Orthopedic Q&A

Christopher Brown, M.D.
Christopher Brown, M.D.
orthopedic surgeon

Q: I have a lot of pain in my knee, but I am not ready to consider joint replacement. What else can I try first?

If you are having significant pain, you should first see one of our Orthopedic Specialists to determine the cause. It may be something that can be remedied by rest, medication, physical therapy or a combination of these. Once you have determined that your knee pain is caused by a degenerative condition, there are steps you can take to avoid or delay joint replacement surgery.

  • • Losing weight relieves the pain by decreasing stress on the joint.
  • • There are a number of over-the-counter and prescription anti-inflammatory medications that can be useful.
  • • Exercise and conditioning to strengthen the muscles around the joint help some find significant pain relief; the conditioned muscles provide needed support. If regular exercise is too painful, aquatic therapy can be less stressful on the joint.
  • • Studies on over-the-counter supplements for cartilage rebuilding have yielded mixed results, but negative effects of these supplements are rare and minor. Trying them to see if they help is a reasonable step to consider.
  • • There are injections into the joint that can offer temporary pain relief. How long these will last varies from person to person, ranging from a few weeks to many months.
  • • If these methods are not successful, the next course of action is to modify your activity to protect the painful joint, or to use assistive devices like a walker or cane. When you should consider a joint replacement is a personal decision. Most people seriously think about joint replacement when the pain becomes too severe or restricts their activities too much.

Daniel Heller, M.D.
Daniel Heller, M.D.
interventional pain management
Dr. Heller's bio

Q: What are the treatment options for spinal stenosis?

As the premier facility for Virginia Orthopedics, we always recommend an evaluation with one of our Orthopedic Specialists to help find the best treatment for each individual. Depending in part on the severity of your condition, there are a number of treatment options for spinal stenosis, which is when the spinal canal narrows. Usually, you begin with the least invasive options first, which may include:

  • Exercise. Your doctor may refer you to a physical therapist for help.
  • Medication. Over-the-counter and prescription medications are often used for pain relief. Examples are nonsteroidal anti-inflammatory drugs, such as aspirin and ibuprofen, and opioids, which are narcotics sometimes prescribed to relieve severe pain for short periods of time.
  • Injections. There are many different types of injections that can help ease or block pain. These include epidural and steroid injections.
  • Complementary medicine. Complementary medicine techniques can be used alone or in addition to conventional treatments to reduce pain. Examples include spinal manipulation, often performed by a chiropractor who may adjust the spine with his or her hands; transcutaneous electrical nerve stimulation, which sends mild electrical pulses over nerves to block pain and acupuncture, which involves the insertion of thin needles at precise locations to relieve pain.

Surgery is usually a last resort when other, less invasive techniques fail to offer relief. Some surgical options may include laminectomy, which relieves pressure on the spine by removing bone overgrowth, and spinal fusion, which can help strengthen the spine and prevent pain by fusing two spinal vertebrae together.

Find a solution that’s right for you. Orthopedic Specialists offer the latest technologies to diagnose and treat orthopedic injuries. Call 540-347-9220.

Robert Smith, M.D.
Robert Smith, M.D.
orthopedic surgeon
Dr. Smith's bio

Q: My soccer-playing son hurt his ACL. What do I do now?

The anterior cruciate ligament (ACL) plays a crucial role in the knee’s stability, especially when an athlete is cutting, pivoting or moving laterally.

A definitive diagnosis is made by physical examination. X-rays and MRIs are usually obtained to confirm the diagnosis and to look for associated injuries, such as meniscal tears or cartilage damage.

The ACL will not heal itself with rest, immobilization or time. Treatment consists of physical therapy, activity modification or ACL surgery.

In order to restore the stability of the knee, a surgical reconstruction may be performed, in which another ligament or tendon is used as a graft to replace the injured ACL. There are many different graft options and different techniques used to reconstruct the ACL, which your doctor can explain to you. The most common way to reconstruct the ACL is arthroscopically. The surgeon uses small incisions, a camera and specialized instruments to perform the surgery, allowing for the quickest recovery possible.

Rehabilitation varies by doctor, but generally aims to protect against any type of cutting or lateral movement for three months, with a gradual return to full activity by six months. The rehabilitation is lengthy and requires several months of physical therapy — all essential to a positive outcome. The good news is that a full return to pre-injury activities can be expected.

Looking for Northern VA Orthopedic Specialists? Call Fauquier Health’s Physician Referral line at 540-316-DOCS (3627) for help finding an orthopedic specialist.

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