#61: Virtaj Singh, MD

Physiatry Treatments for the Hypermobile Body

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Description

Dr Virtaj Singh, MD, gives us the physical medicine and rehabilitation perspective of the hypermobile body. We start out talking about how 'hypermobility' presents, starting with the various joints that can get hypermobile (spoiler alert: it's all of them). He explains how lax ligaments may trigger muscles to tighten in order to protect a vulnerable joint which is why sometimes treatment is to loosen muscles and sometimes treatment is to tighten ligaments as a way to address a root cause of pain. We review the various stages of dysfunction including acute, subacute and chronic stages and how to look for microscopic injuries that might not be visible on imaging. Dr Singh explains looking for the what, the how and the why- the cause- of pain and dysfunction versus just trying to dull pain with opiates. He walks through a broad range of treatment options top to bottom- medications (anti-inflammatories vs muscle relaxants vs tricyclic antidepressants like amitriptyline/nortriptyline, low dose naltrexone, opiates), physical and occupational therapies, steroid injections, prolotherapy (injections to tighten ligaments as some say 'scar it down'), IMS (Intramuscular Stimulation which is sort of like 'if acupuncture and massage therapy had a baby'), trigger point injections, PRP (platelet rich plasma), stem cell injections into joint spaces, and surgery (fusion/ fixation). We discuss CCI, craniocervical instability, as one possible trigger for many of the global symptoms of neuroinflammation and that it's a very dangerous area from an interventionalist standpoint; Dr Singh refers to the Centeno-Schultz Clinic in Colorado for injection treatments Sprinkled throughout are tips and pearls for understanding the different joints and their role in supporting your full body. Dr Singh walks through various conditions, placing imaging studies like MRI in their proper context- not as diagnostics, but as supports for the physical evaluation of the patient. We finish with a discussion about fixation & fusion surgeries and then recap what is hypermobility and how to think about it when trying to address pain. Jump on board- this is a thorough discussion about physical treatments for the hypermobile body that you don't want to miss.

Bio

As a physiatrist, Dr. Singh has extensive training in electrodiagnostic medicine and is fellowship-trained in the use of fluoroscopically-guided spinal injections for cervical and lumbar disorders, ultrasound-guided injections for the treatment of peripheral joint disorders, intramuscular stimulation (dry needling), trigger point injections, prolotherapy and PRP (platelet rich plasma) injections.

Dr. Singh earned his medical degree from Baylor College of Medicine and completed his residency in Physical Medicine and Rehabilitation at the University of Washington. Following residency he completed a fellowship in Pain Medicine at the University of Washington.

Dr. Singh is committed to providing compassionate care for patients with a wide range of ailments, using a comprehensive approach to diagnosis and treatment. Dr. Singh works with several types of practitioners during the treatment process, including occupational, massage, and physical therapists; chiropractors; surgeons; primary care providers and vocational and case management services. Dr. Singh also performs many treatments himself including spinal and peripheral joint injections. Overall, he believes in using the most conservative and least invasive care possible to help restore his patients to their optimum level of functioning.

Outside of work, Dr. Singh most enjoys spending time with his loved ones and avidly participating in a variety of recreational sports including football, basketball, softball, volleyball, golf, bowling, and even kickball. He very proudly boasts that he is a 3-time kickball champion (hopefully soon to be a 4-time champion) and is more than willing to recount any stories of his past kickball success and glory.