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Answers to your questions will be posted below within 72 hours of submission. To submit a question to the Beth Israel Deaconess Medical Center's experts in orthopaedics,  click here.

Disclaimer: Answers provided are meant to be general in nature and are not a substitute for professional medical advice. For specific advice on your own medical situation, consult your physician.

Q: Question: Doesn't barefoot running decrease injuries because it was how our body was made to run? John, Chelmsford, MA

A: Thank you for your question. Barefoot running, minimalist running, Chi running, etc. are very popular right now and are very important ideas in the running community. In my mind, the central premise to these styles of running hinges on being lighter on your feet. Less pounding equals less injury. So any adaptation in running style, shoe wear, or running surface that deceases the impact during running should impart a benefit. If your forefoot or midfoot contact the ground at impact (rather than your heel), the force at impact is dissipated over the joints in your foot and ankle, then your knee, hip and back. Landing on your heel, you do not benefit from the flexibility and strength of your foot and ankle, leaving your knees, hips and back to handle the blow. For this reason, it has been suggested that running on the balls of your feet (forefoot or midfoot strike) is beneficial.

With that said, there is little evidence to support this notion. Biomechanical studies have shown the force analysis at impact for different runners with different styles of running in different shoe wear. And as a result, it is widely held and commonly thought that a barefoot running style promotes healthier running. However, at this time, the literature offers little in the way of proof. As a runner, these approaches are something that merits thought and consideration. As a scientist, there is no data that proves the long term benefit. Dr. Joe DeAngelis , Sports Medicine & Shoulder Surgery

Q: The bone at the very end of my spine is sore to touch. I kayak a lot and it bothers me then, also. I don't have much fat on my rear (more on my stomach). What can I do? Carol, Newburyport, MA

A: This pain can be from the areas at the bottom of the spine (sacrum and coccyx). Your doctor might want to assess this further with imaging studies to make sure there is no fracture in that area. For symptomatic relief, you can consider use of seat cushion. To help treat the pain, you can use ice several times daily, consider anti-inflammatories (Aleve, Motrin, etc.) as needed or a topical treatments (Lidoderm patches or anti-inflammatory cream). Dr. Stefan Muzin , Spine Center

Q: I am in unbearable pain from worn-out knee cartilage. I have no life because I cannot walk. Can anyone get the new cartilage replacement that regrows your own cartilage? I have been through Synsvic, but it doesn't last. James, Revere, MA

A: Cartilage replacement surgery is an option if only a very small area of cartilage has been damaged. If the majority of the cartilage in your knee is worn away as a result of arthritis, and non-surgical methods have all been attempted (such as anti-inflammatory medications, physical therapy, bracing, injections, etc), then  knee replacement surgery is typically the treatment that will most appropriately treat your pain. Dr. Ayesha Abdeen , Joint Replacement & Reconstructive Surgery

Q: A few weeks ago, I fell and landed on the left side of my face. I had a headache, jaw pain, but that went away within a few days. This morning, I was doing my daily yoga and felt a pop behind my right shoulder blade. Instantly I could not move my neck (still cannot after 8 hours), I had extremely sharp pain where it was difficult to breathe, and now the pain is radiating from my neck all the way down my right arm to my elbow. I have a doctor's appointment tomorrow, but I am curious if it's possible the two are connected and if I may have injured my neck? Michelle, Wrightstown, NJ

A: You may have injured your neck during this fall or this can be a completely separate incident. I would have your doctor do a thorough neurological assessment and examination. Depending on the specific location of the pain, your doctor may want to order further imaging studies, such as x-rays and possibly an MRI of the neck region as this can be consistent with a possibly disc herniation or irritated nerve root in the neck. Dr. Stefan Muzin , Spine Center

Q: I weigh about 210 pounds, I am 5' 11" and run 25 miles per week. I have started to have a pain in my right foot in the middle of the foot between the ball of my foot and the pad by the pinkie toe. It feels almost like a deep bruise and hurts off and on. Should I get an X-ray? Other suggestions? Bill, Sharon, MA

A: Running is a high impact sport that places a lot of repetitive stress on your joints. What you are describing could be either metatarsalgia, morton's neuroma, or less likely a stress fracture. Metatarsalgia is inflammation and pain in the metatarsal heads (e.g. ball of your foot). A morton's neuroma is a thickening of the nerve tissue between the toes. If the nerve is sufficiently irritated it can cause numbness or tingling in your toes as well. Stress fractures develop when microfractures develop in fatigued bone. These conditions are related to high levels of stress on the ball of your foot. You should have your  shoes evaluated to make sure they are a good fit. You should also make sure you are changing your shoes every 300-500 miles. Weight does play a role in these conditions so maintaining a healthy weight is important. I would encourage evaluation by a sports physician so they can evaluate your foot type and perform appropriate imaging such as an x-ray. Dr. Bridget Quinn , Sports Medicine & Shoulder Surgery

Q: I have tennis elbow problems for which I have had injections that have eased the pain for short periods (1-2 months), then pain recurs. Are there any other treatments or will this go away on its own, or do I have to believe this is the way it is? Thank you. Richard, Boston, MA

A:  Tennis elbow is typically self-limiting, meaning that if left alone it will usually resolve on its own. It can, however, take several months (and sometimes years) to do so. There are several treatments (like anti-inflammatories, physical therapy, bracing, and injections) which can help provide some pain relief, although none of them make the tennis elbow resolve any faster. Surgery is reserved for cases that do not improve with time or other conservative measures. Dr. Tamara Rozental , Hand, Wrist and Elbow Surgery

Q: I have arthritis in my left hip and do not wish to have it replaced at this time. Can you give me tips on how to "live with it?" Also what do you think of taking supplements -- I don't feel they helped me. Thanks. Glenn, New Boston NH

A: Hi Glenn. Non-operative treatments for  hip arthritis include anti-inflammatory medications (eg. ibuprofen -- check with your doctor prior to starting one), physical therapy, modifying your activities to exclude running/jumping/high impact exercises and using a cane for long walks to support the hip and alleviate pain. Supplements that may help include glucosamine chondroitin, which can improve pain for some patients but does not definitively cure the arthritis. Maintenance of a healthy body weight reduces the load going to the hip and therefore weight loss, if indicated, can also reduce pain. If these measures fail, then cortisone injections may also be of benefit. Ultimately for very severe hip arthritis, the only definitive treatment is hip replacement surgery. Dr. Ayesha Abdeen , Joint Replacement & Reconstructive Surgery

Q: I have arthritis in my spine. Lately my feet have started to hurt (not while I'm walking or running) after I sit for a while. When i get back up it takes a minute or two for the pain to go away. Once i start moving again, I'm ok. I was wondering if this could also be arthritis. Diane, Marshfield, MA

A: Diane, if you have a new symptom like this, consider further evaluation by your physician.  Arthritis in the spine can cause pain in the region of the spine itself, but it can also affect the nerves that go through the spine, down into the limbs. When this happens patients may experience pain in the limbs, including feet. However, your description of symptoms could also be explained by other causes, and so more evaluation would be necessary. Dr. John Keel , Spine Center

Q: Does phosphoric acid in some soft drinks leach calcium from our bones thereby weakening them? If yes, shouldn't that warning be labeled AND those soft drinks containing phosphoric acid be REMOVED from sale at ALL schools as developing children need calcium the most to be available in their systems while their bones are still growing?!? Steven, Arlington, MA

A: Hi Steve. The dark colas (Coke, Pepsi) contain phosphoric acid which can bind to calcium and decrease its absorption into bones. Like many other things that are not good for us, I agree, better labeling would be a helpful way to educate the public. From my understanding, there has to be a significant amount of concrete evidence for a warning label to be imposed. Some people may argue that people are drinking these colas in place of high calcium choices (like milk) and this is the reason for less absorption of calcium into the bones. These soft drinks are not good for us for many reasons, not only for this one. Many schools have already made the step of removing high sugar beverages such as colas and flavored drinks. We should make our focus on encouraging growing children to choose low-fat / fat-free plain milk instead. Liz Moore, Registered Dietician

Q: I've been diagnosed with a herniated disk in my neck. Pain is behind my shoulder blade radiating to my upper right rib on my chest and down my arm to an area with a quarter sized fatty deposit just above the elbow joint. Pain is worse when walking or driving but terrible when I try to sleep. I've done oral steroids twice, first time with good results, second time about 6 weeks later no help. I'm now scheduled for a joint injection. What are the odds that the joint injection will work or am I destined to surgery? Francis, Boston, MA

A: Francis, the pain you describe could come from a cervical herniated disc. Surgery is an option for herniated disc, but is not always required for this condition, especially if there is not weakness or dysfunction of the limbs. There are many non-surgical options for a cervical herniated disc, such as physical therapies and modalities, exercises and ergonomic strategies, soft collar, traction or other devices, a wide range of medications, and injection therapies. A cervical epidural injection with fluoroscopic guidance is often performed if there is pain in the arm from a cervical herniated disc. Dr. John Keel , Spine Center

Q: My fingers are very stiff and numb. MRI conclusion: cervical spondylosis. Physical therapy is not helping. What should I do? Thanks. Sam, Natick, MA

A: Many things can cause the symptoms you describe in your fingers. Such dysfunction in the hand can be a significant problem, as we rely on our hands so much, so this should be evaluated carefully by your physician.

You said your MRI showed cervical spondylosis. Spondylosis is arthritis of the spine. Arthritis in the spine can cause pain in the spine itself, but it can also affect the nerves that go through the spine, down into the limbs. When this happens patients may experience pain in the limbs, including down into the fingers.

Correct diagnosis is important. Other things can cause your symptoms. For example,  carpal tunnel syndrome can cause stiffness and numbness in the fingers. Carpal tunnel syndrome is a pinching of the nerves in the wrist, and has a very different treatment pathway than arthritis of the neck. Sometimes patients have both problems, and both may need to be treated. An electrodiagnostic test, commonly known as " EMG," can determine if you have carpal tunnel syndrome and/or "pinched nerve" in the neck.

For cervical spondylosis and carpal tunnel, treatments may include different therapies, braces or other physical devices or modalities, medications, injection therapies, or surgical options. Again, many things can cause these symptoms in the fingers, and this should be seen by your physician. Dr. John Keel , Spine Center

Q: What can be done to relive pain from spinal stenosis? Mary, London, Ontario

A: Hi Mary. This is a pretty broad question. Things that can be done for  spinal stenosis range from "doing nothing" to extensive surgery and everything in between. Scientific evidence also varies for these treatments.

Here are some options, summarized from the North American Spine Society (NASS). (Diagnosis and treatment of degenerative lumbar spinal stenosis. Burr Ridge (IL): North American Spine Society (NASS); 2007 Jan.): Pharmacological treatment, physical therapy and exercises, spinal manipulation, epidural steroid injections; bracing, traction, electrical stimulation, and transcutaneous electrical stimulation; surgery (decompressive, with or without fusion, X-STOP, instrumentation plus posterior fusion, etc.). Dr. John Keel , Spine Center

Question: Can spinal manipulation help my low back pain? Dan, Arlington, MA

A: Hi Dan. Yes, it can help. Scientific evidence on spinal manipulation is limited, but it has a low chance of harm for a patient with low back pain. Dr. John Keel , Spine Center

Q: I am 28 and having tightness and pain in my lower back and anterior pain in my knees for over 6 months that's prevented me from running and participating in sports. Physical therapy has not resolved it. Is there anything else I can do? Peter, Somerville, MA

A: I would recommend further evaluation by a sports physician. It is important to have a full examination to determine the cause of your back pain and knee pain. You may require x-rays as well as more advanced imaging (such as MRI). In the interim, make sure you are focusing on maintaining strength in your core (to include glutes and lower abdominals) as well as quadricep flexibility.

Your  shoes should be changed every 300-400 miles as a runner. Furthermore, you want to make sure you are sleeping at least 6 hours per night for musculoskeletal repair and recovery. Nutrition plays a large role in tissue healing as well. Dr. Bridget Quinn , Sports Medicine & Shoulder Surgery

Q: Hello, I was wondering if you could answer this question. I started going to the gym about a month and a half ago. In the last several days my left foot has become extremely painful, mostly between/behind the big toe and next toe. I have flat feet and use a custom made orthotic. It was also recommended to me to get high-end running shoes that help with flat feet. I used my current pair when starting back to the gym, but I'm not sure if they are still good as I "flop around in them". Do you know how to tell if an athletic shoe is no good anymore? Pamela, Holden, MA

A: Hi Pamela. Typically, I recommend replacing the  shoes every 300-400 miles (or every 6 months in non-runners) as the midsole can wear down before the outsole shows signs of wear. Check for signs of wear on the sole by putting shoes on a table and looking at them from behind. If the soles are worn and leaning to one side, the midsole cushioning is likely worn and the shoe should be replaced. Dr. Bridget Quinn , Sports Medicine & Shoulder Surgery

Q: I have arthritis in my spine. Lately my feet have started to hurt (not while I'm walking or running). After I sit for a while, when I get back up it takes a minute or two for the pain to go away, but once I start moving again I'm OK. I was wondering if this could also be arthritis? Diane, Marshfield, MA

A: These symptoms can be caused by arthritis in the spine, or possibly a disc herniation can cause irritation of the nerve roots in the lumbar spine (low back) that can cause numbness, tingling, or pain in the legs and/or feet while sitting. There are other potential causes for such symptoms including a neuropathy (which can be caused by medical conditions such as  diabetes or various medications) or vascular (blood circulation) conditions which should be checked by your primary care physician. Dr. Stefan Muzin , Spine Center

Q: How do I treat a frozen shoulder? My doctor told me to use five minutes of cold and ten minutes of heat [sic]. Could you please clarify or indicate the best treatment for recovering mobility in my left shoulder? Arthur, Winchester, MA

A: Frozen shoulder, or adhesive capsulitis, is best treated with activity to tolerance. In the early phase, when the shoulder is inflamed and there is pain at rest, motion and activity should be limited to avoid additional irritation. When the shoulder moves to the second phase (frozen), the rest pain will abate but the stiffness remains. Slowly, in time, the frozen shoulder will begin to loosen (thaw) and the range of motion will improve.

In general, adhesive capsulitis may last for 6 to 18 months. Some evidence suggests that x-ray guided injections of corticosteroid into the shoulder (glenohumeral) joint may decrease pain and speed the time to recovery. Dr. Joe DeAngelis , Sports Medicine & Shoulder Surgery

Q: I have several knee issues (ie: tri-compartmental osteoarthritis, chondromalacia, etc.) that I have been battling through for about 5 years. I have had microfracturing and ACL replacement, and am constantly going for injections. My question is this: how young is too young for a knee replacement? And why don't doctors like to perform knee replacements on people under the age of 40? I understand that longevity is a factor but at some point quality of life must be taken into consideration. What is your opinion? Stacey, Leominster, MA

A: Traditionally,  knee replacement surgery was designed to be performed in patients above the age of 65. Recently our population has experienced an increase in younger patients who have arthritic conditions. There is currently no specific minimum age at which  total knee replacement is recommended. The decision to proceed with surgery is based upon the severity and frequency of the pain, the severity of the x-ray findings (loss of joint cartilage, bone spur formation, etc), and whether all other non-operative treatments have been tried (physical therapy, weight loss, anti-inflammatory medications, cortisone or viscosupplementation injections). In general, knee replacements are best reserved as a "last resort", given that they are made of artificial materials (metal and plastic) that will effectively "wear out" in time. Most knee replacements will last approximately 15-20 years and thus if performed at a very young age, one will need multiple subsequent surgeries in their lifetime to revise the original knee replacement. Dr. Ayesha Abdeen , Joint Replacement & Reconstructive Surgery

Q: What are the possible causes of an ache in the lower back, right side of center, that sometimes reaches around to, or merges with, an ache in the front pelvic area, right of center? (I have had a recent endometrial biopsy with negative results). The back and pelvic aches are periodic, not constant. The lower back ache has been severe on two occasions recently, both on days after backyard exercise, in which I was raking matted leaves off the garden after the winter snows melted. Each time, the severe pain has abated, but the periodic ache continues. Meryem, Newton, MA

A: Thank you for your question, Meryem. It's difficult to say from the information given, but this could be from several or more than one anatomical source. Joints and discs of the lumber spine can cause this type of pain. You might want to talk to your doctor about seeing a spine specialist, if you have not already done so. I would be happy to see you in the Spine Center at BIDMC so we could discuss further. Dr. John Keel , Spine Center

Q: My fingers are very stiff and numb, mri conclusion--cervical spondylisis, physical therapy is not helping--what can be done? Thanks. Sam, Natick, MA

A: While cervical spondylosis ( arthritis) can cause these symptoms and they can be attributable to an irritated nerve in the neck region, there are other potential causes that should be ruled out such as carpal tunnel syndrome, peripheral neuropathy and/or general arthritis affected other joints. A useful diagnostic test to consider in your situation would be an EMG/Nerve Conduction Study. This is not a pleasant test but it may give some helpful diagnostic information about the function of the nerves in your arm and neck and would rule out another coexisting peripheral nerve issues (such as carpal tunnel syndrome or peripheral neuropathy). It can also help confirm if indeed there is nerve damage and if so the severity. You might ask your doctor about this test and if he/she thinks it might be helpful. We do this test at our  Spine Center here at BIDMC. Dr. Stefan Muzin , Spine Center

Q: I'm an avid runner and still experience low back pain after several corticosteroid injections. Do I need to keep getting these? What other alternative medicine/treatment may I try? Teresa, Chelsea, MA

A: Teresa, low  back pain has a wide range of treatments: alternative therapies, physical treatments and devices, exercise, occasional medications, and finally, invasive treatments like injections. Exercise and general fitness are most important.

There are many types of spine injections, not all are the same. Spine injections often have to be repeated, but I would not recommend repeating the same thing if it has not been beneficial. Steroids have potential side effects throughout the body, and this has to be weighed against the chance of benefit when deciding to repeat steroid injections.

For pain that is primarily in the back (as opposed to leg pain that shoots from the back) there is a multi-step injection pathway that uses very little or even no steroid. This pathway deactivates the nerve to the small joints in the back, and can decrease pain for a long time. I would be happy to see you in the Spine Center at BIDMC so we could discuss further. Best of luck to you. Dr. Kevin McGuire , Spine Center

Q: I am 29 years old and had to have my left shoulder fused (humeral/glenoid) 6 years ago due to severe trauma and subsequent dislocations/instability. This inevitably reduced the range of motion in this arm significantly and also resulted in some loss of function and discomfort, affecting both my personal and professional activities (I work FT as an RN). Are there any procedures that could potentially increase my range of motion while still maintaining stability? I would greatly appreciate any insight you can provide, thank you!!! Autumn, Somerville, MA

A: Thank you for your question. The difficulty you are having is very normal for someone with a fused shoulder. Unfortunately, your prior injury was so severe interventions to preserve the shoulder joint and its motion were not successful. To treat this instability, the ball (head of the humerus) and socket (glenoid) were fused together. In doing so, the unstable joint was made stable at the cost of motion. As time has gone on, the stress applied to your shoulder blade (scapula) by your fused shoulder has led to your upper back pain.

Strengthening the muscles in your upper back (scapular stabilizers) with a structured physical therapy program may provide you will some relief. Similarly, using a sling or supportive brace can help decrease the stress on your shoulder.

Alternatively, taking down the scapulo-thoracic fusion is a consideration. This procedure would aim to restore motion at the gleno-humeral joint, but is a sizable undertaking that warrants careful deliberation. Dr. Joe DeAngelis , Sports Medicine & Shoulder Surgery

Q: On a recent (Sunday afternoon) 12K run, I apparently sprained my left ankle....I do not remember doing it. The following morning, it was stiff and sore. I am doing a half marathon May 22, and am looking for good advice as to rapid recovery and strengthening. As of today the soreness has greatly diminished and the stiffness is also reduced. I am wearing a slip on compression bandage, and icing the ankle. Any other advice is greatly appreciated. I thank you in advance for your consideration. Flint, Yarmouth, MA

A: You have done a great job so far. Rest, Ice, Compression and Elevation (RICE) are the essentials to dealing with the acute inflammation associated with your ankle sprain. The next step will be to begin functional rehabilitation. This phase will include range of motion, strengthening, as well as balance and proprioceptive training. It is essential to making a full recovery and preventing a repeat injury.

Please visit the  Rehabilitation Protocols web page at our website ( bidmc.org/sports) for a copy of the Ankle Sprain Guidelines. Dr. Joe DeAngelis , Sports Medicine & Shoulder Surgery

Q: Can you direct me to specific exercises to help strengthen "severe osteoporosis" of the spine? And will this improve bone mass without taking osteoporosis drugs, but just calcium supplements with vitamin D and diet? Diane, Gardner, MA

A: Diane,  osteoporosis is a disease characterized by loss of bone density that increases the risk for fractures, specifically compression fractures in the spine. Individuals with severe osteoporosis present with hyperkyphotic postures or what is commonly known as "Dowager's hump."

In conjunction with calcium supplements, vitamin D and a proper diet, recent physical therapy literature supports mild weight-bearing exercises to increase bone mineral density. The key to any exercise program is proper posture and alignment. Physical therapists instruct patients to sit or stand with the crown of the head elongated towards the ceiling, keeping the shoulders back, and contracting the abdominal muscles.

Exercises can be done while sitting in a chair. One example is squeezing the shoulder blades together to enhance proper postural alignment in the thoracic spine.

We also advise individuals to use lumbar rolls and to sit in straight back chairs to improve spinal alignment. All exercises should be performed within a pain-free range of motion. Also, isometric abdominal exercises, where you draw your abdomen in while either lying down (supine) or sitting, engages the deep abdominal muscles and strengthens the core.

When a patient is in pain, we begin a program of light to moderate activity in a chair with graded resistive exercises using bands or tubing to strengthen the upper and lower extremities.

Individuals with osteoporosis should avoid exercises involving twisting and explosive movements. Flexion exercises are not recommended due to the increased vertical compression forces on the vertebrae that places the spine at high risk for compression fractures. Balance exercises, under the guidance of a licensed physical therapist, should be performed to prevent falls.

If an individual is asymptomatic, we encourage them to engage in a walking program for up to 20-30 minutes three times a week. This is one of the best forms of weight-bearing exercises in people with osteoporosis. We advise patients to wear supportive shoe wear and perform their activity on a level surface.

It is best to consult with a physical therapist for the best treatment program because each individual's needs differ based on their mobility, strength and activity level. For more information, visit the " Consumer Information" section on  www.geriatricspt.org. Or  make an appointment with or  learn more about our physical therapy program at BIDMC. Pinelopi Gianakouras, Rehabilitation Services

Q: After 2 laminectomies, I still having BURNING in my lower back and down the outside of my left leg. What else is there left for treatment? I am on Morphine 30mg three times a day, and Lyrica 3 times a day. The burning is so painful at times that it wakes me, and keeps me awake. The BURNING IS INTENSE!!!! What's left for me for treatment? Tom, Saugus, MA

A: Tom, assuming that you have had an adequate decompression of your nerves (there is no pressure on your nerves), you may have residual "neuropathic" pain from the previous pressure and subsequent chronic damage to the nerves. For this, drugs such as Lyrica are the first treatment of choice. More invasive treatments might include a spinal cord stimulator which works well for these symptoms in selected patients. You might inquire about this possibility with your surgeon or pain clinic. Dr. Kevin McGuire , Spine Center

Q: My knees and lower back hurt on a constant basis. I am 54 years old, very active but the pain sometimes is agonizing. Gregory, Beverly, MA

A: Gregory, I'm sorry to hear about your  knee pain and lower back pain. There could be any number of causes for this pain. What I suggest is that you make an appointment with your primary care doctor and explain your symptoms. If he/she cannot assist, they may send you for a referral to an orthopaedic specialist who can further explore potential causes. Best of luck to you. Dr. Fadi Badlissi, Musculoskeletal Medicine

Q: Most of the time my left knee is fine. Every 4 to 6 months I'll experience sudden bad pain in my left knee. This often happens when turning my body slightly but can also happen for no apparent reason as I am walking. The pain gradually decreases over a week or two and I often feel significant relief at the same time I hear a cracking or popping sound in the knee. My PCP told me simply that "it's not bad enough for surgery." Is there anything I can do to lessen or eliminate these episodes? Is there anything I can do to relieve the pain more quickly when they occur? Luke, Concord, MA

A: Thanks for your question and I'm sorry you are dealing with the knee pain. One of the best remedies for intermittent knee pain is stretching. The thigh muscles are active stabilizers of the knee joint. If this tissue becomes tight it can place undue stress on various parts of your knee, especially your kneecap. The quadricep muscle is one of the biggest culprits and needs special attention. Our website bidmc.org/sports has links to rehabilitation protocols. Under the knee section, click on Patellofemoral Pain Phase 1 to download examples of quadricep, hamstring, and iliotibial band stretching exercises. To get the most out of your stretch it is best to hold it for 30 seconds and perform the stretch twice a day. When pain occurs a period of relative rest, ice, and oral anti-inflammatories may help temporarily. This being said, you need a clear diagnosis in order to construct a good rehabilitation program. You may need to have your knee checked out further by specialist. Dr. Bridget Quinn , Sports Medicine & Shoulder Surgery

Q: I had a bone density test done about five years ago and the results stated I had moderate arthritis. I was aware of this already because of the pain I had on and off in the knee area. My questions is; does arthritis cause a huge amount of swelling if it does not get treated early on (if one does no know they have it)? It has been a chronic situation since child hood but the bone density was my first test regarding the this issue. Thanks. Mary, East Bridgewater, MA

A: Mary, depending on the type of arthritis, someone could have swelling in the joint to a variable degrees. For example,  osteoarthritis is not usually associated with a lot of swelling compared to inflammatory arthritis, such as gout. Knee pain could be related to many conditions other than arthritis ( bursitis, tendinitis, etc.).  Bone density testing is usually a test for osteoporosis and not arthritis (is it possible you had  x-rays and not a bone density test?). At any rate, you may want to seek follow-up with a rheumatologist. Thank you for your question. Dr. Fadi Badlissi , Musculoskeletal Medicine

Q: I've been told by an orthopedic doctor that I have a stress fracture in my left knee and it would take a LONG time to heal. I wear a brace and see the dr. every 2 months for x-rays etc. It feels OK for 2 - 3 weeks and then I will have a few painful days. What causes a stress fracture and how long will it take to heal? Should I just have a knee replacement and get it over with? Anne, Wilmington, MA

A: Thanks for your question, Anne. Bone is always in a state of breaking down and building back up as it responds to stress. A lot goes into bone health including nutrition, normal menstrual cycles in women, exercise, muscle fatigue and genetics. Stress fractures occur when the bone is fatigued to a point where it begins to swell and microfractures ("hairline fractures") may develop. These may not be visible on plain film x-rays.

Stress fractures occur in many settings. You can have strong, healthy bones that cannot respond quick enough to a change in impact or stress. This commonly occurs in runners when they increase their running frequency, duration, or speed before their body can adapt. On the flip side, you can have weaker bones that are not able to respond to stress. This occurs in people with low bone density and can also be seen in young  women who exercise excessively, do not eat enough calories to match their expenditure, and/or have abnormal menstrual cycles. This is a condition called female athlete triad.

The length of time it takes a stress fracture to heal depends on its location and degree of fracture. Fractures can take anywhere from 6 weeks to 3 months to heal. Some may take longer. Some fractures have poor blood supply and take longer to heal than others. The best place to start in treating the stress fracture is to understand why it occurred (i.e. are you training for a marathon). It is a good idea to make sure you are getting enough calcium and vitamin D in your diet. The best treatment for a stress fracture is rest. However, it is also important to make sure that your soft tissue is balanced in terms of strength and flexibility. Physical therapy is often initiated after a period of immobilization and rest and can begin in the pool.

If this continues to be a problem for you, please consider making an appointment with someone in our women's orthopaedic clinic. Best of luck to you. Dr. Bridget Quinn , Sports Medicine & Shoulder Surgery

Q: Hip surgery is recommended for me, bone on bone. I would prefer trying an injection and wonder if it would help with walking and pain management. Dee, Lenox, MA

A: Dee, sorry to hear about your hip pain. In the context of very severe arthritis, the duration of pain relief following an injection is not very predictable, however it CAN be helpful in some situations. I would suggest you ask your hip surgeon if an injection is likely to help. Or please feel free to make an appointment with me or one of our other hip surgeons so we can evaluate this possibility. Dr. Ayesha Abdeen , Joint Replacement & Reconstructive Surgery

Above content provided by Beth Israel Deaconess Medical Center. For advice about your medical care, consult your doctor.

Posted April and May 2011

Contact Information

Carl J. Shapiro Department of Orthopaedics
Beth Israel Deaconess Medical Center
330 Brookline Avenue
Boston, MA 02215
617-667-3940

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