Dear Vori

My cartilage is going away and I have bone-on-bone. Is it too late to prevent knee replacement surgery?

Although pictures usually paint a thousand words, your x-rays are not the most powerful part of your joint replacement story—even if they show bone-on-bone. "We treat the patient, not the x-ray," explains Jim Fiechtl, DO, a sports medicine physician at Vori Health. “The right time to have joint replacement surgery, even if you are bone-on-bone, depends on important factors like your age, overall health, and quality of life."

I have a friend who just had back surgery. Will I need back surgery?

Good news: While a disc injury can be a literal pain, it also has a high chance of healing without surgery. In a study of nearly 400 individuals with disc herniations, more than 90% healed with non-surgical treatment. ​Even though the first-line treatment for most disc injuries does not involve surgery, it is still important to see a healthcare provider if you are experiencing symptoms, because some rare cases require emergency care.

Why do I need integrated care for back pain?​

Your everyday lifestyle plays an important role in your back pain. Stress, sleep, diet, and more can all affect the pain you feel. This is why we practice a biopsychosocial (or whole-person) approach to back care. We understand that your health is not measured by a single x-ray or lab result, but shaped by a combination of your biology (bio), mindset (psycho), and relationships (social). We work together as a team to see you as a whole person, not just a body part.​

I have a herniated disc. Can I ever pick up my child again without pain?

Although disc injuries are common, their outlook is promising. With standard treatment (a combination of pain control, anti-inflammatory medication, and physical therapy), most people with disc injuries heal without surgery.

I am so tired and exhausted. Where do I even begin to fix things?​

When you're dealing with back pain, it's hard to focus your attention anywhere else. But, other factors in your life may be worsening your symptoms, if not causing them. ​For example, research shows high stress and a poor diet, among other lifestyle factors, increase your risk for injuries to your discs (the cushions in between the bones of your back). To effectively treat your back pain, your care should include more than just a prescription for your back, explains Holly Krymis, Vori Health's Director of Behavior Change & Health Coaching.

Does everyone eventually end up with lower back pain?​

The chances are high: Studies show at least 80 percent of people in the United States will experience some form of low back pain at least once in their lives. ​Why is the lower back problematic? To start, the bones in your lower back (called the lumbar spine) bear a lot of your body’s weight. This raises the risk of injury to this area right out of of the gate. Other factors like the hours we spend sitting—and the poor posture, weak muscles, and weight gain that usually follow—dramatically worsen the problem.

Are the arches in my feet falling? ​

The arches of your feet are architectural feats! They absorb shock, helping you stand tall and strong with minimal effort. But just like iconic arches around the world, the arches of your feet can also fall or collapse over time, says Jim Fiechtl, MD, a Vori Health sports medicine physician. In addition to age, other factors like injuries, arthritis, weight gain, and pregnancy can also cause fallen arches (also known as flat feet or pes planus). “You can also blame your parents,” Dr. Fiechtl says. "Some people are born with fallen arches. There is a genetic component that rarely skips generations.”

I have four herniated discs in my back. I did physical therapy—now what?​

We’re sorry to hear about your struggle with disc herniations.​​ If you have not already done so, be sure to get a thorough medical evaluation to confirm your diagnosis. Disc changes are a natural part of the aging process—which is why many people who get an MRI find out they have disc herniations. In some people, these herniations cause pain, and in other people, they are silent. It’s important to speak with a medical provider about your symptoms to rule out any other potential causes.

I was just diagnosed with pre-diabetes. What can I do to get better? ​

If you have pre-diabetes, you are not alone: Approximately 88 million adults in the United States have this diagnosis. ​​With pre-diabetes, a person’s blood sugar levels are above normal but not high enough to be classified as type 2 diabetes. Pre-diabetes is a serious health condition that can progress to type 2 diabetes as well as increase your risk for heart disease and stroke—but it doesn’t have to.

I’ve been told I have bone spurs in my back. What does this mean?​

Although they sound scary, bone spurs are actually very common and many times don’t cause any symptoms. Bone spurs are usually found when people get x-rays for other reasons.

If the problem is in my back, why do I have pain in my leg?​

If you are experiencing sharp, burning pains that travel from your back down your legs, you may be feeling symptoms of a pinched nerve (also called sciatica or a radiculopathy). In your back, the cushions between your bones (called intervertebral discs) sit very close to your spinal cord and nerves.

I work with a computer every day. ​ How should I deal with my neck and shoulder pain?

We feel you, more and more with each word we type! Most humans share your plight and know the discomfort of tech neck (or text neck)—the aches and pains that arise from staring at a screen.

I've spent so much money and time on imaging. Is it necessary?

Surprisingly, no: Most people with low back pain do not need imaging studies (x-ray, MRI, etc). Unless there are signs of a serious issue, studies show there is no benefit to looking inside the human body for a cause of low back pain.

Bulging, slipped, ruptured—what’s the difference between all these terms?​

If you're confused by all the ways to describe a disc injury, you’re not alone! Several years ago, a task force of spine specialists sat down to simplify the terminology. As a result, there are just two main types of disc issues: herniations and bulges. Like a herniation, a bulge is an injury that changes the shape of a disc and can inflame nearby structures; but, unlike a herniation (where one part of the disc pushes through a tear), a bulge refers to a general enlargement of the disc’s edges (the whole disc appears swollen). ​

Keto, South Beach, Paleo—​ which diet will help me lose the most weight?

With so many diets on the table, it’s easy to get caught up in their different weight-loss claims. ​Instead of analyzing food fads pound for pound, we first recommend understanding how they work. “While many fad diets may help you lose weight, they can also be restrictive,” says Christi Bowling, a Vori Health Registered Dietitian Nutritionist.

I’m training for my first triathalon—​ what should I eat on race day? ​

Just like you map your training routes, it’s a good idea to plan your game day diet. ​“Timing and pairing of nutrients and fluids make all the difference when training for an endurance-type race,” says Christi Bowling, a registered dietitian nutritionist and director of nutrition at Vori Health.

What does the word herniation mean?

What can I do to protect my back?

Research suggests certain foods can worsen inflammation. ​If you are battling inflammation from a condition such as diabetes, heart disease, or arthritis, Christi Bowling, a registered dietitian nutritionist and director of nutrition at Vori Health, recommends limiting the following foods:

What are the worst foods for inflammation?​

Research suggests certain foods can worsen inflammation. ​If you are battling inflammation from a condition such as diabetes, heart disease, or arthritis, Christi Bowling, a registered dietitian nutritionist and director of nutrition at Vori Health, recommends limiting the following foods:

My knees pop every time I go up and down stairs – is that bad? ​

You describe one of the most common noises associated with the knee. The crunching, grinding, and popping you may hear is called crepitus. Not only can you hear the grinding in your knee, but you may also ‘feel’ it, too. ​The most common source of these knee noises is your patellofemoral joint—where the back of your kneecap (your patella) connects with your thigh bone (femur), explains Jim Fiechtl, MD, a sports medicine physician at Vori Health. “Grinding can happen here as a result of some roughness of the cartilage behind your kneecap,” Dr. Fiechtl says. “Crepitus is most noticeable when the knee is bent, such as when squatting, kneeling, or going up and down stairs.”

The side of my hip hurts when I walk—is this arthritis?​

It’s possible, but the causes of hip pain can be complex.​ Where you feel your pain (on the side of your hip) is actually not the location of your hip joint. Your hip ​joint, which connects your thigh bone (femur)and pelvis, is located deeper within your body, closer to your groin. People with hip arthritis—or other problems affecting the hip joint itself—generally tend to feel discomfort near the groin area.

My dad has stenosis in his lower back. ​Why does he feel better when he bends forward?​

To learn why bending forward feels better for your dad, let's first do a quick anatomy lesson. ​The word "stenosis" means a narrowing. It can occur in many passageways in the body (you may have heard of a stenosis in a blood vessel or a heart valve, for example). Spinal stenosis refers to a narrowing of the canal formed by the body's interlocking vertebral bones. Stacked one atop of the other, these bones form a passageway (known as the spinal canal) through which the spinal cord runs.

My parents complain about being in pain—​how can I help them?

Caring for elderly parents can be an uphill climb.​​ But the best thing you might be able to do is lift your parents up and out of their chairs. Studies show that adults 65 years of age and older (a large group that makes up 16.5 percent of the US population) spend 65 to 80 percent of their waking time sitting. This sedentary state is toxic—deteriorating all aspects of our elders' health from the strength of their hearts to their sense of independence (Galloza, 2017).​​

What do discs do, ​other than cause problems?

Your intervertebral discs are round cushions in your back. Sandwiched in between the bones of your spine, they absorb the shock of each step you take.​ Your discs are often likened to a jelly doughnut as they have two layers: an inner jelly-like filling (the nucleus pulposus) and a tougher, outer casing (the annulus fibrosus).​

Can what I eat help my pain?​

Yes—especially if you eat the rainbow! Studies show that eating anti-inflammatory foods (think berries!) and taking certain supplements (hey, Vitamin D!) can lower pain from musculoskeletal injuries.

Is my MRI normal?

Even if your MRI shows changes in your spine, like a disc bulge, it can still be considered "normal." Many people walk around with disc changes unknowingly: If you asked a group of pain-free individuals over the ages of 30 years to get an MRI of their spines, at least 30 percent would have bulges or herniations, explains Dr. David Woznica, Director of Clinical Medicine at Vori Health.

You can't tell me what is causing my back pain?​

If you have the most common type of low back pain—known as non-specific back pain (NSBP)—then, the answer is a frustratingly hum-drum: “No, not specifically.” ​ Also known as a back strain, sprain, mechanical pain, or lumbago, NSBP makes up the vast majority—about 90%—of all low back pain cases.

Will certain foods help me run faster?

Bravo on getting out there! While we can’t promise a personal record, we can help fuel your journey. ​Whether you’re a professional or weekend warrior, what you eat makes a difference to your athletic performance, says Christi Bowling, a Vori Registered Dietitian Nutritionist (RDN). “An athlete’s dietary requirements depend on several aspects, including the sport, goals, environment, and practical issues,” says Bowling.

Why does my lower back hurt when I stand?​

You're not alone in your discomfort—many people feel pain in their lower backs after a few hours on their feet. The exact reason can vary, but more often than not, the root of this pain is postural. ​​Your posture, which is how you position your body in space, can play a crucial role in how you feel. For many reasons, including the large amount of time we spend sitting, the muscles that support our spines (like our abdominal and back muscles) tend to be weak. When we stand, these weak muscles slowly give way to gravity. We slouch, arch, sway, or lean to relieve the pressure, but eventually our muscles spasm and our joints ache from the extra work—resulting in the likely cause of your discomfort. ​