Dr. David T. Neuman

Hello and thanks for sharing your history of a dented head and the potential problems it is creating now. Thanks for allowing me to offer my thoughts, tips, and suggestions regarding your question. Do you believe that the headaches directly come from pressing on the dent? Or, may the headaches come first, and then pushing on the dent makes it worse? As a 14-year-old adolescent female, your bones may have stopped growing. Therefore the dent may be there forever. However, the soft tissues around the dent may be inflamed when pressed or massaged. Tissue massage around that area may help make these dent-related headaches subside or become less severe. The nerves between the skin of your skull and your skull (not deep into your brain) may be trapped or deformed around the dented area. So, massaging it a lot may help make them healthier and give you less pain. I hope this helps.

Hello and thanks for sharing your bodily issue with the FATD community. I offer you my thoughts, tips, and suggestions regarding your problem. It seems as if you have had several challenges with the lower back condition and surgeries you have had. I am sure the numbness and pain in the legs and toes are tough to deal with. How long has it been like this? Is this a recent onset, or has this been ongoing for a long time? Is the severity and duration of the pain getting worse? My thoughts revolve around a good neurological examination and an orthopedic evaluation as well. If both legs/feet are affected equally, then I feel it is a nerve problem that arises somewhere in the back. If the nerves are being stimulated somewhere specific (like the lower back, at one or two specific levels), it would be great to know where that is. Once there is an understanding as to where along with your nervous system the nerves are being stimulated, then you can treat with a pain management doctor. There are many new procedures and techniques available that a competent and knowledgeable pain management specialist can offer. I hope this helps.

Sorry to read about your rib cage issue. Thanks for sharing with the FATD community. I offer you my thoughts, tips, and suggestions regarding your pain. From what you wrote, your area of concern is your rib age area. The history seems like a sudden stretch (distraction of the tissues) suggests a muscle/tendon or ligament problem/damage. If the rib cage is still the same shape as the other side, then no bones moved from their resting anatomy. And the sharp pain makes me think it is a cartilage strain. This will heal over time. After clearing it with your doctor, Aleve tablets with food can help with the inflammation. Tylenol can help too, but only after you have asked your doctor about the safety of this, for you. Get some rest and maintain a normal breathing pattern (if it hurts to breathe). Gentle stretching with the wall can begin in 3-4 days. It make take 3-4 weeks to feel better, but try and maintain a full range of motion for your shoulders.

Sorry to read about your toe. Thanks for sharing with the FATD community. I am happy to offer my thoughts, tips, and suggestions. Since there was not much bruising or extreme swelling I feel it was not broken but rather ‘jammed’. This can bruise the surfaces of the bones in the joint, or stretch or tear the tissues holding the joints together. By three weeks (and wearing a hard-some shoe to protect it while walking) I would work on regaining full range of active (your toe and foot muscles moving the joint) and passive (your hands or floor moving the joints) motion. These types of injuries can take 6-12 weeks to resolve. And prolonged high heel wearing not be possible for 3 months or so (depending on how bad the injury was and how your body perceives pain and heals). I hope this helps.

Hello. Please excuse the tardiness of this. I am sorry to read about your lower back pain. Thanks for sharing your issue with the FATD community. Thanks for allowing me to give you my thoughts, tips and suggestions for you. Lower back pain is so common. I would not worry about it being a life-threatening occurrence. As a 21-year-old, I assume that your bones have stopped growing. Therefore, if your scoliosis is not too severe, it should not progress or cause pain such as this. However, I would certainly recommend stretching and a fascial training program to coax your spine back to a straighter alignment and with less pain.
I like this link:https://www.pop-doc.com/browse.cgi?category1=Regain&CGISESSID=23866db9197aa655b7429150e68ea12f
I hope this helps.

Thanks for sharing your foot concern with the FATD community. I am sorry to read about this. I would be happy to offer you my thoughts, tips, and suggestions. Many of my thoughts around people and their musculoskeletal problems or concerns are influenced by a thorough history. If you are in good health and have a good history of weight-bearing activities and exercises, regular menses, and no family history of osteoporosis, then it is not likely that you have a stress fracture. However, if you exercise too much for your body, have irregular menses, and had some pain in that area over the last several weeks, then the possibility of a stress fracture increases. Without a big traumatic event and immediate onset of pain, it is not likely that you acutely broke a bone in your foot.
What type of shoes were you using when you went for a walk? I hope they were supportive sneakers of some sort. What were you walking on? Asphalt, cement, and concrete are more detrimental than grass or a cushioned track or treadmill. How long was the walk? Did you stretch or take your ankle through a full range of motion before and/or after the walk?
I am thinking it is more of a stress reaction than that of a fracture. You may have over-impacted the surfaces of the bones in the outside aspect of your left foot. Therefore, it is as if you bruised this area. I am an advocate of an anti-inflammatory (as long as your doctor is OK with them, and you do not have a history of stomach problems or gastritis) with food, and see how it goes. Obviously, do not try and run, jump, stair-climb repetitively, or hop on it (and would even avoid walking for exercise for the next 2-3 days, until you feel better) until it feels better.
I hope this helps and I hope you feel better soon.

Hello, and I am sorry to read about this frustrating knee issue. Thanks for sharing and allowing me to share my thoughts, tips, and suggestions regarding this condition. If the history you provided was the first known trauma to the knee, and there has been no new injury to it, then sure the current knee issues began as a result of this trauma. I am not sure, by your question, where the dent in the knee cap is. Did it show up as a dent close to the skin, or along with the deeper aspects of the knee cap?

MRI is not always good or reliable at ‘seeing’ damage or bruising to the surfaces of the bone (the articular cartilage). If there is persistent pain despite time, therapy, and conservative measures, a repeat MRI done with a strong magnet (3T or Tesla) is warranted. Also, MRI does not reliably pick up scar tissue formations inside the knee joint. I like to describe them as spider webs or rubber bands that form and attach to the lining of the joint and can pull on nerves (and cause pain) when the joint is used.

A good physical exam can help determine the best course of action. However, if activities like running, stair-climbing, getting up from a chair, prolonged biking, squatting, crawling, or kneeling cause knee pain along the same area each time, then arthroscopic surgery is medically indicated, necessary, warranted, and justified. It can be a great treatment (a therapeutic modality to help lower the feeling of pain and permit an increase in function) and can be diagnostic (it is better at determining the pathology within the knee joint than an MRI scan).

Thanks for sharing your spine bulge issue with the FATD community. I am sorry to read about this. I would be happy to offer you my thoughts, tips and suggestions. It is unlikely that your area of concern (L4-L5 vertebral level) has anything to do with an erection. This usually occurs from the parasympathetic nervous system and nerves from the sacral level of the spine (lower, closer to the pelvis and tailbone). The pudendal nerve is also involved in erections. Unless the spinal canal is compromised (which was not written in your question), it is not likely that your lower back pain and the problem are causing this lack of erection.
I think that after the trauma of lifting too much, the lower back can sometimes hurt for 4-8 weeks (depending on how severe the damage is and the strength of the inflammatory reaction). Generally, I believe in controlled elongation (traction) of the lower back while in a prone (face-down) position. This can help re-hydrate a disc that has escaped from its home (the annulus fibrosus or ligaments that house the gelatinous disc): the protrusion. With anti-inflammatory medication (not narcotics, they can have negatively affected a person’s ability to have an erection)., and the right exercises to strengthen the muscles around the lower back, one can usually feel less pain and get back to great function. However, this may take 3-6 months and with a routine of stretching, conditioning, and strengthening exercises. Sometimes a ‘cure’ is not possible, but rather a loss of the feeling of pain and the ability to do the things you like without fail can occur (which may as well be a ‘cure’). The best way to not get this again is to not lift too much, and if you do like to lift weights, do it with meticulous technique. I like exercises like those found at this link:
https://www.pop-doc.com/browse.cgi?&action=browse_results&category1=Lower%20Back&category2=Tone
I hope this helps.

Thanks for sharing your spine lump concern with the FATD community. I am sorry to read about this. I would be happy to offer you my thoughts, tips, and suggestions. It seems like this has only been going on for a few days. Therefore, stay positive that this will resolve soon. How did this lump get there? Were you working out or doing some strenuous activity? I am a bit confused as to where exactly the lump is, and how it can be affecting both your neck and lower back at the same time. Perhaps it is a muscle spasm. I would encourage some anti-inflammatory medication (NSAIDS) or Tylenol after you consult with your medical doctor about the safety of these medications for you. Take NSAIDS with food and no alcohol, and if there are feelings of stomach pain, stop the medication. I hope this helps and I hope you feel better soon.

Thanks for sharing your knee and leg concerns with the FATD community. I am sorry to read about this. I would be happy to offer you my thoughts, tips and suggestions. Did you have any trauma to the leg? Have you ever? If not, then it is not likely that you have torn your ACL. In addition, sometimes hip problems lead to referred pain in the knee. I am not sure where the ‘ripping’ feeling is. At times, swelling in the knee makes it tight and the feeling of pulling or ripping can be felt upon moving it. Thankfully it has only been ongoing for 2 weeks or so. I am an advocate of using anti-inflammatory medication (NSAIDS) as long as your doctor permits these types of medications. If so, please take it with food. Lowering an inflammatory reaction (from overuse, degeneration, soft tissue tearing, etc.) can help ease the bothersome feelings you are having. I also believe in regaining or maintaining a full range of motion in your hips, knees and ankles (and lower back). If you gently and on a daily basis put your ‘imperfect’ leg joints (hip, knee, ankle, toes) through a range of motion, it will help keep the joints healthy as well as the muscles. Over the next two weeks, and two weeks after that, I am optimistic that you will feel better. If not, then I would suggest consulting with a medical provider for a good physical examination.
Here are some great range of motion exercises:
https://www.pop-doc.com/browse.cgi?category1=Maintain&CGISESSID=e1b529efc880b4a79b47fd390aad331d
I hope this helps.

Thanks for sharing your ankle concern with the FATD community. I am sorry to read about this. I would be happy to offer you my thoughts, tips, and suggestions. A rolled ankle can be an annoying and recurrent problem. Was this the first time? If so, the swelling can arise over the next 2-3 days. Hearing a sound when it rolls can be gas escaping from the joint, or can be a stretching or tearing of tissues around the ankle. Numbness may be due to a sudden stretch of a nerve, but with only mild pain or swelling, I think it is not a severe stretch. The number one reason for rolling the ankle a second time is incomplete rehab of the first ‘roll’. After a week or so, while taking anti-inflammatory (NSAIDs) medication (once cleared by your doctor), with food to protect your stomach, the rehab can begin (either at home or at PT). I like these exercises (starting with a range of motion and then progressing to toning, flexibility, and strengthening).

Sorry I missed this. Depends on where it is and how it looks. Warm soapy water can help, and can some rubbing alcohol on it.

Thanks for sharing your question with the FATD community. I am sorry to read about your post-operative feelings.

Sometimes the swelling from the surgery can track down the arm (from gravity) and cause feelings of numbness into the forearm. Other times nerves may have been stretched around the shoulder and lead to numbness and burning in the forearm. Warming up the arm and performing wrists and elbow motion exercises can help alleviate these feelings. Please make sure your physical therapist and surgeon know you have these forearm issues. If the nerves are swollen or stretched it may take several months for the forearm to feel more like normal.

I hope this helps. Good luck healing.

Hello and thanks for sharing your hand problem with me. I am happy to share my thoughts, tips, and suggestions with you. Are you more concerned about the pain, shape of the hand, numbness, or the lack of being able to use the hand well? At times the fracture (break) can damage the nerves around the finger. Sometimes the pins get close to the nerves or touch them. In addition, the pain can slowly resolve by 2-3 months after the pins are removed. Finally, sometimes the fracture surgery (pin placement) does not get the finger completely straight (like the same finger, on the other hand, assuming it has not been damaged before). However, the fingers can generally still work very well even with them not being perfectly straight.
From what you wrote about the x-ray, it is difficult for me to know whether or not the break is healing. I feel that if the nerve pain becomes worse in the next 2-3 weeks, then it is worth seeing the surgeon again. I believe that working hard at getting back full range of movement is an important part of recovery after this type of surgery. Did your surgeon start you on physical therapy? It may take 4-8 months to completely recover after a fracture and surgery like this. Every 2 weeks or so you should feel a bit better, and not worse. But, it takes time and effort to get an optimal outcome after surgery. I hope this helps.

Hello and thanks for sharing your foot problem with me. I am happy to share my thoughts, tips and suggestions with you. I want to let you know that the history of your pain is an important part of understanding what it may be. How physically active are you? Did you have a traumatic event? What are the things that make it better or worse? If there has been no trauma then it may be due to show-wear. It can also arise from overuse. In any event, I would give it some days and encourage you to check out this link: https://www.pop-doc.com/joint-preactive.html

I hope this helps.

Hello and thank for sharing your upper back/neck pain issue. I appreciate your allowing me to offer my thoughts, tips and suggestions to help you understand and overcome your back problem.

Thanks for the detailed history of the problem. Part of the history I am lacking is about how much time you spend on screens (computer, phone, tablet, laptop, etc.), and the exact position during these activities (screen time). There are muscles that run alongside your spinal processes (the bony prominences in your vertebrae, or the bones of the back) all the way from the base of your skull to your tailbone. There is an odd-shaped muscle in your upper back that essentially makes a thick cross across the base of the neck and then down the back. In addition, there are some deeper muscles (2-3 more layers) that make up the upper back muscles. Finally, there are some small yet complex muscles around the base of the neck (those permit all the movements your neck can make: 6 planes of movement). Without a big traumatic event, by far the most likely cause of nagging and bothersome upper back pain comes from the fatigue of the postural muscles of the upper back and neck (overuse).

Whether brought on by poor posture (screen watching), developmental imbalances (as young people transition from immature bones to mature or fully grown bones), straining from lifting too much or with poor technique, or a combination of any of them, the pain represents an inflammatory response (as does the stiffness and loss of function). In addition, sleeping poorly, carrying a heavy backpack (correctly or incorrectly; correct backpack usage is important and can be found here: https://youtu.be/oTNbw84rbSk), poor hydration and/or rest/nutrition can also add to the problem. It is not likely that there are big tears to muscles, tumors, or disc problems (bulging or herniations) at this age.

I am an advocate of following this acronym:
https://www.pop-doc.com/joint-preactive.html

Each step can be done, and then the exercise portion includes regaining and maintaining full range of motion of the neck and shoulders, and then also working on strengthening the postural muscles (those located along the upper back and neck) and stretching out the chest or muscles along the front of the body (to help regain balance). Of course, do not forget the ‘normal’ ergonomics of sitting and working at a computer. Once the pain and inflammation comes on, it may take 4-8 weeks to fully resolve (while altering your lifestyle and making changes to your daily activities.

I hope this helps.


David T. Neuman, MD FAAOS
Sports Medicine and Orthopedics
131 West 33rd St.
Suite 12E
New York, NY 10001

P: 212-813-3634
F: 212-857-9411

www.nysportscare.com<http://www.nysportscare.com/>



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Good morning and thanks for sharing your knee problem with the FATD team. I appreciate your share and would like to offer you my thoughts, tips and suggestions about this problem.

You are not alone. So many young athletes love their sports but their bodies get damaged and these issues sometimes leave them with ‘permanent’ alterations to their joints and bodies. Do you remember one specific injury or accident that affected the troublesome knee?

When I think of ‘buckling’ and giving way of a knee, I think about stability and therefore ligaments (the small rope-like structures that connect one bone to the other). By far the most common knee ligament to give feelings of instability is the ACL (anterior cruciate ligament).

The best way to understand your knee issue is through a good history and physical by a sports medicine-trained orthopedic surgeon (or orthopedic doctor). They may also get X-rays and an MRI scan to help understand what is going inside the knee.

I encourage you to stay positive but also seek help from a doctor like the one I mentioned above, because a chronically unstable knee (or feelings like that) can lead to early onset knee tissue breakdown and painful degeneration (that is called arthritis).

I hope this helps.

Hello and thanks for your question. In addition, thanks for permitting me to share my thoughts, tips, and suggestions around your question. Sorry to read about your condition.

I think many chiropractors offer strong clinical expertise and treatment when it comes to neck, mid-back, and lower back problems. They can help with the alignment of these areas of the body and work well to relieve pain within these areas. However, I am not sure I have read about or heard a chiropractor treating the condition you mention (plantar fasciitis: the painful inflammation along the course of the thick ligaments and connective tissues on the sole of the foot, from the base of the heel bone to the heads of the metatarsals). For this condition, I would recommend seeing and treating with either a podiatrist, rehab doctor, orthopedist, or physical therapist. Getting into and continuing a routine of stretching the tissues around the involved foot is an effective part of treatment. Some people suffer from this condition for 4-8 months.

I thank you for sharing your concerns about your son. I also appreciate your allowing me to give you my thoughts, tips, and suggestions in regards to this situation.

As much as chronic back pain can be debilitating, the surgeries for intractable pain are usually elective (and not a matter of life or death). Therefore, any doctor should make sure the person is in an optimal state of health, so the procedure can be done safely and with the best chance that the patient tolerates and successfully makes it through the procedure. I believe that the medical doctor who knows his liver the best (and how it is functioning) should assess and write a medical opinion about what steps can be taken to minimize the bleeding during the surgery. I do not know how severe the liver problem is. I also have not seen any imaging of the painful joints, and am not sure if there can be a less-invasive way to treat the problem. I also think it is fine to get a second (or third) opinion before undergoing spine surgery. It would be something I would want to endure only once.

I hope this helps.

Hello! Thanks for sharing your question with the FATD community. I am sorry to read about your ACL tear. I appreciate your allowing me to give you my thoughts, tips and suggestions regarding this question.

The ACL is a rope-like structure that connects the thigh and leg bone together in the knee. It provides stability in the front-to-back plane and during rotation (torsion). ACL tears can be partial or complete. A complete or near-complete tear can lead to feelings of instability to the knee and the main bones of the knee (tibia and femur). A partial tear, and some complete tears, give pain more than feelings of instability. An unstable knee due to an ACL tear should be stabilized. This will decrease the likelihood that the knee will become painfully eroded and damaged over the life of the knee. Therefore, to ‘recover’ from an unstable knee due to ACL tear is more short-lived rather than long-term, especially if you plan on staying active and participating in sporting activities.

If the pain resolves, there are minimal to no feelings of instability (upon sudden stops, dancing, cutting back and forth while running, or swimming/stair climbing), the motion returns to ‘full’, and the muscles are strong around the knee, then ‘recovery’ has occurred. This can take anywhere from 3 weeks to 3 months. However, this takes desire, determination, and knowledge of what things to do in order to maximize ‘recovery’ outcomes. I like to use this link to find the best ‘exercises’ for recovery:

https://www.pop-doc.com/browse.cgi?&action=browse_results&category1=Knee&category2=Injury/Condition

I hope this helps.

David T. Neuman, MD FAAOS