By Dr. Michael Avery, Rheumatologist

My patients ask me if there’s anything they can do to make their arthritis better. Their faces light up when I say, ‘Yes, in fact there is.’

I am referring to their diet.

Certain foods have been shown to exhibit anti-inflammatory characteristics based on the compounds of which they are made, all which ease the symptoms of the disease and in turn, ease the pain of the disease. In fact, a 2017 survey conducted by the US National Library of Medicine National Institutes of Health indicated that 24% of those with rheumatoid arthritis reported their diet had an impact on the severity of their symptoms.

Even better news is that the foods that offer anti-inflammatory aid range throughout the food groups, so those who suffer from arthritis are sure to find something that will please their palettes while helping ease their arthritis pain.

Fish

Certain types of fish are packed with inflammation-fighting omega-3 fatty acids, including salmon, tuna, trout, mackerel and herring. Experts recommend at least 3 to 4 ounces of fish twice a week to help ward off inflammation.

Soy

Soy carries the same inflammation-battling omega-3 fatty acids as fish, but without the fins. Soybeans, tofu, and edamame are a few examples of anti-inflammatory soy.

Oils

Extra virgin olive oil and walnut oil are at the top of the list for fighting inflammation in the oil category. Extra virgin olive oil is packed with oleocanthal, which has a make up similar to non-steroidal, anti-inflammatory drugs. Walnut oil is loaded with omega-3s.

Tart Cherries

Cherries are particularly helpful in reducing the frequency of gout flares. Anthocyanins in cherries, which also give cherries their color, have an anti-inflammatory effect. Anthocyanins can also be found in other red and purple fruits like strawberries, raspberries, blueberries and blackberries.

Broccoli

Broccoli, Brussels sprouts and cabbage are all rich in vitamins K and C. As part of the cruciferous family, they are also full of a compound called sulforaphane. Sulforaphane helps slow cartilage damage in joints due to osteoarthritis. Broccoli is also rich in calcium, known for its bone-building benefits.

Green Tea

Green tea is loaded with polyphenols, antioxidants believed to reduce inflammation and slow cartilage destruction. Epigallocatechin-3-gallate (EGCG) is another antioxidant in green tea and is believed to block the production of molecules that cause joint damage.

Fruit

Citrus fruits – like oranges, grapefruits and limes – are rich in vitamin C. So are strawberries, kiwi, pineapple, and cantaloupe. Eating these foods helps prevent inflammatory arthritis and maintain healthy joints.

Beans

Beans help lower C-reactive protein (CRP) in the blood, which rises in response to inflammation in the body. Red beans, kidney beans and pinto beans are especially beneficial to lowering CRP.

Garlic

Garlic, along with onions and leeks, are part of the allium family. Studies have shown that people who regularly ate foods from the allium family showed fewer signs of early osteoarthritis. Researchers also believe the compound diallyl disulphine found in garlic may limit cartilage-damaging enzymes.

Ginger

Gingerol is the main bioactive compound in ginger and is responsible for much of its medicinal properties and anti-inflammatory effects.

It really comes down to eating healthy foods. Working some of the anti-inflammatory fruits, veggies, spices and fish into your diet can have a positive effect on your arthritis symptoms and on your arthritis pain. Eating these foods also can help you lose weight, which helps take pressure off the joints. You’ll feel the benefits with your arthritis and your overall health.

Dr. Avery is a Rheumatologist who sees patients at the OSMS Rheumatology and Infusion Therapy Clinic in Appleton and Green Bay.

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Editor’s note: This post is from a presentation Mira put together for her class at school and is her own words. It is being published with written permission. Mira is a junior ambassador for the Arthritis Foundation.

Before I tell you about my day when I have infusions, here is a little about me. I’m 13 years-old and was diagnosed with Poly JIA (Polyarticular Juvenile Idiopathic Arthritis) a year and a half ago. I am a very active teenager and my hobbies include playing saxophone, flute, soccer, gymnastics, and running. My favorite saying that I try and live by is “Impossible stands for I’m Possible.”

When I was diagnosed I realized doctors will have traditional medicines or injections to try and if they are not working well to help relieve your symptoms, an option might be infusions (biologics). Infusions are given by an IV through your hand and are relatively painless. Depending on the medicine, it can take a few hours to many hours and depending on the medicine and dose you may get them every four to eight weeks. You may still take other oral medicine or injections to help you as your doctor sees necessary.

The places you can get infusions include:

• Home – with a nurse coming to your house
• Doctor’s Office – few hours
• Hospital – most of the day

Here is a day in the life of me getting infusion at Dr. Tuttle’s office at OSMS.

• Check in at doctor’s office (2pm)
• Get seated in a reclining chair and nurse does temperature and blood pressure
• One needle poke and nurse puts medicine in bag with saline
• Get good snacks and drinks – even hot chocolate in winter!
• Get warm blankets and can watch TV, watch videos, or color (I have even done homework!)
• Every 20 minutes they open the flow up faster (you don’t feel anything different)
• As the medicine finishes, they take your temperature and blood pressure to make sure you are feeling ok (about 4:15pm)
• Go home! (less than 2.5 hours)

I love infusions because they help me and I only spend a few hours in the doctor’s office every seven to eight weeks. I feel tired for the first day, but my energy is back then. One to two weeks before my next one I can feel it wearing off. I’m so glad I get infusions at a doctor’s office because:

• Same nurse
• Not all day
• Doctor stops to see me sometimes
• It costs less for my mom

Infusions have helped me get back to the sports and hobbies I love by reducing my pain and fatigue.  I am thankful for medicines like this and a great doctor who continues to make sure the medicines are allowing me to live an active teenage life!

Dr. Paul Tuttle is a Pediatric and Adult Rheumatologist at OSMS serving patients in Appleton and Green Bay.

Read more blog posts about arthritis by clicking here.

Register for “Living Your Yes with RA: A Personalized Goal-Setting Event” presented by the Arthritis Foundation and OSMS on Tuesday, July 24th by clicking here.

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Knee pain, hip pain, really any joint pain can significantly impact your motivation to exercise. You may even think that exercise could make your arthritis worse.

But staying active with arthritis is possible. The truth is, exercise is a very important part of managing the joint pain, swelling and stiffness that goes along with arthritis. By keeping the joints flexible and the muscles around the joints strong, exercise can reduce the amount of stress put on the joints, and therefore, help reduce joint pain.

However, working out with arthritis typically requires switching to lower-impact, “joint-friendly” activities.

Let’s talk about the 4 exercises to keep you active with arthritis.

Walking
Walking is free, easy and provides so many health benefits. Here are a few reasons you should start walking:

• It keeps your joints healthy by improving the circulation of oxygen and nutrients in joint cartilage.
• It keeps leg muscles strong, which can take some of the stress off of arthritic knees or hips.
• It strengthens bones and can help prevent bone loss that may lead to osteoporosis.
• It helps with weight loss.
• It works the cardiovascular system and helps strengthen the heart.

Water Exercise
Water helps support your body’s weight while exercising, which reduces the amount of stress put on weight-bearing joints like the hips and knees. According to the Arthritis Foundation, doing water aerobics (as opposed to a class on a hard floor) reduces the impact on joints by 75 percent.

Water allows for greater freedom of movement. Since the water is helping to support your body, water exercise isn’t limited by your ability to balance. You can move through full range of motion without fear of falling.

Water also provides more resistance than air, so water exercise is a great way to strengthen muscles and improve cardiovascular stamina.
Types of water exercise include:

• Swimming
• Water walking (taking your walk from the park to the pool)
• Water aerobics

Cycling
An important component to any exercise routine is cardiovascular activity. These help keep your heart strong and play a key role in weight loss. Some types of cardio exercise, like running or fast-paced fitness classes, are probably too high-intensity if you suffer from arthritis joint pain. That’s why cycling is a great option. Cycling works your lower body muscles as well as your cardiovascular system, but it doesn’t put significant stress on weight-bearing joints.

Cycling can be done outside or on an indoor stationary bike, which can be helpful if you have difficulties with balance.

 Yoga
Yoga is an activity that strengthens muscles and improves flexibility. And with the use of chairs, blocks and other props, it can be gentle enough on the joints to do daily.

However, to ensure that no unnecessary stress is put on your joints, it is important to find an appropriate style of yoga, learn how to do yoga poses properly, and understand when modifications may be needed.

Dr.  Dan Linehan is an Orthopedic Surgeon with OSMS and sees patients in Green Bay and Sturgeon Bay.

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Think back to when you were 12 years old. What was your favorite thing to do? For Mira, it’s being active in things like gymnastics and soccer. Unfortunately, after doing a front handspring at gymnastics, she tore her meniscus. Little did she know this would lead to a life changing diagnosis.

Mira tore her meniscus in 2016 and saw Dr. Hein, an OSMS orthopedic surgeon to get it repaired. The surgery went well, but after the surgery, it was taking a longer than normal time to recover.

“Nothing was healing or feeling better,” Mira says. “We didn’t know what was wrong, and then all my joints started to get swollen and started hurting so, Dr. Hein referred me to Dr. Tuttle.”

After going through tests with Dr. Tuttle, one of the only pediatric rheumatologists in Northeast Wisconsin, Mira was diagnosed with juvenile idiopathic arthritis (JIA). According to the Arthritis Foundation, “Juvenile idiopathic arthritis is the most common type of arthritis in children where the immune system mistakenly attacks the body’s tissues, causing inflammation in joints and potentially other areas of the body.” This was why she was unable to properly heal after the meniscus surgery.

Mira explains, “I was really tired, I was in pain, and I would literally limp to the bathroom in the morning.”

After the diagnosis, Mira started her treatment plan at OSMS. Part of Mira’s treatment plan includes infusions. These usually take a little more than two hours, but patients are offered heated blankets, snacks, and drinks, and are also able to watch TV, do homework, read, or play games to help pass the time.

When asked what it is like to have arthritis, Mira explains, “There are good days and bad days; you don’t know which one tomorrow is going to be. You have fatigue, pain and some weakness and have to do daily medications, injections and infusions. I have a lot of needle pokes in a year. The right medicine helps though.”

She continues, “The hardest part is I don’t look sick. I don’t have a cast or brace on so it is not obvious. Sometimes people don’t understand why I can’t stand or sit in the same position for a while or understand that I am in pain.”

By following her treatment plan, Mira is feeling better and is able to do the things all kids enjoy, like sleep overs and hanging out with friends. She was also able to play in the soccer season last year.

After having to miss out on some of this while going through treatment, Mira is excited she is getting back to the life she loves.

Read about Mira’s account of a day of infusion at OSMS.

Find more I’m Back stories.

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By Dr. Debbie Lim, Rheumatologist

Most people realize that physical activity is good for you. The benefits of exercise are limitless, and endless studies have proven that people who exercise feel better about themselves, are healthier and happier, and live longer than those who are more sedentary.

This includes people with arthritis. Yet, some people with arthritis claim arthritis is the reason for limiting their physical activity. What they may not realize is inactivity only enhances the pain and discomfort of arthritis. It may also agitate arthritis symptoms like weak muscles, stiff joints and poor balance. And it can result in a variety of other health issues, including Type II diabetes, cardiovascular disease and osteoporosis, too. All of this means one thing: It is vital for those who have arthritis to exercise.

Exercise can:

• Strengthen the muscles around your joints
• Help you maintain bone strength
• Give you more energy to get through the day
• Make it easier to get a good night’s sleep
• Enhance your quality of life
• Improve your balance

Remember, any movement, no matter how small, can help: Vacuuming, walking the dog, washing the car, mowing the lawn, etc. Daily activities count.

Don’t Overdo It

Anyone, but particularly those with arthritis, should ease their way into exercising. If you push yourself too hard, you can overwork, and even injure, your muscles and worsen your joint pain. Listen to your body. Follow its signals for the best and safest results.

• Keep the impact low.Low impact exercises like a stationary bike, elliptical trainer or exercising in water are good for keeping the stress on joints low.
• Apply heat before.Heat can relax your joints and muscles and relieve pain you have before you start exercising. Heating pads, warm towels, or hot packs should be warm, not hot, and should be applied for about 20 minutes.
• Move gently.Move your joints gently at first to warm up. Range-
• of-motion exercises before strengthening or aerobic exercises are beneficial.
• Go slowly.Exercise with slow and easy motion. If you feel pain, take a break. Sharp pain or pain that is stronger than usual might mean something is wrong. Slow down if you notice swelling or redness in your joints.
• Ice afterward.Apply ice to your joints for up to 20 minutes after activity, especially if your joints have swollen.
• Have several exercise options. This keeps exercising fresh and interesting.
• Trust your instincts. Don’t exert more energy than you think your joints can handle.

Dr. Lim is a rheumatologist and sees patients at the OSMS Green Bay clinic.

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Can CBD help with my arthritis pain?

by Dr. Paul Utrie – OSMS Adult Rheumatologist and Owner
Dr. Utrie has been practicing rheumatology for over 20 years and is seeing patients at our Green Bay and Appleton locations. Request an appointment with Dr. Utrie here.

Cannabidiol, or CBD, is currently a hot topic in many areas of health care, as some patients have seen positive results after using it for various mental and physical health conditions.

CBD is an active ingredient in cannabis (marijuana) and plays a crucial role in medical marijuana. CBD, however, does not cause a “high” and is derived from the hemp plant.

CBD is most commonly used to treat epilepsy. It is also commonly used to alleviate anxiety and help with chronic pain. As a rheumatologist, many of my patients have asked me if CBD is a viable treatment for arthritic conditions.

Although the benefits of CBD sound harmless and appealing, there are safety and quality concerns that patients should be aware of.

CBD is not a medical product; it is an agricultural product and therefore is without quality oversight, study of benefits, drug interactions or any understanding of risk.  The industry that manufactures and markets this product is not obligated to provide this type of information before selling it to consumers.

All information available to date is not backed by scientific research and is not evidence-based. If CBD was a medical product, it would not be permitted to be on the market without more research.

This is not the first time in the past many decades that medical consumers have been marketed to heavily in such a fashion.  Magnets, copper bracelets, Noni Juice, MSM (Methylsulfonylmethane), glucosamine, chondroitin, gin soaked raisins and bee sting therapy are but a small sample of products making amazing claims only to fall by the wayside.

We don’t know what the future will be for CBD.  For now, our best advice is to do thorough research, make smart decisions and beware of products such as CBD that are not cleared for safety and quality standards.

If you would like to learn more about the effects of CBD specifically for arthritis patients, check out this article written by our friends at the Arthritis Foundation.

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Osteoarthritis: Causes and Conservative Treatments
By Dr. Joseph McCormick, Orthopedic Surgeon

Dr. Joseph McCormick is a board-certified orthopedic surgeon. He is seeing patients at our Appleton orthopedic office, located in Ascension NE Wisconsin – St. Elizabeth campus. Request an appointment with him here.

Many people experience pain from some form of arthritis at some point in their lives. Osteoarthritis is the most common form of arthritis and occurs when flexible tissue at the ends of bones wear down.

Symptoms

Image courtesy of Sanofi-Aventis

Clinical symptoms include joint pain associated with injury, overuse or advancing age.  Two general features include loss of articular cartilage (the “joint space” seen on weight-bearing X-rays) and formation of bone spurs. Bone spurs are a secondary reaction to osteoarthritis and are usually not the cause of pain. Patients often ask if the bone spurs can be removed, but if removal is done without addressing the cause of arthritis, they would simply grow back.

The true complaints of pain surrounding arthritis include “achy” pain, end of day stiffness and intermittent swelling.  Many patients complain of good days and bad days, meaning the symptoms shift from day to day or even week to week. These increased achy shifts are sometimes associated with overuse, recent injury or even changes in the weather.

Risk Factors

In general, the stress of any joint is a combination of the load applied multiplied by activity.  Other risk factors include being overweight, family history, old fractures/injuries and certain natural problems of joint alignment. Women are slightly more commonly affected by osteoarthritis than men.

Treatments

There is a myriad of treatments that can be used for arthritis pain, and a few treatments that are currently experimental or unknown.

1. Activity Modification

A good start to conservative arthritis treatment would be to avoid activities that cause increased pain and avoiding lifting or carrying excessively heavy objects.

For the lower extremities, limit walking or use assistive devices such as a cane, and avoid stairs as much as possible. For shoulder arthritis, avoid heavy overhead lifting.

Low-impact exercises that do not provoke an increase in pain can be useful in conditioning muscles and maintaining natural flexibility. Patients can apply ice or heat to the affected joint. Over-the-counter braces can be purchased and worn for support. Many of my patients participate in specialized arthritis fitness classes such as pool aerobics, chair yoga, or Silver Sneakers classes.

2. Simple Medications

Pain relief is often achieved with Tylenol or non-steroidal anti-inflammatory (NSAID) medications. Keep in mind that heavy use of NSAIDs for more than two weeks should be noted with your primary care doctor.

Capsaicin creams may help reduce pain, and some doctors use lidocaine patches near the painful joint. Nutraceuticals are a new brand of medicines aimed at joint support by offering an oral version of proteins felt to be the building blocks of cartilage (glucosamine and chondroitin sulfate). There are various brands available and as of yet, they are not studied by the FDA, so the chemical compositions are varied.

Your doctor may recommend a brand for you, or you could check with a trusted pharmacist or a friend who has had success with supplementation in order to find what works for you.

3. Injections

Steroid injections or viscosupplementation injections can be used to diminish inflammation and provide long-term pain relief.  Injections are offered at your doctor’s office and are typically well tolerated for pain relief.  Steroids usually provide up to three to six months for relief, and the newer viscosupplementation shots can last up to a year.

Image courtesy of arthritis-health.com

Some specialists are experimenting with stem cell aspirates and even platelet-rich plasma injections to battle arthritis pain.  Since the source of these injections come from the patient in the form of marrow aspirates or peripheral blood draws, they are considered natural alternatives to traditional medical choices.

The Iovera° treatment uses a liquid nitrogen needle to freeze pain receptors near the affected joint, for non-narcotic, non-steroidal pain relief lasting up to three months. Subchondroplasty is another needle treatment capable of pain relief for bone marrow lesions, a specialized condition associated with some arthritis and seen most easily on MRI.

Your orthopedic provider at OSMS is a skilled resource for newer conservative treatments, and as always, are a trusted source of surgery options should the need arise.

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The latest talk in reducing knee pain? Walk the walk.

It’s a well-known fact: walking has a wide variety of health benefits, including improved sleep quality, stress and weight management, muscle strength and flexibility, respiratory fitness, joint health, bone density, enhanced mood, and more.

Add less new frequent joint pain for those with knee osteoarthritis. A recent study published in Arthritis & Rheumatology led by researchers out of Baylor College of Medicine indicates that “walkers” (labeled as such for 10 or more instances of walking for exercise) 50 years and older diagnosed with knee osteoarthritis experienced less new frequent knee pain than “non-walkers” (those who reported less than 10 instances of walking). Once the results were tallied; walkers have a 40% less chance of developing new frequent knee pain compared to non-walkers.

The study also suggests that walking for exercise may also slow the damage that occurs within the joint.

Dr. Grace Hsiao-Wei Lo, assistant professor of immunology, allergy and rheumatology at Baylor, chief of rheumatology at the Michael E. DeBakey VA Medical Center, and one of the study’s researchers, says the findings should be of particular interest to people who have knee osteoarthritis but don’t experience daily knee pain.

“This is important information that all OSMS patients should know, particularly our knee osteoarthritis patients, states OSMS Board-Certified Rheumatologist, Dr. Paul Utrie. It’s a safe, non-invasive way to manage arthritis pain and joint deterioration. Short of surgery, most attempts of medically managing arthritis have typically fallen short. Walking is low impact, free and doesn’t have any side effects like medications might…so I encourage everyone to try it.”

Dr Utrie emphasizes that osteoarthritis patients, along with anyone else wanting to walk for exercise, should start slow and build up to a distance and pace suitable for your individual needs. Call OSMS or request an appointment, and we will help you set and meet your pain management and joint health goals.

Find more information about the study here: https://www.bcm.edu/news/walking-towards-healthier-knees

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OSMS Board Certified Rheumatologist and physician owner Dr. Manpreet Sethi joined Dr. Larry Loewen, chiropractor, and host of the Dr. Larry Radio Show, recently to talk about rheumatology.

When people think of rheumatology or rheumatic diseases, most people think of arthritis or joint diseases. Although this is true, there is more to rheumatology than people think.

Rheumatic diseases can be complex for many reasons. There is not just one type of arthritis since it can come from different conditions. Additionally, many diseases can affect someone systemically which means that they can be affected by a rheumatic disease across their whole body. Rheumatology deals with the whole body, not just a specific area.

Common reasons people may schedule an appointment to see a rheumatologist is swelling or pain in their joints, muscle weakness, and more. Many times, people are referred to a rheumatologist by their primary care physician. This may happen when the primary care physician determines that the patient’s case is more complex, ultimately deciding that it would be better for the patient to see a specialist.

One way that some rheumatic diseases can be treated is through an infusion. An infusion is when a patient is given their medication through an IV. Dr. Sethi covers the history of infusions, how the medications were developed and how they are still developing today.

Three rheumatic diseases that OSMS rheumatologists treat includes rheumatoid arthritis, psoriatic arthritis or psoriasis, and myositis. Each of these rheumatic diseases can be treated in a variety of ways, where different medications will be used for patients, as their cases are all different. Dr. Sethi discusses some of the common medications that are used to treat each of these diseases.

Signs and symptoms of psoriatic arthritis and psoriasis include red, flaky skin which can be easily seen on the knees and elbows or can be hidden in the belly button or on the scalp.

Signs and symptoms of myositis, which is a disease that is not as common as the others discussed, includes muscle weakness, where people may find that they have difficulty raising their arms or moving their legs.

Finally, three rheumatic disease success stories were shared, where each patient had a unique case, with its own unique and positive outcome. Our rheumatologists strive to understand the history of their patients’ conditions and work closely with their patients to diagnose the disease, while they actively listen to their concerns during the entirety of their process together.

To watch Part 2 of Dr. Sethi’s interview with Dr. Larry, click here: https://youtu.be/6Rpnpuri50M

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OSMS Board Certified Physical Medicine & Rehabilitation (PM&R) and Pain Management Physician, Dr. Paul Bruhnding, joined Dr. Larry Loewen, chiropractor, and host of the Dr. Larry Radio Show, recently to discuss what PM&R and Pain Management is, the difference between an MD and DO, arthritis of the spine and sciatica, along with treatment options.

Dr. Bruhnding is a Doctor of Osteopathic Medicine (DO) with board certifications in PM&R and Pain Management. Being a DO allows Dr. Bruhnding to view his patients and their conditions through an osteopathic lens. This means that he takes a holistic approach and uses osteopathic techniques to understand the foundation or reasoning behind how or why pain is occurring.

Dr. Larry takes the time to explain what the differences are between a Doctor of Medicine (MD) and a Doctor of Osteopathic Medicine (DO), along with the history of how and why DO license’ were created.

The goal of Physical Medicine & Rehabilitation, otherwise known as PM&R, is to get one’s musculoskeletal functions back to normal, so that everyday things are done in the most functional way possible. PM&R is a type of residency, where Pain Management is a fellowship. Pain Management takes the musculoskeletal and spine conditions dealt with in PM&R and takes it a step further. Training with invasive procedures becomes more in depth, as well as the literature, exposure of patients and pathology.

Arthritis is a standard aging process of a joint where inflammation can cause cartilage, joint capsules and articular surface damage that leads to limited ranges of motion, an increase in pain, and eventually can lead to chronic pain.

There are two different types of pain, somatic and visceral. Dr. Bruhnding takes the time to explain the difference between the two and explains how arthritis pain is a form of somatic pain. Arthritis will become more painful due to the loss of articular cartilage. This is when the cushion, or cartilage, between two joints starts to damage. This can downstream into cartilage loss, then, causing the small nerve endings to become sensitized.

The first two steps to treatment of neck or back arthritis that Dr. Bruhnding provides is getting the right diagnosis and manual or indirect soft tissue techniques. Dr. Bruhnding explains that getting the right diagnosis is where the physician takes the time to sit down with the patient, talks with them about their pain, provides a physical exam, and figures out what the specific problem or source of pain is.

After it is proven that a patient has symptomatic arthritis, then the first two steps to medicated treatment is injecting the arthritis nerves with an anesthetic like Novocain to see if the pain improves. If the pain improves, then the patient will go back in for a second injection two to three weeks later. If this process goes well, then the third and final step is a radiofrequency ablation (RFA). RFA is where an electron is placed on the arthritic nerve to then burn the nerve and change the ability to feel the arthritic pain.

Dr. Bruhnding explains that this injection typically lasts 5-6 months, however, he has seen it last up to one year. After this RFA is completed, patients can continue to go in for yearly injections to manage the pain.

Furthermore, another condition that Dr. Bruhnding sees and treats is sciatica. Sciatica is where the spinal nerves at the lower part of the back are pinched, causing pain, numbness, and weakness to travel down the legs. Anthemia or pressure on the nerves restrict the blood flow and nutrients to the nerves which then causes pain.

Treatment is determined by the amount of pain the patient is experiencing. If the patient is in debilitating pain, then they may be started on one to two neuropathic or nerve pain medicines or receive an epidural steroid injection. The epidural steroid injection is used to calm down the pain by numbing it and decreasing the sensitivity. Dr. Bruhnding goes into further detail on how he targets the location of where to inject the epidural steroid, along with what the process will look like.

Finally, a treatment option for acute sciatica is nerve glide therapy or nerve flossing. This is where one can work to manipulate and stretch the pinched nerve in order to alleviate pain. 

If you are suffering from neck or back arthritis or sciatica, schedule an appointment with Dr. Bruhnding here.

To watch Part 2 of Dr. Bruhnding’s interview with Dr. Larry, click here: https://youtu.be/RJciDn-enE4

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