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When is the right time to have a Total Knee Replacement (TKR)?

Joseph Coupal - Wednesday, July 25, 2018
Village Family Clinic - Total Knee Replacement Hackettstown, NJ

We get this question often from our patient’s, friends and relatives. Recently I read an excellent review article of a Danish Randomized Clinical Trial (RCT) by John Orchard, MD a sports physician from Australia. Here is a synopsis of his article.

100 patients eligible for TKR; randomized to 50 getting TKR, 50 to conservative care

The group was followed for 12 months, 26% (13) patients crossed over from conservative care to TKR

Both groups showed similar improvements in decreased pain and improved function at 1 year

The authors could not rule out an additional surgical placebo effect over and above the non-surgery group

TKR group had a higher complication rate do to the intervention of 16% (this was expected) vs 2% for the non-surgical group

However serious adverse medical events not directly associated to the surgery over the 12 months was 48% for the TKR group and only 12% for the conservative care group.

TKR seriously challenges a patient’s general health to warrant warning patients about the increased risk

These findings can make the decision to undergo TKR more difficult for some patients. “Does the more likely improvements in pain and function of TKR outweigh the increased serious adverse risk?”

You may want to take this aspect into account

Current fitness level: Pain is subjective but fitness and activity levels are objective.

Low levels of activity are hazardous to long term health.

If your knee pain is preventing you from walking less than 6000-7000 steps a day (can be tracked with a fitness tracker or smartphone) it may be time to consider TKR.

Medical history: Pre-existing cardiac or renal disease, history of deep vein thrombosis (DVT) that requires blood thinners for control, diabetes and a history of smoking increase the risk of serious medical complications following TKR.

Recent cortisone or arthroscopic surgery : Studies found that having either or both procedures within 3 months of TKR increased the complication rates.

Did conservative care fail or was never attempted: Person was never sent for physical therapy, education /exercise classes. Did not have a trail of Hyaluron gel injections or a trial of a joint off loading brace.

Do not make the decision based on the following:

X-ray or MRI severity of OA: X-ray can help establish the diagnosis of knee OA. However, several studies have found poor correlation between X-ray OA severity and actual levels of activity and walking tolerance. (again think physical activity level capabilities vs X-ray findings)

The patient’s age: There is a tendency for surgeons to state the best age for TKR is 60-65 years old. They are considered young enough to do well and old enough that they most likely will not a revision (second TKR), within their remaining lifetime. Although there is some fact to this statement it should not be used to encourage a patient of 60-65 to have a TKR that is not needed. Conversely allowing a 40-50 year old who is extremely debilitated an unable walk more than a several thousand steps a day not being considered for TKR.

Hopefully this synopsis helps if you are currently considering TKR. In closing TKR is a good and viable surgical procedure for the right person done at the right time. If you have medical issues you may want to consider addressing them with your doctors and medical providers to help reduce your risk levels and get the best results following TKR. Village Family Clinic offers proven conservative care such as Physical Therapy, fitting of knee Off Loading Braces, Chiropractic care, Nutritional counseling and Acupuncture . If you are having TKR we offer prehabilitation to prepare you for surgery and postoperative TKR care to help you get back to the activities and life you want to have!.

Should you have any questions regarding this information please feel free to contact us.

Bob Scanlon, PT, Cert MDT, NJ Lic # 40QA00283600

The Opioid Crisis Claims Thousands of American Lives Dr. James Fedich Discusses Healthy and Natural Alternatives to Opioids

Joseph Coupal - Thursday, July 19, 2018
Village Family Clinic - Natural Alternatives to Opioids Hackettstown, NJ

According to two recent CBS news articles and a report published by the National Institute on Drug Abuse, opioids are culpable for more than 115 U.S. deaths every day. The abuse of opioids, prescribed pain-relieving drugs, has increased dramatically and the search is on for a natural alternative to these drugs.

Ashley Welch, a CBS news writer, writes about the logistics involved in the opioid crisis in her article, “Opioid Overdoses Spike 30 Percent, Hospitals Report.” Welch writes that “Data from hospital emergency departments show a big increase in drug overdoses across the country.” The National Institute on Drug Abuse confirms this point as well as demonstrates the prevalence of general opioid abuse nationwide: “21 to 29 percent of patients prescribed opioids for chronic pain misuse them.”

Fortunately, there are alternative methods to treat pain and promote pain management that many people are unaware of. Dr. James R. Fedich, Chiropractic and director at Village Family Clinic discusses the healthy and natural forms to relieve pain and foster recovery and rehabilitation from injuries and accidents.

Fedich talks about the success he has had in relieving pain for patients suffering from a variety of injuries, accidents, or pains. “Our patients have diverse backgrounds and range in age. We treat patients that suffer from sports injuries, injuries from vehicular and falling accidents, and pains that stem from the natural wear and tear of life. Patient testimonials validate the effectiveness of the treatments we offer” such as adjustments, spinal decompression, and physical therapy.

If you are seeking an alternative method to treat pain and discomfort, call Village Family Clinic at (908) 813-8200 or visit http://wwwhackettstownfamilyclinic.com. Their team of chiropractors, physical therapists, a pain management doctor, an acupuncturist, and a nutritionist are trained to rehabilitate your body and relieve pain.

# # #

Alemany, Jacqueline. “Trump to Roll out Plan to Combat Opioids with No Clear Funding Plan.” CBS News, CBS Interactive, 18 Mar. 2018, www.cbsnews.com/news/opioid-epidemic-crisis-new-hampshire-donald-trump/.
National Institute on Drug Abuse. “Opioid Overdose Crisis.” NIDA, 6 Mar. 2018, www.drugabuse.gov/drugs-abuse/opioids/opioid-overdose-crisis.
Welch, Ashley. “Opioid Overdoses Spike 30 Percent, Hospitals Report.” CBS News, CBS Interactive, 6 Mar. 2018, www.cbsnews.com/news/opioid-overdoses-increase-across-us/.

Personal Injury

Joseph Coupal - Friday, July 13, 2018

By Dr. Tyler J. Carlock, D.C.

Village Family Clinic - Whiplash Car Accident Injury

Did you know that even a minor fender bender can cause serious injury to your spine? Whiplash is a common word but not many people know exactly what it means. Whiplash occurs when you are in a collision with a car especially being rear-ended. When the collision happens, your neck rapidly extends backwards then flexes forward in a split second, which is traumatic to the ligaments and muscles in your neck. This can be very painful and cause decreased range of motion in your cervical spine (sometimes people don’t feel any pain until the next day). In most instances, the inflammation will irritate the spinal nerves which can cause sharp pains into your shoulder or down your arm which can cause decreased muscle strength or sensory changes. This is called a “radiculopathy.” In severe cases, fractures can even occur in the bones in your neck. According to a study, whiplash at even 5 mph can cause permanent damage to your cervical spine.

Whiplash is not the only injury one can sustain from even a minor car accident, low back pain and disc herniations in the lumbar spine can be very common as well. People may experience “sciatica” which is a sharp shooting pain down your leg. Most people will get sent to the hospital after a car accident, and if the x-ray is negative for fractures they will just be released with an anti-inflammatory or muscle relaxers. Most of the time this is not a sufficient treatment for the underlying cause of the injuries. Visiting a chiropractor for all of these injuries after an accident is a great way to deal and recover from the injuries. Taking pressure off of the nerves and getting you out of pain and increasing range of motion is the main goal of treatment. In most cases, the automobile insurance company will pay for all of the care you receive from a chiropractor for injuries due to a motor vehicle accident.

Dr. Tyler Carlock, D.C. Reveals the Truths about Whiplash

Joseph Coupal - Thursday, July 12, 2018
Village Family Clinic - Auto Accident Injury

Hackettstown, NJ (July 11, 2018) Dr. Tyler Carlock, Chiropractic physician at Village Family Clinic explains the gravity of the damage a car accident can inflict on the spine and ways to promote recovery and rehabilitation.

Dr. Carlock defines whiplash, “a common word but [one that] not many people know exactly what it means,” as an injury that occurs most often during a collision. Specifically, with whiplash, the “neck rapidly extends backwards then flexes forward in a split second, which is traumatic to the ligaments and muscles in the neck” Carlock explains. Most often, the effects of whiplash materialize into “inflammation [that] irritates the spinal nerves which can cause sharp pains into the shoulder or down the arm which can cause decreased muscle strength or sensory changes. This is called ‘radiculopathy’.” The symptoms of whiplash may not be felt right away but could lead to issues in the future.

Carlock stresses the importance of visiting a chiropractor after even a minor car accident. Following a car accident, victims are sent to the hospital where they have x-rays that do not show inflammation and other symptoms of whiplash that many accident victims endure. Carlock indicates that “visiting a chiropractor for all of these injuries after an accident is a great way to deal and recover from the injuries. Taking pressure off of the nerves and getting you out of pain and increasing range of motion is the main goal of [chiropractic] treatment.”

If you have been involved in a car accident, however minor, a visit to a chiropractor can ensure a full recovery. Dr. Carlock points out that “in most cases, automobile insurance companies will pay for all of the care you receive from a chiropractor for injuries due to a motor vehicle accident.”

At Village Family Clinic, a team of chiropractors, physical therapists, and an acupuncturist are equipped to treat car accident victims and foster rehabilitation. For more information, a consultation, or treatment, call the Village Family Clinic at (908) 813-8200, or visit them on the web at hackettstownfamilyclinic.com.

The Village Family Clinic Prepares to Host their Seventh Annual Pet Food Drive to Benefit Local Animal Shelters

Joseph Coupal - Wednesday, July 11, 2018
Village Family Clinic - Pet Food Drive

Hackettstown, NJ (July 11, 2018) Village Family Clinic hosts their seventh annual Pet Food Drive at their office location in Hackettstown, NJ to collect pet food for local animal shelters August 20th through the 24th during office hours.

Dr. James R. Fedich, clinic director at Village Family Clinic, has organized a Pet Food Drive to support local animal shelters. Over the past seven years, Dr. Fedich’s team and their patients have collectively donated enough pet food to fill seven pick-up trucks. “Our Pet Food Drive has perennially benefited the local animal shelters and has allowed myself and our community to give back” Dr Fedich explains. “It also encourages new patients as well as beloved returning patients to visit the office.” In fact, Dr. Fedich is offering special services to motivate new and returning patients to donate pet food. If a patient, new or returning, donates just one 5lb bag of dog or cat food, he or she can choose to receive a free exam, free adjustment, or receive half off of one acupuncture session.

Dr. Fedich is excited about the opportunity to meet new patients: “Some people are hesitant that chiropractic, acupuncture, and other services offered at our clinic are what they need. The week of our Pet Food Drive is an opportunity for those people to see our office, meet and speak with the doctors, and save money by receiving a free exam, free adjustment, or half off an acupuncture session all for the cost of one 5lb bag of pet food.” During the Pet Food Drive, new and returning patients can save money on their treatment and play a part in giving back to the community by benefiting local animal shelters and the animals there. According to Dr. Fedich, the goal of this year’s Pet Food Drive is to collect enough pet food to fill one entire pick-up truck.

The Pet Food Drive will be held at the Village Family Clinic in Hackettstown, NJ the week of August 20-24, 2018, during office hours, 9am until 7pm. For more information, directions, or an appointment, contact the Village Family Clinic at (908) 813-8200, or visit them on the web at www.hackettstownfamilyclinic.com.


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Hi I'm Laurel, I'm a patient at the Village Family Clinic. I just want to thank Dr. Fedich and the whole staff for everything they have done for me. My back feels so much better. This machine that I have been using has really helped my back and I just want to thank everybody. Thank you!


Hi! My name Maria and I'm here at the Village Family Clinic. I came for compression for my neck and chiropractic for my back and I'm feeling better. The atmosphere in this clinic is so friendly. They know what they're doing and I would love for people come to this place. They're very friendly, especially my friend Jessica. Fully nice work, everybody fully nice. I wish everybody would come here. Very friendly people in this clinic.


Hi my name is Karen. Back in December, I came to Dr. Fedich because I'd been in a lot of pain with my neck. I had a herniated disk and they introduced me to this Triton machine, which has really been a God send, helping me pull my neck and taking the pain away. I also referred my father and my son because I trust this Doctor so much...he's helped me so much. Now, I'm going to Ashley for massages. I'm just addicted to this place..