Pain Management

Pain Management

Ok, I’am Better

By PPSM Staff

You’ve just spent months undergoing chiropractic care and physical therapy for your injury or condition. You’ve arranged your appointments around your already busy schedule and put in the time and work required to give your body its best chance at healing. Now you’re ready to go back to life as you knew it before all this happened.  So where do you go from here? How do you resume your normal activities without risking ending up right back where you started?

One of the most common mistakes patients make is falling into the trap of not making the same time to abide by their home care instructions as they did to make it to their treatments when they were under active care. When you get discharged from care you are given home exercises, certain tools if necessary, and instructions on when and how often to carry out these tasks. The temptation of letting a busy life keep you from doing these things, without the supervision a treatment session provides, is an easy one to fall victim to. The purpose of these home programs is to facilitate both maintaining your recovery and to hinder rapid deconditioning and regression. Now that you’ve gotten better the goal is to keep you that way.

Another common mistake made amongst patients is improperly resuming physical activity once they are discharged from care. For patients who were active prior to care the inability to continue certain rigorous physical exercise programs while under treatment is often tough to tolerate. Once patients have properly recovered, they sometimes forget that their bodies have not trained with the same intensity for weeks, and often months, at a time. It is crucial to reintroduce your body to its old activity regimen GRADUALLY.  A good rule of thumb is to pretend you are a novice at that particular activity again and reintroduce your body to that physical demand at a beginner level. This will allow you the opportunity to appropriately listen to your body’s ques and increase your intensity and difficulty levels at an appropriate gradual rate so as to avoid re-injury or even new injuries.

The final common mistake made by patients is ignoring signs of re-aggravation. For most patients it is not hard to remember the debilitating feeling of when the pain first became a problem, and when you resume your everyday activities you may feel discomfort that resurfaces but not to the same degree as your initial onset of pain. Where most patients go wrong is assuming that because they aren’t doubled over in pain again that they don’t need to heed these warnings from their body as important. If you experience an onset of discomfort that does NOT quickly self-resolve, no matter how mild, being proactive is your first best action to keep the problem at bay. Don’t wait until the problem becomes life-altering again before you seek intervention of care. In general, small tweaks are easier to quell than major re-exacerbations of pain and discomfort.

When you take care of your body, your body will take care of you. J


Until next time, be well.

Flip Flop Fever Fest

By PPSM Staff

The summer and hot weather is upon us!!! Now is the time of year that more and more folks will ditch their conventional footwear and opt for sandals and flip flops. Although many manufacturers are producing more ergonomically sound designs, the difference in support offered is enough to cause issues with many patients and their ailments; particularly foot pain. If you desire more summer friendly footwear but contend with the discomfort and pain that comes with wearing flip flops or sandals all summer long here are a few tips to aid in alleviating your foot pain this summer.

  1. Obviously you’ll want to go with the most ergonomically appropriate design for you. Whether you have flat feet, normal arches, or high arches you’ll want to take care to purchase sandals and flip flops with the most beneficial/appropriate design for your feet.
  2. If you have pretty standard sandals or flip flips that don’t have any,or many, ergonomic features you may want to opt for gel insoles that have an adhesion to help them stick to the bottom of your sandal.
  3. Stretch out your plantar fascia by propping your toes on the bottom of the wall or the bottom step, count to 10, repeat 10 times. Do this for both feet even if only one is bothering you.
  4. Use a frozen golf ball to work on any tender spots along the foot. Focus on tender spots/problem areas and hold a firm pressure (nothing that hurts you more though) on them for relief. You can also do this with a frozen water bottle to roll across the entire bottom of the foot and roll it continuously. Make sure that you have already stretched out the fascia of the bottom of the foot, as previously mentioned in step 3, BEFORE you do this and NOT AFTER.
  5. Foam roll your calves to help with muscular involvement that may be affecting your gait and causing increased foot discomfort as well. If you have tight or sore calves this will affect your gait and can contribute to putting more strain on your feet. Combined with the potential decreased support in flip flops this could make foot discomfort worse. So get rollin!!!

Dangers of opioids and other alternatives for pain management

By PPSM Staff

No one likes being in pain. Patients choose care at Performance Spine and Sports Medicine because of this fact. Sure, pain has its purpose. For most people it is the first signal that something is awry in the body and our natural instinct is to put a stop to the pain as quickly as possible. The problem with this approach is that treating the pain often becomes the main focus rather than eradicating the source of the pain. Our clinical approach is all about identifying and correcting the cause of your pain. It shouldn’t be enough to simply FEEL better temporarily. The goal should be to actually BE better permanently. Otherwise, the pain is something you will ALWAYS contend with because the actual problem has remained unaddressed.

Since the early 2000’s Opioid prescription drugs such as Hydrocodone, Oxycodone, OxyContin, Opana, and methadone, and combination drugs like Percocet and Vicodin have been increasingly prescribed for Americans. Opioids are medications used to treat pain by creating a morphine-like effect. Listed below are several startling facts about opioids according to the Center for Disease Control and Prevention and their effect on the American population:

1. In 2012, health care providers wrote 259 million prescriptions for opioid pain medication, enough for every American adult to have their own bottle of pills.
2. As many as 1 in 4 people who receive prescription opioids long term for noncancerous pain in primary care settings struggle with addiction.
3. Every day, more than 1,000 people are treated in emergency departments for misusing prescription opioids.
4. More than 165,000 persons in the United States have died from opioid pain-medication-related overdoses since 1999.

The numbers are startling because they are true. So, what can be done about this? How do you avoid this course? What else is there? If you’ve been looking for answers to these questions already you may have come across the #ChoosePT campaign. The goal of this national effort is to give the masses the information needed to help them choose to do more than simply mask the pain they are feeling but to treat the root cause so they can truly be pain-free. As aforementioned, if you don’t treat the source the problem will be there no matter what prescription for pain you take. The CDC has launched an objective to encourage healthcare providers to significantly reduce the use of opioids in favor of giving patients safer options for addressing their pain. That’s where Performance Spine and Sports Medicine excels in patient care.

The National Institute of Health reports this as a “silent epidemic” that is troubling and dangerous to patients. Here at Performance Spine and Sports Medicine, our physicians work closely with our physical therapists, acupuncturist, chiropractors, and massage therapists to treat an individual’s pain and control their symptoms without overusing opioid medications. A recent study out of Mayo Clinic in Jacksonville, Florida found that “comprehensive interdisciplinary outpatient rehabilitation can significantly improve the quality of life in people with chronic pain.” Acupuncture is making the move from “alternative medicine” and more insurance companies are offering coverage as studies have shown its benefit in treating chronic pain.

The potential benefits of an interdisciplinary rehabilitation program far outweigh the risks involved. In addition, chronic opioid use carries much higher risks including opioid-induced constipation, respiratory depression, developing a tolerance to the medication, and physical dependence/addiction. Our motto is “Get better faster, stay better longer” and we truly believe in this. With our multidisciplinary approach, we are able to tailor a program that will fit the specific needs of the individual patient and not the masses.Before you consider opioids for chronic pain, we urge you to try alternative methods of pain management here at Performance Spine and Sports Medicine.

1. American Physical Therapy Association. Avoid Addictive Opioids. Choose Physical Therapy for Safe Pain Management. #ChoosePT. Available from URL:
2. Centers for Disease Control and Prevention. Increases in Drug and Opioid Overdose Deaths — United States, 2000–2014 MMWR 2015; 64;1-5.
3. Centers for Disease Control and Prevention. Morbidity and Mortality Weekly Report. Available from URL:
4. Chang H, Daubresse M, Kruszewski S, et al. Prevalence and treatment of pain in emergency departments in the United States, 2000 – 2010. Amer J of Emergency Med 2014; 32(5): 421-31.
5. Daubresse M, Chang H, Yu Y, Viswanathan S, et al. Ambulatory diagnosis and treatment of nonmalignant pain in the United States, 2000 – 2010. Medical Care 2013; 51(10): 870-878.
6. CDC. Wide-ranging online data for epidemiologic research (WONDER). Atlanta, GA: CDC, National Center for Health Statistics; 2016. Available at

Posture and TMJ

By PPSM Staff

Are you suffering from Upper Cross Syndrome or TMJ Disorder and you can’t find any relief? Look no further. Performance Spine and Sports Medicine will use an integrated approach to help treat your pain so you can live your life pain free, drug free, and surgery free.

From a physical therapist’s perspective, we can evaluate the source of the TMJ pain whether it is a postural, muscular or disc issue or a combination of these. All of these sources can be addressed with a physical therapy program, and each program is individualized to the patient. Any muscular issues would be addressed with hands on manual treatment including trigger point release and jaw mobilizations. Tightness in neck musculature may also contribute to TMJ pain so this area would also be addressed if needed. Another component of TMJ therapy is neuro reeducation of the jaw muscles to improve control of jaw opening and closing. This comes with a home exercise program for patients to work on throughout the day in order to make long term changes. Lastly, we address the postural issues that often accompany TMJ pain. Treatment for postural reeducation includes ergonomic assessments, kinesiotaping, postural muscle strengthening and core work.

Chiropractic can also be a very effective nonsurgical treatment for temporomandibular joint dysfunction. The chiropractor recognizes the relationship between the spine, jaw, skull and nervous system. Evaluation and correction of structural misalignment as well as addressing the myofascial trigger points in these areas leads to better temporomandibular joint function as well as pain relief. Gentle spinal adjustments are performed to the cervical and thoracic spine to improve segmental movement and alignment. Myofascial trigger point release technique is used in the jaw, skull and spine to relieve muscle tension.

Our medical doctors would take this approach after dental issues are ruled out and the patient has exhausted other options including rehab, manipulation, stretching techniques or using a mouth guard. The medical doctor will almost always get an MRI first and then they would then do a workup including ultrasound. Usually TMJ could be one of two types of problems, a nerve problem or a joint problem. If it is a nerve issue, the doctor could use injections from cortisone to Botox and/ or try acupuncture. If it is an unstable joint, the use of regenerative injections like prolotherapy or PRP to stem cells with ultrasound guidance can be used.

Here at PSSM we have the tools to help you break this pattern. We can help you eliminate the negative compensatory factors, teach you proper functional cues to improve the condition, teach proper ergonomics for activities of daily living that are contributing to the condition, rehabilitate the weak musculature in order to stabilize you from a postural standpoint, and reestablish your body’s optimal functional capacity in the correction of these conditions.Let Performance Spine and Sports Medicine help you get better faster and stay better longer!

Rotator Cuff: Solutions for Shoulder Pain

By Mahmud Ibrahim

Whether there is a chill in the air or summer is heating up, seasonal activities can lead to shoulder pain and rotator cuff injuries. Dr. Mahmud Ibrahim with Performance Spine and Sports Medicine of Lawrenceville said that shoulder injuries are a common complaint heard year-round.   “In the winter the cold usually flares up arthritis. Shoveling heavy snow can also aggravate shoulder pain,” said Ibrahim. He said that slips and falls are also a consideration in the winter months, as slips and falls can lead to rotator cuff tears, dislocations or even fractures. In the spring and summer shoulder pain is more likely to be caused by sports. “Many patients haven’t thrown a ball in months and think they can just go out and throw a baseball for an hour without warming up first,” said Ibrahim. One simple solution is to warm up and take it slow the first few days out.

Shoulder pain can be something more than an overuse injury, according to Ibrahim, and there are warning signs. It may seem obvious, but the first sign of trouble is excruciating pain. If the pain is unbearable it’s best to get checked by a medical professional immediately. Other symptoms that may indicate a serious problem are pain that interferes with activities of daily life, or pain that does not improve with two to four weeks of rest, ice and anti-inflammatory medication.

If the pain does not fall into any of the above categories Ibrahim recommends some home exercises to try. One of the exercises is meant to massage the back of the shoulder, called the posterior cuff. It is done by the patient using a lacrosse ball wedged between their back and the wall. It is done by crossing the arms over the chest, and placing the ball on the back of the shoulder then moving up and down to roll the ball around on the back.

Another home exercise requiring no special equipment is called scaption. To do this exercise, stand with both arms out, elbows at a 45 degree angle with thumbs up. Once in position, tighten the abdominal core muscles and slowly lower arms down and then back up to shoulder level. The thumb remains up the whole time.
Ibrahim’s goal is to try and restore function using the most conservative therapy available. His methods are exercise and healthy living to combat problems before they start. Non-invasive techniques like ultrasound technology to diagnose and treat many common tendon, ligament and nerve problems are also employed.

Soda is a Four Letter Word

By Matthias H. Wiederholz

America has an obesity problem.  And it seems the rest of the developed world is following suit.  A question that many people wonder is whether soda consumption increases the likelihood of weight gain. The short answer is YES.

Soft drink consumption has increased globally from 9.5 gallons per person per year in 1997 to 11.4 gallons per person per year in 2010.  Simply a 1% rise in simoft drink consumption contributes to an additional 4.8% overweight adults, 2.3% obese adults, and 0.3% adults with diabetes.1  If this trend of increased consumption of caloric beverages continues, it is clear that these rates will rise drastically.

There is an alarming statistic. Consumption of sugar sweetened beverages (SSB) in the United States is increasing.2,3  About half of mothers with children age 2 reported that their children drank SSB’s at least one day per week.  Moreover, there is a much higher likelihood that children who drink the highest amount of SSB come from low-income families.  These families are the same families that likely have limited access to quality healthcare.

So what does this mean for society in general?  Well, SSB consumption is increasing and the obesity epidemic is worsening.  Insulin resistance is becoming commonplace.  Based on the studies outlined above, we can conclude that soda consumption is certainly contributing to this problem.  In fact, as mentioned earlier, soda consumption predicts weight gain.

Therefore, if you don’t want to gain weight, don’t drink soda!

don’t drink soda


  1. Basu S, et al. Relationship of Soft Drink Consumption to Global Overweight, Obesity, and Diabetes: a Cross-National Analysis of 75 Countries. American Journal of Public Health. Nov 2013; Vol 103, No. 11: pp. 2071-2077.

PSSM sponsors Shady Brook Farm’s *Holiday Light Show*, a Bucks County tradition

By PPSM Staff

PSSM has partnered up with Shady Brook Farm as a Top Sponsor for their annual Holiday Light Show, Bucks County’s most anticipated community event of the year!

annual Holiday Light Show

Experience the magic of millions of lights illuminating acres of farmland at the Shady Brook Farm 2013 Holiday Light Show!”

This event makes a wonderful holiday tradition for families and friends. There are incredible new displays this year, including the ‘Seven Wonders of the World’….and our very own PSSM customized light display!!

Our PSSM light display is located upfront by the ticket booth entrance. You can’t miss it, at 18′ high by 60′ wide – also seen from highway I-95! We couldn’t be more thrilled of our awesome display and, of course, our partnership with Shady Brook Farm!

Our display design pays homage to a keyword at PSSM; Performance. Its aesthetic correlates to our 3 significant graphic rings shown on the PSSM logo – our performance rings of service & achievement, acknowledging the state-of-the-art non-surgical multidisciplinary platform we offer. Our logo is lit with the animation of a flaming torch, representing PSSM’s promise to serve, treat & help heal our patients. “Our Patients Results are our Goals”.

New Sponsors of the Holiday Light Show

Here is an excerpt from the Bucks County Courier Times special edition Holiday Guide, handed to all who attend the light show:  New Sponsors of the Holiday Light Show, by correspondent Sandi Pachuta:

Percy Naranjo, Chief Executive Officer of Performance Spine & Sports Medicine, said he is excited that his medical practice is a new light display sponsor for Shady Brook Farm this year.  Naranjo’s practice is one block down the road from the farm, and he is pleased they are neighbors.  “We are in step with Shady Brook and how they interact with the community,” said Naranjo.

“We are so glad Shady Brook is having us as a sponsor for the community-oriented event of the light show; Shady Brook Farm provides a great environment for the family all year long,” said Naranjo.

Naranjo has been taking his children, now ages 5 and 7 years, to the light show ever since they were babies. “The light show is awesome, and we have been attending the show ever since we moved to the area six years ago,” said Naranjo. 

Performance Spine & Sports Medicine ( is slated to open its third location in Bordentown, NJ, in December.  The practice began in 2009 in Lawrenceville NJ, followed by the Newtown location in 2011.”

After visiting the light display show, we encourage everyone to enjoy all that the farm has to offer, including the market for their selection of nutritious fruits and nuts for added holiday health!  PSSM brochures are available all year long in the Farm Market and Garden Center, also handed out together with the Holiday Guide on special evenings during the light show event.  Spread the word; PSSM is at your service.

The Holiday Light Show is on display now through January 5, 2014 from dusk to 10PM.  Visit for prices.

Shady Brook Farm is celebrating 100 years in business and we couldn’t be more proud to be associated with this farm’s iconic heritage, commitment and service to Bucks County.  Enjoy some holiday light show magic ~ Doctors orders.  😉

Happy Holidays from PSSM!

Boost Your Energy Levels For a Healthy Holiday!

By PPSM Staff

Boost Your Energy

Give Yourself the Gift of HEALTH this Holiday:  Knock-Out Stress  &  Get Energized!

The Holiday Season is in full force!  Parties & shopping make this the most exciting time of the year. But all of this entertaining, eating out & overcommitting can cause stress.  Fitness maintenance often times is placed on hold & energy is quickly consumed.

Resolve to make this holiday season your healthiest yet, with more energy & vitality! Learn how you can come through the next few weeks looking & feeling your best.

PSSM is a proud partner of Gold’s Gym “Extra, Extra” Wellness Series ~ designed just for you.  Join us for this FREE lecture:

THURSDAY  •  DECEMBER 12  •  6PM  •  Gold’s Gym Lawrenceville, Mind & Body Room

Learn ALL About How to BOOST Your Energy Levels:

• Get healthy advice for energy all day long!
• Learn about the benefits of physical activity than can power-boost your mind & body.
• Get tips on active lifestyle, exercise recommendations & nutrition.  Plus more!  

Get expert advice from Physical Therapist Krista Rubini, DPT.  

Krista Rubini, DPT

Everyone can benefit from this insightful lecture.

All are welcome!   Q&A to follow.

See you  next Thursday!

* Happy, Healthy Holidays from PSSM *