Do you have a health issue or pain? Ask the Doctor! Barnmice welcomes Dr. James Warson!

Hello All!

 

We just got lucky.

 

Dr. James Warson, neurosurgeon and the only physician in the world exclusively specializing in equestrian health, is launching a new column just for our community called "Ask the Doctor".

 

Dr. Warson is a renowned physician and writer. He is a distinguished military surgeon who served in Viet Nam. He is also an avid horseman and previous owner of J&J Farms training and show barn which produced 23 national and world champion Morgan horses. He has generously offered to share his vast medical knowledge with our community.

 

Dr. Warson invites all our members to ask him any questions at all about injuries, aches and pains, or any other issue that is affective your health and well-being.  Just post your questions in the comment box below!

 

Question:

  I have had chronic neck pain for several years. It comes and goes and is most pronounced when I wake up in the morning. It seems to be located on the left side of my neck. I also notice that when it is really bad, I also have a headache. Both seem to feel better as the morning progresses.

A bit of background: I am left-handed and years ago, I had surgery to correct a dislocating left shoulder. My last two horses both have both been stronger in the left rein and I have been told that I ride with my left shoulder somewhat higher and in front of my right shoulder.

Help!

 

Answer:

I'd love to see you actually ride, or else a video, but here goes.

 

Dressage riders who are middle aged or older and have ridden for a while commonly suffer with neck pain. It starts like this; as we age, we tend to use the muscles of back extension less. This tends to result in the forward thrusted position of a middle aged riders' pelvis during dressage rides. When this happens, the neck becomes flexed forward during the ride in order to balance the head. This chronically stresses the muscles of neck extension and makes them irritable. Irritable muscles often tighten up during sleep. Once you're up and using the neck muscles, you stretch them and stretched muscles become less irritable.


  Shoulder surgery is the extra here. Most shoulder dislocations are anterior, and the surgical repair results in tightening ligaments anteriorly. This may produce stress on the neck through chronic elevation of the shoulder also.

 

You have a really fascinating complex of problems, but here's the bottom line - It sounds like the shoulder either wasn't rehabilitated fully after surgery, or the muscles have tightened perhaps due to discomfort. I would suggest a 3 way approach:


1. Shoulder examination for strength and range of motion.If there are deficits they can be addressed.


2. Appropriate nonsteroidal antiinflammatory medications combined with heat, not ice, to the shoulder and neck. The heat should be moderate, not high, so that it can be applied for a longer period of time once or twice a day.


3. An Xray of the neck would be good to see if there are potential problems there. If no problems are evident, you might benefit from a single course of cervical traction in a seated position for 15 minutes with a 12 to 15 pound weight twice a day for only about 30 days. Consult your physician to see if this is safe and appropriate for you.


After all this if effective, you don't want the pain to return. Lumbar spine extension muscles that are strengthened will hold you in a more vertical frame when you ride and will equalize your forward and backward pelvic movements, resulting in a more natural,fluid moving ride. Look at the gold medal rides on youtube. Those riders are beautifully balance in their forward and backward movements in the saddle.









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Comment by Barnmice Admin on April 29, 2011 at 9:02am

To MagsNMe:

Hello - a hematoma on the lateral side of the leg over the hip can reach a tremendous size, due to a space there that can fill up with blood or any other fluid. I would suggest a plain Xray of the hip, just to be sure where you are.Such modalities as heat and ultrasound thrapy can help remove a chronic blood clot, You don't want this lump to calcify and remain in your leg chronically. The numbness probably means the nerve on the outside of the leg. hte lateral femoral cutaneous nerve, was bruised. You may notice a tingling sensation replacing the numbness as the nerve awakens.   JSW

Comment by MagsNMe on April 25, 2011 at 12:30am
Question I hope you have some insight into: I bailed off a cantering horse onto my right hip. I expected the massive bruise, moving down into my thigh, gravity being what it is, however, I continue to have a lump on that hip, and the skin remains completely numb. It's been about a month now. How long does it take a big ol' haematoma like that to clear out?!?! I'm on the larger side, the mare is 17hh, so it was a good solid hit.
Comment by Sarah Dixon on April 24, 2011 at 12:55am

 wow that sounds good one i know a couple of people that have had some of the same problems and are going for surgery, i will be going back to the doctor and i have not had my arm in a sling all though some days i think it would feel great, as i am typing elbow just seized as i straighted arm, i will letvyou know what they say... thank you

 

 

 

Comment by Barnmice Admin on April 23, 2011 at 11:00am

To Sarah:

This story sounds familiar! Let' get a diagnosis first. Put the hand from the unaffected arm on top of the shoulder and raise the affected arm like you're a bird flapping a wing. If you feel crackling and popping on the top of the shoulder, you probably have subdeltoid bursitis. I'm guessing that is your problem, since the common other problem, a rotator cuff tear, isn't usually associated with popping and crackling, unless the two situations happen to coexist. That might be the case, but I'd treat the bursitis first and see what's left. That will require another visit to your doctor, or, preferably, an orthopedic surgeon. They'll examine the shoulder and probably inject  the bursa with a steroid medicine. This will be followed with range of motion exercises, and if this diagnosis is correct, your outlook is pretty good. Elbow problems can be associated with this diagnosis if the pain has caused you to not use the elbow normally, or use it in an abnormal manner due to the pain.

Have you been using a sling? That may have contributed to the elbow problem in addition. Try these suggestions on for size! I saw a lot of women with subdeltoid bursitis, and injection with range of motion exercises and topical heat usually did the trick.   JSW

Comment by Sarah Dixon on April 23, 2011 at 2:09am

pain in the shoulder,

For the 12 years i have not been able to lean or sleep, fork large amounts of hay, with my arm the pain is dull and long lasting, my whole arm goes to sleep, i have been to a doctor twice for it, one gave me exercises which i still do it has done nothing, my shoulder cracks like an old door and i am only twenty eight, i am frustrated, and not sure what else to do to my knowledge i have never broke it as it has been x rayed and now my elbow is now cracking and catching or locking up.

Comment by Barnmice Admin on April 22, 2011 at 5:20pm

To Ruth from Dr. Warson:

Ruth Thanks very much for your rather detailed history. A couple of things stand out at once. The first one is a slight fever with morning pain and stiffness. The fact that cold and rainy days make them worse is also an important point. I note that you have been tested for thyroid before, and the thinning hair and dry skin go along with low thyroid. I really think it's time for you to see your doctor and ask for a referral to someone like a Rheumatologist. The muscle and joint problems could be anything from rheumatoid arthritis to a number of other autoimmune diseases which can only be diagnosed through proper testing. If one of these diseases is present, it is very important to be on the appropriate therapy as early as possible. Best of luck.  JSW

Comment by Ruth Musolf on April 22, 2011 at 11:51am

Hi Dr. Warson,
For some time now I have just not felt well. I wake up virtually every morning feeling stiff and not well rested. I often feel fatigued during the day, and occasionally I have a slight fever with no other signs of being ill, it's gotten to the point where if I have a bad day or feel depressed my husband will ask me to check my temperature. This winter I have been getting progressively worse, headaches, being cold all the time, thinning hair, super dry skin and often thirsty, and especially having pain and stiffness in many of my muscles and joints (especially my hands and elbows) It is worse on cold or rainy days but constantly there.

We eat a fairly good diet with lots of whole grains, veggies and healthy meat. When I was a teenager my doctor thought I might be allergic to gluten and put me on a wheat free diet and that helped a lot with the issues I was having (depression, fatigue and headaches) I have been off wheat for eight years and recently cut dairy out of my diet to see if that would help since my Mom is allergic to dairy. My thyroid was tested when I was a teen and came back on the low side of normal and I was anemic. I currently take a multivitamin and a supplemental iodine/thyroid supplement that was recommended to me by a nutritionist I saw last summer, she also recommended fish oil and cal/mag. I am at a healthy weight and quite active, ride my horse almost daily (dressage, trail riding and jumping), try to do pilates several times a week, run with my dogs when the weather is warmer.

So I worry if I don't deal with this now it is going to continue getting worse, especially since it is holding me back in my riding as I am starting to Event. Any idea what's going on? Do I need to see a doctor?

sincerely,

Ruth

Comment by Barnmice Admin on March 9, 2011 at 7:34pm

To Jennifer from Dr. Warson:

 It's entirely possible that a small gall stone could dislodge because of a fall. If it went down the common bile duct and lodged in the head of the pancreas I would expect that pancreatitis might result. If you had episodes of jaundice, abdominal pain, dark urine or clay colored stools it might indicate that you were making and passing stones before this event. Since your gall bladder has been removed, you won't be forming stones in the future. At least you won't have THAT to worry about when riding!

To Katherine from Dr. Warson:

Concussions suffered years earlier aren't cumulative. It's only when you suffer a concussion before you've healed from the previous one that a "glass jaw" is likely to take place. After a concussion, if you are experiencing headache, dizziness, difficulty concentrating, or intolerance to loud noise, your brain is still recovering and you need to be careful to avoid reinjury.

To Gary from Dr. Warson:

.Sitting is actually rather hard on the back. You don't say how old you are, so I'll guess middle aged. Irritated muscles often tighten up, so you need to find out what's irritating them. Most commonly it's osteoarthritis. If that's the case, you need to check with your physician, who will probably start with an examination followed by at least an Xray . This will probably show some osteoathritis (wear and tear arthritis). This can be treated by proper exercises and appropriate antiinflammatory medications. Since you engage in riding, a contact sport, you need to tell your doctor this, so medications that don't interfere with blood clotting will be prescribed.

Comment by Barnmice Admin on March 9, 2011 at 7:27pm

To Kim, from Dr. Warson:

It would help if I knew how long it has been since your surgery. In any event, let me give you my "recipe" for dealing with patients that had a simple 1 level lumbar discectomy.I would usually let them take life easy for 2 to 3 weeks, with just walking. This would be followed by about 3 weeks of stretching and flexibility exercises. Then I would add strengthening exercises for about 2 or 3 weeks. It sounds like your problem might be that flexibility wasn't pursued adequately, so the muscles are tight. Tight muscles tend to produce guarding. Find a copy of The Rider's Pain Free Back. The book has the appropriate exercises for riders. Give it a few weeks, and then let me know how you're doing.
PS It's OK to ride during this time, just be sure you do stretching exercises before and AFTER the ride. The walking movement of a horse may be beneficial in loosening up a tight back.  JSW

Comment by Jennifer Leigh on February 5, 2011 at 8:49pm
Last year I began learning to jump. As happens with new jumpers, I fell a few times, though I always landed on my back and wore my safety helmet. One time, I fell rather hard and had a more difficult time getting back up. I thought I was fine. The next day I was in the hospital having my gallbladder removed and following that developed severe pancreatitis. Could the fall from the horse jumping have caused this? Obviously I must have already had a gallbladder stone in my gallbladder, but could the fall have pushed the stone into the duct? It took over 6 months for my pancreatitis to heal. Could another fall cause another flair up?

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