Physio Logic Spine & Sports Medicine is lead by Dr. Tanuj Palvia, our Pain Managment Specialist and Anesthesiologist. Interventional Medicine emphasizes the prevention, diagnosis, and treatment of sports-related injuries and musculoskeletal conditions.
Our physicians at Physio Logic are nerve, muscle and bone experts who specialize in conditions affecting how you move. The role of the Interventional Medicine team at Physio Logic is to diagnose and treat pain, restore maximum function lost through injury or disabling conditions, treat the whole person, not just the problem area, collaborate with other medical professionals, provide non-surgical treatments for pain management, and explain your medical problems and treatment plan.
Our physicians take the time needed to accurately pinpoint the source of an injury through various diagnostic tests. By providing an appropriate comprehensive treatment plan, our physical medicine team helps patients stay as active as possible at any age. Their broad medical expertise allows them to treat disabling injuries and conditions throughout a person’s lifetime.
Dr. Tanuj Palvia, MD
Board Certified in Pain Management & Anesthesiology
Trigger Points are fibrous bands or “knots” of scar tissue that are felt over a muscle. When the layer of tissue overlying our muscles called the myofascia becomes injured or over used, the resulting scar tissue can be painful and refer pain to nearby areas of the body. An effective way to treat these trigger points is by receiving either ultrasound guided or unguided injections of simple sterile saline and a local anesthetic into the trigger point in order to break up the adhesion’s and relive the pain.
Epidural Steroid Injections are an effective method in treating pain caused by herniated or degenerated discs of the spine. When a disc becomes herniated it compresses the neighboring nerve, causing it to become inflamed. These nerves branch out and downward all the way to the toes and pain can be felt in the back, legs, and even the feet. During an Epidural Injection, fluoroscopy is used to precisely place the needle into the epidural space, which lies beyond the vertebrae, and deliver the medication. The medicine relieves the pressure on the nerves caused by the encroachment of the disc by reducing their inflammation.
Facet Joints are small joints all along either side of the spine that allow for the gliding of the individual bones during movement. Like all joints, facets are encapsulated. When the joint becomes damaged or irritated the capsule becomes inflamed, causing pain. Sometimes, this inflammatory process reaches the surrounding nerves. Facet Joint Injections are done under fluoroscopic guidance, administering anti-inflammatory medicine to help relieve the cause of pain. When the nerve is involved, the same methods of treating the fact joint can also treat its medial nerve.
The Sacroiliac Joints connect the sacrum and the hips. These joints act as a shock absorber and damage or dysfunction of the sacroiliac joints can mimic the pain caused by sciatic nerve injury or a herniated lumbar disc, which is why it is important to determine the true source of pain. These injections can be either diagnostic or therapeutic. An injection to the sacroiliac joint is done under fluoroscopic guidance, delivering anti-inflammatory medicine to the joint space to reduce the pain.
Joints are necessary for several functions of the musculoskeletal anatomy including smooth motion and shock absorption. There are multitudes of ways in which a joint can become injured or damaged, but if there is an injury, a joint injection can provide both short and longer term pain relief. Joint injections are given under either ultrasound imaging guidance or fluoroscopic guidance, depending on the location and size of the joint. Joint injections can treat acute or chronic inflammation in large joints like hips, shoulders and knees as well as intermediate and small joints like elbows, ankles, wrists and even the tiny joints of the fingers and toes.
The signal of pain that a nerve sends to the brain can be interrupted using anesthetics. Nerve blocks can be performed to manage acute pain of the extremities or headaches caused by occipital nerves as well as for diagnostic purposes such as a selective nerve root block, which can help determine a specific cause of pain in the spine. Nerve blocks are performed under ultrasound imaging guidance.
Radiofrequency Ablation is a procedure in which, under fluoroscopic guidance, a needle is placed near the targeted nerve and an electrode is passed through to stimulate the nerve. Once the targeted nerve is identified, a small current of radiofrequency is administered, which heats the nerve effectively disrupting its conduction. With the activity of the treated nerve now interrupted, the signal of pain is not produced. RFA can provide longer lasting relief when other more conservative methods have failed.
Spinal Cord Stimulation involves the implantation of a tiny, programmable generator, which is placed under the skin and emits electrical currents to the spinal column. Soft, thin wires with electrical leads on their tips are placed through a needle in the back near the spinal column under fluoroscopic guidance. In Spinal Cord Stimulation, the generator will then be programmed by the physician and adjusted as necessary to provide optimal pain relief. Patients will learn how to control the stimulation on their own and adjust it to their pain levels.
The major joints of the body (Hip, Shoulder, Knee) can become damaged, more specifically, the cartilage that overlies the bone. This is called osteoarthritis and can be caused by normal wear and tear, sports injuries or significant over use. The cartilage can begin to erode not only causing pain and inflammation but also compromising the health of the entire joint. One way to avoid surgical replacement of the joint is to try and maintain the health of the osteoarthritic joint with visco-supplemenation. A viscous material, usually hyaluronic acid, mimics the material found naturally inside the joint and helps to coat the cartilage. This allows the cartilage to glide more smoothly in instances where its surface is rough because of erosion.
|“Dr. Palvia was instrumental in helping me lower the inflammation in my knee with cortisone shots. The injections were quick and painless. I have a significant amount of arthritis built up around my knee. The team at Physio Logic have successfully gotten my body to a point where I don’t feel nearly as much irritation as I used to. I feel so much better these last 6 months than I have in the last 2 years of my life.”
|“Almost a week after getting the PRP injection, there was a noticeable decrease of pain. I felt much more comfortable doing certain exercises that gave me trouble in the past… I feel confident that the PRP treatment will continue to help my body heal and look forward to seeing my progress all the way through.”
|“I decided to give platelet rich plasma (PRP) therapy a try and after a week or so I felt great. The pain went away and I felt so much more mobile.”
|“For many years I have been suffering from the pain in my knees due to osteoarthritis. The sports medicine specialist at Physio Logic was the only doctor that recommended Platelet Rich Plasma (PRP) Therapy to me. Going up and down stairs proved to be difficult because of the pain in my knees. Walking fast was also an issue. I limped around a lot. It’s gotten much better now with Physio Logic’s help. I’m optimistic about the PRP treatment results.”
When you come for your visit you should bring all the medications you are currently taking in their original bottles or an accurate, updated list. Bring all your medical records with you. Bring the films or CDs of any X-rays, MRIs or CT scans that you have had recently.
Wear comfortable clothes and leave unnecessary valuables at home.The medical assistant will bring you back to an exam room, review your history and verify your current medications.
Your physician will evaluate you and perform a physical exam. If a treatment is indicated, your physician will discuss the steps involved in the procedure, the expected outcomes and potential risks and then answer any remaining questions you have. You will be required to provide consent to permit your physician to do the procedure.
For most procedures, you will then be taken into the procedure room and positioned on a procedure table.
We make every effort to make you comfortable during the entire process. After completion of the procedure, you will be monitored for any side effects. You will be given follow-up instructions during the discharge process.
After your discussion and exam, the doctor will review with you potential treatment options that are safe and efficacious during pregnancy.
Although most procedures take five to fifteen minutes, you may remain at our facility for a longer period of time because of admission, evaluation, procedure, recovery, and discharge time.
The vast majority of our patients indicate that the procedures are relatively painless. Most procedures are performed with a local anesthetic, which usually reduces the discomfort of the procedure.
Anxiety regarding injection procedures is not uncommon, especially when you don’t know what to expect. Most injections are very fast, and are for the most part, painless. You should discuss your anxiety with your physician when you are evaluated here. More than 98 percent of our patients do not need sedation and we discourage sedation in our pain practice. Your safety is our number one priority. It is important that we can directly communicate with you at all times during the procedure.
Take all of your usual medications for other health conditions. The ONLY exception would be blood thinners, such as Plavix®, Pletal®, Coumadin®, Lovenox® and similar medications that “thin” the blood. Please let us know if you are taking Aspirin, Ibuprofen, Aleve® or other anti-inflammatory medications. Supplements like Vitamin E or fish oil may not be allowed before some injections. If you are taking a blood thinner, please inform our office and nurse at your first visit. With your physician’s approval, you will need to stop taking your blood thinner medication three to five days prior to your procedure.
If you’ve had an epidural steroid injection, you should have a relaxing remainder of the day. You should limit your activities to your home. We do not recommend that you go back to work or do any major physical activity or air travel that day.
If you’ve had medial branch nerve blocks, facet joint injections or sacroiliac joint injections, you should do things that would normally aggravate your pain in order to test the effectiveness of the block.
For example, if you’ve had lumbar medial branch blocks for your lower back and you normally wouldn’t be able to touch your toes or mow the lawn, you should try to do those things over the six to eight hours after your medial branch nerve blocks. This “test” of your pain will let our physician know whether or not the procedure was successful.
You may need to take off of work after your procedure. We can provide a physician’s note for the day of the procedure at your request. We are NOT able to provide a “work excuse” for any day other than the day of your procedure.