Healthcare in Hampton Roads

HealthcareNovember 2011 Edition

Local Advancements in Medical TreaTMenTs

www.dardenpublishing.net

Bones Joints

Muscles & Pain

MedicAre for duMMiesHypnotHerApy

nutritioncHiroprActic cAre

»

HealthcareAugust 2012 Edition

Thank You Hampton Roads

DarDen PublishingQuality Publications Since 1993

Check out our Virtual World at www.dardenpublishing.net

features 3 cover story

Bones & Joints Materials for replacement joints have improved and

orthopedic surgeons have improved their techniques

over thousands of procedures.

7 Partners in Motion: Physical Therapists After joint surgery, commiting to completing your

physical therapy routine from your doctor is one of

the most important things you can do to keep

yourself healthy.

10 What’s new in Orthopaedics and Pain Management?

12 Hypnotherapy and Chronic Pain Management

14 Backing Chiropractors

departments

16 Senior Living Medicare for Dummies

18 nutrition and Wellness

Want to Improve your Diet?

Bone, Joints, Muscles & Pain

7

3

12

Healthcare

Think color!

18Healthcare in Hampton Roads 1

froM tHe puBLisHer

Hello Neighbors

This edition is dedicated to my wife Jackie and to all of you orthopaedic surgeons, physical therapists, nurses, nutritionists and support staff that share a common practice “to help us live without pain”.

In my wife’s own words: “I am one of those individuals that grew up with knee problems. Even as a young child I would wake up during the night crying because of my “leg aches”. As an adult I still experienced knee problems. I exercised, biked, walked, played golf but

the pain continued. Finally I had had enough. The pain was constant in my right knee. My family doctor referred me to Atlantic Orthopaedic Specialists in Chesapeake for consultation with Dr. Shelton Cohn and then a MRI. Not only did I have arthritis but I had a torn cartilage and menis-cus. My arthroscopic surgery was performed at The Surgery Center in the W. Stanley Jennings Outpatient Center and 4 days later I was in physical therapy at the Atlantic Orthopaedic Specialists office in Chesapeake. My PT Danielle put me through a series of measurements and then exer-cises not only to do during my therapy sessions but also at home. I was determined to “get back on my feet again” and without Danielle and my sessions I would not have accomplished it. I can honestly say I enjoyed my therapy sessions at AOS and am now walking pain free.”

Can you relate to this scenario? As an aging senior trying to maintain an active lifestyle, I wake up some mornings unable to rise and shine like I did 30 years ago. Without our support group of friends it may be difficult to eat properly or maintain our habitual exercise programs. As baby boomers, it takes a daily conscious effort to keep our mind and muscles active, after all, we want to be able to enjoy every day for as long as we can. Sitting on the couch, watching TV is no way to avoid our pain. I have lost many friends in the blink of an eye. There are no guarantees in life…that we will wake up tomorrow to share and remem-ber our life’s adventures with the love of our family and friends.

Healthcare in Hampton Roads is my newest publication with a mission to spread the word about local health awards, accolades and quality of healthcare now available for people of all ages. I see it every day when I walk among the sick and listen to their stories of how our health professionals from Hampton Roads saved a life or recommended a new procedure that put bounce back in their step.

In upcoming editions we will present national health concerns in a way that you can understand and hopefully share your newfound knowledge with family and friends so we all can live longer, healthier lives with confidence that we are in good hands right here in Hampton Roads.

neXt up: DIABETES and CheckUp America, an American Diabetes Association program working to help people lower their risk for type 2 diabetes, heart disease and cancer.

To Your Good Health!

paul Q. darden, publisher

2 www.HRHealth.net

PUBlisHer

Paul Quillin Darden

coPy ediTor

Jackie Nelson Darden

arT direcTor

Sherril Schmitz

conTriBUTinG WriTers

Brian Cole

Paul Darden

Natalie Miller Moore

Alexandra Whiteside

Shannon Woods

Diane York

©Copyright 2012 by Darden Publishing.

The information herein has been

obtained from sources believed to be

reliable: however, Darden Publishing

makes no warranty to the accuracy or

reliability of this information.

Healthcare in Hampton Roads

is a bi-annual publication with

current distribution to area Chambers of

Commerce, and a delivery program to

selected health related businesses

throughout Hampton Roads. To obtain a

copy or to find a location nearest you,

please contact:

darden PUBlisHinG

931 A Shoal Creek Trail

Chesapeake, Virginia 23320-9483

(757) 389-5473

[email protected]

www.dardenpublishing.net

www.HRHealth.net

Jackie Darden

Healthcare in Hampton Roads 3

Hip and knee replacement surgeries topped over 1 million

per year in 2009, according to the Centers for Disease

Control. They are among the most successful operations

performed in the US because of their low rate of complications

and the quantity performed by surgeons, which improves the

techniques. The result is better quality of life for patients, particu-

larly less pain and improved levels of activity. But, the number of

surgeries are also increasing due to obesity putting more pressure

on joints, and the increase in arthritis diagnoses.

Patients are benefitting from the innovations happening with

the surgical aspect, but also from a better understanding of what

makes for a good surgical candidate and what the best meth-

ods are for getting them back to their favorite activities. Physical

therapists have refined their patient’s regimens to include pre- and

post-surgery therapy. Recovery time has improved, and pain man-

agement during and after surgery has as well.

Dr. James Dowd, a Joint Replacement Surgeon at the

it’s an amazing, almost science fiction-like process, to be able to remove worn

out joints and to replace them with new ones, made of metal, ceramic or plastic.

Materials for replacement joints have improved and orthopedic surgeons have

improved their techniques over thousands of procedures.

Jordan Young Institute, performs more than 2,000 joint re-

placement surgeries a year. He tells a story about his brother’s

ACL surgery in the mid-1980s, “He was in the hospital for

three days, in a cast for six weeks, and had to go to physical

therapy to get it to move. Today, the surgery is a half hour,

you can leave the same day, wearing a knee brace a few

days. With immediate physical therapy, you could be running

again in six weeks.”

Dowd feels that the innovations in joint surgery are

better, and that it’s important to get people moving again

because “motion is life.”

Diagnostic tools aided doctors in assessing patient’s joint

conditions, such as a CT scan or an MRI. Dr. Jeffrey Carlson,

from Orthopedic Spine Center, said that “the MRI scan has

revolutionized back surgery. It gives us a very clear view of

back ahead of time. We have more tools now.”

Computer assisted surgery started being used in the

By natalie Miller Moore

Bones & Joints

the 49-60 year old age group, and that the field has seen a drop

in the average age of patient in past 10 years.

That may be due to more people needing joint surgery, or

it may be because people are doing it sooner than they used

to. This is important because living with a disabled joint may

severely limit mobility, and muscles may become damaged

in compensating for the injured joint. “Don’t limit your life,”

Carlson said.

Newer treatments offer better results, and there are more

advances on the horizon, such as genetic treatments, stem cell

advancements and the ability to create replacement cartilage.

Anesthetic techniques are much better than they used to

be, including nerve blocks and

epidurals for lower extremi-

ties. “This keeps patients

awake, they are sleepy but

there’s no tube down the

throat. There’s less feeling

a loss of control, and it

helps patients, they are

not worried about

going to sleep

and not nauseous

from anesthesia,”

Carlson said.

Opinions

vary about joint

surgery as an

outpatient proce-

dure, but increased

availability of home

nursing care and physi-

cal therapy follow up

seem to be leading

in that direction. The

orthopedic field seems

to follow a fairly ath-

letic mindset, one of

“let’s get back on the

field.” That means they

are finding ways to in-

novate to get patients

back into their lives.

A Sentara coor-

dinator for inpatient

rehab and physical

early 2000s, allowing for more precise reconstruction. Dowd

said that an increase in minimally invasive techniques means

less cutting, better pain control, and a quicker recovery. When

the patient is more prepared for the surgery, the surgery itself is

more precise, and the recovery and physical therapy protocols

are improved, hospital stays become shorter.

“When I was training 10-12 years ago, folks would stay

in the hospital for weeks,” said Carlson. Replacement joints

are lasting longer, too, which makes the replacement surgery

more successful. He also said that “materials in knee

replacements last 30 years rather than 10-15 years.”

All hip and knee replacements involve a two parts: a bear-

ing and a bushing, basically the ball

and cup of the joint for a knee

or hip, with some variations.

These parts can be made

from ceramic, metal

or polyethylene plastic.

“Think of it as going from

20,0000 miles to 100,000

miles of wear,” said

Dowd.

Parts that

are attached

to the bone

may be co-

balt chrome

or titanium,

because

they don’t

need to

move like the

joint parts. The

doctor decides on

the materials based

on the patient, in a

case by case fashion.

Dowd said that

a younger person

who is highly active,

might get a ceramic

ball with a high

density plastic liner.

He said that more

joint replacements

are being done in

4 www.HRHealth.net

a Sentara physical therapist assists an orthopedic surgery patient to get mobile as part of the rehabilitation process.

PHOTO COURTESY OF SENTARA

cover story

therapist Sandy Slovak said, “We help people get back on the

golf course. Someone might set the goal of a certain tee time,

or to dance at their 60th anniversary party.”

Here’s the scene at one Sentara hospital that shows just

how they do that: On the whiteboard, the man saw that the

woman had moved her marker ahead of him. So he took the

long way to get in the extra feet to pull even with her. The most

remarkable thing about this competition? It’s happening on

the Sentara Orthojoint Center floor with people who had knee

replacement surgery a few DAYS ago.

Everything about joint replacement has changed, from the

materials to the techniques, and especially the physical therapy

to get people back on their feet again. The OrthoJoint program

creates a class of people who have scheduled surgery around

the same time, work together on physical therapy, and encour-

age each other to do the work needed to recover from their

surgeries. They cheer each other on down the hall.

Kay Domine, 64, was in for her second knee surgery in

two years – she’d had the right knee joint replaced last year,

and the left one in April 2012. “I can already tell the difference,”

she said, as she worked her knee with the physical therapist.

Domine said that she’d had problems with her knees since

childhood. Was it daunting to have surgery and face the

recovery process again? “I asked myself, ‘Could I do it again?’

and decided that I could.”

KJ said that choosing to do the OrthoJoint program this

time helped her feel stronger sooner. “I realized I could move

my leg without my cane, and the muscles are healing sooner,

she said. “It’s creating a different experience and I think it will

be a different story than last time.

Her competitive cohort, Donald Kent, 73, a former

military man, worked equally as hard on stretching his leg after

surgery. They compare notes on stitches, staples, glue and

wraps.

Each day, they measure the angle that the knee can

bend to, with the same physical therapist, who knows what

benchmarks they should be reaching, and where each patient

was the day before. Physical therapy is for one hour twice a

day. The goal is for patients who have surgery on Monday to

be discharged by noon on Thursday.

Rita Wade acts as the Orthopedic Patient Navigator for

her patients, encouraging them to call her with questions. RN

Rita Wade supervises the program for hip and knee replace-

ments and she gave the Williamsburg unit a revolutionary

theme.

“People often say ‘I’ve had enough. Something has to

change.’ We have them sign their ‘declaration of indepen-

dence,’” she said. The markers on the leaderboard are even in

the shape of small revolutionary soldiers. If there’s a big improve-

ment, you get a cannon!

The Orthojoint Center is laid out in a triangle with three

hallways and nurses stations at each corner of the triangle. Maps

indicating the hallway’s distance in feet help encourage patients

to continue working their new joints. If they take a longer route,

they could go 352 feet rather than the shorter route where

they turn at a smaller hallway, which is a total of only 216 feet.

Whichever way they go, they are getting moving and that

matters a great deal to patients who’ve had joint surgery.

As part of the OrthoJoint program, patients and their

families are asked to first attend a class to educate themselves

about the process of having joint surgery and what kind of

commitment they’ll need to make to their recovery. One person

is designated the coach, usually a spouse or adult child, and

they encourage the patient to do their exercises during physical

therapy in the hospital and at home. Wade provides them with a

guidebook which includes what to expect prior to surgery, infor-

mation about their hospital stay, as well as the exercises week by

week for their “homework.”

Surgeries are scheduled at the beginning of the week and

every patient on the floor attends group physical therapy. The

Donald Kent, 73, works his way down the hall after his knee replacement surgery to his physical therapy session, aided by staff at the Sentara Williamsburg OrthoJoint Center.


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“class” gets to know each other during lunches and it “builds

camaraderie and competition.” They wear loose street clothes,

mainly shorts and T-shirts, to emphasize that they are not sick. They

are working towards returning to an active lifestyle.

In a change from past philosophies, patients are encouraged

to walk sooner after surgery. Bev Sabourin, the Nurse Manager

on the floor, called this “early ambulation.” They have large blue

recliners that staff follow them down the hall with, and that’s what

they use in the PT

room. The recliners

are designed with

no gaps between

the seat and the

footrest, preventing

the leg from being

able to fall through.

It’s a chair that’s all

one seamless piece,

and square plastic

exercise boards slide

under the legs to

allow more acces-

sibility for PT. “People

are surprised how

quickly they can

walk. Sometimes it’s

the day of surgery, if

they are stable, don’t have any nausea and their pain is managed.”

Rita Wade.

“Quality of life triggers it (the decision to have surgery.) Pain

issues vary from chronic to severe. People wait as long as they can,

until it’s impeding their walking, or driving even. They might have

to use a walker or a wheelchair,” Sabourin said.

6 www.HRHealth.net

This new program emphasizes on the whole patient, and get-

ting them moving more quickly after surgery. Research shows that

with this method clinical outcomes improve, patient satisfaction

increases, and length of stay decreases. Sentara has five facilities of-

fering this program currently, including Sentara Lee, Obici, Princess

Anne, Virginia Beach and Williamsburg.

“One of the benefits of this program is that you have team-

mates who get you moving, and raise expectations. We have

people doing laps

around the floor,

laughing,” said

Wade.

Patients are

still followed after

they go home, to

make sure their

functional and

clinical results are

on track. As part

of the OrthoJoint

program, there’s

a reunion lunch

three months

after the surger-

ies, so everyone

can get back to-

gether with their

classmates. Rita Wade acts as the Orthopedic Patient Navigator for

her patients, encouraging them to call her with questions. They

meet in the same multipurpose room where they did their physical

therapy, as a reminder of how far they’ve come. Wade said that

patients are thrilled and showing off what they can do – and see

how far their new joints can move!

Sentara OrthoJoint Class with OrthoJoint navigator at Sentara Leigh ann Phillips. One big element of the new patient centered experience of the OrthoJoint Centers is the OrthoJoint navigator and her accessibility and collaboration with patients.

COnSuLTinG an ORTHOPeDiC SuRGeOn

Here are some signs that you might want to consult an orthopedic surgeon:

• Are you limping?

• Do daily activities seem to be getting more difficult?

• Is pain keeping you awake?

• Have you tried other treatments for a reasonable amount

of time without success?

• Are you in general good health except for your joint?

• Have you given up activities you enjoy?The Sentara Patient Guide offers very detailed

information about how to plan for joint replacement, pre-operative schedules,

education and information about recovery.

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After joint surgery, one of the most important things you can do to keep yourself

healthy and be on the road to recovery is to commit to completing your physical

therapy routine from your doctor. Having to go to a physical therapy center three

times a week can be time consuming – but it may be worth it.

“the people who get better, do their homework,” said Tony Grillo, a physical therapist with tidewater physical therapy. Going to a physical therapy center can be motivating. “people may do a small number of exercises at home, and they might do 1 or 2 of them, but not all 12,” Grillo said. working with a physical therapist can make patients more compliant, and encourage them to keep the effort up. Grillo said he thinks it’s important to be an active participant in the recovery.

Wayne MacMasters, the president of tidewater physical

therapy, said that “Good therapy is timing.” Muscles heal best when they are activated and remain flexible, like rubber bands. not following a therapist’s exercise prescription could cause them to help more like ropes, and become stiff. But besides those recovering from surgery, many people dealing with orthopedic issues, chronic illness, sports injuries or pain can benefit from physical therapy. A trained and licensed physical therapist is an expert in movement, so they can assess your issue and create a plan to strengthen muscle,

Partners in Motion:

PHYSICAL THERAPISTS


8 www.HRHealth.net

cover story

as well as control pain. There are a num-

ber of techniques, such as hands-on

mobilization and manipulation, as well as

heat to relax muscles, exercises, ice and

compression.

PTs (what physical therapists are

often called) may also prepare patients for

the surgery by helping them strengthen

their body so it’s in better shape to recov-

er. It’s also possible that physical therapy

can help joint issues so that surgery isn’t

needed, depending on the individual

issues.

Physical therapists can do manual

procedures to check the function of differ-

ent parts of the body, and assess whether

a joint is hypermobile or unstable (moving

too much) or if there is insufficient move-

ment and it’s too stiff or there is too much

scar tissue. The goal is strength and stabil-

ity for long term function.

A physical therapist can also be

like a detective looking for the cause

of problem; for example, sometimes a

knee hurts but it’s the actually hip that’s

weak. MacMasters gave an example of

a woman having pain on her right side,

particularly her shoulder. When they

discovered she worked in a narrow office

where her phone and her door were

sharply to her right, they suggested some

counter exercises – and that she rearrange

her office.

MacMasters said that for patients,

starting with physical therapy, or just hav-

ing an evaluation, is a low risk proposition.

“It’s non-invasive, we don’t use meds, and

it’s a reasonable and conservative first stop

option for a lot of patients,” he said.

The Comber Physical Therapy

practices in Williamsburg also promote

physical therapy as an alternative for

Joe Flannery, DPT, CiMT Williamsburg Physical Therapy Clinical Director includes cuboid supination mobilization in plan of care for patient with persistent lateral ankle pain.

Joe Flannery, DPT, CiMT Williamsburg Physical Therapy Clinical Director evaluates patient’s degree of shoulder impinge-ment. Shoulder impingement dramatically limits patients’ ability to perform many overhead, behind back, and across body activities of daily living (aDLs).

a CiMT certified therapist is trained to identify the underlying CauSe of patient’s

complaint, not just treat the symptoms.

(Page 7) Tony Grillo, DPT, OCS, CiMT & Clinical Director at Tidewater Physical Therapy transitions patient from aquatic to land based therapeutic exercise. aquatic Therapy allows patients with serious limitations to enjoy the benefits of gentle physical therapy with less pain. Conditions including: Leg fractures that cannot bear weight, Lower back problems, Post-surgery, especially lumbar laminectomy or reconstructive joint surgery, arthritis, osteoporosis and fibromyalgia benefit from aquatic therapy.

s

s

s

PHOTOS COURTESY OF TIDEWATER PHYSICAL THERAPY, INC.


www.tpti.com

32 Locations in Richmond, the

Peninsula & Southside

Hampton Roads

Our people.Independence.

Professionalism.Relationships with physicians and patients.

Specialized therapy and professional growth.

Dedication to clinical excellence and improving the lives of others.

Belief that physical therapy is a noble profession.

Knowledge that physicians use our services because they believe that we are the best option for their patients.

SOUTHSIDE: Virginia Beach Smithfield Kempsville Western Branch Great Bridge Battlefield Windsor Franklin PENINSULA: Executive Drive Magruder Oyster Point Tidewater Performance Denbigh Hidenwood WILLIAMSBURG: Williamsburg PT Williamsburg ASC Williamsburg Hand Therapy Norge Gloucester Courthouse Gloucester Point RICHMOND: West Point Brandermill Colonial Heights Glen Allen Kings Charter Midlothian John Rolfe Mechanicsville Ironbridge Powhatan Laburnum West Hampton

The Strength of Tidewater Physical Therapy is

considering surgery, or at least as the first

step. “People have a tendency to go down

the surgical route, and we educate them

on conservative treatments like lifestyle

changes – because many of them haven’t

exhausted conservative care plans yet,”

said erika Comber, the owner of Comber

Physical Therapy. “We say, ‘let’s try this,’ or

‘we’ll strengthen you before surgery’ and

they’ll tolerate it better,” she said.

The Comber post-rehab program

provides a safe place for people, particu-

larly older patients, to continue their exer-

cises. “They already know how to set up

the equipment, so that level of comfort is

already there,” she said. The atmosphere

is positive and she said that “people feed

off of the energy” as they work to build

strength and endurance. “Our patients

undergo a transformation, and we get

rewards in the form of hugs. It’s the best

job in the world,” Comber said.

One of those patients is Claire Sink,

age 68. After her second back surgery

and recovery in 2004, Claire continued

physical therapy at her doctor’s suggestion.

“The surgeries significantly improved my

quality of life, and so has in-depth physical

therapy. My muscles have been recondi-

tioned,” she said.

She continued with the post-rehab

program, and still exercises several times a

week to keep her muscles in shape. She

finds Comber’s post-rehab center very sup-

portive and friendly.

“I would go to Comber PT a couple

times a week to work on my muscles,

joints, and the overall mechanics of motion.

In essence, the PT provides a comprehen-

sive systems perspective to my exercising

that is enhanced over working with a

trainer at the gym. I do my own timing

and charting, with the PTs and technicians

overseeing my technique and form.”

Sink said that her advice to other pa-

tients is that they develop a regular exercise

routine, and stick with it.

“Patients need to understand once

they complete a physical therapy program,

they just can’t stop exercising and expect to

stay fit. They should continue their own

regimen, or do one under the guidance

of a PT or trainer,” she said.

She feels that having a regular place

to work out gives her accountability and

motivation.

“I know that I’m expected to be

there – it gets you there. Because you

don’t want to go back to have to do

rehab, you don’t want to lose ground, so

you have to have motivation and dedica-

tion to do it,” Sink said.

There are a variety of patients who

visit physical therapy, including chronic

illness, orthopedic issues and balance

dysfunctions. Comber said that balance

issues related to aging are often discour-

aging for people. “They lost hope and

faith. But when you tell them they can be

better and still be healthy, it makes them

so happy,” Comber said.

Physical therapy offices offer a vari-

ety of methods to help you get moving

again, which truly makes them partners in

motion.

In keeping with the theme of this edition of Healthcare in Hampton

Roads, the physicians at Orthopaedic & Spine Center have been asked to

comment on the medical innovations that are providing the most relief

to their patients or that are most-greatly impacting their quality of life.

Q: What unique surgical innovation has most influ-enced the care of your shoulder pain patients?

a: The greatest single advance in management of shoulder pain

in my career has been the development of arthroscopic shoul-

der surgery. Early in my career when the only alternative was painful

open surgery for conditions such as rotator cuff tears, many patients,

even physicians, chose to simply live with their pain. Today, the vast

majority of patients with shoulder pain can be successfully treated via

out-patient arthroscopic surgery, done through several small incisions.

This allows us to see clearly all the details of the anatomy, and carry out

repairs without large incisions, resulting in a shorter, less painful recovery.

The “Scope” has revolutionized shoulder surgery, and this technique

now represents the primary focus of my practice.

Martin Coleman, MD – Orthopaedic Shoulder Specialist

Q: What medical innovation(s) is having the biggest positive impact on the care that your

chronic Pain patients are receiving?

a: I believe that the biggest breakthrough we are seeing in the

field of Pain Management is the development of the Interdis-

ciplinary Pain Management team. This involves gathering experts in

the areas of Interventional Pain Management, Orthopaedics, Physical

Therapists and other Specialists (as needed) to collaborate in the care

of Chronic Pain patients. Using this team approach, I find that we can

actively manage patient care and work together to achieve the best

outcome. The patient benefits from such concentrated attention and,

as a result, they tend to live more active lives with less pain.

Jenny L. andrus, MD – interventional Pain Management

Q: as an orthopaedic surgeon and Fellowship-trained spine specialist, what advances in

surgery, medical technology or delivery of pain medi-cation do you believe most benefit your patient’s?

a: Minimally-invasive hip and knee replacement surgery offer

my patients the biggest life changing experience in the least

amount of time. My patients go into surgery, barely able to walk and

suffering a great deal of pain. They come out of surgery, in much less

pain, even after having a major operation, and walk with much greater

ease the same day of their procedure. Their recovery time is relatively

quick as well. Pain relief has been greatly aided by the use of the femo-

ral nerve block for knee replacement patients.

For patients with pinched nerves from herniated discs, Epidural

steroid injections offer great pain relief for those who do not want to or

cannot have surgery. Pain relief is usually felt within a week of having

the injection, lasts months, or even years, in some cases.

In the area of oral medications, extended-release formulations are

affording patients longer-lasting, stronger pain control without having

to ingest so many pills so often.

In spine surgery, better instrumentation is allowing us to operate

on the spine in a much more minimally-invasive way, minimizing blood

loss, scarring and infection. The biologics (bone proteins used in spine

fusion surgeries) are getting better and better and we are seeing more

successful fusions with fewer non-unions. Mark W. McFarland, DO – Orthopaedic Spine/Total Joint Replacement

Orthopaedic & Spine Center is an independent, physician-owned Orthpaedic and Interventional Pain Management Specialty practice that provides world-class patient care in a state-of-the-art facility in Newport News, VA. To learn more, check out their website and patient success stories at www.osc-ortho.com. To make an ap-pointment, please call 757-596-1900.

what’s new in orthopaedics and pain Management?By shannon Woods, osc outreach director

10 www.HRHealth.net


12 www.HRHealth.net

the benefits of hypnosis as a thera-peutic tool are wide ranging, including treatment of chronic pain, phobias, and unhealthy habits. Beyond empirical and anecdotal evidence, numerous clinical trials have returned impressive results on the effect of hypnotherapy in the man-agement of various pain conditions, such as childbirth, burns and fibromyalgia. through professionally guided suggestion by a hypnotherapist, the client is able to distance themselves from their pain and even decrease their perception of pain.

Hypnotherapy also assists the client in peeling away mental

layers of pain – memories of yesterday’s pain, anticipation of

tomorrow’s pain – which are piled on top of the

actual root cause of pain. By peeling away these

mental and emotional memory layers, the

perception of pain can be reduced to a level

where medical care and physical therapy

have a greater effect, the client can be-

come more functional with an improved

quality of life, and medications may

even be decreased or discontinued

(under the direction of a medical

professional). A 1991 study by

Haanen et al demonstrated that

a group of fibromyalgia patients responded to hypnotherapy

with reduced symptoms of pain and fatigue, and required less

medication than the group that did not undergo hypnotherapy.

His conclusion was that “in professional hands it is a safe and

inexpensive mode of treatment.”

Hypnosis is a natural state of mind that everyone passes in

and out of multiple times each day. When you daydream, get

lost in a book or are riveted by a good movie, when you’re driv-

ing and you realize that you don’t remember the last few miles

you’ve just driven – you are experiencing a natural hypnotic

state. Hypnosis is essentially a state of extreme focus, where

the usually busy conscious mind (beta wave activity) is quieted

down, and your subconscious (alpha and theta activity) is at the

helm instead. This is deep relaxation but is not deep sleep. This

is what allows you to experience mental imagery, to “get lost in

thought,” and to suspend disbelief in order to enjoy a thrilling

book or film.

Clinical hypnotherapy harnesses the natural hypnotic state

for therapeutic purposes. The hypnotherapist guides the client

purposefully into a state of relaxation and intense focus on

the issue to be treated. Many people express the fear of

“handing over control” to the hypnotherapist. This fear

stems from an erroneous mindset the general public has

developed largely due to the fictional way that hypno-

sis is portrayed in movies. The Mayo Clinic reports,

“Although you’re more open to suggestion during

therapeutic hypnosis, your free will remains intact

and you don’t lose control over your behav-

ior.” Even in a deeply relaxed state, you can

still hear what’s going on around you, and

you have complete control over your ability

HYPNOTHERAPY and chronic pain Management

By alexandra Whiteside, cPc, cHT


to move and respond to your environment. In natural hyp-

nosis, you are able to instantly respond to the sound of your

child suddenly crying, no matter how engrossed you are in a

book, for example. The same holds true in a clinical hypno-

therapy setting. You can move, scratch an itch, take a drink of

water or respond instantly to an emergency. It is you, the client,

who is in complete control during the session. The hypno-

therapist simply provides verbal suggestions to guide you into a

relaxed state and then to guide you through various therapeutic

imagery techniques. You can choose to accept or reject any of

these hypnotic suggestions, which means, if you are directed to

cluck like a chicken, and you don’t want to cluck like a chicken,

you simply are not going to cluck like a chicken. (Participants in

stage hypnosis shows are chosen because they have naturally

exhibitionist personalities and are highly likely to act on the hyp-

notist’s suggestions. They want to cluck like chickens! They are

not being forced or controlled.) So, contrary to popular belief,

hypnosis cannot be used to control someone else’s mind.

The hypnosis session typically progresses through five

stages: pre-induction, induction, deepening, therapeutic

suggestion and termination. The pre-induction period is an

interview between the hypnotherapist and the client to discuss

the client’s issues and address any concerns the client has

about hypnosis. Induction is the first stage of hypnosis, with

the hypnotherapist guiding the client into a relaxed state,

followed by deepening which takes the client into a deeper

state of hypnosis where imagery and hypnotic suggestion can

be utilized. Therapeutic suggestion can be accomplished via

a wide range of modalities such as

disassociation, guided imagery and

anchoring. In chronic pain manage-

ment, disassociation can help the client

remove themselves from their pain.

An example of guided imagery to help

lower perceived pain levels would be

envisioning cooling water washing

away the pain. Of course, the guided

imagery process is more involved and

detailed than this brief description.

Anchoring is a technique that enables

the client to activate a mental pain con-

trol mechanism as-needed outside of

hypnosis. A common anchor is pressing

the thumb and forefinger together as

a signal to the subconscious mind to

“feel” the cooling water flowing over

the area of pain. The anchor sugges-

tion is implanted in the subconscious

prior to termination of the hypnotherapy session. Termination of

the session is achieved by bringing the client back to a normal,

conscious state, usually by counting to 5, and then re-orienting

the client to time, since the awareness of time tends to be dis-

torted during hypnosis, the same as “losing track of time” when

you are totally immersed in an enjoyable activity.

The emphasis of chronic pain management is on improving

the quality of life. “Pain is a multifaceted, complex phenomenon

which can be treated successfully by hypnosis.” (Dowd) Hypno-

therapy offers numerous advantages with no side effects or risk

of addiction. When carefully integrated with medical treatment,

hypnosis can be clinically utilized to enhance the mind-body com-

munication with impressive results.

Sources:

Haanen H et al. Controlled trial of hypnotherapy in treatment of refractory fibromyal-gia; J Rheum 18:72-75 1991

Mayo Clinic online: http://www.mayoclinic.com/health/hypnosis/MY01020

Dowd, E. Thomas. Cognitive hypnotherapy in the management of pain; Journal of Cognitive Psychotherapy, Summer2001, Vol. 15 Issue 2, p87

Alexandra Whiteside is a certified life coach and certified hyp-

notist with advanced training in integrative clinical hypnotherapy.

Ms. Whiteside owns and operates Selformations, a wellness

coaching and hypnotherapy firm. www.selformations.com

14 www.HRHealth.net

this specialty hasn’t always

gotten respect – in fact, the

American Medical Association

boycotted chiropractic until

1987. this was determined to be illegal

by the supreme court, but the residue

of that bias still remains in the way that

chiropractors interact with the medi-

cal establishment. But that is chang-

ing, both with the many people who

turn to chiropractic care because of the

emphasis on treating the whole person,

and because of the evolving interaction

with the medical community.

Dr. Daniel Shaye, a second-generation chiropractor

and acupuncture provider and co-founder of Performance

Chiropractic, said that he gets referrals from medical doctors.

“Modern chiropractic methods have a growing body of

research supporting them; but there is a metaphorical, poetic

aspect that is an advantage in communicating with the pa-

tient, but a disadvantage in communicating with the medical

community,” Shaye said.

He also said, “Some physicians refer with a better under-

standing of what we do, and some have less of an under-

standing. What referring physicians have in common is recog-

nition that risks of chiropractic are relatively low compared to

other options, our outcomes are positive, and patients have a

very high level of satisfaction with their care.”

The people who walk through the doors of chiro-

practic clinics often come due to complaints of pain in their

neck, back, spine, or arthritis, headaches, sprains, or strains.

Sometimes they are patients who distrust the conventional

medical community or who have exhausted other options,

but more commonly, they are people just looking for the

least invasive path.

“I have seen a chiropractor for my back pain because

they are really good at keeping things aligned correctly and

can suggest exercises or lifestyle adjustments to help prevent

a reoccurrence. They help me fix the problem without sur-

gery and don’t try to mask the pain with pain killers,” said

Heather Hughes Ostermaier, from Newport News.

erika Comber, founder of Comber Physical Therapy,

actually added a chiropractor to her staff last year, because

she’d seen a demand for it from her patients. They were

going to see a chiropractor off-site anyway, so she thought

she’d make it one stop shopping for them.

Comber said she wanted to have her practice centered

around “treating the whole person” and the practice cur-

rently includes a chiropractor, in addition to physical thera-

pists. Keeping with that philosophy, the practice also offers

massage therapists and recently added a holistic nutritionist.

The chiropractor at Comber Physical Therapy, Dr. Michelle Booth, said that one of the best ways a chiroprac-

tor can help a patient is to alleviate chronic pain. Booth said

she sees people in pain, mainly in their back or neck, and it

tends to be recurring rather than sudden, traumatic pain. “It

doesn’t have to be catastrophic…we are improving quality

of life. It might not be a life or death situation, but we are

helping people do things they want to do again,” she said.

She also said that chiropractic is becoming more

understood and more conventional, and that working with

physical therapist has helped open doors. “It might take a

PT telling a patient, ‘I can work on muscles, but the align-

ment or rotation – this is hindering your progress. The best

way to get at that is to be adjusted’ (by a chiropractor.)”

Booth enjoys working in a multi-disciplinary environ-

ment. “We are working together here to give patients

the best of both worlds. There’s a multiple care approach

Backing chiropractorsBy natalie Miller Moore

for a single patient -- several people with

different disciplines looking at them and

communicating with each other,” she said.

For example, she said she might notice a pa-

tient’s shoulder is tight after an adjustment,

and refer them to a PT.

Many people see physical therapists

after injuries or to recover from orthopedic

surgery. For people who are seeing a

chiropractor after joint surgery, there

can be a change in the dynamics of the

body, and the chiropractor can make sure

everything is aligned, adjusting to a new

hip or knee.

Booth mentioned that during the

recovery process, a patient may experi-

ence some low back discomfort from

leaning or using crutches. Adjustments

“can really help, with function improved

and discomfort lessened,” she said.

It’s up to you to decide who makes

up your team of health care providers – a

chiropractor may be an addition you’d

like to make.

When should you see a chiropractor?

You know your body the best, so ask these questions:

•Doyouhaverecurrentinjuriesor aches that don’t seem to heal over time?

•Doyouhaveneckpain,backpain, or chronic aches and stiffness that you attribute to “just getting older?”

•Doyoufeeloutofbalanceoruneven?

•Doyourshoesshowunevenwear patterns, or do you suspect you have a short leg?

•Areyouunableorunwillingto tolerate the negative side effects of pain medications?

•Doyouturnyourwholebodyto check your blind spot rather than just your head?

•Areyousittingatacomputer8 hours a day, or perform-ing any repetitive, physically stressful activity?

•Haveyouhistoricallyhadbackpain, neck pain, or sprain/strain injuries?


16 www.HRHealth.net

Make yourself a cup of your favorite beverage, something warm

and comforting, tea, hot chocolate or something stronger. depend-

ing on your perspective you want to either sharpen your senses

with caffeine or dull them with something else. find a comfy chair

with good light, get your pen and legal pad and listen up as i tell

you about one of the most mind-deadening topics of all time, the

wonders of Medicare and supplemental health insurance.

Medicare – what it provides and how you

get it.

Medicare is a program designed to help

the elderly (65 and over) to get their medi-

cal needs covered. If you are receiving Social

Security benefits now you will automatically

receive a little pulp paper card in the mail

with your Medicare number on it. If you are

not receiving benefits yet- you can call and

apply for both Social Security and Medicare.

Medicare will cost you about $99 – deducted

from your social security check. There are two

parts. Part A covers hospital bills and part B is

for doctors and other medical expenses. Part

A, (hospital bills) pays for the first 60 days in

the hospital and most of the cost for the next

61-90 days. Part B pays 80% of your other

medically related expenses. This is a good deal

but you will still have a deductible for both

part A, hospital (around $1,000) and for doc-

tor’s bills, part B (usually about $135.) Simple,

right?

Yes, until you start looking at supple-

mental insurance (also called Medigap) to cover extra hospital days and that 20%

leftover from part B. Supplemental insur-

ance that you buy may cover an additional

365 days in the hospital (very handy) and

the 20% for doctors and other services not

paid by Medicare. Since hospital bills can be

astronomical this is a good idea.

The cheapest supplemental insurance

is called Part C or Medicare advantage.

These plans can be virtually free. You still pay

the $99 for Medicare but there is often no

other monthly charge. These plans operate

like your typical HMO or PPO plans. There

are significant limits to charges and co-pays

and deductibles. They may work for you if

Medicare for DummiesBy diane york

you are very healthy and plan on staying that

way. But because your choice of providers is

limited to your network, it won’t work if you

travel a lot or spend your winters in some

warm, sunny place other than your home

state.

Other supplemental insurance plans

are simply private insurance plans that fill in

that 20% gap that Medicare Part B does not

pay and perhaps the deductibles for Part A &

B. The cost runs anywhere from about $40

to $170 or more per month. Most major

health insurance companies offer their own

Medigap plan and AARP is associated with

one through United Healthcare. These rates

depend on where you live and which insur-

ers are in your area.

Confused yet? No, that’s good because

there’s more. Each company may offer as

many as 5-14 different plans designated by

the letters A-N. The plans are similar com-

pany to company. For example, the “F” poli-

cies provide the most benefits and cost the

most and are similar with United Healthcare,

Aetna, Anthem and others. What are the

differences in these plans? Predictably, the

higher the price, the more coverage you get.

The biggest other differences in options are

below:

Differences in supplemental insurance:

1. Whether or not the price will increase

each year per your age or stay the

same. Policies labeled age-related

increase as you age while others called

community or issue related do not.

All of these Medigap policies may

increase in price each year, but age

related policies will definitely increase

each year.

2. The number of extra in-hospital days

the supplement will pay for. (Some

pay as much as 365 extra days.)

3. The number of skilled nursing home

days the policy will pay for.

4. The amount of part B (doctor and

other services) each plan will pay for.

For example, each company may

have 5 or more plans. Some will

pay 100% of Part B expenses not

covered by Medicare, some 75%,

some 50%.

5. “Excess charges,” charges from hos-

pital or doctor that Medicare does

not find necessary or acceptable.

6. Foreign travel emergency care.

Hang in there- we are almost done.

One last wrinkle, none of these plans cover

your prescriptions. So if you want that

coverage you need Part D, (think D for

drugs.) If you are not on any long term

meds right now and do not have a chronic

illness you can let the drug coverage go

until later. If you wait to get drug coverage,

you will be able to apply only once a year

and there is a penalty to wait. For example,

let’s say you are in good health now and

not taking any medications and so you do

not elect to get drug coverage. Five years

from now however, you decide you need

it. Your penalty for waiting would be 1%

of the average monthly cost (now about

$40) which is .40 cents multiplied by the

number of months you waited, in this case

60 months. Your drug coverage would

cost the normal price- say $40 plus $24 a

month penalty. Drug coverage would then

cost you $64 per month if you wait till year

five to subscribe.

These are pretty much the basics of

Medicare. But just in case you were won-

dering what Medicaid vs. Medicare is,

let me explain. Medicaid was designed to

provide critical medical care for those with

little or no income and for those who are

disabled. If you are already receiving Social

Security Disability income you will qualify

for this regardless of age. If you are Medi-

care eligible by virtue of your age and have

virtually no income and less than $2,000 in

the bank, you may qualify for Medicaid in

addition to Medicare. In that case Medicaid

will kick in that extra 20% that Medicare

does not pay as well as the $99 per month

charge for Medicare (and you won’t need

to read about all those supplemental plans.)

Now for some good news. A really

great thing about both Medicare and

Medicaid is that they both cover some

preventive services that your health

insurance may not. These tests are not

provided every year, so check the Medi-

care website (below) or call to get more

specific information.

Some preventive services covered

by Medicare and/or Medicaid include:

Abdominal Aortic Aneurysm Screen-

ings, Alcohol Abuse Counseling, Bone

Mass Measurements (Bone density tests

for Osteoporosis.) Cardiovascular Dis-

ease and Screenings – Cholesterol, lipid

and triglyceride levels and a once a year

visit with your doctor to discuss preven-

tion of heart disease, hypertension and

dietary recommendations. Colorectal

screening tests to detect any signs

of colon or rectal cancer. Depression

Screenings, Diabetes Screenings and

Diabetes Self-Management Training,

EKG Screenings, Flu Shots, Glaucoma

Tests, Hepatitis B Shots, HIV Screen-

ings, Mammograms, Medical Nutrition

Therapy Services, Obesity Screening

and Counseling, Pap Tests and Pelvic

Exams, Pneumococcal Shots, Prostate

Cancer Screenings, Sexually Transmitted

Infections Screening and Counseling,

Smoking Cessation (counseling to stop

smoking.)

And you were wondering what

to do with all that free time once you

retired……

This US government website lists all the

carriers in your area and will help you

compare respective plans http://www.medicare.gov. You can call Medicare

at 1 800 Medicare or 1 800 633-4227.

They will ask for your Medicare number.

If you don’t have one yet simply say

“agent.”

senior LivinG


18 www.HRHealth.net

a decrease in joint inflammation. It’s also a great way to

increase antioxidants, by consuming dark red and purple fruits,

such as plums, grapes, cherries. You want to avoid having a

monochrome diet of tan fried foods!

It’s a dietician’s job to help people change the way they eat

– and they often are great resources for small steps to improve

eating habits. Johnson said that many people make assumptions

about what “seeing a dietician” might involve.

“It can be so positive if dietician knows how to

individualize,” she said. “It’s about helping them to their goals.

People often say ‘I don’t know what to do… where should I

start?’ and that’s where we can help.”

Johnson said that people often confess that they don’t

want to see a dietician because they think the dietician will

forbid them from eating their favorite food.

“I don’t do diets. You aren’t on a diet --

This is you making slow changes. My job is to

let people know that all foods can fit – but

the key is: frequency and amount!”

Unfortunately, the typical

American diet is made up of refined

grains, and high sodium foods,

saturated fats, transfats, and

cholesterol, all of which contribute to

the development of heart disease. Our

bodies were not designed to consume

or digest these foods in large amounts.

We’ve gotten off track and dieticians are

trying to help steer everyone towards healthier

options.

If you would like more tips, or a more personalized plan for

your life, think about consulting a dietician. They can help, or

they can reinforce that you are making good choices. Ask your

doctor if you can be referred to a dietician or find out if your

hospital system provides this service. If you want to do more

research about diet or joint health, see resources next page.

W hether you are facing joint surgery

or chronic joint pain, improving

your diet can improve your symptoms, and

how you feel about your overall health. Two

dieticians want you to know small steps are

the way to making healthier eating choices.

Both dieticians said that there is no proven way to change

the progression of a disease, but that changes to your diet can

decrease inflammation, and a healthier diet can benefit your

entire body.

Dietician Chantye Johnson, a certified

diabetes educator and outpatient dietician

from Sentara, said, “Healthy eating helps,

no matter the reason. Maintaining a

healthy weight is important for joint

health, because it puts less pressure on

the joints.”

Katherine alice Werner, a

registered dietitian at the Riverside

Medical & Surgical Weight Loss

Center, said that, “Both eating right

and incorporating physical activity into

your day are key components for a healthy

lifestyle. Eating the right foods – whole grains,

fresh fruits and vegetables, lean meats, fish, bean,

legumes, and nuts – can help our bodies recover faster from

illness, injury, or surgery.”

One of the biggest tips they have is easy: “Think color!”

Johnson said. “People should ask themselves, ‘How colorful is

my meal plan?”

Specific studies showed that pigmented foods, such

as cherries, onions, ginger, berries, turmeric apples, showed


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Resources for people dealing with arthritis or joint problems:Arthritis Foundation website: Arthritis.orgAmerican College of Rheumatology: Rheumatology.orgJohn Hopkins arthritis center: Hopkins-arthritis.orgMayoclinic.com and www.mayoclinic.com/health/arthritis

nutrition And weLLness

concrete tips from the dieticians to help you improve your diet:

• use olive oil whenever you can in cooking – it can decrease

inflammation. Johnson recommended popping popcorn on the stove using olive oil for a healthier alternative to microwave popcorn.

• Replace meat dishes with beans or fish several times a week. Good quality complete proteins – fish, chicken, beef, pork, turkey, soybeans, and tofu – are key to reducing inflammation, healing, and preventing infection post operation.

• Dairy is commonly thought of as source of calcium, but other fortified items, such as almond milk, soy milk, and some juices can also provide calcium with less calories.

• If given a choice between whole grain and something else, always go for the whole grain! Switching to whole grain sandwich bread, or whole grain pasta is an easy first step.

• add berries to whatever you are eating for a quick burst of colorful antioxidants. They can be your dessert or added to a dish you are eating, such as oatmeal or a salad.

• For those specifically concerned with their bone and joint health, Werner recommends discussing supplements with your doctor. “Calcium, phosphorus, and vitamin D play a huge role in bone health. Those consuming the typical American diet will most likely need supplementation to ensure they are getting enough,” she said.

• avoid fried foods. Americans who eat diets that are high in Omega 6 fatty acids, which come from cooking oil, fried food, and processed foods, have more joint inflammation. Omega 6s, which are different from Omega 3s, should be a small part of any diet.

• Dairy products should always be low fat – that’s not 2%, that’s 1% or skim milk. Please consider a calcium / citrate supplement if you aren’t consuming your amount daily. Most patients don’t.

20 www.HRHealth.nett

Some common diagnoses include:

• Stenosis - a narrowing of the spinal canal causing nerve

compression

• Spondylolithsesis - one or more vertebrae are out of

proper alignment

• Sciatica - a symptom of an underlying problem not a diag-

nosis of the cause. The 5 sciatic roots originate in the lower

spine and run thru the muscles of the buttocks and down

the back of each leg. Compression can occur in the muscles

or at the spine.

• Herniated disc, pinched nerve, bulging disc, ruptured disc, etc. - all are terms that describe essentially the same

condition. This is not necessarily a permanent and often can

be treated successfully.

• Degenerative disc disease - not as bad as it sounds.

MRI scans will show some degree of it in most of us with

and without any pain or discomfort.

Very few problems actually occur as a result of an “event”.

Most trouble is a result of repetitive stress either from poor

biomechanics, faulty recruitment, poor posture and/or weak

musculature.

Many post-rehab techniques still focus on increasing range

of motion in the back and hamstrings (the muscles down the

back of the legs) by stretching and also on strengthening the

abdominals.

It is doubtful the cause of back pain is excessive tightness.

In fact, in muscles with a postural function, weakness precedes

tightness. The muscles are “tight” to protect themselves and

provide some semblance of posture because they are too weak

to perform as intended.

Armed with tons of up-to-date supportive research, I’m

Just about every movement of

the human body involves the

low back (lumbar) area so it can

be very debilitating. Low back

pain and the common cold are

the two most frequent dr. visits

and the two most cited reasons

Americans miss work.

Bones, Joints, Muscles & Pain

saying this old approach is not addressing the issue. Range of mo-

tion in the hips is usually poor in symptomatic backs. This results in

too much back range of motion especially when under load. Put

another way, if we free the gluteals (buttocks) and the hip flexors

to operate efficiently, pressure is properly proportioned and the

back is relieved of improper duties. While we work differently with

say, spondylolithsesis than with spondylosis, the goal is the same.

tHe GoAL is stABiLity. The back should be stabilized by

exercise not have its range of motion increased. The supportive

muscles all should be strengthened to provide stability and to be

capable of sustaining improved posture.

This prepares our vulnerable lumbar region to withstand the

many forces that attack us, to enjoy a lifetime of activity and to be

able to hold proper posture during our short stay in this life.

Our Training approach incorporates many of the beneficial

aspects of Pilates and Yoga which we combine with specific

strength work. Again, this is not about increasing the back’s flex-

ibility. This is focused on stability. Many of the Pilates principles

train the back and core to be stable during limb movements.

Many Yoga poses are designed to free the ball and socket hip

joint. This is a joint which is made for efficient movement. Un-

fortunately our forward-flexion ( seated) lifestyle deprograms our

hips and they just don’t operate freely which puts undue strain on

our spines. We sit to eat our meals, to drive everywhere we go, at

our desks, to watch television, at most entertainment shows,…

As a result the muscles that operate the hip joint become

shortened and weakened. This is why I don’t recommend biking/

pedaling in any form as the primary calorie burning cardiovascular

work. The position is just more forward flexion and therefore

doesn’t allow the hip flexors or extensors to move freely through

necessary range of motion. As a secondary supplement to upright

movement ( walking, running, elliptical, strider,…) pedaling is fine

but we benefit by exercising in a vertical position while holding

good posture.

What is the most common condition that lets us know

something is not right in our back? Muscle spasm. The muscles

tighten and restrict just about everything we try to do. Naturally

that makes us think we should try to gently stretch to address the

tightness. Sounds like reasonable common sense. Except it isn’t.

These muscles have a postural function. Their job is to hold us up-

right. So if they’re weak they can’t just atrophy or we’d be lying on the

ground in a heap. If your biceps aren’t trained, they atrophy and you

have weak arms. But weak back muscles still have postural responsibility

so their tightness is the sign they’re too weak to do their job. In postural

muscles weakness precedes tightness.

Whether your back has recurrent spasms, hasn’t had them yet,

or is in spasm as you read this, the goal is the same. These overly tight

muscles must be strengthened. This takes time, effort and knowledge

of how to do this safely.

I’ve focused here on our muscular system because improving it

is within everyone’s capability. Many of the conditions listed above will

necessitate intervention by a doctor of orthopedics, chiropractic or

neurology. But muscular function improvement will complement any

of those modalities and is essential for lasting relief.

nutrition And weLLness

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— Hip and Knee

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Bones, Joints, Muscles & Pain By Brian cole

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A Different WAy to think About Aging

For a personal consultation with our senior care navigator call (757) 856-7030 or visit

riversideonline.com/services/seniors.

It’s about honoring and supporting what people want as they get older — “As I age, I will control my destiny in a place of my choosing.” Seems simple enough. But in the world of healthcare where “we know best” has been the tradition, asking people what they value as they get older is a true innovation that’s making a difference in the lives of thousands.

It’s an approach that promises to change the way people think about aging. And it all begins by asking what matters most. That’s what happens at Riverside, where we have world class physicians and the most comprehensive network of services in the state dedicated to helping you reach your life goals as you age.

As I age, I will control my destiny in a place

of my choosing.

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Healthcare in Hampton Roads