As a non-surgeon practicing at the busiest orthopedic surgery hospital in the country, Dr. Vijay Vad stands out. Instead of sending his patients to surgery, his goal is to keep them out of it. A sports medicine specialist at New York’s Hospital for Special Surgery who regularly works with professional golfers and tennis players, Dr. Vad is a believer in the power of the mind-body connection and regularly prescribes yoga exercises and other alternative strategies for his patients. He is also the author of the new book “Stop Pain: Inflammation Relief for an Active Life,’’ which is packed with practical advice and self-care options to help chronic pain patients reduce their dependence on narcotics and avoid additional medical procedures.
I spoke with Dr. Vad recently about his new book and the problem of chronic pain. Here’s our conversation.
Why did you think there needed to be a book about pain?
I have seen a big explosion in chronic back pain and arthritis, and what I realized is that people have very limited self-help options. In the medical system, unfortunately, many health care providers do what they are trained to do. They push you into prescription medications which have side effects or suggest tons of medical procedures. Medical procedures like joint replacements and lumbar fusions have skyrocketed. I felt there was a need for people whose main focus is self help, giving them clinically proven options that will really help them improve their quality of life and minimize their dependence on narcotics and medical procedures as soon as possible.
What else can someone do to relieve pain besides take a prescription pain reliever or undergo a procedure?
There are so many self-help things you can do. Something as simple as trying to do 30 minutes of aerobic exercise can help. With pain, you’re in a vicious cycle – you take more narcotics, your REM sleep decreases, and then you’re tired and you don’t want to exercise. If you can get through the first week or two of extra pain by doing the proper exercise, like 30 minutes of walking daily, long term that’s going to have an impact. Most people give up on simple walking, but it can have a huge impact long term.
For people treating pain with exercise, do you have to be willing to get worse in order to get rid of pain eventually?
In the case of exercises, that’s true. If the pain goes up four-fold, you’re doing something wrong, but proper exercise will make you a little worse for a while before it makes you better. It’s a pain desensitization period. Think about if you have raw skin on your knuckle and you tap it. At first it hurts, but if you tap it more and more it will get desensitized. You’re doing the same to your chronic pain structure when you exercise. There is so much data on this with rehabilitation for back pain, for instance. You become pain desensitized by proper exercise with gradual increases in stress. The overall consensus for exercise therapy is that it has a positive impact. It can be something simple — it doesn’t have to be fancy machines or stretches.
Are other types of pain helped by exercise?
We see the same thing with arthritis. A gradual increase in load on an arthritic knee joint not only reduces pain, but there are data to show proper exercise therapy can slow down the loss of cartilage. Muscles are the shock absorbers, but they’re shut down by arthritic pain. You can reactivate those muscles gradually with proper exercise therapy.
Are there other self-help measures besides exercise?
That’s only one part of self help. There are topical treatments and supplements as well. When I started exploring this I used to think the topical thing is bogus. But there is a whole science behind topical pain relievers.
Are there food and diet options for treating chronic pain?
The whole book really establishes the link between inflammation and pain, and an anti-inflammatory diet is very important. The book talks about the fundamentals of diet, proper exercise and topicals and proper supplements that you may use to try to control your pain. I look at supplements with known data for certain problems, like glucosamine and chondroitin and vitamin D.
Do any of these treatments work for pain disorders like fibromyalgia or chronic fatigue syndrome?
I talk in my book about fibromyalgia. I have my own personal biases. Yes, it definitely exists, but I do think it’s over-diagnosed. I give an example of a woman who had been suffering from fibromyalgia for six or seven years. She couldn’t sleep, she was exhausted. I examined her and she didn’t have the classic fibromyalgia points. We talked, and she really had an irritated nerve in her neck that was causing pain in her shoulder blade. Literally, after one epidural and one proper pillow, she was night and day a different woman. But the book also talks about people who truly have fibromyalgia and other problems, and about the importance of aerobic exercise and how that can affect endorphin levels and how exercise increases REM sleep.
When should you use self help versus alternative treatment like acupuncture versus seeing a medical doctor?
If people have gone to a chiropractor or acupuncturist for back pain for six months with no relief, to me there are lots of red flags that there is something else going on. If you try things for a month or two and things haven’t improved, you really need to see a doctor. That doctor visit can rule out something very serious.
What are you hoping people get out of this book?
Whether you have a medical procedure or not, there are so many things you can do that are available right now. Every little thing adds up. Look at your mattress. Maybe the chair at work isn’t right. Maybe your computer setup isn’t perfect and is causing you neck pain.
What we’re trying to do here is add up six things you can do properly on your own, and it might have a huge impact on your quality of life. I’m trying to get people off using narcotics every time. Narcotics are a downward spiral. It’s a deal with the devil. I don’t know if you’ve seen anybody on heavy duty chronic pain medication, but it really affects how they live their life. And even with anti-inflammatory drugs, there are health issues. I’m trying to give people options that really don’t have a lot of downside.
For more, watch this New York Times video about relieving back pain that features Dr. Vad.
Tiger Woods has proven himself time and time again to be anything but typical. According to Dr. Vijay Vad, a sports medicine specialist at Hospital for Special Surgery in New York, his time spent in rehab should be no exception.
"We say six to eight months with the average person, but we're talking about a fit specimen," Vad said. "He could baffle you because he's in the top one percent of fitness. He's going to have the best rehab team surrounding him 24-7."
Woods is expected to return to professional golf once his rehabilitation period is complete. However, according to Vad, Woods could face further complications with his knee down the road.
"He has a very high risk of developing arthritis in the next five to 10 years," Vad said. "Is his career going to be cut short because of this? We are developing technologies to treat arthritis and he will benefit from them."
In the immediate future, though, Woods has further professional play to look forward to.
"But [the possibility of arthritis] kind of puts a time pressure on him to break Jack's [Nicklaus] record," Vad added.
Read the full story at jsonline.com.
This article specifically focuses on various sports types and their related injuries. Tennis, football, gymnastics, diving, rowing, cycling, running and even golf is mentioned. The usual suspect here is though, the lower back and back pain that accumulates from the twisting motion of some of these sports. The importance of core flexibility is mentioned as well as defined what is the core by DR.Vad; "To really include all of the elements that move and stabilize the spine, you have to go from your knees to your nipples. That's the core." Importance of warm ups, regular exercises and flexibility are also mentioned by Dr. Vad.
Another important step to decrease the pressure on our joints, muscles and spine is controlling our eating habits. A good diet will not only makes us look good, but also eases the weight on our knees and on our spine, hence prevents any future problems before they happen. One of the books that Dr. Vad had written “Arthritis RX” has a very good section about nutrition and its benefits to our anatomical functions. Also more information can be found in our Pressroom Section or by clicking the link of
One exemplary innovative technique is "the use of a joint "lubricant" called hyaluronic acid. Hyaluronic acid, a lubricant used to treat knee arthritis, may also play a role in treating arthritic toes and ankles. This substance exists naturally in many tissues of the body such as cartilage, skin and the vitreous humor of the eye. The process involves getting two to three injections of hyaluronic acid into the arthritic joint under ultrasound guidance, which guidance provides precise placement of the medication in the joint."
(Author TARA PARKER POPE)
Doctors say it's important to view any spinal surgery as a treatment of last resort. Vijay Vad, a Sports Medicine specialist at Cornell University Medical Center's Hospital for Special Surgery has presented research to the American Academy of Orthopaedic Surgeons in March of 2001 showing an 84% success rate using a specialized epidural injection called "Transforaminal Epidural Injection" using fluoroscopy which is an x-ray guidance system. This success rate was obtained combining the injections with proper physical therapy exercises. Dr. Vad said that while the treatment required a significant effort and time investment by the patient, it's far more desirable than surgery. "The more we do non-surgically for the back, the patient win out," says Dr. Vad. Note: The transforaminal epidural injection is a non-surgical outpatient procedure for patients with disc herniation (slipped disc) with continuing back and "sciatic" pain.
Two new procedures called Intradiscal Electrothermal Therapy and Nucleoplasty may offer relief from chronic disc associated low back pain. In our initial institutional series, two thirds of the patients who were selected based on their results of a study called a discogram which was positive were selected for this procedure. The procedure involved putting a heating probe inside the disc to render the pain fibers inactive. Patients with ongoing low back pain due to disc problems may be good candidates if they have tried all other treatments including spinal injections, oral medications and physical therapy. Our future developmental efforts are focused on trying to regenerate a degenerated disc.
The New York Times- Sunday, June 24, 2001- Larry Katzenstein author. Mr. Crawford, a former New York Knicks basketball player, had been scheduled for a hip replacement. But he cancelled the procedure after hearing about a non-surgical alternative. Visco-supplementation is injecting artificial joint lubricant into the hip. Dr. Vad has visco-supplemented 70 hips and over 600 knees. When a joint lavage (washout) is performed with good patient selection ( age 40-60) with instillation of Synvisc using x-ray guidance and proper rehabilitation exercises, Dr. Vad has reported an 86% success rate at American Academy of Orthopaedic Surgeons annual meeting in March of 2001.
Non-surgical management of knee arthritis has changed dramatically over the past few years says Dr. Vijay Vad of Hospital for Special Surgery. Patients who are between ages of 40-60 and who have failed all oral and physical therapy efforts are good candidates for his knee lavage with synvisc protocol. The protocol has yielded a 79% success rate and is non-surgical. His results were presented at the American Academy of Orthopaedic Surgeons annual meeting in 1999.
(Author RIDGELY OCHS)
Dr. Vad has come up with a new twist on an old procedure that is non-surgical and less invasive. Called capsular distention it has worked for all 60 patients so far. The patients are candidates if they have frozen shoulder with continuing pain and motion deficits. Vad anesthetizes the shoulder joint and then injects saline until the adhesions rupture and the capsule is doubled or tripled in size. The procedure is combined with one month of physical therapy. Barbara Freundlich, one of his patients, had both shoulders done with some initial pain the day of the procedure with immediate gains in motion and decrease in pain.
As it may sound as a very common knowledge, stretching and exercising are the two profoundly proven measures that enable us to have a healthy state. One type of this measure is called yoga and its medical studies are still researched over and over and proven to be one of the best solutions for most patients or prospective patients for chronic back pain. “ Some results of a regular yoga regimen – involving a variety of postures, deep breathing and meditation exercises - can offer relief for patients suffering from asthma, chronic back pain, arthritis and even obsessive compulsive disorder among other problems.”
According to research published in the American Journal of Sports Medicine by Professional Golf Association (PGA) Tour physician Vijay Vad, MD, the study--and also his golf medicine book--states that approximately one third of professional golfers and one half of recreational golfers suffer from lower back pain.http://www.hss.edu/newsroom_prevent-injuries-improve-golf-game.asp
"If people have failed standard treatments like oral medications and cortisone injections, hyaluronic acid injections may help the right candidates," says Dr. Vijay Vad, a sports medicine specialist at Hospital for Special Surgery and author of Arthritis Rx: A Cutting Edge Program for a Pain-Free Life (Gotham 2006).http://www.hss.edu/newsroom_joint-lubricant-young-athletes-arthritis.asp