Dr. Thomas Hudgins (NorthShore) - 11:59 AM:
Hello everyone! Thank you for taking the time to join our chat today. I am Dr Hudgins, a Primary Care Sports Medicine Physician part of the Division of Physical Medicine and Rehabilitation here at NorthShore. I treat a variety of spine and orthopedic conditions in a non-surgical conservative manner. I am ready for your questions.
Kathryn (Moderator) - 12:00 PM:
Our online chat about managing orthopaedic pain is now open. You can submit questions at any time during this chat.
Diane (Lincolnshire, IL) - 12:04 PM:
What is the maximum amount of times a patient can have a cortisone injection in the spine?
Can injections cause Arachnoiditis?
Dr. Thomas Hudgins (NorthShore)
Cortisone injetions are steroid injections. There is concern that repetitively placing steroids in any one tissue in the body can lead to deterioration and weakening of that tissue. Therefore, in general we avoid performing more than 3 steroid injections in any one area of the body to avoid causing harm. That includes the spine.
Eva (Northbrook, IL) - 12:07 PM:
What type of doctor should you start with for hip pain if you don't want surgery?
Dr. Thomas Hudgins (NorthShore)
A non surgical specialist such as myself is a good place to start. We would perform an evaluation to determine the correct diagnosis then develop a treatment plan to address your pain and improve your function. Fortunately for us 90% of musculoskeletal issues can be managed to avoid surgery.
Andrew (Buffalo Grove, IL) - 12:09 PM:
I was diagnosed with a disc herniation in my lower back in January and have not had much relief with NSAIDs or PT. What could be next steps?
Dr. Thomas Hudgins (NorthShore)
Disc herniations cause pain through a chemical inflammatory process that irritates the nerve. If you have not responded to NSAIDs and PT then next steps would include steroids. Steroids are our most powerful antinflammatory medications and can be prescribed orally in pill form or be placed in the area of the disc by an epidural steroid injection.
PT (Evanston, IL) - 12:11 PM:
I have had SI Joint pain and problems with my piriformis for quite some time now. I have gone to physical therapy and also seen a chiropractor. The pain persists and travels down my legs causing my legs to go numb. What options are there to alleviate this type of pain?
Dr. Thomas Hudgins (NorthShore)
First we want to make sure we are dealing wtih the correct diagnosis. SI joint pain typically does not travel below the knee. Piriformis syndrome can result in sciatica below the knee when the muscle irritates the sciatic nerve but typically this would be unilateral (one leg). if you are having numbness in both legs it may be worthwhile to pursue further testing with something called an EMG that can evaluate your nerves and assess for other potential causes of your numbness such as peripheral neuropathy.
Nancy (Chicago, IL) - 12:14 PM:
Are there some good stretches for lower back and hip pain?
Dr. Thomas Hudgins (NorthShore)
Yes. Because of the nature of what we all do such as sitting in front of a computer as I am now, we do not get enough spinal mobility on a daily basis. We need to extend our backs by leaning back or performing a stretch called a press up daily. This extension is the positoin of neutrality for the discs.
Likewise, always important to maintain flexiblity of our hip flexors (front of the thighs) and our hamstrings (back of thighs) for both hip and spinal health and mobility
Jim (Vernon Hills, IL) - 12:17 PM:
Do the devices that are strapped to your leg (like the Quell device) really work for pain relief?
Dr. Thomas Hudgins (NorthShore)
I am not aware of extensive literature on these devices proving efficacy. Many of them including copper bands and others work on the premise of affecting our electrical impulses we have in our bodies and for some can be effective for pain relief but it is anectdotal
H. Clark (Glencoe, IL) - 12:19 PM:
I have been diagnosed with arthritis and herniated discs in my lower back. I've tried physical therapy, acupuncture with massage, creams, and other options, but nothing seem to provide lasting relief. Is there anything else I could look into?
Dr. Thomas Hudgins (NorthShore)
This is a common and tough problem unfortunately. The traditional methods discussed in the literature would be a tailored physical therapy regimen that addresses your diagnoses and any imbalances, medications and that may include cortisone injections.
There are many other alternative treatments including acupuncture that can be effective for some
Joan (Evanston, IL) - 12:22 PM:
How can you tell the difference between pain caused by sciatica and pain caused by piriformis syndrome? Are they treated similarly since they can both cause lower back pain?
Dr. Thomas Hudgins (NorthShore)
The difference can be obtained by a thorough history and physical examination. Piriformis syndrome will cause more pain sitting on hard surfaces where the piriformis muscle is located. For this reason it is often called "wallet neuritis".
Treatments are very different as the two entities have different causes. Physical Therapy would address each separately and if we consider cortisone injections, the steroids would be placed in either the back or the piriformis pending which we assess to be the cause of the leg symptoms
Christine (Highland Park, IL) - 12:25 PM:
My 92 year old father suffers from lumbar disk disease with radiculopathy and has severe lumbar region pain as well as severe sciatica pain and weakness in his left leg. He takes gabapentin (200mg three times a day) to try to relieve the pain, but it does not help much. Are there any other medications that might help relieve the lumbar and sciatica pain or would it be more likely to have the gabapentin dose increased?
Dr. Thomas Hudgins (NorthShore) - 12:32 PM:
There are numerous pain medication options but we want to make sure we are cognizant of adverse side effects particularly in a 92 y/o patient. Gabapentin is a nice choice with minimal side effects and 200mg is very low dosage. Consider increasing dose first before switching medications.
Janice (Morton Grove, IL) - 12:32 PM:
What specific things would you recommend for someone with herniated discs who is going on a very long plane ride (Australia)?
Dr. Thomas Hudgins (NorthShore)
walk the aisle every 1-2 hours and get a lumbar roll or mckenzie roll for the seat
Karen (Round Lake, IL) - 12:33 PM:
I have Transverse Myelitis. Is there any research being done to repair the Myelin Shield? Can I eat or take anything to repair the Myelin Shield? The effect this damage has caused with the sensitivity in my legs comes with a lot of extreme tightening pain throughout my legs. Sitting is very difficult as well as finding the least pressure position for laying down to sleep.
Dr. Thomas Hudgins (NorthShore)
I will have to defer this question to my Neurology colleagues
Marie (Grayslake, IL) - 12:34 PM:
I've noticed I get lower back pain in the middle of a walk or golf game. Should I continue to be active, or should I stop and take the rest of the day off if I feel the pain come on?
Dr. Thomas Hudgins (NorthShore)
"Relative Rest" is always a good rule of thumb. This means you want to be active but be smart. Walking in general will not cause harm to your spine so continue to walk. Golf does cause a fair amount of torque to the spine and you may want to make some modifications.
Marta (Lincolnwood, IL) - 12:36 PM:
What options are available for knee pain, once if OTCs don't work?
Dr. Thomas Hudgins (NorthShore)
First we would like to have an accurate diagnosis as to what is causing the knee pain. With an evaluation we can target the pain generator with a tailored program with the physical therapist and then explore other options to help ameliorate the pain that may include prescription medicatoins, gels or cortisone injections
Andy (Morton Grove, IL) - 12:38 PM:
I’m a 72 year old male and I’ve had my L2 through S1 vertebrae fused. My spinal surgeries were in 2003, 2006 and 2013. I am on blood thinners. I still have significant lower back pain and my left leg feels extremely heavy. The pain is affecting my quality of life. What ways could I alleviate the pain?
Dr. Thomas Hudgins (NorthShore)
Difficult problem as your entire spinal mechanics have been altered wtih surgery. Medical Marijuana is now approved in Illinois for chronic spinal conditions and may be an option to explore if all other medications have not provided any relief
Myra (Wadsworth, IL) - 12:39 PM:
I have hip pain connected to my fibromyalgia. It’s all over and both sides. I’ve done chiropractic adjustments, physical therapy, and massage. Pain is so unbearable that it makes me avoid physical activity. I know it will help, but in the meantime, exercise makes it worse and then I’m even more exhausted than usual. Are there any other ways to alleviate pain?
Dr. Thomas Hudgins (NorthShore)
If the pain is due to your hip joints then you may want to consider a cortisone injection. If the pain is due to your fibromyalgia then you may want to discuss with your physician other medication options or see someone with an expertise in treating fibromyalgia such as a rheumatologist
Eva (Northbrook, IL) - 12:42 PM:
Besides x-rays and MRI's, what what would be a good way to differentiate where pain is coming from - hip or back or something else (dealing with groin pain for years)?
Dr. Thomas Hudgins (NorthShore)
We do have advanced imaging with MRI arthrogram that can evaluate for possible labral tear. This is something I have often picked up in my practice in patients with chronic groin pain. We also utilize an ultrasound more frequently in the Sports and Orthopedic area to evaluate joints. We can also utilize our injetions techniques for diagnostic purposes.
Diane (Lincolnshire, IL) - 12:44 PM:
In addition to the pain in my back, I have been having severe pain that grabs and strangles me where the butt meets the top of the leg. I do have arachnoiditis and wonder if this pain is related to that. I have read that epidural injections may contribute to this issue. Are there any methods of pain relief for this? Would physical therapy help?
Dr. Thomas Hudgins (NorthShore)
Oral steroids for short period of time may be beneficial for this. PT is also a nice way to implement a long term home exercise program that will address any biomechanical imbalances and core stabiltiy
Linda (Barrington, IL) - 12:46 PM:
I was recently diagnosed with lumbar stenosis (neurogenic claudication). My main symptoms are aching muscles around hip area whenever I walk more than 20-30 feet. Long term standing is also painful, but sitting is fine. I’m a 68 year old woman. Physical therapy was helpfu,l but the aching seems to be getting worse when I walk shorter distances now. Is there anything other than surgery that can really address this condition on a long term basis?
Dr. Thomas Hudgins (NorthShore)
Conservative management can help you manage these symptoms such as PT and epidural steroid injetions. Surgery will change the anatomy by removing bone to open up the space
Lyuba (Skokie, IL) - 12:47 PM:
In your opinion, are strong core muscles essential to avoiding back pain?
Dr. Thomas Hudgins (NorthShore)
Strong core is certainly important but so is spinal mobility and flexibility. This would include the press up I mentioned earlier as well as hip flexiblity.
But remember, nothing is absolute and back pain is extraordinarily commmon. These exercises will certainly minimize your risk of getting back pain
Jen (Chicago, IL) - 12:49 PM:
You mentioned press ups earlier; is there a good resource to show how to do this? Are there any other good stretches to use daily to prevent lower body pain?
Dr. Thomas Hudgins (NorthShore)
Yes, look up "press ups" or "mckenzie" exericses for back pain or for herniated disc in the lumbar spine.
In addition, hamstring and hip flexor stretches.
Ava (Evanston, IL) - 12:52 PM:
Sometimes, I tweak my knee, and feel pain on the inner side. What could this pain indicate? Is it best to ice it or leave it be?
Dr. Thomas Hudgins (NorthShore)
That area of your knee corresponds to possible structures such as bursa, tendon, cartilage (meniscus) or less likely ligament (MCL)
Ice for sure the initial 72 hours. If this continues to occur I would recommend an evaluation with someone like myself to obtain a diagnosis and treatment plan
Ava (Evanston, IL) - 1:00 PM:
Thanks for the response!
James P. (Winnetka, IL) - 1:01 PM:
Could you explain exactly what your specialty is and how you can assist with these issues?
Dr. Thomas Hudgins (NorthShore)
My practice focuses on diagnosing and managing orthopedic, sports and spine injuries of all ages and all abilities in an effort to return to function and sport while avoiding surgery. My specialty trains physicians like myself to perform these assessments in the office and devise a plan that may include physical therapy, medications and cortisone injections
Kathryn (Moderator) - 1:02 PM:
This will be our last question.
Dr. Thomas Hudgins (NorthShore) - 1:06 PM:
Thank you everyone for joining me this afternoon. I hope this was helpful and informative. If you have any further questions about my Orthopedic Spine and Sports practice please contact NorthShore at 847.503.4500.
Kathryn (Moderator) - 1:08 PM:
This will be the end of our chat. Thank you for your questions. For more information about ways to manage orthopaedic pain, or to schedule an appointment with a specialist like Dr. Hudgins, contact the
Department of Physical Medicine and Rehabilitation.