Dr. Bernard Portner is considered by many of his peers to be a pioneer in the field of non-surgical orthopedics — and his recent endeavors show he’s not slowing down any time soon. Dr. Portner’s current work-in-progress is a handbook of “Geriatric Orthopedics,” a term he may have coined.

He pulls from his 35+ years as a clinical physiatrist subspecializing in medical orthopedics to present a series of guidelines for other medical professionals. His goal is to help the medical community, specifically those involved in geriatric care, understand the basic soft tissue diagnosis as well as the effective, safe and non-surgical treatment options available. The new book targets a wide medical audience, including geriatrists, internists, family practitioners, generalists and nurse practitioners working with the geriatric population.

Dr. Portner states that his idea for the handbook came from a desire to help end unnecessary suffering of elderly patients with musculoskeletal disorders. After seeing so many elderly patients misdiagnosed and mistreated, he realized a lot of the problem is a lack of information about an age group with distinctive needs, and an area of medicine (non-surgical orthopedics) not emphasized in medical training.

Dr. Portner had this to say about his decision to write the book:

“As I knew that there was much suffering ahead for these patients that was perhaps unavoidable, my frustrations were enhanced by those that did not need to suffer but were doing so for lack of better care. To help improve this situation, I have decided to write this handbook to assist the physician in diagnosing and effectively and expeditiously treating the most common presenting orthopedic complaints of the elderly patient.”

The handbook follows a logical progression, beginning with a thorough look at the physical exam, an evaluation of various common pain complaints (hip, knee, sciatica, foot, lower back pain, etc.), followed by careful analysis of specific orthopedic solutions and their effectiveness in treating the lesion, including therapeutic exercise.

Here’s an excerpt from his current draft:

“The great majority of these conditions can be readily diagnosed simply with a careful history and skilled orthopedic exam. The art of history taking and the meticulous physical exam is increasingly being lost in today’s medical student and resident training programs… I will first outline important principles of both orthopedic medicine and rehabilitation medicine that are important to understand in this endeavor. Next I will present hypothetical cases and go through the important historical and physical findings for each of these common conditions, and suggest reasonable treatments for each of these.”

He adds helpful bonus content, such as “Orthopedic Manifestation of Internal Disorders” and “Non-orthopedic Manifestations of Orthopedic Conditions,” along with an intriguing final section called “Beware the Dogma,” which addresses “a few of the common misconceptions, conventional non-wisdom and dogmatic foolishness that plague this area of medicine.”

Dr. Portner will speak to Hui o Kilauea at the Kilauea District Park on Feb. 21^st regarding the topic of Geriatric Orthopedics. Check The Moving Body Blog in February for our next piece on the topic entitled: “Red Flags for Geriatric Patients: How to Get the Most from your Orthopedic Visit”

To learn more about Portner Orthopedic Rehabilitation and keep up with current news, please “Like” our Facebook page and follow us on Twitter (@PortnerClinic).

—Lindsey Kesel, Orthopedic Consultant

Tune in to “The Moving Body” Radio Show every Saturday at 7 a.m. on KHVH–AM 830. 

In 2006, Mark was prescribed Lipitor, the cholesterol lowering drug, by his primary physician. Shortly after adding it to his daily regimen, he developed intense pain in the buttocks, thighs and lower back that made even small movements difficult. After doing a little online research, Mark learned that muscle pain was a common side effect of Lipitor (although the Lipitor would later be found to be unrelated). He stopped taking the drug immediately, but the pain continued. Mark had trouble finding a comfortable sleeping position and struggled to get out of bed and in and out of the car. It hurt when he stepped off a curb, turned around, and went from standing to sitting. Even sneezing was a dreaded activity.

Mark saw several doctors in search of relief, but was met with disappointing results. He was told things like “It’s only your age,” “It’s all in your head” and “You’ll just have to learn to live with it.” The doctors suggested exercise, blaming his aging physique and arthritis. An avid fitness buff his entire life, Mark wasn’t buying it.

Trips to various other healthcare practitioners — physical therapists, chiropractors and acupuncturists — occasionally produced temporary relief, but the intense pain always returned. Mark relied on daily large doses of aspirin just to function. Unwilling to accept chronic pain, he scheduled more doctor visits in search of a real diagnosis, but was again met with the same resistance. At one point surgery was suggested, but wasn’t a risk he was willing to take. After a chiropractor suggested an MRI, Mark’s doctor talked him out of it, saying the test wouldn’t show anything. Another doctor said the same thing — that his pain was due to wear and tear, an MRI would not help and a solution simply did not exist.

Then one day, a simple trip to the sauna turned everything around. Mark talks about the conversation that changed his life:

“One of my sauna acquaintances mentioned a friend who had been helped by something called injection therapy, an orthopedic treatment where a targeted dose of medication is injected into the spine. I asked my doctor about it and lo and behold, he advised against it, said it would be a waste of time. I didn’t accept his theory. I brought up the topic with my daughter; she mentioned she had tried spinal injections after a car accident, and they worked well for her. Had I finally found a way out of living with debilitating pain? At this point I had nothing to lose.

“I saw Dr. Portner shortly after learning about this treatment. He listened to my stories of pain and considered all of my symptoms. He performed a Sacro-Iliac (SI) joint injection and within a few days, and I felt like a new man. My ‘10’ on the pain scale went down to a ‘4’ and completely disappeared most days. I could finally get a good night’s rest.”

When asked about Mark’s case, Dr. Portner couldn’t stress enough the unfortunate fact that too many doctors fail to perform a proper physical exam and don’t take time to truly listen to their patients. “It’s common for providers to put aging patients in a lump category where ‘aging’ is used as a diagnosis. It is simply unfair to write these patients off or skip steps in the diagnostic process based solely on age.” Between listening to his history and administering the injection, I performed a very methodical physical exam, testing all the structures and joints in the area to determine the precise diagnosis. An accurate diagnosis tells me where to place the needle — otherwise, it’s literally a shot in the dark. In fact, my success in helping people get pain relief is completely dependent on my physical diagnostic skills. Anyone can give a shot, but the effectiveness of the spinal injection is completely based on the doctor’s ability to pinpoint the trouble spot.”

Dr. Portner encourages geriatric patients to trust their instincts and be assertive with doctors who are giving them the run-around. “At Portner Orthopedic Rehabilitation, we believe our patients when they say something is wrong. Building relationships is a two-way street — we trust that they’ll give us the proper clues in the form of symptoms and history, and they trust that we’ll use our diagnostic knowledge to the best of our abilities to help them find a solution.”

Mark expressed immeasurable gratitude for what Dr. Portner and his team did to improve his quality of life:

“I was a wellness nut my whole life, working out all the time, and knew my body was trying to tell me something. I figured the medical profession should be able to find the problem and make it better. It was Dr. Portner who listened to my symptoms and examined my body carefully using his hands in order to find a true diagnosis. All of the trauma of living with daily pain, plus all the money and time I spent seeing doctors, could have been eliminated had I gone to someone like Dr. Portner years ago.”

For more information on geriatric orthopedics, please check back next week for Dr. Portner’s blog entitled “Red Flags for Geriatric Patients: How to Get the Most From Your Orthopedic Visit.”

—Lindsey Kesel, Orthopedic Consultant

Ask Dr. Portner your orthopedic questions directly! Tune in to “The Moving Body” Radio Show every Saturday at 7 a.m. on KHVH–AM 830 and call in for straight medical advice.

After serving five years in the Department of Orthopedics at Straub Clinic, I decided to strike off on my own and start a new practice that would fulfill my vision of how orthopedic care should be delivered.

The reasons for my decision were numerous. There were so many new programs that I wanted to initiate, but red tape and administration delays left all initiatives stalled or incomplete — frustrating to say the least. I wanted to start a clinic where patients were given access to new technology, numerous nonsurgical treatments and personalized programs right when they needed them.

Another issue during my Straub days was the high overhead that kept me limited. I knew that becoming a solo practitioner would allow me more freedom to invest in equipment and resources that could benefit patients significantly.

I was especially unhappy with scheduling, frequently put in a position to apologize to patients for appointment delays of an hour or more. This aspect, perhaps above all other reasons, reassured me that a practice like the one I envisioned was sorely needed on Oahu. A new clinic was born.

As Portner Orthopedic Rehabilitation got up and running, I spent quite a bit of time developing an effective, efficient scheduling protocol in order to ensure all appointments were kept and the days ran smoothly. I was especially selective with staff members, finding out the hard way that good people are integral to success.

When we opened our doors in 1986, I employed one secretary and worked with limited equipment, including a few exam tables, an EMG machine and a traction table. This first employee was neither organized nor a people person, so I found myself replacing her after just one month. I was a one-man show for a time, doing everything from physical exams to EMG tests, physical therapy, spinal manipulations, spinal traction, friction massage and exercise instruction. I definitely learned a lot about how to manage the many aspects of an orthopedic practice while catering to patients’ unique needs.

As business picked up and word-of-mouth referrals brought in new patients, I hired a competent secretary/office manager and a physical therapist. Soon after, I added space and an X-ray machine, but I learned to take my own X-rays and read them, which I did for several years before hiring an X-ray technician. Additional physical therapists were added, and we acquired more physical therapy space and a massage therapist.

The demand for alternative therapies grew, so I added a chiropractor and an acupuncturist. We tried out a DEXA bone scan density machine but this proved unsupportable. My physical therapy services expanded to such a great extent, at one time I had over 10 full-time physical therapists and a separate physical therapy clinic just one floor down. This clinic extension also had a “back school,” a mock apartment where patients with back pain were taught to do laundry, wash dishes, bake, vacuum, set the table and other activities. One of the first of its kind in the state, the back school offered patients empowerment through physical independence.

In the mid-90s, the clinic added radiofrequency nerve ablation, a machine that cost well over $30,000, in response to one particular patient’s needs. Since then, we’ve used the machine countless times and recently replaced it with a brand-new, far superior model. This technology has helped us treat a vast number of patients with debilitating back and neck pain.

In the beginning, when I needed to give a specific spinal injection to the patient that required Fluoroscopic X-ray control, we would use the facilities at a nearby Straub clinic, both inconvenient and inefficient. We eventually purchased our own Fluoroscopy machine to enable us to perform these procedures right in the clinic. The original machine has since been replaced twice, most recently just this past year. We were extremely excited to add the new C-arm Fluoroscopy machine, used daily to guide sophisticated spinal injections.

After about 20 years, I began a fellowship program, fulfilling a promise I made many years ago to my mentor, Dr. James Cyriax, to teach what he taught me as well as practice it. Our fellowship became very popular and to this day I still receive dozens of qualified applications to fill just one or two spaces in the program.

Just recently, I was able to open up a satellite clinic in Kaneohe with Dr. Stephen Scheper, a former Portner Orthopedic fellowship graduate. We have also added ultrasound diagnostic machines at both locations to help us better diagnose soft tissue injuries and more precisely guide our needle injections without the need for X-rays. Stay tuned to our blog, Facebook page and Twitter account (@PortnerClinic) for regular updates on new additions and clinic news.

I am extremely grateful for the amazing staff members who contribute to the success of Portner Orthopedic Rehabilitation on a daily basis and are always willing to go the extra mile for our patients. As we continue to provide multiple nonsurgical services under one roof and strive for excellence, we hope the communities of Oahu will continue to invest in us as we have invested in them. Many thanks for your support.

—Dr. Bernard Portner

Tune in to “The Moving Body” Radio Show every Saturday at 7 a.m. on KHVH–AM 830 for call-in discussions on orthopedic issues. 

Portner Orthopedic Rehabilitation has been helping Hawaii patients for 25 years, specializing in orthopedic medicine, physical medicine and rehabilitation, and pain medicine. From humble beginnings to a multiple-location practice with medical doctors, osteopathic physicians, physical therapists, acupuncturists and massage therapists, Portner Orthopedic is a trusted name that continues to provide a high standard of care for patients of all ages and issues.

A New Kind of Practice

Dr. Bernard Portner and his lone assistant opened the clinic doors in 1986 with a goal of delivering exceptional, patient-centered care. With hard work and determination, Dr. Portner took an office with a couple of exam tables, an EMG machine and a traction table, and turned it into the thriving practice it is today. The ups and downs of starting a new practice were challenging and at times comical, but with a sense of humor, a positive attitude and a supportive community, Dr. Portner was able to gradually expand the clinic into a facility that could provide comprehensive orthopedic services in a warm and friendly environment. In time, he was able to add new team members and technologies that proved to be very beneficial to his patients.

Continual Progress

Since its inception, the clinic has seen many exciting additions, like a fellowship program that has become extremely popular with aspiring medical doctors, and the new satellite clinic in Kaneohe. Over the years, Portner Orthopedic Rehabilitation has experienced ups and downs, forever evolving and moving with the changing laws and challenging medical and economic environment. The clinic is one of few comprehensive nonsurgical orthopedics clinics in the state of Hawaii that still accepts nearly all types of insurance, Medicare, and no-fault and work comp injuries, despite the ever-increasing overhead of dealing with these cases.

Attitude of Gratitude

The clinic continues to gain popularity among the citizens Hawaii, as well as tourists and other visitors. Dr. Portner is proud of the work the team has done and is grateful for the continued support: “I’ve had the pleasure of providing care not only to patients on a repeated basis over these past 25 years, but also to their children and grandchildren. Portner Orthopedic Rehabilitation hopes to continue to provide our services into the indefinite future and to expand according to our patients’ needs.”

You can read more about the amusing history of the clinic in next week’s blog, The Founding of Portner Orthopedic. To learn more about what makes Portner Orthopedic so unique, please contact our team today for a personalized evaluation. You can also check our Facebook page and Twitter account (@PortnerClinic) for regular updates on clinic news.

—Lindsey Kesel, Orthopedic Consultant

Tune in to “The Moving Body” Radio Show this Saturday January 21st at 7 a.m. on KHVH–AM 830 as we discuss shoulder pain.

Let the Buyer Beware

When medical professionals promise to fix your symptoms, keep in mind that there is no remedy for a symptom and symptom management is often temporary. An effective, permanent solution can only come after the pain source is correctly identified, a diagnosis is made and a comprehensive treatment plan is designed.

Sourcing Your Pain

Pain can be a real trickster. The brain’s pain center localizes pain signals, but the source of your pain may actually be different from where it seems to hurts. Instead of asking your doctor to make your symptoms go away, the question you should be posing is “Where is my pain coming from?”

Although the team does use diagnostic tests to help present a comprehensive picture, the most effective tool in the quest to identify and control pain is the physical evaluation. Dr. Bernard Portner and his colleagues use the hands-on examination process to figure out what the body is trying to tell you. Successful pain management can greatly improve your quality of life when performed with long-term relief in mind. This is the difference in the Portner Orthopedic style of medicine.

Relief That Fits

Many orthopedic practices will promote a new procedure or treatment, leading patients to visit the doctor seeking specific remedies. Here, the team focuses on locating the source of pain before applying personalized orthopedic treatments tailored to your body’s unique needs. Dr. Portner offers nonsurgical pain relief in many forms. From physical therapy to acupuncture and massage therapy, there are several non-invasive solutions that can promote healing and restore harmony to your bones, joints, muscles, ligaments and tendons — and get you back to the active lifestyle you enjoyed before pain took over.

To learn more about the diagnostic process and the various pain treatments available, please contact Portner Orthopedic Rehabilitation in Kaneohe and Honolulu, Hawaii. Don’t forget to check our Facebook page and Twitter account (@PortnerClinic) for regular updates on new additions and clinic news.

—Lindsey Kesel, Orthopedic Consultant

Tune in to “The Moving Body” Radio Show every Saturday at 7 a.m. on KHVH–AM 830.