb the central nervous system and are highly addictive if they’re overused, so doctors prescribe them sparingly.
*Anti-depressants can help with the emotional stress and emotional fatigue that comes from suffering chronic pain. 

Medications cannot stop degeneration, but they can help control your symptoms so you can move and exercise easier. Work with your doctor to find what works best for you.


I keep reading about using glucosamine for arthritis. Will it help me?

No one knows for sure at this point. Glucosamine has been tested for knee osteoarthritis, with good results in easing pain. However, these tests only looked at knee osteoarthritis, and the studies only followed patients for up to two months. Glucosamine’s long-term effects, effects on different joints, and effects on different diseases are unknown.

Glucosamine does look promising. Some doctors have decided that glucosamine is worth a try, even if it isn’t fully tested yet. Talk to your doctor if you are interested in trying glucosamine.


Some people say I should use heat for my pain, and others say ice. Which is best?

They both have their place in treating and inflammation. Ice or other cold treatments are usually used in the early stages of an injury. Cold applied to the injured area makes the blood vessels get narrower (vasoconstrict), limiting the swelling of the initial period of healing. Cold treatments should be applied for about 15 minutes, three to four times a day for the first two or three days after the injury.

In some cases, heat is helpful two or three days after the injury. Heat makes the blood vessels get larger (vasodilate). This brings more blood to the area, infusing it with nutrients and oxygen to help healing and flushing away chemicals that have built up in the injured tissue. True heat, such as moist hot packs, heating pads, or warm showers or baths, are better than creams that just make the skin feel hot. Heat treatments should usually be held on the injured area for 15 to 20 minutes, three to four times a day. Be careful not to burn yourself by routinely checking your skin for extra redness. 

Where do bone grafts come from?

Surgeons use two main types of bone graft–autograft and allograft. Autograft comes from the patient’s own body. Allograft is transplanted material from another person (a donor).

I have had intense pain for months. Why won’t my doctor keep giving me strong pain medications? The pain is just as bad now as it was earlier.

Some strong pain medications can be addictive. In cases of severe pain, emergency, or trauma, doctors will prescribe narcotics. Narcotics can be very effective, but they are also very addictive and must be used sparingly. Narcotics are not a long-term solution.

There are other ways to control your pain, including non-narcotic medications and different kinds of therapies. You need to work with your doctor to find other medications and techniques to control your pain.

My doctor wants to do an MRI. What is it, and what will it show?

MRI stands for magnetic resonance imaging. This kind of test uses magnetic and radio waves to show layers of soft tissues such as muscles, tendons, blood vessels, and nerves. Doctors use these MRI “slices” to see if there are problems in the soft tissues.

I have an artificial hip, and I need an MRI scan of my low back. I know the MRI machine uses a very strong magnet. Will the metal in my artificial hip cause a problem with the MRI?

No. MRI scans are safe even for people with metal implants such as artificial joints, metal plates, and large screws.

The only metal that can cause problems with the MRI is if you have any metal pieces in your head. You need to tell the doctor or the MRI technician if you have any sort of metal clips in your skull from a brain surgery. You may need to get an X-ray of your skull before the scan to double check that there are no pieces of metal near your eyes.