Thursday, March 19, 2020

COVID-19: we are open for Telemedicine!

The fine doctors at Lake Washington Sports & Spine are open for telemedicine as of 3/17/2020

We want to be a valuable resource to help patients as they navigate issues related to their musculoskeletal health during this trying time

We can be reached at  (425) 818-0558

Thursday, December 6, 2018

Friday Faves: Office

• Varidesk turns any table or desk into a standing workstation! We've had them for years and our staff loves them

• Ergonomic mice can take some getting used to, so try a few and choose your personal best

• Swopper stool helps engage core muscles with 3 dimensions of movement.

• Topo mat for standing desks helps encourage position changes while standing

Tuesday, March 20, 2018

6 Tips for Staying Fit on Vacation

Spring Break is just around the corner, which means traveling and spending time outside the normal routine.  So, how do you enjoy yourself without sabotaging your diet and fitness progress?  Here are some tips to relax, unwind, and stay fit!

1. Pack accordingly

Before you leave for your trip, make sure to pack exercise essentials like workout clothing, running shoes, resistance bands, a jump rope, and headphones.

2. Utilize wait times for movement

Flying to your vacation destination guarantees you will spend hours sitting on the plane (sedentary).  Why not utilize your time at the airport to burn some calories?  Walk, plank, lunge, & squat!
Dr. Hyman planking during a flight delay @ SeaTac

3. Schedule time to workout (with your travel companions)

A week or more of unhealthy diet choices and no workouts will make it feel impossible to get back on track once you return home.  The simplest way to make sure workouts happen is to prioritize them at the start of the day (even before breakfast).  30 minutes of increased heart rate and sweat will do the trick!    
Nashville vacation marathon training.  Great way to see the city!

4. Hit the hotel gym

If you know your day ahead will not allow for exercise, wake up 30 minutes earlier and visit the hotel gym.  Do it bright and early so you don't have time to make excuses (like too tired, too full, etc).
Dr. Chimes and baby Jim staying active!

4. No gym?  No problem!
There is legitimately NO EXCUSE not to workout; all you need to stay fit is your own body weight.  Try 3 sets of the exercises below, or check out Youtube for some other great options.

15 Triceps dips
15 Lunges
12 Burpees
10 Push-ups
1 Minute plank
15 Jump squats
40 bicycle crunches
Pre-breakfast sweat sesh in Cabo

5. Walk or bike, don't drive or taxi!

Walking and biking are win-wins: physical activity and sightseeing.  See your destination by foot or 2 wheels to burn extra calories and mindfully experience your surroundings. 
I insisted my friend and I walk the 4 miles uphill on a country
road to San Gimignano.  We earned our pasta for sure!

6. Chose your indulgences wisely & sparingly

It's easy to fall into the "I'm on vacation, I deserve this!" mentality when it comes to eating.  Unfortunately, your body doesn't take a holiday from storing unused calories as fat.  Pick a portion of one meal a day for your treat.  For example, if you need to have those fries, balance the meal with grilled fish or chicken and a large salad.  Need that dessert?  Make sure you eat a veggie-loaded entree and pass on the alcohol.  Another tip- follow an unhealthy meal with a healthy one.  It's all about balance.
Fish tacos from 1&Only Taco in Cabo San Lucas

Monday, March 12, 2018

LWSS Does Hot Yoga!

LWSS Does Hot Yoga!

In the next iteration to better understand the exercise preferences of our patients and exercise-specific injuries, the LWSS team decided to try out hot yoga! (Prior to trying out hot yoga, we tried out Barre3). 

Like Barre3, most of us were new to hot yoga too.

Prior to class:
-Different yoga studios heat their rooms at different temperatures. We recommend having your first class in a “warm” room, 80-90F degrees. We attended class at Shakti East Vinyasa Yoga in Bellevue which was an excellent temperature for an intro class. 

-Hydrate well, starting the day prior to class. 

-Bring a yoga mat and large towel to class (or rent from the studio).

-Arrive ~20mins early to class to register, set up your mat, and acclimate to the room prior to starting class!

What to expect:
-Yoga is often thought of as a moving meditation. Rooms are quiet and the emphasis is focusing on the breath and pose. 

-Keep breathing…

-Instructors will cue you and being in the back of the room will help you understand how to move through the poses. 

-Keep breathing...the breath is the first priority but hard to master.

Final thoughts:
Hot yoga is a great way to get the therapeutic benefits of a moving meditation while increasing your heart rate. There are different types of hot yoga; hatha is a gentle introduction to postures, vinyasa focuses on the flow between postures, power is designed to be more intense than vinyasa, and Bikram is a series of 26 postures that are distinct from each other and arguably the most challenging. We enjoyed the vinyasa class at Shakti, but can also recommend the more demanding/hotter classes at Hot Yoga Inc., and Ashram Yoga Bellevue (Bikram style) in the downtown Bellevue area.

Friday, February 23, 2018

Physical therapy…What’s the Point? Q & A on PT with Dr. Hyman

1.  What’s the goal of physical therapy (PT)?

The primary goal of physical therapy is to optimize your body mechanics, so that you may return to sport or chosen physical activity.

While pain relief is not the primary purpose of physical therapy, most often the pain goes away and stays away when body mechanics issues are corrected.

Ideally, all persons with a sports or back injury should see a physical therapist first, before seeing a medical doctor.  The majority of the time, physical therapists will lead you successfully back to full function without a hitch.  In some cases, problems persist despite physical therapy, and then ideally your physical therapist will refer you to a musculoskeletal specialist medical doctor.  I like to use a 4 visit threshold — you should see improvement in PT within 4 visits, and if not, then seeing a specialist doctor is appropriate.  Why not first see your primary care physician?  Well, in most cases your primary care physician will rely on a physical therapist to evaluate and treat an injury.  So if you’ve already been responsible enough to participate in PT, then you’re ready for specialty care with a sports medicine physician.

2.  What should you expect from a PT visit?  

Expect to arrive 10-15 mins early, dressed for exercise.  The sessions usually last 45-60 minutes.  During the initial assessment the physical therapist will get to know you and your problem by taking a history and performing an extensive physical examination. Each follow up session typically involves some period of reassessment (i.e. talking about how you’ve been doing since last session), a physical examination to check biomechanics, sometimes an intervention (i.e. hands on treatment that might feel like massage, stretching, or joint manipulation), and then additional exercise instruction.

We expect you to attend physical therapy sessions once or twice per week for several weeks before we follow up together.  Typically within 4 visits a person will notice some improvement.  The overall duration of physical therapy depends on several factors including the complexity of a condition and its chronicity.

3.  Why spend the time and resources to participate in PT?  Why don’t you just hand me a printed exercise handout?

A physical therapist is a medical exercise specialist, and they are able to design a customized exercise program to help you achieve your particular exercise goals. Each person’s body mechanics are different.  It is the physical therapist’s expertise to understand what normal flexibility and strength looks like.  Every person has areas of inflexibility and areas that are weaker than what is optimal.  Often making tailored corrections to your flexibility or weak areas will make all the difference and allow you to return to full function.

Exercise handouts are designed to treat the “average” person in a general sort of way.  Perhaps up to 50% of the time this approach works.  However, we take your recovery seriously, and we prefer better odds.   With physical therapy intervention for most conditions, the likelihood of improvement goes up to 75-85% in our experience.

Sometimes I’m asked why I can’t just teach the exercises at our office visit.  The simple answer is that I’m not a specialist in teaching people how to properly exercise.  Additionally, most physical therapists understand how to assess biomechanics on a more sophisticated level than most specialist physicians.  So they can both assess complex biomechanical issues, and they are experts in creating an exercise plan to correct those issues.  Just to overemphasize, when I have an injury or issue, I personally go to see a physical therapist because I won’t appreciate my weak spots nearly as well as a physical therapist.

Thursday, February 15, 2018

Dr. Hyman, what are steroids and why do we use them?

Debunking Steroid Myths
Most people associate steroids with bodybuilding or injections, but steroids are also naturally occurring meaning that the body can make its own steroids. Steroids that are administered from outside the body, often in the clinical setting, are called “exogenous” steroids. 

The most commonly thought of steroid is “cortisone.” People will use the term “cortisone” interchangeably with steroid. 

So, what are steroids, really?
Steroids are hormones. Hormones are chemicals that signal cells to perform an action at the tissue level. In this case, steroids might signal nerve cells to calm pain signals and are also the most potent anti-inflammatory drug, meaning it will stop a cell from releasing other chemicals that promote inflammation. In our clinic, we use steroids to independently relieve pain by calming the nerve signals that carry pain signals and to suppress inflammation. 

We traditionally use steroids almost anywhere and everywhere—it has been a ubiquitous drug, either given by mouth or injected. Typically, we are using injectable steroids in our practice. Why? Because we have the ability to figure out the specific tissue that is the source of pain and thereby can target that tissue with the injected steroid. If you take steroids by mouth, it goes through the entire system and has a larger chance of affecting cells in your whole body, potentially causing a variety of side effects.

What are the potential side effects of injected and systemic steroids?
Some of the most common and usually temporary steroid side effects are insomnia, mood swings, flu-like symptoms, weight gain, increase in blood sugar, abnormal menses, and palpitations. A reduction in bone density is one longer-term adverse effect of exogenous steroids. Again, steroids are hormones and hormones can have both tissue level and systemic effects. For example, melatonin is a hormone that helps our body sleep and melatonin can be influenced by steroids, thereby creating the side effect of insomnia. Steroids can disrupt all other hormone pathways. While not always true, injected steroid may minimize those systemic side effects. 

And the truthfully, there are probably still some systemic effects of steroids because we have these little blood vessels nearby injured tissues that take up the injectable steroid. So there may be some systemic effects even when injected, potentially. 

Additionally, there is some evidence to suggest that injectable steroids can be damaging to tissue; steroid injections into the knee can degrade the cartilage more quickly and steroid injections may also increase the chance of rupture in some tendons. 

What can steroids help with?
It is important to note the risks of steroids and ensure appropriate use. When steroids are used in a targeted and appropriate manner, they can be a wonder drug; decreasing swelling, reducing pain, and restoring mobility. Typical uses for steroid include: swelling in a soft tissue, bursitis, adhesive capsulitis (frozen shoulder), and epidural injections into the spine. Steroid injections into these areas carry relatively low risk with great potential improvement for carefully selected patients. 


I’ve been prescribed Prednisone (oral steroids) in the past and it helped. Why not try that?
Again, there is a greater side effect profile with oral steroids because they are distributed throughout the body. The benefits of an oral steroid may also be more transient and may not be prescribed at a high enough dose to be effective. 

How often can I have a steroid injected?
Short answer: it depends on the body part. In weight-bearing joints—like the ankle, knee, and hip—we try to be stingy with steroid and maybe not use it at all. Steroid injections in these joints may last only a few weeks and there is evidence that steroid can increase the rate of cartilage loss in the knee. In contrast, epidural steroid injections into the spine may be given liberally as a tool to prevent surgery and promote an active recovery. Insurance only pays for surgery and steroids for most musculoskeletal and spine pain whereas other treatments may be a better option. Other therapies like prolotherapy, PRP (platelet rich plasma), stem cells, and viscosupplementation are not covered by insurance but may be the better option.